Abstract:
OBJECTIVE:To determine prevalence of documented preoperative code status discussions and post-operative outcomes (specifically mortality, readmission and discharge disposition) of patients with completed Medical Orders for Life-Sustaining Treatments (MOLST) forms before surgery. SUMMARY OF BACKGROUND DATA:A MOLST form documents patient care preference regarding treatment limitations. When considering surgery in these patients, preoperative discussion is necessary to ensure concordance of care. Little is known about prevalence of these discussions and post-operative outcomes. METHODS:A retrospective cohort study was conducted consisting of all patients having surgery during a one-year period at a tertiary care academic center in Boston, Massachusetts. RESULTS:Among 21787 surgical patients meeting inclusion criteria, 402 (1.8%) patients had preoperative MOLST. Within the MOLST, 224 (55.7%) patients had chosen to limit cardiopulmonary resuscitation and 214 (53.2%) had chosen to limit intubation and mechanical ventilation.Code status discussion was documented pre-surgery in 169 (42.0%) patients with MOLST. Surgery was elective or non-urgent for 362 (90%), and median length of stay [Q1, Q3] was 5.1 days [1.9, 9.9]. The minority of patients with preoperative MOLST were discharged home (169 [42%]), and 103 (25.6%) patients were readmitted within 30 days. Patients with preoperative MOLST had a 30-day mortality of 9.2% (37 patients) and cumulative 90-day mortality of 14.9% (60 patients). CONCLUSIONS:Fewer than half of surgical patients with preoperative MOLST have documented code status discussions before surgery. Given their high risk of post-operative mortality and the diversity of preferences found in MOLST, thoughtful discussion before surgery is critical to ensure concordant perioperative care.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Tanious M,Lindvall C,Cooper Z,Tukan N,Peters S,Streid J,Fields K,Bader Adoi
10.1097/SLA.0000000000004675subject
Has Abstractpub_date
2020-12-18 00:00:00eissn
0003-4932issn
1528-1140pii
00000658-900000000-93860journal_volume
Publish Ahead of Printpub_type
杂志文章abstract::A historical review of work bearing on the rationale for hepatic artery ligation in the treatment of malignant disease in the liver is presented, particularly the early work showing that malignant disease of the liver is supplied primarily by the arterial circulation and not by the portal. A review is presented of som...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197409000-00008
更新日期:1974-09-01 00:00:00
abstract::In the absence of a prospective randomized study of patients treated conservatively or with thymectomy, a computer-assisted retrospective matches study was devised. Of 563 patients treated for myasthenia gravis without thymoma up to 1965, 104 had thymectomy. With computer assistance, each surgical patient was matched ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197610000-00008
更新日期:1976-10-01 00:00:00
abstract:OBJECTIVE:To study the effects of autologous platelet-rich fibrin (PRF) versus human albumin on incisional wound breaking strength and subcutaneous collagen deposition in patients undergoing laparoscopic cholecystectomy in a randomized trial. SUMMARY BACKGROUND DATA:Platelet peptidic growth factors may stimulate colla...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SLA.0b013e3181d3548c
更新日期:2010-05-01 00:00:00
abstract::The factors contributing to the development of esophageal mucosal injury in gastroesophageal reflux disease (GERD) are unclear. The lower esophageal sphincter, esophageal acid and acid/alkaline exposure, and the presence of excessive duodenogastric reflux (DGR) was evaluated in 205 consecutive patients with GERD and v...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199207000-00006
更新日期:1992-07-01 00:00:00
abstract::The effects of pH on the tensile properties of eight commonly used 2-0 suture materials--plain catgut, Dexon, Vicryl, silk, Nurolon, Ethilon, Mersilene, and Prolene--were examined. The pH level ranged from 3.0 to 10.0. In general, absorbable suture materials were more sensitive to pH than non-absorbable suture materia...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198308000-00019
更新日期:1983-08-01 00:00:00
abstract::Obstructive cholangitis with acute renal failure is a dramatic syndrome which merits individual definition. Twenty-one patients with acute suppurative cholangitis complicated by rapidly developing renal insufficiency were studied, and the severity of the renal failure, an acute interstitial tubulopathy, bore no signif...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197506000-00022
更新日期:1975-06-01 00:00:00
abstract::Barium sulfate granuloma of the rectum may develop when this contrast material is forced through a discontinuity in the rectal mucosa. The ensuing mass may be confused with carcinoma. Preoperative biopsy and attention to plain films will prevent unnecessary inappropriate surgery. ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197504000-00009
