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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 56 Research Studies DisplayedHolcomb CN, Graham LA, Richman JS
The incremental risk of noncardiac surgery on adverse cardiac events following coronary stenting.
The investigators sought to determine the incremental risk of noncardiac surgery on myocardial infarction (MI) and coronary revascularization following coronary stenting. They found that the incremental risk of noncardiac surgery on adverse cardiac events among post-stent patients is highest in the initial 6 months following stent implantation and stabilizes at 1.0% after 6 months.
AHRQ-funded; HS013852.
Citation: Holcomb CN, Graham LA, Richman JS .
The incremental risk of noncardiac surgery on adverse cardiac events following coronary stenting.
J Am Coll Cardiol 2014 Dec 30;64(25):2730-9. doi: 10.1016/j.jacc.2014.09.072.
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Keywords: Adverse Events, Cardiovascular Conditions, Patient-Centered Healthcare, Risk, Surgery
Singh JA, Lewallen DG
Are outcomes after total knee arthroplasty worsening over time? A time-trends study of activity limitation and pain outcomes.
The authors examined whether function and pain outcomes of patients undergoing primary total knee arthroplasty (TKA) are changing over time. Using Mayo Clinic Total Joint Registry data, they found that patient-reported function and pain outcomes after primary TKA have worsened over the study period 1993-95 to 2002-05; this time-trend is independent of changes in preoperative pain/limitation and certain patient characteristics.
AHRQ-funded; HS021110.
Citation: Singh JA, Lewallen DG .
Are outcomes after total knee arthroplasty worsening over time? A time-trends study of activity limitation and pain outcomes.
BMC Musculoskelet Disord 2014 Dec 17;15:440. doi: 10.1186/1471-2474-15-440.
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Keywords: Centers for Education and Research on Therapeutics (CERTs), Orthopedics, Pain, Patient-Centered Outcomes Research, Surgery
Franklin PD, Lewallen D, Bozic K
Implementation of patient-reported outcome measures in U.S. total joint replacement registries: rationale, status, and plans.
The authors report on the status of patient-reported outcomes (PRO) implementation as well as perceived barriers and facilitators of PRO use among five U.S. total joint replacement registries. They find that the current stage of implementation of patient-reported outcomes measures varies widely among U.S. registries.
AHRQ-funded; HS018910.
Citation: Franklin PD, Lewallen D, Bozic K .
Implementation of patient-reported outcome measures in U.S. total joint replacement registries: rationale, status, and plans.
J Bone Joint Surg Am 2014 Dec 17;96 Suppl 1:104-9. doi: 10.2106/jbjs.n.00328..
Keywords: Registries, Surgery, Comparative Effectiveness, Patient-Centered Outcomes Research
Singh JA, Lewallen DG
Increasing obesity and comorbidity in patients undergoing primary total hip arthroplasty in the U.S.: a 13-year study of time trends.
The researchers examined the time-trends in key demographic and clinical characteristics of patients undergoing primary total hip arthroplasty (THA). They found that obesity, medical and psychological comorbidity increased and the underlying diagnosis of RA/inflammatory arthritis decreased rapidly in primary THA patients over 13-years.
AHRQ-funded; HS021110.
Citation: Singh JA, Lewallen DG .
Increasing obesity and comorbidity in patients undergoing primary total hip arthroplasty in the U.S.: a 13-year study of time trends.
BMC Musculoskelet Disord 2014 Dec 17;15:441. doi: 10.1186/1471-2474-15-441..
Keywords: Surgery, Obesity, Risk, Registries, Arthritis
Raebel MA, Newcomer SR, Bayliss EA
Chronic opioid use emerging after bariatric surgery.
The purpose of this study was to determine opioid use the year after bariatric surgery among patients who did not use opioids chronically pre-surgery and to identify pre-surgery characteristics associated with chronic opioid use after surgery. It found that patients dispensed 60 to 119 days’ supply during the pre-surgery year were 13.23 to 14.29 times more likely to use opioids chronically post-surgery than patients without opioid use pre-surgery.
