Patient-Reported Outcomes and Readmission after Ileostomy Creation in Older Adults

2018 ◽  
Vol 84 (11) ◽  
pp. 1814-1818 ◽  
Author(s):  
Pridvi Kandagatla ◽  
Vahagn C. Nikolian ◽  
Niki Matusko ◽  
Shayna Mason ◽  
Scott E. Regenbogen ◽  
...  
Keyword(s):  
Older Adults ◽  
Self Efficacy ◽  
Patient Reported Outcomes ◽  
Care Pathway ◽  
Surgical Patients ◽  
Younger Patients ◽  
Patient Reported ◽  
Multivariable Analyses ◽  
American Society ◽  
American Society Of Anesthesiologists

Because of the concern about risk of poor outcome, ileostomy creation is sometimes avoided in older adults. We sought to evaluate the effect of a rigorous postoperative pathway and checklist on readmission and self-efficiacy in older surgical patients. After implementing a self-care checklist and standardized care pathway at our institution, we performed a retrospective review of patients between June 2013 and June 2016 and compared characteristics and outcomes for patients aged <65 and ≥65 years. Using logistic regression, we identified independent predictors of readmission. We also conducted a survey of patient self-efficacy after discharge to assess independence. There were 288 younger patients and 72 older patients. The older group had more patients with an American Society of Anesthesiologists >2 (53.0% vs 81.4%, P < 0.01) and were more likely to have had surgery for cancer (22.9% vs 48.5%, P < 0.01). In the multivariable analyses, age was not a predictor of readmission but American Society of Anesthesiologist and length of stay were. In the 57 patients surveyed after discharge, we found that older and younger patients reported similar self-efficacy scores. In our study, older and younger patients have similar rates of readmission and similar ability to independently care for their themselves after ileostomy creation.

scholarly journals Clinical Outcomes of Decompression Alone Versus and Decompression and Fusion for First Episode Recurrent Disc Herniation

2019 ◽  
Vol 10 (7) ◽  
pp. 832-836 ◽  
Author(s):  
Leah Y. Carreon ◽  
Erica F. Bisson ◽  
Eric A. Potts ◽  
Morgan E. Brown ◽  
Stacie Gren ◽  
...  
Keyword(s):  
Disc Herniation ◽  
Patient Reported Outcomes ◽  
Smoking Status ◽  
First Episode ◽  
Recurrent Disc Herniation ◽  
Estimated Blood Loss ◽  
Patient Reported ◽  
Quality And Outcomes ◽  
American Society ◽  
American Society Of Anesthesiologists

Study Design: Longitudinal cohort. Objective: It is unclear if patients with a recurrent disc herniation benefit from a concurrent fusion compared with a repeat decompression alone. We compared outcomes of decompression alone (D0) versus decompression and fusion (DF) for recurrent disc herniation. Methods: Patients enrolled in the Quality and Outcomes Database from 3 sites with a first episode of recurrent disc herniation were identified. Demographic, surgical, and radiographic data including the presence of listhesis and extent of facet resection on computed tomography or magnetic resonance imaging prior to the index surgery were collected. Patient-reported outcomes were collected preoperatively and at 3 and 12 months postoperatively. Results: Of 94 cases identified, 55 had D0 and 39 had DF. Patients were similar in age, sex distribution, smoking status, body mass index, American Society of Anesthesiologists grade and surgical levels. Presence of listhesis (D0 = 7, DF = 5, P = .800) and extent of facet resection (D0 = 19%, DF = 16%, P = .309) prior to index surgery were similar between the 2 groups. Estimated blood loss (D0 = 26 cm3, DF = 329 cm3, P < .001), operating room time (D0 = 79 minutes, DF = 241 minutes, P < .001) and length of stay (D0 <1 day, DF = 4 days, P < .001) were significantly less in the D0 group. Preoperative and 1-year postoperative patient-reported outcomes were similar in both groups. Three patients in the D0 group and 2 patients in the DF group required revision. Regression analysis showed that presence of listhesis, extent of facet resection and fusion were not associated with the 12-month Oswestry Disability Index (ODI) score. Conclusion: For a first episode recurrent disc herniation, surgeons can expect similar outcomes whether patients are treated with decompression alone or decompression and fusion.

