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Evans SK, Ober AJ, Korn AR, Peltz A, Friedmann PD, Page K, Murray-Krezan C, Huerta S, Ryzewicz SJ, Tarhuni L, Nuckols TK, E Watkins K, Danovitch I. Contextual barriers and enablers to establishing an addiction-focused consultation team for hospitalized adults with opioid use disorder. Addict Sci Clin Pract 2024; 19:31. [PMID: 38671482 PMCID: PMC11046820 DOI: 10.1186/s13722-024-00461-x] [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: 09/18/2023] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Hospitalization presents an opportunity to begin people with opioid use disorder (OUD) on medications for opioid use disorder (MOUD) and link them to care after discharge; regrettably, people admitted to the hospital with an underlying OUD typically do not receive MOUD and are not connected with subsequent treatment for their condition. To address this gap, we launched a multi-site randomized controlled trial to test the effectiveness of a hospital-based addiction consultation team (the Substance Use Treatment and Recovery Team (START)) consisting of an addiction medicine specialist and care manager team that provide collaborative care and a specified intervention to people with OUD during the inpatient stay. Successful implementation of new practices can be impacted by organizational context, though no previous studies have examined context prior to implementation of addiction consultation services (ACS). This study assessed pre-implementation context for implementing a specialized ACS and tailoring it accordingly. METHODS We conducted semi-structured interviews with hospital administrators, physicians, physician assistants, nurses, and social workers at the three study sites between April and August 2021 before the launch of the pragmatic trial. Using an analytical framework based on the Consolidated Framework for Implementation Research, we completed a thematic analysis of interview data to understand potential barriers or enablers and perceptions about acceptability and feasibility. RESULTS We interviewed 28 participants across three sites. The following themes emerged across sites: (1) START is an urgently needed model for people with OUD; (2) Intervention adaptations are recommended to meet local and cultural needs; (3) Linking people with OUD to community clinicians is a highly needed component of START; (4) It is important to engage stakeholders across departments and roles throughout implementation. Across sites, participants generally saw a need for change from usual care to support people with OUD, and thought the START was acceptable and feasible to implement. Differences among sites included tailoring the START to support the needs of varying patient populations and different perceptions of the prevalence of OUD. CONCLUSIONS Hospitals planning to implement an ACS in the inpatient setting may wish to engage in a systematic pre-implementation contextual assessment using a similar framework to understand and address potential barriers and contextual factors that may impact implementation. Pre-implementation work can help ensure the ACS and other new practices fit within each unique hospital context.
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Affiliation(s)
- Sandra K Evans
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA.
| | - Allison J Ober
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA
| | - Ariella R Korn
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA
| | - Alex Peltz
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA
| | - Peter D Friedmann
- Department of Medicine, University of Massachusetts Chan Medical School-Baystate and Baystate Health, 3601 Main Street, 3rd Floor, 01107, Springfield, MA, USA
| | - Kimberly Page
- University of New Mexico Health Sciences Center, 1 University, MSC10 5550, 87133, Albuquerque, NM, USA
| | - Cristina Murray-Krezan
- Departement of Medicine, University of Pittsburgh School of Medicine, 200 Meyran Ave, Suite 300, 15213, Pittsburgh, PA, USA
| | - Sergio Huerta
- University of New Mexico Health Sciences Center, 1 University, MSC10 5550, 87133, Albuquerque, NM, USA
| | - Stephen J Ryzewicz
- Department of Medicine, University of Massachusetts Chan Medical School-Baystate and Baystate Health, 3601 Main Street, 3rd Floor, 01107, Springfield, MA, USA
| | - Lina Tarhuni
- University of New Mexico Health Sciences Center, 1 University, MSC10 5550, 87133, Albuquerque, NM, USA
| | - Teryl K Nuckols
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, 90048, West Hollywood, CA, USA
| | - Katherine E Watkins
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA
| | - Itai Danovitch
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, 90048, West Hollywood, CA, USA
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Huerta S, Raj R, Chang J. Botulinum Toxin A as an Adjunct for the Repair Giant Inguinal Hernias: Case Reports and a Review of the Literature. J Clin Med 2024; 13:1879. [PMID: 38610644 PMCID: PMC11012701 DOI: 10.3390/jcm13071879] [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: 02/18/2024] [Revised: 03/17/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
The management of giant inguinoscrotal hernias remains a challenge as a result of the loss of the intra-abdominal domain from long-standing hernia contents within the scrotum. Multiple techniques have been described for abdominal wall relaxation and augmentation to allow the safe return of viscera from the scrotum to the intraperitoneal cavity without adversely affecting cardiorespiratory physiology. Preoperative progressive pneumoperitoneum, phrenectomy, and component separation are but a few common techniques previously described as adjuncts to the management of these massively large hernias. However, these strategies require an additional invasive stage, and reproducibility remains challenging. Botulinum toxin A (BTA) has been successfully used for the management of complex ventral hernias. Its use for these hernias has shown reproducibility and a low side effect profile. In the present report, we describe our institutional experience with BTA for giant inguinal hernias in two patients and present a review of the literature. In one case, a 77-year-old man with a substantial cardiac history presented with a giant left inguinal hernia that was interfering with his activities of daily living. He had BTA six weeks prior to inguinal hernia repair. Repair was performed via an inguinal incision with a favorable return of the viscera into the peritoneum. He was discharged on the same day of the operation. A second patient, 78 years of age, had a giant right inguinoscrotal hernia. He had a significant cardiac history and was treated with BTA six weeks prior to inguinal hernia repair via a groin incision. Neither patient had complaints nor recurrence at 7- and 3-month follow-ups. While the literature on this topic is scarce, we found 13 cases of inguinal hernias treated with BTA as an adjunct. BTA might be a promising adjunct for the management of giant inguinoscrotal hernias in addition to or in place of current strategies.
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Affiliation(s)
- Sergio Huerta
- Department of Surgery, VA North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
| | - Roma Raj
- Department of Surgery, VA North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
| | - Jonathan Chang
- Department of Anesthesia and Pain Management, VA North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
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Huerta S. Letter re: Elective Operations in Class III Obese Patients. Am Surg 2024; 90:168. [PMID: 35977552 DOI: 10.1177/00031348221121543] [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: 11/15/2022]
Affiliation(s)
- Sergio Huerta
- Department of Surgery, VA North Texas Health Care System, University of Texas Southwestern Medical Center, TX, USA
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Favela JG, Argo MB, McAllister J, Waldrop CL, Huerta S. Gastric Outlet Obstruction from Stomach-Containing Groin Hernias: Case Report and a Systematic Review. J Clin Med 2023; 13:155. [PMID: 38202162 PMCID: PMC10779582 DOI: 10.3390/jcm13010155] [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: 11/19/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 01/12/2024] Open
Abstract
Most abdominopelvic structures can find their way to a groin hernia. However, location, and relative fixation are important for migration. Gastric outlet obstruction (GOO) from a stomach-containing groin hernia (SCOGH) is exceedingly rare. In the current report, we present a 77-year-old man who presented with GOO from SCOGH to our facility. We performed a review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) of patients presenting with SCOGH since it was first reported in 1802. Ninety-one cases of SCOGH were identified (85 inguinal and six femoral) over the last two centuries (1802-2023). GOO from SCOGH occurred in 48% of patients in one review and 18% in our systematic analysis. Initial presentation ranged from a completely asymptomatic patient to peritonitis. Management varied from entirely conservative treatment to elective hernia repair to emergent laparotomy. Only one case of laparoscopic management was documented. Twenty-one deaths from SCOGH were reported, with most occurring in early manuscripts (1802-1896 [n = 9] and 1910-1997 [n = 10]). In the recent medical era, outcomes for patients with this rare clinical presentation are satisfactory and treatment ranging from conservative, non-operative management to surgical repair should be tailored towards patients' clinical presentation.
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Affiliation(s)
- Juan G. Favela
- Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, WI 53792, USA; (J.G.F.); (M.B.A.)
| | - Madison B. Argo
- Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, WI 53792, USA; (J.G.F.); (M.B.A.)
| | - Jared McAllister
- Department of Surgery, VA North Texas Health Care System, Dallas, TX 75216, USA; (J.M.); (C.L.W.)
| | - Caitlyn L. Waldrop
- Department of Surgery, VA North Texas Health Care System, Dallas, TX 75216, USA; (J.M.); (C.L.W.)
| | - Sergio Huerta
- Department of Surgery, VA North Texas Health Care System, Dallas, TX 75216, USA; (J.M.); (C.L.W.)
