Stephanie Parlacoski

Experienced medical professional with expertise in science, mathematics, leadership, entrepreneurship, surgical techniques, medical research, writing, and publishing. Proven leader and instrumental in developing new research, protocols, and programs. Collaborate and synthesize work with renowned medical and research teams to contribute to the holistic success of healthcare organizations. Proven track record of maintaining quality, patient safety, and healthcare providers' satisfaction while improving overall outcomes and financial performance. Eager to take the next career step with the growing organization offering opportunities for professional development and advancement and passionately using mathematics to make a robust impact on the quality of life of the global community.

• Certified Surgical Technology
• IRB-Human-subjects research training
• BLS
• Modeling &Valuation
• Business Plan for Fortune 100 Leaders
• World Religions
• General Psychology
• Corporate Strategy
• Principals of Leadership
• Transformational Leadership
• Leadership Communication
• Leadership Skills for Facilitating Effective Meetings
• Building Community Partnerships Conflict Management Practicum
• Corporate Strategy
• Conflict Management Practicum
• The Ethical Leader
• Emotionally Intelligent Leadership
• Group Process/Team Dynamics
• Leadership Practical Applications
• Presentation Skills in Advocating for Change
• CITI Training
• CITI Good Clinical Practice
• SPSS
• Statistical analysis
• MATLAB
• Business Analysis Modeling Skills & Techniques
• Corporate Finance
• SWOT Analysis for Organizational Success
• SPSS for Research
• Effective Business Strategy and Research
• Strategic Workforce Planning
• Fundamentals in Healthcare Quality
• Strategic Corporate Management
• Revenue Cycle in Healthcare Finance
• Fundamentals of Healthcare Quality Improvement
• Instructional Design for Development
• Project Management

• Comparative Review of Outcomes: Laparoscopic and Robotic Enhanced-View Totally Extraperitoneal (eTEP) Access Retrorectus Repairs, Surgical Endoscopy/Springer, 2019-10-11, 10.1007/s00464-019-07132-y
• The Perceptions of Cancer Patients Regarding the Causes and Preventability of Unplanned Hospital Admissions, The American Journal of Clinical Oncology, https://pubmed.ncbi.nlm.nih.gov/32739972/

RESEARCH PUBLICATIONS & DESCRIPTIONS

• Comparative review of outcomes: laparoscopic and robotic enhanced-view totally extraperitoneal (eTEP) access retrorectus repairs Hybrid versus open retromuscular abdominal wall repair: early outcomes (2018 – 2019)
• Hybrid versus open retromuscular abdominal wall repair: early outcomes (2018-2019)
• Laparoscopic revision para esophageal hernia repair: a 16-year experience at a single institution (2018 – 2019)
• Impact of Depression on Patient Symptoms and Hospitalizations in a Geriatric Cancer Population (2018 – 2019)
• Implications for Practice and Future Research Protocol Driven Approach to Improve Test Utilization in Bone Marrow Biopsies (2018 – 2019)
• Lessons Learned: A Prophylactic Pathway for At Risk Obstetric Patients to Reduce Venous Thromboembolism (2018 – 2019)
• Benign papilloma excised at an NAPBC-accredited breast center: analysis of local upgrade rates for use in patient counseling (2018 – 2019)
• Implementation of a Standardized Pulmonary Embolism Rule-Out Process in the Emergency Department (2018 – 2019)
• FOXp2 Regulates Neurogenesis during Embryonic Cortical Development (2015)

Background: Building on the principles of eTEP access, described by Dr. Jorge Daes, our group has previously described and standardized a novel minimally invasive approach to restoration of the linea alba and repair of lateral atypical defects of the abdominal wall. The purpose of this report is to present comparative analysis of laparoscopic and robotic eTEP access retrorectus repairs.

Methods: A retrospective review was conducted in patients who underwent laparoscopic eTEP (lap-eRS) and robotic-assisted eTEP (robo-eRS) Rives-Stoppa repairs between September 2015 and May 2018 at our institution. We analyzed the preoperative demographics and the perioperative outcomes.

Results: Our review identified 206 patients (Lap-eRS 120 vs. robo-eRS 86). The groups were comparable (p > 0.05) in gender distribution (47.6% vs. 53% male) and mean age (53.2 vs. 50.8 years), but different (p 0.05). Patients in both groups (lap-eRS vs. robo-eRS) were followed for an average of 5.7 months vs. 5.5 months (p = .735) and showed similar recurrence rates (1.7% vs. 1.2%, p > 0.05).

Conclusion: We present the largest series to-date of eTEP access laparoscopic and robotic ventral hernia retrorectus repairs. Morbidly obese patients and those with more complex abdominal wall defects were more likely to undergo a robo-eRS. The significantly longer operative time and higher hospital cost associated with the robo-eRS group may be in part due to these factors. Both robotic and laparoscopic eTEP Rives-Stoppa repairs are associated with favorable perioperative outcomes and low recurrence rates.

