Impact of Surgical Quality Improvement on Payments in Medicare Patients.


OBJECTIVE:To examine the financial impact of quality improvement using Medicare payment data. BACKGROUND:Demonstrating a business case for quality improvement--that is, that fewer complications translates into lower costs--is essential to justify investment in quality improvement. Prior research is limited to cross-sectional studies showing that patients with complications have higher costs. We designed a study to better evaluate the relationship between payments and complications by using quality improvement itself as a measured outcome. METHODS:We used national Medicare data for patients undergoing general (n = 1,485,667) and vascular (n = 531,951) procedures. We calculated hospitals' rates of serious complications in 2 time periods: 2003-2004 and 2009-2010. We sorted hospitals into quintiles by the change in complication rates across these time periods. Costs were assessed using price-standardized Medicare payments, and regression analyses used to determine the average change in payments over time. RESULTS:There was significant change in serious complication rates across the 2 time periods. The top 20% of hospitals demonstrated a 38% decrease (14.3% vs 11.6%, P < 0.001) in complications; in contrast the bottom 20% demonstrated a 25% increase (11.1% vs 16.5%, P < 0.001). There was a strong relationship between quality improvement and payments. The top hospitals reduced their payments by $1544 per patient (95% confidence interval: $1334-1755), whereas the bottom of hospitals had no significant change (average $67 increase, 95% confidence interval: -$123 to $258). CONCLUSIONS:Hospitals that reduced their complications over time had significant reductions in Medicare payments. This demonstrates that payers are clearly incentivized to invest in quality improvement.


Ann Surg


Annals of surgery


Scally CP,Thumma JR,Birkmeyer JD,Dimick JB




Has Abstract


2015-08-01 00:00:00












  • Regeneration of the rat neonatal intestine in transplantation.

    abstract:OBJECTIVE:Based on development of stem cell technology, newborn tissue, even undergoing cryopreservation, possesses promising potential as a donor source in the field of organ transplantation. However, the precise regeneration processes remains unclear. This study was designed to investigate the regenerative potential ...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Tahara K,Murakami T,Fujishiro J,Takahashi M,Inoue S,Hashizume K,Matsuno K,Kobayashi E

    更新日期:2005-07-01 00:00:00

  • Protective effects of ischemic preconditioning for liver resection performed under inflow occlusion in humans.

    abstract:OBJECTIVE:To determine whether ischemic preconditioning protects the human liver against a subsequent period of ischemia in patients undergoing hemihepatectomy, and to identify possible underlying protective mechanisms of ischemic preconditioning, such as inhibition of hepatocellular apoptosis. SUMMARY BACKGROUND DATA...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Clavien PA,Yadav S,Sindram D,Bentley RC

    更新日期:2000-08-01 00:00:00

  • Management Considerations for the Surgical Treatment of Colorectal Cancer During the Global Covid-19 Pandemic.

    abstract:OBJECTIVE:The COVID-19 pandemic requires to conscientiously weigh "timely surgical intervention" for colorectal cancer against efforts to conserve hospital resources and protect patients and health care providers. SUMMARY BACKGROUND DATA:Professional societies provided ad-hoc guidance at the outset of the COVID-19 pan...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: O'Leary MP,Choong KC,Thornblade LW,Fakih MG,Fong Y,Kaiser AM

    更新日期:2020-08-01 00:00:00

  • Use of radionuclide imaging in the early diagnosis and treatment of renal allograft rejection.

    abstract::Data are presented on the clinical application of radionuclide imaging to evaluate changes in cadaver transplant function in the immediate postoperative period. The method uses orthoiodohippuric acid (hippuran) administered IV, with scintillation imaging, and curve analysis by a digital computer. An initial study is a...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Mandel SR,Mattern WD,Staab E,Johnson G Jr

    更新日期:1975-05-01 00:00:00

  • Weekday of Esophageal Cancer Surgery and Its Relation to Prognosis.

