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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.
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1 to 25 of 995 Research Studies Displayed
Bucher BT, Yang M, Richards Steed R, BT, Yang M, Richards Steed R
Geographic proximity of family members and healthcare utilization after complex surgical procedures.
This retrospective cohort study sought to determine the relationship between a patient's proximal familial social support, defined as the geographic proximity of family members, and healthcare utilization after complex cardiovascular and oncologic procedures. The authors defined healthcare utilization outcomes as 30-day all-cause readmission unplanned readmission, nonindex hospital readmission, index hospital length of stay, and home discharge disposition. The number of first-degree relatives (FDRs) living within 30 miles of the patient was measured using 60,895 patients undergoing complex cardiovascular procedures or oncologic procedures. Compared with patients with 0 to 1 FDRs, patients with 6+ FDRs living in close proximity had significantly lower rates of all-cause readmission (12.1% vs 13.5%), unplanned readmission, nonindex readmission; higher rates of home discharge. A larger number of FDRs living within 30 miles of the patient was significantly associated with a lower likelihood of all-cause readmission, 30-day unplanned readmission, nonindex readmission; higher likelihood of home discharge; and shorter index length of stay.
AHRQ-funded; HS025776.
Citation:
Bucher BT, Yang M, Richards Steed R, BT, Yang M, Richards Steed R .
Geographic proximity of family members and healthcare utilization after complex surgical procedures.
Ann Surg 2022 Oct 1;276(4):720-31. doi: 10.1097/sla.0000000000005584..
Keywords:
Surgery, Hospital Discharge, Hospital Readmissions, Healthcare Utilization
Cohen TN, Anger JT, Kanji FF
A novel approach for engagement in team training in high-technology surgery: the Robotic-Assisted Surgery Olympics.
The purpose of this study was to develop the “Robotic-Assisted Surgery (RAS) Olympics,” a “serious game”-based educational competition to improve the skills required to successfully perform RAS. The pilot study was conducted at an academic medical center in Southern California. Sixteen operating room members participated in the event, reporting that they preferred the RAS Olympics to traditional training, enjoyed the activity, would recommend all staff participate, felt that it was relevant to their work, and believed that they practiced and learned new techniques that would improve their practice. The participants’ confidence in their skills did not change. The researchers concluded that new information was gained about new possibilities for simultaneously engaging and training surgical staff while emphasizing RAS safety and efficiency.
AHRQ-funded; HS026491.
Citation:
Cohen TN, Anger JT, Kanji FF .
A novel approach for engagement in team training in high-technology surgery: the Robotic-Assisted Surgery Olympics.
J Patient Saf 2022 Sep 1;18(6):570-77. doi: 10.1097/pts.0000000000001056..
Keywords:
Surgery, Training, Education: Continuing Medical Education, Simulation, Teams
Oke I, Hall N, Elze T
Adjustable suture technique is associated with fewer strabismus reoperations in the Intelligent Research in Sight Registry.
This study compared the reoperation rates of patients who underwent strabismus surgery during the first year with or without the adjustable suture technique. This retrospective cohort study looked at a total of 34,872 patients who underwent strabismus surgery with 72% undergoing horizontal muscle surgery, 17% vertical muscle surgery, and 11% combined horizonal and vertical muscle surgery. Adjustable suture surgery rates were 18% of surgeries. The overall 1-year reoperation rate was 7.7%, with 6.0% for patients treated with adjustable sutures and 8.1% for patients treated without adjustable sutures. There was a statistically significant 30% decrease in the odds of 1-year reoperation when adjustable sutures were used, a 40% increase in those with a history of prior strabismus surgery, and a 9% increase per decade of age at surgery.
AHRQ-funded; HS000063.
Citation:
Oke I, Hall N, Elze T .
Adjustable suture technique is associated with fewer strabismus reoperations in the Intelligent Research in Sight Registry.
Ophthalmology 2022 Sep;129(9):1028-33. doi: 10.1016/j.ophtha.2022.04.021..
Keywords:
Surgery, Registries
Blakeslee-Carter J, Potter HA, Banks CA
Aortic visceral segment instability is evident following thoracic endovascular aortic repair for acute and subacute type B aortic dissection.
