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
51 to 75 of 85 Research Studies DisplayedHoward R, Chao GF, Yang J
Medication use for obesity-related comorbidities after sleeve gastrectomy or gastric bypass.
The purpose of this comparative effectiveness research study was to evaluate prior laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass patients and compare the incidence of medication discontinuation and restart of diabetes, hypertension, and hyperlipidemia medications. The researchers reviewed the records of adult Medicare beneficiaries who underwent sleeve gastrectomy or gastric bypass between January 1, 2012, to December 31, 2018, and had a claim for diabetes, hypertension, or hyperlipidemia medication in the 6 months before surgery with a corresponding diagnosis. The study found that when compared with sleeve gastrectomy, gastric bypass was associated with a slightly higher 5-year cumulative incidence of medication discontinuation among 30,588 patients with diabetes medication use and diagnosis at the time of surgery, 5,081 patients with antihypertensive medication use and diagnosis at the time of surgery and 35,055 patients with lipid-lowering medication use and diagnosis at the time of surgery. Among the patients who discontinued medication, gastric bypass was also associated with a slightly lower incidence of medication restart up to 5 years after discontinuation. The researchers concluded that gastric bypass was associated with a slightly higher incidence of medication discontinuation and a slightly lower incidence of medication restart among patients who discontinued medication than sleeve gastrectomy.
AHRQ-funded; HS025778; HS025365.
Citation: Howard R, Chao GF, Yang J .
Medication use for obesity-related comorbidities after sleeve gastrectomy or gastric bypass.
JAMA Surg 2022 Mar;157(3):248-56. doi: 10.1001/jamasurg.2021.6898..
Keywords: Obesity, Obesity: Weight Management, Surgery, Medication
Schreyer J, Koch A, Herlemann A
RAS-NOTECHS: validity and reliability of a tool for measuring non-technical skills in robotic-assisted surgery settings.
This study’s objective was to develop and consent-validate a tool to assess multidisciplinary non-technical skills (NTS) in robotic-assisted surgery (RAS). The authors conducted a scoping literature review first to compile a set of RAS-specific teamwork behaviors. They then merged these behaviors with a well-established assessment tool on operating room (OR) teamwork called NOTECHS II. Finally, the new tool RAS-NOTECHS was applied in standardized observations of real-world procedures to test its reliability. The scoping review found 5242 articles, of which 21 were included based on pre-established inclusion criteria. The authors elicited 16 RAS-specific behaviors from the literature base. They were synthesized further with 18 behavioral markers into a list of 26 behavioral markers. The list was reviewed by 7 RAS experts and condensed to 15 expert-validated RAS-specific behavioral markers. For five observations of urologic RAS procedures, inter-rater agreement for identification of behavioral markers was strong. Agreement of RAS-NOTECHS scores ranged from moderate to strong agreement.
AHRQ-funded; HS026491.
Citation: Schreyer J, Koch A, Herlemann A .
RAS-NOTECHS: validity and reliability of a tool for measuring non-technical skills in robotic-assisted surgery settings.
Surg Endosc 2022 Mar;36(3):1916-26. doi: 10.1007/s00464-021-08474-2..
Keywords: Surgery
Graber J, Lockhart S, Matlock DD
"This is not negotiable. You need to do this…": a directed content analysis of decision making in rehabilitation after knee arthroplasty.
In this qualitative study, researchers sought to understand patients' and physical therapists' perspectives related to decision making during outpatient rehabilitation after total knee arthroplasty (TKA) and further to describe potential barriers and opportunities for shared decision making (SDM) in this setting. They found that physical therapists described using decision-making strategies with varying levels of patient involvement, while both patients and physical therapists described barriers to routine use of SDM in the outpatient setting. They also presented actionable strategies for overcoming these barriers for providers and organizations seeking consistently to use SDM in outpatient TKA rehabilitation.
AHRQ-funded; HS025692.
Citation: Graber J, Lockhart S, Matlock DD .
"This is not negotiable. You need to do this…": a directed content analysis of decision making in rehabilitation after knee arthroplasty.
J Eval Clin Pract 2022 Feb;28(1):99-107. doi: 10.1111/jep.13591..
