Volume–outcome relationship in severe operative trauma surgery: A retrospective cohort study using a Japanese nationwide administrative database

ObjectiveTo examine the association between reimbursement rates and the length of stay (LOS).DesignA retrospective cohort study.SettingThe study was conducted in Shenzhen, China by using health administrative database from 1 January 2015 to 31 December 2017.Participants6583 patients with acute myocardial infarction (AMI), 12 395 patients with pneumonia and 10 485 patients who received percutaneous coronary intervention (PCI) surgery.MeasuresThe reimbursement rate was defined as one minus the ratio of out-of-pocket to the total expenditure, multiplied by 100%. The outcome of interest was the LOS. Multilevel negative binomial regression models were constructed to control for patient-level and hospital-level characteristics, and the marginal effect was reported when non-linear terms were available.ResultsEach additional unit of the reimbursement rate was associated with an average of an additional increase of 0.019 (95% CI, 0.015 to 0.023), 0.011 (95% CI, 0.009 to 0.014) and 0.013 (95% CI, 0.010 to 0.016) in the LOS for inpatients with AMI, pneumonia and PCI surgery, respectively. Adding the interaction term between the reimbursement rate and in-hospital survival, the average marginal effects for the deceased inpatients with AMI and PCI surgery were 0.044 (95% CI, 0.031 to 0.058) and 0.034 (95% CI, 0.017 to 0.051), respectively. However, there was no evidence that higher reimbursement rates prolonged the LOS of the patients who died of pneumonia (95% CI, −0.013 to 0.016).ConclusionsThe findings indicate that the higher the reimbursement rate, the longer the LOS; and implementing dynamic supervision and improving the service capabilities of primary healthcare providers may be an important strategy for reducing moral hazard in low-income and middle-income countries including China.

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The effect of tranexamic acid on blood loss in non-urgent trauma patients undergoing major orthopaedic surgery: A retrospective cohort study

Journal of Clinical Images and Medical Case Reports ◽

10.52768/2766-7820/1394 ◽

2021 ◽

Vol 2 (6) ◽

Author(s):

Vasileia Nyktari ◽

◽

Helen Diamantaki ◽

Georgios Stefanakis ◽

Emmanouela Koutoulaki ◽

...

Keyword(s):

Cohort Study ◽

Blood Loss ◽

Tranexamic Acid ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Orthopaedic Surgery ◽

Trauma Surgery ◽

Trauma Patients ◽

Transfusion Requirements ◽

Major Orthopaedic Surgery

Objectives: This study aims to clarify the role of prophylactic TXA on blood loss and transfusion requirements in a subgroup of trauma patients undergoing major orthopaedic surgery on a non-urgent basis. Study design: This is a retrospective cohort study Setting: Tertiary University Hospital of Crete (2017-2018) Patients/participants: Polytrauma patients who underwent delayed major orthopaedic surgery Main outcome measurement: Significant haemorrhage occurrence in relation to TXA administration. In a subgroup of patients Rotational Thromboelastometry (ROTEM) was used to reveal their haemostatic profile prior to TXA administration. Methods: Data from anaesthetic and ICU records were analyzed regarding age, sex, body mass index, ASA physical status, Injury Severity Score, Caprini Score, intraoperative blood loss, number of packed red blood cells units transfused, volume of crystalloids administered, operation duration, preoperative and postoperative haemoglobin values, and days from hospital admission to surgery. ROTEM analysis in a subgroup of patients revealed their haemostatic profile prior to TXA administration. Results: Twenty five out of 46 patients received prophylactic TXA treatment. After adjustment for confounding factors, the odds ratio for the composite endpoint for prophylactic TXA (n=25) vs no TXA (n=21) was 1.27 (95% confidence interval, CI 0.39-4.16). Propensity matched analysis confirmed the absence of a difference between patients with and without TXA. In all patients analyzed with ROTEM normal or hypercoagulable status was revealed. Conclusions: In trauma patients undergoing major orthopaedic surgery more than 12 hours after the initial injury, TXA has no effect on blood loss and transfusion requirements. Keywords: tranexamic acid; blood loss; transfusion; orthopaedic trauma surgery; spine surgery; pelvis surgery; significant bleeding in orthopaedic surgery

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Effect of the COVID-19 pandemic during the first lockdown in the Netherlands on the number of trauma-related admissions, trauma severity and treatment: the results of a retrospective cohort study in a level 2 trauma centre

BMJ Open ◽

10.1136/bmjopen-2020-045015 ◽

2021 ◽

Vol 11 (2) ◽

pp. e045015

Author(s):

Gijs J.J. van Aert ◽

Lijckle van der Laan ◽

Leandra J.M. Boonman-de Winter ◽

Cornelis A.S. Berende ◽

Hans G.W. de Groot ◽

...

Keyword(s):

Cohort Study ◽

The Netherlands ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Trauma Surgery ◽

Trauma Centre ◽

Trauma Severity ◽

Number Of Patients ◽

The Impact ◽

Level 2

ObjectivesTo determine the impact of the first lockdown in the Netherlands’ measures during the COVID-19 pandemic on the number and type of trauma-related injuries presenting to the emergency department (ED).DesignA single-centre retrospective cohort study.SettingA level 2 trauma centre in Breda, The Netherlands.ParticipantsAll patients with trauma seen at the ED between 11 March and 10 May 2020 (the first Dutch lockdown period) were included in this study. Comparable groups were generated for 2019 and 2018.Main outcome measuresPrimary outcomes were the total number of patients with trauma admitted to the ED and the trauma mechanism. Secondary outcomes were triage categories, time of ED visit, trauma severity (Injury Severity Score (ISS) >12), anatomical region of injury and treatment.ResultsA total of 4674 patients were included in this study. During the first months of the COVID-19 pandemic, there was a decrease of 32% in traumatic injuries at the ED (n=1182) compared with the previous years 2019 (n=1717) and 2018 (n=1775) (p<0.001). Sports-related injuries decreased most during the lockdown (n=164) compared with 2019 (n=386) and 2018 (n=367) (p<0.001). We observed more frequent injuries due to a fall from standing height (p<0.001) and work-related injuries (p<0.05). The mean age was significantly higher (mean 48 years vs 42 and 43 years). There was no difference in anatomical place of injury or ISS >12. The amount of patients admitted for emergency surgery was significantly higher (14.6% vs 9.4%; 8.6%, p<0.001). Seven patients (0.6%) tested positive for COVID-19.ConclusionsMeasures taken in the COVID-19 outbreak result in a predictable decrease in the total number of patients with trauma, especially sports-related trauma. Although the trauma burden on the emergency room appears to be lower, more people have been admitted for trauma surgery, possibly due to increased throughput in the operating theatres.

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