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Park SS, Verm RA, Abdelsattar ZM, Kramer S, Swanson J, Fernando M, Cohn T, Luchette FA, Baker MS. Does commission on cancer (CoC) accreditation mitigate the effect of care fragmentation on clinical outcome in localized rectal cancer? Am J Surg 2024; 230:63-67. [PMID: 38148258 DOI: 10.1016/j.amjsurg.2023.12.024] [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] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Studies of fragmented care (FC) in rectal cancer have not adjusted for indicators of hospital quality and may misrepresent the effects of FC. METHODS We queried the National Cancer Database to identify patients undergoing care for clinical stage II and III rectal adenocarcinoma between 2006 and 2019. Those undergoing FC were sub-categorized based on whether (FC CoC) or not (FC non-CoC) they received systemic therapy at CoC accredited facilities. RESULTS 44,339 patients met inclusion criteria; 23,921 (54 %) underwent FC, 16,929 (71 %) FC non-CoC. Differences in utilization of neoadjuvant therapy (92.3 % vs 89.7 % vs 89.5 %, p < 0.01) and 5-year overall survival (76.1 vs 75.5 vs 74.1 %, p < 0.01) between treatment cohorts were marginal. CONCLUSION In patients undergoing multimodality therapy for rectal cancer, care fragmentation is not associated with long-term clinical outcome. Decisions regarding where these patients go for systemic therapy may be safely made on the basis of ease of access.
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Affiliation(s)
- Simon S Park
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA; Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Raymond A Verm
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA; Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Zaid M Abdelsattar
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA; Department of Surgery, Edward Hines Jr. Veterans Administration Hospital, Hines, IL, USA; Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Sarah Kramer
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA; Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - James Swanson
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA; Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Mitchel Fernando
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA; Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Tyler Cohn
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA; Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Frederick A Luchette
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA; Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA; Department of Surgery, Edward Hines Jr. Veterans Administration Hospital, Hines, IL, USA
| | - Marshall S Baker
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA; Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA; Department of Surgery, Edward Hines Jr. Veterans Administration Hospital, Hines, IL, USA; Department of Surgery, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA.
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Odeh AM, Perez-Tamayo RA, Abdelsattar ZM. A wedge is still better than stereotactic body radiation therapy in the national cancer database. J Thorac Cardiovasc Surg 2024; 167:e100-e101. [PMID: 37747399 DOI: 10.1016/j.jtcvs.2023.08.044] [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] [Received: 08/16/2023] [Accepted: 08/24/2023] [Indexed: 09/26/2023]
Affiliation(s)
- Ayham M Odeh
- Stritch School of Medicine, Loyola University Chicago, Maywood, Ill; Department of Thoracic & Cardiovascular Surgery, Loyola University Medical Center, Maywood, Ill
| | - R Anthony Perez-Tamayo
- Stritch School of Medicine, Loyola University Chicago, Maywood, Ill; Department of Thoracic & Cardiovascular Surgery, Loyola University Medical Center, Maywood, Ill; Department of Surgery, US Department of Veteran Affairs, Edward Hines VA Hospital, Hines, Ill
| | - Zaid M Abdelsattar
- Stritch School of Medicine, Loyola University Chicago, Maywood, Ill; Department of Thoracic & Cardiovascular Surgery, Loyola University Medical Center, Maywood, Ill; Department of Surgery, US Department of Veteran Affairs, Edward Hines VA Hospital, Hines, Ill
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Park SS, Verm RA, Abdelsattar ZM, Kramer S, Swanson J, Fernando M, Cohn T, Luchette FA, Baker MS. Fragmented care in localized pancreatic cancer: Is commission on cancer accreditation associated with improved overall survival? Surgery 2024; 175:695-703. [PMID: 37863686 DOI: 10.1016/j.surg.2023.08.040] [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] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/01/2023] [Accepted: 08/08/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Prior studies of fragmentation of care in pancreatic cancer have not adjusted for indicators of hospital quality such as Commission on Cancer accreditation. The effect of fragmentation of care has not been well defined. METHODS We queried the National Cancer Database to identify patients undergoing pancreaticoduodenectomy and distal pancreatectomy with perioperative systemic therapy for clinical stages I-III pancreatic cancer between 2006 and 2019. Patients who received systemic therapy at a center different than the center performing surgery were categorized as having fragmentation of care. Patients having fragmentation of care were further categorized on the basis of whether (fragmentation of care Commission on Cancer) or not (fragmentation of care non-Commission on Cancer) systemic therapy was administered at a facility accredited by the Commission on Cancer. RESULTS A total of 11,732 patients met inclusion criteria; 5,668 (48.3%) underwent fragmentation of care, and 3,426 (29.2%) fragmentation of care non-Commission on Cancer. Patients undergoing fragmentation of care non-Commission on Cancer were less likely to receive neoadjuvant systemic therapy than those undergoing fragmentation of care Commission on Cancer or non-fragmented care (27.7% vs 40.1% vs 36.8%, P < .001). On Cox analysis, advanced age, comorbid disease, node-positive disease, and facility type were associated with risk of overall survival. Fragmentation of care was not (adjusted hazard ratio = 0.99, 95% confidence interval [0.94-1.06], P = .8). On Kaplan-Meier analysis, there were no significant differences in 5-year overall survival between treatment cohorts. CONCLUSION In patients undergoing fragmentation of care for localized pancreatic cancer, those treated with systemic therapy in Commission on Cancer accredited facilities are more likely to be given neoadjuvant therapy but demonstrate no significant improvement in survival relative to those undergoing non-fragmented care or those undergoing fragmentation of care but receiving systemic therapy in nonaccredited facilities.
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Affiliation(s)
- Simon S Park
- Department of Surgery, Loyola University Medical Center, Maywood, IL; Loyola University Chicago Stritch School of Medicine, Maywood, IL
| | - Raymond A Verm
- Department of Surgery, Loyola University Medical Center, Maywood, IL; Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL
| | - Zaid M Abdelsattar
- Department of Surgery, Loyola University Medical Center, Maywood, IL; Loyola University Chicago Stritch School of Medicine, Maywood, IL; Department of Surgery, Edward Hines Jr Veterans Administration Hospital, Hines, IL; Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL
| | - Sarah Kramer
- Department of Surgery, Loyola University Medical Center, Maywood, IL; Loyola University Chicago Stritch School of Medicine, Maywood, IL
| | - James Swanson
- Department of Surgery, Loyola University Medical Center, Maywood, IL; Loyola University Chicago Stritch School of Medicine, Maywood, IL
| | - Mitchel Fernando
- Department of Surgery, Loyola University Medical Center, Maywood, IL; Loyola University Chicago Stritch School of Medicine, Maywood, IL
| | - Tyler Cohn
- Department of Surgery, Loyola University Medical Center, Maywood, IL; Loyola University Chicago Stritch School of Medicine, Maywood, IL
| | - Frederick A Luchette
- Department of Surgery, Loyola University Medical Center, Maywood, IL; Loyola University Chicago Stritch School of Medicine, Maywood, IL; Department of Surgery, Edward Hines Jr Veterans Administration Hospital, Hines, IL
| | - Marshall S Baker
- Department of Surgery, Loyola University Medical Center, Maywood, IL; Loyola University Chicago Stritch School of Medicine, Maywood, IL; Department of Surgery, Edward Hines Jr Veterans Administration Hospital, Hines, IL; Department of Surgery, Huntsman Cancer Institute, University of Utah Health Salt Lake City, UT.
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Verm RA, Baker MM, Cohn T, Park S, Swanson J, Freeman R, Abdelsattar ZM. Fragmented care, Commission on Cancer accreditation, and overall survival in patients receiving surgery and chemotherapy for esophageal cancer. Surgery 2024; 175:618-628. [PMID: 37743107 DOI: 10.1016/j.surg.2023.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/21/2023] [Accepted: 07/08/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Increasing regionalization for esophagectomy for cancer may lead patients to travel for surgery at one institution and receive chemotherapy at another closer to home. We explore the effects on survival for care fragmentation, the Commission on Cancer status of secondary institutions providing chemotherapy, and the type of institution performing surgery. METHODS We queried the National Cancer Database to identify all patients who underwent esophagectomy for esophageal cancer and received perioperative chemotherapy between 2006 and 2019. Patients were divided into single-center care, fragmented-to-Commission on Cancer care, or fragmented-to-non-Commission on Cancer care. We identified associations using multivariable logistic regression, Kaplan-Meier survival analyses, and Cox proportional hazards models. RESULTS A total of 18,502 patients met the criteria for inclusion: 8,290 (44.8%) received single-center care; 3,414 (18.5%) fragmented-to-Commission on Cancer care; and 6,798 (36.4%) fragmented-to-non-Commission on Cancer care. Fragmented care was more likely in White patients (adjusted odds ratio = 1.25; P < .001) and in patients nonadjacent to a metropolitan area (adjusted odds ratio = 1.36; P < .001). Overall survival was equivalent between single-center and fragmented care, but undergoing an esophagectomy at an academic center was associated with improved survival (adjusted hazard ratio = 0.82; P = .016). In patients with an esophagectomy at a nonacademic center, overall survival was best if perioperative chemotherapy was administered at Commission on Cancer-accredited facilities compared with chemotherapy at fragmented-to-non-Commission on Cancer centers (P = .022). CONCLUSION Most of the esophageal cancer care in the US is fragmented at multiple institutions. When care is fragmented, it is most commonly at non-Commission on Cancer centers for perioperative chemotherapy. Overall survival is best when esophagectomy is performed at an academic center, and perioperative therapy is administered at Commission on Cancer-accredited facilities.
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Affiliation(s)
- Raymond A Verm
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL. https://twitter.com/RaymondVerm
| | - Marshall M Baker
- Department of Surgery, Edward Hines VA Medical Center, Hines, IL
| | - Tyler Cohn
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL; Department of Surgery, Edward Hines VA Medical Center, Hines, IL
| | - Simon Park
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL
| | - James Swanson
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL
| | - Richard Freeman
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL
| | - Zaid M Abdelsattar
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL; Department of Surgery, Edward Hines VA Medical Center, Hines, IL.
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Odeh AM, Wyant K, Freeman RK, Abdelsattar ZM. Tackling complex thoracic surgical operations with robotic solutions: a narrative review. J Thorac Dis 2024; 16:1521-1536. [PMID: 38505049 PMCID: PMC10944716 DOI: 10.21037/jtd-23-1570] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/15/2023] [Indexed: 03/21/2024]
Abstract
Background and Objective The adoption of robotic surgery for general thoracic surgery has rapidly progressed over the last two decades from its application in basic operations to complex pathologies. As such, the purpose of this narrative review is to highlight the collective experience of tackling complex thoracic surgical operations with minimally invasive robotic solutions. Methods Electronic searches of PubMed were conducted for each subtopic, using specific keywords and inclusion criteria. Once identified, the articles were screened through the abstract, introduction, results and conclusion for relevancy, and included based on a standard narrative review inclusion criteria. Key Content and Findings The role of the robotic approach has increased in thoracic outlet syndrome, chest wall resection, tracheobronchomalacia, airway and sleeve lung surgery, lobectomy after neoadjuvant therapy, complex segmentectomy, giant paraesophageal hernia repair, esophagectomy and esophageal enucleation, mediastinal masses and thymectomy and lung transplantation. Robotic surgery has several advantages when compared to video-assisted and open thoracoscopic surgery. These include better pain control and aesthetic outcome, improved handling of complex anatomy, enhanced access to lymph nodes, and faster recovery rates. Although it is associated with longer operative time, robotic surgery has comparable morbidity rates. Conclusions The robotic approach to complex thoracic problems is safe, effective, and associated with improved patient outcomes. To encourage wider adoption of robotic technology, increased training and expanded research efforts are essential, alongside improved worldwide access to this technology.
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Affiliation(s)
- Ayham M. Odeh
- Stritch School of Medicine, Loyola University Chicago, Chicago, IL, USA
- Department of Thoracic & Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Kody Wyant
- Stritch School of Medicine, Loyola University Chicago, Chicago, IL, USA
- Department of Thoracic & Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Richard K. Freeman
- Stritch School of Medicine, Loyola University Chicago, Chicago, IL, USA
- Department of Thoracic & Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Zaid M. Abdelsattar
- Stritch School of Medicine, Loyola University Chicago, Chicago, IL, USA
- Department of Thoracic & Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA
- US Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, IL, USA
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Verm RA, Vigneswaran WT, Lin A, Zywiciel J, Freeman R, Abdelsattar ZM. Robotic chest wall resection for primary benign chest wall tumors and locally advanced lung cancer: an institutional case series and national report. J Thorac Dis 2023; 15:4849-4858. [PMID: 37868869 PMCID: PMC10586962 DOI: 10.21037/jtd-23-532] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/11/2023] [Indexed: 10/24/2023]
Abstract
Background Limited data exists for robotic chest wall resection; we report institutional and national experience of robotic chest wall resection. Methods In this comparative retrospective case series we describe patients who underwent robotic chest wall resection at our institution and enrich this case series with data from the National Cancer Database (NCDB). We describe our preoperative workup, operative technique, and postoperative care. Outcomes included conversion to open, length of stay, readmissions, and 30- and 90-day mortality. The results are descriptively reported and compared. Results We describe 6 patients institutionally and 96 NCDB patients. At our institution 66.7% were males, median age was 70.0 (range, 39-91) years, and 50% were primary chest wall tumors. Median tumor size was 5.25 (range, 2.3-8.3) cm. Outcomes were as follows: no open conversions, median length of stay 3 (range, 1-6) days, no unplanned 30-day readmissions or 90-day mortality. In the NCDB, 55.2% were males with median age of 68.5 (range, 30-89) years. Median tumor size was 3.90 (range, 2.4-6.0) cm. NCDB outcomes were as follows: 18.8% open conversion, median length of stay 7 (range, 5-10) days, 3.1% unplanned 30-day readmission, and 8.3% 90-day mortality. Our institutional case series had 18.0 months median follow-up (range, 6-54 months) with no functional deficits. Median survival in NCDB was 49.6 months. Conclusions Robotic chest wall resection is feasible and is performed nationally with acceptable short- and long-term outcomes. Our institutional experience reports our technique, resultant short hospital stay, and excellent functional outcomes.
