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World Journal of Gastroenterology 2007年第26期13卷 3575-3580页

作者： anthony J michaels Peter V Draganov University of Florida Department of GastroenterologyHepatology and NutritionUnited States

Pain is a common symptom of pancreatic disease and is frequently difficult to manage. Pain relief provided by narcotics is often suboptimal and is associated with significant side effects. An alternative approach to pain management in pancreatic disease is the use of celiac plexus block (CPB) or neurolysis (CPN). Originally performed by anesthesiologists and radiologists via a posterior approach,recent advances in endoscopic ultrasonography (EUS) have made this technique an attractive alternative. EUS guided celiac plexus block/ neurolysis is simple to perform and avoids serious complications such as paraplegia or pneumothorax that are associated with the posterior approach. EUS guided CPN should be considered first line therapy in patients with pain due to pancreatic cancer. It provides superior pain control compared to traditional management with narcotics. A trend for improved survival in pancreatic cancer patients treated with CPN has been reported,but larger studies are needed to confirm this finding. At this time,the use of EUS guided CPB cannot be recommended as routine therapy for pain in chronic pancreatitis since only one-half of the patients experience pain reduction and the beneficial effect tends to be short lived. EUS guided CPB and CPN should be used as part of a multidisciplinary team approach for pain management.

关键词： Celiac plexus Celiac plexus neurolysis Celiacplexus block Endoscopic ultrasound Pain management

Diagnosis of morbid obesity may not impact healthcare utilization for orthotopic liver transplantation:A propensity matched study

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World Journal of Hepatology 2017年第12期9卷 595-602页

作者： Joshua R Peck Nicholas Latchana anthony michaels Adam J Hanje Alice Hinton Elmahdi A Elkhammas Sylvester M Black Khalid Mumtaz Division of Gastroenterology Hepatology and Nutritionthe Ohio State University Wexner Medical Center Department of Surgery the Ohio State University Wexner Medical Center Department of Biostatistics the Ohio State University Wexner Medical Center

AIM To study mortality, length of stay, and total charges in morbidly obese adults during index hospitalization for orthotopic liver *** The Nationwide Inpatient Sample was queried to obtain demographics, healthcare utilization, post orthotopic liver transplantation(OLT) complications, and short term outcomes of OLT performed from 2003 to 2011(n = 46509). We divided patients into those with [body mass index(BMI) ≥ 40] and without(BMI < 40) morbid obesity. Multivariable logistic regression analysis was performedto characterize differences in in-hospital mortality, length of stay(LOS), and charges for OLT between patients with and without morbid obesity after adjusting for significant confounders. Additionally, propensity matching was performed to further validate the *** Of the 46509 patients who underwent OLT during the study period, 818(1.8%) were morbidly obese. Morbidly obese recipients were more likely to be female(46.8% vs 33.4%, P = 0.002), Caucasian(75.2% vs 67.8%, P = 0.002), in the low national income quartile(32.3% vs 22.5%, P = 0.04), and have ≥ 3 comorbidities(modified Elixhauser index; 83.9% vs 45.0%, P < 0.001). Morbidly obese patient also had an increase in procedure related hemorrhage(P = 0.028) and respiratory complications(P = 0.043). Multivariate and propensity matched analysis showed no difference in mortality(OR: 0.70; 95%CI: 0.27-1.84, P = 0.47), LOS(β:-4.44; 95%CI:-9.93, 1.05, P = 0.11) and charges for transplantation(β: $15693; 95%CI:-51622-83008, P = 0.64) between the two groups. Morbidly obese patients were more likely to have transplants on weekdays(81.7%) as compared to those without morbid obesity(75.4%, P = 0.029).CONCLUSION Morbid obesity may not impact in-hospital mortality and health care utilization in OLT recipients. However, morbidly obese patients may be selected after careful assessment of co-morbidities.

关键词： Deceased donors Outcome Complications Economics Selection criteria

Paracentesis in cirrhotics is associated with increased risk of 30-day readmission

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World Journal of Hepatology 2018年第6期10卷 425-432页

作者： Lindsay A Sobotka Rohan M Modi Akshay Vijayaraman A James Hanje anthony J michaels Lanla F Conteh Alice Hinton Ashraf El-Hinnawi Khalid Mumtaz Department of Internal Medicine the Ohio State University Wexner Medical Center Division of Gastroenterology Hepatology and Nutrition the Ohio State Wexner Medical Center Division of Biostatistics College of Public Health the Ohio State University Department of Surgery the Ohio State Wexner Medical Center

AIM To determine the readmission rate, its reasons, predictors, and cost of 30-d readmission in patients with cirrhosis and *** A retrospective analysis of the nationwide readmission database(NRD) was performed during the calendar year 2013. All adults cirrhotics with a diagnosis of ascites,spontaneous bacterial peritonitis, or hepatic encephalopathy were identified by ICD-9 codes. Multivariate analysis was performed to assess predictors of 30-d readmission and cost of *** Of the 59597 patients included in this study, 18319(31%) were readmitted within 30 d. Majority(58%) of readmissions were for liver related reasons. Paracentesis was performed in 29832(50%) patients on index admission. Independent predictors of 30-d readmission included age 3 Elixhauser comorbidity(OR: 1.13; CI: 1.05-1.22), nonalcoholic cirrhosis(OR: 1.16; CI: 1.10-1.23), paracentesis on index admission(OR: 1.28; CI: 1.21-1.36) and having hepatocellular carcinoma(OR: 1.21; CI: 1.05; 1.39). Cost of index admission was similar in patients readmitted and not readmitted(P-value: 0.34); however cost of care was significantly more on 30 d readmission($30959 ± 762) as compared to index admission($12403 ± 378), P-value: < *** Cirrhotic patients with ascites have a 33% chance of readmission within 30-d. Younger patients, with public insurance, nonalcoholic cirrhosis and increased comorbidity who underwent paracentesis are at increased risk of readmission. Risk factors for unplanned readmission should be targeted given these patients have higher healthcare utilization.

