Readmission after abdominal aortic aneurysm repair: what does it mean?

Thirty-day readmission is common after AAA repair, an d postoperative events are strong predictors of readmission after adjusting for comorbidity. In addition, readmission is strongly associated with 1-year mortality. Considering the current evidence for readmission after AAA repair, improved coordination of care across the inpatient, transitional care, and outpatient settings, with active surveillance for procedure-specific (EVAR vs open) postoperative complications, may prevent some early readmissions.

Early graft failure after infrainguinal arterial bypass.

Introduction: Early graft failure (EGF), defined as failure within 30 days of an index procedure, is a serious complication after infrainguinal arterial bypass. EGF has not been examined by the use of national data since the widespread adoption of percutaneous treatments for arterial occlusive disease.

Methods: We used data from the American College of Surgeons National Surgical Quality Improvement Program.

Preoperative factors predict mortality after major lower-extremity amputation.

Background: The objective was to develop a preoperative mortality risk stratification tool for patients facing major amputation.

Methods: Patients who underwent above-knee (AKA) or below-knee amputation (BKA) from 2005 to 2010 were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Univariate and multivariate analyses were performed to determine the association of preoperative factors with 30-day mortality.

Causes and implications of readmission after abdominal aortic aneurysm repair.

Objective: To determine the frequency, causes, predictors, and consequences of 30-day readmission after abdominal aortic aneurysm (AAA) repair.

Background Data: Centers for Medicare & Medicaid Services (CMS) will soon reduce total Medicare reimbursements for hospitals with higher-than-predicted 30-day readmission rates after vascular surgical procedures, including AAA repair. However, causes and factors leading to readmission in this population have never before been systematically analyzed.

Adjuvant chemotherapy for stage II colon cancer with poor prognostic features.

Purpose: Adjuvant chemotherapy is typically considered for patients with stage II colon cancer characterized by poor prognostic features, including obstruction, perforation, emergent admission, T4 stage, resection of fewer than 12 lymph nodes, and poor histology. Despite frequent use, the survival advantage conferred on patients with stage II disease by chemotherapy is yet unproven. We sought to determine the overall survival benefit of chemotherapy among patients with stage II colon cancer having poor prognostic features.

Predictors of surgical site infection after open lower extremity revascularization.

Objectives: Surgical site infection (SSI) after open surgery for lower extremity revascularization is a serious complication that may lead to graft infection, prolonged hospitalization, and increased cost. Rates of SSI after revascularization vary widely, with most studies reported from single institutions. The objective of this study was to describe the rate and predictors of SSI after surgery for arterial occlusive disease using national data, and to identify any association between SSI and length of hospital stay, reoperation, graft loss, and mortality.

Short-term outcomes after laparoscopic-assisted proctectomy for rectal cancer: results from the ACS NSQIP.

Background: Although numerous studies have demonstrated improved short-term outcomes after laparoscopic resection of colon cancer, the benefits of laparoscopic-assisted proctectomy (LAP) for rectal cancer are less clear. The current report addresses the need for a large multi-institutional study on early outcomes after proctectomy for cancer.

Study Design: Patients who underwent elective LAP or open proctectomy for cancer during 2005 to 2009 were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database.

Preoperative factors predict perioperative morbidity and mortality after pancreaticoduodenectomy.

Background: Pancreaticoduodenectomy (PD) has long been associated with high rates of morbidity and mortality. The objective of this study was to identify preoperative risk factors for serious complications and mortality after PD and to construct a prediction tool to facilitate risk stratification prior to surgery.

Materials And Methods: Patients who underwent elective PD from 2005 to 2009 were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database.

Risk stratification for distal pancreatectomy utilizing ACS-NSQIP: preoperative factors predict morbidity and mortality.

Background: Evaluation of risk factors for adverse outcomes following distal pancreatectomy (DP) has been limited to data collected from retrospective, primarily single-institution studies. Using a large, multi-institutional prospectively collected dataset, we sought to define the incidence of complications after DP, identify the preoperative and operative risk factors for the development of complications, and develop a risk score that can be utilized preoperatively.

Methods: The American College of Surgeons National Surgical Quality Improvement Program participant use file was utilized to identify patients who underwent DP from 2005 to 2008 by Current Procedural Terminology codes.

Lithium inhibits carcinoid cell growth in vitro.

Carcinoids are slow growing neuroendocrine tumors that often cause debilitating symptoms due to excessive secretion of hormones such as serotonin. Surgery is the only potentially curative treatment, but many patients have unresectable metastatic disease. Lithium is a non- competitive inhibitor of GSK-3 with an established safety profile.

Readmission after colectomy for cancer predicts one-year mortality.

Objectives: Early hospital readmission is a common and costly problem in the Medicare population. In 2009, the Centers for Medicaid and Medicare Services began mandating hospital reporting of disease-specific readmission rates. We sought to determine the rate and predictors of readmission after colectomy for cancer, as well as the association between readmission and mortality.

Thyroid resection improves perception of swallowing function in patients with thyroid disease.

Background: Patients with thyroid disease frequently complain of dysphagia. To date, there have been no prospective studies evaluating swallowing function before and after thyroid surgery. We used the swallowing quality of life (SWAL-QOL) validated outcomes assessment tool to measure changes in swallowing-related QOL in patients undergoing thyroid surgery.

Older age and larger tumor size predict malignancy in hürthle cell neoplasms of the thyroid.