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Affiliation(s)
- Raymond A. Verm
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Wickii T. Vigneswaran
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA
- Department of Surgery, Edward Hines VA Medical Center, Hines, IL, USA
| | - Andrew Lin
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA
- Department of Surgery, Edward Hines VA Medical Center, Hines, IL, USA
| | - Joseph Zywiciel
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Richard Freeman
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Zaid M. Abdelsattar
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA
- Department of Surgery, Edward Hines VA Medical Center, Hines, IL, USA
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Roat-Shumway S, Tonelli CM, Baker MS, Abdelsattar ZM. Prognosis of Unresected vs Resected Small Pulmonary Carcinoid Tumors. Ann Thorac Surg 2023; 116:553-561. [PMID: 37054928 DOI: 10.1016/j.athoracsur.2023.04.008] [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: 11/12/2022] [Revised: 03/13/2023] [Accepted: 04/04/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Previous studies have shown that overall survival after lung resection for pulmonary carcinoid tumors is favorable. It is unclear what the prognosis is for observation rather than resection for small carcinoid tumors. METHODS We queried the National Cancer Database to identify patients presenting with primary pulmonary carcinoid tumors between 2004 and 2017. We included patients with small (<3 cm) primary pulmonary carcinoids, who were observed or underwent a lung resection. To minimize confounding by indication, we used propensity score matching, while accounting for age, sex, race, insurance type, Charlson-Deyo comorbidity score, typical and atypical histology, tumor size, and year of diagnosis. We used Kaplan-Meier survival analyses to compare 5-year overall survival in the matched cohorts. RESULTS Of 8435 patients with small pulmonary carcinoids, 783 (9.3%) underwent observation and 7652 (91%) underwent surgical resection. After propensity score matching, surgical resection was associated with improved 5-year overall survival (66% vs 81%, P < .001). No significant difference in overall survival was found between wedge and anatomic resection (88% vs 88%, P = .83). In patients undergoing resection, lymph node sampling at the time of wedge and anatomic resection increased 5-year overall survival (90% vs 86%, P = .0042; 88% vs 82%, P = .04, respectively). CONCLUSIONS Surgical resection of small pulmonary carcinoids is associated with improved survival compared with observation. When surgical resection is performed, wedge and anatomic resection result in similar survival, and lymph node sampling improves survival.
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Affiliation(s)
| | - Celsa M Tonelli
- Stritch School of Medicine, Loyola University Chicago, Maywood Illinois; Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Marshall S Baker
- Stritch School of Medicine, Loyola University Chicago, Maywood Illinois; Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Zaid M Abdelsattar
- Stritch School of Medicine, Loyola University Chicago, Maywood Illinois; Department of Surgery, Loyola University Medical Center, Maywood, Illinois.
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Verm RA, Abdelsattar ZM. Forecasting the need for blood transfusions in non-cardiac thoracic surgery. J Thorac Dis 2023; 15:2374-2376. [PMID: 37324085 PMCID: PMC10267935 DOI: 10.21037/jtd-2023-03] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/10/2023] [Indexed: 06/17/2023]
Affiliation(s)
- Raymond A. Verm
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Zaid M. Abdelsattar
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA
- Department of Surgery, Edward Hines VA Medical Center, IL, USA
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9
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Khouzam MS, Wood DE, Vigneswaran W, Goyal A, Czerlanis C, Blackmon SH, Donington J, Albain KS, Freeman RK, Abdelsattar ZM. Impact of Federal Lung Cancer Screening Policy on the Incidence of Early-stage Lung Cancer. Ann Thorac Surg 2023; 115:827-833. [PMID: 36470567 DOI: 10.1016/j.athoracsur.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/21/2022] [Accepted: 11/07/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND In December 2013 the US Preventative Services Task Force (USPSTF) recommended annual lung cancer screening for high-risk patients. The Centers for Medicare & Medicaid Services (CMS) later announced coverage in 2015. The impact of these federal decisions at the population level is unknown. METHODS Using the Surveillance, Epidemiology, and End Results database, we studied changes in lung cancer incidence by stage and linked to US census data to obtain age-adjusted estimates standardized to the US population. Based on age at diagnosis we stratified patients as age-eligible or age-ineligible for screening. We used difference-in-differences regression to determine the effect of screening on lung cancer incidence by stage. RESULTS For all age groups the incidence of early-stage lung cancer both before and after the USPSTF guidelines remained relatively stable at 12.8 ± 0.52 and 13.5 ± 0.92 per 100,000 patients, respectively (P = .068). However the difference-in-differences analysis estimated an absolute increase in the age-adjusted incidence by 3.4 per 100,000 persons in the age-eligible group after the announcement of the guidelines (P = .007). The effect was even larger after the CMS decision (4.3/100,000 persons, P < .001). Similarly there was a 14.2 per 100,000 persons absolute reduction in the incidence of advanced-stage lung cancer (P < .001). CONCLUSIONS The 2013 USPSTF lung cancer screening guidelines and CMS coverage decisions were associated with an increased incidence of early-stage lung cancer and decreased incidence of advance-staged lung cancer at the population level.
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Affiliation(s)
- Matthew S Khouzam
- Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | - Douglas E Wood
- Department of Surgery, University of Washington, Seattle, Washington
| | - Wickii Vigneswaran
- Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois; Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Amit Goyal
- Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois; Department of Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Cheryl Czerlanis
- Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois; Department of Medicine, Loyola University Medical Center, Maywood, Illinois
| | | | - Jessica Donington
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Kathy S Albain
- Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois; Department of Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Richard K Freeman
- Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois; Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Zaid M Abdelsattar
- Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois; Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, Illinois.
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10
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Abdelsattar ZM, Joshi V, Cassivi S, Kor D, Shen KR, Nichols F, Allen M, Blackmon SH, Wigle D. Preoperative Type and Screen Before General Thoracic Surgery: A Nomogram to Reduce Unnecessary Tests. Ann Thorac Surg 2023; 115:519-525. [PMID: 35809656 DOI: 10.1016/j.athoracsur.2022.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 04/17/2022] [Accepted: 06/13/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND A preoperative type and screen (T&S) is traditionally routinely obtained before noncardiac thoracic surgery; however an intraoperative blood transfusion is rare. This practice is overly cautious and expensive. METHODS We included adult patients undergoing major thoracic surgery at the Mayo Clinic from 2007 to 2016. Patients receiving a T&S blood test ≤72 hours of surgery was the main exposure. We randomly split the cohort into derivation and validation datasets. We used multiple logistic regression to create a parsimonious nomogram predicting the need for a T&S in relation to the likelihood of intraoperative blood transfusion. We validated the nomogram in terms of discrimination, calibration, and negative predictive value. RESULTS Of 6280 patients 46.1% had a preoperative T&S, but only 7.1% received intraoperative transfusions. The derivation dataset had 4196 patients. Patients who had a T&S were more likely to have baseline hemoglobin level <10 g/dL (7.9% vs 3.6%, P < .001) and less likely to have minimally invasive operations (36.1% vs 43.5%, P < .001) but were otherwise similar in baseline age and comorbidities. A transfusion threshold of 5% was selected a priori. The nomogram included age, planned operation, approach, body mass index, and preoperative hemoglobin. The nomogram was validated with a c-statistic of 86% and a negative predictive value of 97.9%. Patients who needed a blood transfusion but who did not have a preoperative T&S did not have a higher rate of mortality (P = .121). CONCLUSIONS An intraoperative blood transfusion during major thoracic surgery is a rare event. Patient who required transfusion but did not have a T&S did not have worse outcomes. A simple nomogram can aid in the selective use of T&S orders preoperatively.
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Affiliation(s)
- Zaid M Abdelsattar
- Department of Surgery, Mayo Clinic, Rochester, Minnesota; Department of Thoracic & Cardiovascular Surgery, Loyola University, Chicago, Illinois.
| | - Vijay Joshi
- Department of Surgery, University Hospital of South Manchester, Manchester, United Kingdom
| | | | - Daryl Kor
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - K Robert Shen
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Mark Allen
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Dennis Wigle
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
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Jaradeh M, Vigneswaran WT, Raad W, Lubawski J, Freeman R, Abdelsattar ZM. Neoadjuvant Chemotherapy vs Chemoradiation Therapy Followed by Sleeve Resection for Resectable Lung Cancer. Ann Thorac Surg 2022; 114:2041-2047. [PMID: 35351422 DOI: 10.1016/j.athoracsur.2022.03.037] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/09/2022] [Accepted: 03/14/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Traditionally, neoadjuvant chemoradiation therapy is followed by resection in patients with locally advanced non-small cell lung cancer (NSCLC). The risks and benefits of this approach are not well defined in patients requiring a sleeve lung resection. In this context, we compare the short- and long-term outcomes of neoadjuvant chemotherapy alone vs chemoradiation therapy followed by sleeve lung resection. METHODS We used the National Cancer Database to identify locally advanced NSCLC patients who received chemotherapy-alone or chemoradiation therapy in the neoadjuvant setting, followed by a sleeve lung resection, between 2006 and 2017. Our outcomes of interest were 30-day mortality, 90-day mortality, and overall survival. To minimize confounding by indication, we used propensity score adjustment, logistic regression, Kaplan-Meier survival analysis, and Cox proportional hazards models to identify associations. RESULTS Of 176 patients undergoing sleeve lung resection, 92 (52.3%) received neoadjuvant chemotherapy-alone, and 84 (47.7%) received neoadjuvant chemoradiation therapy. Patients in both groups were well balanced in age, sex, race, Charlson-Deyo comorbidity index, insurance status, median income, and education (all P > .05). Similarly, the groups were well balanced in histology, tumor location, and stage (all P > .05). Patients receiving neoadjuvant chemoradiation therapy had higher 90-day mortality (11.96% vs 2.38%, P = .015), and there was no difference in overall survival between the neoadjuvant chemotherapy-alone vs chemoradiation therapy cohorts (P = .621). CONCLUSIONS In this national study of patients with locally advanced resectable NSCLC requiring a sleeve lung resection, neoadjuvant chemoradiation therapy was associated with a 5-fold increase in 90-day mortality without an overall survival benefit over neoadjuvant chemotherapy-alone.
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Affiliation(s)
- Mark Jaradeh
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Wickii T Vigneswaran
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois; Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Wissam Raad
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois; Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, Illinois
| | - James Lubawski
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois; Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Richard Freeman
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois; Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Zaid M Abdelsattar
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois; Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, Illinois.
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12
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Kulshrestha S, Penton A, Luchette FA, Baker MS, Abdelsattar ZM. Variation in Hospital Cost and 1-Year Episodes of Care after Diaphragmatic Hernia Repair. J Am Coll Surg 2022; 235:111-118. [PMID: 35703968 DOI: 10.1097/xcs.0000000000000211] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Diaphragmatic hernia repair is a common operation performed at all types of hospitals. The variation in costs and repeat episodes of care after this operation is not known. STUDY DESIGN The Healthcare Cost and Utilization Project State Inpatient and State Ambulatory Surgery and Services Databases for Florida were queried to identify patients undergoing diaphragmatic hernia repair between 2011 and 2018 and the associated inpatient and outpatient encounters within 12 months postoperatively. Hospitals were ranked by cost and grouped into quintiles. All costs and charges were reliability and case-mix adjusted with the use of hierarchical multivariable regression. RESULTS In total, 8,848 patients underwent diaphragmatic hernia operations at 158 hospitals. The most expensive hospital quintile had lower surgical volume, location in rural settings, and fewer than 100 beds. There was a wide variation in costs after diaphragmatic hernia repair. On unadjusted comparison, index costs were $23,041 more expensive in hospitals in the highest quintile than in the lowest quintile. Cost differences were persistent even after case-mix and reliability adjustment. The variation in adjusted aggregate charges for associated outpatient and inpatient encounters in the first year after the index operation was considerably lower than that of the index hospitalization. CONCLUSION There is nearly a 2-fold variation in the cost of a diaphragmatic hernia repair across hospitals. Most of the variation occurs during the index surgical encounter and not for repeat encounters during the first postoperative year. As bundled payment models mature, hospitals and payers will need to target this variation to ensure cost-efficiency.
