Abstract：
BACKGROUND:Adult colorectal surgery patients continue to have high rates of readmissions, despite known risk factors for non-routine postdischarge care (emergency department (ED) visit or rehospitalization) and countless interventions to address these. It is unclear how the difficult-to-quantify patient perspective frames and modifies the impact of these quantifiable risk factors. STUDY DESIGN:We identified consecutive adult inpatient colorectal surgery patients from 2017 to 2018. This mixed methods study merged data from electronic health records and in-depth patient interviews. RESULTS:We enrolled 258 participants, surveyed 167, and interviewed 18. Depressive symptoms represent one of many risk factors confirmed to increase non-routine healthcare utilization (RR 1.85, 95% CI 1.02-3.37), though the patient perspective explained why these symptoms seemed to greatly impact some patients more than others. Additionally, consistent with patient report, patients with non-routine postdischarge care (26%) were less likely to report communication with their surgical team (80% vs 97%, p < 0.001). CONCLUSION:Patient perspectives add depth and understanding of the impact of risk factors on non-routine post-discharge care. This expanded knowledge explains why one patient is more likely to visit an ED close to home whereas another patient might prefer to visit their surgeon's clinic directly. Effective strategies to reduce unplanned postdischarge care should be tailored.
journal_name
Am J Surgjournal_title
American journal of surgeryauthors
Lumpkin ST,Mihas P,Baldwin X,Adams U,Carey T,Stitzenberg Kdoi
10.1016/j.amjsurg.2020.05.016subject
Has Abstractpub_date
2021-01-01 00:00:00pages
195-203issue
1eissn
0002-9610issn
1879-1883pii
S0002-9610(20)30273-7journal_volume
221pub_type
杂志文章abstract：:The orthopedic surgeon has several options available for blood conservation. Preoperative autologous donation (PAD) of blood is a cost-effective measure when the cost of managing transfusion-transmitted infectious disease is considered; overuse and underuse are expensive problems, however. Hemodilution, while used suc...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(99)80061-0
更新日期：1995-12-01 00:00:00
abstract：:A retrospective study of 115 patients who presented to the University of Benin Teaching Hospital with intestinal gangrene over a 5 year period is presented. Although hernia is the most common cause of bowel gangrene, more patients with volvulus end up with gangrenous bowel. Because Nigerian patients present with late ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(81)90439-6
更新日期：1981-11-01 00:00:00
abstract：:Infections that involve the attention of the surgeon include those that require operations for cure as well as those that complicate emergency and elective surgical procedures. Mechanical correction is of paramount importance in the eradication of such infections with antibiotics serving an adjuvant role, primarily to...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(06)80057-7
更新日期：1992-10-01 00:00:00
abstract：BACKGROUND:Thirty-five percent of hemodialysis patients with polytetrafluoroethylene grafts lose their access secondary to infection. We hypothesized that partial graft excision (PGE) for infection increases the incidence of vascular anastomotic complications when compared with total graft excision (TGE). METHODS:The ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2006.09.028
更新日期：2007-03-01 00:00:00
abstract：INTRODUCTION:Newborns with gastroschisis have historically undergone surgical repair under general anesthesia. Our institution recently transitioned to the sutureless umbilical closure for gastroschisis. We sought to evaluate the feasibility of bedside gastroschisis repair without endotracheal intubation. METHODS:A re...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2017.03.017
更新日期：2017-05-01 00:00:00
abstract：:Reoperation to remove an aortic graft was performed in 18 patients. The need for removal was infection in the majority. A changing flora was seen in aortic graft infection with gram-negative organisms predominating. Despite a standardized approach with total graft removal, aortic closure, and extraanatomic reconstruct...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(83)90371-9
更新日期：1983-08-01 00:00:00
abstract：BACKGROUND:The laparoscopic approach to surgical diseases of the foregut is rapidly gaining acceptance. These new approaches, however, pit the unwary surgeon against potentially devastating complications. PATIENTS AND METHODS:Based on a retrospective review of 153 consecutive laparoscopic foregut surgeries performed a...
