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
1 to 25 of 68 Research Studies DisplayedThompson MP, Stewart JW, Hou H
Determinants and outcomes associated with skilled nursing facility use after coronary artery bypass grafting: a statewide experience.
The purpose of this study was to assess determinants and outcomes related with Skilled nursing facility (SNF) use after isolated coronary artery bypass grafting. The study sample included 8,614 patients, with an average age of 73.3 years. A skilled nursing facility (SNF) was used by 22.3% of patients within 90 days of discharge and ranged from 3.2% to 58.3% across the 33 hospitals. Patients utilizing SNFs had a greater likelihood of being female, older, non-White, with greater comorbidities, worse cardiovascular function, a perioperative morbidity, and longer hospital lengths of stay. Outcomes were significantly worse for users of SNFs, including higher rates of 90-day readmissions and ED visits and lower use of home health and rehabilitation services. Compared with non-SNF users, users of SNFs had a greater risk-adjusted hazard of mortality and had 2.7-percentage point greater 5-year mortality rate in a propensity-matched cohort of patients.
AHRQ-funded; HS027830.
Citation: Thompson MP, Stewart JW, Hou H .
Determinants and outcomes associated with skilled nursing facility use after coronary artery bypass grafting: a statewide experience.
Circ Cardiovasc Qual Outcomes 2023 Oct; 16(10):e009639. doi: 10.1161/circoutcomes.122.009639..
Keywords: Elderly, Nursing Homes, Heart Disease and Health, Cardiovascular Conditions, Medicare, Surgery
Herzig 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
Valentine KD, Vo H, Mancini B
Shared decision making for elective surgical procedures in older adults with and without cognitive insufficiencies.
The purpose of this study was to examine surgical decision-making processes of older adults with and without cognitive insufficiencies and to evaluate the psychometric properties of the shared decision making (SDM) Process scale. Participants were eligible patients aged 65 or older who were scheduled for a preoperative appointment before elective surgery; a baseline phone survey was administered a week before the visit and a follow-up survey 3 months later to assess decision regret. Survey responses indicated that patient-reported shared decision making, decisional conflict, and decision regret did not differ significantly for patients with and without cognitive insufficiencies. The authors concluded that the SDM Process scale was an acceptable, reliable, and valid measure of shared decision making.
AHRQ-funded; HS025718.
Citation: Valentine KD, Vo H, Mancini B .
Shared decision making for elective surgical procedures in older adults with and without cognitive insufficiencies.
Med Decis Making 2023 Aug; 43(6):656-66. doi: 10.1177/0272989x231182436..
Keywords: Shared Decision Making, Elderly, Surgery
Silber JH, Rosenbaum PR, Reiter JG
The safety of performing surgery at ambulatory surgery centers versus hospital outpatient departments in older patients with or without multimorbidity.
The objective of this matched cohort study was to determine if there are differential outcomes in older patients undergoing surgical procedures at ambulatory surgery centers (ASCs) versus hospital outpatient departments (HOPDs). The results indicated that revisits and complication rates for ASC patients were lower than for closely matched HOPD patients. The observed initial baseline risk in HOPD patients was higher than the baseline risk for the same procedures performed at the ASC, which suggested that surgeons are selecting their riskier patients to be treated at the HOPD rather than the ASC.
AHRQ-funded; HS026897.
Citation: Silber JH, Rosenbaum PR, Reiter JG .
The safety of performing surgery at ambulatory surgery centers versus hospital outpatient departments in older patients with or without multimorbidity.
Med Care 2023 May; 61(5):328-37. doi: 10.1097/mlr.0000000000001836..
Keywords: Elderly, Surgery, Patient Safety, Ambulatory Care and Surgery
Bongiovanni T, Gan S, Finlayson E
Prolonged use of newly prescribed gabapentin after surgery.
This study investigated postoperative prolonged gabapentin use in adults 65 years and older. The authors merged a 20% sample of Medicare Carrier, MedPAR, and Outpatient Files with Part D for 2013-2018. They defined new postoperative gabapentin as fills for 7 days before surgery until 7 days after discharge. Overall, 3% of all eligible patients (n = 17,970) had a new prescription for gabapentin postsurgery. Out of those, the mean age was 73 years old and 62% were female. The most common surgeries that gabapentin was prescribed for was total knee (45%) and total hip (21%) replacements. Prolonged use occurred in 22% of patients, with women, non-White, those with concurrent prolonged opioid use, and patients having undergone emergency surgery more likely to have prolonged use.
