Papers by Shalini Selvarajah
Journal of Spinal Cord Medicine, Sep 1, 2013
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Journal of Surgical Research, 2016
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Journal of Vascular Surgery, 2015
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Journal of Vascular Surgery, 2014
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The Spine Journal, 2016
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The Journal of surgical research, Jun 1, 2016
Trauma centers (TCs) have been demonstrated to improve outcomes for some nontrauma surgical condi... more Trauma centers (TCs) have been demonstrated to improve outcomes for some nontrauma surgical conditions, such as appendicitis, but it remains unclear if this extends to all emergency general surgery procedures. Using emergent colectomy in patients with diverticulitis as index condition, this study compared outcomes between TCs and nontrauma centers (NTCs). The Nationwide Emergency Department Sample (2006-2011) was queried for patients ≥16 y with diverticulitis who underwent emergency surgical intervention. Outcomes included mortality, total charges, and length of stay (LOS). Mortality in TC and NTC was compared using logistic regression, controlling for patient, procedure, and hospital-level characteristics. Adjusted total charges and LOS were analyzed using generalized linear models with gamma and Poisson distributions, respectively. A total of 25,396 patients were included, 5189 (20.4%) were treated at TC and 20,207 (79.6%) at NTC. Median age and sex distribution were similar. Unad...
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The Journal of surgical research, Jan 2, 2015
Lower extremity bypass (LEB) for peripheral vascular disease is a common procedure in diabetics a... more Lower extremity bypass (LEB) for peripheral vascular disease is a common procedure in diabetics and is associated with readmission. Thus, we hypothesized that diabetes might be a predictor of 30-d unplanned readmission after LEB. Patients undergoing infrainguinal LEB in the 2011-12 American College of Surgeons National Surgery Quality Improvement Program database were divided into nondiabetics mellitus (NDM), non-insulin-dependent diabetics mellitus (NIDDM), and insulin-dependent diabetic mellitus (IDDM). Univariate and multivariate analyses were used to evaluate the influence of diabetes on 30-d readmission. A total of 9207 patients (5155 [56%] NDM, 1690 (18%) NIDDM, and 2362 (26%) IDDM) underwent LEB. Unplanned readmission was observed in 1448 patients (16%). IDDM had significantly higher crude postoperative complication (43% versus 30% NDM, 36% NIDDM; P < 0.001) and unplanned readmission rates (20% versus 14% NDM, 16% NIDDM; P < 0.001). Concomitant cardiac disease significa...
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Gastroenterology, 2013
ABSTRACT
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The Journal of surgical research, 2015
An estimated 1.7 million people sustain a traumatic brain injury (TBI) annually in the United Sta... more An estimated 1.7 million people sustain a traumatic brain injury (TBI) annually in the United States. We sought to examine factors contributing to mortality among TBI patients aged ≥65 y in the United States. TBI data from the Nationwide Inpatient Sample were combined from 2000-2010. Patients were stratified by age, sex, mechanism of injury, payer status, comorbidity, injury severity, and other factors. Odds of death were explored using an adjusted multivariable logistic regression. A total of 950,132 TBI-related hospitalizations and 107,666 TBI-related deaths occurred among adults aged ≥65 y from 2000-2010. The most common mechanism of injury was falling, and falls were more common among the oldest age groups. Logistic regression analysis showed highest odds of death among male patients, those whose mechanism of injury was motor vehicle related, patients with three or more comorbidities, and patients who were designated as self-paying.
