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Dreyfuss LD, Nik-Ahd F, Wang L, Shatkin-Margolis A, Covinsky K, John Boscardin W, Suskind AM. Sacral neuromodulation in nursing home residents: Predictors of success and complications in a national cohort of older adults. Neurourol Urodyn 2024. [PMID: 38624030 DOI: 10.1002/nau.25465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/21/2024] [Accepted: 04/01/2024] [Indexed: 04/17/2024]
Abstract
AIMS There is limited evidence to support the efficacy of sacral neuromodulation (SNM) for older adults with overactive bladder (OAB). This study aims to report outcomes following SNM among nursing home (NH) residents, a vulnerable population with high rates of frailty and comorbidity. METHODS This is a retrospective cohort study of long-stay NH residents who underwent a trial of percutaneous nerve evaluation (PNE) or Stage 1 permanent lead placement (Stage 1) between 2014 and 2016. Residents were identified using the Minimum Data Set linked to Medicare claims. The primary outcome of this study was successful progression from trial to implant. Rates of 1-year device explant/revisions were also investigated. RESULTS Trial of SNM was observed in 1089 residents (mean age: 77.9 years). PNE was performed in 66.9% of residents and 33.2% underwent Stage 1. Of Stage 1 procedures, 23.8% were performed with simultaneous device implant (single-stage). Overall, 53.1% of PNEs and 72.4% of Stage 1 progressed to device implant, which was associated with Stage 1 procedure versus PNE (adjusted relative risk [aRR]: 1.34; 95% confidence interval [95% CI]: 1.21-1.49) and female versus male sex (aRR: 1.26; 95% CI: 1.09-1.46). One-year explant/revision was observed in 9.3% of residents (6.3% for PNE, 10.5% for Stage 1, 20.3% single-stage). Single stage procedure versus PNE was significantly associated with device explant/revision (aRR: 3.4; 95% CI: 1.9-6.2). CONCLUSIONS In this large cohort of NH residents, outcomes following SNM were similar to previous reports of younger healthier cohorts. Surgeons managing older patients with OAB should use caution when selecting patients for single stage SNM procedures.
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Affiliation(s)
- Leo D Dreyfuss
- Department of Urology, Weill Cornell Medical Center, New York, New York, USA
| | - Farnoosh Nik-Ahd
- Department of Urology, University of California-San Francisco, San Francisco, California, USA
| | - Lufan Wang
- Department of Urology, University of California-San Francisco, San Francisco, California, USA
| | - Abigail Shatkin-Margolis
- Department of Obstetrics and Gynecology, University of California, San Francisco, California, USA
| | - Kenneth Covinsky
- Division of Geriatrics, University of California-San Francisco, San Francisco, California, USA
| | - W John Boscardin
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California, USA
| | - Anne M Suskind
- Department of Urology, University of California-San Francisco, San Francisco, California, USA
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Nik-Ahd F, De Hoedt A, Butler C, Anger JT, Carroll PR, Cooperberg MR, Freedland SJ. Prostate Cancer in Transgender Women in the Veterans Affairs Health System, 2000-2022. JAMA 2023; 329:1877-1879. [PMID: 37119522 PMCID: PMC10148974 DOI: 10.1001/jama.2023.6028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/28/2023] [Indexed: 05/01/2023]
Abstract
This case series investigates the rate of prostate cancer diagnoses among transgender women treated in the Veterans Affairs health system.
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Affiliation(s)
| | - Amanda De Hoedt
- Division of Urology, Veterans Affairs Health Care System, Durham, North Carolina
| | - Christi Butler
- Department of Urology, University of California, San Francisco
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Shaw NM, Nik-Ahd F, Jones C, Breyer BN, Walter LC, Sudore R, Cooperberg MR, Baussan C, Quanstrom K, Allen IE, Hampson LA. Patient decision-making for surgical treatment of post-prostatectomy stress urinary incontinence: a mixed-methods exploratory pilot study. Transl Androl Urol 2023; 12:849-858. [PMID: 37305624 PMCID: PMC10251091 DOI: 10.21037/tau-22-618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 03/15/2023] [Indexed: 11/08/2023] Open
Abstract
Background Male stress urinary incontinence (SUI) is a known complication following surgical intervention on the prostate, particularly following surgery for prostate cancer. Effective surgical treatments for SUI include artificial urinary sphincter (AUS) and male urethral sling. Prior data suggest that men may forego available treatment despite bothersome symptoms. The objective was to explore how men who underwent surgical correction for post-prostatectomy SUI navigated SUI treatment decisions. Methods Mixed method study was employed. Semi-structured interviews, participant surveys and objective clinical assessment of SUI were performed among a group of men living with incontinence after prostate cancer surgery who underwent surgery for SUI at the University of California in 2017. Results Eleven men were interviewed after consultation for SUI and all had complete quantitative clinical data. Surgery for SUI included AUS (n=8) and sling (n=3). There was a decrease in pads per day from 3.2 to 0.9 and no major complications. Most patients found that the impact on activities and their treating urologist were of great importance. Sexual and relationships played a variable role with some participants ranking these as "great deal of influence" and others "little or no influence". Participants who underwent AUS were more likely to cite a higher importance on "being very dry" in choosing that surgery while sling patients had more variable ranking of important factors. Participants found a variety of inputs helpful in hearing information about SUI treatment options. Conclusions Among a group of 11 men who underwent surgical correction for post-prostatectomy SUI, there were identifiable themes on how men make decisions, evaluate quality of life (QoL) changes and approach treatment options. Men value more than being dry with measures of individual success that can include sexual and relationship health. Furthermore the role of the Urologist remains crucial as patients relied heavily on input and discussion with their Urologist to assist in treatment decisions. These findings can be used to inform future studies of the experience of men with SUI.
