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Musters SCW, Kreca SM, van Dieren S, van der Wal-Huisman H, Romijn JA, Chaboyer W, Nieveen van Dijkum EJM, Eskes AM, Besselink MGH, Bakker CA, van Langen R, Heidsma C, Ouwens M, Hendriks MJ, van Leeuwen BL, de Jong M, Hoekstra R, Blaauw E, Smith R, Schreuder M. Surgical outcomes in surgical oncology patients who participated in a family involvement program. Surgery 2024; 176:826-834. [PMID: 38897885 DOI: 10.1016/j.surg.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 04/29/2024] [Accepted: 05/06/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND There is a lack of evidence regarding the relationship between family involvement and outcomes in gastrointestinal oncology patients after surgery. To evaluate the effect of a family involvement program for patients undergoing oncologic gastrointestinal surgery on unplanned readmissions within 30 days after surgery. METHODS A multicenter patient-preference cohort study compared 2 groups: patients who participated in the family involvement program versus usual care. The program comprised involvement of family caregivers in care and training of health care professionals in family-centered care. Multivariable regression analyses were used to evaluate the effect of the FIP on the number of unplanned readmissions up to 30 days after surgery. Secondary outcomes included complications sensitive to fundamental care activities, emergency department visits, intensive care unit admissions, hospital length of stay, and the need for professional home care after discharge. RESULTS Of the 301 patients included, 152 chose the family involvement program, and 149 chose usual care. Postoperative readmissions occurred in 25 (16.4%) patients in the family involvement program group, and 15 (10.1%) in the usual care group (P = .11). A significant reduction of 16.2% was observed in the need for professional home care after discharge in the family involvement program group (P < .01). No significant differences were found between the 2 groups in the other secondary outcomes. CONCLUSION The family involvement program did not reduce the number of unplanned readmissions, but it led to a substantial reduction in-home care, which suggests an economic benefit from a societal perspective. Implementation of the family involvement program should, therefore, be considered in clinical practice.
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Affiliation(s)
- Selma C W Musters
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, The Netherlands; Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Sani M Kreca
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, The Netherlands; Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Susan van Dieren
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, The Netherlands; Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands
| | | | | | - Wendy Chaboyer
- Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia
| | - Els J M Nieveen van Dijkum
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, The Netherlands; Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands; Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, The Netherlands
| | - Anne M Eskes
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, The Netherlands; Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands; Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia; Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, The Netherlands.
| | - Marc G H Besselink
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, The Netherlands
| | - Chris A Bakker
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, The Netherlands
| | - Rosanna van Langen
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, The Netherlands
| | - Charlotte Heidsma
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, The Netherlands
| | - Marjan Ouwens
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, The Netherlands
| | - Marie-José Hendriks
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, The Netherlands
| | - Barbara L van Leeuwen
- Department of Surgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Maarten de Jong
- Department of Surgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Rommy Hoekstra
- Department of Surgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Eline Blaauw
- Department of Surgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Reggie Smith
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, The Netherlands
| | - Marthe Schreuder
- Amsterdam UMC Location University of Amsterdam, Department of Surgery, The Netherlands
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Cook A, Swindall R, Spencer K, Wadle C, Cage SA, Mohiuddin M, Desai Y, Norwood S. Hospitalization and readmission after single-level fall: a population-based sample. Inj Epidemiol 2023; 10:49. [PMID: 37858271 PMCID: PMC10588028 DOI: 10.1186/s40621-023-00463-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/08/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Single-level falls (SLFs) in the older US population is a leading cause of hospital admission and rates are increasing. Unscheduled hospital readmission is regarded as a quality-of-care indication and a preventable burden on healthcare systems. We aimed to characterize the predictors of 30-day readmission following admission for SLF injuries among patients 65 years and older. METHODS We conducted a retrospective cohort study using the Nationwide Readmission Database from 2018 to 2019. Included patients were 65 and older, admitted emergently following a SLF with a primary injury diagnosis. Hierarchical logit regression was used to model factors associated with readmission within 30 days of discharge. RESULTS Of 1,338,905 trauma patients, 65 years or older, 61.3% had a single-level fall as the mechanism of injury. Among fallers, the average age was 81.1 years and 68.5% were female. SLF patients underwent more major therapeutic procedures (56.3% vs. 48.2%), spent over 2 million days in the hospital and incurred total charges of over $28 billion annually. Over 11% of SLF patients were readmitted within 30 days of discharge. Increasing income had a modest effect, where the highest zip code quartile was 9% less likely to be readmitted. Decreasing population density had a protective effect of readmission of 16%, comparing Non-Urban to Large Metropolitan. Transfer to short-term hospital, brain and vascular injuries were independent predictors of 30-day readmission in multivariable analysis (OR 2.50, 1.31, and 1.42, respectively). Palliative care consultation was protective (OR 0.41). The subsequent hospitalizations among those 30-day readmissions were primarily emergent (92.9%), consumed 260,876 hospital days and a total of $2.75 billion annually. CONCLUSIONS SLFs exact costs to patients, health systems, and society. Transfer to short-term hospitals at discharge, along with brain and vascular injuries were strong predictors of 30-day readmission and warrant mitigation strategy development with consideration of expanded palliative care consultation.
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Affiliation(s)
- Alan Cook
- Trauma Services, UT Health East Texas, 1020 E. Idel St., Tyler, TX, 75701, USA
| | - Rebecca Swindall
- Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at Tyler, 11937 US Highway 271, Room H252, Tyler, TX, 75708, USA
| | - Katherine Spencer
- CHRISTUS Health-Texas A&M Spohn Emergency Medicine Residency, Texas A&M University-Corpus Christi, 600 Elizabeth Street, 9B, Corpus Christi, TX, 78404, USA
| | - Carly Wadle
- Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at Tyler, 11937 US Highway 271, Room H252, Tyler, TX, 75708, USA
| | - S Andrew Cage
- Department of Sports Medicine, The University of Texas at Tyler, 3900 University Blvd., Tyler, TX, 75799, USA
| | - Musharaf Mohiuddin
- Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at Tyler, 11937 US Highway 271, Room H252, Tyler, TX, 75708, USA.
| | - Yagnesh Desai
- Department of Emergency Medicine, UT Health East Texas, 1000 S. Beckham Ave., Tyler, TX, 75701, USA
| | - Scott Norwood
- Trauma Services, UT Health East Texas, 1020 E. Idel St., Tyler, TX, 75701, USA
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3
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Yu R. How well can fine balance work for covariate balancing. Biometrics 2023; 79:2346-2356. [PMID: 36222330 DOI: 10.1111/biom.13771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 10/03/2022] [Indexed: 12/01/2022]
Abstract
Fine balance is a matching technique to improve covariate balance in observational studies. It constrains a match to have identical distributions for some covariates without restricting who is matched to whom. However, despite its wide application and excellent performance in practice, there is very little theory indicating when the method is likely to succeed or fail and to what extent it can remove covariate imbalance. In order to answer these questions, this paper studies the limits of what is possible for covariate balancing using fine balance and near-fine balance. The investigations suggest that given the distributions of the treated and control groups, in large samples, the maximum achievable balance by using fine balance only depends on the matching ratio (ie, the ratio of the sample size of the control group to that of the treated group). In addition, the results indicate how to estimate this matching ratio threshold without knowledge of the true distributions in finite samples. The findings are also illustrated by numerical studies in this paper.
