51
|
Ramirez JL, Zarkowsky DS, Sorrentino TA, Hicks CW, Vartanian SM, Gasper WJ, Conte MS, Iannuzzi JC. Antegrade Common Femoral Artery Closure Device Use Is Safe and Associated With Decreased Complications. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.06.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
52
|
Boitano LT, Iannuzzi JC, Tanious A, Latz CA, Schwartz SI, Sosa JA, Eagleton MJ, Conrad MF. IP061. Novel Risk Score Predicts Need for Nonhome Discharge Following Open Abdominal Aortic Aneurysm Repair. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.04.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
53
|
Boitano LT, DeBono M, Tanious A, Iannuzzi JC, Clouse WD, Eagleton MJ, LaMuraglia G, Conrad MF. VESS13. Men With a History of Retention, Diabetes and Advanced Age Are at High Risk for Urinary Retention After Carotid Endarterectomy. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
54
|
Ramirez JL, Ramirez FD, Zarkowsky DS, Gasper WJ, Cohen BE, Conte MS, Grenon SM, Iannuzzi JC. IP039. Depression Predicts Nonhome Discharge After Abdominal Aortic Aneurysm Repair. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.04.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
55
|
Boitano LT, Iannuzzi JC, Tanious A, Mohebali J, Schwartz SI, Chang DC, Clouse WD, Conrad MF. Preoperative Predictors of Discharge Destination after Endovascular Repair of Abdominal Aortic Aneurysms. Ann Vasc Surg 2019; 57:109-117. [DOI: 10.1016/j.avsg.2018.12.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 11/21/2018] [Accepted: 12/06/2018] [Indexed: 01/01/2023]
|
56
|
Iannuzzi JC, Stapleton SM, Bababekov YJ, Chang D, Lancaster RT, Conrad MF, Cambria RP, Patel VI. Favorable impact of thoracic endovascular aortic repair on survival of patients with acute uncomplicated type B aortic dissection. J Vasc Surg 2018; 68:1649-1655. [DOI: 10.1016/j.jvs.2018.04.034] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/07/2018] [Indexed: 11/28/2022]
|
57
|
Boitano LT, Ergul EA, Tanious A, Iannuzzi JC, Cooper MA, Stone DH, Clouse WD, Conrad MF. A Regional Experience with Carotid Endarterectomy in Patients with a History of Neck Radiation. Ann Vasc Surg 2018; 54:12-21. [PMID: 30223012 DOI: 10.1016/j.avsg.2018.08.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 07/28/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Historically, a history of neck radiation has been considered as an anatomic risk factor for poor outcomes after carotid endarterectomy (CEA). However, this is based on small and primarily single institution reports with few comparative series. This study uses a regional quality database to compare perioperative outcomes of CEA in patients with and without a history of neck radiation (RAD and NORAD, respectively). METHODS The Vascular Study Group of New England database was queried for all CEA from 2003 to 2017. The RAD group included a history of neck radiation. Primary end points included perioperative stroke (30-day), myocardial infarction (MI) (in-hospital), death (30-day), a composite end point including major adverse events (MAEs: stroke, MI, and death), and long-term survival. RESULTS Overall, 18,832 patients underwent CEA (18,551 NORAD, 281 RAD). Baseline demographics differed in the following: the RAD group more frequently had a history of contralateral carotid artery stenting (1.4% vs. 0.3%, P = 0.009), anatomic high risk features (12.8% vs. 1.3%, P < 0.001), and contralateral carotid occlusion (5.3% vs. 2.4%, P = 0.005). The NORAD cohort comprised mostly women (38.9% vs. 29.5%, P < 0.001), had American Society of Anesthesiologists class 4 or 5 (8.0% vs. 4.6%, P = 0.035), had higher body mass index (28.3 ± 5.6 vs. 27.1 ± 5.4, P < 0.001), on a beta blocker preoperatively (68.0% vs. 62.3%, P = 0.042), and had major cardiovascular comorbidities including coronary artery disease (29.6% vs. 22.1%, P = 0.006). There were no differences in the percent stenosis, proportion symptomatic (37.4% vs. 34.2%, P = 0.259), use of preoperative antiplatelet agents or statins. Electroencephalography monitoring was more frequently used in RAD (54.5% vs. 46.0%, P = 0.005). There was no difference in perioperative complications, including stroke (RAD 0.4% vs. NORAD 0.7%, P > 0.999), MI (0.4% vs. 0.9%, P = 0.736), death (0.7% vs. 0.6%, P = 0.683), MAE (2.1% vs. 2.2%, P > 0.999), or long-term survival (79.9% vs. 85.0%, P = 0.357). When only symptomatic or asymptomatic stenosis was considered, there remained no difference in primary end points. However, perioperative neurologic events (transient ischemic attack or stroke) was higher in symptomatic RAD versus symptomatic NORAD (6.7% vs. 2.6%, P = 0.020). CONCLUSIONS This regional experience with CEA in RAD patients shows similar perioperative morbidity, mortality, and long-term survival when compared with CEA for standard surgical patients (NORAD). Symptomatic presentation was associated with higher perioperative neurologic events, but this was not reflected in stroke rates. RAD is not always a contraindication to CEA and select patients can expect outcomes comparable to standard surgical patients.