Keywords: Shared Decision Making, Rehabilitation, Orthopedics, Surgery, Patient-Centered Healthcare
Greenberg JK, Brown DS, Olsen MA
Association of Medicaid expansion under the Affordable Care Act with access to elective spine surgical care.
This study's goal was to evaluate the impact of Medicaid expansion under the Affordable Care Act on the volume and payer mix of elective spine surgery in the United States. The authors evaluated elective spinal surgeries performed in the U.S. from 2011 to 2016 and included 10 states with expanded Medicaid access and 4 states that did not. They identified 218,648 surgical procedures performed in 10 Medicaid expansion states and 118,693 procedures performed in 4 nonexpansion states. Medicaid expansion was associated with a 17% increase in mean hospital spine surgical volume and a 23% increase in Medicaid volume. Privately insured surgical volumes did not change significantly. This increase indicated improved access to care.
AHRQ-funded; HS027075.
Citation: Greenberg JK, Brown DS, Olsen MA .
Association of Medicaid expansion under the Affordable Care Act with access to elective spine surgical care.
J Neurosurg Spine 2022 Feb;36(2):336–44. doi: 10.3171/2021.3.Spine2122..
Keywords: Healthcare Cost and Utilization Project (HCUP), Medicaid, Access to Care, Surgery
Ross SW, Reinke CE, Ingraham AM
Emergency general surgery quality improvement: a review of recommended structure and key issues.
In this article, the authors presented a collective narrative review of advances in quality improvement structure in emergency general surgery (EGS) in recent years and summarized plans for a national EGS registry and American College of Surgeons verification for this under-resourced area of surgery.
AHRQ-funded; HS025224.
Citation: Ross SW, Reinke CE, Ingraham AM .
Emergency general surgery quality improvement: a review of recommended structure and key issues.
J Am Coll Surg 2022 Feb;234(2):214-25. doi: 10.1097/xcs.0000000000000044..
Keywords: Surgery, Quality Improvement, Quality of Care
Joseph JM, Gori D, Curtin C
Gaps in standardized postoperative pain management quality measures: a systematic review.
Poor pain control in patients can lead to chronic pain, chronic opiate use or addiction, and patient suffering, making postoperative pain an important clinical issue. The researchers state that it is unclear whether measures for managing pain after surgery exist, warranting the study goal of assessment of the availability of postoperative pain management quality measures, including National Quality Forum-endorsed measures. In November 2019, the researchers conducted a systematic literature review using the National Quality Forum Quality Positioning System, the Agency for Healthcare Research and Quality Indicators, and the Centers for Medicare and Medicaid Services Measures Inventory Tool databases, to identify quality measures for the period between March 11, 2015, and March 11, 2020. The review identified 19 pain management quality measures, 5 of which were endorsed by the National Quality Forum. Three of the non-endorsed measures were specific to postoperative pain, with none of the endorsed measures specific to post-operative pain. The study concluded that there is a need for published, endorsed, rigorous postoperative pain quality measures.
AHRQ-funded; HS024096; HS027434.
Citation: Joseph JM, Gori D, Curtin C .
Gaps in standardized postoperative pain management quality measures: a systematic review.
Surgery 2022 Feb;171(2):453-58. doi: 10.1016/j.surg.2021.08.004..
Keywords: Pain, Surgery, Quality Measures, Quality of Care, Practice Patterns
Lai LY, Kaufman SR, Modi PK
Impact of advanced practice provider integration into multispecialty group practices on outcomes following major surgery.
Researchers examined the impact of advanced practice provider (APP) integration into multispecialty group practices on outcomes after major surgery. Using Medicare data, they found that integration of APPs into multispecialty group practices was associated with improved postoperative outcomes after major surgery. They recommended that future research identify the mechanisms by which APPs improve outcomes to inform optimal utilization.
AHRQ-funded; HS025707.
Citation: Lai LY, Kaufman SR, Modi PK .
Impact of advanced practice provider integration into multispecialty group practices on outcomes following major surgery.
Surg Innov 2022 Feb;29(1):111-17. doi: 10.1177/15533506211013150..