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Huerta S. Letter re: Elective Hernia Repair in Obese Patients. Am Surg 2023; 89:6438-6439. [PMID: 34823404 DOI: 10.1177/00031348211058638] [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] [Indexed: 11/16/2022]
Abstract
NA this is a Letter to the Editor.
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Affiliation(s)
- Sergio Huerta
- Department of Surgery, VA North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Huerta S. The best strategy for the management of inguinodynia is prevention. Hernia 2023; 27:1619-1620. [PMID: 36973466 DOI: 10.1007/s10029-023-02778-z] [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: 02/18/2023] [Accepted: 03/12/2023] [Indexed: 03/29/2023]
Affiliation(s)
- S Huerta
- Department of Surgery, VA North Texas Health Care System, University of Texas Southwestern Medical Center, 4500 S. Lancaster Road (112), Dallas, Texas, 75216, USA.
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Huerta S, Huchim-Peña CJ, Ta T, Quiñones ME, Mendoza JA, Corzo VF, Ortiz C. Patients', Local Staff, and Medical Students' Perceptions on a Medical Mission Trip to Guatemala. Curr Probl Surg 2023; 60:101378. [PMID: 37993236 DOI: 10.1016/j.cpsurg.2023.101378] [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: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Sergio Huerta
- Department of Surgery, VA North Texas Health Care System, Dallas, TX; Hospital Nacional de San Benito, El Peten, Guatemala.
| | - Cristian J Huchim-Peña
- Federico Gomez Children's Hospital of Mexico, Mexico City, Mexico; Faculty of Medicine, Autonomous University of Yucatan, Merida, Yucatan, Mexico
| | - Timothy Ta
- Texas A&M University, College Station, TX
| | | | | | | | - Cesar Ortiz
- Hospital Nacional de San Benito, El Peten, Guatemala
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Bokhari SM, Sambandam S, Tsai S, Nathan VS, Senthil T, Lanier H, Huerta S. Does obesity predict morbidity and mortality amongst patients undergoing transfemoral amputations? Vascular 2023:17085381231165592. [PMID: 36939229 DOI: 10.1177/17085381231165592] [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] [Indexed: 03/21/2023]
Abstract
BACKGROUND We investigated the role of obesity on morbidity and mortality in patients undergoing above knee amputation. METHODS Data of 4225 patients undergoing AKAs was extracted from NIS Database (2016-2019) for a retrospectively matched case-control study and were grouped into; Non-obese (N-Ob-BMI <29.9 kg/m2; n = 1413), class I/II obese (Ob-I/II-BMI: 30-39.9 kg/m2; n = 1413), and class III obese groups (Ob-IIIBMI > 40; n = 1399). Morbidity, mortality, length of stay, and hospital charges were analyzed. RESULTS Blood loss anemia (OR = 1.42; 95% CI = 1.19-1.64), superficial SSI (OR = 5.10; 95% CI = 1.4717.63) and acute kidney injury (AKI- OR = 1.42; 95% CI = 1.21-1.67) were higher in Ob-III patients. Mortality was 5.8%, 4.5%, and 6.4% in N-Ob, Ob-I/II and Ob-III patients (p < 0.001; Ob-I/II vs. Ob-III), respectively. Hospital LOS was 3 days higher in Ob-III (16.1 ± 18.0), comparatively resulting in $25,481 higher inpatient-hospital charge. CONCLUSION Patients in Ob-III group were noted to have increased morbidity, higher LOS, and inpatient-hospital cost.
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Affiliation(s)
- Syed Mma Bokhari
- Department of General Surgery, 20115VA North Texas Health Care System, Dallas, TX, USA
| | - Senthil Sambandam
- Department of Orthopedics, 20115VA North Texas Health Care System, Dallas, TX, USA
| | - Shirling Tsai
- Department of Vascular Surgery, 20115VA North Texas Health Care System, Dallas, TX, USA
| | - Vishaal S Nathan
- Department of Orthopedics, 20115VA North Texas Health Care System, Dallas, TX, USA
| | - Tejas Senthil
- Department of Orthopedics, 20115VA North Texas Health Care System, Dallas, TX, USA
| | - Heather Lanier
- Department of General Surgery, 20115VA North Texas Health Care System, Dallas, TX, USA
| | - Sergio Huerta
- Department of General Surgery, 20115VA North Texas Health Care System, Dallas, TX, USA
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Huerta S, Pérez-Lara L, Pinilla-González A, Morell C, Llorens-Salvador R, Villarroya-Villalba Á, Carreras C, Cernada M. Hemophagocytic Lymphohistiocytosis and Severe Hypoxemia in a Preterm Infant. Pediatr Infect Dis J 2023; 42:271-273. [PMID: 36102741 DOI: 10.1097/inf.0000000000003705] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Sergio Huerta
- From the Division of Neonatology, General University Hospital, Castellon, Spain
| | - Laura Pérez-Lara
- Division of Neonatology, La Fe University & Polytechnic Hospital
| | | | - Carlos Morell
- From the Division of Neonatology, General University Hospital, Castellon, Spain
| | | | | | - Carmen Carreras
- Department of Primary Inmunodeficiencies, La Fe University & Polytechnic Hospital, Valencia, Spain
| | - María Cernada
- Division of Neonatology, La Fe University & Polytechnic Hospital
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10
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Affiliation(s)
- S Huerta
- Department of Surgery, University of Texas Southwestern Medical Center, VA North Texas Health Care System, 4500 S. Lancaster Road (112), Dallas, TX, 75216, USA.
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11
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Huerta S. Total extraperitoneal repair of inguinal hernia under local anesthesia. Hernia 2023; 27:199-200. [PMID: 36385352 DOI: 10.1007/s10029-022-02711-w] [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] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 11/04/2022] [Indexed: 11/17/2022]
Affiliation(s)
- S Huerta
- Department of Surgery, VA North Texas Health Care System, University of Texas Southwestern Medical Center, 4500 S. Lancaster Road (112), Dallas, TX, 75216, USA.
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Calcaterra SL, Bottner R, Martin M, Englander H, Weinstein ZM, Weimer MB, Lambert E, Ronan MV, Huerta S, Zaman T, Ullal M, Peterkin AF, Torres-Lockhart K, Buresh M, O’Brien MT, Snyder H, Herzig SJ. Management of opioid use disorder, opioid withdrawal, and opioid overdose prevention in hospitalized adults: A systematic review of existing guidelines. J Hosp Med 2022; 17:679-692. [PMID: 35880821 PMCID: PMC9474657 DOI: 10.1002/jhm.12908] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/11/2022] [Accepted: 05/22/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Hospitalizations related to the consequences of opioid use are rising. National guidelines directing in-hospital opioid use disorder (OUD) management do not exist. OUD treatment guidelines intended for other treatment settings could inform in-hospital OUD management. OBJECTIVE Evaluate the quality and content of existing guidelines for OUD treatment and management. DATA SOURCES OVID MEDLINE, PubMed, Ovid PsychINFO, EBSCOhost CINHAL, ERCI Guidelines Trust, websites of relevant societies and advocacy organizations, and selected international search engines. STUDY SELECTION Guidelines published between January 2010 to June 2020 addressing OUD treatment, opioid withdrawal management, opioid overdose prevention, and care transitions among adults. DATA EXTRACTION We assessed quality using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. DATA SYNTHESIS Nineteen guidelines met the selection criteria. Most recommendations were based on observational studies or expert consensus. Guidelines recommended the use of nonstigmatizing language among patients with OUD; to assess patients with unhealthy opioid use for OUD using the Diagnostic Statistical Manual of Diseases-5th Edition criteria; use of methadone or buprenorphine to treat OUD and opioid withdrawal; use of multimodal, nonopioid therapy, and when needed, short-acting opioid analgesics in addition to buprenorphine or methadone, for acute pain management; ensuring linkage to ongoing methadone or buprenorphine treatment; referring patients to psychosocial treatment; and ensuring access to naloxone for opioid overdose reversal. CONCLUSIONS Included guidelines were informed by studies with various levels of rigor and quality. Future research should systematically study buprenorphine and methadone initiation and titration among people using fentanyl and people with pain, especially during hospitalization.
