2021
Labor prior to cesarean delivery associated with higher post-discharge opioid consumption
Ende HB, Landau R, Cole NM, Burns SM, Bateman BT, Bauer ME, Booth JL, Flood P, Leffert LR, Houle TT, Tsen LC. Labor prior to cesarean delivery associated with higher post-discharge opioid consumption. PLOS ONE 2021, 16: e0253990. PMID: 34242277, PMCID: PMC8270408, DOI: 10.1371/journal.pone.0253990.Peer-Reviewed Original ResearchConceptsDay of surgeryPostoperative pain scoresPain scoresOpioid utilizationOpioid useSurgical proceduresTime pointsHigher postoperative pain scoresPost-cesarean delivery painPost-discharge opioid consumptionAcute post-operative painComplications of CDMaximal pain scoresPost-cesarean analgesiaProspective cohort studyPost-operative painAdditional surgical proceduresNumeric rating scaleIdentification of womenAcademic medical centerNumber of tabletsSet of confoundersPhone two weeksOpioid consumptionOpioid requirementsThe Society for Obstetric Anesthesia and Perinatology Coronavirus Disease 2019 Registry: An Analysis of Outcomes Among Pregnant Women Delivering During the Initial Severe Acute Respiratory Syndrome Coronavirus-2 Outbreak in the United States
Katz D, Bateman BT, Kjaer K, Turner DP, Spence NZ, Habib AS, George RB, Toledano RD, Grant G, Madden HE, Butwick AJ, Lynde G, Minehart RD, Beilin Y, Houle TT, Sharpe EE, Kodali B, Bharadwaj S, Farber MK, Palanisamy A, Prabhu M, Gonzales NY, Landau R, Leffert L. The Society for Obstetric Anesthesia and Perinatology Coronavirus Disease 2019 Registry: An Analysis of Outcomes Among Pregnant Women Delivering During the Initial Severe Acute Respiratory Syndrome Coronavirus-2 Outbreak in the United States. Anesthesia & Analgesia 2021, 133: 462-473. PMID: 33830956, DOI: 10.1213/ane.0000000000005592.Peer-Reviewed Original ResearchMeSH KeywordsAdultAnalgesia, ObstetricalAnesthesia, GeneralAnesthesia, ObstetricalCase-Control StudiesCesarean SectionCOVID-19Delivery, ObstetricFemaleGestational AgeHumansInfant, PrematurePregnancyPregnancy Complications, InfectiousPremature BirthRegistriesRisk AssessmentRisk FactorsUnited StatesYoung AdultConceptsSARS-CoV-2 patientsSARS-CoV-2 infectionWeeks of gestationCesarean deliveryObstetric anesthesiaPositive SARS-CoV-2 polymerase chain reaction testSARS-CoV-2 polymerase chain reaction testAcute respiratory syndrome coronavirus 2 infectionSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infectionSARS-CoV-2-infected patientsSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreakSyndrome coronavirus 2 infectionMaternal respiratory failureAdverse pregnancy outcomesCoronavirus 2 infectionNeuraxial labor analgesiaUS cohort studyDays of deliveryUS medical centersPolymerase chain reaction testComposite outcome measureAnalysis of outcomesChain reaction testPeripartum outcomesAsymptomatic patients
2020
Stroke in Pregnancy: A Focused Update.
