Introduction
Roux-en-Y gastric bypass (RYGB) continues to be safely performed in racial cohorts. However, studies continue to report differences in complications, with non-Hispanic black (NHB) ...patients having a higher rate of adverse outcomes, including mortality. It is unclear how these disparate outcomes have evolved over time. Our objective was to determine RYGB procedure and mortality trends in racial cohorts.
Methods
Using the 2015 to 2019 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project (MBSAQIP) database, we identified primary RYGB cases performed laparoscopically or robotically. Non-Hispanic white (NHW) and non-Hispanic black (NHB) patient cohorts were matched based on patient and surgical characteristics. Conditional logistic regression analysis was conducted on the matched pairs. Primary outcomes of interest included year-to-year all-cause and procedure-related mortality. Stata/MP 16.1 was utilized for analysis, and a
p
-value of < 0.05 and a 95% confidence interval that excluded 1 were considered significant.
Results
A total of 148,829 RYGB cases in NHW (82.8%) and Black (17.2%) patients were analyzed. RYGB trends remain similar for NHB and NHW patients over 5 years. In matched cohorts, all-cause mortality (
OR
2.23; 95% CI: 1.16–4.29), aggregate related readmission (
OR
1.39; 95% CI: 1.27–1.51), related reintervention (
OR
1.36; 95% CI: 1.19–1.56), and VTE (
OR
1.86; 95% CI: 1.40–2.45) were more likely in NHB patients. During the study period, year-to-year mortality was higher in NHB patients compared to NHW patients.
Conclusion
Over a 5-year period, year-to-year mortality remains higher in NHB patients after RYGB. While bariatric outcomes continue to improve, outcome gaps between racial cohorts seem to persist.
Graphical Abstract
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
LINKED CONTENT
This article is linked to Caldera et al papers. To view these articles, visit https://doi.org/10.1111/apt.17454 and https://doi.org/10.1111/apt.17490
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
BACKGROUND:US hospitals are penalized for excess 30-day readmissions and mortality for select conditions. Under the Centers for Medicare and Medicaid Services policy, readmission prevention is ...incentivized to a greater extent than mortality reduction. A strategy to potentially improve hospital performance on either measure is by improving nursing care, as nurses provide the largest amount of direct patient care. However, little is known as to whether achieving nursing excellence, such as Magnet status, is associated with improved hospital performance on readmissions and mortality.
OBJECTIVE:The purpose of this study was to examine the relationship between hospitals’ Magnet status and performance on readmission and mortality rates for Medicare beneficiaries.
RESEARCH DESIGN:This is a cross-sectional analysis of Medicare readmissions and mortality reduction programs from 2013 to 2016. A propensity score–matching approach was used to take into account differences in baseline characteristics when comparing Magnet and non-Magnet hospitals.
SUBJECTS:The sample was comprised of 3877 hospitals.
MEASURES:The outcome measures were 30-day risk-standardized readmission and mortality rates.
RESULTS:Following propensity score matching on hospital characteristics, we found that Magnet hospitals outperformed non-Magnet hospitals in reducing mortality; however, Magnet hospitals performed worse in reducing readmissions for acute myocardial infarction, coronary artery bypass grafting, and stroke.
CONCLUSIONS:Magnet hospitals performed better on the Hospital Value-Based Purchasing Mortality Program than the Hospital Readmissions Reduction Program. The results of this study suggest the need for The Magnet Recognition Program to examine the role of nurses in postdischarge activities as a component of its evaluation criteria.
Summary
Background
Recombinant zoster vaccine (RZV) is recommended for all adults ≥19 years of age who are at increased risk for HZ, including patients with inflammatory bowel disease (IBD).
Methods
...A Markov model was constructed to compare the RZV cost‐effectiveness with no vaccination in patients with Crohn's Disease (CD) and ulcerative colitis (UC). A simulated cohort of 1 million patients was used for each IBD group at ages 18, 30, 40, and 50. The primary objective of this analysis was to compare RZV cost‐effectiveness in patients with CD and UC, comparing vaccination to no vaccination.
