2025
Hospital and Clinician Practice Variation in Cardiac Surgery and Postoperative Acute Kidney Injury
Mathis M, Mentz G, Cao J, Balczewski E, Janda A, Likosky D, Schonberger R, Hawkins R, Heung M, Ailawadi G, Ladhania R, Sjoding M, Kheterpal S, Singh K, Sundt T, Fitzsimons M, Shann K, Kumar V, Yarboro L, Naik B, Tibayan F, Aziz M, Mulligan M, Jelacic S, Kaneko T, Graetz T, Assi R, Mallidi H, Querejeta-Roca G, Shook D, Tsai C, Jewell E, Wanderer J, Freundlich R, Rock P, Douville N, Fisher C, Pace N, Domino K, Wagener G, King C, O'Reilly-Shah V, Bardia A, Clark D. Hospital and Clinician Practice Variation in Cardiac Surgery and Postoperative Acute Kidney Injury. JAMA Network Open 2025, 8: e258342. PMID: 40314957, PMCID: PMC12048843, DOI: 10.1001/jamanetworkopen.2025.8342.Peer-Reviewed Original ResearchImplementation of Brief Submaximal Cardiopulmonary Testing in a High-Volume Presurgical Evaluation Clinic: Feasibility Cohort Study
Carr Z, Agarkov D, Li J, Charchaflieh J, Brenes-Bastos A, Freund J, Zafar J, Schonberger R, Heerdt P. Implementation of Brief Submaximal Cardiopulmonary Testing in a High-Volume Presurgical Evaluation Clinic: Feasibility Cohort Study. JMIR Perioperative Medicine 2025, 8: e65805. PMID: 39773953, PMCID: PMC11888076, DOI: 10.2196/65805.Peer-Reviewed Original ResearchConceptsDuke Activity Status IndexPeak oxygen uptakePeak METsEvaluation clinicParticipant satisfactionOxygen uptakeSubmaximal cardiopulmonary exercise testingFunctional capacity assessmentLow functional capacityCardiopulmonary exercise testingPerceived exertionMET assessmentStructured surveyCapacity surveyMedian patient satisfactionProvider-drivenExercise testMean session timePearson correlation coefficientSurvey scoresCardiopulmonary testFunctional capacityPatient satisfactionCohort studyInclusion criteria
2024
Multicenter Analysis of the Relationship Between Operative Team Familiarity and Safety and Efficiency Outcomes in Cardiac Surgery
Bauer T, Janda A, Wu X, Ling C, Shook D, Querejeta-Roca G, Shann K, Smith T, Mathis M, Kaneko T, Sundt T, Schonberger R, Harrington S, Dias R, Pagani F, Likosky D, Yule S, Caldwell M, Corso J, Louis N, Krein S, Manojlovich M, Stakich-Alpirez K, Sturmer D, Yalamuri S, Lawton J, Abernathy J, Cleveland J, Clendenen N, Justison G, Fried M, Nemeh H, Fitzsimons M, Dickinson T, Stulak J, de la Cruz K. Multicenter Analysis of the Relationship Between Operative Team Familiarity and Safety and Efficiency Outcomes in Cardiac Surgery. Circulation Cardiovascular Quality And Outcomes 2024, 17: e011065. PMID: 39689169, PMCID: PMC11654451, DOI: 10.1161/circoutcomes.124.011065.Peer-Reviewed Original ResearchMeSH KeywordsAgedAnesthesiologistsCardiac Surgical ProceduresCardiopulmonary BypassClinical CompetenceCooperative BehaviorFemaleHealth Knowledge, Attitudes, PracticeHumansInterdisciplinary CommunicationMaleMiddle AgedOperative TimeOutcome and Process Assessment, Health CarePatient Care TeamPatient SafetyPostoperative ComplicationsQuality Indicators, Health CareRegistriesRetrospective StudiesRisk AssessmentRisk FactorsSurgeonsTime FactorsTreatment OutcomeUnited StatesConceptsSociety of Thoracic SurgeonsCardiopulmonary bypass durationTeam familiarityBypass durationElectronic health record dataHealth record dataEffective team dynamicsSociety of Thoracic Surgeons morbidityCardiac Surgery RegistryComposite major morbidityCardiac surgical proceduresMortality measuresLinear regression modelsCrude analysisQuaternary hospitalRecord dataRisk adjustmentPrimary outcomePatient outcomesProcedural efficiencyMajor morbidityCardiac surgeryCardiac operationsMulticenter analysisPatient ageIndividual and System-level Factors Contributing to Guideline Nonadherent Surgical Antibiotic Prophylaxis at a Tertiary Healthcare System: A Qualitative Analysis
Bardia A, Melnick E, McCall T, Zhao X, Lin H, Fisher C, Burg M, Schonberger R. Individual and System-level Factors Contributing to Guideline Nonadherent Surgical Antibiotic Prophylaxis at a Tertiary Healthcare System: A Qualitative Analysis. Anesthesiology 2024, 142: 489-499. PMID: 39556527, PMCID: PMC11813683, DOI: 10.1097/aln.0000000000005302.Peer-Reviewed Original ResearchClinical decision supportCertified Registered Nurse AnesthetistsGuideline adherenceInfectious Diseases Society of AmericaQualitative studyTertiary health care systemClinical decision support toolSemi-structured interview formatSystem-level factorsHealth care systemRegistered Nurse AnesthetistsConstant comparison methodInfectious Diseases SocietyDecision supportAntibiotic guidelinesCare systemProvider needsNurse anesthetistsPerioperative pharmacistLimited familiarityPerceived benefitsNon-adherenceInterview formatLevel factorsResident traineesInternational multi-institutional external validation of preoperative risk scores for 30-day in-hospital mortality in paediatric patients
