Brian Brigman

Positions:

Professor of Orthopaedic Surgery

Orthopaedic Surgery
School of Medicine

Professor in Pediatrics

Pediatrics
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1994

University of North Carolina - Chapel Hill

Intern, Surgery

University of Nebraska - Lincoln

Resident, Orthopaedic Surgery

University of Nebraska - Lincoln

Fellow, Orthopaedic Oncology

Boston University

Grants:

Fresh Tissue Lab Agreement

Awarded By
DePuy Synthes Companies
Role
Principal Investigator
Start Date
End Date

Protocol Number: 14-03-PATHOLHUM-02

Administered By
Orthopaedic Surgery
Awarded By
IlluminOss Medical, Inc.
Role
Principal Investigator
Start Date
End Date

Publications:

Postoperative changes in cognition and cerebrospinal fluid neurodegenerative disease biomarkers.

OBJECTIVE: Numerous investigators have theorized that postoperative changes in Alzheimer's disease neuropathology may underlie postoperative neurocognitive disorders. Thus, we determined the relationship between postoperative changes in cognition and cerebrospinal (CSF) tau, p-tau-181p, or Aβ levels after non-cardiac, non-neurologic surgery in older adults. METHODS: Participants underwent cognitive testing before and 6 weeks after surgery, and lumbar punctures before, 24 h after, and 6 weeks after surgery. Cognitive scores were combined via factor analysis into an overall cognitive index. In total, 110 patients returned for 6-week postoperative testing and were included in the analysis. RESULTS: There was no significant change from before to 24 h or 6 weeks following surgery in CSF tau (median [median absolute deviation] change before to 24 h: 0.00 [4.36] pg/mL, p = 0.853; change before to 6 weeks: -1.21 [3.98] pg/mL, p = 0.827). There were also no significant changes in CSF p-tau-181p or Aβ over this period. There was no change in cognitive index (mean [95% CI] 0.040 [-0.018, 0.098], p = 0.175) from before to 6 weeks after surgery, although there were postoperative declines in verbal memory (-0.346 [-0.523, -0.170], p = 0.003) and improvements in executive function (0.394, [0.310, 0.479], p < 0.001). There were no significant correlations between preoperative to 6-week postoperative changes in cognition and CSF tau, p-tau-181p, or Aβ42 changes over this interval (p > 0.05 for each). INTERPRETATION: Neurocognitive changes after non-cardiac, non-neurologic surgery in the majority of cognitively healthy, community-dwelling older adults are unlikely to be related to postoperative changes in AD neuropathology (as assessed by CSF Aβ, tau or p-tau-181p levels or the p-tau-181p/Aβ or tau/Aβ ratios). TRIAL REGISTRATION: clinicaltrials.gov (NCT01993836).
Authors
Berger, M; Browndyke, JN; Cooter Wright, M; Nobuhara, C; Reese, M; Acker, L; Bullock, WM; Colin, BJ; Devinney, MJ; Moretti, EW; Moul, JW; Ohlendorf, B; Laskowitz, DT; Waligorska, T; Shaw, LM; Whitson, HE; Cohen, HJ; Mathew, JP; MADCO-PC Investigators,
MLA Citation
Berger, Miles, et al. “Postoperative changes in cognition and cerebrospinal fluid neurodegenerative disease biomarkers.Ann Clin Transl Neurol, vol. 9, no. 2, Feb. 2022, pp. 155–70. Pubmed, doi:10.1002/acn3.51499.
URI
https://scholars.duke.edu/individual/pub1509218
PMID
35104057
Source
pubmed
Published In
Annals of Clinical and Translational Neurology
Volume
9
Published Date
Start Page
155
End Page
170
DOI
10.1002/acn3.51499

Intraoperative angiography imaging correlates with wound complications following soft tissue sarcoma resection.

For soft tissue sarcoma patients receiving preoperative radiation therapy, wound complications are common and potentially devastating. The purpose of this study was to assess the feasibility of intraoperative indocyanine green fluorescent angiography (ICGA) as a predictor of wound complications in these patients. A consecutive series of patients with soft tissue sarcoma of the extremities or pelvis who received neoadjuvant radiation and a subsequent radical resection received intraoperative ICGA with the SPY PHI device (Stryker Inc.) at the time of closure. Retrospective analysis of fluorescence signal along multiple points of the wound length was performed and quantified. The primary endpoint was wound complication, defined as delayed wound healing or wound dehiscence, within 3 months of surgery. Fourteen patients with preoperative irradiated soft tissue sarcoma were consecutively imaged. There were six patients with wound complications classified as "aseptic" in five cases. Using the ICGA, blinded surgeons correctly predicted wound complications in 75% of cases. During the inflow phase, a mean ratio of normal of 0.62 maximized the area under the curve (AUC = 0.90) for predicting wound complications with a sensitivity of 100% and specificity of 77.4%. During the peak phase, a mean ratio of normal of 0.55 maximized the AUC (0.95) for predicting wound complications with a sensitivity of 88.9% and a specificity of 100%. Intraoperative use of ICGA may help to predict wound complications in patients undergoing resection of preoperatively irradiated soft tissue sarcomas of the extremities and pelvis.
Authors
Lazarides, AL; Saltzman, EB; Visgauss, JD; Mithani, SK; Eward, WC; Brigman, BE
MLA Citation
Lazarides, Alexander L., et al. “Intraoperative angiography imaging correlates with wound complications following soft tissue sarcoma resection.J Orthop Res, Jan. 2022. Pubmed, doi:10.1002/jor.25270.
URI
https://scholars.duke.edu/individual/pub1505865
PMID
35005805
Source
pubmed
Published In
J Orthop Res
Published Date
DOI
10.1002/jor.25270

Extent of tumor fibrosis/hyalinization and infarction following neoadjuvant radiation therapy is associated with improved survival in patients with soft-tissue sarcoma.

