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9. Defining and Measuring Quality

Author

Hutter, Matthew M., Morton, John M., editor, Brethauer, Stacy A., editor, DeMaria, Eric J., editor, Kahan, Scott, editor, and Hutter, Matthew M., editor

Published
2019
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11. Expanding the scope of quality measurement in surgery to include nonoperative care

Author

Wandling, Michael W, Ko, Clifford Y, Bankey, Paul E, Cribari, Chris, Cryer, H Gill, Diaz, Jose J, Duane, Therese M, Hameed, S Morad, Hutter, Matthew M, Metzler, Michael H, Regner, Justin L, Reilly, Patrick M, Reines, H David, Sperry, Jason L, Staudenmayer, Kristan L, Utter, Garth H, Crandall, Marie L, Bilimoria, Karl Y, and Nathens, Avery B

Subjects
Patient Safety, 8.1 Organisation and delivery of services, Health and social care services research, Management of diseases and conditions, 7.3 Management and decision making, Appendicitis, Benchmarking, Cholecystitis, Emergency Medicine, Female, General Surgery, Humans, Intestinal Obstruction, Intestine, Small, Male, Pilot Projects, Quality Improvement, Emergency general surgery, surgical quality assessment, nonoperative management, Cardiorespiratory Medicine and Haematology, Clinical Sciences, Nursing, Emergency & Critical Care Medicine
Abstract

Patients managed non-operatively have been excluded from risk-adjusted benchmarking programs, including the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP). Consequently, optimal performance evaluation is not possible for specialties like emergency general surgery (EGS) where non-operative management is common. We developed a multi-institutional EGS clinical data registry within ACS NSQIP that includes patients managed non-operatively to evaluate variability in non-operative care across hospitals and identify gaps in performance assessment that occur when only operative cases are considered.Using ACS NSQIP infrastructure and methodology, surgical consultations for acute appendicitis, acute cholecystitis, and small bowel obstruction (SBO) were sampled at 13 hospitals that volunteered to participate in the EGS clinical data registry. Standard NSQIP variables and 16 EGS-specific variables were abstracted with 30-day follow-up. To determine the influence of complications in non-operative patients, rates of adverse outcomes were identified and hospitals were ranked by performance with and then without including non-operative cases.2,091 patients with EGS diagnoses were included, 46.6% with appendicitis, 24.3% with cholecystitis, and 29.1% with SBO. The overall rate of non-operative management was 27.4%, 6.6% for appendicitis, 16.5% for cholecystitis, and 69.9% for SBO. Despite comprising only 27.4% of patients in the EGS Pilot, non-operative management accounted for 67.7% of deaths, 34.3% of serious morbidities, and 41.8% of hospital readmissions. After adjusting for patient characteristics and hospital diagnosis mix, addition of non-operative management to hospital performance assessment resulted in 12 of 13 hospitals changing performance rank, with 4 hospitals changing by 3 or more positions.This study identifies a gap in performance evaluation when non-operative patients are excluded from surgical quality assessment and demonstrates the feasibility of incorporating non-operative care into existing surgical quality initiatives. Broadening the scope of hospital performance assessment to include non-operative management creates an opportunity to improve the care of all surgical patients, not just those who have an operation.III, Prognostic and Epidemiological.

Published
2017

15. Current recommendations for procedure selection in class I and II obesity developed by an expert modified Delphi consensus

