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Article ; Online: Outcome of bile leakage following liver resection with hepaticojejunostomy for liver cancer.

Moghadamyeghaneh, Zhobin / Krosser, Alec F / Rubinshteyn, Vladimir / Dresner, Lisa

2021 Volume 73, Issue 2, Page(s) 411–417

Abstract: We aimed to investigate contemporary management and outcomes of bile leakage in patients who underwent hepatectomy with hepaticojejunostomy for liver malignancy. The NSQIP database was used to study clinical data of patients who underwent a hepatectomy ... ...

Abstract	We aimed to investigate contemporary management and outcomes of bile leakage in patients who underwent hepatectomy with hepaticojejunostomy for liver malignancy. The NSQIP database was used to study clinical data of patients who underwent a hepatectomy with hepaticojejunostomy for a primary hepatobiliary cancer and developed bile leakage between 1/2014 and 12/2017. Multivariate regression analysis was performed to investigate outcomes. Five hundred patients underwent a hepatectomy with hepaticojejunostomy for a malignant primary hepatobiliary cancer (41% intrahepatic cholangiocarcinoma, 38.2% hilar cholangiocarcinoma, 9.8% hepatocellular carcinoma, 6% gallbladder cancer, and 5% others). The rate of bile leakage was 33.4%. Most patients (90.4%) did not require re-exploration. In 77 of 157 patients (49.1%), bile leakages were contained with intraoperatively placed drain(s) and no additional surgical intervention was required. A total of 71 patients (42.5%)-including 64 patients with intraoperative drains-required interventional radiology (IR)-guided drainage, with a 88.7% success rate. A total of 16 patients (9.6%) required re-exploration to control the leakage, with 8 of them having undergone failed IR-drainage. When running multivariate analysis, post-hepatectomy liver failure (AOR: 158.26, P < 0.01), preoperative sepsis (AOR: 36.24, P = 0.03), and smoking (AOR: 14.07, P = 0.03) were significantly associated with mortality of patients. Biliary leakage is relatively common following hepatectomy with hepaticojejunostomy for liver malignancy (33.4%), but most patients (90.4%) do not require re-exploration. Intraoperatively placed drains successfully controlled 46.7% of bile leakages. IR-guided drain placement had a 88.7% success rate for adequate leak control.
MeSH term(s)	Bile ; Bile Duct Neoplasms/surgery ; Drainage ; Hepatectomy ; Humans ; Liver Neoplasms/surgery ; Treatment Outcome
Language	English
Publishing date	2021-01-20
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2572692-4
ISSN	2038-3312 ; 2038-131X
ISSN (online)	2038-3312
ISSN	2038-131X
DOI	10.1007/s13304-021-00974-z
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Article ; Online: Minimally Invasive Surgical Approach to Toxic Colitis.

Moghadamyeghaneh, Zhobin / Rahimi, Murwarid / Kopatsis, Katherine / Kopatsis, Anthony Paul / Kopatsis, Anthony

The American surgeon

2022 Volume 88, Issue 7, Page(s) 1411–1419

Abstract: Background: We aimed to compare outcomes of surgical treatments of toxic colitis (infectious/inflammatory/ischemic) by the extent of colectomy (partial vs total colectomy) and different surgical approaches (minimally invasive surgery (MIS) vs open).: ... ...

Abstract	Background: We aimed to compare outcomes of surgical treatments of toxic colitis (infectious/inflammatory/ischemic) by the extent of colectomy (partial vs total colectomy) and different surgical approaches (minimally invasive surgery (MIS) vs open). Methods: Multivariate analysis using logistic regression was used to investigate outcomes of patients with toxic colitis who underwent emergent colectomy during 2012-2019 by surgical approach and the extent of resection using NSQIP database. Results: Overall, 2,104 adult patients underwent emergent colectomy for toxic colitis within NSQIP database during 2012-2019. Overall, 1,578 (75.4%) underwent total colectomy with colostomy, 486 (23.2%) underwent partial colectomy with colostomy, and 28 (1.3%) underwent partial colectomy with anastomosis. Overall, 198 (9.4%) of procedures were minimally invasive (MIS) with a 40.1% conversion rate to open. Thirty days mortality and morbidity of the patients were 31 and 86%, respectively. There was no significant difference in mortality of partial colectomy without anastomosis compared to total colectomy ( Conclusion: Patients with toxic colitis undergoing surgical treatment have high mortality and morbidity. An MIS approach when possible is significantly associated with decreased morbidity and mortality of patients. There was no significant difference in outcomes seen when extending the resection in multivariate analysis. Anastomosis is associated with a high anastomosis leakage and need for reoperation risk.
MeSH term(s)	Adult ; Anastomosis, Surgical ; Colectomy/methods ; Colitis/surgery ; Humans ; Laparoscopy/methods ; Minimally Invasive Surgical Procedures ; Postoperative Complications/epidemiology ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2022-03-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/00031348221080420
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Article ; Online: The Economic Effects on Acute Care Surgery in a New York City Public Hospital During the COVID Pandemic.