The purpose of this multicenter retrospective study was to investigate the visceral aortic behavior after thoracic endovascular aortic repair (TEVAR) for acute or subacute type B aortic dissection (TBAD) to identify any correlations with the clinical outcomes. The researchers reviewed all imaging studies for all patients from 2006 to 2020 who had undergone TEVAR for acute (0-14 days) and subacute (14-90 days) nontraumatic TBAD, identifying a total of 82 patients. The study found that VSI was present in 55% of the cohort, with an average maximal increase in the TAD of 10.4 ± 6.3 mm during a median follow-up of 2.1 years. Approximately one third of the cohort had experienced rapid VSI (growth ≥5 mm in the first year), and 4.8% of the cohort had developed a large paravisceral aortic aneurysm (TAD ≥5 cm) secondary to VSI. The preoperative factor most strongly associated with VSI was a cumulative number of zones dissected of six or more. The odds for aortic reintervention were significantly increased for cases in which VSI led to the development of a paravisceral aortic aneurysm of greater than or equal to 5 cm. The researchers concluded that VSI was identified in most patients who had undergone TEVAR for management of acute and subacute TBAD, and also identified a subset of patients who might have an increased risk of reintervention. The study results emphasize the importance of ongoing and lifelong monitoring after TEVAR.
AHRQ-funded; HS013852.
Citation:
Blakeslee-Carter J, Potter HA, Banks CA .
Aortic visceral segment instability is evident following thoracic endovascular aortic repair for acute and subacute type B aortic dissection.
J Vasc Surg 2022 Aug;76(2):389-99.e1. doi: 10.1016/j.jvs.2022.02.046..
Keywords:
Heart Disease and Health, Cardiovascular Conditions, Surgery
Schlick CJR, Huang R, Brajcich BC
Unbundling bundles: evaluating the association of individual colorectal surgical site infection reduction bundle elements on infection rates in a statewide collaborative.
The purpose of this study was to evaluate the association of individual surgical site infection reduction bundle elements with infection rates. Focusing on patients who had elective colorectal resections at participating hospitals from 2016 to 2017, findings showed that bundle elements had varying association with infection reduction. Recommendations included implementation of colorectal surgical site infection reduction bundles in order to focus on the specific elements associated with low surgical site infections.
AHRQ-funded; HS024516.
Citation:
Schlick CJR, Huang R, Brajcich BC .
Unbundling bundles: evaluating the association of individual colorectal surgical site infection reduction bundle elements on infection rates in a statewide collaborative.
Dis Colon Rectum 2022 Aug;65(8):1052-61. doi: 10.1097/dcr.0000000000002223..
Keywords:
Surgery, Healthcare-Associated Infections (HAIs), Quality Improvement, Quality of Care
Nanji KC, Garabedian PM, Langlieb ME
Usability of a perioperative medication-related clinical decision support software application: a randomized controlled trial.
The purpose of this study was assess the usability of a newly developed, comprehensive, medication-related operating room clinical decision support (CDS) software and compare it with the standard electronic health record (EHR) medication workflow. Forty participants were randomized to a CDS group (n=20) or a control group (n=20) and asked to complete 7 simulation tasks. The study found that in a simulation setting the new CDS software improved efficiency and quality of care and reduced task time, excelling over the current EHR workflow.
AHRQ-funded; HS024764.
Citation:
Nanji KC, Garabedian PM, Langlieb ME .
Usability of a perioperative medication-related clinical decision support software application: a randomized controlled trial.
J Am Med Inform Assoc 2022 Jul 12;29(8):1416-24. doi: 10.1093/jamia/ocac035..
Keywords:
Medication, Clinical Decision Support (CDS), Health Information Technology (HIT), Surgery, Decision Making
Skube SJ, Hu Z, Simon GJ
Accelerating surgical site infection abstraction with a semi-automated machine-learning approach.
The purpose of this study was to test a supervised machine learning algorithm developed for testing surgical site infection (SSI) on performing semi-automated SSI abstraction, and to demonstrate that a semi-automated approach to health data abstraction provides a high level of accuracy and significant efficiencies. The researchers evaluated data from 6,188 patients in a 2011-2013 dataset and 5,132 patients in a 2015-2015 dataset. The study concluded that very good performance is achieved using the semi-automated machine learning-aided SSI abstraction, which also accelerates the abstraction process.
AHRQ-funded; HS024532.
Citation:
Skube SJ, Hu Z, Simon GJ .
Accelerating surgical site infection abstraction with a semi-automated machine-learning approach.
Ann Surg 2022 Jul 1;276(1):180-85. doi: 10.1097/sla.0000000000004354..
