Terrence Fullum - Academia.edu (original) (raw)

Papers by Terrence Fullum

Journal of the National Medical Association, 1990

In a retrospective review of 100 consecutive cases of stab wounds to the chest, 44 patients were ... more In a retrospective review of 100 consecutive cases of stab wounds to the chest, 44 patients were successfully treated with tube thoracostomy, 14 patients required thoracotomy, 17 patients with small pneumothoraces were observed, and 25 patients were asymptomatic. The overall mortality was 4%, operative mortality was 7.1%, and the mortality rate for cardiac injuries was 50%. Of the eight patients with cardiac injuries, three were dead on arrival to the hospital and one patient died in the operating room. Patients treated with tube thoracostomy had a shorter hospital stay than patients managed by observation alone. Our findings support the opinion that asymptomatic patients (normal chest x-rays) may be discharged after 24 hours of observation and asymptomatic patients with nonprogressive small pneumothoraces (less than 20%) not requiring a chest tube may be discharged after 48 hours of observation. All patients should have close outpatient follow-up.

ABSTRACT ABSTRACT Background: The number of Americans undergoing weight loss surgery annually has... more ABSTRACT ABSTRACT Background: The number of Americans undergoing weight loss surgery annually has more than quadrupled since 1998, with 242,000 operations performed in 2008. Roux-en-Y gastric bypass, the most commonly performed procedure, results in the creation of a gastric remnant, which is inaccessible by conventional esophagogastroduodenoscopy. Ulcers, bleeding, and malignancy in the gastric remnant have all been reported. The identification of preoperative endoscopic abnormalities in a patient undergoing Roux-en-Y gastric bypass theoretically creates an at-risk gastric remnant. In order to establish guidelines for the management of this at-risk gastric remnant, the incidence of preoperative endoscopic abnormalities must be established. Objective: To determine the incidence of preoperative endoscopic abnormalities in patients undergoing Roux-en-Y gastric bypass. Methods: We reviewed prospectively collected data on 764 patients who underwent laparoscopic Roux-en-Y gastric bypass from August 2001 to December 2005 by a single surgeon. All patients who underwent preoperative esophagogastroduodenoscopy were reviewed for abnormalities. Results: Of the 764 patients reviewed, 636 patients had a preoperative screening esophagogastroduodenoscopy. There was no morbidity or mortality associated with the esophagogastroduodenoscopies. Forty-two patients (6.6%) were determined to have at-risk gastric remnants, including gastric polyps in 15 patients, gastric ulcers in 15 patients, Helicobacter pylori infections in eight patients, duodenal ulcers in three patients, and duodenal polyps in one patient. No gastric or duodenal cancers were identified. Conclusion: A small but significant proportion of patients undergoing RYGB had abnormalities on preoperative screening esophagogastroduodenoscopy. Guidelines for preoperative screening esophagogastroduodenoscopy, incorporating this finding, should be developed.

Journal of the …, 1997

... In phase 2, two Nissen fundoplications were performed with the mentors in the operating room ... more ... In phase 2, two Nissen fundoplications were performed with the mentors in the operating room (group C), and two Nissen fundoplications were performed with the mentors 5 miles away from the operating room (group D) using existing land lines at the T1 level. ...

The American Journal of Surgery, 2016

Background: The current management paradigm for recurrent adhesive small bowel obstruction (SBO) ... more Background: The current management paradigm for recurrent adhesive small bowel obstruction (SBO) is nonoperative. Rates of recurrence differ based upon time interval between and number of previous occurrences. Optimal time to intervene has not been determined. Methods: We constructed a Markov model to evaluate costs and quality of life on a hypothetical cohort of 40 y.o. patients after their first episode of medical management for post-operative SBO. We estimated a relative risk reduction of .55 with surgical intervention and a relative risk increase of 2.1, 2.9, and 5.7 after the medical management of the 2nd, 3rd, and 4th SBO. Results: Surgery performed after earlier episodes of SBO was more costly but also more effective. The cost difference between surgery after the 1st SBO recurrence versus the 2nd SBO recurrence was 1,643,withanincreaseof0.135qualityadjustedlifeyears(QALYs),theincrementalcosteffectivenessratio(ICER)was1,643, with an increase of 0.135 quality adjusted life years (QALYs), the incremental costeffectiveness ratio (ICER) was 1,643,withanincreaseof0.135qualityadjustedlifeyears(QALYs),theincrementalcosteffectivenessratio(ICER)was12,170/QALY. Conclusion: Surgery after the first episode of SBO provides a small increase in QALY at a small cost since surgical intervention lowers the risk of recurrence.

