Hadiza Kazaure

Positions:

Assistant Professor of Surgery

Surgical Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

B.S. 2007

Temple University

M.D. 2012

Yale University School of Medicine

General Surgery Residency, Surgery

Stanford University

Endocrine Surgery Fellowship, Surgery

Duke University School of Medicine

Grants:

Scaling and Spreading Electronic Capture of Patient-Reported Outcomes Using a National Surgical Quality Improvement Program.

Administered By
Surgical Oncology
Awarded By
American College of Surgeons
Role
Principal Investigator
Start Date
End Date

Publications:

Patient-Reported Outcomes Following Total Thyroidectomy for Graves' Disease.

BACKGROUND: Graves' disease accounts for ~80% of all cases of hyperthyroidism and is associated with significant morbidity and decreased quality-of-life. Understanding the association of total thyroidectomy with patient-reported quality-of-life and thyroid-specific symptoms is critical to shared decision-making and high-quality care. We estimate the change in patient-reported outcomes (PROs) before and after surgery for patients with Graves' disease to inform the expectations of patients and their physicians. METHODS: PROs using the MD Anderson Symptom Inventory (MDASI) validated questionnaire were collected prospectively from adult patients with Graves' disease from January 1, 2015 to November 20, 2020 on a longitudinal basis. Survey responses were categorized as Before Surgery (≤120 days), Short-Term After Surgery (<30 days) (ST), and Long-Term After Surgery (≥30 days) (LT). Negative binomial regression was used to estimate the association of select covariates with PROs. RESULTS: 85 patients with Graves' disease were included. The majority were female (83.5%); 47.1% were Non-Hispanic White and 35.3% were Non-Hispanic Black. The median TSH value prior to surgery was 0.05, which increased to 0.82 in ST and 1.57 in LT. In bivariate analysis, the Total Symptom Burden Score, a composite of all patient-reported burden, significantly reduced shortly after surgery (Before Surgery mean 56.88 vs ST 39.60, p<0.001), demonstrating improvement in PROs. Further, both the Thyroid Symptoms Score, including patient-reported thermoregulation, palpitations, and dysphagia, and the Quality-of-Life Symptom Score improved in ST and LT (Thyroid Symptoms, Before Surgery 13.88 vs. ST 8.62 and LT 7.29; Quality-of-Life, Before Surgery 16.16 vs. ST 9.14 and LT 10.04, all p<0.05). After multivariate adjustment, the patient-reported burden in the Thyroid Symptom Score and the Quality-of-Life Symptom Score exhibited reduction in ST (Thyroid Symptoms, Rate Ratio [RR] 0.55, 95% Confidence Interval [CI]: 0.42-0.72) (Quality-of-Life, RR 0.57, 95% CI: 0.40-0.81) and LT (Thyroid Symptoms, RR 0.59, 95% CI: 0.44-0.79) (Quality-of-Life, RR 0.43, 95% CI: 0.28-0.65). CONCLUSIONS: Quality-of-life and thyroid-specific symptoms of Graves' patients improved significantly from their baseline prior to surgery to both shortly after and longer after surgery. This work can be used to guide clinicians and patients with Graves' disease on the expected outcomes following total thyroidectomy.
Authors
Gunn, AH; Frisco, N; Thomas, S; Stang, M; Scheri, RP; Kazaure, HS
MLA Citation
Gunn, Alexander H., et al. “Patient-Reported Outcomes Following Total Thyroidectomy for Graves' Disease.Thyroid, Oct. 2021. Pubmed, doi:10.1089/thy.2021.0285.
URI
https://scholars.duke.edu/individual/pub1499300
PMID
34663089
Source
pubmed
Published In
Thyroid : Official Journal of the American Thyroid Association
Published Date
DOI
10.1089/thy.2021.0285

Identifying high-risk surgical patients: A study of older adults whose code status changed to Do-Not-Resuscitate.

