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Surgery | 2012

Impact of neoadjuvant chemotherapy on wound complications after breast surgery.

Marquita R. Decker; David Yu Greenblatt; Jeff A. Havlena; Lee G. Wilke; Caprice C. Greenberg; Heather B. Neuman

BACKGROUND Use of neoadjuvant chemotherapy for breast cancer is increasing. The objective was to examine risk of postoperative wound complications in patients receiving neoadjuvant chemotherapy for breast cancer. METHODS Patients undergoing breast surgery from 2005 to 2010 were selected from the American College of Surgeons National Surgical Quality Improvement Program database. Patients were included if preoperative diagnosis suggested malignancy and an axillary procedure was performed. We performed a stepwise multivariable regression analysis of predictors of postoperative wound complications, overall and stratified by type of breast surgery. Our primary variable of interest was receipt of neoadjuvant chemotherapy. RESULTS Of 44,533 patients, 4.5% received neoadjuvant chemotherapy. Wound complications were infrequent with or without neoadjuvant chemotherapy (3.4% vs. 3.1%; P = .4). Smoking, functional dependence, obesity, diabetes, hypertension, and mastectomy were associated with wound complications. No association with neoadjuvant chemotherapy was seen (odds ratio [OR], 1.01; 95% confidence interval [CI], 0.78-1.32); however, a trend was observed toward increased complications in neoadjuvant patients undergoing mastectomy with immediate reconstruction (OR, 1.58; 95% CI, 0.98-2.58). CONCLUSION Postoperative wound complications after breast surgery are infrequent and not associated with neoadjuvant chemotherapy. Given the trend toward increased complications in patients undergoing mastectomy with immediate reconstruction, however, neoadjuvant chemotherapy should be among the many factors considered when making multidisciplinary treatment decisions.


Journal of The American College of Surgeons | 2013

The General Surgery Job Market: Analysis of Current Demand for General Surgeons and Their Specialized Skills

Marquita R. Decker; Nathan W. Bronson; Caprice C. Greenberg; James P. Dolan; Kenneth C. Kent; John G. Hunter

BACKGROUND The majority of general surgery residents pursue fellowships. However, the relative demand for general surgical skills vs more specialization is not understood. Our objective was to describe the current job market for general surgeons and compare the skills required by the market with those of graduating trainees. STUDY DESIGN Positions for board eligible/certified general surgeons in Oregon and Wisconsin from 2011 to 2012 were identified by review of job postings and telephone calls to hospitals, private practice groups, and physician recruiters. Data were gathered on each job to determine if fellowship training or specialized skills were required, preferred, or not requested. Information on resident pursuit of fellowship training was obtained from all residency programs within the represented states. RESULTS Of 71 general surgery positions available, 34% of positions required fellowship training. Rural positions made up 46% of available jobs. Thirty-five percent of positions were in nonacademic metropolitan settings and 17% were in academic metropolitan settings. Fellowship training was required or preferred for 18%, 28%, and 92% of rural, nonacademic, and academic metropolitan positions, respectively. From 2008 to 2012, 67% of general surgery residents pursued fellowship training. CONCLUSIONS Most general surgery residents pursue fellowship despite the fact that the majority of available jobs do not require fellowship training. The motivation for fellowship training is unclear, but residency programs should tailor training to the skills needed by the market with the goal of improving access to general surgical services.


The Journal of Thoracic and Cardiovascular Surgery | 2014

Lung volume reduction surgery since the National Emphysema Treatment Trial: Study of Society of Thoracic Surgeons Database

Marquita R. Decker; Glen Leverson; Wassim Abi Jaoude; James D. Maloney

OBJECTIVES The National Emphysema Treatment Trial demonstrated that lung volume reduction surgery is an effective treatment for emphysema in select patients. With chronic lower respiratory disease being the third leading cause of death in the United States, this study sought to assess practice patterns and outcomes for lung volume reduction surgery on a national level since the National Emphysema Treatment Trial. METHODS Aggregate statistics on lung volume reduction surgery reported in the Society of Thoracic Surgeons Database from January 2003 to June 2011 were analyzed to assess procedure volume, preoperative and operative characteristics, and outcomes. Comparisons with published data from the National Emphysema Treatment Trial were made using chi-square and 2-sided t tests. RESULTS In 8.5 years, 538 patients underwent lung volume reduction surgery, with 20 to 118 cases reported in the Society of Thoracic Surgeons Database per year. When compared with subjects in the National Emphysema Treatment Trial, subjects in the Society of Thoracic Surgeons Database were younger (P < .001), a larger proportion underwent the procedure thoracoscopically (P < .001), and forced expiratory volume in 1 second was 31% versus 28% of predicted (P < .001). When mortality was compared between subjects in the Society of Thoracic Surgeons Database and all subjects in the National Emphysema Treatment Trial randomized to surgery, there were no significant differences. However, mortality was 3% higher in subjects in the Society of Thoracic Surgeons Database when compared with the non-high-risk National Emphysema Treatment Trial subset (P = .005). CONCLUSIONS This study demonstrates the importance of patient selection and the need to develop consensus on appropriate benchmarks for mortality rates after lung volume reduction surgery. It underscores the need for dedicated centers to increasingly address the heavy burden of chronic lower respiratory disease in the United States in a multidisciplinary fashion, particularly for preoperative evaluation and postoperative management of emphysema.