Author

Kermansaravi, Mohammad, primary, Chiappetta, Sonja, additional, Parmar, Chetan, additional, Shikora, Scott A., additional, Prager, Gerhard, additional, LaMasters, Teresa, additional, Ponce, Jaime, additional, Kow, Lilian, additional, Nimeri, Abdelrahman, additional, Kothari, Shanu N., additional, Aarts, Edo, additional, Abbas, Syed Imran, additional, Aly, Ahmad, additional, Aminian, Ali, additional, Bashir, Ahmad, additional, Behrens, Estuardo, additional, Billy, Helmuth, additional, Carbajo, Miguel A., additional, Clapp, Benjamin, additional, Chevallier, Jean-Marc, additional, Cohen, Ricardo V., additional, Dargent, Jerome, additional, Dillemans, Bruno, additional, Faria, Silvia L., additional, Neto, Manoel Galvao, additional, Garneau, Pierre Y., additional, Gawdat, Khaled, additional, Haddad, Ashraf, additional, ElFawal, Mohamad Hayssam, additional, Higa, Kelvin, additional, Himpens, Jaques, additional, Husain, Farah, additional, Hutter, Matthew M., additional, Kasama, Kazunori, additional, Kassir, Radwan, additional, Khan, Amir, additional, Khoursheed, Mousa, additional, Kroh, Matthew, additional, Kurian, Marina S., additional, Lee, Wei-Jei, additional, Loi, Ken, additional, Mahawar, Kamal, additional, McBride, Corrigan L., additional, Almomani, Hazem, additional, Melissas, John, additional, Miller, Karl, additional, Misra, Monali, additional, Musella, Mario, additional, Northup, C. Joe, additional, O’Kane, Mary, additional, Papasavas, Pavlos K., additional, Palermo, Mariano, additional, Peterson, Richard M., additional, Peterli, Ralph, additional, Poggi, Luis, additional, Pratt, Janey S. A., additional, Alqahtani, Aayad, additional, Ramos, Almino C., additional, Rheinwalt, Karl, additional, Ribeiro, Rui, additional, Rogers, Ann M., additional, Safadi, Bassem, additional, Salminen, Paulina, additional, Santoro, Sergio, additional, Sann, Nathaniel, additional, Scott, John D., additional, Shabbir, Asim, additional, Sogg, Stephanie, additional, Stenberg, Erik, additional, Suter, Michel, additional, Torres, Antonio, additional, Ugale, Surendra, additional, Vilallonga, Ramon, additional, Wang, Cunchuan, additional, Weiner, Rudolf, additional, Zundel, Natan, additional, Angrisani, Luigi, additional, and De Luca, Maurizio, additional

Published
2024
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16. Continuous Positive Airway Pressure Mitigates Opioid-induced Worsening of Sleep-disordered Breathing Early after Bariatric Surgery

Author

Zaremba, Sebastian, Shin, Christina H, Hutter, Matthew M, Malviya, Sanjana A, Grabitz, Stephanie D, MacDonald, Teresa, Diaz-Gil, Daniel, Ramachandran, Satya Krishna, Hess, Dean, Malhotra, Atul, and Eikermann, Matthias

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Neurosciences, Behavioral and Social Science, Sleep Research, Lung, Clinical Research, Respiratory, Adult, Aged, Analgesics, Opioid, Arousal, Bariatric Surgery, Continuous Positive Airway Pressure, Cross-Over Studies, Female, Hemodynamics, Humans, Male, Middle Aged, Oxygen, Polysomnography, Postoperative Complications, Prospective Studies, Respiratory Insufficiency, Respiratory Mechanics, Sleep Apnea Syndromes, Clinical Sciences, Anesthesiology, Clinical sciences
Abstract

BackgroundBariatric surgery patients are vulnerable to sleep-disordered breathing (SDB) early after recovery from surgery and anesthesia. The authors hypothesized that continuous positive airway pressure (CPAP) improves postoperative oxygenation and SDB and mitigates opioid-induced respiratory depression.MethodsIn a randomized crossover trial, patients after bariatric surgery received 30% oxygen in the postanesthesia care unit (PACU) under two conditions: atmospheric pressure and CPAP (8 to 10 cm H2O). During 1 h of each treatment, breathing across cortical arousal states was analyzed using polysomnography and spirometry. Arousal state and respiratory events were scored in accordance with American Academy of Sleep Medicine guidelines. Data on opioid boluses in the PACU were collected. The primary and secondary outcomes were the apnea hypopnea index (AHI) and apnea after self-administration of opioids in the PACU. Linear mixed model analysis was used to compare physiologic measures of breathing.ResultsSixty-four percent of the 33 patients with complete postoperative polysomnography data demonstrated SDB (AHI greater than 5/h) early after recovery from anesthesia. CPAP treatment decreased AHI (8 ± 2/h vs. 25 ± 5/h, P < 0.001), decreased oxygen desaturations (5 ± 10/h vs. 16 ± 20/h, P < 0.001), and increased the mean oxygen saturation by 3% (P = 0.003). CPAP significantly decreased the respiratory-depressant effects observed during wakefulness-sleep transitions without affecting hemodynamics. The interaction effects between CPAP treatment and opioid dose for the dependent variables AHI (P < 0.001), inspiratory flow (P = 0.002), and minute ventilation (P = 0.015) were significant.ConclusionsThis pharmacophysiologic interaction trial shows that supervised CPAP treatment early after surgery improves SDB and ameliorates the respiratory-depressant effects of opioids without undue hemodynamic effects.

