Staff Profile

@article{pmid39310342,

title = {Characteristics Associated with Successful Residency Match in General Surgery},

author = {Reagan A Collins and Kaitlyn Nimmer and Salma A Sheriff and Tania K Arora and Anai N Kothari and Carrie Cunningham and Callisia N Clarke},

doi = {10.1097/AS9.0000000000000469},

issn = {2691-3593},

year  = {2024},

date = {2024-09-01},

journal = {Ann Surg Open},

volume = {5},

number = {3},

pages = {e469},

abstract = {OBJECTIVE: To evaluate characteristics of matched and unmatched general surgery residency (GSR) applicants.nnBACKGROUND: Given the recent change of the United States Medical Licensing Exam Step 1 grading to pass/fail, understanding the factors that influence GSR match success is integral to identifying potential interventions to improve match rates for diverse medical students.nnMETHODS: Retrospective review of GSR National Residency Matching Program (NRMP) applicant and Accreditation Council for Graduate Medical Education (ACGME) active resident data between 2011 and 2022. Data included application characteristics for United States ("US") and "independent" applicants, factors cited by program directors in the interview and ranking process, paths pursued if applicants went unmatched, and racial/ethnic representation.nnRESULTS: A total of 9149 US and 3985 independent applicants applied to GSR between 2011 and 2021. Matched  unmatched applicants had higher step 1 scores (US: 236  218,  0.005; independent: 237  228,  0.001), higher step 2 scores (US: 248  232,  0.006; independent: 245  234,  0.001), more likely to belong to alpha omega alpha (US: 17.1%  1.6%,  0.002) or to attend a top 40 National Institutes of Health-funded school (US: 31.0%  19.4%,  0.002) compared to unmatched applicants. Program directors heavily factored step 1 and step 2 scores, letters of recommendation, interactions with faculty and trainees, and interpersonal skills when interviewing and ranking applicants. The proportion of active general surgery residents  applicants was lower for Asians (12.3%  20.9%,  0.001), Black/African American (5.0%  8.8%,  0.001), Hispanic/Latino (5.0%  9.4%,  0.001), and underrepresented in medicine students (10.3%  19.1%,  0.001).nnCONCLUSIONS: In the pass/fail step 1 era, factors including step 2 score and other subjective metrics may be more heavily weighted in the GSR match process.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37991182,

title = {Unspoken Truths: Mental Health Among Academic Surgeons},

author = {Reagan A Collins and Tianna Herman and Rebecca A Snyder and Krista L Haines and Anne Stey and Tania K Arora and Sunil K Geevarghese and Joseph D Phillips and Diego Vicente and Cornelia L Griggs and Imani E McElroy and Anji E Wall and Tasha M Hughes and Srijan Sen and Jaber Valinejad and Andres Alban and J Shannon Swan and Nathaniel Mercaldo and Mohammad S Jalali and Jagpreet Chhatwal and G Scott Gazelle and Erika Rangel and Chi-Fu Jeffrey Yang and Karen Donelan and Jessica A Gold and Colin P West and Carrie Cunningham},

