Pub Date : 2024-01-10DOI: 10.1177/00031348241227195
Kevin N. Harrell, Arthur D Grimes, H. Gill, Jessica K. Reynolds, Walker R. Ueland, Jason D Sciarretta, S. Todd, Marc D Trust, Marielle Ngoue, Bradley W Thomas, S. Ayuso, Aimee K. LaRiccia, Chance Spalding, Michael J Collins, Bryan R Collier, B. Karam, Marc A. De Moya, Mark J Lieser, John M. Chipko, James M Haan, Kelly L. Lightwine, D. Cullinane, C. Falank, Ryan C Phillips, M. Kemp, Hasan B Alam, Pascal O Udekwu, Gloria D. Sanin, Amy N Hildreth, W. Biffl, K. Schaffer, Gary Marshall, Omaer Muttalib, Jeffry T. Nahmias, N. Shahi, Steven L Moulton, Robert A Maxwell
Blunt traumatic abdominal wall hernias (TAWHs) are rare but require a variety of operative techniques to repair including bone anchor fixation (BAF) when tissue tears off bony structures. This study aimed to provide a descriptive analysis of BAF technique for blunt TAWH repair. Bone anchor fixation and no BAF repairs were compared, hypothesizing increased hernia recurrence with BAF repair. A secondary analysis of the WTA blunt TAWH multicenter study was performed including all patients who underwent repair of their TAWH. Patients with BAF were compared to those with no BAF with bivariate analyses. 176 patients underwent repair of their TAWH with 41 (23.3%) undergoing BAF. 26 (63.4%) patients had tissue fixed to bone, with 7 of those reinforced with mesh. The remaining 15 (36.6%) patients had bridging mesh anchored to bone. The BAF group had a similar age, sex, body mass index, and injury severity score compared to the no BAF group. The time to repair (1 vs 1 days, P = .158), rate of hernia recurrence (9.8% vs 12.7%, P = .786), and surgical site infection (SSI) (12.5% vs 15.6%, P = .823) were all similar between cohorts. This largest series to date found nearly one-quarter of TAWH repairs required BAF. Bone anchor fixation repairs had a similar rate of hernia recurrence and SSI compared to no BAF repairs, suggesting this is a reasonable option for repair of TAWH. However, future prospective studies are needed to compare specific BAF techniques and evaluate long-term outcomes including patient-centered outcomes such as pain and quality of life.
{"title":"Bone Anchor Fixation in the Repair of Blunt Traumatic Abdominal Wall Hernias: A Western Trauma Association Multicenter Study","authors":"Kevin N. Harrell, Arthur D Grimes, H. Gill, Jessica K. Reynolds, Walker R. Ueland, Jason D Sciarretta, S. Todd, Marc D Trust, Marielle Ngoue, Bradley W Thomas, S. Ayuso, Aimee K. LaRiccia, Chance Spalding, Michael J Collins, Bryan R Collier, B. Karam, Marc A. De Moya, Mark J Lieser, John M. Chipko, James M Haan, Kelly L. Lightwine, D. Cullinane, C. Falank, Ryan C Phillips, M. Kemp, Hasan B Alam, Pascal O Udekwu, Gloria D. Sanin, Amy N Hildreth, W. Biffl, K. Schaffer, Gary Marshall, Omaer Muttalib, Jeffry T. Nahmias, N. Shahi, Steven L Moulton, Robert A Maxwell","doi":"10.1177/00031348241227195","DOIUrl":"https://doi.org/10.1177/00031348241227195","url":null,"abstract":"Blunt traumatic abdominal wall hernias (TAWHs) are rare but require a variety of operative techniques to repair including bone anchor fixation (BAF) when tissue tears off bony structures. This study aimed to provide a descriptive analysis of BAF technique for blunt TAWH repair. Bone anchor fixation and no BAF repairs were compared, hypothesizing increased hernia recurrence with BAF repair. A secondary analysis of the WTA blunt TAWH multicenter study was performed including all patients who underwent repair of their TAWH. Patients with BAF were compared to those with no BAF with bivariate analyses. 