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Article ; Online: Geographic distribution of colonoscopy providers in the United States: An analysis of medicare claims data.

Carmichael, Heather / Samuels, Jason M / Velopulos, Catherine G / Jones, Edward L

2022 Volume 36, Issue 10, Page(s) 7673–7678

Abstract: Introduction: Screening colonoscopy is one of the few procedures that can prevent cancer. While the majority of colonoscopies in the USA are performed by gastroenterologists, general surgeons play a key role in at-risk, rural populations. The aim of ... ...

Abstract	Introduction: Screening colonoscopy is one of the few procedures that can prevent cancer. While the majority of colonoscopies in the USA are performed by gastroenterologists, general surgeons play a key role in at-risk, rural populations. The aim of this study was to examine geographic practice patterns in colonoscopy using a nationwide Medicare claims database. Methods and procedures: The 2017 Medicare Provider Utilization and Payment database was used to identify physicians performing colonoscopy. Providers were classified as gastroenterologists, surgeons, ambulatory surgical centers (ASCs), or other. Rural-Urban Commuting Area classification at the zip code level was used to determine whether the practice location for an individual provider was in a rural area/small town (< 10,000 people), micropolitan area (10-50,000 people), or metropolitan area (> 50,000 people). Results: Claims data from 3,861,187 colonoscopy procedures on Medicare patients were included. The majority of procedures were performed by gastroenterologists (57.2%) and ASCs (32.1%). Surgeons performed 6.8% of cases overall. When examined at a zip code level, surgeons performed 51.6% of procedures in small towns/rural areas and 21.7% of procedures in micropolitan areas. Individual surgeons performed fewer annual procedures as compared to gastroenterologists (median 51 vs. 187, p < 0.001). Conclusions: Surgeons perform the majority of colonoscopies in rural zip codes on Medicare patients. High-quality, surgical training in endoscopy is essential to ensure access to colonoscopy for patients outside of major metropolitan areas.
MeSH term(s)	Aged ; Colonoscopy ; Endoscopy, Gastrointestinal ; Humans ; Medicare ; Rural Population ; Surgeons ; United States
Language	English
Publishing date	2022-06-21
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/s00464-022-09083-3
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Article ; Online: When more is less: Urban disparities in access to surgical care by transportation means.

Carmichael, Heather / Tran, Billy / Velopulos, Catherine G

American journal of surgery

2021 Volume 223, Issue 1, Page(s) 112–119

Abstract: Background: Structural factors limiting access to surgical care require elucidation. We hypothesize transportation time to hospitals with surgical capacity disproportionately burdens minority populations.: Methods: We identified hospitals with ... ...

Abstract	Background: Structural factors limiting access to surgical care require elucidation. We hypothesize transportation time to hospitals with surgical capacity disproportionately burdens minority populations. Methods: We identified hospitals with surgical capacity within a 20-mile radius of our city center. Using geocoding, we estimated travel times from each census tract to the nearest facility by car or public bus. Results: For 143 tracts within the county, drive time was 13 ± 4 min and bus time was 33 ± 15 min. Only 41.2% of the population had a facility within 30 min by bus; access was further diminished for those with minority race/ethnicity and/or no insurance. Bus time was associated with percent minority population in a census tract: for each 10% increase in minority population there was a 4.3-min increase in bus time (p < 0.001) when controlling for socioeconomic status and other characteristics. Conclusions: Geographic information systems analysis has potential to identify communities with disproportionate burden to access surgical services.
MeSH term(s)	Adult ; Census Tract ; Health Services Accessibility/economics ; Health Services Accessibility/statistics & numerical data ; Healthcare Disparities/statistics & numerical data ; Hospitals, Urban/statistics & numerical data ; Humans ; Social Determinants of Health/economics ; Social Determinants of Health/statistics & numerical data ; Socioeconomic Factors ; Time Factors ; Transportation/economics ; Transportation/methods ; Transportation/statistics & numerical data
Language	English
Publishing date	2021-08-10
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.2021.07.052
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Article ; Online: Medical Response and Factors Leading to Violent Death in the United States Incarcerated Population.

Moore, Allison / Carmichael, Heather / Velopulos, Catherine

The Journal of surgical research

2021 Volume 269, Page(s) 234–240

Abstract: Background: This study aims to characterize trauma-associated deaths in the United States prison system. We hypothesize that incarcerated victims are less likely to receive appropriate medical care compared to the non-incarcerated.: Methods: We ... ...

