Publications by authors named "Kyle Zanocco"
Background: Misuse of prescription opioids is a well-established contributor to the US opioid epidemic. The primary objective of this study was to identify which level of care delivery (ie patient, prescriber, or hospital) produced the most unwarranted variation in opioid prescribing after common surgical procedures.
Study Design: Electronic health record data from a large multihospital healthcare system were used in conjunction with random-effect models to examine variation in opioid prescribing practices after similar inpatient and outpatient surgical procedures between October 2019 and September 2021.
Article Synopsis
- Excessive opioid prescribing after surgery can lead to ongoing use and potential misuse, and social norm-based email feedback may help decrease these prescriptions.
- A study tested two email interventions aimed at surgeons to see if they could reduce the number of opioids prescribed beyond recommended guidelines after surgeries.
- Results showed that surgeons receiving peer comparison feedback prescribed above guidelines only 27.5% of the time, significantly lower than the 36.8% in the control group, indicating the effectiveness of these targeted interventions.
Objectives: To examine racial and ethnic disparities in postoperative opioid prescribing.
Data Sources: Electronic health records (EHR) data across 24 hospitals from a healthcare delivery system in Northern California from January 1, 2015 to February 2, 2020 (study period).
Study Design: Cross-sectional, secondary data analyses were conducted to examine differences by race and ethnicity in opioid prescribing, measured as morphine milligram equivalents (MME), among patients who underwent select, but commonly performed, surgical procedures.
The 3 phases of thyroid cancer care are discussed: diagnosis, management, and survivorship. Drivers of quality of life (QOL) in each phase are described, and suggestions are made for mitigating the risk of poor QOL. Active surveillance is another emerging management strategy that has the potential to improve QOL by eliminating upfront surgical morbidity but will need to be studied prospectively.
View Article and Find Full Text PDFImportance: Legislation mandating consultation with a prescription drug monitoring program (PDMP) was implemented in California on October 2, 2018. This mandate requires PDMP consultation before prescribing a controlled substance and integrates electronic health record (EHR)-based alerts; prescribers are exempt from the mandate if they prescribe no more than a 5-day postoperative opioid supply. Although previous studies have examined the consequences of mandated PDMP consultation, few have specifically analyzed changes in postoperative opioid prescribing after mandate implementation.
View Article and Find Full Text PDFBackground And Objectives: The recent de-escalation of care for differentiated thyroid cancer (DTC) has broadened the range of initial treatment options. We examined the association between physicians' perception of risk and their management of DTC.
Methods: Thyroid specialists were surveyed with four clinical vignettes: (1) indeterminate nodule (2) tall cell variant papillary thyroid cancer (PTC), (3) papillary thyroid microcarcinoma (mPTC), and (4) classic PTC.
Article Synopsis
- Molecular testing is increasingly used to help diagnose indeterminate thyroid nodules, and this study compares the costs of two testing strategies: reflexive vs. selective.
- A Markov model was used to analyze the costs associated with both strategies, revealing that the average cost per patient was higher in the reflexive approach ($8,045) compared to the selective approach ($6,090).
- The study concludes that while reflexive testing is more expensive, it prevents unnecessary surgeries, leading to a significant cost savings of approximately $20,600 for each avoided thyroid lobectomy.
Article Synopsis
- In response to the COVID-19 pandemic, this study evaluated patient satisfaction with postoperative telemedicine versus in-person visits after thyroid and parathyroid surgery.
- The research included 45 telemedicine and 32 in-person encounters, with both groups reporting similar high satisfaction ratings around 9.7 to 9.8 out of 10.
- Results indicated that patients experienced excellent communication with their surgeons, showing no significant difference between telemedicine (83%) and in-person visits (86%), while the use of telemedicine in endocrine surgery increased dramatically during the study period.
Article Synopsis
- Thyroid surgeons are shifting towards less aggressive management for low-risk thyroid conditions to avoid overdiagnosis, which requires strong communication skills to explain rationale to patients.
- A study involving 107 adult patients assessed communication skills using the Makoul Communication Assessment Tool, revealing that 23% of patients fell into the low-outlier group for communication effectiveness.
- The overall communication scores were high, but the study highlighted a particular concern where 29% of patients felt doctors did not encourage them to ask questions, indicating areas for potential improvement.