Moghadamyeghaneh, Zhobin / Ojo, Adedolapo / Rahimi, Murwarid / Kopatsis, Anthony Paul / Kopatsis, Katherine / Kopatsis, Anthony

The American surgeon

2022 Volume 89, Issue 5, Page(s) 1584–1591

Abstract: Background: Since the start of the COVID-19 pandemic, less acute care surgical procedures have been performed and consequently hospitals have experienced significant revenue loss. We aim to investigate these procedures performed before and after the ... ...

Abstract	Background: Since the start of the COVID-19 pandemic, less acute care surgical procedures have been performed and consequently hospitals have experienced significant revenue loss. We aim to investigate these procedures performed before and after the start of the COVID-19 pandemic, as well as their effect on the economy. Methods: This is a retrospective analysis of patients who underwent cholecystectomies and appendectomies during March-May 2019 compared to the same time period in 2020 using Chi-square and t-tests. Results: There were 345 patients who presented with appendicitis or cholecystitis to Elmhurst Hospital Center during the March-May 2019 and 2020 time period. There were three times as many total operations, or about 75%, in 2019 (261) compared to 2020 (84). There was a decrease in the number of admissions from 2019 to 2020 for both acute cholecystitis (149 vs 43, respectively) and acute appendicitis (112 vs 41, respectively). The largest decrease in the number of admissions in 2020 compared to 2019 was observed in April 2020 (98 vs 9, Conclusion: We observed almost a triple reduction in the number of cholecystitis and appendicitis procedures performed during the 2020 pandemic surge as compared to the 2019 pre-pandemic data. Elmhurst hospital also experienced four times the loss of revenue during the same time period.
MeSH term(s)	Humans ; COVID-19/epidemiology ; SARS-CoV-2 ; Pandemics ; Retrospective Studies ; New York City/epidemiology ; Appendicitis/epidemiology ; Appendicitis/surgery ; Hospitals, Public ; Cholecystitis, Acute/surgery ; Appendectomy
Language	English
Publishing date	2022-01-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/00031348211069788
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Article ; Online: Minimal-invasive approach to pancreatoduodenectomy is associated with lower early postoperative morbidity.

Moghadamyeghaneh, Zhobin / Sleeman, Danny / Stewart, Lygia

American journal of surgery

2018 Volume 217, Issue 4, Page(s) 718–724

Abstract: Objectives: We aim to investigate the impact of the operation time for pancreatoduodenectomy (PD) in different surgical approaches.: Methods: The NSQIP database was used to examine the clinical data of patients underwent PD during 2014-2016.: ... ...

Abstract	Objectives: We aim to investigate the impact of the operation time for pancreatoduodenectomy (PD) in different surgical approaches. Methods: The NSQIP database was used to examine the clinical data of patients underwent PD during 2014-2016. Results: We sampled a total of 6151 patients who underwent elective PD. Of these, 452(7.3%) had minimally invasive approaches to PD. Minimally invasive approaches (MIS) to PD was associated with a significant decrease in morbidity of patients (AOR: 0.67, P < 0.01). Following risk adjustment for morbidity predictors, operation length was statistically associated with post-operative morbidity (AOR: 1.002, P < 0.01). Although MIS procedures were significantly longer operations compared to open procedures (443 min vs. 371 min, CI: 53-82 min, P < 0.01), MIS approaches were associated with significantly decreased morbidity in low stage tumors (stage zero-II) (51.3% vs. 56.2%, AOR: 0.72, P = 0.03) and advanced stage disease (stage III-IV) (50% vs. 60.3%, AOR: 0.38, P = 0.04). Conclusion: Minimally invasive approaches to PD were associated with decreased post-operative morbidity, even though they were associated with longer operative times. Operation length also significantly correlated with postoperative morbidity.
MeSH term(s)	Aged ; Female ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Neoplasm Staging ; Operative Time ; Pancreatic Neoplasms/pathology ; Pancreatic Neoplasms/surgery ; Pancreaticoduodenectomy/methods ; Postoperative Complications/epidemiology
Language	English
Publishing date	2018-04-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2018.04.009
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Article ; Online: Unplanned readmission after outpatient laparoscopic cholecystectomy.

