Characterizing Firearms-Related Injuries and Craniofacial Fractures: A TQIP Study

FACE ◽  
2021 ◽  
pp. 273250162110574
Author(s):  
Alexandra T. Bourdillon ◽  
Sebastian Dobrow ◽  
Benjamin Steren ◽  
Parsa P. Salehi ◽  
Kevin Y. Pei ◽  
...  
Keyword(s):  
Public Health ◽  
Brain Injuries ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Improvement Program ◽  
Economic Implications ◽  
Hospital Size ◽  
Firearm Injuries ◽  
Relationship Of ◽  
Craniofacial Fractures

Background: Interest in firearm injuries (FAIs), from medical and public health perspectives continues to grow. Few studies have analyzed the relationship of FAIs, craniofacial fractures, and traumatic brain injuries (TBIs). Methods: FAIs were isolated from national data from the American College of Surgeons (ACS) Trauma Quality Improvement Program (TQIP) 2014 to 2016 using external cause encodings. Pertinent demographic, injury, and hospital characteristics were extracted to characterize trends and statistically significant outcomes. Results: Thirty-two thousand eight hundred ninety-three (out of 829 805 cases) FAIs were captured, with a majority of patients being male and non-Hispanic/Latino Black. Multivariate linear regression revealed that race/ethnicity, age, hospital size, hospital region, intent of injury, and ISS significantly contributed to risk of mortality, increased hospital length of stay (LOS), and intensive care unit (ICU) duration. Five thousand nine hundred ten (18.0%) FAIs had at least 1 craniofacial fracture, and among these 75.1% (4441) incurred a traumatic brain injury (TBI). Mortality rate among patients with craniofacial FAI was 43.8% (2586/5910), compared to 9.7% (2618/26 983) without. Delayed surgical repair significantly increased hospital LOS ( P < .01), but not mortality ( P = .09). Conclusion: FAIs with craniofacial injury have significantly higher mortality rates than those without craniofacial injury. FAI-associated craniofacial injuries are frequently associated with TBI which is associated with significant morbidity and mortality. Such findings pose important public health and economic implications.

Efficacy of Negative Pressure Wound Treatment in Preventing Surgical Site Infections after Whipple Procedures

2017 ◽  
Vol 83 (10) ◽  
pp. 1166-1169 ◽  
Author(s):  
Ryan Gupta ◽  
Geoffrey C. Darby ◽  
David K. Imagawa
Keyword(s):  
Negative Pressure ◽  
Average Rate ◽  
Surgical Site Infections ◽  
Whipple Procedure ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Tube Placement ◽  
Wound Treatment ◽  
Improvement Program ◽  
Significant Difference

Surgical site infections (SSIs) occur at an average rate of 21.1 per cent after Whipple procedures per NSQIP data. In the setting of adherence to standard National Surgery Quality Improvement Program (NSQIP) Hepatopancreatobiliary recommendations including wound protector use and glove change before closing, this study seeks to evaluate the efficacy of using negative pressure wound treatment (NPWT) over closed incision sites after a Whipple procedure to prevent SSI formation. We retrospectively examined consecutive patients from January 2014 to July 2016 who met criteria of completing Whipple procedures with full primary incision closure performed by a single surgeon at a single institution. Sixty-one patients were included in the study between two cohorts: traditional dressing (TD) (n = 36) and NPWT dressing (n = 25). There was a statistically significant difference (P = 0.01) in SSI formation between the TD cohort (n = 15, SSI rate = 0.41) and the NPWT cohort (n = 3, SSI rate = 0.12). The adjusted odds ratio (OR) of SSI formation was significant for NPWT use [OR = 0.15, P = 0.036] and for hospital length of stay [OR = 1.21, P = 0.024]. Operative length, operative blood loss, units of perioperative blood transfusion, intraoperative gastrojejunal tube placement, preoperative stent placement, and postoperative antibiotic duration did not significantly impact SSI formation (P > 0.05).