176 patients underwent repair of their TAWH with 41 (23.3%) undergoing BAF. 26 (63.4%) patients had tissue fixed to bone, with 7 of those reinforced with mesh. The remaining 15 (36.6%) patients had bridging mesh anchored to bone. The BAF group had a similar age, sex, body mass index, and injury severity score compared to the no BAF group. The time to repair (1 vs 1 days, P = .158), rate of hernia recurrence (9.8% vs 12.7%, P = .786), and surgical site infection (SSI) (12.5% vs 15.6%, P = .823) were all similar between cohorts. This largest series to date found nearly one-quarter of TAWH repairs required BAF. Bone anchor fixation repairs had a similar rate of hernia recurrence and SSI compared to no BAF repairs, suggesting this is a reasonable option for repair of TAWH. However, future prospective studies are needed to compare specific BAF techniques and evaluate long-term outcomes including patient-centered outcomes such as pain and quality of life.","PeriodicalId":218262,"journal":{"name":"The American Surgeon™","volume":"63 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139441220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-08DOI: 10.1177/00031348231220570
Maria N. Som, Natalie T. Chao, Allison Karwoski, Luke T. Pitsenbarger, Eleanor Dunlap, Khanjan H. Nagarsheth
Major lower extremity amputation (LEA) is associated with significant morbidity and mortality. The modified frailty index (mFI-5) has been used to predict outcomes including ambulation and mortality after LEA. It remains unknown for which patient demographics the mFI-5 is a reliable predictor. This was a retrospective review of all patients who underwent a first-time major LEA at our institution from 2015 to 2022. Patients were stratified into 2 risk groups based on their mFI-5 score: non-frail (mFI<3) and frail (mFI≥3) and assessed on outcomes. Our sample consisted of 687 patients of whom 134 (19.6%) were considered frail and 551 (80.4%) were considered non-frail. A higher mFI-5 is associated with decreased ambulation rates (OR: 0.565, P = .004), increased hospital readmission (OR: 1.657, P = .021), and increased mortality (OR: 2.101, P = .001) following major LEA. In African American patients, frail and non-frail patients differed on readmission at 90 days ( P = .008), mortality at 1 year ( P = .001), ambulatory status ( P < .001), and prosthesis use ( P = .023). In male patients, frail and non-frail patients differed on readmission at 90 days ( P = .019), death at 1 year ( P = .001), and ambulatory status ( P = .002). In Caucasian patients and female patients, frail and non-frail patients did not differ significantly on outcomes. The mFI-5 is a valuable predictor of outcomes following major LEA, specifically in males and African American patients. Moreover, surgeons should consider using frailty status to risk stratify patients and inform treatment plans.
下肢大截肢(LEA)具有显著的发病率和死亡率。改进的衰弱指数(mFI-5)已被用于预测LEA后的结果，包括活动和死亡率。目前尚不清楚mFI-5是哪类患者的可靠预测指标。这是一项回顾性研究，纳入了2015年至2022年在我院首次接受重大LEA的所有患者。根据患者的mFI-5评分将患者分为2个危险组:非虚弱(mFI<3)和虚弱(mFI≥3)，并对结果进行评估。我们的样本包括687例患者，其中134例(19.6%)被认为虚弱，551例(80.4%)被认为非虚弱。较高的mFI-5与严重LEA后活动率降低(OR: 0.565, P = 0.004)、再入院率增加(OR: 1.657, P = 0.021)和死亡率增加(OR: 2.101, P = 0.001)相关。在非裔美国患者中，体弱和非体弱患者在90天再入院(P = 0.008)、1年死亡率(P = 0.001)、活动状态(P < 0.001)和假体使用(P = 0.023)方面存在差异。在男性患者中，体弱和非体弱患者在90天再入院(P = 0.019)、1年死亡(P = 0.001)和活动状态(P = 0.002)方面存在差异。在高加索患者和女性患者中，体弱和非体弱患者的结果没有显着差异。mFI-5是主要LEA后预后的重要预测指标，特别是在男性和非裔美国患者中。此外，外科医生应考虑使用虚弱状态对患者进行风险分层，并告知治疗计划。
