1
|
Martin AN, Newhook TE, Arvide EM, Kim BJ, Dewhurst WL, Kawaguchi Y, Tran Cao HS, Chun YS, Katz MH, Vauthey JN, Tzeng CWD. Utilizing risk-stratified pathways to personalize post-hepatectomy discharge planning: A contemporary analysis of 1,354 patients. Am J Surg 2023:S0002-9610(23)00659-1. [PMID: 38129274 DOI: 10.1016/j.amjsurg.2023.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 11/07/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND While risk-stratified post-hepatectomy pathways (RSPHPs) reduce length-of-stay, can they stratify hepatectomy patients by risk of early postoperative events. METHODS 90-day outcomes from consecutive hepatectomies were analyzed (1/1/2017-12/31/2021). Pre/post-pathway analysis was performed for pathways: minimally invasive surgery ("MIS"); non-anatomic resection/left hepatectomy ("low-intermediate risk"); right/extended hepatectomy ("high-risk"); "Combination" operations. Time-to-event (TTE) analyses for readmission and interventional radiology procedures (IRPs) was performed. RESULTS 1354 patients were included: MIS/n= 119 (9 %); low-intermediate risk/n= 443 (33 %); high-risk/n= 328 (24 %); Combination/n= 464 (34 %). There was no difference in readmission (pre: 13 % vs. post:11.5 %, p = 0.398). There were fewer readmissions in post-pathway patients amongst MIS, low-intermediate risk, and Combination patients (all p > 0.1). 114 (8.4 %) patients required IRPs. Time-to-readmission and time-to-IR-procedure plots demonstrated lower plateaus and flatter slopes for MIS/low-intermediate-risk pathways post-pathway implementation (p < 0.001). CONCLUSION RSPHPs can reliably stratify patients by risks of readmission or need for an IR procedure by predicting the most frequent period for these events.
Collapse
Affiliation(s)
- Allison N Martin
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Timothy E Newhook
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elsa M Arvide
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bradford J Kim
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Whitney L Dewhurst
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yoshikuni Kawaguchi
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hop S Tran Cao
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yun Shin Chun
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Matthew Hg Katz
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ching-Wei D Tzeng
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| |
Collapse
|
2
|
Martin AN. Invited Commentary: Limitations of National Databases Hinder Our Ability to Assess Surgical Outcomes and Mitigate Disparity for Minority Populations. J Am Coll Surg 2023; 237:555-557. [PMID: 37326310 DOI: 10.1097/xcs.0000000000000745] [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: 06/17/2023]
|
3
|
Martin AN, Snyder RA. Invited commentary on conversion of unresectable to resectable colorectal liver metastases: Even the best predictive models cannot substitute for surgical evaluation. Surgery 2023; 173:1518-1519. [PMID: 37029017 DOI: 10.1016/j.surg.2023.02.029] [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] [Received: 02/08/2023] [Accepted: 02/23/2023] [Indexed: 04/09/2023]
Affiliation(s)
- Allison N Martin
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX. https://twitter.com/globalsurgallie
| | - Rebecca A Snyder
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX.
| |
Collapse
|
4
|
Martin AN, Tzeng CWD, Arvide EM, Skibber JM, Chang GJ, Nancy You YQ, Bednarski BK, Uppal A, Dewhurst WL, Cristo JV, Chun YS, Tran Cao HS, Vauthey JN, Newhook TE. Impact of cumulative operative time on postoperative complication risk in simultaneous resections of colorectal liver metastases and primary tumors. HPB (Oxford) 2023; 25:347-352. [PMID: 36697350 DOI: 10.1016/j.hpb.2022.12.008] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 12/14/2022] [Accepted: 12/31/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Simultaneous resection of colorectal liver metastases (CLM) and primary colorectal cancers (CRC) is nuanced without firm rules for selection. This study aimed to identify factors associated with morbidity after simultaneous resection. METHODS Using a prospective database, patients undergoing simultaneous CLM-CRC resection from 1/1/2017-7/1/2020 were analyzed. Regression modeling estimated impact of colorectal resection type, Kawaguchi-Gayet (KG) hepatectomy complexity, and perioperative factors on 90-day complications. RESULTS Overall, 120 patients underwent simultaneous CLM-CRC resection. Grade≥2 complications occurred in 38.3% (n = 46); these patients experienced longer length of stay (median LOS 7.5 vs. 4, p < 0.001) and increased readmission (39% vs. 1.4%, p < 0.001) compared to patients with zero or Grade 1 complications. Median OR time was 298 min. Patients within highest operative time quartile (>506 min) had higher grade≥2 complications (57%vs. 23%, p = 0.04) and greater than 4-fold increased odds of grade≥2 morbidity (OR 4.3, 95% CI (Confidence Interval) 1.41-13.1, p = 0.01). After adjusting for Pringle time, KG complexity and colorectal resection type, increasing operative time was associated with grade≥2 complications, especially for resections in highest quartile of operative time (OR 7.28, 95% CI 1.73-30.6, p = 0.007). CONCLUSION In patients undergoing simultaneous CLM-CRC resection, prolonged operative time is independently associated with grade≥2 complications. Awareness of cumulative operative time may inform intraoperative decision-making by surgical teams.
Collapse
Affiliation(s)
- Allison N Martin
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ching-Wei D Tzeng
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elsa M Arvide
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John M Skibber
- Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - George J Chang
- Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yi-Qian Nancy You
- Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brian K Bednarski
- Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Abhineet Uppal
- Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Whitney L Dewhurst
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jenilette V Cristo
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yun S Chun
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hop S Tran Cao
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Timothy E Newhook
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| |
Collapse
|
5
|
Traweek RS, Martin AN, Rajkot NF, Guadagnolo BA, Bishop AJ, Lazar AJ, Keung EZ, Torres KE, Hunt KK, Feig BW, Roland CL, Scally CP. ASO Visual Abstract: Re-Excision After Unplanned Excision of Soft Tissue Sarcoma Is Associated with High Morbidity and Limited Pathologic Identification of Residual Disease. Ann Surg Oncol 2023; 30:492. [PMID: 36245056 DOI: 10.1245/s10434-022-12415-1] [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: 12/13/2022]
Affiliation(s)
- Raymond S Traweek
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Allison N Martin
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nikita F Rajkot
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - B Ashleigh Guadagnolo
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew J Bishop
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alexander J Lazar
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Emily Z Keung
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Keila E Torres
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kelly K Hunt
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Barry W Feig
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christina L Roland
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christopher P Scally
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| |
Collapse
|
6
|
Traweek RS, Martin AN, Rajkot NF, Guadagnolo BA, Bishop AJ, Lazar AJ, Keung EZ, Torres KE, Hunt KK, Feig BW, Roland CL, Scally CP. Re-excision After Unplanned Excision of Soft Tissue Sarcoma is Associated with High Morbidity and Limited Pathologic Identification of Residual Disease. Ann Surg Oncol 2023; 30:480-489. [PMID: 36085392 DOI: 10.1245/s10434-022-12359-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/11/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients with unplanned excision (UPE) of trunk and extremity soft tissue sarcoma (STS) present a significant management challenge for sarcoma specialists. Oncologic re-resection has been considered standard practice after UPE with positive or uncertain margins. A strategy of active surveillance or "watch and wait" has been suggested as a safe alternative to routine re-excision. In this context, the current study sought to evaluate short-term outcomes and morbidity after re-resection to better understand the risks and benefits of this treatment strategy. METHODS A retrospective, single-institution study reviewed patients undergoing oncologic re-resection after UPE of an STS during a 5-year period (2015-2020), excluding those with evidence of gross residual disease. Short-term clinical outcomes were evaluated together with final pathologic findings. RESULTS The review identified 67 patients undergoing re-resection after UPE of an STS. Of these 67 patients, 45 (67%) were treated with a combination of external beam radiation therapy (EBRT) and surgery. Plastic surgery was involved for reconstruction in 49 cases (73%). The rate of wound complications after re-resection was 45 % (n = 30), with 15 % (n = 10) of the patients experiencing a major wound complication. Radiation therapy and plastic surgery involvement were independently associated with wound complications. Notably, 45 patients (67%) had no evidence of residual disease in the re-resection specimen, whereas 13 patients (19 %) had microscopic disease, and 9 patients (13%) had indeterminate pathology. CONCLUSION Given the morbidity of re-resection and limited identification of residual disease, treatment plans and discussions with patients should outline the expected pathologic findings and morbidity of surgery.
