2024
Impact of medicaid expansion on cervical cancer screening: A state-specific difference in difference analysis
Bergstein A, Huang Y, Hershman D, Xu X, Wright J. Impact of medicaid expansion on cervical cancer screening: A state-specific difference in difference analysis. Gynecologic Oncology 2024, 189: 49-55. PMID: 39013240, DOI: 10.1016/j.ygyno.2024.06.028.Peer-Reviewed Original ResearchConceptsCervical cancer screeningBaseline screening ratesNon-expansion statesCancer screeningMedicaid expansion statesScreening ratesExpansion statesMedicaid expansionBehavioral Risk Factor Surveillance SystemRisk Factor Surveillance SystemImpact of Medicaid expansionPre-expansion periodPost-expansion periodAffordable Care ActEffect of Medicaid expansionOutcome measuresCare ActMedicaid coverageHousehold incomeEvaluate trendsSurveillance systemMedicaidDiD analysisState-specific differencesFemale respondents
2020
Hospital variation in responses to safety warnings about power morcellation in hysterectomy
Xu X, Desai VB, Wright JD, Lin H, Schwartz PE, Gross CP. Hospital variation in responses to safety warnings about power morcellation in hysterectomy. American Journal Of Obstetrics And Gynecology 2020, 224: 589.e1-589.e13. PMID: 33359176, PMCID: PMC8180513, DOI: 10.1016/j.ajog.2020.12.1207.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overFemaleGuideline AdherenceHealthcare DisparitiesHospitalsHumansHysterectomyIntraoperative ComplicationsLaparoscopyLogistic ModelsMiddle AgedMorcellationOutcome Assessment, Health CarePatient SafetyPostoperative ComplicationsPractice Guidelines as TopicPractice Patterns, Physicians'Retrospective StudiesRisk AssessmentUnited StatesYoung AdultConceptsLaparoscopic supracervical hysterectomyOpen abdominal hysterectomySupracervical hysterectomyPower morcellationAbdominal hysterectomySurgical complicationsMajor complicationsPatient clinical risk factorsNew York Statewide PlanningClinical risk factorsDistinct trajectory patternsState Ambulatory SurgeryState Inpatient DatabasesSafety warningsTrajectory groupsResearch Cooperative SystemLow useHigher useHysterectomy practiceMinor complicationsBenign hysterectomyBenign indicationsComplication riskHospital variationCorpus uteriUnanticipated Uterine and Cervical Malignancy in Women Undergoing Hysterectomy for Uterovaginal Prolapse.
Andiman SE, Bui AH, Hardart A, Xu X. Unanticipated Uterine and Cervical Malignancy in Women Undergoing Hysterectomy for Uterovaginal Prolapse. Urogynecology 2020, 27: e549-e554. PMID: 33208657, DOI: 10.1097/spv.0000000000000990.Peer-Reviewed Original ResearchConceptsMultivariable logistic regressionUterovaginal prolapseUterine cancerCervical cancerSurgeons National Surgical Quality Improvement ProgramNational Surgical Quality Improvement ProgramSurgical Quality Improvement ProgramLogistic regressionUnexpected uterine malignancyQuality Improvement ProgramSample eligibility criteriaPathology-confirmed diagnosisUterine malignanciesRadical hysterectomyTotal hysterectomyPatient characteristicsUterine weightCervical malignancyGynecologic cancerOutcome measuresHysterectomyAmerican CollegeEligibility criteriaBivariate statistical testsConcurrent proceduresTrial of Labor After Two Prior Cesarean Deliveries: Patient and Hospital Characteristics and Birth Outcomes.
