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January 2017 - July 1920

Decade

Year

Issue

May 1, 2011, Vol 146, No. 5, Pages 498-634 | New England Surgical Society

Paper

Transplant ToleranceBench to Bedside—26th Annual Samuel Jason Mixter Lecture

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Arch Surg. 2011;146(5):501-505. doi:10.1001/archsurg.2011.101

Computed Tomographic Diagnosis of Pneumatosis IntestinalisClinical Measures Predictive of the Need for Surgical Intervention

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Arch Surg. 2011;146(5):506-510. doi:10.1001/archsurg.2011.95

Critical Role of Identification of the Second Gland During Unilateral Parathyroid SurgeryA Prospective Review of 119 Patients With Concordant Localization

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Arch Surg. 2011;146(5):512-516. doi:10.1001/archsurg.2011.91

The Palliative TriangleImproved Patient Selection and Outcomes Associated With Palliative Operations

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Arch Surg. 2011;146(5):517-523. doi:10.1001/archsurg.2011.92

Surgical Vampires and Rising Health Care ExpenditureReducing the Cost of Daily Phlebotomy

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Arch Surg. 2011;146(5):524-527. doi:10.1001/archsurg.2011.103

Successful Selective Nonoperative Management of Abdominal Gunshot Wounds Despite Low Penetrating Trauma Volumes

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Arch Surg. 2011;146(5):528-532. doi:10.1001/archsurg.2011.94

Implications of Incidentally Discovered, Nonfunctioning Pancreatic Endocrine TumorsShort-term and Long-term Patient Outcomes

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Arch Surg. 2011;146(5):534-538. doi:10.1001/archsurg.2011.102

Determining the Need for Radical Surgery in Patients With T1 Rectal Cancer

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Arch Surg. 2011;146(5):540-544. doi:10.1001/archsurg.2011.76

Mortality Rate After Nonelective Hospital Admission

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Arch Surg. 2011;146(5):545-551. doi:10.1001/archsurg.2011.106

Optimizing Advanced Practitioner Charge Capture in High-Acuity Surgical Intensive Care Units

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Arch Surg. 2011;146(5):552-555. doi:10.1001/archsurg.2011.93
Original Article

Prevalence and Implications of Preinjury Warfarin UseAn Analysis of the National Trauma Databank

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Arch Surg. 2011;146(5):565-570. doi:10.1001/archsurg.2010.313
ObjectivesTo describe the prevalence of preinjury warfarin use in a large national sample of trauma patients and to define the relationship between preinjury warfarin use and mortality.DesignRetrospective cohort study.SettingThe National Trauma Databank (7.1).PatientsAll patients admitted to eligible trauma centers during the study period; 1 230 422 patients (36 270 warfarin users) from 402 centers were eligible for analysis.Main Outcome MeasuresPrevalence of warfarin use and all-cause in-hospital mortality. Multivariate logistic regression was used to estimate the odds ratio (OR) for mortality associated with preinjury warfarin use.ResultsWarfarin use increased among all patients from 2.3% in 2002 to 4.0% in 2006 (P < .001), and in patients older than 65 years, use increased from 7.3% in 2002 to 12.8% in 2006 (P < .001). Among all patients, 9.3% of warfarin users died compared with only 4.8% of nonusers (OR, 2.02; 95% confidence interval [CI], 1.95-2.10; P < .001). After adjusting for important covariates, warfarin use was associated with increased mortality among all patients (OR, 1.72; 95% CI, 1.63-1.81; P < .001) and patients 65 years and older (OR, 1.38; 95% CI, 1.30-1.47; P < .001).ConclusionsWarfarin use is common among injured patients and its prevalence has increased each year since 2002. Its use is a powerful marker of mortality risk, and even after adjusting for confounding comorbidities, it is associated with a significant increase in death.