{"title":"Modified Frailty Index Helps Predict Mortality and Ambulation Differences Between Genders and Racial Differences Following Major Lower Extremity Amputation","authors":"Maria N. Som, Natalie T. Chao, Allison Karwoski, Luke T. Pitsenbarger, Eleanor Dunlap, Khanjan H. Nagarsheth","doi":"10.1177/00031348231220570","DOIUrl":"https://doi.org/10.1177/00031348231220570","url":null,"abstract":"Major lower extremity amputation (LEA) is associated with significant morbidity and mortality. The modified frailty index (mFI-5) has been used to predict outcomes including ambulation and mortality after LEA. It remains unknown for which patient demographics the mFI-5 is a reliable predictor. This was a retrospective review of all patients who underwent a first-time major LEA at our institution from 2015 to 2022. Patients were stratified into 2 risk groups based on their mFI-5 score: non-frail (mFI<3) and frail (mFI≥3) and assessed on outcomes. Our sample consisted of 687 patients of whom 134 (19.6%) were considered frail and 551 (80.4%) were considered non-frail. A higher mFI-5 is associated with decreased ambulation rates (OR: 0.565, P = .004), increased hospital readmission (OR: 1.657, P = .021), and increased mortality (OR: 2.101, P = .001) following major LEA. In African American patients, frail and non-frail patients differed on readmission at 90 days ( P = .008), mortality at 1 year ( P = .001), ambulatory status ( P < .001), and prosthesis use ( P = .023). In male patients, frail and non-frail patients differed on readmission at 90 days ( P = .019), death at 1 year ( P = .001), and ambulatory status ( P = .002). In Caucasian patients and female patients, frail and non-frail patients did not differ significantly on outcomes. The mFI-5 is a valuable predictor of outcomes following major LEA, specifically in males and African American patients. Moreover, surgeons should consider using frailty status to risk stratify patients and inform treatment plans.","PeriodicalId":218262,"journal":{"name":"The American Surgeon™","volume":"31 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138588988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-08DOI: 10.1177/00031348231220583
Elizabeth A. Jacob, Alexa D. Melucci, Ethan Talbot, Fergal Fleming, Matthew Schiralli, C. Foster, Laurie Foster, Kellie Donovan, K. Simran, Vincy J. John, N. Hellenthal
Over 5 million Americans currently abuse prescription opioids. Patients’ first exposure to opioids is often after surgery. Few opioid guidelines account for the challenges to health care institutions that serve wide catchment areas. We standardized postoperative opioid prescribing recommendations amongst surgical providers at our institutions and analyzed postoperative prescribing habits. The Upstate New York Surgical Quality Improvement (UNYSQI) collaborative met with surgical champions from 16 hospitals to standardize opioid prescribing for 21 surgical procedures. The guidelines were distributed to all surgical care providers at participating institutions. 581,465 pills were dispensed for 12,672 surgeries (average of 45.9 pills per procedure) before implementation. Post-implementation, 1,097,849 pills were dispensed for 28,772 surgeries (average of 38.2 pills per surgery) with over 222,000 fewer pills being prescribed. Our project suggests opioid prescribing guidelines for institutions that serve diverse communities.
