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Factors Associated with Short-Term Morbidity in Patients Undergoing Colon Resection for Crohn's Disease

Aydinli, H Hande; Aytac, Erman; Remzi, Feza H; Bernstein, Mitchell; Grucela, Alexis L
BACKGROUND:Patients undergoing colon resection for Crohn's disease are at risk of developing postoperative complications. The aim of this study is to identify factors associated with short-term (30-day) morbidity in patients undergoing colon resection for Crohn's disease from a national database. METHODS:Patients who underwent colon resection for Crohn's disease in 2015 were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. The groups were classified based on presence of postoperative 30-day complications. The overall morbidity was calculated by including patients who had at least one postoperative complication. Demographics, preoperative, and operative factors were assessed and compared between the two groups. Further multivariate logistic regression analysis was conducted. RESULTS:A total of 1643 patients met the inclusion criteria [mean age of 41.2 (± 15.5) years, 871 (53%) female]. Sixty percent (n = 993) of the procedures were performed laparoscopically and 128 (12.8%) cases were converted to open. Ninety-five patients (5%) underwent emergent resections. Thirty percent (n = 507) of patients had at least one postoperative complication within 30 days of surgery. Ileus (16%), transfusion (7%), and organ-space surgical site infection (6%) were the most common morbidities. Independent risk factors for postoperative morbidity were male gender (p = 0.01), open surgery (p = 0.002), preoperative severe anemia (p = 0.001), and preoperative weight loss (p = 0.04). CONCLUSION/CONCLUSIONS:Approximately one third of the patients who undergo colon resection for Crohn's disease experience postoperative complications. Preoperative optimization of nutrition and anemia may improve outcomes. Laparoscopic technique appears to be the preferred surgical treatment option for resection when feasible.
PMID: 29663305
ISSN: 1873-4626
CID: 3043022

Consensus Statement of Definitions for Anorectal Physiology Testing and Pelvic Floor Terminology (Revised)

Bordeianou, Liliana G; Carmichael, Joseph C; Paquette, Ian M; Wexner, Steven; Hull, Tracy L; Bernstein, Mitchell; Keller, Deborah S; Zutshi, Massarat; Varma, Madhulika G; Gurland, Brooke H; Steele, Scott R
PMID: 29521821
ISSN: 1530-0358
CID: 3333842

Robotic subtotal colectomy for severe acute ulcerative colitis is as safe as laparoscopic approach [Meeting Abstract]

Lynn, P; Schwartzberg, D; Hande, Aydinli H; Bernstein, M; Grucela, A
Introduction: Laparoscopic subtotal colectomy (LSTC) was initially controversial in patients with severe acute Ulcerative Colitis (UC) given patients' severity of illness, toxicity, and technical factors such as colonic dilatation. Since then, it has been shown to be feasible and safe in experienced hands. The development and adoption of the Intuitive da Vinci Xi Robot has allowed ease of use for multiquadrant surgery with minimal docking time. Our goal is to compare the intra-operative and postoperative outcomes of our early experience with Robotic Subtotal Colectomy (RSTC) vs. LSTC. Methods: We queried our prospectively maintained database of patients who underwent RSTC from 2015 to 2017. We identified patients who underwent RSTC for severe acute UC and compared them to a matched cohort of patients who underwent LSTC for the same diagnosis. Statistical significance was set at 0.05. The Intuitive da Vinci Xi was used for all Robotic approaches. Port placement and specimen extraction (via the ileostomy site) were uniform within both groups. Results: We identified 6 patients who underwent RSTC (4 females, median age: 41.5 years) and 13 patients who underwent LSTC (6 females, median age: 29 years). They were well matched for gender and demographic variables. The RSTC group had more patients with significant comorbidities (5/6= 83%) than the LSTC group (3/13=23%)(p=0.01). There wereno differences inoperative time (mean RSTC 314.0 vs. LSTC 294 minutes, p=0.5) orestimated blood loss (RSTC79mlvs. LSTC 75ml,p= 0.9). Mean length ofstay was shorter (1.2 days) for RTSC (3.4 vs.4.6 days, p=0.2) andreturnofbowel function was earlier (0.7 days) in the RSTC group (1.3 vs. 2 days, p=0.1), however, these were not statistically different. There were no intraoperative complications in either group. Postoperative major complication rates were similar (RSTC, 1/6=16% vs.3/13=23% for LSTC; p=0.9). Read-mission rate was less for the RSTC group (16%) than LSTC group (38.4%) (p=0.3). No patient required reoperation in the RSTC group (0%) vs. 2 patients (15.3%) in the LSTC (p=0.2). Conclusions: RSTC for severe acute UC is at least as safe as the laparoscopic approach. Although the robotic cohort had more comorbidities, major postoperative complications, readmissions, and reoperation rates were less when compared to LSTC. RSTC was also associated with an earlier return of bowel function and shorter length of stay. A prospective study with larger numbers is needed to see if the superiority of robotic versus laparoscopic approaches is reproducible
EMBASE:622360555
ISSN: 1432-2218
CID: 3153942

