Implementation of postoperative opioid prescribing guidelines after carpal tunnel release: a quality collaborative study.

Opioid prescribing after carpal tunnel release (CTR) is not well understood. We assessed CTR opioid prescribing within a quality collaborative after the dissemination of guidelines. Post guidelines, the odds of receiving a prescription decreased by 67%.

Non-inferiority Study Design: Application to Clinical Trials.

Non-inferiority trials, a distinct category within randomized controlled trials, are garnering increased attention in medical research. Their unique and evolving role comes to the forefront in scenarios where new treatments, despite not surpassing the efficacy of an existing standard, bring additional benefits like reduced side effects, enhanced compliance, or cost savings. As the field of surgery witnesses a growing number of published non-inferiority trials, it becomes imperative for surgeons to grasp the intricacies of this trial type to accurately decipher and interpret their outcomes.

Utilization Trends of Nerve Autograft Alternatives for the Reconstruction of Peripheral Nerve Defects.

Background: Autologous nerve grafting is the time-honored reconstruction method for peripheral nerve gaps. However, it is associated with donor-site morbidities. A growing number of studies have demonstrated the effective use of decellularized nerve allograft and synthetic conduits, which are convenient options with no donor deficit.

Predictors and Variation in Steroid Injection Use for Carpal Tunnel Syndrome from a Multicenter Quality Collaborative.

Background: Steroid injections are commonly used as first-line treatment for carpal tunnel syndrome (CTS); however, research has shown that their benefit is generally short term, and many patients go on to receive carpal tunnel release (CTR). The purpose of this study was to determine the variation in steroid injection use by hand surgeons.

Methods: The authors analyzed data from a nine-center hand surgery quality collaborative.

A Quality Collaborative Study of the Concordance of Electrodiagnostic Scores and Clinical Severity in Carpal Tunnel Syndrome.

Background: Electrodiagnostic studies are commonly used to diagnose carpal tunnel syndrome. However, these examinations are prone to false-positive and false-negative values. The authors evaluated the agreement of electrodiagnostic study severity, clinical assessment scores, and probability of carpal tunnel syndrome [Six-Item Carpal Tunnel Syndrome Evaluation Tool (CTS-6) scores.

Preventable Hospitalization Trends Before and After the Affordable Care Act.

Introduction: The Patient Protection and Affordable Care Act aimed to increase the number of individuals with health insurance, which may lead to adequate primary care management and reduced rates of preventable hospitalizations. To investigate the rates of preventable hospitalization after the passing of the Affordable Care Act in 2010 and Medicaid expansion in 2014 across 26 states, a population-based study was conducted using the Healthcare Cost and Utilization Project National Inpatient Sample database from 2005-2017.

Methods: A logistic regression and trend analysis was performed to assess the changes in preventable hospitalization rates over time and the impact of policy changes on the rate of preventable hospitalization.

Task-Specific Patient Preferences for Shared Decision-Making in Hand Surgery.

Background: Shared decision-making for surgery can increase patient engagement, satisfaction, and clinical outcomes. However, the level of involvement that patients desire at each step of the decision-making process is unknown.

Methods: The authors surveyed patients at an academic hand surgery clinic to examine the preferred role in decision-making using validated questionnaires (i.

Evaluation of Factors Relevant to Pain Control Among Patients After Surgical Treatment.

Importance: Opioids are often prescribed after elective surgical treatment despite the potential for misuse. Although various pain control regimens exist, patient preferences for acute postoperative pain management are unknown.

Objective: To describe patient-reported key attributes of postoperative pain management.

Opioid Prescribing after Carpal Tunnel Release: Analysis from the Michigan Collaborative Hand Initiative for Quality in Surgery.

Background: Little is known regarding the national practice patterns for postoperative opioid prescribing after carpal tunnel release, which is one of the most common surgical procedures performed. The authors sought to assess the rate of opioid prescribing after carpal tunnel release and patient-, surgeon-, and practice-level predictors of opioid prescriptions after surgery.

Methods: The authors conducted a cohort study from the Michigan Collaborative Hand Initiative for Quality in Surgery, a national consortium of nine practices with 33 surgeons who prospectively collect data for the purpose of quality improvement.

Trends in Funding and Acquisition of Surgical Practices by Private Equity Firms in the US From 2000 to 2020.

This cross-sectional study examines trends in acquisition and funding of surgical practices and facilities by private equity firms in the US from January 1, 2000, to October 30, 2020.

