Clinical fellow at Division of Abdominal Wall Surgery at CUIMC #Sechenov #1MSMU alumni, @SaintAgnesMD general surgery graduate '22
Enjoying caring for my patients, big data research, statistical programming, outdoors activities, music, and my family He/Him/His ☮️ ⚛️ Address: Stony Brook, NY
Background Complicated acute appendicitis (CAA) has been linked to extremes of age, racial and so... more Background Complicated acute appendicitis (CAA) has been linked to extremes of age, racial and socioeconomic disparities, public insurance, and remote residency. CAA rate has been used from 2005 to 2018 as a health care quality metric, with the assumption that delay in treatment was a main cause of perforation. We studied factors that could contribute to CAA focusing on modifiable factors which could be altered as part of a health care delivery system. Materials and Methods All primary admissions for acute appendicitis (AA) from the 2010 Nationwide Inpatient Sample were linked to 2010 state-level physician density data. CAA was distinguished by codes for perforation, generalized peritonitis, or intra-abdominal abscess. A multivariable logistic regression model for CAA prediction was built. Results A total of 288 556 patients were admitted with AA and 86 272 (29.9%) had CAA. Independent factors, linked to CAA, included age outside the 10-39 range (odds ratio (OR) = 2.1-2.4 and all P ...
BACKGROUND The incidence of acute pancreatitis (AP) is characterized by circannual and geographic... more BACKGROUND The incidence of acute pancreatitis (AP) is characterized by circannual and geographical variation. The aim of this study was to describe seasonal variation and trends in hospitalizations for AP in the USA with respect to AP etiology. METHODS The Nationwide Inpatient Sample data (2000-2016) from the Healthcare Cost and Utilization Project were used. The study population included all primary hospitalizations for AP. Biliary AP (BAP) and alcohol-induced AP (AAP) were distinguished by diagnostic and procedural ICD codes. Seasonal trend decomposition was performed. RESULTS There was a linear increase in annual incidence (per 100 000 population) of AAP in the USA (from 17.0 in 2000 to 22.9 in 2016), while incidence of BAP, equaled 19.9 in 2000, peaked at 22.1 in 2006 and decreased to 17.4 in 2016. AP incidence demonstrated 18% annual incidence amplitude with summer peak and winter trough, more prominent in AAP. In 2016, within AAP, the highest incidence (per 100 000 population) was noted among African-Americans (up to 50.4), followed by males aged 56-70 years (26.5) and Asians of low income (25.5); within BAP, above the average incidence was observed in Hispanic (up to 25.8) and Asian (up to 25.0) population. The most consistent and rapid increase in AP incidence was noted in males aged 56-70 years with an alcoholic etiology (average 6% annual incidence growth). CONCLUSIONS The incidence and annual trends of AP vary significantly among demographic and socioeconomic groups and this knowledge may be useful for the planning of healthcare resources and identification of at-risk populations.
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, Jul 16, 2017
Dear Editors, We would like to congratulate the authors for publishing their study on this very c... more Dear Editors, We would like to congratulate the authors for publishing their study on this very common and important question, viz., how does cholecystectomy influence recurrence of idiopathic acute pancreatitis? The authors performed a retrospective study of 2236 patients diagnosed with acute pancreatitis lacking a confirmed cause. Those who did and did not undergo cholecystectomy were compared regarding recurrence rate of acute pancreatitis (AP). BIdiopathic^AP (IAP) was defined as a case of pancreatitis in which Ba causative factor could not be determined through history, physical examination, laboratory studies, and noninvasive imaging such as transabdominal ultrasound [TAUS] or computerized tomography [CT].^ Inclusion criteria were TAUS, no prior cholecystectomy, no nonbiliary cause identified, and no gallstones seen on TAUS. Nonbiliary causes were excluded by Bclose review of clinical notes [and] radiologic investigations.^ Regarding alcohol, the authors were careful not to assume that no mention of alcohol means no alcohol; rather, patients were deemed not to have alcohol as an etiology only if Bthe clinician specifically remarked in the notes that alcohol was not thought to be a causative factor.^ Unfortunately, the results are still difficult to interpret since further details regarding assessment for etiology are not provided. For example, it is not reported how many patients had hypertriglyceridemia, which is such a common cause of AP (next most common after alcohol and gallstones), that its testing is part of the American College of Gastroenterology Guidelines. It would be helpful to know how many patients had, did not have, or can’t be known to have had or not, this third most common cause of AP. Although the proportion of all AP patients with hypertriglyceridemia is only 5%, the proportion among those lacking alcohol or gallstones is certainly much higher. Similarly, another 5% of all cases of AP are attributable to medications, but it is not reported how many patients are taking medications which could have caused AP, how many are not, and howmany have an incomplete medication history. Finally, there is the long list of other causes, including autoimmunity, genetic causes, environmental exposures, and obstruction from small tumors, divisum, sphincter of Oddi syndrome, the details of which are not reported. Further, hindering interpretation of this paper is the understandable (but still problematic) lack of endoscopic ultrasound (EUS). While the authors cannot be faulted for this