National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (15)
- Adverse Events (17)
- Ambulatory Care and Surgery (2)
- Antibiotics (12)
- Antimicrobial Stewardship (5)
- Arthritis (1)
- Behavioral Health (2)
- Blood Clots (2)
- Blood Thinners (3)
- Cancer (6)
- Cancer: Breast Cancer (3)
- Cardiovascular Conditions (7)
- Care Management (5)
- Children/Adolescents (3)
- Chronic Conditions (1)
- Clinical Decision Support (CDS) (2)
- Comparative Effectiveness (3)
- Complementary and Alternative Medicine (1)
- Dental and Oral Health (1)
- Depression (2)
- Digestive Disease and Health (1)
- Elderly (3)
- Electronic Health Records (EHRs) (1)
- Evidence-Based Practice (7)
- Guidelines (1)
- Healthcare-Associated Infections (HAIs) (7)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Healthcare Costs (1)
- Healthcare Utilization (2)
- Health Information Technology (HIT) (2)
- Heart Disease and Health (1)
- Hospitalization (2)
- Hospital Readmissions (1)
- Hospitals (1)
- Infectious Diseases (1)
- Injuries and Wounds (3)
- Inpatient Care (2)
- Labor and Delivery (2)
- Maternal Care (1)
- Medical Errors (2)
- (-) Medication (79)
- Medication: Safety (11)
- Men's Health (1)
- Mortality (2)
- Neurological Disorders (1)
- Newborns/Infants (2)
- Obesity (6)
- Obesity: Weight Management (2)
- Opioids (32)
- Orthopedics (8)
- Outcomes (12)
- Pain (24)
- Patient-Centered Outcomes Research (11)
- Patient Experience (1)
- Patient Safety (17)
- Patient Self-Management (1)
- Practice Patterns (15)
- Pregnancy (2)
- Prevention (9)
- Provider: Physician (2)
- Quality Improvement (2)
- Quality Indicators (QIs) (1)
- Quality of Care (1)
- Respiratory Conditions (2)
- Risk (5)
- Shared Decision Making (3)
- Stress (1)
- Stroke (2)
- Substance Abuse (8)
- (-) Surgery (79)
- Transitions of Care (1)
- Transplantation (1)
- Treatments (2)
- Women (5)
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 79 Research Studies DisplayedLiu S, Matvekas A, Naimi T
Morphomics-informed population pharmacokinetic and physiologically-based pharmacokinetic modeling to optimize cefazolin surgical prophylaxis.
This study’s objective was to use algorithms that repurpose radiologic data into body composition (morphomics) to aid in informing dosing decisions for the antibiotic cefazolin for patients undergoing colorectal surgery who have obesity. This prospective study measured cefazolin plasma, fat, and colon tissue concentrations in these patients to develop a morphomics-informed population pharmacokinetic (PopPK) model to guide dose adjustments. A physiologically-based pharmacokinetic (PBPK) model was also constructed to inform tissue partitioning in 21 morbidly obese patients (body mass index ≥35 kg/m2 with one or more co-morbid conditions). Morphomics and pharmacokinetic data were available in 58 patients with a median weight of 95.9 kg and and 55 years, respectively. The plasma-to-subcutaneous fat partition coefficient was predicted to be 0.072 for the PopPK model and 0.060 for the PBPK model. Covariates of cefazolin exposure were identified as the estimated creatinine clearance (eCL(cr) ) and body depth at the third lumbar vertebra (body depth_L3). The authors concluded that kidney function and morphomics were more informative than body weight as covariates of cefazolin target site exposure. They advised that data from more diverse populations, consensus on target cefazolin exposure, and comparative studies are needed before a change in practice can be implemented.
AHRQ-funded; HS027183.
Citation: Liu S, Matvekas A, Naimi T .
Morphomics-informed population pharmacokinetic and physiologically-based pharmacokinetic modeling to optimize cefazolin surgical prophylaxis.
Pharmacotherapy 2024 Jan; 44(1):77-86. doi: 10.1002/phar.2878..
Keywords: Surgery, Antibiotics, Medication, Prevention, Obesity, Healthcare-Associated Infections (HAIs)
Herzig SJ, Anderson TS, Urman RD
Risk factors for opioid-related adverse drug events among older adults after hospitalization for major orthopedic procedures.