Tangel V, Hoeks S, Stolker R, Brown S, Pryor K, de Graaff J, Committee M, Pace N, Domino K, Muehlschlegel J, Kheterpal S, Vaughan M, Mathis M, Jiang S, Obembe S, Freundlich R, Schonberger R, Kim D. International multi-institutional external validation of preoperative risk scores for 30-day in-hospital mortality in paediatric patients. British Journal Of Anaesthesia 2024, 133: 1222-1233. PMID: 39477712, DOI: 10.1016/j.bja.2024.09.003.Peer-Reviewed Original ResearchConceptsSurgical risk scoresPediatric risk assessmentArea under the receiver operating characteristic curveIn-hospital mortalityRisk scoreMulticenter Perioperative Outcomes GroupPreoperative risk scoreDecision curve analysisReceiver operating characteristic curvePhysical status scoreExternal validationAssess model discriminationRisk prediction scoreASA physical status scoreClinical decision-makingPaediatric patientsLow probability of mortalityDutch hospitalsOutcome groupPatient-specific risk scoresPrimary outcomeClustering of casesCurve analysisStatus scoreCharacteristic curveIncidence of Concurrent Cerebral Desaturation and Electroencephalographic Burst Suppression in Cardiac Surgery Patients.
Ramachandran R, Behera A, Hussain Z, Peck J, Ananthakrishanan A, Mathur P, Banner-Goodspeed V, Muehlschlegel J, Pittet J, Bardia A, Schonberger R, Marcantonio E, Kveraga K, Subramaniam B. Incidence of Concurrent Cerebral Desaturation and Electroencephalographic Burst Suppression in Cardiac Surgery Patients. Anesthesia & Analgesia 2024 PMID: 39446661, DOI: 10.1213/ane.0000000000007209.Peer-Reviewed Original ResearchCerebral desaturationAortic cross-clampingCardiac surgeryPost-CPBBurst suppressionCross-clampingRemoval of aortic cross-clampCerebral oximetryAssociated with postoperative deliriumPhase of cardiac surgeryCardiac surgery patientsElectroencephalographic burst suppressionConfidence intervalsIntraoperative burst suppressionPostoperative cognitive functionPre-CPBPrecardiopulmonary bypassSurgery patientsEntire surgeryEEG monitoringPostoperative deliriumTargeted interventionsOdds ratioSurgerySurgical phaseAssociation of Medicare eligibility with access to cardiac surgical care by patients identifying as other than non-Hispanic White: a regression discontinuity analysis
Arndt M, Lin H, Strand E, Fisher C, Schonberger R. Association of Medicare eligibility with access to cardiac surgical care by patients identifying as other than non-Hispanic White: a regression discontinuity analysis. British Journal Of Anaesthesia 2024, 133: 1341-1343. PMID: 39277456, DOI: 10.1016/j.bja.2024.07.031.Peer-Reviewed Original ResearchAssociation between inspired oxygen fraction and development of postoperative pulmonary complications in thoracic surgery: a multicentre retrospective cohort study
Douville N, Smolkin M, Naik B, Mathis M, Colquhoun D, Kheterpal S, Collins S, Martin L, Popescu W, Pace N, Blank R, Committee M, Aziz M, Blasberg J, Chang A, Freundlich R, O’Reilly-Shah V, Schonberger R. Association between inspired oxygen fraction and development of postoperative pulmonary complications in thoracic surgery: a multicentre retrospective cohort study. British Journal Of Anaesthesia 2024, 133: 1073-1084. PMID: 39266439, PMCID: PMC11619793, DOI: 10.1016/j.bja.2024.08.005.Peer-Reviewed Original ResearchPostoperative pulmonary complicationsOne-lung ventilationAssociated with postoperative pulmonary complicationsInspired oxygen fractionPulmonary complicationsThoracic surgeryLogistic regression modelsDevelopment of postoperative pulmonary complicationsIntraoperative inspired oxygen fractionDuration of one-lung ventilationReduce postoperative pulmonary complicationsMulticentre retrospective cohort studyComposite of postoperative pulmonary complicationsUS medical centresLung resection surgeryRetrospective multicentre studyThoracic surgical proceduresArea under the curveRetrospective cohort studyOxygen fractionExposure of interestResection surgeryMulticentre studyUnivariate analysisSurgical proceduresOpioid Dose Variation in Cardiac Surgery: A Multicenter Study of Practice.
