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

Publications:

Race is an independent predictor of survival in patients with soft tissue sarcoma of the extremities.

BACKGROUND: In the United States, race and socioeconomic status are well known predictors of adverse outcomes in several different cancers. Existing evidence suggests that race and socioeconomic status may impact survival in soft tissue sarcoma (STS). We investigated the National Cancer Database (NCDB), which contains several socioeconomic and medical variables and contains the largest sarcoma patient registry to date. Our goal was to determine the impact of race, ethnicity and socioeconomic status on patient survival in patients with soft tissue sarcoma of the extremities (STS-E). METHODS: We retrospectively analyzed 14,067 STS-E patients in the NCDB from 1998 through 2012. Patients were stratified based on race, ethnicity and socioeconomic status. Univariate and multivariate analyses were used to correlate specific outcomes and survival measures with these factors. Then, long-term survival between groups was evaluated using the Kaplan-Meier (KM) method with comparisons based on the log-rank test. Multiple variables were analyzed between two groups. RESULTS: Of the 14,067 patients analyzed, 84.9% were white, 11% were black and 4.1% were Asian. Black patients were significantly more likely (7.18% vs 5.65% vs 4.47%) than white or Asian patients to receive amputation (p = 0.027). Black patients were also less likely to have either an above-median education level or an above-median income level (p < 0.001). In addition, black patients were more likely to be uninsured (p < 0.001) and more likely to have a higher Charleson Comorbidity Score than white or Asian patients. Tumors were larger in size upon presentation in black patients than in white or Asian patients (p < 0.001). Black patients had significantly poorer overall survival than did white or Asian patients (p < 0.001) with a KM 5-year survival of 61.4% vs 66.9% and 69.9% respectively, and a 24% higher independent likelihood of dying in a multivariate analysis. CONCLUSION: This large database review reveals concerning trends in black patients with STS-E. These include larger tumors, poorer resources, a greater likelihood of amputation, and poorer survival than white and Asian patients. Future studies are warranted to help ensure adequate access to effective treatment for all patients.
Authors
Lazarides, AL; Visgauss, JD; Nussbaum, DP; Green, CL; Blazer, DG; Brigman, BE; Eward, WC
MLA Citation
Lazarides, Alexander L., et al. “Race is an independent predictor of survival in patients with soft tissue sarcoma of the extremities.Bmc Cancer, vol. 18, no. 1, Apr. 2018, p. 488. Pubmed, doi:10.1186/s12885-018-4397-3.
URI
https://scholars.duke.edu/individual/pub1315594
PMID
29703171
Source
pubmed
Published In
Bmc Cancer
Volume
18
Published Date
Start Page
488
DOI
10.1186/s12885-018-4397-3

Total shoulder arthroplasty in patients with HIV infection: complications, comorbidities, and trends.

BACKGROUND: Patients with human immunodeficiency virus (HIV) infection were previously at substantial risk for immunosuppression-related complications. As a result of highly active antiretroviral therapy, HIV-infected patients are living longer and are presenting for elective surgery. Outcomes in HIV-infected patients are well described for hip and knee arthroplasty but not for total shoulder arthroplasty (TSA). The purpose of this study was to examine postoperative complications of TSA in HIV-positive patients. METHODS: We queried the entire 2005 to 2012 Medicare database. Current Procedural Terminology and International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify the procedure, demographics, comorbidities, and postoperative complications. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. RESULTS: The query returned 2528 HIV-positive patients who underwent TSA or reverse TSA (RTSA). There was increased utilization of TSA and RTSA in this population from 2005 to 2012; 1353 patients had 2-year follow-up. These patients were slightly older and had higher prevalence of comorbidities, suggesting a sicker cohort. HIV-positive patients had alarmingly higher rates of 90-day cerebrovascular accident (OR, 35.98; CI, 30.34-42.67). HIV-positive patients had higher overall rates of broken prosthetic joints (OR, 1.72; CI, 1.20-2.47), periprosthetic infection (OR, 1.36; CI, 1.01-1.82), and TSA revision or repair (OR, 2.44; CI, 1.81-3.28). CONCLUSIONS: To our knowledge, this is the first study that directly examines the postoperative outcomes of HIV-positive patients after TSA or RTSA. As more of these patients present for surgery, surgeons should be aware that these patients might be at increased risk for certain postoperative surgical and medical complications.
Authors
Bala, A; Penrose, CT; Visgauss, JD; Seyler, TM; Randell, TR; Bolognesi, MP; Garrigues, GE
MLA Citation
Bala, Abiram, et al. “Total shoulder arthroplasty in patients with HIV infection: complications, comorbidities, and trends.J Shoulder Elbow Surg, vol. 25, no. 12, Dec. 2016, pp. 1971–79. Pubmed, doi:10.1016/j.jse.2016.02.033.
URI
https://scholars.duke.edu/individual/pub1130763
PMID
27117043
Source
pubmed
Published In
J Shoulder Elbow Surg
Volume
25
Published Date
Start Page
1971
End Page
1979
DOI
10.1016/j.jse.2016.02.033

Innovations in Intraoperative Tumor Visualization.

In the surgical management of solid tumors, adequacy of tumor resection has implications for local recurrence and survival. The standard method of intraoperative identification of tumor margin is frozen section pathologic analysis, which is time-consuming with potential for sampling error. Intraoperative tumor visualization has the potential to significantly improve surgical cancer care across disciplines, by guiding accuracy of biopsies, increasing adequacy of resections, directing adjuvant therapy, and even providing diagnostic information. We provide an outline of various methods of intraoperative tumor visualization developed to aid in the real-time assessment of tumor extent and adequacy of resection.
MLA Citation
Visgauss, Julia D., et al. “Innovations in Intraoperative Tumor Visualization.Orthop Clin North Am, vol. 47, no. 1, Jan. 2016, pp. 253–64. Pubmed, doi:10.1016/j.ocl.2015.08.023.
URI
https://scholars.duke.edu/individual/pub1111037
PMID
26614939
Source
pubmed
Published In
Orthop Clin North Am
Volume
47
Published Date
Start Page
253
End Page
264
DOI
10.1016/j.ocl.2015.08.023

Medial Patellofemoral Ligament Reconstruction Using a Femoral Loop Button Fixation Technique.

Medial patellofemoral ligament (MPFL) reconstruction is a common procedure used to treat both acute and chronic patellar instability. Although many variations of MPFL reconstruction have been described, there is no consensus regarding the optimal surgical technique. We describe a technique for MPFL reconstruction with a looped gracilis tendon autograft using suture anchors to secure the graft to the patella and a suspensory loop button system for fixation to the femur. This technique replicates the native shape of the MPFL while minimizing the risk of patellar fracture and allowing for gradual tensioning of the graft.
Authors
Godin, JA; Karas, V; Visgauss, JD; Garrett, WE
MLA Citation
Godin, Jonathan A., et al. “Medial Patellofemoral Ligament Reconstruction Using a Femoral Loop Button Fixation Technique.Arthrosc Tech, vol. 4, no. 5, Oct. 2015, pp. e601–07. Pubmed, doi:10.1016/j.eats.2015.06.005.
URI
https://scholars.duke.edu/individual/pub1112907
PMID
26900561
Source
pubmed
Published In
Arthroscopy Techniques
Volume
4
Published Date
Start Page
e601
End Page
e607
DOI
10.1016/j.eats.2015.06.005