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- Access to Care (3)
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- (-) Surgery (24)
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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 24 of 24 Research Studies DisplayedIantorno SE, Scaife JH, Bryce JR
Emergency department utilization for pediatric gastrostomy tubes across the United States.
This study investigated the number and nature of emergency department (ED) visits to community hospitals for pediatric gastrostomy tube complication. The authors used the 2019 Nationwide Emergency Department Sample to perform a retrospective cross-sectional analysis of pediatric patients (<18 y) with a primary diagnosis of gastrostomy tube complication. Their primary outcome was a potentially preventable ED visit, defined as an encounter that did not result in any imaging, procedures, or an inpatient admission. They observed 32,036 ED visits at 535 hospitals and 15,165 (47.3%) were potentially preventable. Median age was 2 years, and 17,707 (55%) were male. Compared to White patients, patients with higher odds of potentially preventable visits were Black and Hispanic. Patients with residential zip codes in the first, second, and third median household income quartiles had higher odds of potentially preventable visits compared to the highest.
AHRQ-funded; HS025776.
Citation: Iantorno SE, Scaife JH, Bryce JR .
Emergency department utilization for pediatric gastrostomy tubes across the United States.
J Surg Res 2024 Mar; 295:820-26. doi: 10.1016/j.jss.2023.11.028.
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Emergency Department, Healthcare Utilization, Surgery, Adverse Events
Brajcich BC, Johnson JK, Holl JL
Evaluation of emergency department treat-and-release encounters after major gastrointestinal surgery.
The purpose of this study was to assess the incidence of, reasons for, and predictors of emergency department treat-and-release encounters after gastrointestinal cancer operations. The researchers identified patients who underwent elective colorectal, esophageal, gastric, hepatobiliary, pancreatic, or small intestinal operations for cancer from the 2015-2017 Healthcare Cost and Utilization Project State Inpatient and State Emergency Department Databases for New York, Maryland, and Florida. The study found that among 51,527 patients at 406 hospitals, 7.9% had an ED treat-and-release encounter, and 10.8% had an ED encounter with readmission. In total, 40.7% of ED encounters were treat-and-release encounters. 12% of ED treat-and-release encounters were for pain, 11.7% for device/ostomy complaints, and 11.4% were for wound complaints (11.4%). ED treat-and-release encounters predictors included non-Hispanic Black race/ethnicity and Medicare or Medicaid coverage.
AHRQ-funded; HS026385.
Citation: Brajcich BC, Johnson JK, Holl JL .
Evaluation of emergency department treat-and-release encounters after major gastrointestinal surgery.
J Surg Oncol 2023 Aug; 128(2):402-08. doi: 10.1002/jso.27292..
Keywords: Emergency Department, Digestive Disease and Health, Surgery, Hospital Readmissions
Johnson CL, Colley A, Pierce L
Disparities in advance care planning rates persist among emergency general surgery patients: current state and recommendations for improvement.
A sudden shift in health condition and the intensification of chronic conditions often necessitate the consideration of emergency general surgery (EGS). While goal-oriented care discussions can enhance goal-concordant care and mitigate feelings of depression and anxiety in patients and caregivers, such conversations, along with standardized documentation, are seldom conducted for EGS patients. The researchers conducted a retrospective cohort study employing data from electronic health records of patients admitted to the EGS service in a high-level academic center to ascertain the frequency of significant advance care planning (ACP) documentation (discussions and legal ACP forms) during EGS hospitalization. Multivariable regression was used to identify patient, clinician, and procedural elements contributing to the absence of ACP. The study found that out of the 681 patients admitted to the EGS service in 2019, only 20.1% had ACP documentation in the electronic health record at any stage during their hospital stay. Two-thirds (65.8%) of the entire cohort underwent surgery during their admission, but none of them had an ACP conversation documented with the surgical team before the operation. Patients with ACP documentation were likely to be insured by Medicare and had a higher incidence of comorbid conditions.
AHRQ-funded; HS024532.
Citation: Johnson CL, Colley A, Pierce L .
Disparities in advance care planning rates persist among emergency general surgery patients: current state and recommendations for improvement.