Abstract	Background: This study aims to characterize trauma-associated deaths in the United States prison system. We hypothesize that incarcerated victims are less likely to receive appropriate medical care compared to the non-incarcerated. Methods: We utilized 2015-2017 National Violent Death Reporting System data. Victims were classified by whether they were seen by emergency medical services, in the emergency room, or hospitalized prior to death, with the latter considered higher levels of care. Propensity score matching was used to compare highest level of care received by incarcerated versus non-incarcerated victims with similar age, sex, race/ethnicity, weapon type, and state where the incident occurred. Results: Of 101,054 victims, 1229 (1.2%) were incarcerated at the time of fatal injury; 64.4% died by suicide. For suicide, the proportion of minority victims was higher in the incarcerated compared to the non-incarcerated population, but the opposite was true of homicide. Firearms were more commonly used in the non-incarcerated population. After Propensity score matching, we found that incarcerated victims received higher levels of medical care following suicide (P < 0.001) while there was no difference for homicide (P = 0.28). However, when only victims injured in public settings were included, we found that incarcerated homicide victims were less likely to receive hospital-based medical care. Conclusions: Contrary to our hypothesis, overall, incarcerated victims received similar levels of medical care as compared to non-incarcerated victims following lethal injury. However, this fails to account for the highly supervised setting of prisons. Our findings reinforce that violence prevention methods should be tailored to specific populations.
MeSH term(s)	Cause of Death ; Homicide ; Humans ; Population Surveillance ; Prisoners ; United States/epidemiology ; Violence
Language	English
Publishing date	2021-10-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2021.07.002
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Article ; Online: Circumstances of Suicide Among Lesbian, Gay, Bisexual and Transgender Individuals.

Patten, Monica / Carmichael, Heather / Moore, Alison / Velopulos, Catherine

The Journal of surgical research

2021 Volume 270, Page(s) 522–529

Abstract: Introduction: Suicide rates for sexual minorities are higher than the heterosexual population. The purpose of this study is to explore circumstances surrounding suicide completion to inform future intervention strategies for suicide among lesbian, gay, ... ...

Abstract	Introduction: Suicide rates for sexual minorities are higher than the heterosexual population. The purpose of this study is to explore circumstances surrounding suicide completion to inform future intervention strategies for suicide among lesbian, gay, bisexual and transgender (LGBT) individuals. Materials and methods: We completed a retrospective analysis of data from the National Violent Death Reporting System (NVDRS) from 2013-2017. Victims identified as transgender were considered separately. We stratified analysis by identified sex of the victim for the LGB population. Results: Of the 16,831 victims whose sexual orientation or transgender status was known: 3886 (23.1%) were identified as female, 12,945 (76.9%) were identified as male. 479 (2.8%) were identified as LGBT; of these, 53 (11%) were transgender. LGBT victims were younger than non-LGBT victims. Male LGB victims were more likely to have a history of prior suicide attempts, past or current mental illness diagnosis, and were less likely to use firearms than male heterosexual victims. Female LGB victims were more likely to have problems in an intimate partner relationship than heterosexual women, while LGB men were more likely to have problems in family or other relationships. Transgender victims were again more likely to have mental health problems and a history of prior attempts, but less likely to have intimate partner problems and more likely to have a history of child abuse. Conclusions: These results highlight the importance of promoting suicide interventions that recognize the complex intersection between stated gender, sex, and sexuality and the different cultural impacts these identities can have.
MeSH term(s)	Female ; Gender Identity ; Humans ; Male ; Retrospective Studies ; Sexual Behavior ; Sexual and Gender Minorities ; Transgender Persons
Language	English
Publishing date	2021-11-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2021.08.029
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Article ; Online: Immigrating to Unsafe Spaces: Unique Patterns of Homicide in Immigrant Victims Compared to Native-Born Citizens.

Abolarin, Joshua / Myers, Quintin W O / Carmichael, Heather / Moore, Allison / Velopulos, Catherine G

The Journal of surgical research

2023 Volume 288, Page(s) 321–328

Abstract: Introduction: Contrary to popular belief, immigrant enclaves produce less crime than other areas of the United States, yet that does not mean immigrants avoid violent crime altogether. The purpose of this project is to better characterize the victims of ...

