540 results on '"PANDIT, VIRAJ"'
Search Results
152. Removal of Gold Particles from Chromium Oxynitride Surface with Dilute Sulfuric Acid Solutions
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Pandit, Viraj S., primary, Keswani, Manish, additional, Raghavan, Srini, additional, Muralidharan, Krishna, additional, Deymier, Pierre, additional, Eshbach, Florence, additional, Sengupta, Archita, additional, and Yun, Henry, additional
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- 2007
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153. Certified acute care surgery programs improve outcomes in patients undergoing emergency surgery: A nationwide analysis.
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Khalil, Mazhar, Pandit, Viraj, Rhee, Peter, Kulvatunyou, Narong, Orouji, Tahereh, Tang, Andrew, O'Keeffe, Terence, Gries, Lynn, Vercruysse, Gary, Friese, Randall S., and Joseph, Bellal
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- 2015
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154. Mild traumatic brain injury defined by Glasgow Coma Scale: Is it really mild?
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Joseph, Bellal, Pandit, Viraj, Aziz, Hassan, Kulvatunyou, Narong, Zangbar, Bardiya, Green, Donald J., Haider, Ansab, Tang, Andrew, O'Keeffe, Terence, Gries, Lynn, Friese, Randall S., and Rhee, Peter
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EVALUATION of medical care , *BRAIN injuries , *COMPUTED tomography , *RETROSPECTIVE studies , *SEVERITY of illness index , *GLASGOW Coma Scale , *EVALUATION - Abstract
Introduction: Conventionally, a Glasgow Coma Scale (GCS) score of 13-15 defines mild traumatic brain injury (mTBI). The aim of this study was to identify the factors that predict progression on repeat head computed tomography (RHCT) and neurosurgical intervention (NSI) in patients categorized as mild TBI with intracranial injury (intracranial haemorrhage and/or skull fracture). Methods: This study performed a retrospective chart review of all patients with traumatic brain injury who presented to a level 1 trauma centre. Patients with blunt TBI, an intracranial injury and admission GCS of 13-15 without anti-platelet and anti-coagulation therapy were included. The outcome measures were: progression on RHCT and need for neurosurgical intervention (craniotomy and/or craniectomy). Results: A total of 1800 patients were reviewed, of which 876 patients were included. One hundred and fifteen (13.1%) patients had progression on RHCT scan. Progression on RHCT was 8-times more likely in patients with subdural haemorrhage ≥10 mm, 5-times more likely with epidural haemorrhage ≥10 mm and 3-times more likely with base deficit ≥4. Forty-seven patients underwent a neurosurgical intervention. Patients with displaced skull fracture were 10-times more likely and patients with base deficit >4 were 21-times more likely to have a neurosurgical intervention. Conclusion: In patients with intracranial injury, a mild GCS score (GCS 13-15) in patients with an intracranial injury does not preclude progression on repeat head CT and the need for a neurosurgical intervention. Base deficit greater than four and displaced skull fracture are the greatest predictors for neurosurgical intervention in patients with mild TBI and an intracranial injury. [ABSTRACT FROM AUTHOR]
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- 2015
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155. Wet Cleaning of Cross-Contamination of High-k Dielectrics in Plasma Etch Tool
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Pandit, Viraj, primary, Parks, H. G., additional, Vermeire, Bert, additional, and Raghavan, Srini, additional
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- 2006
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156. Megasonic cleaning, cavitation, and substrate damage: an atomistic approach.
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Kapila, Vivek, Deymier, Pierre A., Shende, Hrishikesh, Pandit, Viraj, Raghavan, Srini, and Eschbach, Florence O.
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- 2006
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157. Acoustic streaming effects in megasonic cleaning of EUV photomasks: a continuum model.
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Kapila, Vivek, Deymier, Pierre A., Shende, Hrishikesh, Pandit, Viraj, Raghavan, Srini, and Eschbach, Florence O.
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- 2005
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158. Optimal Timing of Operative Intervention for High-grade Carotid Injuries in Patients with Blunt Trauma: A Nationwide Analysis of Trauma Quality Improvement Program.
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Zeeshan, Muhammad, Khan, Muhammad, Chang, Heepeel, Bikk, Andras, Jehan, Faisal, Babu, Sateesh C., Laskowski, Igor A., Mateo, Romeo B., and Pandit, Viraj
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- 2022
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159. Prevalence of Domestic Violence Among Trauma Patients
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Joseph, Bellal, Khalil, Mazhar, Zangbar, Bardiya, Kulvatunyou, Narong, Orouji, Tahereh, Pandit, Viraj, O’Keeffe, Terence, Tang, Andrew, Gries, Lynn, Friese, Randall S., Rhee, Peter, and Davis, James W.
- Abstract
IMPORTANCE: Domestic violence is an extremely underreported crime and a growing social problem in the United States. However, the true burden of the problem remains unknown. OBJECTIVE: To assess the reported prevalence of domestic violence among trauma patients. DESIGN, SETTING, AND PARTICIPANTS: A 6-year (2007-2012) retrospective analysis of the prospectively maintained National Trauma Data Bank. Trauma patients who experienced domestic violence and who presented to trauma centers participating in the National Trauma Data Bank were identified using International Classification of Diseases, Ninth Revision diagnosis codes (995.80-995.85, 995.50, 995.52-995.55, and 995.59) and E codes (E967.0-E967.9). Patients were stratified by age into 3 groups: children (≤18 years), adults (19-54 years), and elderly patients (≥55 years). Trend analysis was performed on April 10, 2014, to assess the reported prevalence of domestic violence over the years. PARTICIPANTS: Trauma patients presenting to trauma centers participating in the National Trauma Data Bank. MAIN OUTCOMES AND MEASURES: To assess the reported prevalence of domestic violence among trauma patients. RESULTS: A total of 16 575 trauma patients who experienced domestic violence were included. Of these trauma patients, 10 224 (61.7%) were children, 5503 (33.2%) were adults, and 848 (5.1%) were elderly patients. The mean (SD) age was 15.9 (20.6), the mean (SD) Injury Severity Score was 10.9 (9.6), and 8397 (50.7%) were male patients. Head injuries (46.8% of patients) and extremity fractures (31.2% of patients) were the most common injuries. A total of 12 515 patients (75.1%) were discharged home, and the overall mortality rate was 5.9% (n = 980). The overall reported prevalence of domestic violence among trauma patients was 5.7 cases per 1000 trauma center discharges. The prevalence of domestic violence increased among children (14.0 cases per 1000 trauma center discharges in 2007 to 18.5 case per 1000 trauma center discharges in 2012; P = .001) and adults (3.2 cases per 1000 discharges in 2007 to 4.5 cases per 1000 discharges in 2012; P = .001) over the 6-year period and remained unchanged for elderly patients (0.8 cases per 1000 discharges in 2007 to 0.96 cases per 1000 discharges in 2012; P = .09). On subanalysis of adults and elderly patients, the prevalence of domestic violence increased among both female (4.6 cases per 1000 discharges in 2007 to 5.3 cases per 1000 discharges in 2012; P = .001) and male patients (1.5 cases per 1000 discharges in 2007 to 2.8 cases per 1000 discharges in 2012; P = .001). CONCLUSIONS AND RELEVANCE: Domestic violence is prevalent among trauma patients. Over the years, the reported prevalence of domestic violence has been increasing among children and adults, and continues to remain high among female trauma patients. A robust mandatory screening for evaluating domestic violence among trauma patients, along with a focused national intervention, is warranted.
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- 2015
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160. In brief.
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Jurkovich, Gregory J., Davis, Kimberly A., Becher, Robert D., Burlew, Clay Cothren, de Moya, Marc, Dente, Christopher J., Galante, Joseph M., Goodwin II, Joel S., Joseph, Bellal, and Pandit, Viraj
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- 2017
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161. Prothrombin Complex Concentrate Versus Fresh-Frozen Plasma for Reversal of Coagulopathy of Trauma: Is There a Difference?
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Joseph, Bellal, Aziz, Hassan, Pandit, Viraj, Hays, Daniel, Kulvatunyou, Narong, Yousuf, Zeeshan, Tang, Andrew, O'Keeffe, Terence, Green, Donald, Friese, Randall, and Rhee, Peter
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PROTHROMBIN ,WOUNDS & injuries ,BLOOD coagulation factors ,BLOOD products ,DRUG therapy ,WARFARIN ,BLOOD coagulation disorders ,BLOOD disease treatment - Abstract
Introduction: The development of coagulopathy of trauma is multifactorial associated with hypoperfusion and consumption of coagulation factors. Previous studies have compared the role of factor replacement versus FPP for reversal of trauma coagulopathy. The purpose of our study was to determine the time to correction of coagulopathy and blood product requirement in patients who received PCC+FFP compared with patients who received FFP alone. Methods: We performed a retrospective analysis of a prospectively maintained database of all coagulopathic (INR ≥ 1.5) trauma patients presenting to our level I trauma center during a 2-years period (2011-2012). Patients were stratified into two groups: patients who received PCC+FFP and patients who received FFP alone. Patients in the two groups were matched in a 1:3 (PCC+FFP:FFP) ratio using propensity score matching for demographics, injury severity, vital parameters, and initial INR. The two groups were then compared for: correction of INR, time to correction of INR, thromboembolic complications, mortality, and cost of therapy. Results: A total of 252 were included in the analysis [PCC+FFP:63; FFP:189]. The mean age was 44 ± 20 years; 70 % were male, with a median ISS score of 27 [16-38]. PCC use was associated with an accelerated correction of INR (394 vs. 1,050 min; p 0.001), reduction in requirement of pack red blood cell (6.6 vs. 10 units; p 0.001) and FFP (2.8 vs. 3.9 units; p 0.01), and decline in mortality (23 vs. 28 %; p 0.04). PCC+FFP use was associated with a higher cost of therapy ($1,470 ± 845 vs. 1,171 ± 949; p 0.01) but lower overall cost of transfusion ($7,110 ± 1,068 vs. 9,571 ± 1,524; p 0.01) compared with FFP therapy alone. Conclusions: PCC in conjunction with FFP rapidly corrects INR in a matched cohort of trauma patients not on warfarin therapy compared with FFP therapy alone. The use of PCC as an adjunct to FFP therapy is associated with reduction of blood product requirement and also lowers overall cost. [ABSTRACT FROM AUTHOR]
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- 2014
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162. Superiority of frailty over age in predicting outcomes among geriatric trauma patients: a prospective analysis.
