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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
#1
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/27926559/preoperative-immunonutrition-and-elective-colorectal-resection-outcomes
#2
Lucas W Thornblade, Thomas K Varghese, Xu Shi, Eric K Johnson, Amir Bastawrous, Richard P Billingham, Richard Thirlby, Alessandro Fichera, David R Flum
BACKGROUND: Randomized controlled trials demonstrate the efficacy of arginine-enriched nutritional supplements (immunonutrition) in reducing complications after surgery. The effectiveness of preoperative immunonutrition has not been evaluated in a community setting. OBJECTIVE: This study aims to determine whether immunonutrition before elective colorectal surgery improves outcomes in the community at large. DESIGN: This is a prospective cohort study with a propensity score-matched comparative effectiveness evaluation...
January 2017: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/27919580/variation-in-diagnoses-for-hip-arthroplasty-among-new-york-state-hospitals-implications-for-the-comprehensive-care-for-joint-replacement-model
#3
John A Buza, Jeffrey M Jancuska, James D Slover, Richard Iorio, Joseph A Bosco
BACKGROUND: The Comprehensive Care for Joint Replacement model is designed to minimize costs and improve quality for Medicare patients undergoing joint arthroplasty. The cost of hip arthroplasty (HA) episode varies depending on the preoperative diagnosis and is greater for fracture than for osteoarthritis. Hospitals that perform a higher percentage of HA for OA may therefore have an advantage in the Comprehensive Care for Joint Replacement model. The purposes of this study are to (1) determine the variability in underlying diagnosis for HA in New York State hospitals, and (2) determine hospital characteristics, such as volume, associated with this...
November 15, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27917566/perioperative-hypothermia-in-neonatal-intensive-care-unit-patients-effectiveness-of-a-thermoregulation-intervention-and-associated-risk-factors
#4
Branden M Engorn, Stephanie L Kahntroff, Karen M Frank, Sarabdeep Singh, Helen A Harvey, Charles T Barkulis, Annika M Barnett, Olamide O Olambiwonnu, Eugenie S Heitmiller, Robert S Greenberg
BACKGROUND: Hypothermia in neonatal intensive care unit patients is associated with morbidity. Perioperative normothermia is the standard of care. AIMS: We hypothesized that a quality improvement intervention (transport protocol, transport education, ongoing monitoring) would decrease the incidence of perioperative hypothermia. Secondarily, we hypothesized that patients undergoing surgery at a postmenstrual age of <37 weeks or at a weight of <1.5 kg would be at higher risk for perioperative hypothermia...
December 5, 2016: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/27905060/perioperative-risk-adjustment-for-total-shoulder-arthroplasty-are-simple-clinically-driven-models-sufficient
#5
David N Bernstein, Aakash Keswani, David Ring
BACKGROUND: There is growing interest in value-based health care in the United States. Statistical analysis of large databases can inform us of the factors associated with and the probability of adverse events and unplanned readmissions that diminish quality and add expense. For example, increased operating time and high blood urea nitrogen (BUN) are associated with adverse events, whereas patients on antihypertensive medications were more likely to have an unplanned readmission. Many surgeons rely on their knowledge and intuition when assessing the risk of a procedure...
November 30, 2016: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/27902826/association-of-a-frailty-screening-initiative-with-postoperative-survival-at-30-180-and-365-days
#6
Daniel E Hall, Shipra Arya, Kendra K Schmid, Mark A Carlson, Pierre Lavedan, Travis L Bailey, Georgia Purviance, Tammy Bockman, Thomas G Lynch, Jason M Johanning
Importance: As the US population ages, the number of operations performed on elderly patients will likely increase. Frailty predicts postoperative mortality and morbidity more than age alone, thus presenting opportunities to identify the highest-risk surgical patients and improve their outcomes. Objective: To examine the effect of the Frailty Screening Initiative (FSI) on mortality and complications by comparing the surgical outcomes of a cohort of surgical patients treated before and after implementation of the FSI...
