Research
Areas of Research
Diversity, Equity, and Inclusion
The SHORE Lab is committed to researching and addressing disparities in surgical care, with a focus on minority and health disparity populations. This includes minority racial and ethnic groups (e.g., Blacks/African Americans, Hispanics/Latinos, American Indians/Alaska Natives, Asians, Native Hawaiians and other Pacific Islanders, defined by the U.S. Census), socioeconomically disadvantaged populations, incarcerated, medically underserved rural residents, and sexual gender minorities. Our work spans various surgical specialties and research areas like outcomes research, community-based participatory research, health services research, health economics, dissemination and implementation sciences, public health, and clinical trials.
Despite advancements in surgical research, disparities persist, leading to significant morbidity, extended hospital stays, and poor outcomes for many patients from health disparity populations. At SHORE we aim to make a scientific contribution to surgical disparities through the development of culturally and linguistically sensitive interventions that aim to alleviate health disparities in surgery.
The SHORE Lab is unwavering in its commitment to addressing these disparities and ensuring that all patients, regardless of their background, receive safe, high-quality surgical care and optimal outcomes. We align with organizations like the American College of Surgeons (ACS) and the National Institute of Minority Health Disparities (NIMHD), and we actively engage in the NIH U.N.I.T.E. initiative, focusing on health disparities, diversity, and scientific contributions to improve surgical outcomes. Our team emphasizes culturally sensitive interventions and community involvement to reduce disparities in surgery.
Katragadda C, Fung C, Yousefi-Nooraie R, Cupertino P, Joseph J, Kim Y, Li Y. Medicare Accountable Care Organizations: Post-acute Care Use and Post-surgical Outcomes in Urologic Cancer Surgery. Urology. 2022 Sep;167:102-108. doi: 10.1016/j.urology.2022.06.018. Epub 2022 Jun 28. PMID: 35772480.
Holloway MR, Cai X, Simning A, Cheng Z, Li Y. Changes in Income and Household Spending During Early Months of COVID-19 Pandemic Reveal Racial and Ethnic Disparities Among Older Adults. Harv Public Health Rev (Camb). 2021 Oct 13;48:https://hphr.org/48-article-holloway/. Epub 2022 Jan 13. PMID: 35935036; PMCID: PMC9351986.
Li Y, Cai X, Mao Y, Cheng Z, Temkin-Greener H. Trends in racial and ethnic disparities in coronavirus disease 2019 (COVID-19) outcomes among nursing home residents. Infect Control Hosp Epidemiol. 2022 Aug;43(8):997-1003. doi: 10.1017/ice.2021.246. Epub 2021 Jun 16. PMID: 34130766; PMCID: PMC8220019.
Li Y, Cen X, Cai X, Temkin-Greener H. Racial and Ethnic Disparities in COVID-19 Infections and Deaths Across U.S. Nursing Homes. J Am Geriatr Soc. 2020 Nov;68(11):2454-2461. doi: 10.1111/jgs.16847. Epub 2020 Sep 28. PMID: 32955105; PMCID: PMC7537079.
Surgical Technique and Outcomes
SHORE researchers have led several seminal studies on the volume-outcome relationship in surgery and how technique influences outcome. Some representative studies are below.
Justiniano CF, Becerra AZ, Loria A, Xu Z, Aquina CT, Temple LK, Fleming FJ. Is robotic utilization associated with increased minimally invasive colorectal surgery rates? Surgeon-level evidence. Surg Endosc. 2022 Aug;36(8):5618-5626. doi: 10.1007/s00464-022-09023-1. Epub 2022 Jan 13. PMID: 35024928; PMCID: PMC8757409.
Aquina CT, Becerra AZ, Justiniano CF, Xu Z, Boscoe FP, Schymura MJ, Noyes K, Monson JRT, Temple LK, Fleming FJ. Surgeon, Hospital, and Geographic Variation in Minimally Invasive Colectomy. Ann Surg. 2019 Jun;269(6):1109-1116. doi: 10.1097/SLA.0000000000002694. PMID: 31082909.
Justiniano CF, Aquina CT, Fleming FJ, Xu Z, Boscoe FP, Schymura MJ, Temple LK, Becerra AZ. Hospital and surgeon variation in positive circumferential resection margin among rectal cancer patients. Am J Surg. 2019 Nov;218(5):881-886. doi: 10.1016/j.amjsurg.2019.02.029. Epub 2019 Feb 28. PMID: 30853095.
Purrman KC, Ziazadeh D, Loria A, Jones C. Pectus Bar Displacement Causing Right Ventricular Outflow Tract Obstruction. Ann Thorac Surg. 2021 Oct;112(4):e267-e270. doi: 10.1016/j.athoracsur.2020.10.059. Epub 2021 Jan 4. PMID: 33412139.
Melucci AD, Lynch OF, Loria A, Mustian KM, Dunne RF, Temple LK, Fleming FJ. A Novel Use for Pelvic MRI Scans to Estimate Lean Body Mass and Screen for Sarcopenia in Patients With Rectal Cancer. Dis Colon Rectum. 2023 Mar 1;66(3):e122-e126. doi: 10.1097/DCR.0000000000002597. Epub 2022 Dec 22. PMID: 36649180.
