Hysteroscopy in the Office vs the Operating Room: A Comparison of Clinical Outcomes, Resource Utilization and Costs

Purpose: Evaluate the impact of hybrid operating room (HOR) guidance on the long-term clinical outcomes following fenestrated and branched endovascular repair (F-BEVAR) for complex aortic aneurysms. Materials and Methods: Prospectively collected registry data were retrospectively analyzed to compare the procedural, short- and long-term outcomes of consecutive F-BEVAR performed from January 2010 to December 2014 under standard mobile C-arm versus hybrid room guidance in a high-volume aortic center. Results: A total of 262 consecutive patients, including 133 patients treated with a mobile C-arm equipped operating room and 129 with a HOR guidance, were enrolled in this study. Patient radiation exposure and contrast media volume were significantly reduced in the HOR group. Short-term clinical outcomes were improved despite higher case complexity in the HOR group, with no statistical significance. At a median follow-up of 63.3 months (Q1 33.4, Q3 75.9) in the C-arm group, and 44.9 months (Q1 25.1, Q3 53.5, p=0.53) in the HOR group, there was no statistically significant difference in terms of target vessel occlusion and limb occlusion. When the endograft involved 3 or more fenestrations and/or branches (complex F-BEVAR), graft instability (36% vs 25%, p=0.035), reintervention on target vessels (20% vs 11%, p=0.019) and total reintervention rates (24% vs 15%, p=0.032) were significantly reduced in the HOR group. The multivariable Cox regression analysis did not show statistically significant differences for long-term death and aortic-related death between the 2 groups. Conclusion: Our study suggests that better long-term clinical outcomes could be observed when performing complex F-BEVAR in the latest generation HOR.

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Clinical outcomes and resource utilization analysis in patients with rheumatoid arthritis undergoing endoscopic retrograde cholangiopancreatography

JGH Open ◽

10.1002/jgh3.12510 ◽

2021 ◽

Author(s):

Ahmed Ahmed ◽

Aaron Kahlam ◽

Suraj Pai ◽

Sushil Ahlawat

Keyword(s):

Rheumatoid Arthritis ◽

Clinical Outcomes ◽

Resource Utilization ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Endoscopic Retrograde

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Influence of trauma on clinical outcomes, quality of life and healthcare resource utilization following psychogastroenterology intervention

Journal of Psychosomatic Research ◽

10.1016/j.jpsychores.2021.110481 ◽

2021 ◽

pp. 110481

Author(s):

Christina H. Jagielski ◽

William D. Chey ◽

Megan E. Riehl

Keyword(s):

Quality Of Life ◽

Clinical Outcomes ◽

Resource Utilization ◽

Healthcare Resource ◽

Healthcare Resource Utilization

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Recent Trends in Clinical Outcomes and Resource Utilization for Pulmonary Embolism in the United States

CHEST Journal ◽

10.1378/chest.08-2258 ◽

2009 ◽

Vol 136 (4) ◽

pp. 983-990 ◽

Cited By ~ 103

Author(s):

Brian Park ◽

Louis Messina ◽

Phong Dargon ◽

Wei Huang ◽

Rocco Ciocca ◽

...

Keyword(s):

United States ◽

Pulmonary Embolism ◽

Clinical Outcomes ◽

Resource Utilization ◽

The United States ◽

Recent Trends

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Blood, Sweat, Toil, and Tears of Surgical Training. Part I: Blood

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230701500408 ◽

2007 ◽

Vol 15 (4) ◽

pp. 307-309 ◽

Cited By ~ 2

Author(s):

Andrew J Drain ◽

Jonathon I Ferguson ◽

Sharon Wilkinson ◽

Samer AM Nashef

Keyword(s):

Adverse Effect ◽

Blood Loss ◽

Operating Room ◽

Clinical Outcomes ◽

Surgical Training ◽

Clinical Service ◽

Significant Difference ◽

Potential Impact ◽

The Impact ◽

Cardiac Operations

There may be conflict between the requirements of surgical training and those of the clinical service if training has an impact on clinical outcomes. One area of potential impact is perioperative blood loss. We compared total and 12-hour blood loss after 2,079 consecutive cardiac operations performed over 2 years by trainees and consultants. One- and two-way analyses of variance with EuroSCORE and surgeon status as factors were carried out to evaluate the impact of surgeon status on blood loss. There was no difference in blood loss between consultants and trainees. We also compared the rates between consultants and trainees of patients returning to the operating room due to bleeding. This showed a significant difference, with trainees having a higher rate of investigation for bleeding. Cardiac surgical training can be achieved without an adverse effect on blood loss, but it may be associated with a higher rate of re-intervention for bleeding.

