Jamil Kazma | The George Washington University (original) (raw)

Papers by Jamil Kazma

Research paper thumbnail of Knowledge, Attitude, and Beliefs of Medication Use in Pregnancy in an Urban Tertiary Care Center

The Journal of Clinical Pharmacology

Research paper thumbnail of Clinical predictors of mortality in patients with pseudomonas aeruginosa infection

PLOS ONE

Background Infections caused by Pseudomonas aeruginosa are difficult to treat with a significant ... more Background Infections caused by Pseudomonas aeruginosa are difficult to treat with a significant cost and burden. In Lebanon, P. aeruginosa is one of the most common organisms in ventilator-associated pneumonia (VAP). P. aeruginosa has developed widespread resistance to multiple antimicrobial agents such as fluoroquinolones and carbapenems. We aimed at identifying risk factors associated for P. aeruginosa infections as well as identifying independent risk factors for developing septic shock and in-hospital mortality. Methods We used a cross-sectional study design where we included patients with documented P. aeruginosa cultures who developed an infection after obtaining written consent. Two multivariable regression models were used to determine independent predictors of septic shock and mortality. Results During the observed period of 30 months 196 patients were recruited. The most common predisposing factor was antibiotic use for more than 48 hours within 30 days (55%). The prevale...

Research paper thumbnail of Human papillomavirus vaccination receipt and provider counseling rates among high-risk patients

Research paper thumbnail of Epidemiology of Methicillin-resistant and Methicillin-sensitive Staphylococcus aureus infections in Lebanon

Microbes, Infection and Chemotherapy

Background. Methicillin-resistant Staphylococcus aureus (MRSA) is a prevalent pathogen associated... more Background. Methicillin-resistant Staphylococcus aureus (MRSA) is a prevalent pathogen associated with significant morbidity and mortality. In Lebanon, MRSA rates have recently started to rise. We aimed to determine risk factors for acquiring MRSA and Methicillin-sensitive Staphylococcus aureus (MSSA) infections and identify independent risk factors for in-hospital mortality among patients with S. aureus infection. Methods. We used a case-case-control study design that included patients with infections and compared them to uninfected controls. Two multivariable regression models were constructed to determine variables associated with acquiring MRSA and MSSA infections. We explored independent predictors of mortality in the overall population compared with the MRSA subgroup. Results. 356 patients with S. aureus infections were identified and compared to 208 uninfected controls. A recent history of surgery and underlying diabetes were independent risk factors for acquiring both infect...

Research paper thumbnail of Impact of anemia and thrombocytopenia on postpartum hemorrhage risk among women with term singleton pregnancy

Journal of Thrombosis and Thrombolysis

Research paper thumbnail of Demographic and attitude determinants regarding the receipt of the human papillomavirus vaccine among individuals with cervical dysplasia (455)

Research paper thumbnail of Effect of implementation of a colorimetric quantitative blood loss system for postpartum hemorrhage

International Journal of Gynecology & Obstetrics

ObjectiveTo evaluate if the implementation of a colorimetric quantitative blood loss (QBL) system... more ObjectiveTo evaluate if the implementation of a colorimetric quantitative blood loss (QBL) system during cesarean delivery improves clinical outcomes.MethodsWe conducted a retrospective cohort analysis after cesarean section before and after implementation of the Triton based colorimetric QBL system. Prevalence of postpartum hemorrhage, amount of blood products transfused, length of hospitalization, and rates of intensive care unit (ICU) admission were compared.ResultsA total of 2221 patients were included. There were 1192 patients in the pre‐intervention group and 1029 patients in the post‐intervention group. There was no significant difference between groups in the prevalence of postpartum hemorrhage (8.6% vs 9.3%, P = 0.57), amount of packed red blood cells (pRBCs) transfused (45 vs 30, P = 0.41) or average length of hospital stay in days (3.0 vs 3.0, P = 0.37). There was a statistically significant decrease in ICU admissions between the pre‐ and post‐intervention groups (2.2% vs...