Citation: Bongiovanni T, Gan S, Finlayson E .
Prolonged use of newly prescribed gabapentin after surgery.
J Am Geriatr Soc 2022 Dec;70(12):3560-69. doi: 10.1111/jgs.18005..
Keywords: Medication, Surgery, Pain, Elderly, Practice Patterns
Laskow T, Zhu J, Buta B
Risk factors for nonresilient outcomes in older adults after total knee replacement.
The purpose of this study was to develop a simple measure of physical resilience and identify risk factors for nonresilient patient outcomes in total knee replacement procedures (TKR). The researchers conducted a secondary analysis of the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE-TJR) cohort study, including 7,239 adults aged 60 or older who underwent TKR between 2011 and 2015. The study found that the variables of age, body mass index, and Charlson Comorbidity Index (CCI) were associated with increased risk of physically nonresilient outcomes across the 3 patient-reported outcomes of the physical component summary (PCS), bodily pain (BP), and vitality (VT). A household income of greater than $45 000 associated with lower risk for PCS (RR = 0.81 [0.70-0.93]), BP (RR = 0.80 [0.69-0.91]), and VT (RR = 0.86 [0.78-0.93]). CONCLUSIONS: We operationalized physical resilience and identified factors predicting resilience after TKR. This approach may aid clinical risk stratification, guide further investigation of causes, and ultimately aid patients through the design of interventions to enhance physical resilience.
AHRQ-funded; HS018910.
Citation: Laskow T, Zhu J, Buta B .
Risk factors for nonresilient outcomes in older adults after total knee replacement.
J Gerontol A Biol Sci Med Sci 2022 Sep;77(9):1915-22. doi: 10.1093/gerona/glab257..
Keywords: Orthopedics, Surgery, Elderly, Risk
Chao GF, Chhabra KR, Yang J
Bariatric surgery in Medicare patients: examining safety and healthcare utilization in the disabled and elderly.
The purpose of this study was to compare safety and healthcare use after sleeve gastrectomy versus Roux-en-Y gastric bypass in a national Medicare cohort. The researchers analyzed Medicare claims from 2012-2017 for 30,105 bariatric surgery patients receiving benefits due to age or disability and compared all outcomes between sleeve and bypass for each benefit group at 30 days, 1 year, and 3 years. The study found that among the disabled patients (n = 21,595), sleeve gastrectomy was associated with lower 3-year ED utilization, complications, reinterventions, rehospitalizations, and mortality. Cumulative expenditures were $46,277 after sleeve gastrectomy and $48,211 after gastric bypass. Among the elderly (n = 8510), sleeve was associated with lower 3-year ED utilization, complications, reinterventions, and rehospitalizations. Expenditures were $38,632 after sleeve gastrectomy and $39,270 after gastric bypass. Procedure treatment effect significantly differed by benefit group for paraesophageal hernia repair, revision, and mortality. The study concluded that healthcare utilization benefits of sleeve over bypass are maintained across Medicare elderly populations and Medicare disabled subpopulations.
AHRQ-funded; HS025778.
Citation: Chao GF, Chhabra KR, Yang J .
Bariatric surgery in Medicare patients: examining safety and healthcare utilization in the disabled and elderly.
Ann Surg 2022 Jul 1;276(1):133-39. doi: 10.1097/sla.0000000000004526..
Keywords: Obesity: Weight Management, Obesity, Surgery, Medicare, Elderly, Disabilities
Herb J, Staley BS, Roberson M
Use and disparities in parathyroidectomy for symptomatic primary hyperparathyroidism in the Medicare population.
The investigators’ objective was to determine national usage and disparities in parathyroidectomy for symptomatic primary hyperparathyroidism among insured older adults. Data was obtained using Medicare claims. They found that parathyroidectomy was underused and recommended that quality improvement efforts, rooted in equitable care, be undertaken to increase access to parathyroidectomy for this disease.
AHRQ-funded; HS000032.
