Julia Visgauss

Positions:

Assistant Professor of Orthopaedic Surgery

Orthopaedics
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2012

Johns Hopkins University School of Medicine

Resident, Orthopaedic Surgery

Duke University School of Medicine

Grants:

Genetic Profiling of Chondrosarcoma: A Clinical and Histologic Correlative Study

Administered By
Orthopaedics
Awarded By
Piedmont Orthopedic Foundation
Role
Principal Investigator
Start Date
End Date

Publications:

Identifying Modifiable and Non-modifiable Risk Factors of Readmission and Short-Term Mortality in Osteosarcoma: A National Cancer Database Study.

<h4>Background</h4>There are limited data to inform risk of readmission and short-term mortality in musculoskeletal oncology. The goal of this study was to identify factors independently associated with 30-day readmission and 90-day mortality following surgical resection of osteosarcoma.<h4>Methods</h4>We retrospectively reviewed patients (n = 5293) following surgical resection of primary osteosarcoma in the National Cancer Database (2004-2015). Univariate and multivariate methods were used to correlate variables with readmission and short-term mortality.<h4>Results</h4>Of 210 readmissions (3.97%), risk factors independently associated with unplanned 30-day readmission included comorbidity burden (odds ratio [OR] 2.4, p = 0.042), Medicare insurance (OR 1.9, p = 0.021), and axial skeleton location (OR 1.5, p = 0.029). A total of 91 patients died within 90 days of their surgery (1.84%). Risk factors independently associated with mortality included age (hazard ratio 1.1, p < 0.001), increasing comorbidity burden (OR 6.6, p = 0.001), higher grade (OR 1.7, p = 0.007), increasing tumor size (OR 2.2, p = 0.03), metastatic disease at presentation (OR 8.5, p < 0.001), and amputation (OR 2.0, p = 0.04). Chemotherapy was associated with a decreased risk of short-term mortality (p < 0.001).<h4>Conclusions</h4>Several trends were clear: insurance status, tumor location and comorbidity burden were independently associated with readmission rates, while age, amputation, grade, tumor size, metastatic disease, and comorbidity burden were independently associated with short-term mortality.
Authors
Evans, DR; Lazarides, AL; Cullen, MM; Visgauss, JD; Somarelli, JA; Blazer, DG; Brigman, BE; Eward, WC
MLA Citation
Evans, Daniel R., et al. “Identifying Modifiable and Non-modifiable Risk Factors of Readmission and Short-Term Mortality in Osteosarcoma: A National Cancer Database Study.Annals of Surgical Oncology, vol. 28, no. 12, Nov. 2021, pp. 7961–72. Epmc, doi:10.1245/s10434-021-10099-7.
URI
https://scholars.duke.edu/individual/pub1482798
PMID
34018083
Source
epmc
Published In
Annals of Surgical Oncology
Volume
28
Published Date
Start Page
7961
End Page
7972
DOI
10.1245/s10434-021-10099-7

Reverse total shoulder arthroplasty for oncologic reconstruction of the proximal humerus: a systematic review.