Research paper thumbnail of Impact of anemia and thrombocytopenia on postpartum hemorrhage risk among women with term singleton deliveries

American Journal of Obstetrics and Gynecology, 2022

Research paper thumbnail of Maternal depressive symptoms at the postpartum visit during the COVID-19 pandemic

American Journal of Obstetrics and Gynecology, 2022

Research paper thumbnail of The Crossroads of Wellness and Second Victim Syndrome: Identifying Factors that Alter the Pathway of Caregiver Recovery Following an Unanticipated Adverse Patient Outcome

Journal of Wellness, 2020

Introduction: Second Victim Syndrome (SVS) describes the phenomenon in which a caregiver experien... more Introduction: Second Victim Syndrome (SVS) describes the phenomenon in which a caregiver experiences a traumatic psychological and emotional response to an adverse patient event or medical error. Using quantitative survey analysis, we aim to better understand the personal factors that affect SVS development and recovery. Methods: Caregivers at a small urban academic medical center who had experienced an adverse patient event in the past six months were invited to take part in this institution-wide, voluntary, quantitative, cross-sectional study. Three surveys were administered; the Holmes-Rahe Life Stress Inventory (HRLSI) was used as a surrogate to measure stressful life events. The Impact of Event Scale-Revised (IES-R) was used as a measure of the stress a provider senses following a traumatic event. The Second Victim Experience and Support Tool (SVEST) was used to assess the medical provider’s emotional response and level of institutional support in response to an adverse clinica...

Research paper thumbnail of Rates of anastomotic leak and fistula following surgical management of bowel endometriosis: a comparison of shaving, discoid excision, and segmental resection

Hormone Molecular Biology and Clinical Investigation, 2021

Endometriosis is a complex chronic inflammatory condition that can create a multitude of botherso... more Endometriosis is a complex chronic inflammatory condition that can create a multitude of bothersome painful symptoms for women. Bowel endometriosis is often misdiagnosed or overlooked leading to years of suffering for many women. The surgical management of bowel endometriosis varies based on extent of disease as well as surgeon experience. Surgical treatment for bowel endometriosis is complex and a variety of intraoperative and postoperative complications must be considered. Two significant postoperative complications for bowel endometriosis include anastomotic leak and fistula formation. There is continued debate regarding the appropriate surgical treatment for bowel endometriosis. Aggressive surgery with segmental bowel resection is being utilized more cautiously, with an increase in less aggressive shaving or disc excision techniques. Historic beliefs regarding the limitations of shaving and disc excision are being challenged, and with a reduction in morbidity these less aggressi...

Research paper thumbnail of Pharmacoethics and pregnancy: Overcoming the therapeutic orphan stigma

British Journal of Clinical Pharmacology, 2022

There is paucity of evidence to support clinical decision making and counseling related to medica... more There is paucity of evidence to support clinical decision making and counseling related to medication use in pregnancy. Despite multiple efforts from legislative bodies and advocacy groups, the inclusion of pregnant women in clinical drug trials assessing efficacy and safety remains scarce. Pregnancy can be complicated by multiple co-morbidities that require pharmacological intervention; these interventions primarily target the pregnant women but also sometimes have secondary effects for the fetus. The U.S. Food and Drug Administration has issued multiple guidance documents on incorporating pregnant women in clinical trials to aid pharmaceutical companies in designing a protocol to ensure safety and adherence to ethical standards. Advances in pediatric pharmacology studies provide lessons for researchers on the best practice of designing clinical trials with inclusion of patients from special populations. In this review, we present the status of pregnant women in clinical trials, highlighting the ethical stigma and possible future directives.

Research paper thumbnail of Discrepancies in Access to Minimally Invasive Gynecologic Surgery Care Between Privately and Publicly Insured Patients

Journal of Gynecologic Surgery, 2020

Objective: The goal of this research was to characterize the discrepancy in access to care betwee... more Objective: The goal of this research was to characterize the discrepancy in access to care between publicly and privately insured patients when seeking subspecialty minimally invasive gynecologic s...

