24 results on '"Samantha Maasarani"'
Search Results
2. Novel Application of the Piezoelectric Device with an Intraoral Approach to Lateral Osteotomies in Rhinoplasty, An Anatomical Study
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Anthony Deleonibus, MD, Marco Swanson, MD, Viren Patel, MD, Vikas Kotha, MD, Samantha Maasarani, MD, Bahar Bassiri Gharb, MD, PhD, and Antonio Rampazzo, MD
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Surgery ,RD1-811 - Published
- 2023
- Full Text
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3. Outcomes following percutaneous endoscopic gastrostomy versus fluoroscopic procedures in the Medicare population
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Samantha Maasarani, Syed I. Khalid, Chantal Creighton, Athena J. Manatis-Lornell, Aaron L. Wiegmann, Samantha L. Terranella, Nicholas J. Skertich, Laura DeCesare, and Edie Y. Chan
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Surgery ,RD1-811 - Abstract
Background: In the United States, few high-quality manuscripts have directly compared the complication profiles of percutaneous endoscopic versus fluoroscopic gastrostomy. Thus, it is our goal to compare these 2 common procedures to better understand their efficacy and complication profiles. Materials and Methods: A retrospective analysis of patient records from Medicare parts A/B from 2007 to 2012 was used to identify percutaneous fluoroscopic gastrostomy and percutaneous endoscopic gastrostomy procedures. Patient demographics were stratified by age, sex, comorbidities, and complications. Results: A total of 258,641 patients were found to have either percutaneous fluoroscopic gastrostomy (26,477, 10.2%) or percutaneous endoscopic gastrostomy (232,164, 89.8%). Percutaneous fluoroscopic gastrostomy experienced greater rates for all complications queried. Multivariate analysis revealed that the percutaneous fluoroscopic gastrostomy cohort had statistically significant increased odds for short-term complications, such as ileus (odds ratio 1.4, 95% confidence interval 1.22–1.54), mechanical (odds ratio 2.4, 95% confidence interval 2.28–2.58), wound infection (odds ratio 1.4, 95% confidence interval 1.24–1.52), persistent fistula after tube removal (odds ratio 1.9, 95% confidence interval 1.78–2.12), and other complications (odds ratio 2.2, 95% confidence interval 2.03–2.37), and long-term complications, including abdominal wall pain (odds ratio 1.4, 95% confidence interval 1.33–1.44), wound infection (odds ratio 1.1, 95% confidence interval 1.01–1.15), and persistent fistula after tube removal (odds ratio 1.8, 95% confidence interval 1.72–1.87). Conclusion: Gastrostomy tubes are more frequently being placed via percutaneous endoscopic and fluoroscopic methods. This study suggests that those undergoing fluoroscopic placement have higher odds of developing short- and long-term postoperative complications.
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- 2021
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4. Outcomes following port-a-catheter placement in the Medicare population
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Syed I. Khalid, MD, Samantha Maasarani, MPH, Rachyl M. Shanker, BS, Aaron Lee Wiegmann, MD, Rita Wu, BS, Nicholas J. Skertich, MD, Samantha L. Terranella, MD, Laura DeCesare, MD, and Edie Y. Chan, MD
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Surgery ,RD1-811 - Abstract
Background: We aimed to evaluate the long-term complication profile associated with port-a-catheter placement. Methods: Patients undergoing port-a-catheter placement from 2007 to 2012 with 5-year follow up were identified. Descriptive statistics, χ2 tests, and multivariate regression models were analyzed. Results: Any complication occurring within 5 years postoperatively was common (59.04%, n = 53,353). Arrhythmogenic (32.66%, n = 30,625) and thrombovascular (36.80%, n = 34,499) complications were more common than infection (17.86%, n = 16,745) and mechanical (10.31%, n = 9,670) complications. Multivariate analysis demonstrated that history of atrial fibrillation is a risk factor for developing any complication (odds ratio 7.99, 95% confidence interval 7.29–8.77). Conclusion: Patients with history of atrial fibrillation have increased odds of developing infectious, thrombovascular, mechanical, and arrhythmogenic complications with port-a-catheter placement. This study is the first to show that postprocedure arrhythmias occur at significant rates within the 5-year follow-up period. We caution that development of new arrhythmia should be monitored throughout a prolonged follow-up period. We hope our analysis encourages multidisciplinary coordination of patients with ports so that implants are promptly removed when they are no longer needed to avoid these complications.
