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
1 to 25 of 77 Research Studies DisplayedWu J, Yuan CT, Moyal-Smith R
Electronic health record-supported implementation of an evidence-based pathway for perioperative surgical care.
This study examines the role of electronic health records (EHRs) in implementing enhanced recovery pathways (ERPs) for perioperative surgical care. Interviews with informaticians and clinicians from eight US hospitals revealed three thematic clusters: "EHR difficulties," "EHR enablers," and "EHR barriers." Researchers concluded that high performers and improvers successfully integrated ERPs into EHRs with dedicated multidisciplinary teams, while others faced challenges. Early involvement of informatics expertise benefited ERP implementation and sustainability.
AHRQ-funded; 2332015000201.
Citation: Wu J, Yuan CT, Moyal-Smith R .
Electronic health record-supported implementation of an evidence-based pathway for perioperative surgical care.
J Am Med Inform Assoc 2024 Feb 16; 31(3):591-99. doi: 10.1093/jamia/ocad237.
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Surgery, Evidence-Based Practice, Hospitals
Krouse RS, Anderson GL, Arnold KB
Surgical versus non-surgical management for patients with malignant bowel obstruction (S1316): a pragmatic comparative effectiveness trial.
The purpose of this study was to compare surgical versus non-surgical management with the goal of determining the optimal approach for managing malignant bowel obstruction. From May 11, 2015, to April 27, 2020, 221 patients were enrolled, with 199 evaluable participants. The study found no variation between surgery and non-surgery for the primary outcome of good days: mean 42·6 days in the randomized surgery group, 43·9 days (29·5) in the randomized non-surgery group, 54·8 days (27·0) in the patient choice surgery group, and 52·7 days (30·7) in the patient choice non-surgery group. During their initial hospital stay, six participants died, five due to cancer progression and one due to malignant bowel obstruction treatment complications The most common grade 3-4 malignant bowel obstruction treatment complication was anemia.
AHRQ-funded; HS021491.
Citation: Krouse RS, Anderson GL, Arnold KB .
Surgical versus non-surgical management for patients with malignant bowel obstruction (S1316): a pragmatic comparative effectiveness trial.
Lancet Gastroenterol Hepatol 2023 Oct; 8(10):908-18. doi: 10.1016/s2468-1253(23)00191-7..
Keywords: Cancer, Surgery, Treatments, Comparative Effectiveness, Evidence-Based Practice
Ayers DC, Yousef M, Yang W
Age-related differences in pain, function, and quality of life following primary total knee arthroplasty: results from a FORCE-TJR (Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement) cohort.
The purpose of this prospective, multicenter cohort study was to evaluate the differences in pain, function, and quality of life (QoL) reported 1 year after total knee arthroplasty (TKA) across varying age groups. The researchers preoperatively assessed 11,602 unilateral primary TKA patients, and collected demographic data, comorbid conditions, and patient-reported outcome measures including the knee injury and osteoarthritis outcome score (KOOS), KOOS-12, KOOS Joint Replacement, and Short-Form health survey (12-item) and then collected again at 1-year postoperatively. The study found that prior to surgery, patients less than 55 years reported worse KOOS pain (39), function (50), and QoL (18) scores with poor mental health score (47) than other older patient groups. At 1 year after TKA, patients less than 55 years reported lower KOOS pain, function, and QoL scores when compared to patients 75 years or older. The differences in score changes among the age groups were statistically significant but clinically irrelevant. Further statistical analyses revealed that age was a significant predictor for pain, but not for function at 1 year where KOOS pain score was predicted to be higher in patients 75 years or older when compared to patients less than 55 years of age.
AHRQ-funded; HS018910.
Citation: Ayers DC, Yousef M, Yang W .
Age-related differences in pain, function, and quality of life following primary total knee arthroplasty: results from a FORCE-TJR (Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement) cohort.
J Arthroplasty 2023 Jul; 38(7 Suppl 2):S169-S76. doi: 10.1016/j.arth.2023.04.005..