Citation: Herb J, Staley BS, Roberson M .
Use and disparities in parathyroidectomy for symptomatic primary hyperparathyroidism in the Medicare population.
Surgery 2021 Nov;170(5):1376-82. doi: 10.1016/j.surg.2021.05.026..
Keywords: Elderly, Disparities, Medicare, Surgery, Racial and Ethnic Minorities
De Roo AC, Vitous CA, Rivard SJ
High-risk surgery among older adults: not-quite shared decision-making.
This study explored surgeons’ approaches to decision-making for surgery among adults ≥65 years at high-risk of postoperative complications or death. The authors conducted semistructured in-depth interviews with 46 practicing surgeons across Michigan. They found that although shared decision-making is strongly recommended, surgeons who perform high-risk operations among older adults predominantly focused on assessing risk and setting expectations with patients and families rather than inviting them to actively participate in the decision-making process. Surgeons were also influenced by quality metrics, referrals, and personal experiences.
AHRQ-funded; HS026772; HS000053.
Citation: De Roo AC, Vitous CA, Rivard SJ .
High-risk surgery among older adults: not-quite shared decision-making.
Surgery 2021 Sep;170(3):756-63. doi: 10.1016/j.surg.2021.02.005..
Keywords: Elderly, Surgery, Shared Decision Making, Patient and Family Engagement
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
Savitz ST, Falk K, Stearns SC
Coronary revascularization outcomes in relation to skilled nursing facility use following hospital discharge.
Observational analyses comparing coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI) among elderly or frail patients are likely biased by treatment selection. PCI is typically chosen for frail patients, while CABG is more common for patients with good recovery potential. In this study. The investigators hypothesized that skilled nursing facility (SNF) use after revascularization was a measure of relative frailty associated with outcomes following coronary revascularization.
AHRQ-funded; HS000032.
Citation: Savitz ST, Falk K, Stearns SC .
Coronary revascularization outcomes in relation to skilled nursing facility use following hospital discharge.
Clin Cardiol 2021 May;44(5):627-35. doi: 10.1002/clc.23583..
Keywords: Elderly, Heart Disease and Health, Cardiovascular Conditions, Surgery, Outcomes, Nursing Homes
Dworsky JQ, Shellito AD, Childers CP
Association of geriatric events with perioperative outcomes after elective inpatient surgery.
Researchers investigated the prevalence and association of geriatric events (GEs) with clinical outcomes after elective surgery. Using National Inpatient Sample data, they found that, compared to admissions with no GEs, one or more GEs were associated with higher probability of worse outcomes including mortality, postoperative complications, prolonged length of stay, and discharge to a skilled nursing facility. They recommended efforts focusing on mutable factors responsible for GEs in order to optimize surgical care for older adults.
AHRQ-funded; HS000046.
Citation: Dworsky JQ, Shellito AD, Childers CP .
Association of geriatric events with perioperative outcomes after elective inpatient surgery.
J Surg Res 2021 Mar;259:192-99. doi: 10.1016/j.jss.2020.11.011..
Keywords: Healthcare Cost and Utilization Project (HCUP), Elderly, Surgery, Adverse Events, Outcomes
Dworsky JQ, Shenoy R, Childers CP
Older veterans undergoing inpatient surgery: what is the compliance with best practice guidelines?
This study’s objective was to determine the documented compliance with best practice guidelines for optimal perioperative care for the older adult surgical patient that were created by the American College of Surgeons Quality Improvement Program and the American Geriatrics Society. The guidelines include 38 measures. A retrospective chart review was conducted on 86 older adults undergoing elective inpatient coronary artery bypass graft, prostatectomy, or colectomy over a 2-year period at a single Veterans Affairs hospital. Mean reported compliance across measures was 41% ± 4%. Of the 38 analyzed measures, 10 measures were achieved for 0 patients, and only 1 patient for 7 measures. Future work is needed to understand barriers for implementation.
AHRQ-funded; HS000046.
Citation: Dworsky JQ, Shenoy R, Childers CP .
Older veterans undergoing inpatient surgery: what is the compliance with best practice guidelines?
Surgery 2021 Feb;169(2):356-61. doi: 10.1016/j.surg.2020.08.033..