Fisher C, Janda A, Zhao X, Deng Y, Bardia A, Yanez N, Burns M, Aziz M, Treggiari M, Mathis M, Lin H, Schonberger R. Opioid Dose Variation in Cardiac Surgery: A Multicenter Study of Practice. Anesthesia & Analgesia 2024 PMID: 39167548, PMCID: PMC11842693, DOI: 10.1213/ane.0000000000007128.Peer-Reviewed Original ResearchCardiac surgeryOpioid doseDose variationIntraoperative opioid administrationIntraoperative opioid doseHigh-dose opioidsAdult cardiac surgerySurgical differencesOpioid-freeOpioid administrationOpioid useMultimodal analgesiaAnalgesic techniquesCardiopulmonary bypassMulticenter studyFentanyl equivalentsSufentanil infusionSurgical patientsOpioidSurgeryAnesthetic techniqueCardiac casesAttending anesthesiologistPatientsDoseIdentifying Variation in Intraoperative Management of Brain-Dead Organ Donors and Opportunities for Improvement: A Multicenter Perioperative Outcomes Group Analysis
Lele A, Vail E, O’Reilly-Shah V, DeGraw X, Domino K, Walters A, Fong C, Gomez C, Naik B, Mori M, Schonberger R, Deshpande R, Souter M, Committee T. Identifying Variation in Intraoperative Management of Brain-Dead Organ Donors and Opportunities for Improvement: A Multicenter Perioperative Outcomes Group Analysis. Anesthesia & Analgesia 2024, 140: 41-50. PMID: 39167559, DOI: 10.1213/ane.0000000000007001.Peer-Reviewed Original ResearchIntraclass correlation coefficientMulticenter Perioperative Outcomes GroupOrgan procurement organization regionBrain-dead organ donorsNon-Hispanic whitesPoisson regression analysisOrgan procurement organizationsIntraoperative eventsUS hospitalsYears of ageMedication useIncidence of hypotensionOrgan donorsManagement of brain-dead donorsPrimary outcomeManagement of brain-dead organ donorsMixed-effects Poisson regression analysisIntravenous heparinVasoactive medicationsBrain-dead donorsMulticenter cohortIntraoperative managementTransplant outcomesCase volumeMm HgPreoperative Blood Pressures and the Physician Anesthesiologist
Schonberger R. Preoperative Blood Pressures and the Physician Anesthesiologist. Anesthesiology 2024, 141: 208-210. PMID: 38980164, PMCID: PMC11239125, DOI: 10.1097/aln.0000000000005101.Peer-Reviewed Original ResearchAnesthesia Techniques for Vitreoretinal Surgery in the United States: A Report from the Multicenter Perioperative Outcomes Group Research Consortium
Chauhan M, SOLIMAN M, Pace N, Mathis M, Schonberger R, Sallam A, Group M. Anesthesia Techniques for Vitreoretinal Surgery in the United States: A Report from the Multicenter Perioperative Outcomes Group Research Consortium. American Journal Of Ophthalmology 2024, 267: 30-40. PMID: 38871268, DOI: 10.1016/j.ajo.2024.06.010.Peer-Reviewed Original ResearchMonitored anesthesia careVR surgeryMulticenter Perioperative Outcomes GroupGeneral anesthesiaAmerican Society of Anesthesiologists (ASAHistory of drug abuseChronic pulmonary diseaseType of anesthesiaMonitored anesthesia care casesAlcohol abuse disordersMultivariate mixed-effects modelRandom-effects modelRetinal detachmentSB surgeryVitreoretinal surgeryYounger patientsAnesthesia useSurgery casesOutcome groupAnesthesia techniquesPrimary outcomeSurgeryLiver diseaseSecondary outcomesPulmonary diseaseSame-Day Primary Care Referral Versus Usual Care for Patients With Elevated Blood Pressures Seen in a Preoperative Clinic
Butler S, Holt N, Dai F, Quick C, Kravetz J, Perrino A, Schonberger R. Same-Day Primary Care Referral Versus Usual Care for Patients With Elevated Blood Pressures Seen in a Preoperative Clinic. Cureus 2024, 16: e58401. PMID: 38756290, PMCID: PMC11098054, DOI: 10.7759/cureus.58401.Peer-Reviewed Original ResearchPrimary care referralsPrimary care groupsCare referralUsual careCare groupPreoperative clinicQuality improvementCare coordination effortsLong-term health outcomesPrimary care visitsPrimary care appointmentsCohort of US veteransMonths post-interventionSame-day referralElectronic health recordsBlood pressureSurgical care episodesHypertension treatmentProspective QI projectPreoperative evaluation clinicImprove BP controlQI projectCare appointmentsPreoperative clinic visitPrimary careImproving Anesthesia Start Time Documentation Through a Departmental Education Initiative at Yale New Haven Hospital, New Haven, United States
