Abstract:
OBJECTIVES:The purpose of this study was to perform the first statewide, population-based, time-series analysis of the frequency of ruptured abdominal aortic aneurysm (RAAA), to determine the outcomes of RAAA, and to assess the association of patient, physician, and hospital factors with survival after RAAA. The hypotheses of the study were as follows: 1) the rate of RAAA would increase over time and 2) patient, surgeon, and hospital factors would be associated with survival. BACKGROUND:Ruptured abdominal aortic aneurysm is a life-threatening emergency that presents the surgeon with a technically demanding challenge that must be met and surmounted in a short time if the patient is to survive. METHODS:Data were obtained from the following four separate data sources: 1) the North Carolina Hospital Discharge database, 2) the North Carolina American Hospital Association database, 3) the North Carolina State Medical Examiner's database, and 4) the Area Resource File. All patients with the diagnosis of an abdominal aortic aneurysm (AAA) were selected for initial assessment. Patients were grouped into those with and those without rupture of the abdominal aneurysm. RESULTS:During the 6 years of the study, 14,138 patients were admitted with a diagnosis of AAA. Of these, 1480 (10%) had an RAAA. The yearly number of patients with elective AAAs increased 33% from 1889 in 1988 to 2518 in 1993. The yearly number of RAAAs increased 27% from 203 to 258. The mortality rate for AAA was 5%, as compared with 54% in RAAA patients. The patient's age was found to be the most powerful predictor of survival. Univariate logistic regression analyses demonstrated an association of the surgeon's experience with RAAA and patient survival after RAAA. Analysis of the survival rates of board-certified and nonboard-certified surgeons demonstrated that patients with RAAAs who were treated by board-certified surgeons had significantly better survival. When the survival was compared in small (less than 100 beds) and large (more than 100 beds) hospitals, survival was significantly better in the larger hospitals. CONCLUSIONS:Ruptured abdominal aortic aneurysm remains a highly lethal lesion, even in the best of hands. Despite the many improvements in the care of seriously ill patients, there was no significant improvement in the survival of RAAA during this study. This suggests that early diagnosis is the best hope of survival in these patients. The study demonstrated that survival after RAAA was related most strongly to patient age at the time of the RAAA. The physician's and the hospital's experience with RAAA, the physician's background as measured by board certification, and the type of hospital at which the operation was performed (small vs. large) also may be associated with survival. These findings may have important implications for the regionalization of care and the education and credentialling of physicians. Given the lack of recent progress of improving the outcome of RAAA, aggressive efforts to treat patients before rupture are appropriate.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Rutledge R,Oller DW,Meyer AA,Johnson GJ Jrdoi
10.1097/00000658-199605000-00005subject
Has Abstractpub_date
1996-05-01 00:00:00pages
492-502; discussion 503-5issue
5eissn
0003-4932issn
1528-1140journal_volume
223pub_type
杂志文章abstract::In an attempt to determine the best provocative test for the diagnosis of gastrinoma, ten normal subjects, 13 patients with known gastrinoma, and one patient with presumed gastrinoma were administered four regimens: (1) rapid calcium infusion (2 mg Ca++/kg/min), (2) secretin (2 clinical units (CU)/kg/bolus), (3) long ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198305000-00015
更新日期:1983-05-01 00:00:00
abstract:OBJECTIVE:To evaluate the gene expression signature of hepatocellular carcinoma (HCC) in relation to the gross morphology. BACKGROUND:Eggel's nodular type of HCC is morphologically subclassified into the single nodular (SN) type, the single nodular type with extranodular growth (SNEG), and the confluent multinodular (...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181f9bc00
更新日期:2011-01-01 00:00:00
abstract:OBJECTIVE:To compare cancer-specific results of local excision with major resection. BACKGROUND:Technological advances have enabled endoscopic and local excision techniques to be applied in the treatment of early colorectal cancer in preference to radical surgery. METHOD:Patients with stage 0 (carcinoma in situ) or s...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3182a4e85a
更新日期:2013-10-01 00:00:00
abstract:OBJECTIVES:We recently reported increased CD4 CD25 T regulatory (Treg) activity after burn injury in mice. This study sought to determine if Tregs mediate the reduction in TH1-type immunity after serious injury in man and if Treg function is altered by injury. METHODS:Peripheral blood was withdrawn from 19 consenting ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000239031.06906.1f
更新日期:2006-10-01 00:00:00