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- 2021
- Full Text
- View/download PDF
5. The Effects of Obesity and Bariatric Surgery on Rates of Upper Extremity Compression Neuropathies
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Syed I. Khalid, MD, Samantha Maasarani, MD, MPH, Kyle B. Thomson, BS, Giovanna R. Pires, BS, Adan Becerra, PhD, Owoicho Adogwa, MD, MPH, Ankit I. Mehta, MD, Shelley S. Noland, MD, and Alfonso Torquati, MD
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Surgery ,RD1-811 - Abstract
Objectives:. To estimate the effects of obesity on all types of upper extremity compression neuropathies (UECN) (carpal tunnel syndrome and other median nerve, radial nerve, and ulnar nerve compression neuropathies) and to assess whether bariatric surgery modifies these effects. Background:. UECN are increasingly prevalent and decrease the quality of life of affected individuals. Studies suggest obesity as a risk factor for carpal tunnel syndrome, the most common type of UECN. Methods:. A retrospective cohort study was conducted using the PearlDiver Mariner Database, an all-payor claims database containing claims for over 53 million patients from 2010 to 2019 in all 50 US states. Rates and odds of all types of UECN were compared between 1:1:1 exact matched cohorts of obese patients who were medically managed, obese patients who underwent bariatric surgery, and nonobese patients (111,967 patients in each cohort). Results:. Compared with nonobese patients, patients with obesity were significantly more likely to develop any UECN (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.09–1.18), carpal tunnel syndrome (OR, 1.15; 95% CI, 1.10–1.30), and 2 or more UECN (OR, 1.34; 95% CI, 1.20–1.48). Compared with obese patients who were managed medically, obese patients who underwent bariatric surgery were significantly less likely to develop any UECN (OR, 0.87; 95% CI, 0.84–0.91) and carpal tunnel syndrome (OR, 0.85; 95% CI, 0.81–0.89). Conclusions:. Obese patients have higher odds of both single and concomitant UECN, specifically carpal tunnel syndrome, compared with nonobese patients. Bariatric surgery decreases the odds of developing UECN compared with obese patients not undergoing surgical intervention.
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- 2022
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6. Patients prescribed antithrombotic medication in elective implant-based breast reconstruction are high risk for major thrombotic complications
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Aaron Lee Wiegmann, Syed I Khalid, Brandon E Alba, Elizabeth S O'Neill, Idanis Perez-Alvarez, Samantha Maasarani, and Keith C Hood
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Fibrinolytic Agents ,Mammaplasty ,Anticoagulants ,Humans ,Hemorrhage ,Thrombosis ,Surgery ,Prospective Studies ,Warfarin ,Platelet Aggregation Inhibitors - Abstract
Implant-based reconstruction (IBR) is the most frequently performed breast reconstruction procedure in the USA. As the US population ages, an increasing number of these patients suffer from comorbidities requiring the use of chronic antithrombotic therapy. Outcomes following IBR in patients prescribed these medications are not well understood.An all-payor administrative claims database (52 million patients) was queried for patients undergoing IBR from 2010 through 2018. Patients who were prescribed therapeutic antithrombotic therapy, and those who were not, were matched in a one-to-one fashion for comorbidities independently associated with bleeding and thrombo-ischemic events following first-stage IBR. Cox proportional hazards models investigated the 90-day risk of bleeding and major thrombo-ischemic events following IBR.Of the 36,379 patients found to have undergone IBR, 2,024 patients were perfectly matched for age and high-risk comorbidities. Patients prescribed antithrombotic drugs had increased 90-day risk for all thrombo-ischemic complications (HR: 5.62, 95% CI: 3.53-8.95, p0.0001), as well as a significantly increased risk for 90-day DVT, 90-day PE, 90-day myocardial infarction, and 90-day stroke. Patients specifically prescribed antiplatelet drugs, direct oral anticoagulants (DOAC), and warfarin had a significantly increased risk for transfusion.Patients prescribed antithrombotic therapy had a significantly increased risk for life-threatening thrombotic events and transfusion following elective IBR. This suggests a role for further monitoring and a potential role for multi- and interdisciplinary interventions to help mitigate this risk. These interventions can be the subject of future prospective studies.
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- 2022
7. Preinjury Social Determinants of Health Disparities Predict Postinjury Psychosocial Conditions in Adult Traumatic Brachial Plexus Injuries
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Samantha Maasarani, Anthony DeLeonibus, Corinne Wee, Tripp Leavitt, Christina D. Lee, Syed I. Khalid, Sarah Layon, Bahar Bassiri Gharb, Antonio Rampazzo, and Shelley S. Noland
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Surgery ,Neurology (clinical) - Published
- 2023
8. Association of Bariatric Surgery and Risk of Cancer in Patients With Morbid Obesity
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Julia Wiegmann, Syed I. Khalid, Aaron L. Wiegmann, Alfonso Torquati, Samantha Maasarani, Phillip Omotosho, and Adan Z. Becerra
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Sleeve gastrectomy ,medicine.medical_specialty ,business.industry ,Colorectal cancer ,medicine.medical_treatment ,Cancer ,medicine.disease ,Obesity ,Surgery ,Weight loss ,Uterine cancer ,Cohort ,Medicine ,medicine.symptom ,business ,Lung cancer - Abstract
Objective This study investigates the rates of obesity-related cancers in patients undergoing vertical sleeve gastrectomy (VSG), Roux-en-Y gastric bypass (RYGB), or no surgical intervention. Summary background data Obesity has been previously associated with increased rates of cancers; however, weight loss surgeries have not been explored to demonstrate their potential risk reduction impact. Methods Patients meeting bariatric eligibility criteria between January 2010 and December 2018 were identified. Exact 1:1:1 matching based on baseline patient demographics and comorbidities was used to create three groups with identical covariates: patients undergoing VSG, RYGB, and no surgery. Results A total of 28,908 bariatric-eligible patients equally split into patients undergoing VSG (n = 9,636, 33.3%), RYGB (n = 9,636, 33.3%), and those with no surgical intervention (n = 9,636, 33.3%). Bariatric-eligible patients that did not undergo surgical intervention had significantly higher rates and odds of developing numerous cancer types included in our study when compared to either surgical cohorts, with any cancer type (4.61%), uterine (0.86%), colorectal (0.57%), and lung cancers (0.50%) being most common. Individuals undergoing RYGB were significantly less likely to develop colorectal cancer compared to patients without any surgical intervention (OR 0.47, 95% CI 0.30-0.75). Additionally, those undergoing VSG were significantly less likely to develop lung cancer than the bariatric eligible no surgery cohort (OR 0.42, 95% CI 0.25-0.70). Conclusion Postoperative rates of any cancer type, lung, ovarian, and uterine cancer were significantly lower in obese patients undergoing either vertical sleeve gastrectomy (VSG) or Roux-en-Y gastric bypass (RYGB) compared to bariatric-eligible patients without any surgical intervention.
