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Calderwood MS, Kleinman K, Bruce CB, Shimelman L, Kaganov RE, Platt R, Huang SS. National validation of the Centers for Medicare & Medicaid Services strategy for identifying potential surgical-site infections following colon surgery and abdominal hysterectomy. Infect Control Hosp Epidemiol 2024; 45:167-173. [PMID: 37675504 DOI: 10.1017/ice.2023.193] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
OBJECTIVE National validation of claims-based surveillance for surgical-site infections (SSIs) following colon surgery and abdominal hysterectomy. DESIGN Retrospective cohort study. SETTING US hospitals selected for data validation by Centers for Medicare & Medicaid Services (CMS). PARTICIPANTS The study included 550 hospitals performing colon surgery and 458 hospitals performing abdominal hysterectomy in federal fiscal year 2013. METHODS We requested 1,200 medical records from hospitals selected for validation as part of the CMS Hospital Inpatient Quality Reporting program. For colon surgery, we sampled 60% with a billing code suggestive of SSI during their index admission and/or readmission within 30 days and 40% who were readmitted without one of these codes. For abdominal hysterectomy, we included all patients with an SSI code during their index admission, all patients readmitted within 30 days, and a sample of those with a prolonged surgical admission (length of stay > 7 days). We calculated sensitivity and positive predictive value for the different groups. RESULTS We identified 142 colon-surgery SSIs (46 superficial SSIs and 96 deep and organ-space SSIs) and 127 abdominal-hysterectomy SSIs (58 superficial SSIs and 69 deep and organ-space SSIs). Extrapolating to the full CMS data validation cohort, we estimated an SSI rate of 8.3% for colon surgery and 3.0% for abdominal hysterectomy. Our colon-surgery surveillance codes identified 93% of SSIs, with 1 SSI identified for every 2.6 patients reviewed. Our abdominal-hysterectomy surveillance codes identified 73% of SSIs, with 1 SSI identified for every 1.6 patients reviewed. CONCLUSIONS Using claims to target record review for SSI validation performed well in a national sample.
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Affiliation(s)
- Michael S Calderwood
- Section of Infectious Disease and International Health, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Ken Kleinman
- University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, Massachusetts, USA
| | - Christina B Bruce
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Lauren Shimelman
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Rebecca E Kaganov
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Richard Platt
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Susan S Huang
- Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California, USA
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Sabet F, Ravan S, Shahraki AD. Prophylaxis Effect of Metronidazole Vaginal Gel in Decreasing the Risk of Surgical Site Infections after Elective Hysterectomy. J Res Pharm Pract 2023; 12:9-14. [PMID: 38213606 PMCID: PMC10779691 DOI: 10.4103/jrpp.jrpp_66_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/27/2022] [Indexed: 01/13/2024] Open
Abstract
Objective Infections are an important cause of morbidity and mortality after hysterectomy. Here, we aimed to investigate and evaluate the beneficial effects of metronidazole vaginal gel on the rate of surgical site infections in women undergoing elective abdominal hysterectomy. Methods This is a randomized prospective, double-blind controlled clinical trial performed in 2020 in Isfahan on 108 candidates for elective hysterectomy. At the beginning of the study, we completed a checklist of the patient's characteristics (patient age, body mass index [BMI], and history of medical conditions such as diabetes, hypertension, anemia, and immune deficiency) and the cause of hysterectomy. All patients were randomized into two groups. The first group received a lubricant vaginal gel single dosage, and the second group received a 0.75% metronidazole vaginal gel single dosage the night before surgery. Patients were visited up to 6 weeks after surgery, and the frequency of infection at the surgical site was determined. Findings The rates of infection were lower in patients who received metronidazole vaginal gel (5.8%) compared to the control group (11.6%) (P = 0.03). Patients with an estimated blood loss volume of more than 500 mL had higher rates of infection (13.46%) compared to patients with a bleeding volume of fewer than 500 mL (1.9%) (P = 0.001). We also found that patients with diabetes (13.5%) and patients with BMI more than 30 kg/m2(13.5%) had higher rates of infection compared to patients without diabetes (5.8%) and patients with BMI <30 kg/m2 (11.5%) (P = 0.001 for both). Patients with higher hospitalization duration had higher infection rates (P = 0.009). Conclusion Administration of a single dosage of metronidazole vaginal gel before abdominal hysterectomy may reduce surgical site infection and have clinical values.
