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Vazquez S, Dominguez JF, Lu VM, Kumar V, Shah S, Brusko GD, Levi AD. Characteristics and Outcomes of Patients Treated with Cervical Spine Fusion at High Volume Hospitals. World Neurosurg 2024:S1878-8750(24)00688-0. [PMID: 38677643 DOI: 10.1016/j.wneu.2024.04.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND High volume (HV) has been associated with improved outcomes in various neurosurgical procedures. The objective of this study was to explore the regional distribution of HV spine centers for cervical spine fusion and compare characteristics and outcomes for patients treated at HV centers versus lower volume centers. METHODS The National Inpatient Sample database 2016-2020 was queried for patients undergoing cervical spine fusion for degenerative pathology. HV was defined as case-loads greater than 2 standard deviations above the mean. Patient characteristics, procedures, and outcomes were compared. RESULTS Of 3895 hospitals performing cervical spine fusion for degenerative pathology, 28 (0.76%) were HV. The Mid-Atlantic and West South Central regions had the highest number of HV hospitals. HV hospitals were more likely to perform open anterior fusion surgeries (P < 0.01). Patients treated at HV hospitals were less likely to have severe symptomatology or comorbidities (P < 0.01 for all). When controlling for severity and demographics on multivariate analysis, HV centers had higher odds of length of stay ≤1 day, favorable discharge, and decreased total charges. CONCLUSIONS Patients who underwent cervical spine fusion surgery at HV hospitals were less complex and had increased odds of length of stay ≤1, favorable discharge, and total charges in the lower 25th percentile than patients treated at non-HV hospitals. Physician comfort, patient selection, institutional infrastructure, and geographic characteristics likely play a role.
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Affiliation(s)
- Sima Vazquez
- School of Medicine, New York Medical College, Valhalla, New York, USA.
| | - Jose F Dominguez
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Victor M Lu
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Vignessh Kumar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sumedh Shah
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - G Damian Brusko
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Allan D Levi
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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Vazquez S, Dominguez JF, Wu E, Spirollari E, Soldozy S, Ivan ME, Merenzon M, Hanft SJ, Komotar RJ. High-Volume Centers Provide Superior Value of Care in the Surgical Treatment of Malignant Brain Tumor. World Neurosurg 2024; 183:e787-e795. [PMID: 38216033 DOI: 10.1016/j.wneu.2024.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/07/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND Improved outcomes in surgical patients have been associated with increasing volume of cases. This has led to the development of centers that facilitate care for a specific patient population. This study aimed to evaluate associations of outcomes with hospital characteristics in patients undergoing resection of malignant brain tumors. METHODS The 2016-2020 National Inpatient Sample was queried for patients undergoing resection of malignant brain tumors. Teaching hospitals with caseloads >2 standard deviations above the mean (140 cases) were categorized as high-volume centers (HVCs). Value of care was evaluated by adding one point for each of the following: short length of stay, low total charges, favorable discharge disposition, and lack of major comorbidity or complication. RESULTS In 3009 hospitals, 118,390 patients underwent resection of malignant brain tumors. HVC criteria were met by 91 (3%) hospitals. HVCs were more likely to treat patients of younger age or higher socioeconomic status (P < 0.01 for all). The Mid-Atlantic and South Atlantic regions had the highest percentage of cases and number of HVCs. Value of care was higher at HVCs (P < 0.01). Care at HVCs was associated with decreased complications (P < 0.01 for all) and improved patient outcomes (P < 0.01 for all). CONCLUSIONS Patients undergoing craniotomy for malignant brain neoplasms have superior outcomes in HVCs. Trends of centralization may reflect the benefits of multidisciplinary treatment, geographic preferences, publicity, and cultural impact. Improvement of access to care is an important consideration as this trend continues.
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Affiliation(s)
- Sima Vazquez
- School of Medicine, New York Medical College, Valhalla, New York, USA.
| | - Jose F Dominguez
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Eva Wu
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Eris Spirollari
- School of Medicine, New York Medical College, Valhalla, New York, USA
| | - Sauson Soldozy
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Martin Merenzon
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Simon J Hanft
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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Yanagisawa T, Kimura T, Hata K, Narita S, Hatakeyama S, Mori K, Sano T, Otsuka T, Iwamoto Y, Enei Y, Nakazono M, Sakanaka K, Iwatani K, Matsukawa A, Atsuta M, Nishikawa H, Tsuzuki S, Miki J, Habuchi T, Ohyama C, Shariat SF, Egawa S. Combination of docetaxel versus nonsteroidal antiandrogen with androgen deprivation therapy for high-volume metastatic hormone-sensitive prostate cancer: a propensity score-matched analysis. World J Urol 2023; 41:2051-2062. [PMID: 35596809 PMCID: PMC10415473 DOI: 10.1007/s00345-022-04030-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/24/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The aim of this study was to investigate the oncologic efficacy of combining docetaxel with androgen deprivation therapy (ADT) versus nonsteroidal antiandrogen (NSAA) with ADT in patients with high-volume metastatic hormone-sensitive prostate cancer (mHSPC) with focus on the effect of sequential therapy in a real-world clinical practice setting. METHODS The records of 382 patients who harbored high-volume mHSPC, based on the CHAARTED criteria, and had received ADT with either docetaxel (n = 92) or NSAA (bicalutamide) (n = 290) were retrospectively analyzed. The cohorts were matched by one-to-one propensity scores based on patient demographics. Overall survival (OS), cancer-specific survival (CSS), progression-free survival (PFS), including time to castration-resistant prostate cancer (CRPC), and time to second-line progression (PFS2) were compared. 2nd-line PFS defined as the time from CRPC diagnosis to progression after second-line therapy was also compared. RESULTS After matching, a total of 170 patients were retained: 85 patients treated with docetaxel + ADT and 85 patients treated with NSAA + ADT. The median OS and CSS for docetaxel + ADT versus NSAA + ADT were not reached (NR) vs. 49 months (p = 0.02) and NR vs. 55 months (p = 0.02), respectively. Median time to CRPC and PFS2 in patients treated with docetaxel + ADT was significantly longer compared to those treated with NSAA (22 vs. 12 months; p = 0.003 and, NR vs. 28 months; p < 0.001, respectively). There was no significant difference in 2nd-line PFS between the two groups. CONCLUSIONS Our analysis suggested that ADT with docetaxel significantly prolonged OS and CSS owing to a better time to CRPC and PFS2 in comparison to NSAA + ADT in high-volume mHSPC.