    abstract:OBJECTIVE:To assess whether weekday of surgery influences long-term survival in esophageal cancer. BACKGROUND:Increased 30-day mortality rates have been reported in patients undergoing elective surgery later compared with earlier in the week. METHODS:This population-based cohort study included 98% of all esophageal c...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Lagergren J,Mattsson F,Lagergren P

    更新日期:2016-06-01 00:00:00

  • Weight Loss, Satiety, and the Postprandial Gut Hormone Response After Esophagectomy: A Prospective Study.

    abstract:OBJECTIVE:To prospectively characterize changes in body weight, satiety, and postprandial gut hormone profiles following esophagectomy. BACKGROUND:With improved oncologic outcomes in esophageal cancer, there is an increasing focus on functional status and health-related quality of life in survivorship. Early satiety a...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Elliott JA,Docherty NG,Eckhardt HG,Doyle SL,Guinan EM,Ravi N,Reynolds JV,Roux CWL

    更新日期:2017-07-01 00:00:00

  • Blunt carotid artery trauma: report of two cases and review of the literature.

    abstract::Blunt carotid artery trauma is uncommon but has been associated with severe, permanent neurologic deficits in 42% and mortality in 30% of 96 patients previously reported in the English literature. Since neurologic symptoms characteristically develop only after a latent interval and since physical evidence of significa...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Krajewski LP,Hertzer NR

    更新日期:1980-03-01 00:00:00

  • Desmoid-type fibromatosis and pregnancy: a multi-institutional analysis of recurrence and obstetric risk.

    abstract:BACKGROUND:Many women who present with desmoid-type fibromatosis (DF) have had a recent pregnancy. Long-term data about disease behavior during and after pregnancy are lacking. OBJECTIVE:To investigate the possible relationship between DF and pregnancy. PATIENTS AND METHODS:A cohort of women with DF and pregnancy was...

    journal_title:Annals of surgery

    pub_type: 杂志文章,多中心研究


    authors: Fiore M,Coppola S,Cannell AJ,Colombo C,Bertagnolli MM,George S,Le Cesne A,Gladdy RA,Casali PG,Swallow CJ,Gronchi A,Bonvalot S,Raut CP

    更新日期:2014-05-01 00:00:00

  • Carcinoma of the ampulla of Vater: Review of 38 cases with emphasis on treatment and prognostic factors.

    abstract::Thirty-eight cases of carcinoma of the ampulla of Vater are presented. The diagnosis has been confirmed at laparatomy in all patients. Three operations were done, a pancreaticoduodenal resection in 23 patients, a biliary-enteric bypass in 7 patients and a biliary-enteric bypass plus excision of tumor in 8 patients. Th...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Makipour H,Cooperman A,Danzi JT,Farmer RG

    更新日期:1976-04-01 00:00:00

  • Prevalence and Risk Factors for Bariatric Surgery Readmissions: Findings From 130,007 Admissions in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program.

    abstract:OBJECTIVE:To evaluate readmissions following laparoscopic adjustable gastric banding (LAGB), laparoscopic sleeve gastrectomy (LSG), and laparoscopic Roux-en-Y gastric bypass (LRYGB). BACKGROUND:Few studies have evaluated national readmission rates for primary bariatric surgery with national, bariatric-specific data. ...

    journal_title:Annals of surgery

    pub_type: 杂志文章,多中心研究


    authors: Berger ER,Huffman KM,Fraker T,Petrick AT,Brethauer SA,Hall BL,Ko CY,Morton JM

    更新日期:2018-01-01 00:00:00

  • Carotid sinus syndrome: treatment by carotid sinus denervation.

    abstract::Hypersensitive carotid sinus is a rare cause of spontaneous syncopal attacks. It must be differentiated from the other more common causes, such as intrinsic cardiac disease, vasovagal responses, postural hypotension and cerebrovascular insufficiency, although it may accompany these conditions. The definition of caroti...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Trout HH 3rd,Brown LL,Thompson JE