Moghadamyeghaneh, Zhobin / Badami, Abbasali / Masi, Antonio / Misawa, Ryosuke / Dresner, Lisa

HPB : the official journal of the International Hepato Pancreato Biliary Association

2019 Volume 22, Issue 5, Page(s) 702–709

Abstract: Background: Readmission after surgery has been considered as a measure of quality of hospital and surgical care. This study aims to investigate unplanned readmission after laparoscopic cholecystectomy.: Methods: The NSQIP database was used to ... ...

Abstract	Background: Readmission after surgery has been considered as a measure of quality of hospital and surgical care. This study aims to investigate unplanned readmission after laparoscopic cholecystectomy. Methods: The NSQIP database was used to investigate 30 days unplanned readmission after laparoscopic cholecystectomy. Multivariate analysis was used to identify predictors of readmission. Results: We found a total of 117,248 patients who underwent outpatient laparoscopic cholecystectomy during 2014-2016. Of these 3315 (2.8%) had unplanned readmission. Overall, 90% of readmitted patients were discharged after one day of hospitalization. Pain (14.07%) followed by unspecified symptoms including fever, nausea, vomiting, ileus was the most common reason for readmission. After adjustment, factors such as renal failure on dialysis (AOR: 2.26, P < 0.01), discharge to a facility (AOR: 1.93, P < 0.01), and steroid use for chronic condition (AOR: 1.51, P < 0.01), were associated with unplanned readmission. Conclusion: Overall, 2.8% of the patients undergoing outpatient laparoscopic cholecystectomy are readmitted to the hospital. Most of such patients are discharged after one day of hospitalization. Unspecified symptoms such as pain and vomiting were the most common reasons for readmission. Readmission strongly influences patients' comorbid factors and it is not a reliable measurement of quality of hospital and surgical care.
MeSH term(s)	Cholecystectomy, Laparoscopic/adverse effects ; Humans ; Outpatients ; Patient Readmission ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/therapy ; Retrospective Studies ; Risk Factors
Language	English
Publishing date	2019-09-28
Publishing country	England
Document type	Journal Article
ZDB-ID	2131251-5
ISSN	1477-2574 ; 1365-182X
ISSN (online)	1477-2574
ISSN	1365-182X
DOI	10.1016/j.hpb.2019.09.005
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Article ; Online: Patient Co-Morbidity and Functional Status Influence the Occurrence of Hospital Acquired Conditions More Strongly than Hospital Factors.

Moghadamyeghaneh, Zhobin / Stamos, Michael J / Stewart, Lygia

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

2018 Volume 23, Issue 1, Page(s) 163–172

Abstract: Background: Never events (NE) and hospital-acquired conditions (HAC) are used by Medicare/Medicaid Services to define hospital performance measures that dictate payments/penalties. Pre-op patient comorbidity may significantly influence HAC development.!# ...

Abstract	Background: Never events (NE) and hospital-acquired conditions (HAC) are used by Medicare/Medicaid Services to define hospital performance measures that dictate payments/penalties. Pre-op patient comorbidity may significantly influence HAC development. Methods: We studied 8,118,615 patients from the NIS database (2002-2012) who underwent upper/lower gastrointestinal and/or hepatopancreatobiliary procedures. Multivariate analysis, using logistic regression, was used to identify HAC and NE risk factors. Results: A total of 63,762 (0.8%) HAC events and 1645 (0.02%) NE were reported. A total of 99.9% of NE were retained foreign body. Most frequent HAC were: pressure ulcer stage III/IV (36.7%), poor glycemic control (26.9%), vascular catheter-associated infection (20.3%), and catheter-associated urinary tract infection (13.7%). Factors correlating with HAC included: open surgical approach (AOR: 1.25, P < 0.01), high-risk patients with significant comorbidity [severe loss function pre-op (AOR: 6.65, P < 0.01), diabetes with complications (AOR: 2.40, P < 0.01), paraplegia (AOR: 3.14, P < 0.01), metastatic cancer (AOR: 1.30, P < 0.01), age > 70 (AOR: 1.09, P < 0.01)], hospital factors [small vs. large (AOR: 1.07, P < 0.01), non-teaching vs teaching (AOR: 1.10, P < 0.01), private profit vs. non-profit/governmental (AOR: 1.20, P < 0.01)], severe preoperative mortality risk (AOR: 3.48, P < 0.01), and non-elective admission (AOR: 1.38, P < 0.01). HAC were associated with increased: hospitalization length (21 vs 7 days, P < 0.01), hospital charges ($164,803 vs $54,858, P < 0.01), and mortality (8 vs 3%, AOR: 1.14, P < 0.01). Conclusion: HAC incidence was highest among patients with severe comorbid conditions. While small, non-teaching, and for-profit hospitals had increased HAC, the strongest HAC risks were non-modifiable patient factors (preoperative loss function, diabetes, paraplegia, advanced age, etc.). This data questions the validity of using HAC as hospital performance measures, since hospitals caring for these complex patients would be unduly penalized. CMS should consider patient comorbidity as a crucial factor influencing HAC development.
MeSH term(s)	Adult ; Age Factors ; Aged ; Aged, 80 and over ; Catheter-Related Infections/epidemiology ; Comorbidity ; Databases, Factual ; Diabetes Mellitus/epidemiology ; Digestive System Surgical Procedures/adverse effects ; Female ; Foreign Bodies/epidemiology ; Health Status ; Hospital Charges ; Hospitals/standards ; Hospitals/statistics & numerical data ; Humans ; Iatrogenic Disease/epidemiology ; Incidence ; Length of Stay ; Male ; Medical Errors/statistics & numerical data ; Medicare ; Middle Aged ; Neoplasm Metastasis ; Paraplegia/epidemiology ; Quality of Health Care ; Risk Factors ; United States ; Urinary Tract Infections/epidemiology
Language	English
Publishing date	2018-09-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	2012365-6
ISSN	1873-4626 ; 1934-3213 ; 1091-255X
ISSN (online)	1873-4626 ; 1934-3213
ISSN	1091-255X
DOI	10.1007/s11605-018-3957-9
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Article ; Online: Short-term outcomes of laparoscopic approach to colonic obstruction for colon cancer.

