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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 64 Research Studies DisplayedKrouse RS, Anderson GL, Arnold KB
Surgical versus non-surgical management for patients with malignant bowel obstruction (S1316): a pragmatic comparative effectiveness trial.
The purpose of this study was to compare surgical versus non-surgical management with the goal of determining the optimal approach for managing malignant bowel obstruction. From May 11, 2015, to April 27, 2020, 221 patients were enrolled, with 199 evaluable participants. The study found no variation between surgery and non-surgery for the primary outcome of good days: mean 42·6 days in the randomized surgery group, 43·9 days (29·5) in the randomized non-surgery group, 54·8 days (27·0) in the patient choice surgery group, and 52·7 days (30·7) in the patient choice non-surgery group. During their initial hospital stay, six participants died, five due to cancer progression and one due to malignant bowel obstruction treatment complications The most common grade 3-4 malignant bowel obstruction treatment complication was anemia.
AHRQ-funded; HS021491.
Citation: Krouse RS, Anderson GL, Arnold KB .
Surgical versus non-surgical management for patients with malignant bowel obstruction (S1316): a pragmatic comparative effectiveness trial.
Lancet Gastroenterol Hepatol 2023 Oct; 8(10):908-18. doi: 10.1016/s2468-1253(23)00191-7..
Keywords: Cancer, Surgery, Treatments, Comparative Effectiveness, Evidence-Based Practice
Ayers DC, Yousef M, Yang W
Age-related differences in pain, function, and quality of life following primary total knee arthroplasty: results from a FORCE-TJR (Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement) cohort.
The purpose of this prospective, multicenter cohort study was to evaluate the differences in pain, function, and quality of life (QoL) reported 1 year after total knee arthroplasty (TKA) across varying age groups. The researchers preoperatively assessed 11,602 unilateral primary TKA patients, and collected demographic data, comorbid conditions, and patient-reported outcome measures including the knee injury and osteoarthritis outcome score (KOOS), KOOS-12, KOOS Joint Replacement, and Short-Form health survey (12-item) and then collected again at 1-year postoperatively. The study found that prior to surgery, patients less than 55 years reported worse KOOS pain (39), function (50), and QoL (18) scores with poor mental health score (47) than other older patient groups. At 1 year after TKA, patients less than 55 years reported lower KOOS pain, function, and QoL scores when compared to patients 75 years or older. The differences in score changes among the age groups were statistically significant but clinically irrelevant. Further statistical analyses revealed that age was a significant predictor for pain, but not for function at 1 year where KOOS pain score was predicted to be higher in patients 75 years or older when compared to patients less than 55 years of age.
AHRQ-funded; HS018910.
Citation: Ayers DC, Yousef M, Yang W .
Age-related differences in pain, function, and quality of life following primary total knee arthroplasty: results from a FORCE-TJR (Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement) cohort.
J Arthroplasty 2023 Jul; 38(7 Suppl 2):S169-S76. doi: 10.1016/j.arth.2023.04.005..
Keywords: Orthopedics, Surgery, Quality of Life, Outcomes, Comparative Effectiveness, Evidence-Based Practice, Patient-Centered Outcomes Research, Pain
Rastogi V, Marcaccio CL, Kim NH
The effect of supraceliac versus infraceliac landing zone on outcomes following fenestrated endovascular repair of juxta-/pararenal aortic aneurysms.
The purpose of this study was to assess perioperative outcomes in patients in the Vascular Quality Initiative who underwent juxta-/pararenal FEVAR with supraceliac vs infraceliac sealing. 1,486 Patients who received an elective FEVAR for juxta-/pararenal aortic aneurysms in the Vascular Quality Initiative between 2014 and 2021were identified and included.
