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Avulova S, Enemchukwu E, Kaufman M, Khavari R, Mir C, Moses K, Pierorazio P, Samplaski M, Seideman C, Siemens DR, Suskind A. Reflections on Diversity, Equity, and Inclusion in Medical Publishing: The Journal of Urology® HEAD Table. J Urol 2023; 209:830-832. [PMID: 37026640 DOI: 10.1097/ju.0000000000003376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Affiliation(s)
| | - Ekene Enemchukwu
- Department of Urology, Stanford University Medical Center, Stanford, California
| | - Melissa Kaufman
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rose Khavari
- Department of Urology, Methodist Hospital, Houston, Texas
| | - Carmen Mir
- Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - Kelvin Moses
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Phillip Pierorazio
- Department of Urology, University of Pennsylvania Health System: Penn Medicine, Philadelphia, Pennsylvania
| | - Mary Samplaski
- Department of Urology, University of Southern California, Los Angeles, California
| | - Casey Seideman
- Department of Urology, Oregon Health and Science University, Portland, Oregon
| | - D Robert Siemens
- Department of Urology, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada
| | - Anne Suskind
- Department of Urology, University of California San Francisco, San Francisco, California
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Colley A, Finlayson E, Zhao S, Boscardin J, Suskind A. High risk of complications after a "low risk" procedure: A national study of nursing home residents and older adults undergoing haemorrhoid surgery. Colorectal Dis 2023; 25:298-304. [PMID: 36097828 DOI: 10.1111/codi.16334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/15/2022] [Accepted: 09/01/2022] [Indexed: 02/08/2023]
Abstract
AIM To evaluate 30-day complications and 1-year mortality for older adults undergoing haemorrhoid surgery. METHOD This retrospective cohort study evaluated older adults (age 66+) undergoing haemorrhoid surgery using Medicare claims and the minimum data set (MDS). Long-stay nursing home residents were identified, and propensity score matched to community-dwelling older adults. Generalized estimating equation models were created to determine the adjusted relative risk of 30-day complications, length of stay (LOS), and 1-year mortality. Among nursing home residents, functional and cognitive status were evaluated using the MDS-activities of daily living (ADL) score and the Brief Instrument of Mental Status. Faecal continence status was evaluated among a subset of nursing home residents. RESULTS A total of 3664 subjects underwent haemorrhoid surgery and were included in the analyses. Nursing home residents were at significantly higher risk for 30-day complications (52.3% vs. 32.9%, aRR 1.6 [95% CI: 1.5-1.7], p < 0.001), and 1-year mortality (24.9% vs. 16.1%, aRR 1.6 [95% CI: 1.3-1.8], p < 0.001). Functional and mental status showed an inflection point of decline around the time of the procedure, which did not recover to the baseline trajectory in the following year. Additionally, a subset of nursing home residents demonstrated worsening faecal incontinence. CONCLUSION This study demonstrated high rates of 30-day complications and 1-year mortality among all older adults (yet significantly worse among nursing home residents). Ultimately, primary care providers and surgeons should carefully weigh the potential harms of haemorrhoid surgery in older adults living in a nursing home.
