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Cortina CS, Lloren JI, Rogers C, Johnson MK, Cobb AN, Huang CC, Kong AL, Singh P, Teshome M. Does Neoadjuvant Chemotherapy in Clinical T1-T2 N0 Triple-Negative Breast Cancer Increase the Extent of Axillary Surgery? Ann Surg Oncol 2024; 31:3128-3140. [PMID: 38270828 PMCID: PMC11003830 DOI: 10.1245/s10434-024-14914-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/03/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Current management strategies for early-stage triple-negative breast cancer (TNBC) include upfront surgery to determine pathologic stage to guide chemotherapy recommendations, or neoadjuvant chemotherapy (NAC) to de-escalate surgery, elucidate tumor response, and determine the role of adjuvant chemotherapy. However, patients who receive NAC with residual pathological nodal (pN) involvement require axillary lymph node dissection (ALND) as they are Z11/AMAROS ineligible. We aimed to evaluate the impact of NAC compared with upfront surgery on pN status and ALND rates in cT1-2N0 TNBC. METHODS The National Cancer Database (NCDB) was queried for women with operable cT1-2N0 TNBC from 2014 to 2019. Demographic, clinicopathologic, and treatment data were collected. Multivariable linear regression analysis was performed to assess the odds of pN+ disease and undergoing ALND. RESULTS Overall, 55,624 women were included: 26.9% (n = 14,942) underwent NAC and 73.1% (n = 40,682) underwent upfront surgery. The NAC cohort was younger (mean age 52.9 vs. 61.3 years; p < 0.001) with more cT2 tumors (71.6% vs. 31.0%; p < 0.001), and had lower ALND rates (4.3% vs. 5.5%; p < 0.001). The upfront surgery cohort was more likely to have one to three pathologically positive nodes (12.1% vs. 6.5%; odds ratio [OR] 2.37, 95% confidence interval (CI) 2.17-2.58; p < 0.001) but there was no difference in the likelihood of ALND (OR 1.1, 95% CI 0.99-1.24; p = 0.08). CONCLUSION Patients who underwent upfront surgery were more likely to be pN+; however, ALND rates were similar between the two cohorts. Thus, the use of NAC does not result in a higher odds of ALND and the decision for NAC should be individualized and based on modern guidelines and systemic therapy benefits.
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Affiliation(s)
- Chandler S Cortina
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA.
| | - Jan Irene Lloren
- Division of Biostatistics, Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Christine Rogers
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Morgan K Johnson
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Adrienne N Cobb
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Chiang-Ching Huang
- Division of Biostatistics, Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Amanda L Kong
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA
| | - Puneet Singh
- Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mediget Teshome
- Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Cortina CS, Lloren JI, Rogers C, Johnson MK, Cobb AN, Huang CC, Kong AL, Singh P, Teshome M. ASO Visual Abstract: Does Neoadjuvant Chemotherapy in Clinical T1-T2 N0 Triple-Negative Breast Cancer Increase the Extent of Axillary Surgery? Ann Surg Oncol 2024:10.1245/s10434-024-15037-x. [PMID: 38358610 DOI: 10.1245/s10434-024-15037-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Affiliation(s)
- Chandler S Cortina
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA.
| | - Jan Irene Lloren
- Division of Biostatistics, Joseph J. Zibler School of Public Health, University of Wisconsin Milwaukee, Milwaukee, WI, USA
| | - Christine Rogers
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Morgan K Johnson
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Adrienne N Cobb
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Chiang-Ching Huang
- Division of Biostatistics, Joseph J. Zibler School of Public Health, University of Wisconsin Milwaukee, Milwaukee, WI, USA
| | - Amanda L Kong
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA
| | - Puneet Singh
- Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mediget Teshome
- Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Rogers C, Cobb AN, Lloren JIC, Chaudhary LN, Johnson MK, Huang CC, Teshome M, Kong AL, Singh P, Cortina CS. National trends in neoadjuvant chemotherapy utilization in patients with early-stage node-negative triple-negative breast cancer: the impact of the CREATE-X trial. Breast Cancer Res Treat 2024; 203:317-328. [PMID: 37864105 PMCID: PMC10872271 DOI: 10.1007/s10549-023-07114-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/24/2023] [Indexed: 10/22/2023]
Abstract
PURPOSE Neoadjuvant chemotherapy (NAC) for triple-negative breast cancer (TNBC) allows for assessment of tumor pathological response and has survival implications. In 2017, the CREATE-X trial demonstrated survival benefit with adjuvant capecitabine in patients TNBC and residual disease after NAC. We aimed to assess national rates of NAC for cT1-2N0M0 TNBC before and after CREATE-X and examine factors associated with receiving NAC vs adjuvant chemotherapy (AC). METHODS A retrospective cohort study of women with cT1-2N0M0 TNBC diagnosed from 2014 to 2019 in the National Cancer Database (NCDB) was performed. Variables were analyzed via ANOVA, Chi-squared, Fisher Exact tests, and a multivariate linear regression model was created. RESULTS 55,633 women were included: 26.9% received NAC, 52.4% AC, and 20.7% received no chemotherapy (median ages 53, 59, and 71 years, p < 0.01). NAC utilization significantly increased over time: 19.5% in 2014-15 (n = 3,465 of 17,777), 27.1% in 2016-17 (n = 5,140 of 18,985), and 33.6% in 2018-19 (n = 6,337 of 18,871, p < 0.001). On multivariate analysis, increased NAC was associated with younger age (< 50), non-Hispanic white race/ethnicity, lack of comorbidities, cT2 tumors, care at an academic or integrated-network cancer program, and diagnosis post-2017 (p < 0.05 for all). Patients with government-provided insurance were less likely to receive NAC (p < 0.01). Women who traveled > 60 miles for treatment were more likely to receive NAC (p < 0.01). CONCLUSION From 2014 to 2019, NAC utilization increased for patients with cT1-2N0M0 TNBC. Racial, socioeconomic, and access disparities were observed in who received NAC vs AC and warrants interventions to ensure equitable care.
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Affiliation(s)
- Christine Rogers
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Adrienne N Cobb
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Jan I C Lloren
- Zibler School of Public Health, University of Wisconsin at Milwaukee, Milwaukee, WI, USA
| | - Lubna N Chaudhary
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA
| | - Morgan K Johnson
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Chiang-Ching Huang
- Zibler School of Public Health, University of Wisconsin at Milwaukee, Milwaukee, WI, USA
| | - Mediget Teshome
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amanda L Kong
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA
| | - Puneet Singh
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chandler S Cortina
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA.
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA.
