Browsing by Author "Hwang, E. Shelley"

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    Pain Control in Breast Surgery: Survey of Current Practice and Recommendations for Optimizing Management—American Society of Breast Surgeons Opioid/Pain Control Workgroup
    (Springer, 2020-04) Rao, Roshni; Jackson, Rubie Sue; Rosen, Barry; Brenin, David; Cornett, Wendy; Fayanju, Oluwadamilola M.; Chen, Steven L.; Golesorkhi, Negar; Ludwig, Kandice; Ma, Ayemoethu; Koslow Mautner, Starr; Sowden, Michelle; Wilke, Lee; Wexelman, Barbara; Blair, Sarah; Gary, Monique; Grobmyer, Stephen; Hwang, E. Shelley; James, Ted; Kapoor, Nimmi S.; Lewis, Jaime; Lizarraga, Ingrid; Miller, Megan; Neuman, Heather; Showalter, Shayna; Smith, Linda; Froman, Joshua; Medicine, School of Medicine
    Introduction: The opioid epidemic in the United States is a public health crisis. Breast surgeons are obligated to provide good pain control for their patients after surgery but also must minimize administration of narcotics to prevent a surgical episode of care from becoming a patient's gateway into opioid dependence. Methods: A survey to ascertain pain management practice patterns after breast surgery was performed. A review of currently available literature that was specific to breast surgery was performed to create recommendations regarding pain management strategies. Results: A total of 609 surgeons completed the survey and demonstrated significant variations in pain management practices, specifically within regards to utilization of regional anesthesia (e.g., nerve blocks), and quantity of prescribed narcotics. There is excellent data to guide the use of local and regional anesthesia. There are, however, fewer studies to guide narcotic recommendations; thus, these recommendations were guided by prevailing practice patterns. Conclusions: Pain management practices after breast surgery have significant variation and represent an opportunity to improve patient safety and quality of care. Multimodality approaches in conjunction with standardized quantities of narcotics are recommended.
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    Racial-Ethnic Variations in Phyllodes Tumors among a Multi-Center United States Cohort
    (Wiley, 2023) Nash, Amanda L.; Thomas, Samantha M.; Nimbkar, Suniti N.; Hieken, Tina J.; Ludwig, Kandice K.; Jacobs, Lisa K.; Miller, Megan E.; Gallagher, Kristalyn K.; Wong, Jasmine; Neuman, Heather B.; Tseng, Jennifer; Hassinger, Taryn E.; King, Tari A.; Hwang, E. Shelley; Jakub, James W.; Rosenberger, Laura H.; Surgery, School of Medicine
    Background and objectives: Previous studies have identified racial-ethnic differences in the diagnostic patterns and recurrence outcomes of women with phyllodes tumors (PT). However, these studies are generally limited in size and generalizability. We therefore sought to explore racial-ethnic differences in age, tumor size, subtype, and recurrence in a large US cohort of women with PT. Methods: We performed an 11-institution retrospective review of women with PT from 2007 to 2017. Differences in age at diagnosis, tumor size and subtype, and recurrence-free survival according to race-ethnicity. Results: Women of non-White race or Hispanic ethnicity were younger at the time of diagnosis with phyllodes tumor. Non-Hispanic Other women had a larger proportion of malignant PT. There were no differences in recurrence-free survival in our cohort. Conclusions: Differences in age, tumor size, and subtype were small. Therefore, the workup of young women with breast masses and the treatment of women with PT should not differ according to race-ethnicity. These conclusions are supported by our finding that there were no differences in recurrence-free survival.