更新日期:1975-04-01 00:00:00
abstract:OBJECTIVE:Esophageal cancer surgery carries a risk of splenic injury, which may require splenectomy, but predictors of such events remain uncertain. Moreover, the hypothesis that incidental splenectomy carries a worse prognosis deserves attention. DESIGN:A population-based, nationwide cohort study was conducted on 167...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000000650
更新日期:2015-01-01 00:00:00
abstract:OBJECTIVE:We sought to determine whether a data-driven scheduling approach improves Operative Suite (OS) efficiency. BACKGROUND:Although efficient use of the OS is a critical determinant of access to health care services, OS scheduling methodologies are simplistic and do not account for all the available characteristi...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SLA.0000000000002763
更新日期:2019-12-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to assess safety and efficacy of pancreatic duct occlusion (PDO) with neoprene-based glue in selected patients undergoing pancreatoduodenectomy (PD) at high risk of postoperative pancreatic fistula (POPF). BACKGROUND DATA:PD is the reference standard approach for tumors of the pancr...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章
doi:10.1097/SLA.0000000000003514
更新日期:2019-11-01 00:00:00
abstract:OBJECTIVE:This study aimed to identify risk factors for recurrence after pancreatic resection for intraductal papillary mucinous neoplasm (IPMN). SUMMARY BACKGROUND DATA:Long-term follow-up data on recurrence after surgical resection for IPMN are currently lacking. Previous studies have presented mixed results on the ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000004427
更新日期:2020-11-17 00:00:00
abstract::Population based surgical rates for various common surgical procedures were analyzed on a regional basis by examining select uniform hospital discharge abstract data from Wisconsin hospitals. The surgical asbracts of nearly 64,000 procedures were compared to the supply of physicians and showed a significant variation ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197802000-00012
更新日期:1978-02-01 00:00:00
abstract:OBJECTIVE:To determine whether surgical subspecialty training in colorectal surgery or frequency of rectal cancer resection by the surgeon are independent prognostic factors for local recurrence (LR) and survival. SUMMARY BACKGROUND DATA:Variation in patient outcome in rectal cancer has been shown among centers and am...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/00000658-199802000-00001
更新日期:1998-02-01 00:00:00
abstract:OBJECTIVE:To test the hypothesis that higher hospital volume decreases endoscopic and surgical re-intervention rates after antireflux surgery. BACKGROUND:Antireflux surgery for gastro-esophageal reflux disease is followed by varying rates of re-interventions. Whether hospital volume influences re-intervention rates is...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003776
更新日期:2020-01-06 00:00:00
abstract::The objective of this study was to define the patterns of myoelectric activity that occur throughout the gastrointestinal tract during normal recovery from laparotomy. Electrodes were placed on the stomach, jejunum, and transverse colon of 44 patients undergoing laparotomy. Basal electric rhythms in all areas showed n...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199006000-00018
更新日期:1990-06-01 00:00:00
abstract:OBJECTIVE:Arginine transport was characterized and studied in human liver. SUMMARY BACKGROUND DATA:Plasma arginine uptake may regulate hepatocyte intracellular availability and the subsequent biosynthesis of nitric oxide (NO), but little is known about arginine transport across the human hepatocyte plasma membrane. M...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199309000-00014
更新日期:1993-09-01 00:00:00
abstract:OBJECTIVE:This study was aimed to investigate the prognostic value of tumor-infiltrating neutrophils (TINs) and to generate a predictive model to refine postoperative risk stratification system for patients with gastric cancer. BACKGROUND:TIN presents in various malignant tumors, but its clinical significance in gastr...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0000000000002058
更新日期:2018-02-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to identify the utility of "keyhole" thoracotomy approaches to single vessel coronary artery bypass surgery. SUMMARY BACKGROUND DATA:Although minimally invasive surgery is efficacious in a wide variety of surgical disciplines, it has been slow to emerge in cardiac surgery. Amo...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199610000-00004
更新日期:1996-10-01 00:00:00