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El modelo Clinical outcomes, healthcare resource utilization, and related costs (COHERENT). Aplicación en pacientes con insuficiencia cardiaca

Revista Española de Cardiología ◽

10.1016/j.recesp.2021.08.016 ◽

2021 ◽

Author(s):

Héctor Bueno ◽

José L. Bernal ◽

Víctor Jiménez-Jiménez ◽

Francisco Javier Martín-Sánchez ◽

Xavier Rossello ◽

...

Keyword(s):

Clinical Outcomes ◽

Resource Utilization ◽

Healthcare Resource ◽

Healthcare Resource Utilization ◽

Insuficiencia Cardiaca

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Clinical outcomes of a false positive antenatal diagnosis of placenta accreta spectrum

American Journal of Perinatology ◽

10.1055/a-1673-5103 ◽

2021 ◽

Author(s):

Bahram Salmanian ◽

Amir A. Shamshirsaz ◽

Karin Fox ◽

nazlisadat meshinchi asl ◽

Hadi Erfani ◽

...

Keyword(s):

Clinical Outcomes ◽

Resource Utilization ◽

False Positive ◽

Maternal Morbidity ◽

Placenta Accreta ◽

Antenatal Diagnosis ◽

Estimated Blood Loss ◽

Management Protocol ◽

Significant Difference ◽

Placenta Accreta Spectrum

Objective: Antenatal diagnosis of placenta accreta spectrum (PAS) is critical to reduce maternal morbidity. While clinical outcomes of women with PAS have been extensively described, little information is available regarding the women who undergo cesarean delivery with a presumptive PAS diagnosis which is not confirmed by histopathologic examination. We sought to examine resource utilization and clinical outcomes of this group of women with a false-positive diagnosis of PAS. Study design: Retrospective analysis of patients with prenatally diagnosed PAS cared for between 2015 and 2020 by our multidisciplinary PAS team. Maternal outcomes were examined. Univariate analysis was performed and a multivariate model was employed to compare outcomes between women with and without histopathologically confirmed PAS. Results: A total of 162 patients delivered with the pre-operative diagnosis of PAS. Of these, 146 (90%) underwent hysterectomy and had histopathologic confirmation of PAS. Thirteen women did not undergo the planned hysterectomy. Three women underwent hysterectomy but pathologic examination did not confirm PAS. In comparing women with and without pathologic confirmation of PAS, the false positive PAS group delivered later in pregnancy (34 vs. 33 weeks of gestation, P=0.015) and had more planned surgery (88% vs. 47%, P = 0.002). There was no difference in skin incision type or hysterotomy placement for delivery. No significant difference in either the estimated blood loss or blood components transfused was noted between groups. Conclusion: Careful intraoperative evaluation of women with pre-operatively presumed PAS resulted in a 3/149 (2%) retrospectively unnecessary hysterectomy. Management of women with PAS in experienced centers benefits patients both in terms of resource utilization and avoidance of unnecessary maternal morbidity, understanding that our results are produced in a center of excellence for PAS. We also propose a management protocol to assist in the avoidance of unnecessary hysterectomy in women with the pre-operative diagnosis of PAS.

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A two-week inpatient programme with a booster improved long-term management of severe chronic paediatric pain

Journal of Child Health Care ◽

10.1177/1367493517697479 ◽

2017 ◽

Vol 21 (2) ◽

pp. 171-180 ◽

Cited By ~ 4

Author(s):

János Major ◽

Zsófia K Varga ◽

Andrea Gyimesi-Szikszai ◽

Szilvia Ádám

Keyword(s):

Clinical Outcomes ◽

Resource Utilization ◽

Pain Treatment ◽

Longitudinal Design ◽

Cost Effective ◽

Family Intervention ◽

Medical Visits ◽

Interdisciplinary Pain Treatment ◽

Short And Long Term

In the context of limited healthcare resources and increasing demands for more cost-effective healthcare solutions, this study assessed the short- and long-term clinical outcomes and resource utilization of a two-week inpatient, interdisciplinary, pain treatment (IIPT) including individual and group cognitive behavioural, occupational, physical and recreational therapy, education and family intervention and a booster in the chronic paediatric pain setting. Using a longitudinal design with a two-year follow-up, two-week IIPT resulted in sustainable improvements in mean and maximum pain intensity, physical functioning and internalization and reductions in the mean number of medical visits, school absence and frequency of pain medication at year 2 following IIPT. While pain-related disability scores did not improve, problem-focused coping became more prevalent, and patient and parent-assessed satisfaction as well as pain experience continued to improve throughout the study. Our results demonstrate that a two-week IIPT with a booster confers meaningful short- and long-term improvements in clinical outcomes and resource utilization among paediatric patients with severe chronic pain.

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