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https://www.readbyqxmd.com/read/28526041/implementation-of-enhanced-recovery-after-surgery-a-strategy-to-transform-surgical-care-across-a-health-system
#1
Leah M Gramlich, Caroline E Sheppard, Tracy Wasylak, Loreen E Gilmour, Olle Ljungqvist, Carlota Basualdo-Hammond, Gregg Nelson
BACKGROUND: Enhanced Recovery After Surgery (ERAS) programs have been shown to have a positive impact on outcome. The ERAS care system includes an evidence-based guideline, an implementation program, and an interactive audit system to support practice change. The purpose of this study is to describe the use of the Theoretic Domains Framework (TDF) in changing surgical care and application of the Quality Enhancement Research Initiative (QUERI) model to analyze end-to-end implementation of ERAS in colorectal surgery across multiple sites within a single health system...
May 19, 2017: Implementation Science: IS
https://www.readbyqxmd.com/read/28522915/ninety-day-readmissions-after-inpatient-cholecystectomy-a-5-year-analysis
#2
Alba Manuel-Vázquez, Raquel Latorre-Fragua, Carmen Ramiro-Pérez, Aylhin López-Marcano, Farah Al-Shwely, Roberto De la Plaza-Llamas, José Manuel Ramia
AIM: To determine the incidence of readmission after cholecystectomy using 90 d as a time limit. METHODS: We retrospectively reviewed all patients undergoing cholecystectomy at the General Surgery and Digestive System Service of the University Hospital of Guadalajara, Spain. We included all patients undergoing cholecystectomy for biliary pathology who were readmitted to hospital within 90 d. We considered readmission to any hospital service as cholecystectomy-related complications...
April 28, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28522108/hospital-readmission-after-ovarian-cancer-surgery-are-we-measuring-surgical-quality
#3
Emma L Barber, Kemi M Doll, Paola A Gehrig
OBJECTIVES: Readmission after surgery is a quality metric hypothesized to reflect the quality of care in the index hospitalization. We examined the link between readmissions and a surrogate of surgical quality - major postoperative complication - among ovarian cancer patients. METHODS: Patients who underwent surgery for ovarian cancer between 2012 and 2013 were identified from the National Surgical Quality Improvement Project (NSQIP). Major complications were defined as grade 3 or ≥complications on the validated Claviden-Dindo scale and included both NSQIP and non-NSQIP defined complications based on readmission ICD-9 code...
May 15, 2017: Gynecologic Oncology
https://www.readbyqxmd.com/read/28521598/malnutrition-critical-illness-survivors-and-postdischarge-outcomes-a-cohort-study
#4
Kris M Mogensen, Clare M Horkan, Steven W Purtle, Takuhiro Moromizato, James D Rawn, Malcolm K Robinson, Kenneth B Christopher
BACKGROUND: We hypothesized that preexisting malnutrition in patients who survived critical care would be associated with adverse outcomes following hospital discharge. METHODS: We performed an observational cohort study in 1 academic medical center in Boston. We studied 23,575 patients, aged ≥18 years, who received critical care between 2004 and 2011 and survived hospitalization. RESULTS: The exposure of interest was malnutrition determined at intensive care unit (ICU) admission by a registered dietitian using clinical judgment and on data related to unintentional weight loss, inadequate nutrient intake, and wasting of muscle mass and/or subcutaneous fat...
May 1, 2017: JPEN. Journal of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/28521346/real-time-magnetic-resonance-imaging-guided-biopsy-using-smartframe%C3%A2-stereotaxis-in-the-setting-of-a-conventional-diagnostic-magnetic-resonance-imaging-suite
#5
Justin K Scheer, Thomas Hamelin, Leon Chang, Brian Lemkuil, Bob S Carter, Clark C Chen
BACKGROUND: Real-time magnetic resonance imaging (MRI) visualization during stereotactic needle biopsies affords several valuable benefits to the neurosurgeon, including the opportunity to visually confirm the biopsy site at the time of surgery. Until now, reported experiences with this technique have been limited to the setting of intraoperative MRI or dedicated procedural MRI suites with modified ventilation systems. OBJECTIVE: To describe our experience with 11 consecutive patients who underwent real-time MRI-guided biopsy performed using SmartFrame® stereotaxis (MRI Interventions, Irvine, California) in the setting of a conventional diagnostic MRI suite...
