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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 25 of 113 Research Studies Displayed
Greenberg JK, Olsen MA, Dibble CF
Comparison of cost and complication rates for profiling hospital performance in lumbar fusion for spondylolisthesis.
Investigators sought to evaluate the reliability of 90-day inpatient hospital costs, overall complications, and rates of serious complications for profiling hospital performance in lumbar fusion surgery for spondylolisthesis. Using HCUP data, they found that 90-day inpatient costs were highly reliable for assessing variation across hospitals, whereas overall and serious complications were only moderately reliable for profiling performance. They concluded that their results support the viability of emerging bundled payment programs that assume true differences in costs of care exist across hospitals.
AHRQ-funded; HS027075; HS019455.
Citation: Greenberg JK, Olsen MA, Dibble CF . Comparison of cost and complication rates for profiling hospital performance in lumbar fusion for spondylolisthesis. Spine J 2021 Dec;21(12):2026-34. doi: 10.1016/j.spinee.2021.06.014..
Keywords: Healthcare Costs, Hospitals, Provider Performance, Surgery, Quality Measures, Quality of Care
Kittelson AJ, Loyd BJ, Graber J
Examination of exclusion criteria in total knee arthroplasty rehabilitation trials: influence on the application of evidence in day-to-day practice.
This study investigated whether total knee arthroplasty (TKA) patients seen in routine practice who meet common exclusion criteria in clinical trials recover differently compared to research-eligible patients. Postoperative functional outcomes were compared using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Timed Up and Go (TUG). A total of 2,528 participants from 27 trials were compared to 474 patients from the clinical dataset. Research participants were older, with lower BMI than patients in the clinical dataset. There were no differences observed in functional recovery rate between groups, except for patients with diabetes whose TUG recovered more slowly than “eligible” patients.
Citation: Kittelson AJ, Loyd BJ, Graber J . Examination of exclusion criteria in total knee arthroplasty rehabilitation trials: influence on the application of evidence in day-to-day practice. J Eval Clin Pract 2021 Dec;27(6):1335-42. doi: 10.1111/jep.13564..
Keywords: Orthopedics, Surgery, Rehabilitation, Patient-Centered Outcomes Research, Evidence-Based Practice, Outcomes
Abraham J, Meng A, Holzer KJ
Exploring patient perspectives on telemedicine monitoring within the operating room.
The authors sought to identify participant-rated items contributing to patient attitudes, beliefs, and level of comfort with electronic OR (eOR) monitoring and to highlight barriers and facilitators to eOR use. They found that participants expressed significant support for intraoperative telemedicine use and greater comfort with local telemedicine systems instead of long-distance telemedicine systems. They further found that reservations centered on organizational policies, procedures, environment, culture; people; workflow and communication; and hardware and software.
Citation: Abraham J, Meng A, Holzer KJ . Exploring patient perspectives on telemedicine monitoring within the operating room. Int J Med Inform 2021 Dec;156:104595. doi: 10.1016/j.ijmedinf.2021.104595..
Keywords: Telehealth, Health Information Technology (HIT), Surgery, Patient Experience
Zachrison KS, Schwamm LH, Xu H
Frequency, characteristics, and outcomes of endovascular thrombectomy in patients with stroke beyond 6 hours of onset in US clinical practice.
In 2018, 2 randomized controlled trials showed the benefit of endovascular thrombectomy (EVT) in acute ischemic stroke patients treated 6 to 24 hours from last known well using imaging-guided selection. However, little is known about outcomes in contemporary nontrial settings. In this study, the investigators assessed the frequency of EVT and outcomes beyond 6 hours in the US Get With The Guidelines-Stroke clinical registry.
Citation: Zachrison KS, Schwamm LH, Xu H . Frequency, characteristics, and outcomes of endovascular thrombectomy in patients with stroke beyond 6 hours of onset in US clinical practice. Stroke 2021 Dec;52(12):3805-14. doi: 10.1161/strokeaha.121.034069..
Keywords: Stroke, Cardiovascular Conditions, Surgery, Outcomes
Gupta AR, Brajcich BC, Yang AD
Necessity of posttreatment surveillance for low-grade appendiceal mucinous neoplasms.
This study’s objectives were to characterize posttreatment surveillance and determine the risk of recurrence following surgical resection of low-grade appendiceal mucinous neoplasms (LAMNs). Patients who underwent surgical rection of localized LAMNs in an 11-hospital regional healthcare system from 2000 to 2019 were included. A total of 114 patients with LAMNs were identified with various tumor grades, most of them pTis (80.7%). Patients were followed up with posttreatment surveillance (n = 39). No patients experienced tumor recurrence after a mean follow-up duration of 4.7 years, suggesting that routine surveillance may be unnecessary.
