Browsing by Author "Berger, Ian"

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    30-day readmission after radical cystectomy: Identifying targets for improvement using the phases of surgical care
    (Canadian Urological Association Journal) Berger, Ian; Xia, Leilei; Wirtalla, Christopher; Dowzicky, Phillip; Guzzo, Thomas J; Kelz, Rachel R
    Introduction: Postoperative readmissions following radical cystectomy (RC) have gained attention in the past decade. Postoperative and post-discharge complications play a role in readmission rates; however, our ability to predict readmissions remains poor.Methods: Using the National Surgical Quality Improvement Program database, we identified patients with bladder cancer undergoing RC from 2013–2015. Complications were defined as postoperative and post-discharge. Outcomes were 30-day readmission, post-discharge complications, and post-discharge major complications. Patient, operative, and complication factors were assessed using multivariable logistic regression.Results: We identified 4457 patients who underwent RC; 9.2% of patients experienced a postoperative complication, 18.8% experienced a post-discharge complication, and 20.3% were readmitted. Overweight and obese body mass index (BMI), dependent functional status, chronic obstructive pulmonary disease (COPD), a continent diversion, and duration of operation were associated with post-discharge complications. Postoperative complications were not associated with post-discharge complications. Readmission was associated with Black race (odds ratio [OR] 1.5; 95% confidence interval [CI] 1.0–2.1), overweight (OR 1.5; 95% CI 1.2–1.8) and obese BMI (OR 1.5; 95% CI 1.2–1.9), diabetes (OR 1.2; 95% CI 1.0–1.5), COPD (OR 1.4; 95% CI 1.0–1.8), steroid use (OR 1.5; 95% CI 1.0–2.2), a continent diversion (OR 1.4; 95% CI 1.1–1.7), duration of operation (OR 1.1; 95% CI 1.1–1.2), and postoperative complications (OR 1.5; 95% CI 1.2–2.0). The majority of readmissions experienced a post-discharge complication.Conclusions: Factors that span the preoperative, intraoperative, postoperative, and post-discharge phases of care were identified to increase readmission risk. To improve readmission rates, interventions will have to target factors across the surgical experience.
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    Early detection of pemetrexed-induced inhibition of thymidylate synthase in non-small cell lung cancer with FLT-PET imaging
    (Oncotarget, 2017-04-11) Chen, Xiao; Yang, Yizeng; Berger, Ian; Khalid, Urooj; Patel, Akash; Cai, Jenny; Farwell, Michael D; Langer, Corey; Aggarwal, Charu; Albelda, Steven M; Katz, Sharyn I
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    Evaluation of the Risk Assessment and Prediction Tool for Postoperative Disposition Needs After Cervical Spine Surgery
    (Neurosurgery, 2019-11-01) Berger, Ian; Piazza, Matthew; Sharma, Nikhil; Glauser, Gregory; Osiemo, Benjamin; McClintock, Scott D; Lee, John YK; Schuster, James M; Ali, Zarina; Malhotra, Neil R
    Abstract BACKGROUND Bundled care payment models are becoming more prevalent in neurosurgery. Such systems place the cost of postsurgical facilities in the hands of the discharging health system. Opportunity exists to leverage prediction tools for discharge disposition by identifying patients who will not benefit from prolonged hospitalization and facilitating discharge to post-acute care facilities. OBJECTIVE To validate the use of the Risk Assessment and Predictive Tool (RAPT) along with other clinical variables to predict discharge disposition in a cervical spine surgery population. METHODS Patients undergoing cervical spine surgery at our institution from June 2016 to February 2017 and over 50 yr old had demographic, surgical, and RAPT variables collected. Multivariable regression analyzed each variable's ability to predict discharge disposition. Backward selection was used to create a binomial model to predict discharge disposition. RESULTS A total of 263 patients were included in the study. Lower RAPT score, RAPT walk subcomponent, older age, and a posterior approach predicted discharge to a post-acute care facility compared to home. Lower RAPT also predicted an increased risk of readmission. RAPT score combined with age increased the predictive capability of discharge disposition to home vs skilled nursing facility or acute rehabilitation compared to RAPT alone (P < .001). CONCLUSION RAPT score combined with age is a useful tool in the cervical spine surgery population to predict postdischarge needs. This tool may be used to start early discharge planning in patients who are predicted to require post-acute care facilities. Such strategies may reduce postoperative utilization of inpatient resources.
