Dong Gi Hur

All Publications

• Trauma Activation Fees Among For-profit and Nonprofit Trauma Centers: Hierarchical Spatial Clustering Analysis of Regional Market Competition, and Socioeconomic Characteristics of Neighboring Residents. Annals of surgery Hur, D. G., Hameed, S. M., Choi, J. 2025

  Abstract

  Compare trauma activation fees (TAFs) between for-profit and nonprofit trauma centers within granular geographic clusters, accounting for regional market competition and socioeconomic factors.TAFs remain unregulated, and evidence suggests higher fees among for-profit centers. Evaluating whether these differences are justified requires examining trauma centers within geographic clusters alongside market and socioeconomic characteristics.This cross-sectional study analyzed TAFs at American College of Surgeons Committee-on-Trauma-verified level 1-3 trauma centers. Clusters were identified using hierarchical density-based spatial clustering. We obtained market competition and socioeconomic data of residents within one-hour driving distance. Mixed-effects regression assessed associations between TAFs and ownership status.Among 55 clusters of trauma centers (N=546), 26 included both for-profit and nonprofit centers. Within these, median (IQR) tier 1 TAFs were higher in for-profit centers ($29,000[20,000-38,000] vs. $11,000[7,800-15,000]; P<0.001). Residents near for-profit centers had greater socioeconomic disadvantage (Area-Deprivation-Index: 42.3[27.3] vs. 33.9[28.0], SMD=-0.30) and higher exposure to concentrated markets (Herfindahl-Hirschman Index >2500: 29.4% vs. 14.9%, SMD= 0.56). We found no significant association between TAFs and for-profit status alone (β=870[-2,830-4,580]; P=0.64), but a significant interaction between for-profit status and level 1/2 centers (β=15,300[15,100-15,600]; P<0.001).Among level 1/2 trauma centers, for-profit status was associated with higher TAFs after accounting for clustering, socioeconomic, and market factors. Negotiated payor fees or cash prices remain unclear, yet higher TAFs among for-profit centers warrant further investigation. Until the drivers of TAF differences are clarified, higher fees at for-profit centers and the need for regulation warrant further investigation.

  View details for DOI 10.1097/SLA.0000000000006999

  View details for PubMedID 41413795

• US Capacity for Critical Care in a Mass Casualty Incident. JAMA surgery Green, A., Le, A., Hur, D. G., Choi, J., Staudenmayer, K., Ibrahim, A. M., Sheckter, C. C. 2025

  View details for DOI 10.1001/jamasurg.2025.2476

  View details for PubMedID 40737030

  View details for PubMedCentralID PMC12311815

• Using Circulating Tumor DNA to Monitor Sarcoma Treatment and Recurrence Sun, B. J., Yue, T. M., Hur, D., Allen, J., Delitto, D., Poultsides, G., Lee, B. SPRINGER. 2025: S32-S33

  View details for Web of Science ID 001610671600060

• Increasing Utilization of Database Studies in Surgical Oncology Literature Sun, B. J., Yue, T. M., Hur, D., Sakamoto, M., Doan, A., Lee, B. SPRINGER. 2025: S275

  View details for Web of Science ID 001610671600591

• Predictive Value of Magnetic Resonance Complete Response After Neoadjuvant Therapy for Rectal Cancer. The Journal of surgical research Liu, C., Boncompagni, A. C., Perrone, K. H., Agarwal, A. A., Hur, D. G., Lopez, I., Sheth, V., Morris, A. M. 2025; 306: 474-478

  Abstract

  Previous research has demonstrated that after neoadjuvant therapy for rectal cancer, the sensitivity of magnetic resonance complete response (mrCR) for detecting pathologic complete response (pCR) in the surgical specimen ranges from 74 to 94%. Patient and provider interest in nonoperative management of rectal cancer that responds favorably to neoadjuvant therapy has grown, necessitating stronger evidence for how well radiographic complete response truly predicts pCR. We sought to determine the current association between mrCR and pCR in locally advanced rectal cancer.We conducted a retrospective cohort study of patients with rectal adenocarcinoma who underwent neoadjuvant chemoradiation followed by index proctectomy at a single academic referral center from January 2012 to December 2021. Our primary outcomes were mrCR, defined as the absence of residual disease on restaging MRI, and pCR, defined as the absence of residual adenocarcinoma in surgical pathology specimens.Among 523 eligible patients, 157 met the inclusion criteria (38.9% females; 51.0% nonwhite; mean [SD] age, 58.6 [13.2] years). Overall, 8.9% of patients had mrCR and 7.0% had pCR. The sensitivity and positive predictive value of mrCR were 36.4% (95% CI: 10.9 to 69.2) and 28.6% (95% CI: 8.4 to 58.1). Our findings were qualitatively unchanged when only patients in the last 5 years of the study period were included. Study limitations include that neoadjuvant therapy regimens were not standardized and patients who were offered and elected to undergo nonoperative management were not included.The value of mrCR in predicting pathologic response following neoadjuvant therapy in locally advanced rectal cancer is low, and mrCR should be interpreted with caution when counseling patients about nonoperative management. Early, frequent surveillance is critical in patients who elect nonoperative management after mrCR.