scholarly journals Development of an Enhanced Recovery After Surgery (ERAS) approach for lumbar spinal fusion

2017 ◽  
Vol 26 (4) ◽  
pp. 411-418 ◽  
Author(s):  
Michael Y. Wang ◽  
Peng-Yuan Chang ◽  
Jay Grossman
Keyword(s):  
Spinal Fusion ◽  
Surgical Procedure ◽  
Enhanced Recovery ◽  
Lumbar Fusion ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Improvement Program ◽  
Female Ratio ◽  
Open Operation ◽  
The Mean

OBJECTIVE Over the past decade, Enhancing Recovery After Surgery (ERAS) programs have been implemented throughout the world across multiple surgical disciplines. However, to date no spinal surgery equivalent has been described. In this report the authors review the development and implementation of a “fast track” surgical approach for lumbar fusion. METHODS The first 42 consecutive cases in which patients were treated with the new surgical procedure were reviewed. A combination of endoscopic decompression, expandable cage deployment, and percutaneous screw placement were performed with liposomal bupivacaine anesthesia to allow the surgery to be performed without general endotracheal anesthesia. RESULTS In all cases the surgical procedure was performed successfully without conversion to an open operation. The patients' mean age (± SD) was 66.1 ± 11.7 years, the male/female ratio was 20:22, and a total of 47 levels were treated. The mean operative time was 94.6 ± 22.4 minutes, the mean intraoperative blood loss was 66 ± 30 ml, and the mean hospital length of stay was 1.29 ± 0.9 nights. Early follow-up showed a significant improvement in the mean Oswestry Disability Index score (from 40 ± 13 to 17 ± 11, p = 0.0001). Return to the operating room was required in 2 cases due to infection and in 1 case due to cage displacement. An iterative quality improvement program demonstrated areas of improvement, including steps to minimize infection, improve postoperative analgesia, and reduce cage osteolysis. CONCLUSIONS ERAS programs for improving spinal fusion surgery are possible and necessary. This report demonstrates a first foray to apply these principles through 1) a patient-focused approach, 2) reducing the stress of the operation, and 3) an iterative improvement process.

scholarly journals Epidemiology of Organophosphate Poisoning in North of Iran

2021 ◽  
Author(s):  
Hamid Mohammadi-Kojidi ◽  
Mohammad Habibullah Pulok ◽  
Enayatollah Homaie Rad ◽  
Banafsheh Felezi-Nasiri ◽  
Mirsaeid Attarchi
Keyword(s):  
Heart Failure ◽  
Age Groups ◽  
Hospital Length ◽  
Careful Consideration ◽  
Hospital Length Of Stay ◽  
Limited Resources ◽  
Organophosphate Poisoning ◽  
Age Group ◽  
North Of Iran ◽  
Relationship Of

Abstract Introduction: The use of pesticides as one of the main agricultural poles has been increased in Iran in recent years. Organophosphate poisoning has harmful the consequences for human health. This study present clinical and laboratory evidences on the patients exposed to agricultural insecticides poisoning and the cause of these poisons.Methods: We collected clinical data from the patients referred to Razi Hospital, Rasht, Iran who were poisoned with organophosphorus toxins. For this purpose, a checklist was prepared, and data were collected for 414 patients between 2011 and 2016. Results: The results showed that the most cases of poisoning were men (73%) and about 27.2% of the patients was in the age group of 45-60 years (highest frequency in age groups)..The most frequent symptoms were vomiting (65%), nausea (61%), abdominal pain (39%), and perspiration (27%). There was also a decrease in consciousness (16%) and sialorrhea (16%). 186 (46.2%) patients were exposed to organophosphorus toxins by respiratory and 215 (53.4%) orally. Out of the 414 samples, 102 (33%) had abnormal CPK enzymes and 114 (34.5%) abnormal LDHs. Mean hospital length of stay (LOS) was 3.3 days. We found significant relationship of LOS with heart failure, hypertension, and addiction. Conclusion: To better manage the process of treatment of agricultural poisoned patients and to reduce the waste of limited resources available, careful consideration should be given to the type of pesticide used by the patient to prevent overdose and unintentional use of antidote. Act.