Keywords:
Healthcare-Associated Infections (HAIs), Surgery, Health Information Technology (HIT)
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
VanderVeen DK, Oke I, Nihalani BR
Deviations from age-adjusted normative biometry measures in children undergoing cataract surgery: implications for postoperative target refraction and IOL power selection.
The purpose of this longitudinal cohort study was to assess whether children’s eyes that deviate from age-adjusted normative biometry measures are predictive of variations in target refraction and IOL power selection after cataract surgery. The researchers prospectively collected biometry data from the normal eyes of children under 10 years of age (100 eyes) with biometry data from eyes undergoing cataract surgery (162 eyes). The study analysis found greater myopic shift associated with younger age and male gender and concluded that adjustments can be made for cataract surgery for children’s eyes whose measures deviate from the norm for their age.
AHRQ-funded; HS000063.
Citation:
VanderVeen DK, Oke I, Nihalani BR .
Deviations from age-adjusted normative biometry measures in children undergoing cataract surgery: implications for postoperative target refraction and IOL power selection.
Am J Ophthalmol 2022 Jul;239:190-201. doi: 10.1016/j.ajo.2022.02.022..
Keywords:
Children/Adolescents, Eye Disease and Health, Surgery
Rastogi V, Kim NH, Marcaccio CL
Retroperitoneal versus transperitoneal approach for open repair of complex abdominal aortic aneurysms.
This retrospective analysis compared the outcomes of a transperitoneal approach (TP) versus the retroperitoneal approach (RP) for infrarenal abdominal aortic aneurysm (AAA) repair. Several studies have found an advantage for the RP approach. Among a cohort of 1,195 patients identified 729 (61%) underwent cAAA repair via a TP approach and 39% via an RP approach. After adjustment, the RP approach was associated with lower odds of peri-operative death (4.0% versus 7.2%) and lower odds of any major, cardiac, or wound complications and post-operative sepsis. Despite this, the proportion of repairs using an RP approach decreased between 2011 to 2015 and 2016 to 2019.
AHRQ-funded; HS027285.
Citation:
Rastogi V, Kim NH, Marcaccio CL .
Retroperitoneal versus transperitoneal approach for open repair of complex abdominal aortic aneurysms.
Eur J Vasc Endovasc Surg 2022 Jul;64(1):23-31. doi: 10.1016/j.ejvs.2022.05.030..
Keywords:
Cardiovascular Conditions, Surgery, Comparative Effectiveness, Evidence-Based Practice
Theiss LM, Wood T, McLeod MC
The association of health literacy and postoperative complications after colorectal surgery: a cohort study.
The purpose of this retrospective cohort study of patients undergoing elective colorectal surgery between 2015 and 2020 was to describe the association between health literacy, a determinant of health, and surgical outcomes. The outcomes of the study included: postoperative complications, length of stay (LOS), readmissions, and mortality. The study found that of 552 patients, 8.3% (46) had limited health literacy. Patients with limited health literacy had higher rates of overall complications, especially surgical site infections, and longer LOS. Readmission and mortality rates did not differ between limited and non-limited patients. The researchers concluded that limited health literacy is related to an increased likelihood of post-surgical complications in elective colorectal surgery patients.
Citation:
Theiss LM, Wood T, McLeod MC .
The association of health literacy and postoperative complications after colorectal surgery: a cohort study.
Am J Surg 2022 Jun;223(6):1047-52. doi: 10.1016/j.amjsurg.2021.10.024..
Keywords:
Health Literacy, Surgery, Adverse Events
Ayers DC, Yousef M, Zheng H
The prevalence and predictors of patient dissatisfaction 5-years following primary total knee arthroplasty.
This retrospective cohort study’s purpose was to determine dissatisfaction among total knee arthroplasty (TKA) patients 5 years after the procedure and to determine patient factors predictive of dissatisfaction. Demographic and clinical data on 4402 patients who underwent primary unilateral TKA between 2012 and 2015 were collected prospectively through the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE-TJR) comparative effectiveness consortium including diverse community and academic practices distributed across 23 states in the United States. Several different satisfaction scales were used to collect data at 1 year preoperatively and 5 years postoperatively including patient satisfaction (using a 5-point Likert satisfaction scale) and patient-reported outcome measures (PROMs) including the Knee injury and Osteoarthritis Outcome Score (KOOS) and Short-Form health survey (36-item). A total of 12.7% (5549) patients expressed dissatisfaction 5 years postoperatively. Higher dissatisfaction rates were present in young patients, patients with less education, and non-White patients. It was also significantly associated with poor preoperative and 5-year postoperative PROMs scores and less score improvement from baseline to 5 years.
