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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
101 to 125 of 1110 Research Studies DisplayedCohen 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
Khouja T, Polk DE, Suda KJ
Opioid prescribing by oral and maxillofacial surgeons in the United States, 2016-2019.
The objective of this study was to describe opioid prescribing trends among oral and maxillofacial surgeons (OMFS). The IQVIA Longitudinal Prescription Dataset, 2016-2019, was used to identify prescriptions written by OMFS. The results indicated that while OMFS-prescribed hydrocodone and oxycodone decreased in most states, 12 percent of states showed increases. Tramadol and codeine prescriptions also increased. From these findings, the authors concluded that targeted interventions are warranted in some areas.
AHRQ-funded; HS025177.
Citation: Khouja T, Polk DE, Suda KJ .
Opioid prescribing by oral and maxillofacial surgeons in the United States, 2016-2019.
J Public Health Dent 2022 Sep;82(4):491-94. doi: 10.1111/jphd.12544..
Keywords: Opioids, Medication, Practice Patterns, Orthopedics, Surgery, Dental and Oral Health, Provider: Physician
Laskow T, Zhu J, Buta B
Risk factors for nonresilient outcomes in older adults after total knee replacement.
The purpose of this study was to develop a simple measure of physical resilience and identify risk factors for nonresilient patient outcomes in total knee replacement procedures (TKR). The researchers conducted a secondary analysis of the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE-TJR) cohort study, including 7,239 adults aged 60 or older who underwent TKR between 2011 and 2015. The study found that the variables of age, body mass index, and Charlson Comorbidity Index (CCI) were associated with increased risk of physically nonresilient outcomes across the 3 patient-reported outcomes of the physical component summary (PCS), bodily pain (BP), and vitality (VT). A household income of greater than $45 000 associated with lower risk for PCS (RR = 0.81 [0.70-0.93]), BP (RR = 0.80 [0.69-0.91]), and VT (RR = 0.86 [0.78-0.93]). CONCLUSIONS: We operationalized physical resilience and identified factors predicting resilience after TKR. This approach may aid clinical risk stratification, guide further investigation of causes, and ultimately aid patients through the design of interventions to enhance physical resilience.
AHRQ-funded; HS018910.
Citation: Laskow T, Zhu J, Buta B .
Risk factors for nonresilient outcomes in older adults after total knee replacement.
J Gerontol A Biol Sci Med Sci 2022 Sep;77(9):1915-22. doi: 10.1093/gerona/glab257..
Keywords: Orthopedics, Surgery, Elderly, Risk
Herb J, Holmes M, Stitzenberg K
Trends in rural-urban disparities among surgical specialties treating cancer, 2004-2017.
The purpose of this study was to assess trends over time in rural and urban disparities in the supply of surgeons treating patients with cancer. The researchers utilized the Area Health Resource File to conduct a retrospective observational study of medical workforce changes from 2004-2017. The study found that the density of surgical specialists in rural areas declined from 16 to 14 per 100,000 population and in urban areas from 33 to 31 per 100,000 population for a rural-urban disparity increase of 8%. The percentage increase in the supply disparity between the rural and urban workforce was largest for colorectal surgeons (66%) and general surgeons (72%). The study concluded that temporal changes in the rural-urban physician workforce depend on community factors, region, and area of specialization.
AHRQ-funded; HS000032.
Citation: Herb J, Holmes M, Stitzenberg K .
Trends in rural-urban disparities among surgical specialties treating cancer, 2004-2017.
J Rural Health 2022 Sep;38(4):838-44. doi: 10.1111/jrh.12658..
Keywords: Rural Health, Disabilities, Surgery, Cancer, Workforce
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 and 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
Marcaccio CL, Patel PB, Wang S
Effect of postoperative antithrombotic therapy on lower extremity outcomes after infrapopliteal bypass for chronic limb-threatening ischemia.
This study’s goal was to examine the effects of different postoperative antithrombotic regimens on 3-year clinical outcomes after infrapopliteal bypass for chronic limb-threatening ischemia (CLTI). The authors identified patients who had undergone infrapopliteal bypass for CLTI in the Vascular Quality Initiative (VQI) registry from 2003 to 2017 with linkage to Medicare claims for long-term outcomes. They divided the patients into three cohorts according to the discharge antithrombotic regimen: single-antiplatelet therapy (SAPT; aspirin or clopidogrel), dual antiplatelet therapy (DAPT; aspirin and clopidogrel), or anticoagulation (AC) plus any antiplatelet (AP) agent. To reduce selection bias, they restricted the analysis cohorts to patients treated by providers who discharged >50% of patients with each antithrombotic regimen. Their primary outcome was 3-year major adverse limb events (MALE; major amputation or reintervention). Among 1812 patients with a median follow-up time of >2 years, 693 (38%) were discharged with SAPT, 544 (30%) with DAPT, and 575 (32%) with AC+AP. At 3 years, MALE rates were 75% with DAPT, 74% with AC+AP, and 68% with SAPT. In adjusted analyses with SAPT as the reference group, no differences were found in 3-year MALE with DAPT or AC+AP. Across the treatment groups, we also found no differences in the individual end points of 3-year major amputation (DAPT: aHR, 0.98; AC+AP: aHR, 1.3), reintervention (DAPT: aHR, 1.0; AC+AP: aHR, 1.1), or mortality (DAPT: aHR, 1.1; AC+AP: aHR, 0.95).