Journal of Surgical Education, 2021

As the US healthcare system restructured to deal with the COVID-19 pandemic, medical training was... more As the US healthcare system restructured to deal with the COVID-19 pandemic, medical training was significantly disrupted. During the peak of the crisis, three surgical trainees in different stages of their residency shared their experiences and concerns on how this pandemic affected their training. The article is intended to generate discussion on the concerns of derailment and stagnation of surgical training and difficulties faced at all levels of surgical training to perform clinical duties and fulfill academic responsibilities during the early months of the COVID pandemic. (J Surg Ed 000:1À5.

Surgery for Obesity and Related Diseases, 2019

Surgical Endoscopy, 2019

Background Exploratory laparotomy (EL) has been the definitive diagnostic and therapeutic modalit... more Background Exploratory laparotomy (EL) has been the definitive diagnostic and therapeutic modality for operative abdominal trauma in the US. Recently, many trauma centers have started using diagnostic laparoscopy (DL) in stable trauma patients in an effort to reduce the incidence of non-therapeutic laparotomy (NL). We aim to evaluate the incidence of NL in the trauma population in the US and compare the outcomes between DL and NL. Methods Using ICD-9 codes, the National Trauma Data Bank (2010-2015) was queried for patients undergoing any abdominal surgical intervention. Patients were divided into two groups: diagnostic laparoscopy (DL) and exploratory laparotomy (EL). Hemodynamically unstable patients on arrival and patients with abbreviated injury score (AIS) > 3 were excluded. Patients in EL group without any codes for gastrointestinal, diaphragmatic, hepatic, splenic, vascular, or urological procedures were considered to have undergone NL. After excluding patients who were converted to open from the DL group, multivariate regression models were used to analyze the outcomes of DL vs NL group with respect to mortality, length of stay, and complications. Results A total of 3197 patients underwent NL vs 1323 patients who underwent DL. Compared to DL group, the NL group were older (mean age: 35 vs. 31, P < 0.01). Rate of penetrating injury was 77% vs 86% for patients in NL vs DL. On multivariate analysis, NL was associated with increased mortality (OR 4.5, 95% CI 2.1-9.7), higher rate of complications (OR 2.2, 95% CI 1.4-3.3), and a longer hospital stay (OR 2.7, 95% CI 2.1-3.5). NL was also associated with higher rates of pneumonia, VTE, ARDS, and cardiac arrest. Conclusion With increasing experience in minimally invasive surgery, DL should be a part of the armamentarium of trauma surgeons. This study supports that in well-selected trauma patients DL has favorable outcomes compared to NL. These findings warrant further investigation.