June 1, 2017: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/28521010/prospective-audit-of-a-pathway-for-in-patient-pain-management-of-chronic-abdominal-pain-a-novel-and-cost-effective-strategy
#6
Gopinath Niraj, Sanjay Chaudhri
Background.:  Unexplained abdominal pain is a common cause of hospital admission and utilizes significant resource. Current in-patient pain management of acute exacerbation of chronic abdominal pain is primarily directed at pharmacological and psychological management strategies in this group of complex patients. We adopted a novel approach that proved to be both clinically effective and cost-effective. Design.:  Adult patients admitted to a surgical ward with acute exacerbation of chronic abdominal pain referred to in-patient pain management were prospectively audited over a two-year period at a single tertiary centre...
May 17, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28516154/wbc-associates-with-readmission-following-cystectomy
#7
Andrew G McIntosh, Tianyu Li, Timothy Ito, Jason Mannion, Mark Dziemianowicz, Nikhil Waingankar, Mohammed Haseebuddin, David Y T Chen, Richard E Greenberg, Rosalia Viterbo, Alexander Kutikov, Robert G Uzzo, Marc C Smaldone, Philip H Abbosh
Background: Radical cystectomy is associated with perioperative complication rates exceeding 50% in some series. Readmission rates are increasingly used as a surgical quality metric. White blood cell count is a crude surrogate for physiologic processes which may reflect postoperative complications leading to readmission. Objective: We assessed the association between final white blood cell count at discharge and risk of readmission following radical cystectomy. Methods: Records on 477 patients undergoing radical cystectomy from 2006-2013 were reviewed...
April 27, 2017: Bladder Cancer
https://www.readbyqxmd.com/read/28514469/association-of-very-low-volume-practice-with-vascular-surgery-outcomes-in-new-york
#8
Jialin Mao, Philip Goodney, Jack Cronenwett, Art Sedrakyan
Importance: Little research has focused on very low-volume surgery, especially in the context of decreasing vascular surgery volume with the adoption of endovascular procedures. Objective: To investigate the existence and outcomes of open abdominal aortic aneurysm repair (OAR) and carotid endarterectomy (CEA) performed by very low-volume surgeons in New York. Design, Settings, and Participants: This cohort study examined inpatient data of patients undergoing elective OAR or CEA from 2000 to 2014 from all New York hospitals...
May 17, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28512772/subspecialty-approach-for-the-management-of-acute-cholecystitis-an-alternative-to-acute-surgical-unit-model-of-care
#9
Sonia Tran, Vincent Choi, Kirsten Hepburn, Nathan Hewitt, Joel Zhou, Daniel L Chan, Michael L Talbot
BACKGROUND: Acute cholecystitis is a common condition. Recent studies have shown an association between creation of an acute surgical unit (ASU) and improved outcomes. This study aimed to evaluate the outcomes of a subspecialty based approach to the management of acute cholecystitis as an alternative to the traditional 'generalist' general surgery approach or the ASU model. METHOD: A 6-year retrospective analysis of outcomes in patients admitted under a dedicated upper gastrointestinal service for acute cholecystitis undergoing emergency laparoscopic cholecystectomy...
May 16, 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/28507993/enhanced-recovery-after-emergency-surgery-a-systematic-review
#10
REVIEW
Mihai Paduraru, Luca Ponchietti, Isidro Martinez Casas, Peter Svenningsen, Mauro Zago
OBJECTIVE: To evaluate the current scientific evidence for the applicability, safety and effectiveness of pathways of enhanced recovery after emergency surgery (ERAS). METHODS: We undertook a search using PubMed and Cochrane databases for ERAS protocols in emergency cases. The search generated 65 titles; after eliminating the papers not meeting search criteria, we selected 4 cohort studies and 1 randomized clinical trial (RCT). Data extracted for analysis consisted of: patient age, type of surgery performed, ERAS elements implemented, surgical outcomes in terms of postoperative complications, mortality, length of stay (LOS) and readmission rate...
