Munier Nazzal
University of Cincinnati, Early Childhood Education, Graduate Student
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ObjectivesThis study examined the current demographic and outcome trends regarding endovascular and open revascularization for people with diabetes.MethodsThe National Inpatient Sample database was utilized to identify diabetic patients... more
ObjectivesThis study examined the current demographic and outcome trends regarding endovascular and open revascularization for people with diabetes.MethodsThe National Inpatient Sample database was utilized to identify diabetic patients who underwent lower extremity revascularization and amputation procedures between 2008 and 2014. International Classification of Diseases 9th edition codes were used to identify the procedures, diagnoses, and comorbidities.ResultsWe identified 38,143 diabetic patients who underwent endovascular revascularization and 25,415 who underwent open revascularization between 2008 and 2014. The number of endovascular and open revascularization procedures decreased steadily by 17.5% and 12.43% during the study period, respectively. The total charges for the endovascular procedure were greater than the open procedure ($98,761 vs. $80,782, p ≤ 0.001) despite similar median length of stay (5 days (inner quartile range (IQR) = 1–10) vs. 5 days (IQR = 3–10), p ≤ 0.001). Compared to open, the in-patient amputation rate for endovascular patients has been increasing faster for both minor (11.75% vs. 0.37%) and major amputations (3.08% vs. 0.19%). Although the post-procedure amputation rates between endovascular and open procedures were increased for endovascular patients (odds ratio [OR] = 1.71, confidence interval [CI] = 1.35–2.18, p ≤ 0.001) in 2008, by 2014 the risk of major amputation was doubled in endovascular patients (OR = 2.88, CI = 2.27–3.64, p ≤ 0.001). African Americans were more likely to undergo minor amputation than Whites ( p ≤ 0.001). Lastly, diabetic patients with uncontrolled diabetes, systemic infection, weight loss, congestive heart failure, gangrene, and end-stage renal disease were more likely to undergo endovascular repair.ConclusionsAs more medically complex patients undergo endovascular revascularization, endovascular revascularization for diabetic patients is becoming associated with higher total cost despite similar length of stay, minor amputation, and major amputation rates. Further studies are needed to continuously evaluate the post-procedural outcomes and cost effectiveness of this trend.
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Objectives Non-traumatic lower extremity amputation (LEA) is associated with significant morbidity and mortality. Diabetes mellitus (DM) and peripheral vascular disease (PVD) are associated with increased risk for LEA. As such, DM and PVD... more
Objectives Non-traumatic lower extremity amputation (LEA) is associated with significant morbidity and mortality. Diabetes mellitus (DM) and peripheral vascular disease (PVD) are associated with increased risk for LEA. As such, DM and PVD account for 54% of all LEA’s, performed in the United States annually. As obesity is highly associated with both DM and PVD, our study sought to explore the relationship between LEA and obesity defined by BMI. Methods Using the National Inpatient Sample (NIS) database, a retrospective review of patients who underwent non-traumatic LEA (LEA) between 2008 and 2014 was performed. The International Classification of Diseases 9th edition (ICD-9) codes were utilized to determine the diagnoses, comorbidities, and procedures. Patient BMIs were classified as follows: Non-obese [BMI <30], Obesity class I [BMI 30–34.9], Obesity class II [BMI 35–39.9], and Obesity class III [BMI ≥40]. Predictors for LEA were compared between groups using chi-square test and...