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Affiliation(s)
- Sujay Kulshrestha
- From the Department of Surgery, Loyola University Medical Center, Maywood, IL (Kulshrestha, Penton, Luchette, Baker)
| | - Ashley Penton
- From the Department of Surgery, Loyola University Medical Center, Maywood, IL (Kulshrestha, Penton, Luchette, Baker)
| | - Fred A Luchette
- From the Department of Surgery, Loyola University Medical Center, Maywood, IL (Kulshrestha, Penton, Luchette, Baker)
- the Department of Surgery, Edward Hines, Jr Veterans Administration Hospital, Hines, IL (Luchette, Baker)
| | - Marshall S Baker
- From the Department of Surgery, Loyola University Medical Center, Maywood, IL (Kulshrestha, Penton, Luchette, Baker)
- the Department of Surgery, Edward Hines, Jr Veterans Administration Hospital, Hines, IL (Luchette, Baker)
| | - Zaid M Abdelsattar
- the Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL (Abdelsattar)
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Diaz A, Bujnowski D, McMullen P, Lysandrou M, Ananthanarayanan V, Husain AN, Freeman R, Vigneswaran WT, Ferguson MK, Donington JS, Madariaga MLL, Abdelsattar ZM. Pulmonary Parenchymal Changes in COVID-19 Survivors. Ann Thorac Surg 2022; 114:301-310. [PMID: 34343471 PMCID: PMC8325553 DOI: 10.1016/j.athoracsur.2021.06.076] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 06/03/2021] [Accepted: 06/23/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND As the COVID-19 pandemic moves into the survivorship phase, questions regarding long-term lung damage remain unanswered. Previous histopathologic studies are limited to autopsy reports. We studied lung specimens from COVID-19 survivors who underwent elective lung resections to determine whether postacute histopathologic changes are present. METHODS This multicenter observational study included 11 adult COVID-19 survivors who had recovered but subsequently underwent unrelated elective lung resection for indeterminate lung nodules or lung cancer. We compared these against an age- and procedure-matched control group who never contracted COVID-19 (n = 5) and an end-stage COVID-19 group (n = 3). A blinded pulmonary pathologist examined the lung parenchyma focusing on 4 compartments: airways, alveoli, interstitium, and vasculature. RESULTS Elective lung resection was performed in 11 COVID-19 survivors with asymptomatic (n = 4), moderate (n = 4), and severe (n = 3) COVID-19 infections at a median 68.5 days (range 24-142 days) after the COVID-19 diagnosis. The most common operation was lobectomy (75%). Histopathologic examination identified no differences between the lung parenchyma of COVID-19 survivors and controls across all compartments examined. Conversely, patients in the end-stage COVID-19 group showed fibrotic diffuse alveolar damage with intra-alveolar macrophages, organizing pneumonia, and focal interstitial emphysema. CONCLUSIONS In this study to examine the lung parenchyma of COVID-19 survivors, we did not find distinct postacute histopathologic changes to suggest permanent pulmonary damage. These results are reassuring for COVID-19 survivors who recover and become asymptomatic.
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Affiliation(s)
- Ashley Diaz
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Daniel Bujnowski
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Phillip McMullen
- Department of Pathology, University of Chicago Medicine, Chicago, Illinois
| | - Maria Lysandrou
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | | | - Aliya N. Husain
- Department of Pathology, University of Chicago Medicine, Chicago, Illinois
| | - Richard Freeman
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Wickii T. Vigneswaran
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Mark K. Ferguson
- Section of Thoracic Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Jessica S. Donington
- Section of Thoracic Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Maria Lucia L. Madariaga
- Section of Thoracic Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Zaid M. Abdelsattar
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, Illinois,Address correspondence to Dr Abdelsattar, Department of Cardiovascular & Thoracic Surgery, Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153
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14
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Littau MJ, Freeman R, Vigneswaran WT, Luchette FA, Baker MS, Raad W, Abdelsattar ZM, Grenda T, Lubawski J, Madariaga MLL. Comparative effectiveness of stereotactic body radiation therapy versus surgery for stage I lung cancer in otherwise healthy patients: An instrumental variable analysis. JTCVS Open 2022; 9:249-261. [PMID: 36003477 PMCID: PMC9390152 DOI: 10.1016/j.xjon.2021.09.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/24/2021] [Indexed: 12/04/2022]
Abstract
Objectives Stereotactic body radiation therapy (SBRT) is an established primary treatment modality in patients with lung cancer who have multiple comorbidities and/or advanced-stage disease. However, its role in otherwise healthy patients with stage I lung cancer is unclear. In this context, we compared the effectiveness of SBRT versus surgery on overall survival using a national database. Methods We identified all patient with clinical stage I non–small cell lung cancer from the National Cancer Database from 2004 to 2016. We defined otherwise healthy patients as those with a Charlson-Deyo comorbidity index of 0 and whose treatment plan included options for either SBRT or surgery. We further excluded patients who received SBRT due to a contraindication to surgery. We first used propensity score matching and Cox proportional hazard models to identify associations. Next, we fit 2-stage residual inclusion models using an instrumental variables approach to estimate the effects of SBRT versus surgery on long-term survival. We used the hospital SBRT utilization rate as the instrument. Results Of 25,963 patients meeting all inclusion/exclusion criteria, 5465 (21%) were treated with SBRT. On both Cox proportional hazards modeling and propensity-score matched Kaplan-Meier analysis, surgical resection was associated with improved survival relative to SBRT. In the instrumental-variable–adjusted model, SBRT remained associated with decreased survival (hazard ratio, 2.64; P < .001). Both lobectomy (hazard ratio, 0.17) and sublobar resections (hazard ratio, 0.28) were associated with improved overall survival compared with SBRT (P < .001). Conclusions In otherwise healthy patients with stage I NSCLC, surgical resection is associated with a survival benefit compared with SBRT. This is true for both lobar and sublobar resections.
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Kulshrestha S, Sweigert PJ, Tonelli C, Bunn C, Luchette FA, Abdelsattar ZM, Pawlik TM, Baker MS. Textbook oncologic outcome in pancreaticoduodenectomy: Do regionalization efforts make sense? J Surg Oncol 2022; 125:414-424. [PMID: 34617590 PMCID: PMC8799483 DOI: 10.1002/jso.26712] [Citation(s) in RCA: 4] [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: 05/24/2021] [Revised: 09/13/2021] [Accepted: 09/30/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES Few empiric studies evaluate the effects of regionalization on pancreatic cancer care. METHODS We queried the National Cancer Database to identify patients undergoing pancreaticoduodenectomy for clinical stage I/II pancreatic adenocarcinoma between 2006 and 2015. Facilities were categorized by annual pancreatectomy volume. Textbook oncologic outcome was defined as a margin negative resection, appropriate lymph node assessment, no prolonged hospitalization, no 30-day readmission, no 90-day mortality, and timely receipt of adjuvant chemotherapy. Multivariable regression adjusted for comorbid disease, pathologic stage, and facility characteristics was used to evaluate the relationship between facility volume and textbook outcome. RESULTS Sixteen thousand six hundred and two patients underwent pancreaticoduodenectomy; 3566 (21.5%) had a textbook outcome. Operations performed at high volume centers increased each year (45.8% in 2006 to 64.2% in 2015, p < 0.001) as did textbook outcome rates (14.3%-26.2%, p < 0.001). Surgical volume was associated with textbook outcome. High volume centers demonstrated higher unadjusted rates of textbook outcome (25.4% vs. 11.8% p < 0.01) and increased adjusted odds of textbook outcome relative to low volume centers (odds ratio: 2.39, [2.02, 2.85], p < 0.001). Textbook outcome was associated with improved overall survival independent of volume. CONCLUSIONS Regionalization of care for pancreaticoduodenectomy to high volume centers is ongoing and is associated with improved quality of care.
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Affiliation(s)
- Sujay Kulshrestha
- Burn and Shock Trauma Research Institute, Loyola University Chicago, Maywood, IL,Department of Surgery, Loyola University Medical Center, Maywood, IL
| | | | - Celsa Tonelli
- Department of Surgery, Loyola University Medical Center, Maywood, IL,Edward Hines Jr. Veterans Affair Hospital, Hines, IL
| | - Corinne Bunn
- Burn and Shock Trauma Research Institute, Loyola University Chicago, Maywood, IL,Department of Surgery, Loyola University Medical Center, Maywood, IL
| | - Fred A. Luchette
- Department of Surgery, Loyola University Medical Center, Maywood, IL,Edward Hines Jr. Veterans Affair Hospital, Hines, IL
| | - Zaid M. Abdelsattar
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL
| | - Timothy M. Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Marshall S. Baker
- Department of Surgery, Loyola University Medical Center, Maywood, IL,Edward Hines Jr. Veterans Affair Hospital, Hines, IL
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Nakahama H, Jaradeh M, Abdelsattar ZM, Lubawski J, Vigneswaran WT. The impact of marginal lung function on outcomes in the era of minimally invasive thoracic surgery. J Thorac Dis 2022; 13:6800-6809. [PMID: 35070364 PMCID: PMC8743406 DOI: 10.21037/jtd-21-1382] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/28/2021] [Indexed: 11/24/2022]
Abstract
Background The effect of marginal lung function on outcomes after lung resection has traditionally been studied in the context of open thoracic surgery. Its impact on postoperative outcomes in the era of minimally invasive lung resection is unclear. Methods In this retrospective cohort study, we included adult patients who underwent minimally invasive lung resection at our institution between January 2017 and May 2020 for known malignancy or lung nodule. Marginal lung function was defined as pre-operative forced expiratory volume in 1 second (FEV1) and/or diffusion lung capacity of carbon monoxide <60% of predicted. Our outcomes included a composite outcome of pulmonary morbidity and/or 30- and 90-day mortality, and hospital length of stay. We used multivariable logistic and Poisson regression models to identify associations with outcomes, and Kaplan-Meier and Cox models to estimate survival. Results Of 300 patients, 88 (29%) had marginal lung function. Patients in the marginal group were more likely to be female (69% vs. 56%; P=0.028), and more likely to have: hypertension (HTN) (83% vs. 71%; P=0.028), chronic obstructive pulmonary disease (COPD) (38% vs. 12%; P<0.001), interstitial lung disease (ILD) (9% vs. 3%; P<0.019), and ischemic heart disease (28% vs. 18%; P=0.033). Patients were similar in terms of age (68±8 vs. 68±10 years; P=0.932), and other comorbidities. Anatomic lung resection comprised 56.8% of the marginal group vs. 74% in the non-marginal group (P=0.003). The most common complication was prolonged air leak (18.2% vs. 11.8%; P=0.479). Marginal lung function had a trend toward increased composite respiratory complications (22.7% vs. 15.1%; P=0.112) and 90-day mortality (5.7% vs. 4.2%; P=0.591), although they did not reach statistical significance. There was a statistically significant 1-day average increase in length of stay in the marginal lung function cohort (4.6 vs. 3.4 days; P<0.015) with a stronger association with diffusion lung capacity of carbon monoxide than FEV1. Survival was similar (marginal function HR =1.0; P=0.994). Conclusions In the era of minimally invasive thoracic surgery, lung resection in patients with marginal lung function may be considered in select patients. These findings aid in the selection consideration and counseling of this patient population.
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Affiliation(s)
- Hiroko Nakahama
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Mark Jaradeh
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Zaid M Abdelsattar
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - James Lubawski
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Wickii T Vigneswaran
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA
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Savitch SL, Zheng R, Abdelsattar ZM, Barta JA, Okusanya OT, Evans NR, Grenda TR. Surgical Outcomes in the National Lung Screening Trial Compared to Contemporary Practice. Ann Thorac Surg 2022; 115:1369-1377. [PMID: 35007506 DOI: 10.1016/j.athoracsur.2021.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/11/2021] [Accepted: 12/06/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND The National Lung Screening Trial (NLST) established a role for lung cancer screening. Mortality benefits with screening are predicated on successful treatment with low surgical mortality. Given variations observed in perioperative outcomes following lung cancer resection, it remains unknown if benefits observed in the NLST are generalizable to a broader population. We sought to determine if NLST perioperative outcomes are reflective of contemporary practice in a national cohort. METHODS We identified patients diagnosed with non-small cell lung cancer who underwent lung resection in the 2014-2015 National Cancer Database (NCDB) and the NLST. We compared demographic and cancer characteristics in both datasets. We used hierarchical logistic regression to compare 30-day and 90-day postoperative mortality across facilities in both datasets. RESULTS 65,054 patients in NCDB and 1,003 patients in the NLST treated across 1,119 NCDB hospitals and 33 NLST hospitals were included. After risk- and reliability-adjustment, mean 30-day and 90-day mortality were significantly higher among NCDB hospitals (mean [95% CI]; 30-day: 2.2 [2.2-2.2] vs. 1.8 [1.8-1.8], p<0.001; 90-day: 4.2 [4.2-4.3] vs. 2.9 [2.9-2.9], p<0.001). Variation in risk- and reliability-adjusted 30-day (1.1%-4.9%) and 90-day (2.6%-9.7%) mortality was observed among NCDB hospitals. Adjusted mortality was similar among NLST facilities (30-day: 1.8%-1.8%; 90-day: 2.9%-2.9%). CONCLUSIONS Risk- and reliability-adjusted postoperative mortality varies widely in a national cohort compared to outcomes observed in the NLST. Efforts to minimize this variation are needed to ensure that benefits of lung cancer screening are fully realized in the United States.
