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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
76 to 100 of 1116 Research Studies DisplayedCarey K, Lin MY
Safety-net hospital performance under comprehensive care for joint replacement.
The objective of this study was to investigate the relative progress of safety-net hospitals (SNHs) under Medicare's Comprehensive Care for Joint Replacement (CJR) mandatory bundled payment model and to identify contributors to SNHs' realization of success under the CJR program. Secondary data on all CJR hospitals from 2016-2020 were taken from CMS public use files and from the American Hospital Association. The findings indicated that SNHs were less successful in meeting spending targets when compared to CJR hospitals overall. The authors concluded that the formula used by CMS to determine spending targets may not be sufficient to address disparities in SNH financial performances under mandatory bundled payment.
AHRQ-funded; HS027786.
Citation: Carey K, Lin MY .
Safety-net hospital performance under comprehensive care for joint replacement.
Health Serv Res 2023 Feb; 58(1):101-06. doi: 10.1111/1475-6773.14042..
Keywords: Hospitals, Surgery, Orthopedics, Provider Performance
Tsou AY, Kessler SK, Wu M
Surgical treatments for epilepsies in children aged 1-36 months: a systematic review.
The purpose of this article was to summarize the findings of a systematic review commissioned by the American Epilepsy Society to evaluate evidence and describe evidence gaps for surgical treatments for epilepsy in children aged 1 to 36 months without infantile spasms. The researchers searched EMBASE, MEDLINE, PubMed, and the Cochrane Library for studies published from 1/1/1999 to 8/19/21 and included studies reporting data on children aged 1 month to 36 months or less enrolled in surgical interventions or neurostimulation for epilepsy. Eighteen studies met inclusion criteria. The review found that seizure freedom for infants undergoing hemispherectomy/hemispherotomy ranged from 7% to 76% at 1 year after surgery. For non-hemispheric surgeries seizure freedom ranged from 40% to 70%. Over half of infants undergoing hemispherectomy/hemispherotomy achieved a favorable outcome (Engel I or II, ILAE I to IV, or >50% seizure reduction) at follow-up of over 1 year. The researchers note that the studies had important limitations. The researchers concluded that while evidence remains sparse and low quality, some infants achieve seizure freedom after surgery and 50% or greater achieve favorable outcomes.
AHRQ-funded; 75Q80120D00002.
Citation: Tsou AY, Kessler SK, Wu M .
Surgical treatments for epilepsies in children aged 1-36 months: a systematic review.
Neurology 2023 Jan 3;100(1):e1-e15. doi: 10.1212/wnl.0000000000201012..
Keywords: Children/Adolescents, Newborns/Infants, Surgery, Treatments, Evidence-Based Practice
Diaz A, Lindau ST, Obeng-Gyasi S
Association of hospital quality and neighborhood deprivation with mortality after inpatient surgery among Medicare beneficiaries.
The purpose of this cross-sectional study was to compare postoperative mortality among Medicare beneficiaries based on the level of neighborhood deprivation where they live and the hospital quality where they received care. The researchers examined outcomes among Medicare beneficiaries undergoing one of five common surgical procedures (colon resection, coronary artery bypass, cholecystectomy, appendectomy, or incisional hernia repair) between 2014 and 2018. Hospital quality was assigned using the Centers for Medicare & Medicaid Services Star Rating. Each beneficiary's neighborhood was identified at the census tract level and sorted into quintiles based on its Area Deprivation Index score. A risk matrix across hospital quality and neighborhood deprivation was created to determine the relative contribution of each to mortality after surgery. Data were analyzed from June 1 to December 31, 2021. The study included 1,898,829 Medicare beneficiaries. Patients from all neighborhood deprivation group quintiles sought care at hospitals across hospital quality levels. Thirty-day risk-adjusted mortality varied across high- and low-quality hospitals and across the least and most deprived neighborhoods. When combined, comparing patients from the least deprived neighborhoods going to high-quality hospitals vs patients from the most deprived neighborhoods going to low-quality hospitals, the variation increased further. The researchers concluded that both a patient's neighborhood and the hospital where they received treatment were associated with the risk of death after commonly performed inpatient surgical procedures. The associations of these factors on mortality may be additive. Efforts to address variation in postoperative mortality should include both hospital quality improvement and addressing drivers of neighborhood deprivation.
