Increased complications in geriatric patients with a fracture of the hip whose postoperative weight-bearing is restricted

2018 ◽  
Vol 100-B (10) ◽  
pp. 1377-1384 ◽  
Author(s):  
T. D. Ottesen ◽  
R. P. McLynn ◽  
A. R. Galivanche ◽  
P. S. Bagi ◽  
C. K. Zogg ◽  
...  
Keyword(s):  
Adverse Event ◽  
Hip Fracture ◽  
Length Of Stay ◽  
Adverse Events ◽  
Weight Bearing ◽  
Multivariate Regression Analysis ◽  
Operating Theatre ◽  
Improvement Program ◽  
Surgical Quality ◽  
Evidence Based Guideline

Aims The aims of this study were to evaluate the incidence of postoperatively restricted weight-bearing and its association with outcome in patients who undergo surgery for a fracture of the hip. Patients and Methods Patient aged > 60 years undergoing surgery for a hip fracture were identified in the 2016 National Surgical Quality Improvement Program (NSQIP) Hip Fracture Targeted Procedure Dataset. Analysis of the effect of restricted weight-bearing on adverse events, delirium, infection, transfusion, length of stay, return to the operating theatre, readmission and mortality within 30 days postoperatively were assessed. Multivariate regression analysis was used to adjust for confounding demographic, comorbid and procedural characteristics. Results Of the 4918 patients who met inclusion criteria, 3668 (63.53%) were allowed to weight-bear as tolerated postoperatively. Controlling for patient and procedural factors, multivariate odds of any adverse event, major adverse event, delirium, infection, transfusion, length of stay ≥ 75th percentile (six days) and mortality within 30 days were all higher in patients with weight-bearing restrictions. Notably, there were no differences for thromboembolic events, return to the operating theatre or readmission within 30 days between the groups. Conclusion Elderly patients with a fracture of the hip with postoperative weight-bearing restrictions have a significantly greater risk of developing most adverse events compared with those who are encouraged to weight-bear as tolerated. These findings emphasize the importance of immediate weight-bearing as tolerated to optimize the outcome in these frail patients; however nearly 25% of surgeons fail to meet this evidence-based guideline. Cite this article: Bone Joint J 2018;100-B:1377–84.

Missing data may lead to changes in hip fracture database studies

2018 ◽  
Vol 100-B (2) ◽  
pp. 226-232 ◽  
Author(s):  
B. A. Basques ◽  
R. P. McLynn ◽  
A. M. Lukasiewicz ◽  
A. M. Samuel ◽  
D. D. Bohl ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adverse Event ◽  
Quality Improvement ◽  
Hip Fracture ◽  
Missing Data ◽  
Adverse Events ◽  
Elderly Patients ◽  
National Database ◽  
Improvement Program ◽  
Surgical Quality

Aims The aims of this study were to characterize the frequency of missing data in the National Surgical Quality Improvement Program (NSQIP) database and to determine how missing data can influence the results of studies dealing with elderly patients with a fracture of the hip. Patients and Methods Patients who underwent surgery for a fracture of the hip between 2005 and 2013 were identified from the NSQIP database and the percentage of missing data was noted for demographics, comorbidities and laboratory values. These variables were tested for association with ‘any adverse event’ using multivariate regressions based on common ways of handling missing data. Results A total of 26 066 patients were identified. The rate of missing data was up to 77.9% for many variables. Multivariate regressions comparing three methods of handling missing data found different risk factors for postoperative adverse events. Only seven of 35 identified risk factors (20%) were common to all three analyses. Conclusion Missing data is an important issue in national database studies that researchers must consider when evaluating such investigations. Cite this article: Bone Joint J 2018;100-B:226–32.

scholarly journals Delayed Ileal Pouch Anal Anastomosis Has a Lower 30-Day Adverse Event Rate: Analysis From the National Surgical Quality Improvement Program

2018 ◽  
Vol 24 (8) ◽  
pp. 1833-1839 ◽  
Author(s):  
Bharati Kochar ◽  
Edward L Barnes ◽  
Anne F Peery ◽  
Katherine S Cools ◽  
Joseph Galanko ◽  
...  
Keyword(s):  
Adverse Event ◽  
Quality Improvement ◽  
Adverse Events ◽  
Ileal Pouch ◽  
Ileal Pouch Anal Anastomosis ◽  
Quality Improvement Program ◽  
Adverse Event Rate ◽  
Improvement Program ◽  
Surgical Quality ◽  
Anal Anastomosis