Collapse
Affiliation(s)
- Raymond S Traweek
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Allison N Martin
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nikita F Rajkot
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - B Ashleigh Guadagnolo
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Andrew J Bishop
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alexander J Lazar
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Emily Z Keung
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Keila E Torres
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kelly K Hunt
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Barry W Feig
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Christina L Roland
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Christopher P Scally
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| |
Collapse
|
7
|
Kim BJ, Arvide EM, Gaskill C, Martin AN, Kawaguchi Y, Chiang YJ, Dewhurst WL, Lee T, Tran Cao HS, Chun YS, Katz MH, Vauthey JN, Tzeng CWD, Newhook TE. Risk-Stratified Post-Hepatectomy Pathways Based Upon the Kawaguchi-Gayet Complexity Classification and Impact on Length of Stay. Surg Open Sci 2022; 9:109-116. [PMID: 35747509 PMCID: PMC9209704 DOI: 10.1016/j.sopen.2022.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 10/25/2022] Open
|
8
|
Lattimore CM, Kane WJ, Fleming MA, Martin AN, Mehaffey JH, Smolkin ME, Ratcliffe SJ, Zaydfudim VM, Showalter SL, Hedrick TL. Disparities in telemedicine utilization among surgical patients during COVID-19. PLoS One 2021; 16:e0258452. [PMID: 34624059 PMCID: PMC8500431 DOI: 10.1371/journal.pone.0258452] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/27/2021] [Indexed: 11/19/2022] Open
Abstract
Background Telemedicine has been rapidly adopted in the wake of the COVID-19 pandemic. There is limited work surrounding demographic and socioeconomic disparities that may exist in telemedicine utilization. This study aimed to examine demographic and socioeconomic differences in surgical patient telemedicine usage during the COVID-19 pandemic. Methods Department of Surgery outpatients seen from July 1, 2019 to May 31, 2020 were stratified into three visit groups: pre-COVID-19 in-person, COVID-19 in-person, or COVID-19 telemedicine. Generalized linear models were used to examine associations of sex, race/ethnicity, Distressed Communities Index (DCI) scores, MyChart activation, and insurance status with telemedicine usage during the COVID-19 pandemic. Results 14,792 patients (median age 60, female [57.0%], non-Hispanic White [76.4%]) contributed to 21,980 visits. Compared to visits before the pandemic, telemedicine visits during COVID-19 were more likely to be with patients from the least socioeconomically distressed communities (OR, 1.31; 95% CI, 1.08,1.58; P = 0.005), with an activated MyChart (OR, 1.38; 95% CI, 1.17–1.64; P < .001), and with non-government or commercial insurance (OR, 2.33; 95% CI, 1.84–2.94; P < .001). Adjusted comparison of telemedicine visits to in person visits during COVID-19 revealed telemedicine users were more likely to be female (OR, 1.38, 95% CI, 1.10–1.73; P = 0.005) and pay with non-government or commercial insurance (OR, 2.77; 95% CI, 1.85–4.16; P < .001). Conclusions During the first three months of the COVID-19 pandemic, telemedicine was more likely utilized by female patients and those without government or commercial insurance compared to patients who used in-person visits. Interventions using telemedicine to improve health care access might consider such differences in utilization.
Collapse
Affiliation(s)
- Courtney M. Lattimore
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, United States of America
| | - William J. Kane
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, United States of America
| | - Mark A. Fleming
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, United States of America
| | - Allison N. Martin
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - J. Hunter Mehaffey
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, United States of America
| | - Mark E. Smolkin
- Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia, United States of America
| | - Sarah J. Ratcliffe
- Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia, United States of America
| | - Victor M. Zaydfudim
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, United States of America
| | - Shayna L. Showalter
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, United States of America
| | - Traci L. Hedrick
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, United States of America
- * E-mail:
| |
Collapse
|
9
|
Fleming MA, Scott EJ, Bradford PS, Lattimore CM, Omesiete WI, Williams CA, Williams MD, Martin AN. The Risk and Reward of Speaking Out for Racial Equity in Surgical Training. J Surg Educ 2021; 78:1387-1392. [PMID: 33531275 DOI: 10.1016/j.jsurg.2021.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/22/2020] [Accepted: 01/23/2021] [Indexed: 06/12/2023]
Abstract
In order to maintain productivity and career advancement, Black and Brown individuals often find themselves downplaying persistent elements of bias and racism experienced in predominantly white fields. These elements are commonly reinforced by institutional and departmental policies that hinder the creation of an equitable and inclusive environment for all. In this manuscript, we outline specific challenges faced by Black and Brown trainees and faculty that are perpetuated by such policies. The challenges are followed by specific recommendations for change as they may apply to faculty, staff and trainees. The outlined recommendations or "action items" may be enacted by any residency program or department based on perceived timeliness and should serve as a foundation for change-one that is intently created through a lens of anti-racism. The risk of speaking up for racial equity is outweighed by the potential rewards of building an environment that is diverse, inclusive and better for everyone.
Collapse
Affiliation(s)
- Mark A Fleming
- Department of Surgery, University of Virginia, Charlottesville, Virginia.
| | - Erik J Scott
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Perry S Bradford
- Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia
| | | | - Wilson I Omesiete
- Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia
| | - Carlin A Williams
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Michael D Williams
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Allison N Martin
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| |
Collapse
|
10
|
Martin AN, Hassinger TE, Lynch KT, Martin LW, Modesitt SC, Thiele RH, Hedrick TL. Perioperative Impact of Widespread Implementation of an Enhanced Recovery Protocol on Short-term Outcomes in Cancer Patients. J Gastrointest Surg 2021; 25:1316-1318. [PMID: 33037555 DOI: 10.1007/s11605-020-04820-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/01/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Allison N Martin
- Department of Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22908-0709, USA
| | - Taryn E Hassinger
- Department of Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22908-0709, USA
| | - Kevin T Lynch
- Department of Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22908-0709, USA
| | - Linda W Martin
- Department of Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22908-0709, USA
| | - Susan C Modesitt
- Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, USA
| | - Robert H Thiele
- Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA
| | - Traci L Hedrick
- Department of Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22908-0709, USA.
| |
Collapse
|
11
|
Martin AN, Stein SL. Female Surgical Trainees and Departmental Awards: Narrowing the Gap. JAMA Surg 2020:2769844. [PMID: 32876669 DOI: 10.1001/jamasurg.2020.3532] [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: 11/14/2022]
Affiliation(s)
| | - Sharon L Stein
- Department of Surgery, University Hospitals/Cleveland Medical Center, Cleveland, Ohio
| |
Collapse
|
12
|
Martin AN, Petroze RT. Academic global surgery and COVID-19: Turning impediments into opportunities. Am J Surg 2020; 220:53-54. [PMID: 32418632 PMCID: PMC7224147 DOI: 10.1016/j.amjsurg.2020.05.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 01/28/2023]
Affiliation(s)
- Allison N Martin
- University of Virginia Department of Surgery, Charlottesville, VA, USA
| | - Robin T Petroze
- University of Florida, Division of Pediatric Surgery, Gainesville, FL, USA.
| |
Collapse
|
13
|
Martin AN, Meredith K, Norman MD, Bryan E, Baker A. Lithium and strontium isotope dynamics in a carbonate island aquifer, Rottnest Island, Western Australia. Sci Total Environ 2020; 715:136906. [PMID: 32041044 DOI: 10.1016/j.scitotenv.2020.136906] [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] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/22/2020] [Accepted: 01/22/2020] [Indexed: 06/10/2023]
Abstract
Water-rock interactions in aquifer systems are a key control on water quality but remain poorly understood. Lithium (Li) isotopes are useful for understanding water-rock interactions, but there are few data available for groundwater aquifers. Here we present a Li isotope dataset for rainfall and groundwater samples from a carbonate island aquifer system: Rottnest Island, Western Australia. This dataset was complemented by strontium (Sr) isotope and major and trace element data for groundwaters, and leaching experiments on bedrock samples. The δ7Li values and 87Sr/86Sr ratios of fresh groundwaters ranged from +23 to +36‰ and 0.709167 to 0.709198, respectively. Mass balance calculations indicated that silicate weathering supplied ~60 and 70% of dissolved Li and Sr in fresh groundwaters, respectively, with the remainder provided by atmospheric input, and carbonate weathering; for major cations, the majority of calcium and sodium (Na) are supplied by carbonate weathering and atmospheric input, respectively. The estimated low proportion of Sr produced by carbonate weathering was surprising in a carbonate aquifer, and the 87Sr/86Sr data indicated that the silicate Sr source had low Rb/Sr and 87Sr/86Sr ratios. There was an increase in the maximum δ7Li values in fresh groundwaters (+36‰) relative to the maximum value in rainfall and seawater (ca. +31‰). As clay minerals are undersaturated in fresh groundwaters, this increase may be explained by Li isotope fractionation associated with ion-exchange reactions on clays and iron(oxy)hydroxides. In the more saline groundwaters, the minimum δ7Li values decreased with depth to +14.5‰, suggesting increased silicate mineral dissolution in the deeper aquifer. These results reveal the importance of water-rock interactions in a coastal carbonate aquifer, and demonstrate the usefulness of Li isotopes for tracing weathering reactions in an environmental setting where traditional weathering tracers, such as sodium and Sr isotopes, are less appropriate.