Collapse
|
58
|
Iannuzzi JC, Boitano LT, Cooper M, Tanious A, Watkins M, Clouse WD, Eagleton MJ, Conrad MF. PC160. Risk Score for Non-Home Discharge After Lower Extremity Bypass. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.03.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
|
59
|
Boitano LT, Ergul E, Tanious A, Iannuzzi JC, Cooper MA, Stone DH, Clouse WD, Conrad MF. A Regional Experience with Carotid Endarterectomy in Patients with a History of Neck Radiation. Ann Vasc Surg 2018. [DOI: 10.1016/j.avsg.2018.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
60
|
Boitano LT, Iannuzzi JC, Mohebali J, Tanious A, Schwartz SI, Chang DC, Clouse WD, Conrad MF. Predictors of Discharge to a Skilled Nursing Facility after EVAR. Ann Vasc Surg 2018. [DOI: 10.1016/j.avsg.2018.01.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
61
|
Thorsness RJ, Iannuzzi JC, Shields EJ, Noyes K, Voloshin I. Cost-effectiveness of Open Reduction and Internal Fixation Compared With Hemiarthroplasty in the Management of Complex Proximal Humerus Fractures. J Shoulder Elb Arthroplast 2018. [DOI: 10.1177/2471549217751453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives To determine if open reduction and internal fixation (ORIF) is more cost-effective than hemiarthroplasty (HA) in the management of proximal humerus fracture. Design Retrospective cohort study with cost-effectiveness analysis. Setting Tertiary referral center in Rochester, NY. Patients/participants The records of 459 consecutive patients in whom a proximal humerus fracture was treated surgically at our institution between the years 2002 and 2012 were studied retrospectively. We identified 30 consecutive patients with a mean follow-up of 60.3 months (13.6–134.5 months) of which 15 patients underwent primary ORIF and another 15 underwent primary HA for the management of head-splitting fracture or fracture-dislocation of the proximal humerus. Intervention HA or ORIF for the management of proximal humerus fracture. Main outcome measurements SF-36 scores were converted to utility weights, and a cost-effectiveness model was designed to evaluated ORIF and HA. Results Given the baseline assumptions, ORIF was slightly more costly but also more effective (0.75 quality-adjusted life years [QALY] vs 0.67 QALY) than HA. The incremental cost-effectiveness ratio (ICER) was $5319/QALY for ORIF compared to HA, which is less than the cost-effectiveness standard utilized based on a willingness to pay of $50,000/QALY. Conclusions Compared to HA, ORIF is the more cost-effective approach for the surgical management of complex proximal humerus fractures. These data are limited by patient selection which would impact the relative utility scores. These results suggest that ORIF should be considered the preferable surgical approach given payer and patient perspectives. Level of Evidence: This is a Level III retrospective, cohort therapeutic study.