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Joseph, Bellal, Pandit, Viraj, Zangbar, Bardiya, Kulvatunyou, Narong, Hashmi, Ammar, Green, Donald J, O'Keeffe, Terence, Tang, Andrew, Vercruysse, Gary, Fain, Mindy J, Friese, Randall S, and Rhee, Peter
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- 2014
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163. Perforated Appendicitis with Gastrointestinal Basidiobolomycosis: A Rare Finding.
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Pandit, Viraj, Rhee, Peter, Aziz, Hassan, Jehangir, Qasim, Friese, Randall S., and Joseph, Bellal
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APPENDICITIS , *GASTROENTERITIS , *APPENDIX diseases , *MYCOSES , *MORTALITY - Abstract
Background: Basidiobolomycosis is a rare fungal infection caused by the fungus Basidiobolus ranarum. Gastrointestinal basidiobolomycosis (GIB) is an unusual presentation of the fungal infection that is reported sparsely in the literature, but is an emerging infection in the southwestern United States. Lack of awareness of GIB has resulted in its delayed diagnosis and in extensive morbidity and mortality in patients with GIB. Methods: Case report and literature review. Case Report: We report the rare case of a young female with GIB that presented as perforated appendicitis with abscess formation. Conclusion: Although GIB is rare, immediate and aggressive therapy should be initiated when it is diagnosed. Both long-term medical and surgical treatment is required for its definitive management. [ABSTRACT FROM AUTHOR]
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- 2014
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164. Acquired coagulopathy of traumatic brain injury defined by routine laboratory tests: Which laboratory values matter?
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Joseph, Belial, Aziz, Hassan, Zangbar, Bardiya, Kulvatunyou, Narong, Pandit, Viraj, O'Keeffe, Terence, Andrew Tang, Wynne, Julie, Friese, Randall S., and Rhee, Peter
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- 2014
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165. Improving Hospital Quality and Costs in Nonoperative Traumatic Brain Injury: The Role of Acute Care Surgeons
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Joseph, Bellal, Pandit, Viraj, Haider, Ansab A., Kulvatunyou, Narong, Zangbar, Bardiya, Tang, Andrew, Aziz, Hassan, Vercruysse, Gary, O’Keeffe, Terence, Freise, Randall S., and Rhee, Peter
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IMPORTANCE: The role of acute care surgeons is evolving; however, no guidelines exist for the selective treatment of patients with traumatic brain injury (TBI) exclusively by acute care surgeons. We implemented the Brain Injury Guidelines (BIG) for managing TBI at our institution on March 1, 2012. OBJECTIVE: To compare the outcomes in patients with TBI before and after implementation of the BIG protocol. DESIGN, SETTING, AND PARTICIPANTS: We conducted a 2-year analysis of our prospectively maintained database of all patients with TBI (findings of skull fracture and/or intracranial hemorrhage on an initial computed tomographic scan of the head) who presented to our level I trauma center. The pre-BIG group included patients with TBI from March 1, 2011, through February 29, 2012, and the post-BIG group included patients from July 1, 2012, through June 30, 2013. MAIN OUTCOMES AND MEASURES: The primary outcome measures were patients with repeated computed tomography of the head and neurosurgical consultations. Secondary outcome measures were findings of progression of intracranial hemorrhage on repeated computed tomographic scans, neurosurgical intervention, hospital admission, intensive care unit admission, hospital and intensive care unit length of stay, 30-day readmission rate, and hospital costs per patient. RESULTS: A total of 796 patients (415 in the pre-BIG group and 381 in the post-BIG group) were included. There was a significant reduction (19.0%) in the rate of neurosurgical consultation (post-BIG group, 273 patients [71.7%]; pre-BIG group, 376 [90.6%]; P < .001), repeated computed tomography of the head (post-BIG group, 255 patients [66.9%]; pre-BIG group, 381 patients [91.8%]; P < .001), hospital (post-BIG group, 330 [86.6%]; pre-BIG group, 398 [95.9%]; P < .001) and intensive care unit admission (post-BIG group, 202 [53.0%]; pre-BIG group, 257 [61.9%]; P = .01), hospital length of stay (post-BIG group, 5.4 [4.5] days; pre-BIG group, 6.1 [4.8] days; P = .03), and hospital costs per patient ($4772 per patient; P = .03) with implementation of BIG. There was no difference in the in-hospital mortality rate (post-BIG group, 62 patients [16.3%]; pre-BIG group, 69 patients [16.6%]; P = .89), progression of intracranial hemorrhage on repeated scans (post-BIG group, 41 patients [10.8%]; pre-BIG group, 59 patients [14.2%]; P = .14), neurosurgical intervention (post-BIG group, 61 patients [16.0%]; pre-BIG group, 59 patients [14.2%]; P = .48), and 30-day readmission rate (post-BIG group, 31 patients [8.1%]; pre-BIG group, 37 patients [8.9%]; P = .69) after implementation of BIG. CONCLUSIONS AND RELEVANCE: Implementation of BIG is safe and cost-effective. BIG defines the management of TBI without the need for neurosurgical consultation and unnecessary imaging. Establishing a national, multi-institutional study implementing the BIG protocol is warranted.
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- 2015
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166. Prothrombin complex concentrate: An effective therapy in reversing the coagulopathy of traumatic brain injury.
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Joseph, Bellal, Hadjizacharia, Pantelis, Aziz, Hassan, Kulvatunyou, Narong, Tang, Andrew, Pandit, Viraj, Wynne, Julie, O'Keeffe, Terence, Friese, Randall S., and Rhee, Peter
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- 2013
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167. Hafnium or Zirconium High-k Fab Cross-Contamination Issues.
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Vermeire, Bert, Pandit, Viraj S., Parks, Harold G., Raghavan, Srmi, Ramkumar, Krishnaswami, and Jeon, Joong
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HYDROXIDES , *PEROXIDES , *AMMONIUM , *PLASMA etching , *DIELECTRICS , *ELECTRICAL engineering materials - Abstract
Hf and Zr contamination during immersion in process solutions is most likely to occur in neutral and caustic solutions. Both Hf and Zr contamination are introduced onto the wafer surface if they are present in an ammonium hydroxide peroxide mixture solution (which is caustic), but such contamination is removed using existing acid cleans. Large amounts of wafer-to-wafer cross contamination occurs in plasma etch tools. Particles can cause cross contamination in a thermal reactor during high-temperature anneals of high-k dielectric layers. Residual surface cross contamination does not diffuse into the wafers during thermal processing. If contamination remains on a wafer, gate oxide integrity degradation is only observed at high concentrations. Near surface minority carrier lifetime is also affected, but bulk lifetime is not. [ABSTRACT FROM AUTHOR]
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- 2004
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168. Venous Thromboembolism Malignancy Score (VTEM): An Effective Tool for Identifying Patients With Occult Malignancy.
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Pandit, Viraj, Kempe, Kelly, Vang, Steven, Kim, Hyein, Zamor, Kimberly C., Khorgami, Zhamak, Hassenstein, Todd, William, Jennings, and Nelson, Peter
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- 2021
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169. Comparison of Gold Particle Removal from Fused Silica and Thermal Oxide Surfaces in Dilute Ammonium Hydroxide Solutions
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Pandit, Viraj, Keswani, Manish, Siddiqui, Shariq, and Raghavan, Srini
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Removal of gold particles (40 nm and 100 nm) from fused silica and thermal oxide surfaces in dilute ammonium hydroxide solutions has been investigated. The particle removal efficiency (PRE) from fused silica surface has been found to be a strong function of ammonium hydroxide concentration and bath temperature. PRE increases from 0 to 85 % with increase in bath temperature from 30 to 80 °C for ammonium hydroxide concentration of 1 %. Addition of megasonic energy to the ammonium hydroxide bath at 30 °C has also shown to improve the PRE significantly. In the case of thermal oxide, the removal of gold particles is much easier compared to that from fused silica. Even for cleaning at 30 °C, the PRE for oxide surface increases from 10 to 90 % with increase in ammonium hydroxide concentration from 0 % to 4 %. Atomic force microscopy measurements reveal that an adhesion force of 10 mN/m exists between fused silica and gold particles in 4 % ammonium hydroxide solution as opposed to only repulsive force in the case of thermal oxide.
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- 2012
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170. Frailty Syndrome in Patients with Carotid Disease: Simplying How we Calculate Frailty
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Pandit, Viraj, Jahjj, Sandeep, Lee, Ashton, Trinadad, Bradley, Goshima, Kaoru, Weinkauf, Craig, Zhou, Wei, and Tan, Tze-Woei
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- 2019
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171. A Protocol-Driven Reduction in Surgical Site Infections After Colon Surgery.
