Amir A Ghaferi

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BACKGROUND Hospital mortality that is associated with inpatient surgery varies widely. Reducing rates of postoperative complications, the current focus of payers and regulators, may be one approach to reducing mortality. However, effective management of complications once they have occurred may be equally important. METHODS We studied 84,730 patients who(More)
OBJECTIVE We sought to determine whether hospital variations in surgical mortality were due to differences in complication rates or failure to rescue rates (ie, case-fatality rates in patients with a complication). BACKGROUND Wide variations in mortality after major surgery are becoming increasingly apparent. The clinical mechanisms underling these(More)
INTRODUCTION Although the relationship between surgical volume and mortality is well established, the mechanisms underlying these associations remain uncertain. We sought to determine whether increased mortality at low-volume centers was due to higher complication rates or less success in rescuing patients from complications. METHODS Using 2005 to 2007(More)
BACKGROUND Staged palliative surgical procedures have been an effective treatment of complex congenital heart defects. The Fontan procedure has been of particular benefit to infants with functional single-ventricle complexes but with the consequence of a sustained increase of right-sided venous pressure. METHODS We reviewed the clinical and pathologic(More)
VIPomas are rare pancreatic endocrine tumors associated with a well-defined clinical syndrome characterized by watery diarrhea, hypokalemia, and metabolic acidosis. The objective of this study was to review a single institution’s experience with VIPomas, as well as to review the English literature. A retrospective review of the Johns Hopkins pancreatic(More)
BACKGROUND Failure to rescue (ie, mortality after a major complication) has recently been demonstrated as a mechanism underlying differences between high and low mortality hospitals. In this study, we sought to better understand the hospital characteristics that may explain failure to rescue. STUDY DESIGN Using data from the 2000 to 2006 Nationwide(More)
OBJECTIVE To determine whether a hospital's ability to rescue patients from major complications underlies variation in outcomes for elderly patients undergoing emergent surgery. BACKGROUND Perioperative mortality rates in elderly patients undergoing emergent general/vascular operations are high and vary widely across Michigan hospitals. METHODS We(More)
The effect of obesity on perioperative outcomes following hepatic resection is not clearly defined. We sought to understand the implications of obesity on post-hepatectomy outcomes in a nationally represented cohort of patients. Using a retrospective cohort design, we studied the effect of obesity on complications and 30-day mortality using multivariable(More)
IMPORTANCE To effectively guide interventions aimed at reducing mortality in low-volume hospitals, the underlying mechanisms of the volume-outcome relationship must be further explored. Reducing mortality after major postoperative complications may represent one point along the continuum of patient care that could significantly affect overall hospital(More)
BACKGROUND Reliability adjustment, a novel technique for quantifying and removing statistical "noise" from quality rankings, is becoming more widely used outside surgery. We sought to evaluate its impact on hospital outcomes assessed with the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP). METHODS We used(More)