Abstract:
OBJECTIVE:To determine the impact of a clinical pathway for elective infrarenal aortic reconstruction on outcome, resource utilization, and cost in a university medical center. SUMMARY BACKGROUND DATA:Clinical pathways have been reported to control costs, reduce resource utilization, and maintain or improve the quality of patient care, although their use during elective aortic reconstructions remains unresolved. METHODS:A clinical pathway was developed for elective infrarenal aortic reconstructions by a multidisciplinary group comprised of representatives from each involved service. The prepathway practice and costs were analyzed and an efficient, cost-effective practice with specific outcome measures was defined. The impact of the pathway was determined by retrospective comparison of outcome, resource utilization, and cost (total and direct variable) between the pathway patients (PATH, n = 45) and a prepathway control group (PRE, n = 20). RESULTS:There were no significant differences in the patient demographics, comorbid conditions, operative indications, or type of reconstruction between the groups. There were no operative deaths and the overall complication rate (PRE, 35% vs. PATH, 34%) was similar. The pathway resulted in significant decreases in the total length of stay and preoperative length of stay and a trend toward a significant decrease (p = 0.08) in the intensive care length of stay for the admission during which the operation was performed. The pathway also resulted in significant decreases in both direct variable and total hospital costs for this admission, as well as a significant decrease in the overall direct variable and total hospital costs for the operative admission and the preoperative evaluation (< or =30 days before operative admission). Despite these reductions, the discharge disposition, 30-day readmissions, and number of postoperative clinic visits within 90 days of discharge were not different. CONCLUSIONS:Implementation of a clinical pathway for elective infrarenal aortic reconstructions dramatically decreased resource utilization and hospital costs without affecting the quality of patient care and did not appear to shift the costs to another setting.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Huber TS,Carlton LM,Harward TR,Russin MM,Phillips PT,Nalli BJ,Flynn TC,Seeger JMdoi
10.1097/00000658-199805000-00009subject
Has Abstractpub_date
1998-05-01 00:00:00pages
691-9; discussion 699-701issue
5eissn
0003-4932issn
1528-1140journal_volume
227pub_type
杂志文章abstract::The clinical outcome in 155 patients with papillary or follicular carcinoma of the thyroid gland operated on over a 25-year period demonstrated no difference in survival rates or incidence of recurrent tumor between those treated by total thyroidectomy and those undergoing less than total thyroidectomy. However, the c...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198012000-00001
更新日期:1980-12-01 00:00:00
abstract:OBJECTIVES:To evaluate the results of a vertical rectus abdominis myocutaneus (VRAM) flap after abdomino-perineal resection (APR) for anal cancer (AC). BACKGROUND DATA:APR is the only curative treatment for AC that recurs or persists after radiochemotherapy. To obtain a clear surgical margin, APR frequently includes a...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181bce334
更新日期:2009-11-01 00:00:00
abstract:OBJECTIVE:To analyze the yield and rate of node metastases (pN1) for prophylactic central (CND) and lateral neck dissection (LND) for papillary thyroid carcinoma, the risk factors for pN1, and outcomes. BACKGROUND:Prophylactic CND and LND are not routinely employed. Adjuvant radioiodine treatment may be modulated, how...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31824b7b68
更新日期:2012-04-01 00:00:00
abstract::In a prospective study of 112 patients suspected of periampullary cancer endoscopic retrograde cholangiopancreatography (ERCP) was successfully performed in 87 patients (78%). Technical failures were due to gastric outlet obstruction in four patients and inability to cannulate the ampulla of Vater in 21 patients. Succ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197803000-00018
更新日期:1978-03-01 00:00:00
abstract::This study examines the influence of total parenteral nutrition (TPN) compared with 5% dextrose (D5) infusion on skeletal muscle and adipose tissue lipoprotein lipase (LPL) activity in nutritionally depleted, injured and infected patients. The plasma concentrations of glucose, free fatty acid (FFA), triglyceride and i...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198112000-00003
更新日期:1981-12-01 00:00:00
abstract:OBJECTIVE:Splitting of the liver at the line of Cantlie of otherwise healthy people is accepted worldwide as a reasonable procedure for the donors in adult living donor liver transplantation. A similar operation is still considered as experimental if performed in the deceased donor liver. The aim of this study is to ev...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000189120.62975.0d
