2024
National Estimates of Short- and Longer-Term Hospital Readmissions After Major Surgery Among Community-Living Older Adults
Wang Y, Leo-Summers L, Vander Wyk B, Davis-Plourde K, Gill T, Becher R. National Estimates of Short- and Longer-Term Hospital Readmissions After Major Surgery Among Community-Living Older Adults. JAMA Network Open 2024, 7: e240028. PMID: 38416499, PMCID: PMC10902728, DOI: 10.1001/jamanetworkopen.2024.0028.Peer-Reviewed Original ResearchConceptsCenters for Medicare & Medicaid ServicesFee-for-serviceMedicare Advantage beneficiariesHospital readmissionUS residentsNational Health and Aging Trends Study dataCommunity-living older adultsProspective longitudinal cohort studyCommunity-living participantsRate of hospital readmissionLikelihood of hospital readmissionPopulation-based estimatesNationally representative estimatesSex-adjusted modelsCommunity-livingData linkageGeriatric conditionsMedicaid ServicesOlder personsOlder adultsMain OutcomesNational estimatesRepresentative estimatesData analysisCohort study
2023
Relationship Between Distressing Symptoms and Changes in Disability After Major Surgery Among Community-living Older Persons
Gill T, Han L, Feder S, Gahbauer E, Leo-Summers L, Becher R. Relationship Between Distressing Symptoms and Changes in Disability After Major Surgery Among Community-living Older Persons. Annals Of Surgery 2023, 279: 65-70. PMID: 37389893, PMCID: PMC10761592, DOI: 10.1097/sla.0000000000005984.Peer-Reviewed Original ResearchConceptsMajor surgeryDistressing symptomsElective surgeryFunctional outcomeOlder personsCommunity-living older personsMultiple distressing symptomsSocioeconomic disadvantageCommunity-living personsTiming of surgerySerious health eventsNumber of disabilitiesSurgerySignificant associationSymptomsHealth eventsRate ratioPotential targetDisabilityUnit increaseDeleterious effectsOutcomesPersonsMultimorbidityAdmission
2022
Population-Based Estimates of 1-Year Mortality After Major Surgery Among Community-Living Older US Adults
Gill TM, Vander Wyk B, Leo-Summers L, Murphy TE, Becher RD. Population-Based Estimates of 1-Year Mortality After Major Surgery Among Community-Living Older US Adults. JAMA Surgery 2022, 157: e225155. PMID: 36260323, PMCID: PMC9582971, DOI: 10.1001/jamasurg.2022.5155.Peer-Reviewed Original ResearchConceptsPopulation-based estimatesMajor surgeryMean survival timeOlder US adultsProbable dementiaUS adultsSurvival timeSex-adjusted hazard ratioProspective longitudinal cohort studyCommunity-living older adultsLongitudinal cohort studyPotential prognostic valueService Medicare beneficiariesNon-Hispanic blacksNon-Hispanic whitesAging Trends StudyGeriatric characteristicsCohort studyGeriatric surgeryHazard ratioNonelective surgeryElective surgeryGeriatric conditionsPrognostic valueMean ageThe effect of the COVID-19 pandemic on community violence in Connecticut
O'Neill KM, Dodington J, Gawel M, Borrup K, Shapiro DS, Gates J, Gregg S, Becher RD. The effect of the COVID-19 pandemic on community violence in Connecticut. The American Journal Of Surgery 2022, 225: 775-780. PMID: 36253316, PMCID: PMC9540704, DOI: 10.1016/j.amjsurg.2022.10.004.Peer-Reviewed Original ResearchConceptsCommunity violenceCOVID-19 pandemicTrauma registry dataViolence-related traumaLarge-scale morbiditySystemic healthPatient presentationRegistry dataPre-COVID periodTraumaLinear regression modelsCOVID periodNegative healthRegression modelsPandemicHealthCOVID pandemicMorbidityInjuryMortalityLatinx communitiesSocial inequitiesFactors Associated With Days Away From Home in the Year After Major Surgery Among Community-living Older Persons
