Publications by authors named "Lillian S Kao"

Background: Addressing equity in healthcare is necessary to improve population health outcomes. In doing so, a requisite level of foundational resources, organization, and processes are needed. Although increasing attention is being devoted to addressing health inequities, the current landscape supporting these efforts remains unknown.

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Background: The relationship between inflammatory biomarkers (IB) and organ space surgical site infections (OS-SSIs) after emergency laparotomy (EL) is poorly understood.

Methods: Retrospective, single-center analysis of patients in the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial who underwent EL and survived 48 ​h after admission was performed. IB levels of IL-6, IL-8, G-CSF, MCP-1, neutrophil to lymphocyte ratio, and platelet to lymphocyte ratio were analyzed.

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Addressing disparities is crucial for enhancing population health, ensuring health security, and fostering resilient health systems. Disparities in acute care surgery (trauma, emergency general surgery, and surgical critical care) have been well documented and the magnitude of inequities demand an intentional, organized, and effective response. As part of its commitment to achieve high-quality, equitable care in all aspects of acute care surgery, the American Association for the Surgery of Trauma convened an expert panel at its eigty-second annual meeting in September 2023 to discuss how to take action to work towards health equity in acute care surgery practice.

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Article Synopsis
  • The AJHP posts accepted manuscripts online swiftly after peer review and editing, but they are not the final versions and will later be replaced by formatted articles.
  • The purpose of the report is to highlight the development of a peer prereview (PPR) service by the Clinical Pharmacy and Pharmacology section to enhance manuscript acceptance rates.
  • Since its inception in 2011, 64% of reviewed manuscripts were accepted for publication, with high satisfaction reported by both authors and reviewers regarding the PPR service.
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Article Synopsis
  • The Surgical Infection Society (SIS) has updated its evidence-based guidelines for managing intra-abdominal infections (IAI) after a systematic review of literature from 2016 to February 2024.
  • This update includes new recommendations and revisions based on rigorous evaluations of evidence using the GRADE system, which ranks the strength and quality of recommendations.
  • Key topics covered involve antimicrobial agent selection, treatment timing and methods, pathogen-specific treatments, and the implementation of antimicrobial stewardship programs in hospitals.
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Background: Management of geriatric trauma patients requires balancing chronic comorbidities with acute injuries. We developed a care model in which patients are managed by hospitalists with trauma-centered education and hypothesized that clinical outcomes would be similar to outcomes in patients primarily managed by trauma surgeons.

Methods: This was a retrospective study of trauma patients aged ≥65 from January 2020 to December 2021.

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Article Synopsis
  • - The study assessed the effectiveness of a decision support tool (DST) in helping patients with appendicitis make informed treatment choices between antibiotics and surgery, aiming to reduce uncertainty and decisional conflict.
  • - An analysis of 8,243 participants showed that using the DST lowered the percentage of undecided patients from 55% to 49%, while many participants reported a significant reduction in decisional conflict after using the tool.
  • - Overall, the DST, available at appyornot.org, was found to positively impact patients' treatment preferences and help clarify their decisions regarding appendicitis treatment options.
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Importance: Gallstone pancreatitis (GSP) is the leading cause of acute pancreatitis, accounting for approximately 50% of cases. Without appropriate and timely treatment, patients are at increased risk of disease progression and recurrence. While there is increasing consensus among guidelines for the management of mild GSP, adherence to these guidelines remains poor.

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Background: Non-narcotic intravenous medications may be a beneficial adjunct to oral multimodal pain regimens (MMPRs) which reduce but do not eliminate opioid exposure and prescribing after trauma. We hypothesized that the addition of a subdissociative ketamine infusion (KI) to a standardized oral MMPR reduces inpatient opioid exposure.

Methods: Eligible adult trauma patients admitted to the intermediate or intensive care unit were randomized upon admission to our institutional MMPR per usual care (UC) or UC plus subdissociative KI for 24 hours to 72 hours after arrival.

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Objective: Among critically injured patients of various blood groups, we sought to compare survival and complication rates between COVID-19-positive and COVID-19-negative cohorts.

