148 results on '"Matthew W. Mell"'
Search Results
102. IP185. Institutional Retrospective Review of Ultrasound-Accelerated Arterial and Venous Thrombolysis
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Venita Chandra, Matthew W. Mell, Kathryn L. Howe, Andy Lee, and Elizabeth L. George
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medicine.medical_specialty ,Retrospective review ,business.industry ,medicine.medical_treatment ,Ultrasound ,medicine ,Surgery ,Thrombolysis ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business - Published
- 2017
103. Aortoiliac elongation after endovascular aortic aneurysm repair
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Matthew W. Mell, Dominik Fleischmann, Martin Rouer, Trit Garg, and Venita Chandra
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Male ,medicine.medical_specialty ,Tobacco use ,Time Factors ,Endoleak ,Pulmonary disease ,Computed tomography ,Aortography ,Iliac Artery ,Coronary artery disease ,Blood Vessel Prosthesis Implantation ,Imaging, Three-Dimensional ,Postoperative Complications ,Predictive Value of Tests ,Risk Factors ,medicine ,Humans ,Aorta ,Aged ,Retrospective Studies ,Aged, 80 and over ,Aortic aneurysm repair ,medicine.diagnostic_test ,business.industry ,Endovascular Procedures ,Mean age ,General Medicine ,medicine.disease ,Surgery ,Treatment Outcome ,Landing zone ,Cohort ,Linear Models ,Radiographic Image Interpretation, Computer-Assisted ,Female ,Cardiology and Cardiovascular Medicine ,business ,Tomography, X-Ray Computed ,Aortic Aneurysm, Abdominal - Abstract
Background Aortoiliac elongation after endovascular aortic aneurysm repair (EVAR) is not well studied. We sought to assess the long-term morphologic changes after EVAR and identify potentially modifiable factors associated with such a change. Methods An institutional review board–approved retrospective review was conducted for 88 consecutive patients who underwent EVAR at a single academic center from 2003 to 2007 and who also had at least 2 follow-up computed tomography angiograms (CTAs) available for review up to 5 years after surgery. Standardized centerline aortic lengths and diameters were obtained on Aquarius iNtuition 3D workstation (TeraRecon Inc., San Mateo, CA) on postoperative and all-available follow-up CTAs. Relationships to aortic elongation were determined using Wilcoxon rank-sum test or linear regression (Stata version 12.1, College Station, TX). Changes in length over time were determined by mixed-effects analysis (SAS version 9.3, Cary, NC). Results The study cohort was composed of mostly men (88%), with a mean age of (76 ± 8) and a mean follow-up of 3.2 years (range, 0.4–7.5 years). Fifty-seven percent of patients ( n = 50) had devices with suprarenal fixation and 43% ( n = 38) had no suprarenal fixation. Significant lengthening was observed over the study period in the aortoiliac segments, but not in the iliofemoral segments. Aortoiliac elongation over time was not associated with sex ( P = 0.3), hypertension ( P = 0.7), coronary artery disease ( P = 0.3), diabetes ( P = 0.3), or tobacco use ( P = 0.4), but was associated with the use of statins ( P = 0.03) and the presence of chronic obstructive pulmonary disease ( P = 0.02). Significant aortic lengthening was associated with increased type I endoleaks ( P = 0.03) and reinterventions ( P = 0.03). Over the study period, 4 different devices were used; Zenith (Cook Medical Inc., Bloomington, IN), Talent (Medtronic, Minneapolis, MN), Aneuryx (Medtronic), and Excluder (W. L. Gore and Associates Inc., Flagstaff, AZ). After adjusting for differences in proximal landing zone, significant differences in aortic lengthening over time were observed by device type ( P = 0.02). Conclusions Significant aortoiliac elongation was observed after EVAR. Such morphologic changes may impact long-term durability of EVAR, warranting further investigation into factors associated with these morphologic changes.
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- 2014
104. VESS11. Postoperative Surveillance and Long-term Outcomes After Endovascular Aneurysm Repair Among Medicare Beneficiaries
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Laurence C. Baker, Trit Garg, and Matthew W. Mell
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Medicare beneficiary ,Vascular surgery ,medicine.disease ,Logistic regression ,Endovascular aneurysm repair ,Surgery ,surgical procedures, operative ,Aneurysm ,Internal medicine ,Propensity score matching ,Cohort ,medicine ,Long term outcomes ,cardiovascular diseases ,business ,Cardiology and Cardiovascular Medicine - Abstract
Importance The Society for Vascular Surgery recommends annual surveillance with computed tomography (CT) or ultrasonography after endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysms. However, such lifelong surveillance may be unnecessary for most patients, thereby contributing to overuse of imaging services. Objective To investigate whether nonadherence to Society for Vascular Surgery–recommended surveillance guidelines worsens long-term outcomes after EVAR among Medicare beneficiaries. Design, Setting, and Participants We collected data from Medicare claims from January 1, 2002, through December 31, 2011. A total of 9503 patients covered by fee-for-service Medicare who underwent EVAR from January 1, 2002, through December 31, 2005, were categorized as receiving complete or incomplete surveillance. We performed logistic regressions controlling for patient demographic and hospital characteristics. Patients were then matched by propensity score with adjusting for all demographic variables, including age, sex, race, Medicaid eligibility, residential status, hospital volume, ruptured abdominal aortic aneurysms, and all preexisting comorbidities. We then calculated differences in long-term outcomes after EVAR between adjusted groups. Data analysis was performed from January 1, 2002, through December 31, 2011. Main Outcomes and Measures Post-EVAR imaging modality, aneurysm-related mortality, late rupture, and complications. Results Median follow-up duration was 6.1 years. Incomplete surveillance was observed in 5526 of 9695 patients (57.0%) who survived the initial hospital stay at a mean (SD) of 5.2 (2.9) years after EVAR. After propensity matching, our cohort consisted of 7888 patients, among whom 3944 (50.0%) had incomplete surveillance. For those in the matched cohort, patients with incomplete surveillance had a lower incidence of late ruptures (26 of 3944 [0.7%] vs 57 of 3944 [1.4%]; P = .001) and major or minor reinterventions (46 of 3944 [1.2%] vs 246 of 3944 [6.2%]; P P = .07). In adjusted analysis of postoperative outcomes controlling for all patient and hospital factors by the tenth postoperative year, patients in the incomplete surveillance group experienced lower rates of total complications (2.1% vs 14.0%; P P P P P Conclusions and Relevance Nonadherence to the Society for Vascular Surgery guidelines for post-EVAR imaging was not associated with poor outcomes, suggesting that, in many patients, less frequent surveillance is not associated with worse outcomes. Improved criteria for defining optimal surveillance will achieve higher value in aneurysm care.
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- 2014
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105. PS42 National Trends of Operative Approach and Mortality for Ruptured Abdominal Aortic Aneurysms from 2002 to 2011
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Matthew W. Mell, Trit Garg, and Laurence C. Baker
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medicine.medical_specialty ,business.industry ,General surgery ,medicine ,Surgery ,National trends ,business ,Cardiology and Cardiovascular Medicine - Published
- 2014
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106. Long-term Cost-effectiveness in the Veterans Affairs Open vs Endovascular Repair Study of Aortic Abdominal Aneurysm
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Hosam Farouk El Sayed, Cinda Sobotta, Reba Jones, Kellie R. Brown, Henry M. Baraniewski, Amanda J. Snodgrass, C. Keith Ozaki, Fred N. Littooy, Roderick A. Barke, Christian De Virgillio, Richard J. Massen, Anne S. Irwin, Gregory L. Moneta, George Pisimisis, Sister Frances Randall, Sheila M. Coogan, Joseph S. Giglia, Caron Rockman, Richard L. McCann, David Whitley, Erika R. Ketteler, Jeffrey H. Lawson, Matthew W. Mell, John L. Gray, Angela G. Vouyouka, Howard Greisler, Roy M. Fujitani, John W. Hallett, James M. Goff, Kathleen Hickson, Elizabeth Latts, Claudia Yales, Margaret Antonelli, Mina Behdad, Andrea M. Escalante, Karen Chong, Stephen M. Kubaska, Jorge Lopez, Joseph J. Cullen, Glenn C. Hunter, Brenda J. Jasper, John M. Marek, Kimberly Yan, Dennis F. Bandyk, June Poulton, Thomas S. Burdick, Bassem Safadi, Richard J. Gusberg, Sally Reinhardt, Erik Owens, Randy Baum, Robert J. Guerra, Laura Ashe, Mary T. O'Sullivan, Edward Perry, Michael A. Golden, Lynn Durant, Peter H. Lin, Margaret L. Schwarze, Jennifer Poirier, Jessie M. Jean-Claude, Jane Guidot, J. David Pitcher, Elaine O'Brien, Steven J. Busuttil, Stephanie Ross, Darra D. Kingsley, Vicki Bishop, Anna Busman, Kathleen M. Swanson, Rebecca L. Reinhard, Scott Zellner, Beth A. Forbes, John L. Mills, Carmelene Joncas, Georgia Purviance, Theodore Karrison, Sherilyn Pillack, Christine Maagas, Mark Langsfeld, Nancy Oberle, Stephen G. Lalka, Clair M. Haakenson, Carlos F. Bechara, Scott A. Berceli, Murray L. Shames, Michelle A. Bhola, Mary Le Gwin, Anna Rockich, Stephen P. Johnson, Robert W. Zickler, Julie A. Freischlag, John P. Matts, Heather G. Allore, Christian Bianchi, Bernadette Aulivola, Terry O'Connor, Richard A. Yeager, Brad Johnson, Ronald M. Fairman, John F. Eidt, Melita Braganza, Alice Kossack, Rajni Mehta, Bauer E. Sumpio, David Minion, Joseph H. Rapp, Brajesh K. Lal, Michelle Endo, Jon S. Matsumura, Iraklis I. Pipinos, Melanie Estes, Girma Tefera, Mitzi Rusomaroff, Gregory J. Landry, John R. Hoch, Cindy Inman, Janice Rieder, Loretta Cole, Gary Lemmon, Shemuel B. Psalms, James M. Edwards, Ted R. Kohler, Peter R. Nelson, David A. Katz, Hugh