National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
101 to 125 of 171 Research Studies DisplayedLou I, Chennell TB, Schaefer SC
Optimizing outpatient pain management after thyroid and parathyroid surgery: a two-institution experience.
This study aimed to describe the outpatient narcotic medication needs for patients undergoing thyroid and parathyroid surgery, and to identify predictors of higher requirement. It concluded that overall, 93 percent of patients undergoing thyroidectomy and parathyroidectomy require 20 or fewer oral morphine equivalents by their postoperative visit.
AHRQ-funded; HS023009.
Citation: Lou I, Chennell TB, Schaefer SC .
Optimizing outpatient pain management after thyroid and parathyroid surgery: a two-institution experience.
Ann Surg Oncol 2017 Jul;24(7):1951-57. doi: 10.1245/s10434-017-5781-y.
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Keywords: Cancer, Medication, Pain, Patient-Centered Outcomes Research, Surgery
Brummett CM, Waljee JF, Goesling J
New persistent opioid use after minor and major surgical procedures in US adults.
The authors sought to determine the incidence of new persistent opioid use after minor and major surgical procedures. They found that risk factors independently associated with new persistent opioid use included preoperative tobacco use, alcohol and substance abuse disorders, mood disorders, anxiety, and preoperative pain disorders. They concluded that new persistent opioid use after surgery is not significantly different between minor and major surgical procedures but rather associated with behavioral and pain disorders.
AHRQ-funded; HS023313.
Citation: Brummett CM, Waljee JF, Goesling J .
New persistent opioid use after minor and major surgical procedures in US adults.
JAMA Surg 2017 Jun 21;152(6):e170504. doi: 10.1001/jamasurg.2017.0504.
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Keywords: Medication, Opioids, Pain, Patient-Centered Outcomes Research, Surgery
Mehta HB, Vargas GM, Adhikari D
Comparative effectiveness of chemotherapy vs resection of the primary tumour as the initial treatment in older patients with Stage IV colorectal cancer.
The objectives were to determine trends in the use of chemotherapy as the initial treatment and to evaluate the comparative effectiveness of initial chemotherapy vs resection of the primary tumor on survival (intention-to-treat analysis) in Stage IV colorectal cancer (CRC). Instrumental variable analysis found that, compared with resection, chemotherapy as the initial treatment offers similar or better 2-year survival in patients with Stage IV CRC.
AHRQ-funded; HS022134.
Citation: Mehta HB, Vargas GM, Adhikari D .
Comparative effectiveness of chemotherapy vs resection of the primary tumour as the initial treatment in older patients with Stage IV colorectal cancer.
Colorectal Dis 2017 Jun;19(6):O210-o18. doi: 10.1111/codi.13659.
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Keywords: Cancer: Colorectal Cancer, Treatments, Comparative Effectiveness, Patient-Centered Outcomes Research, Surgery
Gandek B, Ware JE, Jr.
Validity and responsiveness of the knee injury and osteoarthritis outcome score: a comparative study among total knee replacement patients.
The researchers evaluated validity and responsiveness of the Knee Injury and Osteoarthritis Outcome Score (KOOS) in relation to other patient-reported outcome measures before and after total knee replacement (TKR). They concluded that KOOS scales were valid and responsive in a cohort of 1,143 US TKR patients. KOOS QOL performed particularly well in capturing aggregate knee-specific outcomes.
AHRQ-funded; HS018910; HS024632.
Citation: Gandek B, Ware JE, Jr. .
Validity and responsiveness of the knee injury and osteoarthritis outcome score: a comparative study among total knee replacement patients.
Arthritis Care Res 2017 Jun;69(6):817-25. doi: 10.1002/acr.23193.
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Keywords: Arthritis, Surgery, Patient-Centered Outcomes Research, Outcomes, Injuries and Wounds
O'Toole RV, Gary JL, Reider L
A prospective randomized trial to assess fixation strategies for severe open tibia fractures: modern ring external fixators versus internal fixation (FIXIT study).
The FIXIT study is a prospective, multicenter randomized trial comparing 1-year outcomes after treatment of severe open tibial shaft fractures with modern external ring fixation versus internal fixation among men and women of ages 18-64. The primary outcome is rehospitalization for major limb complications. One-year treatment costs and patient satisfaction will be compared between the 2 groups.
AHRQ-funded; HS000029.
Citation: O'Toole RV, Gary JL, Reider L .
A prospective randomized trial to assess fixation strategies for severe open tibia fractures: modern ring external fixators versus internal fixation (FIXIT study).