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Affiliation(s)
- Susan L. Calcaterra
- Department of Medicine, Division of General Internal Medicine and Division of Hospital Medicine, University of Colorado, Aurora, CO, USA
| | - Richard Bottner
- Department of Internal Medicine, Dell Medical School at The University of Texas at Austin, Austin, TX, USA
| | - Marlene Martin
- Department of Medicine, Division of Hospital Medicine, University of California San Francisco and San Francisco General Hospital, San Francisco, CA, USA
| | - Honora Englander
- Section of Addiction Medicine and Division of Hospital Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Zoe M. Weinstein
- Boston University School of Medicine, Boston Medical Center, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston, MA, USA
| | | | - Eugene Lambert
- Harvard Medical School, Boston, MA and Massachusetts General Hospital, Medicine, Charlestown, MA, USA
| | - Matthew V. Ronan
- Harvard Medical School, Boston, MA and Massachusetts General Hospital, Medicine, Charlestown, MA, USA
- Department of Medicine, VA Boston Healthcare System, West Roxbury, MA, USA
| | - Sergio Huerta
- Department of Internal Medicine, Division of Hospital Medicine, University of New Mexico School of Medicine, NM, USA
| | - Tauheed Zaman
- San Francisco VA Medical Center, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Monish Ullal
- Department of Internal Medicine at Highland Hospital, Alameda Health System, Oakland, CA, USA
| | - Alyssa F. Peterkin
- Boston University School of Medicine, Boston Medical Center, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston, MA, USA
| | | | - Megan Buresh
- Division of Addiction Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Meghan T. O’Brien
- Department of Medicine, Division of Hospital Medicine, University of California San Francisco and San Francisco General Hospital, San Francisco, CA, USA
| | - Hannah Snyder
- Family Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Shoshana J. Herzig
- Harvard Medical School, Boston, MA and Massachusetts General Hospital, Medicine, Charlestown, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Huerta S, Kakati R, Lanier H. Gas-Containing Biliary Calculi: Case Series and a Systematic Review. Am Surg 2022:31348221121553. [PMID: 35969478 DOI: 10.1177/00031348221121553] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cholelithiasis is a common gallbladder finding leading to cholecystitis in 7% of cases. Sonographic imaging or computed tomography scans are commonly employed for the diagnosis of benign gallbladder disease. Air within the gallbladder might carry various diagnoses. As opposed to pathologic air in the gallbladder seen in emphysematous cholecystitis, gas-containing gallstones are no more pathological than the exclusive presence of gallstones. In the present report, we review the incidence, physiology, typical characteristics, and clinical significance of gas-containing gallstones within the gallbladder. METHODS We performed an institutional review of all patients with benign gallbladder disease over the past 16 years (2005 to 2021) to identify patients with gas-containing gallstones in the gallbladder. We performed a review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) to identify all reported cases of patients with gas-containing biliary calculi within the gallbladder. RESULTS Our institutional review identified 5 patients with gas-containing biliary calculi in 1252 consecutive cholecystectomies; 4 of which had cholecystitis, while 1 was an incidental finding. Our review of the literature identified 30 manuscripts documenting 54 unique patients with gas-containing biliary calculi. None of these patients had consequential pathology related to gas in the stones other than that caused by the gallstones (ie, biliary colic and cholecystitis). CONCLUSIONS Gas-containing biliary calculi are uncommon. How gas finds itself within gallstones within the gallbladder is not entirely clear. Gas-containing gallstones should not be interpreted as free gas within the gallbladder or within an abscess.
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Affiliation(s)
- Sergio Huerta
- Department of Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA.,University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Rasha Kakati
- Department of Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Heather Lanier
- University of Texas Southwestern Medical School, Dallas, TX, USA
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Huerta S, Lanier H, Tsai S, Pham T, Sambandam S. The VASQIP Calculator is a poor predictor of morbidity and mortality in octogenarian and nonagenarian veterans undergoing major lower extremity amputations. Ann Vasc Surg 2022; 85:32-40. [PMID: 35595212 DOI: 10.1016/j.avsg.2022.04.054] [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: 03/04/2022] [Revised: 04/03/2022] [Accepted: 04/28/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Morbidity and mortality for major (above the ankle) lower extremity amputation (LEA) is high in veteran patients and age is a predictor of mortality. The Veteran Affair Surgical Quality Improvement Program (VASQIP) risk assessment tool has been validated for several operations, but not for elderly patients undergoing LEA. The present study interrogated the accuracy for the VASQIP calculator for a medium/high-risk operation in a high-risk veteran population (octogenarians and nonagenarians). METHODS Variables required from input for the VASQIP calculator were retrospectively obtained for 57 octogenarians and 11 nonagenarians submitting to LEA at our institution from (2009 to 2021). The six-outcome variables provided by the VASQIP calculator (30-d mortality; 180-d mortality; 30-day morbidity; 30-day SSI risk; probability of ICU stay; probability of hospital stay) were compared to observed morbidity and mortality. The accuracy of the calculator was assessed by area under the receiver operating characteristic curve and reported by the area under the curve (AUC) as previously described. RESULTS In the 68 patients included in this analysis, the time to death from the last index operation was 422.0 ± 604.9 days for octogenarians and 65.6 ± 89.3 days for nonagenarians. Predicted vs. observed 30-d mortality for octogenarians and nonagenarians was 8.46 vs. 24.56 [AUC=0.739; 95% CI (0.581 to 0.898)] and 24.46 vs. 45.45 [AUC=0.600 (0.171 to 1.000); respectively]. Predicted vs. observed 180-d mortality for the same cohorts was 25.22 vs. 47.37 [AUC=0.578 (0.427 to 0.728)] and 45.34 vs. 90.91 [AUC=0.100 (0.000 to 0.286); respectively]. Thirty-day morbidity, 30-day SSI, probability of ICU and probability of in-hospital stay produced an AUC below 0.600 for all these outcomes. CONCLUSION The VASQIP risk calculator is a poor predictor of short-term outcomes in octogenarians and nonagenarians undergoing major LEA. Most octogenarian and nonagenarian veterans died within 1 year, and the mean survival for nonagenarians was less than 3 months after LEA. The decision for major LEA in octogenarian and nonagenarian veterans warrants informed discussion with the patient and family.
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Affiliation(s)
- Sergio Huerta
- VA North Texas Health Care System, Department of General Surgery Surgery.
| | - Heather Lanier
- VA North Texas Health Care System, Department of General Surgery Surgery
| | | | - Thai Pham
- VA North Texas Health Care System, Department of General Surgery Surgery
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15
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Affiliation(s)
- Sergio Huerta
- Department of Surgery, VA North Texas Health Care System, Dallas
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Tsai S, Lanier HD, Tran N, Pham T, Huerta S. Current Predictors of Mortality in Veteran Patients Undergoing Major Lower Extremity Amputations: Risk Factors Have Not Changed and Mortality Remains High. Am Surg 2022:31348221074235. [PMID: 35124982 DOI: 10.1177/00031348221074235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Major lower extremity amputation (LEA-above the ankle) carries a high rate of mortality. In the present study, we performed an institutional review of all patients submitting to LEAs at a Veteran Administration Hospital (between 2009 and 2021) accompanied with a review of the literature.For the past 12 years, 1042 LEAs were performed in 603 patients at our hospital. The 30-day, 1-year, and 5-year mortalities were 8.5%, 28.9%, and 53.0%, respectively. Age, hypoalbuminemia, and Clavien-Dindo Class were independent predictors of mortality in all the time intervals in the analysis. Cardiac disease was not an independent predictor of mortality. In 39 studies reviewed, the average 30-day, 1-year, and 5-year mortality was 14%, 36%, and 56%, respectively. There was no difference in mortality in multiple studies analyzed. No significant temporal variation was identified between 1950 and 2000 vs. 2001 and 2021. Predictors of mortality were not substantially different from our institutional experience.The mortality rate for LEAs remains constant over time. Increasing age and hypoalbuminemia are strong predictors of short- and long-term mortality.