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- 2021
9. 199 Rates of Upper Extremity Compression Neuropathies Among Obese Patients Compared to Non-Obese Controls and Obese Patients Who Underwent Bariatric Surgery
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Syed Ibad Khalid, Samantha Maasarani, Kyle Thomson, Giovanna Pires, Adan Becerra, Owoicho Adogwa, Ankit Indravadan Mehta, Shelley Noland, and Alfonso Torquati
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Surgery ,Neurology (clinical) - Published
- 2023
10. Macromastia as a Cause of Chronic Back Pain
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Samantha Maasarani, Lacey R Pflibsen, Shelley S. Noland, and Sarah A. Layon
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medicine.medical_specialty ,Back Pain ,business.industry ,Mammaplasty ,Back pain ,Physical therapy ,Humans ,Medicine ,Breast ,Hypertrophy ,General Medicine ,medicine.symptom ,business - Published
- 2021
11. Outcomes following port-a-catheter placement in the Medicare population
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Nicholas J. Skertich, Laura DeCesare, Rita Wu, Rachyl M Shanker, Edie Y. Chan, Samantha Maasarani, Syed I. Khalid, Aaron L. Wiegmann, and Samantha Terranella
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medicine.medical_specialty ,Multivariate analysis ,business.industry ,lcsh:Surgery ,Atrial fibrillation ,Odds ratio ,lcsh:RD1-811 ,medicine.disease ,Confidence interval ,Article ,Odds ,Surgery ,medicine ,Risk factor ,Complication ,Catheter placement ,business - Abstract
Background We aimed to evaluate the long-term complication profile associated with port-a-catheter placement. Methods Patients undergoing port-a-catheter placement from 2007 to 2012 with 5-year follow up were identified. Descriptive statistics, χ2 tests, and multivariate regression models were analyzed. Results Any complication occurring within 5 years postoperatively was common (59.04%, n = 53,353). Arrhythmogenic (32.66%, n = 30,625) and thrombovascular (36.80%, n = 34,499) complications were more common than infection (17.86%, n = 16,745) and mechanical (10.31%, n = 9,670) complications. Multivariate analysis demonstrated that history of atrial fibrillation is a risk factor for developing any complication (odds ratio 7.99, 95% confidence interval 7.29–8.77). Conclusion Patients with history of atrial fibrillation have increased odds of developing infectious, thrombovascular, mechanical, and arrhythmogenic complications with port-a-catheter placement. This study is the first to show that postprocedure arrhythmias occur at significant rates within the 5-year follow-up period. We caution that development of new arrhythmia should be monitored throughout a prolonged follow-up period. We hope our analysis encourages multidisciplinary coordination of patients with ports so that implants are promptly removed when they are no longer needed to avoid these complications., Highlights • New arrhythmia development is not just an acute phase complication. • Arrhythmogenic events are common and can occur at rates of 32.66%. • Atrial fibrillation patients are 7.98 times more likely to develop any complication.
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- 2020
12. Materials Used in Cranial Reconstruction: A Systematic Review and Meta-Analysis
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Syed I. Khalid, Kyle B. Thomson, Samantha Maasarani, Aaron L. Wiegmann, Jenny Smith, Owoicho Adogwa, Ankit I. Mehta, and Amir H. Dorafshar
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Titanium ,Postoperative Complications ,Skull ,Humans ,Methacrylates ,Surgery ,Neurology (clinical) ,Prospective Studies ,Plastic Surgery Procedures ,Retrospective Studies - Abstract
Cranioplasty is a common neurologic procedure, with complication rates ranging from 20% to 50%. It is hypothesized that the risks of various complications are affected by which material is used for cranioplasty.To evaluate the literature comparing rates of complications after cranioplasty using different materials including autologous bone, hydroxyapatite, methyl methacrylate, demineralized bone matrix, polyetheretherketone, titanium, or composite materials.The PubMed/MEDLINE database was searched for relevant articles published between 2010 and 2020. After screening, 35 articles were included. Outcomes included infection, wound problems, poor cosmesis, overall complications, duration of surgery, and length of stay. For each outcome, a frequentist network meta-analysis was conducted to compare materials used.The risk of infection was 1.62 times higher when methyl methacrylate was used compared with autologous bone (relative risk, 1.62; 95% confidence interval [CI], 1.07-2.45). Length of stay after cranioplasty was on average 3.62 days shorter when titanium was used compared with autologous bone (95% CI, 6.26 to -0.98). The networks constructed for other outcomes showed moderate to substantial between-study heterogeneity, wide CIs, and no significant differences between materials.The quality of existing literature on this topic is relatively poor, almost exclusively comprising single-center retrospective studies. There is not strong enough evidence available to make comprehensive conclusions regarding the risk profiles of various cranioplasty materials across multiple outcomes. Prospective randomized trials are necessary to confirm the significant results found in this analysis and to further elucidate the differential risks of various cranioplasty materials.