AHRQ-funded; HS018910.
Citation:
Ayers DC, Yousef M, Zheng H .
The prevalence and predictors of patient dissatisfaction 5-years following primary total knee arthroplasty.
J Arthroplasty 2022 Jun;37(6s):S121-s28. doi: 10.1016/j.arth.2022.02.077..
Keywords:
Orthopedics, Surgery, Patient Experience
Roberson ML, Nichols HB, Olshan AF
Trends in surgical treatment of early-stage breast cancer reveal decreasing mastectomy use between 2003 and 2016 by age, race, and rurality.
The authors sought to examine trends in the surgical treatment of breast cancer by age, rurality, and among Black women in a populous, racially diverse, state in the Southeastern United States of America. Using data from the North Carolina Central Cancer Registry, they found declining mastectomy rates in the early 2000s in a Southern US state with a racially and geographically diverse population. These decreasing trends were consistent among key subgroups affected by cancer inequities, including Black and White rural women.
AHRQ-funded; HS027299.
Citation:
Roberson ML, Nichols HB, Olshan AF .
Trends in surgical treatment of early-stage breast cancer reveal decreasing mastectomy use between 2003 and 2016 by age, race, and rurality.
Breast Cancer Res Treat 2022 Jun;193(2):445-54. doi: 10.1007/s10549-022-06564-w..
Keywords:
Cancer: Breast Cancer, Cancer, Women, Surgery, Racial / Ethnic Minorities, Rural Health
De Roo AC, Shubeck SP SP, Cain-Nielsen AH
Cost consequences of age and comorbidity in accelerated postoperative discharge after colectomy.
The initial cost benefits of reductions in post-surgery duration of stay could be weakened by an increase in post-acute care or readmissions for those patients, especially for older adults and/ or those with comorbidities. The study objective was to assess whether thea hospitals with faster post-surgery discharge accumulate larger total episode savings and/or experience larger payments post-discharge. The researchers conducted a retrospective cross-sectional study utilizing national data from the July 2012 to June 2015 Medicare Provider Analysis and Review files focused on 88,860 Medicare beneficiaries undergoing elective colectomy procedures. The primary outcome measure was the average total episode payment among the different age and comorbidity categories, further stratified by duration of hospital stay. The study found that average total episode payments were lower in the shortest versus longest duration-of-stay hospitals across all age and comorbidity strata. Post-discharge payments were similar among duration-of-stay hospitals by age but greater among high comorbidity. The researchers note a study limitation that the post-acute care use data may be influenced by factors at the patient level, such as patient preference and the availability of caregivers, and concluded that the hospitals with the shortest duration of post-surgical stays had lower total episode payments and no related increase in post-acute care payments even in older adults and/ or those with comorbidities.
AHRQ-funded; HS000053.
Citation:
De Roo AC, Shubeck SP SP, Cain-Nielsen AH .
Cost consequences of age and comorbidity in accelerated postoperative discharge after colectomy.
Dis Colon Rectum 2022 May;65(5):758-66. doi: 10.1097/dcr.0000000000002020..
Keywords:
Healthcare Costs, Surgery
Mao J, Sedrakyan A, Sun T
Assessing adverse event reports of hysteroscopic sterilization device removal using natural language processing.
This study’s objective was to develop an annotation model to develop natural language processing (NLP) to device adverse event reports and to implement the model to evaluate the most frequently experienced events among women reporting a sterilization device removal. Adverse event reports from the Manufacturer and User Facility Device Experience database from January 2005 to June 2018 were included. The authors used an iterative process to develop an annotation model that extracts six categories of desired information and applied the annotation model to train an NLP algorithm. A total of 16,535 reports of device removal were analyzed with the most frequently reported patient and device events being abdominal/pelvic/genital pain (79.6%) and device dislocation/migration (19.2%), respectively. A total of 7,932 patients reported an additional sterilization procedure of a hysterectomy or salpingectomy. One-fifth of the cases that had device removal timing specified reported a removal 7 years after original insertion.
AHRQ-funded; HS026291.
Citation:
Mao J, Sedrakyan A, Sun T .