Adherence to the Enhanced Recovery After Surgery Protocol and Outcomes After Colorectal Cancer Surgery

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Arch Surg. 2011;146(5):571-577. doi:10.1001/archsurg.2010.309
ObjectivesTo study the impact of different adherence levels to the enhanced recovery after surgery (ERAS) protocol and the effect of various ERAS elements on outcomes following major surgery.DesignSingle-center prospective cohort study before and after reinforcement of an ERAS protocol. Comparisons were made both between and across periods using multivariate logistic regression. All clinical data (114 variables) were prospectively recorded.SettingErsta Hospital, Stockholm, Sweden.PatientsNine hundred fifty-three consecutive patients with colorectal cancer: 464 patients treated in 2002 to 2004 and 489 in 2005 to 2007.Main Outcome MeasuresThe association between improved adherence to the ERAS protocol and the incidence of postoperative symptoms, complications, and length of stay following major colorectal cancer surgery was analyzed.ResultsFollowing an overall increase in preoperative and perioperative adherence to the ERAS protocol from 43.3% in 2002 to 2004 to 70.6% in 2005 to 2007, both postoperative complications (odds ratio, 0.73; 95% confidence interval, 0.55-0.98) and symptoms (odds ratio, 0.53; 95% confidence interval, 0.40-0.70) declined significantly. Restriction of intravenous fluid and use of a preoperative carbohydrate drink were major independent predictors. Across periods, the proportion of adverse postoperative outcomes (30-day morbidity, symptoms, and readmissions) was significantly reduced with increasing adherence to the ERAS protocol (>70%, >80%, and >90%) compared with low ERAS adherence (<50%).ConclusionImproved adherence to the standardized multimodal ERAS protocol is significantly associated with improved clinical outcomes following major colorectal cancer surgery, indicating a dose-response relationship.

Rural-Urban Differences in Surgical Procedures for Medicare Beneficiaries

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Arch Surg. 2011;146(5):579-583. doi:10.1001/archsurg.2010.306
ObjectiveTo determine whether Medicare beneficiaries in rural areas were less likely to undergo a variety of surgical procedures compared with their urban counterparts.Design, Setting, and PatientsCross-sectional study of Medicare beneficiaries.Main Outcome MeasureAny incidence of the surgical procedures studied.ResultsCompared with urban Medicare beneficiaries, rural Medicare beneficiaries were more likely to undergo a broad array of surgical procedures: 35% more likely for carotid endarterectomy (odds ratio [OR] = 1.35; 95% confidence interval [CI], 1.33-1.38), 32% for lumbar spine fusion (OR = 1.32; 95% CI, 1.29-1.35), 30% for knee replacement surgery (OR = 1.30; 95% CI, 1.28-1.31), 28% for abdominal aortic aneurysm repair (OR = 1.28; 95% CI, 1.24-1.31), 22% for prostatectomy (OR = 1.22; 95% CI, 1.19-1.24), 19% for hip replacement surgery (OR = 1.19; 95% CI, 1.17-1.21), 18% for aortic valve replacement (OR = 1.18; 95% CI, 1.14-1.21), 16% for open reduction and internal fixation of the femur (OR = 1.16; 95% CI, 1.14-1.18), and 15% for appendectomy (OR = 1.15; 95% CI, 1.11-1.19). To determine whether these differences could be explained by known confounding variables, we then used logistic regression to adjust for age, sex, race/ethnicity, median household income, average house value, mean poverty ratio, and state of residence. Rural beneficiaries were still more likely to undergo all of these surgical procedures.ConclusionsMedicare beneficiaries living in rural areas were more likely to undergo a broad array of surgical procedures compared with those living in urban areas. While allaying some concern about rural access to surgical procedures, the uniformity of these results raises concern that people living in rural areas may have an overall poorer quality of health.