BACKGROUND: There is a paucity of data on older adults (age ≥65 years) undergoing surgery who had an inpatient do-not-resuscitate (DNR) order, and the association between timing of DNR order and outcomes. METHODS: This was a retrospective analysis of 1976 older adults in the American College of Surgeons National Surgical Quality Improvement Program geriatric-specific database (2014-2018). Patients were stratified by institution of a DNR order during their surgical admission ("new-DNR" vs. "no-DNR"), and matched by age (±3 years), frailty score (range: 0-1), and procedure. The main outcome of interest was occurrence of death or hospice transition (DoH) ≤30 postoperative days; this was analyzed using bivariate and multivariable methods. RESULTS: One in 36 older adults had a new-DNR order. After matching, there were 988 new-DNR and 988 no-DNR patients. Median age and frailty score were 82 years and 0.2, respectively. Most underwent orthopedic (47.6%), general (37.6%), and vascular procedures (8.4%). Overall DoH rate ≤30 days was 44.4% for new-DNR versus 4.0% for no-DNR patients (p < 0.001). DoH rate for patients who had DNR orders placed in the preoperative, day of surgery, and postoperative setting was 16.7%, 23.3%, and 64.6%, respectively (p < 0.001). In multivariable analysis, compared to no-DNR patients, those with a new-DNR order had a 28-fold higher adjusted odds of DoH (odds ratio [OR] 28.1, 95% confidence interval: 13.0-60.1, p < 0.001); however, odds were 10-fold lower if the DNR order was placed preoperatively (OR: 5.8, p = 0.003) versus postoperatively (OR: 52.9, p < 0.001). Traditional markers of poor postoperative outcomes such as American Society of Anesthesiologists class and emergency surgery were not independently associated with DoH. CONCLUSIONS: An inpatient DNR order was associated with risk of DoH independent of traditional markers of poor surgical outcomes. Further research is needed to understand factors leading to a DNR order that may aid early recognition of high-risk older adults undergoing surgery.
Authors
Kazaure, HS; Truong, T; Kuchibhatla, M; Lagoo-Deenadayalan, S; Wren, SM; Johnson, KS
MLA Citation
Kazaure, Hadiza S., et al. “Identifying high-risk surgical patients: A study of older adults whose code status changed to Do-Not-Resuscitate.J Am Geriatr Soc, July 2021. Pubmed, doi:10.1111/jgs.17391.
URI
https://scholars.duke.edu/individual/pub1492783
PMID
34331702
Source
pubmed
Published In
Journal of the American Geriatrics Society
Published Date
DOI
10.1111/jgs.17391

Postoperative Surveillance in Older Adults With T1N0M0 Low-risk Papillary Thyroid Cancer.

BACKGROUND: The frequency and cost of postoperative surveillance for older adults (>65 y) with T1N0M0 low-risk papillary thyroid cancer (PTC) have not been well studied. METHODS: Using the SEER-Medicare (2006-2013) database, frequency and cost of surveillance concordant with American Thyroid Association (ATA) guidelines (defined as an office visit, ≥1 thyroglobulin measurement, and ultrasound 6- to 24-month postoperatively) were analyzed for the overall cohort of single-surgery T1N0M0 low-risk PTC, stratified by lobectomy versus total thyroidectomy. RESULTS: Majority of 2097 patients in the study were white (86.7%) and female (77.5%). Median age and tumor size were 72 y (interquartile range 68-76) and 0.6 cm (interquartile range 0.3-1.1 cm), respectively; 72.9% of patients underwent total thyroidectomy. Approximately 77.5% of patients had a postoperative surveillance visit; however, only 15.9% of patients received ATA-concordant surveillance. Patients who underwent total thyroidectomy as compared with lobectomy were more likely to undergo surveillance testing, thyroglobulin (61.7% versus 24.8%) and ultrasound (37.5% versus 29.2%) (all P < 0.01), and receive ATA-concordant surveillance (18.5% versus 9.0%, P < 0.001). Total surveillance cost during the study period was $621,099. Diagnostic radioactive iodine, ablation, and advanced imaging (such as positron emission tomography scans) accounted for 55.5% of costs ($344,692), whereas ATA-concordant care accounted for 44.5% of costs. After multivariate adjustment, patients who underwent total thyroidectomy as compared with lobectomy were twice as likely to receive ATA-concordant surveillance (adjusted odds ratio 2.0, 95% confidence interval: 1.5-2.8, P < 0.001). CONCLUSIONS: Majority of older adults with T1N0M0 low-risk PTC do not receive ATA-concordant surveillance; discordant care was costly. Total thyroidectomy was the strongest predictor of receiving ATA-concordant care.
Authors
Pradhan, MC; Kazaure, HS; Wang, F; Zambeli-Ljepovic, A; Perkins, JM; Stang, MT; Scheri, RP
MLA Citation
Pradhan, Molly C., et al. “Postoperative Surveillance in Older Adults With T1N0M0 Low-risk Papillary Thyroid Cancer.J Surg Res, vol. 264, Aug. 2021, pp. 37–44. Pubmed, doi:10.1016/j.jss.2021.01.049.
URI
https://scholars.duke.edu/individual/pub1477594
PMID
33765509
Source
pubmed
Published In
J Surg Res
Volume
264
Published Date
Start Page
37
End Page
44
DOI
10.1016/j.jss.2021.01.049

