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
201 to 225 of 1121 Research Studies DisplayedJohnson CL, Schwartz H, Greenberg A
Patient perceptions on barriers and facilitators to accessing low-acuity surgery during COVID-19 pandemic.
The onset of the COVID-19 pandemic led to the postponement of low-acuity surgical procedures in an effort to conserve resources and ensure patient safety. This study aimed to characterize patient-reported concerns about undergoing surgical procedures during the pandemic. The investigators concluded that eliciting patients' perspectives, adapting processes to address potential barriers, and effectively educating patients about institutional measures to minimize in-hospital transmission of COVID-19 should be integrated into surgical care.
AHRQ-funded; HS024532.
Citation: Johnson CL, Schwartz H, Greenberg A .
Patient perceptions on barriers and facilitators to accessing low-acuity surgery during COVID-19 pandemic.
J Surg Res 2021 Aug;264:30-36. doi: 10.1016/j.jss.2021.01.028..
Keywords: COVID-19, Surgery, Access to Care, Patient Experience, Public Health
Delaney LD, Kattapuram M, Haidar JA
The impact of surgeon adherence to preoperative optimization of hernia repairs.
This study looked at the ways that surgeon-level adherence to preoperative optimization impacts postoperative outcomes. A cohort of patients receiving hernia repair surgery were studied using data from the Michigan Surgical Quality Collaborative from 2014 to 2018. Adherence to preoperative optimization was defined as operating on patients who were nontobacco users with a body mass index of >18.5 kg/m2 and <40 kg/m2. Risk- and reliability-adjusted adherence rates were used to divide surgeons into tertiles. Across 70 Michigan hospitals, 15,016 patients underwent ventral and incisional hernia repair, cared for by 454 surgeons. Preoperative optimization rates ranged from 51% to 76%. Surgeons in the lowest tertile had higher rates of emergency department visits and serious complications versus any complication than middle and high optimization tertiles.
AHRQ-funded; HS025778.
Citation: Delaney LD, Kattapuram M, Haidar JA .
The impact of surgeon adherence to preoperative optimization of hernia repairs.
J Surg Res 2021 Aug;264:8-15. doi: 10.1016/j.jss.2021.01.044..
Keywords: Surgery, Provider: Physician, Provider, Outcomes
Joseph A, Neyens D, Mihandoust S
Impact of surgical table orientation on flow disruptions and movement patterns during pediatric outpatient surgeries.
This quantitative observational study observed the impacts of surgical table orientation on flow disruptions (FDs), the number of contacts between team members, and the distance traveled. Findings showed that the orientation of the surgical table significantly influenced staff workflow and movement in the operating room, with an angled surgical table orientation being the least disruptive to surgical work. The anesthesia provider, scrub nurse, and circulating nurse experienced more FDs compared to the surgeon.
AHRQ-funded; HS024380.
Citation: Joseph A, Neyens D, Mihandoust S .
Impact of surgical table orientation on flow disruptions and movement patterns during pediatric outpatient surgeries.
Int J Environ Res Public Health 2021 Jul 31;18(15). doi: 10.3390/ijerph18158114..
Keywords: Children/Adolescents, Ambulatory Care and Surgery, Surgery, Workflow
Kanji F, Cohen T, Alfred M
Room size influences flow in robotic-assisted surgery.
This study’s objective was to explore the impact of operating room size on the environmental causes of surgical flow disruptions occurring during robotic-assisted surgery. Findings from this study demonstrated previously unrecognized spatial challenges involved with introducing surgical robots into the operating domain. It is important to consider the needs of the technology prior to integration.
AHRQ-funded; HS026491.
Citation: Kanji F, Cohen T, Alfred M .
Room size influences flow in robotic-assisted surgery.
Int J Environ Res Public Health 2021 Jul 28;18(15). doi: 10.3390/ijerph18157984..
Keywords: Surgery, Patient Safety
Pritchard KT, Baillargeon J, Raji Ma
Association of occupational and physical therapy with duration of prescription opioid use after hip or knee arthroplasty: a retrospective cohort study of Medicare enrollees.
The purpose of this study was to establish whether non-pharmacological interventions, such as occupational and physical therapy, were associated with a shorter duration of prescription opioid use after hip or knee arthroplasty. The investigators concluded that occupational and physical therapy with home health were associated with a shorter duration of prescription opioid use after hip and knee arthroplasty.
AHRQ-funded; HS026133.
Citation: Pritchard KT, Baillargeon J, Raji Ma .