Gill TM, Becher RD, Murphy TE, Gahbauer EA, Leo-Summers L, Han L. Factors Associated With Days Away From Home in the Year After Major Surgery Among Community-living Older Persons. Annals Of Surgery 2022, 278: e13-e19. PMID: 35837967, PMCID: PMC9840715, DOI: 10.1097/sla.0000000000005528.Peer-Reviewed Original ResearchConceptsHealth care facilitiesMajor surgeryAge 85 yearsCare facilitiesOlder personsRisk factorsNumber of daysLower peak expiratory flowCommunity-living older personsShort Physical Performance BatteryIndependent risk factorCommunity-living personsPhysical Performance BatteryPeak expiratory flowCandidate risk factorsQuality of lifeHospital dischargeMultivariable analysisExpiratory flowMedian numberPerformance BatteryMusculoskeletal surgerySurgeryMean differenceHospitalGeriatric vulnerability and the burden of disability after major surgery
Gill TM, Murphy TE, Gahbauer EA, Leo‐Summers L, Becher RD. Geriatric vulnerability and the burden of disability after major surgery. Journal Of The American Geriatrics Society 2022, 70: 1471-1480. PMID: 35199332, PMCID: PMC9106872, DOI: 10.1111/jgs.17693.Peer-Reviewed Original ResearchConceptsBurden of disabilityMajor surgeryGeriatric vulnerabilitiesHospital dischargeElective surgeryFunctional outcomeLong-term functional outcomeStrong epidemiologic evidenceCommunity-living personsPoor functional outcomeNon-elective surgeryProspective longitudinal studyAdditional vulnerability factorVulnerability factorsMultivariable analysisEpidemiologic evidenceSurgery increasesBlack raceDisability burdenFemale sexMore disabilityAge 85Hispanic ethnicitySurgeryOlder personsEvaluation of Firearm-related Reinjury in Connecticut: An Opportunity for Gun Violence Prevention
O'Neill KM, Jean RA, Dodington J, Davis K, Becher RD. Evaluation of Firearm-related Reinjury in Connecticut: An Opportunity for Gun Violence Prevention. Journal Of Surgical Research 2022, 274: 23-30. PMID: 35121547, DOI: 10.1016/j.jss.2021.12.009.Peer-Reviewed Original ResearchConceptsFirearm-related injuriesFirearm injuriesYale New Haven Health SystemMedical record dataChief Medical ExaminerCohort studyTrauma patientsGun violence preventionConnecticut OfficePatient controlsPatientsInjuryHealth systemRelevant covariatesPrevention effortsRecord dataViolence prevention effortsReinjuryMedical examinersMortalityFirearm violenceRiskViolence preventionHomicide mortalityYears
2021
The Incidence and Cumulative Risk of Major Surgery in Older Persons in the United States
Becher RD, Vander Wyk B, Leo-Summers L, Desai MM, Gill TM. The Incidence and Cumulative Risk of Major Surgery in Older Persons in the United States. Annals Of Surgery 2021, 277: 87-92. PMID: 34261884, PMCID: PMC8758792, DOI: 10.1097/sla.0000000000005077.Peer-Reviewed Original ResearchConceptsMajor surgeryOlder personsCumulative riskNational HealthCommunity-living older personsHigh-quality surgical careNon-frail groupPopulation-based incidenceService Medicare beneficiariesMedicaid Services dataCumulative risk estimatesProspective longitudinal studyUnited States agesAging Trends StudyGeriatric characteristicsRepresentative incidenceFrail groupAdjusted incidenceGeriatric populationProbable dementiaSurgical carePersons 85Medicare beneficiariesSurgeryVulnerable subgroupsNational trends in emergency department closures, mergers, and utilization, 2005-2015