doi = {10.1097/SLA.0000000000006159},

issn = {1528-1140},

year  = {2024},

date = {2024-03-01},

urldate = {2024-03-01},

journal = {Ann Surg},

volume = {279},

issue = {3},

pages = {429-436},

abstract = {OBJECTIVE: To characterize the current state of mental health within the surgical workforce in the United States (US).nnSUMMARY BACKGROUND DATA: Mental illness and suicide is a growing concern in the medical community; however, the current state is largely unknown.nnMETHODS: Cross-sectional survey of the academic surgery community assessing mental health, medical error, and suicidal ideation. The odds of suicidal ideation adjusting for sex, prior mental health diagnosis, and validated scales screening for depression, anxiety, post-traumatic stress disorder (PTSD), and alcohol use disorder were assessed.nnRESULTS: Of 622 participating medical students, trainees, and surgeons (estimated response rate=11.4-14.0%), 26.1% (141/539) reported a previous mental health diagnosis. 15.9% (83/523) of respondents screened positive for current depression, 18.4% (98/533) for anxiety, 11.0% (56/510) for alcohol use disorder, and 17.3% (36/208) for PTSD. Medical error was associated with depression (30.7% vs. 13.3%, P\<0.001), anxiety (31.6% vs. 16.2%, P=0.001), PTSD (12.8% vs. 5.6%, P=0.018), and hazardous alcohol consumption (18.7% vs. 9.7%, P=0.022). 13.2% (73/551) of respondents reported suicidal ideation in the past year and 9.6% (51/533) in the past two weeks. On adjusted analysis, a previous history of a mental health disorder (aOR: 1.97, 95% CI: 1.04-3.65, P=0.033), and screening positive for depression (aOR: 4.30, 95% CI: 2.21-8.29, P\<0.001) or PTSD (aOR: 3.93, 95% CI: 1.61-9.44, P=0.002) were associated with increased odds of suicidal ideation over the past 12 months.nnCONCLUSIONS: Nearly 1 in 7 respondents reported suicidal ideation in the past year. Mental illness and suicidal ideation are significant problems among the surgical workforce in the US.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37925258,

title = {Association of patient-practitioner sex concordance with specialist referral in primary hyperparathyroidism},

author = {Jordan M Broekhuis and Maria P Cote and Reagan A Collins and Jorge L Gomez-Mayorga and Natalia Chaves and Benjamin C James},

doi = {10.1016/j.surg.2023.08.048},

issn = {1532-7361},

year  = {2024},

date = {2024-01-01},

urldate = {2023-11-01},

journal = {Surgery},

volume = {175},

issue = {1},

pages = {19-24},

abstract = {BACKGROUND: Prior research has demonstrated barriers to the workup and management of primary hyperparathyroidism. As recent data have suggested that patient and practitioner sex concordance is associated with lower surgical complications, we sought to evaluate the effect of sex concordance on referral for primary hyperparathyroidism.nnMETHODS: We queried an institutional database for patients with first-incident hypercalcemia and subsequent biochemical evidence of primary hyperparathyroidism between 2010 and 2018. Primary care practitioner and endocrinologist sex, laboratory values, and complications of primary hyperparathyroidism were collected. Sex concordance (male patient/male practitioner or female patient/female practitioner) was evaluated as a binary predictor of specialist evaluation using logistic regression and Cox proportional hazards modeling.nnRESULTS: Among 1,100 patients, mean age was 62.5 (standard deviation 13.6), and 74% were female sex. Primary care practitioner sex was 52% female, and 63% of patients had sex concordance with their primary care practitioner. Endocrinologist sex was 59% female, and 45% of patients had sex concordance with their endocrinologist. Patients with sex concordance with their primary care practitioner (70 vs 80%, P = .001) and endocrinologist (71 vs 82%, P \< .001) were less likely to be female sex compared to those with discordance. After adjusting for demographics and clinical covariates, those patients with primary care practitioner sex concordance had 32% higher odds of endocrinologist evaluation (odds ratio 1.32, 95% confidence interval 1.003-1.734, P = .047). Similarly, those patients with endocrinologist sex concordance had a 48% higher rate of surgeon evaluation (hazard ratio 1.48, confidence interval 1.1-2.0, P = .009). Stratified analysis revealed that sex discordance reduced the rate of surgeon referral for female patients (hazard ratio 0.63, confidence interval 0.44-0.89, P = .008) but not male patients (hazard ratio 1.06, CI 0.58-1.93, P = .861).nnCONCLUSION: Sex discordance between patients and their health care professionals may contribute to under-referral in primary hyperparathyroidism. Further evaluation of the effect of patient and practitioner identities on communication and decision-making in surgery are needed.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37872045,

title = {The impact of social determinants of health on thyroid cancer mortality and time to treatment},

author = {Reagan A Collins and Catherine McManus and Eric J Kuo and Rachel Liou and James A Lee and Jennifer H Kuo},

