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Papers by Sharon Phillips

This is an uncopyedited electronic version of an article accepted for publication in Diabetes Car... more This is an uncopyedited electronic version of an article accepted for publication in Diabetes Care. The American Diabetes Association, publisher of Diabetes Care, is not responsible for any errors or omissions in this version of the manuscript or any version derived from it by third parties. The definitive publisher-authenticated version will be available in a future issue of Diabetes Care in print and online at

Forum of Clinical Oncology, 2020

Objectives Appropriate chemotherapy and radiation near end of life is a moving target; challenged... more Objectives Appropriate chemotherapy and radiation near end of life is a moving target; challenged by increasing costs, evolving therapies, new reimbursement models and quality metrics. We review treatment trends and variables impacting the initiation of chemotherapy (CHT) and radiotherapy (XRT) in the final 60, 30 and 14 days of life in metastatic non-small cell lung cancer (NSCLC). Methods The Florida Cancer Data System was studied to complete a retrospective cohort analysis of 48,858 individuals with Stage IV (M1) NSCLC from 1995–2010. We evaluated the initiation of CHT and XRT after diagnosis and associations with patient demographics, insurance and socioeconomic status (SES). Results The use of CHT increased from 35% to 49%, while XRT decreased from 52% to 37% between 1995 and 2010. Initial courses of CHT occurred 8.1%, 5.0%, and 3.6% in the final 60, 30, and 14 days of life, and XRT 13.8%, 7.7%, and 5.2% of the time, respectively. Younger, married, and male patients were more l...

BACKGROUND: The authors investigated the prevalence of pretreatment urinary, sexual, hormonal, an... more BACKGROUND: The authors investigated the prevalence of pretreatment urinary, sexual, hormonal, and bowel dysfunction in a contemporary, population-based prostate cancer cohort. They also explored the associations between baseline function and age, comorbidity, and timing of baseline survey completion with respect to treatment. METHODS: The Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study is a population-based, prospective cohort study that enrolled 3691 men with incident prostate cancer during 2011 and 2012. Pretreatment function was ascertained using the Expanded Prostate Cancer Index-26 (EPIC-26). Data were stratified by age, comorbidity, and timing of baseline survey completion with respect to treatment. Unadjusted and multivariable linear regression analyses were performed to evaluate the relations between exposures and pretreatment function. RESULTS: After applying exclusion criteria, the study cohort comprised 3072 men. A strikingly high proportion of men reported inability to obtain erections satisfactory for intercourse (45%) and some degree of urinary incontinence (17%) at baseline. Sexual function was particularly age-sensitive, with patients aged 60 years reporting summary scores in excess of 30 points higher than patients aged 75 years (P <.001). Compared with the healthiest men, highly comorbid patients reported less favorable function in each domain, including urinary incontinence (summary score, 89.5 vs 74.1; P <.001) and sexual function (summary score, 70.8 vs 32.9; P <.001). Although statistically significant differences in summary scores were identified between patients who completed the baseline questionnaire before treatment (52%) versus after treatment (48%), the absolute differences were small (range, 1-3 points). CONCLUSIONS: Patients with newly diagnosed prostate cancer exhibit a wide distribution of pretreatment function. The current data may be used to redefine the population "at risk" for treatment-related harms.

Hernia, 2020

Purpose The outcomes of utilizing anti-adhesive barrier-coated mesh in the retrorectus position d... more Purpose The outcomes of utilizing anti-adhesive barrier-coated mesh in the retrorectus position during open ventral hernia repair are unknown. We compared the wound-related outcomes between non-coated (NCM) and coated mesh (CM) placed in the retrorectus space. Methods Patients undergoing elective, open, clean ventral hernia repair with retrorectus mesh were retrospectively identified in the Americas Hernia Society Quality Collaborative. Propensity score matching was performed based on clinically relevant demographic and operative covariates. The primary outcome was wound morbidity, defined as surgical site infection (SSI), surgical site occurrence (SSO), and SSO requiring procedural intervention (SSOPI). Results 3609 patients were included (3281 NCM, 328 CM). Following 2:1 propensity score matching, rates of myofascial release remained the only statistically different matching parameter; external oblique releases were performed more frequently in the CM group (8% vs. 15%; p = 0.03). Rates of SSI (3% vs. 4%; p = 0.16) were similar between groups. Increased rates of SSO (13% vs. 18%; p = 0.045) and SSOPI (4% vs. 8%; p = 0.038) were observed in the CM group. The CM group had a higher rate of postoperative seroma (3% vs. 7%; p = 0.027) compared to the NCM group. Conclusion Barrier-coated mesh in the retrorectus position was associated with increased wound morbidity requiring procedural intervention. Due to a lack of clinical benefit, the use of more costly barrier-coated mesh in the retrorectus position is not justified for routine, open ventral hernia repairs at this time.