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Affiliation(s)
- Alexis Colley
- Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Emily Finlayson
- Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Shoujun Zhao
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
| | - John Boscardin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Anne Suskind
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
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Bayne D, Hicks CR, Srirangapatanam S, Armas-Phan M, Maru J, Gennatas E, Allen IE, Seligman H, Stoller M, Suskind A, Chi TL. Underinsurance And Multiple Surgical Treatments for Kidney Stones. Urology 2023; 172:61-68. [PMID: 36170903 PMCID: PMC9925403 DOI: 10.1016/j.urology.2022.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/23/2022] [Accepted: 09/08/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To further elucidate the relationship between low socioeconomic status (SES) and larger, more complex stones requiring staged surgical interventions. Specifically, we aimed to determine if underinsurance (Medicaid, Medicare, and self-pay insurance types) is associated with multiple surgeries within 1 year. METHODS We performed a retrospective longitudinal analysis of prospectively collected data from the California statewide Department of Health Care Access and Information (HCAI) dataset. We included adult patients who had their first recorded kidney stone encounter between 2009 and 2018 and underwent at least 1 urologic stone procedure. We followed these patients within the dataset for one year after their initial surgery to assess for factors predicting multiple surgical treatments for stones. RESULTS A total of 156,319 adults were included in the study. The proportions of individuals in private insurance, Medicaid, Medicare and self-pay/indigent groups differed by the presence or absence of additional surgeries (64.0%, 13.5%, 19.4%, and 0.1%, vs 70.3%, 10.1%, 16.6%, and 0.1%, respectively). Compared to private insurance, Medicaid (1.46 [1.40-1.53] P < .001) and Medicare (1.15 [1.10-1.20] P < .001) insurance types were associated with significantly greater odds of multiple surgeries, whereas no significant association was seen in the self-pay/indigent insurance type (1.35 [0.83-2.19], P = 1.0). CONCLUSION In a statewide, California database from 2009 to 2018, underinsured adults had higher odds of undergoing a second procedure for kidney stones within 1 year of initial surgical treatment. This study adds to the expanding body of literature linking suboptimal healthcare access and disparate outcomes for kidney stone patients.
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Affiliation(s)
- David Bayne
- Urology, University of California, San Francisco, CA.
| | | | | | | | - Johsias Maru
- Urology, University of California, San Francisco, CA
| | | | | | - Hilary Seligman
- Epidemiology and Biostatistics, University of California, San Francisco, CA
| | | | - Anne Suskind
- Urology, University of California, San Francisco, CA
| | - Thomas L Chi
- Urology, University of California, San Francisco, CA
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Bayne D, Srirangapatanam S, Hicks CR, Armas-Phan M, Showen A, Suskind A, Seligman H, Bibbins-Domingo K, Stoller M, Chi TL. Community Income, Healthy Food Access, and Repeat Surgery for Kidney Stones. Urology 2022; 160:51-59. [PMID: 34813836 PMCID: PMC9851910 DOI: 10.1016/j.urology.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To determine if limited food access census tracts and food swamp census tracts are associated with increased risk for repeat kidney stone surgery. And to elucidate the relationship between community-level food retail environment relative to community-level income on repeat stone surgery over time. METHODS Data were abstracted from the University of California, San Francisco Information Commons. Adult patients were included if they underwent at least one urologic stone procedure. Census tracts from available geographical data were mapped using Food Access Research Atlas data from the United States Department of Agriculture Economic Research Service. Kaplan-Meier curves were employed to illustrate time to a second surgical procedure over 5 years, and log-rank tests were used to test for statistically significant differences. A multivariate Cox regression model was used to generate hazard ratios for undergoing second surgery by group. RESULTS A total of 1496 patients were included in this analysis. Repeat stone surgery occurred in 324 patients. Kaplan-Meier curves demonstrated a statistically significant difference in curves depicting patients living in low income census tracts (LICTs) vs those not living in LICTs (P <.001). On Cox regression models, patients in LICTs had significantly higher risk of undergoing repeat surgery (P = .011). Patients from limited food access census tracts and food swamp census tracts did not have a significantly higher adjusted risk of undergoing second surgery (P = .11 and P = .88, respectively). CONCLUSION Income more so than food access associates with increased risk of repeat kidney stone surgery. Further research is needed to explore the interaction between low socioeconomic status and kidney stone outcomes.
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Affiliation(s)
- David Bayne
- Urology, University of California San Francisco, San Francisco, CA.