Citation: Gupta AR, Brajcich BC, Yang AD . Necessity of posttreatment surveillance for low-grade appendiceal mucinous neoplasms. J Surg Oncol 2021 Dec;124(7):1115-20. doi: 10.1002/jso.26621..
Keywords: Cancer, Surgery, Care Management
Thelen AE, Kendrick DE, Chen X
Novel method to link surgical trainee performance data to patient outcomes.
A significant roadblock in surgical education research has been the inability to compare trainee performance to the outcomes of those surgeons after they enter independent practice. In this study, the investigators described the feasibility of an innovative method to link trainee performance data with patient outcomes. They indicated that this innovation could enable future research investigating the relationship between surgical trainee performance and patient outcomes in independent practice.
Citation: Thelen AE, Kendrick DE, Chen X . Novel method to link surgical trainee performance data to patient outcomes. Am J Surg 2021 Dec;222(6):1072-78. doi: 10.1016/j.amjsurg.2021.10.018..
Keywords: Surgery, Education: Continuing Medical Education, Provider Performance, Provider: Physician, Outcomes
Ernest EC, Hellar A, Varallo J
Reducing surgical site infections and mortality among obstetric surgical patients in Tanzania: a pre-evaluation and postevaluation of a multicomponent safe surgery intervention.
This study evaluated the impact of a multicomponent safe surgery intervention in Tanzania to reduce surgical site infection (SSI) rates and mortality after caesarean sections (CS). The authors used the WHO Surgical Safety Checklist (SSC) to measure WHO SSC utilization, SSI rates, and CS-related perioperative mortality rates (POMRs) before and 18 months after implementation. The SSC utilization rate for CS increased from 3.7% to 95.1%, which decreased the proportion of women with SSI after CS from 14% during baseline to 1%. CS-related POMR decreased by 38.5% after implementation of safe surgery interventions as well.
Citation: Ernest EC, Hellar A, Varallo J . Reducing surgical site infections and mortality among obstetric surgical patients in Tanzania: a pre-evaluation and postevaluation of a multicomponent safe surgery intervention. BMJ Glob Health 2021 Dec;6(12). doi: 10.1136/bmjgh-2021-006788..
Keywords: Maternal Care, Pregnancy, Healthcare-Associated Infections (HAIs), Surgery, Injuries and Wounds, Adverse Events, Patient Safety
Chhabra KR, Sheetz KH, Regenbogen SE
Wide variation in surgical spending within hospital systems: a missed opportunity for bundled payment success.
Researchers sought to measure the extent of variation in episode spending around total hip replacement for fee-for-service Medicare patients within and across hospital systems identified in the American Hospital Association Annual Survey. They found that average episode payments varied nearly as much within hospital systems as they did between the lowest- and highest-cost quintiles of systems, with variation driven by post-acute care utilization.
Citation: Chhabra KR, Sheetz KH, Regenbogen SE . Wide variation in surgical spending within hospital systems: a missed opportunity for bundled payment success. Ann Surg 2021 Dec 1;274(6):e1078-e84. doi: 10.1097/sla.0000000000003741..
Keywords: Surgery, Healthcare Systems, Medicare, Healthcare Costs, Hospitals
Whitebird RR, Solberg LI, Ziegenfuss JY
Personalized outcomes for hip and knee replacement: the patients point of view.
Patient reported outcome measures (PROMs) are increasingly being incorporated into clinical and surgical care for assessing outcomes. This study examined outcomes important to patients in their decision to have hip or knee replacement surgery, their perspectives on PROMs and shared decision-making, and factors they considered important for postoperative care.
Citation: Whitebird RR, Solberg LI, Ziegenfuss JY . Personalized outcomes for hip and knee replacement: the patients point of view. J Patient Rep Outcomes 2021 Nov 4;5(1):116. doi: 10.1186/s41687-021-00393-z..
Keywords: Orthopedics, Surgery, Patient-Centered Outcomes Research, Patient Experience, Decision Making
Shipe ME, Baechle JJ, Deppen SA
Modeling the impact of delaying surgery for early esophageal cancer in the era of COVID-19.
