Publications by authors named "Amber L Turner"

10 Publications

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Socioeconomic risk factors for mortality and readmission after surgery for bowel obstruction: An analysis of the Nationwide Readmissions Database.

Am J Surg 2021 Apr 30. Epub 2021 Apr 30.

Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, 07103, USA. Electronic address:

Background: Small bowel obstructions (SBO) are one of the most common surgical emergencies, but they remain a major cause of high morbidity and mortality in patients with previous history of abdominal and pelvic surgery. Socioeconomic factors have not been extensively studied in surgical management of SBO.

Methods: We queried the 2016 NRD database for all surgically managed admissions ≥18 years of age with a primary diagnosis of SBO. The primary outcomes for this analysis were index admission mortality, 30-day mortality, and 30-day readmissions. Multivariate logistic regression models were utilized to examine the association between predictors and primary outcomes.

Results: Medicaid patients had a higher likelihood of index admission mortality. Medicare and Medicaid patients both had higher likelihoods of 30-day readmissions.results CONCLUSIONS: Careful consideration should be taken before deciding the optimal surgical approach in patients with SBO. Medicaid beneficiaries and those with existing comorbidities should receive careful post-operative follow-up to ensure optimal outcomes.

Conclusion:
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http://dx.doi.org/10.1016/j.amjsurg.2021.04.026DOI Listing
April 2021

A Resident-Driven Mobile Evaluation System Can Be Used to Augment Traditional Surgery Rotation Evaluations.

Am Surg 2021 Apr 21:31348211011130. Epub 2021 Apr 21.

Division of Trauma and Surgical Critical Care, Department of Surgery, 12286Rutgers - New Jersey Medical School, Newark, NJ, USA.

Background: The Accreditation Council for Graduate Medical Education requires residents to receive milestone-based evaluations in key areas. Shortcomings of the traditional evaluation system (TES) are a low completion rate and delay in completion. We hypothesized that adoption of a mobile evaluation system (MES) would increase the number of evaluations completed and improve their timeliness.

Methods: Traditional evaluations for a general surgery residency program were converted into a web-based form via a widely available, free, and secure application and implemented in August 2017. After 8 months, MES data were analyzed and compared to that of our TES.

Results: 122 mobile evaluations were completed; 20% were solicited by residents. Introduction of the MES resulted in an increased number of evaluations per resident ( = .0028) and proportion of faculty completing evaluations ( = .0220). Timeliness also improved, with 71% of evaluations being completed during one's clinical rotation.

Conclusions: A resident-driven MES is an inexpensive and effective method to augment traditional end-of-rotation evaluations.
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http://dx.doi.org/10.1177/00031348211011130DOI Listing
April 2021

Effect of On-Site Cardiac Surgery Program on General Thoracic Surgery Outcomes.

Innovations (Phila) 2021 Mar-Apr;16(2):142-147. Epub 2021 Feb 3.

240544598 Thoracic Surgical Services, RWJ Barnabas Health, West Orange, NJ, USA.

Objective: Limited data exist exploring the relationship between multispecialty surgical collaboration and outcomes in general thoracic surgery. To address this, the Nationwide Inpatient Sample (NIS) was analyzed to determine whether the presence of an on-site cardiac surgery program is associated with improved general thoracic surgery outcomes.

Methods: The NIS (1999-2008) was utilized to identify 389,959 patients who had a lobectomy, pneumonectomy, or esophagectomy. Short-term outcomes of patients undergoing these procedures were compared between hospitals with and without an on-site cardiac surgery program. Univariate and multivariate analyses were performed to determine patient and hospital predictors of mortality and morbidity.

Results: During the study period, patients undergoing lobectomy ( = 314,130), pneumonectomy ( = 34,860), or esophagectomy ( = 40,969) were identified. Univariate analysis demonstrated lower mortality for lobectomy ( < 0.001) and esophagectomy ( < 0.001) but not pneumonectomy ( = 0.344) in hospitals with a cardiac surgery program. All-cause morbidity was significantly lower for all 3 procedures in hospitals with a cardiac surgery program. However, multivariate analysis demonstrated that a cardiac surgery program was not an independent predictor when adjusted for known confounders, particularly procedure volume and hospital academic teaching status.