AHRQ-funded; HS028606.
Citation: Diaz A, Lindau ST, Obeng-Gyasi S .
Association of hospital quality and neighborhood deprivation with mortality after inpatient surgery among Medicare beneficiaries.
JAMA Netw Open 2023 Jan; 6(1):e2253620. doi: 10.1001/jamanetworkopen.2022.53620..
Keywords: Hospitals, Quality of Care, Surgery, Mortality, Social Determinants of Health
Theiss LM, Wood L, Shao C
Disparities in perioperative use of patient engagement technologies - not all use is equal.
The objective of this retrospective cohort study was to determine the association of patient-level characteristics and the use of a patient engagement technology during the perioperative period. Patients who had undergone elective colorectal surgery were enrolled in a patient engagement technology at a single institution and received educational content, healthcare reminders, patient reported outcome surveys, and health checks. Findings indicated that use of a patient engagement technology in the perioperative period differs significantly by sex, race/ethnicity, and insurance status. The authors concluded that this diverse usage should be considered during implementation of interventions to improve surgical outcomes.
AHRQ-funded; HS023009.
Citation: Theiss LM, Wood L, Shao C .
Disparities in perioperative use of patient engagement technologies - not all use is equal.
Ann Surg 2023 Jan;277(1):e218-e25. doi: 10.1097/sla.0000000000004970.
Keywords: Patient and Family Engagement, Disparities, Surgery, Hospital Discharge
Ko H, Martin BI, Nelson RE
How does the effect of the comprehensive Care for Joint Replacement model vary based on surgical volume and costs of care?
This article described differences in costs, quality, and patient selection between hospitals that continued to participate in the comprehensive Care for Joint Replacement (CJR) program after the CMS policy revision and those that withdrew from CJR before and after the implementation of CJR. Study subjects were Medicare beneficiaries who had undergone elective lower extremity joint replacement from 2013 to 2017. The results indicated that hospitals that continued to participate in CJR achieved a greater cost reduction. The authors noted that these the cost reductions were partly attributable to the avoidance of potential higher-cost patients.
AHRQ-funded; HS024714.
Citation: Ko H, Martin BI, Nelson RE .
How does the effect of the comprehensive Care for Joint Replacement model vary based on surgical volume and costs of care?
Med Care 2023 Jan;61(1):20-26. doi: 10.1097/mlr.0000000000001785..
Keywords: Orthopedics, Surgery, Healthcare Costs, Medicare, Payment
Likosky DS, Strobel RJ, Wu X
Interhospital failure to rescue after coronary artery bypass grafting.
Researchers conducted an observational study to evaluate whether interhospital variation in mortality rates for coronary artery bypass grafting was driven by complications and failure to rescue. Subjects were patients undergoing grafting surgery across 90 hospitals between 2011 and 2017. Results indicated the predicted mortality risk was similar across hospital observed:expected mortality terciles. Observed and expected failure to rescue rates were positively correlated among patients with major and overall complications. The researchers concluded that interhospital variability in successful rescue after coronary artery bypass grafting supports the importance of identifying best practices at high-performing hospitals; this includes early recognition and management of complications.
AHRQ-funded; HS026003.
Citation: Likosky DS, Strobel RJ, Wu X .
Interhospital failure to rescue after coronary artery bypass grafting.
J Thorac Cardiovasc Surg 2023 Jan;165(1):134-43.e3. doi: 10.1016/j.jtcvs.2021.01.064..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Surgery, Hospitals, Adverse Events
Konnyu KJ, Thoma LM, Cao W
Prehabilitation for total knee or total hip arthroplasty: a systematic review.
This systematic review sought to examine evidence on the benefits and harms of prehabilitation interventions for patients scheduled to undergo elective, unilateral total knee arthroplasty or total hip arthroplasty surgery for the treatment of primary osteoarthritis. Evidence from 13 total knee arthroplasty studies suggested that prehabilitation may result in increased strength and reduced length of hospital stays and may not lead to increased harms; it may be comparable in terms of pain, range of motion, and activities of daily living. No evidence or insufficient evidence was found for all other outcomes after total knee arthroplasty. No evidence or insufficient evidence was found for all total hip arthroplasty outcomes.