The purpose of this retrospective cohort study was to identify risk factors for opioid-related adverse drug events (ORADEs) after hospital discharge following orthopedic procedures. The participants of this study included a national sample of Medicare beneficiaries who underwent major orthopedic surgery during hospitalization in 2016 and had an opioid prescription filled within 2 days of discharge. The study found that among 30,514 hospitalizations with a major orthopedic procedure and an opioid claim, a potential ORADE requiring hospital revisit occurred in 2.5%. After adjustment for patient characteristics, prior opioid use, co-prescribed sedating medications, and opioid prescription characteristics were not related with ORADEs. Independent risk factors did include age of 80 years or older, female sex, and clinical conditions, including heart failure, respiratory illness, kidney disease, dementia/delirium, anxiety disorder, and musculoskeletal/nervous system injuries.
AHRQ-funded; HS026215.
Citation: Herzig SJ, Anderson TS, Urman RD .
Risk factors for opioid-related adverse drug events among older adults after hospitalization for major orthopedic procedures.
J Patient Saf 2023 Oct 1; 19(6):379-85. doi: 10.1097/pts.0000000000001144..
Keywords: Elderly, Opioids, Adverse Drug Events (ADE), Adverse Events, Hospitalization, Orthopedics, Surgery, Medication, Risk, Medication: Safety, Patient Safety
Langlieb ME, Sharma P, Hocevar M
The additional cost of perioperative medication errors.
The aim of this study was to calculate the additional annual cost to the U.S. healthcare system attributable to preventable medication errors (MEs) in the operating room. The ME types were grouped into 13 categories by their related harm (or potential harm), and researchers calculated the incidence of operations involving each ME category: 1) delayed or missed required perioperative antibiotic; 2) prolonged hemodynamic swings; 3) untreated postoperative pain; 4) residual neuromuscular blockade; 5) oxygen saturation <90% due to ME; 6) delayed emergence; 7) untreated new onset intraoperative cardiac arrhythmia; 8) medication documentation errors; 9) syringe swaps; 10) presumed hypotension with inability to obtain a blood pressure reading; 11) potential for bacterial contamination due to expired medication syringes; 12) untreated bradycardia <40 beats/min; and 13) other. Through a PubMed search, the researchers established the possibility that the ME category would cause downstream patient harm such as surgical site infection or acute kidney injury, and the additional fully allocated cost of care for each potential downstream patient harm event. The cost of the MEs across the U.S. healthcare system was then calculated by scaling the number of MEs to the total number of annual operations in the United States. The total additional fully allocated annual cost of care due to perioperative MEs was estimated to be $5.33 billion U.S. dollars.
AHRQ-funded; HS024764.
Citation: Langlieb ME, Sharma P, Hocevar M .
The additional cost of perioperative medication errors.
J Patient Saf 2023 Oct 1; 19(6):375-78. doi: 10.1097/pts.0000000000001136..
Keywords: Medication: Safety, Medication, Medical Errors, Adverse Drug Events (ADE), Adverse Events, Surgery, Patient Safety
Rolfzen ML, Wick A, Mascha EJ
Best Practice Alerts Informed by Inpatient Opioid Intake to Reduce Opioid Prescribing after Surgery (PRIOR): a cluster randomized multiple crossover trial.
This study tested the hypothesis that a decision-support tool embedded in electronic health records (EHRs) leads clinicians to prescribe fewer opioids at discharge after inpatient surgery. Over 21,000 surgical inpatient discharges in a cluster randomized multiple crossover trial in four Colorado hospitals were included. The results indicated that within the context of vigorous opioid education and awareness efforts a decision-support tool incorporated into EHRs did not reduce discharge opioid prescribing for postoperative patients. The authors concluded that opioid prescribing alerts might be valuable in other contexts.
AHRQ-funded; HS027795.
Citation: Rolfzen ML, Wick A, Mascha EJ .
Best Practice Alerts Informed by Inpatient Opioid Intake to Reduce Opioid Prescribing after Surgery (PRIOR): a cluster randomized multiple crossover trial.
Anesthesiology 2023 Aug 1; 139(2):186-96. doi: 10.1097/aln.0000000000004607..
Keywords: Opioids, Medication, Surgery, Inpatient Care, Clinical Decision Support (CDS), Health Information Technology (HIT)
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
Sun EC, Rishel CA, Waljee JF
Association between state limits on opioid prescribing and the incidence of persistent postoperative opioid use among surgical patients.
