Impact of preoperative frailty status on decision regret following elective hernia repair.

Purpose: Decision regret following hernia repair is common, particularly for patients who experience complications. Frailty is a risk factor for complications, but whether frailty is independently associated with regret remains unknown.

Methods: We retrospectively reviewed the Michigan Surgical Quality Collaborative Core Optimization Hernia Registry, a representative sample of adult patients from > 70 hospitals across Michigan.

Variation in approach for midsize (4-6cm) ventral hernias across a statewide quality improvement collaborative.

Introduction: Repair of midsize (4-6 cm) ventral hernias is challenging given lack of guidelines. Within this context, we sought to characterize surgical approach among patients undergoing repair of midsize ventral hernias within the only population-level, clinically-nuanced hernia registry in the US.

Methods: Retrospective cohort study of patients undergoing ventral hernia repair in the Michigan Surgical Quality Collaborative Core Optimization Hernia Registry (MSQC-COHR).

Travel Time as an Indicator of Poor Access to Care in Surgical Emergencies.

Importance: Timely access to care is a key metric for health care systems and is particularly important in conditions that acutely worsen with delays in care, including surgical emergencies. However, the association between travel time to emergency care and risk for complex presentation is poorly understood.

Objective: To evaluate the impact of travel time on disease complexity at presentation among people with emergency general surgery conditions and to evaluate whether travel time was associated with clinical outcomes and measures of increased health resource utilization.

Postoperative Outcomes Following Lung Resection Performed at Private Equity-Acquired Hospitals.

Objective: Private equity acquisition of hospitals performing complex operations is increasingly prevalent in the United States healthcare landscape. While comparative health outcomes for common medical conditions have been investigated, the quality of thoracic surgical care in private equity-acquired hospitals is unknown.

Methods: Medicare Beneficiaries, aged 65-99 years, undergoing elective lung resection between 2016 to 2020 were included.

Challenges in Geographic Access to Specialized Pediatric Burn Care in the United States.

Background: Geographical access to pediatric burn centers in the US is not well described. Patients may receive care at American Burn Association (ABA)-verified burn centers, unverified burn centers, or non-burn centers. A recent study indicated that most US counties do not have an ABA-verified pediatric burn center within 100 miles.

Ex-vivo lung perfusion: National trends and post-transplant outcomes.

Background: Ex-vivo lung perfusion (EVLP) has potential to expand donor lung utilization, evaluate allograft viability, and mitigate ischemia-reperfusion injury. However, trends in EVLP use and recipient outcomes are unknown on a national scale. We examined trends in EVLP use and recipient outcomes in the United States.

Multicomponent Deimplementation Strategy to Reduce Low-Value Preoperative Testing.

Importance: Routine preoperative blood tests and electrocardiograms before low-risk surgery do not prevent adverse events or change management but waste resources and can cause patient harm. Given this, multispecialty organizations recommend against routine testing before low-risk surgery.

Objective: To determine whether a multicomponent deimplementation strategy (the intervention) would reduce low-value preoperative testing before low-risk general surgery operations.

Association of Pre- and Postinjury Mental Health With Long-term Clinical and Financial Outcomes.

Background: As increased attention is placed on optimizing long-term outcomes of trauma patients by addressing mental health, little is known regarding the interplay of pre- and postinjury mental health on long-term financial and functional outcomes.

Methods: Patients from 19 Level 1 and 2 trauma centers took part in serial surveys 1 to 24 months postdischarge. Preinjury mental health diagnoses were identified using trauma registry data and postinjury mental health symptoms from survey data.

Development of an implementation intervention to promote adoption of the COMFORT clinical practice guideline for peripartum pain management: a qualitative study.

Background: Pain management after childbirth is widely variable, increasing risk of untreated pain, opioid harms, and inequitable experiences of care. The Creating Optimal Pain Management FOR Tailoring Care (COMFORT) clinical practice guideline (CPG) seeks to promote evidence-based, equitable acute peripartum pain management in the United States. We aimed to identify contextual conditions (i.

Associations between rural hospital closures and acute and post-acute care access and outcomes.

Objective: To determine whether rural hospital closures affected hospital and post-acute care (PAC) use and outcomes.

Study Setting And Design: Using a staggered difference-in-differences design, we evaluated associations between 32 rural hospital closures and changes in county-level: (1) travel distances to and lengths of stay at hospitals; (2) functional limitations at and time from hospital discharge to start of PAC episode; (3) 30-day readmissions and mortality and hospitalizations for a fall-related injury; and (4) population-level hospitalization and death rates.

Data Sources And Analytic Sample: 100% Medicare claims and home health and skilled nursing facility clinical data to identify approximately 3 million discharges for older fee-for-service Medicare beneficiaries.

Challenges and Strategies in Colorectal Surgery among Patients with Morbid Obesity.

