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 101 Research Studies DisplayedSkube SJ, Hu Z, Arsoniadis EG
Characterizing surgical site infection signals in clinical notes.
Building off of previous work for automated and semi-automated surgical site infections (SSIs) detection using expert-derived "strong features" from clinical notes, researchers hypothesized that additional SSI phrases may be contained in clinical notes. They systematically characterized phrases and expressions associated with SSIs. While 83 percent of expert-derived original terms overlapped with new terms and modifiers, an additional 362 modifiers associated with both positive and negative SSI signals were identified.
AHRQ-funded; HS024532.
Citation: Skube SJ, Hu Z, Arsoniadis EG .
Characterizing surgical site infection signals in clinical notes.
Stud Health Technol Inform 2017;245:955-59.
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Keywords: Healthcare-Associated Infections (HAIs), Surgery, Injuries and Wounds, Patient Safety, Adverse Events, Quality Improvement, Quality of Care
Haynes AB, Edmondson LB, Lipsitz SR
Mortality trends after a voluntary checklist-based surgical safety collaborative.
This study sought to determine whether completion of a voluntary, checklist-based surgical quality improvement program is associated with reduced 30-day postoperative mortality. It It found that, despite similar pre-existing rates and trends of postoperative mortality, hospitals in South Carolina completing a voluntary checklist-based surgical quality improvement program had a reduction in deaths after inpatient surgery over the first 3 years of the collaborative compared with other hospitals in the state.
AHRQ-funded; HS019631.
Citation: Haynes AB, Edmondson LB, Lipsitz SR .
Mortality trends after a voluntary checklist-based surgical safety collaborative.
Annals of Surgery 2017 Dec;266(6):923-29. doi: 10.1097/SLA.0000000000002249.
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Keywords: Mortality, Patient Safety, Surgery, Quality Improvement, Quality of Care
Morabito J, Bell MT, Montenij LJ
Perioperative considerations for chylothorax.
This paper presents the case report of a 73 year old man with recurrent right pleural effusions, and a mediastinal mass of indeterminate etiology after a computer tomography-guided biopsy and thoracentesis. It discusses the perioperative considerations for chylothorax.
AHRQ-funded; HS024124.
Citation: Morabito J, Bell MT, Montenij LJ .
Perioperative considerations for chylothorax.
J Cardiothorac Vasc Anesth 2017 Dec;31(6):2277-81. doi: 10.1053/j.jvca.2017.06.001..
Keywords: Case Study, Imaging, Respiratory Conditions, Surgery
George MD, Baker JF, Hsu JY
Perioperative timing of infliximab and the risk of serious infection after elective hip and knee arthroplasty.
The purpose of this retrospective cohort study was to evaluate the association between infliximab timing and serious infection after elective hip or knee arthroplasty. The investigators concluded that administering infliximab within 4 weeks of elective knee or hip arthroplasty was not associated with a higher risk of short- or long-term serious infection compared to withholding infliximab for longer time periods. They also concluded that glucocorticoid use, especially >10 mg/day, was associated with an increased infection risk.
AHRQ-funded; HS018517.
Citation: George MD, Baker JF, Hsu JY .
Perioperative timing of infliximab and the risk of serious infection after elective hip and knee arthroplasty.
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Keywords: Adverse Drug Events (ADE), Adverse Events, Medication, Medication: Safety, Orthopedics, Patient Safety, Surgery
Leeds IL, Canner JK, Efron JE
The independent effect of cancer on outcomes: a potential limitation of surgical risk prediction.
This study aims to compare the use of common risk models for benign versus malignant gastrointestinal disease. It found that the National Surgical Quality Improvement Program (NSQIP) prediction models less effectively evaluate the risk of death in cancer patients as compared to patients with benign disease. A diagnosis of cancer is independently associated with an increased risk of surgical complications.
AHRQ-funded; HS024736.
Citation: Leeds IL, Canner JK, Efron JE .
The independent effect of cancer on outcomes: a potential limitation of surgical risk prediction.
J Surg Res 2017 Dec;220:402-09.e6. doi: 10.1016/j.jss.2017.08.039.
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Keywords: Adverse Events, Cancer, Digestive Disease and Health, Risk, Surgery
Saeed MJ, Turner TE, Brown DL
Trends in inferior vena cava filter placement by indication in the United States from 2005 to 2014.