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Affiliation(s)
- Nathan M. Shaw
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Farnoosh Nik-Ahd
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Charles Jones
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Benjamin N. Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Louise C. Walter
- Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, CA, USA
- Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Rebecca Sudore
- Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, CA, USA
- Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Matthew R. Cooperberg
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
- Department of Surgery, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Caitlin Baussan
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Kathryn Quanstrom
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - I. Elaine Allen
- Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Lindsay A. Hampson
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
- Department of Surgery, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
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Nik-Ahd F, Anger JT, Cooperberg MR, Freedland SJ. Prostate cancer is not just a man's concern - the use of PSA screening in transgender women. Nat Rev Urol 2023:10.1038/s41585-023-00780-9. [PMID: 37217694 DOI: 10.1038/s41585-023-00780-9] [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: 05/24/2023]
Affiliation(s)
- Farnoosh Nik-Ahd
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA.
| | - Jennifer T Anger
- Department of Urology, University of California, San Diego, San Diego, CA, USA
| | - Matthew R Cooperberg
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA
| | - Stephen J Freedland
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Section of Urology, Durham VA Medical Center, Durham, NC, USA
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Nik-Ahd F, Cooperberg MR, Freedland SJ. Reply to Sandra Patricia García Nader, Sebastián Peña Rodríguez, and Cesar Alejandro Diaz Ritter's Letter to the Editor re: Farnoosh Nik-Ahd, Andrew Jarjour, Jane Figueiredo, et al. Prostate-specific Antigen Screening in Transgender Patients. Eur Urol. 2023;83:48-54. Eur Urol 2023; 83:e104. [PMID: 36653258 DOI: 10.1016/j.eururo.2022.12.030] [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] [Received: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 01/18/2023]
Affiliation(s)
- Farnoosh Nik-Ahd
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA.
| | - Matthew R Cooperberg
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Stephen J Freedland
- Department of Surgery, Division of Urology, Center for Integrated Research on Cancer and Lifestyle, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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6
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Nik-Ahd F, Waller J, De Hoedt AM, Garcia MM, Figueiredo JC, Carroll PR, Cooperberg MR, Freedland SJ. Seeing the unseen: how can we best identify transgender women within the Veterans Affairs healthcare system's electronic medical record? J Sex Med 2023; 20:559-567. [PMID: 36814112 DOI: 10.1093/jsxmed/qdac033] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 06/10/2022] [Revised: 10/03/2022] [Accepted: 12/17/2022] [Indexed: 02/24/2023]
Abstract
BACKGROUND One challenge in transgender research is reliably identifying patients through electronic medical records data, as there is no universal transgender International Classification of Diseases (ICD) code, but rather multiple ICD codes that can be used. AIM To explore the sensitivity and specificity of 5 commonly used ICD codes to identify transgender patients overall and transgender women specifically (assigned male sex at birth) by using data from the Veterans Affairs (VA), the largest integrated health system in the United States. METHODS Patients aged ≥18 years were identified via ICD-9 codes 302.5 and 302.6 (Ninth Revision) and ICD-10 codes F64.0, F64.8, and F64.9 (Tenth Revision) using VA health records from 2000 to 2021 and stratified by bilateral orchiectomy status. OUTCOMES Detailed chart review was performed on 32 randomly selected patients for each code (half with and half without orchiectomy) to confirm transgender status and to perform descriptive analyses. RESULTS For each ICD code, rates of confirmed transgender status ranged from 88% to 100% for those with and without an orchiectomy, with the majority being transgender women (consistent with most veterans being assigned male sex at birth). Most transgender women (66%-100%) were undergoing estrogen gender-affirming therapy. The majority of provider-driven entries of transgender status took place from 2011 to 2020, with 75% of entries made from 2011 to 2020, consistent with increased recognition and societal acceptance of this population. False negatives were detected at a rate of 15%. Based upon these 5 ICD codes alone, we estimate that the VA has records for 9,449 to 10,738 transgender individuals. CLINICAL IMPLICATIONS All 5 codes are very sensitive in identifying transgender patients, and the combination of these codes with orchiectomy is extremely sensitive in identifying transgender women, specifically. STRENGTHS AND LIMITATIONS Major strengths of the study are the use of universal ICD codes and a large patient sample size that spans health records nationally and across multiple decades, potentially making our data more generalizable. The main limitation of this study is that subanalyses were performed on a limited number of patients, which prevented us from capturing all false positives and thus from calculating specificity for each code. Similarly, our true negatives were derived from a small, random subset of the population; as such, our calculation for specificity is an estimate. CONCLUSION This study highlights a novel method to identify transgender women and paves the way for further research.