Assessing adverse event reports of hysteroscopic sterilization device removal using natural language processing.
Pharmacoepidemiol Drug Saf 2022 Apr;31(4):442-51. doi: 10.1002/pds.5402..
Keywords:
Adverse Events, Surgery, Medical Devices, Patient Safety
Taylor K, Diaz A, Nuliyalu U
Association of dual Medicare and Medicaid eligibility with outcomes and spending for cancer surgery in high-quality hospitals.
The purpose of this study was to assess whether treatment at high-quality hospitals mitigates dual-eligibility-associated disparities in outcomes and spending for cancer surgery. Medicare beneficiaries 65 years or older who underwent colectomy, rectal resection, lung resection, or pancreatectomy were evaluated. The findings indicate that, even among the highest-quality hospitals, dual-eligibility patients had poorer outcomes and higher spending. Dually eligible patients were more likely to be discharged to a facility and thus incurred higher post-acute care costs. Although treatment at high-quality hospitals is associated with reduced differences in outcomes, dual-eligibility patients remain at high risk for adverse post-operative outcomes as well as increased readmissions and post-acute care use.
AHRQ-funded; HS024763.
Citation:
Taylor K, Diaz A, Nuliyalu U .
Association of dual Medicare and Medicaid eligibility with outcomes and spending for cancer surgery in high-quality hospitals.
JAMA Surg 2022 Apr;157(4):e217586. doi: 10.1001/jamasurg.2021.7586..
Keywords:
Cancer, Surgery, Medicare, Medicaid, Outcomes, Hospitals
Murphy PB, Oslock WM, Ingraham AM
Quality of care for gallstone pancreatitis-the impact of the acute care surgery model and hospital-level operative resources.
This study aimed to determine the influence of structure and process related to operating room access on achieving index cholecystectomy for gallstone pancreatitis. In 2015, 2811 US hospitals on acute care surgery practices were surveyed, including infrastructure for operative access, with 1690 hospitals (60%) responding. The authors identified patients ≥ 18 years who were admitted with gallstone pancreatitis. Over the study period, 5656 patients were admitted with gallstone pancreatitis, and 70% had an index cholecystectomy. High-performing hospitals had an index cholecystectomy rate of 84.1%, compared to 58.5% at low-performing hospitals. High-performing hospitals were associated with teaching, and access to dedicated daytime operative resources.
AHRQ-funded; HS022694.
Citation:
Murphy PB, Oslock WM, Ingraham AM .
Quality of care for gallstone pancreatitis-the impact of the acute care surgery model and hospital-level operative resources.
J Gastrointest Surg 2022 Apr;26(4):849-60. doi: 10.1007/s11605-021-05145-4..
Keywords:
Healthcare Cost and Utilization Project (HCUP), Surgery, Quality of Care
Eisenberg MT, Block AM, Vopat ML
Rates of infection after ACL reconstruction in pediatric and adolescent patients: a MarketScan database study of 44,501 patients.
This study’s objective was to describe and analyze the rates of surgical site infections after anterior cruciate ligament (ACL) surgery in pediatric patients. The Truven Health Analytics MarketScan Commercial Claims and Encounters database was used to access data for privately insured individuals aged 5 to 30 years old. ACL reconstruction operation records were accessed for operations performed from 2006 to 2018. The database identified 44,501 individuals up to 18 years old, and 63,495 individuals aged 18 to 30 years old that underwent arthroscopic ACL reconstruction. No differences in infection rates were found between the two groups. However, among patients younger than 18 years, patients below 15 years old had a significantly lower infection rate at 0.37% compared with adolescents 15 to 17 years old at 0.55%. Among young adults, males had a higher infection rate than females, while no differences were observed in the pediatric and adolescent population.
AHRQ-funded; HS019455.
Citation:
Eisenberg MT, Block AM, Vopat ML .
Rates of infection after ACL reconstruction in pediatric and adolescent patients: a MarketScan database study of 44,501 patients.
J Pediatr Orthop 2022 Apr;42(4):e362-e66. doi: 10.1097/bpo.0000000000002080..
Keywords:
Children/Adolescents, Surgery, Orthopedics, Healthcare-Associated Infections (HAIs), Adverse Events, Injuries and Wounds
Yang P, Diaz A, Chhabra KR
Surgical quality assurance at expanding health networks: a qualitative study.
