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Risks scream caution for catheter-directed thrombolysis for proximal DVT
Catheter-directed thrombolysis plus anticoagulation is no more effective than anticoagulation alone in preventing in-hospital death among adults who have lower-extremity proximal deep vein thrombosis, according to a nationwide observational study reported online July 21 in JAMA Internal Medicine.
However, catheter-directed thrombolysis carries higher risks, particularly serious bleeding risks such as intracranial hemorrhage, than does anticoagulation alone, and it costs nearly three times as much money. These findings highlight the need for randomized trials "to evaluate the magnitude of the effect of catheter-directed thrombolysis on ... mortality, postthrombotic syndrome, and recurrence of DVT [deep vein thrombosis]. In the absence of such data, it may be reasonable to restrict this form of therapy to those patients who have a low bleeding risk and a high risk for postthrombotic syndrome, such as patients with iliofemoral DVT," said Dr. Riyaz Bashir of the division of cardiovascular diseases, Temple University, Philadelphia, and his associates.
Conflicting data from several small studies as to the safety and effectiveness of catheter-directed thrombolysis have led professional societies to devise conflicting recommendations for its use: the American College of Chest Physicians advises against using the procedure, while the American Heart Association recommends it as a first-line therapy for certain patients. "We sought to assess real-world comparative-safety outcomes in patients proximal and caval DVT who underwent catheter-directed thrombolysis plus anticoagulation with a group treated with anticoagulation alone using risk-adjusted propensity-score matching," the investigators said.
They analyzed data from an Agency for Healthcare Research and Quality administrative database of patient discharges from approximately 1,000 nonfederal acute-care hospitals per year for a 6-year period. They identified 90,618 patients with a discharge diagnosis of proximal DVT; propensity-score matching yielded 3,594 well-matched patients in each study group. In-hospital mortality was not significantly different between patients who had catheter-directed thrombolysis plus anticoagulation (1.2%) and those who had anticoagulation alone (0.9%), Dr. Bashir and his associates wrote (JAMA Intern. Med. 2014 July 21 [doi:10.1001/jamainternmed.2014.3415]).
However, rates of blood transfusion (11.1% vs. 6.5%), pulmonary embolism (17.9% vs 11.4%), and intracranial hemorrhage (0.9% vs 0.3%) were significantly higher with the invasive intervention. And patients in the catheter-directed thrombolysis group required significantly longer hospitalizations (7.2 vs. 5.0 days) and incurred significantly higher hospital expenses ($85,094 vs. $28,164). "It is imperative that the magnitude of benefit from catheter-directed therapy be substantial to justify the increased initial resource utilization and bleeding risks of this therapy," the investigators noted.
Catheter-directed thrombolysis plus anticoagulation is no more effective than anticoagulation alone in preventing in-hospital death among adults who have lower-extremity proximal deep vein thrombosis, according to a nationwide observational study reported online July 21 in JAMA Internal Medicine.
However, catheter-directed thrombolysis carries higher risks, particularly serious bleeding risks such as intracranial hemorrhage, than does anticoagulation alone, and it costs nearly three times as much money. These findings highlight the need for randomized trials "to evaluate the magnitude of the effect of catheter-directed thrombolysis on ... mortality, postthrombotic syndrome, and recurrence of DVT [deep vein thrombosis]. In the absence of such data, it may be reasonable to restrict this form of therapy to those patients who have a low bleeding risk and a high risk for postthrombotic syndrome, such as patients with iliofemoral DVT," said Dr. Riyaz Bashir of the division of cardiovascular diseases, Temple University, Philadelphia, and his associates.
Conflicting data from several small studies as to the safety and effectiveness of catheter-directed thrombolysis have led professional societies to devise conflicting recommendations for its use: the American College of Chest Physicians advises against using the procedure, while the American Heart Association recommends it as a first-line therapy for certain patients. "We sought to assess real-world comparative-safety outcomes in patients proximal and caval DVT who underwent catheter-directed thrombolysis plus anticoagulation with a group treated with anticoagulation alone using risk-adjusted propensity-score matching," the investigators said.
They analyzed data from an Agency for Healthcare Research and Quality administrative database of patient discharges from approximately 1,000 nonfederal acute-care hospitals per year for a 6-year period. They identified 90,618 patients with a discharge diagnosis of proximal DVT; propensity-score matching yielded 3,594 well-matched patients in each study group. In-hospital mortality was not significantly different between patients who had catheter-directed thrombolysis plus anticoagulation (1.2%) and those who had anticoagulation alone (0.9%), Dr. Bashir and his associates wrote (JAMA Intern. Med. 2014 July 21 [doi:10.1001/jamainternmed.2014.3415]).
However, rates of blood transfusion (11.1% vs. 6.5%), pulmonary embolism (17.9% vs 11.4%), and intracranial hemorrhage (0.9% vs 0.3%) were significantly higher with the invasive intervention. And patients in the catheter-directed thrombolysis group required significantly longer hospitalizations (7.2 vs. 5.0 days) and incurred significantly higher hospital expenses ($85,094 vs. $28,164). "It is imperative that the magnitude of benefit from catheter-directed therapy be substantial to justify the increased initial resource utilization and bleeding risks of this therapy," the investigators noted.
Catheter-directed thrombolysis plus anticoagulation is no more effective than anticoagulation alone in preventing in-hospital death among adults who have lower-extremity proximal deep vein thrombosis, according to a nationwide observational study reported online July 21 in JAMA Internal Medicine.
However, catheter-directed thrombolysis carries higher risks, particularly serious bleeding risks such as intracranial hemorrhage, than does anticoagulation alone, and it costs nearly three times as much money. These findings highlight the need for randomized trials "to evaluate the magnitude of the effect of catheter-directed thrombolysis on ... mortality, postthrombotic syndrome, and recurrence of DVT [deep vein thrombosis]. In the absence of such data, it may be reasonable to restrict this form of therapy to those patients who have a low bleeding risk and a high risk for postthrombotic syndrome, such as patients with iliofemoral DVT," said Dr. Riyaz Bashir of the division of cardiovascular diseases, Temple University, Philadelphia, and his associates.
Conflicting data from several small studies as to the safety and effectiveness of catheter-directed thrombolysis have led professional societies to devise conflicting recommendations for its use: the American College of Chest Physicians advises against using the procedure, while the American Heart Association recommends it as a first-line therapy for certain patients. "We sought to assess real-world comparative-safety outcomes in patients proximal and caval DVT who underwent catheter-directed thrombolysis plus anticoagulation with a group treated with anticoagulation alone using risk-adjusted propensity-score matching," the investigators said.
They analyzed data from an Agency for Healthcare Research and Quality administrative database of patient discharges from approximately 1,000 nonfederal acute-care hospitals per year for a 6-year period. They identified 90,618 patients with a discharge diagnosis of proximal DVT; propensity-score matching yielded 3,594 well-matched patients in each study group. In-hospital mortality was not significantly different between patients who had catheter-directed thrombolysis plus anticoagulation (1.2%) and those who had anticoagulation alone (0.9%), Dr. Bashir and his associates wrote (JAMA Intern. Med. 2014 July 21 [doi:10.1001/jamainternmed.2014.3415]).
However, rates of blood transfusion (11.1% vs. 6.5%), pulmonary embolism (17.9% vs 11.4%), and intracranial hemorrhage (0.9% vs 0.3%) were significantly higher with the invasive intervention. And patients in the catheter-directed thrombolysis group required significantly longer hospitalizations (7.2 vs. 5.0 days) and incurred significantly higher hospital expenses ($85,094 vs. $28,164). "It is imperative that the magnitude of benefit from catheter-directed therapy be substantial to justify the increased initial resource utilization and bleeding risks of this therapy," the investigators noted.
FROM JAMA INTERNAL MEDICINE
Key clinical point: Catheter-directed thrombolysis carries higher risks and may not improve outcomes for proximal DVT patients.
Major finding: In-hospital mortality was not significantly different between patients who had catheter-directed thrombolysis plus anticoagulation (1.2%) and those who had anticoagulation alone (0.9%), but rates of blood transfusion (11.1% vs 6.5%), pulmonary embolism (17.9% vs 11.4%), and intracranial hemorrhage (0.9% vs 0.3%) were significantly higher with the invasive intervention.
Data source: A propensity-matched analysis comparing the effectiveness and safety profiles between catheter-directed thrombolysis plus anticoagulation and anticoagulation alone in 3,594 adults across the country hospitalized with lower-extremity proximal DVT during a 6-year period.
Disclosures: This study was supported by Temple University Hospital, Philadelphia. Dr. Bashir reported no financial conflicts of interest; his associates reported ties to Covidien, Health Systems Networks, and Insight Telehealth.
Weekend surgery poses extra risks for children
Children receiving common urgent surgeries on the weekend face greater risks of death, blood transfusions, and surgical complications, according to a recent study.
"Our results are consistent with a growing body of evidence that mortality is overall increased during weekend hospitalizations," Dr. Seth Goldstein and his associates at Johns Hopkins University, Baltimore, reported. They noted that adult diverticulitis, stroke, pneumonia, traumatic brain injury, and ICU admissions have all also shown a "detrimental weekend effect" in past research (J. Pediatr. Surg. 2014;49:1087-91).
Dr. Goldstein’s team analyzed rates of death, blood transfusions, and surgical complications – including hemorrhage, accidental puncture or laceration, infections and wound-related complications – in 439,457 pediatric cases admitted to the hospital and requiring same-day procedures between 1988 and 2010.
Data on the 112,064 weekend admissions (25.5%) and 327,393 weekday admissions (74.5%) were pulled from the Nationwide Inpatient Sample and the Kid's Inpatient Database and included the following procedures: abscess drainage, appendectomy, inguinal hernia repair, open reduction with internal fixation of bone fracture, and placement or revision of ventricular shunt.
Admissions were more likely to be emergent on the weekend (60.9%) than on the weekday (52.6%), and children admitted on the weekends were slightly older and more often male, white, and uninsured but had less comorbidity when discharged. Rates of death were not statistically significant before adjustment for confounders, with deaths occurring among 0.11% of children admitted on weekdays and 0.14% of children admitted on weekends.
Preadjusted rates of blood transfusion were greater for weekend admissions (0.71%) than for weekday admissions (0.60%, P = .002), as were accidental punctures or lacerations, with 0.21% among weekend cases and 0.18% among weekday cases (P = .018). Yet wound complications were less common among children admitted on the weekend (0.11%) than on weekdays (0.13%, P = .044). Hemorrhage and wound infections did not differ between the groups before adjustment.
After adjusting for age, sex, race, insurance status, comorbidities, geographic region, hospital type (rural and urban teaching or nonteaching), admission type, and procedure type, the researchers found children admitted on the weekend had 1.63 greater odds of death than children admitted on weekdays. Children admitted on the weekend also had 1.4 times greater odds of an accidental puncture or laceration and 1.14 times greater odds of a blood transfusion, despite similar rates of hemorrhage. Wound infections and other wound-related complications did not differ between the groups after adjustment.
"We believe these findings to be predominately a result of systems issues such as decreased availability of staff and other hospital resources that contribute to patient care in a manner that is multifactorial and difficult to individually ascertain," the researchers wrote.
"While the exact etiology of these findings is not clear, these findings motivate a careful search for systems-based deficiencies that may be a detriment to pediatric surgical care provided on the weekend," they wrote.
With regard to mortality, the researchers wrote, "The mortality associated with pediatric surgical procedures is generally very low, requiring the large patient numbers included in these cohorts to detect potential differences. As an illustration, the significant adjusted odds ratio for mortality of 1.63 represents an increase in actual unadjusted death rate of only 0.03% (0.14% from 0.11%)." Nonetheless, they estimated that reducing weekend mortality rates to those of weekdays would have prevented the deaths of approximately 30 patients during the study period, a 20% reduction of inpatient deaths.
The study was internally funded, and the authors had no disclosures.
Children receiving common urgent surgeries on the weekend face greater risks of death, blood transfusions, and surgical complications, according to a recent study.