Clinical Lung Cancer, 2019

Early palliative care implementation has been shown to be beneficial for metastatic non-small cel... more Early palliative care implementation has been shown to be beneficial for metastatic non-small cell lung cancer (NSCLC) patients. This study surveyed United States oncologists and metastatic NSCLC patients on their practices and attitudes regarding the role of early palliative care referral. Our study highlights that few patients are referred at the time of diagnosis likely due to several noteworthy barriers.

Journal of the American College of Surgeons, 2018

Early readmission after ventral hernia repair (VHR) can hinder patient recovery and increase reso... more Early readmission after ventral hernia repair (VHR) can hinder patient recovery and increase resource use. The objective of this study was to evaluate the effectiveness of the Americas Hernia Society Quality Collaborative Early Readmission Reduction Initiative in reducing early readmissions after VHR. Risk factors for early readmission and best practices of surgeons with the lowest readmission rates after VHR were determined through collaborative learning. Two interventions for reducing early readmissions were developed: a structured questionnaire administered to patients within 1 week after discharge from the hospital or an early clinic visit after discharge and before a regularly scheduled postoperative visit. Multivariable logistic regression was used to evaluate the impact of these interventions on early readmission. Use of the questionnaire and early clinic visit was tracked in 3,007 patients. Of these, 343 received the questionnaire (2.6% readmission rate), 761 had an early cl...

Journal of the American College of Surgeons, Jan 24, 2017

Robotic intraperitoneal mesh placement (rIPOM) has recently emerged as an alternative to laparosc... more Robotic intraperitoneal mesh placement (rIPOM) has recently emerged as an alternative to laparoscopic intraperitoneal mesh placement (LapIPOM) for minimally invasive incisional hernia repair. We aimed to compare LapIPOM to rIPOM in terms of hospital length of stay (LOS) and 30-day postoperative complications in patients undergoing incisional hernia repair within the Americas Hernia Society Quality Collaborative (AHSQC) STUDY DESIGN: Propensity score analysis was used to compare matched groups of patients within the AHSQC undergoing LapIPOM versus rIPOM. The primary outcome measure was hospital LOS, and secondary outcomes were 30-day wound events. 454 (71.9%) patients underwent LapIPOM and 177 (28.1%) underwent rIPOM. The laparoscopic group had an increased median LOS (1 vs 0 days; interquartile range (IQR) 3.00; p<0.001). The risk of surgical site occurrence (SSO) was higher in the LapIPOM group vs the rIPOM group (14% vs 5%; p=0.001), however SSO requiring procedural interventio...

Journal of the American College of Surgeons, 2016

The Journal of Urology, 2013

Transactions of the American Clinical and Climatological Association, 2016

In the United States, primary stroke prevention in children with sickle cell anemia (SCA) is now ... more In the United States, primary stroke prevention in children with sickle cell anemia (SCA) is now the standard of care and includes annual transcranial Doppler ultrasound evaluation to detect elevated intracranial velocities; and for those at risk, monthly blood transfusion therapy for at least a year followed by the option of hydroxyurea therapy. This strategy has decreased stroke prevalence in children with SCA from approximately 11% to 1%. In Africa, where 80% of all children with SCA are born, no systematic approach exists for primary stroke prevention. The two main challenges for primary stroke prevention in children with SCA in Africa include: 1) identifying an alternative to blood transfusion therapy, because safe monthly blood transfusion therapy is not feasible; and 2) assembling a health care team to implement and expand this effort. We will emphasize early triumphs and challenges to decreasing the incidence of strokes in African children with SCA.

Annals of surgery, Jan 10, 2017

We aimed to evaluate the association of epidural analgesia (EA) with hospital length of stay (LOS... more We aimed to evaluate the association of epidural analgesia (EA) with hospital length of stay (LOS), wound morbidity, postoperative complications, and patient-reported outcomes in patients undergoing ventral hernia repair (VHR). EA has been shown to reduce LOS in certain surgical populations. The LOS benefit in VHR is unclear. Patients having VHR performed in the Americas Hernia Society Quality Collaborative (AHSQC) were separated into 2 comparable groups matched on several confounding factors using a propensity score algorithm: one group received postoperative EA, and the other did not. The groups were then evaluated for hospital LOS, 30-day wound morbidity, other complications, and 30-day patient-reported outcomes using pain and hernia-specific quality-of-life instruments. A 1:1 match was achieved and the final analysis included 763 patients receiving EA and 763 not receiving EA. The EA group had an increased LOS (5.49 vs 4.90 days; P < 0.05). The rate of wound events was simila...