This study used qualitative methods to understand the nuances that affect the variation in network-level surgical quality assurance and provided strategies that surgical leaders can use to improve surgical quality at expanding health networks. Through semi-structured interviews, three themes emerged. Participants wanted standardized tools for quality measurement, an organizational structure that provides clear oversight over quality, and a culture shift toward quality improvement.
AHRQ-funded; HS024763.
Citation:
Yang P, Diaz A, Chhabra KR .
Surgical quality assurance at expanding health networks: a qualitative study.
Surgery 2022 Apr;171(4):966-72. doi: 10.1016/j.surg.2021.09.023..
Keywords:
Surgery, Quality Improvement, Quality of Care
Kanters AE, Evilsizer SK, Regenbogen SE
Correlation of colorectal surgical skill with patient outcomes: a cautionary tale.
Some have proposed that video-based skill assessments be used as a way to measure technical skills, quality improvement, and credentialing in colorectal surgeons and other practitioners. However, it must first be determined whether video-based assessments can accurately predict patient outcomes. The researchers assembled a panel of 10 peer surgeons to evaluate videos of minimally invasive colectomy procedures submitted by 21 surgeons. Each surgeon submitted one video, and the videos were edited to highlight key steps in the procedure. The panel and the surgeon participants were all associated with the Michigan Surgical Quality Collaborative. The panel used a validated American Society of Colon and Rectal Surgeons assessment instrument to rate the surgeon’s skills. The surgeon’s ratings were then linked to a validated registry of surgical outcomes, and the researchers assessed the relationship between skill level and risk-adjusted complication rates. The researchers found that after risk-adjustment there was no statistically significant difference in complication rates between the bottom (17.5%) and top (16.8%) quartile surgeons (p=0.41). The study concluded that there was no correlation between video-based peer rating of minimally invasive colectomy and postoperative complications among specialty surgeons, and that caution should be used when utilizing video review in credentialing.
AHRQ-funded; HS025365.
Citation:
Kanters AE, Evilsizer SK, Regenbogen SE .
Correlation of colorectal surgical skill with patient outcomes: a cautionary tale.
Dis Colon Rectum 2022 Mar;65(3):444-51. doi: 10.1097/dcr.0000000000002124..
Keywords:
Surgery, Provider: Physician, Provider Performance, Digestive Disease and Health, Outcomes
Fitzgerald DC, Simpson AN, Baker RA DC, Simpson AN, Baker RA
Determinants of hospital variability in perioperative red blood cell transfusions during coronary artery bypass graft surgery.
This observational cohort study’s objective was to identify to what extent distinguishing patient and procedural characteristics can explain center-level transfusion variation during coronary artery bypass grafting (CABG) surgery. The study used patients from the Perfusion Measures and Outcomes Registry from 43 adult cardiac surgical programs from July 2011 through June 2017. Of the 22,272 adult patients undergoing isolate CABG surgery using cardiopulmonary bypass, 7241 (32.5%) received at least 1 U allogeneic red blood cells. Patients who received transfusions were older (68 vs 64 years), were women (41.5% vs 15.9%), and had a lower body surface area, respectively. The majority of center-level transfusion variations could not be explained through models containing both patient and intraoperative factors.
AHRQ-funded; HS026003.
Citation:
Fitzgerald DC, Simpson AN, Baker RA DC, Simpson AN, Baker RA .
Determinants of hospital variability in perioperative red blood cell transfusions during coronary artery bypass graft surgery.
J Thorac Cardiovasc Surg 2022 Mar;163(3):1015-24.e1. doi: 10.1016/j.jtcvs.2020.04.141..
Keywords:
Surgery, Heart Disease and Health, Cardiovascular Conditions, Hospitals, Practice Patterns, Disparities
Shao CC, McLeod MC, Gleason L
Effect of COVID-19 pandemic restructuring on surgical volume and outcomes of non-COVID patients undergoing surgery.
The authors sought to assess changes in surgical case mix and outcomes due to restructuring during the pandemic. Institutional ACS-NSQIP data was used to identify patients undergoing surgery at a single tertiary care institution in the Deep South. They found that surgeries during the COVID-19 pandemic were more often outpatient without differences in post-operative outcomes. They recommended additional analysis to determine the impact of duration of operative delay on surgical outcomes with restructuring focusing more on outpatient surgeries.
AHRQ-funded; HS013852.
Citation:
Shao CC, McLeod MC, Gleason L .