The objective of this study was to examine whether laws limiting opioid prescribing were associated with reductions in the incidence of persistent postoperative opioid use. Over identified 950,000 privately insured patients who had undergone one of 10 procedures were identified; researchers then estimated the association between persistent postoperative opioid use and whether state opioid prescribing limits were in effect on the day of surgery. The findings suggested that laws limiting opioid prescriptions were not associated with subsequent reductions in persistent postoperative opioid use.
AHRQ-funded; HS026753.
Citation: Sun EC, Rishel CA, Waljee JF .
Association between state limits on opioid prescribing and the incidence of persistent postoperative opioid use among surgical patients.
Ann Surg 2023 Apr;277(4):e759-e65. doi: 10.1097/sla.0000000000005283.
Keywords: Opioids, Medication, Surgery, Substance Abuse, Practice Patterns
Anjorin AC, Marcaccio CL, Rastogi V
Statin therapy is associated with improved perioperative outcomes and long-term mortality following carotid revascularization in the Vascular Quality Initiative.
This study evaluated the outcomes of carotid artery stenosis (CAS) patients using statin therapy before undergoing carotid revascularization in the Vascular Quality Initiative registry. The authors identified all patients who underwent carotid endarterectomy (CEA), transfemoral carotid artery stenting (tfCAS), or transcarotid artery revascularization (TCAR) in the Vascular Quality Initiative registry from January 2016 to September 2021. Compared with statin use, no statin use was associated with a higher risk of in-hospital stroke or death and 5-year mortality among CEA and tfCAS patients, although there was no significant difference in outcomes among TCAR patients.
AHRQ-funded; HS027285.
Citation: Anjorin AC, Marcaccio CL, Rastogi V .
Statin therapy is associated with improved perioperative outcomes and long-term mortality following carotid revascularization in the Vascular Quality Initiative.
J Vasc Surg 2023 Jan;77(1):158-69.e8. doi: 10.1016/j.jvs.2022.08.019..
Keywords: Cardiovascular Conditions, Medication, Stroke, Surgery, Outcomes
Varady NH, Worsham CM, Chen AF
Inappropriate prescribing of opioids for patients undergoing surgery.
This study examined inappropriate prescribing of opioids for patients undergoing surgery, in this instance prescribing them to a patient’s spouse. Among 450,125 opioid-naïve couples with commercial insurance studied, for patients who did not fill perioperative opioid prescriptions themselves, the rate of spousal fills on the day of surgery (DOS) was 2.39 fills per 1,000 surgeries compared with 0.44 fills on all other perioperative days. Increases in spousal fills were not present for patients that filled opioid prescriptions themselves.
AHRQ-funded; HS026753.
Citation: Varady NH, Worsham CM, Chen AF .
Inappropriate prescribing of opioids for patients undergoing surgery.
Proc Natl Acad Sci U S A 2022 Dec 6;119(49):e2210226119. doi: 10.1073/pnas.2210226119..
Keywords: Opioids, Medication, Surgery, Practice Patterns, Provider: Physician
Fry BT, Howard RA, Gunaseelan V
Association of postoperative opioid prescription size and patient satisfaction.
The purpose of this prospective cohort study was to assess the relationship between postoperative opioid prescription size and patient-reported satisfaction among surgical patients. The researchers included 1,520 opioid-naive adult patients undergoing laparoscopic cholecystectomy, laparoscopic appendectomy, and minor hernia repair between January 1 and May 31, 2018. The main outcome was patient satisfaction measured on a scale of 0 to 10 and dichotomized into "highly satisfied" (9-10) and "not highly satisfied" (0-8). The explanatory variable of interest was size of opioid prescription at discharge from surgery, converted into milligrams of oral morphine equivalents (OME). The study found that 84.1% of patients were highly satisfied and 15.9% were not highly satisfied. There was no significant association between opioid prescription size and satisfaction. The researchers concluded that in a large cohort of patients undergoing common surgical procedures, there was no association between opioid prescription size at discharge after surgery and patient satisfaction.
AHRQ-funded; HS023313.
Citation: Fry BT, Howard RA, Gunaseelan V .
Association of postoperative opioid prescription size and patient satisfaction.
Ann Surg 2022 Dec 1;276(6):e1064-e69. doi: 10.1097/sla.0000000000004784..
Keywords: Opioids, Surgery, Medication, Patient Experience
Pannucci CJ, Fleming KI, Varghese TK
Low anti-factor Xa level predicts 90-day symptomatic venous thromboembolism in surgical patients receiving enoxaparin prophylaxis: a pooled analysis of eight clinical trials.
