ObjectiveTo evaluate the clinical and economic burden associated with anastomotic leaks following colorectal surgery.MethodsRetrospective data (January 2008 to December 2010) were analyzed from patients who had colorectal surgery with and without postoperative leaks, using the Premier Perspective™ database. Data on in-hospital mortality, length of stay (LOS), re-admissions, postoperative infection, and costs were analyzed using univariate and multivariate analyses, and the propensity score matching (PSM) and generalized linear models (GLM).ResultsOf the patients, 6,174 (6.18 %) had anastomotic leaks within 30 days after colorectal surgery. Patients with leaks had 1.3 times higher 30-day re-admission rates and 0.8–1.9 times higher postoperative infection rates as compared with patients without leaks (P < 0.001 for both). Anastomotic leaks incurred additional LOS and hospital costs of 7.3 days and $24,129, respectively, only within the first hospitalization. Per 1,000 patients undergoing colorectal surgery, the economic burden associated with anastomotic leaks—including hospitalization and re-admission—was established as 9,500 days in prolonged LOS and $28.6 million in additional costs. Similar results were obtained from both the PSM and GLM for assessing total costs for hospitalization and re-admission.ConclusionsAnastomotic leaks in colorectal surgery increase the total clinical and economic burden by a factor of 0.6–1.9 for a 30-day re-admission, postoperative infection, LOS, and hospital costs.

This review provides a robust base for descriptive assessment of AEs associated with long-acting tramadol formulations. Although the actions of different tramadol formulations are biologically similar, differences in pharmacokinetics, drug-release patterns, and availability may influence the incidence of AEs associated with tramadol. Because of the limitations of a qualitative safety analysis across studies with different populations and study designs, any observed differences should be interpreted with caution, but these differences may help educate healthcare providers about tramadol treatment in patients with chronic osteoarthritis pain and help them select the optimal dose for specific patients.

Objectives. Describe the perceptual dimensions of student assessments of the quality of their education. Link those dimensions with student satisfaction with their educational experience. Methods. A 37-item educational service quality instrument and a seven-item satisfaction scale were administered to 372 students in their final year of education in years 1999 to 2002. Results. Factor analysis identified 5 dimensions of service quality labeled resources, interpersonal behavior of faculty, faculty expertise, faculty communication, and administration. Stepwise regression analysis showed that all factors were significantly related to overall satisfaction with each explaining the following percent variance: faculty interpersonal behavior (47%), administration (8%), resources (4%), faculty communication (3%), and faculty knowledge (1%). Mean scores of service quality dimensions demonstrated significant improvement from 1999 to 2002 for four of the five dimensions. Conclusion. The 5 dimensions of educational service quality found in this study are unique to the services marketing literature. Student perceptions of faculty are multidimensional with faculty interpersonal behavior explaining the most variance in student satisfaction responses.

This study provides clinical evidence in support of less invasive approaches to hysterectomy. In addition to other documented benefits of such less invasive procedures, the lower incidence of SSIs and lower rates of associated complications and costs with these procedures than with open abdominal hysterectomy should be taken into account when weighing the risks and benefits of a surgical approach for patients whose condition warrants hysterectomy.

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Background: Minimally invasive liver resection (MILR) has gained momentum in recent years. This study of contemporary data compares economic and clinical outcomes between MILR and open liver resection (OLR).Methods: We extracted data for patients undergoing liver resection between October 2015-September 2018 from the Premier Healthcare Database. We conducted a propensity score matched analysis to compare complications, in-hospital mortality, inpatient readmissions, discharge to institutional postacute care, operating room time (ORT), length of stay (LOS), and total hospital cost between MILR and OLR patients.Results: From the eligible OLR (n = 3349) and MILR (n = 1367) patients, we propensity score matched 1261 from each cohort at a 1:1 ratio. After matching, MILR was associated with lower rates of complications (bleeding: 8.2% vs. 17.4%; respiratory failure: 5.5% vs. 10.9%; intestinal obstruction: 3.6% vs. 6.0%, and pleural effusion: 1.9% vs. 4.9%), in-hospital mortality (0.5% vs. 3.0%), 90-day inpatient readmissions (10.4% vs. 14.3%), discharge to institutional post-acute care (6.9% vs. 12.3%), shorter ORT (257 vs. 308 min) and LOS (4.3 vs. 7.2 days), and lower hospital costs ($19463 vs. $29119) (all P < 0.001). Conclusion:MILR was associated with lower risk of complications and reduced hospital resource utilizations as compared with OLR.

Patients who had laparoscopic bariatric surgery used fewer medications for type 2 diabetes, hypertension and dyslipidaemia and had significant improvement in cardiometabolic risk factors for up to 5 years of follow-up compared with matched control subjects.

The availability of a standard-of-practice clinic for smoking cessation within a primary care clinic can help patients who have a desire to quit. A combination of intensive counseling, pharmacotherapy, and office spirometry helped patients in a Veterans Administration population to achieve long-term smoking cessation.