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Monreal A, Eze AN, Kazaure HS. Presentation and management of medullary thyroid cancer by sex and race/ethnicity in the United States-A state of disunion. Am J Surg 2024:S0002-9610(24)00229-0. [PMID: 38644135 DOI: 10.1016/j.amjsurg.2024.04.012] [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] [Received: 04/02/2024] [Revised: 04/06/2024] [Accepted: 04/10/2024] [Indexed: 04/23/2024]
Affiliation(s)
- Alberto Monreal
- Division of Surgical Oncology, Department of Surgery, Duke University, Durham, NC, USA
| | - Anthony N Eze
- Division of Surgical Oncology, Department of Surgery, Duke University, Durham, NC, USA
| | - Hadiza S Kazaure
- Division of Surgical Oncology, Department of Surgery, Duke University, Durham, NC, USA.
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Frisco NA, Gunn AH, Thomas SM, Stang MT, Scheri RP, Kazaure HS. Medullary thyroid cancer with RET V804M mutation: more indolent than expected? Surgery 2023; 173:260-267. [PMID: 36150924 DOI: 10.1016/j.surg.2022.05.005] [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] [Received: 02/21/2022] [Revised: 04/19/2022] [Accepted: 05/03/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Significant genotype-phenotype variability among multiple endocrine neoplasia type 2A patients with a RET V804M mutation has been reported. METHODS Patients with a RET V804M mutation treated at a single center were identified (January 1996-December 2020). The baseline characteristics, operative details, pathology, biochemical, and long-term data were analyzed. RESULTS There were 79 patients; none developed pheochromocytoma or hyperparathyroidism or died in the study period. The mean age was 41.5 years (range = 1.0-81.0 years); 46.8% were men. Of 68 surgical patients, 53 (77.9%) underwent total thyroidectomy and 15 (22.1%) underwent total thyroidectomy with central neck dissection with or without lateral neck dissection. Twenty-four patients had elevated preoperative calcitonin, of whom 12 underwent total thyroidectomy (median = 7.5; range = 5.0-237.0 pg/mL), 10 underwent total thyroidectomy + central neck dissection (median = 27.6; range = 5.1-147.0 pg/mL), and 2 underwent total thyroidectomy + central neck dissection + lateral neck dissection (median = 3182.0; range = 361.0-6003.0 pg/mL). Pathology was benign (27.9%), papillary thyroid cancer alone (1.5%), C-cell hyperplasia (23.5%), and medullary thyroid cancer (47.1%; median tumor size = 3.0 mm). Three patients had elevated calcitonin postoperatively (median follow-up time = 60.0 months). In adjusted modeling, a preoperative calcitonin >5 pg/mL was associated with having medullary thyroid cancer on final pathology (odds ratio = 13.3; 95% confidence interval, 3.2-56.3; P < .001). CONCLUSION In this large United States cohort of surgical patients with a RET V804M mutation, most had indolent disease and were without classic multiple endocrine neoplasia type 2A features. Calcitonin >5 pg/mL may serve as a meaningful value to guide surveillance and timing of surgery.
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Affiliation(s)
- Nicholas A Frisco
- Department of Surgery, Duke University Medical Center, Durham, NC; Duke University School of Medicine, Durham, NC
| | - Alexander H Gunn
- Department of Surgery, Duke University Medical Center, Durham, NC; Duke University School of Medicine, Durham, NC
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University Medical Center, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC
| | - Michael T Stang
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Randall P Scheri
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Hadiza S Kazaure
- Department of Surgery, Duke University Medical Center, Durham, NC.
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Sag AA, Perkins JM, Kazaure HS, Stang MT, Rocke DJ, Collins A, Choe JH, Scheri RP. Salvage Cryoablation for Local Recurrences of Thyroid Cancer Inseparable from the Trachea and Neurovascular Structures. J Vasc Interv Radiol 2023; 34:54-62. [PMID: 36220608 DOI: 10.1016/j.jvir.2022.10.001] [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] [Received: 01/24/2022] [Revised: 04/17/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To demonstrate safety, feasibility, and effectiveness of cryoablation of recurrent papillary thyroid cancer ineligible for reoperation because of scarring, eligible for focal ablation as defined within 2015 American Thyroid Association guideline sections C16 and C17. MATERIALS AND METHODS With multidisciplinary consensus, cryoablation was performed with curative intent for 15 tumors in 10 patients between January 2019 and July 2021. Demographics, procedural details, and serial postprocedural imaging findings were analyzed. RESULTS The mean age was 72.5 years (range, 57-88 years), and 80% of the patients were women. The tumors (mean size, 16 mm ± 6; range, 9-29 mm) received 1 session of cryoablation with 100% technical success. The mean and median postcryoablation tumor volumetric involution rates were 88% and 99%, respectively, with 9 (60%) of 15 tumors involuting completely or down to the scar and 6 (40%) involuting partially at the end of the study period. Tumor size did not increase after cryoablation (0% local progression rate). All tumors abutted the trachea, skin, and/or vascular structures, and hydrodissection failed in all cases because of scarring. The major adverse event rate was 20% (3/15), with 2 cases of voice change and 1 case of Horner syndrome; all resolved at 6 months with no permanent sequelae. No vascular, tracheal, dermal, or infectious adverse events occurred during a mean follow-up of 242 days (range, 114-627 days). One patient died at 386 days after cryoablation because of unrelated cholangiocarcinoma. CONCLUSIONS Cryoablation of local recurrences of papillary thyroid cancer abutting the trachea and/or neurovascular structures in the setting of hydrodissection failure because of scarring yielded a mean volumetric involution of 88%, primary efficacy of 60%, and objective response rate of 100% with no local recurrences or permanent complications during a mean follow-up of 242 days. The secondary efficacy and longer-term outcomes remain forthcoming.
