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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 25 of 981 Research Studies Displayed
Roberson ML, Nichols HB, Olshan AF
Trends in surgical treatment of early-stage breast cancer reveal decreasing mastectomy use between 2003 and 2016 by age, race, and rurality.
The authors sought to examine trends in the surgical treatment of breast cancer by age, rurality, and among Black women in a populous, racially diverse, state in the Southeastern United States of America. Using data from the North Carolina Central Cancer Registry, they found declining mastectomy rates in the early 2000s in a Southern US state with a racially and geographically diverse population. These decreasing trends were consistent among key subgroups affected by cancer inequities, including Black and White rural women.
Citation: Roberson ML, Nichols HB, Olshan AF . Trends in surgical treatment of early-stage breast cancer reveal decreasing mastectomy use between 2003 and 2016 by age, race, and rurality. Breast Cancer Res Treat 2022 Jun;193(2):445-54. doi: 10.1007/s10549-022-06564-w..
Keywords: Cancer: Breast Cancer, Cancer, Women, Surgery, Racial / Ethnic Minorities, Rural Health
De Roo AC, Shubeck SP SP, Cain-Nielsen AH
Cost consequences of age and comorbidity in accelerated postoperative discharge after colectomy.
The initial cost benefits of reductions in post-surgery duration of stay could be weakened by an increase in post-acute care or readmissions for those patients, especially for older adults and/ or those with comorbidities. The study objective was to assess whether thea hospitals with faster post-surgery discharge accumulate larger total episode savings and/or experience larger payments post-discharge. The researchers conducted a retrospective cross-sectional study utilizing national data from the July 2012 to June 2015 Medicare Provider Analysis and Review files focused on 88,860 Medicare beneficiaries undergoing elective colectomy procedures. The primary outcome measure was the average total episode payment among the different age and comorbidity categories, further stratified by duration of hospital stay. The study found that average total episode payments were lower in the shortest versus longest duration-of-stay hospitals across all age and comorbidity strata. Post-discharge payments were similar among duration-of-stay hospitals by age but greater among high comorbidity. The researchers note a study limitation that the post-acute care use data may be influenced by factors at the patient level, such as patient preference and the availability of caregivers, and concluded that the hospitals with the shortest duration of post-surgical stays had lower total episode payments and no related increase in post-acute care payments even in older adults and/ or those with comorbidities.
Citation: De Roo AC, Shubeck SP SP, Cain-Nielsen AH . Cost consequences of age and comorbidity in accelerated postoperative discharge after colectomy. Dis Colon Rectum 2022 May;65(5):758-66. doi: 10.1097/dcr.0000000000002020..
Keywords: Healthcare Costs, Surgery
Mao J, Sedrakyan A, Sun T
Assessing adverse event reports of hysteroscopic sterilization device removal using natural language processing.
This study’s objective was to develop an annotation model to develop natural language processing (NLP) to device adverse event reports and to implement the model to evaluate the most frequently experienced events among women reporting a sterilization device removal. Adverse event reports from the Manufacturer and User Facility Device Experience database from January 2005 to June 2018 were included. The authors used an iterative process to develop an annotation model that extracts six categories of desired information and applied the annotation model to train an NLP algorithm. A total of 16,535 reports of device removal were analyzed with the most frequently reported patient and device events being abdominal/pelvic/genital pain (79.6%) and device dislocation/migration (19.2%), respectively. A total of 7,932 patients reported an additional sterilization procedure of a hysterectomy or salpingectomy. One-fifth of the cases that had device removal timing specified reported a removal 7 years after original insertion.
Citation: Mao J, Sedrakyan A, Sun T . Assessing adverse event reports of hysteroscopic sterilization device removal using natural language processing. Pharmacoepidemiol Drug Saf 2022 Apr;31(4):442-51. doi: 10.1002/pds.5402..
Keywords: Adverse Events, Surgery, Medical Devices, Patient Safety
Taylor K, Diaz A, Nuliyalu U
Association of dual Medicare and Medicaid eligibility with outcomes and spending for cancer surgery in high-quality hospitals.