Keywords: Orthopedics, Surgery, Quality of Life, Outcomes, Comparative Effectiveness, Evidence-Based Practice, Patient-Centered Outcomes Research, Pain
Cabral SM, Harris AD, Cosgrove SE
Adherence to antimicrobial prophylaxis guidelines for elective surgeries across 825 US hospitals, 2019-2020.
This retrospective cohort study assessed adherence to surgical antimicrobial prophylaxis guidelines for elective surgeries across 825 US hospitals from 2019 to 2020. The authors looked at adults who underwent elective craniotomy, hip replacement, knee replacement, spinal procedure, or hernia repair in 2019-2020 at hospitals in the PINC AI (Premier) Healthcare Database. They evaluated adherence of prophylaxis regimes, with respect to antimicrobial agents endorsed in the American Society of Health-System Pharmacist guidelines, accounting for patient antibiotic allergy and methicillin-resistant Staphylococcus aureus colonization status. They found that across 825 hospitals and 521,091 inpatient elective surgeries, 59% were adherent to prophylaxis guidelines. The most common reason found for nonadherence was unnecessary vancomycin use. Patients receiving cefazolin plus vancomycin had 19% higher odds of acute kidney injury (AKI) compared with patients receiving cefazolin alone.
AHRQ-funded; HS028363.
Citation: Cabral SM, Harris AD, Cosgrove SE .
Adherence to antimicrobial prophylaxis guidelines for elective surgeries across 825 US hospitals, 2019-2020.
Clin Infect Dis 2023 Jun 16; 76(12):2106-15. doi: 10.1093/cid/ciad077..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Guidelines, Evidence-Based Practice, Surgery
Bartels K, Howard-Quijano K, Prin M
Meeting report: first Cardiovascular Outcomes Research in Perioperative Medicine conference.
This article summarized the background and objectives of the first Cardiovascular Outcomes Research in Perioperative Medicine (COR-PM) conference. It also described the conduct of the conference and outlined future directions for scientific meetings which are focused on the fostering of high-quality clinical research in the broader perioperative medicine community.
AHRQ-funded; HS027795.
Citation: Bartels K, Howard-Quijano K, Prin M .
Meeting report: first Cardiovascular Outcomes Research in Perioperative Medicine conference.
Anesth Analg 2023 Feb; 136(2):418-20. doi: 10.1213/ane.0000000000006248..
Keywords: Cardiovascular Conditions, Surgery, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
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
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
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
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
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
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
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
Kittelson AJ, Loyd BJ, Graber J
Examination of exclusion criteria in total knee arthroplasty rehabilitation trials: influence on the application of evidence in day-to-day practice.
This study investigated whether total knee arthroplasty (TKA) patients seen in routine practice who meet common exclusion criteria in clinical trials recover differently compared to research-eligible patients. Postoperative functional outcomes were compared using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Timed Up and Go (TUG). A total of 2,528 participants from 27 trials were compared to 474 patients from the clinical dataset. Research participants were older, with lower BMI than patients in the clinical dataset. There were no differences observed in functional recovery rate between groups, except for patients with diabetes whose TUG recovered more slowly than “eligible” patients.
AHRQ-funded; HS024316.
Citation: Kittelson AJ, Loyd BJ, Graber J .
Examination of exclusion criteria in total knee arthroplasty rehabilitation trials: influence on the application of evidence in day-to-day practice.
J Eval Clin Pract 2021 Dec;27(6):1335-42. doi: 10.1111/jep.13564..
Keywords: Orthopedics, Surgery, Rehabilitation, Patient-Centered Outcomes Research, Evidence-Based Practice, Outcomes
Delaney LD, Howard R, Palazzolo K
Outcomes of a presurgical optimization program for elective hernia repairs among high-risk patients.
The authors evaluated the feasibility of evidence-based patient optimization before surgery by implementing a low-cost preoperative optimization clinic. They found that a hernia optimization clinic safely improved management of high-risk patients and increased operative yield for the institution. They concluded that their results represented an opportunity to create sustainable and scalable models that provide longitudinal care and optimize patients to improve outcomes of hernia repair.
AHRQ-funded; HS025778.
Citation: Delaney LD, Howard R, Palazzolo K .
Outcomes of a presurgical optimization program for elective hernia repairs among high-risk patients.