Keywords: Surgery, Healthcare Delivery
Merkow RP, Massarweh NN
Looking beyond perioperative morbidity and mortality as measures of surgical quality.
The authors discussed the problems with a contemporaneous focus on morbidity and mortality as surgical quality measures and offered potential alternative options which could better refine and evolve surgical quality measurement, including process measures, value-based measures, patient-centered measures, and health equity.
AHRQ-funded; HS026385.
Citation: Merkow RP, Massarweh NN .
Looking beyond perioperative morbidity and mortality as measures of surgical quality.
Ann Surg 2022 Feb;275(2):e281-e83. doi: 10.1097/sla.0000000000004966..
Keywords: Surgery, Quality Measures, Quality of Care, Mortality
Ko H, Martin BI, Nelson RE
Patient selection in the Comprehensive Care for Joint Replacement model.
This study investigated whether the Comprehensive Care for Joint Replacement (CJR) program induced participating hospitals to 1) preferentially select lower risk patients, 2) reduce 90-day episode-of-care costs, 3) improve quality of care, and 4) achieve greater cost reduction during its second year. The authors identified Medicare beneficiaries age 65 years or older undergoing hip or knee joint replacement from fee-for-service inpatient (Part A) claims from January 2013 through August 2017. Cases were linked to subsequent outpatient, Part B, home health agency, and skilled nursing facility claims. The effect of CJR was estimated for 785 participating hospitals in 67 metropolitan statistical area (MSA) and compared to those in 104 non-CJR MSAs (962 hospitals total). They excluded 172 hospitals from their analysis due to their preexisting BPCI participation. Reductions in 90-day episode-of-care costs were greater among CJR hospitals, which was largely driven by a 16.8% decline in 90-day spending in skilled nursing homes. CJR hospitals also significantly reduced the 90-day readmission rate and preferentially avoided patients 85 years or older and Black patients.
AHRQ-funded; HS024714.
Citation: Ko H, Martin BI, Nelson RE .
Patient selection in the Comprehensive Care for Joint Replacement model.
Health Serv Res 2022 Feb;57(1):72-90. doi: 10.1111/1475-6773.13880..
Keywords: Orthopedics, Surgery
Chhabra KR, Ghaferi AA, Yang J
Relationship between health care spending and clinical outcomes in bariatric surgery: implications for Medicare bundled payments.
This study’s objective was to evaluate sources of 90-day episode spending variation in Medicare patients undergoing bariatric surgery and whether spending variation was related to quality of care. A retrospective analysis of fee-for-service Medicare claims data from 761 acute care hospitals providing inpatient bariatric surgery was conducted between January 1, 2011 and September 30, 2016. Of 64,537 bariatric patients, 46% went sleeve gastrectomy, 22% revisited the emergency department (ED) within 90 days, and 12.5% were readmitted. Average 90-day payments were $14,124, ranging from $12,220 to $16,887. The largest components of spending variation were readmissions (44% of variation), post-acute care (19%), and index professional fees (15%). The lowest spending hospitals had the lowest complication, ED visit, post-acute utilization, and readmission rates.
AHRQ-funded; HS024403; HS023597.
Citation: Chhabra KR, Ghaferi AA, Yang J .
Relationship between health care spending and clinical outcomes in bariatric surgery: implications for Medicare bundled payments.
Ann Surg 2022 Feb;275(2):356-62. doi: 10.1097/sla.0000000000003979..
Keywords: Healthcare Costs, Surgery, Obesity, Outcomes
Patel PB, De Guerre L, Marcaccio CL
Sex-specific criteria for repair should be utilized in patients undergoing aortic aneurysm repair.
