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Ambulatory surgery

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https://www.readbyqxmd.com/read/29155340/ambulatory-anterior-cervical-discectomy-and-fusion-is-associated-with-a-higher-risk-of-revision-surgery-and-perioperative-complications-an-analysis-of-a-large-nationwide-database
#1
Armin Arshi, Christopher Wang, Howard Y Park, Gideon W Blumstein, Zorica Buser, Jeffrey C Wang, Arya N Shamie, Don Y Park
BACKGROUND CONTEXT: With the changing landscape of healthcare, outpatient spine surgery is being more commonly performed to reduce cost and improve efficiency. Anterior cervical discectomy and fusion (ACDF) is one of the most common spine surgeries performed and demand is expected to increase with an aging population. PURPOSE: To determine the nationwide trends and relative complication rates associated with outpatient ACDF. STUDY DESIGN/SETTING: Large-scale retrospective case control study PATIENT SAMPLE: Humana-insured patients who underwent 1-2 level ACDF as either outpatients or inpatients from 2011-2016 OUTCOME MEASURES: Incidence and adjusted odds ratio (OR) of postoperative medical and surgical complications within one year of the index surgery METHODS: A retrospective review was performed of the PearlDiver® Humana insurance records database to identify patients undergoing 1-2 level ACDF (CPT-22551 AND ICD-9-816...
November 16, 2017: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/29148356/specialization-as-an-organizing-principle-the-case-of-ambulatory-surgery-centers
#2
Kathleen Carey, Jean M Mitchell
Ambulatory surgery centers (ASCs) recently have grown to become the dominant provider of specific surgical procedures in the United States. While the majority of ASCs focus primarily on a single specialty, many have diversified to offer a wide range of surgical specialties. We exploited a unique data set from Pennsylvania for the years 2004 to 2014 to conduct an empirical investigation of the relative cost of production in ASCs over varying degrees of specialization. We found that for the majority of ASCs, focus on a specialty was associated with lower facility costs...
August 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29148080/genetic-risk-factors-for-perception-of-symptoms-in-gerd-an-observational-cohort-study
#3
A Patel, S Hasak, B D Nix, G S Sayuk, R D Newberry, C P Gyawali
BACKGROUND: Genetic polymorphisms in G-protein beta-3 subunit (GNβ3) and beta-2 adrenergic receptor (ADRB2) are associated with pain and gut hypersensitivity, which can overlap with gastroesophageal reflux disease (GERD). AIM: To evaluate relationships between single nucleotide polymorphisms (SNPs) within GNβ3 and ADRB2 systems, and reflux symptom burden, GERD phenotypes from ambulatory reflux monitoring, and quality of life. METHODS: Symptomatic adults undergoing ambulatory reflux testing were recruited and phenotyped based on acid burden and symptom reflux association; major oesophageal motor disorders and prior foregut surgery were exclusions...
November 17, 2017: Alimentary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/29145986/hand-surgery-in-the-ambulatory-surgery-center
#4
REVIEW
Norfleet B Thompson, James H Calandruccio
Outpatient surgery, especially in free-standing ambulatory surgery centers (ASC), provides a safe, cost-effective option for a variety of surgical procedures and has become the preferred choice over inpatient and hospital-based outpatient surgery for most hand and wrist procedures. Complication rates after ASC hand surgery are low (0.2%-2.5%). Patient dissatisfaction with ASC surgery is primarily associated with postoperative nausea and vomiting and inadequate pain control.
January 2018: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/29143383/who-performs-colonoscopy-workforce-trends-over-space-and-time
#5
Jan M Eberth, Michele J Josey, Lee R Mobley, Davidson O Nicholas, Donna B Jeffe, Cassie Odahowski, Janice C Probst, Mario Schootman
PURPOSE: With the increased availability of colonoscopy to average risk persons due to insurance coverage benefit changes, we sought to identify changes in the colonoscopy workforce. We used outpatient discharge records from South Carolina between 2001 and 2010 to examine shifts over time and in urban versus rural areas in the types of medical providers who perform colonoscopy, and the practice settings in which they occur, and to explore variation in colonoscopy volume across facility and provider types...
