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Susan S Huang - One of the best experts on this subject based on the ideXlab platform.

  • the limited utility of ranking hospitals based on their Colon Surgery infection rates
    Clinical Infectious Diseases, 2020
    Co-Authors: Daniel A Caroff, Robert E Wolf, Rui Wang, Zilu Zhang, Edward J Septimus, Anthony D Harris, Sarah S Jackson, Russell E Poland, Jason Hickok, Susan S Huang
    Abstract:

    BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) use Colon surgical site infection (SSI) rates to rank hospitals and apply financial penalties. CMS's risk adjustment model omits potentially impactful variables that might disadvantage hospitals with complex surgical populations. METHODS: We analyzed adult patients who underwent Colon Surgery within facilities associated with HCA Healthcare from 2014 to 2016. SSIs were identified from National Health Safety Network (NHSN) reporting. We trained and validated three SSI prediction models using 1) current CMS model variables, including hospital-specific random effects (HCA-adapted-CMS), 2) demographics and claims-based comorbidities (expanded-claims), and 3) demographics, claims-based comorbidities, and NHSN variables (claims-plus-EHR). Discrimination, calibration, and resulting rankings were compared among all models and the current CMS model with published coefficient values (CMS). RESULTS: We identified 39,468 Colon surgeries in 149 hospitals resulting in 1,216 (3.1%) SSIs. Compared to the HCA-adapted-CMS model, the expanded-claims model had similar performance (c-statistic 0.65 vs 0.67), while the claims-plus-EHR model was more accurate (c-statistic 0.70, 95% CI: 0.67-0.73; p=0.004). The sampling variation due to low surgical volume and small number of infections contributed 74% of the total variation in observed SSI rates between hospitals. When CMS model rankings were compared to those from the expanded-claims and claims-plus-EHR models, eighteen (15%) and 26 (22%) hospitals changed quartiles, and 10 (8.3%) and 12 (10%) hospitals changed into or out of the lowest-performing quartile, respectively. CONCLUSIONS: An expanded set of variables improved Colon SSI risk prediction and quartile assignment, but low procedure volumes and SSI events remain a barrier to effectively compare hospitals.

  • association of open approach vs laparoscopic approach with risk of surgical site infection after Colon Surgery
    JAMA network open, 2019
    Co-Authors: Daniel A Caroff, Christina Chan, Ken Kleinman, Michael S Calderwood, Robert E Wolf, Elizabeth C Wick, Richard Platt, Susan S Huang
    Abstract:

    Importance Colon Surgery is associated with a high rate of surgical site infection (SSI), and there is an urgent need for strategies to reduce infection rates. Objective To assess whether laparoscopic Colon Surgery is associated with a lower surgical site infection rate than open-approach laparoscopy, especially in patients with medically complex conditions. Design, Setting, and Participants This cohort study used previously validated diagnosis and procedure codes from Medicare beneficiaries who underwent Colon Surgery from January 1, 2009, to November 30, 2013. Analyses were performed from August 1 to December 31, 2018. Main Outcomes and Measures Outcome measures were SSI events, medical comorbidities, and laparoscopic or open approach procedures. Results A total of 229 726 patients (mean [SD] age, 74.3 [9.4] years; 128 499 [55.9%] female) underwent Colon procedures. There were 105 144 laparoscopic procedures and 124 582 open procedures. The overall mean SSI rate was 6.2%, varying by surgical procedure from 5.8% to 7.6%. Among the full study population, adjusted model results showed a significant association of laparoscopy with lower odds of SSI (odds ratio, 0.43; 95% CI, 0.41-0.46;P  50%) procedures laparoscopically. Conclusions and Relevance Policy changes that promote surgical education and resources for laparoscopy, especially at low-adoption hospitals, may be associated with reduced Colon SSI rates. Support of the development of innovative educational policies may help achieve improvement in patient outcomes and decreased health care use in Colon Surgery.