Niziolek G, Keating J, Bailey J, Klingensmith NJ, Moren AM, Skarupa DJ, Loria A, Vella MA, Maher Z, Moore SA, Smith MC, Leung A, Shuster KM, Seamon MJ. Rethinking Protocolized Completion Angiography Following Extremity Vascular Trauma: A Prospective Observational Multicenter Trial Angiography Following Extremity Vascular Trauma. J Trauma Acute Care Surg. 2023 Apr 11. doi: 10.1097/TA.0000000000003925. Epub ahead of print. PMID: 37038254.
Keating JJ, Klingensmith N, Moren AM, Skarupa DJ, Loria A, Maher Z, Moore SA, Smith MC, Seamon MJ; Fasciotomy Group Investigators. Dispelling Dogma: American Association for Surgery of Trauma Prospective, Multicenter Trial of Index vs Delayed Fasciotomy after Extremity Trauma. J Am Coll Surg. 2023 May 1;236(5):1037-1044. doi: 10.1097/XCS.0000000000000612. Epub 2023 Feb 3. PMID: 36735489.
Xu Z, Fleming FJ, Justiniano CF, Becerra AZ, Boodry CI, Aquina CT, Temple LK, Speranza JR. Trends in Surgeon-Level Utilization of Sacral Nerve Stimulator Implantation for Fecal Incontinence in New York State. Dis Colon Rectum. 2018 Jan;61(1):107-114. doi: 10.1097/DCR.0000000000000941. PMID: 29215481.
Xu Z, Berho ME, Becerra AZ, Aquina CT, Hensley BJ, Arsalanizadeh R, Noyes K, Monson JRT, Fleming FJ. Lymph node yield is an independent predictor of survival in rectal cancer regardless of receipt of neoadjuvant therapy. J Clin Pathol. 2017 Jul;70(7):584-592. doi: 10.1136/jclinpath-2016-203995. Epub 2016 Dec 8. PMID: 27932667.
Medhekar AN, Mix DS, Aquina CT, Trakimas LE, Noyes K, Fleming FJ, Glocker RJ, Stoner MC. Outcomes for critical limb ischemia are driven by lower extremity revascularization volume, not distance to hospital. J Vasc Surg. 2017 Aug;66(2):476-487.e1. doi: 10.1016/j.jvs.2017.01.062. Epub 2017 Apr 10. PMID: 28408154.
Aquina CT, Probst CP, Becerra AZ, Hensley BJ, Xu Z, Iannuzzi JC, Noyes K, Monson JRT, Fleming FJ. Patients with adhesive small bowel obstruction should be primarily managed by a surgical team. Annals of Surgery. 2016 Sep;264(3):437-47. PMID: 27433901.
Becerra AZ, Berho ME, Probst CP, Aquina CT, Tejani MA, Gonzalez MG, Xu Z, Swanger AA, Noyes K, Monson JR, Fleming FJ. Variation in Hospital-Specific Rates of Suboptimal Lymphadenectomy and Survival in Colon Cancer: Evidence from the National Cancer Data Base. Ann Surg Oncol. 2016. PMID: 27613558.
Aquina CT, Probst CP, Becerra AZ, Hensley BJ, Iannuzzi JC, Noyes K, Monson JR, Fleming FJ. The impact of surgeon volume on colostomy reversal outcomes after Hartmann’s procedure for diverticulitis. Surgery. 2016 Nov;160(5):1309-1317. PMID:27395762.
Aquina CT, Probst CP, Kelly KN, Iannuzzi JC, Noyes K, Fleming FJ, Monson JR. The pitfalls of inguinal herniorrhaphy: Surgeon volume matters. Surgery. 2015 Sep;158(3):736-46. doi: 10.1016/j.surg.2015.03.058. Epub 2015 May 30. PMID: 26036880.
Probst CP, Becerra AZ, Aquina CT, Tejani MA, Hensley BJ, González MG, Noyes K, Monson JR, Fleming FJ. Watch and Wait?--Elevated Pretreatment CEA Is Associated with Decreased Pathological Complete Response in Rectal Cancer. J Gastrointest Surg. 2016 Jan;20(1):43-52; discussion 52. doi: 10.1007/s11605-015-2987-9. Epub 2015 Nov 6. PMID: 26546119.
Aquina CT, Probst CP, Becerra AZ, Iannuzzi JC, Hensley BJ, Noyes K, Monson JR, Fleming FJ. Missed Opportunity: Laparoscopic Colorectal Resection Is Associated With Lower Incidence of Small Bowel Obstruction Compared to an Open Approach. Ann Surg. 2016 Jul;264(1):127-34. doi: 10.1097/SLA.0000000000001389. PMID: 26421688.
Rickles, A. S., D. W. Dietz, G. J. Chang, S. D. Wexner, M. E. Berho, F. H. Remzi, F. L. Greene, J. W. Fleshman, M. A. Abbas, W. Peters, K. Noyes, J. R. Monson and F. J. Fleming (2015). "High Rate of Positive Circumferential Resection Margins Following Rectal Cancer Surgery: A Call to Action." Ann Surg 262(6): 891-898.
Kelly, K. N., Iannuzzi, J. C., Rickles, A. S., Garimella, V., Monson, J. R., & Fleming, F. J. (2014). Laparotomy for small-bowel obstruction: first choice or last resort for adhesiolysis? A laparoscopic approach for small-bowel obstruction reduces 30-day complications. Surgical Endoscopy, 28(1), 65-73. doi: 10.1007/s00464-013-3162-6
Cellini C, Deeb AP, Sharma A, Monson JR, Fleming FJ. Association between operative approach and complications in patients undergoing Hartmann's reversal. Br J Surg. 2013 Jul;100(8):1094-9. doi: 10.1002/bjs.9153. Epub 2013 May 21. PMID: 23696424.