Research paper thumbnail of Low‐ and middle‐income country abstract representation at the Society for Maternal Fetal Medicine Annual Pregnancy Meeting

International Journal of Gynecology & Obstetrics, 2021

SynopsisThe representation of LMICs in SMFM meetings is limited. Most abstracts presented are ret... more SynopsisThe representation of LMICs in SMFM meetings is limited. Most abstracts presented are retrospective analyses.

Research paper thumbnail of Outcomes of Benign Hysterectomy for Patients with Severe Obesity

Journal of Minimally Invasive Gynecology, 2021

Research paper thumbnail of Patterns of voiding following laparoscopic hysterectomy

Journal of Gynecology Obstetrics and Human Reproduction, 2021

OBJECTIVE Clarify the normal patterns of voiding after minimally invasive hysterectomy. We also a... more OBJECTIVE Clarify the normal patterns of voiding after minimally invasive hysterectomy. We also aim to identify perioperative factors associated with delayed time to void immediately following hysterectomy. DESIGN Retrospective cohort study SELECTION: Women undergoing laparoscopic hysterectomy between September 2012 to October 2018 at a single academic university hospital. RESULTS 450 minimally invasive hysterectomies were included in the final analysis; 274 (60.9%) robotically-assisted, and 176 (39.1%) conventional laparoscopy. The overall median postoperative time-to-void following a retrograde bladder filling of 150 mL normal saline was 179 minutes. Based on the 50th percentile of the distribution of the time-to-void, two groups were created. Demographic characteristics between the groups were similar, except those who were above the 50th percentile were more likely to be older, have a reported history of previous myomectomy, and had a longer postoperative PACU stay compared to those below or equal to the 50th percentile. The mean time-to-void following conventional laparoscopic hysterectomy was less than that of robotic surgery (187.3 vs 200.5 minutes) however the difference was not statistically significant (p=0.22). The use of hydromorphone intraoperatively and the combination of oxycodone-acetaminophen postoperatively were more likely to be associated with the group of patients above the 50th percentile but there was no significant difference in perioperative utilization of median morphine milliequivalents (MME) between the two groups. CONCLUSIONS Following laparoscopic hysterectomy (either conventional or with robotic-assistance) with a retrograde bladder fill of 150 mL normal saline most patients will void within 4 hours after surgery. This is consistent with historic data on normal voiding patterns facilitating safe same day discharge without prolonged time in the PACU.

Research paper thumbnail of 972 Preventing postpartum hemorrhage in vaginal and cesarean deliveries: an expanded cost-effectiveness analysis of tranexamic acid

American Journal of Obstetrics and Gynecology, 2021

Research paper thumbnail of Clinical characteristics, risk factors and microbiology of infections in patients receiving chronic hemodialysis

Journal of Infection and Public Health, 2020

Background: The infectious complications in hemodialysis patients are still among the main reason... more Background: The infectious complications in hemodialysis patients are still among the main reasons for their increased morbidity and mortality. The possible reasons behind this might be due to impairments in the host defense mechanisms, comorbidities, invasive procedures and pathogenicity of the infecting organisms. With the increased incidence of bacteremia in hemodialysis patients and the overt use of antibiotics, we have witnessed a rise in the number of new multidrug resistant (MDR) strains in those patients. Aim: We aim to determine the epidemiology, risk factors and complications of infections in patients receiving chronic hemodialysis, particularly bloodstream infections. Methods: This is a retrospective case-control study involving patients undergoing hemodialysis at a tertiary care center. We studied the prevalence of infectious complications among those patients as well as the responsible agent in each respective infectious episode and the risk factors associated with bacteremia. Findings: 46.6% of the studied population had at least one documented episode of infection. The most common were blood and respiratory infections (33.2% and 32.7% respectively). Among patients with bacteremia, coagulase-negative Staphylococcus was the predominant pathogen (49% of cases), followed by Staphylococcus aureus and Escherichia coli. Mortality was higher in patients who had MDR bacteremia, and in those who had mechanical ventilation or intensive care unit (ICU) admission. Conclusion: Due to the alarming increase in the incidence of infection among hemodialysis patients and its strong association with mortality, further studies are needed to look for risk factors associated with infection and for ways to control those risk factors.