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Affiliation(s)
- Farnoosh Nik-Ahd
- Department of Urology, University of California San Francisco, San Francisco, CA, United States
| | - Justin Waller
- Division of Urology, Veterans Affairs Health Care System, Durham, NC, United States
| | - Amanda M De Hoedt
- Division of Urology, Veterans Affairs Health Care System, Durham, NC, United States
| | - Maurice M Garcia
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Jane C Figueiredo
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Peter R Carroll
- Department of Urology, University of California San Francisco, San Francisco, CA, United States
| | - Matthew R Cooperberg
- Department of Urology, University of California San Francisco, San Francisco, CA, United States.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States.,Section of Urology, San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Stephen J Freedland
- Division of Urology, Veterans Affairs Health Care System, Durham, NC, United States.,Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Center for Integrated Research on Cancer and Lifestyle, Cedars-Sinai Medical Center, Los Angeles, CA, United States
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Nik-Ahd F, Jarjour A, Figueiredo J, Anger JT, Garcia M, Carroll PR, Cooperberg MR, Vidal AC, Freedland SJ. Prostate-Specific Antigen Screening in Transgender Patients. Eur Urol 2023; 83:48-54. [PMID: 36344317 DOI: 10.1016/j.eururo.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/05/2022] [Accepted: 09/06/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT Approximately 0.4-1.3% of the worldwide population is transgender. Although the exact prevalence is unknown, there is an increase in open identification as transgender. Among transgender women (TW), the prostate is retained even after gender-affirmation surgery, thus necessitating ongoing screening for prostate cancer (CaP). However, little is known about CaP screening in this population. OBJECTIVE To assess our current understanding of CaP incidence and prostate-specific antigen (PSA) screening in TW. EVIDENCE ACQUISITION We performed a nonsystematic narrative review of all PubMed publications through June 2022 according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. Given the limited primary research on this subject, case reports were also included. Studies were reviewed to understand PSA screening practices and reports of CaP in this population, as applicable. EVIDENCE SYNTHESIS There is no consensus regarding PSA screening in TW from any of the major societies, and TW are largely absent from guidelines. Case report data suggest that TW with CaP may have more aggressive disease, and these cancers may have been pre-existing prior to present before gender-affirming hormone therapy (GAHT) or be castrate-resistant. CONCLUSIONS We are in the infancy of our understanding of PSA screening in TW. Important avenues for future research include understanding the risks/benefits of PSA screening in TW, how best to mitigate potential negative psychological effects of PSA screening in TW, establishing baseline PSA values for those on GAHT (and determining what values should be considered "elevated"), establishing when to initiate PSA screening for those on GAHT, and establishing the accuracy of biomarkers for those undergoing GAHT. PATIENT SUMMARY We examined patterns of prostate cancer screening for transgender women. Little is known about prostate cancer incidence or screening in this population. Additional research is needed to establish guidelines for screening in this population.
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Affiliation(s)
- Farnoosh Nik-Ahd
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA.
| | - Andrew Jarjour
- College of Osteopathic Medicine of the Pacific, Western University, Pomona, CA, USA
| | - Jane Figueiredo
- Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jennifer T Anger
- Department of Urology, University of California-San Diego Health System, La Jolla, CA, USA
| | - Maurice Garcia
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Peter R Carroll
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Matthew R Cooperberg
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Adriana C Vidal
- Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Stephen J Freedland
- Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Reddy R, Zhao S, Boscardin WJ, Nik-Ahd F, Van Kuiken M, Suskind AM. The Role of Frailty on Surgical Outcomes Following Pelvic Organ Prolapse Surgery in Medicare Beneficiaries: A National Study. Urology 2022; 168:96-103. [PMID: 35830919 PMCID: PMC10999252 DOI: 10.1016/j.urology.2022.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 04/05/2022] [Revised: 06/23/2022] [Accepted: 06/28/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the association of frailty with surgical outcomes following pelvic organ prolapse (POP) surgery in Medicare beneficiaries. METHODS This is a retrospective cohort study of female Medicare beneficiaries ≥65 years of age undergoing POP surgery between 2014 and 2016. Primary outcomes were hospital length-of-stay (LOS) ≥3 days, 30-day post-operative complications (excluding urinary tract infections (UTI)), and 30-day UTI. Frailty was quantified using the validated Claims-Based Frailty Index (CFI) and categorized into not frail (CFI<0.15), pre-frail (0.15≤CFI<0.25), mildly frail (0.25≤CFI<0.35), and moderately to severely frail (0.35≤CFI≤1). RESULTS Among the 107,890 women included (mean age, 73.3±6 years), 91.3% were White as and 4.3% were classified as mildly or moderately to severely frail. Rates of hospital LOS≥3 days and 30-day UTI increased over 7-fold and rates of 30-day complications increased over 3-fold as CFI increased from not frail to moderately to severely frail (all P values <.001). Compared to women who were not frail, women who were moderately to severely frail demonstrated an increased relative risk of hospital LOS≥3 days (aRR 3.1 [95% CI 2.5-3.8,P <.001]), 30-day complications (aRR 2.8 [95% CI 2.2-3.6, P <.001]), and 30-day UTI (aRR 2.5 [95% CI 2.2-3.0, P <.001]). CONCLUSION Among Medicare beneficiaries undergoing POP surgery in the United States, frailty is strongly associated with increased risk of prolonged hospital stay and 30-day complications. Frailty should be considered in the preoperative assessment for POP surgeries to improve patient outcomes.