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Affiliation(s)
- Alan Alper Sag
- Division of Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, North Carolinia.
| | - Jennifer M Perkins
- Division of Endocrinology, University of California San Francisco Medical Center, San Francisco, California
| | - Hadiza S Kazaure
- Section of Endocrine Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Michael T Stang
- Section of Endocrine Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Daniel J Rocke
- Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina
| | - Alissa Collins
- Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina
| | - Jennifer H Choe
- Division of Hematology and Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Randall P Scheri
- Section of Endocrine Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Hsiao V, Kazaure HS, Drake FT, Inabnet WB, Rosen JE, Davenport DL, Schneider DF. A comparison of NSQIP and CESQIP in data quality and ability to predict thyroidectomy outcomes. Surgery 2023; 173:215-225. [PMID: 36402607 DOI: 10.1016/j.surg.2022.05.046] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/22/2022] [Accepted: 05/14/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Collaborative Endocrine Surgery Quality Improvement Program tracks thyroidectomy outcomes with self-reported data, whereas the National Surgical Quality Improvement Program uses professional abstractors. We compare completeness and predictive ability of these databases at a single-center and national level. METHOD Data consistency in the Collaborative Endocrine Surgery Quality Improvement Program and the National Surgical Quality Improvement Program at a single institution (2013-2020) was evaluated using McNemar's test. At the national level, data from the Collaborative Endocrine Surgery Quality Improvement Program and the National Surgical Quality Improvement Program (2016-2019) were used to compare predictive capability for 4 outcomes within each data source: thyroidectomy-specific complication, systemic complication, readmission, and reoperation, as measured by area under curve. RESULTS In the single-center analysis, 66 cases were recorded in both the Collaborative Endocrine Surgery Quality Improvement Program and the National Surgical Quality Improvement Program. The reoperation variable had the most discrepancies (2 vs 0 in the National Surgical Quality Improvement Program versus the Collaborative Endocrine Surgery Quality Improvement Program, respectively; χ2 = 2.00, P = .16). At the national level, there were 24,942 cases in the National Surgical Quality Improvement Program and 17,666 cases in the Collaborative Endocrine Surgery Quality Improvement Program. In the National Surgical Quality Improvement Program, 30-day thyroidectomy-specific complication, systemic complication, readmission, and reoperation were 13.25%, 2.13%, 1.74%, and 1.39%, respectively, and in the Collaborative Endocrine Surgery Quality Improvement Program 7.27%, 1.95%, 1.64%, and 0.81%. The area under curve of the National Surgical Quality Improvement Program was higher for predicting readmission (0.721 [95% confidence interval 0.703-0.737] vs 0.613 [0.581-0.649]); the area under curve of the Collaborative Endocrine Surgery Quality Improvement Program was higher for thyroidectomy-specific complication (0.724 [0.708-0.737] vs 0.677 [0.667-0.687]) and reoperation (0.735 [0.692-0.775] vs 0.643 [0.611-0.673]). Overall, 3.44% vs 27.22% of values were missing for the National Surgical Quality Improvement Program and the Collaborative Endocrine Surgery Quality Improvement Program, respectively. CONCLUSION The Collaborative Endocrine Surgery Quality Improvement Program was more accurate in predicting thyroidectomy-specific complication and reoperation, underscoring its role in collecting granular, disease-specific variables. However, a higher proportion of data are missing. The National Surgical Quality Improvement Program infrastructure leads to more rigorous data capture, but the Collaborative Endocrine Surgery Quality Improvement Program is better at predicting thyroid-specific outcomes.
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Affiliation(s)
- Vivian Hsiao
- Department of Surgery, University of Wisconsin-Madison, Madison, WI.
| | - Hadiza S Kazaure
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Frederick T Drake
- Department of Endocrine Surgery, Boston Medical Center, Boston, Massachusetts
| | | | | | | | - David F Schneider
- Department of Surgery, University of Wisconsin-Madison, Madison, WI; Division of Endocrine Surgery, University of Wisconsin-Madison, Madison, WI
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Melucci AD, Liu JB, Brajcich BC, Collins CE, Kazaure HS, Ko CY, Pusic AL, Temple LK. Scaling and spreading the electronic capture of patient-reported outcomes using a national surgical quality improvement programme: a feasibility study protocol. BMJ Open Qual 2022; 11:e001909. [PMID: 36375858 PMCID: PMC9664302 DOI: 10.1136/bmjoq-2022-001909] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 10/28/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Patient-reported outcomes (PROs) are important for research, patient care and quality assessment; however, large-scale collection among the US surgical patient population has been limited. A structured implementation and dissemination programme focused on electronic PRO collection could improve the use of PROs data to improve surgical care. This study aims to (1) evaluate the feasibility of PRO collection among a larger volume of surgical patients through the stepwise implementation of PRO collection processes in a sample of American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) hospitals; (2) identify best practices and barriers to PRO collection through qualitative study of participating hospitals and patients; and (3) evaluate the utility of PROs at detecting differences in the quality of care among surgical patients. METHODS AND ANALYSIS ACS NSQIP-participating hospitals are being recruited, and patients at participating hospitals who undergo elective surgical procedures receive invitations via e-mail or short message service 'text'message to complete PROs after surgery. Validated PRO measures which evaluate physical and mental health-related quality of life, pain, fatigue, physical function and shared decision-making were selected. The scalability of PRO collection will be assessed by site enrolment, patient accrual and response rates. Qualitative interviews and focus groups will be performed with patients and hospital personnel to identify best practices and barriers to successful enrolment and PRO collection. Multivariable hierarchical regression models will be used to evaluate the distinctness of PROs from clinical outcomes captured in ACS NSQIP and the ability of PROs to detect differences in hospital performance. ETHICS AND DISSEMINATION This study was reviewed by the Advarra Institutional Review Board (IRB) and deemed to be exempt from IRB oversight. Findings will be disseminated through peer-reviewed manuscripts, reports and presentations.
