Joshua Philip Parreco

Florida Atlantic University | FAU · Charles E. Schmidt College of Medicine

Purpose: The purpose of this study was to compare machine learning techniques for predicting central line-associated bloodstream infection (CLABSI). Materials and methods: The Multiparameter Intelligent Monitoring in Intensive Care III database was queried for all ICU admissions. The variables included six different severities of illness scores...

Hospitalization for violent trauma costs as much as $8.5 billion per year in the United States, and reinjury rates are as high as 40%.¹ Most trauma reinjury studies include data from a single center. However, nearly 60% of reinjured patients present to a different hospital, making prediction of reinjury difficult.¹,2 Machine learning allows compute...

Objective: To compare the risk factors and costs associated with readmission after firearm injury nationally, including different hospitals. Background: No national studies capture readmission to different hospitals after firearm injury. Methods: The 2013 to 2014 Nationwide Readmissions Database was queried for patients admitted after firearm...

Background: Most prior studies of readmission after trauma have been limited to single institutions while multi-institutional studies have been limited to single states and an inability to distinguish between elective and nonelective readmissions. The purpose of this study was to identify the risk factors and costs associated with nonelective read...

Background: A significant proportion of postoperative readmission occurs at a different hospital and is thus missed by current benchmarking. There are no national studies tracking readmission at different hospitals after colorectal surgery. This study aimed to determine the national burden of postoperative colorectal readmission, including readmis...

Background The rise of value-based purchasing has led to decreased compensation for hospital-acquired conditions, including surgical site infections (SSI). This study aims to assess the risk factors for SSI in children and teenagers undergoing gastrointestinal surgery across US hospitals. Methods The 2018-2020 Nationwide Readmissions Database was...

Background: In the setting of limited funding and high expectations for quality care, safety net hospitals play a crucial role in treating pediatric trauma patients. This study aimed to compare outcomes and hospitalization costs of pediatric trauma patients in safety net hospitals across the United States. Methods: The Nationwide Readmissions Datab...

INTRODUCTION: Outcomes after mastectomy with immediate reconstruction may vary depending on the type of reconstruction, but the evidence is limited and inconsistent. The purpose of this study was to compare the most common reconstruction techniques in a large national cohort of women undergoing these procedures. METHODS: The Nationwide Readmissions...

Currently, there is no universally accepted, standardized protocol for pre-operative antibiotic administration in the setting of appendectomy for complicated appendicitis among pediatric patients. Strategies to mitigate surgical site infections (SSIs) must be balanced with optimal antibiotic use and exposure. We conducted a retrospective chart revi...

Inadequate health literacy poses a significant public health challenge, influencing patient treatment adherence and outcomes. This study explores outcomes in the setting of language congruence at the time of discharge for pediatric patients following laparoscopic gastrostomy tube insertion. We conducted a retrospective chart review from 2019 to 202...

Venous thromboembolism (VTE) in pediatric trauma patients is under-investigated. The purpose of this study was to perform an evaluation of the risk factors for VTE after pediatric trauma, including readmissions across the United States. The Nationwide Readmissions Database for 2016-2020 was queried for all patients under the age of 18 years admitte...

Background Triage accuracy is essential for delivering effective trauma care, especially in the pediatric population where unique challenges exist. The purpose of this study was to investigate risk factors contributing to under-triage and over-triage in an urban pediatric trauma center. Methods This retrospective cohort study included all trauma a...

This cohort study examines the rates and risks associated with surgical site infection during admission or readmission of socioeconomically marginalized patients undergoing gastrointestinal surgery.

Purpose The incidence of pulmonary embolism (PE) in hospitalized children has increased in recent years. This study sought to characterize factors and outcomes associated with PE using a national pediatric cohort. Methods The Nationwide Readmissions Database was queried (2016-2018) for patients (<18 years) with a diagnosis of PE. Index and prior h...

