Emily Stockert, MD/MBA

All Publications

• Validation of Claims-Based Algorithms for Identifying Congenital Urinary Tract, Genital, Gastrointestinal, and Musculoskeletal Malformations. Pharmacoepidemiology and drug safety Fung, K., Leonard, S. A., Huybrechts, K. F., Hernandez-Diaz, S., Bateman, B. T., Straub, L., Sujan, A., Gray, K. J., Andersen, K., Chen, E. Y., El-Tayeb, K., Jeancharles, M., Mootz, A. A., Winkler, A. E., Fernando, A. M., Qin, C. X., Stockert, E. W., Mogun, H., Zhu, Y. 2026; 35 (9): e70461

  Abstract

  Congenital malformations are important outcomes when evaluating medication safety in pregnancy. However, the accuracy of claims-based algorithms for identifying organ-specific malformations remains understudied. We validated algorithms for four malformation groups: urinary tract, genital, gastrointestinal, and musculoskeletal.Using the Mass General Brigham (MGB, 2007-2020) and Stanford Medicine (2016-2023) databases, we identified infants with potential malformations of interest based on diagnosis and procedure codes within 90 days of birth. A total of 150 cases were sampled for each malformation group. Positive predictive values (PPV) were estimated to quantify the validity of the algorithms, separately by site and by International Classification of Diseases (ICD) coding system.For MGB ICD-9, MGB ICD-10, and Stanford ICD-10 algorithms, respectively, PPVs were 100%, 98.0%, and 95.8% for urinary tract malformations; 98.0%, 95.9%, and 93.8% for genital malformations; 76.0%, 78.0%, and 76.0% for gastrointestinal malformations; and 85.4%, 84.0%, and 62.0% for musculoskeletal malformations. False positives were primarily attributed to suspected malformations that were later ruled out and to broader or inaccurate coding for diagnoses that were not major malformations.Claims-based algorithms demonstrated high PPVs for urinary tract and genital malformations and moderate for gastrointestinal malformations, but there was variation in musculoskeletal PPVs between the institutions with different patient populations.

  View details for DOI 10.1002/pds.70461

  View details for PubMedID 42618046

  View details for PubMedCentralID PMC13489719

• Neuraxial labor analgesia use among racial and ethnic groups in the United States, 2016-2022. Pregnancy (Hoboken, N.J.) Martinez, E., Siadat, S., Stockert, E., Bateman, B. T., Butwick, A. J., Leonard, S. A. 2025; 1 (6): e70127

  Abstract

  Neuraxial analgesia is the most effective modality for pain relief during labor; yet utilization varies considerably among racial and ethnic groups in the United States-representing a health disparity. Little is known about how maternal and obstetric characteristics may contribute to these differences and whether variation exists among a larger number of racial and ethnic groups. The objective of our study was to evaluate differences in neuraxial labor analgesia use among racial and ethnic groups in the United States.We analyzed vital statistics data from in-hospital spontaneous vaginal births of singletons during 2016 to 2022 in the United States (N = 26,345,765). Race and Hispanic ethnicity were considered as social constructs, measured by self-report, and combined into seven racial and ethnic groups for analysis. The outcome of interest was neuraxial labor analgesia use. We conducted sequentially adjusted multivariable modified Poisson regression models to estimate relative risks (RRs) with 95% confidence intervals (CIs) for associations between racial and ethnic groups and neuraxial labor analgesia. We first adjusted for delivery year and maternal characteristics: age, body mass index, insurance status, and educational background. We then additionally adjusted for obstetric characteristics: timing of prenatal care initiation, gestational age at delivery, and obstetric history (prior live birth and prior cesarean birth). We further descriptively assessed variation in utilization among Asian, Native Hawaiian or Other Pacific Islander (NHOPI), and Hispanic subgroups.The rate of neuraxial labor analgesia use was 74% among 15,373,550 spontaneous vaginal, singleton births in the United States. White individuals had the highest rate (78%), and NHOPI and American Indian and Alaska Native (AI/AN) individuals had the lowest rates (58% and 61%, respectively) of use. After adjustment for covariates, the RR of using neuraxial labor analgesia was lowest in NHOPI individuals (0.78; 95% CI, 0.77-0.79) and AI/AN individuals (0.82; 95% CI, 0.82-0.82) compared with White individuals. The fully adjusted RRs were 0.93 (95% CI, 0.93-0.93) for Hispanic individuals, 0.98 (95% CI, 0.98-0.98) for Asian individuals, 0.96 (95% CI, 0.96-0.96) for Black individuals, and 0.97 (95% CI, 0.97-0.98) for multiracial individuals. In a secondary analysis, utilization ranged from 70% to 82% among Asian subgroups, 60% to 69% among NHOPI subgroups, and 64% to 81% among Hispanic subgroups.Neuraxial labor analgesia use in the United States was lowest among NHOPI and AI/AN individuals, independent of measured maternal and obstetric characteristics. Efforts are needed to understand and address disparities in contemporary practice with a particular focus on healthcare access and NHOPI and AI/AN communities.