Research paper thumbnail of Safety and feasibility of the three-port robot-assisted hysterectomy across uterine weights

Journal of Robotic Surgery, 2020

One strategy thought to reduce direct costs associated with robotic surgery is minimizing the num... more One strategy thought to reduce direct costs associated with robotic surgery is minimizing the number of robotic arms used for a surgery. We aim to demonstrate the safety and feasibility of the three-port robot-assisted hysterectomy across uterine weights. Retrospective cohort study in a tertiary care university hospital of consecutive patients undergoing a three-port robot-assisted hysterectomy for benign indications. All surgeries were performed between 2012 and 2018 by fellowshiptrained minimally invasive gynecologic surgeons. Data from 232 patients were collected. Eighty-eight (37.9%) patients had a uterine weight < 250 g, 63 (27.2%) had a uterine weight between 250 and 500 g, 51 (22.0%) had a uterine weight between 500 and 1000 g, and 30 (12.9%) had a uterine weight ≥ 1000 g. Multivariable regression analysis revealed no statistically significant differences between uterine weight groups and time spent in PACU, the total length of hospital stay, or direct cost. When setting the < 250 g as referent, patients with uterine weights between 500 and 1000 g, and more than 1000 g had an operative time that was on average 23.4% and 91.6% longer than patients with uterine weight < 250 g, respectively (p < 0.01). Patients with uterine weights between 500 and 1000 g and more than 1000 g had an EBL that was on average 35% and 156% higher than patients with uterine weight < 250 g, respectively (p < 0.01). Our data support the safety and feasibility of the three-port robot-assisted hysterectomy technique across uterine weights.

Research paper thumbnail of Cost variance across obesity class for women undergoing laparoscopic hysterectomy by high-volume gynecologic surgeons

Journal of Robotic Surgery, 2020

Health-care costs are affected by obesity with both the direct and indirect costs of health care ... more Health-care costs are affected by obesity with both the direct and indirect costs of health care increasing as body mass index (BMI) increases. However, one important aspect of obesity that lacks rigorous study is what impact BMI has on direct surgical cost. We performed a retrospective cohort study of women undergoing a laparoscopic hysterectomy at our single academic university center between January 2012 and December 2017. Women were excluded if their surgery was performed by anyone other than those surgeons with subspecialty training in minimally invasive gynecologic surgery (MIGS), if their hysterectomy was performed by a modality other than conventional laparoscopy or with robotic assistance, or if the indication for hysterectomy was related to any gynecologic malignancy. We identified 600 patients who underwent laparoscopic hysterectomy during the study period. Women who underwent robotic hysterectomy, compared to laparoscopic, had a shorter operative time, lower estimated blood loss, and shorter length of stay. Mean direct cost (± standard deviation) for the cohort was 6398.53±6398.53 ± 6398.53±2304.67, age was 44.5 ± 7.5 years, and BMI was 32.2 ± 7.6. Direct cost for all laparoscopic hysterectomies was evaluated across the five different BMI quintiles and no significant difference between groups was found. There was no significant difference in direct cost across procedures between obese and non-obese patients (p = 0.62) and this remained true when separated out by surgical modality. However, when evaluating morbidly obese patients, there appears to be a trend toward cost reduction with robotic hysterectomy compared to conventional laparoscopy. It does not appear that BMI has a statistically significant impact on direct cost between robotic-assisted and conventional laparoscopic hysterectomy. However, these findings may be due to surgical proficiency and warrant further investigation among surgeons with lesser volume.

