11 results on '"Thomsen, Kristine"'
Search Results
2. Reoperation for Complications after Lumpectomy and Mastectomy for Breast Cancer from the 2012 National Surgical Quality Improvement Program (ACS-NSQIP).
- Author
-
Al-Hilli Z, Thomsen KM, Habermann EB, Jakub JW, and Boughey JC
- Subjects
- Adult, Aged, Aged, 80 and over, Breast Neoplasms pathology, Female, Follow-Up Studies, Humans, Mammaplasty, Middle Aged, Neoplasm Invasiveness, Neoplasm Staging, Patient Readmission statistics & numerical data, Prognosis, Risk Factors, Second-Look Surgery, Breast Neoplasms surgery, Mastectomy, Mastectomy, Segmental, Postoperative Complications, Quality Improvement, Reoperation
- Abstract
Background: Hospital readmissions and reoperations are quality indicators of patient care. In 2012, the National Surgical Quality Improvement Program (ACS-NSQIP) began reporting details regarding unplanned reoperations within 30 days of initial procedure. The main objective of this study was to identify reoperation rates as a result of complications and evaluate complications by type of breast surgery., Methods: Patients who underwent surgery for breast cancer were identified from the 2012 ACS-NSQIP Participant User File. Breast procedures were categorized as mastectomy or lumpectomy, each with or without immediate breast reconstruction (IBR). All reoperations and complication-related reoperations were categorized on the basis of procedure and diagnosis codes, and rates were compared by breast procedure by Chi square tests., Results: Of 18,500 patients, 781 (4 %) required an unplanned reoperation within 30 days (single reoperation in 747, 2+ reoperations in 34). Mean time to first reoperation was 13.4 days and varied by procedure. A majority (73 %) of ACS-NSQIP coded unplanned reoperations were due to complications. Rates of reoperation due to complication were highest in mastectomy with IBR (7 %). Most common complications requiring reoperation were bleeding, followed by infection and wound-related problems., Conclusions: Unplanned reoperations after breast cancer surgery are more frequent after mastectomy with IBR than other breast operations. Bleeding is the most common complication requiring reoperation.
- Published
- 2015
- Full Text
- View/download PDF
3. A NSQIP Review of Major Morbidity and Mortality of Synchronous Liver Resection for Colorectal Metastasis Stratified by Extent of Liver Resection and Type of Colorectal Resection.
- Author
-
Shubert CR, Habermann EB, Bergquist JR, Thiels CA, Thomsen KM, Kremers WK, Kendrick ML, Cima RR, and Nagorney DM
- Subjects
- Aged, Female, Humans, Male, Middle Aged, Morbidity, Retrospective Studies, United States, Colectomy, Colorectal Neoplasms pathology, Colorectal Neoplasms surgery, Hepatectomy, Liver Neoplasms secondary, Liver Neoplasms surgery
- Abstract
Introduction: Safety of synchronous hepatectomy and colorectal resection (CRR) for metastatic colorectal cancer remains controversial. We hypothesized that both the extent of hepatectomy and CRR influences postoperative outcomes., Methods: Prospective 2005-2013 ACS-NSQIP data were retrospectively reviewed for mortality and major morbidity (MM) after (1) isolated hepatectomy, (2) isolated CRR, and (3) synchronous resection for colorectal cancer. Hepatectomy and CRR risk categories were created based on mortality and MM of respective isolated resections. The synchronous cohort was then stratified based on risk categories. Cumulative asynchronous mortality and MM were estimated compared to that observed in the synchronous cohort via unadjusted relative risk and risk difference., Results: There were 43,408 patients identified. Among isolated hepatectomy patients (N = 6,661), trisectionectomy and right hepatectomy experienced the greatest mortality and were defined as "major" hepatectomy. Among isolated CRR patients (N = 35,825), diverted left colectomy, abdominoperineal resection, total abdominal colectomy, and total abdominal proctocolectomy experienced the greatest MM and were defined as "high risk" CRR. Synchronous patients (N = 922) were stratified by hepatectomy and CRR risk categories; mortality and MM varied from 0.9 to 5.0 % and 25.5 to 55.0 %, respectively. Mortality and MM were greatest for patients undergoing "high risk" CRR and "major" hepatectomy and lowest for synchronous CRR and "minor" hepatectomy. As both CRR and hepatectomy risk categories increased, there was a significant trend in increasing mortality and MM in synchronous patients. Additionally, comparison of the synchronous resections versus the estimated cumulative asynchronous outcomes showed that (1) mortality was significantly less after synchronous minor hepatectomy and either low or high risk CRR, and (2) neither mortality nor major morbidity differed significantly after major hepatectomy with either high or low risk CRR., Conclusion: Major morbidity after synchronous hepatic and colorectal resections vary incrementally and are related to both the risk of hepatectomy and CRR. Stratification of outcomes by the hepatectomy and CRR components may reflect a more accurate description of risks. Comparison of synchronous and combined outcomes of individual operations supports a potential benefit for synchronous resections with minor hepatectomy.