Introduction: The utility of incidental appendectomy (IA) during many ovarian operations has not been evaluated in the pediatric population. This study sought to compare outcomes after ovarian surgery with IA in the pediatric population. Methods: Females (≤20 y old) undergoing ovarian surgeries (oophorectomy, detorsion and/or drainage) were iden...

Objective: Considerable variation in primary spontaneous pneumothorax (PSP) management exists in the pediatric population. This study aims to compare nationwide outcomes of children with PSP. Methods: The Nationwide Readmissions Database (2016 to 2018) was used to identify patients 1 to 18 years old with PSP. Trauma, secondary pneumothoraces, an...

Background: Non-elderly trauma patients represent the largest portion of preventable years of life loss in the US. The purpose of this study was to compare outcomes in patients admitted to investor-owned vs public and not-for-profit hospitals across the US. Material and methods: The Nationwide Readmissions Database 2018 was queried for trauma pa...

Introduction: Maintaining trust in the patient-doctor relationship requires transparency in the details of the financial relationships between physicians and drug and medical device corporations. These details are publicly available through the Open Payments database, and patients are encouraged to ask surgeons to interpret their implications. The...

Purpose: Intestinal malrotation may be asymptomatic in patients with heterotaxy syndrome (HS), and whether these newborns benefit from prophylactic Ladd procedures is unknown. This study sought to uncover nationwide outcomes of newborns with HS receiving Ladd procedures. Methods: Newborns with malrotation were identified from the Nationwide Read...

Purpose: Debate exists on whether patients with Hirschsprung Disease (HD) should undergo immediate resection during their newborn hospitalization or undergo a staged procedure. This study sought to compare postoperative outcomes among newborns receiving immediate versus staged surgery for rectosigmoid HD. Methods: The Nationwide Readmission Data...

Purpose: Oophorectomy and ovarian detorsion are some of the most frequent operations performed in the female pediatric population. Despite the advent of laparoscopy, many surgeons continue to utilize open surgical approaches in these patients. This study sought to compare nationwide trends and postoperative outcomes in laparoscopic and open ovaria...

Purpose: Management of complicated pleural effusions and empyema using tube thoracostomy with intrapleural fibrinolysis versus surgical drainage has been debated for decades. However, there remains considerable variation in management with these approaches in the pediatric population. This study aims to compare the nationwide outcomes of pediatric...

Background: Financial toxicity describes the harmful effect of individual treatment costs and fiscal burdens that have a compounding negative impact on outcomes in surgery. While this phenomenon has been widely studied in surgical oncology, the purpose of this study was to perform a novel exploration of the impact of financial toxicity in emergenc...

Purpose: Hirschsprung Disease (HD) is a common congenital intestinal disorder. While aganglionosis most commonly affects the rectosigmoid colon (rectosigmoid HD), outcomes for patients in which aganglionosis extends to more proximal segments (long-segment HD) remain understudied. This study sought to compare postoperative outcomes among newborns w...

Background: The Focused Assessment Sonography in Trauma (FAST) examination is the standard of care for detecting hemoperitoneum in hypotensive blunt trauma patients. A pilot study demonstrated earlier identification of intra-abdominal fluid via FAST after right-sided roll (FASTeR) when compared with the standard FAST. The purpose of this study was...

Purpose: Although conservative management followed by readmission for interval appendectomy is commonly used to manage perforated appendicitis, many studies are limited to individual or noncompeting pediatric hospitals. This study sought to compare national outcomes following interval or same-admission appendectomy in children with perforated appe...

Background: Untreated pediatric choledochal cyst (CC) is associated with complications including cholangitis, pancreatitis, and risk of malignancy. Therefore, CC is typically treated by surgical excision with biliary reconstruction. Both open and laparoscopic (lap) surgical approaches are regularly used, but outcomes have not been compared on a na...