| | | | - Cameron R Hicks
- Urology, University of California San Francisco, San Francisco, CA
| | | | - Amy Showen
- Urology, University of California San Francisco, San Francisco, CA
| | - Anne Suskind
- Urology, University of California San Francisco, San Francisco, CA
| | - Hilary Seligman
- Urology, University of California San Francisco, San Francisco, CA
| | | | - Marshall Stoller
- Urology, University of California San Francisco, San Francisco, CA
| | - Thomas L Chi
- Urology, University of California San Francisco, San Francisco, CA
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Washington SL, Gregorich S, Song S, Meng MV, Suskind A, Porten SP. Missed opportunity: An intersectional approach to disparities in long-term survival in bladder cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
476 Background: For individuals with muscle-invasive bladder cancer (MIBC), studies focused on racial disparities have shown black race is associated with 21% lower odds of guideline-based treatment (GBT) and differences in treatment explain 35% of observed black-white differences in survival. To characterize how the interaction between race/ethnicity and receipt of GBT drive within- and between-race differences in survival for black, white, and Latino individuals with MIBC. Methods: We identified a cohort of individuals with cT2-4 MIBC from 2004-2013 in the National Cancer Database. GBT was defined by American Urological Association guidelines. A Cox proportional hazards model of patient mortality estimated effects of patient GBT status, race/ethnicity, and the GBT-by-race/ethnicity interaction, adjusting for covariates. Results: Of 54,910 MIBC individuals with 125,821 person-years of post-treatment observation (max=11 years), 90.1% were white, 6.9% black, and 3.0% Latino. Half (50.2%) received GBT. Averaging across GBT status, Latino individuals had lower hazard of death compared to black (HR 0.81, 95% CI 0.75-0.87) and white individuals (HR 0.92, 0.86-0.98). With GBT, Latino and white individuals had similar outcomes (HR=1.00, 0.91-1.10) and both groups fared significantly better than black individuals (HR=0.88, 0.79-0.99 and HR=0.88, 0.83-0.94, respectively). Without GBT, Latino individuals fared better than white (HR=0.85, 0.77-0.93) and black individuals (HR=0.74, 0.67-0.82) while white individuals fared better than black individuals (HR=0.87, 0.83-0.92). Latino without GBT fared better than black individuals with GBT (H=0.98, 0.88-1.09), although not statistically significant. Conclusions: Our study finds that not only are GBT levels generally low, which is concerning, but there is also an apparent 'under-allocation' of GBT to a patient group who arguably needs it the most-- black individuals. Future efforts to improve the delivery of GBT, a factor directly impacted by urologic care providers, may mitigate the race-based survival differences observed in individuals with MIBC.
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Affiliation(s)
| | | | - Sikai Song
- University of California, San Francisco, San Francisco, CA
| | | | - Anne Suskind
- University of California, San Francisco, San Francisco, CA
| | - Sima P. Porten
- University of California, San Francisco, San Francisco, CA
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Wiener S, Stoller M, Suskind A. MP50-09 REGIONAL VARIATION IN UTILIZATION OF URETEROSCOPY OVER SHOCKWAVE LITHOTRIPSY IN CALIFORNIA. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Suskind A, Cawthon P, Nakagawa S, Subak L, Reinders I, Satterfield S, Cummings S, Huang A. THE ROLE OF BODY COMPOSITION AND STRENGTH ON URINARY INCONTINENCE IN WOMEN FROM THE HEALTH ABC STUDY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | - L. Subak
- UCSF, San Francisco, California,
| | | | | | | | - A. Huang
- UCSF, San Francisco, California,
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Cameron A, Suskind A, Neer C, Hussain H, Montgomery J, Latini J, DeLancey J. MP12-09 FUNCTIONAL AND ANATOMICAL DIFFERENCES BETWEEN CONTINENT AND INCONTINENT MEN POST RADICAL PROSTATECTOMY ON URODYNAMICS AND 3T MRI. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Schroeck F, Kaufman S, Jacobs B, Skolarus T, Hollingsworth J, Miller D, Suskind A, Hollenbeck B. 424 REGIONAL VARIATION IN THE QUALITY OF PROSTATE CANCER CARE. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.1814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Suskind A, Bernstein B, Murphy-Setzko M. 1014 PATIENT-PERCEIVED OUTCOMES OF THE ADVANCE SLING UP TO 40 MONTHS POST PROCEDURE. J Urol 2011. [DOI: 10.1016/j.juro.2011.02.1048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Suskind A, Hayner-Buchan A, Feustel PJ, Kogan BA. Fibrosis correlates with detailed histological analysis of human undescended testes. BJU Int 2008; 101:1441-5. [DOI: 10.1111/j.1464-410x.2007.07406.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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