The Journal of surgical research
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Little is known about the quality of trauma care undocumented immigrants receive. Documentation status may serve as a risk factor for health disparities. We hypothesized that undocumented Latino immigrants have an increased risk of mortality after trauma compared with Latinos with legal residence. ⋯ Undocumented Latino immigrants did not have an increased risk of in-hospital mortality after trauma; however, being uninsured was associated with a higher risk of death after trauma. For Latinos, we found no disparities based on immigration status for mortality after trauma, though disparities based on insurance status continue to persist.
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A wealth of evidence from animal experiments has indicated that hypertonic saline (HS) maybe a better choice for fluid resuscitation in traumatic hypovolemic shock in comparison with conventional isotonic saline. However, the results of several clinical trials raised controversies on the superiority of fluid resuscitation with HS. This meta-analysis was performed to better understand the efficacy of HS in patients with traumatic hypovolemic shock comparing with isotonic saline. ⋯ The present meta-analysis was unable to demonstrate a clinically important improvement in mortality after the HS administration. Moreover, we observed HS administration maybe accompanied with significant increase in blood pressure and serum sodium.
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Ultrasonography has been suggested as a useful noninvasive tool for the detection of hypovolemia in critically ill patients. Hypovolemia after preoperative fasting and bowel preparation may compromise hemodynamic function during gastrointestinal surgery. However, there are few data comparing ultrasonographic examination of the inferior vena cava (IVC) diameter with central venous pressure (CVP) measurement in patients undergoing gastrointestinal surgery in the assessment of intravascular volume status. ⋯ Our data demonstrate that the IVC and RV diameters are consistently low in patients undergoing gastrointestinal surgery when compared with healthy subjects. Ultrasonographic measurements of the IVC and RV diameters are useful supplement of CVP for the evaluation of preoperative patients with hypovolemia.
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Persistent and recurrent hyperparathyroidism necessitate reoperation, which is associated with increased procedure-specific complication rates. The effect of reoperative parathyroidectomy on more generalized outcomes is poorly understood. We sought to determine patient, provider, and perioperative characteristics associated with reoperation, as well as to determine the associated risks. ⋯ Obesity and an American Society of Anesthesiologist 3 classification are independently associated with reoperation. Readmission within 30 d is associated with reoperation and is a target for patient education and quality improvement after this procedure.
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Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a hemorrhage control and resuscitative adjunct that has been demonstrated to improve central perfusion during hemorrhagic shock. The aim of this study was to characterize the systemic inflammatory response associated and cardiopulmonary sequelae with 30, 60, and 90 min of balloon occlusion and shock on the release of interleukin 6 (IL-6) and tumor necrosis factor alpha. ⋯ REBOA is a useful adjunct in supporting central perfusion during hemorrhagic shock; however, increasing occlusion time and shock results in a greater IL-6 release. Clinicians must anticipate inflammation-mediated organ failure in post-REBOA use patients.