Keywords: Elderly, Surgery, Guidelines, Evidence-Based Practice, Quality Improvement, Quality of Care, Quality Measures
Osterman CK, Deal AM, McCloskey H
Impairment and longitudinal recovery of older adults treated with radical cystectomy for muscle invasive bladder cancer.
Treatment for muscle invasive bladder cancer includes radical cystectomy, a major surgery that can be associated with significant toxicity. Limited data exist related to changes in patient global health status and recovery following radical cystectomy. In this study, the investigators used geriatric assessment to longitudinally compare health related impairments in older and younger patients with muscle invasive bladder cancer who undergo radical cystectomy.
AHRQ-funded; HS024134.
Citation: Osterman CK, Deal AM, McCloskey H .
Impairment and longitudinal recovery of older adults treated with radical cystectomy for muscle invasive bladder cancer.
J Urol 2021 Jan;205(1):94-99. doi: 10.1097/ju.0000000000001323..
Keywords: Elderly, Cancer, Surgery, Adverse Events, Quality of Life
Qian JZ, McAdams-DeMarco M, Ng DK
Arteriovenous fistula placement, maturation, and patency loss in older patients initiating hemodialysis.
The current clinical guidelines for vascular access do not have specific recommendations for older hemodialysis patients. This retrospective cohort study aimed to determine the association of age with arteriovenous fistula (AVF) placement, maturation, and primary and secondary patency loss among older hemodialysis recipients. The authors conclude that the likelihood of AVF maturation is an important consideration for vascular access planning.
AHRQ-funded; HS022931.
Citation: Qian JZ, McAdams-DeMarco M, Ng DK .
Arteriovenous fistula placement, maturation, and patency loss in older patients initiating hemodialysis.
Am J Kidney Dis 2020 Oct;76(4):480-89.e1. doi: 10.1053/j.ajkd.2020.02.449..
Keywords: Elderly, Dialysis, Kidney Disease and Health, Surgery
Modi PK, Moloci N, Herrel LA
Medicare accountable care organizations reduce spending on surgery.
This study examined the impact that Medicare accountable care organization (ACO) alignment has on spending for inpatient and outpatient surgical care. Researchers identified adults 65 years of age and older enrolled in fee-for-service Medicare from among a 20% random sample of beneficiaries and distinguished between those aligned and unaligned with a Medicare ACO, then measured payments for surgical services made on the enrollees’ behalf. Findings showed that ACO alignment was associated with savings on surgical care. These savings resulted from increased outpatient surgery and reduced use of inpatient surgery as well as reduced spending per inpatient surgical episode. Greater focus on surgical care to improve the ability of ACOs to control healthcare spending was recommended.
AHRQ-funded; HS024728; HS024525; HS026908.
Citation: Modi PK, Moloci N, Herrel LA .
Medicare accountable care organizations reduce spending on surgery.
Am J Accountable Care 2020 Sep;8(3):12-19..
Keywords: Medicare, Surgery, Healthcare Costs, Health Insurance, Elderly
McIsaac DI, Taljaard M, Bryson GL
Frailty as a predictor of death or new disability after surgery: a prospective cohort study.
The purpose of this study was to compare the accuracy of the modified Fried Index (mFI) and the Clinical Frailty Scale (CFS) to predict death or patient-reported new disability 90 days after major elective surgery. Results showed that older people with frailty are significantly more likely to die or experience a new patient-reported disability after surgery and that although accuracy was similar, the CFS, compared to the mFI, was easier to use and feasibility was higher.
AHRQ-funded; HS023313.
Citation: McIsaac DI, Taljaard M, Bryson GL .
Frailty as a predictor of death or new disability after surgery: a prospective cohort study.
Ann Surg 2020 Feb;271(2):283-89. doi: 10.1097/sla.0000000000002967..
Keywords: Elderly, Patient-Centered Outcomes Research, Surgery, Mortality, Adverse Events, Risk, Outcomes
Dworsky JQ, Childers CP, Gornbein J
Hospital experience predicts outcomes after high-risk geriatric surgery.