The researchers defined supraceliac sealing as proximal sealing in aortic zone 5, or zone 6 with a celiac scallop/fenestration/branch or celiac occlusion. The study’s primary outcomes were perioperative and 3-year mortality, and secondary outcomes were completion endoleaks, in-hospital complications, and variables related with 3-year mortality. The study found that of the included patients, 84% underwent infraceliac sealing, and 16% underwent supraceliac sealing. Of the supraceliac patients, 60% had a celiac fenestration/branch, 31% had a celiac scallop, and 9.2% had a celiac occlusion (intentional or unintentional). Compared with infraceliac sealing, there were no differences after risk-adjusted analysis in perioperative mortality following supraceliac sealing. Supraceliac sealing was associated with lower odds of type-IA completion endoleaks, but higher odds of any complication including cardiac complications, lower extremity ischemia and acute kidney injury when compared with infraceliac sealing. The researchers concluded that supraceliac sealing was associated with lower risk of type IA endoleaks and similar mortality compared with sealing at an infraceliac level. The researchers advise that providers should be aware that supraceliac sealing was related with higher perioperative morbidity.
The researchers defined supraceliac sealing as proximal sealing in aortic zone 5, or zone 6 with a celiac scallop/fenestration/branch or celiac occlusion. The study’s primary outcomes were perioperative and 3-year mortality, and secondary outcomes were completion endoleaks, in-hospital complications, and variables related with 3-year mortality. The study found that of the included patients, 84% underwent infraceliac sealing, and 16% underwent supraceliac sealing. Of the supraceliac patients, 60% had a celiac fenestration/branch, 31% had a celiac scallop, and 9.2% had a celiac occlusion (intentional or unintentional). Compared with infraceliac sealing, there were no differences after risk-adjusted analysis in perioperative mortality following supraceliac sealing. Supraceliac sealing was associated with lower odds of type-IA completion endoleaks, but higher odds of any complication including cardiac complications, lower extremity ischemia and acute kidney injury when compared with infraceliac sealing. The researchers concluded that supraceliac sealing was associated with lower risk of type IA endoleaks and similar mortality compared with sealing at an infraceliac level. The researchers advise that providers should be aware that supraceliac sealing was related with higher perioperative morbidity.
AHRQ-funded; HS027285.
Citation: Rastogi V, Marcaccio CL, Kim NH .
The effect of supraceliac versus infraceliac landing zone on outcomes following fenestrated endovascular repair of juxta-/pararenal aortic aneurysms.
J Vasc Surg 2023 Jan;77(1):9-19.e2. doi: 10.1016/j.jvs.2022.08.007..
Keywords: Cardiovascular Conditions, Surgery, Evidence-Based Practice, Patient-Centered Outcomes Research, Outcomes, Comparative Effectiveness, Treatments
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
Brajcic BC, Ko CY, Liu JB
A NSQIP-based randomized clinical trial evaluating choice of prophylactic antibiotics for pancreaticoduodenectomy.
This paper describes the protocol for an upcoming multicenter randomized surgical trial to evaluate choice of prophylactic antibiotics for pancreaticoduodenectomy. The rationale and methodology of the trial evaluating piperacillin-tazobactam compared to cefoxitin for surgical site infection prevention is described. The study will utilize a clinical registry for data collection.
AHRQ-funded; HS000078.
Citation: Brajcic BC, Ko CY, Liu JB .
A NSQIP-based randomized clinical trial evaluating choice of prophylactic antibiotics for pancreaticoduodenectomy.
J Surg Oncol 2021 May;123(6):1387-94. doi: 10.1002/jso.26402..
Keywords: Cancer, Antibiotics, Medication, Prevention, Surgery, Healthcare-Associated Infections (HAIs), Comparative Effectiveness, Evidence-Based Practice
Brown CS, Obi AT, Cronenwett JL
Outcomes after truncal ablation with or without concomitant phlebectomy for isolated symptomatic varicose veins (C2 disease).
