Advance Care Planning and Treatment Intensity Before Death Among Black, Hispanic, and White Patients Hospitalized with COVID-19.

Background: Black and Hispanic people are more likely to contract COVID-19, require hospitalization, and die than White people due to differences in exposures, comorbidity risk, and healthcare access.

Objective: To examine the association of race and ethnicity with treatment decisions and intensity for patients hospitalized for COVID-19.

Design: Retrospective cohort analysis of manually abstracted electronic medical records.

Barriers to high-quality rectal cancer care: A qualitative study.

Background: High quality multidisciplinary care improves outcomes for rectal cancer (RC) but is not consistently provided. Our objective was to understand surgeons' barriers to RC care.

Methods: Semi-structured interviews were conducted with 18 surgeons from 10 Michigan hospitals.

Treatment intensity and mortality among COVID-19 patients with dementia: A retrospective observational study.

Background: We sought to determine whether dementia is associated with treatment intensity and mortality in patients hospitalized with COVID-19.

Methods: This study includes review of the medical records for patients >60 years of age (n = 5394) hospitalized with COVID-19 from 132 community hospitals between March and June 2020. We examined the relationships between dementia and treatment intensity (including intensive care unit [ICU] admission and mechanical ventilation [MV] and care processes that may influence them, including advance care planning [ACP] billing and do-not-resuscitate [DNR] orders) and in-hospital mortality adjusting for age, sex, race/ethnicity, comorbidity, month of hospitalization, and clustering within hospital.

The Impact Of The COVID-19 Pandemic On Hospital Admissions In The United States.

Hospital admissions in the US fell dramatically with the onset of the coronavirus disease 2019 (COVID-19) pandemic. However, little is known about differences in admissions patterns among patient groups or the extent of the rebound. In this study of approximately one million medical admissions from a large, nationally representative hospitalist group, we found that declines in non-COVID-19 admissions from February to April 2020 were generally similar across patient demographic subgroups and exceeded 20 percent for all primary admission diagnoses.

Preferences for bariatric surgery: comparing surgeons and patients using a discrete choice experiment.

Background: Increased attention to shared decision-making is particularly important in bariatric surgery. It is unclear whether the large shift toward sleeve gastrectomy is evidence of good alignment between patient and surgeon preferences.

Objective: To identify surgeon preferences for risks, benefits, and other attributes of treatment options available for bariatric surgery and to compare results with patient preferences.

Association of Race With Bariatric Surgery Outcomes.

Importance: The outcomes of bariatric surgery vary considerably across patients, but the association of race with these measures remains unclear.

Objective: To examine the association of race on perioperative and 1-year outcomes of bariatric surgery.

Design, Setting, And Participants: Propensity score matching was used to assemble cohorts of black and white patients from the Michigan Bariatric Surgery Collaborative who underwent a primary bariatric operation (Roux-en-Y gastric bypass, sleeve gastrectomy, or adjustable gastric banding) between June 2006 and January 2017.

Patient Preferences for Bariatric Surgery: Findings From a Survey Using Discrete Choice Experiment Methodology.

Importance: Surgical options for weight loss vary considerably in risks and benefits, but the relative importance of procedure-associated characteristics in patient decision making is largely unknown.

Objective: To identify patient preferences for risks, benefits, and other attributes of treatment options available to individuals who are candidates for bariatric surgery.

Design, Setting, And Participants: This discrete choice experiment of weight loss procedures was performed as an internet-based survey administered to patients recruited from bariatric surgery information sessions in the State of Michigan.

Variation in Hospital Thromboprophylaxis Practices for Abdominal Cancer Surgery.

Introduction: Venous thromboembolism remains a prominent cause of morbidity and mortality following cancer surgery. Although evidence-based guidelines recommend major cancer surgery thromboprophylaxis starts before incision and continues at least 7-10 days postoperatively, the extent to which the guidelines are followed is unknown. We assessed variation in thromboprophylaxis practices for abdominal cancer surgery in a regional surgical collaborative.

Prophylactic Inferior Vena Cava Filter Placement Does Not Result in a Survival Benefit for Trauma Patients.