This study examined if there an association between a hospital’s annual volume of high-risk geriatric surgery and their risk of inpatient mortality, postoperative length of stay, and discharge to nursing facility. Using the 2014 National Inpatient Sample, older adults were identified who had undergone high-risk geriatric surgery. There were an estimated 514,950 hospital encounters at 3,115 hospitals undergoing surgery. A higher proportion of high-risk geriatric surgery patients was associated with decreased mortality and shorter postoperative length of stay. Higher volume hospitals were not associated with mortality but was associated with longer length of stay and decreased discharge to nursing facilities.
AHRQ-funded; HS000046; HS025079.
Citation: Dworsky JQ, Childers CP, Gornbein J .
Hospital experience predicts outcomes after high-risk geriatric surgery.
Surgery 2020 Feb;167(2):468-74. doi: 10.1016/j.surg.2019.07.026..
Keywords: Healthcare Cost and Utilization Project (HCUP), Elderly, Surgery, Risk, Hospitals, Outcomes, Mortality
De Roo AC, Li Y, Abrahamse PH
Long-term functional decline after high-risk elective colorectal surgery in older adults.
This study examined the long-term risks of functional decline after elective colorectal surgery in older adults. This retrospective matched cohort study used data from the Health and Retirement Study, a nationally representative, longitudinal survey of adults >50 years of age. This survey collected data on functional status, cognition, and demographics, among other topics. The survey was linked with Medicare claims and National Death Index data from 1992 to 2012 and used patients 65 years and older. Surgery patients did experience a greater likelihood of functional decline with or without complications compared to control subjects. The older the patient, the more likelihood of a functional decline occurring after surgery.
AHRQ-funded; HS000053.
Citation: De Roo AC, Li Y, Abrahamse PH .
Long-term functional decline after high-risk elective colorectal surgery in older adults.
Dis Colon Rectum 2020 Jan;63(1):75-83. doi: 10.1097/dcr.0000000000001541..
Keywords: Elderly, Cancer: Colorectal Cancer, Cancer, Surgery, Adverse Events, Risk
Kaye DR, Luckenbaugh AN, Oerline M
Understanding the costs associated with surgical care delivery in the Medicare population.
This study’s objective was to quantify the costs of inpatient and outpatient surgery in the Medicare population. Claims data from a 20% national sample of Medicare beneficiaries was used. Results showed that, while spending on inpatient surgery contributed the most to total surgical payments, it declined over the study period, driven by decreases in index hospitalization and readmissions payments. In contrast, spending on outpatient surgery increased across all sites of care (hospital outpatient department, physician office, and ambulatory surgery center). Ophthalmology and hand surgery witnessed the greatest growth in surgical spending over the study period. Surgical care accounts for half of all Medicare spending.
AHRQ-funded; HS024525; HS024728.
Citation: Kaye DR, Luckenbaugh AN, Oerline M .
Understanding the costs associated with surgical care delivery in the Medicare population.
Ann Surg 2020 Jan;271(1):23-28. doi: 10.1097/sla.0000000000003165..
Keywords: Surgery, Healthcare Delivery, Healthcare Costs, Medicare, Elderly, Hospitalization
Patel DK, Duncan MS, Shah AS
Association of cardiac rehabilitation with decreased hospitalization and mortality risk after cardiac valve surgery.
Investigators sought to characterize cardiac rehabilitation (CR) enrollment after cardiac valve surgery and its association with outcomes, including hospitalizations and mortality. Subjects were all fee-for-service Medicare beneficiaries undergoing open cardiac valve surgery in 2014, identified by inpatient diagnosis codes for open aortic, mitral, tricuspid, and pulmonary valve surgery. They found that fewer than half of Medicare beneficiaries undergoing cardiac valve surgery enrolled in CR programs, and there were marked racial/ethnic disparities among those who do. They recommend further study on barriers to CR enrollment in this population.
AHRQ-funded; HS022990.
Citation: Patel DK, Duncan MS, Shah AS .
Association of cardiac rehabilitation with decreased hospitalization and mortality risk after cardiac valve surgery.
JAMA Cardiol 2019 Dec;4(12):11887-1301. doi: 10.1001/jamacardio.2019.4032..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Rehabilitation, Hospitalization, Surgery, Mortality, Risk, Elderly
Vu JV, Gunaseelan V, Dimick JB
Mechanisms of age and race differences in receiving minimally invasive inguinal hernia repair.