Background: Hürthle cell neoplasms (HCNs) are rare tumors of the thyroid gland. The definitive treatment for Hürthle cell carcinoma (HCC) is total thyroidectomy, while thyroid lobectomy is adequate for Hürthle cell adenoma (HCA). However, differentiating HCC from HCA either before or during surgery is a challenge.

Valproic acid induces Notch1 signaling in small cell lung cancer cells.

Background: Small cell lung cancer (SCLC) is an aggressive malignancy. Current treatments yield dismal survival rates. We have previously demonstrated that histone deacetylase (HDAC) inhibitors can inhibit neuroendocrine tumor growth.

Valproic acid activates Notch1 signaling and induces apoptosis in medullary thyroid cancer cells.

Objective: To examine the effects of valproic acid (VPA) on Notch1 expression and cancer cell proliferation in medullary thyroid cancer (MTC) cells.

Background: Other than surgery, there are no effective treatments for MTC, a neuroendocrine malignancy that frequently metastasizes. We have previously shown that over-expression of Notch1 in MTC cells inhibits cell growth and hormone production.

The role of intraoperative frozen section if suspicious for papillary thyroid cancer.

Background: Optimal surgical intervention is straightforward when a fine-needle aspiration (FNA) is diagnostic for papillary thyroid cancer (PTC). However, if there are characteristics of an aspirate suspicious for PTC but not meeting criteria for diagnosis of PTC, the management is less clear.

Methods: Of the 1,051 patients who underwent thyroid surgery at the University of Wisconsin between May 24, 1994, and October 21, 2004, 102 had preoperative FNA cytology that was diagnostic or suspicious for PTC.

Suberoyl bis-hydroxamic acid activates Notch-1 signaling and induces apoptosis in medullary thyroid carcinoma cells.

Medullary thyroid carcinoma (MTC) is a neuroendocrine (NE) malignancy that frequently metastasizes and has limited treatments. We recently reported that ectopic expression of Notch-1 in human MTC cells suppresses growth. The objective of this study was to evaluate the ability of suberoyl bis-hydroxamic acid (SBHA) to modulate Notch-1 signaling in MTC cells.

The utility of metaiodobenzylguanidine (MIBG) scintigraphy in patients with pheochromocytoma.

Background: Radiolabeled metaiodobenzylguanidine scintigraphy (MIBG) can be used to image pheochromocytomas. While cross-sectional imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI) usually localize the tumor, MIBG is often obtained to rule out multifocal and metastatic disease, and to corroborate anatomic imaging with functional data. We questioned the utility of MIBG in the diagnosis and management of pheochromocytoma.

Suberoyl bishydroxamic acid inhibits cellular proliferation by inducing cell cycle arrest in carcinoid cancer cells.

Carcinoid cancers arise from the neuroendocrine cell system of the gastrointestinal tract, lungs, and other organs. Hepatic metastases are common, and patients often suffer from endocrinopathies secondary to tumor secretion of various hormones and peptides. As complete surgical resection is often not possible because of widespread disease, new therapeutic and palliative treatments are needed.

Palliation of advanced thyroid malignancies.

While most thyroid cancers are slow-growing and have an excellent prognosis after appropriate treatment, a subset of thyroid cancers behave aggressively, and approximately 1500 individuals in the US will die of the disease in the year 2007. Advanced thyroid malignancies can cause distressing and life-threatening symptoms by local invasion in the neck, growth of distant metastases in the lung, bone, and other organs, and tumor production of bioactive substances in the case of medullary thyroid cancer. This article will review palliative modalities, including surgery, radioactive iodine, external beam radiation, and chemotherapy, as well as novel targeted therapies, for the treatment of patients with advanced thyroid malignancies.

Valproic acid activates notch-1 signaling and regulates the neuroendocrine phenotype in carcinoid cancer cells.

Carcinoid tumors are neuroendocrine malignancies that frequently metastasize and secrete hormones that cause debilitating symptoms in patients. In this study we report the effects of valproic acid (VPA), a drug long used for the treatment of epilepsy, on the growth and neuroendocrine phenotype of human carcinoid cancer cells. VPA treatment of gastrointestinal and pulmonary carcinoid cells resulted in a dose-dependent inhibition of cancer cell growth.

The HDAC inhibitor trichostatin A inhibits growth of small cell lung cancer cells.

Background: An estimated 162,460 people will die of lung cancer in the United States in 2006, making it the leading cause of cancer deaths. Small cell lung cancer (SCLC) accounts for 20% of all lung cancers and exhibits aggressive behavior with early metastases. Current treatments yield five-year survival rates of 5 to 10%, indicating a need for novel therapeutic approaches.

Initial lymph node dissection increases cure rates in patients with medullary thyroid cancer.

Objective: Medullary thyroid carcinoma (MTC) is the third most common type of thyroid cancer. MTC spreads early to local lymph nodes, and most endocrine surgeons recommend total thyroidectomy with central lymph node dissection (CLND) as the minimum initial operation. We reviewed our experience to determine if the initial operation influences clinical outcomes.

Raf-1 activation in gastrointestinal carcinoid cells decreases tumor cell adhesion.

Background: Gastrointestinal carcinoid tumors are highly metastatic. Activation of the Raf-1 signaling pathway in carcinoid cells results in morphologic changes. These Raf-1-induced structural changes may affect cellular adhesion, thereby altering metastatic potential.