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https://www.readbyqxmd.com/read/27926773/associations-of-specific-postoperative-complications-with-outcomes-after-elective-colon-resection-a-procedure-targeted-approach-toward-surgical-quality-improvement
#1
John E Scarborough, Jessica Schumacher, K Craig Kent, Charles P Heise, Caprice C Greenberg
Importance: Numerous quality initiatives have been implemented in an effort to minimize the onus of postoperative complications on clinical and economic outcomes after major surgery. It is unknown which complications have the greatest overall effect on these outcomes. Objective: To quantify the associations of specific postoperative complications with outcomes after elective colon resection. Design, Setting, and Participants: Patients undergoing elective colon resection between January 1, 2012, and December 31, 2013, who were included in the Colectomy-Targeted American College of Surgeons National Surgical Quality Improvement Program were assessed for the development of specific types of postoperative complications...
December 7, 2016: JAMA Surgery
https://www.readbyqxmd.com/read/27926758/association-between-surgeon-scorecard-use-and-operating-room-costs
#2
Corinna C Zygourakis, Victoria Valencia, Christopher Moriates, Christy K Boscardin, Sereina Catschegn, Alvin Rajkomar, Kevin J Bozic, Kent Soo Hoo, Andrew N Goldberg, Lawrence Pitts, Michael T Lawton, R Adams Dudley, Ralph Gonzales
Importance: Despite the significant contribution of surgical spending to health care costs, most surgeons are unaware of their operating room costs. Objective: To examine the association between providing surgeons with individualized cost feedback and surgical supply costs in the operating room. Design, Setting, and Participants: The OR Surgical Cost Reduction (OR SCORE) project was a single-health system, multihospital, multidepartmental prospective controlled study in an urban academic setting...
December 7, 2016: JAMA Surgery
https://www.readbyqxmd.com/read/27926675/improvement-in-total-joint-replacement-quality-metrics-year-one-versus-year-three-of-the-bundled-payments-for-care-improvement-initiative
#3
John M Dundon, Joseph Bosco, James Slover, Stephen Yu, Yousuf Sayeed, Richard Iorio
BACKGROUND: In January 2013, a large, tertiary, urban academic medical center began participation in the Bundled Payments for Care Improvement (BPCI) initiative for total joint arthroplasty, a program implemented by the Centers for Medicare & Medicaid Services (CMS) in 2011. Medicare Severity-Diagnosis Related Groups (MS-DRGs) 469 and 470 were included. We participated in BPCI Model 2, by which an episode of care includes the inpatient and all post-acute care costs through 90 days following discharge...
December 7, 2016: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/27926671/of-20-376-lumbar-discectomies-2-6-of-patients-readmitted-within-30-days-surgical-site-infection-pain-and-thromboembolic-events-are-the-most-common-reasons-for-readmission
#4
Matthew L Webb, Stephen J Nelson, Ameya Save, Jonathan Cui, Adam M Lukasiewicz, Andre M Samuel, Pablo J Diaz-Collado, Daniel D Bohl, Nathaniel T Ondeck, Ryan P McLynn, Jonathan N Grauer
STUDY DESIGN: A retrospective cohort study of prospectively collected data. OBJECTIVE: As an initial effort to address readmissions after lumbar discectomy, reasons for hospital readmission are identified and discussed. SUMMARY OF BACKGROUND DATA: Lumbar discectomy is a commonly performed procedure. The Affordable Care Act codifies penalties for hospital readmissions. New quality-based reimbursements tied to readmissions call for a better understanding of the causes of readmission after procedures such as lumbar discectomy...
December 6, 2016: Spine
https://www.readbyqxmd.com/read/27926655/maternal-morbidity-after-previable-prelabor-rupture-of-membranes
#5
Sarah K Dotters-Katz, Alexis Panzer, Matthew R Grace, Marcela C Smid, J Adeolu Keku, Catherine J Vladutiu, Kim A Boggess, Tracy A Manuck
OBJECTIVE: To identify risk factors for maternal morbidity after previable prelabor rupture of membranes (PROM). METHODS: We conducted a case-control study of singleton and twin pregnancies complicated by previable PROM (14.0-22.9 weeks of gestation) at a single tertiary care referral institution, 2000-2015. Pregnancies complicated by fetal anomalies, previable PROM within 2 weeks of chorionic villus sampling or amniocentesis, and those with contraindications to expectant management (eg, chorioamnionitis) were excluded...