  • ranking hospitals based on Colon Surgery and abdominal hysterectomy surgical site infection outcomes impact of limiting surveillance to the operative hospital
    Clinical Infectious Diseases, 2018
    Co-Authors: Deborah S Yokoe, Ken Kleinman, Richard Platt, Susan S Huang, Taliser R Avery
    Abstract:

    Background: Hospital-specific surgical site infection (SSI) performance following Colon Surgery and abdominal hysterectomies can impact hospitals' relative rankings around quality metrics used to determine financial penalties. Current SSI surveillance largely focuses on SSI detected at the operative hospital. Methods: We performed a retrospective cohort study to assess the impact on hospitals' relative SSI performance rankings when SSI detected at nonoperative hospitals are included. We used data from a California statewide hospital registry to assess for evidence of SSI following Colon Surgery or abdominal hysterectomies performed 1 March 2011 through 30 November 2013 using previously validated claims-based SSI surveillance methods. Risk-adjusted hospital-specific rankings based on SSI detected at operative hospitals versus any California hospital were generated. Results: Among 60059 Colon surgeries at 285 hospitals and 64918 abdominal hysterectomies at 270 hospitals, 5921 (9.9%) Colon surgeries and 1481 (2.3%) abdominal hysterectomies received a diagnosis code for SSI within the 30 days following Surgery. Operative hospital surveillance alone would have missed 7.2% of Colon Surgery and 13.4% of abdominal hysterectomy SSIs. The proportion of an individual hospital's SSIs detected during hospitalizations at other hospitals varied widely. Including nonoperative hospital SSIs resulted in improved relative ranking of 11 (3.9%) Colon Surgery and 13 (4.8%) hysterectomy hospitals so that they were no longer in the worst performing quartile, mainly among hospitals with relatively high surgical volumes. Conclusions: Standard SSI surveillance that mainly focuses on infections detected at the operative hospital causes varying degrees of SSI underestimation, leading to inaccurate assignment or avoidance of financial penalties for approximately 1 in 11-16 hospitals.

  • variable case detection and many unreported cases of surgical site infection following Colon Surgery and abdominal hysterectomy in a statewide validation
    Infection Control and Hospital Epidemiology, 2017
    Co-Authors: Michael S Calderwood, Susan S Huang, Vicki Keller, Christina B Bruce, Neely N Kazerouni, Lynn Janssen
    Abstract:

    OBJECTIVE To assess hospital surgical-site infection (SSI) identification and reporting following Colon Surgery and abdominal hysterectomy via a statewide external validation METHODS Infection preventionists (IPs) from the California Department of Public Health (CDPH) performed on-site SSI validation for surgical procedures performed in hospitals that voluntarily participated. Validation involved chart review of SSI cases previously reported by hospitals plus review of patient records flagged for review by claims codes suggestive of SSI. We assessed the sensitivity of traditional surveillance and the added benefit of claims-based surveillance. We also evaluated the positive predictive value of claims-based surveillance (ie, workload efficiency). RESULTS Upon validation review, CDPH IPs identified 239 SSIs following Colon Surgery at 42 hospitals and 76 SSIs following abdominal hysterectomy at 34 hospitals. For Colon Surgery, traditional surveillance had a sensitivity of 50% (47% for deep incisional or organ/space [DI/OS] SSI), compared to 84% (88% for DI/OS SSI) for claims-based surveillance. For abdominal hysterectomy, traditional surveillance had a sensitivity of 68% (67% for DI/OS SSI) compared to 74% (78% for DI/OS SSI) for claims-based surveillance. Claims-based surveillance was also efficient, with 1 SSI identified for every 2 patients flagged for review who had undergone abdominal hysterectomy and for every 2.6 patients flagged for review who had undergone Colon Surgery. Overall, CDPH identified previously unreported SSIs in 74% of validation hospitals performing Colon Surgery and 35% of validation hospitals performing abdominal hysterectomy. CONCLUSIONS Claims-based surveillance is a standardized approach that hospitals can use to augment traditional surveillance methods and health departments can use for external validation. Infect Control Hosp Epidemiol 2017;38:1091–1097

  • Standardized Infection Ratio for Surgical Site Infection after Colon Surgery: Discord in Models Measuring Healthcare Quality.
    Infection Control and Hospital Epidemiology, 2016
    Co-Authors: Raymond Chinn, Susan S Huang, Jason M. Lempp, Rekha Murthy, Francesca J. Torriani, Jacqueline Daley, Elaine Dekker, Barbara Goss-bottorff, Wendy Kaler, Karen Meyer
    Abstract:

