Kooperativer Bibliotheksverbund

Berlin Brandenburg

and
and

Your email was sent successfully. Check your inbox.

An error occurred while sending the email. Please try again.

Proceed reservation?

Export
Filter
  • Retrospective Studies
Type of Medium
Language
Year
  • 1
    Language: English
    In: HPB, September 2015, Vol.17(9), pp.804-810
    Description: Surgical intervention is uncommon in chronic pancreatitis. Literature largely describes single institution or international experiences. This study describes US‐based chronic pancreatitis surgical management. Retrospective analysis of chronic pancreatitis patients in the Healthcare Cost and Utilization Project Florida State Inpatient Database 2007–2011. Patients with malignancy or congenital abnormalities were excluded. Univariate analysis using the chi‐square test. The number of readmissions, inpatient length of stay and cost using Wilcoxon's signed‐rank test. Multivariate analysis of surgery by logistic regression. Twenty‐one thousand four hundred and forty‐five patients with chronic pancreatitis. 10.8% (2 307) underwent surgery including 1652 cholecystectomies, 564 drainage procedures and 498 pancreatectomies. Procedures decreased from 12.1% to 8.3% over time ( 〈 0.001), but intervention within 3 months increased (7.2% to 8.4%; = 0.017). 15.3% (3 278) had pancreatic cysts/pseudocysts and 43.4% (9 312) had diabetes. The median numbers of admissions were 2 [interquartile range (IQR) 1,5] and 3 (IQR 2,7) among non‐surgical and surgical patients, respectively ( 〈 0.001). Predictors of surgery were fewer co‐morbidities, private insurance, and either diabetes mellitus or pancreatic cyst/pseudocyst. Chronic pancreatitis leads to numerous inpatient readmissions, but surgical intervention only occurs in a minority of cases. Complicated patients are more likely to undergo surgery. The complexities of chronic pancreatitis management warrant early multidisciplinary evaluation and ongoing consideration of surgical and non‐surgical options.
    Keywords: Medicine
    ISSN: 1365-182X
    E-ISSN: 1477-2574
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
  • 2
    Language: English
    In: The American Journal of Surgery, October 2016, Vol.212(4), pp.691-699
    Description: This study examines the impact of marriage and next of kin identity on timing of diagnosis, treatment, and survival in cancer patients. Retrospective review of patients with 5 solid tumor types treated at an academic medical center from 2002 to 2012. Exposures of interest were marriage status at time of diagnosis and familial relationship with next of kin (NOK). Association with overall survival determined via Cox regressions and with early diagnosis (stage I to II) and receipt of surgery via logistic regressions. Marriage was not associated with early diagnosis for any cancer type. After adjustment, being married was associated with significantly higher odds of receiving surgery only for pancreatic cancer and with improved survival for breast and lung cancers. Having a nuclear relationship with NOK was not associated with any outcomes. Marriage status was associated with improved outcomes for certain cancers whereas familial relationship with NOK was not.
    Keywords: Cancer ; Social Connectedness ; Outcomes ; Marriage ; Survival
    ISSN: 0002-9610
    E-ISSN: 1879-1883
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
  • 3
    Language: English
    In: American Journal of Obstetrics and Gynecology, 2005, Vol.192(5), pp.1452-1454
    Description: This study was undertaken to determine the (1) impact of delivery route on the natural history of cervical dysplasia and (2) overall regression rates of cervical dysplasia in pregnant women. A retrospective analysis was performed on 705 pregnant women with abnormal Papanicolaou tests who presented for prenatal care at the Kapiolani Medical Center Women's Clinic in Honolulu, Hawaii, between 1991 and 2001. Data collection included demographics, delivery route, and cervical pathology. Two hundred one patients met the inclusion criteria. Regression rates for vaginal and cesarean section groups were as follows: atypical squamous cells (64% vs 70%, = .32), low-grade squamous intraepithelial lesion (58% vs 42%, = .073), and high-grade squamous intraepithelial lesion (53% vs 25%, = .44). Of the total population, 30% of lesions persisted postpartum, 58% regressed, and 12% progressed. Mode of delivery does not influence the natural history of dysplastic lesions. Gravid and nongravid women have similar regression rates.