abstract::Arterial blood flow was measured in dogs simultaneously with electromagnetic flow probes and with ultrasonic "flow probes." The ultrasonic probes were used to determine transcutaneously the mean velocity of arterial flow and the cross-sectional area of the blood vessel. A 10 MHz probe was used for blood vessels 1 cm d...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198204000-00013
更新日期:1982-04-01 00:00:00
abstract:OBJECTIVE:To prevent bile duct injury by using a cold 5% glucose isotonic solution cooling in the bile ducts when radiofrequency (RF) is performed in a porcine model. SUMMARY BACKGROUND DATA:Complications that may arise during liver RF ablation include biliary stenosis and abscesses. METHODS:The RITA 1500 generator w...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000193831.39362.07
更新日期:2006-01-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to determine the results of liver resection for patients with bilateral hepatic metastases from colorectal cancer. We aimed to assess the evolution of the technical approach over time and correlations with morbidity, mortality, and oncologic outcome. SUMMARY BACKGROUND DATA:Although...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181557e47
更新日期:2008-01-01 00:00:00
abstract:OBJECTIVE:To prospectively evaluate the psychosocial outcomes and body image of patients 2 years postmastectomy reconstruction using a multicenter, multisurgeon approach. BACKGROUND:Although breast reconstruction has been shown to confer significant psychosocial benefits in breast cancer patients at year 1 postreconst...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0b013e3181728a5c
更新日期:2008-06-01 00:00:00
abstract:BACKGROUND:Controversy exists on the use of mesh in the repair of paraesophageal hernias (PEH). This debate centers around the type of mesh used, its value in preventing recurrence, its short- and long-term complications, and the consequences of those complications compared with primary repair. Decision analysis is a m...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3182822c8c
更新日期:2013-04-01 00:00:00
abstract::In a prospective, block-randomized, multicenter study, the safety and efficacy of cefoxitin in preoperative prophylaxis were studied. 1735 patients undergoing appendectomy were evaluable, and half of these patients received 2 g of cefoxitin before undergoing operation. The patients were divided into three groups: pati...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1097/00000658-198903000-00010
更新日期:1989-03-01 00:00:00
abstract:OBJECTIVE:The authors determined the molecular mechanisms for the failure of transforming growth factor-beta (TGF-beta) to inhibit the growth of SW1116 and SW48 colon cancer cell lines. BACKGROUND:Transforming growth factor-beta is a bifunctional regulator of cell growth that typically stimulates proliferation of mese...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199506000-00015
更新日期:1995-06-01 00:00:00
abstract:OBJECTIVE:The aim of the study was to investigate whether patients who undergo surgery in hospitals experiencing significant length of stay (LOS) reductions over time are exposed to a higher risk of severe adverse events in the postoperative period. SUMMARY BACKGROUND DATA:Surgical care innovation has encouraged hospi...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003206
更新日期:2020-07-01 00:00:00
abstract::Sixty patients with chronic alcohol-induced pancreatitis with endoscopic retrograde cholangiopancreatography evidence of common bile duct stenosis were studied to determine the clinical spectrum and natural history of this complication, as well as the indications for biliary bypass. In 17% of patients, common bile duc...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198911000-00007
更新日期:1989-11-01 00:00:00
abstract::Thirty-two conditioned 15-18 kg dogs underwent laparotomy, heparinization, left lateral hepatic lobe injury and subsequent partial left lateral hepatic lobectomy. The hemostatic capabilities of the surgical scalpel combined with suture ligatures and stay sutures, the Bovie, and the CO2 laser were compared. The CO2 las...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197501000-00016
更新日期:1975-01-01 00:00:00
abstract:OBJECTIVE:To evaluate the effect of thrombopoietin on liver regeneration after hepatectomy and antifibrosis under conditions of liver cirrhosis in rats. SUMMARY BACKGROUND DATA:We revealed that platelets induced by thrombopoietin administration promote liver regeneration after hepatectomy in the normal liver. METHODS...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31818584c7
更新日期:2008-11-01 00:00:00
abstract::From December 1985 to December 1989, 100 consecutive simultaneous pancreas-kidney (SPK) transplants were performed at the University of Wisconsin Hospital and Clinics. Bladder drainage technique was used for all grafts. One- and three-year patient survival was 93% and 90%; kidney survival, 90% and 85%; and pancreas su...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199112000-00010
更新日期:1991-12-01 00:00:00