AHRQ-funded; HS019912.
Citation: Raebel MA, Newcomer SR, Bayliss EA .
Chronic opioid use emerging after bariatric surgery.
Pharmacoepidemiol Drug Saf 2014 Dec;23(12):1247-57. doi: 10.1002/pds.3625..
Keywords: Medication, Obesity, Opioids, Pain, Substance Abuse, Surgery
Aterburn D, Powers JD, Toh S
Comparative effectiveness of laparoscopic adjustable gastric banding vs laparoscopic gastric bypass.
A retrospective study of 7,457 patients undergoing laparoscopic bariatric surgery found that patients receiving gastric bypass experienced much greater weight loss than those receiving gastric banding but they had a higher risk of short-term complications and long-term subsequent hospitalizations. However, gastric bypass patients had a lower risk of long-term subsequent intervention procedures than did gastric banding patients.
AHRQ-funded; HS019912
Citation: Aterburn D, Powers JD, Toh S .
Comparative effectiveness of laparoscopic adjustable gastric banding vs laparoscopic gastric bypass.
JAMA Surg. 2014 Dec;149(12):1279-87. doi: 10.1001/jamasurg.2014.1674..
Keywords: Obesity, Surgery, Adverse Events, Patient Safety, Hospitalization
Abdelsattar ZM, Wong SL, Birkmeyer NJ
Multi-institutional assessment of sphincter preservation for rectal cancer.
This study sought to identify whether variation in sphincter preservation surgery (SPS) rates for patients with rectal cancer can be explained by patient, tumor, or treatment-related factors across hospitals. It found that SPS rates vary by hospital, even after accounting for clinical characteristics using detailed chart review.
AHRQ-funded; HS000053
Citation: Abdelsattar ZM, Wong SL, Birkmeyer NJ .
Multi-institutional assessment of sphincter preservation for rectal cancer.
Ann Surg Oncol. 2014 Dec;21(13):4075-80. doi: 10.1245/s10434-014-3882-4..
Keywords: Cancer: Colorectal Cancer, Quality of Care, Surgery
Sanger PC, Hartzler A, Han SM
Patient perspectives on post-discharge surgical site infections: towards a patient-centered mobile health solution.
This study explored patient experience of surgical site infections (SSI) and openness to a mobile health (mHealth) wound monitoring ‘‘app’’ as a novel solution to address the problem of patient perceptions about barriers experienced while seeking care for post-discharge SSI. It found that patients are dissatisfied with the current standard post-hospitalization care practice and were accepting of the concept of a patient-centered wound monitoring application.
AHRQ-funded; HS019482.
Citation: Sanger PC, Hartzler A, Han SM .
Patient perspectives on post-discharge surgical site infections: towards a patient-centered mobile health solution.
PLoS One 2014 Dec;9(12):e114016. doi: 10.1371/journal.pone.0114016..
Keywords: Surgery, Health Information Technology (HIT), Adverse Events, Patient Experience, Hospital Discharge
Hollingsworth JM, Birkmeyer JD, Ye Z
Specialty-specific trends in the prevalence and distribution of outpatient surgery: implications for payment and delivery system reforms.
The authors sought to assess the prevalence and distribution of outpatient surgery across specialties. They found that several specialties - urology, gastroenterology, plastic surgery, and ophthalmology - perform most of their cases in outpatient settings. They suggested that incorporating these findings into the design of future payment and delivery system reforms will help to ensure adequate surgeon exposure to the efficiency gains that evolve from them.
AHRQ-funded; HS020927; HS018346.
Citation: Hollingsworth JM, Birkmeyer JD, Ye Z .
Specialty-specific trends in the prevalence and distribution of outpatient surgery: implications for payment and delivery system reforms.