November 16, 2017: Journal of Rural Health
https://www.readbyqxmd.com/read/29139592/single-dose-systemic-acetaminophen-to-improve-patient-reported-quality-of-recovery-after-ambulatory-segmental-mastectomy-a-prospective-randomized-double-blinded-placebo-controlled-clinical-trial
#6
Gildasio S De Oliveira, Meghan E Rodes, Jane Bialek, Mark C Kendall, Robert J McCarthy
Few systemic drug interventions are efficacious to improve patient reported quality of recovery after ambulatory surgery. We aimed to evaluate whether a single dose systemic acetaminophen improve quality of recovery in female patients undergoing ambulatory breast surgery. We hypothesized that patients receiving a single dose systemic acetaminophen at the end of the surgical procedure would have a better global quality of postsurgical recovery compared to the ones receiving saline. The study was a prospective randomized double blinded, placebo controlled, clinical trial...
November 15, 2017: Breast Journal
https://www.readbyqxmd.com/read/29135411/costs-analysis-of-surgical-treatment-of-stress-urinary-incontinence-in-a-brazilian-public-hospital-comparing-burch-and-synthetic-sling-techniques
#7
Leo Francisco Limberger, Fernanda Pacheco Faria, Luciana Silveira Campos, Karin Marise Jaeger Anzolch, Alexandre Fornari
INTRODUCTION: Surgical treatment of urinary incontinence progressed significantly with the introduction of synthetic slings. However, in some public Brazilian hospitals, the costs of these materials prevent their routine use. OBJECTIVE: To compare the costs of ambulatory synthetic sling surgery with an historical series of patients submitted to Burch surgery in a Brazilian public hospital. MATERIALS AND METHODS: Twenty nine incontinent patients were selected to synthetic sling surgery...
November 17, 2017: International Braz J Urol: Official Journal of the Brazilian Society of Urology
https://www.readbyqxmd.com/read/29133606/effects-of-bariatric-surgery-in-obese-patients-with-hypertension-the-gateway-randomized-trial-gastric-bypass-to-treat-obese-patients-with-steady-hypertension
#8
Carlos Aurelio Schiavon, Angela Cristine Bersch-Ferreira, Eliana Vieira Santucci, Juliana Dantas Oliveira, Camila Ragne Torreglosa, Priscila Torres Bueno, Julia Caldas Frayha, Renato Nakagawa Santos, Lucas Petri Damian, Patricia Malvina Noujaim, Helio Halpern, Frederico L J Monteiro, Ricardo Vitor Cohen, Carlos H Uchoa, Marcio Gonçalves de Souza, Celso Amodeo, Luiz Bortolotto, Dimas Ikeoka, Luciano F Drager, Alexandre Biasi Cavalcanti, Otavio Berwanger
BACKGROUND : Recent research efforts on bariatric surgery have focused on metabolic and diabetes mellitus resolution. Randomized trials designed to assess the impact of bariatric surgery in patients with obesity and hypertension are needed. METHODS : In this randomized, single-center, nonblinded trial, we included patients with hypertension (using ≥2 medications at maximum doses or >2 at moderate doses) and a body mass index between 30.0 and 39.9 kg/m(2) Patients were randomized to Roux-en-Y gastric bypass plus medical therapy or medical therapy alone...
November 13, 2017: Circulation
https://www.readbyqxmd.com/read/29127558/effect-of-dexamethasone-dose-and-route-on-the-duration-of-interscalene-brachial-plexus-block-for-outpatient-arthroscopic-shoulder-surgery-a-randomized-controlled-trial
#9
Darren Holland, Ryan J J Amadeo, Scott Wolfe, Linda Girling, Faylene Funk, Mark Collister, Emily Czaplinski, Celeste Ferguson, Jeff Leiter, Jason Old, Peter MacDonald, Brenden Dufault, Thomas C Mutter
PURPOSE: Dexamethasone prolongs the duration of interscalene block, but the benefits of higher doses and perineural vs intravenous administration remain unclear. METHODS: This factorial design, double-blinded trial randomized 280 adult patients undergoing ambulatory arthroscopic shoulder surgery at a single centre in a 1:1:1:1 ratio. Patients received ultrasound-guided interscalene block with 30 mL 0.5% bupivacaine and 4 mg or 8 mg dexamethasone by either the perineural or intravenous route...