Surgical society guidelines have recommended changing the treatment strategy for early esophageal cancer during the novel coronavirus (COVID-19) pandemic. Delaying resection can allow for interim disease progression, but the impact of this delay on mortality is unknown. The COVID-19 infection rate at which immediate operative risk exceeds benefit is unknown. In this study, the investigators sought to model immediate versus delayed surgical resection in a T1b esophageal adenocarcinoma.
Citation: Shipe ME, Baechle JJ, Deppen SA . Modeling the impact of delaying surgery for early esophageal cancer in the era of COVID-19. Surg Endosc 2021 Nov;35(11):6081-88. doi: 10.1007/s00464-020-08101-6..
Keywords: COVID-19, Cancer, Surgery, Decision Making, Risk
Delaney LD, Howard R, Palazzolo K
Outcomes of a presurgical optimization program for elective hernia repairs among high-risk patients.
The authors evaluated the feasibility of evidence-based patient optimization before surgery by implementing a low-cost preoperative optimization clinic. They found that a hernia optimization clinic safely improved management of high-risk patients and increased operative yield for the institution. They concluded that their results represented an opportunity to create sustainable and scalable models that provide longitudinal care and optimize patients to improve outcomes of hernia repair.
Citation: Delaney LD, Howard R, Palazzolo K . Outcomes of a presurgical optimization program for elective hernia repairs among high-risk patients. JAMA Netw Open 2021 Nov;4(11):e2130016. doi: 10.1001/jamanetworkopen.2021.30016..
Keywords: Surgery, Risk, Evidence-Based Practice, Quality Improvement, Quality of Care, Outcomes
Czosek RJ, Anderson JB, Baskar S
Predictors and outcomes of heart block during surgical stage I palliation of patients with a single ventricle: a report from the NPC-QIC.
This study investigated patient and surgical risks of heart block and its effect on 12-month transplant-free survival in children with a single ventricle. In total, 1423 patients were identified from the National Pediatric Cardiology Improvement Collaborative with and without heart block. One-year outcomes were analyzed. A very small percentage (2%) developed heart block during their surgical admission. Associated risk factors for block included heterotaxy syndrome and atrial flutter/fibrillation. Patients with complete heart block had lower 12-month survival, which wasn’t true for patients with second degree block. At 12 months of age, 43% of patients with heart block died and were more likely to experience mortality than patients without heart block.
Citation: Czosek RJ, Anderson JB, Baskar S . Predictors and outcomes of heart block during surgical stage I palliation of patients with a single ventricle: a report from the NPC-QIC. Heart Rhythm 2021 Nov;18(11):1876-83. doi: 10.1016/j.hrthm.2021.05.019..
Keywords: Children/Adolescents, Heart Disease and Health, Cardiovascular Conditions, Surgery, Palliative Care, Risk, Outcomes
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.
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 / Ethnic Minorities
Kuijer A, Dominici LS, Rosenberg SM
Arm morbidity after local therapy for young breast cancer patients.
This study assessed patient-reported arm morbidity in the Young Women's Breast Cancer Study (YWS). Participants were over 1300 women with breast cancer diagnosed at age 40 or younger and who were enrolled in the YWS. Findings showed that high rates of self-reported arm morbidity in young breast cancer survivors were reported, particularly in patients receiving axillary lymph node dissection and post-mastectomy radiation therapy. Recommendations included attention to the risks and benefits of differing local therapy strategies for axillary lymph node dissection and post-mastectomy radiation therapy patients.
Citation: Kuijer A, Dominici LS, Rosenberg SM . Arm morbidity after local therapy for young breast cancer patients. Ann Surg Oncol 2021 Oct;28(11):6071-82. doi: 10.1245/s10434-021-09947-3..
Keywords: Cancer: Breast Cancer, Cancer, Women, Surgery
Dominici L, Hu J, Zheng Y
Association of local therapy with quality-of-life outcomes in young women with breast cancer.
Researchers examined the association of surgery with longer-term satisfaction and quality of life (QOL) in young breast cancer survivors. Participants were women 40 years or older who enrolled in the Young Women's Breast Cancer Study. The results suggested that local therapy in young breast cancer survivors is persistently associated with poorer scores in multiple QOL domains, particularly among those treated with mastectomy and radiotherapy, irrespective of breast reconstruction. Socioeconomic stressors also appear to play a role.
Citation: Dominici L, Hu J, Zheng Y . Association of local therapy with quality-of-life outcomes in young women with breast cancer. JAMA Surg 2021 Oct;156(10):e213758. 2021. doi: 10.1001/jamasurg.2021.3758..