scholarly journals Impact of Helmet Use in Traumatic Brain Injuries Associated with Recreational Vehicles

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Latha Ganti ◽  
Aakash N. Bodhit ◽  
Yasamin Daneshvar ◽  
Pratik Shashikant Patel ◽  
Christa Pulvino ◽  
...  
Keyword(s):  
Brain Injuries ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Safety Education ◽  
Helmet Use ◽  
Vehicle Accidents ◽  
Recreational Vehicles ◽  
Observational Cohort ◽  
The Impact ◽  
Recreational Vehicle

Objective. To study the impact of helmet use on outcomes after recreational vehicle accidents.Methods. This is an observational cohort of adult and pediatric patients who sustained a TBI while riding a recreational vehicle. Recreational vehicles included bicycles, motorcycles, and all-terrain vehicles (ATVs), as well as a category for other vehicles such as skateboards and scooters.Results. Lack of helmet use was significantly associated with having a more severe traumatic brain injury and being admitted to the hospital. Similarly, 25% of those who did wearing a helmet were admitted to the ICU versus 36% of those who did not (P=0.0489). The hospital length of stay was significantly greater for patients who did not use helmets.Conclusion. Lack of helmet use is significantly correlated with abnormal neuroimaging and admission to the hospital and ICU; these data support a call for action to implement more widespread injury prevention and helmet safety education and advocacy.

Surgical Outcomes of Distal Pancreatectomy in Elderly Patients

2020 ◽  
pp. 000313482098257
Author(s):  
Derek Tessman ◽  
Jesse Chou ◽  
Saad Shebrain ◽  
Gitonga Munene
Keyword(s):  
Distal Pancreatectomy ◽  
Surgical Outcomes ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Improvement Program ◽  
Postoperative Myocardial Infarction ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
The Impact

Background The extent to which age impacts surgical outcomes remains poorly characterized. This study aims to evaluate the impact of age on 30-day outcomes in patients after distal pancreatectomy. Methods Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2017), distal pancreatectomy patients were identified and age-stratified, groups A (≤75 years) and B (>75 years). Outcomes included 30-day mortality, morbidity, readmissions, operative time (min), and hospital length of stay (LOS, days). Results Of 3042 total patients identified, 1686 (55.4%) were women. A total of 2649 patients (87.1%) were in group A. Overall, both groups had similar baseline characteristics with the exception of the following: diabetes mellitus (24.8% vs. 30.0%, P = .03), smoking (19.3% vs. 4.8%, P < .001), congestive heart failure (.5% vs. 1.8%, P = .010), hypertension (HTN) (47.9% vs. 72.5%, P < .001), bleeding disorders (3.1% vs. 5.3%, P = .036), the American Society of Anesthesiologists (ASA) (III-V) scores (67.6% vs. 85.5%, P < .001), and body mass index (29.2 [±6.7] vs. 27.4 [±5.6], P = .001). Deep surgical site infection was higher in group A (12.1% vs. 6.6%, P = .001), while acute renal failure (ARF) and postoperative myocardial infarction (MI) were higher in group B. 30-day readmissions were higher in group A (17.4% vs. 12.2%, P = .011) despite no statistically significant difference in LOS (7.10 [±6.36] vs. 7.30 [±4.93] days, P = .553) or overall morbidity (29.4% vs. 28.8%, P = .859). Conclusion(s) Those undergoing distal pancreatectomy experienced similar overall morbidity and mortality outcomes regardless of age. However, those older than 75 years had more cardiovascular risk factors, which may have contributed to their higher rates of postoperative ARF and MI.

