Journal of the American College of Surgeons
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To quantify severity of postoperative complications based on the Accordion Severity Grading System, determine the ability of severity grading to enhance National Surgical Quality Improvement Program (NSQIP) data, and develop an aggregate measure of severity of complications (the postoperative morbidity index). ⋯ Quantitative severity weighting of complications is feasible. Adjustment of American College of Surgeons NSQIP outcomes using this quantitative severity grading system provides uniquely informative representations of relative burdens of morbidities.
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Although comprehensive burn care requires significant resources, patients may be treated at verified burn centers, nonverified burn centers, or other facilities due to a variety of factors. The purpose of this study was to evaluate the association between patient and injury characteristics and treatment location using a national database. ⋯ More than two-thirds of significantly burned patients are treated at nonverified burn centers in the United States. Many patients meeting American Burn Association criteria for transfer to a burn center are being treated at nonburn center facilities.
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Poor access to adequate health care coverage is associated with poor outcomes for many chronic medical conditions. We hypothesized that insurance coverage is also associated with mortality after gunshot trauma. ⋯ Despite similar injury severity, uninsured trauma patients were more likely to die after gunshot injury than insured patients. This difference could not be attributed to demographics or hospital resource use. Insurance coverage may reflect the many social determinants of health. Improving the social determinants of health in patients affected by violent trauma may be a step toward improving outcomes after trauma.
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Maintenance of postsurgical tissue oxygenation depends on the ability of the specific tissue to recruit perfusion and oxygen (O(2)) supply. When native O(2)-carrying capacity is lacking, fluids to improve O(2)-carrying capacity based in hemoglobin (Hb) could prevent partially ischemic tissue hypoxia by increasing O(2) release from the remaining red blood cells. ⋯ Results suggest the existence of an optimal concentration of low O(2)-affinity acellular Hb to increase oxygenation of partially ischemic tissue during anemic conditions.