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 116 Research Studies DisplayedScally CP, Yin H, Birkmeyer JD
Comparing perioperative processes of care in high and low mortality centers performing pancreatic surgery.
The researchers compared high and low mortality hospitals in order to identify differences in patient care impacting safety. They concluded that high and low mortality hospitals both have high compliance with common quality measures; however, high mortality hospitals performed worse in other areas of perioperative care, indicating possible targets for quality improvement efforts.
AHRQ-funded; HS020937.
Citation: Scally CP, Yin H, Birkmeyer JD .
Comparing perioperative processes of care in high and low mortality centers performing pancreatic surgery.
J Surg Oncol 2015 Dec;112(8):866-71. doi: 10.1002/jso.24085.
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Keywords: Surgery, Mortality, Quality Improvement, Outcomes, Patient Safety
Murugiah K, Wang Y, Desai NR
Hospital variation in outcomes for transcatheter aortic valve replacement among Medicare beneficiaries, 2011 to 2013.
The researchers studied hospital performance on transcatheter aortic valve replacement (TAVR) using data from all Medicare fee-for-service (FFS) beneficiaries 65 years of age and older who underwent TAVR from January 1, 2011, to December 31, 2013. They found that for an individual patient, the between-hospital variation translates to a great than 2-fold higher risk of dying within 30 days for a patient undergoing TAVR at a hospital 1 SD above the national average compared with undergoing TAVR at a hospital 1 SD below; the between-hospital variation was
AHRQ-funded; HS023000.
Citation: Murugiah K, Wang Y, Desai NR .
Hospital variation in outcomes for transcatheter aortic valve replacement among Medicare beneficiaries, 2011 to 2013.
J Am Coll Cardiol 2015 Dec 15;66(23):2678-79. doi: 10.1016/j.jacc.2015.10.008.
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Keywords: Cardiovascular Conditions, Hospitals, Medicare, Patient-Centered Outcomes Research, Surgery
Kronman MP, Hersh AL, Gerber JS
Identifying antimicrobial stewardship targets for pediatric surgical patients.
The authors examined the collective pool of all systemic antibiotics prescribed to children hospitalized for surgical conditions and identified common surgical conditions with highly variable and potentially unnecessary antibiotic use. They concluded that the use of vancomycin for pediatric cardiothoracic and neurosurgical patients, and broad-spectrum antipseudomonal agents for gastrointestinal surgery patients, represent potentially high-yield targets for stewardship efforts to reduce unnecessary antimicrobial use.
AHRQ-funded; HS023320.
Citation: Kronman MP, Hersh AL, Gerber JS .
Identifying antimicrobial stewardship targets for pediatric surgical patients.
J Pediatric Infect Dis Soc 2015 Dec;4(4):e100-8. doi: 10.1093/jpids/piv022.
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Keywords: Antibiotics, Antimicrobial Stewardship, Children/Adolescents, Children/Adolescents, Surgery
Ellimoottil C, Miller S, Davis M
Insurance expansion and the utilization of inpatient surgery: evidence for a "Woodwork" effect?
The researchers examined rates of elective surgery in previously insured individuals before and after Massachusetts health care reform. They observed no increase in the overall rate of selected discretionary inpatient surgeries in Massachusetts versus control states for the entire population , as well as among the white and low-income subgroups.
AHRQ-funded; HS018346.
Citation: Ellimoottil C, Miller S, Davis M .
Insurance expansion and the utilization of inpatient surgery: evidence for a "Woodwork" effect?
Surg Innov 2015 Dec;22(6):588-92. doi: 10.1177/1553350615573579.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Surgery, Health Insurance, Policy, Hospitalization
Rajaram R, Ju MH, Bilimoria KY
National evaluation of hospital readmission after pulmonary resection.
The study’s objectives were to (1) assess readmission rates and timing after pulmonary resection, (2) report the most common reasons for rehospitalization, and (3) identify risk factors for unplanned readmission after pulmonary resection. It found that experiencing a postoperative complication was strongly associated with unplanned readmission.
AHRQ-funded; HS000078.
Citation: Rajaram R, Ju MH, Bilimoria KY .
National evaluation of hospital readmission after pulmonary resection.
J Thorac Cardiovasc Surg 2015 Dec;150(6):1508-14.e2. doi: 10.1016/j.jtcvs.2015.05.047..