doi = {10.1016/j.surg.2023.04.062},

issn = {1532-7361},

year  = {2024},

date = {2024-01-01},

urldate = {2023-10-01},

journal = {Surgery},

volume = {175},

issue = {1},

pages = {57-64},

abstract = {BACKGROUND: Whereas racial disparities in thyroid cancer care are well established, the role of social determinants of health is less clear. We aimed to assess the individual and cumulative impact of social determinants of health on mortality and time to treatment among patients with thyroid cancer.nnMETHODS: We collected social determinants of health data from thyroid cancer patients registered in the National Cancer Database from 2004 to 2017. We created a count variable for patients in the lowest quartile of each social determinant of health (ie, low income, low education, and no insurance). We assessed the association of social determinants of health with mortality and time to treatment and the association between cumulative social determinants of health count and time to treatment using Cox regression.nnRESULTS: Of the 142,024 patients we identified, patients with longer time to treatment had greater mortality compared to patients treated within 90 days (90-180 days, adjusted hazard ratio 1.21 (95% confidence interval 1.13-1.29, P \< .001); \>180 days, adjusted hazard ratio 1.57 (95% confidence interval 1.41-1.76, (P \< .001). Compared to patients with no adverse social determinants of health, patients with 1, 2, or 3 adverse social determinants of health had a 10%, 12%, and 34%, respectively, higher likelihood of longer time to treatment (1 social determinant of health, hazard ratio 0.90, 95% confidence interval 0.89-0.92, P \< .001; 2 social determinants of health, hazard ratio 0.88, 95% confidence interval 0.87-0.90, P \< .001; 3 social determinants of health, hazard ratio 0.66, 95% confidence interval 0.62-0.71, P \< .001 for all). On subgroup analysis by race, each adverse social determinant of health was associated with an increased likelihood of a longer time to treatment for Black and Hispanic patients (P \< .05).nnCONCLUSION: A greater number of adverse social determinants of health leads to a higher likelihood of a longer time to treatment for patients with thyroid cancer, which, in turn, is associated with an increased risk for mortality.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37792380,

title = {Depression and Suicide Among American Surgeons-A Grave Threat to the Surgeon Workforce},

author = {Tasha M Hughes and Reagan A Collins and Carrie E Cunningham},

doi = {10.1001/jamasurg.2023.4658},

issn = {2168-6262},

year  = {2024},

date = {2024-01-01},

urldate = {2023-10-01},

journal = {JAMA Surg},

volume = {159},

issue = {1},

pages = {7-8},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37925262,

title = {Social vulnerability and time to surgeon evaluation for primary hyperparathyroidism in a Massachusetts cohort},

author = {Reagan A Collins and Jordan M Broekhuis and Maria P Cote and Jorge L Gomez-Mayorga and Natalia Chaves and Benjamin C James},

doi = {10.1016/j.surg.2023.04.067},

issn = {1532-7361},

year  = {2023},

date = {2023-11-01},

urldate = {2023-11-01},

journal = {Surgery},

volume = {175},

issue = {1},

pages = {25-31},

abstract = {BACKGROUND: Identifying patients at risk for under-evaluation of primary hyperparathyroidism is essential to minimizing long-term sequelae, including osteoporosis, nephrolithiasis, and cardiovascular disease. This study assessed the impact of social vulnerability on time-to-surgery evaluation among patients with primary hyperparathyroidism in a Massachusetts cohort.nnMETHODS: This is a retrospective review of patients from an institutional database with the first incident of hypercalcemia between 2010 and 2018 and subsequent biochemical diagnosis of primary hyperparathyroidism. The overall social vulnerability index and social vulnerability index subthemes were merged with the institutional data via patient ZIP code. Patients were stratified into social vulnerability index quartiles, where quartile 4 represented the highest vulnerability. Baseline sociodemographic and clinical characteristics were compared, and Cox regression was used to assess the association between social vulnerability index and time to surgeon evaluation.nnRESULTS: Of 1,082 patients included, those with a higher social vulnerability index were less likely to be evaluated by a surgeon (quartile 1 social vulnerability index: 31.1% vs. quartile 2 social vulnerability index: 31.41% vs. quartile 3 social vulnerability index: 25.93% vs. quartile 4 social vulnerability index: 21.92%, P = .03). On adjusted analysis, patients with the highest vulnerability had a 33% lower estimated rate of surgeon evaluation and were seen 67 days later compared with patients with the lowest vulnerability (hazard ratio: 0.67, confidence interval 0.47-0.97, P = .032). Differential rates of surgical evaluation by vulnerability persisted for the social vulnerability index subthemes for socioeconomic status, minority status and language, and housing type and transportation.nnCONCLUSION: Among a Massachusetts cohort, highly vulnerable populations with primary hyperparathyroidism are at greater risk for under-evaluation by a surgeon, which may contribute to the development of long-term sequelae of their disease.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36987566,

