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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 1110 Research Studies DisplayedAnderson KE, Wu RJ, Darden M
Medicare Advantage is associated with lower utilization of total joint arthroplasty.
To discover whether Medicare Advantage enrollees have a lower utilization of elective surgical procedures such as inpatient hip and knee total joint arthroplasty (TJA), which have usually been covered by traditional Medicare without restrictions, researchers conducted a cross-sectional study comparing traditional Medicare claims and Medicare Advantage encounter records for enrollees aged 65-85. Their results showed a lower incidence of TJA in Medicare Advantage enrollees. The interval from initial diagnosis to contact with an orthopedic surgeon and to the surgical procedure were shorter among traditional enrollees.
AHRQ-funded; HS000029.
Citation: Anderson KE, Wu RJ, Darden M .
Medicare Advantage is associated with lower utilization of total joint arthroplasty.
J Bone Joint Surg Am 2024 Feb 7; 106(3):198-205. doi: 10.2106/jbjs.23.00507..
Keywords: Medicare, Orthopedics, Surgery
Mattioli DD, Thomas GW, Long S
Fluoroscopic image-based behavior analysis can objectively explain subjective expert assessment of wire navigation skill.
This study evaluated best methods to assess surgical wire navigation skill, which can be objectively evaluated by analysis of intraoperative fluoroscopic image sequences. Prior work suggests that such image-based behavior analysis of operating room (OR) performance can predict performer experience level and agree with expert opinion (the current standard) on the quality of a final implant construct. Objective image-based evaluations were compared to expert assessments for entire technical OR performances. The relationship of three key variables were studied: (1) objective image-based criteria, (2) expert opinions, and (3) performing surgeon experience level. The authors used a paired-comparison survey of seven experts, based upon eight OR fluoroscopic wire navigation image sequences, which showed that the experts' preferences are best explained by objective metrics that reflect psychomotor and decision-making behaviors which are counter-productive to successful implant placement, like image count and behavior tally. One such behavior, adjustments away from goal, uniquely correlated well with all three key variables: a fluoroscopic image-based analysis composite score, expert consensus, and performer experience. The results confirmed that experts view less efficient technical behavior as indicative of lesser technical proficiency.
AHRQ-funded; HS022077; HS025353.
Citation: Mattioli DD, Thomas GW, Long S .
Fluoroscopic image-based behavior analysis can objectively explain subjective expert assessment of wire navigation skill.
J Orthop Res 2024 Feb; 42(2):404-14. doi: 10.1002/jor.25685..
Keywords: Surgery, Orthopedics
Cassidy DE, Shao Z, Howard R
Variability in surgical approaches to hernias in patients with ascites.
This study investigated variability in surgical approaches to hernias in patients with ascites. The authors used data from the Michigan Surgical Quality Collaborative and its corresponding Core Optimization Hernia Registry (MSQC-COHR), which captures specific patient, hernia, and operative characteristics at a population level within the state. This retrospective cohort reviewed patients with ascites who had ventral or inguinal hernia repair surgery between January 2020 and May 3, 2022. The primary outcome observed was incidence and surgical approach for both ventral and inguinal hernia cohorts, and secondary outcomes included 30-day adverse clinical outcomes as listed here: (ED visits, readmission, reoperation, and complications) and surgical priority (urgent/emergent vs elective). In the cohort of 176 patients with ascites, only 1.4% of ventral hernia patients underwent hernia repair surgery, and only 0.2% of inguinal hernia patients. The post-operative 30-day adverse clinical outcomes in both hernia surgery cohorts were greatly increased compared to those without ascites (ventral: 32%; inguinal: 30%). Readmission was the most common complication, with a rate of 15.9% in the inguinal cohort, and 19.3% in the ventral hernia cohort. Open repair was the most common surgical approach (ventral: 86%, open: 77%). Ventral hernias were most commonly considered as urgent or emergency surgery (60%), while inguinal was mostly presented as elective surgery (72%).
AHRQ-funded; HS025778.
Citation: Cassidy DE, Shao Z, Howard R .
Variability in surgical approaches to hernias in patients with ascites.