Deeb AP, Kim MJ, Fleming FJ, Messing S, Gunzler D, Monson JR, Salloum RM. The impact of operative approach in elective splenectomy: a multivariate analysis of outcomes from the NSQIP database. Surg Laparosc Endosc Percutan Tech. 2012 Oct;22(5):415-9. doi: 10.1097/SLE.0b013e31825cba10. PMID: 23047384.
Fleming FJ, Kim MJ, Gunzler D, Messing S, Monson JR, Speranza JR. It's the procedure not the patient: the operative approach is independently associated with an increased risk of complications after rectal prolapse repair. Colorectal Dis. 2012 Mar;14(3):362-8. doi: 10.1111/j.1463-1318.2011.02616.x. PMID: 21692964.
Lee Y, Fleming FJ, Deeb AP, Gunzler D, Messing S, Monson JR. A laparoscopic approach reduces short-term complications and length of stay following ileocolic resection in Crohn's disease: an analysis of outcomes from the NSQIP database. Colorectal Dis. 2012 May;14(5):572-7. doi: 10.1111/j.1463-1318.2011.02756.x. PMID: 21831174.
Patient reported outcomes and Healthcare Utilization
SHORE researchers have a commitment to patient centered outcomes and ensuring value-based care. Some examples in this arena are listed below.
Loria A, Fleming FJ. Restoration of Quality of Life and Functional Recovery After Colorectal Cancer Surgery in Older Adults. J Clin Oncol. 2023 Jun 30:JCO2301066. doi: 10.1200/JCO.23.01066. Epub ahead of print. PMID: 37390379
Melucci AD, Liu JB, Brajcich BC, Collins CE, Kazaure HS, Ko CY, Pusic AL, Temple LK. Scaling and spreading the electronic capture of patient-reported outcomes using a national surgical quality improvement programme: a feasibility study protocol. BMJ Open Qual. 2022 Nov;11(4):e001909. doi: 10.1136/bmjoq-2022-001909. PMID: 36375858; PMCID: PMC9664302.
Melucci AD, Erlick MR, Loria A, Russell MM, Temple LK, Poles GC. Surgical Informed Consent: A Scoping Review of Physician-facing Decision Support Tools. Annals of Surgery Open 4(1):p e259, March 2023. DOI: 10.1097/AS9.0000000000000259
Boodry CI, Fleming FJ, Temple LK. “PROs and Postoperative Recovery.” In the Practice Quality Improvement Manual of the NSQIP Quality in Training Initiative, 2017.
Kelly KN, Noyes K, Dolan J, Fleming FJ, Monson JR, Gonzalez M, Sevdalis N, Dozier A. Patient perspective on care transitions after colorectal surgery. J Surg Res. 2016 Jun. 203(1):103-12. PMID: 27395762.
Iannuzzi JC; Kahn SA; Zhang L; Gestring ML; Noyes K; Monson JR. Getting satisfaction: drivers of surgical Hospital Consumer Assessment of Health care Providers and Systems survey scores. The Journal of surgical research..2015;Epub 2015 Mar 24.
Melucci AD, Loria A, Ramsdale E, Temple LK, Fleming FJ, Aquina CT. An assessment of left-digit bias in the treatment of older patients with potentially curable rectal cancer. Surgery. 2022 Sep;172(3):851-858. doi: 10.1016/j.surg.2022.04.038. Epub 2022 Jul 15. PMID: 35843744.
Melucci AD, Lynch OF, Wright MJ, Baran A, Temple LK, Poles GC, Moalem J. Evaluating Age as a Predictor of Postoperative Opioid Use and Prescribing Habits in Older Adults With Cancer. J Am Med Dir Assoc. 2022 Apr;23(4):678-683.e1. doi: 10.1016/j.jamda.2022.01.081. PMID: 35247360.
Burchard PR, Melucci AD, Lynch O, Loria A, Dave YA, Strawderman M, Schoeniger LO, Galka E, Moalem J, Linehan DC. Intrathecal Morphine and Effect on Opioid Consumption and Functional Recovery after Pancreaticoduodenectomy. J Am Coll Surg. 2022 Sep 1;235(3):392-400. doi: 10.1097/XCS.0000000000000261. Epub 2022 May 4. PMID: 35758927; PMCID: PMC9371061.
Poles G, Kaur R, Ramsdale E, Schymura M, Temple L, Fleming F, Aquina C. Factors affecting short-term survival in patients older than 85 treated with resection for stage II and III colon cancer. Surgery, 2022; 171(5): 1200-1208.
Hsu S, Cupertino AP, Fleming F, Linehan DC, Patel A, Reagan P, Rosen KJ, Snyder E, Strawderman M, Temple L, Barr P. Assessing Barriers to Cancer Clinical Trial Enrollment: A Potential Application of a Clinical Decision-Support Tool. Clin Oncol. 2021; 6: 1880.
Katherine Rosen, Larissa K. Temple. Patient-reported outcomes in colon and rectal surgery: The best is yet to come, Seminars in Colon and Rectal Surgery, Volume 31, Issue 4, 2020.