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Cortina CS, Cobb AN, Kong AL. Invited Commentary: Current and Future Opportunities in Mitigating Breast Cancer Disparity. J Am Coll Surg 2023; 236:1239-1241. [PMID: 37058342 DOI: 10.1097/xcs.0000000000000664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Cobb AN, Diao K, Teshome M, Lucci A, Ueno NT, Stauder M, Layman RM, Kuerer HM, Woodward WA, Sun SX. ASO Visual Abstract: Long-Term Oncologic Outcomes in Patients with Inflammatory Breast Cancer with Supraclavicular Nodal Involvement. Ann Surg Oncol 2022; 29:620-621. [PMID: 36104531 DOI: 10.1245/s10434-022-12457-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Affiliation(s)
- Adrienne N Cobb
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kevin Diao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mediget Teshome
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anthony Lucci
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naoto T Ueno
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Stauder
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rachel M Layman
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Henry M Kuerer
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wendy A Woodward
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susie X Sun
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Cobb AN, Sun SX. ASO Author Reflections: Inflammatory Breast Cancer with Supraclavicular Nodal Involvement-Favorable Long-Term Outcomes can be Achieved. Ann Surg Oncol 2022; 29:6393-6394. [PMID: 35842535 DOI: 10.1245/s10434-022-12235-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 11/18/2022]
Affiliation(s)
- A N Cobb
- Department of Breast Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - S X Sun
- Department of Breast Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
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Cobb AN, Diao K, Teshome M, Lucci A, Ueno NT, Stauder M, Layman RM, Kuerer HM, Woodward WA, Sun SX. Long-term Oncologic Outcomes in Patients with Inflammatory Breast Cancer with Supraclavicular Nodal Involvement. Ann Surg Oncol 2022; 29:6381-6392. [PMID: 35834145 DOI: 10.1245/s10434-022-12144-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/16/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Inflammatory breast cancer (IBC) is a rare and aggressive subtype of breast cancer characterized by rapid progression and early metastasis, often with advanced nodal locations, including the supraclavicular (SCV) nodal basin. Previously considered M1 disease, ipsilateral clinical supraclavicular node involvement (N3c) disease is now considered locally advanced disease and warrants treatment with intent to cure. The objective of this study was to evaluate the long-term outcomes of patients with IBC and N3c disease. PATIENTS AND METHODS This study was conducted using a prospectively collected database of all patients with IBC treated at a dedicated cancer center from 2007 to 2019. Surgical patients with SCV nodal involvement and complete follow-up were identified. Our primary outcome was 5-year overall survival (OS). Multivariate Cox proportional hazards models were used to determine predictors for survival. Event-free survival (EFS) and OS were calculated using the Kaplan-Meier method. RESULTS There were 70 patients who met inclusion criteria. All patients underwent comprehensive trimodality therapy. The majority of patients had complete (66.2%) radiologic response in the SCV nodal basins following neoadjuvant therapy. Six patients (8.6%) had a locoregional recurrence, with two (2.9%) occurring in the supraclavicular fossa. The 5-year OS was 60.2% [95% confidence interval (CI) 47.7-72.7%]. Increasing age (hazard ratio 2.7; p = 0.03) and triple-negative subtype (hazard ratio 4.9; p = 0.03) were associated with poor OS. The 5-year EFS was 56.1% (95% CI 40.9-68.8%). The presence of more than ten positive axillary nodes on final surgical pathology (hazard ratio 5.5; p = 0.01) predicted poor EFS. CONCLUSIONS With comprehensive trimodality therapy and multidisciplinary team approach, patients with IBC with supraclavicular nodal involvement experience excellent locoregional control and favorable survival.
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Affiliation(s)
- Adrienne N Cobb
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kevin Diao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mediget Teshome
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anthony Lucci
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naoto T Ueno
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Stauder
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rachel M Layman
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Henry M Kuerer
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wendy A Woodward
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susie X Sun
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. .,Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Cobb AN, Adesoye T, Teshome M. Progress and Persistent Challenges in Improving Care for Low-Income Women with Breast Cancer. Ann Surg Oncol 2022; 29:2756-2758. [PMID: 35152360 PMCID: PMC8853375 DOI: 10.1245/s10434-022-11343-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/10/2022] [Indexed: 11/22/2022]
Affiliation(s)
- Adrienne N Cobb
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Taiwo Adesoye
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mediget Teshome
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Cobb AN, Janjua HM, Kuo PC. Big Data Solutions for Controversies in Breast Cancer Treatment. Clin Breast Cancer 2020; 21:e199-e203. [PMID: 32933862 DOI: 10.1016/j.clbc.2020.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/29/2020] [Accepted: 08/07/2020] [Indexed: 11/15/2022]
Abstract
The digital world of data is expanding with an annual growth rate of 40%, and health care is among the fastest growing sector of the digital world with an annual growth rate of 48%. Rapid growth in technology has augmented data generation; for example, electronic health records produce huge amounts of patient-level data, whereas national registries capture information on numerous factors affecting health care delivery and patient outcomes. This big data can be utilized to improve health care outcomes. This review discusses relevant applications in breast cancer treatment.
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Affiliation(s)
- Adrienne N Cobb
- Loyola University Medical Center, Department of Surgery, Maywood, IL.
| | - Haroon M Janjua
- Department of Surgery, University of South Florida, Tampa, FL
| | - Paul C Kuo
- Department of Surgery, University of South Florida, Tampa, FL
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Abstract
BACKGROUND Necrotizing skin and soft tissue infection (NSTI) is a surgical emergency that is associated with high morbidity and mortality. This study aims to identify predictors of in-hospital death following a NSTI. MATERIAL AND METHODS We queried the Healthcare Cost and Utilization Project (HCUP) State Inpatient Database (SID) for California between 2006 and 2011. We used conventional and advanced statistical methods to identify predictors of in-hospital mortality, which included: logistic regression, stepwise logistic regression, decision trees, and K-nearest neighbor (KNN) algorithms. RESULTS A total of 10,158 patients had a NSTI. The full and stepwise logistic regression models had a ROC AUC in the validation dataset of 0.83 (95% CI [0.80, 0.86]) and 0.81 (95% CI [0.78, 0.83]), respectively. The KNN and decision tree model had a ROC AUC of 0.84 (95% CI [0.81, 0.85]) and 0.69 (95% CI [0.65, 0.72]), respectively. The top predictors of in-hospital mortality in the KNN and stepwise logistic model included: (1) the presence of in-hospital coagulopathy, (2) having an infectious or parasitic diagnoses, (3) electrolyte disturbances, (4) advanced age, and (5) the total number of beds in a hospital. CONCLUSION Patients with a NSTI have high rates of in-hospital mortality. This study highlights the important factors in managing patients with a NSTI which include: correcting coagulopathy and electrolyte imbalances, treating underlying infectious processes, providing adequate resources to the elderly population, and managing patients in high-volume centers.