The purpose of this study was to assess whether treatment at high-quality hospitals mitigates dual-eligibility-associated disparities in outcomes and spending for cancer surgery. Medicare beneficiaries 65 years or older who underwent colectomy, rectal resection, lung resection, or pancreatectomy were evaluated. The findings indicate that, even among the highest-quality hospitals, dual-eligibility patients had poorer outcomes and higher spending. Dually eligible patients were more likely to be discharged to a facility and thus incurred higher post-acute care costs. Although treatment at high-quality hospitals is associated with reduced differences in outcomes, dual-eligibility patients remain at high risk for adverse post-operative outcomes as well as increased readmissions and post-acute care use.
Citation: Taylor K, Diaz A, Nuliyalu U . Association of dual Medicare and Medicaid eligibility with outcomes and spending for cancer surgery in high-quality hospitals. JAMA Surg 2022 Apr;157(4):e217586. doi: 10.1001/jamasurg.2021.7586..
Keywords: Cancer, Surgery, Medicare, Medicaid, Outcomes, Hospitals
Murphy PB, Oslock WM, Ingraham AM
Quality of care for gallstone pancreatitis-the impact of the acute care surgery model and hospital-level operative resources.
This study aimed to determine the influence of structure and process related to operating room access on achieving index cholecystectomy for gallstone pancreatitis. In 2015, 2811 US hospitals on acute care surgery practices were surveyed, including infrastructure for operative access, with 1690 hospitals (60%) responding. The authors identified patients ≥ 18 years who were admitted with gallstone pancreatitis. Over the study period, 5656 patients were admitted with gallstone pancreatitis, and 70% had an index cholecystectomy. High-performing hospitals had an index cholecystectomy rate of 84.1%, compared to 58.5% at low-performing hospitals. High-performing hospitals were associated with teaching, and access to dedicated daytime operative resources.
Citation: Murphy PB, Oslock WM, Ingraham AM . Quality of care for gallstone pancreatitis-the impact of the acute care surgery model and hospital-level operative resources. J Gastrointest Surg 2022 Apr;26(4):849-60. doi: 10.1007/s11605-021-05145-4..
Keywords: Healthcare Cost and Utilization Project (HCUP), Surgery, Quality of Care
Eisenberg MT, Block AM, Vopat ML
Rates of infection after ACL reconstruction in pediatric and adolescent patients: a MarketScan database study of 44,501 patients.
This study’s objective was to describe and analyze the rates of surgical site infections after anterior cruciate ligament (ACL) surgery in pediatric patients. The Truven Health Analytics MarketScan Commercial Claims and Encounters database was used to access data for privately insured individuals aged 5 to 30 years old. ACL reconstruction operation records were accessed for operations performed from 2006 to 2018. The database identified 44,501 individuals up to 18 years old, and 63,495 individuals aged 18 to 30 years old that underwent arthroscopic ACL reconstruction. No differences in infection rates were found between the two groups. However, among patients younger than 18 years, patients below 15 years old had a significantly lower infection rate at 0.37% compared with adolescents 15 to 17 years old at 0.55%. Among young adults, males had a higher infection rate than females, while no differences were observed in the pediatric and adolescent population.
Citation: Eisenberg MT, Block AM, Vopat ML . Rates of infection after ACL reconstruction in pediatric and adolescent patients: a MarketScan database study of 44,501 patients. J Pediatr Orthop 2022 Apr;42(4):e362-e66. doi: 10.1097/bpo.0000000000002080..
Keywords: Children/Adolescents, Surgery, Orthopedics, Healthcare-Associated Infections (HAIs), Adverse Events, Injuries and Wounds
Yang P, Diaz A, Chhabra KR
Surgical quality assurance at expanding health networks: a qualitative study.
This study used qualitative methods to understand the nuances that affect the variation in network-level surgical quality assurance and provided strategies that surgical leaders can use to improve surgical quality at expanding health networks. Through semi-structured interviews, three themes emerged. Participants wanted standardized tools for quality measurement, an organizational structure that provides clear oversight over quality, and a culture shift toward quality improvement.
