Abstract:
BACKGROUND:Surgical success has traditionally been judged from the surgeon's perspective. A more complete evaluation of outcome incorporates the patient's, surgeon's, and payor's perspectives. Because gastroesophageal reflux disease (GERD) is primarily a quality-of-life (QOL) problem, the evaluation of laparoscopic fundoplication (LF) is a useful model for evaluating outcomes from these 3 perspectives. METHODS:Between 1995 and 2000, 74 patients underwent primary LF for GERD. In addition to undergoing physiologic testing, 63 patients (85%) were evaluated with use of a disease-specific health-related QOL scale (GERD-HRQL), scored from 0 (no symptoms) to 45 (incapacitating symptoms). Thirty-three patients also completed a generic QOL questionnaire (SF-12), in which patient satisfaction was scored from 1 (very satisfied) to 5 (very dissatisfied). Preoperative and postoperative data were compared with use of the Wilcoxon signed rank test or the paired t test. RESULTS:The median GERD-HRQL score improved from 18 to 0 at 2 years postoperation (P <.01). The median satisfaction score improved from 5 to 1 (P <.01). The SF-12 summary scores also improved after 6 weeks postoperatively (P <.05). The mean +/- SD lower esophageal sphincter pressure rose from 7.3 +/- 4 mm Hg preoperatively to 17.5 +/- 6 postoperatively (P <.01), and the mean percentage of time that the esophagus was exposed to a pH of less than 4 declined from 14.7% +/- 12% to 1.1% +/- 2% (P <.01). The median operative time was 110 minutes, which declined with experience with the procedure (P <.01). Median postoperative stay was 2 days. CONCLUSIONS:In evaluating the outcomes of a new procedure, 3 overlapping points of view were addressed: the patient's (QOL, satisfaction), the surgeon's (physiologic changes), and the payor's (operating room time, hospital stay). With use of this framework, we found that LF for GERD improves QOL, corrects the physiologic abnormalities, and is associated with short hospitalization and operating time that declines with experience with the procedure.
journal_name
Surgeryjournal_title
Surgeryauthors
Feldman LS,Mayrand S,Stanbridge D,Mercier L,Barkun JS,Fried GMdoi
10.1067/msy.2001.118092subject
Has Abstractpub_date
2001-10-01 00:00:00pages
686-93; discussion 693-5issue
4eissn
0039-6060issn
1532-7361pii
S0039-6060(01)02620-4journal_volume
130pub_type
杂志文章相关文献
SURGERY文献大全abstract:BACKGROUND:Donor characteristics and graft quality were recently reported to play an important role in the recurrence of hepatocellular carcinoma after liver transplantation. Our aim was to establish a prognostic model by using both donor and recipient variables. METHODS:Data of 1,010 adult patients (training/validati...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2018.01.022
更新日期:2018-04-27 00:00:00
abstract:BACKGROUND:The influence of diabetic therapies on myocardial substrate selection during cardiac surgery is unknown but may be important to ensure optimal surgical outcomes. We hypothesized that metformin and insulin alter myocardial substrate selection during cardiac surgery and may affect reperfusion cardiac function....