title = {Delay in Surgery and Papillary Thyroid Cancer Survival in the United States: a SEER-Medicare Analysis},

author = {Natalia Chaves and Jordan M Broekhuis and Scott C Fligor and Reagan A Collins and Anna M Modest and Sumedh Kaul and Benjamin C James},

doi = {10.1210/clinem/dgad163},

issn = {1945-7197},

year  = {2023},

date = {2023-09-18},

urldate = {2023-03-01},

journal = {J Clin Endocrinol Metab},

volume = {108},

number = {10},

pages = {2589-2596},

abstract = {INTRODUCTION: Delays in surgery and their impact on survival in papillary thyroid cancer (PTC) is unclear. We sought to investigate the association between time to surgery and survival in patients with PTC.nnMETHODS: A total of 8,170 Medicare beneficiaries with PTC who underwent thyroidectomy were identified within the SEER-Medicare linked data files between 1999-2018. Disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan-Meir analysis, and Cox proportional hazards models were specified to estimate the association between time to surgery and survival.nnRESULTS: Among 8,170 patients with PTC, mean age 69.3 (SD+/- 11.4), 89.8% had surgery within the first 90 days, 7.8% had surgery 91-180 days from diagnosis, and 2.4% had surgery after 180 days. Increasing time to surgery was associated with increased mortality for OS in the \>180-day group (aHR 1.24, 95% CI 1.01-1.53). Moreover, on stratification by summary stage, those with localized disease in the 91-180-day group increased risk by 25% (aHR 1.25 95%CI 1.05-1.51) and delaying over 180 days increased risk by 61% (aHR 1.61 95%CI 1.19-2.18) in OS. Those with localized disease in the \>180-day group had almost four times the estimated rate of DSS mortality (aHR3.51 95%CI 1.68-7.32). When stratified by T stage, those with T2 disease in the \>180 days group had double the estimated rate of all-cause mortality (aHR 2.0, 95% CI 1.1-3.3) and almost triple the estimated rate of disease-specific mortality (aHR 2.7, 95% CI 1.05-6.8).nnCONCLUSIONS: Delays in surgery for PTC may impact OS and DSS in localized disease, prior to nodal metastasis.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37079205,

title = {Assessing the Complex General Surgical Oncology Pipeline: Trends in Race and Ethnicity Among US Medical Students, General Surgery Residents, and Complex General Surgical Oncology Trainees},

author = {Reagan A Collins and Salma A Sheriff and Christopher Yoon and Adrianne N Cobb and Anai N Kothari and Lisa A Newman and Lesly A Dossett and Alliric I Willis and Sandra L Wong and Callisia N Clarke},

doi = {10.1245/s10434-023-13499-z},

issn = {1534-4681},

year  = {2023},

date = {2023-08-01},

journal = {Ann Surg Oncol},

volume = {30},

number = {8},

pages = {4579--4586},

abstract = {BACKGROUND: Cancer incidence is expected to increase in coming decades, disproportionately so among minoritized communities. Racially and ethnically concordant care is essential to addressing disparities in cancer outcomes within at-risk groups. Here, we assess trends in racial and ethnic representation of medical students (MS), general surgery (GS) residents, and complex general surgical oncology (CGSO) fellows.nnMETHODS: This is a retrospective review of data from the American Association of Medical Colleges and the Accreditation Council of Medical Education (ACGME) from 2015 to 2020. Self-reported race and ethnicity was obtained for MS, GS, and CGSO trainees. Race and ethnicity proportions were compared with respective representation in the 2020 US Census. Mann-Kendall, Wilcoxon rank sum, and linear regression were used to assess trends, as appropriate.nnRESULTS: A total of 316,448 MS applicants, 128,729 MS matriculants, 27,574 GS applicants, 46,927 active GS residents, 710 CGSO applicants, and 659 active CGSO fellows were included. With every progressive stage in training, there was a smaller proportion of URM active trainees than applicants. Further, URM, Hispanic/Latino, and Black/African American trainees were significantly underrepresented compared with 2020 Census data. While the proportion of White CGSO fellows increased over time (54.5-69.2%, p = 0.009), the proportion of Black/African American and Hispanic/Latino (URM) CGSO fellows did not significantly change over the study period, though URM representation was lower in 2020 as compared with 2015.nnDISCUSSION: From 2015 to 2020, minority representation decreased at every advancing stage in surgical oncology training. Efforts to address barriers for URM applicants to CGSO fellowships are needed.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37191861,