J Orthop Trauma 2017 Apr;31 Suppl 1:S10-s17. doi: 10.1097/bot.0000000000000804.
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Keywords: Injuries and Wounds, Surgery, Patient-Centered Outcomes Research, Comparative Effectiveness, Outcomes, Evidence-Based Practice
Obremskey WT, Schmidt AH, O'Toole RV
A prospective randomized trial to assess oral versus intravenous antibiotics for the treatment of postoperative wound infection after extremity fractures (POvIV study).
The POvIV study is a prospective, multicenter, randomized trial to compare oral (PO) with intravenous (IV) antibiotic therapy in patients with postoperative wound infections after extremity fractures. This study will be the largest prospective randomized trial to evaluate the safety and effectiveness of PO antibiotic use for treatment of postoperative wound infections. Results will inform clinician decisions on antibiotic delivery in patients with postoperative wound infections.
AHRQ-funded; HS000029.
Citation: Obremskey WT, Schmidt AH, O'Toole RV .
A prospective randomized trial to assess oral versus intravenous antibiotics for the treatment of postoperative wound infection after extremity fractures (POvIV study).
J Orthop Trauma 2017 Apr;31 Suppl 1:S32-s38. doi: 10.1097/bot.0000000000000802.
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Keywords: Antibiotics, Surgery, Injuries and Wounds, Healthcare-Associated Infections (HAIs), Comparative Effectiveness, Medication, Patient Safety, Adverse Events, Prevention, Patient-Centered Outcomes Research, Outcomes
Dimou FM, Adhikari D, Mehta HB
Outcomes in older patients with grade III cholecystitis and cholecystostomy tube placement: a propensity score analysis.
The Tokyo Guidelines recommend initial cholecystostomy tube drainage, antibiotics, and delayed cholecystectomy in patients with grade III cholecystitis. The researchers compared mortality, readmission, and complication rates with and without cholecystostomy tube placement in a cohort of patients with grade III cholecystitis. Cholecystostomy tube placement was associated with lower rates of definitive treatment with cholecystectomy, higher mortality, and higher readmission rates.
AHRQ-funded; HS022134.
Citation: Dimou FM, Adhikari D, Mehta HB .
Outcomes in older patients with grade III cholecystitis and cholecystostomy tube placement: a propensity score analysis.
J Am Coll Surg 2017 Apr;224(4):502-11.e1. doi: 10.1016/j.jamcollsurg.2016.12.021.
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Keywords: Elderly, Patient-Centered Outcomes Research, Surgery, Guidelines, Practice Patterns
Chetta MD, Aliu O, Zhong L
Reconstruction of the irradiated breast: a national claims-based assessment of postoperative morbidity.
This study aims to assess the morbidity associated with various breast reconstruction techniques in irradiated patients. It found that overall complication rates were 45.3 percent and 30.8 percent for patients with implant and autologous reconstruction, respectively. Failure of reconstruction occurred in 29.4 percent of patients with implant reconstruction compared with 4.3 percent of patients with autologous reconstruction.
AHRQ-funded; HS023313.
Citation: Chetta MD, Aliu O, Zhong L .
Reconstruction of the irradiated breast: a national claims-based assessment of postoperative morbidity.
Plast Reconstr Surg 2017 Apr;139(4):783-92. doi: 10.1097/prs.0000000000003168.
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Keywords: Cancer, Cancer: Breast Cancer, Surgery, Adverse Events, Patient-Centered Outcomes Research
Chen RC, Basak R, Meyer AM
Association between choice of radical prostatectomy, external beam radiotherapy, brachytherapy, or active surveillance and patient-reported quality of life among men with localized prostate cancer.
This study compared quality of life after radical prostatectomy, external beam radiotherapy, and brachytherapy vs active surveillance. By 24 months, mean scores between treatment groups vs active surveillance were not significantly different in most domains. However, each treatment strategy was associated with distinct patterns of adverse effects over 2 years.
AHRQ-funded; AHRQ contract (no number given).
Citation: Chen RC, Basak R, Meyer AM .
Association between choice of radical prostatectomy, external beam radiotherapy, brachytherapy, or active surveillance and patient-reported quality of life among men with localized prostate cancer.
JAMA 2017 Mar 21;317(11):1141-50. doi: 10.1001/jama.2017.1652.
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Keywords: Comparative Effectiveness, Patient-Centered Outcomes Research, Cancer: Prostate Cancer, Surgery, Quality of Life
Barocas DA, Alvarez J, Resnick MJ
Association between radiation therapy, surgery, or observation for localized prostate cancer and patient-reported outcomes after 3 years.