Conclusions: The presence of an on-site cardiac surgery program is not in and of itself associated with improved general thoracic surgery outcomes. The presence of a cardiac surgery program is likely a surrogate for other known predictors of improved outcomes such as hospital teaching status and procedure volume.
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http://dx.doi.org/10.1177/1556984520976572DOI Listing
February 2021

Neoadjuvant therapy is associated with lower margin positivity rates after Pancreaticoduodenectomy in T1 and T2 pancreatic head cancers: An analysis of the National Cancer Database.

Surg Open Sci 2021 Jan 16;3:22-28. Epub 2020 Dec 16.

Gastrointestinal and Hepatobiliary Oncology, Rutgers Cancer Institute of New, Jersey.

Background: Neoadjuvant therapy (NAT) for T1/T2 pancreatic adenocarcinoma (PDAC) prior to pancreaticoduodenectomy remains controversial. We compared positive margin rates in patients with clinical T1&T2 tumors who did and did not receive NAT.

Methods: The National Cancer Database (NCDB) found clinical T1&T2 PDAC patients who underwent pancreaticoduodenectomy from 2004 to 2014. Univariate and multivariate regression determined factors associated with a positive margin and survival.

Results: 9795 patients underwent surgery for clinical T1 or T2 pancreatic head adenocarcinoma. 8472 patients had data regarding use of neoadjuvant and adjuvant therapies; of which, 774 (9.1%) received NAT and 435 (5.1%) received both chemotherapy and radiation therapy. NAT was found to lower positive margin rates from 21.8 to 15.5% (p < 0.0001) and when radiation was added this rate dropped to 13.4%. Positive margins were associated with worse overall survival (14.9 vs. 23.9 months; HR 1.702,  < 0.0001).

Conclusions: NAT is associated with a reduced positive margin rate in patients with T1 and T2 tumors. These findings support ongoing and future clinical trials of NAT in T1 and T2, early stage PDAC to determine impacts on survival.
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http://dx.doi.org/10.1016/j.sopen.2020.12.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7807160PMC
January 2021

Morbidity and mortality after general surgery in heart and lung transplant patients.

Surg Open Sci 2020 Jul 11;2(3):140-146. Epub 2020 Jan 11.

Thoracic Surgical Services, RWJBarnabas Health, Saint Barnabas Medical Center, West Orange, NJ.

Background: Heart and lung transplant patients can develop conditions necessitating general surgery procedures. Their postoperative morbidity and mortality remain poorly characterized and limited to case series from select centers.

Methods: The National Inpatient Sample (1998-2015) was used to identify 6433 heart and 3015 lung transplant patient admissions for general surgery procedures. For a comparator group, we identified 23,764,164 nontransplant patient admissions for the same procedures. Patient morbidity and mortality after general surgery were compared between transplant patients and nontransplant patients. Data were analyzed with frequency tables, analysis, and a mixed-effects multivariate regression.

Results: Overall mortality was higher and length of stay longer in the transplant group compared to the nontransplant group. Analysis revealed that hospital size and comorbidities were predictors of mortality for patients undergoing certain general surgery procedures. Transplant status alone did not predict mortality.

Conclusion: Our findings demonstrate that heart and lung transplant patients, compared to nontransplant patients, have more complications and a higher length of stay after certain general surgery procedures.
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http://dx.doi.org/10.1016/j.sopen.2019.12.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7391886PMC
July 2020

Fibrosing Mediastinitis Requiring Multimodality Treatment to Maintain Pulmonary Vein Patency.

Semin Thorac Cardiovasc Surg 2020 Winter;32(4):1140-1141. Epub 2020 May 22.