Keywords: Cancer: Breast Cancer, Cancer, Quality of Life, Women, Surgery
Tignanelli CJ, Bramante CT, Dutta NT
Metabolic surgery may protect against admission for COVID-19 in persons with nonalcoholic fatty liver disease.
SARS-CoV-2 (COVID-19) disease causes significant morbidity and mortality through increased inflammation and thrombosis. Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are states of chronic inflammation and indicate advanced metabolic disease. The purpose of this observational study was to characterize the risk of hospitalization for COVID-19 in patients with NAFLD/NASH and evaluate the mitigating effect of various metabolic treatments.
Citation: Tignanelli CJ, Bramante CT, Dutta NT . Metabolic surgery may protect against admission for COVID-19 in persons with nonalcoholic fatty liver disease. Surg Obes Relat Dis 2021 Oct;17(10):1780-86. doi: 10.1016/j.soard.2021.05.029..
Keywords: COVID-19, Surgery, Obesity: Weight Management, Obesity
Shi J, Hurdle JF, Johnson SA
Natural language processing for the surveillance of postoperative venous thromboembolism.
The objective of the study was to develop a portal natural language processing approach to aid in the identification of postoperative venous thromboembolism events from free-text clinical notes. The investigators concluded that accurate surveillance of postoperative venous thromboembolism may be achieved using natural language processing on clinical notes in 2 independent health care systems. They indicated that these findings suggest natural language processing may augment manual chart abstraction for large registries such as National Surgical Quality Improvement Program.
Citation: Shi J, Hurdle JF, Johnson SA . Natural language processing for the surveillance of postoperative venous thromboembolism. Surgery 2021 Oct;170(4):1175-82. doi: 10.1016/j.surg.2021.04.027..
Keywords: Blood Clots, Health Information Technology (HIT), Quality Improvement, Quality of Care, Surgery, Adverse Events
Montgomery JR, Waits SA, Dimick JB
Perioperative risks of sleeve gastrectomy versus roux-en-Y gastric bypass among patients with chronic kidney disease: a review of the MBSAQIP database.
The purpose of this study was to determine whether patients with chronic kidney disease experienced higher rates of perioperative complications after roux-en-Y gastric bypass (RYGB) compared to sleeve gastrectomy. The investigators concluded that among well-matched cohorts of RYGB and sleeve gastrectomy patients, incidence of primary outcomes were similar. Among secondary outcomes, only acute kidney injury was statistically-significantly higher among RYGB patients; however, the E-value for this difference was small and relatively weak confounder(s) could abrogate the statistical difference.
Citation: Montgomery JR, Waits SA, Dimick JB . Perioperative risks of sleeve gastrectomy versus roux-en-Y gastric bypass among patients with chronic kidney disease: a review of the MBSAQIP database. Ann Surg 2021 Oct 1;274(4):e328-e35. doi: 10.1097/sla.0000000000003627..
Keywords: Surgery, Obesity, Kidney Disease and Health, Risk, Chronic Conditions
Cardell CF, Knapp L, Cohen ME
Successful implementation of enhanced recovery in elective colorectal surgery is variable and dependent on the local environment.
This study looked at the results of a national colorectal enhanced recovery program (ERP) to improve patient outcomes. A total of 207 hospitals participated between 2017 and 2020. Quantitative (patient-level process and outcome) and qualitative (survey and structured interviews with hospital teams) data were collected and analyzed. Results shows that 62 hospitals were characterized as High Performance, and 52 as High Improvement. High Performance hospitals were larger with more annual colorectal surgeries. Fewer barriers to staff-buy-in and competing priorities, and more experience with standardized perioperative care were also characteristics of High Performance hospitals. High Improvement hospitals had lower baseline process measure (PM) adherence and less experience with perioperative care but had positive trends in annual patient outcomes such as annual morbidity, readmission, and prolonged length of stay compared to Low Improvement Hospitals.
Citation: Cardell CF, Knapp L, Cohen ME . Successful implementation of enhanced recovery in elective colorectal surgery is variable and dependent on the local environment. Ann Surg 2021 Oct 1;274(4):605-12. doi: 10.1097/sla.0000000000005069..
Keywords: Surgery, Quality Improvement, Quality of Care, Outcomes, Patient-Centered Outcomes Research, Provider Performance
Mathis MR, Yule S, Wu X
The impact of team familiarity on intra and postoperative cardiac surgical outcomes.
