Publications by authors named "Coburn N"
Background: Days at home after surgery is a promising new patient-centred outcome metric that measures time spent outside of healthcare institutions and mortality. The aim of this scoping review was to synthesize the use of days at home in perioperative research and evaluate how it has been termed, defined, and validated, with a view to inform future use.
Methods: The search was run on MEDLINE, Embase, and Scopus on 30 March 2023 to capture all perioperative research where days at home or equivalent was measured.
Development and Validation of a Survival Prediction Model for Patients With Pancreatic Cancer.
Clin Transl Gastroenterol
December 2024
Article Synopsis
- A survival prognostication model was developed for pancreatic ductal adenocarcinoma (PDAC) patients using clinical data, patient-reported symptoms, and treatment specifics to aid in their treatment decisions.
- The study analyzed data from 17,450 PDAC patients in Ontario over a 13-year period, finding significant predictors of survival, including tumor location, disease stage, hospitalizations, heart failure, and various pain and performance scores.
- The model demonstrated good predictive accuracy with a C index of 0.76, suggesting it could enhance shared decision-making between patients and healthcare providers regarding treatment options.
Background: With a growing proportion of patients undergoing surgery for colorectal cancer being older adults, it is unknown whether traditional quality metrics are achieved as often compared with younger adults. This work was done with a view to understand tailoring needs of quality metrics for older adults with colorectal cancer.
Methods: This retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Program registry to identify adults (≥18 years) between 2016 and 2021 who underwent elective colorectal cancer surgery for nonmetastatic cancer.
Article Synopsis
- The study aimed to analyze the relationship between the sex of surgeons and the number of days patients spend alive and at home (DAH) after surgery.
- It found that patients treated by female surgeons had significantly more DAH compared to those treated by male surgeons over all measured time frames (30, 90, and 365 days).
- The findings suggest that higher DAH associated with female surgeons could lead to lower healthcare costs and better patient quality of life, indicating a need for further research in different healthcare settings.
Despite consensus guidelines, most patients with early-stage triple-negative (TN) and HER2-positive (HER2+) breast cancer do not see a medical oncologist prior to surgery and do not receive neoadjuvant chemotherapy (NAC). To understand barriers to care, we aimed to characterize the relationship between geography (region of residence and cancer centre proximity) and receipt of a pre-treatment medical oncology consultation and NAC for patients with TN and HER2+ breast cancer. Using linked administrative datasets in Ontario, Canada, we performed a retrospective population-based analysis of women diagnosed with stage I-III TN or HER2+ breast cancer from 2012 to 2020.
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- Tranexamic acid is known to reduce bleeding and blood transfusions in various surgeries, but its effectiveness for patients undergoing liver resection due to cancer is uncertain.
- A multicenter randomized clinical trial involving 1384 patients was conducted to see if tranexamic acid decreases the need for red blood cell transfusions within 7 days after liver surgery.
- The results showed no significant difference in transfusion rates or blood loss between the tranexamic acid group and the placebo group, and those who received tranexamic acid experienced more complications.
Objective: We sought to examine whether the outcomes of patients who receive a surgical procedure on Friday the 13th differ from patients who receive surgery on flanking Fridays.
Background: Numerous studies have demonstrated that increased anxiety from the provider or patient around the time of surgery can lead to worse outcomes. Superstitious patients often express significant concern and anxiety when undergoing a surgical procedure on Friday the 13th.
Background: The recruitment of neutrophils to sites of localized injury or infection is initiated by changes on the surface of endothelial cells located in proximity to tissue damage. Inflammatory mediators, such as TNF-α, increase surface expression of adhesive ligands and receptors on the endothelial surface to which neutrophils tether and adhere. Neutrophils then transit through the activated endothelium to reach sites of tissue injury with little lasting vascular injury.
View Article and Find Full Text PDFPurpose: Patients with lung cancer can experience significant psychological morbidities including depression. We characterize patterns and factors associated with interventions for symptoms of depression in stage IV non-small cell lung cancer (NSCLC).
Methods: We conducted a population-based cohort study using health services administrative data in Ontario, Canada of stage IV NSCLC diagnosed from January 2007 to September 2018.
Article Synopsis
- Team diversity, particularly in terms of sex, can enhance performance and potentially improve surgical outcomes, though data in healthcare settings are limited.