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Affiliation(s)
- Shirling Tsai
- Department of Vascular, 20115VA North Texas Health Care System, Dallas, TX, USA
| | - Heather D Lanier
- General Surgery, 12334University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Nguyen Tran
- General Surgery, 12334University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Thai Pham
- General Surgery, 12334University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Sergio Huerta
- General Surgery, 12334University of Texas Southwestern Medical School, Dallas, TX, USA
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17
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Christensen BW, Li HC, Huerta S. Blurred Vision and Gastrointestinal Bleeding in a Patient With HIV. JAMA 2022; 327:276-277. [PMID: 35040904 DOI: 10.1001/jama.2021.21510] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Bradley W Christensen
- Division of Hematology and Oncology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Hsiao C Li
- Division of Hematology and Oncology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Sergio Huerta
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
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18
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Loss L, Meier J, Phung T, Ordonez J, Huerta S. Feasibility of Umbilical Hernia Repair Under Local Anesthesia and Monitored Anesthesia Care at a Veteran Affairs Hospital. Am Surg 2021; 88:167-173. [PMID: 34846213 DOI: 10.1177/0003134820951452] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Local anesthesia (LA) for open umbilical hernia tissue repair (OUHTR) is not widely utilized in academic centers in the United States. We hypothesize that LA for OUHTR is feasible in a veteran patient population. METHODS From 2015 to 2019, 449 umbilical hernias were repaired at our institution utilizing a standardized technique in veteran patients. OUHTR was included in this analysis (n = 283). Since 2017, 18.7% (n = 53) UH were repaired under LA. We compared outcomes and operative times between general anesthesia and LA in patients undergoing OUHTR. Univariable and multivariable analyses were performed to determine significance. RESULTS The entire cohort was composed of older (56.3 ± 12.1 years), White (75.5%), obese (body mass index [BMI] = 32.3 ± 4.6 kg/m2) men (98.0%). The average hernia size for the entire cohort was 2.42 ± 1.2 cm. The groups were similar in age and BMI. Patients with higher American Society of Anesthesiologists (ASA) (Odds ratio [OR] 3.1; 95% CI 1.5-6.8) and cardiovascular disease (OR 2.7; 95% CI 1.0-7.2) were more likely to receive LA. Recurrence (0.0% vs 6.0%; P = .9) and 30-day complications (6.0% vs 13%; P = .9) were similar between LA and GA after correcting for hernia size. Operating room times were reduced in the LA group (17.7 minutes; P < .05). None of the patients with LA required postanesthesia care unit for recovery. The patients who received LA reported being comfortable (78.9% of patients), with the worst reported pain being 2.4 ± 2.4 (out of a scale of 10), and 94.7% would elect to receive LA if they had another hernia repair. CONCLUSION Patients who received LA had more cardiac disease and a higher ASA. Complications were similar between both groups. LA reduced operating room times. Patients were satisfied with LA.
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Affiliation(s)
- Lindsey Loss
- Department of Surgery, University of Toledo, Toledo, OH, USA
| | - Jennie Meier
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tri Phung
- 7067 Department of Anesthesiology, VA North Texas Health Care System, TX, USA
| | - Javier Ordonez
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sergio Huerta
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.,7067 Department of Surgery, VA North Texas Health Care System, TX, USA
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19
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Affiliation(s)
- S Huerta
- VA North, Texas Health Care System, Department of Surgery, University of Texas Southwestern Medical Center, 4500 S. Lancaster Road (112), Dallas, TX, USA.
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20
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Huerta S, Pickett ML, Mottershaw AM, Gupta P, Pham T. Volvulus of the Transverse Colon. Am Surg 2021:31348211041564. [PMID: 34461758 DOI: 10.1177/00031348211041564] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND In the United States, the third leading cause of a large bowel obstruction (LBO) is colonic volvulus with torsion occurring most commonly in the sigmoid and the cecum. Transverse colonic volvulus (TCV) is exceedingly rare and specific involvement of the splenic flexure (SFV) is even less common. The present analysis was undertaken to interrogate current trends in presentation, management, and outcomes of TCV. METHODS In the present report, the world literature was reviewed for the past 90 years (1932 to 2021). We conducted a systematic review to identify all cases of TCV following the PRISMA guidelines. RESULTS We identified 317 cases of TCV. This included SFV (n = 75), TCV in pediatric patients (n = 63), TCV in pregnant patients (n = 8), and TCV associated with other pathology such as Chilaiditi's syndrome (n = 11). Compared to sigmoid and cecal volvulus, TCV was rare (.94%). It affected slightly more women (54%) than men, commonly in their third decade of life (37.7 ± 23.8). The clinical presentation and diagnostic imaging were consistent with LBO. Compared to sigmoid volvulus, there was a limited role for conservative management and colonoscopic decompression was less effective. The most common operation was segmental resection (25%). Mortality was (20%) commonly because of cardiopulmonary complications and affected more women (63%). The average age of this cohort was 55.7±24.6 years old. DISCUSSION Our review showed that TCV is an uncommon surgical entity. The diagnosis is likely to be made at laparotomy. Prompt recognition is paramount in preventing ischemia necrosis and perforation. Compared to sigmoid and cecal volvulus, the mortality for TCV remains high.
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Affiliation(s)
- Sergio Huerta
- Department of Surgery, 20115VA North Texas Health Care System, Dallas, TX, USA
| | - Maryanne L Pickett
- Department of Surgery, 20115VA North Texas Health Care System, Dallas, TX, USA
| | - Ann M Mottershaw
- Radiology, 20115VA North Texas Health Care System, Dallas, TX, USA
| | - Pramod Gupta
- Radiology, 20115VA North Texas Health Care System, Dallas, TX, USA
| | - Thai Pham
- Department of Surgery, 20115VA North Texas Health Care System, Dallas, TX, USA
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21
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Pickett ML, Mottershaw AM, Gupta P, Huerta S. Volvulus of the transverse colon in an octogenarian veteran. J Surg Case Rep 2021; 2021:rjab166. [PMID: 33986944 DOI: 10.1093/jscr/rjab166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/09/2021] [Indexed: 11/12/2022] Open
Abstract
In the USA, the third leading cause of a large bowel obstruction in adults is volvulus with torsion occurring commonly in the sigmoid and the cecum. Transverse colonic volvulus is exceedingly rare and specific involvement of the splenic flexure is even more uncommon. In the present report, we discuss a Veteran octogenarian who presented with a long-standing history of constipation, but then developed an acute abdomen from a large bowel obstruction. At laparotomy, he had a double closed loop obstruction with volvulus of the splenic flexure. The colon at the splenic flexure was ischemic with patchy areas of necrosis, but no perforation. He underwent a subtotal colectomy with an ileostomy. This case illustrates the need for prompt intervention of this unusual entity. Current trends in the incidence, management, morbidity and mortality are discussed.
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Affiliation(s)
- Maryanne L Pickett
- VA North Texas Health Care System, Department of Surgery and Radiology, Dallas, TX, USA
| | - Ann M Mottershaw
- VA North Texas Health Care System, Department of Surgery and Radiology, Dallas, TX, USA
| | - Pramod Gupta
- VA North Texas Health Care System, Department of Surgery and Radiology, Dallas, TX, USA
| | - Sergio Huerta
- VA North Texas Health Care System, Department of Surgery and Radiology, Dallas, TX, USA
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22
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Tran N, Emuakhagbon VS, Baker BT, Huerta S. Re-assessing the role of the fecalith in acute appendicitis in adults: case report, case series and literature review. J Surg Case Rep 2021; 2021:rjaa543. [PMID: 33542806 PMCID: PMC7849946 DOI: 10.1093/jscr/rjaa543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/24/2020] [Indexed: 12/04/2022] Open
Abstract
Appendicitis in adults is thought to occur because of luminal obstruction from a fecalith. We present a unique case of a patient who had her entire appendiceal lumen occupied by a fecalith (5.0 cm long) but had no appendicitis. We reviewed the records of 257 veterans who underwent surgical intervention at our institution for the management of acute appendicitis. Fecaliths occurred in 15.6% of patients. At laparotomy, 20.6% had a perforated appendix; pathology showed fecaliths in 20.8% of specimens. A review of the literature inclusive of 25 series showed fecaliths in 33.3% of patients with a normal appendix, 23.5% of patients with acute appendicitis and 24.9% with perforated appendicitis. These data show that appendicitis is not a common cause of fecalith obstruction in adults.