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Affiliation(s)
- Takafumi Yanagisawa
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-shimbashi, Minato-ku, Tokyo, 105-8471 Japan
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-shimbashi, Minato-ku, Tokyo, 105-8471 Japan
| | - Kenichi Hata
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-shimbashi, Minato-ku, Tokyo, 105-8471 Japan
- Department of Urology, Atsugi City Hospital, Kanagawa, Japan
| | - Shintaro Narita
- Department of Urology, Akita University School of Medicine, Akita, Japan
| | - Shingo Hatakeyama
- Department of Urology, Division of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Keiichiro Mori
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-shimbashi, Minato-ku, Tokyo, 105-8471 Japan
| | - Takayuki Sano
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-shimbashi, Minato-ku, Tokyo, 105-8471 Japan
| | - Takashi Otsuka
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-shimbashi, Minato-ku, Tokyo, 105-8471 Japan
| | - Yuya Iwamoto
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-shimbashi, Minato-ku, Tokyo, 105-8471 Japan
| | - Yuki Enei
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-shimbashi, Minato-ku, Tokyo, 105-8471 Japan
| | - Minoru Nakazono
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-shimbashi, Minato-ku, Tokyo, 105-8471 Japan
| | - Keigo Sakanaka
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-shimbashi, Minato-ku, Tokyo, 105-8471 Japan
| | - Kosuke Iwatani
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-shimbashi, Minato-ku, Tokyo, 105-8471 Japan
| | - Akihiro Matsukawa
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-shimbashi, Minato-ku, Tokyo, 105-8471 Japan
| | - Mahito Atsuta
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-shimbashi, Minato-ku, Tokyo, 105-8471 Japan
| | - Hideomi Nishikawa
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-shimbashi, Minato-ku, Tokyo, 105-8471 Japan
| | - Shunsuke Tsuzuki
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-shimbashi, Minato-ku, Tokyo, 105-8471 Japan
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-shimbashi, Minato-ku, Tokyo, 105-8471 Japan
| | - Tomonori Habuchi
- Department of Urology, Akita University School of Medicine, Akita, Japan
| | - Chikara Ohyama
- Department of Urology, Division of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Shahrokh F. Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Urology, Weill Cornell Medical College, New York, NY USA
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Shin Egawa
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-shimbashi, Minato-ku, Tokyo, 105-8471 Japan
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Hughes JD, Gibbs CM, Almast A, Atte A, Sansone M, Karlsson J, Musahl V. More anatomic tunnel placement for anterior cruciate ligament reconstruction by surgeons with high volume compared to low volume. Knee Surg Sports Traumatol Arthrosc 2022; 30:2014-2019. [PMID: 35092445 DOI: 10.1007/s00167-022-06875-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/13/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Correct placement of the femoral and tibial tunnels in the anatomic footprint during anterior cruciate ligament reconstruction (ACLR) is paramount for restoring rotatory knee stability. Recent studies have looked at surgeon volume and its outcomes on procedures such as total knee arthroplasty and infection rates, but only few studies have specifically examined tunnel placement after ACLR based on surgeon volume. The purpose of this study was to compare the placement of femoral and tibial tunnels during ACLR between high-volume and low-volume surgeons. It was hypothesized that high-volume surgeons would have more anatomic tunnel placement compared with low-volume surgeons. METHODS A retrospective review of all ACLR performed between 2015 and 2019 at an integrated health care system consisting of both academic and community hospitals with 68 orthopaedic surgeons was conducted. Surgeon volume was categorized as less than 35 ACLR per year (low volume) and 35 or more ACLR per year (high volume). Femoral tunnel placement for each patient was determined using an exact strict lateral radiograph (less than 6 mm of offset between the posterior halves of the medial and lateral condyles) taken after the primary ACLR using the quadrant method. The centre of the femoral tunnel was measured in relation to the posterior-anterior (PA) and proximal-distal (PD) dimensions (normal centre of anatomic footprint: PA 25% and PD 29%). Tibial tunnel placement for each patient was determined on the same lateral radiographs by measuring the mid-sagittal tibial diameter and the centre of the tibial attachment area of the ACL from the anterior tibial margin (normal centre of anatomic footprint: 43%). Each lateral radiograph was reviewed by one of two blinded reviewers. RESULTS A total of 4500 patients were reviewed, of which 645 patients met all the inclusion/exclusion criteria and were included in the final analysis. There were 228 patients in the low-volume group and 417 patients in the high-volume group. Low-volume surgeons performed a mean of 5 ACLRs per year, whereas surgeons in the high-volume group performed a mean of 40 ACLRs per year. In the PA dimension, the low-volume group had significantly more anterior femoral tunnel placement compared with the high-volume group (32 ± 10% vs 28 ± 9%, p < 0.01). In the PD dimension, the low-volume group had statistically significant more proximal femoral tunnel placement compared to the high-volume group (32 ± 9% vs 35 ± 9%, p < 0.01). For the tibial tunnel, the low-volume group had significantly more posterior tibial tunnel placement compared with the high-volume group (41 ± 10% vs 38 ± 7%, p < 0.01). CONCLUSION Low-volume surgeons placed their femoral tunnels significantly more anterior and proximal (high) during ACLR, and placed their tibial tunnels significantly more posterior, compared with high-volume surgeons. Prior research has indicated that anatomic placement of the femoral and tibial tunnels during ACLR leads to improved rotatory knee stability. The findings of this study demonstrate the importance of surgical volume and experience during ACLR. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jonathan D Hughes
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, University of Pittsburgh, 3200 S. Water St., Pittsburgh, PA, USA.