April 2017: Bulletin of Emergency and Trauma
https://www.readbyqxmd.com/read/28503232/cytoreductive-nephrectomy-in-the-modern-era-predictors-of-use-morbidity-and-survival
#11
Brian J Minnillo, William Tabayoyong, John J Francis, Matthew J Maurice, Hui Zhu, Simon Kim, Robert Abouassaly
INTRODUCTION: To determine tumour, patient, and provider factors associated with cytoreductive nephrectomy (CN) use and to identify those factors that predicted short-term and long-term surgical outcomes. METHODS: We performed a retrospective review (1998-2011) of the National Cancer Database, a U.S. population-based oncology outcomes database. The review included 36 549 patients with metastatic renal cell carcinoma (mRCC). We assessed predictors of CN use, length of stay (LOS), 30-day readmission, and 30-day mortality using multivariable logistic regression...
May 2017: Canadian Urological Association Journal, Journal de L'Association des Urologues du Canada
https://www.readbyqxmd.com/read/28498068/predictors-of-extended-length-of-stay-discharge-to-inpatient-rehab-and-hospital-readmission-following-elective-lumbar-spine-surgery-introduction-of-the-carolina-semmes-grading-scale
#12
Matthew J McGirt, Scott L Parker, Silky Chotai, Deborah Pfortmiller, Jeffrey M Sorenson, Kevin Foley, Anthony L Asher
OBJECTIVE Extended hospital length of stay (LOS), unplanned hospital readmission, and need for inpatient rehabilitation after elective spine surgery contribute significantly to the variation in surgical health care costs. As novel payment models shift the risk of cost overruns from payers to providers, understanding patient-level risk of LOS, readmission, and inpatient rehabilitation is critical. The authors set out to develop a grading scale that effectively stratifies risk of these costly events after elective surgery for degenerative lumbar pathologies...
May 12, 2017: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/28494111/evaluation-of-indicated-non-cosmetic-panniculectomy-at-time-of-gynecologic-surgery
#13
Ryan W Rasmussen, Jay R Patibandla, Michael P Hopkins
OBJECTIVE: To report postoperative outcomes among patients undergoing indicated non-cosmetic panniculectomy at the time of gynecologic surgery. METHODS: Medical charts were retrospectively reviewed for patients who underwent panniculectomy coupled with gynecologic surgery at a university-affiliated hospital in the USA in 1990-2014. The data reviewed included age, body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters), surgical procedure, estimated blood loss, pathology, wound complication, diabetes, hypertension, smoking, and readmission rate...
May 11, 2017: International Journal of Gynaecology and Obstetrics
https://www.readbyqxmd.com/read/28494061/association-between-hospital-volume-and-30-day-readmissions-following-transcatheter-aortic-valve-replacement
#14
Sahil Khera, Dhaval Kolte, Tanush Gupta, Andrew Goldsweig, Poonam Velagapudi, Ankur Kalra, Gilbert H L Tang, Wilbert S Aronow, Gregg C Fonarow, Deepak L Bhatt, Herbert D Aronow, Neal S Kleiman, Michael Reardon, Paul C Gordon, Barry Sharaf, J Dawn Abbott
Importance: With the approval of transcatheter aortic valve replacement (TAVR) for patients with severe symptomatic aortic stenosis at intermediate surgical risk, TAVR volume is projected to increase exponentially in the United States. The 30-day readmission rate for TAVR was recently reported at 17.9%. The association between institutional TAVR volume and the 30-day readmission metric has not been examined. Objective: To assess the association between hospital TAVR volume and 30-day readmission...
May 11, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/28493416/parathyroidectomy-for-the-treatment-of-hyperparathyroidism-thirty-day-morbidity-and-mortality
#15
Jessica A Tang, Anna M Salapatas, Lauren B Bonzelaar, Michael Friedman
OBJECTIVES/HYPOTHESIS: Evaluate morbidity and mortality rates for patients with different levels of hyperparathyroidism (HPT) undergoing parathyroidectomy (PTX), specifically comparing primary hyperparathyroidism to secondary and tertiary hyperparathyroidism. Assess predictive factors of increased morbidity and mortality. STUDY DESIGN: Retrospective national database review. METHODS: Patients undergoing PTX, defined by Current Procedural Terminology codes 60500, 60502, 60505, for the treatment of HPT, were identified in the American College of Surgeons National Surgical Quality Improvement Program database between 2006 and 2014...