Is the Face an Air Bag for the Brain and Torso?—The Potential Protective Effects of Severe Midface Fractures

2018 ◽  
Vol 84 (8) ◽  
pp. 1299-1302
Author(s):  
Hannah E. Woriax ◽  
Mark E. Hamill ◽  
Carol M. Gilbert ◽  
Christopher M. Reed ◽  
Emily R. Faulks ◽  
...  
Keyword(s):  
Brain Injuries ◽  
Injury Severity ◽  
Univariate Analysis ◽  
Penetrating Trauma ◽  
Hospital Length ◽  
Wilcoxon Test ◽  
Hospital Length Of Stay ◽  
Protective Effects ◽  
Exact Test ◽  
Midface Fractures

We investigated the patterns of injury associated with major midface trauma. Our hypothesis is that midface injuries are associated with a decrease in certain traumatic brain injuries as well as major torso injuries. The registry of our Level I trauma center was queried for all adult patients treated over 25 years from 1989 to 2013. Patients with midface fractures were identified based on the ICD-9 code. Associated injuries were defined based both on individual ICD-9 codes as well as the Barell Injury Matrix. Injury etiology was defined based on e-codes. Univariate analysis was performed using chi-squared test, Fisher's exact test, and Wilcoxon test. A total of 29,152 patients were identified. Excluding pediatric patients, those with exclusively penetrating trauma, and patients with incomplete data, 20,971 patients were included for subsequent analysis. Midface fractures were identified in 752 patients. Patients with Le Fort fractures were more likely to be male, have a higher Injury Severity Score, a lower arrival Glasgow Coma Scale, and more likely to require intensive care unit admission and mechanical ventilation, with a longer hospital length of stay. Patients with midface fractures had significantly fewer subdural hematomas, subarachnoid hemorrhages, spine fractures, and were less likely to have associated abdominal and pelvic injuries. Patients with midface fractures were more likely to require facial reconstruction procedures and craniotomy. Patients presenting with midface fractures after blunt trauma have a distinctly different pattern of injuries. One potential mechanism for this is a deceleration effect, where midface impact and resulting fractures dissipate some of the energy.

Unplanned Postoperative Reintubation in Children with Bronchial Asthma

2021 ◽  
Author(s):  
Peter D. Winch ◽  
Christian Mpody ◽  
Teresa M. Murray-Torres ◽  
Shannon Rudolph ◽  
Joseph D. Tobias ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Bronchial Asthma ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Study Cohort ◽  
Asthma Diagnosis ◽  
Improvement Program ◽  
Respiratory Events ◽  
Prolonged Hospital ◽  
Adverse Respiratory Events

AbstractUnplanned postoperative reintubation is a serious complication that may increase postsurgical hospital length of stay and mortality. Although asthma is a risk factor for perioperative adverse respiratory events, its association with unplanned postoperative reintubation in children has not been comprehensively examined. Our aim was to determine the association between a preoperative comorbid asthma diagnosis and the incidence of unplanned postoperative reintubation in children. This was a retrospective cohort study comprising of 194,470 children who underwent inpatient surgery at institutions participating in the National Surgical Quality Improvement Program–Pediatric. The primary outcome was the association of preoperative asthma diagnosis with early, unplanned postoperative reintubation (within the first 72 hours following surgery). We also evaluated the association between bronchial asthma and prolonged hospital length of stay (longer than the 75th percentile for the cohort). The incidence of unplanned postoperative reintubation in the study cohort was 0.5% in patients with a history of asthma compared with 0.2% in patients without the diagnosis (odds ratio [OR]: 2.23, 95% confidence interval [CI]: 1.71–2.89). This association remained significant after controlling for several clinical characteristics (OR: 1.54, 95% CI: 1.17–2.20). Additionally, asthmatic children were more likely to require a hospital length of stay longer than the 75th percentile for the study cohort (adjusted OR: 1.05, 95% CI: 1.01–1.10). Children with preoperative comorbid asthma diagnosis have an increased incidence of early, unplanned postoperative reintubation and prolonged postoperative hospitalization following inpatient surgery. By identifying these patients as having higher perioperative risks, it may be possible to institute strategies to improve their outcomes.

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