Trend of ambulatory benign prostatic obstruction surgeries during COVID-19 pandemic.

Introduction: Benign prostatic obstruction (BPO) is one of the most common causes of male lower urinary tract symptoms. Some institutions routinely perform BPO surgeries in ambulatory setting, while others elect for overnight hospitalization. With the COVID-19 pandemic limiting resources and hospital space for elective surgery, we investigated the time trend of ambulatory BPO procedures performed around the COVID-19 outbreak.

Preoperative Care Intensity and Cost for Renal Colic: Implications for Surgical Value-Based Reforms.

Introduction: The aim of this study was to identify preoperative patient/facility factors associated with postoperative and total episode-related costs using renal colic as a model surgical condition to improve value-based payment models.

Methods: Using state Healthcare Cost and Utilization Project data, we performed a retrospective cohort study examining perioperative costs for individuals presenting to an emergency department for renal colic and who ultimately underwent definitive surgical management. We estimated multivariable ordered and binary logistic regressions to examine the association between preoperative and operative cost quartiles on the probability of specific postoperative cost quartiles after accounting for hospital and individual factors.

Impact of COVID-19 pandemic on ambulatory urologic oncology surgeries.

Introduction: Robot-assisted laparoscopic prostatectomy (RALP) and transurethral resection of bladder tumor (TURBT) are two common surgeries for prostate and bladder cancer. We aim to assess the trends in the site of care for RALP and TURBT before and after the COVID outbreak.

Materials And Methods: We identified adults who underwent RALP and TURBT within the California Healthcare Cost and Utilization Project State Inpatient Database and the State Ambulatory Surgery Database between 2018 and 2020.

Incidence and cost of potentially avoidable emergency department visits for urolithiasis.

Objectives: Urolithiasis represents a leading cause of emergency department (ED) presentation nationally, affecting approximately 10% of Americans. However, most patients require neither hospital admission nor surgical intervention. This study investigates patient and facility factors associated with potentially avoidable ED visits and their economic consequences.

Value of Ambulatory Modified Radical Mastectomy.

Background: Modified radical mastectomy (MRM) still is largely performed in inpatient settings. This study sought to determine the value (expenditures and complications) of ambulatory MRM.

Methods: Health Care Utilization Project (HCUP) state databases from 2016 were queried for patients who underwent MRM.

Influence of Clinical and Sociodemographic Factors on the Management, Costs and Outcomes of Acute Urinary Retention in the Acute Care Setting.

Introduction: We evaluated clinical and sociodemographic factors that influence care pathways following acute urinary retention with attention to subsequent bladder outlet procedures.

Methods: This was a retrospective cohort study examining patients who presented for emergent care with concomitant diagnoses of urinary retention and benign prostatic hyperplasia in New York and Florida in 2016. Using Healthcare Cost and Utilization Project data, patients were followed throughout a calendar year across subsequent encounters for recurrent urinary retention and bladder outlet procedures.

Comparison of Ordering Tools on Adherence to Treatment Protocols in the Emergency Department.

Objective: To assess adherence to clinical protocols in the emergency department after the implementation of embedded order panels in the electronic health record.

Materials And Methods: Due to infrequent use, a subset of order sets were redesigned as embedded order panels in a menu-style quick list. Usage was measured before and after implementation at seven departments.

Health-related quality of life disparities among Hispanic/Latinx patients with nephrolithiasis.

It is documented that Hispanic/Latinx kidney stone formers have inferior health-related quality of life (HRQoL) compared to the general population. We hypothesized that socioeconomic factors drive HRQoL disparities. Specifically, we sought to determine if medical insurance type is associated with HRQoL disparities among Hispanic/Latinx stone formers.

Comparison of Cost and Perioperative Outcomes Among Patients Undergoing Simple Prostatectomy and Laser Enucleation of the Prostate.

Simple prostatectomy (SP) and laser enucleation of the prostate (LEP) are treatments for symptomatic benign prostatic hyperplasia (BPH) in men with large glands (e.g., >80 g).

Tracheal Bronchus With Difficult Lung Isolation: A Case Report.

Tracheal bronchus (TB) occurs in 0.1-3% of the population as an accessory bronchus that originates in the trachea, typically supplying the right upper lobe. The presence of a TB can pose unique airway challenges, particularly during procedures that require lung isolation.

