Thromboembolism prophylaxis timing is associated with center mortality in traumatic brain injury: A Trauma Quality Improvement Program retrospective analysis.

Background: Timing of venous thromboembolism chemoprophylaxis (VTEPPx) in traumatic brain injury (TBI) is complex given concerns for potential worsening of hemorrhage. While timing of VTEPPx for TBI patients is known to vary at the patient level, to our knowledge, variation at the hospital level and correlation with quality metrics have not been quantified in a cohort of nonneurosurgical patients.

Methods: This was a retrospective cohort study of the Trauma Quality Improvement database from 2018 to 2021.

Racial disparities in presenting stage and surgical management among octogenarians with breast cancer: a national cancer database analysis.

Background: As the US faces a diverse aging population, racial disparities in breast cancer outcomes among elderly patients remain poorly understood. We evaluate the association of race with presenting stage, treatment, and survival of invasive breast cancer among octogenarians.

Methods: Women (≥ 80 years) with invasive breast cancer were identified in 2004-2020 NCDB.

Hospital volume does not mitigate the impact of area socioeconomic deprivation on heart transplantation outcomes.

Background: While structural socioeconomic inequity has been linked with inferior health outcomes, some have postulated reduced access to high-quality care to be the mediator. We assessed whether treatment at high-volume centers (HVC) would mitigate the adverse impact of area deprivation on heart transplantation (HT) outcomes.

Methods: All HT recipients ≥18 years were identified in the 2005-2022 Organ Procurement and Transplantation Network.

Outcomes of surgery for inflammatory bowel disease among patients with psychiatric disorders.

Background: Psychiatric disorders (PDs) are common among patients with inflammatory bowel disease (IBD). Brain-gut dysfunction and psychotropic medications may have adverse effects on postoperative outcomes in patients with IBD. This study aimed to evaluate the association between PD and outcomes after surgery for IBD.

Association of Frailty With Clinical and Financial Outcomes Following Liver Transplantation.

Introduction: Frailty, a measure of physiological aging and reserve, has been validated as a prognostic indicator of mortality in patients with cirrhosis. However, large-scale analyses of the independent association of frailty with clinical and financial outcomes following liver transplantation (LT) are lacking.

Methods: Adults (≥18 years) undergoing LT were identified in the 2016-2020 National Readmissions Database.

Defining the Cross-Volume Effect of Extracorporeal Life Support on Outcomes of Cardiogenic Shock.

Background: Cardiogenic shock (CS) remains a leading cause of mortality despite advancements in mechanical circulatory support and other management strategies. In particular, venoarterial extracorporeal membrane oxygenation (ECMO) requires expertise in cardiac surgery, cardiology, and critical care. The benefits of such expertise may extend beyond patients undergoing ECMO.

Failure to rescue following emergency general surgery: A national analysis.

Background: Failure to rescue (FTR) is increasingly recognized as a quality metric but remains understudied in emergency general surgery (EGS). We sought to identify patient and operative factors associated with FTR to better inform standardized metrics to mitigate this potentially preventable event.

Methods: All adult (≥18 years) non-elective hospitalizations for large bowel resection, small bowel resection, repair of perforated ulcer, laparotomy and lysis of adhesions were identified in the 2016-2020 National Readmissions Database.

Discharge against medical advice in trauma patients: Trends, risk factors, and implications for health care management strategies.

Objective: Given the nonelective nature of most trauma admissions, patients who experience trauma are at a particular risk of discharge against medical advice. Despite the risk of unplanned readmission and financial burden on the health care system, discharge against medical advice among hospitalized patients continues to rise. The present study aimed to assess evolving trends and outcomes associated in patients with discharge against medical advice among patients hospitalized for traumatic injury.

Hospital-level variation in costs of elective nonruptured abdominal aortic aneurysm repair.

Background: With the aging population in the United States, the incidence of abdominal aortic aneurysms is shifting to older ages. Given changing demographic characteristics and increasing health care expenditures, the present study evaluated the degree of center-level variation in the cost of elective abdominal aortic aneurysm repair.

Methods: We identified all adult (≥18 years) hospitalizations for elective repair of nonruptured abdominal aortic aneurysms in the 2017 to 2020 Nationwide Readmissions Database.

The impact of rurality on racial disparities in costs of bowel obstruction treatment.

Background: Black race has been associated with increased resource utilization after operation for small bowel obstruction (SBO). While prior literature has similarly demonstrated differences between urban and rural institutions, limited work has defined the impact of rurality on resource utilization by race.

Methods: The 2016-2020 National Inpatient Sample was used to identify adults undergoing adhesiolysis after non-elective admission for SBO.

Association of severe obesity with risk of conversion to open in laparoscopic cholecystectomy for acute cholecystitis.

Background: Obesity is a known risk factor for cholecystitis and is associated with technical complications during laparoscopic procedures. The present study seeks to assess the association between obesity class and conversion to open (CTO) during laparoscopic cholecystectomy (LC).

Methods: Adult acute cholecystitis patients with obesity undergoing non-elective LC were identified in the 2017-2020 Nationwide Readmissions Database.

Persistent Racial Disparities in Morbidity Following Major Elective Operations.

Despite considerable national attention, racial disparities in surgical outcomes persist. We sought to consider whether race-based inequities in outcomes following major elective surgery have improved in the contemporary era. All adult hospitalization records for elective coronary artery bypass grafting, abdominal aortic aneurysm repair, colectomy, and hip replacement were tabulated from the 2016-2020 National Inpatient Sample.

