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Huerta CT, Rodriguez C, Parreco J, Thorson CM, Sola JE, Perez EA. Contemporary Trends in Laparoscopy and Ovarian Sparing Surgery for Ovarian Torsion in the Pediatric Population. J Pediatr Surg 2024; 59:393-399. [PMID: 37968152 DOI: 10.1016/j.jpedsurg.2023.10.042] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/16/2023] [Indexed: 11/17/2023]
Abstract
PURPOSE Although total oophorectomy (TO) was historically performed in cases of nonviable-appearing ovaries, considerable evidence has demonstrated equivalent outcomes after ovarian sparing surgery (OSS) as well as long-term fertility preservation benefits. This study sought to compare outcomes of OSS and TO for patients with ovarian torsion. METHODS Females <21 years old admitted for ovarian torsion were identified from the Nationwide Readmissions Database (2016-2018) and stratified by OSS or TO. Propensity score-matched analysis (PSMA) utilizing >50 covariates (demographics, medical comorbidities, ovarian diagnoses, etc.) was constructed between those receiving TO and OSS. RESULTS There were 3,161 females (median 15 [12-18] years) with ovarian torsion, and concomitant pathologies included cysts (42%), benign masses (25%), and malignant masses (<1%). Open approaches were more common (52% vs. 48% laparoscopic), and ovarian resection (OSS or TO) was performed in 87% (39% OSS and 48% TO). OSS was more commonly performed with laparoscopic detorsions (60% vs. 40% TO), while TO was more frequent in open operations (59% vs. 41% TO; both p < 0.001). No differences in overall readmissions (7% OSS vs. 8% TO) or readmissions for recurrent torsion (<1% overall) and ovarian masses (<1%) were observed (both groups <1%; p = 0.612). After PSMA, laparoscopy was still utilized less frequently with TO (39% vs. 53%; p < 0.001) despite similar rates of malignant masses. CONCLUSIONS Overall, these data offer additional support for the current practice guidelines that give preference to OSS as the primary method of treatment for pediatric ovarian torsion in the majority of cases. LEVEL OF EVIDENCE III. TYPE OF STUDY Retrospective Comparative Study.
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Affiliation(s)
- Carlos Theodore Huerta
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Cindy Rodriguez
- Florida State University School of Medicine, Tallahassee, FL, USA
| | - Joshua Parreco
- Department of Surgery, Memorial Regional Hospital, Hollywood, FL, USA
| | - Chad M Thorson
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Juan E Sola
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eduardo A Perez
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
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Huerta CT, Saberi RA, Gilna GP, Ramsey WA, Kodia K, Parreco J, Thorson CM, Sola JE, Perez EA. Primary Spontaneous Pneumothorax Outcomes in Children: A National Analysis. Innovations (Phila) 2023; 18:175-184. [PMID: 37042098 DOI: 10.1177/15569845231166929] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
OBJECTIVE Considerable variation in primary spontaneous pneumothorax (PSP) management exists in the pediatric population. This study aims to compare nationwide outcomes of children with PSP. METHODS The Nationwide Readmissions Database (2016 to 2018) was used to identify patients 1 to 18 years old with PSP. Trauma, secondary pneumothoraces, and elective admissions were excluded. Demographics and complications were compared among patients undergoing initial nonoperative management (NOM; observation or percutaneous drainage) or operative resection using standard statistical tests. RESULTS A total of 3,890 patients were identified with PSP (median age, 16 [interquartile range 14 to 17] years). Most (78%) underwent NOM, of which 17% failed requiring operative resection. Of the intent-to-treat cohort, 28% failed NOM during index admission or required repeat percutaneous drainage or operative resection on readmission. Patients treated by NOM had higher 30-day and overall readmission rates compared with operative resection (all P < 0.001). Ipsilateral recurrent pneumothorax was higher in those receiving NOM (13% vs 3%, P < 0.001). Patients from the lowest median household income quartile more frequently received NOM compared with the highest income quartile (82% vs 76%) with more readmissions. CONCLUSIONS Patients with PSP who underwent initial NOM experienced higher readmission rates than those receiving operative resection. Furthermore, socioeconomic status was associated with the utilization of nonoperative versus operative management.
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Affiliation(s)
| | | | | | | | | | | | | | - Juan E Sola
- University of Miami Miller School of Medicine, FL, USA
| | - Eduardo A Perez
- University of Miami Miller School of Medicine, FL, USA
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, FL, USA
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Huerta CT, Kodia K, Ramsey WA, Espinel A, Gilna GP, Saberi RA, Parreco J, Thorson CM, Sola JE, Perez EA. Operative versus percutaneous drainage with fibrinolysis for complicated pediatric pleural effusions: A nationwide analysis. J Pediatr Surg 2023; 58:814-821. [PMID: 36805137 DOI: 10.1016/j.jpedsurg.2023.01.013] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/02/2023] [Indexed: 01/20/2023]
Abstract
PURPOSE Management of complicated pleural effusions and empyema using tube thoracostomy with intrapleural fibrinolysis versus surgical drainage has been debated for decades. However, there remains considerable variation in management with these approaches in the pediatric population. This study aims to compare the nationwide outcomes of pediatric patients with complicated pleural effusions. METHODS Patients <18 years old with a diagnosis of pleural effusion or empyema associated with pneumonia were identified from the Nationwide Readmissions Database (2016-2018). Demographics, hospital characteristics, and complications were compared among patients undergoing isolated percutaneous drainage (PD), percutaneous drainage with intrapleural fibrinolysis (PDF), or operative drainage (OD) using standard statistical tests. RESULTS 5424 patients (age 4 [IQR 1-11] years) were identified with a pleural effusion or empyema who underwent percutaneous or surgical intervention. PD (22%) and OD (24%) were utilized more frequently than PDF (3%). Index complications, including bleeding and postprocedural air leak, were similar between groups. Those receiving PDF had lower index length of stay (LOS) and admission costs. Thirty-day and overall readmission rates were highest in patients receiving PD (15% and 24%) and OD (12% and 23%) versus PDF, all p < 0.001. Those receiving OD had fewer readmission complications including recurrent effusion or empyema, pneumonia, and bleeding. Overall readmission cost was highest in those receiving PD (p = 0.005). CONCLUSION In this nationwide cohort, PDF was associated with lower index admission cost, shorter LOS and lower rates of readmissions compared to OD. This knowledge should be used to improve selection of these treatments in this patient population. TYPE OF STUDY Retrospective Comparative LEVEL OF EVIDENCE: III.
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Affiliation(s)
- Carlos Theodore Huerta
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Karishma Kodia
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Walter A Ramsey
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Gareth P Gilna
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rebecca A Saberi
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joshua Parreco
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Chad M Thorson
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Juan E Sola
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eduardo A Perez
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
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Qafiti FN, Marsh AM, Yi S, Rosenthal A, Parreco J, Lopez-Viego MA, Buicko JL. Nationwide Analysis of Hospital admissions Prior to Hartmann's Procedure for Acute Diverticulitis. Am Surg 2022; 88:2148-2157. [PMID: 35483378 DOI: 10.1177/00031348221087378] [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] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Diverticular disease is one of the most common gastrointestinal diseases that require hospital admission. This study aims to identify trends in prior hospital admissions for patients that ultimately require a Hartmann's procedure for complicated diverticulitis. METHODS The Nationwide Readmissions Database for 2010-2014 was queried for all patients aged 18 years or older admitted with an ICD-9 code for colonic diverticulitis and end colostomy creation. Patients with prior hospital admissions were identified. The primary outcome was mortality after Hartmann's procedure. Secondary outcomes were prior hospital admission and previous percutaneous drain placement. Multivariable logistic regression was performed to control for confounding factors for each outcome and results were weighted for national estimates. RESULTS There were 90,162 patients admitted with complicated diverticulitis requiring end colostomy creation. Prior hospital admissions were found in 28.1% (n = 25,307) and 14.4% (n = 12,947) had a previous percutaneous drain placed during a prior admission. The overall mortality rate was 5.9% (n = 5314) after Hartman's procedure. The mortality rate for patients with prior hospital admissions was 8.7% (P < .001), and the mortality rate for patients with previous percutaneous drain placement was 4.3% (P < .001). After controlling for confounding factors including comorbidities, patients with prior admission had an increased risk of mortality (OR 1.48 [1.40-1.58], P < .001) and patients with previous percutaneous drain placement had a decreased risk of mortality (OR .66 [.60-.72], P < .001). CONCLUSIONS Hospitalizations for complications of diverticulitis are a costly burden to our healthcare system. By identifying those patients at high risk for readmission and emergency surgery, perioperative outcomes may be improved.
