National Healthcare Quality and Disparities Report
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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
101 to 125 of 1121 Research Studies DisplayedWu 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
Graber J, Kittelson A, Juarez-Colunga E
Comparing "people-like-me" and linear mixed model predictions of functional recovery following knee arthroplasty.
This study compared the relative strengths and weaknesses of 2 prediction model approaches for predicting functional recovery after knee arthroplasty: a neighbors-based "people-like-me" (PLM) approach and a linear mixed model (LMM) approach. The authors used 2 distinct datasets to train and then test PLM and LMM prediction approaches. They used the Timed Up and Go (TUG)-a common test of mobility-to operationalize physical function. Both approaches use patient characteristics and baseline postoperative TUG values to predict TUG recovery from days 1-425 following surgery. They then compared the accuracy and precision of the two approaches. A total of 317 patient records with 1379 TUG observations were used to train approaches, and 456 patient records with 1244 TUG observations were used to test the predictions. Both approaches performed similarly in terms of mean squared error and bias, but the PLM approach provided more accurate and precise estimates of prediction uncertainty.
AHRQ-funded; HS025692.
Citation: Graber J, Kittelson A, Juarez-Colunga E .
Comparing "people-like-me" and linear mixed model predictions of functional recovery following knee arthroplasty.
J Am Med Inform Assoc 2022 Oct 7;29(11):1899-907. doi: 10.1093/jamia/ocac123..
Keywords: Orthopedics, Surgery, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Outcomes
Alagoz E, Saucke M, Arroyo N
Communication during interhospital transfers of emergency general surgery patients: a qualitative study of challenges and opportunities.
This study’s objective was to understand the nature of and challenges to communication between referring (RP) and accepting (AP) providers transferring emergency general surgery (EGS) patients from the transfer center nurse’s (TCN) perspective. Worse outcomes have been shown to be experienced by transferred EGS patients than directly admitted patients. The authors interviewed 17 transfer center nurses (TCNs) at an academic medical center regarding (in)efficient and (in)effective communication between RPs and APs. The in-person interviews were recorded, transcribed and managed in NVivo. Four researchers developed a codebook, which was then co-coded with the transcripts. A consensus was developed to discuss emergency themes and arrive at higher-level concepts. Issues relating to ineffective communication included RPs that provided incomplete information because of a lack of necessary infrastructure, personnel, or technical knowledge; competing clinical demands; or a fear of the transfer request being rejected. Inefficient communication resulted from RPs being unfamiliar with the information APs expected and the lack of a structured process to share information and communication also failed when providers disagreed about the necessity of the transfer.
AHRQ-funded; HS025224.
Citation: Alagoz E, Saucke M, Arroyo N .
Communication during interhospital transfers of emergency general surgery patients: a qualitative study of challenges and opportunities.
J Patient Saf 2022 Oct 1;18(7):711-16. doi: 10.1097/pts.0000000000000979..
Keywords: Care Coordination, Communication, Transitions of Care, Surgery
Li RD, Joung RH, BC BC
Comprehensive evaluation of the trends in length of stay and post-discharge complications after colon surgery in the USA.
The purpose of this study focusing on colon surgery was to 1) describe temporal changes in length of stay (LOS) and post-discharge complications and 2) assess risk factors related with post-discharge complications. The study found that of the 98,136 patients who underwent colon resection between 2012 and 2018, the median LOS decreased from 5 days in 2012 to 4 days in 2018. Overall, the 30-day complication rate was 21.5%, which decreased during the study period. Of the 13 individual complications evaluated, 4 demonstrated a significant increase in the proportion of post-discharge events including overall SSI, superficial SSI, wound disruption, and UTI. Factors associated with the development of any post-discharge complication included female sex, ASA III/IV/V, dependent functional status, and higher BMI. Intraoperative factors included wound class, operation time, and approach. The study concluded that LOS and 30-day complications decreased over time, however the percentage of incidents taking place post-discharge increased for a number of complications.
AHRQ-funded; HS024516; HS026385
Citation: Li RD, Joung RH, BC BC .
Comprehensive evaluation of the trends in length of stay and post-discharge complications after colon surgery in the USA.
J Gastrointest Surg 2022 Oct;26(10):2184-92. doi: 10.1007/s11605-022-05391-0..
