Kyle Porter

Exact Sciences (United States)

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Somashekar G. Krishna

The Ohio State University Wexner Medical Center

Darwin L. Conwell

The Ohio State University Wexner Medical Center

Hisham Hussan

University of California, Davis

Peter P. Stanich

The Ohio State University Wexner Medical Center

Lisa M. Christian

The Ohio State University Wexner Medical Center

Khalid Mumtaz

The Ohio State University Wexner Medical Center

Claire V. Murphy

University of North Carolina at Chapel Hill

Matthew D. Ringel

The Ohio State University

Lanla Conteh

The Ohio State University Wexner Medical Center

Sylvester M. Black

The Ohio State University Wexner Medical Center

Cooperative Institutions

The Ohio State University

412

The Ohio State University Wexner Medical Center

339

NIHR Clinical Research Network

170

Lymphatic Education & Research Network

159

The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute

133

Nationwide Children's Hospital

Harvard University

Columbus Oncology and Hematology Associates

Ohio University

Exact Sciences (United States)

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Papers

Citation

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Postoperative Hospital Outcomes of Elective Surgery for Nonmalignant Colorectal Polyps: Does the Burden Justify the Indication?

The American Journal of Gastroenterology (2021)

Andrew J. Kruger Hisham Hussan Peter P. Stanich Darrell M. Gray Kyle Porter

Despite the increasing availability of advanced endoscopic resections and its favorable safety profile, surgery for nonmalignant colorectal polyps has continually increased. We sought to evaluate readmission rates and outcomes of elective surgery for nonmalignant colorectal polyps on a national level in the United States.The Nationwide Readmissions Database (2010-2014 [International Classification of Diseases, Ninth Revision] and 2016-2018 [International Classification of Diseases, 10th Revision]) was used to identify all adult subjects (age ≥18 years) who underwent elective surgical resection of nonmalignant colorectal polyps. Multivariable analyses were performed for predictors of postoperative morbidity and 30-day readmission.Elective surgery for nonmalignant colorectal polyps was performed in 108,468 subjects from 2010 to 2014 and in 54,956 subjects from 2016 to 2018, most of whom were laparoscopic. Postoperative morbidity and 30-day readmission rates were 20.5% and 8.5% from 2010 to 2014, and 13.0% and 7.6% from 2016 to 2018, respectively. Index admission mortality rates were 0.3-0.4%; mortality rates were higher in those with postoperative morbidity. Multivariable analyses revealed that male sex, ≥3 comorbidities, insurance status, and open surgery predicted an increased risk of both postoperative morbidity and 30-day readmission. In addition, postoperative morbidity (2010-2014 [odds ratio 1.58; 95% confidence interval 1.44-1.74] and 2016-2018 [odds ratio 1.55; 95% confidence interval 1.37-1.75]) predicted early readmission.In this investigation of national practices, elective surgery for nonmalignant colorectal polyps remains common. There is considerable risk of adverse postoperative outcomes, which highlights the importance of increasing awareness of the range of endoscopic resections and referring subjects to expert endoscopy centers.

Colorectal Surgery

Elective surgery

10.14309/ajg.0000000000001374

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Citations (3)

The Long-term Impact of Roux-en-Y Gastric Bypass on Colorectal Polyp Formation and Relation to Weight Loss Outcomes

Obesity Surgery (2019)

Hisham Hussan Alyssa Drosdak M Roux Kishan Patel Kyle Porter

Roux-en-Y anastomosis

10.1007/s11695-019-04176-w

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Citations (12)

Patient‐Level Medication Regimen Complexity in an Adolescent and Adult Population with Autism Spectrum Disorders

Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy (2018)

