Establishing Minimal Clinically Important Difference for PROMIS Physical Function Improvement After Revascularization for Peripheral Artery Disease.

Objective: Patients with peripheral arterial disease (PAD) undergo revascularization to improve physical function, yet meaningful improvement has not been defined. This study aims to define a threshold for improvement in patient-reported physical function (PROMIS-PF) and establish factors predictive of improvement following lower extremity revascularization.

Methods: This study is a single-center retrospective cohort analysis of adults undergoing elective revascularization for PAD 2016-2023 who had PROMIS-PF scores.

Large endograft diameter is associated with poor outcomes following thoracic endovascular aortic aneurysm repair in Medicare beneficiaries.

Objective: Multiple factors contribute to early and/or late failure after endovascular aortic repair. Notably, the impact of device-related parameters, specifically diameter, on postoperative outcomes following thoracic endovascular aortic aneurysm repair (TEVAR) has not been thoroughly explored. This study aimed to determine whether use of large diameter (≥40 mm) endografts increase the risk of adverse outcomes after TEVAR.

Long-term survival among older adults with frailty undergoing elective vascular surgery procedures.

Objective: The Vascular Quality Initiative Frailty Index (VQI-FI) was developed using seven variables captured in all VQI registries and combined with procedure risk to provide a simple mortality risk assessment tool for preoperative decision-making. This study was designed to validate the ability of the VQI-FI within a subgroup population for discriminating long-term mortality risk among Medicare beneficiaries undergoing common elective vascular procedures.

Methods: The VISION VQI-Medicare linked database (2010-2019) was used to assess survival among Medicare beneficiaries undergoing elective vascular procedures from seven arterial VQI registries.

The Age-stratified Cost of Biliary Atresia: A MarketScan®-Based Cost Analysis.

Introduction: Biliary atresia (BA) is the leading cause of childhood liver failure requiring liver transplantation. Early diagnosis and Kasai portoenterostomy (KP) offer the only opportunity to avoid liver failure and transplantation. This study aimed to assess BA healthcare costs in the United States.

Outcomes of Retroperitoneal vs Transperitoneal Approach for Open Abdominal Aortic Aneurysm Repair Stratified by Aortic Cross-Clamping Site.

Background: The approach for open infrarenal abdominal aortic aneurysm (AAA) repair is mainly surgeon driven based on experience and previous training. Although the midline transperitoneal (TP) approach remains the most common, the retroperitoneal (RP) approach is usually used in more complex cases where suprarenal cross-clamping is necessary. As previous literature is conflicting on optimal outcomes between the 2 approaches, we aimed to compare RP vs TP outcomes stratified by aortic clamp level.

Factors that impact the implementation of patient reported outcomes in routine clinical care for peripheral artery disease from the patient perspective.

Purpose: Patient reported outcome measures (PROMs) are well-suited for the longitudinal assessment of quality of life, including depression and physical limitations associated with peripheral artery disease (PAD) that are not routinely assessed in clinical care. This study was designed to gain the patient perspective to facilitate implementation of PROMs into clinical practice for PAD management.

Methods: Twenty-three patients with PAD at a single vascular surgery clinic were enrolled for a qualitative interview, July-December 2022.

Impact of Social Risk Screening on Discharge Care Processes and Postdischarge Outcomes: A Pragmatic Mixed-Methods Clinical Trial During the COVID-19 Pandemic.

Background: Social risk screening during inpatient care is required in new CMS regulations, yet its impact on inpatient care and patient outcomes is unknown.

Objectives: To evaluate whether implementing a social risk screening protocol improves discharge processes, patient-reported outcomes, and 30-day service use.

Research Design: Pragmatic mixed-methods clinical trial.

Decision making in the frail vascular surgery patient: A scoping review.

Increasing evidence highlights the adverse impact of frailty and reduced physiologic reserve on surgical outcomes. Therefore, identification of frailty is essential for older adults being evaluated for vascular surgery procedures. Numerous frailty assessment tools are available to quantify the level of frailty and assist in preoperative decision making for these older patients.

Increased Risk of Acute Aortic Events following COVID-19 and Influenza Respiratory Viral Infections.

Background: Acute respiratory viral infections have been associated with an increased incidence of adverse cardiovascular events. However, it is unclear whether severe respiratory viral infections are associated with an increased risk of acute aortic syndromes (AAS). This study was designed to assess whether Coronavirus disease 2019 (COVID-19) and Influenza illnesses are associated with an increased incidence of subsequent AAS in the US population.

A transitional pain management program is associated with reduced opioid dependence after major shoulder surgery.

Background: Overprescription of opioids in the United States increases risks of opioid dependence, overdose, and death. Increased perioperative and postoperative opioid use during orthopedic shoulder surgery is a significant risk factor for long-term opioid dependence. The authors hypothesized that a multidisciplinary perioperative pain management program (Transitional Pain Service [TPS]) for major shoulder surgery would lead to a reduced amount of opioids required postoperatively.

Sex Differences in Patient-Reported Depression Following Vascular Surgery Procedures.