A. Gelabert, James Ebaugh, Brian D. Lewis, Nancy N. Day, Nikhil Kansal, Glenn R. Jacobowitz, Ruth L. Bush, Reverend Michael Zeman, Sandra M. Walsh, Jill Warner-Carpenter, Catherine Cagiannos, Mark R. Nehler, Carlos H. Timaran, Prakash Chand, Leah J. Caropolo, Ling Ge, Shirley Joyner, Karen Eschberger, Mohammed Moursi, Michael P. Lilly, Susan Framberg, Christa Kallio, Robyn A. Macsata, Barbara Salabsky, Charles W. Acher, Frank A. Lederle, Jason M. Johanning, Tammy Nguyen, Gerald Treiman, Ian L. Gordon, Deanna Maples, Catherine Proebstle, Joy Kimbrough, William Farrell, Satish Muluk, Gilles Pinault, Beth Dunlap, Sandra C. Carr, William D. Jordan, Erin Olgren, Thomas A. Whitehill, Donald Beckwith, Peter Guarino, Lloyd M. Taylor, Wendy Meadows, Vanessa McBride, Subodh Arora, James Niederman, E. Lynne Kelly, Jonathan Weiswasser, David G. Glickerman, Gene Guinn, Pamela Strecker, Bart E. Muhs, Eleanor Cannady, Heron E. Rodriguez, Christopher Owens, Karen L. Wilson, Shawna Thunen, Elizabeth Davis, Stanislav V. Kasl, Shelley S. Dwyer, Julie Thornton, Maria Foster, Vickie Beach, Doghdoo D. Bahmani, Penny Vasilas, Luis R. Leon, Matthew Nalbandian, Reza Azadegan, Diane C. Robertson, Richard A. Marottoli, Ross Milner, John M. Stuart, David A. Rigberg, Nina M. Peterson, Mary Evans, David Chew, Subhash Lathi, Nadine White, Macario Riveros, Jeffrey Pollak, Timothy J. O'Leary, Yvonne Jonk, Frank T. Padberg, Richard Feldman, Stephanie Hatton-Ward, J. Gregory Modrall, Paul J. Gagne, James Wong, Kimberly Pedersen, Norman Hertzer, Brian D. Matteson, Wei Zhou, Nina Lee, Mark W. Sebastian, Steven M. Santilli, William C. Krupski, Neal Cayne, Anton N. Sidawy, Neal R. Barshes, Christina Paap, Sherry M. Wren, Alex Westerband, Sandra Brock, Vivian Gahtan, John D. Hughes, Panagiotis Kougias, Jonathan B. Towne, Michael Ranella, W. Anthony Lee, Ryan Nachreiner, Cynthia K. Shortell, Patricia A. Prinzo, Kea Ellis, Ronald L. Dalman, Thomas G. Lynch, Karthikeshwar Kasirajan, H. Edward Garrett, Joaquim J. Cerveira, Peter Peduzzi, Marcelo Spector, Carla Blackwell, Omran Abul-Khoudoud, Dolores F. Cikrit, Jean Kistler Tetterton, Martin Back, Darrell N. Jones, Darryl S. Weiman, Donna Kerns, Mark Wilson, Preet Kang, Kenneth Granke, Gary R. Johnson, Linda M. Reilly, Marilyn Bader, Lauri Lee Johnson, Ravi K. Veeraswamy, Sandra L. Perez, W. John Sharp, Gary R. Seabrook, Karthnik Kasirajan, Brenda Allende, John D. Corson, Kathy Zalecki, Joseph D. Raffetto, Thomas H. Schwarcz, Mark A. Patterson, Matthew Eiseman, John K.Y. Chacko, Mark Adelman, Holly De Spiegelaere, Alan Dardik, Madeline Ruf, Kevin T. Stroupe, Grant D. Huang, M. Burress Welborn, Alexandre C. D'Audiffret, Rajaabrata Sarkar, Michael Sobel, Steve M. Taylor, Barbara Guillory, Sandra C. Thomas, Thomas S. Hatsukami, Robert A. Cambria, Jeanne L. McCandless, Susan Stratton, Cindy Cushing, Karen A. Hauck, Atef Salam, Melina R. Kibbe, Tassos C. Kyriakides, Amy B. Reed, Jason T. Lee, Jamal J. Hoballah, Marc E. Mitchell, Hasan H. Dosluoglu, Marc A. Passman, Edith Tzeng, Patricia Cleary, and John Aruny
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Diagnostic Imaging ,Male ,medicine.medical_specialty ,Time Factors ,Cost effectiveness ,Cost-Benefit Analysis ,Comparative effectiveness research ,030204 cardiovascular system & hematology ,030230 surgery ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Humans ,Medicine ,cardiovascular diseases ,Veterans Affairs ,health care economics and organizations ,Aged ,Intention-to-treat analysis ,business.industry ,Endovascular Procedures ,Health Care Costs ,Length of Stay ,Middle Aged ,medicine.disease ,Abdominal aortic aneurysm ,Quality-adjusted life year ,Surgery ,Elective Surgical Procedures ,Quality of Life ,Health Resources ,Female ,Quality-Adjusted Life Years ,business ,Aortic Aneurysm, Abdominal ,Follow-Up Studies ,Abdominal surgery - Abstract
Importance Because of the similarity in clinical outcomes after elective open and endovascular repair of abdominal aortic aneurysm (AAA), cost may be an important factor in choosing a procedure. Objective To compare total and AAA-related use of health care services, costs, and cost-effectiveness between groups randomized to open or endovascular repair. Design, Setting, and Participants This unblinded randomized clinical trial enrolled 881 patients undergoing planned elective repair of AAA who were candidates for open and endovascular repair procedures. Patients were randomized from October 15, 2002, to April 15, 2008, at 42 Veterans Affairs medical centers. Follow-up was completed on October 15, 2011, and data were analyzed from April 15, 2013, to April 15, 2016, based on intention to treat. Main Outcomes and Measures Mean total and AAA-related health care cost per life-year and per quality-adjusted life-year (QALY). Results A total of 881 patients (876 men [99.4%]; 5 women [0.6%]; mean [SD] age, 70 [7.8] years) were included in the analysis. After a mean of 5.2 years of follow-up, mean life-years were 4.89 in the endovascular group and 4.84 in the open repair group ( P = .68), and mean QALYs were 3.72 in the endovascular group and 3.70 in the open repair group ( P = .82). Total mean health care costs did not differ significantly between the 2 groups (endovascular group, $142 745; open repair group, $153 533; difference, −$10 788; 95% CI, −$29 796 to $5825; P = .25). Costs related to AAA, including the initial repair, constituted nearly 40% of total costs and did not differ significantly between the 2 groups (endovascular group, $57 501; open repair group, $57 893; difference, −$393; 95% CI, −$12 071 to $7928; P = .94). Lower costs due to shorter hospitalization for initial endovascular repair were offset by increased costs from AAA-related secondary procedures and imaging studies. The probability of endovascular repair being less costly and more effective was 56.8% when effectiveness was measured in life-years and 55.4% when effectiveness was measured in QALYs for total costs and 31.3% and 34.3%, respectively, for AAA-related costs. Conclusions and Relevance In this multicenter randomized clinical trial with follow-up to 9 years, survival, quality of life, costs, and cost-effectiveness did not differ between elective open and endovascular repair of AAA. Trial Registration clinicaltrials.gov Identifier:NCT00094575
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- 2016
107. Novel Educational Mobile Application Improves Postoperative Patient Knowledge and Patient Experience
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Kimberly E. Souza and Matthew W. Mell
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medicine.medical_specialty ,Physical medicine and rehabilitation ,business.industry ,Patient experience ,Physical therapy ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Postoperative management - Published
- 2015
108. No Difference in Mortality After Inter-Facility Transfer for Patients with Ruptured Abdominal Aortic Aneurysm
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Matthew W. Mell, Tina Hernandez-Boussard, N. Ewen Wang, and Doug Morrison
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medicine.medical_specialty ,Ruptured abdominal aortic aneurysm ,business.industry ,cardiovascular system ,Medicine ,Surgery ,business ,Cardiology and Cardiovascular Medicine - Published
- 2013
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109. Anterior Retroperitoneal Spine Exposure following Prior Endovascular Aortic Aneurysm Repair
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Matthew W. Mell, Patrick C. Thompson, and Brant W. Ullery
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Male ,medicine.medical_specialty ,Endoleak ,Computed Tomography Angiography ,medicine.medical_treatment ,Neurogenic claudication ,Aortography ,Severity of Illness Index ,Endovascular aneurysm repair ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,Aortic aneurysm ,Spinal Stenosis ,0302 clinical medicine ,Aneurysm ,Blood vessel prosthesis ,medicine.artery ,medicine ,Humans ,030212 general & internal medicine ,Aged ,Aorta ,Lumbar Vertebrae ,business.industry ,Endovascular Procedures ,General Medicine ,medicine.disease ,Abdominal aortic aneurysm ,Blood Vessel Prosthesis ,Surgery ,Stenosis ,Spinal Fusion ,Treatment Outcome ,Stents ,Radiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery ,Aortic Aneurysm, Abdominal - Abstract
Background We describe successful anterior retroperitoneal spine exposure to facilitate anterior lumbar interbody fusion (ALIF) in a patient with a prior endovascular aneurysm repair (EVAR). Methods A 74-year-old male with an extensive spine surgical history presented with progressive neurogenic claudication and paresthesia involving both feet. In addition, his surgical history was notable for an EVAR performed elsewhere 5 years earlier, with subsequent right renal stent placement for encroachment of the right renal artery. Diagnostic evaluation identified severe L3-4 and L4-5 canal stenosis, and a 48 × 36-mm aneurysm sac with a type II endoleak. Revision L3–L5 fusion from an anterior approach with vascular surgery assistance was recommended. Results The retroperitoneum was accessed through a left paramedian abdominal incision. The abdominal aortic aneurysm sac was visualized and noted to be nonpulsatile. The distal aorta and left iliac vessels were dissected and retracted medially to facilitate anterior exposure of the L3-4 and L4-5 disk spaces. Successful ALIF of the L3-5 vertebrae was then performed. Retractors were removed and the aortoiliac vessels were carefully returned to anatomic position. The aneurysm sac remained nonpulsatile, with normal pulses in the iliac arteries. Postoperative imaging demonstrated stable appearance of aortic stent graft. At 1-year follow-up, the patient reports complete resolution of symptoms and imaging demonstrates a patent aortic stent graft with a stable type II endoleak. Conclusions Widespread application of ALIF will inevitably include an increasing subgroup of patients with previous EVAR. Such patients require thorough clinical and radiographic perioperative considerations for the access surgeon.
