Open or Closed? Management of Skin Incisions After Emergency General Surgery Laparotomies.

Introduction: We sought to determine if there was a relationship between skin management and surgical site infections (SSIs) among patients undergoing a laparotomy for emergency general surgery (EGS). We hypothesize that skin closure technique is not associated with SSI.

Methods: We performed a retrospective review of adult patients (>18 y) who underwent an exploratory laparotomy for EGS conditions within 6 h of surgical consultation from 2015 to 2019.

Using chest X-ray to predict tube thoracostomy in traumatic pneumothorax: A single-institution retrospective review.

Background: Traumatic pneumothorax (PTX) is a common occurrence in thoracic trauma patients, with a majority requiring tube thoracostomy (TT) for management. Recently, the "35-mm" rule has advocated for observation of patients with PTX less than 35 mm on chest computed tomography (CT) scan. This rule has not been examined in chest x-ray (CXR).

The effect of amantadine on acute cognitive disability after severe traumatic brain injury: An institutional pilot study.

Background: Amantadine is used in the post-acute care setting to improve cognitive function after a traumatic brain injury. Its utility in the acute postinjury period is unknown. In this pilot study, we sought to examine the effect of amantadine on short-term cognitive disability among patients with a severe traumatic brain injury and hypothesized that patients receiving amantadine would have a greater improvement in disability throughout their acute hospitalization.

Surgical Apgar scores predict complications after emergency general surgery laparotomy.

Background: The Surgical Apgar Score (SAS) is a 10-point validated score comprised of three intraoperative variables (blood loss, lowest heart rate, and lowest mean arterial pressure). Lower scores are worse and predict major postoperative complications. The SAS has not been applied in emergency general surgery (EGS) but may help guide postoperative disposition.

Using Methicillin-Resistant Staphylococcus aureus Nasal Screens to Rule Out Methicillin-Resistant S aureus Pneumonia in Surgical Intensive Care Units.

Introduction: The methicillin-resistant Staphylococcus aureus (MRSA) polymerase chain reaction (PCR) has a high negative predictive value (NPV). We aimed to understand if there was a difference in the NPV of the MRSA screen in surgical intensive care units (ICUs) and to determine its role in antibiotic de-escalation.

Methods: We performed a single-center, retrospective cohort study of adults with a positive respiratory culture and MRSA nasal PCR admitted to a surgical ICU from 2016 to 2019.

Effect of Frailty on the Management of Suspected Choledocholithiasis.

Introduction: The American Society for Gastrointestinal Endoscopy and The Society of American Gastrointestinal and Endoscopic Surgeons (ASGE-SAGES) guidelines for managing choledocholithiasis (CDL) omit patient-specific factors like frailty. We evaluated how frail patients with CDL undergoing same-admission cholecystectomy were managed within ASGE-SAGES guidelines.

Methods: We analyzed patients undergoing same-admission cholecystectomy for CDL and/or acute biliary pancreatitis (ABP) from 2016 to 2019 at 12 US academic medical centers.

The Effect of Physiatry Involvement for Patients With Acute Traumatic Spinal Cord Injury at a Level 1 Trauma Center.

Objective: To explore the impact of physiatry on acute traumatic spinal cord injury (ATSCI) outcomes using a propensity score matching (PSM) analysis.

Methods: We retrospectively reviewed all patients with ATSCI at a level 1 trauma center from 2018 to 2019. In a 1:1 fashion, we matched patients who were evaluated by physiatry to those who were not.

Fatal opioid overdoses geospatially cluster with level 1 trauma centers in Ohio.

Objective: Ohio is consistently ranked as one of the worst states for opioid overdose deaths. Traumatic injury has been linked to opioid overdose deaths, yet the location of trauma centers has not been explored. We examined whether geospatial clustering occurred between county-level opioid overdose deaths (OODs) and trauma center levels.

Characterizing injury patterns and outcomes in hospitalized trauma patients with non-English Language Preferences.

Introduction: Patients with Non-English Language Preferences (NELP) experience challenges navigating the US healthcare system which can lead to disparate outcomes. This study sought to investigate injury patterns and outcomes in hospitalized trauma patients with NELP.

Methods: A retrospective review was performed at a trauma center from January 2019-December 2020.

Broad vs Narrow Spectrum Antibiotics in Common Bile Duct Stones: A Post Hoc Analysis of an Eastern Association for the Surgery of Trauma Multicenter Study.

Background: Antimicrobial guidance for common bile duct stones during the perioperative period is limited. We sought to examine the effect of broad-spectrum (BS) vs narrow-spectrum (NS) antibiotics on surgical site infections (SSIs) in patients with common bile duct stones undergoing same-admission cholecystectomy.

Study Design: We performed a post hoc analysis of a prospective, observational, multicenter study of patients undergoing same-admission cholecystectomy for choledocholithiasis and/or acute biliary pancreatitis between 2016 and 2019.

Academic Medical Centers Experienced Higher Rates of Post-Operative Health-Care-Associated Infections during the COVID-19 Pandemic: A Post Hoc Analysis of an Eastern Association for the Surgery of Trauma Multicenter Trial.

We sought to examine health-care-associated infections (HAIs) among patients undergoing an appendectomy at academic medical centers (AMCs) and non-AMCs during the coronavirus disease 2019 (COVID-19) peri-pandemic. We hypothesized that AMCs would have higher rates of post-operative HAIs during the first wave of the pandemic. We performed a post hoc analysis of a prospective, observational, multi-center study of patients aged >18 years who underwent an appendectomy for acute appendicitis before (pre-CoV), during (CoV), and after pandemic restrictions were lifted (post-CoV).

The Impact of Steroids and Inflammatory Bowel Disease in Colectomies in the Era of Enhanced Recovery.

