Featured Publications
How Far Is Too Far? Cost-Effectiveness Analysis of Regionalized Rectal Cancer Surgery
Leeds I, Xu Z, Loria A, Pantel H, Mongiu A, Longo W, Reddy V. How Far Is Too Far? Cost-Effectiveness Analysis of Regionalized Rectal Cancer Surgery. Diseases Of The Colon & Rectum 2022, 66: 467-476. PMID: 36538713, DOI: 10.1097/dcr.0000000000002636.Peer-Reviewed Original ResearchMeSH KeywordsColectomyCost-Effectiveness AnalysisHumansPostoperative ComplicationsProctectomyRectal NeoplasmsRectumRetrospective StudiesConceptsMultivariable probabilistic sensitivity analysesCost-effectiveness standardsIncremental cost-effectiveness ratioProbabilistic sensitivity analysesCost-effectiveness analysisCost-effectiveness ratioTotal societal costsSensitivity analysisDecision analysis modelEl análisisSocietal perspectiveIncremental costPacientes con cáncerSocietal costsLos costosLargo plazoPolicy levelDecision analysisTotal costCostOn All Accounts: Cost-Effectiveness Analysis of Limited Preoperative Optimization Efforts Before Colon Cancer Surgery
Leeds IL, Drabo EF, Lehmann LS, Safar B, Johnston FM. On All Accounts: Cost-Effectiveness Analysis of Limited Preoperative Optimization Efforts Before Colon Cancer Surgery. Diseases Of The Colon & Rectum 2021, 64: 744-753. PMID: 33955409, PMCID: PMC8835996, DOI: 10.1097/dcr.0000000000001926.Peer-Reviewed Original ResearchConceptsCost-effectiveness analysisProbabilistic sensitivity analysesNet monetary benefitIncremental cost-effectiveness ratioTotal costCost-effectiveness ratioMonetary benefitsSensitivity analysisBreakeven costDominant strategyEconomic costsDecision analysis methodologyCostHypothetical scenariosAlto riesgoEl análisisAnálisisEconómicoBenefitsAnalysis methodologyReducción
2023
Racial disparities in complications following elective colon cancer resection: Impact of laparoscopic versus robotic approaches
Ahuja V, Paredes L, Leeds I, Perkal M, Tsutsumi A, Bhandarkar S, King J. Racial disparities in complications following elective colon cancer resection: Impact of laparoscopic versus robotic approaches. The American Journal Of Surgery 2023, 227: 85-89. PMID: 37806892, PMCID: PMC10842593, DOI: 10.1016/j.amjsurg.2023.09.038.Peer-Reviewed Original ResearchMeSH KeywordsColectomyColonic NeoplasmsHumansLaparoscopyLength of StayMalePostoperative ComplicationsRetrospective StudiesRobotic Surgical ProceduresTreatment OutcomeConceptsRC patientsLaparoscopic colectomyElective colon cancer resectionImpact of laparoscopicACS-NSQIP databaseColon cancer resectionMultivariable logistic regressionCancer resectionWhite patientsBlack patientsRobotic colectomyHigher complicationsOperative approachMinority patientsPatientsComplicationsColectomyLogistic regressionRobotic approachRacial disparitiesLaparoscopicCausal pathwaysLower ratesOutcomesMortalityClinical outcomes of elective robotic vs laparoscopic surgery for colon cancer utilizing a large national database