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- 2022
13. American Society of Plastic Surgeons Evidence-Based Clinical Practice Guideline Revision: Reduction Mammaplasty
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Galen Perdikis, Claire Dillingham, Stefanos Boukovalas, Adeyemi A. Ogunleye, Francisco Casambre, Arianna Dal Cin, Caryn Davidson, Claire C. Davies, Katelyn C. Donnelly, John P. Fischer, Debra J. Johnson, Brian I. Labow, Samantha Maasarani, Kyle Mullen, Juliann Reiland, Christine Rohde, Sheri Slezak, Anne Taylor, Vidya Visvabharathy, and Diana Yoon-Schwartz
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Evidence-Based Medicine ,Mammaplasty ,Humans ,Surgery ,Female ,Breast ,Hypertrophy ,Surgery, Plastic ,Societies, Medical ,United States - Abstract
A multidisciplinary work group involving stakeholders from various backgrounds and societies convened to revise the guideline for reduction mammaplasty. The goal was to develop evidence-based patient care recommendations using the new American Society of Plastic Surgeons guideline methodology. The work group prioritized reviewing the evidence around the need for surgery as first-line treatment, regardless of resection weight or volume. Other factors evaluated included the need for drains, the need for postoperative oral antibiotics, risk factors that increase complications, a comparison in outcomes between the two most popular techniques (inferior and superomedial), the impact of local anesthetic on narcotic use and other nonnarcotic pain management strategies, the use of epinephrine, and the need for specimen pathology. A systematic literature review was performed, and an established appraisal process was used to rate the quality of relevant scientific research (Grading of Recommendations Assessment, Development and Evaluation methodology). Evidence-based recommendations were made and strength was determined based on the level of evidence and the assessment of benefits and harms.
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- 2022
14. Association of Bariatric Surgery and Risk of Cancer in Patients With Morbid Obesity
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Syed I, Khalid, Samantha, Maasarani, Julia, Wiegmann, Aaron L, Wiegmann, Adan Z, Becerra, Philip, Omotosho, and Alfonso, Torquati
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Adult ,Male ,Incidence ,Bariatric Surgery ,Middle Aged ,United States ,Obesity, Morbid ,Postoperative Complications ,Neoplasms ,Weight Loss ,Humans ,Female ,Aged ,Follow-Up Studies ,Retrospective Studies - Abstract
This study investigates the rates of obesity-related cancers in patients undergoing vertical sleeve gastrectomy (VSG), Roux-en-Y gastric bypass (RYGB), or no surgical intervention.Obesity has been previously associated with increased rates of cancers; however, weight loss surgeries have not been explored to demonstrate their potential risk reduction impact.Patients meeting bariatric eligibility criteria between January 2010 and December 2018 were identified. Exact 1:1:1 matching based on baseline patient demographics and comorbidities was used to create 3 groups with identical covariates: patients undergoing VSG, RYGB, and no surgery.A total of 28, bariatric-eligible patients equally split into patients undergoing VSG (n = 9636, 33.3%), RYGB (n = 9636, 33.3%), and those with no surgical intervention (n = 9636, 33.3%). Bariatric-eligible patients that did not undergo surgical intervention had significantly higher rates and odds of developing numerous cancer types included in our study when compared to either surgical cohorts, with any cancer type (4.61%), uterine (0.86%), colorectal (0.57%), and lung cancers (0.50%) being most common. Individuals undergoing RYGB were significantly less likely to develop colorectal cancer compared to patients without any surgical intervention [odds ratio (OR) 0.47, 95% confidence interval (CI) 0.30-0.75]. Additionally, those undergoing VSG were significantly less likely to develop lung cancer than the bariatric eligible no surgery cohort (OR 0.42, 95% CI 0.25-0.70).Postoperative rates of any cancer type, lung, ovarian, and uterine cancer were significantly lower in obese patients undergoing either vertical sleeve gastrectomy (VSG) or RYGB compared to bariatric-eligible patients without any surgical intervention.
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- 2021
15. Outpatient and inpatient readmission rates of 3- and 4-level anterior cervical discectomy and fusion surgeries
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Jessica Moreno, Jonathan Citow, Owoicho Adogwa, Arjun Ranade, Ryan Kelly, Syed I. Khalid, Patrick Melville, Rita Wu, Samantha Maasarani, Patrick Kim, and Adam Carlton
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Male ,medicine.medical_specialty ,Outpatient surgery ,Anterior cervical discectomy and fusion ,Comorbidity ,Patient Readmission ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,medicine ,Humans ,Retrospective Studies ,business.industry ,Retrospective cohort study ,General Medicine ,Perioperative ,Middle Aged ,medicine.disease ,Spinal Fusion ,Ambulatory Surgical Procedures ,030220 oncology & carcinogenesis ,Emergency medicine ,Ambulatory ,Cervical Vertebrae ,Delirium ,Female ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Diskectomy ,Follow-Up Studies ,Kidney disease - Abstract
OBJECTIVEWith the costs related to the United States medical system constantly rising, efforts are being made to turn traditional inpatient procedures into outpatient same-day surgeries. In this study the authors looked at the various comorbidities and perioperative complications and their impact on readmission rates of patients undergoing outpatient versus inpatient 3- and 4-level anterior cervical discectomy and fusion (ACDF).METHODSThis was a retrospective study of 337 3- and 4- level ACDF procedures in 332 patients (5 patients had both primary and revision surgeries that were included in this total of 337 procedures) between May 2012 and June 2017. In total, 331 procedures were analyzed, as 6 patients were lost to follow-up. Outpatient surgery was performed for 299 procedures (102 4-level procedures and 197 3-level procedures), and inpatient surgery was performed for 32 procedures (11 4-level procedures and 21 3-level procedures). Age, sex, comorbidities, number of fusion levels, pain level, and perioperative complications were compared between both cohorts.RESULTSAnalysis was performed for 331 3- and 4-level ACDF procedures done at 6 different hospitals. The overall 30-day readmission rate was 1.2% (outpatient 3 [1.0%] vs inpatient 1 [3.1%], p = 0.847). Outpatients had increased readmission risk, with comorbidities of coronary artery disease (OR 1.058, p = 0.039), autoimmune disease (OR 1.142, p = 0.006), diabetes (OR 1.056, p = 0.001), and chronic kidney disease (OR 0.933, p = 0.035). Perioperative complications of delirium (OR 2.709, p < 0.001) and surgical site infection (OR 2.709, p < 0.001) were associated with increased risk of 30-day hospital readmission in outpatients compared to inpatients.CONCLUSIONSThis study demonstrates the safety and effectiveness of 3- and 4-level ACDF surgery, although various comorbidities and perioperative complications may lead to higher readmission rates. Patient selection for outpatient 3- and 4-level ACDF cases might play a role in the safety of performing these procedures in the ambulatory setting, but further studies are needed to accurately identify which factors are most pertinent for appropriate selection.