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Christopher M Gibbs
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, University of Pittsburgh, 3200 S. Water St., Pittsburgh, PA, USA
| | - Anmol Almast
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Akere Atte
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, University of Pittsburgh, 3200 S. Water St., Pittsburgh, PA, USA
| | - Mikael Sansone
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jon Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, University of Pittsburgh, 3200 S. Water St., Pittsburgh, PA, USA
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Abstract
Pancreatic cancer is the third leading cause of cancer deaths in the United States. Black patients with pancreatic cancer experience higher incidence and increased mortality. Although racial biologic differences exist, socioeconomic status, insurance type, physician bias, and patient beliefs contribute to the disparities in outcomes observed among patients who are Black, indigenous, and people of color.
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Affiliation(s)
- Madeline B Torres
- General Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Avenue MC H149, Hershey, PA 17033, USA. https://twitter.com/MadelineBTorres
| | - Matthew E B Dixon
- Division of Surgical Oncology, Penn State Health Milton S. Hershey Medical Center, 500 University Avenue MC H070, Hershey, PA 17036, USA. https://twitter.com/mebdixon
| | - Niraj J Gusani
- Section of Surgical Oncology, Baptist MD Anderson Cancer Center, 1301 Palm Avenue, Jacksonville, FL 32207, USA.
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Diaz A, Chavarin D, Paredes AZ, Pawlik TM. Utilization of High-Volume Hospitals for High-Risk Cancer Surgery in California Following Medicaid Expansion. J Gastrointest Surg 2021; 25:1875-84. [PMID: 32705616 DOI: 10.1007/s11605-020-04747-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/15/2020] [Indexed: 01/31/2023]
Abstract
INTRODUCTION A primary goal of the recent state and federal health reform is to increase access to care through expanded insurance coverage. We sought to evaluate the effect of Medicaid expansion (ME) on four high-risk cancer operations in California. METHODS The California Office of Statewide Health Planning database was used to identify patients who underwent either lung, esophageal, pancreas, or rectal resection for cancer between 2012 and 2016. To include only patients eligible for Medicaid and not Medicare, patients > 65 years were excluded. Trends in insurance coverage rates and utilization of high-volume hospitals were evaluated relative to the pre-policy (2012-2013) versus the post-policy (2014-2016) period. RESULTS Overall 10,569 individuals (esophageal: 5.6%; lung: 38%; pancreas: 14.1%; rectal: 42.3%) underwent a cancer operation. Following ME, Medicaid coverage increased from 12.4 to 20.2% (p < 0.001). There were no differences in age, sex, and race of Medicare beneficiaries pre- versus post-policy implementation (all p > 0.05). Of note, following ME, there was an increase in probability of utilization of high-volume hospitals for lung (47.6% vs. 56.3%), rectal (74.0% vs. 77.7%), and pancreas (60.2% vs. 68.5%) (p < 0.05 for all) cancer operations. Overall probability of surgery at a high-volume center after expansion increased by 5.8% among Medicaid beneficiaries versus other patients in the same time period. ME was not associated, however, with improvement in clinical outcomes such as complications, in-hospital mortality, or readmission (all p > 0.05). CONCLUSION ME was associated with an increase in Medicaid coverage, which resulted in more beneficiaries undergoing cancer operations at high-volume hospitals. While ME was associated with increased access to care, peri-operative outcomes were comparable pre- versus post-ME implementation.