Effect of COVID-19 pandemic restructuring on surgical volume and outcomes of non-COVID patients undergoing surgery.
Am Surg 2022 Mar;88(3):489-97. doi: 10.1177/00031348211054528..
Keywords:
COVID-19, Surgery, Public Health, Outcomes
Olsen MA, Greenberg JK, Peacock K
Lack of association of post-discharge prophylactic antibiotics with decreased risk of surgical site infection following spinal fusion.
This study’s objective was to determine the prevalence and factors associated with post-discharge prophylactic antibiotic use after spinal fusion and whether use was associated with decreased risk of surgical site infection (SSI). The study cohort included persons aged 10-64 years undergoing 156,446 spinal fusion procedures between January 2010 and July 2015. Excluded patients included complicated cases and those coded for infection from 30 days before to 2 days after surgical admission. Outpatient oral antibiotic prescriptions were identified within 2 days of surgical discharge. ICD-9-CM diagnosis codes were used to identify SSI within 90 days of surgery. Post-discharge prophylactic antibiotics were used in 9223 surgeries. SSIs occurred after 2557 procedures (1.6%). Factors significantly associated with post-discharge antibiotic use included history of lymphoma, diabetes, 3-7 versus 1-2 vertebral levels fused, and non-infectious postoperative complications. Analysis showed antibiotic use was not associated with decreased SSI risk after spinal fusion.
AHRQ-funded; HS019455; HS027075.
Citation:
Olsen MA, Greenberg JK, Peacock K .
Lack of association of post-discharge prophylactic antibiotics with decreased risk of surgical site infection following spinal fusion.
J Antimicrob Chemother 2022 Mar 31;77(4):1178-84. doi: 10.1093/jac/dkab475..
Keywords:
Antibiotics, Medication, Surgery, Antimicrobial Stewardship, Practice Patterns
Schreyer J, Koch A, Herlemann A
RAS-NOTECHS: validity and reliability of a tool for measuring non-technical skills in robotic-assisted surgery settings.
This study’s objective was to develop and consent-validate a tool to assess multidisciplinary non-technical skills (NTS) in robotic-assisted surgery (RAS). The authors conducted a scoping literature review first to compile a set of RAS-specific teamwork behaviors. They then merged these behaviors with a well-established assessment tool on operating room (OR) teamwork called NOTECHS II. Finally, the new tool RAS-NOTECHS was applied in standardized observations of real-world procedures to test its reliability. The scoping review found 5242 articles, of which 21 were included based on pre-established inclusion criteria. The authors elicited 16 RAS-specific behaviors from the literature base. They were synthesized further with 18 behavioral markers into a list of 26 behavioral markers. The list was reviewed by 7 RAS experts and condensed to 15 expert-validated RAS-specific behavioral markers. For five observations of urologic RAS procedures, inter-rater agreement for identification of behavioral markers was strong. Agreement of RAS-NOTECHS scores ranged from moderate to strong agreement.
AHRQ-funded; HS026491.
Citation:
Schreyer J, Koch A, Herlemann A .
RAS-NOTECHS: validity and reliability of a tool for measuring non-technical skills in robotic-assisted surgery settings.
Surg Endosc 2022 Mar;36(3):1916-26. doi: 10.1007/s00464-021-08474-2..
Keywords:
Surgery
Graber J, Lockhart S, Matlock DD
"This is not negotiable. You need to do this…": a directed content analysis of decision making in rehabilitation after knee arthroplasty.
In this qualitative study, researchers sought to understand patients' and physical therapists' perspectives related to decision making during outpatient rehabilitation after total knee arthroplasty (TKA) and further to describe potential barriers and opportunities for shared decision making (SDM) in this setting. They found that physical therapists described using decision-making strategies with varying levels of patient involvement, while both patients and physical therapists described barriers to routine use of SDM in the outpatient setting. They also presented actionable strategies for overcoming these barriers for providers and organizations seeking consistently to use SDM in outpatient TKA rehabilitation.
AHRQ-funded; HS025692.
Citation:
Graber J, Lockhart S, Matlock DD .
"This is not negotiable. You need to do this…": a directed content analysis of decision making in rehabilitation after knee arthroplasty.
J Eval Clin Pract 2022 Feb;28(1):99-107. doi: 10.1111/jep.13591..
Keywords:
Decision Making, Rehabilitation, Orthopedics, Surgery, Patient-Centered Healthcare
