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Standardized Preoperative Pathways Determining Preoperative Echocardiogram Usage Continue to Improve Hip Fracture Quality

Esper, Garrett; Anil, Utkarsh; Konda, Sanjit; Furgiuele, David; Zaretsky, Jonah; Egol, Kenneth
Introduction/UNASSIGNED:The purpose of this study was to assess the hospital quality measures and outcomes of operative hip fracture patients before and after implementation of an anesthesiology department protocol assigning decision for a preoperative transthoracic echocardiogram (TTE) to the hospitalist co-managing physician. Materials and Methods/UNASSIGNED:Demographics, injury details, hospital quality measures, and outcomes were reviewed for a consecutive series of patients presenting to our institution with an operative hip fracture. In May of 2019, a new protocol assigning the responsibility to indicate a patient for preoperative TTE was mandated to the co-managing hospitalist at the institution. Patients were split into pre-protocol and post-protocol cohorts. Linear regression modeling and comparative analyses were conducted with a Bonferroni adjusted alpha as appropriate. Results/UNASSIGNED:Between September 2015 and June 2021, 1002 patients presented to our institution and were diagnosed with a hip fracture. Patients in the post-protocol cohort were less likely to undergo a preoperative echocardiogram, experienced a shorter time (days) to surgery, shorter length of stay, an increase in amount of home discharges, and lower complication risks for urinary tract infection and acute blood loss anemia as compared to those in the pre-protocol cohort. There were no differences seen in inpatient or 30-day mortality. Multivariable linear regression demonstrated a patient's comorbidity profile (Charlson Comorbidity Index (CCI)) and their date of presentation (pre- or post-protocol), were both associated with (P<0.01) a patients' time to surgery. Conclusion/UNASSIGNED:A standardized preoperative work flow protocol regarding which physician evaluates and determines which patients require a preoperative TTE allows for a streamlined perioperative course for hip fracture patients. This allows for a shortened time to surgery and length of stay with an increase in home discharges and was associated with a reduced risk of common index hospitalization complications including UTI and anemia.
PMCID:9016569
PMID: 35450301
ISSN: 2151-4585
CID: 5218572

Recurrence after Liver Transplantation for HCC - A New MORAL to the Story [Meeting Abstract]

Halazun, Karim; El-Najjar, Abdulrahman; Zaretsky, Jonah; Brubaker, William; Guarrera, James V.; Samstein, Benjamin; Kato, Tomoaki; Brown, Robert S., Jr.; Emond, Jean
ISI:000312540200044
ISSN: 1600-6135
CID: 3128102

Diabetes, body mass index, and outcomes in hepatocellular carcinoma patients undergoing liver transplantation

Siegel, Abby B; Lim, Emerson A; Wang, Shuang; Brubaker, William; Rodriguez, Rosa D; Goyal, Abhishek; Jacobson, Judith S; Hershman, Dawn L; Verna, Elizabeth C; Zaretsky, Jonah; Halazun, Karim; Dove, Lorna; Brown, Robert S; Neugut, Alfred I; Kato, Tomoaki; Remotti, Helen; Coppleson, Yael J; Emond, Jean C
UNLABELLED:For many cancers, features of the metabolic syndrome, such as diabetes and obesity, have been associated with both increased risk of cancer development and poor outcomes. METHODS:We examined a large retrospective cohort of 342 consecutive patients who underwent liver transplantation for hepatocellular carcinoma between January 1999 and July 2010 at our institution. We evaluated the relationship between diabetes, obesity, hepatocellular carcinoma (HCC) recurrence, and overall survival. RESULTS:We found that a body mass index (BMI) higher than 30 was an independent predictor of poor overall survival in a multivariable Cox model, approximately doubling the risk of death after transplantation. A BMI higher than 30 was also a predictor of recurrent HCC, although this was of borderline statistical significance (hazard ratio for recurrence, 1.9; 95% confidence interval, 0.9-4.1). We also found increased BMI to be an independent predictor of microvascular invasion within HCC tumors, lending a possible explanation to these results. Those with diabetes showed worsened overall survival compared with those without diabetes in univariate but not multivariable analysis, possibly related to longer wait times. CONCLUSIONS:Our findings suggest a relationship between higher BMI, tumor vascular invasion, increased recurrence, and worsened overall survival. These findings may help explain why those with high BMI have worse outcomes from their cancers. A better understanding of the role of obesity and diabetes in patients with cancer should help develop better predictors of outcome and improved treatment options for patients with HCC.
PMCID:3605709
PMID: 22864187
ISSN: 1534-6080
CID: 3128042