Surg Endosc 2024 Feb; 38(2):735-41. doi: 10.1007/s00464-023-10598-6..
Keywords: Surgery
Liu 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)
Oke I, Elze T, Miller JW
Surgical approach and reoperation risk in intermittent exotropia in the IRIS Registry.
This cohort study compared the 5-year reoperation rates for children with intermittent exotropia (IXT). Reoperation rates for children with IXT treated with horizontal muscle strabismus surgery using bilateral lateral rectus recession (BLR) vs unilateral lateral rectus recession with medial rectus resection (RR) were compared. The authors examined data obtained from the Intelligent Research in Sight (IRIS) Registry on 7482 children (age, <18 years) with IXT who underwent horizontal eye muscle strabismus surgery, excluding children undergoing initial surgeries involving 3 or more horizontal muscles, vertical muscles, or reoperations. Primary outcome was the adjusted cumulative incidence of repeat horizontal muscle surgery within 5 years after the initial surgery. BLR was performed more frequently than RR (85.3% vs 14.7%), especially in younger children. After data adjustment, the 5-year cumulative incidence of reoperation was 21.3%. The adjusted 5-year cumulative incidence of reoperation was higher for BLR than for RR. Unilateral lateral rectus recession with medial rectus resection was associated with a lower 5-year reoperation risk compared with BLR. Younger age at time of initial surgery was associated with a higher reoperation risk.
AHRQ-funded; HS000063.
Citation: Oke I, Elze T, Miller JW .
Surgical approach and reoperation risk in intermittent exotropia in the IRIS Registry.
JAMA Ophthalmol 2024 Jan; 142(1):48-52. doi: 10.1001/jamaophthalmol.2023.5288..
Keywords: Surgery, Risk
Roberts ET, Xue L, Lovelace J
Changes in care associated with integrating Medicare and Medicaid for dual-eligible individuals.
This study’s objective was to evaluate changes in care associated with integrating Medicare and Medicaid coverage in a fully integrated dual-eligible special needs plan (FIDE-SNP) in Pennsylvania. This cohort study used a difference-in-differences analysis compared changes in care between 2 cohorts of dual-eligible individuals: (1) an integration cohort composed of Medicare Dual Eligible Special Needs Plan enrollees who joined a companion Medicaid plan following a 2018 state reform mandating Medicaid managed care (leading to integration), and (2) a comparison cohort with nonintegrated coverage before and after the start of Medicaid managed care. Analyses were conducted of outcomes in 4 domains: use of home- and community-based services (HCBS), care management and coordination, hospital stays and postacute care, and long-term nursing home stays. The study included 7967 individuals in the integration cohort and 3832 individuals in the comparison cohort. HCBS use increased differentially in the integration vs comparison cohorts by 0.61 days/person-month. However, integration was not associated with changes in care management and coordination, including medication use for chronic conditions (-0.02 fills/person-month) or follow-up outpatient care after a hospital stay (-0.01 visits/hospital stay). There was no significant difference in hospital stays between the cohorts.
AHRQ-funded; HS026727.
Citation: Roberts ET, Xue L, Lovelace J .
Changes in care associated with integrating Medicare and Medicaid for dual-eligible individuals.
JAMA Health Forum 2023 Dec; 4(12):e234583. doi: 10.1001/jamahealthforum.2023.4583..
Keywords: Medicare, Medicaid, Health Insurance, Surgery, Outcomes
Zondlak AN, Oh EJ, Neiman PU
Association of intellectual disability with delayed presentation and worse outcomes in emergency general surgery.
Individuals with intellectual disabilities may be at higher risk of delayed presentation and worse outcomes for emergency general surgery (EGS) conditions. The purpose of this study was to explore the relationship between intellectual disability and both severity of disease and clinical outcomes in patients presenting with typical EGS conditions. The study found that of 1,317,572 adult EGS admissions, 0.38% of patients had an ICD-9/-10 code consistent with current intellectual disability. EGS patients with intellectual disabilities had 31% greater odds of more severe disease at presentation when compared with neurotypical patients. Intellectual disability was also related with a higher likelihood of complications and mortality, longer lengths of stay, lower rate of discharge to home, and higher inpatient costs.