Becerra AZ, Probst CP, Fleming FJ, Xu Z, Aquina CT, Justiniano CF, Boodry CI, Swanger AA, Noyes K, Katz AW, Monson JR, Jusko TA. Patterns and Yearly Time Trends in the Use of Radiation Therapy During the Last 30 Days of Life Among Patients With Metastatic Rectal Cancer in the United States From 2004 to 2012. Am J Hosp Palliat Care. 2018 Feb;35(2):336-342. doi: 10.1177/1049909117706959. Epub 2017 May 11. PMID: 28494653.
Xu Z, Mohile SG, Tejani MA, Becerra AZ, Probst CP, Aquina CT, Hensley BJ, Arsalanizadeh R, Noyes K, Monson JR, Fleming FJ. Poor compliance with adjuvant chemotherapy use associated with poorer survival in patients with rectal cancer: An NCDB analysis. Cancer. 2017 Jan 1;123(1):52-61. doi: 10.1002/cncr.30261. Epub 2016 Aug 25. PMID: 27560162.
Aquina CT, Mohile SG, Tejani MA, Becerra AZ, Xu Z, Hensley BJ, Arsalanizadeh R, Boscoe FP, Schymur, Becerra AZ, Aquina CT, Hensley BJ, Justiniano CF, Boodry C, Swanger AA, Arsalanizadeh R, Noyes K, Monson JR, Fleming FJ. Emergent Colectomy Is Independently Associated with Decreased Long-Term Overall Survival in Colon Cancer Patients. J Gastrointest Surg. 2017 Mar;21(3):543-553. PMI a MJ, Noyes K, Monson JR, Fleming FJ. Br J Cancer. 2017 Jan;116(3):389-397. PMID: 28056465.
Justiniano CF, Xu Z, Becerra AZ, Aquina CT, Boodry CI, Swanger A, Temple LK, Fleming FJ. Long-term Deleterious Impact of Surgeon Care Fragmentation After Colorectal Surgery on Survival: Continuity of Care Continues to Count. Dis Colon Rectum. 2017 Nov;60(11):1147-1154. doi: 10.1097/DCR.0000000000000919. PMID: 28991078.
Becerra AZ, Probst CP, Tejani MA, Aquina CT, Gonzalez MG, Hensley BJ, Noyes K, Monson JRT, Fleming FJ. Evaluating the prognostic role of elevated preoperative carcinoembryonic antigen levels in colon cancer patients: Results from the National Cancer Data Base. Annals of Surgical Oncology. 2016; 23(5): 1554-1461.
Becerra AZ, Aquina CT, Mohile SG, Tejani MA, Schymura MJ, Boscoe FP, Xu Z, Justiniano CF, Boodry CI, Swanger AA, Noyes K, Monson JR, Fleming FJ. Variation in Delayed Time to Adjuvant Chemotherapy and Disease-Specific Survival in Stage III Colon Cancer Patients. Ann Surg Oncol. 2016. PMID: 27738848.
Aquina CT, Rickles AS, Probst CP, Kelly KN, Deeb AP, Iannuzzi JC, Noyes K, Langstein HN, Monson JRT, Fleming FJ. Visceral obesity, not elevated BMI, is strongly associated with incisional hernia after colorectal surgery. Diseases of the Colon & Rectum. 2015; 58(2): 220-227. PMID: 25585081
Kelly KN, Iannuzzi JC, Aquina CT, Probst CP, Noyes K, Monson JRT, Fleming FJ. Timing of discharge: a key to understanding the reason for readmission after colorectal surgery. Journal of Gastrointestinal Surgery. 2015; 19(3): 418-428. PMID: 25519081
Kelly KN, Fleming FJ, Aquina CT, Probst CP, Noyes K, Pegoli W, Monson JR. Disease Severity, Not Operative Approach, Drives Organ Space Infection after Pediatric Appendectomy. Annals of Surgery. 2014; 260(3):466-471. PMID: 25115422
Iannuzzi JC, Deeb AP, Rickles AS, Sharma A, Fleming FJ, Monson JR. Recognizing risk: bowel resection in the chronic renal failure population. J Gastrointest Surg. 2013 Jan;17(1):188-94. doi: 10.1007/s11605-012-2027-y. Epub 2012 Sep 13. PMID: 22972012.
Sharma A, Deeb AP, Iannuzzi JC, Rickles AS, Monson JR, Fleming FJ. Tobacco smoking and postoperative outcomes after colorectal surgery. Ann Surg. 2013 Aug;258(2):296-300. doi: 10.1097/SLA.0b013e3182708cc5. PMID: 23059503.
Quality improvement and standardization
SHORE researchers are actively engaged in the dissemination and implementation of efficacious quality improvement efforts for the Department of Surgery and the larger surgical community. Examples include.
Melucci AD, Loria A, Swanson H, White Q, Moalem J, Fleming FJ, Temple LK. Are postoperative opioid stewardship protocols sustainable? Results from a 2-year quality improvement project. Surgery. 2023 Jul 3:S0039-6060(23)00332-X. doi: 10.1016/j.surg.2023.05.036. Epub ahead of print. PMID: 37407396.
Hsu S, Melucci AD, Dave YA, et al. Outpatient endocrine surgery practice patterns are highly variable among US endocrine surgery fellowship programs [published online ahead of print, 2022 Sep 30]. Surgery. 2022;S0039-6060(22)00322-1. doi:10.1016/j.surg.2022.05.004
Melucci AD, Dave YA, Lynch OF, Hsu S, Erlick MR, Linehan DC, Moalem J; University of Rochester's Efforts to Decrease Unnecessary Controlled substances in Surgery (UReduces) Initiative. Predictors of opioid-free discharge after laparoscopic cholecystectomy. Am J Surg. 2022 Aug 3:S0002-9610(22)00492-5. doi: 10.1016/j.amjsurg.2022.07.027. PMID: 35948514.