The authors hypothesized that familiarity among cardiac surgery team members may be an important contributor to better outcomes and thus serve as a target for enhancing outcomes. They found that high team familiarity was associated with reduced cardiopulmonary bypass duration for medium-risk and high-risk patients. Increasing team familiarity was not significantly associated with the odds of major morbidity and mortality. They concluded that team familiarity, which was predictive of improved intraoperative efficiency without compromising major postoperative outcomes, may serve as a novel quality improvement target in the setting of cardiac surgery.
Citation: Mathis MR, Yule S, Wu X . The impact of team familiarity on intra and postoperative cardiac surgical outcomes. Surgery 2021 Oct;170(4):1031-38. doi: 10.1016/j.surg.2021.05.020..
Keywords: Teams, Surgery, Heart Disease and Health, Cardiovascular Conditions, Outcomes
Halawi MJ, Gronbeck C, Metersky ML
AHRQ Author: Eldridge N
Time trends in patient characteristics and in-hospital adverse events for primary total knee arthroplasty in the United States: 2010-2017.
This study looked at trends in patient characteristics and in-hospital adverse events (AEs) for primary total knee arthroplasty (TKA) from 2010 to 2017. A total of 14,057 primary TKAs captured by the Medicare Patient Safety Monitoring System was retrospectively reviewed. Risk factors that increased included obesity prevalence, tobacco smoking, and renal disease. There were reductions in coronary artery disease and chronic warfarin use. Inpatient AEs decreased from 4.9% to 2.5%, primarily driven by reductions in anticoagulant-associated AEs, including major bleeding and hematomas, catheter-associated urinary tract infections, pressure ulcers, and venous thromboembolism.
AHRQ-authored; AHRQ-funded; 290201800005C.
Citation: Halawi MJ, Gronbeck C, Metersky ML . Time trends in patient characteristics and in-hospital adverse events for primary total knee arthroplasty in the United States: 2010-2017. Arthroplast Today 2021 Oct;11:157-62. doi: 10.1016/j.artd.2021.08.010..
Keywords: Surgery, Orthopedics, Adverse Events, Risk
Greenberg JK, Olsen MA, Poe J
Administrative data are unreliable for ranking hospital performance based on serious complications after spine fusion.
The authors evaluated the extent to which a metric of serious complications determined from administrative data can reliably profile hospital performance in spine fusion surgery. They found that a metric of serious complications was unreliable for benchmarking cervical fusion outcomes and only modestly reliable for thoracolumbar fusion. They concluded that, when assessed using administrative datasets, these measures appeared to be inappropriate for high-stakes applications, such as public reporting or pay-for-performance.
AHRQ-funded; HS027075; HS019455.
Citation: Greenberg JK, Olsen MA, Poe J . Administrative data are unreliable for ranking hospital performance based on serious complications after spine fusion. Spine 2021 Sep 1;46(17):1181-90. doi: 10.1097/brs.0000000000004017..
Keywords: Surgery, Provider Performance, Hospitals, Adverse Events, Back Health and Pain
Bucher BT, Yang M, Arndorfer J
Changes in the accuracy of administrative data for the detection of surgical site infections.
The authors performed a retrospective analysis of the changes in accuracy of International Classification of Diseases, Clinical Modification (ICD-CM) diagnosis codes for colectomy and hysterectomy surgical site infection surveillance. They found no significant change in the accuracy of these codes following the transition from ICD-CM ninth edition to tenth edition codes.
Citation: Bucher BT, Yang M, Arndorfer J . Changes in the accuracy of administrative data for the detection of surgical site infections. Infect Control Hosp Epidemiol 2021 Sep;42(9):1128-30. doi: 10.1017/ice.2020.1346..
Keywords: Surgery, Healthcare-Associated Infections (HAIs), Diagnostic Safety and Quality
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, Decision Making, Patient and Family Engagement
Hewitt DB, Chung JW, Ellis RJ
National evaluation of surgical resident grit and the association with wellness outcomes.
Investigators sought to characterize grit among US general surgery residents and to examine the association between resident grit and wellness outcomes. Grit was measured using the 8-item Short Grit Scale. They found that, in this national survey evaluation, higher grit scores were associated with a lower likelihood of burnout, thoughts of attrition, and suicidal thoughts among general surgery residents. They concluded that grit is likely not an effective screening instrument to select residents; instead, they recommended that institutions ensure an organizational culture that promotes and supports trainees across this elevated range of grit scores.
Citation: Hewitt DB, Chung JW, Ellis RJ . National evaluation of surgical resident grit and the association with wellness outcomes. JAMA Surg 2021 Sep;156(9):856-63. doi: 10.1001/jamasurg.2021.2378.
Keywords: Provider: Physician, Surgery, Burnout