2020
Hospital 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
Hospital 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 increasePatientsThe EGS Grading Scale For Skin And Soft Tissue Infections Is Predictive Of Poor Outcomes
Savage SA, Li SW, Utter GH, Cox JA, Wydo SM, Cahill K, Sarani B, Holzmacher J, Duane TM, Gandhi RR, Zielinski MD, Ray-Zack M, Tierney J, Chapin T, Murphy PB, Vogt KN, Schroeppel TJ, Callaghan E, Kobayashi L, Coimbra R, Schuster KM, Gillaspie D, Timsina L, Louis A, Crandall M. The EGS Grading Scale For Skin And Soft Tissue Infections Is Predictive Of Poor Outcomes. Journal Of Trauma And Acute Care Surgery 2019, Publish Ahead of Print: &na;. PMID: 30601458, PMCID: PMC6433490, DOI: 10.1097/ta.0000000000002175.Peer-Reviewed Original ResearchConceptsSoft tissue infectionsLength of stayDisease processGrading scaleInter-rater reliabilityGrade IVEmergency general surgery (EGS) diseasesDisparate disease processesRetrospective multicenter trialLaboratory Risk IndicatorNecrotizing Fasciitis (LRINEC) scoreSurgery of TraumaMulti-institutional trialHigh gradeDifferent disease processesClinical disease processesOverall complicationsHospital lengthICU lengthFasciitis (LRINEC) scoreMulticenter trialTissue infectionsValidation studyPoor outcomeDisease characteristicsSymptomatic human immunodeficiency virus–infected patients have poorer outcomes following emergency general surgery
Sandler BJ, Davis KA, Schuster KM. Symptomatic human immunodeficiency virus–infected patients have poorer outcomes following emergency general surgery. Journal Of Trauma And Acute Care Surgery 2019, 86: 479-488. PMID: 30531208, DOI: 10.1097/ta.0000000000002161.Peer-Reviewed Original ResearchConceptsHIV/AIDS patientsHIV-negative patientsAsymptomatic HIV-positive patientsHIV-positive patientsActive antiretroviral therapyAIDS patientsAntiretroviral therapyHospital stayPostoperative complicationsHuman immunodeficiency virus-infected patientsEmergency general surgery proceduresHigher median total chargesImmune deficiency syndrome (AIDS) patientsHuman immunodeficiency virus (HIV) infectionEmergency general surgeryLonger hospital stayRetrospective cohort studyAcute renal failureHIV-negative controlsImmunodeficiency virus infectionVirus-infected patientsRecords of patientsUrinary tract infectionMedian total chargesNationwide Inpatient Sample
2018
Racial/Ethnic Disparities in Longer-term Outcomes Among Emergency General Surgery Patients
Zogg CK, Jiang W, Ottesen TD, Shafi S, Schuster K, Becher R, Davis KA, Haider AH. Racial/Ethnic Disparities in Longer-term Outcomes Among Emergency General Surgery Patients. Annals Of Surgery 2018, 268: 968-979. PMID: 28742704, PMCID: PMC5783796, DOI: 10.1097/sla.0000000000002449.Peer-Reviewed Original ResearchConceptsEmergency general surgery patientsNon-Hispanic whitesGeneral surgery patientsLong-term outcomesNon-Hispanic blacksNon-Hispanic AsiansMinority patientsMajor morbidityUnplanned readmissionSurgery patientsOlder adultsRisk-adjusted Cox proportional hazards modelsEthnic disparitiesCox proportional hazards modelDiagnostic categoriesRacial/Ethnic DisparitiesUS population agesProportional hazards modelNHB patientsNonagenarian patientsNHW patientsBACKGROUND DATAHospital's percentageMortality differencesMedicare dataTransfer status
DeWane MP, Davis KA, Schuster KM, Erwin SP, Maung AA, Becher RD. Transfer status. Journal Of Trauma And Acute Care Surgery 2018, 85: 348-353. PMID: 29664889, DOI: 10.1097/ta.0000000000001939.Peer-Reviewed Original ResearchConceptsOutside emergency departmentHospital inpatient unitsEmergency departmentNursing homesInpatient unitTransfer statusSurgeons National Surgical Quality Improvement Program databaseNational Surgical Quality Improvement Program databaseBackward multivariable logistic regressionOutside hospital emergency departmentEmergency general surgery patientsQuality Improvement Program databaseMultivariate Cox regression analysisEmergency colon surgeryGeneral surgery patientsThirty-day mortalityImprovement Program databaseChronic care facilitiesCox regression analysisRates of morbidityTransfer of patientsHospital emergency departmentHospital inpatient wardsEmergent colectomyPhysiologic decompensationVenous Thromboembolism-Related Readmission in Emergency General Surgery Patients: A Role for Prophylaxis on Discharge?