Miller EC, Leffert L. Stroke in Pregnancy: A Focused Update. Anesthesia & Analgesia 2020, 130: 1085-1096. PMID: 31124843, PMCID: PMC7035913, DOI: 10.1213/ane.0000000000004203.Peer-Reviewed Original ResearchConceptsHemorrhagic strokeCesarean deliveryPregnant womenIschemic strokeGeneral anesthesiaObstetric anesthesiologistHigh-risk obstetriciansLarge stroke trialsPregnancy-related strokeHigh-risk groupRisk of herniationMaternal strokeObstetric indicationsTherapeutic anticoagulationExtremity weaknessStroke neurologistsAcute strokeDevastating complicationNeuraxial analgesiaNonpregnant womenStroke subtypesIntracranial hypertensionRecent strokeVaginal deliveryStroke trials
2019
Risk Factors, Etiologies, and Screening Tools for Sepsis in Pregnant Women
Bauer ME, Housey M, Bauer ST, Behrmann S, Chau A, Clancy C, Clark EAS, Einav S, Langen E, Leffert L, Lin S, Madapu M, Maile MD, McQuaid-Hanson E, Priessnitz K, Sela HY, Shah A, Sobolewski P, Toledo P, Tsen LC, Bateman BT. Risk Factors, Etiologies, and Screening Tools for Sepsis in Pregnant Women. Anesthesia & Analgesia 2019, Publish Ahead of Print: &na;. PMID: 31743182, PMCID: PMC7543988, DOI: 10.1213/ane.0000000000003709.Peer-Reviewed Original ResearchConceptsSystemic inflammatory response syndromeQuick Sequential Organ Failure AssessmentRisk factorsDelivery hospitalizationsMaternal sepsisSepsis casesCommon causeMortality rateMaternal Early Warning CriteriaSequential Organ Failure AssessmentScreening toolHours of diagnosisTiming of antibioticsOrgan Failure AssessmentCohort of patientsInflammatory response syndromePotential risk factorsHalf of casesAcademic medical centerDate of deliveryQSOFA criteriaControl patientsAntibiotic therapyResponse syndromeSignificant morbidityAppraisal of Headache Trigger Patterns Using Calendars
Turner DP, Leffert LR, Houle TT. Appraisal of Headache Trigger Patterns Using Calendars. Headache The Journal Of Head And Face Pain 2019, 60: 370-381. PMID: 31784989, PMCID: PMC7077923, DOI: 10.1111/head.13703.Peer-Reviewed Original ResearchConceptsPatterns of triggersHigher participant ratingsAbility of individualsLaboratory tasksParticipants' ratingsHeadache activityDaily diariesPrevious beliefRatingsNegative associationLow correlationTrigger patternsBeliefsParticipantsIndividualsHeadache calendarExperimental triggersJudgmentsTaskHigh positive correlationDegree of associationRelationshipAppraisalAssociationPositive correlation
2018
Long-term impact of a faculty mentoring program in academic medicine
Efstathiou JA, Drumm MR, Paly JP, Lawton DM, O’Neill R, Niemierko A, Leffert LR, Loeffler JS, Shih HA. Long-term impact of a faculty mentoring program in academic medicine. PLOS ONE 2018, 13: e0207634. PMID: 30496199, PMCID: PMC6264475, DOI: 10.1371/journal.pone.0207634.Peer-Reviewed Original ResearchImplementation of a Quality Improvement Initiative to Decrease Opioid Prescribing After Cesarean Delivery
Prabhu M, Dubois H, James K, Leffert LR, Riley LE, Bateman BT, Henderson M. Implementation of a Quality Improvement Initiative to Decrease Opioid Prescribing After Cesarean Delivery. Obstetrics And Gynecology 2018, 132: 631-636. PMID: 30095765, PMCID: PMC6105442, DOI: 10.1097/aog.0000000000002789.Peer-Reviewed Original ResearchConceptsOpioid refill ratesOpioid tabletsCesarean deliveryOpioid prescribingRefill ratesAnalgesic useMean numberProspective quality improvement studyNonopioid analgesic useDays of dischargeNumber of opioidsPhase 2Quality improvement protocolPhase 1Quality improvement studyQuality improvement initiativesQuality improvement effortsDischarge providersAnalgesic prescriptionOpioid prescriptionsSecondary outcomesDischarge prescriptionsPrimary outcomeΧ analysisOpioidsTiming and Risk Factors of Postpartum Stroke