Introduction: Enhanced recovery after surgery protocols are commonly used, but their utility in patients with inflammatory bowel disease and steroid use is poorly studied. We sought to examine influence of inflammatory bowel disease (IBD) and steroid use on hospital length of stay (LOS) and operative duration in patients undergoing colectomies in the era of ERAS.

Methods: We performed retrospective review of our institutional National Surgical Quality Improvement Program (NSQIP) registry (2016-2018) for colectomies.

Examining the accuracy of the AM-PAC "6-clicks" at predicting discharge disposition in traumatic brain injury.

Objective: To assess the accuracy of the AM-PAC "6-Clicks" in predicting discharge dispositions among severely injured patients with an acute traumatic brain injury (TBI).

Methods: We performed a retrospective review of patients with a TBI who presented to our trauma center from 2016 through 2018 and received a "6-Clicks" assessment. Outcomes were hospital length of stay (LOS) and discharge disposition: home, inpatient rehabilitation facility (IRF), subacute location (SL), or death/hospice.

HIV geospatially clusters with firearm trauma in 35 Atlanta zip codes.

The purpose of this study was to assess if rates of firearm trauma within Atlanta geospatially clustered with HIV prevalence and new HIV diagnosis rates. We retrospectively reviewed our Atlanta trauma center's registry for patients sustaining a ballistic firearm trauma from 2014 through 2018. Using the patient's zip code of home residence, we determined the rate of firearm trauma for that zip code.

National adherence to the ASGE-SAGES guidelines for managing suspected choledocholithiasis: An EAST multicenter study.

Background: The American Society for Gastrointestinal Endoscopy and Society of American Gastrointestinal and Endoscopic Surgeons provide guidelines for managing suspected common bile duct (CBD) stones. We sought to evaluate adherence to the guidelines among patients with choledocholithiasis and/or acute biliary pancreatitis (ABP) and to evaluate the ability of these guidelines to predict choledocholithiasis.

Methods: We prospectively identified patients undergoing same-admission cholecystectomy for choledocholithiasis and/or ABP from 2016 to 2019 at 12 United States medical centers.

Examining Violence Against Women at a Regional Level 1 Trauma Center During the COVID-19 Pandemic.

Introduction: There is a growing concern that certain public health restrictions imposed to prevent the spread of coronavirus disease 2019 (COVID-19) could result in more violence against women (VAW). We sought to determine if the rates and types of VAW changed during the COVID-19 pandemic at our level 1 trauma center (L1TC).

Methods: We performed a retrospective review of female patients who presented to our L1TC because of violence from 2019 through 2020.

Dual Neurostimulant Therapy May Optimize Acute Neurorecovery for Severe Traumatic Brain Injuries.

Background: Neurostimulants (NS) can be used to treat patients with a traumatic brain injury (TBI) with altered levels of consciousness. We sought to determine if amantadine alone (monotherapy) versus amantadine + methylphenidate (dual therapy) would correlate with better neurorecovery (NR) among acutely hospitalized patients with a severe TBI.

Methods: We performed a retrospective review of adult patients admitted to our level I trauma center from 2016-2019 with a severe TBI.

The effect of prolonged antibiotics on postoperative complications for common bile duct stones: A post hoc analysis of an EAST multicenter study.

Background: Antimicrobial guidance for common bile duct (CBD) stones is limited. We sought to examine the effect of antibiotic duration on infectious complications in patients with choledocholithiasis and/or gallstone pancreatitis.

Methods: We performed a post hoc analysis of a prospective, observational, multicenter study of patients undergoing same admission cholecystectomy for choledocholithiasis and gallstone pancreatitis between 2016 and 2019.

Outcomes of same admission cholecystectomy and endoscopic retrograde cholangiopancreatography for common bile duct stones: A post hoc analysis of an Eastern Association for the Surgery of Trauma multicenter study.

Background: The optimal timing for cholecystectomy after endoscopic retrograde cholangiopancreatography (ERCP) for common bile duct (CBD) stones is unknown. We hypothesized that a delay between procedures would correlate with more biliary complications and longer hospitalizations.

Methods: We prospectively identified patients who underwent same admission cholecystectomy after ERCP for CBD stones from 2016 to 2019 at 12 US medical centers.

Social Media in Surgery.

Social media has become a permeating form of communication with billions of daily users. Twitter in particular has become a tool for the surgical community to engage with other providers, as well as patients, through active online discussions, sharing of research, and highlighting opportunities for community outreach. Twitter can help with personal branding, mentorship, and international collaboration on multiple types of academic endeavors.

The 11-Item Modified Frailty Index as a Tool to Predict Unplanned Events in Traumatic Brain Injury.

Background: Frailty has been studied extensively in trauma, but there is minimal research detailing its impact on traumatic brain injury (TBI). We hypothesized that the 11-item modified frailty index (mFI-11) would predict complications and discharge outcomes in patients with TBI.

Methods: A retrospective review of our trauma quality improvement program (TQIP) registry was conducted for all patients with TBI.

Outcomes and implications of a single brain death examination policy on organ donation outcomes at a high-volume trauma center.

Background: Despite current neurological guidelines that a single brain death examination (SBDE) is sufficient to determine brain death, a vast majority of hospitals still use a two brain death examination (TBDE) policy based on historical practice. The purpose of this study was to analyze the outcomes and implications of an SBDE policy compared with a TBDE policy with respect to organ donation outcomes.

Methods: We retrospectively reviewed all adult patients declared dead by neurological criteria between 2010 and 2018 at a high-volume trauma center.

Food Insecurity Predicts Urban Gun Violence.

Introduction: Food insecurity (FI), defined as inadequate access to affordable and quality nutrition, has negative health consequences. FI and violence share similar root causes. The aim of this study was to determine the association of FI with gunshot injury (GSI) incidence.