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Affiliation(s)
- Samantha L Savitch
- Division of Thoracic Surgery, Sidney Kimmel Medical College, Philadelphia, PA.
| | - Richard Zheng
- Division of Thoracic Surgery, Sidney Kimmel Medical College, Philadelphia, PA
| | - Zaid M Abdelsattar
- Department of Cardiovascular and Thoracic Surgery, Loyola University, Chicago, IL
| | - Julie A Barta
- Division of Pulmonary, Allergy, and Critical Care Medicine, Sidney Kimmel Medical College, Philadelphia, PA
| | | | - Nathaniel R Evans
- Division of Thoracic Surgery, Sidney Kimmel Medical College, Philadelphia, PA
| | - Tyler R Grenda
- Division of Thoracic Surgery, Sidney Kimmel Medical College, Philadelphia, PA
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Hendren S, Kanters AE, Morris AM, Abdelsattar ZM, Berry RR, Resnicow K, Birkmeyer NJ. Barriers to high-quality rectal cancer care: A qualitative study. Am J Surg 2022; 224:483-488. [DOI: 10.1016/j.amjsurg.2022.01.011] [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] [Received: 11/11/2021] [Revised: 12/27/2021] [Accepted: 01/19/2022] [Indexed: 11/25/2022]
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Littau MJ, Kim P, Kulshrestha S, Bunn C, Tonelli C, Abdelsattar ZM, Luchette FA, Baker MS. Resectable intrahepatic and hilar cholangiocarcinoma: Is margin status associated with survival? Surgery 2021; 171:703-710. [PMID: 34872744 DOI: 10.1016/j.surg.2021.09.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/16/2021] [Accepted: 09/10/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prior studies evaluating the effect of margin status on clinical outcome in patients undergoing resection for intrahepatic and extrahepatic hilar cholangiocarcinoma include small numbers of patients with histologically positive margins. The value of margin negative resection in these cases remains unclear. METHODS We queried the National Cancer Database to identify patients undergoing resection for clinical stage I to III intrahepatic and extrahepatic hilar between 2004 and 2015. Patients receiving neoadjuvant therapy and those having <3 lymph nodes examined were excluded. Patients undergoing positive resection were 1:1 propensity matched to those undergoing negative resection. Kaplan-Meier methods were used to compare overall survival for the matched cohorts. RESULTS In the study, 3,618 patients met the inclusion criteria, and 3,018 (83.4%) underwent negative resection; 600 (16.6%) positive resection. Patients undergoing negative resection had smaller tumors (2.97 ± 0.07 cm vs 3.49 ± 0.15 cm), were less likely to have stage 3 disease (16.7% vs 25.7%) and to receive adjuvant radiation (27.1% vs 45.7%) and chemotherapy (49.4% vs 61.0%) than those undergoing positive resection (all P < .05). On comparison of matched cohorts, patients undergoing negative resection had longer median overall survival (24.5 ± 0.02 vs 19.1 ± 0.02 months) and higher rates of 5-year overall survival (24.5% vs 16.7%) than those undergoing positive resection (P < .01). CONCLUSION In patients presenting with resectable intrahepatic and extrahepatic hilar, negative resection is associated with improved overall survival. Extended resections performed in an effort to clear surgical margins are warranted in patients fit for such procedures.
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Affiliation(s)
- Michael J Littau
- Department of Surgery, Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - Preston Kim
- Department of Surgery, Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - Sujay Kulshrestha
- Department of Surgery, Edward Hines Veterans Affairs Medical Center, Hines, IL
| | - Corinne Bunn
- Department of Surgery, Edward Hines Veterans Affairs Medical Center, Hines, IL
| | - Celsa Tonelli
- Department of Surgery, Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - Zaid M Abdelsattar
- Department of Surgery, Stritch School of Medicine, Loyola University Chicago, Maywood, IL; Department of Surgery, Edward Hines Veterans Affairs Medical Center, Hines, IL
| | - Fred A Luchette
- Department of Surgery, Stritch School of Medicine, Loyola University Chicago, Maywood, IL; Department of Surgery, Edward Hines Veterans Affairs Medical Center, Hines, IL
| | - Marshall S Baker
- Department of Surgery, Stritch School of Medicine, Loyola University Chicago, Maywood, IL; Department of Surgery, Edward Hines Veterans Affairs Medical Center, Hines, IL.
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Littau MJ, Bunn C, Kim P, Kulshrestha S, Tonelli C, Abdelsattar ZM, Luchette FA, Baker MS. Low and moderate grade retroperitoneal liposarcoma: Is adjuvant radiotherapy associated with improved survival in patients undergoing R1 resection? Am J Surg 2021; 223:527-530. [DOI: 10.1016/j.amjsurg.2021.12.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/26/2021] [Accepted: 12/21/2021] [Indexed: 11/29/2022]
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Tonelli CM, Lorenzo I, Bunn C, Kulshrestha S, Agnew SP, Abdelsattar ZM, Luchette FA, Baker MS. Does resident autonomy in colectomy procedures result in inferior clinical outcomes? Surgery 2021; 171:598-606. [PMID: 34844760 DOI: 10.1016/j.surg.2021.09.036] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/08/2021] [Accepted: 09/16/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The amount of time surgical trainees spend operating independently has been reduced by work-hour restrictions and shifts in the health care environment that impede autonomy. Few studies evaluate the association between clinical outcome and resident autonomy. METHODS The Veterans Affairs Surgical Quality Improvement Program database was queried to identify patients undergoing partial colectomy for neoplasm between 2004 and 2019. Rectal resections, emergency procedures, and those involving postgraduate year 1 and 2 residents were excluded. Records were categorized as performed with the attending scrubbed or not scrubbed. Hierarchical logistic regression was used to identify factors independently associated with operative time, morbidity, and mortality. RESULTS In total, 7,347 patients met inclusion criteria; 6,890 (93.6%) were categorized as attending scrubbed and 457 (6.4%) as attending not scrubbed. The cohorts were similar in terms of patient demographics, including age, race, body mass index, and American Society of Anesthesiologists class. There were no differences between cohorts in terms of operative time (attending not scrubbed 3.02 hours, attending scrubbed 3.07 hours, P = .42). On hierarchical logistic regression adjusted for age, gender, race, body mass index, functional status, cancer location, facility operative level, wound class, American Society of Anesthesiologists class, length of operation, operative modality (open or minimally invasive), postgraduate year of resident, and year, there were no differences in odds of complications, major morbidity, or mortality based on attending involvement. CONCLUSION Colectomies performed by residents with appropriate levels of autonomy are efficient and safe. Our results indicate that attending surgeon judgment regarding resident autonomy is sound and that educational environments can be designed to foster resident independence and preserve clinical quality, safety, and efficiency.
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Affiliation(s)
- Celsa M Tonelli
- Department of Surgery, Loyola University Medical Center, Maywood, IL; Department of Surgery, Edward Hines Jr Veterans Administration Hospital, Hines, IL.
| | - Isabela Lorenzo
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - Corinne Bunn
- Department of Surgery, Loyola University Medical Center, Maywood, IL; Burn and Shock Trauma Research Institute, Loyola University Chicago, Maywood, IL. https://twitter.com/CorinneBunn
| | - Sujay Kulshrestha
- Department of Surgery, Loyola University Medical Center, Maywood, IL; Burn and Shock Trauma Research Institute, Loyola University Chicago, Maywood, IL
| | - Sonya P Agnew
- Department of Surgery, Loyola University Medical Center, Maywood, IL
| | - Zaid M Abdelsattar
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL. https://twitter.com/ZaidAbdelsattar
| | - Frederick A Luchette
- Department of Surgery, Loyola University Medical Center, Maywood, IL; Department of Surgery, Edward Hines Jr Veterans Administration Hospital, Hines, IL
| | - Marshall S Baker
- Department of Surgery, Loyola University Medical Center, Maywood, IL; Department of Surgery, Edward Hines Jr Veterans Administration Hospital, Hines, IL
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Lorenzo IL, Tonelli CM, Bunn C, Kulshrestha S, Agnew SP, Cohn TD, Abdelsattar ZM, Baker MS, Luchette FA. Supervised independence in elective inguinal hernia repairs performed by surgical residents is not associated with compromised short clinical outcome or rates of reoperation for recurrence. Am J Surg 2021; 223:470-474. [PMID: 34815028 DOI: 10.1016/j.amjsurg.2021.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND We evaluate the association between attending surgeon involvement and clinical outcome in elective inguinal hernia repairs performed by residents. METHODS Patients undergoing initial elective unilateral inguinal hernia repair between 2004 and 2019 were identified using the Veterans Administration Surgical Quality Improvement Program Database. The level of attending surgeon involvement was categorized as active (attending scrubbed [AS]) or passive (supervising the resident's performance but not scrubbed [ANS]). AS and ANS herniorrhaphies were 1:1 propensity matched for patient demographics, comorbidities, surgical approach, resident postgraduate level, and year of repair. Rates of complication and recurrence for matched cohorts were compared by standard methods. RESULTS 30,784 patients met inclusion criteria. 5136 (17%) repairs were performed without the attending scrubbed. On comparison of matched-cohorts, overall complication rates (1.7% vs 1.2%, p = 0.07) and rates of recurrence (1.9% vs 1.4%, p = 0.041) for patients undergoing herniorrhaphy AS were statistically similar to those performed ANS. CONCLUSION Supervised independence in elective inguinal hernia repair performed by surgical residents is not associated with inferior clinical outcomes.
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Affiliation(s)
- Isabela L Lorenzo
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA.
| | - Celsa M Tonelli
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA; Department of Surgery, Edward Hines, Jr. VA Medical Center, Hines, IL, USA
| | - Corinne Bunn
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Sujay Kulshrestha
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Sonya P Agnew
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Tyler D Cohn
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Zaid M Abdelsattar
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Marshall S Baker
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA; Department of Surgery, Edward Hines, Jr. VA Medical Center, Hines, IL, USA
| | - Frederick A Luchette
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA; Department of Surgery, Edward Hines, Jr. VA Medical Center, Hines, IL, USA
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Abdelsattar ZM, Allen M, Blackmon S, Cassivi S, Mandrekar J, Nichols F, Reisenauer J, Wigle D, Shen KR. Contemporary Practice Patterns of Lung Volume Reduction Surgery in the United States. Ann Thorac Surg 2021; 112:952-960. [DOI: 10.1016/j.athoracsur.2020.08.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/07/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
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Kulshrestha S, Vigneswaran WT, Pawlik TM, Baker MS, Luchette FA, Raad W, Abdelsattar ZM, Freeman RK, Grenda T, Lubawski J. Assessment of Textbook Outcome After Surgery for Stage I/II Non-small Cell Lung Cancer. Semin Thorac Cardiovasc Surg 2021; 34:1351-1359. [PMID: 34411699 DOI: 10.1053/j.semtcvs.2021.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/02/2021] [Indexed: 11/11/2022]
Abstract
``Outcomes after cancer resection are traditionally measured individually. Composite metrics, or textbook outcomes, bundle outcomes into a single value to facilitate assessments of quality. We propose a composite outcome for non-small cell lung cancer resections, examine factors associated with the outcome, and evaluate its effect on overall survival. We queried the National Cancer Database for patients with stage I/II non-small cell lung cancer who underwent sublobar resection, lobectomy, or pneumonectomy from 2010 to 2016. We defined the metric as margin-negative resection, sampling of ≥10 lymph nodes, length of stay <75th percentile, no 30-day mortality, no readmission, and receipt of indicated adjuvant therapy. Multivariable logistic regression, Cox proportional hazards modeling, survival analyses, and propensity score matching were used to identify factors associated with the outcome and overall survival. Of 88,208 patients, 70,149 underwent lobectomy, 14,922 underwent sublobar resection, and 3,137 underwent pneumonectomy. Textbook outcome was achieved in 26.3% of patients. Failure to achieve the outcome was most commonly driven by inadequate nodal assessment. Textbook outcome was more likely after minimally invasive surgical approaches (aOR = 1.47; P< 0.001) relative to open resection and less likely after sublobar resection (aOR = 0.20; P< 0.001) relative to lobectomy. Achievement of textbook outcome was associated with an 9.6% increase in 5-year survival (P< 0.001), was independently associated with improved survival (aHR = 0.72; P < 0.001), and remained strongly associated with survival independent of resection extent after propensity matching. One in 4 patients undergoing non-small cell lung cancer resection achieve textbook outcome. Textbook outcome is associated with improved survival and has value as a quality metric.
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Affiliation(s)
- Sujay Kulshrestha
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois; Burn and Shock Trauma Research Institute, Loyola University Chicago, Chicago, Illinois.
| | - Wickii T Vigneswaran
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Timothy M Pawlik
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Marshall S Baker
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois; Department of Surgery, Edward Hines, Jr. Veterans Administration Hospital, Hines, Illinois
| | - Fred A Luchette
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois; Department of Surgery, Edward Hines, Jr. Veterans Administration Hospital, Hines, Illinois
| | - Wissam Raad
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Zaid M Abdelsattar
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Richard K Freeman
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Tyler Grenda
- Division of Thoracic Surgery, Department of Surgery, Sidney Kimmel Medical College, Philadelphia, Pennsylvania
| | - James Lubawski
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, Illinois
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25
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Bunn C, Ringhouse B, Patel P, Baker M, Gonzalez R, Abdelsattar ZM, Luchette FA. Trends in utilization of whole-body computed tomography in blunt trauma after MVC: Analysis of the Trauma Quality Improvement Program database. J Trauma Acute Care Surg 2021; 90:951-958. [PMID: 34016919 PMCID: PMC8244576 DOI: 10.1097/ta.0000000000003129] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The use of whole-body computed tomography (WBCT) in awake, clinically stable injured patients is controversial. It is associated with unnecessary radiation exposure and increased cost. We evaluate use of computed tomography (CT) imaging during the initial evaluation of injured patients at American College of Surgeons Levels I and II trauma centers (TCs) after blunt trauma. METHODS We identified adult blunt trauma patients after motor vehicle crash (MVC) from the American College of Surgeons Trauma Quality Improvement Program (TQIP) database between 2007 and 2016 at Level I or II TCs. We defined awake clinically stable patients as those with systolic blood pressure of 100 mm Hg or higher with a Glasgow Coma Scale score of 15. Computed tomography imaging had to have been performed within 2 hours of arrival. Whole-body computed tomography was defined as simultaneous CT of the head, chest and abdomen, and selective CT if only one to two aforementioned regions were imaged. Patients were stratified by Injury Severity Score (ISS). RESULTS There were 217,870 records for analysis; 131,434 (60.3%) had selective CT, and 86,436 (39.7%) had WBCT. Overall, there was an increasing trend in WBCT utilization over the study period (p < 0.001). In patients with ISS less than 10, WBCT was utilized more commonly at Level II versus Level I TCs in patients discharged from the emergency department (26.9% vs. 18.3%, p < 0.001), which had no surgical procedure(s) (81.4% vs. 80.3%, p < 0.001) and no injury of the head (53.7% vs. 52.4%, p = 0.008) or abdomen (83.8% vs. 82.1%, p = 0.001). The risk-adjusted odds of WBCT was two times higher at Level II TC vs. Level I (odds ratio, 1.88; 95% confidence interval 1.82-1.94; p < 0.001). CONCLUSION Whole-body computed tomography utilization is increasing relative to selective CT. This increasing utilization is highest at Level II TCs in patients with low ISSs, and in patients without associated head or abdominal injury. The findings have implications for quality improvement and cost reduction. LEVEL OF EVIDENCE Care management, Level IV.