Abstract Background Ulcerative colitis (UC) patients requiring colectomy often have a staged ileal pouch anal anastomosis (IPAA). There are no prospective data comparing timing of pouch creation. We aimed to compare 30-day adverse event rates for pouch creation at the time of colectomy (PTC) with delayed pouch creation (DPC). Methods Using prospectively collected data from 2011–2015 through the National Surgical Quality Improvement Program, we conducted a cohort study including subjects aged ≥18 years with a postoperative diagnosis of UC. We assessed 30-day postoperative rates of unplanned readmissions, reoperations, and major and minor adverse events (AEs), comparing the stage of the surgery where the pouch creation took place. Using a modified Poisson regression model, we estimated risk ratios (RRs) with 95% confidence intervals (CIs) adjusting for age, sex, race, body mass index, smoking status, diabetes, albumin, and comorbidities. Results Of 2390 IPAA procedures, 1571 were PTC and 819 were DPC. In the PTC group, 51% were on chronic immunosuppression preoperatively, compared with 15% in the DPC group (P < 0.01). After controlling for confounders, patients who had DPC were significantly less likely to have unplanned reoperations (RR, 0.42; 95% CI, 0.24–0.75), major AEs (RR, 0.72; 95% CI, 0.52–0.99), and minor AEs (RR, 0.48; 95% CI, 0.32–0.73) than PTC. Conclusions Patients undergoing delayed pouch creation were at lower risk for unplanned reoperations and major and minor adverse events compared with patients undergoing pouch creation at the time of colectomy.

Predictors of Adverse Events after Neck Dissection: An Analysis of the 2006–2011 National Surgical Quality Improvement Program (NSQIP) Database

2017 ◽  
Vol 96 (2) ◽  
pp. E37-E45 ◽  
Author(s):  
Umang Jain ◽  
Jessica Somerville ◽  
Sujata Saha ◽  
Jon P. Ver Halen ◽  
Anuja K. Antony ◽  
...  
Keyword(s):  
Risk Factors ◽  
Quality Improvement ◽  
Adverse Events ◽  
Neck Dissection ◽  
Multivariate Regression Analysis ◽  
Quality Improvement Program ◽  
Patient Counseling ◽  
Improvement Program ◽  
Surgical Quality ◽  
Factors Associated

While neck dissection is an important primary and adjunctive procedure in the treatment of head and neck cancer, there is a paucity of studies evaluating outcomes. A retrospective review of the National Surgical Quality Improvement Program (NSQIP) database was performed to identify factors associated with adverse events (AEs) in patients undergoing neck dissection. A total of 619 patients were identified, using CPT codes specific to neck dissection. Of the 619 patients undergoing neck dissection, 142 (22.9%) experienced an AE within 30 days of the surgical procedure. Risk factors on multivariate regression analysis associated with increased AEs included dyspnea (odds ratio [OR] 2.57; 95% confidence interval [CI] 1.06 to 6.22; p = 0.037), previous cardiac surgery (OR 3.38; 95% CI 1.08 to 10.52; p = 0.036), increasing anesthesia time (OR 1.005; 95% CI 1 to 1.009; p = 0.036), and increasing total work relative value units (OR 1.09; CI 1.04 to 1.13; p < 0.001). The current study is the largest, most robust analysis to identify specific risk factors associated with AEs after neck dissection. This information will assist with preoperative optimization, patient counseling, and appropriate risk stratification, and it can serve as benchmarking for institutions comparing surgical outcomes.

scholarly journals Patient factors associated with 30-day morbidity, mortality, and length of stay after surgery for subdural hematoma: a study of the American College of Surgeons National Surgical Quality Improvement Program

2016 ◽  
Vol 124 (3) ◽  
pp. 760-766 ◽  
Author(s):  
Adam M. Lukasiewicz ◽  
Ryan A. Grant ◽  
Bryce A. Basques ◽  
Matthew L. Webb ◽  
Andre M. Samuel ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Length Of Stay ◽  
Adverse Events ◽  
Subdural Hematoma ◽  
Adverse Outcomes ◽  
Improvement Program ◽  
Surgical Quality ◽  
Factors Associated ◽  
American College Of Surgeons ◽  
Male Sex