Keywords: Hospital Readmissions, Risk, Surgery, Quality Indicators (QIs), Adverse Events
Dicks KV, Baker AW, Durkin MJ
Short operative duration and surgical site infection risk in hip and knee arthroplasty procedures.
The purpose of this paper was to determine the association between shorter operative duration and surgical site infection (SSI) and also between surgeon median operative duration and SSI risk among first-time hip and knee arthroplasties. The researchers concluded that short operative durations were not associated with a higher SSI risk for knee or hip arthroplasty procedures in their analysis.
AHRQ-funded; HS023866.
Citation: Dicks KV, Baker AW, Durkin MJ .
Short operative duration and surgical site infection risk in hip and knee arthroplasty procedures.
Infect Control Hosp Epidemiol 2015 Dec;36(12):1431-6. doi: 10.1017/ice.2015.222.
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Keywords: Healthcare-Associated Infections (HAIs), Orthopedics, Patient Safety, Adverse Events, Surgery, Injuries and Wounds
Strope SA, Vetter J, Elliott S
Use of medical therapy and success of laser surgery and transurethral resection of the prostate for benign prostatic hyperplasia.
To assess the impact of surgery for benign prostatic hyperplasia (BPH) on use of medication (5-alpha reductase inhibitors, alpha blockers, antispasmodics), the researchers assessed preoperative and postoperative medication utilization among surgically treated men. They found that most patients experience durable improvement after surgical intervention for BPH. However, their results show a need for effective patient counseling about continued or new use of medical therapy after laser and TURP procedures.
AHRQ-funded; HS019455.
Citation: Strope SA, Vetter J, Elliott S .
Use of medical therapy and success of laser surgery and transurethral resection of the prostate for benign prostatic hyperplasia.
Urology 2015 Dec;86(6):1115-22. doi: 10.1016/j.urology.2015.07.019..
Keywords: Surgery, Medication, Patient-Centered Outcomes Research, Men's Health
Grenda TR, Pradarelli JC, Thumma JR
Variation in hospital episode costs with bariatric surgery.
This study examined hospital variation in episode costs for a common high-risk procedure that is a prime candidate for bundled payment programs (ie, bariatric surgery). It found that mean total payments for bariatric procedures varied from $11,086 to $13,073 per episode of care, resulting in a mean difference of $1,987 (16.5 percent difference) per episode of care between the lowest and highest hospital quartiles.
AHRQ-funded; HS000053.
Citation: Grenda TR, Pradarelli JC, Thumma JR .
Variation in hospital episode costs with bariatric surgery.
JAMA Surg 2015 Dec;150(12):1109-15. doi: 10.1001/jamasurg.2015.2394.
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Keywords: Surgery, Obesity, Healthcare Costs
Goldberg J, Paugh TA, Dickinson TA
Greater volume of acute normovolemic hemodilution may aid in reducing blood transfusions after cardiac surgery.
The researchers describe the relationship between acute normovolemic hemodilution (ANH) and red blood cell (RBC) transfusions after cardiac surgery using a multicenter registry. They found a significant association between ANH and reduced perioperative RBC transfusion in cardiac surgery. Transfusion reduction is most profound with larger volumes of ANH.
AHRQ-funded; HS022535; HS022909.
Citation: Goldberg J, Paugh TA, Dickinson TA .
Greater volume of acute normovolemic hemodilution may aid in reducing blood transfusions after cardiac surgery.
Ann Thorac Surg 2015 Nov;100(5):1581-7; discussion 87. doi: 10.1016/j.athoracsur.2015.04.135.
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Keywords: Cardiovascular Conditions, Surgery, Registries
Britt RC, Scerbo MW, Montano M
Intracorporeal suturing: transfer from fundamentals of laparoscopic surgery to cadavers results in substantial increase in mental workload.
The researchers hypothesized that laparoscopic suturing on genuine bowel would be more challenging than on the Fundamentals of Laparoscopic Surgery (FLS)-simulated bowel as reflected in differences on both suturing and secondary task scores. They found that the increase in mental workload is indexed by both an increase in suturing times and a decrease in the ability to attend to the secondary task.
AHRQ-funded; HS020386.
Citation: Britt RC, Scerbo MW, Montano M .
Intracorporeal suturing: transfer from fundamentals of laparoscopic surgery to cadavers results in substantial increase in mental workload.
