المؤلفون: B. Mark Evers, Avinash S. Bhakta, Vashisht Madabhushi, Robert-Marlo F. Bautista, Joshua M. Judge, Daniel L. Davenport

المصدر: Journal of Gastrointestinal Surgery. 26:191-196

مصطلحات موضوعية: education.field_of_study, medicine.medical_specialty, business.industry, Exploratory laparotomy, medicine.medical_treatment, General surgery, Medical record, Population, Gastroenterology, 030230 surgery, 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, Concomitant, Incision and drainage, Medicine, Surgery, Diagnosis code, business, education, Medicaid, Reimbursement

الوصف: Kentucky had one of the nation’s largest increases in insurance coverage with the Affordable Care Act’s (ACA) Medicaid expansion, quadrupling the proportion of Kentuckians with insurance coverage. This study compares reimbursement rates for surgical procedures performed by emergency general surgery (EGS) services at the University of Kentucky (UK) before and after Medicaid expansion in January 2014. This IRB-approved, single-institution study retrospectively evaluated all patients undergoing surgical treatment by our EGS team from 1/1/2011 to 12/31/2016. We queried operative records for the most frequently performed procedures by the EGS service. We reviewed patient electronic medical records and hospital financial records to identify insurance status, diagnosis codes, and expected hospital reimbursements, based on UK Hospital’s procedure/payer accounting models. Four thousand six hundred ninety-three patient procedures met inclusion criteria; 46.5% of these came before ACA expansion and 53.5% after expansion. The most frequent procedures performed were incision and drainage, laparoscopic appendectomy, laparoscopic cholecystectomy, and exploratory laparotomy. After ACA expansion, the proportion of patients with Medicaid nearly doubled (19.8% vs. 35.6%, p < 0.001). Concomitantly, there was a more than fivefold decrease in the uninsured patient population after expansion (23.3% vs. 4.6%, p < 0.001), and mean hospital reimbursement increased for laparoscopic appendectomy (13.7%, p < 0.001), laparoscopic cholecystectomy (50.7%, p < 0.001), and incision and drainage (70.2%, p < 0.001). After ACA expansion, there was a sustained decrease in proportion of uninsured patients and a concomitant sustained increase in proportion of patients with access to Medicaid services in the EGS operative population, leading to increased mean hospital reimbursements and decreased patient financial burden.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::53d0a3a38cf8a31069cd33bd55579013Test
https://doi.org/10.1007/s11605-021-05028-8Test

المؤلفون: Brittany E. Levy, Jennifer T. Castle, Laura M. Ebbitt, Caleb Kennon, Erin McAtee, Daniel L. Davenport, B. Mark Evers, Avinash Bhakta

المصدر: The Journal of surgical research. 283

مصطلحات موضوعية: Surgery

الوصف: Appropriate prescribing practices are imperative to ensure adequate pain control, without excess opioid dispensing across colorectal patients.National Surgical Quality Improvement Program, Kentucky All Scheduled Prescription Electronic Reporting, and patient charts were queried to complete a retrospective study of elective colorectal resections, performed by a fellowship-trained colorectal surgeon, from January 2013 to December 2020. Opioid use at 14 d and 30 d posthospital discharge converted into morphine milligram equivalents (MMEs) were analyzed and compared across preadmission and inpatient factors.One thousand four hundred twenty seven colorectal surgeries including 56.1% (N = 800) partial colectomy, 24.1% (N = 344) low anterior resection, 8.3% (N = 119) abdominoperineal resection, 8.4% (N = 121) sub/total colectomy, and 3.0% (N = 43) total proctocolectomy. Abdominoperineal resection and sub/total colectomy patients had higher 30-day postdischarge MMEs (P 0.001, P = 0.041). An operative approach did not affect postdischarge MMEs (P = 0.440). Trans abdominal plane blocks do not predict postdischarge MMEs (0.616). Epidural usage provides a 15% increase in postdischarge MMEs (P = 0.020). Age (P 0.001), smoking (P 0.001), chronic obstructive pulmonary disease (P = 0.006,0.001), dyspnea (P = 0.001,0.001), albumin3.5 (P = 0.085, 0.010), disseminated cancer (P = 0.018, 0.001), and preadmission MMEs (P 0.001) predict elevated 14-day and 30-day postdischarge MMEs.We conclude that perioperative analgesic procedures, as enhanced recovery pathway suggests, are neither predictive nor protective of postoperative discharge MMEs in colorectal surgery. Provider should account for preoperative risk factors when prescribing discharge opioid medications. Furthermore, providers should identify appropriate adjunct procedures to improve discharge opioid prescription stewardship.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::9e5a1432814b7768a30981fa7d7835c4Test
https://pubmed.ncbi.nlm.nih.gov/36423479Test

