Publications by authors named "Velmahos G"
Background: Intraoperative adverse events (iAEs) during general surgery can lead to significant morbidity and healthcare burden, yet their impact remains underexplored. We aimed to estimate the nationwide incidence of iAEs in general surgery and explore their associations with mortality, complications, length of stay, and costs.
Methods: We conducted a retrospective cohort study using the Nationwide Readmissions Database 2019 and included adult patients (aged 18 years and older) who underwent general surgical procedures.
Background: The impact of tracheostomy timing on outcomes is unclear in geriatric patients with traumatic brain injury (TBI).
Methods: Patients aged≥65 with isolated severe TBI who underwent tracheostomy were identified in the ACS-TQIP 2017-2020 database. Patients were grouped by early (<10 days) vs.
Background: The prolonged use of percutaneous cholecystostomy tubes (PCTs) in patients with acute cholecystitis, deemed inoperable, is fraught with complications. Transpapillary cholecystoduodenal stenting (TCDS) is an alternative technique that restores the physiologic outflow of bile, avoiding the need for an external drain. However, the long-term safety and efficacy of this approach remain unclear.
View Article and Find Full Text PDFBackground: 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.
Article Synopsis
- Pancreas divisum (PD) is a common birth defect of the pancreas, but the genetic factors behind it are still unclear, prompting a genome-wide study to find potential genetic links.
- Researchers analyzed data from 13,940 participants, identifying a significant genetic locus on chromosome 3q29 associated with PD, specifically linked to two genes related to cellular functions.
- The study not only established a genetic link to PD but also identified potential regulatory genes that might influence pancreatic development, which could aid in better understanding and treating related pancreatic conditions.
Article Synopsis
- Renal angioembolization (RAE) is effective for low-grade renal injuries and may improve outcomes in high-grade renal trauma (HGRT), compared to traditional surgery.
- A study using data from 591 patients with HGRT found that RAE did not significantly change morbidity or length of hospital stays but was linked to lower mortality rates compared to surgery.
- The findings suggest that RAE might help preserve kidney function and enhance non-operative treatment efficacy, but further randomized studies are necessary to confirm these results.
Background: The aim of this study is to quantify the relative contribution of comorbidities and pre-operative functional status on outcomes in geriatric emergency general surgery (EGS) patients.
Methods: This is a retrospective study of older-adult EGS patients at an academic medical center between 2017 and 2018. Patients ≥65 years were included.
Introduction: Racial and ethnic disparities in emergency general surgery (EGS) patients have been well described in the literature. Nonetheless, the burden of these disparities, specifically within the more vulnerable older adult population, is relatively unknown. This study aims to investigate racial and ethnic disparities in clinical outcomes among older adult patients undergoing EGS.
View Article and Find Full Text PDFOutcomes of severe isolated blunt chest trauma in young and geriatric patients.
Eur J Trauma Emerg Surg
October 2024
Purpose: Our understanding of the growing geriatric population's risk factors for outcomes after traumatic injury remains incomplete. This study aims to compare outcomes of severe isolated blunt chest trauma between young and geriatric patients and assess predictors of mortality.
Methods: The ACS-TQIP 2017-2020 database was used to identify patients with severe isolated blunt chest trauma.
Article Synopsis
- Emergent surgical conditions in older patients often require major procedures, making it essential to assess risk factors for better decision-making and care planning.
- A study analyzing data from thousands of patients aged 65 and older found that 13.6% died within 30 days post-surgery, with ASA status 5, septic shock, and dialysis being significant predictors of mortality.
- The findings highlight that older patients with these risk factors face extremely high mortality rates after surgery, underscoring the importance of evaluating surgical futility in this vulnerable group.
Article Synopsis
- Obesity is a growing issue, particularly in emergency general surgery (EGS), where its effects on postoperative outcomes and decision-making are not fully understood.
- Analyzed data from nearly 79,000 EGS patients revealed that higher obesity classes, especially class III, increased risks for postoperative complications, prolonged surgeries, and longer hospital stays.
- The study indicates a clear link between obesity class and various surgical outcomes, highlighting the need for further research on how BMI influences surgical strategies and costs.
Article Synopsis
- Delayed fascial closure (DFC) is a technique used in emergency general surgery, but its benefits are not well established, prompting a comparison with immediate fascial closure (IFC) for patients with intra-abdominal contamination.
- A study using data from the American College of Surgeons analyzed outcomes of 36,974 patients undergoing exploratory laparotomy, revealing that DFC leads to higher mortality rates and complications, including pneumonia and longer hospital stays.
- The findings suggest that while DFC is common, it may lead to worse clinical outcomes and does not reduce complications, indicating a need for more research to clarify when DFC should be used in practice.*
Article Synopsis
- Care fragmentation in elderly patients post-hospital discharge is linked to higher morbidity and mortality, necessitating a study to identify contributing factors and their relation to mortality rates.
- A retrospective analysis of over 447,000 patients showed that 24.3% faced unplanned readmissions within 90 days, with 20.8% experiencing care fragmentation, particularly among older females.