Too G, Wen T, Boehme AK, Miller EC, Leffert LR, Attenello FJ, Mack WJ, D'Alton M, Friedman AM. Timing and Risk Factors of Postpartum Stroke. Obstetrics And Gynecology 2018, 131: 70-78. PMID: 29215510, PMCID: PMC6402829, DOI: 10.1097/aog.0000000000002372.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultCohort StudiesConfidence IntervalsCost-Benefit AnalysisDatabases, FactualFemaleHumansHypertension, Pregnancy-InducedMaternal AgeOdds RatioPatient DischargePatient ReadmissionPostpartum PeriodPre-EclampsiaPregnancyPregnancy, High-RiskPrognosisRetrospective StudiesRisk AssessmentStrokeTime FactorsYoung AdultConceptsChronic hypertensionDays of dischargeNationwide Readmissions DatabaseHypertensive diseasePostpartum strokeStroke readmissionDelivery hospitalizationsIndex hospitalizationOdds ratioUtilization Project Nationwide Readmissions DatabaseOptimal blood pressure managementDelivery hospitalization dischargeRetrospective cohort studyBlood pressure managementRisk of readmissionCases of strokeMajority of readmissionsCases of readmissionCalendar year 2013Hospitalization dischargeCohort studyHospital dischargeMedian timeReadmission riskRisk factors
2017
A Shared Decision-Making Intervention to Guide Opioid Prescribing After Cesarean Delivery
Prabhu M, McQuaid-Hanson E, Hopp S, Burns SM, Leffert LR, Landau R, Lauffenburger JC, Choudhry NK, Kaimal A, Bateman BT. A Shared Decision-Making Intervention to Guide Opioid Prescribing After Cesarean Delivery. Obstetrics And Gynecology 2017, 130: 42-46. PMID: 28594762, PMCID: PMC5482786, DOI: 10.1097/aog.0000000000002094.Peer-Reviewed Original ResearchConceptsCesarean deliveryDecision-making interventionLeftover opioid medicationsNumber of opioidsNumber of tabletsPain resolutionPostcesarean painOpioid medicationsOpioid prescribingOpioid useOxycodone tabletsMedian numberWomenPrescribingPrescriptionComputer-based decision aidDeliveryInterventionDecision aidStandard prescriptionPromising strategyHospitalizationMedicationsOpioidsPainPatterns of Opioid Prescription and Use After Cesarean Delivery
Bateman BT, Cole NM, Maeda A, Burns SM, Houle TT, Huybrechts KF, Clancy CR, Hopp SB, Ecker JL, Ende H, Grewe K, Corradini B, Schoenfeld RE, Sankar K, Day LJ, Harris L, Booth JL, Flood P, Bauer ME, Tsen LC, Landau R, Leffert LR. Patterns of Opioid Prescription and Use After Cesarean Delivery. Obstetrics And Gynecology 2017, 130: 29-35. PMID: 28594763, PMCID: PMC5600205, DOI: 10.1097/aog.0000000000002093.Peer-Reviewed Original ResearchConceptsAmount of opioidsOpioid prescriptionsCesarean deliveryMedian numberLeftover opioid medicationsPhone 2 weeksAcademic medical centerLeftover opioidsOpioid tabletsOpioid medicationsPain controlPain scoresPatient characteristicsOpioid analgesicsPatient satisfactionMedical CenterExcess medicationOpioidsMedicationsPrescriptionStructured interviewsConcomitant increaseWomenDeliveryAnalgesicsNeuraxial Anesthesia in Obstetric Patients Receiving Thromboprophylaxis With Unfractionated or Low-Molecular-Weight Heparin
Leffert LR, Dubois HM, Butwick AJ, Carvalho B, Houle TT, Landau R. Neuraxial Anesthesia in Obstetric Patients Receiving Thromboprophylaxis With Unfractionated or Low-Molecular-Weight Heparin. Anesthesia & Analgesia 2017, 125: 223-231. PMID: 28628578, DOI: 10.1213/ane.0000000000002173.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAnesthesia, ConductionAnesthesia, ObstetricalAnesthesiologyAnestheticsAnticoagulantsCesarean SectionDelivery, ObstetricFemaleHematoma, Epidural, SpinalHeparinHeparin, Low-Molecular-WeightHumansMiddle AgedNerve BlockPregnancyPregnancy Complications, CardiovascularThrombosisYoung AdultConceptsSpinal epidural hematomaCases of SEHNeuraxial anesthesiaObstetric patientsVenous thromboembolismWeight heparinAnesthesia Closed Claims Project databaseSystematic reviewPractice changePostpartum venous thromboembolismVaginal delivery hospitalizationsWeight heparin doseRisk of thromboembolismLarge-scale registriesMajority of womenEnglish-language studiesAnticoagulated womenDelivery hospitalizationsPharmacological thromboprophylaxisAnticoagulant doseCesarean deliveryEpidural hematomaHeparin doseVaginal deliveryGeneral anesthesiaRisk Factors for Pregnancy-Associated Stroke in Women With Preeclampsia