This study’s goal was determine if identifying inherent anatomic differences between sexes, aortic size index (ASI) and aortic height index (AHI) may provide an additional method for guiding treatment for abdominal aortic aneurysm (AAA) surgery. Females are more likely to undergo repair at smaller aortic diameter compared with male patients. The authors identified all patients who underwent AAA repair between 2003 and 2019 in the Vascular Quality Initiative database. The Dubois and Dubois formula was used to calculate body surface area; aortic diameter was divided by body surface area to calculate ASI, and aortic diameter was divided by height to calculate AHI. They identified 55,647 patients, of whom 12,664 were female (20%). For both types of repairs (intact and rupture), female patients were older, less likely to undergo endovascular aneurysm repair, and more likely to have comorbid conditions. Female patients underwent repair at smaller median aortic diameter compared with male patients for intact (5.4 vs 5.5 cm) and rupture repair (6.7 vs 7.7 cm). When they analyzed the cumulative distribution of rupture repair in male patients, they found that 12% of rupture repairs were performed at an aortic diameter below 5.5 cm, but to achieve the same proportion of rupture repair in female patients, the repair diameter was only 4.9 cm. When both ASI and AHI were used, female and male patients both reached 12% of rupture repair at an ASI of 2.7 cm/m(2) and an AHI of 3.0 cm/m.
AHRQ-funded; HS027285.
Citation: Patel PB, De Guerre L, Marcaccio CL .
Sex-specific criteria for repair should be utilized in patients undergoing aortic aneurysm repair.
J Vasc Surg 2022 Feb; 75(2):515-25. doi: 10.1016/j.jvs.2021.08.060..
Keywords: Sex Factors, Cardiovascular Conditions, Surgery
Dos Santos Marques IC, Herbey II, Theiss LM
Understanding the surgical experience for Black and White patients with inflammatory bowel disease (IBD): the importance of health literacy.
The purpose of this qualitative study was to describe the surgical experience for Black and White inflammatory bowel disease patients. Same race, semi-structured qualitative interviews with patients with IBD who had undergone surgery were conducted to explore barriers and facilitators to a positive or negative surgical experience. The study reported that 6 focus groups were conducted with 10 Black and 17 White IBD participants with a mean age of 44.8 years, 52% of whom were male and 65% of whom had Crohn’s disease. Four themes were identified that most characterized the surgical experience: the impact of the IBD diagnosis, the quality of the information that was provided, disease management, and the surgery. Within these theme groupings, identified barriers to a positive surgical experience included inadequate personal knowledge of IBD, ineffective written and verbal communication, lack of a support system and complications after surgery. Both groups indicated that information was provided inconsistently which led to unclear expectations of surgical outcomes. The study concluded that surgical experiences vary between Black and White patients, but both groups emphasized the need for understandable, accurate, and trustworthy health information.
AHRQ-funded; HS023009; HS013852.
Citation: Dos Santos Marques IC, Herbey II, Theiss LM .
Understanding the surgical experience for Black and White patients with inflammatory bowel disease (IBD): the importance of health literacy.
Am J Surg 2022 Feb;223(2):303-11. doi: 10.1016/j.amjsurg.2021.06.003..
Keywords: Health Literacy, Surgery, Racial and Ethnic Minorities, Racial and Ethnic Minorities, Digestive Disease and Health, Patient Experience
Roberson ML, Nichols HB, Wheeler
Validity of breast cancer surgery treatment information in a state-based cancer registry.
Surgery is an important part of early stage breast cancer treatment that affects overall survival. Statewide cancer registries contain data on first course of cancer treatment for all patients diagnosed with cancer but the accuracy of these data are uncertain. In this study, the authors examined validity of breast cancer surgery treatment information in a state-based cancer registry.
AHRQ-funded; HS027299.
Citation: Roberson ML, Nichols HB, Wheeler .
Validity of breast cancer surgery treatment information in a state-based cancer registry.
Cancer Causes Control 2022 Feb;33(2):261-69. doi: 10.1007/s10552-021-01520-3..
Keywords: Cancer: Breast Cancer, Cancer, Surgery, Registries
Fatemi P, Zhang Y, Han SS
A, et al. External validation of a predictive model of adverse events following spine surgery.
The authors externally validated a previously developed predictive model for common 30-day adverse events after spine surgery, the Risk Assessment Tool for Adverse Events after Spine Surgery (RAT-Spine). Their results are presented as low-, moderate-, and high-risk designations.
AHRQ-funded; HS023800.
Citation: Fatemi P, Zhang Y, Han SS .
A, et al. External validation of a predictive model of adverse events following spine surgery.
Spine J 2022 Jan;22(1):104-12. doi: 10.1016/j.spinee.2021.06.006..