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Affiliation(s)
- Alexa D Melucci
- Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Jason B Liu
- Department of Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Brian C Brajcich
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Northwestern Medicine, Chicago, Illinois, USA
| | - Courtney E Collins
- Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Hadiza S Kazaure
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Clifford Y Ko
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois, USA
- Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Andrea L Pusic
- Department of Surgery, Brigham Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Larissa K Temple
- Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
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6
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Kazaure HS, McDonald SR, Lagoo-Deenadayalan SA. A Sobering Tale of Missed Opportunities for Advance Care Planning-Now Is the Time for Action. JAMA Surg 2022; 157:e223693. [PMID: 36001308 DOI: 10.1001/jamasurg.2022.3693] [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: 11/14/2022]
Affiliation(s)
- Hadiza S Kazaure
- Division of Surgical Oncology, Department of Surgery, Duke University, Durham, North Carolina
| | - Shelley R McDonald
- Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Durham VA Health Care System, Durham, North Carolina
| | - Sandhya A Lagoo-Deenadayalan
- Division of Surgical Oncology, Department of Surgery, Duke University, Durham, North Carolina.,Durham VA Health Care System, Durham, North Carolina
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Abstract
Background: Graves' disease accounts for ∼80% of all cases of hyperthyroidism and is associated with significant morbidity and decreased quality of life. Understanding the association of total thyroidectomy with patient-reported quality-of-life and thyroid-specific symptoms is critical to shared decision-making and high-quality care. We estimate the change in patient-reported outcomes (PROs) before and after surgery for patients with Graves' disease to inform the expectations of patients and their physicians. Methods: PROs using the MD Anderson Symptom Inventory (MDASI) validated questionnaire were collected prospectively from adult patients with Graves' disease from January 1, 2015, to November 20, 2020, on a longitudinal basis. Survey responses were categorized as before surgery (≤120 days), short term after surgery (<30 days; ST), and long term after surgery (≥30 days; LT). Negative binomial regression was used to estimate the association of select covariates with PROs. Results: Eighty-five patients with Graves' disease were included. The majority were female (83.5%); 47.1% were non-Hispanic white and 35.3% were non-Hispanic black. The median thyrotropin (TSH) value before surgery was 0.05, which increased to 0.82 in ST and 1.57 in LT. In bivariate analysis, the Total Symptom Burden Score, a composite of all patient-reported burden, significantly reduced shortly after surgery (before surgery mean of 56.88 vs. ST 39.60, p < 0.001), demonstrating improvement in PROs. Furthermore, both the Thyroid Symptoms Score, including patient-reported thermoregulation, palpitations, and dysphagia, and the Quality-of-Life Symptom Score improved in ST and LT (thyroid symptoms, before surgery 13.88 vs. ST 8.62 and LT 7.29; quality of life, before surgery 16.16 vs. ST 9.14 and LT 10.04, all p < 0.05). After multivariate adjustment, the patient-reported burden in the Thyroid Symptom Score and the Quality-of-Life Symptom Score exhibited reduction in ST (thyroid symptoms, rate ratio [RR] 0.55, confidence interval [CI]: 0.42-0.72; quality of life, RR 0.57, CI: 0.40-0.81) and LT (thyroid symptoms, RR 0.59, CI: 0.44-0.79; quality of Life, RR 0.43, CI: 0.28-0.65). Conclusions: Quality of life and thyroid-specific symptoms of Graves' patients improved significantly from their baseline before surgery to both shortly after and longer after surgery. This work can be used to guide clinicians and patients with Graves' disease on the expected outcomes following total thyroidectomy.
