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Imran N, Ayesh A, Workeneh B, Shahait A. Sodium Bicarbonate: Use and Misuse in Clinical Medicine. Am J Ther 2024:00045391-990000000-00186. [PMID: 38657126 DOI: 10.1097/mjt.0000000000001709] [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: 04/26/2024]
Affiliation(s)
- Nashat Imran
- Nephrology Division, Internal Medicine Department, Wayne State University School of Medicine, Detroit, MI
| | - Ali Ayesh
- Nephrology Division, Internal Medicine Department, Wayne State University School of Medicine, Detroit, MI
| | - Biruh Workeneh
- Division of Nephrology, Baylor College of Medicine, Houston, TX
| | - Awni Shahait
- School of Medicine, Department of Surgery, Southern Illinois University, Carbondale, IL
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Bria J, Shahait A, Nagle L, White M, Tarras S. No Association of Blood Alcohol Concentration on Burn Patient Outcomes. J Surg Res 2024; 296:766-771. [PMID: 38377703 DOI: 10.1016/j.jss.2024.01.038] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 01/09/2024] [Accepted: 01/18/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Alcohol abuse is common among burn patients. Burn patients under the influence of alcohol are at risk for developing organ failure, prolonged hospital duration, and increased intensive care unit (ICU) resources. Our study aims to analyze the association between presenting alcohol levels and the outcomes of burn patients. METHODS A retrospective analysis of admitted burn patients was performed from 2016 to 2021. Patients were divided into two groups based on blood alcohol content (BAC), low (<80), and high (≥80) mg/dL. Data included demographics, comorbidities, and outcomes. Univariate analyses were performed, and a P value <0.05 was significant. RESULTS A total of 197 patients were included (32.5% females, mean age 47.2 ± 15.2, 26.9% smokers, 28.4% illegal drug abuse, and 56.3% no comorbidities). Mortality was 7.6%, morbidity 20.8%, 39.1% required burn ICU admission, and 25.9% were intubated. When comparing BAC groups, we found no differences in demographics, comorbidities, inhalational injury incidence, carbon monoxide level, intubation, or burn ICU admission rates. The high-BAC group had longer ventilator days (high BAC 16.7 ± 19.3 versus low BAC 7.5 ± 9.1, P = 0.026) and longer stays in the ICU (18.6 ± 21.8 versus 10.7 ± 15.4, P = 0.075). The low-BAC group had more 3rd-degree burn percentage (5.0 ± 15.3 versus 15.4 ± 27.5, P = 0.024). Both morbidity and in-house mortality rates were similar for both groups (23.8% versus 16.0%, P = 0.192, and 6.6% versus 9.3%, P = 0.476, respectively). CONCLUSIONS Burn patients with higher BAC had significantly longer mechanical ventilator days. However, higher alcohol concentrations had no association with regard to mortality, overall length of stay, or complication rates.
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Affiliation(s)
- Justin Bria
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Awni Shahait
- Department of Surgery, Southern Illinois University School of Medicine, Carbondale, Illinois
| | - Luz Nagle
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Michael White
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Samantha Tarras
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan.