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ObjectiveTo assess the feasibility of implementing the National Surgical Quality Improvement Program (NSQIP) methodology in non-VA hospitals. Summary Background DataUsing data adjusted for patient preoperative risk, the NSQIP compares the... more
ObjectiveTo assess the feasibility of implementing the National Surgical Quality Improvement Program (NSQIP) methodology in non-VA hospitals. Summary Background DataUsing data adjusted for patient preoperative risk, the NSQIP compares the performance of all VA hospitals performing major surgery and anonymously compares these hospitals using the ratio of observed to expected adverse events. These results are provided to each hospital and used to identify areas for improvement. Since the NSQIP’s inception in 1994, the VA has reported consistent improvements in all surgery performance measures. Given the success of the NSQIP within the VA, as well as the lack of a comparable system in non-VA hospitals, this pilot study was undertaken to test the applicability of the NSQIP models and methodology in the nonfederal sector. MethodsBeginning in 1999, three academic medical centers (Emory University, Atlanta, GA; University of Michigan, Ann Arbor, MI; University of Kentucky, Lexington, KY) volunteered the time of a dedicated surgical nurse reviewer who was trained in NSQIP methodology. At each academic center, these nurse reviewers used NSQIP protocols to abstract clinical data from general surgery and vascular surgery patients. Data were manually collected and then transmitted via the Internet to a secure web site developed by the NSQIP. These data were compared to the data for general and vascular surgery patients collected during a concurrent time period (10/99 to 9/00) within the VA by the NSQIP. Logistic regression models were developed for both non-VA and VA hospital data. To assess the models’ predictive values, C-indices (0.5 = no prediction; 1.0 = perfect prediction) were calculated after applying the models to the non-VA as well as the VA databases. ResultsData from 2,747 (general surgery 2,251; vascular surgery 496) non-VA hospital cases were compared to data from 41,360 (general surgery 31,393; vascular surgery 9,967) VA cases. The bivariate relationships between individual risk factors and 30-day mortality or morbidity were similar in the non-VA and VA patient populations for over 66% of the risk variables. C-indices of 0.942 (general surgery), 0.915 (vascular surgery), and 0.934 (general plus vascular surgery) were obtained following application of the VA NSQIP mortality model to the non-VA patient data. Lower C-indices (0.778, general surgery; 0.638, vascular surgery; 0.760, general plus vascular surgery) were obtained following application of the VA NSQIP morbidity model to the non-VA patient data. Although the non-VA sample size was smaller than the VA, preliminary analysis suggested no differences in risk-adjusted mortality between the non-VA and VA cohorts. ConclusionsWith some adjustments, the NSQIP methodology can be implemented and generates reasonable predictive models within non-VA hospitals.
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Research Interests: Cardiology, Comorbidity, Humans, Internal Medicine, Congestive Heart Failure, and 15 moreFemale, Clinical Sciences, Aged, Coronary heart disease, Carotid Endarterectomy, Chronic obstructive pulmonary disease, Cerebral protection, Carotid Artery, Cerebrovascular Accident, Cardiac Disease, Carotid Stenosis, Cardiopulmonary bypass, Coronary artery bypass graft, High risk, and Cardiovascular medicine and haematology(Female, Clinical Sciences, Aged, Coronary heart disease, Carotid Endarterectomy, Chronic obstructive pulmonary disease, Cerebral protection, Carotid Artery, Cerebrovascular Accident, Cardiac Disease, Carotid Stenosis, Cardiopulmonary bypass, Coronary artery bypass graft, High risk, and Cardiovascular medicine and haematology)
(Female, Clinical Sciences, Aged, Coronary heart disease, Carotid Endarterectomy, Chronic obstructive pulmonary disease, Cerebral protection, Carotid Artery, Cerebrovascular Accident, Cardiac Disease, Carotid Stenosis, Cardiopulmonary bypass, Coronary artery bypass graft, High risk, and Cardiovascular medicine and haematology)
Cricopharyngeal myotomy as an independent procedure has been performed on fourteen patients with a variety of neuromuscular disorders, suffering from neurogenic oropharyngeal dysphagia in the interval between 1994-1997. All of them were... more
Cricopharyngeal myotomy as an independent procedure has been performed on fourteen patients with a variety of neuromuscular disorders, suffering from neurogenic oropharyngeal dysphagia in the interval between 1994-1997. All of them were referred from a neurophysician or physiatrist after failure of improvement by medical treatment. The selection of patients for operation was based mainly on clinical evaluation and simple exclusion criteria without manometric studies. There was dramatic improvement in twelve, with recurrent laryngeal nerve palsy and temporary pharyngeal fistula in two patients. No mortality was recorded. We conclude that cricopharyngeal myotomy is a simple, safe and effective procedure with acceptable morbidity. It should be considered as a rehabiliation procedure for patients with dysphagia due to various neurologic disorders based on simple, clinical exclusion criteria without the need for the tedious, time consuming and expensive manometric studies.
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Attached are the data-set and the data output files obtained from the data analysis in our study.