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Affiliation(s)
- Emanuel Eguia
- Department of Surgery, Burn Shock Trauma Research Institute, Loyola University Medical Center, 2160 S. 1st Avenue, Maywood, IL, 60153, USA.
| | - Vincent Vivirito
- Department of Surgery, Burn Shock Trauma Research Institute, Loyola University Medical Center, 2160 S. 1st Avenue, Maywood, IL, 60153, USA
| | - Adrienne N Cobb
- Department of Surgery, Burn Shock Trauma Research Institute, Loyola University Medical Center, 2160 S. 1st Avenue, Maywood, IL, 60153, USA
| | - Haroon Janjua
- Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Matthew Cheung
- Department of Surgery, Burn Shock Trauma Research Institute, Loyola University Medical Center, 2160 S. 1st Avenue, Maywood, IL, 60153, USA
| | - Paul C Kuo
- Department of Surgery, University of South Florida, Tampa, FL, USA
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Cobb AN, Barkat A, Daungjaiboon W, Halandras P, Crisostomo P, Kuo PC, Aulivola B. Carotid Body Tumor Resection: Just as Safe without Preoperative Embolization. Ann Vasc Surg 2020; 64:163-168. [DOI: 10.1016/j.avsg.2019.09.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 09/18/2019] [Accepted: 09/21/2019] [Indexed: 10/25/2022]
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Eguia E, Fahmy JN, Cobb AN, Sweigert P, Aranha GV, Abood G, Kuo PC, Baker MS. Non-Hispanic Blacks undergoing distal pancreatectomy have higher risk-adjusted rates of morbidity and are more likely to be high-cost outliers. Am J Surg 2020; 221:759-763. [PMID: 32278489 DOI: 10.1016/j.amjsurg.2020.02.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 02/20/2020] [Accepted: 02/24/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Few studies evaluate racial disparities in costs and clinical outcomes for patients undergoing distal pancreatectomy (DP). METHODS We queried the Healthcare Cost and Utilization Project State Inpatient Databases to identify patients undergoing DP. Multivariable regression (MVR) was used to evaluate the association between race and postoperative outcomes. RESULTS 2,493 patients underwent DP; 265 (10%) were black, and 221 (8%) were of Hispanic ethnicity. On MVR, black and Hispanic patients were less likely than whites to undergo surgery in high volume centers (OR 0.53, 95% CI [0.40, 0.71]; OR 0.45, 95% CI [0.32, 0.62]). Black patients had a greater risk of postoperative complication (OR 1.40, 95% CI [1.07, 1.83]), 90-day readmission (OR 1.53, 95% CI [1.15, 2.02]), prolonged length of stay (OR 1.74, 95% CI [1.25-2.44]), and of being a high cost outliers (OR 1.40, 95% CI [1.02, 1.91]) compared to white patients. CONCLUSION Black patients have increased risk of having a postoperative complication, prolonged hospitalization, and of being a high-cost outlier than non-Hispanic whites.
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Affiliation(s)
- Emanuel Eguia
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Joseph N Fahmy
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Adrienne N Cobb
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Patrick Sweigert
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Gerard V Aranha
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Gerard Abood
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Paul C Kuo
- Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Marshall S Baker
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA.
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Cobb AN, Erickson TR, Kothari AN, Eguia E, Brownlee SA, Yao W, Choi H, Greenberg V, Mboya J, Voss M, Raicu DS, Settimi-Woods R, Kuo PC. Corrigendum to Commercial Quality "Awards" Are Not a Strong Indicator of Quality Surgical Care [Surgery 164 (2018) 379-386]. Surgery 2020; 167:520. [PMID: 31324433 DOI: 10.1016/j.surg.2019.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Adrienne N Cobb
- Loyola University Medical Center, Department of Surgery, Maywood, IL; One:MAP Section of Surgical Analytics, Department of Surgery, Loyola University Chicago, Maywood, IL
| | - Taylor R Erickson
- Loyola University Medical Center, Department of Surgery, Maywood, IL
| | - Anai N Kothari
- Loyola University Medical Center, Department of Surgery, Maywood, IL; One:MAP Section of Surgical Analytics, Department of Surgery, Loyola University Chicago, Maywood, IL
| | - Emanuel Eguia
- Loyola University Medical Center, Department of Surgery, Maywood, IL; One:MAP Section of Surgical Analytics, Department of Surgery, Loyola University Chicago, Maywood, IL
| | - Sarah A Brownlee
- Loyola University Medical Center, Department of Surgery, Maywood, IL
| | - Weiwei Yao
- DePaul University, College of Computing and Digital Media, Chicago, IL
| | - Hyunyou Choi
- DePaul University, College of Computing and Digital Media, Chicago, IL
| | | | - Joy Mboya
- DePaul University, College of Computing and Digital Media, Chicago, IL
| | - Michael Voss
- DePaul University, College of Computing and Digital Media, Chicago, IL
| | | | | | - Paul C Kuo
- One:MAP Section of Surgical Analytics, Department of Surgery, Loyola University Chicago, Maywood, IL; University of South Florida, Department of Surgery, Tampa, FL.
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Cobb AN, Kuo MC, Kuo PC. New docs on the block: A profile of applicants and subsequent PGY1 trainees of categorical general surgery programs (2013–2016). Am J Surg 2019; 218:218-224. [DOI: 10.1016/j.amjsurg.2018.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/04/2018] [Accepted: 11/24/2018] [Indexed: 11/15/2022]
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Cheung M, Cobb AN, Kuo PC. Corrigendum to 'Predicting burn patient mortality with electronic medical records' [Surgery 164 (2018) 839-847]. Surgery 2019; 167:519. [PMID: 31230840 DOI: 10.1016/j.surg.2019.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Matthew Cheung
- Department of Surgery, Loyola University Medical Center, Maywood, IL.
| | - Adrienne N Cobb
- Department of Surgery, Loyola University Medical Center, Maywood, IL; One:MAP Division of Clinical Informatics and Analytics, Department of Surgery, Loyola University Chicago, IL
| | - Paul C Kuo
- Department of Surgery, University of South Florida, Tampa, FL
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Eguia E, Cobb AN, Baker MS, Joyce C, Gilbert E, Gonzalez R, Afshar M, Churpek MM. Risk factors for infection and evaluation of Sepsis-3 in patients with trauma. Am J Surg 2019; 218:851-857. [PMID: 30885453 DOI: 10.1016/j.amjsurg.2019.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/01/2019] [Accepted: 03/06/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND We aim to examine the risk factors associated with infection in trauma patients and the Sepsis-3 definition. METHODS This was a retrospective cohort study of adult trauma patients admitted to a Level I trauma center between January 2014 and January 2016. RESULTS A total of 1499 trauma patients met inclusion criteria and 15% (n = 232) had an infection. Only 19.8% (n = 46) of infected patients met criteria for Sepsis-3, with the majority (43%) of infected cases having a Sequential Organ Failure Assessment (SOFA) score greater on admission compared to the time of suspected infection. In-hospital death was 7% vs 9% (p = 0.65) between Sepsis-3 and infected patients, respectively. Risk factors associated with infection were female sex, admission SOFA score, Elixhauser score, and severe injury (P < 0.05). CONCLUSION Patients with trauma often arrive with organ dysfunction, which adds complexity and inaccuracy to the operational definition of Sepsis-3 using changes in SOFA scores. Injury severity score, comorbidities, SOFA score, and sex are risk factors associated with developing an infection after trauma.