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Martinez, Carolina, Omesiete, Pamela, Pandit, Viraj, Thompson, Eli, Nocera, Meleesa, Riall, Taylor, Guerrero, Marlon, and Nfonsam, Valentine
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SURGICAL site infections , *COLON (Anatomy) , *PROPENSITY score matching , *LENGTH of stay in hospitals , *ELECTIVE surgery - Abstract
Surgical site infection (SSI) is an established quality indicator and predictor for adverse patient outcomes. Multiple strategies have been established to reduce SSI; however, optimum protocol remains unclear. The aim of the study was to assess the impact of established protocol on SSI after colon surgery. We established a colon SSI bundle in 2017, which includes a chlorhexidine prescrub followed by chloraPrep, betadine wound wash, antibiotic infused irrigation, use of closure tray, and incision coverage with silver impregnated dressing. Retrospective analysis of a 2-y (2016-2017) prospectively collected before and after analysis of all patients undergoing elective colon surgery was performed. Patients were divided into two groups: preprotocol (PP: year 2016) and postprotocol (PoP: year 2017). Patients in the two groups were matched using propensity score matching for age, gender, comorbidities, Anesthesiology Severity Score, indication of procedure, and procedure type. Outcome measures were SSI, hospital length of stay, and readmission rate. A total of 328 patients were analyzed, and after propensity matching, 94 patients (PP:47 and PoP:47) were included. The mean age was 63.7 ± 16.4 y, 43.6% male, and 44.6% of procedures were performed laparoscopically. There was no difference in demographics, comorbidities, and procedure details between two groups. PoP patients had significantly lower superficial (odds ratio: 0.91 [0.74-0.98]; P = 0.045) and deep SSI (odds ratio:0.97 [0.65-0.99]; P = 0.048) than PP patients. PoP patient had shorter length of stay (P = 0.049) and trend toward lower readmission rate (P = 0.098) compared with PP patients and an 85% reduction in the Centers for Medicare and Medicaid Services standardized infection rate. Protocol-driven patient care improves patient outcomes. SSI bundle reduced SSI in patient undergoing colon surgery. Establishing national SSI bundles will help standardize care and help optimize patient outcomes. [ABSTRACT FROM AUTHOR]
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- 2020
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172. Restricting Intraoperative Fluid Volume Allows Earlier Return of Bowel Function After Colon and Rectal Surgery.
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Omesiete, Nkechinye, Martinez, Carolina, Pandit, Viraj, Villalvazo, Yadira, Jecius, Hunter, Thompson, Eli, Norcera, Meleesa, and Nfonsam, Valentine
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RECTAL surgery , *PROPENSITY score matching , *LENGTH of stay in hospitals , *ABDOMINAL surgery , *RATINGS of hospitals , *FLUID therapy - Abstract
Return of bowel function (ROBF) after abdominal surgery is an important determinant of patient outcomes. The role of intraoperative fluids (IOFs) in colon surgery remains unclear. The aim of this study was to assess the impact of IOF on ROBF in patients undergoing colon surgery. We hypothesized that minimizing IOFs allows earlier ROBF. A 2-year (2016-2017) retrospective analysis of all patients undergoing elective colon resection was performed at our tertiary hospital using a protocol limiting IOF and postoperative narcotics. Patients were divided into two groups: preprotocol (2016) and postprotocol (PoP) (2017). Patients were matched using propensity score matching for age, gender, comorbidities, Anesthesiology Severity Score, indication for procedure, and procedure type. The outcome measured was ROBF. Secondary outcome measures were complication rates and hospital length of stay. A total of 360 patients were analyzed. After propensity matching, 90 patients (preprotocol: 45; PoP: 45) were included. The mean age was 62.2 ± 14.8 y, 43.3% male, and 44.4% of procedures were performed laparoscopically. There was no difference in demographics and comorbidities between groups. PoP patients received lower IOF (P = 0.036, 2016: 1198.8 ± 1096.5 mL, 2017: 2176.7 ± 1458.3 mL) and lower postoperative narcotics (P = 0.042). PoP patients had earlier ROBF 2[2-4], 4[3-5] (odds ratio: 1.18 [1.05-1.52], P = 0.04), shorter length of stay 3[2-5] d versus 5[4-7] (odds ratio: 1.11 [1.09-1.89], P = 0.043), and trended toward lower complication rates (P = 0.09). IOF volume independently impacts ROBF after colon surgery. Restricting IOF allows for earlier bowel function and shorter hospital stay. Further studies defining optimum fluid management impacting ROBF may help optimize patient care. [ABSTRACT FROM AUTHOR]
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- 2019
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173. Frailty in trauma: A systematic review of the surgical literature for clinical assessment tools.
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Joseph, Bellal, Hassan, Ahmed, and Pandit, Viraj
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- 2016
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174. Neurosurgeons' Critical Role in Managing Traumatic Brain Injury--Reply.
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Joseph, Bellal, Pandit, Viraj, and Aziz, Hassan
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- 2016
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175. Erratum to: Age and Obesity are Independent Predictors of Bile Duct Injuries in Patients Undergoing Laparoscopic Cholecystectomy.
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Aziz, Hassan, Pandit, Viraj, Joseph, Bellal, Jie, Tun, and Ong, Evan
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CHOLECYSTECTOMY complications , *BILE ducts , *OBESITY , *WOUNDS & injuries - Abstract
A correction to the article "Age and Obesity are Independent Predictors of Bile Duct Injuries in Patients Undergoing Laparoscopic Cholecystectomy" by Hassan Aziz and colleagues is presented.
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- 2015
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176. Validating Trauma-Specific Frailty Index for Geriatric Trauma Patients: A Prospective Analysis.
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Joseph, Bellal, Pandit, Viraj, Zangbar, Bardiya, Kulvatunyou, Narong, Tang, Andrew, O'Keeffe, Terence, Green, Donald J., Vercruysse, Gary, Fain, Mindy J., Friese, Randall S., and Rhee, Peter
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VALIDATION therapy , *FRAGILITY (Psychology) , *PAIN in old age , *PREDICTION models , *TRAUMA centers , *NURSING care facilities - Abstract
Background: The Frailty Index has been shown to predict discharge disposition in geriatric patients. The aim of this study was to validate the modified 15-variable Trauma-Specific Frailty Index (TSFI) to predict discharge disposition in geriatric trauma patients. We hypothesized that TSFI can predict discharge disposition in geriatric trauma patients. Study Design: We performed a 2-year (2011–2013) prospective analysis of all geriatric trauma patients presenting to our Level I trauma center. Patient discharge disposition was dichotomized into unfavorable (discharge to skilled nursing facility or death) and favorable (discharge to home or rehabilitation center) discharge disposition. Patients were evaluated using the developed 15-variable TSFI. Multivariate logistic regression was performed to identify factors that predict unfavorable discharge disposition. Results: A total of 200 patients were enrolled for validation of TSFI. Mean age was 77 ± 12.1 years, median Injury Severity Score was 15 (interquartile range [IQR] 9 to 20), median Glasgow Coma Scale score was 14 (IQR 13 to 15), and median Frailty Index score was 0.20 (IQR 0.17 to 0.28); 29.5% (n = 59) patients had unfavorable discharge. After adjusting for age, sex, Injury Severity Score, Head Abbreviated Injury Scale, and vitals on admission, Frailty Index (odds ratio = 1.5; 95% CI, 1.1–2.5) was the only significant predictor for unfavorable discharge disposition. Age (odds ratio = 1.2; 95% CI, 0.9–3.1; p = 0.2) was not predictive of unfavorable discharge disposition. Conclusions: The 15-variable TSFI is an independent predictor of unfavorable discharge disposition in geriatric trauma patients. The Trauma-Specific Frailty Index is an effective tool that can aid clinicians in planning discharge disposition of geriatric trauma patients. Level of Evidence: II Prognostic Studies−Investigating the Effect of a Patient Characteristic on the Outcome of Disease. [ABSTRACT FROM AUTHOR]
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- 2014
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177. Emergency General Surgery in the Elderly: Too Old or Too Frail?
