Qinyu Chen

Defining Early Recurrence of Hilar Cholangiocarcinoma After Curative-intent Surgery: A Multi-institutional Study from the US Extrahepatic Biliary Malignancy Consortium

BackgroundTime to tumor recurrence may be associated with outcomes following resection of hepatobiliary cancers. The objective of the current study was to investigate risk factors and prognosis among patients with early versus late recurrence of hilar cholangiocarcinoma (HCCA) after curative-intent resection.MethodsA total of 225 patients who underwent curative-intent resection for HCCA were identified from 10 academic centers in the USA. Data on clinicopathologic characteristics, pre-, intra-, and postoperative details and overall survival (OS) were analyzed. The slope of the curves identified by linear regression was used to categorize recurrences as early versus late.ResultsWith a median follow-up of 18.0xa0months, 99 (44.0%) patients experienced a tumor recurrence. According to the slope of the curves identified by linear regression, the functions of the two straight lines were yxa0=xa0−0.465xxa0+xa016.99 and yxa0=xa0−0.12xxa0+xa07.16. The intercept value of the two lines was 28.5xa0months, and therefore, 30xa0months (2.5xa0years) was defined as the cutoff to differentiate early from late recurrence. Among 99 patients who experienced recurrence, the majority (nxa0=xa080, 80.8%) occurred within the first 2.5xa0years (early recurrence), while 19.2% of recurrences occurred beyond 2.5xa0years (late recurrence). Early recurrence was more likely present as distant disease (75.1% vs. 31.6%, pxa0=xa00.001) and was associated with a worse OS (Median OS, early 21.5 vs. late 50.4xa0months, pxa0<xa00.001). On multivariable analysis, poor tumor differentiation (HR 10.3, pxa0=xa00.021), microvascular invasion (HR 3.3, pxa0=xa00.037), perineural invasion (HR 3.9, pxa0=xa00.029), lymph node metastases (HR 5.0, pxa0=xa00.004), and microscopic positive margin (HR 3.5, pxa0=xa00.046) were independent risk factors associated with early recurrence.ConclusionsEarly recurrence of HCCA after curative resection was common (~35.6%). Early recurrence was strongly associated with aggressive tumor characteristics, increased risk of distant metastatic recurrence and a worse long-term survival.

Patient-Provider Communication and Health Outcomes Among Individuals with Hepato-Pancreato-Biliary Disease in the USA

BackgroundPatient-provider communication (PPC) is utilized as a value-based metric in pay-for-performance programs. We sought to evaluate the association of PPC with patient-reported health outcomes, as well as healthcare resource utilization among a nationally representative cohort of patients with hepato-pancreato-biliary (HPB) diagnoses.MethodsPatients with HPB diseases were identified from the 2008–2014 Medical Expenditure Panel Survey cohort. A weighted PPC composite score was categorized using the responses from the CAHPS (Consumer Assessment of Healthcare Providers and Systems) survey as optimal, average, or poor. Multivariate analysis was performed using logistic regression.ResultsAmong 1951 adult-patients, representing 21.7 million HPB patients, reported PPC was optimal (33.4%), average (46.3%), or poor (15.3%). Patients who were older and patients with low income were more likely to report poor PPC (both pxa0<xa00.05). Statin use, a quality of care measure, was associated with optimal PPC (OR 1.70, 95% CI 1.10–2.64; pxa0=xa00.01). In contrast, patients who reported poor PPC were more likely to have a poor physical (20.8%) or mental (8.8%) health component on their SF12 (both pxa0<xa00.05). Furthermore, patients with poor PPC were more likely to report poor mental status (OR 2.97, 95% CI 1.60–5.52), as well as higher emergency department visits (OR 1.95, 95% CI 1.25–3.05) and hospitalizations (OR 1.90, 95% CI 1.02–3.55) (both pxa0<xa00.05). Reported PPC was not associated with differences in overall healthcare expenditures or out-of-pocket expenditures.ConclusionsPPC was associated with a wide spectrum of patient-specific demographic and health utilization factors. Self-reported patient satisfaction with provider communication may be impacted by other considerations than simply the patient-provider interaction.

Hospital Teaching Status and Medicare Expenditures for Hepato-Pancreato-Biliary Surgery

BackgroundThe association of hospital teaching status and overall expenditures has not been studied among patients undergoing hepato-pancreato-biliary (HPB) surgery. We sought to define the impact of hospital teaching intensity on payments and charges associated with (HPB) surgery from the payer perspective.MethodsSurgical patients undergoing HPB procedures were identified using 2013–2015 Medicare Provider Analysis and Review (MEDPAR) data. Hospital teaching intensity was categorized based on hospital resident-to-bed ratio: non-teaching (NTH: 0), minor teaching (minor-TH: 0–0.363), and major teaching (major-TH: u2009>u20090.363). Risk-adjusted price-standardized Medicare payments were assessed and compared among HPB surgical patients at NTH versus major-TH.ResultsA total of 8863 patients underwent HPB (NTH: nu2009=u20091239, 14.0%; minor-TH: nu2009=u20093202, 36.1%; major-TH: nu2009=u20094422, 49.9%). Patient comorbidities did not vary across hospital according to teaching intensity (pu2009=u20090.27). Mean risk-adjusted Medicare payment at a major-TH was

Perioperative and long-term outcome of intrahepatic cholangiocarcinoma involving the hepatic hilus after curative-intent resection: comparison with peripheral intrahepatic cholangiocarcinoma and hilar cholangiocarcinoma.

29,541 versus

Impact of histological subtype on the prognosis of patients undergoing surgery for colon cancer

19,345 at a NTH (Δ-payment:u2009+u2009

Impact of Post-Discharge Disposition on Risk and Causes of Readmission Following Liver and Pancreas Surgery

10,195; pu2009<u20090.001). Differences in Medicare payments associated with hospital teaching status persisted when the risk-adjusted price was standardized to remove social subsidies and regional variation in costs (NTH:

Lymphadenectomy for Intrahepatic Cholangiocarcinoma: Has Nodal Evaluation Been Increasingly Adopted by Surgeons over Time?A National Database Analysis

19,760 vs. major-TH:

Serum tumor markers enhance the predictive power of the AJCC and LCSGJ staging systems in resectable intrahepatic cholangiocarcinoma

28,382; Δ-payment: u2009+u2009

Time to Readmission and Mortality Among Patients Undergoing Liver and Pancreatic Surgery

8623). Major-TH had higher total charges submitted to Medicare versus NTH (NTH:

Surgical Procedures in Health Professional Shortage Areas: Impact of a Surgical Incentive Payment Plan

100,583 vs. major-TH: