Publications by authors named "Dorken-Gallastegi A"
Article Synopsis
- The UNOS 2018 heart allocation policy prioritizes patients on temporary mechanical circulatory support (tMCS) due to their high risk of mortality while waiting for a heart transplant.
- A study analyzed 27,343 adults on the waitlist and found a significant increase in tMCS use from 7.4% to 22.4% after the policy change.
- Results showed that patients on tMCS had lower waitlist mortality, higher chances of receiving a transplant, and similar one-year mortality rates after transplantation compared to previous trends.
Article Synopsis
- - The study investigates how donor cardiopulmonary resuscitation (CPR) status affects the outcomes of heart transplants from donors after circulatory death (DCD).
- - An analysis of 683 adult DCD heart transplant recipients showed that those who received donor hearts from CPR donors had similar 1-year survival rates (around 92%) as those from non-CPR donors.
- - Results indicate that using DCD hearts from donors who underwent CPR can help increase the availability of donor organs without harming initial post-transplant survival rates.
Background: This study evaluates the impact of the agonal phase and related hemodynamic measures on post-transplant outcomes and heart utilization in donation after circulatory death (DCD) heart transplantation.
Methods: United Network for Organ Sharing registry was queried to analyze adult recipients who underwent isolated DCD heart transplantation between January 1, 2019 and September 30, 2023. The recipients were stratified into 2 groups based on donor agonal period: <30 and ≥30 minutes.
Background: This study evaluates the effects of pre-transplant transpulmonary gradient (TPG) and donor right ventricular mass (RVM) on outcomes following heart transplantation.
Methods: UNOS registry was queried to analyze adult recipients who underwent primary isolated heart transplantation from 1/1/2010 to 12/31/2018. The recipients were dichotomized into 2 groups based on their TPG at the time of transplantation, < 12 and ≥ 12 mmHg.
Article Synopsis
- This study aimed to validate a prediction model for early identification of patients at risk for nosocomial pneumonia in US level-1 trauma centers, which could enhance patient survival and reduce healthcare costs.
- The research analyzed data from over 900,000 trauma patients, focusing on incidents of total nosocomial pneumonia and ventilator-associated pneumonia (VAP) over two time periods.
- Results showed that the Croce model effectively discriminates patients at risk for pneumonia, suggesting its implementation in clinical practice could improve preventative strategies for those most vulnerable.*
Article Synopsis
- - Whole blood (WB) resuscitation has been shown to be safer and potentially more effective than component therapy (CT) for trauma patients, particularly in pediatric cases, yet there is limited understanding of how the amount of WB given relates to patient outcomes.
- - A study analyzed data from over 4,300 injured children to assess the impact of WB on mortality rates, revealing that WB transfusions significantly decreased the odds of death both at 4 hours (42% reduction) and at 24 hours (54% reduction) compared to those receiving only CT.
- - The research also indicated that as the proportion of WB in total blood transfusion volume (WB/TTV ratio) increases, the likelihood of survival improves, with
Background: This study evaluates the interaction of donor and recipient age with outcomes following heart transplantation under the 2018 heart allocation system.
Methods: The United Network for Organ Sharing registry was queried to analyze adult primary isolated orthotopic heart transplant recipients and associated donors from August 18, 2018, to June 30, 2021. Both recipient and donor cohorts were grouped according to age: <65 and ≥65 y for recipients and <50 and ≥50 y for donors.
Prior studies assessing the effects of Impella 5.5 support duration on posttransplant outcomes have been limited to single-center case reports and series. This study evaluates the impact of Impella 5.
View Article and Find Full Text PDFBackground: This study evaluates the clinical trends, risk factors, and impact of waitlist blood transfusion on outcomes following isolated heart transplantation.
Methods: The UNOS registry was queried to identify adult recipients from January 1, 2014, to June 30, 2022. The recipients were stratified into two groups depending on whether they received a blood transfusion while on the waitlist.
Background: Acute substance intoxication is associated with traumatic injury and worse hospital outcomes. The objective of this study was to evaluate the association between simultaneous opioids and benzodiazepines (OB) use and hospital outcomes in elderly trauma patients.
Methods: We performed a retrospective analysis using the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) 2017 database.
Article Synopsis
- The study aimed to assess how whole blood (WB) transfusions influence mortality rates in trauma patients when used alongside blood components.
- Key findings showed that using WB was linked to significantly lower mortality within 4 hours, 24 hours, and 30 days after trauma compared to transfusing only blood components.
- Additionally, higher ratios of WB to total transfusion volume (WB:TTV) and balanced blood component transfusions combined with WB were also associated with reduced mortality rates in critically injured patients.
Introduction: Accurate risk scoring in emergency general surgery (EGS) is vital for consent and resource allocation. The emergency surgery score (ESS) has been validated as a reliable preoperative predictor of postoperative outcomes in EGS but has been studied only in the US population. Our primary aim was to perform an external validation study of the ESS in a UK population.
View Article and Find Full Text PDFBackground: The diversion of unused opioid prescription pills to the community at large contributes to the opioid epidemic in the US. In this county-level population-based study, we aimed to examine the US surgeons' opioid prescription patterns, trends, and system-level predictors in the peak years of the opioid epidemic.
Study Design: Using the Medicare Part D database (2013 to 2017), the mean number of opioid prescriptions per beneficiary (OPBs) was determined for each US county.
Background: A novel hydrophobically modified chitosan (hm-chitosan) polymer has been previously shown to improve survival in a non-compressible intra-abdominal bleeding model in swine. We performed a 28-day survival study to evaluate the safety of the hm-chitosan polymer in swine.
