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Halverson AL. Rural Surgical Quality: Policy and Practice. Surg Clin North Am 2020; 100:901-908. [PMID: 32882172 DOI: 10.1016/j.suc.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Several national studies have demonstrated that rural hospitals successfully deliver high-quality care. Data at the national, regional, institutional, and individual practitioner levels all contribute to understanding of surgical outcomes in the rural setting. Quality metrics should be interpreted within the context of the rural community and outcomes analyzed with relevant risk adjustment for patient factors.
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Affiliation(s)
- Amy L Halverson
- Northwestern University Feinberg School of Medicine, 676 North Street Clair, Suite 650, Chicago, IL 60611, USA.
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AlMarzooqi R, Tish S, Tastaldi L, Fafaj A, Olson M, Stewart T, Prabhu A, Krpata D, Petro C, Rosen M. Is concomitant cholecystectomy safe during abdominal wall reconstruction? An AHSQC analysis. Hernia 2020; 25:295-303. [PMID: 32417989 DOI: 10.1007/s10029-020-02208-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 05/04/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Unlike routine ventral hernia repair, abdominal wall reconstruction (AWR) can results in large pieces of mesh and extensive manipulation of the intra-abdominal contents, rendering subsequent laparoscopic cholecystectomy challenging. This study addresses the additional wound morbidity of concomitant cholecystectomy. METHODS The Americas Hernia Society Quality Collaborative (AHSQC) was retrospectively reviewed and logistic regression modeling was used to control for multiple covariates. Patients that underwent open AWR with cholecystectomy were compared to a similar group of patients undergoing uncomplicated, open, clean, AWR alone. RESULTS 130 patients undergoing concomitant cholecystectomy were compared to a control group of 6440 patients. The addition of a cholecystectomy did not cause a significant change in wound morbidity (SSI: p = 0.16; SSOPI: p = 0.65). CONCLUSIONS This study noted that a concomitant cholecystectomy does not increase the wound morbidity as compared to an uncomplicated, clean, AWR. This provides support for consideration of routine cholecystectomy in patients with cholelithiasis undergoing AWR.
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Affiliation(s)
- R AlMarzooqi
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA.
| | - S Tish
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - L Tastaldi
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - A Fafaj
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - M Olson
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - T Stewart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - A Prabhu
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - D Krpata
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - C Petro
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - M Rosen
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
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Abstract
Collaborative quality improvement has demonstrated success in improving quality and reducing health care costs in several state-based examples. Professional societies and payers are keen on identifying the most effective strategies to improve the safety and efficiency of surgical care. This review highlights the development and features of collaborative quality improvement programs, their advantages and examples of successful collaborations for several surgical conditions, and their potential application for surgeons caring for patients with upper extremity trauma and disability.
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Affiliation(s)
- Jennifer F Waljee
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical Center, University of Michigan Health System, 1500 East Medical Center Drive, 2131 Taubman Center, Ann Arbor, MI 48109, USA.
| | - Nancy J O Birkmeyer
- Michigan Bariatric Surgery Collaborative, Center for Healthcare Outcomes and Policy, North Campus Research Complex, 2800 Plymouth Road, B016, Ann Arbor, MI 48109, USA; Department of Surgery, University of Michigan Medical Center, 1500 East Medial Center Drive, Ann Arbor, MI 48109, USA
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