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Joseph, Bellal, Zangbar, Bardiya, Pandit, Viraj, Fain, Mindy, Mohler, Martha Jane, Kulvatunyou, Narong, Jokar, Tahereh Orouji, O'Keeffe, Terence, Friese, Randal S., Rhee, Peter, and O'Keeffe, Terence
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SURGERY , *OLDER patients , *GERIATRICS , *FRAGILITY (Psychology) , *AGE distribution , *GERIATRIC assessment , *FRAIL elderly , *LONGITUDINAL method , *MEDICAL emergencies , *RISK assessment , *OPERATIVE surgery , *TREATMENT effectiveness - Abstract
Background: Assessment of operative risk in geriatric patients undergoing emergency general surgery (EGS) is challenging. Frailty is an established measure for risk assessment in elective surgical cases. Emerging literature suggests the superiority of frailty measurements to chronological age in predicting outcomes. The aim of this study was to assess the outcomes in elderly patients undergoing EGS using an established Rockwood frailty index.Study Design: We prospectively measured preadmission frailty in all geriatric (aged 65 years and older) patients undergoing EGS at our institution during a 2-year period. Frailty index (FI) was calculated using the modified 50-variable Rockwood Preadmission FI. Frail patients were defined by FI ≥ 0.25. Outcomes measures were in-hospital complications, development of major complications, and mortality. Multivariate regression analysis was performed.Results: A total of 220 patients were enrolled, of which 82 (37%) were frail. Frailty index score did not correlate with age (R = 0.64; R(2) = 0.53; p = 0.1) and poorly correlated with American Society of Anesthesiologists score (R = 0.51; R(2) = 0.44; p = 0.045). Thirty-five percent (n = 77) of patients had postoperative complications and 19% (n = 42) had major complications. Frailty index was an independent predictor for development of in-hospital complications (odds ratio = 2.13; 95% CI, 1.09-4.16; p = 0.02) and major complications (odds ratio = 3.87; 95% CI, 1.69-8.84; p = 0.001). Age and American Society of Anesthesiologists score were not predictive of postoperative and major complications. Our FI model had 80% sensitivity, 72% specificity, and area under the curve of 0.75 in predicting complications in geriatric patients undergoing EGS. The overall mortality rate was 3.2% (n = 7) and all patients who died were frail.Conclusions: Frailty index independently predicts postoperative complications, major complications, and hospital length of stay in elderly patients undergoing emergency general surgery. Use of FI will provide insight into the hospital course of elderly patients, allowing for identification of patients in need and more efficient allocation of hospital resources. [ABSTRACT FROM AUTHOR]- Published
- 2016
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178. Wet Cleaning of Cross-Contamination of High-kDielectrics in Plasma Etch Tool
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Pandit, Viraj, Parks, H. G., Vermeire, Bert, and Raghavan, Srini
- Abstract
Direct tunneling through the gate SiO2(εr≈4)has become a serious concern for metal-oxide semiconductor field effect transistor scaling. The semiconductor industry is focusing on dielectrics with high relative dielectric constants (εr≥10)to replace SiO2gate oxides. Among the potential high-kmaterials, oxides and silicates of hafnium (Hf) have shown the most promise. The possibility of process cross-contamination by integrating these materials into silicon processes is a major concern for integrated circuit manufacturers. Cross-contamination of Hf in a plasma etch tool has been investigated. These studies confirm that significant cross-contamination occurs when HfO2is etched in a chloro-fluoro-carbon plasma etch system. None of the standard cleaning processes commonly used in the semiconductor industry (such as SC1 and SC2) completely remove the contamination; however, dilute hydrofluoric acid, hydrofluoric acid-hydrogen peroxide water mixture, and SC1 cleans removed contamination below the concentration thresholds for oxide degradation and close to the total reflection X-ray fluorescence detection limit.
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- 2006
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179. Impact of Hemorrhagic Shock on Pituitary Function.
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Joseph, Bellal, Haider, Ansab A., Pandit, Viraj, Kulvatunyou, Narong, Orouji, Tahereh, Khreiss, Mohammad, Tang, Andrew, O’Keeffe, Terence, Friese, Randall, and Rhee, Peter
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- *
HEMORRHAGIC shock , *PITUITARY diseases , *HYPOPITUITARISM , *COHORT analysis , *LUTEINIZING hormone - Abstract
Background Hypopituitarism after hypovolemic shock is well established in certain patient cohorts. However; the effects of hemorrhagic shock on pituitary function in trauma patients remains unknown. The aim of this study was to assess pituitary hormone variations in trauma patients with hemorrhagic shock. Study Design Patients with acute traumatic hemorrhagic shock presenting to our level 1 trauma center were prospectively enrolled. Hemorrhagic shock was defined as systolic blood pressure (SBP) ≤ 90 mmHg on arrival or within 10 minutes of arrival in the emergency department, and requirement of ≥2 units of packed red blood cell transfusion. Serum cortisol and serum pituitary hormones (vasopressin [ADH], adrenocorticotrophic hormone [ACTH], thyroid stimulating hormone [TSH], follicular stimulating hormone [FSH], and luteinizing hormone [LH]) were measured in each patient on admission and at 24, 48, 72, and 96 hours after admission. Outcome measure was variation in pituitary hormones. Results A total of 42 patients were prospectively enrolled; mean age was 37 ± 12 years, mean SBP 85.4 ± 64.5 mmHg, and median Injury Severity Score was 26 (range 18 to 38). There was an increase in the levels of cortisol (p < 0.001), a decrease in the levels of ACTH (p < 0.001) and ADH (p < 0.001), but no change in the levels of LH (p = 0.30), FSH (p = 0.07), and TSH (p = 0.89) over 96 hours. Ten patients died during their hospital stay. Patients who died had higher mean admission ADH levels (p = 0.03), higher mean admission ACTH levels (p < 0.001), and lower mean admission cortisol levels (p = 0.04) compared with patients who survived. Conclusions Acute hypopituitarism does not occur in trauma patients with acute hemorrhagic shock. In patients who died, there was a decrease in cortisol levels, which appears to be adrenal in origin. [ABSTRACT FROM AUTHOR]
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- 2015
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180. A Three-Year Prospective Study of Repeat Head Computed Tomography in Patients with Traumatic Brain Injury.
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Joseph, Bellal, Aziz, Hassan, Pandit, Viraj, Kulvatunyou, Narong, Hashmi, Ammar, Tang, Andrew, Sadoun, Moutamn, O’Keeffe, Terence, Vercruysse, Gary, Green, Donald J., Friese, Randall S., and Rhee, Peter
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- *
LONGITUDINAL method , *COMPUTED tomography , *BRAIN injuries , *BRAIN imaging , *HEMORRHAGE , *NEUROLOGY - Abstract
Background: A definitive consensus on the standardization of practice of a routine repeat head CT (RHCT) scan in patients with traumatic intracranial hemorrhage is lacking. We hypothesized that in examinable patients without neurologic deterioration, RHCT scan does not lead to neurosurgical intervention (craniotomy/craniectomy). Study Design: This was a 3-year prospective cohort analysis of patients aged 18 years and older, without antiplatelet or anticoagulation therapy, presenting to our level 1 trauma center with intracranial hemorrhage on initial head CT and a follow-up RHCT. Neurosurgical intervention was defined by craniotomy/craniectomy. Neurologic deterioration was defined as altered mental status, focal neurologic deficits, and/or pupillary changes. Results: A total of 1,129 patients were included. Routine RHCT was performed in 1,099 patients. The progression rate was 19.7% (216 of 1,099), with subsequent neurosurgical intervention in 4 patients. Four patients had an abnormal neurologic examination, with a Glasgow Coma Scale (GCS) of ≤8 requiring intubation. Thirty patients had an RHCT secondary to neurologic deterioration; 53% (16 of 30) had progression on RHCT, of which 75% (12 of 16) required neurosurgical intervention. There was an association between deterioration in neurologic examination and need for neurosurgical intervention (odds ratio 3.98; 95% CI 1.7 to 9.1). The negative predictive value of a deteriorating neurologic examination in predicting the need for neurosurgical intervention was 100% in patients with GCS > 8. Conclusions: Routine repeat head CT scan is not warranted in patients with normal neurologic examination. Routine repeat head CT scan does not supplement the need for neurologic examination for determining management in patients with traumatic brain injury. [Copyright &y& Elsevier]
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- 2014
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181. Distal Retrograde Access for Infrainguinal Arterial Chronic Total Occlusions: A Prospective, Single Center, Observational Study in the Office-Based Laboratory Setting.
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Leon Jr, Luis R., Green, Courtney, Labropoulos, Nicos, Pacanowski Jr, John P., Jhajj, Sandeep, and Pandit, Viraj
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ANTICOAGULANTS , *ARTERIAL occlusions , *ENDOVASCULAR surgery , *FEMORAL artery , *MEDICAL care costs , *RADIATION doses , *SURGICAL complications , *SURGICAL therapeutics , *TREATMENT effectiveness , *TIBIAL arteries , *POPLITEAL artery - Abstract
Objective: To assess the safety and efficacy of retrograde arterial recanalization of infrainguinal CTOs in the OBL setting. Methods: Consecutive patients who underwent interventions for lower extremity CTOs in the OBL setting by a single vascular surgeon were evaluated (January 2013-November 2017). If antegrade crossing was not possible, then a retrograde distal approach was used. Patient characteristics, CTO location, procedural time, contrast, anticoagulation and radiation doses and costs were recorded. Post-procedural complications were documented on post-procedure day 1 and 10-14 days post procedure. Three groups were compared: group 1 —antegrade approach for femoropopliteal CTOs; group 2 —antegrade approach for tibial CTOs, and; group 3 —retrograde approach for femoropopliteal and tibial CTOs. Results: Two hundred and thirty-seven patients were studied. In 39 (16.5%), the lesions could not be crossed. A successful antegrade approach was used in 185 of them, of which 69% (group 1, n = 128) patients had femoropopliteal CTOs and 31% (group 2, n = 57) had tibial CTOs. Fourteen patients (5.9%, group 3) were treated by retrograde distal approach. Group 3 patients received higher contrast doses than groups 1 and 2 (p = 0.01). However, patients in groups 1 and 2 received similar contrast doses. Group 3 patients had the highest operative time and treatment costs followed by group 1 and then group 2 (p = 0.01). Three femoral pseudoaneurysms were noted in group 1, and 2 in group 2. No complications were seen in group 3. Conclusions: Although the operative times, costs, radiation and contrast dose are higher with retrograde arterial access, it represents a safe and effective method for the crossing of CTO infrainguinal lesions in an ambulatory venue. [ABSTRACT FROM AUTHOR]
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- 2021
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182. Does it matter where you get your surgery for colorectal cancer?
