Justine Chinn

All Publications

• Weight Trajectory in Young People Undergoing Sleeve Gastrectomy: Does Age Make a Difference? A Children's Obesity Surgery Multi-Institutional Collaborative (COSMIC) Analysis. Obesity surgery Rodrigues de Oliveira Filho, J., Kochis, M. A., Shacker, M., Brennan, K., Bizimana, C. B., Stetson, A. E., Chinn, J. O., Pratt, J. S., Griggs, C., Hornick, M. 2026

  View details for DOI 10.1007/s11695-026-08636-y

  View details for PubMedID 41944991

  View details for PubMedCentralID 4060250

• Social Vulnerability and Age at Sleeve Gastrectomy among Adolescents: Does ZIP Code Make a Difference? - A COSMIC Retrospective Study OBESITY SURGERY Rodrigues de Oliveira Filho, J., Pratt, J. S. A., Chinn, J. O., Bowen-Jallow, K., Hornick, M., Griggs, C. L. 2026

  View details for DOI 10.1007/s11695-025-08475-3

  View details for Web of Science ID 001655830500001

  View details for PubMedID 41501578

  View details for PubMedCentralID 9805112

• Pediatric metabolic and bariatric surgery: When is the right time to operate? Current problems in pediatric and adolescent health care Shacker, M., Chinn, J., Pratt, J. S., Fell, G. L. 2025: 101882

  Abstract

  Pediatric obesity is a growing epidemic associated with serious long-term health consequences, including diabetes, cardiovascular disease, and reduced life expectancy. Metabolic and bariatric surgery (MBS) is a safe, effective, and durable treatment for adolescents with severe or refractory obesity; however, it remains significantly underutilized. As a consequence, children with severe obesity and associated comorbidities progress to an advanced stage of disease that can be even more challenging to treat than in adults. Current evidence demonstrates that MBS in adolescents achieves comparable or even superior weight loss and comorbidity resolution compared to adults, with favorable long-term safety profiles. In select cases, GLP-1 receptor agonists (GLP-1RAs), may be used as an adjunct to MBS. Current evidence for GLP-1RA use in the preoperative period is limited, although when reinitiated early in the postoperative period, they may be associated with improved weight loss outcomes. Despite strong guideline support, <0.05 % of eligible children undergo MBS, likely due to poor access to adolescent MBS centers, limited insurance coverage, and a lack of awareness or misinformation surrounding MBS, among other causes. Multidisciplinary support including preoperative teaching, mental health services, and long-term postoperative follow-up is essential to the success of the procedure. Further research is needed to better characterize the disparities in access, improve outreach and education efforts, combat the stigma associated with adolescent MBS, and address this growing public health crisis.

  View details for DOI 10.1016/j.cppeds.2025.101882

  View details for PubMedID 41344950

• The impact of social determinants of health on adolescent metabolic and bariatric surgical outcomes. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery Chinn, J. O., Herdes, R. E., Shacker, M., Santos, V., Fell, G. L., Pratt, J. S. 2025

  Abstract

  Prior research has shown higher rates of complications across a broad spectrum of surgeries in pediatric patients with higher Social Vulnerability Index (SVI).This study aims to compare how SVI impacts outcomes in adolescents undergoing metabolic and bariatric surgery (MBS).Academic Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program-adolescent accredited care center METHODS: We performed a retrospective cohort study of 126 adolescents and young adults undergoing laparoscopic sleeve gastrectomy between September 2014 and April 2021. Comparative analysis was performed for demographics, percent total body weight loss (%TBWL), and complications between those with high (≥ .75) and low (<.75) SVI.There were 47 patients in the high SVI group and 79 in the low SVI group. Age at surgery, gender, primary language, and insurance type were similar between groups. Preoperative weight and body mass index (BMI) were higher in the high SVI group compared to the low SVI group (145 kg vs 136 kg, P = .033, BMI 52 vs 46, P < .001). Average distance to the hospital was similar (82 miles in high SVI group vs 100 miles in low SVI group, P = .079). The high SVI group had a trend towards a higher percentage of patients who identified as Hispanic/Latino (64% vs 47%, P = .064) and less patients who identified as white (28% vs 51%, P = .054). There was no significant difference in mean %TBWL at 3 months, 6 months, or 12 months (23% in high SVI group (N = 40) compared to 22% in low SVI group (N = 66), P = .4). Complication rates were low in both groups, with no difference between SVI groups (6.5% vs 5.1%, P = .707). While the number of patients with long-term data decreased over time, there was no difference in %TBWL at 2, 3, or 4 years after surgery.Despite a diverse patient population and significant geographic barriers, the outcomes between high and low SVI in this cohort were comparable. Continued efforts need to be made to expand access to MBS for socioeconomic disadvantaged adolescent patients with obesity.

  View details for DOI 10.1016/j.soard.2025.11.009

  View details for PubMedID 41339175

• The impact of preoperative antiobesity medications on weight loss in adolescents undergoing metabolic and bariatric surgery - a COSMIC study. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery Chinn, J. O., Shacker, M., Brennan, K. A., Kochis, M., Stetson, A., Bizimana, C., Rodrigues de Oliveira Filho, J., Hornick, M. A., Pratt, J. S., Abu El Haija, M., Griggs, C. 2025

  Abstract

  While new medications are transforming the management of obesity, their association with outcomes in adolescents undergoing metabolic and bariatric surgery (MBS) is not clear.The objective was to determine how preoperative prescription of antiobesity medications (AOMs) is associated with postoperative weight loss after MBS.The study was conducted using data from 3 academic children's hospitals, spanning the period from March 2013 to September 2024.This is a retrospective review in which demographics, obesity-related diseases, preoperative and postoperative weight and body mass index (BMI) were compared between patients who were treated preoperatively with topiramate or glucagon-like peptide-1 receptor agonists (GLP-1RAs) and those who were not. Statistical analyses included Wilcoxon rank-sum, Pearson's χ2, and Fisher's exact tests, plus 1:1 propensity score matching and multivariable linear regression sensitivity models adjusting for time-to-surgery.Of 324 patients, 22 were treated with topiramate and 30 with a GLP-1RA. Rates of obesity-related diseases were similar. Patients on GLP-1RA lost weight from first consultation to surgery (-2% BMI), while those on no medication gained (+1% BMI) and those on topiramate remained stable (0%, P = .023). There was no difference in weight/BMI at the time of surgery; however, patients pretreated with medications lost less weight than those not taking medications at 6 months (no medications: -20% BMI reduction; GLP-1RA: -18%; topiramate: -17%, P = .017) and 12 months (no medications -23% BMI reduction, GLP-1RA -15%, topiramate -17%, P = .015). From initial consultation to 12 months after surgery, the differences in weight loss between groups were not significant (P = .072).Preoperative exposure to topiramate or GLP-1RA was associated with less postoperative weight loss, despite similar starting weights/BMIs. Total weight loss from consultation through 12 months did not differ significantly between groups. These findings raise important questions regarding the use and timing of obesity management medications in relation to surgery for adolescents.

  View details for DOI 10.1016/j.soard.2025.10.014

  View details for PubMedID 41353013

• Timing of Antiobesity Medications and Adolescent Metabolic and Bariatric Surgery. JAMA surgery Chinn, J. O., Shacker, M., Brennan, K. A., Esquivel, M. M., Pratt, J. S. 2025

  View details for DOI 10.1001/jamasurg.2025.4430

  View details for PubMedID 41123888

  View details for PubMedCentralID PMC12547670

• ASO Visual Abstract: Comparison of Two Wireless Localization Technologies for Removal of Nonpalpable Breast Lesions-SCOUT® Radar Reflector and Pintuition® Magnetic Seed. Annals of surgical oncology Chinn, J., Earley, M., Dashevsky, B. Z., Stone, K., Thompson, C. N., Bao, J. 2025

  View details for DOI 10.1245/s10434-025-18560-7

  View details for PubMedID 41099957

• Does the MBSAQIP Bariatric Surgical Risk/Benefit Calculator Accurately Predict Weight Loss in Adolescents? Obesity surgery Kochis, M. A., Chinn, J. O., Nzenwa, I. C., Brennan, K. A., Pratt, J. S., Griggs, C. L. 2025

  Abstract

  BACKGROUND: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) online calculator incorporates individual patient data to predict weight loss up to 1year after MBS, but it was derived from an adult database and has not been validated in younger cohorts. This study evaluates the accuracy of this calculator for adolescent MBS patients and explores patient factors which may be associated with prediction inaccuracy.METHODS: We include patients age≤21 who underwent laparoscopic sleeve gastrectomy at two major academic institutions from 2013 to 2023. Data were stratified between patients age<18 and 18-21. The calculator's predictions were compared to actual weight loss values at 1year. Relationships between various preoperative variables and the difference between predicted and actual weight loss were assessed using correlation, regression, and t-tests.RESULTS: There were 265 patients, with 176 age<18. The correlation coefficients for predicted and actual weight loss were 0.48 for patients age<18 and 0.38 for patients 18-21. On average, the proportion of predicted weight loss actually attained at 1year was 0.73. There were no statistically significant associations between calculator inaccuracy and patient age, sex, preoperative body mass index, or area deprivation index (all p>0.05).CONCLUSIONS: The MBASQIP calculator predictions show weak to moderate correlation with actual weight loss at 1year and should be used with caution when counseling pediatric patients considering MBS. This project underscores the importance of building multi-institutional collaborations and databases specific to the pediatric MBS context.