JAMA Netw Open 2021 Nov;4(11):e2130016. doi: 10.1001/jamanetworkopen.2021.30016..
Keywords: Surgery, Risk, Evidence-Based Practice, Quality Improvement, Quality of Care, Outcomes
Garsa A, Jang JK, Baxi S
Radiation therapy for brain metastases: a systematic review.
This systematic review synthesizes the available evidence on radiation therapy for brain metastases. A literature search was conducted using the major medical databases and included randomized controlled trials and large observational studies which evaluated whole brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS) alone or in combination as initial or postoperative treatment, with or without systemic therapy for adults with brain metastases due to lung cancer, breast cancer, or melanoma. No statistically significant difference in overall survival was found with a combination of SRS plus WBRT compared with SRS alone or WBRT alone. Radiation therapy after surgery did not improve overall survival compared with surgery alone. WBRT plus systemic therapy was associated with increased risks for vomiting compared with WBRT alone. There was not enough data on patient-relevant outcomes such as quality of life, functional status, and cognitive effects.
AHRQ-funded; 290201500010I.
Citation: Garsa A, Jang JK, Baxi S .
Radiation therapy for brain metastases: a systematic review.
Pract Radiat Oncol 2021 Sep-Oct;11(5):354-65. doi: 10.1016/j.prro.2021.04.002..
Keywords: Cancer, Surgery, Treatments, Patient-Centered Outcomes Research, Evidence-Based Practice
Brajcic BC, Ko CY, Liu JB
A NSQIP-based randomized clinical trial evaluating choice of prophylactic antibiotics for pancreaticoduodenectomy.
This paper describes the protocol for an upcoming multicenter randomized surgical trial to evaluate choice of prophylactic antibiotics for pancreaticoduodenectomy. The rationale and methodology of the trial evaluating piperacillin-tazobactam compared to cefoxitin for surgical site infection prevention is described. The study will utilize a clinical registry for data collection.
AHRQ-funded; HS000078.
Citation: Brajcic BC, Ko CY, Liu JB .
A NSQIP-based randomized clinical trial evaluating choice of prophylactic antibiotics for pancreaticoduodenectomy.
J Surg Oncol 2021 May;123(6):1387-94. doi: 10.1002/jso.26402..
Keywords: Cancer, Antibiotics, Medication, Prevention, Surgery, Healthcare-Associated Infections (HAIs), Comparative Effectiveness, Evidence-Based Practice
Chan H, Zhang L, Choti MA
Recurrence patterns after surgical resection of gastroenteropancreatic neuroendocrine tumors: analysis from the national comprehensive cancer network oncology outcomes database.
Current National Comprehensive Cancer Network guidelines for gastroenteropancreatic neuroendocrine tumors (GEPNETs) recommend complete (R0) surgical resection of the primary tumor and metastases, if feasible. This study conducted large multicenter studies of recurrence patterns of GEPNETs after resection. Findings showed that R0 resection was associated with variable risk of recurrence across subtypes. Recommendations included further research to inform refinement of guidelines for the appropriate duration of surveillance after R0 resection.
AHRQ-funded; HS021700.
Citation: Chan H, Zhang L, Choti MA .
Recurrence patterns after surgical resection of gastroenteropancreatic neuroendocrine tumors: analysis from the national comprehensive cancer network oncology outcomes database.
Pancreas 2021 Apr;50(4):506-12. doi: 10.1097/mpa.0000000000001791..
Keywords: Cancer, Surgery, Patient-Centered Outcomes Research, Evidence-Based Practice, Outcomes
Brown CS, Osborne NH, Kim GY
Effect of concomitant deep venous reflux on truncal endovenous ablation outcomes in the Vascular Quality Initiative.