Moghadamyeghaneh, Zhobin / Talus, Henry / Ballantyne, Garth / Stamos, Michael J / Pigazzi, Alessio

Surgical endoscopy

2020 Volume 35, Issue 6, Page(s) 2986–2996

Abstract: Background: We speculated that a laparoscopic approach to emergent/urgent partial colectomy for colonic obstruction would be associated with less morbidity and shorter length of stay with similar mortality to open colectomy. We compared the outcomes of ... ...

Abstract	Background: We speculated that a laparoscopic approach to emergent/urgent partial colectomy for colonic obstruction would be associated with less morbidity and shorter length of stay with similar mortality to open colectomy. We compared the outcomes of laparoscopic and open approaches to emergent/urgent partial colectomy for colonic obstruction from colonic cancer using data from the National Surgical Quality Improvement Program (NSQIP) database for the period of 2012-2017. Methods: Multivariate analysis compared NSQIP data points following laparoscopic, laparoscopic converted to open, and open colectomy for emergent/urgent colectomy for colonic obstruction from colon cancer from 2012 to 2017. Results: A total of 1293 patients who underwent emergent colectomy for colon obstruction from colon cancer during 2012-2017 were identified within the NSQIP database. Laparoscopic approach was used for colonic obstruction in 19.3% of operations with a conversion rate of 28.5%. A laparoscopic approach to obstructing colonic cancers was associated with lower morbidity (50% vs. 61.8%, AOR: 0.67, P = 0.01) and shorter hospitalization length (10 days vs. 13 days, mean difference: 3 days, P < 0.01) compared with an open approach. However, the mean operation duration was longer in laparoscopic operations than open operations (159 min vs. 137 min, P < 0.01). Conclusion: A laparoscopic approach to malignant colonic obstruction is associated with decreased morbidity. This suggests that efforts should be directed towards increasing the utilization of laparoscopic approaches for the surgical treatment of colonic obstruction.
MeSH term(s)	Colectomy ; Colonic Neoplasms/complications ; Colonic Neoplasms/surgery ; Humans ; Laparoscopy ; Length of Stay ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2020-06-22
Publishing country	Germany
Document type	Journal Article
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-020-07743-w
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Article ; Online: Outcomes of Minimally Invasive Colectomy for Perforated Diverticulitis.

Moghadamyeghaneh, Zhobin / Talus, Henry / Fitzgerald, Simon / Muthusamy, Muthukumar / Stamos, Michael J / Roudnitsky, Valery

The American surgeon

2020 Volume 87, Issue 4, Page(s) 561–567

Abstract: Background: We hypothesized that a laparoscopic approach to sigmoidectomy for perforated diverticulitis is associated with less morbidity and mortality.: Methods: The NSQIP database was used to investigate adult patients who underwent emergent ... ...