scholarly journals Validation of the Berlin Questionnaire and American Society of Anesthesiologists Checklist as Screening Tools for Obstructive Sleep Apnea in Surgical Patients

2008 ◽  
Vol 108 (5) ◽  
pp. 822-830 ◽  
Author(s):  
Frances Chung ◽  
Balaji Yegneswaran ◽  
Pu Liao ◽  
Sharon A. Chung ◽  
Santhira Vairavanathan ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
High Risk ◽  
Screening Tools ◽  
Surgical Patients ◽  
Apnea Hypopnea Index ◽  
Berlin Questionnaire ◽  
Obstructive Sleep ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Stop Questionnaire

Background Because of the high prevalence of obstructive sleep apnea (OSA) and its adverse impact on perioperative outcome, a practical screening tool for surgical patients is required. This study was conducted to validate the Berlin questionnaire and the American Society of Anesthesiologists (ASA) checklist in surgical patients and to compare them with the STOP questionnaire. Methods After hospital ethics approval, preoperative patients aged 18 yr or older and without previously diagnosed OSA were recruited. The scores from the Berlin questionnaire, ASA checklist, and STOP questionnaire were evaluated versus the apnea-hypopnea index from in-laboratory polysomnography. The perioperative data were collected through chart review. Results Of 2,467 screened patients, 33, 27, and 28% were respectively classified as being at high risk of OSA by the Berlin questionnaire, ASA checklist, and STOP questionnaire. The performance of the screening tools was evaluated in 177 patients who underwent polysomnography. The sensitivities of the Berlin questionnaire, ASA checklist, and STOP questionnaire were 68.9-87.2, 72.1-87.2, and 65.6-79.5% at different apnea-hypopnea index cutoffs. There was no significant difference between the three screening tools in the predictive parameters. The patients with an apnea-hypopnea index greater than 5 and the patients identified as being at high risk of OSA by the STOP questionnaire or ASA checklist had a significantly increased incidence of postoperative complications. Conclusions Similar to the STOP questionnaire, the Berlin questionnaire and ASA checklist demonstrated a moderately high level of sensitivity for OSA screening. The STOP questionnaire and the ASA checklist were able to identify the patients who were likely to develop postoperative complications.

scholarly journals Patient-Reported Outcomes Demonstrate The Value Of Non-Operative And Operative Orthopedic Treatments And Predict The Odds Of Improvement With Surgery

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Andrew Haskell ◽  
Todd S. Kim
Keyword(s):  
Pain Intensity ◽  
Patient Reported Outcomes ◽  
Pain Interference ◽  
Surgical Patients ◽  
Final Visit ◽  
Adaptive Tests ◽  
Item Banks ◽  
Patient Reported ◽  
Computer Adaptive Tests ◽  
Better Than

