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4. Enhanced Recovery After Surgery (ERAS®) Society Consensus Guidelines for Emergency Laparotomy Part 3: Organizational Aspects and General Considerations for Management of the Emergency Laparotomy Patient

Author

Peden, Carol J., Aggarwal, Geeta, Aitken, Robert J., Anderson, Iain D., Balfour, Angie, Foss, Nicolai Bang, Cooper, Zara, Dhesi, Jugdeep K., French, W. Brenton, Grant, Michael C., Hammarqvist, Folke, Hare, Sarah P., Havens, Joaquim M., Holena, Daniel N., Hübner, Martin, Johnston, Carolyn, Kim, Jeniffer S., Lees, Nicholas P., Ljungqvist, Olle, Lobo, Dileep N., Mohseni, Shahin, Ordoñez, Carlos A., Quiney, Nial, Sharoky, Catherine, Urman, Richard D., Wick, Elizabeth, Wu, Christopher L., Young-Fadok, Tonia, and Scott, Michael J.

Published
2023
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5. Consensus Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS®) Society Recommendations Part 2—Emergency Laparotomy: Intra- and Postoperative Care

Author

Scott, Michael J., Aggarwal, Geeta, Aitken, Robert J., Anderson, Iain D., Balfour, Angie, Foss, Nicolai Bang, Cooper, Zara, Dhesi, Jugdeep K., French, W. Brenton, Grant, Michael C., Hammarqvist, Folke, Hare, Sarah P., Havens, Joaquim M., Holena, Daniel N., Hübner, Martin, Johnston, Carolyn, Kim, Jeniffer S., Lees, Nicholas P., Ljungqvist, Olle, Lobo, Dileep N., Mohseni, Shahin, Ordoñez, Carlos A., Quiney, Nial, Sharoky, Catherine, Urman, Richard D., Wick, Elizabeth, Wu, Christopher L., Young-Fadok, Tonia, and Peden, Carol J.

Published
2023
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18. In defense of Direct Care: Limiting access to military hospitals could worsen quality and safety

Author

Zogg, Cheryl K., Lichtman, Judith H., Dalton, Michael K., Learn, Peter A., Schoenfeld, Andrew J., Koehlmoos, Tracey Perez, Weissman, Joel S., and Cooper, Zara

Subjects
United States. Department of Defense -- Powers and duties, Hospitals, Military -- Powers and duties, Health care reform -- Forecasts and trends, Medical care -- Quality management, Market trend/market analysis, Business, Health care industry
Abstract

Objective: Ongoing health care reforms within the US Military Health System (MHS) are expected to shift >1.9 million MHS beneficiaries from military treatment facilities (MTFs) into local civilian hospitals over the next 1-2 years. The objective of this study was to examine how such health care reforms are likely to affect the quality of MHS care. Data sources: Adult MHS beneficiaries, aged 18-64 years, treated in MTFs (under a program known as Direct Care) were compared against (1) MHS beneficiaries treated in locally available civilian hospitals (under a program known as Purchased Care) and (2) similarly-aged adult civilian patients across the United States. MHS beneficiaries in Direct and Purchased Care were identified from fiscal-year 2016-2018 MHS inpatient claims. National inpatients were identified in the 2017 Nationwide Readmissions Database. Study design: Retrospective cohort. Data collection: Differences in quality were compared using two sets of quality metrics endorsed by the US Agency for Healthcare Research and Quality (AHRQ): Inpatient Quality Indicators, 19 quality metrics that look at differences in in-hospital mortality, and Patient Safety Indicators, 18 quality metrics that look at differences in in-hospital morbidity and adverse events. Among MHS beneficiaries (Direct and Purchased Care), we further simulated what changes in quality indicators might look like under various proposed scenarios of reduced access to Direct Care. Principal findings: A total of 502,252 MHS admissions from 37 MTFs and surrounding civilian hospitals were included (326,076 Direct Care, 179,176 Purchased Care). Nationwide, 9.34 million adult admissions from 2453 hospitals were included. On average, MHS beneficiaries treated in MTFs experienced better inpatient quality and improved patient safety compared with MHS beneficiaries treated in locally available civilian hospitals (e.g., summary observed-to-expected ratio for medical mortality: 0.98 vs. 1.03, p < 0.001) and adult patients across the United States (0.98 vs. 1.02, p < 0.001). Simulations of proposed changes resulted in consistently worse outcomes for MHS patients, whether reducing MTF access by 10%, 20%, or 50% nationwide; limiting MTF access to active-duty beneficiaries; or closing MTFs with the worst performance on patient safety (p < 0.001 for overall quality indicators for each). Conclusions: Reducing access to MTFs could result in significant harm to MHS patients. The results underscore the importance of health-policy planning based on evidence-based evaluation and the need to consider the consequential downstream effects caused by changes in access to care. KEYWORDS access to care, health care reform, military, Military Health System, MTF Realignment, patient safety, quality, TRICARE What is known on this topic * The US Military Health System (MHS) has long served as a proving ground for theories about the importance of access to care. * In October 2019, major health care reforms within the MHS led to a substantial restructuring of MHS beneficiaries' access to military treatment facilities. What this study adds * Ongoing MHS health care reforms could lead to marked changes in AHRQ-endorsed quality metrics for inpatient quality (Inpatient Quality Indicators) and patient safety (Patient Safety Indicators), resulting in significantly worse care for MHS beneficiaries. * The results underscore the importance of health-policy planning based on evidence-based evaluation and need to consider the consequential downstream effects caused by changes in access to care., 1 | INTRODUCTION As one of the largest health systems in the United States and the single largest provider of government-sponsored universal health insurance coverage for adults aged Since the [...]