Collapse
Affiliation(s)
- A N Martin
- Connected Waters Initiative Research Centre, UNSW Sydney, Sydney, NSW 2052, Australia; Australian Nuclear Science and Technology Organisation, Lucas Heights, NSW 2234, Australia; School of Biological, Earth and Environmental Sciences, UNSW Sydney, Sydney, NSW 2052, Australia; Institut für Mineralogie, Leibniz Universität Hannover, Callinstraße 3, 30167 Hannover, Germany.
| | - K Meredith
- Connected Waters Initiative Research Centre, UNSW Sydney, Sydney, NSW 2052, Australia; Australian Nuclear Science and Technology Organisation, Lucas Heights, NSW 2234, Australia
| | - M D Norman
- Research School of Earth Sciences, The Australian National University, Canberra, ACT 2601, Australia
| | - E Bryan
- Connected Waters Initiative Research Centre, UNSW Sydney, Sydney, NSW 2052, Australia; Australian Nuclear Science and Technology Organisation, Lucas Heights, NSW 2234, Australia; School of Biological, Earth and Environmental Sciences, UNSW Sydney, Sydney, NSW 2052, Australia
| | - A Baker
- Connected Waters Initiative Research Centre, UNSW Sydney, Sydney, NSW 2052, Australia; School of Biological, Earth and Environmental Sciences, UNSW Sydney, Sydney, NSW 2052, Australia
| |
Collapse
|
14
|
Martin AN, Hoagland DL, Turrentine FE, Jones RS, Zaydfudim VM. Safety of Major Abdominal Operations in the Elderly: A Study of Geriatric-Specific Determinants of Health. World J Surg 2020; 44:2592-2600. [PMID: 32318790 PMCID: PMC7223877 DOI: 10.1007/s00268-020-05515-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Preoperative assessment of geriatric-specific determinants of health may enhance perioperative risk stratification among elderly patients. This study examines effects of geriatric-specific variables on postoperative outcomes in patients undergoing elective major abdominal operations. METHODS Patients included in the ACS NSQIP pilot Geriatric Surgery Research File program who underwent elective pancreatic, liver, and colorectal operations between 2014 and 2016 were examined. Multivariable analyses were performed to evaluate associations between patient-specific geriatric variables and risk of death, morbidity, readmission, and discharge destination. RESULTS A total of 4165 patients were included. Patients ≥85 years were more likely to die, experience postoperative morbidity, and be discharged to a facility (all p ≤ 0.039) than younger patients. Preoperatively, patients ≥85 years were more likely to use a mobility aid, have a prior fall, have consent signed by a surrogate, and to live alone at home prior to operation (all p < 0.001). After adjustment for ACS NSQIP-estimated probabilities of morbidity or mortality, no geriatric-specific preoperative risk factors were significantly associated with increased risk of death or complications in any age group (all p > 0.055). Patients 75-84 and ≥85 years were more likely to be discharged to facility (OR 2.33 and 4.75, respectively, both p < 0.001) compared to patients 65-74 years. All geriatric-specific variables: use of mobility aid, living alone, consent signed by a surrogate, and fall history, were significantly associated with discharge to a facility (all p ≤ 0.001). CONCLUSIONS After adjusting for comorbid conditions, geriatric-specific variables are not associated with postoperative mortality and morbidity among elderly patients; however, geriatric-specific variables are significantly associated with discharge to a facility.
Collapse
Affiliation(s)
- Allison N Martin
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Darian L Hoagland
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Florence E Turrentine
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
- Surgical Outcomes Research Center, University of Virginia, Charlottesville, VA, USA
| | - R Scott Jones
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
- Surgical Outcomes Research Center, University of Virginia, Charlottesville, VA, USA
| | - Victor M Zaydfudim
- Department of Surgery, University of Virginia, Charlottesville, VA, USA.
- Division of Surgical Oncology, Section of Hepatobiliary and Pancreatic Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22908-0709, USA.
- Surgical Outcomes Research Center, University of Virginia, Charlottesville, VA, USA.
| |
Collapse
|
15
|
Turrentine FE, Zaydfudim VM, Martin AN, Jones RS. Association of Geriatric-Specific Variables with 30-Day Hospital Readmission Risk of Elderly Surgical Patients: A NSQIP Analysis. J Am Coll Surg 2020; 230:527-533.e1. [PMID: 32081752 DOI: 10.1016/j.jamcollsurg.2019.12.032] [Citation(s) in RCA: 4] [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: 12/16/2019] [Accepted: 12/16/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Elderly patients (65 years of age and older) undergo an increasing number of operations performed annually in the US and they present with unique healthcare needs. Preventing postoperative readmission remains an important challenge to improving surgical care. This study examined whether geriatric-specific variables were independently associated with postoperative readmissions of elderly patients. METHODS The American College of Surgeons (ACS) Geriatric Surgery Research File (GSRF) was joined with the ACS NSQIP Participant Use Data Files for 2014 to 2016. This data set included 13 GSRF variables and 26 ACS NSQIP variables. Associations between clinically relevant variables and readmission were tested with multivariable logistic regression. RESULTS The data represented 6,039 general surgery patients age 65 years and older. Fifty-eight percent of patients had colorectal operations, 19% pancreatic or hepatobiliary, 15% hernia, 4% thyroid or esophageal, and 3% had appendix operations. Twenty-four percent of patients experienced an NSQIP-defined 30-day postoperative complication and 3% died within 30 days after operation. Eleven percent of patients had unplanned 30-day readmission. Standard NSQIP variables, including 30-day composite morbidity (odds ratio [OR] 5.11; 95% CI, 4.24 to 6.16; p < 0.001), reoperation (OR 2.8; 95% CI, 2.07 to 3.79; p < 0.001), and steroid use (1.42; 95% CI, 1.03 to 1.96; p = 0.03) were associated with readmission. In addition, GSRF variables, including incompetent on admission (OR 1.63; 95% CI, 1.11 to 2.38; p = 0.01), fall risk at discharge (OR 1.42; 95% CI, 1.11 to 1.82; p = 0.005), use of mobility aid (OR 1.26; 95% CI, 1.02 to 1.56; p = 0.03), and discharged home with skilled care (OR, 1.22; 95% CI, 1.0 to 1.49; p = 0.04) were associated with readmission. CONCLUSIONS Four GSRF and 3 current standard ACS NSQIP variables were important in the evaluation of postoperative readmission of elderly patients. Geriatric-specific variables contributed to the explanation of the relationship between clinical variables and readmissions in elderly surgical patients.
Collapse
Affiliation(s)
| | | | - Allison N Martin
- Department of Surgery, University of Virginia, Charlottesville, VA
| | - R Scott Jones
- Department of Surgery, University of Virginia, Charlottesville, VA
| |
Collapse
|
16
|
Johnson-Mann C, Martin AN, Williams MD, Hallowell PT, Schirmer B. Investigating racial disparities in bariatric surgery referrals. Surg Obes Relat Dis 2019; 15:615-620. [DOI: 10.1016/j.soard.2019.02.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/03/2019] [Accepted: 02/06/2019] [Indexed: 01/28/2023]
|
17
|
Martin AN, Wilkins LR, Das D, Johnston LE, Bauer TW, Adams RB, Zaydfudim VM. Efficacy of Radiofrequency Ablation versus Transarterial Chemoembolization for Patients with Solitary Hepatocellular Carcinoma ≤3 cm. Am Surg 2019. [DOI: 10.1177/000313481908500220] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Optimal treatment for small hepatocellular carcinoma (HCC) ≤ 3 cm remains controversial. Ablation and chemoembolization are considered for nonoperative candidates. This study compares survival among patients with solitary HCC ≤ 3 cm treated with radiofrequency ablation (RFA) and transarterial chemoembolization (TACE). Patients diagnosed with HCC ≤ 3 cm between 2005 and 2014 were included. Kaplan-Meier survival functions with log-rank tests were used to estimate recurrence-free survival and overall survival (OS) survival. Among 161 patients with solitary HCC ≤ 3 cm, 145 patients with mean age of 65.2 years (69.2) and 95 per cent prevalence of cirrhosis had operative treatment or TACE, and/or RFA. From this cohort, 27 (19%) patients had TACE, 27 (19%) patients had RFA, and 15 (10%) patients had TACE/RFA. The patients treated with definitive TACE, RFA, or TACE/RFA had a similar 1-year recurrence-free survival (23% vs 27% vs 36%, respectively, P = 0.445) and similar 5-year OS (21% vs 24% vs 33%, respectively, P = 0.287). Thirty-five (24%) patients were bridged to transplantation with TACE and/or RFA. The 5-year OS was significantly improved in patients bridged to transplantation (P < 0.001). Survival does not differ between patients with solitary HCC ≤ 3 cm treated with TACE or RFA. Patients who were bridged to transplantation had significantly greater OS compared with patients who were not transplanted.