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- 2016
110. National Comparison of Hybrid and Open Repair for Aortoiliac-Femoral Occlusive Disease
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Matthew W. Mell, Elsie Gyang Ross, and Marco Zavatta
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03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,business.industry ,Occlusive disease ,Medicine ,Open repair ,Surgery ,030204 cardiovascular system & hematology ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery - Published
- 2016
111. Management of Symptomatic Unruptured Aortic Aneurysms Over the Past 20 Years
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Karen Trang, Ronald L. Dalman, Venita Chandra, E. John Harris, Jason T. Lee, and Matthew W. Mell
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medicine.medical_specialty ,business.industry ,medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Published
- 2016
112. PC150. Lower Extremity CT Angiography Can Predict Technical Success of Endovascular Revascularization in the Superficial Femoral and Popliteal Arteries
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Tanner I. Kim, Matthew W. Mell, Anna M. Sailer, Dominik Fleischmann, and Nathan K. Itoga
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medicine.medical_specialty ,Endovascular revascularization ,medicine.diagnostic_test ,Arterial disease ,business.industry ,Radiography ,Technical success ,Disease distribution ,Angiography ,medicine ,Surgery ,In patient ,cardiovascular diseases ,Radiology ,Cardiology and Cardiovascular Medicine ,Radiation treatment planning ,business ,psychological phenomena and processes - Abstract
OBJECTIVES Pre-procedural CT angiography (CTA) assists in evaluating vascular morphology, disease distribution and treatment planning in patients with lower extremity peripheral artery disease (PAD). The aim of the study was to determine the predictive value of radiographic findings on CTA and technical success of endovascular revascularization of occlusions in the superficial femoral-popliteal (SFA-pop) region.
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- 2016
113. PC146. A National VQI Database Comparison of Hybrid and Open Repair for Aortoiliac-Femoral Occlusive Disease
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Marco Zavatta and Matthew W. Mell
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medicine.medical_specialty ,Pathology ,business.industry ,Occlusive disease ,Medicine ,Open repair ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Published
- 2016
114. Impact of the Screening Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act on abdominal ultrasonography use among Medicare beneficiaries
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Jacqueline Baras Shreibati, Laurence C. Baker, Mark A. Hlatky, and Matthew W. Mell
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Male ,medicine.medical_specialty ,Geographic variation ,Smoking prevalence ,Logistic regression ,Medicare ,Sex Factors ,Internal Medicine ,medicine ,Odds Ratio ,Prevalence ,Humans ,Mass Screening ,Aged ,Retrospective Studies ,Ultrasonography ,Gynecology ,medicine.diagnostic_test ,Obstetrics ,business.industry ,Medicare beneficiary ,Reproducibility of Results ,Odds ratio ,medicine.disease ,Abdominal aortic aneurysm ,United States ,Survival Rate ,medicine.anatomical_structure ,Abdominal ultrasonography ,Abdomen ,Female ,business ,Aortic Aneurysm, Abdominal ,Follow-Up Studies - Abstract
Since January 1, 2007, Medicare has covered abdominal aortic aneurysm (AAA) screening for new male enrollees with a history of smoking under the Screening Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act. We examined the association between this program and abdominal ultrasonography for AAA screening, elective AAA repair, hospitalization for AAA rupture, and all-cause mortality.We used a 20% sample of traditional Medicare enrollees from 2004 to 2008 to identify 65-year-old men eligible for screening and 3 control groups not eligible for screening (70-year-old men, 76-year-old men, and 65-year-old women). We used logistic regression to examine the change in outcomes at 365 days for eligible vs ineligible beneficiaries before and after SAAAVE Act implementation, adjusting for comorbidities, state-level smoking prevalence, geographic variation, and time trends.Fewer than 3% of abdominal ultrasonography claims after 2007 were for SAAAVE-specific AAA screening. There was a significantly greater increase in abdominal ultrasonography use among SAAAVE-eligible beneficiaries (2.0 percentage points among 65-year-old men, from 7.6% in 2004 to 9.6% in 2008; 0.7 points [8.9% to 9.6%] among 70-year-old men; 0.7 points [10.8% to 11.5%] among 76-year-old men; and 0.9 points [7.5% to 8.4%] among 65-year-old women) (P.001 for all comparisons with 65-year-old men). The SAAAVE Act was associated with increased use of abdominal ultrasonography in 65-year-old men compared with 70-year-old men (adjusted odds ratio [AOR], 1.15; 95% CI, 1.11-1.19) (P.001), and this increased use remained even when SAAAVE-specific AAA screening was excluded (AOR, 1.12; 95% CI, 1.08-1.16) (P.001). Implementation of the SAAAVE Act was not associated with changes in rates of AAA repair, AAA rupture, or all-cause mortality.The impact of the SAAAVE Act on AAA screening was modest and was based on abdominal ultrasonography use that it did not directly reimburse. The SAAAVE Act had no discernable effect on AAA rupture or all-cause morality.
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- 2012
115. Causes and implications of readmission after abdominal aortic aneurysm repair
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Jeffrey A. Havlena, Caprice C. Greenberg, Matthew T. Nelson, David Yu Greenblatt, Matthew W. Mell, Amy J.H. Kind, K. Craig Kent, and Maureen A. Smith
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Male ,Patient Transfer ,medicine.medical_specialty ,macromolecular substances ,Comorbidity ,Kaplan-Meier Estimate ,Medicare ,Patient Readmission ,Article ,Cohort Studies ,Aortic aneurysm ,Postoperative Complications ,Risk Factors ,medicine ,Odds Ratio ,Humans ,cardiovascular diseases ,Aged ,Retrospective Studies ,Patient discharge ,Aged, 80 and over ,business.industry ,Endovascular Procedures ,Retrospective cohort study ,Odds ratio ,Vascular surgery ,Length of Stay ,medicine.disease ,Abdominal aortic aneurysm ,Patient Discharge ,United States ,Surgery ,Logistic Models ,Treatment Outcome ,Multivariate Analysis ,cardiovascular system ,Female ,Vascular Grafting ,business ,Abdominal surgery ,Aortic Aneurysm, Abdominal - Abstract
To determine the frequency, causes, predictors, and consequences of 30-day readmission after abdominal aortic aneurysm (AAA) repair.Centers for MedicareMedicaid Services (CMS) will soon reduce total Medicare reimbursements for hospitals with higher-than-predicted 30-day readmission rates after vascular surgical procedures, including AAA repair. However, causes and factors leading to readmission in this population have never before been systematically analyzed.We analyzed elective AAA repairs over a 2-year period from the CMS Chronic Conditions Warehouse, a 5% national sample of Medicare beneficiaries.A total of 2481 patients underwent AAA repair--1502 endovascular aneurysm repair (EVAR) and 979 open aneurysm repair. Thirty-day readmission rates were equivalent for EVAR (13.3%) and open repair (12.8%). Although wound complication was the most common reason for readmission after both procedures, the relative frequency of other causes differed-eg, bowel obstruction was common after open repair, and graft complication after EVAR. In multivariate analyses, preoperative comorbidities had a modest effect on readmission; however, postoperative factors, including serious complications leading to prolonged length of stay and discharge destination other than home, had a profound influence on the probability of readmission. The 1-year mortality in readmitted patients was 23.4% versus 4.5% in those not readmitted (P0.001).Early readmission is common after AAA repair. Adjusting for comorbidities, postoperative events predict readmission, suggesting that proactively preventing, detecting, and managing postoperative complications may provide an approach to decreasing readmissions, with the potential to reduce cost and possibly enhance long-term survival.
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- 2012
116. Abstract 248: Impact of the Screening for Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act on Abdominal Ultrasound Use Among Medicare Beneficiaries
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Jacqueline Baras Shreibati, Laurence C Baker, Mark A Hlatky, and Matthew W Mell
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Cardiology and Cardiovascular Medicine - Abstract
Context: Since January 1, 2007, Medicare has covered the costs of abdominal aortic aneurysm (AAA) screening for new male enrollees with a history of smoking under the Screening Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act. The association of the Act with changes in rates of screening for AAA has not been well established. Objective : To determine whether the implementation of the SAAAVE Act was associated with changes in use of abdominal ultrasound for AAA screening among 65-year-old men (eligible) compared with a control group of 70-year-old men (not eligible). Design, Setting, and Patients : Retrospective, observational study of 65-year-old and 70-year-old men from a 20% random sample of Medicare fee-for-service beneficiaries from January 1, 2004, to December 31, 2009 (N%781,264). Data from the 2004 to 2008 Behavioral Risk Factor Surveillance System were used to estimate the prevalence of prior smoking among men 65 to 75 years of age. Logistic regression was used to examine the change in abdominal ultrasound use for 65-year-old versus 70-year-old men before (2004-2006) and after (2007-2009) SAAAVE Act implementation, adjusting for patient comorbidities, state-level smoking prevalence, geographic variation, and time trends. Main Outcome Measures : Abdominal ultrasound use, elective repair of AAA, hospitalization for AAA rupture, and all-cause mortality over 365 days of follow-up. Results : The prevalence of prior smoking among 65-to-75-year-old men during the study period was 65.6%. Prior to SAAAVE, in 2004, 7.6% (6965/91,836) of 65-year-old beneficiaries and 8.9% (8975/100,987) of 70-year-old beneficiaries received abdominal ultrasound. Following SAAAVE, in 2008, both age groups had similar rates of use at 9.6% (age 65: 9235/95,980; age 70: 9328/97,336). After multivariate adjustment, the relative increase in abdominal ultrasound use among 65-year-old Medicare beneficiaries after the SAAAVE Act was statistically significant (adjusted odds ratio [AOR] 1.15, 95% confidence interval [CI] 1.11-1.19, p < 0.001). The association of the SAAAVE Act with increases in abdominal ultrasound use differed by region (Northwest, AOR 1.10, 95% CI 1.02-1.19, p < 0.011; Midwest, AOR 1.23, 95% CI 1.15-1.33, p < 0.001; South, AOR 1.12, 95% CI 1.05-1.18; p < 0.001; West, AOR 1.18, 95% CI 1.09-1.28; p < 0.001). There was no statistically significant association of the SAAAVE Act with 365-day rates of AAA repair (AOR 0.76, 95% CI 0.55-1.05, p=0.10), hospitalization for ruptured AAA (AOR 0.87, 95% CI 0.28-2.68, p=0.81), or all-cause mortality (AOR 0.98, 95% CI 0.91-1.05, p=0.61). Conclusion : The SAAAVE Act was associated with a modest, yet significant, increase in abdominal ultrasound use during the first three years of implementation. The proportion of male Medicare enrollees that received AAA screening was a small fraction of the men eligible to be screened, suggesting substantial underuse of a service with proven clinical benefit.