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Shahait A, Pearl A, Saleh KJ. Outcomes of Colectomy in United States Veterans With Cirrhosis: Predicting Outcomes Using Nomogram. J Surg Res 2024; 293:570-577. [PMID: 37832308 DOI: 10.1016/j.jss.2023.09.055] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/05/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION With growing incidence of liver cirrhosis worldwide, there is more need for a risk assessment tool to aid in perioperative management of cirrhotic patients undergoing colorectal procedures. We aim to assess the association of open (OC) versus laparoscopic (LC) approach with colorectal procedures' outcomes and develop an easy-to-use nomogram to predict outcomes. METHODS We analyzed the Veterans Affairs Surgical Quality Improvement Program to identify all patients with cirrhosis and ascites who underwent colorectal procedures from 2008 to 2015. Model for End-stage Liver Disease score was calculated as well as five-items modified frailty index. The chi-square test was utilized to analyze categorical variables. Two-sided unpaired Student's t-test or Mann-Whitney U-test were used for numerical variables as appropriate. Multivariate logistic regression adjusting for demographics, comorbidities, and other preoperative factors was used to analyze postoperative outcomes. A predictive nomogram was constructed and internally validated. RESULTS A total of 731 patients were identified. Overall, complications occurred in 48.2% of patients, and 30-d mortality was 24.8%, with 57.5% were performed emergently. Malignant neoplasm was the most common indication (25.4%). LC was performed in 22.4%, with shorter operative time, less blood transfusions, shorter length of stay, and lower morbidity compared to OC. Overall, Model for End-stage Liver Disease score was an independent factor of mortality, while laparoscopic approach had a protective effect on morbidity. An easy-to-use nomogram was generated for morbidity and 30-d mortality with calculated area under cure of 74.5% and 77.9%, respectively, indicating reliability. CONCLUSIONS Although colectomy is a high-risk operation in cirrhotic veterans, LC may have favorable outcomes than OC in selected patients. An easy-to-use nomogram to predict morbidity and mortality for cirrhotic patients undergoing colectomy is proposed.
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Affiliation(s)
- Awni Shahait
- Departement of Surgery, Southern Illinois University School of Medicine, Carbondale, Illinois; Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, Michigan.
| | - Adam Pearl
- Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, Michigan
| | - Khaled J Saleh
- Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, Michigan
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Shahait A, Mesquita-Neto JWB, Weaver D, Mostafa G. Outcomes of umbilical hernia repair in cirrhotic veterans: a VASQIP study. Langenbecks Arch Surg 2023; 408:246. [PMID: 37358646 DOI: 10.1007/s00423-023-02984-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/14/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE Umbilical hernia repair (UHR) in cirrhotics with ascites is a challenging problem associated with increased morbidity and mortality. This study examines the outcomes of UHR in veterans, comparing those undergoing elective versus emergent repair. METHODS VASQIP was queried for all UHRs during the period 2008-2015. Data collection included demographics, operative details, Model for End-stage Liver Disease (MELD) score, and postoperative outcomes. Univariate and multivariate regression analyses were performed, and a p value of ≤ 0.05 was considered significant. RESULTS A total of 383 patients were included in the analysis. Overall, mean age was 58.9, 99.0% were males, mean body mass index (BMI) was 26.7 kg/m2, 98.2% had American Society of Anesthesiologists (ASA) classification ≥ III, and 87.7% had independent functional status. More than 1/3 the patients underwent emergent UHR (37.6%). Compared with the elective UHR group, who underwent emergent repair were older, more likely to be functionally dependent, higher MELD score. Hypoalbuminemia, emergency repair and MELD score were found to be independent predictors of poor outcomes. CONCLUSION UHR in cirrhotic veterans has worse outcomes when performed emergently. Diagnosis should be followed by medical optimization and elective repair, rather than waiting for an emergent indication in > 1/3 of patients.
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Affiliation(s)
- Awni Shahait
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Medical Center, 6C, University Health Center, 4201 St. Antoine, Detroit, MI, 48201, USA.
- Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA.
