Laura Rosenberger

Positions:

Assistant Professor of Surgery

Surgical Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

B.S. 2003

Eastern Mennonite University

M.D. 2008

Jefferson Medical College of Thomas Jefferson University

General Surgery Resident, Surgery

University of Virginia School of Medicine

Breast Surgical Oncology Fellow, Surgery

Memorial Sloan Kettering Cancer Center

Publications:

Aspergillus infections in transplant and non-transplant surgical patients.

BACKGROUND: Aspergillus infections are associated commonly with immunocompromised states, such as transplantation and hematologic malignant disease. Although Aspergillus infections among patients having surgery occur primarily in transplant recipients, they are found in non-recipients of transplants, and have a mortality rate similar to that seen among transplant recipients. METHODS: We conducted a retrospective analysis of a prospective data base collected from 1996 to 2010, in which we identified patients with Aspergillus infections. We compared demographic data, co-morbidities, and outcomes in non-transplant patients with those in abdominal transplant recipients. Continuous data were evaluated with the Student t-test, and categorical data were evaluated through χ(2) analysis. RESULTS: Twenty-three patients (11 transplant patients and 12 non-transplant patients) were identified as having had Aspergillus infections. The two groups were similar with regard to their demographics and co-morbidities, with the exceptions of their scores on the Acute Physiology and Chronic Health Evaluation II (APACHE II), of 23.6±8.1 points for transplant patients vs. 16.8±6.1 points for non-transplant patients (p=0.03); Simplified Acute Physiology Score (SAPS) of 16.6±8.3 points vs. 9.2±4.1 points, respectively (p=0.02); steroid use 91.0% vs. 25.0%, respectively (p=0.003); and percentage of infections acquired in the intensive care unit (ICU) 27.3% vs. 83.3%, respectively (p=0.01). The most common site of infection in both patient groups was the lung. The two groups showed no significant difference in the number of days from admission to treatment, hospital length of stay following treatment, or mortality. CONCLUSIONS: Although Aspergillus infections among surgical patients have been associated historically with solid-organ transplantation, our data suggest that other patients may also be susceptible to such infections, especially those in an ICU who are deemed to be critically ill. This supports the idea that critically ill surgical patients exist in an immunocompromised state. Surgical intensivists should be familiar with the diagnosis and treatment of Aspergillus infections even in the absence of an active transplant program.
Authors
Davies, S; Guidry, C; Politano, A; Rosenberger, L; McLeod, M; Hranjec, T; Sawyer, R
MLA Citation
Davies, Stephen, et al. “Aspergillus infections in transplant and non-transplant surgical patients..” Surg Infect (Larchmt), vol. 15, no. 3, June 2014, pp. 207–12. Pubmed, doi:10.1089/sur.2012.239.
URI
https://scholars.duke.edu/individual/pub1148995
PMID
24799182
Source
pubmed
Published In
Surg Infect (Larchmt)
Volume
15
Published Date
Start Page
207
End Page
212
DOI
10.1089/sur.2012.239

Jejunal tube extensions via percutaneous endoscopic gastrostomy and delayed small-bowel perforations: a case series.

Authors
Rosenberger, LH; Newhook, T; Mauro, DM; Hennessy, SA; Sawyer, RG
MLA Citation
Rosenberger, Laura H., et al. “Jejunal tube extensions via percutaneous endoscopic gastrostomy and delayed small-bowel perforations: a case series..” Gastrointest Endosc, vol. 75, no. 3, Mar. 2012, pp. 683–87. Pubmed, doi:10.1016/j.gie.2011.10.009.
URI
https://scholars.duke.edu/individual/pub1149010
PMID
22243831
Source
pubmed
Published In
Gastrointest Endosc
Volume
75
Published Date
Start Page
683
End Page
687
DOI
10.1016/j.gie.2011.10.009

Endoluminal negative-pressure therapy for preventing rectal anastomotic leaks: a pilot study in a pig model.