This study examined whether low anti-factor Xa (aFXa) level predicts 90-day symptomatic venous thromboembolism (VTE) in surgical patients receiving enoxaparin prophylaxis. The authors conducted a pooled analysis of 8 clinical trials from a single institution over a 4-year period. Among 985 patients, 2.3% had symptomatic 90-day VTE, 4.2% had 90-day clinically relevant bleeding, and 2.1% had major bleeding. Patients with initial low aFXa were significantly more likely to have 90-day VTE than patients with adequate or high xFXa (4.2% vs 1.3%). This relationship was significant for patients who received enoxaparin twice daily as opposed to once a day. No association was seen between high xFXa and 90-day clinically relevant bleeding or major bleeding.
AHRQ-funded; HS024326.
Citation: Pannucci CJ, Fleming KI, Varghese TK .
Low anti-factor Xa level predicts 90-day symptomatic venous thromboembolism in surgical patients receiving enoxaparin prophylaxis: a pooled analysis of eight clinical trials.
Ann Surg 2022 Dec 1;276(6):e682-e90. doi: 10.1097/sla.0000000000004589..
Keywords: Blood Thinners, Surgery, Medication, Blood Clots
Bongiovanni T, Gan S, Finlayson E
Prolonged use of newly prescribed gabapentin after surgery.
This study investigated postoperative prolonged gabapentin use in adults 65 years and older. The authors merged a 20% sample of Medicare Carrier, MedPAR, and Outpatient Files with Part D for 2013-2018. They defined new postoperative gabapentin as fills for 7 days before surgery until 7 days after discharge. Overall, 3% of all eligible patients (n = 17,970) had a new prescription for gabapentin postsurgery. Out of those, the mean age was 73 years old and 62% were female. The most common surgeries that gabapentin was prescribed for was total knee (45%) and total hip (21%) replacements. Prolonged use occurred in 22% of patients, with women, non-White, those with concurrent prolonged opioid use, and patients having undergone emergency surgery more likely to have prolonged use.
Citation: Bongiovanni T, Gan S, Finlayson E .
Prolonged use of newly prescribed gabapentin after surgery.
J Am Geriatr Soc 2022 Dec;70(12):3560-69. doi: 10.1111/jgs.18005..
Keywords: Medication, Surgery, Pain, Elderly, Practice Patterns
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
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
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
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
Marcaccio CL, Patel PB, Wang S
Effect of postoperative antithrombotic therapy on lower extremity outcomes after infrapopliteal bypass for chronic limb-threatening ischemia.
This study’s goal was to examine the effects of different postoperative antithrombotic regimens on 3-year clinical outcomes after infrapopliteal bypass for chronic limb-threatening ischemia (CLTI). The authors identified patients who had undergone infrapopliteal bypass for CLTI in the Vascular Quality Initiative (VQI) registry from 2003 to 2017 with linkage to Medicare claims for long-term outcomes. They divided the patients into three cohorts according to the discharge antithrombotic regimen: single-antiplatelet therapy (SAPT; aspirin or clopidogrel), dual antiplatelet therapy (DAPT; aspirin and clopidogrel), or anticoagulation (AC) plus any antiplatelet (AP) agent. To reduce selection bias, they restricted the analysis cohorts to patients treated by providers who discharged >50% of patients with each antithrombotic regimen. Their primary outcome was 3-year major adverse limb events (MALE; major amputation or reintervention). Among 1812 patients with a median follow-up time of >2 years, 693 (38%) were discharged with SAPT, 544 (30%) with DAPT, and 575 (32%) with AC+AP. At 3 years, MALE rates were 75% with DAPT, 74% with AC+AP, and 68% with SAPT. In adjusted analyses with SAPT as the reference group, no differences were found in 3-year MALE with DAPT or AC+AP. Across the treatment groups, we also found no differences in the individual end points of 3-year major amputation (DAPT: aHR, 0.98; AC+AP: aHR, 1.3), reintervention (DAPT: aHR, 1.0; AC+AP: aHR, 1.1), or mortality (DAPT: aHR, 1.1; AC+AP: aHR, 0.95).
AHRQ-funded; HS027285.
Citation: Marcaccio CL, Patel PB, Wang S .
Effect of postoperative antithrombotic therapy on lower extremity outcomes after infrapopliteal bypass for chronic limb-threatening ischemia.