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Affiliation(s)
- Nguyen Tran
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | | | - Bradford T Baker
- Department of Pathology, VA North Texas Health Care System, Dallas, TX, USA
| | - Sergio Huerta
- University of Texas Southwestern Medical School, Dallas, TX, USA
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23
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Yi B, Tran N, Huerta S. Biliary Dyskinesia in Veteran Patients. Am Surg 2021; 87:1521-1522. [PMID: 33502217 DOI: 10.1177/0003134820988809] [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: 11/15/2022]
Affiliation(s)
- Bing Yi
- 20115VA North Texas Health Care System, Dallas, TX, USA
| | - Nguyen Tran
- Department of Surgery, 25989University of Texas Southwestern Medical Center Medical School, Dallas, TX, USA
| | - Sergio Huerta
- 20115VA North Texas Health Care System, Dallas, TX, USA
- Department of Surgery, 25989University of Texas Southwestern Medical Center Medical School, Dallas, TX, USA
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24
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Yi B, Tran N, Huerta S. Local, regional, and general anesthesia for inguinal hernia repair: the importance of the study, the patient population, and surgeon's experience. Hernia 2021; 25:1367-1368. [PMID: 33459894 DOI: 10.1007/s10029-021-02369-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/05/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Bing Yi
- VA North Texas Health Care System, University of Texas Southwestern Medical Center Medical School, Dallas, TX, USA
| | - Nguyen Tran
- Department of Surgery, University of Texas Southwestern Medical Center Medical School, 4500 S. Lancaster Road (112), Dallas, TX, 75216, USA
| | - Sergio Huerta
- VA North Texas Health Care System, University of Texas Southwestern Medical Center Medical School, Dallas, TX, USA. .,Department of Surgery, University of Texas Southwestern Medical Center Medical School, 4500 S. Lancaster Road (112), Dallas, TX, 75216, USA.
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25
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Tao Z, Emuakhagbon VS, Pham T, Augustine MM, Guzzetta A, Huerta S. Outcomes of robotic and laparoscopic cholecystectomy for benign gallbladder disease in Veteran patients. J Robot Surg 2021; 15:849-857. [PMID: 33400103 DOI: 10.1007/s11701-020-01183-3] [Citation(s) in RCA: 2] [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: 06/12/2020] [Accepted: 12/17/2020] [Indexed: 12/29/2022]
Abstract
The robotic platform for cholecystectomy has been extensively studied in comparison to its laparoscopic counterpart with acceptable outcomes. However, wide acceptance of a robotic approach to cholecystectomy has been limited by increased operative room (OR) times and substantially higher cost. This is a single-institution retrospective review of Veteran patients presenting for elective laparoscopic (LC) and robotic (RC) cholecystectomies for benign biliary disease at the Dallas VA Medical Center. The primary goal was to interrogate 30-day morbidity as well as operative room times, estimated blood loss (EBL), hospital length of stay (LOS), and conversion rates. The entire cohort included 612 patients (age = 55.1 ± 12.9 years, men = 77.9%, BMI = 31.2 ± 6.3 kg/m2) undergoing elective cholecystectomy (LC = 441 and RC = 171) for benign biliary disease (biliary colic = 78.8%, history of biliary pancreatitis = 7.8%, history of cholecystitis = 5.7%). Univariate analysis comparing LC and RC showed the two groups to be of similar age (55.4 ± 12.4 vs. 54.4 ± 14.2 years; p = 0.4), male gender (79.4% vs. 74.3%, p = 0.2), and BMI (31.1 ± 6.4 vs. 31.5 ± 6.3 kg/m2; p = 0.5). Except for dyslipidemia (LC = 48.3% vs. RC = 36.8%; p = 0.01), both groups had the same rate of co-morbid conditions. ASA level III and IV (LC = 60.1 vs. RC = 69.0%, p = 0.04) was higher in the RC group. Both groups underwent surgical intervention for similar indications (biliary colic LC = 80.5% vs. RC = 74.3; p = 0.1). Hospital LOS (1.7 ± 3.2 vs. 0.3 ± 0.9 days, p < 0.001), EBL (32.3 ± 52.3 vs. 17.0 ± 43.1; p = 0.001), and conversion to open (6.6% vs. 0.6%, p = 0.001) were all superior with the robotic platform. Thirty-day overall morbidity (9.8% vs. 12.3%, p = 0.4), skin-to-skin OR time (84.5 ± 33.5 vs. 88.0 ± 35.3 min, p = 0.2), and total OR time (129.2 ± 36.8 vs. 129.7 ± 39.7, p = 0.9) were similar between the LC and RC groups. Despite being older and having more comorbidities, Veteran patients undergoing robotic cholecystectomy experienced equivalent OR time and a moderate improvement in conversion rate, EBL, and hospital LOS compared to those undergoing conventional laparoscopy, therein demonstrating the safety and efficacy of the robotic platform for this patient population.
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Affiliation(s)
- Zoe Tao
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Valerie-Sue Emuakhagbon
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.,VA North Texas Health Care System, 4500 S. Lancaster Road, Surgical Service (112), Dallas, TX, 75216, USA
| | - Thai Pham
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.,VA North Texas Health Care System, 4500 S. Lancaster Road, Surgical Service (112), Dallas, TX, 75216, USA
| | - M Mathew Augustine
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.,VA North Texas Health Care System, 4500 S. Lancaster Road, Surgical Service (112), Dallas, TX, 75216, USA
| | - Angela Guzzetta
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.,VA North Texas Health Care System, 4500 S. Lancaster Road, Surgical Service (112), Dallas, TX, 75216, USA
| | - Sergio Huerta
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA. .,VA North Texas Health Care System, 4500 S. Lancaster Road, Surgical Service (112), Dallas, TX, 75216, USA.
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26
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Main CR, Tyler R, Huerta S. Microbial Source Tracking in the Love Creek Watershed, Delaware (USA). Dela J Public Health 2021; 7:22-31. [PMID: 34467176 PMCID: PMC8352542 DOI: 10.32481/djph.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Fecal contamination of waterways in Delaware pose an ongoing problem for environmental and public health. For monitoring efforts, Enterococcus has been widely adopted by the state to indicate the presence of fecal matter from warm-blooded animals and to establish Primary and Secondary Contact Recreation criteria. In this study, we examined sites within the Love Creek watershed, a tributary of the Rehoboth bay, using next-generation sequencing and SourceTracker to determine sources of potential fecal contamination and compared to bacterial communities to chemical and nutrient concentrations. Microbial community from fecal samples of ten different types of animals and one human sample were used to generate a fecal library for community-based microbial source tracking. Orthophosphate and total dissolved solids were among the major factors associated with community composition. SourceTracker analysis of the monthly samples from the Love Creek watershed indicated the majority of the microbial community were attributed to "unknown" sources, i.e. wildlife. Those that attribute to known sources were primarily domestic animals, i.e. cat and dog. These results suggest that at the state level these methods are capable of giving the start for source tracking as a means to understanding bacterial contamination.
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Affiliation(s)
- Christopher R Main
- Environmental Laboratory Section, Division of Water, Delaware Department of Natural Resources and Environmental Control
| | - Robin Tyler
- Environmental Laboratory Section, Division of Water, Delaware Department of Natural Resources and Environmental Control
| | - Sergio Huerta
- Laboratory Director, Public Health and Environmental Laboratories, State of Delaware
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27
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Alejo G, Ruiz M, Hernandez-Ochoa A, Ortiz C, Huerta S. Differences in treatment strategies in the management of acute appendicitis in a county hospital in Guatemala and an academic teaching institution in the United States. Trop Doct 2020; 51:158-162. [PMID: 33356919 DOI: 10.1177/0049475520981231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Laparoscopy and antibiotic-first (NOM) strategies have been introduced in the management of acute appendicitis in industrialised countries. Data regarding the feasibility of these strategies in low-income nations are sparse. A retrospective analysis of adult patients undergoing appendicectomy at a county non-teaching hospital in San Benito, Guatemala (Hospital Nacional (HNSB)) was compared to an academic, teaching institution in Dallas, USA (Veterans Medical Centre). Most patients at the VA (92%) underwent computed tomography prior to being operated upon while none did so at HNSB. Whilst all patients at HNSB underwent an open approach, 95% of VA patients underwent a laparoscopic appendicectomy with a 4.7% conversion rate. General anaesthesia was universally used at Veterans Medical Centre, whilst spinal anaesthesia was utilised in 88% of cases at HNSB. NOM of acute appendicitis was undertaken only rarely at the Veterans Medical Centre and never at HNSB, where it was not thought expedient.
