Showing papers by "Gilbert R. Upchurch published in 2008"
TL;DR: As the endovascular repair becomes more widespread, the relationship between hospital volume and operative mortality still remains, and high-volume hospitals are more likely to use theendovascular approach, and this explains a significant portion of the observed impact of hospital volume on mortality.
109 citations
TL;DR: Individualized treatment changed little over the period of study, remaining dependent on the pattern of anatomic lesions, patient age, and anticipated growth potential, and salutary outcomes exceeding 90% following carefully performed operative therapy.
105 citations
TL;DR: Percutaneous aortic fenestration and renal artery stenting are both technically feasible and associated with an acceptable complication rate, and most patients respond well symptomatically, obviating the need for immediate surgical relief of renal artery obstruction and allowing for renal malperfusion recovery.
60 citations
TL;DR: Despite more complex preoperative comorbidities, the TEVAR group had shorter hospitalization, a trend towards a reduction in early mortality, and similar late outcomes, according to a concurrent comparison with open descending thoracic aneurysm repair in elderly patients.
58 citations
TL;DR: When compared with coils for hypogastric embolization during EVAR, nitinol vascular plugs are less expensive, produce less technical complications, and are associated with a significantly lower incidence of gluteal claudication.
51 citations
TL;DR: It is shown that low-molecular-weight heparin accelerates or protects the endothelium and preserves medial smooth muscle cell integrity after DVT, but that this effect is limited to a relatively early time period.
31 citations
TL;DR: The available approaches to measure the quality of care for high-risk abdominal aortic aneurysm surgery will be reviewed and the promise and pitfalls of existing improvement efforts will be considered.
Abstract: Because of widespread recognition of variations in surgical performance, patients and payers are placing renewed focus on holding providers accountable for the quality of care they provide. Patients are becoming more cautious informed consumers. Payers are stepping up efforts to align reimbursement to physicians and hospitals with the quality of care they provide. Providers can count on quality measurement and improvement being part of the health policy landscape for the foreseeable future. As stakeholders in this movement, we need to continually refine and update our understanding of the best approach to answer this call for accountability, and each of us needs to fulfill our obligation to contribute to the improvement of our clinical specialty.
The purpose of this article is to update our knowledge on the best methods to approach quality measurement and improvement in aortic surgery. Whereas many agree that improving the quality of care is important, few agree on the best way to go about it. The available approaches to measure the quality of care for high-risk abdominal aortic aneurysm surgery will be reviewed. In addition, the promise and pitfalls of existing improvement efforts will be considered.
Abdominal aortic aneurysm repair is both a relatively common and high-risk procedure. Many patients die each year after elective repair of abdominal aortic aneurysms.1 Improving the quality of care provided to these patients could potentially avert many of these deaths. For this reason, operations for aortic aneurysm disease are often the focus of quality measurement and improvement. Although most existing quality measurement initiatives focus on a narrow group of operations, they invariably include surgery for abdominal aortic aneurysms.
Before improving the quality of care in patients with aortic disease, it must first be decided on how to best measure it. Unfortunately, no consensus on how to go about measuring quality …
16 citations