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AUTOMATED MACHINE LEARNING WITH AUTOGLUON TO PREDICT POSTOPERATIVE PNEUMONIA USING THE AMERICAN COLLEGE OF SURGEONS' NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM DATABASE [Meeting Abstract]

Brill, Kenneth; Thangirala, Avinash; Aphinyanaphongs, Yin; Chen, Ji; Hu, Eric; Kelleher, Andrew C.; Martin, Jacob; Oeding, Jacob F.; Ostberg, Nicolai; Katz, Gregory; Brejt, Shelly; Ramanathan, Rudra; Kan, Karen
ISI:000895468902427
ISSN: 0012-3692
CID: 5522432

[S.l.] : Core IM, 2021

5 Pearls on Dual Antiplatelet Therapy (DAPT)

Katz, Greg; Harmon, Evan; Villines, Todd; Iqbal, Sohah; Ragosta, Michael; Kassapidis, Vickie; Trivedi, Shreya P
(Website)
CID: 5325832

Systemic Lupus Erythematosus and Increased Prevalence of Atherosclerotic Cardiovascular Disease in Hospitalized Patients

Katz, Gregory; Smilowitz, Nathaniel R; Blazer, Ashira; Clancy, Robert; Buyon, Jill P; Berger, Jeffrey S
OBJECTIVE:To assess the prevalence of atherosclerotic cardiovascular disease (ASCVD) and its individual phenotypes of coronary artery disease (CAD), peripheral artery disease (PAD), and cerebrovascular disease by age and sex in a large US cohort of hospitalized patients with systemic lupus erythematosus (SLE). METHODS:A nested case-control study of adults with and without SLE was conducted from the January 1, 2008, through December 31, 2014, National Inpatient Sample. Hospitalized patients with SLE were matched (1:3) by age, sex, race, and calendar year to hospitalized patients without SLE. The prevalences of CAD, PAD, and cerebrovascular disease were evaluated, and associations with SLE were determined after adjustment for common cardiovascular risk factors. RESULTS:Among the 252,676 patients with SLE and 758,034 matched patients without SLE, the mean age was 51 years, 89% were women, and 49% were white. Patients with SLE had a higher prevalence of ASCVD vs those without SLE (25.6% vs 19.2%; OR, 1.45; 95% CI, 1.44-1.47; P<.001). After multivariable adjustment, SLE was associated with a greater odds of ASCVD (adjusted odds ratio [aOR], 1.46; 95% CI, 1.41-1.51). The association between SLE and ASCVD was observed in women and men and was attenuated with increasing age. Also, SLE was associated with increased odds of CAD (aOR, 1.42; 95% CI, 1.40-1.44), PAD (aOR, 1.25; 95% CI, 1.22-1.28), and cerebrovascular disease (aOR, 1.68; 95% CI, 1.65-1.71). CONCLUSION/CONCLUSIONS:In hospitalized US patients, SLE was associated with increased ASCVD prevalence, which was observed in both sexes and was greatest in younger patients.
PMID: 31303426
ISSN: 1942-5546
CID: 3977552

Systemic lupus erythematosus and the risk of perioperative major adverse cardiovascular events

Smilowitz, Nathaniel R; Katz, Gregory; Buyon, Jill P; Clancy, Robert M; Berger, Jeffrey S
Systemic lupus erythematosus (SLE) is a significant risk factor for cardiovascular disease. The relationship between SLE and perioperative cardiovascular risks following non-cardiac surgery is uncertain. We investigated associations between a diagnosis of SLE and outcomes following major non-cardiac surgery in a large national database from the United States. Patients age ≥ 18 years requiring major non-cardiac surgery were identified from Healthcare Cost and Utilization Project's National Inpatient Sample data from 2004 to 2014. Systemic lupus erythematosus and perioperative major adverse cardiovascular events (MACE; myocardial infarction, ischemic stroke or death) were defined by ICD-9 diagnosis codes. Perioperative MACE were reported for SLE patients stratified by age and sex. From 2004 to 2014, a total of 17,853,194 hospitalizations for major non-cardiac surgery met study inclusion criteria. SLE was identified in 70,578 (0.4%) hospitalizations. Overall, the frequency of perioperative MACE was higher in patients with vs. without SLE [2.4 vs. 2.0%, p < 0.001; adjusted OR (aOR) 1.25; 95% CI 1.18-1.31]. Perioperative MACE associated with SLE was largely driven by increased death (aOR 1.58 95% CI 1.40-1.77) and myocardial infarction (aOR 1.32; 95% CI 1.05-1.66) in younger patients with SLE. The increased risk of perioperative MACE associated with SLE in younger patients was attenuated with increasing age. A diagnosis of SLE is associated with increased risk of perioperative MACE, particularly among younger patients. Efforts to improve the perioperative management and outcomes of patients with SLE are needed.
PMCID:5756514
PMID: 29230625
ISSN: 1573-742x
CID: 2844452

Echocardiography in acute neurologic syndrome

Chapter by: Katz, G; Saric, M
in: Echocardiography in the CCU by
pp. 113-132
ISBN: 9783319902784
CID: 3330112