This study compares functional outcomes and adverse effects associated with radical prostatectomy, external beam radiation therapy (EBRT), and active surveillance. It concluded that radical prostatectomy was associated with a greater decrease in sexual function and urinary incontinence than either EBRT or active surveillance after 3 years and was associated with fewer urinary irritative symptoms than active surveillance.
AHRQ-funded; HS019356; HS022640.
Citation: Barocas DA, Alvarez J, Resnick MJ .
Association between radiation therapy, surgery, or observation for localized prostate cancer and patient-reported outcomes after 3 years.
JAMA 2017 Mar 21;317(11):1126-40. doi: 10.1001/jama.2017.1704.
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Keywords: Comparative Effectiveness, Patient-Centered Outcomes Research, Adverse Events, Cancer: Prostate Cancer, Surgery
Sathe N, Chinnadurai S, McPheeters M
Comparative effectiveness of partial versus total tonsillectomy in children.
This review assessed the effectiveness of partial versus total tonsillectomy in children. Data did not allow firm conclusions regarding the comparative benefit of partial versus total removal; however, neither surgical technique nor extent of surgery appeared to affect outcomes markedly. Partial tonsillectomy conferred moderate advantages in return to normal diet/activity but was also associated with tonsillar regrowth and symptom recurrence.
AHRQ-funded; 290201500003I.
Citation: Sathe N, Chinnadurai S, McPheeters M .
Comparative effectiveness of partial versus total tonsillectomy in children.
Otolaryngol Head Neck Surg 2017 Mar;156(3):456-63. doi: 10.1177/0194599816683916.
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Keywords: Comparative Effectiveness, Children/Adolescents, Surgery, Patient-Centered Outcomes Research, Children/Adolescents
Francis DO, Fonnesbeck C, Sathe N
Postoperative bleeding and associated utilization following tonsillectomy in children.
This review assessed posttonsillectomy hemorrhage (PTH), associated nonoperative readmissions/revisits, and reoperations in children. It concluded that PTH occurred in roughly 4 percent of tonsillectomies. Although studies typically did not report bleeding severity or amount, relatively few episodes of PTH necessitated reoperation for hemostasis. Frequency of PTH across techniques was similar; thus, it cannot be concluded that a given technique is superior.
AHRQ-funded; 290201500003I.
Citation: Francis DO, Fonnesbeck C, Sathe N .
Postoperative bleeding and associated utilization following tonsillectomy in children.
Otolaryngol Head Neck Surg 2017 Mar;156(3):442-55. doi: 10.1177/0194599816683915.
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Keywords: Children/Adolescents, Surgery, Adverse Events, Hospital Readmissions, Patient-Centered Outcomes Research
Fish DR, Mancuso CA, Garcia-Aguilar JE
Readmission after ileostomy creation: retrospective review of a common and significant event.
This study evaluated the causes and predictors of readmission after new ileostomy creation. It concluded that Readmissions are most commonly caused by dehydration, and are predicted by serious complications, comorbidity burden, loop stoma, shorter length of stay, and age. Readmissions in older patients are easier to predict, representing an important target for improvement.
AHRQ-funded; HS000066.
Citation: Fish DR, Mancuso CA, Garcia-Aguilar JE .
Readmission after ileostomy creation: retrospective review of a common and significant event.
Ann Surg 2017 Feb;265(2):379-87. doi: 10.1097/sla.0000000000001683.
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Keywords: Patient-Centered Outcomes Research, Surgery, Hospital Readmissions, Adverse Events
Franklin PD
Research priorities for optimal use of patient-reported outcomes in quality and outcome improvement for total knee arthroplasty.
This paper uses the traditional quality management's framework of inputs (patients), processes (clinical care), and outcomes to outline priority research questions to learn how clinicians, hospital managers, and patients can interpret patient-reported outcomes to improve total knee arthroplasty care and outcomes. It concludes that research should identify best practices to minimize variation in a patient's health status before surgery.
AHRQ-funded; HS018910.
Citation: Franklin PD .
Research priorities for optimal use of patient-reported outcomes in quality and outcome improvement for total knee arthroplasty.
J Am Acad Orthop Surg 2017 Feb;25 Suppl 1:S51-s54. doi: 10.5435/jaaos-d-16-00632.
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Keywords: Patient-Centered Outcomes Research, Surgery, Quality Improvement, Patient Experience, Evidence-Based Practice
Roxbury CR, Jatana KR, Shah RK
Safety and postoperative adverse events in pediatric airway reconstruction: analysis of ACS-NSQIP-P 30-day outcomes.