IntroductionWhile operative intervention for Chiari malformation type I (CMI) with syringomyelia is well established, there is limited data on outcomes of intraoperative neuromonitoring (IONM). This study sought to explore differences in procedural characteristics and their effects on postoperative readmission rates.Methods The Nationwide Readmissi...

Background Malrotation with midgut volvulus is a surgical emergency commonly encountered in pediatric surgical practice. Outcomes are excellent with timely diagnosis and treatment, but the development of bowel ischemia is associated with many negative consequences. Methods The Nationwide Readmissions Database was used to identify patients 0-18 yea...

Introduction: Diverticular disease is one of the most common gastrointestinal diseases that require hospital admission. This study aims to identify trends in prior hospital admissions for patients that ultimately require a Hartmann's procedure for complicated diverticulitis. Methods: The Nationwide Readmissions Database for 2010-2014 was queried...

Purpose Surgical management of pediatric ovarian torsion includes total oophorectomy (TO) or ovarian preservation surgery (OPS). This study sought to identify factors contributing to surgical management and readmission outcomes for ovarian torsion. Methods The Nationwide Readmission Database from 2010-2014 was used to identify patients < 18 years...

Purpose: Pediatric patients with Crohn's disease often require colectomies. The laparoscopic approach is considered safe, but there is little national data on outcomes and readmissions in this population. Methods: The Nationwide Readmissions Database was queried from 2010-2014 for patients ≤ 18 years who underwent colectomy for Crohn's disease duri...

Background This study aims to compare the morbidity of open versus laparoscopic colectomy or proctocolectomy for pediatric patients with ulcerative colitis (UC) using national readmission outcomes. Materials and Methods The 2010-2014 Nationwide Readmissions Database was used to identify patients ≤ 18 years (excluding newborns) who underwent colect...

Purpose Pyloromyotomy for hypertrophic pyloric stenosis (HPS) is one of the most common non-elective operations performed in the neonatal period. This project aims to explore outcomes of pyloromyotomy and compare differences between laparoscopic versus open pyloromyotomies in newborns diagnosed with HPS. Methods The Nationwide Readmissions Databas...

Purpose: Fundoplications are a common operation in the pediatric population. This study aims to explore outcomes comparing laparoscopic versus open operative techniques. Methods: From 2010 to 2014 the Nationwide Readmissions Database was used to identify patients aged 0-18 years who underwent a fundoplication. Propensity score matched analysis was...

Background: There are few nationwide studies comparing outcomes of open, laparoscopic (LAP), and percutaneous endoscopic (PEG) gastrostomy tube (GT) placement in the pediatric population. Materials and Methods: The Nationwide Readmissions Database from 2010 to 2014 was used to identify patients ≤18 years (excluding newborns) who underwent GT placem...

Background Laparoscopic Ladd's procedure has been proven safe and effective for the treatment of malrotation. However, the nationwide utilization and outcomes of elective Ladd's procedure are largely unknown. Methods The Nationwide Readmissions Database from 2010-2014 was used to identify patients 0-18 years (excluding newborns) with malrotation w...

Background: Randomized controlled trials (RCTs) are generally regarded as the gold standard for demonstrating causality because they effectively mitigate bias from both known and unknown confounders. However, conducting an RCT is not always feasible because of logistical and ethical considerations. This is especially true when evaluating surgical i...

Background: There are no national studies of nonelective readmissions after emergency general surgery (EGS) diagnoses that track non-index hospital readmission. We sought to determine the rate of overall and non-index hospital readmissions at 30 and 90 days after discharge for EGS diagnoses, hypothesizing a significant portion would be to non-inde...

Background Of the few studies comparing simultaneous versus staged resection of primary colorectal cancer and synchronous liver metastases, most are limited to resections performed at the same facility. This study was performed to compare outcomes of simultaneous versus staged resection in these patients, including resections performed at a differe...

Objective: To quantify the proportion of postpartum VTE readmissions, including those that occur at different hospitals from index admission, and describe risk factors for this outcome. Design: Retrospective observational study. Setting: United States hospitals included in the Nationwide Readmissions Database. Sample: A total of 3,719,238 pa...