| | - Jose Wilson B Mesquita-Neto
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Medical Center, 6C, University Health Center, 4201 St. Antoine, Detroit, MI, 48201, USA
- Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA
| | - Donald Weaver
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Medical Center, 6C, University Health Center, 4201 St. Antoine, Detroit, MI, 48201, USA
- Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA
| | - Gamal Mostafa
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Medical Center, 6C, University Health Center, 4201 St. Antoine, Detroit, MI, 48201, USA
- Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA
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Almufarrej F, Shahait A, Nava G. Assessing the Validity and Reliability of the Zwisch Scale in Plastic Surgery Residency. Plast Reconstr Surg 2022; 151:699e-700e. [PMID: 36729712 DOI: 10.1097/prs.0000000000010025] [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: 02/03/2023]
Abstract
BACKGROUND The Zwisch scale is a recognized model for assessing surgical skills competency and autonomy, with paucity of its application in plastic surgery field. We look to assess the validity of utilizing this model for plastic surgery residency programs. METHODS This 6-month pilot study was a prospective study with attending surgeons from 3 different teaching hospitals. Two samples were obtained. The first sample contained all procedures performed by a participating faculty member and resident during a specified time period. The second sample was a subset of the first consisting of 15 procedures. The procedures were observed in person by 2 additional surgeons who rated the resident's performance leveraging the Zwisch scores. A third surgeon utilized the operative skill assessment tool- Ottawa Surgical Competency OR Evaluation (O-SCORE) to provide ratings. All ratings were confidential. RESULTS Six residents and 5 attendings participated with a total number of 126 encounters for 184 procedures. The association between the Q1 (complexity of procedure- easiest, average, hardest) and Q2 (Zwisch level) was estimated with Spearman's correlation and tested using Chi-square test. ICC and Spearman's rank correlation coefficient demonstrated validity of the Zwisch scores in plastic surgery procedures with good reliability amongst attending surgeons with resident self-rating decreased score reliability (ICC Without self-rating 0.817, with self-rating 0.752). CONCLUSION Plastic surgery cases are often more complex and have longer operative times making it difficult to evaluate residents. This research substantiates developing a specifically modified Zwisch scoring system for plastic surgery.
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Affiliation(s)
- Faisal Almufarrej
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Medical Center, Detroit, MI
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Shahait A, Saleh K, Weaver D, Mostafa G. Two Decades' Outcomes and Trends of Adrenalectomy for Benign Pathologies in Veterans. Surg Laparosc Endosc Percutan Tech 2022; 32:736-740. [PMID: 36130717 DOI: 10.1097/sle.0000000000001098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/26/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Since the introduction of laparoscopic adrenalectomy (LA) in 1992, it has become the standard of care for most adrenal benign pathologies. This study compares the outcomes and trends of open (OA) versus LA in veterans for benign pathologies. METHODS Veterans Affairs Surgical Quality Improvement Program was queried for adrenalectomies performed for benign pathologies during the period 2000-2019. Data collection included demographics, comorbidities, operative details, and postoperative outcomes. RESULTS A total of 1683 patients were included (91.4% males, mean age 59.6, mean body mass index 31.2, and 87.2% with American Society of Anesthesiologists class≥III). Overall, the mean operative time (OT) was 3.2 hours, the majority performed by general surgeons (71.4%), and the mean length of stay (LOS) was 4.1 days. There were 12 (0.7%) 30-day mortalities, and 162 patients (8.8%) developed ≥1 complication. LA was performed in 70.9% (1306), with the conversion rate of 0.85% (10). When compared with OA, patients with the laparoscopic approach were functionally independent, shorter OT, less intraoperative blood transfusion, shorter LOS, and lower mortality and morbidity. Dependent functional status, congestive heart failure, American Society of Anesthesiologists class ≥III, and smoking were independent predictors of mortality, whereas intraoperative transfusions, chronic obstructive pulmonary disease, and dependent functional status were predictors of morbidity. Trend analysis showed an 8-fold increase in the use of LA. However, trend analysis for morbidity and mortality rates showed no significant change for both approaches. CONCLUSION LA is being well adopted in the veterans affairs system with an 8-fold increase over 20 years, with lower morbidity and mortality compared with the open approach for benign adrenal pathologies.