Abstract	Introduction: Contrary to popular belief, immigrant enclaves produce less crime than other areas of the United States, yet that does not mean immigrants avoid violent crime altogether. The purpose of this project is to better characterize the victims of homicide in this population. Specifically, we sought to compare differences in victim demographics, injury patterns, and circumstances of violent death between the immigrant population and native-born victims of homicide. Methods: We queried the National Violent Death Reporting System (NVDRS) from the years 2003-2019 for deaths in victims who were born outside of the United States. We extracted demographic information including age, race or ethnicity, means of homicide, and circumstances surrounding the event to compare immigrant to nonimmigrant deaths. Results: Immigrant victims were less likely to be killed by a firearm and to have substance use or alcohol implicated. Immigrant victims were twice as likely to be killed during multiple homicide events that involved suicide of the perpetrator (2.1% to 1%, P ≤ 0.001) and to be killed by a stranger (12.9% to 6.2%, P ≤ 0.001). Immigrant victims were also more likely to be killed during the perpetration of another crime (19.1% to 15%, P ≤ 0.001), and more likely to be killed in a commercial setting such as a grocery store or retail outlet (7.6% to 2.4%, P ≤ 0.001). Conclusions: Injury prevention measures for the immigrant population require different techniques, focusing on distinct features of victimization centered on random acts in contrast to native-born citizens who tend to be victims of people they know.
MeSH term(s)	Humans ; United States/epidemiology ; Homicide ; Cause of Death ; Population Surveillance ; Emigrants and Immigrants ; Indigenous Peoples
Language	English
Publishing date	2023-04-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2023.01.005
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Article ; Online: Sex Differences in Violent Death During Incarceration and Legal Intervention.

Stearns, Dorothy R / Moore, Allison / Myers, Quintin W O / Carmichael, Heather / Velopulos, Catherine G

The Journal of surgical research

2023 Volume 289, Page(s) 90–96

Abstract: Introduction: This study clarifies the differences in death during incarceration and legal intervention between males and females, delineating the differences in demographic features and the circumstances of the violent death including location, injury ... ...

Abstract	Introduction: This study clarifies the differences in death during incarceration and legal intervention between males and females, delineating the differences in demographic features and the circumstances of the violent death including location, injury pattern, and perpetrator. Methods: The data used are from the National Violent Death Reporting System database from 2003 to 2019. All victims were either in custody, in the process of custody, or in prison. Sex was coded as female or male and as assigned at birth. All analyses were conducted using SAS 9.4 software using chi-square tests, with an alpha of 0.05 to test significant differences in the circumstances of mortality and demographic characteristics for each group. Results: Our findings show that suicide was the most common cause of death during incarceration for both females and males (89.8% versus 77.4%; P < 0.001). Homicide was less common in females (1.6% versus 14.8%; P < 0.001) and legal intervention only occurred in males (2.2%; P < 0.001). Male victims were more likely to be of non-White race/ethnicity compared to females, while females were more likely to be experiencing homelessness, have documented mental illness, and comorbid substance abuse. Conclusions: Victim sex is significantly associated with circumstances of violent death among the incarcerated and highlights the need for appropriate mental health and substance abuse treatment.
MeSH term(s)	Female ; Humans ; Infant, Newborn ; Male ; Cause of Death ; Population Surveillance ; Substance-Related Disorders ; United States/epidemiology ; Violence/legislation & jurisprudence ; Violence/statistics & numerical data ; Sex Factors ; Prisons/statistics & numerical data ; Prisoners/statistics & numerical data ; Homicide/statistics & numerical data
Language	English
Publishing date	2023-04-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2023.02.024
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Article ; Online: Safer Behind Bars? Comparing In-Custody Deaths Prior to and During Incarceration.

Moore, Allison / Stearns, Dorothy / Carmichael, Heather / Myers, Quintin W O / Velopulos, Catherine G

The Journal of surgical research

2023 Volume 291, Page(s) 260–264

Abstract: Introduction: This project aims to characterize trauma-associated deaths of the American incarcerated population through legal intervention (LI) or death by law enforcement officials while in custody before and during incarceration. We determined the ... ...