American Journal of Gastroenterology, 2017

American Journal of Gastroenterology, 2011

American Journal of Gastroenterology, 2010

Surgery for Obesity and Related Diseases, 2016

Background: Bariatric surgery as a treatment for severe obesity has increased dramatically over t... more Background: Bariatric surgery as a treatment for severe obesity has increased dramatically over the past two decades, but there have been few high-quality, long-term studies comparing the outcomes of different procedures. Prior studies have not been sufficiently large to examine differences in outcomes across important patient subgroups, including older adults (4¼65 years of age) and racial/ ethnic minorities. Bariatric surgery outcomes research is limited and consists of studies with limited follow-up duration. More studies are needed in larger, broadly representative samples to help inform patient and provider decisions about the optimal choice of bariatric surgical procedure in various populations. Methods: The study's main goal is to provide accurate estimates of the one-, three-, and five-year benefits and risks of the three most common bariatric procedures in the United States today-Roux-en-y gastric bypass, adjustable gastric banding, and sleeve gastrectomywith a focus on outcomes that are important to adults and adolescents with severe obesity: 1) changes in weight, 2) rates of remission and relapse of diabetes, and 3) risk of major adverse events. The study has two additional goals: 1) the identification of patient preferences and opinions about (a) whether to undergo bariatric surgery; (b) which bariatric procedure to utilize; and (c) the delivery of follow-up care after bariatric surgery to be studied through a series of focus groups involving adults and children with severe obesity, and 2) the development of infrastructure-in the form of study processes and procedures-to support future comparative effectiveness studies using the National Patient-Centered Clinical Research Network (PCORnet). The study will demonstrate the PCORnet distributed research network's capacity to efficiently use electronic health records data from across the country to answer clinically-relevant questions. Patients and other stakeholders have been engaged in the development of the research questions, the selection of outcomes and the design of the study protocol, and will be engaged in all stages of the research moving forward, including protocol development, monitoring study conduct, and designing and implementing dissemination plans. Results: This study involves 11 of PCORnet's Clinical Data Research Networks (CDRNs) including 56 healthcare organizations across the United States and more than 60,000 patients who have previously undergone bariatric surgery from 2005-2015, with approximately 50 percent gastric bypass, 10 percent gastric banding, and 40 percent sleeve gastrectomy procedures. There is also large geographic variation in the bariatric procedures performed, with some areas dominated by gastric bypass while others are dominated by sleeve gastrectomy. This study includes more than 900 adolescent bariatric patients (the largest adolescent cohort ever) and more than 17,000 adult patients with diabetes. The study will take place in 2016-2017, with final results of all study aims anticipated by January 2018. Conclusions: This study is particularly timely because the sleeve gastrectomy procedure has rapidly grown in popularity in the United States (introduced in the late 2000s as a stand-alone procedure, it currently represents more than 50 percent of all procedures in our 11 PCORnet CDRNs), yet it lacks long-term data comparing its outcomes to the more well-established procedures. Apart from its size and geographic diversity, another key feature of the study is the depth and diversity of its stakeholder involvement, which includes several patients as study team members and executive stakeholder advisors, multiple pediatric and adult bariatric surgeons from different institutions, primary care and specialty physicians, researchers, and leaders of patient-level policy and

The American Journal of Surgery, 2016

BACKGROUND: Many temporary stomas are never reversed leading to significantly worse quality of li... more BACKGROUND: Many temporary stomas are never reversed leading to significantly worse quality of life. Recent evidence suggests a lower rate of reversal among minority patients. Our study aimed to elucidate disparities in national stoma closure rates by race, medical insurance status, and household income. METHODS: Five years of data from the Nationwide Inpatient Sample (2008 to 2012) was used to identify the annual rates of stoma formation and annual rates of stoma closure. Stomas labeled as ''permanent'' or those created secondary to colorectal cancers were excluded. Temporary stoma closure rates were calculated, and differences were tested with the chi-square test. Separate analyses were performed by race/ethnicity, insurance status, and household income. Nationally representative estimates were calculated using discharge-level weights. RESULTS: The 5-year average annual rate of temporary stoma creation was 76,551 per year (46% colostomies and 54% ileostomies). The annual rate of stoma reversal was 50,155 per year that equated to an annual reversal rate of 65.5%. Reversal rates were higher among white patients compared with black patients (67% vs 56%, P , .001) and among privately insured patients compared with uninsured patients (88% vs 63%, P , .001). Reversal rates increased as the household income increased from 61% in the lowest income quartile to 72% in the highest quartile (P , .001). CONCLUSIONS: Stark disparities exist in national rates of stoma closure. Stoma closure is associated with race, insurance, and income status. This study highlights the lack of access to surgical health care among patients of minority race and low-income status.