  View details for DOI 10.1007/s11695-025-08295-5

  View details for PubMedID 41068350

• ASO Author Reflections: From Performance to Preference: Wireless Localization Technologies in Breast Surgery. Annals of surgical oncology Chinn, J., Bao, J. 2025

  View details for DOI 10.1245/s10434-025-18465-5

  View details for PubMedID 41028640

  View details for PubMedCentralID 4933133

• Comparison of Two Wireless Localization Technologies for Removal of Non-palpable Breast Lesions: SCOUTRadar Reflector and PintuitionMagnetic Seed. Annals of surgical oncology Chinn, J., Earley, M., Dashevsky, B. Z., Stone, K., Thompson, C. N., Bao, J. 2025

  Abstract

  BACKGROUND: The SCOUT radar reflector (SCOUT) is a common wireless technology used for removal of non-palpable breast lesions. The Pintuition magnetic seed (Pintuition) utilizes a magnetic marker encapsulated in nickel-free titanium. This is the first study comparing surgical outcomes of SCOUT and Pintuition.METHODS: A retrospective, single-institution review was conducted evaluating lumpectomies and excisional biopsies of non-palpable breast lesions performed between May 2022 and July 2024 utilizing wireless localization for intraoperative guidance. The SCOUT was the only wireless option at our institution prior to June 2023, at which time the Pintuition seed became available. Patients with multiple localizations or oncoplastic reconstruction were excluded. Patient characteristics, procedure type, lesion characteristics, positive margin, and re-excision rates were compared using the Chi-square or Fisher's exact tests for categorical variables and Wilcoxon rank-sum test for continuous variables. Generalized linear models were used to compare surgery length and specimen volume.RESULTS: Of 90 lesions identified, 45 were localized by SCOUT and 45 by Pintuition. Age, body mass index (BMI), surgery type, neoadjuvant therapy, total specimen volume, pathologic cancer size, positive margin, and margin re-excision rates were not found to differ by device. All Pintuition seeds were removed on index operation, whereas one SCOUT was not. Surgery length was significantly shorter for Pintuition cases compared with SCOUT (median 37 min vs. 50 min; p=0.006). One patient in each group required margin re-excision.CONCLUSIONS: Operative time was significantly shorter for Pintuition cases. Pintuition represents a reliable and effective wireless localization technique. Considerations need to be given to nuanced features of each device.

  View details for DOI 10.1245/s10434-025-18354-x

  View details for PubMedID 40946252

• Bariatric Surgery: Improving Access without Compromising Outcomes. Obesity surgery Chinn, J. O., Bartoletti, S., Shen, J. X., Kulhanek, K. R., Shacker, M., Zak, Y., Azagury, D. E., Esquivel, M. M. 2025

  Abstract

  Bariatric surgery pre-operative workup mandates many multidisciplinary visits demanding patient's commitment in time and travel. Due to the COVID pandemic, our bariatric clinic transitioned to a telemedicine model. The objective of this work is to determine the impact of this shift.Our population is adults who underwent gastric bypass or sleeve gastrectomy at a single hospital between 2018 and 2022. We analyzed the impact of telemedicine on demographics, days from consultation to surgery, length of hospital stay, type of procedures, BMI, and complications. Statistical analyses were conducted using χ2 tests for categorical variables and t-test for continuous variables as well as logistic regression.Of 794 patients, 71.3% received in-person care while 28.7% received telemedicine. There were no differences in race, ethnicity, or gender. The average duration from consultation to surgery was longer (p < 0.001) for in-person (551.1 days) compared to telemedicine (375.8 days). The pre-operative BMI was higher for the in-person cohort versus telemedicine (45.5; SD 8.0 vs. 43.9; SD 6.7; p < 0.001), but there was no difference in percent weight loss at 12 months. The average length of stay was longer in the in-person group compared to telemedicine (1.9 vs 1.2 days). There was no difference in readmission or emergency department visit rates.Despite being the best treatment for severe obesity, bariatric surgery remains underutilized. When comparing telemedicine to an in-person model, we found shorter time to surgery, shorter length of stay, and similar outcomes with no difference in weight loss or complications. Telemedicine may be a safe and useful way to improve access.

  View details for DOI 10.1007/s11695-025-08222-8

  View details for PubMedID 40921958

  View details for PubMedCentralID 11325826

• Mild to moderate GERD before sleeve: Can we better predict post-operative GERD? Surgical endoscopy Chinn, J. O., Ruhi-Williams, P., Shacker, M., Esquivel, M. M., Garcia, P., Clarke, J. O., Azagury, D. E. 2025

  Abstract

  Gastroesophageal reflux disease (GERD) can be debilitating for patients after sleeve gastrectomy (SG). However, no clear numerical thresholds have been identified to help predict which patients will develop worsening symptoms post-operatively. We therefore sought to characterize which pre-operative wireless pH testing and endoscopy findings were associated with GERD after SG.Patients with a history of SG and pre-operative wireless pH studies were identified. Abnormal DeMeester score was defined as > 14.7 and abnormal acid exposure time (AET) as > 4% of time with a pH < 4. Clinically meaningful post-operative GERD was defined as GERD symptoms requiring proton pump inhibitor (PPI) therapy. We performed a univariate analysis and a Youden's index analysis to determine when DeMeester score and AET become predictive of post-operative GERD.Of 76 patients included, 41 patients (53.9%) reported pre-operative GERD symptoms. Of those with symptoms, 20% had LA Grade A or B esophagitis, 25% had a hiatal hernia, 56.1% had an elevated DeMeester score, and 58.5% had an elevated AET. Post-operatively, 13.2% (5/38) of patients with pre-operative symptoms required a PPI compared to 6.1% (p = 0.4) in patients without pre-operative symptoms. There was no difference in the rate of post-operative GERD between those with a normal vs abnormal pre-operative DeMeester (13.3% vs 13.0%, p > 0.9). In univariate analysis, abnormal DeMeester score (OR 1.25, p = 0.779), grade A or B esophagitis (OR = 1.70, p = 0.554), or abnormal AET (OR = 1.25, p = 0.779) were not predictive of post-operative GERD. However, a threshold of DeMeester score of ≥ 30 or AET ≥ 10.35 was predictive of post-operative GERD.In patients with moderate GERD, standard cutoffs of abnormal DeMeester score or AET were not predictive of post-operative GERD, however a threshold DeMeester score of ≥ 30 or AET ≥ 10.35 was predictive. Patients with such findings should be particularly counseled about the risk of post-operative GERD and/or offered a Roux-en-Y gastric bypass.

  View details for DOI 10.1007/s00464-025-12091-8

  View details for PubMedID 40877626

  View details for PubMedCentralID 10735086

• Metabolic and bariatric surgery in adolescents compared to young adults: an MBSAQIP database analysis. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery Shacker, M., Chao, S. D., Chinn, J. O., Fell, G. L., Mueller, C. M., Pratt, J. S. 2025

  Abstract

  Metabolic and bariatric surgery (MBS) is a highly durable, safe and effective treatment for severe obesity in adults. However, MBS remains underutilized in the pediatric and adolescent population, likely due to safety concerns of elective surgery in children.We aimed to analyze whether the benefits of MBS outweigh the risks in adolescents when compared to young adults.Multicenter, national database study.Patients aged 10-39 who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Patients with prior foregut surgery were excluded.556,628 patients were identified; 10,883 (2.0%) were aged 10-19 (adolescents), 161,938 (29.1%) were 20-29 (young adults), and 383,807 (69.0%) were 30-39 (adults). Preoperative body mass index (BMI) was clinically similar between groups, though statistically significant due to large sample size (10-19: 46, 20-29: 45, 30-39: 45 kg/m2, P < .001). SG was more common in younger cohorts (10-19: 86%, 20-29: 77%, 30-39: 75%, P < .001). At 30 days postoperatively, adolescents demonstrated marginally greater BMI reduction (10-19: 2.91, 20-29: 2.69, 30-39: 2.53 kg/m2, P < .001). Adolescents had fewer postoperative complications, including surgical site infections, gastrointestinal bleeding, and blood transfusions (P < .001). Among adolescents, SG (aOR: .39, CI: .31-.48, P < .001) was associated with reduced postoperative complications.Adolescents undergoing MBS have BMI reductions similar to those of young adults and have lower rates of complications and readmissions. MBS should be offered as a safe treatment for adolescents to treat morbid obesity with at least similar frequency as it is offered to adults.