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Affiliation(s)
- Awni Shahait
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Medical Center
- Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI
| | - Khaled Saleh
- Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI
| | - Donald Weaver
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Medical Center
| | - Gamal Mostafa
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Medical Center
- Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI
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Shahait A, Odisho T, Alshare B, Alghanem LJ, Weaver D. An Unusual Cause of Adrenal Mass in Neurofibromatosis Type 1: Malignant Peripheral Nerve Sheath Tumor. Cureus 2022; 14:e21782. [PMID: 35251852 PMCID: PMC8890766 DOI: 10.7759/cureus.21782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
A malignant peripheral nerve sheath tumor (MPNST) is an aggressive tumor that can arise from the malignant transformation of benign neurofibromas in patients with neurofibromatosis type 1 (NF1). MPNST occurs in 2% of patients with NF1, contributing to significant mortality in these patients. Here, we report the case of a 67-year-old female with a known history of neurofibromatosis type 1 who was referred to general surgery after the discovery of a large left-sided adrenal mass on CT imaging five months earlier. Lab workup revealed elevated urine catecholamines, concerning pheochromocytoma. As pheochromocytoma is also common in those with NF-1, appropriate medical management followed by surgical resection was performed. The final pathology report revealed an MPNST.
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Odisho T, Joseph S, Shahait A, Choi-Kim L, McGee J, Kim S. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac138. [PMID: 35495083 PMCID: PMC9048657 DOI: 10.1093/jscr/rjac138] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 03/14/2022] [Indexed: 11/25/2022] Open
Abstract
Pancreatic cancer has a low survival rate even after ostensible complete resection, and treatment for recurrence is usually only palliative. However, rare solitary metastasis can occur and may be operable. In this report, we describe such a case and review the literature on metastasectomy for pancreatic adenocarcinoma. A 66-year-old female underwent Whipple procedure at our institution in 2014 for a pT3N0 pancreatic adenocarcinoma. A slowly growing umbilical mass was noted 6 years later with concomitant rise in her CA 19-9 levels. CT-guided biopsy of her abdominal wall mass confirmed a well-differentiated adenocarcinoma consistent with her primary pancreatic cancer. The patient underwent metastasectomy of the isolated abdominal wall mass, with negative margins. She received no further postoperative treatment. The patient remains disease and symptom-free over 18 months after resection of the metastasis. In highly selected cases of pancreatic adenocarcinoma, resection of solitary metastasis may be therapeutic.
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Affiliation(s)
- Tanya Odisho
- Correspondence address. Department of Surgery, Detroit Medical Center, Sinai Grace Hospital, 6071 Outer Dr. W, Detroit, MI 48235, USA. E-mail:
| | - Stephanie Joseph
- Department of Surgery, Detroit Medical Center, Detroit, MI, USA
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Awni Shahait
- Department of Surgery, Detroit Medical Center, Detroit, MI, USA
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Lydia Choi-Kim
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Oncology, Karmanos Cancer Institute, Detroit, MI, USA
| | - Jessica McGee
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Steve Kim
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Oncology, Karmanos Cancer Institute, Detroit, MI, USA
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Shahait A, Qadeer AF, Hasnain MR, Baldawi M, Gruber SA, Weaver D, Mostafa G. Hartmann's Reversal Outcomes: a VASQIP Study. J Gastrointest Surg 2021; 25:539-541. [PMID: 32968932 DOI: 10.1007/s11605-020-04807-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/15/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Awni Shahait
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit, MI, USA.,Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI, USA
| | - Afreen Fatma Qadeer
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Mohanad Baldawi
- Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI, USA
| | - Scott A Gruber
- Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI, USA
| | - Donald Weaver
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Gamal Mostafa
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit, MI, USA. .,Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI, USA.
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Shahait A, Mesquita-Neto JWB, Hasnain MR, Baldawi M, Girten K, Weaver D, Saleh KJ, Gruber SA, Mostafa G. Outcomes of cholecystectomy in US veterans with cirrhosis: Predicting outcomes using nomogram. Am J Surg 2020; 221:538-542. [PMID: 33358373 DOI: 10.1016/j.amjsurg.2020.12.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/16/2020] [Accepted: 12/17/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study examines the outcomes of open and laparoscopic cholecystectomy (OC/LC) in veterans with cirrhosis and develops a nomogram to predict outcomes. METHODS We analyzed the Veterans Affairs Surgical Quality Improvement Program to identify all patients with cirrhosis and ascites who underwent cholecystectomy from 2008 to 2015. Univariate and multivariate regression were used to identify predictors of morbidity and mortality. A predictive nomogram was constructed and internally validated. RESULTS A total of 349 patients were identified. Overall, complications occurred in 18.7% of patients, and mortality was 3.8%. LC was performed in 58.9%, and 19.2% were preformed emergently. Overall, Model for End-Stage Liver Disease score was an independent factor of morbidity and mortality, while laparoscopic approach had a protective effect on morbidity. CONCLUSIONS Although cholecystectomy is a high-risk operation in cirrhotic veterans, LC may have favorable outcomes than OC in selected patients. An easy-to-use nomogram to predict morbidity and mortality for cirrhotic patients undergoing cholecystectomy is proposed.