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Affiliation(s)
| | - Shoujun Zhao
- Department of Urology, University of California, San Francisco, CA
| | - W John Boscardin
- Department of Epidemiology and Statistics, University of California, San Francisco, CA
| | - Farnoosh Nik-Ahd
- Department of Urology, University of California, San Francisco, CA
| | | | - Anne M Suskind
- Department of Urology, University of California, San Francisco, CA
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Nik-Ahd F, Jin C, Boscardin WJ, Suskind AM. Reply by Authors. Urol Pract 2022; 9:320. [PMID: 37145793 DOI: 10.1097/upj.0000000000000309.02] [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] [Accepted: 03/29/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Farnoosh Nik-Ahd
- Department of Urology, University of California, San Francisco, San Francisco, California
| | - Chengshi Jin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - W John Boscardin
- Department of Geriatrics, University of California, San Francisco, San Francisco, California
| | - Anne M Suskind
- Department of Urology, University of California, San Francisco, San Francisco, California
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Nik-Ahd F, Jin C, Boscardin WJ, Suskind AM. Population Trends in Frailty in Older Adults with Benign Urological Conditions in Northern California. Urol Pract 2022; 9:314-320. [PMID: 37145772 DOI: 10.1097/upj.0000000000000309] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 01/19/2022] [Accepted: 03/30/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION We sought to understand regional variation of frailty across health service areas (HSAs) in Northern and Central California among older adults with benign urological conditions. METHODS This retrospective study utilizes the University of California, San Francisco Geriatric Urology Database, which includes adults ≥65 years old with benign urological conditions who underwent a Timed Up and Go Test (TUGT) between December 2015 and June 2020. The TUGT is a validated proxy for frailty, whereby a TUGT ≤10 seconds represents robust individuals and a TUGT >10 seconds represents prefrail and frail individuals. Subjects were assigned to the HSA wherein they live, and HSAs were stratified by mean TUGT scores. Analyses were conducted at the HSA level. Characteristics associated with prefrail/frail HSAs were identified using multivariable logistic regression. Least square means were used to determine variation in adjusted mean TUGT scores. RESULTS A total of 2,596 subjects were stratified into 69 HSAs in Northern and Central California. Twenty-one HSAs were categorized as robust and 48 HSAs were categorized as prefrail/frail. Prefrail/frail HSAs were significantly associated with older age (adjusted odds ratio [aOR] 4.03, CI 3.29-4.94, p <0.001), female sex (aOR 1.10, CI 1.07-1.11, p <0.001), non-White race (aOR 1.12, CI 1.10-1.14, p <0.001), underweight body mass index (BMI; aOR 1.14, CI 1.07-1.22, p <0.001) and obese BMI (aOR 1.06, CI 1.04-1.08, p <0.001). There was a 1.7-fold difference in mean TUGT values across HSAs. CONCLUSIONS Older age, non-White race, and underweight and obese BMIs are associated with prefrail/frail HSAs. Further investigation into health disparities as they pertain to geography and frailty is needed to expand upon these findings.
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Affiliation(s)
- Farnoosh Nik-Ahd
- Department of Urology, University of California, San Francisco, San Francisco, California
| | - Chengshi Jin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - W John Boscardin
- Department of Geriatrics, University of California, San Francisco, San Francisco, California
| | - Anne M Suskind
- Department of Urology, University of California, San Francisco, San Francisco, California
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Suskind AM, Zhao S, Nik-Ahd F, Boscardin WJ, Covinsky K, Finlayson E. Comparative outcomes for older adults undergoing surgery for bladder and bowel dysfunction. J Am Geriatr Soc 2021; 69:2210-2219. [PMID: 33818753 DOI: 10.1111/jgs.17118] [Citation(s) in RCA: 3] [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] [Revised: 01/27/2021] [Accepted: 02/19/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES To compare surgical outcomes between vulnerable nursing home (NH) residents and matched community-dwelling older adults undergoing surgery for bladder and bowel dysfunction. DESIGN Retrospective cohort study. PARTICIPANTS A total of 55,389 NH residents and propensity matched (based on procedure, age, sex, race, comorbidity, and year) community-dwelling older adults undergoing surgery for bladder and bowel dysfunction [female pelvic surgery, transurethral resection of the prostate, suprapubic tube placement, hemorrhoid surgery, rectal prolapse surgery]. Individuals were identified using Medicare claims and the Minimum Data Set (MDS) for NH residents between 2014 and 2016. MEASUREMENTS Thirty-day complications, 1-year mortality, and weighted changes in healthcare resource utilization (hospital admissions, emergency room visits, office visits) in the year before and after surgery. RESULTS NH residents demonstrated statistically significant increased risk of 30-day complications [60.1% v. 47.2%; RR 1.3 (95% CI 1.3-1.3)] and 1-year mortality [28.9% vs. 21.3%; RR 1.4 (95% CI 1.3-1.4)], compared to community-dwelling older adults. NH residents also demonstrated decreased healthcare resource utilization, compared to community-dwelling older adults, changing from 3.9 to 1.9 (vs.1.1 to 1.0) hospital admissions, 11 to 10.1 (vs. 9 to 9.7) office visits, and 3.4 to 2.2 (vs. 1.9 to 1.9) emergency room visits from the year before to after surgery. CONCLUSION Despite matching on several important clinical characteristics, NH residents demonstrated increased rates of 30-day complications and 1-year mortality after surgery for bowel and bladder dysfunction, while demonstrating decreased healthcare resource utilization. These mixed findings suggest that outcomes may be more varied among vulnerable older adults and warrant further investigation.