J Trauma Acute Care Surg 2023 Jun; 94(6):863-69. doi: 10.1097/ta.0000000000003909..
Keywords: Disparities, Surgery, Emergency Department, Chronic Conditions
Fernandes-Taylor S, Yang Q, Yang DY
Greater patient sharing between hospitals is associated with better outcomes for transferred emergency general surgery patients.
The availability of emergency surgical services has diminished as the rural workforce has decreased. The growing need for interhospital patient transfers makes care coordination across different settings essential for maintaining high-quality care. The purpose of this study was to investigate the impact of recurrent patient-sharing between hospitals on the outcomes of emergency general surgery (EGS) patient transfers. A multicenter analysis was conducted involving inpatient acute care hospital stays in Wisconsin that required the transfer of EGS patients. Data was sourced from the Wisconsin Hospital Association (WHA), a comprehensive statewide hospital discharge database for the years 2016-2018. We postulated that a higher percentage of patients transferred between hospitals would lead to improved outcomes. The relationship between the proportion of EGS patient transfers and patient outcomes, such as in-hospital morbidity, mortality, and duration of stay, was examined. Additional factors considered were hospital organizational features and patient sociodemographic and clinical attributes. The researchers found that during the two-year study period, 118 hospitals transferred 3,197 EGS patients; 1,131 of these patients experienced in-hospital complications, death, or an extended stay (beyond the 75th percentile). The average patient age was 62 years, with 50% being female and 5% non-white. In the mixed-effects model, the proportion of shared patients between hospitals was linked to a reduced likelihood of in-hospital complications. Specifically, when the proportion of shared patients doubled between two hospitals, the relative odds of any adverse outcome shifted by 0.85.
AHRQ-funded; HS025224
Citation: Fernandes-Taylor S, Yang Q, Yang DY .
Greater patient sharing between hospitals is associated with better outcomes for transferred emergency general surgery patients.
J Trauma Acute Care Surg 2023 Apr;94(5):592-98. doi: 10.1097/ta.0000000000003789.
Keywords: Emergency Department, Hospitals, Surgery, Transitions of Care
Ingraham AM, Chaffee SM, Ayturk MD
Gaps in emergency general surgery coverage in the United States.
Researchers sought to measure gaps in round-the-clock emergency general surgery (EGS) care via a survey of all US adult acute care general hospitals with an emergency room, at least 1 operating room. They found that 17.1% of hospitals responding were unable to always provide round-the-clock EGS care. Rural location, smaller bed size, and non-teaching status were associated with lack of round-the-clock care. Inconsistent surgeon coverage was the primary reason for this lack. However, lack of a tiered system for booking emergency cases, no anesthesia availability overnight, and no stipend for EGS call were also associated with the inability to provide round-the-clock EGS care.
AHRQ-funded; HS025224; HS022694.
Citation: Ingraham AM, Chaffee SM, Ayturk MD .
Gaps in emergency general surgery coverage in the United States.
Ann Surg Open 2021 Mar;2(1). doi: 10.1097/as9.0000000000000043..
Keywords: Surgery, Emergency Department, Hospitals, Access to Care, Workforce
Fernandes-Taylor S, Yang DY, Schumacher J
Factors associated with Interhospital transfers of emergency general surgery patients from emergency departments.
This study looked at the factors contributing to transfer of emergency general surgery (EGS) patients to another hospital. Data from the AHRQ Nationwide Emergency Department Sample (NEDS) from 2010-2014 was analyzed. The transfer rate during that time was 1.9%. Patients with Medicare or other insurance had higher odds of transfer compared to patients with private health insurance. Odds of transfer increased with a greater number of comorbid conditions as well as resuscitation, intestinal obstruction, and conditions of the upper gastrointestinal tract. Transfers were more likely to originate from rural hospitals or Level I or II trauma centers.
AHRQ-funded; HS025224.
Citation: Fernandes-Taylor S, Yang DY, Schumacher J .
Factors associated with Interhospital transfers of emergency general surgery patients from emergency departments.
Am J Emerg Med 2021 Feb;40:83-88. doi: 10.1016/j.ajem.2020.12.012..