The researchers describe postoperative sequelae of pediatric airway reconstructive procedures and identify predictive factors for adverse events. They conclude that the 30-day adverse event rate in pediatric airway surgery is high, with no identifiable predictors noted in the analysis of these data. Findings imply that systematic collection of variables and outcomes will be essential to truly effect quality improvement in these high-risk procedures..
AHRQ-funded; HS022932.
Citation: Roxbury CR, Jatana KR, Shah RK .
Safety and postoperative adverse events in pediatric airway reconstruction: analysis of ACS-NSQIP-P 30-day outcomes.
Laryngoscope 2017 Feb;127(2):504-08. doi: 10.1002/lary.26165.
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Keywords: Children/Adolescents, Patient Safety, Adverse Events, Patient-Centered Outcomes Research, Surgery
Chinnadurai S, Jordan AK, Sathe NA
Tonsillectomy for obstructive sleep-disordered breathing: a meta-analysis.
This meta-analysis compared sleep, cognitive or behavioral, and health outcomes of tonsillectomy versus watchful waiting with supportive care in children with sleep-disordered breathing. It determined that, relative to watchful waiting, most studies reported better sleep-related outcomes in children who had a tonsillectomy.
AHRQ-funded; 290201500003I.
Citation: Chinnadurai S, Jordan AK, Sathe NA .
Tonsillectomy for obstructive sleep-disordered breathing: a meta-analysis.
Pediatrics 2017 Feb;139(2). doi: 10.1542/peds.2016-3491.
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Keywords: Children/Adolescents, Sleep Problems, Surgery, Evidence-Based Practice, Respiratory Conditions, Patient-Centered Outcomes Research, Evidence-Based Practice, Outcomes
Franklin PD, Miozzari H, Christofilopoulos P
Important patient characteristics differ prior to total knee arthroplasty and total hip arthroplasty between Switzerland and the United States.
The researchers compared preoperative patient and clinical characteristics from two large cohorts who underwent either total knee (TKA) or hip (THA) arthroplasty, one in Switzerland, the other in the US. They found substantial differences between US and Swiss cohorts in pre-operative patient characteristics and pain levels, which has potentially important implications for cross-cultural comparison of TKA/THA outcomes.
AHRQ-funded; HS018910.
Citation: Franklin PD, Miozzari H, Christofilopoulos P .
Important patient characteristics differ prior to total knee arthroplasty and total hip arthroplasty between Switzerland and the United States.
BMC Musculoskelet Disord 2017 Jan 11;18(1):14. doi: 10.1186/s12891-016-1372-5.
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Keywords: Surgery, Pain, Patient-Centered Outcomes Research, Osteoporosis, Arthritis
Lou I, Balentine C, Clarkson S
How long should we follow patients after apparently curative parathyroidectomy?
This study aimed to evaluate the risk of recurrent hyperparathyroidism in the 10 years after operation. It evaluated 196 patients with a 14.8 percent 10-year recurrence rate. It found that median time to recurrence was 6.3 years and 34.5 percent of all recurrences were identified more than 10 years after operation.
AHRQ-funded; HS023009.
Citation: Lou I, Balentine C, Clarkson S .
How long should we follow patients after apparently curative parathyroidectomy?
Surgery 2017 Jan;161(1):54-61. doi: 10.1016/j.surg.2016.05.049.
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Keywords: Care Management, Patient-Centered Outcomes Research, Surgery
Krakovitz PR, Boss EF
Intraoperative nerve monitoring during thyroidectomy-more complex than cost alone.
This brief invited commentary discussed intraoperative nerve monitoring and surgery.
AHRQ-funded; HS022932.
Citation: Krakovitz PR, Boss EF .
Intraoperative nerve monitoring during thyroidectomy-more complex than cost alone.
JAMA Otolaryngol Head Neck Surg 2016 Dec;142(12):1206-07. doi: 10.1001/jamaoto.2016.3116.
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Keywords: Shared Decision Making, Healthcare Costs, Patient-Centered Outcomes Research, Quality of Life, Surgery
Nguyen UD, Ayers DC, Li W
Preoperative pain and function: profiles of patients selected for total knee arthroplasty.
The researchers examined patient-reported preoperative pain and function profiles to understand symptom severity at the time of total knee arthroplasty (TKA) decision. Of 6,936 patients, 77 percent had high pain and poor function (group 4), 19 percent had high pain "or" poor function (groups 2-3), and 5 percent had little pain and high function before TKA (group 1).
AHRQ-funded; HS018910.
Citation: Nguyen UD, Ayers DC, Li W .
Preoperative pain and function: profiles of patients selected for total knee arthroplasty.