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Affiliation(s)
- Gabriela Alejo
- BS, Medical Student, Department of Surgery, Southwestern Medical Center, University of Texas, Dallas, TX, USA
| | - Maria Ruiz
- BD, Medical Student, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Anny Hernandez-Ochoa
- MD, Chief of Surgery, Department of Surgery, Hospital Nacional in San Benito, Guatemala
| | - Cesar Ortiz
- MD, Hospital Director, Hospital Nacional in San Benito, Guatemala
| | - Sergio Huerta
- MD, FACS, Professor, Department of Surgery, University of Texas Southwestern Medical Center and VA North Texas Health Care System, Dallas, TX, USA
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Abstract
INTRODUCTION Umbilical hernia repair (UHR) using mesh has been demonstrated to significantly reduce recurrence. However, many surgical centers still perform tissue repair for UH. In the present study, we assessed a cohort of veteran patients undergoing a standard open tissue repair for primary UH to determine at which size recurrence may preclude tissue repair. A systematic review of the literature on hernia size recommendations to guide mesh placement was performed. METHODS A single-institution single-surgeon retrospective review of all patients undergoing open tissue repair of primary UH (n = 344) was undertaken at the VA North Texas Health Care System between 2005 and 2019. Guidelines for the preferred reporting items for systematic reviews and meta-analysis were undertaken for systematic review. RESULTS A literature review yielded inconsistent guidance for a specific hernia size to proceed with tissue vs. mesh repair. Our institutional review yielded 17 (4.9%) recurrences. Univariable analysis demonstrated recurrence to be associated with hernia size (2.8 vs. 2.3 cm; P = .04). However, on multivariable analysis, hernia size was demonstrated as not an independent predictor of recurrence [OR 1.47 (95% CI; .97-2.21; P = .07)]. CONCLUSION A review of the literature suggests mesh placement most commonly when the hernia size is > 2.0 cm; however, sources of evidence are heterogeneous in study design, patient population, and hernia types studied. Our institutional review demonstrated that primary UHs < 2.3 cm can successfully be treated via tissue repair. Larger, recurrent, incisional, and primary epigastric hernias may benefit from mesh placement.
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Affiliation(s)
- Zoe Tao
- Department of Surgery and VA North Texas Health Care System, Southwestern Medical Center, 25989University of Texas, Dallas, TX, USA
| | - Javier Ordonez
- Department of Surgery and VA North Texas Health Care System, Southwestern Medical Center, 25989University of Texas, Dallas, TX, USA
| | - Sergio Huerta
- Department of Surgery and VA North Texas Health Care System, Southwestern Medical Center, 25989University of Texas, Dallas, TX, USA
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29
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Loss L, Meier J, Ordonez JE, Phung T, Balentine C, Zhu H, Huerta S. Feasibility of a Local Anesthesia Program for Inguinal Hernia Repair at a Veteran Affairs Hospital. J Surg Res 2020; 255:1-8. [DOI: 10.1016/j.jss.2020.05.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/14/2020] [Accepted: 05/03/2020] [Indexed: 02/06/2023]
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30
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Chandra R, Dogeas E, Nevarez N, Augustine M, Huerta S. Peritonitis from perforated sigmoid mass as the first manifestation of metastatic squamous cell lung cancer: a case report and review of literature. J Surg Case Rep 2020; 2020:rjaa315. [PMID: 32963763 PMCID: PMC7490971 DOI: 10.1093/jscr/rjaa315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 07/21/2020] [Indexed: 12/24/2022] Open
Abstract
Lung cancer (LC) is an aggressive malignancy with early metastatic spread and poor prognosis. Gastrointestinal metastases from primary LC are extremely rare with highly variable presentations. In this report, we review the case of a patient who presented with peritonitis secondary to perforated sigmoid mass as the first manifestation of metastatic squamous cell LC.
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Affiliation(s)
- Raghav Chandra
- Department of Surgery, University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | - Epameinondas Dogeas
- Department of Surgery, University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | - Nicole Nevarez
- Department of Surgery, University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | - Mathew Augustine
- Department of Surgery, University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | - Sergio Huerta
- Department of Surgery, University of Texas, Southwestern Medical Center, Dallas, TX, USA
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Abstract
Gallstone ileus is an unusual complication of cholelithiasis. Classically, a stone is impacted at the terminal ileum originating from a cholecystoduodenal fistula. Exceptions to this pathophysiology have been noted at each step. In this systematic review, we document a comprehensive review of postcholecystectomy gallstone ileus inclusive of 49 separate cases and report 8 different mechanisms leading to this unusual complication. The most common mechanism is a lost stone during cholecystectomy that then erodes through the intestinal wall leading to bowel obstruction. Our review showed an older, female predominance (64.0%) at an average age of 68.0 years, patients typically had a burden of comorbidities. Delay in diagnosis was common (64% of cases) with the correct diagnosis made in 37.5% of patients during admission. Pneumobilia was commonly reported (29.0%). There was a wide range in the amount of time between cholecystectomy and gallstone ileus, from 10 days to 50 years (mean 12.4 years). Postcholecystectomy gallstone ileus is an unusual complication of cholelithiasis, which mandates surgery. Retrieval of stones should be undertaken if they are spilled during cholecystectomy. Owing to the increasing age of the American patient population, it is likely that a higher number of patients with this condition will be encountered.
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Affiliation(s)
- Jennie Meier
- 20115 Department of Surgery, VA North Texas Health Care System, Dallas, TX, USA.,12334 Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Angela A Guzzetta
- 20115 Department of Surgery, VA North Texas Health Care System, Dallas, TX, USA
| | - Sergio Huerta
- 20115 Department of Surgery, VA North Texas Health Care System, Dallas, TX, USA
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32
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Affiliation(s)
- Zoe Tao
- University of Texas Southwestern Medical Center, Department of Surgery and VA North Texas Health Care System, Dallas, TX, USA
| | - Oswaldo Renteria
- University of Texas Southwestern Medical Center, Department of Surgery and VA North Texas Health Care System, Dallas, TX, USA
| | - Sergio Huerta
- University of Texas Southwestern Medical Center, Department of Surgery and VA North Texas Health Care System, Dallas, TX, USA.
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Abstract
Outcomes from emergent inguinal hernia (IH) repair in veteran octogenarians are not well described. We reviewed outcomes for this cohort from 2005 to 2012 at the VA North Texas Health Care System. There were 15 emergent (Group I) and 86 elective (Group II) operations performed in octogenarians. Age and American Society of Anesthesiologists status were similar in both groups. The rate of minor and major complications was higher in Group I compared with Group II (33 and 19% vs 22 and 2%, respectively; both Ps < 0.001). Hospital length of stay (LOS) and intensive care unit LOS were also longer in Group I compared with Group II (6.7 ± 7.0 and 2.5 ± 4.4 vs 0.8 ± 1.9 and 0.12 ± 0.6 days, respectively; both Ps < 0.001). Thirty-day mortality was 13 per cent for Group I and 0 per cent for Group II. Despite the high rate of comorbid conditions in our group, the risk associated with elective repair of IH was not prohibitive. In contrast, we observed that 15 per cent of patients presented with an incarcerated hernia during the study period and the mortality rate was 13 per cent in this cohort. Factors that might predict incarceration in veteran octogenarians need to be further investigated.
