Measuring Critical Care Unit Performance Using a Postoperative Mechanical Ventilation Quality Metric.

Background: Safely minimizing postoperative mechanical ventilation duration after congenital heart surgery could be a cardiac intensive care unit (CICU) quality measure. We aimed to measure CICU performance using duration of postoperative mechanical ventilation and identify organizational factors associated with this metric.

Methods: Observational analysis of 16,848 surgical hospitalizations of patients invasively ventilated on admission from the operating room from 26 Pediatric Cardiac Critical Care Consortium CICUs.

Patient Preferences and Satisfaction With Decisions in Stage-III Melanoma: A Mixed Methods Study.

Introduction: Rapid accumulation of data in surgical and medical oncology has changed the treatment landscape for patients with stage-III melanoma, introducing options for active surveillance and adjuvant systemic therapy; however, these options have increased the complexity of decision making.

Methods: We conducted an explanatory sequential mixed-methods study consisting of surveys and semistructured interviews among patients diagnosed with stage-III melanoma at a single institution from August 2019 to December 2021. The survey included the validated 30-point satisfaction with decision scale (SWD).

"Their Whole Lives Are Going To Change": A Photo-Elicitation Study of Rectal Cancer Survivorship.

Background: Rectal cancer survivors experience persistent symptoms, which may lead to unmet needs.

Objective: This study aimed to explore the rectal cancer survivor experience and identify the impacts of treatment using photo-elicitation.

Design: This was a novel study in which patients were instructed to take photographs that showed aspects of life that have been challenging to deal with since undergoing treatment.

Surgical Leadership Competencies for Navigating Hospital Network Expansion.

Introduction: Today, many hospitals are part of a multihospital network, which changes the context in which surgeons are asked to lead. This study explores key leadership competencies that surgical leaders use to navigate this hospital network expansion.

Methods: In this qualitative study, 30 surgical leaders were interviewed.

The impact of frailty on ventral hernia repair outcomes in a statewide database.

Introduction: Preoperative frailty is a strong predictor of postoperative morbidity in the general surgery population. Despite this, there are a paucity of research examining the effect of frailty on outcomes after ventral hernia repair (VHR), one of the most common abdominal operations in the USA. We examined the association of frailty with short-term postoperative outcomes while accounting for differences in preoperative, operative, and hernia characteristics.

Assessment of Patterns of Atherectomy Use.

Background Atherectomy has become the fastest growing catheter-based peripheral vascular intervention performed in the United States, and overuse has been linked to increased reimbursement, but the patterns of use have not been well characterized. Methods and Results We used Blue Cross Blue Shield of Michigan Preferred Provider Organization and Medicare fee-for-service professional claims data from the Michigan Value Collaborative for patients undergoing office-based laboratory atherectomy in 2019 to calculate provider-specific rates of atherectomy use, reimbursement, number of vessels treated, and number of atherectomies per patient. We also calculated the rate that each provider converted a new patient visit to an endovascular procedure within 90 days.

Experiences With Prenatal Care Delivery Reported by Black Patients With Low Income and by Health Care Workers in the US: A Qualitative Study.

Importance: Black pregnant people with low income face inequities in health care access and outcomes in the US, yet their voices have been largely absent from redesigning prenatal care.

Objective: To examine patients' and health care workers' experiences with prenatal care delivery in a largely low-income Black population to inform care innovations to improve care coordination, access, quality, and outcomes.

Design, Setting, And Participants: For this qualitative study, human-centered design-informed interviews were conducted at prenatal care clinics with 19 low-income Black patients who were currently pregnant or up to 1 year post partum and 19 health care workers (eg, physicians, nurses, and community health workers) in Detroit, Michigan, between October 14, 2019, and February 7, 2020.

Predicting Early Weight Loss Failure Using a Bariatric Surgery Outcomes Calculator and Weight Loss Curves.

Context: Weight loss after bariatric surgery can be accurately predicted using an outcomes calculator; however, outliers exist that do not meet the 1 year post-surgery weight projections.

Objective: Our goal was to determine how soon after surgery these outliers can be identified.

Design: We conducted a retrospective cohort study.

The Role of Lung Cancer Surgical Technique on Lymph Node Sampling and Pathologic Nodal Upstaging.

Background: The role of operative approach in surgical lymphadenectomies and pathologic nodal upstaging for lung cancer remains unclear.