AHRQ-funded; HS028672; HS027788.
Citation: Zondlak AN, Oh EJ, Neiman PU .
Association of intellectual disability with delayed presentation and worse outcomes in emergency general surgery.
Ann Surg 2023 Nov 1; 278(5):e1118-e22. doi: 10.1097/sla.0000000000005863..
Keywords: Healthcare Cost and Utilization Project (HCUP), Disabilities, Surgery, Outcomes
Bauer TM, Yaser JM, Daramola T
Cardiac rehabilitation reduces two-year mortality after coronary artery bypass grafting.
This study analyzed the outcome of cardiac rehabilitation (CR) use for patients who have undergone coronary revascularization procedures. The study looked at Medicare fee-for-service claims linked to surgical data patients discharged alive following isolated coronary artery bypass grafting (CABG) from January 2015 to October 2019. A total of 3,848/6,412 (60.0%) of patients were enrolled in CR for an average of 23.2 sessions with 770/6,412 (12.0%) completing all recommended 36 sessions. Predictors of post-discharge CR use included increasing age, discharge to home (vs extended care facility), and shorter length of stay. Unadjusted and inverse probability treatment weighting (IPTW) analyses showed significant reduction in 2-year mortality in CR users as compared to CR non-users (unadjusted 9.4%).
AHRQ-funded; HS027830.
Citation: Bauer TM, Yaser JM, Daramola T .
Cardiac rehabilitation reduces two-year mortality after coronary artery bypass grafting.
Ann Thorac Surg 2023 Nov; 116(5):1099-105. doi: 10.1016/j.athoracsur.2023.05.044..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Surgery, Mortality, Outcomes
Scott JW, Knowlton LM, Murphy P
Financial toxicity after trauma and acute care surgery: from understanding to action.
The negative impact of major injuries and surgical emergencies on patients’ long-term financial wellbeing is a factor that is often overlooked by clinicians and researchers. The concept of financial toxicity includes the objective financial repercussions of illness and medical care and also subjective financial concerns of patients. The purpose of this review was to 1) provide a conceptual overview of financial toxicity after trauma or emergency surgery, 2) outline what is known about the long-term economic outcomes among trauma and emergency surgery patients, 3) examine the relationship between financial toxicity and long-term physical and mental health outcomes, 4) describe policies and programs that may mitigate financial toxicity, and 5) identify the current knowledge gaps and urgent next steps for clinicians and researchers engaged in this area of work.
AHRQ-funded; HS028672.
Citation: Scott JW, Knowlton LM, Murphy P .
Financial toxicity after trauma and acute care surgery: from understanding to action.
J Trauma Acute Care Surg 2023 Nov 1; 95(5):800-05. doi: 10.1097/ta.0000000000003979..
Keywords: Healthcare Costs, Trauma, Surgery
Chen VW, Chidi AP, Dong Y
Risk-adjusted cumulative sum for early detection of hospitals with excess perioperative mortality.
This study’s goal was to compare the risk-adjusted cumulative sum (CUSUM) with episodic evaluation for early detection of hospitals with excess perioperative mortality. The study cohort included 697,566 patients treated at 104 Veterans’ Affairs hospitals across 24 quarters with a mean age of 60.9 years and 91.4% male. These patients underwent a noncardiac operation at a Veterans Affairs hospital, had a record in the Veterans Affairs Surgical Quality Improvement Program (January 1, 2011, through December 31, 2016), and were aged 18 years or older. For each hospital, the median number of quarters detected with observed to expected ratios, at least 1 CUSUM signal, and more than 1 CUSUM signal was 2 quarters (IQR, 1-4 quarters), 8 quarters (IQR, 4-11 quarters), and 3 quarters (IQR, 1-4 quarters). Outlier hospitals were identified 33.3% of the time (830 quarters) with at least 1 CUSUM signal within a quarter, 12.5% (311 quarters) with more than 1 CUSUM signal, and 11.0% (274 quarters) with observed to expected ratios at the end of the quarter. The CUSUM detection occurred a median of 49 days (IQR, 25-63 days) before observed to expected ratio reporting (1 signal, 35 days [IQR, 17-54 days]; 2 signals, 49 days [IQR, 26-61 days]; 3 signals, 58 days [IQR, 44-69 days]; ≥4 signals, 49 days [IQR, 42-69 days]. Of 274 hospital quarters detected with observed to expected ratios, 72.6% were concurrently detected by at least 1 CUSUM signal vs 42.7% by more than 1 CUSUM signal. There was a dose-response relationship between the number of CUSUM signals in a quarter and the median observed to expected ratio (0 signals, 0.63; 1 signal, 1.28; 2 signals, 1.58; 3 signals, 2.08; ≥4 signals, 2.49).