Clinical and financial outcomes associated with the utilization of right internal mammary artery versus radial artery in multivessel coronary artery bypass grafting.

Background: Multi-arterial coronary bypass grafting with the left internal mammary artery as a conduit has been shown to offer superior long-term survival compared to single-arterial coronary bypass grafting. Nevertheless, the selection of a secondary conduit between the right internal mammary artery and the radial artery remains controversial. Using a national cohort, we examined the relationships between the right internal mammary artery and the radial artery with acute clinical and financial outcomes.

Mortality and resource utilization in surgical versus transcatheter repeat mitral valve replacement: A national analysis.

Background: Transcatheter mitral valve replacement (TMVR) has garnered interest as a viable alternative to the traditional surgical mitral valve replacement (SMVR) for high-risk patients requiring redo operations. This study aims to evaluate the association of TMVR with selected clinical and financial outcomes.

Methods: Adults undergoing isolated redo mitral valve replacement were identified in the 2016-2020 Nationwide Readmissions Database and categorized into TMVR or SMVR cohorts.

Association of uninsured status and rurality with risk of financial toxicity after pediatric trauma.

Background: Pediatric traumatic injury is associated with long-term morbidity as well as substantial economic burden. Prior work has labeled the catastrophic out-of-pocket medical expenses borne by patients as financial toxicity. We hypothesized uninsured rural patients to be vulnerable to exorbitant costs and thus at greatest risk of financial toxicity.

Demystifying the association of center-level operative trauma volume and outcomes of emergency general surgery.

Background: Recent studies have demonstrated a positive volume-outcome relationship in emergency general surgery. Some have advocated for the sub-specialization of emergency general surgery independent from trauma. We hypothesized inferior clinical outcomes of emergency general surgery with increasing center-level operative trauma volume, potentially attributable to overall hospital quality.

Impact of Safety-Net Hospital Status on Immediate Reconstruction Following Mastectomy: A Contemporary National Analysis.

Introduction: Immediate breast reconstruction (IBR) following mastectomy has been shown to improve quality of life and partially mitigate the adverse psychological impacts associated with the procedure. The present study examined hospital-based and patient-level disparities in utilization and outcomes of IBR following mastectomy.

Methods: All female adult hospitalizations with a diagnosis of breast cancer undergoing mastectomy were identified in the 2016 to 2020 National Inpatient Sample.

Machine learning based predictive modeling of readmissions following extracorporeal membrane oxygenation hospitalizations.

Background: Despite increasing utilization and survival benefit over the last decade, extracorporeal membrane oxygenation (ECMO) remains resource-intensive with significant complications and rehospitalization risk. We thus utilized machine learning (ML) to develop prediction models for 90-day nonelective readmission following ECMO.

Methods: All adult patients receiving ECMO who survived index hospitalization were tabulated from the 2016-2020 Nationwide Readmissions Database.

Income-Based Disparities in Outcomes Following Pediatric Appendectomy: A National Analysis.

Background: Appendectomy remains a common pediatric surgical procedure with an estimated 80,000 operations performed each year. While prior work has reported the existence of racial disparities in postoperative outcomes, we sought to characterize potential income-based inequalities using a national cohort.

Methods: All non-elective pediatric (<18 years) hospitalizations for appendectomy were tabulated in the 2016-2020 National Inpatient Sample.

Association of Interhospital Transfer With Outcomes of Extracorporeal Membrane Oxygenation: A Contemporary Analysis.

Background: Extracorporeal membrane oxygenation (ECMO) has emerged as a life-sustaining measure for individuals with end-stage cardiopulmonary derangements. An estimated one-third of patients must be transferred to a specialized center to receive this intervention. Therefore, the present study sought to characterize the impact of interhospital transfer (IHT) status on outcomes following ECMO.

Association of rurality with short-term outcomes of peripheral vascular trauma.

Background: Peripheral vascular trauma is a major contributing factor to long-term disability and mortality among patients with traumatic injuries. However, an analysis focusing on individuals at a high risk of experiencing limb loss due to rural and urban peripheral vascular trauma is lacking.

Method: This was a retrospective analysis of the 2016 to 2020 Nationwide Readmissions Database.

Current Status of Contralateral Prophylactic Mastectomy: Investigating Structural Racial Disparity.

Background: Contralateral prophylactic mastectomy (CPM) remains a personal decision, influenced by psychosocial factors, including cosmesis and peace of mind. Although use of CPM is disproportionately low among Black patients, the degree to which these disparities are driven by patient- vs hospital-level factors remains unknown.

Study Design: Patients undergoing mastectomy for nonmetastatic ductal or lobular breast cancer were tabulated using the National Cancer Database from 2004 to 2020.

Interhospital Transfer for Emergency General Surgery: A Contemporary National Analysis.

Background: Patients undergoing emergency general surgery (EGS) often require complex management and transfer to higher acuity facilities, especially given increasing national efforts aimed at centralizing care. We sought to characterize factors and evaluate outcomes associated with interhospital transfer using a contemporary national cohort.

Methods: All adult hospitalizations for EGS (appendectomy, cholecystectomy, laparotomy, lysis of adhesions, small/large bowel resection, and perforated ulcer repair) ≤2 days of admission were identified in the 2016-2020 National Inpatient Sample.