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Figueroa-Parra G, Gilbert EL, Valenzuela-Almada MO, Vallejo S, Neville MR, Patel NJ, Cook C, Fu X, Hagi R, McDermott GC, Dilorio MA, Masto L, Vanni KMM, Kowalski E, Qian G, Zhang Y, Wallace ZS, Duarte-García A, Sparks JA. Risk of severe COVID-19 outcomes associated with rheumatoid arthritis and phenotypic subgroups: a retrospective, comparative, multicentre cohort study. Lancet Rheumatol 2022; 4:e765-e774. [PMID: 36118532 PMCID: PMC9472567 DOI: 10.1016/s2665-9913(22)00227-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Rheumatoid arthritis has been associated with severe COVID-19, but few studies have investigated how phenotypes of rheumatoid arthritis affect these associations. We aimed to investigate the associations between rheumatoid arthritis and phenotypes of interstitial lung disease, serostatus, and bone erosions with COVID-19 severity. Methods We did a retrospective, comparative, multicentre cohort study at two large health-care systems (Mayo Clinic [19 hospitals and affiliated outpatient centres] and Mass General Brigham [14 hospitals and affiliated outpatient centres]) in the USA. Consecutive patients with rheumatoid arthritis meeting the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria and who had COVID-19 between March 1, 2020, and June 6, 2021, were matched 1:5 on age, sex, and calendar date with patients without rheumatoid arthritis (comparators). Data were received from electronic health records from Mayo Clinic and Mass General Brigham. We examined subgroups of patients with rheumatoid arthritis by phenotypic features: rheumatoid arthritis-associated interstitial lung disease, seropositivity (for anti-cyclic citrullinated peptide, rheumatoid factor, or both), and bone erosions. Severe COVID-19 was a composite of hospitalisation or death. We used Cox regression to estimate hazard ratios (HR) for severe COVID-19, comparing rheumatoid arthritis and subgroups to the comparator group. Findings We identified 582 patients with rheumatoid arthritis and 2875 matched comparators, all of whom had COVID-19 within the study dates. The mean age of those with rheumatoid arthritis was 62 [SD 14] years, 421 (72%) of 582 were women and 161 (28%) were men, 457 (79%) were White, 65 (11%) were Hispanic or Latino, and 41 (7%) were Black. Among patients with rheumatoid arthritis, 50 (9%) of 582 had interstitial lung disease, 388 (68%) of 568 were seropositive, and 159 (27%) of 582 had bone erosions. Severe COVID-19 occurred in 126 (22%) of 582 patients with rheumatoid arthritis versus 363 (13%) 2875 in the comparator group. Patients with rheumatoid arthritis had an HR of 1·75 (95% CI 1·45-2·10) for severe COVID-19 versus the comparator group. Patients with rheumatoid arthritis-associated interstitial lung disease had an HR of 2·50 (1·66-3·77) versus the comparator group for severe COVID-19. The risk for severe COVID-19 was also higher in patients with rheumatoid arthritis who were seropositive (HR 1·97 [95% CI 1·58-2·46]) or had erosive disease (1·93 [1·41-2·63]) than for those in the comparator group. Interpretation Patients with rheumatoid arthritis have an increased risk of severe COVID-19 across phenotypic subgroups, especially among patients with interstitial lung disease. These findings suggest that rheumatoid arthritis with interstitial lung disease, or its treatment, might be a substantial contributor to severe COVID-19 outcomes for patients with rheumatoid arthritis. Funding None.
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Affiliation(s)
| | - Emily L Gilbert
- Division of Rheumatology, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Matthew R Neville
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Phoenix, AZ, USA
| | - Naomi J Patel
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Claire Cook
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Xiaoqing Fu
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Ramla Hagi
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Gregory C McDermott
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael A Dilorio
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Lucy Masto
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Kathleen M M Vanni
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Emily Kowalski
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Grace Qian
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Zachary S Wallace
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Alí Duarte-García
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
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2
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Sanghavi DK, Bhakta S, Wadei HM, Bosch W, Cowart JB, Carter RE, Shah SZ, Pollock BD, Neville MR, Oman SP, Speicher L, Siegel J, Scindia AD, Libertin CR, Kunze KL, Johnson PW, Matson MW, Franco PM. Low antispike antibody levels correlate with poor outcomes in COVID-19 breakthrough hospitalizations. J Intern Med 2022; 292:127-135. [PMID: 35194861 PMCID: PMC9115098 DOI: 10.1111/joim.13471] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND While COVID-19 immunization programs attempted to reach targeted rates, cases rose significantly since the emergence of the delta variant. This retrospective cohort study describes the correlation between antispike antibodies and outcomes of hospitalized, breakthrough cases during the delta variant surge. METHODS All patients with positive SARS-CoV-2 polymerase chain reaction hospitalized at Mayo Clinic Florida from 19 June 2021 to 11 November 2021 were considered for analysis. Cases were analyzed by vaccination status. Breakthrough cases were then analyzed by low and high antibody titers against SARS-CoV-2 spike protein, with a cut-off value of ≥132 U/ml. Outcomes included hospital length of stay (LOS), need for intensive care unit (ICU), mechanical ventilation, and mortality. We used 1:1 nearest neighbor propensity score matching without replacement to assess for confounders. RESULTS Among 627 hospitalized patients with COVID-19, vaccine breakthrough cases were older with more comorbidities compared to unvaccinated. After propensity score matching, the unvaccinated patients had higher mortality (27 [28.4%] vs. 12 [12.6%], p = 0.002) and LOS (7 [1.0-57.0] vs. 5 [1.0-31.0] days, p = 0.011). In breakthrough cases, low-titer patients were more likely to be solid organ transplant recipients (16 [34.0%] vs. 9 [12.3%], p = 0.006), with higher need for ICU care (24 [51.1%] vs. 22 [11.0%], p = 0.034), longer hospital LOS (median 6 vs. 5 days, p = 0.013), and higher mortality (10 [21.3%] vs. 5 [6.8%], p = 0.025) than high-titer patients. CONCLUSIONS Hospitalized breakthrough cases were more likely to have underlying risk factors than unvaccinated patients. Low-spike antibody titers may serve as an indicator for poor prognosis in breakthrough cases admitted to the hospital.