- Published
- 2015
- Full Text
- View/download PDF
4. Proximal intestinal diversion is associated with increased morbidity in patients undergoing elective colectomy for diverticular disease: an ACS-NSQIP study.
- Author
-
Wise KB, Merchea A, Cima RR, Colibaseanu DT, Thomsen KM, and Habermann EB
- Subjects
- Adult, Aged, Elective Surgical Procedures, Female, Humans, Logistic Models, Male, Middle Aged, Morbidity, Quality Improvement, Retrospective Studies, Treatment Outcome, Colectomy adverse effects, Diverticulum, Colon surgery
- Abstract
Background: Elective colectomy for diverticular disease is common. Some patients undergo primary resection with proximal diversion in an effort to limit morbidity associated with potential anastomotic leak., Methods: The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database was queried. All patients undergoing a single, elective resection for diverticular disease from 2005 to 2011 were analyzed. Thirty-day outcomes were reviewed. Factors predictive of undergoing diversion and the risk-adjusted odds of postoperative morbidity with and without proximal diversion were determined by multivariable logistic regression models., Results: Fifteen thousand six hundred two patients undergoing non-emergent, elective resection were identified, of whom 348 (2.2 %) underwent proximal diversion. Variables predictive for undergoing proximal diversion included age ≥65 years, BMI ≥30, current smoking status, corticosteroid use, and serum albumin <3.0 g/dL. Multivariable analysis demonstrated that diversion was associated with significantly increased risk of surgical site infection (OR = 1.68), deep venous thrombosis (OR = 5.27), acute renal failure (OR = 5.83), sepsis or septic shock (OR = 1.75), readmission (OR = 2.57), and prolonged length of stay (OR = 3.35)., Conclusions: Proximal diversion in the setting of elective segmental colectomy for diverticular disease is uncommon. A combination of preoperative factors and intraoperative factors drives the decision for diversion. Patients who undergo diversion experience increased postoperative morbidity. Surgeons should have a low index of suspicion for postoperative complications and be prepared to mitigate their effect on the patient's outcome.
