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Call for action:Increased healthcare utilization with growing use of percutaneous cholecystectomy tube over initial cholecystectomy in cirrhotics

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Hepatobiliary & Pancreatic Diseases International 2022年第1期21卷 56-62页

作者： Srikanth Vedachalam Sajid Jalil Somashaker G Krishna Kyle Porter Na Li Sean G Kelly lanla conteh Khalid Mumtaz Department of Internal Medicine The Ohio State University Wexner Medical CenterColumbusOH 43210USA Division of Gastroenterology Hepatology and NutritionThe Ohio State University Wexner Medical CenterColumbusOH 43210USA Center for Biostatistics Department of Biomedical InformaticsThe Ohio State University Wexner Medical CenterColumbusOH 43210USA

Background:Acute calculous cholecystitis(ACC)is frequently seen in cirrhotics,with some being poor candidates for initial cholecystectomy.Instead,these patients may undergo percutaneous cholecystostomy tube(PCT)placement.We studied the healthcare utilization and predictors of cholecystectomy and PCT in patients with ACC.Methods:The National Database was queried to study all cirrhotics and non-cirrhotics with ACC between 2010-2014 who underwent initial PCT(with or without follow-up cholecystectomy)or cholecystectomy.Cirrhotic patients were divided into compensated and decompensated cirrhosis.Independent predictors and outcomes of initial PCT and failure to undergo subsequent cholecystectomy were studied.Results:Out of 919189 patients with ACC,13283(1.4%)had cirrhosis.Among cirrhotics,cholecystec-tomy was performed in 12790(96.3%)and PCT in the remaining 493(3.7%).PCT was more frequent in cirrhotics(3.7%)than in non-cirrhotics(1.4%).Multivariate analyses showed increased early readmis-sions[odds ratio(OR)=2.12,95%confidence interval(CI):1.43-3.13,P<0.001],length of stay(effect ratio=1.39,95%CI:1.20-1.61,P<0.001),calendar-year hospital cost(effect ratio=1.34,95%CI:1.28-1.39,P<0.001)and calendar-year mortality(hazard ratio=1.89,95%CI:1.07-3.29,P=0.030)in cir-rhotics undergoing initial PCT compared to cholecystectomy.Decompensated cirrhosis(OR=2.25,95%CI:1.67-3.03,P<0.001)had the highest odds of getting initial PCT.Cirrhosis,regardless of compensated(OR=0.56,95%CI:0.34-0.90,P=0.020)or decompensated(OR=0.28,95%CI:0.14-0.59,P<0.001),reduced the chances of getting a subsequent cholecystectomy.Conclusions:Cirrhotic patients undergo fewer cholecystectomy incurring initial PCT instead.Moreover,the rates of follow-up cholecystectomy are lower in cirrhotics.Increased healthcare utilization is seen with initial PCT amongst cirrhotic patients.This situation reflects suboptimal management of ACC in cirrhotics and a call for action.

关键词： National Healthcare Cholecystectomy Percutaneous cholecystostomy Cirrhosis Decompensated cirrhosis

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Women receive more inpatient resections and ablations for hepatocellular carcinoma than men

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World Journal of Hepatology 2017年第36期9卷 1346-1351页

作者： Lindsay Sobotka Alice Hinton lanla conteh Department of Internal Medicine the Ohio State University Wexner Medical Center Division of Biostatistics College of Public Health the Ohio State University Section of Hepatology Division of Gastroenterology Hepatology and Nutrition the Hepatocellular Carcinoma Multidisciplinary Clinic the James Comprehensive Cancer Center the Ohio State University Wexner Medical Center

AIM To evaluate disparities in the treatment of hepatocellular carcinoma(HCC) based on gender.METHODS A retrospective database analysis using the Nationwide Inpatient Sample(NIS) was performed between 2010 and 2013. Adult patients with a primary diagnosis of hepatocellular carcinoma determined by International Classification of Disease 9(ICD-9) codes were included. Univariate analysis and multivariate logistic regressions were performed to analyze differences in treatment, mortality, features of decompensation, and metastatic disease based on the patient's gender.RESULTS The analysis included 62582 patients with 45908 men and 16674 women. Women were less likely to present with decompensated liver disease(OR = 0.84, P < 0.001) and had less risk of inpatient mortality when compared to men(OR = 0.75, P < 0.001). Women were more likely to receive inpatient resection(OR = 1.31, P < 0.001) or an ablation(OR = 1.22, P = 0.028) than men. There was no significant difference between men and women in regard to liver transplantation and transcatheter arterial chemoembolization(TACE).CONCLUSION Gender impacts treatment for hepatocellular carcinoma. Women are more likely to undergo an ablation or resection then men. Gender disparities in transplantation have resolved.