abstract:OBJECTIVE:To specifically target tumor angiogenesis by linking transgene expression of engineered mesenchymal stem cells to angiopoietin-1-induced differentiation. BACKGROUND:Mesenchymal stem cells (MSCs) have been used to deliver therapeutic genes into solid tumors. These strategies rely on their homing mechanisms on...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181fcb5d8
更新日期:2011-03-01 00:00:00
abstract:OBJECTIVE:To evaluate the association between anesthetic management before and after graft reperfusion and early graft regeneration in living donor liver transplantation (LDLT). BACKGROUND:Sufficient graft regeneration is essential for the success of LDLT. Diverse signals start to trigger liver regeneration immediatel...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001526
更新日期:2016-12-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to determine the contribution of the hepatic artery, gastroduodenal artery, and portal vein to the microvascular blood flow in the common bile duct (CBD). BACKGROUND:Biliary complications are a common cause of graft loss after liver transplantation. The occurrence is, partly, attrib...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31824714d0
更新日期:2012-03-01 00:00:00
abstract:BACKGROUND:Length of postoperative stay (LOS) has gained increasing attention as a potential indicator of surgical efficiency. Our objective was to examine the feasibility of assessing LOS at 182 hospitals to identify institutions with outlying performance. METHODS:Patients were identified who underwent colorectal sur...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/sla.0b013e3181b2a948
更新日期:2009-12-01 00:00:00
abstract:OBJECTIVE:To evaluate the survival and function of hepatocytes (HCs) on a novel three-dimensional (3D) synthetic biodegradable polymer scaffold with an intrinsic network of interconnected channels under continuous flow conditions. SUMMARY BACKGROUND DATA:The authors' laboratory has investigated HC transplantation usin...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199807000-00002
更新日期:1998-07-01 00:00:00
abstract:OBJECTIVE:To determine whether F-fluorodeoxyglucose (F-FDG) micro-positron emission tomography (micro-PET) can predict abdominal aortic aneurysm (AAA) rupture. BACKGROUND:An infrarenal AAA model is needed to study inflammatory mechanisms that drive rupture. F-FDG PET can detect vascular inflammation in animal models a...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000000602
更新日期:2015-02-01 00:00:00
abstract:OBJECTIVE:To achieve consensus on the best practices in the management of ventral hernias (VH). BACKGROUND:Management patterns for VH are heterogeneous, often with little supporting evidence or correlation with existing evidence. METHODS:A systematic review identified the highest level of evidence available for each ...
journal_title:Annals of surgery
pub_type: 共识发展会议,杂志文章
doi:10.1097/SLA.0000000000001701
更新日期:2017-01-01 00:00:00
abstract::Thrombotic thrombocytopenic purpura (TTP) is a disease process characterized by microangiopathic anemia, fever, neurologic manifestations, renal abnormalities, and thrombocytopenia. These clinical findings are caused by vascular occlusions of the microcirculation. At present the utilization of splenectomy, in the trea...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197811000-00021
更新日期:1978-11-01 00:00:00
abstract:OBJECTIVES:The objectives of this study were to define appropriate criteria for assessing the presence of lymphedema, and to report the prevalence and risk factors for development of upper limb lymphedema after level I-III axillary dissection for melanoma. SUMMARY BACKGROUND DATA:The lack of a consistent and reliable ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000143271.32568.2b
更新日期:2004-11-01 00:00:00
abstract:OBJECTIVE:Regional circulatory changes in intestinal mucosa were evaluated after the onset of septic shock and the effect of nitric oxide (NO) inhibition on mucosal blood flow was investigated at different locations along the intestine. SUMMARY BACKGROUND DATA:The response of intestinal blood flow to different physiol...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199801000-00018
更新日期:1998-01-01 00:00:00
abstract:OBJECTIVE:To determine the association between race/ethnicity and perioperative outcomes in individuals undergoing major oncologic and nononcologic surgical procedures in the United States. BACKGROUND:Prior work has shown that there are significant racial/ethnic disparities in perioperative outcomes after several type...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001078
更新日期:2015-12-01 00:00:00
abstract::Fibronectin exists in a soluble form in plasma and in an insoluble form in tissues. Plasma fibronectin can modulate phagocytic function as well as incorporate into the tissue matrix where it is believed to influence microvascular integrity and tissue repair. The temporal alterations in plasma and lung lymph fibronecti...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198508000-00016
更新日期:1985-08-01 00:00:00
abstract::Emergency portacaval shunt for variceal bleeding is associated with a high operative mortality, particularly if used as a last resort. Because of this, a strong case has been made against emergency shunt. This report describes an experience with emergency portacaval shunt for the treatment of variceal bleeding when us...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198707000-00007