"Our results are consistent with a growing body of evidence that mortality is overall increased during weekend hospitalizations," Dr. Seth Goldstein and his associates at Johns Hopkins University, Baltimore, reported. They noted that adult diverticulitis, stroke, pneumonia, traumatic brain injury, and ICU admissions have all also shown a "detrimental weekend effect" in past research (J. Pediatr. Surg. 2014;49:1087-91).
Dr. Goldstein’s team analyzed rates of death, blood transfusions, and surgical complications – including hemorrhage, accidental puncture or laceration, infections and wound-related complications – in 439,457 pediatric cases admitted to the hospital and requiring same-day procedures between 1988 and 2010.
Data on the 112,064 weekend admissions (25.5%) and 327,393 weekday admissions (74.5%) were pulled from the Nationwide Inpatient Sample and the Kid's Inpatient Database and included the following procedures: abscess drainage, appendectomy, inguinal hernia repair, open reduction with internal fixation of bone fracture, and placement or revision of ventricular shunt.
Admissions were more likely to be emergent on the weekend (60.9%) than on the weekday (52.6%), and children admitted on the weekends were slightly older and more often male, white, and uninsured but had less comorbidity when discharged. Rates of death were not statistically significant before adjustment for confounders, with deaths occurring among 0.11% of children admitted on weekdays and 0.14% of children admitted on weekends.
Preadjusted rates of blood transfusion were greater for weekend admissions (0.71%) than for weekday admissions (0.60%, P = .002), as were accidental punctures or lacerations, with 0.21% among weekend cases and 0.18% among weekday cases (P = .018). Yet wound complications were less common among children admitted on the weekend (0.11%) than on weekdays (0.13%, P = .044). Hemorrhage and wound infections did not differ between the groups before adjustment.
After adjusting for age, sex, race, insurance status, comorbidities, geographic region, hospital type (rural and urban teaching or nonteaching), admission type, and procedure type, the researchers found children admitted on the weekend had 1.63 greater odds of death than children admitted on weekdays. Children admitted on the weekend also had 1.4 times greater odds of an accidental puncture or laceration and 1.14 times greater odds of a blood transfusion, despite similar rates of hemorrhage. Wound infections and other wound-related complications did not differ between the groups after adjustment.
"We believe these findings to be predominately a result of systems issues such as decreased availability of staff and other hospital resources that contribute to patient care in a manner that is multifactorial and difficult to individually ascertain," the researchers wrote.
"While the exact etiology of these findings is not clear, these findings motivate a careful search for systems-based deficiencies that may be a detriment to pediatric surgical care provided on the weekend," they wrote.
With regard to mortality, the researchers wrote, "The mortality associated with pediatric surgical procedures is generally very low, requiring the large patient numbers included in these cohorts to detect potential differences. As an illustration, the significant adjusted odds ratio for mortality of 1.63 represents an increase in actual unadjusted death rate of only 0.03% (0.14% from 0.11%)." Nonetheless, they estimated that reducing weekend mortality rates to those of weekdays would have prevented the deaths of approximately 30 patients during the study period, a 20% reduction of inpatient deaths.
The study was internally funded, and the authors had no disclosures.
Children receiving common urgent surgeries on the weekend face greater risks of death, blood transfusions, and surgical complications, according to a recent study.
"Our results are consistent with a growing body of evidence that mortality is overall increased during weekend hospitalizations," Dr. Seth Goldstein and his associates at Johns Hopkins University, Baltimore, reported. They noted that adult diverticulitis, stroke, pneumonia, traumatic brain injury, and ICU admissions have all also shown a "detrimental weekend effect" in past research (J. Pediatr. Surg. 2014;49:1087-91).
Dr. Goldstein’s team analyzed rates of death, blood transfusions, and surgical complications – including hemorrhage, accidental puncture or laceration, infections and wound-related complications – in 439,457 pediatric cases admitted to the hospital and requiring same-day procedures between 1988 and 2010.
Data on the 112,064 weekend admissions (25.5%) and 327,393 weekday admissions (74.5%) were pulled from the Nationwide Inpatient Sample and the Kid's Inpatient Database and included the following procedures: abscess drainage, appendectomy, inguinal hernia repair, open reduction with internal fixation of bone fracture, and placement or revision of ventricular shunt.
Admissions were more likely to be emergent on the weekend (60.9%) than on the weekday (52.6%), and children admitted on the weekends were slightly older and more often male, white, and uninsured but had less comorbidity when discharged. Rates of death were not statistically significant before adjustment for confounders, with deaths occurring among 0.11% of children admitted on weekdays and 0.14% of children admitted on weekends.
Preadjusted rates of blood transfusion were greater for weekend admissions (0.71%) than for weekday admissions (0.60%, P = .002), as were accidental punctures or lacerations, with 0.21% among weekend cases and 0.18% among weekday cases (P = .018). Yet wound complications were less common among children admitted on the weekend (0.11%) than on weekdays (0.13%, P = .044). Hemorrhage and wound infections did not differ between the groups before adjustment.
After adjusting for age, sex, race, insurance status, comorbidities, geographic region, hospital type (rural and urban teaching or nonteaching), admission type, and procedure type, the researchers found children admitted on the weekend had 1.63 greater odds of death than children admitted on weekdays. Children admitted on the weekend also had 1.4 times greater odds of an accidental puncture or laceration and 1.14 times greater odds of a blood transfusion, despite similar rates of hemorrhage. Wound infections and other wound-related complications did not differ between the groups after adjustment.
"We believe these findings to be predominately a result of systems issues such as decreased availability of staff and other hospital resources that contribute to patient care in a manner that is multifactorial and difficult to individually ascertain," the researchers wrote.
"While the exact etiology of these findings is not clear, these findings motivate a careful search for systems-based deficiencies that may be a detriment to pediatric surgical care provided on the weekend," they wrote.
With regard to mortality, the researchers wrote, "The mortality associated with pediatric surgical procedures is generally very low, requiring the large patient numbers included in these cohorts to detect potential differences. As an illustration, the significant adjusted odds ratio for mortality of 1.63 represents an increase in actual unadjusted death rate of only 0.03% (0.14% from 0.11%)." Nonetheless, they estimated that reducing weekend mortality rates to those of weekdays would have prevented the deaths of approximately 30 patients during the study period, a 20% reduction of inpatient deaths.
The study was internally funded, and the authors had no disclosures.
FROM JOURNAL OF PEDIATRIC SURGERY
Key clinical point: Weekend surgery for children carries some increased risk for complications and need for transfusion.
Major finding: Pediatric patients admitted and receiving same-day surgery during weekends had 1.63 times greater odds of death, 1.15 times greater odds of a blood transfusion, and 1.4 times greater odds of suffering surgery complications, compared with patients receiving surgery on weekdays.
Data source: The findings are based on data in the Nationwide Inpatient Sample and the Kids’ Inpatient Database on 439,457 pediatric admissions, from 1988 to 2010, which required same-day surgery.
Disclosures: The study was internally funded. The authors had no disclosures.
Weekend surgery poses extra risks for children
Children receiving common urgent surgeries on the weekend face greater risks of death, blood transfusions, and surgical complications, according to a recent study.
"Our results are consistent with a growing body of evidence that mortality is overall increased during weekend hospitalizations," Dr. Seth Goldstein and his associates at Johns Hopkins University, Baltimore, reported. They noted that adult diverticulitis, stroke, pneumonia, traumatic brain injury, and ICU admissions have all also shown a "detrimental weekend effect" in past research (J. Pediatr. Surg. 2014;49:1087-91).
Dr. Goldstein’s team analyzed rates of death, blood transfusions, and surgical complications – including hemorrhage, accidental puncture or laceration, infections and wound-related complications – in 439,457 pediatric cases admitted to the hospital and requiring same-day procedures between 1988 and 2010.
Data on the 112,064 weekend admissions (25.5%) and 327,393 weekday admissions (74.5%) were pulled from the Nationwide Inpatient Sample and the Kid's Inpatient Database and included the following procedures: abscess drainage, appendectomy, inguinal hernia repair, open reduction with internal fixation of bone fracture, and placement or revision of ventricular shunt.
Admissions were more likely to be emergent on the weekend (60.9%) than on the weekday (52.6%), and children admitted on the weekends were slightly older and more often male, white, and uninsured but had less comorbidity when discharged. Rates of death were not statistically significant before adjustment for confounders, with deaths occurring among 0.11% of children admitted on weekdays and 0.14% of children admitted on weekends.
Preadjusted rates of blood transfusion were greater for weekend admissions (0.71%) than for weekday admissions (0.60%, P = .002), as were accidental punctures or lacerations, with 0.21% among weekend cases and 0.18% among weekday cases (P = .018). Yet wound complications were less common among children admitted on the weekend (0.11%) than on weekdays (0.13%, P = .044). Hemorrhage and wound infections did not differ between the groups before adjustment.
After adjusting for age, sex, race, insurance status, comorbidities, geographic region, hospital type (rural and urban teaching or nonteaching), admission type, and procedure type, the researchers found children admitted on the weekend had 1.63 greater odds of death than children admitted on weekdays. Children admitted on the weekend also had 1.4 times greater odds of an accidental puncture or laceration and 1.14 times greater odds of a blood transfusion, despite similar rates of hemorrhage. Wound infections and other wound-related complications did not differ between the groups after adjustment.
"We believe these findings to be predominately a result of systems issues such as decreased availability of staff and other hospital resources that contribute to patient care in a manner that is multifactorial and difficult to individually ascertain," the researchers wrote.
"While the exact etiology of these findings is not clear, these findings motivate a careful search for systems-based deficiencies that may be a detriment to pediatric surgical care provided on the weekend," they wrote.
With regard to mortality, the researchers wrote, "The mortality associated with pediatric surgical procedures is generally very low, requiring the large patient numbers included in these cohorts to detect potential differences. As an illustration, the significant adjusted odds ratio for mortality of 1.63 represents an increase in actual unadjusted death rate of only 0.03% (0.14% from 0.11%)." Nonetheless, they estimated that reducing weekend mortality rates to those of weekdays would have prevented the deaths of approximately 30 patients during the study period, a 20% reduction of inpatient deaths.
The study was internally funded, and the authors had no disclosures.
Children receiving common urgent surgeries on the weekend face greater risks of death, blood transfusions, and surgical complications, according to a recent study.
"Our results are consistent with a growing body of evidence that mortality is overall increased during weekend hospitalizations," Dr. Seth Goldstein and his associates at Johns Hopkins University, Baltimore, reported. They noted that adult diverticulitis, stroke, pneumonia, traumatic brain injury, and ICU admissions have all also shown a "detrimental weekend effect" in past research (J. Pediatr. Surg. 2014;49:1087-91).
Dr. Goldstein’s team analyzed rates of death, blood transfusions, and surgical complications – including hemorrhage, accidental puncture or laceration, infections and wound-related complications – in 439,457 pediatric cases admitted to the hospital and requiring same-day procedures between 1988 and 2010.
Data on the 112,064 weekend admissions (25.5%) and 327,393 weekday admissions (74.5%) were pulled from the Nationwide Inpatient Sample and the Kid's Inpatient Database and included the following procedures: abscess drainage, appendectomy, inguinal hernia repair, open reduction with internal fixation of bone fracture, and placement or revision of ventricular shunt.
Admissions were more likely to be emergent on the weekend (60.9%) than on the weekday (52.6%), and children admitted on the weekends were slightly older and more often male, white, and uninsured but had less comorbidity when discharged. Rates of death were not statistically significant before adjustment for confounders, with deaths occurring among 0.11% of children admitted on weekdays and 0.14% of children admitted on weekends.
Preadjusted rates of blood transfusion were greater for weekend admissions (0.71%) than for weekday admissions (0.60%, P = .002), as were accidental punctures or lacerations, with 0.21% among weekend cases and 0.18% among weekday cases (P = .018). Yet wound complications were less common among children admitted on the weekend (0.11%) than on weekdays (0.13%, P = .044). Hemorrhage and wound infections did not differ between the groups before adjustment.