November 30, 2016: JAMA Surgery
https://www.readbyqxmd.com/read/27898510/the-effect-of-implementation-of-preoperative-and-postoperative-care-elements-of-a-perioperative-surgical-home-model-on-outcomes-in-patients-undergoing-hip-arthroplasty-or-knee-arthroplasty
#7
Thomas R Vetter, Joydip Barman, James M Hunter, Keith A Jones, Jean-Francois Pittet
BACKGROUND: The Perioperative Surgical Home (PSH) seeks to remedy the currently highly fragmented and expensive perioperative care in the United States. The 2 specific aims of this health services research study were to assess the association between the preoperative and postoperative elements of an initial PSH model and a set of (1) clinical, quality, and patient safety outcomes and (2) operational and financial outcomes, in patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA)...
November 28, 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27896467/audit-of-geriatric-hip-fracture-care-a%C3%A2-slovenian-trauma-center-analysis
#8
Dejan Krušič, Drago Brilej, Colin Currie, Radko Komadina
BACKGROUND: The aim was to describe an audit of hip fracture patient care and outcomes in a Slovenian healthcare setting prior to the implementation of the Geriatric Fracture Center (GFC) model of care. METHODS: The Fragility Fracture Network (FFN) hip fracture audit database was used to collect data on hip fracture care in elderly patients. Epidemiological data were submitted as well as fracture type, prefracture residence and mobility prior to the fracture. The timeline of events and acute care data were also collected...
November 28, 2016: Wiener Klinische Wochenschrift
https://www.readbyqxmd.com/read/27893030/development-and-initial-validation-of-the-risk-analysis-index-for-measuring-frailty-in-surgical-populations
#9
Daniel E Hall, Shipra Arya, Kendra K Schmid, Casey Blaser, Mark A Carlson, Travis L Bailey, Georgia Purviance, Tammy Bockman, Thomas G Lynch, Jason Johanning
Importance: Growing consensus suggests that frailty-associated risks should inform shared surgical decision making. However, it is not clear how best to screen for frailty in preoperative surgical populations. Objective: To develop and validate the Risk Analysis Index (RAI), a 14-item instrument used to measure surgical frailty. It can be calculated prospectively (RAI-C), using a clinical questionnaire, or retrospectively (RAI-A), using variables from the surgical quality improvement databases (Veterans Affairs or American College of Surgeons National Surgical Quality Improvement Projects)...
November 23, 2016: JAMA Surgery
https://www.readbyqxmd.com/read/27887932/assessing-national-provision-of-care-variability-in-bariatric-clinical-care-pathways
#10
Dana A Telem, Saniea F Majid, Kinga Powers, Eric DeMaria, John Morton, Daniel B Jones
BACKGROUND: The American Society for Metabolic and Bariatric Surgery (ASMBS) Quality Improvement and Patient Safety (QIPS) Committee hypothesized that collecting and sharing clinical pathways could provide a valuable resource to new and existing bariatric programs. OBJECTIVE: To shed light on the variability in practice patterns across the country by analyzing pathways. SETTING: United States Centers of Excellence METHODS: From June 2014 to April 2015, clinical pathways pertaining to preoperative, intraoperative, and postoperative management of bariatric patients were solicited from the ASMBS executive council (EC), QIPS committee members, and state chapter presidents...
August 3, 2016: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
https://www.readbyqxmd.com/read/27884330/factors-associated-with-adverse-events-after-emergency-laparotomy-in-cape-town-south-africa-identifying-opportunities-for-quality-improvement
#11
Richard Trafford Spence, Mark Hampton, Kent Pluke, Miriam Kahn, Nkhabe Chinyepi, Mohamed Elmusbahi, Tirsa van Wyngaard, Eugenio Panieri
BACKGROUND: Surgical outcomes research is limited in areas of the world with the greatest unmet surgical need and likely greatest variation in outcomes. Measurement alone may improve outcomes-the so-called Hawthorne effect. The purpose of this multicenter cohort study was to identify factors that are both feasible to collect and are associated with a major adverse event following a targeted procedure in Cape Town, South Africa. METHODS: A collaborative of four acute care surgical units was formed to develop a data set with minimal data burden describing outcomes after an emergency exploratory laparotomy during a 3-mo period (February-April 2015)...