Category: Outcomes Measurement Introduction/Purpose: The importance of patient reported outcomes (PROs) has become increasingly recognized as an important tool to measure our clinical value. The National Institute of Health (NIH) created the Patient-Reported Outcomes Measurement Information System (PROMIS), a series of validated item banks, to help clinicians and researches measure key clinical domains. The PROMIS computer adaptive tests (CAT) may be administered with minimal resources or administrative burden. This study describes the results of administering computer adaptive tests (CAT) to every patient in a high volume Orthopedic Surgery practice. We test the hypotheses that both non-operative treatment and operative treatments improve PRO scores. Furthermore, we test the hypothesis that preoperative scores in these domains may be used to predict chances of improvement after surgery. Methods: The PROMIS CAT was administered prospectively for all patients as part of standard clinic intake and recorded in the patient’s electronic medical record (EMR) at each clinic visit. The PROMIS item banks are normalized to mean 50±10 for the US population. De-identified data was retrospectively extracted from the EMR including PROMIS scores, demographic information, as well as surgery specific information. As of this submission, 1688 PROMIS CATs from March 2015 to September 2016 have been analyzed. Data for initial and final clinic visits, as well as for the final preoperative visit for patients who had surgery, are compared using Wilcoxon Matched Pairs Test for paired samples and Mann-Whitney U Test for unpaired samples. Linear regression is used to assess the association of initial values to change in value after treatment. The effect of stratified initial clinic domain value on odds of improving with surgery is assessed using Analysis of Variance. Results: Non-surgical and surgical patients present with similar pain intensity (49.6±7.9 vs. 49.4±7.8). Surgical patients do not improve prior to surgery, but both improve by their final visit (45.7±7.5, 43.7±8.8, p<0.05). Non-surgical and surgical patients present with similar pain interference (60.0±8.4 vs. 60.3±8.9). Surgical patients do not improve prior to surgery, but both improve by their final visit (56.9±8.8, 54.3±9.4, p<0.05). For surgical patients, change in pain intensity and pain interference correlate with initial values (R2 0.32 and 0.27, p<0.05). The percentage whose pain intensity improves after surgery when initial value is over one SD worse than mean is 96%, within one SD worse than mean is 81%, within one SD better than mean is 56%, and over one SD better than mean is 40% (p<0.05). Conclusion: Both non-operative and operative orthopedic treatments improve patient reported pain intensity and pain interference. For patients that have surgery, patients that present with more severe symptoms tend to improve more with surgery. Furthermore, the odds of improving after surgery can be calculated based on preoperative PRO scores. This may allow surgeons to counsel patients about the potential benefits of surgery with personalized precision that is currently unavailable. Measuring PROs using PROMIS CATs demonstrates the value of both non-operative and operative Orthopedic Surgery care for our patients. Preoperative PRO scores may predict the odds of successful surgical intervention.

scholarly journals P342 Maladaptive coping, self-efficacy and patient reported outcomes in inflammatory bowel disease

2017 ◽  
Vol 11 (suppl_1) ◽  
pp. S250-S251
Author(s):  
C.-Y. Chao ◽  
C. Lemieux ◽  
W. Afif ◽  
A. Bitton ◽  
G. Wild ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Self Efficacy ◽  
Patient Reported Outcomes ◽  
Maladaptive Coping ◽  
Patient Reported ◽  
Inflammatory Bowel

Effect of Physical Therapy Visits on Clinical Outcomes Following Anterior Cruciate Ligament Reconstruction With and Without Concurrent Meniscal Repair

2019 ◽  
Vol 28 (1) ◽  
pp. 24-32 ◽  
Author(s):  
Jesse C. Christensen ◽  
Caitlin J. Miller ◽  
Ryan D. Burns ◽  
Hugh S. West
Keyword(s):  
Anterior Cruciate Ligament ◽  
Patient Reported Outcomes ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Meniscal Repair ◽  
Patient Reported Outcome ◽  
Younger Patients ◽  
Cruciate Ligament Reconstruction ◽  
Patient Reported ◽  
Anterior Cruciate

Background:Health care payment reform has increased employers and health insurance companies’ incentive to take measures to control the rising costs of medical care in the United States. To date, limited research has investigated the influence outpatient physical therapy (PT) visits have on clinical outcomes following anterior cruciate ligament reconstruction (ACLR) with and without a concurrent meniscal repair.Objective:To examine the relationship between the number of PT visits and patient-reported outcome scores following ACLR outpatient rehabilitation.Study Design:Retrospective cohort.Level of Evidence:2b.Methods:Patients following ACLR with (n = 62) and without (n = 328) meniscal repair were identified through an electronic medical record database.Results:Patients with more PT visits had higher knee outcome survey—activities of daily living (KOS-ADL) change scores (P = .01) following ACLR without meniscal repair. Younger patients yielded significantly higher KOS-ADL change scores (P = .05) in the same cohort. Patients in the semisupervised PT visit strata recorded an 11.1 higher KOS-ADL change score compared with patients within the unsupervised PT visit stratum (P = .02). Younger patients also yielded significantly larger reductions in numeric pain (P = .01) following ACLR without meniscal repair. No significant differences were found between PT visits and either patient-reported outcome following ACLR with meniscal repair.Conclusions:Our findings suggest that younger patients and those in a semisupervised PT visit model have superior patient-reported outcomes following ACLR without meniscal repair. Preliminary findings indicate no relationship with PT visits and patient-reported outcomes in patients after ACLR with meniscal repair surgery.Clinical Relevance:These findings promote an alternative model to outpatient PT following ACLR without meniscal repair that may be more clinically effective and value based. There appears to be a need for patients to undergo a balanced regimen of supervised PT and effective interventions that can be conducted independently.

