Publications by authors named "Nam Yong Cho"
Introduction: Surgical society guidelines facilitate implementation of up-to-date, evidence-based care, but concerns regarding the contemporality and quality of evidence can hinder adherence. We aimed to evaluate the time gap between evidence publication and their inclusion within clinical guidelines-the publication-to-guideline delay-and characterize the quality of evidence within contemporary surgical society guidelines.
Study Design: This cross-sectional study analyzed guidelines published by U.
Background: Timing of venous thromboembolism chemoprophylaxis (VTEPPx) in traumatic brain injury (TBI) is complex given concerns for potential worsening of hemorrhage. While timing of VTEPPx for TBI patients is known to vary at the patient level, to our knowledge, variation at the hospital level and correlation with quality metrics have not been quantified in a cohort of nonneurosurgical patients.
Methods: This was a retrospective cohort study of the Trauma Quality Improvement database from 2018 to 2021.
Article Synopsis
- Aortic dissection, particularly Type B, is a common emergency in the U.S., and the study explored trends in treatment methods like thoracic endovascular repair (TEVAR) between 2010 and 2020.
- Out of over 85,000 patients studied, fewer received TEVAR initially (decreasing from 11.3% to 9.6%), while more opted for it during later hospital visits (increasing from 13.0% to 21.6%).
- The findings indicated that patients receiving early TEVAR had lower mortality rates but incurred higher hospital costs, while delayed TEVAR patients experienced fewer major complications without a significant increase in 90-day costs.
Article Synopsis
- A new comorbidity score called the Comorbid Operative Risk Evaluation (CORE) was developed specifically for surgical research to enhance mortality predictions compared to existing indices from previous decades.
- The study analyzed data from 699,155 surgical patients and used several machine learning algorithms to identify significant chronic disease factors, validating the CORE score with multiple datasets.
- Results showed the CORE score significantly outperformed both the Elixhauser and Charlson comorbidity indices in predicting in-hospital mortality across various healthcare databases.
Introduction: The American College of Surgeons (ACS) Committee on Trauma has established a framework for trauma center quality improvement. Despite efforts, recent studies show persistent variation in patient outcomes across national trauma centers. We aimed to investigate whether risk-adjusted mortality varies at the hospital level and if high-performing centers demonstrate better adherence to ACS Verification, Review, and Consultation (VRC) program quality measures.
View Article and Find Full Text PDFBackground: Failure to rescue (FTR) is increasingly recognized as a quality metric but remains understudied in emergency general surgery (EGS). We sought to identify patient and operative factors associated with FTR to better inform standardized metrics to mitigate this potentially preventable event.
Methods: All adult (≥18 years) non-elective hospitalizations for large bowel resection, small bowel resection, repair of perforated ulcer, laparotomy and lysis of adhesions were identified in the 2016-2020 National Readmissions Database.
Background: Pancreaticoduodenectomy is a highly morbid operation with significant resource utilization. Using a national cohort, we examined the interhospital variation in pancreaticoduodenectomy hospitalization cost in the United States.
Methods: Adults undergoing elective pancreaticoduodenectomy in the setting of pancreatic cancer were tabulated from the 2016-2020 Nationwide Readmissions Database.
Objective: Given the nonelective nature of most trauma admissions, patients who experience trauma are at a particular risk of discharge against medical advice. Despite the risk of unplanned readmission and financial burden on the health care system, discharge against medical advice among hospitalized patients continues to rise. The present study aimed to assess evolving trends and outcomes associated in patients with discharge against medical advice among patients hospitalized for traumatic injury.
View Article and Find Full Text PDFIntroduction: Congenital heart disease (CHD) is the most common and resource demanding birth defect managed in the United States, with approximately 40,000 children undergoing CHD surgery year. Researchers have compared high-volume to low-volume hospitals and found significant hospital-level variation in major complications, health resource utilization, and health care costs after CHD surgery.
Materials And Methods: Using nationwide representative claim data from the United States Military Health System from 2016 to 2020, TRICARE beneficiaries diagnosed with CHD were tabulated based on ICD-10 codes (International Classification of Diseases, 10th revision).
Background: Robot-assisted surgery has seen exponential adoption over the last decade. Although the safety and efficacy of robotic surgery in the elective setting have been demonstrated, data regarding robotic emergency general surgery remains sparse.
Methods: All adults undergoing non-elective appendectomy, cholecystectomy, small or large bowel resection, perforated ulcer repair, or lysis of adhesions were identified in the 2008 to 2020 National Inpatient Sample.
Background: With the aging population in the United States, the incidence of abdominal aortic aneurysms is shifting to older ages. Given changing demographic characteristics and increasing health care expenditures, the present study evaluated the degree of center-level variation in the cost of elective abdominal aortic aneurysm repair.
Methods: We identified all adult (≥18 years) hospitalizations for elective repair of nonruptured abdominal aortic aneurysms in the 2017 to 2020 Nationwide Readmissions Database.