  View details for DOI 10.1002/pmf2.70127

  View details for PubMedID 42597099

  View details for PubMedCentralID PMC13344680

• Quantification of breath metabolites in labouring<i> versus</i> non-labouring patients: a feasibility study BRITISH JOURNAL OF ANAESTHESIA Hengelage, J., Fowler, C., Goldsberry, M. D., Stockert, E., Bekemeyer, Z., Lee, H., Wagner, N., Sultan, P., Carvalho, B., Gross, E. R. 2025; 135 (5): 1373-1375

  Abstract

  clinicaltrials.gov NCT04564196.

  View details for Web of Science ID 001603979700029

  View details for PubMedID 40930875

• Quantification of breath metabolites in labouring versus non-labouring patients: a feasibility study. British journal of anaesthesia Hengelage, J., Fowler, C., Goldsberry, M. D., Stockert, E., Bekemeyer, Z., Lee, H., Wagner, N. M., Sultan, P., Carvalho, B., Gross, E. R. 2025

  Abstract

  clinicaltrials.gov NCT04564196.

  View details for DOI 10.1016/j.bja.2025.07.081

  View details for PubMedID 40930875

• Trends in Neuraxial Labor Analgesia Utilization: Reply. Anesthesiology Stockert, E., Siadat, S., Bateman, B. T., Martinez, E., Butwick, A. J., Leonard, S. A. 2025; 143 (3): 782-783

  View details for DOI 10.1097/ALN.0000000000005573

  View details for PubMedID 40793809

• Trends in Neuraxial Labor Analgesia Utilization by Race and Ethnicity among Nulliparous Individuals Undergoing Spontaneous Vaginal Delivery, United States, 2007 to 2022. Anesthesiology Stockert, E., Siadat, S., Bateman, B. T., Martinez, E., Butwick, A. J., Leonard, S. A. 2025; 142 (2): 409-411

  View details for DOI 10.1097/ALN.0000000000005274

  View details for PubMedID 39807921

• Continuous wound infusion catheter as part of a multimodal analgesia regimen for post-Caesarean delivery pain: a quality improvement impact study. BJA open Fowler, C., Stockert, E., Hoang, D., Guo, N., Riley, E., Sultan, P., Carvalho, B. 2024; 9: 100242