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Affiliation(s)
- Alexander H. Gunn
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
- Duke-Margolis Center for Health Policy, Durham, North Carolina, USA
| | - Nicholas Frisco
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Samantha M. Thomas
- Duke University Cancer Institute, Durham, North Carolina, USA
- Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Michael T. Stang
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Randall P. Scheri
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Hadiza S. Kazaure
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
- Address correspondence to: Hadiza S. Kazaure, MD, Department of Surgery, Duke University Medical Center, 466G Seeley Mudd Building, Durham, NC 27710, USA
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8
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Kazaure HS, Truong T, Kuchibhatla M, Lagoo-Deenadayalan S, Wren SM, Johnson KS. Identifying high-risk surgical patients: A study of older adults whose code status changed to Do-Not-Resuscitate. J Am Geriatr Soc 2021; 69:3445-3456. [PMID: 34331702 DOI: 10.1111/jgs.17391] [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] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/02/2021] [Accepted: 07/11/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is a paucity of data on older adults (age ≥65 years) undergoing surgery who had an inpatient do-not-resuscitate (DNR) order, and the association between timing of DNR order and outcomes. METHODS This was a retrospective analysis of 1976 older adults in the American College of Surgeons National Surgical Quality Improvement Program geriatric-specific database (2014-2018). Patients were stratified by institution of a DNR order during their surgical admission ("new-DNR" vs. "no-DNR"), and matched by age (±3 years), frailty score (range: 0-1), and procedure. The main outcome of interest was occurrence of death or hospice transition (DoH) ≤30 postoperative days; this was analyzed using bivariate and multivariable methods. RESULTS One in 36 older adults had a new-DNR order. After matching, there were 988 new-DNR and 988 no-DNR patients. Median age and frailty score were 82 years and 0.2, respectively. Most underwent orthopedic (47.6%), general (37.6%), and vascular procedures (8.4%). Overall DoH rate ≤30 days was 44.4% for new-DNR versus 4.0% for no-DNR patients (p < 0.001). DoH rate for patients who had DNR orders placed in the preoperative, day of surgery, and postoperative setting was 16.7%, 23.3%, and 64.6%, respectively (p < 0.001). In multivariable analysis, compared to no-DNR patients, those with a new-DNR order had a 28-fold higher adjusted odds of DoH (odds ratio [OR] 28.1, 95% confidence interval: 13.0-60.1, p < 0.001); however, odds were 10-fold lower if the DNR order was placed preoperatively (OR: 5.8, p = 0.003) versus postoperatively (OR: 52.9, p < 0.001). Traditional markers of poor postoperative outcomes such as American Society of Anesthesiologists class and emergency surgery were not independently associated with DoH. CONCLUSIONS An inpatient DNR order was associated with risk of DoH independent of traditional markers of poor surgical outcomes. Further research is needed to understand factors leading to a DNR order that may aid early recognition of high-risk older adults undergoing surgery.
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Affiliation(s)
- Hadiza S Kazaure
- Division of Surgical Oncology, Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Tracy Truong
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Sandhya Lagoo-Deenadayalan
- Division of Surgical Oncology, Department of Surgery, Duke University, Durham, North Carolina, USA.,Department of Surgery, Durham VA Health Care System, Durham, North Carolina, USA.,Geriatrics Research Education and Clinical and Clinical Center, Durham, Virginia, USA
| | - Sherry M Wren
- Department of General Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Kimberly S Johnson
- Department of Surgery, Durham VA Health Care System, Durham, North Carolina, USA.,Geriatrics Research Education and Clinical and Clinical Center, Durham, Virginia, USA.,Division of Geriatrics, Department of Medicine, Center for the Study of Aging and Human Development, Center for Palliative Care, Duke University School of Medicine, Durham, North Carolina, USA
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9
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Kazaure HS, Lidsky ME, Lagoo-Deenadayalan SA. If the Patient Is Frail, Emergency Abdominal Surgery Is High Risk. JAMA Surg 2020; 156:74-75. [PMID: 33237280 DOI: 10.1001/jamasurg.2020.5398] [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: 11/14/2022]
Affiliation(s)
- Hadiza S Kazaure
- Division of Surgical Oncology, Department of Surgery, Duke University, Durham, North Carolina
| | - Michael E Lidsky
- Division of Surgical Oncology, Department of Surgery, Duke University, Durham, North Carolina
| | - Sandhya A Lagoo-Deenadayalan
- Division of Surgical Oncology, Department of Surgery, Duke University, Durham, North Carolina.,Durham VA Health Care System, Durham, North Carolina
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Marrero AP, Kazaure HS, Thomas SM, Stang MT, Scheri RP. Patient selection and outcomes of laparoscopic transabdominal versus posterior retroperitoneal adrenalectomy among surgeons in the Collaborative Endocrine Surgery Quality Improvement Program (CESQIP). Surgery 2020; 167:250-256. [DOI: 10.1016/j.surg.2019.03.034] [Citation(s) in RCA: 6] [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] [Received: 02/02/2019] [Revised: 03/06/2019] [Accepted: 03/12/2019] [Indexed: 12/11/2022]
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Abstract
The relationship between operative volume and perioperative outcomes after several oncologic operations is well documented. Recent studies on adrenalectomy reveal a robust association between higher surgeon volume and improved patient outcomes. Statistical analyses have demonstrated that outcomes are improved when surgeons perform at least six adrenalectomies annually; based on this threshold definition of a 'high-volume' surgeon, more than 80% of adrenalectomies in the United States are performed by 'low-volume' surgeons. When compared to low-volume surgeons, high-volume surgeons on average achieve lower rates of postoperative complications and mortality, as well as a shorter length of hospital stay, and lower cost of hospitalization. There does not appear to be a similar association between hospital adrenalectomy volume and improved patient outcomes; however, there is evidence of benefit for the subset of patients with adrenocortical carcinoma. Despite limitations of existing literature, evidence is sufficient to recommend the referral of patients with adrenal tumors to high-volume surgeons.
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Affiliation(s)
- Hadiza S Kazaure
- Department of Surgery, Section of Endocrine Surgery, Duke University Medical Center, Durham, NC, USA
| | - Julie A Sosa
- Department of Surgery, University of California at San Francisco (UCSF), San Francisco, CA, USA.