J Vasc Surg 2022 May; 75(5):1696-706.e4. doi: 10.1016/j.jvs.2022.01.011..
Keywords: Cardiovascular Conditions, Medication, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Surgery, Medication: Safety
Marcaccio CL, Patel PB, Liang P
Efficacy and safety of perioperative dual antiplatelet therapy with ticagrelor versus clopidogrel in carotid artery stenting.
This study’s objective was to compare the efficacy and safety of perioperative dual antiplatelet therapy with aspirin/ticagrelor vs aspirin/clopidogrel in patients undergoing transfemoral carotid artery stenting (tfCAS) or transcarotid artery revascularization (TCAR). The authors identified all patients who underwent tfCAS or TCAR in the Vascular Quality Initiative registry from January 2016 to March 2021. They stratified patients by procedure and assessed outcomes using 1:3 propensity score-matched cohorts of patients who received perioperative aspirin/ticagrelor vs aspirin/clopidogrel. Among the cohort of 17,731 tfCAS patients, 593 (3.3%) received aspirin/ticagrelor and 11,404 (64%) received aspirin/clopidogrel. For the 2065 matched patients, no significant differences were found in the composite endpoint of stroke/death (aspirin/ticagrelor, 4.1%; vs aspirin/clopidogrel, 2.6%) or in the individual endpoints of stroke (2.9% vs 1.8%) or death (1.7% vs 1.1%). However, aspirin/ticagrelor was associated with a higher risk of bleeding (5.8% vs 2.8%). In a subgroup analysis of 297 tfCAS patients (14%) who received intraoperative protamine, no differences remained in stroke/death (1.5% vs 3.9%), and there was no longer a difference in bleeding (3.0% vs 2.6%). Among 17,946 TCAR patients, 453 (2.5%) received aspirin/ticagrelor and 13,696 (76%) received aspirin/clopidogrel. With the 1618 matched patients, no differences were found in stroke/death (0.7% vs 1.4%), stroke (0.2% vs 1.2%), death (0.5% vs 0.2%), or bleeding (1.2% vs 1.6%). For the 1429 TCAR patients (88%) who received protamine, no differences were found in stroke/death (0.8% vs 1.2%) or bleeding (0.6% vs 1.4%).
AHRQ-funded; HS027285.
Citation: Marcaccio CL, Patel PB, Liang P .
Efficacy and safety of perioperative dual antiplatelet therapy with ticagrelor versus clopidogrel in carotid artery stenting.
J Vasc Surg 2022 Apr; 75(4):1293-303.e8. doi: 10.1016/j.jvs.2021.09.045..
Keywords: Cardiovascular Conditions, Medication, Stroke, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Surgery
Olsen MA, Greenberg JK, Peacock K
Lack of association of post-discharge prophylactic antibiotics with decreased risk of surgical site infection following spinal fusion.
This study’s objective was to determine the prevalence and factors associated with post-discharge prophylactic antibiotic use after spinal fusion and whether use was associated with decreased risk of surgical site infection (SSI). The study cohort included persons aged 10-64 years undergoing 156,446 spinal fusion procedures between January 2010 and July 2015. Excluded patients included complicated cases and those coded for infection from 30 days before to 2 days after surgical admission. Outpatient oral antibiotic prescriptions were identified within 2 days of surgical discharge. ICD-9-CM diagnosis codes were used to identify SSI within 90 days of surgery. Post-discharge prophylactic antibiotics were used in 9223 surgeries. SSIs occurred after 2557 procedures (1.6%). Factors significantly associated with post-discharge antibiotic use included history of lymphoma, diabetes, 3-7 versus 1-2 vertebral levels fused, and non-infectious postoperative complications. Analysis showed antibiotic use was not associated with decreased SSI risk after spinal fusion.
AHRQ-funded; HS019455; HS027075.
Citation: Olsen MA, Greenberg JK, Peacock K .
Lack of association of post-discharge prophylactic antibiotics with decreased risk of surgical site infection following spinal fusion.
J Antimicrob Chemother 2022 Mar 31;77(4):1178-84. doi: 10.1093/jac/dkab475..
Keywords: Antibiotics, Medication, Surgery, Antimicrobial Stewardship, Practice Patterns
Howard 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
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
Bongiovanni T, Lancaster E, Ledesma Y
Systematic review and meta-analysis of the association between non-steroidal anti-inflammatory drugs and operative bleeding in the perioperative period.
