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Dive into the research topics where June A. Sullivan is active.

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Featured researches published by June A. Sullivan.


Journal of The American College of Surgeons | 2013

Cost of Major Surgery in the Sarcopenic Patient

Kyle H. Sheetz; Seth A. Waits; Michael N. Terjimanian; June A. Sullivan; Darrell A. Campbell; Stewart C. Wang; Michael J. Englesbe

BACKGROUND Sarcopenia is associated with poor outcomes after major surgery. There are currently no data regarding the financial implications of providing care for these high-risk patients. STUDY DESIGN We identified 1,593 patients within the Michigan Surgical Quality Collaborative (MSQC) who underwent elective major general or vascular surgery at a single institution between 2006 and 2011. Patient sarcopenia, determined by lean psoas area (LPA), was derived from preoperative CT scans using validated analytic morphomic methods. Financial data including hospital revenue and direct costs were acquired for each patient through the hospitals finance department. Financial data were adjusted for patient and procedural factors using multiple linear regression methods, and Mann-Whitney U test was used for significance testing. RESULTS After controlling for patient and procedural factors, decreasing LPA was independently associated with increasing payer costs (


JAMA Surgery | 2014

Morphometric Age and Mortality After Liver Transplant

Seth A. Waits; Edward K. Kim; Michael N. Terjimanian; Lindsay M. Tishberg; Calista M. Harbaugh; Kyle H. Sheetz; Christopher J. Sonnenday; June A. Sullivan; Stewart C. Wang; Michael J. Englesbe

6,989.17 per 1,000 mm(2) LPA, p < 0.001). The influence of LPA on payer costs increased to


Journal of Surgical Research | 2014

Analytic morphomics corresponds to functional status in older patients

Ashley L. Miller; Lillian Min; Kathleen M. Diehl; David C. Cron; Chiao Li Chan; Kyle H. Sheetz; Michael N. Terjimanian; June A. Sullivan; William C. Palazzolo; Stewart C. Wang; Karen E. Hall; Michael J. Englesbe

26,988.41 per 1,000 mm(2) decrease in LPA (p < 0.001) in patients who experienced a postoperative complication. Further, the covariate-adjusted hospital margin decreased by


Surgery | 2017

The Michigan Surgical Home and Optimization Program is a scalable model to improve care and reduce costs

Michael J. Englesbe; Dane R. Grenda; June A. Sullivan; Brian A. Derstine; Brooke Kenney; Kyle H. Sheetz; William C. Palazzolo; Nicholas Wang; Rebecca Goulson; Jay S. Lee; Stewart C. Wang

2,620 per 1,000 mm(2) decrease in LPA (p < 0.001) such that average negative margins were observed in the third of patients with the smallest LPA. CONCLUSIONS Sarcopenia is associated with high payer costs and negative margins after major surgery. Although postoperative complications are universally expensive to payers and providers, sarcopenic patients represent a uniquely costly patient demographic. Given that sarcopenia may be remediable, efforts to attenuate costs associated with major surgery should focus on targeted preoperative interventions to optimize these high risk patients for surgery.


Antimicrobial Agents and Chemotherapy | 2017

Relationships of Vancomycin Pharmacokinetics to Body Size and Composition Using a Novel Pharmacomorphomic Approach Based on Medical Imaging

Manjunath P. Pai; Brian A. Derstine; Matt Lichty; Brian E. Ross; June A. Sullivan; Grace L. Su; Stewart C. Wang

IMPORTANCE Morphometric assessment has emerged as a strong predictor of postoperative morbidity and mortality. However, a gap exists in translating this knowledge to bedside decision making. We introduced a novel measure of patient-centered surgical risk assessment: morphometric age. OBJECTIVE To investigate the relationship between morphometric age and posttransplant survival. DATA SOURCES Medical records of recipients of deceased-donor liver transplants (study population) and kidney donors/trauma patients (morphometric age control population). STUDY SELECTION A retrospective cohort study of 348 liver transplant patients and 3313 control patients. We assessed medical records for validated morphometric characteristics of aging (psoas area, psoas density, and abdominal aortic calcification). We created a model (stratified by sex) for a morphometric age equation, which we then calculated for the control population using multivariate linear regression modeling (covariates). These models were then applied to the study population to determine each patients morphometric age. DATA EXTRACTION AND SYNTHESIS All analytic steps related to measuring morphometric characteristics were obtained via custom algorithms programmed into commercially available software. An independent observer confirmed all algorithm outputs. Trained assistants performed medical record review to obtain patient characteristics. RESULTS Cox proportional hazards regression model showed that morphometric age was a significant independent predictor of overall mortality (hazard ratio, 1.03 per morphometric year [95% CI, 1.02-1.04; P < .001]) after liver transplant. Chronologic age was not a significant covariate for survival (hazard ratio, 1.02 per year [95% CI, 0.99-1.04; P = .21]). Morphometric age stratified patients at high and low risk for mortality. For example, patients in the middle chronologic age tertile who jumped to the oldest morphometric tertile have worse outcomes than those who jumped to the youngest morphometric tertile (74.4% vs 93.2% survival at 1 year [P = .03]; 45.2% vs 75.0% at 5 years [P = .03]). CONCLUSIONS AND RELEVANCE Morphometric age correlated with mortality after liver transplant with better discrimination than chronologic age. Assigning a morphometric age to potential liver transplant recipients could improve prediction of postoperative mortality risk.