  View details for DOI 10.1016/j.soard.2025.08.010

  View details for PubMedID 40946077

• Comparison of Two Non-Radioactive Wireless Localization Technologies for Removal of Non-Palpable Breast Lesions: SCOUT® Radar Reflector and Pintuition® Magnetic Seed Chinn, J., Earley, M., Dashevsky, B., Stone, K., Thompson, C., Bao, J. SPRINGER. 2025: 858-859

  View details for Web of Science ID 001610682000318

• The Impact of Socioeconomic Disadvantage on Metabolic and Bariatric Surgical Outcomes using Area Deprivation Index. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract Chinn, J. O., Kulhanek, K. R., Shen, J. X., Shacker, M., Zak, Y., Azagury, D. E., Esquivel, M. M. 2025: 102136

  View details for DOI 10.1016/j.gassur.2025.102136

  View details for PubMedID 40582560

• Pediatric Metabolic and Bariatric Surgery and Anti-Obesity Medications: Weighing Efficacy, Risks, and Future Directions. The Journal of pediatrics Chinn, J. O., Baidal, J. W., Pratt, J. S., Shepard, W. E., Fell, G. L. 2025: 114610

  View details for DOI 10.1016/j.jpeds.2025.114610

  View details for PubMedID 40252955

• The Importance of Sexual History-Taking Within Surgery ACADEMIC MEDICINE Chinn, J. O., Hawn, M. T. 2025; 100 (4): 410-412

  Abstract

  Sexual and reproductive health is an essential part of comprehensive medical care. As the field of medicine becomes more specialized and siloed and the diagnostic workup in surgery more advanced, the risk of anchoring diagnoses and partitioning of care increases. Thus, the fundamentals of a complete patient history and review of each body system remain critical in ensuring that surgeons establish a broad differential diagnosis; provide comprehensive, well-rounded care to patients; and create opportunities for patient counseling and interventions. The article by Coleman and colleagues reports on an intervention that did not result in trainees being more likely to take a sexual history; however, the intervention group did ask significantly more questions regarding sexual health than the comparison group when they did take a sexual history. They highlight that there is a persistent gap in sexual history-taking, and that this results in potential misdiagnoses as well as missed opportunities to counsel patients about sexual and reproductive health. Clinicians have a responsibility to recognize factors that increase risk for their patients and provide appropriate counseling, which they cannot do if they are not asking all the necessary questions, even the difficult ones.

  View details for DOI 10.1097/ACM.0000000000005965

  View details for Web of Science ID 001455250200018

  View details for PubMedID 39752576

• Transforming Clinical Care: The Emergence of Ambulatory Bariatric Surgery for Patients with Obesity Tennakoon, L., Chinn, J., Esquivel, M. LIPPINCOTT WILLIAMS & WILKINS. 2024: S45-S46

  View details for Web of Science ID 001348680700066

• The Impact of Area Deprivation Index on Bariatric Surgical Outcomes Chinn, J., Adams, M., Kulhanek, K. R., Shen, J. X., Tennakoon, L., Bartoletti, S., Azagury, D. E., Esquivel, M. LIPPINCOTT WILLIAMS & WILKINS. 2024: S44

  View details for Web of Science ID 001348680700063

• Comparing Accuracy of Night Radiology Interpretations for Pediatric Trauma: Radiology Residents Versus Attending Teleradiologists. The American surgeon Martino, A. M., Yeates, E. O., Grigorian, A., Chinn, J., Young, H., Colin Escobar, J., Glavis-Bloom, J., Anavim, A., Yaghmai, V., Nguyen, N. T., Dolich, M., Schubl, S. D., Goodman, L. F., Guner, Y. S., Nahmias, J. 2024; 90 (10): 2436-2441

  Abstract

  Background: Overnight radiology coverage for pediatric trauma patients (PTPs) is addressed with a combination of on-call radiology residents (RRs) and/or attending teleradiologists (ATs); however, the accuracy of these two groups has not been investigated for PTPs. We aimed to compare the accuracy of RRs vs AT interpretations of computed tomography (CT) scans for PTPs. Methods: Pediatric trauma patients (<18 years old) at a single level-I adult/level-II pediatric trauma center were studied in a retrospective analysis (3/2019-5/2020). Computed tomography scans interpreted by both RRs and ATs were included. Radiology residents were compared to ATs for time to interpretation (TTI) and accuracy compared to faculty attending radiologist interpretation, using the validated RADPEER scoring system. Additionally, RR and AT accuracies were compared to a previously studied adult cohort during the same time-period. Results: 42 PTPs (270 interpretations) and 1053 adults (8226 interpretations) were included. Radiology residents had similar rates of discrepancy (13.3% vs 13.3%), major discrepancy (4.4% vs 4.4%), missed findings (9.6% vs 12.6%), and overcalls (3.7% vs .7%) vs ATs (all P > .05). Mean TTI was shorter for RRs (55.9 vs 90.4 minutes, P < .001). Radiology residents had a higher discrepancy rate for PTPs (13.3% vs 7.5%, P = .01) than adults. Attending teleradiologists had a similar discrepancy rate for PTPs and adults (13.3% vs 8.9%, P = .07). Discussion: When interpreting PTP CT imaging, RRs had similar discrepancy rates but faster TTI than ATs. Radiology residents had a higher discrepancy rate for PTP CTs than RR interpretation of adult patients, indicating both RRs and ATs need more focused training in the interpretation of PTP studies.

  View details for DOI 10.1177/00031348241248794

  View details for PubMedID 38655777

• The Effect of 2019 Coronavirus Stay-at-Home Order on Geriatric Trauma Patients in Southern California. The American surgeon Manasa, M., Yeates, E. O., Grigorian, A., Barrios, C., Schellenberg, M., Owattanapanich, N., Barmparas, G., Margulies, D., Juillard, C., Garber, K., Cryer, H., Tillou, A., Burruss, S., Penaloza-Villalobos, L., Lin, A., Figueras, R. A., Coimbra, R., Brenner, M., Costantini, T., Santorelli, J., Curry, T., Wintz, D., Biffl, W. L., Schaffer, K. B., Duncan, T. K., Barbaro, C., Diaz, G., Johnson, A., Tay-Lasso, E., Chinn, J., Naaseh, A., Leung, A., Grabar, C., Nahmias, J. 2023; 89 (12): 6053-6059

  Abstract

  California issued stay-at-home (SAH) orders to mitigate COVID-19 spread. Previous studies demonstrated a shift in mechanisms of injuries (MOIs) and decreased length of stay (LOS) for the general trauma population after SAH orders. This study aimed to evaluate the effects of SAH orders on geriatric trauma patients (GTPs), hypothesizing decreased motor vehicle collisions (MVCs) and LOS.A post-hoc analysis of GTPs (≥65 years old) from 11 level-I/II trauma centers was performed, stratifying patients into 3 groups: before SAH (1/1/2020-3/18/2020) (PRE), after SAH (3/19/2020-6/30/2020) (POST), and a historical control (3/19/2019-6/30/2019) (CONTROL). Bivariate comparisons were performed.5486 GTPs were included (PRE-1756; POST-1706; CONTROL-2024). POST had a decreased rate of MVCs (7.6% vs 10.6%, P = .001; vs 11.9%, P < .001) and pedestrian struck (3.4% vs 5.8%, P = .001; vs 5.2%, P = .006) compared with PRE and CONTROL. Other mechanisms of injury, LOS, mortality, and operations performed were similar between cohorts. However, POST had a lower rate of discharge to skilled nursing facility (SNF) (20% vs 24.5%, P = .001; and 20% vs 24.4%, P = .001).This retrospective multicenter study demonstrated lower rates of MVCs and pedestrian struck for GTPs, which may be explained by decreased population movement as a result of SAH orders. Contrary to previous studies on the generalized adult population, no differences in other MOIs and LOS were observed after SAH orders. However, there was a lower rate of discharge to SNF, which may be related to a lack of resources due to the COVID-19 pandemic, and thus potentially negatively impacted recovery of GTPs.Keywords.