Burchard PR, Dave YA, Loria AP, Parikh NB, Pineda-Solis K, Ruffolo LI, Strawderman M, Schoeniger LO, Galka E, Tomiyama K, Orloff MS, Carpizo DR, Linehan DC, Hernandez-Alejandro R. Early postoperative ERAS compliance predicts decreased length of stay and complications following liver resection. HPB (Oxford). 2022 Sep;24(9):1425-1432. doi: 10.1016/j.hpb.2022.01.008. Epub 2022 Jan 25. PMID: 35135723.
Aquina CT, Truong M, Justiniano CF, Kaur R, Xu Z, Boscoe FP, Schymura MJ, Becerra AZ. Variation in Adequate Lymph Node Yield for Gastric, Lung, and Bladder Cancer: Attributable to the Surgeon, Pathologist, or Hospital? Ann Surg Oncol. 2020 Oct;27(11):4093-4106. doi: 10.1245/s10434-020-08509-3. Epub 2020 May 6. PMID: 32378089.
Xu Z, Fleming FJ. Quality Assurance, Metrics, and Improving Standards in Rectal Cancer Surgery in the United States. Front Oncol. 2020 Apr 29;10:655. doi: 10.3389/fonc.2020.00655. PMID: 32411608; PMCID: PMC7202129.
Aquina CT, Fleming FJ, Hall J, Hyman N. Do All Patients Require Resection After Successful Drainage of Diverticular Abscesses? J Gastrointest Surg. 2020 Jan;24(1):219-220. doi: 10.1007/s11605-019-04396-6. Epub 2019 Sep 16. PMID: 31529197.
Justiniano CF, Aquina CT, Fleming FJ, Xu Z, Boscoe FP, Schymura MJ, Temple LK, Becerra AZ. Hospital and surgeon variation in positive circumferential resection margin among rectal cancer patients. Am J Surg. 2019 Nov;218(5):881-886. doi: 10.1016/j.amjsurg.2019.02.029. Epub 2019 Feb 28. PMID: 30853095.
Brady JT, Xu Z, Scarberry KB, Saad A, Fleming FJ, Remzi FH, Wexner SD, Winchester DP, Monson JRT, Lee L, Dietz DW; Consortium for Optimizing the Treatment of Rectal Cancer (OSTRiCh). Evaluating the Current Status of Rectal Cancer Care in the US: Where We Stand at the Start of the Commission on Cancer's National Accreditation Program for Rectal Cancer. J Am Coll Surg. 2018 May;226(5):881-890. doi: 10.1016/j.jamcollsurg.2018.01.057. Epub 2018 Mar 23. Erratum in: J Am Coll Surg. 2018 Oct;227(4):484-487. PMID: 29580675.
Becerra AZ, Aquina CT, Berho M, Boscoe FP, Schymura MJ, Noyes K, Monson JR, Fleming FJ. Surgeon-, pathologist-, and hospital-level variation in suboptimal lymph node examination after colectomy: Compartmentalizing quality improvement strategies. Surgery. 2017 Jan. PMID: 28088321.
Srinivasaiah N, Arsalani-Zadeh R, Monson JR. Thrombo-prophylaxis in colorectal surgery: a National Questionnaire Survey of the members of the Association of Coloproctology of Great Britain and Ireland. Colorectal Dis. 2012 Jul;14(7):e390-3. doi: 10.1111/j.1463-1318.2012.02974.x. PMID: 22321914.
Postoperative Complications and Adverse Events
SHORE researchers understand, and have consistently demonstrated, that postoperative complications have long term effects.
Loria A, Glance LG, Melucci AD, Boodry C, Justiniano CF, Dunne RF, Mustian KM, Becerra AZ, Jusko TA, Temple LK, Fleming FJ. Low Preoperative Serum Creatinine is Common and Associated With Poor Outcomes After Nonemergent Inpatient Surgery. Ann Surg. 2023 Feb 1;277(2):246-251. doi: 10.1097/SLA.0000000000005760. Epub 2022 Nov 28. PMID: 36448909.
Loria A, Melucci AD, Burchard PR, Ghaffar A, Levatino E, Temple LK, Fleming FJ. Implementation of a new definition for acute kidney injury in the National Surgical Quality Improvement Project: What is the impact? Surgery. 2023 Jul;174(1):2-9. doi: 10.1016/j.surg.2022.11.035. Epub 2023 Jan 6. PMID: 36610895.
Loria A, Z Becerra A, D Melucci A, Ghaffar A, Croft A, A Hanchett V, K Temple L, J Fleming F. Major renal morbidity following elective rectal cancer resection by the type of diverting ostomy. Colorectal Dis. 2023 Mar;25(3):404-412. doi: 10.1111/codi.16375. Epub 2022 Nov 13. PMID: 36237178.
Loria A, Fleming FJ. Postoperative Acute Kidney Injury in Colorectal Surgery. Dis Colon Rectum. 2022 Mar 1;65(3):308-312. doi: 10.1097/DCR.0000000000002390. PMID: 35138283.