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Affiliation(s)
- Anne M Suskind
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
| | - Shoujun Zhao
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
| | - Farnoosh Nik-Ahd
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
| | - W John Boscardin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Kenneth Covinsky
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA
| | - Emily Finlayson
- Department of Surgery, University of California, San Francisco, San Francisco, California, USA
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Nik-Ahd F, Howard LE, Aronson WJ, Terris MK, Klaassen Z, Cooperberg MR, Amling CL, Kane CJ, Freedland SJ. Obese men undergoing radical prostatectomy: Is robotic or retropubic better to limit positive surgical margins? Results from SEARCH. Int J Urol 2020; 27:851-857. [PMID: 32681540 DOI: 10.1111/iju.14307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 01/14/2020] [Accepted: 06/04/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the association between obesity and positive surgical margins in patients undergoing retropubic radical prostatectomy versus robotic-assisted laparoscopic prostatectomy. METHODS We retrospectively reviewed the data of 3141 men undergoing retropubic radical prostatectomy and 1625 undergoing robotic-assisted laparoscopic prostatectomy between 1988 and 2017 at eight Veterans Health Administration hospitals. The positive surgical margin location (peripheral, apical, bladder neck, overall) was determined from pathology reports. We adjusted for age, race, prostate-specific antigen, surgery year, prostate weight, pathological grade group, extracapsular extension, seminal vesicle invasion, hospital surgical volume and surgical method (in analyses not stratified by surgical method). Interactions between body mass index and surgical approach were tested. RESULTS Among all patients, higher body mass index was associated with increased odds of overall, peripheral and apical positive surgical margins (OR 1.02-1.03, P ≤ 0.02). Although not statistically significant, there was a trend between higher body mass index and increased odds of bladder neck positive surgical margins (OR 1.03, P = 0.09). Interactions between body mass index and surgical method were significant for peripheral positive surgical margins only (P = 0.024). Specifically, there was an association between body mass index and peripheral positive surgical margins among men undergoing retropubic radical prostatectomy (OR 1.04, P < 0.001), but not robotic-assisted laparoscopic prostatectomy (OR 1.00, P = 0.98). Limitations include lacking individual surgeon data and lacking central pathology review. CONCLUSIONS In this multicenter cohort, higher body mass index was associated with increased odds of positive surgical margins at all locations except the bladder neck. Furthermore, there was a significant association between obesity and peripheral positive surgical margins in men undergoing retropubic radical prostatectomy, but not robotic-assisted laparoscopic prostatectomy. Long-term clinical significance requires further study.
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Affiliation(s)
- Farnoosh Nik-Ahd
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Lauren E Howard
- Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA.,Section of Urology, Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - William J Aronson
- Department of Urology, UCLA School of Medicine, Los Angeles, California, USA.,Urology Section, Department of Surgery, Veterans Affairs Greater Los Angeles, Los Angeles, California, USA
| | - Martha K Terris
- Division of Urology, Veterans Affairs Medical Center, Augusta, Georgia, USA.,Section of Urology, Department of Surgery, Augusta University Medical College of Georgia, Augusta, Georgia, USA
| | - Zachary Klaassen
- Section of Urology, Department of Surgery, Augusta University Medical College of Georgia, Augusta, Georgia, USA
| | - Matthew R Cooperberg
- David Geffen School of Medicine, University of California, Los Angeles, California, USA.,Division of Urology, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Christopher L Amling
- Department of Urology, Oregon Health and Science University, Portland, Oregon, USA
| | - Christopher J Kane
- Department of Urology, University of California San Diego Health System, San Diego, California, USA.,Division of Urology, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Stephen J Freedland
- Section of Urology, Veterans Affairs Medical Center, Durham, North Carolina, USA.,Department of Surgery, Division of Urology, Center for Integrated Research on Cancer and Lifestyle, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Nik-Ahd F, Souders CP, Houman J, Zhao H, Chughtai B, Anger JT. Robotic Urologic Surgery: Trends in Food and Drug Administration-Reported Adverse Events Over the Last Decade. J Endourol 2019; 33:649-654. [DOI: 10.1089/end.2018.0802] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Colby P. Souders
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Justin Houman
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Hanson Zhao
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical Center, New York, New York
| | - Jennifer T. Anger
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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15
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Nik-Ahd F, Howard LE, Eisenberg AT, Aronson WJ, Terris MK, Cooperberg MR, Amling CL, Kane CJ, Freedland SJ. Poorly controlled diabetes increases the risk of metastases and castration-resistant prostate cancer in men undergoing radical prostatectomy: Results from the SEARCH database. Cancer 2019; 125:2861-2867. [PMID: 31034601 DOI: 10.1002/cncr.32141] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 11/25/2018] [Revised: 01/31/2019] [Accepted: 03/14/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Although diabetes is inversely related to prostate cancer (PC) risk, to the authors' knowledge the impact of glycemic control on PC progression is unknown. In the current study, the authors tested the association between hemoglobin A1c (HbA1c) and long-term PC outcomes among diabetic men undergoing radical prostatectomy (RP). METHODS The authors retrospectively reviewed data regarding men undergoing RP from 2000 to 2017 at 8 Veterans Affairs hospitals. Diabetic patients were identified using International Classification of Diseases, Ninth Revision (ICD-9) codes (250.x) or by an HbA1c value >6.5% at any time before RP. Cox models tested the association between HbA1c and biochemical disease recurrence (BCR), castration-resistant PC (CRPC), metastases, PC-specific mortality, and all-cause mortality. The model for BCR was adjusted for multiple variables. Due to limited events, models for long-term outcomes were adjusted for biopsy grade and prostate-specific antigen only. RESULTS A total of 1409 men comprised the study population. Of these, 699 patients (50%) had an HbA1c value <6.5%, 631 (45%) had an HbA1c value of 6.5% to 7.9%, and 79 (6%) had an HbA1c value ≥8.0%. Men with an HbA1c value ≥8.0% were younger (P < .001) and more likely to be black (P = .013). The median follow-up after RP was 6.8 years (interquartile range, 3.7-10.6 years). On multivariable analysis, HbA1c was not found to be associated with BCR. However, a higher HbA1c value was associated with metastasis (hazard ratio [HR], 1.21; 95% CI, 1.02-1.44 [P = .031]) and CRPC (HR, 1.27; 95% CI, 1.03-1.56 [P = .023]). Although not statistically significant, there were trends between higher HbA1c and risk of PC-specific mortality (HR, 1.24; 95% CI, 0.99-1.56 [P = .067]) and all-cause mortality (HR, 1.09; 95% CI, 0.99-1.19 [P = .058]). CONCLUSIONS Among diabetic men undergoing RP, a higher HbA1c value was associated with metastases and CRPC. If validated in larger studies with longer follow-up, future research should test whether better glycemic control improves long-term PC outcomes.