BACKGROUND: In recent years, there has been growing interest in the use of reverse total shoulder arthroplasty (rTSA) for reconstruction of the proximal humerus after oncologic resection. However, the indications and outcomes of oncologic rTSA remain unclear. METHODS: We conducted a systematic review to identify studies that reported outcomes of patients who underwent rTSA for oncologic reconstruction of the proximal humerus. Extracted data included demographic characteristics, indications, operative techniques, outcomes, and complications. Weighted means were calculated according to sample size. RESULTS: Twelve studies were included, containing 194 patients who underwent rTSA for oncologic reconstruction of the proximal humerus. The mean patient age was 48 years, and 52% of patients were male. Primary malignancies were present in 55% of patients; metastatic disease, 30%; and benign tumors, 9%. The mean humeral resection length was 12 cm. The mean postoperative Musculoskeletal Tumor Society score was 78%; Constant score, 60; and Toronto Extremity Salvage Score, 77%. The mean complication rate was 28%, with shoulder instability accounting for 63% of complications. Revisions were performed in 16% of patients, and the mean implant survival rate was 89% at a mean follow-up across studies of 53 months. CONCLUSIONS: Although the existing literature is of poor study quality, with a high level of heterogeneity and risk of bias, rTSA appears to be a suitable option in appropriately selected patients undergoing oncologic resection and reconstruction of the proximal humerus. The most common complication is instability. Higher-quality evidence is needed to help guide decision making on appropriate implant utilization for patients undergoing oncologic resection of the proximal humerus.
Authors
Ferlauto, HR; Wickman, JR; Lazarides, AL; Hendren, S; Visgauss, JD; Brigman, BE; Anakwenze, OA; Klifto, CS; Eward, WC
MLA Citation
Ferlauto, Harrison R., et al. “Reverse total shoulder arthroplasty for oncologic reconstruction of the proximal humerus: a systematic review.J Shoulder Elbow Surg, vol. 30, no. 11, Nov. 2021, pp. e647–58. Pubmed, doi:10.1016/j.jse.2021.06.004.
URI
https://scholars.duke.edu/individual/pub1488549
PMID
34273534
Source
pubmed
Published In
J Shoulder Elbow Surg
Volume
30
Published Date
Start Page
e647
End Page
e658
DOI
10.1016/j.jse.2021.06.004

Preoperative nasopharyngeal swab testing and postoperative pulmonary complications in patients undergoing elective surgery during the SARS-CoV-2 pandemic.

<h4>Background</h4>Surgical services are preparing to scale up in areas affected by COVID-19. This study aimed to evaluate the association between preoperative SARS-CoV-2 testing and postoperative pulmonary complications in patients undergoing elective cancer surgery.<h4>Methods</h4>This international cohort study included adult patients undergoing elective surgery for cancer in areas affected by SARS-CoV-2 up to 19 April 2020. Patients suspected of SARS-CoV-2 infection before operation were excluded. The primary outcome measure was postoperative pulmonary complications at 30 days after surgery. Preoperative testing strategies were adjusted for confounding using mixed-effects models.<h4>Results</h4>Of 8784 patients (432 hospitals, 53 countries), 2303 patients (26.2 per cent) underwent preoperative testing: 1458 (16.6 per cent) had a swab test, 521 (5.9 per cent) CT only, and 324 (3.7 per cent) swab and CT. Pulmonary complications occurred in 3.9 per cent, whereas SARS-CoV-2 infection was confirmed in 2.6 per cent. After risk adjustment, having at least one negative preoperative nasopharyngeal swab test (adjusted odds ratio 0.68, 95 per cent confidence interval 0.68 to 0.98; P = 0.040) was associated with a lower rate of pulmonary complications. Swab testing was beneficial before major surgery and in areas with a high 14-day SARS-CoV-2 case notification rate, but not before minor surgery or in low-risk areas. To prevent one pulmonary complication, the number needed to swab test before major or minor surgery was 18 and 48 respectively in high-risk areas, and 73 and 387 in low-risk areas.<h4>Conclusion</h4>Preoperative nasopharyngeal swab testing was beneficial before major surgery and in high SARS-CoV-2 risk areas. There was no proven benefit of swab testing before minor surgery in low-risk areas.
Authors
COVIDSurg Collaborative,
MLA Citation
COVIDSurg Collaborative, Christopher S. “Preoperative nasopharyngeal swab testing and postoperative pulmonary complications in patients undergoing elective surgery during the SARS-CoV-2 pandemic.The British Journal of Surgery, vol. 108, no. 1, Jan. 2021, pp. 88–96. Epmc, doi:10.1093/bjs/znaa051.
URI
https://scholars.duke.edu/individual/pub1481716
PMID
33640908
Source
epmc
Published In
British Journal of Surgery
Volume
108
Published Date
Start Page
88
End Page
96
DOI
10.1093/bjs/znaa051

Staging and Surveillance of Myxoid Liposarcoma: Follow-up Assessment and the Metastatic Pattern of 169 Patients Suggests Inadequacy of Current Practice Standards.