Abstract	Background: We hypothesized that a laparoscopic approach to sigmoidectomy for perforated diverticulitis is associated with less morbidity and mortality. Methods: The NSQIP database was used to investigate adult patients who underwent emergent colectomy with end colostomy for perforated diverticulitis. A multivariate analysis using logistic regression was used to compare outcomes of patients by surgical approach. Results: We found a total of 2937 adult patients who underwent emergent colectomy for perforated diverticulitis during 2012-2017. The rate of minimally invasive surgery (MIS) was 11.4% with 38.6% conversion rate to open. The 30-day mortality and morbidity rates were 8.8% and 65.8%, respectively. Following adjustment using a multivariate analysis, the open approach was associated with higher morbidity (67.2% vs 56.8%, AOR: 1.70, Conclusion: The MIS approach to emergent partial colectomy for perforated diverticulitis is associated with decreased morbidity and hospitalization length of patients. Utilization of the MIS approach for partial colectomy for perforated diverticulitis is 11.4% with a conversion rate of 38.6%. Efforts should be directed toward increasing the utilization of laparoscopic approaches for the surgical treatment of perforated diverticulitis.
MeSH term(s)	Aged ; Colectomy/methods ; Colon, Sigmoid/surgery ; Diverticulitis, Colonic/complications ; Diverticulitis, Colonic/surgery ; Female ; Humans ; Intestinal Perforation/etiology ; Intestinal Perforation/surgery ; Laparoscopy ; Male ; Postoperative Complications/epidemiology ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2020-10-29
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/0003134820950295
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Article ; Online: Hospital-Acquired Conditions after Liver Transplantation.

Moghadamyeghaneh, Zhobin / Masi, Antonio / Silver, Michael / Misawa, Ryosuke / Renz, John F / Gruessner, Angelika C / Gruessner, Rainer W G

The American surgeon

2020 Volume 86, Issue 1, Page(s) 21–27

Abstract: Hospital-acquired conditions (HACs) are used to define hospital performance measures. Patient comorbidity may influence HAC development. The National Inpatient Sample database was used to investigate HACs for the patients who underwent liver ... ...

Abstract	Hospital-acquired conditions (HACs) are used to define hospital performance measures. Patient comorbidity may influence HAC development. The National Inpatient Sample database was used to investigate HACs for the patients who underwent liver transplantation. Multivariate analysis was used to identify HAC risk factors. We found a total of 13,816 patients who underwent liver transplantation during 2002-2014. Of these, 330 (2.4%) had a report of HACs. Most frequent HACs were vascular catheter-associated infection [220 (1.6%)], falls and trauma [66 (0.5%), catheter-associated UTI [24 (0.2%)], and pressure ulcer stage III/IV [22 (0.2%)]. Factors correlating with HACs included extreme loss function (AOR: 52.13,
MeSH term(s)	Adult ; Aged ; Comorbidity ; Female ; Hospital Mortality ; Humans ; Iatrogenic Disease/epidemiology ; Liver Transplantation ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Postoperative Complications/mortality ; Risk Factors ; United States/epidemiology
Language	English
Publishing date	2020-02-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
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Article: Implications of preoperative hypoalbuminemia in colorectal surgery.

Truong, Adam / Hanna, Mark H / Moghadamyeghaneh, Zhobin / Stamos, Michael J

World journal of gastrointestinal surgery

2016 Volume 8, Issue 5, Page(s) 353–362

Abstract: Serum albumin has traditionally been used as a quantitative measure of a patient's nutritional status because of its availability and low cost. While malnutrition has a clear definition within both the American and European Societies for Parenteral and ... ...

Abstract	Serum albumin has traditionally been used as a quantitative measure of a patient's nutritional status because of its availability and low cost. While malnutrition has a clear definition within both the American and European Societies for Parenteral and Enteral Nutrition clinical guidelines, individual surgeons often determine nutritional status anecdotally. Preoperative albumin level has been shown to be the best predictor of mortality after colorectal cancer surgery. Specifically in colorectal surgical patients, hypoalbuminemia significantly increases the length of hospital stay, rates of surgical site infections, enterocutaneous fistula risk, and deep vein thrombosis formation. The delay of surgical procedures to allow for preoperative correction of albumin levels in hypoalbuminemic patients has been shown to improve the morbidity and mortality in patients with severe nutritional risk. The importance of preoperative albumin levels and the patient's chronic inflammatory state on the postoperative morbidity and mortality has led to the development of a variety of surgical scoring systems to predict outcomes efficiently. This review attempts to provide a systematic overview of albumin and its role and implications in colorectal surgery.
Language	English
Publishing date	2016-03-25
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2573700-4
ISSN	1948-9366
ISSN	1948-9366
DOI	10.4240/wjgs.v8.i5.353
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