Venkatesh AK, Janke A, Rothenberg C, Chan E, Becher RD. National trends in emergency department closures, mergers, and utilization, 2005-2015. PLOS ONE 2021, 16: e0251729. PMID: 34015007, PMCID: PMC8136839, DOI: 10.1371/journal.pone.0251729.Peer-Reviewed Original ResearchConceptsHospital-based EDsEmergency department closureED visitsHospital admissionHospital bedsED closureYearly ED visitsLarge health systemAmerican Hospital Association Annual SurveyInpatient bed capacityPrimary outcomeSecondary outcomesMore patientsEmergency departmentRelative increaseInpatient bedsPatient volumeRural areasHealth systemAdmissionVisitsNational trendsBed capacityEDObservational analysisAnalysis of Hospital Resource Availability and COVID‐19 Mortality Across the United States
Janke AT, Mei H, Rothenberg C, Becher RD, Lin Z, Venkatesh AK. Analysis of Hospital Resource Availability and COVID‐19 Mortality Across the United States. Journal Of Hospital Medicine 2021, 16: 211-214. PMID: 33496664, PMCID: PMC8025594, DOI: 10.12788/jhm.3539.Peer-Reviewed Original ResearchConceptsCOVID-19 casesHospital resourcesIntensive care unit bedsHospital referral regionsCOVID-19 mortalityAmerican Hospital Association dataCOVID-19 deathsHospital resource availabilityDeath countsIncidence rateSurgical bedCare modelReferral regionsUnit bedsCOVID-19MortalityDeathUnited StatesLittle assessmentCOVID-19 dataCountGeographic areasNurses
2020
Functional Effects of Intervening Illnesses and Injuries After Hospitalization for Major Surgery in Community-living Older Persons
Gill TM, Han L, Gahbauer EA, Leo-Summers L, Murphy TE, Becher RD. Functional Effects of Intervening Illnesses and Injuries After Hospitalization for Major Surgery in Community-living Older Persons. Annals Of Surgery 2020, 273: 834-841. PMID: 33074902, PMCID: PMC8370041, DOI: 10.1097/sla.0000000000004438.Peer-Reviewed Original ResearchConceptsMajor surgeryED visitsRestricted activityFunctional statusFunctional declineOlder personsCommunity-living older personsAdjusted hazard ratioAdverse functional outcomesCommunity-living personsEmergency department visitsTraditional risk factorsCorresponding odds ratiosFunctional effectsIllness/injuryHazard ratioDepartment visitsFunctional recoveryFunctional outcomeRisk factorsOdds ratioHospitalizationSurgeryInjuryVisitsPhenobarbital Monotherapy for the Management of Alcohol Withdrawal Syndrome in Surgical-Trauma Patients
Ammar MA, Ammar AA, Rosen J, Kassab HS, Becher RD. Phenobarbital Monotherapy for the Management of Alcohol Withdrawal Syndrome in Surgical-Trauma Patients. Annals Of Pharmacotherapy 2020, 55: 294-302. PMID: 32830517, DOI: 10.1177/1060028020949137.Peer-Reviewed Original ResearchConceptsManagement of AWSAlcohol withdrawal syndromePhenobarbital monotherapyRespiratory depressionWithdrawal syndromeDevelopment of AWSSurgical trauma intensive care unitPatient experienced hypotensionSurgical trauma patientsInvasive mechanical ventilationSafety end pointFirst-line therapyMajority of patientsManagement of patientsIntensive care unitExperienced hypotensionTaper regimenSignificant hypotensionAdjunct therapyIll patientsLoading doseCare unitMechanical ventilationPatient populationSurgical traumaFinancial Hardship After Traumatic Injury: Risk Factors and Drivers of Out-of-Pocket Health Expenses