Keywords: Surgery, Adverse Events, Orthopedics, Risk
Mallela DP, Canner JK, Zarkowsky DS
Association between race and perioperative outcomes after carotid endarterectomy for asymptomatic carotid artery stenosis in NSQIP.
This study investigated the association of race on carotid endarterectomy (CEA) outcomes. Perioperative outcomes (at 30 days) were compared for Black vs. White patients adjusting for age/sex, comorbidities and disease characteristics. Out of 16,764 patients from the ACS-NSQIP targeted vascular database (2011-2019), 95.2% were White and 4.8% were Black. Black patients were slightly younger and more frequently (79.5% vs 74.0%) had high-grade carotid artery stenosis compared to White patients. Comorbidities including hypertension, diabetes, kidney disease, congestive heart failure, and coronary artery disease were all more prevalent among Black patients. Crude perioperative stroke and stroke/death were higher for Black patients, but myocardial infarction leading to death were similar. After adjusting for baseline differences between groups, the risk of perioperative stroke and stroke/death remained significantly higher for Black patients than White patients.
AHRQ-funded; HS024547.
Citation: Mallela DP, Canner JK, Zarkowsky DS .
Association between race and perioperative outcomes after carotid endarterectomy for asymptomatic carotid artery stenosis in NSQIP.
J Am Coll Surg 2022 Jan;234(1):65-73. doi: 10.1097/xcs.0000000000000016..
Keywords: Racial and Ethnic Minorities, Surgery, Cardiovascular Conditions, Stroke, Risk, Adverse Events
Cofran L, Cohen T, Alfred M
Barriers to safety and efficiency in robotic surgery docking.
The authors sought to explore operating room variation in robotic-assisted surgery across multiple clinical sites and procedures and further sought to examine the sources of those flow disruptions. They concluded that direct observation of surgical procedures can help to identify approaches to improve the design of technology and procedures, the training of staff, and the configuration of the operating room environment, with the eventual goal of improving safety, efficiency, and teamwork in high technology surgery.
AHRQ-funded; HS026491.
Citation: Cofran L, Cohen T, Alfred M .
Barriers to safety and efficiency in robotic surgery docking.
Surg Endosc 2022 Jan;36(1):206-15. doi: 10.1007/s00464-020-08258-0..
Keywords: Patient Safety, Surgery
Kho RM, Desai VB, Schwartz PE
Endometrial sampling for preoperative diagnosis of uterine leiomyosarcoma.
This retrospective cohort study examined the effectiveness of endometrial sampling for preoperative detection of uterine leiomyosarcoma in women undergoing hysterectomy, identified factors associated with missed diagnosis, and compared the outcomes of patients who had a preoperative diagnosis with those patients who had a missed diagnosis. A total of 79 patients with uterine leiomyosarcoma were included in the study. Of those patients, 46 (58.2%) were diagnosed preoperatively and 33 postoperatively. The groups were similar in age, race/ethnicity, bleeding symptoms, and comorbidities. Women who had endometrial sampling performed with hysteroscopy had a higher likelihood of preoperative diagnosis. Patients with localized stage (vs distant stage) or tumor size >11 cm were less likely to be diagnosed preoperatively.
AHRQ-funded; HS024702.
Citation: Kho RM, Desai VB, Schwartz PE .
Endometrial sampling for preoperative diagnosis of uterine leiomyosarcoma.
J Minim Invasive Gynecol 2022 Jan;29(1):119-27. doi: 10.1016/j.jmig.2021.07.004.
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Keywords: Cancer, Diagnostic Safety and Quality, Surgery, Women
Heiderscheit EA, Schlick CJR, Ellis RJ
Experiences of LGBTQ+ residents in US general surgery training programs.
The purpose of this study was to determine the national prevalence of mistreatment and poor well-being for lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) surgery residents compared with their non-LGBTQ+ peers. A voluntary, anonymous survey was conducted for clinically active general surgery residents training in accredited general surgery programs following their American Board of Surgery In-Training Examination. Findings showed that mistreatment was a common experience for LGBTQ+ surgery residents, with attending surgeons being the most common overall source. Increased suicidality among LGBTQ+ surgery residents was associated with this mistreatment. Recommendations included multifaceted interventions to develop safer and more inclusive learning environments.
