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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 225 Research Studies DisplayedHerzig 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
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
Bamdad MC, Vitous CA, Rivard SJ
"You remember those days"-a qualitative study of resident surgeon responses to complications and deaths.
This qualitative study examined the impact of complications and deaths on surgery residents to facilitate development of improved support systems. Twenty-eight mid-level and senior residents (PGY3 and above) from 14 different training programs across the US were given semi-structured interviews. The interviewees described an initial emotional response of sadness, frustration, or grief. Simultaneously or soon after went through an examination period where they looked at how and why the outcome occurred with the goal of learning from it. The last phase was having a feeling of ownership, which was strengthened by involved in patient care and length of rotation.
AHRQ-funded; HS026772.
Citation: Bamdad MC, Vitous CA, Rivard SJ .
"You remember those days"-a qualitative study of resident surgeon responses to complications and deaths.
J Surg Educ 2022 Mar-Apr; 79(2):452-62. doi: 10.1016/j.jsurg.2021.09.011..
Keywords: Surgery, Provider: Physician, Adverse Events, Mortality
Difazio RL, Shore BJ, Melvin P
Pneumonia after hip surgery in children with neurological complex chronic conditions.
The purpose of this retrospective cohort study was to estimate rates of postoperative pneumonia in children with neurological complex chronic conditions (CCC) undergoing hip surgery, to determine the effect of pneumonia on postoperative hospital resource use, and to identify predictors. Researchers used data from the Pediatric Health Information System for children 4 years and older with a neurological CCC who had undergone hip surgery from 2016 to 2018 in U.S. children's hospitals. Findings indicate that postoperative pneumonia in children with a neurological CCC was associated with longer length-of-stay, readmissions, and higher costs. Children who had undergone pelvic osteotomies and who had multimorbidity needed additional clinical support to prevent postoperative pneumonia and to decrease resource utilization.
AHRQ-funded; HS024453.
Citation: Difazio RL, Shore BJ, Melvin P .
Pneumonia after hip surgery in children with neurological complex chronic conditions.
Dev Med Child Neurol 2023 Feb; 65(2):232-42. doi: 10.1111/dmcn.15339..
Keywords: Children/Adolescents, Surgery, Neurological Disorders, Pneumonia, Respiratory Conditions, Hospital Readmissions, Adverse Events
Ervin JN, Vitous CA, Wells EE
Rescue Improvement Conference: a novel tool for addressing failure to rescue.
The objective of this study was to understand the effectiveness of the Rescue Improvement Conference, a forum that addresses failure to rescue (FTR). FTR is the phenomenon where delayed recognition or response to surgical complications leads to a progressive cascade of adverse events culminating in patient death. The authors used 5 indicators of effectiveness: educational value, conference takeaways, discussion time, changes to surgical practice, and opportunities for improvement and conducted semi-structured interviews. The results showed that conference felt that the Rescue Improvement Conference was effective in all five indicators. The authors concluded that the conference has the potential to support other surgical departments in developing system-level strategies to recognize and manage postoperative complications that contribute to FTR.
AHRQ-funded; HS024403; HS023621.
Citation: Ervin JN, Vitous CA, Wells EE .
Rescue Improvement Conference: a novel tool for addressing failure to rescue.
Ann Surg 2023 Feb; 277(2):233-37. doi: 10.1097/sla.0000000000004832..
Keywords: Surgery, Adverse Events, Patient Safety, Quality of Care, Quality Improvement
Likosky DS, Strobel RJ, Wu X
Interhospital failure to rescue after coronary artery bypass grafting.
Researchers conducted an observational study to evaluate whether interhospital variation in mortality rates for coronary artery bypass grafting was driven by complications and failure to rescue. Subjects were patients undergoing grafting surgery across 90 hospitals between 2011 and 2017. Results indicated the predicted mortality risk was similar across hospital observed:expected mortality terciles. Observed and expected failure to rescue rates were positively correlated among patients with major and overall complications. The researchers concluded that interhospital variability in successful rescue after coronary artery bypass grafting supports the importance of identifying best practices at high-performing hospitals; this includes early recognition and management of complications.