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Objective Readmission after vascular procedures is a burden to hospitals and the Medicare system. Therefore, identifying risk factors leading to readmission is vital. We examined the frequency of and risk factors for 30-day readmission... more
Objective Readmission after vascular procedures is a burden to hospitals and the Medicare system. Therefore, identifying risk factors leading to readmission is vital. We examined the frequency of and risk factors for 30-day readmission after open aneurysm repair (OAR) and explored post-operative outcomes with special attention for those with preexisting chronic kidney disease (CKD). Methods Patients who underwent OAR were identified in the National Readmission Database (2016–2018). Demographic information and comorbidities were collected. Patients readmitted within 30 days after their index hospitalization were identified and compared to patients without readmission records. Results A total of 5090 patients underwent OAR during the study timeframe with 488 patients (9.6%) were readmitted within 30 days. Females were more readmitted than males (F = 11.1% vs M = 9.0%, P < 0.001). Readmitted patients had more comorbidities (median ECI 12, P < 0.05), were on Medicare (73.7%, P <...
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OBJECTIVES Increased demand for quality health care has led to lay-press ranking systems, such as the ranking from US News and World Report (US News). Their "Best Hospitals" publication advertises itself as the go-to resource... more
OBJECTIVES Increased demand for quality health care has led to lay-press ranking systems, such as the ranking from US News and World Report (US News). Their "Best Hospitals" publication advertises itself as the go-to resource for patients seeking care in a number of specialty areas. We sought to test the relationship between US News rankings and transplant outcomes. MATERIALS AND METHODS Using data from 2014 to 2018, we compared outcomes from the Scientific Registry of Transplant Recipients database for liver and kidney transplants against US News-ranked centers using the categories "Nephrology" and "GI Surgery and Gastroenterology" as substitutes, as US News does not rank transplant centers specifically. P < .05 was set as significant. RESULTS Using hazard ratio data, we found that kidney transplant center rank had only a small impact on postoperative outcomes in terms of patient survival (hazard ratio = 0.996, P = .049) but had no impact on graft survival (hazard ratio = 0.997, P = .077). In addition, liver transplant center rank had no impact on liver graft survival (hazard ratio = 1.003, P = .304). The impact of hospital ranking on survival was minimal compared with other variables. CONCLUSIONS The US News rankings for "Nephrology" and "GI Surgery and Gastroenterology" have minimal values as a measure of liver and kidney transplant outcomes, highlighting that these lay press rankings are not useful to the unique transplant patient population and that providers should help guide patients to transplant-specific resources.
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Intradural disc herniation accounts for < 0.3% of all disc herniations. Intraradicular disc herniation accounts for 4.1% of all such cases. Preoperative diagnosis is difficult, and a high index of suspicion during surgery is required... more
Intradural disc herniation accounts for < 0.3% of all disc herniations. Intraradicular disc herniation accounts for 4.1% of all such cases. Preoperative diagnosis is difficult, and a high index of suspicion during surgery is required for the diagnosis. We present a patient with intraradicular disc herniation in the lumbar region whose symptoms were severe enough to recommend surgery. The myelogram showed a block at the involved nerve root. Diagnosis of intraradicular herniation was made during surgery. The symptoms were immediately relieved by surgery. The literature on intradural and intraradicular disc herniation is reviewed.
Research Interests: Medicine, Case Report, Humans, Male, Middle Aged, and 2 moreSpinal and Myelography(Spinal and Myelography)
(Spinal and Myelography)
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Laparoscopic appendectomy (LA) is relatively a new technique and requires comparison to open appendectomy (OA) to determine the more favorable approach in the surgical management of acute appendicitis. We designed this study to compare... more
Laparoscopic appendectomy (LA) is relatively a new technique and requires comparison to open appendectomy (OA) to determine the more favorable approach in the surgical management of acute appendicitis. We designed this study to compare the course and postoperative complications between LA and OA. We reviewed the charts of both groups of patients and followed their course in the hospital. Seventy-seven patients who underwent LA with one conversion to the open technique (1.3%) were compared to 84 patients who underwent OA. There was no difference in age and sex distribution. The mean hospital stay was shorter in the LA (32.5+/-10 vs 74.2+/-24 h, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). Parenteral analgesia requirement was higher in the OA group (4.7+/-1.4 vs 2.6+/-2, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). The total cost was higher in the OA group ($11,260+/-4000 vs 7,090+/-3500, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). There was no significant difference in the OR time, duration of the procedure, and surgery costs between both groups. Normal appendices removed were similar in both OA and LA groups (23.8 vs 28.9%). There was no difference in the rates of postoperative complications between both groups. We conclude that LA is a viable alternative to OA. It is safe, cost effective, and less invasive than the OA with less pain and shorter hospital stay.