Keywords: Lap-eRS; Retromuscular repair; Retrorectus repair; Rives-Stoppa repair; Robo-eRS; Ventral hernia repair; eTEP.

Background: The hybrid approach to abdominal wall reconstruction (AWR) for abdominal wall hernias combines minimally invasive posterior component separation and retromuscular dissection with open fascial closure and mesh implantation. This combination may enhance patient outcomes and recovery compared to the open approach alone. The purpose of this study is to evaluate the operative outcomes of hybrid vs. open abdominal wall reconstruction.

Methods: A retrospective review was conducted to compare patients who underwent open versus hybrid AWR between September 2015 and August of 2018 at Anne Arundel Medical Center. Patient demographics and perioperative data were collected and analyzed using univariate analysis.

Results: Sixty-five patients were included in the final analysis: 10 in the hybrid and 55 in the open groups. Mean age was higher in the hybrid vs. open group (65.1 vs. 56.2 years, p 0.05) in gender distribution, mean BMI, and ASA score. Intraoperative comparison found hybrid patients parallel to open patients (p > 0.05) in mean operative time (294.5 vs. 267.5 min), defect size (14.4 vs. 13.6 cm), mesh area, and drain placement. The mean total hospital cost was lower in the hybrid group compared to the open group ($16,426 vs. $19,054, p = 0.43). The hybrid group had a shorter length of stay (5.3 vs. 3.6 days, p = 0.03) after surgery and was followed for a similar length of time (12.3 vs. 12.6 months, p = 0.91). The hybrid group showed a lower trend of seroma, hematoma, wound infection, ileus, and readmission rates after surgery.

Conclusion: A review of patient outcomes after hybrid AWR highlights a trend towards shorter length of stay, lower hospital cost, and fewer complications without significant addition to operative time. Long-term studies on a larger number of patients are definitively needed to characterize the comprehensive benefits of this approach.

Keywords: AWR; Abdominal wall reconstruction; Enhanced or extended totally extraperitoneal approach; Hybrid; Ventral hernia; eTEP

Background: Laparoscopic paraesophageal hernia repair (PEHr) is a safe and effective procedure for relieving foregut symptoms associated with paraesophageal hernias (PEH). Nonetheless, it is estimated that about 30-50% of patients will have symptomatic recurrence requiring additional surgical intervention. Revision surgery is technically demanding and may be associated with a higher rate of morbidity and poor patient-reported outcomes. We present the largest study of perioperative and quality-of-life outcomes among patients who underwent laparoscopic revision PEHr.

Methods: A retrospective review of all patients who underwent laparoscopic revision paraesophageal hernia repair between February 2003 and October 2019, at a single institution was conducted. All revisions of Type I hiatal hernias were excluded. The following validated surveys were used to evaluate quality-of-life outcomes: Reflux Symptom Index (RSI) and Gastroesophageal Reflux Disease Health-Related QOL (GERD-HRQL). Patient demographic, perioperative, and quality-of-life (QOL) data were analyzed using univariate analysis.

Results: One hundred ninety patients were included in the final analysis (63.2% female, 90.5% single revision, 9.5% multiple revisions) with a mean age, BMI, and age-adjusted Charlson score of 56.6 ± 14.7 years, 29.7 ± 5.7 kg/m2, and 2.04 ± 1.9, respectively. The study cohort consisted of type II (49.5%), III (46.3%), and IV hiatal hernia (4.2%), respectively. Most patients underwent either a complete (68.7%) or partial (27.7%) fundoplication. A Collis gastroplasty was performed in 14.7% of patients. The median follow-up was 17.6 months. The overall morbidity and mortality rate were 15.8% and 1.1%, respectively. The 30-day readmission rate was 9.5%. Additionally, at latest follow-up 47.9% remained on antireflux medication. At latest follow-up, there was significant improvement in mean RSI score (46.4%, p < 0.001) from baseline within the study population. Furthermore, there was no significant difference in QOL between patients who had a history of an initial repair only or history of revision surgery at latest review. The overall recurrence rate was 16.3% with 6.3% requiring a surgical revision.

Conclusion: Laparoscopic revision PEHr is associated with a low rate of morbidity and mortality. Revision surgery may provide improvement in QOL outcomes, despite the high rate of long-term antireflux medication use. The rate of recurrent paraesophageal hernia remains low with few patients requiring a second revision. However, longer follow-up is needed to better characterize the long-term recurrence rate and symptomatic improvements.

Keywords: GERD; Hiatal hernia repair; Paraesophageal hernia (PEH); Paraesophageal hernia repair (PEHr); Quality of life (QOL); Reflux; Revision surgery.

Cancer providers have recognized that depression is often undiagnosed and untreated which can impact patient’s quality of life and acceptance of cancer treatment. The prevalence of depression in older cancer patients ranges from 3 to 31% and depressed individuals are 2 to 3 times more likely to access medical services than those who are not depressed. Depressed cancer patients are at 147% increased risk for ED visits, 75% increased risk for hospitalization, and 73% increased risk for re-hospitalization relative to non-depressed cancer patients. To better understand and treat older cancer patients, it is imperative to understand the reasons for patient presentation to the hospital.