  Abstract

  The role of continuous wound infusion catheters as part of a multimodal analgesia strategy after Caesarean delivery is unclear. We introduced continuous wound infusion catheters to our multimodal analgesia regimen to evaluate the impact on analgesic outcomes after Caesarean delivery.After institutional review board (IRB) approval, a 4-month practice change was instituted as a quality improvement initiative. In addition to multimodal analgesia, continuous wound infusion catheters for up to 3 days were offered on alternate weeks for all women undergoing Caesarean deliveries. The primary outcome was postoperative in-hospital opioid consumption. Secondary outcomes were static and dynamic pain scores at 24 and 72 h, time until first analgesic request, opioid-related side-effects, length of stay, satisfaction (0-100%), and continuous wound infusion catheter-related complications.All women scheduled for Caesarean delivery (n=139) in the 4-month period were included in the analysis, with 70 women receiving continuous wound infusion catheters, and 69 in the control group. Opioid consumption (continuous wound infusion catheter group 11.3 [7.5-61.9] mg morphine equivalents vs control group 30.0 [11.3-48.8] mg morphine equivalents), pain scores (except 24 h resting pain scores which were higher in the control group 2 [1-3] vs 1.5 [0-3] in the continous wound infusion catheters group; P=0.05), side-effects, length of stay, and complications were similar between groups. Satisfaction scores at 24 h were higher with continuous wound infusion catheters (100% [91-100%] vs 90% [86-100%]; P=0.003) with no differences at 72 h. One patient demonstrated symptoms of systemic local anaesthetic toxicity which resolved without significant harm.The addition of continuous wound infusion catheters to a multimodal analgesia regimen for post-Caesarean delivery pain management demonstrated minimal clinically significant analgesic benefits. Future studies are needed to explore the use of continuous wound infusion catheters in populations that may benefit most from this intervention.

  View details for DOI 10.1016/j.bjao.2023.100242

  View details for PubMedID 38179106

  View details for PubMedCentralID PMC10761342

• A Cost and Waste-Savings Comparison Between Single-Use and Reusable Pulse Oximetry Sensors Across US Operating Rooms. Anesthesia and analgesia Stockert, E. W., Carvalho, B., Sun, E. C. 2024

  Abstract

  BACKGROUND: Operating room (OR) expenditures and waste generation are a priority, with several professional societies recommending the use of reprocessed or reusable equipment where feasible. The aim of this analysis was to compare single-use pulse oximetry sensor stickers ("single-use stickers") versus reusable pulse oximetry sensor clips ("reusable clips") in terms of annual cost savings and waste generation across all ORs nationally.METHODS: This study did not involve patient data or research on human subjects. As such, it did not meet the requirements for institutional review board approval. An economic model was used to compare the relative costs and waste generation from using single-use stickers versus reusable clips. This model took into account: (1) the relative prices of single-use stickers and reusable clips, (2) the number of surgeries and ORs nationwide, (3) the workload burden of cleaning the reusable clips, and (4) the costs of capital for single-use stickers and reusable clips. In addition, we also estimated differences in waste production based on the raw weight plus unit packaging of single-use stickers and reusable clips that would be disposed of over the course of the year, without any recycling interventions. Estimated savings were rounded to the nearest $0.1 million.RESULTS: The national net annual savings of transitioning from single-use stickers to reusable clips in all ORs ranged from $510.5 million (conservative state) to $519.3 million (favorable state). Variability in savings estimates is driven by scenario planning for replacement rate of reusable clips, workload burden of cleaning (ranging from an additional expense of $618k versus a cost savings of $309k), and cost of capital-interest gained on investment of capital that is freed up by the monetary savings of a transition to reusable clips contributes between $541k (low-interest rates of 2.85%) and $1.3 million (high-interest rates of 7.08%). The annual waste that could be diverted from landfill by transitioning to reusable clips was found to be between 587 tons (conservative state) up to 589 tons (favorable state). If institutions need to purchase new vendor monitors or cables to make the transition, that may increase the 1-time capital disbursement.CONCLUSIONS: Using reusable clips versus single-use stickers across all ORs nationally would result in appreciable annual cost savings and waste generation reduction impact. As both single-use stickers and reusable clips are equally accurate and reliable, this cost and waste savings could be instituted without a compromise in clinical care.