Research paper thumbnail of Knowledge, Attitude, and Beliefs of Medication Use in Pregnancy in an Urban Tertiary Care Center

The Journal of Clinical Pharmacology

Research paper thumbnail of Clinical predictors of mortality in patients with pseudomonas aeruginosa infection

PLOS ONE

Background Infections caused by Pseudomonas aeruginosa are difficult to treat with a significant ... more Background Infections caused by Pseudomonas aeruginosa are difficult to treat with a significant cost and burden. In Lebanon, P. aeruginosa is one of the most common organisms in ventilator-associated pneumonia (VAP). P. aeruginosa has developed widespread resistance to multiple antimicrobial agents such as fluoroquinolones and carbapenems. We aimed at identifying risk factors associated for P. aeruginosa infections as well as identifying independent risk factors for developing septic shock and in-hospital mortality. Methods We used a cross-sectional study design where we included patients with documented P. aeruginosa cultures who developed an infection after obtaining written consent. Two multivariable regression models were used to determine independent predictors of septic shock and mortality. Results During the observed period of 30 months 196 patients were recruited. The most common predisposing factor was antibiotic use for more than 48 hours within 30 days (55%). The prevale...

Research paper thumbnail of Human papillomavirus vaccination receipt and provider counseling rates among high-risk patients

Research paper thumbnail of Epidemiology of Methicillin-resistant and Methicillin-sensitive Staphylococcus aureus infections in Lebanon

Microbes, Infection and Chemotherapy

Background. Methicillin-resistant Staphylococcus aureus (MRSA) is a prevalent pathogen associated... more Background. Methicillin-resistant Staphylococcus aureus (MRSA) is a prevalent pathogen associated with significant morbidity and mortality. In Lebanon, MRSA rates have recently started to rise. We aimed to determine risk factors for acquiring MRSA and Methicillin-sensitive Staphylococcus aureus (MSSA) infections and identify independent risk factors for in-hospital mortality among patients with S. aureus infection. Methods. We used a case-case-control study design that included patients with infections and compared them to uninfected controls. Two multivariable regression models were constructed to determine variables associated with acquiring MRSA and MSSA infections. We explored independent predictors of mortality in the overall population compared with the MRSA subgroup. Results. 356 patients with S. aureus infections were identified and compared to 208 uninfected controls. A recent history of surgery and underlying diabetes were independent risk factors for acquiring both infect...

Research paper thumbnail of Impact of anemia and thrombocytopenia on postpartum hemorrhage risk among women with term singleton pregnancy

Journal of Thrombosis and Thrombolysis

Research paper thumbnail of Demographic and attitude determinants regarding the receipt of the human papillomavirus vaccine among individuals with cervical dysplasia (455)

Research paper thumbnail of Effect of implementation of a colorimetric quantitative blood loss system for postpartum hemorrhage

International Journal of Gynecology & Obstetrics

ObjectiveTo evaluate if the implementation of a colorimetric quantitative blood loss (QBL) system... more ObjectiveTo evaluate if the implementation of a colorimetric quantitative blood loss (QBL) system during cesarean delivery improves clinical outcomes.MethodsWe conducted a retrospective cohort analysis after cesarean section before and after implementation of the Triton based colorimetric QBL system. Prevalence of postpartum hemorrhage, amount of blood products transfused, length of hospitalization, and rates of intensive care unit (ICU) admission were compared.ResultsA total of 2221 patients were included. There were 1192 patients in the pre‐intervention group and 1029 patients in the post‐intervention group. There was no significant difference between groups in the prevalence of postpartum hemorrhage (8.6% vs 9.3%, P = 0.57), amount of packed red blood cells (pRBCs) transfused (45 vs 30, P = 0.41) or average length of hospital stay in days (3.0 vs 3.0, P = 0.37). There was a statistically significant decrease in ICU admissions between the pre‐ and post‐intervention groups (2.2% vs...