Factors Associated With Trauma Center Use for Elderly Patients With TraumaA Statewide Analysis, 1999-2008

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Arch Surg. 2011;146(5):585-592. doi:10.1001/archsurg.2010.311
ObjectivesTo estimate the likelihood of trauma center admission for injured elderly patients with trauma, determine trends in trauma center admissions, and identify factors associated with trauma center use for elderly patients with trauma.DesignRetrospective analysis.SettingAcute care hospitals in California.PatientsAll patients hospitalized for acute traumatic injuries during the period from January 1, 1999, to December 31, 2008 (n = 430 081). Patients who had scheduled admissions for nonacute or minor trauma were excluded.Main Outcome MeasureLikelihood of admission to level I or II trauma center was calculated according to age categories after adjusting for patient and system factors.ResultsOf 430 081 patients admitted to California acute care hospitals for trauma-related diagnoses, 27% were older than 65 years. After adjusting for demographic, clinical, and system factors, compared with trauma patients aged 18-25 years, the odds of admission to a trauma center decreased with increasing age; patients aged 26-45 years had lower odds (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.71-0.80) of being admitted to a trauma center for their injuries than did patients 46-65 years of age (OR, 0.57; 95% CI, 0.54-0.60), patients 66-85 years of age (OR, 0.35; 95% CI, 0.30-0.41), and patients older than 85 years (OR, 0.30; 95% CI, 0.25-0.36). Similar patterns were found when stratifying the analysis by trauma type and severity. Living more than 50 miles away from a trauma center (OR, 0.03; 95% CI, 0.01-0.06) and lack of county trauma center (OR, 0.17; 95% CI, 0.09-0.35) were also predictors of not receiving trauma care.ConclusionAge and likelihood of admission to a trauma center for injured patients were observed to be inversely proportional after controlling for other factors. System-level factors play a major role in determining which injured patients receive trauma care.

Dramatic Decreases in Mortality From Laparoscopic Colon Resections Based on Data From the Nationwide Inpatient Sample

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Arch Surg. 2011;146(5):594-599. doi:10.1001/archsurg.2011.79

Evaluating Popular Media and Internet-Based Hospital Quality Ratings for Cancer Surgery

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Arch Surg. 2011;146(5):600-604. doi:10.1001/archsurg.2011.119

Surgical Site Infection in Elective Operations for Colorectal Cancer After the Application of Preventive Measures

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Arch Surg. 2011;146(5):606-612. doi:10.1001/archsurg.2011.90

The Microbiology of Secondary and Postoperative Pancreatic InfectionsImplications for Antimicrobial Management

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Arch Surg. 2011;146(5):613-619. doi:10.1001/archsurg.2011.85
Special Article

The World Health Organization Program for Emergency Surgical, Obstetric, and Anesthetic CareFrom Mongolia to the Future

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Arch Surg. 2011;146(5):620-623. doi:10.1001/archsurg.2011.84
Invited Critique

Sorting Through the Evidence of Adult Pneumatosis Intestinalis as a Harbinger for Disaster vs Benign DiseaseComment on “Computed Tomographic Diagnosis of Pneumatosis Intestinalis”

Abstract Full Text
Arch Surg. 2011;146(5):511-511. doi:10.1001/archsurg.2011.96

How Many Criteria Does It Take to Remove a Single Parathyroid Gland?Comment on “Critical Role of Identification of the Second Gland During Unilateral Parathyroid Surgery”

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Arch Surg. 2011;146(5):516-516. doi:10.1001/archsurg.2011.77

The Palliative Care Triangle: A Strategy to Help Make Difficult Surgical DecisionsComment on “The Palliative Triangle”

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Arch Surg. 2011;146(5):522-523. doi:10.1001/archsurg.2011.68

Modern Day Bloodletting: Is That Laboratory Test Necessary?Comment on “Surgical Vampires and Rising Health Care Expenditure”

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Arch Surg. 2011;146(5):527-527. doi:10.1001/archsurg.2011.104