    Author(s): Chinn, Raymond; Lempp, Jason M; Huang, Susan S; Murthy, Rekha; Torriani, Francesca J; Daley, Jacqueline; Dekker, Elaine; Goss-Bottorff, Barbara; Kaler, Wendy; Meyer, Karen; Myers, Frank; Nichols, Amy; Kathleen Quan; Birnbaum, David | Abstract: The government publishes 3 different public report surgical site infection (SSI) metrics, all called standardized infection ratios (SIRs), that impact perceived hospital quality. We conducted a non-random cross-sectional observational pilot study of 20 California hospitals that voluntarily submitted Colon Surgery and SSI data. Discordant SIR values, leading to contradictory conclusions, occurred in 35% of these hospitals. Infect Control Hosp Epidemiol 2016;1-5.

Kyu-joo Park - One of the best experts on this subject based on the ideXlab platform.

  • Effects of a surgical ward care protocol following open Colon Surgery as part of an enhanced recovery after Surgery programme
    Journal of Clinical Nursing, 2017
    Co-Authors: Rn Sunghee Park, Kyu-joo Park, Seung-bum Ryoo
    Abstract:

    Aims and Objectives To investigate the effects of a standardised care protocol as part of an enhanced recovery after Surgery programme on the management of patients who underwent open Colon Surgery at the University Hospital, South Korea. Background Patients who undergo open Colon Surgery often have concerns about their care as they prepare for hospitalisation. By shortening hospital stay lengths, enhanced recovery after Surgery programmes could reduce the number of opportunities for patient education and communication with nurses. Therefore, our surgical team developed an enhanced recovery after Surgery programme, applied using a care protocol for patients with colorectal cancer, that spans the entire recovery process. Design A retrospective, comparative study was conducted using a care protocol as part of an enhanced recovery after Surgery programme. Comparisons were made before and after the implementation of an enhanced recovery after Surgery programme with a care protocol. Methods Records of 219 patients who underwent open Colon Surgery were retrospectively audited. The records were grouped according to the care protocol used (enhanced recovery after Surgery programme with a care protocol or traditional care programme). The outcomes, including postoperative bowel function recovery, postoperative pain control, recovery time and postoperative complications, were compared between two categories. Results Patients who were managed using the programme with a care protocol had shorter hospital stays, fewer complications, such as postoperative ileus wound infections, and emergency room visits than those who were managed using the traditional care programme. Conclusion The findings can be used to facilitate the implementation of an enhanced recovery after Surgery programme with a care protocol following open Colon Surgery. Relevance to clinical practice We present a care protocol that enables effective management using consistent and standardised education providing bedside care for patients who undergo open Colon Surgery. This care protocol empowers long-term patient self-care capacity, which contributes to increasing the effectiveness of clinical nursing care.

  • Effects of a surgical ward care protocol following open Colon Surgery as part of an enhanced recovery after Surgery programme.
    Journal of clinical nursing, 2016
    Co-Authors: Sunghee Park, Kyu-joo Park, Seung-bum Ryoo
    Abstract:

    To investigate the effects of a standardised care protocol as part of an enhanced recovery after Surgery programme on the management of patients who underwent open Colon Surgery at the University Hospital, South Korea. Patients who undergo open Colon Surgery often have concerns about their care as they prepare for hospitalisation. By shortening hospital stay lengths, enhanced recovery after Surgery programmes could reduce the number of opportunities for patient education and communication with nurses. Therefore, our surgical team developed an enhanced recovery after Surgery programme, applied using a care protocol for patients with colorectal cancer, that spans the entire recovery process. A retrospective, comparative study was conducted using a care protocol as part of an enhanced recovery after Surgery programme. Comparisons were made before and after the implementation of an enhanced recovery after Surgery programme with a care protocol. Records of 219 patients who underwent open Colon Surgery were retrospectively audited. The records were grouped according to the care protocol used (enhanced recovery after Surgery programme with a care protocol or traditional care programme). The outcomes, including postoperative bowel function recovery, postoperative pain control, recovery time and postoperative complications, were compared between two categories. Patients who were managed using the programme with a care protocol had shorter hospital stays, fewer complications, such as postoperative ileus wound infections, and emergency room visits than those who were managed using the traditional care programme. The findings can be used to facilitate the implementation of an enhanced recovery after Surgery programme with a care protocol following open Colon Surgery. We present a care protocol that enables effective management using consistent and standardised education providing bedside care for patients who undergo open Colon Surgery. This care protocol empowers long-term patient self-care capacity, which contributes to increasing the effectiveness of clinical nursing care. © 2016 John Wiley & Sons Ltd.