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Affiliation(s)
- Awni Shahait
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Medical Center, Detroit, MI, USA; Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA.
| | - Jose Wilson B Mesquita-Neto
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Medical Center, Detroit, MI, USA; Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA
| | | | - Mohanad Baldawi
- Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA
| | - Kara Girten
- Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA
| | - Donald Weaver
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Medical Center, Detroit, MI, USA; Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA
| | - Khaled J Saleh
- Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA
| | - Scott A Gruber
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Medical Center, Detroit, MI, USA; Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA
| | - Gamal Mostafa
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Medical Center, Detroit, MI, USA; Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA
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Kong J, Shahait A, Girten K, Baldawi M, Hasnain MR, Saleh KJ, Gruber SA, Weaver D, Mostafa G. Recent trends in cholecystectomy in US veterans. Surg Endosc 2020; 35:5558-5566. [PMID: 33025254 DOI: 10.1007/s00464-020-08056-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION We hypothesize that the recent trend in performing cholecystectomy in US Veterans shows wide adoption of the laparoscopic technique and improvement in the outcome following both laparoscopic (LC) and open cholecystectomy (OC). This study utilizes the Veterans Affairs Surgical Quality Improvement Program database to examine the status and outcome of cholecystectomy. METHODS A retrospective review of veterans who underwent cholecystectomy between 2008 and 2015 was performed. Data analysis included patient demographics, operations, and postoperative outcomes. Cochran-Armitage trend analysis was used to assess significant changes in outcome over the study period. p ≤ 0.05 was considered significant. RESULTS A total of 40,722 patients (average age of 61 years) were included in the study (males 85.6%). LC was performed in the majority of patients (86.4%). Patients in the OC group (13.6%) were more likely to have advanced age (≥ 65 years) (47.6% vs 32.0%, p < 0.001) and higher ASA class (III-V) (81.9% vs 65.4%, p < 0.001) than those in the LC group. Compared with LC, OC had higher mortality rates at 30 days (1.3% vs 0.3%; OR = 1.6, p = 0.03), 3 months (2.6% vs 0.7%; OR = 1.7, p < 0.001), 6 months (3.9% vs 1.1%; OR = 1.5, p < 0.001) and 1 year (5.7% vs 2.0%; OR = 1.5, p < 0.001); higher rates of morbidity, including pneumonia (OR = 1.9, p < 0.001), deep venous thrombosis (OR = 2.4, p = 0.02), reoperation (OR = 1.8, p < 0.001), and superficial (OR = 4.9, p < 0.001) and deep (OR = 1.5, p = 0.01) surgical site infections; and a longer length of stay (6.5 days vs 2.6 days, p < 0.001). Trend analysis showed a significant decrease in both mortality (p = 0.02) and morbidity (p < 0.001) for LC over the study period, but no improvement in mortality (p = 0.35) and a only a minimal improvement in morbidity (p = 0.04) for OC. CONCLUSION In the recent era, LC has been widely performed in the VA with significant improvement in outcome. Efforts are needed to adopt alternative approaches to planned OC and to improve postoperative outcomes.