BACKGROUND: Unlike other sarcoma subtypes, myxoid liposarcoma (MLS) has a propensity for extra-pulmonary metastases. Computed tomography (CT) scan of the chest, abdomen, and pelvis has become an accepted practice for surveillance. However, recent literature suggests that this may be inadequate. This study aimed to assess the ability of current imaging methods to detect metastases adequately in this population. METHODS: The study identified 169 patients with MLS diagnosed between 2000 and 2016. The timing and location of metastases, the reasons leading to the MLS diagnosis, and the imaging methods were recorded. The locations of metastases were classified into the following categories: pulmonary, soft tissue, bone, retroperitoneal, intraperitoneal, solid organ, and lymph node. RESULTS: An initial diagnosis of metastasis was made at presentation with staging CT scan for 3 (10 %) of 31 patients, with a follow-up surveillance CT scan for 15 (48 %) of the patients or with subsequent imaging obtained in response to patient-reported symptoms for 13 (42 %) of the patients. The proportions of patients who had metastases in each location were as follows: soft tissue (84 %), pulmonary (68 %), intraabdominal (48 %), solid organ (48 %), bone (45 %), lymph node (32 %), and retroperitoneal (29 %). Although 14 patients had bone metastases, only 1 patient had a sclerotic/blastic presentation visualized on CT scan, and the diagnosis for the remaining 13 patients was determined by magnetic resonance imaging (MRI). CONCLUSION: Due to metastatic disease identified outside surveillance imaging for 58 % of the patients, the diversity of locations, and the significant failure of CT and bone scan to identify bone metastases, this study questioned the adequacy of CT scan for surveillance of MLS. Consideration should be given to the use of whole-body MRI for detection of metastasis in MLS.
Authors
Visgauss, JD; Wilson, DA; Perrin, DL; Colglazier, R; French, R; Mattei, J-C; Griffin, AM; Wunder, JS; Ferguson, PC
MLA Citation
Visgauss, Julia D., et al. “Staging and Surveillance of Myxoid Liposarcoma: Follow-up Assessment and the Metastatic Pattern of 169 Patients Suggests Inadequacy of Current Practice Standards.Ann Surg Oncol, vol. 28, no. 12, Nov. 2021, pp. 7903–11. Pubmed, doi:10.1245/s10434-021-10091-1.
URI
https://scholars.duke.edu/individual/pub1482267
PMID
33961173
Source
pubmed
Published In
Annals of Surgical Oncology
Volume
28
Published Date
Start Page
7903
End Page
7911
DOI
10.1245/s10434-021-10091-1

Treatment of Chondroblastoma with Denosumab: A Case Report with a Correlative Analysis of Effect on the RANK Signaling Pathway.

CASE: A 15-year-old boy with chondroblastoma of the right hemipelvis presented with significant periacetabular bone destruction. Neoadjuvant denosumab treatment facilitated initial joint preserving surgery. Unfortunately, he experienced 2 local recurrences and underwent wide surgical resection 2 years after his initial diagnosis. CONCLUSION: Inhibition of the receptor activator of NF-κB (RANK)/RANK ligand (RANK-L) pathway with denosumab has been used neoadjuvantly for the treatment of giant cell tumor of bone, but its role in the treatment of chondroblastoma is less understood. This patient's clinical response and effect on cellular RANK/RANK-L activity support the consideration of denosumab in the treatment algorithm for other osteolytic bone tumors such as chondroblastoma.
Authors
Visgauss, JD; Lazarides, A; Dickson, B; Cardona, D; Sheth, M; DeWitt, SB; Somarelli, JA; Eward, WC
MLA Citation
Visgauss, Julia D., et al. “Treatment of Chondroblastoma with Denosumab: A Case Report with a Correlative Analysis of Effect on the RANK Signaling Pathway.Jbjs Case Connect, vol. 11, no. 2, May 2021. Pubmed, doi:10.2106/JBJS.CC.20.00178.
URI
https://scholars.duke.edu/individual/pub1482459
PMID
33999872
Source
pubmed
Published In
Jbjs Case Connector
Volume
11
Published Date
DOI
10.2106/JBJS.CC.20.00178