{"title":"The Upstate New York Surgical Quality Improvement Opioid Reduction Project","authors":"Elizabeth A. Jacob, Alexa D. Melucci, Ethan Talbot, Fergal Fleming, Matthew Schiralli, C. Foster, Laurie Foster, Kellie Donovan, K. Simran, Vincy J. John, N. Hellenthal","doi":"10.1177/00031348231220583","DOIUrl":"https://doi.org/10.1177/00031348231220583","url":null,"abstract":"Over 5 million Americans currently abuse prescription opioids. Patients’ first exposure to opioids is often after surgery. Few opioid guidelines account for the challenges to health care institutions that serve wide catchment areas. We standardized postoperative opioid prescribing recommendations amongst surgical providers at our institutions and analyzed postoperative prescribing habits. The Upstate New York Surgical Quality Improvement (UNYSQI) collaborative met with surgical champions from 16 hospitals to standardize opioid prescribing for 21 surgical procedures. The guidelines were distributed to all surgical care providers at participating institutions. 581,465 pills were dispensed for 12,672 surgeries (average of 45.9 pills per procedure) before implementation. Post-implementation, 1,097,849 pills were dispensed for 28,772 surgeries (average of 38.2 pills per surgery) with over 222,000 fewer pills being prescribed. Our project suggests opioid prescribing guidelines for institutions that serve diverse communities.","PeriodicalId":218262,"journal":{"name":"The American Surgeon™","volume":"29 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138589390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-08DOI: 10.1177/00031348231220577
Marshall L. Robaczewski, Reese W. Randall, Thomas P. Sullivan
Lymphatic leak after lymph node dissection is a rare but well-known surgical complication that is often treated with conservative management and ultimately reoperation. The purpose of this report is to offer an alternative treatment for chyle leak that avoids hospitalization and subsequent surgery. Sclerotherapy has been used to treat lymphatic leaks in the past and has been shown to be safe and effective. This report presents a patient with a known cervical lymphocele who was followed through multiple sclerotherapy appointments until resolution of the lymphocele.
{"title":"Treatment of Postoperative Neck Dissection Cervical Lymphocele With Percutaneous Bleomycin Sclerotherapy","authors":"Marshall L. Robaczewski, Reese W. Randall, Thomas P. Sullivan","doi":"10.1177/00031348231220577","DOIUrl":"https://doi.org/10.1177/00031348231220577","url":null,"abstract":"Lymphatic leak after lymph node dissection is a rare but well-known surgical complication that is often treated with conservative management and ultimately reoperation. The purpose of this report is to offer an alternative treatment for chyle leak that avoids hospitalization and subsequent surgery. Sclerotherapy has been used to treat lymphatic leaks in the past and has been shown to be safe and effective. This report presents a patient with a known cervical lymphocele who was followed through multiple sclerotherapy appointments until resolution of the lymphocele.","PeriodicalId":218262,"journal":{"name":"The American Surgeon™","volume":"9 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138590150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-07DOI: 10.1177/00031348231220587
Monique Motta, Azalia Avila, Shenae Samuels, Michael Weiss, Tamar L. Levene
{"title":"The Impact of Preoperative Chlorhexidine Baths on Surgical Site Infections and Readmissions in Pediatric Patients Undergoing Laparoscopic Cholecystectomy","authors":"Monique Motta, Azalia Avila, Shenae Samuels, Michael Weiss, Tamar L. Levene","doi":"10.1177/00031348231220587","DOIUrl":"https://doi.org/10.1177/00031348231220587","url":null,"abstract":"","PeriodicalId":218262,"journal":{"name":"The American Surgeon™","volume":"116 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138590474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-07DOI: 10.1177/00031348231216485
Alexandra E. Hernandez, Kelley N. Benck, Carlos T. Huerta, I. Ogobuiro, Gabriel De la Cruz Ku, Mecker G. Möller
Melanoma causes most skin cancer–related deaths, and disparities in mortality persist. Rural communities, compared to urban, face higher levels of poverty and more barriers to care, leading to higher stage at presentation and shorter survival in melanoma. To further evaluate these disparities, we sought to assess the association between rurality and melanoma cause-specific mortality and receipt of recommended surgery in a national cohort. Patients with primary non-ocular, cutaneous melanoma from the SEER database, 2000-2017, were included. Outcomes included melanoma-specific survival and receipt of recommended surgery. Rurality was based on Rural-Urban Continuum Codes. Variables included age, sex, race, ethnicity, income, and stage. Multivariate regression models assessed the effect of rurality on survival and receipt of recommended surgery. 103,606 patients diagnosed with non-ocular cutaneous primary melanoma met criteria during this period. 93.3% ( n = 96620) were in urban areas and 6.7% ( n = 6986) were in rural areas. On multivariate regression controlling for age, sex, race, ethnicity, and stage patients living in a rural area were less likely to receive recommended surgery (aOR .52, 95% CI: .29-.90, P = .02) and had increased hazard of melanoma-specific mortality (aHR 1.19, 95% CI: 1.02-1.40, P = .03) even after additionally controlling for surgery receipt. Using a large national cohort, our study found that rural patients were less likely to receive recommended surgery and had shorter melanoma cause-specific survival. Our findings highlight the importance of access to cancer care in rural areas and how this ultimately effects survival for these patients.