AHRQ-funded; HS013853.
Citation: Chen VW, Chidi AP, Dong Y .
Risk-adjusted cumulative sum for early detection of hospitals with excess perioperative mortality.
JAMA Surg 2023 Nov; 158(11):1176-83. doi: 10.1001/jamasurg.2023.3673..
Keywords: Quality Improvement, Surgery, Hospitals, Patient Safety, Mortality, Quality of Care
Mullens CL, Lussiez A, Scott JW
Association of health professional shortage area hospital designation with surgical outcomes and expenditures among Medicare beneficiaries.
This study’s objective was to compare surgical outcomes and expenditures at hospitals located in Health Professional Shortage Areas to nonshortage area designated hospitals among Medicare beneficiaries. This cross-sectional retrospective study used data from 842,787 Medicare beneficiary patient admissions to hospitals with and without Health Professional Shortage Area designations for common operations including appendectomy, cholecystectomy, colectomy, and hernia repair from 2014 to 2018. Primary outcomes measures were 30-day mortality, hospital readmissions, and 30-day surgical episode payments. Patients (mean age=75.6 years, males=44.4%) undergoing common surgical procedures in shortage area hospitals were less likely to be White (84.6% vs 88.4%) and less likely to have≥2 Elixhauser comorbidities (75.5% vs 78.2%). Patients undergoing surgery at Health Professional Shortage Area hospitals had lower risk-adjusted rates of 30-day mortality (6.05% vs 6.69%) and readmission (14.99% vs 15.74%). Medicare expenditures at Health Professional Shortage Area hospitals were also lower than nonshortage designated hospitals ($28,517 vs $29,685).
AHRQ-funded; HS028606; HS028672.
Citation: Mullens CL, Lussiez A, Scott JW .
Association of health professional shortage area hospital designation with surgical outcomes and expenditures among Medicare beneficiaries.
Ann Surg 2023 Oct 1; 278(4):e733-e39. doi: 10.1097/sla.0000000000005762..
Keywords: Hospitals, Surgery, Medicare, Healthcare Costs, Workforce, Outcomes
Bonner SN, Lagisetty K, Reddy RM
Clinical implications of removing race-corrected pulmonary function tests for African American patients requiring surgery for lung cancer.
This study’s objective was to identify how many hospitals providing lung cancer surgery use race correction in pulmonary function tests (PFTs), examine the association of race correction with predicted lung function, and test the effect of decorrection on surgeons' treatment recommendations. Percent predicted preoperative and postoperative forced expiratory volume in 1 second (FEV1) was calculated for African American patients who underwent lung cancer resection between January 1, 2015, and September 31, 2022, using race-corrected and race-neutral equations for hospitals performing race correction. Randomization of US cardiothoracic surgeons was conducted to receive 1 clinical vignette that differed by the use of Global Lung Function Initiative equations for (1) African American patients (percent predicted postoperative FEV1, 49%), (2) other race or multiracial patients (percent predicted postoperative FEV1, 45%), and (3) race-neutral patients (percent predicted postoperative FEV1, 42%). A total of 515 African American patients (308 [59.8%] female; mean age, 66.2 years) were included in the study. Among these patients, the percent predicted preoperative FEV1 and postoperative FEV1 would have decreased by 9.2% and 7.6%, respectively, if race-neutral equations had been used. A total of 225 surgeons (194 male [87.8%]; mean time in practice, 19.4 years) were successfully randomized and completed the vignette items regarding risk perception and treatment outcomes (76% completion rate). Surgeons randomized to the vignette with African American race-corrected PFTs were more likely to recommend lobectomy (79.2%) compared with surgeons randomized to the other race or multiracial-corrected (61.7%) or race-neutral PFTs (52.8%).