December 2016: Journal of Surgical Research
https://www.readbyqxmd.com/read/27881360/an-observational-registry-of-carotid-endarterectomy-and-carotid-artery-stenting-in-brazil-study-protocol
#12
Edwaldo Edner Joviliano, Winston Bonetti Yoshida, Marcone Lima Sobreira, Regina Moura, Ana Terezinha Guillaumon, Selma Regina De Oliveira Raymundo, Daniel Gustavo Miquelin, Ludvig Hafner, Marcelo Jose Almeida
BACKGROUND: Carotid artery stenting (CAS) and carotid endarterectomy (CEA) are alternative strategies for stroke prevention in patients with atherosclerotic carotid disease. CEA has been considered the first-line treatment for carotid stenosis worldwide, and the safety and efficacy of CAS compared to CEA remains in question. OBJECTIVE: The purpose of this study is to compare the practice and outcomes of CAS and CEA in a real-world setting within public university hospitals in Brazil...
November 23, 2016: JMIR Research Protocols
https://www.readbyqxmd.com/read/27878350/home-return-after-surgery-in-patients-aged-over-85%C3%A2-years-is-associated-with-preoperative-albumin-levels-the-type-of-surgery-and-apache-ii-score
#13
Bora Lee, Sungwon Na, Miran Park, Sungyeon Ham, Jeongmin Kim
BACKGROUND: Owing to an aging society, both the number of operations for patients aged >85 years and the average age of patients admitted to the intensive care unit (ICU) are rapidly increasing. However, mortality is not an appropriate outcome measurement in patients aged >85 years; a more important outcome is home return (HR), because quality of life is valuable to these patients. We identified predictors for HR of patients aged >85 years admitted to the ICU after surgery...
November 22, 2016: World Journal of Surgery
https://www.readbyqxmd.com/read/27876255/patient-and-perioperative-variables-affecting-30-day-readmission-for-surgical-complications-after-hip-and-knee-arthroplasties-a-matched-cohort-study
#14
Benjamin F Ricciardi, Kathryn K Oi, Steven B Daines, Yuo-Yu Lee, Amethia D Joseph, Geoffrey H Westrich
BACKGROUND: Changes in reimbursement for total hip and knee arthroplasties (THA and TKA) have placed increased financial burden of early readmission on hospitals and surgeons. Our purpose was to characterize factors of 30-day readmission for surgical complications after THA and TKA at a single, high-volume orthopedic specialty hospital. METHODS: Patients with a diagnosis of osteoarthritis and who were readmitted within 30 days of their unilateral primary THA or TKA procedure between 2010 and 2014...
October 21, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27872976/development-and-validation-of-a-scoring-system-to-predict-surgical-site-infection-after-ventral-hernia-repair-a-michigan-surgical-quality-collaborative-study
#15
Efstathios Karamanos, Pridvi Kandagatla, Jenna Watson, Nathan Schmoekel, Aamir Siddiqui
INTRODUCTION: Surgical site infections (SSIs) are a rare but significant complication following an elective ventral hernia repair. This study aims to develop a risk assessment tool in order to predict the risk of developing SSIs postoperatively. METHODS: All patients undergoing an elective ventral hernia repair were identified using the Michigan Surgical Quality Collaborative (MSQC) database. Patients' demographics, comorbidities and technical aspects of the operations were extracted...