- Published
- 2012
117. Association of an Endovascular-First Protocol for Ruptured Abdominal Aortic Aneurysms With Survival and Discharge Disposition
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Kenneth Tran, Matthew W. Mell, Jason T. Lee, Brant W. Ullery, Edmund J. Harris, Ronald L. Dalman, and Venita Chandra
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Male ,medicine.medical_specialty ,Databases, Factual ,medicine.medical_treatment ,Kaplan-Meier Estimate ,Aneurysm, Ruptured ,Risk Assessment ,Endovascular aneurysm repair ,Statistics, Nonparametric ,Cohort Studies ,Postoperative Complications ,Sex Factors ,Predictive Value of Tests ,Cause of Death ,Confidence Intervals ,medicine ,Humans ,Hospital Mortality ,Survival analysis ,Aged ,Retrospective Studies ,Cause of death ,Aged, 80 and over ,Intention-to-treat analysis ,business.industry ,Endovascular Procedures ,Age Factors ,Retrospective cohort study ,Perioperative ,Middle Aged ,medicine.disease ,Survival Analysis ,Patient Discharge ,Abdominal aortic aneurysm ,Surgery ,Radiography ,Treatment Outcome ,Predictive value of tests ,Female ,Emergencies ,business ,Aortic Aneurysm, Abdominal ,Follow-Up Studies - Abstract
Importance Mortality after an open surgical repair of a ruptured abdominal aortic aneurysm (rAAA) remains high. The role and clinical benefit of ruptured endovascular aneurysm repair (rEVAR) have yet to be fully elucidated. Objective To evaluate the effect of an endovascular-first protocol for patients with an rAAA on perioperative mortality and associated early clinical outcomes. Design, Setting, and Participants Retrospective review of a consecutive series of patients presenting with an rAAA before (1997-2006) and after (2007-2014) implementation of an endovascular-first treatment strategy (ie, protocol) at an academic medical center. Main Outcomes and Measures Early mortality, perioperative morbidity, discharge disposition, and overall survival. Results A total of 88 patients with an rAAA were included in the analysis, including 46 patients in the preprotocol group (87.0% underwent an open repair and 13.0% underwent an rEVAR) and 42 patients in the intention-to-treat postprotocol group (33.3% underwent an open repair and 66.7% underwent an rEVAR; P = .001). Baseline demographics were similar between groups. Postprotocol patients died significantly less often at 30 days (14.3% vs 32.6%; P = .03), had a decreased incidence of major complications (45.0% vs 71.8%; P = .02), and had a greater likelihood of discharge to home (69.2% vs 42.1%; P = .04) after rAAA repair compared with preprotocol patients. Kaplan-Meier analysis demonstrated significantly greater long-term survival in the postprotocol period (log-rank P = .002). One-, 3-, and 5-year survival rates were 50.0%, 45.7%, and 39.1% for open repair, respectively, and 61.9%, 42.9%, and 23.8% for rEVAR, respectively. Conclusions and Relevance Implementation of a contemporary endovascular-first protocol for the treatment of an rAAA is associated with decreased perioperative morbidity and mortality, a higher likelihood of discharge to home, and improved long-term survival. Patients with an rAAA and appropriate anatomy should be offered endovascular repair as first-line treatment at experienced vascular centers.
- Published
- 2015
118. Payer status is associated with the use of prophylactic inferior vena cava filter in high-risk trauma patients
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Rachael A. Callcut, Kristan Staudenmayer, Danielle M. Pickham, David A. Spain, Matthew W. Mell, Paul M. Maggio, and Fritz Bech
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Adult ,Male ,medicine.medical_specialty ,Vena Cava Filters ,Traumatic brain injury ,Inferior vena cava filter ,Logistic regression ,Inferior vena cava ,Insurance Coverage ,Internal medicine ,Medicine ,Humans ,Spinal cord injury ,Aged ,Retrospective Studies ,business.industry ,Middle Aged ,medicine.disease ,Pulmonary embolism ,Surgery ,Venous thrombosis ,medicine.vein ,Cohort ,Wounds and Injuries ,Female ,business ,Pulmonary Embolism - Abstract
Background It is controversial whether patients at high risk for pulmonary embolism (PE) should receive prophylactic inferior vena cava filters (IVC) filters. This lack of clarity creates the potential for variability and disparities in care. We hypothesized there would be differential use of prophylactic IVC filters for patients at high risk for PE on the basis of insurance status. Methods We performed a retrospective analysis using the National Trauma Databank (2002–2007). We included adult patients at high risk for PE (traumatic brain injury or spinal cord injury) and excluded patients with a diagnosis of deep venous thrombosis (DVT) or PE. Logistic regression was performed to control for confounders and a hierarchical mixed effects model was used to control for center. Results A prophylactic filter was placed in 3,331 (4.3%) patients in the study cohort. Patients without insurance had an IVC filter placed less often compared with those with any form of insurance (2.7% vs 4.9%, respectively). After adjusting for confounders, we found that patients without insurance were less likely to receive a prophylactic IVC filter, even when we controlled for center (OR 5.3, P Conclusion When guidelines lack clarity, unconscious bias has the potential to create a system with different levels of care based on socioeconomic disparities.
- Published
- 2011
119. Readmissions after Abdominal Aortic Aneurysm Repair: Differences between Open Repair and Endovascular Aneurysm Repair
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Weesam K. Al-Khatib, Jason T. Lee, Tina Hernandez-Boussard, Kevin Casey, and Matthew W. Mell
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Medicine ,Open repair ,Surgery ,business ,medicine.disease ,Cardiology and Cardiovascular Medicine ,Endovascular aneurysm repair ,Abdominal aortic aneurysm - Published
- 2011
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120. Effect of early plasma transfusion on mortality in patients with ruptured abdominal aortic aneurysm
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A.S. O'Neil, Matthew W. Mell, and Rachael A. Callcut
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medicine.medical_specialty ,Resuscitation ,Multivariate analysis ,Ruptured abdominal aortic aneurysm ,business.industry ,Vital signs ,Odds ratio ,Confidence interval ,Surgery ,medicine ,In patient ,business ,Prospective cohort study ,Cardiology and Cardiovascular Medicine - Abstract
Background. The ratio of red blood cell (PRBC) transfusion to plasma (FFP) transfusion (PRBC:FFP ratio) has been shown to impact survival in trauma patients with massive hemorrhage. The purpose of this study was to determine the effect of the PRBC:FFP ratio on mortality for patients with massive hemorrhage after ruptured abdominal aortic aneurysm (RAAA). Methods. A retrospective review was performed of patients undergoing emergent open RAAA repair from January 1987 to December 2007. Patients with massive hemorrhage ($10 units of blood products transfused prior to conclusion of the operation) were included. The effects of patient demographics, admission vital signs, laboratory values, peri-operative variables, amount of blood products transfused, and the PRBC:FFP ratio on 30-day mortality were analyzed by multivariate analysis. Results. One hundred and twenty-eight of the 168 (76%) patients undergoing repair for RAAA received at least 10 units of blood products within the peri-operative period. Mean age was 73.1 ± 9.1 years, and 109 (85%) were men. Thirty-day mortality was 22.6% (29/128), including 11 intra-operative deaths. By multivariate analysis, 30-day mortality was markedly lower (15% vs 39%; P 2:1 (LOW FFP), and the likelihood of death was more than 4-fold greater in the LOW FFP group (odds ratio 4.23; 95% confidence interval, 1.2--14.49). Patients in the HIGH FFP group had a significantly lower incidence of colon ischemia than those in the LOW FFP group (22.4% vs 41.1%; P = .004). Conclusion. For RAAA patients requiring massive transfusion, more equivalent transfusion of PRBC to FFP (HIGH FFP) was independently associated with lower 30-day mortality. The lower incidence of colonic ischemia in the HIGH FFP group may suggest an additional benefit of early plasma transfusion that could translate into further mortality reduction. Analysis from this study suggests the potential feasibility for a more standardized protocol of initial resuscitation for these patients, and prospective studies are warranted to determine the optimum PRBC:FFP ratio in RAAA patients. (Surgery 2010;148:955-62.)