This study looked outcomes of patients with varicose veins (C2 disease) who were treated with venous ablation alone or ablation plus phlebectomy using the Vascular Quality Initiative Varicose Vein Registry. Data between January 2015 and March 2015 was used to investigate postoperative as well as long-term clinical and patient-reported outcomes among patients with documented symptomatic C2 disease undergoing truncal endovenous ablations alone and combined ablation and phlebectomy. Out of 3375 patients, 40.1% underwent isolated truncal ablation and the rest had the combined procedure of ablation and phlebectomy. Complications were low for both procedures (8.4% and 8.7%). Overall, improvement in symptoms was experienced by 94.4% of patients with more increases in patients undergoing ablation and phlebectomy than ablation alone. Both procedures are recommended by the authors to be covered by insurance.
AHRQ-funded; HS000053.
Citation: Brown CS, Obi AT, Cronenwett JL .
Outcomes after truncal ablation with or without concomitant phlebectomy for isolated symptomatic varicose veins (C2 disease).
J Vasc Surg Venous Lymphat Disord 2021 Mar;9(2):369-76. doi: 10.1016/j.jvsv.2020.05.016..
Keywords: Cardiovascular Conditions, Chronic Conditions, Surgery, Outcomes, Patient-Centered Outcomes Research, Comparative Effectiveness, Evidence-Based Practice
Brown CS, Osborne NH, Kim GY
Comparison of unilateral vs bilateral and staged bilateral vs concurrent bilateral truncal endovenous ablation in the Vascular Quality Initiative.
This study compares outcomes in patients who have undergone unilateral vs bilateral venous ablation procedures or between staged and concurrent bilateral procedures. Data from the Vascular Quality Initiative from 2015 to 2019 was used to investigate immediate postoperative as well as long-term clinical and patient-reported outcomes. A total of 5029 patients were included, of whom 75.2% underwent unilateral procedures. Follow-up was conducted with a median of 227 days after. Unilateral patients were less likely to be female and white and had lower BMI compared with patients undergoing bilateral procedures. In addition, unilateral patients had fewer prior varicose vein treatments and had higher Venous Clinical Severity Scores (VCSS). There were no differences in complications in patients undergoing unilateral vs bilateral procedures. Systemic complications were rare in both groups.
AHRQ-funded; HS000053.
Citation: Brown CS, Osborne NH, Kim GY .
Comparison of unilateral vs bilateral and staged bilateral vs concurrent bilateral truncal endovenous ablation in the Vascular Quality Initiative.
J Vasc Surg Venous Lymphat Disord 2021 Jan;9(1):113-21.e3. doi: 10.1016/j.jvsv.2020.05.008..
Keywords: Cardiovascular Conditions, Chronic Conditions, Surgery, Outcomes, Patient-Centered Outcomes Research, Comparative Effectiveness, Evidence-Based Practice
Reisz PA, Laviana AA, Zhao Z
Assessing the quality of surgical care for clinically localized prostate cancer: results from the CEASAR study.
Prior studies suggest that nationally endorsed quality measures for prostate cancer care are not linked closely with outcomes. Using a prospective, population based cohort the investigators measured clinically relevant variation in structure, process and outcome measures in men undergoing radical prostatectomy. The authors did not identify and meaningful variation in quality of care across racial groups, age groups and surgeon volume strata, in this cohort, suggesting that men were receiving comparable quality of care across these strata.
AHRQ-funded; HS019356.
Citation: Reisz PA, Laviana AA, Zhao Z .
Assessing the quality of surgical care for clinically localized prostate cancer: results from the CEASAR study.
J Urol 2020 Dec;204(6):1236-41. doi: 10.1097/ju.0000000000001198..
Keywords: Surgery, Cancer: Prostate Cancer, Cancer, Quality of Care, Quality of Life, Patient-Centered Outcomes Research, Comparative Effectiveness, Evidence-Based Practice
Huelster Huelster, Laviana AA, Joyce DD
Radiotherapy after radical prostatectomy: effect of timing of postprostatectomy radiation on functional outcomes.