This study looked at outcomes for patients with varicose veins (C2 disease) undergoing truncal endovenous ablation with and without deep venous reflux. Data from the Vascular Quality Initiative was analyzed from 2015 to 2019. A total of 4881 patients were included, with 46.2% having combined deep and superficial reflux. Follow-up around a year later (median 336.5 days) was conducted after. Patients with deep reflux were less likely to be female, more likely to be Caucasian, and had no difference in BMI. Additionally, there were no differences in rates of prior varicose vein treatments, number of pregnancies, or history of deep venous thrombosis. However, patients without deep reflux were more likely to use anticoagulants at the time of the procedure. Patients without deep reflux had slightly higher median preprocedural Venous Clinician Severity Score (VCSS) scores as well as postprocedural VCSS scores. Total symptom score was higher for patients without deep reflux before and after the procedure, but there was no change in symptom score after the procedure. Patients with deep reflux had substantially higher rates of complications with a particular increase in proximal thrombus extension.
AHRQ-funded; HS000053.
Citation: Brown CS, Osborne NH, Kim GY .
Effect of concomitant deep venous reflux on truncal endovenous ablation outcomes in the Vascular Quality Initiative.
J Vasc Surg Venous Lymphat Disord 2021 Mar;9(2):361-68.e3. doi: 10.1016/j.jvsv.2020.04.031..
Keywords: Cardiovascular Conditions, Chronic Conditions, Surgery, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
Brown CS, Obi AT, Cronenwett JL
Outcomes after truncal ablation with or without concomitant phlebectomy for isolated symptomatic varicose veins (C2 disease).
This study looked outcomes of patients with varicose veins (C2 disease) who were treated with venous ablation alone or ablation plus phlebectomy using the Vascular Quality Initiative Varicose Vein Registry. Data between January 2015 and March 2015 was used to investigate postoperative as well as long-term clinical and patient-reported outcomes among patients with documented symptomatic C2 disease undergoing truncal endovenous ablations alone and combined ablation and phlebectomy. Out of 3375 patients, 40.1% underwent isolated truncal ablation and the rest had the combined procedure of ablation and phlebectomy. Complications were low for both procedures (8.4% and 8.7%). Overall, improvement in symptoms was experienced by 94.4% of patients with more increases in patients undergoing ablation and phlebectomy than ablation alone. Both procedures are recommended by the authors to be covered by insurance.
AHRQ-funded; HS000053.
Citation: Brown CS, Obi AT, Cronenwett JL .
Outcomes after truncal ablation with or without concomitant phlebectomy for isolated symptomatic varicose veins (C2 disease).
J Vasc Surg Venous Lymphat Disord 2021 Mar;9(2):369-76. doi: 10.1016/j.jvsv.2020.05.016..
Keywords: Cardiovascular Conditions, Chronic Conditions, Surgery, Outcomes, Patient-Centered Outcomes Research, Comparative Effectiveness, Evidence-Based Practice
Pennington KM, Dykhoff HJ, Yao X
The impact of antifungal prophylaxis in lung transplant recipients.
This study evaluated the effect of antifungal prophylaxis on all-cause mortality and invasive fungal infections (IFI) on lung transplant recipients. Administrative claims data was used to identify adult patients who underwent lung transplantation between 2005 and 2018. The authors identified 662 lung transplant recipients. All-cause mortality was found to be significantly lower in those receiving antifungal prophylaxis compared to those who did not. Patients receiving antifungal prophylaxis also had a lower rate of IFI, but it was not statistically significant.
AHRQ-funded; HS025164; HS025402; HS025517; HS024075.
Citation: Pennington KM, Dykhoff HJ, Yao X .
The impact of antifungal prophylaxis in lung transplant recipients.
Ann Am Thorac Soc 2021 Mar;18(3):468-76. doi: 10.1513/AnnalsATS.202003-267OC..
Keywords: Transplantation, Surgery, Medication, Prevention, Respiratory Conditions, Mortality, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
McKinney WT, Schaffhausen CR, Schladt D
Designing a patient-specific search of transplant program performance and outcomes: feedback from heart transplant candidates and recipients.
The Scientific Registry of Transplant Recipients provides transplant program-specific information, but it is unclear what patients and stakeholders need to know. Acceptance criteria for the candidate waitlist and donor organs vary by program and region, but there is no means to search for programs by the clinical profiles of recipients and donors. The authors examined variability in program-specific characteristics that could influence access to transplantation.
AHRQ-funded; HS026379; HS024527.
Citation: McKinney WT, Schaffhausen CR, Schladt D .