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Wenzel M, Würnschimmel C, Nocera L, Collà Ruvolo C, Tian Z, Shariat SF, Saad F, Briganti A, Tilki D, Graefen M, Kluth LA, Roos FC, Mandel P, Chun FKH, Karakiewicz PI. Overall Survival After Systemic Treatment in High-volume Versus Low-volume Metastatic Hormone-sensitive Prostate Cancer: Systematic Review and Network Meta-analysis. Eur Urol Focus 2021:S2405-4569(21)00109-7. [PMID: 33853754 DOI: 10.1016/j.euf.2021.04.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/16/2021] [Accepted: 04/04/2021] [Indexed: 02/08/2023]
Abstract
CONTEXT Novel prospective randomized controlled observations addressing combination therapy in metastatic hormone-sensitive prostate cancer (mHSPC) have demonstrated promising overall survival (OS) outcomes. OBJECTIVE To compare these novel findings and systematically review and address them within formal network meta-analyses (NMAs) that include observations from other prospective randomized controlled trials (RCTs). EVIDENCE ACQUISITION First, we focused on abiraterone, enzalutamide, apalutamide, and docetaxel effects on OS in mHSPC using the PRISMA methodology. PubMed and abstracts identified prospective RCTs in first-line mHSPC. Second, we focused on mature studies that reached median OS and tested OS between abiraterone and docetaxel with tumor burden stratification. EVIDENCE SYNTHESIS The first part included seven studies (n = 6639) and the second part, five studies (n = 4462). In the first part, abiraterone ranked first for high-volume mHSPC. Conversely, enzalutamide ranked first for low-volume mHSPC. In the second part, abiraterone treatment in high-volume mHSPC resulted in median OS of 50.1 mo and exceeded that with docetaxel (45.9 mo) and ADT alone (34.0 mo). Docetaxel treatment in low volume mHSPC resulted in median OS of 69.5 mo versus 67.7 mo with ADT alone. CONCLUSIONS In conventional NMA that relied on conventional hazard ratios, differences were identified with respect to the relative efficacy of the combination therapies examined; abiraterone dominated the alternatives in high-volume mHSPC. In part two, which relied on trials for which median OS is available, comparison of abiraterone versus docetaxel revealed a 4-mo difference in OS in high-volume mHSPC. Conventional NMA may have overestimated the importance of treatment efficacy instead of focusing on median OS duration, which might represent a more important clinical endpoint. PATIENT SUMMARY We reviewed studies on hormonal treatments and chemotherapy used for prostate cancer that has spread outside the prostate gland (metastatic prostate cancer, mPC). We found that the best overall survival was with the hormone agents abiraterone in high-volume mPC and enzalutamide in low-volume mPC. In comparison to the chemotherapy drug docetaxel, median overall survival with abiraterone was 4 months longer among patients with mPC.
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Bhat KRS, Moschovas MC, Onol FF, Rogers T, Reddy SS, Corder C, Roof S, Patel VR. Evidence-based evolution of our robot-assisted laparoscopic prostatectomy (RALP) technique through 13,000 cases. J Robot Surg 2021; 15:651-60. [PMID: 33040249 DOI: 10.1007/s11701-020-01157-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 10/05/2020] [Indexed: 02/06/2023]
Abstract
Robot-assisted laparoscopic radical prostatectomy (RALP) has become the standard of surgical care in the USA and around the world. Over the past 18 years, we have performed 13,000 radical prostatectomies, and our surgical technique has evolved over time. We discuss this evolution and how it has helped us achieve optimal patient outcomes.
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Xun X, Zongyue H, Liling D, Yudong Z, Yulong X, Weichao L. Investigation of high volume of CFBC ash on performance of basic magnesium sulfate cement. J Environ Manage 2020; 256:109878. [PMID: 31818751 DOI: 10.1016/j.jenvman.2019.109878] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/13/2019] [Accepted: 11/15/2019] [Indexed: 06/10/2023]
Abstract
Basic magnesium sulfate cement has the advantages of fast setting, high strength, high toughness, water resistance, corrosion resistance, etc. But the cost has become a reason for limiting its widespread application. With the widespread application of circulating fluidized bed combustion (CFBC) technology in China, the accumulation of CFBC ash is increasing. Reasonable use of CFBC ash can not only reduce cost of basic magnesium sulfate cement but also protect environment. In this paper, the effect of a high volume of CFBC ash on fluidity, flexural strength and compressive strength of basic magnesium sulfate cement is studied. Hydration products and micromorphology analyses are measured by X-ray diffraction (XRD) and scanning electron microscopy (SEM). The results reveal that the strength of basic magnesium sulfate cement with 20% CFBC ash is the highest, and its microstructure is the model that CFBC ash and MgO fill a three-dimensional network structure established by needle-shaped 5·1·7 phase. When the amount of CFBC ash is more than 40%, the formation of 5·1·7 phase is affected severely, which greatly reduces the strength.
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Affiliation(s)
- Xu Xun
- School of Civil Engineering and Architecture, Southwest University of Science and Technology, Mianyang, 621010, PR China; State Key Laboratory for Environment-friendly Energy Materials, Southwest University of Science and Technology, Mianyang, 621010, PR China; State Key Laboratory of Green Building Materials, China Building Materials Academy, Beijing, 100024, PR China.
| | - Hu Zongyue
- School of Material Science and Engineering, Southwest University of Science and Technology, Mianyang, 621010, PR China
| | - Duan Liling
- School of Material Science and Engineering, Southwest University of Science and Technology, Mianyang, 621010, PR China
| | - Zhang Yudong
- School of Material Science and Engineering, Southwest University of Science and Technology, Mianyang, 621010, PR China
| | - Xiao Yulong
- School of Civil Engineering and Architecture, Southwest University of Science and Technology, Mianyang, 621010, PR China
| | - Lin Weichao
- School of Civil Engineering and Architecture, Southwest University of Science and Technology, Mianyang, 621010, PR China
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Rausch S, Hasinger O, König T, Schlegel A, Weiss G. An automated high throughput solution for DNA extraction and bisulfite-conversion from high volume liquid biopsy specimens: sample preparation for epigenetic analysis. BMC Res Notes 2019; 12:551. [PMID: 31470896 PMCID: PMC6716871 DOI: 10.1186/s13104-019-4595-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 08/23/2019] [Indexed: 01/09/2023] Open
Abstract
Objective DNA methylation analysis via real-time PCR or other analytical techniques requires purified bisulfite converted DNA. We report on an automated high throughput solution for DNA extraction, bisulfite-conversion, and purification of 96 samples with an input volume of up to 3.5 mL of plasma or urine, using reagents from the commercially available Epi BisKit. Results Magnetic bead-based DNA extraction, bisulfite conversion at high temperature, and efficient DNA purification was conducted on a customized commercially available liquid-handling platform. A highly interlaced 4 × 24 sample protocol was implemented for DNA extraction, elution in a 96-well plate, efficient bisulfite-conversion and extensive purification. The resulting bisulfite-converted DNA was stored in a 96-well format, ready for PCR set-up or other down-stream applications. The automated method is a walk-away solution for processing 96 samples in 7 h 30 min. Performance of the method was validated by comparison with the standard manual method of the Epi BiSKit using technical and biological samples. Overall DNA yield was assessed with a standardized β-actin assay. The automated workflow demonstrated equivalent performance to the manual method for technical, plasma and urine samples. It may provide a new standard for effective high-throughput preparation of bisulfite-converted DNA from a variety of high volume liquid biopsy specimens.
