National Healthcare Quality and Disparities Report
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- Adverse Events (3)
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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 21 of 21 Research Studies DisplayedXu X, Lin H, Wright JD
Association between power morcellation and mortality in women with unexpected uterine cancer undergoing hysterectomy or myomectomy.
Despite concerns that power morcellation may adversely affect prognosis of patients with occult uterine cancer, empirical evidence has been limited and inconclusive. In this study, the investigators aimed to determine whether uncontained power morcellation at the time of hysterectomy or myomectomy was associated with increased mortality risk in women with occult uterine cancer.
AHRQ-funded; HS024702.
Citation: Xu X, Lin H, Wright JD .
Association between power morcellation and mortality in women with unexpected uterine cancer undergoing hysterectomy or myomectomy.
J Clin Oncol 2019 Dec 10;37(35):3412-24. doi: 10.1200/jco.19.00562..
Keywords: Cancer, Mortality, Women, Surgery, Risk, Adverse Events
Chapman CH, Caram MEV, Radhakrishnan A
Association between PSA values and surveillance quality after prostate cancer surgery.
This study examined the association between PSA values and posttreatment surveillance after prostate cancer surgery. Normally the treatment cutoff rate is 0.2 ng/mL but 4.0 ng/mL may be more appropriate. Data from the US Veterans Health Administration was used to perform a retrospective longitudinal cohort study for men diagnosed with nonmetastatic prostate cancer from 2005 to 2008 who underwent radical prostatectomy. Guideline concordance was high at year 1 (95%) but decreased to 79% in year 7. After adjustment, guideline concordance was lowered for the youngest and oldest, Black, and unmarried men.
AHRQ-funded; HS018726.
Citation: Chapman CH, Caram MEV, Radhakrishnan A .
Association between PSA values and surveillance quality after prostate cancer surgery.
Cancer Med 2019 Dec;8(18):7903-12. doi: 10.1002/cam4.2663..
Keywords: Cancer: Prostate Cancer, Cancer, Surgery, Screening, Guidelines, Prevention, Evidence-Based Practice
Sheetz KH, Dimick JB, Nathan H
Centralization of high-risk cancer surgery within existing hospital systems.
Centralization is often proposed as a strategy to improve the quality of certain high-risk health care services. In this study, the investigators evaluated the extent to which existing hospital systems centralize high-risk cancer surgery and whether centralization is associated with short-term clinical outcomes. The investigators concluded that greater centralization of complex cancer surgery within existing hospital systems was associated with better outcomes.
AHRQ-funded; HS023597.
Citation: Sheetz KH, Dimick JB, Nathan H .
Centralization of high-risk cancer surgery within existing hospital systems.
J Clin Oncol 2019 Dec 1;37(34):3234-42. doi: 10.1200/jco.18.02035..
Keywords: Surgery, Cancer, Risk, Hospitals, Health Systems, Quality Improvement, Quality Indicators (QIs), Quality of Care, Outcomes
Fuzesi S, Becetti K, Klassen AF
Expectations of breast-conserving therapy: a qualitative study.
The goal of this study was to describe expectations of breast-conserving therapy (BCT) among patients with early breast cancer and aimed to inform preoperative patient education and improve the patient experience through knowledge. The researchers identified themes related to patient expectations of BCT and found that patients had a clear knowledge gap regarding BCT. This data may be used to enhance preoperative discussions aimed at preparing patients for surgery and treatment.
AHRQ-funded; T32HS00066.
Citation: Fuzesi S, Becetti K, Klassen AF .
Expectations of breast-conserving therapy: a qualitative study.
J Patient Rep Outcomes 2019 Dec 27;3(1):73. doi: 10.1186/s41687-019-0167-5..
Keywords: Cancer: Breast Cancer, Cancer, Education: Patient and Caregiver, Surgery
Wang S, Lai S, von Itzstein MS
Type and case volume of health care facility influences survival and surgery selection in cases with early-stage non-small cell lung cancer.