Keywords: Surgery, Adverse Events, Hospital Discharge
Bucher BT, Yang M, Richards Steed R, BT, Yang M, Richards Steed R
Geographic proximity of family members and healthcare utilization after complex surgical procedures.
This retrospective cohort study sought to determine the relationship between a patient's proximal familial social support, defined as the geographic proximity of family members, and healthcare utilization after complex cardiovascular and oncologic procedures. The authors defined healthcare utilization outcomes as 30-day all-cause readmission unplanned readmission, nonindex hospital readmission, index hospital length of stay, and home discharge disposition. The number of first-degree relatives (FDRs) living within 30 miles of the patient was measured using 60,895 patients undergoing complex cardiovascular procedures or oncologic procedures. Compared with patients with 0 to 1 FDRs, patients with 6+ FDRs living in close proximity had significantly lower rates of all-cause readmission (12.1% vs 13.5%), unplanned readmission, nonindex readmission; higher rates of home discharge. A larger number of FDRs living within 30 miles of the patient was significantly associated with a lower likelihood of all-cause readmission, 30-day unplanned readmission, nonindex readmission; higher likelihood of home discharge; and shorter index length of stay.
AHRQ-funded; HS025776.
Citation: Bucher BT, Yang M, Richards Steed R, BT, Yang M, Richards Steed R .
Geographic proximity of family members and healthcare utilization after complex surgical procedures.
Ann Surg 2022 Oct 1;276(4):720-31. doi: 10.1097/sla.0000000000005584..
Keywords: Surgery, Hospital Discharge, Hospital Readmissions, Healthcare Utilization
Warren DK, Peacock KM, Nickel KB
Postdischarge prophylactic antibiotics following mastectomy with and without breast reconstruction.
The authors investigated factors associated with post-discharge prophylactic antibiotic use after mastectomy with and without immediate reconstruction and the impact on surgical-site infection (SSI). They found that anti-methicillin-sensitive Staphylococcus aureus antibiotics were associated with decreased risk of SSI for patients who had mastectomy only and those who had mastectomy with immediate reconstruction. They concluded that the high numbers needed to treat suggest that potential benefits of post-discharge antibiotics should be weighed against potential harms associated with antibiotic overuse.
AHRQ-funded; HS019455.
Citation: Warren DK, Peacock KM, Nickel KB .
Postdischarge prophylactic antibiotics following mastectomy with and without breast reconstruction.
Infect Control Hosp Epidemiol 2022 Oct;43(10):1382-88. doi: 10.1017/ice.2021.400..
Keywords: Antibiotics, Cancer: Breast Cancer, Cancer, Medication, Surgery, Healthcare-Associated Infections (HAIs), Prevention, Women, Practice Patterns
Fritz B, King C, Chen Y
Protocol for the perioperative outcome risk assessment with computer learning enhancement (Periop ORACLE) randomized study.
This paper describes a protocol for an ongoing study that hypothesizes that anesthesiology clinicians can predict postoperative complications more accurately with machine learning assistance than without machine learning assistance. This investigation is a sub-study nested within the TECTONICS randomized clinical trial. Study team members who are anesthesiology clinicians working in a telemedicine setting are currently reviewing ongoing surgical cases and documenting how likely they feel the patient is to experience 30-day in-hospital death or acute kidney injury. These case reviews will be randomized to be performed with access to a display showing machine learning predictions for the postoperative complications or without access to the display, and the accuracy of the predictions will be compared across these two groups.
AHRQ-funded; HS024581.
Citation: Fritz B, King C, Chen Y .
Protocol for the perioperative outcome risk assessment with computer learning enhancement (Periop ORACLE) randomized study.
F1000Res 2022; 11:653. doi: 10.12688/f1000research.122286.2..
Keywords: Surgery, Risk, Outcomes, Health Information Technology (HIT)
Cohen TN, Anger JT, Kanji FF
A novel approach for engagement in team training in high-technology surgery: the Robotic-Assisted Surgery Olympics.