  View details for DOI 10.1177/00031348221124329

  View details for PubMedID 37347234

• Risk factors for SARS-CoV-2 seropositivity in a health care worker population during the early pandemic. BMC infectious diseases Schubl, S. D., Figueroa, C., Palma, A. M., de Assis, R. R., Jain, A., Nakajima, R., Jasinskas, A., Brabender, D., Hosseinian, S., Naaseh, A., Hernandez Dominguez, O., Runge, A., Skochko, S., Chinn, J., Kelsey, A. J., Lai, K. T., Zhao, W., Horvath, P., Tifrea, D., Grigorian, A., Gonzales, A., Adelsohn, S., Zaldivar, F., Edwards, R., Amin, A. N., Stamos, M. J., Barie, P. S., Felgner, P. L., Khan, S. 2023; 23 (1): 330

  Abstract

  While others have reported severe acute respiratory syndrome-related coronavirus 2(SARS-CoV-2) seroprevalence studies in health care workers (HCWs), we leverage the use of a highly sensitive coronavirus antigen microarray to identify a group of seropositive health care workers who were missed by daily symptom screening that was instituted prior to any epidemiologically significant local outbreak. Given that most health care facilities rely on daily symptom screening as the primary method to identify SARS-CoV-2 among health care workers, here, we aim to determine how demographic, occupational, and clinical variables influence SARS-CoV-2 seropositivity among health care workers.We designed a cross-sectional survey of HCWs for SARS-CoV-2 seropositivity conducted from May 15th to June 30th 2020 at a 418-bed academic hospital in Orange County, California. From an eligible population of 5,349 HCWs, study participants were recruited in two ways: an open cohort, and a targeted cohort. The open cohort was open to anyone, whereas the targeted cohort that recruited HCWs previously screened for COVID-19 or work in high-risk units. A total of 1,557 HCWs completed the survey and provided specimens, including 1,044 in the open cohort and 513 in the targeted cohort. Demographic, occupational, and clinical variables were surveyed electronically. SARS-CoV-2 seropositivity was assessed using a coronavirus antigen microarray (CoVAM), which measures antibodies against eleven viral antigens to identify prior infection with 98% specificity and 93% sensitivity.Among tested HCWs (n = 1,557), SARS-CoV-2 seropositivity was 10.8%, and risk factors included male gender (OR 1.48, 95% CI 1.05-2.06), exposure to COVID-19 outside of work (2.29, 1.14-4.29), working in food or environmental services (4.85, 1.51-14.85), and working in COVID-19 units (ICU: 2.28, 1.29-3.96; ward: 1.59, 1.01-2.48). Amongst 1,103 HCWs not previously screened, seropositivity was 8.0%, and additional risk factors included younger age (1.57, 1.00-2.45) and working in administration (2.69, 1.10-7.10).SARS-CoV-2 seropositivity is significantly higher than reported case counts even among HCWs who are meticulously screened. Seropositive HCWs missed by screening were more likely to be younger, work outside direct patient care, or have exposure outside of work.

  View details for DOI 10.1186/s12879-023-08284-y

  View details for PubMedID 37194021

  View details for PubMedCentralID PMC10186297

• Comparison of BMI on operative time and complications of robotic inguinal hernia repair at a VA medical center. Surgical endoscopy Chinn, J., Tellez, R., Huy, B., Farzaneh, C., Christian, A., Ramsay, J., Kim, H., Smith, B., Hinojosa, M. W. 2022; 36 (12): 9398-9402

  Abstract

  BMI is a risk factor for recurrence and post-operative complications in both open and laparoscopic totally extraperitoneal approach (TEP) repair. Robotic surgery using the transabdominal preperitoneal approach (TAPP) is a safe and viable option for inguinal hernia repair (IHR). The objective of this study is to determine how difference in BMI influences rate of operative time, complications, and rate of recurrence in a robotic TAPP IHR.We performed a retrospective review of patients who underwent robotic inguinal hernia repair between 2012 and 2019 at a Veterans Health Administration facility (N = 304). The operating time, outcomes, and overall morbidity and mortality for robotic IHR were compared between three different BMI Groups. These groups were divided into: "Underweight/Normal Weight" (BMI < 25) n = 102, "Pre-Obese" (BMI 25-29.9) n = 120, and "Obese" (BMI 30 +) n = 82.The average operating time of a bilateral IHR by BMI group was 83.5, 98.4, and 97.8 min for BMIs < 25, 25-29.9, and 30 +, respectively. Operating time was lower in the Underweight/Normal BMI group compared to the Pre-Obese group (p = 0.006) as well as the Obese group (p = 0.001). For unilateral repair, the average operation length by group was 65.2, 70.9, and 85.6 min for BMIs < 25, 25-29.9, and 30 +, respectively, demonstrating an increased time for Obese compared to Underweight/Normal BMI (p = 0.001) and for Obese compared to Pre-Obese (p = 0.01). Demographic/comorbidity variables were not significantly different, except for a higher percentage of white patients in the Underweight/Normal BMI group compared to the Pre-Obese and Obese groups (p = 0.02 and p = 0.0003). There was no significant difference in complications or recurrence.BMI has a significant impact on the operating time of both unilateral and bilateral robotic hernia repair. Despite this increased operative time, BMI group did not differ significantly in postoperative outcomes or in recurrence rates.

  View details for DOI 10.1007/s00464-022-09259-x

  View details for PubMedID 35543772

• Adolescent Trauma During the COVID Pandemic: Just Like Adults, Children, or Someone Else? The American surgeon Ruhi-Williams, P., Yeates, E. O., Grigorian, A., Schellenberg, M., Owattanapanich, N., Barmparas, G., Margulies, D., Juillard, C., Garber, K., Cryer, H., Tillou, A., Burruss, S., Penaloza-Villalobos, L., Lin, A., Figueras, R. A., Coimbra, R., Brenner, M., Costantini, T., Santorelli, J., Curry, T., Wintz, D., Biffl, W. L., Schaffer, K. B., Duncan, T. K., Barbaro, C., Diaz, G., Johnson, A., Chinn, J., Naaseh, A., Leung, A., Grabar, C., Nahmias, J. 2022; 88 (10): 2429-2435

  Abstract

  COVID-19 stay-at-home (SAH) orders were impactful on adolescence, when social interactions affect development. This has the potential to change adolescent trauma. A post-hoc multicenter retrospective analysis of adolescent (13-17 years-old) trauma patients (ATPs) at 11 trauma centers was performed. Patients were divided into 3 groups based on injury date: historical control (CONTROL:3/19/2019-6/30/2019, before SAH (PRE:1/1/2020-3/18/2020), and after SAH (POST:3/19/2020-6/30/2020). The POST group was compared to both PRE and CONTROL groups in separate analyses. 726 ATPs were identified across the 3 time periods. POST had a similar penetrating trauma rate compared to both PRE (15.8% vs 13.8%, P = .56) and CONTROL (15.8% vs 14.5%, P = .69). POST also had a similar rate of suicide attempts compared to both PRE (1.2% vs 1.5%, P = .83) and CONTROL (1.2% vs 2.1%, P = .43). However, POST had a higher rate of drug positivity compared to CONTROL (28.6% vs 20.6%, P = .032), but was similar in all other comparisons of alcohol and drugs to PRE and POST periods (all P > .05). Hence ATPs were affected differently than adults and children, as they had a similar rate of penetrating trauma, suicide attempts, and alcohol positivity after SAH orders. However, they had increased drug positivity compared to the CONTROL, but not PRE group.

  View details for DOI 10.1177/00031348221101475

  View details for PubMedID 35583103

  View details for PubMedCentralID PMC9127450

• Night Radiology Coverage for Trauma: Residents, Teleradiology, or Both? Journal of the American College of Surgeons Yeates, E. O., Grigorian, A., Chinn, J., Young, H., Colin Escobar, J., Glavis-Bloom, J., Anavim, A., Yaghmai, V., Nguyen, N. T., Nahmias, J. 2022; 235 (3): 500-509

  Abstract

  Overnight radiology coverage for trauma patients is often addressed with a combination of on-call radiology residents (RR) and a teleradiology service; however, the accuracy of these 2 readers has not been studied for trauma. We aimed to compare the accuracy of RR versus teleradiologist interpretations of CT scans for trauma patients.A retrospective analysis (March 2019 through May 2020) of trauma patients presenting to a single American College of Surgeons Level I trauma center was performed. Patients whose CT scans were performed between 10 pm to 8 am were included, because their scans were interpreted by both a RR and teleradiologist. Interpretations were compared with the final attending faculty radiologist's interpretation and graded for accuracy based on the RADPEER scoring system. Discrepancies were characterized as traumatic injury or incidental findings and missed findings or overcalls. Turnaround time was also compared.A total of 1,053 patients and 8,226 interpretations were included. Compared with teleradiologists, RR had a lower discrepancy (7.7% vs 9.0%, p = 0.026) and major discrepancy rate (3.8% vs 5.2%, p = 0.003). Among major discrepancies, RR had a lower rate of traumatic injury discrepancies (3.2% vs 4.4%, p = 0.004) and missed findings (3.4% vs 5.1%, p < 0.001), but a higher rate of overcalls (0.5% vs 0.1%, p < 0.001) compared with teleradiologists. The mean turnaround time was shorter for RR (51.3 vs 78.8 minutes, p < 0.001). The combination of both RR and teleradiologist interpretations had a lower overall discrepancy rate than RR (5.0% vs 7.7%, p < 0.001).This study identified lower discrepancy rates and a faster turnaround time by RR compared with teleradiologists for trauma CT studies. The combination of both interpreters had an even lower discrepancy rate, suggesting this combination is optimal when an in-house attending radiologist is not available.

