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  1. Article ; Online: Improvements in Self-Reported Depression Following Treatment of Fecal Incontinence with Sacral Neuromodulation.

    Gevelinger, Matthew M / Jaworski, Elaine Minerva / Speranza, Jenny R / Sanderson, Derrick J

    Neuromodulation : journal of the International Neuromodulation Society

    2020  Volume 23, Issue 8, Page(s) 1158–1163

    Abstract: Objective: To evaluate changes in self-reported depression after treatment of fecal incontinence (FI) with sacral neuromodulation.: Materials and methods: This is a subanalysis of data collected from March 2016 to October 2017 for an Institutional ... ...

    Abstract Objective: To evaluate changes in self-reported depression after treatment of fecal incontinence (FI) with sacral neuromodulation.
    Materials and methods: This is a subanalysis of data collected from March 2016 to October 2017 for an Institutional Review Board-approved retrospective cohort study. Demographic information, medical history, psychiatric comorbidities, and the Patient-Reported Outcomes Measurement Information System item bank t-scores were extracted from the electronic medical record. The differences in t-scores were compared with a two-sided paired t-test, and a p value <0.05 was considered statistically significant.
    Results: Of the cohort (n = 24), most were Caucasian (88%), female (92%), nonsmokers (92%). Median age was 63.5 years (interquartile range 57.5-71.0 years) and median body mass index was 27.7 kg/m
    Conclusions: Treatment of FI with sacral neuromodulation was associated with improvement in self-reported depression with the greatest improvement in those with anxiety. Further prospective research is needed to corroborate these findings.
    MeSH term(s) Aged ; Depression/etiology ; Depression/therapy ; Electric Stimulation Therapy ; Fecal Incontinence/therapy ; Female ; Humans ; Lumbosacral Plexus ; Male ; Middle Aged ; Retrospective Studies ; Self Report ; Treatment Outcome
    Language English
    Publishing date 2020-08-17
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1500372-3
    ISSN 1525-1403 ; 1094-7159
    ISSN (online) 1525-1403
    ISSN 1094-7159
    DOI 10.1111/ner.13249
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 5912: Show issues Location:
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  2. Article ; Online: Acute kidney injury is a common and significant complication following ileostomy formation.

    Loria, Anthony / Melucci, Alexa / Speranza, Jenny / Cellini, Christina / Salloum, Rabih / Temple, Larissa K / Fleming, Fergal J / Justiniano, Carla F

    Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

    2021  Volume 24, Issue 1, Page(s) 102–110

    Abstract: Aim: The aim was to characterize the incidence and short-term prognostic value of an acute kidney injury (AKI) during the admission where an ileostomy is formed.: Methods: Adults with a baseline serum creatinine measurement discharged alive after ... ...

    Abstract Aim: The aim was to characterize the incidence and short-term prognostic value of an acute kidney injury (AKI) during the admission where an ileostomy is formed.
    Methods: Adults with a baseline serum creatinine measurement discharged alive after ileostomy formation from 2014 to 2016 were included. All patients had daily basic metabolic panels and the Kidney Diseases Improving Global Outcomes criteria were used to determine the presence and severity of any AKI. Dehydration was defined by a single urine abnormality or clinical criteria combined with an objective abnormality in vitals or basic metabolic panels.
    Results: Of 262 patients, 19.4% sustained an AKI (74.5% Stage I, 15.7% Stage II, 9.8% Stage III) during the index admission. Predictors of incident AKI were increasing age, male sex, higher baseline creatinine and open surgery. Patients with AKI had significantly longer length of stay and 45% had creatinine <1.0 mg/dl at discharge. Of the total cohort, 11% were readmitted with dehydration and the independent predictors were AKI during the index admission, high ileostomy output, age >65 years, male sex and prior ileostomy. Of those readmitted with dehydration, 79% had AKI at readmission.
    Conclusions: Nearly 20% of patients with ileostomies develop an AKI during the index admission with almost half resolving by discharge. Patients with AKIs are at high risk for 30-day dehydration-related readmission and AKI is present in nearly 80% of those readmitted with dehydration. Since AKI is objective, based on routine laboratory measures, and has known prognostic value it is probably a more robust outcome than dehydration for researchers, surgeons and patients.
    MeSH term(s) Acute Kidney Injury/epidemiology ; Acute Kidney Injury/etiology ; Adult ; Aged ; Humans ; Ileostomy/adverse effects ; Male ; Patient Readmission ; Retrospective Studies ; Risk Factors
    Language English
    Publishing date 2021-10-07
    Publishing country England
    Document type Journal Article
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.15917
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  3. Article ; Online: Readmissions With Dehydration After Ileostomy Creation: Rethinking Risk Factors.

    Justiniano, Carla F / Temple, Larissa K / Swanger, Alex A / Xu, Zhaomin / Speranza, Jenny R / Cellini, Christina / Salloum, Rabih M / Fleming, Fergal J

    Diseases of the colon and rectum

    2018  Volume 61, Issue 11, Page(s) 1297–1305

    Abstract: Background: Twenty-nine percent of postileostomy discharges are readmitted, most commonly because of dehydration. However, there is a lack of detailed data specifically evaluating factors associated with readmission with dehydration. In addition, ... ...