Background: SARS-CoV-2 infections have been shown to cause endothelial injury and dysfunctional coagulation. We hypothesized that, among patients with trauma in hemorrhagic shock, COVID-19-positive status would be associated with increased mortality and inpatient complications.

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Introduction: Risk stratification for poor outcomes is not currently age-specific. Risk stratification of older patients based on observational cohorts primarily composed of young patients may result in suboptimal clinical care and inaccurate quality benchmarking. We assessed two hypotheses.

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Patients undergoing trauma laparotomy experience high rates of surgical site infection (SSI). Although intra-operative shock is a likely contributor to SSI risk, little is known about the relation between shock, intra-operative restoration of physiologic normalcy, and SSI development. A retrospective review of trauma patients who underwent emergent definitive laparotomy was performed.

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Background: Hypofibrinogenemia has been shown to predict massive transfusion and is associated with higher mortality in severely injured patients. However, the role of empiric fibrinogen replacement in bleeding trauma patients remains controversial. We sought to determine the effect of empiric cryoprecipitate as an adjunct to a balanced transfusion strategy (1:1:1).

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Background: Although racial disparities in receipt of immediate breast reconstruction (IBR) have been previously reported, prior studies may not have fully assessed the impact of recent advocacy efforts as healthcare disparities gain increased national attention. The aim of this study is to assess more recent racial differences and annual trends in receiving IBR.

Methods: Using the National Surgery Quality Improvement Program database, black or white women over 18 years who underwent mastectomy from 2012 to 2021 were included.

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Article Synopsis
  • This study investigates patient-reported outcomes (PROs) in individuals who experienced abdominal trauma, comparing those who underwent definitive laparotomy (DEF) with those treated with damage control laparotomy (DCL).
  • A randomized trial found that both groups had functional limitations after surgery, with survival rates indicating a higher death count in the DEF group and some differences in EQ-5D scores at discharge and six months later.
  • The results suggest that functional deficits persist for trauma patients regardless of the type of surgery, highlighting the need for long-term research to guide recovery expectations.
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Although oral hygiene in patients in the intensive care unit (ICU) has been shown to reduce hospital-associated infections, baseline and progressive oral health are often not reported because of lack of a standardized tool. The Oral Health Risk Assessment Value Index (OHRAVI) is a comprehensive oral assessment validated by dental providers. This study hypothesizes that non-dental providers can use OHRAVI in trauma ICU patients with minimal training and acceptable inter-rater reliability (IRR).

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Objective: Assess associations of Social Determinants of Health (SDoH) using Area Deprivation Index (ADI), race/ethnicity and insurance type with Textbook Outcomes (TO).

Summary Background Data: Individual- and contextual-level SDoH affect health outcomes, but only one SDoH level is usually included.

Methods: Three healthcare system cohort study using National Surgical Quality Improvement Program (2013-2019) linked with ADI risk-adjusted for frailty, case status and operative stress examining TO/TO components (unplanned reoperations, complications, mortality, Emergency Department/Observation Stays and readmissions).

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Background: Hemorrhagic shock in the setting of traumatic brain injury (TBI) reduces cerebral blood flow and doubles mortality. The optimal resuscitation strategy for hemorrhage in the setting of TBI is unknown. We hypothesized that, among patients presenting with concomitant hemorrhagic shock and TBI, resuscitation including whole blood (WB) is associated with decreased overall and TBI-related mortality when compared with patients receiving component (COMP) therapy alone.

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Objective: Develop an ordinal Desirability of Outcome Ranking (DOOR) for surgical outcomes to examine complex associations of Social Determinants of Health.

Background: Studies focused on single or binary composite outcomes may not detect health disparities.

Methods: Three health care system cohort study using NSQIP (2013-2019) linked with EHR and risk-adjusted for frailty, preoperative acute serious conditions (PASC), case status and operative stress assessing associations of multilevel Social Determinants of Health of race/ethnicity, insurance type (Private 13,957; Medicare 15,198; Medicaid 2835; Uninsured 2963) and Area Deprivation Index (ADI) on DOOR and the binary Textbook Outcomes (TO).

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