Department of Thoracic Surgery, RWJBarnabas Health, Newark Beth Israel Medical Center, Newark, New Jersey; Department of Thoracic Surgery, RWJBarnabas Health, Saint Barnabas Medical Center, West Orange, New Jersey; Department of Surgery, RWJBarnabas Health, Saint Barnabas Medical Center, Livingston, New Jersey. Electronic address:

Fibrosing mediastinitis is a rare condition with limited epidemiologic data. We detail a case of a 43-year-old female with no past medical history, who presented with chest pain and dyspnea on exertion. Chest computed tomography revealed a large mediastinal mass that was invading into the anterior chest as well as encasing the pulmonary hilum. Surgical pathology returned as dense hyaline fibrosis tissue with focal histiocytic aggregates and giant cells consistent with fibrosing mediastinitis. Treatment with rituximab and steroids showed a reduction in the size of her mass.
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http://dx.doi.org/10.1053/j.semtcvs.2020.05.013DOI Listing
April 2021

A Comparative Analysis of Long-Term Survival of Robotic Versus Thoracoscopic Lobectomy.

Ann Thorac Surg 2020 10 1;110(4):1139-1146. Epub 2020 May 1.

Thoracic Surgical Services, RWJBarnabas Health, West Orange, New Jersey; Department of Surgery, Saint Barnabas Medical Center, RWJBarnabas Health, Livingston, New Jersey. Electronic address:

Background: Minimally invasive lobectomy can be performed robotically or thoracoscopically. Short-term outcomes between the 2 approaches are reported to be similar; however, the comparative oncological effectiveness is not known. We sought to compare long-term survival after robotic and thoracoscopic lobectomy.

Methods: We performed a propensity-matched analysis of SEER (Surveillance, Epidemiology and End Results)-Medicare patients with non-small cell lung cancer from 2008 to 2013 who underwent minimally invasive lobectomy using either a thoracoscopic (n = 3881) or a robotic-assisted (n = 426) approach. Patients in the 2 groups were propensity matched 1:1 based on demographics, comorbidities, treatment, and tumor characteristics. We compared the overall survival (OS) and cancer-specific mortality (CSM) between the 2 groups.

Results: Within the matched cohort (n = 409 per group), the median age at surgery was 73 (range, 65-91) years, with a median follow-up of 35 months postsurgery. There was no difference in OS or CSM between the thoracoscopic and robotic-assisted groups (OS: 71.4% vs 73.1% at 3 years, overall P = .366; CSM: 16.6% vs 14.9% at 3 years, overall P = .639).

Conclusions: Our propensity-matched analysis demonstrates that patients undergoing robotic-assisted lobectomy have similar OS and CSM compared with those patients undergoing thoracoscopic lobectomy. Oncologic outcomes are similar between the 2 minimally invasive approaches. These results demonstrate that further investigation is needed in the form of a randomized control trial, its variations, or additional large-scale registry analyses to verify these results.
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http://dx.doi.org/10.1016/j.athoracsur.2020.03.085DOI Listing
October 2020

Disparities in Follow-Up After Low-Dose Lung Cancer Screening.

Semin Thorac Cardiovasc Surg 2020 Winter;32(4):1058-1063. Epub 2019 Oct 16.

Department of Thoracic Surgery, RWJBarnabas Health, West Orange, New Jersey; Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.

The National Lung Cancer Screening Trial (NLST) demonstrated an improvement in overall survival with lung cancer screening. Achieving follow-up for a positive screen is essential to impact early intervention for lung cancer. The objective of this study was to determine predictors of follow-up after a positive lung cancer screening test. The NLST database was queried for participants with a positive lung cancer screening exam. This cohort was then subdivided into patients who had follow-up and those who did not. Pairwise comparison was performed within different subgroups. A logistic regression model was then utilized to identify predictive factors associated with follow-up. Of the 53,454 patients who participated in the study, we identified 14,000 patients who had a positive lung cancer screening test. Of those patients, 12,503 followed up appropriately (89.3%). Women had a statistically higher follow-up rate compared to men (90% vs 88.8%, P ≤ 0.05). Patients reported as married or living as married also showed a higher rate of follow-up compared to patients reported as never married, divorced, separated, or widowed (90.2% vs 87.5%, P ≤ 0.05). The rate of follow-up among African-American patients was 82.8%, while those in white patients was 89.6%, this was statistically significant (P ≤ 0.05). Education level was not a significant factor in follow-up rates. Current smokers followed up at lower rates compared to former smokers (87.9 % vs 90.6%, P ≤ 0.05). Logistic regression determined gender, marital status, race, and smoking status to be predictors of follow-up. Follow-up rates after a positive lung cancer screening test were associated with a patient's gender, marital status, race, and smoking status.
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http://dx.doi.org/10.1053/j.semtcvs.2019.10.006DOI Listing
April 2021