更新日期:2005-12-01 00:00:00
abstract:OBJECTIVE:To assess our long-term complications from complete axillary lymph node dissection (AXLND) in patients with breast cancer. SUMMARY BACKGROUND DATA:Complete AXLND as part of the surgical therapy for breast cancer has come under increased scrutiny due the use of the sentinel lymph node (SLN) biopsy technique t...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000129358.80798.62
更新日期:2004-07-01 00:00:00
abstract:OBJECTIVE:To evaluate the relation between delay in surgery because of preoperative biliary drainage (PBD) and survival in patients scheduled for surgery for pancreatic head cancer. BACKGROUND:Patients with obstructive jaundice due to pancreatic head cancer can undergo PBD. The associated delay of surgery can lead to ...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/SLA.0b013e3181fd36a2
更新日期:2010-11-01 00:00:00
abstract:OBJECTIVE:This study investigated the current state of fecal and urinary continence in an extensive group of adults after operative correction for high anorectal malformations and how they cope with their incontinence. SUMMARY BACKGROUND DATA:Normal fecal continence is hardly to be expected after correction for high a...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199308000-00012
更新日期:1993-08-01 00:00:00
abstract:OBJECTIVES:The American Joint Committee on Cancer (AJCC) staging system for gastric cancer bases N status on absolute number of metastatic nodes, regardless of the number of examined nodes. We examined a modified staging system utilizing node ratio (Nr), the ratio of metastatic to examined nodes. METHODS:A total of 18...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31824857e2
更新日期:2012-03-01 00:00:00
abstract:OBJECTIVE:To study the mechanical characteristics of the esophagogastric junction (EGJ) of postfundoplication patients and compare them with previously reported data on normal subjects and GERD patients. METHODS:Eight normal subjects, 9 GERD patients, and 8 fundoplication patients were studied with concurrent manometr...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000167868.44211.f0
更新日期:2005-07-01 00:00:00
abstract:OBJECTIVE:Based on development of stem cell technology, newborn tissue, even undergoing cryopreservation, possesses promising potential as a donor source in the field of organ transplantation. However, the precise regeneration processes remains unclear. This study was designed to investigate the regenerative potential ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000168089.64630.94
更新日期:2005-07-01 00:00:00
abstract:OBJECTIVE:To measure plasma levels of angiopoietin-1 (Ang-1), angiopoietin-2 (Ang-2), and vascular endothelial growth factor (VEGF) early after trauma and to determine their clinical significance. BACKGROUND:Angiopoietins and VEGF play a central role in the physiology and pathophysiology of endothelial cells. Ang-2 ha...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e318162d616
更新日期:2008-02-01 00:00:00
abstract::The contraction of the gallbladder by ultrasonography and release of cholecystokinin (CCK) by specific radioimmunoassay in response to the ingestion of oral fatty meal before and 1 month after gastrectomy in five patients with early gastric cancer was studied. Before gastrectomy, basal concentrations of CCK (13.4 +/- ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:
更新日期:1987-01-01 00:00:00
abstract::Five-year survival after resection of hepatic metastases from colorectal cancer is 25%. Although resection palliates some patients who do not live that long, 50% of patients so treated are not helped at all. Until ignorance of a cancer's real stage is resolved by improved techniques, the evaluation and choice of thera...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198405000-00002
更新日期:1984-05-01 00:00:00
abstract::Carcinoma of the gallbladder is an uncommon, but not rare tumor that is associated with a 5% five-year survival rate after resection and this rate has not appreciably improved over the last decades in most series. Nevin et al.(20) however have reported that favorably staged gallbladder cancers (according to histologic...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198205000-00012
更新日期:1982-05-01 00:00:00
abstract::Release of pancreatic polypeptide (PP) after a meal is biphasic, with an early transient peak believed to be under cholinergic control, and a secondary, prolonged intestinal phase thought to be mediated by hormones. Endogenous release of PP was stimulated by intraduodenal oleate (6.8 mmol/hr) or by intravenous adminis...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198411000-00008
更新日期:1984-11-01 00:00:00