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Affiliation(s)
- Fred N Qafiti
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Amanda M Marsh
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Slee Yi
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | | | | | - Miguel A Lopez-Viego
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Jessica L Buicko
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
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Ferrantella A, Sola JE, Parreco J, Quiroz HJ, Willobee BA, Reyes C, Thorson CM, Perez EA. Complications while awaiting elective inguinal hernia repair in infants: Not as common as you thought. Surgery 2021; 169:1480-1485. [PMID: 33500157 DOI: 10.1016/j.surg.2020.12.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 12/14/2020] [Accepted: 12/14/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND The dogma of early inguinal hernia repair in infants, especially those born prematurely, has dominated clinical practice owing to reports of a high frequency of incarceration and significant complications associated with untreated inguinal hernias. We aim to evaluate the frequency of complications after discharge with delayed surgery for inguinal hernia repair. METHODS The Nationwide Readmissions Database (2010-2014) was queried to identify infants diagnosed with inguinal hernia. We compared the frequency and characteristics of inguinal hernia repair performed during the index admission, discharge from the index admission without hernia repair, and unplanned readmissions. RESULTS We identified 33,530 infants (16,624 preterm and 16,906 full-term) diagnosed with an inguinal hernia during an index admission. For those infants diagnosed with an inguinal hernia at birth, inguinal hernia repair was performed during the birth admission for only a minority of both preterm (35%) and full-term infants (18%; P < .001). Of the infants discharged without hernia repair, 15% required nonelective readmission up to 1 year later, but only 2% of preterm and 1% of full-term infants actually underwent inguinal hernia repair during these unplanned readmissions. None of the readmitted infants underwent additional procedures suggestive of a strangulated hernia. CONCLUSION Complications among infants awaiting inguinal hernia repair may be substantially less common than previously reported, and the occurrence of significant associated morbidity is quite rare.
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Affiliation(s)
- Anthony Ferrantella
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, FL. https://twitter.com/JESola1
| | - Juan E Sola
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, FL. https://twitter.com/DrChadTHOR
| | - Joshua Parreco
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, FL
| | - Hallie J Quiroz
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, FL. https://twitter.com/halliequirozmd
| | - Brent A Willobee
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, FL
| | - Clara Reyes
- Department of Pediatric Hospital Medicine, Nicklaus Children's Hospital, Miami, FL
| | - Chad M Thorson
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, FL. https://twitter.com/TonyFerrantella
| | - Eduardo A Perez
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, FL.
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Qafiti FN, Lopez MA, Kichler K, Parreco J, Buicko JL. Hospital Readmissions for Hyperparathyroidism After Bariatric Surgery in the United States: A National Database Review. Cureus 2020; 12:e10585. [PMID: 33110721 PMCID: PMC7580962 DOI: 10.7759/cureus.10585] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: The incidence and significance of hyperparathyroidism in patients after bariatric surgery have been established to some degree; however, the impact it has on the national healthcare system has not. We sought to assess the risk of readmission and related comorbidities in this patient population. Methods: The Healthcare Cost and Utilization Project Nationwide Readmission Database was queried for all patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Multivariate logistic regression analysis was conducted to identify factors associated with readmission for hyperparathyroidism. Results: A total of 915,792 patients between 2010 and 2015 were queried; 43.2% had undergone SG and 56.8% had RYGB. A total of 589 patients were readmitted for hyperparathyroidism; 80.8% were female and 68% had a Charlson comorbidity index ≥ 2. Factors associated with readmission were as follows: age 45-64 years (odds ratio [OR] 1.42, p=0.001), Medicare (OR 3.01, p<0.001) or Medicaid (OR 2.61, p<0.001) insurance status, lower median household income, renal failure (OR 17.14, p<0.001), hypertension (OR 2.89, p<0.001), and deficiency anemia (OR 2.62, p<0.01). Conclusions: Parathyroid axis monitoring may provide benefits to predictably high-risk patients. Appropriate surveillance may decrease the impact of bariatric hyperparathyroidism readmission on the U.S. healthcare system.
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Affiliation(s)
- Fred N Qafiti
- General Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Michael A Lopez
- General Surgery, University of Miami Miller School of Medicine, Lantana, USA
| | - Kandace Kichler
- Bariatric Surgery, University of Miami Miller School of Medicine, Lantana, USA
| | | | - Jessica L Buicko
- General Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA.,General Surgery, Bethesda Health Physician Group, Bethesda Hospital East, Boynton Beach, USA
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Parreco J, Soe-Lin H, Parks JJ, Byerly S, Chatoor M, Buicko JL, Namias N, Rattan R. Comparing Machine Learning Algorithms for Predicting Acute Kidney Injury. Am Surg 2020. [DOI: 10.1177/000313481908500731] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Prior studies have used vital signs and laboratory measurements with conventional modeling techniques to predict acute kidney injury (AKI). The purpose of this study was to use the trend in vital signs and laboratory measurements with machine learning algorithms for predicting AKI in ICU patients. The eICU Collaborative Research Database was queried for five consecutive days of laboratory measurements per patient. Patients with AKI were identified and trends in vital signs and laboratory values were determined by calculating the slope of the least-squares-fit linear equation using three days for each value. Different machine learning classifiers (gradient boosted trees [GBT], logistic regression, and deep learning) were trained to predict AKI using the laboratory values, vital signs, and slopes. There were 151,098 ICU stays identified and the rate of AKI was 5.6 per cent. The best performing algorithm was GBT with an AUC of 0.834 ± 0.006 and an F-measure of 42.96 per cent ± 1.26 per cent. Logistic regression performed with an AUC of 0.827 ± 0.004 and an F-measure of 28.29 per cent ± 1.01 per cent. Deep learning performed with an AUC of 0.817 ± 0.005 and an F-measure of 42.89 per cent ± 0.91 per cent. The most important variable for GBT was the slope of the minimum creatinine (30.32%). This study identifies the best performing machine learning algorithms for predicting AKI using trends in laboratory values in ICU patients. Early identification of these patients using readily available data indicates that incorporating machine learning predictive models into electronic medical record systems is an inevitable requisite for improving patient outcomes.
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Affiliation(s)
- Joshua Parreco
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida
| | - Hahn Soe-Lin
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida
| | | | - Saskya Byerly
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida
| | - Matthew Chatoor
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida
| | - Jessica L. Buicko
- Division of Endocrine Surgery, Weil Cornell Medical Center, New York, New York
| | - Nicholas Namias
- Division of Trauma Surgery and Surgical Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Rishi Rattan
- Division of Trauma Surgery and Surgical Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
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Parreco J, Quiroz HJ, Willobee BA, Sussman M, Buicko JL, Rattan R, Namias N, Thorson CM, Sola JE, Perez EA. National Risk Factors for Child Maltreatment after Trauma: Failure to Prevent. Am Surg 2020. [DOI: 10.1177/000313481908500726] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to identify the risk factors for hospital readmission for child maltreatment after trauma, including admissions across different hospitals nationwide. The Nationwide Readmissions Database for 2010–2014 was queried for all patients younger than 18 years admitted for trauma. The primary outcome was readmission for child maltreatment. The secondary outcome was readmission for maltreatment presenting to a hospital different than the index admission hospital. A subgroup analysis was performed on patients without a diagnosis of maltreatment during the index admission. Multivariable logistic regression was performed for each outcome. There were 608,744 admissions identified and 44,569 (7.32%) involved maltreatment at the index admission. Readmission for maltreatment was found in 1,948 (0.32%) patients and 368 (18.89%) presented to a different hospital. The highest risk for readmission for maltreatment was found in patients with maltreatment identified at the index admission (odds ratios (OR) 9.48 [8.35–10.76]). The strongest risk factor for presentation to a different hospital was found with the lowest median household income quartile (OR 3.50 [2.63–4.67]). The subgroup analysis identified 647 (0.11%) children with readmission for maltreatment that was missed during the index admission. The strongest risk factor for this outcome was Injury Severity Score > 15 (OR 3.29 [2.68–4.03]). This study demonstrates that a significant portion of admissions for trauma in children and teenagers could be misrepresented as not involving maltreatment. These index admissions could be the only chance for intervention for child maltreatment. Identifying these at-risk individuals is critical to prevention efforts.
