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
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 ageGeriatric 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 persons
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 costsHospital 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
Top-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 increasePatientsEvaluating mortality outlier hospitals to improve the quality of care in emergency general surgery.
Becher RD, DeWane MP, Sukumar N, Stolar MJ, Gill TM, Maung AA, Schuster KM, Davis KA. Evaluating mortality outlier hospitals to improve the quality of care in emergency general surgery. Journal Of Trauma And Acute Care Surgery 2019, 87: 297-306. PMID: 30908450, PMCID: PMC6660354, DOI: 10.1097/ta.0000000000002271.Peer-Reviewed Original ResearchConceptsStandardized mortality ratioOutlier hospitalsHospital variationMortality ratioStandardized mortalityEmergency general surgery operationsCalifornia State Inpatient DatabaseEGS operationsCommon EGS operationsSignificant hospital variationEmergency general surgeryHospital-level characteristicsHospital-level variablesSignificant excess mortalityGeneral surgery operationsState Inpatient DatabasesQuality improvement initiativesQuality of careHospital quality indicatorsNational Quality ForumEGS outcomesInpatient DatabaseExcess mortalityOnly hospitalEpidemiologic studiesFactors Associated With Functional Recovery Among Older Survivors of Major Surgery
Becher RD, Murphy TE, Gahbauer EA, Leo-Summers L, Stabenau HF, Gill TM. Factors Associated With Functional Recovery Among Older Survivors of Major Surgery. Annals Of Surgery 2019, Publish Ahead of Print: &na;. PMID: 30741734, PMCID: PMC6684864, DOI: 10.1097/sla.0000000000003233.Peer-Reviewed Original ResearchConceptsFunctional recoveryMajor surgeryOlder personsElective surgeryYears of educationPersons 70 yearsProspective longitudinal studyGreater increaseHospital dischargeSurgical treatmentGeriatric patientsMedian timePresurgical levelsOlder survivorsHigh riskSurgeryMost older personsPremorbid functionPotential predictorsAnalytic sampleMonthsDisabilityLongitudinal studyImpairmentCurrent study
2018
Functional Trajectories Before and After Major Surgery in Older Adults
Stabenau HF, Becher RD, Gahbauer EA, Leo-Summers L, Allore HG, Gill TM. Functional Trajectories Before and After Major Surgery in Older Adults. Annals Of Surgery 2018, 268: 911-917. PMID: 29356710, PMCID: PMC6521949, DOI: 10.1097/sla.0000000000002659.Peer-Reviewed Original ResearchConceptsMajor surgeryNonelective surgeryFunctional trajectoriesSevere disabilityOlder adultsCourse of disabilityFirst major surgeryPersons 70 yearsProspective cohort studyCohort studyFunctional prognosisModerate disabilityPartial improvementSurgeryPremorbid functionOlder personsStudy periodAnalytic sampleLittle improvementRapid improvementTrajectory groupsMild disabilityMost participantsDisabilityGradual improvement
2012
An innovative approach to predict the development of adult respiratory distress syndrome in patients with blunt trauma
Becher RD, Colonna AL, Enniss TM, Weaver AA, Crane DK, Martin RS, Mowery NT, Miller PR, Stitzel JD, Hoth JJ. An innovative approach to predict the development of adult respiratory distress syndrome in patients with blunt trauma. Journal Of Trauma And Acute Care Surgery 2012, 73: 1229-1235. PMID: 22914080, DOI: 10.1097/ta.0b013e31825b2124.Peer-Reviewed Original ResearchConceptsAdult respiratory distress syndromeDevelopment of ARDSPulmonary contusionRespiratory distress syndromeBlunt traumaAdmission chestDistress syndromeContusion sizePredictive valuePaO2/FiO2 ratioMultivariable logistic regression analysisBlunt chest traumaCongestive heart failureBilateral pulmonary contusionDiffuse bilateral infiltratesTotal lung volumeLogistic regression analysisNegative predictive valuePositive predictive valueTremendous clinical utilityBilateral infiltratesFiO2 ratioRespiratory complicationsChest traumaLung contusion
2011
A Critical Assessment of Outcomes in Emergency versus Nonemergency General Surgery Using the American College of Surgeons National Surgical Quality Improvement Program Database
Becher RD, Hoth JJ, Miller PR, Mowery NT, Chang MC, Meredith JW. A Critical Assessment of Outcomes in Emergency versus Nonemergency General Surgery Using the American College of Surgeons National Surgical Quality Improvement Program Database. The American Surgeon 2011, 77: 951-959. PMID: 21944366, DOI: 10.1177/000313481107700738.Peer-Reviewed Original ResearchConceptsEmergent operationPostoperative morbidityAmerican CollegeNonemergent casesSurgeons National Surgical Quality Improvement Program databaseNational Surgical Quality Improvement Program databaseQuality Improvement Program databaseGeneral surgery inpatientsGeneral surgery patientsImprovement Program databaseDeep vein thrombosisSpecific outcome dataGeneral surgery operationsGeneral surgery proceduresHigh mortality rateSystems of carePostoperative complicationsRenal failureSurgery patientsVein thrombosisNonemergent patientsHigh morbidityPoor outcomeUnique ClinicalInflammatory response