With the expansion of non-small cell lung cancer (NSCLC) screening methods, the percentage of cases with early-stage NSCLC is anticipated to increase. Yet it remains unclear how the type and case volume of the health care facility at which treatment occurs may affect surgery selection and overall survival for cases with early-stage NSCLC. In this study, the investigators examine how type and case volume of health care facility influenced survival and surgery selection in cases with early-stage non-small cell lung cancer.
AHRQ-funded; HS022418.
Citation: Wang S, Lai S, von Itzstein MS .
Type and case volume of health care facility influences survival and surgery selection in cases with early-stage non-small cell lung cancer.
Cancer 2019 Dec 1;125(23):4252-59. doi: 10.1002/cncr.32377..
Keywords: Cancer: Lung Cancer, Surgery, Cancer, Patient-Centered Outcomes Research, Outcomes, Mortality
Ellis RJ, Zhang LM, Ko CY
Variation in hospital utilization of minimally invasive distal pancreatectomy for localized pancreatic neoplasms.
The objectives of this study were to identify factors associated with use of minimally invasive distal pancreatectomy (MIDP) for localized neoplasms and to assess hospital variation in MIDP utilization. Results showed that utilization of MIDP for localized pancreatic neoplasms is highly variable; while some patient-level factors are associated with MIDP use, hospital adoption of MIDP appears to be the primary driver of utilization. Monitoring hospital-level use of MIDP may be a useful quality measure to monitor uptake of emerging techniques in pancreatic surgery.
AHRQ-funded; HS026385; HS000078.
Citation: Ellis RJ, Zhang LM, Ko CY .
Variation in hospital utilization of minimally invasive distal pancreatectomy for localized pancreatic neoplasms.
J Gastrointest Surg 2020 Dec;24(12):2780-88. doi: 10.1007/s11605-019-04414-7..
Keywords: Cancer, Surgery, Hospitals, Quality of Care
Sheetz KH, Chhabra KR, Smith ME
Association of discretionary hospital volume standards for high-risk cancer surgery with patient outcomes and access, 2005-2016.
Various clinical societies and patient advocacy organizations continue to encourage minimum volume standards at hospitals that perform certain high-risk operations. Although many clinicians and quality and safety experts believe this can improve outcomes, the extent to which hospitals have responded to these discretionary standards remains unclear. The purpose of this study was to evaluate the association between short-term clinical outcomes and hospitals' adherence to the Leapfrog Group's minimum volume standards for high-risk cancer surgery.
AHRQ-funded; HS000053; HS023597; HS024763.
Citation: Sheetz KH, Chhabra KR, Smith ME .
Association of discretionary hospital volume standards for high-risk cancer surgery with patient outcomes and access, 2005-2016.
JAMA Surg 2019 Nov;154(11):1005-12. doi: 10.1001/jamasurg.2019.3017..
Keywords: Patient Safety, Hospitals, Outcomes, Surgery, Cancer
Mullins BT, Basak R, Broughman JR
Patient-reported sexual quality of life after different types of radical prostatectomy and radiotherapy: analysis of a population-based prospective cohort.
This study compares the effects of different types of radical prostatectomy and radiotherapy on sexual function. A population-based cohort of 835 men with newly diagnosed prostate cancer from 2011 through 2013 was recruited in collaboration with the Rapid Case Ascertainment system of the North Carolina Central Cancer Registry. They were enrolled prior to treatment and followed retrospectively using the validated Prostate Cancer Symptom Indices (PCSI) instrument. The sexual function scores were compared among patients who received the following treatment types: external-beam RT (EBRT), EBRT with androgen deprivation therapy (ADT), brachytherapy, nerve-sparing radical prostatectomy (RP), and non-nerve-sparing RP. The cohort was surveyed at 24 months post-therapy, and RT alone was found to result in the best preservation of sexual function with brachytherapy, RT with ADT, and nerve-sparing RP yielding similar outcomes. Patients treated with non-nerve-sparing RP experienced the worst sexual function outcome.
AHRQ-funded.
Citation: Mullins BT, Basak R, Broughman JR .