The purpose of this study was to develop the “Robotic-Assisted Surgery (RAS) Olympics,” a “serious game”-based educational competition to improve the skills required to successfully perform RAS. The pilot study was conducted at an academic medical center in Southern California. Sixteen operating room members participated in the event, reporting that they preferred the RAS Olympics to traditional training, enjoyed the activity, would recommend all staff participate, felt that it was relevant to their work, and believed that they practiced and learned new techniques that would improve their practice. The participants’ confidence in their skills did not change. The researchers concluded that new information was gained about new possibilities for simultaneously engaging and training surgical staff while emphasizing RAS safety and efficiency.
AHRQ-funded; HS026491.
Citation: Cohen TN, Anger JT, Kanji FF .
A novel approach for engagement in team training in high-technology surgery: the Robotic-Assisted Surgery Olympics.
J Patient Saf 2022 Sep 1;18(6):570-77. doi: 10.1097/pts.0000000000001056..
Keywords: Surgery, Training, Education: Continuing Medical Education, Simulation, Teams
Oke I, Hall N, Elze T
Adjustable suture technique is associated with fewer strabismus reoperations in the Intelligent Research in Sight Registry.
This study compared the reoperation rates of patients who underwent strabismus surgery during the first year with or without the adjustable suture technique. This retrospective cohort study looked at a total of 34,872 patients who underwent strabismus surgery with 72% undergoing horizontal muscle surgery, 17% vertical muscle surgery, and 11% combined horizonal and vertical muscle surgery. Adjustable suture surgery rates were 18% of surgeries. The overall 1-year reoperation rate was 7.7%, with 6.0% for patients treated with adjustable sutures and 8.1% for patients treated without adjustable sutures. There was a statistically significant 30% decrease in the odds of 1-year reoperation when adjustable sutures were used, a 40% increase in those with a history of prior strabismus surgery, and a 9% increase per decade of age at surgery.
AHRQ-funded; HS000063.
Citation: Oke I, Hall N, Elze T .
Adjustable suture technique is associated with fewer strabismus reoperations in the Intelligent Research in Sight Registry.
Ophthalmology 2022 Sep;129(9):1028-33. doi: 10.1016/j.ophtha.2022.04.021..
Keywords: Surgery, Registries
Khouja T, Polk DE, Suda KJ
Opioid prescribing by oral and maxillofacial surgeons in the United States, 2016-2019.
The objective of this study was to describe opioid prescribing trends among oral and maxillofacial surgeons (OMFS). The IQVIA Longitudinal Prescription Dataset, 2016-2019, was used to identify prescriptions written by OMFS. The results indicated that while OMFS-prescribed hydrocodone and oxycodone decreased in most states, 12 percent of states showed increases. Tramadol and codeine prescriptions also increased. From these findings, the authors concluded that targeted interventions are warranted in some areas.
AHRQ-funded; HS025177.
Citation: Khouja T, Polk DE, Suda KJ .
Opioid prescribing by oral and maxillofacial surgeons in the United States, 2016-2019.
J Public Health Dent 2022 Sep;82(4):491-94. doi: 10.1111/jphd.12544..
Keywords: Opioids, Medication, Practice Patterns, Orthopedics, Surgery, Dental and Oral Health, Provider: Physician
Laskow T, Zhu J, Buta B
Risk factors for nonresilient outcomes in older adults after total knee replacement.
The purpose of this study was to develop a simple measure of physical resilience and identify risk factors for nonresilient patient outcomes in total knee replacement procedures (TKR). The researchers conducted a secondary analysis of the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE-TJR) cohort study, including 7,239 adults aged 60 or older who underwent TKR between 2011 and 2015. The study found that the variables of age, body mass index, and Charlson Comorbidity Index (CCI) were associated with increased risk of physically nonresilient outcomes across the 3 patient-reported outcomes of the physical component summary (PCS), bodily pain (BP), and vitality (VT). A household income of greater than $45 000 associated with lower risk for PCS (RR = 0.81 [0.70-0.93]), BP (RR = 0.80 [0.69-0.91]), and VT (RR = 0.86 [0.78-0.93]). CONCLUSIONS: We operationalized physical resilience and identified factors predicting resilience after TKR. This approach may aid clinical risk stratification, guide further investigation of causes, and ultimately aid patients through the design of interventions to enhance physical resilience.
AHRQ-funded; HS018910.
Citation: Laskow T, Zhu J, Buta B .
Risk factors for nonresilient outcomes in older adults after total knee replacement.