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Hamidi, Mohammad, Hanna, Kamil, Omesiete, Pamela, Cruz, Alejandro, Ewongwo, Agnes, Pandit, Viraj, Joseph, Bellal, and Nfonsam, Valentine
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COLORECTAL cancer , *PROCTOLOGY , *URBAN hospitals , *ONCOLOGIC surgery , *LAPAROSCOPIC surgery - Abstract
Background: The influence of hospital-related factors on outcomes following colorectal surgery is not well-established. The aim of our study was to evaluate the relationship between hospital factors on outcomes in surgically managed colorectal cancer patients. Methods: We performed a 2-year (2014–2015) analysis of the NIS database. Adult (> 18 years) patients who underwent open or laparoscopic colorectal resection were identified using ICD-9 codes. Patients were stratified based on hospital: volume (low vs. high), teaching status, and location (urban vs. rural). Outcome measures were complications and mortality. Multivariate logistic regression was performed. Results: A total of 153,453 patients with CRC were identified of which 35.3% underwent surgical management. Mean age was 69 ± 13 years, 51.6% were female, and 67% were white. Twenty-seven percent of the patients were managed at a high-volume center, 48% at intermediate-volume center while 25% at a low-volume center. Complications and mortality rates were lower in patients who were managed at high-volume centers and urban hospitals, while no difference was noticed based on teaching status. On regression analysis, patients managed at high-volume centers (OR 0.76 [0.56–0.89]) and urban hospitals (OR 0.83 [0.64–0.91]) have lower odds of complications; similarly, high-volume centers (OR 0.79 [0.65–0.90]) and urban facility (OR 0.87 [0.70–0.92]) were associated with lower odds of mortality. However, there was no association between teaching status and outcomes. Conclusion: Hospital factors significantly influence outcomes in patients with CRC managed surgically. High-volume centers and urban facilities have relatively better outcomes. Regionalization of care along with the appropriate availability of resources may improve outcomes in patients with CRC. Level of evidence: Level III, Retrospective Observational Study [ABSTRACT FROM AUTHOR]
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- 2019
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183. Colon cancer in the young: contributing factors and short-term surgical outcomes.
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Hanna, Kamil, Zeeshan, Muhammad, Hamidi, Mohammad, Pandit, Viraj, Omesiete, Pamela, Cruz, Alejandro, Ewongwo, Agnes, Joseph, Bellal, and Nfonsam, Valentine
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- *
COLON cancer , *LENGTH of stay in hospitals , *COLECTOMY , *UNIVARIATE analysis , *DEMOGRAPHIC characteristics , *REGRESSION analysis - Abstract
Background: The incidence in young patients has increased significantly over the last few decades. The aim of this study is to evaluate demographic and tumor characteristics of young patients and analyze the short-term surgical outcomes of patients undergoing surgery. Methods: We performed a 2-year review (2015–2016) of the ACS-NSQIP and included all patients with CC who underwent surgical management. Patients were stratified into two groups: early-onset CC (< 50 years old) and late-onset CC (≥ 50 years old). Outcome measures were hospital length of stay, 30-day complications, mortality, and readmission. Results: We included a total of 15,957 patients in the analysis. Mean age was 65 ± 13 years, and 52% were male. Overall 10% of the patients had early-onset CC. Patients with early-onset CC were more likely to be black (11% vs 7%, p = 0.04) and Hispanic (8% vs 4%, p = 0.02). Additionally, they presented with a more aggressive tumor and higher TNM staging. Patients with early onset CC had lower 30-day complications (18% vs 22%, p = 0.02), shorter hospital length of stay (6[3–8] vs 8[5–11], p = 0.03) and lower 30-day mortality (0.4% vs 1.8%, p = 0.04) compared to their counterparts. However, there was no difference between the two groups regarding 30-day readmission. On regression analysis, there was no difference between the two groups regarding study outcomes. Conclusions: Racial disparity does exist in the incidence of colon cancer in the young with higher incidence in blacks. Younger patients with CC tend to have better surgical outcomes on univariate analysis. On regression analysis, the surgical outcomes between the two groups are comparable. [ABSTRACT FROM AUTHOR]
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- 2019
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184. Postoperative Casting of Below-Knee Amputation Reduces StumpComplications.
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Bikk A, Sekhon S, Snider D, Johnson L, Chaudhari J, Schott J, Maheta B, and Pandit V
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- Humans, Retrospective Studies, Male, Female, Aged, Middle Aged, Treatment Outcome, Time Factors, Length of Stay, Risk Factors, Aged, 80 and over, Ischemia physiopathology, Ischemia surgery, Postoperative Complications etiology, Postoperative Complications prevention & control, Amputation, Surgical adverse effects, Amputation Stumps physiopathology, Wound Healing, Casts, Surgical adverse effects
- Abstract
Background: Against the technological advances in limb salvage, below-the-knee amputation (BKA) remains a common procedure. Although most elective BKA is classified as clean operation, the reported stump complication rate is much higher than predicted. Postoperative casting (PC) may reduce the number of these complications. The aim of this study was to compare the efficacy of elastic bandage with knee immobilizer (EBKI) and PC in BKA stump complications., Methods: Retrospective cohort comparison design identified patients who underwent BKA between 2000 and 2023 for non-correctable critical limb ischemia (CLI), or excessive tissue loss secondary to CLI, infection, severe neuropathy, or the combination of these and stratified them into 2 cohorts based on their postoperative stump dressing: EBKI and PC. BKAs that were done for trauma or neoplastic processes were excluded. The primary outcome measures: wound healing in 6 weeks and length of stay (LOS)., Secondary Outcome Measures: stump injury, infection, dehiscence, necrosis, number of higher-level amputations, knee contracture, and post-BKA mobility with Special Interest Group of Amputee Medicine score., Results: One hundred sixteen patients with 122 limbs (52 EBKI and 70 PC) were found who met inclusion criteria and analyzed. The groups were comparable in demographics and comorbidities and preoperative variables, including mobility. The primary wound healing at 6 weeks was higher (P = 0.007); wound dehiscence (P = 0.01) and LOS (P = 0.006) was lower in the PC group compared to EBKI group. The PC group achieved higher Special Interest Group of Amputee Medicine mobility score and lower number of contractures developed compared to the EBKI group., Conclusions: Applying and maintaining PC to the BKA stump during the first month of healing reduced the incidence of stump complications, shortened the LOS, and improved postrehabilitation mobility results. We found no effect of PC on postoperative infections, stump necrosis, and higher-level amputations., (Published by Elsevier Inc.)
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- 2024
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185. Methamphetamine spasm in the large caliber arteries-the severity is likely underestimated.
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Bikk A, Chaudhari J, Navaran P, Johnson L, and Pandit V
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This report describes two cases of rarely reported, severe large arterial vascular spasms seen on computed tomography images after methamphetamine abuse. Although the effects of methamphetamine on the central nervous system and smaller arteries are relatively well known, its effects on large caliber arteries are rarely discussed. We present two cases of severe large arterial multisegmented vasospasm, captured on contrast-enhanced computed tomography, several hours after methamphetamine abuse. One of the patients was discharged without apparent tissue loss or organ failure. The other developed severe heart failure, liver failure, and toe gangrene. The publication of the de-identified images has been approved by the VA Central California Health Care System's Research and Development Committee and Privacy Officer. Vascular surgeons and, perhaps, acute care physicians, who are usually aware of small arterial vasospastic conditions, should also be aware of this methamphetamine-induced large arterial finding, which can be quite dramatic in appearance on imaging., Competing Interests: None., (© 2023 The Authors.)
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- 2023
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186. Creating reverse flow arteriovenous fistulas with a forearm cannulation target.
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Kim H, Nelson PR, Mushtaq N, Mallios A, Kempe K, Zamor K, Pandit V, Vang S, and Jennings WC
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- Humans, Female, Retrospective Studies, Vascular Patency, Treatment Outcome, Renal Dialysis methods, Catheterization, Forearm blood supply, Arteriovenous Shunt, Surgical adverse effects, Arteriovenous Shunt, Surgical methods
- Abstract
Background: Establishing a forearm arteriovenous fistula (AVF) offers preferred cannulation sites and preserves proximal access opportunities. When a radiocephalic AVF at the wrist is not feasible and the upper arm cephalic and median cubital veins are inadequate, an AV graft or more complex access procedure is often required. Creating a retrograde flow forearm AVF (RF-AVF) is a valuable alternative where the mid-forearm median antebrachial or cephalic vein is adequate, offering forearm cannulation zones with AVF outflow through deep and superficial collaterals. We report our technique and results., Methods: We retrospectively reviewed our vascular access data base of consecutive patients during an 11-year study period where a RF-AVF established the only available cannulation target in the forearm. In addition to physical examination, all patients had ultrasound vessel mapping., Results: A forearm access was established with a RF-AVF as the only opportunity for cannulation in 48 patients. Ages were 14-86 years (median = 62 years). Forty-four percent female, 63% diabetic, 13% obese, and 29% had previous access operations. Inflow was proximal radial artery in 47 individuals and one proximal ulnar. Nine AVFs (19%) failed at 2-66 months (median 14 months). One RF-AVF was ligated due to arm edema. Follow-up was 2-111 months (median = 23.5 months). Primary and cumulative patency rates were 62% and 91% at 12 months, and 46% and 85% at 24 months. Five patients were lost to follow-up with functioning RF-AVFs (mean 41 months). Twenty-three patients (48%) died during F/U of causes unrelated to access procedures (mean 25 months)., Conclusions: Establishing a reverse flow forearm AVF offers a successful autogenous access option in the forearm for selected patients with an inadequate distal radial artery and/or cephalic vein at the wrist, avoiding more complex or staged procedures and preserving upper arm sites for future use. A proximal radial artery inflow procedure is recommended., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2023
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187. Reassessing the Role of Sarcopenia for Predicting Long-Term Survival After Abdominal Aortic Aneurysm Repair.
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Pandit V and Aziz H
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- Humans, Vascular Surgical Procedures, Treatment Outcome, Risk Factors, Retrospective Studies, Sarcopenia complications, Aortic Aneurysm, Abdominal complications, Aortic Aneurysm, Abdominal surgery, Endovascular Procedures, Blood Vessel Prosthesis Implantation
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- 2023
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188. The association of racial and ethnic disparities and frailty in geriatric patients undergoing revascularization for peripheral artery disease.
