Showing papers by "Vahakn B. Shahinian published in 2019"
TL;DR: This study suggests that laparoscopic sleeve gastrectomy has replaced Roux-en-Y gastric bypass as the most common bariatric surgical procedure in patients with ESKD, and the data also demonstrate a favorable complication profile in Patients with sleeve Gastrectomy.
Abstract: Background and objectives Despite the potential for improving health status or increasing access to transplantation, national practice patterns for bariatric surgery in obese patients with ESKD are poorly understood. The purpose of this study was to describe current trends in surgical care for this population. Design, setting, participants, & measurements Using 100% Medicare data, we identified all beneficiaries undergoing bariatric surgery in the United States between 2006 and 2016. We evaluated longitudinal practice patterns using linear regression models. We also estimated risk-adjusted complications, readmissions, and length of stay using Poisson regression for patients with and without ESKD. Results The number of patients with ESKD undergoing bariatric surgery increased ninefold between 2006 and 2016. The proportional use of sleeve gastrectomy increased from Conclusions This study suggests that laparoscopic sleeve gastrectomy has replaced Roux-en-Y gastric bypass as the most common bariatric surgical procedure in patients with ESKD. The data also demonstrate a favorable complication profile in patients with sleeve gastrectomy.
43 citations
TL;DR: Hospital affiliation with Shared Savings ACOs was associated with significant additional reductions in readmissions, and this emphasis on readmission reduction is 1 mechanism through which ACOs improve value in a surgical population.
Abstract: Objective:To evaluate the effect of Medicare Shared Savings Program accountable care organizations (ACOs) on hospital readmission after common surgical procedures.Summary Background Data:Hospital readmissions following surgery lead to worse patient outcomes and wasteful spending. ACOs, and their ass
23 citations
TL;DR: Urologists are increasingly prescribing oral therapies for metastatic castration-resistant prostate cancer, a disease most commonly treated by medical oncologists, using data from the Centers for Medicare and Medicaid Services and the geographic distribution of those providers.
20 citations
TL;DR: Urologist practice structure is associated with payments for prostate cancer care while MSGs had the lowest Medicare payments per episode of prostate cancer Care while groups with IMRT ownership had the highest.
9 citations
TL;DR: There is increasing variation among group practices in the use of conservative management for prostate cancer, which underscores the need for a better understanding of practice-level factors that influence prostate cancer management.
Abstract: PURPOSE:We describe the longitudinal adoption of conservative management (ie, the absence of treatment) for prostate cancer among urology group practices in the United States and identify group pra...
8 citations
TL;DR: A retrospective cohort study of patients who underwent potentially low-value orthopedic procedures using a 20% sample of national Medicare claims found ACOs were not associated with a reduction in the frequency of vertebroplasty and arthroscopic partial meniscectomy.
Abstract: Objective. To evaluate the effect of Accountable Care Organizations (ACOs) on the use of vertebroplasty and arthroscopic partial meniscectomy, 2 procedures for which randomized controlled trials su...
8 citations
TL;DR: Differences in episode payments between TAVR and SAVR were greatest for the sickest patients but much less in healthier patients, suggesting that the economic advantages of T AVR relative to S AVR may diminish.
Abstract: Background: Aortic stenosis is the most common valvular heart disease in the United States. Transcatheter aortic valve replacement (TAVR) is increasingly being adopted as an alternative to surgical...
5 citations
TL;DR: Urology groups would, on average, benefit from the anticipated change in Medicare office E&M visit payments, however, solo practices with a high office focus and academic multispecialty practices may see reduced Medicare payments.
5 citations
TL;DR: In this paper, a cross-sectional ecological study at the state level using data from State Inpatient Databases and U.S. Renal Data System was conducted to investigate whether state-level variations in renal recovery among incident end-stage renal disease patients correlated with state level variations in incidence of acute kidney injury requiring dialysis (AKI-D).
Abstract: Approximately 4–6% of incident end stage renal disease (ESRD) patients in the U.S. recover enough kidney function to discontinue dialysis but there is considerable geographic variation. We undertook this study to investigate whether state-level variations in renal recovery among incident ESRD patients correlated with state-level variations in incidence of acute kidney injury requiring dialysis (AKI-D). We conducted a national cross-sectional ecological study at the state-level using data from State Inpatient Databases and U.S. Renal Data System. All hospital admissions and all ESRD patients in 18 US states (AZ, AR, CA, FL, IA, KY, MA, MD, MI, NJ, NM, NY, NV, OR, RI, SC, VT, and WA) were included. Correlation between AKI-D incidence and rate of renal recovery across states was determined using Pearson’s r (overall and in subgroups). We also calculated partial correlations adjusted for sex and age. AKI-D incidence ranged from 99.0 per million population (pmp) in Vermont to 490.4 pmp in Nevada. Rate of renal recovery among incident ESRD patients ranged from 8.8 pmp in Massachusetts to 29.3 pmp in Florida. A positive correlation between AKI-D incidence and rate of renal recovery among incident ESRD patients at state level was found overall (unadjusted r = 0.67; p = 0.002) and in age, sex, and race subgroups. The overall correlation persisted after adjusting for age (adjusted r = 0.62; p < 0.001) and sex (adjusted r = 0.65; p < 0.001). Our findings suggest that AKI-D incidence is an important driver of renal recovery rates among incident ESRD patients.
4 citations