Collapse
Affiliation(s)
- Allison N. Martin
- Section of Hepatobiliary and Pancreatic Surgery, Department of Surgery
| | | | - Deepanjana Das
- Section of Hepatobiliary and Pancreatic Surgery, Department of Surgery
| | - Lily E. Johnston
- Section of Hepatobiliary and Pancreatic Surgery, Department of Surgery
| | - Todd W. Bauer
- Section of Hepatobiliary and Pancreatic Surgery, Department of Surgery
| | - Reid B. Adams
- Section of Hepatobiliary and Pancreatic Surgery, Department of Surgery
| | - Victor M. Zaydfudim
- Section of Hepatobiliary and Pancreatic Surgery, Department of Surgery
- Surgical Outcomes Research Center, University of Virginia, Charlottesville, Virginia
| |
Collapse
|
18
|
Martin AN, Wilkins LR, Das D, Johnston LE, Bauer TW, Adams RB, Zaydfudim VM. Efficacy of Radiofrequency Ablation versus Transarterial Chemoembolization for Patients with Solitary Hepatocellular Carcinoma ≤3 cm. Am Surg 2019; 85:150-155. [PMID: 30819290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Optimal treatment for small hepatocellular carcinoma (HCC) ≤ 3 cm remains controversial. Ablation and chemoembolization are considered for nonoperative candidates. This study compares survival among patients with solitary HCC ≤ 3 cm treated with radiofrequency ablation (RFA) and transarterial chemoembolization (TACE). Patients diagnosed with HCC ≤ 3 cm between 2005 and 2014 were included. Kaplan-Meier survival functions with log-rank tests were used to estimate recurrence-free survival and overall survival (OS) survival. Among 161 patients with solitary HCC ≤ 3 cm, 145 patients with mean age of 65.2 years (±9.2) and 95 per cent prevalence of cirrhosis had operative treatment or TACE, and/or RFA. From this cohort, 27 (19%) patients had TACE, 27 (19%) patients had RFA, and 15 (10%) patients had TACE/RFA. The patients treated with definitive TACE, RFA, or TACE/RFA had a similar 1-year recurrence-free survival (23% vs 27% vs 36%, respectively, P = 0.445) and similar 5-year OS (21% vs 24% vs 33%, respectively, P = 0.287). Thirty-five (24%) patients were bridged to transplantation with TACE and/or RFA. The 5-year OS was significantly improved in patients bridged to transplantation (P < 0.001). Survival does not differ between patients with solitary HCC ≤ 3 cm treated with TACE or RFA. Patients who were bridged to transplantation had significantly greater OS compared with patients who were not transplanted.
Collapse
|
19
|
Martin AN, Kaneza KM, Kulkarni A, Mugenzi P, Ghebre R, Ntirushwa D, Ilbawi AM, Pace LE, Costas-Chavarri A. Cancer Control at the District Hospital Level in Sub-Saharan Africa: An Educational and Resource Needs Assessment of General Practitioners. J Glob Oncol 2019; 5:1-8. [PMID: 30668270 PMCID: PMC6426480 DOI: 10.1200/jgo.18.00126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
PURPOSE The WHO framework for early cancer diagnosis highlights the need to improve health care capacity among primary care providers. In Rwanda, general practitioners (GPs) at district hospitals (DHs) play key roles in diagnosing, initiating management, and referring suspected patients with cancer. We sought to ascertain educational and resource needs of GPs to provide a blueprint that can inform future early cancer diagnosis capacity–building efforts. METHODS We administered a cross-sectional survey study to GPs practicing in 42 Rwandan DHs to assess gaps in cancer-focused knowledge, skills, and resources, as well as delays in the referral process. Responses were aggregated and descriptive analysis was performed to identify trends. RESULTS Survey response rate was 76% (73 of 96 GPs). Most responders were 25 to 29 years of age (n = 64 [88%]) and 100% had been practicing between 3 and 12 months. Significant gaps in cancer knowledge and physical exam skills were identified—88% of respondents were comfortable performing breast exams, but less than 10 (15%) GPs reported confidence in performing pelvic exams. The main educational resource requested by responders (n = 59 [81%]) was algorithms to guide clinical decision-making. Gaps in resource availability were identified, with only 39% of responders reporting breast ultrasound availability and 5.8% reporting core needle biopsy availability in DHs. Radiology and pathology resources were limited, with 52 (71%) reporting no availability of pathology services at the DH level. CONCLUSION The current study reveals significant basic oncologic educational and resource gaps in Rwanda, such as physical examination skills and diagnostic tools. Capacity building for GPs in low- and middle-income countries should be a core component of national cancer control plans to improve accurate and timely diagnosis of cancer. Continuing professional development activities should address and focus on context-specific educational gaps, resource availability, and referral practice guidelines.
Collapse
Affiliation(s)
| | | | | | | | - Rahel Ghebre
- University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda.,University of Minnesota Medical School, Minneapolis, MN.,Yale School of Medicine, New Haven, CT
| | - David Ntirushwa
- University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | | | | | - Ainhoa Costas-Chavarri
- Rwanda Military Hospital, Kigali, Rwanda.,Yale School of Medicine, New Haven, CT.,Boston Children's Hospital, Boston, MA
| |
Collapse
|
20
|
Johnson-Mann C, Martin AN, Williams MD, Hallowell P, Schirmer B. Investigating racial disparities in bariatric surgery referrals. Surg Obes Relat Dis 2018. [DOI: 10.1016/j.soard.2018.09.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
21
|
Martin AN, Silverstein A, Ssebuufu R, Lule J, Mugenzi P, Fehr A, Mpunga T, Shulman LN, Park PH, Costas-Chavarri A. Impact of delayed care on surgical management of patients with gastric cancer in a low-resource setting. J Surg Oncol 2018; 118:1237-1242. [PMID: 30380140 DOI: 10.1002/jso.25286] [Citation(s) in RCA: 4] [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: 08/30/2018] [Accepted: 10/11/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Gastric cancer is the fifth most common cancer in Eastern Africa. Diagnostic delays in low-resource countries result in advanced disease presentation. We describe perioperative management of gastric cancer in Rwanda. METHODS A retrospective review of records at three hospitals was performed to identify gastric adenocarcinoma cases from January 2012 to June 2016. Multiple perioperative and tumor-related variables were collected. Descriptive and bivariate analyses were performed. RESULTS The final analysis included 229 patients with gastric cancer. Median age was 58 years (interquartile range [IQR] 49-65) and 49.6% were female (n = 114). Patients reported symptoms (ie, weight loss, epigastric pain) for a median time of 12 months (IQR 7.5-24). On presentation, 18.8% ( n = 43) had gastric outlet obstruction; 13.5% ( n = 31) had a palpable mass. Fifty-one percent ( n = 117) underwent an operation; of these, 74% ( n = 86) received gastrojejunostomy or were inoperable; and 29% ( n = 34) underwent curative resection. Palliative care referrals were made for 9% ( n = 20). Pathology reports were available for 190 patients (83.0%). Only 11.3% ( n = 26) had Helicobacter pylori ( H. pylori) testing of which 65.4% tested positive ( n = 17). CONCLUSIONS A majority of patients presented with advanced disease. Very few patients had a curative resection. Significant advances in diagnosis and treatment are needed to improve the care of gastric cancer patients in Rwanda.
Collapse
Affiliation(s)
- Allison N Martin
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Allison Silverstein
- Department of Plastic Surgery, Boston Children's Hospital, Boston, Massachusetts.,Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts.,Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Robinson Ssebuufu
- Department of Surgery, Centre Hospitalier Universitaire de Butare, Butare, Rwanda
| | - Joseph Lule
- Department of Surgery, Rwanda Military Hospital, Kigali, Rwanda
| | | | | | | | - Lawrence N Shulman
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennyslavia
| | - Paul H Park
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts.,Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.,Department of Global Health and Social Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ainhoa Costas-Chavarri
- Department of Plastic Surgery, Boston Children's Hospital, Boston, Massachusetts.,Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts.,Department of Surgery, Rwanda Military Hospital, Kigali, Rwanda
| |
Collapse
|
22
|
Martin AN, Byiringiro JC, Petroze RT, Nkeshimana M, Byiringiro F, Calland JF. Assessing the impact of HIV status on injury outcomes: A multicenter study of trauma patients in Rwanda. Surgery 2018; 165:444-449. [PMID: 30327188 DOI: 10.1016/j.surg.2018.07.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 07/24/2018] [Accepted: 07/30/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is conflicting evidence regarding the impact of human immunodeficiency virus serostatus on trauma outcomes in low-resource settings. This study sought to evaluate the impact of human immunodeficiency virus serostatus on mortality outcomes for Rwandan patients presenting after trauma. METHODS This retrospective review of the University of Rwanda trauma registry captured all adult trauma patients with known human immunodeficiency virus status presenting between March 2011 and July 2015. Confirmed human immunodeficiency virus-positive cases were matched 1:2 with known human immunodeficiency virus-negative controls using a modified Kampala Trauma Score, sex, and district of residence or primary hospital. All-cause mortality was compared using multivariable logistic regression. RESULTS In total, 11,280 patients were recorded prospectively in the registry (169 human immunodeficiency virus positive; 334 human immunodeficiency virus negative matches). There was no difference in delay of hospital presentation or time until operation (P = .50 and P = .57, respectively). Less than 30% of all patients underwent operation during admission (n = 133), and the rate of operative intervention was independent of human immunodeficiency virus serostatus (P = .946). There was no association between development of any complication and human immunodeficiency virus status (P = .837). The overall mortality rate was 8.9% and 3.3% for human immunodeficiency virus-positive and human immunodeficiency virus-negative patients, respectively (P = .010). Human immunodeficiency virus positivity was associated with increased 30-day mortality when controlling for potential confounders (P = .016; odds ratio 3.60, 95% confidence interval: 1.27-10.2, C statistic 0.88). CONCLUSION Both human immunodeficiency virus and trauma pose substantial public health threats in sub-Saharan Africa. Known human immunodeficiency virus seropositivity in Rwandan trauma patients is associated with early mortality. Further investigation regarding testing, treatment, and outcomes in human immunodeficiency virus-positive trauma patients is warranted and provides an opportunity for leveraging human immunodeficiency virus global health efforts in trauma outcomes assessment.