Keywords: Healthcare Cost and Utilization Project (HCUP), Surgery, Emergency Department, Transitions of Care, Hospitals, Healthcare Delivery
Fischer CP, Knapp L, Cohen ME
Feasibility of enhanced recovery in emergency colorectal operation.
This study examines the feasibility of using enhanced recovery pathways (ERPs) in emergency colorectal operations. It has been successfully used with elective surgical care but has not been examined for emergency procedures. A total of 31,511 patients who underwent colorectal operations at 235 hospitals were identified from a national ERP collaborative. Most were elective surgeries (28,425), with 3,086 emergencies. For emergency cases, rates of early Foley removal and venous thromboembolism prophylaxis were highest. Rates of multimodal pain control, early mobilization, and early liquid intake were modest. Patients younger than age 65 years, those with independent functional status, American Society of Anesthesiologists Physical Status Classification 1 to 3, and without physiologic derangement had the most nonadherence. Lack of mobilization or liquid intake was independently associated with increased odds of ileus and prolonged length of stay.
AHRQ-funded; 233201500020I.
Citation: Fischer CP, Knapp L, Cohen ME .
Feasibility of enhanced recovery in emergency colorectal operation.
J Am Coll Surg 2021 Feb;232(2):178-85. doi: 10.1016/j.jamcollsurg.2020.10.004..
Keywords: Surgery, Digestive Disease and Health, Emergency Department, Patient-Centered Outcomes Research, Outcomes
Lumpkin ST, Mihas P, Baldwin X
Surgical patient values frame and modify the impact of risk factors for non-routine postdischarge care: a mixed-methods study.
This mixed methods study looked at patient perspectives on risk factors of non-routine postdischarge care (emergency department visit or rehospitalization) for adult colorectal surgery patients. Surgery patients were identified from hospital records from 2017 to 2018. The authors enrolled 258 participants, surveyed 167, and interviewed 18. Depressive symptoms were found to be one of the many risk factors confirmed to increase non-routine health utilization.
AHRQ-funded; HS026363.
Citation: Lumpkin ST, Mihas P, Baldwin X .
Surgical patient values frame and modify the impact of risk factors for non-routine postdischarge care: a mixed-methods study.
Am J Surg 2021 Jan;221(1):195-203. doi: 10.1016/j.amjsurg.2020.05.016..
Keywords: Digestive Disease and Health, Surgery, Risk, Hospital Readmissions, Emergency Department
Tameron AM, Ricci KB, Oslock WM
The association between self-declared acute care surgery services and critical care resources: results from a national survey.
In this study, the investigators examined differences in critical care structures and processes between hospitals with Acute Care Surgery (ACS) versus general surgeon on call (GSOC) models for emergency general surgery (EGS) care. The investigators concluded that while harnessing of critical care structures and processes varied across hospitals that had implemented ACS, overall ACS models of care appeared to have more robust critical care practices.
AHRQ-funded; HS022694.
Citation: Tameron AM, Ricci KB, Oslock WM .
The association between self-declared acute care surgery services and critical care resources: results from a national survey.
J Crit Care 2020 Dec;60:84-90. doi: 10.1016/j.jcrc.2020.04.002..
Keywords: Surgery, Critical Care, Emergency Department, Healthcare Delivery, Hospitals
Brown CS, Yang J, Meng Z
Trends in emergency department utilization following common operations in New York State, 2005-2014.
Researchers examined emergency department (ED) utilization following three common surgeries: cholecystectomy, appendectomy, and inguinal hernia repair. A longitudinal analysis was conducted using data from the SPARCS New York (NY) administrative database on 746,633 who underwent those procedures from 2005 to 2014. Nearly 1 in 10 patients who underwent cholecystectomy or appendectomy and 1 in 20 patients went to the ED after discharge. Of those, only 9.5% cholecystectomy, 9.1% appendectomy, and 5.1% inguinal hernia repair patients were readmitted indicating possible overutilization of the ED following common operations.
AHRQ-funded; HS025778; HS000053.
Citation: Brown CS, Yang J, Meng Z .
Trends in emergency department utilization following common operations in New York State, 2005-2014.
