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https://www.readbyqxmd.com/read/28424140/impact-of-multimodality-pain-regimens-on-elective-colorectal-surgery-outcomes
#1
Jennifer A Kaplan, Emily Finlayson, Andrew D Auerbach
Trials of enhanced recovery programs suggest that multimodality pain regimens improve outcomes after colorectal surgery. We sought to determine whether patients receiving postoperative multimodality pain regimens would have shorter lengths of stay without an associated increase in readmission rate as compared to those receiving opioid-based pain regimens. Retrospective cohort study of adults who underwent elective colorectal surgery between January 1, 2006, and December 31, 2012, in a national hospital network participating in the Premier Perspective database...
April 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28424131/postoperative-complications-predict-30-day-readmission-in-geriatric-general-surgery-patients
#2
James D Dieterich, Celia M Divino
The Affordable Care Act has placed unplanned patient readmissions under more scrutiny than ever. Geriatric patients, in particular, suffer a disproportionate amount of complications from any kind of hospitalization, including readmissions. This study seeks to identify risk factors in this population that predispose them to an unplanned readmission within 30 days after index surgery. The National Surgical Quality Improvement Program database was used to select patients 65 years and older, who underwent general surgery procedures in 2012...
April 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28424074/implementation-and-adaptation-of-the-re-engineered-discharge-red-in-five-california-hospitals-a-qualitative-research-study
#3
S E Mitchell, G M Weigel, V Laurens, J Martin, B W Jack
BACKGROUND: Project Re-Engineered Discharge (RED) is an evidence-based strategy to reduce readmissions disseminated and adapted by various health systems across the country. To date, little is known about how adapting Project RED from its original protocol impacts RED implementation and/or sustainability. The goal of this study was to identify and characterize contextual factors influencing how five California hospitals adapted and implemented RED and the subsequent impact on RED program sustainability...
April 19, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28423233/ivabradine-versus-metoprolol-in-patients-with-acute-inferior-wall-myocardial-infarction-expanding-arena-for-ivabradine
#4
Rajendra K Go Khroo, K Priti, Bhanwar L Ranwa, Kamal Kishor, Devendra Bisht, Sajal Gupta
BACKGROUND: Atrioventricular (AV) blocks are of concern with the use of beta blockers in inferior wall myocardial infarction (MI). Ivabradine lowers heart rate with a lesser risk of AV blocks. OBJECTIVES: To compare ivabradine with metoprolol in acute inferior wall MI in terms of feasibility, tolerability and efficacy METHODS: It was a prospective double blind single centre randomized controlled study. Of 1032 patients with acute inferior wall MI, 468 eligible patients were randomized in 1:1 manner to ivabradine (group A) and metoprolol (group B)...
April 19, 2017: Cardiovascular Therapeutics
https://www.readbyqxmd.com/read/28422906/risk-factors-and-costs-associated-with-nationwide-nonelective-readmission-after-trauma
#5
Joshua Parreco, Jessica Buicko, Nicholas Cortolillo, Nicholas Namias, Rishi Rattan
BACKGROUND: Most prior studies of readmission after trauma have been limited to single institutions while multi-institutional studies have been limited to single states and an inability to distinguish between elective and nonelective readmissions. The purpose of this study was to identify the risk factors and costs associated with nonelective readmission after trauma across the US. METHODS: The Nationwide Readmission Database was queried for all patients with nonelective admissions in 2013 and 2014 with a primary diagnosis of trauma...
April 18, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28420587/should-recent-smoking-be-a-contraindication-for-sleeve-gastrectomy
#6
Ivy N Haskins, Amy S Nowacki, Zhamak Khorgami, Karen Schulz, Leslie J Heinberg, Phillip R Schauer, Stacy A Brethauer, Ali Aminian
BACKGROUND: One of the ultimate goals of bariatric and metabolic surgery is to decrease cardiovascular morbidity and mortality. Obese individuals who smoke tobacco are at an increased risk of cardiovascular events and may benefit the most by positive effects of bariatric surgery on cardiometabolic risk factors. The safety profile of sleeve gastrectomy in patients who smoke has not yet been characterized. OBJECTIVES: To investigate the independent effect of smoking on early postoperative morbidity and mortality of laparoscopic sleeve gastrectomy...
