Journal of the American College of Surgeons
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This investigation sought to evaluate risk factors for morbidity and mortality from a large series of below-knee amputees prospectively entered in a national database. ⋯ Renal disease, cardiac issues, history of sepsis, steroid use, COPD, and increased patient age were identified as predictors of mortality after below-knee amputation. Renal disease, cardiac issues, history of sepsis, steroid use, contaminated/infected wounds, and alcohol use were also found to be predictors of postoperative complications.
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Multicenter Study
Influence of socioeconomic status on trauma center performance evaluations in a Canadian trauma system.
Trauma center performance evaluations generally include adjustment for injury severity, age, and comorbidity. However, disparities across trauma centers may be due to other differences in source populations that are not accounted for, such as socioeconomic status (SES). We aimed to evaluate whether SES influences trauma center performance evaluations in an inclusive trauma system with universal access to health care. ⋯ We observed an important variation in SES across trauma centers but no change in risk-adjusted mortality estimates when SES was added to adjustment models. Results suggest that after adjustment for injury severity, age, comorbidity, and transfer status, disparities in SES across trauma center source populations do not influence trauma center performance evaluations in a system offering universal health coverage.
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The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) has become an important surgical quality program in the United States, yet few studies describe their methods for handling missing data. Our study examines the impact of missing data on predictive models for short-term operative outcomes after cancer surgery in the ACS NSQIP database. ⋯ Missing data present challenges to interpreting predictors of short-term operative outcomes after cancer surgery at ACS NSQIP hospitals. Similar to best practices for other data sets, this study highlights the importance of using missing values carefully when using ACS NSQIP. Given its potential to introduce bias, the approach to handling missing values should be detailed in future ACS NSQIP studies.
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Geriatric trauma patients (GTPs) are the fastest growing segment of patients admitted to trauma centers. We examined the characteristics and outcomes of genitourinary (GU) trauma sustained by GTPs compared with nongeriatric trauma patients (NGTPs). ⋯ GTPs sustain a significant number of GU injuries. Penetrating GU injuries are less common in GTPs. Although GTPs and NGTPs had similar mean Injury Severity Scores, GTPs had more ICU admissions, longer ICU stays, and twice the mortality rate when compared with NGTPs.