New developments in the assessment of COPD: early diagnosis is key.

Chronic obstructive pulmonary disease (COPD) is the most common chronic lung disease in the world, and its associated health burdens and costs are mounting. Until recently, it was generally accepted that targeting the diagnosis of COPD early in its course was a relatively fruitless effort, since treatments other than already ubiquitous smoking-cessation efforts were unlikely to alter its course. However, there is strong evidence to suggest that the majority of patients with objective COPD are not aware of their condition, and this leads to a significant delay in diagnosis, more aggressive smoking-cessation intervention, and potential treatment.

Comparison of right lobe donor hepatectomy with elective right hepatectomy for other causes in New York.

Introduction: Right lobe donor hepatectomy (RLDH) is a potential source of liver allografts given the ongoing shortage of deceased donor organs available. Since there is no live donor registry in the United States, a population-based, unsolicited state-wide analysis has yet to be reported.

Methods: The New York (NY) State Inpatient Database was used to query 1,524 elective liver lobectomies performed from 2001 to 2006.

Predictors of major complications after laparoscopic cholecystectomy: surgeon, hospital, or patient?

Background: Regionalization of care has been proposed for complex operations based on hospital/surgeon volume-mortality relationships. Controversy exists about whether more common procedures should be performed at high-volume centers. Using mortality alone to assess routine operations is hampered by relatively low perioperative mortality.

Surgeon volume metrics in laparoscopic cholecystectomy.

Aim: Numerous reports in the 1990s pointed to a learning curve for laparoscopic cholecystectomy (LC), critical in achieving excellent outcomes. As LC is now standard therapy for acute cholecystitis (AC), we aimed to determine if surgeon volume is still vital to patient outcomes.

Methods: The Nationwide Inpatient Sample was used to query 80,149 emergent/urgent cholecystectomies performed for AC from 1999 to 2005 in 12 states with available surgeon/hospital identifiers.

National hospital volume in acute pancreatitis: analysis of the Nationwide Inpatient Sample 1998-2006.

Background: The optimal management of acute pancreatitis remains controversial and current treatment protocols vary in degrees of medical and surgical management. Our group has previously shown in population-based studies that high-volume (HV) hospitals have lower rates of in-hospital mortality after pancreatectomy. We sought to examine if a similar mortality benefit exists for patients admitted with acute pancreatitis.

The impact of socioeconomic status on presentation and treatment of diverticular disease.

Introduction: Diverticular disease is a common medical problem, but it is unknown if lower socioeconomic status (SES) affects patient outcomes in diverticular disease.

Material And Methods: The New York (NY) State Inpatient Database was used to query 8,117 cases of diverticular disease occurring in patients aged 65-85 in 2006. Race and SES were assessed by creating a composite score based on race, primary insurance payer, and median income bracket.

Admission volume determines outcome for patients with acute pancreatitis.

Background & Aims: There is controversy over the optimal management strategy for patients with acute pancreatitis (AP). Studies have shown a hospital volume benefit for in-hospital mortality after surgery, and we examined whether a similar mortality benefit exists for patients admitted with AP.

Methods: Using the Nationwide Inpatient Sample, discharge records for all adult admissions with a primary diagnosis of AP (n = 416,489) from 1998 to 2006 were examined.

Predicting major complications after laparoscopic cholecystectomy: a simple risk score.

Introduction: Reported morbidity varies widely for laparoscopic cholecystectomy (LC). A reliable method to determine complication risk may be useful to optimize care. We developed an integer-based risk score to determine the likelihood of major complications following LC.

Is the growth in laparoscopic surgery reproducible with more complex procedures?

Background: Laparoscopic (LAP) surgery has experienced significant growth since the early 1990s and is now considered the standard of care for many procedures like cholecystectomy. Increased expertise, training, and technological advancements have allowed the development of more complex LAP procedures including the removal of solid organs. Unlike LAP cholecystectomy, it is unclear whether complex LAP procedures are being performed with the same growth today.

Surgeon volume impacts hospital mortality for pancreatic resection.

Objective: Improved outcomes after pancreatic resection (PR) by high volume (HV) surgeons have been reported in single center studies, which may be confounded with potential selection and referral bias. We attempted to determine if improved outcomes by HV surgeons are reproducible when patient demographic factors are controlled at the population level.

Methods: Using the Nationwide Inpatient Sample, discharge records with surgeon identifiers for all nontrauma PR (n = 3581) were examined from 1998 to 2005.

Nationwide volume and mortality after elective surgery in cirrhotic patients.

Background: The outcomes after elective surgery in patients with cirrhosis have not been well studied.

Study Design: We used the Nationwide Inpatient Sample (NIS) to identify all patients undergoing elective surgery for four index operations (cholecystectomy, colectomy, abdominal aortic aneurysm repair, and coronary artery bypass grafting) from 1998 to 2005. Elixhauser comorbidity measures were used to characterize patients' disease burden.

High volume and outcome after liver resection: surgeon or center?

Introduction: In a case controlled analysis, we attempted to determine if the volume-survival benefit persists in liver resection (LR) after eliminating differences in background characteristics.

Methods: Using the Nationwide Inpatient Sample (NIS), we identified all LR (n = 2,949) with available surgeon/hospital identifiers performed from 1998-2005. Propensity scoring adjusted for background characteristics.

Trends in surgical management for acute cholecystitis.

Introduction: Cholecystectomy, which can be performed with either a laparoscopic (LC) or open (OC) approach, remains the definitive treatment for acute cholecystitis (AC) in the United States. There has not been an overall evaluation of the safety and efficacy of LC vs. OC as treatment for AC.

Surgical specialization and operative mortality in hepato-pancreatico-biliary (HPB) surgery.

Introduction: Surgeon specialization has been shown to result in improved outcomes but may not be the sole measure of surgical quality in hepato-pancreatico-biliary (HPB) surgery. We attempted to determine which factors predominate in optimal patient outcomes between volume, surgeon, and hospital resources.

Methods: All non-transplant pancreatic (n = 7195) and liver operations (n = 4809) from the Nationwide Inpatient Sample (NIS) were examined from 1998-2005.