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Affiliation(s)
- Devang K Sanghavi
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Shivang Bhakta
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Hani M Wadei
- Department of Transplantation, Mayo Clinic, Jacksonville, Florida, USA
| | - Wendelyn Bosch
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA
| | - Jennifer B Cowart
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida, USA
| | - Sadia Z Shah
- Department of Transplantation, Mayo Clinic, Jacksonville, Florida, USA
| | - Benjamin D Pollock
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA
| | - Matthew R Neville
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA
| | - Sven P Oman
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Leigh Speicher
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Jason Siegel
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA.,Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Ameya D Scindia
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Claudia R Libertin
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA
| | - Katie L Kunze
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona, USA
| | - Patrick W Johnson
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida, USA
| | - Mark W Matson
- Center for Digital Health-Data & Analytics, Mayo Clinic, Rochester, Minnesota, USA
| | - Pablo Moreno Franco
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA.,Department of Transplantation, Mayo Clinic, Jacksonville, Florida, USA.,Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA
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3
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Bhakta S, Sanghavi DK, Johnson PW, Kunze KL, Neville MR, Wadei HM, Bosch W, Carter RE, Shah SZ, Pollock BD, Oman SP, Speicher L, Siegel J, Libertin CR, Matson MW, Franco PM, Cowart JB. Clinical and Laboratory Profiles of SARS-CoV-2 Delta Variant Compared to Pre-Delta Variants. Int J Infect Dis 2022; 120:88-95. [PMID: 35487339 PMCID: PMC9040426 DOI: 10.1016/j.ijid.2022.04.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 03/03/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The emergence of SARS-CoV-2 variants of concern has led to significant phenotypical changes in transmissibility, virulence, and public health measures. Our study used clinical data to compare characteristics between a Delta variant wave and a pre-Delta variant wave of hospitalized patients. METHODS This single-center retrospective study defined a wave as an increasing number of COVID-19 hospitalizations, which peaked and later decreased. Data from the United States Department of Health and Human Services was used to identify the waves' primary variant. Wave 1 (08/08/20-04/01/21) was characterized by heterogeneous variants, while Wave 2 (06/26/21-10/18/21) was predominantly Delta variant. Descriptive statistics, regression techniques, and machine learning approaches supported the comparisons between waves. RESULTS From the cohort(n=1318), Wave 2 patients(n=665) were more likely to be younger, have fewer comorbidities, require more ICU care, and show an inflammatory profile with higher C-reactive protein, lactate dehydrogenase, ferritin, fibrinogen, prothrombin time, activated thromboplastin time, and INR compared to Wave 1. The gradient boosting model showed an area under the ROC curve of 0.854(sensitivity 86.4%;specificity 61.5%;positive predictive value 73.8%; negative predictive value 78.3%). CONCLUSIONS Clinical and laboratory characteristics can be used to estimate the COVID-19 variant regardless of genomic testing availability. This finding has implications for variant-driven treatment protocols and further research.
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Affiliation(s)
- Shivang Bhakta
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA.
| | - Devang K Sanghavi
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Patrick W Johnson
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida, USA
| | - Katie L Kunze
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona, USA
| | - Matthew R Neville
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA
| | - Hani M Wadei
- Department of Transplantation, Mayo Clinic, Jacksonville, Florida, USA
| | - Wendelyn Bosch
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA
| | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida, USA
| | - Sadia Z Shah
- Department of Transplantation, Mayo Clinic, Jacksonville, Florida, USA
| | - Benjamin D Pollock
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA
| | - Sven P Oman
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Leigh Speicher
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Jason Siegel
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA; Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Claudia R Libertin
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA
| | - Mark W Matson
- Center for Digital Health - Data & Analytics, Mayo Clinic, Rochester, Minnesota, USA
| | - Pablo Moreno Franco
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA; Department of Transplantation, Mayo Clinic, Jacksonville, Florida, USA
| | - Jennifer B Cowart
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA.
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4
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Bosch W, Cowart JB, Bhakta S, Carter RE, Wadei HM, Shah SZ, Sanghavi DK, Pollock BD, Neville MR, Oman SP, Speicher L, Scindia AD, Matson MW, Moreno Franco P. Coronavirus Disease 2019 Vaccine-Breakthrough Infections Requiring Hospitalization in Mayo Clinic Florida Through August 2021. Clin Infect Dis 2021; 75:e892-e894. [PMID: 34726700 PMCID: PMC8689905 DOI: 10.1093/cid/ciab932] [Citation(s) in RCA: 15] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Indexed: 01/19/2023] Open
Abstract
We characterized coronavirus disease 2019 (COVID-19) breakthrough cases admitted to a single center in Florida. With the emergence of delta variant, an increased number of hospitalizations was seen due to breakthrough infections. These patients were older and more likely to have comorbidities. Preventive measures should be maintained even after vaccination.
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Affiliation(s)
- Wendelyn Bosch
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA
| | - Jennifer B Cowart
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Shivang Bhakta
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida, USA
| | - Hani M Wadei
- Division of Nephrology, Mayo Clinic, Jacksonville, Florida, USA
| | - Sadia Z Shah
- Department of Transplantation, Mayo Clinic, Jacksonville, Florida, USA
| | - Devang K Sanghavi
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Benjamin D Pollock
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA
| | - Matthew R Neville
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA
| | - Sven P Oman
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Leigh Speicher
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, Florida, USAand
| | - Ameya D Scindia
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Mark W Matson
- Center for Digital Health, Data and Analytics, Mayo Clinic, Rochester, Minnesota, USA
| | - Pablo Moreno Franco
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA,Department of Transplantation, Mayo Clinic, Jacksonville, Florida, USA,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA,Correspondence: P. Moreno Franco, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 ()
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5
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Storlie CB, Pollock BD, Rojas RL, Demuth GO, Johnson PW, Wilson PM, Heinzen EP, Liu H, Carter RE, Habermann EB, Kor DJ, Neville MR, Limper AH, Noe KH, Bydon M, Franco PM, Sampathkumar P, Shah ND, Dunlay SM, Dowdy SC. Quantifying the Importance of COVID-19 Vaccination to Our Future Outlook. Mayo Clin Proc 2021; 96:1890-1895. [PMID: 34218862 PMCID: PMC8075811 DOI: 10.1016/j.mayocp.2021.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 11/23/2022]
Abstract
Predictive models have played a critical role in local, national, and international response to the COVID-19 pandemic. In the United States, health care systems and governmental agencies have relied on several models, such as the Institute for Health Metrics and Evaluation, Youyang Gu (YYG), Massachusetts Institute of Technology, and Centers for Disease Control and Prevention ensemble, to predict short- and long-term trends in disease activity. The Mayo Clinic Bayesian SIR model, recently made publicly available, has informed Mayo Clinic practice leadership at all sites across the United States and has been shared with Minnesota governmental leadership to help inform critical decisions during the past year. One key to the accuracy of the Mayo Clinic model is its ability to adapt to the constantly changing dynamics of the pandemic and uncertainties of human behavior, such as changes in the rate of contact among the population over time and by geographic location and now new virus variants. The Mayo Clinic model can also be used to forecast COVID-19 trends in different hypothetical worlds in which no vaccine is available, vaccinations are no longer being accepted from this point forward, and 75% of the population is already vaccinated. Surveys indicate that half of American adults are hesitant to receive a COVID-19 vaccine, and lack of understanding of the benefits of vaccination is an important barrier to use. The focus of this paper is to illustrate the stark contrast between these 3 scenarios and to demonstrate, mathematically, the benefit of high vaccine uptake on the future course of the pandemic.