AHRQ-funded; 75Q80120D00001.
Citation: Konnyu KJ, Thoma LM, Cao W .
Prehabilitation for total knee or total hip arthroplasty: a systematic review.
Am J Phys Med Rehabil 2023 Jan;102(1):1-10. doi: 10.1097/phm.0000000000002006..
Keywords: Rehabilitation, Orthopedics, Evidence-Based Practice, Surgery
Shen MR, Jiang S, Millis MA
Racial variation in baseline characteristics and wait times among patients undergoing bariatric surgery.
The purpose of this study was to examine whether differences exist in baseline characteristics or access to care between white and non-white patients of bariatric surgery. The researchers utilized a statewide bariatric-specific data registry and assessed all patients of bariatric surgery who completed a baseline questionnaire prior to the operation and compared data among racial groups. A total of 73,141 patients were included with 25.5% self-identifying as non-white. Non-white males were the least represented group with 4% of all bariatric surgery cases performed. Despite having higher rates of college education, when compared to white patients non-white patients were more likely to be younger, disabled, and have Medicaid. Despite having higher rates of patients with a body mass index above 50 kg/m the median time from the first evaluation to surgery was longer among non-white patients (157 days vs. 127 days.) The study concluded that despite presenting with higher rates of severe obesity, when compared with white patients non-white patients of bariatric surgery are an extremely diverse group with greater socioeconomic disadvantages and longer wait times.
AHRQ-funded; HS000053.
Citation: Shen MR, Jiang S, Millis MA .
Racial variation in baseline characteristics and wait times among patients undergoing bariatric surgery.
Surg Endosc 2023 Jan; 37(1):564-70. doi: 10.1007/s00464-022-09292-w..
Keywords: Racial and Ethnic Minorities, Surgery, Obesity: Weight Management, Obesity, Disparities
Konnyu KJ, Pinto D, Cao W
Rehabilitation for total hip arthroplasty: a systematic review.
This systematic review sought to determine the comparative benefits and harms of rehabilitation interventions for patients who had undergone elective, unilateral total hip arthroplasty (THA) for the treatment of primary osteoarthritis. Evidence from 15 studies suggested that individual rehabilitation programs may not differ in terms of risk of harm, outcomes of pain, strength, activities of daily living, or quality of life. No differences in outcomes were found between different rehabilitation programs after THA. The authors concluded that further evidence is needed to inform decisions on which rehabilitation program attributes are most effective for various outcomes.
AHRQ-funded; 75Q80120D00001.
Citation: Konnyu KJ, Pinto D, Cao W .
Rehabilitation for total hip arthroplasty: a systematic review.
Am J Phys Med Rehabil 2023 Jan;102(1):11-18. doi: 10.1097/phm.0000000000002007..
Keywords: Rehabilitation, Orthopedics, Surgery, Evidence-Based Practice
Konnyu KJ, Thoma LM, Cao W
Rehabilitation for total knee arthroplasty: a systematic review.
This systematic review sought to determine comparative benefits and harms of rehabilitation interventions for patients had undergone elective, unilateral total knee arthroplasty for the treatment of primary osteoarthritis. Evidence from 53 studies suggested that diverse rehabilitation programs may lead to comparable improvements in pain, range of motion, and activities of daily living. No studies reported evidence of risk of harms due to rehabilitation delivered in the acute period nor among various postacute rehabilitation programs. All findings were of low strength of evidence.
AHRQ-funded; 75Q80120D00001.
Citation: Konnyu KJ, Thoma LM, Cao W .
Rehabilitation for total knee arthroplasty: a systematic review.
Am J Phys Med Rehabil 2023 Jan;102(1):19-33. doi: 10.1097/phm.0000000000002008..
Keywords: Rehabilitation, Surgery, Orthopedics, Evidence-Based Practice
Anjorin AC, Marcaccio CL, Rastogi V
Statin therapy is associated with improved perioperative outcomes and long-term mortality following carotid revascularization in the Vascular Quality Initiative.