AHRQ-funded; HS026003.
Citation: Likosky DS, Strobel RJ, Wu X .
Interhospital failure to rescue after coronary artery bypass grafting.
J Thorac Cardiovasc Surg 2023 Jan;165(1):134-43.e3. doi: 10.1016/j.jtcvs.2021.01.064..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Surgery, Hospitals, Adverse Events
Li RD, Joung RH, BC BC
Comprehensive evaluation of the trends in length of stay and post-discharge complications after colon surgery in the USA.
The purpose of this study focusing on colon surgery was to 1) describe temporal changes in length of stay (LOS) and post-discharge complications and 2) assess risk factors related with post-discharge complications. The study found that of the 98,136 patients who underwent colon resection between 2012 and 2018, the median LOS decreased from 5 days in 2012 to 4 days in 2018. Overall, the 30-day complication rate was 21.5%, which decreased during the study period. Of the 13 individual complications evaluated, 4 demonstrated a significant increase in the proportion of post-discharge events including overall SSI, superficial SSI, wound disruption, and UTI. Factors associated with the development of any post-discharge complication included female sex, ASA III/IV/V, dependent functional status, and higher BMI. Intraoperative factors included wound class, operation time, and approach. The study concluded that LOS and 30-day complications decreased over time, however the percentage of incidents taking place post-discharge increased for a number of complications.
AHRQ-funded; HS024516; HS026385
Citation: Li RD, Joung RH, BC BC .
Comprehensive evaluation of the trends in length of stay and post-discharge complications after colon surgery in the USA.
J Gastrointest Surg 2022 Oct;26(10):2184-92. doi: 10.1007/s11605-022-05391-0..
Keywords: Surgery, Adverse Events, Hospital Discharge
Theiss LM, Wood T, McLeod MC
The association of health literacy and postoperative complications after colorectal surgery: a cohort study.
The purpose of this retrospective cohort study of patients undergoing elective colorectal surgery between 2015 and 2020 was to describe the association between health literacy, a determinant of health, and surgical outcomes. The outcomes of the study included: postoperative complications, length of stay (LOS), readmissions, and mortality. The study found that of 552 patients, 8.3% (46) had limited health literacy. Patients with limited health literacy had higher rates of overall complications, especially surgical site infections, and longer LOS. Readmission and mortality rates did not differ between limited and non-limited patients. The researchers concluded that limited health literacy is related to an increased likelihood of post-surgical complications in elective colorectal surgery patients.
Citation: Theiss LM, Wood T, McLeod MC .
The association of health literacy and postoperative complications after colorectal surgery: a cohort study.
Am J Surg 2022 Jun;223(6):1047-52. doi: 10.1016/j.amjsurg.2021.10.024..
Keywords: Health Literacy, Surgery, Adverse Events
Marcaccio CL, Patel PB, Wang S
Effect of postoperative antithrombotic therapy on lower extremity outcomes after infrapopliteal bypass for chronic limb-threatening ischemia.
This study’s goal was to examine the effects of different postoperative antithrombotic regimens on 3-year clinical outcomes after infrapopliteal bypass for chronic limb-threatening ischemia (CLTI). The authors identified patients who had undergone infrapopliteal bypass for CLTI in the Vascular Quality Initiative (VQI) registry from 2003 to 2017 with linkage to Medicare claims for long-term outcomes. They divided the patients into three cohorts according to the discharge antithrombotic regimen: single-antiplatelet therapy (SAPT; aspirin or clopidogrel), dual antiplatelet therapy (DAPT; aspirin and clopidogrel), or anticoagulation (AC) plus any antiplatelet (AP) agent. To reduce selection bias, they restricted the analysis cohorts to patients treated by providers who discharged >50% of patients with each antithrombotic regimen. Their primary outcome was 3-year major adverse limb events (MALE; major amputation or reintervention). Among 1812 patients with a median follow-up time of >2 years, 693 (38%) were discharged with SAPT, 544 (30%) with DAPT, and 575 (32%) with AC+AP. At 3 years, MALE rates were 75% with DAPT, 74% with AC+AP, and 68% with SAPT. In adjusted analyses with SAPT as the reference group, no differences were found in 3-year MALE with DAPT or AC+AP. Across the treatment groups, we also found no differences in the individual end points of 3-year major amputation (DAPT: aHR, 0.98; AC+AP: aHR, 1.3), reintervention (DAPT: aHR, 1.0; AC+AP: aHR, 1.1), or mortality (DAPT: aHR, 1.1; AC+AP: aHR, 0.95).