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Affiliation(s)
- Curtis B Storlie
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
| | | | - Ricardo L Rojas
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Gabriel O Demuth
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - Patrick M Wilson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Robert D. Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Ethan P Heinzen
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Hongfang Liu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Rickey E Carter
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Elizabeth B Habermann
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN; Robert D. Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Daryl J Kor
- Department of Anesthesiology, Mayo Clinic, Rochester, MN; Division of Critical Care Medicine, Mayo Clinic, Rochester, MN
| | | | | | | | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | | | | | - Nilay D Shah
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Department of Medicine, Mayo Clinic, Rochester, MN
| | - Shannon M Dunlay
- Department of Gynecologic Surgery, Mayo Clinic College of Medicine, Rochester, MN
| | - Sean C Dowdy
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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6
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Pflibsen LR, Foley BM, Bernard RW, Lee GK, Neville MR, Almader-Douglas D, Noland SS. Representation of Women on Plastic Surgery Journal Editorial Boards in the United States. Aesthet Surg J 2021; 41:NP914-NP920. [PMID: 33491085 DOI: 10.1093/asj/sjab034] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND During the past decade, a growing number of women have pursued medical careers, including in plastic surgery. However, female physicians have tended to be underrepresented in a variety of leadership roles in their respective specialties. OBJECTIVES The authors sought to evaluate the representation of female plastic surgeons on the editorial boards of high-impact plastic surgery journals. METHODS The gender of editorial board members on 3 high-impact plastic surgery journals was evaluated from 2009 and 2018. The number of women on each editorial board was then compared with the number of board-certified female plastic surgeons (BCFPS) and board-certified female academic plastic surgeons (BCFAPS), a subgroup of BCFPS. RESULTS There were 555 unique editorial board members from Plastic and Reconstructive Surgery, Aesthetic Surgery Journal, and Annals of Plastic Surgery from 2009 to 2018. During that period, 72 editors (13.0%) were women. At the beginning of the study, there were significantly fewer female editors than expected based on proportionate representation of BCFPS and BCFAPS to all board-certified plastic surgeons (P = 0.007 and 0.007, respectively). During the study, there was a 177% increase in women holding editorial board positions. At study end, women were adequately represented on all 3 editorial boards compared with their population data (BCFPS and BCFAPS). CONCLUSIONS During the 10 years of this study (2009-2018), editorial boards have overcome the underrepresentation of women on, and female plastic surgeons are currently adequately represented on the top 3 high-impact journal editorial boards.
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Affiliation(s)
- Lacey R Pflibsen
- Division of Plastic and Reconstructive Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | | | - Robert W Bernard
- Division of Plastic and Reconstructive Surgery, and consultant, Mayo Clinic Arizona and Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | - Gordon K Lee
- Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Matthew R Neville
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic Arizona, Phoenix, AZ, USA
| | | | - Shelley S Noland
- Division of Plastic and Reconstructive Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
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7
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Pollock BD, Carter RE, Dowdy SC, Dunlay SM, Habermann EB, Kor DJ, Limper AH, Liu H, Franco PM, Neville MR, Noe KH, Poe JD, Sampathkumar P, Storlie CB, Ting HH, Shah ND. Deployment of an Interdisciplinary Predictive Analytics Task Force to Inform Hospital Operational Decision-Making During the COVID-19 Pandemic. Mayo Clin Proc 2021; 96:690-698. [PMID: 33673920 PMCID: PMC7833949 DOI: 10.1016/j.mayocp.2020.12.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/11/2020] [Accepted: 12/23/2020] [Indexed: 11/21/2022]
Abstract
In March 2020, our institution developed an interdisciplinary predictive analytics task force to provide coronavirus disease 2019 (COVID-19) hospital census forecasting to help clinical leaders understand the potential impacts on hospital operations. As the situation unfolded into a pandemic, our task force provided predictive insights through a structured set of visualizations and key messages that have helped the practice to anticipate and react to changing operational needs and opportunities. The framework shared here for the deployment of a COVID-19 predictive analytics task force could be adapted for effective implementation at other institutions to provide evidence-based messaging for operational decision-making. For hospitals without such a structure, immediate consideration may be warranted in light of the devastating COVID-19 third-wave which has arrived for winter 2020-2021.