关键词： Cirrhosis Readmission rates Paracentesis Ascites

Impact of transjugular intrahepatic porto-systemic shunt on post liver transplantation outcomes: Study based on the United Network for Organ Sharing database

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World Journal of Hepatology 2017年第2期9卷 99-105页

作者： Khalid Mumtaz Sherif Metwally Rohan M Modi Nishi Patel Dmitry Tumin anthony J michaels James Hanje Ashraf El-Hinnawi Don Hayes Jr Sylvester M Black Wexner Medical Center Gastroenterology Hepatology and Nutrition Division the Ohio State University Department of Internal Medicine the Ohio State University Department of Pediatrics the Ohio State University Department of Surgery the Ohio State University Section of Pulmonary Medicine the Ohio State University

AIMTo determine the impact of transjugular intrahepatic porto-systemic shunt (TIPS) on post liver transplantation (LT) outcomes. METHODSUtilizing the United Network for Organ Sharing (UNOS) database, we compared patients who underwent LT from 2002 to 2013 who had underwent TIPS to those without TIPS for the management of ascites while on the LT waitlist. The impact of TIPS on 30-d mortality, length of stay (LOS), and need for re-LT were studied. For evaluation of mean differences between baseline characteristics for patients with and without TIPS, we used unpaired t-tests for continuous measures and χ2 tests for categorical measures. We estimated the impact of TIPS on each of the outcome measures. Multivariate analyses were conducted on the study population to explore the effect of TIPS on 30-d mortality post-LT, need for re-LT and LOS. All covariates were included in logistic regression analysis. RESULTSWe included adult patients (age ≥ 18 years) who underwent LT from May 2002 to September 2013. Only those undergoing TIPS after listing and before liver transplant were included in the TIPS group. We excluded patients with variceal bleeding within two weeks of listing for LT and those listed for acute liver failure or hepatocellular carcinoma. Of 114770 LT in the UNOS database, 32783 (28.5%) met inclusion criteria. Of these 1366 (4.2%) had TIPS between the time of listing and LT. We found that TIPS increased the days on waitlist (408 ± 553 d) as compared to those without TIPS (183 ± 330 d), P P P = 0.001) by TIPS to LOS. CONCLUSIONTIPS did increase time on waitlist for LT. More importantly, TIPS was not associated with 30-d mortality and re-LT, but it did lengthen hospital LOS after transplantation.

关键词： Transjugular intrahepatic porto-systemic shunt Shunt Liver Transplantation Ascites Model for end-stage liver disease Mortality Transjugular

Effect of transplant center volume on post-transplant survival in patients listed for simultaneous liver and kidney transplantation

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World Journal of Hepatology 2018年第1期10卷 134-141页

作者： Rohan M Modi Dmitry Tumin Andrew J Kruger Eliza W Beal Don Hayes Jr James Hanje anthony J michaels Kenneth Washburn Lanla F Conteh Sylvester M Black Khalid Mumtaz Department of Internal Medicine Ohio State University Wexner Medical CenterColumbusOH 43210United States Department of Anesthesiology and Pain Medicine Nationwide Children’s HospitalColumbusOH 43205United States Department of General Surgery Division of TransplantationOhio State University Wexner Medical CenterColumbusOH 43210United States Comprehensive Transplant Center Ohio State University Wexner Medical CenterColumbusOH 43210United States Section of Pulmonary Medicine Nationwide Children’s HospitalColumbusOH 43205United States Department of Internal Medicine Division of GastroenterologyHepatology and NutritionOhio State University Wexner Medical CenterColumbusOH 43210United States

AIM To examine the effect of center size on survival differences between simultaneous liver kidney transplantation(SLKT) and liver transplantation alone(LTA) in SLKT-listed *** The United Network of Organ Sharing database was queried for patients ≥ 18 years of age listed for SLKT between February 2002 and December 2015. Posttransplant survival was evaluated using stratified Cox regression with interaction between transplant type(LTA vs SLKT) and center *** During the study period, 393 of 4580 patients(9%) listed for SLKT underwent a LTA. Overall mortality was higher among LTA recipients(180/393, 46%) than SLKT recipients(1107/4187, 26%). The Cox model predicted a significant survival disadvantage for patients receiving LTA vs SLKT [hazard ratio, hazard ratio(HR) = 2.85; 95%CI: 2.21, 3.66; P < 0.001] in centers performing 30 SLKT over the study period. This disadvantage was modestly attenuated as center SLKT volume increased, with a 3% reduction(HR = 0.97; 95%CI: 0.95, 0.99; P = 0.010) for every 10 SLKs *** In conclusion, LTA is associated with increased mortality among patients listed for SLKT. This difference is modestly attenuated at more experienced centers and may explain inconsistencies between smaller-center and larger registry-wide studies comparing SLKT and LTA outcomes.

关键词： Kidney transplantation Center volume Mortality Liver transplantation United network for organ sharing