This study sought to compare patient-reported functional outcomes after radical prostatectomy (RP) and postprostatectomy radiation as well as elucidate the timing of radiation to allow optimal recovery of function. Findings showed that, in men with localized prostate cancer, post-RP radiotherapy was associated with significantly worse sexual, urinary, and bowel function domain scores at 5 years compared to RP alone. Radiation delayed for approximately 24 months after RP may be optimal for preserving erectile function compared to radiation administered closer to the time of RP.
AHRQ-funded; HS019356; HS022640.
Citation: Huelster Huelster, Laviana AA, Joyce DD .
Radiotherapy after radical prostatectomy: effect of timing of postprostatectomy radiation on functional outcomes.
Urol Oncol 2020 Dec;38(12):930.e23-30.e32. doi: 10.1016/j.urolonc.2020.06.022..
Keywords: Cancer: Prostate Cancer, Cancer, Men's Health, Surgery, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice, Comparative Effectiveness
Sauder CAM, Bateni SB, Davidson AJ
Breast conserving surgery compared with mastectomy in male breast cancer: a brief systematic review.
The surgical guidelines for male breast cancer (MBC) have been largely guided by female-predominant clinical trials. Because no clinical trial has been conducted to examine the surgical treatment of MBC, the investigators performed a systematic review comparing the survival of patients with MBC who had undergone breast conserving surgery (BCS) and those who had undergone mastectomy and evaluated the patients' radiotherapy compliance after BCS.
AHRQ-funded; HS022236.
Citation: Sauder CAM, Bateni SB, Davidson AJ .
Breast conserving surgery compared with mastectomy in male breast cancer: a brief systematic review.
Clin Breast Cancer 2020 Jun;20(3):e309-e14. doi: 10.1016/j.clbc.2019.12.004..
Keywords: Cancer: Breast Cancer, Cancer, Surgery, Evidence-Based Practice, Comparative Effectiveness, Patient-Centered Outcomes Research, Outcomes
Wallace K, Zhang S, Thomas L
Comparative effectiveness of hysterectomy versus myomectomy on one-year health-related quality of life in women with uterine fibroids.
The purpose of this prospective cohort study was to compare long-term health-related quality of life (HRQOL) 1 year after hysterectomy or myomectomy for treatment of uterine fibroids (UFs) and to determine whether route of procedure, race, or age affected improvements in HRQOL. The investigators concluded that HRQOL improved in all women 1 year after hysterectomy or myomectomy.
AHRQ-funded; HS023418.
Citation: Wallace K, Zhang S, Thomas L .
Comparative effectiveness of hysterectomy versus myomectomy on one-year health-related quality of life in women with uterine fibroids.
Fertil Steril 2020 Mar;113(3):618-26. doi: 10.1016/j.fertnstert.2019.10.028..
Keywords: Comparative Effectiveness, Women, Quality of Life, Surgery, Evidence-Based Practice, Patient-Centered Outcomes Research, Outcomes
Hoffman KE, Penson DF, Zhao Z
Patient-reported outcomes through 5 years for active surveillance, surgery, brachytherapy, or external beam radiation with or without androgen deprivation therapy for localized prostate cancer.
This study compared different treatment of men with favorable-risk prostate cancer and those with unfavorable-risk disease and their functional outcomes 5 years post-treatment. Treatment options for favorable-risk disease include active surveillance, nerve-sparing prostatectomy, external beam radiation therapy (EBRT), or low-dose-rate brachytherapy with prostatectomy being the most common. Treatment options for men with unfavorable-risk disease is prostatectomy or EBRT with androgen deprivation therapy (ADT). The cohort analyzed included men diagnosed with prostate cancer in 2011 through 2012, accrued from 5 Surveillance, Epidemiology and End Results Program sites and a US prostate cancer registry, using surveys through September 2017. A total of 2005 men met inclusion criteria. For men with favorable-risk disease low-dose-rate brachytherapy was associated with worse urinary irritative, and sexual and bowel function at 1 year compared with active surveillance. Nerve-sparing prostatectomy was associated with worse urinary incontinence at 5 years and sexual function at 3 years compared with active surveillance. EBRT was not associated with clinically different function changes from active surveillance at any point during the 5 years. For men with unfavorable-risk disease, EBRT with ADT was associated with lower hormonal function at 6 months, bowel function at 1 year, but better sexual function and incontinence than prostatectomy.
