Annals of surgery
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Comparative Study
Comparison of outcomes for open abdominal aortic aneurysm repair and endovascular repair in patients with chronic renal insufficiency.
This study investigates whether this practice is supported by multicenter prospectively collected data. ⋯ Contrary to current practice, and despite the use of contrast, EVAR should be the first choice in patients with moderate renal dysfunction if they have the appropriate anatomy. Higher threshold for AAA repair with either OPEN or EVAR should be applied in patients with severe renal dysfunction because postoperative complications were significantly high with either approach.
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Comparative effectiveness research has mostly been focused on comparison of treatment techniques. The goal of the present study was to extend the research to physician specialty. ⋯ Physician specialty is associated with patient outcomes. Surgeons are associated with improved outcomes, with lower mortality, shorter length of stay, and lower charges for EVAR cases, when compared with interventionalists. This finding has significant implications for future comparative effectiveness research and potential policy changes in patient referrals or physician admitting privileges.
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"The elderly" is an often used but poorly defined descriptor of surgical patients. Investigators have used varying subjectively determined age cutoffs to report outcomes in the elderly. We set out to use objective outcomes data to determine the "at-risk" elderly population. ⋯ Mortality risk for major gastrointestinal surgical resections starts increasing at 50 years of age, and at 75 years of age, it starts increasing very rapidly. The optimum age of 68.5 years predicts mortality with the best combination of sensitivity and specificity. These ages should be used to standardize outcome data and focus perioperative resources to improve outcomes.
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To analyze a 28-year single-center experience with orthotopic liver transplantation (OLT) for patients with irreversible liver failure. ⋯ We present the world's largest reported single-institution experience with OLT. Despite increasing acuity in post-MELD era recipients, patient and graft survival continues to improve, justifying the "sickest first" allocation approach.
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To evaluate the effect of surgical delay on the outcomes of patients with adhesive small bowel obstruction (ASBO). ⋯ Early operative intervention for patients with ASBO is associated with a significant survival benefit, lower incidence of local and systemic complications, and shorter hospitalization.