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Affiliation(s)
- Fahimeh Sabet
- Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sara Ravan
- Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azar Danesh Shahraki
- Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran
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Xu X, Desai VB, Wright JD, Lin H, Schwartz PE, Gross CP. Hospital variation in responses to safety warnings about power morcellation in hysterectomy. Am J Obstet Gynecol 2021; 224:589.e1-589.e13. [PMID: 33359176 DOI: 10.1016/j.ajog.2020.12.1207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/17/2020] [Accepted: 12/17/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Safety warnings about power morcellation in 2014 considerably changed hysterectomy practice, especially for laparoscopic supracervical hysterectomy that typically requires morcellation to remove the corpus uteri while preserving the cervix. Hospitals might vary in how they respond to safety warnings and altered hysterectomy procedures to avoid use of power morcellation. However, there has been little data on how hospitals differ in their practice changes. OBJECTIVE This study aimed to examine whether hospitals varied in their use of laparoscopic supracervical hysterectomy after safety warnings about power morcellation and compare the risk of surgical complications at hospitals that had different response trajectories in use of laparoscopic supracervical hysterectomy. STUDY DESIGN This was a retrospective analysis of data from the New York Statewide Planning and Research Cooperative System and the State Inpatient Databases and State Ambulatory Surgery and Services Databases from 14 other states. We identified women aged ≥18 years undergoing hysterectomy for benign indications in the hospital inpatient and outpatient settings from October 1, 2013 to September 30, 2015. We calculated a risk-adjusted utilization rate of laparoscopic supracervical hysterectomy for each hospital in each calendar quarter after accounting for patient clinical risk factors. Applying a growth mixture modeling approach, we identified distinct groups of hospitals that exhibited different trajectories of using laparoscopic supracervical hysterectomy over time. Within each trajectory group, we compared patients' risk of surgical complications in the prewarning (2013Q4-2014Q1), transition (2014Q2-2014Q4), and postwarning (2015Q1-2015Q3) period using multivariable regressions. RESULTS Among 212,146 women undergoing benign hysterectomy at 511 hospitals, the use of laparoscopic supracervical hysterectomy decreased from 15.1% in 2013Q4 to 6.2% in 2015Q3. The use of laparoscopic supracervical hysterectomy at these 511 hospitals exhibited 4 distinct trajectory patterns: persistent low use (mean risk-adjusted utilization rate of laparoscopic supracervical hysterectomy changed from 2.8% in 2013Q4 to 0.6% in 2015Q3), decreased medium use (17.0% to 6.9%), decreased high use (51.4% to 24.2%), and rapid abandonment (30.5% to 0.8%). In the meantime, use of open abdominal hysterectomy increased by 2.1, 4.1, 7.8, and 11.8 percentage points between the prewarning and postwarning periods in these 4 trajectory groups, respectively. Compared with the prewarning period, the risk of major complications in the postwarning period decreased among patients at "persistent low use" hospitals (adjusted odds ratio, 0.88; 95% confidence interval, 0.81-0.94). In contrast, the risk of major complications increased among patients at "rapid abandonment" hospitals (adjusted odds ratio, 1.48; 95% confidence interval, 1.11-1.98), and the risk of minor complications increased among patients at "decreased high use" hospitals (adjusted odds ratio, 1.31; 95% confidence interval, 1.01-1.72). CONCLUSION Hospitals varied in their use of laparoscopic supracervical hysterectomy after safety warnings about power morcellation. Complication risk increased at hospitals that shifted considerably toward open abdominal hysterectomy.
