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).

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.

American Black Authorship Has Decreased Across All Clinical Specialties Despite an Increasing Number of Black Physicians Between 1990 and 2020 in the USA.

Purpose: Many diversity, equity, and inclusion initiatives assume that attainment of a racially diverse healthcare workforce will translate to increased diversity elsewhere in the healthcare system (e.g., leadership roles or academic authorship).

Contemporary Surgical Management of Pancreatic Necrosis.

Importance: For decades, infected or symptomatic pancreatic necrosis was managed by open surgical necrosectomy, an approach that has now been largely supplanted by an array of techniques referred to as the step-up approach.

Observations: This review describes the evidence base behind the step-up approach, when to use the different techniques, and their technical basics. The most common treatment strategies are included: percutaneous drainage, video-assisted retroperitoneal debridement, sinus tract endoscopy, endoscopic transgastric necrosectomy, and surgical transgastric necrosectomy.

Trauma patients with limited English proficiency: Outcomes from two level one trauma centers.

Background: Outcomes for surgical patients with limited English proficiency (LEP) may be worse compared to patients with English proficiency. We sought to evaluate the association of LEP with outcomes for trauma patients.

Methods: Admitted adult patients on trauma service at two Level One trauma centers from 2015 to 2019 were identified.

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.

Role of Transfusion Volume and Transfusion Rate as Markers of Futility During Ultramassive Blood Transfusion in Trauma.

Background: Using a large national database, we evaluated the relationship between RBC transfusion volume, RBC transfusion rate, and in-hospital mortality to explore the presence of a futility threshold in trauma patients receiving ultramassive blood transfusion.

Study Design: The ACS-TQIP 2013 to 2018 database was analyzed. Adult patients who received ultramassive blood transfusion (≥20 units of RBC/24 hours) were included.

Preperitoneal Pelvic Packing is Associated With Increased Risk of Venous Thromboembolism.

Introduction: Preperitoneal pelvic packing (PPP) is an important intervention for control of severe pelvic hemorrhage in blunt trauma patients. We hypothesized that PPP is associated with an increased incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE).

Methods: A retrospective cohort analysis of blunt trauma patients with severe pelvic fractures (AIS ≥4) using the 2015-2017 American College of Surgeons-Trauma Quality Improvement Program database was performed.

Treatment and Prevention of Intraabdominal Bleeding in Necrotizing Pancreatitis Patients Treated With a Step-Up Approach.

Objectives: A minimally invasive step-up (MIS) approach for management of necrotizing pancreatitis (NP) has been associated with reduced morbidity and mortality compared with open surgical techniques. We sought to evaluate bleeding complications in NP patients treated with a MIS approach and to describe the management and outcomes of these events.

Methods: An observational, cohort study was performed using a prospectively maintained NP database at a tertiary referral center from 2013 to 2019.

POTTER-ICU: An artificial intelligence smartphone-accessible tool to predict the need for intensive care after emergency surgery.

Background: Delays in admitting high-risk emergency surgery patients to the intensive care unit result in worse outcomes and increased health care costs. We aimed to use interpretable artificial intelligence technology to create a preoperative predictor for postoperative intensive care unit need in emergency surgery patients.

Methods: A novel, interpretable artificial intelligence technology called optimal classification trees was leveraged in an 80:20 train:test split of adult emergency surgery patients in the 2007-2017 American College of Surgeons National Surgical Quality Improvement Program database.

Planning for the Next Pandemic: Trauma Injuries Require Pre-COVID-19 Levels of High-Intensity Resources.

As hospital systems plan for health care utilization surges and stress, understanding the necessary resources of a trauma system is essential for planning capacity. We aimed to describe trends in high-intensity resource utilization (operating room [OR] usage and intensive care unit [ICU] admissions) for trauma care during the initial months of the COVID-19 pandemic. Trauma registry data (2019 pre-COVID-19 and 2020 COVID-19) were collected retrospectively from 4 level I trauma centers.

Hospital Academic Status and the Volume-Outcome Association in Postoperative Patients Requiring Intensive Care: Results of a Nationwide Analysis of Intensive Care Units in the United States.