Collapse
|
62
|
Iannuzzi JC, Stapleton SM, Bababekov YJ, Chang DC, Lancaster RT, Conrad MF, Cambria RP, Patel VI. Favorable Impact of Thoracic Endovascular Aortic Repair on Long-Term Survival in Patients With Acute Uncomplicated Type B Aortic Dissection. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.07.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
63
|
Aquina CT, Becerra AZ, Probst CP, Xu Z, Hensley BJ, Iannuzzi JC, Noyes K, Monson JRT, Fleming FJ. Patients With Adhesive Small Bowel Obstruction Should Be Primarily Managed by a Surgical Team. Ann Surg 2017; 264:437-47. [PMID: 27433901 DOI: 10.1097/sla.0000000000001861] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate the impact of a primary medical versus surgical service on healthcare utilization and outcomes for adhesive small bowel obstruction (SBO) admissions. SUMMARY BACKGROUND DATA Adhesive-SBO typically requires hospital admission and is associated with high healthcare utilization and costs. Given that most patients are managed nonoperatively, many patients are admitted to medical hospitalists. However, comparisons of outcomes between primary medical and surgical services have been limited to small single-institution studies. METHODS Unscheduled adhesive-SBO admissions in NY State from 2002 to 2013 were identified using the Statewide Planning and Research Cooperative System. Bivariate and mixed-effects regression analyses were performed assessing factors associated with healthcare utilization and outcomes for SBO admissions. RESULTS Among 107,603 admissions for adhesive-SBO (78% nonoperative, 22% operative), 43% were primarily managed by a medical attending and 57% were managed by a surgical attending. After controlling for patient, physician, and hospital-level factors, management by a medical service was independently associated with longer length of stay [IRR = 1.39, 95% confidence interval (CI) = 1.24, 1.56], greater inpatient costs (IRR = 1.38, 95% = 1.21, 1.57), and a higher rate of 30-day readmission (OR = 1.32, 95% CI = 1.22, 1.42) following nonoperative management. Similarly, of those managed operatively, management by a medicine service was associated with a delay in time to surgical intervention (IRR = 1.84, 95% CI = 1.69, 2.01), extended length of stay (IRR=1.36, 95% CI = 1.25, 1.49), greater inpatient costs (IRR = 1.38, 95% CI = 1.11, 1.71), and higher rates of 30-day mortality (OR = 1.92, 95% CI = 1.50, 2.47) and 30-day readmission (OR = 1.13, 95% CI = 0.97, 1.32). CONCLUSIONS This study suggests that management of patients presenting with adhesive-SBO by a primary medical team is associated with higher healthcare utilization and worse perioperative outcomes. Policies favoring primary management by a surgical service may improve outcomes and reduce costs for patients admitted with adhesive-SBO.
Collapse
|
64
|
Aquina CT, Probst CP, Becerra AZ, Hensley BJ, Iannuzzi JC, Noyes K, Monson JR, Fleming FJ. The impact of surgeon volume on colostomy reversal outcomes after Hartmann's procedure for diverticulitis. Surgery 2016; 160:1309-1317. [DOI: 10.1016/j.surg.2016.05.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/20/2016] [Accepted: 05/11/2016] [Indexed: 12/22/2022]
|
65
|
Aquina CT, Probst CP, Hensley BJ, Becerra AZ, Xu Z, Iannuzzi JC, Noyes K, Monson JR, Fleming F. Variation in Use of a Minimally Invasive Approach for Colectomy: Time to Teach Old Dogs New Tricks? J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.06.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
66
|
Aquina CT, Probst CP, Becerra AZ, Iannuzzi JC, Hensley BJ, Xu Z, Noyes K, Monson JR, Fleming F. Emergency Surgery for Inflammatory Bowel Disease in the 21st Century Remains Life-Threatening–A Continual Failure of Decision-Making? J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.08.217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
67
|
Aquina CT, Becerra AZ, Probst CP, Hensley BJ, Xu Z, Iannuzzi JC, Noyes K, Monson JR, Fleming F. Are Surgeons Good at Both Inguinal and Ventral Hernia Repairs? Evidence from New York State. J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.06.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
68
|
Aquina CT, Becerra AZ, Probst CP, Hensley BJ, Xu Z, Iannuzzi JC, Noyes K, Monson JR, Fleming F. Delayed Cholecystectomy for Acute Cholecystitis Remains Common and is Still Associated with Higher Health Care Utilization and Worse Outcomes: Evidence-Based Medicine or Not? J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.06.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
69
|
Aquina CT, Probst CP, Becerra AZ, Iannuzzi JC, Hensley BJ, Noyes K, Monson JR, Fleming FJ. Missed Opportunity. Ann Surg 2016; 264:127-34. [DOI: 10.1097/sla.0000000000001389] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
70
|