المؤلفون: Malay B Shah, Diego A Villagomez Rubio, Gabriel Orozco, Siddharth Desai, Alexandre Ancheta, Meera Gupta, Xiaonan Mei, B Mark Evers, Roberto Gedaly, Robert M Cannon

المصدر: Journal of the American College of Surgeons. 234(5)

مصطلحات موضوعية: End Stage Liver Disease, Carcinoma, Hepatocellular, Treatment Outcome, Liver Neoplasms, Humans, Surgery, alpha-Fetoproteins, Severity of Illness Index, Aged, Liver Transplantation

الوصف: Orthotopic liver transplantation (OLT) is the accepted treatment in patients with unresectable, early-stage hepatocellular carcinoma (HCC) in the setting of cirrhosis. Due to increasing waitlist demand for OLT, determining optimal groups for transplant is critical. Elderly patients are known to have poorer postoperative outcomes. Considering the effectiveness of liver-directed therapies for HCC, we sought to determine whether elderly patients received survival benefit from OLT over liver-directed therapy alone.The National Cancer Database participant use file was used to analyze data between 2004 and 2017. Only patients ≥70 years of age who received OLT or liver-directed therapy alone were included. Patients with alpha-fetoprotein500 ng/mL or missing alpha-fetoprotein values were excluded. Baseline demographic variables, model for end-stage liver disease score, and overall survival from time of diagnosis were collected. Descriptive statistics, Kaplan-Meier survival, Cox proportional hazards model, and propensity score matching were used.A total of 2,377 patients received ablative therapy alone, and 214 patients received OLT. Multivariable analysis and Kaplan-Meier showed that OLT conferred a significant survival benefit compared to liver-directed therapy alone. Age was also associated with a yearly 3% increase in risk of mortality. Propensity-matched analysis adjusting also demonstrated a significant survival benefit for elderly patients receiving OLT compared to liver-directed therapy alone.Despite increased age and associated comorbidities being factors associated with poor outcomes, OLT confers a survival advantage compared to liver-directed ablative therapies alone in selected elderly patients with HCC. OLT should be offered in medically appropriate elderly patients with HCC.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::4fd36979a445211440d7138af0520ce7Test
https://pubmed.ncbi.nlm.nih.gov/35426403Test

المؤلفون: Nicholas A. Jackson, Avinash S. Bhakta, Laura M. Ebbitt, B. Mark Evers, Daniel L. Davenport, Doug R. Oyler, Tong Gan

المصدر: Surgical Endoscopy

مصطلحات موضوعية: Adult, medicine.medical_specialty, Adolescent, medicine.drug_class, 030230 surgery, Article, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Colorectal surgery, Internal medicine, Prescription drug use, Humans, Hypnotics and Sedatives, Medicine, In patient, Hospital Costs, Retrospective Studies, business.industry, Medical record, Healthcare costs, Hepatology, ACS-NSQIP, Antidepressive Agents, Analgesics, Opioid, Opioids, Opioid, Sedative, Antidepressant, 030211 gastroenterology & hepatology, Surgery, business, Abdominal surgery, medicine.drug