Surg Innov 2014 Dec;21(6):560-5. doi: 10.1177/1553350613520515.
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Keywords: Ambulatory Care and Surgery, Surgery, Healthcare Delivery, Payment
Sanger P, Hartzler A, Lober WB
Design considerations for post-acute care mHealth: patient perspectives.
The authors are developing an mHealth platform to engage patients in wound tracking to identify and manage surgical site infections (SSI) after hospital discharge. Their key design qualities include: meeting basic accessibility, usability and security needs; encouraging patient-centeredness; facilitating better, more predictable communication; and supporting personalized management by providers. In this article, they illustrated their application of these guiding design considerations and proposed a new framework for mHealth design based on illness duration and intensity.
AHRQ-funded; HS019482.
Citation: Sanger P, Hartzler A, Lober WB .
Design considerations for post-acute care mHealth: patient perspectives.
AMIA Annu Symp Proc 2014 Nov 14;2014:1920-9.
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Keywords: Telehealth, Patient Self-Management, Surgery, Injuries and Wounds, Healthcare-Associated Infections (HAIs), Hospital Discharge, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Adverse Events
Segal CG, Waller DK, Tilley B
An evaluation of differences in risk factors for individual types of surgical site infections after colon surgery.
The authors developed four independent, multivariate, predictive models to assess the unique associations between risk factors and each surgical site infection (SSI) group: superficial, deep, organ space, and an aggregate of all 3 types of SSIs. They found that unique risks for superficial SSIs include diabetes, chronic obstructive pulmonary disease, and dyspnea; deep SSIs had the greatest magnitude of association with BMI and the greatest incidence of wound disruption; and organ space SSIs were often owing to anastomotic leaks and were uniquely associated with disseminated cancer, preoperative dialysis, preoperative radiation treatment, and a bleeding disorder. They concluded that more effective prevention strategies may be developed by reporting and examining each type of SSI separately.
AHRQ-funded; HS021857.
Citation: Segal CG, Waller DK, Tilley B .
An evaluation of differences in risk factors for individual types of surgical site infections after colon surgery.
Surgery 2014 Nov;156(5):1253-60. doi: 10.1016/j.surg.2014.05.010.
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Keywords: Risk, Healthcare-Associated Infections (HAIs), Adverse Events, Surgery, Patient Safety
Du DT, McKean SJ, Kelman JA, et al.
AHRQ Author: Encinosa W
Early mortality after aortic valve replacement with mechanical prosthetic vs bioprosthetic valves among Medicare beneficiaries: a population-based cohort study.
The researchers compared early mortality after aortic valve replacement (AVR) between the recipients of mechanical and bioprosthetic aortic valves. Among 66,453 Medicare beneficiaries who received AVRs, use of mechanical valves was associated with a higher risk for death on the date of surgery and within 30 days compared with the bioprosthetic aortic valves. However, this applied only to those who underwent concurrent AVR and coronary artery bypass graft but not isolated AVR.
AHRQ-authored
Citation: Du DT, McKean SJ, Kelman JA, et al..
Early mortality after aortic valve replacement with mechanical prosthetic vs bioprosthetic valves among Medicare beneficiaries: a population-based cohort study.
JAMA Intern Med. 2014 Nov;174(11):1788-95. doi: 10.1001/jamainternmed.2014.4300..
Keywords: Cardiovascular Conditions, Medicare, Mortality, Patient-Centered Outcomes Research, Surgery
Ghomrawi HM, Alexiades M, Pavlov H
Evaluation of two appropriateness criteria for total knee replacement.
The researchers evaluated the performance of 2 sets of non-U.S. appropriateness criteria (one from Spain and the other from Canada) for total knee replacement (TKR) in a group of 508 TKR patients. Although only 4.7 percent were classified as inappropriate by both sets of criteria, there was little agreement between the two.