December 2, 2016: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27926638/determining-optimal-route-of-hysterectomy-for-benign-indications-clinical-decision-tree-algorithm
#6
Jennifer J Schmitt, Daniel A Carranza Leon, John A Occhino, Amy L Weaver, Sean C Dowdy, Jamie N Bakkum-Gamez, Kalyan S Pasupathy, John B Gebhart
OBJECTIVE: To evaluate practice change after initiation of a robotic surgery program using a clinical algorithm to determine the optimal surgical approach to benign hysterectomy. METHODS: A retrospective postrobot cohort of benign hysterectomies (2009-2013) was identified and the expected surgical route was determined from an algorithm using vaginal access and uterine size as decision tree branches. We excluded the laparoscopic hysterectomy route. A prerobot cohort (2004-2005) was used to evaluate a practice change after the addition of robotic technology (2007)...
December 2, 2016: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27926622/reducing-chronic-obstructive-pulmonary-disease-30-day-readmissions-a-nurse-led-evidence-based-quality-improvement-project
#7
Joan Agee
Chronic obstructive pulmonary disease (COPD) is a debilitating disease resulting in frequent hospitalizations and increased healthcare costs. As leaders of multidisciplinary teams, acute care nurse leaders are challenged to reduce readmissions and costs. In October 2014, the Centers for Medicare and Medicaid Services expanded readmission penalties for 30-day readmissions to include COPD, making this an important issue for nurse leaders. This article describes how a regional medical center was able to decrease COPD readmissions...
January 2017: Journal of Nursing Administration
https://www.readbyqxmd.com/read/27926583/evaluation-of-the-financial-and-health-burden-of-infants-at-risk-for-respiratory-syncytial-virus
#8
Stephanie McCallum Blake, David Tanaka, Lisa M Bendz, Suzanne Staebler, Debra Brandon
BACKGROUND: Respiratory syncytial virus (RSV) is the leading viral cause of death in infants younger than 1 year. In July 2014, the American Academy of Pediatrics (AAP) Committee on Infectious Diseases concluded that the "limited clinical benefit" for infants born at more than 29 weeks' gestation, together with the associated high cost of the immunoprophylaxis, no longer supported the routine use of palivizumab (Synagis). PURPOSE: To evaluate the impact of the newly adopted AAP palivizumab prophylaxis administration on health and subsequent hospital costs of infants born between 29 and less than 32 weeks' gestation...
December 6, 2016: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
https://www.readbyqxmd.com/read/27926560/using-modified-frailty-index-to-predict-safe-discharge-within-48-hours-of-ileostomy-closure
#9
Yuxiang Wen, Murad A Jabir, Eslam M G Dosokey, Dongjin Choi, Clayton C Petro, Justin T Brady, Scott R Steele, Conor P Delaney
BACKGROUND: Enhanced recovery pathways allow for safe discharge and optimal outcomes within 48 hours after ileostomy closure. Unfortunately, some patients undergoing ileostomy closure have prolonged hospital stays. We have shown previously that the Modified Frailty Index can help predict patients who will fail early discharge after laparoscopic colorectal surgery. OBJECTIVE: The purpose of this study was to use the Modified Frailty Index to identify patients who were safe for early discharge after ileostomy closure...
January 2017: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/27926556/natural-orifice-specimen-extraction-with-single-stapling-colorectal-anastomosis-for-laparoscopic-anterior-resection-feasibility-outcomes-and-technical-considerations
#10
Bansal Saurabh, Sheng-Chi Chang, Tao-Wei Ke, Yu-Chun Huang, Takashi Kato, Hwei-Ming Wang, William Tzu-Liang Chen, Abe Fingerhut
BACKGROUND: Double and triple stapling techniques to close the rectal stump in laparoscopic anterior resection are fraught with technical drawbacks that could possibly be avoided with the use of the single stapling technique. However, little is known of its safety in laparoscopic surgery or outcomes when combined with natural orifice specimen extraction. OBJECTIVE: This study aims to analyze the feasibility and the operative and immediate postoperative outcomes of single-stapled anastomosis and natural orifice specimen extraction with conventional techniques...