AHRQ-funded; HS028038.
Citation: Bonner SN, Lagisetty K, Reddy RM .
Clinical implications of removing race-corrected pulmonary function tests for African American patients requiring surgery for lung cancer.
JAMA Surg 2023 Oct; 158(10):1061-68. doi: 10.1001/jamasurg.2023.3239..
Keywords: Racial and Ethnic Minorities, Cancer: Lung Cancer, Cancer, Surgery, Diagnostic Safety and Quality
Thompson MP, Stewart JW, Hou H
Determinants and outcomes associated with skilled nursing facility use after coronary artery bypass grafting: a statewide experience.
The purpose of this study was to assess determinants and outcomes related with Skilled nursing facility (SNF) use after isolated coronary artery bypass grafting. The study sample included 8,614 patients, with an average age of 73.3 years. A skilled nursing facility (SNF) was used by 22.3% of patients within 90 days of discharge and ranged from 3.2% to 58.3% across the 33 hospitals. Patients utilizing SNFs had a greater likelihood of being female, older, non-White, with greater comorbidities, worse cardiovascular function, a perioperative morbidity, and longer hospital lengths of stay. Outcomes were significantly worse for users of SNFs, including higher rates of 90-day readmissions and ED visits and lower use of home health and rehabilitation services. Compared with non-SNF users, users of SNFs had a greater risk-adjusted hazard of mortality and had 2.7-percentage point greater 5-year mortality rate in a propensity-matched cohort of patients.
AHRQ-funded; HS027830.
Citation: Thompson MP, Stewart JW, Hou H .
Determinants and outcomes associated with skilled nursing facility use after coronary artery bypass grafting: a statewide experience.
Circ Cardiovasc Qual Outcomes 2023 Oct; 16(10):e009639. doi: 10.1161/circoutcomes.122.009639..
Keywords: Elderly, Nursing Homes, Heart Disease and Health, Cardiovascular Conditions, Medicare, Surgery
Romijn AC, Rastogi V, Proaño-Zamudio JA
Early versus delayed thoracic endovascular aortic repair for blunt thoracic aortic injury: a propensity score-matched analysis.
This study examined the outcomes of ≤24 h) versus delayed (>24 h) thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injury (BTAI), taking the aortic injury severity into consideration. Current trauma surgery guidelines recommend delayed TEVAR. Patients undergoing TEVAR for BTAI in the American College of Surgeons Trauma Quality Improvement Program between 2016 and 2019 were included and then stratified into early (≤24 h) or delayed (>24 h). The cohort looked at included 1339 patients, of whom 1054 (79%) underwent early TEVAR. Compared with the delayed group, the early group had significantly less severe head injuries (early vs delayed; 25% vs 32%), fewer early interventions for AAS grade 1 occurred, and AAS grade 3 aortic injuries often were intervened upon within 24 hours (grade 1: 28% vs 47%; grade 3: 49% vs 23%). Compared with the delayed group, the early group had significantly higher in-hospital mortality (8.8% vs 4.4%, relative risk: 2.2, 95% CI: 1.1-4.4), alongside a shorter length of hospital stay (5.0 vs 10 days), a shorter intensive care unit length of stay (4.0 vs 11 days) and fewer days on the ventilator (4.0 vs 6.5 days). Regardless of the higher risk of acute kidney injury in the delayed group (3.3% vs 7.7%), no other differences in in-hospital complications were observed between the early and delayed group.
AHRQ-funded; HS027285.
Citation: Romijn AC, Rastogi V, Proaño-Zamudio JA .
Early versus delayed thoracic endovascular aortic repair for blunt thoracic aortic injury: a propensity score-matched analysis.
Ann Surg 2023 Oct 1; 278(4):e848-e54. doi: 10.1097/sla.0000000000005817..