  View details for DOI 10.1213/ANE.0000000000006778

  View details for PubMedID 38195082

• Expert Consensus Regarding Core Outcomes for Enhanced Recovery after Cesarean Delivery Studies: A Delphi study. Anesthesiology Sultan, P., George, R., Weiniger, C. F., El-Boghdadly, K., Pandal, P., Carvalho, B., CRADLE Study Investigators, Ansari, J. R., Benhamou, D., Baluku, M., Bernstein, P. S., Bollag, L. A., Bowden, S. J., Fay, E., Habib, A. S., Halder, S., Landau, R., Lim, G., Liu, V., Moreno, C., Nelson, G. S., Powell, M. F., Pujic, B., Sharawi, N., Singh, N., Smith, R., Stockert, E., Sultan, E., Tiouririne, M., Wilson, R. D., Wrench, I. J., Yun, R., Zakowski, M. 2022

  Abstract

  BACKGROUND: Heterogeneity among reported outcomes from enhanced recovery after cesarean delivery impact studies is high. This study aimed to develop a standardized enhanced recovery core outcome set for use in future enhanced recovery after cesarean delivery studies.METHODS: An international consensus study involving physicians, patients and a director of Midwifery and Nursing Services, was conducted using a three-round modified Delphi approach (2 rounds of electronic questionnaires and a 3rd round e-discussion), to produce the core outcome set. An initial list of outcomes was based on a previously published systematic review. Consensus was obtained for the final core outcome set, including definitions for key terms, and preferred units of measurement. Strong consensus was defined as ≥70% agreement and weak consensus as 50-69% agreement. Of the 64 stakeholders who were approached, 32 agreed to participate. All 32, 31 and 26 stakeholders completed Rounds 1, 2 and 3, respectively.RESULTS: The number of outcomes in the final core outcome set was reduced from 98 to 15. Strong consensus (≥70% stakeholder agreement) was achieved for 15 outcomes. The core outcome set included: length of hospital stay; compliance with enhanced recovery protocol; maternal morbidity (hospital re-admissions or unplanned consultations); provision of optimal analgesia (maternal satisfaction, compliance with analgesia, opioid consumption / requirement and incidence of nausea or vomiting); fasting times; breastfeeding success; and times to mobilization and urinary catheter removal. The Obstetric Quality of Recovery-10 item composite measure was also included in the final core outcome set. Areas identified as requiring further research included readiness for discharge and analysis of cost savings.CONCLUSIONS: Results from an international consensus to develop a core outcome set for enhanced recovery after cesarean delivery are presented. These are outcomes that could be considered when designing future enhanced recovery studies.

  View details for DOI 10.1097/ALN.0000000000004263

  View details for PubMedID 35511169

• Assessing the Magnitude and Costs of Intraoperative Inefficiencies Attributable to Surgical Instrument Trays JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS Stockert, E., Langerman, A. 2014; 219 (4): 646-655

  Abstract

  Efficiency in the operating room has become a topic of great interest. This study aimed to quantify the percent use of instruments among common instrument trays across 4 busy surgical services: Otolaryngology, Plastic Surgery, Bariatric Surgery, and Neurosurgery. We further aimed to calculate the costs associated with tray and instrument sterilization, as well as the implications of missing or damaged instruments.This was a single-site, observational study conducted on the surgical instrumentation at a large academic medical center in Chicago. Data were collected through direct observation by a trained investigator. Operating room instrument use and labor time required for cleaning and repacking instrument trays in central sterile processing (CSP) were analyzed using descriptive statistics and linear regression. Institutional data on volume and expenses were gathered from hospital leadership.Forty-nine procedures and 237 individual trays were observed. Average instrument (±SD)use rates were 13.0% for Otolaryngology (±4.2%), 15.5% for Plastic Surgery (±2.9%), 18.2% for Bariatric Surgery (±5.0%), and 21.9% for Neurosurgery (±1.7%). An increasing number of instruments per tray was associated with decreased use and increased instrument error rate. Using recorded labor time, the cost of cleaning and repackaging an individual instrument was calculated to be $0.10. Adding in CSP operating expenses and instrument depreciation per use, total processing cost per instrument increases to $0.51 or more.Our study demonstrates that the percent use of instruments across surgical specialties and multiple tray types is low. Attention to tray composition may result in immediate and significant cost savings.

  View details for DOI 10.1016/j.jamcollsurg.2014.06.019

  View details for Web of Science ID 000342422500008

  View details for PubMedID 25154669