January 2017: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/27926553/omission-of-adjuvant-chemotherapy-is-associated-with-increased-mortality-in-patients-with-t3n0-colon-cancer-with-inadequate-lymph-node-harvest
#11
Katerina O Wells, Alexander T Hawkins, Devi M Krishnamurthy, Sekhar Dharmarajan, Sean C Glasgow, Steven R Hunt, Matthew G Mutch, Paul Wise, Matthew L Silviera
BACKGROUND: Adjuvant chemotherapy for T3N0 colon cancer is controversial. National guidelines recommend its use in patients with stage II with high-risk features, including lymph node harvest of less than 12, yet this treatment is underused. OBJECTIVE: The purpose of this study was to demonstrate that the use of adjuvant chemotherapy in patients with T3N0 adenocarcinoma with inadequate lymph node harvest is beneficial. DESIGN: This was a retrospective population-based study of patients with resected T3N0 adenocarcinoma of the colon...
January 2017: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/27926497/coronary-computed-tomographic-angiography-for-patients-with-low-to-intermediate-risk-chest-pain-a-systematic-review-and-meta-analysis
#12
REVIEW
Yu Chen, Yuqi Fan, Zhaofang Yin, Huili Zhang, Yang Zhang, Zhihua Han, Changqian Wang
Coronary computed tomographic angiography (CCTA) can image the coronary vasculature rapidly and detect the presence and severity of luminal stenosis accurately. However, whether CCTA based care strategy could gain more benefits than conventional strategy with functional tests for patients with low-to-intermediate risk chest pain remains unknown. In this study we performed a meta-analysis to compare the clinical efficacy of CCTA versus conventional strategy. Eight randomized controlled trials with 14749 patients were finally included in this review after database searching...
December 2, 2016: Oncotarget
https://www.readbyqxmd.com/read/27925632/sepsis-induces-telomere-shortening-a-potential-mechanism-responsible-for-delayed-pathophysiological-events-in-sepsis-survivors
#13
Naara Mendes Oliveira, Ester C S Rios, Thais Martins de Lima, Vanessa Jacob Victorino, Hermes Barbeiro, Fabiano Pinheiro da Silva, Csaba Szabo, Francisco Garcia Soriano
Sepsis survivors suffer from additional morbidities, including higher disk of readmissions, nervous system disturbances and cognitive dysfunction, and increased mortality, even several years after the initial episode of sepsis. In many ways, the phenotype of sepsis survivors resembles the phenotype associated with accelerated aging. Since telomere shortening is a hallmark of aging, we investigated whether sepsis also leads to telomere shortening. Male balb/c mice were divided into two groups: the control group received 100 μl of normal saline intraperitoneally; the sepsis group received 15 mg/kg of bacterial lipopolysaccharide i...
December 5, 2016: Molecular Medicine
https://www.readbyqxmd.com/read/27925393/intensive-care-unit-icu-readmission-after-major-lung-resection-prevalence-patterns-and-mortality
#14
Jae Jun Jung, Jong Ho Cho, Tae Hee Hong, Hong Kwan Kim, Yong Soo Choi, Jhingook Kim, Young Mog Shim, Jae Ill Zo
BACKGROUND: The aim of this study was to identify risk factors associated with mortality in patients re-admitted to an intensive care unit (ICU) after initial recovery from major lung resection. METHODS: We retrospectively reviewed the case records of all patients who underwent major lung resection between February 2011 and May 2013. A total of 1916 patients underwent major resection surgery for various lung diseases, 63 (3.3%) of which required ICU admission after initial recovery...
December 7, 2016: Thoracic Cancer
https://www.readbyqxmd.com/read/27924871/prognostic-implications-of-aspiration-pneumonia-in-patients-with-community-acquired-pneumonia-a-systematic-review-with-meta-analysis
#15
Kosaku Komiya, Bruce K Rubin, Jun-Ichi Kadota, Hiroshi Mukae, Tomohiro Akaba, Hiroshi Moro, Nobumasa Aoki, Hiroki Tsukada, Shingo Noguchi, Nobuaki Shime, Osamu Takahashi, Shigeru Kohno
: Aspiration pneumonia is thought to be associated with a poor outcome in patients with community acquired pneumonia (CAP). However, there has been no systematic review regarding the impact of aspiration pneumonia on the outcomes in patients with CAP. This review was conducted using the MOOSE guidelines: Patients: patients defined CAP. EXPOSURE: aspiration pneumonia defined as pneumonia in patients who have aspiration risk. Comparison: confirmed pneumonia in patients who were not considered to be at high risk for oral aspiration...