Published
2022
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22. Traumatic Brain Injury in Older Adults: Characteristics, Outcomes, and Considerations. Results From the American Association for the Surgery of Trauma Geriatric Traumatic Brain Injury (GERI-TBI) Multicenter Trial

Author

Adams, Charles, Lueckelm, Stephanie, Murry, Jason, Hsu, Cindy, Bhatti, Umer, Lissauer, Matthew, LaFonte, Marc, Najafi, Kaveh, Lewandowski, Karen, Mukherjee, Kaushik, Imperio-Lagabon, Kristelle, Martin, Niels, Hirsch, Kathleen, Berry, Cherisse, Freitas, Derek, Cullinane, Daniel, Ramwani, Roshini, Truitt, Michael, Pearcy, Chris, Hashimi, Habiba, Kaups, Krista, Claridge, Jeffry, Ladhani, Husayn, Hartwell, Jennifer, Ballou, Jessica, Croce, Martin, Markle, Stephanie, Osserwaarde, Sally, Posluszny, Joseph, Stocker, Benjamin, Hranjec, Tjasa, Solomon, Rachele, Martinek, Lucy, Gupta, Alok, Grabo, Daniel J., Khan, Uzer, Tatum, Danielle, Jacome, Tomas, Gates, Jonathan, Jawani, Alisha, Berndtson, Allison, Curry, Terry, Bala, Miklosh, Dultz, Linda, Houshmand, Natasha, Pieri, Paola, Zielinski, Martin, Hughes, Joy, Malhotra, Ajai, Lee, Tim, Petrone, Patrizio, Joseph, D'andrea, Marshall, Gary, Carrick, Matthew, Pathak, Abhijit, Van Zandt, Andrea, Glass, Nina, Livingston, David, Gregg, Shea, Webb, Travis, Drumheller, Byron, Kozar, Rosemary, Barraco, Robert, Joseph, Bellal, Ghneim, Mira, Brasel, Karen, Vesselinov, Roumen, Albrecht, Jennifer, Liveris, Anna, Watras, Jill, Michetti, Christopher, Haan, James, Lightwine, Kelly, Winfield, Robert, Adams, Sasha, Podbielski, Jeanette, Armen, Scott, Zacko, J. Christopher, Nasrallah, Fady, Schaffer, Kathryn, Dunn, Julie, Smoot, Brittany, Schroeppel, Thomas, Stillman, Zachery, Cooper, Zara, and Stein, Deborah

Published
2022
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23. Impact of peri‐operative frailty and operative stress on post‐discharge mortality, readmission and days at home in Medicare beneficiaries.