November 10, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/29126382/analysis-of-medical-service-use-of-knee-osteoarthritis-and-knee-meniscal-and-ligament-injuries-in-korea-a-cross-sectional-study-of-national-patient-sample-data
#10
Chang Yong Suh, Yoon Jae Lee, Joon-Shik Shin, Jinho Lee, Me-Riong Kim, Wonil Koh, Yun-Yeop Cha, Byung-Cheul Shin, Eui-Hyoung Hwang, Kristin Suhr, Mia Kim, In-Hyuk Ha
BACKGROUND: Osteoarthritis (OA) and meniscal and ligament injuries of the knee are the two most common knee disorders in Korea. The aim of this study was to analyze the demographic characteristics, medical service use and related costs for these disorders, and the results are expected to help inform practitioners, researchers, and policy-makers. METHODS: The present study aimed to evaluate incidence and patient characteristics, and to assess current medical service use, usual care, and medical expenses of knee disorders by analyzing 2014 national patient sample data from the Korean Health Insurance Review and Assessment Service...
November 10, 2017: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/29125521/variation-in-surgical-management-of-neurogenic-bowel-among-centers-participating-in-national-spina-bifida-patient-registry
#11
Jonathan C Routh, David B Joseph, Tiebin Liu, Michael S Schechter, Judy K Thibadeau, M Chad Wallis, Elisabeth A Ward, John S Wiener
PURPOSE: Optimal management of neurogenic bowel in patients with spina bifida (SB) remains controversial. Surgical interventions may be utilized to treat constipation and provide fecal continence, but their use may vary among SB treatment centers. METHODS: We queried the National Spina Bifida Patient Registry (NSBPR) to identify patients who underwent surgical interventions for neurogenic bowel. We abstracted demographic characteristics, SB type, functional level, concurrent bladder surgery, mobility, and NSBPR clinics to determine whether any of these factors were associated with interventions for management of neurogenic bowel...
October 20, 2017: Journal of Pediatric Rehabilitation Medicine
https://www.readbyqxmd.com/read/29121289/association-between-intraoperative-non-depolarising-neuromuscular-blocking-agent-dose-and-30-day-readmission-after-abdominal-surgery
#12
T Thevathasan, S L Shih, K C Safavi, D L Berger, S M Burns, S D Grabitz, R S Glidden, R D Zafonte, M Eikermann, J C Schneider
Background: We hypothesised that intraoperative non-depolarising neuromuscular blocking agent (NMBA) dose is associated with 30-day hospital readmission. Methods: Data from 13,122 adult patients who underwent abdominal surgery under general anaesthesia at a tertiary care hospital were analysed by multivariable regression, to examine the effects of intraoperatively administered NMBA dose on 30-day readmission (primary endpoint), hospital length of stay, and hospital costs...
October 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29114413/perioperative-factors-affecting-ambulatory-outcomes-following-laparoscopic-adjustable-gastric-banding
#13
Mirsad Dupanovic, Ron Krebill, Iris Dupanovic, John Nachtigal, Melissa Rockford, Walter Orr
Objective: Morbidly obese patients are traditionally hospitalised following bariatric surgery. However, laparoscopic-adjustable gastric banding (LAGB) is amenable for ambulatory care. We hypothesised that the majority of patients can receive an ambulatory LAGB and that both surgical and anaesthetic perioperative factors will significantly affect non-ambulatory LAGB outcomes. Methods: Medical records of 201 consecutive LAGB patients performed at the University of Kansas Medical Centre during a 3-y period were reviewed...
October 2017: Turkish Journal of Anaesthesiology and Reanimation
https://www.readbyqxmd.com/read/29113842/ambulatory-care-utilization-among-patients-with-spina-bifida-change-in-care-from-childhood-to-adulthood
#14
Courtney L Shepard, Ella J Doerge, Adam B Eickmeyer, Kate H Kraft, Julian Wan, John T Stoffel
PURPOSE: We examined the ambulatory health care visit utilization of spina bifida children, adults who transitioned to adult care, and adults who continued to seek care in a pediatric setting. METHODS: We evaluated utilization over a one-year period for SB patients who visited any outpatient medical clinic within an integrated health care system. Patients were categorized as pediatric (<18) or adult (> 18). Adults were divided into those who did not fully transition to adult care (DNT) and patients who fully transitioned (adult)...