This study examined trends in inpatient inferior vena cava (IVC) filter placement overall and by indication from 2005 to 2014. The IVC filter placement rate per 100 000 hospitalizations increased from 322.1 (n = 99 779) in 2005 to 412.0 (n = 129 026) in 2010, decreased to 374.1 (n = 117 731) in 2011, and continued declining to 321.8 (n = 95 735) in 2014. The percentage of prophylactic IVC filter placement decreased from 28.9 percent in 2005 to 22.6 percent in 2014.
AHRQ-funded; HS019455.
Citation: Saeed MJ, Turner TE, Brown DL .
Trends in inferior vena cava filter placement by indication in the United States from 2005 to 2014.
JAMA Intern Med 2017 Dec;177(12):1861-62. doi: 10.1001/jamainternmed.2017.5960.
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Keywords: Cardiovascular Conditions, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Surgery
Goldstone AB, Chiu P, Baiocchi M
Mechanical or biologic prostheses for aortic-valve and mitral-valve replacement.
This study compared long-term mortality and rates of reoperation, stroke, and bleeding between cohorts of patients who underwent primary aortic-valve replacement or mitral-valve replacement with a mechanical or biologic prosthesis. The long-term mortality benefit associated with a mechanical prosthesis, as compared with a biologic prosthesis, persisted until 70 years of age among patients undergoing mitral-valve replacement and until 55 years of age among those undergoing aortic-valve replacement.
AHRQ-funded; HS022192.
Citation: Goldstone AB, Chiu P, Baiocchi M .
Mechanical or biologic prostheses for aortic-valve and mitral-valve replacement.
N Engl J Med 2017 Nov 9;377(19):1847-57. doi: 10.1056/NEJMoa1613792.
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Keywords: Adverse Events, Cardiovascular Conditions, Medical Devices, Patient-Centered Outcomes Research, Surgery
Borah BJ, Yao X, Laughlin-Tommaso SK
Comparative effectiveness of uterine leiomyoma procedures using a large insurance claims database.
The objective of this retrospective analysis of administrative claims from a large U.S. commercial insurance database, was to compare risk of reintervention, long-term clinical outcomes, and health care utilization among women who have bulk symptoms from leiomyoma and who underwent the following procedures: hysterectomy, myomectomy, uterine artery embolization, and magnetic resonance-guided, focused ultrasound surgery.
AHRQ-funded; HS023418.
Citation: Borah BJ, Yao X, Laughlin-Tommaso SK .
Comparative effectiveness of uterine leiomyoma procedures using a large insurance claims database.
Obstet Gynecol 2017 Nov;130(5):1047-56. doi: 10.1097/AOG.0000000000002331..
Keywords: Cancer, Comparative Effectiveness, Health Insurance, Outcomes, Patient-Centered Outcomes Research, Surgery, Women
Branzetti JB, Adedipe AA, Gittinger MJ
Randomised controlled trial to assess the effect of a Just-in-Time training on procedural performance: a proof-of-concept study to address procedural skill decay.
The purpose of this study was to evaluate the impact of a novel Just-in-Time (JIT) intervention on transvenous pacemaker (TVP) placement during a simulated patient event. The authors concluded that a JIT intervention improved procedure performance, suggesting a role for JIT interventions in rarely performed procedures.
AHRQ-funded; HS020295
Citation: Branzetti JB, Adedipe AA, Gittinger MJ .
Randomised controlled trial to assess the effect of a Just-in-Time training on procedural performance: a proof-of-concept study to address procedural skill decay.
BMJ Qual Saf 2017 Nov;26(11):881-91. doi: 10.1136/bmjqs-2017-006656..
Keywords: Medical Devices, Patient Safety, Surgery, Training, Emergency Medical Services (EMS)
Tedesco D, Gori D, Desai KR
Drug-free interventions to reduce pain or opioid consumption after total knee arthroplasty: a systematic review and meta-analysis.
The authors systematically reviewed and meta-analyzed evidence of nonpharmacological interventions for postoperative pain management after total knee arthroplasty. The most commonly performed interventions included in the review were continuous passive motion, preoperative exercise, cryotherapy, electrotherapy, and acupuncture. In the meta-analysis, electrotherapy and acupuncture after total knee arthroplasty were associated with reduced and delayed opioid consumption.
AHRQ-funded; HS024096.
Citation: Tedesco D, Gori D, Desai KR .
Drug-free interventions to reduce pain or opioid consumption after total knee arthroplasty: a systematic review and meta-analysis.
JAMA Surg 2017 Oct 18;152(10):e172872. doi: 10.1001/jamasurg.2017.2872.
