Publications by authors named "Karyn Stitzenberg"
Purpose: With the results of several recently published clinical trials, this guideline focused update provides evidence-based recommendations for the indications and dose-fractionation regimens for neoadjuvant radiation therapy (RT), optimal sequencing of RT and systemic therapy in the context of total neoadjuvant therapy (TNT), and considerations for selective omission of RT and surgery for rectal cancer.
Methods: The American Society for Radiation Oncology convened a multidisciplinary task force to update 3 key questions that focused on the role of RT for patients with operable rectal cancer. The key questions addressed (1) indications for neoadjuvant RT, (2) selection of neoadjuvant regimens, and (3) indications for consideration of a nonoperative management (NOM) or local excision approach after definitive/preoperative chemoradiation.
Objective: The goal of this study was to assess predictive factors for receiving interviews and matching in general surgery (GS), cardiothoracic surgery (TS), vascular surgery (VS), and plastic surgery (PS).
Design: The Texas Seeking Transparency in Applications to Residency (STAR) survey was analyzed for match years 2018-2023. Chi-Square Tests of Independence were used to assess differences among participants who received ≥16 vs <16 interviews and, separately, participants who matched vs went unmatched.
Importance: Evaluating how social determinants of health (SDOH) influence veteran outcomes is crucial, particularly for quality improvement.
Objective: To measure associations between SDOH, care fragmentation, and surgical outcomes using a Desirability of Outcome Ranking (DOOR).
Design, Setting, And Participants: This was a cohort study of US veterans using data from the Veterans Affairs (VA) Surgical Quality Improvement Program (VASQIP; 2013-2019) limited to patients aged 65 years or older with inpatient stays between 2 and 30 days, merged with multiple data sources, including Medicare.
Importance: Insurance coverage expansion has been proposed as a solution to improving health disparities, but insurance expansion alone may be insufficient to alleviate care access barriers.
Objective: To assess the association of Area Deprivation Index (ADI) with postsurgical textbook outcomes (TO) and presentation acuity for individuals with private insurance or Medicare.
Design, Setting, And Participants: This cohort study used data from the National Surgical Quality Improvement Program (2013-2019) merged with electronic health record data from 3 academic health care systems.
Background: Talimogene laherparepvec (T-VEC) is an FDA-approved oncolytic herpesvirus therapy used for unresectable stage IIIB through IV metastatic melanoma. However, the correlation between clinical complete response (cCR) and pathologic complete response (pCR) in patients treated with T-VEC is understudied.
Study Design: We conducted a retrospective study from a prospectively maintained IRB-approved melanoma single-center database in patients treated with T-VEC from October 2015 to April 2022.
Background: Guidelines recommend extended venous thromboembolism (VTE) prophylaxis for high-risk populations undergoing major abdominal cancer operations. Few studies have evaluated extended VTE prophylaxis in the Medicare population who are at higher risk due to age.
Methods: We performed a retrospective study using a 20% random sample of Medicare claims, 2012-2017.
Background: Children, adolescents, and young adults (CAYA) (age ≤39 years) with GIST have high rates of LNM, but their clinical relevance is undefined. This study analyzed the impact of LNM on overall survival (OS) for CAYA with GIST.
Methods: The National Cancer Database was queried for patients with resected GIST and pathologic nodal staging data from 2004-2019.
Objective: Assess associations of Social Determinants of Health (SDoH) using Area Deprivation Index (ADI), race/ethnicity and insurance type with Textbook Outcomes (TO).
Summary Background Data: Individual- and contextual-level SDoH affect health outcomes, but only one SDoH level is usually included.
Methods: Three healthcare system cohort study using National Surgical Quality Improvement Program (2013-2019) linked with ADI risk-adjusted for frailty, case status and operative stress examining TO/TO components (unplanned reoperations, complications, mortality, Emergency Department/Observation Stays and readmissions).
Objective: Develop an ordinal Desirability of Outcome Ranking (DOOR) for surgical outcomes to examine complex associations of Social Determinants of Health.
Background: Studies focused on single or binary composite outcomes may not detect health disparities.
Methods: Three health care system cohort study using NSQIP (2013-2019) linked with EHR and risk-adjusted for frailty, preoperative acute serious conditions (PASC), case status and operative stress assessing associations of multilevel Social Determinants of Health of race/ethnicity, insurance type (Private 13,957; Medicare 15,198; Medicaid 2835; Uninsured 2963) and Area Deprivation Index (ADI) on DOOR and the binary Textbook Outcomes (TO).
Background: Cancer patients with newly created ostomies face complications that reduce quality of life (QOL) and increase morbidity and mortality. This proof-of-concept study examined the feasibility, usability, acceptability, and initial efficacy of an eHealth program titled the "Patient Reported Outcomes-Informed Symptom Management System" (PRISMS) during post-ostomy creation care transition.
Methods: We conducted a 2-arm pilot randomized controlled trial among 23 patients who received surgical treatment with curative intent for bladder and colorectal cancer and their caregivers.