AHRQ-funded; HS000078.
Citation: Heiderscheit EA, Schlick CJR, Ellis RJ .
Experiences of LGBTQ+ residents in US general surgery training programs.
JAMA Surg 2022 Jan;157(1):23-32. doi: 10.1001/jamasurg.2021.5246..
Keywords: Provider: Physician, Surgery, Training, Education: Continuing Medical Education
Ingraham A, Schumacher J, Fernandes-Taylor S
General surgeon involvement in the care of patients designated with an American Association for the Surgery of Trauma-endorsed ICD-10-CM emergency general surgery diagnosis code in Wisconsin.
The authors sought to: (1) translate previously-developed ICD-9-CM diagnosis codes representing emergency general surgery (EGS) conditions to ICD-10-CM codes and (2) determine the national burden of and assess surgeon involvement across EGS conditions. They found that, of the seven most common EGS diagnoses, surgeon involvement was highest for appendicitis and biliary tract disease. For the other five most common conditions, surgeons were involved in roughly 20% of patient care episodes.
AHRQ-funded; HS025224.
Citation: Ingraham A, Schumacher J, Fernandes-Taylor S .
General surgeon involvement in the care of patients designated with an American Association for the Surgery of Trauma-endorsed ICD-10-CM emergency general surgery diagnosis code in Wisconsin.
J Trauma Acute Care Surg 2022 Jan;92(1):117-25. doi: 10.1097/ta.0000000000003387..
Keywords: Healthcare Cost and Utilization Project (HCUP), Surgery, Critical Care
Herb J, Williams B, Stitzenberg K
Hospital price transparency rules are inadequate to inform patients needing major gastrointestinal cancer operations.
This cross-sectional descriptive study evaluated the hospital price transparency web pages, machine-readable files, and online out-of-pocket cost estimators (OOPCEs) for all National Cancer Institute Designated Clinical Cancer Centers. Findings showed that hospital charges were readily available and the availability of consumer-friendly OOPCEs had improved with the updated price transparency policy. However, the utility of the available information for cancer patients who need a major gastrointestinal operation was limited. Although chargemasters were available for nearly all hospitals, using these to determine what a patient may pay would be very difficult, if not impossible.
AHRQ-funded; HS000032.
Citation: Herb J, Williams B, Stitzenberg K .
Hospital price transparency rules are inadequate to inform patients needing major gastrointestinal cancer operations.
Ann Surg Oncol 2022 Jan;29(1):45-46. doi: 10.1245/s10434-021-10244-2..
Keywords: Hospitals, Healthcare Costs, Surgery
Chrenka EA, Solberg LI, Asche SE
Is shared decision-making associated with better patient-reported outcomes? A longitudinal study of patients undergoing total joint arthroplasty.
This study examined whether shared decision making (SDM) provides better outcomes using patients undergoing total joint arthroplasty as a test case. This observational longitudinal survey-based study surveyed patients receiving an initial THA or TKA from a large, multispecialty medical group in the Midwestern United States after they were scheduled for surgery and again at 12 months after their procedure. The majority of included patients were white (1255 of 1344) with only 3% using Medicaid benefits at the time of surgery. The three-item collaboRATE measure of SDM was added to existing patient surveys of patient-reported outcome measures (PROMs). Patient responses were analyzed in regression models to estimate the association between preoperative collaborate scores and Oxford knee or hip scores at 12 months postoperatively. There was a moderate, positive association between preoperative collaborate scores and the Oxford scores at 12 months. The association suggests that SDM could be one tool to encourage better outcomes.
AHRQ-funded; HS025618.
Citation: Chrenka EA, Solberg LI, Asche SE .
Is shared decision-making associated with better patient-reported outcomes? A longitudinal study of patients undergoing total joint arthroplasty.
Clin Orthop Relat Res 2022 Jan;480(1):82-91. doi: 10.1097/corr.0000000000001920..
Keywords: Shared Decision Making, Patient-Centered Outcomes Research, Orthopedics, Surgery
Shore S, Pienta MJ, Watt TMF
Non-patient factors associated with infections in LVAD recipients: a scoping review.