Miller EC, Gatollari HJ, Too G, Boehme AK, Leffert L, Marshall RS, Elkind MSV, Willey JZ. Risk Factors for Pregnancy-Associated Stroke in Women With Preeclampsia. Stroke 2017, 48: 1752-1759. PMID: 28546324, PMCID: PMC5539968, DOI: 10.1161/strokeaha.117.017374.Peer-Reviewed Original ResearchConceptsPregnancy-associated strokeRisk factorsChronic hypertensionProthrombotic stateOdds ratioMultivariable conditional logistic regression modelsConditional logistic regression modelsNew York State hospitalsIndependent risk factorVascular risk factorsSeverity of preeclampsiaLogistic regression modelsRace/ethnicityPregnancy complicationsSevere preeclampsiaMultivariable analysisInpatient DatabaseProthrombotic conditionsPreeclampsiaHigh riskClose monitoringNew York State DepartmentState HospitalCoagulopathyBilling data
2016
Risk of Pregnancy-Associated Stroke Across Age Groups in New York State
Miller EC, Gatollari HJ, Too G, Boehme AK, Leffert L, Elkind MS, Willey JZ. Risk of Pregnancy-Associated Stroke Across Age Groups in New York State. JAMA Neurology 2016, 73: 1461-1467. PMID: 27775757, DOI: 10.1001/jamaneurol.2016.3774.Peer-Reviewed Original ResearchConceptsPregnancy-associated strokePregnant/postpartum womenRisk of strokeIncidence risk ratioRisk factorsPostpartum womenAge groupsNonpregnant womenStroke riskOlder womenCumulative riskAge-specific incidence ratiosPost partumCalendar year 2003Cerebral venous thrombosisStroke risk factorsTransient ischemic attackVascular risk factorsOverall median ageLogistic regression modelsActive smokingChronic hypertensionIschemic attackNPAS groupCerebrovascular events
2015
Treatment patterns and short-term outcomes in ischemic stroke in pregnancy or postpartum period
Leffert LR, Clancy CR, Bateman BT, Cox M, Schulte PJ, Smith EE, Fonarow GC, Kuklina EV, George MG, Schwamm LH. Treatment patterns and short-term outcomes in ischemic stroke in pregnancy or postpartum period. American Journal Of Obstetrics And Gynecology 2015, 214: 723.e1-723.e11. PMID: 26709084, DOI: 10.1016/j.ajog.2015.12.016.Peer-Reviewed Original ResearchConceptsAcute stroke reperfusion therapyStroke reperfusion therapyShort-term outcomesTissue plasminogen activatorGuidelines-Stroke registryPregnancy-related strokeReperfusion therapyIschemic stroke patientsIschemic strokeNonpregnant womenPostpartum womenStroke patientsPlasminogen activatorPostpartum periodIntravenous tissue plasminogen activator useIntravenous tissue plasminogen activatorFavorable short-term outcomesTissue plasminogen activator useAcute reperfusion therapyCatheter-based thrombolysisGreater stroke severityMajor systemic bleedingNonpregnant women 18Symptomatic intracranial hemorrhageHistory of hypertensionElevated Upper Body Position Improves Pregnancy-Related OSA Without Impairing Sleep Quality or Sleep Architecture Early After Delivery
Zaremba S, Mueller N, Heisig AM, Shin CH, Jung S, Leffert LR, Bateman BT, Pugsley LJ, Nagasaka Y, Duarte IM, Ecker JL, Eikermann M. Elevated Upper Body Position Improves Pregnancy-Related OSA Without Impairing Sleep Quality or Sleep Architecture Early After Delivery. CHEST Journal 2015, 148: 936-944. PMID: 25905714, DOI: 10.1378/chest.14-2973.Peer-Reviewed Original ResearchConceptsUpper airway cross-sectional areaAirway cross-sectional areaApnea-hypopnea indexUpper body elevationCross-sectional areaUpper body positionBody positionSleep architectureEarly postpartum womenUpper bodyInstitutional review board approvalUpper airway resistanceSeverity of OSABody elevationTotal sleep timeReview board approvalMassachusetts General HospitalRespiratory safetySevere OSAAcoustic pharyngometryNonpregnant patientsPostpartum patientsAirway resistanceCrossover studySleep apneaPatient Characteristics and Outcomes After Hemorrhagic Stroke in Pregnancy