Designing a patient-specific search of transplant program performance and outcomes: feedback from heart transplant candidates and recipients.
Clin Transplant 2021 Feb;35(2):e14183. doi: 10.1111/ctr.14183..
Keywords: Transplantation, Surgery, Heart Disease and Health, Cardiovascular Conditions, Registries, Patient-Centered Outcomes Research, Evidence-Based Practice, Shared Decision Making
Dworsky JQ, Shenoy R, Childers CP
Older veterans undergoing inpatient surgery: what is the compliance with best practice guidelines?
This study’s objective was to determine the documented compliance with best practice guidelines for optimal perioperative care for the older adult surgical patient that were created by the American College of Surgeons Quality Improvement Program and the American Geriatrics Society. The guidelines include 38 measures. A retrospective chart review was conducted on 86 older adults undergoing elective inpatient coronary artery bypass graft, prostatectomy, or colectomy over a 2-year period at a single Veterans Affairs hospital. Mean reported compliance across measures was 41% ± 4%. Of the 38 analyzed measures, 10 measures were achieved for 0 patients, and only 1 patient for 7 measures. Future work is needed to understand barriers for implementation.
AHRQ-funded; HS000046.
Citation: Dworsky JQ, Shenoy R, Childers CP .
Older veterans undergoing inpatient surgery: what is the compliance with best practice guidelines?
Surgery 2021 Feb;169(2):356-61. doi: 10.1016/j.surg.2020.08.033..
Keywords: Elderly, Surgery, Guidelines, Evidence-Based Practice, Quality Improvement, Quality of Care, Quality Measures
Brown CS, Osborne NH, Kim GY
Comparison of unilateral vs bilateral and staged bilateral vs concurrent bilateral truncal endovenous ablation in the Vascular Quality Initiative.
This study compares outcomes in patients who have undergone unilateral vs bilateral venous ablation procedures or between staged and concurrent bilateral procedures. Data from the Vascular Quality Initiative from 2015 to 2019 was used to investigate immediate postoperative as well as long-term clinical and patient-reported outcomes. A total of 5029 patients were included, of whom 75.2% underwent unilateral procedures. Follow-up was conducted with a median of 227 days after. Unilateral patients were less likely to be female and white and had lower BMI compared with patients undergoing bilateral procedures. In addition, unilateral patients had fewer prior varicose vein treatments and had higher Venous Clinical Severity Scores (VCSS). There were no differences in complications in patients undergoing unilateral vs bilateral procedures. Systemic complications were rare in both groups.
AHRQ-funded; HS000053.
Citation: Brown CS, Osborne NH, Kim GY .
Comparison of unilateral vs bilateral and staged bilateral vs concurrent bilateral truncal endovenous ablation in the Vascular Quality Initiative.
J Vasc Surg Venous Lymphat Disord 2021 Jan;9(1):113-21.e3. doi: 10.1016/j.jvsv.2020.05.008..
Keywords: Cardiovascular Conditions, Chronic Conditions, Surgery, Outcomes, Patient-Centered Outcomes Research, Comparative Effectiveness, Evidence-Based Practice
Reisz PA, Laviana AA, Zhao Z
Assessing the quality of surgical care for clinically localized prostate cancer: results from the CEASAR study.
Prior studies suggest that nationally endorsed quality measures for prostate cancer care are not linked closely with outcomes. Using a prospective, population based cohort the investigators measured clinically relevant variation in structure, process and outcome measures in men undergoing radical prostatectomy. The authors did not identify and meaningful variation in quality of care across racial groups, age groups and surgeon volume strata, in this cohort, suggesting that men were receiving comparable quality of care across these strata.
AHRQ-funded; HS019356.
Citation: Reisz PA, Laviana AA, Zhao Z .
Assessing the quality of surgical care for clinically localized prostate cancer: results from the CEASAR study.
J Urol 2020 Dec;204(6):1236-41. doi: 10.1097/ju.0000000000001198..
Keywords: Surgery, Cancer: Prostate Cancer, Cancer, Quality of Care, Quality of Life, Patient-Centered Outcomes Research, Comparative Effectiveness, Evidence-Based Practice