Ahuja V, Paredes L, Leeds I, Perkal M, King J. Clinical outcomes of elective robotic vs laparoscopic surgery for colon cancer utilizing a large national database. Surgical Endoscopy 2023, 37: 7199-7205. PMID: 37365394, DOI: 10.1007/s00464-023-10215-6.Peer-Reviewed Original ResearchMeSH KeywordsAnastomotic LeakColectomyColonic NeoplasmsFemaleHumansLaparoscopyLength of StayMalePostoperative ComplicationsRetrospective StudiesRobotic Surgical ProceduresConceptsAnastomotic leak rateBody mass indexLarge national databaseOverall complicationsAnastomotic leakOperative timeInvasive colectomyColon cancerElective colon cancer resectionHigher body mass indexNational databaseOperating roomPost-operative lengthColon cancer resectionLonger operative timeRange of surgeryNon-Hispanic whitesCancer resectionACS-NSQIPLaparoscopic colectomyClinical outcomesMass indexLaparoscopic counterpartLaparoscopic surgeryPatient outcomes
2022
Short- and Long-term Outcomes of Ileal Pouch Anal Anastomosis Construction in Obese Patients With Ulcerative Colitis
Leeds IL, Holubar SD, Hull TL, Lipman JM, Lightner AL, Sklow B, Steele SR. Short- and Long-term Outcomes of Ileal Pouch Anal Anastomosis Construction in Obese Patients With Ulcerative Colitis. Diseases Of The Colon & Rectum 2022, 65: e782-e789. PMID: 34958050, DOI: 10.1097/dcr.0000000000002169.Peer-Reviewed Original ResearchMeSH KeywordsCohort StudiesColitis, UlcerativeHumansMiddle AgedObesityPostoperative ComplicationsProctocolectomy, RestorativeQuality of LifeRetrospective StudiesConceptsLong-term pouch failureObese patientsUlcerative colitisNonobese patientsPostoperative complicationsPouch failurePouch surgeryColitis ulcerosaASA class 3Intraoperative technical difficultiesOutcomes of obeseAssociation of obesityPouch failure rateWorse clinical outcomesQuaternary referral centerLong-term outcomesLength of stayIleoanal pouch surgeryQuality of lifePouch leakPouch survivalPreoperative steroidsASA 3Anastomotic leakCohort studyDo Cost Limitations of Extended Prophylaxis After Surgery Apply to Ulcerative Colitis Patients?
Leeds IL, Canner JK, DiBrito SR, Safar B. Do Cost Limitations of Extended Prophylaxis After Surgery Apply to Ulcerative Colitis Patients? Diseases Of The Colon & Rectum 2022, 65: 702-712. PMID: 34840290, PMCID: PMC8995329, DOI: 10.1097/dcr.0000000000002056.Peer-Reviewed Original ResearchMeSH KeywordsColitis, UlcerativeColorectal SurgeryHumansPostoperative ComplicationsQuality-Adjusted Life YearsRetrospective StudiesVenous ThromboembolismConceptsMultivariable probabilistic sensitivity analysesUlcerative colitis patientsIncremental cost-effectiveness ratioProbabilistic sensitivity analysesCost-effectiveness ratioDecision analysisColorectal surgery patientsExtended prophylaxisColitis patientsEl análisisSocietal perspectiveLifetime horizonSurgery patientsVenous thromboembolismColitis ulcerosaDecision analysis methodologyUn análisisPostoperative venous thromboembolismRange of scenariosType of thrombosisMain outcome measuresTotal costIndividual risk profileCostSensitivity analysis
2020
Frailer Patients Undergoing Robotic Colectomies for Colon Cancer Experience Increased Complication Rates Compared With Open or Laparoscopic Approaches.