    更新日期:1979-05-01 00:00:00

  • Colorectal carcinoma in patients under age 40.

    abstract::Patients under the age of 40 with colorectal cancer (29 females, 18 males) were compared with similar patients in our general hospital population and analyzed for patterns of presentation, stage at diagnosis, degree of tumor differentiation, and survival. There was a higher incidence of poorly differentiated tumors in...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Behbehani A,Sakwa M,Ehrlichman R,Maguire P,Friedman S,Steele GD Jr,Wilson RE

    更新日期:1985-11-01 00:00:00

  • Cytology of peritoneal lavage performed during staging laparoscopy for gastrointestinal malignancies: is it useful?

    abstract:OBJECTIVE:To evaluate the potential benefit of cytology of the peritoneal lavage obtained during diagnostic laparoscopy for staging gastrointestinal (GI) malignancies. SUMMARY BACKGROUND DATA:Peritoneal lavage is a simple procedure that can be performed during laparotomy for GI tumors. Tumor cells in the lavage fluid ...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Nieveen van Dijkum EJ,Sturm PD,de Wit LT,Offerhaus J,Obertop H,Gouma DJ

    更新日期:1998-12-01 00:00:00

  • Smaller Inguinal Hernias are Independent Risk Factors for Developing Chronic Postoperative Inguinal Pain (CPIP): A Registry-based Multivariable Analysis of 57, 999 Patients.

    abstract:OBJECTIVE:Impact of inguinal hernia defect size as stratified by the European Hernia Society (EHS) classification I to III on the rate of chronic postoperative inguinal pain (CPIP). BACKGROUND:CPIP is the most important complication after inguinal hernia repair. The impact of hernia defect size according to the EHS cl...

    journal_title:Annals of surgery

    pub_type: 杂志文章,多中心研究


    authors: Hoffmann H,Walther D,Bittner R,Köckerling F,Adolf D,Kirchhoff P

    更新日期:2020-04-01 00:00:00

  • Pedal vasomotor tone following aortofemoral reconstructions: a randomized study of concomitant lumbar sympathectomy.

    abstract::A prospective randomized trial was undertaken to evaluate effects of lumbar sympathectomy as an adjunct to reconstructive surgery of the lower limb. The objective of this study was to assess the early postoperative effect of these procedures on pedal vasomotor tone. A pedal arterial resistance index (PARI) at rest was...

    journal_title:Annals of surgery

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Shanik GD,Ford J,Hayes AC,Baker WH,Barnes RW

    更新日期:1976-02-01 00:00:00

  • Diagnostic Accuracy of Different Surgical Procedures for Axillary Staging After Neoadjuvant Systemic Therapy in Node-positive Breast Cancer: A Systematic Review and Meta-analysis.

    abstract:OBJECTIVE:The aim of this study was to perform a systematic review and meta-analysis to assess the accuracy of different surgical axillary staging procedures compared with ALND. SUMMARY OF BACKGROUND DATA:Optimal axillary staging after neoadjuvant systemic therapy (NST) in node-positive breast cancer is an area of con...

    journal_title:Annals of surgery

    pub_type: 杂志文章,meta分析


    authors: Simons JM,van Nijnatten TJA,van der Pol CC,Luiten EJT,Koppert LB,Smidt ML

    更新日期:2019-03-01 00:00:00

  • Is ambulatory laparoscopic Roux-en-Y gastric bypass associated with higher adverse events?

    abstract:OBJECTIVE:To determine the impact of length of stay upon 30-day outcomes. BACKGROUND:It has been recommended the goal length of stay (LOS) after laparoscopic Roux-en-Y gastric bypass (LRYGB) should be 1 day to improve resource utilization. This study's aim was to assess LRYGB outcomes by LOS. METHODS:Data were obtain...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Morton JM,Winegar D,Blackstone R,Wolfe B

    更新日期:2014-02-01 00:00:00

  • Unique Tracheal Fluid MicroRNA Signature Predicts Response to FETO in Patients With Congenital Diaphragmatic Hernia.

