A5029093958- Peripheral Artery Disease Management
- Cardiac, Anesthesia and Surgical Outcomes
- Diabetic Foot Ulcer Assessment and Management
- Cerebrovascular and Carotid Artery Diseases
- Frailty in Older Adults
- Aortic aneurysm repair treatments
- Acute Ischemic Stroke Management
- Hip and Femur Fractures
- Venous Thromboembolism Diagnosis and Management
- Stroke Rehabilitation and Recovery
- Healthcare Systems and Public Health
- Musculoskeletal pain and rehabilitation
- Vascular Procedures and Complications
- Intracranial Aneurysms: Treatment and Complications
- Cardiovascular Health and Disease Prevention
- Diagnosis and Treatment of Venous Diseases
- Nutrition and Health in Aging
- Aortic Disease and Treatment Approaches
- Muscle and Compartmental Disorders
- Renal and Vascular Pathologies
- Lymphatic System and Diseases
- Palliative Care and End-of-Life Issues
- Balance, Gait, and Falls Prevention
- Radiation Dose and Imaging
- Pain Management and Treatment
University of Nebraska Medical Center
2016-2025
VA Nebraska Western Iowa Health Care System
2016-2025
Veterans Health Administration
2008-2025
John Wiley & Sons (United States)
2019-2023
Omaha VA Medical Center
2014-2023
University of Nebraska at Omaha
2011-2022
Brunswick (United States)
2022
Albany Research Institute
2022
Providence College
2022
Moss Landing Marine Laboratories
2019-2020
Background— Perioperative myocardial infarction or cardiac arrest is associated with significant morbidity and mortality. The Revised Cardiac Risk Index currently the most commonly used risk stratification tool; however, it has several limitations, one of which its relatively low discriminative ability. objective present study was to develop validate a predictive calculator. Methods Results— Patients who underwent surgery were identified from American College Surgeons' 2007 National Surgical...
Inouye, Sharon K. MD, MPH; Robinson, Thomas MS, FACS; Blaum, Caroline MS; Busby-Whitehead, Jan CMD, AGSF; Boustani, Malaz Chalian, Ara MD; Deiner, Stacie Fick, Donna PhD, RN, FGSA, FAAN; Hutchison, Lisa PharmD; Johanning, Jason Katlic, Mark Kempton, James; Kennedy, Maura MD. Kimchi, Eyal Ko, Cliff Leung, Jacqueline Mattison, Melissa; Mohanty, Sanjay Nana, Arvind Needham, Dale PhD; Neufeld, Karin Richter, Holly MD The American Geriatrics Society Expert Panel on Postoperative Delirium in Older...
Growing consensus suggests that frailty-associated risks should inform shared surgical decision making. However, it is not clear how best to screen for frailty in preoperative populations.To develop and validate the Risk Analysis Index (RAI), a 14-item instrument used measure frailty. It can be calculated prospectively (RAI-C), using clinical questionnaire, or retrospectively (RAI-A), variables from quality improvement databases (Veterans Affairs American College of Surgeons National...
<h3>Importance</h3> As the US population ages, number of operations performed on elderly patients will likely increase. Frailty predicts postoperative mortality and morbidity more than age alone, thus presenting opportunities to identify highest-risk surgical improve their outcomes. <h3>Objective</h3> To examine effect Screening Initiative (FSI) complications by comparing outcomes a cohort treated before after implementation FSI. <h3>Design, Setting, Participants</h3> This single-site,...
<h3>Importance</h3> Patients with frailty have higher risk for postoperative mortality and complications; however, most research has focused on small groups of high-risk procedures. The associations among frailty, operative stress, are poorly understood. <h3>Objective</h3> To assess the association between at varying levels stress as measured by Operative Stress Score, a novel measure created this study. <h3>Design, Setting, Participants</h3> This retrospective cohort study included veterans...
<h3>Importance</h3> Frailty is an important risk factor for postoperative mortality. Whether the association between frailty and mortality consistent across all surgical specialties, especially those predominantly performing lower stress procedures, remains unknown. <h3>Objective</h3> To examine specialties. <h3>Design, Setting, Participants</h3> A cohort study was conducted 9 noncardiac specialties in hospitals participating American College of Surgeons National Surgical Quality Improvement...
