CME – Ulcerative Colitis Treatments: Comparing Mortality

CME – Ulcerative Colitis Treatments: Comparing Mortality

According to data from the Crohn’s & Colitis Foundation of America, ulcerative colitis (UC) is an inflammatory bowel disease that affects up to 700,000 Americans. Current medications that are used for UC—which often include corticosteroids or long-term immunosuppressant therapy—do not lead to remission for all patients, and relapse rates are high even among those who achieve remission using medical therapies. “While medical therapy is generally safe for people with UC, only about one-third of patients experience a long-term response to medications,” explains Meenakshi Bewtra, MD, MPH, PhD. Patients also must endure a trial-and-error approach until they find a medication that works for them, which can severely impact quality of life (QOL). In addition, some UC medications come with higher risks of serious side effects. As an alternative to medical therapy, patients with UC can undergo elective colectomy, a surgery which involves performing a total proctocolectomy with ileostomy and, in many cases, restorative ileal pouch anal anastomosis. “Surgery has always been an option for patients with UC, but it is often viewed as a last resort,” says Dr. Bewtra. Research shows that elective colectomy is associated with low morbidity and mortality, but it may also alter patients’ QOL following the procedure.   Assessing Survival QOL, morbidity, and mortality are important factors that drive treatment decisions for patients with UC and their physicians. Dr. Bewtra and colleagues had a retrospective study published in Annals of Internal Medicine that looked at whether or not patients with advanced UC had better survival by undergoing elective colectomy or by being treated with medical therapy. “It’s important to clarify if elective surgery for UC can...
Ulcerative Colitis Treatments: Comparing Mortality

Ulcerative Colitis Treatments: Comparing Mortality

According to data from the Crohn’s & Colitis Foundation of America, ulcerative colitis (UC) is an inflammatory bowel disease that affects up to 700,000 Americans. Current medications that are used for UC—which often include corticosteroids or long-term immunosuppressant therapy—do not lead to remission for all patients, and relapse rates are high even among those who achieve remission using medical therapies. “While medical therapy is generally safe for people with UC, only about one-third of patients experience a long-term response to medications,” explains Meenakshi Bewtra, MD, MPH, PhD. Patients also must endure a trial-and-error approach until they find a medication that works for them, which can severely impact quality of life (QOL). In addition, some UC medications come with higher risks of serious side effects. As an alternative to medical therapy, patients with UC can undergo elective colectomy, a surgery which involves performing a total proctocolectomy with ileostomy and, in many cases, restorative ileal pouch anal anastomosis. “Surgery has always been an option for patients with UC, but it is often viewed as a last resort,” says Dr. Bewtra. Research shows that elective colectomy is associated with low morbidity and mortality, but it may also alter patients’ QOL following the procedure.   Assessing Survival QOL, morbidity, and mortality are important factors that drive treatment decisions for patients with UC and their physicians. Dr. Bewtra and colleagues had a retrospective study published in Annals of Internal Medicine that looked at whether or not patients with advanced UC had better survival by undergoing elective colectomy or by being treated with medical therapy. “It’s important to clarify if elective surgery for UC can...
Surgical Readmissions and Quality of Care

Surgical Readmissions and Quality of Care

Throughout the United States, reducing the rates of hospital readmissions has become a top priority, as evidenced by CMS planning to include surgical procedures in the expansion of the penalty program. “The hospital readmissions reduction program is predicated on the notion that decreasing the frequency with which patients return to hospitals can improve care and lower costs,” says Thomas C. Tsai, MD, MPH. “However, using medical readmission rates as a measure of hospital quality has been controversial.” Hospitals vary substantially in their medical readmission rates, but these data generally do not correlate with the measures that are often used to identify high-quality hospitals, such as mortality. This raises the question of whether or not medical readmission rates actually measure hospital quality or if they instead reflect other factors that are unrelated to hospital care. The relationship between readmission rates and surgical care may be different than that of medical readmissions. Most patients undergo non-urgent major surgery when they’re clinically stable. As a result, surgical readmissions are more likely to result from complications of care received during index hospitalizations. “Clinicians have relatively little information on the types of hospitals that perform well or poorly with regard to surgical readmission rates,” says Dr. Tsai, “but we hypothesized that hospitals excelling in surgical care would generally have fewer readmissions.” A Comprehensive Analysis In a study published in the New England Journal of Medicine, Dr. Tsai and colleagues sought to determine the patterns of surgical readmissions among Medicare patients across a set of major procedures in a national sample of hospitals. The study team combined information from Medicare claims, the American Hospital Association...
Identifying Post-Op Complications for Readmission in General Surgery

Identifying Post-Op Complications for Readmission in General Surgery

In June 2009, CMS began publishing 30-day readmission data for select medical diseases, resulting in hospital readmissions becoming an important metric for measuring the quality of patient care. The changing regulations issued by CMS means that hospital reimbursements can be reduced based on an adjustment factor determined by a hospital’s expected and observed 30-day readmission rates. These changes have also raised the bar for decreasing unnecessary surgical readmissions. In addition to the financial implications, unplanned hospital readmissions further limit hospital resources. For each patient readmitted, there is an opportunity lost to treat another patient who needs care (see also, Strategies for Reducing Hospital Readmissions). “Reducing the number of 30-day readmissions after surgery is important for institutions as well as patients,” says John F. Sweeney, MD, FACS. “Developing a better understanding of the predictors of readmission for general surgery patients will allow hospitals to develop programs to decrease readmission rates. Surgical patients are different from medical patients because surgery, in and of itself, places them at risk for readmission, above and beyond their medical problems. There is an opportunity to intervene preoperatively to decrease the risk of readmission postoperatively.” Important New Data on Hospital Readmission In the Journal of the American College of Surgeons, Dr. Sweeney and colleagues had a study published that analyzed patient records of 1,442 general surgery patients operated on between 2009 and 2011. Of them, 163 patients (11.3%) were readmitted to the hospital within 30 days of discharge. There is a paucity of information focusing on readmission rates among surgical patients, says Dr. Sweeney. “Although factors associated with 30-day readmission after general surgery procedures are multifactorial,...