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Affiliation(s)
- Ruoqi Yu
- Department of Statistics, University of California, Davis, California, USA
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Subramanian T, Shinn D, Shahi P, Akosman I, Amen T, Maayan O, Zhao E, Araghi K, Song J, Dalal S, Dowdell J, Iyer S, Qureshi S. Severe Obesity Is an Independent Risk Factor of Early Readmission and Nonhome Discharge After Cervical Disc Replacement. Neurospine 2023; 20:890-898. [PMID: 37798984 PMCID: PMC10562223 DOI: 10.14245/ns.2346442.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/23/2023] [Accepted: 06/06/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE Despite growing interest in cervical disc replacement (CDR) for conditions such as cervical radiculopathy, limited data exists describing the impact of obesity on early postoperative outcomes and complications. These data are especially important as nearly half of the adult population in the United States is expected to become obese (body mass index [BMI] ≥ 30 kg/m2) by 2030. The goal of this study was to compare the demographics, perioperative variables, and complication rates following CDR. METHODS The 2005-2020 American College of Surgeons National Surgical Quality Improvement Program datasets were queried for patients who underwent primary 1- or 2-level CDR. Patients were divided into 3 cohorts: Nonobese (BMI: 18.5-29.9 kg/m2), Obese class-I (BMI: 30-34.9 kg/m2), Obese class-II/III (BMI ≥ 35 kg/m2). Morbidity was defined as the presence of any complication within 30 days postoperatively. Rates of 30-day readmission, reoperation, morbidity, individual complications, length of stay, frequency of nonhome discharge disposition were collected. RESULTS A total of 5,397 patients were included for analysis: 3,130 were nonobese, 1,348 were obese class I, and 919 were obese class II/III. There were more 2-level CDRs performed in the class II/III cohort compared to the nonobese group (25.7% vs. 21.5%, respectively; p < 0.05). Class-II/III had more nonhome discharges than class I and nonobese (2.1% vs. 0.5% vs. 0.7%, respectively; p < 0.001). Readmission rates differed as well (nonobese: 0.5%, class I: 1.1%, class II/III: 2.1%; p < 0.001) with pairwise significance between class II/II and nonobese. Class II/III obesity was an independent risk factor for both readmission (odds ratio [OR], 3.32; p = 0.002) and nonhome discharge (OR, 2.51; p = 0.02). Neither 30-day reoperation nor morbidity rates demonstrated significance. No mortalities were reported. CONCLUSION Although obese class-II/III were risk factors for 30-day readmission and nonhome discharge, there was no significant difference in reoperation rates or morbidity. CDR procedures can continue to be safely preformed independent of obesity status.
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Affiliation(s)
- Tejas Subramanian
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medicine, New York, NY, USA
| | - Daniel Shinn
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medicine, New York, NY, USA
| | | | - Izzet Akosman
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medicine, New York, NY, USA
| | - Troy Amen
- Hospital for Special Surgery, New York, NY, USA
| | - Omri Maayan
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medicine, New York, NY, USA
| | - Eric Zhao
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medicine, New York, NY, USA
| | | | - Junho Song
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medicine, New York, NY, USA
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Lim S, Lee SS, Oh J, Lee DH. Weight Is a Predictor of Delayed Operation Time in Primary Isolated Anterior Cruciate Ligament Reconstruction. Biomedicines 2023; 11:2137. [PMID: 37626634 PMCID: PMC10452883 DOI: 10.3390/biomedicines11082137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Few studies have evaluated the impact of obesity on operation time in patients with ACL reconstruction. The purpose of this study was to understand the effect of obesity on operation time in patients with arthroscopic anterior cruciate ligament (ACL) reconstruction. METHODS A total of 103 patients were included. The mean pure operation time was 45.9 ± 13.4 min. Considering that 15 min incremental increases in operation time are an independent risk factor for complications, all patients were classified into two groups according to operation time: more or less than 61 min. Demographic data were compared between both groups. Pure operation time was defined as operative time without suture time (pure operation time = suture start time - operation start time). Correlation analysis between demographic data and pure operation time was performed, and multiple linear regression analysis was used to identify the predictors of pure operation time. RESULTS The pure operation time ≥61 min group (n = 34) had a 14.7 kg higher weight and 4.5 kg/m2 higher body mass index (BMI) than those with pure operation time < 61 min (n = 69). Weight (r = 0.635, p < 0.001) and BMI (r = 0.584, p < 0.001) were positively correlated with operation time. Multiple linear regression analysis showed that weight (β = 0.635, p < 0.001) was the only predictor of operation time. A weight of 74.25 kg was a cut-off value for a pure operation time of >61 min. CONCLUSIONS The weight and BMI of the group with pure operation time of ≥61 min were 14.7 kg and 4.5 kg/m2 higher, respectively. The weight of patients with ACL tears was a factor affecting delay in the operation time. Patients weighing over 74.25 kg were more likely to delay ACL reconstruction.
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Affiliation(s)
- Sungtae Lim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (S.L.); (J.O.)
| | - Sung-Sahn Lee
- Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyangsi 10380, Republic of Korea;
| | - Juyong Oh
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (S.L.); (J.O.)
| | - Dae-Hee Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (S.L.); (J.O.)
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Low ZK, Liew L, Chua V, Chew S, Ti LK. Predictors of unplanned hospital readmission after non-cardiac surgery in Singapore: a 2-year retrospective review. BMC Surg 2023; 23:202. [PMID: 37442969 DOI: 10.1186/s12893-023-02102-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/07/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Unplanned hospital readmissions after surgery contribute significantly to healthcare costs and potential complications. Identifying predictors of readmission is inherently complex and involves an intricate interplay between medical factors, healthcare system factors and sociocultural factors. Therefore, the aim of this study was to elucidate the predictors of readmissions in an Asian surgical patient population. METHODS A two-year single-institution retrospective cohort study of 2744 patients was performed in a university-affiliated tertiary hospital in Singapore, including patients aged 45 and above undergoing intermediate or high-risk non-cardiac surgery. Unadjusted analysis was first performed, followed by multivariable logistic regression. RESULTS Two hundred forty-nine patients (9.1%) had unplanned 30-day readmissions. Significant predictors identified from multivariable analysis include: American Society of Anaesthesiologists (ASA) Classification grades 3 to 5 (adjusted OR 1.51, 95% CI 1.10-2.08, p = 0.01), obesity (adjusted OR 1.66, 95% CI 1.18-2.34, p = 0.04), asthma (OR 1.70, 95% CI 1.03-2.81, p = 0.04), renal disease (OR 2.03, 95% CI 1.41-2.92, p < 0.001), malignancy (OR 1.68, 95% CI 1.29-2.37, p < 0.001), chronic obstructive pulmonary disease (OR 2.46, 95% CI 1.19-5.11, p = 0.02), cerebrovascular disease (OR 1.73, 95% CI 1.17-2.58, p < 0.001) and anaemia (OR 1.45, 95% CI 1.07-1.96, p = 0.02). CONCLUSION Several significant predictors of unplanned readmissions identified in this Asian surgical population corroborate well with findings from Western studies. Further research will require future prospective studies and development of predictive risk modelling to further address and mitigate this phenomenon.
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Affiliation(s)
- Zhao Kai Low
- Department of Anaesthesia, National University Health System, National University Hospital, Main Building, Level 3 (Near Lift Lobby 1), 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
| | - Lydia Liew
- Department of Anaesthesia, National University Health System, National University Hospital, Main Building, Level 3 (Near Lift Lobby 1), 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Vanessa Chua
- Department of Anaesthesia, National University Health System, National University Hospital, Main Building, Level 3 (Near Lift Lobby 1), 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
- Department of Anaesthesia, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sophia Chew
- Department of Anaesthesiology, Singapore General Hospital, Singapore, Singapore
| | - Lian Kah Ti
- Department of Anaesthesia, National University Health System, National University Hospital, Main Building, Level 3 (Near Lift Lobby 1), 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
- Department of Anaesthesia, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Araghi K, Subramanian T, Haque N, Merrill R, Amen TB, Shahi P, Singh S, Maayan O, Sheha E, Dowdell J, Iyer S, Qureshi SA. Provider Referral Patterns and Surgical Utilization Among New Patients Seen in Spine Clinic. Spine (Phila Pa 1976) 2023; 48:885-891. [PMID: 37026719 DOI: 10.1097/brs.0000000000004656] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/05/2023] [Indexed: 04/08/2023]
Abstract
STUDY DESIGN Retrospective chart review. OBJECTIVE The objective of this study was to elucidate the demographics of patient referrals from different sources and identify factors that affect a patient's likelihood of undergoing surgery. SUMMARY OF BACKGROUND DATA Despite baseline factors for surgical consideration, such as attempting conservative management, surgeons encounter many patients who are not surgically indicated. Overreferrals, that is, a patient referred to a surgeon that does not need surgery, can result in long wait times, delayed care, worse outcomes, and resource waste. MATERIALS AND METHODS All new patients at a single academic institution seen in the clinic by eight spine surgeons between January 1, 2018, and January 1, 2022, were analyzed. Referral types included self-referral, musculoskeletal (MSK), and non-MSK provider referral. Patient demographics included age, body mass index (BMI), zip code as a proxy for socioeconomic status, sex, insurance type, and surgical procedures undergone within 1.5 years postclinic visit. Analysis of variance and a Kruskal-Wallis test was used to compare means among normally and non-normally disturbed referral groups, respectively. Multivariable logistic regressions were run to assess demographic variables associated with undergoing surgery. RESULTS From 9356 patients, 84% (7834) were self-referred, 3% (319) were non-MSK, and 13% (1203) were MSK. A statistically significant association with ultimately undergoing surgery was observed with MSK referral type compared with non-MSK referral [odds ratio (OR)=1.37, CI: 1.04-1.82, P =0.0246]. Additional independent variables observed to be associated with patients undergoing surgery included older age (OR=1.004, CI: 1.002-1.007, P =0.0018), higher BMI (OR=1.02, CI: 1.011-1.029, P <0.0001), high-income quartile (OR=1.343, CI: 1.177-1.533, P <0.0001), and male sex (OR=1.189, CI: 1.085-1.302, P =0.0002). CONCLUSIONS A statistically significant association with undergoing surgery was observed with a referral by an MSK provider, older age, male sex, high BMI, and a high-income quartile home zip code. Understanding these factors and patterns is critical for optimizing practice efficiency and reducing the burdens of inappropriate referrals.