AHRQ-funded; HS027285.
Citation: Marcaccio CL, Patel PB, Wang S .
Effect of postoperative antithrombotic therapy on lower extremity outcomes after infrapopliteal bypass for chronic limb-threatening ischemia.
J Vasc Surg 2022 May; 75(5):1696-706.e4. doi: 10.1016/j.jvs.2022.01.011..
Keywords: Cardiovascular Conditions, Medication, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Surgery, Medication: Safety
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.
AHRQ-funded; HS026291.
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
Marcaccio CL, Patel PB, Liang P
Efficacy and safety of perioperative dual antiplatelet therapy with ticagrelor versus clopidogrel in carotid artery stenting.
This study’s objective was to compare the efficacy and safety of perioperative dual antiplatelet therapy with aspirin/ticagrelor vs aspirin/clopidogrel in patients undergoing transfemoral carotid artery stenting (tfCAS) or transcarotid artery revascularization (TCAR). The authors identified all patients who underwent tfCAS or TCAR in the Vascular Quality Initiative registry from January 2016 to March 2021. They stratified patients by procedure and assessed outcomes using 1:3 propensity score-matched cohorts of patients who received perioperative aspirin/ticagrelor vs aspirin/clopidogrel. Among the cohort of 17,731 tfCAS patients, 593 (3.3%) received aspirin/ticagrelor and 11,404 (64%) received aspirin/clopidogrel. For the 2065 matched patients, no significant differences were found in the composite endpoint of stroke/death (aspirin/ticagrelor, 4.1%; vs aspirin/clopidogrel, 2.6%) or in the individual endpoints of stroke (2.9% vs 1.8%) or death (1.7% vs 1.1%). However, aspirin/ticagrelor was associated with a higher risk of bleeding (5.8% vs 2.8%). In a subgroup analysis of 297 tfCAS patients (14%) who received intraoperative protamine, no differences remained in stroke/death (1.5% vs 3.9%), and there was no longer a difference in bleeding (3.0% vs 2.6%). Among 17,946 TCAR patients, 453 (2.5%) received aspirin/ticagrelor and 13,696 (76%) received aspirin/clopidogrel. With the 1618 matched patients, no differences were found in stroke/death (0.7% vs 1.4%), stroke (0.2% vs 1.2%), death (0.5% vs 0.2%), or bleeding (1.2% vs 1.6%). For the 1429 TCAR patients (88%) who received protamine, no differences were found in stroke/death (0.8% vs 1.2%) or bleeding (0.6% vs 1.4%).
AHRQ-funded; HS027285.
Citation: Marcaccio CL, Patel PB, Liang P .
Efficacy and safety of perioperative dual antiplatelet therapy with ticagrelor versus clopidogrel in carotid artery stenting.
J Vasc Surg 2022 Apr; 75(4):1293-303.e8. doi: 10.1016/j.jvs.2021.09.045..
Keywords: Cardiovascular Conditions, Medication, Stroke, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Surgery
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.
AHRQ-funded; HS019455.
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
Blakeslee-Carter J, Beck AW, Spangler EL
Type III endoleaks in complex endovascular abdominal aortic aneurysm repair within the Vascular Quality Initiative.