Smoking and hepatocellular carcinoma mortality

Siegel, Abby B; Conner, Kristina; Wang, Shuang; Jacobson, Judith S; Hershman, Dawn L; Hidalgo, Rosa; Verna, Elizabeth C; Halazun, Karim; Brubaker, William; Zaretsky, Jonah; Moniodis, Anna; Delgado-Cruzata, Lissette; Dove, Lorna; Emond, Jean; Kato, Tomoaki; Brown, Robert S Jr; Neugut, Alfred I
The association between cigarette smoking and mortality from hepatocellular carcinoma (HCC) is ambiguous. We analyzed the association between smoking and mortality in HCC patients seen at our center. We collected data retrospectively on patients diagnosed with HCC between 2002 and 2009. We estimated the association of smoking history with demographic, clinical and treatment factors. We then modeled these factors as predictors of mortality. Among smokers, we analyzed the effects of pack-year history and cessation times on survival. Two hundred and twenty-three out of 444 patients with HCC had a history of smoking. Smokers were more likely to be younger at diagnosis, to have alpha fetoprotein (AFP) values less than the median, and to have had surgery (p=0.04) compared to non-smokers. In a Cox model, younger age, lower AFP and Child's Class were all independently predictive of survival, but smoking was not. Smokers with over 20 pack-years did not have worse survival than lighter smokers, and cessation times also did not affect survival after controlling for age. We found a significant interaction between smoking and drinking. In our data, smoking was not independently associated with HCC survival in a multivariable model. Smoking was associated with favorable prognostic features which likely outweighed any independent effect of smoking.
PMCID:3438642
PMID: 22969856
ISSN: 1792-0981
CID: 1822372

RECURRENCE AFTER LIVER TRANSPLANTATION FOR HCC-A NEW MORAL TO THE STORY [Meeting Abstract]

Halazun, Karim J.; Zaretsky, Jonah; Brubaker, William D.; Verna, Elizabeth C.; Kato, Tomoaki; Guarrera, James V.; Samstein, Benjamin; Seigel, Abby B.; Brown, Robert S.; Emond, Jean C.
ISI:000295578004582
ISSN: 0270-9139
CID: 3128092

NOVEL RADIOLOGIC FEATURES TO PREDICT HEPATOCELLULAR CARCINOMA RECURRENCE AFTER LIVER TRANSPLANTATION: A PILOT STUDY [Meeting Abstract]

Zaretsky, Jonah; Guo, Xiaotao; Fu, Jie; Persigeh, Thorsten; Siege, Abby; Halazun, Karim J.; Lukose, Thresiamma; Brown, Robert S.; Schwartz, Lawrence; Zhao, Binsheng; Emond, Jean C.
ISI:000295578003367
ISSN: 0270-9139
CID: 3128082

OPTIMIZING OUTCOMES OF 105 LIVER TRANSPLANTS USING ELDERLY DONORS OVER 70: IMPROVEMENTS ALONG THE LEARNING CURVE [Meeting Abstract]

Zaretsky, Jonah; Wien, Mark; Lukose, Thresiamma; Brown, Robert S.; Emond, Jean C.; Guarrera, James V.
ISI:000295578002636
ISSN: 0270-9139
CID: 3128072

Do Preoperative Inflammatory Markers Impact on Outcome After Liver Transplantation for Hepatocellular Carcinoma? Reply [Letter]

Halazun, Karim Jarir; Zaretsky, Jonah; Brubaker, William; Brown, Robert S., Jr.; Emond, Jean C.
ISI:000292908700030
ISSN: 0003-4932
CID: 3128062

VOLUMETRIC TUMOR GROWTH RATE AS A PREDICTOR OF HCC RECURRENCE AFTER LIVER TRANSPLANTATION [Meeting Abstract]

Brubaker, William D.; Zaretsky, Jonah; Chang, Matthew S.; Halazun, Karim J.; Lim, Emerson; Siegel, Abby; Kato, Tomoaki; Brown, Robert S.; Emond, Jean C.
ISI:000288775602365
ISSN: 0270-9139
CID: 3128052