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Affiliation(s)
| | - Tejas Subramanian
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
| | | | | | | | | | | | - Omri Maayan
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
| | - Evan Sheha
- Hospital for Special Surgery, New York, NY
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8
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Mavragani A, Kreca S, van Dieren S, van der Wal-Huisman H, Romijn JA, Chaboyer W, Nieveen van Dijkum EJM, Eskes AM. Activating Relatives to Get Involved in Care After Surgery: Protocol for a Prospective Cohort Study. JMIR Res Protoc 2023; 12:e38028. [PMID: 36440980 PMCID: PMC9862329 DOI: 10.2196/38028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Postoperative complications and readmissions to hospital are factors known to negatively influence the short- and long-term quality of life of patients with gastrointestinal cancer. Active family involvement in activities, such as fundamental care activities, has the potential to improve the quality of health care. However, there is a lack of evidence regarding the relationship between active family involvement and outcomes in patients with gastrointestinal cancer after surgery. OBJECTIVE This protocol aims to evaluate the effect of a family involvement program (FIP) on unplanned readmissions of adult patients undergoing surgery for malignant gastrointestinal tumors. Furthermore, the study aims to evaluate the effect of the FIP on family caregiver (FC) burden and their well-being and the fidelity of the FIP. METHODS This cohort study will be conducted in 2 academic hospitals in the Netherlands. The FIP will be offered to adult patients and their FCs. Patients are scheduled for oncological gastrointestinal surgery and have an expected hospital stay of at least 5 days after surgery. FCs must be willing to participate in fundamental care activities during hospitalization and after discharge. Consenting patients and their families will choose to either participate in the FIP or be included in the usual care group. According to the power calculation, we will recruit 150 patients and families in the FIP group and 150 in the usual care group. The intervention group will receive the FIP that consists of information, shared goal setting, task-oriented training, participation in fundamental care, presence of FCs during ward rounds, and rooming-in for at least 8 hours a day. Patients in the comparison group will receive usual postoperative care. The primary outcome measure is the number of unplanned readmissions up to 30 days after surgery. Several secondary outcomes will be collected, that is, total number of complications (sensitive to fundamental care activities) at 30 and 90 days after surgery, emergency department visits, intensive care unit admissions up to 30 and 90 days after surgery, hospital length of stay, patients' quality of life, and the amount of home care needed after discharge. FC outcomes are caregiver burden and well-being up to 90 days after participating in the FIP. To evaluate fidelity, we will check whether the FIP is executed as intended. Univariable regression and multivariable regression analyses will be conducted. RESULTS The first participant was enrolled in April 2019. The follow-up period of the last participant ended in May 2022. The study was funded by an unrestricted grant of the University hospital in 2018. We aim to publish the results in 2023. CONCLUSIONS This study will provide evidence on outcomes from a FIP and will provide health care professionals practical tools for family involvement in the oncological surgical care setting. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/38028.
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Affiliation(s)
| | - Sani Kreca
- Department of Surgery, Amsterdam UMC, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, Netherlands
| | - Susan van Dieren
- Department of Surgery, Amsterdam UMC, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, Netherlands
| | | | | | - Wendy Chaboyer
- Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
| | - Els J M Nieveen van Dijkum
- Department of Surgery, Amsterdam UMC, Amsterdam Gastroenterology Endocrinology Metabolism and Cancer Center Amsterdam, University of Amsterdam,, Amsterdam, Netherlands
| | - Anne M Eskes
- Department of Surgery, Amsterdam UMC, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, Netherlands.,Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
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9
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Mabeza RM, Mao Y, Maynard K, Lee C, Benharash P, Yetasook A. Bariatric Surgery Outcomes in Geriatric Patients: A Contemporary, Nationwide Analysis. Surg Obes Relat Dis 2022; 18:1005-1011. [DOI: 10.1016/j.soard.2022.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/02/2022] [Accepted: 04/17/2022] [Indexed: 12/13/2022]
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10
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Lazarides AL, Flamant EM, Cullen MC, Ferlauto HR, Goltz DE, Cochrane NH, Visgauss JD, Brigman BE, Eward WC. Why Do Patients Undergoing Extremity Prosthetic Reconstruction for Metastatic Disease Get Readmitted? J Arthroplasty 2022; 37:232-237. [PMID: 34740789 DOI: 10.1016/j.arth.2021.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/11/2021] [Accepted: 10/27/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Orthopedic oncology patients are particularly susceptible to increased readmission rates and poor surgical outcomes, yet little is known about readmission rates. The goal of this study is to identify factors independently associated with 90-day readmission for patients undergoing oncologic resection and subsequent prosthetic reconstruction for metastatic disease of the hip and knee. METHODS This is a retrospective comparative cohort study of all patients treated from 2013 to 2019 at a single tertiary care referral institution who underwent endoprosthetic reconstruction by an orthopedic oncologist for metastatic disease of the extremities. The primary outcome measure was unplanned 90-day readmission. RESULTS We identified 112 patients undergoing 127 endoprosthetic reconstruction surgeries. Metastatic disease was most commonly from renal (26.8%), lung (23.6%), and breast (13.4%) cancer. The most common type of skeletal reconstruction performed was simple arthroplasty (54%). There were 43 readmissions overall (33.9%). When controlling for confounding factors, body mass index >40, insurance status, peripheral vascular disease, and longer hospital length of stay were independently associated with risk of readmission (P ≤ .05). CONCLUSION Readmission rates for endoprosthetic reconstructions for metastatic disease are high. Although predicting readmission remains challenging, risk stratification presents a viable option for helping minimize unplanned readmissions. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Etienne M Flamant
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Mark C Cullen
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Harrison R Ferlauto
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Daniel E Goltz
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Niall H Cochrane
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Julia D Visgauss
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Brian E Brigman
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - William C Eward
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
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Abiri A, Goshtasbi K, Birkenbeue JL, Lin HW, Djalilian HR, Hsu FPK, Kuan EC. Obesity as a Risk Factor for Postoperative Adverse Events in Skull Base Surgery. Ann Otol Rhinol Laryngol 2022; 131:1381-1389. [PMID: 35081772 DOI: 10.1177/00034894221074745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the implications of obesity on postoperative adverse events following skull base surgery. METHODS The 2005-2017 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for adverse events in skull base surgery cases. Patients were stratified by body mass index (BMI) into normal weight (18.5 ≤ BMI < 25), overweight (25 ≤ BMI < 30), and obese (BMI ≥ 30) cohorts. Logistic regression was used to assess the association of overweight or obese BMI with various 30-day postoperative adverse events. RESULTS A total of 2305 patients were included for analysis, of which 732 (31.8%) and 935 (40.6%) were overweight or obese, respectively. The mean age was 53.8 ± 15.3 years and 1214 (52.7%) patients were female. Obese patients were younger (P = .033) and possessed higher frailty (P < .001) and ASA scores (P < .001). Operation times and lengths of hospitalization were not significantly different across patient cohorts (all P > .05). On propensity score-adjusted multivariable analysis, only bleeding (OR = 0.42, P < .001) and deep vein thrombosis (OR = 6.46, P = .015) were significantly associated with obesity. There were no significant differences in rates of readmission, reoperation, or mortality between normal weight and obese patients (all P > .05). CONCLUSIONS Obesity was associated with decreased postoperative bleeding and increased deep vein thromboses. Obese patients were otherwise at no higher risk for medical or surgical complications. Elevated BMI did not confer an increased risk for readmission, reoperation, or death. Thus, patient obesity should not be a major determinant in offering skull base surgery in individuals who would otherwise benefit from treatment.