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Affiliation(s)
- Emanuel Eguia
- Loyola University Chicago Burn Shock Trauma Research Institute, Maywood, IL, USA; Department of Surgery, Acute Care Surgery Division, Loyola University Chicago, Maywood, IL, USA.
| | - Adrienne N Cobb
- Loyola University Chicago Burn Shock Trauma Research Institute, Maywood, IL, USA; Department of Surgery, Acute Care Surgery Division, Loyola University Chicago, Maywood, IL, USA
| | - Marshall S Baker
- Department of Surgery, Acute Care Surgery Division, Loyola University Chicago, Maywood, IL, USA
| | - Cara Joyce
- Department of Public Health Sciences, Loyola University Chicago, Maywood, IL, USA
| | - Emily Gilbert
- Division of Pulmonary and Critical Care Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Richard Gonzalez
- Loyola University Chicago Burn Shock Trauma Research Institute, Maywood, IL, USA; Department of Surgery, Acute Care Surgery Division, Loyola University Chicago, Maywood, IL, USA
| | - Majid Afshar
- Loyola University Chicago Burn Shock Trauma Research Institute, Maywood, IL, USA; Department of Public Health Sciences, Loyola University Chicago, Maywood, IL, USA; Division of Pulmonary and Critical Care Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Matthew M Churpek
- Division of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL, USA
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Kirshenbaum EJ, Blackwell RH, Li B, Eguia E, Janjua HM, Cobb AN, Baldea K, Kuo PC, Gorbonos A. The July Effect in Urological Surgery—Myth or Reality? Urology Practice 2019. [DOI: 10.1016/j.urpr.2018.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Eric J. Kirshenbaum
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
- One:MAP Division of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, Illinois
| | - Robert H. Blackwell
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
- One:MAP Division of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, Illinois
| | - Belinda Li
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Emanuel Eguia
- One:MAP Division of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, Illinois
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Haroon M. Janjua
- One:MAP Division of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, Illinois
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Adrienne N. Cobb
- One:MAP Division of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, Illinois
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Kristin Baldea
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Paul C. Kuo
- One:MAP Division of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, Illinois
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Alex Gorbonos
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
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Cobb AN, Eguia E, Janjua H, Kuo PC. Put Me in the Game Coach! Resident Participation in High-risk Surgery in the Era of Big Data. J Surg Res 2018; 232:308-317. [PMID: 30463734 PMCID: PMC6251497 DOI: 10.1016/j.jss.2018.06.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/11/2018] [Accepted: 06/14/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND With the emphasis on quality metrics guiding reimbursement, concerns have emerged regarding resident participation in patient care. This study aimed to evaluate whether resident participation in high-risk elective general surgery procedures is safe. MATERIALS AND METHODS The American College of Surgeons National Surgical Quality Improvement Program database (2005-2012) was used to identify patients undergoing one of five high-risk general surgery procedures. Resident and nonresident groups were created using a 2:1 propensity score match. Postoperative outcomes were calculated using univariate statistics and multivariable logistic regression for the two groups. Predictors of mortality and morbidity were identified using machine learning in the form of decision trees. RESULTS Twenty-five thousand three hundred sixty three patients met our inclusion criteria. Following matching, each group contained 500 patients and was comparable for matched characteristics. Thirty-day mortality was similar between the groups (2.4% versus 2.6%; P = 0.839). Deep surgical site infection (0% versus 1.6%; P = 0.005), urinary tract infection (5% versus 2.5%; P = 0.029), and operative time (275.6 min versus 250 min; P = 0.0064) were significantly higher with resident participation. Resident participation was not predictive of mortality or complications, while age, American society of anesthesiologists class, and functional status were leading predictors of both. CONCLUSIONS Despite growing time constraints and pressure to perform, surgical resident participation remains safe. Residents should be given active roles in the operating room, even in the most challenging cases.
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Affiliation(s)
- Adrienne N Cobb
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois; Department of Surgery, One:MAP Section of Surgical Analytics, Loyola University Chicago, Maywood, Illinois.
| | - Emanuel Eguia
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois; Department of Surgery, One:MAP Section of Surgical Analytics, Loyola University Chicago, Maywood, Illinois
| | - Haroon Janjua
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois; Department of Surgery, One:MAP Section of Surgical Analytics, Loyola University Chicago, Maywood, Illinois
| | - Paul C Kuo
- Department of Surgery, One:MAP Section of Surgical Analytics, Loyola University Chicago, Maywood, Illinois; Department of Surgery, University of South Florida, Tampa, Florida
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19
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Eguia E, Cobb AN, Janjua HM, Bechara C, Shames ML, Kuo PC. Did the Affordable Care Act Medicaid Expansion Impact Vascular Admissions and Operations? J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
The term big data has been popularized over the past decade and is often used to refer to data sets that are too large or complex to be analyzed by traditional means. Although the term has been utilized for some time in business and engineering, the concept of big data is relatively new to medicine. The reception from the medical community has been mixed; however, the widespread utilization of electronic health records in the United States, the creation of large clinical data sets and national registries that capture information on numerous vectors affecting healthcare delivery and patient outcomes, and the sequencing of the human genome are all opportunities to leverage big data. This review was inspired by a lively panel discussion on big data that took place at the 75th Central Surgical Association Annual Meeting. The authors' aim was to describe big data, the methodologies used to analyze big data, and their practical clinical application.
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Affiliation(s)
- Adrienne N Cobb
- Department of Surgery, Loyola University Medical Center, Maywood, IL; One: MAP Surgical Analytics, Department of Surgery, Loyola University Chicago, Maywood, IL
| | - Andrew J Benjamin
- Department of Surgery, University of Chicago Medical Center, Chicago, IL
| | - Erich S Huang
- Institute for Genome Sciences & Policy, Duke University, Durham, NC; Department of Surgery, Duke University School of Medicine, Durham, NC; Sage Bionetworks, 1100 Fairview Avenue North, Seattle, WA
| | - Paul C Kuo
- Department of Surgery, University of South Florida, Tampa, FL.