November 4, 2017: Journal of Urology
https://www.readbyqxmd.com/read/29106920/single-visit-surgery-for-pediatric-ambulatory-surgical-procedures-a-satisfaction-and-cost-analysis
#15
Jacob K Olson, Lisa A Deming, Denis R King, Terrence M Rager, Sarah Gartner, Natalie Huibregtse, R Lawrence Moss, Gail E Besner
BACKGROUND: Single visit surgery (SVS) consists of same-day pre-operative assessment and operation with telephone post-operative follow-up. This reduces family time commitment to 1 hospital trip rather than 2-3. We began SVS for ambulatory patients with clear surgical indications in 2013. We sought to determine family satisfaction, cost savings to families, and institutional financial feasibility of SVS. METHODS: SVS patients were compared to age/case matched conventional surgery (CS) patients...
October 10, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29103779/is-outpatient-unicompartmental-knee-arthroplasty-safe-to-perform-at-an-ambulatory-surgery-center-a-comparative-study-of-early-post-operative-complications
#16
John P Cody, Kiel J Pfefferle, Deborah J Ammeen, Kevin B Fricka
BACKGROUND: Unicompartmental knee arthroplasty (UKA) lends itself to the outpatient surgical setting. Prior literature has established a low rate of readmission and post-operative complications when performed in a hospital outpatient setting (HOP). To our knowledge, there have been no studies comparing complications of UKA performed at an ambulatory surgery center (ASC) and those in a HOP. METHODS: We retrospectively reviewed all patients who underwent outpatient UKA by a single surgeon from 2012 to 2016...
October 10, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29103529/influence-of-race-insurance-status-and-geographic-access-to-plastic-surgeons-on-immediate-breast-reconstruction-rates
#17
Paris D Butler, Olatomide Familusi, Joseph M Serletti, Justin P Fox
BACKGROUND: This study evaluates the rates of immediate breast reconstruction (IBR) among racial and insurance status subgroups, in the setting of a changing plastic surgeon workforce. METHODS: Using state level inpatient and ambulatory surgery data, we identified discharges for adult women who underwent mastectomy for breast cancer. This information was supplemented with plastic surgeon workforce data and aggregated to the health service area-level (HSA). Hierarchical linear models were used to risk standardized IBR rates for 8 race-payer subgroups...
November 2, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/29102151/age-at-orchiopexy-for-undescended-testis-in-the-united-states
#18
Kibileri Williams, Lauren Baumann, Adil Shah, Fizan Abdullah, Emilie K Johnson, Tolulope A Oyetunji
PURPOSE: Undescended testis (UDT) is the most common congenital anomaly of the male genitalia. The American Urological Association guidelines recommend orchiopexy by age 18months to ameliorate the risk of subfertility. The study aim was to assess adherence to these guidelines on a national level. METHODS: We retrospectively reviewed both the State Ambulatory Surgery Database (SASD) in 2012 and the Pediatric Health Information System (PHIS) for 2015. All patients aged 18years or less with a diagnosis of UDT who underwent orchiopexy were included...
October 12, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29101960/market-evaluation-finances-bundled-payments-and-accountable-care-organizations
#19
REVIEW
Shazia Mehmood Siddique, Shivan J Mehta
To control costs and improve quality, changes in health care delivery and financing have emerged, resulting in shifting of financial risk to providers for the quality and cost of care, including emergence of accountable care organizations and bundled payment models. This article discusses health care financing and delivery models in the context of procedures and surgeries that happen outside of the operating room. It describes the history of health insurance, trends in ambulatory surgery centers, and new payment models that have emerged from the Affordable Care Act and the Medicare Access and Children's Health Insurance Program Reauthorization Act...
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29100608/-outpatient-management-without-day-1-clinical-follow-up-of-patients-undergoing-uncomplicated-filtering-surgery
#20
A-L Jeancolas, J-B Conart, F Tréchot, J-P Berrod, K Angioi-Duprez, T Maalouf
INTRODUCTION: Although the general increase in ambulatory surgery allows for a 20% reduction in costs of hospitalization, the necessity of a day 1 postoperative visit remains the main problem for elderly patients or those who reside at considerable distance. For these reasons, in 2014, we decided to only see patients with uncomplicated filtering surgery at D5 and D21 and to replace the D1 visit with a telephone call. The primary goal of our study was to analyze a population of patients undergoing uncomplicated filtering surgery who were not seen at D1 and to describe the frequency of postoperative complications, intraocular pressure results and therapeutic management at D5 and D21...
October 31, 2017: Journal Français D'ophtalmologie
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