abstract:BACKGROUND:Postcholecystectomy complex bile duct injuries involving the hilar confluence, which are often associated with vascular injuries and liver atrophy, remain a considerable surgical challenge. The aim of this study is to report our experience of major hepatectomy with long-term outcome in these patients. METHO...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31817b65f2
更新日期:2008-07-01 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::Patients recovering from acute respiratory insufficiency are usually not extubated until they can ventilate adequately while breathing spontaneously at ambient end-expiratory pressure (T-tube). It is hypothesized that this period of T-tube breathing might be detrimental to gas exchange since the endotracheal tube abol...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198005000-00004
更新日期:1980-05-01 00:00:00
abstract:OBJECTIVE:To evaluate whether intravascular volume expansion would improve renal blood flow and function during prolonged CO2 pneumoperitoneum. SUMMARY BACKGROUND DATA:Although laparoscopic living donor nephrectomies have a considerably reduced risk of complications for the donors, significant concerns exist regarding...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200002000-00007
更新日期:2000-02-01 00:00:00
abstract:OBJECTIVE:The aim of the present study was to determine whether trainee involvement in esophageal cancer resection is associated with adverse patient outcomes. BACKGROUND:Operative experience for surgical trainees is under threat. A number of factors have been implicated in this leading to fewer hours for training. Es...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000002047
更新日期:2018-01-01 00:00:00
abstract:INTRODUCTION:Radiation therapy is increasingly used as adjuvant treatment of many childhood and adult malignancies. Radiation-induced sarcoma is a well recognized if uncommon event. The objective of this study is to determine the prevalence and long-term outcome for patients who develop radiation-induced sarcomas. MET...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000128686.51815.8b
更新日期:2004-06-01 00:00:00
abstract:INTRODUCTION:Intraductal papillary mucinous neoplasms (IPMNs) are being increasingly recognized, and often harbor cancer. Lymph node metastases are an important prognostic factor for patients with invasive intraductal papillary carcinoma (I-IPMC), but the role of lymph node ratio (LNR) in predicting survival after surg...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181cf9155
更新日期:2010-03-01 00:00:00
abstract:OBJECTIVE:A randomized, controlled, multicenter trial was undertaken in 102 patients with objective evidence of severe acute pancreatitis to evaluate whether selective decontamination reduces mortality. SUMMARY BACKGROUND DATA:Secondary pancreatic infection is the major cause of death in patients with acute necrotizin...
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:10.1097/00000658-199507000-00010
更新日期:1995-07-01 00:00:00
abstract::CLINICAL AND LABORATORY STUDIES OF AFP PRODUCING HEPATOMAS DEMONSTRATED THAT: 1) serum AFP levels correlated directly with tumor growth; 2) circulating AFP could be cleared by passive administration of an. excess of anti-AFP; and 3) highly specific anti-AFP functioned as a carrier to localize diagnostic and possibly t...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197410000-00025
更新日期:1974-10-01 00:00:00
abstract:OBJECTIVES:We aimed to examine the association between total number of resected nodes and survival in patients after esophagectomy with and without nCRT. BACKGROUND:Most studies concerning the potentially positive effect of extended lymphadenectomy on survival have been performed in patients who underwent surgery alon...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SLA.0000000000000965
更新日期:2014-11-01 00:00:00
abstract:OBJECTIVE:To evaluate the correlation between the morphologic nuclear features and clinicopathologic parameters in patients with advanced gastric cancer. SUMMARY BACKGROUND DATA:Nuclear profiles have been reported as useful prognostic predictors in various cancers. Data from computerized morphometries are objective an...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199901000-00007
更新日期:1999-01-01 00:00:00
abstract:BACKGROUND:Acute abdominal pain is the most common indication for surgical admission. Nonspecific abdominal pain (NSAP) may account for up to 40% of cases. There has been no published prospective study in which adult patients presenting with acute abdominal pain are investigated for celiac disease. AIMS:We aimed to as...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000171301.35513.cf
更新日期:2005-08-01 00:00:00
abstract:OBJECTIVE:To examine the clinicopathologic features and clonal relationship of multifocal intraductal papillary mucinous neoplasms (IPMNs) of the pancreas. BACKGROUND:Intraductal papillary mucinous neoplasms are increasingly diagnosed cystic precursor lesions of pancreatic cancer. Intraductal papillary mucinous neopla...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3182378a18
更新日期:2012-02-01 00:00:00