March 9, 2017: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
https://www.readbyqxmd.com/read/28420358/healthcare-utilization-in-older-patients-using-personal-emergency-response-systems-an-analysis-of-electronic-health-records-and-medical-alert-data-brief-description-a-longitudinal-retrospective-analyses-of-healthcare-utilization-rates-in-older-patients-using
#7
Stephen Agboola, Sara Golas, Nils Fischer, Mariana Nikolova-Simons, Jorn Op den Buijs, Linda Schertzer, Joseph Kvedar, Kamal Jethwani
BACKGROUND: Personal Emergency Response Systems (PERS) are traditionally used as fall alert systems for older adults, a population that contributes an overwhelming proportion of healthcare costs in the United States. Previous studies focused mainly on qualitative evaluations of PERS without a longitudinal quantitative evaluation of healthcare utilization in users. To address this gap and better understand the needs of older patients on PERS, we analyzed longitudinal healthcare utilization trends in patients using PERS through the home care management service of a large healthcare organization...
April 18, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28420262/impact-of-an-educational-intervention-to-improve-physician-adherence-to-bronchiolitis-clinical-practice-guidelines-a-pre-post-intervention-study
#8
Marquita C Genies, Julia M Kim, Kristina Pyclik, Suzanne Rossi, Natalie Spicyn, Janet R Serwint
Bronchiolitis is the leading cause of infant hospitalizations in the United States. Despite clinical practice guidelines discouraging the utilization of non-evidence-based therapies, there continues to be wide variation in care and resource utilization. A pre-post physician focused educational intervention was conducted with the aims to reduce the use of non-evidence-based medical therapies, including bronchodilators, among patients admitted for bronchiolitis. Among patients meeting inclusion criteria (pre: n = 45; post: n = 47), bronchodilator use decreased by 50% ( P < ...
April 1, 2017: Clinical Pediatrics
https://www.readbyqxmd.com/read/28419350/epidemiology-of-meningitis-and-encephalitis-in-the-united-states-from-2011-2014
#9
Rodrigo Hasbun, Ning Rosenthal, J M Balada-Llasat, Jessica Chung, Steve Duff, Samuel Bozzette, Louise Zimmer, Christine C Ginocchio
Background: Large epidemiological studies evaluating the etiologies, management decisions and outcomes of adults with meningitis and encephalitis in the United States (US) are lacking. Methods: Adult patients (≥18 years) with meningitis or encephalitis by ICD-9 codes available in the Premier Healthcare Database during 2011-2014 were analyzed. Results: A total of 26,429 patients with meningitis or encephalitis were identified. The median age was 43 years; 53% were female...
April 17, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28419030/ambulatory-total-shoulder-arthroplasty-a-comprehensive-analysis-of-current-trends-complications-readmissions-and-costs
#10
Jourdan M Cancienne, Stephen F Brockmeier, Lawrence V Gulotta, David M Dines, Brian C Werner
BACKGROUND: There have been few studies that have evaluated ambulatory total shoulder arthroplasty. The objectives of the present study were to investigate the current trends in ambulatory total shoulder arthroplasty in the United States; to characterize the rate of postoperative complications, hospital readmission, and risk factors associated with readmission; and to conduct a cost analysis comparing ambulatory total shoulder arthroplasty with matched inpatient total shoulder arthroplasty...
April 19, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28418622/newborn-length-of-stay-and-risk-of-readmission
#11
Katie Harron, Ruth Gilbert, David Cromwell, Sam Oddie, Jan van der Meulen
BACKGROUND: Evidence on the association between newborn length of hospital stay (LOS) and risk of readmission is conflicting. We compared methods for modelling this relationship, by gestational age, using population-level hospital data on births in England between 2005-14. METHODS: The association between LOS and unplanned readmission within 30 days of postnatal discharge was explored using four approaches: (i) modelling hospital-level LOS and readmission rates; (ii) comparing trends over time in LOS and readmission; (iii) modelling individual LOS and adjusted risk of readmission; and (iv) instrumental variable analyses (hospital-level mean LOS and number of births on the same day)...