  • comparison of early mobilization and diet rehabilitation program with conventional care after laparoscopic Colon Surgery a prospective randomized controlled trial
    Diseases of The Colon & Rectum, 2011
    Co-Authors: Sungbum Kang, Samin Hong, Kyu-joo Park
    Abstract:

    PURPOSE: Although laparoscopic Surgery may permit earlier recovery compared with open Surgery, no published randomized controlled trial has investigated the benefit of a multimodal rehabilitation program after laparoscopic Colonic resection. This study aimed to evaluate the efficacy of a rehabilitation program after laparoscopic Colon Surgery in the context of a randomized controlled trial. METHODS: Between September 2007 and October 2009, 100 patients who had received laparoscopic Colon Surgery were selected for the study and randomly assigned on a 1:1 basis to a rehabilitation program group with early mobilization and diet (n = 46) or conventional care group (n = 54). The rehabilitation program group received early oral feeding, early ambulation, and regular laxative. The primary outcome was recovery time, measured with criteria of tolerable diet for 24 hours, safe ambulation, analgesic-free, and afebrile status without major complications. Secondary outcomes were postoperative hospital stay, complications, quality of life by Short Form 36, pain by visual analog scale, and readmission. This study was registered (ID number NCT00606944, http://register.clinicaltrials.gov). RESULTS: Recovery time was shorter in the rehabilitation program group than in the conventional care group (median (interquartile range), 4 (3-5) d vs 6 (5-7) d, respectively; P < .0001). There was no difference in postoperative hospital stay between the 2 groups (rehabilitation program group, 7 (6-8) d vs conventional care group, 8 (7-9) d; P = .065). There was no difference in complication rates between the rehabilitation program group and conventional care group (10.9% vs 20.4%, respectively; P = .136). Quality of life and pain were similar in both groups. There were no readmissions or mortality. CONCLUSIONS: A rehabilitation program with early mobilization and diet after laparoscopic Colon Surgery results in reduced recovery time without increased complications. These results suggest that a multimodal rehabilitation program may increase the short-term benefits after laparoscopic Colon Surgery.

Seung-bum Ryoo - One of the best experts on this subject based on the ideXlab platform.

  • Effects of a surgical ward care protocol following open Colon Surgery as part of an enhanced recovery after Surgery programme
    Journal of Clinical Nursing, 2017
    Co-Authors: Rn Sunghee Park, Kyu-joo Park, Seung-bum Ryoo
    Abstract:

    Aims and Objectives To investigate the effects of a standardised care protocol as part of an enhanced recovery after Surgery programme on the management of patients who underwent open Colon Surgery at the University Hospital, South Korea. Background Patients who undergo open Colon Surgery often have concerns about their care as they prepare for hospitalisation. By shortening hospital stay lengths, enhanced recovery after Surgery programmes could reduce the number of opportunities for patient education and communication with nurses. Therefore, our surgical team developed an enhanced recovery after Surgery programme, applied using a care protocol for patients with colorectal cancer, that spans the entire recovery process. Design A retrospective, comparative study was conducted using a care protocol as part of an enhanced recovery after Surgery programme. Comparisons were made before and after the implementation of an enhanced recovery after Surgery programme with a care protocol. Methods Records of 219 patients who underwent open Colon Surgery were retrospectively audited. The records were grouped according to the care protocol used (enhanced recovery after Surgery programme with a care protocol or traditional care programme). The outcomes, including postoperative bowel function recovery, postoperative pain control, recovery time and postoperative complications, were compared between two categories. Results Patients who were managed using the programme with a care protocol had shorter hospital stays, fewer complications, such as postoperative ileus wound infections, and emergency room visits than those who were managed using the traditional care programme. Conclusion The findings can be used to facilitate the implementation of an enhanced recovery after Surgery programme with a care protocol following open Colon Surgery. Relevance to clinical practice We present a care protocol that enables effective management using consistent and standardised education providing bedside care for patients who undergo open Colon Surgery. This care protocol empowers long-term patient self-care capacity, which contributes to increasing the effectiveness of clinical nursing care.