December 7, 2016: Scientific Reports
https://www.readbyqxmd.com/read/27924173/predictors-of-recurrent-hospital-admission-for-patients-presenting-with-diabetic-ketoacidosis-and-hyperglycemic-hyperosmolar-state
#16
Annabel L Bradford, Courtney Champagne Crider, Xizheng Xu, Syed Hasan Naqvi
BACKGROUND: Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are two serious, preventable complications of diabetes mellitus. Analysis of variables associated with recurrent DKA and HHS admission has the potential to improve patient outcomes by identifying possible areas for intervention. The aim of this study was to evaluate potential predictors of recurrent DKA or HHS admission. METHODS: This was a retrospective case-control study of 367 patients presenting during a 5-year period with DKA or HHS at a US tertiary academic medical center...
January 2017: Journal of Clinical Medicine Research
https://www.readbyqxmd.com/read/27923890/a-comprehensive-nutrition-focused-quality-improvement-program-reduces-30-day-readmissions-and-length-of-stay-in-hospitalized-patients
#17
Krishnan Sriram, Suela Sulo, Gretchen VanDerBosch, Jamie Partridge, Josh Feldstein, Refaat A Hegazi, Wm Thomas Summerfelt
BACKGROUND: Although screening patients for malnutrition risk on hospital admission is standard of care, nutrition shortfalls are undertreated. Nutrition interventions can improve outcomes. We tested effects of a nutrition-focused quality improvement program (QIP) on hospital readmission and length of stay (LOS). MATERIALS AND METHODS: QIP included malnutrition risk screening at admission, prompt initiation of oral nutrition supplements (ONS) for at-risk patients, and nutrition support...
December 6, 2016: JPEN. Journal of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/27923838/the-effect-of-limited-english-proficiency-on-pediatric-hospital-readmissions
#18
Mindy Ju, Nathan Luna, K T Park
BACKGROUND: The relationship between limited English proficiency (LEP) and worse pediatric health outcomes is well documented. OBJECTIVES: To determine the relationship between LEP status and pediatric hospital readmissions. METHODS: We performed a retrospective cohort analysis of children ≤ 18 years old admitted to a tertiary children's hospital from 2008 to 2014. The main exposure was LEP status. Independent variables included sex, age, race/ethnicity, insurance, median household income, surgical/medical status, severity of illness (SOI), the presence of a complex chronic condition, and length of stay...
December 6, 2016: Hospital Pediatrics
https://www.readbyqxmd.com/read/27923419/clostridium-difficile-in-an-urban-university-affiliated-long-term-acute-care-hospital
#19
Jerry Jacob, Jingwei Wu, Jennifer Han, Deborah B Nelson
OBJECTIVES To describe the characteristics and impact of Clostridium difficile infection (CDI) in a long-term acute-care hospital (LTACH). DESIGN Retrospective matched cohort study. SETTING A 38-bed, urban, university-affiliated LTACH. METHODS The characteristics of LTACH-onset CDI were assessed among patients hospitalized between July 2008 and October 2015. Patients with CDI were matched to concurrently hospitalized patients without a diagnosis of CDI. Severe CDI was defined as CDI with 2 or more of the following criteria: age ≥65 years, serum creatinine ≥2 mg/dL, or peripheral leukocyte count ≥20,000 cells/μL...
December 7, 2016: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/27923167/long-term-outcomes-for-different-vaginal-cuff-closure-techniques-in-robotic-assisted-laparoscopic-hysterectomy-a-randomized-controlled-trial
#20
Ziv Tsafrir, Matthew Palmer, Marisa Dahlman, A Karim Nawfal, Joelle Aoun, Andrew Taylor, Jay Fisher, Evan Theoharis, David Eisenstein
OBJECTIVE: This randomized controlled trial aimed to evaluate the outcomes of different vaginal cuff closure techniques in robotic-assisted total laparoscopic hysterectomy. STUDY DESIGN: Ninety women undergoing robotic-assisted total laparoscopic hysterectomy for benign disease were randomized to three vaginal cuff closure techniques: running 2.0 V-Lock™ (Arm 1), 0 Vicryl™ figure-of-eight (Arm 2), and running 0 Vicryl™ with Lapra-Ty(®) (Arm 3). Patients' records were reviewed for age, body mass index, smoking status and relevant co-morbidities...
November 16, 2016: European Journal of Obstetrics, Gynecology, and Reproductive Biology
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