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https://www.readbyqxmd.com/read/28650410/identification-of-risk-factors-in-lymphatic-surgeries-for-melanoma-a-national-surgical-quality-improvement-program-review
#1
Mona Ascha, Mustafa S Ascha, Brian Gastman
INTRODUCTION: Sentinel lymph node biopsy (SLNB) and lymphadenectomy (LAD) are commonly performed in the staging and care of patients with malignant melanoma. These procedures are accompanied by complications that may result in hospital readmission, negatively affecting patient outcomes and potentially affecting surgical procedure reimbursement. The National Surgical Quality Improvement Program (NSQIP) database offers a large data set allowing physicians to evaluate 30-day readmission for surgical complications...
June 23, 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28648651/the-impact-of-functional-status-on-the-outcomes-of-endovascular-lower-extremity-revascularization-for-critical-limb-ischemia-in-the-elderly
#2
Isidore Dinga Madou, Martin D Slade, Kristine C Orion, Timur Sarac, Cassius Iyad Ochoa Chaar
INTRODUCTION: Functional status is an important predictor of outcomes after infrainguinal bypass surgery. There is little data on the effect of functional status on the outcomes of endovascular LE interventions, especially in the elderly frail population. METHODS: This is a retrospective analysis of the American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) files for the years 2011-2013 to assess the impact of functional status on outcome after endovascular intervention for critical limb ischemia...
June 22, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28648159/-treating-post-operative-pain
#3
Morten Rune Blichfeldt-Eckhardt, Jan Mick Jensen, Jytte Frandsen Møller
Post-operative pain is a problem for many patients and affects recovery, risk of post-operative complications and quality of life. A thorough preoperative evaluation, careful perioperative planning, identification, and individualized treatment of high-risk patients can reduce post-operative pain. Multimodal treatment combines different analgesic techniques in order to utilize synergistic and additive effects of different treatments and has the potential to optimize effects and reduce side effects. Identification and treatment of patients with chronic post-operative pain should be prioritized...
June 26, 2017: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/28647069/oncologic-quality-indicators-in-thoracic-surgery
#4
REVIEW
Jessica Hudson, Tara Semenkovich, Varun Puri
This article outlines a structure for assessing thoracic surgical quality and provides an overview of evidence-based quality metrics for surgical care in both lung cancer and esophageal cancer, with a focus on process and outcome measures in the preoperative, intraoperative, and postoperative setting.
August 2017: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/28647068/risk-adjustment-and-performance-measurement-for-esophageal-cancer-resection
#5
REVIEW
Stephanie G Worrell, Andrew C Chang
Achieving high-quality care for all patients undergoing esophageal cancer requires identifying and modifying risk factors associated with poor outcomes. These factors occur at different time points from the preoperative to the postoperative periods. A straightforward model for predicting outcomes has proved difficult to identify. This article reviews the current studies addressing risk adjustment and performance measurement for esophageal cancer resection.
August 2017: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/28637567/the-impact-of-early-recurrence-on-quality-of-life-after-cytoreduction-with-hipec
#6
Nathan M Hinkle, Vandana Botta, John P Sharpe, Paxton Dickson, Jeremiah Deneve, Gitonga Munene
Improved oncological outcomes after cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in highly selected patients have been well documented. The extensive nature of the procedure adversely affects quality of life (QoL). The aim of this study is to longitudinally evaluate QoL following CRS/HIPEC. This is a retrospective review of a prospectively maintained database of patients with peritoneal malignancies undergoing CRS/HIPEC. Clinicopathological data, oncologic outcomes, and QoL were analyzed preoperatively and postoperatively at 2 weeks, and 1, 3, 6, and 12 months...
June 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28637558/travel-time-influences-readmission-risk-geospatial-mapping-of-surgical-readmissions
#7
Florence E Turrentine, Patrick J Buckley, Min-Woong Sohn, Michael D Williams
The University of Virginia (UVA) has recently become an Accountable Care Organization (ACO), intensifying efforts to provide better care for individuals. UVA's ACO population resides across the entire Commonwealth, with a large percentage of patients living in rural areas. To provide better health for this population, the central tenet of the ACO mission, we identified geographic risk factors influencing hospital readmission. We analyzed the relationship between the distance of patients' residence to the nearest hospital and 30-day readmission in general surgery patients...
June 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28637557/nomogram-derived-prediction-of-postoperative-ileus-after-colectomy-an-assessment-from-nationwide-procedure-targeted-cohort
#8
Ahmet Rencuzogullari, Cigdem Benlice, Meagan Costedio, Feza H Remzi, Emre Gorgun
Postoperative ileus (POI) is a clinical burden to health-care system. This study aims to evaluate the incidence and predictors of POI in patients undergoing colectomy and create a nomogram by using recently released procedure-targeted nationwide database. Patients who underwent elective colectomy in 2012 and 2013 were identified from American College of Surgeons National Surgical Quality Improvement Program using the new procedure-targeted database. Demographics, comorbidities, and 30-day postoperative outcomes were evaluated...
