Surgical research using national databases

Alluri, Ram K.; Leland, Hyuma A.; Heckmann, Nathanael

doi:10.21037/atm.2016.10.49

Cited by 209 publications

(161 citation statements)

References 34 publications

(35 reference statements)

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“…The VASQIP database resides in the Veterans Affairs National Surgery Office and was developed in the 1980s to prospectively record data to inform risk adjustment for perioperative quality improvement (28,29). Data for the VASQIP database are entered by nurse data managers using Veterans Health Information Systems and Technology Architecture at VHA surgical facilities.…”

Section: Data Sources and Study Samplementioning

confidence: 99%

Unhealthy alcohol use is associated with postoperative complications in veterans undergoing lung resection

Graf¹,

Zeliadt²,

Rise³

et al. 2018

J. Thorac. Dis.

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Background: Lung resections carry a significant risk of complications necessitating the characterization of peri-operative risk factors. Unhealthy alcohol use represents one potentially modifiable factor. In this retrospective cohort study, the largest to date of lung resections in the Veterans Health Administration (VHA), we examined the association between unhealthy alcohol use and postoperative complications and mortality. Methods: Veterans Affairs Surgical Quality Improvement Program data recorded at 86 medical centers between 2007 and 2011 were used to identify 4,715 patients that underwent lung resection. Logistic regression models, adjusted for demographics and comorbidities, were fit to assess the association between unhealthy alcohol use (report of >2 drinks per day in the 2 weeks preceding surgery) and 30-day outcomes. Results: Among 4,715 patients that underwent pulmonary resection, 630 (13.4%) reported unhealthy alcohol use (>2 drinks/day). Overall, postoperative complications occurred in 896 (19.0%) patients, including pneumonia in 524 (11.1%). The rate of mortality was 2.6%. In adjusted analyses, complications were significantly more common among patients with unhealthy alcohol use [odds ratio (OR), 1.42; 95% confidence interval (CI), 1.15-1.74] including, specifically, pneumonia (OR, 1.69; 95% CI, 1.32-2.15). No statistically significant association was identified between unhealthy alcohol use and mortality (OR, 1.27; 95% CI, 0.75-2.02). In secondary analyses that stratified by smoking status at the time of surgery, drinking more than 2 drinks per day was associated with post-operative complications in patients reporting current smoking (OR, 1.51; 95% CI, 1.18-1.91) and was not identified in those reporting no current smoking at the time of surgery (OR, 1.23; 95% CI, 0.79-1.85). Conclusions:In this large VHA study, 13% of patients undergoing lung resection reported drinking more than 2 drinks per day in the preoperative period, which was associated with increased risk of postoperative complications. Unhealthy alcohol use may be an important target for perioperative risk-mitigation interventions, particularly in patients who report current smoking.

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Section: Data Sources and Study Samplementioning

confidence: 99%

Unhealthy alcohol use is associated with postoperative complications in veterans undergoing lung resection

Graf¹,

Zeliadt²,

Rise³

et al. 2018

J. Thorac. Dis.

View full text Add to dashboard Cite

show abstract

“…These factors include presenting symptoms, diagnostic studies, approaches to treatment, and treatment outcomes. [12] From this data concepts for disease management can be developed based on common patterns recognized within the data. This information can further be utilized to standardize management of the condition or disease under investigation in order to streamline care and regulate practice patterns.…”

Section: Patient Centered Carementioning

confidence: 99%

“…Researchers and end-users of the data need to be acutely aware of how and what data is collected in these databases in order to apply the information correctly to their studies or practice. [12,18] Naidus and Celi offer the concept of big data leading to "big noise" when not applied and analyzed properly. [19] With the vast amount of data being collected today, the risk of discovering unintended and ultimately unrelated correlations can increase and can potentially lead to inappropriate changes in practice patterns if the data comprising these studies is not properly interpreted.…”

Section: Identify the Role Of Big Data In Healthcare Deliverymentioning

confidence: 99%

“…While this is useful to track a full episode of care, the data is limited to the analysis of elderly patients and the disabled making generalizability problematic. [12] Another example, the NIS database tracks patient data during the period that patients are treated in the inpatient hospital setting. [12] While this is useful for tracking complication and cost during the inpatient setting, the ability to evaluate these aspects over the entire episode of care is lacking.…”