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Affiliation(s)
- Sergio Huerta
- From the University of Texas Southwestern Medical Center/VA North Texas Health Care System, Dallas, Texas
| | - Thai Pham
- From the University of Texas Southwestern Medical Center/VA North Texas Health Care System, Dallas, Texas
| | - Scott Foster
- From the University of Texas Southwestern Medical Center/VA North Texas Health Care System, Dallas, Texas
| | - Edward H. Livingston
- From the University of Texas Southwestern Medical Center/VA North Texas Health Care System, Dallas, Texas
| | - Sean Dineen
- From the University of Texas Southwestern Medical Center/VA North Texas Health Care System, Dallas, Texas
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Meier J, Huerta S. Primary repair of umbilical hernias is feasible independent of patient/hernia size. Surgery 2020; 167:884-885. [DOI: 10.1016/j.surg.2019.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 09/04/2019] [Indexed: 11/25/2022]
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Meier J, Huerta S. Primary Repair of Umbilical Hernias: Evidence of Feasibility. Am Surg 2020; 86:e220. [PMID: 32391787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Meier J, Huerta S. Primary Repair of Umbilical Hernias: Evidence of Feasibility. Am Surg 2020. [DOI: 10.1177/000313482008600421] [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: 11/16/2022]
Affiliation(s)
- Jennie Meier
- Department of Surgery VA North Texas Health Care System Dallas, Texas
| | - Sergio Huerta
- Department of Surgery VA North Texas Health Care System Dallas, Texas
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Huerta S, Meier J, Emuakhagbon VS, Favela J, Argo M, Polanco PM, Augustine MM, Pham T. A comparative analysis of outcomes of open, laparoscopic, and robotic elective (procto-) colectomies for benign and malignant disease. J Robot Surg 2020; 15:53-62. [PMID: 32297148 DOI: 10.1007/s11701-020-01069-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 03/16/2020] [Indexed: 01/17/2023]
Abstract
Laparoscopy has emerged as a common alternative to the open approach for colorectal operations. Robotic surgery has many advantages, but cost and outcomes are an area of study. There are no randomized-controlled trials of all techniques. The present study evaluated a cohort of veterans undergoing (procto-) colectomy for benign or malignant colorectal disease. This is a single-institution retrospective review. We compared open, laparoscopic, and robotic colectomies. The primary outcome was 30-day mortality. The secondary endpoints included morbidity, operative times, estimated blood loss (EBL), length of stay (LOS), conversion rate, and the learning curve (LC). Subgroup analyses were undertaken for: (1) right hemicolectomies (RHC) and (2) by specific surgeons most familiar with each approach. The cohort included 390 patients (men = 95%, White = 70.8%, BMI = 29.3 ± 6.4 kg/m2, age = 63.7 ± 10.2 years) undergoing (open = 117, laparoscopic = 168, and robotic = 105), colorectal operations for colorectal adenocarcinoma (52.8%) and benign disease. Thirty-day morbidity was similar across all techniques (open = 46.2%, laparoscopic = 42.9%, and robotic = 38.1%; NS). EBL and LOS were decreased with minimally invasive techniques compared to open. Operative time was longer in robotic, but equalized to laparoscopic after 90 cases. The learning curve was reduced to 20 when performed by the surgeon most familiar with the robot. EBL and operative time independently predicted complications for the entire cohort. The best technique for colorectal operations rests on the surgeon's experience, but minimally invasive techniques are gaining momentum over open colectomies. Robotic colectomy is emerging as a non-inferior approach to laparoscopy in terms of outcomes, while maintaining all its technical advantages.
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Affiliation(s)
- Sergio Huerta
- Department of Surgery, VA North Texas Health Care System, University of Texas Southwestern, 4500 S. Lancaster Road, Dallas, TX, 75216, USA. .,Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Jennie Meier
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Valerie-Sue Emuakhagbon
- Department of Surgery, VA North Texas Health Care System, University of Texas Southwestern, 4500 S. Lancaster Road, Dallas, TX, 75216, USA.,Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Juan Favela
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Madison Argo
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Patricio M Polanco
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mathew M Augustine
- Department of Surgery, VA North Texas Health Care System, University of Texas Southwestern, 4500 S. Lancaster Road, Dallas, TX, 75216, USA.,Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Thai Pham
- Department of Surgery, VA North Texas Health Care System, University of Texas Southwestern, 4500 S. Lancaster Road, Dallas, TX, 75216, USA.,Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Tao Z, Huerta S. The utopia of randomized controlled trials: tissue repair of umbilical hernias is still feasible. Hernia 2020; 25:245-246. [PMID: 32200496 DOI: 10.1007/s10029-020-02172-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/09/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Z Tao
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. E5-810, Dallas, TX, 75390, USA
| | - S Huerta
- Department of Surgery, VA North Texas Health Care System, 4500 South Lancaster Road, Dallas, TX, 75216, USA. .,University of Texas Southwestern Medical Center, 4500 S. Lancaster Road, Dallas, TX, 75225, USA.
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Meier J, Huerta S. Robotic inguinal hernia repair is not superior to laparoscopic or open repair. Am J Surg 2019; 220:251. [PMID: 31733687 DOI: 10.1016/j.amjsurg.2019.11.015] [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: 10/22/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Jennie Meier
- VA North Texas Health Care System, Department of Surgery, Dallas, TX, USA
| | - Sergio Huerta
- VA North Texas Health Care System, Department of Surgery, Dallas, TX, USA.
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Argo M, Favela J, Phung T, Huerta S. Local VS. other forms of anesthesia for open inguinal hernia repair: A meta-analysis of randomized controlled trials. Am J Surg 2019; 218:1008-1015. [DOI: 10.1016/j.amjsurg.2019.06.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/13/2019] [Accepted: 06/25/2019] [Indexed: 01/03/2023]
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Polanco PM, Mokdad AA, Zhu H, Choti MA, Huerta S. Association of Adjuvant Chemotherapy With Overall Survival in Patients With Rectal Cancer and Pathologic Complete Response Following Neoadjuvant Chemotherapy and Resection. JAMA Oncol 2019; 4:938-943. [PMID: 29710272 DOI: 10.1001/jamaoncol.2018.0231] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Adjuvant chemotherapy (AC) in patients with rectal cancer with pathologic complete response following neoadjuvant chemoradiotherapy (nCRT) and resection is recommended by treatment guidelines. However, its role in this setting is equivocal because data supporting benefits are lacking. Objective To compare the overall survival (OS) between AC and postoperative observation (OB) in patients with rectal cancer with pathologic complete response following nCRT and resection. Design, Setting, and Participants We identified a cohort of patients with rectal cancer and a complete pathological response (ypT0N0) after nCRT in the National Cancer Database between 2006 and 2012. Patients who received AC were compared with OB patients by propensity score matching. Overall survival was compared using the stratified log-rank test and stratified Cox regression model. The outcomes after AC vs OB were also evaluated in patient subgroups. The data analysis was completed in June 2017. Exposures Adjuvant chemotherapy and OB. Main Outcomes and Measures Overall survival. Results We identified 2764 patients (mean [SD] age, 60.0 [12.3] years; 40% female) with clinical stage II or III resected adenocarcinoma of the rectum who had received nCRT and were complete responders (ypT0N0M0). Of this cohort, 741 patients in the AC group were matched by propensity score to 741 patients who underwent OB. The AC cohort had better OS compared with the OB cohort (hazard ratio, 0.50; 95% CI, 0.32-0.79). The 1-, 3-, and 5-year OS rates were 99.7%, 97.1%, and 94.7% for the AC group and 99.2%, 93.6%, and 88.4% for the OB group (P = .005). In subgroup analysis, patients with clinical stage T3/T4 and node-positive disease benefited most from AC (hazard ratio, 0.47; 95% CI, 0.25-0.91). Conclusions and Relevance Adjuvant chemotherapy was associated with improved OS in patients with pathologic complete response after nCRT for resected locally advanced rectal cancer. This study supports the use of AC in this setting where there is currently paucity of data.
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Affiliation(s)
- Patricio M Polanco
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas.,Department of Veterans Affairs North Texas Health Care System, Dallas
| | - Ali A Mokdad
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Hong Zhu
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas
| | - Michael A Choti
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Sergio Huerta
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas.,Department of Veterans Affairs North Texas Health Care System, Dallas
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Affiliation(s)
- S Huerta
- Department of Surgery, VA North Texas Health Care System, University of Texas Southwestern, 4500 S. Lancaster Road, Dallas, TX, 75316, USA.
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Ochoa-Hernandez A, Timmerman C, Ortiz C, Huertas VL, Huerta S. Emergent groin hernia repair at a County Hospital in Guatemala: patient-related issues vs. health care system limitations. Hernia 2019; 24:625-632. [PMID: 31429024 DOI: 10.1007/s10029-019-02028-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 03/04/2019] [Accepted: 08/04/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND The rate of emergent groin hernia repair in developing countries is poorly understood. MATERIALS AND METHODS A retrospective analysis of groin hernia repairs performed at a county hospital in Guatemala [Hospital Nacional de San Benito (HSNB)] was undertaken and compared to a literature review in developed countries. Patients with incarcerated hernias were interviewed to determine factors related to late presentation. RESULTS Twenty-five percent of patients with groin hernias in this analysis presented at HNSB emergently (vs. 2.5-7.7% in developed countries). Most patients were male in their fifth decade of life. Ten percent of hernias were femoral. There was no delay in scheduling patients for surgery presenting for elective repair. Most patients lived within 20 miles of the hospital, but only 50% of patients returned for their follow-up appointment. Most patients with an incarcerated inguinal hernia (56%) did not seek medical attention because of family obligations, but when they did, this decision was influence by their children (66%). None of the patients presenting with an incarcerated hernia had education past secondary school. In fact, most (56%) did not have any form formal education. Nearly 90% of patients who had an incarcerated hernia repaired thought that the hospital provided good-to-excellent care. CONCLUSION A high number of patients present emergently for groin hernia repair at a county hospital in Guatemala compared to developed countries. Our data suggest that emergent hernias are likely the result of patient-related issues rather than health care system limitations.