Surgery 2015 Nov;158(5):1428-33. doi: 10.1016/j.surg.2015.03.032..
Keywords: Surgery, Patient Safety, Simulation, Training
Grenda TR, Revels SL, Yin H
Lung cancer resection at hospitals with high vs low mortality rates.
The objective of this study was to evaluate perioperative outcomes in patients who underwent lung cancer resection at high-mortality hospitals [HMHs] and low-mortality hospitals [LMHs]) in order to better understand the factors related to differences in mortality rates after lung cancer resection. It concluded that failure-to-rescue rates are higher at HMHs, which may explain the large differences between hospitals in mortality rates following lung cancer resection.
AHRQ-funded; HS000053; HS020937.
Citation: Grenda TR, Revels SL, Yin H .
Lung cancer resection at hospitals with high vs low mortality rates.
JAMA Surg 2015 Nov;150(11):1034-40. doi: 10.1001/jamasurg.2015.2199..
Keywords: Cancer: Lung Cancer, Surgery, Mortality, Outcomes, Patient Safety
Ellis MC, Paugh TA, Dickinson TA
Nadir hematocrit on bypass and rates of acute kidney injury: does sex matter?
Recent literature has suggested that women, although more often exposed to lower nadir hematocrit (Hct), have a lower risk of postoperative renal dysfunction. The researchers assessed whether this relationship held across a large multicenter registry. They found that lower nadir Hct was associated with an increased risk of AKI, and the effect appears to be stronger among men than women.
AHRQ-funded; HS022535; HS022909.
Citation: Ellis MC, Paugh TA, Dickinson TA .
Nadir hematocrit on bypass and rates of acute kidney injury: does sex matter?
Ann Thorac Surg 2015 Nov;100(5):1549-54; discussion 54-5. doi: 10.1016/j.athoracsur.2015.05.080..
Keywords: Risk, Cardiovascular Conditions, Surgery, Adverse Events, Patient Safety
Hu Y, McMurry TL, Stukenborg GJ
Readmission predicts 90-day mortality after esophagectomy: analysis of surveillance, epidemiology, and end results registry linked to Medicare outcomes.
The purpose of this study was to characterize postesophagectomy readmissions and determine their relationship with subsequent 90-day mortality. It found that one in 5 esophagectomy patients are readmitted early after discharge. Readmitted patients have a 5-fold increase in early mortality.
AHRQ-funded; HS018049.
Citation: Hu Y, McMurry TL, Stukenborg GJ .
Readmission predicts 90-day mortality after esophagectomy: analysis of surveillance, epidemiology, and end results registry linked to Medicare outcomes.
J Thorac Cardiovasc Surg 2015 Nov;150(5):1254-60. doi: 10.1016/j.jtcvs.2015.08.071..
Keywords: Hospital Readmissions, Mortality, Outcomes, Registries, Surgery
Likosky DS, Wallace AS, Prager RL
Sources of variation in hospital-level infection rates after coronary artery bypass grafting: an analysis of the Society of Thoracic Surgeons Adult Heart Surgery Database.
This descriptive study characterized the hospital-level variability in healthcare-acquired infection (HAI) rates across hospitals participating in The Society of Thoracic Surgeons Adult Cardiac Surgery Database. It found substantial hospital-level variation exists in postoperative HAIs among patients undergoing coronary artery bypass graft surgery, driven predominantly by pneumonia.
AHRQ-funded; HS022535; HS022909.
Citation: Likosky DS, Wallace AS, Prager RL .
Sources of variation in hospital-level infection rates after coronary artery bypass grafting: an analysis of the Society of Thoracic Surgeons Adult Heart Surgery Database.
Ann Thorac Surg 2015 Nov;100(5):1570-5; discussion 75-6. doi: 10.1016/j.athoracsur.2015.05.015.
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Keywords: Healthcare-Associated Infections (HAIs), Surgery, Adverse Events, Injuries and Wounds, Registries
Waljee JF, Ghaferi A, Finks JF
Variation in patient-reported outcomes across hospitals following surgery.
The researchers examined variation in patient-reported outcomes (PROs), specifically health-related quality of life (HRQOL), across hospitals performing bariatric surgery. They found that patient factors explain a large proportion of hospital-level variation in PROs following bariatric surgery, underscoring the importance of risk adjustment.
AHRQ-funded; HS023313.