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- 2019
16. Adult intradural intramedullary astrocytomas: a multicenter analysis
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Adam Carlton, Rita Wu, Akhil Peta, Owoicho Adogwa, Haley Meyer, Ryan Kelly, Syed I. Khalid, Patrick Melville, and Samantha Maasarani
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Oncology ,medicine.medical_specialty ,business.industry ,Hazard ratio ,Confounding ,Astrocytoma ,Retrospective cohort study ,Spinal cord ,medicine.disease ,law.invention ,Cancer registry ,Intramedullary rod ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,law ,030220 oncology & carcinogenesis ,Internal medicine ,Epidemiology ,Medicine ,Original Study ,Orthopedics and Sports Medicine ,Surgery ,business ,030217 neurology & neurosurgery - Abstract
Background: Intramedullary tumors constitute approximately 20–30% of all spinal cord tumors and approximately 30–40% of these are astrocytomas. Furthermore, they comprise only about 2–4% of all primary central nervous system (CNS) tumors. Due to their rarity and poor prognosis, large population-based studies are needed to assess the epidemiology and survival risk factors associated with these tumors in the hope of improving outcomes. The authors undertook this retrospective study to explore factors that may influence survival in adult patients with intramedullary astrocytomas. Methods: Utilizing the Surveillance, Epidemiology, and End Results (SEER) database, a prospective cancer registry, the authors retrospectively assessed survival in histologically confirmed, intramedullary spinal cord astrocytomas in patients 18 years of age and older. Survival was described with Kaplan-Meier curves and multivariate regression analysis was used to assess the association of several variables with survival while controlling for confounding variables. Results: Analysis by multivariate regression of 131 cases showed that increasing age of diagnosis [hazard ratio (HR) 1.52, 95% CI: 1.17–1.99, P=0.001], WHO grade IV classification (HR 8.85, 95% CI: 2.83–27.69, P
- Published
- 2019
17. Association Between Social Determinants of Health and Postoperative Outcomes in Patients Undergoing Single-Level Lumbar Fusions: A Matched Analysis
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Rachyl M Shanker, Anne Isabelle Reme, Alecia A. Cherney, Syed I. Khalid, Ravi S. Nunna, Owoicho Adogwa, Samantha Maasarani, and Jennifer S. Smith
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Adult ,Male ,Reoperation ,medicine.medical_specialty ,Adolescent ,Databases, Factual ,Social Determinants of Health ,media_common.quotation_subject ,Population ,Cohort Studies ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Lumbar ,Postoperative Complications ,Internal medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,Social determinants of health ,Patient Reported Outcome Measures ,Healthcare Disparities ,education ,media_common ,Aged ,Retrospective Studies ,030222 orthopedics ,education.field_of_study ,Lumbar Vertebrae ,business.industry ,Convalescence ,Postoperative complication ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Pseudarthrosis ,Spinal Fusion ,Female ,Neurology (clinical) ,business ,Complication ,030217 neurology & neurosurgery - Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE The aim of this study was to analyze association between social determinants of health (SDH) disparity on postoperative complication rates, and 30-day and 90-day all-cause readmission in patients undergoing single-level lumbar fusions. SUMMARY OF BACKGROUND DATA Decreasing postoperative complication rates is of great interest to surgeons and healthcare systems. Postoperative complications are associated with poor convalescence, inferior patient reported outcomes measures, and increased health care resource utilization. Better understanding of the association between Social Determinants of Health (SDH) on postoperative outcomes maybe helpful to decrease postoperative complication rates. METHODS MARINER 2020, an all-payer claims database, was utilized to identify patients undergoing single-level lumbar fusions between 2010 and 2018. The primary outcomes were the rates of any postoperative complication, symptomatic pseudarthrosis, need for revision surgery, or 30-day and 90-day all-cause readmission. RESULTS The exact matched population analyzed in this study contained 16,560 patients (8280 [50.0%] patients undergoing single-level lumbar fusion with an SDH disparity; 8280 [50.0%] patients undergoing single-level lumbar fusion without a disparity). Both patient groups were balanced at baseline. The rate of symptomatic pseudarthrosis (1.0% vs. 0.6%, P
- Published
- 2020
18. Social determinants of health and their impact on rates of postoperative complications among patients undergoing vertical sleeve gastrectomy
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Alfonso Torquati, Philip Omotosho, Samantha Maasarani, Syed I. Khalid, Adan Z. Becerra, and Rachyl M Shanker