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MESH Headings
- Accidents, Traffic
- Adolescent
- Adult
- Aged
- Cost Savings
- Databases, Factual/statistics & numerical data
- Emergency Service, Hospital/economics
- Emergency Service, Hospital/statistics & numerical data
- Emergency Service, Hospital/trends
- Female
- Glasgow Coma Scale
- Humans
- Injury Severity Score
- Male
- Medical Overuse/economics
- Medical Overuse/statistics & numerical data
- Medical Overuse/trends
- Middle Aged
- Practice Patterns, Physicians'/economics
- Practice Patterns, Physicians'/statistics & numerical data
- Practice Patterns, Physicians'/trends
- Quality Improvement
- Retrospective Studies
- Tomography, X-Ray Computed/economics
- Tomography, X-Ray Computed/methods
- Tomography, X-Ray Computed/statistics & numerical data
- Tomography, X-Ray Computed/trends
- Trauma Centers/economics
- Trauma Centers/statistics & numerical data
- Trauma Centers/trends
- Wounds, Nonpenetrating/diagnosis
- Wounds, Nonpenetrating/etiology
- Young Adult
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Affiliation(s)
- Corinne Bunn
- Burn and Shock Trauma Research Institute, Loyola University Chicago, Maywood, IL, USA
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Brendan Ringhouse
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Purvi Patel
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Marshall Baker
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
- Edward Hines Jr. Veterans Affair Hospital, Hines, IL, USA
| | - Richard Gonzalez
- Burn and Shock Trauma Research Institute, Loyola University Chicago, Maywood, IL, USA
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Zaid M. Abdelsattar
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL USA
- Edward Hines Jr. Veterans Affair Hospital, Hines, IL, USA
| | - Fred A. Luchette
- Burn and Shock Trauma Research Institute, Loyola University Chicago, Maywood, IL, USA
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
- Edward Hines Jr. Veterans Affair Hospital, Hines, IL, USA
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Kulshrestha S, Janjua HM, Bunn C, Rogers M, DuCoin C, Abdelsattar ZM, Luchette FA, Kuo PC, Baker MS. State-Level Examination of Clinical Outcomes and Costs for Robotic and Laparoscopic Approach to Diaphragmatic Hernia Repair. J Am Coll Surg 2021; 233:9-19.e2. [PMID: 34015455 DOI: 10.1016/j.jamcollsurg.2021.05.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Published studies evaluating the effect of robotic assistance on clinical outcomes and costs of care in diaphragmatic hernia repair (DHR) have been limited. STUDY DESIGN The Healthcare Cost and Utilization Project State Inpatient and State Ambulatory Surgery and Services Databases for Florida were queried to identify patients undergoing transabdominal DHR between 2011 and 2018 and associated inpatient and outpatient encounters within 12 months after the index operation. Patients undergoing robotic DHR were 1:1:1 propensity score-matched for age, sex, race, Elixhauser comorbidity score, case priority, payer, and facility volume with patients undergoing open and laparoscopic DHR. RESULTS There were 5,962 patients (67.3%) who underwent laparoscopic DHR, 1,520 (17.2%) who underwent open DHR, and 1,376 (15.5%) who underwent robotic DHR. On comparison of matched cohorts, median index length of stay (3 days; interquartile range [IQR] 2 to 5 days vs 2 days; IQR 1 to 4 days; p < 0.001) and index hospitalization costs ($17,236; IQR $13,231 to $22,183 vs $12,087; IQR $8,881 to $17,439; p < 0.001) for robotic DHR were greater than for laparoscopic DHR. Median length of stay for open DHR (6 days; IQR 4 to 10 days) was longer than that for both laparoscopic and robotic DHR. Median index hospitalization costs for open DHR ($16,470; IQR $11,152 to $23,768) were greater than those for laparoscopic DHR, but less than those for robotic DHR. There were no significant differences between cohorts in the overall rate of post-index care. CONCLUSIONS Laparoscopic DHR is the most cost-effective approach to DHR. Robotic assistance provides clinical outcomes comparable with laparoscopic DHR, but is associated with increased index cost.
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Affiliation(s)
- Sujay Kulshrestha
- Department of Surgery, Loyola University Medical Center, Maywood, IL; Burn and Shock Trauma Research Institute, Loyola University Chicago, Maywood, IL.
| | - Haroon M Janjua
- Department of Surgery, University of South Florida, Tampa, FL; OnetoMap Analytics, University of South Florida, Tampa, FL
| | - Corinne Bunn
- Department of Surgery, Loyola University Medical Center, Maywood, IL; Burn and Shock Trauma Research Institute, Loyola University Chicago, Maywood, IL
| | - Michael Rogers
- Department of Surgery, University of South Florida, Tampa, FL
| | | | - Zaid M Abdelsattar
- Depatment of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL; Edward Hines, Jr Veterans Administration Hospital, Hines, IL
| | - Fred A Luchette
- Department of Surgery, Loyola University Medical Center, Maywood, IL; Edward Hines, Jr Veterans Administration Hospital, Hines, IL
| | - Paul C Kuo
- Department of Surgery, University of South Florida, Tampa, FL; OnetoMap Analytics, University of South Florida, Tampa, FL
| | - Marshall S Baker
- Department of Surgery, Loyola University Medical Center, Maywood, IL; Edward Hines, Jr Veterans Administration Hospital, Hines, IL
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Bunn C, Kulshrestha S, Di Chiaro B, Maduekwe U, Abdelsattar ZM, Baker MS, Luchette FA, Agnew S. A Leg to Stand on: Trauma Center Designation and Association with Rate of Limb Salvage in Patients Suffering Severe Lower Extremity Injury. J Am Coll Surg 2021; 233:120-129.e5. [PMID: 33887482 DOI: 10.1016/j.jamcollsurg.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/24/2021] [Accepted: 04/05/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mangled extremities are one of the most difficult injuries for trauma surgeons to manage. We compare limb salvage rates for a limb-threatening lower extremity injuries managed at Level I vs Level II trauma centers (TCs). STUDY DESIGN We identified all adult patients with a limb-threatening injury who underwent primary amputation or limb salvage (LS) using the American College of Surgeons (ACS) Trauma Quality Improvement Program database at ACS Level I vs II TCs between 2007 and 2017. A limb-threatening injury was defined as an open tibial fracture with concurrent arterial injury (Gustilo type IIIc). Multivariable analysis and propensity score matching were performed to minimize confounding by indication. RESULTS There were 712 records for analysis; 391 (54.9%) LS performed and 321 (45.1%) underwent amputation. The rate of LS was statistically higher among patients treated at Level I TCs vs those treated at Level II TCs (47.4% vs 34.8%; p = 0.01). Patients with penetrating injuries (13% vs 9.5%; p = 0.046) and tibial/peroneal artery injury (72.9% vs 50.4%; p < 0.001), as opposed to popliteal artery injury (30.8% vs 58.8%; p < 0.001), were more likely to have LS. The risk-adjusted odds of LS was 3.13 times higher at Level I TCs vs Level II TCs (95% CI, 1.59 to 6.34; p = 0.001). Limb salvage rates were significantly higher at Level I TCs compared with Level II TCs (53.0% vs 34.8%; p = 0.004), even after propensity matching. CONCLUSIONS In patients with a mangled extremity, limb salvage rates are 50% higher at Level I TCs compared with Level II TCs, independent of case mix and injury severity.
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Affiliation(s)
- Corinne Bunn
- Department of Surgery, Loyola University Chicago, Maywood; Burn and Shock Trauma Research Institute, Loyola University Chicago, Maywood.
| | - Sujay Kulshrestha
- Department of Surgery, Loyola University Chicago, Maywood; Burn and Shock Trauma Research Institute, Loyola University Chicago, Maywood
| | - Bianca Di Chiaro
- Department of Plastic and Reconstructive Surgery, Loyola University Chicago, Maywood
| | - Uma Maduekwe
- Department of Plastic and Reconstructive Surgery, Loyola University Chicago, Maywood; Department of Plastic and Reconstructive Surgery, John Hopkins, Baltimore, MD
| | - Zaid M Abdelsattar
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood; Department of Surgery, Edward Hines Jr Veterans Administration Hospital, Hines, IL
| | - Marshall S Baker
- Department of Surgery, Loyola University Chicago, Maywood; Department of Surgery, Edward Hines Jr Veterans Administration Hospital, Hines, IL
| | - Fred A Luchette
- Department of Surgery, Loyola University Chicago, Maywood; Department of Surgery, Edward Hines Jr Veterans Administration Hospital, Hines, IL
| | - Sonya Agnew
- Department of Plastic and Reconstructive Surgery, Loyola University Chicago, Maywood; Department of Surgery, Edward Hines Jr Veterans Administration Hospital, Hines, IL
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28
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Jaradeh M, Curran B, Poulikidis K, Rodrigues A, Jeske W, Abdelsattar ZM, Lubawski J, Walenga J, Vigneswaran WT. Inflammatory cytokines in robot-assisted thoracic surgery versus video-assisted thoracic surgery. J Thorac Dis 2021; 14:2000-2010. [PMID: 35813755 PMCID: PMC9264093 DOI: 10.21037/jtd-21-1820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/23/2022] [Indexed: 12/02/2022]
Abstract
Background Cytokines play a crucial role in the inflammatory response and are essential modulators of injury repair mechanisms. While minimally invasive operations have been shown to induce lower levels of cytokines compared to open thoracotomy, the inflammatory cytokine profile difference between video-assisted (VATS) and robotic-assisted thoracic surgery (RATS) techniques has yet to be elucidated. Methods In this prospective observational study of 45 patients undergoing RATS (n=30) or VATS (n=15) lung resection for malignancy, plasma levels of interleukin (IL)-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, vascular endothelial growth factor (VEGF), interferon (IFN)-γ, tumor necrosis factor (TNF)-α, monocyte chemo-attractant protein (MCP)-1, and endothelial growth factor (EGF) were measured before and after surgery via immunoassay. Results Levels of IL-6 and MCP-1 were significantly higher in patients undergoing VATS than in patients undergoing RATS (P<0.001 and P=0.005, respectively) 2 hours following surgery. MCP-1 levels were also found to be significantly higher in the VATS group (P<0.001) 24 hours following surgery. IL-1α, IL-1β, IL-2, IL-4, IL-8, IL-10, IFN-γ, TNF-α, and EGF levels were not significantly different at any time-point comparing VATS to RATS. Conclusions The VATS approach is associated with a more robust pro-inflammatory cytokine response through the upregulation of MCP-1 and IL-6 when compared to the RATS approach in patients undergoing anatomic lung resection. Further studies are necessary to validate the clinical significance of this finding.
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Abdelsattar ZM, Elsisy MF, Schaff H, Stulak J, Greason K, Pochettino A, Arghami A, Rowse P, Bagameri G, Khullar V, Daly R, Cicek S, Dearani J, Crestanello J. Comparative Effectiveness of Mechanical Valves and Homografts in Complex Aortic Endocarditis. Ann Thorac Surg 2020; 111:793-799. [PMID: 32890491 DOI: 10.1016/j.athoracsur.2020.06.082] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 05/07/2020] [Accepted: 06/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The ideal surgical reconstruction of the aortic root in patients with complex endocarditis is controversial. We compared the short- and long-term outcomes between mechanical valves, bioprostheses, and homografts. METHODS We identified all patients undergoing an operation for active complex aortic endocarditis at our institution between 2003 and 2017. We grouped patients according to those who received a mechanical valve, bioprosthesis, or homograft. We used multiple logistic regression and proportional hazards models. To minimize confounding by indication, we used marginal risk adjustment to simulate that every patient would undergo (contrary to fact) all 3 operations. RESULTS Of 159 patients with complex active endocarditis, 48 (30.2%) had a valve plus patch reconstruction, and 85 (53.4%) had a root replacement. Of all, 50 (31.5%) had a mechanical valve, 56 (35.2%) had a bioprosthesis, and 53 (33.3%) had a homograft. The groups were similar in age, sex, body mass index, comorbid conditions, organism, abscess location, and mitral involvement (all P > .05). However, patients receiving mechanical reconstructions were more likely to have native valve endocarditis (46% vs 37.5% vs 17%; P = .005) and less likely to undergo root replacement (32% vs 28.6% vs 100%; P < .001). Marginal risk-adjusted operative mortality was lowest for mechanical valves (4.8%) and highest for homografts (16.9%; P = .041). Long-term survival after root replacement was worse with homografts than with mechanical valve conduits (adjusted hazard ratio, 2.9; P = .045). CONCLUSIONS In patients with complex endocarditis, mechanical valves are associated with similar, if not better, short- and long-term outcomes compared with homografts, even after adjusting for important baseline characteristics and limiting the analysis to root replacements only.