Author

Park, Chan Mi, Lie, Jessica J., Yang, Laiji, Cooper, Zara, and Kim, Dae Hyun

Subjects
MEDICARE beneficiaries, FRAILTY, PATIENT readmissions, PHYSIOLOGICAL stress, OLDER patients
Abstract

Summary: Background: Understanding how patients' frailty and the physiological stress of surgical procedures affect postoperative outcomes may inform risk stratification of older patients undergoing surgery. The objective of the study was to examine the association of peri‐operative frailty with mortality, 30‐day readmission and days at home after non‐cardiac surgical procedures of different physiological stress. Methods: This retrospective study used Medicare claims data from a 7.125% random sample of Medicare fee‐for‐service beneficiaries from 2015 to 2019 who were aged ≥ 65 years and underwent non‐cardiac surgical procedure listed in the Operative Stress Score categories. The exposure of the study was claims‐based frailty index (robust, < 0.15; pre‐frail, 0.15 to < 0.25; mildly frail, 0.25 to < 0.35; and moderate‐to‐severely frail, ≥ 0.35) with Operative Stress Score categories being 1, very low stress to 5, very high stress. The primary outcome was all‐cause mortality at 30 days and 365 days after the surgical procedure. Results: In total, 1,019,938 patients (mean (SD) age of 76.1 (7.3) years; 52.3% female; 16.8% frail) were included. The cumulative incidence of mortality generally increased with Operative Stress Score category, ranging from 5.0% (Operative Stress Score 2) to 24.9% (Operative Stress Score 4) at 365 days. Within each category, increasing frailty was associated with mortality at 30 days (hazard ratio comparing moderate‐to‐severe frailty vs. robust ranged from 1.59–3.91) and at 365 days (hazard ratio 1.30–4.04). The variation in postoperative outcomes by patients' frailty level was much greater than the variation by the operative stress category. Conclusions: These results emphasise routine frailty screening before major and minor non‐cardiac procedures and the need for greater clinician awareness of postoperative outcomes beyond 30 days in shared decision‐making with older adults with frailty. [ABSTRACT FROM AUTHOR]

Published
2024
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26. Developing a National Trauma Research Action Plan: Results from the injury prevention research gap Delphi survey

Author

Cooper, Zara, Herrera-Escobar, Juan P., Phuong, Jimmy, Braverman, Maxwell A., Bonne, Stephanie, Knudson, Mary Margaret, Rivara, Frederick P., Rowhani-Rahbar, Ali, Price, Michelle A., Bulger, Eileen M., Baldwin, Grant, Betz, Marian, Bonne, Stephanie, Campbell, Brendan, Castor, Jill R., Christmas, Ashley, Cooper, Zara, Danner, Omar, Dicker, Rochelle, Frangos, Spiros, Goldberg, Amy, Ho, Vanessa, Joseph, D’Andrea, Joseph, Kimberly, Knudson, Mary Margaret, Kuhls, Deborah, Macauley, Karen, Meredith, Wayne, Ranney, Megan L., Rivara, Frederick P., Rogers, Selwyn, Rosenblatt, Michael S., Rowhani-Rahbar, Ali, Sakran, Joseph, Smith, Randi N., Stewart, Ronald M., Stitzel, Joel, Arabian, Sandra Strack, and Tinkoff, Glen

Published
2022
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36. Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS) Society Recommendations: Part 1—Preoperative: Diagnosis, Rapid Assessment and Optimization

Author

Peden, Carol J., Aggarwal, Geeta, Aitken, Robert J., Anderson, Iain D., Bang Foss, Nicolai, Cooper, Zara, Dhesi, Jugdeep K., French, W. Brenton, Grant, Michael C., Hammarqvist, Folke, Hare, Sarah P., Havens, Joaquim M., Holena, Daniel N., Hübner, Martin, Kim, Jeniffer S., Lees, Nicholas P., Ljungqvist, Olle, Lobo, Dileep N., Mohseni, Shahin, Ordoñez, Carlos A., Quiney, Nial, Urman, Richard D., Wick, Elizabeth, Wu, Christopher L., Young-Fadok, Tonia, and Scott, Michael

Published
2021
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