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Affiliation(s)
- Farnoosh Nik-Ahd
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Lauren E Howard
- Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina.,Division of Urology, Veterans Affairs Medical Center, Durham, North Carolina
| | - Adva T Eisenberg
- Department of Endocrinology, Duke University School of Medicine, Durham, North Carolina
| | - William J Aronson
- Department of Urology, University of California at Los Angeles School of Medicine, Los Angeles, California.,Urology Section, Department of Surgery, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Martha K Terris
- Section of Urology, Veterans Affairs Medical Center, Augusta, Georgia.,Section of Urology, Medical College of Georgia, Augusta, Georgia
| | - Matthew R Cooperberg
- Department of Urology, University of California at San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Christopher L Amling
- Division of Urology, Department of Surgery, Oregon Health and Science University, Portland, Oregon
| | - Christopher J Kane
- Department of Urology, University of California at San Diego Health System, San Diego, California
| | - Stephen J Freedland
- Division of Urology, Department of Surgery, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
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Huen KH, Nik-Ahd F, Chen L, Lerman S, Singer J. Neomycin-polymyxin or gentamicin bladder instillations decrease symptomatic urinary tract infections in neurogenic bladder patients on clean intermittent catheterization. J Pediatr Urol 2019; 15:178.e1-178.e7. [PMID: 30611650 DOI: 10.1016/j.jpurol.2018.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 08/01/2018] [Revised: 10/21/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Recurrent urinary tract infections (UTIs) are common in patients with neurogenic bladder (NGB) performing clean intermittent catheterization (CIC) treated with or without oral antibiotic prophylaxis. OBJECTIVE The authors aim to determine if daily neomycin-polymyxin or gentamicin bladder instillations reduce the rate of symptomatic UTIs, the need for oral antibiotic prophylaxis, emergency department (ED) visits for UTI, and inpatient hospitalizations for UTI in patients with NGB on CIC. The authors also aim to investigate resistance patterns in urine microorganisms in patients treated with antibiotic bladder instillations. STUDY DESIGN The authors retrospectively reviewed the records of all-age patients cared for in the pediatric urology clinic with NGB on CIC having symptomatic UTIs and on daily intravesical instillations of neomycin-polymyxin or gentamicin between 2013 and 2017. Symptomatic UTIs were defined as a positive urine culture with greater than 10,000 colony forming units/mL associated with one or more of the following patient complaints: cloudy/foul-smelling urine, fevers, chills, increase in bladder spasms, pain, urinary leakage, or physician decision for antibiotic treatment. Multidrug-resistant organisms were resistant to two or more classes of antibiotics. RESULTS Fifty-two patients with a median age of 14.5 years and 192 distinct urine cultures were identified. 90.4% and 9.6% of patients received neomycin-polymyxin and gentamicin instillations, respectively. After initiation of intravesical antibiotics, the rate of symptomatic UTIs was reduced by 58% (incidence rate ratio [IRR]: 0.42, 95% confidence interval [CI]: 0.31-0.56; P < 0.001), the rate of ED visits was reduced by 54% (IRR: 0.46, 95% CI: 0.30-0.71; P < 0.001), and the rate of inpatient hospitalizations for UTI was reduced by 39% (IRR: 0.61, 95% CI: 0.37-0.98; P = 0.043). Fewer patients received oral antibiotic prophylaxis after initiation of antibiotic instillations (odds ratio: 0.12, 95% CI: 0.02-0.067; P = 0.016). There was a trend toward a decrease in multidrug resistance and no change in gentamicin resistance in urine microorganisms. DISCUSSION This study describes a feasible alternative treatment for patients with NGB on CIC who have persistent UTIs despite oral antibiotic prophylaxis, and for some patients, it may suggest a possibility of discontinuing oral prophylaxis. Limitations include a retrospective design with a small cohort of patients and varying dosages of neomycin-polymyxin. CONCLUSIONS Antibiotic bladder instillations appear to decrease frequency of symptomatic UTIs, ED visits for UTI, inpatient hospitalizations for UTI, and the need for oral antibiotic prophylaxis in patients with NGB on CIC. There was no increase in multidrug resistance or gentamicin resistance in UTI organisms with use of intravesical antibiotic instillation.