Outcomes Following Major Oncologic Operations for Non-AIDS-Defining Cancers in the HIV Population: A Matched Comparison to the General Population.

World J Surg 2019 12;43(12):3019-3026

Department of Surgery, Saint Barnabas Medical Center, RWJBarnabas Health, Livingston, NJ, USA.

Introduction: Human immunodeficiency virus (HIV) patients are living longer due to the availability of antiretroviral therapies, and non-AIDS-defining cancers are becoming more prevalent in this patient population. A paucity of data remains on post-operative outcomes following resection of non-AIDS-defining cancers in the HIV population.

Methods: The National Inpatient Sample was utilized to identify patients who underwent surgical resection for malignancy from 2005 to 2015 (HIV, N = 52,742; non-HIV, N = 11,885,184). Complications were categorized by international classification of disease (ICD)-9 diagnosis codes. Cohorts were matched on insurance, household income, zip code and urban/rural setting. Logistic regression assessed whether HIV was an independent predictor of post-operative complications.

Results: Descriptive statistics found HIV patients to have an increased rate of complications following select oncologic surgical resections. Univariate and multivariate logistic regression found HIV to only be an independent predictor of complications following pulmonary lobectomy (p = 0.011; OR 2.93, 95% CI 1.29-6.73). Length of stay was statistically longer following colectomy (2.61 days, 95% CI 1.98-3.44) in those with HIV.

Conclusions: Our findings are hypothesis generating and highlight the potential safety of major cancer surgery in the HIV population. However, care providers need be cognizant of the potential increased risk of post-operative complications following pulmonary lobectomy and the potential for increased length of stay. These findings are an initial insight into quality of care and outcomes metrics on HIV patients undergoing major cancer operations.
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http://dx.doi.org/10.1007/s00268-019-05151-3DOI Listing
December 2019

Randomized controlled trial of a web-based indoor tanning intervention: Acceptability and preliminary outcomes.

Health Psychol 2015 Dec;34S:1278-85

Division of Population Sciences, Rutgers Cancer Institute of New Jersey.

Objective: This article describes the acceptability and preliminary behavioral outcomes of a pilot randomized control trial of a web-based indoor tanning intervention for young adult women. The intervention targets indoor tanning users' perceptions of the benefits and value of tanning and addresses the role of body image-related constructs in indoor tanning.

Method: Participants were 186 young adult women who reported indoor tanning at least once in the past 12 months. The study design was a 2-arm randomized controlled trial with pre- and postintervention assessments and random assignment to an intervention or control condition. Intervention acceptability was assessed by obtaining participants' evaluation of the intervention. Regression analyses were used to test for intervention condition differences in preliminary behavioral outcomes measured at 6 weeks postintervention.

Results: Participants provided favorable evaluations of the intervention on several dimensions and a highly positive overall rating. Intervention participants were more likely to report abstaining from indoor tanning and indicated a lower likelihood of using indoor tanning in the future compared with control participants on the postintervention assessment. No differences were found for sunburns.

Conclusions: The results of this pilot randomized controlled trial provide evidence that the indoor tanning intervention is acceptable to participants and may encourage cessation of indoor tanning behavior. The findings provide preliminary support for an indoor tanning intervention that engages tanners to challenge their beliefs about the benefits of indoor tanning. The use of a web-based indoor tanning intervention is unique and provides strong potential for dissemination.
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http://dx.doi.org/10.1037/hea0000254DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4681403PMC
December 2015