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Affiliation(s)
- Zaid M Abdelsattar
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota; Department of Thoracic and Cardiovascular Surgery, Loyola University Chicago, Chicago, Illinois
| | - Mohamed F Elsisy
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota
| | - Hartzell Schaff
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota
| | - John Stulak
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kevin Greason
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Arman Arghami
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota
| | - Philip Rowse
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota
| | - Gabor Bagameri
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota
| | - Vishal Khullar
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota
| | - Richard Daly
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota
| | - Sertac Cicek
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joseph Dearani
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota
| | - Juan Crestanello
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota.
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Said SM, Abdelsattar ZM, Schaff HV, Greason KL, Daly RC, Pochettino A, Joyce LD, Dearani JA. Outcomes of surgery for infective endocarditis: a single-centre experience of 801 patients. Eur J Cardiothorac Surg 2019; 53:435-439. [PMID: 29029030 DOI: 10.1093/ejcts/ezx341] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 02/12/2017] [Revised: 08/20/2017] [Accepted: 08/24/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Infective endocarditis (IE) remains a life-threatening disease, despite the improvement in diagnostic and therapeutic measures. We reviewed our outcomes for all adults who underwent surgery for endocarditis at our centre. METHODS Between January 1995 and December 2013, 801 patients [586 men (73%)] underwent surgery for IE. Mean age was 60 ± 14.7 years. Native endocarditis (NE) was present in 372 patients (46%), and 379 (47%) patients had active IE. The mean follow-up period was 4.6 ± 4.75 years (maximum 20 years). RESULTS Single-valve endocarditis was present in 551 (69%) patients (392 aortic and 159 mitral). Multivalve involvement was present in 250 (31%) patients. Preoperative stroke was present in 149 (19%) patients, while 62 (8%) patients were on dialysis prior to surgery. Valve repair was possible in 122 (15%) patients, while 679 (85%) patients underwent valve replacement. Mechanical valves were used in 312 (39%) patients. Aortic homografts were used in 84 (10%) patients. Early mortality occurred in 64 (8%) patients. Overall survival at 5, 10 and 20 years was 68%, 45% and 8.4%, respectively. Postoperative stroke occurred in 16 (2%) patients, while 59 (7%) patients required new dialysis postoperatively. Multivariate analysis revealed active IE (P = 0.002), preoperative dialysis (P = 0.007), previous coronary artery bypass grafting (P = 0.001), root abscess (P = 0.006) and tricuspid valve or multivalve involvement (P = 0.002) to be predictors of early mortality. The need for dialysis (P < 0.001), previous coronary artery bypass grafting (P < 0.001) and mitral valve (P = 0.002) and tricuspid valve/multivalve involvement (P < 0.001) were significant predictors of late mortality. CONCLUSIONS Active IE is associated with high perioperative mortality especially with multivalve and aortic root involvement. Preoperative stroke has no impact on perioperative mortality. Long-term survival for those who survived the immediate postoperative period is satisfactory, and mechanical valves are associated with the best long-term survival.
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Affiliation(s)
- Sameh M Said
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Richard C Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Lyle D Joyce
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
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Abdelsattar ZM, Crestanello JA. Commentary: CABG vs PCI in NSTEMI/UA: Abbreviated alternatives. J Thorac Cardiovasc Surg 2019; 160:936. [PMID: 31648836 DOI: 10.1016/j.jtcvs.2019.08.133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Received: 08/29/2019] [Revised: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 11/17/2022]
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Abdelsattar ZM, Stulak JM, Crestanello JA. Commentary: Alive without a pulse and bleeding. J Thorac Cardiovasc Surg 2019; 159:916-917. [PMID: 31126660 DOI: 10.1016/j.jtcvs.2019.04.023] [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] [Received: 04/07/2019] [Accepted: 04/08/2019] [Indexed: 11/20/2022]
Affiliation(s)
| | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
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Abdelsattar ZM, Blackmon SH. Video-assisted thoracoscopic surgery lobectomy: pulled in many directions. J Thorac Dis 2019; 11:29. [PMID: 30863562 DOI: 10.21037/jtd.2018.11.105] [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: 11/06/2022]
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Abdelsattar ZM, Blackmon SH. Using novel technology to augment complex video-assisted thoracoscopic single basilar segmentectomy. J Thorac Dis 2018; 10:S1168-S1178. [PMID: 29785291 PMCID: PMC5949387 DOI: 10.21037/jtd.2018.02.22] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 01/06/2018] [Accepted: 01/25/2018] [Indexed: 11/06/2022]
Abstract
There are many novel technologies that enable complex segmentectomy to be performed. As lung cancer screening becomes more prevalent, patients are increasingly diagnosed with early stage lung cancer, multifocal disease, and second primary tumors. This shift to an earlier clinical presentation combined with advances in technology and an emphasis on minimally invasive techniques have led to the current developments we are now seeing with anatomic segmentectomy. In this paper, we describe the operative technique of an indocyanine green (ICG)-guided video-assisted thoracoscopic surgery (VATS) single basilar segmental resection, augmented with methylene blue dye marker localization via SuperDimension electromagnetic navigational bronchoscopy. The CT scans of the posterior basal segment tumor are enhanced with three-dimensional (3D) modeling. A description of the approach is detailed with a video, intraoperative photographs, and illustrations. Successful removal of the S10 segment with novel techniques permitted the patient to have five percent of the lung removed (segmentectomy) instead of 25% (right lower lobectomy). In the setting of multifocal disease, future treatment options for the tumors in other locations of the lung are enhanced. Novel lung imaging techniques along with careful intraoperative identification of appropriate segmental anatomy allow patients to be offered an optimal basilar parenchymal-sparing segmentectomy.
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Affiliation(s)
- Zaid M Abdelsattar
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Shanda H Blackmon
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
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Saddoughi SA, Abdelsattar ZM, Blackmon SH. National Trends in the Epidemiology of Malignant Pleural Mesothelioma: A National Cancer Data Base Study. Ann Thorac Surg 2018; 105:432-437. [DOI: 10.1016/j.athoracsur.2017.09.036] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/23/2017] [Accepted: 09/11/2017] [Indexed: 12/01/2022]
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Abdelsattar ZM, Ishitani MB, Kim BD. Surgical Stabilization of Rib Fractures in a 6-Year-Old Child After Blunt Trauma. Ann Thorac Surg 2017; 104:e439-e441. [PMID: 29153813 DOI: 10.1016/j.athoracsur.2017.07.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/03/2017] [Accepted: 07/15/2017] [Indexed: 10/18/2022]
Abstract
When identified, rib fractures in children are associated with high-energy trauma, nonaccidental trauma, or both. Traditionally, the optimal management of rib fractures in children is supportive care. In this case report, we present a 6-year-old boy who underwent surgical rib fixation for multiple displaced and comminuted rib fractures after being stepped on by a horse.
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Affiliation(s)
| | | | - Brian D Kim
- Department of Surgery, Mayo Clinic, Rochester, Minnesota.
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Alrahmani L, Abdelsattar ZM, Adekola H, Gonik B, Awonuga A. Adolescence and risk of preterm birth in multifetal gestations. J Matern Fetal Neonatal Med 2017; 32:1321-1324. [DOI: 10.1080/14767058.2017.1404981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Layan Alrahmani
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Zaid M. Abdelsattar
- Department of Surgery, Mayo Clinic, Rochester, Rochester, Minnesota, MN, USA
| | - Henry Adekola
- Department of Obstetrics and Gynecology, Hurley Medical Center, Michigan State University, Flint, MI, USA
| | - Bernard Gonik
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Awoniyi Awonuga
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
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Abdelsattar ZM, Shen KR, Yendamuri S, Cassivi S, Nichols FC, Wigle DA, Allen MS, Blackmon SH. Outcomes After Sleeve Lung Resections Versus Pneumonectomy in the United States. Ann Thorac Surg 2017; 104:1656-1664. [DOI: 10.1016/j.athoracsur.2017.05.086] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 05/25/2017] [Accepted: 05/30/2017] [Indexed: 11/26/2022]
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Abdelsattar ZM, Hendren S, Wong SL. The impact of health insurance on cancer care in disadvantaged communities. Cancer 2017; 123:1219-1227. [PMID: 27859019 PMCID: PMC5360496 DOI: 10.1002/cncr.30431] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 09/16/2016] [Accepted: 10/12/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Individuals from disadvantaged communities are among the millions of uninsured Americans gaining insurance under the Affordable Care Act. The extent to which health insurance can mitigate the effects of the social determinants of health on cancer care is unknown. METHODS This study linked the Surveillance, Epidemiology, and End Results registries to US Census data to study patients diagnosed with the 4 leading causes of cancer deaths between 2007 and 2011. A county-level social determinant score was developed with 5 measures of wealth, education, and employment. Patients were stratified into quintiles, with the lowest quintile representing the most disadvantaged communities. Logistic regression and Cox proportional hazards models were used to estimate associations and cancer-specific survival. RESULTS A total of 364,507 patients aged 18 to 64 years were identified (134,105 with breast cancer, 106,914 with prostate cancer, 62,606 with lung cancer, and 60,882 with colorectal cancer). Overall, patients from the most disadvantaged communities (median household income, $42,885; patients below the poverty level, 22%; patients completing college, 17%) were more likely to present with distant disease (odds ratio, 1.6; P < .001) and were less likely to receive cancer-directed surgery (odds ratio, 0.8; P < .001) than the least disadvantaged communities (median income, $78,249; patients below the poverty level, 9%; patients completing college, 42%). The differences persisted across quintiles regardless of the insurance status. The effect of having insurance on cancer-specific survival was more pronounced in disadvantaged communities (relative benefit at 3 years, 40% vs 31%). However, it did not fully mitigate the effect of social determinants on mortality (hazard ratio, 0.75 vs 0.68; P < .001). CONCLUSIONS Cancer patients from disadvantaged communities benefit most from health insurance, and there is a reduction in disparities in outcome. However, the gap produced by social determinants of health cannot be bridged by insurance alone. Cancer 2017;123:1219-1227. © 2016 American Cancer Society.
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Affiliation(s)
- Zaid M. Abdelsattar
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor MI
- Department of Surgery, Mayo Clinic, Rochester MN
| | - Samantha Hendren
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor MI
| | - Sandra L. Wong
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor MI
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon NH
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Abdelsattar ZM, Allen MS, Shen KR, Cassivi SD, Nichols FC, Wigle DA, Blackmon SH. Variation in Hospital Adoption Rates of Video-Assisted Thoracoscopic Lobectomy for Lung Cancer and the Effect on Outcomes. Ann Thorac Surg 2017; 103:454-460. [DOI: 10.1016/j.athoracsur.2016.08.091] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2016] [Indexed: 11/28/2022]
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Alrahmani L, Abdelsattar ZM, Adekola H, Puscheck E, Gonik B, Awonuga AO. Risk-profiles and outcomes of multi-foetal pregnancies in adolescent mothers. J OBSTET GYNAECOL 2016; 36:1056-1060. [PMID: 27624001 DOI: 10.1080/01443615.2016.1196477] [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: 10/21/2022]
Abstract
In this retrospective review of 468 mothers with a multi-foetal pregnancy in Detroit, we describe the risk-profiles and the obstetrical, maternal and foetal outcomes of multi-foetal pregnancy in 59 (13%) adolescents. Overall, most mothers were African American, did not have private insurance and all were unmarried. For most mothers, this was their first pregnancy (59.3%) and their first delivery (69.5%). Almost 50% presented to triage at least once during their pregnancy. Anaemia (78%) and hypertensive disorders (18.6%) were common in this age group. The majority of adolescents delivered preterm as 81.4% were <37 weeks and 49% were <34 weeks. Furthermore, the majority of infants (79%) had low birth weights (median: 1975 g, range: 365-3405 g). This contemporary report emphasises the need for multidisciplinary prenatal management and specialist supervision, as multi-foetal pregnancies in adolescents pose real risks and impact obstetrical, maternal and neonatal outcomes.