Collapse
Affiliation(s)
- Allison N Martin
- Department of Surgery, University of Virginia, Charlottesville, VA
| | - Jean Claude Byiringiro
- Division of Clinical Education and Research, University Teaching Hospital of Kigali, Kigali, Rwanda; College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
| | - Robin T Petroze
- Department of Pediatric Surgery, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Menelas Nkeshimana
- Department of Accident and Emergency, University Teaching Hospital of Kigali, Rwanda
| | - Fidele Byiringiro
- Department of Surgery, University Teaching Hospital of Kigali, Rwanda
| | - James F Calland
- Department of Surgery, University of Virginia, Charlottesville, VA
| |
Collapse
|
23
|
Redko C, Bessong P, Burt D, Luna M, Maling S, Moore C, Ntirenganya F, Martin AN, Petroze R, den Hartog J, Ballard A, Dillingham R. Exploring the Significance of Bidirectional Learning for Global Health Education. Ann Glob Health 2018; 82:955-963. [PMID: 28314497 DOI: 10.1016/j.aogh.2016.11.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Cristina Redko
- Center for Global Health, Department of Population and Public Health Sciences, Wright State University Boonshoft School of Medicine, Dayton, OH.
| | - Pascal Bessong
- HIV/AIDS and Global Health Research Program, Professor of Microbiology, University of Venda, Thohoyandou, South Africa
| | - David Burt
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | - Max Luna
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | - Samuel Maling
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Christopher Moore
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | | | - Allison N Martin
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Robin Petroze
- Department of Surgery, McGill University, Montreal, Quebec
| | - Julia den Hartog
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | - April Ballard
- Center for Global Health, University of Virginia, Charlottesville, VA
| | - Rebecca Dillingham
- Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, VA
| |
Collapse
|
24
|
Martin AN, Narayanan S, Turrentine FE, Bauer TW, Adams RB, Zaydfudim VM. Pancreatic duct size and gland texture are associated with pancreatic fistula after pancreaticoduodenectomy but not after distal pancreatectomy. PLoS One 2018; 13:e0203841. [PMID: 30212577 PMCID: PMC6136772 DOI: 10.1371/journal.pone.0203841] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 08/28/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Pancreatic fistula remains a morbid complication after pancreatectomy. Since the proposed mechanism of pancreatic fistula is different between pancreaticoduodenectomy and distal pancreatectomy, we hypothesized that pancreatic gland texture and duct size are not associated with pancreatic fistula after distal pancreatectomy. METHODS All patients ≥18 years in the 2014-15 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) targeted pancreatectomy dataset were linked with the ACS NSQIP Public Use File (PUF). Pancreatic duct size (<3 mm, 3-6 mm, >6 mm) and pancreatic gland texture (hard, intermediate, soft) were categorized. Separate multivariable analyses were performed to evaluate associations between pancreatic duct size and gland texture after pancreaticoduodenectomy and distal pancreatectomy. RESULTS A total of 9366 patients underwent pancreaticoduodenectomy or distal pancreatectomy during the study period. Proportion of pancreatic fistula was similar after distal pancreatectomy (606 of 3132, 19.4%) and pancreaticoduodenectomy (1163 of 6335, 18.4%, p = 0.245). Both pancreatic gland texture and duct size were significantly associated with pancreatic fistula after pancreaticoduodenectomy (p<0.001). However, there was no association between pancreatic fistula and gland texture or duct size (all p≥0.169) after distal pancreatectomy. Operative approach (minimally invasive versus open) was not associated with pancreatic fistula after distal pancreatectomy (p = 0.626). Patients with pancreatic fistula after distal pancreatectomy had increased rate of postoperative complications including longer length of stay, higher rates of readmission and reoperation compared to patients who did not have a pancreatic fistula (all p<0.001). CONCLUSIONS Unlike among patients who had pancreaticoduodenectomy, pancreatic gland texture and duct size are not associated with development of pancreatic fistula following distal pancreatectomy. Other clinical factors should be considered in this patient population.
Collapse
Affiliation(s)
- Allison N. Martin
- Department of Surgery, University of Virginia, Charlottesville, VA, United States of America
| | - Sowmya Narayanan
- Department of Surgery, University of Virginia, Charlottesville, VA, United States of America
| | - Florence E. Turrentine
- Department of Surgery, University of Virginia, Charlottesville, VA, United States of America
- Surgical Outcomes Research Center, University of Virginia, Charlottesville, VA, United States of America
| | - Todd W. Bauer
- Department of Surgery, University of Virginia, Charlottesville, VA, United States of America
- Section of Hepatobiliary and Pancreatic Surgery, University of Virginia, Charlottesville, VA, United States of America
| | - Reid B. Adams
- Department of Surgery, University of Virginia, Charlottesville, VA, United States of America
- Section of Hepatobiliary and Pancreatic Surgery, University of Virginia, Charlottesville, VA, United States of America
| | - Victor M. Zaydfudim
- Department of Surgery, University of Virginia, Charlottesville, VA, United States of America
- Surgical Outcomes Research Center, University of Virginia, Charlottesville, VA, United States of America
- Section of Hepatobiliary and Pancreatic Surgery, University of Virginia, Charlottesville, VA, United States of America
- * E-mail:
| |
Collapse
|
25
|
Narayanan S, Martin AN, Turrentine FE, Bauer TW, Adams RB, Zaydfudim VM. Mortality after pancreaticoduodenectomy: assessing early and late causes of patient death. J Surg Res 2018; 231:304-308. [PMID: 30278945 DOI: 10.1016/j.jss.2018.05.075] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [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: 02/27/2018] [Revised: 05/06/2018] [Accepted: 05/31/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Safety of pancreaticoduodenectomy has improved significantly in the past 3 decades. Current inpatient and 30-d mortality rates are low. However, incidence and causes of 90-d and 1-y mortality are poorly defined and largely unexplored. METHODS All patients who had pancreaticoduodenectomy between 2007 and 2016 were included in this single institution, retrospective cohort study. Distributions of pancreaticoduodenectomy-specific morbidity and cause-specific mortality were compared between early (within 90 d) and late (91-365 d) postoperative recovery periods. RESULTS A total of 551 pancreaticoduodenectomies were performed during the study period. Of these, 6 (1.1%), 20 (3.6%), and 91 (16.5%) patients died within 30, 90, and 365 d after pancreaticoduodenectomy, respectively. Causes of early and late mortality varied significantly (all P ≤ 0.032). The most common cause of death within 90 d was due to multisystem organ failure from sepsis or aspiration in 9 (45%) patients, followed by post-pancreatectomy hemorrhage in 5 (25%) patients, and cardiopulmonary arrest from myocardial infarction or pulmonary embolus in 3 (15%) patients. In contrast, recurrent cancer was the most common cause of death in 46 (65%) patients during the late postoperative period between 91 and 365 d. Mortality from failure to thrive and debility was similar between early and late postoperative periods (15% versus 19.7%, P = 0.76). CONCLUSIONS Most quality improvement initiatives in patients selected for pancreaticoduodenectomy have focused on reduction of technical complications and improvement of early postoperative mortality. Further reduction in postoperative mortality after pancreaticoduodenectomy can be achieved by improving patient selection, mitigating postoperative malnutrition, and optimizing preoperative cancer staging and management strategies.
Collapse
Affiliation(s)
- Sowmya Narayanan
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Allison N Martin
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Florence E Turrentine
- Department of Surgery, University of Virginia, Charlottesville, Virginia; Surgery Outcomes Research Center, University of Virginia, Charlottesville, Virginia
| | - Todd W Bauer
- Department of Surgery, University of Virginia, Charlottesville, Virginia; Division of Surgical Oncology, University of Virginia, Charlottesville, Virginia
| | - Reid B Adams
- Department of Surgery, University of Virginia, Charlottesville, Virginia; Division of Surgical Oncology, University of Virginia, Charlottesville, Virginia
| | - Victor M Zaydfudim
- Department of Surgery, University of Virginia, Charlottesville, Virginia; Surgery Outcomes Research Center, University of Virginia, Charlottesville, Virginia; Division of Surgical Oncology, University of Virginia, Charlottesville, Virginia.
| |
Collapse
|
26
|
Martin AN, Narayanan S, Turrentine FE, Bauer TW, Adams RB, Stukenborg GJ, Zaydfudim VM. Clinical Factors and Postoperative Impact of Bile Leak After Liver Resection. J Gastrointest Surg 2018; 22:661-667. [PMID: 29247421 PMCID: PMC5871550 DOI: 10.1007/s11605-017-3650-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 11/28/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Despite technical advances, bile leak remains a significant complication after hepatectomy. The current study uses a targeted multi-institutional dataset to characterize perioperative factors that are associated with bile leakage after hepatectomy to better understand the impact of bile leak on morbidity and mortality. METHODS Adult patients in the 2014-2015 ACS NSQIP targeted hepatectomy dataset were linked to the ACS NSQIP PUF dataset. Bivariable and multivariable regression analyses were used to assess the associations between clinical factors and post-hepatectomy bile leak. RESULTS Of 6859 patients, 530 (7.7%) had a postoperative bile leak. Proportion of bile leaks was significantly greater in patients after major compared to minor hepatectomy (12.6 vs. 5.1%, p < 0.001). The proportion of patients with bile leak was significantly greater in patients after major hepatectomy who had concomitant enterohepatic reconstruction (31.8 vs. 10.1%, p < 0.001). Postoperative mortality was significantly greater in patients with bile leaks (6.0 vs. 1.7%, p < 0.001). After adjusting for significant covariates, bile leak was independently associated with increased risk of postoperative morbidity (OR = 4.55; 95% CI 3.72-5.56; p < 0.001). After adjusting for significant effects of postoperative complications, liver failure, and reoperation (all p<0.001), bile leak was not independently associated with increased risk of postoperative mortality (p = 0.262). CONCLUSION Major hepatectomy and enterohepatic biliary reconstruction are associated with significantly greater rates of bile leak after liver resection. Bile leak is independently associated with significant postoperative morbidity. Mitigation of bile leak is critical in reducing morbidity and mortality after liver resection.