O'Neill KM, Jean RA, Gross CP, Becher RD, Khera R, Elizondo JV, Nasir K. Financial Hardship After Traumatic Injury: Risk Factors and Drivers of Out-of-Pocket Health Expenses. Journal Of Surgical Research 2020, 256: 1-12. PMID: 32663705, DOI: 10.1016/j.jss.2020.05.095.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedChildChild, PreschoolCost of IllnessCross-Sectional StudiesFamilyFemaleFinancial StressHealth ExpendituresHospitalizationHumansInfantInfant, NewbornInsurance, HealthMaleMiddle AgedPrescription DrugsRetrospective StudiesRisk FactorsSocioeconomic FactorsUnited StatesWounds and InjuriesYoung AdultConceptsTraumatic injuryOOP expensesPocket health expensesExcess financial burdenHealth expensesInpatient costsCatastrophic medical expensesFinancial burdenMultivariable logistic regression analysisMedical expensesHealth care factorsCostly medical conditionsCross-sectional studyMedical Expenditure Panel SurveyLogistic regression analysisPrescription drug costsFinancial hardshipHealth care systemFamily membersTrauma-related disordersPrimary outcomeCare factorsEmergency roomRisk factorsDrug costsGeographic Variation in the Utilization of and Mortality After Emergency General Surgery Operations in the Northeastern and Southeastern United States
Becher RD, Jin L, Warren JL, Gill TM, DeWane MP, Davis KA, Zhang Y. Geographic Variation in the Utilization of and Mortality After Emergency General Surgery Operations in the Northeastern and Southeastern United States. Annals Of Surgery 2020, 275: 340-347. PMID: 32516232, PMCID: PMC7726051, DOI: 10.1097/sla.0000000000003939.Peer-Reviewed Original ResearchConceptsHospital service areasSubsequent mortalityEmergency general surgery careEmergency general surgery operationsEGS operationsCommon EGS operationsAge-standardized ratesGeneral surgery careState Inpatient DatabasesGeneral surgery operationsRandom-effects modelWide geographic variationHospital mortalityInpatient DatabaseSurgery careKruskal-Wallis testMortality rateUnwarranted variationMortalityStandardized ratesLinear random effects modelSurgery operationsUnited StatesGeographic variationCareSurvivors of gun violence and the experience of recovery.
O'Neill KM, Vega C, Saint-Hilaire S, Jahad L, Violano P, Rosenthal MS, Maung AA, Becher RD, Dodington J. Survivors of gun violence and the experience of recovery. Journal Of Trauma And Acute Care Surgery 2020, 89: 29-35. PMID: 32118821, DOI: 10.1097/ta.0000000000002635.Peer-Reviewed Original ResearchConceptsGun violenceQualitative research studyCommunity-based organizationsCommunity-based participatory research approachInterview transcript dataParticipatory research approachSense of safetyExperience of recoveryRepeat violenceConstant comparison methodMental health treatmentViolenceCommunity membersViolent recidivismDepth oneResearch approachBlack menSocial restrictionsHealth treatmentSuboptimal supportRecovery experiencesQualitative analysisThemesHigh-risk populationInterviewsHospital Variation in Geriatric Surgical Safety for Emergency Operation
Becher RD, Sukumar N, DeWane MP, Stolar MJ, Gill TM, Schuster KM, Maung AA, Zogg CK, Davis KA. Hospital Variation in Geriatric Surgical Safety for Emergency Operation. Journal Of The American College Of Surgeons 2020, 230: 966-973.e10. PMID: 32032720, PMCID: PMC7409563, DOI: 10.1016/j.jamcollsurg.2019.10.018.Peer-Reviewed Original ResearchConceptsStandardized mortality ratioHospital-level characteristicsGeneral surgery operationsGeriatric patientsEmergency operationHospital variationEmergency general surgery operationsMean standardized mortality ratioCalifornia State Inpatient DatabaseHospital-based mortalitySignificant hospital variationPatients 65 yearsSubstantial excess mortalitySurgery operationsState Inpatient DatabasesMixed effects logistic regression modelsCommon general surgery operationsLow-mortality outliersLogistic regression modelsPostoperative mortalityHospital deathOlder patientsInpatient DatabaseMortality outcomesNonelective operations
2019
Regionalization of emergency general surgery operations: A simulation study.