Black patients and older adults are less likely to receive minimally invasive hernia repair. In this study, the investigators explored the association between race, age, and surgeon utilization of minimally invasive surgery (MIS) with the likelihood of receiving MIS inguinal hernia repair. The investigators concluded that race differences were explained by surgeon MIS utilization, implicating access to MIS-performing surgeon as a mediator. Conversely, age disparity was independent of MIS utilization, even after adjusting for comorbidities, indicating some degree of provider bias against performing MIS repair in older patients.
AHRQ-funded; HS025778.
Citation: Vu JV, Gunaseelan V, Dimick JB .
Mechanisms of age and race differences in receiving minimally invasive inguinal hernia repair.
Surg Endosc 2019 Dec;33(12):4032-37. doi: 10.1007/s00464-019-06695-0..
Keywords: Racial and Ethnic Minorities, Surgery, Elderly, Access to Care, Healthcare Utilization
Smith JW, Knight Davis J, Quatman-Yates CC
Loss of community-dwelling status among survivors of high-acuity emergency general surgery disease.
The purpose of this study was to examine the loss of community-dwelling status 9 months after hospitalization for high-acuity emergency general surgery (HA-EGS) disease among older Americans. The investigators concluded that older Americans, known to prioritize living in the community, will experience substantial loss of independence due to HA-EGS. They indicate that long-term expectations after surviving HA-EGS must be framed from the perspective of the outcomes that older patients value the most.
AHRQ-funded; HS022694.
Citation: Smith JW, Knight Davis J, Quatman-Yates CC .
Loss of community-dwelling status among survivors of high-acuity emergency general surgery disease.
J Am Geriatr Soc 2019 Nov;67(11):2289-97. doi: 10.1111/jgs.16046..
Keywords: Elderly, Surgery, Outcomes, Quality of Life
Dworsky JQ, Childers CP, Copeland T
Geriatric events among older adults undergoing nonelective surgery are associated with poor outcomes.
This study analyzed the rate of geriatric events (GEs): delirium, dehydration, falls/fractures, failure to thrive, and pressure ulcers) with older adults undergoing nonelective surgery. The 2013 to 2014 National Inpatient Sample was used to analyze nonelective admissions for 5 common operations: laparoscopic cholecystectomy, colectomy, soft tissue debridgement, small bowel resection, and laparoscopic appendectomy in adults aged 65 years and older and a younger referent group (aged 55-65 years). Logistic regression estimated the association of age and outcomes with GEs. Having any GE was found to be associated with higher probability of all outcomes including mortality, postoperative complications, prolonged length of stay, and skilled nursing facility discharge.
AHRQ-funded; HS00046; HS025079.
Citation: Dworsky JQ, Childers CP, Copeland T .
Geriatric events among older adults undergoing nonelective surgery are associated with poor outcomes.
Am Surg 2019 Oct;85(10):1089-93..
Keywords: Healthcare Cost and Utilization Project (HCUP), Elderly, Surgery, Adverse Events, Outcomes
Kundi H, Popma JJ, Valsdottir LR
The value of claims-based nontraditional risk factors in predicting long-term mortality after MitraClip procedure.
The goals of this study were to identify nontraditional risk factors coded in administrative claims data and to evaluate their ability to improve prediction of long-term mortality in patients undergoing percutaneous mitral valve repair. Patients undergoing transcatheter mitral valve repair using MitraClip implantation were identified among Medicare fee-for-service beneficiaries; researchers used nested Cox regression models to identify claims codes predictive of long-term mortality. Four groups of variables were introduced: cardiac, noncardiac, and nontraditional risk factors, and presentation characteristics. The authors conclude that risk-prediction models, which include nontraditional risk factors as identified in claims data, can be used to predict long-term mortality risk more accurately in patients who have undergone MitraClip procedures.
AHRQ-funded; HS024520.
Citation: Kundi H, Popma JJ, Valsdottir LR .
The value of claims-based nontraditional risk factors in predicting long-term mortality after MitraClip procedure.
Can J Cardiol 2018 Dec;34(12):1648-54. doi: 10.1016/j.cjca.2018.10.002..
Keywords: Cardiovascular Conditions, Elderly, Mortality, Heart Disease and Health, Medicare, Risk, Surgery