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12
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Chereau N, Oyekunle TO, Zambeli-Ljepović A, Kazaure HS, Roman SA, Menegaux F, Sosa JA. Predicting recurrence of papillary thyroid cancer using the eighth edition of the AJCC/UICC staging system. Br J Surg 2019; 106:889-897. [PMID: 31012500 DOI: 10.1002/bjs.11145] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 11/09/2018] [Accepted: 01/29/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND The AJCC/UICC classification is widely used for predicting survival in papillary thyroid cancer (PTC), but has not been evaluated as a predictor of recurrence. The hypothesis of this study was that the eighth edition of the AJCC system can be used in this novel way. METHODS All patients in the study underwent surgery for PTC at a high-volume endocrine surgery centre in France between 1985 and 2015. The seventh and eighth editions of the AJCC/UICC staging system for PTC were employed to predict recurrence and disease-specific survival using the Kaplan-Meier and log rank tests. RESULTS Among 4124 patients (79·7 per cent female), median age was 50 (i.q.r. 38-60) years; 3906 patients (94·7 per cent) underwent total thyroidectomy, with lymph node dissection in 2495 (60·5 per cent). The eighth edition of the AJCC/UICC staging system placed 91·8, 7·1, 0·4 and 0·7 per cent of patients in stages I-IV respectively. After reclassifying patients from the seventh to the eighth AJCC/UICC edition, the disease was downstaged in 23·8 per cent. Over a median follow-up of 7 years, 260 patients (6·4 per cent) developed recurrent disease, including 5·2 per cent of patients with stage I, 19·6 per cent with stage II, 59 per cent with stage III and 50 per cent with stage IV disease, according to the eighth edition. The eighth edition was a better predictor of recurrence than the seventh edition. CONCLUSION The eighth edition of the AJCC/UICC staging system appears to be a novel tool for predicting PTC recurrence, which is a meaningful outcome for this indolent disease. The eighth edition can be used to risk-stratify patients, keeping in mind that other molecular and pathological predictive factors must be integrated into the assessment of recurrence risk.
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Affiliation(s)
- N Chereau
- Department of Endocrine and Digestive Surgery, Sorbonne Université, Hospital Pitié Salpêtrière, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - T O Oyekunle
- Duke University School of Medicine, Durham, North Carolina, USA
| | | | - H S Kazaure
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - S A Roman
- Department of Surgery, University of California at San Francisco, San Francisco, California, USA
| | - F Menegaux
- Department of Endocrine and Digestive Surgery, Sorbonne Université, Hospital Pitié Salpêtrière, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - J A Sosa
- Department of Surgery, University of California at San Francisco, San Francisco, California, USA
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13
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Abstract
Surgical hypoparathyroidism is the most common cause of hypoparathyroidism and the result of intentional or inadvertent extirpation, trauma, or devascularization of the parathyroid glands. Surgical hypoparathyroidism may present as a medical emergency. Pediatric patients, those with Graves disease, and those undergoing extensive neck dissections or reoperative neck surgery are at particular risk for this complication. Extensive surgical expertise, immediate or delayed autotransplantation, and prophylactic and postoperative calcium/vitamin D supplementation in select patients are associated with a reduction in the risk of surgical hypoparathyroidism. Intraoperative parathyroid imaging is among novel strategies being investigated to mitigate surgical hypoparathyroidism in the intraoperative setting.
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Affiliation(s)
- Hadiza S Kazaure
- Section of Endocrine Surgery, Department of Surgery, Duke Cancer Institute, Duke University Medical Center, Box 2945, Durham, NC 27710, USA
| | - Julie Ann Sosa
- Department of Surgery, University of California, San Francisco, 513 Parnassus Avenue, Suite S320, Box 0104, San Francisco, CA 94143, USA.
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14
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Abstract
PURPOSE OF REVIEW Patient age at diagnosis is a well established prognostic factor for thyroid cancer survival; it is included in the American Joint Committee on Cancer (AJCC) thyroid cancer-staging system. This review provides an update on the epidemiology, risk stratification, and staging of differentiated thyroid cancer (DTC), in the context of patient age. RECENT FINDINGS In the eighth edition AJCC staging system for DTC, the age cut-point was increased from 45 to 55 years. The appropriate age-cut point remains a subject of debate, as some studies have found a linear association of age and survival, and therefore, questioned the use of an age cut-point in the DTC staging system altogether. Emerging data on the additive role of molecular markers in the compromised survival of older patients with DTC raise the prospect of eventual inclusion of genetic markers in the management of patients and risk-stratification systems. SUMMARY DTC staging is evolving. The pathogenesis of the compromised survival of older patients with DTC is complex, multifactorial, and not well understood. Recent advances in molecular testing are promising. More studies are needed prior to the formal inclusion of molecular markers in the staging system of DTC.