AHRQ-funded; HS016075
Citation: Ghomrawi HM, Alexiades M, Pavlov H .
Evaluation of two appropriateness criteria for total knee replacement.
Arthritis Care Res. 2014 Nov;66(11):1749-53. doi: 10.1002/acr.22390..
Keywords: Surgery, Arthritis, Decision Making
Shah RK, Stey AM, Jantana KR
Identification of opportunities for quality improvement and outcome measurement in pediatric otolaryngology.
This study evaluated perioperative outcomes in pediatric otolaryngology through analysis of records residing in the American College of Surgeons (ACS) National Surgical Quality Improvement Program (ACS-NSQIP) database. It found that although the overall rate of major postoperative morbidity in pediatric otolaryngology is low, the following areas may be targeted for targeted quality-improvement interventions: tracheostomy, airway reconstruction, mastoidectomy, and abscess drainage.
AHRQ-funded; HS022932
Citation: Shah RK, Stey AM, Jantana KR .
Identification of opportunities for quality improvement and outcome measurement in pediatric otolaryngology.
JAMA Otolaryngol Head Neck Surg. 2014 Nov;140(11):1019-26. doi: 10.1001/jamaoto.2014.2067..
Keywords: Surgery, Children/Adolescents, Quality Improvement, Outcomes, Patient-Centered Outcomes Research
Duffy RP, Adams JE, Callas PW
The influence of gender on functional outcomes of lower extremity bypass.
The researchers aimed to evaluate the effect of gender on early and late procedural and functional outcomes of lower extremity bypass (LEB). They found that women have complication rates similar to men with inferior early and late functional outcomes after LEB. The reduced patency rates in women with critical limb ischemia did not translate into differences in limb salvage.
AHRQ-funded; HS021581.
Citation: Duffy RP, Adams JE, Callas PW .
The influence of gender on functional outcomes of lower extremity bypass.
J Vasc Surg 2014 Nov;60(5):1282-90, 90.e1. doi: 10.1016/j.jvs.2014.05.008.
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Keywords: Cardiovascular Conditions, Outcomes, Sex Factors, Surgery
Jacoby VL, Jacoby A, Learman LA
Use of medical, surgical and complementary treatments among women with fibroids.
This study examined the use of medical management, uterus-preserving surgery, and complementary treatments among women with uterine fibroids. It found that uterus-preserving fibroid surgery is effective, but many symptomatic women can be successfully treated with nonsurgical management, including complementary and alternative therapy.
AHRQ-funded; HS011657; HS07373; HS09478.
Citation: Jacoby VL, Jacoby A, Learman LA .
Use of medical, surgical and complementary treatments among women with fibroids.
Eur J Obstet Gynecol Reprod Biol 2014 Nov;182:220-5. doi: 10.1016/j.ejogrb.2014.09.004..
Keywords: Care Management, Complementary and Alternative Medicine, Medication, Surgery, Treatments, Women
Maeda JL, Mosher Henke R, Marder WD
AHRQ Author: Karaca Z, Friedman BS, Wong HS
Variation in hospital inpatient prices across small geographic areas.
The authors examined whether market competition may influence the difference in the inpatient price per discharge between public and private payers across small geographic areas. They found greater geographic variation in the inpatient price per discharge among private than public payers for most hospital services, while hospitals in more concentrated markets were associated with a higher price per discharge among knee arthroplasty discharges for both payers. They concluded that hospitals charged significantly higher prices to private than public payers.
AHRQ-authored; AHRQ-funded; 290200600009C.
Citation: Maeda JL, Mosher Henke R, Marder WD .
Variation in hospital inpatient prices across small geographic areas.
Am J Manag Care 2014 Nov;20(11):907-16.
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Keywords: Healthcare Costs, Healthcare Cost and Utilization Project (HCUP), Orthopedics, Surgery
Bish EK, El-Amine H, Steighner LA
A socio-technical, probabilistic risk assessment model for surgical site infections in ambulatory surgery centers.
