Validation of Artificial Intelligence-Based POTTER Calculator in Emergency General Surgery Patients Undergoing Laparotomy: Prospective, Bi-Institutional Study.

Background: The POTTER calculator, a widely used interpretable artificial intelligence (AI) risk calculator, has been validated in population-based studies and shown to predict outcomes in emergency general surgery (EGS) patients better than surgeons. We sought to prospectively validate POTTER.

Study Design: Patients undergoing an emergency exploratory laparotomy for non-trauma indications at two Academic Medical Centers between June 2020 and March 2022 were included.

Impact of Neoadjuvant Therapy on Oncological Outcomes of Patients With Distal Pancreatic Adenocarcinoma.

Background: Distal pancreatic ductal adenocarcinoma (D-PDAC) often presents at an advanced stage. The efficacy of neoadjuvant therapy (NAT) in improving outcomes for D-PDAC is not well-established. This study evaluates the impact of NAT on the oncological outcomes of patients with D-PDAC.

Validation of the emergency surgery score (ESS) in a UK patient population and comparison with NELA scoring: a retrospective multicentre cohort study.

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.

Nationwide, County-Level Analysis of the Patterns, Trends, and System-Level Predictors of Opioid Prescribing in Surgery in the US: Social Determinants and Access to Mental Health Services Matter.

Background: 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.

The use of POTTER (Predictive Optimal Trees in Emergency Surgery Risk) calculator to predict mortality and complications in patients submitted to Emergency Surgery.

Introduction: the ability of the care team to reliably predict postoperative risk is essential for improvements in surgical decision-making, patient and family counseling, and resource allocation in hospitals. The Artificial Intelligence (AI)-powered POTTER (Predictive Optimal Trees in Emergency Surgery Risk) calculator represents a user-friendly interface and has since been downloaded in its iPhone and Android format by thousands of surgeons worldwide. It was originally developed to be used in non-traumatic emergency surgery patients.

Insurance Not Socioeconomic Status is Associated With Access to Postacute Care After Injury: A Multicenter Cohort Study.

Introduction: Access to postacute care services in rehabilitation or skilled nursing facilities is essential to return trauma patients to their preinjury functional level but is often hindered by systemic barriers. We sought to study the association between the type of insurance, socioeconomic status (SES) measures, and postacute care utilization after injury.

Methods: Adult trauma patients with an Injury Severity Score (ISS) ≥9 admitted to one of three Level I trauma centers were contacted 6-12 mo after injury to gather long-term functional and patient-centered outcome measures.

Use of artificial intelligence for nonlinear benchmarking of surgical care.

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).

Video-Assisted Thoracic Surgery Evacuation of Retained Hemothorax; Timing May Not Increase Thoracoscopic Failure.

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.

Timing of regional analgesia in elderly patients with blunt chest-wall injury.

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.

Prevalence and risk factors of unruptured intracranial aneurysms in ischemic stroke patients - A global meta-analysis.

Background: Unruptured intracranial aneurysms (UIAs) have an estimated global prevalence of 2.8% in the adult population; however, UIA was identified among more than 10% of ischemic stroke patients. Many epidemiological studies and reviews have pointed to the presence of UIA among patients with ischemic stroke; yet, the extent of this association is not fully known.

Artificial intelligence versus surgeon gestalt in predicting risk of emergency general surgery.

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.

Open Abdomen in Elderly Patients With Surgical Sepsis: Predictors of Mortality.

Introduction: Elderly patients are frequently presenting with emergency surgical conditions. The open abdomen technique is widely used in abdominal emergencies needing rapid control of intrabdominal contamination. However, specific predictors of mortality identifying candidates for comfort care are understudied.

A Surgical Perspective of Gastrointestinal Manifestations and Complications of COVID-19 Infection.

The coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2, has quickly spread over the world since December 2019. COVID-19 is a systemic disease that can affect various organs throughout the body. Gastrointestinal (GI) symptoms have been reported in 16% to 33% of all patients with COVID-19 and in 75% of critically ill patients.

Surgical Implications of Coronavirus Disease-19.