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Affiliation(s)
- Joshua Parreco
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida
| | - Hallie J. Quiroz
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Brent A. Willobee
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Mathew Sussman
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Jessica L. Buicko
- Division of Endocrine Surgery, Weil Cornell Medical Center, New York, New York
| | - Rishi Rattan
- Division of Trauma Surgery and Surgical Critical Care; and
| | | | - Chad M. Thorson
- Division of Pediatric Surgery, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Juan E. Sola
- Division of Pediatric Surgery, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Eduardo A. Perez
- Division of Pediatric Surgery, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
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Ferrantella A, Quinn K, Parreco J, Quiroz HJ, Willobee BA, Ryon E, Thorson CM, Sola JE, Perez EA. Incidence of recurrent intussusception in young children: A nationwide readmissions analysis. J Pediatr Surg 2020; 55:1023-1025. [PMID: 32247601 DOI: 10.1016/j.jpedsurg.2020.02.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 02/20/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND/PURPOSE Recurrent intussusception following successful nonoperative reduction has previously been reported with a frequency of 8%-12% based on data from individual institutions. Meanwhile, the timing of discharge after successful reduction continues to be debated. Here, we evaluate readmissions for recurrent intussusception in young children using a large-scale national database. METHODS The National Readmissions Database (2010-2014) was queried to identify young children (age < 5 years) diagnosed with intussusception. We compared procedures performed during the index admission and frequency of readmissions for recurrent intussusception. Results were weighted for national estimates. RESULTS We identified 8289 children diagnosed with intussusception during an index admission. These patients received definitive treatment with nonoperative reduction alone (43%), surgical reduction (42%), or bowel resection (15%). Readmission for recurrent intussusception was required for 3.7% of patients managed with nonoperative reduction alone, 2.3% of patients that underwent surgical reduction, and 0% of those that underwent bowel resection. Median time to readmission was 4 days after nonoperative reduction, and only 1.5% of these patients experienced recurrence within 48 h of discharge. CONCLUSIONS Recurrent intussusception may be substantially less common than previously reported. Our findings support the practice of discharge shortly after successful nonoperative reduction. TYPE OF STUDY Retrospective, prognosis study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Anthony Ferrantella
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kirby Quinn
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joshua Parreco
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hallie J Quiroz
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Brent A Willobee
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Emily Ryon
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Chad M Thorson
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Juan E Sola
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eduardo A Perez
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
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Quiroz HJ, Turpin A, Willobee BA, Ferrantella A, Parreco J, Lasko D, Perez EA, Sola JE, Thorson CM. Nationwide analysis of mortality and hospital readmissions in esophageal atresia. J Pediatr Surg 2020; 55:824-829. [PMID: 32061361 DOI: 10.1016/j.jpedsurg.2020.01.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 01/25/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE The purpose of this study is to identify determinants of mortality and hospital readmission in infants born with esophageal atresia ± tracheoesophageal fistula. METHODS The Nationwide Readmissions Database (2010-2014) was queried for newborns with a diagnosis of esophageal atresia. Outcomes included mortality and readmissions at 30-day and 1-year. RESULTS 3157 patients were identified, of which 54% were male. 81% had an additional congenital anomaly, and 35% had VACTERL association. Overall mortality at index hospitalization was 11% (n = 360) and was significantly higher with additional congenital anomalies (13%), VACTERL (19%), and Spitz classification II/III (18%) vs. isolated esophageal atresia/tracheoesophageal fistula (4%), all p < 0.001. After esophageal atresia repair (n = 2179), 10% (n = 212) were readmitted within 30 days and 26% (n = 563) within 1 year, with 17% admitted to different hospitals. Common diagnoses during readmission were GERD (54%), infections (42%), failure to thrive (17%), tracheomalacia (14%), and esophageal stricture (10%). Unplanned readmissions accounted for 85% of readmissions. A large number underwent operative procedures, most commonly esophageal dilation (17%) and fundoplication/gastrostomy (12%). CONCLUSION Our study has uncovered a high likelihood of complications and unplanned readmission within the first year of life for newborns with esophageal atresia. Coordinated multidisciplinary care may help to decrease unnecessary readmissions and improve outcomes in this vulnerable population. TYPE OF STUDY Retrospective comparative analysis. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Hallie J Quiroz
- Dewitt-Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine
| | | | - Brent A Willobee
- Dewitt-Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine
| | - Anthony Ferrantella
- Dewitt-Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine
| | - Joshua Parreco
- Dewitt-Daughtry Family Department of Surgery, Division of Trauma and Acute Care Surgery, University of Miami Miller School of Medicine
| | | | - Eduardo A Perez
- Dewitt-Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine
| | - Juan E Sola
- Dewitt-Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine
| | - Chad M Thorson
- Dewitt-Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine.
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Parreco J, Sussman MS, Crandall M, Ebler DJ, Lee E, Namias N, Rattan R. Nationwide Outcomes and Risk Factors for Reinjury After Penetrating Trauma. J Surg Res 2020; 250:59-69. [PMID: 32018144 DOI: 10.1016/j.jss.2019.12.029] [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: 05/02/2019] [Revised: 09/27/2019] [Accepted: 12/27/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Previous studies have shown that a notable portion of patients who are readmitted for reinjury after penetrating trauma present to a different hospital. The purpose of this study was to identify the risk factors for reinjury after penetrating trauma including reinjury admissions to different hospitals. METHODS The 2010-2014 Nationwide Readmissions Database was queried for patients surviving penetrating trauma. E-codes identified patients subsequently admitted with a new diagnosis of blunt or penetrating trauma. Univariable analysis was performed using 44 injury, patient, and hospital characteristics. Multivariable logistic regression using significant variables identified risk factors for the outcomes of reinjury, different hospital readmission, and in-hospital mortality after reinjury. RESULTS There were 443,113 patients identified. The reinjury rate was 3.5%. Patients presented to a different hospital in 30.0% of reinjuries. Self-inflicted injuries had a higher risk of reinjury (odds ratio [OR]: 2.66, P < 0.05). Readmission to a different hospital increased risk of mortality (OR: 1.62, P < 0.05). Firearm injury on index admission increased risk of mortality after reinjury (OR: 1.94, P < 0.05). CONCLUSIONS This study represents the first national finding that one in three patients present to a different hospital for reinjury after penetrating trauma and have a higher risk of mortality due to this fragmentation of care. These findings have implications for quality and cost improvements by identifying areas to improve continuity of care and the implementation of penetrating injury prevention programs.
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Affiliation(s)
- Joshua Parreco
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida
| | - Matthew S Sussman
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida.
| | - Marie Crandall
- Division of Acute Care Surgery, Department of Surgery, University of Florida College of Medicine Jacksonville, Jacksonville, Florida
| | - David J Ebler
- Division of Acute Care Surgery, Department of Surgery, University of Florida College of Medicine Jacksonville, Jacksonville, Florida
| | - Eugenia Lee
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida
| | - Nicholas Namias
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida
| | - Rishi Rattan
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida
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Parreco J, Soe-Lin H, Byerly S, Lu N, Ruiz G, Yeh DD, Namias N, Rattan R. Multi-Center Outcomes of Chlorhexidine Oral Decontamination in Intensive Care Units. Surg Infect (Larchmt) 2020; 21:659-664. [PMID: 31928384 DOI: 10.1089/sur.2019.172] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The efficacy of oral chlorhexidine (oCHG) for decontamination in intensive care unit (ICU) patients is controversial. The purpose of this study was to evaluate the effect of oCHG decontamination on the incidence of pneumonia, sepsis, and death in ICU patients. Methods: The Philips eICU database version 2.0 was queried for patients admitted to the ICU for ≥48 hours in 2014-2015. The primary outcome of interest was death in the ICU. Secondary outcomes were a diagnosis of pneumonia or sepsis. Patients with pneumonia or sepsis diagnosed within the first 48 hours of ICU admission were excluded from the outcome analyses. Univariable analysis was performed comparing age, gender, race, severity of illness scores, hospital characteristics, and oCHG order. Multivariable logistic regression was performed using univariable results with p < 0.05. Results: Of the 64,904 patients from 186 hospitals, 22.1% (n = 14,333) had oCHG ordered. The overall mortality rate was 6.9% (n = 4,449) and the mortality rate in patients receiving oCHG was 10.6% (n = 1,518; p < 0.001). After controlling for confounding factors, oCHG remained an independent risk factor for death (odds ratio [OR] 1.25; 95% confidence interval [CI] 1.16-1.34). After excluding patients with an early diagnosis of pneumonia, the overall pneumonia incidence was 2.6% (n = 1,431) and the incidence in patients having oCHG was 4.2% (n = 517; p < 0.001). However, multivariable logistic regression revealed no significant difference in the risk of pneumonia with oCHG (OR 0.97; 95% CI 0.85-1.09). After excluding patients with an early diagnosis of sepsis, the overall rate of sepsis was 1.8% (n = 949) and for patients with oCHG, the rate was 3.3% (n = 388; p < 0.001). After controlling for other confounders, oCHG remained an independent risk factor for sepsis (OR 1.37; 95% CI 1.19-1.59). Conclusions: A chlorhexidine mouthwash order is associated with increased odds of death and sepsis without decreased odds of pneumonia in a heterogeneous cohort of ICU patients. Additional studies are needed to understand better the effect of oCHG on outcomes.