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Pandit V, Brown T, Bhogadi SK, Kempe K, Zeeshan M, Bikk A, Tan TW, and Nelson P
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- Aged, Female, Humans, Male, Postoperative Complications etiology, Retrospective Studies, Risk Factors, Treatment Outcome, Frail Elderly, Frailty diagnosis, Frailty complications, Peripheral Arterial Disease diagnosis, Peripheral Arterial Disease surgery, Vascular Surgical Procedures
- Abstract
Frailty is defined as a state of decreased physiologic reserve contributing to functional decline and adverse outcomes. Racial disparities in frail patients have been described sparsely in the literature. We aimed to assess whether race influences frailty status in geriatric patients undergoing revascularization for peripheral artery disease (PAD) with chronic limb-threatening ischemia (CLTI). A 5-year analysis of the National Surgical Quality Improvement Program database included all geriatric (65 years and older) patients who underwent revascularization for lower extremity PAD with CLTI. The frailty index was calculated using a 11-variable modified frailty index and a cutoff of 0.27 indicated frail status. The primary outcome was an association of race or ethnicity with frailty status. We included 7,837 geriatric patients who underwent a surgical procedure (open: 55.2%) for PAD with CLTI. Mean age of patients was 75.4 years, 63.8% were male, 24.1% (n = 1,889) were frail, and 21.8% (n = 1,710) were African American (AA). Overall complication rate was 11.2% (n = 909) and overall mortality rate was 1.9% (n = 148). AA patients were more likely to be frail than White patients (29.6% v 23.9%; P = .03). AA and Hispanic patients were more likely to have complications (P = .03 and P = .001) and require readmission (P = .015 and P = .001) compared with White and non-Hispanic patients, respectively. Frail AA and frail Hispanic patients were more likely to have 30-day complications and readmission compared with frail White and frail non-Hispanic patients, respectively. Race and ethnicity influence frailty status in geriatric patients with PAD and CLTI. These disparities exist regardless of age, sex, comorbid conditions, and type of operative procedure. Additional studies are needed to highlight disparities by race and ethnicity to identify potentially modifiable risk factors to improve outcomes., (Published by Elsevier Inc.)
- Published
- 2023
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189. Frailty Predicts Loss of Independence After Liver Surgery.
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Jehan FS, Pandit V, Khreiss M, Joseph B, and Aziz H
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- Humans, Retrospective Studies, Hepatectomy adverse effects, Liver, Postoperative Complications epidemiology, Postoperative Complications etiology, Frailty complications
- Abstract
Background: Loss of independence (LOI) is a significant concern in patients undergoing liver surgery. Although the risks of morbidity and mortality have been well studied, there is a dearth of data regarding the risk of LOI. Therefore, this study aimed to assess predictors of LOI after liver surgery., Methods: This study utilized the National Surgical Quality Improvement Program (NSQIP) data from 2015 to 2018 from a retrospective cohort study of patients undergoing liver resections. LOI was defined as the change from preoperative functional independence to the postoperative discharge requirement in a post-care facility. Frailty was defined using the modified frailty index-5 (mFI-5)., Results: A total of 22,463 patients underwent hepatectomy via the NSQIP during the study period. In total, 22,067 participants were included in the analysis. A total of 4.7% of patients had LOI after surgery and were discharged to a rehabilitation center or nursing facility. mFI-1 was an independent predictor of LOI (OR:2.2 [1.9-4.3]). However, the odds for LOI were higher (OR:5.1[2.5-8.2]) in patients with mFI ≥ 2., Conclusion: LOI is an important outcome of liver surgery. Frailty is a predictor of LOI and should be used as a guide to inform patients about the potential outcomes., (© 2022. The Society for Surgery of the Alimentary Tract.)
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- 2022
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190. Venous thromboembolism as the first sign of malignancy.
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Pandit V, Kempe K, Hanna K, Baab K, Jennings W, Khorgami Z, Zamor K, Shakir Z, Kim H, and Nelson P
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- Female, Humans, Retrospective Studies, Risk Factors, Neoplasms complications, Neoplasms diagnosis, Neoplasms epidemiology, Pulmonary Embolism complications, Pulmonary Embolism diagnosis, Pulmonary Embolism epidemiology, Venous Thromboembolism complications, Venous Thromboembolism diagnosis, Venous Thromboembolism epidemiology, Venous Thrombosis complications, Venous Thrombosis diagnostic imaging, Venous Thrombosis epidemiology
- Abstract
Background: Venous thromboembolism (VTE) is commonly associated with hypercoagulability in patients with cancer; however, there have been few investigations of VTE as the first sign of malignancy and even fewer performed in the United States. The aim of our study was to evaluate the incidence and predictors of unrecognized malignancy in patients presenting with VTE., Methods: We performed a 1-year retrospective analysis of the Nationwide Readmission Database, including patients aged 18 years or older, presenting with a primary diagnosis of deep vein thrombosis (DVT) or a pulmonary embolism (PE). Patients known to have preexisting malignant diseases were excluded. Outcomes included the rate of newly diagnosed malignancy within 6 months from the discovery of VTE and demographic or associated illness predictors for the diagnosis of malignancy. A regression analysis was performed, based on which a VTE malignancy score was developed., Results: A total of 116,048 patients were identified with VTE (49.8% DVT, 41.7% PE, 8.6% DVT and PE), 16% (n = 18,294) with malignancy. Of the remaining 97,754 patients, 31% were readmitted within 6 months. The incidence of newly diagnosed malignancy within 6 months was 2.4% (n = 2354). The most common malignancies were gastrointestinal in origin (29.2%). Demographic and diagnostic predictors for malignancy included age 65 years or older, female sex, inferior vena cava (IVC) thrombus, upper extremity thrombus, and a Charlson Comorbidity Index score of 5 or more. Receiver operating characteristic curve analysis found a cutoff VTE Malignancy score of 3 (sensitivity, 86%; specificity, 89%) to be predictive of an increased risk of a newly discovered malignancy within 6 months., Conclusions: VTE can be a risk indicator of underlying malignancy. Validation of a patient risk stratification score using multiple demographic or comorbid predictors for VTE on index admission may offer an opportunity for earlier diagnosis of occult malignancy., (Copyright © 2022 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
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- 2022
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191. Autogenous Vascular Access in American Indians.
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Kempe K, Nelson PR, Mushtaq N, Kim H, Zamor K, Vang S, Pandit V, Randel M, Christie R, and Jennings W
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- Female, Graft Occlusion, Vascular diagnostic imaging, Graft Occlusion, Vascular etiology, Humans, Male, Middle Aged, Obesity complications, Obesity epidemiology, Renal Dialysis adverse effects, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Vascular Patency, American Indian or Alaska Native, Arteriovenous Fistula etiology, Arteriovenous Shunt, Surgical adverse effects
- Abstract
Background: American Indians (AI) or Alaska Natives, or in combination with another race, comprised 6.8 million individuals in 2010 and the population is expected to exceed 10 million in the current census. Diabetes is more common in AIs than in other races in the United States and is responsible for 69% of new onset end stage renal disease in AI patients. The incidence of obesity is also higher among AIs. As both diabetes and obesity make creating a successful autogenous vascular access more challenging, we reviewed our experience creating arteriovenous fistulas in AI patients., Methods: Our vascular access database was reviewed for consecutive new AI patients undergoing creation of a hemodialysis vascular access during a 10-year period. Each patient underwent ultrasound vessel mapping by the operating surgeon in addition to history and physical examination. The goal for initial cannulation was 4-6 weeks after access creation. Minimal AVF flow volume for cannulation was 500 mL/min with an outflow vein diameter of 6 mm., Results: 235 consecutive new AI patients were identified. All patients had an autogenous access constructed. The median age was 56 years (range, 15-89 years). Diabetes was present in 85% and 42% were female. Obesity was noted in 27% of the patients and 37% had previous vascular access operations. Primary patency at 12 and 24 months was 62% and 46%, respectively. Cumulative patency at 12 and 24 months was 96% and 94%, respectively. Female gender and previous access operations were associated with lower primary (P = 0.002 and 0.02, respectively) and cumulative patency (P = 0.01 and 0.04, respectively). Obesity was associated with lower cumulative access patency (P = 0.02). Overall, 74% of the access operations used the radial or ulnar artery for AVF inflow. Distal radial artery inflow AVFs were associated with longer patient survival (P = 0.01) and individuals with proximal radial inflow had longer survival when compared to brachial artery AVFs. Previous access operations were associated with shorter patient survival (P = 0.04)., Conclusions: Safe and functional arteriovenous fistulas can be created for American Indians despite a higher prevalence of vascular access risk factors such as diabetes and obesity., (Copyright © 2021. Published by Elsevier Inc.)
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- 2022
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192. Avoiding hemodialysis access-induced distal ischemia.
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Horst VD, Nelson PR, Mallios A, Kempe K, Pandit V, Kim H, and Jennings WC
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- Hand, Humans, Ischemia diagnostic imaging, Ischemia etiology, Renal Dialysis adverse effects, Treatment Outcome, Vascular Patency, Arteriovenous Shunt, Surgical adverse effects, Kidney Failure, Chronic diagnosis, Kidney Failure, Chronic therapy
- Abstract
Timely creation and maintenance of a safe and reliable vascular access is essential for hemodialysis patients with end-stage renal disease. Hemodialysis access-induced distal ischemia (HAIDI) is a recognized complication of arteriovenous fistulas and grafts that may result in serious or even devastating consequences. Avoiding such complications is clearly preferred over treatment of HAIDI once established. Proper recognition of patients at increased risk of HAIDI includes careful pre-operative evaluation of the patient's medical and surgical history along with physical examination and imaging to determine a plan for creating a functional permanent access while minimizing the risk of distal ischemia. Our aim is to review identifying characteristics of individuals at risk of HAIDI and provide recommendations regarding pre-operative assessment. Vascular access options and techniques are suggested for establishing a functional vascular access without distal ischemia for such patients.