This study evaluated the outcomes of carotid artery stenosis (CAS) patients using statin therapy before undergoing carotid revascularization in the Vascular Quality Initiative registry. The authors identified all patients who underwent carotid endarterectomy (CEA), transfemoral carotid artery stenting (tfCAS), or transcarotid artery revascularization (TCAR) in the Vascular Quality Initiative registry from January 2016 to September 2021. Compared with statin use, no statin use was associated with a higher risk of in-hospital stroke or death and 5-year mortality among CEA and tfCAS patients, although there was no significant difference in outcomes among TCAR patients.
AHRQ-funded; HS027285.
Citation: Anjorin AC, Marcaccio CL, Rastogi V .
Statin therapy is associated with improved perioperative outcomes and long-term mortality following carotid revascularization in the Vascular Quality Initiative.
J Vasc Surg 2023 Jan;77(1):158-69.e8. doi: 10.1016/j.jvs.2022.08.019..
Keywords: Cardiovascular Conditions, Medication, Stroke, Surgery, Outcomes
Rastogi V, Marcaccio CL, Kim NH
The effect of supraceliac versus infraceliac landing zone on outcomes following fenestrated endovascular repair of juxta-/pararenal aortic aneurysms.
The purpose of this study was to assess perioperative outcomes in patients in the Vascular Quality Initiative who underwent juxta-/pararenal FEVAR with supraceliac vs infraceliac sealing. 1,486 Patients who received an elective FEVAR for juxta-/pararenal aortic aneurysms in the Vascular Quality Initiative between 2014 and 2021were identified and included.
The researchers defined supraceliac sealing as proximal sealing in aortic zone 5, or zone 6 with a celiac scallop/fenestration/branch or celiac occlusion. The study’s primary outcomes were perioperative and 3-year mortality, and secondary outcomes were completion endoleaks, in-hospital complications, and variables related with 3-year mortality. The study found that of the included patients, 84% underwent infraceliac sealing, and 16% underwent supraceliac sealing. Of the supraceliac patients, 60% had a celiac fenestration/branch, 31% had a celiac scallop, and 9.2% had a celiac occlusion (intentional or unintentional). Compared with infraceliac sealing, there were no differences after risk-adjusted analysis in perioperative mortality following supraceliac sealing. Supraceliac sealing was associated with lower odds of type-IA completion endoleaks, but higher odds of any complication including cardiac complications, lower extremity ischemia and acute kidney injury when compared with infraceliac sealing. The researchers concluded that supraceliac sealing was associated with lower risk of type IA endoleaks and similar mortality compared with sealing at an infraceliac level. The researchers advise that providers should be aware that supraceliac sealing was related with higher perioperative morbidity.
The researchers defined supraceliac sealing as proximal sealing in aortic zone 5, or zone 6 with a celiac scallop/fenestration/branch or celiac occlusion. The study’s primary outcomes were perioperative and 3-year mortality, and secondary outcomes were completion endoleaks, in-hospital complications, and variables related with 3-year mortality. The study found that of the included patients, 84% underwent infraceliac sealing, and 16% underwent supraceliac sealing. Of the supraceliac patients, 60% had a celiac fenestration/branch, 31% had a celiac scallop, and 9.2% had a celiac occlusion (intentional or unintentional). Compared with infraceliac sealing, there were no differences after risk-adjusted analysis in perioperative mortality following supraceliac sealing. Supraceliac sealing was associated with lower odds of type-IA completion endoleaks, but higher odds of any complication including cardiac complications, lower extremity ischemia and acute kidney injury when compared with infraceliac sealing. The researchers concluded that supraceliac sealing was associated with lower risk of type IA endoleaks and similar mortality compared with sealing at an infraceliac level. The researchers advise that providers should be aware that supraceliac sealing was related with higher perioperative morbidity.
AHRQ-funded; HS027285.
Citation: Rastogi V, Marcaccio CL, Kim NH .
The effect of supraceliac versus infraceliac landing zone on outcomes following fenestrated endovascular repair of juxta-/pararenal aortic aneurysms.
J Vasc Surg 2023 Jan;77(1):9-19.e2. doi: 10.1016/j.jvs.2022.08.007..
Keywords: Cardiovascular Conditions, Surgery, Evidence-Based Practice, Patient-Centered Outcomes Research, Outcomes, Comparative Effectiveness, Treatments
Collins CR, Abel MK, Shui A
Preparing for participation in the centers for Medicare and Medicaid Services' bundle care payment initiative-advanced for major bowel surgery.
