American journal of surgery
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Observational Study
Evaluation of StO2 tissue perfusion monitoring as a tool to predict the need for lifesaving interventions in trauma patients.
Hemorrhage remains the leading cause of mortality in preventable trauma deaths. Earlier recognition of hemorrhagic shock decreases the time to implementation of life-saving interventions improves patient survival. The presence of hemorrhagic shock is not always apparent using standard vital signs monitoring, a clinical state referred to as occult shock. ⋯ Admission StO2 measurements less than 75% predict the need for blood products and emergent surgical procedures and may be used as an adjunct method for identifying shock. StO2 measurements can aid where laboratory values are unavailable.
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Surgical wound classification (SWC) is a component of surgical site infection risk stratification. Studies have demonstrated that SWC is often incorrectly documented. This study examines the accuracy of SWC after implementation of a multifaceted plan targeted at accurate documentation. ⋯ Implementation of a multifaceted approach improved accuracy of documented SWC.
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The high prevalence of ventilator-associated pneumonia (VAP) in trauma patients has been reported in the literature, but the reasons for this observation remain unclear. We hypothesize that trauma factors play critical roles in VAP etiology. ⋯ It is time to redefine VAP in trauma patients based on the effect of rib fractures, pulmonary contusions, and failed prehospital intubations. The Centers for Disease Control and Prevention definition of VAP needs to be modified to reflect the effect of trauma factors in the etiology of trauma-associated pneumonia.
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Obesity's influence on postoperative complications in either laparoscopic ventral hernia repair (LVHR) or open ventral hernia repair (OVHR) has yet to be defined. Although 30-day postoperative complications increase with higher body mass index (BMI), we propose LVHR minimizes surgical site infections (SSIs) and surgical site occurrences (SSOs) for given BMI categories. ⋯ Obese patients are over-represented in VHRs. Thirty-day postoperative wound complications increase with higher BMI. LVHR minimizes both SSIs and SSOs, especially in higher obesity classes.
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Review Meta Analysis
The influence of sex on outcomes in trauma patients: a meta-analysis.
This study aims to assess the influence of sex on outcomes among trauma patients, including injury severity, medical resource utility, complications, and mortality. ⋯ Evidence of this meta-analysis strongly supports the sex dimorphism in the prognosis of trauma patients and further work should be done to decipher potential mechanism.