Abstract	Introduction: This project aims to characterize trauma-associated deaths of the American incarcerated population through legal intervention (LI) or death by law enforcement officials while in custody before and during incarceration. We determined the preceding events leading to violent death, including initiation of medical care, use of restraints and force, and demographics of the victims. Methods: We used National Violent Death Reporting System data from the years 2003-2019 to identify deaths that occurred while in custody or incarcerated, including discriminate and narrative data. Event information included weapon type, location of death, incident type, incarceration status, use of restraints, and prone positioning. Results: There were 86 victims who died from LI included in the analysis. Most events occurred after incarceration. All victims in our cohort were male, and race was an associated factor for death by LI. Only 16% of victims had an education level above high school/general educational development. Death by firearm compared to other weapons was significantly more common in the in-custody but not yet incarcerated group (83% versus 42%, P ≤ 0.0001). Other associated factors included a history of mental health, physical confrontations, the belief that the victim had a weapon, and being restrained in prone positioning. Conclusions: Our study shows that racial minority victims are disproportionately affected by LI deaths. Firearms and restraint type were important factors in LI deaths. Our findings suggest that violence prevention in the justice system should focus on prevention and de-escalation across setting with specific attention to use of force and inmate access to the weapons of police, guards, and other law and justice system workers. More transparent quality data is sorely needed to adequately define and address this problem.
MeSH term(s)	Humans ; Male ; United States/epidemiology ; Female ; Homicide ; Suicide ; Cause of Death ; Population Surveillance ; Violence
Language	English
Publishing date	2023-07-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2023.06.002
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Article ; Online: Chronic psychiatric diagnoses increase emergency department utilization following bariatric surgery.

Samuels, Jason / Carmichael, Heather / Hazel, Kweku / Velopulos, Catherine / Rothchild, Kevin / Schoen, Jonathan

Surgical endoscopy

2022 Volume 37, Issue 3, Page(s) 2215–2223

Abstract: Introduction: This study aims to evaluate the impact mental health disorders have on emergency department (ED) utilization following bariatric surgery. We hypothesize that the presence of preexisting psychiatric diagnoses is predictive of increased post- ...

Abstract	Introduction: This study aims to evaluate the impact mental health disorders have on emergency department (ED) utilization following bariatric surgery. We hypothesize that the presence of preexisting psychiatric diagnoses is predictive of increased post-bariatric surgical ED usage as compared to a matched cohort without psychiatric comorbidities. Methods and procedures: We utilized the Colorado All Payers Claim Database to identify patients undergoing laparoscopic sleeve gastrectomy, gastric band, or gastric bypass, (N = 5393). Patients with preexisting diagnoses of schizophrenia or bipolar disorder (PSY), and no concomitant mental health diagnosis were included (N = 427). Patients without a psychiatric diagnosis (CON) were used for comparison. Propensity score matching in a 1:1 ratio was done matching for age, sex, BMI, procedure type, and comorbidities. Baseline ED utilization was calculated over the year preceding surgery. Results: A total of 240 patients with bipolar disorder or schizophrenia were identified. After matching, baseline ED utilization was 62% higher in the PSY group (ED visits per person per month (EDVPP) of 0.17 (95%CI 0.16-0.18) in the PSY group compared to 0.10 (95%CI 0.09-0.12) in the CON group). ED utilization increased dramatically in the month following surgery for both PSY and CON groups (EDVPP 0.58 (95%CI 0.52-0.65) vs 0.34 (95%CI 0.28-0.41)), but visits returned to baseline for the CON but not PSY patients by three months after surgery (11% vs 60% above baseline, respectively). In the PSY group, ED utilization remained elevated at 18% above baseline for two years post-surgery (EDVPP 0.20 (95%CI 0.19-0.22). Conclusions: Bariatric patients with schizophrenia or bipolar disorder have higher baseline ED usage compared to a matched cohort. ED usage increases post-operatively in all patients but to a greater extent in patients with these diagnoses. Such patients would benefit from intensive outpatient follow-up to limit ED visits.
MeSH term(s)	Humans ; Obesity, Morbid/surgery ; Bariatric Surgery ; Gastric Bypass ; Mental Disorders/diagnosis ; Mental Disorders/epidemiology ; Mental Disorders/complications ; Emergency Service, Hospital ; Retrospective Studies
Language	English
Publishing date	2022-07-25
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/s00464-022-09451-z
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Article ; Online: Prioritizing rapid COVID-19 testing in emergency general surgery patients decreases burden of inpatient hospital admission.