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Unlike vein bypasses, the role of duplex surveillance of infrainguinal prosthetic bypass grafts is controversial. The purpose of this study was to evaluate the adequacy of color duplex surveillance in identifying failing infrainguinal... more
Unlike vein bypasses, the role of duplex surveillance of infrainguinal prosthetic bypass grafts is controversial. The purpose of this study was to evaluate the adequacy of color duplex surveillance in identifying failing infrainguinal polytetrafluoroethylene (PTFE) bypass grafts and to assess its value in predicting continued bypass patency. The surveillance data of primarily patent PTFE bypass grafts were compared with those of revised/occluded PTFE grafts. Ninety-five patients underwent 102 infrainguinal PTFE bypass grafts from January 1991 to December 1996 and were enrolled in a duplex surveillance program at 1 month postoperatively, every 3 months in the first year, every 6 months in the second year, and yearly thereafter. Seventy grafts remained primarily patent, 5 were revised and 27 occluded. There was no significant difference in the mean age, gender, indication for surgery, type of original procedure, or duration of follow-up between both groups. Four hundred and seven duplex surveillance data were available for analysis. Focal increase in peak systolic velocity (PSV) 3 x the adjacent segment or low flow manifested by PSV &amp;amp;amp;amp;amp;amp;amp;amp;lt;45 cm/sec were considered abnormal. In the primarily patent group, 5 bypasses had abnormal duplex surveillance and were found to have no abnormality on angiogram and remained patent during the study period. In the revised/occluded group, duplex surveillance was abnormal in 8 bypasses. Twenty-four bypasses occluded without any predicting abnormalities on their last duplex examination, which was performed within 3 months from the occlusion in the majority of the patients. In the 27 occluded bypasses, no intervention was necessary following the occlusion in 7 grafts because of mild or no symptoms. Two patients were treated with a primary amputation and 2 had new bypasses. In 16 occluded grafts, salvage of the PTFE bypass was attempted. Ten of these grafts were patent at the end of the follow-up. The sensitivity of duplex surveillance was 25% with a positive predictive value of 61.5%. Duplex surveillance of infrainguinal PTFE bypass grafts has a low yield and is inadequate at predicting continued bypass patency.
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Objectives This study examined the current demographic and outcome trends regarding endovascular and open revascularization for people with diabetes. Methods The National Inpatient Sample database was utilized to identify diabetic... more
Objectives This study examined the current demographic and outcome trends regarding endovascular and open revascularization for people with diabetes. Methods The National Inpatient Sample database was utilized to identify diabetic patients who underwent lower extremity revascularization and amputation procedures between 2008 and 2014. International Classification of Diseases 9th edition codes were used to identify the procedures, diagnoses, and comorbidities. Results We identified 38,143 diabetic patients who underwent endovascular revascularization and 25,415 who underwent open revascularization between 2008 and 2014. The number of endovascular and open revascularization procedures decreased steadily by 17.5% and 12.43% during the study period, respectively. The total charges for the endovascular procedure were greater than the open procedure ($98,761 vs. $80,782, p ≤ 0.001) despite similar median length of stay (5 days (inner quartile range (IQR) = 1–10) vs. 5 days (IQR = 3–10), p...
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Objectives This study examined the current demographic and outcome trends regarding endovascular and open revascularization for people with diabetes. Methods The National Inpatient Sample database was utilized to identify diabetic... more
Objectives This study examined the current demographic and outcome trends regarding endovascular and open revascularization for people with diabetes. Methods The National Inpatient Sample database was utilized to identify diabetic patients who underwent lower extremity revascularization and amputation procedures between 2008 and 2014. International Classification of Diseases 9th edition codes were used to identify the procedures, diagnoses, and comorbidities. Results We identified 38,143 diabetic patients who underwent endovascular revascularization and 25,415 who underwent open revascularization between 2008 and 2014. The number of endovascular and open revascularization procedures decreased steadily by 17.5% and 12.43% during the study period, respectively. The total charges for the endovascular procedure were greater than the open procedure ($98,761 vs. $80,782, p ≤ 0.001) despite similar median length of stay (5 days (inner quartile range (IQR) = 1–10) vs. 5 days (IQR = 3–10), p...