As the coronavirus disease-19 (COVID-19) pandemic continues to evolve in 2022 with the surge of novel viral variants, it is important for physicians to understand and appreciate the surgical implications of the pandemic. This review provides an overview of the implications of the ongoing COVID-19 pandemic on surgical care and provides recommendations for perioperative management. Most observational studies suggest a higher risk for patients undergoing surgery with COVID-19 compared with risk-adjusted non-COVID-19 patients.

Association of Comorbidities and Functional Level With Mortality in Geriatric Bowel Perforation.

Introduction: Spontaneous bowel perforation is associated with high morbidity and mortality. This entity remains understudied in the geriatric patient. We sought to use a national surgical sample to uncover independent predictors of mortality in elderly patients undergoing emergent operation for perforated bowel.

Balanced blood component resuscitation in trauma: Does it matter equally at different transfusion volumes?

Background: It remains unclear whether the association between balanced blood component transfusion and lower mortality is generalizable to trauma patients receiving varying transfusion volumes. We sought to study the role red blood cell transfusion volume plays in the relationships between red blood cell:platelet and red blood cell:fresh frozen plasma ratios and 4-hour mortality.

Methods: Adult patients in the 2013 to 2018 American College of Surgeons Trauma Quality Improvement Program database receiving ≥6 red blood cell, ≥1 platelet, and ≥1 fresh frozen plasma within 4 hours were included.

Revisiting abdominal closure in mesenteric ischemia: is there an association with outcome?

Purpose: Current guidelines advocate liberal use of delayed abdominal closure in patients with acute mesenteric ischemia (AMI) undergoing laparotomy. Few studies have systematically examined this practice. The goal of this study was to evaluate the effect of delayed abdominal closure on postoperative morbidity and mortality in patients with AMI.

Mesenteric Ischemia in Patients with Coronavirus 2019: A Scoping Review.

Coronavirus 2019 (COVID-19) is a systemic disease associated with severe gastrointestinal complications including life-threatening mesenteric ischemia. We sought to review and summarize the currently available literature on the presentation, management, and outcomes of mesenteric ischemia in patients with COVID-19. The PubMed database was searched to identify studies published between January 2020 and January 2021 that reported one or more adult (≥18 years) patients with COVID-19 who developed mesenteric ischemia during hospitalization.

Timing and choice of systemic anticoagulation in the setting of extremity arterial injury repair.

Purpose: The role of perioperative anticoagulation in the setting of peripheral arterial injury remains unclear. We hypothesized that early initiation of anticoagulation is associated with a reduced amputation rate without increasing bleeding complications.

Methods: Using the 2016-2019 ACS-TQIP database, adult patients with upper and lower extremity vascular injuries who underwent open arterial repair and received anticoagulation were included.

Opioid Misuse: A Review of the Main Issues, Challenges, and Strategies.

In the United States, from 1999 to 2019, opioid overdose, either regularly prescribed or illegally acquired, was the cause of death for nearly 500,000 people. In addition to this pronounced mortality burden that has increased gradually over time, opioid overdose has significant morbidity with severe risks and side effects. As a result, opioid misuse is a cause for concern and is considered an epidemic.

Possible risk factors involved in psychological and emotional stress and depression among forensic medicine workers.

Introduction: Different forms of rationalization are introduced through work, which result from economic, political, and social changes that increase the need for labor force. Within this context, there are institutions that neglect the effects of poor work environments on workers' health, such as the development of work-related mental and psychological disorders.

Objectives: To understand what it means to work as an official expert at a forensic medicine institute and investigate occupational and workplace factors that may contribute to emotional and psychological stress and/or depression.

The variation of opioid prescription after injury and its association with long-term chronic pain: A multicenter cohort study.

Background: Opioid overprescription in trauma contributes to the opioid epidemic through diversion of unused pills. Through our study, we sought to do the following: (1) understand the variation in opioid prescription after injury and its relationship to patient and/or clinical variables, and (2) study the relationship between opioid prescribing and long-term pain and analgesic use.

Method: Trauma patients with an injury severity score ≥9 admitted to 3 level 1 trauma centers were screened for chronic pain and analgesic use 6 to 12 months postinjury.