Extended length of stay after surgery: complications, inefficient practice, or sick patients?

Importance: With the health policy focus on shifting risk to hospitals and physicians, hospital leaders are increasing efforts to reduce excessive resource use, such as patients with extended length of stay (LOS) after surgery. However, the degree to which extended LOS represents complications, patient illness, or inefficient practice style is unclear.

Objective: To examine the influence of complications on the variance in hospitals' extended LOS rates after colorectal resections.

Patients' perspectives of care and surgical outcomes in Michigan: an analysis using the CAHPS hospital survey.

Objective: To determine the relationship between postoperative morbidity and mortality and patients' perspectives of care.

Background: Priorities in health care quality research are shifting to place greater emphasis on patient-centered outcomes. Whether patients' perspectives of care correlate with surgical outcomes remains unclear.

Reliability of hospital readmission rates in vascular surgery.

Objective: The Center for Medicare and Medicaid Services recently began assessing financial penalties to hospitals with high readmission rates for a narrow set of medical conditions. Because these penalties will be extended to surgical conditions in the near future, we sought to determine whether readmissions are a reliable predictor of hospital performance with vascular surgery.

Methods: We examined 4 years of national Medicare claims data from 1576 hospitals on beneficiaries undergoing three common vascular procedures: open or endovascular abdominal aortic aneurysm repair (n = 81,520) or lower extremity arterial bypass (n = 57,190).

Racial disparities in readmissions and site of care for major surgery.

Background: Racial disparities have been described in many surgical outcomes. We sought to examine whether these disparities extend to postoperative readmission rates and whether the disparities are associated with differences in patient mix and/or hospital-level differences.

Study Design: National Medicare beneficiaries undergoing operations in 3 different specialties from 2006 to 2008 were examined: colectomy, hip replacement, and coronary artery bypass grafting (CABG) (n = 798,279).

Hospital readmissions after colectomy: a population-based study.

Background: Surgical readmissions will be targeted for reimbursement cuts in the near future. We sought to understand differences between hospitals with high and low readmission rates in a statewide surgical collaborative to identify potential quality improvement targets.

Study Design: We studied 5,181 patients undergoing laparoscopic or open colectomy at 24 hospitals participating in the Michigan Surgical Quality Collaborative between May 2007 and January 2011.

Iliofemoral complications associated with thoracic endovascular aortic repair: frequency, risk factors, and early and late outcomes.

Background: Risk factors and outcomes after iliofemoral complications after thoracic aortic endovascular repair remain poorly characterized. This study was performed to characterize factors influencing perioperative iliofemoral complications during thoracic aortic endovascular repair.

Methods: All patients undergoing transfemoral thoracic aortic endovascular repair since 2005 with adequate preoperative aortoiliac 3-dimensional imaging (n = 126) were identified.

Hospital morbidity rankings and complication severity in vascular surgery.

Introduction: The American College of Surgeons National Surgical Quality Improvement Program ranks hospitals according to risk-adjusted rates of postoperative complications. However, this approach does not consider the severity or number of complications that occurred. We sought to determine whether incorporating this information would alter hospital rankings.

Developing strategies for predicting and preventing readmissions in vascular surgery.

The escalating cost burden of hospital readmission has prompted recent nationwide efforts aimed at reducing the incidence of this important quality measure. Because patients undergoing vascular surgery account for a significant proportion of readmissions, vascular surgeons may face reduced reimbursements in the near future if these trends continue. However, risk factors associated with readmission remain poorly defined, and further research is needed to identify interventions that will prevent readmission following vascular procedures.

Surgically placed left ventricular leads provide similar outcomes to percutaneous leads in patients with failed coronary sinus lead placement.

Background: Cardiac resynchronization therapy using a left ventricular (LV) lead inserted via the coronary sinus (CS) improves symptoms of congestive heart failure, decreases hospitalizations, and improves survival. An epicardial LV lead is often placed surgically after a failed percutaneous attempt, but whether it offers the same benefits is unknown.

Objective: The purpose of this study was to determine if patients who receive a surgical LV lead after failed CS lead placement for cardiac resynchronization therapy derive the same benefit as do patients with a successfully placed CS lead.

The ventriculo-gallbladder shunt in the treatment of refractory hydrocephalus: a review of the current literature.

The ventriculo-gallbladder (VGB) shunt has been reported on several occasions for the alleviation of ventriculo-peritoneal (VP) -shunt-refractory hydrocephalus. There is little data regarding VGB shunts and a need for delineating appropriate surgical therapy when cerebrospinal fluid drainage to the peritoneum becomes infeasible. We report our experience with VGB shunt placement in three patients with chronic hydrocephalus.

Do you need to clamp a patent left internal thoracic artery-left anterior descending graft in reoperative cardiac surgery?

Background: Dogma suggests optimal myocardial protection in cardiac surgery after prior coronary artery bypass graft surgery (CABG) with patent left internal thoracic artery (LITA) pedicle graft requires clamping the graft. However, we hypothesized that leaving a patent LITA-left anterior descending (LAD) graft unclamped would not affect mortality from reoperative cardiac surgery.

Methods: Data were collected on reoperative cardiac surgery patients with prior LITA-LAD grafts from July 1995 through June 2006 at our institution.

Is mitral valve repair superior to replacement in elderly patients?

Background: Mitral valve replacement is more frequently performed and perceived to be equivalent to repair in elderly patients, despite the superiority of repair in younger patients. Our objective was to compare mitral repair to replacement in elderly patients age 75 years or older. Patients younger than 75 years undergoing mitral valve surgery served as a reference population.

Cardiac injury during resternotomy does not affect perioperative mortality.

Background: Cardiac injury at the time of resternotomy is a complication faced by all cardiac surgeons, although little is known about its effects on morbidity and mortality. This study was designed to address these questions.

Study Design: Resternotomies performed at the University of Virginia from 1996 to 2005 were identified.