Loria A, Melucci A, Speranza J, Cellini C, Salloum R, Temple LK, Fleming FJ, Justiniano CF. Acute kidney injury is a common and significant complication following ileostomy formation. Colorectal Dis. 2022 Jan;24(1):102-110. doi: 10.1111/codi.15917. PMID: 34536959.
Loria A, Jacobson T, Melucci AD, Bartell N, Nabozny MJ, Temple LK, Fleming FJ. Sigmoid volvulus: Evaluating identification strategies and contemporary multicenter outcomes. Am J Surg. 2022 Aug 1:S0002-9610(22)00491-3. doi: 10.1016/j.amjsurg.2022.07.025. PMID: 35934559.
Hsu S, Rosen KJ, Temple L, Fleming FJ. The Association between Pathologic Complete Response after Neoadjuvant Chemoradiotherapy and Postoperative Complications. Dig Surg. 2021;38(4):300-306. doi: 10.1159/000515725. Epub 2021 Jun 1. PMID: 34062543.
Deeb AP, Aquina CT, Monson JRT, Blumberg N, Becerra AZ, Fleming FJ. Allogeneic Leukocyte-Reduced Red Blood Cell Transfusion Is Associated with Postoperative Infectious Complications and Cancer Recurrence after Colon Cancer Resection. Dig Surg. 2020;37(2):163-170. doi: 10.1159/000498865. Epub 2019 Mar 5. PMID: 30836367.
Justiniano CF, Aquina CT, Becerra AZ, Xu Z, Boodry CI, Swanger AA, Monson JRT, Fleming FJ. Postoperative Mortality After Nonelective Surgery for Inflammatory Bowel Disease Patients in the Era of Biologics. Ann Surg. 2019 Apr;269(4):686-691. doi: 10.1097/SLA.0000000000002628. PMID: 29232213.
Justiniano CF, Xu Z, Becerra AZ, Aquina CT, Boodry CI, Temple LK, Fleming FJ. Effect of care continuity on mortality of patients readmitted after colorectal surgery. Br J Surg. 2019 Apr;106(5):636-644. doi: 10.1002/bjs.11078. Epub 2019 Feb 1. PMID: 30706462.
Justiniano CF, Temple LK, Swanger AA, Xu Z, Speranza JR, Cellini C, Salloum RM, Fleming FJ. Readmissions With Dehydration After Ileostomy Creation: Rethinking Risk Factors. Dis Colon Rectum. 2018 Nov;61(11):1297-1305. doi: 10.1097/DCR.0000000000001137. PMID: 30239391; PMCID: PMC6172143.
Aquina CT, Blumberg N, Becerra AZ, Boscoe FP, Schymura MJ, Noyes K, Monson JRT, Fleming FJ. Association Among Blood Transfusion, Sepsis, and Decreased Long-term Survival After Colon Cancer Resection. Ann Surg. 2017 Aug;266(2):311-317. doi: 10.1097/SLA.0000000000001990. PMID: 27631770.
Aquina CT, Mohile SG, Tejani MA, Becerra AZ, Xu Z, Hensley BJ, Arsalani-Zadeh R, Boscoe FP, Schymura MJ, Noyes K, Monson JR, Fleming FJ. The impact of age on complications, survival, and cause of death following colon cancer surgery. Br J Cancer. 2017 Jan;116(3):389-397. doi: 10.1038/bjc.2016.421. Epub 2017 Jan 5. PMID: 28056465; PMCID: PMC5294480.
Noyes K, Baack-Kukreja J, Messing EM, Schoeniger L, Galka E, Pan W, Xueya C, Fleming FJ, Monson JR, Mohile SG, Francone T. Surgical readmissions: results of integrating pre-, peri- and postsurgical care. Nurs Open. 2016 May 10;3(3):168-178. doi: 10.1002/nop2.52. PMID: 27708827; PMCID: PMC5047346.
Iannuzzi JC, Aquina CT, Rickles AS, Hensley BJ, Probst CP, Noyes K, Monson JRT, Fleming FJ. Risk factors for post-discharge venothromboembolism following colorectal resection. Diseases of the Colon & Rectum. 2016; 59(3): 224-229. PMID: 26855397
Aquina CT, Probst CP, Becerra AZ, Hensley BJ, Iannuzzi JC, Noyes K, Monson JRT, Fleming FJ. High variability in nosocomial Clostridium difficile infection rates across hospitals following colorectal resection. Diseases of the Colon & Rectum. 2016; 59(4): 323-331. PMID: 26953991
Aquina CT, Blumberg N, Probst CP, Becerra AZ, Hensley BJ, Noyes K, Monson JRT, Fleming FJ. Large variation in blood transfusion utilization following colorectal resection: A call to action. Diseases of the Colon & Rectum. 2016; 59(5): 411-418. PMID: 27050603.
Aquina CT, Blumberg N, Probst CP, Becerra AZ, Hensley BJ, Iannuzzi JC, Gonzalez MG, Deeb AP, Noyes K, Monson JR, Fleming FJ. Significant Variation in Blood Transfusion Practice Persists following Upper GI Cancer Resection. J Gastrointest Surg. 2015 Nov;19(11):1927-37. doi: 10.1007/s11605-015-2903-3. Epub 2015 Aug 12. PMID: 26264360.
