Anne H. Cain-Nielsen

Prophylactic Inferior Vena Cava Filter Placement Does Not Result in a Survival Benefit for Trauma Patients.

OBJECTIVE Trauma patients are at high risk for life-threatening venous thromboembolic (VTE) events. We examined the relationship between prophylactic inferior vena cava (IVC) filter use, mortality, and VTE. SUMMARY BACKGROUND DATA The prevalence of prophylactic placement of IVC filters has increased among trauma patients. However, there exists little data on the overall efficacy of prophylactic IVC filters with regard to outcomes. METHODS Trauma quality collaborative data from 2010 to 2014 were analyzed. Patients were excluded with no signs of life, Injury Severity Score <9, hospitalization <3 days, or who received IVC filter after occurrence of VTE event. Risk-adjusted rates of IVC filter placement were calculated and hospitals placed into quartiles of IVC filter use. Mortality rates by quartile were compared. We also determined the association of deep venous thrombosis (DVT) with the presence of an IVC filter, accounting for type and timing of initiation of pharmacological VTE prophylaxis. RESULTS A prophylactic IVC filter was placed in 803 (2%) of 39,456 patients. Hospitals exhibited significant variability (0.6% to 9.6%) in adjusted rates of IVC filter utilization. Rates of IVC placement within quartiles were 0.7%, 1.3%, 2.1%, and 4.6%, respectively. IVC filter use quartiles showed no variation in mortality. Adjusting for pharmacological VTE prophylaxis and patient factors, prophylactic IVC filter placement was associated with an increased incidence of DVT (OR = 1.83; 95% CI, 1.15-2.93, P-value = 0.01). CONCLUSIONS High rates of prophylactic IVC filter placement have no effect on reducing trauma patient mortality and are associated with an increase in DVT events.

Costs and Consequences of Early Hospital Discharge After Major Inpatient Surgery in Older Adults

Importance As prospective payment transitions to bundled reimbursement, many US hospitals are implementing protocols to shorten hospitalization after major surgery. These efforts could have unintended consequences and increase overall surgical episode spending if they induce more frequent postdischarge care use or readmissions. Objective To evaluate the association between early postoperative discharge practices and overall surgical episode spending and expenditures for postdischarge care use and readmissions. Design, Setting, and Participants This investigation was a cross-sectional cohort study of Medicare beneficiaries undergoing colectomy (189 229 patients at 1876 hospitals), coronary artery bypass grafting (CABG) (218 940 patients at 1056 hospitals), or total hip replacement (THR) (231 774 patients at 1831 hospitals) between January 1, 2009, and June 30, 2012. The dates of the analysis were September 1, 2015, to May 31, 2016. Associations between surgical episode payments and hospitals’ length of stay (LOS) mode were evaluated among a risk and postoperative complication–matched cohort of patients without major postoperative complications. To further control for potential differences between hospitals, a within-hospital comparison was also performed evaluating the change in hospitals’ mean surgical episode payments according to their change in LOS mode during the study period. Exposure Undergoing surgery in a hospital with short vs long postoperative hospitalization practices, characterized according to LOS mode, a measure least sensitive to postoperative outliers. Main Outcomes and Measures Risk-adjusted, price-standardized, 90-day overall surgical episode payments and their components, including index, outlier, readmission, physician services, and postdischarge care. Results A total of 639 943 Medicare beneficiaries were included in the study. Total surgical episode payments for risk and postoperative complication–matched patients were significantly lower among hospitals with lowest vs highest LOS mode (

Regional collaborative quality improvement for trauma reduces complications and costs

26 482 vs

Unfractionated heparin versus low-molecular-weight heparin for venous thromboembolism prophylaxis in trauma

29 250 for colectomy,

The Michigan Trauma Quality Improvement Program: Results from a collaborative quality initiative

44 777 vs

Association of Hospital Participation in a Regional Trauma Quality Improvement Collaborative With Patient Outcomes

47 675 for CABG, and

Cost-effectiveness of uterine-preserving procedures for the treatment of uterine fibroid symptoms in the USA

24 553 vs

Spending On Care After Surgery Driven By Choice Of Care Settings Instead Of Intensity Of Services

27 927 for THR; P < .001 for all). Shortest LOS hospitals did not exhibit a compensatory increase in payments for postdischarge care use (

Goals vs. Expectations: What Patients and Referring Physicians should know about who achieves a BMI < 30 kg/m2 after Bariatric Surgery

4011 vs

Utilization and Outcomes among Adopters and Abandoners of Robotics in Bariatric Surgery

5083 for colectomy, P < .001;