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- 2021
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193. Frailty Syndrome in Patients With Lower Extremity Amputation: Simplifying How We Calculate Frailty.
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Pandit V, Tan TW, Kempe K, Chitwood J, Kim H, Horst V, Zhou W, and Nelson P
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- Aged, Aged, 80 and over, Female, Frailty complications, Hospital Mortality, Humans, Lower Extremity blood supply, Lower Extremity surgery, Male, Patient Readmission statistics & numerical data, Peripheral Arterial Disease mortality, Postoperative Complications etiology, Predictive Value of Tests, Retrospective Studies, Risk Assessment methods, Risk Assessment statistics & numerical data, Risk Factors, Severity of Illness Index, United States epidemiology, Amputation, Surgical adverse effects, Frailty diagnosis, Geriatric Assessment methods, Peripheral Arterial Disease surgery, Postoperative Complications epidemiology
- Abstract
Background: Frailty syndrome is an established predictor of adverse outcomes after surgical procedures. Our study aimed to compare the simplified National Surgical Quality Improvement Program 5-factor-modified frailty index (mFI-5) to its prior 11-factor-modified frailty index (mFI-11) with respect to the predictive ability for mortality, postoperative complications, and unplanned 30-d readmission in patients undergoing lower limb amputation., Methods: The National Surgical Quality Improvement Program (2005-2012) databank was queried for all geriatric patients (>65 y) who underwent above-knee and below-knee amputations. We calculated each mFI by dividing the number of factors present for a patient by the total number of available factors. To assess the correlation between the mFI-5 and mFI-11, we used Spearman's rho rank coefficient. We then compared the two indices for each outcome (30-d complication, 30-d mortality, and 30-d readmission) and C-Statistic using predictive models., Results: A total of 8681 patients were included with mean age of 76 ± 9 y, complication rate 35.8%, mortality rate 10.2%, and readmission rate 15.9%. There was no difference in type of amputation in frail and nonfrail. Correlation between the mFI-5 and mFI-11 was above 0.9 for all outcome measures. Both mFI-5 and mFI-11 indexes had strong predictive ability for mortality, postoperative complications, and 30-d readmissions., Conclusions: In patients undergoing major lower limb amputation, we found mFI-5 and the mFI-11 were equally effective in predicting postoperative outcomes. Frailty remained a strong predictor of postoperative complications, mortality, and 30-d readmission., (Copyright © 2020 Elsevier Inc. All rights reserved.)
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- 2021
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194. Racial and ethnic disparities in lower extremity amputation: Assessing the role of frailty in older adults.
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Pandit V, Nelson P, Kempe K, Gage K, Zeeshan M, Kim H, Khan M, Trinidad B, Zhou W, and Tan TW
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- Black or African American statistics & numerical data, Aged, Aged, 80 and over, Amputation, Surgical methods, Amputation, Surgical statistics & numerical data, Female, Frail Elderly statistics & numerical data, Frailty complications, Frailty diagnosis, Geriatric Assessment statistics & numerical data, Hispanic or Latino statistics & numerical data, Humans, Limb Salvage methods, Limb Salvage statistics & numerical data, Lower Extremity surgery, Male, Minority Groups statistics & numerical data, Patient Readmission statistics & numerical data, Peripheral Arterial Disease complications, Postoperative Complications etiology, Retrospective Studies, Risk Assessment statistics & numerical data, Risk Factors, Amputation, Surgical adverse effects, Frailty epidemiology, Health Status Disparities, Limb Salvage adverse effects, Peripheral Arterial Disease surgery, Postoperative Complications epidemiology
- Abstract
Background: Frailty is a state of decreased physiologic reserve contributing to functional decline and is associated with adverse surgical outcomes, particularly in the elderly. Racial disparities have been reported previously both in frail individuals and in limb-salvage patients. Our goal was to assess whether race and ethnicity are disproportionately linked to frailty status in geriatric patients undergoing lower-limb amputation, leading to an increased risk of complications., Methods: A 3-year analysis was conducted of the National Surgical Quality Improvement Program database and included all geriatric (age ≥65 years) patients who underwent amputation of the lower limb. The frailty index was calculated using the 11-factor modified frailty index with a cutoff limit of 0.27 defined for frail status. Outcomes were 30-day complications, mortality, and readmissions. Multivariate regression analysis was performed., Results: A total of 4,218 geriatric patients underwent surgical amputation of a lower extremity (above knee: 41%; below knee: 59%). Of these patients, 29% were frail, 26% were African American, and 9% were Hispanic. Being African American (odds ratio: 1.6 [1.3-1.9]) and Hispanic (odds ratio: 1.1 [1.05-2.5]) was independently associated with frail status. Frail African Americans had a higher likelihood of 30-day complications (odds ratio: 3.2 [1.9-4.4]) and 30-day readmissions (odds ratio: 2.9 [1.8-3.6]) when compared with nonfrail individuals. Similarly, frail Hispanics had higher 30-day complications (odds ratio: 2.6 [1.9-3.1]) and 30-day readmissions (odds ratio: 1.4 [1.1-2.7]) compared with nonfrail Hispanics/Latinos., Conclusion: African American and Hispanic geriatric patients undergoing lower-limb amputation are at increased risk for frailty status and, as a result, increased associated operative complications. These disparities exist regardless of age, sex, comorbid conditions, and location of amputation. Further studies are needed to highlight disparities by race and ethnicity to identify potentially modifiable risk factors, decrease frailty, and improve outcomes., (Copyright © 2020 Elsevier Inc. All rights reserved.)
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- 2020
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195. Effect of frailty syndrome on the outcomes of patients with carotid stenosis.
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Pandit V, Lee A, Zeeshan M, Goshima K, Tan TW, Jhajj S, Trinidad B, Weinkauf C, and Zhou W
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- Age Factors, Aged, Aged, 80 and over, Carotid Stenosis diagnostic imaging, Carotid Stenosis mortality, Databases, Factual, Failure to Rescue, Health Care, Female, Frailty mortality, Health Status, Hospital Mortality, Humans, Inpatients, Length of Stay, Male, Patient Readmission, Postoperative Complications mortality, Postoperative Complications therapy, Retrospective Studies, Risk Assessment, Risk Factors, Stents, Time Factors, Treatment Outcome, United States, Carotid Stenosis surgery, Endarterectomy, Carotid adverse effects, Endarterectomy, Carotid mortality, Endovascular Procedures adverse effects, Endovascular Procedures instrumentation, Endovascular Procedures mortality, Frail Elderly, Frailty diagnosis
- Abstract
Background: Frailty syndrome confers a greater risk of morbidity and mortality after operative interventions. The aim of the present study was to assess the effect of frailty on the outcomes after carotid interventions, including both carotid endarterectomy (CEA) and carotid artery stenting (CAS)., Methods: We performed an 8-year (2005-2012) retrospective analysis of the National Surgery Quality and Improvement Program database, including patients who had undergone CEA or CAS for carotid artery stenosis. A modified frailty index score was calculated. Frail status was defined as a modified frailty index score of ≥0.27. The outcome measures were inpatient complications, mortality, failure to rescue (FTR), hospital length of stay, and 30-day readmissions. Multivariable regression analysis was performed to study the association between frailty and the perioperative outcomes., Results: The data from 37,875 patients were included. Of the 37,875 patients, 95.7% had undergone CEA, and 27.3% of the patients were frail (27% of the CEA and 26% of the CAS groups had qualified as frail). Overall, 11.7% of the patients had experienced complications, 2.2% had died, and 6.7% had been readmitted after discharge. On regression analysis, after controlling for age, gender, albumin level, type of surgery, and American Society of Anesthesiologists class, frail status was an independent predictor of complications (23.5% vs 7.2%; P < .001), mortality (5.2% vs 1.1%; P = .02), FTR (12.1% vs 4.7%; P = .02), and 30-day readmissions (14.9% vs 3.7%; P = .03). On subanalysis of the patients who had undergone CAS, no association was found between frail status and the occurrence of complications (odds ratio [OR], 1.5; 95% confidence interval [CI], 0.8-3.2), mortality (OR, 1.2; 95% CI, 0.6-2.7), FTR (OR, 0.9; 95% CI, 0.4-2.3), and 30-day readmission rate (OR, 1.1; 95% CI, 0.5-3.1)., Conclusions: Frailty syndrome was associated with morbidity and mortality among patients undergoing surgical interventions for carotid stenosis. In the present study, frailty was associated with significant mortality and morbidity for those who had undergone CEA but not for those who had undergone CAS. However, the present study was not designed to determine the optimal treatment of frail patients. Incorporating frailty status into the treatment algorithm (CEA vs CAS) might provide a more accurate risk assessment and improve patient outcomes., (Copyright © 2019 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
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- 2020
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196. Frailty Syndrome in Patients with Carotid Disease: Simplifying How We Calculate Frailty.
