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Surgical care quality

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https://www.readbyqxmd.com/read/28742774/improving-adherence-to-intraoperative-lung-protective-ventilation-strategies-at-a-university-medical-center
#1
Sean A Josephs, Gretchen A Lemmink, Judith A Strong, Cassandra L Barry, William E Hurford
BACKGROUND: Intraoperative lung-protective ventilation (ILPV) is defined as tidal volumes <8 mL/kg ideal bodyweight and is increasingly a standard of care for major abdominal surgical procedures performed under general anesthesia. In this study, we report the result of a quality improvement initiative targeted at improving adherence to ILPV guidelines in a large academic teaching hospital. METHODS: We performed a time-series study to determine whether anesthesia provider adherence to ILPV was affected by certain improvement interventions and patient ideal body weight (IBW)...
July 24, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28742736/comparative-analysis-of-perioperative-outcomes-using-nationally-derived-hospital-discharge-data-relative-to-a-prospective-multicenter-surgical-database-of-adult-spinal-deformity-surgery
#2
Gregory W Poorman, Peter G Passias, Aaron J Buckland, Cyrus M Jalai, Michael Kelly, Daniel M Sciubba, Brian J Neuman, D Kojo Hamilton, Amit Jain, Bassel Diebo, Virginie Lafage, Shay Bess, Eric O Klineberg
STUDY DESIGN: Retrospective analysis of three prospectively collected databases. OBJECTIVE: To compare perioperative outcomes in Adult Spinal Deformity (ASD) surgeries in a surgeon-run (SR-ASD) and two national databases: the Nationwide Inpatient Sample (NIS) and the National Surgical Quality Improvement Program (NSQIP). SUMMARY OF BACKGROUND DATA: Much has been learned on the treatment of ASD in the last decade with prospective multicenter collaborative research focusing on this specific condition...
August 1, 2017: Spine
https://www.readbyqxmd.com/read/28742681/targeting-value-driven-quality-improvement-for-laparoscopic-cholecystectomy-in-michigan
#3
Kyle H Sheetz, Brooke Kenney, James M Dupree, Darrell A Campbell, Michael J Englesbe
OBJECTIVE: The purpose of this study was to evaluate complete episode expenditures for laparoscopic cholecystectomy, a common and lower-risk operation, to characterize novel targets for value-based quality improvement. SUMMARY BACKGROUND DATA: Despite enthusiasm for improving the overall value of surgical care, most efforts have focused on high-risk inpatient surgery. METHODS: We identified 19,213 patients undergoing elective laparoscopic cholecystectomy from 2012 to 2015 using data from Medicare and a large private payer...
July 24, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28739067/the-unique-role-of-the-pediatric-clinical-research-nurse-in-anesthesia-an-interdisciplinary-collaboration
#4
Christine Dube, Vanessa Young, Michelle Anderson, Brenda Barton, Izabela Leahy
This article describes the distinctive function of the pediatric clinical research nurse (CRN) in the anesthesia setting. The pediatric CRN in anesthesia acts as a liaison between families and the research team and is the major nexus between the principal investigator or anesthesiologist on a study, and the collaborating surgeons from many different departments. This is unique because the CRNs collaborate with physicians in specialties that can include plastics, urology, neurosurgery, orthopaedics, otolaryngology, cardiology, critical care, and many other departments...
August 2017: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
https://www.readbyqxmd.com/read/28738984/transfusing-wisely-clinical-decision-support-improves-blood-transfusion-practices
#5
Ian Jenkins, Jay J Doucet, Brian Clay, Patricia Kopko, Donald Fipps, Eema Hemmen, Debra Paulson
BACKGROUND: The cost and risks of red blood cell (RBC) transfusions, along with evidence of overuse, suggest that improving transfusion practices is a key opportunity for health systems to improve both the quality and value of patient care. Previous work, which included a BestPractice Advisory (BPA), was adapted in a quality improvement project designed to reduce both exposure to unnecessary blood products and costs. METHODS: A prospective, pre-post study was conducted at an academic medical center with a diverse patient population...