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Affiliation(s)
- Xiao Xu
- Departments of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT; Cancer Outcomes Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, CT.
| | - Vrunda B Desai
- Departments of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT; Medical Affairs, CooperSurgical, Inc, Trumbull, CT
| | - Jason D Wright
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Haiqun Lin
- Division of Nursing Science, School of Nursing, Rutgers University, Newark, NJ
| | - Peter E Schwartz
- Departments of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | - Cary P Gross
- Internal Medicine, Yale School of Medicine, New Haven, CT; Cancer Outcomes Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, CT
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Hospital Safety-Net Burden Is Associated With Increased Inpatient Mortality and Perioperative Complications After Colectomy. J Surg Res 2021; 259:24-33. [DOI: 10.1016/j.jss.2020.11.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 10/19/2020] [Accepted: 11/01/2020] [Indexed: 12/14/2022]
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Pop-Vicas A, Stern R, Osman F, Safdar N. Variability in infection surveillance methods and impact on surgical site infection rates. Am J Infect Control 2021; 49:188-193. [PMID: 32622837 DOI: 10.1016/j.ajic.2020.06.211] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND The impact of variability in infection surveillance methodologies on publicly reported rates of surgical site infection (SSI) is not well defined. METHODS We performed a cross-sectional study to assess infection preventionists' surveillance practices across acute care US hospitals. We collected self-reported annual facility standardized infection ratios for colon surgery and abdominal hysterectomy as provided by the National Healthcare Safety Network. Trend analysis using Kendall's rank correlation evaluated the association between surveillance rigor and SSI rates. RESULTS Among 492 participating hospitals, 63%, 15%, 13%, and 8% were community, university-affiliated, critical access, and ambulatory surgical centers, respectively. Most critical access hospitals (82%) and ambulatory surgical centers (98%) reported less than one full time infection preventionists (P ≤ .001). University-affiliated medical centers spent significantly more time and used more data sources for monthly SSI review compared with other hospitals. Critical access hospitals and ambulatory surgical centers were more likely to rely on manual surveillance only (P < .001). The number of different data sources used for SSI surveillance was positively associated with higher SSI rates: (KT 0.14, P = .028 for colon SSI in 2017; KT 0.20, P = .009 for hysterectomy SSI in 2016; KT 0.25, P = .001 for hysterectomy SSI in 2017). CONCLUSIONS Rigorous SSI surveillance using more data sources for case-finding is more likely to be associated with higher facility SSI rates for colon surgery and abdominal hysterectomy.
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Affiliation(s)
- Aurora Pop-Vicas
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
| | - Rebecca Stern
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Fauzia Osman
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Nasia Safdar
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Goodman KE, Pineles L, Magder LS, Anderson DJ, Ashley ED, Polk RE, Quan H, Trick WE, Woeltje KF, Leekha S, Cosgrove SE, Harris AD. Electronically Available Patient Claims Data Improve Models for Comparing Antibiotic Use Across Hospitals: Results from 576 U.S. Facilities. Clin Infect Dis 2020; 73:e4484-e4492. [PMID: 32756970 PMCID: PMC8662758 DOI: 10.1093/cid/ciaa1127] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Indexed: 12/19/2022] Open
Abstract
Background The Centers for Disease Control and Prevention (CDC) uses standardized antimicrobial administration ratios (SAARs)—that is, observed-to-predicted ratios—to compare antibiotic use across facilities. CDC models adjust for facility characteristics when predicting antibiotic use but do not include patient diagnoses and comorbidities that may also affect utilization. This study aimed to identify comorbidities causally related to appropriate antibiotic use and to compare models that include these comorbidities and other patient-level claims variables to a facility model for risk-adjusting inpatient antibiotic utilization. Methods The study included adults discharged from Premier Database hospitals in 2016–2017. For each admission, we extracted facility, claims, and antibiotic data. We evaluated 7 models to predict an admission’s antibiotic days of therapy (DOTs): a CDC facility model, models that added patient clinical constructs in varying layers of complexity, and an external validation of a published patient-variable model. We calculated hospital-specific SAARs to quantify effects on hospital rankings. Separately, we used Delphi Consensus methodology to identify Elixhauser comorbidities associated with appropriate antibiotic use. Results The study included 11 701 326 admissions across 576 hospitals. Compared to a CDC-facility model, a model that added Delphi-selected comorbidities and a bacterial infection indicator was more accurate for all antibiotic outcomes. For total antibiotic use, it was 24% more accurate (respective mean absolute errors: 3.11 vs 2.35 DOTs), resulting in 31–33% more hospitals moving into bottom or top usage quartiles postadjustment. Conclusions Adding electronically available patient claims data to facility models consistently improved antibiotic utilization predictions and yielded substantial movement in hospitals’ utilization rankings.