Published
2016

23. Understanding Bariatric Research

Author

Hutter, Matthew M., Auchincloss, Hugh G., Nguyen, Ninh T., editor, Blackstone, Robin P., editor, Morton, John M., editor, Ponce, Jaime, editor, and Rosenthal, Raul J., editor

Published
2015
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37. Distinct Hepatic Gene‐Expression Patterns of NAFLD in Patients With Obesity

Author

Ludwig Center for Molecular Oncology (Massachusetts Institute of Technology), Subudhi, Sonu, Drescher, Hannah K, Dichtel, Laura E, Bartsch, Lea M, Chung, Raymond T, Hutter, Matthew M, Gee, Denise W, Meireles, Ozanan R, Witkowski, Elan R, Gelrud, Louis, Masia, Ricard, Osganian, Stephanie A, Gustafson, Jenna L, Rwema, Steve, Bredella, Miriam A, Bhatia, Sangeeta N, Warren, Andrew, Miller, Karen K, Lauer, Georg M, Corey, Kathleen E, Ludwig Center for Molecular Oncology (Massachusetts Institute of Technology), Subudhi, Sonu, Drescher, Hannah K, Dichtel, Laura E, Bartsch, Lea M, Chung, Raymond T, Hutter, Matthew M, Gee, Denise W, Meireles, Ozanan R, Witkowski, Elan R, Gelrud, Louis, Masia, Ricard, Osganian, Stephanie A, Gustafson, Jenna L, Rwema, Steve, Bredella, Miriam A, Bhatia, Sangeeta N, Warren, Andrew, Miller, Karen K, Lauer, Georg M, and Corey, Kathleen E

Abstract

Approaches to manage nonalcoholic fatty liver disease (NAFLD) are limited by an incomplete understanding of disease pathogenesis. The aim of this study was to identify hepatic gene-expression patterns associated with different patterns of liver injury in a high-risk cohort of adults with obesity. Using the NanoString Technologies (Seattle, WA) nCounter assay, we quantified expression of 795 genes, hypothesized to be involved in hepatic fibrosis, inflammation, and steatosis, in liver tissue from 318 adults with obesity. Liver specimens were categorized into four distinct NAFLD phenotypes: normal liver histology (NLH), steatosis only (steatosis), nonalcoholic steatohepatitis without fibrosis (NASH F0), and NASH with fibrosis stage 1-4 (NASH F1-F4). One hundred twenty-five genes were significantly increasing or decreasing as NAFLD pathology progressed. Compared with NLH, NASH F0 was characterized by increased inflammatory gene expression, such as gamma-interferon-inducible lysosomal thiol reductase (IFI30) and chemokine (C-X-C motif) ligand 9 (CXCL9), while complement and coagulation related genes, such as C9 and complement component 4 binding protein beta (C4BPB), were reduced. In the presence of NASH F1-F4, extracellular matrix degrading proteinases and profibrotic/scar deposition genes, such as collagens and transforming growth factor beta 1 (TGFB1), were simultaneously increased, suggesting a dynamic state of tissue remodeling. Conclusion: In adults with obesity, distinct states of NAFLD are associated with intrahepatic perturbations in genes related to inflammation, complement and coagulation pathways, and tissue remodeling. These data provide insights into the dynamic pathogenesis of NAFLD in high-risk individuals.

Published
2022

41. ADAMTSL2 protein and a soluble biomarker signature identify at-risk non-alcoholic steatohepatitis and fibrosis in adults with NAFLD

Author

Corey, Kathleen E., primary, Pitts, Rebecca, additional, Lai, Michelle, additional, Loureiro, Joseph, additional, Masia, Ricard, additional, Osganian, Stephanie A., additional, Gustafson, Jenna L., additional, Hutter, Matthew M., additional, Gee, Denise W., additional, Meireles, Ozanan R., additional, Witkowski, Elan R., additional, Richards, Shola M., additional, Jacob, Jaison, additional, Finkel, Nancy, additional, Ngo, Debby, additional, Wang, Thomas J., additional, Gerszten, Robert E., additional, Ukomadu, Chinweike, additional, and Jennings, Lori L., additional

Published
2022
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42. Discordance Between Perioperative Antibiotic Prophylaxis and Wound Infection Cultures in Patients Undergoing Pancreaticoduodenectomy

Author

Fong, Zhi Ven, McMillan, Matthew T., Marchegiani, Giovanni, Sahora, Klaus, Malleo, Giuseppe, De Pastena, Matteo, Loehrer, Andrew P., Lee, Grace C., Ferrone, Cristina R., Chang, David C., Hutter, Matthew M., Drebin, Jeffrey A., Bassi, Claudio, Lillemoe, Keith D., Vollmer, Charles M., and Fernández-del Castillo, Carlos

Published
2016
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43. Zoledronic acid for prevention of bone loss in patients receiving bariatric surgery

Author

Liu, Yi, Côté, Maya M., Cheney, Michael C., Lindeman, Katherine G., Rushin, Claire C., Hutter, Matthew M., and Yu, Elaine W.