August 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28738944/predicting-postoperative-complications-for-acute-care-surgery-patients-using-the-acs-nsqip-surgical-risk-calculator
#6
Jessica R Burgess, Benjamin Smith, Rebecca Britt, Leonard Weireter, Travis Polk
The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) risk calculator has been used to assist surgeons in predicting the risk of postoperative complications. This study aims to determine if the risk calculator accurately predicts complications in acute care surgical patients undergoing laparotomy. A retrospective review was performed on all patients on the acute care surgery service at a tertiary hospital who underwent laparotomy between 2011 and 2012. The preoperative risk factors were used to calculate the estimated risks of postoperative complications in both the original ACS NSQIP calculator and updated calculator (June 2016)...
July 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28738723/patients-expectations-for-the-functional-and-psychosocial-outcomes-of-orbital-decompression-surgery-for-thyroid-eye-disease-a-qualitative-study
#7
Sadie Wickwar, Hayley McBain, Matthew R Edmunds, Daniel G Ezra, Geoffrey E Rose, Stanton P Newman
Patients with appearance-altering conditions may be dissatisfied with the outcomes of reconstructive surgery due to unmet expectations. This study explored patients' expectations of orbital decompression surgery for thyroid eye disease (TED) and whether these were met. Semi-structured interviews were conducted at two times: (1) in the weeks after patients were listed for decompression surgery and before surgery; (2) up to 12 months after surgery. Thematic analysis was performed for each time point, to identify themes within the data...
July 25, 2017: Psychology, Health & Medicine
https://www.readbyqxmd.com/read/28737598/epidemiology-and-outcomes-of-cardiac-arrest-in-pediatric-cardiac-icus
#8
Jeffrey A Alten, Darren Klugman, Tia T Raymond, David S Cooper, Janet E Donohue, Wenying Zhang, Sara K Pasquali, Michael G Gaies
OBJECTIVES: In-hospital cardiac arrest occurs in 2.6-6% of children with cardiac disease and is associated with significant morbidity and mortality. Much remains unknown about cardiac arrest in pediatric cardiac ICUs; therefore, we aimed to describe cardiac arrest epidemiology in a contemporary multicenter cardiac ICU cohort. DESIGN: Retrospective analysis within the Pediatric Cardiac Critical Care Consortium clinical registry. SETTING: Cardiac ICUs within 23 North American hospitals...
July 21, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28737572/european-society-for-paediatric-gastroenterology-hepatology-and-nutrition-guidelines-for-the-evaluation-and-treatment-of-gastrointestinal-and-nutritional-complications-in-children-with-neurological-impairment
#9
Claudio Romano, Myriam van Wynckel, Jessie Hulst, Ilse Broekaert, Jiri Bronsky, Luigi Dall'Oglio, Nataša F Mis, Iva Hojsak, Rok Orel, Alexandra Papadopoulou, Michela Schaeppi, Nikhil Thapar, Michael Wilschanski, Peter Sullivan, Frédéric Gottrand
OBJECTIVES: Feeding difficulties are frequent in children with neurological impairments and can be associated with undernutrition, growth failure, micronutrients deficiencies, osteopenia, and nutritional comorbidities. Gastrointestinal problems including gastroesophageal reflux disease, constipation, and dysphagia are also frequent in this population and affect quality of life and nutritional status. There is currently a lack of a systematic approach to the care of these patients. With this report, European Society of Gastroenterology, Hepatology and Nutrition aims to develop uniform guidelines for the management of the gastroenterological and nutritional problems in children with neurological impairment...
August 2017: Journal of Pediatric Gastroenterology and Nutrition
https://www.readbyqxmd.com/read/28735120/outpatient-lumbar-microdiscectomy-in-france-from-an-economic-imperative-to-a-clinical-standard-an-observational-study-of-201-cases
#10
Bertrand Debono, Pascal Sabatier, Valérie Garnault, Olivier Hamel, Philippe Bousquet, Jean-Paul Lescure, Jean-Yves Plas
PURPOSE: The outpatient lumbar discectomy procedures have been established for more than two decades. However, especially in Europe, there are still obstacles to the development of these procedures, which may be related to medico-economic imperatives, and to several factors concerning both surgeons and patients. We describe our initial experience in introducing this method in our institution. METHODS: Over a three year period, 201 patients met the criteria for ambulatory lumbar microdiscectomy...