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Klompmaker S, Boggi U, Hackert T, Salvia R, Weiss M, Yamaue H, Zeh HJ, Besselink MG. Distal Pancreatectomy with Celiac Axis Resection (DP-CAR) for Pancreatic Cancer. How I do It. J Gastrointest Surg 2018; 22:1804-1810. [PMID: 30105677 PMCID: PMC6153684 DOI: 10.1007/s11605-018-3894-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 07/20/2018] [Indexed: 01/31/2023]
Abstract
Approximately 30% of all pancreatic cancer patients have locally advanced (AJCC stage 3) disease. A sub-group of these patients-where the cancer only involves the celiac axis-may benefit from distal pancreatectomy with celiac axis resection (DP-CAR). Previous studies have shown that DP-CAR offers a survival benefit to a selected group of patients with otherwise unresectable pancreatic cancer, when performed by experienced pancreatic cancer treatment teams at high-volume centers. This article proposes a standardized approach to DP-CAR, including routine neoadjuvant (FOLFIRINOX) chemotherapy. This approach to selecting patients and performing DP-CAR has the potential to improve short-term outcomes and overall survival in selected patients, but it should be reserved for high-volume centers.
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Affiliation(s)
- Sjors Klompmaker
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Thilo Hackert
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Roberto Salvia
- Department of Surgery, University of Verona, Verona, Italy
| | - Matthew Weiss
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD USA
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Herbert J. Zeh
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX USA
| | - Marc G. Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
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12
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Macías N, Vega A, Abad S, Santos A, Cedeño S, Linares T, García-Prieto AM, Aragoncillo I, Yuste C, López-Gómez JM. Is High-Volume Online Hemodiafiltration Associated With Malnutrition? Ther Apher Dial 2018; 21:361-369. [PMID: 28834362 DOI: 10.1111/1744-9987.12602] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/01/2016] [Accepted: 01/12/2017] [Indexed: 12/16/2022]
Abstract
Chronic malnutrition is a common problem in patients with end-stage renal disease on hemodialysis. Some studies have reported albumin loss into dialysis fluid during postdilution online hemodiafiltration (OL-HDF). The aim of the study was to assess the nutritional status of patients on high-volume OL-HDF and to demonstrate that higher convective clearances are not associated with malnutrition due to possible loss of nutrients with ultrafiltration. Demographic and clinical data, corporal composition with bioimpedance spectroscopy, dialysis features, albumin loss into dialysis fluid and laboratory parameters were collected in twenty-eight patients with ESRD undergoing postdilution OL-HDF with stable convective volumes over 28 L/session. Convective volume (CV) in the last six months was 32.51 ± 3.52 L per session. Cross-sectional analysis of dialysis features showed 32.7 ± 3.34 L of CV and high reduction rates of beta-2-microglobulin (84.2 ± 3.8%) and cystatin-C (81.6 ± 3.47%). Beta-2-microglobulin reduction showed a positive correlation with prealbumin levels (P = 0.048). CV was only correlated with cystatin-C reduction (P = 0.025). Estimated albumin loss into dialysis fluid (1.82 ± 1.05 g/session) was not related to laboratory or bioimpedance nutritional parameters, or to CV. Among patients with higher CV, serum albumin levels maintained more stability during the observational period. High volume OL-HDF results in better convective clearances and is not associated with malnutrition. Albumin and nutrients loss into dialysis fluid should not be a limiting factor of the substitution volume.