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Affiliation(s)
- Joshua Parreco
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida, USA
| | - Hahn Soe-Lin
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida, USA
| | - Saskya Byerly
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida, USA
| | - Ning Lu
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida, USA
| | - Gabriel Ruiz
- Division of Trauma Surgery and Surgical Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - D Dante Yeh
- Division of Trauma Surgery and Surgical Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Nicholas Namias
- Division of Trauma Surgery and Surgical Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Rishi Rattan
- Division of Trauma Surgery and Surgical Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, USA
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Quiroz HJ, Parreco J, Easwaran L, Willobee B, Ferrantella A, Rattan R, Thorson CM, Sola JE, Perez EA. Identifying Populations at Risk for Child Abuse: A Nationwide Analysis. J Pediatr Surg 2020; 55:135-139. [PMID: 31757508 PMCID: PMC7848807 DOI: 10.1016/j.jpedsurg.2019.09.069] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 09/29/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Child abuse is a national, often hidden, epidemic. The study objective was to determine at-risk populations that have been previously hospitalized prior to their admission for child abuse. METHODS The Nationwide Readmissions Database (NRD) was queried for all children hospitalized for abuse. Outcomes were previous admissions and diagnoses. χ2 analysis was used; significance equals p < 0.05. RESULTS 31,153 children were hospitalized for abuse (half owing to physical abuse) during the study period. 11% (n = 3487) of these children had previous admissions (one in three to a different hospital), while 3% (n = 1069) had multiple hospitalizations. 60% of prior admissions had chronic conditions, and 12% had traumatic injuries. Children with chronic conditions were more likely to have sexual abuse (89% vs. 57%, p < 0. 001) and emotional abuse (75% vs. 60%, p < 0. 01). 25% of chronic diagnoses were psychiatric, who were also more likely to have sexual and emotional abuse (47% vs. 5.5% and 10% vs. 1%, all p < 0. 001). CONCLUSION This study uncovers a hidden population of children with past admissions for chronic conditions, especially psychiatric diagnoses that are significantly associated with certain types of abuse. Improved measures to accurately identify at-risk children must be developed to prevent future childhood abuse and trauma. LEVEL OF EVIDENCE Level III. TYPE OF STUDY Retrospective comparative study.
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Affiliation(s)
- Hallie J. Quiroz
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, RMSB RM 1010, 1600 NW 10th Avenue, Miami, Florida 33136,Corresponding author. Tel.: +1 316 253-8950. (H.J. Quiroz)
| | - Joshua Parreco
- Division of Trauma Surgery and Surgical Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine
| | | | - Brent Willobee
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine
| | - Anthony Ferrantella
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine
| | - Rishi Rattan
- Division of Trauma Surgery and Surgical Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine
| | - Chad M. Thorson
- Division of Pediatric Surgery, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine
| | - Juan E. Sola
- Division of Pediatric Surgery, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine
| | - Eduardo A. Perez
- Division of Pediatric Surgery, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine
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Franklin KN, Martinez RA, Hernandez A, Parreco J, Rice A, Zeltzer J. Mortality and Unrecognized Readmissions Following Abdominal Aortic Aneurysm Repair Conclusions from a National Analysis. Ann Vasc Surg 2019. [DOI: 10.1016/j.avsg.2019.10.029] [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: 11/25/2022]
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Parreco J, Byerly S, Soe-Lin H, Ginzburg E, Namias N, Rattan R. Disparities in Access to and Affordability of Abdominal Wall Hernia Repair. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.1022] [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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Lopez M, Parreco J, Kichler K, Polcari K, Rattan R, Buicko J. A188 Risk Factors and Rates of Cholecystectomy During Readmission Following Bariatric Surgery. Surg Obes Relat Dis 2019. [DOI: 10.1016/j.soard.2019.08.133] [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: 11/30/2022]
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Byerly S, Tamariz L, Lee E, Parreco J, Barrett CD, Nemeth Z, Palacio A, Stahl K, Namias N, Magee GA. Systematic Review and Meta-Analysis of Ligation vs Repair of Inferior Vena Cava (IVC) Injuries. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.1398] [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: 11/25/2022]
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Affiliation(s)
- Joshua Parreco
- Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Rishi Rattan
- Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
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Parks J, Vasileiou G, Parreco J, Pust GD, Rattan R, Zakrison T, Namias N, Yeh DD. Validating the ATLS Shock Classification for Predicting Death, Transfusion, or Urgent Intervention. J Surg Res 2019; 245:163-167. [PMID: 31419641 DOI: 10.1016/j.jss.2019.07.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/19/2019] [Accepted: 07/16/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Advanced Trauma Life Support (ATLS) shock classification has been accepted as the conceptual framework for clinicians caring for trauma patients. We sought to validate its ability to predict mortality, blood transfusion, and urgent intervention. MATERIALS AND METHODS We performed a retrospective review of trauma patients using the 2014 National Trauma Data Bank. Using initial vital signs data, patients were categorized into shock class based on the ATLS program. Rates for urgent blood transfusion, urgent operative intervention, and mortality were compared between classes. RESULTS 630,635 subjects were included for analysis. Classes 1, 2, 3, and 4 included 312,404, 17,133, 31, and 43 patients, respectively. 300,754 patients did not meet criteria for any ATLS shock class. Of the patients in class 1 shock, 2653 died (0.9%), 3123 (1.0%) were transfused blood products, and 7115 (2.3%) underwent an urgent procedure. In class 2, 219 (1.3%) died, 387 (2.3%) were transfused, and 1575 (9.2%) underwent intervention. In class 3, 7 (22.6%) died, 10 (32.3%) were transfused, and 13 (41.9%) underwent intervention. In class 4, 15 (34.9%) died, 19 (44.2%) were transfused, and 23 (53.5%) underwent intervention. For uncategorized patients, 21,356 (7.1%) died, 15,168 (5.0%) were transfused, and 23,844 (7.9%) underwent intervention. CONCLUSIONS Almost half of trauma patients do not meet criteria for any ATLS shock class. Uncategorized patients had a higher mortality (7.1%) than patients in classes 1 and 2 (0.9% and 1.3%, respectively). Classes 3 and 4 only accounted for 0.005% and 0.007%, respectively, of patients. The ATLS classification system does not help identify many patients in severe shock.
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Affiliation(s)
- Jonathan Parks
- Ryder Trauma Center, University of Miami, Miami, Florida.
| | | | - Joshua Parreco
- Ryder Trauma Center, University of Miami, Miami, Florida
| | - Gerd D Pust
- Ryder Trauma Center, University of Miami, Miami, Florida
| | - Rishi Rattan
- Ryder Trauma Center, University of Miami, Miami, Florida
| | - Tanya Zakrison
- The University of Chicago Medicine, Section for Trauma and Acute Care Surgery, Chicago, Illinois
| | | | - D Dante Yeh
- Ryder Trauma Center, University of Miami, Miami, Florida
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Parreco J, Soe-Lin H, Parks JJ, Byerly S, Chatoor M, Buicko JL, Namias N, Rattan R. Comparing Machine Learning Algorithms for Predicting Acute Kidney Injury. Am Surg 2019; 85:725-729. [PMID: 31405416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Prior studies have used vital signs and laboratory measurements with conventional modeling techniques to predict acute kidney injury (AKI). The purpose of this study was to use the trend in vital signs and laboratory measurements with machine learning algorithms for predicting AKI in ICU patients. The eICU Collaborative Research Database was queried for five consecutive days of laboratory measurements per patient. Patients with AKI were identified and trends in vital signs and laboratory values were determined by calculating the slope of the least-squares-fit linear equation using three days for each value. Different machine learning classifiers (gradient boosted trees [GBT], logistic regression, and deep learning) were trained to predict AKI using the laboratory values, vital signs, and slopes. There were 151,098 ICU stays identified and the rate of AKI was 5.6 per cent. The best performing algorithm was GBT with an AUC of 0.834 ± 0.006 and an F-measure of 42.96 per cent ± 1.26 per cent. Logistic regression performed with an AUC of 0.827 ± 0.004 and an F-measure of 28.29 per cent ± 1.01 per cent. Deep learning performed with an AUC of 0.817 ± 0.005 and an F-measure of 42.89 per cent ± 0.91 per cent. The most important variable for GBT was the slope of the minimum creatinine (30.32%). This study identifies the best performing machine learning algorithms for predicting AKI using trends in laboratory values in ICU patients. Early identification of these patients using readily available data indicates that incorporating machine learning predictive models into electronic medical record systems is an inevitable requisite for improving patient outcomes.