Results
Overall, vaccination is cost‐effective for both CD and UC, with the incremental cost‐effectiveness ratio (ICERs) below $100,000/quality‐adjusted life years (QALY) for all age cohorts. For patients with CD, 30 years of age and older, and those with UC 40 years and older, vaccination was both more effective and less expensive than the non‐vaccinated strategy (CD ≥30: ICERs $6183–$24,878 and UC ≥40: ICERs $9163–$19,655). However, for CD patients under 30 (CD 18: ICER $2098) and UC patients under 40 (UC = 18: ICER $11,609, and UC = 30: $1343), costs were greater for vaccinated patients, but there was an increase in QALY. One‐way sensitivity analysis of age indicates that cost break‐even occurs at age 21.8 for the CD group and 31.5 for the UC group. In probabilistic sensitivity analysis, 92% of both CD and UC simulations indicated that vaccination was preferred.
Conclusion
In our model, vaccination with RZV was cost‐effective for all adult patients with IBD.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
Tranexamic acid (TXA) administration to reduce postoperative blood loss and transfusion is a well-established practice for total knee arthroplasty (TKA) and total hip arthroplasty (THA). However, ...clinical concerns remain about the safety of TXA in patients with a history of a prothrombotic condition. We sought to determine the risk of complications between high-risk and low-risk TKA and THA patients receiving TXA.
We retrospectively reviewed 38,220 patients (8877 high-risk cases) who underwent primary TKA and THA between 2011 and 2017 at our institution. Intravenous TXA was administered in 20,501 (54%) of cases. The rates of thrombotic complications (deep vein thrombosis DVT, pulmonary embolism PE, myocardial infarction MI, and cerebrovascular accident CVA) as well as mortality and readmission were assessed at 90 days postoperatively. Additionally, we evaluated 90-day postoperative occurrence of DVT and PE separate from occurrence of MI and CVA. Patients were categorized as high risk if they had a past medical history of a prothrombotic condition prior to surgery.
There was no significant difference in the odds of these adverse outcomes between high-risk patients who received TXA and high-risk patients who did not receive TXA (odds ratio OR 1.00, 95% confidence interval CI 0.85-1.18). There were also no differences when evaluating the odds of 90-day postoperative DVT and PE (OR 0.84, 95% CI 0.59-1.19) nor MI and CVA (OR 0.91, 95% CI 0.56-1.49) for high-risk patients receiving TXA vs high-risk patients who did not receive TXA.
TXA administration to high-risk TKA and THA patients is not associated with a statistically significant difference in adverse outcomes. We present incremental evidence in support of TXA administration for high-risk patients undergoing primary arthroplasties.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Tranexamic acid (TXA) is an antifibrinolytic drug that has been shown to reduce blood loss following surgery. The use of TXA during orthopedic procedures has gained widespread acceptance, with ...multiple clinical studies demonstrating no increase in thrombotic complications. While TXA has been shown to be safe and effective for several orthopedic procedures, its use in orthopedic sarcoma surgery is not well established. Cancer-associated thrombosis remains a significant cause of morbidity and mortality in patients with sarcoma. It is unknown if intraoperative TXA use will increase the risk of developing a postoperative thrombotic complication in this population. This study aimed to compare the risk of postoperative thrombotic complications in patients who received TXA during sarcoma resection to patients who did not receive TXA.
A retrospective review was performed of 1099 patients who underwent resection of a soft tissue or bone sarcoma at our institution between 2010 and 2021. Baseline demographics and postoperative outcomes were compared between patients who did and did not receive intraoperative TXA. We evaluated 90-day complication rates, including: deep venous thrombosis (DVT), pulmonary embolism (PE), myocardial infarction (MI), cerebrovascular accident (CVA), and mortality.
TXA was used more commonly for bone tumors (p < 0.001), tumors located in the pelvis (p = 0.004), and larger tumors (p < 0.001). Patients who received intraoperative TXA were associated with a significant increase in developing a postoperative DVT (odds ratio OR: 2.22, p = 0.036) and PE (OR: 4.62, p < 0.001), but had no increase in CVA, MI, or mortality (all p > 0.05) within 90 days of surgery, following univariate analysis. Multivariable analysis confirmed that TXA was independently associated with developing a postoperative PE (OR: 10.64, 95% confidence interval: 2.23-50.86, p = 0.003). We found no association with DVT, MI, CVA, or mortality within 90 days postoperatively, following intraoperative TXA use.