    Keywords: Cervical Dysplasia ; Mode of Delivery ; Natural History ; Pregnancy ; Medicine
    ISSN: 0002-9378
    E-ISSN: 1097-6868
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
  • 4
    Language: English
    In: HPB, September 2015, Vol.17(9), pp.753-762
    Description: Bile duct reconstruction (BDR) is used to manage benign and malignant neoplasms, congenital anomalies, bile duct injuries and other non-malignant diseases. BDR outcomes overall, by year, and by indication were compared. Retrospective analysis of Nationwide Inpatient Sample discharges (2004–2011) including ICD-9 codes for BDR. All statistical testing was performed using survey weighting. Univariate analysis of admission characteristics by chi square testing. Multivariate modelling for inpatient complications and inpatient death by logistic regression. Identified 67 160 weighted patient admissions: 2.5% congenital anomaly, 37.4% malignant neoplasm, 2.3% benign neoplasm, 9.9% biliary injury, 47.9% other non-malignant disease. Most BDRs were performed in teaching hospitals (69.6%) but only 25% at centres with a BDR volume more than 35/year. 32.3% involved ≥ 1 complication, and 84.7% were discharges home. There was a 4.2% inpatient death rate. The complication rate increased but the inpatient death rate decreased over time. The rates of acute renal failure increased. Significant multivariate predictors of inpatient death include indication of biliary injury or malignancy, and predictors of any complication include public insurance and non-elective admission. This is the first national description of BDRs using a large database. In this diverse sampling, both procedure indication and patient characteristics influence morbidity and mortality.
    Keywords: Medicine
    ISSN: 1365-182X
    E-ISSN: 1477-2574
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
  • 5
    Language: English
    In: Journal of Gastrointestinal Surgery, 2016, Vol.20(5), pp.1012-1019
    Description: This study analyzes the relationship between hospital teaching status, failure to rescue, and time of year in select gastrointestinal operations. Procedure codes for laparoscopic cholecystectomy, colectomy, and pancreatectomy were queried from the Nationwide Inpatient Sample (2004–2011). Failure to rescue was defined as inpatient mortality when ≥1 complication. A total of 2,777,267 laparoscopic cholecystectomies, 2,519,903 colectomies, and 129,619 pancreatectomies were performed. Teaching hospitals had increased overall rates of failure to rescue compared to non-teaching hospitals, 10.0 vs. 9.5 % ( p  = 0.0187), particularly between May and August. There was greater inter-month variability in non-teaching hospitals amongst individual operations. On multivariable analysis, July was not predictive of increased odds of failure to rescue. Teaching status, hospital characteristics, and patient demographics were associated with increased odds of failure to rescue. Although teaching hospitals have a higher overall failure to rescue rate amongst the selected gastrointestinal operations, odds of failure to rescue are not increased in the month of July. Non-teaching hospitals tend to exhibit more monthly variation in failure to rescue rates, and hospital/patient demographics are predictive of failure to rescue. Further investigation targeted at identifying drivers of temporal variation is warranted to optimize patient outcomes.
    Keywords: Failure to rescue ; July effect ; Teaching hospitals
    ISSN: 1091-255X
    E-ISSN: 1873-4626
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
  • 6
    Language: English
    In: Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health, November 2015, Vol.74(11), pp.369-74
    Description: The levonorgestrel intrauterine device (LNG-IUD) is a safe, effective, long-acting, reversible contraceptive that reduces unintended pregnancy and decreases heavy menstrual bleeding. Many procedures such as IUD insertion are more challenging in overweight and obese women. The objective of this study was to describe LNG-IUD insertion, continuation, and complications in overweight and obese women in an ethnically diverse population in Hawai'i. A retrospective cohort study of women who had a LNG-IUD inserted at the University of Hawai'i, Department of Obstetrics and Gynecology Resident and Faculty practice sites between January 2009 and December 2010 was performed. A total of 149 women were followed. The most commonly reported races were Asian (32%), Native Hawaiian (26%), and non-Hawaiian Pacific Islander (20%). The mean BMI of the study population was 28.4 (standard deviation 7.2) with 37% classified as normal weight, 30% as overweight, and 33% as obese. Overall, 76% of women continued the LNG-IUD 12 months after insertion. No statistically significant difference emerged in 12-month IUD continuation between the BMI groups. Difficult (5%) and failed (3%) IUD insertions were rare for all BMI groups. IUD complications occurred in 9% of women and included expulsion and self-removal. In this diverse population, the majority of women continued to use the LNG-IUD one year after insertion with low rates of difficult insertions and complications.