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Parreco J, Quiroz HJ, Willobee BA, Sussman M, Buicko JL, Rattan R, Namias N, Thorson CM, Sola JE, Perez EA. National Risk Factors for Child Maltreatment after Trauma: Failure to Prevent. Am Surg 2019; 85:700-707. [PMID: 31405411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The purpose of this study was to identify the risk factors for hospital readmission for child maltreatment after trauma, including admissions across different hospitals nationwide. The Nationwide Readmissions Database for 2010-2014 was queried for all patients younger than 18 years admitted for trauma. The primary outcome was readmission for child maltreatment. The secondary outcome was readmission for maltreatment presenting to a hospital different than the index admission hospital. A subgroup analysis was performed on patients without a diagnosis of maltreatment during the index admission. Multivariable logistic regression was performed for each outcome. There were 608,744 admissions identified and 44,569 (7.32%) involved maltreatment at the index admission. Readmission for maltreatment was found in 1,948 (0.32%) patients and 368 (18.89%) presented to a different hospital. The highest risk for readmission for maltreatment was found in patients with maltreatment identified at the index admission (odds ratios (OR) 9.48 [8.35-10.76]). The strongest risk factor for presentation to a different hospital was found with the lowest median household income quartile (OR 3.50 [2.63-4.67]). The subgroup analysis identified 647 (0.11%) children with readmission for maltreatment that was missed during the index admission. The strongest risk factor for this outcome was Injury Severity Score > 15 (OR 3.29 [2.68-4.03]). This study demonstrates that a significant portion of admissions for trauma in children and teenagers could be misrepresented as not involving maltreatment. These index admissions could be the only chance for intervention for child maltreatment. Identifying these at-risk individuals is critical to prevention efforts.
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Martinez RA, Franklin KN, Hernandez AE, Parreco J, Cortolillo N, Ross R. Readmissions to an alternate hospital in patients undergoing vascular intervention for claudication and critical limb ischemia associated with significantly higher mortality. J Vasc Surg 2019; 70:1960-1972. [PMID: 31153697 DOI: 10.1016/j.jvs.2019.02.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/27/2018] [Accepted: 02/21/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hospital readmissions with 30 days after vascular surgical interventions have been associated with increased morbidity, mortality, and cost. Readmission rates, now a Centers for Medicare and Medicaid Services quality measure, have been studied in databases that have excluded certain payer types and states and have not accounted for readmission to a hospital different from that of the index admission. More accurate and nationally representative data are needed, because this fragmentation of care could lead to flawed conclusions. The purpose of the present study was to examine the incidence and risk factors for readmission to a nonindex hospital for patients admitted for claudication or critical limb ischemia (CLI). We also examined how this disruption of patient care affects mortality. METHODS The 2013 to 2014 Nationwide Readmissions Database was queried for all patients admitted for claudication or CLI who had undergone angioplasty, lower extremity bypass, or aortobifemoral bypass. The outcomes of interest were 30- and 365-day readmission rates to any hospital, 30- and 365-day readmission rates to a nonindex hospital, and mortality rates. Multivariable logistic regression was used to identify risk factors for readmission to a nonindex hospital. The most common readmission diagnoses and diagnosis-related groups were identified. RESULTS A total of 92,769 patients had been admitted with peripheral vascular disease (33,055 with claudication and 59,714 with CLI). The 30- and 365-day readmission rate was 8.97% and 21.49% and 19.26% and 40.36%, for claudication and CLI, respectively. Of the 30- and 365-day readmissions, 20.47% and 24.92% had occurred at a nonindex hospital, respectively. Significantly higher mortality rates were found for patients with 30- or 365-day readmissions to different hospitals (odds ratio, 1.4 and 1.8, respectively). Multivariable analysis revealed that procedural indication and angioplasty are not significant risk factors for readmission to a different hospital. However, female sex, length of stay >7 days, and Charlson Comorbidity Index >3 remained significant risk factors for nonindex readmissions. The most common disease groups for nonindex readmission were "septicemia and disseminated infections" (6.5%), "heart failure" (6.4%), "other vascular procedures" (6.1%), and "amputation of lower limb except toes" (4.0%). CONCLUSIONS Previously unreported, ≥1 in 4 readmissions after lower extremity vascular procedures for peripheral vascular disease will occur at a nonindex hospital. This fragmentation of care is associated with increased mortality and has serious implications for guiding outcome and quality measures. With a sizeable portion of patients missed by current metrics, concern exists that providers are using flawed data. Further study into social- and patient-specific risk factors might provide methods to prevent these readmissions and improve outcomes in this difficult patient population.
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Affiliation(s)
- Rennier A Martinez
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla.
| | - Kelsey N Franklin
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla
| | | | - Joshua Parreco
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla
| | - Nicholas Cortolillo
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla
| | - Reagan Ross
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla
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Abstract
Up to one in three readmissions occur at a different hospital and are thus missed by current quality metrics. There are no national studies examining 30-day readmission, including to different hospitals, after umbilical hernia repair (UHR). We tested the hypothesis that a large proportion were readmitted to a different hospital, that risk factors for readmission to a different hospital are unique, and that readmission costs differed between the index and different hospitals. The 2013 to 2014 Nationwide Readmissions Database was queried for patients admitted for UHR, and cost was calculated. Multivariate logistic regression identified risk factors for 30-day readmission at index and different hospitals. There were 102,650 admissions for UHR and 8.9 per cent readmissions, of which 15.8 per cent readmissions were to a different hospital. The most common reason for readmission was infection (25.8%). Risk factors for 30-day readmission to any hospital include bowel resection, index admission at a for-profit hospital, Medicare, Medicaid, and Charlson Comorbidity Index ≥ 2. Risk factors for 30-day readmission to a different hospital include elective operation, drug abuse, discharge to a skilled nursing facility, and leaving against medical advice. The median cost of initial admission was higher in those who were readmitted ($16,560 [$10,805–$29,014] vs $11,752 [$8151–$17,724], P < 0.01). The median cost of readmission was also higher among those readmitted to a different hospital ($9826 [$5497–$19,139] vs $9227 [$5211–$16,817], P = 0.02). After UHR, one in six readmissions occur at a different hospital, have unique risk factors, and are costlier. Current hospital benchmarks fail to capture this sub-population and, therefore, likely underestimate UHR readmissions.
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Affiliation(s)
- Sarah A. Eidelson
- DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Joshua Parreco
- DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Michelle B. Mulder
- DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Arjuna Dharmaraja
- DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - L. Renee Hilton
- Department of Surgery, Medical College of Georgia, University of Augusta, Augusta, Georgia
| | - Rishi Rattan
- DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
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Eidelson SA, Parreco J, Mulder MB, Dharmaraja A, Hilton LR, Rattan R. Variations in Nationwide Readmission Patterns after Umbilical Hernia Repair. Am Surg 2019; 85:494-500. [PMID: 31126362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Up to one in three readmissions occur at a different hospital and are thus missed by current quality metrics. There are no national studies examining 30-day readmission, including to different hospitals, after umbilical hernia repair (UHR). We tested the hypothesis that a large proportion were readmitted to a different hospital, that risk factors for readmission to a different hospital are unique, and that readmission costs differed between the index and different hospitals. The 2013 to 2014 Nationwide Readmissions Database was queried for patients admitted for UHR, and cost was calculated. Multivariate logistic regression identified risk factors for 30-day readmission at index and different hospitals. There were 102,650 admissions for UHR and 8.9 per cent readmissions, of which 15.8 per cent readmissions were to a different hospital. The most common reason for readmission was infection (25.8%). Risk factors for 30-day readmission to any hospital include bowel resection, index admission at a for-profit hospital, Medicare, Medicaid, and Charlson Comorbidity Index ≥ 2. Risk factors for 30-day readmission to a different hospital include elective operation, drug abuse, discharge to a skilled nursing facility, and leaving against medical advice. The median cost of initial admission was higher in those who were readmitted ($16,560 [$10,805-$29,014] vs $11,752 [$8151-$17,724], P < 0.01). The median cost of readmission was also higher among those readmitted to a different hospital ($9826 [$5497-$19,139] vs $9227 [$5211-$16,817], P = 0.02). After UHR, one in six readmissions occur at a different hospital, have unique risk factors, and are costlier. Current hospital benchmarks fail to capture this subpopulation and, therefore, likely underestimate UHR readmissions.