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Affiliation(s)
- Katherine E Goodman
- The University of Maryland School of Medicine, Department of Epidemiology and Public Health
| | - Lisa Pineles
- The University of Maryland School of Medicine, Department of Epidemiology and Public Health
| | - Laurence S Magder
- The University of Maryland School of Medicine, Department of Epidemiology and Public Health
| | - Deverick J Anderson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine
| | - Elizabeth Dodds Ashley
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine
| | - Ronald E Polk
- School of Pharmacy, School of Medicine, Virginia Commonwealth University
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary
| | | | - Keith F Woeltje
- Department of Internal Medicine, Division of Infectious Diseases, Washington University School of Medicine
| | - Surbhi Leekha
- The University of Maryland School of Medicine, Department of Epidemiology and Public Health
| | - Sara E Cosgrove
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine
| | - Anthony D Harris
- The University of Maryland School of Medicine, Department of Epidemiology and Public Health
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Ryu M, Yoo H, Choi YK. National hospital quality measures for surgical site infections in South Korea: a survey among 20 expert physicians. Patient Saf Surg 2020; 14:29. [PMID: 32684979 PMCID: PMC7359616 DOI: 10.1186/s13037-020-00255-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 07/07/2020] [Indexed: 12/23/2022] Open
Abstract
Background Surgical site infection (SSI) is recognized as an important quality indicator for patient safety. In Korea, the use of prophylactic antibiotics for surgery is conducted as a national quality measures related to SSI prevention. The objective of the present study was to investigate physicians’ perceptions of hospital quality measures for SSI as well as identify obstacles that might hinder its implementation in South Korea. Method Online-based questionnaires were administered twice. Twenty physician experts who were members of the Healthcare Review and Assessment Committee that was constituted for the “Assessment of prophylactic use of antibiotics for surgery” participated in the study. The first survey comprised open-ended questions that were designed to elicit the physician who could hinder the implementation of SSI indicators. The second survey, which was developed on the basis of the initial survey’s results, consisted of 10 closed-ended questions about the feasibility of objective perception and the need for subjectivity, with regard to SSI. Results From among the 20 physicians, we collected data from 16 respondents in the first survey (response rate of 80%) and 15 respondents in the second survey (response rate of 75%).Thirty-one percent of the respondents supported hospital SSI evaluations, and 69% expressed objections. The obstacles that were perceived as being able to hinder hospital SSI evaluations pertained to difficulties in collecting data, unavailability of information, possibility of underreporting, and redundancy of the inquiry undertaken by the Korean National Healthcare-associated Infections Surveillance System-SSI. Physician experts provide significantly higher ratings for the clinical indicator, rate of readmission due to SSI, both in terms of feasibility and need, when evaluating the results of SSI prevention in hospitals. Conclusion The results of this study show that physicians perceive the need for QI development of hospital SSI measurements to prevent nation-wide SSIs in Korea. However, the feasibility of hospital SSI measurements is low. To develop QIs of hospital SSIs using health insurance claims data, it is necessary to develop a methodology for claims data-based surveillance systems and a data collection system in order to increase the sensitivity and validity of post-operative SSI detection.