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Affiliation(s)
- Joshua Kong
- Michael and Marian Ilitch Department of Surgery, Wayne State University/Detroit Medical Center, 6C, University Health Center, 4201 St. Antoine, Detroit, MI48201, USA.,Department of Surgery, John D. Dingell Veteran Affairs Medical Center, Detroit, MI, 48201, USA
| | - Awni Shahait
- Michael and Marian Ilitch Department of Surgery, Wayne State University/Detroit Medical Center, 6C, University Health Center, 4201 St. Antoine, Detroit, MI48201, USA.,Department of Surgery, John D. Dingell Veteran Affairs Medical Center, Detroit, MI, 48201, USA
| | - Kara Girten
- Department of Surgery, John D. Dingell Veteran Affairs Medical Center, Detroit, MI, 48201, USA
| | - Mohanad Baldawi
- Department of Surgery, John D. Dingell Veteran Affairs Medical Center, Detroit, MI, 48201, USA
| | - Mustafa Rashad Hasnain
- Department of Surgery, John D. Dingell Veteran Affairs Medical Center, Detroit, MI, 48201, USA
| | - Khaled J Saleh
- Department of Surgery, John D. Dingell Veteran Affairs Medical Center, Detroit, MI, 48201, USA
| | - Scott A Gruber
- Michael and Marian Ilitch Department of Surgery, Wayne State University/Detroit Medical Center, 6C, University Health Center, 4201 St. Antoine, Detroit, MI48201, USA.,Department of Surgery, John D. Dingell Veteran Affairs Medical Center, Detroit, MI, 48201, USA
| | - Donald Weaver
- Michael and Marian Ilitch Department of Surgery, Wayne State University/Detroit Medical Center, 6C, University Health Center, 4201 St. Antoine, Detroit, MI48201, USA
| | - Gamal Mostafa
- Michael and Marian Ilitch Department of Surgery, Wayne State University/Detroit Medical Center, 6C, University Health Center, 4201 St. Antoine, Detroit, MI48201, USA. .,Department of Surgery, John D. Dingell Veteran Affairs Medical Center, Detroit, MI, 48201, USA.
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Mesquita-Neto JWB, Cmorej P, Shahait A, Kim S, Weaver DW, Macedo FIB. Effect of Hospital Volume and Regionalization of Care in Patients Undergoing Pancreatic Cancer Resection: A Propensity-Score Matched Analysis. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mahafza WS, Manzalawi KA, Gharaibeh AA, Khayat OW, Shahait A, Juweid ME. Diagnosis of mesenteric panniculitis in the multi-detector computed tomography era. Association with malignancy and surgical history. Saudi Med J 2018; 38:1013-1018. [PMID: 28917065 PMCID: PMC5694634 DOI: 10.15537/smj.2017.10.20163] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES To assess the prevalence and associations of mesenteric panniculitis (MP) using multi-detector CT (MDCT). METHODS This retrospective study included 4758 consecutive patients who underwent abdomino-pelvic MDCT between January 2012 and December 2014 at Jordan University Hospital, Amman, Jordan. Radiological database was searched for MP diagnosis and patients with suspected MP were re-evaluated by an experienced radiologist to confirm the diagnosis. Data on all patients with confirmed MP diagnosis were subsequently collected and analyzed. RESULTS Computed tomography features of MP were identified in 90 patients (41 males, 49 females), a prevalence of 1.9%. Mesenteric panniculitis was identified in both asymptomatic and symptomatic patients. Malignancy was found in 28 MP patients (31%) and 44 of the MP patients (49%) had prior history of abdomino-pelvic surgery. Mesenteric panniculitis was significantly more frequently associated with prior abdomino-pelvic surgery (p=0.0001) and the likelihood of associated malignancy in patients with MP was 2.1-fold higher than in patients without MP (p=0.0013). Conclusion: Mesenteric panniculitis can be reliably diagnosed by MDCT due to its typical CT appearance. Its identification is important because of its significant association with malignancy and because it represents one of the differential diagnoses in patients with nonspecific symptoms referred for abdomino-pelvic CT.
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Affiliation(s)
- Waleed S Mahafza
- Diagnostic Radiology Department, The Jordan University Hospital, Amman, Jordan. E-mail.
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