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Affiliation(s)
- Arash Abiri
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA
| | - Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA
| | - Jack L Birkenbeue
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA
| | - Harrison W Lin
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA
| | - Hamid R Djalilian
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA
| | - Frank P K Hsu
- Department of Neurological Surgery, University of California, Irvine, Orange, CA, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA.,Department of Neurological Surgery, University of California, Irvine, Orange, CA, USA
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Wang W, Small DS, Cafri G, Paxton EW. The Case-Control Approach Can be More Powerful for Matched Pair Observational Studies When the Outcome is Rare. AM STAT 2021. [DOI: 10.1080/00031305.2021.1972835] [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]
Affiliation(s)
- Wei Wang
- Department of Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA
| | - Dylan S. Small
- Department of Statistics, The Wharton School, University of Pennsylvania, PA
| | - Guy Cafri
- Medical Device Epidemiology and Real World Data Sciences, Johnson & Johnson Medical Devices and Office of the Chief Medical Officer, CA
| | - Elizabeth W. Paxton
- Department of Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA
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Mamidi IS, Benito DA, Lee R, Thakkar PG, Goodman JF, Joshi AS. Obesity is a predictor of increased morbidity after tracheostomy. Am J Otolaryngol 2021; 42:102651. [PMID: 33068956 DOI: 10.1016/j.amjoto.2020.102651] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/04/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of this study was to analyze the relationship between body mass index (BMI) and 30-day morbidity and mortality risk in patients undergoing tracheostomy using the American College of Surgeons National Quality Improvement Program (ACS-NSQIP). STUDY DESIGN This is a retrospective, cross-sectional, cohort study. SETTING Patients were identified with Current Procedural Terminology codes in the ACS-NSQIP database. SUBJECTS AND METHODS Patients who underwent tracheostomy from 2005 to 2018 were queried. They were stratified into four BMI classes and matched to normal BMI cohorts. Multivariate logistic regression was used to identify independent predictors for complications, readmissions, and unplanned reoperations within 30 days. RESULTS Among 3784 patients meeting inclusion and exclusion criteria, obesity was shown to be a significant independent risk factor for overall complications (OR 1.439, 95% CI 1.226-1.689, p < 0.001), postoperative acute renal failure (OR 10.715, 95% CI 1.213-94.646, p = 0.033), and unplanned readmissions (OR 1.702, 95% CI 1.095-2.647, p = 0.018). A significantly lower rate of postoperative transfusions was observed for obese patients (OR 0.581, 95% CI 0.432-0.781, p < 0.001). CONCLUSIONS Obesity was found to be independently associated with an increased risk of overall complication, developing acute renal failure, and having an unplanned 30-day readmission following tracheostomy. The risk of postoperative transfusion appears to be lower in obese patients. LEVEL OF EVIDENCE 4.
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Georgino MM, Murphy K, Paton BL, Schiffern L, Ross SW, Reinke CE. Association between interhospital transfer and morbid obesity in emergency general surgery procedures. Am J Surg 2020; 220:1290-1295. [PMID: 32731957 DOI: 10.1016/j.amjsurg.2020.06.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/11/2020] [Accepted: 06/25/2020] [Indexed: 12/07/2022]
Abstract
BACKGROUND Obese patients may have unique surgical needs. The goal of this study is to determine if there is an association between obesity and transfer in patients undergoing EGS. METHODS EGS patients were identified in the NSQIP 2011-2016 database. Outcome variables included interhospital transfer, days to surgery, SSI, postoperative LOS, discharge destination, and 30-day readmission. Descriptive statistics and multivariable regression were utilized. RESULTS 419,373 EGS patients were identified, and transfer status varied by obesity class. After controlling for other factors, obese patients had increased odds of interhospital transfer (OR = 1.07-1.53), SSI (OR = 1.22-1.69), and decreased odds of discharge to home (OR = 0.42-0.71, all p < 0.01) but not of 30-day readmission or delay from admission to surgical intervention. CONCLUSIONS Obese patients undergoing EGS procedures have an increased likelihood of transfer from an acute care hospital. As obese EGS patients are increasingly prevalent, determining best triage practices for this unique patient population warrants additional investigation.
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Affiliation(s)
- Madeline M Georgino
- Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Plaza Suite 300, Charlotte, NC, 28204, USA.
| | - Keith Murphy
- Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Plaza Suite 300, Charlotte, NC, 28204, USA.
| | - B Lauren Paton
- Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Plaza Suite 300, Charlotte, NC, 28204, USA.
| | - Lynn Schiffern
- Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Plaza Suite 300, Charlotte, NC, 28204, USA.
| | - Samuel W Ross
- Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Plaza Suite 300, Charlotte, NC, 28204, USA.
| | - Caroline E Reinke
- Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Plaza Suite 300, Charlotte, NC, 28204, USA.
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Cai S, Wang S, Mukamel DB, Caprio T, Temkin-Greener H. Hospital Readmissions Among Post-acute Nursing Home Residents: Does Obesity Matter? J Am Med Dir Assoc 2019; 20:1274-1279.e4. [PMID: 30853424 PMCID: PMC7273841 DOI: 10.1016/j.jamda.2019.01.136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/14/2019] [Accepted: 01/16/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To explore profiles of obese residents who receive post-acute care in nursing homes (NHs) and to assess the relationship between obesity and hospital readmissions and how it is modified by individual comorbidities, age, and type of index hospitalizations. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Medicare fee-for-service beneficiaries who were newly admitted to free-standing US NHs after an acute inpatient episode between 2011 and 2014 (N = 2,323,019). MEASURES The Minimum Data Set 3.0 were linked with Medicare data. The outcome variable was 30-day hospital readmission from an NH. Residents were categorized into 3 groups based on their body mass index (BMI): nonobese, mildly obese, moderate-to-severely obese. We tested the relationship between obesity and 30-day readmissions by fixed-effects logit models and stratified analyses by the type of index hospitalization and residents' age. RESULTS Forty percent of the identified residents were admitted after a surgical episode, and the rest were admitted after a medical episode. The overall relationship between obesity and readmissions suggested that obesity was associated with higher risks of readmission among the oldest old (≥85 years) residents but with lower risks of readmission among the youngest group (65-74 years). After accounting for individual co-covariates, the association between obesity and readmissions among the oldest old residents became weaker; the adjusted odds ratio was 1.061 (P = .049) and 1.004 (P = .829) for moderate-to-severely obese patients with surgical and medical index hospitalizations, respectively. The protective effect of obesity among younger residents reduced after adjusting for covariates. CONCLUSIONS/RELEVANCE The relationship between obesity and hospital readmission among post-acute residents could be affected by comorbidities, age, and the type of index hospitalization. Further studies are also warranted to understand how to effectively measure NH quality outcomes, including hospital readmissions, so that policies targeting at quality improvement can successfully achieve their goals without unintended consequences.
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Affiliation(s)
- Shubing Cai
- Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, NY.
| | - Sijiu Wang
- Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, NY
| | - Dana B Mukamel
- iTEQC Research Program, Medicine-Division of General Internal Medicine, University of California, Irvine, CA
| | - Thomas Caprio
- Department of Medicine, University of Rochester School of Medicine, Rochester, NY
| | - Helena Temkin-Greener
- Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, NY
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Bright HR, Chandy SJ, Chacko RT, Backianathan S. Intercycle Unplanned Hospital Admissions Due to Cisplatin-based Chemotherapy Regimen-induced Adverse Reactions: A Retrospective Analysis. Curr Drug Saf 2019; 14:182-191. [PMID: 31250766 PMCID: PMC6865053 DOI: 10.2174/1574886314666190619123047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/16/2019] [Accepted: 05/27/2019] [Indexed: 12/04/2022]
Abstract
BACKGROUND Cisplatin is a commonly used chemotherapy agent known to induce serious adverse reactions that may require hospital readmission. We aimed to analyze the extent and factors associated with unplanned hospital admissions due to cisplatin-based chemotherapy regimen-induced adverse reactions. METHODS Retrospective review of medical records of those patients who received at least one cycle of chemotherapy with cisplatin-based regimen during a six-month period from March to August 2017. RESULTS Of the 458 patients who received cisplatin during the study period, 142 patients did not meet inclusion criteria. The remaining 316 patients had a total of 770 episodes of primary admissions for chemotherapy administration. Overall, 187 episodes (24%) of intercycle unplanned hospital admission were recorded of which a major proportion (n=178; 23%) was due to chemotherapy-induced adverse reactions. Underweight patients had higher odds of unplanned admission (OR 1.77, 95% confidence interval [CI] 1.11 to 1.77). Significantly, more number of patients with cancers of head and neck and cancers of musculoskeletal were readmitted (p<0.001). Compared to high-dose cisplatin, low- and intermediate-dose cisplatin had lesser odds of unplanned admission (OR 0.52 and 0.77; 95% CI, 0.31 to 0.88 and 0.41 to 1.45, respectively). Patients without concomitant radiotherapy, drug-drug interaction and initial chemotherapy cycles had lesser odds of unplanned admission (OR 0.38, 0.50 and 0.52; 95% CI, 0.26 to 0.55, 0.25 to 0.99 and 0.32 to 0.84 respectively). Unplanned admissions were mainly due to blood-related (31%) and gastrointestinal (19%) adverse reactions. Among chemotherapy regimens, cisplatin monotherapy (34%) and cisplatin with doxorubicin (20%) regimens resulted in a major proportion of unplanned admissions. CONCLUSION These findings highlight risk factors that help identify high-risk patients and suggest that therapy modifications may reduce hospital readmissions due to cisplatin-based chemotherapy-induced adverse reactions.