Surg Endosc 2020 May;34(5):1994-99. doi: 10.1007/s00464-019-06975-9..
Keywords: Emergency Department, Surgery, Healthcare Utilization
Lauerman MH, Herrera AV, Albrecht JS
Percentage of mortal encounters transferred in emergency general surgery.
The purpose of this study was to describe individual hospital transfer rates of mortal encounters. Using data from the Maryland Health Services Cost Review Commission database, results showed broad variability in individual hospital practices for mortality transferred to other institutions. Application of this knowledge of percentage of mortal encounters transferred includes consideration in hospital quality metrics.
AHRQ-funded; HS024560.
Citation: Lauerman MH, Herrera AV, Albrecht JS .
Percentage of mortal encounters transferred in emergency general surgery.
J Surg Res 2019 Nov;243:391-98. doi: 10.1016/j.jss.2019.05.040.
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Keywords: Emergency Department, Surgery, Mortality, Hospitals
Ricci KB, Rushing AP, Ingraham AM
The association between self-declared acute care surgery services and operating room access: results from a national survey.
In this study, the investigators conducted a national survey on emergency general surgery (EGS) structures and processes to examine if implementation of acute care surgery (ACS) would improve OR accessibility compared with a traditional general surgeon on call (GSOC) approach.
AHRQ-funded; HS022694.
Citation: Ricci KB, Rushing AP, Ingraham AM .
The association between self-declared acute care surgery services and operating room access: results from a national survey.
J Trauma Acute Care Surg 2019 Oct;87(4):898-906. doi: 10.1097/ta.0000000000002394..
Keywords: Surgery, Emergency Department, Access to Care
Oslock WM, Paredes AZ, Baselice HE
Women surgeons and the emergence of acute care surgery programs.
The authors sought to examine predictors of women surgeons in emergency general surgery (EGS) generally, and in acute care surgery (ACS) particularly. They found that 50.4% of hospitals studied had zero women surgeons. Women were more likely to be among EGS surgeons at hospitals with ACS models. They concluded that their study highlighted the dearth of women representation within EGS hospitals nationally and illuminated some of the underlying characteristics of ACS that may draw women: urban, academic, and staffed by more recently trained surgeons.
AHRQ-funded; HS022694.
Citation: Oslock WM, Paredes AZ, Baselice HE .
Women surgeons and the emergence of acute care surgery programs.
Am J Surg 2019 Oct;218(4):803-08. doi: 10.1016/j.amjsurg.2019.07.008..
Keywords: Surgery, Provider: Physician, Provider, Emergency Department
Ingraham AM, Ayturk MD, Kiefe CI
Adherence to 20 emergency general surgery best practices: results of a national survey.
The authors used a hybrid questionnaire to examine national adherence to emergency general surgery (EGS) best practices. They found that there was substantial room for performance improvement, and that adopting an acute care surgery model predicts better performance. They conclude that this novel overview of adherence to EGS best practices will enable surgeons and policymakers to address variations in EGS care nationally.
AHRQ-funded; HS022694.
Citation: Ingraham AM, Ayturk MD, Kiefe CI .
Adherence to 20 emergency general surgery best practices: results of a national survey.
Ann Surg 2019 Aug;270(2):270-80. doi: 10.1097/sla.0000000000002746..
Keywords: Surgery, Emergency Department, Guidelines, Quality of Care, Quality Improvement
Ingraham A, Wang X, Havlena J
Factors associated with the interhospital transfer of emergency general surgery patients.
Researchers used data from the Nationwide Inpatient Sample to determine patient- and hospital-level factors associated with interhospital emergency general surgery (EGS) transfers. They identified that hospital-level characteristics more strongly predicted the need for transfer than patient-related factors. They recommended considering these factors in order to facilitate transfer decision-making.
AHRQ-funded; HS025224.
Citation: Ingraham A, Wang X, Havlena J .
Factors associated with the interhospital transfer of emergency general surgery patients.
J Surg Res 2019 Aug;240:191-200. doi: 10.1016/j.jss.2018.11.053..