AHRQ-funded; HS019356; HS022640.
Citation: Hoffman KE, Penson DF, Zhao Z .
Patient-reported outcomes through 5 years for active surveillance, surgery, brachytherapy, or external beam radiation with or without androgen deprivation therapy for localized prostate cancer.
JAMA 2020 Jan 14;323(2):149-63. doi: 10.1001/jama.2019.20675..
Keywords: Cancer: Prostate Cancer, Cancer, Comparative Effectiveness, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice, Treatments, Men's Health, Adverse Events, Surgery
Lee T, Qian JZ, Zhang Y
Long-term outcomes of arteriovenous fistulas with unassisted versus assisted maturation: a retrospective national hemodialysis cohort study.
The authors retrospectively compared patients with assisted versus unassisted arteriovenous fistula (AVF) maturation for post-maturation AVF outcomes, including functional primary patency loss, AVF abandonment, and frequency of interventions. For the studied group of patients undergoing assisted AVF maturation, they observed a positive association between the number of pre-maturation AVF interventions and the likelihood of functional primary patency loss and frequency of post-maturation interventions.
AHRQ-funded; HS022931.
Citation: Lee T, Qian JZ, Zhang Y .
Long-term outcomes of arteriovenous fistulas with unassisted versus assisted maturation: a retrospective national hemodialysis cohort study.
J Am Soc Nephrol 2019 Nov;30(11):2209-18. doi: 10.1681/asn.2019030318..
Keywords: Kidney Disease and Health, Comparative Effectiveness, Surgery, Evidence-Based Practice, Outcomes, Patient-Centered Outcomes Research
Mullins BT, Basak R, Broughman JR
Patient-reported sexual quality of life after different types of radical prostatectomy and radiotherapy: analysis of a population-based prospective cohort.
This study compares the effects of different types of radical prostatectomy and radiotherapy on sexual function. A population-based cohort of 835 men with newly diagnosed prostate cancer from 2011 through 2013 was recruited in collaboration with the Rapid Case Ascertainment system of the North Carolina Central Cancer Registry. They were enrolled prior to treatment and followed retrospectively using the validated Prostate Cancer Symptom Indices (PCSI) instrument. The sexual function scores were compared among patients who received the following treatment types: external-beam RT (EBRT), EBRT with androgen deprivation therapy (ADT), brachytherapy, nerve-sparing radical prostatectomy (RP), and non-nerve-sparing RP. The cohort was surveyed at 24 months post-therapy, and RT alone was found to result in the best preservation of sexual function with brachytherapy, RT with ADT, and nerve-sparing RP yielding similar outcomes. Patients treated with non-nerve-sparing RP experienced the worst sexual function outcome.
AHRQ-funded.
Citation: Mullins BT, Basak R, Broughman JR .
Patient-reported sexual quality of life after different types of radical prostatectomy and radiotherapy: analysis of a population-based prospective cohort.
Cancer 2019 Oct 15;125(20):3657-65. doi: 10.1002/cncr.32288..
Keywords: Quality of Life, Sexual Health, Surgery, Treatments, Comparative Effectiveness, Patient-Centered Outcomes Research, Outcomes, Cancer: Prostate Cancer, Cancer, Evidence-Based Practice
Nicholson WK, Wegienka G, Zhang S
Short-term health-related quality of life after hysterectomy compared with myomectomy for symptomatic leiomyomas.
