LaMiah Hall

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Objective: Clinical trials are the cornerstone of medical innovation and set the standard for medical care. Cancer clinical trials drive critical innovation and availability of new treatments. However, obstacles to successful recruitment and participation of patients in clinical trials still significantly limit their success. Our objective is to evaluate trial enrollment trends according to both patient and trial demographics/features for those who have sought care at our multi-center, mixed-setting Gynecologic Oncology practice, allowing for us to describe specific trial criteria designs that are negatively associated with diverse enrollment or lack of enrollment completion on cancer clinical trials. Methods: An IRB-approved, retrospective cohort study was completed to evaluate patients who screened positive for a clinical trial through the Gynecologic Oncology practice’s manual screening process. We looked at how trial characteristics affect enrollment success. Results: After adjustment, there were no significant differences between patient factors and enrollment status. Higher rates of enrollment were seen among Asian patients and patients whose race was reported as “unknown” (>50%, p = 0.125). There was a drastic, unadjusted estimated increase in enrollment for Medicaid patients compared to patients with other insurance types (55.2% vs. 32%, p = 0.031), but multivariable logistic regression showed that insurance status (Medicaid vs. others) lost significance, p = 0.148. Patients with Stage I cancer accounted for 42.1% of patients enrolled, and enrollment rates were higher than for other cancer stages (p = 0.087). There was a significant increase in enrollment likelihood if the trial did not exclude subjects with prior cancer (50.0% vs. 33.3%, p = 0.046). Conclusions: We demonstrated equitable trial enrollment across different races and insurance statuses and were able to identify criteria that lend itself towards higher rates of enrollment. These findings can be used to tailor cancer trial portfolios to a diverse patient catchment.

Introduction: The purpose of this study is to assess the effect of race and ethnicity on the length of stay in hospitals following elective foot and ankle procedures. We aimed to determine whether (1) there are differences in the amount of time spent in a hospital following surgery between black, Hispanic, and white patients and (2) to assess for differences in complications. Methods: A retrospective review of the National Inpatient Sample (NIS) was conducted for 14 different foot and ankle procedures between 2016 and 2021. International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) and International Classification of Diseases, 10th Revision (ICD-10) codes guided the inclusion and exclusion criteria. Patient demographics, comorbidities, and postoperative outcomes and length of stay in hospitals were collected. A biostatistician was used to conduct all analyses. Regression analyses were used to assess differences between length of stay between races. Demographic variables, comorbidities and outcomes were analyzed using χ ² and Fisher exact tests. Results: The database search yielded 16,126 patients with a weighted sum of 84,085. White patients were older on average (61.98 years) than black patients (52.30), with an average length of stay of 3.08 days and black patients had an average of 3.35 days (P < .0001). Prevalence of pulmonary embolism, pneumonia, myocardial infarction, and stroke were not significantly different between the groups (P > .05). Conclusion: Our study found that minority patients experience longer stays in the hospital following elective foot and ankle procedures. No differences were found between complication rates among the 2 groups. These findings suggest a need for further research into reasons for longer stays in this patient population.

Introduction: Surgical cancellations have been a long-standing issue in the United States health care system, with orthopaedic surgery having some of the highest cancellation rates among all specialties. Purpose: This study aims to assess the reasons for surgical cancellations by exploring patient, surgeon, and institutional factors. Methods: A retrospective chart review of elective orthopaedic surgery procedures performed at an academic outpatient hospital between January 2019 and August 2024 was conducted. Results: Total joint and hand procedures had the highest relative cancellation rates. Among the subspecialties, trauma and joints were the most common. The predominant reasons for cancellation were patient-related, surgeon-related, clerical issues, medical/anaesthesia-related matters, and COVID-19, respectively. The most common patient-related factors included clearance, lack of transportation, and patient noncompliance with day of surgery instructions (eating, drinking, and medications). Conclusion: This study highlights opportunities for interventions to reduce same-day cancellations through patient engagement, preoperative planning, resource coordination, and administrative efficiency.