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21
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Cheung M, Cobb AN, Kuo PC. Predicting burn patient mortality with electronic medical records. Surgery 2018; 164:839-847. [PMID: 30174140 DOI: 10.1016/j.surg.2018.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 07/10/2018] [Accepted: 07/16/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although there exists robust literature on mortality-associated factors in burn patients, it is not known how electronic medical records affect outcomes. Using burn injury as a surgical care model of information and communication, we hypothesized that functionality and interoperability of the electronic medical record could serve as determinants of outcome. METHODS We used the state inpatient databases for New York, Washington, California, and Florida for the years 2009 and 2010 for all states, with the additional years of 2012 and 2013 for New York (n = 6,002), and the respective data from the American Hospital Association Information Technology survey. Using International Classification of Diseases, Ninth Revision, codes, we included burn patients and characterized total body surface area burned. We summed the binary answers to questions 1 and 2 and question 3 from the American Hospital Association Information Technology survey to make continuous functionality and interoperability scores. Mortality was predicted using extreme gradient boosting in Python. RESULTS In each state in which our models had an accuracy and area under the curve of more than 0.90, electronic medical record functionality but not interoperability was a significant predictor in New York, California, and Florida. Important predictors in each state were, age, duration of stay, total body surface area burned/severity, and total charges. Electronic medical record functionality was more important than all comorbidities except for coagulopathies and electrolyte disorders. Higher functionality scores were associated with mortality (P < .01). CONCLUSION Our data support our hypothesis that electronic medical records may be associated with mortality in burn patients; however, electronic medical records are not having the intended impact on outcomes, and further research needs to elucidate exactly how electronic medical records are being used in clinical settings.
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Affiliation(s)
- Matthew Cheung
- Department of Surgery, Loyola University Medical Center, Maywood, IL.
| | - Adrienne N Cobb
- Department of Surgery, Loyola University Medical Center, Maywood, IL; One:MAP Division of Clinical Informatics and Analytics, Department of Surgery, Loyola University Chicago, IL
| | - Paul C Kuo
- Department of Surgery, University of South Florida, Tampa, FL
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22
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Eguia E, Cobb AN, Kirshenbaum EJ, Afshar M, Kuo PC. Racial and Ethnic Postoperative Outcomes After Surgery: The Hispanic Paradox. J Surg Res 2018; 232:88-93. [PMID: 30463790 DOI: 10.1016/j.jss.2018.05.074] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/03/2018] [Accepted: 05/31/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Hispanic population in the United States have previously been shown to have, in some cases, better health outcomes than non-Hispanic whites (NHWs) despite having lower socioeconomic status and higher frequency of comorbidities. This epidemiologic finding is coined as the Hispanic Paradox (HP). Few studies have evaluated if the HP exists in surgical patients. Our study aimed to examine postoperative complications between Hispanic and NHW patients undergoing low- to high-risk procedures. MATERIALS AND METHODS We conducted a retrospective cohort study analyzing adult patients who underwent high-, intermediate-, and low-risk procedures. The Healthcare Cost and Utilization Project California State Inpatient Database between 2006 and 2011 was used to identify the patient cohort. Candidate variables for the adjusted model were determined a priori and included patient demographics with the ethnic group as the exposure of interest. RESULTS The median age for Hispanics was 52 (SD 19.3) y, and 38.8% were male (n = 87,837). A higher proportion of Hispanics had Medicaid insurance (23.9% versus 3.8%) or were self-pay (14.2% versus 4.5%) compared with NHWs. In adjusted analysis, Hispanics had a higher odds risk for postoperative complications across all risk categories combined (OR 1.06, 95% CI 1.04-1.09). They also had an increased in-hospital (OR 1.38, 95% CI 1.14-1.30) and 30-d mortality in high-risk procedures (OR 1.34, 95% CI 1.19-1.51). CONCLUSIONS Hispanics undergoing low- to high-risk surgery have worse outcomes compared with NHWs. These results do not support the hypothesis of an HP in surgical outcomes.
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Affiliation(s)
- Emanuel Eguia
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois; One: MAP Division of Clinical Informatics and Analytics, Department of Surgery, Loyola University Chicago, Maywood, Illinois.
| | - Adrienne N Cobb
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois; One: MAP Division of Clinical Informatics and Analytics, Department of Surgery, Loyola University Chicago, Maywood, Illinois
| | - Eric J Kirshenbaum
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Majid Afshar
- Department of Pulmonary and Critical Care, Loyola University Medical Center, Maywood, Illinois
| | - Paul C Kuo
- Department of Surgery, University of South Florida, Tampa, Florida
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23
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Cannon AR, Kuprys PV, Cobb AN, Ding X, Kothari AN, Kuo PC, Eberhardt JM, Hammer AM, Morris NL, Li X, Choudhry MA. Alcohol enhances symptoms and propensity for infection in inflammatory bowel disease patients and a murine model of DSS-induced colitis. J Leukoc Biol 2018; 104:543-555. [PMID: 29775230 DOI: 10.1002/jlb.4ma1217-506r] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/28/2018] [Accepted: 04/11/2018] [Indexed: 12/13/2022] Open
Abstract
Over 1.4 million Americans have been diagnosed with inflammatory bowel disease (IBD), and ulcerative colitis (UC) makes up approximately half of those diagnoses. As a disease, UC cycles between periods of remission and flare, which is characterized by intense abdominal pain, increased weight loss, intestinal inflammation, rectal bleeding, and dehydration. Interestingly, a widespread recommendation to IBD patients for avoidance of a flare period is "Don't Drink Alcohol" as recent work correlated alcohol consumption with increased GI symptoms in patients with IBD. Alcohol alone not only induces a systemic pro-inflammatory response, but can also be directly harmful to gut barrier integrity. However, how alcohol could result in the exacerbation of UC in both patients and murine models of colitis has yet to be elucidated. Therefore, we conducted a retrospective analysis of patients admitted for IBD with a documented history of alcohol use in conjunction with a newly developed mouse model of binge alcohol consumption following dextran sulfate sodium (DSS)-induced colitis. We found that alcohol negatively impacts clinical outcomes of patients with IBD, specifically increased intestinal infections, antibiotic injections, abdomen CT scans, and large intestine biopsies. Furthermore, in our mouse model of binge alcohol consumption following an induced colitis flare, we found alcohol exacerbates weight loss, clinical scores, colonic shortening and inflammation, and propensity to infection. These findings highlight alcohol's ability to potentiate symptoms and susceptibility to infection in UC and suggest alcohol as an underlying factor in perpetuating symptoms of IBD.