To determine whether the outcomes of postoperative patients admitted directly to an intensive care unit (ICU) differ based on the academic status of the institution and the total operative volume of the unit. This was a retrospective analysis using the eICU Collaborative Research Database v2.0, a national database from participating ICUs in the United States.

Adding to the story, did penetrating trauma really increase? changes in trauma patterns during the COVID-19 pandemic: A multi-institutional, multi-region investigation.

Background: Results from single-region studies suggest that stay at home orders (SAHOs) had unforeseen consequences on the volume and patterns of traumatic injury during the initial months of the Coronavirus disease 2019 (COVID-19). The aim of this study was to describe, using a multi-regional approach, the effects of COVID-19 SAHOs on trauma volume and patterns of traumatic injury in the US.

Methods: A retrospective cohort study was performed at four verified Level I trauma centers spanning three geographical regions across the United States (US).

Underuse and Variability in Substance Use Screening Among Adult Trauma Patients in the U.S.: A Nationwide Retrospective Cohort Study.

Objective: To characterize the rates and variability in substance screening among adult trauma patients in the U.S.

Summary Background Data: Emergency Department trauma visits provide a unique opportunity to identify patients with substance use disorders.

Does An ERAS Protocol Reduce Postoperative Opiate Prescribing in Plastic Surgery?

Background: Enhanced recovery after surgery (ERAS) protocols are effective at reducing inpatient opiate use. There is a paucity of studies on the effects of an ERAS protocol on outpatient opiate prescriptions. The aim of this study was to determine whether an ERAS protocol for plastic and reconstructive surgery would reduce opiate use in the outpatient postoperative setting.

Increasing Frequency of Interpreting Services is Associated With Shorter Peri-operative Length of Stay.

Background: Patients with limited English proficiency have barriers to accessing care. Rather than a binary use or no use, this study uses granular data on frequency of interpreting services to determine if this frequency is associated with differences in peri-operative length of stay for patients with limited English proficiency.

Materials And Methods: This is a cross sectional study on length of stay for peri-operative admissions of at least one night during 2018, for patients who used medical interpreting services in an academic medical center in Boston, Massachusetts.

Lower Mortality with Cryoprecipitate During Massive Transfusion in Penetrating but Not Blunt Trauma.

Background: Balanced blood product transfusion improves the outcomes of trauma patients with exsanguinating hemorrhage, but it remains unclear whether administering cryoprecipitate improves mortality. We aimed to examine the impact of early cryoprecipitate transfusion on the outcomes of the trauma patients needing massive transfusion (MT).

Methods: All MT patients 18 years or older in the 2017 Trauma Quality Improvement Program (TQIP) were retrospectively reviewed.

Non-English Primary Language is Associated with Emergency Surgery for Diverticulitis.

Background: Language barriers can limit access to care for patients with a non-English primary language (NEPL). The objective of this study was to define the association between primary language and emergency versus elective surgery among diverticulitis patients.

Materials And Methods: Retrospective cohort study of adult patients from the 2009-2014 New Jersey State Inpatient Database.

Machine Learning and Artificial Intelligence for Surgical Decision Making.

The use of machine learning (ML) and artificial intelligence (AI) in medical research continues to grow as the amount and availability of clinical data expands. These techniques allow complex interpretation of data and capture non-linear relations not immediately apparent by classic statistical techniques. This review of the ML/AI literature provides a brief overview for practicing surgeons and clinicians of the current and future roles these methods will have within surgical infection research.

Enhanced Recovery After Surgery Patients Are Prescribed Fewer Opioids at Discharge: A Propensity-score Matched Analysis.

Objective: We aimed to compare discharge opioid prescriptions pre- and post-ERAS implementation.

Summary Of Background Data: ERAS programs decrease inpatient opioid use, but their relationship with postdischarge opioids remains unclear.

Methods: All patients undergoing hysterectomy between October 2016 and November 2020 and pancreatectomy or hepatectomy between April 2017 and November 2020 at 1 tertiary care center were included.