Keywords: Surgery, Cardiovascular Conditions, Risk, Outcomes
Montgomery KB, Fazendin JM, Broman KK
Evolving variation in the extent of surgery for low-risk papillary thyroid cancer in the United States.
This study looked at contemporary trends in the extent of surgery in patients with clinically node-negative papillary thyroid cancer ≤4 cm. Since 2015 there has been a debate over total thyroidectomy versus lobectomy and declining favor for prophylactic central neck dissection in this low-risk cohort. The authors used retrospective data from the National Cancer Database to identify adult patients with clinically node-negative papillary thyroid cancer ≤4 cm who underwent resection from 2012 to 2020. Primary outcome was the extent of surgery (lobectomy or total thyroidectomy, with or without prophylactic central neck dissection). Of 83,464 included patients, 79.3% were female with a median age of 51 years. Most patients underwent total thyroidectomy either with prophylactic central neck dissection (39.1%) or without (37.5%) versus lobectomy with prophylactic central neck dissection (7.2%) or without (16.2%). There was an increase in lobectomy from 18.3% in 2012 to 29.9% in 2020. Prophylactic central neck dissection rates also increased from 42.9% to 52.1%. There was a decreased likelihood of total thyroidectomy in patients who were male sex, Asian American, had smaller tumors or were treated at community cancer programs. There was a decreased likelihood of prophylactic central neck dissection in patients who were older, male sex, Black race, with smaller tumors, or were treated at community cancer programs or mid- or low-volume facilities.
AHRQ-funded; HS013852.
Citation: Montgomery KB, Fazendin JM, Broman KK .
Evolving variation in the extent of surgery for low-risk papillary thyroid cancer in the United States.
Surgery 2023 Oct; 174(4):828-35. doi: 10.1016/j.surg.2023.07.001.
Keywords: Surgery, Cancer
Scott JW, Neiman PU, Scott KW
High deductibles are associated with severe disease, catastrophic out-of-pocket payments for emergency surgical conditions.
This retrospective analysis of claims data examined the association of a high-deductible health insurance plan (HDHP) with severe disease and catastrophic out-of-pocket payments for emergency surgical conditions (e.g., appendicitis, cholecystitis, diverticulitis, and intestinal obstruction). Primary outcome was disease severity at presentation-determined using ICD-10-CM diagnoses codes and based on validated measures of anatomic severity (e.g., perforation, abscess, diffuse peritonitis). The secondary outcome was catastrophic out-of-pocket spending, defined by the World Health Organization as out-of-pocket spending >10% of annual income. Among 43,516 patients [mean age 48.4 years; 51% female], 41% were enrolled in HDHPs. Despite being younger, healthier, wealthier, and more educated, HDHP enrollees were more likely to present with more severe disease (28.5% vs 21.3%); even after adjusting for relevant demographics. HDHP enrollees were also more likely to incur 30-day out-of-pocket spending that exceeded 10% of annual income (20.8% vs 6.4%).
AHRQ-funded; HS027788; HS028672.
Citation: Scott JW, Neiman PU, Scott KW .
High deductibles are associated with severe disease, catastrophic out-of-pocket payments for emergency surgical conditions.
Ann Surg 2023 Oct 1; 278(4):e667-e74. doi: 10.1097/sla.0000000000005819..
Keywords: Health Insurance, Healthcare Costs, Payment, Surgery
Thumma SR, Dualeh SHA, Kunnath NJ
Outcomes for high-risk surgical procedures across high- and low-competition hospital markets.