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Affiliation(s)
- Heber Rew Bright
- Address correspondence to this author at the Pharmacy Services, Christian Medical College & Hospital, Vellore 632 004, Tamil Nadu, India; Tel: 91-416-228 2690; E-mail:
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Cooper JD, Lorenzana DJ, Heckmann N, McKnight B, Mostofi A, Gamradt SC, Rick Hatch GF. The Effect of Obesity on Operative Times and 30-Day Readmissions After Anterior Cruciate Ligament Reconstruction. Arthroscopy 2019; 35:121-129. [PMID: 30611339 DOI: 10.1016/j.arthro.2018.07.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 07/18/2018] [Accepted: 07/20/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To understand the effect of obesity on operative times and 30-day readmission rates after arthroscopic anterior cruciate ligament reconstruction (ACLR). METHODS The American College of Surgeons National Surgical Quality Improvement Program database was queried using Current Procedural Terminology billing codes to identify all patients aged 18 years and older who underwent ACLR between 2007 and 2014. The Student t test was used for continuous variables, and the χ-square or Fisher exact test was used for categorical variables. Multivariate analysis was conducted to identify factors associated with 30-day readmission. RESULTS We identified 9,000 patients who underwent ACLR. In the readmission analysis, the total readmission rate was 0.70%. After multivariate analysis, a body mass index (BMI) of 40 or greater was associated with a significantly increased risk of 30-day readmission (odds ratio, 3.06; 95% confidence interval, 1.09-8.57). An operative time of less than 80 minutes was associated with a decreased risk of readmission (odds ratio, 0.40, 95% confidence interval, 0.18-0.92). In the operative-time analysis, the mean operative time was 100.7 minutes. Older age was predictive of decreasing operative time, with the operative time being 32.75 minutes shorter in patients aged 65 years or older than in those younger than 25 years. After multivariate analysis, class II obesity (BMI of 35-39.9) predicted an increase of 7.11 minutes and class III obesity (BMI ≥ 40) predicted an increase of 8.70 minutes compared with normal weight (BMI of 18.5-24.9). CONCLUSIONS Obesity is associated with longer operative times and increased 30-day readmissions after ACLR, with patients with a BMI of 40 or greater having over 3 times the risk of readmission compared with patients with a normal weight. Male sex, black race, and younger age are all also associated with increased operative times. LEVEL OF EVIDENCE Level III, observational, retrospective cohort study.
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Affiliation(s)
- Joseph D Cooper
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A..
| | - Daniel J Lorenzana
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, U.S.A
| | - Nathanael Heckmann
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Braden McKnight
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Amir Mostofi
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A.; Huntington Memorial Hospital, Pasadena, California, U.S.A
| | - Seth C Gamradt
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - George F Rick Hatch
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
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Abstract
OBJECTIVES Chronic pancreatitis (CP) hospitalizations along with associated morbidity and costs are increasing. The goal of this study was to use the National Readmission Database to identify the incidence and risk factors for 30-day readmissions among patients with CP. METHODS We performed a retrospective analysis of National Readmission Database from January 2013 to December 2013 to determine patient demographic and clinical characteristics predictive of 30-day hospital readmission for adult patients (aged >18 years) discharged with a principle diagnosis of CP. A survey logistic regression model was used to determine the predictive value of selected variables for 30-day readmission. RESULTS In 2013, 12,545 admissions with primary diagnosis of CP were noted, and 30.4% were readmitted within 30 days. Cholecystectomy (odds ratio [OR], 0.53; P = 0.0024) or endoscopic retrograde cholangiopancreatography (OR, 0.70; P = 0.01) during index admission was associated with decreased all-cause readmissions. Pancreatectomy during index admission was associated with reduced (OR, 0.2; P = 0.0005) pancreatitis-related readmissions. CONCLUSIONS Hospital readmissions for CP are frequent and pose a significant healthcare burden. Performing cholecystectomy, endoscopic retrograde cholangiopancreatography, or pancreatectomy during index admission was associated with reduced odds of readmission.
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McKenna NP, Mathis KL, Khasawneh M, Shariq O, Dozois EJ, Larson DW, Lightner AL. Thirty-Day Hospital Readmission After Restorative Proctocolectomy and Ileal Pouch Anal Anastomosis for Chronic Ulcerative Colitis at a High-Volume Center. J Gastrointest Surg 2017; 21:1859-1864. [PMID: 28840472 DOI: 10.1007/s11605-017-3542-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 08/07/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Ileal pouch anal anastomosis (IPAA) is associated with a high 30-day hospital readmission rate. Risk factors and etiology of readmission remain poorly defined. We sought to determine the 30-day hospital readmission rate following IPAA at a high-volume center and identify any modifiable perioperative factors. METHODS A retrospective review of all patients undergoing two- or three-stage IPAA for chronic ulcerative colitis at our institution between 2002 and 2013 was performed. Analysis was performed on rate of readmission, readmission diagnosis, intervention performed upon readmission, and risk factors for readmission. RESULTS Thirty-day primary and secondary readmission rates after IPAA were 20.3% (n = 185) and 2.1% (n = 19), respectively. The leading etiologies for readmission included partial small bowel obstruction/ileus (n = 52, 21.9%), pelvic sepsis (n = 43, 18.1%), dehydration (n = 42, 17.7%), and venous thromboembolism (n = 31, 13.1%). While the majority of readmissions were managed medically (n = 119, 65.4%), 19.2% (n = 35) required radiologic intervention and 15.3% (n = 28) required a return to the operating room. On univariate analysis, younger age (p = 0.03) and female sex (p = 0.04) had a significantly increased risk of readmission. On multivariable analysis, BMI ≥ 30 (OR 0.51; 95% CI, 0.25-0.97, p = 0.04) was protective of readmission. CONCLUSIONS Thirty-day hospital readmission following IPAA remains a common problem. Preventable etiologies of readmission include dehydration and venous thromboembolism (VTE). Future quality improvement efforts should focus on education regarding stoma output and extended VTE prophylaxis to decrease hospital readmission rates following IPAA.
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Affiliation(s)
| | - Kellie L Mathis
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Omair Shariq
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Eric J Dozois
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - David W Larson
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Amy L Lightner
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA. .,Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN, 55902, USA.
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Abstract
PURPOSE OF REVIEW Outpatient total joint arthroplasty (OTJA) allows for a safe, cost effective pathway for appropriately selected patients. With current pressures on arthroplasty surgeons and their associated institutions to reduce costs per episode of care, it is important to define the steps and challenges associated with establishing an outpatient arthroplasty program. RECENT FINDINGS Several studies have outlined techniques of selecting patients suitable for this type of postoperative pathway. With emerging concerns about patients who undergo outpatient arthroplasty being at increased risk of medical complications, which may lessen projected cost savings, it is important to identify value-based strategies to optimize patient recovery after OTJA. This article reviews digital techniques for patient selection and data collection, operating room efficiency systems, and provides a summary of methods to build and maintain value in outpatient total joint replacement within the framework of bundled payment reimbursement.