Research paper thumbnail of Impact of anemia and thrombocytopenia on postpartum hemorrhage risk among women with term singleton deliveries

American Journal of Obstetrics and Gynecology, 2022

Research paper thumbnail of Maternal depressive symptoms at the postpartum visit during the COVID-19 pandemic

American Journal of Obstetrics and Gynecology, 2022

Research paper thumbnail of The Crossroads of Wellness and Second Victim Syndrome: Identifying Factors that Alter the Pathway of Caregiver Recovery Following an Unanticipated Adverse Patient Outcome

Journal of Wellness, 2020

Introduction: Second Victim Syndrome (SVS) describes the phenomenon in which a caregiver experien... more Introduction: Second Victim Syndrome (SVS) describes the phenomenon in which a caregiver experiences a traumatic psychological and emotional response to an adverse patient event or medical error. Using quantitative survey analysis, we aim to better understand the personal factors that affect SVS development and recovery. Methods: Caregivers at a small urban academic medical center who had experienced an adverse patient event in the past six months were invited to take part in this institution-wide, voluntary, quantitative, cross-sectional study. Three surveys were administered; the Holmes-Rahe Life Stress Inventory (HRLSI) was used as a surrogate to measure stressful life events. The Impact of Event Scale-Revised (IES-R) was used as a measure of the stress a provider senses following a traumatic event. The Second Victim Experience and Support Tool (SVEST) was used to assess the medical provider’s emotional response and level of institutional support in response to an adverse clinica...

Research paper thumbnail of Rates of anastomotic leak and fistula following surgical management of bowel endometriosis: a comparison of shaving, discoid excision, and segmental resection

Hormone Molecular Biology and Clinical Investigation, 2021

Endometriosis is a complex chronic inflammatory condition that can create a multitude of botherso... more Endometriosis is a complex chronic inflammatory condition that can create a multitude of bothersome painful symptoms for women. Bowel endometriosis is often misdiagnosed or overlooked leading to years of suffering for many women. The surgical management of bowel endometriosis varies based on extent of disease as well as surgeon experience. Surgical treatment for bowel endometriosis is complex and a variety of intraoperative and postoperative complications must be considered. Two significant postoperative complications for bowel endometriosis include anastomotic leak and fistula formation. There is continued debate regarding the appropriate surgical treatment for bowel endometriosis. Aggressive surgery with segmental bowel resection is being utilized more cautiously, with an increase in less aggressive shaving or disc excision techniques. Historic beliefs regarding the limitations of shaving and disc excision are being challenged, and with a reduction in morbidity these less aggressi...

Research paper thumbnail of Pharmacoethics and pregnancy: Overcoming the therapeutic orphan stigma

British Journal of Clinical Pharmacology, 2022

There is paucity of evidence to support clinical decision making and counseling related to medica... more There is paucity of evidence to support clinical decision making and counseling related to medication use in pregnancy. Despite multiple efforts from legislative bodies and advocacy groups, the inclusion of pregnant women in clinical drug trials assessing efficacy and safety remains scarce. Pregnancy can be complicated by multiple co-morbidities that require pharmacological intervention; these interventions primarily target the pregnant women but also sometimes have secondary effects for the fetus. The U.S. Food and Drug Administration has issued multiple guidance documents on incorporating pregnant women in clinical trials to aid pharmaceutical companies in designing a protocol to ensure safety and adherence to ethical standards. Advances in pediatric pharmacology studies provide lessons for researchers on the best practice of designing clinical trials with inclusion of patients from special populations. In this review, we present the status of pregnant women in clinical trials, highlighting the ethical stigma and possible future directives.

Research paper thumbnail of Discrepancies in Access to Minimally Invasive Gynecologic Surgery Care Between Privately and Publicly Insured Patients

Journal of Gynecologic Surgery, 2020

Objective: The goal of this research was to characterize the discrepancy in access to care betwee... more Objective: The goal of this research was to characterize the discrepancy in access to care between publicly and privately insured patients when seeking subspecialty minimally invasive gynecologic s...