الوصف: Background Opioid (OPD), sedative (SDT), and antidepressant (ADM) prescribing has increased dramatically over the last 20 years. This study evaluated preoperative OPD, SDT, and ADM use on hospital costs in patients undergoing colorectal resection at a single institution. Methods This study was a retrospective record review. The local ACS-NSQIP database was queried for adult patients (age ≥ 18 years) undergoing open/laparoscopic, partial/total colectomy, or proctectomy from January 1, 2013 to December 31, 2016. Individual patient medical records were reviewed to determine preoperative OPD, SDT, and AD use. Hospital cost data from index admission were captured by the hospital cost accounting system and matched to NSQIP query-identified cases. All ACS-NSQIP categorical patient characteristic, operative risk, and outcome variables were compared in medication groups using chi-square tests or Fisher’s exact tests, and continuous variables were compared using Mann–Whitney U tests. Results A total of 1185 colorectal procedures were performed by 30 different surgeons. Of these, 27.6% patients took OPD, 18.5% SDT, and 27.8% ADM preoperatively. Patients taking OPD, SDT, and ADM were found to have increased mean total hospital costs (MTHC) compared to non-users (30.8 vs 23.6 for OPD, 31.6 vs 24.4 for SDT, and 30.7 vs 23.8 for ADM). OPD and SDT use were identified as independent risk factors for increased MTHC on multivariable analysis. Conclusion Preoperative OPD and SDT use can be used to predict increased MTHC in patients undergoing colorectal resections.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::31f4622114a8662fb28a4ba48e47c8d8Test
https://doi.org/10.1007/s00464-020-08062-wTest

المؤلفون: Heather A. Frohman, Piotr G. Rychahou, Jing Li, B. Mark Evers, Tong Gan

المصدر: Journal of Surgical Research. 229:302-310

مصطلحات موضوعية: medicine.medical_specialty, Sleeve gastrectomy, Time Factors, medicine.medical_treatment, Gastric Bypass, 030209 endocrinology & metabolism, Anastomosis, Diet, High-Fat, Article, Resection, Mice, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Gastrectomy, Diabetes mellitus, medicine, Animals, Humans, 030212 general & internal medicine, Perioperative Period, business.industry, Genetically engineered, Incidence, Stomach, Perioperative, medicine.disease, Survival Analysis, Obesity, Morbid, Surgery, Disease Models, Animal, Treatment Outcome, medicine.anatomical_structure, Murine model, Female, business

الوصف: Roux-en-Y gastric bypass (RYGB) improves comorbidities such as diabetes and hypertension and lowers the risk of obesity-related cancers. To better understand the physiologic and genetic influences of bariatric surgery, a reliable murine model is needed that can be extended to genetically engineered mice. Given the complexity of these procedures, few researchers have successfully implemented these techniques beyond larger rodent models. The purpose of our study was to develop a technically feasible and reproducible murine model for RYGB and sleeve gastrectomy (SG). Mice were converted to liquid diet perioperatively without fasting and housed in groups on raised wire platforms. SG involved significant reduction of stomach volume followed by multilayer repair of the gastrotomy. RYGB procedure consisted of side-to-side, functional end-to-side bowel anastomoses and exclusion of the stomach medial to the gastroesophageal junction. Sham surgeries consisted of enterotomies and gastrotomy followed by primary repair without resection or rerouting. Survival after incorporation of the aforementioned techniques was 100% in the SG group and 41% in the RYGB group at 1 mo after surgery. Only 26% of RYGB mortality was attributed to leak, obstruction, or stricture; the majority of postoperative mortality was due to stress, dumping, or malnutrition. Much of the survival challenge for this surgical model was related to perioperative husbandry, which is to be expected given their small stature and poor response to stress. Utilization of the perioperative and surgical techniques described will increase survival and feasibility of these technically challenging procedures, allowing for a better understanding of mechanisms to explain the beneficial effects of bariatric surgery.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::b9c0038ebe44b2a918163876122632abTest
https://doi.org/10.1016/j.jss.2018.04.022Test

المؤلفون: Bin Huang, B. Mark Evers, Nancy E. Schoenberg, Mark Dignan, Patrick Osterhaus, Quan Chen, Avinash S. Bhakta, Zeta Chow

المصدر: J Surg Res

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Colorectal cancer, Colonoscopy, Aftercare, Kentucky, Logistic regression, Medical Oncology, Medicare, Health Services Accessibility, Insurance Coverage, Article, Time-to-Treatment, 03 medical and health sciences, Young Adult, 0302 clinical medicine, medicine, Humans, Mass Screening, Stage (cooking), Referral and Consultation, Early Detection of Cancer, Specialist care, Aged, Neoplasm Staging, medicine.diagnostic_test, business.industry, Medicaid, Gastroenterology, Treatment delay, Middle Aged, Patient Acceptance of Health Care, medicine.disease, digestive system diseases, United States, Cancer registry, 030220 oncology & carcinogenesis, Family medicine, Educational Status, 030211 gastroenterology & hepatology, Surgery, Female, business, Colorectal Neoplasms, SEER Program