Patient-reported sexual quality of life after different types of radical prostatectomy and radiotherapy: analysis of a population-based prospective cohort.
Cancer 2019 Oct 15;125(20):3657-65. doi: 10.1002/cncr.32288..
Keywords: Quality of Life, Sexual Health, Surgery, Treatments, Comparative Effectiveness, Patient-Centered Outcomes Research, Outcomes, Cancer: Prostate Cancer, Cancer, Evidence-Based Practice
Symer MM, Sedrakyan A, Yeo HL
Case sequence analysis of the robotic colorectal resection learning curve.
This study examined trends in the increasing rate of resection surgery for colorectal cancer using robots. It has a major learning curve so investigators wanted to see if complication rates went down as the technology become more common. The cohort included adults undergoing colorectal section from 2008 through 2016 from data in the New York Statewide Planning and Research Cooperative database. The number of procedures started at 76 cases in 2010 and increased to 702 cases in 2015. Findings were that major complications (myocardial infarction, pulmonary embolism, shock, and death) did not decrease but iatrogenic complications were reduced. The odds of prolonged length of stay also decreased over time.
AHRQ-funded; HS000066.
Citation: Symer MM, Sedrakyan A, Yeo HL .
Case sequence analysis of the robotic colorectal resection learning curve.
Dis Colon Rectum 2019 Sep;62(9):1071-78. doi: 10.1097/dcr.0000000000001437..
Keywords: Cancer: Colorectal Cancer, Cancer, Surgery, Education: Continuing Medical Education, Outcomes
Sepucha KR, Langford AT, Belkora JK
Impact of timing on measurement of decision quality and shared decision making: longitudinal cohort study of breast cancer patients.
Med Decis Making 2019 Aug;39(6):642-50. doi: 10.1177/0272989x19862545.
AHRQ-funded; HS025718.
Citation: Sepucha KR, Langford AT, Belkora JK .
Impact of timing on measurement of decision quality and shared decision making: longitudinal cohort study of breast cancer patients.
Med Decis Making 2019 Aug;39(6):642-50. doi: 10.1177/0272989x19862545..
Keywords: Decision Making, Cancer: Breast Cancer, Cancer, Surgery
Kirk PS, Borza T, Caram MEV
Characterising potential bone scan overuse amongst men treated with radical prostatectomy.
The authors characterized bone scan use after radical prostatectomy (RP) using data from a large, national integrated delivery system. They found a substantial rate of bone scan utilization after RP. The majority were performed for prostate-specific antigen levels in which the likelihood of a positive test was low. They recommended more judicious use of imaging in the post-RP setting.
AHRQ-funded; HS025707.
Citation: Kirk PS, Borza T, Caram MEV .
Characterising potential bone scan overuse amongst men treated with radical prostatectomy.
BJU Int 2019 Jul;124(1):55-61. doi: 10.1111/bju.14551..
Keywords: Cancer: Prostate Cancer, Cancer, Surgery, Imaging, Healthcare Utilization
Bateni SB, Gingrich AA, Jeon SY
Clinical outcomes and costs following unplanned excisions of soft tissue sarcomas in the elderly.
This study’s goal was to analyze the costs and outcomes of planned vs. unplanned soft tissue sarcoma (STS) excisions in the Medicare population. The authors analyzed 3913 surgical patients with STS >/=66 y old from 1992 to 2011 using the Surveillance, Epidemiology, and End Results-Medicare (SEER-Medicare) datafiles. Planned excision rates were classified from preoperative MRI or biopsy records. There was no difference in survival rates between planned vs. unplanned excisions. Planned excisions costs were higher than unplanned excision with the first resection contributing to the majority of costs.
AHRQ-funded; HS022236.
Citation: Bateni SB, Gingrich AA, Jeon SY .
Clinical outcomes and costs following unplanned excisions of soft tissue sarcomas in the elderly.
J Surg Res 2019 Jul;239:125-35. doi: 10.1016/j.jss.2019.01.055..
