Publications by authors named "Syed Shahyan Bakhtiyar"
Background: Although postoperative cardiac arrest is a well-studied complication of cardiac surgery, few guidelines exist regarding timing of surgery in preoperative cardiac arrest (pCA). We examined the association between delayed timing of operation and postoperative outcomes following cardiac surgery in a large cohort of pCA.
Methods: Adults with a diagnosis of pCA undergoing a cardiac operation were identified in the 2016-2020 National Inpatient Sample.
Background: Socioeconomic disadvantage and Medicaid insurance have been linked with inferior survival following heart transplantation, yet the contributing mechanisms remain to be elucidated. We evaluated the association of Medicaid with the development of cardiac allograft vasculopathy(CAV).
Methods: We considered heart transplant recipients ≥18years within the 2004-2022 Organ Procurement and Transplantation Network.
Purpose: Patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) have been noted to face increased cancer incidence. Yet, the impact of concomitant renal dysfunction on acute outcomes following elective surgery for cancer remains to be elucidated.
Methods: All adult hospitalizations entailing elective resection for lung, esophageal, gastric, pancreatic, hepatic, or colon cancer were identified in the 2016-2020 National Inpatient Sample.
Objective: To characterize contemporary surgeons' viewpoints and perspectives on the academic mission during healthcare corporatization.
Summary Background Data: Academic surgery, traditionally driven by the tripartite missions of excellence in clinical care, scientific research, and education, faces increasing challenges from a corporatized healthcare environment. While previous studies have addressed the financial aspects of corporatization, a comprehensive evaluation of academic surgeons' attitudes and experiences remains lacking.
Background: Despite efforts to ensure equitable access to liver transplantation (LT), significant disparities remain. Although prior literature has considered the effects of patient sex, race, and income, the contemporary impact of community socioeconomic disadvantage on outcomes after waitlisting for LT remains to be elucidated. We sought to evaluate the association of community-level socioeconomic deprivation with survival after waitlisting for LT.
View Article and Find Full Text PDFImportance: Ongoing efforts have encouraged the regionalization of esophageal adenocarcinoma treatment to high-volume centers (HVCs). Yet such centralization has been linked with increased patient travel burden and reduced postoperative continuity of care.
Objective: To determine whether traveling to undergo esophagectomy at HVCs is linked with superior overall survival compared with receiving care locally at low-volume centers (LVC).
Background: While structural socioeconomic inequity has been linked with inferior health outcomes, some have postulated reduced access to high-quality care to be the mediator. We assessed whether treatment at high-volume centers (HVC) would mitigate the adverse impact of area deprivation on heart transplantation (HT) outcomes.
Methods: All HT recipients ≥18 years were identified in the 2005-2022 Organ Procurement and Transplantation Network.
Objective: Although national efforts have aimed to improve the safety of inpatient operations, income-based inequities in surgical outcomes persist, and the evolution of such disparities has not been examined in the contemporary setting. We sought to examine the association of community-level household income with acute outcomes of cardiac procedures over the past decade.
Methods: All adult hospitalizations for elective coronary artery bypass grafting/valve operations were tabulated from the 2010-2020 Nationwide Readmissions Database.
Introduction: Transcatheter mitral valve repair offers a minimally invasive treatment option for patients at high risk for traditional open repair. We sought to develop dynamic machine-learning risk prediction models for in-hospital mortality after transcatheter mitral valve repair using a national cohort.
Methods: All adult hospitalization records involving transcatheter mitral valve repair were identified in the 2016-2020 Nationwide Readmissions Database.
Article Synopsis
- Recent studies indicate that non-operative management can be a safe alternative to surgery for treating acute uncomplicated appendicitis, but there's inconsistent application of this approach across hospitals.
- A study analyzed data from over 447,000 hospitalizations to evaluate factors influencing the rate of non-operative management, finding that about 11.7% of patients were treated non-operatively, with significant variability depending on the hospital's practices.
- Findings revealed that hospitals with higher rates of non-operative management (over 90th percentile) had worse surgical outcomes, suggesting a need for further research to understand the factors leading to increased non-operative treatment utilization.