Debra J. Barnette Christopher Hanks Weiyi Li Kyle Porter

Background Adults with autism spectrum disorder ( ASD ) frequently experience polypharmacy. However, there is limited understanding of how to quantify medication complexity in this vulnerable population. Objectives This study examined medication administration difficulty using the Medication Regimen Complexity Index ( MRCI ) tool in adolescents and adults with ASD . The outcomes compared the mean total MRCI score with the medication count, described MRCI contributions for over‐the‐counter medication ( OTC ), and compared MRCI scores by patient characteristics. Methods This was a retrospective chart review of patients aged 7–45 years (mean = 20.1) enrolled in a primary care ASD transitions program. Each patient's listed medications were counted and then scored using the validated MRCI tool. Results For the 142 patients studied, mean total MRCI was 14.6 ± 14.6 (range 0–89) and mean medication count was 6.3 ± 5.4 (range 0–38). For patients on 0–4 medications (66 of 142; 46.5%), the mean MRCI was 5.5 ± 4.2, 5–9 medications (50 of 142; 35.2%) the mean MRCI was 15.2 ± 6.8, and 10–38 medications (26 of 142; 18.3%) the mean MRCI was 36.5 ± 18.9 (p<0.001). Sixty percent (85 of 142) reported OTC use, which contributed 26.6% to the mean total MRCI . Reported benzodiazepine (mean MRCI 25.8 ± 17.2), antiepileptic (mean MRCI 23.7 ± 16.9), antipsychotic (mean MRCI 19.7 ± 15.9), or antidepressant (mean MRCI 17.0 ± 14.8) use received higher MRCI scores compared to nonuse (p<0.001 for all except antidepressants [p=0.004]). Total MRCI did not differ significantly by age group, sex, or attention‐deficit‐hyperactivity disorder ( ADHD ) medication use (stimulant or nonstimulant). Conclusions Medication regimen complexity in adolescents and adults with ASD was increased significantly for individuals taking ≥ 5 medications. Central nervous system agent use, other than ADHD therapy, identified patients with higher regimen complexity. The related clinical effects of these findings warrant further investigation.

Regimen

10.1002/phar.2202

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Citations (10)

Mo1554 Opioid Use Is Associated With Prolonged Gastric Transit Time but Not Incomplete Studies in Hospitalized Patients Receiving Wireless Capsule Endoscopy

Gastrointestinal Endoscopy (2014)

Bryan Kleinman Peter P. Stanich Kavita Betkerur Kyle Porter Marty Meyer

Gastrointestinal transit

Transit time

Capsule

10.1016/j.gie.2014.02.731

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Citations (0)

Physical activity during video capsule endoscopy correlates with shorter bowel transit time

Endoscopy International Open (2017)

Peter P. Stanich Joshua Peck Christopher Murphy Kyle Porter Marty Meyer

Video capsule endoscopy (VCE) is limited by reliance on bowel motility for propulsion, and lack of physical activity has been proposed as a cause of incomplete studies. Our aim was to prospectively investigate the association between physical activity and VCE bowel transit. Ambulatory outpatients receiving VCE were eligible for the study. A pedometer was attached at the time of VCE ingestion and step count was recorded at the end of the procedure. VCE completion was assessed by logistic regression models, which included step count (500 steps as one unit). Total transit time was analyzed by Cox proportional hazards models. The hazard ratios (HR) with 95 % confidence interval (CI) indicated the "hazard" of completion, such that HRs > 1 indicated a reduced transit time. A total of 100 patients were included. VCE was completed in 93 patients (93 %). The median step count was 2782 steps. Step count was not significantly associated with VCE completion (odds ratio 1.45, 95 %CI 0.84, 2.49). Pedometer step count was significantly associated with shorter total, gastric, and small-bowel transit times (HR 1.09, 95 %CI 1.03, 1.16; HR 1.05, 95 %CI 1.00, 1.11; HR 1.07, 95 %CI 1.01, 1.14, respectively). Higher body mass index (BMI) was significantly associated with VCE completion (HR 1.87, 95 %CI 1.18, 2.97) and shorter bowel transit times (HR 1.05, 95 %CI 1.02, 1.08). Increased physical activity during outpatient VCE was associated with shorter bowel transit times but not with study completion. In addition, BMI was a previously unreported clinical characteristic associated with VCE completion and should be included as a variable of interest in future studies.

Pedometer

Gastrointestinal transit

10.1055/s-0043-115385

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Citations (16)

Risk Factors and Outcomes Associated with Prolonged Subtherapeutic Anticoagulation with Bivalirudin: A Retrospective Cohort Study

Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy (2019)