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Background In previous carotid revascularization trials, stroke as a qualifying symptom has had the greatest importance as a predictor of subsequent outcomes. However, the importance of stroke, TIA, amaurosis fugax, and asymptomatic... more
Background In previous carotid revascularization trials, stroke as a qualifying symptom has had the greatest importance as a predictor of subsequent outcomes. However, the importance of stroke, TIA, amaurosis fugax, and asymptomatic status has not been analyzed together and comparatively as predictors of outcome for carotid stenosis in a randomized clinical trial (RCT). Methods Qualifying events were analyzed for the 1321 symptomatic patients in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) and were modeled as predictors of the primary outcome (stroke, myocardial infarction, and death during a 30-day peri-procedural period, or ipsilateral stroke over the follow-up period out to 4 years); the potential predictive value was also tested for the outcome of stroke and death. The model included other potential predictors such as age, sex, and treatment. Results The distribution of pre-randomization qualifying events among symptomatic patients in CREST was 572 ...
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Background In previous carotid revascularization trials, stroke as a qualifying symptom has had the greatest importance as a predictor of subsequent outcomes. However, the importance of stroke, TIA, amaurosis fugax, and asymptomatic... more
Background In previous carotid revascularization trials, stroke as a qualifying symptom has had the greatest importance as a predictor of subsequent outcomes. However, the importance of stroke, TIA, amaurosis fugax, and asymptomatic status has not been analyzed together and comparatively as predictors of outcome for carotid stenosis in a randomized clinical trial (RCT). Methods Qualifying events were analyzed for the 1321 symptomatic patients in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) and were modeled as predictors of the primary outcome (stroke, myocardial infarction, and death during a 30-day peri-procedural period, or ipsilateral stroke over the follow-up period out to 4 years); the potential predictive value was also tested for the outcome of stroke and death. The model included other potential predictors such as age, sex, and treatment. Results The distribution of pre-randomization qualifying events among symptomatic patients in CREST was 572 ...
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BACKGROUND The objective of this study was to create an algorithm that could predict diabetic foot ulcer (DFU) incidence in the in-patient population. MATERIALS AND METHODS The Nationwide Inpatient Sample datasets were examined from 2008... more
BACKGROUND The objective of this study was to create an algorithm that could predict diabetic foot ulcer (DFU) incidence in the in-patient population. MATERIALS AND METHODS The Nationwide Inpatient Sample datasets were examined from 2008 to 2014. The International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM) and the Agency for Healthcare Research and Quality comorbidity codes were used to assist in the data collection. Chi-square testing was conducted, using variables that positively correlated with DFUs. For descriptive statistics, the Student T-test, Wilcoxon rank sum test, and chi-square test were used. There were six predictive variables that were identified. A decision tree model CTREE was utilized to help develop an algorithm. RESULTS 326,853 patients were noted to have DFU. The major variables that contributed to this diagnosis (both with p < 0.001) were cellulitis (OR 63.87, 95% CI [63.87-64.49]) and Charcot joint (OR 25.64, 95% CI [25.09-26.20]...
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Les consequences hemodynamiques de lesions combinees arterielles et veineuses et de la stase veineuse ont ete etudiees au niveau des pattes arrieres de 10 chiens. La pression et le debit arteriels femoraux, la pression veineuse... more
Les consequences hemodynamiques de lesions combinees arterielles et veineuses et de la stase veineuse ont ete etudiees au niveau des pattes arrieres de 10 chiens. La pression et le debit arteriels femoraux, la pression veineuse peripherique et les resistances peripheriques ont ete mesures pendant les 72 heures suivant la restauration du flux sanguin apres une lesion arterio-veineuse et une periode de quatre heures d'interruption vasculaire. Chez chacun des chiens, l'artere et la veine d'une patte ont ete reparees alors qu'au niveau de l'autre patte, seule l'artere etait reparee et la veine liee. Le debit arteriel etait diminue de facon significative dans les deux groupes par rapport aux valeurs de base pendant les 30 premieres minutes suivant la restauration du flux sanguin
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BACKGROUND We sought to assess health professionals' satisfaction with the National Pressure Injury Advisory Panel staging system (NPUAP). METHODS A paper survey assessing the satisfaction with the NPUAP was distributed to... more
BACKGROUND We sought to assess health professionals' satisfaction with the National Pressure Injury Advisory Panel staging system (NPUAP). METHODS A paper survey assessing the satisfaction with the NPUAP was distributed to participants of a national wound care meeting. A total of 88 surveys were completed. Results were tabulated using SPSS. RESULTS The survey response rate was 50%. Nearly all respondents (95.0%) used NPAUP for documentation. 75.3% indicated that a better staging system was needed. When participants were asked to evaluate their current staging system, 63.5% stated that the system does not adequately reflect patient's clinical condition, 61.6% felt that the current staging system was not easily reproducible, 58.0% believed that the current staging system was generally easy-to-use, and 43.9% indicated that it is unable to suggest management recommendations. When asked about an ideal classification system, the respondents proposed incorporating tissue necrosis (...
