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Tsafrir Vanounou
Harvard University
SurgeryPancreaticoduodenectomyPancreatic fistulaGeneral surgeryMedicine
7Publications
6H-index
554Citations
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Publications 7
Newest
#1Wande B. Pratt (Harvard University)H-Index: 17
#2Richard A. Steinbrook (Harvard University)H-Index: 16
Last. Charles M. Vollmer (Harvard University)H-Index: 40
view all 6 authors...
Introduction Epidural analgesia has emerged as a commonly applied method to improve pain management and reduce perioperative complications in major abdominal surgery. However, there is no detailed analysis of its efficacy for pancreatic operations. This study compares clinical and economic outcomes after epidural and intravenous analgesia for pancreatoduodenectomy.
40 CitationsSource
#1Tsafrir Vanounou (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 6
#2Wande B. Pratt (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 17
Last. Charles M. Vollmer (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 40
view all 4 authors...
Background The efficacy of prophylactic octreotide after pancreaticoduodenectomy has been rigorously scrutinized, yet few studies have specifically illustrated its impact in patients at high risk for pancreatic fistula. Applying a previously validated clinical classification scheme (International Study Group on Pancreatic Fistula) for postoperative pancreatic fistula severity, we examined whether prophylactic octreotide could effectuate a clinical or fiscal benefit, or both, after pancreatic res...
42 CitationsSource
#1Charles M. VollmerH-Index: 40
#2Wande B. PrattH-Index: 17
Last. Mark P. CalleryH-Index: 48
view all 5 authors...
Hypothesis A new quality assessment model for high-acuity surgery links process improvements with hospital costs and patient-centered outcomes and accurately reflects the clinical and economic impact of variance in patient acuity at the level of the practice and health care professional. Design Retrospective case series and cost analysis. Setting University tertiary care referral center. Patients A total of 296 patients undergoing elective pancreatic resection in 5 years. Main Outcome Measures E...
54 CitationsSource
#1Tsafrir Vanounou (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 6
#2Wande B. Pratt (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 17
Last. Mark P. Callery (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 48
view all 5 authors...
Background Although clinical pathways were developed to streamline patient care cost efficiently, few have been put to rigorous financial test. This is important today, because payors demand clear solutions to the cost-quality puzzle. We describe a novel, objective, and versatile model that can evaluate and link the clinical and economic impacts of clinical pathways. Study Design Outcomes for 209 consecutive patients undergoing high-acuity surgery (pancreaticoduodenectomy), before and after path...
79 CitationsSource
#1Wande B. PrattH-Index: 17
#2Shishir K. MaithelH-Index: 38
Last. Charles M. VollmerH-Index: 40
view all 6 authors...
Pancreatic fistula is widely regarded as the most ominous of complications following pancreatic resection. Its clinical impact and sequelae have been previously described and shown to contribute to the development of other morbid complications and high rates of mortality.1–4 Despite refinements in operative technique and advancements in postoperative management, fistulas still occur with a frequency of 5% to 30%.5–12 Efforts to mitigate this problem have included technical considerations (modifi...
251 CitationsSource
#1Wande B. Pratt (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 17
#2Shishir K. Maithel (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 38
Last. Charles M. Vollmer (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 40
view all 5 authors...
It is uncertain whether postoperative pancreatic fistulas after distal and central pancreatectomies behave similarly to those after pancreaticoduodenectomy. To date, this concept has not been validated either clinically or economically. Overall, 256 consecutive pancreatic resections from October 2001 to February 2006 (184 pancreaticoduodenectomies, 66 distal pancreatectomies, and 6 central pancreatectomies) were evaluated according to the International Study Group of Pancreatic Fistula classific...
88 CitationsSource
#1Tsafrir Vanounou (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 6
#2Wande B. Pratt (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 17
Last. Charles M. Vollmer (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 40
view all 4 authors...
RESULTS: A total of 29,637 patients had appendicitis, of whom 7,969 (26.9%) had a perforation. By univariate analysis, increased age, obesity, lower hospital volume, and an admission source other than the emergency department were the strongest predictors of perforation. By multivariate analysis, no difference existed in odds of perforation for white patients compared to either black or Hispanic patients. However, compared to privately insured patients, uninsured patients (OR 1.19, 95% C.I. [1.0...
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