الوصف: INTRODUCTION: Abundant studies have associated colorectal cancer (CRC) treatment delay with advanced diagnosis and worse mortality. Delay in seeking specialist is a contributor to CRC treatment delay. The goal of this study is to investigate contributing factors to 14-days delay from diagnosis of CRC on colonoscopy to the first specialist visit in the state of Kentucky. METHODS: The Kentucky Cancer Registry (KCR) database linked with health administrative claims data was queried to include adult patients diagnosed with stage I-IV CRC from January 2007 to December 2012. The dates of last colonoscopy and first specialist visit were identified through the claims. Bivariate and logistic regression analysis were performed to identify factors associated with delay to CRC specialist visit. RESULTS: A total of 3,927 patients, from 100 hospitals in Kentucky were included. Approximately 19% of CRC patients visited a specialist more than 14 days after CRC detection on colonoscopy. Delay to Specialist (DTS) was found more likely in patients with Medicaid insurance (OR 3.1, p

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::951c715a756a6da3de10beff7a790803Test
https://pubmed.ncbi.nlm.nih.gov/33092860Test

المؤلفون: Mary C. Schroeder, B. Mark Evers, Timothy W. Mullett, Mary E. Charlton, Jason Jacob, Thomas C. Tucker, Cheri Tolle

المصدر: Ann Surg Oncol

مصطلحات موضوعية: medicine.medical_specialty, media_common.quotation_subject, Community population, Psychological intervention, MEDLINE, Hospitals, Community, 030230 surgery, Cancer Care Facilities, Article, Accreditation, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Neoplasms, Medicine, Humans, Quality (business), media_common, business.industry, Cancer, medicine.disease, National Cancer Institute (U.S.), United States, Cancer registry, Patient volume, Oncology, 030220 oncology & carcinogenesis, Family medicine, Surgery, business

الوصف: Cancer patients treated in community hospitals receive less guideline-recommended care and experience poorer outcomes than those treated in academic medical centers or National Cancer Institute-Designated Cancer Centers. The Markey Cancer Center Affiliate Network (MCCAN) was designed to address this issue in Kentucky, the state with the highest cancer incidence and mortality rates in the U.S. Using data obtained from the Kentucky Cancer Registry, the study evaluated the impact of patients treated in MCCAN hospitals on four evidence-based Commission on Cancer (CoC) quality measures using a before-and-after matched-cohort study design. Each group included 13 hospitals matched for bed size, cancer patient volume, community population, and region (Appalachian vs. non-Appalachian). Compliance with quality measures was assessed for the 3 years before the hospital joined MCCAN (T1) and the 3 years afterward (T2). In T1, the control hospitals demonstrated greater compliance with two quality measures than the MCCAN hospitals. In T2, the MCCAN hospitals achieved greater compliance in three measures than the control hospitals. From T1 to T2, the MCCAN hospitals significantly increased compliance on three measures (vs. 1 measure for the control hospitals). Although most of the hospitals were not accredited by the CoC in T1, 92% of the MCCAN hospitals had achieved accreditation by the end of T2 compared with 23% of the control hospitals. After the MCCAN hospitals joined the Network, their compliance with quality measures and achievement of CoC accreditation increased significantly compared with the control hospitals. The unique academic/community-collaboration model provided by MCCAN was able to make a significant impact on improvement of cancer care. Future research is needed to adapt and evaluate similar interventions in other states and regions.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::1632ba51568211009ec6fb183e973a67Test
https://pubmed.ncbi.nlm.nih.gov/32712893Test

المؤلفون: B. Mark Evers

المصدر: Journal of the American College of Surgeons. 220:387-395

مصطلحات موضوعية: Medical education, business.industry, Medicine, Surgery, business, Surgeon scientist

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::24b7040b011694de0729d7c53f60a5a4Test
https://doi.org/10.1016/j.jamcollsurg.2014.12.044Test

المؤلفون: Victoria A. Elliott, Piotr G. Rychahou, Tianyan Gao, Yekaterina Y. Zaytseva, Chi Wang, Joseph D. Valentino, W. Conan Mustain, B. Mark Evers