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Predictors of readmission in nonagenarians: analysis of the American College of Surgeons National Surgical Quality Improvement Project dataset. J Surg Res 2017; 213:32-38. [DOI: 10.1016/j.jss.2017.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 01/05/2017] [Accepted: 02/16/2017] [Indexed: 11/21/2022]
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Third Place Award Off-label versus on-label outcomes of total joint arthroplasty. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Musich S, MacLeod S, Bhattarai GR, Wang SS, Hawkins K, Bottone FG, Yeh CS. The Impact of Obesity on Health Care Utilization and Expenditures in a Medicare Supplement Population. Gerontol Geriatr Med 2016; 2:2333721415622004. [PMID: 28138482 PMCID: PMC5119873 DOI: 10.1177/2333721415622004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/20/2015] [Accepted: 11/07/2015] [Indexed: 01/20/2023] Open
Abstract
Objective: Obesity is a contributor to increased chronic conditions resulting in higher utilization of medical services among broad populations of older adults. The objective of this study was to evaluate the magnitude of the impact of weight on health care use patterns among Medicare Supplement insureds. Method: We estimated the impact of weight as a function of body mass index (BMI) on health care utilization and expenditures using propensity weighted multivariate regression models. The outcomes were controlled initially for demographics and socioeconomics and then additionally for chronic conditions and health status. Results: Among the 9,484 survey respondents, 22.9% were obese. Those categorized as obese were significantly more likely to incur inpatient admissions and orthopedic procedures. Annualized health care expenditures were US$1,496 higher for obese compared with normal weight. The excess utilization and expenditures associated with obesity were explained by chronic conditions and poor health status. Conclusion: Obesity-related expenditures associated with medical management are largely preventable and may benefit from interventions that target lifestyle behaviors and weight management among older adults.
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Postoperative length of stay and 30-day readmission after geriatric hip fracture: an analysis of 8434 patients. J Orthop Trauma 2015; 29:e115-20. [PMID: 25210835 DOI: 10.1097/bot.0000000000000222] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To identify factors associated with increased postoperative length of stay (LOS) and readmission after surgical repair of geriatric hip fractures. METHODS Patients aged 70 years and older who underwent hip fracture surgery from January 2011 through December 2012 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patient characteristics were tested for association with postoperative LOS and readmission using bivariate and multivariate analyses. RESULTS For the 8434 patients with hip fracture identified, the average age was 83.8 ± 5.9 years (mean ± SD), and 26.9% were male. Average postoperative LOS was 5.6 ± 6.0 days. Ten percent were readmitted within the first 30 postoperative days. Increased postoperative LOS of at least 1 full day was associated with increased time from admission to surgery, non-general anesthesia, and procedure type on multivariate analysis. Readmission was associated with increased age, male sex, body mass index ≥35 kg/m, American Society of Anesthesiologists class ≥3, pulmonary disease, hypertension, steroid use, dependent functional status, and discharge to a facility on multivariate analysis. CONCLUSIONS Ten percent of patients were readmitted after hip fracture repair in this national sample. Preoperative time to surgery, anesthesia type, and implant selection are 3 risk factors for increased LOS that can potentially be modified. A clinically significant risk factor for readmission was body mass index ≥35 kg/m, which was not associated with increased postoperative LOS. The identified risk factors illuminate opportunities for optimizing care for hip fracture patients aged 70 and older. LEVEL OF EVIDENCE Prognostic level II. See Instructions for Authors for a complete description of levels of evidence.
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Abstract
OBJECTIVE To evaluate the impact of hospital accreditation upon bariatric surgery outcomes. BACKGROUND Since 2004, the American College of Surgeons and the American Society of Metabolic and Bariatric Surgery have accredited bariatric hospitals. Few studies have evaluated the impact of hospital accreditation on all bariatric surgery outcomes. METHODS Bariatric surgery hospitalizations were identified using International Classification of Diseases, Ninth Revision (ICD9) codes in the 2010 Nationwide Inpatient Sample (NIS). Hospital names and American Hospital Association (AHA) codes were used to identify accredited bariatric centers. Relevant ICD9 codes were used for identifying demographics, length of stay (LOS), total charges, mortality, complications, and failure to rescue (FTR) events. RESULTS There were 117,478 weighted bariatric patient discharges corresponding to 235 unique hospitals in the 2010 NIS data set. A total of 72,615 (61.8%) weighted discharges, corresponding to 145 (61.7%) named or AHA-identifiable hospitals were included. Among the 145 hospitals, 66 (45.5%) were unaccredited and 79 (54.5%) accredited. Compared with accredited centers, unaccredited centers had a higher mean LOS (2.25 vs 1.99 days, P < 0.0001), as well as total charges ($51,189 vs $42,212, P < 0.0001). Incidence of any complication was higher at unaccredited centers than at accredited centers (12.3% vs 11.3%, P = 0.001), as was mortality (0.13% vs 0.07%, P = 0.019) and FTR (0.97% vs 0.55%, P = 0.046). Multivariable logistic regression analysis identified unaccredited status as a positive predictor of incidence of complication [odds ratio (OR) = 1.08, P < 0.0001], as well as mortality (OR = 2.13, P = 0.013). CONCLUSIONS AND RELEVANCE Hospital accreditation status is associated with safer outcomes, shorter LOS, and lower total charges after bariatric surgery.
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Predictive risk factors for 30-day readmissions following primary total joint arthroplasty and modification of patient management. J Arthroplasty 2014; 29:1938-42. [PMID: 24975486 DOI: 10.1016/j.arth.2014.05.023] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 05/08/2014] [Accepted: 05/22/2014] [Indexed: 02/01/2023] Open
Abstract
The Centers for Medicare and Medicaid have begun to publically publish statistics on readmissions following primary total hip (THA) and total knee arthroplasty (TKA). Our study retrospectively assesses 30-day readmissions rates following THA and TKA, performed by a single surgeon at a tertiary care medical center between 2007 and 2012. Results of a univariate analysis and logistic regression model indicated female gender, high ASA class, and increased operative time to be significantly associated with higher rates of readmission (OR 4.646, OR 1.257, and OR 5.323, respectively). Readmissions most often occurred within the first week of patient discharge. Surgical complications and gastrointestinal discomfort were the most common causes for readmission. Using readmission risk we can stratify patients into tiered critical care pathways to reduce readmissions.
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Redžek A, Mironicki M, Gvozdenović A, Petrović M, Čemerlić-Ađić N, Ilić A, Velicki L. Predictors for Hospital Readmission After Cardiac Surgery. J Card Surg 2014; 30:1-6. [DOI: 10.1111/jocs.12441] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Aleksandar Redžek
- Medical Faculty; University of Novi Sad; Novi Sad Serbia
- Institute of Cardiovascular Diseases Vojvodina; Sremska Kamenica; Sremska Kamenica Serbia
| | - Melisa Mironicki
- Institute of Cardiovascular Diseases Vojvodina; Sremska Kamenica; Sremska Kamenica Serbia
| | - Andrea Gvozdenović
- Institute of Cardiovascular Diseases Vojvodina; Sremska Kamenica; Sremska Kamenica Serbia
| | - Milovan Petrović
- Medical Faculty; University of Novi Sad; Novi Sad Serbia
- Institute of Cardiovascular Diseases Vojvodina; Sremska Kamenica; Sremska Kamenica Serbia
| | - Nada Čemerlić-Ađić
- Medical Faculty; University of Novi Sad; Novi Sad Serbia
- Institute of Cardiovascular Diseases Vojvodina; Sremska Kamenica; Sremska Kamenica Serbia
| | - Aleksandra Ilić
- Institute of Cardiovascular Diseases Vojvodina; Sremska Kamenica; Sremska Kamenica Serbia
| | - Lazar Velicki
- Medical Faculty; University of Novi Sad; Novi Sad Serbia
- Institute of Cardiovascular Diseases Vojvodina; Sremska Kamenica; Sremska Kamenica Serbia
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Kadry B, Press CD, Alosh H, Opper IM, Orsini J, Popov IA, Brodsky JB, Macario A. Obesity increases operating room times in patients undergoing primary hip arthroplasty: a retrospective cohort analysis. PeerJ 2014; 2:e530. [PMID: 25210656 PMCID: PMC4157296 DOI: 10.7717/peerj.530] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 07/30/2014] [Indexed: 12/29/2022] Open
Abstract
Background. Obesity impacts utilization of healthcare resources. The goal of this study was to measure the relationship between increasing body mass index (BMI) in patients undergoing total hip arthroplasty (THA) with different components of operating room (OR) time. Methods. The Stanford Translational Research Integrated Database Environment (STRIDE) was utilized to identify all ASA PS 2 or 3 patients who underwent primary THA at Stanford Medical Center from February 1, 2008 through January 1, 2013. Patients were divided into five groups based on the BMI weight classification. Regression analysis was used to quantify relationships between BMI and the different components of total OR time. Results. 1,332 patients were included in the study. There were no statistically significant differences in age, gender, height, and ASA PS classification between the BMI groups. Normal-weight patients had a total OR time of 138.9 min compared 167.9 min (P < 0.001) for morbidly obese patients. At a BMI > 35 kg/m2 each incremental BMI unit increase was associated with greater incremental total OR time increases. Conclusion. Morbidly obese patients required significantly more total OR time than normal-weight patients undergoing a THA procedure. This increase in time is relevant when scheduling obese patients for surgery and has an important impact on health resource utilization.