Kelly, K. N., Iannuzzi, J. C., Rickles, A. S., Monson, J. R., & Fleming, F. J. (2014). Risk factors associated with 30-day postoperative readmissions in major gastrointestinal resections. J Gastrointest Surg, 18(1), 35-44. doi: 10.1007/s11605-013-2354-7
Sharma A, Deeb AP, Rickles AS, Iannuzzi JC, Monson JR, Fleming FJ. Closure of defunctioning loop ileostomy is associated with considerable morbidity. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2013;15(4):458-62.
Health Economics and Cost-Effectiveness
Health economics and cost-effectiveness analysis play a crucial role in shaping surgical research and healthcare decision-making. SHORE recognizes that with the rising cost of healthcare and the ever-expanding range of surgical options, health economics and cost-effectiveness analysis provide evidence-based insights that aid in making informed decisions about the adoption of surgical innovations.
Leeds IL, Xu Z, Loria A, Pantel HJ, Mongiu AK, Longo WL, Reddy V. How Far Is Too Far? Cost-Effectiveness Analysis of Regionalized Rectal Cancer Surgery. Dis Colon Rectum. 2023 Mar 1;66(3):467-476. doi: 10.1097/DCR.0000000000002636. Epub 2022 Nov 28. PMID: 36538713.
Xu Z, Fleming FJ. The treatment-travel tradeoff of colorectal cancer care. Surgery. 2021 Apr;169(4):989-990. doi: 10.1016/j.surg.2020.10.010. Epub 2020 Nov 19. PMID: 33220976.
Justiniano CF, Becerra AZ, Xu Z, Aquina CT, Boodry CI, Schymura MJ, Boscoe FP, Noyes K, Temple LK, Fleming FJ. A Population-Based Study of 90-Day Hospital Cost and Utilization Associated with Robotic Surgery in Colon and Rectal Cancer. J Surg Res. 2020 Jan;245:136-144. doi: 10.1016/j.jss.2019.07.052. Epub 2019 Aug 13. PMID: 31419638.
Xu Z, Aquina CT, Justiniano CF, Becerra AZ, Boscoe FP, Schymura MJ, Temple LK, Fleming FJ. Centralizing Rectal Cancer Surgery: What Is the Impact of Travel on Patients? Dis Colon Rectum. 2020 Mar;63(3):319-325. doi: 10.1097/DCR.0000000000001581. PMID: 32045397.
Xu Z, Becerra AZ, Justiniano CF, Boodry CI, Aquina CT, Swanger AA, Temple LK, Fleming FJ. Is the Distance Worth It? Patients With Rectal Cancer Traveling to High-Volume Centers Experience Improved Outcomes. Dis Colon Rectum. 2017 Dec;60(12):1250-1259. doi: 10.1097/DCR.0000000000000924. PMID: 29112560.
Aquina CT, Probst CP, Becerra AZ, Iannuzzi JC, Kelly KN, Hensley BJ, Rickles AS, Noyes K, Fleming FJ, Monson JRT. High volume improves outcomes: The argument for centralization of rectal cancer surgery. Surgery. 2016; 159(3): 736-748. PMID: 26576696
Aquina CT, Kelly KN, Probst CP, Iannuzzi JC, Noyes K, Langstein HN, Monson JRT, Fleming FJ. Surgeon volume plays a significant role in outcomes and cost following open incisional hernia repair. Journal of Gastrointestinal Surgery. 2015; 19(1): 100-110. PMID: 25118644
Iannuzzi JC, Rickles AS, Kelly KN, Fleming FJ, Dolan JG, Monson JR, Noyes K. Defining high risk: cost-effectiveness of extended-duration thromboprophylaxis following major oncologic abdominal surgery. J Gastrointest Surg. 2014 Jan;18(1):60-8. doi: 10.1007/s11605-013-2373-4. Epub 2013 Oct 8. PMID: 24101450; PMCID: PMC4652588.
Epidemiology and Population-Based Studies
SHORE believes that epidemiology and population-based studies are indispensable tools for surgical research as they provide a comprehensive understanding of the distribution and determinants of surgical diseases, guide treatment decisions, enhance patient care, and inform public health strategies. SHORE combines clinical expertise with robust population-level data, the surgical community can continuously advance patient care, reduce surgical risks, and optimize the overall health outcomes for diverse populations.
Loria A, Marianetti I, Cook CA, Melucci AD, Ghaffar A, Juviler P, Temple LK, Jones CMC, Fleming FJ. Epidemiology and healthcare utilization for rectal foreign bodies in United States adults, 2012-2021. Am J Emerg Med. 2023 Mar 30;69:76-82. doi: 10.1016/j.ajem.2023.03.041. Epub ahead of print. PMID: 37060632.
Hsu S, Rosen KJ, Cupertino A, Temple L, Fleming F. Generalizability of Randomized Controlled Trials in Rectal Cancer. J Gastrointest Surg. 2022 Feb;26(2):453-465. doi: 10.1007/s11605-021-05192-x. PMID: 34755313.
Loria A, Jacobson T, Melucci AD, Bartell N, Nabozny MJ, Temple LK, Fleming FJ. Sigmoid volvulus: Evaluating identification strategies and contemporary multicenter outcomes. Am J Surg. 2022 Aug 1:S0002-9610(22)00491-3. doi: 10.1016/j.amjsurg.2022.07.025. PMID: 35934559.
Casabianca AS, Tsagkalidis V, Burchard PR, Chacon A, Melucci A, Reitz A, Swift DA, McCook AA, Switchenko JM, Shah MM, Carpizo DR. Surgery in combination with systemic chemotherapy is associated with improved survival in stage IV gallbladder cancer. Eur J Surg Oncol. 2022 Jun 22:S0748-7983(22)00534-0. doi: 10.1016/j.ejso.2022.06.029. PMID: 35773092.