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2017.10.020
更新日期:2018-02-01 00:00:00
abstract:BACKGROUND:The purpose of this study was to clarify the relationships of extractable and secreted parathyroid hormone (PTH) and parathyroid secretory protein (PSP) in human parathyroid tumors to PTH messenger RNA (mRNA), PSP mRNA, and cell replication. METHODS AND RESULTS:In tissue cultures of seven adenomas and five ...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1992-12-01 00:00:00
abstract::Earlier work has shown that morphine sulfate can produce a dose-related decrease in heart rate (HR) and cardiac output (CO) in isolated working rat hearts. This response is preventable with the use of the opiate receptor antagonist, naloxone hydrochloride. In this study, the stereospecificity of the opiate response wa...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1987-08-01 00:00:00
abstract:BACKGROUND:We have demonstrated that gastrin-releasing peptide (GRP) binds specifically to its cell surface receptor, GRP-R, to act as an autocrine/paracrine growth factor for neuroblastomas (NBs); an increased expression of GRP-R was found in more advanced-stage NBs. Ets family proteins are nuclear targets for intrace...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2004.05.030
更新日期:2004-08-01 00:00:00
abstract:BACKGROUND:The carcinogenic effect of duodenoesophageal reflux, gastroesophageal reflux, and nitrosamines was studied in the rat esophagus. METHODS:Twenty male Sprague-Dawley rats underwent esophagogastroplasty to produce gastroesophageal reflux and 60 underwent duodenoesophageal anastomosis to produce duodenoesophage...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1992-05-01 00:00:00
abstract:BACKGROUND:Nodal status is one of the most important prognostic factors for carcinoma of the papilla of Vater. The pattern of lymphatic spread and mode of recurrence were analyzed by determining the frequency of nodal involvement and antemortem and postmortem examination of patients with recurrent disease. METHODS:Fro...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/s0039-6060(97)90048-9
更新日期:1997-06-01 00:00:00
abstract:BACKGROUND:Alcoholism is the leading cause of end-stage liver failure in the United States, but the application of liver transplantation to the treatment of alcoholic liver disease remains controversial because of medical and ethical concerns. Information about the outcome of patients who undergo transplantation for al...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1992-10-01 00:00:00
abstract::Autonomously functioning thyroid nodules (AFTNs) in children and adolescents (under age 18) are unusual but are not as rare as earlier reports suggested. These lesions have a significantly different biologic potential than similar lesions in older patients. In the younger age group there is a more rapid progression to...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1987-12-01 00:00:00
abstract:BACKGROUND:The aim of this study was to determine if nonoperative, noninterventional expectant management of pancreatic pseudocysts is warranted in selected patients. METHODS:From 1980 to 1985, 114 patients with the diagnosis of pancreatic pseudocyst were evaluated. RESULTS:Forty-six patients underwent primary operat...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1992-02-01 00:00:00
abstract::The utility of fine-needle aspiration biopsy to detect carcinoma in thyroid nodules was evaluated by a decision-analysis approach in 102 patients. The procedure caused no morbidity. Cytologic diagnoses were categorized as unsatisfactory (4), no abnormality detected (61), atypical (13), suspicious for malignancy (14), ...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1982-10-01 00:00:00
abstract::The intravenous infusion of amino acid and carbohydrate solutions is a well-established technique for nutritional support of the pediatric surgical patient. By using peripheral veins for total parenteral nutrition (TPN), weight gain can be achieved and the complications of central venous catheters avoided. Over a 2-ye...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1979-09-01 00:00:00
abstract::The mesoatrial shunt is performed in patients with the Budd-Chiari syndrome when the inferior vena cava is occluded and not available for a conventional portosystemic shunt. Computed tomography (CT), with injection of contrast media, was used to evaluate mesoatrial shunt patency with five examinations in four patients...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1985-01-01 00:00:00
abstract:BACKGROUND:Bacterial translocation has been implicated in the alteration of the immune response after shock and trauma. This study examined the effect of bacterial translocation on myelopoiesis after hemorrhagic shock in germ-free and conventional rats. METHODS:Awake, unrestrained germ-free and conventional rats were ...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1992-10-01 00:00:00
abstract::A case of abdominal aortic aneurysm associated with renovascular hypertension in a 3-year-old boy is reported. The child was treated by resection of the aneurysm and replacement with a 12 mm polyester (Dacron) bifurcated graft. The cause of the aneurysm was not revealed by clinical and pathologic examination. In addit...