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Minimally invasive sigmoid colectomy via the laparoscopic approach (LA) has numerous benefits. We seek to compare outcomes between laparoscopic and robotic sigmoid colectomies. We analyzed the data using the National Inpatient Sample... more
Minimally invasive sigmoid colectomy via the laparoscopic approach (LA) has numerous benefits. We seek to compare outcomes between laparoscopic and robotic sigmoid colectomies. We analyzed the data using the National Inpatient Sample database between 2008 and 2014. Utilization and outcome measures were compared. The seven-year average number of patients who underwent elective sigmoid colectomy in the United States from 2008 to 2014 was estimated to be 197,053. Of these, 95.1 per cent were conducted using the LA. The mean age was 58.33 + 13.6 years and 58.23 + 12.8 years in laparoscopic and robotic approaches, respectively. No significant differences existed in respect to morbidities. Postoperative complications were comparable with respect to other complications. Length of hospital stay was statistically significantly shorter in the robot-assisted approach compared with the LA (mean 4.8 + 4 vs 5.7 + 5 days, respectively, P < 0.001). Patients who underwent robotic surgery had sign...
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The aim of this study was to compare postoperative outcomes after robotic-assisted and laparoscopic bariatric sleeve gastrectomy (SG). Sleeve gastrectomy is traditionally performed using laparoscopic techniques. Robotic-assisted surgery... more
The aim of this study was to compare postoperative outcomes after robotic-assisted and laparoscopic bariatric sleeve gastrectomy (SG). Sleeve gastrectomy is traditionally performed using laparoscopic techniques. Robotic-assisted surgery enables surgeons to perform minimally invasive SG, but with unknown benefits. Using a national database, we compared postoperative outcomes after laparoscopic SG and robotic-assisted SG. National data from individuals undergoing elective SG in the National Inpatient Sample database between 2011 and 2013 were analyzed. Propensity score matching was used to match robotic and laparoscopic groups by demographics, comorbidities, and hospital characteristics. The matching cohorts were compared. A total of 26,195 patients who underwent elective SG for morbid obesity were included. Of these, 25,391 (96.9%) were completed via laparoscopy, whereas 804 (3.1%) were performed with robotic assistance. There were no significant differences in demographics and subse...
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OBJECTIVE To determine if history of kidney transplant is an independent risk factor for increased incidence of wound infection and other morbidities in burn patients. BACKGROUND While the goal of immunosuppression post-organ... more
OBJECTIVE To determine if history of kidney transplant is an independent risk factor for increased incidence of wound infection and other morbidities in burn patients. BACKGROUND While the goal of immunosuppression post-organ transplantation is to prevent graft rejection, it is often associated with significant adverse effects such as increased susceptibility to infection, drug toxicity, and malignancy. Burn injuries lead to a dysregulated hypermetabolic state and a compromised cutaneous barrier, which predisposes to infection and delayed wound healing. We surmise that a history of kidney transplant increases the risk of wound infection in in-hospital burn victims. METHODS A retrospective analysis was performed on 57,948 adults diagnosed in-hospital with a burn injury between 2008-2014, obtained from the Nationwide Inpatient Sample (NIS) by Healthcare Cost and Utilization Project (HCUP). RESULTS 103 burn victims (0.2%) with a history of kidney transplant (KTX) were identified. Compared to burn patients without a history of transplant (No-KTX), they were older (54.3 ± 13.8 vs 49.8 ± 18.7; p = 0.001), more likely be insured under Medicare (69.9% vs 31.1%; p < 0.001), and less likely to have Medicaid (5.8% vs 17.2%; p = 0.002). Higher in-hospital mortality index scores were observed in KTX compared to no-KTX with p < 0.001. The incidence rates of complications such as wound infection (33.0 vs 16.3; p < 0.001) and acute renal failure (18.4 vs 7.7; p < 0.001) were significantly higher in the KTX group. After adjusting for confounding factors in multivariable analysis, the incidence of wound infection remained significantly higher. Burn patients with history of KTX were not more likely to be treated at a transplant (TX) center. TX centers were determined to have higher mortality rate, longer length of stay, and higher total hospital charges. CONCLUSION History of kidney transplant is an independent risk factor for increased incidence of wound infection in burn patients.