Infections are the most common complication in recipients of durable left ventricular assist devices (LVAD) and are associated with increased morbidity, mortality, and expenditures. The existing literature examining factors associated with infection in LVAD recipients is limited and principally comprises single-center studies. This scoping review synthesized all available evidence related to identifying modifiable, non-patient factors associated with infections among LVAD recipients.
AHRQ-funded; HS026003.
Citation: Shore S, Pienta MJ, Watt TMF .
Non-patient factors associated with infections in LVAD recipients: a scoping review.
J Heart Lung Transplant 2022 Jan;41(1):1-16. doi: 10.1016/j.healun.2021.10.006..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Surgery, Medical Devices
Su WK, Coleman CM, Bossick AS
Racial differences in planned hysterectomy procedure route.
The objective of this study was to assess any racial differences in the likelihood of having a planned minimally invasive surgical (MIS) hysterectomy. Using data from the Henry Ford Health System, findings showed that Black women were not less likely than White women to have planned an MIS hysterectomy.
AHRQ-funded; HS022417
Citation: Su WK, Coleman CM, Bossick AS .
Racial differences in planned hysterectomy procedure route.
J Womens Health 2022 Jan;31(1):31-37. doi: 10.1089/jwh.2021.0132..
Keywords: Women, Racial and Ethnic Minorities, Surgery
Popp J, Weinberg DS, Ems E
Reevaluating the evidence for intensive postoperative extracolonic surveillance for nonmetastatic colorectal cancer.
This study reevaluated the evidence for intensive postoperative extracolonic surveillance for nonmetastatic colorectal cancer. The authors looked at the FACS, GILDA, and COLOFOL trials and used a model to predict the large-sample mortality reduction expected for each trial and the implied statistical power. An investigation was done of a potential recurrence imbalance in the FACS trial. The model predicted a mortality reduction of ≤5% and power of <10% for all 3 trials. The FACS recurrence imbalance most likely led to a large relative bias (>2.5) in the hazard ratio for overall survival favoring control. After adjustment, both COLOFOL and FACS results were consistent with model predictions. A 2.6 and 3.6 month increase in life expectancy is predicted comparing intensive extracolonic surveillance-routine computed tomography scans and carcinoembryonic antigen assays with 1 computed tomography scan at 12 months or no surveillance, respectively. A larger trial that would randomize at least 200 to 300 patients is needed, but is not feasible at this time. The authors concluded recent trial results do not warrant de novo skepticism or metastasectomy nor targeted extracolonic surveillance.
AHRQ-funded; HS022998.
Citation: Popp J, Weinberg DS, Ems E .
Reevaluating the evidence for intensive postoperative extracolonic surveillance for nonmetastatic colorectal cancer.
Value Health 2022 Jan; 25(1):36-46. doi: 10.1016/j.jval.2021.07.017..
Keywords: Cancer: Colorectal Cancer, Cancer, Surgery, Evidence-Based Practice
Hughes TM, Ellsworth B, Berlin NL
Statewide episode spending variation of mastectomy for breast cancer.
The purpose of this study was to characterize variations in episode spending related to volume and complication rates for mastectomy. A secondary study aim was to identify patient- and facility-level determinants of variation. The researchers assessed mean spending for 7,342 patients undergoing mastectomy at 74 facilities across Michigan state. The study found that mean 30-day spending by facility ranged from $11,129 to $20,830 and ninety-day spending ranged from $17,303 to $31,060. Patient-level factors associated with greater spending included bilateral surgery, simultaneous breast reconstruction, length of stay, and readmission. The researchers concluded that Michigan hospitals have considerable variation in mastectomy spending, and that reducing the frequency of bilateral surgery and length of stay may increase value, without risking patient safety or oncologic outcomes.
AHRQ-funded; HS026030.
Citation: Hughes TM, Ellsworth B, Berlin NL .
Statewide episode spending variation of mastectomy for breast cancer.
J Am Coll Surg 2022 Jan;234(1):14-23. doi: 10.1097/xcs.0000000000000005..
Keywords: Cancer: Breast Cancer, Cancer, Women, Surgery