Citation: Yang P, Diaz A, Chhabra KR . Surgical quality assurance at expanding health networks: a qualitative study. Surgery 2022 Apr;171(4):966-72. doi: 10.1016/j.surg.2021.09.023..
Keywords: Surgery, Quality Improvement, Quality of Care
Kanters AE, Evilsizer SK, Regenbogen SE
Correlation of colorectal surgical skill with patient outcomes: a cautionary tale.
Some have proposed that video-based skill assessments be used as a way to measure technical skills, quality improvement, and credentialing in colorectal surgeons and other practitioners. However, it must first be determined whether video-based assessments can accurately predict patient outcomes. The researchers assembled a panel of 10 peer surgeons to evaluate videos of minimally invasive colectomy procedures submitted by 21 surgeons. Each surgeon submitted one video, and the videos were edited to highlight key steps in the procedure. The panel and the surgeon participants were all associated with the Michigan Surgical Quality Collaborative. The panel used a validated American Society of Colon and Rectal Surgeons assessment instrument to rate the surgeon’s skills. The surgeon’s ratings were then linked to a validated registry of surgical outcomes, and the researchers assessed the relationship between skill level and risk-adjusted complication rates. The researchers found that after risk-adjustment there was no statistically significant difference in complication rates between the bottom (17.5%) and top (16.8%) quartile surgeons (p=0.41). The study concluded that there was no correlation between video-based peer rating of minimally invasive colectomy and postoperative complications among specialty surgeons, and that caution should be used when utilizing video review in credentialing.
Citation: Kanters AE, Evilsizer SK, Regenbogen SE . Correlation of colorectal surgical skill with patient outcomes: a cautionary tale. Dis Colon Rectum 2022 Mar;65(3):444-51. doi: 10.1097/dcr.0000000000002124..
Keywords: Surgery, Provider: Physician, Provider Performance, Digestive Disease and Health, Outcomes
Fitzgerald DC, Simpson AN, Baker RA DC, Simpson AN, Baker RA
Determinants of hospital variability in perioperative red blood cell transfusions during coronary artery bypass graft surgery.
This observational cohort study’s objective was to identify to what extent distinguishing patient and procedural characteristics can explain center-level transfusion variation during coronary artery bypass grafting (CABG) surgery. The study used patients from the Perfusion Measures and Outcomes Registry from 43 adult cardiac surgical programs from July 2011 through June 2017. Of the 22,272 adult patients undergoing isolate CABG surgery using cardiopulmonary bypass, 7241 (32.5%) received at least 1 U allogeneic red blood cells. Patients who received transfusions were older (68 vs 64 years), were women (41.5% vs 15.9%), and had a lower body surface area, respectively. The majority of center-level transfusion variations could not be explained through models containing both patient and intraoperative factors.
Citation: Fitzgerald DC, Simpson AN, Baker RA DC, Simpson AN, Baker RA . Determinants of hospital variability in perioperative red blood cell transfusions during coronary artery bypass graft surgery. J Thorac Cardiovasc Surg 2022 Mar;163(3):1015-24.e1. doi: 10.1016/j.jtcvs.2020.04.141..
Keywords: Surgery, Heart Disease and Health, Cardiovascular Conditions, Hospitals, Practice Patterns, Disparities
Shao CC, McLeod MC, Gleason L
Effect of COVID-19 pandemic restructuring on surgical volume and outcomes of non-COVID patients undergoing surgery.
The authors sought to assess changes in surgical case mix and outcomes due to restructuring during the pandemic. Institutional ACS-NSQIP data was used to identify patients undergoing surgery at a single tertiary care institution in the Deep South. They found that surgeries during the COVID-19 pandemic were more often outpatient without differences in post-operative outcomes. They recommended additional analysis to determine the impact of duration of operative delay on surgical outcomes with restructuring focusing more on outpatient surgeries.
Citation: Shao CC, McLeod MC, Gleason L . Effect of COVID-19 pandemic restructuring on surgical volume and outcomes of non-COVID patients undergoing surgery. Am Surg 2022 Mar;88(3):489-97. doi: 10.1177/00031348211054528..