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Affiliation(s)
- Benjamin D Pollock
- Department of Quality, Experience, and Affordability, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL; Department of Neurology, Mayo Clinic, Phoenix, AZ.
| | - Rickey E Carter
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL; Department of Neurology, Mayo Clinic, Phoenix, AZ
| | - Sean C Dowdy
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL; Department of Neurology, Mayo Clinic, Phoenix, AZ
| | - Shannon M Dunlay
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Department of Health Sciences Research and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Elizabeth B Habermann
- Department of Health Sciences Research and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Daryl J Kor
- Department of Data and Analytics, Mayo Clinic, Rochester, MN
| | - Andrew H Limper
- Department of Health Sciences Research and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Hongfang Liu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Pablo Moreno Franco
- Department of Quality, Experience, and Affordability, Mayo Clinic, Rochester, MN; Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL
| | - Matthew R Neville
- Department of Health Sciences Research and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Katherine H Noe
- Department of Quality, Experience, and Affordability, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic, Phoenix, AZ
| | - John D Poe
- Department of Quality, Experience, and Affordability, Mayo Clinic, Rochester, MN
| | | | - Curtis B Storlie
- Department of Health Sciences Research and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Henry H Ting
- Department of Quality, Experience, and Affordability, Mayo Clinic, Rochester, MN
| | - Nilay D Shah
- Department of Health Sciences Research and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN
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8
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Linnaus ME, Neville MR, Habermann EB, Gray RJ. Postoperative Opioid Utilization and Patient Satisfaction in General Surgery Procedures: A Prospective Observational Study. Am Surg 2021; 88:219-225. [PMID: 33522273 DOI: 10.1177/0003134821989040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Wide variation of opioid prescribing persists despite attempts to quantify number of opioids utilized postoperatively. We aim to prospectively determine number of opioids used after common surgery procedures to guide future prescribing. METHODS A prospective observational trial was performed of opioids prescribed and used postoperatively. Patients filled out pre- and postoperative surveys, and number of opioids utilized was captured at postoperative visit. RESULTS One-hundred-and-thirteen patients met inclusion. Median opioids prescribed exceeded number of opioids taken for all procedures. Median number of opioids taken postoperatively was fewer than 10 for all categories of procedures: simple skin/soft tissue 2 (IQR 1-4), complex skin/soft tissue 1.5 (IQR 0-14), simple laparoscopy 1 (IQR 0-20) and complex laparoscopy 4 (IQR 0-20), laparotomy 0 (IQR 0-26), and open inguinal hernia 2 (IQR 0-2). Nearly 80% of patients had leftover opioids, and 31% planned to keep them. There was little difference between preoperative and postoperative level of satisfaction with a pain control regimen. DISCUSSION Postoperatively, patients utilize opioids less frequently than prescribed and often keep leftover pills. Patient pain control satisfaction is unrelated to number of opioids prescribed and taken postoperatively.
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Affiliation(s)
- Maria E Linnaus
- Department of Surgery, Mayo Clinic, Phoenix, AZ, USA.,Department of Surgery, Mayo Clinic Health System, Eau Claire, WI, USA
| | | | - Elizabeth B Habermann
- Division of Health Services Research, Department of Surgery, Mayo Clinic, Rochester, MN, USA
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Das DM, Huskey JL, Harbell JW, Heilman RL, Singer AL, Mathur A, Neville MR, Morgan P, Reddy KS, Jadlowiec CC. Early technical pancreas failure in Simultaneous Pancreas-Kidney Recipients does not impact renal allograft outcomes. Clin Transplant 2020; 35:e14138. [PMID: 33131111 DOI: 10.1111/ctr.14138] [Citation(s) in RCA: 5] [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: 06/18/2020] [Revised: 10/12/2020] [Accepted: 10/19/2020] [Indexed: 01/08/2023]
Abstract
Early pancreas loss in simultaneous pancreas-kidney (SPK) transplants has been associated with longer perioperative recovery and reduced kidney allograft function. We assessed the impact of early pancreas allograft failure on transplant outcomes in a contemporary cohort of SPK patients (n = 218). Early pancreas allograft loss occurred in 12.8% (n = 28) of recipients. Delayed graft function (DGF) was more common (21.4% vs. 7.4%, p = 0.03) in the early pancreas loss group, but there were no differences in hospital length of stay (median 6.5 vs. 7.0, p = 0.22), surgical wound complications (p = 0.12), or rejection episodes occurring in the first year (p = 0.87). Despite differences in DGF, both groups had excellent renal function at 1 year post-transplant (eGFR 64.1 ± 20.8 vs. 65.8 ± 22.9, p = 0.75). There were no differences in patient (HR 0.58, 95% CI 0.18-1.87, p = 0.26) or kidney allograft survival (HR 0.84, 95% CI 0.23-3.06, p = 0.77). One- and 2-year protocol kidney biopsies were comparable between the groups and showed minimal chronic changes; the early pancreas loss group showed more cv changes at 2 years (p = 0.04). Current data demonstrate good outcomes and excellent kidney allograft function following early pancreas loss.
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Affiliation(s)
- Devika M Das
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | | | - Jack W Harbell
- Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ, USA
| | | | - Andrew L Singer
- Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Amit Mathur
- Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Matthew R Neville
- Instructor in Biostatistics, Mayo Clinic College of Medicine, Phoenix, AZ, USA
| | - Paige Morgan
- Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Kunam S Reddy
- Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ, USA
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10
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Aimé VL, Neville MR, Thornburg DA, Noland SS, Mahabir RC, Bernard RW. Venous Thromboembolism Prophylaxis in Aesthetic Surgery: A Survey of Plastic Surgeons' Practices. Aesthet Surg J 2020; 40:1351-1369. [PMID: 32253425 DOI: 10.1093/asj/sjaa085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Deep venous thrombosis and pulmonary embolism, collectively known as venous thromboembolism (VTE), are among the most feared yet preventable surgical complications. Although many recommendations exist to reduce the risk of VTE, the actual VTE prophylaxis practices of aesthetic plastic surgeons remain unknown. OBJECTIVES The primary aim of this study was to elucidate plastic surgeons' experiences with VTE, preferred VTE prophylaxis practices, and areas in which VTE prevention may be improved. METHODS Members of The Aesthetic Society were queried via a 55-question electronic survey regarding their experience with VTE as well as their VTE prophylaxis practices. Anonymous responses were collected and analyzed by the Mayo Clinic Survey Research Center. RESULTS The survey was sent to 1729 of The Aesthetic Society members, of whom 286 responded. Fifty percent, 38%, and 6% of respondents reported having had a patient develop a deep venous thrombosis, pulmonary embolism, or death secondary to VTE, respectively. Procedures performed on the back or trunk were associated with the highest rate of VTE. Lower extremity procedures were associated with a significantly higher rate of VTE than expected. Over 90% of respondents reported utilizing a patient risk stratification assessment tool. Although at least one-half of respondents reported that the surgical facility in which they operate maintains some form of VTE prophylaxis protocol, 39% self-reported nonadherence with these protocols. CONCLUSIONS Considerable variability exists in VTE prophylaxis practices among The Aesthetic Society responders. Future efforts should simplify guidelines and tailor prophylaxis recommendations to the aesthetic surgery population. Furthermore, education of plastic surgeons performing aesthetic surgery and more diligent surgical venue supervision is needed to narrow the gap between current recommendations and actual practices.