Investigators sought to understand the risk of bleeding caused by NSAIDs in the perioperative period. They performed a systematic review of articles on the use of NSAIDs and outcomes of interest such as surgical complications and bleeding, then conducted a meta-analysis of the data. They concluded that NSAIDs were unlikely to be the cause of postoperative bleeding complications. The literature studied covered a large number of patients and remained consistent across types of NSAIDs and operations.
AHRQ-funded; HS027369; HS026383; 233201500020I.
Citation: Bongiovanni T, Lancaster E, Ledesma Y .
Systematic review and meta-analysis of the association between non-steroidal anti-inflammatory drugs and operative bleeding in the perioperative period.
J Am Coll Surg 2021 May;232(5):765-90.e1. doi: 10.1016/j.jamcollsurg.2021.01.005..
Keywords: Adverse Drug Events (ADE), Adverse Events, Medication, Surgery, Medication: Safety
Malone S, McKay VR, Krucylak C
A cluster randomized stepped-wedge trial to de-implement unnecessary post-operative antibiotics in children: the optimizing perioperative antibiotic in children (OPerAtiC) trial.
This paper describes an upcoming clinical trial to determine best strategies to de-implement inappropriate antibiotic use in pediatric post-operative surgical cases deemed low risk for infection. This study will provide important information on the impact of two potential strategies while assessing important clinical outcomes.
AHRQ-funded; HS026742.
Citation: Malone S, McKay VR, Krucylak C .
A cluster randomized stepped-wedge trial to de-implement unnecessary post-operative antibiotics in children: the optimizing perioperative antibiotic in children (OPerAtiC) trial.
Implement Sci 2021 Mar 19;16(1):29. doi: 10.1186/s13012-021-01096-1..
Keywords: Children/Adolescents, Antimicrobial Stewardship, Antibiotics, Medication, Surgery
Agarwal AK, Lee D, Ali Z
Patient-reported opioid consumption and pain intensity after common orthopedic and urologic surgical procedures with use of an automated text messaging system.
This prospective study looked at the number of opioid tablets taken compared to the number prescribed after orthopedic and urologic surgery at a large urban academic health center in Pennsylvania from May to December 2019 with the use of an automated text messaging system. Of the 919 study participants, 80.7% (742) underwent orthopedic procedures and 19.2% underwent urologic procedures. Among those who underwent orthopedic procedures, 384 were women, 491 were White, and the median age was 48 years; with almost 70% outpatient procedures. Among those who underwent urologic procedures, 84.8% were men, 80.7% were White, and the median age was 56 years; 62% had an outpatient procedure. Orthopedic patients were prescribed an average of 20 tablets and urologic patients 7 tablets. The majority of patients (64.1%) used less than half of the amount prescribed, and 256 orthopedic and 77 urologic patients did not use any opioids. The findings suggest that clinicians can tailor prescriptions to limit excess quantities of prescribed opioids.
AHRQ-funded; HS026372.
Citation: Agarwal AK, Lee D, Ali Z .
Patient-reported opioid consumption and pain intensity after common orthopedic and urologic surgical procedures with use of an automated text messaging system.
JAMA Netw Open 2021 Mar;4(3):e213243. doi: 10.1001/jamanetworkopen.2021.3243..
Keywords: Opioids, Medication, Pain, Orthopedics, Surgery
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
Eyrich NW, Sloss KR, Howard RA
Opioid prescribing exceeds consumption following common surgical oncology procedures.
Researchers aimed to compare opioid prescribing to opioid consumption for common surgical oncology procedures. They found that the median quantity of opioid prescribed was significantly larger than consumed following breast biopsy, lumpectomy, and mastectomy or wide local excision. The majority of patients reported receiving education on taking opioids, but only 27% received instructions on proper disposal; 82% of prescriptions filled resulted in unused opioids, and only 11% of these patients safely disposed of them. They concluded that their study demonstrated that opioid prescribing exceeds consumption following common surgical oncology procedures, thus indicating the potential for reductions in prescribing.
AHRQ-funded; HS023313.
Citation: Eyrich NW, Sloss KR, Howard RA .
Opioid prescribing exceeds consumption following common surgical oncology procedures.
J Surg Oncol 2021 Jan;123(1):352-56. doi: 10.1002/jso.26272..
Keywords: Opioids, Medication, Surgery, Cancer: Breast Cancer, Cancer, Practice Patterns, Pain