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Adil A. Shah Umar F. Bhatti Mikael Petrosyan George Washington Wasay Nizam Mallory Williams Daniel Tran Edward E. Cornwell Terrence M. Fullum 《American journal of surgery》2019,217(4):732-738
Background
Laparoscopic cholecystectomy (LC) is the standard operative intervention for gallbladder disease. Complications may necessitate conversion to an open cholecystectomy (OC). This study aims to determine the cost-consequences of laparoscopic-to-open conversion using a nationally-representative sample.Methods
Using the National Inpatient Sample (2007–2011), adult patients undergoing emergent LC were identified. Patients undergoing secondary-conversion to OC were subsequently identified. Multivariable regression analyses, accounting for differences in propensity-quintile, mortality, length of stay, and hospital-level factors were then performed to assess for differences in the odds of conversion and total predicted mean costs per index-hospitalization.Results
Of 225,805 observations, conversion to open occurred in 1.86% (n?=?4203) of cases. Increased age, African-American ethnicity, public-insurance and teaching-hospital status were associated with a higher likelihood of conversion (p?<?0.05) after risk-adjustment. Risk-adjusted odds of conversion increased by 34% (95%CI:1.33–1.36) for each day surgery was delayed. Risk-adjusted costs, were 259% higher (absolute-difference $23,358,p?<?0.05) with conversion. Mortality was higher amongst patients undergoing conversion to open (4.98% vs 0.34%,p?<?0.001).Conclusion
Patients undergoing conversion from laparoscopic to open cholecystectomy are at an increased risk of receiving disparate care and increased mortality. 相似文献5.
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Carriage of the New Delhi metallo-β-lactamase variant 1 (NDM-1) enables drug resistance to move between communities and hospitals. In Bangladesh, we found the blaNDM-1 gene in 62% of environmental waters and in fermentative and nonfermentative gram-negative bacteria. Escherichia coli sequence type (ST) 101 was most commonly found, reflecting a common global relationship between ST101 and NDM-1. 相似文献
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Difference in outcomes after antibody‐mediated rejection between abo‐incompatible and positive cross‐match transplantations 下载免费PDF全文
Lionel Couzi Miriam Manook Ranmith Perera Olivia Shaw Zubir Ahmed Nicos Kessaris Anthony Dorling Nizam Mamode 《Transplant international》2015,28(10):1205-1215
Graft survival seems to be worse in positive cross‐match (HLAi) than in ABO‐incompatible (ABOi) transplantation. However, it is not entirely clear why these differences exist. Sixty‐nine ABOi, 27 HLAi and 10 combined ABOi+HLAi patients were included in this retrospective study, to determine whether the frequency, severity and the outcome of active antibody‐mediated rejection (AMR) were different. Five‐year death‐censored graft survival was better in ABOi than in HLAi and ABOi+HLAi patients (99%, 69% and 64%, respectively, P = 0.0002). Features of AMR were found in 38%, 95% and 100% of ABOi, HLAi and ABOi+HLAi patients that had a biopsy, respectively (P = 0.0001 and P = 0.001). After active AMR, a declining eGFR and graft loss were observed more frequently in HLAi and HLAi+ABOi than in ABOi patients. The poorer prognosis after AMR in HLAi and ABOi+HLAi transplantations was not explained by a higher severity of histological lesions or by a less aggressive treatment. In conclusion, ABOi transplantation offers better results than HLAi transplantation, partly because AMR occurs less frequently but also because outcome after AMR is distinctly better. HLAi and combined ABOi+HLAi transplantations appear to have the same outcome, suggesting there is no synergistic effect between anti‐A/B and anti‐HLA antibodies. 相似文献
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Micro‐ and Macrosurgical Techniques in the Coverage of Gingival Recession Using Connective Tissue Graft: 2 Years Follow‐Up 下载免费PDF全文
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Sack RB Siddique AK Longini IM Nizam A Yunus M Islam MS Morris JG Ali A Huq A Nair GB Qadri F Faruque SM Sack DA Colwell RR 《The Journal of infectious diseases》2003,187(1):96-101
How Vibrio cholerae spreads around the world and what determines its seasonal peaks in endemic areas are not known. These features of cholera have been hypothesized to be primarily the result of environmental factors associated with aquatic habitats that can now be identified. Since 1997, fortnightly surveillance in 4 widely separated geographic locations in Bangladesh has been performed to identify patients with cholera and to collect environmental data. A total of 5670 patients (53% <5 years of age) have been studied; 14.3% had cholera (10.4% due to V. cholerae O1 El Tor, 3.8% due to O139). Both serogroups were found in all locations; outbreaks were seasonal and often occurred simultaneously. Water-use patterns showed that bathing and washing clothes in tube-well water was significantly protective in two of the sites. These data will be correlated with environmental factors, to develop a model for prediction of cholera outbreaks. 相似文献