Keywords: Healthcare Cost and Utilization Project (HCUP), Emergency Department, Surgery, Shared Decision Making, Hospitals, Healthcare Delivery, Transitions of Care
Hoonakker PLT, Wooldridge AR, Hose BZ
Information flow during pediatric trauma care transitions: things falling through the cracks.
In order to investigate information flow during pediatric trauma care transitions, researchers interviewed 18 clinicians about communication and coordination between the emergency department, operating room, and pediatric intensive care unit, then surveyed the clinicians about patient safety during these transitions. They found that, despite the fact that the many services and units involved in pediatric trauma cooperate well together during trauma cases, important patient care information is often lost when transitioning patients between units. To manage the transition of this fragile and complex population better, they recommend finding ways to manage the information flow during these transitions better by, for instance, providing technological support to ensure shared mental models.
AHRQ-funded; HS023837.
Citation: Hoonakker PLT, Wooldridge AR, Hose BZ .
Information flow during pediatric trauma care transitions: things falling through the cracks.
Intern Emerg Med 2019 Aug;14(5):797-805. doi: 10.1007/s11739-019-02110-7..
Keywords: Children/Adolescents, Communication, Emergency Department, Healthcare Delivery, Intensive Care Unit (ICU), Patient Safety, Provider, Provider: Clinician, Surgery, Transitions of Care, Trauma
Daniel VT, Rushing AP, Ingraham AM
Association between operating room access and mortality for life-threatening general surgery emergencies.
Few diseases truly require emergency surgery today. In this study, the authors investigated the relationship between access to operating room (OR) and outcomes for patients with life-threatening emergency general surgery (LT-EGS) diseases at US hospitals. The investigators concluded that round-the-clock availability of personnel, specifically emergency general surgeons and recovery room nurses, is associated with decreased mortality.
AHRQ-funded; HS022694.
Citation: Daniel VT, Rushing AP, Ingraham AM .
Association between operating room access and mortality for life-threatening general surgery emergencies.
J Trauma Acute Care Surg 2019 Jul;87(1):35-42. doi: 10.1097/ta.0000000000002267..
Keywords: Access to Care, Emergency Department, Healthcare Cost and Utilization Project (HCUP), Mortality, Outcomes, Surgery
Lauerman MH, Herrera AV, Albrecht JS
Interhospital transfers with wide variability in emergency general surgery.
This study examined modern hospital practices for interhospital transfers of emergency general surgery patients. A retrospective review of the Maryland Health Services Cost Review Commission database was conducted from 2013 to 2015. The majority of patients (94.1%) were not transferred with only 3.2% transferred to a hospital and 2.7% transferred from a hospital. For individual hospitals, there was a range of 0-30.5% of encounters transferred to a hospital, 0.02-14.62% transferred from a hospital and 69.25-99.95% not transferred.
AHRQ-funded; HS024560.
Citation: Lauerman MH, Herrera AV, Albrecht JS .
Interhospital transfers with wide variability in emergency general surgery.
Am Surg 2019 Jun;85(6):595-600..
Keywords: Emergency Department, Healthcare Delivery, Hospitalization, Hospitals, Outcomes, Quality of Care, Surgery, Transitions of Care
Shaffer R, Backhus L, Finnegan MA
Thirty-day unplanned postoperative inpatient and emergency department visits following thoracotomy.
This study examined thirty-day unplanned postoperative inpatient and emergency department visits following thoracotomy. The study concluded that following thoracotomy, postoperative emergency department visits and inpatient readmissions are common. Patients with public insurance were at high risk for readmission, while patients with underlying lung cancer diagnosis had a lower readmission risk. Emphasizing postoperative management in at-risk populations could improve health outcomes and reduce unplanned returns to care.
AHRQ-funded; HS024096.
Citation: Shaffer R, Backhus L, Finnegan MA .
Thirty-day unplanned postoperative inpatient and emergency department visits following thoracotomy.
J Surg Res 2018 Oct;230:117-24. doi: 10.1016/j.jss.2018.04.065..
Keywords: Emergency Department, Hospital Readmissions, Outcomes, Patient Safety, Surgery
Murphy PB, Vogt KN, Lau BD
Venous thromboembolism prevention in emergency general surgery: a review.