lack (indeed, even a RCT <1 year prior did not include EUS), still, EUS is recommended by the IAP/APA evidence-based guidelines, since 32–88% of patients with so-called IAP are found to have an etiology, such as pancreatic-duct obstruction or missed stones or sludge. Therefore, if EUS had been done in all patients, not to mention reporting of other, nonlithiasis causes above, the composition of the two groups, and therefore the results, may have been drastically different. Also, not reported is whether the polyps are cholesterol or adenomatous polyps. Although some literature suggests the possibility that cholesterol polyps could be an occult cause of IAP, 8, 9 this seems not to be the case in a more recent study of 6868 patients undergoing cholecystectomy. Still, the point is controversial, and it would be interesting to know if these polyps were adenomatous polyps or cholesterol polyps. Despite these problems, the authors are to be commended for a long mean follow-up period of 50 months. And the authors’ results do agree with the abovementioned RCT * Steven Clark Cunningham Steven.Cunningham@stagnes.org
Minimally invasive surgery (MIS) for gallbladder cancer (GBC) has been increasingly performed, in... more Minimally invasive surgery (MIS) for gallbladder cancer (GBC) has been increasingly performed, including an increasing number of reports of radical cholecystectomy with hepatectomy, lymphadenectomy and excision of the extrahepatic biliary tree, but continues to be controversial. Here, we highlight these controversies and review the management of incidental GBC, and the MIS management of early and advanced nonincidental GBC. While initial results are promising, and are likely to improve, adequate long-term survival data are lacking and for now MIS for GBC should be limited to high-volume centers with adequate expertise in both MIS and hepatobiliary surgery.
Aim Analysis of all healthcare encounters (readmissions and emergency department visits, EDV) fol... more Aim Analysis of all healthcare encounters (readmissions and emergency department visits, EDV) following both inpatient and outpatient abdominal hernia repairs (AHR), with respect to the timeline of such encounters. Material and Methods Patients undergoing AHR were identified in Maryland State Inpatient and State Ambulatory Surgery and Services Databases, 2016-2017, and all their hospital and ED encounters were assembled into a comprehensive database, covering almost 95% of all AHR performed in Maryland. Results Of the total 26,215 patients who underwent AHR (3,333 inpatient and 22,950 outpatient; 48.7% inguinal and 53.0% ventral/umbilical), 5,802 (22.1%) had at least one postoperative encounter (4,186 EDV, 1,415 readmissions, and 248 encounters for mostly outpatient another AHR). 419 (80.4%) post-operative encounters within the first 48 hours were EDV and 98 (18.8%) were readmissions. Fraction of EDV within later encounters was in 69.6–71.1% range. Most frequent reasons for EDV were...
Background Complicated acute appendicitis (CAA) has been linked to extremes of age, racial and so... more Background Complicated acute appendicitis (CAA) has been linked to extremes of age, racial and socioeconomic disparities, public insurance, and remote residency. CAA rate has been used from 2005 to 2018 as a health care quality metric, with the assumption that delay in treatment was a main cause of perforation. We studied factors that could contribute to CAA focusing on modifiable factors which could be altered as part of a health care delivery system. Materials and Methods All primary admissions for acute appendicitis (AA) from the 2010 Nationwide Inpatient Sample were linked to 2010 state-level physician density data. CAA was distinguished by codes for perforation, generalized peritonitis, or intra-abdominal abscess. A multivariable logistic regression model for CAA prediction was built. Results A total of 288 556 patients were admitted with AA and 86 272 (29.9%) had CAA. Independent factors, linked to CAA, included age outside the 10-39 range (odds ratio (OR) = 2.1-2.4 and all P ...
BACKGROUND The incidence of acute pancreatitis (AP) is characterized by circannual and geographic... more BACKGROUND The incidence of acute pancreatitis (AP) is characterized by circannual and geographical variation. The aim of this study was to describe seasonal variation and trends in hospitalizations for AP in the USA with respect to AP etiology. METHODS The Nationwide Inpatient Sample data (2000-2016) from the Healthcare Cost and Utilization Project were used. The study population included all primary hospitalizations for AP. Biliary AP (BAP) and alcohol-induced AP (AAP) were distinguished by diagnostic and procedural ICD codes. Seasonal trend decomposition was performed. RESULTS There was a linear increase in annual incidence (per 100 000 population) of AAP in the USA (from 17.0 in 2000 to 22.9 in 2016), while incidence of BAP, equaled 19.9 in 2000, peaked at 22.1 in 2006 and decreased to 17.4 in 2016. AP incidence demonstrated 18% annual incidence amplitude with summer peak and winter trough, more prominent in AAP. In 2016, within AAP, the highest incidence (per 100 000 population) was noted among African-Americans (up to 50.4), followed by males aged 56-70 years (26.5) and Asians of low income (25.5); within BAP, above the average incidence was observed in Hispanic (up to 25.8) and Asian (up to 25.0) population. The most consistent and rapid increase in AP incidence was noted in males aged 56-70 years with an alcoholic etiology (average 6% annual incidence growth). CONCLUSIONS The incidence and annual trends of AP vary significantly among demographic and socioeconomic groups and this knowledge may be useful for the planning of healthcare resources and identification of at-risk populations.