J Gerontol A Biol Sci Med Sci 2022 Sep;77(9):1915-22. doi: 10.1093/gerona/glab257..
Keywords: Orthopedics, Surgery, Elderly, Risk
Herb J, Holmes M, Stitzenberg K
Trends in rural-urban disparities among surgical specialties treating cancer, 2004-2017.
The purpose of this study was to assess trends over time in rural and urban disparities in the supply of surgeons treating patients with cancer. The researchers utilized the Area Health Resource File to conduct a retrospective observational study of medical workforce changes from 2004-2017. The study found that the density of surgical specialists in rural areas declined from 16 to 14 per 100,000 population and in urban areas from 33 to 31 per 100,000 population for a rural-urban disparity increase of 8%. The percentage increase in the supply disparity between the rural and urban workforce was largest for colorectal surgeons (66%) and general surgeons (72%). The study concluded that temporal changes in the rural-urban physician workforce depend on community factors, region, and area of specialization.
AHRQ-funded; HS000032.
Citation: Herb J, Holmes M, Stitzenberg K .
Trends in rural-urban disparities among surgical specialties treating cancer, 2004-2017.
J Rural Health 2022 Sep;38(4):838-44. doi: 10.1111/jrh.12658..
Keywords: Rural Health, Disabilities, Surgery, Cancer, Workforce
Blakeslee-Carter J, Potter HA, Banks CA
Aortic visceral segment instability is evident following thoracic endovascular aortic repair for acute and subacute type B aortic dissection.
The purpose of this multicenter retrospective study was to investigate the visceral aortic behavior after thoracic endovascular aortic repair (TEVAR) for acute or subacute type B aortic dissection (TBAD) to identify any correlations with the clinical outcomes. The researchers reviewed all imaging studies for all patients from 2006 to 2020 who had undergone TEVAR for acute (0-14 days) and subacute (14-90 days) nontraumatic TBAD, identifying a total of 82 patients. The study found that VSI was present in 55% of the cohort, with an average maximal increase in the TAD of 10.4 ± 6.3 mm during a median follow-up of 2.1 years. Approximately one third of the cohort had experienced rapid VSI (growth ≥5 mm in the first year), and 4.8% of the cohort had developed a large paravisceral aortic aneurysm (TAD ≥5 cm) secondary to VSI. The preoperative factor most strongly associated with VSI was a cumulative number of zones dissected of six or more. The odds for aortic reintervention were significantly increased for cases in which VSI led to the development of a paravisceral aortic aneurysm of greater than or equal to 5 cm. The researchers concluded that VSI was identified in most patients who had undergone TEVAR for management of acute and subacute TBAD, and also identified a subset of patients who might have an increased risk of reintervention. The study results emphasize the importance of ongoing and lifelong monitoring after TEVAR.
AHRQ-funded; HS013852.
Citation: Blakeslee-Carter J, Potter HA, Banks CA .
Aortic visceral segment instability is evident following thoracic endovascular aortic repair for acute and subacute type B aortic dissection.
J Vasc Surg 2022 Aug;76(2):389-99.e1. doi: 10.1016/j.jvs.2022.02.046..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Surgery
Schlick CJR, Huang R, Brajcich BC
Unbundling bundles: evaluating the association of individual colorectal surgical site infection reduction bundle elements on infection rates in a statewide collaborative.
The purpose of this study was to evaluate the association of individual surgical site infection reduction bundle elements with infection rates. Focusing on patients who had elective colorectal resections at participating hospitals from 2016 to 2017, findings showed that bundle elements had varying association with infection reduction. Recommendations included implementation of colorectal surgical site infection reduction bundles in order to focus on the specific elements associated with low surgical site infections.
AHRQ-funded; HS024516.
Citation: Schlick CJR, Huang R, Brajcich BC .
Unbundling bundles: evaluating the association of individual colorectal surgical site infection reduction bundle elements on infection rates in a statewide collaborative.
Dis Colon Rectum 2022 Aug;65(8):1052-61. doi: 10.1097/dcr.0000000000002223..
Keywords: Surgery, Healthcare-Associated Infections (HAIs), Quality Improvement, Quality of Care
Nanji KC, Garabedian PM, Langlieb ME
Usability of a perioperative medication-related clinical decision support software application: a randomized controlled trial.