Objective: Inferior vena cava (IVC) injuries have a high mortality rate that may be related to the location of injury and type of repair. Previous studies have been either single center series or database studies lacking granular detail. These have reported conflicting results. We aimed to perform a systematic review and meta-analysis of published...

Background The dogma of early inguinal hernia repair in infants, especially those born prematurely, has dominated clinical practice owing to reports of a high frequency of incarceration and significant complications associated with untreated inguinal hernias. We aim to evaluate the frequency of complications after discharge with delayed surgery for...

Background The purpose of this study was to identify the pattern of injuries that relates to abuse and neglect in children with burn injuries. Methods The Nationwide Readmissions Database for 2010-2014 was queried for all patients aged less than 18 y admitted with burn injuries. The primary outcome was child maltreatment identified at the index ad...

Background Kasai portoenterostomy (KPE) remains the first-line operation for patients with biliary atresia (BA), but ultimately fails in up to 60% of cases. This study sought to identify factors contributing to hospital readmission and early liver transplant. Methods The Nationwide Readmissions Database from 2010 to 2014 was used to identify patie...

Purpose Congenital diaphragmatic hernia (CDH) is a congenital anomaly associated with lifelong multisystem morbidity. This study sought to identify factors contributing to hospital readmission after CDH repair. Methods The Nationwide Readmissions Database from 2010 to 2014 was used to identify patients with CDH who underwent surgical repair. Prima...

Background: Parathyroidectomy is frequently performed as ambulatory surgery. This study seeks to characterize the socioeconomic factors that may impact the patient selection for outpatient parathyroidectomy. Methods: The 2016 Florida State Inpatient Database (SID) and the 2016 Florida State Ambulatory Surgery Database (SASD) were queried for all...

Background: Prior studies of venous thromboembolism (VTE) after emergency general surgery (EGS) are not nationally representative nor do they fully capture readmissions to different hospitals. We hypothesized that different-hospital readmission accounted for a significant number of readmissions with VTE after EGS and that predictive factors would...

Introduction: The incidence and significance of hyperparathyroidism in patients after bariatric surgery have been established to some degree; however, the impact it has on the national healthcare system has not. We sought to assess the risk of readmission and related comorbidities in this patient population. Methods: The Healthcare Cost and Util...

Objectives Historically, carotid procedures incur a readmission rate of approximately 6%, however, these studies are not nationally representative and are limited to tracking only the index hospitals. We sought to to evaluate a nationally representative database for readmission rates (including different hospitals) after both CEA and CAS, and deter...

Introduction Repeated pediatric assault should be a never event. The purpose of this study was to evaluate the readmission and reinjury patterns in pediatric victims of assault including readmissions to different hospitals across the US. Methods The 2010–2014 Nationwide Readmissions Database was queried for all nonelective admissions for patients...

Background: Previous studies have shown that a notable portion of patients who are readmitted for reinjury after penetrating trauma present to a different hospital. The purpose of this study was to identify the risk factors for reinjury after penetrating trauma including reinjury admissions to different hospitals. Methods: The 2010-2014 Nationwi...

Introduction: The efficacy of vitamin C (VitC) and thiamine (THMN) in patients admitted to the intensive care unit (ICU) with sepsis is unclear. The purpose of this study was to evaluate the effect of VitC and THMN on mortality and lactate clearance in ICU patients. We hypothesized that survival and lactate clearance would be improved when treated...

Purpose: The purpose of this study is to identify determinants of mortality and hospital readmission in infants born with esophageal atresia ± tracheoesophageal fistula. Methods: The Nationwide Readmissions Database (2010-2014) was queried for newborns with a diagnosis of esophageal atresia. Outcomes included mortality and readmissions at 30-day...