- A study analyzing over 700,000 surgeries from 2009 to 2019 found that hospitals with more than 35% female anaesthetists and surgeons had significantly reduced rates of 90-day major morbidity.
- The association was even stronger for surgeries involving female anaesthetists and surgeons, indicating that higher female representation in surgical teams leads to better patient outcomes.
Purpose: Neoadjuvant chemotherapy (NAC) for triple-negative (TN) and Her2-positive (HER2) breast cancers is supported by international guidelines as it can decrease extent of surgery, provide prognostic information, and allow response-driven adjuvant therapies. Our goal was to describe practice patterns for patients with TN and HER2-positive breast cancer and identify the factors associated with the receipt of NAC versus surgery as initial treatment.
Methods: A retrospective population-based cohort study of adult women diagnosed with stage I-III TN or HER2-positive breast cancer (2012-2020) in Ontario was completed using linked administrative datasets.
Objective: Chemoradiation followed by esophagectomy is a standard treatment option for patients with locally advanced esophageal cancer (LAEC). Esophagectomy is a high-risk procedure, and recent evidence suggests select patients may benefit from omitting or delaying surgery. This study aims to compare surgery versus active surveillance for LAEC patients with complete clinical response (cCR) after neoadjuvant chemoradiotherapy (nCRT).
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- Surgical stress can weaken the immune system in patients after surgery, increasing the risk of infections and possibly cancer recurrence; this study examines how dietary changes, specifically arginine-enhanced diets, can improve immune function during and after hepatopancreaticobiliary surgery.
- The study is a randomized controlled trial with 45 patients, aiming to compare immune function and clinical outcomes between a control group and those receiving immunonutrition, measuring changes in natural killer cell activity one day after surgery.
- Ethical approval has been obtained for the trial, and results will be shared through various channels including conferences, publications, and the ClinicalTrials.gov database to ensure transparency and accessibility of information.
Background: Approximately 15% of patients experience post-hepatectomy liver failure after major hepatectomy. Poor hepatocyte uptake of gadoxetate disodium, a magnetic resonance imaging contrast agent, may be a predictor of post-hepatectomy liver failure.
Methods: A retrospective cohort study of patients undergoing major hepatectomy (≥3 segments) with a preoperative gadoxetate disodium-enhanced magnetic resonance imaging was conducted.
Objective: To examine the association of anesthesiologist sex on postoperative outcomes.
Background: Differences in patient postoperative outcomes exist, depending on whether the primary surgeon is male or female, with better outcomes seen among patients treated by female surgeons. Whether the intraoperative anesthesiologist's sex is associated with differential postoperative patient outcomes is unknown.
Strategies to ramp up breast cancer screening after COVID-19 require data on the influence of the pandemic on groups of women with historically low screening uptake. Using data from Ontario, Canada, our objectives were to 1) quantify the overall pandemic impact on weekly bilateral screening mammography rates (per 100,000) of average-risk women aged 50-74 and 2) examine if COVID-19 has shifted any mammography inequalities according to age, immigration status, rurality, and access to material resources. Using a segmented negative binomial regression model, we estimated the mean change in rate at the start of the pandemic (the week of March 15, 2020) and changes in weekly trend of rates during the pandemic period (March 15-December 26, 2020) compared to the pre-pandemic period (January 3, 2016-March 14, 2020) for all women and for each subgroup.
View Article and Find Full Text PDFImportance: Prior research has shown differences in postoperative outcomes for patients treated by female and male surgeons. It is important to understand, from a health system and payer perspective, whether surgical health care costs differ according to the surgeon's sex.
Objective: To examine the association between surgeon sex and health care costs among patients undergoing surgery.
Importance: Collecting patient-reported outcomes (PROs) in routine cancer care improves patient-clinician communication, decision making, and overall patient satisfaction. Recommendations exist regarding standardized ways to collect, store, and interpret PRO data. However, evidence on incorporating PROs into cancer process of care, especially the type of HIs that are warranted after observing a concerning PRO and the effectiveness of these HIs are lacking.
View Article and Find Full Text PDFObjective: To determine whether patient-surgeon gender concordance is associated with mortality of patients after surgery in the United States.
Design: Retrospective observational study.
Setting: Acute care hospitals in the US.