The purpose of this study was assess the usability of a newly developed, comprehensive, medication-related operating room clinical decision support (CDS) software and compare it with the standard electronic health record (EHR) medication workflow. Forty participants were randomized to a CDS group (n=20) or a control group (n=20) and asked to complete 7 simulation tasks. The study found that in a simulation setting the new CDS software improved efficiency and quality of care and reduced task time, excelling over the current EHR workflow.
AHRQ-funded; HS024764.
Citation: Nanji KC, Garabedian PM, Langlieb ME .
Usability of a perioperative medication-related clinical decision support software application: a randomized controlled trial.
J Am Med Inform Assoc 2022 Jul 12;29(8):1416-24. doi: 10.1093/jamia/ocac035..
Keywords: Medication, Clinical Decision Support (CDS), Health Information Technology (HIT), Surgery, Shared Decision Making
Skube SJ, Hu Z, Simon GJ
Accelerating surgical site infection abstraction with a semi-automated machine-learning approach.
The purpose of this study was to test a supervised machine learning algorithm developed for testing surgical site infection (SSI) on performing semi-automated SSI abstraction, and to demonstrate that a semi-automated approach to health data abstraction provides a high level of accuracy and significant efficiencies. The researchers evaluated data from 6,188 patients in a 2011-2013 dataset and 5,132 patients in a 2015-2015 dataset. The study concluded that very good performance is achieved using the semi-automated machine learning-aided SSI abstraction, which also accelerates the abstraction process.
AHRQ-funded; HS024532.
Citation: Skube SJ, Hu Z, Simon GJ .
Accelerating surgical site infection abstraction with a semi-automated machine-learning approach.
Ann Surg 2022 Jul 1;276(1):180-85. doi: 10.1097/sla.0000000000004354..
Keywords: Healthcare-Associated Infections (HAIs), Surgery, Health Information Technology (HIT)
Chao GF, Chhabra KR, Yang J
Bariatric surgery in Medicare patients: examining safety and healthcare utilization in the disabled and elderly.
The purpose of this study was to compare safety and healthcare use after sleeve gastrectomy versus Roux-en-Y gastric bypass in a national Medicare cohort. The researchers analyzed Medicare claims from 2012-2017 for 30,105 bariatric surgery patients receiving benefits due to age or disability and compared all outcomes between sleeve and bypass for each benefit group at 30 days, 1 year, and 3 years. The study found that among the disabled patients (n = 21,595), sleeve gastrectomy was associated with lower 3-year ED utilization, complications, reinterventions, rehospitalizations, and mortality. Cumulative expenditures were $46,277 after sleeve gastrectomy and $48,211 after gastric bypass. Among the elderly (n = 8510), sleeve was associated with lower 3-year ED utilization, complications, reinterventions, and rehospitalizations. Expenditures were $38,632 after sleeve gastrectomy and $39,270 after gastric bypass. Procedure treatment effect significantly differed by benefit group for paraesophageal hernia repair, revision, and mortality. The study concluded that healthcare utilization benefits of sleeve over bypass are maintained across Medicare elderly populations and Medicare disabled subpopulations.
AHRQ-funded; HS025778.
Citation: Chao GF, Chhabra KR, Yang J .
Bariatric surgery in Medicare patients: examining safety and healthcare utilization in the disabled and elderly.
Ann Surg 2022 Jul 1;276(1):133-39. doi: 10.1097/sla.0000000000004526..
Keywords: Obesity: Weight Management, Obesity, Surgery, Medicare, Elderly, Disabilities
VanderVeen DK, Oke I, Nihalani BR
Deviations from age-adjusted normative biometry measures in children undergoing cataract surgery: implications for postoperative target refraction and IOL power selection.
The purpose of this longitudinal cohort study was to assess whether children’s eyes that deviate from age-adjusted normative biometry measures are predictive of variations in target refraction and IOL power selection after cataract surgery. The researchers prospectively collected biometry data from the normal eyes of children under 10 years of age (100 eyes) with biometry data from eyes undergoing cataract surgery (162 eyes). The study analysis found greater myopic shift associated with younger age and male gender and concluded that adjustments can be made for cataract surgery for children’s eyes whose measures deviate from the norm for their age.