Xu Z, Becerra AZ, Justiniano CF, Aquina CT, Fleming FJ, Boscoe FP, Schymura MJ, Sinno AK, Chaoul J, Morrow GR, Minasian L, Temkin SM. Complications and Survivorship Trends After Primary Debulking Surgery for Ovarian Cancer. J Surg Res. 2020 Feb;246:34-41. doi: 10.1016/j.jss.2019.08.027. Epub 2019 Sep 24. PMID: 31561176; PMCID: PMC6917987.
Aquina CT, Becerra AZ, Xu Z, Justiniano CF, Noyes K, Monson JRT, Fleming FJ. Population-based study of outcomes following an initial acute diverticular abscess. Br J Surg. 2019 Mar;106(4):467-476. doi: 10.1002/bjs.10982. Epub 2018 Oct 18. PMID: 30335195.
Aquina CT, Fleming FJ, Becerra AZ, Hensley BJ, Noyes K, Monson JRT, Temple LK, Cellini C. Who gets a pouch after colectomy in New York state and why? Surgery. 2018 Feb;163(2):305-310. doi: 10.1016/j.surg.2017.07.024. Epub 2017 Oct 13. PMID: 29033223.
Aquina CT, Becerra AZ, Xu Z, Boscoe FP, Schymura MJ, Noyes K, Monson JR, Fleming FJ. Nonelective colon cancer resection: A continued public health concern. Surgery. 2017 Feb. PMID: 28237645.
Al-Khyatt W, Mytton J, Tan BH, Aquina CT, Evison F, Fleming FJ, Pasquali S, Griffiths EA, Vohra RS. A Population-Based Cohort Study of Emergency Appendectomy Performed in England and New York State. World J Surg. 2017 Mar. PMID: 28299474.
Aquina CT, Fleming FJ, Becerra AZ, Xu Z, Hensley BJ, Noyes K, Monson JRT, Jusko TA. Explaining variation in ventral and inguinal hernia repair outcomes: A population-based analysis. Surgery. 2017 Sep;162(3):628-639. doi: 10.1016/j.surg.2017.03.013. Epub 2017 May 18. PMID: 28528663.
Tan BH, Mytton J, Al-Khyatt W, Aquina CT, Evison F, Fleming FJ, Griffiths E, Vohra RS. A comparison of mortality following emergency laparotomy between populations from New York State and England. Annals of Surgery. 2016 Aug. PMID: 27548571.
Surgical Collaboratives and Practice Guidelines
SHORE is committed to surgical collaboratives and practice guidelines and believes that these are vital components of contemporary surgical practice. They promote collaboration, standardization, and evidence-based decision-making, leading to safer and more effective surgical procedures and improved patient outcomes. By embracing these approaches, the surgical community can continuously advance the field, ensuring that patients receive the highest level of care and benefit from the latest surgical innovations and knowledge.
The Upstate New York Surgical Quality Initiative (UNYSQI) was launched in 2007 through a partnership between Excellus Health Plan, Hospitals and the American College of Surgeons' National Surgical Quality Improvement Program with the goal of providing improved quality of surgical care to New York residents. This collaborative has played an important role in demonstrating care practices at small and medium sized hospitals from rural areas.
Website: www.unysqi.org
Justiniano CF, Loria A, Hellenthal NJ, Schiralli MP, Soto FC, Albright JB, Giangreco L, Temple LK, Fleming FJ; UNYSQI Collaborative. The accumulation of ERAS (enhanced recovery after surgery) components reduces post-colectomy length of stay at small and low volume hospitals. Am J Surg. 2022 Apr;223(4):744-752. doi: 10.1016/j.amjsurg.2021.07.004. Jul 7. PMID: 34311949.
Hensley BJ, Cooney RN, Hellenthal NJ, Aquina CT, Noyes K, Monson JR, Kelly KN, Fleming FJ; Upstate New York Surgical Quality Initiative Collaborative. Readmissions After Colectomy: The Upstate New York Surgical Quality Initiative Experience. Dis Colon Rectum. 2016 May;59(5):419-25. doi: 10.1097/DCR.0000000000000566. PMID: 27050604.
Rickles AS, Iannuzzi JC, Kelly KN, Cooney RN, Brown DA, Davidson M, Hellenthal N, Max C, Johnson J, DeTraglia J, McGurrin M, Kimball R, DiBenedetto A, Galyon D, Esposito SL, Noyes K, Monson JR, Fleming FJ; UNYSQI Collaborative. Anastomotic leak or organ space surgical site infection: What are we missing in our quality improvement programs? Surgery. 2013 Oct;154(4):680-7; discussion 687-9. doi: 10.1016/j.surg.2013.06.035. PMID: 24074406.
In addition to this regional collaborative, SHORE researchers are actively involved in National professional society leadership roles and international surgical collaboratives.
Ternent CA, Fleming F, Welton ML, Buie WD, Steele S, Rafferty J; American Society of Colon and Rectal Surgeons. Clinical Practice Guideline for Ambulatory Anorectal Surgery. Dis Colon Rectum. 2015 Oct;58(10):915-22. doi: 10.1097/DCR.0000000000000451. PMID: 26347962.
PelvEx
National Institute for Health and Care Research Global Health Research Unit on Global Surgery etc