Surgery for Obesity and Related Diseases, 2015

Surgery for Obesity and Related Diseases, 2015

Surgery for Obesity and Related Diseases, 2015

American journal of surgery, 2015

This study seeks to investigate the outcomes of laparoscopic procedures in patients with previous... more This study seeks to investigate the outcomes of laparoscopic procedures in patients with previous open abdominal surgery. Using data from the National Surgical Quality Improvement Program (2005 to 2009), we identified patients who had undergone laparoscopic cholecystectomy, Nissen fundoplication, Heller myotomy, splenectomy, Roux-en-Y, sleeve gastrectomy, gastric band, appendectomy, or colectomy. Patients were then classified as to whether adhesiolysis (AD) was also carried out. Bivariate and multivariate analysis was used to compare groups. A total of 162,415 patients met our inclusion criteria, comprising 4,501 (3%) in the AD group and 157,913 (97%) in the nonadhesiolysis (NAD) group. Patient who had received lysis of adhesion were older, had 41% higher odds of overall complications, 17% higher adjusted mean lysis of adhesion (P < .001), and 26% higher adjusted mean operation duration (P < .001). A history of previous open abdominal surgery increases the potential complicati...

The American Journal of Surgery, 2015

Background: The use laparoscopy in trauma is, in general, limited for diagnostic purposes. We aim... more Background: The use laparoscopy in trauma is, in general, limited for diagnostic purposes. We aim to evaluate the therapeutic role of laparoscopic surgery in trauma patients. Methods: We analyzed the National Trauma Databank years 2007 to 2010 for all patients undergoing diagnostic laparoscopy (DL). Patients undergoing a therapeutic laparoscopic surgical procedure were identified and tabulated. Mortality and hospital length of stay for patients with isolated abdominal injuries was compared between the open and laparoscopic groups. Results: Out of a total of 2,539,818 trauma visits in the NTDB, 4,755 patients underwent a DL at 467 trauma centers. Of these 916 (19.3%) patients underwent a therapeutic laparoscopic intervention. Common laparoscopic operations included diaphragm repair, bowel repair or resection, and splenectomy. Patients undergoing laparoscopic surgery had a significantly shorter length of stay than the open group (5 days vs 6 days; p value <0.001). Conclusion: Therapeutic laparoscopic surgery for trauma is feasible and may provide better outcomes.

Journal of the American College of Surgeons, 2015

The Diverse Surgeons Initiative (DSI) is a program that was created to provide underrepresented m... more The Diverse Surgeons Initiative (DSI) is a program that was created to provide underrepresented minority surgical residents with the clinical knowledge and minimally invasive surgical skills necessary to excel in surgical residency and successfully transition into surgical practice. The early success of the graduates of the program has been published; however, a more longitudinal assessment of the program was suggested and warranted. This study provides a 5-year follow-up of the 76 physicians that participated in the DSI from 2002 to 2009 to determine if the trend toward fellowship placement and academic appointments persisted. Additionally, this extended evaluation yields an opportunity to assess these young surgeons' professional progress and contributions to the field. The most current professional development and employment information was obtained for the 76 physicians that completed the DSI from 2002 to 2009. The percentage of DSI graduates completing surgical residency, o...

The American Journal of Surgery, 2015

BACKGROUND: Sleepiness and fatigue affect surgical outcomes. We wished to determine the associati... more BACKGROUND: Sleepiness and fatigue affect surgical outcomes. We wished to determine the association between time of day and outcomes following surgery for trauma. METHODS: From the National Trauma Data Bank (2007 to 2010), we analyzed all adults who underwent an exploratory laparotomy between midnight and 6 am or between 7 am and 5 pm. We compared hospital mortality between these groups using multivariate logistic regression. Additionally, for each hour, a standardized mortality ratio was calculated. RESULTS: About 16,096 patients and 15,109 patients were operated on in the night time and day time, respectively. No difference was found in the risk-adjusted mortality rate between the 2 time periods (odds ratio .97, 95% confidence interval .893 to 1.058). However, hourly variations in mortality during the 24-hour period were noted. CONCLUSION: Trauma surgery during the odd hours of the night did not have an increased riskadjusted mortality when compared with surgery during the day.