This study aimed to assess where the largest opportunities for care improvement lay with the bundled payment reimbursement model and how best to identify patients at high risk of suffering costly complications, including hospital readmission. The authors used a cohort of patients from 2014 and 2016 who met inclusion criteria for the Major Bowel Bundled Payment Program and performed a cost analysis to identify opportunities for improved care efficiency. Using the results, they identified readmissions as a target for improvement and then assessed whether the American College of Surgeons' National Surgical Quality Improvement Program surgical risk calculator (ACS NSQIP SRC) could accurately identify patients within the bundled payment population who were at high risk of readmission using a logistic regression model. Patients who were readmitted within 90-days post-surgery were 2.53 times more likely to be high-cost (>$60,000) then non-readmitted patients. However, the ACS NSQIP SRC did not accurately predict patients at high risk of readmission within the first 30 days post-surgery.
AHRQ-funded; HS024532.
Citation: Collins CR, Abel MK, Shui A .
Preparing for participation in the centers for Medicare and Medicaid Services' bundle care payment initiative-advanced for major bowel surgery.
Perioper Med 2022 Dec 9;11(1):54. doi: 10.1186/s13741-022-00286-9..
Keywords: Provider Performance, Payment, Hospital Readmissions, Quality Improvement, Quality of Care, Surgery, Medicare, Medicaid
Varady NH, Worsham CM, Chen AF
Inappropriate prescribing of opioids for patients undergoing surgery.
This study examined inappropriate prescribing of opioids for patients undergoing surgery, in this instance prescribing them to a patient’s spouse. Among 450,125 opioid-naïve couples with commercial insurance studied, for patients who did not fill perioperative opioid prescriptions themselves, the rate of spousal fills on the day of surgery (DOS) was 2.39 fills per 1,000 surgeries compared with 0.44 fills on all other perioperative days. Increases in spousal fills were not present for patients that filled opioid prescriptions themselves.
AHRQ-funded; HS026753.
Citation: Varady NH, Worsham CM, Chen AF .
Inappropriate prescribing of opioids for patients undergoing surgery.
Proc Natl Acad Sci U S A 2022 Dec 6;119(49):e2210226119. doi: 10.1073/pnas.2210226119..
Keywords: Opioids, Medication, Surgery, Practice Patterns, Provider: Physician
Fry BT, Howard RA, Gunaseelan V
Association of postoperative opioid prescription size and patient satisfaction.
The purpose of this prospective cohort study was to assess the relationship between postoperative opioid prescription size and patient-reported satisfaction among surgical patients. The researchers included 1,520 opioid-naive adult patients undergoing laparoscopic cholecystectomy, laparoscopic appendectomy, and minor hernia repair between January 1 and May 31, 2018. The main outcome was patient satisfaction measured on a scale of 0 to 10 and dichotomized into "highly satisfied" (9-10) and "not highly satisfied" (0-8). The explanatory variable of interest was size of opioid prescription at discharge from surgery, converted into milligrams of oral morphine equivalents (OME). The study found that 84.1% of patients were highly satisfied and 15.9% were not highly satisfied. There was no significant association between opioid prescription size and satisfaction. The researchers concluded that in a large cohort of patients undergoing common surgical procedures, there was no association between opioid prescription size at discharge after surgery and patient satisfaction.
AHRQ-funded; HS023313.
Citation: Fry BT, Howard RA, Gunaseelan V .
Association of postoperative opioid prescription size and patient satisfaction.
Ann Surg 2022 Dec 1;276(6):e1064-e69. doi: 10.1097/sla.0000000000004784..
Keywords: Opioids, Surgery, Medication, Patient Experience
Graber J, Juarez-Colunga E, Thigpen C
Development of reference charts for monitoring quadriceps strength with handheld dynamometry after total knee arthroplasty.
This retrospective analysis’ purpose was to develop reference charts that describe normative quadriceps strength recovery after total knee arthroplasty (TKA) as measured by handheld dynamometry (HHD). The authors analyzed post-TKA quadriceps strength recovery using a longitudinal dataset consisting of both clinical and research HHD data. They created sex-specific models for recovery using Generalized Additive Models for Location, Scale, and Shape and reference charts from the models to display the recovery of population centiles over the first six postoperative months. They analyzed a total of 588 patient records with 1176 observations. There was a rapid increase in quadriceps strength for both sexes over the first 60 postoperative days followed by a more gradual increase over the next 120 days. They found that males appeared to demonstrate faster recovery and greater strength on average compared to females. The reference charts may aid clinicians’ ability to monitor and intervene upon quadriceps weakness-a pronounced and debilitating post-TKA impairment-throughout rehabilitation.