Becher RD, Sukumar N, DeWane MP, Gill TM, Maung AA, Schuster KM, Stolar MJ, Davis KA. Regionalization of emergency general surgery operations: A simulation study. Journal Of Trauma And Acute Care Surgery 2019, 88: 366-371. PMID: 31804419, PMCID: PMC7472889, DOI: 10.1097/ta.0000000000002543.Peer-Reviewed Original ResearchConceptsEmergency general surgeryHigh-volume hospitalsEGS careEmergency general surgery operationsCalifornia inpatient databaseCommon EGS operationsRisk-adjusted deathsSignificant survival benefitLow-volume hospitalsUmbilical hernia repairSmall bowel resectionHigh-mortality hospitalsGeneral surgery operationsRegional trauma systemEGS operationsBowel resectionAdult patientsPrimary outcomeSurvival benefitInpatient DatabaseHernia repairTrauma systemLevel IVGeneral surgeryCare managementHigh-performance acute care hospitals: Excelling across multiple emergency general surgery operations in the geriatric patient.
DeWane MP, Sukumar N, Stolar MJ, Gill TM, Maung AA, Schuster KM, Davis KA, Becher RD. High-performance acute care hospitals: Excelling across multiple emergency general surgery operations in the geriatric patient. Journal Of Trauma And Acute Care Surgery 2019, 87: 140-146. PMID: 31259872, PMCID: PMC7656193, DOI: 10.1097/ta.0000000000002273.Peer-Reviewed Original ResearchConceptsCommon EGS operationsEmergency general surgeryOlder patientsGeriatric patientsEmergency general surgery operationsEGS operationsCalifornia State Inpatient DatabaseGeneral surgery hospitalsPatients 65 yearsRisk-adjusted mortalitySurvival rates 1State Inpatient DatabasesGeneral surgery operationsClusters of hospitalsOperation typeHospital performanceEGS patientsSurgery HospitalInpatient DatabaseGroup of hospitalsGeriatric populationGeneral surgeryPatientsHospitalLevel IIITop-tier emergency general surgery hospitals: Good at one operation, good at them all.
DeWane MP, Sukumar N, Stolar MJ, Gill TM, Maung AA, Schuster KM, Davis KA, Becher RD. Top-tier emergency general surgery hospitals: Good at one operation, good at them all. Journal Of Trauma And Acute Care Surgery 2019, 87: 289-296. PMID: 31349347, PMCID: PMC6771423, DOI: 10.1097/ta.0000000000002367.Peer-Reviewed Original ResearchConceptsRisk-adjusted mortalityEGS hospitalsHospital risk-adjusted mortalityOperation typeEGS operationsCalifornia State Inpatient DatabaseGeneral surgery hospitalsHospital-level factorsAcute care hospitalsState Inpatient DatabasesAmerican Hospital Association databasePoor-performing hospitalsSystems of careLow-risk operationAssessment of mortalityAdult patientsCare hospitalSurgery HospitalInpatient DatabaseHospital characteristicsMultinomial logistic regressionMortality rateHospitalLevel IIIZ-scoreHospital Operative Volume and Quality Indication for General Surgery Operations Performed Emergently in Geriatric Patients
Becher RD, DeWane MP, Sukumar N, Stolar MJ, Gill TM, Becher RM, Maung AA, Schuster KM, Davis KA. Hospital Operative Volume and Quality Indication for General Surgery Operations Performed Emergently in Geriatric Patients. Journal Of The American College Of Surgeons 2019, 228: 910-923. PMID: 31005629, PMCID: PMC6582986, DOI: 10.1016/j.jamcollsurg.2019.02.053.Peer-Reviewed Original ResearchConceptsHospital operative volumeGeneral surgery operationsGeriatric patientsOperative volumeEmergency operationHospital volumeProbability of survivalEmergency general surgery operationsCalifornia State Inpatient DatabaseRetrospective cohort studySurgery operationsState Inpatient DatabasesHigher operative volumesAverage mortality riskOlder patientsCohort studyInpatient DatabaseGeriatric populationSurgical careSurgical qualityAmerican CollegeMortality riskOptimizing outcomesStandardized increasePatients