Journal of the National Medical Association, 1990

In a retrospective review of 100 consecutive cases of stab wounds to the chest, 44 patients were ... more In a retrospective review of 100 consecutive cases of stab wounds to the chest, 44 patients were successfully treated with tube thoracostomy, 14 patients required thoracotomy, 17 patients with small pneumothoraces were observed, and 25 patients were asymptomatic. The overall mortality was 4%, operative mortality was 7.1%, and the mortality rate for cardiac injuries was 50%. Of the eight patients with cardiac injuries, three were dead on arrival to the hospital and one patient died in the operating room. Patients treated with tube thoracostomy had a shorter hospital stay than patients managed by observation alone. Our findings support the opinion that asymptomatic patients (normal chest x-rays) may be discharged after 24 hours of observation and asymptomatic patients with nonprogressive small pneumothoraces (less than 20%) not requiring a chest tube may be discharged after 48 hours of observation. All patients should have close outpatient follow-up.

ABSTRACT ABSTRACT Background: The number of Americans undergoing weight loss surgery annually has... more ABSTRACT ABSTRACT Background: The number of Americans undergoing weight loss surgery annually has more than quadrupled since 1998, with 242,000 operations performed in 2008. Roux-en-Y gastric bypass, the most commonly performed procedure, results in the creation of a gastric remnant, which is inaccessible by conventional esophagogastroduodenoscopy. Ulcers, bleeding, and malignancy in the gastric remnant have all been reported. The identification of preoperative endoscopic abnormalities in a patient undergoing Roux-en-Y gastric bypass theoretically creates an at-risk gastric remnant. In order to establish guidelines for the management of this at-risk gastric remnant, the incidence of preoperative endoscopic abnormalities must be established. Objective: To determine the incidence of preoperative endoscopic abnormalities in patients undergoing Roux-en-Y gastric bypass. Methods: We reviewed prospectively collected data on 764 patients who underwent laparoscopic Roux-en-Y gastric bypass from August 2001 to December 2005 by a single surgeon. All patients who underwent preoperative esophagogastroduodenoscopy were reviewed for abnormalities. Results: Of the 764 patients reviewed, 636 patients had a preoperative screening esophagogastroduodenoscopy. There was no morbidity or mortality associated with the esophagogastroduodenoscopies. Forty-two patients (6.6%) were determined to have at-risk gastric remnants, including gastric polyps in 15 patients, gastric ulcers in 15 patients, Helicobacter pylori infections in eight patients, duodenal ulcers in three patients, and duodenal polyps in one patient. No gastric or duodenal cancers were identified. Conclusion: A small but significant proportion of patients undergoing RYGB had abnormalities on preoperative screening esophagogastroduodenoscopy. Guidelines for preoperative screening esophagogastroduodenoscopy, incorporating this finding, should be developed.

Journal of the …, 1997

... In phase 2, two Nissen fundoplications were performed with the mentors in the operating room ... more ... In phase 2, two Nissen fundoplications were performed with the mentors in the operating room (group C), and two Nissen fundoplications were performed with the mentors 5 miles away from the operating room (group D) using existing land lines at the T1 level. ...

The American Journal of Surgery, 2016

Background: The current management paradigm for recurrent adhesive small bowel obstruction (SBO) ... more Background: The current management paradigm for recurrent adhesive small bowel obstruction (SBO) is nonoperative. Rates of recurrence differ based upon time interval between and number of previous occurrences. Optimal time to intervene has not been determined. Methods: We constructed a Markov model to evaluate costs and quality of life on a hypothetical cohort of 40 y.o. patients after their first episode of medical management for post-operative SBO. We estimated a relative risk reduction of .55 with surgical intervention and a relative risk increase of 2.1, 2.9, and 5.7 after the medical management of the 2nd, 3rd, and 4th SBO. Results: Surgery performed after earlier episodes of SBO was more costly but also more effective. The cost difference between surgery after the 1st SBO recurrence versus the 2nd SBO recurrence was 1,643,withanincreaseof0.135qualityadjustedlifeyears(QALYs),theincrementalcosteffectivenessratio(ICER)was1,643, with an increase of 0.135 quality adjusted life years (QALYs), the incremental costeffectiveness ratio (ICER) was 1,643,withanincreaseof0.135qualityadjustedlifeyears(QALYs),theincrementalcosteffectivenessratio(ICER)was12,170/QALY. Conclusion: Surgery after the first episode of SBO provides a small increase in QALY at a small cost since surgical intervention lowers the risk of recurrence.