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Affiliation(s)
- Abigail R Cannon
- Alcohol Research Program, Loyola University Chicago Health Sciences Division, Maywood, Illinois, USA.,Burn & Shock Trauma Research Institute, Loyola University Chicago Health Sciences Division, Maywood, Illinois, USA.,Integrative Cell Biology Program, Loyola University Chicago Health Sciences Division, Maywood, Illinois, USA
| | - Paulius V Kuprys
- Alcohol Research Program, Loyola University Chicago Health Sciences Division, Maywood, Illinois, USA.,Burn & Shock Trauma Research Institute, Loyola University Chicago Health Sciences Division, Maywood, Illinois, USA.,Integrative Cell Biology Program, Loyola University Chicago Health Sciences Division, Maywood, Illinois, USA
| | - Adrienne N Cobb
- Burn & Shock Trauma Research Institute, Loyola University Chicago Health Sciences Division, Maywood, Illinois, USA.,Department of Surgery, Loyola University Chicago Health Sciences Division, Maywood, Illinois, USA
| | - Xianzhong Ding
- Department of Pathology, Loyola University Chicago Health Sciences Division, Maywood, Illinois, USA
| | - Anai N Kothari
- Burn & Shock Trauma Research Institute, Loyola University Chicago Health Sciences Division, Maywood, Illinois, USA.,Department of Surgery, Loyola University Chicago Health Sciences Division, Maywood, Illinois, USA
| | - Paul C Kuo
- Department of Surgery, Loyola University Chicago Health Sciences Division, Maywood, Illinois, USA
| | - Joshua M Eberhardt
- Department of Surgery, Loyola University Chicago Health Sciences Division, Maywood, Illinois, USA
| | - Adam M Hammer
- Alcohol Research Program, Loyola University Chicago Health Sciences Division, Maywood, Illinois, USA.,Burn & Shock Trauma Research Institute, Loyola University Chicago Health Sciences Division, Maywood, Illinois, USA.,Integrative Cell Biology Program, Loyola University Chicago Health Sciences Division, Maywood, Illinois, USA
| | - Niya L Morris
- Alcohol Research Program, Loyola University Chicago Health Sciences Division, Maywood, Illinois, USA.,Burn & Shock Trauma Research Institute, Loyola University Chicago Health Sciences Division, Maywood, Illinois, USA.,Integrative Cell Biology Program, Loyola University Chicago Health Sciences Division, Maywood, Illinois, USA
| | - Xiaoling Li
- Alcohol Research Program, Loyola University Chicago Health Sciences Division, Maywood, Illinois, USA.,Burn & Shock Trauma Research Institute, Loyola University Chicago Health Sciences Division, Maywood, Illinois, USA.,Department of Surgery, Loyola University Chicago Health Sciences Division, Maywood, Illinois, USA
| | - Mashkoor A Choudhry
- Alcohol Research Program, Loyola University Chicago Health Sciences Division, Maywood, Illinois, USA.,Burn & Shock Trauma Research Institute, Loyola University Chicago Health Sciences Division, Maywood, Illinois, USA.,Department of Surgery, Loyola University Chicago Health Sciences Division, Maywood, Illinois, USA.,Department of Pathology, Loyola University Chicago Health Sciences Division, Maywood, Illinois, USA.,Department of Microbiology and Immunology, Loyola University Chicago Health Sciences Division, Maywood, Illinois, USA.,Integrative Cell Biology Program, Loyola University Chicago Health Sciences Division, Maywood, Illinois, USA
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24
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Cobb AN, Daungjaiboon W, Brownlee SA, Baldea AJ, Sanford AP, Mosier MM, Kuo PC. Seeing the forest beyond the trees: Predicting survival in burn patients with machine learning. Am J Surg 2018; 215:411-416. [PMID: 29126594 PMCID: PMC5837911 DOI: 10.1016/j.amjsurg.2017.10.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 10/04/2017] [Accepted: 10/05/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND This study aims to identify predictors of survival for burn patients at the patient and hospital level using machine learning techniques. METHODS The HCUP SID for California, Florida and New York were used to identify patients admitted with a burn diagnosis and merged with hospital data from the AHA Annual Survey. Random forest and stochastic gradient boosting (SGB) were used to identify predictors of survival at the patient and hospital level from the top performing model. RESULTS We analyzed 31,350 patients from 670 hospitals. SGB (AUC 0.93) and random forest (AUC 0.82) best identified patient factors such as age and absence of renal failure (p < 0.001) and hospital factors such as full time residents (p < 0.001) and nurses (p = 0.004) to be associated with increased survival. CONCLUSIONS Patient and hospital factors are predictive of survival in burn patients. It is difficult to control patient factors, but hospital factors can inform decisions about where burn patients should be treated.
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Affiliation(s)
- Adrienne N Cobb
- Loyola University Medical Center, Department of Surgery, 2160 S. 1st Avenue, Maywood, IL 60153, USA; One:MAP Section of Surgical Analytics, Department of Surgery, Loyola University Chicago, 2160 S. 1st Avenue, Maywood, IL 60153, USA.
| | - Witawat Daungjaiboon
- DePaul University, College of Computing and Digital Media, Department of Predictive Analytics, 243 South Wabash Avenue, Chicago, IL 60604, USA.
| | - Sarah A Brownlee
- One:MAP Section of Surgical Analytics, Department of Surgery, Loyola University Chicago, 2160 S. 1st Avenue, Maywood, IL 60153, USA.
| | - Anthony J Baldea
- Loyola University Medical Center, Department of Surgery, 2160 S. 1st Avenue, Maywood, IL 60153, USA.
| | - Arthur P Sanford
- Loyola University Medical Center, Department of Surgery, 2160 S. 1st Avenue, Maywood, IL 60153, USA.
| | - Michael M Mosier
- Loyola University Medical Center, Department of Surgery, 2160 S. 1st Avenue, Maywood, IL 60153, USA.
| | - Paul C Kuo
- Loyola University Medical Center, Department of Surgery, 2160 S. 1st Avenue, Maywood, IL 60153, USA; One:MAP Section of Surgical Analytics, Department of Surgery, Loyola University Chicago, 2160 S. 1st Avenue, Maywood, IL 60153, USA.
