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Articles by D Mukherjee
Total Records ( 4 ) for D Mukherjee
  D Mukherjee , H. A Zaidi , T Kosztowski , K. L Chaichana , H Brem , D. C Chang and A. Quinones Hinojosa

Hypothesis  Race/ethnicity and social status influence admission to high-volume hospitals among patients who undergo craniotomy for tumor biopsy or resection.

Design  Retrospective analysis of the Nationwide Inpatient Sample (1988-2005), with additional factors from the Area Resource File.

Setting  A 20% representative sample of all hospitals in 37 US states.

Patients  A total of 76 436 patients 18 years or older who were admitted and underwent craniotomy for tumor biopsy or resection.

Main Outcome Measures  Odds ratios (ORs) for the association of age, sex, race/ethnicity, insurance status, Charlson Comorbidity Index, and county-level characteristics with admission to high-volume hospitals (>50 craniotomies per year) or low-volume hospitals.

Results  A total of 25 481 patients (33.3%) were admitted to high-volume hospitals. Overall access to high-volume hospitals improved over time. However, racial/ethnic disparities in access to high-volume hospitals dramatically worsened for Hispanics (OR, 0.49) and African Americans (OR, 0.62) in recent years. Factors associated with better access to high-volume hospitals included years since 1988 (OR, 1.11), greater countywide neurosurgeon density (OR, 1.66), and higher countywide median household income (OR, 1.71). Factors associated with worse access to high-volume hospitals included older age (OR, 0.34 per year increase), increased countywide poverty rate (OR, 0.57), Hispanic race/ethnicity (OR, 0.68), and higher Charlson Comorbidity Index (OR, 0.96 per point increase).

Conclusions  African Americans and Hispanics have disproportionately worse access to high-quality neuro-oncologic care over time compared with whites. Higher countywide median household income and decreased countywide poverty rate were associated with better access to high-volume hospitals, implicating socioeconomic factors in predicting admission to high-quality centers.

  A. J Hayanga , D Mukherjee , D Chang , H Kaiser , T Lee , S Gearhart , N Ahuja and J. Freischlag

Objective  To compare risk- and volume-adjusted outcomes of colon resections performed at teaching hospitals (THs) vs non-THs to assess whether benign disease may influence the volume-outcome effect.

Design  Retrospective data analysis examining colon resections determined by International Classification of Diseases, Ninth Revision, Clinical Modification classification performed in the United States from 2001 through 2005 using the Nationwide Inpatient Sample (NIS) and the Area Resource File (2004). Patient covariates used in adjustment included age, sex, race, Charlson Index comorbidity score, and insurance status. Hospital covariates included TH status, presence of a colorectal surgery fellowship approved by the Accreditation Council for Graduate Medical Education, geographical region, institutional volume, and urban vs rural location. County-specific surgeon characteristics used in adjustment included average age of surgeons and proportion of colorectal board-certified surgeons within each county. Environmental or county covariates included median income and percentage of county residents living below the federal poverty level.

Setting  A total of 1045 hospitals located in 38 states in the United States that were included in the NIS.

Patients  All patients older than 18 years who had colon resection and were discharged from a hospital included in the NIS.

Main Outcome Measures  Operative mortality, length of stay (LOS), and total charges.

Results  A total of 115 250 patients were identified, of whom 4371 died (3.8%). The mean LOS was 10 days. Fewer patients underwent surgical resection in THs than in non-THs (46 656 vs 68 589). Teaching hospitals were associated with increased odds of death (odds ratio, 1.14) (P = .03), increased LOS (P = .003), and a nonsignificant trend toward an increase in total charges (P = .36).

Conclusions  With the inclusion of benign disease, colon surgery displays a volume-outcome relationship in favor of non-THs. Inclusion of benign disease may represent a tipping point.

  D Mukherjee , Y Zhang , D. C Chang , L. A Vricella , J. I Brenner and F. Abdullah

Through an analysis of 2 databases, we describe outcomes among 11 958 neonates with congenital heart disease undergoing cardiac procedures, with 194 developing necrotizing enterocolitis (NEC). Neonates with congestive heart failure or those undergoing systemic to pulmonary artery shunting were more likely to develop NEC, but these patients had inpatient mortality similar to that of their non-NEC counterparts.

  F Abdullah , Y Zhang , M Camp , D Mukherjee , A Gabre Kidan , P. M Colombani and D. C. Chang

Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency of the neonate. Previous information about this disease has largely been gathered from limited series. We analyzed 13 years of the National Inpatient Sample (NIS) and 3 years of the Kids’ Inpatient Database (KID; 1997, 2000, 2003) to generate the most comprehensive profile of outcomes to date of medically versus surgically treated NEC. We identified 20 822 infants with NEC, of whom 15 419 (74.1%) and 5403 (25.9%) were undergoing medical and surgical management, respectively. Overall, surgical patients had greater length of stay, total hospital charges, and mortality. Among infants dying during admission, there was no significant difference in length of stay or charges between the medical and surgical groups. These findings highlight the need for developing a clinically relevant risk stratification tool to identify NEC patients at high risk for death.

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