The objective of this national multicenter cohort study was to evaluate the occurrence of Type III endoleaks (T3ELs) after complex endovascular aneurysm repair (c-EVAR) for abdominal aortic aneurysm, identify potential procedural characteristics, and determine their impact on c-EVAR clinical outcomes. Investigators reviewed elective c-EVAR for nonruptured aneurysms within the Vascular Quality Initiative. The findings indicated that T3ELs in c-EVAR remain relatively uncommon and are identified predominately at index hospitalization. T3EL development was associated with higher device modularity and modification. The presence of T3ELs did not appear to have a statistically significant relationship with aortic reinterventions or survival, but the authors note that these findings are not definitive.
AHRQ-funded; HS013852.
Citation: Blakeslee-Carter J, Beck AW, Spangler EL .
Type III endoleaks in complex endovascular abdominal aortic aneurysm repair within the Vascular Quality Initiative.
J Vasc Surg 2022 Apr; 75(4):1172-80. doi: 10.1016/j.jvs.2021.10.038..
Keywords: Cardiovascular Conditions, Surgery, Adverse Events
Patel PB, Marcaccio CL, de Guerre L
Complications after thoracic endovascular aortic repair for ruptured thoracic aortic aneurysms remain high compared with elective repair.
This study evaluated the outcomes associated with presentation of ruptured aneurysms and outcomes after thoracic endovascular aortic repair (TEVAR). The Vascular Quality Initiative (VQI) registry was queried for ten years (2010-2020) to identify patients who had undergone TEVAR for ruptured and intact thoracic aortic aneurysms. Primary outcome was to identify the factors associated with ruptured thoracic aortic aneurysms and secondary outcomes including perioperative mortality and morbidity, 5-year survival, and the identification of factors associated with adverse outcomes after TEVAR. The majority of the 3039 patients identified with a thoracic aortic aneurysm (92%) had undergone repair for an intact aneurysm and 8% had undergone repair for a ruptured aneurysm. Chronic kidney disease was associated with greater odds of a presentation with ruptured aneurysm. Lower odds of rupture included prior aortic aneurysm repair, prior smoker, preoperative beta-blocker therapy, and preoperative statin therapy. TEVAR for ruptured thoracic aortic aneurysms was associated with higher perioperative mortality (rupture vs intact, 27% vs 4.6%) and the composite outcome of mortality, new dialysis, paralysis, and stroke (38% vs 9.5%). The 5-year survival was significantly lower after TEVAR for ruptured thoracic aortic aneurysms (50% vs 76%). Preoperative statin therapy was associated with higher 5-year survival.
AHRQ-funded; HS027285.
Citation: Patel PB, Marcaccio CL, de Guerre L .
Complications after thoracic endovascular aortic repair for ruptured thoracic aortic aneurysms remain high compared with elective repair.
J Vasc Surg 2022 Mar; 75(3):842-50. doi: 10.1016/j.jvs.2021.09.047..
Keywords: Cardiovascular Conditions, Surgery, Adverse Events
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.
AHRQ-funded; HS023800.
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.
AHRQ-funded; HS024547.
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 and Ethnic Minorities, Surgery, Cardiovascular Conditions, Stroke, Risk, Adverse Events
Ernest EC, Hellar A, Varallo J
Reducing surgical site infections and mortality among obstetric surgical patients in Tanzania: a pre-evaluation and postevaluation of a multicomponent safe surgery intervention.
This study evaluated the impact of a multicomponent safe surgery intervention in Tanzania to reduce surgical site infection (SSI) rates and mortality after caesarean sections (CS). The authors used the WHO Surgical Safety Checklist (SSC) to measure WHO SSC utilization, SSI rates, and CS-related perioperative mortality rates (POMRs) before and 18 months after implementation. The SSC utilization rate for CS increased from 3.7% to 95.1%, which decreased the proportion of women with SSI after CS from 14% during baseline to 1%. CS-related POMR decreased by 38.5% after implementation of safe surgery interventions as well.
AHRQ-funded; HS024235.
Citation: Ernest EC, Hellar A, Varallo J .