The purpose of this retrospective study was to assess whether there is a relationship between hospital market competition and outcomes post high-risk surgery. The study included Medicare beneficiaries 65 years and older who electively underwent 1 of 10 high-risk surgical procedures. Procedures included: bariatric surgery, carotid endarterectomy, esophagectomy hip replacement, knee replacement, mitral lung resection valve repair, open aortic aneurysm repair, pancreatectomy, and rectal resection. Hospitals were categorized into high-competition and low-competition markets based on the hospital market Herfindahl-Hirschman index. The primary outcome was 30-day postoperative mortality and readmissions. The study found that when analyzed by procedure, compared with low-competition hospitals, high-competition market hospitals demonstrated higher 30-day mortality for 2 of 10 procedures (mitral valve repair and carotid endarterectomy) and no difference for 5 of 10 procedures (open aortic aneurysm repair, bariatric surgery, esophagectomy, knee replacement, and hip replacement.) High-competition hospitals also demonstrated 30-day readmissions that were higher for 5 of 10 procedures (carotid endarterectomy, knee replacement, mitral valve repair, open aortic aneurysm repair, and rectal resection) and no difference for 3 procedures (bariatric surgery, esophagectomy: and pancreatectomy.) Hospitals in high-competition compared with low-competition markets cared for patients who were older, were more likely to be racial and ethnic minority individuals and had more comorbidities.
AHRQ-funded; HS028963; HS028606.
Citation: Thumma SR, Dualeh SHA, Kunnath NJ .
Outcomes for high-risk surgical procedures across high- and low-competition hospital markets.
JAMA Surg 2023 Oct; 158(10):1041-48. doi: 10.1001/jamasurg.2023.3221..
Keywords: Surgery, Outcomes, Hospitals
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
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
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
Oke I, Hunter DG, Mantagos IS
The impact of the COVID-19 pandemic on the surgical volume of pediatric ophthalmology and strabismus fellows.
This article described a study that used data from the annual fellowship survey to describe trends in surgical experience for pediatric ophthalmology and strabismus fellows, and to quantify the impact of the COVID-19 pandemic on trainee surgical volume. The findings showed that the overall number of procedures performed by fellows in the primary surgeon role declined during the first academic year of the pandemic but recovered in the second year. The number of intraocular cases performed per year increased during the study’s 7-year interval.
AHRQ-funded; HS000063.
Citation: Oke I, Hunter DG, Mantagos IS .
The impact of the COVID-19 pandemic on the surgical volume of pediatric ophthalmology and strabismus fellows.
J AAPOS 2023 Oct; 27(5):305-07. doi: 10.1016/j.jaapos.2023.06.006..
Keywords: COVID-19, Children/Adolescents, Surgery
Koch A, Quartucci C, Buchner A
Associations of flow disruptions with patient, staff, and process outcomes: a prospective observational study of robotic-assisted radical prostatectomies.
The purpose of this study was to examine the relationships between intraoperative flow disruptions (FDs) and patient outcomes, staff workload, and surgery duration. Sixty-one robotic-assisted radical prostatectomy procedures were captured (with 61 patients and 243 staff reports). The study found that high rates of FDs were observed; however, there were no significant associations with the rates of patient complications. Equipment- and patient-related FDs were associated with higher staff workload. No relationship was found between greater rates of FDs and duration of procedure.
AHRQ-funded; HS026491.
Citation: Koch A, Quartucci C, Buchner A .
Associations of flow disruptions with patient, staff, and process outcomes: a prospective observational study of robotic-assisted radical prostatectomies.
Surg Endosc 2023 Sep; 37(9):6964-74. doi: 10.1007/s00464-023-10162-2..
Keywords: Surgery, Workflow
Zamudio J, Woodward J, Kanji FF
Demands of surgical teams in robotic-assisted surgery: an assessment of intraoperative workload within different surgical specialties.
Existing approaches to evaluating workload in robotic-assisted surgery (RAS) focus on surgeons and lack real-world data. The purpose of this study was to understand how workload differs by role and specialty aids to identify effective ways to optimize workload. The researchers administered SURG-TLX surveys to surgical staff at three sites. 188 questionnaires were obtained across 90 RAS procedures. Significantly higher aggregate scores were reported for gynecology and urology than for general. Surgeons reported significantly higher scores for task complexity than both technicians and nurses.
AHRQ-funded; HS026491.
Citation: Zamudio J, Woodward J, Kanji FF .
Demands of surgical teams in robotic-assisted surgery: an assessment of intraoperative workload within different surgical specialties.
Am J Surg 2023 Sep; 6(3):365-70. doi: 10.1016/j.amjsurg.2023.06.010..