Journal of Surgical Education, 2021

As the US healthcare system restructured to deal with the COVID-19 pandemic, medical training was... more As the US healthcare system restructured to deal with the COVID-19 pandemic, medical training was significantly disrupted. During the peak of the crisis, three surgical trainees in different stages of their residency shared their experiences and concerns on how this pandemic affected their training. The article is intended to generate discussion on the concerns of derailment and stagnation of surgical training and difficulties faced at all levels of surgical training to perform clinical duties and fulfill academic responsibilities during the early months of the COVID pandemic. (J Surg Ed 000:1À5.

Surgery for Obesity and Related Diseases, 2019

Surgical Endoscopy, 2019

Background Exploratory laparotomy (EL) has been the definitive diagnostic and therapeutic modalit... more Background Exploratory laparotomy (EL) has been the definitive diagnostic and therapeutic modality for operative abdominal trauma in the US. Recently, many trauma centers have started using diagnostic laparoscopy (DL) in stable trauma patients in an effort to reduce the incidence of non-therapeutic laparotomy (NL). We aim to evaluate the incidence of NL in the trauma population in the US and compare the outcomes between DL and NL. Methods Using ICD-9 codes, the National Trauma Data Bank (2010-2015) was queried for patients undergoing any abdominal surgical intervention. Patients were divided into two groups: diagnostic laparoscopy (DL) and exploratory laparotomy (EL). Hemodynamically unstable patients on arrival and patients with abbreviated injury score (AIS) > 3 were excluded. Patients in EL group without any codes for gastrointestinal, diaphragmatic, hepatic, splenic, vascular, or urological procedures were considered to have undergone NL. After excluding patients who were converted to open from the DL group, multivariate regression models were used to analyze the outcomes of DL vs NL group with respect to mortality, length of stay, and complications. Results A total of 3197 patients underwent NL vs 1323 patients who underwent DL. Compared to DL group, the NL group were older (mean age: 35 vs. 31, P < 0.01). Rate of penetrating injury was 77% vs 86% for patients in NL vs DL. On multivariate analysis, NL was associated with increased mortality (OR 4.5, 95% CI 2.1-9.7), higher rate of complications (OR 2.2, 95% CI 1.4-3.3), and a longer hospital stay (OR 2.7, 95% CI 2.1-3.5). NL was also associated with higher rates of pneumonia, VTE, ARDS, and cardiac arrest. Conclusion With increasing experience in minimally invasive surgery, DL should be a part of the armamentarium of trauma surgeons. This study supports that in well-selected trauma patients DL has favorable outcomes compared to NL. These findings warrant further investigation.

