Asian Science Citation Index is committed to provide an authoritative, trusted and significant information by the coverage of the most important and influential journals to meet the needs of the global scientific community.  
ASCI Database
308-Lasani Town,
Sargodha Road,
Faisalabad, Pakistan
Fax: +92-41-8815544
Contact Via Web
Suggest a Journal
 
Articles by S. A Roman
Total Records ( 3 ) for S. A Roman
  S Kuy , S. A Roman , R Desai and J. A. Sosa
 

Objectives  To perform the first population-based measurement of clinical and economic outcomes after thyroid and parathyroid surgery in pregnant women and identify the characteristics of this population and the predictors of outcome.

Design  Retrospective cross-sectional study.

Setting  Health Care Utilization Project Nationwide Inpatient Sample (HCUP-NIS), a 20% sample of nonfederal US hospitals.

Patients  All pregnant women, compared with age-matched nonpregnant women, who underwent thyroid and parathyroid procedures from 1999 to 2005.

Main Outcome Measures  Fetal, maternal, and surgical complications, in-hospital mortality, median length of stay, and hospital costs.

Results  A total of 201 pregnant women underwent thyroid (n = 165) and parathyroid (n = 36) procedures and were examined together. The mean age was 29 years, 60% were white, 25% were emergent or urgent admissions, and 46% had thyroid cancer. Compared with nonpregnant women (n = 31 155), pregnant patients had a higher rate of endocrine (15.9 vs 8.1%; P < .001) and general complications (11.4 vs 3.6%; P < .001), longer unadjusted lengths of stay (2 days vs 1 day; P < .001), and higher unadjusted hospital costs ($6873 vs $5963; P = .007). The fetal and maternal complication rates were 5.5% and 4.5%, respectively. On multivariate regression analysis, pregnancy was an independent predictor of higher combined surgical complications (odds ratio, 2; P < .001), longer adjusted length of stay (0.3 days longer; P < .001), and higher adjusted hospital costs ($300; P < .001). Other independent predictors of outcome were surgeon volume, patient race or ethnicity, and insurance status.

Conclusions  Pregnant women have worse clinical and economic outcomes following thyroid and parathyroid surgery than nonpregnant women, with disparities in outcomes based on race, insurance, and access to high-volume surgeons.

  H. S Park , S. A Roman and J. A. Sosa
 

Objective  To assess the effect of surgeon volume and specialty on clinical and economic outcomes after adrenalectomy.

Design  Population-based retrospective cohort analysis.

Setting  Healthcare Cost and Utilization Project Nationwide Inpatient Sample.

Participants  Adults (≥18 years) undergoing adrenalectomy in the United States (1999-2005). Patient demographic and clinical characteristics, surgeon specialty (general vs urologist), surgeon adrenalectomy volume, and hospital factors were assessed.

Main Outcome Measures  The 2 test, analysis of variance, and multivariate linear and logistic regression were used to assess in-hospital complications, mean hospital length of stay (LOS), and total inpatient hospital costs.

Results  A total of 3144 adrenalectomies were included. Mean patient age was 53.7 years; 58.8% were women and 77.4% white. A higher proportion of general surgeons were high-volume surgeons compared with urologists (34.1% vs 18.2%, P < .001). Low-volume surgeons had more complications (18.2% vs 11.3%, P < .001) and their patients had longer LOS (5.5 vs 3.9 days, P < .001) than did high-volume surgeons; urologists had more complications (18.4% vs 15.2%, P = .03) and higher costs ($13 168 vs $11 732, P = .02) than did general surgeons. After adjustment for patient and provider characteristics in multivariate analyses, surgeon volume, but not specialty, was an independent predictor of complications (odds ratio = 1.5, P < .002) and LOS (1.0-day difference, P < .001). Hospital volume was associated only with LOS (0.8-day difference, P < .007). Surgeon volume, specialty, and hospital volume were not predictors of costs.

Conclusion  To optimize outcomes, patients with adrenal disease should be referred to surgeons based on adrenal volume and laparoscopic expertise irrespective of specialty practice.

  A. L Friedman , K Cheung , S. A Roman and J. A. Sosa
 

Background  Efforts to maximize kidney transplantation are tempered by concern for the live donor's safety. Case series and center surveys exist, but national aggregate data are lacking. We sought to determine predictors of early clinical and economic outcomes following living donor nephrectomy.

Design  A retrospective cross-sectional analysis using 1999-2005 discharge data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample was performed. Cases were identified by International Classification of Diseases, Ninth Revision (ICD-9), codes. Clinical and economic outcomes were analyzed with regard to patient and provider characteristics using bivariate and multivariate regression analyses.

Setting  Healthcare Cost and Utilization Project Nationwide Inpatient Sample.

Patients  Patients undergoing living donor nephrectomy, identified by the ICD-9 codes.

Interventions  Clinical and economic outcomes were analyzed with regard to patient and provider characteristics using bivariate and multivariate regression analyses.

Main Outcome Measures  In-hospital complications, mortality, mean length of stay (LOS), and mean total hospital costs.

Results  A total of 6320 cases were identified with 0% mortality and a complication rate of 18.4%. The mean (SD) LOS was 3.3 (0.3) days, and the mean inpatient cost was $10 708 ($505). Independent predictors of donor complications included older age (odds ratio [OR], 1.01), male sex (OR, 1.19), Charlson Comorbidity Index of at least 1 (OR, 1.49), obesity (OR, 1.76), medium-size hospitals (OR, 1.88), and low-volume hospitals (OR, 1.37). Predictors of longer LOS included older age, female sex, Charlson score of at least 1, lower household income, low-volume and urban hospitals, and low-volume surgeons.

Conclusions  Kidney donation is associated with a low mortality rate but an 18% complication rate. Donation by those with advanced age or obesity is associated with higher risks. Informed consent should include discussion of these risks.

 
 
 
Copyright   |   Desclaimer   |    Privacy Policy   |   Browsers   |   Accessibility