Collapse
Affiliation(s)
- Allison N. Martin
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Sowmya Narayanan
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | | | - Todd W. Bauer
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Reid B. Adams
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | | | - Victor M. Zaydfudim
- Department of Surgery, University of Virginia, Charlottesville, VA, USA,Surgical Outcomes Research Center, University of Virginia, Charlottesville, VA
| |
Collapse
|
27
|
Elwood NR, Martin AN, Turrentine FE, Jones RS, Zaydfudim VM. The negative effect of perioperative red blood cell transfusion on morbidity and mortality after major abdominal operations. Am J Surg 2018; 216:487-491. [PMID: 29475550 DOI: 10.1016/j.amjsurg.2018.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 12/07/2017] [Revised: 01/30/2018] [Accepted: 02/05/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND This study aims to test associations between perioperative blood transfusion and postoperative morbidity and mortality after major abdominal operations. METHODS The 2014 ACS NSQIP dataset was queried for all patients who underwent one of the ten major abdominal operations. Separate multivariable regression models, were developed to evaluate the independent effects of perioperative blood transfusion on morbidity and mortality. RESULTS Of 48,854 patients in the study cohort, 4887 (10%) received a blood transfusion. Rates of transfusion ranged from 4% for laparoscopic gastrointestinal resection to 58% for open AAA. After adjusting for significant effects of NSQIP-estimated probabilities, transfusion was independently associated with morbidity and mortality after open AAA repair (OR = 1.99/14.4 respectively, p ≤ 0.010), esophagectomy (OR = 2.80/3.0, p < 0.001), pancreatectomy (OR = 1.88/3.01, p < 0.001), hepatectomy (OR = 2.82/5.78, p < 0.001), colectomy (OR = 2.15/3.17, p < 0.001), small bowel resection (OR = 2.81/3.83, p ≤ 0.004), and laparoscopic gastrointestinal operations (OR = 2.73/4.05, p < 0.001). CONCLUSIONS Perioperative blood transfusion is independently associated with an increased risk of morbidity and mortality after most major abdominal operations.
Collapse
Affiliation(s)
- Nathan R Elwood
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Allison N Martin
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Florence E Turrentine
- Department of Surgery, University of Virginia, Charlottesville, VA, USA; Surgery Outcomes Research Center, University of Virginia, Charlottesville, VA, USA
| | - R Scott Jones
- Department of Surgery, University of Virginia, Charlottesville, VA, USA; Surgery Outcomes Research Center, University of Virginia, Charlottesville, VA, USA
| | - Victor M Zaydfudim
- Department of Surgery, University of Virginia, Charlottesville, VA, USA; Surgery Outcomes Research Center, University of Virginia, Charlottesville, VA, USA; Division of Surgical Oncology, University of Virginia, Charlottesville, VA, USA.
| |
Collapse
|
28
|
Jackson JN, Zee RS, Martin AN, Corbett ST, Herndon CDA. A practice pattern assessment of members of the Society of Pediatric Urology for evaluation and treatment of urinary tract dilation. J Pediatr Urol 2017; 13:602-607. [PMID: 28506597 DOI: 10.1016/j.jpurol.2017.03.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 03/26/2017] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Over the last decade the literature, including a multidisciplinary consensus statement, has supported a paradigm shift in management of urinary tract dilation, yet the impact on practice patterns has not been well documented. OBJECTIVE This study aims to elucidate specific practice patterns for treatment of prenatal unilateral urinary tract dilation and to assess surgical intervention patterns for ureteropelvic junction obstruction. STUDY DESIGN An online survey was distributed to 234 pediatric urologists through the Society of Pediatric Urology. The survey was composed of five clinical case scenarios addressing evaluation and management of unilateral urinary tract dilation. RESULTS The response rate was 71% (n = 168). Circumcision status, gender, and grade were significant factors in recommending prophylactic antibiotics for newborn urinary tract dilation. Prophylactic antibiotic use in the uncircumcised male and female was twice that of a circumcised male for grade 3 (Table). This difference was minimized for grade 4. Use of VCUG was high for circumcised males with grade 3 or 4 (Table). The choice of minimally invasive surgery for ureteropelvic junction repair increased with age from 19% for a 5-month-old, 49% for a 2-year-old, and 85% for a 10-year-old. Notably, 44% of respondents would observe a 10-year-old with intermittent obstruction. Retrograde pyelography was recommended in conjunction with repair in 65% of respondents. Antegrade stent placement was the most common choice (38-47%) for urinary diversion after pyeloplasty. Regarding postoperative imaging, only 5% opted for routine renal scan whereas most would perform renal ultrasound alone. DISCUSSION Practice patterns seen for use of prophylactic antibiotics are in agreement with the literature, which promotes selective use in those at highest risk for urinary tract infections. Interestingly, use of aggressive screening was not concordant with this literature. Several studies have indicated an increased usage of robotic pyeloplasty; however, results indicate that minimally invasive surgery is not preferred in those younger than 6 months. Study limitations include use of clinical case scenarios as opposed to actual clinical practice. CONCLUSION Practice patterns for prophylactic antibiotic use for neonatal urinary tract dilation are dependent on gender, circumcision status, and grade. The use of minimally invasive surgery for ureteropelvic junction repair increased with patient age, with 50% preferring this modality at 2 years.
Collapse
Affiliation(s)
- Jessica N Jackson
- Department of Urology, University of Virginia, Charlottesville, VA, USA.
| | - Rebecca S Zee
- Department of Urology, University of Virginia, Charlottesville, VA, USA
| | - Allison N Martin
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Sean T Corbett
- Department of Urology, University of Virginia, Charlottesville, VA, USA
| | | |
Collapse
|
29
|
Martin AN, Berry PS, Friel CM, Hedrick TL. Impact of minimally invasive surgery on short-term outcomes after rectal resection for neoplasm within the setting of an enhanced recovery program. Surg Endosc 2017; 32:2517-2524. [PMID: 29101566 DOI: 10.1007/s00464-017-5956-4] [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: 05/18/2017] [Accepted: 10/21/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Minimally invasive surgery (MIS) for rectal cancer has increased in recent years. Enhanced recovery (ER) protocols are associated with improved outcomes, such as decreased length of stay (LOS). We examined the impact of MIS and ER protocols on outcomes after rectal resection for neoplasm. METHODS A retrospective analysis was performed for patients undergoing elective open (OS) or MIS rectal resection for neoplasm from 2010 to 2015 at a single institution. MIS was defined as any laparoscopic or robotic procedure. An ER protocol was implemented in 8/2013. Regression models were used to estimate outcomes including LOS, 30-day morbidity, readmission, and hospital costs. RESULTS Among 325 patients, 252 (77.5%) underwent OS; 73 (22.5%) underwent MIS rectal resection. Prior to ER implementation, only 6.1% underwent MIS, compared to 23.1 and 54.4% in the 2 years following ER implementation (p < 0.001). Prior to ER implementation, median LOS was 7 days (n = 181) with 23.8% 30-day morbidity. Following ER implementation, median LOS was 4 days (n = 144); patients receiving OS had median LOS of 5.5 days (n = 82) and 30-day morbidity of 19.5%. ER patients receiving MIS had median LOS of 3 days (n = 62) and 30-day morbidity of 14.5%. Univariate regression demonstrated that MIS patients on ER protocol were more likely to have a shortened LOS (< 6 days) compared to OS patients on non-ER protocol (both p < 0.001). CONCLUSIONS The combination of MIS and ER protocol is significantly associated with reduced LOS for patients undergoing rectal resection for neoplasm. Further research is needed to determine which patients are best suited to MIS from an oncologic standpoint.