  View details for DOI 10.1097/XCS.0000000000000280

  View details for PubMedID 35972171

• Decreased hospital length of stay and intensive care unit admissions for non-COVID blunt trauma patients during the COVID-19 pandemic. American journal of surgery Yeates, E. O., Grigorian, A., Schellenberg, M., Owattanapanich, N., Barmparas, G., Margulies, D., Juillard, C., Garber, K., Cryer, H., Tillou, A., Burruss, S., Penaloza-Villalobos, L., Lin, A., Figueras, R. A., Coimbra, R., Brenner, M., Costantini, T., Santorelli, J., Curry, T., Wintz, D., Biffl, W. L., Schaffer, K. B., Duncan, T. K., Barbaro, C., Diaz, G., Johnson, A., Chinn, J., Naaseh, A., Leung, A., Grabar, C., Nahmias, J. 2022; 224 (1 Pt A): 90-95

  Abstract

  The COVID-19 pandemic overwhelmed hospitals, forcing adjustments including discharging patients earlier and limiting intensive care unit (ICU) utilization. This study aimed to evaluate ICU admissions and length of stay (LOS) for blunt trauma patients (BTPs).A retrospective review of COVID (3/19/20-6/30/20) versus pre-COVID (3/19/19-6/30/19) BTPs at eleven trauma centers was performed. Multivariable analysis was used to identify risk factors for ICU admission.12,744 BTPs were included (6942 pre-COVID vs. 5802 COVID). The COVID cohort had decreased mean LOS (3.9 vs. 4.4 days, p = 0.029), ICU LOS (0.9 vs. 1.1 days, p < 0.001), and rate of ICU admission (22.3% vs. 24.9%, p = 0.001) with no increase in complications or mortality compared to the pre-COVID cohort (all p > 0.05). On multivariable analysis, the COVID period was associated with decreased risk of ICU admission (OR = 0.82, CI 0.75-0.90, p < 0.001).BTPs had decreased LOS and associated risk of ICU admission during COVID, with no corresponding increase in complications or mortality.

  View details for DOI 10.1016/j.amjsurg.2022.02.055

  View details for PubMedID 35219493

  View details for PubMedCentralID PMC8863305

• Outcomes of COVID-19 adults managed in an outpatient versus hospital setting. PloS one Nguyen, N. T., Chinn, J., Kirby, K., Hohmann, S. F., Amin, A. 2022; 17 (2): e0263813

  Abstract

  The coronavirus disease 2019 (COVID-19) pandemic continues to spread globally and as of February 4, 2021, there are more than 26 million confirmed cases and more than 440,000 deaths in the United States (US). A top priority of the Centers for Disease Control and Prevention (CDC) is to identify risk factors for severe COVID-19 illness. The objective of this study was to analyze the characteristics and outcomes of COVID-19 adults who were managed in an outpatient setting compared to patients who required hospitalization at US academic centers.Using the Vizient clinical database, Discharge records of adults with a diagnosis of COVID-19 between March 1, 2020 and January 31, 2021 were reviewed. Outcome measures included demographics, characteristics, rate of hospitalization, and mortality, and data were analyzed based on inpatient versus outpatient management.Among COVID-19 adults, 1,360,078 patients were managed in an outpatient setting while 545,635 patients required hospitalization. Compared to hospitalized COVID-19 adults, COVID-19 adults who were managed in an outpatient setting were more likely to be female (56.1% vs 47.5%, p <0.001), white (57.7% vs 54.8%, p <0.001), within younger age group of 18-50 years (p<0.001) and have lower rate of comorbidities. Mortality was significantly lower in outpatient group compared to hospitalized group (0.2% vs 12.2%, respectively, p <0.01%). For outpatient group, mortality increased with increasing age group: 0.02% (52 of 295,112) for patients 18-30 years and 1.2% (1,373 of 117,866) for patients >75 years. The rate of hospitalization was lowest for age group 18-30 years at 10.6% (35,607 of 330,719) and highest for age group >75 years at 56.1% (150,381 of 268,247).This analysis of US academic centers showed that 28.6% of COVID-19 adults who sought care at one of the hospitals reporting data to the Vizient clinical database required in-patient treatment. The rate of hospitalization in our study was lowest for the youngest age group of 18-30 years and highest for age group >75 years. Beside older age, other factors associated with outpatient management included female gender, white race, and having commercial insurance.

  View details for DOI 10.1371/journal.pone.0263813

  View details for PubMedID 35157718

  View details for PubMedCentralID PMC8843227

• Effects of the COVID-19 pandemic on pediatric trauma in Southern California. Pediatric surgery international Yeates, E. O., Grigorian, A., Schellenberg, M., Owattanapanich, N., Barmparas, G., Margulies, D., Juillard, C., Garber, K., Cryer, H., Tillou, A., Burruss, S., Penaloza-Villalobos, L., Lin, A., Figueras, R. A., Coimbra, R., Brenner, M., Costantini, T., Santorelli, J., Curry, T., Wintz, D., Biffl, W. L., Schaffer, K. B., Duncan, T. K., Barbaro, C., Diaz, G., Johnson, A., Chinn, J., Naaseh, A., Leung, A., Grabar, C., Nahmias, J. 2022; 38 (2): 307-315

  Abstract

  The COVID-19 pandemic resulted in increased penetrating trauma and decreased length of stay (LOS) amongst the adult trauma population, findings important for resource allocation. Studies regarding the pediatric trauma population are sparse and mostly single-center. This multicenter study examined pediatric trauma patients, hypothesizing increased penetrating trauma and decreased LOS after the 3/19/2020 stay-at-home (SAH) orders.A multicenter retrospective analysis of trauma patients ≤ 17 years old presenting to 11 centers in California was performed. Demographic data, injury characteristics, and outcomes were collected. Patients were divided into three groups based on injury date: 3/19/2019-6/30/2019 (CONTROL), 1/1/2020-3/18/2020 (PRE), 3/19/2020-6/30/2020 (POST). POST was compared to PRE and CONTROL in separate analyses.1677 patients were identified across all time periods (CONTROL: 631, PRE: 479, POST: 567). POST penetrating trauma rates were not significantly different compared to both PRE (11.3 vs. 9.0%, p = 0.219) and CONTROL (11.3 vs. 8.2%, p = 0.075), respectively. POST had a shorter mean LOS compared to PRE (2.4 vs. 3.3 days, p = 0.002) and CONTROL (2.4 vs. 3.4 days, p = 0.002). POST was also not significantly different than either group regarding intensive care unit (ICU) LOS, ventilator days, and mortality (all p > 0.05).This multicenter retrospective study demonstrated no difference in penetrating trauma rates among pediatric patients after SAH orders but did identify a shorter LOS.

  View details for DOI 10.1007/s00383-021-05050-6

  View details for PubMedID 34853885

  View details for PubMedCentralID PMC8635318

• Visual inspection with acetic acid screening for cervical cancer among women receiving anti-retroviral therapy for human immunodeficiency virus infection in northern Tanzania. The journal of obstetrics and gynaecology research Chinn, J. O., Runge, A. S., Dinicu, A. I., Chang, J., Maher, J. A., Crawford, E. W., Naaseh, A., Cooper, E. C., Zezoff, D. C., White, K. M., Lucas, A. N., Bera, K. R., Bernstein, M., Hari, A., Ziogas, A., Tewari, S. E., Pearre, D. C., Tewari, K. S. 2021; 47 (12): 4365-4370

  Abstract

  To evaluate visual inspection with acetic acid (VIA) screening for cervical cancer among human immunodeficiency virus (HIV)-positive patients in an East African community.During a July 2018 cervical cancer screen-and-treat in Mwanza, Tanzania, participants were offered free cervical VIA screening, cryotherapy when indicated, and HIV testing. Acetowhite lesions and/or abnormal vascularity were designated VIA positive in accordance with current guidelines. The association between VIA results and HIV status was compared using Chi-square and Fisher exact tests.Eight hundred and twenty-four of 921 consented participants underwent VIA screening and 25.0% (n = 206) were VIA positive. VIA-positive nonpregnant women (n = 147) received cryotherapy and 15 (1.8%) with cancerous-appearing lesions were referred to Bugando Hospital. Sixty-six women were HIV-positive and included 25 diagnosed with HIV at the cervical cancer VIA screening and 41 with a prior diagnosis of HIV who were receiving antiretroviral therapy (ART) at the time of cervical cancer VIA screening. Sixty-four of these 66 patients, were screened with VIA. HIV infection was not associated with VIA findings. Abnormal VIA positive screening was observed in 20.3% (n = 13) of HIV-positive patients and in 24.4% (n = 145) of HIV-negative patients (p = 0.508). A nonsignificant trend of higher VIA positive screens among newly diagnosed HIV patients of 26.1% (n = 6) versus patients with preexisting HIV on ART of 17.1% (n = 7) was observed (p = 0.580).The unexpected lack of correlation between HIV infection and VIA positivity in a community with access to ART warrants additional research regarding the previously described role of ART in attenuating HPV-mediated neoplasia.