Objective: Trauma patients are at high risk for life-threatening venous thromboembolic (VTE) events. We examined the relationship between prophylactic inferior vena cava (IVC) filter use, mortality, and VTE.

Summary Background Data: The prevalence of prophylactic placement of IVC filters has increased among trauma patients.

Regional collaborative quality improvement for trauma reduces complications and costs.

Background: Although evidence suggests that quality improvement to reduce complications for trauma patients should decrease costs, studies have not addressed this question directly. In Michigan, trauma centers and a private payer have created a regional collaborative quality initiative (CQI). This CQI program began as a pilot in 2008 and expanded to a formal statewide program in 2010.

Self-reported remission of obstructive sleep apnea following bariatric surgery: cohort study.

Background: Evidence on remission of obstructive sleep apnea (OSA) after bariatric surgery and its relation to weight loss is conflicting. We sought to identify factors associated with successful self-reported OSA remission in a large cohort of bariatric surgery patients.

Methods: We analyzed data from the statewide, prospective clinical registry of the Michigan Bariatric Surgery Collaborative and identified 3,550 patients with OSA who underwent a primary bariatric procedure between June 2006 and October 2011 and had at least 1 year of follow-up data.

Collaborative quality improvement in surgery.

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.

Influence of median surgeon operative duration on adverse outcomes in bariatric surgery.

Background: Evidence suggests that prolonged operative time adversely affects surgical outcomes. However, whether faster surgeons have better outcomes is unclear, as a surgeon׳s speed could reflect skill and efficiency, but may alternatively reflect haste. This study evaluates whether median surgeon operative time is associated with adverse surgical outcomes after laparoscopic Roux-en-Y gastric bypass.

Multi-institutional assessment of sphincter preservation for rectal cancer.

Background: Sphincter-preserving surgery (SPS) has been proposed as a quality measure for rectal cancer surgery. However, previous studies on SPS rates lack critical clinical characteristics, rendering it unclear if variation in SPS rates is due to unmeasured case-mix differences or surgeons' selection criteria. In this context, we investigate the variation in SPS rates at various practice settings.

Variation in utilization of acid-reducing medication at 1 year following bariatric surgery: results from the Michigan Bariatric Surgery Collaborative.

Background: Morbidly obese patients undergoing bariatric surgery have high rates of gastroesophageal reflux and are often treated with acid-reducing medications (ARM) such as proton pump inhibitors or H2-blockers. The objective of this study was to evaluate the effect of bariatric procedures on the utilization of ARM. We analyzed data from the clinical registry of the Michigan Bariatric Surgery Collaborative on 35,477 patients undergoing bariatric surgery between January 2006 and October 2012 who completed both baseline and 1-year follow-up surveys.

Implementation of a hospital-based quality assessment program for rectal cancer.

Purpose: Quality improvement programs in Europe have had a markedly beneficial effect on the processes and outcomes of rectal cancer care. The quality of rectal cancer care in the United States is not as well understood, and scalable quality improvement programs have not been developed. The purpose of this article is to describe the implementation of a hospital-based quality assessment program for rectal cancer, targeting both community and academic hospitals.

Effects of resident involvement on complication rates after laparoscopic gastric bypass.

Background: Although resident involvement has been shown to be safe for most procedures, the impact of residents on outcomes after complex laparoscopic procedures is not well understood. We sought to examine the impact of resident involvement on outcomes after bariatric surgery using a population-based clinical registry.

Study Design: We analyzed 17,057 patients who underwent a primary laparoscopic gastric bypass in the 35-hospital Michigan Bariatric Surgery Collaborative from July 2006 to August 2012.

Composite measures for profiling hospitals on bariatric surgery performance.

Importance: The optimal approach for profiling hospital performance with bariatric surgery is unclear.

Objective: To develop a novel composite measure for profiling hospital performance with bariatric surgery.

Design, Setting, And Participants: Using clinical registry data from the Michigan Bariatric Surgery Collaborative, we studied all patients undergoing bariatric surgery from January 1, 2008, through December 31, 2010.