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Muething L, Quach B, Smith DE, Gao D, Smith JA, Simril RT, Tompkins A, Espinoza J, Cowan ML, Hammad H, Wani S, Patel SG. Adoption of Optimal Small (6-9 mm) Colorectal Polyp Resection Technique Over Time. Dig Dis Sci 2023; 68:240-251. [PMID: 35624328 DOI: 10.1007/s10620-022-07554-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/29/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cold snare polypectomy (CSP) is the preferred resection technique for small (6-9 mm) polyps due to lower rate of incomplete resection compared to cold forceps polypectomy (CFP) and improved safety profile over hot snare polypectomy (HSP). AIMS To describe resection techniques for small (6-9 mm) polyps and determine factors associated with sub-optimal technique. METHODS This was retrospective cohort study of colonoscopies performed by gastroenterological and surgical endoscopists from 2012 to 2019 where at least one 6-9 mm polyp was removed. Patient, provider, and procedure characteristics were collected. Univariate and multivariate regression analyses were performed to determine factors associated with sub-optimal technique. RESULTS In total, 773 colonoscopies where 1,360 6-9 mm polyps removed by 21 endoscopists were included. CSP was used for 1,122 (82.5%), CFP for 61 (4.5%), and HSP for 177 (13.0%). Surgeon specialty was associated with CFP use (aOR 7.81; 95% CI 3.02-20.16). Polyp location in left colon (aOR 1.65; 95% CI 1.17-2.33) and pedunculated morphology (aOR 12.76; 95% CI 7.24-22.50) were associated with HSP. There was a significant increase in overall CSP use from 30.4% in 2012 to 96.8% in 2019. CONCLUSIONS 82.5% of all 6-9 mm polyps removed from 2012 to 2019 were removed using a cold snare with significant increase in CSP from 2012 to 2019. Differences in how optimal technique was adopted over time based on specialty highlight the need for standardized practice guidelines and quality monitoring.
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Affiliation(s)
- Larissa Muething
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - Bill Quach
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - Derek E Smith
- Department of Pediatrics, Cancer Center Biostatistics Core, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Dexiang Gao
- Department of Pediatrics, Cancer Center Biostatistics Core, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Joshua A Smith
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Robert T Simril
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - Amanda Tompkins
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jeannine Espinoza
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - Michelle L Cowan
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Hazem Hammad
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - Sachin Wani
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Swati G Patel
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA.
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Smith ZL, Park KH, Llano EM, Donboli K, Fayad L, Han S, Kang L, Simril RT, Patel R, Hollander T, Rogers MC, Elmunzer BJ, Siddiqui UD, Aadam AA, Mullady DK, Lang GD, Das KK, Jamil LH, Lo SK, Gaddam S, Chapman CG, Keswani RN, Wani S, Cote GA, Kumbhari V, Kushnir VM. Outcomes of endoscopic treatment of leaks and fistulae after sleeve gastrectomy: results from a large multicenter U.S. cohort. Surg Obes Relat Dis 2019; 15:850-855. [DOI: 10.1016/j.soard.2019.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/06/2019] [Accepted: 04/06/2019] [Indexed: 02/07/2023]
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Simril RT, Scannell BP, Wally MK, LeFlore MH, Seymour RB, Hsu JR, Beuhler M, Bosse MJ, Gerkin E, Gibbs M, Griggs C, Jarrett S, Leas D, Runyon M, Saha A, Schiro S, Watling B, Wyatt S. Opioid Prescribing in the Pediatric Orthopaedic Trauma Population. J Surg Orthop Adv 2018; 27:269-273. [PMID: 30777824] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The purpose of this article is to describe opioid prescribing patterns for children with orthopaedic injuries. A retrospective chart review was conducted on pediatric orthopaedic trauma patients (n = 124) who were discharged from the hospital or emergency department or had a clinic visit during a 1-month period. Patient demographics, prescription specifics, injury details, and fracture fixation information were collected. Results show that most children received opioids after injury (82.3%). While children undergoing operative fixation typically received opioids, only 39.5% with closed reduction did. Hydrocodone- acetaminophen accounted for 93% of prescriptions, but adolescents were more likely to receive other drugs. There was a significant trend of increasing daily dosage with increased age; 36.73% of adolescents received > 50 morphine milligram equivalents per day. Children with orthopaedic injuries are typically prescribed opioids; older children more commonly receive higher dosages. Further study is needed to define prescribing trends across facility and specialty types to aid in development of standardized prescribing guidelines. (Journal of Surgical Orthopaedic Advances 27(4):269-273, 2018).
