The American surgeon
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The American surgeon · Jun 2018
Comparative StudyComparison of Outcomes for Pediatric Trauma at Different Types of Trauma Centers: The Unresolved Mystery.
In Florida, injured children can receive emergent care at one of three types of state-approved trauma centers (TCs). A Level 1 combined adult/pediatric TC (L1, A + P), a Level 2 TC with an associated pediatric hospital (L2 + PH) or a pediatric TC at a pediatric hospital (PTH). This study aims to compare the mortality outcomes between Florida L1, A + Ps, to L2 + PHs, and PTHs. ⋯ When O/E's at L1, A + Ps and L2 + PHs were compared, results were statistically significant (P = <0.03),but not at L1, A + P versus PTHs. This is the first study to reveal that Level 1 adult/pediatric TCs have lower mortality rates compared with Level 2 TCs with an associated pediatric hospital. Level 1,A + P TCs had similar outcomes to pediatric TCs at stand-alone pediatric hospitals.
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The American surgeon · Jun 2018
Life over Limb: Lower Extremity Ischemia in the Setting of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA).
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a temporizing maneuver used to decrease hemorrhage, and thus perfusion, below the level of aortic occlusion (AO). We sought to investigate lower extremity ischemia in patients who received REBOA. Between February 2013 and September 2016 patients at a tertiary center that received REBOA and survived more than six hours were enrolled. ⋯ There was no association with sheath size or laterality and need for fasciotomy. Neither groin access for REBOA or AO solely caused limb loss or LECS. The contribution to distal ischemia by REBOA remains unclear in patients with lower extremity injury.
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The American surgeon · Jun 2018
The Impact of Epidural Analgesia on the Rate of Thromboembolism without Chemical Thromboprophylaxis in Major Oncologic Surgery.
Patients with abdominopelvic cancers are at increased risk of venous thromboembolism (VTE) due to their malignancy. We evaluated outcomes and the rate of VTE in patients undergoing abdominopelvic surgery for malignancy with preoperative epidural analgesia without postoperative chemical VTE prophylaxis. A retrospective review between 2009 and 2015 identified 285 patients with malignancy who underwent abdominopelvic surgery by a single surgeon (AWS). ⋯ No patient developed a pulmonary embolism. Our data suggest that patients undergoing major open operations with epidural analgesia have low rates of DVT and may obviate the need for chemical prophylaxis. However, larger studies are required to determine the overall effects of epidural analgesia on the development of DVTs postoperatively.
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The American surgeon · Jun 2018
Cost Analysis of Direct Oral Anticoagulants Compared with Warfarin in Patients with Blunt Traumatic Intracranial Hemorrhages.
Direct oral anticoagulants (DOACs) are rapidly gaining popularity as alternatives to warfarin in the prevention of stroke or systemic embolic events because of the simplicity of their dosing and lack of monitoring requirement. Many physicians feared that these novel agents would be cost-prohibitive not only in their administration but also in their sequelae of bleeding, given the few reversal agents available. Whereas the medication itself is more expensive than traditional warfarin, the total cost of a hospital admission has not been compared between patients on DOACs and warfarin who have sustained a blunt traumatic intracranial hemorrhage (ICH). ⋯ The average charged cost for the hospital stay of a patient with an ICH was significantly higher for patients on warfarin compared with DOACs [$70,384.08 vs $49,226.66 (P = 0.02)]. The average reimbursement rate for the hospital was also significantly higher for those patients on warfarin as compared with those on DOACs [$23,922.93 vs $14,705.77 (P = 0.02)]. DOACs are associated with a significant cost benefit in patients admitted for blunt traumatic ICHs when compared with those on warfarin.