The researchers sought to identify the risk factors associated with surgical site infections (SSIs) resulting from procedures performed at ambulatory surgery centers (ASCs) and to design an intervention to mitigate the likelihood of SSIs for the most common risk factors that were identified by the socio-technical probabilistic risk assessment (ST-PRA) tool for a particular surgical procedure. They found that failure to protect the patient effectively accounted for 51.9% of SSIs in the ambulatory care setting. Critical components of this event included skin preparation, antibiotic administration, staff training, proper response to glove punctures during surgery, and adherence to surgical preparation rules related to the wearing of jewelry, watches, and artificial nails. They determined that, assuming a 75% reduction in noncompliance on any combination of 2 of these 5 components, the risk for an SSI decreased.
AHRQ-funded; 290200600019I.
Citation: Bish EK, El-Amine H, Steighner LA .
A socio-technical, probabilistic risk assessment model for surgical site infections in ambulatory surgery centers.
Infect Control Hosp Epidemiol 2014 Oct;35 Suppl 3:S133-41. doi: 10.1086/677824.
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Keywords: Ambulatory Care and Surgery, Risk, Surgery, Healthcare-Associated Infections (HAIs), Patient Safety, Injuries and Wounds, Adverse Events
Warren DK, Nickel KB, Wallace AE
Can additional information be obtained from claims data to support surgical site infection diagnosis codes?
The authors sought to confirm a claims algorithm to identify surgical site infections (SSIs) by examining the presence of clinically expected SSI treatment. They found that over 94% of patients identified by their claims algorithm as having an SSI received clinically expected treatment for infection, including antibiotics, surgical treatment, and culture, suggesting that this algorithm has very good positive predictive value. They concluded that their method may facilitate retrospective SSI surveillance and comparison of SSI rates across facilities and providers.
AHRQ-funded; HS019713.
Citation: Warren DK, Nickel KB, Wallace AE .
Can additional information be obtained from claims data to support surgical site infection diagnosis codes?
Infect Control Hosp Epidemiol 2014 Oct;35 Suppl 3:S124-32. doi: 10.1086/677830.
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Keywords: Data, Healthcare-Associated Infections (HAIs), Patient Safety, Surgery, Injuries and Wounds, Adverse Events
Calderwood MS, Kleinman K, Bratzler DW
Medicare claims can be used to identify US hospitals with higher rates of surgical site infection following vascular surgery.
This study found that among Medicare patients who underwent vascular surgery at 2,512 U.S. hospitals, a patient undergoing surgery in a hospital ranked in the worst-performing decile based on claims had a 2.5 times greater likelihood of developing a chart-confirmed surgical site infection relative to a patient characteristics in a hospital in the best-performing decile.
AHRQ-funded; HS018878
Citation: Calderwood MS, Kleinman K, Bratzler DW .
Medicare claims can be used to identify US hospitals with higher rates of surgical site infection following vascular surgery.
Med Care. 2014 Oct;52(10):918-25. doi: 10.1097/MLR.0000000000000212..
Keywords: Medicare, Surgery, Healthcare-Associated Infections (HAIs), Patient Safety, Hospitals, Adverse Events
Ayers DC, Franklin PD
Joint replacement registries in the United States: a new paradigm.
This commentary serves as an introduction to an upcoming series of articles about orthopaedic registries, in general, with an emphasis on lessons learned from the evolving U.S. and international total joint replacement registries. Specifically, this paper provides an overview of total joint replacement registries and the current expansion of data collection beyond implant attributes and survival to include postoperative complications and patient-reported outcomes.
AHRQ-funded; HS018910.
Citation: Ayers DC, Franklin PD .
Joint replacement registries in the United States: a new paradigm.
J Bone Joint Surg Am 2014 Sep 17;96(18):1567-9. doi: 10.2106/jbjs.n.00641.