- Factors like living in rural areas, low-income neighborhoods, and specific discharge decisions significantly predicted care fragmentation, which correlates with increased mortality rates in this population.
Background: Emergency general surgery performed among patients over 65 years of age represents a particularly high-risk population. Although interhospital transfer has been linked to higher mortality in emergency general surgery patients, its impact on outcomes in the geriatric population remains uncertain. We aimed to establish the effect of interhospital transfer on postoperative outcomes in geriatric emergency general surgery patients.
View Article and Find Full Text PDFIntroduction: General surgery procedures place stress on geriatric patients, and postdischarge care options should be evaluated. We compared the association of discharge to a skilled nursing facility (SNF) versus home on patient readmission.
Methods: We retrospectively reviewed the Nationwide Readmission Database (2016-2019) and included patients ≥65 y who underwent a general surgery procedure between January and September.
Purpose: For polytrauma patients with bilateral femoral shaft fractures (BFSF), there is currently no consensus on the optimal timing of surgery. This study assesses the impact of early (≤ 24 h) versus delayed (>24 h) definitive fixation on clinical outcomes, especially focusing on concomitant versus staged repair. We hypothesized that early definitive fixation leads to lower mortality and morbidity rates.
View Article and Find Full Text PDFBackground: Acute substance intoxication is associated with traumatic injury and worse hospital outcomes. The objective of this study was to evaluate the association between simultaneous opioids and benzodiazepines (OB) use and hospital outcomes in elderly trauma patients.
Methods: We performed a retrospective analysis using the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) 2017 database.
Article Synopsis
- Noncompressible truncal hemorrhage is a significant cause of preventable deaths outside of hospital settings, necessitating reliable animal models to test new treatments.
- This study created a lethal injury model using Yorkshire swine, combining severe liver damage with controlled blood volume loss, resulting in rapid and consistent outcomes.
- The developed model consistently led to high mortality rates within a short timeframe, making it a valuable tool for evaluating interventions for severe abdominal bleeding.
Article Synopsis
- This study compares two surgical methods, Hartmann's procedure (HP) and resection with primary anastomosis (RPA), for treating acute left-sided colonic emergencies among 1215 patients from 204 centers globally.
- Results showed that while HP was the more common treatment (57.3%), RPA was favored for younger patients with fewer health issues and those needing surgery sooner.
- The study concluded that although HP is still widely used, RPA might be the better option, emphasizing the importance of patient characteristics and surgeon experience in determining treatment choice.
Background: The impact of COVID-19 infection at the time of traumatic injury remains understudied. Previous studies demonstrate that the rate of COVID-19 vaccination among trauma patients remains lower than in the general population. This study aims to understand the impact of concomitant COVID-19 infection on outcomes in trauma patients.
View Article and Find Full Text PDFArticle Synopsis
- About 61 million people in the U.S. have a disability, but not much is known about how this affects their hospital care after surgery.
- The study looked at over 378,000 patients who had emergency surgeries and compared those with disabilities to those without, finding that disabled patients had more health issues afterward.
- It showed that disabled patients had a higher chance of returning to the hospital within 30 days, suffered more complications, and stayed in the hospital longer than those without disabilities.
Background: Despite the high prevalence of disability conditions in the US, their association with access to minimally invasive surgery (MIS) remains under-characterized.
Objective: To understand the association of disability conditions with rates of MIS and describe nationwide temporal trends in MIS in patients with disability conditions.
Methods: We conducted a retrospective cohort study using the Nationwide Readmission Database (2016-2019).
Weight-based enoxaparin thromboprophylaxis in young trauma patients: analysis of the CLOTT-1 registry.
Trauma Surg Acute Care Open
February 2024
Introduction: Optimal venous thromboembolism (VTE) enoxaparin prophylaxis dosing remains elusive. Weight-based (WB) dosing safely increases anti-factor Xa levels without the need for routine monitoring but it is unclear if it leads to lower VTE risk. We hypothesized that WB dosing would decrease VTE risk compared with standard fixed dosing (SFD).
View Article and Find Full Text PDFIntroduction: Collectively, studies from medical and surgical intensive care units (ICU) suggest that long-term outcomes are poor for patients who have spent significant time in an ICU. We sought to identify determinants of post-intensive care physical and mental health outcomes 6-12 months after injury.
Methods: Adult trauma patients [ISS ≥9] admitted to one of three Level-1 trauma centers were interviewed 6-12 months post-injury to evaluate patient-reported outcomes.
Article Synopsis
- This study investigated if lower extremity amputation in civilian injuries increases the risk of venous thromboembolism (VTE), specifically pulmonary embolism (PE) and deep vein thrombosis (DVT).
- Researchers analyzed data from over 145,000 patients with severe leg injuries, comparing those who underwent amputation with those who had limb salvage.
- Findings showed that amputee patients had significantly higher rates of both PE (4.2% vs. 2.5%) and DVT (6.5% vs. 3.4%), highlighting the increased risk of VTE after traumatic limb loss.