July 19, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28734963/variability-in-elective-day-surgery-rates-between-belgian-hospitals-analyses-of-administrative-data-explained-by-surgical-experts
#11
Roos Leroy, Cécile Camberlin, Mélanie Lefèvre, Koen Van den Heede, Carine Van de Voorde, Claire Beguin
BACKGROUND: In the last decades, day surgery has steadily and significantly grown in many countries, yet the increase has been uneven. There are large variations in day-surgery activity between countries, but also within countries between hospitals and surgeons. This paper explores the variability in day-care activity for elective surgical procedures between Belgian hospitals. MATERIALS AND METHODS: The administrative hospital data of all patients formally admitted in a Belgian hospital for inpatient or day-surgery care between 2011 and 2013 were analysed and summarized in graphs...
July 19, 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/28734706/emerging-minimally-invasive-treatment-options-for-male-lower-urinary-tract-symptoms
#12
REVIEW
Giuseppe Magistro, Christopher R Chapple, Mostafa Elhilali, Peter Gilling, Kevin T McVary, Claus G Roehrborn, Christian G Stief, Henry H Woo, Christian Gratzke
CONTEXT: Lower urinary tract symptoms (LUTS) are one of the most common and troublesome nonmalignant conditions affecting quality of life in aging men. A spectrum of established medical and surgical options is available to provide relief of bothersome LUTS. Both the adverse events of medication and the morbidity with surgical treatment modalities have to be counterbalanced against efficacy. Novel minimally invasive treatment options aim to be effective, ideally to be performed in an ambulatory setting under local anaesthesia and to offer a more favourable safety profile than existing reference techniques...
July 19, 2017: European Urology
https://www.readbyqxmd.com/read/28734657/exercise-performance-and-22q11-2-deletion-status-affect-quality-of-life-in-tetralogy-of-fallot
#13
Elizabeth Goldmuntz, Amy Cassedy, Laura Mercer-Rosa, Mark A Fogel, Stephen M Paridon, Bradley S Marino
OBJECTIVE: To identify mediators of health status and quality of life (QOL) in children and adolescents aged 8-18 years old following surgical repair for tetralogy of Fallot (TOF), including resource use, exercise performance, and 22q11.2 deletion status. STUDY DESIGN: We performed a corollary study to a cross-sectional analysis of subjects following repair for TOF that completed cardiac magnetic resonance imaging, cardiopulmonary exercise tests, and instruments assessing health status and QOL...
July 19, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/28733171/are-residents-prepared-for-surgical-cases-implications-in-patient-safety-and-education
#14
Minh-Bao Mundschenk, Elizabeth B Odom, Trina D Ghosh, Grant M Kleiber, Andrew Yee, Kamlesh B Patel, Susan E Mackinnon, Marissa M Tenenbaum, Donald W Buck
OBJECTIVE: In surgical education, the areas of focus and evaluation are skewed toward technical skill and operative knowledge; less emphasized is familiarity with the patient's medical history. The purposes of this study were to characterize how surgical trainees prepare for cases and to determine the comprehensiveness of their preparation. DESIGN: A 27-question survey was created through a web-based software program and distributed to all resident physicians and fellows in the Departments of Surgery, Neurosurgery, and Otolaryngology at our institution...
July 18, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/28730301/biopsychosocial-factors-predict-quality-of-life-in-thoracolumbar-spine-surgery
#15
Dean A Tripp, Edward Abraham, Maude Lambert, Kate Wagg, Erin Bigney, Eden Daly, Phylicia Verreault, Neil Manson
PURPOSE: Surgical intervention is a treatment option for various spinal pathology but many patients report no improvement or even an exacerbation of symptoms like pain. This study examined the association of preoperative (pre-op) biopsychosocial risk factors with poor quality of life at 2 and 6 months using hierarchical models controlling demographic and medical variables. METHOD: Participants undergoing thoracolumbar spine surgery (N = 214) were provided with questionnaire packages to complete pre-op, at 2 and at 6-month postoperative clinical follow-ups (i...