Introduction: Female patients frequently experience worse clinical outcomes than male patients after undergoing vascular surgery procedures. However, it is unclear whether these sex-based disparities also impact mental health outcomes. This study was designed to investigate sex differences in patient-reported outcome measures of depression for patients undergoing vascular surgery.

Effect of Multidisciplinary Transitional Pain Service on Health Care Use and Costs Following Orthopedic Surgery.

Background: Opioid use disorder is a significant cause of morbidity, mortality, and health care costs. A transitional pain service (TPS) approach to perioperative pain management has been shown to reduce opioid use among patients undergoing orthopedic joint surgery. However, whether TPS also leads to lower health care use and costs is unknown.

Postsurgical opioid prescribing among veterans using community care for orthopedic surgery at non-VA hospitals compared to a VA hospital with a transitional pain service: a retrospective cohort study.

Background: The USA provides medical services to its military veterans through Veterans Health Administration (VHA) medical centers. Passage of recent legislation has increased the number of veterans having VHA-paid orthopedic surgery at non-VHA facilities.

Methods: We conducted a retrospective cohort study among veterans who underwent orthopedic joint surgery paid for by the VHA either at the Salt Lake City VHA Medical Center (VAMC) or at non-VHA hospitals between January 2018 and December 2021.

Long-term patient-reported outcomes among patients undergoing revascularization vs medical therapy for intermittent claudication.

Objective: Society for Vascular Surgery guidelines recommend revascularization for patients with intermittent claudication (IC) if it can improve patient function and quality of life. However, it is still unclear if patients with IC achieve a significant functional benefit from surgery compared with medical management alone. This study examines the relationship between IC treatment modality (operative vs nonoperative optimal medical management) and patient-reported outcomes for physical function (PROMIS-PF) and satisfaction in social roles and activities (PROMIS-SA).

Recurrence of severe diverticulitis is associated with age and birth decade.

Background: The risk of recurrence is an important consideration when deciding to treat patients medically or with elective colectomy after recovery from diverticulitis. It is unclear whether age is associated with recurrence. This study aimed to examine the relationship between age and the risk of recurrent diverticulitis while considering important epidemiologic factors, such as birth decade.

Accreditation Council for Graduate Medical Education Milestone Training Ratings and Surgeons' Early Outcomes.

Importance: National data on the development of competence during training have been reported using the Accreditation Council for Graduate Medical Education (ACGME) Milestones system. It is now possible to consider longitudinal analyses that link Milestone ratings during training to patient outcomes data of recent graduates.

Objective: To evaluate the association of in-training ACGME Milestone ratings in a surgical specialty with subsequent complication rates following a commonly performed operation, endovascular aortic aneurysm repair (EVAR).

Evaluating a health system-wide opioid disposal intervention distributing home-disposal bags.

Objective: To evaluate a health system-wide intervention distributing free home-disposal bags to surgery patients prescribed opioids.

Data Sources And Study Setting: We collected patient surveys and electronic medical record data at an academic health system.

Study Design: We conducted a prospective observational study.

Exogenous Testosterone Replacement Therapy Is Associated with Increased Risk for Vascular Graft Infections Among Hypogonadal Men.

Background: Vascular graft infections (VGIs) are a major source of morbidity following vascular bypass surgery. Hypogonadal men may be at increased risk for impaired wound healing and infections, but it is unclear if testosterone replacement therapy (TRT) mitigates this risk. We designed this study to evaluate the relationship between hypogonadism and the use of testosterone replacement therapy (TRT) with subsequent risk for developing a VGI.

Predictors of Arteriovenous Fistula Maturation among Patients with Severe Obesity.

Background: There is an increasing prevalence of obesity among patients who develop end-stage renal disease and require dialysis. While referrals for arteriovenous fistulas (AVFs) among patients with class 2-3 obesity (i.e.

Improving pain management and safe opioid use after surgery: A DMAIC-based quality intervention.

Background: Multimodal perioperative patient education and expectation-setting can reduce post-operative opioid use while maintaining pain control and satisfaction. As part of a quality-improvement project, we developed a standardized model for perioperative education built upon the American College of Surgeons (ACS) Safe and Effective Pain Control After Surgery (SEPCAS) brochure to improve perioperative education regarding opioid use and pain control.

Material And Methods: Our study was designed within the Define, Measure, Analyze, Improve, Control (DMAIC) quality-improvement framework.

Vascular Quality Initiative assessment of compliance with Society for Vascular Surgery clinical practice guidelines on the management of extracranial cerebrovascular disease.

Objectives: Compliance with Society for Vascular Surgery (SVS) clinical practice guidelines (CPGs) is associated with improved outcomes for the treatment of abdominal aortic aneurysm, but this has not been assessed for carotid artery disease. The Vascular Quality Initiative (VQI) registry was used to examine compliance with the SVS CPGs for the management of extracranial cerebrovascular disease and its impact on outcomes.

Methods: The 2021 SVS extracranial cerebrovascular disease CPGs were reviewed for evaluation by VQI data.