June 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28632535/perioperative-surgical-home-evaluation-of-a-new-protocol-focused-on-a-multidisciplinary-approach-to-manage-children-undergoing-posterior-spinal-fusion-operation
#9
Eugene Kim, Brian Lee, Giovanni Cucchiaro
BACKGROUND: The concept of Perioperative Surgical Home has been gaining significant attention in surgical centers. This model is delivering and improving coordinated care in a cost-effective manner to patients undergoing surgical procedures. It starts with the decision for surgical intervention, continues to the intraoperative and postoperative periods, and follows into long-term recovery. Constant re-evaluation of outcomes and modifications of delivery provides a feedback loop for improvement...
June 17, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28631129/optimizing-the-deep-brain-stimulation-care-pathway-in-patients-with-parkinson-s-disease
#10
N J Thomas, P Mertens, T Danaila, G Polo, H Klinger, E Broussolle, S Thobois
Management of Parkinson's disease (PD) using deep brain stimulation (DBS) requires complex care in specialized, multidisciplinary centers. A well-organized, efficient patient flow is crucial to ensure that eligible patients can quickly access DBS. Delays or inefficiencies in patient care may impact a center's ability to meet demand, creating a capacity bottleneck. Analysis of the current practices within a center may help identify areas for improvement. After external audit of the DBS workflow of the Lyon Neurological Hospital and comparison with other European centers, manageable steps were suggested to restructure the care pathway...
June 19, 2017: Journal of Neurology
https://www.readbyqxmd.com/read/28614127/a-hospital-is-not-just-a-factory-but-a-complex-adaptive-system-implications-for-perioperative-care
#11
Aman Mahajan, Salim D Islam, Michael J Schwartz, Maxime Cannesson
Many methods used to improve hospital and perioperative services productivity and quality of care have assumed that the hospital is essentially a factory, and therefore, that industrial engineering and manufacturing-derived redesign approaches such as Six Sigma and Lean can be applied to hospitals and perioperative services just as they have been applied in factories. However, a hospital is not merely a factory but also a complex adaptive system (CAS). The hospital CAS has many subsystems, with perioperative care being an important one for which concepts of factory redesign are frequently advocated...
July 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28607678/choosing-wisely-a-quality-improvement-initiative-to-decrease-unnecessary-preoperative-testing
#12
John Matulis, Stephen Liu, John Mecchella, Frederick North, Alison Holmes
Dartmouth-Hitchcock Medical Center is a rural, academic medical center in the northeastern United States; its General Internal Medicine (GIM) division performs about 900 low and intermediate surgical risk preoperative evaluations annually. Routine preoperative testing in these evaluations is widely considered a low-value service. Our baseline data sample showed unnecessary testing rates of approximately 36%. A multi-disciplinary team used a micro-systems approach to analyze the existing process and formulate a rapid cycle improvement strategy...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28601329/predictors-of-readmission-in-nonagenarians-analysis-of-the-american-college-of-surgeons-national-surgical-quality-improvement-project-dataset
#13
Zachary Hothem, Dustin Baker, Christina S Jenkins, Jason Douglas, Rose E Callahan, Catherine C Shuell, Graham W Long, Robert J Welsh
BACKGROUND: Increased longevity has led to more nonagenarians undergoing elective surgery. Development of predictive models for hospital readmission may identify patients who benefit from preoperative optimization and postoperative transition of care intervention. Our goal was to identify significant predictors of 30-d readmission in nonagenarians undergoing elective surgery. METHODS: Nonagenarians undergoing elective surgery from January 2011 to December 2012 were identified using the American College of Surgeons National Surgical Quality Improvement Project participant use data files...
June 1, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28594992/association-of-modified-frailty-index-score-with-perioperative-risk-for-patients-undergoing-total-laryngectomy
#14
Brandon Wachal, Matthew Johnson, Alissa Burchell, Harlan Sayles, Katherine Rieke, Robert Lindau, William Lydiatt, Aru Panwar
Importance: Objective preoperative risk assessment tools, such as the Modified Frailty Index (mFI), may inform patient and physician decision making when considering total laryngectomy. Estimation of outcomes may help to set realistic expectations about recovery and outcomes and facilitate optimal resource management. Objective: To evaluate the association between the mFI score as a measure of frailty and outcomes following total laryngectomy. Design, Setting, and Participants: Retrospective evaluation using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), a risk- and case-mix-adjusted national quality assessment program...
