Analgesic Use Among Adults with a Trauma-Related Emergency Department Visit: A Retrospective Cohort Study from Alberta, Canada.

Introduction: A better understanding of current acute pain-driven analgesic practices within the emergency department (ED) and upon discharge will provide foundational information in this area, as few studies have been conducted in Canada.

Methods: Administrative data were used to identify adults with a trauma-related ED visit in the Edmonton area in 2017/2018. Characteristics of the ED visit included time from initial contact to analgesic administration, type of analgesics dispensed during and upon being discharged home directly from the ED (≤ 7 days after), and patient characteristics.

Data resources for evaluating the economic and financial consequences of surgical care in the United States.

Abstract: Evaluating the relationship between health care costs and quality is paramount in the current health care economic climate, as an understanding of value is needed to drive policy decisions. While many policy analyses are focused on the larger health care system, there is a pressing need for surgically focused economic analyses. Surgical care is costly, and innovative technology is constantly introduced into the operating room, and surgical care impacts patients' short- and long-term physical and economic well-being.

Liver trauma in the intensive care unit.

Purpose Of Review: To review the surgical and critical care management of liver trauma; one of the most common abdominal injuries sustained due to its size and location.

Recent Findings: Hepatic injuries range from negligible to life threatening: in the acute phase, the most common cause of morbidity and mortality is hemorrhage; however, severe traumatic hepatic injuries can also lead to biochemical abnormalities, altered coagulation, and ultimately liver failure. This brief review will review the classification of traumatic liver injuries by mechanism, grade, and severity.

Value in acute care surgery, Part 1: Methods of quantifying cost.

With health care expenditures continuing to increase rapidly, the need to understand and provide value has become more important than ever. In order to determine the value of care, the ability to accurately measure cost is essential. The acute care surgeon leader is an integral part of driving improvement by engaging in value increasing discussions.

Cost-utility analysis of normothermic machine perfusion compared to static cold storage in liver transplantation in the Canadian setting.

To estimate the incremental cost-effectiveness of a liver transplant program that utilizes normothermic machine perfusion (NMP) alongside static cold storage (SCS) compared to SCS alone (control). A Markov model compared strategies (NMP vs. control) using 1-year cycle lengths over a 5-year time horizon from the public healthcare payer perspective.

The real-world cost-effectiveness of bariatric surgery for the treatment of severe obesity: a cost-utility analysis.

Background: Severe obesity is associated with adverse health outcomes and increased risk of death. This study evaluates the real-world cost-utility of therapy for severe obesity, from the publicly funded health care system and societal perspectives.

Methods: We conducted a cost-utility analysis using primary data from a prospective observational cohort of adults living with severe obesity (BMI ≥ 35 kg/m and a major medical comorbidity or BMI ≥ 40 kg/m) who were enrolled in a regional obesity program over 2 years.

The Impact of the Affordable Care Act on Burn Outcomes.

Uninsured and low socioeconomic status patients who suffer burn injuries have disproportionately worse morbidity and mortality. The Affordable Care Act was signed into law with the goal of increasing access to insurance, with Medicaid expansion in January 2014 having the largest impact. To analyze the population-level impact of the Affordable Care Act on burn outcomes, and investigate its impact on identified at-risk subgroups, a retrospective time series of patients was created using data from the Healthcare Cost and Utilization Project National Inpatient Sample database between 2011 and 2016.

The Impact of the Affordable Care Act on Trauma Outcomes in At-Risk Groups: An Interrupted Time Series Analysis with Control Group.

Objective: Analyze the impact of the Affordable Care Act (ACA) on trauma outcomes at a population level and within at-risk subgroups.

Background: Trauma disproportionately affects the uninsured. Compared to the insured, uninsured patients have worse functional outcomes and increased mortality.

There Is No Weekend Effect in the Trauma Patient.

Background: The presence of a "weekend effect", that is, increased morbidity/mortality for patients admitted to the hospital on a weekend, has been reported in numerous studies across many specialties. Postulated causes include reduced weekend staffing, increased time between admission and undergoing procedures/surgery, and decreased subspecialty availability. The aim of this study is to evaluate if a "weekend effect" exists in trauma care in the United States.