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, Jul 16, 2017
Dear Editors, We would like to congratulate the authors for publishing their study on this very c... more Dear Editors, We would like to congratulate the authors for publishing their study on this very common and important question, viz., how does cholecystectomy influence recurrence of idiopathic acute pancreatitis? The authors performed a retrospective study of 2236 patients diagnosed with acute pancreatitis lacking a confirmed cause. Those who did and did not undergo cholecystectomy were compared regarding recurrence rate of acute pancreatitis (AP). BIdiopathic^AP (IAP) was defined as a case of pancreatitis in which Ba causative factor could not be determined through history, physical examination, laboratory studies, and noninvasive imaging such as transabdominal ultrasound [TAUS] or computerized tomography [CT].^ Inclusion criteria were TAUS, no prior cholecystectomy, no nonbiliary cause identified, and no gallstones seen on TAUS. Nonbiliary causes were excluded by Bclose review of clinical notes [and] radiologic investigations.^ Regarding alcohol, the authors were careful not to assume that no mention of alcohol means no alcohol; rather, patients were deemed not to have alcohol as an etiology only if Bthe clinician specifically remarked in the notes that alcohol was not thought to be a causative factor.^ Unfortunately, the results are still difficult to interpret since further details regarding assessment for etiology are not provided. For example, it is not reported how many patients had hypertriglyceridemia, which is such a common cause of AP (next most common after alcohol and gallstones), that its testing is part of the American College of Gastroenterology Guidelines. It would be helpful to know how many patients had, did not have, or can’t be known to have had or not, this third most common cause of AP. Although the proportion of all AP patients with hypertriglyceridemia is only 5%, the proportion among those lacking alcohol or gallstones is certainly much higher. Similarly, another 5% of all cases of AP are attributable to medications, but it is not reported how many patients are taking medications which could have caused AP, how many are not, and howmany have an incomplete medication history. Finally, there is the long list of other causes, including autoimmunity, genetic causes, environmental exposures, and obstruction from small tumors, divisum, sphincter of Oddi syndrome, the details of which are not reported. Further, hindering interpretation of this paper is the understandable (but still problematic) lack of endoscopic ultrasound (EUS). While the authors cannot be faulted for this lack (indeed, even a RCT <1 year prior did not include EUS), still, EUS is recommended by the IAP/APA evidence-based guidelines, since 32–88% of patients with so-called IAP are found to have an etiology, such as pancreatic-duct obstruction or missed stones or sludge. Therefore, if EUS had been done in all patients, not to mention reporting of other, nonlithiasis causes above, the composition of the two groups, and therefore the results, may have been drastically different. Also, not reported is whether the polyps are cholesterol or adenomatous polyps. Although some literature suggests the possibility that cholesterol polyps could be an occult cause of IAP, 8, 9 this seems not to be the case in a more recent study of 6868 patients undergoing cholecystectomy. Still, the point is controversial, and it would be interesting to know if these polyps were adenomatous polyps or cholesterol polyps. Despite these problems, the authors are to be commended for a long mean follow-up period of 50 months. And the authors’ results do agree with the abovementioned RCT * Steven Clark Cunningham Steven.Cunningham@stagnes.org
Minimally invasive surgery (MIS) for gallbladder cancer (GBC) has been increasingly performed, in... more Minimally invasive surgery (MIS) for gallbladder cancer (GBC) has been increasingly performed, including an increasing number of reports of radical cholecystectomy with hepatectomy, lymphadenectomy and excision of the extrahepatic biliary tree, but continues to be controversial. Here, we highlight these controversies and review the management of incidental GBC, and the MIS management of early and advanced nonincidental GBC. While initial results are promising, and are likely to improve, adequate long-term survival data are lacking and for now MIS for GBC should be limited to high-volume centers with adequate expertise in both MIS and hepatobiliary surgery.
Aim Analysis of all healthcare encounters (readmissions and emergency department visits, EDV) fol... more Aim Analysis of all healthcare encounters (readmissions and emergency department visits, EDV) following both inpatient and outpatient abdominal hernia repairs (AHR), with respect to the timeline of such encounters. Material and Methods Patients undergoing AHR were identified in Maryland State Inpatient and State Ambulatory Surgery and Services Databases, 2016-2017, and all their hospital and ED encounters were assembled into a comprehensive database, covering almost 95% of all AHR performed in Maryland. Results Of the total 26,215 patients who underwent AHR (3,333 inpatient and 22,950 outpatient; 48.7% inguinal and 53.0% ventral/umbilical), 5,802 (22.1%) had at least one postoperative encounter (4,186 EDV, 1,415 readmissions, and 248 encounters for mostly outpatient another AHR). 419 (80.4%) post-operative encounters within the first 48 hours were EDV and 98 (18.8%) were readmissions. Fraction of EDV within later encounters was in 69.6–71.1% range. Most frequent reasons for EDV were...
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