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- 2011
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121. Low frequency of primary lipid screening among medicare patients with rheumatoid arthritis
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Amy J.H. Kind, Matthew W. Mell, Christie M. Bartels, Patrick E. McBride, Christine M. Everett, and Maureen A. Smith
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Male ,medicine.medical_specialty ,Immunology ,Population ,Medicare ,Arthritis, Rheumatoid ,Rheumatology ,Internal medicine ,JUPITER trial ,medicine ,Immunology and Allergy ,Humans ,Mass Screening ,Pharmacology (medical) ,education ,National Cholesterol Education Program ,Mass screening ,Cause of death ,Aged ,Retrospective Studies ,Aged, 80 and over ,education.field_of_study ,Primary Health Care ,business.industry ,Absolute risk reduction ,Retrospective cohort study ,medicine.disease ,Lipids ,United States ,Cardiovascular Diseases ,Physical therapy ,Female ,business ,Rheumatism - Abstract
Although patients with rheumatoid arthritis (RA) are most often cared for by both primary care providers (PCPs) and rheumatologists, preventive screening remains suboptimal (1, 2), and the mortality gap between RA patients and peers has widened (3, 4). Cardiovascular disease (CVD) is the leading cause of death for patients with RA. These patients experience a 10-year risk of CVD events that is 50–60% higher than age-matched peers (5, 6). Reductions in cardiovascular mortality seen in the general population in recent decades (7) have not been seen among patients with RA (3–5), and cardiovascular risk has not equilibrated even with aggressive RA treatments (8). Consequently, adequate screening for traditional CVD risk factors is strongly indicated for RA patients. Primary preventive screening is key to identify modifiable traditional CVD risk factors. To date primary preventive lipid screening performance has not been systematically examined in a national RA sample. Compounding the challenge, no widely known RA-specific CVD preventive guidelines exist despite increased CVD risk in RA. The European League Against Rheumatism (EULAR) has issued recommendations for an annual CVD risk review (9). For all adults, the National Cholesterol Education Program (NCEP) recommends lipid screening in those with CVD risk factors “more frequently than every 5 years” (10). Prior reports suggest that RA patients frequently experience unidentified and uncontrolled traditional modifiable CVD risk factors including hyperlipidemia and hypertension (11–13). Though not studied specifically in RA, according to the recent JUPITER trial, C-reactive protein elevations may also merit consideration of lipid-lowering therapy (14, 15). RA patients see multiple physicians annually, with rheumatology visits often outnumbering primary care encounters (16). The influence of multisource care and competing comorbidities raise questions of whether the process of care can be optimized to improve primary preventive screening for patients with RA and other chronic conditions (17). Older adults, in particular, are receiving aggressive RA treatment (18) but are at greatest absolute risk for coronary events. They may also be most vulnerable to lapsed prevention due to competing comorbidities and multisource care. As a result, older RA patients represent a key target population for CVD risk factor modification. In this study we investigated the impact of rheumatology and primary care outpatient visit patterns upon primary preventive lipid screening among a group of older adults with RA. We specifically examined whether individual likelihood of lipid screening differed by types of providers seen each year and relative proportions of visits to primary care and rheumatology. Reflecting the more conservative NCEP recommendation versus EULAR recommendations, we examined lipid screening over a three-year window.
- Published
- 2011
122. For-Profit Hospital Status and Rehospitalizations to Different Hospitals: An Analysis of Medicare Data
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Amy J.H. Kind, John Mullahy, Maureen A. Smith, Matthew W. Mell, and Christie M. Bartels
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Gerontology ,Male ,medicine.medical_specialty ,Time Factors ,Medicare ,Article ,Hospitals, University ,Assurance maladie ,Acute care ,Internal Medicine ,medicine ,Health insurance ,For profit ,Odds Ratio ,Humans ,Hospital Mortality ,Aged ,Population statistics ,business.industry ,Hospitals, Public ,Health services research ,Medicare beneficiary ,General Medicine ,Middle Aged ,Hospitals, Proprietary ,United States ,Hospitalization ,Hospital Bed Capacity ,Emergency medicine ,Female ,business ,Health care quality - Abstract
About one quarter of rehospitalized Medicare patients are admitted to hospitals different from their original hospital. The extent to which this practice is related to for-profit hospital status and affects payments and mortality is unknown.To describe and examine predictors of and payments for rehospitalization at a different hospital among Medicare patients rehospitalized within 30 days at for-profit and nonprofit or public hospitals.Cohort study of patients discharged and rehospitalized from January 2005 to November 2006.Medicare fee-for-service hospitals throughout the United States.A 5% random national sample of Medicare patients with acute care rehospitalizations within 30 days of discharge (n = 74,564).30-day rehospitalizations at different hospitals and total payments or mortality over the subsequent 30 days. Multivariate logistic and quantile regression models included index hospital for-profit status, discharge counts, geographic region, rural-urban commuting area, and teaching status; patient sociodemographic characteristics, disability status, and comorbid conditions; and a measure of risk adjustment.16 622 patients (22%) in the sample were rehospitalized at a different hospital. Factors associated with increased risk for rehospitalization at a different hospital included index hospitalization at a for-profit, major medical school-affiliated, or low-volume hospital and having a Medicare-defined disability. Compared with patients rehospitalized at the same hospital, patients rehospitalized at different hospitals had higher adjusted 30-day total payments (median additional cost, $1308 per patient; P0.001) but no statistically significant differences in 30-day mortality, regardless of index hospital for-profit status.The database lacked detailed clinical information about patients and did not include information about specific provider practice motivations or the role of patient choice in hospitalization venues.Rehospitalizations at different hospitals are common among Medicare patients, are more likely among those initially hospitalized at a for-profit hospital, and are related to increased overall payments without improved mortality.University of Wisconsin Hartford Center of Excellence in Geriatrics, National Institutes of Health.
- Published
- 2010
123. Presurgical localization of the artery of Adamkiewicz with time-resolved 3.0-T MR angiography
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Mark L. Schiebler, Charles W. Acher, Thomas M. Grist, Christopher J. François, Scott B. Reeder, Thorsten A. Bley, Corey C. Duffek, and Matthew W. Mell
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Adult ,Male ,medicine.medical_specialty ,Contrast Media ,Aortic aneurysm ,Bolus (medicine) ,Imaging, Three-Dimensional ,Meglumine ,medicine.artery ,medicine ,Image Processing, Computer-Assisted ,Organometallic Compounds ,Humans ,Radiology, Nuclear Medicine and imaging ,Aged ,Retrospective Studies ,Aged, 80 and over ,medicine.diagnostic_test ,Aortic Aneurysm, Thoracic ,business.industry ,Mr angiography ,Arteries ,Middle Aged ,Aortic surgery ,medicine.disease ,Spinal Cord ,Cardiothoracic surgery ,Angiography ,cardiovascular system ,Female ,Radiology ,Artery of Adamkiewicz ,business ,Magnetic Resonance Angiography ,Abdominal surgery ,Aortic Aneurysm, Abdominal - Abstract
To evaluate the use of time-resolved magnetic resonance (MR) angiography in the presurgical localization of the artery of Adamkiewicz prior to reimplantation of the feeding intercostal artery, lumbar artery, or both during aortic aneurysm repair.This institutional review board-approved retrospective study included 68 patients (36 men, 32 women) who underwent time-resolved spinal MR angiography (0.2 mmol per kilogram of body weight gadobenate dimeglumine administered at a rate of 2.0 mL per second) performed with a 3.0-T imager with a dedicated eight-element spine coil. Images were reviewed at a three-dimensional workstation by two experienced radiologists in consensus. The artery of Adamkiewicz was identified, and the location of the feeding intercostal and/or lumbar artery was ascertained by using a five-point confidence index (scores ranged from 1 to 5). The phases in which the artery of Adamkiewicz, aorta, and great anterior radiculomedullary vein (GARV) demonstrated peak enhancement were also recorded.The artery of Adamkiewicz and the location of the feeding intercostal and/or lumbar artery were identified with high confidence in 60 (88%) of the 68 patients. Origins of the artery of Adamkiewicz were on the left side of the body in 65% of patients and on the right side in 35%. The level of origin ranged from the T6 neuroforamina to the L1 neuroforamina. The arrival of contrast material was highly variable in this patient population, which had substantial aortic disease. The highest signal intensity in the aorta, artery of Adamkiewicz, and GARV occurred a mean of 55 seconds (range, 27-99 seconds; 95% confidence interval [CI] 51, 58), 72 seconds (range, 38-110 seconds; 95% CI: 68, 76), and 95 seconds (range, 46-156 seconds; 95% CI: 89, 101) after contrast material administration, respectively.The artery of Adamkiewicz and the anterior spinal artery can be identified and differentiated from the GARV even in patients with substantially altered hemodynamics by using time-resolved 3.0-T MR angiography.
- Published
- 2010
124. A New Intercostal Artery Management Strategy for Thoracoabdominal Aortic Aneurysm Repair
- Author
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Scott B. Reeder, Martha M. Wynn, and Matthew W. Mell
- Subjects
medicine.medical_specialty ,Management strategy ,Aortic aneurysm repair ,business.industry ,medicine.artery ,medicine ,Surgery ,business ,Cardiology and Cardiovascular Medicine ,Intercostal arteries - Published
- 2009
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125. Effect of early plasma transfusion on mortality in patients with ruptured abdominal aortic aneurysm
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Girma Tefera, Charles W. Acher, William D. Turnipseed, John R. Hoch, Matthew W. Mell, Rachael A. Callcut, and Amy S. O'Neil
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Male ,Resuscitation ,medicine.medical_specialty ,Aortic Rupture ,Vital signs ,Blood Component Transfusion ,Aortic aneurysm ,Plasma ,medicine.artery ,Blood plasma ,medicine ,Humans ,Prospective cohort study ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Abdominal aorta ,Odds ratio ,Middle Aged ,medicine.disease ,Confidence interval ,Surgery ,Anesthesia ,Female ,business ,Erythrocyte Transfusion ,Aortic Aneurysm, Abdominal - Abstract
The ratio of red blood cell (PRBC) transfusion to plasma (FFP) transfusion (PRBC:FFP ratio) has been shown to impact survival in trauma patients with massive hemorrhage. The purpose of this study was to determine the effect of the PRBC:FFP ratio on mortality for patients with massive hemorrhage after ruptured abdominal aortic aneurysm (RAAA).A retrospective review was performed of patients undergoing emergent open RAAA repair from January 1987 to December 2007. Patients with massive hemorrhage (≥10 units of blood products transfused prior to conclusion of the operation) were included. The effects of patient demographics, admission vital signs, laboratory values, peri-operative variables, amount of blood products transfused, and the PRBC:FFP ratio on 30-day mortality were analyzed by multivariate analysis.One hundred and twenty-eight of the 168 (76%) patients undergoing repair for RAAA received at least 10 units of blood products within the peri-operative period. Mean age was 73.1 ± 9.1 years, and 109 (85%) were men. Thirty-day mortality was 22.6% (29/128), including 11 intra-operative deaths. By multivariate analysis, 30-day mortality was markedly lower (15% vs 39%; P.03) for patients transfused at a PRBC:FFP ratio ≤2:1 (HIGH FFP group) compared with those transfused at a ratio of2:1 (LOW FFP), and the likelihood of death was more than 4-fold greater in the LOW FFP group (odds ratio 4.23; 95% confidence interval, 1.2-14.49). Patients in the HIGH FFP group had a significantly lower incidence of colon ischemia than those in the LOW FFP group (22.4% vs 41.1%; P = .004).For RAAA patients requiring massive transfusion, more equivalent transfusion of PRBC to FFP (HIGH FFP) was independently associated with lower 30-day mortality. The lower incidence of colonic ischemia in the HIGH FFP group may suggest an additional benefit of early plasma transfusion that could translate into further mortality reduction. Analysis from this study suggests the potential feasibility for a more standardized protocol of initial resuscitation for these patients, and prospective studies are warranted to determine the optimum PRBC:FFP ratio in RAAA patients.