Dombrowski M, Illuzzi JL, Reddy UM, Lipkind HS, Lee HC, Lin H, Lundsberg LS, Xu X. Trial of Labor After Two Prior Cesarean Deliveries: Patient and Hospital Characteristics and Birth Outcomes. Obstetrics And Gynecology 2020, 136: 109-117. PMID: 32541284, PMCID: PMC7321852, DOI: 10.1097/aog.0000000000003845.Peer-Reviewed Original ResearchConceptsComposite severe maternal morbidityTrial of laborPrior cesarean deliverySevere maternal morbidityCesarean deliveryMaternal morbidityNewborn complicationsHospital characteristicsPropensity score-matched analysisSevere neonatal morbiditySuccessful vaginal birthSingleton live birthsAssociation of patientCohort of mothersBirth certificate dataSample eligibility criteriaModest increaseNeonatal morbidityNeonatal outcomesHospital dischargeBirth outcomesVaginal birthClear contraindicationsLive birthsMultivariable regressionUse and Costs of Breast Cancer Screening for Women in Their 40s in a US Population With Private Insurance
Kunst N, Long JB, Xu X, Busch SH, Kyanko KA, Richman IB, Gross CP. Use and Costs of Breast Cancer Screening for Women in Their 40s in a US Population With Private Insurance. JAMA Internal Medicine 2020, 180: 799-801. PMID: 32202606, PMCID: PMC7147248, DOI: 10.1001/jamainternmed.2020.0262.Peer-Reviewed Original Research
2019
Association Between Power Morcellation and Mortality in Women With Unexpected Uterine Cancer Undergoing Hysterectomy or Myomectomy.
Xu X, Lin H, Wright JD, Gross CP, Boscoe FP, Hutchison LM, Schwartz PE, Desai VB. Association Between Power Morcellation and Mortality in Women With Unexpected Uterine Cancer Undergoing Hysterectomy or Myomectomy. Journal Of Clinical Oncology 2019, 37: 3412-3424. PMID: 31518176, PMCID: PMC6901279, DOI: 10.1200/jco.19.00562.Peer-Reviewed Original ResearchConceptsTotal abdominal hysterectomyOccult uterine sarcomaUncontained power morcellationDisease-specific mortalityOccult uterine cancerSupracervical abdominal hysterectomyPower morcellationOccult endometrial carcinomaAbdominal hysterectomyUterine sarcomaUterine cancerEndometrial carcinomaMortality riskMultivariable Cox regressionPrognosis of patientsSubset of womenTime of hysterectomyHospital discharge recordsCancer registry dataHigher mortality riskOccult leiomyosarcomaCause mortalityLaparoscopic myomectomyPatient characteristicsBenign indicationsLaparoscopic Hysterectomy Route, Resource Use, and Outcomes: Change After Power Morcellation Warning.
Desai VB, Wright JD, Lin H, Gross CP, Sallah YH, Schwartz PE, Xu X. Laparoscopic Hysterectomy Route, Resource Use, and Outcomes: Change After Power Morcellation Warning. Obstetrics And Gynecology 2019, 134: 227-238. PMID: 31348209, DOI: 10.1097/aog.0000000000003375.Peer-Reviewed Original ResearchConceptsLaparoscopic supracervical hysterectomyTotal laparoscopic hysterectomyLaparoscopic hysterectomySupracervical hysterectomySurgical outcomesFDA warningOperative timeSurgeons National Surgical Quality Improvement ProgramNational Surgical Quality Improvement ProgramSurgical Quality Improvement ProgramLength of stayInterrupted time series analysisQuality Improvement ProgramHysterectomy routePatient characteristicsBenign indicationsInpatient stayPower morcellationPatient outcomesHysterectomyAmerican CollegeSurgical settingU.S. FoodOutcomesStayRisk of unexpected uterine Cancer in women undergoing myomectomy: A population-based study
Desai VB, Wright J, Gross C, Lin H, Boscoe F, Schwartz P, Xu X. Risk of unexpected uterine Cancer in women undergoing myomectomy: A population-based study. European Journal Of Obstetrics & Gynecology And Reproductive Biology 2019, 238: 188-190. PMID: 31103353, DOI: 10.1016/j.ejogrb.2019.03.021.Peer-Reviewed Original ResearchPrevalence, characteristics, and risk factors of occult uterine cancer in presumed benign hysterectomy
