The impact of intraoperative erythrocyte transfusion on outcomes anemic patients undergoing noncardiac surgery has not been well characterized. objective this study was to examine the association between blood and mortality morbidity in with severe anemia (hematocrit less than 30%) who are exposed one or two units erythrocytes intraoperatively.This a retrospective analysis 30-day 10,100 general, vascular, orthopedic surgery. We estimated separate multivariate logistic regression models for...

Background: Generations of clinicians have used the Baux score, defined as sum age in years and percent body burn, to predict mortality after trauma, but advances burn care rendered predictions this score too pessimistic. Additionally, does not include effects inhalation injury. Methods: We revised injury recalibrated its using a single-term logistic regression model developed data on 39,888 burned patients provided by national repository. compared more complex derived from same set...

Background: System approaches, such as improving working conditions, have been advocated to improve patient safety. However, the independent effect of many condition variables on outcomes is unknown. Objective: To examine effects a comprehensive set conditions elderly safety in intensive care units. Design: Observational study, with outcome data collected using National Nosocomial Infection Surveillance system protocols and Medicare files. Several measures health status fixed setting...

To develop a 30-day mortality risk index for noncardiac surgery that can be used to communicate information patients and guide clinical management at the "point-of-care," by surgeons hospitals internally audit their quality of care.Clinicians rely on Revised Cardiac Risk Index quantify cardiac complications in undergoing surgery. Because from causes accounts many perioperative deaths, there is also need simple bedside predict all-cause after surgery.Retrospective cohort study 298,772 during...

The Glasgow Coma Scale (GCS) has served as an assessment tool in head trauma and a measure of physiologic derangement outcome models (e.g., TRISS Acute Physiology Chronic Health Evaluation), but it not been rigorously examined predictor outcome.Using large data set (National Trauma Data Bank, N = 204,181), we compared the predictive power (pseudo R2, receiver operating characteristic [ROC]) calibration GCS to its components.The is actually collection 120 different combinations 3 predictors...

<h3>Objective</h3>To explore the clinical impact and economic burden of hospital-acquired infections (HAIs) in trauma patients using a nationally representative database.<h3>Design</h3>Retrospective study.<h3>Setting</h3>The Healthcare Cost Utilization Project Nationwide Inpatient Sample.<h3>Patients</h3>Trauma patients.<h3>Main Outcome Measures</h3>We examined association between HAIs (sepsis, pneumonia, Staphylococcus infections, Clostridium difficile– associated disease) in-hospital...

Background Previous studies have demonstrated that obesity is paradoxically associated with a lower risk of mortality after noncardiac surgery. This study will determine the impact modified metabolic syndrome (defined as presence obesity, hypertension, and diabetes) on perioperative outcomes. Methods based data from 310,208 patients in American College Surgeons National Surgical Quality Improvement Program database. We estimated separate multivariate logistic regression models for 30-day...

In Brief Objective: To develop and validate a new ICD-9 injury model that uses regression modeling, as opposed to simple ratio measurement, estimate empiric severities for each of the injuries in ICD-9-CM lexicon. Background: The American College Surgeons now requires International Classification diseases ninth Edition (ICD-9-CM) codes coding National Trauma Databank. Injury Severity Score (ICISS) is best-known risk-adjustment when are recorded using coding, would likely be used risk-adjust...

Shared decision making in surgical care requires a culture shift. For patients at high risk for adverse events after surgery, or cases with an equivocal risk–benefit balance, evidence-based may require input from multidisciplinary group of experts.

Hospital readmissions are believed to be an indicator of suboptimal care and the focus efforts by Centers for Medicare Medicaid Services reduce health cost improve quality. Strategies surgical may most effective if applied prospectively patients who at increased risk readmission. Hospitals do not currently have means identify high unplanned rehospitalizations.To examine whether American College Surgeons National Surgical Quality Improvement Program (ACS NSQIP) predicted major complications...

Background There is strong evidence that pain undertreated in black and Hispanic patients. The association between race ethnicity the use of epidural analgesia for labor not well described. Methods Using New York State Perinatal Database, authors examined whether were associated with likelihood receiving after adjusting clinical characteristics, demographics, insurance coverage, provider effect. This retrospective cohort study was based on 81,883 women admitted childbirth 1998 2003. Results...