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Affiliation(s)
- Victoria L Aimé
- The Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ
| | - Matthew R Neville
- Division of Biomedical Sciences and Informatics, Department of Health Science Research, Mayo Clinic, Phoenix, AZ
| | - Danielle A Thornburg
- The Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ
| | - Shelley S Noland
- The Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ
| | | | - Robert W Bernard
- The Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ
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11
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Schwartz AJ, Clarke HD, Spangehl MJ, Bingham JS, Etzioni DA, Neville MR. Can a Convolutional Neural Network Classify Knee Osteoarthritis on Plain Radiographs as Accurately as Fellowship-Trained Knee Arthroplasty Surgeons? J Arthroplasty 2020; 35:2423-2428. [PMID: 32418746 DOI: 10.1016/j.arth.2020.04.059] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/13/2020] [Accepted: 04/19/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Osteoarthritis (OA) is the leading cause of disability among adults in the United States. As the diagnosis is based on the accurate interpretation of knee radiographs, use of a convolutional neural network (CNN) to grade OA severity has the potential to significantly reduce variability. METHODS Knee radiographs from consecutive patients presenting to a large academic arthroplasty practice were obtained retrospectively. These images were rated by 4 fellowship-trained knee arthroplasty surgeons using the International Knee Documentation Committee (IKDC) scoring system. The intraclass correlation coefficient (ICC) for surgeons alone and surgeons with a CNN that was trained using 4755 separate images were compared. RESULTS Two hundred eighty-eight posteroanterior flexion knee radiographs (576 knees) were reviewed; 131 knees were removed due to poor quality or prior TKA. Each remaining knee was rated by 4 blinded surgeons for a total of 1780 human knee ratings. The ICC among the 4 surgeons for all possible IKDC grades was 0.703 (95% confidence interval [CI] 0.667-0.737). The ICC for the 4 surgeons and the trained CNN was 0.685 (95% CI 0.65-0.719). For IKDC D vs any other rating, the ICC of the 4 surgeons was 0.713 (95% CI 0.678-0.746), and the ICC of 4 surgeons and CNN was 0.697 (95% CI 0.663-0.73). CONCLUSIONS A CNN can identify and classify knee OA as accurately as a fellowship-trained arthroplasty surgeon. This technology has the potential to reduce variability in the diagnosis and treatment of knee OA.
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Affiliation(s)
- Adam J Schwartz
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Henry D Clarke
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Mark J Spangehl
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Joshua S Bingham
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - David A Etzioni
- Department of Colon and Rectal Surgery, Mayo Clinic Arizona, Phoenix, AZ
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12
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Pollock BD, Herrin J, Neville MR, Dowdy SC, Moreno Franco P, Shah ND, Ting HH. Association of Do-Not-Resuscitate Patient Case Mix With Publicly Reported Risk-Standardized Hospital Mortality and Readmission Rates. JAMA Netw Open 2020; 3:e2010383. [PMID: 32662845 PMCID: PMC7361656 DOI: 10.1001/jamanetworkopen.2020.10383] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The Centers for Medicare and Medicaid Services's (CMS's) 30-day risk-standardized mortality rate (RSMR) and risk-standardized readmission rate (RSRR) models do not adjust for do-not-resuscitate (DNR) status of hospitalized patients and may bias Hospital Readmissions Reduction Program (HRRP) financial penalties and Overall Hospital Quality Star Ratings. OBJECTIVE To identify the association between hospital-level DNR prevalence and condition-specific 30-day RSMR and RSRR and the implications of this association for HRRP financial penalty. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study obtained patient-level data from the Medicare Limited Data Set Inpatient Standard Analytical File and hospital-level data from the CMS Hospital Compare website for all consecutive Medicare inpatient encounters from July 1, 2015, to June 30, 2018, in 4484 US hospitals. Hospitalized patients had a principal diagnosis of acute myocardial infarction (AMI), heart failure (HF), stroke, pneumonia, or chronic obstructive pulmonary disease (COPD). Incoming acute care transfers, discharges against medical advice, and patients coming from or discharged to hospice were among those excluded from the analysis. EXPOSURES Present-on-admission (POA) DNR status was defined as an International Classification of Diseases, Ninth Revision diagnosis code of V49.86 (before October 1, 2015) or as an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis code of Z66 (beginning October 1, 2015). Hospital-level prevalence of POA DNR status was calculated for each of the 5 conditions. MAIN OUTCOMES AND MEASURES Hospital-level 30-day RSMRs and RSRRs for 5 condition-specific cohorts (mortality cohorts: AMI, HF, stroke, pneumonia, and COPD; readmission cohorts: AMI, HF, pneumonia, and COPD) and HRRP financial penalty status (yes or no). RESULTS Included in the study were 4 884 237 inpatient encounters across condition-specific 30-day mortality cohorts (patient mean [SD] age, 78.8 [8.5] years; 2 608 182 women [53.4%]) and 4 450 378 inpatient encounters across condition-specific 30-day readmission cohorts (patient mean [SD] age, 78.6 [8.5] years; 2 349 799 women [52.8%]). Hospital-level median (interquartile range [IQR]) prevalence of POA DNR status in the mortality cohorts varied: 11% (7%-16%) for AMI, 13% (7%-23%) for HF, 14% (9%-22%) for stroke, 17% (9%-26%) for pneumonia, and 10% (5%-18%) for COPD. For the readmission cohorts, the hospital-level median (IQR) POA DNR prevalence was 9% (6%-15%) for AMI, 12% (6%-22%) for HF, 16% (8%-24%) for pneumonia, and 9% (4%-17%) for COPD. The 30-day RSMRs were significantly higher for hospitals in the highest quintiles vs the lowest quintiles of DNR prevalence (eg, AMI: 12.9 [95% CI, 12.8-13.1] vs 12.5 [95% CI, 12.4-12.7]; P < .001). The inverse was true among the readmission cohorts, with the highest quintiles of DNR prevalence exhibiting the lowest RSRRs (eg, AMI: 15.3 [95% CI, 15.1-15.5] vs 15.9 [95% CI, 15.7-16.0]; P < .001). A 1% absolute increase in risk-adjusted hospital-level DNR prevalence was associated with greater odds of avoiding HRRP financial penalty (odds ratio, 1.06; 95% CI, 1.04-1.08; P < .001). CONCLUSIONS AND RELEVANCE This cross-sectional study found that the lack of adjustment in CMS 30-day RSMR and RSRR models for POA DNR status of hospitalized patients may be associated with biased readmission penalization and hospital-level performance.
