URMC / Department of Surgery / Research / SHORE / Projects / Quality Improvement

Quality Improvement, Healthcare Economics & High-Value Care

SHORE is committed to quality improvement in surgical care and optimizing high value care through targeted research. Health economics and cost-effectiveness analysis play a crucial role in shaping surgical research and healthcare decision-making. SHORE recognizes that with the rising cost of healthcare and the ever-expanding range of surgical options, health economics and cost-effectiveness analysis provide evidence-based insights that aid in making informed decisions about the adoption of surgical innovations.

Quality Improvement

Juviler PJ, Loria A, et al. Journal of Pediatric Surgery. Reducing Unplanned Intubations in the Neonatal Intensive Care Unit After Children's Surgery: A Quality Improvement Project J Pediatr Surg. 2024 Apr;59(1):45-52. doi:10.1016/j.jpedsurg.2023.09.029

Jacob EA, Melucci AD, Talbot EA, et al. The Upstate New York Surgical Quality Improvement Opioid Reduction Project. Am Surg. 2024;90(5):1100-1102. doi:10.1177/00031348231220583

Melucci AD, Loria A, Swanson H, White Q, Moalem J, Fleming FJ, Temple LK. Are postoperative opioid stewardship protocols sustainable? Results from a 2-year quality improvement project. Surgery. 2023 Jul 3:S0039-6060(23)00332-X. doi: 10.1016/j.surg.2023.05.036. Epub ahead of print. PMID: 37407396.

Melucci AD, Liu JB, Brajcich BC, Collins CE, Kazaure HS, Ko CY, Pusic AL, Temple LK. Scaling and spreading the electronic capture of patient-reported outcomes using a national surgical quality improvement programme: a feasibility study protocol. BMJ Open Qual. 2022 Nov;11(4):e001909. doi: 10.1136/bmjoq-2022-001909. PMID: 36375858; PMCID: PMC9664302.

Hsu S, Melucci AD, Dave YA, et al. Outpatient endocrine surgery practice patterns are highly variable among US endocrine surgery fellowship programs [published online ahead of print, 2022 Sep 30]. Surgery. 2022;S0039-6060(22)00322-1.doi:10.1016/j.surg.2022.05.004

Melucci AD, Dave YA, Lynch OF, Hsu S, Erlick MR, Linehan DC, Moalem J; University of Rochester's Efforts to Decrease Unnecessary Controlled substances in Surgery (UReduces) Initiative. Predictors of opioid-free discharge after laparoscopic cholecystectomy. Am J Surg. 2022 Aug 3:S0002-9610(22)00492-5. doi: 10.1016/j.amjsurg.2022.07.027. PMID: 35948514.

Burchard PR, Dave YA, Loria AP, Parikh NB, Pineda-Solis K, Ruffolo LI, Strawderman M, Schoeniger LO, Galka E, Tomiyama K, Orloff MS, Carpizo DR, Linehan DC, Hernandez-Alejandro R. Early postoperative ERAS compliance predicts decreased length of stay and complications following liver resection. HPB (Oxford). 2022 Sep;24(9):1425-1432. doi: 10.1016/j.hpb.2022.01.008. Epub 2022 Jan 25. PMID: 35135723.

Aquina CT, Truong M, Justiniano CF, Kaur R, Xu Z, Boscoe FP, Schymura MJ, Becerra AZ. Variation in Adequate Lymph Node Yield for Gastric, Lung, and Bladder Cancer: Attributable to the Surgeon, Pathologist, or Hospital? Ann Surg Oncol. 2020 Oct;27(11):4093-4106. doi: 10.1245/s10434-020-08509-3. Epub 2020 May 6. PMID: 32378089.

Xu Z, Fleming FJ. Quality Assurance, Metrics, and Improving Standards in Rectal Cancer Surgery in the United States. Front Oncol. 2020 Apr 29;10:655. doi: 10.3389/fonc.2020.00655. PMID: 32411608; PMCID: PMC7202129.

Aquina CT, Fleming FJ, Hall J, Hyman N. Do All Patients Require Resection After Successful Drainage of Diverticular Abscesses? J Gastrointest Surg. 2020 Jan;24(1):219-220. doi: 10.1007/s11605-019-04396-6. Epub 2019 Sep 16. PMID: 31529197.

Justiniano CF, Aquina CT, Fleming FJ, Xu Z, Boscoe FP, Schymura MJ, Temple LK, Becerra AZ. Hospital and surgeon variation in positive circumferential resection margin among rectal cancer patients. Am J Surg. 2019 Nov;218(5):881-886. doi: 10.1016/j.amjsurg.2019.02.029. Epub 2019 Feb 28. PMID: 30853095.