  View details for DOI 10.1016/j.jss.2024.12.042

  View details for PubMedID 39874930

• Circulating Tumor DNA in the Monitoring of Soft Tissue Sarcoma Treatment and Recurrence. Annals of surgical oncology Sun, B. J., Li, A. Y., Hur, D. G., Zhou, M., Poultsides, G. A., Delitto, D. J., Lee, B. 2024

  View details for DOI 10.1245/s10434-024-15902-9

  View details for PubMedID 39060690

  View details for PubMedCentralID 10119774

• The burden of readmissions after rib fractures among older adults. Surgery Choi, J., Hur, D. G., Tennakoon, L., Spain, D. A., Staudenmayer, K. 2024

  Abstract

  The index hospitalization morbidity and mortality of rib fractures among older adults (aged ≥65 years) is well-known, yet the burden and risks for readmissions after rib fractures in this vulnerable population remain understudied. We aimed to characterize the burdens and etiologies associated with 3-month readmissions among older adults who suffer rib fractures. We hypothesized that readmissions would be common and associated with modifiable etiologies.This survey-weighted retrospective study using the 2017 and 2019 National Readmissions Database evaluated adults aged ≥65 years hospitalized with multiple rib fractures and without major extrathoracic injuries. The main outcome was the proportion of patients experiencing all-cause 3-month readmissions. We assessed the 5 leading principal readmission diagnoses overall and delineated them by index hospitalization discharge disposition (home or facility). Sensitivity analysis using clinical classification categories characterized readmissions that could reasonably represent rib fracture-related sequelae.In 2017, 25,092 patients met the inclusion criteria, with 20% (N = 4,894) experiencing 3-month readmissions. Six percent of patients did not survive their readmission. The 5 leading principal readmission diagnoses were sepsis (many associated with secondary diagnoses of pneumonia [41%] or urinary tract infections [41%]), hypertensive heart/kidney disease, hemothorax, pneumonia, and respiratory failure. In 2019, a comparable 3-month readmission rate of 23% and identical 5 leading diagnoses were found. Principal readmission diagnosis of hemothorax was associated with the shortest time to readmission (median [interquartile range]:9 [5-23] days). Among patients discharged home after index hospitalization, pleural effusion-possibly representing mischaracterized hemothorax-was among the leading principal readmission diagnoses. Some patients readmitted with a principal diagnosis of hemothorax or pleural effusion had these diagnoses at index hospitalization; a lower proportion of these patients underwent pleural fluid intervention during index hospitalization compared with readmission. On sensitivity analysis, 30% of 3-month readmissions were associated with principal diagnoses suggesting rib fracture-related sequelae.Readmissions are not infrequent among older adults who suffer rib fractures, even in the absence of major extrathoracic injuries. Future studies should better characterize how specific complications associated with readmissions, such as pneumonia, urinary tract infections, and delayed hemothoraces, could be mitigated.

  View details for DOI 10.1016/j.surg.2024.05.021

  View details for PubMedID 38880698

• Pediatric Trauma Center Access, Regional Injury Burden, and Socioeconomic Disadvantage. JAMA surgery Hur, D. G., Ren, A. L., Yue, T. M., Spain, D. A., Choi, J. 2024

  View details for DOI 10.1001/jamasurg.2024.0962

  View details for PubMedID 38748438

• Access to Burn Care in the US. JAMA surgery Hur, D. G., Yao, J., Yue, T. M., Sheckter, C. C., Choi, J. 2024

  Abstract

  This cross-sectional study examines burn incidence rates and accessibility of American Burn Association-verified or self-designated burn centers from 2013 to 2019.

  View details for DOI 10.1001/jamasurg.2023.7763

  View details for PubMedID 38353985

• Detection of Circulating Tumor DNA Predicts Recurrence in Soft Tissue Sarcomas Sun, B. J., Li, A., Alobuia, W., Hur, D., Daniel, S. K., Kirane, A. R., Poultsides, G., Lee, B. SPRINGER. 2023: S16

  View details for Web of Science ID 001046841200028

• Predictive Value of Clinical Complete Response after Chemoradiation for Rectal Cancer Liu, C., Boncompagni, A. A., Perrone, K., Agarwal, A., Hur, D. G., Lopez, I., Sheth, V., Morris, A. M. LIPPINCOTT WILLIAMS & WILKINS. 2022: S51-S52

  View details for DOI 10.1097/01.XCS.0000893308.54894.46

  View details for Web of Science ID 000867889300080