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Affiliation(s)
- Bassam Kadry
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center , Stanford, CA , USA
| | - Christopher D Press
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center , Stanford, CA , USA
| | - Hassan Alosh
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania , Silverstein, Philadelphia, PA , USA
| | - Isaac M Opper
- Stanford University Economics Department , Stanford, CA , USA
| | - Joe Orsini
- Stanford University Economics Department , Stanford, CA , USA
| | - Igor A Popov
- Stanford University Economics Department , Stanford, CA , USA
| | - Jay B Brodsky
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center , Stanford, CA , USA
| | - Alex Macario
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center , Stanford, CA , USA
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Identification of process measures to reduce postoperative readmission. J Gastrointest Surg 2014; 18:1407-15. [PMID: 24912913 DOI: 10.1007/s11605-013-2429-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 12/02/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Readmission rates after intestinal surgery have been notably high, ranging from 10 % for elective surgery to 21 % for urgent/emergent surgery. Other than adherence to established strategies for decreasing individual postoperative complications, there is little guidance available for providers to work toward reducing their postoperative readmission rates. STUDY DESIGN Processes of care that may affect postoperative readmissions were identified through a systematic literature review, assessment of existing guidelines, and semi-structured interviews with individuals who have expertise in hospital readmissions and surgical quality improvement. Eleven experts ranked potential process measures for validity on the basis of the RAND/University of California, Los Angeles Appropriateness Methodology. RESULTS Of 49 proposed process measures, 34 (69 %) were rated as valid. Of the 34 valid measures, two measures addressed care in the preoperative period. These included evaluation of patient's comorbidities, providing written instruction detailing the anticipated perioperative course, and communication with the patient's referring or primary care doctor. A measure addressing perioperative care stated that institutions should have a standardized perioperative care protocol. Additional measures focused on discharge instructions and communication. CONCLUSIONS An expert panel identified several aspects of care that are considered essential to quality patient care and important to reducing postoperative readmissions.
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Khavanin N, Bethke KP, Lovecchio FC, Jeruss JS, Hansen NM, Kim JYS. Risk Factors for Unplanned Readmissions Following Excisional Breast Surgery. Breast J 2014; 20:288-94. [DOI: 10.1111/tbj.12253] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Nima Khavanin
- Department of Surgery; Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | - Kevin P Bethke
- Department of Surgery; Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | - Francis C Lovecchio
- Department of Surgery; Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | - Jacqueline S Jeruss
- Department of Surgery; Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | - Nora M Hansen
- Department of Surgery; Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | - John YS Kim
- Department of Surgery; Feinberg School of Medicine; Northwestern University; Chicago Illinois
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Maradit Kremers H, Visscher SL, Kremers WK, Naessens JM, Lewallen DG. Obesity increases length of stay and direct medical costs in total hip arthroplasty. Clin Orthop Relat Res 2014; 472:1232-9. [PMID: 24101527 PMCID: PMC3940745 DOI: 10.1007/s11999-013-3316-9] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 09/24/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND The number of obese patients undergoing THA is increasing. Previous studies have shown that obesity is associated with an increased likelihood of complications after THA, but there is little information regarding the impact of obesity on medical resource use and direct medical costs in THA. QUESTIONS/PURPOSES We sought to examine the relationship between obesity, length of stay, and direct medical costs in a large cohort of patients undergoing THAs. METHODS The study included 8973 patients who had undergone 6410 primary and 2563 revision THAs at a large US medical center between January 1, 2000, and September 31, 2008. Patients with bilateral procedures within 90 days after index admission and patients with acute trauma were excluded. Data regarding clinical, surgical characteristics, and complications were obtained from the original medical records and the institutional joint registry. Patients were classified into eight groups based on their BMI at the time of surgery. Direct medical costs were calculated by using standardized, inflation-adjusted costs for services and procedures billed during hospitalization and the 90-day window. Study end points were hospital length of stay, direct medical costs during hospitalization, and the 90-day window. End points were compared across the eight BMI categories in multivariable risk-adjusted linear regression models. RESULTS Mean length of stay and the direct medical costs were lowest for patients with a BMI of 25 to 35 kg/m(2). Increasing BMI was associated with longer hospital stays and costs. Every five-unit increase in BMI beyond 30 kg/m(2) was associated with approximately USD $500 higher hospital costs and USD $900 higher 90-day costs in primary THA (p = 0.0001), which corresponded to 5% higher costs. The cost increase associated with BMI was greater in the revision THA cohort where every five-unit increase in BMI beyond 30 kg/m(2) was associated with approximately USD $800 higher hospital costs and USD $1500 higher 90-day costs. These estimates remained unchanged after adjusting for comorbidities or complications. CONCLUSIONS Obesity is associated with longer hospital stays and higher costs in THA. The significant effect of obesity on costs persists even among patients without comorbidities but the increased costs associated with obesity may be balanced by the potential benefits of THA in the obese. Increasing prevalence of obesity likely contributes to the increasing financial burden of THA worldwide. LEVEL OF EVIDENCE Level IV, economic and decision analyses. See the Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hilal Maradit Kremers
- />Department of Health Sciences Research, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Sue L. Visscher
- />Department of Health Sciences Research, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Walter K. Kremers
- />Department of Health Sciences Research, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - James M. Naessens
- />Department of Health Sciences Research, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - David G. Lewallen
- />Department of Orthopedic Surgery, College of Medicine, Mayo Clinic, Rochester, MN USA
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Inacio MCS, Kritz-Silverstein D, Raman R, Macera CA, Nichols JF, Shaffer RA, Fithian DC. The impact of pre-operative weight loss on incidence of surgical site infection and readmission rates after total joint arthroplasty. J Arthroplasty 2014; 29:458-64.e1. [PMID: 24018161 DOI: 10.1016/j.arth.2013.07.030] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 07/10/2013] [Accepted: 07/22/2013] [Indexed: 02/01/2023] Open
Abstract
This study characterized a cohort of obese total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients (1/1/2008-12/31/2010) and evaluated whether a clinically significant amount of pre-operative weight loss (5% decrease in body weight) is associated with a decreased risk of surgical site infections (SSI) and readmissions post-surgery. 10,718 TKAs and 4066 THAs were identified. During the one year pre-TKA 7.6% of patients gained weight, 12.4% lost weight, and 79.9% remained the same. In the one year pre-THA, 6.3% of patients gained weight, 18.0% lost weight, and 75.7% remained the same. In TKAs and THAs, after adjusting for covariates, the risk of SSI and readmission was not significantly different in the patients who gained or lost weight pre-operatively compared to those who remained the same.
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Affiliation(s)
- Maria C S Inacio
- Joint Doctoral Program Epidemiology, San Diego State University/University of California, San Diego, California
| | - Donna Kritz-Silverstein
- Department of Family and Preventive Medicine, University of California San Diego School of Medicine, San Diego California
| | - Rema Raman
- Department of Biostatistics, University of California San Diego School of Medicine, San Diego, California
| | - Caroline A Macera
- Graduate School of Public Health, San Diego State University, San Diego, California
| | - Jeanne F Nichols
- School of Exercise & Nutritional Sciences, San Diego State University, San Diego, California
| | - Richard A Shaffer
- Graduate School of Public Health, San Diego State University, San Diego, California
| | - Donald C Fithian
- Southern California Permanente Medical Group, Department of Orthopaedic Surgery, San Diego, California
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Factors associated with readmission following plastic surgery: a review of 10,669 procedures from the 2011 American College of Surgeons National Surgical Quality Improvement Program data set. Plast Reconstr Surg 2013; 132:666-674. [PMID: 23676965 DOI: 10.1097/prs.0b013e31829acc8c] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND This study explored factors associated with readmission following plastic surgery using a prospective, validated, national database. METHODS Patients who underwent primary plastic surgery procedures (n = 10,669) were identified from the 2011 American College of Surgeons National Surgical Quality Improvement Program databases. Those who were readmitted were compared with those who were not. Preoperative patient comorbidities, laboratory values, and intraoperative details derived from the data set were analyzed, and multivariate regression analysis was used to identify predictors of readmission. RESULTS A total of 10,669 patients were included, with a 4.5 percent readmission rate. Their average age was 49.5 years, 32.2 percent were obese, 15.2 percent were smokers, and 81.7 percent were women. The most commonly performed procedures included elective/cosmetic breast (23.4 percent), implant breast reconstruction (16.5 percent), revision breast procedures (14.9 percent), hand operations (9.7 percent), and body contouring (5.9 percent). The wound complication rate was 4.6 percent and the medical complication rate was 4.9 percent. The overall incidence of any postoperative complication was 10.9 percent, of which 4.8 percent were defined as major surgical complications. Independent risk factors associated with readmission included procedure type (p = 0.029); obesity (p = 0.011); anemia (p = 0.003); and medical (p < 0.001), major surgical (p < 0.001), and wound (p < 0.001) complications. CONCLUSIONS The most significant predictor of readmission was postoperative complications. Patients experiencing postoperative surgical complications were six times more likely to be readmitted. These findings can assist surgeons and health systems to better tailor preoperative risk counseling, resource allocation, and postoperative discharge services.