Libby Orzel Erik Abel Danielle Blais Tzu‐Fei Wang Kyle Porter

Bivalirudin, a direct thrombin inhibitor, is a treatment option for the management of heparin-induced thrombocytopenia (HIT) and other coagulation disorders. To date, no published studies have identified patients at risk for or the consequence of subtherapeutic bivalirudin therapy.The primary objective was to identify factors associated with failure to achieve early therapeutic anticoagulation (ETA) with bivalirudin, defined as achievement of two consecutive therapeutic activated partial thromboplastin times (aPTTs) within 24 hours. Secondary objectives included evaluating whether failure to achieve ETA was a risk factor for clinical outcomes of interest including thromboembolism, hemorrhage, and mortality.This was a retrospective cohort study. Patients between the ages of 18 and 89 years treated with bivalirudin for 24 hours or longer were identified and classified as either achieving or failing to achieve ETA.Nonadherence to the dosing protocol (odds ratio [OR] 1.7, 95% confidence interval [CI] 1.07-2.71) and creatinine clearance (CrCl) of 60 ml/min or greater (OR 2.99, 95% CI 1.12-7.97) were significantly associated with failure to achieve ETA in univariate analyses. Conversely, increasing age (OR 0.98, 95% CI 0.97-0.99) was significantly associated with achievement of ETA. Failure to achieve ETA was associated with a 4-fold increase in the odds of thromboembolism.Younger age, normal renal function, and nonadherence to the dosing protocol when targeting therapeutic anticoagulation is associated with increased risk of failure to achieve ETA. This confers an elevated risk of thromboembolism when using bivalirudin for the management of HIT or other coagulation disorders.

Bivalirudin

10.1002/phar.2335

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Citations (0)

Outpatient Ultrafiltration as an Alternative to Hospitalization for Mild to Moderate Decompensated Heart Failure

Journal of Cardiac Failure (2013)

Sitaramesh Emani Jennifer Host Tara Baxter Todd Yamokoski Matthew Potter

Ultrafiltration (renal)

10.1016/j.cardfail.2013.06.280

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111 Clinical Utility of EUS-Guided Needle-Based Confocal Endomicroscopy of Pancreatic Cystic Lesions for Surgical Decision Making

The American Journal of Gastroenterology (2019)

Somashekar G. Krishna Phil A. Hart Anjuli Luthra Kyle Porter George Papachristou

INTRODUCTION: There is a need to assess the clinical impact of utilizing EUS-guided needle-based confocal endomicroscopy (nCLE) in the surgical management of PCLs. Hence, we sought to evaluate the concordance of diagnoses using the standard of care (SOC) clinical data with EUS-nCLE, and the impact on surgical resections of PCLs. METHODS: Subjects included consecutive patients enrolled in a prospective study (2015–2018) evaluating EUS-nCLE for the diagnosis of PCLs who underwent a clinically indicated EUS-FNA, along with EUS-nCLE. Data used to derive the SOC diagnosis included clinical history, cross-sectional imaging, EUS morphology, cyst fluid CEA, and cytology (based on hierarchical group assignment, Table 1). Decisions for patient management also involved multidisciplinary tumor board meetings. A final diagnosis of PCLs was defined for those with surgical histopathology or presence of established mutations in the cyst fluid (KRAS/GNAS: mucinous cyst, VHL: serous cystadenoma). The diagnostic concordance of EUS-nCLE alone with SOC was assessed. RESULTS: A total of 138 subjects with PCLs (mean cyst size 36.4 ± 15.7 mm) underwent SOC and EUS-nCLE. A final diagnosis was available in 93 subjects (surgical histopathology, n = 67, molecular markers in cyst fluid, n = 26). Diagnostic concordance was observed in 80 (86%) subjects, with a discordant nCLE diagnosis in the remaining 13 (14%) subjects. Among PCLs with discordant diagnoses (Table 2), EUS-nCLE was “ clinically advantageous ” in 11 subjects with successful downstaging of PCLs which were otherwise classified as mucinous by SOC, hence potentially preventing unwarranted surgery. In one subject, nCLE was “ clinically advantageous ” with successful upstaging of PCL (final diagnosis: IPMN), while SOC inaccurately classified the lesion as a non-mucinous PCL. EUS-nCLE was “clinically disadvantageous” in one subject (final diagnosis was mucinous cystic neoplasm) who were classified as a mucinous cyst by SOC, but nCLE did not reveal diagnostic image patterns. CONCLUSION: EUS-nCLE has a significant clinical impact by preventing at least one unwarranted pancreatic surgery for every ten subjects undergoing multimodality SOC evaluation. Hence EUS-nCLE should be considered for a comprehensive assessment of PCLs when FNA is being performed.

Concordance

Histopathology

Serous Cystadenoma

10.14309/01.ajg.0000589976.06988.fb

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Citations (0)

The Ai Act in a Law Enforcement Context: The Case of Automatic Speech Recognition for Transcribing Investigative Interviews

Radina Stoykova Kyle Porter Thomas Beka

Speech act

10.2139/ssrn.4913090

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