Brady JT, Xu Z, Scarberry KB, Saad A, Fleming FJ, Remzi FH, Wexner SD, Winchester DP, Monson JRT, Lee L, Dietz DW; Consortium for Optimizing the Treatment of Rectal Cancer (OSTRiCh). Evaluating the Current Status of Rectal Cancer Care in the US: Where We Stand at the Start of the Commission on Cancer's National Accreditation Program for Rectal Cancer. J Am Coll Surg. 2018 May;226(5):881-890. doi: 10.1016/j.jamcollsurg.2018.01.057. Epub 2018 Mar 23. Erratum in: J Am Coll Surg. 2018 Oct;227(4):484-487. PMID: 29580675.

Becerra AZ, Aquina CT, Berho M, Boscoe FP, Schymura MJ, Noyes K, Monson JR, Fleming FJ. Surgeon-, pathologist-, and hospital-level variation in suboptimal lymph node examination after colectomy: Compartmentalizing quality improvement strategies. Surgery. 2017 Jan. PMID: 28088321.

Srinivasaiah N, Arsalani-Zadeh R, Monson JR. Thrombo-prophylaxis in colorectal surgery: a National Questionnaire Survey of the members of the Association of Coloproctology of Great Britain and Ireland. Colorectal Dis. 2012 Jul;14(7):e390-3. doi: 10.1111/j.1463-1318.2012.02974.x. PMID: 22321914.

Health Economics & High Value Care

Leeds IL, Xu Z, Loria A, Pantel HJ, Mongiu AK, Longo WL, Reddy V. How Far Is Too Far? Cost-Effectiveness Analysis of Regionalized Rectal Cancer Surgery. Dis Colon Rectum. 2023 Mar 1;66(3):467-476. doi: 10.1097/DCR.0000000000002636. Epub 2022 Nov 28. PMID: 36538713.

Enumah SJ, Sundt TM, Chang DC. Association of measured quality and future financial performance among hospitals performing cardiac surgery. J Healthc Manag. 2022;67(5):367-379.

Enumah SJ, Resnick AS, Chang DC. Association of measured quality with financial health among U.S. hospitals. PLoS One. 2022;17(4):e0266696.

Xu Z, Fleming FJ. The treatment-travel tradeoff of colorectal cancer care. Surgery. 2021 Apr;169(4):989-990. doi: 10.1016/j.surg.2020.10.010. Epub 2020 Nov 19. PMID: 33220976.

Enumah SJ, Chang DC. Predictors of financial distress among private U.S. hospitals. J Surg Res. 2021;267:251-259.

Justiniano CF, Becerra AZ, Xu Z, Aquina CT, Boodry CI, Schymura MJ, Boscoe FP, Noyes K, Temple LK, Fleming FJ. A Population-Based Study of 90-Day Hospital Cost and Utilization Associated with Robotic Surgery in Colon and Rectal Cancer. J Surg Res. 2020 Jan;245:136-144. doi: 10.1016/j.jss.2019.07.052. Epub 2019 Aug 13. PMID: 31419638.

Xu Z, Aquina CT, Justiniano CF, Becerra AZ, Boscoe FP, Schymura MJ, Temple LK, Fleming FJ. Centralizing Rectal Cancer Surgery: What Is the Impact of Travel on Patients? Dis Colon Rectum. 2020 Mar;63(3):319-325. doi: 10.1097/DCR.0000000000001581. PMID: 32045397.

Xu Z, Becerra AZ, Justiniano CF, Boodry CI, Aquina CT, Swanger AA, Temple LK, Fleming FJ. Is the Distance Worth It? Patients With Rectal Cancer Traveling to High-Volume Centers Experience Improved Outcomes. Dis Colon Rectum. 2017 Dec;60(12):1250-1259. doi: 10.1097/DCR.0000000000000924. PMID: 29112560.

Aquina CT, Probst CP, Becerra AZ, Iannuzzi JC, Kelly KN, Hensley BJ, Rickles AS, Noyes K, Fleming FJ, Monson JRT. High volume improves outcomes: The argument for centralization of rectal cancer surgery. Surgery. 2016; 159(3): 736-748. PMID: 26576696

Aquina CT, Kelly KN, Probst CP, Iannuzzi JC, Noyes K, Langstein HN, Monson JRT, Fleming FJ. Surgeon volume plays a significant role in outcomes and cost following open incisional hernia repair. Journal of Gastrointestinal Surgery. 2015; 19(1): 100-110. PMID: 25118644

Iannuzzi JC, Rickles AS, Kelly KN, Fleming FJ, Dolan JG, Monson JR, Noyes K. Defining high risk: cost-effectiveness of extended-duration thromboprophylaxis following major oncologic abdominal surgery. J Gastrointest Surg. 2014 Jan;18(1):60-8. doi: 10.1007/s11605-013-2373-4. Epub 2013 Oct 8. PMID: 24101450; PMCID: PMC4652588.