Cancer Research | 2015

Abstract P6-09-06: Balancing the harms and benefits of radiation therapy for DCIS: A decision analysis examining the risk of radiation-associated sarcoma

Marquita R. Decker; Joseph F. Levy; Lee G. Wilke; David J. Vanness; Heather B. Neuman

INTRODUCTION: More than 60,000 women are diagnosed with ductal carcinoma in situ (DCIS) annually and offered the option of breast conserving surgery (BCS), often including radiation (RT) to reduce local recurrence. Although the incidence of radiation-associated sarcoma (RAS) is low (0.05-0.25% at 10 years), the low mortality associated with DCIS and large number of DCIS diagnoses means that an increasingly large number of women are at risk of RAS. This study sought to weigh the risk of RAS with the benefits of BCS+RT for DCIS. METHODS: A second-order Monte Carlo micro-simulation model of women ages 35 and older with DCIS was constructed. The decision analysis compared harm-benefit ratios of sarcoma-related deaths per breast cancer deaths averted within 20 years of treatment with BCS+RT versus BCS alone. Stratified analyses were performed by age group to account for differential life expectancy. To generate parameter estimates for model inputs, Bayesian network meta-analysis was used to synthesize rates of DCIS and invasive recurrence from clinical trials of BCS+RT and BCS alone using a Weibull specification. Sarcoma incidence was estimated non-parametrically using SEER. Constant hazard rates for breast cancer mortality after invasive recurrence and RAS mortality were estimated from clinical trials. To account for uncertainty, probabilistic sensitivity analysis was conducted using 10,000 Monte Carlo samples and 95% credible intervals (CrI) were constructed for event rates and harm-benefit ratios. RESULTS: The micro-simulation model of an age-distributed cohort demonstrated that 1 in 840 women with DCIS (95%CrI 1:648 to 1:3522) would develop RAS within 20 years after treatment with BCS+RT. Overall, there would be 1 RAS-related death for every 12 breast cancer deaths averted (95%CrI 1:7 to 1:19) by the addition of RT to BCS. Stratified analysis demonstrated that the harm-benefit ratio was higher in women CONCLUSIONS: The risk of developing a RAS following BCS+RT for DCIS should not be overlooked. This may be especially true for women at low risk of recurrence and younger women ( Citation Format: Marquita R Decker, Joseph F Levy, Lee G Wilke, David J Vanness, Heather B Neuman. Balancing the harms and benefits of radiation therapy for DCIS: A decision analysis examining the risk of radiation-associated sarcoma [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-09-06.


Archive | 2014

Clinical Trials: Ensuring Quality and Standardization

Marquita R. Decker; Lee G. Wilke

Well-designed and implemented clinical trials provide the cornerstone of evidence-based medicine and surgery. Ensuring the safety of participants in these trials is of paramount importance to retain the confidence of the public in human subjects research. Prior to initiating a clinical trial, the surgical trialist is advised to familiarize themselves with the regulatory documents and processes within the Belmont Report, good clinical practice, and an institutional review board as well as the structure of a protocol which includes standardized case report forms and adverse event reporting. At the start and conclusion to a trial, the principal investigator should refer to the Consolidated Standards of Reporting Trials checklist and flow diagram to provide accurate performance and documentation of the outcomes.


Journal of Surgical Research | 2014

Optimizing risk-adjusted outcome measures: a moving target.: Invited Commentary on: Variability of NSQIP assessed surgical quality based on age and disease process

Marquita R. Decker; David Yu Greenblatt

The optimal risk-adjustment tool to measure quality of surgical care would control for patient comorbidities, complexity of operations, physician and hospital case mix, and specialty-specific conditions. This ideal tool would help to produce generalizable and disease-specific risk-adjusted measurements of mortality, surgical site infection rates, and other surgical outcomes. Unfortunately no such risk adjustment tool exists. However, the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) is in a position to develop this tool in its continuous efforts to provide risk-adjusted performance data that participating sites can use to improve the quality of care delivered to surgical patients [1].


Annals of Surgical Oncology | 2013

Impact of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial on Clinical Management of the Axilla in Older Breast Cancer Patients: A SEER-Medicare Analysis

Holly Caretta-Weyer; Caprice G. Greenberg; Lee G. Wilke; Jennifer M. Weiss; Noelle K. LoConte; Marquita R. Decker; Nicole M. Steffens; Maureen A. Smith; Heather B. Neuman


Journal of The American College of Surgeons | 2014

Specialization and the Current Practices of General Surgeons

Marquita R. Decker; Christopher M. Dodgion; Alvin C. Kwok; Yue Yung Hu; Jeff A. Havlena; Wei Jiang; Stuart R. Lipsitz; K. Craig Kent; Caprice C. Greenberg


Journal of Surgical Oncology | 2014

Determining breast cancer axillary surgery within the surveillance epidemiology and end results‐Medicare database

Ryan K. Schmocker; Holly Caretta-Weyer; Jennifer M. Weiss; Katie Ronk; Jeffrey A. Havlena; Noelle K. LoConte; Marquita R. Decker; Maureen A. Smith; Caprice C. Greenberg; Heather B. Neuman


Annals of Surgical Oncology | 2016

The Role of Intraoperative Pathologic Assessment in the Surgical Management of Ductal Carcinoma In Situ

Marquita R. Decker; Amy Trentham-Dietz; Noelle K. LoConte; Heather B. Neuman; Maureen A. Smith; Rinaa S. Punglia; Caprice C. Greenberg; Lee G. Wilke

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Caprice C. Greenberg

University of Wisconsin-Madison

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Heather B. Neuman

University of Wisconsin-Madison

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Lee G. Wilke

University of Wisconsin-Madison

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David Yu Greenblatt

University of Wisconsin-Madison

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Maureen A. Smith

University of Wisconsin-Madison

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Jeffrey A. Havlena

University of Wisconsin-Madison

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Noelle K. LoConte

University of Wisconsin-Madison

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Christopher M. Dodgion

University of Wisconsin-Madison

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Emily R. Winslow

University of Wisconsin-Madison

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Stuart R. Lipsitz

Brigham and Women's Hospital

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