April 18, 2017: Paediatric and Perinatal Epidemiology
https://www.readbyqxmd.com/read/28416652/simplification-of-the-hospital-score-for-predicting-30-day-readmissions
#12
Carole E Aubert, Jeffrey L Schnipper, Mark V Williams, Edmondo J Robinson, Eyal Zimlichman, Eduard E Vasilevskis, Sunil Kripalani, Joshua P Metlay, Tamara Wallington, Grant S Fletcher, Andrew D Auerbach, Drahomir Aujesky, Jacques D Donzé
OBJECTIVE: The HOSPITAL score has been widely validated and accurately identifies high-risk patients who may mostly benefit from transition care interventions. Although this score is easy to use, it has the potential to be simplified without impacting its performance. We aimed to validate a simplified version of the HOSPITAL score for predicting patients likely to be readmitted. DESIGN AND SETTING: Retrospective study in 9 large hospitals across 4 countries, from January through December 2011...
April 17, 2017: BMJ Quality & Safety
https://www.readbyqxmd.com/read/28416016/variation-in-rates-of-icu-readmissions-and-post-icu-in-hospital-mortality-and-their-association-with-icu-discharge-practices
#13
Nelleke van Sluisveld, Ferishta Bakhshi-Raiez, Nicolette de Keizer, Rebecca Holman, Gert Wester, Hub Wollersheim, Johannes G van der Hoeven, Marieke Zegers
BACKGROUND: Variation in intensive care unit (ICU) readmissions and in-hospital mortality after ICU discharge may indicate potential for improvement and could be explained by ICU discharge practices. Our objective was threefold: (1) describe variation in rates of ICU readmissions within 48 h and post-ICU in-hospital mortality, (2) describe ICU discharge practices in Dutch hospitals, and (3) study the association between rates of ICU readmissions within 48 h and post-ICU in-hospital mortality and ICU discharge practices...
April 17, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28413365/integrating-the-principles-of-evidence-based-medicine-and-evidence-based-public-health-impact-on-the-quality-of-patient-care-and-hospital-readmission-rates-in-jordan
#14
Mohammad S Alyahya, Heba H Hijazi, Hussam A Alshraideh, Mohammad Aser Alsharman, Rabah Al Abdi, Heather Lea Harvey
INTRODUCTION: Hospital readmissions impose not only an extra burden on health care systems but impact patient health outcomes. Identifying modifiable behavioural risk factors that are possible causes of potentially avoidable readmissions can lower readmission rates and healthcare costs. METHODS: Using the core principles of evidence based medicine and public health, the purpose of this study was to develop a heuristic guide that could identify what behavioural risk factors influence hospital readmissions through adopting various methods of analysis including regression models, t-tests, data mining, and logistic regression...
August 31, 2016: International Journal of Integrated Care
https://www.readbyqxmd.com/read/28412109/reengineering-valve-patients-postdischarge-management-for-adapting-to-bundled-payment-models
#15
Michael S Koeckert, Patricia A Ursomanno, Mathew R Williams, Michael Querijero, Elias A Zias, Didier F Loulmet, Kevin Kirchen, Eugene A Grossi, Aubrey C Galloway
BACKGROUND: Bundled Payments for Care Improvement (BPCI) initiatives were developed by Medicare in an effort to reduce expenditures while preserving quality of care. Payment model 2 reimburses based on a target price for 90-day episode of care postprocedure. The challenge for valve patients is the historically high (>35%) 90-day readmission rate. We analyzed our institutional cardiac surgical service line adaptation to this initiative. METHODS: On May 1, 2015, we instituted a readmission reduction initiative (RRI) that included presurgical risk stratification, comprehensive predischarge planning, and standardized postdischarge management led by cardiac nurse practitioners (CNPs) who attempt to guide any postdischarge encounters (PDEs)...
March 10, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28411866/addressing-the-challenges-of-sleeve-gastrectomy-in-end-stage-renal-disease-analysis-of-100-consecutive-renal-failure-patients
#16
Young Kim, Junzi Shi, Christopher M Freeman, Andrew D Jung, Vikrom K Dhar, Shimul A Shah, E Steve Woodle, Tayyab S Diwan
BACKGROUND: While previous studies have demonstrated short-term efficacy of laparoscopic sleeve gastrectomy in candidates awaiting renal transplantation, the combination of morbid obesity and end-stage renal disease presents unique challenges to perioperative care. We demonstrate how increasing experience and the development of postoperative care guidelines can improve outcomes in this high-risk population. METHODS: Single-center medical records were reviewed for renal transplantation candidates undergoing laparoscopic sleeve gastrectomy between 2011 and 2015 by a single surgeon...
