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  • Variation in Medicare Expenditures for Treating Perioperative Complications: The Cost of Rescue

    Abstract Full Text
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    JAMA Surg. 2016; 151(12):e163340. doi: 10.1001/jamasurg.2016.3340

    This retrospective cohort study evaluates differences across hospitals in the costs of care for patients surviving perioperative complications after major inpatient surgery.

  • JAMA Surgery December 1, 2016

    Figure 2: Survival and Use of Combination Epidural and General Anesthesia (EA-GA) for Abdominal Aortic Aneurysm (AAA) Surgery

    A, Survival after AAA surgery stratified according to EA use. Kaplan-Meier estimates with 95% Hall-Wellner CI bands; patients who received EA-GA had lower all-cause mortality (26%; 95% CI, 24% to 28%) compared with those who received GA alone (35%; 95% CI, 32% to 38%) at 5 years (log-rank P < .01). B, No change in EA-GA utilization rates was observed for elective, open AAA surgery during the 9-year study period. Annual estimated percentage change, −2.4% (95% CI, −5.1% to 0.4%; P = .13).
  • Long-term Cost-effectiveness in the Veterans Affairs Open vs Endovascular Repair Study of Aortic Abdominal Aneurysm: A Randomized Clinical Trial

    Abstract Full Text
    JAMA Surg. 2016; 151(12):1139-1144. doi: 10.1001/jamasurg.2016.2783

    This randomized clinical trial compares the use of health care services, costs, and cost-effectiveness between patients undergoing open and endovascular repair of abdominal aortic aneurysm.

  • JAMA Surgery December 1, 2016

    Figure 1: CONSORT Diagram

    Randomization and treatment of study patients. Adapted from Lederle et al. AAA indicates abdominal aortic aneurysm.
  • JAMA Surgery December 1, 2016

    Figure 1: Criteria for Patient Inclusion

    Patients who underwent elective, open abdominal aortic aneurysm (AAA) surgery from 2003 to 2011 were assessed using the Vascular Society Group of New England database. EA indicates epidural anesthesia; GA, general anesthesia.
  • JAMA Surgery December 1, 2016

    Figure 2: Cost-effectiveness Planes

    Bootstrap replications show the differences in costs, life-years, and quality-adjusted life-years (QALYs) on the cost-effectiveness plane between patients randomized to endovascular or open repair of abdominal aortic aneurysm (AAA). Differences are calculated as the endovascular repair group finding minus the open repair group finding. The large dot indicates the point estimate from the study. Solid diagonal line indicates willingness to pay $50 000 per life-year or QALY; dashed diagonal line, willingness to pay $100 000 per life-year or QALY.
  • JAMA Surgery September 1, 2016

    Figure 2: Relative Effect of Various Patient- and Hospital-Level Factors on In-Hospital Mortality Following Abdominal Aortic Aneurysm (AAA) Repair

    Aside from operative approach, intrinsic patient risk was the strongest independent predictor of in-hospital death following AAA repair. Hospital volume (Leapfrog criteria ≥50 AAA cases/year) and adequate institutional experience with open AAA repair techniques (≥25% open cases) also play a significant role. Relative impact represents β coefficient of each variable from the multivariable regression model. aP < .05.
  • Comprehensive Assessment of Factors Associated With In-Hospital Mortality After Elective Abdominal Aortic Aneurysm Repair

    Abstract Full Text
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    JAMA Surg. 2016; 151(9):838-845. doi: 10.1001/jamasurg.2016.0782

    This study describes the association of patient- and hospital-level factors on in-hospital mortality after elective abdominal aortic aneurysm repair.

  • Does Abdominal Aortic Aneurysm Screening Save Lives?

    Abstract Full Text
    JAMA Surg. 2016; 151(8):697-698. doi: 10.1001/jamasurg.2016.0044

    This Viewpoint reviews a meta-analysis investigating whether ultrasound screening for abdominal aortic aneurysm reduces mortality in men older than 65 years and questions the math and recommendation.