- Published
- 2009
126. Complications of spinal fluid drainage in thoracoabdominal aortic aneurysm repair: a report of 486 patients treated from 1987 to 2008
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Martha M. Wynn, Matthew W. Mell, Charles W. Acher, John R. Hoch, and Girma Tefera
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Male ,medicine.medical_specialty ,Time Factors ,Central Venous Pressure ,Spinal Puncture ,Catheterization ,Aortic aneurysm ,Hematoma ,Cerebrospinal Fluid Pressure ,Risk Factors ,medicine ,Humans ,Aged ,Retrospective Studies ,Cerebral atrophy ,Paraplegia ,Brain Diseases ,Aortic Aneurysm, Thoracic ,business.industry ,Central venous pressure ,Headache ,medicine.disease ,Surgery ,Hematoma, Subdural ,Treatment Outcome ,Cardiothoracic surgery ,Anesthesia ,Drainage ,Female ,Cerebrospinal fluid pressure ,Atrophy ,Cardiology and Cardiovascular Medicine ,business ,Tomography, X-Ray Computed ,Intracranial Hemorrhages ,Vascular Surgical Procedures - Abstract
ObjectiveSpinal fluid drainage reduces paraplegia risk in thoracic (TAA) and thoracoabdominal (TAAA) aortic aneurysm repair. There has not been a comprehensive study of the risks of spinal fluid drainage and how these risks can be reduced. Here we report complications of spinal fluid drainage in patients undergoing TAA/TAAA repair.MethodsThe study comprised 648 patients who had TAA or TAAA repair from 1987 to 2008. Spinal drains were used in 486 patients. Spinal fluid pressure was measured continuously, except when draining fluid, and was reduced to
- Published
- 2008
127. Postoperative Surveillance and Long-term Outcomes After Endovascular Aneurysm Repair Among Medicare Beneficiaries
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Laurence C. Baker, Trit Garg, and Matthew W. Mell
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Medicare ,Logistic regression ,Endovascular aneurysm repair ,Aneurysm ,Internal medicine ,medicine ,Humans ,Aged ,Postoperative Care ,business.industry ,Endovascular Procedures ,Medicare beneficiary ,Vascular surgery ,medicine.disease ,United States ,Abdominal aortic aneurysm ,Surgery ,Treatment Outcome ,Population Surveillance ,Propensity score matching ,Cohort ,Female ,Guideline Adherence ,business ,Aortic Aneurysm, Abdominal - Abstract
The Society for Vascular Surgery recommends annual surveillance with computed tomography (CT) or ultrasonography after endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysms. However, such lifelong surveillance may be unnecessary for most patients, thereby contributing to overuse of imaging services.To investigate whether nonadherence to Society for Vascular Surgery-recommended surveillance guidelines worsens long-term outcomes after EVAR among Medicare beneficiaries.We collected data from Medicare claims from January 1, 2002, through December 31, 2011. A total of 9503 patients covered by fee-for-service Medicare who underwent EVAR from January 1, 2002, through December 31, 2005, were categorized as receiving complete or incomplete surveillance. We performed logistic regressions controlling for patient demographic and hospital characteristics. Patients were then matched by propensity score with adjusting for all demographic variables, including age, sex, race, Medicaid eligibility, residential status, hospital volume, ruptured abdominal aortic aneurysms, and all preexisting comorbidities. We then calculated differences in long-term outcomes after EVAR between adjusted groups. Data analysis was performed from January 1, 2002, through December 31, 2011.Post-EVAR imaging modality, aneurysm-related mortality, late rupture, and complications.Median follow-up duration was 6.1 years. Incomplete surveillance was observed in 5526 of 9695 patients (57.0%) who survived the initial hospital stay at a mean (SD) of 5.2 (2.9) years after EVAR. After propensity matching, our cohort consisted of 7888 patients, among whom 3944 (50.0%) had incomplete surveillance. For those in the matched cohort, patients with incomplete surveillance had a lower incidence of late ruptures (26 of 3944 [0.7%] vs 57 of 3944 [1.4%]; P = .001) and major or minor reinterventions (46 of 3944 [1.2%] vs 246 of 3944 [6.2%]; P .001) in unadjusted analysis. Aneurysm-related mortality was not statistically different between groups (13 of 3944 [0.3%] vs 24 of 3944 [0.6%]; P = .07). In adjusted analysis of postoperative outcomes controlling for all patient and hospital factors by the tenth postoperative year, patients in the incomplete surveillance group experienced lower rates of total complications (2.1% vs 14.0%; P .001), late rupture (1.1% vs 5.3%; P .001), major or minor reinterventions (1.4% vs 10.0%; P .001), aneurysm-related mortality (0.4% vs 1.3%; P .001), and all-cause mortality (30.9% vs 68.8%, P .001).Nonadherence to the Society for Vascular Surgery guidelines for post-EVAR imaging was not associated with poor outcomes, suggesting that, in many patients, less frequent surveillance is not associated with worse outcomes. Improved criteria for defining optimal surveillance will achieve higher value in aneurysm care.
- Published
- 2015
128. Arterial Cut-Down Reduces Complications Following Brachial Access for Peripheral Vascular Interventions
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Ronald L. Dalman, Matthew W. Mell, Jeffrey A. Kalish, and Marcus R. Kret
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business.industry ,Anesthesia ,Psychological intervention ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Peripheral - Published
- 2015
129. Does Metformin Suppress Aneurysmal Aortic Degeneration?
- Author
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Keith J Glover, Naoki Fujimura, Jiang Xiong, Baohui Xu, Ronald L. Dalman, Haojuan Xuan, Matthew W. Mell, Sara A. Michie, and Ellen B. Kettler
- Subjects
Pathology ,medicine.medical_specialty ,business.industry ,Medicine ,Surgery ,Degeneration (medical) ,Cardiology and Cardiovascular Medicine ,business ,Metformin ,medicine.drug - Published
- 2015
130. PC158. Arterial Cut-Down Reduces Complications Following Brachial Access for Peripheral Vascular Interventions
- Author
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Ronald L. Dalman, Jeffrey A. Kalish, Marcus R. Kret, and Matthew W. Mell
- Subjects
business.industry ,Anesthesia ,Psychological intervention ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Peripheral - Published
- 2015
131. RR4. Reducing Length of Stay Is Not Associated With Increased Readmission Rates Following Lower Extremity Arterial Bypass
- Author
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Nicholas H. Osborne, Andrew A. Gonzalez, and Matthew W. Mell
- Subjects
business.industry ,Anesthesia ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Published
- 2015
132. The contemporary management of renal artery aneurysms
- Author
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Jill Q. Klausner, Adnan Z. Rizvi, Christopher J. Abularrage, Peter Pak, Jacob W. Loeffler, Michael P. Harlander-Locke, Nathan K. Itoga, Matthew R. Smeds, Josefina Dominguez, Misty D. Humphries, James C. Stanley, Mark D. Morasch, Dawn M. Coleman, Christopher H. Lee, Naoki Fujimura, Peter F. Lawrence, York Hsiang, Tazo Inui, Matthew W. Mell, Joseph S. Ladowski, Robert J. Feezor, Vivian M. Leung, Paul Bove, Neal S. Cayne, Audra Duncan, Joseph M. Ladowski, Fred A. Weaver, Gustavo S. Oderich, Robert J. Hye, and Amir F. Azarbal
- Subjects
Adult ,Male ,medicine.medical_specialty ,Abdominal pain ,Adolescent ,medicine.medical_treatment ,Comorbidity ,Aneurysm, Ruptured ,Asymptomatic ,Young Adult ,Renal Artery ,Aneurysm ,Risk Factors ,Internal medicine ,medicine ,Humans ,Myocardial infarction ,Child ,Vascular Calcification ,Dialysis ,Aged ,Retrospective Studies ,Asymptomatic Diseases ,Aged, 80 and over ,business.industry ,Retrospective cohort study ,Middle Aged ,medicine.disease ,United States ,Surgery ,Hypertension, Renovascular ,Treatment Outcome ,Practice Guidelines as Topic ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Vascular Surgical Procedures - Abstract
Background Renal artery aneurysms (RAAs) are rare, with little known about their natural history and growth rate or their optimal management. The specific objectives of this study were to (1) define the clinical features of RAAs, including the precise growth rate and risk of rupture, (2) examine the current management and outcomes of RAA treatment using existing guidelines, and (3) examine the appropriateness of current criteria for repair of asymptomatic RAAs. Methods A standardized, multi-institutional approach was used to evaluate patients with RAAs at institutions from all regions of the United States. Patient demographics, aneurysm characteristics, aneurysm imaging, conservative and operative management, postoperative complications, and follow-up data were collected. Results A total of 865 RAAs in 760 patients were identified at 16 institutions. Of these, 75% were asymptomatic; symptomatic patients had difficult-to-control hypertension (10%), flank pain (6%), hematuria (4%), and abdominal pain (2%). The RAAs had a mean maximum diameter of 1.5 ± 0.1 cm. Most were unilateral (96%), on the right side (61%), saccular (87%), and calcified (56%). Elective repair was performed in 213 patients with 241 RAAs, usually for symptoms or size >2 cm; the remaining 547 patients with 624 RAAs were observed. Major operative complications occurred in 10%, including multisystem organ failure, myocardial infarction, and renal failure requiring dialysis. RAA repair for difficult-to-control hypertension cured 32% of patients and improved it in 26%. Three patients had ruptured RAA; all were transferred from other hospitals and underwent emergency repair, with no deaths. Conservatively treated patients were monitored for a mean of 49 months, with no acute complications. Aneurysm growth rate was 0.086 cm/y, with no difference between calcified and noncalcified aneurysms. Conclusions This large, contemporary, multi-institutional study demonstrated that asymptomatic RAAs rarely rupture (even when >2 cm), growth rate is 0.086 ± 0.08 cm/y, and calcification does not protect against enlargement. RAA open repair is associated with significant minor morbidity, but rarely a major morbidity or mortality. Aneurysm repair cured or improved hypertension in >50% of patients whose RAA was identified during the workup for difficult-to-control hypertension.