Morbidity associated with colectomy for cecal volvulus: A nationwide analysis [Meeting Abstract]

Aydinli, H H; Aytac, E; Grieco, M J; Keshinro, A; Bernstein, M A; Remzi, F H
INTRODUCTION: The aim of this study was to evaluate 30-day postoperative morbidity in patients undergoing colectomy for cecal volvulus. METHODS: Patients who underwent surgery for cecal volvulus between 2012 and 2015 were identified from the American College of Surgeons-NSQIP by using current procedural terminology codes and ICD-9 code. Demographics, perioperative, and operative factors were assessed and compared between 2 groups, which were classified according to the presence or absence of postoperative morbidity. RESULTS: A total of 591 patients were identified with a mean age of 61.8 (range 18-89) of which 74% were female. Forty-three percent of patients had postoperative complications and 3% of patients died within 30 days of surgery. Most common postoperative complication was ileus (23%) followed by transfusion (10%) and superficial surgical site infection (8%). Mean length of stay was 8.5 days >=days and 9% of patients were readmitted within 30 days of surgery. African American (AA) race (odds ratio [OR]: 2.3, p=0.03), preoperative septic status (OR: 1.8, p=0.04) and wound class of 3-4 (OR: 1.9, p=0.01) were associated with 30-day postoperative morbidity. Length of stay (5.7+/- 2.6 vs 12.2+/- 10, p<0.0001) was longer and readmission rates (11 (3.2) vs 44 (17.1), p<0.0001) were higher among the patents with postoperative morbidity. CONCLUSIONS: Thirty-day postoperative morbidity in patients who underwent colectomy for cecal volvulus is high with a longer length of stay. Severity of infection seems strictly related to postoperative morbidity and individualized patient care can be designed based on the extent of infection in these patients
EMBASE:619489785
ISSN: 1879-1190
CID: 2862042

Practicality of exchanging transparent 3D CT for radiography for pelvic fractures

Hutten, Ryan; Lomasney, Laurie M; Vasilopoulos, Vasilios; Song, Albert; Chiang, Andrew; Bernstein, Mitchell; Summers, Hobie
OBJECTIVE:We assess the utility of transparent 3D reconstructed CT images for evaluation of traumatic pelvic bony injuries compared to traditional radiographs. METHODS:Radiographs and 3D reconstructed CT were anonymized and randomized before review by 4 board certified physicians using a standardized questionnaire and compared to a gold-standard axial CT by a fifth board certified physician. RESULTS:49 patients were included. We found significant agreement (K=[0.5-0.92], p<0.001) and comparable accuracy (K=[0.36-0.38], p<0.02) and ghost images of radiographs and transparent 3D reconstructed CT without a difference in confidence (p=0.38). CONCLUSION/CONCLUSIONS:Transparent 3D reconstructed CT images may be sufficient for pelvic trauma injury without the use of radiographs.
PMID: 28463744
ISSN: 1873-4499
CID: 3333792

Ultrassonografia Endoanal, Endovaginal e Transperineal

Chapter by: Deutsch, Michael; Bernstein, MA
in: Fisiologia anorretal by Oliveira, Lucia Camara Castro [Eds]
[S.l.] : Rubio Editora, 2017
pp. ?-?
ISBN: 9788584110711
CID: 2580542

Three-Year Cost-effectiveness Model for Non-Animal Stabilized Hyaluronic Acid and Dextranomer Copolymer Compared With Sacral Nerve Stimulation After Conservative Therapy for the Management of Fecal Incontinence