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Affiliation(s)
- Hadiza S Kazaure
- Department of Surgery, Section of Endocrine Surgery, Duke University Medical Center, Durham, North Carolina
| | - Sanziana A Roman
- Department of Surgery, University of California at San Francisco (UCSF), San Francisco, Caifornia, USA
| | - Julie A Sosa
- Department of Surgery, University of California at San Francisco (UCSF), San Francisco, Caifornia, USA
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15
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Minami CA, Sheils CR, Bilimoria KY, Johnson JK, Berger ER, Berian JR, Englesbe MJ, Guillamondegui OD, Hines LH, Cofer JB, Flum DR, Thirlby RC, Kazaure HS, Wren SM, O'Leary KJ, Thurk JL, Kennedy GD, Tevis SE, Yang AD. Process improvement in surgery. Curr Probl Surg 2015; 53:62-96. [PMID: 26806271 DOI: 10.1067/j.cpsurg.2015.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 11/10/2015] [Indexed: 11/22/2022]
Affiliation(s)
- Christina A Minami
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Healthcare Studies in the Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Catherine R Sheils
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, IL; University of Rochester School of Medicine, University of Rochester, Rochester, NY
| | - Karl Y Bilimoria
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Healthcare Studies in the Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Julie K Johnson
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Healthcare Studies in the Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Elizabeth R Berger
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Surgery, Loyola University Medical Center, Maywood, IL
| | - Julia R Berian
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Surgery, University of Chicago Medical Center, Chicago, IL
| | - Michael J Englesbe
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI
| | | | - Leonard H Hines
- Department of Surgery, University of Tennessee College of Medicine, Knoxville, TN
| | - Joseph B Cofer
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, TN
| | - David R Flum
- Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | | | - Hadiza S Kazaure
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA
| | - Sherry M Wren
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA
| | - Kevin J O'Leary
- Division of Hospital Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jessica L Thurk
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Gregory D Kennedy
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Sarah E Tevis
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Anthony D Yang
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Healthcare Studies in the Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
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16
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Abstract
OBJECTIVE Existing literature on unplanned reoperation (UR) after vascular surgery is limited. The frequency of 30-day UR and its association with other adverse outcomes was analyzed. METHODS Patients who underwent vascular procedures in the American College of Surgeons National Surgical Quality Improvement Program (2012) were abstracted. UR, captured by a distinct variable now available in the data set, and its association with complications, readmissions, mortality, and failure to rescue (FTR) were analyzed using bivariate and multivariate methods. RESULTS Among 35,106 patients, 3545 URs were performed on 2874 patients. The overall UR rate was 10.1%. Among patients who underwent URs, approximately 80.4%, 15.8%, and 3.8% had one, two, and three or more reoperations, respectively; 39.4% of URs occurred after initial discharge. Median time to UR was 7 days but varied by procedure. Procedures with the highest UR rates were embolectomy (18.2%), abdominal bypass (14.4%), and open procedures for peripheral vascular disease (13.8%). Common indications for UR were hemorrhage, graft failure or infection, thromboembolic events, and wound complications. Patients with URs had higher rates of subsequent complications (49.9% vs 19.9%; P < .001), readmission (41.8% vs 7.0%; P < .001), and mortality (8.0% vs 2.5%; P < .001) than those not undergoing URs. FTR was more likely among patients who had a UR (13.6% vs 9.3%; P < .001); this varied within procedure groups. After multivariate adjustment, UR was independently associated with mortality in an incremental fashion (for one UR: adjusted odds ratio, 2.0; 95% confidence interval, 1.7-2.5; for two or more URs: adjusted odds ratio, 3.1; 95% confidence interval, 2.2-4.2). CONCLUSIONS URs within 30 days are frequent among patients undergoing vascular surgery and are associated with worse outcomes, including mortality and FTR.
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Affiliation(s)
- Hadiza S Kazaure
- Department of Surgery, Stanford University School of Medicine, Palo Alto, Calif
| | - Venita Chandra
- Department of Surgery, Stanford University School of Medicine, Palo Alto, Calif
| | - Matthew W Mell
- Department of Surgery, Stanford University School of Medicine, Palo Alto, Calif.
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Abstract
IMPORTANCE Pneumonia is the third most common complication in postoperative patients and is associated with significant morbidity and high cost of care. Prevention has focused primarily on mechanically ventilated patients. This study outlines the results of the longest-running postoperative pneumonia prevention program for nonmechanically ventilated patients, to our knowledge. OBJECTIVE To present long-term results (2008-2012) of a standardized postoperative ward-acquired pneumonia prevention program introduced in 2007 on the surgical ward of our hospital and compare our postintervention pneumonia rates with those captured in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). We also estimate the cost savings attributable to the pneumonia prevention program. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study at a university-affiliated Veterans Affairs hospital of all noncardiac surgical patients with ward-acquired postoperative pneumonia. INTERVENTION A previously described standardized postoperative pneumonia prevention program for patients on the surgical ward. MAIN OUTCOME AND MEASURE Ward-acquired postoperative pneumonia. RESULTS Between 2008 and 2012, there were 18 cases of postoperative pneumonia among 4099 at-risk patients hospitalized on the surgical ward, yielding a case rate of 0.44%. This represents a 43.6% decrease from our preintervention rate (0.78%) (P = .01). The pneumonia rates in all years were lower than the preintervention rate (0.25%, 0.50%, 0.58%, 0.68%, and 0.13% in 2008-2012, respectively). The overall pneumonia rate in ACS-NSQIP was 2.56% (14,033 cases of pneumonia among 547,571 at-risk patients), which is 582% higher than the postintervention rate at our ward. Using a national average of $46,400 in attributable health care cost of postoperative pneumonia and a benchmark of a 43.6% decrease in pneumonia rate achieved at our facility over the 5-year study period, a similar percentage of decrease in pneumonia occurrence at ACS-NSQIP hospitals would represent approximately 6118 prevented pneumonia cases and a cost savings of more than $280 million. CONCLUSIONS AND RELEVANCE The standardized pneumonia prevention program achieved substantial and sustained reduction in postoperative pneumonia incidence on our surgical ward; its wider adoption could improve postoperative outcomes and reduce overall health care costs.