Association of occupational and physical therapy with duration of prescription opioid use after hip or knee arthroplasty: a retrospective cohort study of Medicare enrollees.
Arch Phys Med Rehabil 2021 Jul;102(7):1257-66. doi: 10.1016/j.apmr.2021.01.086..
Keywords: Orthopedics, Surgery, Opioids, Pain, Practice Patterns
Ellis RJ, Nicolas JD, Cheung E
Comprehensive characterization of the general surgery residency learning environment and the association with resident burnout.
Researchers sought to characterize the learning environment and to evaluate associations with burnout using a cross-sectional survey administered to all U.S. general surgery residents. They found that the overall burnout rate was 43.0%, and residents were more likely to report burnout if they also identified problems with residency workload, efficiency, social support, organizational culture, meaning in work, or experienced workplace mistreatment. They recommended efforts to help programs identify and address weaknesses in a targeted fashion in order to improve trainee burnout.
AHRQ-funded; HS000078.
Citation: Ellis RJ, Nicolas JD, Cheung E .
Comprehensive characterization of the general surgery residency learning environment and the association with resident burnout.
Ann Surg 2021 Jul 1;274(1):6-11. doi: 10.1097/sla.0000000000004796..
Keywords: Burnout, Surgery, Stress, Provider: Physician
Purnell TS, Simpson DC, Callender CO
Dismantling structural racism as a root cause of racial disparities in COVID-19 and transplantation.
As the United States faces unparalleled challenges due to COVID-19, racial disparities in health and healthcare have once again taken center stage. If effective interventions to address racial disparities in transplantation, including those magnified by COVID-19, are to be designed and implemented at the national level, it is first critical to understand the complex mechanisms by which structural, institutional, interpersonal, and internalized racism influence the presence of racial disparities in healthcare and transplantation. IN this article the authors discuss their viewpoint.
AHRQ-funded; HS024600.
Citation: Purnell TS, Simpson DC, Callender CO .
Dismantling structural racism as a root cause of racial disparities in COVID-19 and transplantation.
Am J Transplant 2021 Jul;21(7):2327-32. doi: 10.1111/ajt.16543..
Keywords: COVID-19, Racial and Ethnic Minorities, Disparities, Transplantation, Surgery, Access to Care
Wissel BD, Greiner HM, Glauser TA
Early identification of epilepsy surgery candidates: a multicenter, machine learning study.
Epilepsy surgery is underutilized. Automating the identification of potential surgical candidates may facilitate earlier intervention. The study objective was to develop site-specific machine learning (ML) algorithms to identify candidates before they undergo surgery. The investigators concluded that site-specific machine learning algorithms could identify candidates for epilepsy surgery early in the disease course in diverse practice settings.
AHRQ-funded; HS024977.
Citation: Wissel BD, Greiner HM, Glauser TA .
Early identification of epilepsy surgery candidates: a multicenter, machine learning study.
Acta Neurol Scand 2021 Jul;114(1):41-50. doi: 10.1111/ane.13418..
Keywords: Neurological Disorders, Surgery, Health Information Technology (HIT)
Kutney-Lee A, Brooks Carthon M, Sloane DM
Electronic health record usability: associations with nurse and patient outcomes in hospitals.
Researchers examined associations between electronic health record (EHR) usability and nurse job and surgical patient outcomes. Data from the American Hospital Association, state patient discharges, and nurse surveys were linked in a cross-sectional analysis. The researchers found that employing EHR systems with suboptimal usability was associated with higher odds of adverse nurse job outcomes and surgical patient mortality and readmission.
AHRQ-funded; HS023805.
Citation: Kutney-Lee A, Brooks Carthon M, Sloane DM .
Electronic health record usability: associations with nurse and patient outcomes in hospitals.
Med Care 2021 Jul;59(7):625-31. doi: 10.1097/mlr.0000000000001536..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Surgery, Outcomes, Nursing, Provider: Nurse
Rosko AJ, Gay BL, Reyes-Gastelum D
Surgeons' attitudes on total thyroidectomy vs lobectomy for management of papillary thyroid microcarcinoma.
The incidence of papillary thyroid cancer has increased in the past 25 years without a clear increase in thyroid cancer deaths. Given these findings, there has been a shift toward recommending conservative surgical options, with current management guidelines favoring lobectomy, especially for patients with papillary thyroid microcarcinoma. The aim of this study was to identify surgeons’ attitudes regarding surgical management of microcarcinomas with the hypothesis that surgeons consider other factors, in addition to tumor size, when selecting a surgical procedure.