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Keywords: Care Management, Medication, Opioids, Orthopedics, Pain, Surgery
Balentine CJ, Xie R, Kirklin JK
Failure to diagnose hyperparathyroidism in 10,432 patients with hypercalcemia: opportunities for system-level intervention to increase surgical referrals and cure.
Researchers sought to determine whether a significant number of patients with hyperparathyroidism remain undiagnosed and untreated. After reviewing administrative data on 682,704 patients from a tertiary referral center between 2011 and 2015 and identifying hypercalcemia (>10.5 mg/dL) in 10,432 patients, they concluded that a significant proportion of patients with hyperparathyroidism do not undergo appropriate evaluation and surgical referral.
AHRQ-funded; HS023009.
Citation: Balentine CJ, Xie R, Kirklin JK .
Failure to diagnose hyperparathyroidism in 10,432 patients with hypercalcemia: opportunities for system-level intervention to increase surgical referrals and cure.
Ann Surg 2017 Oct;266(4):632-40. doi: 10.1097/sla.0000000000002370.
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Keywords: Diagnostic Safety and Quality, Patient-Centered Outcomes Research, Surgery
Charles EJ, Johnston LE, Herbert MA
Impact of Medicaid expansion on cardiac surgery volume and outcomes.
The objective of this study was to evaluate the effect of Medicaid expansion on cardiac surgery volume and outcomes comparing one state that expanded to one that did not. It concluded that Medicaid expansion was associated with fewer uninsured cardiac surgery patients and improved predicted risk scores and morbidity rates. In addition to improving health care financing, Medicaid expansion may positively affect patient care and outcomes.
AHRQ-funded; HS022535.
Citation: Charles EJ, Johnston LE, Herbert MA .
Impact of Medicaid expansion on cardiac surgery volume and outcomes.
Ann Thorac Surg 2017 Oct;104(4):1251-58. doi: 10.1016/j.athoracsur.2017.03.079.
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Keywords: Patient-Centered Outcomes Research, Medicaid, Surgery, Cardiovascular Conditions, Policy
Pellegrini CA, Song J, Semanik PA
Patients less likely to lose weight following a knee replacement: results from the osteoarthritis initiative.
The purpose of this study was to examine weight change patterns preoperatively and postoperatively among overweight/obese knee replacement patients. Overweight and obese patients initially lost weight during the interval including knee replacement; however, they were less likely to lose more than 2.5% of their weight in the 1 to 2 years immediately after the surgery.
AHRQ-funded; HS023011.
Citation: Pellegrini CA, Song J, Semanik PA .
Patients less likely to lose weight following a knee replacement: results from the osteoarthritis initiative.
J Clin Rheumatol 2017 Oct;23(7):355-60. doi: 10.1097/rhu.0000000000000579..
Keywords: Obesity: Weight Management, Arthritis, Patient-Centered Outcomes Research, Surgery
Zenga J, Suko J, Kallogjeri D
Postoperative hemorrhage and hospital revisit after transoral robotic surgery.
The researchers investigated the incidence and complications related to postoperative hemorrhage (POH) after transoral robotic surgery (TORS). Using HCUP data, they found that the incidence of POH after TORS was low, and few of these patients had a severe complication related to this event. Medical comorbidity and tonsillar subsite may be independent risk factors for POH.
AHRQ-funded; HS019455.
Citation: Zenga J, Suko J, Kallogjeri D .
Postoperative hemorrhage and hospital revisit after transoral robotic surgery.
Laryngoscope 2017 Oct;127(10):2287-92. doi: 10.1002/lary.26626.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Surgery, Adverse Events, Risk
Leeds IL, Alimi Y, Hobson DR
Racial and socioeconomic differences manifest in process measure adherence for enhanced recovery after surgery pathway.
This study aims to demonstrate the association between recovery pathway implementation, process measures, and short-term surgical outcomes by population subgroup. It concluded that differences in outcomes by race and socioeconomic status did not arise following implementation of an enhanced recovery pathway. Differences in process measures by population subgroups highlight differences in care that require further investigation.
AHRQ-funded; HS024736; HS024547.
Citation: Leeds IL, Alimi Y, Hobson DR .
Racial and socioeconomic differences manifest in process measure adherence for enhanced recovery after surgery pathway.
Dis Colon Rectum 2017 Oct;60(10):1092-101. doi: 10.1097/dcr.0000000000000879.
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Keywords: Racial and Ethnic Minorities, Social Determinants of Health, Surgery, Outcomes, Adverse Events
Ban KA, Gibbons MM, Ko CY
Surgical technical evidence review for colorectal surgery conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery.