Bernstein, Mitchell A; Purdy, Christopher H; Becker, Alison; Magar, Raf
BACKGROUND: Two new therapies for fecal incontinence (FI) are now available: non-animal stabilized hyaluronic acid and dextranomer copolymer (NASHA/Dx) and sacral nerve stimulation (SNS). PURPOSE: This study aimed to determine the cost-effectiveness of NASHA/Dx compared with SNS and conservative therapy (CT) for the treatment of FI after CT failure. METHODS: Decision tree models with Markov subbranches were developed to compare all direct costs and outcomes during a 3-year period from the viewpoint of the US third-party payer. Costs (in 2013 US dollars) of devices, medical and surgical care, and hospitalization were included. Outcomes included quality-adjusted life-years (QALYs) and incontinence-free days (IFDs). Both costs and outcomes were discounted at an annual rate of 3%. The incremental cost-effectiveness ratio was calculated for each outcome. One-way and probabilistic sensitivity analyses were performed to examine robustness of results and model stability. A budget impact analysis was also undertaken to estimate the potential cost and savings of NASHA/Dx for a payer with 1,000,000 covered lives. RESULTS: For the 3-year cost-effectiveness models, the expected cost was $9053 for CT, $14,962 for NASHA/Dx, and $33,201 for SNS. The numbers of QALYs were 1.769, 1.929, and 2.004, respectively. The numbers of IFDs were 128.8, 267.6, and 514.8, respectively. The incremental cost-effectiveness ratios per additional IFD gained were $42.60 for NASHA/Dx vs CT, $73.76 for SNS vs NASHA/Dx, and $62.55 for SNS vs CT. The incremental costs per QALY gained were $37,036 for NASHA/Dx vs CT, $244,509 for SNS vs NASHA/Dx, and $103,066 for SNS vs CT. The budget impact analysis evaluated the financial effect on the health care system of the use of NASHA/Dx and SNS. For the scenarios evaluated, when all of the patients receive NASHA/Dx, the net annual effect to the health care payer budget ranged from $571,455 to $2,857,275. When all of the patients receive SNS, the net annual effect to the health care payer budget ranged from $1,959,323 to $9,796,613. CONCLUSION: Both NASHA/Dx and SNS have produced significant improvements in FI symptoms for affected patients. NASHA/Dx is a cost-effective and more efficient use of resources for the treatment of FI when compared with SNS. The budget impact analysis suggests that although reimbursement for NASHA/Dx treatment initially adds costs to the health care system, it is significantly less expensive than SNS for patients who are candidates for either treatment.
PMID: 24815061
ISSN: 0149-2918
CID: 1051732

A ten-year analysis of the research funding program of the orthopaedic trauma association

Bernstein, Mitchell; Desy, Nicholas M; Matache, Bogdan A; McKinley, Todd O; Harvey, Edward J
BACKGROUND:The Orthopaedic Trauma Association (OTA) awarded over $3 million in research grants during 2000 through 2009. However, little is known regarding the outcomes of this funding program. Given the continued constraints in securing research dollars, we evaluated the research funding program of the OTA over this ten-year period. We studied the association of grant funding with (1) the publication rate, (2) the cost per publication, (3) the journal impact factor for published manuscripts, and (4) the dollar amount of extramural funding secured. METHODS:Grants from the target period were identified with use of the OTA online archive. The title of each grant and the name of the principal investigator were used to search across seven scientific databases for associated publications. RESULTS:Over the study period, $3,507,050 was awarded through 131 grants (thirty-three clinical, thirty-nine basic science, and fifty-nine resident). A total of 202 associated publications (seventy-three for the clinical grants, eighty-four for the basic science grants, and forty-five for the resident grants) were identified. Twenty-two (67%) of the clinical grants led to at least one publication compared with thirty-one (79%) of the basic science grants and twenty-four (41%) of the resident grants. The cost per publication was $26,892 for the clinical grants compared with $11,357 for the basic science grants and $13,111 for the resident grants. The mean impact factor of the journals containing the publications was 2.58. CONCLUSIONS:Over the study period, the publication output for the funded projects was substantial. Basic science grants had the highest publication rate. The three types of grants resulted in publication in peer-reviewed journals with similar impact factors.
PMID: 24088977
ISSN: 1535-1386
CID: 4587212

A FIVE-YEAR MARKOV MODEL EVALUATING THE COST-UTILITY OF NASHA/DX FOR THE TREATMENT OF FECAL INCONTINENCE: A UNITED STATES PERSPECTIVE [Meeting Abstract]

Wexner, S. D. ; Bernstein, M. ; Purdy, C. ; Magar, R.
ISI:000312411100427
ISSN: 1098-3015
CID: 214742

Novel treatment of fecal incontinence with an injectable biocompatible tissue bulking agent

Bernstein, Mitchell
PMCID:3533221
PMID: 23293555
ISSN: 1554-7914
CID: 211482