AHRQ-funded; HS024512.
Citation: Rosko AJ, Gay BL, Reyes-Gastelum D .
Surgeons' attitudes on total thyroidectomy vs lobectomy for management of papillary thyroid microcarcinoma.
JAMA Otolaryngol Head Neck Surg 2021 Jul;147(7):667-69. doi: 10.1001/jamaoto.2021.0525..
Keywords: Cancer, Surgery, Practice Patterns, Provider: Physician
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
Lumpkin ST, Harvey E, Mihas P
Understanding patients' decisions to obtain unplanned, high-resource health care after colorectal surgery.
Researchers investigated effective strategies to reduce unplanned post-discharge health care visits following colorectal surgery (CRS). They found that interview participants voiced clear mental algorithms about when to visit an emergency department, identified facilitators and barriers to optimal health care use, and identified tangible targets for health care utilization reduction efforts. The researchers concluded that efforts should be directed at improving post-discharge communication and care coordination in order to reduce CRS patients' high-resource health care utilization.
AHRQ-funded; HS026363.
Citation: Lumpkin ST, Harvey E, Mihas P .
Understanding patients' decisions to obtain unplanned, high-resource health care after colorectal surgery.
Qual Health Res 2021 Jul;31(9):1582-95. doi: 10.1177/10497323211002479..
Keywords: Shared Decision Making, Digestive Disease and Health, Surgery
Herb JN, Ollila DW, Stitzenberg KB
Use and costs of sentinel lymph node biopsy in non-ulcerated T1b melanoma: analysis of a population-based registry.
This study looked at the utility of sentinel lymph node biopsy (SLNB) for non-ulcerated T1b melanoma. The aim of the study was to estimate SLNB use, positivity, prevalence, and procedural costs in patients with non-ulcerated T1b melanoma using a population-based registry. Patients with clinically node-negative, non-ulcerated T1b melanoma were identified in the SEER database from 2010 to 2016. Among 7245 included patients, 53% underwent SLNB of which 156 (4.1%) had a positive SLNB. Higher odds of positivity were associated with younger age, >1 mitosis per mm2, female sex, and truncal tumor location. Estimated SLNB costs to identify one patient with Stage II disease was $71,700. Out-of-pocket expenses for a Medicare patient was estimated to be $652 for a wide local excision (WLE) and SLNB and $79 for WLE alone.
AHRQ-funded; HS000032.
Citation: Herb JN, Ollila DW, Stitzenberg KB .
Use and costs of sentinel lymph node biopsy in non-ulcerated T1b melanoma: analysis of a population-based registry.
Ann Surg Oncol 2021 Jul;28(7):3470-78. doi: 10.1245/s10434-021-09998-6..
Keywords: Cancer: Skin Cancer, Cancer, Surgery, Healthcare Costs, Skin Conditions
Chao GF, Li KY, Zhu Z
Use of telehealth by surgical specialties during the COVID-19 pandemic.
This study’s objective was to determine telehealth use by surgical specialty before and during the pandemic period starting in March 2020. Insurance claims from a Michigan statewide commercial payer for new patient visits with a surgeon from 1 of 9 surgical specialties during one of the following periods: prior to the COVID-19 pandemic (period 1: January 5 to March 7, 2020), early pandemic (period 2: March 8 to June 6, 2020), and late pandemic (period 3: June 7 to September 5, 2020) were analyzed. For new patient visits, 1182 surgeons (26.8%) in any patient context used telehealth. Telehealth use peaked in April 2020 and facilitated 34.6% of all new patient visits during that week. Urology was the specialty with the highest telehealth conversion rate (14.3%).
AHRQ-funded; HS027632.
Citation: Chao GF, Li KY, Zhu Z .
Use of telehealth by surgical specialties during the COVID-19 pandemic.
JAMA Surg 2021 Jul;156(7):620-26. doi: 10.1001/jamasurg.2021.0979..
Keywords: COVID-19, Telehealth, Health Information Technology (HIT), Access to Care, Practice Patterns, Surgery
Childers CP, Ettner SL, Hays RD
Variation in intraoperative and postoperative utilization for 3 common general surgery procedures.
The goal of this study was to understand variation in intraoperative and postoperative utilization for common general surgery procedures. Electronic health record data for 7762 operations from two health systems were analyzed. Findings showed that surgeons were significant drivers of variation in surgical supply costs and procedure time, but much less so for postoperative length of stay. Intraoperative and postoperative utilization profiles can be generated for individual surgeons and may be an important tool for reducing surgical costs.