BACKGROUND: Anastomotic leak after rectal resection carries substantial morbidity and mortality. A diverting ileostomy is beneficial for high-risk anastomoses, but its creation and reversal carry a surgical risk in addition to that of resection itself. We sought an alternative method for managing complications of rectal anastomosis. METHODS: We developed an endoluminal negative-pressure technology with a diverting proximal sump, and hypothesized that it would close anastomotic disruptions in pigs. We performed rectal resections on pigs, with primary anastomoses and the creation of an anastomotic defect. In animals in the treatment group we inserted an endoluminal negative-pressure device and kept it at a low level of continuous suction for 5 d. No device was inserted in a control group of animals. After the 5-d period of treatment we evaluated the anastomoses in both the treatment and control groups of animals for leakage, using contrast enemas. Specimens of anastomosed rectum were evaluated histologically for mucosal integrity and for the location and density of inflammatory responses. RESULTS: Fourteen pigs were assigned to either the treatment (n=10) or control (n=4) group. Of the pigs in the treatment group, 90% had complete closure of their rectal defect, as compared with 25% of the animals in the control group (χ(2) test, p=0.04). The animals in the treatment group had only minimal mucosal and serosal inflammation, whereas those in the control group had extensive mucosal damage with associated serositis. CONCLUSIONS: Endoluminal negative-pressure therapy was well-tolerated and led to successful closure of 90% of the anastomic rectal defects in the treatment group of animals in the present study. Additional evaluation of this therapy is warranted.
Authors
Shada, AL; Rosenberger, LH; Mentrikoski, MJ; Silva, MA; Feldman, SH; Kleiner, DE
MLA Citation
Shada, Amber L., et al. “Endoluminal negative-pressure therapy for preventing rectal anastomotic leaks: a pilot study in a pig model..” Surg Infect (Larchmt), vol. 15, no. 2, Apr. 2014, pp. 123–30. Pubmed, doi:10.1089/sur.2012.198.
URI
https://scholars.duke.edu/individual/pub1148990
PMID
24476015
Source
pubmed
Published In
Surg Infect (Larchmt)
Volume
15
Published Date
Start Page
123
End Page
130
DOI
10.1089/sur.2012.198

Complicated postpartum type B aortic dissection and endovascular repair.

BACKGROUND: Fifty percent of aortic dissections in women younger than 40 years occur in association with pregnancy. Of these, half of type B dissections occur in the postpartum period. CASE: A 30-year-old woman was status post spontaneous vaginal delivery at 30 weeks of gestation for fetal death, complicated by an eclamptic seizure. On postpartum day 4, she suffered an acute, complicated type B aortic dissection treated with endovascular stent graft placement. CONCLUSION: Endovascular repair may be an attractive option for the treatment of complicated type B aortic dissections in pregnancy and the peripartum period, with reduced maternal and fetal mortality. This may allow the fetus to remain in situ and avoid the risks of surgery and possible cardiopulmonary bypass, with little radiation risk to the fetus.
Authors
Rosenberger, LH; Adams, JD; Kern, JA; Tracci, MC; Angle, JF; Cherry, KJ
MLA Citation
Rosenberger, Laura H., et al. “Complicated postpartum type B aortic dissection and endovascular repair..” Obstet Gynecol, vol. 119, no. 2 Pt 2, Feb. 2012, pp. 480–83. Pubmed, doi:10.1097/AOG.0b013e3182390622.
URI
https://scholars.duke.edu/individual/pub1149008
PMID
22270446
Source
pubmed
Published In
Obstet Gynecol
Volume
119
Published Date
Start Page
480
End Page
483
DOI
10.1097/AOG.0b013e3182390622

Intraoperative Versus Extended Antibiotic Prophylaxis in Liver Transplant Surgery: A Randomized Controlled Pilot Trial.

The appropriate duration of surgical antibiotic prophylaxis in orthotopic liver transplantation (OLT) in the presence of significant iatrogenic immunosuppression is unclear. We hypothesized that 72 hours of perioperative antibiotic prophylaxis would decrease rates of surgical site infection (SSI) in OLT patients when compared with intraoperative antibiotic prophylaxis alone. OLT recipients were randomized to receive either intraoperative antibiotics only (short antibiotics [SAs]) or 72 hours of perioperative antibiotics (extended antibiotics [EAs]). A total of 102 patients were randomized: 51 to the EA group and 51 to the SA group. Rates of SSI and nosocomial infection (NI) in the SA group were 19% and 17%, respectively, compared with 27% (SSI; P = 0.36) and 22% (NI; P = 0.47) in the EA group, although these differences were not statistically significant. Intensive care unit (ICU) length of stay (LOS), hospital LOS, 30-day mortality, and time to infection were also similar between the 2 groups. Patients developing infections had longer ICU LOS and hospital LOS and a higher association with reoperation, endoscopic retrograde cholangiopancreatography, and 30-day readmission. In conclusion, extending perioperative antibiotics to 72 hours from intraoperative dosing alone in OLT patients does not appear to decrease the incidence of SSI or NI. The results from this pilot trial with 60% power suggest that it is acceptable for OLT recipients to receive intraoperative antibiotic prophylaxis alone.
Authors
Berry, PS; Rosenberger, LH; Guidry, CA; Agarwal, A; Pelletier, S; Sawyer, RG
MLA Citation
Berry, Puja S., et al. “Intraoperative Versus Extended Antibiotic Prophylaxis in Liver Transplant Surgery: A Randomized Controlled Pilot Trial..” Liver Transpl, vol. 25, no. 7, July 2019, pp. 1043–53. Pubmed, doi:10.1002/lt.25486.
URI
https://scholars.duke.edu/individual/pub1396199
PMID
31063679
Source
pubmed
Published In
Liver Transpl
Volume
25
Published Date
Start Page
1043
End Page
1053
DOI
10.1002/lt.25486