Tahereh Soleimani

Defining failure and its predictors in mandibular distraction for Robin sequence.

INTRODUCTION Robin sequence (RS) is defined as the triad of micrognathia, glossoptosis and airway obstruction. A popular surgical treatment is mandibular distraction osteogenesis (MDO). In this study, it is demonstrated that the associated variables change, dependent on the manner in which failure is defined. These multiple failure outcomes are used to construct a scoring system to predict MDO failure. METHODS A retrospective database of neonatal MDO patients was constructed. Failure outcomes studied included tracheostomy; a decrease in the apnea-hypopnea index (AHI) but an AHI >20; and death. A combination of bivariate and regression analysis was used to produce significantly associated variables and a scoring system. RESULTS Statistical analysis demonstrated the association of gastroesophageal reflux; age >30 days; neurologic anomaly; airway anomalies, other than laryngomalacia; an intact palate; and pre-operative intubation on the outcome variables studied. Multiple scoring systems were produced with reasonable sensitivity, specificity, and positive and negative predictive value. CONCLUSIONS When reporting surgical outcomes of MDO in the setting of RS, it is important to consider the AHI as well as avoidance of tracheostomy as an outcome variable. Incomplete amelioration of AHI accounts for half of the patients with a problem after MDO. The predictive scores presented will be used and validated on a larger, prospectively collected dataset.

Does payer type influence pediatric burn outcomes? A national study using the Healthcare Cost and Utilization Project Kids' Inpatient Database

Pediatric burns are a considerable source of injury in the United States. Socioeconomic status has been demonstrated to influence other disease outcomes. The goal of this study was to analyze national pediatric burn outcomes based on payer type. A retrospective study was designed using the Kids’ Inpatient Database (KID), years 2000 to 2009. Patients 18 years of age and under with Major Diagnostic code number 22 for burn were included. A total of 22,965 patients were identified, estimating 37,856 discharges. Descriptive and bivariate statistics were performed. Multiple regression analysis was used to assess correlation of payer type with complications and length of stay (LOS). The majority of patients were Medicaid (52.3%). Medicaid patients were younger (4.25, P < .05), had a higher rate of being in the first quartile of their zipcode’s income (46.26%, P < .05), and contained a higher proportion of African-Americans (30.01%, P < .05). Overall complication rate was higher among Medicaid patients than private insurance and self-pay patients (6.64 vs 5.51 and 4.35%, respectively, P = .11). Logistic regression analysis of complications showed that Medicaid coverage (P < .001) was associated with complications. The geometric mean LOS among Medicaid patients was 3.7 days compared with private insurance (3.5 days) and self-pay patients (3.1 days). Medicaid patients had longer LOS and more complications. Regression analysis revealed that payer type was a factor in LOS and overall complication rate. Identifying dissimilar outcomes based on patient and injury characteristics is critical in providing information on how to improve those outcomes.

Pyoderma gangrenosum demographics, treatments, and outcomes: an analysis of 2,273 cases

OBJECTIVE Pyoderma gangrenosum is a rare, neutrophil-mediated, auto-inflammatory dermatosis. This condition has clinical features analogous to infectious processes and must be quickly diagnosed to be properly treated. The purpose of this study was to characterise relevant clinical features associated with pyoderma gangrenosum based on a large inpatient cohort. METHOD The National Inpatient Sample (US) was used to identify patients with the diagnosis of pyoderma gangrenosum using ICD-9 diagnosis code 686.01, during the years 2008-2010. Data was collected on demographics, associated diagnoses, treatments and outcomes. Data analysis was performed using SAS 9.3 software. RESULTS A total of 2,273 adult patients were identified with pyoderma gangrenosum. Mean age was 56 years; 66.4% were female; 71.1% were Caucasian. Pyoderma gangrenosum was the primary diagnosis in 22.6% of patients, followed by cellulitis (9.4%), inflammatory bowel disease (IBD) (6.9%), wound/ulcer (5.4%), sepsis (4.7%), and postoperative infection/complication (2.7%). The most common procedures performed were wound debridement (5.3%), skin biopsy (5.1%), esophagogastroduodenoscopy (2%), large bowel biopsy (1.9%), and incision and drainage (1.1%). A total of 74 patients (3.2%) died during hospitalisation. CONCLUSION Pyoderma gangrenosum is a serious skin condition, frequently associated with systemic disease, and often confused with other skin pathergies. Pyoderma gangrenosum should be considered when evaluating patients with ulcers, wounds, and post-operative complications. A high index of suspicion is necessary for early and accurate diagnosis and prompt treatment.

Comparison of Neurologic Trauma and Motorcycle Helmet Use in Drivers vs Passengers

Comparison of Neurologic Trauma and Motorcycle Helmet Use in Drivers vs Passengers Tyler A. Evans, MD, Sarah Sasor, MD, Stephen Duquette, MD, Michael W. Chu, MD, Imtiaz Munshi, MD, MBA, Tahereh Soleimani, MD, MPH, and Sunil S. Tholpady, MD, PhD Indiana University School of Medicine, Indianapolis, Indiana Department of Surgery, R. L. Roudebush VA Medical Center, Indianapolis, Indiana R. L. Roudebush VA Medical Center, Indianapolis, Indiana Corresponding author. Article Information Corresponding Author: Sunil S. Tholpady, MD, PhD, Department of Surgery, R. L. Roudebush VA Medical Center, 705 Riley Hospital Dr, RI 2513, Indianapolis, IN 46202 (stholpad@iupui.edu). Published Online: November 15, 2017. doi:10.1001/jamasurg.2017.3163 Author Contributions: Drs Tholpady and Evans had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: Evans, Duquette, Chu, Soleimani, Tholpady. Acquisition, analysis, or interpretation of data: Evans, Sasor, Munshi, Soleimani, Tholpady. Drafting of the manuscript: Evans, Tholpady. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: Soleimani, Tholpady. Obtained funding: Tholpady. Administrative, technical, or material support: Evans, Tholpady. Supervision: Chu, Munshi, Tholpady. Conflict of Interest Disclosures: None reported. Meeting Presentation: This study was presented at the 2017 Association of VA Surgeons Annual Meeting, May 7, 2017, Houston, Texas. Received 2017 May 17; Accepted 2017 Jun 25. Copyright 2017 American Medical Association. All Rights Reserved.

Predictors of Reconstructive Surgery Among Burn Patients.

RESULTS: Overall, 676 out of 1475 patients (45.8%) underwent reconstruction after mastectomy with the majority undergoing autologous tissue reconstruction compared to implant reconstruction. The rates of breast reconstruction and plastic surgery referrals increased dramatically from 53.1% to 75.4% and from 53.8% to 93.8% respectively during the study period. Advanced age and stage of disease were significant predictors for not undergoing evaluation or reconstruction. Ethnicity was also a negative predictor for reconstruction during the study period. There were significant racial disparities during the first half of the study period with Caucasian (11.0%) and Asian (23.1%) women being more likely to undergo autologous tissue reconstruction compared to African-American (2.7%) or Hispanic (0%) women. These differences were no longer evident during the second half of the study. Referral to the plastic and reconstructive surgery service did not result in any significant delays in cancer treatment.