Pancreaticoduodenectomy in trauma patients with grade IV-V duodenal or pancreatic injuries: a post hoc analysis of an EAST multicenter trial.

Introduction: The utility of pancreaticoduodenectomy (PD) for high-grade traumatic injuries remains unclear and data surrounding its use are limited. We hypothesized that PD does not result in improved outcomes when compared with non-PD surgical management of grade IV-V pancreaticoduodenal injuries.

Methods: This is a retrospective, multicenter analysis from 35 level 1 trauma centers from January 2010 to December 2020.

Outcomes among trauma patients with duodenal leak following primary versus complex repair of duodenal injuries: An Eastern Association for the Surgery of Trauma multicenter trial.

Background: Duodenal leak is a feared complication of repair, and innovative complex repairs with adjunctive measures (CRAM) were developed to decrease both leak occurrence and severity when leaks occur. Data on the association of CRAM and duodenal leak are sparse, and its impact on duodenal leak outcomes is nonexistent. We hypothesized that primary repair alone (PRA) would be associated with decreased duodenal leak rates; however, CRAM would be associated with improved recovery and outcomes when leaks do occur.

Small bowel obstruction due to Roux-en-Y enterolith 13 years following deceased donor liver transplantation: a case report.

Primary sclerosing cholangitis (PSC) is a progressive, cholestatic liver disease, and liver transplantation (LT) is considered the only therapeutic option for patients with end-stage liver disease secondary to PSC. Intestinal obstruction in adults after LT surgery is a rare complication with diverse clinical presentations. The most common etiology is intestinal adhesions, but this can also result from other rare causes such as enterolith.

A Randomized Trial Comparing Antibiotics with Appendectomy for Appendicitis.

Background: Antibiotic therapy has been proposed as an alternative to surgery for the treatment of appendicitis.

Methods: We conducted a pragmatic, nonblinded, noninferiority, randomized trial comparing antibiotic therapy (10-day course) with appendectomy in patients with appendicitis at 25 U.S.

Necrotizing pancreatitis: A review for the acute care surgeon.

Background: Necrotizing pancreatitis is a common condition with high mortality; the acute care surgeon is frequently consulted for management recommendations. Furthermore, there has been substantial change in the timing, approach, and frequency of surgical intervention for this group of patients.

Methods: In this article we summarize key clinical and research developments regarding necrotizing pancreatitis, including current recommendations for treatment of patients requiring intensive care and those with common complications.

Rib fractures in the elderly: physiology trumps anatomy.

Introduction: Rib fractures in elderly patients are associated with increased morbidity and mortality. Predicting which patients are at risk for complications is an area of debate. Current models use anatomic, physiologic or laboratory parameters in isolation to answer this question.

Clostridium Difficile-Associated Infection in Trauma Patients: Development of the Clostridium Difficile Influencing Factors (CDIF) Score.

Context: Clostridium difficile-associated infection (CDAI) can result in longer hospitalization, increased morbidity, and higher mortality rates for surgical patients. The impact on trauma patients is unknown, however.

Objective: To assess the effect of CDAI on trauma patients and develop a scoring system to predict CDAI in that population.

Predictors of Clavien 4 Complications and Mortality After Necrosectomy: Analysis of the NSQIP Database.

Background: Acute severe pancreatitis is one of the most common gastrointestinal reasons for admission to hospitals in the USA. Up to 20 % of these patients will progress to necrotizing pancreatitis requiring intervention. The aim of this study is to identify specific preoperative factors for the development of Clavien 4 complications and mortality in patients undergoing pancreatic necrosectomy.

Influence of energy balance on the antimicrobial peptides S100A8 and S100A9 in the endometrium of the post-partum dairy cow.

Uterine inflammation occurs after calving in association with extensive endometrial remodelling and bacterial contamination. If the inflammation persists, it leads to reduced fertility. Chronic endometritis is highly prevalent in high-yielding cows that experience negative energy balance (NEB) in early lactation.

Are the frail destined to fail? Frailty index as predictor of surgical morbidity and mortality in the elderly.

Background: America's aging population has led to an increase in the number of elderly patients necessitating emergency general surgery. Previous studies have demonstrated that increased frailty is a predictor of outcomes in medicine and surgical patients. We hypothesized that use of a modification of the Canadian Study of Health and Aging Frailty Index would be a predictor of morbidity and mortality in patients older than 60 years undergoing emergency general surgery.

