Mortality following helicopter versus ground transport of injured children.

Introduction: Injured children may be transported to trauma centers by helicopter air ambulance (HAA); however, a benefit in outcomes to this expensive resource has not been consistently shown in the literature and there is concern that HAA is over-utilized. A study that adequately controls for selection biases in transport mode is needed to determine which injured children benefit from HAA. The purpose of this study was to determine if HAA impacts mortality differently in minimally and severely injured children and if there are predictors of over-triage of HAA in children that can be identified.

Risk Factors for Venous Thromboembolism following Thoracolumbar Surgery: Analysis of 43,777 Patients from the American College of Surgeons National Surgical Quality Improvement Program 2005 to 2012.

 Retrospective clinical study of a prospectively collected, national database.  Determine the 30-day incidence, timing, and risk factors for venous thromboembolism (VTE) following thoracolumbar spine surgery.  The American College of Surgeons National Surgical Quality Improvement Program Participant Use File identified 43,777 patients who underwent thoracolumbar surgery from 2005 to 2012.

Readability of discharge summaries: with what level of information are we dismissing our patients?

Background: We assessed the health literacy of trauma discharge summaries and hypothesize that they are written at higher-than-recommended grade levels.

Methods: The Flesch-Kincaid grade level (FKGL) and Flesch reading ease scores (FRES), 2 universally accepted scales for evaluating readability of medical information, were used.

Results: A total of 497 patients were included.

Validation of a Soft Tissue Sarcoma Nomogram Using a National Cancer Registry.

Background: A nomogram to predict disease-specific mortality (DSM) following surgery for soft tissue sarcoma (STS) has been developed by the Memorial Sloan Kettering Cancer Center (MSKCC). The goal of this study was to validate this nomogram by assessing discrimination and calibration at the population level using a national cancer database.

Methods: Retrospective review of the Surveillance, Epidemiology, and End Results cancer registries identified patients undergoing surgery for STS from 1988 to 2011.

Clinical Risk Score to Predict Pancreatic Fistula after Pancreatoduodenectomy: Independent External Validation for Open and Laparoscopic Approaches.

Background: A clinical risk score for pancreatic fistula (CRS-PF) was recently reported to predict postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD). An independent external validation has not been performed. Our hypothesis was that CRS-PF predicts POPF after both laparoscopic and open PD.

The Changing Landscape of Vestibular Schwannoma Management in the United States--A Shift Toward Conservatism.

Objective: To characterize the evolving management of vestibular schwannoma (VS) in the United States.

Study Design: Retrospective analysis of the Surveillance, Epidemiology, and End Results (SEER) database.

Setting: SEER database.

A comparison of two quality measurement tools in pediatric surgery--the American College of Surgeons National Surgical Quality Improvement Program-Pediatric versus the Agency for Healthcare Research and Quality Pediatric Quality Indicators.

Background/purpose: Identifying quality in pediatric surgery can be difficult given the low frequency of postoperative complications. We compared postoperative events following pediatric surgical procedures at a single institution identified by ACS-NSQIP Pediatric (ACS NSQIP-P) methodology and AHRQ Pediatric Quality Indicators (AHRQ PDIs), an administrative tool.

Methods: AHRQ PDI algorithms were run on inpatient hospital discharge abstracts for 1257 children in the 2010 to 2013 ACS NSQIP-P at our institution.

Association of worksite wellness center attendance with weight loss and health care cost savings: Mayo Clinic's experience.

Objective: To assess the impact of wellness center attendance on weight loss and costs.

Methods: A retrospective analysis was conducted using employee data, administrative claims, and electronic health records. A total of 3199 employees enrolled for 4 years (2007 to 2010) were included.

Benchmarks for splenectomy in pediatric trauma: how are we doing?

Background/purpose: Following publication of American Pediatric Surgical Association (APSA) hospital benchmarks for the operative management of blunt splenic trauma in specialized centers, it was found that most hospitals exceeded these benchmarks. We sought to determine if benchmarks were being met a decade later and to identify factors associated with splenectomy in injured children.

Methods: Rates of splenic procedures were calculated for children≤19 with a blunt splenic injury (ICD-9 865) using the 2010-2011 National Trauma Data Bank.

National trends of 3- versus 2-stage restorative proctocolectomy for chronic ulcerative colitis.

Background: Patients undergoing surgical treatment of chronic ulcerative colitis usually undergo a staged approach to IPAA.

Objective: The purpose of this work was to identify the national trends in approach to IPAA for chronic ulcerative colitis and to evaluate 30-day outcomes using the American College of Surgeons National Surgical Quality Improvement Program.

Design: This was a retrospective review study

Settings: : This study was conducted at a tertiary care cancer center.

Utility of intraoperative cystoscopy in detecting ureteral injury during vaginal hysterectomy.

Objectives: The aim of this study was to determine the utility of intraoperative cystoscopy in detecting and managing ureteral injury among women undergoing vaginal hysterectomy.

Methods: We performed a secondary analysis of a retrospective cohort study of 593 patients who underwent vaginal hysterectomy for benign indications, with or without additional pelvic floor reconstructive surgery, from January 2, 2004, through December 30, 2005. A logistic regression model determining the propensity to undergo intraoperative cystoscopy was constructed.

Surgical site infections (SSIs) after stoma reversal (SR): risk factors, implications, and protective strategies.