  View details for DOI 10.1111/jog.15011

  View details for PubMedID 34614540

• COVID-19 in trauma: a propensity-matched analysis of COVID and non-COVID trauma patients. European journal of trauma and emergency surgery : official publication of the European Trauma Society Yeates, E. O., Grigorian, A., Schellenberg, M., Owattanapanich, N., Barmparas, G., Margulies, D., Juillard, C., Garber, K., Cryer, H., Tillou, A., Burruss, S., Figueras, R. A., Mladenov, G., Brenner, M., Firek, C., Costantini, T., Santorelli, J., Curry, T., Wintz, D., Biffl, W. L., Schaffer, K. B., Duncan, T. K., Barbaro, C., Diaz, G., Johnson, A., Chinn, J., Naaseh, A., Leung, A., Grabar, C., Nahmias, J. 2021; 47 (5): 1335-1342

  Abstract

  There is mounting evidence that surgical patients with COVID-19 have higher morbidity and mortality than patients without COVID-19. Infection is prevalent amongst the trauma population, but any effect of COVID-19 on trauma patients is unknown. We aimed to evaluate the effect of COVID-19 on a trauma population, hypothesizing increased mortality and pulmonary complications for COVID-19-positive (COVID) trauma patients compared to propensity-matched COVID-19-negative (non-COVID) patients.A retrospective analysis of trauma patients presenting to 11 Level-I and II trauma centers in California between 1/1/2019-6/30/2019 and 1/1/2020-6/30/2020 was performed. A 1:2 propensity score model was used to match COVID to non-COVID trauma patients using age, blunt/penetrating mechanism, injury severity score, Glasgow Coma Scale score, systolic blood pressure, respiratory rate, and heart rate. Outcomes were compared between the two groups.A total of 20,448 trauma patients were identified during the study period. 53 COVID trauma patients were matched with 106 non-COVID trauma patients. COVID patients had higher rates of mortality (9.4% vs 1.9%, p = 0.029) and pneumonia (7.5% vs. 0.0%, p = 0.011), as well as a longer mean length of stay (LOS) (7.47 vs 3.28 days, p < 0.001) and intensive care unit LOS (1.40 vs 0.80 days, p = 0.008), compared to non-COVID patients.This multicenter retrospective study found increased rates of mortality and pneumonia, as well as a longer LOS, for COVID trauma patients compared to a propensity-matched cohort of non-COVID patients. Further studies are warranted to validate these findings and to elucidate the underlying pathways responsible for higher mortality in COVID trauma patients.

  View details for DOI 10.1007/s00068-021-01699-9

  View details for PubMedID 34031703

  View details for PubMedCentralID PMC8143988

• Drug and alcohol positivity of traumatically injured patients related to COVID-19 stay-at-home orders. The American journal of drug and alcohol abuse Young, K. N., Yeates, E. O., Grigorian, A., Schellenberg, M., Owattanapanich, N., Barmparas, G., Margulies, D., Juillard, C., Garber, K., Cryer, H., Tillou, A., Burruss, S., Penaloza-Villalobos, L., Lin, A., Figueras, R. A., Brenner, M., Firek, C., Costantini, T., Santorelli, J., Curry, T., Wintz, D., Biffl, W. L., Schaffer, K. B., Duncan, T. K., Barbaro, C., Diaz, G., Johnson, A., Chinn, J., Naaseh, A., Leung, A., Grabar, C., Nahmias, J. 2021; 47 (5): 605-611

  Abstract

  Background: COVID-19 related stay-at-home (SAH) orders created many economic and social stressors, possibly increasing the risk of drug/alcohol abuse in the community and trauma population.Objectives: Describe changes in alcohol/drug use in traumatically injured patients after SAH orders in California and evaluate demographic or injury pattern changes in alcohol or drug-positive patients.Methods: A retrospective analysis of 11 trauma centers in Southern California (1/1/2020-6/30/2020) was performed. Blood alcohol concentration, urine toxicology results, demographics, and injury characteristics were collected. Patients were grouped based on injury date - before SAH (PRE-SAH), immediately after SAH (POST-SAH), and a historical comparison (3/19/2019-6/30/2019) (CONTROL) - and compared in separate analyses. Groups were compared using chi-square tests for categorical variables and Mann-Whitney U tests for continuous variables.Results: 20,448 trauma patients (13,634 male, 6,814 female) were identified across three time-periods. The POST-SAH group had higher rates of any drug (26.2% vs. 21.6% and 24.7%, OR = 1.26 and 1.08, p < .001 and p = .035), amphetamine (10.4% vs. 7.5% and 9.3%, OR = 1.43 and 1.14, p < .001 and p = .023), tetrahydrocannabinol (THC) (13.8% vs. 11.0% and 11.4%, OR = 1.30 and 1.25, p < .001 and p < .001), and 3,4-methylenedioxy methamphetamine (MDMA) (0.8% vs. 0.4% and 0.2%, OR = 2.02 and 4.97, p = .003 and p < .001) positivity compared to PRE-SAH and CONTROL groups. Alcohol concentration and positivity were similar between groups (p > .05).Conclusion: This Southern California multicenter study demonstrated increased amphetamine, MDMA, and THC positivity in trauma patients after SAH, but no difference in alcohol positivity or blood concentration. Drug prevention strategies should continue to be adapted within and outside of hospitals during a pandemic.

  View details for DOI 10.1080/00952990.2021.1904967

  View details for PubMedID 34087086

• The coronavirus disease 2019 (COVID-19) stay-at-home order's unequal effects on trauma volume by insurance status in Southern California. Surgery Yeates, E. O., Juillard, C., Grigorian, A., Schellenberg, M., Owattanapanich, N., Barmparas, G., Margulies, D., Garber, K., Cryer, H., Tillou, A., Burruss, S., Penaloza-Villalobos, L., Lin, A., Figueras, R. A., Brenner, M., Firek, C., Costantini, T., Santorelli, J., Curry, T., Wintz, D., Biffl, W. L., Schaffer, K. B., Duncan, T. K., Barbaro, C., Diaz, G., Johnson, A., Chinn, J., Naaseh, A., Leung, A., Grabar, C., Yeates, T. O., Nahmias, J. 2021; 170 (3): 962-968

  Abstract

  The rapid spread of coronavirus disease 2019 in the United States led to a variety of mandates intended to decrease population movement and "flatten the curve." However, there is evidence some are not able to stay-at-home due to certain disadvantages, thus remaining exposed to both coronavirus disease 2019 and trauma. We therefore sought to identify any unequal effects of the California stay-at-home orders between races and insurance statuses in a multicenter study utilizing trauma volume data.A posthoc multicenter retrospective analysis of trauma patients presenting to 11 centers in Southern California between the dates of January 1, 2020, and June 30, 2020, and January 1, 2019, and June 30, 2019, was performed. The number of trauma patients of each race/insurance status was tabulated per day. We then calculated the changes in trauma volume related to stay-at-home orders for each race/insurance status and compared the magnitude of these changes using statistical resampling.Compared to baseline, there was a 40.1% drop in total trauma volume, which occurred 20 days after stay-at-home orders. During stay-at-home orders, the average daily trauma volume of patients with Medicaid increased by 13.7 ± 5.3%, whereas the volume of those with Medicare, private insurance, and no insurance decreased. The average daily trauma volume decreased for White, Black, Asian, and Latino patients with the volume of Black and Latino patients dropping to a similar degree compared to White patients.This retrospective multicenter study demonstrated that patients with Medicaid had a paradoxical increase in trauma volume during stay-at-home orders, suggesting that the most impoverished groups remain disproportionately exposed to trauma during a pandemic, further exacerbating existing health disparities.