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Affiliation(s)
- K H Huen
- Department of Urology, David Geffen School of Medicine at UCLA, 300 Stein Plaza, 3rd Floor, Suite 331, Los Angeles, CA 90095, USA.
| | - F Nik-Ahd
- David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
| | - L Chen
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, 911 Broxton Ave, 3rd Floor, Los Angeles, CA 90024, USA
| | - S Lerman
- Department of Urology, David Geffen School of Medicine at UCLA, 300 Stein Plaza, 3rd Floor, Suite 331, Los Angeles, CA 90095, USA
| | - J Singer
- Department of Urology, David Geffen School of Medicine at UCLA, 300 Stein Plaza, 3rd Floor, Suite 331, Los Angeles, CA 90095, USA
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17
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Souders C, Nik-Ahd F, Zhao H, Eilber K, Chugtai B, Anger J. Robotic sacrocolpopexy: adverse events reported to the FDA over the last decade. Int Urogynecol J 2019; 30:1919-1923. [PMID: 30617505 DOI: 10.1007/s00192-018-3845-6] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/30/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS As surgeons increase the volume of robotic abdominal sacrocolpopexies (rASCs) and become more experienced, a subsequent decrease in the number of adverse events is expected over time. Further, as the leading manufacturer of the operative robot (Intuitive Surgical) improves the technology, adverse events should also decrease. We hypothesized that there has been a decrease in adverse event reporting for rASCs and that serious adverse events are rare. METHODS We performed a search of the FDA Manufacturer and User Facility Device Experience (MAUDE) database. All entries with the manufacturer "Intuitive Surgical" were exported from 2007 to 2017. All entries with "sacrocolpopexy" were then isolated and analyzed. RESULTS The number of adverse events reported for rASC peaked in 2013 and 2014, at 107 and 124 respectively. In 2015 and 2016, the number dropped to 11 and 7 respectively. There were 334 reported adverse events from 2007 to 2017. Five (1.50%) were categorized as death, 33 (9.88%) as injury, and 296 (88.62%) as malfunction. Analysis of the malfunction reports found that 15 out of 296 (5.07%) were converted to open surgery, 4 out of 296 (1.3%) were converted to laparoscopic surgery, 4 out of 296 (1.3%) cases were aborted, and 6 out of 296 (2.03%) malfunctions resulted in patient injury. CONCLUSIONS Although the MAUDE database has its limitations, it does indicate that the number of adverse events reported for rASC peaked in 2013 and 2014 and has decreased annually since then. This may be due to improved proficiency of the surgeon and surgical team, in addition to improvements in the robot. When malfunctions do occur, they infrequently cause serious injury or have an impact on surgical approach.
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Affiliation(s)
- Colby Souders
- Cedars-Sinai Medical Center, 99 N. La Cienega Blvd., Suite M102, Beverly Hills, CA, 90211, USA
| | - Farnoosh Nik-Ahd
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Hanson Zhao
- Cedars-Sinai Medical Center, 99 N. La Cienega Blvd., Suite M102, Beverly Hills, CA, 90211, USA
| | - Karyn Eilber
- Cedars-Sinai Medical Center, 99 N. La Cienega Blvd., Suite M102, Beverly Hills, CA, 90211, USA
| | | | - Jennifer Anger
- Cedars-Sinai Medical Center, 99 N. La Cienega Blvd., Suite M102, Beverly Hills, CA, 90211, USA.
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18
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Lindsay I, Nik-Ahd F, Aboulhosn JA, Moore JP. Electrophysiology and structural interventions in adults with congenital heart disease: Comparison of combined versus separate procedures. J Cardiovasc Electrophysiol 2018; 29:1280-1286. [PMID: 29777556 DOI: 10.1111/jce.13637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 04/28/2018] [Accepted: 05/15/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Electrophysiologic (EP) and structural interventions in adult congenital heart disease (ACHD) are typically completed during separate hospital encounters. With planning/coordination, these cases can be combined. OBJECTIVES We hypothesized that this integrated approach would yield patient and health system benefits. METHODS Consecutive ACHD patients undergoing combined interventions were matched to controls with identical but separate procedures. Primary endpoints of total hospital length of stay and cost were compared. RESULTS Sixty-six combined cases and 120 controls were identified (45% male, mean age 36.2 ± 14.2 years). The most common diagnoses were Fontan (27%), tetralogy of Fallot (23%), and transposition complexes (20%). The most common EP procedure was catheter ablation (n = 30) followed by electrophysiologic study (n = 13); the most common structural intervention was transcatheter valve replacement (n = 16) followed by angioplasty/stenting (n = 14). Compared to controls, cases showed shorter anesthesia duration (323 [IQR 238-405] vs. 355 minutes [270-498], P = 0.06), smaller contrast dose (130 [50-189] vs. 177 mL [94-228], P = 0.045), fewer venipunctures (4 [3-4] vs. 6 [5-7], P < 0.001), and fewer work days missed (2 [2-5] vs. 4 [4-6], P < 0.001). There was shorter hospital stay (30 [19-35] vs. 38 hours [26-50], P = 0.023) and a 37% reduction in hospital charges ($117,894 vs. $187,648; P = 0.039) and 27% reduction in payments ($65,757 vs. $88,859; P = 0.016), persisting after adjustment for group differences. There were no significant differences in number of complications or efficacy. CONCLUSIONS There appear to be advantages to combining ACHD interventional procedures that include reductions in hospital length of stay and cost, without detectable difference in procedural outcome.