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Affiliation(s)
- Nicolás Macías
- Nephrology Department, Hospital Gregorio Marañón, Madrid, Spain
| | - Almudena Vega
- Nephrology Department, Hospital Gregorio Marañón, Madrid, Spain
| | - Soraya Abad
- Nephrology Department, Hospital Gregorio Marañón, Madrid, Spain
| | - Alba Santos
- Nephrology Department, Hospital Gregorio Marañón, Madrid, Spain
| | - Santiago Cedeño
- Nephrology Department, Hospital Gregorio Marañón, Madrid, Spain
| | - Tania Linares
- Nephrology Department, Hospital Gregorio Marañón, Madrid, Spain
| | | | | | - Claudia Yuste
- Nephrology Department, Hospital Gregorio Marañón, Madrid, Spain
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Gravis G, Boher JM, Chen YH, Liu G, Fizazi K, Carducci MA, Oudard S, Joly F, Jarrard DM, Soulie M, Eisenberger MJ, Habibian M, Dreicer R, Garcia JA, Hussain MHM, Kohli M, Vogelzang NJ, Picus J, DiPaola R, Sweeney C. Burden of Metastatic Castrate Naive Prostate Cancer Patients, to Identify Men More Likely to Benefit from Early Docetaxel: Further Analyses of CHAARTED and GETUG-AFU15 Studies. Eur Urol 2018; 73:847-855. [PMID: 29475737 DOI: 10.1016/j.eururo.2018.02.001] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 02/01/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Docetaxel (D) at the time of starting androgen deprivation therapy (ADT) for metastatic castrate naive prostate cancer shows a clear survival benefit for patients with high-volume (HV) disease. It is unclear whether patients with low-volume (LV) disease benefit from early D. OBJECTIVE To define the overall survival (OS) of aggregate data of patient subgroups from the CHAARTED and GETUG-AFU15 studies, defined by metastatic burden (HV and LV) and time of metastasis occurrence (at diagnosis or after prior local treatment [PRLT]). DESIGN, SETTING, AND PARTICIPANTS Data were accessed from two independent phase III trials of ADT alone or ADT+D-GETUG-AFU15 (N=385) and CHAARTED (N=790), with median follow-ups for survivors of 83.2 and 48.2 mo, respectively. The definition of HV and LV disease was harmonized. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary end point was OS. RESULTS AND LIMITATIONS Meta-analysis results of the aggregate data showed significant heterogeneity in ADT+D versus ADT effect sizes between HV and LV subgroups (p=0.017), and failed to detect heterogeneity in ADT+D versus ADT effect sizes between upfront and PRLT subgroups (p=0.4). Adding D in patients with HV disease has a consistent effect in improving median OS (HV-ADT: 34.4 and 35.1 mo, HV-ADT+D: 51.2 and 39.8 mo in CHAARTED and GETUG-AFU15, respectively; pooled average hazard ratio or HR (95% confidence interval [CI]) 0.68 ([95% CI 0.56; 0.82], p<0.001). Patients with LV disease showed much longer OS, without evidence that D improved OS (LV-ADT: not reached [NR] and 83.4; LV-ADT+D: 63.5 and NR in CHAARTED and GETUG-AFU15, respectively; pooled HR (95% CI) 1.03 (95% CI 0.77; 1.38). Aggregate data showed no evidence of heterogeneity of early D in LV and HV subgroups irrespective of whether patients had PRLT or not. Post hoc subgroup analysis was based on aggregated data from two independent phase III randomized trials. CONCLUSIONS There was no apparent survival benefit in the CHAARTED and GETUG-AFU15 studies with D for LV. Across both studies, early D showed consistent effect and improved OS in HV patients. PATIENT SUMMARY Patients with a higher burden of metastatic prostate cancer starting androgen deprivation therapy (ADT) have a poorer prognosis and are more likely to benefit from early docetaxel. Low-volume patients have longer overall survival with ADT alone, and the toxicity of docetaxel may outweigh its benefits.
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Affiliation(s)
- Gwenaelle Gravis
- Centre de Recherche en Cancerologie de Marseille (CRCM), Institut Paoli-Calmettes, Aix-Marseille University, Marseille, France.
| | - Jean-Marie Boher
- Biostatistic, Institut Paoli-Calmettes, Aix-Marseille Universite, Marseille, France
| | - Yu-Hui Chen
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - Glenn Liu
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Karim Fizazi
- Gustave Roussy, University of Paris Sud, Villejuif, France
| | | | - Stephane Oudard
- Department of Medical Oncology, Hopital Europeen Georges Pompidou, Paris, France
| | | | - David M Jarrard
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Michel Soulie
- Centre Hospitalier Universitaire Rangueil, Toulouse, France
| | | | | | | | | | | | | | | | - Joel Picus
- Washington University School of Medicine, St. Louis, MO, USA
| | - Robert DiPaola
- University of Kentucky College of Medicine, Lexington, KY, USA
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Abstract
Tendinopathy is increasingly recognized as an important cause of musculoskeletal pain and disability. Tendinopathy is thought to be principally a degenerative process, rather than inflammatory as was traditionally believed. Consequently, traditional tendinopathy treatments focused solely on decreasing inflammation have often been ineffective or even harmful. The advancement of ultrasonography as for guidance of outpatient musculoskeletal procedures has facilitated the development of novel percutaneous procedures for the treatment of tendinopathy, mostly by using mechanical intervention to stimulate regeneration. Several of these techniques, including percutaneous needle tenotomy, percutaneous ultrasonic tenotomy, high-volume injection, and percutaneous needle scraping, are reviewed in this article.