title = {ASO Visual Abstract: Assessing the Complex General Surgical Oncology Pipeline-Trends in Race and Ethnicity Among US Medical Students, General Surgery Residents, and Complex General Surgical Oncology Trainees},

author = {Reagan A Collins and Salma A Sheriff and Christopher Yoon and Adrianne N Cobb and Anai N Kothari and Lisa A Newman and Lesly A Dossett and Alliric I Willis and Sandra L Wong and Callisia N Clarke},

doi = {10.1245/s10434-023-13609-x},

issn = {1534-4681},

year  = {2023},

date = {2023-08-01},

urldate = {2023-05-01},

journal = {Ann Surg Oncol},

volume = {30},

issue = {8},

pages = {4587-4588},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37040051,

title = {ASO Visual Abstract: Adoption of Robotic Adrenalectomy: A Two-Institution Study of Surgeon Learning Curve},

author = {Reagan A Collins and Tracy S Wang and Sophie Dream and Carmen C Sol\'{o}rzano and Colleen M Kiernan},

doi = {10.1245/s10434-023-13492-6},

issn = {1534-4681},

year  = {2023},

date = {2023-07-01},

urldate = {2023-07-01},

journal = {Ann Surg Oncol},

volume = {30},

issue = {7},

pages = {4179},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37040047,

title = {Adoption of Robotic Adrenalectomy: A Two-Institution Study of Surgeon Learning Curve},

author = {Reagan A Collins and Tracy S Wang and Sophie Dream and Carmen C Sol\'{o}rzano and Colleen M Kiernan},

doi = {10.1245/s10434-023-13406-6},

issn = {1534-4681},

year  = {2023},

date = {2023-07-01},

urldate = {2023-04-01},

journal = {Ann Surg Oncol},

volume = {30},

issue = {7},

pages = {4167-4178},

abstract = {BACKGROUND: Robotic adrenalectomy is feasible and safe, yet concerns over increased operative times and the learning curve (LC) for proficiency have limited its adoption. This study aimed to assess the LC for robotic adrenalectomy.nnMETHODS: This is a two-institution retrospective review of consecutive unilateral minimally invasive adrenalectomies performed by four high-volume adrenal surgeons between 2007 and 2022. Two surgeons transitioned from laparoscopic to robotic adrenalectomy, and two surgeons adopted the approach, with proctoring, after completion of fellowship training without robotic experience. Operative time and complications were analyzed. Multivariable regression was used to identify factors associated with operative time. The number of cases required to overcome the LC was determined using the LC-cumulative-sum (LC-CUSUM) analysis.nnRESULTS: Of 457 adrenalectomies, 182 (40%) were laparoscopic and 275 (60%) robotic. The robotic approach was associated with shorter median operative time (106 vs 119 min; p = 0.002), fewer complications (6% vs 13%; p = 0.018), and fewer conversions to open adrenalectomy (1% vs 4%; p = 0.030), with no difference between the senior and junior surgeons. On adjusted analysis, factors associated with increased operative time were male sex (p \< 0.001), BMI \> 30 kg/m (p \< 0.001), and higher gland weight (p \< 0.001). The LC-CUSUM analysis showed proficiency after 8-29 procedures. Compared with the first 10 cases, there was a mean reduction in operative time of 14 min after 10-20 cases, 28 min after 20-30 cases, and 29 min after \> 30 cases, regardless of surgeon experience.nnDISCUSSION: With dedicated teams and proctoring, robotic adrenalectomy can be safely adopted at high-volume centers with a minimal LC.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37014086,

