The American surgeon
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The American surgeon · Aug 2021
Multicenter StudyGoal-Directed Fluid Therapy and Postoperative Outcomes in an Enhanced Recovery Program for Colorectal Surgery: A Propensity Score-Matched Multicenter Study.
Goal-directed fluid therapy (GDFT) has increasingly been utilized in major surgery as a key component to ensure fluid optimization and adequate tissue perfusion, showing improvements in the rate of morbidity and mortality under conventional care. It is unclear if patients derive similar benefit as part of an enhanced recovery program (ERP). Our group sought to assess the association between GDFT and postoperative outcomes within an ERP for colorectal surgery. ⋯ There was no associated between GDFT and major postoperative outcomes within an ERAS program for colorectal surgery. Additional large-scale or pragmatic randomized trials are necessary to determine whether GDFT has a role in ERP for colorectal surgery.
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The American surgeon · Apr 2021
Multicenter Study Comparative StudyIs NBATS-2 up to the Task? Actual vs. Predicted Patient Volume Shifts With the Addition of Another Trauma Center.
Version 2 of the Needs-Based Assessment of Trauma Systems (NBATS) tool quantifies the impact of an additional trauma center on a region. This study applies NBATS-2 to a system where an additional trauma center was added to compare the tool's predictions to actual patient volumes. ⋯ NBATS-2 failed to predict the post-period volume changes. Without a change in EMS destination guidelines, this finding was not surprising for severely injured patients. However, the 288% increase in volume of minor injuries was unexpected. NBATS-2 must be refined to assess the impact of local factors on patient volume.
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The American surgeon · Sep 2020
Multicenter Study Observational StudyEarly Chemoprophylaxis in Severely Injured Trauma Patients Reduces Risk of Venous Thromboembolism.
Venous thromboembolism (VTE) remains a serious complication for trauma patients. While early VTE prophylaxis has gained traction, the timing of prophylaxis remains uncertain. We hypothesized that VTE prophylaxis within 24 hours of admission would have lower VTE rates and similar rates of adverse events in seriously injured patients. ⋯ In severely injured trauma patients with ISS >15, early VTE prophylaxis within 24 hours significantly reduced the risk of VTE as compared with delayed prophylaxis. Early chemoprophylaxis was found to be efficacious in reducing the incidence of VTE; however, the safety of this practice should be evaluated by future prospective studies.
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The American surgeon · Jul 2018
Multicenter StudyThe Impact of Trauma Center Patient Volume on Observed/Expected Mortality: Does Size Matter?
Relationship between trauma center patient volume (TCV) and mortality remains inconclusive. Our aim was to determine the relationship between TCVs and observed/expected (O/E) all-cause mortality. This is the first study to evaluate the relationship between trauma center (TC) volumes and O/E all-cause mortality with no exclusion. ⋯ When controlling for Injury Severity Score, the correlation between mechanism of injury (blunt vs penetrating) and O/E mortality was r = -0.025. The group with the lowest average volumes had statistically significantly worse outcomes than the group with next higher volumes and also worse than the group with the highest volumes (Group 5, P = 0.04). Higher TC volumes correlated with higher injury severity and lower O/E mortality.