- Published
- 2015
- Full Text
- View/download PDF
5. Defining perioperative risk after hepatectomy based on diagnosis and extent of resection.
- Author
-
Shubert CR, Habermann EB, Truty MJ, Thomsen KM, Kendrick ML, and Nagorney DM
- Subjects
- Aged, Analysis of Variance, Bile Duct Neoplasms diagnosis, Bile Duct Neoplasms mortality, Bile Duct Neoplasms surgery, Carcinoma, Hepatocellular diagnosis, Carcinoma, Hepatocellular mortality, Carcinoma, Hepatocellular surgery, Chi-Square Distribution, Cholangiocarcinoma diagnosis, Cholangiocarcinoma mortality, Cholangiocarcinoma surgery, Databases, Factual, Female, Follow-Up Studies, Humans, Length of Stay, Liver Neoplasms diagnosis, Liver Neoplasms mortality, Liver Neoplasms surgery, Logistic Models, Male, Middle Aged, Multivariate Analysis, Postoperative Care methods, Postoperative Complications diagnosis, Preoperative Care methods, Retrospective Studies, Risk Assessment, Survival Analysis, Time Factors, Treatment Outcome, United States, Hepatectomy methods, Hepatectomy mortality, Hospital Mortality trends, Postoperative Complications mortality
- Abstract
Outcomes after hepatectomy have been assessed incompletely and have not been stratified by both extent of resection and diagnosis. We hypothesized that operative risk is better assessed by stratifying diagnoses into low- and high-risk categories and extent of resection into major and minor resection categories to more accurately evaluate the outcomes after hepatectomy. ACS-NSQIP was reviewed for 30-day operative mortality and major morbidity after partial hepatectomy (PH), left hepatectomy (LH), right hepatectomy (RH), and trisectionectomy (TS). Mortality was reviewed per diagnosis. "High Risk" was defined as the diagnoses associated with the greatest mortality. Major and minor resections were defined by comparison of outcomes for extent of resection by univariate analysis. Chi-square tests, t tests, Fisher's exact tests, and multivariable logistic regression were utilized to compare the outcomes across groups. Among the 7,043 patients, the greatest mortality was observed with hepatocellular carcinoma (5.2%) and cholangiocarcinoma (8.2%), either intra- or extrahepatic, which were classified "High Risk". Metastatic disease, benign neoplasms, and gallbladder cancer had a mortality rate of 1.3, 0.5, and 1.0%, respectively, and were classified "Low Risk". PH and LH were similar statistically for operative mortality and major morbidity within respective diagnosis risk groups (Low Risk: PH vs. LH and High Risk: PH vs. LH; all p > 0.05) and were defined as "Minor Resections". Similarly, RH and TS had similar operative mortality and major morbidity within respective diagnosis risk groups (Low Risk: RH vs. TS and High Risk: RH vs. TS; all p > 0.05) and were defined as "Major Resections". Risks of major morbidity and mortality increased for both diagnoses and the extent of resection. With minor resections, mortality and major morbidity were 5 and 1.6 times greater respectively for high-risk diagnosis than for low-risk diagnosis. With major resections, mortality and major morbidity were 4 and 1.6 times greater, respectively, for high-risk diagnoses than low-risk diagnoses. With low-risk diagnoses, mortality and major morbidity were 2.9 and 1.7 times greater, respectively, for major resections than minor resections (p < 0.001). With high-risk diagnoses, mortality and major morbidity were 2.3 and 1.7 times greater, respectively, for major resections than minor resections (all p < 0.001). Regardless of the extent of resection, high-risk diagnoses were independently associated with mortality (OR = 3.2 and 3.1, respectively) and major morbidity (OR = 1.5 and 1.5, respectively). Risk of hepatectomy is better assessed when stratified by both the diagnostic risk and the extent of resection. Accurate assessment of these outcomes has significant implications for preoperative planning, informed consent, resource utilization, and inter-institutional comparisons.
- Published
- 2014
- Full Text
- View/download PDF
6. Impact of availability of immediate breast reconstruction on bilateral mastectomy rates for breast cancer across the United States: data from the nationwide inpatient sample.
- Author
-
Habermann EB, Thomsen KM, Hieken TJ, and Boughey JC
- Subjects
- Adolescent, Adult, Aged, Breast Neoplasms pathology, Cohort Studies, Datasets as Topic, Female, Follow-Up Studies, Humans, Middle Aged, Neoplasm Staging, Prognosis, Young Adult, Breast Neoplasms surgery, Carcinoma, Intraductal, Noninfiltrating surgery, Hospitals, High-Volume statistics & numerical data, Mammaplasty, Mastectomy trends
- Abstract
Background: Availability of immediate breast reconstruction (IBR) varies among institutions, yet the impact of IBR availability on the rates of bilateral mastectomy (BM) versus unilateral mastectomy (UM) for breast cancer is unknown., Methods: From the 2002 to 2010 Nationwide Inpatient Sample, we identified women with breast cancer undergoing UM or BM with and without IBR using ICD-9 codes. Hospitals were classified as performing IBR if at least one hospitalization included both mastectomy and reconstruction and then by IBR volume. Statistical comparisons utilized Chi square tests, tests for trend, and multivariable logistic regression., Results: We identified 130,420 women undergoing UM (76.9 %) or BM (23.1 %) for breast cancer. Of 6,579 hospitals, 3,358 (51.0 %) performed no IBRs, while in the remaining 3,221 hospitals, 1 to 638 IBRs were performed per year. Large, teaching, urban, and Northeastern hospitals were more likely to have higher IBR volumes. BM rates were significantly higher in patients treated at those hospitals with higher IBR volumes, from 33.1 % at hospitals performing ≥24 IBRs per year to 9.0 % at hospitals without IBR (p < 0.001). Upon adjusted analysis, patients who elected BM were more likely to be seen at hospitals performing ≥24 IBRs per year (odds ratio 1.69 vs. UM, p < 0.001)., Conclusions: In this analysis of national data, BM rates were higher in hospitals where IBR was available, suggesting a significant influence of institutional factors on treatment options for breast cancer patients. Efforts are needed to ensure patients have access to IBR when desired and to better understand the reasons for hospital variation in BM rates.