  • Effects of a surgical ward care protocol following open Colon Surgery as part of an enhanced recovery after Surgery programme.
    Journal of clinical nursing, 2016
    Co-Authors: Sunghee Park, Kyu-joo Park, Seung-bum Ryoo
    Abstract:

    To investigate the effects of a standardised care protocol as part of an enhanced recovery after Surgery programme on the management of patients who underwent open Colon Surgery at the University Hospital, South Korea. Patients who undergo open Colon Surgery often have concerns about their care as they prepare for hospitalisation. By shortening hospital stay lengths, enhanced recovery after Surgery programmes could reduce the number of opportunities for patient education and communication with nurses. Therefore, our surgical team developed an enhanced recovery after Surgery programme, applied using a care protocol for patients with colorectal cancer, that spans the entire recovery process. A retrospective, comparative study was conducted using a care protocol as part of an enhanced recovery after Surgery programme. Comparisons were made before and after the implementation of an enhanced recovery after Surgery programme with a care protocol. Records of 219 patients who underwent open Colon Surgery were retrospectively audited. The records were grouped according to the care protocol used (enhanced recovery after Surgery programme with a care protocol or traditional care programme). The outcomes, including postoperative bowel function recovery, postoperative pain control, recovery time and postoperative complications, were compared between two categories. Patients who were managed using the programme with a care protocol had shorter hospital stays, fewer complications, such as postoperative ileus wound infections, and emergency room visits than those who were managed using the traditional care programme. The findings can be used to facilitate the implementation of an enhanced recovery after Surgery programme with a care protocol following open Colon Surgery. We present a care protocol that enables effective management using consistent and standardised education providing bedside care for patients who undergo open Colon Surgery. This care protocol empowers long-term patient self-care capacity, which contributes to increasing the effectiveness of clinical nursing care. © 2016 John Wiley & Sons Ltd.

Richard C Thirlby - One of the best experts on this subject based on the ideXlab platform.

  • standardized perioperative care protocols and reduced length of stay after Colon Surgery
    Journal of The American College of Surgeons, 1998
    Co-Authors: Barton G G Bradshaw, Richard C Thirlby
    Abstract:

    Abstract Background: Recent studies have suggested that critical pathways and standard order sets decrease hospital length of stay and improve quality of care. A recently conducted prospective, randomized study at our institution found that patients undergoing elective Colon resections had earlier return of bowel function if perioperative epidural anesthesia and analgesia were provided. All patients in the study were also placed on a standardized perioperative regimen. We hypothesized that the standardized perioperative protocol used in this study contributed to early return of bowel function and hospital discharge compared with similar patients managed off protocol. Study Design: To test this hypothesis, we performed a case-controlled study comparing the hospital courses of 36 study patients to 36 control patients undergoing colorectal Surgery by the same surgeons during the same calendar year. The distribution of types of operations and anesthetic techniques was similar in both groups. Results: As dictated by the protocol, all study patients had their nasogastric tubes removed, were started on a low fat liquid diet, and ambulated in the first postoperative day. Nasogastric tubes were removed in control patients and study patients 2.2 ± 0.9 (mean value ± SD) and 1.0 ± 0.0 days postoperatively, respectively. Control patients were started on an oral diet, usually clear liquids, an average of 2.9 ± 1.1 days postoperatively, a specific liquid diet was started 1.0 day postoperatively in study patients (p Conclusions: Our results suggest that the return of bowel function and the length of stay of patients undergoing Colon Surgery are improved if patients are entered into a standardized protocol that eliminates variation in intraoperative and postoperative anesthesia and postoperative surgical care. We believe these results can be reproduced in routine clinical Surgery by having a clearly outlined protocol for perioperative care similar to that used in this study.