المصدر: Surgery. 152:277-285

مصطلحات موضوعية: Antimetabolites, Antineoplastic, Small interfering RNA, Class I Phosphatidylinositol 3-Kinases, Colorectal cancer, Apoptosis, Cell Cycle Proteins, Biology, medicine.disease_cause, Article, Proto-Oncogene Proteins p21(ras), Phosphatidylinositol 3-Kinases, RNA interference, Proto-Oncogene Proteins, medicine, Humans, Phosphorylation, RNA, Small Interfering, neoplasms, Protein kinase B, PI3K/AKT/mTOR pathway, Adaptor Proteins, Signal Transducing, Cell Proliferation, Cell growth, Carcinoma, RNA, HCT116 Cells, Phosphoproteins, medicine.disease, Molecular biology, digestive system diseases, Mutation, ras Proteins, Cancer research, RNA Interference, Surgery, Fluorouracil, KRAS, Colorectal Neoplasms

الوصف: Background RNA interference has the potential to be more selective than small molecule inhibitors and can be used to target proteins, such as Ras, that are currently undruggable. The purpose of our study was to determine the optimal cotargeting strategy of the commonly mutated PI3K/AKT/mTOR and Ras pathways by a selective RNA interference approach in colorectal cancer cell lines possessing coexistent PIK3CA and KRAS mutations. Methods Human colorectal cancer cell lines HCT116 and DLD-1 were treated with a panel of small interfering RNAs directed against the PI3K/AKT/mTOR and Ras pathways; proliferation, apoptosis, and protein expression were assessed. Combined treatment with small interfering RNA and 5-fluorouracil was then evaluated. Results PIK3CA and KRAS small interfering RNAs were most effective as single treatments; combined treatments with PIK3CA and KRAS small interfering RNA resulted in a more pronounced inhibition of colorectal cancer cell proliferation. Either KRAS small interfering RNA alone or combined PIK3CA and KRAS small interfering RNA treatments increased apoptosis in HCT116 cells but not in the DLD-1 cell line. Inhibition of 4E-BP1 phosphorylation correlated with increased apoptosis. In addition, small interfering RNA treatment combined with 5-fluorouracil further inhibited colorectal cancer cell proliferation. Conclusion Combined PIK3CA and KRAS small interfering RNA treatments offer an effective therapy against colorectal cancer cells with coexisting mutations in both pathways. Decreased 4E-BP1 phosphorylation correlates with increased apoptosis and may provide a biomarker indicative of treatment success. In addition, small interfering RNA directed to PIK3CA and KRAS may be used to enhance the effects of current chemotherapy.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::2d7c39d8b2122246436038953d4fa8ebTest
https://doi.org/10.1016/j.surg.2012.05.006Test

المؤلفون: B. Mark Evers, Joseph Valentino

المصدر: Advances in Surgery. 45:285-300

مصطلحات موضوعية: medicine.medical_specialty, Magnetic Resonance Spectroscopy, Database analysis, Carcinoid tumors, Rectum, Angiogenesis Inhibitors, Carcinoid Tumor, Relatively benign course, Gastroenterology, Duodenal Neoplasms, Internal medicine, medicine, Humans, Gastrointestinal Neoplasms, Malignant Carcinoid Syndrome, Gastrointestinal tract, business.industry, Incidence (epidemiology), Liver Neoplasms, medicine.disease, digestive system diseases, Appendix, Small intestine, medicine.anatomical_structure, Appendiceal Neoplasms, Surgery, Somatostatin, business

الوصف: C arcinoid tumors were first described by Lubarsch in 1888 [1]. In 1907, Oberndorfer [2] was the first to recognize these tumors as distinct from carcinomas and coined the term, Karzinoide, to describe the carcinomalike appearance of these tumors as well as what was originally thought a relatively benign course. Since that time, the malignant potential of carcinoid tumors has become apparent. Currently, carcinoid tumors account for 0.49% of all malignancies [3]. Although these tumors are relatively uncommon, their incidence has been increasing. A recent database analysis of 13,715 carcinoid tumors revealed a 43.1% increase in carcinoid tumors compared proportionally with other cancers [3]. The most common location for carcinoid tumors is the gastrointestinal tract followed by the pulmonary system. Within the gastrointestinal tract, the highest frequency of tumors occurs in the small intestine followed by the rectum, colon, and appendix [3].

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::3b39f1dd7a795ef9bebd4389afd09c6eTest
https://doi.org/10.1016/j.yasu.2011.03.014Test