- Published
- 2014
- Full Text
- View/download PDF
7. Risk factors associated with breast lymphedema.
- Author
-
Boughey JC, Hoskin TL, Cheville AL, Miller J, Loprinzi MD, Thomsen KM, Maloney S, Baddour LM, and Degnim AC
- Subjects
- Adult, Aged, Aged, 80 and over, Axilla, Body Mass Index, Breast Neoplasms complications, Female, Follow-Up Studies, Humans, Middle Aged, Neoplasm Staging, Prognosis, Prospective Studies, Risk Factors, Breast Neoplasms surgery, Lymphedema etiology, Mastectomy adverse effects, Postoperative Complications etiology, Sentinel Lymph Node Biopsy adverse effects
- Abstract
Background: The development of breast lymphedema (BLE) after breast/axillary surgery is poorly characterized. We prospectively evaluated clinical and surgical factors associated with development of BLE., Methods: Patients undergoing unilateral breast-conserving surgery were prospectively enrolled preoperatively and followed for development of BLE. To augment the number of patients with BLE for evaluation of risk factors, postoperative patients identified in the clinic with signs and symptoms of BLE were also enrolled. Logistic regression with Firth's penalized likelihood bias-reduction method was used for univariate and multivariate analysis., Results: Of 144 women, 124 were enrolled preoperatively (38 of whom developed BLE), and 20 women with BLE were enrolled postoperatively. Any type of axillary surgery was the strongest factor associated with BLE (odds ratio, 134; 95 % confidence interval, 18 to >1,000). All 58 BLE events occurred in women with axillary surgery as compared with no events in the 46 patients without axillary surgery (p < 0.0001). Among 98 women who underwent axillary surgery, BLE did not occur more often after axillary lymph node dissection versus sentinel lymph node biopsy (p = 0.38) and was not associated with total number of nodes removed (p = 0.52). In multivariate analysis, factors associated with the development of BLE in the axillary surgery subgroup included baseline BMI (p = 0.004), incision location (p = 0.009), and prior surgical biopsy (p = 0.01)., Conclusions: Risk of BLE is primarily related to performance of any axillary surgery but not the extent of axillary surgery or number of lymph nodes removed. Other factors associated with BLE were increased body mass index, incision location, and prior surgical excisional biopsy.
- Published
- 2014
- Full Text
- View/download PDF
8. Impact of neoadjuvant chemotherapy with FOLFOX/FOLFIRI on disease-free and overall survival of patients with colorectal metastases.
- Author
-
Boostrom SY, Nagorney DM, Donohue JH, Harmsen S, Thomsen K, Que F, Kendrick M, and Reid-Lombardo KM
- Subjects
- Camptothecin analogs & derivatives, Camptothecin therapeutic use, Chemotherapy, Adjuvant, Colorectal Neoplasms drug therapy, Colorectal Neoplasms surgery, Disease-Free Survival, Female, Fluorouracil therapeutic use, Hepatectomy, Humans, Leucovorin therapeutic use, Male, Middle Aged, Neoadjuvant Therapy, Organoplatinum Compounds therapeutic use, Retrospective Studies, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Colorectal Neoplasms mortality, Colorectal Neoplasms pathology, Liver Neoplasms mortality, Liver Neoplasms secondary
- Abstract
Study Aims: To determine if neoadjuvant FOLFOX/FOLFIRI is associated with improved disease-free survival (DFS) or overall survival (OS) in patients with colorectal metastases (CRM) to the liver., Methods: Ninety-nine patients (from 457 eligible) with CRM that underwent hepatic resection during 2000 to 2005 were included. Group 1 (n = 44) patients received neoadjuvant FOLFOX/FOLFIRI, and Group 2 (n = 55) did not receive neoadjuvant therapy., Results: There were 58% men. The median age for Group 1 was 58 and Group 2, 64 (p = 0.03). OS for Group 1 at 1, 3, and 5 years was 93%, 62%, and 51%, respectively, with a median OS of 5.8 years. In Group 2 survival at 1l, 3, and 5 years was 90%, 63%, and 45%, respectively, with a median OS of 3.7 years (HR 1.06, p = 0.87). The DFS for Group 1 at 1, 3, and 5 years was 51%, 20%, and 20%, with a median DFS of 1.1 years and Group 2 at 1, 3, and 5 years was 58%, 32%, and 32% (median DFS-1.2 years; HR = 1.24, p = 0.45)., Conclusions: Neoadjuvant FOLFOX/FOLFIRI was employed more frequently in younger patients with CRM; however, neoadjuvant chemotherapy for CRM was not significantly associated with an increase in OS or DFS, despite additional adjuvant therapy.