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Affiliation(s)
- Evan Peck
- Section of Sports Health, Department of Orthopaedic Surgery, Cleveland Clinic Florida, 525 Okeechobee Boulevard, Suite 1400, West Palm Beach, FL 33401, USA; Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA.
| | - Elena Jelsing
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Mayo Clinic Sports Medicine Center, Minneapolis, MN 55403, USA
| | - Kentaro Onishi
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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Abstract
Objectives When a clinical assay is stressed with extraordinarily high volume of specimens over a short period of time, extra caution may be needed to avoid systematic errors and biases. Here we report our experience with a HgbA1c assay used for high volume wellness screening purpose, to illustrate the importance of stress testing during assay validation. Design and Methods Over 15,000 whole blood specimens were tested for HgbA1c in a period of 2 months. HgbA1c was tested by an immunoturbidimetric method on a high through-put automation line. The HgbA1c population distribution in our study was compared to that from the NHANES database. Daily distributions of HgbA1c values ≥6%, means and medians were plotted. Correlation studies were performed between the high through-put immunoturbidimetric assay and a medium through-put HPLC method. Results We observed a shift of HgbA1c distribution to the higher values compared to the NHANES. A bias of 15–20% was noted from further stress testing where large number of samples were batched and tested using the immunoturbidimetric assay. A 5–7% higher bias remained after implementing a cuvette washing program after each HgbA1c sample. We hypothesized this bias was caused by build-up of blood cell fragments in the cuvettes when continuous whole blood samples are run through the system. Our experience suggests stress testing needs to be incorporated early in the test validation process for high volume batched screening applications. This seemingly extra validation step may save significant troubleshooting and retesting efforts down the road.
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Affiliation(s)
- Zheng Cao
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, United States
| | - Ping Wang
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, United States
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Huang K, D'Souza D, Patil N, Velker V, Leung E, Stitt L, Whiston F, Sugimoto A, McGee J, Prefontaine M. High-dose-rate interstitial brachytherapy for the treatment of high-volume locally recurrent endometrial carcinoma. Brachytherapy 2016; 15:543-8. [PMID: 27475479 DOI: 10.1016/j.brachy.2016.06.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/16/2016] [Accepted: 06/20/2016] [Indexed: 01/08/2023]
Abstract
PURPOSE Limited therapeutic options are available for the treatment of locally recurrent endometrial carcinoma. Our objective was to report an institutional experience using interstitial brachytherapy (IBT) to treat significant recurrent endometrial carcinoma, including previously irradiated disease. METHODS AND MATERIALS Between December 2004 and September 2012, 40 patients with high-volume locally recurrent endometrial cancer were treated by high-dose-rate IBT (± external beam radiation therapy EBRT). Sixteen patients had prior radiotherapy: EBRT alone (n = 5), intracavitary brachytherapy alone (n = 3), or EBRT with intracavitary brachytherapy boost (n = 8). Actuarial outcome rates were calculated using the Kaplan-Meier method and compared using the log-rank test. RESULTS Median followup interval was 18 months. Median disease-free interval was 61 months. Actuarial local control, progression-free survival (PFS), and overall survival were 74% and 60%, 70% and 51%, and 83% and 72% at 12 and 24 months, respectively. p-Values for local control, progression-free survival, and overall survival between patient who had prior RT (n = 16) to no prior RT (n = 24) were p = 0.38, 0.32, and 0.90, respectively. Acute toxicities include Grade 1-2 pain (5%), genitourinary (7%), gastrointestinal (12%), soft tissue (5%), and dermatologic (12%). Four patients observed late Grade 3-4 toxicities, including rectal bleeding/fistula and soft tissue necrosis. CONCLUSIONS High-dose-rate IBT is an effective treatment for locally recurrent endometrial carcinoma with an acceptable toxicity profile. Outcomes are similar between previously irradiated and nonirradiated patients. In women who have received prior radiotherapy and are often considered for palliative treatment, interstitial brachytherapy is a potentially curative option.
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Affiliation(s)
- Kitty Huang
- Department of Oncology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - David D'Souza
- Department of Oncology, London Health Sciences Centre, Western University, London, Ontario, Canada.
| | - Nikhilesh Patil
- Department of Radiation Oncology, Capital District Health Authority, Dalhousie University, Nova Scotia, Canada
| | - Vikram Velker
- Department of Oncology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Eric Leung
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Larry Stitt
- Department of Oncology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Frances Whiston
- Department of Oncology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Akira Sugimoto
- Department of Oncology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Jacob McGee
- Department of Oncology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Michel Prefontaine
- Department of Oncology, London Health Sciences Centre, Western University, London, Ontario, Canada
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17
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Hall EC, Zheng C, Langan RC, Johnson LB, Shara N, Al-Refaie WB. Medicaid beneficiaries undergoing complex surgery at quality care centers: insights into the Affordable Care Act. Am J Surg 2016; 211:750-4. [PMID: 26874897 DOI: 10.1016/j.amjsurg.2015.11.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 10/07/2015] [Accepted: 11/06/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Medicaid beneficiaries do not have equal access to high-volume centers for complex surgical procedures. We hypothesize there is a large Medicaid Gap between those receiving emergency general vs complex surgery at the same hospital. METHODS Using the Nationwide Inpatient Sample, 1998 to 2010, we identified high-volume pancreatectomy hospitals. We then compared the percentage of Medicaid patients receiving appendectomies vs pancreatectomies at these hospitals. Hospital characteristics associated with increased Medicaid Gap were evaluated using generalized estimating equation models. RESULTS A total of 602 hospital-years of data from 289 high-volume pancreatectomy hospitals were included. Median percentages of Medicaid appendectomies and pancreatectomies were 12.1% (interquartile range: 5.8% to 19.8%) and 6.7% (interquartile range: 0% to 15.4%), respectively. Hospitals that performed greater than or equal to 40 pancreatic resections per year had higher odds of having significant Medicaid Gap (odds ratio 2.3, 95% confidence interval 1.1 to 5.0). CONCLUSIONS Gaps exist between the percentages of Medicaid patients receiving emergency general surgery vs more complex surgical care at the same hospital and may be exaggerated in hospitals with very high volume of complex elective surgeries.