关键词： Hepatocellular carcinoma Gender disparities Liver transplantation Liver resection Ablation

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Neoadjuvant and adjuvant treatment strategies for hepatocellular carcinoma

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World Journal of Gastroenterology 2019年第28期25卷 3704-3721页

作者： Clifford Akateh Sylvester M Black lanla conteh Eric D Miller Anne Noonan Eric Elliott Timothy M Pawlik Allan Tsung Jordan M Cloyd Department of Surgery The Ohio State University Wexner Medical Center Columbus OH 43210 United States Division of Transplant Surgery Department of Surgery The Ohio State University Wexner Medical Center Columbus OH 43210 United States Division of Gastroenterology Hepatology and Nutrition Department of Internal Medicine The Ohio State University Wexner Medical Center Columbus OH 43210 United States Department of Radiation Oncology The Ohio State University Wexner Medical Center Columbus OH 43210 United States Division of Medical Oncology Department of Internal Medicine The Ohio State University Wexner Medical Center Columbus OH 43210 United States Division of Diagnostic Radiology Department of Radiology The Ohio State University Wexner Medical Center Columbus OH 43210 United States Division of Surgical Oncology Department of Surgery The Ohio State University Wexner Medical Center Columbus OH 43210 United States

Hepatocellular carcinoma (HCC) is the most common liver malignancy worldwide and a major cause of cancer-related mortality for which liver resection is an important curative-intent treatment option. However, many patients present with advanced disease and with underlying chronic liver disease and/or cirrhosis, limiting the proportion of patients who are surgical candidates. In addition, the development of recurrent or de novo cancers following surgical resection is common. These issues have led investigators to evaluate the benefit of neoadjuvant and adjuvant treatment strategies aimed at improving resectability rates and decreasing recurrence rates. While high-level evidence to guide treatment decision making is lacking, recent advances in locoregional and systemic therapies, including antiviral treatment and immunotherapy, raise the prospect of novel approaches that may improve the outcomes of patients with HCC. In this review, we evaluate the evidence for various neoadjuvant and adjuvant therapies and discuss opportunities for future clinical and translational research.

关键词： Hepatocellular carcinoma Neoadjuvant therapy Adjuvant therapy Neoplasm recurrence Hepatectomy Liver cirrhosis

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Randomized intervention and outpatient follow-up lowers 30-d readmissions for patients with hepatic encephalopathy,decompensated cirrhosis

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World Journal of Hepatology 2023年第6期15卷 826-840页

作者： Antoinette Pusateri Kevin Litzenberg Claire Griffiths Caitlin Hayes Bipul Gnyawali Michelle Manious Sean G Kelly lanla F conteh Sajid Jalil Haikady N Nagaraja Khalid Mumtaz Division of Gastroenterology Hepatology and NutritionThe Ohio State University Wexner Medical CenterColumbusOH 43210United States Division of Internal Medicine The Ohio State University Wexner Medical CenterColumbusOH 43210United States The Ohio State University College of Medicine The Ohio State University Wexner Medical CenterColumbusOH 43210United States Division of Gastroenterology and Hepatology The Ohio State Wexner Medical CenterColumbusOH 43210United States Division of Biostatistics The Ohio State UniversityColumbusOH 43210United States