Section: Identify the Role Of Big Data In Healthcare Deliverymentioning

confidence: 99%

“…[12] Another example, the NIS database tracks patient data during the period that patients are treated in the inpatient hospital setting. [12] While this is useful for tracking complication and cost during the inpatient setting, the ability to evaluate these aspects over the entire episode of care is lacking. Both of these sources are heavily reliant on the input of data via coding systems namely, International Classification of Disease (ICD) coding.…”

Section: Identify the Role Of Big Data In Healthcare Deliverymentioning

confidence: 99%

See 2 more Smart Citations

Let’s not blame the patient: Understanding the benefits and shortcomings of population health in orthopaedic surgery

Amato

Sayeed²,

Lane

et al. 2018

JHA

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Population health is a concept that emerged from the desire of providers to care for patients in a manner that produces the best possible outcomes while minimizing cost. It may be defined as the study of medical data of large groups of people in order to recognize and investigate patterns. This information is then used to create disease management guidelines that streamline care and regulate practice patterns. Whereas population health looks to recognize commonalities in data, the concept of patient-centered care focuses on embracing individualization and increasing the involvement of each patient within their treatment planning. Combining both perspectives creates a challenge for providers and patients to strike the proper balance between adhering to standardized guidelines based on the treatment methods and outcomes recognized in populations and applying it clinically to individual patients. A significant contribution of population health studies is the identification of risk factors associated with increased rates of complications following total joint arthroplasty as well as preventative measures for conditions such as osteoarthritis. However, to employ these findings in a patient-centered manner orthopaedic surgeons must take this a step further and also evaluate a patient's ability to adhere to the recommendations by exploring factors such as home environment and socioeconomic factors, thus proactively addressing issues that could hinder patient compliance. With focused collection methods of acquiring data, these two practices of care will hopefully begin to see less divergence when it comes to applying data derived from population health initiatives to individual patients in a patient-centered manner.

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The association between race/ethnicity and peripartum hysterectomy and the risk of perioperative complications

Lawson

Chou

Martin

et al. 2020

Intl J Gynecology & Obste

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Objective To compare perioperative outcomes by patient race/ethnicity. Methods A retrospective cohort study identified 7 331 638 childbirth hospitalizations for women aged 12–55 years in the USA between 2004–2014. Peripartum hysterectomy, in‐hospital mortality, perioperative complications, length of stay, and cost of hysterectomy data were analyzed using SAS. Results Among childbirth hospitalizations (52.9% white, 13.5% black, 23.0% Hispanic, 5.2% Asian, and 5.4% other), peripartum hysterectomy occurred in 6619. The incidence of peripartum hysterectomy was 90.3 (95% confidence interval [CI] 87.7–93.0) per 100 000 hospitalizations, and higher for black (111.0, 95% CI 104.5–117.4), Hispanic (104.9, 95% CI 99.1–110.8), and Asian women (119.6, 95% CI 109.1–130.2) compared to whites (75.7, 95% CI 72.8–78.5). After adjustment, Hispanic women had an 18% higher odds of undergoing peripartum hysterectomy (odds ratio [OR] 1.18, 95% CI 1.08–1.29; P=0.004) than white women. Non‐white women had a 2–3‐fold higher odds of in‐hospital mortality (ORblack 2.76, 95% CI 1.44–5.30; ORHispanic 1.99, 95% CI 1.04–3.82; ORAsian+other 2.44, 95% CI 1.11–5.40. Black and Asian/other women were more likely to undergo blood transfusions. Conclusion Women of color have higher rates of peripartum hysterectomy and experience higher rates of poor perioperative outcomes and mortality.

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Surgical research using national databases

Cited by 209 publications

References 34 publications

Unhealthy alcohol use is associated with postoperative complications in veterans undergoing lung resection

Unhealthy alcohol use is associated with postoperative complications in veterans undergoing lung resection

Let’s not blame the patient: Understanding the benefits and shortcomings of population health in orthopaedic surgery

The association between race/ethnicity and peripartum hysterectomy and the risk of perioperative complications

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