    Keywords: Contraception -- Statistics & Numerical Data ; Contraceptive Agents, Female -- Therapeutic Use ; Intrauterine Devices, Medicated -- Statistics & Numerical Data ; Levonorgestrel -- Therapeutic Use ; Overweight -- Ethnology
    E-ISSN: 2165-8242
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
  • 7
    Language: English
    In: Contraception, July 2017, Vol.96(1), pp.19-24
    Description: Some providers use oxytocin during dilation and evacuation (D&E) to prevent or treat hemorrhage, although evidence to support this is scarce. We sought to describe the association between prophylactic oxytocin use, estimated blood loss (EBL), and surgical outcomes during D&E. We performed a chart review of 730 women at 14 to 26 weeks’ gestation who had a D&E at our institution between May 2010 and May 2014 to assess the association between prophylactic oxytocin use and EBL. We determined whether sociodemographic and health-related factors were associated with excessive blood loss (EBL≥250 mL) and whether oxytocin use was associated with complications, including hemorrhage (i.e., EBL≥500 mL or interventions for bleeding). We performed univariate analyses and multivariable regression models to evaluate the relationship between health-related factors and EBL≥250 mL. Providers used prophylactic oxytocin in 59.9% of procedures. Asian (p=.005 and Native Hawaiian/Pacific Islander (p=.005) race, nulliparity (p=.007) and higher gestational age (p〈.001) were associated with prophylactic oxytocin use. We found no difference in mean EBL (116.2±105.5 mL versus 130.7±125.5 mL, p=.09), EBL≥250 mL (31.4% vs. 68.6%, p=.15) or complications (6.1% vs. 7.1%, p=.73) including hemorrhage (1.4% vs. 5.3%, p=.14) between those who did not receive prophylactic oxytocin and those who did. No transfusions occurred in either group. In multivariable regression modeling, the adjusted OR for excessive blood loss was 0.42 (95% confidence interval 0.16–1.07) with prophylactic oxytocin use. Prophylactic oxytocin use during D&E was not associated with hemorrhage or transfusion in our population. Routine use of interventions for bleeding, such as intravenous oxytocin, should be based on scientific evidence or not performed. Findings from our study provide information on how oxytocin use is associated with blood loss during D&E.
    Keywords: Abortion ; Dilation and Evacuation ; Oxytocin ; Hemorrhage ; Medicine
    ISSN: 0010-7824
    E-ISSN: 1879-0518
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
  • 8
    Language: English
    In: HPB, October 2014, Vol.16(10), pp.899-906
    Description: The volume effect in pancreatic surgery is well established. Regionalization to high-volume centres has been proposed. The effect of this proposal on practice patterns is unknown. Retrospective review of pancreatectomy patients in the Nationwide Inpatient Sample 2004–2011. Inpatient mortality and complication rates were calculated. Patients were stratified by annual centre pancreatic resection volume (low 〈5, medium 5–18, high 〉18). Multivariable regression model evaluated predictors of resection at a high-volume centre. In total, 129 609 patients underwent a pancreatectomy. The crude inpatient mortality rate was 4.3%. 36.0% experienced complications. 66.5% underwent a resection at high-volume centres. In 2004, low-, medium- and high-volume centres resected 16.3%, 24.5% and 59.2% of patients, compared with 7.6%, 19.3% and 73.1% in 2011. High-volume centres had lower mortality ( 〈 0.001), fewer complications ( 〈 0.001) and a shorter median length of stay ( 〈 0.001). Patients at non-high-volume centres had more comorbidities ( = 0.001), lower rates of private insurance ( 〈 0.001) and more non-elective admissions ( 〈 0.001). In spite of a shift to high-volume hospitals, a substantial cohort still receives a resection outside of these centres. Patients receiving non-high-volume care demonstrate less favourable comorbidities, insurance and urgency of operation. The implications are twofold: already disadvantaged patients may not benefit from the high-volume effect; and patients predisposed to do well may contribute to observed superior outcomes at high-volume centres.