AHRQ-funded; HS000063.
Citation: VanderVeen DK, Oke I, Nihalani BR .
Deviations from age-adjusted normative biometry measures in children undergoing cataract surgery: implications for postoperative target refraction and IOL power selection.
Am J Ophthalmol 2022 Jul;239:190-201. doi: 10.1016/j.ajo.2022.02.022..
Keywords: Children/Adolescents, Eye Disease and Health, Surgery
Rastogi V, Kim NH, Marcaccio CL
Retroperitoneal versus transperitoneal approach for open repair of complex abdominal aortic aneurysms.
This retrospective analysis compared the outcomes of a transperitoneal approach (TP) versus the retroperitoneal approach (RP) for infrarenal abdominal aortic aneurysm (AAA) repair. Several studies have found an advantage for the RP approach. Among a cohort of 1,195 patients identified 729 (61%) underwent cAAA repair via a TP approach and 39% via an RP approach. After adjustment, the RP approach was associated with lower odds of peri-operative death (4.0% versus 7.2%) and lower odds of any major, cardiac, or wound complications and post-operative sepsis. Despite this, the proportion of repairs using an RP approach decreased between 2011 to 2015 and 2016 to 2019.
AHRQ-funded; HS027285.
Citation: Rastogi V, Kim NH, Marcaccio CL .
Retroperitoneal versus transperitoneal approach for open repair of complex abdominal aortic aneurysms.
Eur J Vasc Endovasc Surg 2022 Jul;64(1):23-31. doi: 10.1016/j.ejvs.2022.05.030..
Keywords: Cardiovascular Conditions, Surgery, Comparative Effectiveness, Evidence-Based Practice
Theiss LM, Wood T, McLeod MC
The association of health literacy and postoperative complications after colorectal surgery: a cohort study.
The purpose of this retrospective cohort study of patients undergoing elective colorectal surgery between 2015 and 2020 was to describe the association between health literacy, a determinant of health, and surgical outcomes. The outcomes of the study included: postoperative complications, length of stay (LOS), readmissions, and mortality. The study found that of 552 patients, 8.3% (46) had limited health literacy. Patients with limited health literacy had higher rates of overall complications, especially surgical site infections, and longer LOS. Readmission and mortality rates did not differ between limited and non-limited patients. The researchers concluded that limited health literacy is related to an increased likelihood of post-surgical complications in elective colorectal surgery patients.
Citation: Theiss LM, Wood T, McLeod MC .
The association of health literacy and postoperative complications after colorectal surgery: a cohort study.
Am J Surg 2022 Jun;223(6):1047-52. doi: 10.1016/j.amjsurg.2021.10.024..
Keywords: Health Literacy, Surgery, Adverse Events
Ayers DC, Yousef M, Zheng H
The prevalence and predictors of patient dissatisfaction 5-years following primary total knee arthroplasty.
This retrospective cohort study’s purpose was to determine dissatisfaction among total knee arthroplasty (TKA) patients 5 years after the procedure and to determine patient factors predictive of dissatisfaction. Demographic and clinical data on 4402 patients who underwent primary unilateral TKA between 2012 and 2015 were collected prospectively through the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE-TJR) comparative effectiveness consortium including diverse community and academic practices distributed across 23 states in the United States. Several different satisfaction scales were used to collect data at 1 year preoperatively and 5 years postoperatively including patient satisfaction (using a 5-point Likert satisfaction scale) and patient-reported outcome measures (PROMs) including the Knee injury and Osteoarthritis Outcome Score (KOOS) and Short-Form health survey (36-item). A total of 12.7% (5549) patients expressed dissatisfaction 5 years postoperatively. Higher dissatisfaction rates were present in young patients, patients with less education, and non-White patients. It was also significantly associated with poor preoperative and 5-year postoperative PROMs scores and less score improvement from baseline to 5 years.
AHRQ-funded; HS018910.
Citation: Ayers DC, Yousef M, Zheng H .
The prevalence and predictors of patient dissatisfaction 5-years following primary total knee arthroplasty.
J Arthroplasty 2022 Jun;37(6s):S121-s28. doi: 10.1016/j.arth.2022.02.077..
Keywords: Orthopedics, Surgery, Patient Experience