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    Hospital Teaching Status Impacts Surgical Discharge Efficiency
    (Journal of Surgical Education, 2019-09) Dowzicky, Phillip; Wirtalla, Chris; Fieber, Jennifer; Berger, Ian; Raper, Steve; Kelz, Rachel R
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    Lymphangitic carcinomatosis: A common radiographic manifestation of local failure following extended pleurectomy/decortication in patients with malignant pleural mesothelioma
    (Lung Cancer, 2019-06) Berger, Ian; Cengel, Keith A; Simone, Charles B; Alley, Evan W; Roshkovan, Leonid; Haas, Andrew R; Patel, Akash M; Khalid, Urooj; Culligan, Melissa J; McNulty, Sally; Singhal, Sunil; Friedberg, Joseph S; Katz, Sharyn I
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    Microsurgical treatment of sacral perineural (Tarlov) cysts: case series and review of the literature
    (Journal of Neurosurgery: Spine, 2016-05) Burke, John F; Thawani, Jayesh P; Berger, Ian; Nayak, Nikhil R; Stephen, James H; Farkas, Tunde; Aschyan, Hovik John; Pierce, John; Kanchwala, Suhail; Long, Donlin M; Welch, William C
    OBJECTIVE Tarlov cysts (TCs) occur most commonly on extradural components of the sacral and coccygeal nerve roots. These lesions are often found incidentally, with an estimated prevalence of 4%–9%. Given the low estimated rates of symptomatic TC and the fact that symptoms can overlap with other common causes of low-back pain, optimal management of this entity is a matter of ongoing debate. Here, the authors investigate the effects of surgical intervention on symptomatic TCs and aim to solidify the surgical criteria for this disease process. METHODS The authors performed a retrospective review of data from consecutive patients who were surgically treated for symptomatic TCs from September 2011 to March 2013. Clinical evaluations and results from surveying pain and overall health were used. Univariate statistical analyses were performed. RESULTS Twenty-three adults (4 males, 19 females) who had been symptomatic for a mean of 47.4 months were treated with laminectomy, microsurgical exposure and/or imbrication, and paraspinous muscle flap closure. Eighteen patients (78.3%) had undergone prior interventions without sustained improvement. Thirteen patients (56.5%) underwent lumbar drainage for an average of 8.7 days following surgery. The mean follow-up was 14.4 months. Univariate analyses demonstrated that an advanced age (p = 0.045), the number of noted perineural cysts on preoperative imaging (p = 0.02), and the duration of preoperative symptoms (p = 0.03) were associated with a poor postoperative outcome. Although 47.8% of the patients were able to return to normal activities, 93.8% of those surveyed reported that they would undergo the operation again if given the choice. CONCLUSIONS This is one of the largest published studies on patients with TCs treated microsurgically. The data suggest that patients with symptomatic TCs may benefit from open microsurgical treatment. Although outcomes seem related to patient age, duration of symptoms, and extent of disease demonstrated on imaging, further study is warranted and underway.
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    Microvascular Decompression Versus Stereotactic Radiosurgery for Trigeminal Neuralgia: A Decision Analysis
    (Cureus, 2017-01-26) Berger, Ian; Nayak, Nikhil; Schuster, James; Lee, John; Stein, Sherman; Malhotra, Neil R
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    National Variation in Opioid Prescription Fills and Long-Term Use in Opioid Naïve Patients after Urological Surgery
    (Journal of Urology, 2019-11) Berger, Ian; Strother, Marshall; Talwar, Ruchika; Ziemba, Justin; Wirtalla, Christopher; Xia, Leilei; Guzzo, Thomas; Delgado, M Kit; Kelz, Rachel
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    Next-day discharge after minimally invasive partial nephrectomy: an analysis of the US National Surgical Quality Improvement Program
    (World Journal of Urology, 2019-05) Berger, Ian; Xia, Leilei; Sperling, Colin; Chelluri, Raju; Taylor, Benjamin; Pulido, Jose; Guzzo, Thomas J
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    The Risk Assessment and Prediction Tool (RAPT) for Discharge Planning in a Posterior Lumbar Fusion Population
    (Neurosurgery) Glauser, Gregory; Piazza, Matthew; Berger, Ian; Osiemo, Benjamin; McClintock, Scott D; Winter, Eric; Chen, H Isaac; Ali, Zarina S; Malhotra, Neil R
    Abstract BACKGROUND As the use of bundled care payment models has become widespread in neurosurgery, there is a distinct need for improved preoperative predictive tools to identify patients who will not benefit from prolonged hospitalization, thus facilitating earlier discharge to rehabilitation or nursing facilities. OBJECTIVE To validate the use of Risk Assessment and Prediction Tool (RAPT) in patients undergoing posterior lumbar fusion for predicting discharge disposition. METHODS Patients undergoing elective posterior lumbar fusion from June 2016 to February 2017 were prospectively enrolled. RAPT scores and discharge outcomes were recorded for patients aged 50 yr or more (n = 432). Logistic regression analysis was used to assess the ability of RAPT score to predict discharge disposition. Multivariate regression was performed in a backwards stepwise logistic fashion to create a binomial model. RESULTS Escalating RAPT score predicts disposition to home (P < .0001). Every unit increase in RAPT score increases the chance of home disposition by 55.8% and 38.6% than rehab and skilled nursing facility, respectively. Further, RAPT score was significant in predicting length of stay (P = .0239), total surgical cost (P = .0007), and 30-d readmission (P < .0001). Amongst RAPT score subcomponents, walk, gait, and postoperative care availability were all predictive of disposition location (P < .0001) for both models. In a generalized multiple logistic regression model, the 3 top predictive factors for disposition were the RAPT score, length of stay, and age (P < .0001, P < .0001 and P = .0001, respectively). CONCLUSION Preoperative RAPT score is a highly predictive tool in lumbar fusion patients for discharge disposition.