The objective of this study was to compare short-term health-related quality of life (HRQOL) 6-12 weeks after hysterectomy or myomectomy for the treatment of symptomatic leiomyomas. The investigators conducted a prospective comparative effectiveness analysis of data. They concluded that both hysterectomy and myomectomy were associated with substantial improvement in HRQOL at short-term follow-up, with small but statistically significant differences in symptom severity and certain subscales.
AHRQ-funded; HS023418.
Citation: Nicholson WK, Wegienka G, Zhang S .
Short-term health-related quality of life after hysterectomy compared with myomectomy for symptomatic leiomyomas.
Obstet Gynecol 2019 Aug;134(2):261-69. doi: 10.1097/aog.0000000000003354..
Keywords: Quality of Life, Surgery, Women, Comparative Effectiveness, Patient-Centered Outcomes Research, Outcomes
Bath J, Smith JB, Kruse RL
Cohort study of risk factors for 30-day readmission after abdominal aortic aneurysm repair.
This retrospective cohort study examined 30-day readmission rates for patients who had abdominal aortic aneurysm (AAA) repair comparing two different procedures,. The cohort was selected from inpatients (2009-2016) who had undergone elective AAA repair using the multicenter Cerner Health Facts(R) database and were identified ICD-9 procedure codes. The two procedures compared were 3,101 endovascular aneurysm repairs (EVAR) and 1,622 open procedures. Patients who had EVAR were less likely to be readmitted. Risk factors for readmission included surgical site infection, age, receipt of bronchodilators or steroids, serum potassium > 5.2 mEq/L, and higher Charlson co-morbidity scores. The most common infections causing readmission were pneumonia and urinary tract infection after EVAR.
AHRQ-funded; HS022140.
Citation: Bath J, Smith JB, Kruse RL .
Cohort study of risk factors for 30-day readmission after abdominal aortic aneurysm repair.
Vasa 2019 May;48(3):251-61. doi: 10.1024/0301-1526/a000767..
Keywords: Risk, Hospital Readmissions, Surgery, Outcomes, Comparative Effectiveness, Patient-Centered Outcomes Research
Yuo TH, Wallace JR, Fish L
Editor's choice - comparison of outcomes after open surgical and endovascular lower extremity revascularisation among end stage renal disease patients on dialysis.
This study compared outcomes of different revascularization surgeries among end stage renal disease (ESRD) patients with peripheral arterial disease (PAD). There is a high risk of complications for this surgery. Outcomes of endovascular revascularization (ER) and open surgical revascularisation (OSR) were compared. Outcomes measured included mortality and major amputation. There is a lower mortality risk for ER versus OSR. OSR has better 30-day limb salvage although there are similar long-term outcomes.
AHRQ-funded; HS019486.
Citation: Yuo TH, Wallace JR, Fish L .
Editor's choice - comparison of outcomes after open surgical and endovascular lower extremity revascularisation among end stage renal disease patients on dialysis.
Eur J Vasc Endovasc Surg 2019 Feb;57(2):248-57. doi: 10.1016/j.ejvs.2018.09.008..
Keywords: Adverse Events, Cardiovascular Conditions, Comparative Effectiveness, Dialysis, Evidence-Based Practice, Kidney Disease and Health, Mortality, Outcomes, Patient-Centered Outcomes Research, Risk, Surgery
Deutsch GB, Deneve JL, Al-Kasspooles MF
Intellectual equipoise and challenges: accruing patients with advanced cancer to a trial randomizing to surgical or nonsurgical management (SWOG S1316).
Prospective, randomized trials are needed to determine optimal treatment approaches for palliative care problems such as malignant bowel obstruction (MBO). In this paper, the authors report their experience accruing randomized patients to the Prospective Comparative Effectiveness Trial for Malignant Bowel Obstruction (SWOG S1316) study, comparing surgical and nonsurgical management of MBO. Accrual is ongoing. Experience gained from the S1316 study can aid future palliative care trials. They note that it is possible to randomize patients to palliative studies by giving clinicians clear recommendations utilizing an algorithm of conversation, allotment of necessary time to discuss the trial, and encouragement to overcome internal bias.
