Procedural Choice in Majoritarian Organizations

AbstractClinicians employ various modalities in order to achieve temporal augmentation; however, no literature comprehensively describes these methods or provides perspective on available options. Understanding the available methodologies for cosmetic temporal augmentation allows for improved patient satisfaction with limited risk of complications. To synthesize the available literature on cosmetic temporal augmentation, including all available methodologies, patient satisfaction data, and complication rates, as well as to identify gaps in the available literature to encourage further research. A literature search was performed using the databases PubMed, Ovid Medline, Cochrane Library, and Web of Science. Using the key terms “temporal” or “temple” and “augmentation” or “rejuvenation,” all article formats presenting primary literature data involving cosmetic temporal augmentation were included. Articles not presenting patient data or not discussing cosmetic indications were eliminated. A total of 12 articles were deemed appropriate for analysis. Of the 12 articles included, 6 (50%) evaluated filler techniques, 3 discussed fat grafting (25%), and 3 reviewed solid implant (25%) techniques. Eight (67%) of these were retrospective reviews, with the remaining being prospective trials (33%). All studies found high patient satisfaction rates and a small number of complications with their respective methodology. Several methods are employed for cosmetic temporal augmentation, including various types of injectable fillers, solid implants, and fat grafting, with all reporting successful satisfaction and complication outcomes. Further research is necessary to properly compare these modalities. Clinician discretion should guide procedural choice until future well-controlled studies are able to provide standardized outcomes.

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Abstract 28: Readmissions after Carotid Artery Revascularization in the Medicare Population

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.7.suppl_1.28 ◽

2014 ◽

Vol 7 (suppl_1) ◽

Author(s):

Mohammed Salim Al-Damluji ◽

Weiwei Zhang ◽

Erik Stilp ◽

Lori Geary ◽

Carlos Mena-Hurtado ◽

...

Keyword(s):

Carotid Artery ◽

Readmission Rate ◽

Linear Models ◽

Multivariable Analysis ◽

Administrative Claims ◽

Readmission Rates ◽

Carotid Revascularization ◽

Hospital Variation ◽

Medicare Patients ◽

Procedural Choice

Introduction: In appropriately selected patients with severe carotid stenosis, carotid revascularization reduces risk of ischemic stroke. Prior clinical research has focused on the efficacy and safety of carotid revascularization, but few investigators have considered readmission as a clinically important outcome. We examined frequency and timing of 30-day readmission following carotid revascularization and assessed differences in 30-day readmission rates between patients undergoing carotid endarterectomy (CEA) and carotid artery stenting (CAS). We also examined whether hospital variation in procedural choice (CEA vs CAS) was associated with differences in hospitals’ risk standardized readmission rates (RSRR). Methods: Medicare administrative claims data were used to identify acute care hospitalizations of CEA and CAS from 2009 to 2011. The outcome of interest was time to first hospital readmission within 30-days of carotid revascularization. Hospitals performing more than 25 carotid interventions were stratified into tertiles by the proportion of CAS cases. RSRRs were derived from hierarchical generalized linear models adjusting for hospital clustering and standardized by unadjusted national readmission rate. Results: Of 180,059 revascularizations from 2,287 hospitals, CEA and CAS were performed in 81.5% and 18.5% of cases, respectively. The unadjusted 30-day readmission rate following carotid revascularization was 9.7% with half of these readmissions occurring by day 9. Crude 30-day readmission rates following CEA and CAS were 9.5% and 10.6%, respectively. In multivariable analysis, risk of readmission after CAS was higher than after CEA (Adjusted OR: 1.13, 95% CI: 1.08 - 1.18, P <0.01). When stratified by tertiles of proportional use of CAS, median 30-day RSRR for hospitals using CAS more frequently were comparable to those of hospitals that used CAS less frequently (Figure 1). Conclusions: Almost 10% of Medicare patients undergoing carotid revascularization were readmitted within 30 days of discharge. Compared with CEA, CAS was associated with higher 30-day readmission rates. However, hospitals’ RSRR did not differ by their proportional use of CAS volume. Efforts to identify readmission risk factors are needed to reduce rates of readmissions following carotid revascularization.

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