Subjects
Bariatric surgery, Bone loss, Gastric bypass, Bisphosphonates, Article, Zoledronic acid, Bone turnover marker
Abstract

Purpose Bariatric surgery is an effective treatment for severe obesity but causes substantial bone loss and increased risk of fractures. To date, there have been no studies examining whether pharmacologic treatments can prevent bone loss after bariatric surgery. We performed an exploratory study to examine the preliminary safety and efficacy of zoledronic acid (ZOL), a potent anti-resorptive bisphosphonate, to suppress bone turnover markers (BTM) and prevent declines in bone mineral density (BMD) after Roux-en-Y gastric bypass (RYGB) surgery. Methods We performed an open-label pilot study of pre-operative ZOL in postmenopausal women with obesity who were planning RYGB (n = 4). A single dose of zoledronic acid 5 mg was given intravenously prior to RYGB. Serum bone biochemistries including C-telopeptide (CTX) and procollagen type 1 N-terminal propeptide (P1NP) were measured at multiple timepoints throughout the 24-week study. BMD was also obtained at the spine and hip by dual-energy x-ray absorptiometry (DXA) and at the trabecular spine by quantitative computed tomography (QCT) at pre-operative baseline and 24 weeks. Results were compared against pre-operative baseline and against changes among RYGB historical controls (n = 10). Results At 2 weeks after RYGB, there was a nonsignificant trend for CTX and P1NP levels to be lower than baseline levels in the ZOL group. By 24 weeks after RYGB, however, participants who received ZOL had a significant increase in CTX above pre-operative baseline (+0.228 ± 0.117 ng/dL, p = 0.030) but this CTX rise was less than that observed in the controls (+0.601 ± 0.307 ng/dL, p = 0.042 between groups). Despite ZOL use, participants had significant areal BMD loss at the total hip as compared to pre-operative baseline (−4.2 ± 1.5%, p = 0.012) that was similar in magnitude to total hip BMD loss in the controls (−5.5 ± 3.9%, p = 0.005). There was a suggestion that the ZOL group might be protected against trabecular spine volumetric bone loss as compared to the control group (+4.8 ± 8.0% vs. -5.9 ± 7.0%, p = 0.075 between groups). Serum calcium, 25-hydroxyvitamin D, and parathyroid hormone did not change in either group. No hypocalcemia or serious adverse events were reported after ZOL. Conclusion In this proof of concept study, a single dose of ZOL prior to RYGB appeared to transiently mitigate but not fully prevent high bone turnover in the acute postoperative period. At 24 weeks after RYGB, our preliminary data suggest that ZOL was not sufficient to prevent bone loss at the hip, although it may preserve bone density at the trabecular spine. Further prospective, controlled studies are needed to confirm our findings and to identify the best strategies for preventing bone loss in bariatric patients receiving RYGB., Highlights • In postmenopausal women receiving Roux-en-Y gastric bypass, zoledronate was safe and briefly reduced bone turnover markers. • Pre-operative zoledronic acid was not sufficient to prevent bone loss at the hip in the 24 weeks after gastric bypass. • Larger, placebo-controlled randomized trials are needed to definitively address this question

Published
2021

45. Distinct Hepatic Gene‐Expression Patterns of NAFLD in Patients With Obesity

Author

Subudhi, Sonu, primary, Drescher, Hannah K., additional, Dichtel, Laura E., additional, Bartsch, Lea M., additional, Chung, Raymond T., additional, Hutter, Matthew M., additional, Gee, Denise W., additional, Meireles, Ozanan R., additional, Witkowski, Elan R., additional, Gelrud, Louis, additional, Masia, Ricard, additional, Osganian, Stephanie A., additional, Gustafson, Jenna L., additional, Rwema, Steve, additional, Bredella, Miriam A., additional, Bhatia, Sangeeta N., additional, Warren, Andrew, additional, Miller, Karen K., additional, Lauer, Georg M., additional, and Corey, Kathleen E., additional

Published
2021
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48. Surgical Site Infection Prevention: The Importance of Operative Duration and Blood Transfusion—Results of the First American College of Surgeons–National Surgical Quality Improvement Program Best Practices Initiative

Author

Campbell, Darrell A., Jr, Henderson, William G., Englesbe, Michael J., Hall, Bruce L., O'Reilly, Michael, Bratzler, Dale, Dellinger, E. Patchen, Neumayer, Leigh, Bass, Barbara L., Hutter, Matthew M., Schwartz, James, Ko, Clifford, Itani, Kamal, Steinberg, Steven M., Siperstein, Allan, Sawyer, Robert G., Turner, Douglas J., and Khuri, Shukri F.

Published
2008
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