Lo BD, Leeds IL, Sundel MH, Gearhart S, Nisly GRC, Safar B, Atallah C, Fang SH. Frailer Patients Undergoing Robotic Colectomies for Colon Cancer Experience Increased Complication Rates Compared With Open or Laparoscopic Approaches. Diseases Of The Colon & Rectum 2020, 63: 588-597. PMID: 32032198, DOI: 10.1097/dcr.0000000000001598.Peer-Reviewed Original ResearchConceptsInvasive surgical approachSurgical approachPrimary colon cancerFrailer patientsFrail patientsRobotic surgeryPostoperative complicationsComplication rateMajor complicationsRobotic colectomyOpen surgerySurgeons National Surgical Quality Improvement Program databaseColon cancerNational Surgical Quality Improvement Program databaseQuality Improvement Program databasePropensity scoreImprovement Program databaseColon cancer surgeryMultivariable logistic regressionFrailty indexLaparoscopic approachPrimary outcomeCancer surgeryOperative indicationsRetrospective studyIncreased Healthcare Utilization for Medical Comorbidities Prior to Surgery Improves Postoperative Outcomes
Leeds IL, Canner JK, Gani F, Meyers PM, Haut ER, Efron JE, Johnston FM. Increased Healthcare Utilization for Medical Comorbidities Prior to Surgery Improves Postoperative Outcomes. Annals Of Surgery 2020, Publish Ahead of Print: &na;. PMID: 29864092, PMCID: PMC8559326, DOI: 10.1097/sla.0000000000002851.Peer-Reviewed Original ResearchConceptsPostoperative outcomesNonsurgical cliniciansPreoperative comorbiditiesShort-term postoperative outcomesIncreased healthcare utilizationMultivariable logistic regressionNational administrative databasePropensity-score matchingColectomy patientsElective colectomyModifiable comorbiditiesPreoperative optimizationMajor comorbiditiesMedical comorbiditiesPostoperative complicationsClinic visitsOperative interventionOperative riskSubsequent surgeryComorbid patientsSurgical riskAdjusted analysisHealthcare utilizationProspective studySame surgeon
2019
Delay in emergency hernia surgery is associated with worse outcomes
Leeds IL, Jones C, DiBrito SR, Sakran JV, Haut ER, Kent AJ. Delay in emergency hernia surgery is associated with worse outcomes. Surgical Endoscopy 2019, 34: 4562-4573. PMID: 31741158, PMCID: PMC8710144, DOI: 10.1007/s00464-019-07245-4.Peer-Reviewed Original ResearchConceptsEmergent surgeryMajor complicationsTiming of surgeryUrgent surgical interventionDay of surgeryLonger operative timeMultivariable logistic regressionEmergency hernia surgeryNext-day surgeryPhysiologic optimizationPostoperative lengthUrgent surgeryMajor morbidityNSQIP databaseOperative timeSurgical timingSurgical outcomesSurgical interventionDiaphragmatic herniaMedical clearanceMultinomial propensity scoresHernia typeWorse outcomesAbdominal herniaHernia surgeryCost-Benefit Limitations of Extended, Outpatient Venous Thromboembolism Prophylaxis Following Surgery for Crohn's Disease.
Leeds IL, DiBrito SR, Canner JK, Haut ER, Safar B. Cost-Benefit Limitations of Extended, Outpatient Venous Thromboembolism Prophylaxis Following Surgery for Crohn's Disease. Diseases Of The Colon & Rectum 2019, 62: 1371-1380. PMID: 31596763, PMCID: PMC6788772, DOI: 10.1097/dcr.0000000000001461.Peer-Reviewed Original ResearchConceptsVenous thromboembolism prophylaxisMultivariable probabilistic sensitivity analysesCrohn's diseaseHigh thrombotic riskProbabilistic sensitivity analysesThromboembolism prophylaxisExtended prophylaxisSurgical populationAbdominal surgeryThrombotic eventsUtility weightsSocietal perspectiveProductivity costsLifetime horizonIncremental costConventional measuresEnfermedad de CrohnPostoperative venous thromboembolismLow absolute riskHigh-risk individualsLos costosDecision tree modelDecision analysisRange of scenariosTotal costMissed psychosocial risk factors during routine preoperative evaluations are associated with increased complications after elective cancer surgery