Patient reported stress and depression greatly contribute to patient symptom burden and hospitalizations. Our findings confirm previous research on the association between depression and hospitalizations in an older cancer patient population. Strategies to better recognize and treat depression in older cancer patients may result in a decrease in unplanned hospital admissions ultimately reducing cancer care costs and improving overall quality of life.

It is estimated that up to 30% of laboratory testing may be unnecessary, adding a significant burden to the annual cost of US healthcare. To optimize utilization and ensure appropriate test ordering we developed a data- driven algorithmic protocol and hierarchical guidelines to be used by the pathology department when ordering ancillary molecular tests for bone marrow biopsies within selected diagnostic categories.

A protocol approach was developed to replace traditional test ordering methods for ancillary bone marrow biopsy testing. The objective was to ensure the correct test was ordered when needed while eliminating unnecessary testing. The goals were to decrease the cost of care while enhancing the patient experience by eliminating retesting and optimizing departmental resources.

The protocol was developed by consensus agreement between a group of medical oncologists and pathologists after reviewing clinically appropriate literature and data on the subject. Protocol performance data was analyzed for trends in obtaining diagnostically appropriate studies, eliminating unnecessary tests, and financial impact.

Protocol ordering decreased the cost of ancillary testing per bone marrow specimen by 34% for the diagnostic categories that were analyzed. The results were a strong positive shift toward receiving the appropriate test based on the final pathologic diagnosis and approximately $53,000 of quarterly savings in ancillary testing for these diagnostic categories.

Protocol-oriented practice can successfully reduce unnecessary molecular testing, assure the correct test is available when needed, and reduce the overall cost of a bone marrow biopsy procedure. This approach allowed us to achieve higher quality patient care at a lower cost. We believe these results can be sustained.

Background/Introduction

Venous thromboembolism (VTE) potentially causing a Pulmonary Embolism is a leading cause of maternal mortality and morbidity, accounting for 9% of all maternal deaths in the United States. Currently, there is no single standard guideline for DVT prophylaxis of OB patients. The Center of Obstetrics developed a risk factor data-driven prophylactic pathway and treatment guide for high-risk patients who were assessed and treated for VTE.

Conclusions and Implications/Lessons Learned

Protocol-oriented practice can successfully reduce unnecessary and potentially life-threating outcomes for obstetric patients. What we learned was that hi risk obstetric demography, which was captured in time with prophylactic treatment. This clinical pathway allowed us to achieve higher quality patient and guidelines forward.

Based on our study results, we can counsel patients with intraductal papilloma without atypia and concordant imaging that the risk of being upstaged to cancer on excision is quite low. This aligns with the recommendations put forth by the American Society of Breast Surgeons 2016 Consensus Statement and NCCN guidelines. We continue to recommend excision for any patient with accompanying atypia, large (>1cm) lesion (due to sampling error), palpable, symptomatic, or a peripheral lesion (posterior third of breast). For other patients, observation and excisions are discussed as options. Patients who would consider increased surveillance or chemoprophylaxis in light of a diagnosis of atypia may benefit from excision of a papilloma. We recommend that other surgeons offering observation rather than excision of intraductal papilloma verify their own institutional rate of upgrade to atypia or malignancy.

Pulmonary Embolism (PE) is a serious and potentially life-threatening cause of chest pain and shortness of breath in patients who presented to the Emergency Department (ED). The current standard to rule out PE is CTA of the chest. While this test has high sensitivity and specificity for PE, it exposes patients to radiation and can cause other serious adverse reactions. The American College of Emergency Physicians published a clinical polity to guide clinicians in the evaluation of patients with possible PE. While all ED physicians are familiar with this policy, the recommendations were not adhered to in a consistent or standardized manner, resulting in potentially unnecessary utilization of CTA.

Results: After implementation of the PE screening tool for CTA/D-Dimer indication, the number of CTA’s performed per 100 patients in the ED was reduced from 0.95 to 0.74 and adherence to the new decision rule tool increased by 59% from baseline.

Conclusions: Implementation of an EMR embedded clinical screening and decision tool to rule out PE and to promote appropriate use of CTA resulted in a decrease in the number of CTA’s for PE ordered and an increase in the percent of CTA’s for PE that are positive.

We summarized and wrote on a paper regarding Foxp2 and its potential role in neurological embryogenesis. We determined that FOXp2 is knocked down in developing cortical precursors. FOXP2 enhanced the process of cortical neurogenesis which happens to be coincident with the larger mammalian cortex presenting in the cerebellum. This is supported by the presence of FOXP2 which stimulates the transition from static precursors the proliferative nature of progenitors leading to neurons in the latter of cortical neurogenesis.