No abstract

Objective To examine hospital-level variation in outcomes following benign urologic surgeries given that hospital level variation in surgical outcomes can portend quality and appropriateness of care concerns and identify quality improvement opportunities in perioperative care. Methods Using the Washington State Comprehensive Hospital Abstract Reporting System (CHARS), we identified patients that underwent transurethral resection of the prostate (TURP), percutaneous nephrostolithotomy (PCNL), and pyeloplasty from 2003–2008. We classified prolonged postoperative length of stay (LOS) as that exceeding the 75th percentile, and we measured the rate of Agency for Healthcare Quality Patient Safety Indicators (PSIs), readmissions, and death. We calculated hospital-specific observed-to-expected event rates using random effects multilevel multivariable models adjusted for age and comorbidity. Results We identified 6,699 TURP patients at 54 different hospitals, 2,541 PCNL patients at 45 hospitals, and 584 pyeloplasty patients at 36 hospitals. Complication rates were highest after PCNL (22.9% prolonged LOS vs. 17.3% for TURP and 13.9% for pyeloplasty, p<0.001; 3.4% 90-day mortality vs. 0.6% for TURP and 0% for pyeloplasty). Hospital-level variation was most substantial for LOS after TURP and pyeloplasty (8.1% and 14.3% of variance in prolonged LOS, respectively). Conclusions Hospital-level variation is common after benign inpatient urologic surgeries and may relate to difference in perioperative provider practice patterns. The morbidity of PCNL in this study was higher than expected and merits further investigation.

No abstract

No abstract

Background: Sampling of the nasal epithelial lining fluid (NELF) is a potential method to assess exposure to air pollution within the respiratory tract among high risk populations. We investigated associations of short- and long-term particulate matter exposure (PM) and pollution-related metals in the nasal fluid of people with COPD. Methods: This study included 20 participants with moderate-to-severe COPD from a larger study who measured long-term personal exposure to PM2.5 using portable air monitors and short-term PM2.5 and black carbon using in-home samplers for the 7 days preceding nasal fluid collection. Nasal fluid was sampled from both nares by nasosorption, and inductively coupled plasma mass spectrometry (ICP-MS) was used to determine the concentration of metals with major airborne sources. Correlations of selected elements (Fe, Ba, Ni, Pb, V, Zn, Cu) were determined within the nasal fluid. Associations between personal long-term PM2.5 and 7-day home PM2.5 and black carbon (BC) exposure and nasal fluid metal concentrations were determined by linear regression. Results: Within nasal fluid samples, concentrations of vanadium and nickel (r=0.8) and lead and zinc (r=0.7) were correlated. 7-day and long-term PM2.5 exposure were both associated with higher levels of copper, lead, and vanadium in the nasal fluid. BC exposure was associated with higher levels of nickel and vanadium in the nasal fluid. Conclusion: Levels of certain metals in the nasal fluid may serve as biomarkers of air pollution exposure in the upper respiratory tract.