journal_title：American journal of surgery
pub_type： 临床试验,杂志文章
doi：10.1016/S0002-9610(99)80206-2
更新日期：1995-05-01 00:00:00
abstract：:From 1972 to 1981, 430 patients were treated for bleeding peptic ulcer. Two hundred ten of the patients were treated surgically and 220 medically. In the surgically treated patients, mortality was high among those with posterior duodenal peptic ulcer and after gastrectomy rather than after vagotomy. Mortality after em...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(84)90170-3
更新日期：1984-03-01 00:00:00
abstract：:Silver biopsies of the common bile duct were obtained from 15 patients with clinical and surgical evidence of cholangitis. The most pronounced histologic changes were edema, congestion, and marked mucous gland hypertrophy and hyperplasia. No ulceration, intramural abscess, or areas of necrosis were found. Clinical cho...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(79)90089-8
更新日期：1979-06-01 00:00:00
abstract：:The incidence of postoperative wound complications and early cancer recurrence was studied in 289 patients who had mastectomy alone and in 113 patients who underwent immediate reconstruction following mastectomy. Patients undergoing immediate reconstruction were younger and had less advanced disease than patients who ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(05)80572-0
更新日期：1993-07-01 00:00:00
abstract：BACKGROUND:Restoration of the abdominal wall's integrity after postoperative wound dehiscence is frequently performed in a delayed fashion, necessitating a temporary dressing of the dehisced wound. METHODS:The Vacuum Assisted Closure (VAC) system (Kinetic Concepts, Inc., San Antonio, TX) was used in 21 patients with p...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2005.09.003
更新日期：2006-02-01 00:00:00
abstract：BACKGROUND:Laparoscopic adrenalectomy is now the standard for pheochromocytoma. We report two decades of institutional experience with pheochromocytoma adrenalectomy. METHODS:A retrospective review was undertaken of pheochromocytoma adrenalectomy patients between 1997 and 2017. Clinical variables and postoperative com...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2019.03.016
更新日期：2019-05-01 00:00:00
abstract：:Total pancreatectomy with islet autotransplantation is a promising treatment for refractory chronic pancreatitis. We analyzed postoperative complications in 83 TPIAT patients and their impact on islet graft function. We examined patient demographics, preoperative risk factors, intraoperative variables, and 30- and 90-...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2019.04.007
更新日期：2020-01-01 00:00:00
abstract：BACKGROUND:Mobile atheromas of the aortic arch are associated with otherwise unexplained strokes and transient ischemic attacks (TIA). They are associated with increased perioperative strokes in patients undergoing coronary artery bypass surgery. Peripheral embolization is an additional risk. Transesophageal echocardio...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(99)00115-4
更新日期：1999-09-01 00:00:00
abstract：:A series of 168 patients who underwent 177 inguinal lymph node dissections from 1979 to 1989 were retrospectively reviewed to determine the incidence and severity of postoperative complications as well as the perioperative risk factors associated with them. Operative mortality was 0%, whereas the incidence of moderate...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(05)81181-x
更新日期：1992-11-01 00:00:00
abstract：BACKGROUND:We surveyed surgeons to document their attitudes, practice, and risk tolerance regarding the treatment of appendicitis. METHODS:A web-based survey was sent to the EAST membership. The primary composite endpoint was defined as 1-year incidence of perioperative complications, antibiotic failure, infections, E...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2018.08.019
更新日期：2019-07-01 00:00:00
abstract：BACKGROUND:This is a retrospective study analyzing data of normocalcemic patients with enlarged parathyroid glands discovered during thyroid surgery and comparing it with data of patients operated on for proved primary hyperparathyroidism. METHODS:The records of patients with enlarged parathyroid glands (group 1) and ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2007.01.033
更新日期：2008-01-01 00:00:00
abstract：BACKGROUND:Patients often have an incomplete understanding of the levels of training and roles of the various surgical providers in teaching hospitals, leading to patient confusion and dissatisfaction. METHODS:Pre-intervention discharge surveys were administered to gastrointestinal surgery inpatients (10/2016-02/2017)...