INTRODUCTION: Current standard of care for most intermediate and high-grade soft-tissue sarcomas (STS) includes limb-preserving surgical resection with either neoadjuvant radiation therapy (NRT) or adjuvant radiation therapy. To date, there have been a few studies that attempt to correlate histopathologic response to NRT with oncologic outcomes in patients with STS. METHODS: Using our institutional database, we identified 58 patients who received NRT followed by surgical resection for primary intermediate or high-grade STS and 34 patients who received surgical resection without NRT but did receive adjuvant radiation therapy or did not receive any radiation therapy. We analyzed four histologic parameters of response to therapy: residual viable tumor, fibrosis/hyalinization, necrosis, and infarction (each ratiometrically determined). Data were stratified into two binary groups. Unadjusted, 5- and 10-year overall survival, and relapsed-free survival (RFS) were calculated using the Kaplan-Meier method. RESULTS: Analysis of pathologic characteristics showed that patients treated with NRT demonstrate significantly higher tumor infarction, higher tumor fibrosis/hyalinization, and a lower percent viable tumor compared with patients not treated with NRT (p < 0.0001). Based on Kaplan-Meier curve analysis and multivariate cox proportional hazard model for OS and RFS, patients treated with NRT and showing >12.5% tumor fibrosis/hyalinization have significantly higher overall survival and recurrence-free survival at 5 and 10 years. DISCUSSION AND CONCLUSION: We have identified three histopathologic characteristics-fibrosis, hyalinization, and infarction-that may serve as predictive biomarkers of response to NRT for STS patients. Future prospective studies will be needed to confirm this association.
Authors
Rao, SR; Lazarides, AL; Leckey, BL; Lane, WO; Visgauss, JD; Somarelli, JA; Kirsch, DG; Larrier, NA; Brigman, BE; Blazer, DG; Cardona, DM; Eward, WC
MLA Citation
Rao, Sneha R., et al. “Extent of tumor fibrosis/hyalinization and infarction following neoadjuvant radiation therapy is associated with improved survival in patients with soft-tissue sarcoma.Cancer Med, vol. 11, no. 1, Jan. 2022, pp. 194–206. Pubmed, doi:10.1002/cam4.4428.
URI
https://scholars.duke.edu/individual/pub1502547
PMID
34837341
Source
pubmed
Published In
Cancer Medicine
Volume
11
Published Date
Start Page
194
End Page
206
DOI
10.1002/cam4.4428

The Role of Electronic Learning in Orthopaedic Graduate Medical Training: A Consensus From Leaders in Orthopaedic Training Programs

Authors
Bostrom, MPG; Lewis, KO; Berger, G
MLA Citation
Bostrom, Mathias P. G., et al. “The Role of Electronic Learning in Orthopaedic Graduate Medical Training: A Consensus From Leaders in Orthopaedic Training Programs.” Journal of the American Academy of Orthopaedic Surgeons, vol. 29, no. 8, Ovid Technologies (Wolters Kluwer Health), Apr. 2021, pp. 317–25. Crossref, doi:10.5435/jaaos-d-20-00821.
URI
https://scholars.duke.edu/individual/pub1513855
Source
crossref
Published In
The Journal of the American Academy of Orthopaedic Surgeons
Volume
29
Published Date
Start Page
317
End Page
325
DOI
10.5435/jaaos-d-20-00821

Investigating readmission rates for patients undergoing oncologic resection and endoprosthetic reconstruction for primary sarcomas and tumors involving bone.

BACKGROUND: Little is known about the drivers of readmission in patients undergoing Orthopaedic oncologic resection. The goal of this study was to identify factors independently associated with 90-day readmission for patients undergoing oncologic resection and subsequent prosthetic reconstruction for primary tumors involving bone. METHODS: This was a retrospective comparative cohort study of patients treated from 2008 to 2019 who underwent endoprosthetic reconstruction for a primary bone tumor or soft tissue tumor involving bone, as well as those who underwent a revision endoprosthetic reconstruction if the primary endoprosthetic reconstruction was performed for an oncologic resection. The primary outcome measure was unplanned 90-day readmission. RESULTS: A total of 149 patients were identified who underwent 191 surgeries were for a primary bone or soft tissue tumor. The 90-day readmission rate was 28.3%. Female gender, depression, higher tumor grade, vascular reconstruction, longer procedure duration, longer length of stay (LOS), multiple surgeries during an admission and disposition to a Skilled Nursing Facility were associated with readmission (p < 0.05). In a multivariate analysis, female sex, higher tumor grade and longer procedure duration were independently associated with risk of readmission (p < 0.05). CONCLUSIONS: Readmission rates are high following endoprosthetic reconstruction for Orthopaedic oncologic resections. Further work is necessary to help minimize unplanned readmissions.
Authors
Lazarides, AL; Flamant, EM; Cullen, MM; Ferlauto, HR; Cochrane, N; Gao, J; Jung, S-H; Visgauss, JD; Brigman, BE; Eward, WC
MLA Citation
Lazarides, Alexander L., et al. “Investigating readmission rates for patients undergoing oncologic resection and endoprosthetic reconstruction for primary sarcomas and tumors involving bone.J Surg Oncol, vol. 126, no. 2, Aug. 2022, pp. 356–64. Pubmed, doi:10.1002/jso.26864.
URI
https://scholars.duke.edu/individual/pub1513606
PMID
35319106
Source
pubmed
Published In
J Surg Oncol
Volume
126
Published Date
Start Page
356
End Page
364
DOI
10.1002/jso.26864