AHRQ-funded; HS025692.
Citation: Graber J, Juarez-Colunga E, Thigpen C .
Development of reference charts for monitoring quadriceps strength with handheld dynamometry after total knee arthroplasty.
Disabil Rehabil 2022 Dec;44(24):7535-42. doi: 10.1080/09638288.2021.1995054..
Keywords: Surgery, Orthopedics, Rehabilitation
Baker AW, Ilieş I, Benneyan JC
Early recognition and response to increases in surgical site infections using optimised statistical process control charts - the early 2RIS trial: a multicentre stepped wedge cluster randomised controlled trial.
This study compared outcomes of traditional surgical site infection (SSI) surveillance versus optimized statistical control process (SPC) surveillance post-surgery. The authors conducted a stepped wedge cluster randomized trial of patients who underwent any of 13 types of common surgical procedures across 29 community hospitals in the Southeastern United States. They divided the 13 procedures into six clusters. The study period was from March 2016 through February 2020 with 204,233 unique patients undergoing 237,704 surgical procedures. SSIs occurred more frequently in patients assigned control surveillance (1171 procedures) compared to 781 procedures that received the intervention. More formal investigations were also generated from control surveillance – 74 formal investigations versus 24. Multiple best practice deficiencies were identified from optimized SPC surveillance as well.
AHRQ-funded; HS023821.
Citation: Baker AW, Ilieş I, Benneyan JC .
Early recognition and response to increases in surgical site infections using optimised statistical process control charts - the early 2RIS trial: a multicentre stepped wedge cluster randomised controlled trial.
EClinicalMedicine 2022 Dec;54:101698. doi: 10.1016/j.eclinm.2022.101698..
Keywords: Surgery, Healthcare-Associated Infections (HAIs)
Pannucci CJ, Fleming KI, Varghese TK
Low anti-factor Xa level predicts 90-day symptomatic venous thromboembolism in surgical patients receiving enoxaparin prophylaxis: a pooled analysis of eight clinical trials.
This study examined whether low anti-factor Xa (aFXa) level predicts 90-day symptomatic venous thromboembolism (VTE) in surgical patients receiving enoxaparin prophylaxis. The authors conducted a pooled analysis of 8 clinical trials from a single institution over a 4-year period. Among 985 patients, 2.3% had symptomatic 90-day VTE, 4.2% had 90-day clinically relevant bleeding, and 2.1% had major bleeding. Patients with initial low aFXa were significantly more likely to have 90-day VTE than patients with adequate or high xFXa (4.2% vs 1.3%). This relationship was significant for patients who received enoxaparin twice daily as opposed to once a day. No association was seen between high xFXa and 90-day clinically relevant bleeding or major bleeding.
AHRQ-funded; HS024326.
Citation: Pannucci CJ, Fleming KI, Varghese TK .
Low anti-factor Xa level predicts 90-day symptomatic venous thromboembolism in surgical patients receiving enoxaparin prophylaxis: a pooled analysis of eight clinical trials.
Ann Surg 2022 Dec 1;276(6):e682-e90. doi: 10.1097/sla.0000000000004589..
Keywords: Blood Thinners, Surgery, Medication, Blood Clots
Bongiovanni T, Gan S, Finlayson E
Prolonged use of newly prescribed gabapentin after surgery.
This study investigated postoperative prolonged gabapentin use in adults 65 years and older. The authors merged a 20% sample of Medicare Carrier, MedPAR, and Outpatient Files with Part D for 2013-2018. They defined new postoperative gabapentin as fills for 7 days before surgery until 7 days after discharge. Overall, 3% of all eligible patients (n = 17,970) had a new prescription for gabapentin postsurgery. Out of those, the mean age was 73 years old and 62% were female. The most common surgeries that gabapentin was prescribed for was total knee (45%) and total hip (21%) replacements. Prolonged use occurred in 22% of patients, with women, non-White, those with concurrent prolonged opioid use, and patients having undergone emergency surgery more likely to have prolonged use.