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25
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Cobb AN, Barkat A, Daungjaiboon W, Halandras P, Crisostomo P, Kuo PC, Aulivola B. Carotid Body Tumor Resection: Just as Safe without Preoperative Embolization. Ann Vasc Surg 2018; 46:54-59. [PMID: 28689940 PMCID: PMC5726906 DOI: 10.1016/j.avsg.2017.06.149] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/02/2017] [Accepted: 06/16/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Carotid body tumors (CBTs) are rare entities for which surgical resection remains the gold standard. Given their hypervascularity, preoperative embolization is often used; however, controversy exists over whether a benefit is associated. Proponents of embolization argue that it minimizes blood loss and complications. Critics argue that cost and stroke outweigh benefits. This study aimed to investigate the impact of embolization on outcomes following CBT resection. METHODS Patients undergoing CBT resection were identified using the Healthcare Cost and Utilization Project State Inpatient Database for 5 states between 2006 and 2013. Patients were divided into 2 groups: carotid body tumor resection alone (CBTR) and carotid body tumor resection with preoperative arterial embolization (CBETR). Descriptive statistics were calculated using arithmetic means with standard deviations for continuous variables and proportions for categorical variables. Patients were propensity score matched on the basis of sex, age, race, insurance, and comorbidity prior to analysis. Risk-adjusted odds of mortality, stroke, nerve injury, blood loss, and length of stay (LOS) were calculated using mixed-effects regression models with fixed effects for age, race, sex, and comorbidities. RESULTS A total of 547 patients were identified. Of these, 472 patients underwent CBTR and 75 underwent CBETR. Mean age was 54.7 ± 16 years. Mean number of days between embolization and resection was 0.65 ± 0.72 days (range 0-3). When compared with CBTR, there were no significant differences in mortality for CBETR (1.35% vs. 0%, P = 0.316), cranial nerve injury (2.7% vs. 0%, P = 0.48), and blood loss (2.7% vs. 6.8%, P = 0.245). Following risk adjustment, CBETR increased the odds of prolonged LOS (odds ratio 5.3, 95% confidence interval 2.1-13.3). CONCLUSIONS CBT resection is a relatively rare procedure. The utility of preoperative tumor embolization has been questioned. This study demonstrates no benefit of preoperative tumor embolization.
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Affiliation(s)
- Adrienne N Cobb
- Department of Surgery, Loyola University Medical Center, Maywood, IL; One:MAP Section of Surgical Analytics, Department of Surgery, Loyola University Chicago, Chicago, IL
| | - Adel Barkat
- Department of Surgery, Loyola University Medical Center, Maywood, IL; Division of Vascular Surgery and Endovascular Therapy, Loyola University Medical Center, Maywood, IL
| | - Witawat Daungjaiboon
- One:MAP Section of Surgical Analytics, Department of Surgery, Loyola University Chicago, Chicago, IL; Department of Predictive Analytics, DePaul University, Chicago, IL
| | - Pegge Halandras
- Department of Surgery, Loyola University Medical Center, Maywood, IL; Division of Vascular Surgery and Endovascular Therapy, Loyola University Medical Center, Maywood, IL
| | - Paul Crisostomo
- Department of Surgery, Loyola University Medical Center, Maywood, IL; Division of Vascular Surgery and Endovascular Therapy, Loyola University Medical Center, Maywood, IL
| | - Paul C Kuo
- Department of Surgery, Loyola University Medical Center, Maywood, IL; One:MAP Section of Surgical Analytics, Department of Surgery, Loyola University Chicago, Chicago, IL
| | - Bernadette Aulivola
- Department of Surgery, Loyola University Medical Center, Maywood, IL; Division of Vascular Surgery and Endovascular Therapy, Loyola University Medical Center, Maywood, IL.
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26
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Bruce WJ, Chang V, Joyce CJ, Cobb AN, Maduekwe UI, Patel PA. Age at Time of Craniosynostosis Repair Predicts Increased Complication Rate. Cleft Palate Craniofac J 2017; 55:649-654. [PMID: 29665342 DOI: 10.1177/1055665617725215] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE This study uses administrative data to assess the optimal timing for surgical repair of craniosynostosis and to identify factors associated with risk of perioperative complications. DESIGN Statistical analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database (2006, 2009, 2012). SETTING KID-participating hospitals in 44 states. PATIENTS Children 0 to 3 years of age with ICD-9 codes for surgical correction of craniosynostosis (756 and 0124, 0125, 0201, 0203, 0204, or 0206). MAIN OUTCOME MEASURE Age-based cohorts were assessed for perioperative complications. We performed a multivariable analysis to determine characteristics associated with increased risk of complications. RESULTS 21 million admissions were screened and 8417 visits met criteria for inclusion. Seventy-five percent of procedures occurred before age 1. Complications occurred in 8.6% of patients: 6.6% of patients at age 0 to 6 months, 10.3% of patients aged 7 to 12 months, and 13.9% of patients 12 to 36 months. Patients with acrocephalosyndactyly or associated congenital anomalies experienced complications in 22.9% of cases (OR = 3.07, 95% CI = 2.33, 4.03). CONCLUSION Craniosynostosis repair is safe; however, the risk of complications increases with age at intervention. Presence of a syndromic congenital deformity at any age carries the greatest increased risk of perioperative complications. This suggests that optimal timing of intervention is within the first year of life, especially in those cases with additional factors increasing perioperative risk. These data support the importance of counseling patients of the increased risk associated with delaying craniosynostosis repair.
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Affiliation(s)
- William J Bruce
- 1 Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Victor Chang
- 1 Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Cara J Joyce
- 2 Department of Public Health Science, Loyola University Chicago, Maywood, IL, USA
| | - Adrienne N Cobb
- 3 Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Uma I Maduekwe
- 3 Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Parit A Patel
- 4 Department of Surgery, Division of Plastic and Reconstructive Surgery, Loyola University Medical Center, Maywood, IL, USA.,5 Department of Pediatrics, Loyola University Medical Center, Maywood, IL, USA
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Qu LT, Peters S, Cobb AN, Godellas CV, Perez CB, Vaince FT. Considerations for sentinel lymph node biopsy in breast cancer patients with biopsy proven axillary disease prior to neoadjuvant treatment. Am J Surg 2017; 215:530-533. [PMID: 29246403 DOI: 10.1016/j.amjsurg.2017.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 11/09/2017] [Accepted: 11/09/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Axillary disease can be downstaged with neoadjuvant treatment for breast cancer. We attempted to identify factors to consider in determining whether to perform a sentinel lymph node biopsy in patients with biopsy proven axillary metastases (cN+) prior to neoadjuvant treatment. METHODS A retrospective chart review was conducted on patients at a single tertiary care center who underwent neoadjuvant treatment followed by surgery between 9/2013 and 2/2017. RESULTS 47% of patients with node positive disease prior to neoadjuvant treatment were downstaged to node negative (ypN0) disease. These patients were more likely to have triple negative or Her2 positive disease than those patients who remained node positive (ypN+) as these were more likely to have hormone receptor positive disease. These patients were also more likely to demonstrate complete clinical imaging response of the primary tumor and axilla on preoperative breast MRI. CONCLUSIONS Tumor biology and clinical response noted on breast MRI can help guide the decision to perform sentinel lymph node biopsy in patients with axillary node positive disease prior to neoadjuvant treatment.