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Affiliation(s)
- Hadiza S Kazaure
- Department of General Surgery, Stanford University School of Medicine, Stanford, California
| | - Molinda Martin
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Jung K Yoon
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Sherry M Wren
- Department of General Surgery, Stanford University School of Medicine, Stanford, California2Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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Kazaure HS, Roman SA, Sosa JAA. Not all do-not-resuscitate (DNR) orders are the same: outcomes of 4738 elderly surgical patients who instituted a DNR order at hospital admission. J Am Coll Surg 2014. [DOI: 10.1016/j.jamcollsurg.2014.07.661] [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: 10/24/2022]
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Abstract
OBJECTIVES To describe procedure-specific types, rates, and risk factors for postdischarge (PD) complications occurring within 30 days after 21 groups of inpatient general surgery procedures. DESIGN Retrospective cohort study. SETTING American College of Surgeons National Surgical Quality Improvement Program 2005 through 2010 Participant Use Data Files. PATIENTS A total of 551,510 adult patients who underwent one of 21 groups of general surgery procedures in the inpatient setting. MAIN OUTCOME MEASURES Postdischarge complications, reoperation, and mortality. RESULTS Of 551,510 patients (mean age, 54.6 years), 16.7% experienced a complication; 41.5% occurred PD. Of the PD complications, 75.0% occurred within 14 days PD. Proctectomy (14.5%), enteric fistula repair (12.6%), and pancreatic procedures (11.4%) had the highest PD complication rates. Breast, bariatric, and ventral hernia repair procedures had the highest proportions of complications that occurred PD (78.7%, 69.4%, and 62.0%, respectively). For all procedures, surgical site complications, infections, and thromboembolic events were the most common. Occurrence of an inpatient complication increased the likelihood of a PD complication (12.5% vs 6.2% without an inpatient complication; P < .001). Compared with patients without a PD complication, those with a PD complication had higher rates of reoperation (4.6% vs 17.9%, respectively; P < .001) and death (2.0% vs 6.9%, respectively; P < .001) within 30 days after surgery; those whose PD complication was preceded by an inpatient complication had the highest rates of reoperation (33.7%) and death (24.7%) (all P < .001). After adjustment, PD complications were associated with procedure type, American Society of Anesthesiologists class higher than 3, and steroid use. CONCLUSIONS The PD complication rates vary by procedure, are commonly surgical site related, and are associated with mortality. Fastidious, procedure-specific patient triage at discharge as well as expedited patient follow-up could improve PD outcomes.
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Kazaure HS, Roman SA, Sosa JA. A population-level analysis of 5620 recipients of multiple in-hospital cardiopulmonary resuscitation attempts. J Hosp Med 2014; 9:29-34. [PMID: 24311461 DOI: 10.1002/jhm.2127] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Revised: 10/13/2013] [Accepted: 11/08/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND There is a paucity of data examining the epidemiology of recipients of multiple in-hospital cardiopulmonary resuscitation (CPR) attempts, and their outcomes. DATA SOURCE Nationwide Inpatient Sample, 2000 to 2009. Patient characteristics, survival to discharge, discharge disposition, and cost of hospitalization of patients who had 1 versus multiple (>1) CPR attempts were compared using bivariate and multivariate methods. RESULTS Of 166,519 hospitalized CPR recipients, 3.4% had multiple CPR attempts. Compared with 1-time CPR recipients, those undergoing multiple CPR were younger (age <65 years; 37.3% vs 42.5%, respectively), more often nonwhite (34.2% vs 41.4%), and commonly treated in nonteaching hospitals (58.0% vs 64.5%; all P < 0.001). Survival to discharge decreased by >40% for each additional CPR attempt (23.4% vs 11.9%, and 6.7% for 1, 2, and ≥3 CPR attempts, respectively; P < 0.001). After multivariate adjustment, multiple CPR was independently associated with a lower survival to discharge (odds ratio: 0.41, 95% confidence interval: 0.37-0.44, P < 0.001). Recipients of multiple CPR were more likely to be discharged to destinations other than home (80.7% vs 70.1%, P < 0.001); 1 in 15 survivors of multiple CPR were discharged to hospice (6.8%), compared with 1 in 23 patients (4.3%) who had 1 CPR (P = 0.002). The average cost per day of hospitalization was higher for patients who had multiple CPR versus 1 CPR ($4484.60 vs $3581.40, P < 0.001). CONCLUSIONS Recipients of multiple in-hospital CPR attempts are more likely to be younger, nonwhite, and treated in nonteaching hospitals. Survival to discharge is significantly worse, and the cost of hospitalization is considerably higher for these patients.