Citation: Bongiovanni T, Gan S, Finlayson E .
Prolonged use of newly prescribed gabapentin after surgery.
J Am Geriatr Soc 2022 Dec;70(12):3560-69. doi: 10.1111/jgs.18005..
Keywords: Medication, Surgery, Pain, Elderly, Practice Patterns
Schumacher JR, Zahrieh D, Chow S
Increasing socioeconomically disadvantaged patients' engagement in breast cancer surgery decision-making through a shared decision-making intervention (A231701CD): protocol for a cluster randomised clinical trial.
This paper describes the protocol for a multisite randomized trial to test the impact of a newly developed decision aid to increase socioeconomically disadvantaged patients' engagement in breast cancer surgery decision-making. The study will be conducted through 10 surgical clinics within the National Cancer Institute Community Oncology Research Program (NCORP). A stepped-wedge design with clinics will be randomized to the time of transition from usual care to the decision aid arm. Study participants will be female, aged ≥18 years, with newly diagnosed stage 0-III breast cancer who are planning breast surgery. Data collection will include a baseline surgeon survey, baseline patient survey, audio-recording of the surgeon-patient consultation, a follow-up patient survey and medical record data review. A subset of patients, surgeons, and clinic stakeholders will participate in interviews and focus groups.
AHRQ-funded; HS025194.
Citation: Schumacher JR, Zahrieh D, Chow S .
Increasing socioeconomically disadvantaged patients' engagement in breast cancer surgery decision-making through a shared decision-making intervention (A231701CD): protocol for a cluster randomised clinical trial.
BMJ Open 2022 Nov 17;12(11):e063895. doi: 10.1136/bmjopen-2022-063895..
Keywords: Cancer: Breast Cancer, Cancer, Patient and Family Engagement, Shared Decision Making, Patient-Centered Healthcare, Surgery, Women
Wu A, Wu JY, Lim M
Updates in intraoperative strategies for enhancing intra-axial brain tumor control.
This review looked at recent advances in intraoperative strategies for enhancing intra-axial brain tumor control. The authors looked at published research centered on different innovative tools and techniques, including fluorescence-guided surgery, new methods of drug delivery, and minimally invasive procedural options.
AHRQ-funded; HS028747.
Citation: Wu A, Wu JY, Lim M .
Updates in intraoperative strategies for enhancing intra-axial brain tumor control.
Neuro Oncol 2022 Nov 2;24(suppl 6):S33-S41. doi: 10.1093/neuonc/noac170..
Keywords: Cancer, Surgery, Imaging
Howard R, Gunaseelan V, Brummett C
New persistent opioid use after inguinal hernia repair.
The purpose of this retrospective cross-sectional study was to characterize the risk factors and incidence of new persistent use of opioids after inguinal hernia repair. During the study period of 208-2016, 59,795 patients met the inclusion criteria. The study found that 1.5% of patients continued filling their opioids prescriptions at least 3 months after their surgery. The greatest risk factor for developing new persistent opioid use after surgery was filling an opioid prescription in the 30 days before surgery. Other risk factors for new persistent opioid use after surgery included having a major postoperative complication, receiving a larger opioid prescription, having more comorbidities, and having certain mental health disorders or pain disorders.
AHRQ-funded; HS025778.
Citation: Howard R, Gunaseelan V, Brummett C .
New persistent opioid use after inguinal hernia repair.
Ann Surg 2022 Nov 1;276(5):e577-e83. doi: 10.1097/sla.0000000000004560..
Keywords: Opioids, Surgery, Medication, Pain
Solomon Y, Rastogi V, Marcaccio CL
Outcomes after transcarotid artery revascularization stratified by preprocedural symptom status.
In this study, researchers examined contemporary perioperative outcomes in patients who underwent transcarotid artery revascularization (TCAR) stratified by specific preprocedural symptom status. Using data from the Vascular Quality Initiative, they found that, after TCAR, compared with asymptomatic status, a recent stroke and a recent hemispheric TIA were associated with higher stroke/death rates, whereas a recent ocular TIA was associated with similar stroke/death rates. In addition, a formerly symptomatic status was associated with higher stroke/death rates compared with an asymptomatic status. The researchers concluded that their findings suggested that classifying patients undergoing TCAR as symptomatic versus asymptomatic may be an oversimplification and that patients' specific preoperative neurologic symptoms should instead be used in risk assessment and outcome reporting for TCAR.