- Published
- 2015
133. Transposition of the Left Renal Vein for the Treatment of Nutcracker Syndrome in Children: A Short-term Experience
- Author
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Nathan K. Itoga, Matthew W. Mell, and Brant W. Ullery
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Renal Nutcracker Syndrome ,medicine.medical_specialty ,Time Factors ,Adolescent ,Narcotic ,medicine.medical_treatment ,Flank Pain ,Renal Veins ,Transposition (music) ,Nutcracker syndrome ,medicine.artery ,medicine ,Humans ,Superior mesenteric artery ,Child ,Hematuria ,Surgical repair ,Aorta ,Proteinuria ,business.industry ,Phlebography ,General Medicine ,medicine.disease ,Abdominal Pain ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Ligament ,Female ,medicine.symptom ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Vascular Surgical Procedures - Abstract
Background Nutcracker syndrome is caused by compression of the left renal vein between the superior mesenteric artery and the aorta. Invasive surgical intervention for this pathologic entity is controversial, particularly in the pediatric population. We aim to describe our early clinical and operative experience with such patients. Methods We report 3 cases of pediatric patients undergoing successful left renal vein transposition for the treatment of nutcracker syndrome. Results All 3 patients were female (age 9–17 years) and presented with a mean of 11.7 months of abdominal or left flank pain requiring chronic narcotic analgesia. Initial clinical presentations were associated with either hematuria or proteinuria. Diagnosis of nutcracker syndrome was supported in each case by an elevated renocaval pressure gradient and/or axial imaging demonstrating mesoaortic compression of the left renal vein. All patients underwent open surgical repair, which included left renal vein transposition, liberation of the ligament of Treitz and associated adhesions, as well as excision of periaortic nodal tissue (mean hospital length of stay 5.7 days). After mean follow-up of 13 months, all patients report complete resolution of symptoms and hematuria/proteinuria. Conclusions Transposition of the left renal vein is a safe and effective treatment for nutcracker syndrome in appropriately selected pediatric patients. Further experience and long-term follow-up are warranted to better evaluate the sustained efficacy of this procedure in this unique patient population.
- Published
- 2014
134. Desmoid tumor of the sternum presenting as an anterior mediastinal mass
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Eng C. Saw, Gloria S. Yu, and Matthew W. Mell
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Adult ,Male ,Pulmonary and Respiratory Medicine ,Sternum ,medicine.medical_specialty ,Bone Neoplasms ,Mediastinal Neoplasms ,Diagnosis, Differential ,Biopsy ,Humans ,Medicine ,Periosteum ,medicine.diagnostic_test ,business.industry ,Biopsy, Needle ,Fibromatosis ,Soft tissue ,General Medicine ,Anatomy ,medicine.disease ,Mediastinal Neoplasm ,Fibromatosis, Aggressive ,medicine.anatomical_structure ,Cardiothoracic surgery ,Surgery ,Differential diagnosis ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business - Abstract
A 20-year-old man with a large, asymptomatic mediastinal mass was found to have desmoid-type fibromatosis (DF) by needle biopsy. The tumor arose from the internal periosteum of the sternum and mimicked an anterior mediastinal mass. A wide resection of the sternum, including portions of the clavicles and costal cartilages, and reconstruction with a Gore-Tex soft tissue patch were performed. Although extremely rare, desmoid tumor of the sternum should be considered in the differential diagnosis of anterior mediastinal tumors.
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- 1997
135. THE USE OF SPIRAL COMPUTED TOMOGRAPHY IN THE EVALUATION OF LIVING DONORS FOR KIDNEY TRANSPLANTATION1
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Jane A. Waskerwitz, Matthew W. Mell, Geoffrey D. Rubin, Edward J. Alfrey, R B Jeffrey, Donald C. Dafoe, John D. Scandling, and Paul C. Kuo
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Transplantation ,medicine.medical_specialty ,Kidney ,medicine.anatomical_structure ,business.industry ,Medicine ,Radiology ,business ,medicine.disease ,Spiral computed tomography ,Kidney transplantation - Published
- 1995
136. Failure to Prevent Aneurysm Rupture Despite Early Diagnosis
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Mark A. Hlatky, Matthew W. Mell, Jacqueline Baras Shreibati, and Laurence C. Baker
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Aneurysm rupture ,medicine.medical_specialty ,surgical procedures, operative ,business.industry ,cardiovascular system ,Medicine ,Surgery ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business - Published
- 2012
137. Under-Utilization of Transfer for Ruptured Abdominal Aortic Aneurysm (rAAA) in the Western United States
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David A. Spain, Kristan Staudenmayer, Rachael A. Callcut, Tina Hernandez-Boussard, Matthew W. Mell, Kit Delgado, and Fritz Bech
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medicine.medical_specialty ,Ruptured abdominal aortic aneurysm ,business.industry ,medicine ,Surgery ,business ,Cardiology and Cardiovascular Medicine - Published
- 2011
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138. QS366. Clinical Utility of Selective Intercostal Artery Preservation and Reimplantion During Thoracoabdominal Aortic Aneurysm Repair
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Matthew W. Mell, Charles W. Acher, Girma Tefera, and John R. Hoch
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medicine.medical_specialty ,Aortic aneurysm repair ,business.industry ,medicine.artery ,medicine ,Surgery ,business ,Intercostal arteries - Published
- 2008
139. Late diagnosis of abdominal aortic aneurysms substantiates underutilization of abdominal aortic aneurysm screening for Medicare beneficiaries
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Jacqueline Baras Shreibati, Laurence C. Baker, Ronald L. Dalman, Matthew W. Mell, and Mark A. Hlatky
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Male ,medicine.medical_specialty ,Delayed Diagnosis ,business.industry ,Medicare beneficiary ,Medicare ,medicine.disease ,Preoperative care ,United States ,Abdominal aortic aneurysm ,Surgery ,Abdominal aortic aneurysm screening ,Aortic aneurysm ,Late diagnosis ,Medicare population ,Humans ,Medicine ,Female ,Observational study ,Cardiology and Cardiovascular Medicine ,business ,Aged ,Aortic Aneurysm, Abdominal - Abstract
ObjectiveAbdominal aortic aneurysm (AAA) screening remains largely underutilized in the U.S., and it is likely that the proportion of patients with aneurysms requiring prompt treatment is much higher compared with well-screened populations. The goals of this study were to determine the proportion of AAAs that required prompt repair after diagnostic abdominal imaging for U.S. Medicare beneficiaries and to identify patient and hospital factors contributing to early vs late diagnosis of AAA.MethodsData were extracted from Medicare claims records for patients at least 65 years old with complete coverage for 2 years who underwent intact AAA repair from 2006 to 2009. Preoperative ultrasound and computed tomography was tabulated from 2002 to repair. We defined early diagnosis of AAA as a patient with a time interval of greater than 6 months between the first imaging examination and the index procedure, and late diagnosis as patients who underwent the index procedure within 6 months of the first imaging examination.ResultsOf 17,626 patients who underwent AAA repair, 14,948 met inclusion criteria. Mean age was 77.5 ± 6.1 years. Early diagnosis was identified for 60.6% of patients receiving AAA repair, whereas 39.4% were repaired after a late diagnosis. Early diagnosis rates increased from 2006 to 2009 (59.8% to 63.4%; P < .0001) and were more common for intact repair compared with repair after rupture (62.9% vs 35.1%; P < .0001) and for women compared with men (66.3% vs 59.0%; P < .0001). On multivariate analysis, repair of intact vs ruptured AAAs (odds ratio, 3.1; 95% confidence interval, 2.7-3.6) and female sex (odds ratio, 1.4; 95% confidence interval, 1.3-1.5) remained the strongest predictors of surveillance. Although intact repairs were more likely to be diagnosed early, over one-third of patients undergoing repair for ruptured AAAs received diagnostic abdominal imaging greater than 6 months prior to surgery.ConclusionsDespite advances in screening practices, significant missed opportunities remain in the U.S. Medicare population for improving AAA care. It remains common for AAAs to be diagnosed when they are already at risk for rupture. In addition, a significant proportion of patients with early imaging rupture prior to repair. Our findings suggest that improved mechanisms for observational management are needed to ensure optimal preoperative care for patients with AAAs.