- Published
- 2009
- Full Text
- View/download PDF
9. Predictive and prognostic value of CA 19-9 in resected pancreatic adenocarcinoma.
- Author
-
Barton JG, Bois JP, Sarr MG, Wood CM, Qin R, Thomsen KM, Kendrick ML, and Farnell MB
- Subjects
- Aged, Bilirubin blood, Carcinoma, Pancreatic Ductal pathology, Carcinoma, Pancreatic Ductal surgery, Female, Humans, Lymph Nodes pathology, Male, Middle Aged, Pancreatic Neoplasms pathology, Pancreatic Neoplasms surgery, Pancreaticoduodenectomy, Prognosis, Proportional Hazards Models, ROC Curve, Retrospective Studies, Sensitivity and Specificity, CA-19-9 Antigen blood, Carcinoma, Pancreatic Ductal blood, Carcinoma, Pancreatic Ductal mortality, Pancreatic Neoplasms blood, Pancreatic Neoplasms mortality
- Abstract
Background: Preoperative serum values of CA 19-9 have been reported to be associated with survival in patients undergoing resection of pancreatic adenocarcinoma., Hypothesis: Preoperative CA 19-9 levels are associated with margin and/or lymph node status in patients undergoing pancreatoduodenectomy for pancreatic carcinoma., Methods: We conducted a review of 143 patients undergoing pancreatoduodenectomy for pancreatic adenocarcinoma from July 2001 through April 2006 at our institution. Preoperative serum values of CA 19-9 and total bilirubin, pathologic findings, and survival were analyzed. A cutoff value for CA 19-9 (120 U/ml) was determined using a Cox proportional hazards model for survival., Results: Overall survival at 1, 3, and 5 years for patients with CA 19-9 < or = 120 U/ml was 76%, 41%, and 31%, respectively, versus 64%, 17%, and 10% for patients with CA 19-9 > 120 U/ml (p = 0.002). CA 19-9 > 120 U/ml was not associated, however, with a greater chance of an R1 or R2 resection (p = 0.86), tumor involving the SMA margin (p = 0.88), tumor at the portal vein groove (p = 0.14), or lymph node metastases (p = 0.89)., Conclusions: Our findings do not support a cutoff value for CA 19-9 that is associated with margin or lymph node involvement. Preoperative CA 19-9 < or = 120 U/ml is, however, associated with increased overall and recurrence-free survival.
- Published
- 2009
- Full Text
- View/download PDF
10. Long-term functional and quality of life outcomes of patients after repair of large perianal skin defects for Paget's and Bowen's disease.
- Author
-
Conklin A, Hassan I, Chua HK, Wietfeldt ED, Larson DR, Thomsen KA, and Nivatvongs S
- Subjects
- Aged, Aged, 80 and over, Anus Neoplasms pathology, Anus Neoplasms physiopathology, Bowen's Disease pathology, Bowen's Disease physiopathology, Fecal Incontinence psychology, Female, Follow-Up Studies, Humans, Male, Middle Aged, Paget Disease, Extramammary pathology, Paget Disease, Extramammary physiopathology, Recovery of Function, Skin Neoplasms pathology, Skin Neoplasms physiopathology, Surveys and Questionnaires, Time Factors, Treatment Outcome, Anus Neoplasms surgery, Bowen's Disease surgery, Fecal Incontinence epidemiology, Paget Disease, Extramammary surgery, Quality of Life, Skin Neoplasms surgery
- Abstract
Introduction: The assessment of long- term functional and quality of life outcomes of these patients following repair of large defects after surgical excision has not been reported., Methods: Between 1992 and 2004, at two institutions, 18 patients underwent repair of a perianal defect for Paget's disease (n = 8) or Bowen's disease (n = 10) and were alive with intestinal continuity at last follow-up. Patients were mailed the fecal incontinence quality of life scale (FIQL) and the SF-36., Results: Fourteen patients (78%) responded. Median follow-up for responders was 5 years. Mean age was 65 years with 12 females. Subcutaneous skin flaps (11) and split-thickness skin grafts (three) were used to repair the perianal defects, which were circumferential in 11 patients (79%). Nine patients reported incontinence and completed the FIQL. The FIQL scores of patients reporting incontinence were lower for lifestyle, coping/behavior, and embarrassment but not significantly different for depression compared to patients without incontinence. SF-36 scores of the patients were not significantly different from the normative population., Conclusion: Functional results after repair of large perianal defects are acceptable and overall quality of life (QOL) is similar to the normative population although a large proportion of patients have some form of incontinence that impacts certain aspects of their QOL.
- Published
- 2009
- Full Text
- View/download PDF
11. Long-term anastomotic complications after pancreaticoduodenectomy for benign diseases.
- Author
-
Reid-Lombardo KM, Ramos-De la Medina A, Thomsen K, Harmsen WS, and Farnell MB
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Anastomosis, Surgical, Bile Ducts, Extrahepatic pathology, Constriction, Pathologic, Cystadenoma, Mucinous surgery, Female, Humans, Male, Middle Aged, Pancreatic Diseases diagnosis, Pancreatic Neoplasms surgery, Pancreaticoduodenectomy methods, Pancreatitis, Chronic diagnosis, Pancreatitis, Chronic mortality, Pancreatitis, Chronic surgery, Proportional Hazards Models, Survival Analysis, Pancreatic Diseases surgery, Pancreaticoduodenectomy adverse effects
- Abstract
Background: The study of long-term complications after pancreaticoduodenectomy (PD) for malignant disease has been problematic given the paucity of patients with long-term survival after diagnosis and surgical resection. We therefore studied patients who were surgically treated with a PD for a benign diagnosis to evaluate long-term anastomotic durability., Methods: A retrospective analysis of 122 patients who had PD performed in the interval 1993-2003 inclusive for benign pancreatic diseases was undertaken. Long-term morbidity and mortality (specifically biliary, pancreaticojejunostomy [PJ], and gastrojejunostomy [GJ] strictures) were evaluated., Results: Gender was equally represented with 53% female and 47% male. The median age at surgery was 55 years (range 15-81 years). The three most frequent diagnoses were chronic pancreatitis (40%), intraductal papillary mucinous neoplasm (16%), and cystic neoplasms (9%). Median follow-up in the 95 patients alive at last follow-up was 4.1 years (10 days-12.6 years). The 5- and 10-year survival rates were 83% (76, 91%) and 62% (49%, 78%), respectively. The observed survival was significantly lower than the expected survival in an age- and gender-matched U.S. white population, p<0.001 (one-sample log-rank test). The 5- and 10-year cumulative probability of biliary stricture was 8% (2%, 14%) and 13% (4%, 22%), respectively. For pancreatic strictures the 5- and 10-year rates were 5% (0%, 9%) and 5% (0%, 9%), respectively. No GJ strictures were noted. The management of biliary strictures was primarily with dilatation and stent (78%) and less commonly operative intervention (22%). Pancreatic strictures required surgery alone (25%), surgery followed by endoscopic intervention (25%), or endoscopic therapy alone (50%)., Conclusion: Intervention for anastomotic strictures after pancreaticoduodenectomy is uncommon. Biliary strictures can usually be treated nonoperatively with dilation and stent. Our study likely underestimates the incidence of stricture formation. Prospective imaging studies may be warranted for a more accurate assessment of the rate of long-term anastomotic complications.
- Published
- 2007
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.