Reducing surgical site infections and mortality among obstetric surgical patients in Tanzania: a pre-evaluation and postevaluation of a multicomponent safe surgery intervention.
BMJ Glob Health 2021 Dec;6(12). doi: 10.1136/bmjgh-2021-006788..
Keywords: Maternal Care, Pregnancy, Healthcare-Associated Infections (HAIs), Surgery, Injuries and Wounds, Adverse Events, Patient Safety
Shi J, Hurdle JF, Johnson SA
Natural language processing for the surveillance of postoperative venous thromboembolism.
The objective of the study was to develop a portal natural language processing approach to aid in the identification of postoperative venous thromboembolism events from free-text clinical notes. The investigators concluded that accurate surveillance of postoperative venous thromboembolism may be achieved using natural language processing on clinical notes in 2 independent health care systems. They indicated that these findings suggest natural language processing may augment manual chart abstraction for large registries such as National Surgical Quality Improvement Program.
AHRQ-funded; HS025776.
Citation: Shi J, Hurdle JF, Johnson SA .
Natural language processing for the surveillance of postoperative venous thromboembolism.
Surgery 2021 Oct;170(4):1175-82. doi: 10.1016/j.surg.2021.04.027..
Keywords: Blood Clots, Health Information Technology (HIT), Quality Improvement, Quality of Care, Surgery, Adverse Events
Halawi MJ, Gronbeck C, Metersky ML
AHRQ Author: Eldridge N
Time trends in patient characteristics and in-hospital adverse events for primary total knee arthroplasty in the United States: 2010-2017.
This study looked at trends in patient characteristics and in-hospital adverse events (AEs) for primary total knee arthroplasty (TKA) from 2010 to 2017. A total of 14,057 primary TKAs captured by the Medicare Patient Safety Monitoring System was retrospectively reviewed. Risk factors that increased included obesity prevalence, tobacco smoking, and renal disease. There were reductions in coronary artery disease and chronic warfarin use. Inpatient AEs decreased from 4.9% to 2.5%, primarily driven by reductions in anticoagulant-associated AEs, including major bleeding and hematomas, catheter-associated urinary tract infections, pressure ulcers, and venous thromboembolism.
AHRQ-authored; AHRQ-funded; 290201800005C.
Citation: Halawi MJ, Gronbeck C, Metersky ML .
Time trends in patient characteristics and in-hospital adverse events for primary total knee arthroplasty in the United States: 2010-2017.
Arthroplast Today 2021 Oct;11:157-62. doi: 10.1016/j.artd.2021.08.010..
Keywords: Surgery, Orthopedics, Adverse Events, Risk
Greenberg JK, Olsen MA, Poe J
Administrative data are unreliable for ranking hospital performance based on serious complications after spine fusion.
The authors evaluated the extent to which a metric of serious complications determined from administrative data can reliably profile hospital performance in spine fusion surgery. They found that a metric of serious complications was unreliable for benchmarking cervical fusion outcomes and only modestly reliable for thoracolumbar fusion. They concluded that, when assessed using administrative datasets, these measures appeared to be inappropriate for high-stakes applications, such as public reporting or pay-for-performance.
AHRQ-funded; HS027075; HS019455.
Citation: Greenberg JK, Olsen MA, Poe J .
Administrative data are unreliable for ranking hospital performance based on serious complications after spine fusion.
Spine 2021 Sep 1;46(17):1181-90. doi: 10.1097/brs.0000000000004017..
Keywords: Surgery, Provider Performance, Hospitals, Adverse Events, Back Health and Pain
Yuce TK, Holmstrom A, Soper NJ
Complications and readmissions associated with first assistant training level following elective bariatric surgery.
Little is known regarding the variation in training level and potential clinical impact of the first assistant in bariatric surgery. In this study, the investigators described the postoperative 30-day complications and readmissions following elective bariatric procedures by training level of the first assistant. The investigators concluded that variation in training level of the first assist during bariatric surgery had no influence on DSM or readmissions.
AHRQ-funded; HS000078.
Citation: Yuce TK, Holmstrom A, Soper NJ .