Citation: Waljee JF, Ghaferi A, Finks JF .
Variation in patient-reported outcomes across hospitals following surgery.
Med Care 2015 Nov;53(11):960-6. doi: 10.1097/mlr.0000000000000425..
Keywords: Quality of Life, Surgery, Obesity, Patient-Centered Outcomes Research, Patient Experience
Veluswamy RR, Ezer N, Mhango G
Limited resection versus lobectomy for older patients with early-stage lung cancer: Impact of histology.
The researchers used population-based data to assess the equivalency of limited resection versus lobectomy among older patients with stage IA invasive adenocarcinoma and squamous cell carcinoma less than 2 cm in size. They found generally that limited resection is not equivalent to lobectomy in older patients with invasive non–small-cell lung cancer, although segmentectomy may be equivalent in patients with adenocarcinoma.
AHRQ-funded; HS019670.
Citation: Veluswamy RR, Ezer N, Mhango G .
Limited resection versus lobectomy for older patients with early-stage lung cancer: Impact of histology.
J Clin Oncol 2015 Oct 20;33(30):3447-53. doi: 10.1200/jco.2014.60.6624..
Keywords: Cancer, Cancer: Lung Cancer, Comparative Effectiveness, Surgery
Steiner CA, Maggard-Gibbons M, Raetzman SO
Return to acute care following ambulatory surgery.
This study determined the rates of all-cause, unplanned revisits (i.e., not for routine medical care) within 30 days of ambulatory surgery and whether revisits were related to the operation. It found that acute care revisits following ambulatory operations in low-risk patients occurred with notable frequency across 6 diverse types of operations.
AHRQ-authored
Citation: Steiner CA, Maggard-Gibbons M, Raetzman SO .
Return to acute care following ambulatory surgery.
JAMA 2015 Oct 6;314(13):1397-9. doi: 10.1001/jama.2015.12210..
Keywords: Healthcare Cost and Utilization Project (HCUP), Ambulatory Care and Surgery, Surgery, Adverse Events
Kho JY, Johns BD, Thomas GW
A hybrid reality radiation-free simulator for teaching wire navigation skills.
The objective of this study was to assess the construct validity for a novel radiation-free simulator designed to teach wire navigation skills in hip fracture fixation. It found that the magnitude of improvement on successive simulator attempts was dependent on the level of expertise; tip-apex distance improved significantly in the novice group, whereas it was unchanged in the experienced group.
AHRQ-funded; HS022077.
Citation: Kho JY, Johns BD, Thomas GW .
A hybrid reality radiation-free simulator for teaching wire navigation skills.
J Orthop Trauma 2015 Oct;29(10):e385-90. doi: 10.1097/bot.0000000000000372..
Keywords: Surgery, Training, Health Information Technology (HIT), Injuries and Wounds, Patient Safety
Weinger MB, Slagle JM, Kuntz AH
A multimodal intervention improves postanesthesia care unit handovers.
The researchers introduced a multimodal intervention in an adult and a pediatric postanesthesia care unit (PACU) to improve postoperative handovers between anesthesia providers (APs) and PACU registered nurses (RNs). They concluded that a multimodal intervention substantially improved interprofessional PACU handovers, including those by clinicians who had not undergone formal simulation training.
AHRQ-funded; HS016651.
Citation: Weinger MB, Slagle JM, Kuntz AH .
A multimodal intervention improves postanesthesia care unit handovers.
Anesth Analg 2015 Oct;121(4):957-71. doi: 10.1213/ane.0000000000000670..
Keywords: Patient Safety, Care Coordination, Surgery
Singh JA, Ramachandran R
Age-related differences in the use of total shoulder arthroplasty over time: use and outcomes.
The authors assessed the age-related differences in the use of total shoulder arthroplasty (TSA) and outcomes, and associated time-trends using the United States Nationwide Inpatient Sample (NIS) between 1998 and 2010. They noted a time-related increase in the use of TSA and increasing age-related differences in outcomes indicating a changing epidemiology of the use of TSA and concluded that age-related differences in outcomes suggest that attention should focus on groups with the worst outcomes.
AHRQ-funded; HS021110.
Citation: Singh JA, Ramachandran R .
Age-related differences in the use of total shoulder arthroplasty over time: use and outcomes.