The objective of this article is to provide a comprehensive review of the evidence supporting the surgical components of the Improving Surgical Care and Recovery (ISCR) colorectal (CR) pathway. This review will evaluate the evidence supporting CR pathways and develop an evidence-based CR protocol to help hospitals participating in the ISCR program implement evidence-based practices.
AHRQ-funded; 233201500020I.
Citation: Ban KA, Gibbons MM, Ko CY .
Surgical technical evidence review for colorectal surgery conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery.
J Am Coll Surg 2017 Oct;225(4):548-57.e3. doi: 10.1016/j.jamcollsurg.2017.06.017.
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Keywords: Evidence-Based Practice, Hospitals, Patient Safety, Quality Improvement, Surgery, Quality of Care, Guidelines
Ehlers AP, Khor S, Cizik AM
Use of patient-reported outcomes and satisfaction for quality assessments.
This study investigated the relationship between PROs and satisfaction among spine surgery patients. The authors hypothesized that there would be significant disparities between patient satisfaction and PROs at the 1-year postoperative time point. The study found that overall, patients undergoing elective lumbar spine surgery reported being satisfied with outcomes, but the reported responses in PROs were much more variable.
AHRQ-funded; HS020025.
Citation: Ehlers AP, Khor S, Cizik AM .
Use of patient-reported outcomes and satisfaction for quality assessments.
Am J Manag Care 2017 Oct;23(10):618-22..
Keywords: Patient-Centered Outcomes Research, Patient Experience, Quality of Care, Surgery, Outcomes, Orthopedics
Ross WT, Meister MR, Shepherd JP
Utilization of apical vaginal support procedures at time of inpatient hysterectomy performed for benign conditions: a national estimate.
The researchers sought to estimate trends and factors associated with use of apical support procedures at time of inpatient hysterectomy for benign indications in a large national database. Their study demonstrated that apical support procedures are not routinely performed at time of inpatient hysterectomy regardless of presence of prolapse diagnosis.
AHRQ-funded; HS019455.
Citation: Ross WT, Meister MR, Shepherd JP .
Utilization of apical vaginal support procedures at time of inpatient hysterectomy performed for benign conditions: a national estimate.
Am J Obstet Gynecol 2017 Oct;217(4):436.e1-36.e8. doi: 10.1016/j.ajog.2017.07.010.
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Keywords: Healthcare Utilization, Practice Patterns, Surgery, Women
Symer MM, Abelson JS, Milsom J
A mobile health application to track patients after gastrointestinal surgery: results from a pilot study.
Many surgical readmissions are preventable. Mobile health technology can identify nascent complications and potentially prevent readmission. The researchers performed a pilot study of a new mobile health application in adults undergoing major abdominal surgery and determined the app can track patient recovery from major abdominal surgery, is easy to use, and has potential to improve outcomes.
AHRQ-funded; HS000066.
Citation: Symer MM, Abelson JS, Milsom J .
A mobile health application to track patients after gastrointestinal surgery: results from a pilot study.
J Gastrointest Surg 2017 Sep;21(9):1500-05. doi: 10.1007/s11605-017-3482-2..
Keywords: Telehealth, Health Information Technology (HIT), Hospital Readmissions, Surgery, Adverse Events, Patient Safety, Digestive Disease and Health, Prevention
Waljee JF, Dimick JB
Do patient-reported outcomes correlate with clinical outcomes following surgery?
This study examines whether patient-reported outcomes (PROs) correlate with clinical outcomes following surgery. PROs are distinct from clinical outcomes and represent a potential indicator of performance that can be targeted to improve quality of care. Future studies that examine the influence of measurement techniques, case mix, and disease characteristics on PROs will inform efforts to routinely and efficiently integrate these critical outcomes into existing strategies to capture treatment effectiveness and quality of care for surgical conditions.
AHRQ-funded; HS023313.
Citation: Waljee JF, Dimick JB .
Do patient-reported outcomes correlate with clinical outcomes following surgery?
Adv Surg 2017 Sep;51(1):141-50. doi: 10.1016/j.yasu.2017.03.011..
Keywords: Quality of Care, Outcomes, Patient-Centered Outcomes Research, Surgery, Patient Experience, Quality Measures
Shih YT, Shen C, Hu JC
Do robotic surgical systems improve profit margins? A cross-sectional analysis of California hospitals.
The aim of this study was to examine the association between ownership of robotic surgical systems and hospital profit margins. Hospitals with robotic surgical systems tended to report more favorable profit margins. However, multilevel logistic regression showed that this relationship (an association, not causality) became only marginally significant after controlling for other hospital characteristics.