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Pandit V, Zeeshan M, Nelson PR, Hamidi M, Jhajj S, Lee A, Trinidad B, Goshima K, Horst V, Weinkauf C, Zhou W, and Tan TW
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- Aged, Aged, 80 and over, Carotid Artery Diseases diagnosis, Carotid Artery Diseases mortality, Clinical Decision-Making, Comorbidity, Databases, Factual, Female, Frailty mortality, Health Status, Humans, Male, Patient Readmission, Patient Selection, Predictive Value of Tests, Retrospective Studies, Risk Assessment, Risk Factors, Severity of Illness Index, Surgical Wound Infection epidemiology, Time Factors, Treatment Outcome, Carotid Artery Diseases surgery, Decision Support Techniques, Endarterectomy, Carotid adverse effects, Endarterectomy, Carotid mortality, Frail Elderly, Frailty diagnosis
- Abstract
Background: Frailty syndrome is an established predictor of adverse outcomes after carotid surgery. Recently, a modified 5-factor National Surgical Quality Improvement Program frailty index has been used; however, its utility in vascular procedures is unclear. The aim of our study was to compare the 5-factor modified frailty index (mFI-5) with the 11-factor modified frailty index (mFI-11) regarding value and predictive ability for mortality, postoperative infection, and unplanned 30-day readmission., Methods: The mFI was calculated by dividing the number of factors present for a patient by the number of available factors for which there were no missing data. Spearman rho test was used to assess the correlation between the mFI-5 and mFI-11. Predictive models, using both unadjusted and adjusted logistic regressions, were created for each outcome for carotid endarterectomy using 2005-2012 National Surgical Quality Improvement Program data, the last year all mFI-11 variables existed., Results: A total of 36,000 patients were included with mean age of 74.6 ± 5.9 years, complication rate of 10.7%, mortality rate of 3.1%, and readmission rate of 6.2%. Correlation between mFI-5 and mFI-11 was above 0.9 across all outcomes for patients. mFI-5 had strong predictive ability for mortality, postoperative complications, and 30-day readmission., Conclusions: The mFI-5 and mFI-11 are equally effective predictors of postoperative outcomes in patients undergoing carotid endarterectomy. mFI-5 is a strong predictor of postoperative complications, mortality, and 30-day readmission., (Copyright © 2019 Elsevier Inc. All rights reserved.)
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- 2020
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197. Rectal cancer in the young: analysis of contributing factors and surgical outcomes.
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Mogor O, Ewongwo A, Ojameruaye O, Pandit V, Omesiete P, Martinez C, Hsu P, Scott A, Elquza E, and Nfonsam V
- Abstract
Background: Rectal cancer (RC) among young patients (≤50 years) is on the rise. The factors associated with development of RC are established however; factors leading to early RC remain unclear. The aim of this study was to assess factors associated with RC among young patients., Methods: National estimates for patients with RC were abstracted from the National Inpatient Sample (NIS) database [2010-2012]. Patients were divided into two groups: young (≤50 years) and old (>50 years). Demographic, comorbidities, procedures performed, and hospital outcomes were collected. Regression analysis was performed to compare both groups., Results: A total of 68,699 patients with RC were included. Incidence of RC among young patients increased significantly over the study period (2.4% vs. 3.4%; P=0.04). Majority of young patients with RC were white females. Bleeding was the most common presentation among young patients (P=0.03). Younger patients were more likely to have a family history of RC (P=0.01) and were more likely to undergo elective surgery (P=0.04) and laparoscopic surgery (P=0.02) compared to the older patients. Younger patients with RC were also more likely to use alcohol (P=0.03), be obese (P=0.02) compared to elder patients. There was no difference in the other co-morbidities between the two groups. After controlling for all factors in a regression model, younger patients had a lower complication rate (P=0.01), hospital LOS (P=0.02), and mortality rate (P=0.04)., Conclusions: RC in younger patients appears as a different disease with different outcomes. There appears to be multifactorial and environmental factors contributing to this trend. Race and gender also play a role in the incidence of RC in the young. Identifying these risk factors will lead to a more robust intervention plan to help improve care among younger patients with RC., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare., (2019 Journal of Gastrointestinal Oncology. All rights reserved.)
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- 2019
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198. Disparities in colon and rectal cancer queried individually between Hispanics and Whites.
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Koblinski J, Jandova J, Pandit V, Omesiete P, and Nfonsam V
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Background: Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the second leading cause of cancer related deaths in the United States. Racial disparities between Hispanics and Whites exist for incidence of late-onset (LO) CRC. However, not much is known about potential disparities between colon cancer (CC) and rectal cancer (RC) incidence queried individually., Methods: Using the SEER database data from 2000 to 2010, we obtained the national estimates of CC and RC for Hispanics and Whites. We analyzed trends in incidence, mortality, gender and stage of disease for early-onset (EO) (<50 years old) and LO (>50 years old) CC and RC., Results: In Hispanics, the overall incidence of CC and RC increased by 47% and 52%, respectively; while in Whites, the overall incidence of CC and RC decreased by 13% and 2% respectively. Incidence of EO CC increased in both Hispanics and Whites by 83% and 17%, respectively, and incidence of EO RC also increased for both groups with a 76% increase in Hispanics and a 34% increase in Whites. For LO CC, the incidence increased by 37% in Hispanics while it decreased by 17% in Whites and for LO RC, the trend in incidence increased in Hispanics by 41%, but decreased in Whites by 11%., Conclusions: This study established that the incidence of CC and RC are different and there is racial disparity in incidence between Whites and Hispanics. This study, hopefully, will help in crafting public policy that might help in addressing this disparity., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.
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- 2019
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199. The acute inflammatory response after trauma is heightened by frailty: A prospective evaluation of inflammatory and endocrine system alterations in frailty.
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Palmer J, Pandit V, Zeeshan M, Kulvatunyou N, Hamidi M, Hanna K, Fain M, Nikolich-Zugich J, Zakaria ER, and Joseph B
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- Aged, Biomarkers blood, Female, Frail Elderly, Frailty blood, Human Growth Hormone blood, Humans, Inflammation blood, Insulin-Like Growth Factor I analysis, Interleukin-1beta blood, Interleukin-2 Receptor alpha Subunit blood, Interleukin-6 blood, Male, Prospective Studies, Tumor Necrosis Factor-alpha blood, Wounds and Injuries blood, Frailty complications, Inflammation etiology, Wounds and Injuries complications
- Abstract
Background: Frailty is a geriatric syndrome characterized by decreased physiological reserves, increased inflammation, and decreased anabolic-endocrine response. The biomarkers associated with frailty are poorly understood in trauma. The aim of this study was to analyze the association between frailty and immune: IL-1β, IL-6, IL-2Rα, tumor necrosis factor (TNF)-α, and endocrine biomarkers: insulin-like growth factor-1 and growth hormone in trauma patients., Methods: We conducted a 1-year (2017-2018) prospective analysis of geriatric (≥65 years) trauma patients admitted to our Level I trauma center. Frailty was measured using the trauma-specific frailty index (TSFI) and blood samples were collected within 24 hours of admission. Patients were stratified into two groups: frail (TSFI > 0.25) and nonfrail (TSFI ≤ 0.25). We then measured the levels of immune and endocrine biomarkers by a colorimetric output that was read by a spectrophotometer (Quantikine ELISA). The outcome measures were the levels of the immune and endocrine markers in the two groups. Multivariable linear regression was performed., Results: A total of 100 geriatric trauma patients were consented and enrolled. The mean age was 77.1 ± 9.8 years and 34% were female. Thirty-nine (39%) patients were frail. Frail patients were more likely to present after falls (p = 0.01). There was no difference in age (p = 0.78), sex (p = 0.77), systolic blood pressure (p = 0.16), and heart rate (p = 0.24) between the two groups. Frail patients had higher levels of TNF-α (p = 0.01), IL-1β (p = 0.01), and IL-6(p = 0.01) but lower levels of growth hormone (p = 0.03) and insulin-like growth factor-1 (p < 0.04) compared with nonfrail patients. There was no difference in the level of IL-2Rα (p = 0.25). On regression analysis, frailty was positively correlated with the levels of proinflammatory biomarkers, that is, TNF- α, IL-1 β, and IL-6 and negatively correlated with endocrine biomarkers., Conclusion: This study supports the association between frailty and immune and endocrine markers. Frailty acts synergistically with trauma in increasing the acute inflammatory response. Moreover, frail patients have lower levels of anabolic hormones. Understanding the inflammatory and endocrine response in frail trauma patients may result in better therapeutic strategies.
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- 2019
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200. Racial disparities in the incidence of colon cancer in patients with inflammatory bowel disease.
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Vij P, Chen D, Hsu CH, Pandit V, Omesiete P, Elquza E, Scott A, Cruz A, and Nfonsam V
- Abstract
Background: Studies have explored the relationship between inflammatory bowel disease (IBD) [ulcerative colitis (UC) and Crohn's disease (CD)] and colon cancer (CC). Additionally, racial disparities in the incidence of CC is well known. However, the impact of racial disparity in IBD patients who develop CC remains unclear. The aim of this study is to address the knowledge gap in this particular group of patients., Methods: A retrospective analysis was done using the National Inpatient Sample (NIS) database from 2011. We included patients with IBD over age ≥18 years with a diagnosis of CC. Patients were stratified by race, gender, age, presence of IBD and CC. Statistical analysis was performed to compare the groups., Results: A total of 57,542 patients were included (CD: 36,357, UC: 21,001). Of all patients with and without IBD, advanced age, Black and Asian race conferred an increased risk of developing CC, whereas female gender, Hispanic and Native American race conferred a protective effect. In patients with IBD, advanced age conferred an increased risk for developing CC while female gender conferred a protective effect. In this subset of patients, black race conferred a protective effect., Conclusions: Racial disparity exists in the overall incidence of CC and among patients with IBD who develop CC. Interestingly, black race conferred a protective effect for patients with IBD, contrary to what is seen in the general population. These findings could be attributed to the environmental factors and genetic makeup between racial groups. Further studies are warranted to better understand these disparities., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.
- Published
- 2019
- Full Text
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