  • Survival After Endovascular vs Open Aortic Aneurysm Repairs

    Abstract Full Text
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    JAMA Surg. 2015; 150(12):1160-1166. doi: 10.1001/jamasurg.2015.2644

    This observational study reports that the survival advantage of endovascular over open aortic aneurysm repairs is maintained for 3 years, after which time, endovascular repair was associated with a higher mortality but mortality differences did not reach statistical significance during the study period.

  • JAMA Surgery December 1, 2015

    Figure 3: Reoperation and Rupture Over Time

    Unadjusted Kaplan-Meier analysis of long-term outcomes by repair type. AAA indicates abdominal aortic aneurysm; EVAR, endovascular. The shaded areas indicate 95% CIs.
  • Association of an Endovascular-First Protocol for Ruptured Abdominal Aortic Aneurysms With Survival and Discharge Disposition

    Abstract Full Text
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    JAMA Surg. 2015; 150(11):1058-1065. doi: 10.1001/jamasurg.2015.1861

    This cohort study evaluates the effect of an endovascular-first protocol for patients with a ruptured abdominal aortic aneurysm on perioperative mortality and associated early clinical outcomes.

  • Bundles of Care for Patients With Ruptured Abdominal Aortic Aneurysms: Is Endovascular Repair the Solution?

    Abstract Full Text
    JAMA Surg. 2015; 150(11):1065-1065. doi: 10.1001/jamasurg.2015.1872
  • Postoperative Surveillance and Long-term Outcomes After Endovascular Aneurysm Repair Among Medicare Beneficiaries

    Abstract Full Text
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    JAMA Surg. 2015; 150(10):957-963. doi: 10.1001/jamasurg.2015.1320

    This population-based cohort study investigates whether nonadherence to Society for Vascular Surgery guidelines for postoperative imaging surveillance is associated with poor outcomes among Medicare beneficiaries undergoing endovascular aneurysm repair.

  • JAMA Surgery October 1, 2015

    Figure 1: Flow Diagram for Cohort Construction

    AAA indicates abdominal aortic aneurysm; EVAR, endovascular aortic aneurysm repair; and HMO, health maintenance organization.
  • Elderly Man With 1-Month History of Flank and Abdominal Pain

    Abstract Full Text
    JAMA Surg. 2015; 150(10):1011-1012. doi: 10.1001/jamasurg.2015.0975

    An elderly man presented to the emergency department with a 1-month history of new-onset, persistent lower abdominal and flank pain that was sharp and constant with intermittent radiation to the back and associated anorexia with a 10-kg weight loss. What is your diagnosis?

  • Association Between Weekend Discharge and Hospital Readmission Rates Following Major Surgery

    Abstract Full Text
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    JAMA Surg. 2015; 150(9):849-856. doi: 10.1001/jamasurg.2015.1087

    This review of discharge abstracts from the California Office of State Health Planning and Development reports that weekend discharge after major surgery is not associated with higher 30- or 90-day readmission rates.

  • JAMA Surgery September 1, 2015

    Figure 2: Readmissions by Hospital Type

    Percentage of readmitted patients who are admitted to a different hospital than the discharging hospital. AAA indicates abdominal aortic aneurysm.
  • JAMA Surgery September 1, 2015

    Figure 1: Reasons For Readmission

    Most common reasons for readmission at 30 days after abdominal aortic aneurysm (AAA) repair (A), colectomy and proctectomy (B), total hip arthroplasty (C), and pancreatectomy (D). CAD indicates coronary artery disease; C difficile, Clostridiumdifficile; DGE, delayed gastric emptying; GI, gastrointestinal; MI, myocardial infarction; RAO, renal artery occlusion; SBO, small-bowel obstruction; UTI, urinary tract infection.
  • Hospital-Level Factors Associated With Mortality After Endovascular and Open Abdominal Aortic Aneurysm Repair

    Abstract Full Text
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    JAMA Surg. 2015; 150(7):632-636. doi: 10.1001/jamasurg.2014.3871

    This preliminary analysis of mortality after open abdominal aortic aneurysm repair and endovascular abdominal aortic aneurysm repair shows that outcomes depend on hospital-level effects, particularly hospital size and type. See also the Invited Commentary by Goodney.