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Martinez RA, Parreco J, Ross RL. Missed Readmissions to a Different Hospital in Patients With Peripheral Vascular Disease Associated With Significantly Higher Mortality. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2018.10.021] [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: 11/25/2022]
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Parreco J, Eidelson SA, Revell S, Zakrison TL, Schulman CI, Rattan R. Nationwide risk factors for hospital readmission for subsequent injury after motor vehicle crashes. Traffic Inj Prev 2018; 19:S127-S132. [PMID: 30543465 DOI: 10.1080/15389588.2018.1540866] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 10/06/2018] [Accepted: 10/22/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Some drivers involved in motor vehicle crashes across the United States may be identified as at risk of subsequent injury by a similar mechanism. The purpose of this study was to perform a national review of the risk factors for hospitalization for a new injury due to a subsequent motor vehicle crash. It was hypothesized that presenting to a different hospital after subsequent injury would result in worse patient outcomes when compared to presentation at the same hospital. METHODS The Nationwide Readmissions Database for 2010-2014 was queried for all inpatient hospitalizations with injury related to motor vehicle traffic. The primary patient outcome of interest was subsequent motor vehicle crash-related injury within 1 year. The secondary patient outcomes were different hospital subsequent injury presentation, higher Injury Severity Score (ISS), longer length of stay (LOS), and in-hospital death after subsequent injury. The analysis of secondary patient outcomes was performed only on patients who were reinjured. Univariable analysis was performed for each outcome using all variables during the index admission. Multivariable logistic regression was performed using all significant (P < .05) variables on univariate analysis. Results were weighted for national estimates. RESULTS During the study period, 1,008,991 patients were admitted for motor vehicle-related injury; 12,474 patients (1.2%) suffered a subsequent injury within 1 year. From the reinjured patients, 32.9% presented to a different hospital, 48.9% had a higher ISS, and 22.1% had a longer LOS. The in-hospital mortality rate after subsequent injury was 1.1%. Presentation to a different hospital for subsequent injury was associated with a longer LOS (odds ratio [OR] = 1.32; 95% confidence interval [CI], 1.20-1.45; P < .01) and a higher ISS (OR = 1.38; 95% CI, 1.27-1.49; P < .01). Motorcyclists were more likely to suffer subsequent injury (OR = 1.39; 95% CI, 1.32-1.46; P < .01) and motorcycle passengers were more likely to present to a different hospital with a subsequent injury (OR = 2.49; 95% CI, 1.73-3.59; P < .01). Alcohol abuse was associated with subsequent injury (OR = 1.12; 95% CI, 1.07-1.18; P < .01). CONCLUSIONS Nearly a third of patients suffering subsequent motor vehicle crash-related injury after an initial motor vehicle crash in the United States present to a different hospital. These patients are more likely to suffer more severe injuries and longer hospitalizations due to their subsequent injury. Future efforts to prevent these injuries must consider the impact of this fragmentation of care and the implications for quality and cost improvements.
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Affiliation(s)
- Joshua Parreco
- a Department of Surgery , University of Miami Leonard M. Miller School of Medicine , Miami , Florida
| | - Sarah A Eidelson
- a Department of Surgery , University of Miami Leonard M. Miller School of Medicine , Miami , Florida
| | - Scott Revell
- a Department of Surgery , University of Miami Leonard M. Miller School of Medicine , Miami , Florida
| | - Tanya L Zakrison
- a Department of Surgery , University of Miami Leonard M. Miller School of Medicine , Miami , Florida
| | - Carl I Schulman
- a Department of Surgery , University of Miami Leonard M. Miller School of Medicine , Miami , Florida
| | - Rishi Rattan
- a Department of Surgery , University of Miami Leonard M. Miller School of Medicine , Miami , Florida
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Cortolillo N, Patel C, Parreco J, Kaza S, Castillo A. Nationwide outcomes and costs of laparoscopic and robotic vs. open hepatectomy. J Robot Surg 2018; 13:557-565. [PMID: 30484059 DOI: 10.1007/s11701-018-0896-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 08/28/2018] [Accepted: 11/20/2018] [Indexed: 12/16/2022]
Abstract
The safety of hepatectomy continues to improve and it holds a key role in the management of benign and malignant hepatic lesions. Laparoscopic and robotic approaches to hepatectomy are increasingly utilized. The purpose of this study was to compare outcomes and costs of laparoscopic and robotic vs. open approaches to hepatectomy and to determine the national nonelective postoperative readmission rate, including readmission to other hospitals. The Nationwide Readmission Database from 2013 to 2014 was queried for all patients undergoing hepatectomy. Patients undergoing laparoscopic and robotic hepatectomies were compared to patients undergoing open hepatectomy. Multivariate logistic regression was implemented to determine the odds ratios (OR) for non-elective readmission within 45 days. There were 10,870 patients who underwent hepatectomy from 2013 to 2014 and 724 (6.7%) were approached with laparoscopic or robotic technique. The robotic cohort had lower mean cost of the index admission ($24,983 ± $18,329 vs. open $32,391 ± $31,983, p < 0.001, 95% CI - 18,292 to 534), shorter LOS (4.5 ± 3.8 vs. lap 6.8 ± 6.0 vs. open 7.6 ± 7.7 days, p < 0.01), and were less likely to be readmitted within 45 days (7.9% vs. 13.0% lap vs. 13.8% open, p = 0.05). The robotic cohort was slightly younger (mean age 57.5 ± 13.5 vs. lap 60.1 ± 13.8 vs. open 58.9 ± 13.7, p < 0.05), and no significant differences were seen by Charlson Comorbidity Index. Anastomosis of hepatic duct to GI tract carried higher odds of mortality (OR 2.87, p < 0.01) and higher odds of readmission (OR 1.40, p < 0.01). LOS above 7 days increased odds of readmission (OR 2.24, p < 0.01). Nearly one-fifth of patients readmitted after hepatectomy present to a different hospital. Robotic hepatectomy was associated with favorable cost and readmission outcomes compared to laparoscopic and open hepatectomy patients, despite similar patient comorbid burdens and patient's age. Length of stay over 7 days and anastomosis of hepatic duct to GI tract are strong risk factors for readmission and mortality.
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Affiliation(s)
- Nicholas Cortolillo
- Department of Surgery, University of Miami Miller School of Medicine, 5301 S. Congress Av, Atlantis, FL, 33462, USA.
| | - Chetan Patel
- Department of Surgery, University of Miami Miller School of Medicine, 5301 S. Congress Av, Atlantis, FL, 33462, USA
| | - Joshua Parreco
- Department of Surgery, University of Miami Miller School of Medicine, 5301 S. Congress Av, Atlantis, FL, 33462, USA
| | - Srinivas Kaza
- Department of Surgery, University of Miami Miller School of Medicine, 5301 S. Congress Av, Atlantis, FL, 33462, USA
| | - Alvaro Castillo
- Department of Surgery, University of Miami Miller School of Medicine, 5301 S. Congress Av, Atlantis, FL, 33462, USA
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Rattan R, Parreco J, Eidelson SA, Gold J, Vasileiou G, Zakrison TL, Yeh DD, Namias N. Missed Venous Thromboembolism after Major Cancer Surgery. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.150] [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: 11/15/2022]
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Eidelson SA, Rattan R, Parreco J, Mulder MB, Proctor KG, Hilton LR. National Analysis of Missed Venous Thromboembolism after Bariatric Surgery: Are We Missing Our Own Complications? J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.029] [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: 11/15/2022]
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Buicko JL, Lopez MA, Parreco J, Rice A, Fahey TJ. Risk Factors and Costs Associated with Nationwide Non-Elective Readmissions after Thyroidectomy. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.330] [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: 10/28/2022]
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Parreco J, Crandall ML, Ebler D, Namias N, Rattan R. Nationwide Outcomes and Risk Factors for Reinjury after Penetrating Trauma. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.644] [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: 11/16/2022]
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Martinez R, Gaffney L, Parreco J, Eby M, Hayson A, Donath E, Bathaii M, Finch M, Zeltzer J. Nationally Representative Readmission Factors Associated with Endovascular versus Open Repair of Abdominal Aortic Aneurysm. Ann Vasc Surg 2018; 53:105-116. [PMID: 30092423 DOI: 10.1016/j.avsg.2018.04.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/27/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Hospital readmissions are tied to financial penalties and thus significantly influence health-care policy. Many current studies on readmissions lack national representation by not tracking readmissions across hospitals. The recently released Nationwide Readmission Database is one of the most comprehensive national sources of readmission data available, making it an invaluable resource to understand this critically important health policy issue. METHODS The Nationwide Readmission Database for 2013 and 2014 was queried for adult patients with abdominal aortic aneurysm (441.4) undergoing endovascular (39.71) or open (38.44) repair. Outcomes examined were overall/initial admission mortality and overall/30-day readmissions. Multivariate logistic regression for these outcomes was also performed on multiple readmission factors. RESULTS Fifty-three thousand four hundred seventeen patients underwent abdominal aortic aneurysm repair (47,431 endovascular aortic repair [EVAR] versus 5,986 open surgical repair [OSR]). Significant differences were found for EVAR versus OSR on overall readmissions, initial admission cost, readmission costs, length of stay, days to readmission, and overall/initial admission mortality. Multivariate logistic regression analysis found that length of stay > 30, Charlson Comorbidity Index > 1, discharge disposition, and female sex were all significant predictors of 30-day readmission. Repair type was significantly associated with 30-day readmissions; however, it was not a significant factor for overall readmissions. CONCLUSION There are significant differences in costs, prognosis, and readmission rates for EVAR versus OSR. Given that these differences are being used to create "acceptable" readmission rates, disbursement quotas among hospitals, and subsequent penalties for providers outside the expected rates, it is only prudent to obtain the most accurate information to guide those policies. LEVEL OF EVIDENCE Care management/epidemiological, level IV.