This chapter explores the interplay between morbid obesity and the challenges encountered in colorectal surgery. Understanding the unique considerations in preoperative and intraoperative management along with weight optimization tools such as bariatric surgery emerges as potential mitigators, demonstrating benefits in reducing colorectal cancer risk and improving perioperative outcomes. Furthermore, the pervasive stigma associated with morbid obesity further complicates patient care, emphasizing the need for empathetic and nuanced approaches.

Overcoming Geographic Barriers: Surgical Care in Rural Populations.

This chapter examines the challenges rural Americans face in accessing surgical care, which is characterized by geographical barriers, a decreasing surgical workforce, and unique patient factors. The widening health care disparity between rural and urban residents highlights the need for comprehensive strategies to improve surgical care delivery to rural areas. Focusing on colorectal care delivery, encompassing the spectrum of common and complex care, exemplifies opportunities to optimize care delivery for rural populations.

Impact of same-day sleeve gastrectomy surgery on postoperative emergency department visits: analysis from the Michigan Bariatric Surgery Collaborative.

Background: Same-day discharge after sleeve gastrectomy (SDDSG) is being performed in select patient populations with increased regularity since 2020.

Objectives: To evaluate the impact of SDDSG on emergency department (ED) visits.

Setting: Academic and private practice bariatric surgery programs participating in a statewide quality improvement collaborative.

Lost Work Due to Burn-Related Disability in a US Working Population.

Background: Burn injuries can require hospitalization, operations, and long-term reconstruction. Burn-injured patients can experience short- or long-term disability. We investigated lost workdays (LWDs), short-term disability (STD), and long-term disability (LTD) in the 12-month period following a burn injury.

"It's Traumatic for All of Us": A Qualitative Analysis of Providers Caring for Seriously Ill Veterans With Surgical Conditions.

Objective: We aimed to characterize sources of moral distress among providers in the context of surgery.

Background: Moral distress is defined as psychological unease generated when professionals identify an ethically correct action to take but are constrained in their ability to take that action. While moral distress has been reported among healthcare providers, the perspectives of providers working in surgery specifically are not often explored and reported.

Hospital-level variation in cardiac rehabilitation metrics.

Background: To inform the delivery of cardiac rehabilitation (CR) care nationwide at the hospital level, we described hospital-level variation in CR metrics, overall and stratified by the hospital's tier of cardiac care provided.

Methods: This retrospective cohort analysis used Medicare fee-for-service (FFS) data (2018-2020), Parts A and B, and American Hospital Association (AHA) data (2018). We included beneficiaries with an acute myocardial infarction (AMI), percutaneous coronary intervention (PCI), or coronary artery bypass graft (CABG) in 2018, aged ≥65 years, and continuously enrolled in a FFS plan.

Housing Instability and Outcomes Among Patients With Access-Sensitive Surgical Conditions.

Introduction: Housing instability is a significant contributor to poor health but remains understudied among surgical patients. We evaluated the association between housing instability and rates of unplanned surgical procedures, as well as resultant health and financial outcomes, for patients with access-sensitive conditions.

Methods: Using the Healthcare Cost and Utilization Project National Inpatient Sample, we identified patients who underwent one of four selected procedures for access-sensitive surgical conditions (abdominal aortic aneurysm repair, colectomy, incisional hernia repair, and lower extremity bypass).

Scoping Review: Association of Inpatient Hospital Design Features With Patients' Clinical Outcomes.

To identify associations between inpatient hospital design features and empirical patient clinical outcomes as well as changes over time. A growing body of literature has emerged evaluating the association of hospital design features with measurable clinical outcomes during inpatient hospital admissions. However, there has been limited effort to evaluate the scope and quality of studies examining individual, inpatient hospital design features on empirical patient clinical outcomes.

"You have to hold their hand": experiences of providers integrating virtual care and communication methods while caring for ICU patients during the COVID-19 pandemic.

Background: The rapid expansion of synchronous telephone and video virtual care options allowed the Veterans Health Administration (VHA) to adapt to the coronavirus disease 2019 (COVID-19) pandemic and provided a unique opportunity to assess the potential for integration and utility of virtual care in VHA systems. The objective of this study was to highlight the perspectives of VHA providers caring for intensive care unit (ICU) patients during the COVID-19 pandemic and their views on the use of virtual care and communication for palliative and end-of-life patients.

Methods: Forty-eight semi-structured qualitative interviews were conducted with providers between April 2021 and March 2022 and were analyzed using steps informed by thematic content analysis.

Learning Curves for Robotic-Assisted Ventral Hernia Repair.

Importance: Although the use of robotic-assisted ventral hernia repairs has increased significantly over the last decade, the experience surgeons need to achieve comparable outcomes with more established laparoscopic and open approaches has not been well characterized.

Objective: To estimate the learning curves for robotic-assisted ventral (incisional and umbilical) hernia repair.

Design, Setting, And Participants: This retrospective cohort study included Medicare fee-for-service patients (≥18 years) enrolled in Medicare Part A and Part B with no managed care undergoing ventral hernia repairs between 2010 and 2020.