Using procedural codes to supplement risk adjustment: a nonparametric learning approach.

Background: The American College of Surgeons National Surgical Quality Improvement Program collects information related to procedures in the form of the work relative value unit (RVU) and current procedural terminology (CPT) code. We propose and evaluate a fully automated nonparametric learning approach that maps individual CPT codes to perioperative risk.

Study Design: National Surgical Quality Improvement Program participant use file data for 2005-2006 were used to develop 2 separate support vector machines (SVMs) to learn the relationship between CPT codes and 30-day mortality or morbidity.

Adverse effects of preoperative steroid use on surgical outcomes.

Background: Preoperative steroid use has been associated with increased postoperative complications. We sought to establish these risks using data from the National Surgical Quality Improvement Program (NSQIP).

Methods: NSQIP public use files from 2005 to 2008 were analyzed for preoperative steroid use and postoperative adverse events.

Influence of energy balance on the somatotrophic axis and matrix metalloproteinase expression in the endometrium of the postpartum dairy cow.

Postpartum dairy cows enter a period of negative energy balance (NEB) associated with low circulating IGF1, during which the uterus must undergo extensive repair following calving. This study investigated the effects of NEB on expression of IGF family members and related genes in the involuting uterus. Cows were allocated to two treatments using differential feeding and milking regimes to produce mild NEB or severe NEB (SNEB).

Octogenarian abdominal surgical emergencies: not so grim a problem with the acute care surgery model?

Background: As the aging population continues to increase, the surgical needs of the elderly will increase. The acute care surgery model has been developed in which the trauma team also manages all general surgical emergencies to improve patient outcomes. We retrospectively reviewed our elderly acute care surgery population during the past 5 years to determine the variables affecting major abdominal surgery outcomes.

Implementation of the National Surgical Quality Improvement Program: critical steps to success for surgeons and hospitals.

The National Surgical Quality Improvement Program (NSQIP), as administered by the American College of Surgeons, became available to private sector hospitals across the United States in 2004. The program works to improve surgical outcomes by providing high-quality, risk-adjusted data to surgeons at a given hospital to stimulate discussion and define target areas for improvement. Although the NSQIP began in the early 1990s with Veterans Administration hospitals and expanded to private sector hospitals nearly 5 years ago, the "how to" process for NSQIP implementation has been left to individual institutions to manage on their own.

Negative energy balance alters global gene expression and immune responses in the uterus of postpartum dairy cows.

Most dairy cows suffer uterine microbial contamination postpartum. Persistent endometritis often develops, associated with reduced fertility. We used a model of differential feeding and milking regimes to produce cows in differing negative energy balance status in early lactation (mild or severe, MNEB or SNEB).

Use of human acellular dermal matrix in complex and contaminated abdominal wall reconstructions.

Background: Few good surgical options exist for the repair of complex anterior abdominal wall defects, particularly those in which bacterial contamination is present. The use of prosthetic mesh increases complication rates when the mesh is placed directly over viscera or when the surgical site is contaminated from a pre-existing infection or enteric spillage. The use of an acellular dermal matrix (ADM), which becomes vascularized and remodeled into autologous tissue after implantation, may represent a low-morbidity alternative to prosthetic mesh products in these complex settings.

Selective management of penetrating truncal injuries: is emergency department discharge a reasonable goal?

We undertook this retrospective review to examine the appropriateness of a protocol for the selective emergency department (ED) workup of asymptomatic penetrating truncal injuries. Records of consecutive patients presenting to our urban Level I trauma center with penetrating truncal injuries between January 1, 1997 and September 2000 were reviewed. Data obtained included: patient demographics, ED workup, ED disposition, complications, and follow-up.

Urban trauma centers: not quite dead yet.

With decreasing violent crime and an increase in the use of nonoperative management techniques the viability of urban trauma centers has come into question. In addition the workload and productivity for surgeons at such centers may be threatened. The current study examines the changing characteristics of patients admitted to an urban Level I trauma center over a 5-year period and examines factors that may affect trauma surgeon utilization.

Evaluation of vascular injury in penetrating extremity trauma: angiographers stay home.

The debate over the use of diagnostic angiography (DA) to exclude arterial injury in penetrating extremity trauma (PET) continues. This review evaluates our current protocol for PET and identifies indications for DA. Patients presenting to our urban Level I trauma center between January 1997 and September 2000 with PET were included.