Background: Stoma reversals (SRs) are commonly performed with potentially significant postoperative complications including surgical site infections (SSIs). Our aim was to determine the incidence and risk factors for SSIs in a large cohort of SR patients.

Design: We reviewed our institutional 2006-2011 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for 30-day SSIs in patients undergoing SR.

Effect of multiple chronic diseases on health care expenditures in childhood.

Objectives: To examine multiple chronic conditions and related health care expenditures in children.

Methods: Retrospective cohort study of all dependents of Mayo Clinic employees aged 0-17 on Jan 1, 2004 with continuous health benefits coverage for 4 years (N=14,727). Chronic conditions, health care utilization, and associated expenditures were obtained from medical and pharmacy claims.

Decline in ACEI/ARB Prescribing as Heart Failure Core Metrics Improve During Computer-Based Clinical Decision Support.

Computer-based clinical decision-support systems are effective interventions to improve compliance with guidelines and quality measures. However, understanding of their long-term impact, including unintended consequences, is limited. The authors assessed the clinical impact of the sequential implementation of 2 such systems to improve the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) in inpatients with heart failure.

Episode-based payment: evaluating the impact on chronic conditions.

Background: Policy makers are interested in aggregating fee-for-service reimbursement into episode-based bundle payments, hoping it will lead to greater efficiency in the provision of care. The focus of bundled payment initiatives has been upon surgical or discrete procedures. Relatively little is known about calculating and implementing episode-based payments for chronic conditions.

The effects of incremental costs of smoking and obesity on health care costs among adults: a 7-year longitudinal study.

Objective: To provide the simultaneous 7-year estimates of incremental costs of smoking and obesity among employees and dependents in a large health care system.

Methods: We used a retrospective cohort aged 18 years or older with continuous enrollment during the study period. Longitudinal multivariate cost analyses were performed using generalized estimating equations with demographic adjustments.

The asthma ePrompt: a novel electronic solution for chronic disease management.

Objective: This study tested the ability of an electronic prompt to promote an asthma assessment during primary care visits.

Methods: We performed a prospective study of all eligible adult patients with previously diagnosed asthma in three geographically distinct ambulatory family medicine clinics within a 4-month period. The usual clinic visit process was performed at two geographically distinct control sites (n = 75 and n = 55 patients, respectively).

Direct costs of bipolar disorder versus other chronic conditions: an employer-based health plan analysis.

Objective: This study was a retrospective data-based analysis of health care utilization and costs for patients diagnosed as having bipolar disorder compared with patients with diagnoses of depression, diabetes, coronary artery disease, or asthma.

Methods: Data were from an employer-based health plan. Consistent diagnosis and continuous enrollment from 2004 to 2007 were used to identify the study population (total N = 7,511), including those with bipolar disorder (N = 122), depression (N = 1,290), asthma (N = 2,770), coronary artery disease (N = 1,759), diabetes (N = 1,418), and diabetes with coronary artery disease (N = 455).

Effect of multiple chronic conditions among working-age adults.

Objective: To determine the longitudinal effect on healthcare costs of multiple chronic conditions among adults aged 18 to 64 years.

Study Design: Retrospective cohort assessment of working-age employees and their dependents with continuous coverage in a self-funded health plan from January 1, 2004, to December 31, 2007. Data were obtained from health benefit enrollment files and from medical and pharmacy claims.

Body mass index and the impact on hospital resource use in patients undergoing total knee arthroplasty.

We identified all total knee arthroplasty patients between 1996 and 2004 and classified them by preoperative body mass index (BMI) as normal (BMI, 18.5-24.9 kg/m(2)), overweight (BMI, 25.

The net value of health care for patients with type 2 diabetes, 1997 to 2005.

Background: The net economic value of increased health care spending remains unclear, especially for chronic diseases.

Objective: To assess the net value of health care for patients with type 2 diabetes.

Design: Economic analysis of observational cohort data.

Long-term medication adherence after myocardial infarction: experience of a community.

Background: Adherence to evidence-based medications after myocardial infarction is associated with improved outcomes. However, long-term data on factors affecting medication adherence after myocardial infarction are lacking.

Methods: Olmsted County residents hospitalized with myocardial infarction from 1997-2006 were identified.

Impact of body mass on hospital resource use in total hip arthroplasty.

Objective: To determine the impact of BMI on post-operative outcomes and resource utilization following elective total hip arthroplasty (THA).

Design: A retrospective cohort analysis on all primary elective THA patients between 1996 and 2004. Primary outcomes investigated using regression analyses included length of stay (LOS) and costs (US dollars).

Cost savings of hip arthroplasty patients on specialized orthopedic surgery units.

We retrospectively compared resource use of 2 groups of patients who underwent total hip arthroplasty between 1996 and 2004: those cared for on specialized orthopedic surgery (SOS) units and those cared for on nonorthopedic nursing (NON) units. Of 5546 patients, 5275 (95.1%) were admitted to SOS units and 271 (4.

Flunking asthma? When HEDIS takes the ACT.

Objective: To test several patient-oriented asthma outcome measures and the Healthcare Effectiveness Data and Information Set (HEDIS) measure of appropriate medication for persistent asthma to determine the most useful quality indicator of asthma care.

Design: Prospective mail survey of adult employees and dependents with asthma.

Methods: The medical and pharmacy claims of all subjects from 12 months before and after the survey were abstracted.