Missed Opportunities to Promptly Diagnose and Surgically Treat Adrenal Tumors

Abstract

defined as the proportion of Medicaid or uninsured patient encounters during that time. The highest quartile, representing SNH, was compared to that in lower-burden hospitals. RESULTS: Liver transplant recipients at SNH were more often black and of lower socioeconomic status (p < 0.01), but had similar Model for End-stage Liver Disease (MELD) scores (20 vs 20 vs 18) compared with recipients at medium and low burden hospitals. Lengths of stay (11 days vs 11 vs 10) and readmission rates (36.8% vs 37.1% vs 35.4%) were similar; however, SNH demonstrated higher in-hospital mortality rates (5.2% vs 4.5% vs 2.9%, p < 0.01). Despite these differences, patients who underwent LT at SNH and survived the perioperative setting achieved equivalent overall and graft survival rates at a median follow-up of 2 years (p > 0.05) (Figure). CONCLUSIONS: Despite differences in perioperative outcomes at SNH, these centers achieve equivalent long-term patient and graft survival rates for vulnerable patient populations requiring LT. Strict care standardization, as achieved in LT, may be a mechanism by which outcomes can be improved at SNH after other complex surgical procedures.

Incidental Adrenal Masses: Adherence to Guidelines and Methods to Improve Initial Follow-Up: A Systematic Review

“…There is evidence that these established guidelines are effective at identifying patients with clinically meaningful lesions, 15 that they are cost effective, 16 and that adherence reduces missed opportunities for timely diagnosis. 17 Because adherence to these guidelines and mechanisms that promote adherence are poorly understood, this systematic review was designed to accomplish the following two aims:…”