Aquina CT, Probst CP, Becerra AZ, Hensley BJ, Iannuzzi JC, Noyes K, Monson JRT, Fleming FJ. High Variability in Nosocomial Clostridium difficile Infection Rates Across Hospitals After Colorectal Resection. Dis Colon Rectum 2016; 59:323-31. [PMID: 26953991 DOI: 10.1097/dcr.0000000000000539] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Hospital-acquired Clostridium difficile infection is associated with adverse patient outcomes and high medical costs. The incidence and severity of C. difficile has been rising in both medical and surgical patients. OBJECTIVE Our aim was to assess risk factors and variation associated with the development of nosocomial C. difficile colitis among patients undergoing colorectal resection. DESIGN This was a retrospective cohort study. SETTINGS The study included segmental colectomy and proctectomy cases in New York State from 2005 to 2013. PATIENTS The study cohort included 150,878 colorectal resections. Patients with a documented previous history of C. difficile infection or residence outside of New York State were excluded. MAIN OUTCOME MEASURES A diagnosis of C. difficile colitis either during the index hospital stay or on readmission within 30 days was the main measure. RESULTS C. difficile colitis occurred in 3323 patients (2.2%). Unadjusted C. difficile colitis rates ranged from 0% to 11.3% among surgeons and 0% to 6.8% among hospitals. After controlling for patient, surgeon, and hospital characteristics using mixed-effects multivariable analysis, significant unexplained variation in C. difficile rates remained present across hospitals but not surgeons. Patient factors explained only 24% of the total hospital-level variation, and known surgeon and hospital-level characteristics explained an additional 8% of the total hospital-level variation. Therefore, ≈70% of the hospital variation in C. difficile infection rates remained unexplained by captured patient, surgeon, and hospital factors. Furthermore, there was an ≈5-fold difference in adjusted C. difficile rates across hospitals. LIMITATIONS A limited set of hospital and surgeon characteristics was available. CONCLUSIONS Colorectal surgery patients appear to be at high risk for C. difficile infection, and alarming variation in nosocomial C. difficile infection rates currently exists among hospitals after colorectal resection. Given the high morbidity and cost associated with C. difficile colitis, adopting institutional quality improvement programs and maintaining strict prevention strategies are of the utmost importance.
Collapse
|
71
|
Aquina CT, Probst CP, Becerra AZ, Iannuzzi JC, Kelly KN, Hensley BJ, Rickles AS, Noyes K, Fleming FJ, Monson JR. High volume improves outcomes: The argument for centralization of rectal cancer surgery. Surgery 2016; 159:736-48. [DOI: 10.1016/j.surg.2015.09.021] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 08/04/2015] [Accepted: 09/23/2015] [Indexed: 11/28/2022]
|
72
|
Aquina CT, Blumberg N, Probst CP, Becerra AZ, Hensley BJ, Iannuzzi JC, Gonzalez MG, Deeb AP, Noyes K, Monson JRT, Fleming FJ. Significant Variation in Blood Transfusion Practice Persists following Upper GI Cancer Resection. J Gastrointest Surg 2015; 19:1927-37. [PMID: 26264360 DOI: 10.1007/s11605-015-2903-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 07/27/2015] [Indexed: 01/31/2023]
Abstract
PURPOSE Perioperative blood transfusions are costly and linked to adverse clinical outcomes. We investigated the factors associated with variation in blood transfusion utilization following upper gastrointestinal cancer resection and its association with infectious complications. METHODS The Statewide Planning and Research Cooperative System was queried for elective esophagectomy, gastrectomy, and pancreatectomy for malignancy in NY State from 2001 to 2013. Bivariate and hierarchical logistic regression analyses were performed to assess the factors associated with receiving a perioperative allogeneic red blood cell transfusion. Additional multivariable analysis examined the relationship between transfusion and infectious complications. RESULTS Among 14,875 patients who underwent upper GI cancer resection, 32 % of patients received a perioperative blood transfusion. After controlling for patient, surgeon, and hospital-level factors, significant variation in transfusion rates was present across both surgeons (p < 0.0001) and hospitals (p < 0.0001). Receipt of a blood transfusion was also independently associated with wound infection (OR = 1.68, 95% CI = 1.47 and 1.91), pneumonia (OR = 1.98, 95% CI = 1.74 and 2.26), and sepsis (OR = 2.49, 95% CI = 2.11 and 2.94). CONCLUSION Significant variation in perioperative blood transfusion utilization is present at both the surgeon and hospital level. These findings are unexplained by patient-level factors and other known hospital characteristics, suggesting that variation is due to provider preferences and/or lack of standardized transfusion protocols. Implementing institutional transfusion guidelines is necessary to limit unwarranted variation and reduce infectious complication rates.
