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.

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.

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.

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.

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.

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.

Surgical skill and complication rates after bariatric surgery.

Background: Clinical outcomes after many complex surgical procedures vary widely across hospitals and surgeons. Although it has been assumed that the proficiency of the operating surgeon is an important factor underlying such variation, empirical data are lacking on the relationships between technical skill and postoperative outcomes.

Methods: We conducted a study involving 20 bariatric surgeons in Michigan who participated in a statewide collaborative improvement program.

The comparative effectiveness of sleeve gastrectomy, gastric bypass, and adjustable gastric banding procedures for the treatment of morbid obesity.

Objective: To evaluate the comparative effectiveness of sleeve gastrectomy (SG), laparoscopic gastric bypass (RYGB), and laparoscopic adjustable gastric banding (LAGB) procedures.

Background: Citing limitations of published studies, payers have been reluctant to provide routine coverage for SG for the treatment of morbid obesity.

Methods: Using data from an externally audited, statewide clinical registry, we matched 2949 SG patients with equal numbers of RYGB and LAGB patients on 23 baseline characteristics.

Comparative effectiveness of unfractionated and low-molecular-weight heparin for prevention of venous thromboembolism following bariatric surgery.

Objective: To evaluate the effectiveness and safety of 3 predominant venous thromboembolism (VTE) prophylaxis strategies among patients undergoing bariatric surgery.

Design: Cohort study.

Setting: The Michigan Bariatric Surgery Collaborative, a statewide clinical registry and quality improvement program.

Safety culture and complications after bariatric surgery.

Objective: To assess relationships between safety culture and complications within 30 days of bariatric surgery.

Background: Safety culture refers to the quality of teamwork, coordination, and communication, as well as responses to error in health care settings. Although safety culture is thought to be an important determinant of surgical outcomes, few studies have examined this empirically.

Hospital quality and the cost of inpatient surgery in the United States.

Context: Payers, policy makers, and professional organizations have launched a variety of initiatives aimed at improving hospital quality with inpatient surgery. Despite their obvious benefits for patients, the likely impact of these efforts on health care costs is uncertain. In this context, we examined relationships between hospital outcomes and expenditures in the US Medicare population.

Hospital complication rates with bariatric surgery in Michigan.

Context: Despite the growing popularity of bariatric surgery, there remain concerns about perioperative safety and variation in outcomes across hospitals.

Objective: To assess complication rates of different bariatric procedures and variability in rates of serious complications across hospitals and according to procedure volume and center of excellence (COE) status.

Design, Setting, And Patients: Involving 25 hospitals and 62 surgeons statewide, the Michigan Bariatric Surgery Collaborative (MBSC) administers an externally audited, prospective clinical registry.

Preoperative placement of inferior vena cava filters and outcomes after gastric bypass surgery.

Objective: To assess relationships between inferior vena cava (IVC) filter placement and complications within 30 days of gastric bypass surgery.

Summary Of Background Data: IVC filters are increasingly being used as prophylaxis against postoperative pulmonary embolism in patients undergoing bariatric surgery, despite a lack of evidence of effectiveness.

Methods: On the basis of data from a prospective clinical registry involving 20 Michigan hospitals, we identified 6376 patients undergoing gastric bypass surgery between 2006 and 2008.

Race, socioeconomic status, and the use of bariatric surgery in Michigan.

Studies examining the characteristics of patients undergoing bariatric surgery in the USA have concluded that the procedure is not being used equitably. We used population-based data from Michigan to explore disparities in the use of bariatric surgery by gender, race, and socioeconomic status. We constructed a summary measure of socioeconomic status (SES) for Michigan postal ZIP codes using data from the 2000 census and divided the population into quintiles according to SES.

The effects of bariatric surgery on asthma severity.

Background: Excess body weight increases both the risk and severity of asthma. Several studies indicate that bariatric surgery decreases asthma severity, but either enrolled few patients or were not focused primarily on asthma. Furthermore, none compared the effects of different bariatric surgical procedures.

Socioeconomic status and surgical mortality in the elderly.

Background: Although racial disparities in the quality of surgical care are well described, the impact of socioeconomic status on operative mortality is relatively unexplored.

Methods: We used Medicare data to identify all patients undergoing 1 of 6 common, high risk surgical procedures between 1999 and 2003. We constructed a summary measure of socioeconomic status for each US ZIP code using data from the 2000 US Census linked to the patient's ZIP code of residence.

Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis.

Background: Management of degenerative spondylolisthesis with spinal stenosis is controversial. Surgery is widely used, but its effectiveness in comparison with that of nonsurgical treatment has not been demonstrated in controlled trials.

Methods: Surgical candidates from 13 centers in 11 U.

Meta-analysis comparing the effectiveness and adverse outcomes of antifibrinolytic agents in cardiac surgery.

Background: Since the 1980s, antifibrinolytic therapies have assisted surgical teams in reducing the amount of blood loss. To date, however, serious questions remain regarding the safety and effectiveness of these agents.

Methods And Results: We conducted a meta-analysis to compare aprotinin, epsilon-aminocaproic acid, and tranexamic acid with placebo and head to head on 8 clinical outcomes from 138 trials.

Racial disparities in late survival after rectal cancer surgery.

Background: African-American patients experience higher mortality than Caucasian patients after surgery for most common cancer types. Whether longterm survival after rectal cancer surgery varies by race is less clear.

Study Design: Using 1992 to 2003 Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we examined race and longterm survival among African-American and Caucasian rectal cancer patients undergoing resection.

Racial variation in treatment preferences and willingness to randomize in the Spine Patient Outcomes Research Trial (SPORT).

Study Design: Analysis of baseline data for patients enrolled in Spine Patient Outcomes Research Trial (SPORT), a project conducting three randomized and three observational cohort studies of surgical and nonoperative treatments for intervertebral disc herniation (IDH), spinal stenosis (SpS), and degenerative spondylolisthesis (DS).

Objective: To explore racial variation in treatment preferences and willingness to be randomized.

Summary Of Background Data: Increasing minority participation in research has been a priority at the NIH.

Volume and process of care in high-risk cancer surgery.

Background: Although relations between procedure volume and operative mortality are well established for high-risk cancer operations, differences in clinical practice between high-volume and low-volume centers are not well understood. The current study was conducted to examine relations between hospital volume, process of care, and operative mortality in cancer surgery.

Methods: Using the Medicare claims database (2000-2002), we identified all patients undergoing major resections for lung, esophageal, gastric, liver, or pancreatic cancer (n=71,558).