Journal of the American College of Surgeons, 2017

The use of mesh during ventral hernia repair (VHR) is a well-accepted concept. However, the ideal... more The use of mesh during ventral hernia repair (VHR) is a well-accepted concept. However, the ideal location of mesh placement remains heavily debated. While VHR with onlay mesh placement has been historically associated with a high rate of wound events, this surgical approach is technically less challenging than VHR with sublay mesh placement. The purpose of this study is to compare onlay mesh placement with adhesive fixation to sublay mesh placement 30-day wound events using the Americas Hernia Society Quality Collaborative (AHSQC) database.background STUDY DESIGN: All patients undergoing elective, open VHR with synthetic mesh placement from January 2013 through January 2016 were identified within the AHSQC. Only patients with clean wounds were included. Patients were divided into two groups: onlay mesh placement with the use of adhesive and sublay mesh placement. The association of mesh location with 30-day wound events was investigated using a matched analysis. A total of 1,854 pa...

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2016

Human Pathology, 2016

Antibody-mediated rejection (ABMR) is implicated in 45% of renal allograft failure and 57% of lat... more Antibody-mediated rejection (ABMR) is implicated in 45% of renal allograft failure and 57% of late allograft dysfunction. Peritubular capillary C4d is a specific but insensitive marker of ABMR. The 2013 Banff Conference ABMR revised criteria included C4d-negative ABMR with evidence of endothelial-antibody interaction. We hypothesized that endothelial activation and lymphangiogenesis are increased with C4d-negative ABMR, and correlate with intra-graft Tregulatory cells (Tregs) and T-helper 17 (Th17). Seventy-four renal transplant biopsies were selected to include: a) ABMR with C4d Banff scores ≥2 (n=35); b) variable microvascular injury (MI) and C4d score <2 (n=24); c) variable MI and C4d score=0 (n=15). Controls included normal pre-implantation donor kidneys (n=5). Immunohistochemistry for endothelial activation [P-and E-selectins (SEL)], lymphangiogenesis (D2-40), Tregs (FOXP3), and Th17 (STAT3) was performed. Microvessel and inflammatory infiltrate density was assessed morphometrically in interstitium and peritubular capillaries. All transplants had significantly higher microvessel and lymph vessel density compared to normal. Increased expression of markers of endothelial activation predicted transplant glomerulopathy (P-SEL, p=0.003). Increased P-SEL and D2-40 were associated with longer interval from transplant to biopsy (p=0.005). All three markers were associated with increased interstitial fibrosis, tubular

Journal of the American College of Surgeons, 2015

Surgery for Obesity and Related Diseases, 2010

Background: Compared to other surgical weight loss options, laparoscopic adjustable gastric bandi... more Background: Compared to other surgical weight loss options, laparoscopic adjustable gastric banding (LAGB) can be performed on an outpatient basis. The purpose of this study was to evaluate demographic variations of LAGB on a national level. Methods: Patients undergoing LAGB for obesity were identified from the 2006 National Survey of Ambulatory Surgery (NSAS). The NSAS is a stratified sample of ambulatory procedural facilities in the United States. Both Medicare patients and patients under 18 years of age were excluded. Results: A population of 21,676 patients undergoing LAGB in 2006 was identified from a sample of 175 encounters in the NSAS. The majority of LAGB were performed in a hospital setting as compared to freestanding surgery centers (63% versus 37%, standard error (SE) Ϯ11.3%). A large majority of patients undergoing LAGB were women, with 96% of the patients being female (SE Ϯ1.9%). Overall, 79% of the patients were discharged home the same day of their operation (SE Ϯ18.9%). In this sample, 63% of LAGB patients had private insurance and 28% were self pay patients (SEϮ 5.5% and 8.8% respectively). The total charges for LAGB were higher when the operation was performed at a hospital versus a free standing surgery center ($36,788 vs. 27,283).Additionally,thetotalchargeswerelessforself−paypatientsthaninsuredpatients(27,283). Additionally, the total charges were less for self-pay patients than insured patients (27,283).Additionally,thetotalchargeswerelessforself−paypatientsthaninsuredpatients(26,795 vs. $33,764). Conclusion: The majority of LAGB in the NSAS database are being performed on women and in hospital settings. Total charges are lower for LAGB done on self-pay patients and those performed at free standing surgery centers. Further exploration of these variations is warranted to optimize delivery of LAGB to morbidly obese patients in a outpatient setting.

JAMA surgery, Jan 24, 2018

Surgeons are increasingly interested in using mobile and online applications with wound photograp... more Surgeons are increasingly interested in using mobile and online applications with wound photography to monitor patients after surgery. Early work using remote care to diagnose surgical site infections (SSIs) demonstrated improved diagnostic accuracy using wound photographs to augment patients' electronic reports of symptoms, but it is unclear whether these findings are reproducible in real-world practice. To determine how wound photography affects surgeons' abilities to diagnose SSIs in a pragmatic setting. This prospective study compared surgeons' paired assessments of postabdominal surgery case vignettes with vs without wound photography for detection of SSIs. Data for case vignettes were collected prospectively from May 1, 2007, to January 31, 2009, at Erasmus University Medical Center, Rotterdam, the Netherlands, and from July 1, 2015, to February 29, 2016, at Vanderbilt University Medical Center, Nashville, Tennessee. The surgeons were members of the American Medica...