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Adult ,Male ,Reoperation ,Sleeve gastrectomy ,medicine.medical_specialty ,Social Determinants of Health ,Deep vein ,medicine.medical_treatment ,Population ,Bariatric Surgery ,Patient Readmission ,Postoperative Complications ,Gastrectomy ,Risk Factors ,medicine ,Clinical endpoint ,Humans ,Social determinants of health ,Hospital Mortality ,education ,Retrospective Studies ,education.field_of_study ,business.industry ,Middle Aged ,medicine.disease ,Surgery ,Pulmonary embolism ,Obesity, Morbid ,medicine.anatomical_structure ,Treatment Outcome ,Cohort ,Female ,Complication ,business - Abstract
Vertical sleeve gastrectomy is one of the most common bariatric procedures worldwide, but the impact of social determinants of health on postoperative outcomes for this procedure has not been well characterized. The objective of this study was to analyze the impact that social determinants of health have on postoperative outcomes after vertical sleeve gastrectomy.This was a population-based study using the MARINER-15 database, an all-payer claims database. The primary endpoint of this study was the development of any complication, including cardiac complication, acute kidney injury, deep vein thrombosis, wound complication, hematoma, pneumonia, pulmonary embolism, transfusion, or urinary tract infection within 60 days, 30- and 90-day all-cause mortality, or readmission within 30 or 90 days in patients undergoing vertical sleeve gastrectomy procedures.Individuals in the social determinants of health cohort had a significantly longer length of stay when compared with those without social determinants of health (3.07 days vs 1.582 days, P.001). These patients were more likely to develop any complication within 60 days after surgery (hazard ratio 1.20, 95% confidence interval 1.03-1.40) but were less likely to return for readmission within 30 and 90 days (hazard ratio 0.80, 95% confidence interval 0.66-0.96; hazard ratio 0.85 95% confidence interval 0.72-0.99).Vertical sleeve gastrectomy is an effective treatment for morbid obesity and its associated comorbidities. Although patients with social determinants of health are more likely to develop any of the analyzed postoperative complications within 60 days, they are less likely to return for readmission, highlighting the importance of focused follow-up and other measures to avoid lapses in care and eliminate further barriers to care in this population.
- Published
- 2020
19. Surgical Trigger Finger Release Is Associated With New-Onset Dupuytren Contracture in the Short-Term Postoperative Period: A Matched Analysis
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Samantha Maasarani, Corinne E. Wee, Christina D. Lee, Syed I. Khalid, Sarah Layon, and Shelley S. Noland
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Orthopedics and Sports Medicine ,Surgery - Abstract
Background: This article compares the rates and time-to-development of new-onset Dupuytren disease in patients with trigger finger treated by steroid injection, surgical release, or both. Methods: PearlDiver’s Mariner 30 database was queried to identify patients with trigger finger between January 2010 and June 2019. One-to-one exact matching based on baseline patient demographics allowed us to create 4 identical groups defined by the type of trigger finger intervention received. Results: The matched population analyzed in this study consisted of 85 944 patients who were equally represented in the steroid injection cohort (n = 21 486, 25.00%), surgical release cohort (n = 21 486, 25.00%), steroids prior to surgery cohort (n = 21 486, 25.00%), and no intervention (control) cohort (n = 21 486, 25.00%). A new Dupuytren diagnosis after trigger finger treatment occurred in 1 in 128 patients overall, 1 in 156 patients treated with steroid injection, and 1 in 126 patients treated with surgical release. Trigger fingers treated by steroid injection only had the lowest rates of Dupuytren disease overall (n = 137, 0.64%, P = .0424) and treatment with fasciectomy (n = 14, 0.07%, P < .0005). In all, 171 patients in the surgery cohort developed Dupuytren disease 1 year after undergoing surgical trigger finger release. Furthermore, this cohort had the highest rates of fasciectomy (n = 55, 0.26%, P < .0005) and the lowest rates of no intervention (n = 103, 0.48%, P = .0471). Trigger fingers managed by surgical release developed Dupuytren disease (mean, 56.11 days; SD, 80.93 days, log-rank P = .02) and underwent fasciectomy (mean, 49.74 days; SD, 62.27 days; log-rank P < .0005) more quickly than all other cohorts. Conclusions: Patients solely undergoing surgical release of their trigger finger had significantly higher odds and expedited rate of developing new-onset Dupuytren disease overall and undergoing subsequent treatment by fasciectomy compared with trigger fingers managed by other interventions.