After adjusting for age, sex, race, insurance status, comorbidities, geographic region, hospital type (rural and urban teaching or nonteaching), admission type, and procedure type, the researchers found children admitted on the weekend had 1.63 greater odds of death than children admitted on weekdays. Children admitted on the weekend also had 1.4 times greater odds of an accidental puncture or laceration and 1.14 times greater odds of a blood transfusion, despite similar rates of hemorrhage. Wound infections and other wound-related complications did not differ between the groups after adjustment.
"We believe these findings to be predominately a result of systems issues such as decreased availability of staff and other hospital resources that contribute to patient care in a manner that is multifactorial and difficult to individually ascertain," the researchers wrote.
"While the exact etiology of these findings is not clear, these findings motivate a careful search for systems-based deficiencies that may be a detriment to pediatric surgical care provided on the weekend," they wrote.
With regard to mortality, the researchers wrote, "The mortality associated with pediatric surgical procedures is generally very low, requiring the large patient numbers included in these cohorts to detect potential differences. As an illustration, the significant adjusted odds ratio for mortality of 1.63 represents an increase in actual unadjusted death rate of only 0.03% (0.14% from 0.11%)." Nonetheless, they estimated that reducing weekend mortality rates to those of weekdays would have prevented the deaths of approximately 30 patients during the study period, a 20% reduction of inpatient deaths.
The study was internally funded, and the authors had no disclosures.
Children receiving common urgent surgeries on the weekend face greater risks of death, blood transfusions, and surgical complications, according to a recent study.
"Our results are consistent with a growing body of evidence that mortality is overall increased during weekend hospitalizations," Dr. Seth Goldstein and his associates at Johns Hopkins University, Baltimore, reported. They noted that adult diverticulitis, stroke, pneumonia, traumatic brain injury, and ICU admissions have all also shown a "detrimental weekend effect" in past research (J. Pediatr. Surg. 2014;49:1087-91).
Dr. Goldstein’s team analyzed rates of death, blood transfusions, and surgical complications – including hemorrhage, accidental puncture or laceration, infections and wound-related complications – in 439,457 pediatric cases admitted to the hospital and requiring same-day procedures between 1988 and 2010.
Data on the 112,064 weekend admissions (25.5%) and 327,393 weekday admissions (74.5%) were pulled from the Nationwide Inpatient Sample and the Kid's Inpatient Database and included the following procedures: abscess drainage, appendectomy, inguinal hernia repair, open reduction with internal fixation of bone fracture, and placement or revision of ventricular shunt.
Admissions were more likely to be emergent on the weekend (60.9%) than on the weekday (52.6%), and children admitted on the weekends were slightly older and more often male, white, and uninsured but had less comorbidity when discharged. Rates of death were not statistically significant before adjustment for confounders, with deaths occurring among 0.11% of children admitted on weekdays and 0.14% of children admitted on weekends.
Preadjusted rates of blood transfusion were greater for weekend admissions (0.71%) than for weekday admissions (0.60%, P = .002), as were accidental punctures or lacerations, with 0.21% among weekend cases and 0.18% among weekday cases (P = .018). Yet wound complications were less common among children admitted on the weekend (0.11%) than on weekdays (0.13%, P = .044). Hemorrhage and wound infections did not differ between the groups before adjustment.
After adjusting for age, sex, race, insurance status, comorbidities, geographic region, hospital type (rural and urban teaching or nonteaching), admission type, and procedure type, the researchers found children admitted on the weekend had 1.63 greater odds of death than children admitted on weekdays. Children admitted on the weekend also had 1.4 times greater odds of an accidental puncture or laceration and 1.14 times greater odds of a blood transfusion, despite similar rates of hemorrhage. Wound infections and other wound-related complications did not differ between the groups after adjustment.
"We believe these findings to be predominately a result of systems issues such as decreased availability of staff and other hospital resources that contribute to patient care in a manner that is multifactorial and difficult to individually ascertain," the researchers wrote.
"While the exact etiology of these findings is not clear, these findings motivate a careful search for systems-based deficiencies that may be a detriment to pediatric surgical care provided on the weekend," they wrote.
With regard to mortality, the researchers wrote, "The mortality associated with pediatric surgical procedures is generally very low, requiring the large patient numbers included in these cohorts to detect potential differences. As an illustration, the significant adjusted odds ratio for mortality of 1.63 represents an increase in actual unadjusted death rate of only 0.03% (0.14% from 0.11%)." Nonetheless, they estimated that reducing weekend mortality rates to those of weekdays would have prevented the deaths of approximately 30 patients during the study period, a 20% reduction of inpatient deaths.
The study was internally funded, and the authors had no disclosures.
FROM JOURNAL OF PEDIATRIC SURGERY
Key clinical point: Weekend surgery for children carries some increased risk for complications and need for transfusion.
Major finding: Pediatric patients admitted and receiving same-day surgery during weekends had 1.63 times greater odds of death, 1.15 times greater odds of a blood transfusion, and 1.4 times greater odds of suffering surgery complications, compared with patients receiving surgery on weekdays.
Data source: The findings are based on data in the Nationwide Inpatient Sample and the Kids’ Inpatient Database on 439,457 pediatric admissions, from 1988 to 2010, which required same-day surgery.
Disclosures: The study was internally funded. The authors had no disclosures.
Preadmission NSAID use found protective against trauma-induced coagulopathy
The use of nonsteroidal anti-inflammatory drugs before hospital admission for severe blunt injury is associated with a reduced incidence of trauma-induced coagulopathy, results from a secondary analysis of a prospective cohort study demonstrated.
"Although trauma-induced coagulopathy [TIC] has been increasingly recognized as a critical component of the pathophysiology of trauma and hemorrhagic shock, factors that predict the development of TIC remain largely unexplored," researchers led by Dr. Matthew D. Neal wrote in a study published in Annals of Surgery.
"The lack of ability to predict TIC makes the design of therapeutic interventions challenging, especially considering that TIC seems to develop rapidly and early after injury."
They noted that previous studies from the trauma literature "have linked the development of TIC to alterations in the thrombomodulin protein C pathway and excessive activated protein C activation, resulting in impaired coagulation. These data present a potential link between TIC and inflammation, which is a common finding in other conditions where both sterile (such as myocardial infarction) and pathogen-mediated (sepsis) diseases present with coagulopathy."
In an effort to investigate whether the use of prehospital NSAIDs may lead to a reduced incidence of TIC, the researchers performed a secondary analysis of 1,897 subjects in the Inflammation and the Host Response to Injury program, which is a large-scale, multicenter study of adults who present with hemorrhagic shock after blunt injury and is designed to characterize the genomic and proteomic response after injury. The key outcome of interest was TIC, which was defined as an admission international normalized ratio (INR) of more than 1.5, or clinically significant coagulopathy, which was defined as that which required transfusion of more than 2 units of fresh frozen plasma or more than 1 pack of platelets in the first 6 hours after admission to the trauma center.
Dr. Neal, of the division of general surgery in the department of surgery at the University of Pittsburgh Medical Center, and his associates used logistic regression to evaluate the association between TIC and prehospital medications and comorbidities (Ann. Surg. 2014;260:378-82). A total of 15 medications or medication classes were assessed, including NSAIDs, aspirin, beta-blockers, antihypertensive medications, oral contraceptives, and corticosteroids.
The mean age of the study population was 40 years, 66% were male, and the mean time from injury to admission was 78 minutes. Nearly one-quarter of the subjects (22%) presented with an INR of more than 1.5, 46% received more than 2 units of fresh frozen plasma or more than 1 pack of platelets in the first 6 hours after admission, and 15% met criteria for both TIC and significant coagulopathy. The most common prehospital medications were antihypertensive medications (12%) and statins (6%).
After performing stepwise logistic regression of the data, the researchers found that prehospital use of NSAIDs was associated with a 72% reduced risk of TIC and was the only medication to retain significance in the model. Stepwise logistic regression also demonstrated that the prehospital use of NSAIDs was associated with a 66% lower risk of clinical significant coagulopathy. The findings were independent of comorbid conditions linked to NSAID use. "None of the interaction terms for NSAID use and associated comorbidities reached significance, and, in fact, two of these, myocardial infarction and hyperlipidemia, were actually associated with an increased risk of clinically significant coagulopathy," the researchers wrote.
Reasons that other anti-inflammatory agents did not have the same association with reduced incidence of TIC "could be explained by a potential off-target effect of NSAIDs or may be due to the complexity of the link between the inflammatory cascade and the induction of coagulopathy."
Dr. Neal and his associates acknowledged certain limitations of the study, including the fact that it was a secondary analysis of a prospective cohort study; that variables regarding medication use, dose, and compliance were not recorded; and that all patients in the cohort were injured by blunt means and presented in hemorrhagic shock. "This may limit the applicability of the results and conclusions to other cohorts," they wrote. "Potential unknown or unmeasured confounding variables may be responsible for the associations described and the conclusions formulated."
The study was supported by a grant from the National Institutes of Health. The researchers had no relevant financial conflicts to disclose.
The use of nonsteroidal anti-inflammatory drugs before hospital admission for severe blunt injury is associated with a reduced incidence of trauma-induced coagulopathy, results from a secondary analysis of a prospective cohort study demonstrated.
"Although trauma-induced coagulopathy [TIC] has been increasingly recognized as a critical component of the pathophysiology of trauma and hemorrhagic shock, factors that predict the development of TIC remain largely unexplored," researchers led by Dr. Matthew D. Neal wrote in a study published in Annals of Surgery.
"The lack of ability to predict TIC makes the design of therapeutic interventions challenging, especially considering that TIC seems to develop rapidly and early after injury."
They noted that previous studies from the trauma literature "have linked the development of TIC to alterations in the thrombomodulin protein C pathway and excessive activated protein C activation, resulting in impaired coagulation. These data present a potential link between TIC and inflammation, which is a common finding in other conditions where both sterile (such as myocardial infarction) and pathogen-mediated (sepsis) diseases present with coagulopathy."
In an effort to investigate whether the use of prehospital NSAIDs may lead to a reduced incidence of TIC, the researchers performed a secondary analysis of 1,897 subjects in the Inflammation and the Host Response to Injury program, which is a large-scale, multicenter study of adults who present with hemorrhagic shock after blunt injury and is designed to characterize the genomic and proteomic response after injury. The key outcome of interest was TIC, which was defined as an admission international normalized ratio (INR) of more than 1.5, or clinically significant coagulopathy, which was defined as that which required transfusion of more than 2 units of fresh frozen plasma or more than 1 pack of platelets in the first 6 hours after admission to the trauma center.
Dr. Neal, of the division of general surgery in the department of surgery at the University of Pittsburgh Medical Center, and his associates used logistic regression to evaluate the association between TIC and prehospital medications and comorbidities (Ann. Surg. 2014;260:378-82). A total of 15 medications or medication classes were assessed, including NSAIDs, aspirin, beta-blockers, antihypertensive medications, oral contraceptives, and corticosteroids.
The mean age of the study population was 40 years, 66% were male, and the mean time from injury to admission was 78 minutes. Nearly one-quarter of the subjects (22%) presented with an INR of more than 1.5, 46% received more than 2 units of fresh frozen plasma or more than 1 pack of platelets in the first 6 hours after admission, and 15% met criteria for both TIC and significant coagulopathy. The most common prehospital medications were antihypertensive medications (12%) and statins (6%).
After performing stepwise logistic regression of the data, the researchers found that prehospital use of NSAIDs was associated with a 72% reduced risk of TIC and was the only medication to retain significance in the model. Stepwise logistic regression also demonstrated that the prehospital use of NSAIDs was associated with a 66% lower risk of clinical significant coagulopathy. The findings were independent of comorbid conditions linked to NSAID use. "None of the interaction terms for NSAID use and associated comorbidities reached significance, and, in fact, two of these, myocardial infarction and hyperlipidemia, were actually associated with an increased risk of clinically significant coagulopathy," the researchers wrote.
Reasons that other anti-inflammatory agents did not have the same association with reduced incidence of TIC "could be explained by a potential off-target effect of NSAIDs or may be due to the complexity of the link between the inflammatory cascade and the induction of coagulopathy."
Dr. Neal and his associates acknowledged certain limitations of the study, including the fact that it was a secondary analysis of a prospective cohort study; that variables regarding medication use, dose, and compliance were not recorded; and that all patients in the cohort were injured by blunt means and presented in hemorrhagic shock. "This may limit the applicability of the results and conclusions to other cohorts," they wrote. "Potential unknown or unmeasured confounding variables may be responsible for the associations described and the conclusions formulated."
The study was supported by a grant from the National Institutes of Health. The researchers had no relevant financial conflicts to disclose.
The use of nonsteroidal anti-inflammatory drugs before hospital admission for severe blunt injury is associated with a reduced incidence of trauma-induced coagulopathy, results from a secondary analysis of a prospective cohort study demonstrated.
"Although trauma-induced coagulopathy [TIC] has been increasingly recognized as a critical component of the pathophysiology of trauma and hemorrhagic shock, factors that predict the development of TIC remain largely unexplored," researchers led by Dr. Matthew D. Neal wrote in a study published in Annals of Surgery.
"The lack of ability to predict TIC makes the design of therapeutic interventions challenging, especially considering that TIC seems to develop rapidly and early after injury."
They noted that previous studies from the trauma literature "have linked the development of TIC to alterations in the thrombomodulin protein C pathway and excessive activated protein C activation, resulting in impaired coagulation. These data present a potential link between TIC and inflammation, which is a common finding in other conditions where both sterile (such as myocardial infarction) and pathogen-mediated (sepsis) diseases present with coagulopathy."
In an effort to investigate whether the use of prehospital NSAIDs may lead to a reduced incidence of TIC, the researchers performed a secondary analysis of 1,897 subjects in the Inflammation and the Host Response to Injury program, which is a large-scale, multicenter study of adults who present with hemorrhagic shock after blunt injury and is designed to characterize the genomic and proteomic response after injury. The key outcome of interest was TIC, which was defined as an admission international normalized ratio (INR) of more than 1.5, or clinically significant coagulopathy, which was defined as that which required transfusion of more than 2 units of fresh frozen plasma or more than 1 pack of platelets in the first 6 hours after admission to the trauma center.
Dr. Neal, of the division of general surgery in the department of surgery at the University of Pittsburgh Medical Center, and his associates used logistic regression to evaluate the association between TIC and prehospital medications and comorbidities (Ann. Surg. 2014;260:378-82). A total of 15 medications or medication classes were assessed, including NSAIDs, aspirin, beta-blockers, antihypertensive medications, oral contraceptives, and corticosteroids.
The mean age of the study population was 40 years, 66% were male, and the mean time from injury to admission was 78 minutes. Nearly one-quarter of the subjects (22%) presented with an INR of more than 1.5, 46% received more than 2 units of fresh frozen plasma or more than 1 pack of platelets in the first 6 hours after admission, and 15% met criteria for both TIC and significant coagulopathy. The most common prehospital medications were antihypertensive medications (12%) and statins (6%).
After performing stepwise logistic regression of the data, the researchers found that prehospital use of NSAIDs was associated with a 72% reduced risk of TIC and was the only medication to retain significance in the model. Stepwise logistic regression also demonstrated that the prehospital use of NSAIDs was associated with a 66% lower risk of clinical significant coagulopathy. The findings were independent of comorbid conditions linked to NSAID use. "None of the interaction terms for NSAID use and associated comorbidities reached significance, and, in fact, two of these, myocardial infarction and hyperlipidemia, were actually associated with an increased risk of clinically significant coagulopathy," the researchers wrote.
Reasons that other anti-inflammatory agents did not have the same association with reduced incidence of TIC "could be explained by a potential off-target effect of NSAIDs or may be due to the complexity of the link between the inflammatory cascade and the induction of coagulopathy."
Dr. Neal and his associates acknowledged certain limitations of the study, including the fact that it was a secondary analysis of a prospective cohort study; that variables regarding medication use, dose, and compliance were not recorded; and that all patients in the cohort were injured by blunt means and presented in hemorrhagic shock. "This may limit the applicability of the results and conclusions to other cohorts," they wrote. "Potential unknown or unmeasured confounding variables may be responsible for the associations described and the conclusions formulated."
The study was supported by a grant from the National Institutes of Health. The researchers had no relevant financial conflicts to disclose.
FROM ANNALS OF SURGERY
Key clinical point: Prehospital use of NSAIDs is linked to a reduced incidence of trauma-induced coagulopathy (TIC).
Major finding:. On stepwise regression analysis, prehospital use of NSAIDs was associated with a 72% reduced risk of TIC and was the only medication to retain significance in the model.
Data source: A secondary analysis of 1,897 subjects in the Inflammation and the Host Response to Injury program, which is a multicenter study of adults who present with hemorrhagic shock after blunt injury.
Disclosures: The study was supported by a grant from the National Institutes of Health. The researchers had no relevant financial conflicts to disclose.
Preadmission NSAID use found protective against trauma-induced coagulopathy
The use of nonsteroidal anti-inflammatory drugs before hospital admission for severe blunt injury is associated with a reduced incidence of trauma-induced coagulopathy, results from a secondary analysis of a prospective cohort study demonstrated.
"Although trauma-induced coagulopathy [TIC] has been increasingly recognized as a critical component of the pathophysiology of trauma and hemorrhagic shock, factors that predict the development of TIC remain largely unexplored," researchers led by Dr. Matthew D. Neal wrote in a study published in Annals of Surgery.
"The lack of ability to predict TIC makes the design of therapeutic interventions challenging, especially considering that TIC seems to develop rapidly and early after injury."
They noted that previous studies from the trauma literature "have linked the development of TIC to alterations in the thrombomodulin protein C pathway and excessive activated protein C activation, resulting in impaired coagulation. These data present a potential link between TIC and inflammation, which is a common finding in other conditions where both sterile (such as myocardial infarction) and pathogen-mediated (sepsis) diseases present with coagulopathy."
In an effort to investigate whether the use of prehospital NSAIDs may lead to a reduced incidence of TIC, the researchers performed a secondary analysis of 1,897 subjects in the Inflammation and the Host Response to Injury program, which is a large-scale, multicenter study of adults who present with hemorrhagic shock after blunt injury and is designed to characterize the genomic and proteomic response after injury. The key outcome of interest was TIC, which was defined as an admission international normalized ratio (INR) of more than 1.5, or clinically significant coagulopathy, which was defined as that which required transfusion of more than 2 units of fresh frozen plasma or more than 1 pack of platelets in the first 6 hours after admission to the trauma center.
Dr. Neal, of the division of general surgery in the department of surgery at the University of Pittsburgh Medical Center, and his associates used logistic regression to evaluate the association between TIC and prehospital medications and comorbidities (Ann. Surg. 2014;260:378-82). A total of 15 medications or medication classes were assessed, including NSAIDs, aspirin, beta-blockers, antihypertensive medications, oral contraceptives, and corticosteroids.
The mean age of the study population was 40 years, 66% were male, and the mean time from injury to admission was 78 minutes. Nearly one-quarter of the subjects (22%) presented with an INR of more than 1.5, 46% received more than 2 units of fresh frozen plasma or more than 1 pack of platelets in the first 6 hours after admission, and 15% met criteria for both TIC and significant coagulopathy. The most common prehospital medications were antihypertensive medications (12%) and statins (6%).
After performing stepwise logistic regression of the data, the researchers found that prehospital use of NSAIDs was associated with a 72% reduced risk of TIC and was the only medication to retain significance in the model. Stepwise logistic regression also demonstrated that the prehospital use of NSAIDs was associated with a 66% lower risk of clinical significant coagulopathy. The findings were independent of comorbid conditions linked to NSAID use. "None of the interaction terms for NSAID use and associated comorbidities reached significance, and, in fact, two of these, myocardial infarction and hyperlipidemia, were actually associated with an increased risk of clinically significant coagulopathy," the researchers wrote.
Reasons that other anti-inflammatory agents did not have the same association with reduced incidence of TIC "could be explained by a potential off-target effect of NSAIDs or may be due to the complexity of the link between the inflammatory cascade and the induction of coagulopathy."
Dr. Neal and his associates acknowledged certain limitations of the study, including the fact that it was a secondary analysis of a prospective cohort study; that variables regarding medication use, dose, and compliance were not recorded; and that all patients in the cohort were injured by blunt means and presented in hemorrhagic shock. "This may limit the applicability of the results and conclusions to other cohorts," they wrote. "Potential unknown or unmeasured confounding variables may be responsible for the associations described and the conclusions formulated."
The study was supported by a grant from the National Institutes of Health. The researchers had no relevant financial conflicts to disclose.
The use of nonsteroidal anti-inflammatory drugs before hospital admission for severe blunt injury is associated with a reduced incidence of trauma-induced coagulopathy, results from a secondary analysis of a prospective cohort study demonstrated.
"Although trauma-induced coagulopathy [TIC] has been increasingly recognized as a critical component of the pathophysiology of trauma and hemorrhagic shock, factors that predict the development of TIC remain largely unexplored," researchers led by Dr. Matthew D. Neal wrote in a study published in Annals of Surgery.
"The lack of ability to predict TIC makes the design of therapeutic interventions challenging, especially considering that TIC seems to develop rapidly and early after injury."
They noted that previous studies from the trauma literature "have linked the development of TIC to alterations in the thrombomodulin protein C pathway and excessive activated protein C activation, resulting in impaired coagulation. These data present a potential link between TIC and inflammation, which is a common finding in other conditions where both sterile (such as myocardial infarction) and pathogen-mediated (sepsis) diseases present with coagulopathy."
In an effort to investigate whether the use of prehospital NSAIDs may lead to a reduced incidence of TIC, the researchers performed a secondary analysis of 1,897 subjects in the Inflammation and the Host Response to Injury program, which is a large-scale, multicenter study of adults who present with hemorrhagic shock after blunt injury and is designed to characterize the genomic and proteomic response after injury. The key outcome of interest was TIC, which was defined as an admission international normalized ratio (INR) of more than 1.5, or clinically significant coagulopathy, which was defined as that which required transfusion of more than 2 units of fresh frozen plasma or more than 1 pack of platelets in the first 6 hours after admission to the trauma center.
Dr. Neal, of the division of general surgery in the department of surgery at the University of Pittsburgh Medical Center, and his associates used logistic regression to evaluate the association between TIC and prehospital medications and comorbidities (Ann. Surg. 2014;260:378-82). A total of 15 medications or medication classes were assessed, including NSAIDs, aspirin, beta-blockers, antihypertensive medications, oral contraceptives, and corticosteroids.
The mean age of the study population was 40 years, 66% were male, and the mean time from injury to admission was 78 minutes. Nearly one-quarter of the subjects (22%) presented with an INR of more than 1.5, 46% received more than 2 units of fresh frozen plasma or more than 1 pack of platelets in the first 6 hours after admission, and 15% met criteria for both TIC and significant coagulopathy. The most common prehospital medications were antihypertensive medications (12%) and statins (6%).
After performing stepwise logistic regression of the data, the researchers found that prehospital use of NSAIDs was associated with a 72% reduced risk of TIC and was the only medication to retain significance in the model. Stepwise logistic regression also demonstrated that the prehospital use of NSAIDs was associated with a 66% lower risk of clinical significant coagulopathy. The findings were independent of comorbid conditions linked to NSAID use. "None of the interaction terms for NSAID use and associated comorbidities reached significance, and, in fact, two of these, myocardial infarction and hyperlipidemia, were actually associated with an increased risk of clinically significant coagulopathy," the researchers wrote.
Reasons that other anti-inflammatory agents did not have the same association with reduced incidence of TIC "could be explained by a potential off-target effect of NSAIDs or may be due to the complexity of the link between the inflammatory cascade and the induction of coagulopathy."
Dr. Neal and his associates acknowledged certain limitations of the study, including the fact that it was a secondary analysis of a prospective cohort study; that variables regarding medication use, dose, and compliance were not recorded; and that all patients in the cohort were injured by blunt means and presented in hemorrhagic shock. "This may limit the applicability of the results and conclusions to other cohorts," they wrote. "Potential unknown or unmeasured confounding variables may be responsible for the associations described and the conclusions formulated."
The study was supported by a grant from the National Institutes of Health. The researchers had no relevant financial conflicts to disclose.
The use of nonsteroidal anti-inflammatory drugs before hospital admission for severe blunt injury is associated with a reduced incidence of trauma-induced coagulopathy, results from a secondary analysis of a prospective cohort study demonstrated.
"Although trauma-induced coagulopathy [TIC] has been increasingly recognized as a critical component of the pathophysiology of trauma and hemorrhagic shock, factors that predict the development of TIC remain largely unexplored," researchers led by Dr. Matthew D. Neal wrote in a study published in Annals of Surgery.
"The lack of ability to predict TIC makes the design of therapeutic interventions challenging, especially considering that TIC seems to develop rapidly and early after injury."
They noted that previous studies from the trauma literature "have linked the development of TIC to alterations in the thrombomodulin protein C pathway and excessive activated protein C activation, resulting in impaired coagulation. These data present a potential link between TIC and inflammation, which is a common finding in other conditions where both sterile (such as myocardial infarction) and pathogen-mediated (sepsis) diseases present with coagulopathy."
In an effort to investigate whether the use of prehospital NSAIDs may lead to a reduced incidence of TIC, the researchers performed a secondary analysis of 1,897 subjects in the Inflammation and the Host Response to Injury program, which is a large-scale, multicenter study of adults who present with hemorrhagic shock after blunt injury and is designed to characterize the genomic and proteomic response after injury. The key outcome of interest was TIC, which was defined as an admission international normalized ratio (INR) of more than 1.5, or clinically significant coagulopathy, which was defined as that which required transfusion of more than 2 units of fresh frozen plasma or more than 1 pack of platelets in the first 6 hours after admission to the trauma center.
Dr. Neal, of the division of general surgery in the department of surgery at the University of Pittsburgh Medical Center, and his associates used logistic regression to evaluate the association between TIC and prehospital medications and comorbidities (Ann. Surg. 2014;260:378-82). A total of 15 medications or medication classes were assessed, including NSAIDs, aspirin, beta-blockers, antihypertensive medications, oral contraceptives, and corticosteroids.
The mean age of the study population was 40 years, 66% were male, and the mean time from injury to admission was 78 minutes. Nearly one-quarter of the subjects (22%) presented with an INR of more than 1.5, 46% received more than 2 units of fresh frozen plasma or more than 1 pack of platelets in the first 6 hours after admission, and 15% met criteria for both TIC and significant coagulopathy. The most common prehospital medications were antihypertensive medications (12%) and statins (6%).
After performing stepwise logistic regression of the data, the researchers found that prehospital use of NSAIDs was associated with a 72% reduced risk of TIC and was the only medication to retain significance in the model. Stepwise logistic regression also demonstrated that the prehospital use of NSAIDs was associated with a 66% lower risk of clinical significant coagulopathy. The findings were independent of comorbid conditions linked to NSAID use. "None of the interaction terms for NSAID use and associated comorbidities reached significance, and, in fact, two of these, myocardial infarction and hyperlipidemia, were actually associated with an increased risk of clinically significant coagulopathy," the researchers wrote.
Reasons that other anti-inflammatory agents did not have the same association with reduced incidence of TIC "could be explained by a potential off-target effect of NSAIDs or may be due to the complexity of the link between the inflammatory cascade and the induction of coagulopathy."
Dr. Neal and his associates acknowledged certain limitations of the study, including the fact that it was a secondary analysis of a prospective cohort study; that variables regarding medication use, dose, and compliance were not recorded; and that all patients in the cohort were injured by blunt means and presented in hemorrhagic shock. "This may limit the applicability of the results and conclusions to other cohorts," they wrote. "Potential unknown or unmeasured confounding variables may be responsible for the associations described and the conclusions formulated."
The study was supported by a grant from the National Institutes of Health. The researchers had no relevant financial conflicts to disclose.
FROM ANNALS OF SURGERY
Key clinical point: Prehospital use of NSAIDs is linked to a reduced incidence of trauma-induced coagulopathy (TIC).
Major finding:. On stepwise regression analysis, prehospital use of NSAIDs was associated with a 72% reduced risk of TIC and was the only medication to retain significance in the model.
Data source: A secondary analysis of 1,897 subjects in the Inflammation and the Host Response to Injury program, which is a multicenter study of adults who present with hemorrhagic shock after blunt injury.
Disclosures: The study was supported by a grant from the National Institutes of Health. The researchers had no relevant financial conflicts to disclose.
Proactive efforts can mitigate Open Payments disputes
Early communication with pharmaceutical companies about the requirements of the Physician Payment Sunshine Act and better education on its provisions will prevent data disputes and reduce reporting surprises for doctors.
"A lot of physicians don’t realize how broad [the law] is," Stefanie A. Doebler, special counsel for Covington & Burling health care and food and drug practice groups in Washington, said in an interview. "Virtually everything [doctors] get from a manufacturer going forward is going to be reported. They need to be aware. They need to ask questions."
The federal Sunshine Act, adopted as part of the Affordable Care Act, requires manufacturers of drugs, devices, and biologics who participate in federal health care programs to report payments and items of value provided to physicians and teaching hospitals. The information must be made publicly available on a searchable federal database starting in September.
The federal government now calls the program Open Payments.
A 45-day review and dispute period for physicians began July 14. During this period, doctors can register with the Centers for Medicaid & Medicare Services’s Enterprise Portal, review data reported about them, and, if desired, initiate disputes with applicable manufacturers. Drug and device makers will then have an additional 15 days from then – ending Sept. 11 – to submit updated information to CMS.
Physicians need to make time to register and review their information now, Ms. Doebler said in an interview.
"They really need to be on top of reviewing their data," she said. "It’s kind of a pain in the neck for doctors, but they want to review it now and not once it goes public. Once it goes public, it’s there until the data is refreshed 6 months from now. They want to catch it now."
Physicians appear to be unclear on some areas of the law, Robert Ciolek, senior corporate counsel for Bristol-Myers Squibb, said during an American Bar Association webinar. For example, confusion often surfaces about whether the cost of lunches provided during educational programs are reportable.
"Frequently, the best opportunity [manufacturers] have is to do a lunch program where they can sit with a hospital staff and put together an educational program that talks either about a disease area or about a manufacturer’s product," Mr. Ciolek said. "The issue that always arises is, ‘What about the meal? Is it going to be reportable?’ We’ve seen time and time again, where doctors simply don’t understand the rule."
If a doctor consumes a meal in such a setting, the cost of the physician’s meal is reportable, Mr. Ciolek said. However, the cost of meals provided to office staff or other health care team members is not reportable. If physicians do not want their lunch costs reported, but still want to attend the program, they should not eat the meal, he said.
Open Payments requirements should be discussed by companies and physicians and/or noted before or at the time of transfers of value, said Carolyn M. Bruguera, vice president of consulting services and general counsel for R-Squared Services & Solutions, a consulting and software firm.
For instance, language regarding the law should be included in contracts, referenced on sign-in sheets for group meals, or stated orally during meetings.
Many large manufacturers and industry trade groups have developed websites and brochures to help educate physicians about reporting obligations, she added.
"These are also good tools for avoiding disputes and misunderstandings, but in some cases, manufacturers may need to be more proactive about getting the information to the covered recipients," she said. "Greater coordination with, for example, physician groups, such as specialty societies, might be helpful in this regard."
Another crucial step for doctors is explaining to patients their relationships with pharmaceutical companies and device manufacturers and ensuring patients understand why these interactions are useful, Ms. Doebler said. Once the value transfers go public, some mainstream media likely will paint all transfers of value among companies and doctors in a negative light, she said.
"It’s incumbent on doctors to explain to patients that there are valuable reasons" behind transactions with companies, she said. "It’s helpful for physicians to be able to explain why these relationships are important."
On Twitter @legal_med
Early communication with pharmaceutical companies about the requirements of the Physician Payment Sunshine Act and better education on its provisions will prevent data disputes and reduce reporting surprises for doctors.
"A lot of physicians don’t realize how broad [the law] is," Stefanie A. Doebler, special counsel for Covington & Burling health care and food and drug practice groups in Washington, said in an interview. "Virtually everything [doctors] get from a manufacturer going forward is going to be reported. They need to be aware. They need to ask questions."
The federal Sunshine Act, adopted as part of the Affordable Care Act, requires manufacturers of drugs, devices, and biologics who participate in federal health care programs to report payments and items of value provided to physicians and teaching hospitals. The information must be made publicly available on a searchable federal database starting in September.
The federal government now calls the program Open Payments.
A 45-day review and dispute period for physicians began July 14. During this period, doctors can register with the Centers for Medicaid & Medicare Services’s Enterprise Portal, review data reported about them, and, if desired, initiate disputes with applicable manufacturers. Drug and device makers will then have an additional 15 days from then – ending Sept. 11 – to submit updated information to CMS.
Physicians need to make time to register and review their information now, Ms. Doebler said in an interview.
"They really need to be on top of reviewing their data," she said. "It’s kind of a pain in the neck for doctors, but they want to review it now and not once it goes public. Once it goes public, it’s there until the data is refreshed 6 months from now. They want to catch it now."
Physicians appear to be unclear on some areas of the law, Robert Ciolek, senior corporate counsel for Bristol-Myers Squibb, said during an American Bar Association webinar. For example, confusion often surfaces about whether the cost of lunches provided during educational programs are reportable.
"Frequently, the best opportunity [manufacturers] have is to do a lunch program where they can sit with a hospital staff and put together an educational program that talks either about a disease area or about a manufacturer’s product," Mr. Ciolek said. "The issue that always arises is, ‘What about the meal? Is it going to be reportable?’ We’ve seen time and time again, where doctors simply don’t understand the rule."
If a doctor consumes a meal in such a setting, the cost of the physician’s meal is reportable, Mr. Ciolek said. However, the cost of meals provided to office staff or other health care team members is not reportable. If physicians do not want their lunch costs reported, but still want to attend the program, they should not eat the meal, he said.
Open Payments requirements should be discussed by companies and physicians and/or noted before or at the time of transfers of value, said Carolyn M. Bruguera, vice president of consulting services and general counsel for R-Squared Services & Solutions, a consulting and software firm.
For instance, language regarding the law should be included in contracts, referenced on sign-in sheets for group meals, or stated orally during meetings.
Many large manufacturers and industry trade groups have developed websites and brochures to help educate physicians about reporting obligations, she added.
"These are also good tools for avoiding disputes and misunderstandings, but in some cases, manufacturers may need to be more proactive about getting the information to the covered recipients," she said. "Greater coordination with, for example, physician groups, such as specialty societies, might be helpful in this regard."
Another crucial step for doctors is explaining to patients their relationships with pharmaceutical companies and device manufacturers and ensuring patients understand why these interactions are useful, Ms. Doebler said. Once the value transfers go public, some mainstream media likely will paint all transfers of value among companies and doctors in a negative light, she said.
"It’s incumbent on doctors to explain to patients that there are valuable reasons" behind transactions with companies, she said. "It’s helpful for physicians to be able to explain why these relationships are important."
On Twitter @legal_med
Early communication with pharmaceutical companies about the requirements of the Physician Payment Sunshine Act and better education on its provisions will prevent data disputes and reduce reporting surprises for doctors.
"A lot of physicians don’t realize how broad [the law] is," Stefanie A. Doebler, special counsel for Covington & Burling health care and food and drug practice groups in Washington, said in an interview. "Virtually everything [doctors] get from a manufacturer going forward is going to be reported. They need to be aware. They need to ask questions."
The federal Sunshine Act, adopted as part of the Affordable Care Act, requires manufacturers of drugs, devices, and biologics who participate in federal health care programs to report payments and items of value provided to physicians and teaching hospitals. The information must be made publicly available on a searchable federal database starting in September.
The federal government now calls the program Open Payments.
A 45-day review and dispute period for physicians began July 14. During this period, doctors can register with the Centers for Medicaid & Medicare Services’s Enterprise Portal, review data reported about them, and, if desired, initiate disputes with applicable manufacturers. Drug and device makers will then have an additional 15 days from then – ending Sept. 11 – to submit updated information to CMS.
Physicians need to make time to register and review their information now, Ms. Doebler said in an interview.
"They really need to be on top of reviewing their data," she said. "It’s kind of a pain in the neck for doctors, but they want to review it now and not once it goes public. Once it goes public, it’s there until the data is refreshed 6 months from now. They want to catch it now."
Physicians appear to be unclear on some areas of the law, Robert Ciolek, senior corporate counsel for Bristol-Myers Squibb, said during an American Bar Association webinar. For example, confusion often surfaces about whether the cost of lunches provided during educational programs are reportable.
"Frequently, the best opportunity [manufacturers] have is to do a lunch program where they can sit with a hospital staff and put together an educational program that talks either about a disease area or about a manufacturer’s product," Mr. Ciolek said. "The issue that always arises is, ‘What about the meal? Is it going to be reportable?’ We’ve seen time and time again, where doctors simply don’t understand the rule."
If a doctor consumes a meal in such a setting, the cost of the physician’s meal is reportable, Mr. Ciolek said. However, the cost of meals provided to office staff or other health care team members is not reportable. If physicians do not want their lunch costs reported, but still want to attend the program, they should not eat the meal, he said.
Open Payments requirements should be discussed by companies and physicians and/or noted before or at the time of transfers of value, said Carolyn M. Bruguera, vice president of consulting services and general counsel for R-Squared Services & Solutions, a consulting and software firm.
For instance, language regarding the law should be included in contracts, referenced on sign-in sheets for group meals, or stated orally during meetings.
Many large manufacturers and industry trade groups have developed websites and brochures to help educate physicians about reporting obligations, she added.
"These are also good tools for avoiding disputes and misunderstandings, but in some cases, manufacturers may need to be more proactive about getting the information to the covered recipients," she said. "Greater coordination with, for example, physician groups, such as specialty societies, might be helpful in this regard."
Another crucial step for doctors is explaining to patients their relationships with pharmaceutical companies and device manufacturers and ensuring patients understand why these interactions are useful, Ms. Doebler said. Once the value transfers go public, some mainstream media likely will paint all transfers of value among companies and doctors in a negative light, she said.
"It’s incumbent on doctors to explain to patients that there are valuable reasons" behind transactions with companies, she said. "It’s helpful for physicians to be able to explain why these relationships are important."
On Twitter @legal_med
Proactive efforts can mitigate Open Payments disputes
Early communication with pharmaceutical companies about the requirements of the Physician Payment Sunshine Act and better education on its provisions will prevent data disputes and reduce reporting surprises for doctors.
"A lot of physicians don’t realize how broad [the law] is," Stefanie A. Doebler, special counsel for Covington & Burling health care and food and drug practice groups in Washington, said in an interview. "Virtually everything [doctors] get from a manufacturer going forward is going to be reported. They need to be aware. They need to ask questions."
The federal Sunshine Act, adopted as part of the Affordable Care Act, requires manufacturers of drugs, devices, and biologics who participate in federal health care programs to report payments and items of value provided to physicians and teaching hospitals. The information must be made publicly available on a searchable federal database starting in September.
The federal government now calls the program Open Payments.
A 45-day review and dispute period for physicians began July 14. During this period, doctors can register with the Centers for Medicaid & Medicare Services’s Enterprise Portal, review data reported about them, and, if desired, initiate disputes with applicable manufacturers. Drug and device makers will then have an additional 15 days from then – ending Sept. 11 – to submit updated information to CMS.
Physicians need to make time to register and review their information now, Ms. Doebler said in an interview.
"They really need to be on top of reviewing their data," she said. "It’s kind of a pain in the neck for doctors, but they want to review it now and not once it goes public. Once it goes public, it’s there until the data is refreshed 6 months from now. They want to catch it now."
Physicians appear to be unclear on some areas of the law, Robert Ciolek, senior corporate counsel for Bristol-Myers Squibb, said during an American Bar Association webinar. For example, confusion often surfaces about whether the cost of lunches provided during educational programs are reportable.
"Frequently, the best opportunity [manufacturers] have is to do a lunch program where they can sit with a hospital staff and put together an educational program that talks either about a disease area or about a manufacturer’s product," Mr. Ciolek said. "The issue that always arises is, ‘What about the meal? Is it going to be reportable?’ We’ve seen time and time again, where doctors simply don’t understand the rule."
If a doctor consumes a meal in such a setting, the cost of the physician’s meal is reportable, Mr. Ciolek said. However, the cost of meals provided to office staff or other health care team members is not reportable. If physicians do not want their lunch costs reported, but still want to attend the program, they should not eat the meal, he said.
Open Payments requirements should be discussed by companies and physicians and/or noted before or at the time of transfers of value, said Carolyn M. Bruguera, vice president of consulting services and general counsel for R-Squared Services & Solutions, a consulting and software firm.
For instance, language regarding the law should be included in contracts, referenced on sign-in sheets for group meals, or stated orally during meetings.
Many large manufacturers and industry trade groups have developed websites and brochures to help educate physicians about reporting obligations, she added.
"These are also good tools for avoiding disputes and misunderstandings, but in some cases, manufacturers may need to be more proactive about getting the information to the covered recipients," she said. "Greater coordination with, for example, physician groups, such as specialty societies, might be helpful in this regard."
Another crucial step for doctors is explaining to patients their relationships with pharmaceutical companies and device manufacturers and ensuring patients understand why these interactions are useful, Ms. Doebler said. Once the value transfers go public, some mainstream media likely will paint all transfers of value among companies and doctors in a negative light, she said.
"It’s incumbent on doctors to explain to patients that there are valuable reasons" behind transactions with companies, she said. "It’s helpful for physicians to be able to explain why these relationships are important."
On Twitter @legal_med
Early communication with pharmaceutical companies about the requirements of the Physician Payment Sunshine Act and better education on its provisions will prevent data disputes and reduce reporting surprises for doctors.
"A lot of physicians don’t realize how broad [the law] is," Stefanie A. Doebler, special counsel for Covington & Burling health care and food and drug practice groups in Washington, said in an interview. "Virtually everything [doctors] get from a manufacturer going forward is going to be reported. They need to be aware. They need to ask questions."
The federal Sunshine Act, adopted as part of the Affordable Care Act, requires manufacturers of drugs, devices, and biologics who participate in federal health care programs to report payments and items of value provided to physicians and teaching hospitals. The information must be made publicly available on a searchable federal database starting in September.
The federal government now calls the program Open Payments.
A 45-day review and dispute period for physicians began July 14. During this period, doctors can register with the Centers for Medicaid & Medicare Services’s Enterprise Portal, review data reported about them, and, if desired, initiate disputes with applicable manufacturers. Drug and device makers will then have an additional 15 days from then – ending Sept. 11 – to submit updated information to CMS.
Physicians need to make time to register and review their information now, Ms. Doebler said in an interview.
"They really need to be on top of reviewing their data," she said. "It’s kind of a pain in the neck for doctors, but they want to review it now and not once it goes public. Once it goes public, it’s there until the data is refreshed 6 months from now. They want to catch it now."
Physicians appear to be unclear on some areas of the law, Robert Ciolek, senior corporate counsel for Bristol-Myers Squibb, said during an American Bar Association webinar. For example, confusion often surfaces about whether the cost of lunches provided during educational programs are reportable.
"Frequently, the best opportunity [manufacturers] have is to do a lunch program where they can sit with a hospital staff and put together an educational program that talks either about a disease area or about a manufacturer’s product," Mr. Ciolek said. "The issue that always arises is, ‘What about the meal? Is it going to be reportable?’ We’ve seen time and time again, where doctors simply don’t understand the rule."
If a doctor consumes a meal in such a setting, the cost of the physician’s meal is reportable, Mr. Ciolek said. However, the cost of meals provided to office staff or other health care team members is not reportable. If physicians do not want their lunch costs reported, but still want to attend the program, they should not eat the meal, he said.
Open Payments requirements should be discussed by companies and physicians and/or noted before or at the time of transfers of value, said Carolyn M. Bruguera, vice president of consulting services and general counsel for R-Squared Services & Solutions, a consulting and software firm.
For instance, language regarding the law should be included in contracts, referenced on sign-in sheets for group meals, or stated orally during meetings.
Many large manufacturers and industry trade groups have developed websites and brochures to help educate physicians about reporting obligations, she added.
"These are also good tools for avoiding disputes and misunderstandings, but in some cases, manufacturers may need to be more proactive about getting the information to the covered recipients," she said. "Greater coordination with, for example, physician groups, such as specialty societies, might be helpful in this regard."
Another crucial step for doctors is explaining to patients their relationships with pharmaceutical companies and device manufacturers and ensuring patients understand why these interactions are useful, Ms. Doebler said. Once the value transfers go public, some mainstream media likely will paint all transfers of value among companies and doctors in a negative light, she said.
"It’s incumbent on doctors to explain to patients that there are valuable reasons" behind transactions with companies, she said. "It’s helpful for physicians to be able to explain why these relationships are important."
On Twitter @legal_med
Early communication with pharmaceutical companies about the requirements of the Physician Payment Sunshine Act and better education on its provisions will prevent data disputes and reduce reporting surprises for doctors.
"A lot of physicians don’t realize how broad [the law] is," Stefanie A. Doebler, special counsel for Covington & Burling health care and food and drug practice groups in Washington, said in an interview. "Virtually everything [doctors] get from a manufacturer going forward is going to be reported. They need to be aware. They need to ask questions."
The federal Sunshine Act, adopted as part of the Affordable Care Act, requires manufacturers of drugs, devices, and biologics who participate in federal health care programs to report payments and items of value provided to physicians and teaching hospitals. The information must be made publicly available on a searchable federal database starting in September.
The federal government now calls the program Open Payments.
A 45-day review and dispute period for physicians began July 14. During this period, doctors can register with the Centers for Medicaid & Medicare Services’s Enterprise Portal, review data reported about them, and, if desired, initiate disputes with applicable manufacturers. Drug and device makers will then have an additional 15 days from then – ending Sept. 11 – to submit updated information to CMS.
Physicians need to make time to register and review their information now, Ms. Doebler said in an interview.
"They really need to be on top of reviewing their data," she said. "It’s kind of a pain in the neck for doctors, but they want to review it now and not once it goes public. Once it goes public, it’s there until the data is refreshed 6 months from now. They want to catch it now."
Physicians appear to be unclear on some areas of the law, Robert Ciolek, senior corporate counsel for Bristol-Myers Squibb, said during an American Bar Association webinar. For example, confusion often surfaces about whether the cost of lunches provided during educational programs are reportable.
"Frequently, the best opportunity [manufacturers] have is to do a lunch program where they can sit with a hospital staff and put together an educational program that talks either about a disease area or about a manufacturer’s product," Mr. Ciolek said. "The issue that always arises is, ‘What about the meal? Is it going to be reportable?’ We’ve seen time and time again, where doctors simply don’t understand the rule."
If a doctor consumes a meal in such a setting, the cost of the physician’s meal is reportable, Mr. Ciolek said. However, the cost of meals provided to office staff or other health care team members is not reportable. If physicians do not want their lunch costs reported, but still want to attend the program, they should not eat the meal, he said.
Open Payments requirements should be discussed by companies and physicians and/or noted before or at the time of transfers of value, said Carolyn M. Bruguera, vice president of consulting services and general counsel for R-Squared Services & Solutions, a consulting and software firm.
For instance, language regarding the law should be included in contracts, referenced on sign-in sheets for group meals, or stated orally during meetings.
Many large manufacturers and industry trade groups have developed websites and brochures to help educate physicians about reporting obligations, she added.
"These are also good tools for avoiding disputes and misunderstandings, but in some cases, manufacturers may need to be more proactive about getting the information to the covered recipients," she said. "Greater coordination with, for example, physician groups, such as specialty societies, might be helpful in this regard."
Another crucial step for doctors is explaining to patients their relationships with pharmaceutical companies and device manufacturers and ensuring patients understand why these interactions are useful, Ms. Doebler said. Once the value transfers go public, some mainstream media likely will paint all transfers of value among companies and doctors in a negative light, she said.
"It’s incumbent on doctors to explain to patients that there are valuable reasons" behind transactions with companies, she said. "It’s helpful for physicians to be able to explain why these relationships are important."
On Twitter @legal_med
Experts see larger role for CDC in preventing hospital deaths
The Centers for Disease Control and Prevention, which has lately been under attack for mishandling infectious disease samples, got a vote of confidence from patient safety experts.
At a July 17 hearing of the Primary Health and Aging Subcommittee of the Senate Health, Education, Labor and Pensions Committee, patient safety advocates and physicians called on Congress to get the CDC more involved in tracking and reporting on all forms of preventable harm that occur in the hospital.
The agency already monitors and reports on health care–associated infections such as catheter-associated urinary tract infections and surgical site infections. But the CDC also should be enlisted to help hospitals in other areas where they currently lack a good surveillance system, including venous thromboembolism and medication errors, experts testified.
"We need to expand the efforts of the CDC," said Dr. Ashish Jha, professor of health policy and management at the Harvard School of Public Health. "There is no reason to think that what they have been able to do around health care associated infections, they can’t do in other areas."
As many as 440,000 patients die of preventable errors in U.S. hospitals, according to most recent estimates (J. Pat. Safety 2013;9:122-8 [doi: 10.1097/PTS.0b013e3182948a69]).
About 180,000 Medicare patients likely die each year from preventable adverse events in the hospital, according to a 2010 report from the U.S. Department of Health & Human Services.
Those numbers may seem daunting, but the experts testified that there are plenty of policy steps the government can take to aid physicians and hospitals in tackling the problem.
Creating standards for reporting health care quality and cost measures, similar to the standards for the financial industry created under the Security and Exchange Act, would be a good place to start, said Dr. Peter Pronovost, senior vice president for patient safety and quality at Johns Hopkins Medicine in Baltimore.
"Right now we have no guarantee that the measures that we’re reporting are accurate," said Dr. Pronovost, who spearheaded a checklist protocol that led has resulted in significantly lower rates of central line associated bloodstream infections. "Johns Hopkins Hospital was both congratulated and criticized for its performance on the exact same measure for the exact same time period for bloodstream infections. And when we looked, the one we’re paid on, using administrative data, got it right 13% of the time."
Billing data isn’t adequate for this type of reporting, he said.
Experts at the hearing also called on Congress to help make safety a priority for hospitals by beefing up penalties for errors.
Lisa McGiffert, director of the Safe Patient Project at Consumers Union, said Medicare needs to put more financial pressure on hospitals. Under Medicare’s Hospital-Acquired Conditions payment program, the government withholds payment for hospitalizations in which certain preventable errors occur. But Ms. McGiffert said that policy doesn’t go far enough. The hospital should be responsible for the full range of follow-up care that results from the original adverse event, including physician visits, rehospitalizations, and medications, she said.
Dr. Pronovost said Medicare and the Joint Commission could also use their existing authority to sanction hospitals that have infection rates that are consistently above the national average. But he cautioned that regulators should only exercise this authority in areas where there is good data and validated measures, such as central line associated bloodstream infections.
CEO compensation also plays a role, said Dr. Jha, who has researched this issue among nonprofit hospitals. Right now, patient safety is typically not one of the factors influencing how CEOs at nonprofit hospital are paid, he said.
"Until we get to a point where the CEO of the hospital is lying awake at night worrying about patient safety, I don’t think we’re going to really meaningfully move the needle," Dr. Jha said.
On Twitter @maryellenny
The Centers for Disease Control and Prevention, which has lately been under attack for mishandling infectious disease samples, got a vote of confidence from patient safety experts.
At a July 17 hearing of the Primary Health and Aging Subcommittee of the Senate Health, Education, Labor and Pensions Committee, patient safety advocates and physicians called on Congress to get the CDC more involved in tracking and reporting on all forms of preventable harm that occur in the hospital.
The agency already monitors and reports on health care–associated infections such as catheter-associated urinary tract infections and surgical site infections. But the CDC also should be enlisted to help hospitals in other areas where they currently lack a good surveillance system, including venous thromboembolism and medication errors, experts testified.
"We need to expand the efforts of the CDC," said Dr. Ashish Jha, professor of health policy and management at the Harvard School of Public Health. "There is no reason to think that what they have been able to do around health care associated infections, they can’t do in other areas."
As many as 440,000 patients die of preventable errors in U.S. hospitals, according to most recent estimates (J. Pat. Safety 2013;9:122-8 [doi: 10.1097/PTS.0b013e3182948a69]).
About 180,000 Medicare patients likely die each year from preventable adverse events in the hospital, according to a 2010 report from the U.S. Department of Health & Human Services.
Those numbers may seem daunting, but the experts testified that there are plenty of policy steps the government can take to aid physicians and hospitals in tackling the problem.
Creating standards for reporting health care quality and cost measures, similar to the standards for the financial industry created under the Security and Exchange Act, would be a good place to start, said Dr. Peter Pronovost, senior vice president for patient safety and quality at Johns Hopkins Medicine in Baltimore.
"Right now we have no guarantee that the measures that we’re reporting are accurate," said Dr. Pronovost, who spearheaded a checklist protocol that led has resulted in significantly lower rates of central line associated bloodstream infections. "Johns Hopkins Hospital was both congratulated and criticized for its performance on the exact same measure for the exact same time period for bloodstream infections. And when we looked, the one we’re paid on, using administrative data, got it right 13% of the time."
Billing data isn’t adequate for this type of reporting, he said.
Experts at the hearing also called on Congress to help make safety a priority for hospitals by beefing up penalties for errors.
Lisa McGiffert, director of the Safe Patient Project at Consumers Union, said Medicare needs to put more financial pressure on hospitals. Under Medicare’s Hospital-Acquired Conditions payment program, the government withholds payment for hospitalizations in which certain preventable errors occur. But Ms. McGiffert said that policy doesn’t go far enough. The hospital should be responsible for the full range of follow-up care that results from the original adverse event, including physician visits, rehospitalizations, and medications, she said.
Dr. Pronovost said Medicare and the Joint Commission could also use their existing authority to sanction hospitals that have infection rates that are consistently above the national average. But he cautioned that regulators should only exercise this authority in areas where there is good data and validated measures, such as central line associated bloodstream infections.
CEO compensation also plays a role, said Dr. Jha, who has researched this issue among nonprofit hospitals. Right now, patient safety is typically not one of the factors influencing how CEOs at nonprofit hospital are paid, he said.
"Until we get to a point where the CEO of the hospital is lying awake at night worrying about patient safety, I don’t think we’re going to really meaningfully move the needle," Dr. Jha said.
On Twitter @maryellenny
The Centers for Disease Control and Prevention, which has lately been under attack for mishandling infectious disease samples, got a vote of confidence from patient safety experts.
At a July 17 hearing of the Primary Health and Aging Subcommittee of the Senate Health, Education, Labor and Pensions Committee, patient safety advocates and physicians called on Congress to get the CDC more involved in tracking and reporting on all forms of preventable harm that occur in the hospital.
The agency already monitors and reports on health care–associated infections such as catheter-associated urinary tract infections and surgical site infections. But the CDC also should be enlisted to help hospitals in other areas where they currently lack a good surveillance system, including venous thromboembolism and medication errors, experts testified.
"We need to expand the efforts of the CDC," said Dr. Ashish Jha, professor of health policy and management at the Harvard School of Public Health. "There is no reason to think that what they have been able to do around health care associated infections, they can’t do in other areas."
As many as 440,000 patients die of preventable errors in U.S. hospitals, according to most recent estimates (J. Pat. Safety 2013;9:122-8 [doi: 10.1097/PTS.0b013e3182948a69]).
About 180,000 Medicare patients likely die each year from preventable adverse events in the hospital, according to a 2010 report from the U.S. Department of Health & Human Services.
Those numbers may seem daunting, but the experts testified that there are plenty of policy steps the government can take to aid physicians and hospitals in tackling the problem.
Creating standards for reporting health care quality and cost measures, similar to the standards for the financial industry created under the Security and Exchange Act, would be a good place to start, said Dr. Peter Pronovost, senior vice president for patient safety and quality at Johns Hopkins Medicine in Baltimore.
"Right now we have no guarantee that the measures that we’re reporting are accurate," said Dr. Pronovost, who spearheaded a checklist protocol that led has resulted in significantly lower rates of central line associated bloodstream infections. "Johns Hopkins Hospital was both congratulated and criticized for its performance on the exact same measure for the exact same time period for bloodstream infections. And when we looked, the one we’re paid on, using administrative data, got it right 13% of the time."
Billing data isn’t adequate for this type of reporting, he said.
Experts at the hearing also called on Congress to help make safety a priority for hospitals by beefing up penalties for errors.
Lisa McGiffert, director of the Safe Patient Project at Consumers Union, said Medicare needs to put more financial pressure on hospitals. Under Medicare’s Hospital-Acquired Conditions payment program, the government withholds payment for hospitalizations in which certain preventable errors occur. But Ms. McGiffert said that policy doesn’t go far enough. The hospital should be responsible for the full range of follow-up care that results from the original adverse event, including physician visits, rehospitalizations, and medications, she said.
Dr. Pronovost said Medicare and the Joint Commission could also use their existing authority to sanction hospitals that have infection rates that are consistently above the national average. But he cautioned that regulators should only exercise this authority in areas where there is good data and validated measures, such as central line associated bloodstream infections.
CEO compensation also plays a role, said Dr. Jha, who has researched this issue among nonprofit hospitals. Right now, patient safety is typically not one of the factors influencing how CEOs at nonprofit hospital are paid, he said.
"Until we get to a point where the CEO of the hospital is lying awake at night worrying about patient safety, I don’t think we’re going to really meaningfully move the needle," Dr. Jha said.
On Twitter @maryellenny
FROM A SENATE COMMITTEE HEARING
Experts see larger role for CDC in preventing hospital deaths
The Centers for Disease Control and Prevention, which has lately been under attack for mishandling infectious disease samples, got a vote of confidence from patient safety experts.
At a July 17 hearing of the Primary Health and Aging Subcommittee of the Senate Health, Education, Labor and Pensions Committee, patient safety advocates and physicians called on Congress to get the CDC more involved in tracking and reporting on all forms of preventable harm that occur in the hospital.
The agency already monitors and reports on health care–associated infections such as catheter-associated urinary tract infections and surgical site infections. But the CDC also should be enlisted to help hospitals in other areas where they currently lack a good surveillance system, including venous thromboembolism and medication errors, experts testified.
"We need to expand the efforts of the CDC," said Dr. Ashish Jha, professor of health policy and management at the Harvard School of Public Health. "There is no reason to think that what they have been able to do around health care associated infections, they can’t do in other areas."
As many as 440,000 patients die of preventable errors in U.S. hospitals, according to most recent estimates (J. Pat. Safety 2013;9:122-8 [doi: 10.1097/PTS.0b013e3182948a69]).
About 180,000 Medicare patients likely die each year from preventable adverse events in the hospital, according to a 2010 report from the U.S. Department of Health & Human Services.
Those numbers may seem daunting, but the experts testified that there are plenty of policy steps the government can take to aid physicians and hospitals in tackling the problem.
Creating standards for reporting health care quality and cost measures, similar to the standards for the financial industry created under the Security and Exchange Act, would be a good place to start, said Dr. Peter Pronovost, senior vice president for patient safety and quality at Johns Hopkins Medicine in Baltimore.
"Right now we have no guarantee that the measures that we’re reporting are accurate," said Dr. Pronovost, who spearheaded a checklist protocol that led has resulted in significantly lower rates of central line associated bloodstream infections. "Johns Hopkins Hospital was both congratulated and criticized for its performance on the exact same measure for the exact same time period for bloodstream infections. And when we looked, the one we’re paid on, using administrative data, got it right 13% of the time."
Billing data isn’t adequate for this type of reporting, he said.
Experts at the hearing also called on Congress to help make safety a priority for hospitals by beefing up penalties for errors.
Lisa McGiffert, director of the Safe Patient Project at Consumers Union, said Medicare needs to put more financial pressure on hospitals. Under Medicare’s Hospital-Acquired Conditions payment program, the government withholds payment for hospitalizations in which certain preventable errors occur. But Ms. McGiffert said that policy doesn’t go far enough. The hospital should be responsible for the full range of follow-up care that results from the original adverse event, including physician visits, rehospitalizations, and medications, she said.
Dr. Pronovost said Medicare and the Joint Commission could also use their existing authority to sanction hospitals that have infection rates that are consistently above the national average. But he cautioned that regulators should only exercise this authority in areas where there is good data and validated measures, such as central line associated bloodstream infections.
CEO compensation also plays a role, said Dr. Jha, who has researched this issue among nonprofit hospitals. Right now, patient safety is typically not one of the factors influencing how CEOs at nonprofit hospital are paid, he said.
"Until we get to a point where the CEO of the hospital is lying awake at night worrying about patient safety, I don’t think we’re going to really meaningfully move the needle," Dr. Jha said.
On Twitter @maryellenny
The Centers for Disease Control and Prevention, which has lately been under attack for mishandling infectious disease samples, got a vote of confidence from patient safety experts.
At a July 17 hearing of the Primary Health and Aging Subcommittee of the Senate Health, Education, Labor and Pensions Committee, patient safety advocates and physicians called on Congress to get the CDC more involved in tracking and reporting on all forms of preventable harm that occur in the hospital.
The agency already monitors and reports on health care–associated infections such as catheter-associated urinary tract infections and surgical site infections. But the CDC also should be enlisted to help hospitals in other areas where they currently lack a good surveillance system, including venous thromboembolism and medication errors, experts testified.
"We need to expand the efforts of the CDC," said Dr. Ashish Jha, professor of health policy and management at the Harvard School of Public Health. "There is no reason to think that what they have been able to do around health care associated infections, they can’t do in other areas."
As many as 440,000 patients die of preventable errors in U.S. hospitals, according to most recent estimates (J. Pat. Safety 2013;9:122-8 [doi: 10.1097/PTS.0b013e3182948a69]).
About 180,000 Medicare patients likely die each year from preventable adverse events in the hospital, according to a 2010 report from the U.S. Department of Health & Human Services.
Those numbers may seem daunting, but the experts testified that there are plenty of policy steps the government can take to aid physicians and hospitals in tackling the problem.
Creating standards for reporting health care quality and cost measures, similar to the standards for the financial industry created under the Security and Exchange Act, would be a good place to start, said Dr. Peter Pronovost, senior vice president for patient safety and quality at Johns Hopkins Medicine in Baltimore.
"Right now we have no guarantee that the measures that we’re reporting are accurate," said Dr. Pronovost, who spearheaded a checklist protocol that led has resulted in significantly lower rates of central line associated bloodstream infections. "Johns Hopkins Hospital was both congratulated and criticized for its performance on the exact same measure for the exact same time period for bloodstream infections. And when we looked, the one we’re paid on, using administrative data, got it right 13% of the time."
Billing data isn’t adequate for this type of reporting, he said.
Experts at the hearing also called on Congress to help make safety a priority for hospitals by beefing up penalties for errors.
Lisa McGiffert, director of the Safe Patient Project at Consumers Union, said Medicare needs to put more financial pressure on hospitals. Under Medicare’s Hospital-Acquired Conditions payment program, the government withholds payment for hospitalizations in which certain preventable errors occur. But Ms. McGiffert said that policy doesn’t go far enough. The hospital should be responsible for the full range of follow-up care that results from the original adverse event, including physician visits, rehospitalizations, and medications, she said.
Dr. Pronovost said Medicare and the Joint Commission could also use their existing authority to sanction hospitals that have infection rates that are consistently above the national average. But he cautioned that regulators should only exercise this authority in areas where there is good data and validated measures, such as central line associated bloodstream infections.
CEO compensation also plays a role, said Dr. Jha, who has researched this issue among nonprofit hospitals. Right now, patient safety is typically not one of the factors influencing how CEOs at nonprofit hospital are paid, he said.
"Until we get to a point where the CEO of the hospital is lying awake at night worrying about patient safety, I don’t think we’re going to really meaningfully move the needle," Dr. Jha said.
On Twitter @maryellenny
The Centers for Disease Control and Prevention, which has lately been under attack for mishandling infectious disease samples, got a vote of confidence from patient safety experts.
At a July 17 hearing of the Primary Health and Aging Subcommittee of the Senate Health, Education, Labor and Pensions Committee, patient safety advocates and physicians called on Congress to get the CDC more involved in tracking and reporting on all forms of preventable harm that occur in the hospital.
The agency already monitors and reports on health care–associated infections such as catheter-associated urinary tract infections and surgical site infections. But the CDC also should be enlisted to help hospitals in other areas where they currently lack a good surveillance system, including venous thromboembolism and medication errors, experts testified.
"We need to expand the efforts of the CDC," said Dr. Ashish Jha, professor of health policy and management at the Harvard School of Public Health. "There is no reason to think that what they have been able to do around health care associated infections, they can’t do in other areas."
As many as 440,000 patients die of preventable errors in U.S. hospitals, according to most recent estimates (J. Pat. Safety 2013;9:122-8 [doi: 10.1097/PTS.0b013e3182948a69]).
About 180,000 Medicare patients likely die each year from preventable adverse events in the hospital, according to a 2010 report from the U.S. Department of Health & Human Services.
Those numbers may seem daunting, but the experts testified that there are plenty of policy steps the government can take to aid physicians and hospitals in tackling the problem.
Creating standards for reporting health care quality and cost measures, similar to the standards for the financial industry created under the Security and Exchange Act, would be a good place to start, said Dr. Peter Pronovost, senior vice president for patient safety and quality at Johns Hopkins Medicine in Baltimore.
"Right now we have no guarantee that the measures that we’re reporting are accurate," said Dr. Pronovost, who spearheaded a checklist protocol that led has resulted in significantly lower rates of central line associated bloodstream infections. "Johns Hopkins Hospital was both congratulated and criticized for its performance on the exact same measure for the exact same time period for bloodstream infections. And when we looked, the one we’re paid on, using administrative data, got it right 13% of the time."
Billing data isn’t adequate for this type of reporting, he said.
Experts at the hearing also called on Congress to help make safety a priority for hospitals by beefing up penalties for errors.
Lisa McGiffert, director of the Safe Patient Project at Consumers Union, said Medicare needs to put more financial pressure on hospitals. Under Medicare’s Hospital-Acquired Conditions payment program, the government withholds payment for hospitalizations in which certain preventable errors occur. But Ms. McGiffert said that policy doesn’t go far enough. The hospital should be responsible for the full range of follow-up care that results from the original adverse event, including physician visits, rehospitalizations, and medications, she said.
Dr. Pronovost said Medicare and the Joint Commission could also use their existing authority to sanction hospitals that have infection rates that are consistently above the national average. But he cautioned that regulators should only exercise this authority in areas where there is good data and validated measures, such as central line associated bloodstream infections.
CEO compensation also plays a role, said Dr. Jha, who has researched this issue among nonprofit hospitals. Right now, patient safety is typically not one of the factors influencing how CEOs at nonprofit hospital are paid, he said.
"Until we get to a point where the CEO of the hospital is lying awake at night worrying about patient safety, I don’t think we’re going to really meaningfully move the needle," Dr. Jha said.
On Twitter @maryellenny
FROM A SENATE COMMITTEE HEARING
ACA: Uninsured patient numbers dropped after first enrollment
The uninsured rate of working adults in the United States declined from 20% to 15% after the first Affordable Care Act open enrollment period.
Sara Collins, Ph.D., of the Commonwealth Fund and her associates also found that 6 in 10 newly covered patients have used their health plan to visit a doctor or hospital, or to fill a prescription.
The Commonwealth Fund tracking survey examined data from 4,425 adults about health and insurance trends from April 9 to June 2 and compared the findings with those from a 2013 Commonwealth Fund survey.
The uninsured rate among patients aged 19-64 years went from 20% for July to September 2013 to 15% for April to June 2014. For young adults (19-34 years), the uninsured rate dropped from 28% to 18% over the same time period. Among the Hispanic community, uninsured patients declined from 36% to 23%, the survey found. The findings were published July 10.
In states that expanded Medicaid, the uninsured rate fell from 28% to 17% for patients at the poverty level. However, in states that chose not to expand Medicaid, the rate of uninsured poor patients changed from 38% to 36%.
The survey findings provide early evidence that the ACA’s coverage provisions are helping Americans most at risk for lacking health insurance, Dr. Collins and associates noted. Evidence also shows that the new insurance coverage is helping people gain new access to the health care system. Nearly three-fourths of previously uninsured adults who used their new plan reported they would not have received the same care prior to gaining coverage.
On Twitter @legal_med
The uninsured rate of working adults in the United States declined from 20% to 15% after the first Affordable Care Act open enrollment period.
Sara Collins, Ph.D., of the Commonwealth Fund and her associates also found that 6 in 10 newly covered patients have used their health plan to visit a doctor or hospital, or to fill a prescription.
The Commonwealth Fund tracking survey examined data from 4,425 adults about health and insurance trends from April 9 to June 2 and compared the findings with those from a 2013 Commonwealth Fund survey.
The uninsured rate among patients aged 19-64 years went from 20% for July to September 2013 to 15% for April to June 2014. For young adults (19-34 years), the uninsured rate dropped from 28% to 18% over the same time period. Among the Hispanic community, uninsured patients declined from 36% to 23%, the survey found. The findings were published July 10.
In states that expanded Medicaid, the uninsured rate fell from 28% to 17% for patients at the poverty level. However, in states that chose not to expand Medicaid, the rate of uninsured poor patients changed from 38% to 36%.
The survey findings provide early evidence that the ACA’s coverage provisions are helping Americans most at risk for lacking health insurance, Dr. Collins and associates noted. Evidence also shows that the new insurance coverage is helping people gain new access to the health care system. Nearly three-fourths of previously uninsured adults who used their new plan reported they would not have received the same care prior to gaining coverage.
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The uninsured rate of working adults in the United States declined from 20% to 15% after the first Affordable Care Act open enrollment period.
Sara Collins, Ph.D., of the Commonwealth Fund and her associates also found that 6 in 10 newly covered patients have used their health plan to visit a doctor or hospital, or to fill a prescription.
The Commonwealth Fund tracking survey examined data from 4,425 adults about health and insurance trends from April 9 to June 2 and compared the findings with those from a 2013 Commonwealth Fund survey.
The uninsured rate among patients aged 19-64 years went from 20% for July to September 2013 to 15% for April to June 2014. For young adults (19-34 years), the uninsured rate dropped from 28% to 18% over the same time period. Among the Hispanic community, uninsured patients declined from 36% to 23%, the survey found. The findings were published July 10.
In states that expanded Medicaid, the uninsured rate fell from 28% to 17% for patients at the poverty level. However, in states that chose not to expand Medicaid, the rate of uninsured poor patients changed from 38% to 36%.
The survey findings provide early evidence that the ACA’s coverage provisions are helping Americans most at risk for lacking health insurance, Dr. Collins and associates noted. Evidence also shows that the new insurance coverage is helping people gain new access to the health care system. Nearly three-fourths of previously uninsured adults who used their new plan reported they would not have received the same care prior to gaining coverage.
On Twitter @legal_med
Key clinical point: Early evidence shows ACA coverage provisions are helping residents most at risk for lacking health insurance.
Major finding: After the first enrollment period, the uninsured rate among working adults declined from 20% to 15%; the uninsured rate for young adults aged 19-34 declined by 10%.
Data source: Phone interviews of 4,425 adults.
Disclosures: The investigators reported no relevant financial disclosures.