American Journal of Gastroenterology, 2017

American Journal of Gastroenterology, 2011

American Journal of Gastroenterology, 2010

Surgery for Obesity and Related Diseases, 2016

Background: Bariatric surgery as a treatment for severe obesity has increased dramatically over t... more Background: Bariatric surgery as a treatment for severe obesity has increased dramatically over the past two decades, but there have been few high-quality, long-term studies comparing the outcomes of different procedures. Prior studies have not been sufficiently large to examine differences in outcomes across important patient subgroups, including older adults (4¼65 years of age) and racial/ ethnic minorities. Bariatric surgery outcomes research is limited and consists of studies with limited follow-up duration. More studies are needed in larger, broadly representative samples to help inform patient and provider decisions about the optimal choice of bariatric surgical procedure in various populations. Methods: The study's main goal is to provide accurate estimates of the one-, three-, and five-year benefits and risks of the three most common bariatric procedures in the United States today-Roux-en-y gastric bypass, adjustable gastric banding, and sleeve gastrectomywith a focus on outcomes that are important to adults and adolescents with severe obesity: 1) changes in weight, 2) rates of remission and relapse of diabetes, and 3) risk of major adverse events. The study has two additional goals: 1) the identification of patient preferences and opinions about (a) whether to undergo bariatric surgery; (b) which bariatric procedure to utilize; and (c) the delivery of follow-up care after bariatric surgery to be studied through a series of focus groups involving adults and children with severe obesity, and 2) the development of infrastructure-in the form of study processes and procedures-to support future comparative effectiveness studies using the National Patient-Centered Clinical Research Network (PCORnet). The study will demonstrate the PCORnet distributed research network's capacity to efficiently use electronic health records data from across the country to answer clinically-relevant questions. Patients and other stakeholders have been engaged in the development of the research questions, the selection of outcomes and the design of the study protocol, and will be engaged in all stages of the research moving forward, including protocol development, monitoring study conduct, and designing and implementing dissemination plans. Results: This study involves 11 of PCORnet's Clinical Data Research Networks (CDRNs) including 56 healthcare organizations across the United States and more than 60,000 patients who have previously undergone bariatric surgery from 2005-2015, with approximately 50 percent gastric bypass, 10 percent gastric banding, and 40 percent sleeve gastrectomy procedures. There is also large geographic variation in the bariatric procedures performed, with some areas dominated by gastric bypass while others are dominated by sleeve gastrectomy. This study includes more than 900 adolescent bariatric patients (the largest adolescent cohort ever) and more than 17,000 adult patients with diabetes. The study will take place in 2016-2017, with final results of all study aims anticipated by January 2018. Conclusions: This study is particularly timely because the sleeve gastrectomy procedure has rapidly grown in popularity in the United States (introduced in the late 2000s as a stand-alone procedure, it currently represents more than 50 percent of all procedures in our 11 PCORnet CDRNs), yet it lacks long-term data comparing its outcomes to the more well-established procedures. Apart from its size and geographic diversity, another key feature of the study is the depth and diversity of its stakeholder involvement, which includes several patients as study team members and executive stakeholder advisors, multiple pediatric and adult bariatric surgeons from different institutions, primary care and specialty physicians, researchers, and leaders of patient-level policy and

The American Journal of Surgery, 2016

BACKGROUND: Many temporary stomas are never reversed leading to significantly worse quality of li... more BACKGROUND: Many temporary stomas are never reversed leading to significantly worse quality of life. Recent evidence suggests a lower rate of reversal among minority patients. Our study aimed to elucidate disparities in national stoma closure rates by race, medical insurance status, and household income. METHODS: Five years of data from the Nationwide Inpatient Sample (2008 to 2012) was used to identify the annual rates of stoma formation and annual rates of stoma closure. Stomas labeled as ''permanent'' or those created secondary to colorectal cancers were excluded. Temporary stoma closure rates were calculated, and differences were tested with the chi-square test. Separate analyses were performed by race/ethnicity, insurance status, and household income. Nationally representative estimates were calculated using discharge-level weights. RESULTS: The 5-year average annual rate of temporary stoma creation was 76,551 per year (46% colostomies and 54% ileostomies). The annual rate of stoma reversal was 50,155 per year that equated to an annual reversal rate of 65.5%. Reversal rates were higher among white patients compared with black patients (67% vs 56%, P , .001) and among privately insured patients compared with uninsured patients (88% vs 63%, P , .001). Reversal rates increased as the household income increased from 61% in the lowest income quartile to 72% in the highest quartile (P , .001). CONCLUSIONS: Stark disparities exist in national rates of stoma closure. Stoma closure is associated with race, insurance, and income status. This study highlights the lack of access to surgical health care among patients of minority race and low-income status.