DeWane MP, Davis KA, Schuster KM, Maung AA, Becher RD. Venous Thromboembolism-Related Readmission in Emergency General Surgery Patients: A Role for Prophylaxis on Discharge? Journal Of The American College Of Surgeons 2018, 226: 1072-1077.e3. PMID: 29574180, DOI: 10.1016/j.jamcollsurg.2018.03.021.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overDatabases, FactualEmergenciesFemaleHumansMalePatient DischargePatient ReadmissionPostoperative ComplicationsRisk FactorsUnited StatesVenous ThromboembolismConceptsVenous thromboembolismEmergency general surgery operationsPost-discharge venous thromboembolismEmergency general surgery patientsMultivariable logistic regression modelingCommon EGS operationsGeneral surgery patientsRate of readmissionUrinary tract infectionSurgeons NSQIP databaseHigh-risk groupGeneral surgery operationsLogistic regression modelingEGS operationsProphylactic anticoagulationVTE formationVTE prophylaxisVTE ratesEGS patientsPostoperative sepsisNSQIP databaseProlonged lengthSurgery patientsTract infectionsPredictive factorsRelationship between duration of preoperative symptoms and postoperative ileus for small bowel obstruction
Brandt WS, Wood J, Bhattacharya B, Pei K, Davis KA, Schuster K. Relationship between duration of preoperative symptoms and postoperative ileus for small bowel obstruction. Journal Of Surgical Research 2018, 225: 40-44. PMID: 29605033, DOI: 10.1016/j.jss.2017.12.031.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAged, 80 and overAscitesEquipment and Supplies UtilizationFemaleFood IntoleranceHumansIleusIntensive Care UnitsIntestinal ObstructionIntestine, SmallLength of StayMaleMiddle AgedParenteral NutritionPostoperative ComplicationsPreoperative PeriodRetrospective StudiesRisk FactorsTime FactorsTime-to-TreatmentYoung AdultConceptsTolerance of dietSmall bowel obstructionPreoperative symptomsLength of stayPostoperative ileusUnivariable analysisTotal durationIntensive care unit admissionTotal parenteral nutrition useParenteral nutrition useCare unit admissionIntensive care unitPreoperative ascitesBowel obstructionPrimary endpointSecondary endpointsSymptom durationUnit admissionMedian durationOperative interventionPostoperative outcomesCare unitMultivariable analysisRetrospective reviewNutrition use
2016
Outcomes of acute care surgical cases performed at night
Dalton MK, McDonald E, Bhatia P, Davis KA, Schuster KM. Outcomes of acute care surgical cases performed at night. The American Journal Of Surgery 2016, 212: 831-836. PMID: 27263405, DOI: 10.1016/j.amjsurg.2016.02.024.Peer-Reviewed Original ResearchConceptsAcute care surgeonsRetrospective cohort studyConditional logistic regressionMore hypotensionCohort studyOperative interventionOperative delayDay casesSurgical careOutcome differencesSurgical casesEmergency operationLogistic regressionSurgeonsPotent predictorTeam fatigueComorbiditiesSimilar degreeConfoundersOutcomesMortalityUnmeasured factorsDaysHypotensionSepsis
2014
The Use of Magnetic Resonance Imaging in the Diagnosis of Suspected Appendicitis in Pregnancy : Shortened Length of Stay Without Increase in Hospital Charges
Fonseca AL, Schuster KM, Kaplan LJ, Maung AA, Lui FY, Davis KA. The Use of Magnetic Resonance Imaging in the Diagnosis of Suspected Appendicitis in Pregnancy : Shortened Length of Stay Without Increase in Hospital Charges. JAMA Surgery 2014, 149: 687-693. PMID: 24871698, DOI: 10.1001/jamasurg.2013.4658.Peer-Reviewed Original ResearchConceptsMR imaging groupHospital chargesNontherapeutic explorationsPregnant patientsImaging groupFetal outcomesShorter LOSEmergency departmentUniversity tertiary referral centerMean hospital chargesTertiary referral centerLength of stayMagnetic resonancePathology-confirmed appendicitisAbdominal painOperative interventionReferral centerClinical outcomesGestational ageMultivariable analysisRetrospective reviewFetal lossAppendicitisMAIN OUTCOMEPatients
2012
Non-operative management of acute cholecystitis in the elderly