If the Patient Is Frail, Emergency Abdominal Surgery Is High Risk.

Authors
Kazaure, HS; Lidsky, ME; Lagoo-Deenadayalan, SA
MLA Citation
Kazaure, Hadiza S., et al. “If the Patient Is Frail, Emergency Abdominal Surgery Is High Risk.Jama Surg, vol. 156, no. 1, Jan. 2021, pp. 74–75. Pubmed, doi:10.1001/jamasurg.2020.5398.
URI
https://scholars.duke.edu/individual/pub1465493
PMID
33237280
Source
pubmed
Published In
Jama Surg
Volume
156
Published Date
Start Page
74
End Page
75
DOI
10.1001/jamasurg.2020.5398

Recurrent Laryngeal Nerve Injury After Thyroid Surgery: An Analysis of 11,370 Patients.

<h4>Background</h4>Recurrent laryngeal nerve (RLN) injury is a well-known, potentially serious complication of thyroid surgery. We investigated factors associated with RLN injury during thyroid surgery using a multi-institutional data set.<h4>Materials and methods</h4>Patients who underwent either lobectomy or total thyroidectomy were abstracted from the American College of Surgeons National Surgical Quality Improvement Program thyroidectomy-specific database (2016-2017). Baseline and operative factors associated with RLN injury ≤30 d of surgery were analyzed using bivariate and multivariate methods. Secondary complications of interest included unplanned reintubation and hypocalcemia.<h4>Results</h4>RLN injury occurred in 6.0% (n = 677) of the 11,370 patients included in the study. The RLN injury rate varied significantly based on the primary indication for surgery, from 4.3% in patients undergoing surgery for a single nodule to 9.0% in patients undergoing surgery for differentiated cancer (P < 0.01). RLN injury occurred more often in thyroidectomies than lobectomies (6.9% versus 4.3%, P < 0.01) and in surgeries without intraoperative nerve monitoring (6.5% versus 5.6%, P = 0.01). After multivariate adjustment, RLN injury was independently associated with age ≥65 y [odds ratio (OR) 1.6, 95% confidence interval (CI) 1.3-2.0], total thyroidectomy (OR = 1.4, 95% CI 1.1-1.6), and diagnosis of thyroid malignancy (OR = 2.1, 95% CI = 1.6-2.7) (all P < 0.001) but not intraoperative RLN monitoring (OR = 0.9, 95% CI = 0.7-1.0, P = 0.06).<h4>Conclusions</h4>In this large multi-institutional study, RLN injury ≤30 d of surgery occurred in nearly 6% of thyroid surgeries. This comprehensive analysis of RLN injury can be used to guide informed consent discussions and aid surgeons in identifying candidates who may be at higher risk for injury.
Authors
Gunn, A; Oyekunle, T; Stang, M; Kazaure, H; Scheri, R
MLA Citation
Gunn, Alexander, et al. “Recurrent Laryngeal Nerve Injury After Thyroid Surgery: An Analysis of 11,370 Patients.The Journal of Surgical Research, vol. 255, Nov. 2020, pp. 42–49. Epmc, doi:10.1016/j.jss.2020.05.017.
URI
https://scholars.duke.edu/individual/pub1448019
PMID
32540579
Source
epmc
Published In
Journal of Surgical Research
Volume
255
Published Date
Start Page
42
End Page
49
DOI
10.1016/j.jss.2020.05.017