S R G Finlayson

..Both patient and provider factors may explain the substantially higher use of this procedure in the private sector...

..The intent of this article is to stimulate further inquiry that will create a foundation for meaningful dialogue between rural surgeons, surgical leaders, and health-care policy makers...

..Studies examining the outcomes of surgery for gastroesophageal reflux disease (GERD) have consisted primarily of case series. We sought to assess trends in both utilization and outcomes of antireflux surgery from a national perspective...

..Otherwise, these groups were very similar. Long-term studies assessing hernia recurrence rates will be required to help determine the optimal approach to ventral hernia repair...

..The extent to which laparoscopic colon resections are used nationally is not known...

..7% vs 16.1%, P < .001) morbidity; and reintervention rates (1.33% vs 1.66%, P = .02). Outcome benefits of laparoscopic colectomy previously demonstrated in clinical trials are observed on a population level...

..Our objective is to present a system to estimate the opportunity cost for given surgical specialties and present a model to demonstrate its principle...

..This report describes an example of assessing opportunity cost in the transition from open to laparoscopic colectomy using pooled analysis data from the surgical literature and hospital financial data...

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..No national studies have explored trends in the use of sphincter-preserving rectal resection, while accounting for both hospital and patient factors...

..However, a population-based study examining causes of late death after EVAR vs open surgical repair has not been performed...

..To examine the trends in rates of endoscopic sinus surgery, open sinus procedures (open sinus surgery), and the prevalence of diagnosis of chronic rhinosinusitis in the Medicare population from 1998 to 2006...

..We used decision analysis to examine the effect of these competing risks on quality-adjusted life expectancy (QALE) after ENDO and OPEN...

..To examine this question we designed a retrospective cohort study in the setting of a tertiary care medical center...

..Because of the growing interest in surgery to treat morbid obesity, this study examined changes in the utilization and in-hospital outcomes of bariatric surgery in the United States over a 10-year period...

..We sought to understand the potential impact of volume-based referral policy on rural hospitals by estimating the proportion of low-volume operations occurring in rural versus urban hospitals...

..This trend was largely associated with an increase in the use of gastric bypass procedures...

..However, in the absence of viable alternative measures of surgical quality, imperfect proxies such as volume will likely continue to be a significant part of the national dialogue surrounding surgical quality...

..Additional competence in a few surgical areas that are not currently emphasized in general surgical training could result in an increased role for general surgeons practicing in rural areas...

..Relative to other major surgical procedures, gastric bypass for morbid obesity is associated with substantial gains in life expectancy. Long- term data from prospective studies are needed to confirm this finding...

..CONCLUSION: Our model suggests that surgery would likely benefit a high proportion of medically treated GERD patients. Individual assessment of quality of life with GERD should be considered to aid clinical decision making...

..Other regions had enough cases but too many hospitals performing them. Although consolidation of surgical services may be feasible in some settings, volume-based referral strategies are impractical for many U.S. regions...

..Little is known, however, about the frequency with which laparoscopic inguinal hernia repair is performed and the determinants of its utilization...

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..For many general surgeons, the professional isolation of rural practice serves as an obstacle to the adoption of new techniques. Whether this obstacle impeded the dissemination of laparoscopy in rural settings is not known...

..Further research is needed to determine the appropriate threshold for surgical treatment in patients with gastroesophageal reflux...

..A comprehensive assessment instrument that measures the burden of both symptoms and treatment is needed to determine the optimal management of gastroesophageal reflux disease (GERD), and we developed such an instrument...

..The potential impact of such policies on small rural hospital volume and revenue is unknown...