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Khavanin N, Gart MS, Berry T, Thornton B, Saha S, Kim JYS. Sentinel Lymph Node Biopsy Versus Axillary Lymphadenectomy in Patients Treated with Lumpectomy: An Analysis of Short-Term Outcomes. Ann Surg Oncol 2013; 21:74-80. [DOI: 10.1245/s10434-013-3248-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Indexed: 12/30/2022]
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Acute kidney injury, renal function, and the elderly obese surgical patient: a matched case-control study. Ann Surg 2013; 258:359-63. [PMID: 23676533 DOI: 10.1097/sla.0b013e31829654f3] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To investigate the association between obesity and perioperative acute kidney injury (AKI), controlling for preoperative kidney dysfunction. BACKGROUND More than 30% of patients older than 60 years are obese and, therefore, at risk for kidney disease. Postoperative AKI is a significant problem. METHODS We performed a matched case-control study of patients enrolled in the Obesity and Surgical Outcomes Study, using data of Medicare claims enriched with detailed chart review. Each AKI patient was matched with a non-AKI control similar in procedure type, age, sex, race, emergency status, transfer status, baseline estimated glomerular filtration rate, admission APACHE score, and the risk of death score with fine balance on hospitals. RESULTS We identified 514 AKI cases and 694 control patients. Of the cases, 180 (35%) followed orthopedic procedures and 334 (65%) followed colon or thoracic surgery. After matching, obese patients undergoing a surgical procedure demonstrated a 65% increase in odds of AKI within 30 days from admission (odds ratio = 1.65, P < 0.005) when compared with the nonobese patients. After adjustment for potential confounders, the odds of postoperative AKI remained elevated in the elderly obese (odds ratio = 1.68, P = 0.01.) CONCLUSIONS : Obesity is an independent risk factor for postoperative AKI in patients older than 65 years. Efforts to optimize kidney function preoperatively should be employed in this at-risk population along with keen monitoring and maintenance of intraoperative hemodynamics. When subtle reductions in urine output or a rising creatinine are observed postoperatively, timely clinical investigation is warranted to maximize renal recovery.
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Synergistic effect of age and body mass index on mortality and morbidity in general surgery. J Surg Res 2013; 184:89-100. [PMID: 23764311 DOI: 10.1016/j.jss.2013.05.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 03/27/2013] [Accepted: 05/02/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND The elderly population (aged 65 y and older) is expected to be the dominant age group in the United States by 2030. In addition, the prevalence of obesity in the United States is growing exponentially. Obese elderly patients are increasingly undergoing elective or emergent general surgery. There are few, if any, studies highlighting the combined effect of age and body mass index (BMI) on surgical outcomes. We hypothesize that increasing age and BMI synergistically impact morbidity and mortality in general surgery. MATERIALS AND METHODS We collected individual-level, de-identified patient data from the Michigan Surgical Quality Collaborative. Subjects underwent general surgery with general anesthetic, were >18 y, and had a BMI between 19 and 60. Primary and secondary outcomes were 30-d "Any morbidity" and mortality (from wound, respiratory, genitourinary, central nervous system, and cardiac systems), respectively. Preoperative risk variables included diabetes, dialysis, steroid use, cardiac risk, wound classification, American Society of Anesthesiology class, emergent cases, and 13 other variables. We conducted binary logistic regression models for 30-d morbidity and mortality to determine independent effects of age, BMI, interaction between both age and BMI, and a saturated model for all independent variables. RESULTS We identified 149,853 patients. The average age was 54.6 y, and the average BMI was 30.9. Overall 30-d mortality was 2%, and morbidity was 6.7%. Age was a positive predictor for mortality and morbidity, and BMI was negatively associated with mortality and not significantly associated with morbidity. Age combined with higher BMI was positively associated with morbidity and mortality when the higher age groups were analyzed. Saturated models revealed age and American Society of Anesthesiology class as highest predictors of poor outcomes. CONCLUSIONS Although BMI itself was not a major independent factor predicting 30-d major morbidity or mortality, the morbidly obese, elderly (>50 and 70 y, respectively) subgroup may have an increased morbidity and mortality after general surgery. This information, along with patient-specific factors and their comorbidities, may allow us to better take care of our patients perioperatively and better inform our patients about their risk of surgical procedures.
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Rambousková J, Slavíková M, Krsková A, Procházka B, Anděl M, Dlouhý P. Nutritional status assessment of institutionalized elderly in Prague, Czech Republic. ANNALS OF NUTRITION AND METABOLISM 2013; 62:201-6. [PMID: 23485785 DOI: 10.1159/000346038] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 11/21/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND There are few studies in the Czech Republic describing and evaluating the nutritional status of institutionalized elderly. METHODS Data were collected from 659 women and 156 men aged 65 years and older and living in retirement homes in and around Prague. Data included: a Mini-Nutritional Assessment (MNA questionnaire), anthropometric measurements and biochemical evaluations. RESULTS According to the MNA questionnaire, 10.2% of these elderly individuals were malnourished and 39.4% were at risk of malnutrition. More women than men were malnourished (OR = 0.59 and 95% CI 0.42-0.86). Mean BMI values were 25.5 for females and 27.5 for males. MNA was positively correlated mostly with immobility (r = 0.63; p < 0.001), BMI (r = 0.57; p < 0.001) and mid-arm circumference (r = 0.56; p < 0.001). Serum albumin levels were <28 g/l in 1.3% (1.3% of the women and 1.36% of the men) and between 29.0 - 34.0 g/l in 21% (22.5% of the women and 14.4% of the men). Statistically significant differences between groups according to MNA scores were found for albumin, prealbumin, transferrin and creatinine. Prevalence of smoking was significantly higher among males. CONCLUSION The study results confirmed that institutionalized elderly, especially women, should be considered a nutritionally vulnerable population group that needs attention.
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Affiliation(s)
- Jolana Rambousková
- Centre for Research of Diabetes, Metabolism and Nutrition, Department of Nutrition, Third Faculty of Medicine, Charles University, Prague, Czech Republic.
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Sellers MM, Merkow RP, Halverson A, Hinami K, Kelz RR, Bentrem DJ, Bilimoria KY. Validation of new readmission data in the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg 2013; 216:420-7. [PMID: 23332220 DOI: 10.1016/j.jamcollsurg.2012.11.013] [Citation(s) in RCA: 205] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 11/27/2012] [Accepted: 11/28/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND Hospital readmissions are gathering increasing attention as a measure of health care quality and as a cost-saving target. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) recently began collecting data related to 30-day postoperative readmissions. Our objectives were to assess the accuracy of the ACS NSQIP readmission variable by comparison with the medical record, and to evaluate the readmission variable against administrative data. STUDY DESIGN Readmission data captured in ACS NSQIP at a single academic institution between January and December 2011 were compared with data abstracted from the medical record and administrative data. RESULTS Of 1,748 cases captured in ACS NSQIP, 119 (6.8%) had an all-cause readmission event identified, and ACS NSQIP had very high agreement with chart review for identifying all-cause readmission events (κ = 0.98). For 1,110 inpatient cases successfully matched with administrative data, agreement with chart review for identifying all-cause readmissions was also very high (κ = 0.97). For identifying unplanned readmission events, ACS NSQIP had good agreement with chart review (κ = 0.67). Overall, agreement with chart review on cause of readmission was higher for ACS NSQIP (κ = 0.75) than for administrative data (κ = 0.46). CONCLUSIONS The ACS NSQIP accurately captured all-cause and unplanned readmission events and had good agreement with the medical record with respect to cause of readmission. Administrative data accurately captured all-cause readmissions, but could not identify unplanned readmissions and less consistently agreed with chart review on cause. The granularity of clinically collected data offers tremendous advantages for directing future quality efforts targeting surgical readmission.
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Affiliation(s)
- Morgan M Sellers
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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