更新日期:1987-07-01 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:OBJECTIVE:This study compares outcomes following pancreaticoduodenectomy (PD) for patients treated at local, low-volume centers and those traveling to high-volume centers. BACKGROUND:Although outcomes for PD are superior at high-volume institutions, not all patients live in proximity to major medical centers. Theoreti...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001924
更新日期:2017-08-01 00:00:00
abstract:OBJECTIVE:Patients with major burns and an animal model of burn injury were studied to determine the mechanism of depressed interleukin-2 (IL-2) production after thermal injury and to determine the effect of such injury on IL-2 receptor (IL-2R) expression and function. SUMMARY BACKGROUND DATA:Major burn injury is know...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199409000-00010
更新日期:1994-09-01 00:00:00
abstract:OBJECTIVE:To evaluate the independent prognostic ability of the American Joint Committee on Cancer (AJCC) tumor regression scores within pathologic stage II and III rectal cancers. BACKGROUND:Response to neoadjuvant chemoradiation (nCRT) has been debated as a biologic surrogate for tumor biology and prognosis in recta...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000002719
更新日期:2019-06-01 00:00:00
abstract:OBJECTIVE:To test the hypothesis that pancreatic ductal anatomy may predict the likely success of percutaneous drainage of pseudocysts of the pancreas. SUMMARY BACKGROUND DATA:Various modalities are currently applied to pseudocysts, with little or no data to aid in the choice of management strategy. Pancreatic ductal ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200206000-00001
更新日期:2002-06-01 00:00:00
abstract:OBJECTIVE:To perform a systematic review of economic evaluations of enhanced recovery pathways (ERP) for colorectal surgery. BACKGROUND:Although there is extensive literature investigating the clinical effectiveness of ERP, little is known regarding its cost-effectiveness. METHODS:A systematic literature search ident...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/SLA.0b013e318295fef8
更新日期:2014-04-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to evaluate the adequacy of esophageal classification for adenocarcinoma of the esophagogastric junction (AEJ) of the seventh American Joint Committee on Cancer (AJCC) TNM classification. BACKGROUND:The seventh AJCC TNM classification proposed the new classification for AEJ as a par...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31824beb95
更新日期:2012-05-01 00:00:00
abstract:OBJECTIVE:To determine if certain outcomes of incisional hernia repair have improved in recent eras. SUMMARY BACKGROUND DATA:Technological developments have been reported to improve outcomes in the repair of abdominal wall incisional hernias. METHODS:This retrospective, population-based cohort study was conducted usi...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200301000-00018
更新日期:2003-01-01 00:00:00
abstract:OBJECTIVE:To explore the events and people that shaped Harvey Cushing, one of the nation's leading surgeons, into a political actor as he rallied support for the issue of military medical preparedness for World War One. SUMMARY BACKGROUND DATA:In a little remembered episode of American medical history, for 2 years bef...
journal_title:Annals of surgery
pub_type: 传,历史文章,杂志文章
doi:10.1097/SLA.0b013e3181e77bdc
更新日期:2010-07-01 00:00:00
abstract:OBJECTIVE:To study graft function and ischemia/reperfusion injury of porcine kidneys after preservation with the new Groningen Machine Perfusion (GMP) system versus static cold storage (CS). INTRODUCTION:The increasing proportion of marginal and nonheart beating donors necessitates better preservation methods to maint...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31815c4019
更新日期:2007-12-01 00:00:00
abstract:OBJECTIVES:Congenital diaphragmatic hernia (CDH) remains a significant cause of neonatal morbidity and mortality. SUMMARY OF BACKGROUND DATA:Previous studies have suggested that hospital volume is an independent predictor of in-hospital mortality. We sought to validate this effect using a large national database incor...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181f5b538
更新日期:2010-10-01 00:00:00
abstract:OBJECTIVE:To quantify gender composition of 10 high-impact general surgery journals, delineate how board composition has changed over time, and evaluate qualification metrics by gender. BACKGROUND:Underrepresentation of women on editorial boards may contribute to the gender-based achievement gap in surgery. METHODS:W...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000002667
更新日期:2019-03-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to determine the minimum amount of weight loss required to see a reduction in major adverse cardiovascular events (MACE). BACKGROUND:Although obesity is an established risk factor for morbidity and mortality, the minimum amount of weight loss to have a meaningful impact on cardiovas...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000004369
更新日期:2020-10-01 00:00:00