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Affiliation(s)
- Linda T Qu
- Loyola University Medical Center, Maywood, IL, United States
| | | | - Adrienne N Cobb
- Loyola University Medical Center, Maywood, IL, United States
| | | | - Claudia B Perez
- Loyola University Medical Center, Maywood, IL, United States
| | - Faaiza T Vaince
- Loyola University Medical Center, Maywood, IL, United States.
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Cobb AN, Wong YM, Brownlee SA, Blanco BA, Ezure Y, Paddock HN, Kuo PC, Kothari AN. Perioperative support, not volume, is necessary to optimize outcomes in surgical management of necrotizing enterocolitis. Am J Surg 2016; 213:502-506. [PMID: 27871683 DOI: 10.1016/j.amjsurg.2016.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/04/2016] [Accepted: 11/07/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND This study examines the relationship between hospital volume of surgical cases for necrotizing enterocolitis (NEC) and patient outcomes. METHODS A retrospective cross-sectional review was performed using the HCUP SID for California from 2007 to 2011. Patients with NEC who underwent surgery were identified using ICD-9CM codes. Risk-adjusted models were constructed with mixed-effects logistic regression using patient and demographic covariates. RESULTS 23 hospitals with 618 patients undergoing NEC-related surgical intervention were included. Overall mortality rate was 22.5%. There were no significant differences in the number of NICU beds (p = 0.135) or NICU intensivists (p = 0.469) between high and low volume hospitals. Following risk adjustment, no difference in mortality rate was observed between high and low volume hospitals respectively (24.0% vs. 20.3%, p = 0.555). CONCLUSIONS Our observation that neonates with NEC treated at low-volume centers have no increased risk of mortality may be explained by similar availability of NICU and intensivists resources across hospitals.
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Affiliation(s)
- Adrienne N Cobb
- Loyola University Medical Center, Department of Surgery, Maywood, IL, USA; One:MAP Section of Surgical Analytics, Department of Surgery, Loyola University Chicago, USA
| | - Yee M Wong
- Loyola University Medical Center, Department of Surgery, Maywood, IL, USA
| | - Sarah A Brownlee
- Loyola University Medical Center, Department of Surgery, Maywood, IL, USA; One:MAP Section of Surgical Analytics, Department of Surgery, Loyola University Chicago, USA
| | - Barbara A Blanco
- One:MAP Section of Surgical Analytics, Department of Surgery, Loyola University Chicago, USA
| | - Yoshiki Ezure
- One:MAP Section of Surgical Analytics, Department of Surgery, Loyola University Chicago, USA
| | - Heather N Paddock
- Loyola University Medical Center, Department of Surgery, Maywood, IL, USA; Loyola University Medical Center, Department of Pediatrics, Maywood, IL, USA
| | - Paul C Kuo
- Loyola University Medical Center, Department of Surgery, Maywood, IL, USA; One:MAP Section of Surgical Analytics, Department of Surgery, Loyola University Chicago, USA.
| | - Anai N Kothari
- Loyola University Medical Center, Department of Surgery, Maywood, IL, USA; One:MAP Section of Surgical Analytics, Department of Surgery, Loyola University Chicago, USA
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Plichta JK, Cobb AN, Abood GJ, Godellas C, Perez CB. Abstract P1-10-04: Post-operative imaging after atypical ductal hyperplasia excision: The findings and costs. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p1-10-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: With a reported incidence of 2-12% in breast biopsy specimens, the appropriate management of atypical ductal hyperplasia (ADH) remains in evolution. At present, the optimal screening guidelines for patients with high-risk breast lesions such as ADH remain unclear. Current practices often parallel the surveillance of cancer patients and include a 6 month interval mammogram prior to resuming annual screening, which may result in unnecessary procedures and financial costs. This interval mammogram is typically a diagnostic study, which is an additional cost to the patient and healthcare system. The purpose of this study was to identify interval pathology following initial surgical resection and review associated costs.
Methods: Following institutional review board approval, the pathology database from a single institution was queried for patients who underwent surgical excision for ‘atypical ductal hyperplasia’ from 2008 to 2013. Those who did not have follow-up data available were excluded. Subsequent clinical care was reviewed, including interval imaging and need for additional intervention. Based on a review of hospital charges from 2013, the average charge for a unilateral diagnostic mammogram (out-patient, digital) was $382.
Results: There were 55 patients who underwent an excisional biopsy that were diagnosed with ADH and had subsequent follow-up. The median age was 57 years (range 38-82 years), and the median breast cancer risk assessment score was 2.3% at 5 years (range 0.5-17.9%) and 12.5% lifetime risk (range 2.2-37.6%). Pathology included concurrent lobular carcinoma in situ (n=1), atypical lobular hyperplasia (n=3), flat epithelial atypia (n=14), and papillary lesions (n=19). In addition to a routine clinical breast exam, a short-term follow-up diagnostic (ipsilateral) mammogram was performed in 35 patients. Of the 35 interval mammograms obtained, 31 yielded benign findings on initial imaging, while 4 patients required additional imaging that ultimately resulted in benign findings. The overall hospital charges for the 35 short interval mammograms alone during this 6 year period were roughly $13,370. For the patients that resumed annual surveillance, 3 had abnormal mammograms requiring additional imaging, and no malignancies were identified in this subset of patients. To date, the median physician follow-up is 3 years, and 52 patients have undergone at least one mammogram since their initial imaging; all subsequent findings have been benign for all patients. When extrapolated to national data, cost savings to the healthcare system from eliminating short interval mammograms would exceed $12 million annually without compromising clinical outcomes.
Conclusions: Based on our findings, a 6 month follow-up mammogram is not recommended and incurs unnecessary costs to the patient and healthcare system. In the post-surgical breast, imaging may be misleading and result in additional procedures and significant charges that ultimately do not affect clinical outcomes. Although a clinical exam is still recommended at 6 months following surgical excision for a diagnosis of ADH, patients should forego short interval (6 month) imaging and resume annual mammogram surveillance.
Citation Format: Jennifer K Plichta, Adrienne N Cobb, Gerard J Abood, Constantine Godellas, Claudia B Perez. Post-operative imaging after atypical ductal hyperplasia excision: The findings and costs [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-10-04.
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