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Affiliation(s)
- Hadiza S Kazaure
- Department of General Surgery, Stanford University, Palo Alto, California
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Kazaure HS, Roman SA, Sosa JA. Epidemiology and outcomes of in-hospital cardiopulmonary resuscitation in the United States, 2000–2009. Resuscitation 2013; 84:1255-60. [DOI: 10.1016/j.resuscitation.2013.02.021] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 01/15/2013] [Accepted: 02/26/2013] [Indexed: 12/21/2022]
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23
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Wong RL, Kazaure HS, Roman SA, Sosa JA. Simultaneous medullary and differentiated thyroid cancer: a population-level analysis of an increasingly common entity. Ann Surg Oncol 2012; 19:2635-42. [PMID: 22526904 DOI: 10.1245/s10434-012-2357-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Simultaneous medullary thyroid carcinoma (MTC) and differentiated thyroid carcinoma (DTC) is a rare entity. This is the first population-level analysis of the characteristics and outcomes of simultaneous MTC/DTC. METHODS In the Surveillance, Epidemiology, and End Results (SEER) database (1988-2008), patients with simultaneous MTC/DTC were retrospectively compared with those with MTC alone using χ(2), ANOVA, log-rank tests, Cox multivariate regression, and Kaplan-Meier analyses. RESULTS A total of 162 patients had simultaneous MTC/DTC; 1,699 had MTC alone. MTC was diagnosed first in 67.9 % of simultaneous MTC/DTC cases. Simultaneous MTC/DTC increased from 2.7 % of all MTCs in 1988-1997 to 12.3 % in 2003-2008. Compared with MTC alone, simultaneous MTC/DTC had smaller mean MTC tumor size (2.9 vs. 2.2 cm; p = 0.005) and lower rates of MTC extrathyroidal extension (25.4 vs. 16.8 %; p = 0.015) and distant metastases (15.7 vs. 9.3 %; p = 0.032). Patients diagnosed with DTC first had smaller mean MTC tumor sizes (p = 0.01), whereas patients diagnosed with MTC first had tumor sizes similar to those of MTC alone. Compared with MTC alone, patients with simultaneous MTC/DTC were more likely to receive thyroidectomy (84.7 vs. 93.2 %; p = 0.003) and radioisotopes (4.4 vs. 25 %; p < 0.001). On Kaplan-Meier analysis, disease-specific survival rates were higher for simultaneous MTC/DTC than for MTC alone (10-year survival rates 87 vs. 81 %; p = 0.056). CONCLUSIONS Simultaneous MTC/DTC is diagnosed earlier in tumor development than MTC alone, with a trend toward better prognosis. This entity likely represents a primary tumor with an incidental pathologic finding of a second malignancy. Each malignancy should be treated according to its respective stage and current guidelines.
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Affiliation(s)
- Risa L Wong
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
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Kazaure HS, Roman SA, Sosa JA. Insular thyroid cancer. Cancer 2012; 118:3260-7. [DOI: 10.1002/cncr.26638] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 09/15/2011] [Accepted: 09/16/2011] [Indexed: 11/08/2022]
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Kazaure HS, Roman SA, Sosa JA. Aggressive Variants of Papillary Thyroid Cancer: Incidence, Characteristics and Predictors of Survival among 43,738 Patients. Ann Surg Oncol 2011; 19:1874-80. [DOI: 10.1245/s10434-011-2129-x] [Citation(s) in RCA: 152] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Indexed: 12/21/2022]
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Abstract
BACKGROUND We examined the impact of obesity on 30-day outcomes of adrenalectomy using a multi-institutional database. METHODS Patients who underwent adrenalectomy in 2005-2008 according to the American College of Surgeons-National Surgical Quality Improvement Project (ACS-NSQIP) data set were grouped by body mass index (BMI): normal weight (BMI=18.5-24.9 kg/m2), overweight (BMI=25.0-29.9 kg/m2), obese (BMI=30.0-34.9 kg/m2), and morbidly obese (BMI≥35 kg/m2). Outcomes of the higher BMI groups were compared to those of the normal BMI group using χ2, analysis of variance (ANOVA), and multivariate regression. RESULTS There were 1,629 patients in the study: 22% were normal weight, 31% overweight, 22.2% obese, and 24.7% morbidly obese. Compared to normal-weight patients, obese and morbidly obese patients had a 12.5 and 16.7% increase in operation times (129 vs. 145 and 150 min, respectively, p≤0.01) and sustained more wound complications (0.2 vs. 0.4 and 1.2%, p<0.001), including superficial and deep wound infections (p<0.001 and p<0.01, respectively). Morbid obesity independently predicted overall complications (odds ratio [OR] 2.9, 95% confidence interval [CI]: 1.7-5.7), wound complications (OR 6.1, 95% CI: 2.0-18.9), and septic complications (OR 3.1, 95% CI: 1.1-8.8). Obesity independently predicted longer total time in the operating room (p<0.006). There were no differences in rates of reoperation and length of hospital stay by BMI category. CONCLUSION Obesity is an independent risk factor that needs to be considered in surgical decisions regarding adrenalectomy. Morbidly obese adrenalectomy patients are particularly at risk for wound and septic complications.
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Affiliation(s)
- Hadiza S Kazaure
- Yale University School of Medicine, 330 Cedar St., Tompkins 208, P.O. Box 208062, New Haven, CT 06520, USA
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Kazaure HS, Roman SA, Sosa JA. Medullary thyroid microcarcinoma. Cancer 2011; 118:620-7. [DOI: 10.1002/cncr.26283] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2011] [Revised: 04/14/2011] [Accepted: 04/19/2011] [Indexed: 01/03/2023]
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Kazaure HS, Roman SA, Sosa JA. Adrenalectomy in Older Americans has Increased Morbidity and Mortality: An Analysis of 6,416 Patients. Ann Surg Oncol 2011; 18:2714-21. [PMID: 21544656 DOI: 10.1245/s10434-011-1757-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Indexed: 11/18/2022]
Affiliation(s)
- Hadiza S Kazaure
- Division of Endocrine Surgery, Department of Surgery, Yale University School of Medicine, 330 Cedar St, Tompkins 208, New Haven, CT, USA
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