Warren M, Mehta S, Glowka L, Goncalves O, Gutman E, Schonberger R. Improving Anesthesia Start Time Documentation Through a Departmental Education Initiative at Yale New Haven Hospital, New Haven, United States. Cureus 2024, 16: e54351. PMID: 38500895, PMCID: PMC10945460, DOI: 10.7759/cureus.54351.Peer-Reviewed Original ResearchYale-New Haven HospitalEducational emailCenters for Medicare & Medicaid ServicesEducational initiativesResults Baseline dataQuality improvement studyQuality improvement initiativesQuality improvement effortsNew HavenAnesthesia startUnited StatesImprovement initiativesMedicaid ServicesAnesthetic servicesImprovement studyImprovement effortsIn-room timeDocumentation accuracyAmerican Society of AnesthesiologistsTime documentationPatient factorsBaseline dataPreoperative holding areaNew Haven HospitalAnesthesia practitioners
2023
Perioperative Mortality of the COVID-19 Recovered Patient Compared to a Matched Control: A Multicenter Retrospective Cohort Study
Aziz M, Schenning K, Koike S, O’Glasser A, O’Reilly-Shah V, Sera V, Mathis M, Naik B, Taicher B, Colquhoun D, Freundlich R, Schonberger R, Domino K, Chen L, Pace N. Perioperative Mortality of the COVID-19 Recovered Patient Compared to a Matched Control: A Multicenter Retrospective Cohort Study. Anesthesiology 2023, 140: 195-206. PMID: 37844271, DOI: 10.1097/aln.0000000000004809.Peer-Reviewed Original ResearchConceptsAcute kidney injuryPulmonary complicationsKidney injuryIncreased riskPerioperative mortalityExposed patientsCOVID-19 infectionIncreased 30-day mortality riskElective surgeryIncreased risk of acute kidney injuryIncreased risk of pulmonary complicationsRisk of acute kidney injuryMortality riskPositive testRisk of pulmonary complicationsRisk of perioperative mortalityRetrospective observational cohort studyThirty-day mortalityCOVID-19-recovered patientsCohort of patientsExposure to COVID-19 infectionIncreased risk of mortalityAssociated with increased mortality riskObservational cohort studyElective inpatient surgeryHypoxemia in School-age Children Undergoing One-lung Ventilation: A Retrospective Cohort Study from the Multicenter Perioperative Outcomes Group
Templeton T, Krol B, Miller S, Lee L, Mathis M, Vishneski S, Chatterjee D, Gupta R, Shroeder R, Saha A, Schonberger R. Hypoxemia in School-age Children Undergoing One-lung Ventilation: A Retrospective Cohort Study from the Multicenter Perioperative Outcomes Group. Anesthesiology 2023, 140: 25-37. PMID: 37738432, DOI: 10.1097/aln.0000000000004781.Peer-Reviewed Original ResearchConceptsIncreased risk of hypoxemiaOne-lung ventilationRisk of hypoxemiaRight-sided casesIncreased riskSevere hypoxemiaDuration of one-lung ventilationVideo-assisted thoracoscopic surgeryRoom air oxygen saturationLow tidal volume ventilationRisk factorsOxygen saturationMulticenter Perioperative Outcomes Group databasePrevalence of hypoxemiaAssociated with hypoxemiaAssociated with increased riskTidal volume ventilationRetrospective cohort studySelection operator regression analysisChildren 4Nonmodifiable risk factorsMultivariate least absolute shrinkageSchool-aged childrenThoracoscopic surgeryThoracic surgeryPatient-, Clinician-, and Institution-level Variation in Inotrope Use for Cardiac Surgery: A Multicenter Observational Analysis