Keywords: Surgery, Provider: Physician
Mullens CL, Lussiez A, Scott JW
High-risk surgery among Medicare beneficiaries living in health professional shortage areas.
This study’s objective was to compare high-risk surgical outcomes at hospitals located in Health Professional Shortage Areas to nonshortage area designated hospitals among Medicare beneficiaries. The authors performed a retrospective review of Medicare beneficiaries living in health professional shortage areas and nonshortage areas who underwent abdominal aortic aneurysm repair, coronary artery bypass graft, esophagectomy, liver resection, pancreatectomy, or rectal resection between 2014 and 2018. They compared rates of postoperative complications and 30-day mortality between the patient cohorts. They used beneficiary and hospital ZIP codes to quantify travel time to obtain care. Compared with patients living in nonshortage areas, patients living in health professional shortage areas traveled longer (median 60.0 vs 28.0 minutes). There were no differences in risk-adjusted rates of complications (28.5% vs 28.6%) and small differences in rates of 30-day mortality (4.2% vs 4.4%) between beneficiaries living in shortage areas versus those not in shortage areas, respectively.
AHRQ-funded; HS028606; HS028672; HS027788.
Citation: Mullens CL, Lussiez A, Scott JW .
High-risk surgery among Medicare beneficiaries living in health professional shortage areas.
J Rural Health 2023 Sep; 39(4):824-32. doi: 10.1111/jrh.12748..
Keywords: Surgery, Hospitals, Workforce, Medicare, Outcomes
Anchan RM, Spies JB, Zhang S
Long-term health-related quality of life and symptom severity following hysterectomy, myomectomy, or uterine artery embolization for the treatment of symptomatic uterine fibroids.
This study compared the different surgical procedures used for uterine fibroids with respect to long-term health-related quality of life outcomes and symptom improvement. The authors examined differences in change from baseline to 1-, 2-, and 3-year follow-up in health-related quality of life and symptom severity among patients who underwent abdominal myomectomy, laparoscopic or robotic myomectomy, abdominal hysterectomy, laparoscopic or robotic hysterectomy, or uterine artery embolization. A subset of the COMPARE-UF registry, a multiinstitutional prospective observational cohort study of women undergoing treatment for uterine fibroids was used. A subset of 1384 women aged 31 to 45 years who underwent either abdominal myomectomy (n=237), laparoscopic myomectomy (n=272), abdominal hysterectomy (n=177), laparoscopic hysterectomy (n=522), or uterine artery embolization (n=176) were included. They obtained demographics, fibroid history, and symptoms using questionnaires at enrollment and at 1, 2, and 3 years posttreatment. The Uterine Fibroid Symptom and Quality of Life (UFS-QoL) questionnaire was used to ascertain symptom severity and health-related quality of life scores among participants. Those undergoing hysterectomy and uterine artery embolization reported the longest duration of fibroid symptoms with a mean of 6.3 years. The most common fibroid symptoms were heavy bleeding (menorrhagia) (75.3%), bulk symptoms (74.2%), and bloating (73.2%), with more than half (54.9%) of participants reported anemia, and 9.4% women reported a history of blood transfusion. Across all modalities, total health-related quality of life and symptom severity score markedly improved from baseline to 1-year with the largest improvement in the laparoscopic hysterectomy group. Those undergoing abdominal myomectomy, laparoscopic myomectomy, and uterine artery embolization also demonstrated significant improvement in health-related quality of life and symptom severity at 1 year, and the improvement persisted from baseline for uterine-sparing procedures during second and third year, posttreatment intervals, however with a trend toward decline in degree of improvement from years 1 and 2.
AHRQ-funded; HS023418.
Citation: Anchan RM, Spies JB, Zhang S .
Long-term health-related quality of life and symptom severity following hysterectomy, myomectomy, or uterine artery embolization for the treatment of symptomatic uterine fibroids.
Am J Obstet Gynecol 2023 Sep; 229(3):275.e1-75.e17. doi: 10.1016/j.ajog.2023.05.020..
Keywords: Quality of Life, Women, Surgery