    abstract:OBJECTIVE AND BACKGROUND:Our objective was to determine the fetal in vivo microRNA signature in hypoplastic lungs of human fetuses with severe isolated congenital diaphragmatic hernia (CDH) and changes in tracheal and amniotic fluid of fetuses undergoing fetoscopic endoluminal tracheal occlusion (FETO) to reverse sever...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Pereira-Terra P,Deprest JA,Kholdebarin R,Khoshgoo N,DeKoninck P,Munck AA,Wang J,Zhu F,Rottier RJ,Iwasiow BM,Correia-Pinto J,Tibboel D,Post M,Keijzer R

    更新日期:2015-12-01 00:00:00

  • Perineal transanal approach: a new standard for laparoscopic sphincter-saving resection in low rectal cancer, a randomized trial.

    abstract:BACKGROUND:Laparoscopic sphincter preservation for low rectal cancer is challenging because of the high risk of positive circumferential resection margin. We hypothesized that perineal dissection of the distal rectum may improve quality of surgery, compared with the conventional abdominal dissection. METHODS:Between 2...

    journal_title:Annals of surgery

    pub_type: 杂志文章,随机对照试验


    authors: Denost Q,Adam JP,Rullier A,Buscail E,Laurent C,Rullier E

    更新日期:2014-12-01 00:00:00

  • Treatment of anal incontinence by an implantable prosthetic anal sphincter.

    abstract::Twelve patients with anal incontinence due to neurologic disease or failure of previous incontinence surgery underwent implantation of an artificial anal sphincter. The system used was a modification of the AMS 800 artificial urinary sphincter. In two patients, infection necessitated removal of the system, and in four...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Christiansen J,Sparsø B

    更新日期:1992-04-01 00:00:00

  • Clinicopathologic factors associated with false-negative sentinel lymph-node biopsy in breast cancer.

    abstract:SUMMARY BACKGROUND DATA:Previous studies have suggested a variety of factors that may affect the false negative (FN) rate for sentinel lymph node (SLN) biopsy in breast cancer. Because FN results are relatively rare, no prior studies have had sufficient sample size to allow detailed statistical analysis of factors pred...

    journal_title:Annals of surgery

    pub_type: 杂志文章,多中心研究


    authors: Martin RC 2nd,Chagpar A,Scoggins CR,Edwards MJ,Hagendoorn L,Stromberg AJ,McMasters KM,University of Louisville Breast Cancer Sentinel Lymph Node Study.

    更新日期:2005-06-01 00:00:00

  • Tacrolimus and Single Intraoperative High-dose of Anti-T-lymphocyte Globulins Versus Tacrolimus Monotherapy in Adult Liver Transplantation: One-year Results of an Investigator-driven Randomized Controlled Trial.

    abstract:OBJECTIVE:The aim of the study is to evaluate whether intra-operative induction with anti-lymphocytic serum (ALS) is superior to no induction in adult liver transplantation (LT). BACKGROUND:The efficacy of ALS induction remains inconclusive in LT, because of poorly designed trials. METHODS:A randomized controlled tri...

    journal_title:Annals of surgery

    pub_type: 杂志文章,随机对照试验


    authors: Iesari S,Ackenine K,Foguenne M,De Reyck C,Komuta M,Bonaccorsi Riani E,Ciccarelli O,Coubeau L,Lai Q,Gianello P,Lerut J

    更新日期:2018-11-01 00:00:00

  • Prolonged partial venoarterial bypass: physiologic, biochemical, and hematologic responses.

    abstract::Prolonged veno arterial extracorporeal bypass (50-80% of cardiac output) was evaluated in normal, unanesthetized sheep. The evaluation protocol included serial measurements of hemodynamics, pulmonary and renal function, serum enzymes to detect organ damage, and detailed studies of coagulation and platelets. Blood expo...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Bartlett RH,Fong SW,Burns NE,Gazzaniga AB