  View details for DOI 10.1016/j.surg.2021.02.060

  View details for PubMedID 33849732

  View details for PubMedCentralID PMC9757901

• Characteristics and Outcomes of Women With COVID-19 Giving Birth at US Academic Centers During the COVID-19 Pandemic. JAMA network open Chinn, J., Sedighim, S., Kirby, K. A., Hohmann, S., Hameed, A. B., Jolley, J., Nguyen, N. T. 2021; 4 (8): e2120456

  Abstract

  Prior studies on COVID-19 and pregnancy have reported higher rates of cesarean delivery and preterm birth and increased morbidity and mortality. Additional data encompassing a longer time period are needed.To examine characteristics and outcomes of a large US cohort of women who underwent childbirth with vs without COVID-19.This cohort study compared characteristics and outcomes of women (age ≥18 years) who underwent childbirth with vs without COVID-19 between March 1, 2020, and February 28, 2021, at 499 US academic medical centers or community affiliates. Follow-up was limited to in-hospital course and discharge destination. Childbirth was defined by clinical classification software procedural codes of 134-137. A diagnosis of COVID-19 was identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis of U07.1. Data were analyzed from April 1 to April 30, 2021.The presence of a COVID-19 diagnosis using ICD-10.Analyses compared demographic characteristics, gestational age, and comorbidities. The primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay, intensive care unit (ICU) admission, mechanical ventilation, and discharge status. Continuous variables were analyzed using t test, and categorical variables were analyzed using χ2.Among 869 079 women, 18 715 (2.2%) had COVID-19, and 850 364 (97.8%) did not. Most women were aged 18 to 30 years (11 550 women with COVID-19 [61.7%]; 447 534 women without COVID-19 [52.6%]) and were White (8060 White women [43.1%] in the COVID-19 cohort; 499 501 White women (58.7%) in the non-COVID-19 cohort). There was no significant increase in cesarean delivery among women with COVID-19 (6088 women [32.5%] vs 273 810 women [32.3%]; P = .57). Women with COVID-19 were more likely to have preterm birth (3072 women [16.4%] vs 97 967 women [11.5%]; P < .001). Women giving birth with COVID-19, compared with women without COVID-19, had significantly higher rates of ICU admission (977 women [5.2%] vs 7943 women [0.9%]; odds ratio [OR], 5.84 [95% CI, 5.46-6.25]; P < .001), respiratory intubation and mechanical ventilation (275 women [1.5%] vs 884 women [0.1%]; OR, 14.33 [95% CI, 12.50-16.42]; P < .001), and in-hospital mortality (24 women [0.1%] vs 71 [<0.01%]; OR, 15.38 [95% CI, 9.68-24.43]; P < .001).This retrospective cohort study found that women with COVID-19 giving birth had higher rates of mortality, intubation, ICU admission, and preterm birth than women without COVID-19.

  View details for DOI 10.1001/jamanetworkopen.2021.20456

  View details for PubMedID 34379123

  View details for PubMedCentralID PMC8358731

• Male gender is a predictor of higher mortality in hospitalized adults with COVID-19. PloS one Nguyen, N. T., Chinn, J., De Ferrante, M., Kirby, K. A., Hohmann, S. F., Amin, A. 2021; 16 (7): e0254066

  Abstract

  The coronavirus disease 2019 (COVID-19) pandemic continues to be a global threat, with tremendous resources invested into identifying risk factors for severe COVID-19 illness. The objective of this study was to analyze the characteristics and outcomes of male compared to female adults with COVID-19 who required hospitalization within US academic centers.Using the Vizient clinical database, discharge records of adults with a diagnosis of COVID-19 between March 1, 2020 and November 30, 2020 were reviewed. Outcome measures included demographics, characteristics, length of hospital stay, rate of respiratory intubation and mechanical ventilation, and rate of in-hospital mortality of male vs female according to age, race/ethnicity, and presence of preexisting comorbidities.Among adults with COVID-19, 161,206 were male while 146,804 were female. Adult males with COVID-19 were more likely to have hypertension (62.1% vs 59.6%, p <0.001%), diabetes (39.2% vs 36.0%, p <0.001%), renal failure (22.3% vs 18.1%, p <0.001%), congestive heart failure (15.3% vs 14.6%, p <0.001%), and liver disease (5.9% vs 4.5%, p <0.001%). Adult females with COVID-19 were more likely to be obese (32.3% vs 25.7%, p<0.001) and have chronic pulmonary disease (23.7% vs 18.1%, p <0.001). Gender was significantly different among races (p<0.001), and there was a lower proportion of males versus females in African American patients with COVID-19. Comparison in outcomes of male vs. female adults with COVID-19 is depicted in Table 2. Compared to females, males with COVID-19 had a higher rate of in-hospital mortality (13.8% vs 10.2%, respectively, p <0.001); a higher rate of respiratory intubation (21.4% vs 14.6%, p <0.001); and a longer length of hospital stay (9.5 ± 12.5 days vs. 7.8 ± 9.8 days, p<0.001). In-hospital mortality analyzed according to age groups, race/ethnicity, payers, and presence of preexisting comorbidities consistently showed higher death rate among males compared to females (Table 2). Adult males with COVID-19 were associated with higher odds of mortality compared to their female counterparts across all age groups, with the effect being most pronounced in the 18-30 age group (OR, 3.02 [95% CI, 2.41-3.78]).This large analysis of 308,010 COVID-19 adults hospitalized at US academic centers showed that males have a higher rate of respiratory intubation and longer length of hospital stay compared to females and have a higher death rate even when compared across age groups, race/ethnicity, payers, and comorbidity.

  View details for DOI 10.1371/journal.pone.0254066

  View details for PubMedID 34242273

  View details for PubMedCentralID PMC8270145

• Improved outcomes over time for adult COVID-19 patients with acute respiratory distress syndrome or acute respiratory failure. PloS one Yeates, E. O., Nahmias, J., Chinn, J., Sullivan, B., Stopenski, S., Amin, A. N., Nguyen, N. T. 2021; 16 (6): e0253767

  Abstract

  COVID-19's pulmonary manifestations are broad, ranging from pneumonia with no supplemental oxygen requirements to acute respiratory distress syndrome (ARDS) with acute respiratory failure (ARF). In response, new oxygenation strategies and therapeutics have been developed, but their large-scale effects on outcomes in severe COVID-19 patients remain unknown. Therefore, we aimed to examine the trends in mortality, mechanical ventilation, and cost over the first six months of the pandemic for adult COVID-19 patients in the US who developed ARDS or ARF.The Vizient Clinical Data Base, a national database comprised of administrative, clinical, and financial data from academic medical centers, was queried for patients ≥ 18-years-old with COVID-19 and either ARDS or ARF admitted between 3/2020-8/2020. Demographics, mechanical ventilation, length of stay, total cost, mortality, and discharge status were collected. Mann-Kendall tests were used to assess for significant monotonic trends in total cost, mechanical ventilation, and mortality over time. Chi-square tests were used to compare mortality rates between March-May and June-August. 110,223 adult patients with COVID-19 ARDS or ARF were identified. Mean length of stay was 12.1±13.3 days and mean total cost was $35,991±32,496. Mechanical ventilation rates were 34.1% and in-hospital mortality was 22.5%. Mean cost trended downward over time (p = 0.02) from $55,275 (March) to $18,211 (August). Mechanical ventilation rates trended down (p<0.01) from 53.8% (March) to 20.3% (August). Overall mortality rates also decreased (p<0.01) from 28.4% (March) to 13.7% (August). Mortality rates in mechanically ventilated patients were similar over time (p = 0.45), but mortality in patients not requiring mechanical ventilation decreased from March-May compared to June-July (13.5% vs 4.6%, p<0.01).This study describes the outcomes of a large cohort with COVID-19 ARDS or ARF and the subsequent decrease in cost, mechanical ventilation, and mortality over the first 6 months of the pandemic in the US.

  View details for DOI 10.1371/journal.pone.0253767

  View details for PubMedID 34170950

  View details for PubMedCentralID PMC8232521

• Collaboration between GI surgery & Gastroenterology improves understanding of the optimal antireflux valve-the omega flap valve. Surgical endoscopy Nguyen, N. T., Chinn, J., Chang, K. 2021; 35 (6): 3214-3220

  Abstract

  Gastroesophageal reflux disease (GERD) is a chronic and sometimes disabling disease. An important component in the surgical management of GERD is either laparoscopic or endoscopic restoration of the native gastroesophageal flap valve (GEFV). Recently, a procedure combining laparoscopic hiatal hernia repair with transoral incisionless fundoplication (cTIF) was introduced. This relatively new operation is performed in collaboration between the gastrointestinal (GI) surgeon and the gastroenterologist.By working together, both interventionalists gain new insight into the ideal GEFV by observing the same operation being performed from different perspectives. In the cTIF, the gastroenterologist learns from an external perspective, through the laparoscopic view, the importance of the crura in contributing to the antireflux barrier. Similarly, the GI surgeon gains understanding of the elements that define an effective and desirable GEFV through an endoscopic perspective.This collaboration with cTIF and seeing the procedure from different perspectives have led to our improved understanding of 1) factors contributing to an optimal surgically constructed GEFV and 2) the limitations of the GEFV constructed by the conventional laparoscopic total and partial fundoplications.The collaboration between GI surgery and gastroenterology with cTIF has led to an improved understanding in characteristics of an optimal antireflux barrier and allowed for a proposed technical modification of the current fundoplication technique to optimize the construct of the surgical GEFV.