Thomas, Madeline B / Carmichael, Heather / Harrison, Madison / Abbitt, Danielle / Moore, Allison / Myers, Quintin W O / Velopulos, Catherine G

Trauma surgery & acute care open

2023 Volume 8, Issue 1, Page(s) e001085

Abstract: Objectives: The COVID-19 pandemic has changed delivery of emergency general surgery (EGS) and contributed to widespread bed shortages. At our institution, rapid testing is not routinely approved for EGS patients. We examined common EGS conditions ( ... ...

Abstract	Objectives: The COVID-19 pandemic has changed delivery of emergency general surgery (EGS) and contributed to widespread bed shortages. At our institution, rapid testing is not routinely approved for EGS patients. We examined common EGS conditions (appendicitis and acute cholecystitis), hypothesizing that necessity of testing for COVID-19 significantly delayed operative intervention. Methods: We performed a prepost study to examine a 2-month timeframe, or historical control, prior to COVID-19 testing (January 1, 2020-March 1, 2020) as well as a 2-month timeframe during the COVID-19 era (January 1, 2021-March 1, 2021). We chose conditions that are frequently treated surgically as outpatient or observation status. We examined time for COVID-19 test to result, and associated time to operative intervention (operating room (OR)) and need for admission. Results: Median time to COVID-19 test results was 7.4 hours (IQR 5.8-13.1). For appendectomy, time to surgical consultation or case request did not differ between cohorts. Time to OR after case request was significantly longer (12.5 vs 1.9 hours, p<0.001) and patients more frequently required admission prior to operative intervention if receiving treatment in the COVID-19 timeframe. Similarly, for cholecystectomy there were no differences in time to surgical consultation or case request, but time to OR after case request was longer in the COVID-19 era (21.1 vs 9.0 hours, p<0.001). Conclusion: While COVID-19 positivity rates have declined, the purpose of this study was to reflect on one element of our hospital system's response to the COVID-19 pandemic. Based on our institutional experience, waiting for COVID-19 test results directly impacts time to surgery, as well as the need for admission for a historically outpatient procedure. In the future, if the healthcare system is asked to respond to another pandemic or similar situation, expediting time to OR to eliminate unnecessary time in the hospital and non-critical admissions should be paramount. Level of evidence: Level III, prognostic/epidemiological.
Language	English
Publishing date	2023-11-07
Publishing country	England
Document type	Journal Article
ISSN	2397-5776
ISSN (online)	2397-5776
DOI	10.1136/tsaco-2023-001085
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Article: Social vulnerability is associated with post-operative morbidity following robotic-assisted lung resection.

Stuart, Christina M / Dyas, Adam R / Byers, Sara / Velopulos, Catherine G / Randhawa, Simran K / David, Elizabeth A / Mitchell, John D / Meguid, Robert A

Journal of thoracic disease

2023 Volume 15, Issue 11, Page(s) 5931–5941

Abstract: Background: The social vulnerability index (SVI) is a neighborhood-based metric used to determine an individual's susceptibility to socioeconomic hardship, with high SVI indicating high susceptibility. SVI has previously been associated with surgical ... ...

Abstract	Background: The social vulnerability index (SVI) is a neighborhood-based metric used to determine an individual's susceptibility to socioeconomic hardship, with high SVI indicating high susceptibility. SVI has previously been associated with surgical outcomes. We aimed to determine if SVI influences morbidity following robotic-assisted lung resection. Methods: This was a retrospective cohort study at one academic medical center (1/1/2021-11/30/2022). Patients undergoing robotic-assisted lung resection were grouped into low (<75 Results: We included 320 patients, of which 40 patients (12.5%) in the high-SVI group and 280 (87.5%) in the low-SVI group. High SVI patients were more likely to be non-Caucasian and of Hispanic ethnicity, but there were no other differences in perioperative characteristics (all P>0.05). High SVI patients were more likely to experience a post-operative complication (42.5% Conclusions: High SVI was associated with increased risk-adjusted odds of morbidity after robotic-assisted lung resection. Highly vulnerable patients should be allocated perioperative resources to help mitigate the increased risk of these complications.
Language	English
Publishing date	2023-10-30
Publishing country	China
Document type	Journal Article
ZDB-ID	2573571-8
ISSN	2077-6624 ; 2072-1439
ISSN (online)	2077-6624
ISSN	2072-1439
DOI	10.21037/jtd-23-1122
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