Background: Nonoperative management (NOM) of uncomplicated appendicitis has gained recognition as an alternative to surgery. In the largest published randomized trial (Appendicitis Acuta), patients received a 3-d hospital stay for intravenous antibiotics; however, cost implications for health care systems remain unknown. We hypothesized short stay protocols would be cost saving compared with a long stay protocol.
View Article and Find Full Text PDFBackground: Our study seeks to find a cost-saving screening strategy in a primary care population for diagnosing primary hyperparathyroidism based on peak serum total calcium level, age, and patient sex.
Methods: Laboratory data resulting from primary care office visits at our institution between January 2016 through December 2017 to evaluate patients who had at least 1 episode of hypercalcemia (≥10.5 mg/dL).
Background: Molecular diagnostics can allow some patients with indeterminate thyroid nodule cytopathology to avoid diagnostic hemithyroidectomy; however, the testing is costly. We hypothesized that molecular testing with the intention of preventing unnecessary diagnostic hemithyroidectomy would be cost-effective if this test was applied selectively based on sonographic risk of malignancy.
Methods: A Markov model was constructed depicting a 40-year-old patient with a cytologically indeterminate thyroid nodule.
Background: In an effort to reduce overdiagnosis of low-risk thyroid cancer, recent clinical guidelines increased the size-based biopsy thresholds for thyroid nodules. The cost-effectiveness of these guidelines is largely unknown. We hypothesized that ultrasound surveillance in lieu of immediate fine needle aspiration biopsy would be cost effective for a 1.
View Article and Find Full Text PDFArticle Synopsis
- Molecular testing is increasingly used to avoid unnecessary surgeries for indeterminate thyroid nodules, but there's no direct comparison between different testing methods.
- This study compared the Afirma Gene Expression Classifier (GEC) and ThyroSeq v2 in a group of patients with indeterminate thyroid nodules, finding that ThyroSeq v2 had higher specificity and allowed more patients to avoid surgery.
- The results indicate that while ThyroSeq v2 performed better than GEC, further research is needed to evaluate the long-term effectiveness and comparison with other molecular diagnostic techniques.
Background: Some surgeons perform flexible fiberoptic laryngoscopy (FFL) in all patients prior to thyroid cancer operations. Given the low likelihood of recurrent laryngeal nerve (RLN) or aerodigestive invasion in clinically low-risk thyroid cancers, the value of routine FFL in this group is controversial. We hypothesized that routine preoperative FFL would not be cost effective in low-risk differentiated thyroid cancer (DTC).
View Article and Find Full Text PDFBackground: Lobectomy may be sufficient for patients with intrathyroidal papillary thyroid carcinomas (PTC) <4 cm without nodal metastasis. Based on the 2015 American Thyroid Association guidelines, a strategy using ultrasound to identify appropriate candidates for lobectomy was implemented.
Methods: Patients with Bethesda V or VI cytology who underwent surgery for PTC (January 2016 to May 2017) were retrospectively reviewed.
Importance: The association of initial neck dissection with recurrence in medullary thyroid carcinoma (MTC) has not been evaluated on a population level to date.
Objective: To elucidate risk factors associated with reoperation in MTC and disease-specific mortality.
Design, Setting, And Participants: A retrospective analysis was performed of hospital data obtained from the California Cancer Registry and the Office of Statewide Health Planning and Development from January 1, 1999, through December 31, 2012.
Article Synopsis
- This study focuses on the incidence and outcomes of nonoperatively managed differentiated thyroid cancers (DTCs) in California, specifically targeting papillary thyroid microcarcinoma monitoring through active surveillance.
- Out of nearly 30,000 DTC patients analyzed, only 1.1% were managed nonoperatively, often being older individuals with larger tumors and a higher rate of distant metastasis compared to those who underwent surgery.
- The nonoperative management strategy mainly involved low-risk tumors, and remarkably, there were no disease-specific deaths during a median follow-up of about 21 months, highlighting that active surveillance is uncommon in California.
Primary hyperparathyroidism (PHPT) is the most common cause of chronic hypercalcemia. With the advent of routine calcium screening, the classic presentation of renal and osseous symptoms has been largely replaced with mild, asymptomatic disease. In hypercalcemia caused by PHPT, serum parathyroid hormone levels are either high, or inappropriately normal.
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