Research paper thumbnail of Low‐ and middle‐income country abstract representation at the Society for Maternal Fetal Medicine Annual Pregnancy Meeting

International Journal of Gynecology & Obstetrics, 2021

SynopsisThe representation of LMICs in SMFM meetings is limited. Most abstracts presented are ret... more SynopsisThe representation of LMICs in SMFM meetings is limited. Most abstracts presented are retrospective analyses.

Research paper thumbnail of Outcomes of Benign Hysterectomy for Patients with Severe Obesity

Journal of Minimally Invasive Gynecology, 2021

Research paper thumbnail of Patterns of voiding following laparoscopic hysterectomy

Journal of Gynecology Obstetrics and Human Reproduction, 2021

OBJECTIVE Clarify the normal patterns of voiding after minimally invasive hysterectomy. We also a... more OBJECTIVE Clarify the normal patterns of voiding after minimally invasive hysterectomy. We also aim to identify perioperative factors associated with delayed time to void immediately following hysterectomy. DESIGN Retrospective cohort study SELECTION: Women undergoing laparoscopic hysterectomy between September 2012 to October 2018 at a single academic university hospital. RESULTS 450 minimally invasive hysterectomies were included in the final analysis; 274 (60.9%) robotically-assisted, and 176 (39.1%) conventional laparoscopy. The overall median postoperative time-to-void following a retrograde bladder filling of 150 mL normal saline was 179 minutes. Based on the 50th percentile of the distribution of the time-to-void, two groups were created. Demographic characteristics between the groups were similar, except those who were above the 50th percentile were more likely to be older, have a reported history of previous myomectomy, and had a longer postoperative PACU stay compared to those below or equal to the 50th percentile. The mean time-to-void following conventional laparoscopic hysterectomy was less than that of robotic surgery (187.3 vs 200.5 minutes) however the difference was not statistically significant (p=0.22). The use of hydromorphone intraoperatively and the combination of oxycodone-acetaminophen postoperatively were more likely to be associated with the group of patients above the 50th percentile but there was no significant difference in perioperative utilization of median morphine milliequivalents (MME) between the two groups. CONCLUSIONS Following laparoscopic hysterectomy (either conventional or with robotic-assistance) with a retrograde bladder fill of 150 mL normal saline most patients will void within 4 hours after surgery. This is consistent with historic data on normal voiding patterns facilitating safe same day discharge without prolonged time in the PACU.

Research paper thumbnail of 972 Preventing postpartum hemorrhage in vaginal and cesarean deliveries: an expanded cost-effectiveness analysis of tranexamic acid

American Journal of Obstetrics and Gynecology, 2021

Research paper thumbnail of Clinical characteristics, risk factors and microbiology of infections in patients receiving chronic hemodialysis

Journal of Infection and Public Health, 2020

Background: The infectious complications in hemodialysis patients are still among the main reason... more Background: The infectious complications in hemodialysis patients are still among the main reasons for their increased morbidity and mortality. The possible reasons behind this might be due to impairments in the host defense mechanisms, comorbidities, invasive procedures and pathogenicity of the infecting organisms. With the increased incidence of bacteremia in hemodialysis patients and the overt use of antibiotics, we have witnessed a rise in the number of new multidrug resistant (MDR) strains in those patients. Aim: We aim to determine the epidemiology, risk factors and complications of infections in patients receiving chronic hemodialysis, particularly bloodstream infections. Methods: This is a retrospective case-control study involving patients undergoing hemodialysis at a tertiary care center. We studied the prevalence of infectious complications among those patients as well as the responsible agent in each respective infectious episode and the risk factors associated with bacteremia. Findings: 46.6% of the studied population had at least one documented episode of infection. The most common were blood and respiratory infections (33.2% and 32.7% respectively). Among patients with bacteremia, coagulase-negative Staphylococcus was the predominant pathogen (49% of cases), followed by Staphylococcus aureus and Escherichia coli. Mortality was higher in patients who had MDR bacteremia, and in those who had mechanical ventilation or intensive care unit (ICU) admission. Conclusion: Due to the alarming increase in the incidence of infection among hemodialysis patients and its strong association with mortality, further studies are needed to look for risk factors associated with infection and for ways to control those risk factors.