Surgery for Obesity and Related Diseases, 2015

Surgery for Obesity and Related Diseases, 2015

Surgery for Obesity and Related Diseases, 2015

American journal of surgery, 2015

This study seeks to investigate the outcomes of laparoscopic procedures in patients with previous... more This study seeks to investigate the outcomes of laparoscopic procedures in patients with previous open abdominal surgery. Using data from the National Surgical Quality Improvement Program (2005 to 2009), we identified patients who had undergone laparoscopic cholecystectomy, Nissen fundoplication, Heller myotomy, splenectomy, Roux-en-Y, sleeve gastrectomy, gastric band, appendectomy, or colectomy. Patients were then classified as to whether adhesiolysis (AD) was also carried out. Bivariate and multivariate analysis was used to compare groups. A total of 162,415 patients met our inclusion criteria, comprising 4,501 (3%) in the AD group and 157,913 (97%) in the nonadhesiolysis (NAD) group. Patient who had received lysis of adhesion were older, had 41% higher odds of overall complications, 17% higher adjusted mean lysis of adhesion (P < .001), and 26% higher adjusted mean operation duration (P < .001). A history of previous open abdominal surgery increases the potential complicati...

The American Journal of Surgery, 2015

Background: The use laparoscopy in trauma is, in general, limited for diagnostic purposes. We aim... more Background: The use laparoscopy in trauma is, in general, limited for diagnostic purposes. We aim to evaluate the therapeutic role of laparoscopic surgery in trauma patients. Methods: We analyzed the National Trauma Databank years 2007 to 2010 for all patients undergoing diagnostic laparoscopy (DL). Patients undergoing a therapeutic laparoscopic surgical procedure were identified and tabulated. Mortality and hospital length of stay for patients with isolated abdominal injuries was compared between the open and laparoscopic groups. Results: Out of a total of 2,539,818 trauma visits in the NTDB, 4,755 patients underwent a DL at 467 trauma centers. Of these 916 (19.3%) patients underwent a therapeutic laparoscopic intervention. Common laparoscopic operations included diaphragm repair, bowel repair or resection, and splenectomy. Patients undergoing laparoscopic surgery had a significantly shorter length of stay than the open group (5 days vs 6 days; p value <0.001). Conclusion: Therapeutic laparoscopic surgery for trauma is feasible and may provide better outcomes.

Journal of the American College of Surgeons, 2015

The Diverse Surgeons Initiative (DSI) is a program that was created to provide underrepresented m... more The Diverse Surgeons Initiative (DSI) is a program that was created to provide underrepresented minority surgical residents with the clinical knowledge and minimally invasive surgical skills necessary to excel in surgical residency and successfully transition into surgical practice. The early success of the graduates of the program has been published; however, a more longitudinal assessment of the program was suggested and warranted. This study provides a 5-year follow-up of the 76 physicians that participated in the DSI from 2002 to 2009 to determine if the trend toward fellowship placement and academic appointments persisted. Additionally, this extended evaluation yields an opportunity to assess these young surgeons' professional progress and contributions to the field. The most current professional development and employment information was obtained for the 76 physicians that completed the DSI from 2002 to 2009. The percentage of DSI graduates completing surgical residency, o...

The American Journal of Surgery, 2015

BACKGROUND: Sleepiness and fatigue affect surgical outcomes. We wished to determine the associati... more BACKGROUND: Sleepiness and fatigue affect surgical outcomes. We wished to determine the association between time of day and outcomes following surgery for trauma. METHODS: From the National Trauma Data Bank (2007 to 2010), we analyzed all adults who underwent an exploratory laparotomy between midnight and 6 am or between 7 am and 5 pm. We compared hospital mortality between these groups using multivariate logistic regression. Additionally, for each hour, a standardized mortality ratio was calculated. RESULTS: About 16,096 patients and 15,109 patients were operated on in the night time and day time, respectively. No difference was found in the risk-adjusted mortality rate between the 2 time periods (odds ratio .97, 95% confidence interval .893 to 1.058). However, hourly variations in mortality during the 24-hour period were noted. CONCLUSION: Trauma surgery during the odd hours of the night did not have an increased riskadjusted mortality when compared with surgery during the day.