Keywords: COVID-19, Surgery, Public Health, Outcomes
Olsen MA, Greenberg JK, Peacock K
Lack of association of post-discharge prophylactic antibiotics with decreased risk of surgical site infection following spinal fusion.
This study’s objective was to determine the prevalence and factors associated with post-discharge prophylactic antibiotic use after spinal fusion and whether use was associated with decreased risk of surgical site infection (SSI). The study cohort included persons aged 10-64 years undergoing 156,446 spinal fusion procedures between January 2010 and July 2015. Excluded patients included complicated cases and those coded for infection from 30 days before to 2 days after surgical admission. Outpatient oral antibiotic prescriptions were identified within 2 days of surgical discharge. ICD-9-CM diagnosis codes were used to identify SSI within 90 days of surgery. Post-discharge prophylactic antibiotics were used in 9223 surgeries. SSIs occurred after 2557 procedures (1.6%). Factors significantly associated with post-discharge antibiotic use included history of lymphoma, diabetes, 3-7 versus 1-2 vertebral levels fused, and non-infectious postoperative complications. Analysis showed antibiotic use was not associated with decreased SSI risk after spinal fusion.
AHRQ-funded; HS019455; HS027075.
Citation: Olsen MA, Greenberg JK, Peacock K . Lack of association of post-discharge prophylactic antibiotics with decreased risk of surgical site infection following spinal fusion. J Antimicrob Chemother 2022 Mar 31;77(4):1178-84. doi: 10.1093/jac/dkab475..
Keywords: Antibiotics, Medication, Surgery, Antimicrobial Stewardship, Practice Patterns
Schreyer J, Koch A, Herlemann A
RAS-NOTECHS: validity and reliability of a tool for measuring non-technical skills in robotic-assisted surgery settings.
This study’s objective was to develop and consent-validate a tool to assess multidisciplinary non-technical skills (NTS) in robotic-assisted surgery (RAS). The authors conducted a scoping literature review first to compile a set of RAS-specific teamwork behaviors. They then merged these behaviors with a well-established assessment tool on operating room (OR) teamwork called NOTECHS II. Finally, the new tool RAS-NOTECHS was applied in standardized observations of real-world procedures to test its reliability. The scoping review found 5242 articles, of which 21 were included based on pre-established inclusion criteria. The authors elicited 16 RAS-specific behaviors from the literature base. They were synthesized further with 18 behavioral markers into a list of 26 behavioral markers. The list was reviewed by 7 RAS experts and condensed to 15 expert-validated RAS-specific behavioral markers. For five observations of urologic RAS procedures, inter-rater agreement for identification of behavioral markers was strong. Agreement of RAS-NOTECHS scores ranged from moderate to strong agreement.
Citation: Schreyer J, Koch A, Herlemann A . RAS-NOTECHS: validity and reliability of a tool for measuring non-technical skills in robotic-assisted surgery settings. Surg Endosc 2022 Mar;36(3):1916-26. doi: 10.1007/s00464-021-08474-2..
Graber J, Lockhart S, Matlock DD
"This is not negotiable. You need to do this…": a directed content analysis of decision making in rehabilitation after knee arthroplasty.
In this qualitative study, researchers sought to understand patients' and physical therapists' perspectives related to decision making during outpatient rehabilitation after total knee arthroplasty (TKA) and further to describe potential barriers and opportunities for shared decision making (SDM) in this setting. They found that physical therapists described using decision-making strategies with varying levels of patient involvement, while both patients and physical therapists described barriers to routine use of SDM in the outpatient setting. They also presented actionable strategies for overcoming these barriers for providers and organizations seeking consistently to use SDM in outpatient TKA rehabilitation.
Citation: Graber J, Lockhart S, Matlock DD . "This is not negotiable. You need to do this…": a directed content analysis of decision making in rehabilitation after knee arthroplasty. J Eval Clin Pract 2022 Feb;28(1):99-107. doi: 10.1111/jep.13591..