AHRQ-funded; HS025079.
Citation: Childers CP, Ettner SL, Hays RD .
Variation in intraoperative and postoperative utilization for 3 common general surgery procedures.
Ann Surg 2021 Jul 1;274(1):107-13. doi: 10.1097/sla.0000000000003571..
Keywords: Surgery, 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
Greenberg CC, Byrnes ME, Engler TA
Association of a statewide surgical coaching program with clinical outcomes and surgeon perceptions.
Investigators assessed risk-adjusted outcomes and participant perceptions following a statewide coaching program for bariatric surgeons. They found that this surgical coaching program was perceived as valuable and surgeons reported numerous practice changes. Additionally, operative times improved, but there was no significant improvement in risk-adjusted outcomes.
AHRQ-funded; HS023597.
Citation: Greenberg CC, Byrnes ME, Engler TA .
Association of a statewide surgical coaching program with clinical outcomes and surgeon perceptions.
Ann Surg 2021 Jun;273(6):1034-39. doi: 10.1097/sla.0000000000004800..
Keywords: Surgery, Provider: Physician, Provider Performance, Outcomes
Brauer DG, Wu N, Keller MR
Care fragmentation and mortality in readmission after surgery for hepatopancreatobiliary and gastric cancer: a patient-level and hospital-level analysis of the Healthcare Cost and Utilization Project administrative database.
This study investigates patient-level and hospital-level variables associated with the mortality difference at referral centers and, postoperatively, outside hospitals, in patients undergoing hepatopancreatobiliary (HPB) and gastric oncologic surgeries. Using HCUP data, findings showed that, for readmissions following HPB and gastric oncologic surgery, travel distance and timing were major determinants of care fragmentation. However, these variables were not associated with mortality, nor was annual hospital surgical volume after risk-adjustment.
AHRQ-funded; HS019455.
Citation: Brauer DG, Wu N, Keller MR .
Care fragmentation and mortality in readmission after surgery for hepatopancreatobiliary and gastric cancer: a patient-level and hospital-level analysis of the Healthcare Cost and Utilization Project administrative database.
J Am Coll Surg 2021 Jun;232(6):921-32. doi: 10.1016/j.jamcollsurg.2021.03.017..
Keywords: Healthcare Cost and Utilization Project (HCUP), Cancer, Surgery, Hospital Readmissions, Mortality
Medbery RL, Fernandez FG, Kosinski AS
Costs associated with lobectomy for lung cancer: an analysis merging STS and Medicare data.
Researchers sought to identify underlying case mix factors that contribute to variability of 90-day costs of lobectomy for early-stage lung cancer. Using the Society of Thoracic Surgeons General Thoracic Surgery Database, they found that lobectomy is associated with substantial variability of episode-of-care costs. Variability is driven by patient demographic and clinical factors, hospital characteristics, and the occurrence and severity of complications.
AHRQ-funded; R01 HS022279.
Citation: Medbery RL, Fernandez FG, Kosinski AS .
Costs associated with lobectomy for lung cancer: an analysis merging STS and Medicare data.
Ann Thorac Surg 2021 Jun;111(6):1781-90. doi: 10.1016/j.athoracsur.2020.08.073..
Keywords: Cancer: Lung Cancer, Cancer, Healthcare Costs, Surgery, Elderly, Medicare
Xu X, Desai VB, Wright JD
Hospital variation in responses to safety warnings about power morcellation in hysterectomy.
This study aimed to examine whether hospitals varied in their use of laparoscopic supracervical hysterectomy after safety warnings about power morcellation and compare the risk of surgical complications at hospitals that had different response trajectories in use of laparoscopic supracervical hysterectomy. The investigators found that hospitals varied in their use of laparoscopic supracervical hysterectomy after safety warnings about power morcellation. Complication risk increased at hospitals that shifted considerably toward open abdominal hysterectomy.
AHRQ-funded; HS024702.
Citation: Xu X, Desai VB, Wright JD .
Hospital variation in responses to safety warnings about power morcellation in hysterectomy.
Am J Obstet Gynecol 2021 Jun;224(6):589.e1-89.e13. doi: 10.1016/j.ajog.2020.12.1207..
Keywords: Patient Safety, Surgery, Risk, Women
Ehlers AP, Chhabra K, Thumma JR
In the eye of the beholder: surgeon variation in intra-operative perceptions of hiatal hernia and reflux outcomes after sleeve gastrectomy.