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Affiliation(s)
- Benjamin D. Pollock
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida
- Department of Quality, Experience, and Affordability, Mayo Clinic, Rochester, Minnesota
| | - Jeph Herrin
- Flying Buttress Associates, Charlottesville, Virginia
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Matthew R. Neville
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida
- Department of Quality, Experience, and Affordability, Mayo Clinic, Rochester, Minnesota
| | - Sean C. Dowdy
- Department of Quality, Experience, and Affordability, Mayo Clinic, Rochester, Minnesota
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Pablo Moreno Franco
- Department of Quality, Experience, and Affordability, Mayo Clinic, Rochester, Minnesota
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida
| | - Nilay D. Shah
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida
| | - Henry H. Ting
- Department of Quality, Experience, and Affordability, Mayo Clinic, Rochester, Minnesota
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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13
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Brinkman JC, Zaw TM, Fox MG, Wilcox JG, Hattrup SJ, Chhabra A, Neville MR, Hartigan DE. Calcific Tendonitis of the Shoulder: Protector or Predictor of Cuff Pathology? A Magnetic Resonance Imaging-Based Study. Arthroscopy 2020; 36:983-990. [PMID: 31816365 DOI: 10.1016/j.arthro.2019.11.127] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 07/15/2019] [Revised: 11/23/2019] [Accepted: 11/24/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this investigation is to assess the incidence of rotator cuff tears in cases of calcific tendonitis and evaluate for differences in the incidences of rotator cuff tears by magnetic resonance imaging (MRI) between calcific lesions of different morphology, size, or location. METHODS This single-center study involved a retrospective chart review searching for patients from January 2010 to April 2017 with a diagnosis of calcific tendonitis of the shoulder based on review of all MRI reads done on patients with shoulder pain. Anteroposterior radiographic and MRI studies were reviewed by a musculoskeletal radiologist to assess calcific tendonitis morphology, size, distance from cuff insertion, and any rotator cuff tear. An additional radiologist evaluated calcific tendonitis size, morphology, and location to evaluate the reliability of these variables. RESULTS In the final cohort of 318 shoulders with calcific tendonitis, the incidence of concomitant rotator cuff tears was 56%. Of all 177 tears, 164 (93%) were partial-thickness and 13 (7%) were complete. Type III calcification morphology (cloudy with soft contour) was most frequently associated with rotator cuff tears and demonstrated an increased odds of tear by a factor of 1.8 (CI95% 1.1-2.9).There was no statistical difference regarding calcification size or location prognosticating rotator cuff tears or tear thickness. Intraclass correlation coefficients for calcification size, morphology, and location were 0.78, 0.30, and 0.50, respectively. CONCLUSIONS The incidence of rotator cuff tears in cases of calcific tendonitis in this cohort of patients who underwent MRI is higher than previously reported. Cloudy-appearing calcified lesions showed a significant association with rotator cuff tears with an odds ratio of 1.8. Specific locations or sizes of calcified lesions do not appear to be reliable factors to predict concomitant rotator cuff tears. Interobserver agreement for these radiographic variables ranged from fair to substantial and prompt a cautious interpretation of these results. LEVEL OF EVIDENCE IV Retrospective Case Series.
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Affiliation(s)
| | - Taryar M Zaw
- Department of Orthopedics, Mayo Clinic in Arizona, Phoenix, Arizona, U.S.A
| | - Michael G Fox
- Department of Orthopedics, Mayo Clinic in Arizona, Phoenix, Arizona, U.S.A
| | - Justin G Wilcox
- Department of Orthopedics, Mayo Clinic in Arizona, Phoenix, Arizona, U.S.A
| | - Steven J Hattrup
- Department of Orthopedics, Mayo Clinic in Arizona, Phoenix, Arizona, U.S.A
| | - Anikar Chhabra
- Department of Orthopedics, Mayo Clinic in Arizona, Phoenix, Arizona, U.S.A
| | - Matthew R Neville
- Department of Orthopedics, Mayo Clinic in Arizona, Phoenix, Arizona, U.S.A
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14
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Nokes BT, Raza HA, Cartin-Ceba R, Lyng PJ, Krahn LE, Wesselius L, Jokerst CE, Umar SB, Griffing WL, Neville MR, Malhotra A, Parish JM. Individuals With Scleroderma May Have Increased Risk of Sleep-Disordered Breathing. J Clin Sleep Med 2019; 15:1665-1669. [PMID: 31739857 PMCID: PMC6853384 DOI: 10.5664/jcsm.8036] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 11/30/2018] [Revised: 07/18/2019] [Accepted: 07/19/2019] [Indexed: 12/13/2022]
Abstract
STUDY OBJECTIVES Scleroderma is associated with abnormal skin thickening, interstitial lung disease, pulmonary hypertension, and abnormalities of the upper airway. These changes can cause cardiopulmonary complications, potentially including sleep-disordered breathing. The objective of this study is to examine the risk of sleep-disordered breathing in patients with scleroderma. METHODS We retrospectively identified patients with documented scleroderma. We abstracted data from their electronic health records, including findings from antibody tests, serial pulmonary function tests, transthoracic echocardiography, high-resolution computed tomography, and overnight forehead oximetry. RESULTS We identified 171 patients with scleroderma. Mean age at the time of initial consult was 56.5 years (range, 18-96 years), and 150 (86.7%) were women. Scleroderma was categorized as limited disease for 108 (62.4%), diffuse disease for 59 (34.1%), and mixed connective tissue disease for 6 (3.5%). Fifty-four patients (31.2%) had abnormal overnight forehead oximetry results, defined as an oxygen desaturation index greater than 5 or a baseline mean arterial oxygen saturation level less than 90%. CONCLUSIONS Cardiopulmonary complications are common in patients with scleroderma, one of which may be sleep-disordered breathing. In our cohort, approximately one-third of individuals with scleroderma had evidence of sleep-disordered breathing. Moreover, the rate of sleep-disordered breathing in our population of scleroderma patients was twice the rate of pulmonary hypertension and was approximately the same as the rate of interstitial lung disease. Future prospective studies are needed to further assess the role of sleep-disordered breathing in scleroderma clinical outcomes.