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Internationally, it is recognized that knowledge is required to improve patient safety. In additi... more Internationally, it is recognized that knowledge is required to improve patient safety. In addition, the global community had stated its concern that the increase in publications in patient safety had not shown measurable improvement. MOH approached the Malaysia patient safety R & D agenda by calling for concerted research to identify threats to patient safety, as well as design and test effective strategies to address national needs. The health research priority’s call for research in patient safety resulted in an explicit process of prioritisation to identify crucial areas to meet these requirements. This article attempts to delineate the processes taken to identify MOH’s research agenda for patient safety. (http://www2.moh.gov.my/images/gallery/publications/mh/Malaysia%20Health%202008-2.pdf)
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Introduction: The increase in TBI-related morbidity and mortality have led the CDC to call it “th... more Introduction: The increase in TBI-related morbidity and mortality have led the CDC to call it “the silent epidemic.” Adults age 65+ are more prone to falls and other mechanisms of injury, and may thus be at a higher risk of TBI-related morbidity and mortality. This study seeks to identify factors contributing to TBI and related mortality among the elderly. Methods: We analyzed data from the Nationwide Inpatient Sample, and included records that described hospitalizations occurring among individuals age 65 and older from 2000-2010 and contained data on patient age, sex, mechanism of injury, payer status, as well as descriptive data relating to the hospital involved. A subset of patients was compiled whose records also contained race information. Logistic regression analyses were conducted to produce both crude and adjusted odds ratios (OR) of death. Population-based TBI incidence and mortality rates were calculated. Results: A total of 950,132 hospitalizations were identified that me...
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The Journal of surgical research, Jan 2, 2015
Lower extremity bypass (LEB) for peripheral vascular disease is a common procedure in diabetics a... more Lower extremity bypass (LEB) for peripheral vascular disease is a common procedure in diabetics and is associated with readmission. Thus, we hypothesized that diabetes might be a predictor of 30-d unplanned readmission after LEB. Patients undergoing infrainguinal LEB in the 2011-12 American College of Surgeons National Surgery Quality Improvement Program database were divided into nondiabetics mellitus (NDM), non-insulin-dependent diabetics mellitus (NIDDM), and insulin-dependent diabetic mellitus (IDDM). Univariate and multivariate analyses were used to evaluate the influence of diabetes on 30-d readmission. A total of 9207 patients (5155 [56%] NDM, 1690 (18%) NIDDM, and 2362 (26%) IDDM) underwent LEB. Unplanned readmission was observed in 1448 patients (16%). IDDM had significantly higher crude postoperative complication (43% versus 30% NDM, 36% NIDDM; P < 0.001) and unplanned readmission rates (20% versus 14% NDM, 16% NIDDM; P < 0.001). Concomitant cardiac disease significa...
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Neurology, Apr 8, 2014
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Neurology, Apr 8, 2014
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Annals of vascular surgery, Jan 20, 2016
Costs related to diabetic foot ulcer (DFU) care are greater than $1 billion annually and rising. ... more Costs related to diabetic foot ulcer (DFU) care are greater than $1 billion annually and rising. We sought to describe the impact of diabetes (DM) on foot ulcer admissions in the US, and to investigate potential explanations for rising hospital costs. The Nationwide Inpatient Sample (2005-2010) was queried using ICD-9 codes for a primary diagnosis of foot ulceration. Multivariable analyses were used to compare outcomes and per-admission costs among patients with foot ulceration and DM vs. non-DM. 962,496 foot ulcer patients were admitted over the study period. The overall rate of admissions was relatively stable over time, but the ratio of DM vs. non-DM admissions increased significantly (2005: 10.2 vs. 2010: 12.7; p<0.001). Neuropathy and infection accounted for 90% of DFU admissions, while PVD accounted for most non-DM admissions. Admissions related to infection rose significantly among DM patients (2005: 39,682 vs. 2010: 51,660; p<0.001), but remained stable among non-DM pa...
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JAMA Surgery, 2016
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Neurology, Apr 8, 2014
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American journal of surgery, Jan 29, 2015
Studies have demonstrated racial/ethnic disparities in surgical outcomes and care. Surgeon awaren... more Studies have demonstrated racial/ethnic disparities in surgical outcomes and care. Surgeon awareness and its association with institutional action remain unclear. The study sought to assess surgeons' awareness of racial/ethnic disparities, ascertain whether demographic and practice factors influence acknowledgement of disparities, and determine whether surgeons are seeking to mitigate disparities. Anonymous online survey was administered to a random sample of American College of Surgeons (ACS) general surgeons (July 2013 to March 2014). Responses were weighted for nonresponse and risk-adjusted using logistic regression. 172 surgeons completed the survey. Levels of acknowledged disparities were low. Less than one half reported institutional efforts to address disparities, and less than one fourth had taken efforts to investigate disparities in their personal practice. Several respondent factors including Academic Medical Center affiliation, awareness of the ACS statement on optim...
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Papers by Shalini Selvarajah