黑色素瘤导致大多数皮肤癌相关死亡，死亡率的差异仍然存在。与城市相比，农村社区面临着更高的贫困水平和更多的护理障碍，导致黑色素瘤的发病阶段更长，生存期更短。为了进一步评估这些差异，我们试图在一个国家队列中评估乡村性和黑色素瘤病因特异性死亡率和接受推荐手术之间的关系。纳入了2000-2017年SEER数据库中原发性非眼部皮肤黑色素瘤患者。结果包括黑色素瘤特异性生存和接受推荐手术。农村是基于农村-城市连续代码。变量包括年龄、性别、种族、民族、收入和阶段。多变量回归模型评估乡村性对生存和接受推荐手术的影响。在此期间，103,606名被诊断为非眼部皮肤原发性黑色素瘤的患者符合标准。93.3% (n = 96620)在城市地区，6.7% (n = 6986)在农村地区。在控制年龄、性别、种族、民族和分期的多因素回归分析中，生活在农村地区的患者接受推荐手术的可能性较小(aOR为0.52,95% CI为0.29 -)。90, P = 0.02)，即使在额外控制手术接受情况后，黑素瘤特异性死亡率的风险也增加(aHR 1.19, 95% CI: 1.02-1.40, P = 0.03)。通过一个大型的国家队列，我们的研究发现农村患者接受推荐手术的可能性更小，黑色素瘤病因特异性生存期更短。我们的研究结果强调了在农村地区获得癌症治疗的重要性，以及这最终如何影响这些患者的生存。
{"title":"Rural Melanoma Patients Have Less Surgery and Higher Melanoma-Specific Mortality","authors":"Alexandra E. Hernandez, Kelley N. Benck, Carlos T. Huerta, I. Ogobuiro, Gabriel De la Cruz Ku, Mecker G. Möller","doi":"10.1177/00031348231216485","DOIUrl":"https://doi.org/10.1177/00031348231216485","url":null,"abstract":"Melanoma causes most skin cancer–related deaths, and disparities in mortality persist. Rural communities, compared to urban, face higher levels of poverty and more barriers to care, leading to higher stage at presentation and shorter survival in melanoma. To further evaluate these disparities, we sought to assess the association between rurality and melanoma cause-specific mortality and receipt of recommended surgery in a national cohort. Patients with primary non-ocular, cutaneous melanoma from the SEER database, 2000-2017, were included. Outcomes included melanoma-specific survival and receipt of recommended surgery. Rurality was based on Rural-Urban Continuum Codes. Variables included age, sex, race, ethnicity, income, and stage. Multivariate regression models assessed the effect of rurality on survival and receipt of recommended surgery. 103,606 patients diagnosed with non-ocular cutaneous primary melanoma met criteria during this period. 93.3% ( n = 96620) were in urban areas and 6.7% ( n = 6986) were in rural areas. On multivariate regression controlling for age, sex, race, ethnicity, and stage patients living in a rural area were less likely to receive recommended surgery (aOR .52, 95% CI: .29-.90, P = .02) and had increased hazard of melanoma-specific mortality (aHR 1.19, 95% CI: 1.02-1.40, P = .03) even after additionally controlling for surgery receipt. Using a large national cohort, our study found that rural patients were less likely to receive recommended surgery and had shorter melanoma cause-specific survival. Our findings highlight the importance of access to cancer care in rural areas and how this ultimately effects survival for these patients.","PeriodicalId":218262,"journal":{"name":"The American Surgeon™","volume":"45 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138592163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-07DOI: 10.1177/00031348231220569
S. Gogna, B. Zangbar, Aryan Rafieezadeh, Kamil Hanna, Ilya Shnaydman, Jorge Con, M. Bronstein, J. Klein, K. Prabhakaran
