There is an effect of patient and hospital characteristics on perioperative outcomes for pancreatic resection in the United States.
Retrospective cohort study.
Patient data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project from January 1988 to January 2003.
In-hospital mortality, perioperative complications, and mortality following a major complication.
A total of 103 222 patients underwent major pancreatic surgery. The annual number of pancreatic resections increased 15.0% during the 16-year study period. Resection for benign pancreatic disease increased 26.8%. Overall in-hospital mortality, perioperative complications, and mortality following a major complication were 6.5%, 35.6%, and 15.6%, respectively. Multivariate analysis demonstrated that significant independent predictors for these 3 perioperative outcomes were advancing age, male sex, medical comorbidity, and hospital volume for each type of pancreatic resection. The in-hospital mortality for pancreatoduodenectomy increases with age and ranges from 1.7% to 13.8% (P < .001). After adjusting for other confounders, the odds of in-hospital mortality for pancreatoduodenectomy, distal pancreatectomy, and total pancreatectomy in those 65 years or older were 4.78-fold, 3.84-fold, and 2.60-fold, respectively, lower in the high-volume hospitals compared with those in the lower-volume hospitals.
Perioperative complications derived from this population-based study were higher than those reported in many case series. A significant disparity was noted in perioperative outcomes among surgical centers across the United States. An outcome-based referral guideline may have an immediate effect on improving the quality of care in patients who undergo pancreatic resection for benign and malignant disease.
"The postoperative complications were based on guidelines in the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Following Teh et al. , we established 6 different categories of complications: "
[Show abstract][Hide abstract] ABSTRACT: Background:
Pancreatic cancer is one of the least common tumours, nevertheless it is one of the most lethal. This lethality is mainly due to the fact that the vast majority of patients are diagnosed in an advanced stage. The purpose of this study was to investigate how different covariates affect the transition to death or discharge with and without complications after pancreatic resection.
We analyse the impact of different factors on transitions after pancreatic resection based on a multi state model.
Transitions of interest include the transition to death/discharge with/without complications after pancreatic resection. We consider presence of comorbidities, higher age (>60), gender-male, lower hospital volume (<10 cases per year), type of surgery, localization of tumour and transfusion received as covariates with a potentially negative effect on the transition intensities to death with or without complications.
The multi-state model allows for a very detailed analysis of the impact of covariates on each transition, since effects of covariates may change depending on the current state of the patient, thus helping surgeons and patients throughout the surgical process and counselling patients if needed.
[Show abstract][Hide abstract] ABSTRACT: A secondary cache SRAM is an indispensable CPU partner in a high-performance system. The main objectives are: 1) pipeline burst operation; 2) 32b 500MHz (2GB/s) I/Os, and 3) point-to-point communication with a CPU, as well as shortened latency and reduced noise and power caused by high-speed, high-bandwidth I/O operation. A pre-fetched pipeline scheme enables the cycle time for an internal memory core (I-cycle) to be extended by N times that of an external bus cycle (E-cycle). This is modified to an SRAM to achieve both 4b pipeline-burst cache operation and 500MHz I/O frequency. In this case, I-cycle time of 8ns is four times E-cycle time (2ns)
Digest of Technical Papers - IEEE International Solid-State Circuits Conference 01/1997; DOI:10.1109/ISSCC.1997.585461
[Show abstract][Hide abstract] ABSTRACT: In this work three confined atoms are studied, Ca, Sr and Ba. We estimated the pressure on the system, by enclosing each atom within a sphere with rigid walls and changing the sphere radius. When the pressure is increased, these atoms undergo electronic transitions, from the s to the d orbital, as observed experimentally in the alkaline earth metals. The transition pressures obtained with this model correlate reasonably well with experimental information for Ca and Ba. For Sr, the predicted transition pressure is not close to the experimental data. Additionally, we compare the spin-potential, defined within the spin polarized Density Functional Theory version, with the singlet-triplet excitation energy, and we obtain a linear relationship between these quantities. The spin-potential towards higher multiplicities is related to the HOMOβ and LUMOα gap. In this way, we show that this HOMO–LUMO gap is also related with excitation energies in confined atoms, as has been pointed out for other non-confined systems. We discuss the regions where the HOMO–LUMO gap and the excitation energies show a relationship.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.