Meyers PM, Leeds IL, Enumah ZO, Burkhart RA, He J, Haut ER, Efron JE, Johnston FM. Missed psychosocial risk factors during routine preoperative evaluations are associated with increased complications after elective cancer surgery. Surgery 2019, 166: 177-183. PMID: 31160060, PMCID: PMC8828252, DOI: 10.1016/j.surg.2019.04.015.Peer-Reviewed Original ResearchMeSH KeywordsAcademic Medical CentersAgedCohort StudiesDatabases, FactualDigestive System NeoplasmsDisease-Free SurvivalElective Surgical ProceduresFemaleHumansMaleMiddle AgedNeoplasm InvasivenessNeoplasm StagingPostoperative ComplicationsPreoperative CarePrognosisPsychologyRetrospective StudiesSurvival AnalysisConceptsPsychosocial risk factorsRisk factorsChart reviewCancer surgeryPostoperative outcomesComplication ratePreoperative evaluationThirty-day postoperative complicationsTertiary academic medical centerAbdominal cancer surgeryElective cancer surgeryPatient's preoperative evaluationRoutine preoperative evaluationOverall complication rateRetrospective chart reviewWorse postoperative outcomesPreoperative risk stratificationIndividual risk factorsAcademic medical centerInadequate social supportPostoperative complicationsAdult patientsMajor complicationsRisk stratificationFormal screeningOutcomes for Ulcerative Colitis With Delayed Emergency Colectomy Are Worse When Controlling for Preoperative Risk Factors
Leeds IL, Sundel MH, Gabre-Kidan A, Safar B, Truta B, Efron JE, Fang SH. Outcomes for Ulcerative Colitis With Delayed Emergency Colectomy Are Worse When Controlling for Preoperative Risk Factors. Diseases Of The Colon & Rectum 2019, Publish Ahead of Print: &na;. PMID: 30451754, PMCID: PMC6456379, DOI: 10.1097/dcr.0000000000001276.Peer-Reviewed Original ResearchConceptsTotal abdominal colectomyPreoperative risk factorsUlcerative colitisAbdominal colectomyRisk factorsEmergency colectomyEarly surgeryHospital daysPostoperative complicationsMortality rateSurgeons National Surgical Quality Improvement Program databaseNational Surgical Quality Improvement Program databaseEarly operationNational Surgical Quality Improvement ProgramAcute fulminant ulcerative colitisQuality Improvement Program databaseSurgical Quality Improvement ProgramFulminant ulcerative colitisOngoing medical managementImmediate surgical interventionImprovement Program databaseSingle institution experienceAcute ulcerative colitisDay of admissionTiming of surgeryPsychosocial Risks are Independently Associated with Cancer Surgery Outcomes in Medically Comorbid Patients
Leeds IL, Meyers PM, Enumah ZO, He J, Burkhart RA, Haut ER, Efron JE, Johnston FM. Psychosocial Risks are Independently Associated with Cancer Surgery Outcomes in Medically Comorbid Patients. Annals Of Surgical Oncology 2019, 26: 936-944. PMID: 30617868, PMCID: PMC8710142, DOI: 10.1245/s10434-018-07136-3.Peer-Reviewed Original ResearchConceptsPsychosocial risk factorsRisk factorsPsychosocial risksSurgical outcomesPrimary tumorShort-term surgical outcomesMultiple psychosocial risk factorsCancer surgery patientsColorectal primary tumorsProspective observational studyCancer surgery outcomesMultiple psychosocial risksThreefold oddsChart reviewComplication ratePostoperative courseSurgery patientsComorbid patientsMedian ageCancer surgeryMultivariable analysisPreoperative assessmentCancer patientsSurgery outcomesObservational study
2018