    Abstract Background: Twenty-nine percent of postileostomy discharges are readmitted, most commonly because of dehydration. However, there is a lack of detailed data specifically evaluating factors associated with readmission with dehydration. In addition, patients with a history of an ileostomy have often been excluded from previous studies and therefore represent a group of understudied ileostomates.
    Objective: This study aimed to evaluate factors available at discharge associated with 30-day readmission for dehydration, rather than all-cause readmissions.
    Design: This was a retrospective cohort study.
    Setting: Study patients received ileostomies at a tertiary academic medical center from 2014 to 2016.
    Patients: Patients with a preexisting ileostomy that was not recreated per the operative note were excluded, whereas those who received a new ileostomy were included.
    Main outcome measure: The primary outcome measured was 30-day readmission for dehydration as defined by objective clinical criteria.
    Results: A total of 262 patients underwent ileostomy creation and were discharged alive. Twenty-five percent were ≥65 years of age, 53% were men, 14% had a history of ileostomy, 18% had a creatinine >1.0 on discharge, and 26% had high ileostomy output at any time during the index admission. Among all ileostomates, the all-cause readmission rate was 30%. Mean days to readmission for any cause was 8.5, whereas for dehydration it was 11.6 days. Of the readmissions, 37% were readmitted with a diagnosis of dehydration, and dehydration was the sole reason in 26%. Among those with dehydration, the most common length of stay was 2 days. In multivariable logistic regression, 30-day readmission with dehydration was associated with older age, male sex, history of an ileostomy, high ileostomy output during index admission, and a discharge creatinine >1.0.
    Limitations: This study was limited by its retrospective design.
    Conclusions: Ileostomy dehydration efforts have focused on new ileostomy patients; however, our data suggest that patients with a history of an ileostomy are actually at risk for readmission with dehydration. Further studies aimed at the reduction of readmission with dehydration after ileostomy are warranted and should include patients with a history of an ileostomy. See Video Abstract at http://links.lww.com/DCR/A643.
    MeSH term(s) Age Factors ; Aged ; Creatinine/analysis ; Dehydration/diagnosis ; Dehydration/epidemiology ; Dehydration/etiology ; Dehydration/therapy ; Female ; Humans ; Ileostomy/adverse effects ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Patient Readmission/statistics & numerical data ; Postoperative Complications/diagnosis ; Postoperative Complications/epidemiology ; Postoperative Complications/therapy ; Retrospective Studies ; Risk Factors ; Sex Factors ; United States/epidemiology
    Chemical Substances Creatinine (AYI8EX34EU)
    Language English
    Publishing date 2018-09-21
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Video-Audio Media
    ZDB-ID 212581-x
    ISSN 1530-0358 ; 0012-3706
    ISSN (online) 1530-0358
    ISSN 0012-3706
    DOI 10.1097/DCR.0000000000001137
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Trends in Surgeon-Level Utilization of Sacral Nerve Stimulator Implantation for Fecal Incontinence in New York State.

    Xu, Zhaomin / Fleming, Fergal J / Justiniano, Carla F / Becerra, Adan Z / Boodry, Courtney I / Aquina, Christopher T / Temple, Larissa K / Speranza, Jenny R

    Diseases of the colon and rectum

    2018  Volume 61, Issue 1, Page(s) 107–114

    Abstract: Background: There is a paucity of real-world data regarding surgeon utilization of sacral nerve stimulation for fecal incontinence compared with anal sphincteroplasty.: Objective: This study aims to examine trends in sacral nerve stimulation use ... ...

    Abstract Background: There is a paucity of real-world data regarding surgeon utilization of sacral nerve stimulation for fecal incontinence compared with anal sphincteroplasty.
    Objective: This study aims to examine trends in sacral nerve stimulation use compared with sphincteroplasty for fecal incontinence and surgeon-level variation in progression to implantation of the pulse generator.
    Design: This is a population-based study.
    Patients: Patients with fecal incontinence between 2011 and 2014 in New York who underwent stage 1 of the sacral nerve stimulation procedure were selected. For the comparison with sphincteroplasty, patients with fecal incontinence who underwent anal sphincteroplasty between 2008 and 2014 were included.
    Main outcome measures: The main outcomes after sacral nerve stimulation generator placement were unplanned 30-day admission, emergency department visit within 30 days, revision or explant of leads or generator, and 30-day mortality.
    Results: Six hundred twenty-one patients with fecal incontinence underwent a stage 1 procedure with 79.7% progressing to stage 2. There has been an increase in the number of sacral nerve stimulation cases per year as well as the number of surgeons performing the procedure. The rate of progression to stage 2 among patients treated by colorectal surgeons was 80.2% compared with 77.0% among those treated by noncolorectal surgeons. Among those who completed stage 2, there were 3 (0.5%) unplanned 30-day admissions, 24 (4.4%) emergency department visits within 30 days, and 0 mortalities within 30 days. Thirty-two (6.5%) patients had their leads or pulse generator revised or explanted. There was a significant decrease in annual sphincteroplasty cases and the number of providers performing the procedure starting in 2011.
    Limitations: We lacked data regarding patient and physician decision making and the severity of disease.
    Conclusions: Sacral nerve stimulation for fecal incontinence is increasing in popularity with an increasing number of surgeons utilizing sacral nerve stimulation for fecal incontinence rather than sphincteroplasty. See Video Abstract at http://links.lww.com/DCR/A450.
    MeSH term(s) Aged ; Anal Canal/surgery ; Electric Stimulation Therapy/trends ; Electric Stimulation Therapy/utilization ; Electrodes, Implanted/trends ; Electrodes, Implanted/utilization ; Fecal Incontinence/surgery ; Female ; Humans ; Lumbosacral Plexus/surgery ; Male ; Middle Aged ; New York ; Sphincterotomy/methods
    Language English
    Publishing date 2018-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 212581-x
    ISSN 1530-0358 ; 0012-3706
    ISSN (online) 1530-0358
    ISSN 0012-3706
    DOI 10.1097/DCR.0000000000000941
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Uk I Zs.237: Show issues Location:
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