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Keywords: Arthritis, Chronic Conditions, Patient-Centered Outcomes Research, Registries, Surgery
Ayers DC, Franklin PD
Joint replacement registries in the United States: a new paradigm.
This commentary serves as an introduction to an upcoming series of articles about orthopaedic registries, in general, with an emphasis on lessons learned from the evolving U.S. and international total joint replacement registries. Specifically, this paper provides an overview of total joint replacement registries and the current expansion of data collection beyond implant attributes and survival to include postoperative complications and patient-reported outcomes.
AHRQ-funded; HS018910.
Citation: Ayers DC, Franklin PD .
Joint replacement registries in the United States: a new paradigm.
J Bone Joint Surg Am 2014 Sep 17;96(18):1567-9. doi: 10.2106/jbjs.n.00641..
Keywords: Arthritis, Chronic Conditions, Patient-Centered Outcomes Research, Registries, Surgery
Simianu VV, Bastawrous AL, Farrokhi ET
Addressing the appropriateness of elective colon resection for diverticulitis: a report from the SCOAP CERTAIN collaborative.
The aim of this study was to assess the clinician-reported indications for elective colectomy and describe trends in the number of prior episodes of diverticulitis. It found an increase in the proportion of cases that met expert-established guidelines for appropriate surgery, but nearly 1 in 3 still do not meet established criteria.
AHRQ-funded; HS020025
Citation: Simianu VV, Bastawrous AL, Farrokhi ET .
Addressing the appropriateness of elective colon resection for diverticulitis: a report from the SCOAP CERTAIN collaborative.
Ann Surg. 2014 Sep;260(3):533-8; discussion 38-9. doi: 10.1097/sla.0000000000000894..
Keywords: Decision Making, Surgery, Evidence-Based Practice, Guidelines
Goode AP, Richardson WJ, Schectman RM
Complications, revision fusions, readmissions, and utilization over a 1-year period after bone morphogenetic protein use during primary cervical spine fusions.
The authors sought to determine the 1-year risk of complications, cervical revision fusions, hospital readmissions, and health care services utilization after bone morphogenetic protein (BMP) use with cervical spine fusions. They found that patients receiving BMP were 29% more likely to have a complication and a nervous system complication; cervical revision fusions were more likely among patients receiving BMP; the risk of 30-day readmission was greater with BMP use; and readmission occurred 27.4% sooner on an average. Additionally, patients receiving BMP were more likely to receive computed tomography scans and epidurals with anterior surgical approaches.
AHRQ-funded; HS019479.
Citation: Goode AP, Richardson WJ, Schectman RM .
Complications, revision fusions, readmissions, and utilization over a 1-year period after bone morphogenetic protein use during primary cervical spine fusions.
Spine J 2014 Sep;14(9):2051-9. doi: 10.1016/j.spinee.2013.11.042.
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Keywords: Adverse Events, Hospital Readmissions, Patient Safety, Outcomes, Patient-Centered Outcomes Research, Surgery, Treatments
Parmar AD, Coutin MD, Vargas GM
Cost-effectiveness of elective laparoscopic cholecystectomy versus observation in older patients presenting with mild biliary disease.
The objective was to determine the threshold for probability of recurrent symptoms at which elective cholecystectomy became the most effective and cost-effective options for older patients with mild biliary disease. This procedure was more effective than observation when the probability of continued symptoms exceeded 45.3 percent; when the probability exceeded 82.7 percent, the procedure became more cost-effective as well.
AHRQ-funded; HS022134
Citation: Parmar AD, Coutin MD, Vargas GM .
Cost-effectiveness of elective laparoscopic cholecystectomy versus observation in older patients presenting with mild biliary disease.
J Gastrointest Surg. 2014 Sep;18(9):1616-22. doi: 10.1007/s11605-014-2570-9..
Keywords: Comparative Effectiveness, Healthcare Costs, Elderly, Surgery