AHRQ-funded; HS020263; HS024608.
Citation: Shih YT, Shen C, Hu JC .
Do robotic surgical systems improve profit margins? A cross-sectional analysis of California hospitals.
Value Health 2017 Sep;20(8):1221-25. doi: 10.1016/j.jval.2017.05.010.
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Keywords: Healthcare Costs, Hospitals, Surgery
Jackson SS, Leekha S, Magder LS
Electronically available comorbidities should be used in surgical site infection risk adjustment.
A multicenter retrospective cohort study of patients undergoing surgical procedures at 28 US hospitals was performed. The authors developed a well-performing risk adjustment model for surgical site infections (SSI) using electronically available comorbidities. Healthcare-associated infections, such as SSIs, are used by the Centers for Medicare and Medicaid Services (CMS) as pay-for-performance metrics. The authors recommended that comorbidity-based risk adjustment should be strongly considered by the Centers for Disease Control and Prevention and CMS to adequately compare SSI rates across hospitals.
AHRQ-funded; HS022291.
Citation: Jackson SS, Leekha S, Magder LS .
Electronically available comorbidities should be used in surgical site infection risk adjustment.
Clin Infect Dis 2017 Sep 1;65(5):803-10. doi: 10.1093/cid/cix431..
Keywords: Healthcare-Associated Infections (HAIs), Surgery, Patient Safety, Risk, Injuries and Wounds, Adverse Events
Olsen MA, Nickel KB, Fraser VJ
Prevalence and predictors of postdischarge antibiotic use following mastectomy.
This study determined utilization, predictors, and outcomes of postdischarge prophylactic antibiotics after mastectomy with or without immediate breast reconstruction. The study conclude that prophylactic postdischarge antibiotics are commonly prescribed after mastectomy; immediate reconstruction is the strongest predictor. The authors recommended stewardship efforts in this population to limit continuation of prophylactic antibiotics after discharge are needed to limit antimicrobial resistance.
AHRQ-funded; HS019455.
Citation: Olsen MA, Nickel KB, Fraser VJ .
Prevalence and predictors of postdischarge antibiotic use following mastectomy.
Infect Control Hosp Epidemiol 2017 Sep;38(9):1048-54. doi: 10.1017/ice.2017.128.
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Keywords: Antibiotics, Healthcare-Associated Infections (HAIs), Medication, Patient Safety, Surgery, Injuries and Wounds, Prevention, Adverse Events, Risk
Spertus JA, Ghaferi AA
Transforming the National Surgical Quality Improvement Program to the delivery of precision medicine to improve the value of surgical care: Summary of the John R. Clarke keynote address for the Surgical Outcomes Club 2016 Annual Meeting.
The authors challenged the audience to begin thinking about implementing precision medicine in routine care. They argue that the profession of medicine is undergoing an unprecedented transformation from fee-for-service to value-based reimbursement. This offers an opportunity to rethink current practice patterns and redesign health care delivery to improve patients’ experiences and outcomes while lowering costs. The surgical community has a unique opportunity to embrace this challenge and develop tools to better tailor treatment to risk.
AHRQ-funded; HS023621.
Citation: Spertus JA, Ghaferi AA .
Transforming the National Surgical Quality Improvement Program to the delivery of precision medicine to improve the value of surgical care: Summary of the John R. Clarke keynote address for the Surgical Outcomes Club 2016 Annual Meeting.
JAMA Surg 2017 Sep;152(9):815-16. doi: 10.1001/jamasurg.2017.1610.
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Keywords: Healthcare Delivery, Quality of Care, Patient Safety, Quality Improvement, Surgery
Calderwood MS, Huang SS, Keller V
Variable case detection and many unreported cases of surgical-site infection following colon surgery and abdominal hysterectomy in a statewide validation.
This study assesses hospital surgical-site infection (SSI) identification and reporting following colon surgery and abdominal hysterectomy via a statewide external validation. The authors concluded that claims-based surveillance is a standardized approach that hospitals can use to augment traditional surveillance methods and health departments can use for external validation.
AHRQ-funded; HS021424.
Citation: Calderwood MS, Huang SS, Keller V .
Variable case detection and many unreported cases of surgical-site infection following colon surgery and abdominal hysterectomy in a statewide validation.
Infect Control Hosp Epidemiol 2017 Sep;38(9):1091-97. doi: 10.1017/ice.2017.134..
Keywords: Healthcare-Associated Infections (HAIs), Surgery, Injuries and Wounds, Patient Safety, Women, Adverse Events, Diagnostic Safety and Quality, Hospitals