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Affiliation(s)
- Mikyung Ryu
- College of Nursing and Public Health, Daegu University, 33 Seongdang-ro 50-gil, Nam-gu, Daegu, Seoul, 42400 South Korea
| | - Hyerim Yoo
- Review & Assessment Research Department, Health Insurance Review & Assessment Service, 60 Hyeoksin-ro, Wonju-si, Seoul, Gangwon-do 26465 South Korea
| | - Yun-Kyoung Choi
- Department of Nursing, Korea National Open University, 86, Daehak-ro, Jongno-gu, Seoul, 03087 South Korea
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Thomas Craig KJ, McKillop MM, Huang HT, George J, Punwani ES, Rhee KB. U.S. hospital performance methodologies: a scoping review to identify opportunities for crossing the quality chasm. BMC Health Serv Res 2020; 20:640. [PMID: 32650759 PMCID: PMC7350649 DOI: 10.1186/s12913-020-05503-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/02/2020] [Indexed: 12/25/2022] Open
Abstract
Background Hospital performance quality assessments inform patients, providers, payers, and purchasers in making healthcare decisions. These assessments have been developed by government, private and non-profit organizations, and academic institutions. Given the number and variability in available assessments, a knowledge gap exists regarding what assessments are available and how each assessment measures quality to identify top performing hospitals. This study aims to: (a) comprehensively identify current hospital performance assessments, (b) compare quality measures from each methodology in the context of the Institute of Medicine’s (IOM) six domains of STEEEP (safety, timeliness, effectiveness, efficiency, equitable, and patient-centeredness), and (c) formulate policy recommendations that improve value-based, patient-centered care to address identified gaps. Methods A scoping review was conducted using a systematic search of MEDLINE and the grey literature along with handsearching to identify studies that provide assessments of US-based hospital performance whereby the study cohort examined a minimum of 250 hospitals in the last two years (2017–2019). Results From 3058 unique records screened, 19 hospital performance assessments met inclusion criteria. Methodologies were analyzed across each assessment and measures were mapped to STEEEP. While safety and effectiveness were commonly identified measures across assessments, efficiency, and patient-centeredness were less frequently represented. Equity measures were also limited to risk- and severity-adjustment methods to balance patient characteristics across populations, rather than stand-alone indicators to evaluate health disparities that may contribute to community-level inequities. Conclusions To further improve health and healthcare value-based decision-making, there remains a need for methodological transparency across assessments and the standardization of consensus-based measures that reflect the IOM’s quality framework. Additionally, a large opportunity exists to improve the assessment of health equity in the communities that hospitals serve.
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Affiliation(s)
- Kelly J Thomas Craig
- IBM® Watson Health® Center for AI, Research, and Evaluation, 75 Binney Street, Cambridge, MA, 02142, USA.
| | - Mollie M McKillop
- IBM® Watson Health® Center for AI, Research, and Evaluation, 75 Binney Street, Cambridge, MA, 02142, USA
| | - Hu T Huang
- IBM® Watson Health® Center for AI, Research, and Evaluation, 75 Binney Street, Cambridge, MA, 02142, USA
| | - Judy George
- IBM® Watson Health® Center for AI, Research, and Evaluation, 75 Binney Street, Cambridge, MA, 02142, USA
| | - Ekta S Punwani
- IBM® Watson Health® Center for AI, Research, and Evaluation, 75 Binney Street, Cambridge, MA, 02142, USA
| | - Kyu B Rhee
- IBM® Watson Health® Center for AI, Research, and Evaluation, 75 Binney Street, Cambridge, MA, 02142, USA
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Monsour MA, Wiley W, Le CH, Lee J, Brown KP, Robinson M, Elsamadicy EA. Infectious Causes of 30-Day Unplanned Hospital Encounters and Readmissions After Hysterectomies: A Single Institutional Study. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2018.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Meredith A. Monsour
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
| | - Whittney Wiley
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
| | - Chi H. Le
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
| | - Jaclyn Lee
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
| | - Kelsei P. Brown
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
| | - Marc Robinson
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
| | - Emad A. Elsamadicy
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
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