Journal of Nutrition Health & Aging | 2018

Quantifying Sarcopenia Reference Values Using Lumbar and Thoracic Muscle Areas in a Healthy Population

Brian A. Derstine; Sven Holcombe; Rebecca Goulson; Brian E. Ross; Nicholas Wang; June A. Sullivan; Grace L. Su; Stewart C. Wang

BACKGROUND Older patients account for nearly half of the United States surgical volume, and age alone is insufficient to predict surgical fitness. Various metrics exist for risk stratification, but little work has been done to describe the association between measures. We aimed to determine whether analytic morphomics, a novel objective risk assessment tool, correlates with functional measures currently recommended in the preoperative evaluation of older patients. MATERIALS AND METHODS We retrospectively identified 184 elective general surgery patients aged >70 y with both a preoperative computed tomography scan and Vulnerable Elderly Surgical Pathways and outcomes Assessment within 90 d of surgery. We used analytic morphomics to calculate trunk muscle size (or total psoas area [TPA]) and univariate logistic regression to assess the relationship between TPA and domains of geriatric function mobility, basic and instrumental activities of daily living (ADLs), and cognitive ability. RESULTS Greater TPA was inversely correlated with impaired mobility (odds ratio [OR] = 0.46, 95% confidence interval [CI] 0.25-0.85, P = 0.013). Greater TPA was associated with decreased odds of deficit in any basic ADLs (OR = 0.36 per standard deviation unit increase in TPA, 95% CI 0.15-0.87, P <0.03) and any instrumental ADLs (OR = 0.53, 95% CI 0.34-0.81; P <0.005). Finally, patients with larger TPA were less likely to have cognitive difficulty assessed by Mini-Cog scale (OR = 0.55, 95% CI 0.35-0.86, P <0.01). Controlling for age did not change results. CONCLUSIONS Older surgical candidates with greater trunk muscle size, or greater TPA, are less likely to have physical impairment, cognitive difficulty, or decreased ability to perform daily self-care. Further research linking these assessments to clinical outcomes is needed.


The Journal of Urology | 2013

Re: Morphometric age and surgical risk

Michael J. Englesbe; Michael N. Terjimanian; Julia Shin Jung Lee; Kyle H. Sheetz; Calista M. Harbaugh; Adnan Hussain; S. A. Holcombe; June A. Sullivan; Darrell A. Campbell; Stewart C. Wang; C. J. Sonnenday

Background: The Michigan Surgical Home and Optimization Program is a structured, home‐based, preoperative training program targeting physical, nutritional, and psychological guidance. The purpose of this study was to determine if participation in this program was associated with reduced hospital duration of stay and health care costs. Methods: We conducted a retrospective, single center, cohort study evaluating patients who participated in the Michigan Surgical Home and Optimization Program and subsequently underwent major elective general and thoracic operative care between June 2014 and December 2015. Propensity score matching was used to match program participants to a control group who underwent operative care prior to program implementation. Primary outcome measures were hospital duration of stay and payer costs. Multivariate regression was used to determine the covariate‐adjusted effect of program participation. Results: A total of 641 patients participated in the program; 82% were actively engaged in the program, recording physical activity at least 3 times per week for the majority of the program; 182 patients were propensity matched to patients who underwent operative care prior to program implementation. Multivariate analysis demonstrated that participation in the Michigan Surgical Home and Optimization Program was associated with a 31% reduction in hospital duration of stay (P < .001) and 28% lower total costs (P < .001) after adjusting for covariates. Conclusion: A home‐based, preoperative training program decreased hospital duration of stay, lowered costs of care, and was well accepted by patients. Further efforts will focus on broader implementation and linking participation to postoperative complications and rigorous patient‐reported outcomes.


Journal of The American College of Surgeons | 2013

Morphometric Age and Surgical Risk

Michael J. Englesbe; Michael N. Terjimanian; Jay S. Lee; Kyle H. Sheetz; Calista M. Harbaugh; Adnan Hussain; Sven Holcombe; June A. Sullivan; Darrell A. Campbell; Stewart C. Wang; Christopher J. Sonnenday