Keywords: Healthcare Costs, Cancer, Elderly, Surgery, Outcomes, Patient-Centered Outcomes Research
Desai VB, Wright JD, Gross CP
Risk of unexpected uterine cancer in women undergoing myomectomy: a population-based study.
Data on the risk of unexpected uterine cancer specifically for women undergoing myomectomy are limited, as prior research has centered on hysterectomies (surgical removal of the uterus). In this correspondence, the authors discuss how they addressed this important gap using a large population-based sample.
AHRQ-funded; HS024702.
Citation: Desai VB, Wright JD, Gross CP .
Risk of unexpected uterine cancer in women undergoing myomectomy: a population-based study.
Eur J Obstet Gynecol Reprod Biol 2019 Jul;238:188-90. doi: 10.1016/j.ejogrb.2019.03.021..
Keywords: Cancer, Risk, Surgery, Women
Johnston FM, Beckman M
Navigating difficult conversations.
In this paper, the authors discussed breaking bad news and navigating difficult conversations in surgical oncology practice. They note that mounting evidence supports a patient-centered communication approach and models of shared decisionmaking. Physician training in patient-centered cancer communication also continues to evolve.
AHRQ-funded; HS024736.
Citation: Johnston FM, Beckman M .
Navigating difficult conversations.
J Surg Oncol 2019 Jul;120(1):23-29. doi: 10.1002/jso.25472..
Keywords: Cancer, Clinician-Patient Communication, Communication, Decision Making, Patient-Centered Healthcare, Patient and Family Engagement, Provider: Physician, Surgery
Chapman WC, Subramanian M, Jayarajan S
First, do no harm: rethinking routine diversion in sphincter-preserving rectal cancer resection.
The authors hypothesized that routine temporary diversion is not associated with decreased rates of leak or reintervention in cancer patients at large undergoing sphincter-sparing procedures. Using HCUP data from the Florida State Inpatient Database, they found no association between diversion and anastomotic leak. However, temporary diversion was associated with increased incidence of nonelective reinterventions, readmissions, and higher costs. They recommended additional study to identify which patients would benefit most from diversion.
AHRQ-funded; HS019455.
Citation: Chapman WC, Subramanian M, Jayarajan S .
First, do no harm: rethinking routine diversion in sphincter-preserving rectal cancer resection.
J Am Coll Surg 2019 Apr;228(4):547-56.e8. doi: 10.1016/j.jamcollsurg.2018.12.012..
Keywords: Healthcare Cost and Utilization Project (HCUP), Cancer: Colorectal Cancer, Cancer, Surgery, Treatments
Fernandez FG, Kosinski AS, Tong BC
Lack of correlation between short- and long-term performance after lung cancer surgery.
In this study, the investigators examined correlation between measures of short-term and long-term performance for lung cancer surgery. The investigators concluded that avoidance of perioperative morbidity and mortality is an incomplete measure of performance in lung cancer surgery. They suggest that lung cancer surgery performance metrics should assess the safety of surgery and long-term survival.
AHRQ-funded; HS022279.
Citation: Fernandez FG, Kosinski AS, Tong BC .
Lack of correlation between short- and long-term performance after lung cancer surgery.
J Thorac Cardiovasc Surg 2019 Apr;157(4):1633-43.e3. doi: 10.1016/j.jtcvs.2018.09.141..
Keywords: Cancer, Cancer: Lung Cancer, Outcomes, Surgery
Leeds IL, Meyers PM, Enumah ZO
Psychosocial risks are independently associated with cancer surgery outcomes in medically comorbid patients.
The purpose of this prospective observational study was to assess the association of preoperative psychosocial risk factors and 30-day complications following cancer surgery. The investigators demonstrated a more than threefold odds of a complication in medically comorbid patients with multiple psychosocial risks. They suggest that their findings support the use of psychosocial risks in preoperative assessment and consideration for inclusion in preoperative optimization efforts.
AHRQ-funded; HS024736.
Citation: Leeds IL, Meyers PM, Enumah ZO .
Psychosocial risks are independently associated with cancer surgery outcomes in medically comorbid patients.