Objective and Background: The Risk Analysis Index (RAI) predicts 30-, 180-, 365-day mortality based on variables constitutive of frailty. Initially validated, in a single-center Veteran hospital, we sought to improve model performance by recalibrating the RAI large, veteran surgical registry, externally validate it both national registry cohort patients for whom was measured prospectively before surgery. Methods: recalibrated among development confirmation samples within Veterans Affairs...
Failure to rescue (FTR), or death after a potentially preventable complication, is nationally endorsed, publicly reported quality measure. However, little known about the impact of frailty on FTR, in particular low-risk surgical procedures.To assess association with FTR patients undergoing inpatient surgery.This study assessed cohort 984 550 general, vascular, thoracic, cardiac, and orthopedic surgery National Surgical Quality Improvement Program between January 1, 2005, December 31, 2012....
Peripheral arterial disease (PAD), a manifestation of systemic atherosclerosis that produces blockages in arteries supplying the legs, affects an estimated 27 million people Europe and North America. Increased production reactive oxygen species by dysfunctional mitochondria leg muscles PAD patients is viewed as key mechanism initiation progression disease. Previous studies demonstrated increased oxidative damage homogenates biopsy specimens from gastrocnemius compared to controls, but did...
The objective of this study was to assess the impact preoperative anemia (hematocrit <39%) on postoperative 30-day mortality and adverse cardiac events in patients 65 years or older undergoing elective vascular procedures.Preoperative is associated with outcomes after surgery, but its association open endovascular procedures not well established. Elderly have a decreased tolerance are at high risk for complications procedures.Patients (N = 31,857) were identified from American College...
The need for integrating palliative care into surgical services has been established within the literature. ability to effectively screen, obtain an appropriately timed consultation, and determine effect of consultation remains problematic.To examine consultations over time their relationship initiation implementation a systemwide frailty-screening program.We reviewed all performed between January 1, 2006, August 31, 2013, abstracted referring service (medicine/surgery), date surgery (if...
<h3>Importance</h3> Ambulatory surgery in geriatric populations is increasingly prevalent. Prior studies have demonstrated the association between frailty and readmissions inpatient setting. However, few data exist regarding after outpatient procedures. <h3>Objective</h3> To examine 30-day unplanned elective surgical procedures as well potential mediation of complications. <h3>Design, Setting, Participants</h3> In this retrospective cohort study from 2012 2013 National Surgical Quality...
The goal of this project was to first address barriers implementation the Risk Analysis Index (RAI) within a large, multi-hospital, integrated healthcare delivery system, and subsequently demonstrate its utility for identifying at-risk surgical patients.Prior studies validity RAI evaluating preoperative frailty, but they have not demonstrated feasibility routine clinical practice.Implementation as frailty screening instrument began quality improvement initiative at University Pittsburgh...
Palliative care has the potential to improve for patients and families undergoing high-risk surgery.To characterize use of perioperative palliative its association with family-reported end-of-life experiences who died within 90 days a surgical operation.This secondary analysis administrative data from retrospective cross-sectional patient cohort was conducted in Department Veterans Affairs (VA) Healthcare System. Patients underwent any 227 operations between January 1, 2012, December 31,...
Carotid endarterectomy (CEA) among asymptomatic patients involves a trade-off between higher short-term perioperative risk in exchange for lower long-term of stroke. The clinical benefit observed randomized trials (RCTs) may not extend to real-world practice.To examine whether early intervention was superior initial medical therapy practice preventing fatal and nonfatal strokes with carotid stenosis.This comparative effectiveness study conducted from August 28, 2018, March 2, 2020, using the...
Patient frailty is a known risk factor for adverse outcomes following surgery, but data are limited regarding whether systemwide interventions related to associated with improved patient outcomes.
Patients with peripheral artery disease (PAD) develop a myopathy in their ischemic lower extremities, which is characterized by myofiber degeneration, mitochondrial dysfunction and impaired limb function. Desmin, protein of the cytoskeleton, central to maintenance structure, shape function its organelles, especially mitochondria, translation sarcomere contraction into muscle contraction. In this study, we investigated hypothesis that disruption desmin network occurs gastrocnemius myofibers...