journal_title:Surgery
pub_type: 杂志文章,评审
doi:
更新日期:1989-09-01 00:00:00
abstract:BACKGROUND:The liver is a source of systemic proinflammatory mediators in acute pancreatitis. We have investigated the effects of blood from the pancreas and intestine in liver activation and lung inflammation during early stages of experimental acute pancreatitis in a rat model. METHODS:A portosystemic shunt and a me...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2004.06.039
更新日期:2005-02-01 00:00:00
abstract::Treatment of rat allograft recipients before grafting with donor spleen cells and whole, pooled antidonor alloimmune serum results in indefinite renal allograft survival. The enhancement is immunologically specific. In these experiments a monoclonal, homogenous anti-BN antibody was produced by a hybridoma clone create...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1979-07-01 00:00:00
abstract:BACKGROUND:Although the price hospitals charge for operations has broad financial implications, hospital pricing is not subject to regulation. We sought to characterize national variation in hospital price markup for major cardiothoracic and gastrointestinal operations and to evaluate perioperative outcomes of hospital...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2016.03.014
更新日期:2016-07-01 00:00:00
abstract::Fine-needle aspirations and cutting needle biopsies were performed on 415 patients with solitary thyroid nodules. All nodules were considered hypofunctioning by scintiscans. Specimens were adequate in 399 patients. Ten percent of these patients had thyroid cancers documented by thyroidectomies. Results from either or ...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1986-12-01 00:00:00
abstract:BACKGROUND:Despite the recommendations of the Advanced Trauma Life Support course of the American College of Surgeons, patients undergo computed tomography (CT) in local hospitals before transfer to a trauma center. The problem of repeat CTs caused by technical and protocol issues is ongoing. The objective is to measur...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2018.07.007
更新日期:2018-10-01 00:00:00
abstract::Two patient groups were studied to determine the need to preserve the greater saphenous vein during femoral outflow reconstruction for later aortocoronary bypass procedures. First, 74 patients were followed to the time of death or to a minimum of 5 years after femoral outflow reconstruction was performed. Only four pa...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1984-04-01 00:00:00
abstract:BACKGROUND:Most of the available data on multiglandular disease (MGD) originate from long-term series. The spectrum of the disease has changed now because of earlier diagnosis. We decided to assess the current frequency of MGD in seemingly sporadic primary hyperparathyroidism. METHODS:MGD was defined as the finding th...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1992-12-01 00:00:00
abstract:BACKGROUND:Managed care organizations use a variety of payment strategies to contract for high-end tertiary services with academic healthcare centers. We assessed the financial outcome of these strategies and attempted to identify those that maintain a balance between cost and reimbursement. METHODS:Patients admitted ...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/s0039-6060(03)00329-5
更新日期:2003-10-01 00:00:00
abstract:BACKGROUND:Approximately 10% of patients taking lithium for manic-depressive disorders become hypercalcemic. It remains unclear whether lithium initiates disease or promotes underlying hyperparathyroidism. We have previously demonstrated that at therapeutic concentrations lithium stimulates in vitro incorporation of bo...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/s0039-6060(05)80258-2
更新日期:1995-05-01 00:00:00
abstract:BACKGROUND:The importance of cigarette smoking in the etiology of peripheral arterial occlusive disease is well known, but there have been few studies that have quantified this relationship. METHODS:A case-control study design was used in which the case subjects were men with a history of claudication for at least 1 y...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1993-10-01 00:00:00
abstract:BACKGROUND:Determination of the genetic composition of papillary thyroid cancers may help explain differences in observed clinical behavior. Comparative genomic hybridization (CGH) is a novel molecular cytogenetic assay that allows simultaneous detection of gains, losses, and amplification of genetic information, makin...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1067/msy.2000.110847
更新日期:2000-12-01 00:00:00
abstract:BACKGROUND:Barriers to trauma care for rural populations are well documented, but little is known about the magnitude of urban-rural disparities in injury mortality. This study sought to quantify differences in injury mortality comparing rural and nonrural residents with traumatic injuries. METHODS:Using data from the...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2016.06.020
更新日期:2016-12-01 00:00:00
abstract::Ten patients who had a cricopharyngeal myotomy and diverticulum suspension for pharyngoesophageal diverticulum have been studied clinically, radiologically, and manometrically. There were no deaths or morbidity and all patients have achieved marked improvement of their symptoms. Before operation all patients but one h...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1983-10-01 00:00:00
abstract::Efforts to produce a clinically acceptable hemoglobin solution that could function as a temporary oxygen carrier have evolved through several stages. Beginning with the simple tetramer, we have lowered the affinity state by pyridoxylation and then polymerized the modified tetramer. This new substance, polyhemoglobin, ...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1984-03-01 00:00:00
abstract:BACKGROUND:Patients with endogenous hypercortisolism are thought to be at high risk for adrenalectomy and may experience significant postoperative surgical mortality/morbidity. METHODS:From 1981 through 1991, 91 patients underwent adrenal resection for endogenous hypercortisolism. Causes were adrenal-dependent Cushing...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/s0039-6060(05)80069-8
更新日期:1995-04-01 00:00:00