Desai VB, Wright JD, Gross CP, Lin H, Boscoe FP, Hutchison LM, Schwartz PE, Xu X. Prevalence, characteristics, and risk factors of occult uterine cancer in presumed benign hysterectomy. American Journal Of Obstetrics And Gynecology 2019, 221: 39.e1-39.e14. PMID: 30853364, PMCID: PMC7006101, DOI: 10.1016/j.ajog.2019.02.051.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAsianBlack or African AmericanComorbidityEndometrial NeoplasmsEndometriosisEthnicityFemaleHispanic or LatinoHumansHysterectomyIncidental FindingsLeiomyomaLeiomyosarcomaMenstruation DisturbancesMetrorrhagiaMiddle AgedObesityPrevalenceRisk AssessmentRisk FactorsSarcomaUnited StatesUterine NeoplasmsUterine ProlapseWhite PeopleYoung AdultConceptsOccult uterine cancerUterine cancerBenign indicationsRisk factorsUterine sarcomaBenign hysterectomyEndometrial carcinomaPredictive valueResearch Cooperative System databaseState cancer registry dataNew York Statewide PlanningHigh negative predictive valueLow positive predictive valueAssociated risk factorsCorpus uteri cancerLarge population-based sampleCancer registry dataPopulation-based sampleAmbulatory surgery centersNegative predictive valuePositive predictive valueRisk prediction modelRace/ethnicityPostmenopausal bleedingPatient characteristics
2018
Hospital variation in utilization and success of trial of labor after a prior cesarean
Xu X, Lee HC, Lin H, Lundsberg LS, Campbell KH, Lipkind HS, Pettker CM, Illuzzi JL. Hospital variation in utilization and success of trial of labor after a prior cesarean. American Journal Of Obstetrics And Gynecology 2018, 220: 98.e1-98.e14. PMID: 30278176, DOI: 10.1016/j.ajog.2018.09.034.Peer-Reviewed Original ResearchMeSH KeywordsAdultCaliforniaCesarean SectionCohort StudiesDatabases, FactualFemaleGestational AgeHospitals, High-VolumeHospitals, Low-VolumeHumansInfant, NewbornMaternal AgePatient SafetyPregnancyPregnancy OutcomeRetrospective StudiesRisk AssessmentTrial of LaborUterine RuptureVaginal Birth after CesareanConceptsSuccess of trialCesarean deliveryTrial of laborHospital variationSuccess rateLow success rateNewborn hospital discharge recordsPatient clinical risk factorsSevere unexpected newborn complicationsNewborn respiratory complicationsUnexpected newborn complicationsClinical risk factorsPrior cesarean deliveryHospital discharge recordsPatient case mixBirth certificate dataMidwife-attended birthsAnesthesia availabilityNewborn infectionRespiratory complicationsUterine ruptureNewborn morbidityPrior cesareanNewborn complicationsVaginal birthOptimal maternal and neonatal outcomes and associated hospital characteristics
Campbell KH, Illuzzi JL, Lee HC, Lin H, Lipkind HS, Lundsberg LS, Pettker CM, Xu X. Optimal maternal and neonatal outcomes and associated hospital characteristics. Birth 2018, 46: 289-299. PMID: 30251270, DOI: 10.1111/birt.12400.Peer-Reviewed Original ResearchMeSH KeywordsAdultBirth CertificatesCaliforniaCesarean SectionFemaleGestational AgeHospitalsHumansInfant, NewbornInfant, Newborn, DiseasesMorbidityObstetric Labor ComplicationsObstetricsPatient DischargePoisson DistributionPregnancyQuality Indicators, Health CareRegression AnalysisRisk FactorsYoung AdultConceptsRisk-standardized ratesMorbidity rateNeonatal outcomesObstetrical performancePatient clinical risk factorsFuture quality improvement effortsMaternal morbidity ratesNeonatal morbidity ratesProcedures/surgeriesSevere newborn morbiditySevere maternal morbidityClinical risk factorsShock/resuscitationHospital discharge recordsMaternal-newborn outcomesQuality improvement effortsPrevalent morbidityMaternal morbidityNeonatal morbidityRespiratory complicationsIntravascular coagulationNewborn morbidityHeart failureTerm birthsHospital variation
2017
Hospital variation in cost of childbirth and contributing factors: a cross‐sectional study