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Affiliation(s)
- Layan Alrahmani
- a Department of Obstetrics and Gynecology , Wayne State University , Detroit , MI , USA
| | - Zaid M Abdelsattar
- b Center for Healthcare Outcomes and Policy , University of Michigan , Ann Arbor , MI , USA
| | - Henry Adekola
- a Department of Obstetrics and Gynecology , Wayne State University , Detroit , MI , USA
| | - Elizabeth Puscheck
- a Department of Obstetrics and Gynecology , Wayne State University , Detroit , MI , USA
| | - Bernard Gonik
- a Department of Obstetrics and Gynecology , Wayne State University , Detroit , MI , USA
| | - Awoniyi O Awonuga
- a Department of Obstetrics and Gynecology , Wayne State University , Detroit , MI , USA
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Abdelsattar ZM, Wong SL, Regenbogen SE, Hendren S. Reply to percentage of colorectal cancer diagnoses in adults aged younger than 50 years. Cancer 2016; 122:1463-4. [PMID: 26970468 DOI: 10.1002/cncr.29977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 02/16/2016] [Indexed: 01/22/2023]
Affiliation(s)
- Zaid M Abdelsattar
- Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Sandra L Wong
- Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Scott E Regenbogen
- Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Samantha Hendren
- Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan
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Abdelsattar ZM, Wong SL, Regenbogen SE, Jomaa DM, Hardiman KM, Hendren S. Colorectal cancer outcomes and treatment patterns in patients too young for average-risk screening. Cancer 2016; 122:929-34. [PMID: 26808454 DOI: 10.1002/cncr.29716] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [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: 06/11/2015] [Revised: 08/22/2015] [Accepted: 08/28/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although colorectal cancer (CRC) screening guidelines recommend initiating screening at age 50 years, the percentage of cancer cases in younger patients is increasing. To the authors' knowledge, the national treatment patterns and outcomes of these patients are largely unknown. METHODS The current study was a population-based, retrospective cohort study of the nationally representative Surveillance, Epidemiology, and End Results registry for patients diagnosed with CRC from 1998 through 2011. Patients were categorized as being younger or older than the recommended screening age. Differences with regard to stage of disease at diagnosis, patterns of therapy, and disease-specific survival were compared between age groups using multinomial regression, multiple regression, Cox proportional hazards regression, and Weibull survival analysis. RESULTS Of 258,024 patients with CRC, 37,847 (15%) were aged <50 years. Young patients were more likely to present with regional (relative risk ratio, 1.3; P<.001) or distant (relative risk ratio, 1.5; P<.001) disease. Patients with CRC with distant metastasis in the younger age group were more likely to receive surgical therapy for their primary tumor (adjusted probability: 72% vs 63%; P<.001), and radiotherapy also was more likely in younger patients with CRC (adjusted probability: 53% vs 48%; P<.001). Patients younger than the recommended screening age had better overall disease-specific survival (hazards ratio, 0.77; P<.001), despite a larger percentage of these individuals presenting with advanced disease. CONCLUSIONS Patients with CRC diagnosed at age <50 years are more likely to present with advanced-stage disease. However, they receive more aggressive therapy and achieve longer disease-specific survival, despite the greater percentage of patients with advanced-stage disease. These findings suggest the need for improved risk assessment and screening decisions for younger adults.
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Affiliation(s)
- Zaid M Abdelsattar
- Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan.,Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Sandra L Wong
- Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Scott E Regenbogen
- Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Diana M Jomaa
- College of Literature, Science and the Arts, University of Michigan, Ann Arbor, Michigan
| | - Karin M Hardiman
- Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Samantha Hendren
- Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan
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Krell RW, Scally CP, Wong SL, Abdelsattar ZM, Birkmeyer NJO, Fegan K, Todd J, Henke PK, Campbell DA, Hendren S. Variation in Hospital Thromboprophylaxis Practices for Abdominal Cancer Surgery. Ann Surg Oncol 2015; 23:1431-9. [PMID: 26567148 DOI: 10.1245/s10434-015-4970-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Venous thromboembolism remains a prominent cause of morbidity and mortality following cancer surgery. Although evidence-based guidelines recommend major cancer surgery thromboprophylaxis starts before incision and continues at least 7-10 days postoperatively, the extent to which the guidelines are followed is unknown. We assessed variation in thromboprophylaxis practices for abdominal cancer surgery in a regional surgical collaborative. METHODS We studied abdominal resections for primary gastrointestinal, hepatopancreatobiliary (HPB), and neuroendocrine malignancies in the Michigan Surgical Quality Collaborative from July 2012 to September 2013 (N = 2967 patients in 52 hospitals). We obtained detailed perioperative and postoperative pharmacologic and mechanical thromboprophylaxis information for patients without documented exemptions (e.g., active bleeding, allergy), and compared differences in procedure mix and operative complexity across hospitals based on their perioperative thromboprophylaxis rates. Additionally, we surveyed hospitals to identify variations in perioperative practice and barriers to prophylaxis administration. RESULTS Overall, 40.4 % of eligible patients had perioperative pharmacologic thromboprophylaxis for abdominal cancer surgery, and 25.3 % of the highest-risk patients had evidence of inadequate postoperative prophylaxis (under-prophylaxis, either by dose or duration). Hospital perioperative thromboprophylaxis rates ranged from 0 to 96.1 %, and postoperative thromboprophylaxis rates ranged from 73.9 to 100 %. Epidural use was not independently associated with hospital pharmacologic thromboprophylaxis rates. CONCLUSIONS Fewer than half of patients undergoing abdominal cancer surgery receive perioperative thromboprophylaxis, and there is wide variation in hospital thromboprophylaxis utilization despite strong evidence-based guidelines supporting its use.
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Affiliation(s)
- Robert W Krell
- University of Michigan Health System, Ann Arbor, MI, USA.,Center for Healthcare Outcomes and Policy (CHOP), Ann Arbor, MI, USA
| | - Christopher P Scally
- University of Michigan Health System, Ann Arbor, MI, USA. .,Center for Healthcare Outcomes and Policy (CHOP), Ann Arbor, MI, USA.
| | - Sandra L Wong
- University of Michigan Health System, Ann Arbor, MI, USA.,Center for Healthcare Outcomes and Policy (CHOP), Ann Arbor, MI, USA
| | - Zaid M Abdelsattar
- University of Michigan Health System, Ann Arbor, MI, USA.,Center for Healthcare Outcomes and Policy (CHOP), Ann Arbor, MI, USA
| | - Nancy J O Birkmeyer
- University of Michigan Health System, Ann Arbor, MI, USA.,Center for Healthcare Outcomes and Policy (CHOP), Ann Arbor, MI, USA
| | - Kelsey Fegan
- University of Michigan Health System, Ann Arbor, MI, USA.,Center for Healthcare Outcomes and Policy (CHOP), Ann Arbor, MI, USA
| | - Joanne Todd
- University of Michigan Health System, Ann Arbor, MI, USA.,Center for Healthcare Outcomes and Policy (CHOP), Ann Arbor, MI, USA
| | - Peter K Henke
- University of Michigan Health System, Ann Arbor, MI, USA.,Center for Healthcare Outcomes and Policy (CHOP), Ann Arbor, MI, USA
| | - Darrell A Campbell
- University of Michigan Health System, Ann Arbor, MI, USA.,Center for Healthcare Outcomes and Policy (CHOP), Ann Arbor, MI, USA
| | - Samantha Hendren
- University of Michigan Health System, Ann Arbor, MI, USA.,Center for Healthcare Outcomes and Policy (CHOP), Ann Arbor, MI, USA
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Abstract
PURPOSE Colorectal cancer (CRC) is the second most expensive cancer in the United States. Episode-based bundled payments may be a strategy to decrease costs. However, it is unknown how payments are distributed across hospitals and different perioperative services. METHODS We extracted actual Medicare payments for patients in the fee-for-service Medicare population who underwent CRC surgery between January 2004 and December 2006 (N = 105,016 patients). Payments included all service types from the date of hospitalization up to 1 year later. Hospitals were ranked from least to most expensive and grouped into quintiles. Results were case-mix adjusted and price standardized using empirical Bayes methods. We assessed the contributions of index hospitalization, physician services, readmissions, and postacute care to the overall variation in payment. RESULTS There is wide variation in total payments for CRC care within the first year after CRC surgery. Actual Medicare payments were $51,345 per patient in the highest quintile and $26,441 per patient in the lowest quintile, representing a difference of Δ = $24,902. Differences were persistent after price standardization (Δ = $17,184 per patient) and case-mix adjustment (Δ = $4,790 per patient). Payments for the index surgical hospitalization accounted for the largest share (65%) of payments but only minimally varied (11.6%) across quintiles. However, readmissions and postacute care services accounted for substantial variations in total payments. CONCLUSION Medicare spending in the first year after CRC surgery varies across hospitals even after case-mix adjustment and price standardization. Variation is largely driven by postacute care and not the index surgical hospitalization. This has significant implications for policy decisions on how to bundle payments and define episodes of surgical CRC care.
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Affiliation(s)
- Zaid M Abdelsattar
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI; and Enterprise Support Services, Dartmouth-Hitchcock Health System, Lebanon, NH
| | - John D Birkmeyer
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI; and Enterprise Support Services, Dartmouth-Hitchcock Health System, Lebanon, NH
| | - Sandra L Wong
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI; and Enterprise Support Services, Dartmouth-Hitchcock Health System, Lebanon, NH
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Sartelli M, Malangoni MA, Abu-Zidan FM, Griffiths EA, Di Bella S, McFarland LV, Eltringham I, Shelat VG, Velmahos GC, Kelly CP, Khanna S, Abdelsattar ZM, Alrahmani L, Ansaloni L, Augustin G, Bala M, Barbut F, Ben-Ishay O, Bhangu A, Biffl WL, Brecher SM, Camacho-Ortiz A, Caínzos MA, Canterbury LA, Catena F, Chan S, Cherry-Bukowiec JR, Clanton J, Coccolini F, Cocuz ME, Coimbra R, Cook CH, Cui Y, Czepiel J, Das K, Demetrashvili Z, Di Carlo I, Di Saverio S, Dumitru IM, Eckert C, Eckmann C, Eiland EH, Enani MA, Faro M, Ferrada P, Forrester JD, Fraga GP, Frossard JL, Galeiras R, Ghnnam W, Gomes CA, Gorrepati V, Ahmed MH, Herzog T, Humphrey F, Kim JI, Isik A, Ivatury R, Lee YY, Juang P, Furuya-Kanamori L, Karamarkovic A, Kim PK, Kluger Y, Ko WC, LaBarbera FD, Lee JG, Leppaniemi A, Lohsiriwat V, Marwah S, Mazuski JE, Metan G, Moore EE, Moore FA, Nord CE, Ordoñez CA, Júnior GAP, Petrosillo N, Portela F, Puri BK, Ray A, Raza M, Rems M, Sakakushev BE, Sganga G, Spigaglia P, Stewart DB, Tattevin P, Timsit JF, To KB, Tranà C, Uhl W, Urbánek L, van Goor H, Vassallo A, Zahar JR, Caproli E, Viale P. WSES guidelines for management of Clostridium difficile infection in surgical patients. World J Emerg Surg 2015; 10:38. [PMID: 26300956 PMCID: PMC4545872 DOI: 10.1186/s13017-015-0033-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 08/12/2015] [Indexed: 02/08/2023] Open
Abstract
In the last two decades there have been dramatic changes in the epidemiology of Clostridium difficile infection (CDI), with increases in incidence and severity of disease in many countries worldwide. The incidence of CDI has also increased in surgical patients. Optimization of management of C difficile, has therefore become increasingly urgent. An international multidisciplinary panel of experts prepared evidenced-based World Society of Emergency Surgery (WSES) guidelines for management of CDI in surgical patients.