May 11, 2017: Laryngoscope
https://www.readbyqxmd.com/read/28492821/risk-associated-with-complications-and-mortality-after-urgent-surgery-vs-elective-and-emergency-surgery-implications-for-defining-quality-and-reporting-outcomes-for-urgent-surgery
#16
Matthew G Mullen, Alex D Michaels, J Hunter Mehaffey, Christopher A Guidry, Florence E Turrentine, Traci L Hedrick, Charles M Friel
Importance: Given the current climate of outcomes-driven quality reporting, it is critical to appropriately risk stratify patients using standardized metrics. Objective: To elucidate the risk associated with urgent surgery on complications and mortality after general surgical procedures. Design, Setting, and Participants: This retrospective review used the American College of Surgeons National Surgery Quality Improvement Program database to capture all general surgery cases performed at 435 hospitals nationwide between January 1, 2013, and December 31, 2013...
May 10, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28492816/enhanced-recovery-after-surgery-program-implementation-in-2-surgical-populations-in-an-integrated-health-care-delivery-system
#17
Vincent X Liu, Efren Rosas, Judith Hwang, Eric Cain, Anne Foss-Durant, Molly Clopp, Mengfei Huang, Derrick C Lee, Alex Mustille, Patricia Kipnis, Stephen Parodi
Importance: Novel approaches to perioperative surgical care focus on optimizing nutrition, mobility, and pain management to minimize adverse events after surgical procedures. Objective: To evaluate the outcomes of an enhanced recovery after surgery (ERAS) program among 2 target populations: patients undergoing elective colorectal resection and patients undergoing emergency hip fracture repair. Design, Setting, and Participants: A pre-post difference-in-differences study before and after ERAS implementation in the target populations compared with contemporaneous surgical comparator groups (patients undergoing elective gastrointestinal surgery and emergency orthopedic surgery)...
May 10, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28486844/a-real-world-experience-comparison-of-percutaneous-and-open-femoral-exposure-for-endovascular-abdominal-aortic-aneurysm-repair-in-a-tertiary-medical-center
#18
Dipankar Mukherjee, Erica Emery, Rashad Majeed, Keyvan Heshmati, Homayoun Hashemi
OBJECTIVE: To compare the outcomes of elective percutaneous endovascular aneurysm repair (PEVAR) versus surgical cutdown endovascular aneurysm repair (SEVAR) procedures performed at a tertiary medical center from 2012 to 2015. METHODS: This is a unique study using procedure data from two vascular surgeons who performed SEVAR in almost every case versus three vascular surgeons who performed PEVAR in all cases except when considered prohibitive on account of circumferential calcification or severe occlusive disease of the common femoral artery or some other technical consideration...
January 1, 2017: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28486387/minimally-invasive-versus-open-pancreaticoduodenectomy-a-propensity-matched-study-from-a-national-cohort-of-patients
#19
Ibrahim Nassour, Sam C Wang, Alana Christie, Mathew M Augustine, Matthew R Porembka, Adam C Yopp, Michael A Choti, John C Mansour, Xian-Jin Xie, Patricio M Polanco, Rebecca M Minter
OBJECTIVE: To compare the perioperative outcomes of minimally invasive pancreaticoduodenectomy (MIPD) in comparison with open pancreaticoduodenectomy (OPD) in a national cohort of patients. BACKGROUND: Limited well-controlled studies exist comparing perioperative outcomes between MIPD and OPD. METHODS: Patients who underwent MIPD and OPD were abstracted from the 2014 to 2015 pancreas-targeted American College of Surgeons National Surgical Quality Improvement Program...
May 8, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28486366/changes-in-myomectomy-practice-after-the-u-s-food-and-drug-administration-safety-communication-on-power-morcellation
#20
Natalie C Stentz, Laura G Cooney, Mary Sammel, Divya K Shah
OBJECTIVE: To examine the association between the 2014 U.S. Food and Drug Administration (FDA) safety communication on power morcellation and surgical approach and morbidity after myomectomy. METHODS: In this retrospective cohort study, data were abstracted from the American College of Surgeons National Surgical Quality Improvement Program database on 3,160 myomectomies between April 2012 and December 2013 (pre-FDA) and 4,378 between April 2014 and December 2015 (post-FDA)...
May 5, 2017: Obstetrics and Gynecology
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