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Affiliation(s)
- Rennier Martinez
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL.
| | - Lukas Gaffney
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Joshua Parreco
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Marcus Eby
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Aaron Hayson
- Department of Surgery, Florida State University, Tallahassee, FL
| | - Elie Donath
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Mehdi Bathaii
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Michael Finch
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Jack Zeltzer
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL
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Parreco J, Alawa N, Rattan R, Tashiro J, Sola JE. Teenage Trauma Patients Are at Increased Risk for Readmission for Mental Diseases and Disorders. J Surg Res 2018; 232:415-421. [PMID: 30463750 DOI: 10.1016/j.jss.2018.06.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 06/11/2017] [Revised: 05/28/2018] [Accepted: 06/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Most studies of readmission after trauma are limited to single institutions or single states. The purpose of this study was to determine the risk factors for readmission after trauma for mental illness including readmissions to different hospitals across the United States. MATERIALS AND METHODS The Nationwide Readmission Database for 2013 and 2014 was queried for all patients aged 13 to 64 y with a nonelective admission for trauma and a nonelective readmission within 30 d. Multivariable logistic regression was performed for readmission for mental diseases and disorders. RESULTS During the study period, 53,402 patients were readmitted within 30 d after trauma. The most common major diagnostic category on readmission was mental diseases and disorders (12.1%). The age group with the highest percentage of readmissions for mental diseases and disorders was 13 to 17 y (38%). On multivariable regression, the teenage group was also the most likely to be readmitted for mental diseases and disorders compared to 18-44 y (odds ratio [OR] 0.45, P < 0.01) and 45-64 y (OR 0.24, P < 0.01). Other high-risk comorbidities included HIV infection (OR 2.4, P < 0.01), psychosis (OR 2.2, P < 0.01), drug (OR 2.0, P < 0.01), and alcohol (OR 1.4, P < 0.01) abuse. CONCLUSIONS Teenage trauma patients are at increased risk for hospital readmission for mental illness. Efforts to reduce these admissions should be targeted toward individuals with high-risk comorbidities such as HIV infection, psychosis, and substance abuse.
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Affiliation(s)
- Joshua Parreco
- Department of Surgery, DeWitt-Daughtry Family, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Nawara Alawa
- Department of Surgery, DeWitt-Daughtry Family, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Rishi Rattan
- Department of Surgery, DeWitt-Daughtry Family, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Jun Tashiro
- Department of Surgery, DeWitt-Daughtry Family, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Juan E Sola
- Department of Surgery, DeWitt-Daughtry Family, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida.
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Parreco J, Hidalgo A, Kozol R, Namias N, Rattan R. Predicting Mortality in the Surgical Intensive Care Unit Using Artificial Intelligence and Natural Language Processing of Physician Documentation. Am Surg 2018; 84:1190-1194. [PMID: 30064586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The purpose of this study was to use natural language processing of physician documentation to predict mortality in patients admitted to the surgical intensive care unit (SICU). The Multiparameter Intelligent Monitoring in Intensive Care III database was used to obtain SICU stays with six different severity of illness scores. Natural language processing was performed on the physician notes. Classifiers for predicting mortality were created. One classifier used only the physician notes, one used only the severity of illness scores, and one used the physician notes with severity of injury scores. There were 3838 SICU stays identified during the study period and 5.4 per cent ended with mortality. The classifier trained with physician notes with severity of injury scores performed with the highest area under the curve (0.88 ± 0.05) and accuracy (94.6 ± 1.1%). The most important variable was the Oxford Acute Severity of Illness Score (16.0%). The most important terms were "dilated" (4.3%) and "hemorrhage" (3.7%). This study demonstrates the novel use of artificial intelligence to process physician documentation to predict mortality in the SICU. The classifiers were able to detect the subtle nuances in physician vernacular that predict mortality. These nuances provided improved performance in predicting mortality over physiologic parameters alone.
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Parreco J, Hidalgo A, Kozol R, Namias N, Rattan R. Predicting Mortality in the Surgical Intensive Care Unit Using Artificial Intelligence and Natural Language Processing of Physician Documentation. Am Surg 2018. [DOI: 10.1177/000313481808400736] [Citation(s) in RCA: 11] [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] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to use natural language processing of physician documentation to predict mortality in patients admitted to the surgical intensive care unit (SICU). The Multiparameter Intelligent Monitoring in Intensive Care III database was used to obtain SICU stays with six different severity of illness scores. Natural language processing was performed on the physician notes. Classifiers for predicting mortality were created. One classifier used only the physician notes, one used only the severity of illness scores, and one used the physician notes with severity of injury scores. There were 3838 SICU stays identified during the study period and 5.4 per cent ended with mortality. The classifier trained with physician notes with severity of injury scores performed with the highest area under the curve (0.88 ± 0.05) and accuracy (94.6 ± 1.1%). The most important variable was the Oxford Acute Severity of Illness Score (16.0%). The most important terms were “dilated” (4.3%) and “hemorrhage” (3.7%). This study demonstrates the novel use of artificial intelligence to process physician documentation to predict mortality in the SICU. The classifiers were able to detect the subtle nuances in physician vernacular that predict mortality. These nuances provided improved performance in predicting mortality over physiologic parameters alone.
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Affiliation(s)
| | | | | | - Nicholas Namias
- Division of Trauma Surgery and Surgical Critical Care, Department of Surgery, University of Miami Miller School of Medicine, Atlantis, Florida
| | - Rishi Rattan
- Division of Trauma Surgery and Surgical Critical Care, Department of Surgery, University of Miami Miller School of Medicine, Atlantis, Florida
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Eidelson SA, Parreco J, Mulder MB, Dharmaraja A, Kaufman JI, Proctor KG, Pizano LR, Schulman CI, Namias N, Rattan R. Variation in National Readmission Patterns After Burn Injury. J Burn Care Res 2018; 39:670-675. [DOI: 10.1093/jbcr/iry034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Sarah A Eidelson
- DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Florida
| | - Joshua Parreco
- DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Florida
| | - Michelle B Mulder
- DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Florida
| | - Arjuna Dharmaraja
- DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Florida
| | - Joyce I Kaufman
- DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Florida
| | - Kenneth G Proctor
- DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Florida
| | - Louis R Pizano
- DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Florida
| | - Carl I Schulman
- DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Florida
| | - Nicholas Namias
- DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Florida
| | - Rishi Rattan
- DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Florida
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Parreco J, Hidalgo A, Parks JJ, Kozol R, Rattan R. Using artificial intelligence to predict prolonged mechanical ventilation and tracheostomy placement. J Surg Res 2018; 228:179-187. [PMID: 29907209 DOI: 10.1016/j.jss.2018.03.028] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [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: 11/30/2017] [Revised: 02/07/2018] [Accepted: 03/14/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Early identification of critically ill patients who will require prolonged mechanical ventilation (PMV) has proven to be difficult. The purpose of this study was to use machine learning to identify patients at risk for PMV and tracheostomy placement. MATERIALS AND METHODS The Multiparameter Intelligent Monitoring in Intensive Care III database was queried for all intensive care unit (ICU) stays with mechanical ventilation. PMV was defined as ventilation >7 d. Classifiers with a gradient-boosted decision trees algorithm were created for the outcomes of PMV and tracheostomy placement. The variables used were six different severity-of-illness scores calculated on the first day of ICU admission including their components and 30 comorbidities. Mean receiver operating characteristic curves were calculated for the outcomes, and variable importance was quantified. RESULTS There were 20,262 ICU stays identified. PMV was required in 13.6%, and tracheostomy was performed in 6.6% of patients. The classifier for predicting PMV was able to achieve a mean area under the curve (AUC) of 0.820 ± 0.016, and tracheostomy was predicted with an AUC of 0.830 ± 0.011. There were 60.7% patients admitted to a surgical ICU, and the classifiers for these patients predicted PMV with an AUC of 0.852 ± 0.017 and tracheostomy with an AUC of 0.869 ± 0.015. The variable with the highest importance for predicting PMV was the logistic organ dysfunction score pulmonary component (13%), and the most important comorbidity in predicting tracheostomy was cardiac arrhythmia (12%). CONCLUSIONS This study demonstrates the use of artificial intelligence through machine-learning classifiers for the early identification of patients at risk for PMV and tracheostomy. Application of these identification techniques could lead to improved outcomes by allowing for early intervention.