The health care system for the elderly is fragmented, that is worsened when readmission occurs to different hospitals. There is limited investigation into the impact of fragmentation on geriatric trauma patient outcomes. The aim of this study was to compare the outcomes following readmissions after geriatric trauma. The Nationwide Readmissions Database (2016-2017) was queried for elderly trauma patients (aged ≥65 years) readmitted due to any cause. Patients were divided into 2 groups according to readmission: index vs non-index hospital. Outcomes were 30 and 180-day complications, mortality, and the number of subsequent readmissions. Multivariable logistic regression was performed to analyze the independent predictors of fragmentation of care. A total of 36,176 trauma patients were readmitted, of which 3856 elderly patients (aged ≥65 years) were readmitted: index hospital (3420; 89%) vs non-index hospital (436; 11%). Following 1:2 propensity matching, elderly with non-index hospital readmission had higher rates of death and MI within 180 days ( P = .01 and .02, respectively). They had statistically higher 30 and 180-day pneumonia ( P < .01), CHF ( P < .01), arrhythmias ( P < .01), MI ( P < .01), sepsis ( P < .01), and UTI ( P < .01). On multivariable binary logistic regression analysis, pneumonia (OR 1.70, P = .03), congestive heart failure (CHF) (OR 1.80, P = .03), female gender (OR .72, P = .04), and severe Head and Neck trauma (AIS≥3) (OR 1.50, P < .01) on index admission were independent predictors of fragmentation of care. While the increase in time to readmission (OR 1.01, P < .01) was also associated independently with non-index hospital admission. Fragmented care after geriatric trauma could be associated with higher mortality and complications.
老年人的医疗保健系统是支离破碎的，当再入院发生在不同的医院时，这种情况更加恶化。关于碎片化对老年创伤患者预后影响的调查有限。本研究的目的是比较老年创伤后再入院的结果。查询全国再入院数据库(2016-2017)中因任何原因再入院的老年创伤患者(年龄≥65岁)。根据再入院情况将患者分为两组:指数医院和非指数医院。结果是30天和180天的并发症、死亡率和随后再入院的次数。采用多变量logistic回归分析护理碎片化的独立预测因素。共36176例创伤患者再入院，其中老年患者(年龄≥65岁)3856例再入院:指标医院3420例;89%) vs非指标医院(436;11%)。根据1:2倾向匹配，无指标再入院的老年人在180天内的死亡率和心肌梗死发生率较高(P分别为0.01和0.02)。30天、180天肺炎(P < 0.01)、心力衰竭(P < 0.01)、心律失常(P < 0.01)、心肌梗死(P < 0.01)、脓毒症(P < 0.01)、尿路感染(P < 0.01)的发生率均高于对照组。多变量logistic回归分析显示，入院时肺炎(OR 1.70, P = 0.03)、充血性心力衰竭(OR 1.80, P = 0.03)、女性性别(OR 0.72, P = 0.04)和严重头颈部创伤(AIS≥3)(OR 1.50, P < 0.01)是护理碎片化的独立预测因素。而再入院时间的增加(OR 1.01, P < 0.01)也与非指标住院独立相关。老年创伤后的碎片化护理可能与较高的死亡率和并发症有关。
{"title":"Fragmentation of Care After Geriatric Trauma: A Nationwide Analysis of outcomes and Predictors","authors":"S. Gogna, B. Zangbar, Aryan Rafieezadeh, Kamil Hanna, Ilya Shnaydman, Jorge Con, M. Bronstein, J. Klein, K. Prabhakaran","doi":"10.1177/00031348231220569","DOIUrl":"https://doi.org/10.1177/00031348231220569","url":null,"abstract":"The health care system for the elderly is fragmented, that is worsened when readmission occurs to different hospitals. There is limited investigation into the impact of fragmentation on geriatric trauma patient outcomes. The aim of this study was to compare the outcomes following readmissions after geriatric trauma. The Nationwide Readmissions Database (2016-2017) was queried for elderly trauma patients (aged ≥65 years) readmitted due to any cause. Patients were divided into 2 groups