Michael Pine - One of the best experts on this subject based on the ideXlab platform.

  • Benchmarking hospital outcomes for improvement of care in Medicare elective Colon Surgery.
    American Journal of Surgery, 2016
    Co-Authors: Michael Pine, Susan M. Nedza, David G. Locke, Agnes M. Reband, Gregory Pine
    Abstract:

    Abstract Background Risk-adjusted outcomes are essential for hospitals to benchmark care improvement. Methods We used the Medicare Limited Data Set for 2010 to 2012 to create risk models in elective Colon Surgery for the adverse outcomes (AOs) of inpatient deaths, prolonged length-of-stay outliers, 90-day post-discharge deaths without readmission, and 90-day relevant readmissions. Risk models permitted the prediction of AOs for each hospital and the design of hospital-specific standard deviations (SDs) to define performance from observed values. Risk-adjusted AO rates were computed for hospital comparisons. Results In all, 1,903 hospitals with 129,861 patients were studied. Overall AO rate was 27.8%; 84 hospitals had AO performance that was 2 SDs poorer than average and 66 were 2 SDs better. The top performing decile of hospitals had a risk-adjusted AO rate of 15.8%, whereas the lowest performing hospital's rate was 39.4%. Conclusions Benchmarking risk-adjusted AOs identifies the opportunity for care improvement in elective Colon Surgery in Medicare patients.

  • The appropriate measurement of postdischarge readmissions in Medicare Colon Surgery.
    American Journal of Surgery, 2015
    Co-Authors: Michael Pine, Susan M. Nedza, David G. Locke, Agnes M. Reband, Gregory Pine
    Abstract:

    Abstract Background Readmissions after inpatient care are being used as a metric for clinical outcomes for surgeons and hospitals, but without standardization of the appropriate postdischarge period. Methods Elective Colon Surgery (ECS) for Medicare patients was reviewed to define the frequency and causes of readmission at 30, 60, and 90 days after discharge. Elective, trauma, and cancer readmissions were excluded. A prediction model at 90 days after discharge was designed to identify risk factors that were associated with readmissions. Results A total of 107,459 live discharges after ECS had 12,746 readmissions at 30 days, 4,601 1st-time readmissions at 31 to 60 days, and another 4,042 1st-time readmissions from days 61 to 90; 40% of initial and nearly 50% of all readmissions occurred from days 31 to 90. Primary causes for readmission were gastrointestinal, infectious, and cardiopulmonary events. Conclusions The 90-day postdischarge time period provides the most accurate measurement interval for relevant readmissions after ECS.

  • surgical warranties to improve quality and efficiency in elective Colon Surgery
    Archives of Surgery, 2010
    Co-Authors: Michael Pine, Barbara L Jones, Roger J Meimban
    Abstract:

    Background Uncomplicated surgical care has highly variable costs. High costs of complications have led payers to deny additional payments even for predictable complications. Hypothesis A payment warranty indexed to effective and efficient hospitals can promote quality and economic stewardship in surgical care. Design Analysis of hospital costs for elective Colon Surgery in the Healthcare Cost and Utilization Project's National Inpatient Sample from 2002 through 2005. Setting A 20% sample of acute care hospitals in the United States. Patients and Methods Data for elective Colon resections were used to create predictive models for adverse outcomes (AOs) and costs. Total hospital costs were determined using cost-to-charge ratios. Costs of AOs were computed as total costs minus predicted costs of uncomplicated care. Surgical warranties were computed as the probability of AOs times per-case predicted costs of AOs. Final predictive models were calibrated using data only from effective and efficient hospitals. Results We studied 51 602 cases from 632 hospitals. There were 4048 (7.8%) AOs with 505 deaths (1.0%); 19 hospitals had excessive AOs and 95 hospitals had excessive costs. For 518 effective and efficient hospitals, total per-case costs for routine care were $9843 with an average warranty of $1294 and a $276 stop-loss allocation. This cost model would reduce national expenditures for Colon Surgery by 6%. Conclusions Complications and costs of care can be indexed to quality performing hospitals. Warranties for surgical care can reward effective and efficient care and preclude the need for additional payments for complications.