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BACKGROUND There is currently little consensus on the role of thrombectomy compared with catheter-directed lysis (CDL) for acute, extensive, proximal deep vein thrombosis (DVT). We sought to determine whether any differences in outcomes... more
BACKGROUND There is currently little consensus on the role of thrombectomy compared with catheter-directed lysis (CDL) for acute, extensive, proximal deep vein thrombosis (DVT). We sought to determine whether any differences in outcomes exist between thrombectomy and CDL in terms of postoperative venous patency, pulmonary emboli (PE), and bleeding/hematoma. METHODS In an institutional review board-approved retrospective cohort study, patients from a single academic medical center with confirmed lower extremity DVT were divided into thrombectomy and CDL cohorts. Demographic information, comorbidities and laboratory data, postoperative patency, postoperative bleeding, postoperative PE, popliteal hematoma, and recurrence of DVT were collected. Type I error level was set at 0.05. RESULTS Eighty-seven patients were identified, 51.7% received CDL, and 48.3% underwent thrombectomy. Patient comorbidities and hypercoagulable states were not significantly different among the groups. The two techniques did not have significantly different postoperative patency (P = 0.472), bleeding (P = 0.598), PE (P = 0.868), popliteal hematoma (P = 0.331), or recurrence of DVT (P = 0.835). CONCLUSIONS In selecting optimum treatment for acute, extensive, proximal DVT, our retrospective cohort study found no significant differences among treatment groups in safety, efficacy, recurrence, and progression to PE. We conclude that modality of treatment should be decided based on hospital resources, surgeon experience, and comfort with each technique, patient's physiologic status, and associated costs.
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OBJECTIVE Postoperative mortality following open and endovascular repair of thoracic aortic dissection (AD) has been the focus of previous research. However, a little has been published on the far less common Isolated Abdominal Aortic... more
OBJECTIVE Postoperative mortality following open and endovascular repair of thoracic aortic dissection (AD) has been the focus of previous research. However, a little has been published on the far less common Isolated Abdominal Aortic Dissection (IAAD). The aim of our study was to identify risk factors associated with 30-day postoperative mortality in IAAD patients. METHODS The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) was queried for patients who underwent open or endovascular aortic dissection repair from January 2010 to December 2015. Information regarding patient demographics, comorbidities, pre-operative laboratory values, procedure details, and post-operative complications were analyzed, and predictors of 30-day mortality were identified. Risk stratification by the type of aortic repair and surgery setting was performed, and patient characteristics associated with mortality in each setting were determined. We employed Chi-square test, Student's t-test and Mann-Whitney U test for the univariate analysis; while the multivariate analysis was performed using a stepwise binary logistic regression test. RESULTS There were 229 patients who met the specified criteria, 15 died within 30 days postoperatively, and 214 survived beyond the same period (mortality rate was 6.5%). Among preoperative factors, a history of chronic obstructive pulmonary disease (COPD), preoperative ventilator dependence, preoperative transfusion of ≥1 unit packed RBCs, emergent operation and advanced American Society of Anesthesiologists (ASA) class were associated with increased risk of mortality. Postoperative complications associated with a higher risk of mortality were acute kidney injury, mechanical ventilation ≥48 hours, unplanned intubation, myocardial infarction, septic shock, and blood transfusion. On multivariate analysis, risk factors independently associated with increased risk of mortality were a history of COPD (AOR, 10.5; p=0.013), postoperative acute renal failure (AOR, 12.8; p=0.003) and septic shock (AOR, 15.3; p=0.014). CONCLUSION Multiple preoperative and postoperative factors are associated with a high risk of death following IAAD repair. A better control of COPD and prevention of postoperative acute renal failure and septic shock may result in better outcomes.