    更新日期:1974-12-01 00:00:00

  • The roles of lipocalin-2 in small-for-size fatty liver graft injury.

    abstract:OBJECTIVE:To investigate the roles and underlying mechanism of an inflammatory mediator-lipocalin-2 (Lcn2) in small-for-size fatty graft liver injury. BACKGROUND:Understanding of the distinct mechanism regulating small-for-size fatty liver graft injury will be crucial to prevent marginal graft failure during living do...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Cheng Q,Ng KT,Xu A,Li CX,Liu XB,Guo DY,Poon RT,Fan ST,Lo CM,Man K

    更新日期:2014-12-01 00:00:00

  • Regional differences in surgical care based upon uniform physician and hospital discharge abstract data.

    abstract::Population based surgical rates for various common surgical procedures were analyzed on a regional basis by examining select uniform hospital discharge abstract data from Wisconsin hospitals. The surgical asbracts of nearly 64,000 procedures were compared to the supply of physicians and showed a significant variation ...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Detmer DE,Tyson TJ

    更新日期:1978-02-01 00:00:00

  • A stapling instrument for end-to-end inverting anastomoses in the gastrointestinal tract.

    abstract::A stapling instrument is described for end-to-end inverting anastomoses applicable principally to low rectal anastomosis or esophagogastric or esophagojejunal anastomosis. The instrument creates an inverting anastomosis held by a double staggered row of stainless steel wire staples creating an anastomosis 21.2 mm inte...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Ravitch MM,Steichen FM

    更新日期:1979-06-01 00:00:00

  • Experience with 100 consecutive simultaneous kidney-pancreas transplants with bladder drainage.

    abstract::From December 1985 to December 1989, 100 consecutive simultaneous pancreas-kidney (SPK) transplants were performed at the University of Wisconsin Hospital and Clinics. Bladder drainage technique was used for all grafts. One- and three-year patient survival was 93% and 90%; kidney survival, 90% and 85%; and pancreas su...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Sollinger HW,Knechtle SJ,Reed A,D'Alessandro AM,Kalayoglu M,Belzer FO,Pirsch J

    更新日期:1991-12-01 00:00:00

  • Effect of optimization of hemodynamics on fibrinolytic activity and antithrombotic efficacy of external pneumatic calf compression.

    abstract::External pneumatic calf compression is effective but imperfect for antithrombotic prophylaxis in surgical patients. In preliminary studies, sequential filling of multisegmented leggings with graded pressure decreasing from ankle to knee increased venous flow velocity and wall shear stress, decreased residual venous vo...

    journal_title:Annals of surgery

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Salzman EW,McManama GP,Shapiro AH,Robertson LK,Donovan AS,Blume HW,Sweeney J,Kamm RD,Johnson MC,Black PM

    更新日期:1987-11-01 00:00:00

  • Omega-3 Fatty Acids Protect Fatty and Lean Mouse Livers After Major Hepatectomy.

    abstract:OBJECTIVE:The aim of this study was to assess the effect of Ω3 fatty acids (Ω3FA) on fatty and lean liver in hepatic surgery. BACKGROUND:The global spread of energy-dense diets has led to an endemic rise in fatty liver disease and obesity. Besides metabolic pathologies, steatosis enhances hepatic sensitivity to ischem...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Linecker M,Limani P,Kambakamba P,Kron P,Tschuor C,Calo N,Foti M,Dufour JF,Graf R,Humar B,Clavien PA

    更新日期:2017-08-01 00:00:00

  • Cancer-associated venous thrombosis in the surgical setting.

    abstract:OBJECTIVE:Cancer patients are at a relatively high risk of venous thromboembolism (VTE), and this has implications for surgical outcome. DATA SOURCE:English literature search including the keywords cancer, surgery and VTE was undertaken to review the risk, etiology, prevention and treatment of VTE in surgical oncology...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Behranwala KA,Williamson RC

    更新日期:2009-03-01 00:00:00