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Affiliation(s)
- Ian Lindsay
- Ahmanson-UCLA Adult Congenital Heart Disease Center, University of California at Los Angeles, Los Angeles, CA, USA
| | - Farnoosh Nik-Ahd
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Jamil A Aboulhosn
- Ahmanson-UCLA Adult Congenital Heart Disease Center, University of California at Los Angeles, Los Angeles, CA, USA
| | - Jeremy P Moore
- Ahmanson-UCLA Adult Congenital Heart Disease Center, University of California at Los Angeles, Los Angeles, CA, USA
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Campbell M, Moore JP, Sreeram N, von Alvensleben JC, Shah A, Batra A, Law I, Sanatani S, Thomas V, Nik-Ahd F, Williams S, Nosavan N, Maldonado J, Hart A, Nguyen T, Balaji S. Predictors of electrocardiographic screening failure for the subcutaneous implantable cardioverter-defibrillator in children: A prospective multicenter study. Heart Rhythm 2018; 15:703-707. [PMID: 29309839 DOI: 10.1016/j.hrthm.2018.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 08/26/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Subcutaneous implantable cardioverter-defibrillator (SICD) shows promise for select patients at risk of sudden cardiac death. However, patients need to pass an electrocardiographic (ECG) screening (ECG-S) test before they can receive an SICD. Predictors of ECG-S failure in children are unclear. OBJECTIVE The purpose of this study was to identify the incidence and predictive factors for failure of ECG-S in children. METHODS Patients 18 years and younger with a preexisting ICD underwent ECG-S for SICD. ECG and demographic data were analyzed for factors predictive of failure. RESULTS Seventy-three patients (mean age 14.2 ± 3.3 years; range 5-18 years) with hypertrophic cardiomyopathy (n = 24, 33%), long QT syndrome (n =18, 25%), other inherited arrhythmia syndromes (n = 20, 27%), congenital heart disease (n = 9, 12%), and miscellaneous conditions (n = 2) with an existing transvenous ICD underwent prospective ECG-S. Nineteen (26%) failed ECG-S. Failed patients had a longer corrected QT (QTc) interval (457 ms vs 425 ms; P = .03), a longer QRS duration (120 ms vs 98 ms; P = .04), and a lower ratio of R-wave to T-wave amplitudes (R:T ratio) in lead aVF (4 vs 5; P = .001). Multivariable logistic regression identified QTc interval (odds ratio [OR] 4.31; P = .04), QRS duration (OR 4.93; P = .03), R:T ratio in lead aVF (OR 3.13; P = .08) as predictors of failure. A risk score with 1 point each for QTc interval >440 ms, QRS duration >120 ms, and R:T ratio <6.5 in lead aVF was associated with probability of failure of 15.4% (1 point), 47.4% (2 points), and 88.6% (3 points), respectively. CONCLUSION ECG-S failure for SICD occurred in 26% of children, which is higher than the reported incidence in adults. Factors predicting ECG-S failure included longer QTc interval, longer QRS duration, and lower R:T ratio in lead aVF.
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Affiliation(s)
| | - Jeremy P Moore
- University of California, Los Angeles, Los Angeles, California
| | | | | | - Anjan Shah
- University of Oklahoma, Oklahoma City, Oklahoma
| | - Anjan Batra
- University of California, Irvine, Orange, California
| | - Ian Law
- University of Iowa, Iowa City, Iowa
| | | | | | | | | | - Nina Nosavan
- University of California, Irvine, Orange, California
| | | | - Amelia Hart
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Thuan Nguyen
- Oregon Health and Science University, Portland, Oregon
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20
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Gallotti RG, Madnawat H, Shannon KM, Aboulhosn JA, Nik-Ahd F, Moore JP. Mechanisms and predictors of recurrent tachycardia after catheter ablation for d-transposition of the great arteries after the Mustard or Senning operation. Heart Rhythm 2017; 14:350-356. [DOI: 10.1016/j.hrthm.2016.11.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Indexed: 11/25/2022]
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21
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Nik-Ahd F, Bertoni C. Ex vivo gene editing of the dystrophin gene in muscle stem cells mediated by peptide nucleic acid single stranded oligodeoxynucleotides induces stable expression of dystrophin in a mouse model for Duchenne muscular dystrophy. Stem Cells 2015; 32:1817-30. [PMID: 24753122 DOI: 10.1002/stem.1668] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 01/07/2014] [Accepted: 01/26/2014] [Indexed: 12/27/2022]
Abstract
Duchenne muscular dystrophy (DMD) is a fatal disease caused by mutations in the dystrophin gene, which result in the complete absence of dystrophin protein throughout the body. Gene correction strategies hold promise to treating DMD. Our laboratory has previously demonstrated the ability of peptide nucleic acid single-stranded oligodeoxynucleotides (PNA-ssODNs) to permanently correct single-point mutations at the genomic level. In this study, we show that PNA-ssODNs can target and correct muscle satellite cells (SCs), a population of stem cells capable of self-renewing and differentiating into muscle fibers. When transplanted into skeletal muscles, SCs transfected with correcting PNA-ssODNs were able to engraft and to restore dystrophin expression. The number of dystrophin-positive fibers was shown to significantly increase over time. Expression was confirmed to be the result of the activation of a subpopulation of SCs that had undergone repair as demonstrated by immunofluorescence analyses of engrafted muscles using antibodies specific to full-length dystrophin transcripts and by genomic DNA analysis of dystrophin-positive fibers. Furthermore, the increase in dystrophin expression detected over time resulted in a significant improvement in muscle morphology. The ability of transplanted cells to return into quiescence and to activate upon demand was confirmed in all engrafted muscles following injury. These results demonstrate the feasibility of using gene editing strategies to target and correct SCs and further establish the therapeutic potential of this approach to permanently restore dystrophin expression into muscle of DMD patients.
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Affiliation(s)
- Farnoosh Nik-Ahd
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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