BACKGROUND We previously reported national 30-d readmission rates of 27% in patients with decompensated cirrhosis(DC).AIM To study prospective interventions to reduce early readmissions in DC at our tertiary center.METHODS Adults with DC admitted July 2019 to December 2020 were enrolled and randomized into the intervention(INT) or standard of care(SOC) arms. Weekly phone calls for a month were completed. In the INT arm, case managers ensured outpatient follow-up, paracentesis, and medication compliance. Thirty-day readmission rates and reasons were compared.RESULTS Calculated sample size was not achieved due to coronavirus disease 2019;240 patients were randomized into INT and SOC arms. 30-d readmission rate was 33.75%, 35.83% in the INT vs 31.67% in the SOC arm(P = 0.59). The top reason for 30-d readmission was hepatic encephalopathy(HE, 32.10%). There was a lower rate of 30-d readmissions for HE in the INT(21%) vs SOC arm(45%, P = 0.03). There were fewer 30-d readmissions in patients who attended early outpatient follow-up(n = 17, 23.61% vs n = 55, 76.39%, P = 0.04).CONCLUSION Our 30-d readmission rate was higher than the national rate but reduced by interventions in patients with DC with HE and early outpatient follow-up. Development of interventions to reduce early readmission in patients with DC is needed.

关键词： Decompensated cirrhosis Hospital readmissions Interventions

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African Americans are less likely to receive curative treatment for hepatocellular carcinoma

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World Journal of Hepatology 2018年第11期10卷 849-855页

作者： Lindsay A Sobotka Alice Hinton lanla F conteh Department of Internal Medicine The Ohio State University Wexner Medical Center Division of Biostatistics College of Public Health The Ohio State University Department of Gastroenterology and Hepatology The Ohio State Wexner Medical Center

AIM To determine if racial disparities continue to exist in the treatment of hepatocellular carcinoma(HCC).METHODS A retrospective database analysis using the Nationwide Inpatient Sample was performed including patients with a primary diagnosis of HCC. Univariate and multivariate analyses were utilized to determine racial disparities in liver decompensation, treatment, inpatient mortality, and metastatic disease.RESULTS A total of 62604 patients with HCC were included consisting of 32428 Caucasian, 9726 African-American, 8988 Hispanic, and 11462 patients of other races. Caucasian patients were more likely to undergo curative therapies of liver transplant(OR: 2.66, 95%CI: 1.92-3.68), resection(OR: 1.82, 95%CI: 1.48-2.23), and ablation(OR: 1.77, 95%CI: 1.36-2.30) than African-American patients. Hispanic patients were more likely to undergo transplant(OR: 2.18, 95%CI: 1.40-3.39) and ablation(OR: 1.46, 95%CI:1.05-2.03) than African-American patients. Patients of other races were more likely to receive a liver transplant(OR: 2.41, 95%CI: 1.62-3.61), resection(OR: 1.79 95%CI: 1.39-2.32), and ablation(OR: 2.03, 95%CI: 1.47-2.80) than African-American patients. There are no differences in the rates of transarterial chemoembolization between races.CONCLUSION Racial disparities in HCC treatment exist despite emphasis to support equality in healthcare. African-American patients are less likely to undergo curative treatments for HCC.

关键词：肝细胞癌治疗方法临床分析肝病

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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 ascites.METHODS 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 readmission.RESULTS 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: < 0.001.CONCLUSION 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

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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 patients.METHODS 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 volume.RESULTS 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 performed.CONCLUSION 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

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“大思政”格局下高校实践育人模式的探索与实践

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黑龙江教育（高教研究与评估） 2023年第5期 82-85页

作者：费兰兰浙江大学浙江杭州310058

“大思政”格局下,进一步加强和改进高校大学生思想政治教育工作,构建以学生成长为中心的实践育人体系,是新时代落实党教育方针的重要抓手,是培养社会主义时代新人的重要路径。文章从把握历史脉络、突出时代特点、着眼未来发展三个维度... 详细信息

“大思政”格局下,进一步加强和改进高校大学生思想政治教育工作,构建以学生成长为中心的实践育人体系,是新时代落实党教育方针的重要抓手,是培养社会主义时代新人的重要路径。文章从把握历史脉络、突出时代特点、着眼未来发展三个维度,深入探讨高校实践育人在立德树人过程中的价值意蕴,直面当前面临的理论阐释与实践行动相适应,实践能力与社会需求相契合,实践目标和评价方式相统一等方面的困境和挑战,以全员参与、全程覆盖、全方位融入的方式,积极探索高校实践育人机制途径,切实提升实践育人的能力、水平和成效。

关键词： “大思政”格局实践育人探索路径

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