J Arthroplasty 2016 Nov;31(11):2402-07.e2. doi: 10.1016/j.arth.2016.04.015.
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Keywords: Pain, Surgery, Arthritis, Comparative Effectiveness, Patient-Centered Outcomes Research
Waljee JF, Ghaferi A, Cassidy R
Are patient-reported outcomes correlated with clinical outcomes after surgery? A population-based study.
The researchers evaluated the extent to which patient-reported outcomes (eg, health-related quality of life) are distinct from clinical outcomes following bariatric surgery. They concluded that patient-reported outcomes are not correlated with early perioperative events, but are correlated with measures of clinical effectiveness after bariatric surgery.
AHRQ-funded; HS023313.
Citation: Waljee JF, Ghaferi A, Cassidy R .
Are patient-reported outcomes correlated with clinical outcomes after surgery? A population-based study.
Ann Surg 2016 Oct;264(4):682-9. doi: 10.1097/sla.0000000000001852.
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Keywords: Surgery, Obesity, Adverse Events, Patient-Centered Outcomes Research, Patient Safety
Pezold ML, Pusic AL, Cohen WA
Defining a research agenda for patient-reported outcomes in surgery: using a Delphi survey of stakeholders.
The authors sought to create a research agenda to help determine future directions and advance cross-disciplinary collaboration on the use of patient-reported outcomes (PROs) in surgery. They concluded that the Patient-Reported Outcomes in Surgery Conference research agenda was created using a modified Delphi survey of stakeholders that will help researchers, surgeons, and funders identify crucial areas of future PROs research in surgery.
AHRQ-funded; HS023357; HS000066.
Citation: Pezold ML, Pusic AL, Cohen WA .
Defining a research agenda for patient-reported outcomes in surgery: using a Delphi survey of stakeholders.
JAMA Surg 2016 Oct;151(10):930-36. doi: 10.1001/jamasurg.2016.1640.
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Keywords: Patient-Centered Outcomes Research, Research Methodologies, Surgery, Quality Indicators (QIs)
Goodman SM, Mandl LA, Parks ML
Disparities in TKA outcomes: census tract data show interactions between race and poverty.
Race is an important predictor of total knee arthroplasty (TKA) outcomes in the United States; however, analyses of race can be confounded by socioeconomic factors, which can result in difficulty determining the root cause of disparate outcomes after TKA. This study found that blacks and whites living in communities with little poverty have similar patient-reported TKA outcomes, whereas in communities with high levels of poverty, there are important racial disparities.
AHRQ-funded; HS016075.
Citation: Goodman SM, Mandl LA, Parks ML .
Disparities in TKA outcomes: census tract data show interactions between race and poverty.
Clin Orthop Relat Res 2016 Sep;474(9):1986-95. doi: 10.1007/s11999-016-4919-8.
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Keywords: Disparities, Racial and Ethnic Minorities, Social Determinants of Health, Patient-Centered Outcomes Research, Surgery
Dimou FM, Adhikari D, Mehta HB
Incidence of hepaticojejunostomy stricture after hepaticojejunostomy.
The authors aimed to determine the timing, incidence, and management of stricture after biliary-enteric anastomosis. They found that younger age was associated with a decreased likelihood of stricture formation and that the presence of an endostent predicted stricture formation. They concluded that biliary-enteric anastomotic strictures occur with significant frequency after a biliary-enteric anastomosis, and that while many patients are managed nonoperatively, stricture diagnosis remains burdensome.
AHRQ-funded; HS022134.
Citation: Dimou FM, Adhikari D, Mehta HB .
Incidence of hepaticojejunostomy stricture after hepaticojejunostomy.
Surgery 2016 Sep;160(3):691-8. doi: 10.1016/j.surg.2016.05.021.
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Keywords: Surgery, Adverse Events, Digestive Disease and Health, Elderly, Patient-Centered Outcomes Research
Simianu VV, Flum DR
Rethinking elective colectomy for diverticulitis: a strategic approach to population health.
The authors argue that a rethinking of elective colectomy should come from a patient-centered approach that considers the risks of recurrence, quality of life, patient wishes and experiences about surgical and medical treatment options as well as operative morbidity and risks.
AHRQ-funded; HS020025.
Citation: Simianu VV, Flum DR .
Rethinking elective colectomy for diverticulitis: a strategic approach to population health.
World J Gastroenterol 2014 Nov 28;20(44):16609-14. doi: 10.3748/wjg.v20.i44.16609..
Keywords: Patient-Centered Outcomes Research, Comparative Effectiveness, Surgery, Adverse Events, Risk