Background: Obesity is a known risk factor for cholecystitis and is associated with technical complications during laparoscopic procedures. The present study seeks to assess the association between obesity class and conversion to open (CTO) during laparoscopic cholecystectomy (LC).
Methods: Adult acute cholecystitis patients with obesity undergoing non-elective LC were identified in the 2017-2020 Nationwide Readmissions Database.
Article Synopsis
- The study examines fat embolism as a serious complication in trauma patients undergoing major surgeries, using data from the National Inpatient Sample between 2005 and 2020.
- Out of over 10.6 million hospitalizations, only 7,479 patients (0.07%) were diagnosed with fat embolism, who were generally younger and more likely to be treated at high-volume trauma centers compared to those without this condition.
- The findings indicated that fat embolism significantly increased mortality rates, complications, hospitalization costs, and length of stay, highlighting the need for better early detection and management strategies in trauma settings.
Article Synopsis
- Alcohol withdrawal syndrome (AWS) complicates postoperative management in trauma patients, making it difficult to screen for, especially since their condition often requires urgent attention.
- A study of nearly 3 million trauma hospitalizations revealed that 1.23% developed AWS, significantly increasing risks for in-hospital mortality and various complications such as infectious, cardiac, and respiratory issues.
- Male patients, those on Medicaid, and individuals with head injuries or thoracic surgeries were more likely to develop AWS, highlighting the need for better screening methods to improve care and outcomes in trauma settings.
Background: Pediatric traumatic injury is associated with long-term morbidity as well as substantial economic burden. Prior work has labeled the catastrophic out-of-pocket medical expenses borne by patients as financial toxicity. We hypothesized uninsured rural patients to be vulnerable to exorbitant costs and thus at greatest risk of financial toxicity.
View Article and Find Full Text PDFBackground: Recent studies have demonstrated a positive volume-outcome relationship in emergency general surgery. Some have advocated for the sub-specialization of emergency general surgery independent from trauma. We hypothesized inferior clinical outcomes of emergency general surgery with increasing center-level operative trauma volume, potentially attributable to overall hospital quality.
View Article and Find Full Text PDFBackground: Prior literature has reported inferior surgical outcomes and reduced access to minimally invasive procedures at safety-net hospitals. However, this relationship has not yet been elucidated for elective colectomy. We sought to characterize the association between safety-net hospitals and likelihood of minimally invasive resection, perioperative outcomes, and costs.
View Article and Find Full Text PDFPrevious studies have shown an association between acute limb ischemia and higher mortality in patients with acute myocardial infarction. Although peripheral artery disease (PAD) is a well-known risk factor for development of macrovascular pathology, the effect of its severity is not well investigated in patients hospitalized for acute coronary syndrome (ACS). Using a national cohort of patients with various degrees of PAD, we investigated in-hospital outcomes in patients who were admitted for ACS.
View Article and Find Full Text PDFBackground: The role of minimally invasive surgery (MIS) in the acute management of diverticulitis remains controversial. Using a national cohort, we examined the relationship between operative approaches with acute clinical and financial outcomes.
Methods: Adults undergoing emergent colectomy for diverticulitis were tabulated from the 2015-2020 American College of Surgeons National Surgical Quality Improvement Program.
Background: Readmission at a non-index hospital, or care fragmentation (CF), has been previously linked to greater morbidity and resource utilization. However, a contemporary evaluation of the impact of CF on readmission outcomes following elective colectomy is lacking. We additionally sought to evaluate the role of hospital quality in mediating the effect of CF.
View Article and Find Full Text PDFBackground: Appendectomy remains a common pediatric surgical procedure with an estimated 80,000 operations performed each year. While prior work has reported the existence of racial disparities in postoperative outcomes, we sought to characterize potential income-based inequalities using a national cohort.
Methods: All non-elective pediatric (<18 years) hospitalizations for appendectomy were tabulated in the 2016-2020 National Inpatient Sample.
Background: Acute complicated diverticulitis poses a substantial burden to individual patients and the health care system. A significant proportion of the cases necessitate emergency operations. The choice between Hartmann's procedure and primary anastomosis with diverting loop ileostomy remains controversial.
View Article and Find Full Text PDFBackground: Peripheral vascular trauma is a major contributing factor to long-term disability and mortality among patients with traumatic injuries. However, an analysis focusing on individuals at a high risk of experiencing limb loss due to rural and urban peripheral vascular trauma is lacking.
Method: This was a retrospective analysis of the 2016 to 2020 Nationwide Readmissions Database.
Article Synopsis
- Hyperbaric oxygen therapy (HBOT) was analyzed for its effectiveness in treating necrotizing soft tissue infections (NSTI) by examining data from over 60,000 patients in a recent study (2012-2020).
- Results indicated that patients receiving HBOT had significantly lower in-hospital mortality (2% vs 5.9%) and lower amputation rates (11.8% vs 18.3%), although they experienced longer hospital stays (16.9 days) and higher costs ($54,000).
- Ultimately, after adjusting for various factors, the study concluded that while HBOT reduces deaths and amputations in NSTI patients, it does come with increased financial and time burdens in the hospital.