according to readmission: index vs non-index hospital. Outcomes were 30 and 180-day complications, mortality, and the number of subsequent readmissions. Multivariable logistic regression was performed to analyze the independent predictors of fragmentation of care. A total of 36,176 trauma patients were readmitted, of which 3856 elderly patients (aged ≥65 years) were readmitted: index hospital (3420; 89%) vs non-index hospital (436; 11%). Following 1:2 propensity matching, elderly with non-index hospital readmission had higher rates of death and MI within 180 days ( P = .01 and .02, respectively). They had statistically higher 30 and 180-day pneumonia ( P < .01), CHF ( P < .01), arrhythmias ( P < .01), MI ( P < .01), sepsis ( P < .01), and UTI ( P < .01). On multivariable binary logistic regression analysis, pneumonia (OR 1.70, P = .03), congestive heart failure (CHF) (OR 1.80, P = .03), female gender (OR .72, P = .04), and severe Head and Neck trauma (AIS≥3) (OR 1.50, P < .01) on index admission were independent predictors of fragmentation of care. While the increase in time to readmission (OR 1.01, P < .01) was also associated independently with non-index hospital admission. Fragmented care after geriatric trauma could be associated with higher mortality and complications.","PeriodicalId":218262,"journal":{"name":"The American Surgeon™","volume":"45 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138593797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-07DOI: 10.1177/00031348231220579
Russell K. McAllister
{"title":"Letter re: “Adverse Events Associated With Disparity Between Patients’ BMI and Operating Table Size—A Need for Improved Surgical Innovations”","authors":"Russell K. McAllister","doi":"10.1177/00031348231220579","DOIUrl":"https://doi.org/10.1177/00031348231220579","url":null,"abstract":"","PeriodicalId":218262,"journal":{"name":"The American Surgeon™","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138591772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-21DOI: 10.1177/0003134820971575
Michaelia S. Sunderland, E. Lafranchise, A. Durrant
Background The leading cause of morbidity and mortality in the pediatric population is unintentional injury. Emergent thoracotomies are rarely performed in pediatric patients, especially in the very young pediatric population. We present a case of a 10-year-old male who survived emergent clamshell thoracotomy for penetrating chest trauma. Summary Our patient sustained aortic lacerations after being shot with an air-powered rifle. Thoracotomy was performed in the emergency department. The incision was extended to a clamshell thoracotomy for repair of the aortic lacerations. He survived and made a full recovery. Conclusion This case is one of the youngest reported survivors of an emergent thoracotomy. Air-powered gun injuries can be life-threatening despite their perception as safe toys for children. Surprisingly, there is very little regulation on sale of air guns to minors in the United States. Increased public awareness and regulation of sale may prevent unintentional injury in this population.