Methods: This study retrospectively reviewed patients who underwent lobectomy for non-small cell lung cancer from January 2015 to December 2020 at 16 centers within a statewide quality improvement collaborative in Michigan. Patients were stratified by operative approach, and our primary end points were number of LN recovered, number of LN stations sampled, and rates of nodal upstaging with nodal upstaging defined as a higher final pathologic nodal stage compared with preoperative clinical nodal staging.

Independent predictors and timing of portomesenteric vein thrombosis after bariatric surgery.

Background: Portomesenteric vein thrombosis (PVT) is a rare complication following bariatric surgery but can result in severe morbidity as well as death.

Objective: Identification of risk factors for PVT to facilitate targeted management strategies to reduce incidence.

Setting: Prospective, statewide bariatric-specific clinical registry.

Implementation of melanoma guidelines in the multidisciplinary setting: A qualitative analysis.

Background: Data suggest variation in utilization of completion lymph node dissection (CLND) and adjuvant systemic therapy (AT) for sentinel lymph node-positive melanoma. We aimed to explore how clinicians consider multidisciplinary treatment options.

Methods: We conducted semi-structured interviews of surgical oncologists, medical oncologists, and otolaryngologists to produce a thematic analysis.

A serial cross-sectional study of trends and predictors of prescription controlled substance-related traumatic injury.

Pre-injury drug use is a key contributor to traumatic injury. However, limited research has examined trends and predictors of controlled substance-related trauma. The present study aims to provide better clarity on the specific role of prescription-controlled substances (PCS) in traumatic injury events.

Five year trends in surgical technique and outcomes of groin hernia repair in the United States.

Introduction: Despite being one of the most commonly performed operations in the US, there is a paucity of data on practice patterns and resultant long-term outcomes of groin hernia repair. In this context, we performed a contemporary assessment of operative approach with 5 year follow-up to inform care for the 800000 persons undergoing groin hernia repair annually.

Methods: This was a retrospective cohort study of adult patients undergoing elective groin hernia repair in a 20% representative Medicare sample from 2010-17.

Do all Patients Get the Same Care Across Hospitals?

There is extensive research demonstrating significant variation in the utilization of surgery and outcomes from surgery, including differences in mortality, complications, readmission, and failure to rescue. Literature suggests that these variations exist across as well as within small area geographies in the United States. There is also significant evidence of variation in access and outcomes from surgery that is attributable to race.

Getting better or getting by?: A qualitative study of in-hospital cardiac arrest survivors long-term recovery experiences.

In the United States, approximately 292,000 adults (>18 years old) per year suffer an in-hospital cardiac arrest (IHCA). Survival rates have increased over the last decade and many survivors return to their communities. IHCA has been recognized as a unique disease entity because the arrest happens in a medical care setting and survivors often have more medical co-morbidities.

"Learn from each other": A qualitative exploration of collaborative quality improvement.

Background: Collaborative quality improvement is an established method to conduct quality improvement in surgical care. Despite the success of this method, little is known about the experiences, perceptions, and attitudes of those who participate in collaborative quality improvement. The following study elicited common themes associated with the experiences and perceptions of surgeons participating in collaborative quality improvement.

Disparities in unplanned surgery amongst medicare beneficiaries.

Background: While significant efforts have been made to understand surgical disparities for procedures that are performed in either the elective or unplanned settings, far less is known about procedures performed in both settings.

Methods: Cross-sectional study of 1,135,743 Medicare beneficiaries undergoing incisional hernia repair, colectomy, or abdominal aortic aneurysm repair between 2014 and 2018. Risk-adjusted outcomes were assessed using multivariable logistic regression.

Prophylactic mastectomy and occult malignancy: Surgical and imaging considerations.

Background: Sentinel node biopsy (SLNB) is not routinely recommended for patients undergoing prophylactic mastectomy (PM), yet omission remains a subject of debate among surgeons. A modern patient cohort was examined to determine occult malignancy (OM) incidence within PM specimens to reinforce current recommendations.

Methods: All PM performed over a 5-year period were retrospectively identified, including women with unilateral breast cancer who underwent synchronous or delayed contralateral PM or women with elevated cancer risk who underwent bilateral PM.

Comparative Safety of Sleeve Gastrectomy and Gastric Bypass up to 5 Years After Surgery in Patients With Medicaid.

Objective: Compare adverse outcomes up to 5 years after sleeve gastrectomy and gastric bypass in patients with Medicaid.

Background: Sleeve gastrectomy is the most common bariatric operation among patients with Medicaid; however, its long-term safety in this population is unknown.

Methods: Using Medicaid claims, we performed a retrospective cohort study of adult patients who underwent sleeve gastrectomy or gastric bypass from January 1, 2012, to December 31, 2018.