title = {Urban and Rural Surgical Practice Patterns for Papillary Thyroid Carcinoma},

author = {Reagan A Collins and Natalia Chaves and Gillian Lee and Jordan M Broekhuis and Benjamin C James},

doi = {10.1089/thy.2022.0711},

issn = {1557-9077},

year  = {2023},

date = {2023-07-01},

journal = {Thyroid},

volume = {33},

number = {7},

pages = {849--857},

abstract = { The 2015 American Thyroid Association (ATA) guidelines shifted recommendations toward less aggressive management of papillary thyroid cancer (PTC). Subsequently, several studies demonstrated a trend in performing thyroid lobectomy (TL) over total thyroidectomy (TT). However, regional variation has persisted without a clear indication of what factors may be influencing practice variation. We aimed to evaluate the surgical management of PTC in patients in rural and urban settings to assess trends of TL compared with TT following the implementation of the 2015 ATA guidelines.  A retrospective cohort analysis was performed using the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2019 of patients with localized PTC <4 cm who underwent TT or TL. Patients were classified as living in urban or rural counties based on the 2013 Rural-Urban Continuum Codes. Procedures performed from 2004 to 2015 were categorized as preguidelines, while those performed from 2016 to 2019 were categorized as postguidelines. Chi-square, Student's -test, logistic regression, and Cochran-Mantel-Haenszel test were used.  A total of 89,294 cases were included in the study. Eighty thousand one hundred and fifty (89.8%) were from urban settings and 9144 (9.2%) were from rural settings. Patients from rural settings were older (52 vs. 50 years,  < 0.001) and had smaller nodules ( < 0.001). On adjusted analysis, patients in rural areas were less likely to undergo TT (adjusted odds ratio 0.81, confidence interval [CI] 0.76-0.87). Before the 2015 guidelines, patients in urban settings had a 24% higher odds of undergoing TT compared with those in rural settings (odds ratio 1.24, CI 1.16-1.32,  < 0.001). There was no difference in the proportions of TT and TL based on setting following guideline implementation ( = 0.185).  The 2015 ATA guidelines led to a change in overall practice in surgical management of PTC toward increasing TL. While urban and rural practice variation existed before 2015, both settings had an increase in TL following the guideline change, emphasizing the importance of clinical practice guidelines to ensure best practice in both rural and urban settings.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36960710,

title = {A Comprehensive Study on the Diagnosis and Management of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features},

author = {Bayan A Alzumaili and Lauren N Krumeich and Reagan Collins and Timothy Kravchenko and Emad I Ababneh and Adam S Fisch and William C Faquin and Vania Nos\'{e} and Maria Martinez-Lage and Gregory W Randolph and Rajshri M Gartland and Carrie C Lubitz and Peter M Sadow},