Keywords: Decision Making, Rehabilitation, Orthopedics, Surgery, Patient-Centered Healthcare
Greenberg JK, Brown DS, Olsen MA
Association of Medicaid expansion under the Affordable Care Act with access to elective spine surgical care.
This study's goal was to evaluate the impact of Medicaid expansion under the Affordable Care Act on the volume and payer mix of elective spine surgery in the United States. The authors evaluated elective spinal surgeries performed in the U.S. from 2011 to 2016 and included 10 states with expanded Medicaid access and 4 states that did not. They identified 218,648 surgical procedures performed in 10 Medicaid expansion states and 118,693 procedures performed in 4 nonexpansion states. Medicaid expansion was associated with a 17% increase in mean hospital spine surgical volume and a 23% increase in Medicaid volume. Privately insured surgical volumes did not change significantly. This increase indicated improved access to care.
Citation: Greenberg JK, Brown DS, Olsen MA . Association of Medicaid expansion under the Affordable Care Act with access to elective spine surgical care. J Neurosurg Spine 2022 Feb;36(2):336–44. doi: 10.3171/2021.3.Spine2122..
Keywords: Healthcare Cost and Utilization Project (HCUP), Medicaid, Access to Care, Surgery
Ross SW, Reinke CE, Ingraham AM
Emergency general surgery quality improvement: a review of recommended structure and key issues.
In this article, the authors presented a collective narrative review of advances in quality improvement structure in emergency general surgery (EGS) in recent years and summarized plans for a national EGS registry and American College of Surgeons verification for this under-resourced area of surgery.
Citation: Ross SW, Reinke CE, Ingraham AM . Emergency general surgery quality improvement: a review of recommended structure and key issues. J Am Coll Surg 2022 Feb;234(2):214-25. doi: 10.1097/xcs.0000000000000044..
Keywords: Surgery, Quality Improvement, Quality of Care
Joseph JM, Gori D, Curtin C
Gaps in standardized postoperative pain management quality measures: a systematic review.
Poor pain control in patients can lead to chronic pain, chronic opiate use or addiction, and patient suffering, making postoperative pain an important clinical issue. The researchers state that it is unclear whether measures for managing pain after surgery exist, warranting the study goal of assessment of the availability of postoperative pain management quality measures, including National Quality Forum-endorsed measures. In November 2019, the researchers conducted a systematic literature review using the National Quality Forum Quality Positioning System, the Agency for Healthcare Research and Quality Indicators, and the Centers for Medicare and Medicaid Services Measures Inventory Tool databases, to identify quality measures for the period between March 11, 2015, and March 11, 2020. The review identified 19 pain management quality measures, 5 of which were endorsed by the National Quality Forum. Three of the non-endorsed measures were specific to postoperative pain, with none of the endorsed measures specific to post-operative pain. The study concluded that there is a need for published, endorsed, rigorous postoperative pain quality measures.
AHRQ-funded; HS024096; HS027434.
Citation: Joseph JM, Gori D, Curtin C . Gaps in standardized postoperative pain management quality measures: a systematic review. Surgery 2022 Feb;171(2):453-58. doi: 10.1016/j.surg.2021.08.004..
Keywords: Pain, Surgery, Quality Measures, Quality of Care, Practice Patterns
Lai LY, Kaufman SR, Modi PK
Impact of advanced practice provider integration into multispecialty group practices on outcomes following major surgery.
Researchers examined the impact of advanced practice provider (APP) integration into multispecialty group practices on outcomes after major surgery. Using Medicare data, they found that integration of APPs into multispecialty group practices was associated with improved postoperative outcomes after major surgery. They recommended that future research identify the mechanisms by which APPs improve outcomes to inform optimal utilization.
Citation: Lai LY, Kaufman SR, Modi PK . Impact of advanced practice provider integration into multispecialty group practices on outcomes following major surgery. Surg Innov 2022 Feb;29(1):111-17. doi: 10.1177/15533506211013150..