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Affiliation(s)
| | - C Timmerman
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - C Ortiz
- Hospital Nacional de San Benito, Petén, San Benito, Guatemala
| | - V L Huertas
- Hospital Nacional de San Benito, Petén, San Benito, Guatemala
| | - S Huerta
- University of Texas Southwestern Medical Center, Dallas, TX, USA. .,VA North Texas Health Care System, 4500 S. Lancaster Road, Dallas, TX, 75225, USA.
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Cunningham H, Huerta S. Mesh migration following abdominal hernia repair: author's reply. Hernia 2019; 24:223-224. [PMID: 31134440 DOI: 10.1007/s10029-019-01981-1] [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] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 05/15/2019] [Indexed: 10/26/2022]
Affiliation(s)
- H Cunningham
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - S Huerta
- University of Texas Southwestern Medical Center, Dallas, TX, USA. .,VA North Texas Health Care System, 4500 S. Lancaster Road, Dallas, TX, 75216, USA.
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Timmerman C, Hernandez AO, Ortiz C, Huertas VL, Lopez R, Huerta S. Current View on the Nonoperative Management of Acute Appendicitis in a County Hospital in Guatemala. J Surg Res 2019; 237:108-109. [DOI: 10.1016/j.jss.2018.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 02/20/2018] [Accepted: 03/06/2018] [Indexed: 12/29/2022]
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Huerta S, Timmerman C, Argo M, Favela J, Pham T, Kukreja S, Yan J, Zhu H. Open, Laparoscopic, and Robotic Inguinal Hernia Repair: Outcomes and Predictors of Complications. J Surg Res 2019; 241:119-127. [PMID: 31022677 DOI: 10.1016/j.jss.2019.03.046] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 02/20/2019] [Accepted: 03/22/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The robotic approach to an inguinal hernia has not been compared head to head with the open and laparoscopic techniques in randomized controlled trials. Furthermore, long-term outcomes for robotic inguinal hernia repair (RHR) are lacking. In this study, we compared laparoscopic inguinal hernia repair (LHR) and RHR with open inguinal hernia repair (OHR) in veteran patients performed by surgeons most familiar with each approach. METHODS A retrospective single-institution analysis of 1299 inguinal hernia repairs performed at the VA North Texas Health Care System between 2005 and 2017 was undertaken. Three surgeons performed the operations, each an expert in one approach, and there was no crossover in techniques. A total of 1100 OHRs, 128 LHRs, and 71 RHRs were performed. Univariable analysis was undertaken to determine associations between techniques and outcomes (OHR versus LHR; OHR versus RHR; LHR versus RHR). Setting complications as a dependent variable, multivariable analyses were undertaken to determine an association with complications as well as independent predictors of complications. RESULTS Patient demographics were similar among groups except for age that was higher in the OHR cohort. The average follow-up was 5.2 ± 3.4 y. In the present report, recurrence was associated with a higher rate in the RHR versus OHR (5.6% versus 1.7%; P < 0.02), but not in the LHR versus OHR (3.9% versus 1.9%; P = 0.09). Inguinodynia was more likely to occur in both the LHR and RHR compared with the OHR (9.4% and 14.1 versus 1.5%; both P's < 0.001). Urinary retention was also more common in the LHR and RHR than in the OHR (5.5% and 5.6% versus 1.8%, both P's < 0.05) as was the rate of overall complications (34.4% and 38.0% versus 11.2%, both P's < 0.001). Multivariable regression analysis showed femoral hernias, ASA, serum albumin, operative room time, a recurrent hernia, and the minimally invasive approaches were independent predictors of overall complications. CONCLUSIONS Outcomes in the OHR cohort were, in general, superior compared with both the LHR and RHR. However, these strategies should be viewed as complementary. The best approach to an inguinal hernia repair rests on the specific expertise of the surgeon.
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Affiliation(s)
- Sergio Huerta
- Department of Surgery, University of Texas Southwestern, Medical Center, Dallas, Texas; Department of Surgery, VA North Texas Health Care System, Dallas, Texas.
| | - Corey Timmerman
- Department of Surgery, University of Texas Southwestern, Medical Center, Dallas, Texas
| | - Madison Argo
- Department of Surgery, University of Texas Southwestern, Medical Center, Dallas, Texas
| | - Juan Favela
- Department of Surgery, University of Texas Southwestern, Medical Center, Dallas, Texas
| | - Thai Pham
- Department of Surgery, University of Texas Southwestern, Medical Center, Dallas, Texas; Department of Surgery, VA North Texas Health Care System, Dallas, Texas
| | - Sachin Kukreja
- Department of Surgery, VA North Texas Health Care System, Dallas, Texas
| | - Jingsheng Yan
- Department of Surgery, University of Texas Southwestern Medical Center, Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
| | - Hong Zhu
- Department of Surgery, University of Texas Southwestern Medical Center, Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
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Ruiz M, Shahid Z, Renteria O, Huerta S. Current Trends in Training in the Surgical Management of Acute Appendicitis at a Veteran Affairs Hospital. J Surg Educ 2019; 76:506-511. [PMID: 30249516 DOI: 10.1016/j.jsurg.2018.07.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 04/19/2018] [Revised: 06/14/2018] [Accepted: 07/30/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION An open appendectomy used to be one of the most common cases performed by interns and physical exam dictated operative intervention. We hypothesized that the management of acute appendicitis has drastically changed from these previous practices. METHODS A retrospective, single institution study was performed at the VA North Texas Health Care System between July 2005 to June 2017 for all patients who underwent an appendectomy. Using postgraduate year (PGY)-level (PGY 1-3 and PGY 4-5) as a dependent variable, univariate analyses, and multiple logistic regression analyses were performed. All statistical tests were 2-sided, and the statistical significance level was set at a p ≤ 0.05. RESULTS Only patients with acute appendicitis were included (n = 257; male = 90.7%; age = 45.4 ± 15.6 year old; body mass index = 30.3 ± 6.3 Kg/m2). Of these, only 8 were performed by interns, 25 by PGY-2, 147 by PGY-3, 22 by PGY-4, and 55 by PGY-5. On presentation, 92.2% of patients had a computed tomography scan and 90.7% underwent a laparoscopic appendectomy. Conversion rate was 4.7%. There were 20 complications (7.8%) and length of hospital stay was 2.2±3.7 days. Comparing patients operated by senior (PGY-4 and 5) to junior (PGY-1 to -3) residents: patients were of similar age, gender, body mass index, American Society of Anesthesiologists (ASA), and had similar WBC and blood pressure on initial presentation (all p's > 0.05); but were more likely to have diabetes mellitus, hypertension or pulmonary disease. Complication rate was the same (7.8%) for both senior and junior residents. CONCLUSIONS At the VA North Texas Health Care System, most patients presenting with suspected appendicitis undergo a computed tomography scan. Most cases are performed laparoscopically mainly by PGY ≥ 3 residents. The rate of post-operative complications was similar between junior and senior residents.
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Affiliation(s)
- Maria Ruiz
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Zain Shahid
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Oswaldo Renteria
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sergio Huerta
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Surgery, VA North Texas Health Care System, Dallas, Texas.
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Cunningham HB, Weis JJ, Taveras LR, Huerta S. Mesh migration following abdominal hernia repair: a comprehensive review. Hernia 2019; 23:235-243. [DOI: 10.1007/s10029-019-01898-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 01/22/2019] [Indexed: 12/11/2022]
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Ovando D, Kutz JW, Huerta S. Acute hearing loss, tinnitus, and fullness in the left ear • Weber test lateralized to the right ear • Positive Rinne test and normal tympanometry • Dx? J Fam Pract 2019; 68:355-357. [PMID: 31381624] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Dennerd Ovando
- Department of Surgery UT Southwestern Medical Center, Dallas, USA
| | - J Walter Kutz
- Department of Otolaryngology, UT Southwestern Medical Center, Dallas, USA
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Hester CA, Chansard M, Huerta S, Lopez JA, Yopp AC, Mortensen E, Polanco PM. Temporal Trends of Hepatocellular Carcinoma Diagnosis and Treatment Utilization in the Veteran Affairs Health System. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.491] [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: 11/29/2022]
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