McGillicuddy E, Schuster K, Barre K, Suarez L, Hall M, Kaml G, Davis K, Longo W. Non-operative management of acute cholecystitis in the elderly. British Journal Of Surgery 2012, 99: 1254-1261. PMID: 22829411, DOI: 10.1002/bjs.8836.Peer-Reviewed Original ResearchConceptsRecurrent acute cholecystitisAcute cholecystitisNon-operative managementDiagnosis of ACNon-operative groupAcute respiratory failureNon-operative treatmentTertiary care centerMonth of deathElective cholecystectomyIndex admissionInterval cholecystectomyOperative morbidityPostoperative morbidityRespiratory failureCholecystectomy ratesComplication ratePercutaneous cholecystostomyStandard therapyMajor complicationsPostoperative detailsMedical managementMyocardial infarctionMedical recordsPhysiological reserve
2011
Acute cholecystitis in the elderly: use of computed tomography and correlation with ultrasonography
McGillicuddy EA, Schuster KM, Brown E, Maxfield MW, Davis KA, Longo WE. Acute cholecystitis in the elderly: use of computed tomography and correlation with ultrasonography. The American Journal Of Surgery 2011, 202: 524-527. PMID: 21906722, DOI: 10.1016/j.amjsurg.2011.06.012.Peer-Reviewed Original ResearchMeSH KeywordsAcidosisAgedCholecystectomyCholecystitis, AcuteCholelithiasisCommon Bile DuctFemaleHumansLeukocytosisMalePeritonitisPostoperative ComplicationsTomography, X-Ray ComputedUltrasonographyConceptsAcute cholecystitisCT groupCommon bile duct sizeDiagnosis of ACBile duct sizeDetection of cholelithiasisMore acute presentationsCoronary artery diseaseAcute presentationCholecystectomy ratesElderly patientsNonambulatory statusArtery diseaseUS findingsComputed tomographyService admissionsInflammationUS groupPatientsCTDuct sizeCholecystitisTomographyGroupLeukocytosisAdrenocorticotropic hormone and cortisol response to corticotropin releasing hormone in the critically ill—a novel assessment of the hypothalamic-pituitary-adrenal axis
Schuster KM, Macleod JB, Fernandez JB, Kumar M, Barquist ES. Adrenocorticotropic hormone and cortisol response to corticotropin releasing hormone in the critically ill—a novel assessment of the hypothalamic-pituitary-adrenal axis. The American Journal Of Surgery 2011, 203: 205-210. PMID: 21679920, DOI: 10.1016/j.amjsurg.2010.11.015.Peer-Reviewed Original ResearchMeSH KeywordsAdrenal InsufficiencyAdrenocorticotropic HormoneAgedAged, 80 and overArea Under CurveCorticotropin-Releasing HormoneCosyntropinCritical IllnessFemaleHumansHydrocortisoneHypothalamo-Hypophyseal SystemIntensive Care UnitsLinear ModelsMaleMiddle AgedPituitary-Adrenal SystemPostoperative ComplicationsPrognosisConceptsCorticotropin-releasing hormoneAdrenocorticotropic hormoneSurgical intensive care unitCosyntropin stimulation testIntensive care unitAdrenal insufficiencyCRH administrationACTH responseAdrenal functionCare unitStimulation testingAdrenal axisStimulation testACTH peakACTH responsivenessCortisol peakCortisol responseNormal responsePatientsChi-squareHormoneCortisolNonsurvivorsT-testP-value
2010
Ischemic colitis: risk factors for eventual surgery
Paterno F, McGillicuddy EA, Schuster KM, Longo WE. Ischemic colitis: risk factors for eventual surgery. The American Journal Of Surgery 2010, 200: 646-650. PMID: 21056146, DOI: 10.1016/j.amjsurg.2010.07.005.Peer-Reviewed Original ResearchConceptsComputed tomography scanRisk factorsIschemic colitisImmediate surgeryIntraperitoneal fluidTomography scanIntensive care unit admissionCare unit admissionPeripheral vascular diseaseFree intraperitoneal fluidUnit admissionSame admissionEventual surgerySubsequent surgeryMechanical ventilationSurgical managementAtrial fibrillationSurgical interventionVascular diseaseUnivariate analysisCommon disorderDiseases codesClinical conditionsLactate levelsInternational Classification
2009
Factors Predicting Morbidity and Mortality in Emergency Colorectal Procedures in Elderly Patients
McGillicuddy EA, Schuster KM, Davis KA, Longo WE. Factors Predicting Morbidity and Mortality in Emergency Colorectal Procedures in Elderly Patients. JAMA Surgery 2009, 144: 1157-1162. PMID: 20026835, DOI: 10.1001/archsurg.2009.203.Peer-Reviewed Original ResearchConceptsEmergency colorectal proceduresEmergent colorectal proceduresColorectal proceduresHospital mortalityElderly patientsUniversity tertiary referral centerIntra-abdominal contaminationIntraoperative blood lossPatients 65 yearsAdvanced colorectal cancerCurrent Procedural Terminology codesModifiable risk factorsTertiary referral centerColorectal cancer screeningRecurrent respiratory failureProcedural Terminology codesPredicting MorbidityHospital morbidityPostoperative morbidityRenal insufficiencyRespiratory failureFrequent complicationReferral centerBlood lossRetrospective review