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Affiliation(s)
- Brandon T. Nokes
- Department of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, San Diego, California
| | - Hassan A. Raza
- Division of Pulmonary Medicine, Mayo Clinic Hospital, Phoenix, Arizona
| | | | - Phillip J. Lyng
- Division of Pulmonary Medicine, Mayo Clinic Hospital, Phoenix, Arizona
| | - Lois E. Krahn
- Division of Pulmonary Medicine, Mayo Clinic Hospital, Phoenix, Arizona
- Division of Adult Psychiatry, Mayo Clinic Hospital, Phoenix, Arizona
| | - Lewis Wesselius
- Division of Pulmonary Medicine, Mayo Clinic, Scottsdale, Arizona
| | | | - Sarah B. Umar
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona
| | | | | | - Atul Malhotra
- Department of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, San Diego, California
| | - James M. Parish
- Division of Pulmonary Medicine, Mayo Clinic Hospital, Phoenix, Arizona
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15
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Tseng AS, Kunze KL, Lee JZ, Amin M, Neville MR, Almader-Douglas D, Killu AM, Madhavan M, Cha YM, Asirvatham SJ, Friedman PA, Gersh BJ, Mulpuru SK. Efficacy of Pharmacologic and Cardiac Implantable Electronic Device Therapies in Patients With Heart Failure and Reduced Ejection Fraction: A Systematic Review and Network Meta-Analysis. Circ Arrhythm Electrophysiol 2019; 12:e006951. [PMID: 31159582 DOI: 10.1161/circep.118.006951] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The treatment of heart failure with reduced ejection fraction has been the subject of numerous randomized controlled trials involving medications and cardiac implantable electronic device therapies. As newer effective pharmacological therapies suggest significant reductions in all-cause mortality, the role of additional device therapy in heart failure with reduced ejection fraction deserves further scrutiny. Methods A systematic review and network meta-analysis on the effect of medication and device therapies in heart failure with reduced ejection fraction on all-cause mortality was performed. Randomized controlled trials published between January 1980 and July 2017 were identified using Medline, EMBASE, and Cochrane Controlled Register of Trials databases. Pcnetmeta package in R was used to calculate treatment arm-based estimated rates, rate ratios, and probability ranks with 95% credible intervals. Results Combination therapy of ACE (angiotensin-converting enzyme) inhibitors or ARBs (angiotensin receptor blockers) with β-blockers (BBs) alone or in addition to implantable cardiac defibrillators or cardiac resynchronization therapy with defibrillators demonstrated a significant reduction of all-cause mortality when compared with placebo. By probability rank, implantable cardiac defibrillator+ACE inhibitor or ARB+BB+mineralocorticoid receptor antagonist, implantable cardiac defibrillator+ACE inhibitor or ARB+BB, and angiotensin receptor-neprilysin inhibitor+BB+mineralocorticoid receptor antagonist combination therapies have the highest probability of being ranked the best treatment. There was no significant difference in the rate of mortality when comparing angiotensin receptor-neprilysin inhibitor+BB+mineralocorticoid receptor antagonist to implantable cardiac defibrillator+optimal pharmacological combination therapy. Conclusions BB and renin-angiotensin system blockers alone or in combination with defibrillator device therapy have robust evidence for a reduction in mortality compared with placebo. The comparative efficacy of pharmacological therapy with angiotensin receptor-neprilysin inhibitors and device therapy deserves further investigation.
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Affiliation(s)
- Andrew S Tseng
- Department of Internal Medicine (A.S.T.), Mayo Clinic Arizona, Phoenix
| | - Katie L Kunze
- Division of Biomedical Statistics and Informatics (K.L.K., M.R.N.), Mayo Clinic Arizona, Phoenix
| | - Justin Z Lee
- Division of Cardiovascular Diseases (J.Z.L., S.K.M.), Mayo Clinic Arizona, Phoenix
| | - Mustapha Amin
- Division of Cardiovascular Diseases, Mayo Clinic Rochester, MN (M.A., A.M.K., M.M., Y.-M.C., S.J.A., P.A.F., B.J.G.)
| | - Matthew R Neville
- Division of Biomedical Statistics and Informatics (K.L.K., M.R.N.), Mayo Clinic Arizona, Phoenix
| | | | - Ammar M Killu
- Division of Cardiovascular Diseases, Mayo Clinic Rochester, MN (M.A., A.M.K., M.M., Y.-M.C., S.J.A., P.A.F., B.J.G.)
| | - Malini Madhavan
- Division of Cardiovascular Diseases, Mayo Clinic Rochester, MN (M.A., A.M.K., M.M., Y.-M.C., S.J.A., P.A.F., B.J.G.)
| | - Yong-Mei Cha
- Division of Cardiovascular Diseases, Mayo Clinic Rochester, MN (M.A., A.M.K., M.M., Y.-M.C., S.J.A., P.A.F., B.J.G.)
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Mayo Clinic Rochester, MN (M.A., A.M.K., M.M., Y.-M.C., S.J.A., P.A.F., B.J.G.)
| | - Paul A Friedman
- Division of Cardiovascular Diseases, Mayo Clinic Rochester, MN (M.A., A.M.K., M.M., Y.-M.C., S.J.A., P.A.F., B.J.G.)
| | - Bernard J Gersh
- Division of Cardiovascular Diseases, Mayo Clinic Rochester, MN (M.A., A.M.K., M.M., Y.-M.C., S.J.A., P.A.F., B.J.G.)