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- 2013
140. Implementing Toyota Production System Practices Improves Efficiency of Patient Care in an Academic Vascular Practice
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Tarina Kwong, Ronald L. Dalman, Sridhar B. Seshadri, and Matthew W. Mell
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business.industry ,Medicine ,Surgery ,Operations management ,Toyota Production System ,Cardiology and Cardiovascular Medicine ,business ,Patient care - Published
- 2013
141. The effect of antibiotics on the destruction of cartilage in experimental infectious arthritis
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Robert L. Smith, E. Gilkerson, David J. Schurman, Glen Kajiyama, and Matthew W. Mell
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Ceforanide ,business.industry ,medicine.drug_class ,Cartilage ,Antibiotics ,Arthritis ,General Medicine ,medicine.disease_cause ,medicine.disease ,Glycosaminoglycan ,medicine.anatomical_structure ,Staphylococcus aureus ,Infectious arthritis ,Immunology ,medicine ,Orthopedics and Sports Medicine ,Surgery ,Clinical significance ,business ,medicine.drug - Abstract
In joints with bacterial arthritis, continuing prolonged destruction of cartilage may occur in spite of prompt, effective antibiotic therapy. We measured the extent to which early antibiotic therapy with ceforanide altered the degradation of the cartilage after arthritis due to Staphylococcus aureus had been produced in the knee joint in rabbits. Degradation of the cartilage was quantified by analyses for glycosaminoglycan and collagen. Three weeks after the infection was produced, the cartilage had lost more than half of its glycosaminoglycan whether the antibiotic therapy had been started at one, two, or seven days after infection. Beginning the antibiotic treatment one day after infection reduced over-all loss of collagen by 37 per cent and decreased the area of erosion of the infected articular surfaces. When antibiotic treatment was begun at four, eight, or twelve hours after infection, the loss of glycosaminoglycan averaged 18 per cent. Prophylaxis with antibiotics completely prevented any degradation of the cartilage. Clinical relevance: The findings reported here show how rapidly cartilage loses glycosaminoglycan when it is involved by arthritis caused by staphylococci and how early treatment of the infection reduces the loss of collagen. There is less protection against loss of glycosaminoglycan. The results emphasize the need for early diagnosis and treatment of infectious synovitis and support the rationale for early administration of antibiotics without waiting for identification of the responsible bacteria.
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- 1987
142. Differences in readmissions after open repair versus endovascular aneurysm repair
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Matthew W. Mell, Tina Hernandez-Boussard, Kevin Casey, and Jason T. Lee
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Male ,medicine.medical_specialty ,Time Factors ,Heart Diseases ,medicine.medical_treatment ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Communicable Diseases ,Patient Readmission ,Endovascular aneurysm repair ,California ,Article ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Aneurysm ,medicine ,Humans ,030212 general & internal medicine ,Aged ,Proportional Hazards Models ,Aged, 80 and over ,Chi-Square Distribution ,Proportional hazards model ,business.industry ,Incidence ,Endovascular Procedures ,medicine.disease ,Abdominal aortic aneurysm ,Failure to Thrive ,3. Good health ,Surgery ,Bowel obstruction ,Treatment Outcome ,Elective Surgical Procedures ,Failure to thrive ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Elective Surgical Procedure ,business ,Chi-squared distribution ,Aortic Aneurysm, Abdominal - Abstract
ObjectiveReintervention rates after repair of abdominal aortic aneurysm (AAA) are higher for endovascular repair (EVAR) than for open repair, mostly due to treatment for endoleaks, whereas open surgical operations for bowel obstruction and abdominal hernias are higher after open repair. However, readmission rates after EVAR or open repair for nonoperative conditions and complications that do not require an intervention are not well documented. We sought to determine reasons for all-cause readmissions within the first year after open repair and EVAR.MethodsPatients who underwent elective AAA repair in California during a 6-year period were identified from the Health Care and Utilization Project State Inpatient Database. All patients who had a readmission in California ≤1 year of their index procedure were included for evaluation. Readmission rates and primary and secondary diagnoses associated with each readmission were analyzed and recorded.ResultsFrom 2003 to 2008, there were 15,736 operations for elective AAA repair, comprising 9356 EVARs (60%) and 6380 open repairs (40%). At 1 year postoperatively, the readmission rate was 52.1% after open repair and 55.4% after EVAR (P = .0003). The three most common principle diagnoses associated with readmission after any type of AAA repair were failure to thrive, cardiac issues, and infection. When stratified by repair type, patients who underwent open repair were more likely to be readmitted with primary diagnoses associated with failure to thrive, cardiac complications, and infection compared with EVAR (all P < .001). Those who underwent EVAR were more likely, however, to be readmitted with primary diagnoses of device-related complications (P = .05), cardiac complications, and infection.ConclusionsTotal readmission rates within 1 year after elective AAA repair are greater after EVAR than after open repair. Reasons for readmission vary between the two cohorts but are related to the magnitude of open surgery after open repair, device issues after EVAR, and the usual cardiac and infectious complications after either intervention. Systems-based analysis of these causes of readmission can potentially improve patient expectations and care after elective aneurysm repair.
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143. Predictors of surgical site infection after open lower extremity revascularization
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David Yu Greenblatt, Victoria Rajamanickam, and Matthew W. Mell
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Male ,Reoperation ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Endarterectomy ,Revascularization ,Risk Assessment ,Veins ,Blood Vessel Prosthesis Implantation ,Peripheral Arterial Disease ,Risk Factors ,medicine ,Odds Ratio ,Humans ,Surgical Wound Infection ,Dialysis ,Societies, Medical ,Aged ,Quality Indicators, Health Care ,Chi-Square Distribution ,business.industry ,Odds ratio ,Length of Stay ,Middle Aged ,medicine.disease ,Confidence interval ,United States ,Surgery ,Logistic Models ,Treatment Outcome ,Databases as Topic ,Lower Extremity ,Female ,Risk assessment ,Complication ,Hyponatremia ,business ,Cardiology and Cardiovascular Medicine ,Chi-squared distribution - Abstract
Objectives Surgical site infection (SSI) after open surgery for lower extremity revascularization is a serious complication that may lead to graft infection, prolonged hospitalization, and increased cost. Rates of SSI after revascularization vary widely, with most studies reported from single institutions. The objective of this study was to describe the rate and predictors of SSI after surgery for arterial occlusive disease using national data, and to identify any association between SSI and length of hospital stay, reoperation, graft loss, and mortality. Methods Patients who underwent lower extremity arterial bypass or thromboendarterectomy from 2005-2008 were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) participant use files. Multivariate logistic regression identified predictors of SSI. Odds ratios were adjusted for patient demographics, comorbidities, preoperative laboratory values, and operative factors. The association between SSI and other 30-day outcomes such as mortality and graft failure was determined. Results Of 12,330 patients who underwent revascularization, 1367 (11.1%) were diagnosed with an SSI within 30 days. Multivariate predictors of SSI included female gender (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.3-1.6), obesity (OR, 2.1; 95% CI, 1.8-2.4), chronic obstructive pulmonary disease (OR, 1.2; 95% CI, 1.0-1.5), dialysis (OR, 1.5; 95% CI, 1.1-2.1), preoperative hyponatremia (OR, 1.2; 95% CI, 1.0-1.4), and length of operation >4 hours (OR, 1.4; 95% CI, 1.2-1.6). SSI was associated with prolonged (>10 days) hospital stay (OR, 1.8; 95% CI, 1.4-2.1) and higher rates of 30-day graft loss (OR, 2.3; 95% CI, 1.7-3.1) and reoperation (OR, 3.7; 95% CI, 3.1-4.6). SSI was not associated with increased 30-day mortality. Conclusion SSI is a common complication after open revascularization and is associated with a more than twofold increased risk of early graft loss and reoperation. Several patient and operation-related risk factors that predict postoperative SSI were identified, suggesting that targeted improvements in perioperative care may decrease complications and improve outcomes in this patient population.
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144. Reply
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Matthew W. Mell
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World Wide Web ,Text mining ,business.industry ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Full Text
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145. SS7. The Contemporary Guidelines for Asymptomatic Renal Artery Aneurysms Are Too Aggressive: A North American Experience
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Josefina Dominguez, Michael P. Harlander-Locke, Gustavo S. Oderich, Tazo Inui, Peter F. Lawrence, Robert J. Feezor, Matthew W. Mell, Joseph S. Ladowski, Paul Bove, James C. Stanley, Amir F. Azarbal, York N. Hsiang, Matthew R. Smeds, Mark D. Morasch, Dawn M. Coleman, Christopher J. Abularrage, Misty D. Humphries, and Jill Q. Klausner
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medicine.medical_specialty ,business.industry ,macromolecular substances ,Asymptomatic ,Surgery ,enzymes and coenzymes (carbohydrates) ,medicine ,cardiovascular system ,otorhinolaryngologic diseases ,cardiovascular diseases ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Renal artery aneurysms - Full Text
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146. Aortic Diameter Varies in Trauma Patients: A Function of Hemodynamic Status
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Venita Chandra, Jason T. Lee, Paul M. Maggio, Joshua I. Greenberg, and Matthew W. Mell
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medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Cardiology ,Hemodynamics ,Surgery ,Aortic diameter ,Cardiology and Cardiovascular Medicine ,business - Full Text
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147. Failure to Rescue: Physician Specialty and Mortality After Reoperation for Abdominal Aortic Aneurysm (AAA) Repair
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Amy J.H. Kind, Christie M. Bartels, Matthew W. Mell, and Maureen A. Smith
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medicine.medical_specialty ,Physician specialty ,Failure to rescue ,business.industry ,General surgery ,medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,Complication ,Intensive care medicine ,business ,medicine.disease ,Abdominal aortic aneurysm - Abstract
Objectives Complications after AAA repair resulting in re-intervention increase mortality risk, but have not been well-studied. Mortality after re-intervention is termed failure to rescue and may reflect differences related to quality management of the complication. This study describes the relationship between reoperation and mortality, and examines the effect of physician specialty on re-intervention rates and failure to rescue after AAA repair.
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148. PS130. Factors Impacting Follow-up Care after Placement of Temporary Inferior Vena Cava Filters
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Elsie Gyang, Mohamed Zayed, E. John Harris, Jason T. Lee, Ronald L. Dalman, and Matthew W. Mell
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Surgery ,Cardiology and Cardiovascular Medicine - Full Text
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