November 21, 2016: World Journal of Surgery
https://www.readbyqxmd.com/read/27872117/protocol-for-a-multicentre-randomised-feasibility-trial-evaluating-early-surgery-alone-in-low-rectal-cancer-sailor
#16
Dean A Harris, Kymberley Thorne, Hayley Hutchings, Saiful Islam, Gail Holland, Olivia Hatcher, Sarah Gwynne, Ian Jenkins, Peter Coyne, Michael Duff, Melanie Feldman, Des C Winter, Simon Gollins, Phil Quirke, Nick West, Gina Brown, Deborah Fitzsimmons, Alan Brown, John Beynon
INTRODUCTION: There are 11 500 rectal cancers diagnosed annually in the UK. Although surgery remains the primary treatment, there is evidence that preoperative radiotherapy (RT) improves local recurrence rates. High-quality surgery in rectal cancer is equally important in minimising local recurrence. Advances in MRI-guided prediction of resection margin status and improvements in abdominoperineal excision of the rectum (APER) technique supports a reassessment of the contribution of preoperative RT...
November 21, 2016: BMJ Open
https://www.readbyqxmd.com/read/27870676/bundled-payments-for-care-improvement-lessons-learned-in-the-first-year
#17
Peter L Althausen, Lisa Mead
The Bundled Payments for Care Improvement (BPCI) initiative is the latest cost-saving program developed by the Center for Medicare and Medicaid Innovation. This model is intended to create a system for higher quality and more coordinated care at a lower cost to Medicare. It is currently an optional program for physician groups, hospitals and post-acute care providers to benefit financially from improved care models and cost containment measures. Under the initiative, organizations enter into payment arrangements that include financial and performance accountability for episodes of care...
December 2016: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/27869890/-anmco-sic-sici-gise-sicch-consensus-document-risk-stratification-in-elderly-patients-undergoing-cardiac-surgery-and-transcatheter-aortic-valve-implantation
#18
Giovanni Pulignano, Michele Massimo Gulizia, Samuele Baldasseroni, Francesco Bedogni, Giovanni Cioffi, Ciro Indolfi, Francesco Romeo, Adriano Murrone, Francesco Musumeci, Alessandro Parolari, Leonardo Patanè, Paolo Giuseppe Pino, Annalisa Mongiardo, Carmen Spaccarotella, Roberto Di Bartolomeo, Giuseppe Musumeci
Aortic stenosis is one the most frequent valvular diseases in developed countries, and its impact on public healthcare resources and assistance is increasing. A substantial proportion of elderly patients with severe aortic stenosis is frequently not eligible for surgery because of advanced age, frailty and multiple comorbidities. Transcatheter aortic valve implantation (TAVI) enables the treatment of very elderly patients at high or prohibitive surgical risk considered ineligible for surgery and with an acceptable life expectancy...
September 2016: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/27865752/reconstruction-of-massive-localized-lymphedema-of-the-scrotum-results-complications-and-quality-of-life-improvements
#19
Eric Wisenbaugh, Dena Moskowitz, Joel Gelman
OBJECTIVE: To review the surgical technique, outcomes and complications of surgical excision of massive localized lymphedema of the scrotum, and to determine changes in weight and quality of life after excision. MATERIALS AND METHODS: A retrospective review was performed for all patients who have undergone excision of MLL of the scrotum at our institution between 2008 and 2014. Standard baseline characteristics, complications, pre- and postoperative weight and quality of life data were recorded...
November 16, 2016: Urology
https://www.readbyqxmd.com/read/27864619/bicentric-prospective-evaluation-of-corporoplasty-with-porcine-small-intestinal-submucosa-sis-in-patients-with-severe-peyronie-s-disease
#20
K Sayedahmed, B Rosenhammer, P J Spachmann, M Burger, M Aragona, B T Kaftan, R Olianas, H M Fritsche
INTRODUCTION: Advanced Peyronie's disease (PD) with severe penile deviation demands grafting procedures following plaque incision or partial plaque excision in order to avoid penile shortening and to improve quality of life of affected patients. Small intestinal submucosa (SIS) is an established xenograft. The objective of the present study was to validate external results in a bicentric prospective manner. METHODS: Patient selection criteria, surgical technique and standards for pre- and postoperative care were defined...
November 18, 2016: World Journal of Urology
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