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Affiliation(s)
- Joshua Parreco
- DeWitt Daughtry Family Department of Surgery, University of Miami, Miller School of Medicine, Miami, Florida
| | - Antonio Hidalgo
- DeWitt Daughtry Family Department of Surgery, University of Miami, Miller School of Medicine, Miami, Florida
| | - Jonathan J Parks
- DeWitt Daughtry Family Department of Surgery, University of Miami, Miller School of Medicine, Miami, Florida
| | - Robert Kozol
- DeWitt Daughtry Family Department of Surgery, University of Miami, Miller School of Medicine, Miami, Florida
| | - Rishi Rattan
- Division of Trauma Surgery and Surgical Critical Care, DeWitt Daughtry Family Department of Surgery, University of Miami, Miller School of Medicine, Miami, Florida.
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Rattan R, Parreco J, Lindenmaier LB, Yeh DD, Zakrison TL, Pust GD, Sands LR, Namias N. Underestimation of Unplanned Readmission after Colorectal Surgery: A National Analysis. J Am Coll Surg 2018; 226:382-390. [DOI: 10.1016/j.jamcollsurg.2017.12.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 12/06/2017] [Indexed: 10/18/2022]
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Martinez RA, Shnayder MM, Parreco J, Eby M, Cortolillo N, Lopez M, Zeltzer J. Nationally Representative Readmission Factors in Patients with Claudication Vs Critical Limb Ischmia. Ann Vasc Surg 2018. [DOI: 10.1016/j.avsg.2017.11.022] [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: 10/18/2022]
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Rattan R, Parreco J, Zakrison TL, Yeh DD, Lieberman HM, Namias N. Same-Hospital Re-Admission Rate Is Not Reliable for Measuring Post-Operative Infection-Related Re-Admission. Surg Infect (Larchmt) 2017; 18:904-909. [PMID: 29027888 DOI: 10.1089/sur.2017.127] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Post-operative infections cause morbidity, consume resources, and are an important quality measure in assessing and comparing hospitals. Commonly used metrics do not account for re-admission to a different hospital. The Nationwide Readmissions Database (NRD) tracks re-admissions across United States (US) hospitals. Infection-related re-admission across US hospitals has not been studied previously. PATIENTS AND METHODS The 2013 NRD was queried for admissions with a primary International Classification of Diseases and Related Health Problems, 9th revision, Clinical Modification code for the most frequently performed operations. Non-elective all-cause, infection-related, and different hospital 30-day re-admission rates were calculated, using All Patient Refined Diagnosis Related Groups codes. Multi-variable logistic regression identified risk factors for re-admission. RESULTS Of 826,836 surviving to discharge, 39,281 (4.8%) had an unplanned re-admission within 30 days, occurring at a different hospital 20.5% of the time. The most common reason for re-admission was infection (25.1%). Orthopedic and spinal procedures were at highest risk for all-cause and infection-related different hospital re-admission. Infection-related different hospital re-admission risk factors included: Length of stay >30 days (odds ratio [OR] 2.28 [1.62-3.21], p < 0.01), age ≥65 years (OR 1.56 [1.38-1.76], p < 0.01), and Charlson Comorbidity Index >1 (OR 1.14 [1.01-1.28], p < 0.01) and differed from predictors of same-hospital infectious re-admission. Non-elective surgical procedure (OR 0.79 [0.72-0.87], p < 0.01) and initial hospitalization at a large hospital (OR 0.66 [0.59-0.74], p < 0.01) were protective. CONCLUSION A substantial proportion of post-operative re-admissions are missed by same-hospital re-admission data. All-cause and infection-related post-operative re-admissions to a different hospital are affected by unique patient and institution-specific factors. Re-admission reduction programs, quality metrics, and policy based on same hospital re-admission data should be updated to incorporate different hospital re-admission.
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Affiliation(s)
- Rishi Rattan
- Department of Surgery, University of Miami Miller School of Medicine , Miami, Florida
| | - Joshua Parreco
- Department of Surgery, University of Miami Miller School of Medicine , Miami, Florida
| | - Tanya L Zakrison
- Department of Surgery, University of Miami Miller School of Medicine , Miami, Florida
| | - D Dante Yeh
- Department of Surgery, University of Miami Miller School of Medicine , Miami, Florida
| | - Howard M Lieberman
- Department of Surgery, University of Miami Miller School of Medicine , Miami, Florida
| | - Nicholas Namias
- Department of Surgery, University of Miami Miller School of Medicine , Miami, Florida
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Zarak A, Parreco J, Tuggle K, Duncan T. Predictors for 30-Day Readmissions After Laparoscopic Bariatric Surgery. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.064] [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: 11/16/2022]
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42
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Kichler K, Parreco J, Kozol R, Tamariz L. Cardiopulmonary bypass and coronary artery bypass grafting in patients with morbid obesity: outcomes from a single-center database. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.321] [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: 10/18/2022]
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Parreco J, Lopez M, Ross R, Rattan R. Comparing Outcomes and Costs Between Vascular and Nonvascular Trauma: Injury Severity Classification Is Not an Accurate Predictor in Vascular Trauma. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.103] [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: 11/17/2022]
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Cortolillo N, Parreco J, Martinez R, Puchferran C, Castillo A. Nationwide Analysis of Costs and Outcomes of Treating Acute Cholecystitis in Patients with Portal Hypertension. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.859] [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: 11/26/2022]
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Parreco J, Zakrison TL, Rattan R. Risk Factors for the Development of Episodic Mood Disorders after Penetrating Trauma. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.1031] [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: 10/18/2022]
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Buicko JL, Parreco J, Willobee BA, Wagenaar AE, Sola JE. Risk factors for nonelective 30-day readmission in pediatric assault victims. J Pediatr Surg 2017; 52:1628-1632. [PMID: 28483166 DOI: 10.1016/j.jpedsurg.2017.04.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 04/02/2017] [Accepted: 04/18/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE Hospital readmission in trauma patients is associated with significant morbidity and increased healthcare costs. There is limited published data on early hospital readmission in pediatric trauma patients. As presently in healthcare outcomes and readmissions rates are increasingly used as hospital quality indicators, it is paramount to recognize risk factors for readmission. We sought to identify national readmission rates in pediatric assault victims and identify the most common readmission diagnoses among these patients. METHODS The Nationwide Readmission Database (NRD) for 2013 was queried for all patients under 18years of age with a non-elective admission with an E-code that is designed as assault using National Trauma Data Bank Standards. Multivariate logistic regression was implemented using 18 variables to determine the odds ratios (OR) for non-elective readmission within 30-days. RESULTS There were 4050 pediatric victims of assault and 92 (2.27%) died during the initial admission. Of the surviving patients 128 (3.23%) were readmitted within 30days. Of these readmitted patients 24 (18.75%) were readmitted to a different hospital and 31 (24.22%) were readmitted for repeated assault. The variables associated with the highest risk for non-elective readmission within 30-days were: length of stay (LOS) >7days (OR 3.028, p<0.01, 95% CI 1.67-5.50), psychoses (OR 3.719, p<0.01, 95% CI 1.70-8.17), and weight loss (OR 4.408, p<0.01, 95% CI 1.92-10.10). The most common readmission diagnosis groups were bipolar disorders (8.2%), post-operative, posttraumatic, or other device infections (6.2%), or major depressive disorders and other/unspecified psychoses (5.2%). CONCLUSIONS Readmission after pediatric assault represents a significant resource burden and almost a quarter of those patients are readmitted after a repeated assault. Understanding risk factors and reasons for readmission in pediatric trauma assault victims can improve discharge planning, family education, and outpatient support, thereby decreasing overall costs and resource burden. Psychoses, weight loss, and prolonged hospitalization are independent prognostic indicators of readmission in pediatric assault patients. LEVEL OF EVIDENCE Level IV - Prognostic and Epidemiological - Retrospective Study.
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Affiliation(s)
- Jessica L Buicko
- Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Joshua Parreco
- Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Brent A Willobee
- Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Amy E Wagenaar
- Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Juan E Sola
- Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA.
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Buicko JL, Parreco J, Abel SN, Lopez MA, Sola JE, Perez EA. Pediatric laparoscopic appendectomy, risk factors, and costs associated with nationwide readmissions. J Surg Res 2017; 215:245-249. [DOI: 10.1016/j.jss.2017.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 03/09/2017] [Accepted: 04/11/2017] [Indexed: 01/07/2023]
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