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      Assessment of Distal Radius Fracture Complications Among Adults 60 Years or Older : A Secondary Analysis of the WRIST Randomized Clinical Trial

      Author(s): 1 , 1 , 1 , 2 , for the WRIST Group
      Publication date (Electronic):
      Journal: JAMA Network Open
      Publisher: American Medical Association (AMA)

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          Abstract

          Key Points Question Do rates or types of complications after distal radius fractures depend on treatment type? Findings In this secondary analysis of a randomized clinical trial of 304 adults from 24 health systems, the method of treatment participants received was associated with the rate or type of complications. Compared with participants who received internal fixation, participants who received any other treatments experienced complications at significantly higher rates. Meaning Choice of distal radius fracture treatment method in older patients should be specific to individual goals to minimize complication risks and improve outcomes.

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          The Self-Administered Comorbidity Questionnaire: a new method to assess comorbidity for clinical and health services research.

          Oliver Sangha, Gerold Stucki, Matthew Liang … (2003)
          To develop the Self-Administered Comorbidity Questionnaire (SCQ) and assess its psychometric properties, including the predictive validity of the instrument, as reflected by its association with health status and health care utilization after 1 year. A cross-sectional comparison of the SCQ with a standard, chart abstraction-based measure (Charlson Index) was conducted on 170 inpatients from medical and surgical care units. The association of the SCQ with the chart-based comorbidity instrument and health status (short form 36) was evaluated cross sectionally. The association between these measures and health status and resource utilization was assessed after 1 year. The Spearman correlation coefficient for the association between the SCQ and the Charlson Index was 0.32. After restricting each measure to include only comparable items, the correlation between measures was stronger (Spearman r = 0.55). The SCQ had modest associations with measures of resource utilization during the index admission, and with health status and resource utilization after 1 year. The SCQ has modest correlations with a widely used medical record-based comorbidity instrument, and with subsequent health status and utilization. This new measure represents an efficient method to assess comorbid conditions in clinical and health services research. It will be particularly useful in settings where medical records are unavailable.
          Article 0 comments Cited 533 times – based on 0 reviews     Review now
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            The Rapid Assessment of Physical Activity (RAPA) Among Older Adults

            Tari Topolski, James LoGerfo, Donald L Patrick … (2006)
            Introduction The Rapid Assessment of Physical Activity (RAPA) was developed to provide an easily administered and interpreted means of assessing levels of physical activity among adults older than 50 years. Methods A systematic review of the literature, a survey of geriatricians, focus groups, and cognitive debriefings with older adults were conducted, and an expert panel was convened. From these procedures, a nine-item questionnaire assessing strength, flexibility, and level and intensity of physical activity was developed. Among a cohort of 115 older adults (mean age, 73.3 years; age range, 51–92 years), half of whom were regular exercisers (55%), the screening performance of three short self-report physical activity questionnaires — the RAPA, the Behavioral Risk Factor Surveillance System (BRFSS) physical activity questions, and the Patient-centered Assessment and Counseling for Exercise (PACE) — was compared with the Community Healthy Activities Model Program for Seniors (CHAMPS) as the criterion. Results Compared with the BRFSS and the PACE, the RAPA was more positively correlated with the CHAMPS moderate caloric expenditure (r = 0.54 for RAPA, r = 0.40 for BRFSS, and r = 0.44 for PACE) and showed as good or better sensitivity (81%), positive predictive value (77%), and negative predictive value (75%) as the other tools. Specificity, sensitivity, and positive predictive value of the questions on flexibility and strength training were in the 80% range, except for specificity of flexibility questions (62%). Mean caloric expenditure per week calculated from the CHAMPS was compared between those who did and those who did not meet minimum recommendations for moderate or vigorous physical activity based on these self-report questionnaires. The RAPA outperformed the PACE and the BRFSS. Conclusion The RAPA is an easy-to-use, valid measure of physical activity for use in clinical practice with older adults.
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              The impact of complications on costs of major surgical procedures: a cost analysis of 1200 patients.

              Pierre-Alain Clavien, K. Müller, Dieter Hahnloser … (2011)
              To assess the impact of postoperative complications on full in-hospital costs per case. Rising expenses for complex medical procedures combined with constrained resources represent a major challenge. The severity of postoperative complications reflects surgical outcomes. The magnitude of the cost created by negative outcomes is unclear. Morbidity of 1200 consecutive patients undergoing major surgery from 2005 to 2008 in a tertiary, high-volume center was assessed by a validated, complication score system. Full in-hospital costs were collected for each patient. Statistical analysis was performed using a multivariate linear regression model adjusted for potential confounders. This study population included 393 complex liver/bile duct surgeries, 110 major pancreas operations, 389 colon resections, and 308 Roux-en-Y gastric bypasses. The overall 30-day mortality rate was 1.8%, whereas morbidity was 53.8%. Patients with an uneventful course had mean costs per case of US$ 27,946 (SD US$ 15,106). Costs increased dramatically with the severity of postoperative complications and reached the mean costs of US$ 159,345 (SD US$ 151,191) for grade IV complications. This increase in costs, up to 5 times the cost of a similar operation without complications, was observed for all types of investigated procedures, although the magnitude of the increase varied, with the highest costs in patients undergoing pancreas surgery. This study demonstrates the dramatic impact of postoperative complications on full in-hospital costs per case and that complications are the strongest indicator of costs. Furthermore, the study highlights a relevant savings capacity for major surgical procedures, and supports all efforts to lower negative events in the postoperative course.
              Article 0 comments Cited 151 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Title: JAMA Network Open
                Abbreviated Title: JAMA Netw Open
                Publisher: American Medical Association (AMA)
                ISSN (Electronic): 2574-3805
                Publication date Created: January 04 2019
                Publication date (Electronic): January 18 2019
                Volume: 2
                Issue: 1
                Page: e187053
                Affiliations
                [1 ]Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor
                [2 ]Center for Statistical Consulting and Research, University of Michigan, Ann Arbor
                Article
                DOI: 10.1001/jamanetworkopen.2018.7053
                SO-VID: df0af9db-d9a3-48de-8108-24879d896d19
                Copyright © © 2019
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