Background: Cholecystectomy remains the standard management for acute cholecystitis. Given that rates of nonoperative management have increased, we hypothesize the existence of significant hospital-level variability in operative rates. Thus, we characterized patients who were managed nonoperatively at normal and lower operative hospitals (>90th percentile).
View Article and Find Full Text PDFBackground: While race and insurance have been linked with greater likelihood of hernia incarceration and emergent presentation, the association of broader social determinants of health (SDOH) with outcomes following urgent repair remains to be elucidated.
Study Design: All adult hospitalizations entailing emergent repair for strangulated inguinal, femoral, and ventral hernias were identified in the 2016-2020 Nationwide Readmissions Database. Socioeconomic vulnerability was ascertained using relevant diagnosis codes.
Despite considerable national attention, racial disparities in surgical outcomes persist. We sought to consider whether race-based inequities in outcomes following major elective surgery have improved in the contemporary era. All adult hospitalization records for elective coronary artery bypass grafting, abdominal aortic aneurysm repair, colectomy, and hip replacement were tabulated from the 2016-2020 National Inpatient Sample.
View Article and Find Full Text PDFBackground: Given the renewed interest in heart transplantation after donation after circulatory death (DCD), a contemporary analysis of trends and longer-term survival is warranted.
Methods: Adult heart transplant recipients (December 2019-September 2023) were identified in the Organ Procurement and Transplantation Network. Recipients were stratified as donation after brain death (DBD) or DCD.
Purpose: Social determinants of health are increasingly recognized to shape health outcomes. Yet, the effect of socioeconomic vulnerability on outcomes after emergency general surgery remains under-studied.
Methods: All adult (≥18 years) hospitalizations for emergency general surgery operations (appendectomy, cholecystectomy, laparotomy, large bowel resection, perforated ulcer repair, or small bowel resection), within 2 days of non-elective admission were tabulated in the 2016 to 2020 Nationwide Readmissions Database.
Background: With the steady rise in health care expenditures, the examination of factors that may influence the costs of care has garnered much attention. Although machine learning models have previously been applied in health economics, their application within cardiac surgery remains limited. We evaluated several machine learning algorithms to model hospitalization costs for coronary artery bypass grafting.
View Article and Find Full Text PDFBackground: Prior literature has reported inferior surgical outcomes and reduced access to minimally invasive procedures at safety-net hospitals. However, this relationship has not yet been elucidated for elective colectomy. We sought to characterize the association between safety-net hospitals and likelihood of minimally invasive resection, perioperative outcomes, and costs.
View Article and Find Full Text PDFBackground: Readmission at a non-index hospital, or care fragmentation (CF), has been previously linked to greater morbidity and resource utilization. However, a contemporary evaluation of the impact of CF on readmission outcomes following elective colectomy is lacking. We additionally sought to evaluate the role of hospital quality in mediating the effect of CF.
View Article and Find Full Text PDFArticle Synopsis
- Over 20 million people in the U.S. are affected by substance use disorder (SUD), impacting 4% of hospitalized patients and raising concerns regarding its effects on health outcomes after elective abdominal surgeries.
- A study analyzed data from over 1 million adult patients who underwent five types of elective surgeries between 2016-2020, finding that those with SUD were typically younger, more often male, and had lower incomes or were of Black race.
- Results showed that SUD patients had similar in-hospital mortality rates but faced higher chances of complications, longer hospital stays, increased costs, and a greater likelihood of not being discharged to their homes, indicating the need for targeted interventions.
Background: Patients undergoing emergency general surgery (EGS) often require complex management and transfer to higher acuity facilities, especially given increasing national efforts aimed at centralizing care. We sought to characterize factors and evaluate outcomes associated with interhospital transfer using a contemporary national cohort.
Methods: All adult hospitalizations for EGS (appendectomy, cholecystectomy, laparotomy, lysis of adhesions, small/large bowel resection, and perforated ulcer repair) ≤2 days of admission were identified in the 2016-2020 National Inpatient Sample.