Leffert LR, Clancy CR, Bateman BT, Cox M, Schulte PJ, Smith EE, Fonarow GC, Schwamm LH, Kuklina EV, George MG. Patient Characteristics and Outcomes After Hemorrhagic Stroke in Pregnancy. Circulation Cardiovascular Quality And Outcomes 2015, 8: s170-s178. PMID: 26515206, DOI: 10.1161/circoutcomes.115.002242.Peer-Reviewed Original ResearchConceptsStroke risk factorsSubarachnoid hemorrhage patientsHemorrhagic strokeRisk factorsHS patientsHospital mortalityHemorrhage patientsDiseases-Ninth Revision codesBlood pressure criteriaGuidelines-Stroke registryPregnancy-related strokeAssociation of pregnancyNonpregnant female patientsConditional logistic regressionFisher's exact testWilcoxon rank sum testRank sum testGuidelines-StrokeSevere preeclampsiaHome dischargeIschemic strokeNonpregnant womenPatient characteristicsRisk patientsIndependent ambulationPregnancy complications in women with rare tumor suppressor syndromes affecting central and peripheral nervous system
Terry AR, Merker VL, Barker FG, Leffert L, Bateman BT, Souter I, Plotkin SR. Pregnancy complications in women with rare tumor suppressor syndromes affecting central and peripheral nervous system. American Journal Of Obstetrics And Gynecology 2015, 213: 108-109. PMID: 25687565, DOI: 10.1016/j.ajog.2015.02.013.Peer-Reviewed Original ResearchHypertensive Disorders and Pregnancy-Related Stroke
Leffert LR, Clancy CR, Bateman BT, Bryant AS, Kuklina EV. Hypertensive Disorders and Pregnancy-Related Stroke. Obstetrics And Gynecology 2015, 125: 124-131. PMID: 25560114, PMCID: PMC4445352, DOI: 10.1097/aog.0000000000000590.Peer-Reviewed Original ResearchConceptsTraditional stroke risk factorsPregnancy-associated strokeHypertensive disordersPregnancy hospitalizationsStroke risk factorsStroke-related complicationsStroke riskRisk factorsOdds ratioNationwide Inpatient SampleCongenital heart diseaseCross-sectional studyComplication rateStroke hospitalizationsInpatient SampleHeart diseaseNationwide rateHospitalizationPregnancyStrokeLogistic regressionCongenital coagulationDisordersConfidence intervalsComplications
2014
Continuous measurement of cardiac output with the electrical velocimetry method in patients under spinal anesthesia for cesarean delivery
Liu Y, Pian-Smith MC, Leffert LR, Minehart RD, Torri A, Coté C, Kacmarek RM, Jiang Y. Continuous measurement of cardiac output with the electrical velocimetry method in patients under spinal anesthesia for cesarean delivery. Journal Of Clinical Monitoring And Computing 2014, 29: 627-634. PMID: 25510959, DOI: 10.1007/s10877-014-9645-8.Peer-Reviewed Original ResearchConceptsPre-defined time pointsElective cesarean deliveryCardiac outputCesarean deliverySpinal anesthesiaStroke volumeNon-invasive CO monitorContinuous CO monitoringSystemic vascular resistanceTime pointsMajority of patientsPeripheral venous pressureTreatment of hypotensionOnset of hypotensionCO monitoringVascular resistanceHemodynamic profileVenous pressureHemodynamic changesPatient's hemodynamicsPhenylephrine bolusPhenylephrine administrationPatient outcomesObservational studyPatient managementOpioid Abuse and Dependence during Pregnancy
Maeda A, Bateman BT, Clancy CR, Creanga AA, Leffert LR. Opioid Abuse and Dependence during Pregnancy. Anesthesiology 2014, 121: 1158-1165. PMID: 25405293, DOI: 10.1097/aln.0000000000000472.Peer-Reviewed Original ResearchConceptsOpioid abuseObstetrical outcomesIntrauterine growth restrictionNationwide Inpatient SampleObstetrical morbidityPlacental abruptionPreterm laborCesarean deliveryMaternal deathsPremature rupturePregnant womenCardiac arrestRelevant confoundersInpatient SampleGrowth restrictionPreventive strategiesTherapeutic interventionsPregnancyLogistic regressionNationwide trendsHospitalizationPrevalenceAbuseOutcomesUnited States