Disparities in Index of Care for Otolaryngologic Procedures Performed in Ambulatory and Inpatient Settings.

Objective: To compare the same surgical procedure performed in ambulatory and inpatient settings to determine the demographics associated with this selection, the differences in 30-day revisit rates, and the total 30-day cost of care.

Study Design: Retrospective cohort analysis.

Setting: Ambulatory and inpatient centers in Florida, New York, and Maryland.

Predictors and Cost Comparison of Subsequent Urinary Stone Care at Index Versus Non-Index Hospitals.

Objective: To examine the effects of care fragmentation, or the engagement of different health care systems along the continuum of care, on patients with urinary stone disease.

Methods: All-payer data from the 2016 Healthcare Cost and Utilization Project (HCUP) State Databases from Florida (FL) and New York (NY) were used to identify a cohort of adult patients with an emergency department visit for a diagnosis of urolithiasis, who subsequently re-presented to an index or non-index hospital for renal colic and/or urological intervention. Patient demographics, regional data, and procedural information were collected and 30-day episode-based costs were calculated.

Determining Variable Costs in the Acute Urolithiasis Cycle of Care Through Time-Driven Activity-Based Costing.

Objective: To characterize full cycle of care costs for managing an acute ureteral stone using time-driven activity-based costing.

Methods: We defined all phases of care for patients presenting with an acute ureteral stone and built an overarching process map. Maps for sub-processes were constructed through interviews with providers and direct observation of clinical spaces.

Association of the hospital readmission reduction program with readmission and mortality outcomes after coronary artery bypass graft surgery.

The Affordable Care Act established the Hospital Readmissions Reduction Program (HRRP) to reduce payments to hospitals with excessive readmissions in an effort to link payment to the quality of hospital care. Prior studies demonstrating an association of HRRP implementation with increased mortality after heart failure discharges have prompted concern for potential unintended adverse consequences of the HRRP. We examined the impact of these policies on coronary artery bypass graft (CABG) surgery outcomes using the Nationwide Readmissions Database and found that, in line with previously observed readmission trends for CABG, readmission rates continued to decline in the era of the HRRP, but that this did not come at the expense of increased mortality.

Drug Alert Experience and Salience during Medical Residency at Two Healthcare Institutions.

Background: Drug alerts are clinical decision support tools intended to prevent medication misadministration. In teaching hospitals, residents encounter the majority of the drug alerts while learning under variable workloads and responsibilities that may have an impact on drug-alert response rates.

Objectives: This study was aimed to explore drug-alert experience and salience among postgraduate year 1 (PGY-1), postgraduate year 2 (PGY-2), and postgraduate year 3 (PGY-3) internal medicine resident physicians at two different institutions.

Is the current referral trend a threat to the Military Health System? Perioperative outcomes and costs after colorectal surgery in the Military Health System versus civilian facilities.

Background: TRICARE military beneficiaries are increasingly referred for major surgeries to civilian hospitals under "purchased care." This loss of volume may have a negative impact on the readiness of surgeons working in the "direct-care" setting at military treatment facilities and has important implications under the volume-quality paradigm. The objective of this study is to assess the impact of care source (direct versus purchased) and surgical volume on perioperative outcomes and costs of colorectal surgeries.

A Randomized Controlled Trial of Preoperative Prophylactic Antibiotics for Percutaneous Nephrolithotomy in Moderate to High Infectious Risk Population: A Report from the EDGE Consortium.

Purpose: Postoperative infectious related complications are not uncommon after percutaneous nephrolithotomy. Previously, we noted that 7 days of antibiotics did not decrease sepsis rates compared to just perioperative antibiotics in a low risk percutaneous nephrolithotomy population. This study aimed to compare the same regimens in individuals at moderate to high risk for sepsis undergoing percutaneous nephrolithotomy.

Trends in Surgical Volume in the Military Health System-A Potential Threat to Mission Readiness.

Introduction: The Military Health System (MHS) is tasked with a dual mission both to provide medical services for covered patients and to ensure that its active duty medical personnel maintain readiness for deployment. Knowledge, skills, and attitudes (KSA) is a metric evaluating the transferrable skills incorporated into a given surgery or medical procedure that are most relevant for surgeons deployed to a theatre of war. Procedures carrying a high KSA value are those utilizing skills with high relevance for maintaining deployment readiness.