AHRQ-funded; HS027285.
Citation: Solomon Y, Rastogi V, Marcaccio CL .
Outcomes after transcarotid artery revascularization stratified by preprocedural symptom status.
J Vasc Surg 2022 Nov;76(5):1307-15.e1. doi: 10.1016/j.jvs.2022.05.024..
Keywords: Cardiovascular Conditions, Surgery, Stroke, Outcomes
Anjorin AC, Marcaccio CL, Patel PB
Racial and ethnic disparities in 3-year outcomes following infrainguinal bypass for chronic limb-threatening ischemia.
This study’s objective was to determine the differences in 3-year outcomes after open infrainguinal bypass for chronic limb-threatening ischemia (CLTI) stratified by race/ethnicity and explored the potential factors contributing to these differences to help determine reasons why outcomes are worse for racial and ethnic minorities. The authors identified all CLTI patients who had undergone primary open infrainguinal bypass in the Vascular Quality Initiative registry from 2003 to 2017 with linkage to Medicare claims through 2018 for the 3-year outcomes. Primary outcomes were the 3-year rates of major amputation, reintervention, and mortality. They also recorded 30-day major adverse limb events (MALE) defined as major amputation or reintervention. Of the 7108 patients with CLTI 79% were non-Hispanic White, 15% were Black, 1% were Asian, and 6% were Hispanic. Compared with White patients, Black patients had higher rates of 3-year major amputation (Black vs White, 32% vs 19%), reintervention (Black vs White, 61% vs 57%), and 30-day MALE (Black vs White, 8.1% vs 4.9%) but lower mortality (Black vs White, 38% vs 42%). Hispanic patients also experienced higher rates of amputation (Hispanic vs White, 27% vs 19%), reintervention (Hispanic vs White, 70% vs 57%), and MALE (Hispanic vs White, 8.7% vs 4.9%). However, mortality was similar between Hispanic vs White groups. A higher presence of comorbidities in Black and Hispanic patients with CLTI is considered the greatest contributing factors to higher amputation and reintervention rates.
AHRQ-funded; HS027285.
Citation: Anjorin AC, Marcaccio CL, Patel PB .
Racial and ethnic disparities in 3-year outcomes following infrainguinal bypass for chronic limb-threatening ischemia.
J Vasc Surg 2022 Nov;76(5):1335-46.e7. doi: 10.1016/j.jvs.2022.06.026..
Keywords: Racial and Ethnic Minorities, Disparities, Outcomes, Surgery, Cardiovascular Conditions
Ko H, Pelt CE, Martin BI
Patient-reported outcomes following cemented versus cementless primary total knee arthroplasty: a comparative analysis based on propensity score matching.
The purpose of this study was to compare baseline and early post-operative global and condition-specific patient reported outcomes (PROs) between patients undergoing cemented versus cementless total knee arthroplasty (TKA). The researchers prospectively collected PROs through the Comparative Effectiveness Pulmonary Embolism Prevention After Hip and Knee Replacement (PEPPER) trial using the short-form of the Knee Injury and Osteoarthritis Outcome Score (KOOS-Jr.), the Patient-Reported Outcomes Measurement Information System Physical Health (PROMIS-PH), and the Numeric Pain Rating Scale (NPRS). Pre- and post-operative outcomes in 5,961 patients undergoing primary TKA between December 2016 and August 2021 were examined. The study found that significant pre to- post-operative were observed in both groups. The researchers concluded that patients with cemented TKA reported early benefit in KOOS-Jr. over those with cementless TKA.
AHRQ-funded; HS024714.
Citation: Ko H, Pelt CE, Martin BI .
Patient-reported outcomes following cemented versus cementless primary total knee arthroplasty: a comparative analysis based on propensity score matching.
BMC Musculoskelet Disord 2022 Oct 27;23(1):934. doi: 10.1186/s12891-022-05899-1..
Keywords: Orthopedics, Surgery, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice