High Value Care

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  Defining a “High Volume” Radical Cystectomy Hospital: Where Do We Draw the Line?

  Sohrab Arora, Jacob Keeley, Amit Patel, Sriram V Eleswarapu, Chandler Bronkema, Shaheen Alanee, and Mani Menon

  Background: Centralization of radical cystectomy (RC) to “high volume” centers can lead to decreased morbidity but also limits access to care. In the context of centralization, there is a need to systematically define the hospital volume cutoffs for this procedure. Objective: To systematically examine the effect of hospital volume on inpatient complications of RC) for bladder cancer, and to define a threshold that will minimize morbidity of RC. Design,... Read More

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  Obstructive Sleep Apnea Screening: An Overlooked Aspect of Routine Prenatal Care

  Gaurav Chauhan, Haleema Saeed, Ami Attali, Monique Swain, Brian Waldman, and Xiaoxia Han

  Introduction: There is no single screening measure developed to measure the severity of OSAS in pregnancy. Furthermore, the parturient population usually bypasses the pre-operative optimization clinic further decimating the chances of providing optimum intervention for OSAS. Pregnancy and the physiological changes that accompany it may precipitate or at least exacerbate the co-existing OSAS and there may be a correlation between OSAS and development of pre-eclampsia, gestational diabetes, intra-uterine growth... Read More

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  Does private vehicle transport in trauma really save you time and money?

  Maritza D. Essis, Ursula Barghouth, David Moore, Kendra Colbert, and Jeffrey Johnson

  Introduction: Current data suggest trauma patients arriving via private vehicle transport (PVT) have improved outcomes compared to patients arriving via EMS due to quicker hospital arrival. Though some researchers have speculated that this may be due to a quicker arrival to the hospital, arrival by PVT may actually impair resuscitation efforts due to the lack of pre-hospital triage leading to delayed mobilization of teams, patient drop-offs at the wrong... Read More

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  Inpatient morbidity and cost of cytoreductive radical prostatectomy in the United States

  Marcus Jamil, Sohrab Arora, Akshay Sood, Deepansh Dalela, Jacob Keeley, Nikola Rakic, Audrey Fotouhi, James O Peabody, Mani Menon, and Firas Abdollah

  INTRODUCTION AND OBJECTIVES: Clinical trials are currently examining the role of local therapy in metastatic prostate cancer (mPCa). While the safety of RP in localized disease is proven, few studies have looked at perioperative complications and cost of cytoreductive RP (cRP). We used the National Inpatient Sample (NIS) to study the inpatient morbidity, and cost of cRP in the United States (US). METHODS: Analyzing the NIS dataset from 2008-2014,... Read More

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  Virtual Post-Tonsillectomy Visits: A Model for Recovering Opportunity Costs in the Otolaryngology Clinic

  Joanna Kam, Lamont R Jones, and Ilaaf Darrat

  Background: In surgical subspecialties including urology, orthopedics and vascular surgery, telemedicine is used to monitor postoperative recovery. We pose that virtual post-operative encounters can be used to monitor patients’ recovery while increasing the revenue generated in otolaryngology clinics. Objectives: (1) To determine the opportunity cost associated with post-operative visits in the otolaryngology clinic. (2) To evaluate the role of telemedicine in recovering opportunity costs in the otolaryngology clinic by... Read More

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  The Patient Blood Management Project as part of the Perioperative Surgical Home concept

  Jose R Navas-Blanco and Gary Loyd

  Background: As of today, the prevalence of perioperative anemia is around 40%. Around one third of our patients presenting for elective procedures have some degree of anemia that is potentially treatable. Preoperative anemia, female gender and small body size represent the most common predictors of perioperative allogeneic blood transfusions. This latter embodies the utmost important factor affecting the outcome of our patients during the intra- and post-operative periods. Perioperative... Read More

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  Chronic pain: a disease of the brain

  Vanessa Patel

  Background: As pain became avoidable with pills and other interventions, it became intolerable. Consequently, over 100 million people struggle with chronic pain; making up 20% of medical visits and 10% of drug sales. Discomfort from injury does not shut off even after the incident passes; there are structural differences as well as biochemical changes at the thalamus and medial prefrontal cortex. Research shows 27% of patients with pain meet... Read More

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  The Echogenic Appearance of the Diabetic Deltoid Muscle on Shoulder Ultrasound: Is This Simply from Adipose Tissue Infiltration, Can This Appearance Predict Type 2 Diabetes and Be Used to Detect Pre-Diabetes?

  Kelli Rosen and Steven B Soliman

  Purpose: The purpose of this study is to assess whether radiologists can detect type 2 diabetes in patients based the on the appearance of the deltoid muscle on shoulder ultrasound from other populations, such as obese non-diabetics. Materials and Methods: This study includes retrospective review of 137 shoulder ultrasounds from type 2 diabetic patients, confirmed by hemoglobin A1c levels and medication review. It also includes 49 shoulder ultrasounds from... Read More