Variation in Use of Electrodiagnostic Testing: Analysis From the Michigan Collaborative Hand Initiative for Quality in Surgery.

Purpose: To evaluate factors that predict the use of electrodiagnostic testing (EDS) for patients undergoing carpal tunnel release (CTR).

Methods: In this cohort study, we analyzed 553 patients who underwent primary CTR from 8 practices between July 1, 2019 and December 1, 2019 by 32 surgeons in the Michigan Collaborative Hand Initiative for Quality in Surgery (M-CHIQS). The M-CHIQS is a collaborative initiative aimed at improving quality in hand surgery.

A Nationwide Study Assessing Preventable Hospitalization Rate on Mortality After Major Cardiovascular Surgery.

Despite the use of various factors to measure hospital quality, most measures have not resulted in long-term improvements in patient outcomes. This study's purpose is to determine the effect of a previously unassessed measure of quality of care-a hospital's preventable hospitalization rate-on 30-day mortality at both the hospital and individual levels after three major cardiovascular surgery procedures. This is a population-based study using Taiwan's National Health Insurance database.

The Next Frontier of Outcomes Research: Collaborative Quality Initiatives.

Quality improvement efforts at the federal level have instituted both rewards and penalties as incentives to improve health care quality. However, neither of these methods has shown long-lasting improvements. Furthermore, many programs have focused on decreasing mortality or hospital readmissions, measurements that are not applicable to many surgical fields, including plastic surgery.

Quality Measures in Postmastectomy Breast Reconstruction: Identifying Metrics to Improve Care.

Background: Specific measures tailored to the properties of individual procedures will ensure the appropriate evaluation of quality. Because postmastectomy breast reconstruction (PMBR) is becoming increasingly common, a review of the literature is timely to identify potential breast reconstruction-specific measures that can be applied by institutions and national healthcare organizations to improve quality.

Methods: We searched PubMed and Embase for studies examining the quality of care for patients undergoing PMBR.

A Nationwide Population-based Study From Taiwan Assessing the Influence of Preventable Hospitalization Rate on Mortality After Oncologic Surgery.

Objective: To determine the effect of a previously unassessed measure of quality-preventable hospitalization rate-on mortality after oncologic surgery for 4 procedures with established volume-outcome relationships. We hypothesize that hospitals with higher preventable hospitalization rates (indicating poor quality of primary care) have increased hospital mortality. Additionally, patients having surgery at hospitals with higher preventable hospitalization rates have increased mortality.

Outcomes Following Replantation/Revascularization in the Hand.

The variability in reported outcomes and outcome measures used in digit replantation makes it difficult to compare results among studies. This article reviews the principles of measuring functional and patient-reported outcomes after replantation, and describes the recommended instruments to use and ways to report results.

Finger Replantation Optimization Study (FRONT): Update on National Trends.

Purpose: Traumatic digit amputations have an adverse impact on patients' daily living. Despite experts advocating for digit replantation, studies have shown a continued decrease in rate of replantation. We performed a national-level investigation to examine the recent trend of practice for digital replantation.

A 16-Year Journey in the Study of Rheumatoid Hand Disease.

Evidence-based medicine is a relatively new concept in hand surgery. A lack of high-level evidence often leads to uncertainty in the effectiveness of various procedures and regional variation in their use. Rheumatoid hand surgery has been plagued by a lack of quality data that has caused controversy between rheumatologists and hand surgeons.

Seven-Year Outcomes of the Silicone Arthroplasty in Rheumatoid Arthritis Prospective Cohort Study.

Objective: Rheumatoid arthritis (RA) causes destruction of the metacarpophalangeal (MCP) joints, leading to hand deformities, pain, and loss of function. This study prospectively assessed long-term functional and health-related quality-of-life outcomes in RA patients with severe deformity at the MCP joints.

Methods: RA patients between ages 18 to 80 years with severe deformity at the MCP joints were referred to 1 of the 3 study sites.

A Review of the Use of Medicare Claims Data in Plastic Surgery Outcomes Research.

With a growing national emphasis in data transparency and reporting of public health data, it is essential for researchers to know more about Medicare claims data, the largest and most reliable source of health-care utilization and expenditure for individuals older than 65 years in the United States. This article provides an overview of Medicare claims data for plastic surgery outcomes research. We highlight essential information on various files included in Medicare claims data, strengths and limitations of the data, and ways to expand the use of existing data for research purposes.