AHRQ-funded; HS027285.
Citation: Marcaccio CL, Patel PB, Wang S .
Effect of postoperative antithrombotic therapy on lower extremity outcomes after infrapopliteal bypass for chronic limb-threatening ischemia.
J Vasc Surg 2022 May; 75(5):1696-706.e4. doi: 10.1016/j.jvs.2022.01.011..
Keywords: Cardiovascular Conditions, Medication, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Surgery, Medication: Safety
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
Marcaccio CL, Patel PB, Liang P
Efficacy and safety of perioperative dual antiplatelet therapy with ticagrelor versus clopidogrel in carotid artery stenting.
This study’s objective was to compare the efficacy and safety of perioperative dual antiplatelet therapy with aspirin/ticagrelor vs aspirin/clopidogrel in patients undergoing transfemoral carotid artery stenting (tfCAS) or transcarotid artery revascularization (TCAR). The authors identified all patients who underwent tfCAS or TCAR in the Vascular Quality Initiative registry from January 2016 to March 2021. They stratified patients by procedure and assessed outcomes using 1:3 propensity score-matched cohorts of patients who received perioperative aspirin/ticagrelor vs aspirin/clopidogrel. Among the cohort of 17,731 tfCAS patients, 593 (3.3%) received aspirin/ticagrelor and 11,404 (64%) received aspirin/clopidogrel. For the 2065 matched patients, no significant differences were found in the composite endpoint of stroke/death (aspirin/ticagrelor, 4.1%; vs aspirin/clopidogrel, 2.6%) or in the individual endpoints of stroke (2.9% vs 1.8%) or death (1.7% vs 1.1%). However, aspirin/ticagrelor was associated with a higher risk of bleeding (5.8% vs 2.8%). In a subgroup analysis of 297 tfCAS patients (14%) who received intraoperative protamine, no differences remained in stroke/death (1.5% vs 3.9%), and there was no longer a difference in bleeding (3.0% vs 2.6%). Among 17,946 TCAR patients, 453 (2.5%) received aspirin/ticagrelor and 13,696 (76%) received aspirin/clopidogrel. With the 1618 matched patients, no differences were found in stroke/death (0.7% vs 1.4%), stroke (0.2% vs 1.2%), death (0.5% vs 0.2%), or bleeding (1.2% vs 1.6%). For the 1429 TCAR patients (88%) who received protamine, no differences were found in stroke/death (0.8% vs 1.2%) or bleeding (0.6% vs 1.4%).
AHRQ-funded; HS027285.
Citation: Marcaccio CL, Patel PB, Liang P .
Efficacy and safety of perioperative dual antiplatelet therapy with ticagrelor versus clopidogrel in carotid artery stenting.
J Vasc Surg 2022 Apr; 75(4):1293-303.e8. doi: 10.1016/j.jvs.2021.09.045..
Keywords: Cardiovascular Conditions, Medication, Stroke, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Surgery
DeKeyser GJ, Martin BI, Ko H
Increased complications and cost associated with hip arthroplasty for femoral neck fracture: evaluation of 576,119 Medicare patients treated with hip arthroplasty.
The authors compared perioperative complications and costs of total hip arthroplasty (THA) for treatment of osteoarthritis (OA) to hemiarthroplasty (HA) and THA for treatment of femoral neck fractures (FNFs). Data from CMS were used to identify all patients 65 or older undergoing primary hip arthroplasty. The results showed that CMS hip arthroplasty patients with an FNF had significantly higher rates of mortality, thromboembolic events, readmission, and greater direct cost. The authors concluded that reimbursement models for arthroplasty should account for different perioperative complication and resource utilization for FNF patients.
AHRQ-funded; HS024714.
Citation: DeKeyser GJ, Martin BI, Ko H .
Increased complications and cost associated with hip arthroplasty for femoral neck fracture: evaluation of 576,119 Medicare patients treated with hip arthroplasty.
J Arthroplasty 2022 Apr; 37(4):742-47.e2. doi: 10.1016/j.arth.2021.12.027..
Keywords: Orthopedics, Surgery, Healthcare Costs, Medicare
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
Blakeslee-Carter J, Beck AW, Spangler EL
Type III endoleaks in complex endovascular abdominal aortic aneurysm repair within the Vascular Quality Initiative.
The objective of this national multicenter cohort study was to evaluate the occurrence of Type III endoleaks (T3ELs) after complex endovascular aneurysm repair (c-EVAR) for abdominal aortic aneurysm, identify potential procedural characteristics, and determine their impact on c-EVAR clinical outcomes. Investigators reviewed elective c-EVAR for nonruptured aneurysms within the Vascular Quality Initiative. The findings indicated that T3ELs in c-EVAR remain relatively uncommon and are identified predominately at index hospitalization. T3EL development was associated with higher device modularity and modification. The presence of T3ELs did not appear to have a statistically significant relationship with aortic reinterventions or survival, but the authors note that these findings are not definitive.
AHRQ-funded; HS013852.
Citation: Blakeslee-Carter J, Beck AW, Spangler EL .
Type III endoleaks in complex endovascular abdominal aortic aneurysm repair within the Vascular Quality Initiative.
J Vasc Surg 2022 Apr; 75(4):1172-80. doi: 10.1016/j.jvs.2021.10.038..
Keywords: Cardiovascular Conditions, Surgery, Adverse Events