Researchers sought to determine whether intra-operative diagnosis of hiatal hernia varies among surgeons or if it affects outcomes of laparoscopic sleeve gastrectomy. They found that surgeons who identified hiatal hernias during video review had a higher rate of concurrent hiatal hernia repairs in their practice. However, this identification was not associated with improved patient-reported reflux symptoms after laparoscopic sleeve gastrectomy. They concluded that standardizing identification and management of hiatal hernias during bariatric surgery may help improve reflux outcomes post-operatively.
AHRQ-funded; HS023597.
Citation: Ehlers AP, Chhabra K, Thumma JR .
In the eye of the beholder: surgeon variation in intra-operative perceptions of hiatal hernia and reflux outcomes after sleeve gastrectomy.
Surg Endosc 2021 Jun;35(6):2537-42. doi: 10.1007/s00464-020-07668-4..
Keywords: Obesity, Surgery, Provider: Physician, Provider
Cowper PA, Feng L, Kosinski AS
Initial and longitudinal cost of surgical resection for lung cancer.
This study looked at the 4-year longitudinal cost of surgical resection of non-small cell lung cancer (NSCLC). The study describes initial and 4-year resource use and cost for NSCLC patients aged 65 years of age or older who were treated surgically from 2008 to 2013. Clinical data for NSCLC resections from The Society of Thoracic Surgery Database linked to Medicare claims, resource use and cost of preoperative staging, surgery, and subsequent care through 4 years were examined. Outcomes were stratified by pathologic stage and surgical approach for stage I lobectomy patients. In the first 90 days costs ranged from $12,430 for stage I to $26,350 for stage IV. Cumulative costs ranged from $131,032 for stage I to $205,368 for stage IV. For the stage I lobectomy cohort, patients who had minimally invasive procedures had lower 4-year costs than thoracotomy patients ($120,346 versus $136,250).
AHRQ-funded; R01 HS022279.
Citation: Cowper PA, Feng L, Kosinski AS .
Initial and longitudinal cost of surgical resection for lung cancer.
Ann Thorac Surg 2021 Jun;111(6):1827-33. doi: 10.1016/j.athoracsur.2020.07.048..
Keywords: Cancer: Lung Cancer, Cancer, Surgery, Healthcare Costs
Brown CS, Albright J, Henke PK
Modeling the elective vascular surgery recovery after coronavirus disease 2019: implications for moving forward.
This study looked at the impact of delays in elective vascular surgery caused by the coronavirus pandemic. Data from a 35-hospital regional vascular surgical collaborative consisting of all hospitals performing vascular surgery in the state of Michigan was used to estimate the number of delayed surgical cases for adults undergoing carotid endarterectomy, carotid stenting, endovascular and open abdominal aortic aneurysm repair, and lower extremity bypass. Median statewide monthly vascular surgical volume before the pandemic was 439 procedures, with a maximum statewide monthly case volume of 519 procedures. For the month of April 2020, elective vascular surgery procedure volume decreased by ~90%. Modelling estimated it would take approximately 8 months to catch up with the backlog. The authors suggest that if hospitals across the collaborative shared the burden of backlogged cases, the recovery should be shortened to ~3 months.
AHRQ-funded; HS000053.
Citation: Brown CS, Albright J, Henke PK .
Modeling the elective vascular surgery recovery after coronavirus disease 2019: implications for moving forward.
J Vasc Surg 2021 Jun;73(6):1876-80.e1. doi: 10.1016/j.jvs.2020.11.025..
Keywords: COVID-19, Infectious Diseases, Cardiovascular Conditions, Surgery
Kemp MT, Williams AM, Brown CS
Practical guidance for early identification of barriers in surgical telehealth clinics.
The authors provide advice on early identification of and response to barriers in telehealth settings in order to help patients receive optimal care. Their focus is on standardizing expectations, assessing technological knowledge and resource access, evaluating understanding and comfort with telehealth, and assessing social support.
AHRQ-funded; HS000053.
Citation: Kemp MT, Williams AM, Brown CS .
Practical guidance for early identification of barriers in surgical telehealth clinics.
Ann Surg 2021 Jun;273(6):e268-e70. doi: 10.1097/sla.0000000000004633..
Keywords: Surgery, Telehealth, Health Information Technology (HIT), Healthcare Delivery, Access to 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, Shared Decision Making, Medical Errors, Adverse Events, Imaging