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- 2022
20. 140 Social Determinants of Health: A Critical Factor in Adult Traumatic Brachial Plexus Injury Outcomes
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Samantha Maasarani, Syed I. Khalid, and Shelley Noland
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Surgery ,Neurology (clinical) - Published
- 2022
21. Pharmacologic and cellular therapies in the treatment of traumatic spinal cord injuries: A systematic review
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Syed I. Khalid, Ravi S. Nunna, B.S. Ryan Kelly, Ankit I. Mehta, Owoicho Adogwa, Hannah Sroussi, and Samantha Maasarani
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medicine.medical_specialty ,Ovid medline ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,medicine ,Humans ,Intensive care medicine ,Spinal cord injury ,Spinal Cord Injuries ,business.industry ,General Medicine ,medicine.disease ,Spinal cord ,Review article ,Clinical trial ,Ion homeostasis ,Systematic review ,medicine.anatomical_structure ,Neurology ,030220 oncology & carcinogenesis ,Treatment strategy ,Surgery ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Objective The objective of this review is to synthesize and consolidate the existing literature on the treatment of SCI, focusing on drugs in development and cellular therapeutics, including stem-cell treatments. Methods Studies were identified through a systemic search of PubMed, Ovid MEDLINE, Embase and the Cochrane database from their respective inceptions through January 1, 2020. We used the keywords “spinal cord injuries”, “therapeutics”, “stem cells”, and “pharmacology.” Study selection Studies that assessed treatment strategies for SCI were included. Data extraction and synthesis Data on SCIs were processed according to the Preferred Reporting Items for Systematic Reviews and meta-Analyses (PRISMA) guidelines. Findings In total, 62 articles were found in the literature search and 13 clinical trials were identified and included in this study. This review article discusses the management and treatment of SCI with an emphasis on the pharmacology, molecular approaches, and the use of stem cells. Presently, none of the treatments examined has shown to be clearly effective. Conclusions Present management strategies of SCI are focused on improving spinal cord perfusion and decreasing secondary injuries such as hypoxia, inflammation, edema, excitotoxicity and disturbances of ion homeostasis. This review hopes to demonstrate the significant advances made in the field of SCI and the new methodologies and practices being employed by researchers to improve our knowledge of the pathology. Our hope is that by consolidating the past and current research, improvements can be made in the management, treatment, and outcomes for these patients and other who suffer from spinal pathologies.
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- 2020
22. Outcomes following percutaneous endoscopic gastrostomy versus fluoroscopic procedures in the Medicare population
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Nicholas J. Skertich, Laura DeCesare, Athena J. Manatis-Lornell, Edie Y. Chan, Syed I. Khalid, Chantal Creighton, Samantha Maasarani, Aaron L. Wiegmann, and Samantha Terranella
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medicine.medical_specialty ,Percutaneous ,business.industry ,medicine.medical_treatment ,Fistula ,lcsh:Surgery ,lcsh:RD1-811 ,Odds ratio ,medicine.disease ,Gastrostomy ,Confidence interval ,Article ,Surgery ,Odds ,Percutaneous endoscopic gastrostomy ,medicine ,business ,Percutaneous Fluoroscopic Gastrostomy - Abstract
Background In the United States, few high-quality manuscripts have directly compared the complication profiles of percutaneous endoscopic versus fluoroscopic gastrostomy. Thus, it is our goal to compare these 2 common procedures to better understand their efficacy and complication profiles. Materials and Methods A retrospective analysis of patient records from Medicare parts A/B from 2007 to 2012 was used to identify percutaneous fluoroscopic gastrostomy and percutaneous endoscopic gastrostomy procedures. Patient demographics were stratified by age, sex, comorbidities, and complications. Results A total of 258,641 patients were found to have either percutaneous fluoroscopic gastrostomy (26,477, 10.2%) or percutaneous endoscopic gastrostomy (232,164, 89.8%). Percutaneous fluoroscopic gastrostomy experienced greater rates for all complications queried. Multivariate analysis revealed that the percutaneous fluoroscopic gastrostomy cohort had statistically significant increased odds for short-term complications, such as ileus (odds ratio 1.4, 95% confidence interval 1.22–1.54), mechanical (odds ratio 2.4, 95% confidence interval 2.28–2.58), wound infection (odds ratio 1.4, 95% confidence interval 1.24–1.52), persistent fistula after tube removal (odds ratio 1.9, 95% confidence interval 1.78–2.12), and other complications (odds ratio 2.2, 95% confidence interval 2.03–2.37), and long-term complications, including abdominal wall pain (odds ratio 1.4, 95% confidence interval 1.33–1.44), wound infection (odds ratio 1.1, 95% confidence interval 1.01–1.15), and persistent fistula after tube removal (odds ratio 1.8, 95% confidence interval 1.72–1.87). Conclusion Gastrostomy tubes are more frequently being placed via percutaneous endoscopic and fluoroscopic methods. This study suggests that those undergoing fluoroscopic placement have higher odds of developing short- and long-term postoperative complications., Highlights • Fluoroscopic g-tubes have higher odds of developing short- and long-term complications. • Fluoroscopy has higher odds for abdominal wall pain and mechanical complications. • Hyperlipidemia, smoking, and hypertension are risk factors for abdominal wall pain.