April 12, 2017: Surgery
https://www.readbyqxmd.com/read/28411750/safety-of-air-travel-in-the-immediate-postoperative-period-after-anatomic-pulmonary-resection
#17
Stephen D Cassivi, Karlyn E Pierson, Bettie J Lechtenberg, Francis C Nichols, K Robert Shen, Mark S Allen, Dennis A Wigle
OBJECTIVE: The study objective was to determine whether air travel in the immediate postoperative period after anatomic pulmonary resection is associated with increased morbidity or mortality. METHODS: All patients undergoing anatomic pulmonary resection at the Mayo Clinic (2005-2012) were identified and sent surveys querying their mode of transportation home after hospital dismissal and any complications encountered during or shortly after this travel. This included pneumonia, hospital readmission, deep venous thrombosis/pulmonary embolism, and specific pleural complications (pneumothorax, empyema, or chest tube placement)...
May 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28411287/impact-of-a-connected-care-model-on-30-day-readmission-rates-from-skilled-nursing-facilities
#18
Luke D Kim, Lei Kou, Bo Hu, Eiran Z Gorodeski, Michael B Rothberg
BACKGROUND: About one-fifth of hospitalized Medicare beneficiaries are discharged to skilled nursing facilities (SNFs) for post-acute care. Readmissions are common but interventions to reduce readmissions are scarce. OBJECTIVE: To assess the impact of a connected care model on 30-day hospital readmission rates among patients discharged to SNFs. DESIGN: Retrospective cohort. SETTING: SNFs that receive referrals from an academic medical center in Cleveland, Ohio...
April 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28411085/vaginal-myomectomy-using-d%C3%A3-hrssen-longitudinal-median-cervical-incision-a-case-series-of-19-patients
#19
Wai Yoong, Wei Zhao, Hong Cai, Robyn D'Cruz, Alessia Corrieri, John Hamilton, Abiodun Fakokunde
STUDY OBJECTIVE: To examine demographics and outcome measures of women having undergone vaginal excision of myoma through Dührssen (longitudinal median cervical) incision DESIGN: Prospective case series DESIGN CLASSIFICATION: The design of the study conforms to Canadian Task Force II3 ie evidence from timed series SETTING: A London teaching hospital PATIENTS: 19 patients with either a) submucus myoma (type 1) located near the cervix or b) pedunculated intracavity myoma (type 0), excised via Dührssen incision INTERVENTIONS: Dührssen (median longitudinal) incision on the anterior or posterior cervical lip MEASUREMENTS: Duration of procedure, intraoperative complications, estimated blood loss, length of stay, % 24 hour discharge, readmission rates RESULTS: Between 2009-16, 19 women had their myomas (submucus type 1, n=17; pedunculated intracavity type 0, n=2) removed vaginally via Dührssen incision...
April 11, 2017: Journal of Minimally Invasive Gynecology
https://www.readbyqxmd.com/read/28411029/clinical-and-economic-impact-of-a-multisciplinary-intervention-to-reduce-bleeding-risk-in-patients-with-acute-coronary-syndrome
#20
Ana de Lorenzo-Pinto, Ana Herranz-Alonso, Begoña Cuéllar-Basterrechea, José María Bellón-Cano, María Sanjurjo-Sáez, Héctor Bueno
INTRODUCTION AND OBJECTIVES: To evaluate the clinical and economic impact of a multidisciplinary program to reduce bleeding events in patients with acute coronary syndrome through optimization of antithrombotic therapy. METHODS: We designed a preintervention (PRE) and postintervention (POST) quasi-experimental study using a retrospective analysis of 2 cohorts. The first cohort was analyzed to detect correctable measures contributing to bleeding (PRE). Afterward, a quality improvement intervention with a bundle of recommendations was implemented...
April 11, 2017: Revista Española de Cardiología
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