    Keywords: Medicine
    ISSN: 1365-182X
    E-ISSN: 1477-2574
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
  • 9
    In: Diseases of the Colon & Rectum, 2015, Vol.58(12), pp.1164-1173
    Description: BACKGROUND:: Readmission rates are a measure of surgical quality and an object of clinical and regulatory scrutiny. Despite increasing efforts to improve quality and contain cost, 6% to 25% of patients are readmitted after colorectal surgery. OBJECTIVE:: The aim of this study is to define the predictors and costs of readmission following colorectal surgery. DESIGN:: This is a retrospective cohort study of patients undergoing elective and nonelective colectomy and/or proctectomy in the Healthcare Cost and Utilization Project Florida State Inpatient Database 2007 to 2011. Readmission is defined as inpatient admission within 30 days of discharge. Univariate analyses were performed of sex, age, Elixhauser score, race, insurance type, procedure, indication, readmission diagnosis, cost, and length of stay. Multivariate analysis was performed by logistic regression. Sensitivity analysis of nonemergent admissions was conducted. SETTINGS:: This study was conducted in Florida acute-care hospitals. PATIENTS:: Patients undergoing colectomy and proctectomy from 2007 to 2011 were included. INTERVENTION(S):: There were no interventions. MAIN OUTCOME MEASURE(S):: The primary outcomes measured were readmission and the cost of readmission. RESULTS:: A total of 93,913 patients underwent colectomy; 14.7% were readmitted within 30 days. From 2007 to 2011, readmission rates remained stable (14.6%–14.2%, trend p = 0.1585). After multivariate adjustment, patient factors associated with readmission included nonwhite race, age 〈65, and a diagnosis code other than neoplasm or diverticular disease (p 〈 0.0001). Patients with Medicare or Medicaid were more likely to be readmitted than those with private insurance (p 〈 0.0001). Patients with longer index admissions, those with stomas, and those undergoing all procedures other than sigmoid or transverse colectomy were more likely to be readmitted (p 〈 0.0001). High-volume hospitals had higher rates of readmission (p 〈 0.0001). The most common reason for readmission was infection (32.9%). Median cost of readmission care was $7030 (intraquartile range, $4220–$13,247). Fistulas caused the most costly readmissions ($15,174; intraquartile range, $6725–$26,660). LIMITATIONS:: Administrative data and retrospective design were limitations of this study. CONCLUSIONS:: Readmissions rates after colorectal surgery remain common and costly. Nonprivate insurance, IBD, and high hospital volume are significantly associated with readmission.
    Keywords: Medicine;
    ISSN: 0012-3706
    E-ISSN: 15300358
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
  • 10
    Language: English
    In: Surgical Endoscopy, 2015, Vol.29(7), pp.1897-1902
    Description: Acute appendicitis is the second most common gastrointestinal diagnosis mandating urgent operation in the U.S. The current state of adult appendectomy, including patient and hospital characteristics, complications, and predictors for complications, are unknown.Retrospective review of U.S. Nationwide Inpatient Sample 2003–2011 for appendectomy in ≥18-year-olds was performed. Primary outcomes measures included postoperative complications, length of stay, and patient mortality. Categorical variables were analyzed by χ2, trend analyses by Cochran–Armitage. Multivariable logistic regression was performed to adjust for predictors of developing complications.1,663,238 weighted appendectomy discharges occurred. Over the study period, complications increased from 3.2 to 3.8 % (p 〈 0.0001), but the overall mortality decreased from 0.14 to 0.09 % (p 〈 0.0001) and mean LOS decreased from 3.1 to 2.6 days (p 〈 0.0001). The proportion of laparoscopic appendectomy increased over time, 41.7–80.1 % (p 〈 0.0001). Patients were increasingly older (≥65 years: 9.4–11.6 %, p 〈 0.0001), more obese (3.8–8.9 %, p 〈 0.0001), and with more comorbidities (Elixhauser score ≥3: 4.7–9.8 %, p 〈 0.0001). After adjustment, independent predictors for postoperative complications included: open surgery (OR 1.5, 95 % C.I. 1.4–1.5), male sex (OR 1.6, 95 % CI 1.5–1.6), black race (vs. white: OR 1.5, 95 % CI 1.4–1.6), perforated appendix (OR 2.8, 95 % CI 2.7–3.0), greater comorbidity (Elixhauser ≥3 vs. 0, OR 11.3, 95 % CI 10.5–12.1), non-private insurance status (vs. private: Medicaid OR 1.3, 95 % CI 1.2–1.4; Medicare OR 1.7, 95 % CI 1.6–1.8), increasing age (〉52 years vs. ≤27: OR 1.3; 95 % CI 1.2–1.4), and hospital volume (vs. high: low OR 1.2; 95 % CI 1.1–1.3). Predictors of laparoscopic appendectomy were age, ethnicity, insurance status, comorbidities, and hospital location.Laparoscopic appendectomy is increasing but is unevenly deployed across patient groups. Appendectomy patients were increasingly older, with more comorbidities and with increasing rates of obesity. Black patients and patients with public insurance had less utilization of laparoscopy and inferior outcomes.
    Keywords: Appendectomy ; Acute appendicitis ; NIS ; Laparoscopy ; Complications
    ISSN: 0930-2794
    E-ISSN: 1432-2218
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
Close ⊗
This website uses cookies and the analysis tool Matomo. Further information can be found on the KOBV privacy pages