Bone Joint J 2015 Oct;97-b(10):1385-9. doi: 10.1302/0301-620x.97b10.35696.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Elderly, Orthopedics, Surgery
McElroy LM, Macapagal KR, Collins KM
Clinician perceptions of operating room to intensive care unit handoffs and implications for patient safety: a qualitative study.
The goal of this study is to use qualitative research methods to describe clinician perceptions of OR-to-ICU handoffs, and to elucidate attributes of the handoff process associated with high quality, as well as those with poor quality that can lead to patient harm. The findings suggest that ambiguous roles and conflicting expectations of team members during the OR-to-ICU handoff can increase risk of patient harm.
AHRQ-funded; HS000078.
Citation: McElroy LM, Macapagal KR, Collins KM .
Clinician perceptions of operating room to intensive care unit handoffs and implications for patient safety: a qualitative study.
Am J Surg 2015 Oct;210(4):629-35. doi: 10.1016/j.amjsurg.2015.05.008..
Keywords: Patient Safety, Intensive Care Unit (ICU), Surgery, Adverse Events, Care Coordination
Nieman CL, Benke JR, Boss EF
Does race/ethnicity or socioeconomic status influence patient satisfaction in pediatric surgical care?
The researchers evaluated patient satisfaction in outpatient pediatric surgical care and assess differences in scores by race/ ethnicity and socioeconomic status. Their analysis found no disparities in the patient experience by individual- or community-level factors.
AHRQ-funded; HS022932.
Citation: Nieman CL, Benke JR, Boss EF .
Does race/ethnicity or socioeconomic status influence patient satisfaction in pediatric surgical care?
Otolaryngol Head Neck Surg 2015 Oct;153(4):620-8. doi: 10.1177/0194599815590592..
Keywords: Patient Experience, Social Determinants of Health, Surgery, Racial and Ethnic Minorities, Children/Adolescents
Wasserstein D, Huston LJ, Nwosu S
KOOS pain as a marker for significant knee pain two and six years after primary ACL reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) prospective longitudinal cohort study.
The researchers applied three different models of Knee injury and Osteoarthritis Outcome Score (KOOS) thresholds for significant knee pain to an anterior cruciate ligament reconstruction (ACLR) cohort to identify prevalence and risk factors. They concluded that significant knee pain is prevalent after ACLR; with those who undergo subsequent ipsilateral surgery at greatest risk.
AHRQ-funded; HS016075.
Citation: Wasserstein D, Huston LJ, Nwosu S .
KOOS pain as a marker for significant knee pain two and six years after primary ACL reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) prospective longitudinal cohort study.
Osteoarthritis Cartilage 2015 Oct;23(10):1674-84. doi: 10.1016/j.joca.2015.05.025..
Keywords: Arthritis, Surgery, Pain, Chronic Conditions, Outcomes
McNamara ER, Schaeffer AJ, Logvinenko T
Management of proximal hypospadias with 2-stage repair: 20-year experience.
The researchers describe their experience with 2-stage proximal hypospadias repair. They report outcomes, and patient and procedure characteristics associated with surgical complications. In their review of the largest cohort of patients undergoing this procedure at a single institution, they found that complications and, reoperation rates were approximately 50 percent in the setting of complex genital reconstruction.
AHRQ-funded; HS000063.
Citation: McNamara ER, Schaeffer AJ, Logvinenko T .
Management of proximal hypospadias with 2-stage repair: 20-year experience.
J Urol 2015 Oct;194(4):1080-5. doi: 10.1016/j.juro.2015.04.105..
Keywords: Newborns/Infants, Outcomes, Surgery, Adverse Events
Patorno E, Wang SV, Schneeweiss S
Patterns of beta-blocker initiation in patients undergoing intermediate to high-risk noncardiac surgery.
The objective of this study is to examine patterns of β-Blocker initiation among patients undergoing noncardiac elective surgery in the US. It concluded that after a period of a rapidly increasing trend, perioperative β-Blocker initiation decreased sharply in the second half of 2008 and continued to decrease afterwards.
AHRQ-funded; HS022193.
Citation: Patorno E, Wang SV, Schneeweiss S .
Patterns of beta-blocker initiation in patients undergoing intermediate to high-risk noncardiac surgery.
Am Heart J 2015 Oct;170(4):812-20.e6. doi: 10.1016/j.ahj.2015.06.028..
Keywords: Surgery, Patient-Centered Outcomes Research, Patient Safety, Medication