June 8, 2017: JAMA Otolaryngology—Head & Neck Surgery
https://www.readbyqxmd.com/read/28578845/how-do-preoperative-medications-influence-outcomes-after-total-joint-arthroplasty
#15
Bradley J Zarling, Jakub Sikora-Klak, Chris Bergum, David C Markel
BACKGROUND: Recent health care policy changes require hospitals and physicians to demonstrate improved quality. In 2012, a prospective database was formed with the Blue Cross and Blue Shield of Michigan to improve quality of care. The purpose of this study was to analyze patient preoperative medication as predictors of outcomes after total joint arthroplasty. METHODS: Data were collected on patient's preoperative medications from 2012 to 2015 using a total joint arthroplasty database...
April 27, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28578652/icorg-10-14-neoadjuvant-trial-in-adenocarcinoma-of-the-oesophagus-and-oesophagogastric-junction-international-study-neo-aegis
#16
J V Reynolds, S R Preston, B O'Neill, L Baeksgaard, S M Griffin, C Mariette, S Cuffe, M Cunningham, T Crosby, I Parker, K Hofland, G Hanna, L B Svendsen, C L Donohoe, C Muldoon, D O'Toole, C Johnson, N Ravi, G Jones, A K Corkhill, M Illsley, J Mellor, K Lee, M Dib, V Marchesin, M Cunnane, K Scott, P Lawner, S Warren, S O'Reilly, G O'Dowd, G Leonard, B Hennessy, R Mc Dermott
BACKGROUND: Neoadjuvant therapy is increasingly the standard of care in the management of locally advanced adenocarcinoma of the oesophagus and junction (AEG). In randomised controlled trials (RCTs), the MAGIC regimen of pre- and postoperative chemotherapy, and the CROSS regimen of preoperative chemotherapy combined with radiation, were superior to surgery only in RCTs that included AEG but were not powered on this cohort. No completed RCT has directly compared neoadjuvant or perioperative chemotherapy and neoadjuvant chemoradiation...
June 3, 2017: BMC Cancer
https://www.readbyqxmd.com/read/28570465/shared-medical-appointments-for-adolescent-breast-reduction
#17
Tara L Braun, Matthew G Kaufman, Cristina Hernandez, Laura A Monson
Adolescents with macromastia face serious physical, emotional, and social burdens because of their large breast size. Studies have shown that reduction mammoplasty results in improvement in physical symptoms and quality of life for these patients. Shared medical appointments (SMAs), defined as individual patient-physician encounters that occur in a group setting, have been successfully applied to clinics for adult patients seeking breast reduction for this condition. We decided to apply the SMA model to our clinic for preoperative evaluation of adolescent patients with macromastia...
May 31, 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28560229/is-there-a-rationale-for-structural-quality-assurance-in-esophageal-surgery
#18
REVIEW
Torben Glatz, Jens Höppner
BACKGROUND: Advances regarding perioperative mortality rates and oncological outcomes after esophagectomy have been reported extensively by specialized high-volume centers in Europe and the USA over the last decade. However, recent database analyses reveal that the perioperative mortality of esophagectomy remains high in these countries, indicating a discrepancy between surgical quality in baseline hospitals and specialized centers. METHODS: This article provides an overview over the existing literature on the correlation between structural quality, procedural volume, and surgical outcome in e- sophageal surgery...
May 2017: Visceral Medicine
https://www.readbyqxmd.com/read/28546379/tracheostomy-in-infants-and-children
#19
Karen F Watters
Over the last decade, tracheostomy has been increasingly performed in children, aligned with the improvements in neonatal and pediatric ICU care. Nowadays, the majority of children with tracheostomy represent a very complex cohort of patients with sustained reliance on tracheostomy and related medical technology for long-term survival. Tracheostomy is one of the most commonly performed procedures in the adult ICU. Contrary to adult practice, tracheostomy is a much less common procedure in the pediatric ICU, being performed in < 3% of patients...
June 2017: Respiratory Care
https://www.readbyqxmd.com/read/28542100/global-spinal-alignment-in-patients-with-cervical-spondylotic-myelopathy
#20
Go Yoshida, Abdulmajeed Alzakri, Vincent Pointillart, Louis Boissiere, Ibrahim Obeid, Yukihiro Matsuyama, Jean Marc Vital, Olivier Gille
STUDY DESIGN: Prospective radiographic analysis of cervical spondylotic myelopathy (CSM) OBJECTIVE.: To clarify the pathophysiology of CSM, and use the characteristic of global spinal alignment for determining the surgical strategy. SUMMARY OF BACKGROUND DATA: Radiographic evaluation of CSM, in general, comprises cervical magnetic resonance imaging (MRI) and regional cervical radiography, which cannot distinguish between cervical hyperlodorsis with spinopelvic compensation and cervical lordorsis with normal global alignment...
May 24, 2017: Spine
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