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Hospital charges for laparoscopic sleeve gastrectomy compared to robotic sleeve gastrectomy: a multicenter study
Brown, Avery; Vu, Alexander Hien; Carey, Denston; Lazar, Damien; Sullivan, Brigitte; Ayres, Joshuha; Schroder, Jean; Gujral, Akash; Tursunova, Nilufar; Ferzli, George S; Cheema, Fareed; Tchokouani, Loic
BACKGROUND:Sleeve gastrectomy has become a gold standard in addressing medically refractory obesity. Robotic platforms are becoming more utilized, however, data on its cost-effectiveness compared to laparoscopy remain controversial (1-3). At NYU Langone Health, many of the bariatric surgeons adopted robotic surgery as part of their practices starting in 2021. We present a retrospective cost analysis of laparoscopic sleeve gastrectomy (LSG) vs. robotic sleeve gastrectomy (RSG) at New York University (NYU) Langone Health campuses. METHODS:All adult patients ages 18-65 who underwent LSG or RSG from 202 to 2023 at NYU Langone Health campuses (Manhattan, Long Island, and Brooklyn) were evaluated via electronic medical records and MBSAQIP 30-day follow-up data. Patients with prior bariatric surgery were excluded. Complication-related ICD-10/CPT codes are collected and readmission costs will be estimated from ICD codes using the lower limit of CMS transparent NYU standard charges (3). Direct charge data for surgery and length of stay cost data were also obtained. Statistical T-test and chi-squared analysis were used to compare groups. RESULTS:Direct operating cost data at NYU Health Campuses demonstrated RSG was associated with 4% higher total charges, due to higher OR charges, robotic-specific supplies, and more post-op ED visits. CONCLUSIONS:RSG was associated with higher overall hospital charges compared to LSG, though there are multiple contributing factors. More research is needed to identify cost saving measures. This study is retrospective in nature, and does not include indirect costs nor reimbursement. Direct operating costs, per contractual agreement with suppliers, are only given as percentages. Data are limited to 30-day follow-up.
PMID: 39020117
ISSN: 1432-2218
CID: 5701802
Hypoxaemia related to COVID-19: vascular and perfusion abnormalities on dual-energy CT [Letter]
Lang, Min; Som, Avik; Mendoza, Dexter P; Flores, Efren J; Reid, Nicholas; Carey, Denston; Li, Matthew D; Witkin, Alison; Rodriguez-Lopez, Josanna M; Shepard, Jo-Anne O; Little, Brent P
PMID: 32359410
ISSN: 1474-4457
CID: 5602902
Implementation of the Radiological Society of North America Expert Consensus Guidelines on Reporting Chest CT Findings Related to COVID-19: A Multireader Performance Study
Som, Avik; Lang, Min; Yeung, Tristan; Carey, Denston; Garrana, Sherief; Mendoza, Dexter P; Flores, Efren J; Li, Matthew D; Sharma, Amita; McDermott, Shaunagh; Shepard, Jo-Anne O; Little, Brent P
BACKGROUND:RSNA expert consensus guidelines provide a framework for reporting CT findings related to COVID-19, but have had limited multireader validation. PURPOSE/OBJECTIVE:To assess the performance of the RSNA guidelines and quantify interobserver variability in application of the guidelines in patients undergoing chest CT for suspected COVID-19 pneumonia. MATERIALS AND METHODS/METHODS:A retrospective search from 1/15/20 to 3/30/20 identified 89 consecutive CT scans whose radiological report mentioned COVID-19. One positive or two negative RT-PCR tests for COVID-19 were considered the gold standard for diagnosis. Each chest CT scan was evaluated using RSNA guidelines by 9 readers (6 fellowship trained thoracic radiologists and 3 radiology resident trainees). Clinical information was obtained from the electronic medical record. RESULTS:There was strong concordance of findings between radiology training levels with agreement ranging from 60 to 86% among attendings and trainees (kappa 0.43 to 0.86). Sensitivity and specificity of "typical" CT findings for COVID-19 per the RSNA guidelines were on average 86% (range 72%-94%) and 80.2% (range 75-93%), respectively. Combined "typical" and "indeterminate" findings had a sensitivity of 97.5% (range 94-100%) and specificity of 54.7% (range 37-62%). A total of 163 disagreements were seen out of 801 observations (79.6% total agreement). Uncertainty in classification primarily derived from difficulty in ascertaining peripheral distribution, multiple dominant disease processes, or minimal disease. CONCLUSION/CONCLUSIONS:The "typical appearance" category for COVID-19 CT reporting has an average sensitivity of 86% and specificity rate of 80%. There is reasonable interreader agreement and good reproducibility across various levels of experience.
PMCID:7484923
PMID: 33778625
ISSN: 2638-6135
CID: 5603082
Intracardiac and aortic thrombi in the setting of SARS-CoV-2 infection
Reid, Nicholas; Carey, Denston; Lang, Min; Som, Avik; Cochran, Rory L; Alkasab, Tarik; Little, Brent P
PMCID:7454486
PMID: 33089049
ISSN: 2514-2119
CID: 5603042
Pulmonary Vascular Manifestations of COVID-19 Pneumonia
Lang, Min; Som, Avik; Carey, Denston; Reid, Nicholas; Mendoza, Dexter P; Flores, Efrén J; Li, Matthew D; Shepard, Jo-Anne O; Little, Brent P
PURPOSE/OBJECTIVE:To investigate pulmonary vascular abnormalities at CT pulmonary angiography (CT-PE) in patients with coronavirus disease 2019 (COVID-19) pneumonia. MATERIALS AND METHODS/METHODS:In this retrospective study, 48 patients with reverse-transcription polymerase chain reaction-confirmed COVID-19 infection who had undergone CT-PE between March 23 and April 6, 2020, in a large urban health care system were included. Patient demographics and clinical data were collected through the electronic medical record system. Twenty-five patients underwent dual-energy CT (DECT) as part of the standard CT-PE protocol at a subset of the hospitals. Two thoracic radiologists independently assessed all studies. Disagreement in assessment was resolved by consensus discussion with a third thoracic radiologist. RESULTS:Of the 48 patients, 45 patients required admission, with 18 admitted to the intensive care unit, and 13 requiring intubation. Seven patients (15%) were found to have pulmonary emboli. Dilated vessels were seen in 41 cases (85%), with 38 (78%) and 27 (55%) cases demonstrating vessel enlargement within and outside of lung opacities, respectively. Dilated distal vessels extending to the pleura and fissures were seen in 40 cases (82%) and 30 cases (61%), respectively. At DECT, mosaic perfusion pattern was observed in 24 cases (96%), regional hyperemia overlapping with areas of pulmonary opacities or immediately surrounding the opacities were seen in 13 cases (52%), opacities associated with corresponding oligemia were seen in 24 cases (96%), and hyperemic halo was seen in 9 cases (36%). CONCLUSION/CONCLUSIONS:© RSNA, 2020.
PMCID:7307217
PMID: 34036264
ISSN: 2638-6135
CID: 5603102