Background/Purpose Recurrent intussusception following successful non-operative reduction has previously been reported with a frequency of 8–12% based on data from individual institutions. Meanwhile, the timing of discharge after successful reduction continues to be debated. Here, we evaluate readmissions for recurrent intussusception in young chil...

Purpose: No nationwide studies on hospital readmissions exist for children who have undergone pull-through operations for Hirschsprung disease. The study aim is to identify determinants of postoperative discharge outcomes and hospital readmissions in children with Hirschsprung disease. Methods: The Nationwide Readmissions Database for 2010-2014...

Purpose: Pediatric firearm injury is a national crisis that inflicts significant trauma. No studies have captured risk factors for readmissions after firearm injury, including cost analysis. Methods: Nationwide Readmissions Database (2010-2014) was queried for patients <18 years admitted after acute firearm injury. Outcomes included mortality, l...

Background: The efficacy of oral chlorhexidine (oCHG) for decontamination in intensive care unit (ICU) patients is controversial. The purpose of this study was to evaluate the effect of oCHG decontamination on the incidence of pneumonia, sepsis, and death in ICU patients. Methods: The Philips eICU database version 2.0 was queried for patients admi...

Background: As nonoperative management (NOM) of blunt splenic injury (BSI) increases, understanding risks, especially infectious complications, becomes more important. There are no national studies on BSI outcomes that track readmissions across hospitals. Prior studies demonstrate that infection is a major cause of readmission after trauma and tha...

Purpose: Child abuse is a national, often hidden, epidemic. The study objective was to determine at-risk populations that have been previously hospitalized prior to their admission for child abuse. Methods: The Nationwide Readmissions Database (NRD) was queried for all children hospitalized for abuse. Outcomes were previous admissions and diagno...

Background: The Advanced Trauma Life Support (ATLS) shock classification has been accepted as the conceptual framework for clinicians caring for trauma patients. We sought to validate its ability to predict mortality, blood transfusion, and urgent intervention. Materials and methods: We performed a retrospective review of trauma patients using t...

The safety of hepatectomy continues to improve and it holds a key role in the management of benign and malignant hepatic lesions. Laparoscopic and robotic approaches to hepatectomy are increasingly utilized. The purpose of this study was to compare outcomes and costs of laparoscopic and robotic vs. open approaches to hepatectomy and to determine th...

Prior studies have used vital signs and laboratory measurements with conventional modeling techniques to predict acute kidney injury (AKI). The purpose of this study was to use the trend in vital signs and laboratory measurements with machine learning algorithms for predicting AKI in ICU patients. The eICU Collaborative Research Database was querie...

The purpose of this study was to identify the risk factors for hospital readmission for child maltreatment after trauma, including admissions across different hospitals nationwide. The Nationwide Readmissions Database for 2010-2014 was queried for all patients younger than 18 years admitted for trauma. The primary outcome was readmission for child...

INTRODUCTION Venous thromboembolism (VTE) causes morbidity and mortality after delivery and is a quality indicator. Prior studies have found that readmission to a different hospital can be significant and hidden, with unique risk factors. The national rate of postpartum different hospital readmission for VTE is unknown. The purpose of this study wa...

Background: Hospital readmissions with 30 days after vascular surgical interventions have been associated with increased morbidity, mortality, and cost. Readmission rates, now a Centers for Medicare and Medicaid Services quality measure, have been studied in databases that have excluded certain payer types and states and have not accounted for rea...

Up to one in three readmissions occur at a different hospital and are thus missed by current quality metrics. There are no national studies examining 30-day readmission, including to different hospitals, after umbilical hernia repair (UHR). We tested the hypothesis that a large proportion were readmitted to a different hospital, that risk factors f...

Objective: Some drivers involved in motor vehicle crashes across the United States may be identified as at risk of subsequent injury by a similar mechanism. The purpose of this study was to perform a national review of the risk factors for hospitalization for a new injury due to a subsequent motor vehicle crash. It was hypothesized that presenting...