Research paper thumbnail of Safety and feasibility of the three-port robot-assisted hysterectomy across uterine weights

Journal of Robotic Surgery, 2020

One strategy thought to reduce direct costs associated with robotic surgery is minimizing the num... more One strategy thought to reduce direct costs associated with robotic surgery is minimizing the number of robotic arms used for a surgery. We aim to demonstrate the safety and feasibility of the three-port robot-assisted hysterectomy across uterine weights. Retrospective cohort study in a tertiary care university hospital of consecutive patients undergoing a three-port robot-assisted hysterectomy for benign indications. All surgeries were performed between 2012 and 2018 by fellowshiptrained minimally invasive gynecologic surgeons. Data from 232 patients were collected. Eighty-eight (37.9%) patients had a uterine weight < 250 g, 63 (27.2%) had a uterine weight between 250 and 500 g, 51 (22.0%) had a uterine weight between 500 and 1000 g, and 30 (12.9%) had a uterine weight ≥ 1000 g. Multivariable regression analysis revealed no statistically significant differences between uterine weight groups and time spent in PACU, the total length of hospital stay, or direct cost. When setting the < 250 g as referent, patients with uterine weights between 500 and 1000 g, and more than 1000 g had an operative time that was on average 23.4% and 91.6% longer than patients with uterine weight < 250 g, respectively (p < 0.01). Patients with uterine weights between 500 and 1000 g and more than 1000 g had an EBL that was on average 35% and 156% higher than patients with uterine weight < 250 g, respectively (p < 0.01). Our data support the safety and feasibility of the three-port robot-assisted hysterectomy technique across uterine weights.

Research paper thumbnail of Cost variance across obesity class for women undergoing laparoscopic hysterectomy by high-volume gynecologic surgeons

Journal of Robotic Surgery, 2020

Health-care costs are affected by obesity with both the direct and indirect costs of health care ... more Health-care costs are affected by obesity with both the direct and indirect costs of health care increasing as body mass index (BMI) increases. However, one important aspect of obesity that lacks rigorous study is what impact BMI has on direct surgical cost. We performed a retrospective cohort study of women undergoing a laparoscopic hysterectomy at our single academic university center between January 2012 and December 2017. Women were excluded if their surgery was performed by anyone other than those surgeons with subspecialty training in minimally invasive gynecologic surgery (MIGS), if their hysterectomy was performed by a modality other than conventional laparoscopy or with robotic assistance, or if the indication for hysterectomy was related to any gynecologic malignancy. We identified 600 patients who underwent laparoscopic hysterectomy during the study period. Women who underwent robotic hysterectomy, compared to laparoscopic, had a shorter operative time, lower estimated blood loss, and shorter length of stay. Mean direct cost (± standard deviation) for the cohort was 6398.53±6398.53 ± 6398.53±2304.67, age was 44.5 ± 7.5 years, and BMI was 32.2 ± 7.6. Direct cost for all laparoscopic hysterectomies was evaluated across the five different BMI quintiles and no significant difference between groups was found. There was no significant difference in direct cost across procedures between obese and non-obese patients (p = 0.62) and this remained true when separated out by surgical modality. However, when evaluating morbidly obese patients, there appears to be a trend toward cost reduction with robotic hysterectomy compared to conventional laparoscopy. It does not appear that BMI has a statistically significant impact on direct cost between robotic-assisted and conventional laparoscopic hysterectomy. However, these findings may be due to surgical proficiency and warrant further investigation among surgeons with lesser volume.