Complications and readmissions associated with first assistant training level following elective bariatric surgery.
J Gastrointest Surg 2021 Aug;25(8):1948-54. doi: 10.1007/s11605-020-04787-0..
Keywords: Obesity: Weight Management, Obesity, Surgery, Hospital Readmissions, Adverse Events
Howard R, Johnson E, Berlin NL
Hospital and surgeon variation in 30-day complication rates after ventral hernia repair.
Researchers analyzed variability in 30-day complication rates and identified specific complications that contributed to this variability after ventral hernia repair. They found that, after adjusting for a number of patient-specific clinical variables, there was significant variation in 30-day complication rates after ventral hernia repair, representing a significant opportunity to improve patient outcomes.
AHRQ-funded; HS025778.
Citation: Howard R, Johnson E, Berlin NL .
Hospital and surgeon variation in 30-day complication rates after ventral hernia repair.
Am J Surg 2021 Aug;222(2):417-23. doi: 10.1016/j.amjsurg.2020.12.021..
Keywords: Surgery, Adverse Events, Outcomes, Patient-Centered Outcomes Research
Khanijow AN, Wood LN, Xie R
The impact of an enhanced recovery program (ERP) on the costs of colorectal surgery.
This study’s objective was to investigate the costs associated with a colorectal Enhanced Recovery Program (ERP) in a large academic health system. Subjects were patients who underwent colorectal surgery 2012-14 (pre-ERP) and 2015-17 (ERP). Findings showed that implementation of an ERP for colorectal surgery was associated with lower variable costs compared to pre-ERP.
AHRQ-funded; HS023009.
Citation: Khanijow AN, Wood LN, Xie R .
The impact of an enhanced recovery program (ERP) on the costs of colorectal surgery.
Am J Surg 2021 Jul;222(1):186-92. doi: 10.1016/j.amjsurg.2020.11.034..
Keywords: Surgery, Adverse Events, Healthcare Costs
Zhu Y, Simon GJ, Wick EC
Applying machine learning across sites: external validation of a surgical site infection detection algorithm.
Surgical complications have tremendous consequences and costs. Complication detection is important for quality improvement, but traditional manual chart review is burdensome. Automated mechanisms are needed to make this more efficient. The purpose of the study was to understand the generalizability of a machine learning algorithm between sites; automated surgical site infection (SSI) detection algorithms developed at one center were tested at another distinct center.
AHRQ-funded; HS024532.
Citation: Zhu Y, Simon GJ, Wick EC .
Applying machine learning across sites: external validation of a surgical site infection detection algorithm.
J Am Coll Surg 2021 Jun;232(6):963-71.e1. doi: 10.1016/j.jamcollsurg.2021.03.026..
Keywords: Healthcare-Associated Infections (HAIs), Surgery, Adverse Events, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT), Quality Improvement, Quality of Care
Long S, Thomas GW, Karam MD
Surgical skill can be objectively measured from fluoroscopic images using a novel image-based Decision Error Analysis (IDEA) score.
This study introduces and evaluates a novel Image-based Decision Error Analysis (IDEA) score that captures performance during fluoroscopically assisted wire navigation. Findings showed that the fluoroscopic images obtained in the course of placing a guide wire contained a rich amount of information related to surgical skill. The IDEA scoring provided a basis for evaluating the competence of a resident. The score can be used to assess skill at key timepoints throughout residency, such as when rotating onto/off of a new surgical service and before performing certain procedures in the operating room, or as a tool for debriefing/providing feedback after a procedure is completed.
AHRQ-funded; HS022077; HS025353.
Citation: Long S, Thomas GW, Karam MD .
Surgical skill can be objectively measured from fluoroscopic images using a novel image-based Decision Error Analysis (IDEA) score.
Clin Orthop Relat Res 2021 Jun;479(6):1386-94. doi: 10.1097/corr.0000000000001623..
Keywords: Orthopedics, Surgery, Decision Making, Medical Errors, Adverse Events, Imaging