Background: Surgical analyses often focus on single or binary outcomes; we developed an ordinal Desirability of Outcome Ranking (DOOR) for surgery to increase granularity and sensitivity of surgical outcome assessments. Many studies also combine elective and urgent procedures for risk adjustment. We used DOOR to examine complex associations of race/ethnicity and presentation acuity.
View Article and Find Full Text PDFPurpose: Improved outcomes in lung cancer treatment are seen in high-volume academic centers, making it important to understand barriers to accessing care at such institutions. Few qualitative studies examine the barriers and facilitators to early-stage lung cancer care at US academic institutions.
Methods: Adult patients with suspected or diagnosed early-stage non-small cell lung cancer presenting to a multidisciplinary lung cancer clinic at a US academic institution over a 6-month period beginning in 2019 were purposively sampled for semi-structured interviews.
Introduction: Yentl syndrome describing sex-related disparities has been extensively studied in medical conditions but not after surgery. This retrospective cohort study assessed the association of sex, frailty, presenting with preoperative acute serious conditions (PASC), and the expanded Operative Stress Score (OSS) with postoperative complications, mortality, and failure-to-rescue.
Methods: The National Surgical Quality Improvement Program from 2015 to 2019 evaluating 30-d complications, mortality, and failure-to-rescue.
Background & Aims: Given the risk of intestinal resection for Crohn's disease, postoperative treatment may be informed by several risk factors, including resection type. We compared postoperative treatment strategies for Crohn's disease between emergent/urgent versus elective resection.
Methods: We identified patients with intestinal resection for Crohn's disease between 2002-2018 using the MarketScan databases.
Background: Readmission after colorectal surgery is common and often implies complications for patients and costs for hospitals. Previous works have created predictive models using logistic regression for this outcome but have shown limited accuracy. Machine learning has shown promise in improving predictions by identifying non-linear patterns in data.
View Article and Find Full Text PDFIntroduction: There are multiple measures of area socioeconomic status (SES) and there is little evidence on the comparative performance of these measures. We hypothesized adding area SES measures improves model ability to predict guideline concordant care and overall survival compared to models with standard clinical and demographic data alone.
Materials And Methods: We included patients with colorectal cancer from 2006 to 2015 from the North Carolina Cancer Registry merged with insurance claims data.
Our objectives were to evaluate geographic access to lung cancer treatment modalities in North Carolina and to characterize how practice patterns are changing over time. We hypothesized that rural patients would be less likely to undergo treatment compared to urban patients, with widening disparities over time. We identified patients with Stage I non-small cell lung cancer (NSCLC) from 2006 to 2015 using the North Carolina Central Cancer Registry linked with Medicaid, Medicare, and private insurance claims.
View Article and Find Full Text PDFTrends in rural-urban disparities among surgical specialties treating cancer, 2004-2017.
J Rural Health
September 2022
Purpose: We evaluated temporal trends in rural-urban disparities of the surgeon supply among surgeons commonly treating patients with cancer.
Methods: We performed a retrospective observational study of county-level workforce changes from 2004 to 2017 using the Area Health Resource File. We calculated physician density (providers/100,000 population) for each specialty by rural and urban counties using the 2003 Rural-Urban Commuting Codes (RUCC), and evaluated percent changes in the rural-urban disparity in physician density.
Surgical resection is the cornerstone of curative intent therapy for rectal cancer. The introduction of the concept of total mesorectal excision (TME) led to significant decreases in local recurrence. However, TME carries substantial morbidity.
View Article and Find Full Text PDFBackground: Despite unprecedented changes to undergraduate medical education and the residency selection process during the COVID-19 pandemic, there is little objective evidence on how the pandemic affected match outcomes such as matched applicant characteristics, interview distribution, geographic clustering, and associated costs. We investigated COVID-19's impact on the residency match by comparing surgery applicants' characteristics, interview distribution, and related costs from 2018 to 2020 to 2021.
Methods: Data from the Texas Seeking Transparency in Applications to Residency initiative were analyzed.
Objective: To determine predictive factors for a successful residency match among general surgery applicants from 2018 to 2021.
Design: A retrospective cross-sectional study of general surgery applicants who matched and went unmatched in match years 2018 to 2021. Applicant characteristics, geographic connections to a program, and away rotations were compared among matched and unmatched applicants.
Background: There are multiple different systems that define a rural area in health services research, but few studies compare their ability to measure access to health resources. Our objective was to compare various definitions of rurality to determine which system best measures local surgeon supply.
Materials And Methods: In this retrospective observational study, we used the 2019 Area Health Resource File to obtain the 2017 county-level supply of general surgeons, surgical subspecialists, and total physicians for all counties in the United States.
Objective: The aim of this study was to expand Operative Stress Score (OSS) increasing procedural coverage and assessing OSS and frailty association with Preoperative Acute Serious Conditions (PASC), complications and mortality in females versus males.
Summary Background Data: Veterans Affairs male-dominated study showed high mortality in frail veterans even after very low stress surgeries (OSS1).
Methods: Retrospective cohort using NSQIP data (2013-2019) merged with 180-day postoperative mortality from multiple hospitals to evaluate PASC, 30-day complications and 30-, 90-, and 180-day mortality.