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- 2020
23. Association of osteopenia and osteoporosis with higher rates of pseudarthrosis and revision surgery in adult patients undergoing single-level lumbar fusion
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Ravi S. Nunna, Sai Chilakapati, Palvasha Deme, Samantha Maasarani, Cody M. Eldridge, Erika Belmont, Syed I. Khalid, Ravinderjit Singh, Carlos A. Bagley, and Owoicho Adogwa
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Adult ,Male ,Reoperation ,medicine.medical_specialty ,Osteoporosis ,030218 nuclear medicine & medical imaging ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Lumbar ,Postoperative Complications ,Statistical significance ,medicine ,Teriparatide ,Humans ,Aged ,Retrospective Studies ,Lumbar Vertebrae ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Osteopenia ,Pseudarthrosis ,Bone Diseases, Metabolic ,Denosumab ,Spinal Fusion ,Female ,Neurology (clinical) ,Complication ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
OBJECTIVEPatients with osteopenia or osteoporosis who require surgery for symptomatic degenerative spondylolisthesis may have higher rates of postoperative pseudarthrosis and need for revision surgery than patients with normal bone mineral densities (BMDs). To this end, the authors compared rates of postoperative pseudarthrosis and need for revision surgery following single-level lumbar fusion in patients with normal BMD with those in patients with osteopenia or osteoporosis. The secondary outcome was to investigate the effects of pretreatment with medications that prevent bone loss (e.g., teriparatide, bisphosphonates, and denosumab) on these adverse outcomes in this patient cohort.METHODSPatients undergoing single-level lumbar fusion between 2007 and 2017 were identified. Based on 1:1 propensity matching for baseline demographic characteristics and comorbidities, 3 patient groups were created: osteopenia (n = 1723, 33.3%), osteoporosis (n = 1723, 33.3%), and normal BMD (n = 1723, 33.3%). The rates of postoperative pseudarthrosis and revision surgery were compared between groups.RESULTSThe matched populations analyzed in this study included a total of 5169 patients in 3 groups balanced at baseline, with equal numbers (n = 1723, 33.3%) in each group: patients with a history of osteopenia, those with a history of osteoporosis, and a control group of patients with no history of osteopenia or osteoporosis and with normal BMD. A total of 597 complications were recorded within a 2-year follow-up period, with pseudarthrosis (n = 321, 6.2%) being slightly more common than revision surgery (n = 276, 5.3%). The odds of pseudarthrosis and revision surgery in patients with osteopenia were almost 2-fold (OR 1.7, 95% CI 1.26–2.30) and 3-fold (OR 2.73, 95% CI 1.89–3.94) higher, respectively, than those in patients in the control group. Similarly, the odds of pseudarthrosis and revision surgery in patients with osteoporosis were almost 2-fold (OR 1.92, 95% CI 1.43–2.59) and > 3-fold (OR 3.25, 95% CI 2.27–4.65) higher, respectively, than those in patients in the control group. Pretreatment with medications to prevent bone loss prior to surgery was associated with lower pseudarthrosis and revision surgery rates, although the differences did not reach statistical significance.CONCLUSIONSPostoperative pseudarthrosis and revision surgery rates following single-level lumbar spinal fusion are significantly higher in patients with osteopenia and osteoporosis than in patients with normal BMD. Pretreatment with medications to prevent bone loss prior to surgery decreased these complication rates, although the observed differences did not reach statistical significance.
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- 2020
24. Laparoscopic-Assisted Versus Mini-Open Laparotomy for Ventriculoperitoneal Shunt Placement in the Medicare Population
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Alfonso Torquati, Ravi S. Nunna, Samir Gupta, Richard W. Byrne, Rachyl M Shanker, Samantha Maasarani, Ankit I. Mehta, Syed I. Khalid, Corbin P Edmondson, Edie Y. Chan, Owoicho Adogwa, and Mandana Behbahani
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,Comorbidity ,Medicare ,Ventriculoperitoneal Shunt ,Laparotomy ,medicine ,Humans ,Obesity ,Laparoscopy ,education ,Aged ,Retrospective Studies ,Aged, 80 and over ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,Odds ratio ,Middle Aged ,United States ,Surgery ,Catheter ,medicine.anatomical_structure ,Current Procedural Terminology ,Abdomen ,Female ,Neurology (clinical) ,Peritoneum ,business ,Hydrocephalus ,Abdominal surgery - Abstract
Background Placement of the distal shunt catheter into the peritoneum during ventriculoperitoneal shunt (VPS) surgery can be done with either laparoscopic assistance or laparotomy. Objective To compare outcomes in laparoscopic-assisted vs laparotomy for placement of VPS in the Medicare population. Methods Patients undergoing VPS placement, between 2004 and 2014, were identified by International Classification of Disease, Ninth Revision and Current Procedural Terminology codes in the Medicare database. Demographic data including age, sex, comorbidities, and indications were collected. Six- and twelve-month complication rates were analyzed. Results A total of 1966 (3.2%) patients underwent laparoscopic-assisted VPS and 60 030 (96.8%) patients underwent nonlaparoscopic-assisted VPS placement. Compared with traditional open VPS placement, the laparoscopic approach was associated with decreased odds of distal revision at 6- and 12-mo postoperatively (6 mo: odds ratio [OR] = 0.41, 95% confidence interval [CI]: 0.21-0.74; 12 mo: OR = 0.60, 95% CI: 0.39-0.94). At 6- and 12-mo postoperatively, multivariable regression analysis demonstrated increased odds of distal revision in patients with a body mass index (BMI) > 30 Kg/M2, history of open abdominal surgery, and history of laparoscopic abdominal surgery. Additionally, history of prior abdominal surgery and BMI > 30 Kg/M2 were significantly associated with increase odds of shunt infection at 6 and 12-mo, respectively. Conclusion In the largest retrospective analysis to date, patients with a history of abdominal surgery and obesity were found to be at increased risk of infection and distal revision after VPS placement. However, the laparoscopic approach for abdominal placement of the distal catheter was associated with reduced rates of distal revision in this population, suggesting an avenue for reducing complications in well-selected patients.
- Published
- 2021
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