  View details for DOI 10.1007/s00464-021-08416-y

  View details for PubMedID 33709228

• Changes in traumatic mechanisms of injury in Southern California related to COVID-19: Penetrating trauma as a second pandemic. The journal of trauma and acute care surgery Yeates, E. O., Grigorian, A., Barrios, C., Schellenberg, M., Owattanapanich, N., Barmparas, G., Margulies, D., Juillard, C., Garber, K., Cryer, H., Tillou, A., Burruss, S., Penaloza-Villalobos, L., Lin, A., Figueras, R. A., Brenner, M., Firek, C., Costantini, T., Santorelli, J., Curry, T., Wintz, D., Biffl, W. L., Schaffer, K. B., Duncan, T. K., Barbaro, C., Diaz, G., Johnson, A., Chinn, J., Naaseh, A., Leung, A., Grabar, C., Nahmias, J. 2021; 90 (4): 714-721

  Abstract

  The COVID-19 pandemic resulted in a statewide stay-at-home (SAH) order in California beginning March 19, 2020, forcing large-scale behavioral changes and taking an emotional and economic toll. The effects of SAH orders on the trauma population remain unknown. We hypothesized an increase in rates of penetrating trauma, gunshot wounds, suicide attempts, and domestic violence in the Southern California trauma population after the SAH order.A multicenter retrospective analysis of all trauma patients presenting to 11 American College of Surgeons levels I and II trauma centers spanning seven counties in California was performed. Demographic data, injury characteristics, clinical data, and outcomes were collected. Patients were divided into three groups based on injury date: before SAH from January 1, 2020, to March 18, 2020 (PRE), after SAH from March 19, 2020, to June 30, 2020 (POST), and a historical control from March 19, 2019, to June 30, 2019 (CONTROL). POST was compared with both PRE and CONTROL in two separate analyses.Across all periods, 20,448 trauma patients were identified (CONTROL, 7,707; PRE, 6,022; POST, 6,719). POST had a significantly increased rate of penetrating trauma (13.0% vs. 10.3%, p < 0.001 and 13.0% vs. 9.9%, p < 0.001) and gunshot wounds (4.5% vs. 2.4%, p = 0.002 and 4.5% vs. 3.7%, p = 0.025) compared with PRE and CONTROL, respectively. POST had a suicide attempt rate of 1.9% and a domestic violence rate of 0.7%, which were similar to PRE (p = 0.478, p = 0.514) and CONTROL (p = 0.160, p = 0.618).This multicenter Southern California study demonstrated an increased rate of penetrating trauma and gunshot wounds after the COVID-19 SAH orders but no difference in attempted suicide or domestic violence rates. These findings may provide useful information regarding resource utilization and a target for societal intervention during the current or future pandemic(s).Epidemiological, level IV.

  View details for DOI 10.1097/TA.0000000000003068

  View details for PubMedID 33395031

  View details for PubMedCentralID PMC7996056

• The Impact of COVID-19 on Volume of Inpatient Hospitalization Through General Medicine and Medicine Subspecialty Services at US Medical Centers. Mayo Clinic proceedings. Innovations, quality & outcomes Chinn, J., Ramirez, A., Hohmann, S., Amin, A., Nguyen, N. T. 2021; 5 (2): 516-519

  Abstract

  As the coronavirus disease 2019 pandemic continues to impact hospital systems both in the United States and throughout the world, it is important to understand how the pandemic has impacted the volume of hospital admissions. Using the Vizient Inc (Chicago, IL) clinical databases, we analyzed inpatient hospital discharges from the general medicine service and its subspecialty services including cardiology, neonatology, pulmonary/critical care, oncology, psychiatry, and neurology between December 2019 and July 2020. We compared baseline discharge data to that of the first six months of the pandemic, from February to July 2020. We set the baseline as discharges by specialty from February 2019 through January 2020, averaged over the 12 months. Compared to baseline, by April 2020 the volume of general medicine hospital discharge was reduced by -20.2%, from 235,581 to 188,027 discharges. We found that while overall the number of discharges decreased from baseline, with a nadir in April 2020, pulmonary/critical care services had an increase in hospital discharge volume throughout the pandemic, from 7534 at baseline to 15,792 discharges in April. These findings are important for understanding health care use during the pandemic and ensuring proper allocation of resources and funding throughout the coronavirus disease 2019 pandemic.

  View details for DOI 10.1016/j.mayocpiqo.2021.02.003

  View details for PubMedID 33686379

  View details for PubMedCentralID PMC7927647

• Outcomes and Mortality Among Adults Hospitalized With COVID-19 at US Medical Centers. JAMA network open Nguyen, N. T., Chinn, J., Nahmias, J., Yuen, S., Kirby, K. A., Hohmann, S., Amin, A. 2021; 4 (3): e210417

  Abstract

  This cohort study assesses characteristics and outcomes among adults hospitalized with coronavirus disease 2019 (COVID-19) at US medical centers as well as COVID-19–related mortality over the initial 6 months of the pandemic.

  View details for DOI 10.1001/jamanetworkopen.2021.0417

  View details for PubMedID 33666657

  View details for PubMedCentralID PMC8547263

• Implementation of human papillomavirus video education for women participating in mass cervical cancer screening in Tanzania. American journal of obstetrics and gynecology Cooper, E. C., Maher, J. A., Naaseh, A., Crawford, E. W., Chinn, J. O., Runge, A. S., Lucas, A. N., Zezoff, D. C., Bera, K. R., Dinicu, A. I., White, K. M., Tewari, S. E., Hari, A., Bernstein, M., Chang, J., Ziogas, A., Pearre, D. C., Tewari, K. S. 2021; 224 (1): 105.e1-105.e9

  Abstract

  Because the global disease burden of cervical cancer is greatest in Africa, the World Health Organization has endorsed visual inspection with acetic acid screening with cryotherapy triage for the screen-and-treat approach. With the lowest doctor-to-patient ratio worldwide (1:50,000), Tanzania has nearly 10,000 new cases of cervical cancer and 7000 deaths annually.We report on the feasibility of visual inspection with acetic acid in the severely resource-limited Mwanza district and on the impact of intervening education on baseline human papillomavirus and cervical cancer knowledge.Two 5-day free visual inspection with acetic acid (VIA) clinics in urban Buzuruga and rural Sangabuye on the shores of Lake Victoria were approved by our university institutional review board and local Tanzanian health authorities. Participants completed a demographic survey and a 6-question (1 point per question) multiple choice test written in Kiswahili to assess baseline knowledge. A 15-minute educational video in Kiswahili (MedicalAidFilms: Understanding screening, treatment, and prevention of cervical cancer) was followed by repeated assessment using the same test, visual inspection with acetic acid screening, and optional HIV testing. Pre- and postvideo scores and change of score were analyzed via t test, analysis of variance, and multivariate regression. Significance was considered at P<.05.From July 2, 2018 to July 6, 2018, 825 women were screened, and 207 women (25.1%) were VIA positive (VIA+). One hundred forty-seven VIA+ nonpregnant women received same-day cryotherapy. Seven hundred sixty women participated in an educational intervention-61.6% of whom were from an urban site and 38.2% from a rural site. The mean age was 36.4 (standard deviation, 11.1). Primary languages were Kiswahili (62.2%) and Kisukuma (30.6%). Literacy was approximately 73%, and average education level was equivalent to the seventh grade (United States). Less than 20% of urban and rural women reported access to healthcare providers. Mean score of the participants before watching the video was 2.22 (standard deviation, 1.76) and was not different between VIA+ and VIA negative groups. Mean score of the participants after watching the video was 3.86 (standard deviation, 1.78). Postvideo scores significantly improved regardless of age group, clinic site, primary language, education level, literacy, or access to healthcare provider (P<.0001). Change of score after watching the video was significantly greater in participants from urban areas (1.99±2.07) than in those from rural areas (1.07±1.95) (P<.0001). Multivariate analysis identified urban site as an independent factor in change of score (P=.0211).Visual inspection with acetic acid screening for cervical cancer is feasible and accepted in northern Tanzania. Short video-based educational intervention improved baseline knowledge on the consequences of human papillomavirus infection in the studied populations. The impact was greater in the urban setting than in the rural setting.

  View details for DOI 10.1016/j.ajog.2020.07.018

  View details for PubMedID 32682861

• Multimodality screening and prevention of cervical cancer in sub-Saharan Africa: a collaborative model. Current opinion in obstetrics & gynecology Chinn, J., Tewari, K. S. 2020; 32 (1): 28-35

  Abstract

  Although cervical cancer continues to decrease in incidence throughout the developed world because of rigorous screening and vaccination campaigns, the disease remains a major cause of cancer-related morbidity and mortality in resource-limited regions including sub-Saharan Africa. This review summarizes current efforts to implement cost-effective and widespread cervical cancer education, screening, and community-based interventions in Africa and the challenges faced by local healthcare workers.Effective screening with cytology (with or without high-risk human papillomavirus [HPV] DNA testing) as well as HPV self-sampling remains problematic in African countries because of a paucity of cytopathologists and resources. Accordingly, visual inspection of the cervix with acetic acid (VIA) with cryotherapy triage has gained traction in mass-screening campaigns because of low-cost supplies.Public education to facilitate screening is essential. VIA remains a strong community-based approach. The involvement of technology in teaching local providers, advertising screenings to the community, and helping improve follow-up may also improve screening efforts. Ultimately, the best form of prevention is through HPV vaccination, which also requires implementation of ongoing public education programs.

  View details for DOI 10.1097/GCO.0000000000000597

  View details for PubMedID 31804231