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Acute stroke due to tandem cervical internal carotid artery (ICA) and intracranial large-vessel occlusion (ILVO) has a high rate of morbidity and mortality. The most appropriate treatment strategy for the extracranial culprit lesion... more
Acute stroke due to tandem cervical internal carotid artery (ICA) and intracranial large-vessel occlusion (ILVO) has a high rate of morbidity and mortality. The most appropriate treatment strategy for the extracranial culprit lesion remains unclear. In this study, we report our institutional outcomes with two approaches: emergent carotid endarterectomy (CEA) and carotid artery stenting (CAS). Patients with tandem ICA-ILVO were identified in a prospective mechanical thrombectomy (MT) database between July 2012 and April 2016. Patients had a concomitant complete ICA origin occlusion and occlusion of the intracranial ICA or M1 or M2 middle cerebral artery segment. Baseline characteristics, procedural data, and treatment times were reviewed. End points included good recanalization of both ICA and ILVO, symptomatic intracerebral hemorrhage (defined by clinical decline of >4 points on the National Institutes of Health Stroke Scale), and functional outcome at 90 days. Forty-five patient...
Research Interests: Treatment Outcome, Vascular Surgery, Medicine, Stents, Humans, and 14 moreFemale, Feasibility Studies, Male, Aged, Middle Aged, Time Factors, Retrospective Studies, Carotid Endarterectomy, Emergencies, Carotid Stenosis, Endovascular Procedures, Recovery of Function, Disability Evaluation, and Medical and Health Sciences
Our aim was to assess outcomes in White and African American kidney transplant recipients after induction with alemtuzumab. We performed a retrospective study of 464 patients who received deceased-donor kidney transplants and were induced... more
Our aim was to assess outcomes in White and African American kidney transplant recipients after induction with alemtuzumab. We performed a retrospective study of 464 patients who received deceased-donor kidney transplants and were induced with alem-tuzumab between March 2006 and May 2015. We evaluated ethnic influences on patient and graft survival, delayed graft function, allograft failure, and rejection. There were 337 White (67.3%) and 127 African American (25.3%) patients. We observed no significant differences in 1-, 3-, 5-, and 7- year death-censored graft survival. We also observed no significant differences in 1-, 3-, and 5-year patient survival rates. Having African American ethnicity was not a significant predictor of rejection, graft survival, or patient survival. Our results indicate that recipient ethnicity is not a predictor of rejection, graft survival, or patient survival. White and African American kidney transplant recipients induced with alemtuzumab experienced an...
Research Interests: Medicine()
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Objectives: (1) Describe the prevalence of Ménière’s disease and migraine in the United States. (2) Recognize patient and environmental factors in Ménière’s disease. Methods: Discharge data from the Nationwide Inpatient Sample, the... more
Objectives: (1) Describe the prevalence of Ménière’s disease and migraine in the United States. (2) Recognize patient and environmental factors in Ménière’s disease. Methods: Discharge data from the Nationwide Inpatient Sample, the largest US all-payer inpatient care database, was analyzed for migraine or Ménière’s disease between 2008-2010 in patients >10 years old. Patient characteristics, including prevalence, age, sex, race, household income, and geographic location were studied to determine any correlation with disease prevalence. T test, chi-square, and linear regression testing were used to compare the differences between groups for continuous and categorical data. Results: Ménière’s prevalence was 73 per 100,000, females 84 per 100,000 compared with 56 per 100,000 among males (odds ratio [OR] = 1.51, 95% confidence interval [CI] 1.48-1.54, P < .01). Among Ménière’s patients, migraine prevalence was 142 per 100,000 compared to 25 per 100,000 (relative risk [RR] = 5.7, 9...
Research Interests:
Research Interests:
Pressure ulcers are common, increase patient morbidity and mortality, and costly for patients, their families, and the health care system. A retrospective study was conducted to evaluate the impact of pressure ulcers on short-term... more
Pressure ulcers are common, increase patient morbidity and mortality, and costly for patients, their families, and the health care system. A retrospective study was conducted to evaluate the impact of pressure ulcers on short-term outcomes in United States inpatient populations and to identify patient characteristics associated with having 1 or more pressure ulcers. The US Nationwide Inpatient Sample (NIS) database was analyzed using the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9 CM) diagnosis codes as the screening tool for all inpatient pressure ulcers recorded from 2008 to 2012. Patient demographics and comorbid conditions, as identified by ICD-9 code, were extracted, along with primary outcomes of length of stay (LOS), total hospital charge (TC), inhospital mortality, and discharge disposition. Continuous variables with normal distribution were expressed in terms of mean and standard deviation. Group comparisons were performed using t-tes...