July 20, 2017: Quality of Life Research
https://www.readbyqxmd.com/read/28729319/accelerated-enhanced-recovery-following-minimally-invasive-colorectal-cancer-surgery-recovermi-a-study-protocol-for-a-novel-randomised-controlled-trial
#16
Brandee A Price, Brian K Bednarski, Y Nancy You, Meryna Manandhar, E Michelle Dean, Zeinab M Alawadi, B Bryce Speer, Vijaya Gottumukkala, Marla Weldon, Robert L Massey, Xuemei Wang, Wei Qiao, George J Chang
INTRODUCTION: Definitive treatment of localised colorectal cancer involves surgical resection of the primary tumour. Short-stay colectomies (eg, 23-hours) would have important implications for optimising the efficiency of inpatient care with reduced resource utilisation while improving the overall recovery experience with earlier return to normalcy. It could permit surgical treatment of colorectal cancer in a wider variety of settings, including hospital-based ambulatory surgery environments...
July 20, 2017: BMJ Open
https://www.readbyqxmd.com/read/28728520/in-and-out-hospital-mortality-rate-in-surgical-patients
#17
Philippe Dony, Magali Pirson, Jean G Boogaerts
BACKGROUND: Death rates after surgery are increasingly analysed for clinical audit and quality assessment. Many studies commonly provide information only on deaths that occur during hospital stay, known as in-hospital death rates. By using hospital data set linked to death certificate registry, we recorded in- and out-hospital deaths within 30 and 60 post-operative days. METHODS: The study included all consecutive surgical procedures (denominator) under general or locoregional anaesthesia in adult patients admitted for elective or non-elective inpatient surgery...
July 20, 2017: Acta Chirurgica Belgica
https://www.readbyqxmd.com/read/28728329/liposuction-in-the-treatment-of-lipedema-a-longitudinal-study
#18
Mehran Dadras, Peter Joachim Mallinger, Cord Christian Corterier, Sotiria Theodosiadi, Mojtaba Ghods
BACKGROUND: Lipedema is a condition consisting of painful bilateral increases in subcutaneous fat and interstitial fluid in the limbs with secondary lymphedema and fibrosis during later stages. Combined decongestive therapy (CDT) is the standard of care in most countries. Since the introduction of tumescent technique, liposuction has been used as a surgical treatment option. The aim of this study was to determine the outcome of liposuction used as treatment for lipedema. METHODS: Twenty-five patients who received 72 liposuction procedures for the treatment of lipedema completed a standardized questionnaire...
July 2017: Archives of Plastic Surgery
https://www.readbyqxmd.com/read/28727858/association-of-velopharyngeal-insufficiency-with-quality-of-life-and-patient-reported-outcomes-after-speech-surgery
#19
Aditi Bhuskute, Jonathan R Skirko, Christina Roth, Ahmed Bayoumi, Blythe Durbin-Johnson, Travis T Tollefson
Importance: Patients with cleft palate and other causes of velopharyngeal insufficiency (VPI) suffer adverse effects on social interactions and communication. Measurement of these patient-reported outcomes is needed to help guide surgical and nonsurgical care. Objectives: To further validate the VPI Effects on Life Outcomes (VELO) instrument, measure the change in quality of life (QOL) after speech surgery, and test the association of change in speech with change in QOL...
July 20, 2017: JAMA Facial Plastic Surgery
https://www.readbyqxmd.com/read/28727137/national-evaluation-of-multidisciplinary-quality-metrics-for-head-and-neck-cancer
#20
John D Cramer, Sedona E Speedy, Robert L Ferris, Alfred W Rademaker, Urjeet A Patel, Sandeep Samant
BACKGROUND: The National Quality Forum has endorsed quality-improvement measures for multiple cancer types that are being developed into actionable tools to improve cancer care. No nationally endorsed quality metrics currently exist for head and neck cancer. METHODS: The authors identified patients with surgically treated, invasive, head and neck squamous cell carcinoma in the National Cancer Data Base from 2004 to 2014 and compared the rate of adherence to 5 different quality metrics and whether compliance with these quality metrics impacted overall survival...
July 20, 2017: Cancer
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