OBJECT Surgery for subdural hematoma (SDH) is a commonly performed neurosurgical procedure. This study identifies patient characteristics associated with adverse outcomes and prolonged length of stay (LOS) in patients who underwent surgical treatment for SDH. METHODS All patients in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) who were treated via craniotomy or craniectomy for SDH between 2005 and 2012 were identified. Patient demographics, comorbidities, and 30-day outcomes were described. Multivariate regression was used to identify predictors of adverse events. RESULTS A total of 746 surgical procedures performed for SDH were identified and analyzed. Patients undergoing this procedure were 64% male with an average age (± SD) of 70.9 ± 14.1 years. The most common individual adverse events were death (17%) and intubation for more than 48 hours (19%). In total, 34% experienced a serious adverse event other than death, 8% of patients returned to the operating room (OR), and the average hospital LOS was 9.8 ± 9.9 days. In multivariate analysis, reduced mortality was associated with age less than 60 years (relative risk [RR] = 0.47, p = 0.017). Increased mortality was associated with gangrene (RR = 3.5, p = 0.044), ascites (RR = 3.00, p = 0.006), American Society of Anesthesiologists (ASA) Class 4 or higher (RR = 2.34, p = 0.002), coma (RR = 2.25, p < 0.001), and bleeding disorders (RR = 1.87, p = 0.003). Return to the OR was associated with pneumonia (RR = 3.86, p = 0.044), male sex (RR = 1.85, p = 0.015), and delirium (RR = 1.75, p = 0.016). Serious adverse events were associated with ventilator dependence preoperatively (RR = 1.86, p < 0.001), dialysis (RR = 1.44, p = 0.028), delirium (RR = 1.40, p = 0.005), ASA Class 4 or higher (RR = 1.36, p = 0.035), and male sex (RR = 1.29, p = 0.037). Similarly, LOS was increased in ventilator dependent patients by 1.56-fold (p = 0.002), in patients with ASA Class 4 or higher by 1.30-fold (p = 0.006), and in delirious patients by 1.29-fold (p = 0.008). CONCLUSIONS Adverse outcomes are common after surgery for SDH. In this study, 18% of the patients died within 30 days of surgery. Factors associated with adverse outcomes were identified. Patients and families should be counseled about the serious risks of morbidity and death associated with acute traumatic SDH requiring surgery.

scholarly journals Surgical site infections in outpatient surgeries: Less invasive procedures contribute substantially to the overall burden

2019 ◽  
Vol 40 (10) ◽  
pp. 1191-1193
Author(s):  
Katherine Linsenmeyer ◽  
Westyn Branch-Elliman ◽  
Emily Kalver ◽  
Hillary J. Mull
Keyword(s):  
Adverse Event ◽  
Surgical Site Infections ◽  
Outpatient Setting ◽  
Veterans Affairs ◽  
Site Infection ◽  
Invasive Procedures ◽  
Improvement Program ◽  
Eligibility Criteria ◽  
Surgical Quality

AbstractMore than 50% of outpatient surgeries predicted to have an increased likelihood of an adverse event were excluded from surgical site infection (SSI) surveillance based on Veterans Affairs Surgical Quality Improvement Program (VASQIP) eligibility criteria, defined by clinician determination of invasiveness. Burden of SSI for eligible versus ineligible surgeries was similar; thus, surveillance activities in the outpatient setting need to be re-evaluated.

scholarly journals Change in Adverse Events After Enrollment in the National Surgical Quality Improvement Program: A Systematic Review and Meta-Analysis

PLoS ONE ◽  
2016 ◽  
Vol 11 (1) ◽  
pp. e0146254 ◽  
Author(s):  
Joshua Montroy ◽  
Rodney H. Breau ◽  
Sonya Cnossen ◽  
Kelsey Witiuk ◽  
Andrew Binette ◽  
...  
Keyword(s):  
Systematic Review ◽  
Quality Improvement ◽  
Adverse Events ◽  
Meta Analysis ◽  
Quality Improvement Program ◽  
Improvement Program ◽  
Surgical Quality

scholarly journals The Ability of the Nottingham Hip Fracture Score to Predict Mobility, Length of Stay and Mortality in Hospital, and Discharge Destination in Patients Admitted with a Hip Fracture