Drug-eluting stents: the past, present, and future

Katz, Gregory; Harchandani, Bhisham; Shah, Binita
Since the advent of percutaneous coronary intervention, enormous advances have been made in the treatment of coronary artery disease. Angioplasty and bare metal stents were plagued by high rates of restenosis leading to repeat revascularization procedures. Examination of the underlying pathophysiology of restenosis led to the development of drug-eluting stents to reduce neointimal hyperplasia. However, as restenosis rates declined, length of dual antiplatelet therapy use and risk of long-term stent thrombosis associated with drug-eluting stents increased. Subsequent generations have improved each facet of stent design. Novel alloys maintain durability and reduce strut thickness to increase deliverability, biocompatible polymers decrease the inflammatory response and improve drug elution kinetics, and new generations of drugs predictably inhibit restenosis. Developments on the horizon include stents with bioabsorbable polymers and platforms. The purpose of this review is to assess the evolution of stent design and the evidence behind each generation and to peer into the future of stent technology.
PMID: 25651784
ISSN: 1523-3804
CID: 1457632

Applying quality principles to orthopaedic surgery

Katz, Gregory; Ong, Crispin; Hutzler, Lorraine; Zuckerman, Joseph D; Bosco, Joseph A 3rd
The unsustainable rising cost of medical care is creating financial pressures that will critically alter the way that health care is paid for and delivered. Limited resources dictate that physicians must become more efficient at providing high quality care. In an effort to provide financial incentive for delivering quality care, the federal government instituted value-based purchasing to transform Medicare from a passive payer of claims to an active purchaser of medical care. Healthcare providers must follow the basic tenants of certain quality principles to maximize reimbursement under the value-based purchasing system.
PMID: 24720331
ISSN: 0065-6895
CID: 934602

The Persistence of Staphylococcus aureus Decolonization After Mupirocin and Topical Chlorhexidine: Implications for Patients Requiring Multiple or Delayed Procedures

Immerman, Igor; Ramos, Nicholas L; Katz, Gregory M; Hutzler, Lorraine H; Phillips, Michael S; Bosco, Joseph A 3rd
Preoperative screening and decolonization of methicillin-sensitive and methicillin-resistant Staphylococcus aureus (MSSA and MRSA, respectively) are advocated to reduce surgical site infections. We determined the rate and duration of decolonization in patients undergoing elective orthopedic surgery. Patients undergoing elective orthopedic surgery were seen in our preoperative testing program (PAT) and had their anterior nares cultured for MRSA and MSSA. All patients were treated with intranasal mupirocin and a topical chlorhexidine solution. A cohort of patients returned to PAT before a subsequent elective procedure and were recultured. All culture results and time between PAT visits were recorded, and the rates of successful initial and persistent decolonization were determined. Six hundred ten patients visited PAT 1290 times. Overall, 94 (70.1%) of 134 patients with initially MRSA- or MSSA-positive cultures remained decolonized at a mean time of 156 days (SD=140), whereas 40 patients (29.9%) were not decolonized by the time of repeat testing at a mean time of 213 days (SD=187). At repeat testing, there were 2 newly MRSA-positive and 35 newly MSSA-positive patients. Staphylococcus aureus decolonization with intranasal mupirocin and topical chlorhexidine was effective but not persistent in a significant proportion of patients. A small number of previously uncolonized patients became colonized. Staphylococcus aureus screening and decolonization protocols must be repeated before any readmission, regardless of prior colonization status.
PMID: 22397861
ISSN: 0883-5403
CID: 167500

Maintenance of certification and keys to passing the recertification examination

Katz, Gregory; Bosco, Joseph A
The American Board of Orthopaedic Surgery requires that each board-certified orthopaedic surgeon recertify every 10 years. This formal procedure of demonstrating competence as a surgeon, which used to be known as recertification, has been replaced by a more comprehensive process termed maintenance of certification (MOC). Even an experienced orthopaedic surgeon may find achieving MOC a daunting prospect. Simply preparing for and taking the recertification examination is an enormous challenge, but it is important to remember that the examination is merely one aspect of maintaining certification. Prior to sitting for the examination, each physician is required to complete the other MOC requirements, including amassing continuing medical education credits, compiling a case list, and soliciting peer recommendations. Familiarity with the MOC process, understanding the details of the examination, and proper preparation techniques will help orthopaedic surgeons gain insights into how to approach MOC.
PMID: 22301264
ISSN: 0065-6895
CID: 201762

Medical clearance risk rating as a predictor of perioperative complications after total hip arthroplasty

Schwarzkopf, Ran; Katz, Gregory; Walsh, Michael; Lafferty, Paul M; Slover, James D
Hip arthroplasty has become the standard treatment of end-stage osteoarthritis. However, postoperative complications are the risks associated with joint arthroplasty, which most significantly impact patient results and the total cost of care. Currently, no predictive system has been developed for categorizing levels of risk for the development of postoperative complications in patients undergoing total hip arthroplasty. We examined the association between the medical clearance risk rating by the physician performing the preoperative clearance examination and postoperative complications after total hip arthroplasty. We have demonstrated a significant association between the medical clearance risk rating and postoperative urinary track infection, and the American Society of Anesthesiologist score but no significant association to other complications. This study presents a predictive patient characteristic that may help us identify among our patients the ones that may benefit from a personally tailored preoperative planning and evaluation but demonstrates further work is necessary to better predict the risk of complications after total hip arthroplasty
PMID: 20452180
ISSN: 1532-8406
CID: 117335