Keywords: Surgery, Healthcare Delivery
Merkow RP, Massarweh NN
Looking beyond perioperative morbidity and mortality as measures of surgical quality.
The authors discussed the problems with a contemporaneous focus on morbidity and mortality as surgical quality measures and offered potential alternative options which could better refine and evolve surgical quality measurement, including process measures, value-based measures, patient-centered measures, and health equity.
Citation: Merkow RP, Massarweh NN . Looking beyond perioperative morbidity and mortality as measures of surgical quality. Ann Surg 2022 Feb;275(2):e281-e83. doi: 10.1097/sla.0000000000004966..
Keywords: Surgery, Quality Measures, Quality of Care, Mortality
Ko H, Martin BI, Nelson RE
Patient selection in the Comprehensive Care for Joint Replacement model.
This study investigated whether the Comprehensive Care for Joint Replacement (CJR) program induced participating hospitals to 1) preferentially select lower risk patients, 2) reduce 90-day episode-of-care costs, 3) improve quality of care, and 4) achieve greater cost reduction during its second year. The authors identified Medicare beneficiaries age 65 years or older undergoing hip or knee joint replacement from fee-for-service inpatient (Part A) claims from January 2013 through August 2017. Cases were linked to subsequent outpatient, Part B, home health agency, and skilled nursing facility claims. The effect of CJR was estimated for 785 participating hospitals in 67 metropolitan statistical area (MSA) and compared to those in 104 non-CJR MSAs (962 hospitals total). They excluded 172 hospitals from their analysis due to their preexisting BPCI participation. Reductions in 90-day episode-of-care costs were greater among CJR hospitals, which was largely driven by a 16.8% decline in 90-day spending in skilled nursing homes. CJR hospitals also significantly reduced the 90-day readmission rate and preferentially avoided patients 85 years or older and Black patients.
Citation: Ko H, Martin BI, Nelson RE . Patient selection in the Comprehensive Care for Joint Replacement model. Health Serv Res 2022 Feb;57(1):72-90. doi: 10.1111/1475-6773.13880..
Keywords: Orthopedics, Surgery
Chhabra KR, Ghaferi AA, Yang J
Relationship between health care spending and clinical outcomes in bariatric surgery: implications for Medicare bundled payments.
This study’s objective was to evaluate sources of 90-day episode spending variation in Medicare patients undergoing bariatric surgery and whether spending variation was related to quality of care. A retrospective analysis of fee-for-service Medicare claims data from 761 acute care hospitals providing inpatient bariatric surgery was conducted between January 1, 2011 and September 30, 2016. Of 64,537 bariatric patients, 46% went sleeve gastrectomy, 22% revisited the emergency department (ED) within 90 days, and 12.5% were readmitted. Average 90-day payments were $14,124, ranging from $12,220 to $16,887. The largest components of spending variation were readmissions (44% of variation), post-acute care (19%), and index professional fees (15%). The lowest spending hospitals had the lowest complication, ED visit, post-acute utilization, and readmission rates.
AHRQ-funded; HS024403; HS023597.
Citation: Chhabra KR, Ghaferi AA, Yang J . Relationship between health care spending and clinical outcomes in bariatric surgery: implications for Medicare bundled payments. Ann Surg 2022 Feb;275(2):356-62. doi: 10.1097/sla.0000000000003979..
Keywords: Healthcare Costs, Surgery, Obesity, Outcomes
Roberson ML, Nichols HB, Wheeler
Validity of breast cancer surgery treatment information in a state-based cancer registry.
Surgery is an important part of early stage breast cancer treatment that affects overall survival. Statewide cancer registries contain data on first course of cancer treatment for all patients diagnosed with cancer but the accuracy of these data are uncertain. In this study, the authors examined validity of breast cancer surgery treatment information in a state-based cancer registry.
Citation: Roberson ML, Nichols HB, Wheeler . Validity of breast cancer surgery treatment information in a state-based cancer registry. Cancer Causes Control 2022 Feb;33(2):261-69. doi: 10.1007/s10552-021-01520-3..