| | - Siva K Mulpuru
- Division of Cardiovascular Diseases (J.Z.L., S.K.M.), Mayo Clinic Arizona, Phoenix
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16
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Hassebrock JD, Krych AJ, Domb BG, Levy BA, Neville MR, Hartigan DE. Bilateral Hip Arthroscopy: Can Results From Initial Arthroscopy for Femoroacetabular Impingement Predict Future Contralateral Results? Arthroscopy 2019; 35:1837-1844. [PMID: 30979623 DOI: 10.1016/j.arthro.2018.12.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 12/07/2018] [Accepted: 12/12/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the degree of correlation of radiographic measurements, degree of correlation of intraoperative pathology, and difference in outcomes between sides of patients requiring staged bilateral hip arthroscopy. METHODS Two high-volume hip preservation centers retrospectively reviewed hip preservation databases for staged bilateral hip arthroscopies conducted between 2008 and 2015. Patients were separated into those who presented with bilateral hip pain and those that presented with unilateral pain and developed contralateral pain >2 years later. Patients were analyzed for radiographic correlation (alpha angle, lateral center edge angle, anterior center edge angle, magnetic resonance imaging alpha angle, Tönnis grade) and correlation of intraoperative pathology (acetabular labrum articular disruption grade, Outerbridge grade/location, Villar class ligamentum teres tears, labral tear location, symmetry of Seldes tear types, and the differences between operative procedures). Patient-reported outcomes were analyzed (modified Harris Hip Score, Non-Arthritic Hip Score, International Hip Outcome Tool-12, hip outcome score-sport specific subscale, visual analog scale, patient satisfaction). Correlative tests included Pearson and Spearman; univariate and multivariate analysis for differences included χ-square test and Student t tests for ordinal and continuous variables respectively. RESULTS A total of 133 of 2,705 patients (4.6%) underwent bilateral hip arthroscopy. Radiographic alpha angle, magnetic resonance imaging alpha angle, lateral center edge angle, and anterior center edge angle demonstrated strong correlation (Pearson's coefficients 0.651, 0.648, 0.644, 0.667, respectively, P < .0001). Tönnis grade was weakly correlated (Pearson's coefficient 0.286, P = .001). Intraoperative pathology was moderately correlated (Pearson's coefficients for acetabular Outerbridge location, 0.300, P = .0170; acetabular labrum articular disruption, 0.490, P < .0001; acetabular Outerbridge; 0.530; P < .0001; femoral head Outerbridge, 0.459, P < .0001; Villar class, 0.393, P < .0001; and labral tear location, 0.468, P < .0001). Labral tear Seldes type was compared with Bowker's symmetry test and there was no significant difference between sides. There were no significant differences in surgical interventions performed between sides. Patients with bilateral hip arthroscopies significantly improved in all measured patient-reported outcomes and had a high patient satisfaction after both procedures. Final patient-reported outcomes and change in patient-reported outcomes were not different between procedures; follow up ranged from 3 months to 8 years. CONCLUSIONS This study demonstrated an incidence of 4.6% of patients who require bilateral hip arthroscopy. These patients can expect significant improvement after surgical intervention. Patients that had 1 side done gained similar improvement when the contralateral side was performed. Preoperative radiographic, intraoperative pathology, and procedures performed were similar between hips. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Jeffrey D Hassebrock
- Department of Orthopedics, Sports Medicine, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
| | - Aaron J Krych
- Department of Orthopedics, Mayo Clinic Rochester, Rochester, Minnesota, U.S.A
| | - Benjamin G Domb
- Department of Orthopedics, Hinsdale Orthopaedic Associates, Hinsdale, Illinois, U.S.A
| | - Bruce A Levy
- Department of Orthopedics, Mayo Clinic Rochester, Rochester, Minnesota, U.S.A
| | - Matthew R Neville
- Department of Biostatistics, Mayo Clinic Arizona, Glendale, Phoenix, U.S.A
| | - David E Hartigan
- Department of Orthopedics, Sports Medicine, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A..
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17
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Faraj K, Chang YHH, Neville MR, Blodgett G, Etzioni DA, Habermann EB, Andrews PE, Castle EP, Humphreys MR, Tyson MD. Robotic vs. open cystectomy: How length-of-stay differences relate conditionally to age. Urol Oncol 2019; 37:354.e1-354.e8. [PMID: 30770298 DOI: 10.1016/j.urolonc.2019.01.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/20/2018] [Accepted: 01/28/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The length-of-stay (LOS) benefit of minimally invasive cystectomy varies in the published literature, potentially because of subgroup effects. Here, we investigated the effect of minimally invasive cystectomy on LOS among different age groups. METHODS AND MATERIALS Adult patients who underwent cystectomy (open or minimally invasive) from January 1, 2012, to December 31, 2016, were identified from the National Surgical Quality Improvement Program database. Multivariable linear regression was used to evaluate the adjusted association between the surgical approach and LOS after stratifying patients by age (40-64, 65-79, and ≥80 years). A sensitivity analysis was performed after multiple imputation by using age as a continuous variable with a third-order polynomial term. RESULTS Of the 5,561 patients identified, 640 underwent minimally invasive cystectomy and 4,921 had open cystectomy. The unadjusted analysis showed that minimally invasive cystectomy was associated with a shorter mean LOS compared with the open approach (8.0 vs. 9.7 days; P < 0.001). The predicted difference in LOS between the 2 approaches was 0.72 days (95% confidence interval (CI), -0.28 to 1.72; P = 0.16) for patients aged 40 to 64 years, 1.48 days (95% CI, 0.73-2.23; P < 0.001) for 65 to 79 years, and 2.56 days (95% CI, 0.84-4.29; P = 0.01) for ≥80 years favoring the minimally invasive approach. The sensitivity analysis did not materially change the results. CONCLUSIONS Older patients may derive more LOS benefit from minimally invasive approaches than younger patients. Given the greater expense associated with the minimally invasive approach, an age-adapted strategy to using this technology may be reasonable.
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Affiliation(s)
- Kassem Faraj
- Department of Urology, Mayo Clinic Hospital, Phoenix, AZ
| | | | | | - Gail Blodgett
- Biostatistics, and Patient Collaborator, Mayo Clinic, Scottsdale, AZ
| | - David A Etzioni
- Department of Urology, Division of Colon and Rectal Surgery, Mayo Clinic Hospital, Phoenix, AZ
| | | | - Paul E Andrews
- Department of Urology, Mayo Clinic Hospital, Phoenix, AZ
| | - Erik P Castle
- Department of Urology, Mayo Clinic Hospital, Phoenix, AZ
| | | | - Mark D Tyson
- Department of Urology, Mayo Clinic Hospital, Phoenix, AZ.
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