Xu X, Lee H, Lin H, Lundsberg L, Pettker C, Lipkind H, Illuzzi J. Hospital variation in cost of childbirth and contributing factors: a cross‐sectional study. BJOG An International Journal Of Obstetrics & Gynaecology 2017, 125: 829-839. PMID: 29090498, DOI: 10.1111/1471-0528.15007.Peer-Reviewed Original ResearchConceptsChildbirth hospitalisationsHospital variationObstetric interventionsHospital variancePatient clinical risk factorsSevere maternal morbiditySevere newborn morbidityClinical risk factorsMaternal sociodemographic characteristicsHospital discharge dataCross-sectional studyUrban-rural statusCross-sectional analysisCosts of childbirthHigh-cost hospitalsVertex birthsMaternal morbidityCaesarean deliveryNewborn morbidityBirth attendantsRisk factorsHospital typeCare capacityHospitalisationBetter outcomesPerceived Stress After Acute Myocardial Infarction
Xu X, Bao H, Strait KM, Edmondson DE, Davidson KW, Beltrame JF, Bueno H, Lin H, Dreyer RP, Brush JE, Spertus JA, Lichtman JH, D'Onofrio G, Krumholz HM. Perceived Stress After Acute Myocardial Infarction. Psychosomatic Medicine 2017, 79: 50-58. PMID: 27984507, PMCID: PMC5459399, DOI: 10.1097/psy.0000000000000429.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionPSS-14 scoreMiddle-aged patientsPatient characteristicsMyocardial infarctionSex differencesMonths of recoveryAMI anginaInitial hospitalizationPerceived Stress ScalePatientsAnginaLess improvementLinear mixed-effects modelsFirst monthPsychological stressMixed-effects modelsWomenMonthsHigh levelsMenInfarctionStress ScalePerceived stress
2016
Variation in Hospital Intrapartum Practices and Association With Cesarean Rate
Lundsberg LS, Illuzzi JL, Gariepy AM, Sheth SS, Pettker CM, Lee HC, Lipkind HS, Xu X. Variation in Hospital Intrapartum Practices and Association With Cesarean Rate. Journal Of Obstetric Gynecologic & Neonatal Nursing 2016, 46: 5-17. PMID: 27886948, DOI: 10.1016/j.jogn.2016.07.011.Peer-Reviewed Original ResearchConceptsCesarean rateIntrapartum practicesIntrapartum interventionsIntrapartum careLow-risk womenLower cesarean ratesRegular reviewHospital cesarean rateCross-sectional surveyRank sum testKendall's tau-b correlation coefficientLiberal indicationsLabor inductionVaginal birthHospital variationNewborn careAntibody screenCesarean birthIntravenous lineObstetric servicesHospital characteristicsEligible hospitalsMassachusetts hospitalsFetal monitoringClinical staffInpatient Laparoscopic Hysterectomy in the United States: Trends and Factors Associated With Approach Selection
Desai VB, Guo XM, Fan L, Wright JD, Xu X. Inpatient Laparoscopic Hysterectomy in the United States: Trends and Factors Associated With Approach Selection. Journal Of Minimally Invasive Gynecology 2016, 24: 151-158.e1. PMID: 27614151, DOI: 10.1016/j.jmig.2016.08.830.Peer-Reviewed Original ResearchConceptsLaparoscopic supracervical hysterectomyTotal laparoscopic hysterectomyLaparoscopic approachLaparoscopic hysterectomyNational Inpatient SampleHospital characteristicsPatient race/ethnicityFemale adult patientsClinical Modification codesDifferent laparoscopic approachesAssociation of patientHospital teaching statusHospital inpatient careBenign laparoscopic hysterectomyRace/ethnicityNonobstetric indicationsAdult patientsVaginal hysterectomyClinical factorsSupracervical hysterectomyBenign indicationsComorbid conditionsRetrospective studyNinth RevisionNIS databaseHospital Variation in the Practice of Bilateral Salpingectomy With Ovarian Conservation in 2012
Xu X, Desai VB. Hospital Variation in the Practice of Bilateral Salpingectomy With Ovarian Conservation in 2012. Obstetrics And Gynecology 2016, 127: 297-305. PMID: 26942357, DOI: 10.1097/aog.0000000000001203.Peer-Reviewed Original ResearchConceptsLow-risk womenBilateral salpingectomyLow-risk patientsOvarian conservationBenign hysterectomyHospital variationOvarian cancerAdult womenNational Inpatient SampleCross-sectional studyMultivariable regression analysisOvarian surgeryHighest tertileWhite patientsInpatient SampleSalpingectomyHysterectomyHospital's likelihoodLower riskHospital practiceHospitalPatientsWomenHospitalizationTertileChina Patient-centered Evaluative Assessment of Cardiac Events Prospective Study of Acute Myocardial Infarction: Study Design