journal_title：American journal of surgery
pub_type： 临床试验,杂志文章
doi：10.1016/j.amjsurg.2018.07.056
更新日期：2018-10-01 00:00:00
abstract：BACKGROUND:Platelets are thought to participate in tumor metastasis. However, the relationship between platelet count and prognosis in pancreatic cancer remains unresolved. METHODS:A chart review of patients undergoing resection for pancreatic adenocarcinoma was undertaken. Demographic, perioperative, and outcome data...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2004.11.014
更新日期：2005-03-01 00:00:00
abstract：:A successfully treated case of a duodenal hamartoma is presented. A review of the literature has shown that this is the largest such tumor so far described, and the first time a mass was palpable on abdominal examination. Its large size resulted in pyloric obstruction, and its wide attachment to the duodenum necessita...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(77)90090-3
更新日期：1977-02-01 00:00:00
abstract：INTRODUCTION:Damage control laparotomy with vacuum assisted closure (VAC) is used for selective cases in trauma. In liver transplantation, VAC has also been applied for management of intra-operative hemorrhage. The primary objective was to evaluate peri-operative blood loss and blood product utilization in VAC compared...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2017.12.012
更新日期：2018-05-01 00:00:00
abstract：:A patient with the classic manifestations of the glucagonoma syndrome and hepatic metastases is presented. Clinical improvement occurred after removal of the primary tumor by distal pancreatectomy and splenectomy. No further antitumor therapy has been needed over a 15 month postoperative follow-up despite metastatic d...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(80)90306-2
更新日期：1980-03-01 00:00:00
abstract：:Ostomy closure following the Hartmann procedure is perceived to be associated with higher morbidity and mortality rates than is ostomy closure following divided colostomy, loop colostomy, and divided ileostomy-colostomy so that ostomy closure after Hartmann procedure may be denied to certain patients. To test that per...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(91)90125-w
更新日期：1991-12-01 00:00:00
abstract：BACKGROUND:Antibiotic prophylaxis is controversial in patients undergoing axillary lymph node dissection (ALND). We determined whether preoperative antibiotics decreased incidence or treatment cost of infectious complications following ALND. METHODS:Two hundred patients entered this prospective, randomized, double-bli...
journal_title：American journal of surgery
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1016/s0002-9610(98)00154-8
更新日期：1998-09-01 00:00:00
abstract：:Diabetic neuropathic ulcers are thought to arise from repetitive injury during normal walking in areas of high plantar pressures. It has been suggested that metatarsal head (MTH) resection alleviates elevated pressures at the site of the ulcer and, thus, expedites healing and prevents recurrence. We investigated the e...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(94)90203-8
更新日期：1994-03-01 00:00:00
abstract：BACKGROUND:Medical malpractice is a source of stress and cost to physicians. Little is known about how it impacts resident physicians. METHODS:We analyzed data from the Comparative Benchmarking System between 2007 and 2016. We also surveyed surgery residents at our institution regarding malpractice in training. RESUL...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2018.08.006
更新日期：2019-02-01 00:00:00
abstract：BACKGROUND:Obturator hernia is a relatively rare pelvic hernia and usually occurs in elderly, thin, multiparous women. Because symptoms are nonspecific, the diagnosis is often delayed until laparotomy is performed form to treat bowel obstruction. METHODS:Forty-three patients with obturator hernia undergoing surgery at...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2003.12.041
更新日期：2004-04-01 00:00:00
abstract：:A new, improved drainage system has been specifically designed to provide either closed suction drainage for the ambulating patient or sump drainage for the patient confined to bed. This drainage system is made of silicone that has a hydrogel coating with a low coefficient of friction. This coating facilitates removal...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(85)80089-1
更新日期：1985-02-01 00:00:00
abstract：:False aneurysm formation in a twenty-nine year old black woman treated for renovascular hypertension secondary to fibromuscular hyperplasia by knitted Dacron prosthetic patch angioplasty is reported. Etiologic mechanisms are discussed. The most likely factors leading to false aneurysm formation in this patient are dis...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(76)90366-4
更新日期：1976-11-01 00:00:00
abstract：BACKGROUND:To assess the impact of adding a surgical oncologist to our faculty we examined the operative experience in our program before and after the addition. METHODS:Operative case numbers reported to the American Board of Surgery over a 10-year period were analyzed. This time period encompassed 5 years before and...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2003.01.001
更新日期：2004-01-01 00:00:00