Methods: Female Yorkshire swine (40-50 kg) were used.
Article Synopsis
- Rib fractures are common injuries that can lead to complications like delayed hemothorax (DHTX), which affects 10-37% of patients and involves blood accumulation in the pleural cavity after injury.
- A study using the National Readmission Database examined 242,071 patients with blunt rib fractures, finding that 635 had DHTX readmissions within 30 days, with previous hemothorax diagnosis being a significant risk factor for readmission.
- While DHTX readmissions are relatively rare, they can lead to serious complications like respiratory failure and infections, highlighting the need for more research to identify and address the risk factors involved.
Background: Existent methodologies for benchmarking the quality of surgical care are linear and fail to capture the complex interactions of preoperative variables. We sought to leverage novel nonlinear artificial intelligence methodologies to benchmark emergency surgical care.
Methods: Using a nonlinear but interpretable artificial intelligence methodology called optimal classification trees, first, the overall observed mortality rate at the index hospital's emergency surgery population (index cohort) was compared to the risk-adjusted expected mortality rate calculated by the optimal classification trees from the American College of Surgeons National Surgical Quality Improvement Program database (benchmark cohort).
Introduction: Current guidelines for retained hemothorax (rHTX) in trauma patients recommend video-assisted thoracic surgery (VATS) within 4 days. However, this recommendation is currently based upon evidence from small observational studies. The aim of this study is to further evaluate the association between timing of VATS and clinical outcomes in rHTX following trauma.
View Article and Find Full Text PDFArticle Synopsis
- The study highlights the risk of artificial intelligence in clinical medicine, particularly regarding existing racial biases in access to postinjury rehabilitation services.
- It employs a novel AI methodology called optimal classification trees (OCTs) to identify and analyze racial disparities in discharge destinations for Black and White patients following trauma care.
- Results demonstrated significant differences in discharge to postacute care, with fewer Black patients receiving such services compared to their White counterparts, emphasizing the need for fairness-adjusted AI tools in healthcare decision-making.
Background: Rib fractures represent a typical injury pattern in older people and are associated with respiratory morbidity and mortality. Regional analgesia modalities are adjuncts for pain management, but the optimal timing for their initiation remains understudied. We hypothesized that early regional analgesia would have similar outcomes to late regional analgesia.
View Article and Find Full Text PDFIntroduction: The usage of extracorporeal membrane oxygenation (ECMO) in trauma patients has increased significantly within the past decade. Despite increased research on ECMO application in trauma patients, there remains limited data on factors predicting morbidity and mortality outcome. Therefore, the primary objective of this study is to describe patient characteristics that are independently associated with mortality in ECMO therapy in trauma patients, to further guide future research.
View Article and Find Full Text PDFWe sought to study the role of circulating cellular clusters (CCC) -such as circulating leukocyte clusters (CLCs), platelet-leukocyte aggregates (PLA), and platelet-erythrocyte aggregates (PEA)- in the immunothrombotic state induced by COVID-19. Forty-six blood samples from 37 COVID-19 patients and 12 samples from healthy controls were analyzed with imaging flow cytometry. Patients with COVID-19 had significantly higher levels of PEAs (p value<0.
View Article and Find Full Text PDFOptimal dose of cryoprecipitate in massive transfusion following trauma.
J Trauma Acute Care Surg
January 2024
Background: While cryoprecipitate (Cryo) is commonly included in massive transfusion protocols for hemorrhagic shock, the optimal dose of Cryo transfusion remains unknown. We evaluated the optimal red blood cell (RBC) to RBC to Cryo ratio during resuscitation in massively transfused trauma patients.
Methods: Adult patients in the American College of Surgeon Trauma Quality Improvement Program (2013-2019) receiving massive transfusion (≥4 U of RBCs, ≥1 U of fresh frozen plasma, and ≥1 U of platelets within 4 hours) were included.
Artificial intelligence versus surgeon gestalt in predicting risk of emergency general surgery.
J Trauma Acute Care Surg
October 2023
Background: Artificial intelligence (AI) risk prediction algorithms such as the smartphone-available Predictive OpTimal Trees in Emergency Surgery Risk (POTTER) for emergency general surgery (EGS) are superior to traditional risk calculators because they account for complex nonlinear interactions between variables, but how they compare to surgeons' gestalt remains unknown. Herein, we sought to: (1) compare POTTER to surgeons' surgical risk estimation and (2) assess how POTTER influences surgeons' risk estimation.
Study Design: A total of 150 patients who underwent EGS at a large quaternary care center between May 2018 and May 2019 were prospectively followed up for 30-day postoperative outcomes (mortality, septic shock, ventilator dependence, bleeding requiring transfusion, pneumonia), and clinical cases were systematically created representing their initial presentation.
Objective: Current literature suggests that thoracic endovascular aortic repair (TEVAR) in older patients with aortic aneurysms results in higher peri-operative mortality and lower long term survival in females compared with males. However, sex related outcomes in younger patients with blunt thoracic aortic injury (BTAI) undergoing TEVAR remain unknown. This study examined the association between sex and outcomes after TEVAR for BTAI.
View Article and Find Full Text PDFArticle Synopsis
- Patients undergoing surgery with perioperative COVID-19 had worse postoperative outcomes compared to those without COVID-19, indicating the potential severity of the virus in surgical settings.
- A study matched 1,054 patients with perioperative COVID-19 to 96,882 patients without it, focusing on demographics and health conditions to ensure comparable results.
- After matching, COVID-19 patients experienced higher mortality (12% vs. 8.1%), longer hospital stays, and more complications such as renal failure and sepsis, while having lower rates of bleeding compared to non-COVID patients.