Obesity Paradox in the Burn Patient.

Despite the fact that obesity is a known risk factor for comorbidities and complications, there is evidence suggesting a survival advantage for patients classified by body mass index (BMI) as overweight or obese. Investigated in various clinical areas, this "Obesity Paradox" has yet to be explored in the burn patient population. We sought to clarify whether this paradigm exists in burn patients.

The impact of delayed source control and antimicrobial therapy in 196 patients with cholecystitis-associated septic shock: a cohort analysis.

Background: Cholecystitis-associated septic shock carries a significant mortality. Our aim was to determine whether timing of source control affects survival in cholecystitis patients with septic shock.

Methods: We conducted a nested cohort study of all patients with cholecystitis-associated septic shock from an international, multicentre database (1996–2015).

High-risk medications in older patients with trauma: a cross-sectional study of risk mitigation.

Background: The Beers Criteria for Potentially Inappropriate Medication Use inOlder Adults is a framework that can assess the nature of high-risk medication use. The objective of this study was to use the Beers Criteria to assess the prevalence and nature of polypharmacy, the magnitude of medication changes during the hospital stay and the impact of Beers Criteria medications on outcomes in older patients with trauma.

Methods: We used the Alberta Trauma Registry to conduct a retrospective review of patients aged 65 years or older with major trauma (Injury Severity Score ≥ 12) who were admitted to a level 1 trauma centre between January 2013 and December 2014.

The impact of hypothermia on outcomes in massively transfused patients.

Background: Hypothermia is associated with poor outcomes after injury. The relationship between hypothermia during contemporary large volume resuscitation and blood product consumption is unknown. We evaluated this association, and the predictive value of hypothermia on mortality.

Acute Liver Failure from Tumor Necrosis Factor-α Antagonists: Report of Four Cases and Literature Review.

Background: Tumor necrosis factor-α antagonists (anti-TNF-α) have been associated with drug-induced liver injury. However, cases of anti-TNF-α-associated acute liver failure have only been rarely reported.

Aims: To identify cases of anti-TNF-α-associated acute liver failure and evaluate patterns of liver injury and common characteristics to the cases.

Association of Preference-Based Health-Related Quality of Life with Weight Loss in Obese Adults.

Background: The obesity epidemic is linked to substantial health care resource use, reduction in workforce and home productivity, and poor health-related quality of life (HRQOL). Changes in body mass index (BMI) are associated with improvements in HRQOL; the nature of this relationship, however, has not been reliably described.

Objectives: To determine the independent association between changes in BMI and change in utility-based HRQOL.

Endoscopic versus open component separation: systematic review and meta-analysis.

Background: The component separation technique (CST) was developed to improve the integrity of abdominal wall reconstruction for large, complex hernias. Open CST necessitates large subcutaneous skin flaps and, therefore, is associated with significant ischemic wound complications. The minimally invasive or endoscopic component separation technique (MICST) has been suggested in preliminary studies to reduce wound complication rates post-operatively.

Medical tourism and bariatric surgery: who pays?

Introduction: The objective of this study was to determine the short-term cost impact that medical tourism for bariatric surgery has on a public healthcare system. Due to long wait times for bariatric surgery services, Canadians are venturing to private clinics in other provinces/countries. Postoperative care in this population not only burdens the provincial health system with intervention costs required for complicated patients, but may also impact resources allotted to patients in the public clinic.

The cost of bariatric medical tourism on the Canadian healthcare system.

Background: Medical tourists are defined as individuals who intentionally travel from their home province/country to receive medical care. Minimal literature exists on the cost of postoperative care and complications for medical tourists. The costs associated with these patients were reviewed.

The economic impact of weight regain.

Background. Obesity is well known for being associated with significant economic repercussions. Bariatric surgery is the only evidence-based solution to this problem as well as a cost-effective method of addressing the concern.