2020 ◽  
Vol 107 (4) ◽  
pp. 319-326 ◽  
Author(s):  
Radcliffe Lisk ◽  
Keefai Yeong ◽  
David Fluck ◽  
Christopher H. Fry ◽  
Thang S. Han
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Adverse Events ◽  
Nursing Care ◽  
Risk Group ◽  
Area Under The Curve ◽  
High Risk Group ◽  
Discharge Destination ◽  
Increased Risk ◽  
Surgery Rates

Abstract The Nottingham Hip Fracture Score (NHFS) has been developed for predicting 30-day and 1-year mortality after hip fracture. We hypothesise that NHFS may also predict other adverse events. Data from 666 patients (190 men, 476 women), aged 60.2–103.4 years, admitted with a hip fracture to a single centre from 1/10/2015 and 7/12/2017 were analysed. The ability of NHFS to predict mobility within 1 day after surgery, length of stay (LOS) find mortality, and discharge destination was evaluated by receiver operating characteristic curves and two-graph plots. The area under the curve (95% confidence interval [CI]) for predicting mortality was 67.4% (58.4–76.4%), prolonged LOS was 59.0% (54.0–64.0%), discharge to residential/nursing care was 62.3% (54.0–71.5%), and any two of failure to mobilise, prolonged LOS or discharge to residential/nursing care was 64.8% (59.0–70.6%). NHFS thresholds at 4 and 7 corresponding to the lower and upper limits of intermediate range where sensitivity and specificity equal 90% were identified for mortality and prolonged LOS, and 4 and 6 for discharge to residential/nursing care, which were used to create three risk categories. Compared with the low risk group (NHFS = 0–4), the high risk group (NHFS = 7–10 or 6–10) had increased risk of in-patient mortality: rates = 2.0% versus 7.1%, OR (95% CI) = 3.8 (1.5–9.9), failure to mobilise within 1 day of surgery: rates = 18.9% versus 28.3%, OR = 1.7 (1.0–2.8), prolonged LOS (> 17 days): rates = 20.3% versus 33.9%, OR = 2.2 (1.3–3.3), discharge to residential/nursing care: rates = 4.5% vs 12.3%, OR = 3.0 (1.4–6.4), and any two of failure to mobilise, prolonged LOS or discharge to residential/nursing care: rates = 10.5% versus 28.6%, 3.4 (95% CI 1.9–6.0), and stayed 4.1 days (1.5–6.7 days) longer in hospital. High NHFS associates with increased risk of mortality, prolonged LOS and discharge to residential/nursing care, lending further support for its use to identify adverse events.

Timing of Complications following Hand Surgery

2020 ◽  
Author(s):  
Nitin Goyal ◽  
Daniel D. Bohl ◽  
Robert W. Wysocki
Keyword(s):  
Myocardial Infarction ◽  
Adverse Event ◽  
Adverse Events ◽  
Proportional Hazards ◽  
Kidney Injury ◽  
Hand Surgery ◽  
Cox Proportional Hazards ◽  
Improvement Program ◽  
Level Of Evidence ◽  
Event Timing

Abstract Introduction Our purposes were to (1) characterize the timeline of eight postoperative complications following hand surgery, (2) assess complication timing for the procedures that account for the majority of adverse events, and (3) determine any differences in complication timing between outpatient and inpatient procedures. Materials and Methods Patients undergoing hand, wrist, and forearm procedures from 2005 to 2016 were identified in the National Surgical Quality Improvement Program database. Timing of eight adverse events was characterized. Cox proportional hazards modeling was used to compare adverse event timing between inpatient and outpatient procedures. Results A total of 59,040 patients were included. The median postoperative day of diagnosis for each adverse event was as follows: myocardial infarction 1, pulmonary embolism 2, acute kidney injury 3, pneumonia 8, deep vein thrombosis 9, sepsis 13, urinary tract infection 15, and surgical site infection 16. Amputations, fasciotomies, and distal radius open reduction internal fixation accounted for the majority of adverse events. Complication timing was significantly earlier in inpatients compared with outpatients for myocardial infarction. Conclusion This study characterizes postoperative adverse event timing following hand surgery. Surgeons should have the lowest threshold for testing for each complication during the time period of greatest risk. Level of Evidence This is a therapeutic, Level III study.

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