In Brief Objective: To develop a statistically rigorous trauma mortality prediction model based on empiric estimates of severity for each injury in the abbreviated scale (AIS) and compare performance this new with score (ISS). Summary Background Data: Mortality rates at centers should only be compared after adjusting differences severity, but no reliable measure currently exists. The ISS has served as standard anatomic 30 years. However, it relies individual severities assigned by experts...

Complications during central venous catheterization (CVC) are not rare and can be serious. The use of ultrasound (US) CVC has been recommended to improve patient safety. We performed a survey evaluate the frequency of, factors influencing, US use.We conducted an electronic all members Society Cardiovascular Anesthesiologists. Univariate multivariate logistic regressions were used assess association between hospital physician factors. All tests two-sided, P value <0.05 was considered...

The Agency for Healthcare Research and Quality (AHRQ) has constructed Inpatient Indicator (IQI) mortality measures to measure hospital quality using routinely available administrative data. With the exception of California, New York State, Wisconsin, data do not include a present-on-admission (POA) indicator distinguish between preexisting conditions complications. extent which lack POA biases assessment based on AHRQ is unknown.To examine impact enhanced from includes...

To examine whether failure-to-rescue is an important mechanism driving outcome differences across low- and high-mortality hospitals caring for trauma patients.Reducing medical errors complications has become the focus of quality improvement efforts. Patients undergoing general vascular surgery in have similar rates but higher compared to patients low-mortality hospitals.Retrospective cohort study based on 54,713 patient records National Trauma Databank 2007. Hospitals were classified as...

Performance benchmarking requires accurate measurement of injury severity. Despite its shortcomings, the Injury Severity Score (ISS) remains industry standard 40 years after creation. A new severity measure, Trauma Mortality Prediction Model (TMPM), uses either Abbreviated Scale (AIS) or DRG International Classification Diseases-9th Rev. (ICD-9) lexicons and may better quantify compared with ISS. We performance TMPM ISS other measures in a single cohort patients.We included 337,359 patient...

To examine the hospital variability in use of red blood cells (RBCs), fresh-frozen plasma (FFP), and platelet transfusions patients undergoing major noncardiac surgery.Blood transfusion is commonly used surgical procedures United States. Little known about perioperative rates for surgery.We University HealthSystem Consortium database (2006-2010) to allogeneic RBC, FFP, surgery. We regression-based techniques quantify practices study association between characteristics likelihood...

To examine the association between obesity and outcomes in injured patients.The United States is facing an epidemic affecting 1 3 adult Americans. Very little known about role of acute illness. Optimal care obese trauma patients can only be achieved once we gain a better understanding impact severe on outcomes.We conducted retrospective cohort study 147,680 admitted to 28 level I II Pennsylvania centers 2000 2009. Logistic regression was used in-hospital mortality major complications,...

One of every 150 hospitalized patients experiences a lethal adverse event; nearly half these events involves surgical patients. Although variations in surgeon performance and quality have been reported the literature, less is known about influence anesthesiologists on outcomes after major surgery. Our goal this study was to determine whether there significant variation between controlling for patient case mix hospital quality.Using clinical data from New York State Cardiac Surgery Reporting...

Abstract Background: Most studies examining the prognostic value of preoperative coagulation testing are too small to examine predictive routine in patients having noncardiac surgery. Methods: Using data from American College Surgeons National Surgical Quality Improvement database, authors performed a retrospective observational study on 316,644 surgery who did not have clinical indications for testing. The used multivariable logistic regression analysis explore association between platelet...

Little is known as to whether long-term outcomes of acute ischemic stroke (AIS) vary by race/ethnicity. Using the American Heart Association Get With The Guidelines-Stroke registry linked with Medicare claims data set, we examined 30-day and 1-year differed race/ethnicity among older patients AIS.We analyzed 200 900 AIS >65 years age (170 694 non-Hispanic whites, 85.0%; 20 514 blacks, 10.2%; 6632 Hispanics, 3.3%; 3060 Asian Americans, 1.5%) from 926 US centers participating in program April...

To assess whether differences in readmission rates between safety-net hospitals (SNH) and non-SNHs are due to hospital quality, compare the results of profiling with without SES adjustment.In response concerns that quality measures unfairly penalizes SNH, NQF recently recommended performance adjust for socioeconomic status (SES) when is a risk factor poor patient outcomes.Multivariate regression was used examine association SNH 30-day after major surgery. The adjustment were compared using...