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

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

The role of Denosumab in joint preservation for patients with giant cell tumour of bone.

AIMS: Local recurrence remains a challenging and common problem following curettage and joint-sparing surgery for giant cell tumour of bone (GCTB). We previously reported a 15% local recurrence rate at a median follow-up of 30 months in 20 patients with high-risk GCTB treated with neoadjuvant Denosumab. The aim of this study was to determine if this initial favourable outcome following the use of Denosumab was maintained with longer follow-up. METHODS: Patients with GCTB of the limb considered high-risk for unsuccessful joint salvage, due to minimal periarticular and subchondral bone, large soft tissue mass, or pathological fracture, were treated with Denosumab followed by extended intralesional curettage with the goal of preserving the joint surface. Patients were followed for local recurrence, metastasis, and secondary sarcoma. RESULTS: A total of 25 patients with a mean age of 33.8 years (18 to 67) with high-risk GCTB received median six cycles of Denosumab before surgery. Tumours occurred most commonly around the knee (17/25, 68%). The median follow-up was 57 months (interquartile range (IQR) 13 to 88). The joint was salvaged in 23 patients (92%). Two required knee arthroplasty due to intra-articular fracture and arthritis. Local recurrence developed in 11 patients (44%) at a mean of 32.5 months (3 to 75) following surgery, of whom four underwent repeat curettage and joint salvage. One patient developed secondary osteosarcoma and another benign GCT lung metastases. CONCLUSION: The use of Denosumab for joint salvage was associated with a higher than expected rate of local recurrence at 44%. Neoadjuvant Denosumab for joint-sparing procedures should be considered with caution in light of these results. Cite this article: Bone Joint J 2021;103-B(1):184-191.
Authors
Perrin, DL; Visgauss, JD; Wilson, DA; Griffin, AM; Abdul Razak, AR; Ferguson, PC; Wunder, JS
MLA Citation
Perrin, David Louis, et al. “The role of Denosumab in joint preservation for patients with giant cell tumour of bone.Bone Joint J, vol. 103-B, no. 1, Jan. 2021, pp. 184–91. Pubmed, doi:10.1302/0301-620X.103B1.BJJ-2020-0274.R1.
URI
https://scholars.duke.edu/individual/pub1472989
PMID
33380180
Source
pubmed
Published In
Bone and Joint Journal
Volume
103-B
Published Date
Start Page
184
End Page
191
DOI
10.1302/0301-620X.103B1.BJJ-2020-0274.R1