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Affiliation(s)
- Robert T Simril
- Department of Orthopaedic Surgery, Carolinas HealthCare System, Charlotte, North Carolina; Carolinas Healthcare System Research Center of Excellence, Carolinas HealthCare System, Charlotte, North Carolina
| | - Brian P Scannell
- Department of Orthopaedic Surgery, Carolinas HealthCare System, Charlotte, North Carolina; Carolinas Healthcare System Research Center of Excellence, Carolinas HealthCare System, Charlotte, North Carolina
| | - Meghan K Wally
- Department of Orthopaedic Surgery, Carolinas HealthCare System, Charlotte, North Carolina; Carolinas Healthcare System Research Center of Excellence, Carolinas HealthCare System, Charlotte, North Carolina
| | - Michael H LeFlore
- Department of Orthopaedic Surgery, Carolinas HealthCare System, Charlotte, North Carolina; Carolinas Healthcare System Research Center of Excellence, Carolinas HealthCare System, Charlotte, North Carolina
| | - Rachel B Seymour
- Department of Orthopaedic Surgery, Carolinas HealthCare System, Charlotte, North Carolina; Carolinas Healthcare System Research Center of Excellence, Carolinas HealthCare System, Charlotte, North Carolina; e-mail:
| | - Joseph R Hsu
- Department of Orthopaedic Surgery, Carolinas HealthCare System, Charlotte, North Carolina; Carolinas Healthcare System Research Center of Excellence, Carolinas HealthCare System, Charlotte, North Carolina
| | - Michael Beuhler
- Carolinas Healthcare System Research Center of Excellence, Carolinas HealthCare System, Charlotte, North Carolina; Poison Information Center, Carolinas HealthCare System, Charlotte, North Carolina
| | - Michael J Bosse
- Department of Orthopaedic Surgery, Carolinas HealthCare System, Charlotte, North Carolina; Carolinas Healthcare System Research Center of Excellence, Carolinas HealthCare System, Charlotte, North Carolina
| | - Emily Gerkin
- Department of Orthopaedic Surgery, Carolinas HealthCare System, Charlotte, North Carolina; Carolinas Healthcare System Research Center of Excellence, Carolinas HealthCare System, Charlotte, North Carolina
| | - Michael Gibbs
- Carolinas Healthcare System Research Center of Excellence, Carolinas HealthCare System, Charlotte, North Carolina; Department of Emergency Medicine, Carolinas HealthCare System, Charlotte, North Carolina
| | - Christopher Griggs
- Carolinas Healthcare System Research Center of Excellence, Carolinas HealthCare System, Charlotte, North Carolina; Department of Emergency Medicine, Carolinas HealthCare System, Charlotte, North Carolina
| | - Steven Jarrett
- Carolinas Healthcare System Research Center of Excellence, Carolinas HealthCare System, Charlotte, North Carolina; Patient Safety, Carolinas HealthCare System, Charlotte, North Carolina
| | - Daniel Leas
- Department of Orthopaedic Surgery, Carolinas HealthCare System, Charlotte, North Carolina; Carolinas Healthcare System Research Center of Excellence, Carolinas HealthCare System, Charlotte, North Carolina
| | - Michael Runyon
- Carolinas Healthcare System Research Center of Excellence, Carolinas HealthCare System, Charlotte, North Carolina; Department of Emergency Medicine, Carolinas HealthCare System, Charlotte, North Carolina
| | - Animita Saha
- Carolinas Healthcare System Research Center of Excellence, Carolinas HealthCare System, Charlotte, North Carolina; Department of Internal Medicine, Carolinas HealthCare System, Charlotte, North Carolina
| | - Sharon Schiro
- Department of Orthopaedic Surgery, Carolinas HealthCare System, Charlotte, North Carolina; Carolinas Healthcare System Research Center of Excellence, Carolinas HealthCare System, Charlotte, North Carolina
| | - Bradley Watling
- Carolinas Healthcare System Research Center of Excellence, Carolinas HealthCare System, Charlotte, North Carolina; Emergency Medicine Physicians, Carolinas HealthCare System, Charlotte, North Carolina
| | - Stephen Wyatt
- Carolinas Healthcare System Research Center of Excellence, Carolinas HealthCare System, Charlotte, North Carolina; Adult Psychiatry, Carolinas HealthCare System, Charlotte, North Carolina
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