Operatively and nonoperatively treated emergency general surgery patients are at a comparatively high risk of venous thromboembolism (VTE). This review found that, despite gaps in existing literature with respect to this increasing patient population, successful best practices can be applied. Best practices include assessment of VTE risk, optimal prophylaxis, and physician, nurse, and patient education regarding the use of mechanical and pharmacologic VTE prophylaxis and institutional policies.
AHRQ-funded; HS024547.
Citation: Murphy PB, Vogt KN, Lau BD .
Venous thromboembolism prevention in emergency general surgery: a review.
JAMA Surg 2018 May;153(5):479-86. doi: 10.1001/jamasurg.2018.0015..
Keywords: Blood Clots, Surgery, Emergency Department, Adverse Events, Prevention, Patient Safety
Abdel Khalik H, Stevens H, Carlin AM
Site-specific approach to reducing emergency department visits following surgery.
The aim of this study was to explore the efficacy of current bariatric perioperative measures at reducing emergency department (ED) visits following bariatric surgery in the state of Michigan. The investigators concluded that current practices aimed at reducing ED visits appeared to be ineffective. They suggested that due to heterogeneity in patient populations and local infrastructure, a more tailored approach to ED visit reduction may be more successful.
AHRQ-funded; HS023621; HS024403.
Citation: Abdel Khalik H, Stevens H, Carlin AM .
Site-specific approach to reducing emergency department visits following surgery.
Ann Surg 2018 Apr;267(4):721-26. doi: 10.1097/sla.0000000000002226.
Keywords: Adverse Events, Emergency Department, Healthcare Utilization, Obesity, Surgery
Finnegan MA, Shaffer R, Remington A
Emergency department visits following elective total hip and knee replacement surgery: identifying gaps in continuity of care.
The researchers sought to characterize 30-day ED visits following a major joint replacement surgical procedure. They concluded that ED visits following an elective major joint replacement surgical procedure were numerous and most commonly for pain-related diagnoses. Medicaid patients had almost double the risk of an ED or pain-related ED visit following a surgical procedure.
AHRQ-funded; HS024096.
Citation: Finnegan MA, Shaffer R, Remington A .
Emergency department visits following elective total hip and knee replacement surgery: identifying gaps in continuity of care.
J Bone Joint Surg Am 2017 Jun 21;99(12):1005-12. doi: 10.2106/jbjs.16.00692.
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Keywords: Care Management, Emergency Department, Surgery
Metzler IS, Smith-Bindman R, Moghadassi M
Emergency department imaging modality effect on surgical management of nephrolithiasis: a multicenter, randomized clinical trial.
In this multicenter randomized clinical trial the inivestigators examined rates of urological referral and intervention to elucidate whether the initial diagnostic imaging modality affected the management of nephrolithiasis. They concluded that patients undergoing a urological intervention who had ultrasonography as initial imaging did not experience a significant delay to intervention or different procedure types, but the majority ultimately underwent computerized tomography before surgery.
AHRQ-funded; HS021281.
Citation: Metzler IS, Smith-Bindman R, Moghadassi M .
Emergency department imaging modality effect on surgical management of nephrolithiasis: a multicenter, randomized clinical trial.
J Urol 2017 Mar;197(3 Pt 1):710-14. doi: 10.1016/j.juro.2016.09.122..
Keywords: Emergency Department, Imaging, Surgery
Williams TP, Dimou FM, Adhikari D
Hospital readmission after emergency room visit for cholelithiasis.
This study evaluated the surgical follow-up and outcomes in patients seen in the emergency department (ED) for an episode of symptomatic cholelithiasis and discharged home for elective follow-up. It found that the failure to achieve a timely surgical follow-up leads to multiple ED readmissions and emergent gallstone-related hospitalizations, including emergency cholecystectomy.
AHRQ-funded; HS022134.
Citation: Williams TP, Dimou FM, Adhikari D .
Hospital readmission after emergency room visit for cholelithiasis.
J Surg Res 2015 Aug;197(2):318-23. doi: 10.1016/j.jss.2015.04.032..
Keywords: Hospital Readmissions, Patient-Centered Outcomes Research, Emergency Department, Hospital Discharge, Surgery