Collapse
|
73
|
Aquina CT, Probst CP, Hensley BJ, Iannuzzi JC, Becerra AZ, Noyes K, Monson JR, Fleming F. Impact of Volume in the Aftermath of Diverticulitis Damage Control Operations. J Am Coll Surg 2015. [DOI: 10.1016/j.jamcollsurg.2015.07.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
74
|
Aquina CT, Probst CP, Kelly KN, Iannuzzi JC, Noyes K, Fleming FJ, Monson JRT. The pitfalls of inguinal herniorrhaphy: Surgeon volume matters. Surgery 2015; 158:736-46. [PMID: 26036880 DOI: 10.1016/j.surg.2015.03.058] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 03/03/2015] [Accepted: 03/13/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is currently little information regarding the impact of procedure volume on outcomes after open inguinal hernia repair in the United States. Our hypothesis was that increasing procedure volume is associated with lesser rates of reoperation and resource use. METHODS The database of the Statewide Planning and Research Cooperative System was queried for elective open initial inguinal hernia repairs performed in New York State from 2001 to 2008 via the use of International Classification of Diseases, 9th Revision and Current Procedural Terminology codes. Surgeon and hospital procedure volumes were grouped into tertiles based on the number of open inguinal hernia repairs performed per year. Bivariate, hierarchical mixed effects Cox proportional-hazards, and negative binomial regression analyses were performed assessing for factors associated with reoperation for recurrence, procedure time, and downstream total charges. RESULTS Among 151,322 patients who underwent open inguinal hernia repair, the overall rate of reoperation for recurrence within 5 years was 1.7% with a median time to reoperation of 1.9 years. An inverse relationship was seen between surgeon volume and reoperation rate, procedure time, and health care costs (P < .001). After we controlled for surgeon, facility, operative and patient characteristics, low-volume surgeons (<25 repairs/year) had greater rates of reoperation (hazard ratio 1.23,95% confidence interval [95% CI] 1.11-1.36), longer procedure times (incidence rate ratio 1.22, 95% CI 1.21-1.24), and greater downstream costs (incidence rate ratio 1.13,95% CI 1.10-1.17) than high-volume surgeons (≥25 repairs/year). CONCLUSION Surgeon volume <25 cases per year for open inguinal hernia repair was independently associated with greater rates of reoperation for recurrence, worse operative efficiency, and greater health care costs. Referral to surgeons who perform ≥25 inguinal hernia repairs per year should be considered to decrease reoperation rates and resource use.
Collapse
|
75
|
Kahn SA, Iannuzzi JC, Stassen NA, Bankey PE, Gestring M. Measuring Satisfaction: Factors that Drive Hospital Consumer Assessment of Healthcare Providers and Systems Survey Responses in a Trauma and Acute Care Surgery Population. Am Surg 2015; 81:537-43. [DOI: 10.1177/000313481508100540] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hospital quality metrics now reflect patient satisfaction and are measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Understanding these metrics and drivers will be integral in providing quality care as this process evolves. This study identifies factors associated with patient satisfaction as determined by HCAHPS survey responses in trauma and acute care surgery patients. HCAHPS survey responses from acute care surgery and trauma patients at a single institution between 3/11 and 10/12 were analyzed. Logistic regression determined which responses to individual HCAHPS questions predicted highest hospital score (a rating of 9–10/10). Demographic and clinical variables were also analyzed as predictors of satisfaction. Subgroup analysis for trauma patients was performed. In 70.3 per cent of 182 total survey responses, a 9–10/10 score was given. The strongest predictors of highest hospital ranking were respect from doctors (odds ratio [OR] = 24.5, confidence interval [CI]: 5.44–110.4), doctors listening (OR: 9.33, CI: 3.7–23.5), nurses’ listening (OR = 8.65, CI: 3.62–20.64), doctors’ explanations (OR = 8.21, CI: 3.5–19.2), and attempts to control pain (OR = 7.71, CI: 3.22–18.46). Clinical factors and outcomes (complications, intensive care unit/hospital length of stay, mechanism of injury, and having an operation) were nonsignificant variables. For trauma patients, Injury Severity Score was inversely related to score (OR = 0.93, CI: 0.87–0.98). Insurance, education, and disposition were also tied to satisfaction, whereas age, gender, and ethnicity were nonsignificant. In conclusion, patient perception of interactions with the healthcare team was most strongly associated with satisfaction. Complications did not negatively influence satisfaction. Insurance status might potentially identify patients at risk of dissatisfaction. Listening to patients, treating them with respect, and explaining the care plan are integral to a positive perception of hospital stay.
Collapse
|