Ann Surg Oncol 2019 Apr;26(4):936-44. doi: 10.1245/s10434-018-07136-3..
Keywords: Adverse Events, Cancer, Outcomes, Risk, Surgery
Tong BC, Kim S, Kosinski A
Penetration, completeness, and representativeness of the Society of Thoracic Surgeons General Thoracic Surgery Database for lobectomy.
Not all surgeons performing lobectomy in the United States report outcomes to The Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTSD). In this study, the investigators examined penetration, completeness, and representativeness of the STS GTSD for lobectomy in the Centers for Medicare and Medicaid Services (CMS) patient population. The investigators concluded that participation in the STS GTSD increased over time, but penetration lagged behind that of the other STS National Databases.
AHRQ-funded; HS022279.
Citation: Tong BC, Kim S, Kosinski A .
Penetration, completeness, and representativeness of the Society of Thoracic Surgeons General Thoracic Surgery Database for lobectomy.
Ann Thorac Surg 2019 Mar;107(3):897-902. doi: 10.1016/j.athoracsur.2018.07.059..
Keywords: Surgery, Cancer: Lung Cancer, Cancer, Data, Provider: Physician, Provider
Gani F, Conca-Cheng AM, Nettles B
Trends in outcomes after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.
The goal of this study was to describe temporal trends in clinical outcomes among patients undergoing cytoreductive surgery or hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). Operative time, postoperative morbidity, and length of stay after CRS/HIPEC were observed to improve over the study period. Careful patient selection may result in favorable outcomes for select patients undergoing CRS/HIPEC.
AHRQ-funded; HS024736.
Citation: Gani F, Conca-Cheng AM, Nettles B .
Trends in outcomes after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.
J Surg Res 2019 Feb;234:240-48. doi: 10.1016/j.jss.2018.09.032..
Keywords: Adverse Events, Treatments, Cancer, Surgery, Outcomes
Lin SC, Regenbogen SE, Hollingsworth JM
Coordination of care around surgery for colon cancer: insights from national patterns of physician encounters with Medicare beneficiaries.
This study researched the coordination of care before and after surgery for colon cancer patients using data from Medicare A and B records. There were quite a number of different combinations of care providers both preoperative and postoperative. Larger urban teaching hospitals had the most combinations in all phases.
AHRQ-funded; HS024525; HS024728.
Citation: Lin SC, Regenbogen SE, Hollingsworth JM .
Coordination of care around surgery for colon cancer: insights from national patterns of physician encounters with Medicare beneficiaries.
J Oncol Pract 2019 Feb;15(2):e110-e21. doi: 10.1200/jop.18.00228..
Keywords: Cancer, Cancer: Colorectal Cancer, Care Coordination, Medicare, Surgery
Deutsch GB, Deneve JL, Al-Kasspooles MF
Intellectual equipoise and challenges: accruing patients with advanced cancer to a trial randomizing to surgical or nonsurgical management (SWOG S1316).
Prospective, randomized trials are needed to determine optimal treatment approaches for palliative care problems such as malignant bowel obstruction (MBO). In this paper, the authors report their experience accruing randomized patients to the Prospective Comparative Effectiveness Trial for Malignant Bowel Obstruction (SWOG S1316) study, comparing surgical and nonsurgical management of MBO. Accrual is ongoing. Experience gained from the S1316 study can aid future palliative care trials. They note that it is possible to randomize patients to palliative studies by giving clinicians clear recommendations utilizing an algorithm of conversation, allotment of necessary time to discuss the trial, and encouragement to overcome internal bias.
AHRQ-funded; HS021491.
Citation: Deutsch GB, Deneve JL, Al-Kasspooles MF .
Intellectual equipoise and challenges: accruing patients with advanced cancer to a trial randomizing to surgical or nonsurgical management (SWOG S1316).
Am J Hosp Palliat Care 2020 Jan;37(1):12-18. doi: 10.1177/1049909119851471..
Keywords: Cancer, Surgery, Comparative Effectiveness, Palliative Care