Assessment of Clinical Outcomes Following Erythropoietic Intervention at a Hemoglobin Concentration above 10 g/dL: A Comprehensive Review of Recent Literature.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3714-3714
Author(s):  
Gary Lyman ◽  
Gregory Rossi ◽  
John Glaspy
Keyword(s):  
Relative Risk ◽  
Clinical Outcomes ◽  
Patient Reported Outcomes ◽  
Eligibility Criterion ◽  
Epoetin Alfa ◽  
Treatment Control ◽  
Intervention Point ◽  
Patient Reported ◽  
American Society ◽  
Hb Concentration

Abstract Current practice guidelines for the management of chemotherapy-induced anemia (CIA) recommend initiating erythropoietic intervention at hemoglobin (Hb) ≤ 10 g/dL (American Society of Hematology [ASH]/American Society of Clinical Oncology [ASCO]), or at Hb ≤ 11 g/dL (National Comprehensive Cancer Network [NCCN]). This comprehensive literature review summarizes published findings of randomized controlled trials (RCTs) that evaluated the effects of initiating erythropoietic treatment at Hb > 10 g/dL on transfusion incidence, Hb concentration, and/or patient-reported outcomes, relative to control. A search of the Medline database and conference proceedings (ASH and ASCO) from 1999 to 15 June 2004 was conducted to identify RCTs that evaluated the ability of erythropoietic agents to prevent the onset or worsening of CIA. Mantel-Haenszel weighted summary estimates of the relative risk were calculated to evaluate outcomes in patients treated with epoetin alfa compared to control patients. Using predefined selection criteria, 4 full-length papers (summarized in the table) and 5 abstracts (Chang ASCO 2003; Savonije ASCO 2004; Straus ASH 2003; Crawford ASCO 2003; Rearden ASCO 2004) were identified and reviewed. Epoetin alfa effectively decreased transfusion incidence and the percentage of patients with Hb decline to < 10 g/dL vs no treatment in 4 RCTs reported from 1997 onward (table). The estimated summary relative risk (95% CI) for transfusion and Hb < 10 g/dL are 0.39 (0.26–0.57; P < 0.0001) and 0.48 (0.25–0.89), respectively. These results were consistent with early results reported in 2 additional RCTs (Chang ASCO 2003; Savonije ASCO 2004), which were of similar design. The preliminary results of 3 additional RCTs that directly compared outcomes following early (Hb > 10 g/dL) and late (Hb ≤ 10 g/dL) erythropoietic intervention were presented at recent ASH and ASCO conferences (Straus ASH 2003; Crawford ASCO 2003; Rearden ASCO 2004). All 3 studies provided evidence of lower incidence of transfusion, higher Hb levels over time, and/or better patient-reported outcomes among patients treated early compared with those treated late. The results of the studies examined demonstrate the clinical benefits of initiating erythropoietic treatment at a Hb concentration > 10 g/dL, with respect to reducing transfusion requirements and improving Hb levels, in patients with cancer undergoing chemotherapy. Although the findings are preliminary and have yet to appear in peer-reviewed journals, the comparative RCTs of early vs late intervention point to a trend in which patients who received erythropoietic treatment early experienced better clinical outcomes overall than patients treated late. Bamias 2003 Thatcher 1999 ten Bokkel Huinink 1998 Del Mastro 1997 E=epoetin alfa; C=no treatment control; reported p < 0.05 (*), 0.01 (**), 0.001 (***) vs control. ªHb ≤10 g/dL in Del Mastro study Hb Eligibility Criterion (g/dL) ≤13 ≥10.5 < 13 ≥ 12 Baseline Hb (g/dL) 11.5 (E) 13.7 (E) 12.0 (E) 13.0 (E) 11.5 (C) 13.4 (C) 11.8 (C) 13.1 (C) Transfusion Incidence (%) 15* (E) 45* (E) 4**(E) 0 (E) 33 (C) 59 (C) 39 (C) 6 (C) % Patients with Hb < 10 g/dLª 17*** (E) 48* (E) 18* (E) 0*** (E) 46 (C) 66 (C) 50 (C) 52 (C) Dosing Regimen 10,000 U TIW 150 U/kg TIW 150 U/kg TIW 150 U/kg TIW No treatment (control) No treatment (control) No treatment (control) No treatment (control)

