Publications by authors named "Cassandra Kelleher"
Introduction: Growing evidence supports the success of nonoperative management (NOM) for pediatric adhesive small bowel obstruction (A-SBO). However, there is concern that patients with nonadhesive SBO (NA-SBO) will have repeat episodes of SBO if not treated with surgery upfront. We examined whether NOM of NA-SBO at initial presentation was associated with increased risk of recurrent SBO.
View Article and Find Full Text PDFImportance: Most youths receiving palliative care undergo many surgical interventions over their lifetimes. The intended purposes of interventions in the context of goals of care are not commonly articulated.
Objective: To describe the goals and purposes of surgical intervention in youths receiving palliative care and propose a framework discussing intervention using goal-oriented language.
Background/purpose: Despite the prevalence of surgical intervention in seriously ill children, data is scarce regarding interventions performed based on type of serious illness. We therefore sought to evaluate the surgical interventions performed from the time of serious illness diagnosis to the present in a cohort of children receiving palliative care, including identification of the surgical specialists involved in these procedures.
Methods: We conducted a retrospective cohort analysis of surgical interventions in 197 children enrolled in a multicenter prospective cohort study (Pediatric Palliative Care Research Network SHARE Study).
Multi-institutional quality improvement algorithm for home nasogastric tube care for neonates.
Int J Pediatr Otorhinolaryngol
October 2024
Background: High-risk neonates continuing to need enteral nutrition, but otherwise medically ready for discharge home from the NICU, are often offered ongoing hospitalization for nasogastric tube (NGT) feeding, versus discharge after placement of gastrostomy tube. Our group developed an interdisciplinary algorithm to support a third option-discharge home with enteral nutrition via NGT. Our objective was to develop a cross-institutional and interdisciplinary pathway to optimize outcomes for neonates discharged with NGTs.
View Article and Find Full Text PDFPurpose: The nature of interactions between surgical and pediatric palliative care (PPC) teams caring for seriously ill children is unknown. This study compares pediatric surgeons' and PPC physicians' perspectives and practices regarding PPC in surgical patients.
Methods: A survey was administered to members of the American Pediatric Surgical Association and Pediatric Interest Group of the American Academy of Hospice and Palliative Medicine.
Importance: Retaining female physicians in the academic health care workforce is necessary to serve the needs of sociodemographically diverse patient populations.
Objective: To investigate differences in rates of leaving academia between male and female physicians.
Design, Setting, And Participants: This cohort study used Care Compare data from the Centers for Medicare & Medicaid Services for all physicians who billed Medicare from teaching hospitals from March 2014 to December 2019, excluding physicians who retired during the study period.
Introduction: The literature on gender homophily has mostly been focused on patient-physician relationship but not on interprofessional referrals. The goal of this study is to quantify interphysician gender homophily of referring physicians in surgical referrals.
Methods: An observational study of the referral data at a large academic center was performed.
Over the past few decades, institutions have developed complex systems to compare themselves to others with the goal of improving healthcare quality. This process of comparison to others, called external benchmarking, has become the standard approach for quality improvement. However, external benchmarking is resource intensive, may not be flexible enough to focus on problems unique to individual institutions, and may lead to complacency for institutions ranking near the top of the quality bell curve for the measured metrics.
View Article and Find Full Text PDFObjectives: Necrotizing enterocolitis (NEC) is a severe intestinal inflammatory disease and a leading cause of morbidity and mortality in NICUs. Management of NEC is variable because of the lack of evidence-based recommendations. It is widely accepted that standardization of patient care leads to improved outcomes.
View Article and Find Full Text PDFBackground: Geriatric patients face disparities in prehospital trauma care. We hypothesized that geriatric trauma patients are more likely to experience prolonged prehospital scene time than younger adults.
Methods: Retrospective analysis of the 2017 National Emergency Medical Services Information System.
Background: It has been speculated that women's productivity decreases after maternity leave. In this study, we measured if surgeon clinical productivity decreases after a maternity leave or other types of leave.
Methods: Data from a large medical center was used to measure surgeon productivity before (pre) and after (post) a leave of absence.
Importance: In the US, approximately 40 000 people die due to firearm-related injuries annually. However, nonfatal firearm-related injuries are less precisely tracked.
Objectives: To assess the annual incidence of hospitalization for nonfatal firearm-related injuries in New York and to compare the annual incidence by sex, race/ethnicity, county of residence, and calendar years.
Background: The literature shows that female surgeons have lower operative volumes than male surgeons. Since volume is dependent on new patient referrals for most surgeons, inequities in referrals may contribute to this employment disparity.
Methods: Using 1997-2018 data from a large medical center, we examined the number of new patient referrals for surgeons.
Objective: To compare the complexity of operations performed by female versus male surgeons.
Background: Prior literature has suggested that female surgeons are relatively underemployed when compared to male surgeons, with regards to operative case volume and specialization.
Methods: Operative case records from a large academic medical center from 1997 to 2018 were evaluated.
Study Objective: Current literature lacks data-driven guidelines for surgical treatment of adolescent and young adult (AYA) patients with chronic pelvic pain. We hypothesized that there is a significant variation in treatment of these patients, which might be an indicator of over- or undertreatment by some providers.
Design And Setting: We completed a retrospective population-based analysis of the Nationwide Inpatient Sample from 1998 to 2016.
Background: The "white-flight" phenomenon of the mid-20th century contributed to the perpetuation of residential segregation in American society. In light of recent reports of racial segregation in our healthcare system, could a contemporary "white-flight" phenomenon also exist?
Methods: The New York Statewide Planning and Research Cooperative System was used to identify all Manhattan and Bronx residents of New York city who underwent elective cardiothoracic, colorectal, general, and vascular surgeries from 2010 to 2016. Primary outcome was borough of surgical care in relation to patient's home borough.
Background: It is unknown whether previously noted racial disparities in the use of metabolic and bariatric surgery (MBS) for the management of pediatric obesity could be mitigated by accounting for primary insurance.
Objectives: To examine utilization of pediatric MBS across race and insurance in the United States.
Setting: Retrospective cross-sectional study.
Background: Practice pattern and work environment differences may impact career advancement opportunities and contribute to the gender gap within highly competitive surgical specialties.
Methods: Using a 2000-2015 New York statewide dataset, we compared board-certified pediatric surgeons by specialist case volume and Herfindahl-Hirschman Index (HHI), which quantifies surgeon focus within specialist case mix.
Results: 51 pediatric surgeons were analyzed for 461 surgeon-years.