Our results demonstrate a higher associated risk of PE following TXA use in sarcoma surgery and caution is warranted with TXA use in this patient population.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
ABSTRACT Introduction This study examined simultaneous pancreas–kidney transplant (SPKt) in Black and White patients to identify disparities in transplantation, days on the waitlist, and reasons for ...SPKt waitlist removal. Methods Using the United Network for Organ Sharing Standard Transplant Analysis and Research file, patients between January 1, 2009, and May 31, 2021, were included. Three cohorts (overall, SPKt recipients only, and those not transplanted) were selected using propensity score matching. Conditional logistic regression was used for categorical outcomes. Days on the waitlist were compared using negative binomial regression. Results Black patients had increased odds of receiving a SPKt (OR, 1.25 95% CI, 1.11–1.40, p < 0.001). White patients had increased odds of receiving a kidney‐only transplant (OR 0.48 95% CI, 0.38–0.61, p < 0.001), and specifically increased odds of receiving a living donor kidney (OR 0.34 0.25–0.45, p < 0.001). Conclusion This study found that Black patients are more likely to receive a SPKt. Results suggest that there are opportunities for additional inquiry related to patient removal from the waitlist, particularly considering White patients received or accepted more kidney‐only transplants and were more likely to receive a living donor kidney‐only transplant.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Purpose
Metabolic and bariatric surgery (MBS) remains a safe and effective treatment for morbid obesity with a low-risk profile. Venous thromboembolism (VTE) remains the most common cause of ...mortality. There is increasing consensus that inferior vena cava (IVC) filter use is associated with more harm than benefit. Our study aim was to determine if the timing of IVC filter placement correlates with VTE complications.
Methods
The 2015–2019 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program databases were used to identify Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) patients who had an IVC filter at the time of bariatric procedure. Selected cases were stratified by IVC placement timing. Propensity-score matching estimated the probabilities of receiving pre-existing vs. prophylactic IVC placement. Resultant models were then used to assess VTE complications. Statistical analyses were performed with Stata MP version 16. A
p
-value < 0.05 was considered significant.
Results
In total, 228,986 RYGB and 568,386 SG cases were analyzed, and 0.6% and 0.5% had an IVC filter. Prophylactic IVC filter use declined annually, but not pre-existing filters. VTE and VTE-related mortality were significantly higher in filter vs. no filter cohorts (
p
<0.001). Propensity matching reduced biases between RYGB and SG IVC filter cohorts (pre-existing vs. prophylactic). There were no differences in the RYGB pre-existing and prophylactic IVC filter cohorts; however; for SG cases, pre-existing IVC filters compared to prophylactic IVC filters were associated with decreased odds of having a VTE (OR: 0.97, 95% CI: 0.95, 0.99).
Conclusion
Compared to a pre-existing filter, the presence of a prophylactic IVC filter in SG patients was associated with a higher likelihood of VTE.
Highlights
1. Annual use of prophylactic IVC filter is bariatric surgery patients is decreasing.
2. The presence of a pre-existing IVC filter remain constant.
3. Any IVC filter presence at time of MBS increased VTE and VTE-related mortality and morbidity.
4. In SG cases, prophylactic IVC filter was associated with higher rates of VTE and VTE-related mortality.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Aims
To determine if there is an association between better County Health Rankings and the increased odds of a hospital gaining Magnet designation in subsequent years (2014–2019) compared with ...counties with lower rankings.
Background
The Magnet hospital model is recognized to have a great effect on nurses, patients and organizational outcomes. Although Magnet hospital designation is a well‐established structural marker for nursing excellence, the effect of County Health Rankings and subsequent hospital achievement of Magnet status is unknown.
Design
A descriptive, cross‐sectional quantitative approach was adopted for this study.
Methods
Data were derived from 2010 to 2019 U.S. County Health Rankings, American Hospital Association, and American Nursing Credentialing Center databases. Logistic regression models were utilized to determine associations between county rankings for health behaviours, clinical care, social and economic factors, physical environment and counties with a new Magnet hospital after 2014.
Results
Counties with the worst rankings for clinical care and socio‐economic status had reduced odds of obtaining a Magnet hospital designation compared with best‐ranking counties. While middle‐ranking counties for the physical environment ranking had increased odds of having Magnet designation compared with best‐ranking counties. Additionally, having an increased percent of government non‐federal hospital or a higher percentage of critical access hospitals in the county reduced the odds of having a Magnet‐designated facility after 2014.
Conclusion
The findings underscore the important associations between Magnet‐designated facilities’ location and the health of its surrounding counties. This study is the first to examine the relationship between County Health Rankings and a hospital's likelihood of obtaining Magnet status and points to the need for future research to explore outcomes of care previously identified as improved in Magnet‐designated hospitals.
Implications
Recognizing the benefits of Magnet facilities, it is important for health care leaders and policy makers to seek opportunities to promote centres of excellence in higher need communities through policy and financial intervention.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK, VSZLJ