Eye of the beholder: Risk calculators and barriers to adoption in surgical trainees
Leeds IL, Rosenblum AJ, Wise PE, Watkins AC, Goldblatt MI, Haut ER, Efron JE, Johnston FM. Eye of the beholder: Risk calculators and barriers to adoption in surgical trainees. Surgery 2018, 164: 1117-1123. PMID: 30149939, PMCID: PMC8383120, DOI: 10.1016/j.surg.2018.07.002.Peer-Reviewed Original ResearchConceptsRisk calculatorRisk assessment toolSurgical traineesCurrent risk calculatorsClinical workflow integrationPrimary outcomeMultivariable regressionDomain scoresRoutine useDirect verbal communicationSurgical residentsAccurate risk assessmentBehavioral factorsSystem usability scoreAssessment toolProcess measures facilitate maturation of pediatric enhanced recovery protocols
Leeds IL, Ladd MR, Sundel MH, Fannon ML, George JA, Boss EF, Jelin EB. Process measures facilitate maturation of pediatric enhanced recovery protocols. Journal Of Pediatric Surgery 2018, 53: 2266-2272. PMID: 29801659, PMCID: PMC8710141, DOI: 10.1016/j.jpedsurg.2018.04.037.Peer-Reviewed Original ResearchMeSH KeywordsChildColorectal SurgeryHumansOutcome Assessment, Health CarePostoperative ComplicationsProcess Assessment, Health CareQuality ImprovementConceptsProcess measuresProcess measure adherenceRecovery protocolEnhanced recovery protocolQuality improvement databaseImplementation groupPediatric colorectal surgeryRegional anesthesia techniquesPediatric ColorectalPostoperative complicationsPreoperative medicationsColorectal surgeryPathway patientsSurgical patientsSurgery pathwayPreoperative educationAnesthesia techniquesPatient outcomesOutcome measuresMeasure adherencePatientsLevel IIITreatment studiesComplicationsAdherenceMalnutrition increases the risk of 30-day complications after surgery in pediatric patients with Crohn disease
Ladd MR, Garcia AV, Leeds IL, Haney C, Oliva-Hemker MM, Alaish S, Boss E, Rhee DS. Malnutrition increases the risk of 30-day complications after surgery in pediatric patients with Crohn disease. Journal Of Pediatric Surgery 2018, 53: 2336-2345. PMID: 29843908, PMCID: PMC8841062, DOI: 10.1016/j.jpedsurg.2018.04.026.Peer-Reviewed Original ResearchConceptsCrohn's diseaseAge z-scoreBowel surgeryPediatric patientsACS NSQIP-Pediatric databaseZ-scoreMajor bowel surgeryNSQIP-Pediatric databaseOdds of complicationsOverall complication ratePediatric CD patientsDegree of malnutritionSeverity of malnutritionEffects of malnutritionCDC growth chartsEffects of malnourishmentASA classImportant screening toolMalnutrition effectsPostoperative complicationsCD patientsComplication rateElective surgeryMultivariable analysisSevere malnutrition
2017
Racial and Socioeconomic Differences Manifest in Process Measure Adherence for Enhanced Recovery After Surgery Pathway
Leeds IL, Alimi Y, Hobson DR, Efron JE, Wick EC, Haut ER, Johnston FM. Racial and Socioeconomic Differences Manifest in Process Measure Adherence for Enhanced Recovery After Surgery Pathway. Diseases Of The Colon & Rectum 2017, 60: 1092-1101. PMID: 28891854, PMCID: PMC5647878, DOI: 10.1097/dcr.0000000000000879.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCohort StudiesColectomyColonic DiseasesColorectal SurgeryElective Surgical ProceduresFemaleHumansMaleMiddle AgedOutcome and Process Assessment, Health CarePatient CompliancePostoperative ComplicationsQuality ImprovementRacial GroupsSocioeconomic FactorsUnited StatesConceptsSurgery pathwayPathway implementationSocioeconomic statusWhite patientsPopulation subgroupsOverall adherenceShort-term surgical outcomesTertiary academic medical centerProcess measure adherenceThirty-day outcomesEnhanced recovery pathwayProcess measuresAcademic medical centerHigher socioeconomic statusElective colonPreoperative characteristicsQuality improvement purposesCohort studyComplication rateNonwhite patientsRectal resectionPain therapyMedian lengthSurgical outcomesMedical CenterEarly Surgical Intervention for Acute Ulcerative Colitis Is Associated with Improved Postoperative Outcomes