AHRQ-funded; HS021491.
Citation: Deutsch GB, Deneve JL, Al-Kasspooles MF .
Intellectual equipoise and challenges: accruing patients with advanced cancer to a trial randomizing to surgical or nonsurgical management (SWOG S1316).
Am J Hosp Palliat Care 2020 Jan;37(1):12-18. doi: 10.1177/1049909119851471..
Keywords: Cancer, Surgery, Comparative Effectiveness, Palliative Care
Hsu YJ, Kosinski AS, Wallace AS
Using a society database to evaluate a patient safety collaborative: the Cardiovascular Surgical Translational Study.
The authors assessed the utility of using external databases for quality improvement (QI) evaluations in the context of an innovative QI collaborative aimed to reduce three infections and improve patient safety across the cardiac surgery service line. They compared changes in each outcome between 15 intervention hospitals and 52 propensity score-matched hospitals, and found that improvement trends in several outcomes among the studied intervention hospitals were not statistically different from those in comparison hospitals. They conclude that using external databases may permit comparative effectiveness assessment by providing concurrent comparison groups, additional outcome measures, and longer follow-up.
AHRQ-funded; HS019934.
Citation: Hsu YJ, Kosinski AS, Wallace AS .
Using a society database to evaluate a patient safety collaborative: the Cardiovascular Surgical Translational Study.
J Comp Eff Res 2019 Jan;8(1):21-32. doi: 10.2217/cer-2018-0051..
Keywords: Patient Safety, Quality Improvement, Quality Indicators (QIs), Quality of Care, Surgery, Cardiovascular Conditions, Comparative Effectiveness, Data, Hospitals, Research Methodologies, Patient-Centered Outcomes Research
Bateni SB, Gingrich AA, Stewart SL
Hospital utilization and disposition among patients with malignant bowel obstruction: a population-based comparison of surgical to medical management.
In this study, the investigators sought to compare clinically meaningful outcomes in malignant bowel obstruction (MBO) patients treated with surgical versus medical management using population-based data. In this population-based analysis, medical management was associated with less hospital utilization at 30- and 90-days, fewer in-hospital deaths, and more frequent discharges to home. The authors suggest that these data underscore the potential benefits of medical management for MBO patients at the end-of-life.
AHRQ-funded; HS022236.
Citation: Bateni SB, Gingrich AA, Stewart SL .
Hospital utilization and disposition among patients with malignant bowel obstruction: a population-based comparison of surgical to medical management.
BMC Cancer 2018 Nov 26;18(1):1166. doi: 10.1186/s12885-018-5108-9..
Keywords: Cancer, Comparative Effectiveness, Hospitalization, Palliative Care, Patient-Centered Outcomes Research, Surgery
Pulia MS, Schwei RJ, Patterson BW
Effectiveness of outpatient antibiotics after surgical drainage of abscesses in reducing treatment failure.
The objective of this retrospective observational study was to evaluate the real-world effectiveness of outpatient antibiotic prescribing after surgical drainage of cutaneous abscesses on reducing treatment failure. The investigators found that this real-world, comparative effectiveness analysis did not demonstrate any significant reduction in treatment failure with the use of antibiotics after drainage of abscesses in the emergency department.
AHRQ-funded; HS024558; HS024342.
Citation: Pulia MS, Schwei RJ, Patterson BW .
Effectiveness of outpatient antibiotics after surgical drainage of abscesses in reducing treatment failure.
J Emerg Med 2018 Oct;55(4):512-21. doi: 10.1016/j.jemermed.2018.06.036..
Keywords: Antibiotics, Comparative Effectiveness, Patient-Centered Outcomes Research, Surgery
Boffa DJ, Kosinski AS, Furnary AP
Minimally invasive lung cancer surgery performed by thoracic surgeons as effective as thoracotomy.