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Leberle R, Ernstberger A, Loibl M, Merkl J, Bunz M, Creutzenberg M, Trabold B. Association of high volumes of hydroxyethyl starch with acute kidney injury in elderly trauma patients. Injury 2015; 46:105-9. [PMID: 25240412 DOI: 10.1016/j.injury.2014.08.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 08/05/2014] [Accepted: 08/24/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Initial fluid resuscitation in trauma is still controversial. Hydroxyethyl starch (HES), a commonly used fluid for resuscitation in trauma patients, has potential nephrotoxic effects. Advancing age is a known risk factor for acute kidney injury (AKI) in trauma patients. Therefore, the objective of this study was to evaluate the impact of large volumes of HES 130/0.4 on renal function in trauma patients, with a particular focus on the significance of age. METHODS A retrospective review of all patients admitted to the Trauma Centre of the University Hospital Regensburg from September 1, 2007 to December 31, 2012 was performed. This investigation used data from the TraumaRegister of the German Trauma Society (DGU®), including preclinical data from the prehospital emergency physician's protocol, the patient data management system of the intensive care units and the anaesthesia protocols of the emergency room and the operating room. AKI was evaluated according to the risk, injury, failure, loss, or end-stage kidney disease (RIFLE) criteria. The rate of AKI and the rate of renal replacement therapy (RRT) were compared between patients who received<2000ml HES 130/0.4 during the first 24h (L-HES) after trauma and patients who received≥2000ml HES 130/0.4 during the first 24h (H-HES) after trauma. An additional sub analysis of patients older than 59 years of age was performed. RESULTS A total of 260 patients were included. Although patients in the H-HES group showed a higher injury severity score, the incidence of AKI and RRT were comparable. Furthermore, the sub analysis of patients older than 59 years of age also demonstrated similar results regarding incidence of AKI and the rate of RRT. CONCLUSIONS Fluid resuscitation with more than 2000ml HES (130kD/0.4) during the first twenty four hours after trauma was not associated with an increased incidence of AKI or need for RRT in trauma patients compared to patients who were administered<2000ml HES (130kD/0.4). The analysis of patients older than 59 years of age did not demonstrate any difference in the incidence of AKI or the need for RRT.
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Affiliation(s)
- R Leberle
- Department of Anesthesiology, University Medical Center, Germany.
| | - A Ernstberger
- Department of Trauma Surgery, University Medical Center, Germany.
| | - M Loibl
- Department of Trauma Surgery, University Medical Center, Germany.
| | - J Merkl
- Department of Anesthesiology, University Medical Center, Germany.
| | - M Bunz
- Department of Anesthesiology, University Medical Center, Germany.
| | - M Creutzenberg
- Department of Anesthesiology, University Medical Center, Germany.
| | - B Trabold
- Department of Anesthesiology, University Medical Center, Germany.
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Carter JM, Riley C, Ananth A, Guarisco JL, Rodriguez K, Amedee R. Improving outcomes in a high-output pediatric otolaryngology practice. Int J Pediatr Otorhinolaryngol 2014; 78:2229-33. [PMID: 25458165 DOI: 10.1016/j.ijporl.2014.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 10/06/2014] [Accepted: 10/11/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To identify factors associated with efficient operating room work flow on high volume pediatric otolaryngology days and the effects on provider and perceived parent satisfaction. METHODS Retrospective review was performed of a sample of 20 days with greater than 10 cases per day performed by a pediatric otolaryngologist operating in 2 rooms. Turnover time and complications were the main outcome measures. Providers from otolaryngology and anesthesia that participated in these days were surveyed regarding efficiency, safety, and satisfaction. RESULTS 223 cases were performed over 20 operative days. The average turnover time was significantly longer in "major" surgeries (p=0.03), cases with multispecialty involvement (p=0.01), cases requiring intubation (p<0.001), and in cases where a fellowship trained pediatric anesthesiologist (p=0.01) or CRNA was present (p<0.001). When comparing "fast" (<25min average turnover) operative days vs. "slow" (>25min average turnover) days, presence of a non-fellowship trained anesthesiologist (p<0.001), and the presence of an anesthesiology resident (p=0.03) were significantly associated with "fast" days, while the presence of a CRNA was associated with "slow" days (p<0.001). A significantly greater proportion of patients required intubation on "slow" turnover days vs. "fast" days (p=0.13). Only one complication was observed (0.4%). 48 providers were surveyed with a 63% response rate. Reported satisfaction amongst providers was significantly greater on days with at least 10 cases (p=0.047) and on days with turnover times of 25min or less (p<0.001). Pre-operative nursing evaluation/preparation of the patient, inter-provider communication and delays in room cleaning/setup were identified most often as causative factors responsible for delays in turnover. CONCLUSIONS High-operative volume operating days are common in pediatric otolaryngology and can be safely performed in an efficient manner. Appropriate scheduling and high-level communication between providers is needed to ensure success on these days. Identified areas of potential inefficiency can be a starting point for work flow optimization practices.
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Affiliation(s)
- John M Carter
- Tulane University, Department of Otolaryngology - Head & Neck Surgery, 1430 Tulane Avenue, SL 59, New Orleans, LA 70112, United States.
| | - Charles Riley
- Tulane University, Department of Otolaryngology - Head & Neck Surgery, 1430 Tulane Avenue, SL 59, New Orleans, LA 70112, United States.
| | - Ashwin Ananth
- Tulane University, Department of Otolaryngology - Head & Neck Surgery, 1430 Tulane Avenue, SL 59, New Orleans, LA 70112, United States.
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