Sa1905 The Impact of Medication Self-Efficacy and Health Literacy on Patient-Reported Outcomes in Inflammatory Bowel Disease

2016 ◽  
Vol 150 (4) ◽  
pp. S398-S399
Author(s):  
Lauren K. Tormey ◽  
Jason S. Reich ◽  
Sarah Chen ◽  
Zachary Lipkin-Moore ◽  
Anzhu Yu ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Health Literacy ◽  
Bowel Disease ◽  
Self Efficacy ◽  
Patient Reported Outcomes ◽  
Patient Reported ◽  
Inflammatory Bowel ◽  
The Impact

The use of practice guidelines by the American Society of Anesthesiologists for the identification of surgical patients at high risk of sleep apnea

2012 ◽  
Vol 9 (4) ◽  
pp. 221-230 ◽  
Author(s):  
Munish Munish ◽  
Vandana Sharma ◽  
Kaitlyn M Yarussi ◽  
Andrew Sifain ◽  
Jahan Porhomayon ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
High Risk ◽  
Practice Guidelines ◽  
Surgical Patients ◽  
American Society ◽  
American Society Of Anesthesiologists

Methodologic Considerations for Collecting Patient-reported Outcomes from Unselected Surgical Patients

2016 ◽  
Vol 125 (3) ◽  
pp. 495-504 ◽  
Author(s):  
Daniel L. Helsten ◽  
Arbi Ben Abdallah ◽  
Michael S. Avidan ◽  
Troy S. Wildes ◽  
Anke Winter ◽  
...  
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Patient Reported Outcomes ◽  
Query Language ◽  
Preoperative Assessment ◽  
Surgical Patients ◽  
Clinical Workflow ◽  
Patient Reported ◽  
The Impact ◽  
E Mail

Abstract Background The impact of surgery on health is only appreciated long after hospital discharge. Furthermore, patients’ perceptions of postoperative health are not routinely ascertained. The authors instituted the Systematic Assessment and Targeted Improvement of Services Following Yearlong Surgical Outcomes Surveys (SATISFY-SOS) registry to evaluate patients’ postoperative health based on patient-reported outcomes (PROs). Methods This article describes the methods of establishing the SATISFY-SOS registry from an unselected surgical population, combining perioperative PROs with information from electronic medical records. Patients enrolled during their preoperative visit were surveyed at enrollment, 30 days, and 1-yr postoperatively. Information on PROs, including quality of life, return to work, pain, functional status, medical complications, and cognition, was obtained from online, mail, or telephone surveys. Results Using structured query language, 44,081 patients were identified in the electronic medical records as having visited the Center for Preoperative Assessment and Planning for preoperative assessment between July 16, 2012, and June 15, 2014, and 20,719 patients (47%) consented to participate in SATISFY-SOS. Baseline characteristics and health status were similar between enrolled and not enrolled patients. The response rate for the 30-day survey was 62% (8% e-mail, 73% mail, and 19% telephone) and for the 1-yr survey was 71% (13% e-mail, 78% mail, and 8% telephone). Conclusions SATISFY-SOS demonstrates the feasibility of establishing a PRO registry reflective of a busy preoperative assessment center population, without disrupting clinical workflow. Our experience suggests that patient engagement, including informed consent and multiple survey modalities, enhances PROs collection from a large cohort of unselected surgical patients. Initiatives like SATISFY-SOS could promote quality improvement, enable efficient perioperative research, and facilitate outcomes that matter to surgical patients.

Sign in / Sign up

Export Citation Format

Share Document