The study authors hypothesized that the minimally invasive video-assisted thoracic surgery (VATS) approach to lobectomy for stage I lung cancer resulted in a longitudinal outcome that was not inferior to thoracotomy. After conducting their study, they concluded that the long-term efficacy of lobectomy for stage I lung cancer performed using the VATS approach by board-certified thoracic surgeons does not seem to be inferior to that of thoracotomy.
AHRQ-funded; HS022279.
Citation: Boffa DJ, Kosinski AS, Furnary AP .
Minimally invasive lung cancer surgery performed by thoracic surgeons as effective as thoracotomy.
J Clin Oncol 2018 Aug 10;36(23):2378-85. doi: 10.1200/jco.2018.77.8977..
Keywords: Cancer: Lung Cancer, Comparative Effectiveness, Patient-Centered Outcomes Research, Surgery
Tyson MD, Koyama T, Lee D
Effect of prostate cancer severity on functional outcomes after localized treatment: comparative effectiveness analysis of surgery and radiation study results.
The purpose of this study was to determine whether differences in predicted function over time between radical prostatectomy (RP) or external beam radiotherapy (EBRT) for localized cancer varied by risk group. Patient-reported, disease-specific function was measured using the Expanded Prostate Index Composite and predicted function was estimated using regression models, compared by disease risk. The study found that sexual function was similar between surgery and radiation for patients with high-risk disease, and the authors conclude that high-risk patients undergoing radiation therapy should be counseled that their sexual function may not be as good as low-risk patients also undergoing radiation.
AHRQ-funded; HS019356; HS022640.
Citation: Tyson MD, Koyama T, Lee D .
Effect of prostate cancer severity on functional outcomes after localized treatment: comparative effectiveness analysis of surgery and radiation study results.
Eur Urol 2018 Jul;74(1):26-33. doi: 10.1016/j.eururo.2018.02.012..
Keywords: Cancer: Prostate Cancer, Cancer, Comparative Effectiveness, Treatments, Surgery, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
Semenkovich TR, Panni RZ, Hudson JL
Comparative effectiveness of upfront esophagectomy versus induction chemoradiation in clinical stage T2N0 esophageal cancer: a decision analysis.
This study examined comparative effectiveness and survival rates for upfront esophagectomy versus induction chemoradiation in patients with clinical stage T2N20 esophageal cancer. A decision analysis model was created for the two treatment strategies. Results showed comparable median survival rates for both strategies. The optimal treatment strategy depended on the accuracy of endoscopic ultrasound staging.
AHRQ-funded; HS022330.
Citation: Semenkovich TR, Panni RZ, Hudson JL .
Comparative effectiveness of upfront esophagectomy versus induction chemoradiation in clinical stage T2N0 esophageal cancer: a decision analysis.
J Thorac Cardiovasc Surg 2018 May;155(5):2221-30.e1. doi: 10.1016/j.jtcvs.2018.01.006..
Keywords: Treatments, Cancer, Surgery, Comparative Effectiveness, Decision Making, Evidence-Based Practice, Patient-Centered Outcomes Research, Outcomes, Medication
Goldstone AB, Chiu P, Baiocchi M
Second arterial versus venous conduits for multi-vessel coronary artery bypass surgery in California.
This study sought to determine whether a second arterial conduit improves outcomes after multi-vessel coronary artery bypass grafting. It concluded that second arterial conduit use in California is low and declining, but arterial grafts were associated with significantly lower mortality and fewer cardiovascular events. A right internal thoracic artery graft offered no benefit over that of a radial artery, but did increase risk of sternal wound infection.
AHRQ-funded; HS022192.
Citation: Goldstone AB, Chiu P, Baiocchi M .
Second arterial versus venous conduits for multi-vessel coronary artery bypass surgery in California.
Circulation 2018 Apr 17;137(16):1698-707. doi: 10.1161/circulationaha.117.030959.
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Keywords: Cardiovascular Conditions, Comparative Effectiveness, Mortality, Patient-Centered Outcomes Research, Surgery