Li J, Dreyer RP, Li X, Du X, Downing NS, Li L, Zhang HB, Feng F, Guan WC, Xu X, Li SX, Lin ZQ, Masoudi FA, Spertus JA, Krumholz HM, Jiang LX, Group T. China Patient-centered Evaluative Assessment of Cardiac Events Prospective Study of Acute Myocardial Infarction: Study Design. Chinese Medical Journal 2016, 129: 72-80. PMID: 26712436, PMCID: PMC4797546, DOI: 10.4103/0366-6999.172596.Peer-Reviewed Original ResearchConceptsPatient-reported outcomesAcute myocardial infarctionChina PatientMedical historyMyocardial infarctionPatient experienceLong-term adverse eventsRisk factor controlConsecutive AMI patientsAMI studyPatient's medical historyQuality of lifeNational Coordinating CentreQuality improvement activitiesHospital outcomesCardiac eventsPatient demographicsAdverse eventsMedical chartsHealthcare utilizationAMI patientsMedication adherenceProspective studyHospitalization eventsRisk factors
2015
Cost-Effectiveness of Immediate Compared With Delayed Postpartum Etonogestrel Implant Insertion
Gariepy AM, Duffy JY, Xu X. Cost-Effectiveness of Immediate Compared With Delayed Postpartum Etonogestrel Implant Insertion. Obstetrics And Gynecology 2015, 126: 47-55. PMID: 26241255, PMCID: PMC4526123, DOI: 10.1097/aog.0000000000000907.Peer-Reviewed Original ResearchConceptsImplant insertionUnintended pregnancyContraceptive implantsImmediate postpartum implant insertionHealth care system perspectiveEtonogestrel implant insertionImmediate implant insertionImmediate postpartum provisionIncremental cost-effectiveness ratioFirst postpartum yearFuture unintended pregnanciesAlternative contraceptive methodsOne-way sensitivity analysesCost-effectiveness ratioForm of contraceptionDecision analytic modelPostpartum visitPostpartum yearYear postpartumPostpartum placementContraceptive failureMedical costsContraceptive methodsPregnancyImmediate insertionWide Variation Found In Hospital Facility Costs For Maternity Stays Involving Low-Risk Childbirth
Xu X, Gariepy A, Lundsberg LS, Sheth SS, Pettker CM, Krumholz HM, Illuzzi JL. Wide Variation Found In Hospital Facility Costs For Maternity Stays Involving Low-Risk Childbirth. Health Affairs 2015, 34: 1212-1219. PMID: 26153317, DOI: 10.1377/hlthaff.2014.1088.Peer-Reviewed Original ResearchConceptsCesarean deliveryHospital costsMaternity staysSerious maternal morbidityNationwide Inpatient SampleCoordination of careValue of careMaternal morbidityHospital admissionInpatient SampleDelivery system reformRural hospitalsUS hospitalsHospital practiceSafe reductionHospitalChildbirthStayLong stayHigh rateCareLower proportionUnited StatesFacility costsSex Differences in Perceived Stress and Early Recovery in Young and Middle-Aged Patients With Acute Myocardial Infarction
Xu X, Bao H, Strait K, Spertus JA, Lichtman JH, D'Onofrio G, Spatz E, Bucholz EM, Geda M, Lorenze NP, Bueno H, Beltrame JF, Krumholz HM. Sex Differences in Perceived Stress and Early Recovery in Young and Middle-Aged Patients With Acute Myocardial Infarction. Circulation 2015, 131: 614-623. PMID: 25679303, PMCID: PMC4652932, DOI: 10.1161/circulationaha.114.012826.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionMiddle-aged patientsMyocardial infarctionMental health statusWorse recoveryHealth statusSex differencesBaseline stressSex-based disparitiesYears of ageMultiple health outcomesQuality of lifeGreater mental stressSex-based differencesClinical characteristicsFemale sexEarly recoveryPerceived Stress ScaleGeneral populationGreater psychological stressHealth outcomesImprovement scoresInfarctionPatientsYounger age