doi = {10.1089/thy.2023.0035},

issn = {1557-9077},

year  = {2023},

date = {2023-05-01},

journal = {Thyroid},

volume = {33},

number = {5},

pages = {566--577},

abstract = { Since the noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTPs) was introduced in 2016, most retrospective studies have included cases diagnosed as encapsulated follicular variant of papillary thyroid carcinoma. We investigate a cohort diagnosed with NIFTP at resection.  Retrospective institutional cohort of NIFTP from 2016 to 2022, including clinical, cytological, and molecular data for 319 cases (6.6% of thyroid surgeries, 183 cases as NIFTP-only).  The patient cohort had unifocal or multifocal thyroid nodules. Female:male ratio was 2.7:1, mean age was 52 years and median NIFTP size was 2.1 cm. NIFTP was associated with multiple nodules in 23% patients ( = 73) and 12% of NIFTP were multifocal ( = 39). Fine needle aspiration (FNA) of NIFTP ( = 255) were designated as nondiagnostic = 5%, benign = 13%, atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) = 49%, follicular neoplasm/suspicious for follicular neoplasm (FN/SFN) = 17%, suspicious for malignancy = 12%, or malignant = 4%. Molecular alterations were identified in 93% ( = 114),  or -like. Thyroid Imaging Reporting and Data System (TI-RADS) score 4 was recorded in 50% of NIFTP, followed by scores 3 and 5 (26% and 20%, respectively). We also investigated the factors associated with extent of surgery. In our NIFTP-only group ( = 183), 66% were identified after hemithyroidectomy (HT) and 34% after total thyroidectomy (TT). On univariate analysis, TT patients demonstrated higher Bethesda category by FNA, more often had aberrant preoperative thyroid function, and/or underwent an FNA of additional nodule(s). With multivariable regression, Bethesda V NIFTP, in the presence of other nodules being evaluated by FNA and aberrant preoperative thyroid function, independently predicts TT. Bethesda II NIFTP correlated significantly with HT. Fifty-two patients (28%) with NIFTP-only had at least one postoperative surveillance ultrasound. In the NIFTP-only cohort, no HT patients had completion thyroidectomy or received postoperative radioactive iodine. No recurrence or metastases were recorded with median follow-up of 35 months (6-76 months;  = 120).  Given this large cohort of NIFTP, including a large subset of isolated NIFTP-only, some with >6 years of follow-up and no tumor recurrences, consensus practical guidelines are needed for adequate postoperative management. Given the American Thyroid Association (ATA) provides guidelines for management of low-risk malignancies, guidance regarding that for borderline/biologically uncertain tumors, including NIFTP, is a reasonable next step.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36210185,

title = {Limited disease progression in endocrine surgery patients with treatment delays due to COVID-19},

author = {Reagan A Collins and Catherine DiGennaro and Toni Beninato and Rajshri M Gartland and Natalia Chaves and Jordan M Broekhuis and Lekha Reddy and Jenna Lee and Angelina Deimiller and Maeve M Alterio and Michael J Campbell and Yeon Joo Lee and Tyler K Khilnani and Latoya A Stewart and Mollie A O'Brien and Miguel Valdivia Y Alvarado and Feibi Zheng and David McAneny and Rachel Liou and Catherine McManus and Sophie Y Dream and Tracy S Wang and Tina W Yen and Amal Alhefdhi and Brendan M Finnerty and Thomas J Fahey and Claire E Graves and Amanda M Laird and Matthew A Nehs and Frederick Thurston Drake and James A Lee and Christopher R McHenry and Benjamin C James and Janice L Pasieka and Jennifer H Kuo and Carrie Cunningham Lubitz},

doi = {10.1016/j.surg.2022.06.043},

issn = {1532-7361},

year  = {2023},

date = {2023-01-01},

journal = {Surgery},

volume = {173},

number = {1},

pages = {93--100},

abstract = {BACKGROUND: The COVID-19 pandemic profoundly impacted the delivery of care and timing of elective surgical procedures. Most endocrine-related operations were considered elective and safe to postpone, providing a unique opportunity to assess clinical outcomes under protracted treatment plans.



METHODS: American Association of Endocrine Surgeon members were surveyed for participation. A Research Electronic Data Capture survey was developed and distributed to 27 institutions to assess the impact of COVID-19-related delays. The information collected included patient demographics, primary diagnosis, resumption of care, and assessment of disease progression by the surgeon.



RESULTS: Twelve out of 27 institutions completed the survey (44.4%). Of 850 patients, 74.8% (636) were female; median age was 56 (interquartile range, 44-66) years. Forty percent (34) of patients had not been seen since their original surgical appointment was delayed; 86.2% (733) of patients had a delay in care with women more likely to have a delay (87.6% vs 82.2% of men, χ = 3.84, P = .05). Median duration of delay was 70 (interquartile range, 42-118) days. Among patients with a delay in care, primary disease site included thyroid (54.2%), parathyroid (37.2%), adrenal (6.5%), and pancreatic/gastrointestinal neuroendocrine tumors (1.3%). In addition, 4.0% (26) of patients experienced disease progression and 4.1% (24) had a change from the initial operative plan. The duration of delay was not associated with disease progression (P = .96) or a change in operative plan (P = .66).



CONCLUSION: Although some patients experienced disease progression during COVID-19 delays to endocrine disease-related care, most patients with follow-up did not. Our analysis indicated that temporary delay may be an acceptable course of action in extreme circumstances for most endocrine-related surgical disease.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}