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Affiliation(s)
- Massimo Sartelli
- />Department of Surgery, Macerata Hospital, Via Santa Lucia 2, 62019 Macerata, Italy
| | | | - Fikri M. Abu-Zidan
- />Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | | | - Stefano Di Bella
- />2nd Infectious Diseases Division, National Institute for Infectious Diseases L. Spallanzani, Rome, Italy
| | - Lynne V. McFarland
- />Department of Medicinal Chemistry, School of Pharmacy, University of Washington, Washington, USA
| | - Ian Eltringham
- />Department of Medical Microbiology, King’s College Hospital, London, UK
| | - Vishal G. Shelat
- />Department of Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - George C. Velmahos
- />Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Ciarán P. Kelly
- />Gastroenterology Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA
| | - Sahil Khanna
- />Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN USA
| | | | - Layan Alrahmani
- />Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI USA
| | - Luca Ansaloni
- />General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Goran Augustin
- />Department of Surgery, University Hospital Center Zagreb and School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Miklosh Bala
- />Trauma and Acute Care Surgery Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Frédéric Barbut
- />UHLIN (Unité d’Hygiène et de Lutte contre les Infections Nosocomiales) National Reference Laboratory for Clostridium difficile Groupe Hospitalier de l’Est Parisien (HUEP), Paris, France
| | - Offir Ben-Ishay
- />Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Aneel Bhangu
- />Academic Department of Surgery, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | - Walter L. Biffl
- />Department of Surgery, University of Colorado, Denver Health Medical Center, Denver, USA
| | - Stephen M. Brecher
- />Pathology and Laboratory Medicine, VA Boston Healthcare System, West Roxbury MA and BU School of Medicine, Boston, MA USA
| | - Adrián Camacho-Ortiz
- />Department of Internal Medicine, University Hospital, Dr.José E. González, Monterrey, Mexico
| | - Miguel A. Caínzos
- />Department of Surgery, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Laura A. Canterbury
- />Department of Pathology, University of Alberta Edmonton, Edmonton, AB Canada
| | - Fausto Catena
- />Emergency Surgery Department, Maggiore Parma Hospital, Parma, Italy
| | - Shirley Chan
- />Department of General Surgery, Medway Maritime Hospital, Gillingham Kent, UK
| | - Jill R. Cherry-Bukowiec
- />Department of Surgery, Division of Acute Care Surgery, University of Michigan, Ann Arbor, MI USA
| | - Jesse Clanton
- />Department of Surgery, Northeast Ohio Medical University, Summa Akron City Hospital, Akron, OH USA
| | | | - Maria Elena Cocuz
- />Faculty of Medicine, Transilvania University, Infectious Diseases Hospital, Brasov, Romania
| | - Raul Coimbra
- />Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, University of California San Diego Health Science, San Diego, USA
| | - Charles H. Cook
- />Division of Acute Care Surgery, Trauma and Surgical Critical Care, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA
| | - Yunfeng Cui
- />Department of Surgery,Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | - Jacek Czepiel
- />Department of Infectious Diseases, Jagiellonian University, Medical College, Kraków, Poland
| | - Koray Das
- />Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Zaza Demetrashvili
- />Department of Surgery, Tbilisi State Medical University, Kipshidze Central University Hospital, Tbilisi, Georgia
| | | | | | | | - Catherine Eckert
- />National Reference Laboratory for Clostridium difficile, AP-HP, Saint-Antoine Hospital, Paris, France
| | - Christian Eckmann
- />Department of General, Visceral and Thoracic Surgery, Klinikum Peine, Hospital of Medical University Hannover, Peine, Germany
| | | | - Mushira Abdulaziz Enani
- />Department of Medicine, Section of Infectious Diseases, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mario Faro
- />Department of General Surgery, Trauma and Emergency Surgery Division, ABC Medical School, Santo André, SP Brazil
| | - Paula Ferrada
- />Division of Trauma, Critical Care and Emergency Surgery, Virginia Commonwealth University, Richmond, VA USA
| | | | - Gustavo P. Fraga
- />Division of Trauma Surgery, Hospital de Clinicas, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Jean Louis Frossard
- />Service of Gastroenterology and Hepatology, Geneva University Hospital, Genève, Switzerland
| | - Rita Galeiras
- />Critical Care Unit, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), A Coruña, Spain
| | - Wagih Ghnnam
- />Department of Surgery Mansoura, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Carlos Augusto Gomes
- />Surgery Department, Hospital Universitario (HU) Terezinha de Jesus da Faculdade de Ciencias Medicas e da Saude de Juiz de Fora (SUPREMA), Hospital Universitario (HU) Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, Brazil
| | - Venkata Gorrepati
- />Department of Internal Medicine, Pinnacle Health Hospital, Harrisburg, PA USA
| | - Mohamed Hassan Ahmed
- />Department of Medicine, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, Buckinghamshire UK
| | - Torsten Herzog
- />Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Felicia Humphrey
- />Department of Gastroenterology and Hepatology, Ochsner Clinic Foundation, New Orleans, LA USA
| | - Jae Il Kim
- />Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Arda Isik
- />General Surgery Department, Erzincan University Mengücek Gazi Training and Research Hospital, Erzincan, Turkey
| | - Rao Ivatury
- />Division of Trauma, Critical Care and Emergency Surgery, Virginia Commonwealth University, Richmond, VA USA
| | - Yeong Yeh Lee
- />School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan Malaysia
| | - Paul Juang
- />Department of Pharmacy Practice, St Louis College of Pharmacy, St Louis, MO USA
| | - Luis Furuya-Kanamori
- />Research School of Population Health, The Australian National University, Acton, ACT Australia
| | - Aleksandar Karamarkovic
- />Clinic For Emergency surgery, University Clinical Center of Serbia, Faculty of Medicine University of Belgrade, Belgrade, Serbia
| | - Peter K Kim
- />General and Trauma Surgery, Albert Einstein College of Medicine, North Bronx Healthcare Network, Bronx, NY USA
| | - Yoram Kluger
- />Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Wen Chien Ko
- />Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | | | - Jae Gil Lee
- />Division of Critical Care & Trauma Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Ari Leppaniemi
- />Abdominal Center, Helsinki University Hospital Meilahti, Helsinki, Finland
| | - Varut Lohsiriwat
- />Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sanjay Marwah
- />Department of Surgery, Post-Graduate Institute of Medical Sciences, Rohtak, India
| | - John E. Mazuski
- />Department of Surgery, Washington University School of Medicine, Saint Louis, USA
| | - Gokhan Metan
- />Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ernest E. Moore
- />Department of Surgery, University of Colorado, Denver Health Medical Center, Denver, USA
| | | | - Carl Erik Nord
- />Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Carlos A. Ordoñez
- />Department of Surgery, Fundación Valle del Lili, Hospital Universitario del Valle, Universidad del Valle, Cali, Colombia
| | | | - Nicola Petrosillo
- />2nd Infectious Diseases Division, National Institute for Infectious Diseases L. Spallanzani, Rome, Italy
| | - Francisco Portela
- />Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Basant K. Puri
- />Department of Medicine, Hammersmith Hospital and Imperial College London, London, UK
| | - Arnab Ray
- />Department of Gastroenterology and Hepatology, Ochsner Clinic Foundation, New Orleans, LA USA
| | - Mansoor Raza
- />Infectious Diseases and Microbiology Unit, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, Buckinghamshire UK
| | - Miran Rems
- />Department of Abdominal and General Surgery, General Hospital Jesenice, Jesenice, Slovenia
| | | | - Gabriele Sganga
- />Division of General Surgery and Organ Transplantation, Department of Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Patrizia Spigaglia
- />Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - David B. Stewart
- />Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA USA
| | - Pierre Tattevin
- />Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | | | - Kathleen B. To
- />Department of Surgery, Division of Acute Care Surgery, University of Michigan, Ann Arbor, MI USA
| | - Cristian Tranà
- />Emergency Medicine and Surgery, Macerata hospital, Macerata, Italy
| | - Waldemar Uhl
- />Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Libor Urbánek
- />1st Surgical Clinic, University Hospital of St. Ann Brno, Brno, Czech Republic
| | - Harry van Goor
- />Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Angela Vassallo
- />Infection Prevention/Epidemiology, Providence Saint John’s Health Center, Santa Monica, CA USA
| | - Jean Ralph Zahar
- />Infection Control Unit, Angers University, CHU d’Angers, Angers, France
| | - Emanuele Caproli
- />Department of Surgery, Ancona University Hospital, Ancona, Italy
| | - Pierluigi Viale
- />Clinic of Infectious Diseases, St Orsola-Malpighi University Hospital, Bologna, Italy
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Abdelsattar ZM, Hendren S, Wong SL, Campbell DA, Ramachandran SK. The Impact of Untreated Obstructive Sleep Apnea on Cardiopulmonary Complications in General and Vascular Surgery: A Cohort Study. Sleep 2015; 38:1205-10. [PMID: 25761980 DOI: 10.5665/sleep.4892] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 02/18/2015] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVE To determine whether preoperatively untreated obstructive sleep apnea (OSA) affects postoperative outcomes. DESIGN Cohort study of patients undergoing surgery between July 2012 and September 2013, utilizing prospectively collected data from the Michigan Surgical Quality Collaborative. Multivariable regression models were used to compare complication rates between treated and untreated OSA, while adjusting for important patient covariates and clustering within hospitals. SETTING Fifty-two community and academic hospitals in Michigan. PATIENTS Adult patients undergoing various general or vascular operations were categorized as: (1) no diagnosis or low risk of OSA; (2) documented OSA without therapy or suspicion of OSA; and (3) diagnosis of OSA with treatment (e.g., positive airway pressure). EXPOSURES OSA, preoperatively treated or untreated, was the exposure variable. Postoperative 30-day cardiopulmonary complications including arrhythmias, cardiac arrest, myocardial infarction, unplanned reintubation, pulmonary embolism, and pneumonia were the outcomes of interest. MEASUREMENTS AND RESULTS Of 26,842 patients, 2,646 (9.9%) had a diagnosis or suspicion of OSA. Of those, 1,465 (55.4%) were untreated. Patient and procedural risk factors were evenly balanced between treated and untreated groups. Compared with treated OSA, untreated OSA was independently associated with more cardiopulmonary complications (risk-adjusted rates 6.7% versus 4.0%; adjusted odds ratio [aOR] = 1.8, P = 0.001), particularly unplanned reintubations (aOR = 2.5, P = 0.003) and myocardial infarction (aOR = 2.6, P = 0.031). CONCLUSIONS Patients with obstructive sleep apnea (OSA) who are not treated with positive airway pressure preoperatively are at increased risks for cardiopulmonary complications after general and vascular surgery. Improving the recognition of OSA and ensuring adequate treatment may be a strategy to reduce risk for surgical patients with OSA.
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Affiliation(s)
- Zaid M Abdelsattar
- Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI
| | - Samantha Hendren
- Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI
| | - Sandra L Wong
- Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI
| | - Darrell A Campbell
- Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI
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Healy MA, Krell RW, Abdelsattar ZM, McCahill LE, Kwon D, Frankel TL, Hendren S, Campbell DA, Wong SL. Pancreatic Resection Results in a Statewide Surgical Collaborative. Ann Surg Oncol 2015; 22:2468-74. [PMID: 25820999 PMCID: PMC4792252 DOI: 10.1245/s10434-015-4529-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND A strong relationship between hospital caseload and adverse outcomes has been demonstrated for pancreatic resections. Participation in regional surgical collaboratives may mitigate this phenomenon. This study sought to investigate changes over time in adverse outcomes after pancreatectomy across hospitals with different caseloads in a statewide surgical collaborative. METHODS The study investigated patients undergoing pancreatic resection from January 2008 to August 2013 at Michigan Surgical Quality Collaborative (MSQC) hospitals (1007 patients in 19 academic and community hospitals). Risk-adjusted rates of major complications, mortality, and failure to rescue were compared between hospitals based on caseloads (low, medium, and high) in early (2008-2010) and later (2011-2013) periods. Finally, the degree to which different complications explained changes in hospital outcome variation was assessed. RESULTS Adjusted rates of major complications and mortality decreased over time, driven largely by improvements at low-caseload hospitals. In 2008-2010, risk-adjusted major complication rates were higher for low-caseload than for high-caseload hospitals (27.8 vs. 17.8 %; p = 0.02). However, these differences were attenuated in 2011-2013 (22.2 vs. 20.0 %; p = 0.74). Similarly, adjusted mortality rates were higher in low-caseload hospitals in 2008-2010 (6.2 vs. 0.8 %; p = 0.02), but these differences were attenuated in 2011-2013 (3.3 vs. 1.1 %; p = 0.18). Variation in major complications decreased, largely due to decreased variation in "medical" complication rates, with less change in surgical-site complications. CONCLUSION Participation in regional quality collaboratives by lower-volume hospitals can attenuate the volume-outcome relationship for pancreatic surgery. Continued work in collaboratives with an emphasis on technical and intraoperative aspects of care may improve overall quality of care.
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Affiliation(s)
- Mark A. Healy
- Department of Surgery, Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI
| | - Robert W. Krell
- Department of Surgery, Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI
| | - Zaid M. Abdelsattar
- Department of Surgery, Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI
| | | | - David Kwon
- Department of Surgery, Henry Ford Health System, Detroit, MI
| | - Timothy L. Frankel
- Department of Surgery, Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI
| | - Samantha Hendren
- Department of Surgery, Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI
| | - Darrell A. Campbell
- Department of Surgery, Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI
| | - Sandra L. Wong
- Department of Surgery, Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI
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49
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Abdelsattar ZM, Wong SL. Reply to ESMO guidelines committee comment on 'critical evaluation of the scientific content in clinical practice guidelines'. Cancer 2015; 121:1908-9. [PMID: 25640207 DOI: 10.1002/cncr.29263] [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: 01/02/2015] [Accepted: 01/04/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Zaid M Abdelsattar
- Division of Surgical Oncology, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Sandra L Wong
- Division of Surgical Oncology, Department of Surgery, University of Michigan, Ann Arbor, Michigan
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50
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Abdelsattar ZM, Reames BN, Regenbogen SE, Hendren S, Wong SL. Critical evaluation of the scientific content in clinical practice guidelines. Cancer 2015; 121:783-9. [PMID: 25376967 PMCID: PMC4339394 DOI: 10.1002/cncr.29124] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 08/14/2014] [Revised: 10/04/2014] [Accepted: 10/10/2014] [Indexed: 12/28/2022]
Abstract
BACKGROUND Increasing pressures to provide high-quality evidence-based cancer care have driven the rapid proliferation of clinical practice guidelines (CPGs). The quality and validity of CPGs have been questioned, and adherence to guidelines is relatively low. The purpose of this study was to critically evaluate the development process and scientific content of CPGs. METHODS CPGs addressing management of rectal cancer were evaluated. We quantitatively assessed guideline quality with the validated Appraisal of Guidelines Research & Evaluation (AGREE II) instrument. We identified 21 independent processes of care using the nominal group technique. We then compared the evidence base and scientific agreement for the management recommendations for these processes of care. RESULTS The quality and content of rectal cancer CPGs varied widely. Mean overall AGREE II scores ranged from 27% to 90%. Across the 5 CPGs, average scores were highest for the clarity of presentation domain (85%; range, 58% to 99%) and lowest for the applicability domain (21%; range, 8% to 56%). Randomized controlled trials represented a small proportion of citations (median, 18%; range, 13%-35%), 78% of the recommendations were based on low- or moderate-quality evidence, and the CPGs only had 11 references in common with the highest-rated CPG. There were conflicting recommendations for 13 of the 21 care processes assessed (62%). CONCLUSIONS There is significant variation in CPG development processes and scientific content. With conflicting recommendations between CPGs, there is no reliable resource to guide high-quality evidence-based cancer care. The quality and consistency of CPGs are in need of improvement.
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