{"title":"Pediatric Aortic Injury From a BB Gun Injury Requiring Emergent Thoracotomy","authors":"Michaelia S. Sunderland, E. Lafranchise, A. Durrant","doi":"10.1177/0003134820971575","DOIUrl":"https://doi.org/10.1177/0003134820971575","url":null,"abstract":"Background The leading cause of morbidity and mortality in the pediatric population is unintentional injury. Emergent thoracotomies are rarely performed in pediatric patients, especially in the very young pediatric population. We present a case of a 10-year-old male who survived emergent clamshell thoracotomy for penetrating chest trauma. Summary Our patient sustained aortic lacerations after being shot with an air-powered rifle. Thoracotomy was performed in the emergency department. The incision was extended to a clamshell thoracotomy for repair of the aortic lacerations. He survived and made a full recovery. Conclusion This case is one of the youngest reported survivors of an emergent thoracotomy. Air-powered gun injuries can be life-threatening despite their perception as safe toys for children. Surprisingly, there is very little regulation on sale of air guns to minors in the United States. Increased public awareness and regulation of sale may prevent unintentional injury in this population.","PeriodicalId":218262,"journal":{"name":"The American Surgeon™","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127831140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-09DOI: 10.21203/RS.3.RS-566870/V1
Siyi Lu, Bingyan Wang, Zhenzhen Liu, Fei Li, Yongqu Lu, Yan Meng, Junwei Wang, Hao Wang, Limei Guo, Xin Zhou, W. Fu
Background: The prognostic value of tumour size in colon cancer remains controversial. This study aimed to reveal the correlation between tumour size and prognosis of colon cancer.Methods: A total of 498 patients with colon cancer were included in this study. The correlation of tumour size with prognosis, mismatch repair status and other clinicopathological characteristics as well as tumour microenvironment was analysed.Results: For stage IIA microsatellite stable (MSS) colon cancer, tumours sized <3.5 cm and ≥5 cm were associated with a poorer disease free survival (DFS) compared with tumours sized between 3.5 and 5 cm (p=0.002). Small tumour size (HR=5.098, p=0.001) and large tumour size (HR=2.749, p=0.029) were found to be independent prognostic factors for stage IIA MSS colon cancer. Moreover, high expression of transgelin (TAGLN), a marker of cancer-associated fibroblasts (CAFs), was found to be an independent prognostic factor for poorer DFS (HR=9.651, p=0.009), which was also associated with smaller tumour size (p=0.027).Conclusion: Small (<3.5 cm) and large (≥5 cm) tumour sizes are associated with decreased DFS in stage IIA MSS colon cancer. Enrichment of TAGLN+ CAFs is associated with decreased DFS and small tumour size.
{"title":"Prognostic Value of Tumour Size in Colon Cancer – Smaller is Better?","authors":"Siyi Lu, Bingyan Wang, Zhenzhen Liu, Fei Li, Yongqu Lu, Yan Meng, Junwei Wang, Hao Wang, Limei Guo, Xin Zhou, W. Fu","doi":"10.21203/RS.3.RS-566870/V1","DOIUrl":"https://doi.org/10.21203/RS.3.RS-566870/V1","url":null,"abstract":"\u0000 Background: The prognostic value of tumour size in colon cancer remains controversial. This study aimed to reveal the correlation between tumour size and prognosis of colon cancer.Methods: A total of 498 patients with colon cancer were included in this study. The correlation of tumour size with prognosis, mismatch repair status and other clinicopathological characteristics as well as tumour microenvironment was analysed.Results: For stage IIA microsatellite stable (MSS) colon cancer, tumours sized <3.5 cm and ≥5 cm were associated with a poorer disease free survival (DFS) compared with tumours sized between 3.5 and 5 cm (p=0.002). Small tumour size (HR=5.098, p=0.001) and large tumour size (HR=2.749, p=0.029) were found to be independent prognostic factors for stage IIA MSS colon cancer. Moreover, high expression of transgelin (TAGLN), a marker of cancer-associated fibroblasts (CAFs), was found to be an independent prognostic factor for poorer DFS (HR=9.651, p=0.009), which was also associated with smaller tumour size (p=0.027).Conclusion: Small (<3.5 cm) and large (≥5 cm) tumour sizes are associated with decreased DFS in stage IIA MSS colon cancer. Enrichment of TAGLN+ CAFs is associated with decreased DFS and small tumour size.","PeriodicalId":218262,"journal":{"name":"The American Surgeon™","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116306702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：