Abdominal Gunshot Wounds: Not Yet Ready for ImplementationComment on “Successful Selective Nonoperative Management of Abdominal Gunshot Wounds Despite Low Penetrating Trauma Volumes”

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Arch Surg. 2011;146(5):533-533. doi:10.1001/archsurg.2011.80

Incidentally, It's Still CancerComment on “Implications of Incidentally Discovered, Nonfunctioning Pancreatic Endocrine Tumors”

Abstract Full Text
Arch Surg. 2011;146(5):539-539. doi:10.1001/archsurg.2011.105

Rectal Cancer: The Good, the Bad, and the UglyComment on “Determining the Need for Radical Surgery in Patients with T1 Rectal Cancer ”

Abstract Full Text
Arch Surg. 2011;146(5):544-544. doi:10.1001/archsurg.2011.71

Enhanced Recovery Programs: Major Benefits Demonstrated AgainComment on “Adherence to the Enhanced Recovery After Surgery Protocol and Outcomes After Colorectal Cancer Surgery”

Abstract Full Text
Arch Surg. 2011;146(5):577-578. doi:10.1001/archsurg.2011.118

Surprise, Surprise!: More Surgery in Rural Areas Than in CitiesComment on “Rural-Urban Differences in Surgical Procedures for Medicare Beneficiaries”

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Arch Surg. 2011;146(5):584-584. doi:10.1001/archsurg.2011.38

Mortality in the ElderlyComment on “Factors Associated With Trauma Center Use for Elderly Patients With Trauma”

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Arch Surg. 2011;146(5):592-593. doi:10.1001/archsurg.2011.70

Choosing “The Best”Comment on “Evaluating Popular Media and Internet-Based Hospital Quality Ratings for Cancer Surgery”

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Arch Surg. 2011;146(5):604-605. doi:10.1001/archsurg.2011.97

Pancreatic InfectionsComment on “The Microbiology of Secondary and Postoperative Pancreatic Infections”

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Arch Surg. 2011;146(5):619-619. doi:10.1001/archsurg.2011.86

Teaching a New Dog Old TricksComment on “The World Health Organization Program for Emergency Surgical, Obstetric, and Anesthetic Care”

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Arch Surg. 2011;146(5):624-624. doi:10.1001/archsurg.2011.87
Special Feature

Image of the Month—Quiz Case

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Arch Surg. 2011;146(5):625-625. doi:10.1001/archsurg.2011.98-a

Image of the Month—Diagnosis

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Arch Surg. 2011;146(5):626-626. doi:10.1001/archsurg.2011.98-b

Image of the Month—Quiz Case

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Arch Surg. 2011;146(5):627-627. doi:10.1001/archsurg.2011.99-a

Image of the Month—Diagnosis

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Arch Surg. 2011;146(5):628-628. doi:10.1001/archsurg.2011.99-b

Image of the Month—Quiz Case

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Arch Surg. 2011;146(5):629-629. doi:10.1001/archsurg.2011.107-a

Image of the Month—Diagnosis

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Arch Surg. 2011;146(5):630-630. doi:10.1001/archsurg.2011.107-b
Correspondence

The Need for a Broader View of Human Factors in the Surgical Domain

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Arch Surg. 2011;146(5):631-632. doi:10.1001/archsurg.2011.72

Delayed Appendectomy

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Arch Surg. 2011;146(5):632-633. doi:10.1001/archsurg.2011.88

Prediction and Statistical Analysis

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Arch Surg. 2011;146(5):633-633. doi:10.1001/archsurg.2011.82

Prediction and Statistical Analysis—Reply

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Arch Surg. 2011;146(5):633-634. doi:10.1001/archsurg.2011.83
Poster Session

Improving Glucose Metabolism With Resveratrol in a Swine Model of Metabolic Syndrome Through Alteration of Signaling Pathways in the Liver and Skeletal Muscle

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Arch Surg. 2011;146(5):556-564. doi:10.1001/archsurg.2011.100
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