Mathis M, Janda A, Kheterpal S, Schonberger R, Pagani F, Engoren M, Mentz G, Shook D, Muehlschlegel J, Group M. Patient-, Clinician-, and Institution-level Variation in Inotrope Use for Cardiac Surgery: A Multicenter Observational Analysis. Anesthesiology 2023, 139: 122-141. PMID: 37094103, PMCID: PMC10524016, DOI: 10.1097/aln.0000000000004593.Peer-Reviewed Original ResearchConceptsInotrope useCardiac surgeryHome medicationsAdjusted median odds ratioPulmonary circulation disordersAdult cardiac surgeryMechanical circulatory supportMedian odds ratioMedical school affiliationHome inotropesInotrope infusionInotrope therapyInotropic therapyCardiopulmonary bypassHeart failureMulticenter cohortPrimary outcomeCirculatory supportBlack raceCirculation disordersOdds ratioCommunity hospitalObservational studySame patientPatientsAssociation of adherence to individual components of Society of Thoracic Surgeons cardiac surgery antibiotic guidelines and postoperative infections
Bardia A, Michel G, Farela A, Fisher C, Mori M, Huttler J, Lang A, Geirsson A, Schonberger R. Association of adherence to individual components of Society of Thoracic Surgeons cardiac surgery antibiotic guidelines and postoperative infections. Journal Of Thoracic And Cardiovascular Surgery 2023, 167: 2170-2176.e5. PMID: 37075942, PMCID: PMC10579454, DOI: 10.1016/j.jtcvs.2023.03.031.Peer-Reviewed Original ResearchWeight-adjusted dosingPostoperative infectionAntibiotic guidelinesIncidence of nonadherenceCoronary artery bypassTertiary care hospitalAssociation of adherenceCohort of patientsRetrospective observational studyPost-operative infectionIntraoperative redosingValvular surgeryAntibiotic timingArtery bypassCoronary revascularizationPostoperative complicationsPostoperative sepsisAdult patientsFirst doseAntibiotic choiceCardiac surgeryCardiopulmonary bypassCare hospitalDose adjustmentPrimary outcomeSystemic Effects of Perineural Glucocorticoids on Fasting Serum Glucose, Potassium, and White Blood Cell Count in Total Hip Arthroplasty
Sharma A, Dai F, Tseng L, Effraim P, Zhou B, Schonberger R, Li J. Systemic Effects of Perineural Glucocorticoids on Fasting Serum Glucose, Potassium, and White Blood Cell Count in Total Hip Arthroplasty. Journal Of Pain Research 2023, 16: 553-561. PMID: 36846205, PMCID: PMC9946012, DOI: 10.2147/jpr.s395336.Peer-Reviewed Original ResearchWhite blood cell countTotal hip arthroplastyBlood cell countSerum glucosePAI groupSerum potassiumPOD 2Hip arthroplastySystemic effectsCell countTertiary academic medical centerPrimary total hip arthroplastyRetrospective cohort studyPostoperative day 1Immediate postoperative periodLocal anesthetic injectionPeripheral nerve blocksAcademic medical centerPotential systemic effectsElectronic health recordsPreoperative baselineCohort studyPostoperative periodSecondary outcomesPOD 3Perioperative Complications in Patients with Systemic Sclerosis: A Comparative Cohort Analysis
Carr Z, Yan L, Yanez N, Schonberger R, Bohorquez M, He Z, Li F, Hines R, Treggiari M. Perioperative Complications in Patients with Systemic Sclerosis: A Comparative Cohort Analysis. Medical Research Archives 2023, 11: 10.18103/mra.v11i10.4606. PMID: 38037571, PMCID: PMC10688569, DOI: 10.18103/mra.v11i10.4606.Peer-Reviewed Original ResearchMajor adverse cardiac eventsSystemic sclerosisLength of stayPerioperative complicationsSSc patientsComparative cohort analysisSSc cohortPerioperative outcomesControl cohortCohort analysisCormack-Lehane grade 3Limited cervical rangeAdverse cardiac eventsRare autoimmune disorderComparative cohort studySurgical site infectionBetween-group differencesQuaternary care institutionMultiple organ systemsHigh rateAirway complicationsComposite infectionHospital complicationsCardiac eventsCohort study
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