Keywords: Cancer: Breast Cancer, Cancer, Surgery, Registries
Fatemi P, Zhang Y, Han SS
A, et al. External validation of a predictive model of adverse events following spine surgery.
The authors externally validated a previously developed predictive model for common 30-day adverse events after spine surgery, the Risk Assessment Tool for Adverse Events after Spine Surgery (RAT-Spine). Their results are presented as low-, moderate-, and high-risk designations.
Citation: Fatemi P, Zhang Y, Han SS . A, et al. External validation of a predictive model of adverse events following spine surgery. Spine J 2022 Jan;22(1):104-12. doi: 10.1016/j.spinee.2021.06.006..
Keywords: Surgery, Adverse Events, Orthopedics, Risk
Mallela DP, Canner JK, Zarkowsky DS
Association between race and perioperative outcomes after carotid endarterectomy for asymptomatic carotid artery stenosis in NSQIP.
This study investigated the association of race on carotid endarterectomy (CEA) outcomes. Perioperative outcomes (at 30 days) were compared for Black vs. White patients adjusting for age/sex, comorbidities and disease characteristics. Out of 16,764 patients from the ACS-NSQIP targeted vascular database (2011-2019), 95.2% were White and 4.8% were Black. Black patients were slightly younger and more frequently (79.5% vs 74.0%) had high-grade carotid artery stenosis compared to White patients. Comorbidities including hypertension, diabetes, kidney disease, congestive heart failure, and coronary artery disease were all more prevalent among Black patients. Crude perioperative stroke and stroke/death were higher for Black patients, but myocardial infarction leading to death were similar. After adjusting for baseline differences between groups, the risk of perioperative stroke and stroke/death remained significantly higher for Black patients than White patients.
Citation: Mallela DP, Canner JK, Zarkowsky DS . Association between race and perioperative outcomes after carotid endarterectomy for asymptomatic carotid artery stenosis in NSQIP. J Am Coll Surg 2022 Jan;234(1):65-73. doi: 10.1097/xcs.0000000000000016..
Keywords: Racial / Ethnic Minorities, Surgery, Cardiovascular Conditions, Stroke, Risk, Adverse Events
Cofran L, Cohen T, Alfred M
Barriers to safety and efficiency in robotic surgery docking.
The authors sought to explore operating room variation in robotic-assisted surgery across multiple clinical sites and procedures and further sought to examine the sources of those flow disruptions. They concluded that direct observation of surgical procedures can help to identify approaches to improve the design of technology and procedures, the training of staff, and the configuration of the operating room environment, with the eventual goal of improving safety, efficiency, and teamwork in high technology surgery.
Citation: Cofran L, Cohen T, Alfred M . Barriers to safety and efficiency in robotic surgery docking. Surg Endosc 2022 Jan;36(1):206-15. doi: 10.1007/s00464-020-08258-0..
Keywords: Patient Safety, Surgery
Kho RM, Desai VB, Schwartz PE
Endometrial sampling for preoperative diagnosis of uterine leiomyosarcoma.
This retrospective cohort study examined the effectiveness of endometrial sampling for preoperative detection of uterine leiomyosarcoma in women undergoing hysterectomy, identified factors associated with missed diagnosis, and compared the outcomes of patients who had a preoperative diagnosis with those patients who had a missed diagnosis. A total of 79 patients with uterine leiomyosarcoma were included in the study. Of those patients, 46 (58.2%) were diagnosed preoperatively and 33 postoperatively. The groups were similar in age, race/ethnicity, bleeding symptoms, and comorbidities. Women who had endometrial sampling performed with hysteroscopy had a higher likelihood of preoperative diagnosis. Patients with localized stage (vs distant stage) or tumor size >11 cm were less likely to be diagnosed preoperatively.
Citation: Kho RM, Desai VB, Schwartz PE . Endometrial sampling for preoperative diagnosis of uterine leiomyosarcoma. J Minim Invasive Gynecol 2022 Jan;29(1):119-27. doi: 10.1016/j.jmig.2021.07.004.
Keywords: Cancer, Diagnostic Safety and Quality, Surgery, Women