Collapse
Affiliation(s)
- Allison N Martin
- Department of Surgery, Section of Colon and Rectal Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22908-0709, USA
| | - Puja Shah Berry
- Department of Surgery, Section of Colon and Rectal Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22908-0709, USA
| | - Charles M Friel
- Department of Surgery, Section of Colon and Rectal Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22908-0709, USA
| | - Traci L Hedrick
- Department of Surgery, Section of Colon and Rectal Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22908-0709, USA.
| |
Collapse
|
30
|
Martin AN, Silverstein A, Ssebuufu R, Lule J, Mugenzi P, Fehr AE, Mpunga T, Shulman L, Park PH, Costas-Chavarri A. Impact of Delayed Care on Surgical Management of Patients with Gastric Cancer in a Low-Resource Setting. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
31
|
Martin AN, Marino M, Killerby M, Rosselli-Risal L, Isom KA, Robinson MK. Impact of Spanish-language information sessions on Spanish-speaking patients seeking bariatric surgery. Surg Obes Relat Dis 2017; 13:1025-1031. [DOI: 10.1016/j.soard.2017.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 12/05/2016] [Accepted: 01/04/2017] [Indexed: 11/29/2022]
|
32
|
Ruzigana G, Bazzet-Matabele L, Rulisa S, Martin AN, Ghebre RG. Cervical cancer screening at a tertiary care center in Rwanda. Gynecol Oncol Rep 2017; 21:13-16. [PMID: 28616457 PMCID: PMC5458073 DOI: 10.1016/j.gore.2017.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/10/2017] [Accepted: 05/19/2017] [Indexed: 12/29/2022] Open
Abstract
In limited resource settings such as Rwanda, visual inspection with acetic acid (VIA) is the primary model for cervical cancer screening. The objective of this study was to describe clinical characteristics and outcomes for women presenting for cervical cancer screening. A prospective, observational study was conducted between September 2015 and February 2016 at Kigali University Teaching Hospital (CHUK). Women referred to the VIA clinic were enrolled and completed a semi-structured questionnaire. During the six-month study period, 150 women were enrolled and evaluated with VIA followed by colposcopy directed biopsy for VIA positive. The median age was 42 years (IQR 36-49). Only 20 (13.3%) asymptomatic women presented for screening exam, whereas 126 (84%) were symptomatic. Among symptomatic patients, more than one-third had never had a speculum exam prior to referral (n = 43). Twenty-two (14.7%) women were VIA positive, and 8 (5.3%) had lesions suspicious for cancer, while 120 (80%) were found to be VIA negative. Among women undergoing biopsy (n = 30), 11 were normal (36.7%), 5 cases showed CIN 1 (16.6%), 4 cases showed CIN 2 (13.3%), 2 cases showed CIN 3 (6.7%) and 8 were confirmed cervical cancers (26.7%). In Rwanda, VIA is the current method for cervical cancer screening. In this study, few asymptomatic patients presented for cervical cancer screening. Increasing knowledge about cervical cancer screening and expanding access are key elements to improving cervical cancer control in Rwanda.
Collapse
Affiliation(s)
| | - Lisa Bazzet-Matabele
- School of Medicine, Yale University, United States.,Human Resources for Health, Rwanda
| | - Stephen Rulisa
- University Teaching Hospital of Kigali, Rwanda.,College of Medicine and Health Science, University of Rwanda, Rwanda
| | | | - Rahel G Ghebre
- School of Medicine, Yale University, United States.,Human Resources for Health, Rwanda.,University of Minnesota Medical School, Minneapolis, MN, United States
| |
Collapse
|
33
|
Fashandi AZ, Martin AN, Wang PT, Hedrick TL, Friel CM, Smith PW, Hays RA, Hallowell PT. An institutional comparison of total abdominal colectomy and diverting loop ileostomy and colonic lavage in the treatment of severe, complicated Clostridium difficile infections. Am J Surg 2016; 213:507-511. [PMID: 27964924 DOI: 10.1016/j.amjsurg.2016.11.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 07/25/2016] [Revised: 11/18/2016] [Accepted: 11/22/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Total abdominal colectomy (TAC) is the standard surgical treatment of Clostridium difficile infection (CDI). An alternative therapy, loop ileostomy and colonic lavage (IL), was described in 2011, but the results have never been validated. METHODS Patients treated surgically for CDI between April 2011 and June 2015 were included. Bivariable analysis was used to compare 30-day mortality, 1-year mortality, CDI recurrence, colon preservation and ileostomy reversal. RESULTS Ten IL patients and thirteen TAC patients were identified. 30-day mortality (30% vs 23%, p = 1.0) and 1-year mortality (40% vs 46%, p = 1.0) were similar. Four IL and three TAC patients (57% vs 30%, p = 0.35) experienced recurrent CDI. All six surviving IL patients had successful colon preservation; five underwent ileostomy reversal compared to three in the TAC group (83% vs 43%, p = 0.27). CONCLUSIONS Although IL allowed colon preservation and return of intestinal continuity in most patients, IL did not decrease mortality or recurrent CDI when compared to TAC.
Collapse
Affiliation(s)
- Anna Z Fashandi
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Allison N Martin
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Patty T Wang
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Traci L Hedrick
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Charles M Friel
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Philip W Smith
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - R Ann Hays
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Peter T Hallowell
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA.
| |
Collapse
|
34
|
Jolissaint JS, Langman LW, DeBolt CL, Tatum JA, Martin AN, Wang AY, Strand DS, Zaydfudim VM, Adams RB, Brayman KL. The impact of bacterial colonization on graft success after total pancreatectomy with autologous islet transplantation: considerations for early definitive surgical intervention. Clin Transplant 2016; 30:1473-1479. [PMID: 27623240 PMCID: PMC5183974 DOI: 10.1111/ctr.12842] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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] [Accepted: 09/07/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The purpose of this study was to determine whether bacterial contamination of islets affects graft success after total pancreatectomy with islet autotransplantation (TPIAT). BACKGROUND Factors associated with insulin independence after TPIAT are inconclusive. Although bacterial contamination does not preclude transplantation, the impact of bacterial contamination on graft success is unknown. METHODS Patients who received TPIAT at the University of Virginia between January 2007 and January 2016 were reviewed. Patient charts were reviewed for bacterial contamination and patients were prospectively contacted to assess rates of insulin independence. RESULTS There was no significant difference in demographic or perioperative data between patients who achieved insulin independence and those who did not. However, six of 27 patients analyzed (22.2%) grew bacterial contaminants from culture of the final islet preparations. These patients had significantly lower islet yield and C-peptide at most recent follow-up (P<.05), and none of these patients achieved insulin independence. CONCLUSIONS Islet transplant solutions are often culture positive, likely secondary to preprocurement pancreatic manipulation and introduction of enteric flora. Although autotransplantation of culture-positive islets is safe, it is associated with higher rates of graft failure and poor islet yield. Consideration should be given to identify patients who may develop refractory chronic pancreatitis and offer early operative management to prevent bacterial colonization.
Collapse
Affiliation(s)
| | - Linda W Langman
- Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Claire L DeBolt
- Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Jacob A Tatum
- Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Allison N Martin
- Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Andrew Y Wang
- Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, VA, USA
| | - Daniel S Strand
- Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, VA, USA
| | - Victor M Zaydfudim
- Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Reid B Adams
- Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Kenneth L Brayman
- Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA.
| |
Collapse
|
35
|
Martin AN, Das D, Turrentine FE, Bauer TW, Adams RB, Zaydfudim VM. Morbidity and Mortality After Gastrectomy: Identification of Modifiable Risk Factors. J Gastrointest Surg 2016; 20:1554-64. [PMID: 27364726 PMCID: PMC4987171 DOI: 10.1007/s11605-016-3195-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 06/20/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Morbidity after gastrectomy remains high. The potentially modifiable risk factors have not been well described. This study considers a series of potentially modifiable patient-specific and perioperative characteristics that could be considered to reduce morbidity and mortality after gastrectomy. METHODS This retrospective cohort study includes adults in the ACS NSQIP PUF dataset who underwent gastrectomy between 2011 and 2013. Sequential multivariable models were used to estimate effects of clinical covariates on study outcomes including morbidity, mortality, readmission, and reoperation. RESULTS Three thousand six hundred and seventy-eight patients underwent gastrectomy. A majority of patients had distal gastrectomy (N = 2,799, 76.1 %) and had resection for malignancy (N = 2,316, 63.0 %). Seven hundred and ninety-eight patients (21.7 %) experienced a major complication. Reoperation was required in 290 patients (7.9 %). Thirty-day mortality was 5.2 %. Age (OR = 1.01, 95 % CI = 1.01-1.02, p = 0.001), preoperative malnutrition (OR = 1.65, 95 % CI = 1.35-2.02, p < 0.001), total gastrectomy (OR = 1.63, 95 % CI = 1.31-2.03, p < 0.001), benign indication for resection (OR = 1.60, 95 % CI = 1.29-1.97, p < 0.001), blood transfusion (OR = 2.57, 95 % CI = 2.10-3.13, p < 0.001), and intraoperative placement of a feeding tubes (OR = 1.28, 95 % CI = 1.00-1.62, p = 0.047) were independently associated with increased risk of morbidity. Association between tobacco use and morbidity was statistically marginal (OR = 1.23, 95 % CI = 0.99-1.53, p = 0.064). All-cause postoperative morbidity had significant associations with reoperation, readmission, and mortality (all p < 0.001). CONCLUSIONS Mitigation of perioperative risk factors including smoking and malnutrition as well as identified operative considerations may improve outcomes after gastrectomy. Postoperative morbidity has the strongest association with other measures of poor outcome: reoperation, readmission, and mortality.