ABSTRACT Antibiotics such as vancomycin are empirically dosed on the basis of body weight, which may not be optimal across the expanding adult body size distribution. Our aim was to compare the relationships between morphomic parameters generated from computed tomography images to conventional body size metrics as predictors of vancomycin pharmacokinetics (PK). This single-center retrospective study included 300 patients with 1,622 vancomycin concentration (52% trough) measurements. Bayesian estimation was used to compute individual vancomycin volume of distribution of the central compartment (Vc) and clearance (CL). Approximately 45% of patients were obese with an overall median (5th, 95th percentile) weight and body mass index of 87.2 (54.7, 123) kg and 28.8 (18.9, 43.7) kg/m2, respectively. Morphomic parameters of body size such as body depth, total body area, and torso volume of the twelfth thoracic through fourth lumbar vertebrae (T12 to L4) correlated with Vc. The relationship of vancomycin Vc was poorly predicted by body size but was stronger with T12-to-L4 torso volume (coefficient of determination [R2] = 0.11) than weight (R2 = 0.04). No relationships between vancomycin CL and traditional body size metrics could be discerned; however, relationships with skeletal muscle volume and total psoas area were found. Vancomycin CL independently correlated with total psoas area and inversely correlated with age. Thus, vancomycin CL was significantly related to total psoas area over age (R2 = 0.23, P < 0.0001). This proof-of-concept study suggests a potential role for translation of radiographic information into parameters predictive of drug pharmacokinetics. Prediction of individual antimicrobial pharmacokinetic parameters using analytic morphomics has the potential to improve antimicrobial dose selection and outcomes of obese patients.


Nutrition in Clinical Practice | 2015

Implications of sarcopenia in major surgery

Jeffrey F. Friedman; Alisha D. Lussiez; June A. Sullivan; Stewart C. Wang; Michael J. Englesbe

BackgroundSarcopenia is defined as the loss of skeletal muscle mass and function associated with aging. Muscle mass can be reliably and accurately quantified using clinical CT scans but reference measurements are lacking, particularly in healthy US populations.MethodsTwo-phase CT scans from healthy kidney donors (age 18-40) at the University of Michigan between 1999-2010 were utilized. Muscle mass was quantified using two thoracic and two lumbar muscle cross-sectional area (CSA) measures. Indexed measurements were computed as area divided by height-squared. Paired analyses of non-contrast and contrast phases and different Hounsfield Unit (HU) ranges for muscle were conducted to determine their effect on CSA muscle measures. We report the means, standard deviations, and 2SD sarcopenia cutoffs from this population.ResultsHealthy population CSA (cm2) cutoffs for N=604 males/females respectively were: 34.7/20.9 (T12 Dorsal Muscle), 91.5/55.9 (T12 Skeletal Muscle), 141.7/91.2 (L3 Skeletal Muscle), 23.5/14.3 (L4 Total Psoas Area), and 23.4/14.3 (L4 Psoas Muscle Area). Height-indexed CSA (cm2/m2) cutoffs for males/females respectively were: 10.9/7.8 (T12 Dorsal Muscle), 28.7/20.6 (T12 Skeletal Muscle), 44.6/34.0 (L3 Skeletal Muscle), 7.5/5.2 (L4 Total Psoas Area), and 7.4/5.2 (L4 Psoas Muscle Area). We confirmed that a mask of -29 to 150 HU is optimal and shows no significant difference between contrast-enhanced and non-contrast CT scan CSA measurements.ConclusionsWe quantified reference values for lumbar and thoracic muscle CSA measures in a healthy US population. We defined the effect of IV contrast and different HU ranges for muscle. Combined, these results facilitate the extraction of clinically valuable data from the large numbers of existing scans performed for medical indications.


Annals of Surgery | 2015

Starting a Surgical Home.

Michael J. Englesbe; Alisha D. Lussiez; Jeffrey F. Friedman; June A. Sullivan; Stewart C. Wang

PURPOSE A number of nonmalignant perineal diseases (focal and systemic) require surgery. The long-term outcome of various types of wound coverage for these diseases is not well described. We report the outcomes of perineal reconstruction for these diseases. MATERIALS AND METHODS We identified 32 patients who underwent surgery from July 1995 to December 2012 for a nonmalignant conditions, including local disease (perineal gangrene and focal granulomatous/idiopathic lymphangitis) and regional/systemic disease (post-radiation lymphedema, lymphedema praecox and hidradenitis suppurativa), who had greater than 1-year followup. Wound closure was achieved by split-thickness skin graft, primary closure, musculocutaneous flap or healing by secondary intention. Long-term cosmetic/functional outcomes were measured semiquantitatively. RESULTS Median patient age was 57 years (range 41 to 86) and median followup was 60 months (range 12 to 99). Of the patients 23 (72%) received a split-thickness skin graft, 2 (6%) underwent primary closure, 2 (6%) received a pedicled flap and 5 (16%) healed by secondary intention. Patients with perineal gangrene (21), focal granulomatous lymphangitis (4) and focal idiopathic lymphangitis (1) had favorable cosmetic/functional results regardless of closure type. All 4 patients with perineal gangrene who received a penile split-thickness skin graft and had erectile function before illness regained function after closure. Grafting for systemic lymphatic disease, such as post-radiation lymphedema in 3 cases, lymphedema praecox in 2 and hidradenitis suppurativa in 1, had mostly unfavorable cosmetic/functional long-term results. CONCLUSIONS Wound closure, including grafts/flaps, for local cutaneous and lymphatic diseases affecting the perineum have excellent cosmetic and functional results. In contrast, grafts for regional/systemic diseases have suboptimal results and may assume the characteristics of the original disease.

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Grace L. Su

University of Michigan

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