Leeds IL, Truta B, Parian AM, Chen SY, Efron JE, Gearhart SL, Safar B, Fang SH. Early Surgical Intervention for Acute Ulcerative Colitis Is Associated with Improved Postoperative Outcomes. Journal Of Gastrointestinal Surgery 2017, 21: 1675-1682. PMID: 28819916, PMCID: PMC6201293, DOI: 10.1007/s11605-017-3538-3.Peer-Reviewed Original ResearchConceptsAcute ulcerative colitisEarly surgical interventionUlcerative colitisLength of staySurgical interventionSurgery groupTotal colectomyHospitalization costsEarly operationMedian total hospitalization costModern immunotherapy eraRefractory ulcerative colitisHours of admissionImmediate surgical interventionUlcerative colitis patientsTotal hospitalization costsFurther prospective studiesNational Inpatient SampleImmunotherapy eraColitis patientsHospital outcomesPostoperative complicationsPostoperative outcomesUrgent surgeryComorbid patients
2016
Outcomes of abdominoperineal resection for management of anal cancer in HIV-positive patients: a national case review
Leeds IL, Alturki H, Canner JK, Schneider EB, Efron JE, Wick EC, Gearhart SL, Safar B, Fang SH. Outcomes of abdominoperineal resection for management of anal cancer in HIV-positive patients: a national case review. World Journal Of Surgical Oncology 2016, 14: 208. PMID: 27495294, PMCID: PMC4974747, DOI: 10.1186/s12957-016-0970-x.Peer-Reviewed Original ResearchMeSH KeywordsAbdomenAdultAge FactorsAgedAnus NeoplasmsCarcinoma, Squamous CellComorbidityFemaleFollow-Up StudiesHealth Status DisparitiesHIV InfectionsHospital MortalityHumansIncidenceLength of StayMaleMiddle AgedNeoplasm Recurrence, LocalPerineumPostoperative ComplicationsRetrospective StudiesRisk FactorsSalvage TherapyTreatment OutcomeConceptsHIV-positive patientsLength of stayHIV-negative patientsAnal cancerNational Inpatient SampleAbdominoperineal resectionHospitalization costsHIV infectionAnal squamous cell cancerAnal squamous cell carcinomaUtilization Project National Inpatient SampleGreater hospitalization costsWorse postoperative recoveryHIV-positive groupMethodsA retrospective reviewAnal cancer patientsSquamous cell cancerHuman immunodeficiency virusMultivariable logistic regressionSquamous cell carcinomaHospital mortalityHospital stayPerioperative complicationsPostoperative hemorrhagePostoperative outcomes
2012
Risk Factors for 30-Day Hospital Readmission among General Surgery Patients
Kassin MT, Owen RM, Perez SD, Leeds I, Cox JC, Schnier K, Sadiraj V, Sweeney JF. Risk Factors for 30-Day Hospital Readmission among General Surgery Patients. Journal Of The American College Of Surgeons 2012, 215: 322-330. PMID: 22726893, PMCID: PMC3423490, DOI: 10.1016/j.jamcollsurg.2012.05.024.Peer-Reviewed Original ResearchConceptsGeneral surgery proceduresGeneral surgery patientsRisk of readmissionPostoperative complicationsRisk factorsSurgery proceduresSurgery patientsHospital readmissionInpatient general surgery proceduresInstitutional clinical data warehousePoor quality patient careSignificant independent risk factorsPreoperative open woundSepsis/shockPostoperative pulmonary complicationsDays of dischargeIndependent risk factorUrinary tract infectionSingle academic centerType of procedureClinical data warehousePostoperative readmissionsPulmonary complicationsIndex hospitalizationPostoperative occurrence