Collapse
Affiliation(s)
- Allison N. Martin
- Department of Surgery, University of Virginia, Charlottesville, Virginia,Surgical Outcomes Research Center, University of Virginia, Charlottesville, VA
| | - Deepanjana Das
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Florence E. Turrentine
- Department of Surgery, University of Virginia, Charlottesville, Virginia,Surgical Outcomes Research Center, University of Virginia, Charlottesville, VA
| | - Todd W. Bauer
- Department of Surgery, University of Virginia, Charlottesville, Virginia,Division of Surgical Oncology, Section of Hepatobiliary and Pancreatic Surgery, University of Virginia, Charlottesville, Virginia
| | - Reid B. Adams
- Department of Surgery, University of Virginia, Charlottesville, Virginia,Division of Surgical Oncology, Section of Hepatobiliary and Pancreatic Surgery, University of Virginia, Charlottesville, Virginia
| | - Victor M. Zaydfudim
- Department of Surgery, University of Virginia, Charlottesville, Virginia,Division of Surgical Oncology, Section of Hepatobiliary and Pancreatic Surgery, University of Virginia, Charlottesville, Virginia,Surgical Outcomes Research Center, University of Virginia, Charlottesville, VA
| |
Collapse
|
36
|
Ramirez AG, Shada AL, Martin AN, Raghavan P, Durst CR, Mukherjee S, Gaughen JR, Ornan DA, Hanks JB, Smith PW. Clinical efficacy of 2-phase versus 4-phase computed tomography for localization in primary hyperparathyroidism. Surgery 2016; 160:731-7. [PMID: 27302106 DOI: 10.1016/j.surg.2016.04.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/20/2016] [Accepted: 04/08/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Four-dimensional computed tomography is being used increasingly for localization of abnormal glands in primary hyperparathyroidism. We hypothesized that compared with traditional 4-phase imaging, 2-phase imaging would halve the radiation dose without compromising parathyroid localization and clinical outcomes. METHODS A transition from 4-phase to 2-phase imaging was instituted between 2009 and 2010. A pre-post analysis was performed on patients undergoing operative treatment with a parathyroid protocol computed tomography, and relevant data were correlated with operative findings. Sensitivity, positive predictive value, technical success, and cure rates were calculated. The Fisher exact test or χ(2) test assessed the significance of 2-phase and 4-phase imaging and operative findings. RESULTS Twenty-seven patients had traditional four-dimensional computed tomography and 35 had modified 2-phase computed tomography. Effective radiation doses were 6.8 mSy for 2-phase and 14 mSv for 4-phase. Four-phase computed tomography had a sensitivity and positive predictive value of 93% and 96%, respectively. Two-phase computed tomography had a comparable sensitivity and positive predictive value of 97% and 94%, respectively. Eight patients with discordant imaging had an average parathyroid weight of 240 g compared with 1,300 g for all patients. Technical surgical success (90% for 4-phase computed tomography versus 91% 2-phase computed tomography) and normocalcemia rates at 6 months (88% for both) did not differ between computed tomography protocols. Computed tomography correctly predicted multiglandular disease and localization for reoperations in 88% and 90% of cases, respectively, with no difference by computed tomography protocol. CONCLUSION With regard to surgical outcomes and localization, 2-phase parathyroid computed tomography is equivalent to 4-phase for parathyroid localization, including small adenomas, reoperative cases, and multiglandular disease. Two-phase parathyroid computed tomography for operative planning should be considered to avoid unnecessary radiation exposure.
Collapse
Affiliation(s)
| | - Amber L Shada
- Department of Surgery, University of Wisconsin, Madison, WI
| | - Allison N Martin
- Department of Surgery, University of Virginia, Charlottesville, VA
| | - Prashant Raghavan
- Department of Diagnostic Radiology, University of Maryland, College Park, MD
| | - Christopher R Durst
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA
| | - Sugoto Mukherjee
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA
| | - John R Gaughen
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA
| | - David A Ornan
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA
| | - John B Hanks
- Department of Surgery, University of Virginia, Charlottesville, VA
| | - Philip W Smith
- Department of Surgery, University of Virginia, Charlottesville, VA.
| |
Collapse
|
37
|
|
38
|
Siuciak JA, McCarthy SA, Martin AN, Chapin DS, Stock J, Nadeau DM, Kantesaria S, Bryce-Pritt D, McLean S. Disruption of the neurokinin-3 receptor (NK3) in mice leads to cognitive deficits. Psychopharmacology (Berl) 2007; 194:185-95. [PMID: 17558564 DOI: 10.1007/s00213-007-0828-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2007] [Accepted: 05/14/2007] [Indexed: 12/24/2022]
Abstract
RATIONALE The structurally related neuropeptides, substance P, neurokinin A, and neurokinin B, belong to a family of molecules termed tachykinins and are widely distributed in the central and peripheral nervous systems. These peptides mediate their effects through three G protein coupled receptor subtypes, the neurokinin-1, neurokinin-2 and neurokinin-3 receptors, respectively. OBJECTIVE To study the physiological functions of NK3, a line of NK3 knockout mice were generated and characterized in a broad spectrum of well-established behavioral tests. RESULTS In several tests, including spontaneous locomotor activity, elevated plus maze, forced swim, and hot plate, wild-type and knockout mice performed similarly. However, in several cognition tests, including passive avoidance, acquisition of conditioned avoidance responding (CAR), and the Morris water maze, NK3 knockout mice displayed deficits compared to wild-type mice. Although NK3 wild-type and knockout mice performed similarly in the training phase of the passive avoidance test, knockout mice had shorter latencies to enter the dark compartment on days 3 and 4, suggesting impaired retention. In the acquisition phase of the conditioned avoidance responding assay, NK3 knockout mice acquired the CAR task at a slower rate than wild-type mice. Once the CAR test was acquired, both NK3 wild-type and knockout mice responded similarly to clozapine and risperidone, drugs which suppress responding in this test. In the Morris water maze, NK3 knockout mice showed increased latencies to find the escape platform on day 3 of training, suggesting a modest, but significant delay in acquisition compared to wild-type mice. CONCLUSION These studies suggest a role for NK3 in learning and memory in mice.
Collapse
Affiliation(s)
- Judith A Siuciak
- CNS Discovery, Pfizer Global Research and Development, Eastern Point Road, Groton, CT 06340, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
RNase MRP RNA is the RNA subunit of the RNase mitochondrial RNA processing (MRP) enzyme complex that is involved in multiple cellular RNA processing events. Mutations on RNase MRP RNA gene (RMRP) cause a recessively inherited developmental disorder, cartilage-hair hypoplasia (CHH). The relationship of the genotype (RMRP mutation), RNA processing deficiency of the RNase MRP complex, and the phenotype of CHH and other skeletal dysplasias is yet to be explored.
Collapse
Affiliation(s)
- Allison N Martin
- Department of Biochemistry and Molecular Biology, and Center for Genetics and Molecular Medicine, School of Medicine, University of Louisville, Louisville, KY 40202, USA
| | | |
Collapse
|
40
|
Yakatan GJ, Poynor WJ, Breeding SA, Lankford CE, Dighe SV, Martin AN, Doluisio JT. Single- and multiple-dose bioequivalence of erythromycin pharmaceutical alternatives. J Clin Pharmacol 1980; 20:625-38. [PMID: 7229110 DOI: 10.1002/j.1552-4604.1980.tb01679.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|
41
|
|
42
|
Peradejordi F, Martin AN, Chalvet O, Daudel R. Molecular orbital calculations on some nitrogen derivatives of conjugated hydrocarbons: base strength of benzacridines and their amino derivatives. J Pharm Sci 1972; 61:909-13. [PMID: 5046108 DOI: 10.1002/jps.2600610617] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
43
|
|
44
|
Miller GH, Khalil SA, Martin AN. Structure-activity relationships of tetracyclines. I. Inhibition of cell division and protein and nucleic acid syntheses in Escherichia coli W. J Pharm Sci 1971; 60:33-40. [PMID: 4994066 DOI: 10.1002/jps.2600600104] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
45
|
Abstract
Abstract
Samples of synchronously growing cultures of Escherichia coli B/r removed at predetermined time intervals after synchronization were added to solutions containing bactericidal concentrations of tetra-cycline. Three active antibacterials, 7-nitro-6-demethyl-6-deoxytetracycline, 9-amino-6-demethyl-6-deoxytetracycline and 6-demethyl-6-deoxytetracycline, and one inactive compound, 7-chloroisotetra-cycline, were studied. Survival curves for the active agents, determined using samples of culture differing in age, were of constant slope for a given tetracycline. It is concluded that interruption of protein synthesis is the primary mode of action at bactericidal concentrations of tetracyclines, the same process as has been established for the action of the tetracyclines at the lower bacteriostatic concentrations.
Collapse
|
46
|
Rifino CB, Bousquet WF, Knevel AM, Belcastro P, Martin AN. Effect of certain tetracycline analogs on phenylalanine-14C incorporation by Escherichia coli B cell-free extracts. J Pharm Sci 1968; 57:351-2. [PMID: 4868038 DOI: 10.1002/jps.2600570232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
47
|
|
48
|
|
49
|
Colaizzi JL, Knevel AM, Martin AN. Biophysical study of the mode of action of the tetracycline antibiotics. Inhibition of metalloflavoenzyme NADH cytochrome oxidoreductase. J Pharm Sci 1965; 54:1425-36. [PMID: 4286912 DOI: 10.1002/jps.2600541006] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
50
|
Colaizzi JL, Boenigk JW, Martin AN, Knevel AM. Schiff base formation in the development of a spectrophotometric assay for sulfonamides. J Pharm Sci 1965; 54:564-8. [PMID: 5842340 DOI: 10.1002/jps.2600540415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|