The Journal of surgical research
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Comparative Study
Utilization and costs associated with robotic surgery in children.
To evaluate utilization and costs associated with robotic surgery in children. ⋯ Use of robotic surgery in pediatrics is increasing especially in the management of urologic conditions. Costs of robotic surgery-associated hospitalizations were higher than nonrobotic surgery-associated hospitalizations.
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Older age is associated with high rates of morbidity and mortality after injury. Statewide studies suggest significantly injured patients aged ≥55 y are commonly undertriaged to lower level trauma centers (TCs) or nontrauma centers (NTCs). This study determines whether undertriage is a national phenomenon. ⋯ There is substantial undertriage of patients aged ≥55 y nationwide. Over half of significantly injured older patients are not treated at level I or II TCs. The impact of undertriage should be determined to ensure older patients receive trauma care at the optimal site.
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Comparative Study
Human mesenchymal stromal cells decrease mortality after intestinal ischemia and reperfusion injury.
Cellular therapy is a novel treatment option for intestinal ischemia. Bone marrow-derived mesenchymal stromal cells (BMSCs) have previously been shown to abate the damage caused by intestinal ischemia/reperfusion (I/R) injury. We therefore hypothesized that (1) human BMSCs (hBMSCs) would produce more beneficial growth factors and lower levels of proinflammatory mediators compared to differentiated cells, (2) direct application of hBMSCs to ischemic intestine would decrease mortality after injury, and (3) decreased mortality would be associated with an altered intestinal and hepatic inflammatory response. ⋯ Human BMSCs produce multiple beneficial growth factors. Direct application of hBMSCs to the peritoneal cavity after intestinal I/R decreased mortality by 60%. Improved outcomes with hBMSC therapy were not associated with improved histologic profiles in this model. hBMSC therapy was associated with higher VEGF in intestines and lower levels of proinflammtory MIG, IP-10, and G-CSF in liver tissue after ischemia, suggesting that reperfusion with hBMSC therapy may alter survival by modulating the systemic inflammatory response to ischemia.
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Recent single-institutional data point to the feasibility of same-day discharge (SDD) after appendectomy for nonperforated appendicitis and its potential as a quality-of-care indicator. Opportunities for SDD are greatest the sooner the appendectomy is performed after admission. We examine a national database to assess the pattern of SDD utilization among children who underwent appendectomy on the day of admission and potential limitations to SDD. ⋯ SDD is increasingly used for children with nonperforated appendicitis, but there is significant variability in the utilization of SDD for different ethnicities and hospital regions. These variations need to be further investigated to better delineate its potential role as a quality-of-care indicator.
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Computed tomographic angiography (CTA) tends to be overused in patients with traumatic subarachnoid hemorrhage (tSAH) to rule out intracranial aneurysmal disease. We hypothesized that there are two exclusive subsets of patients with tSAH that maybe at increased risk for aneurysm and thus should undergo CTA, those "found down" with an unknown mechanism of injury and those with "central subarachnoid hemorrhage" (CSH, in the subarachnoid cisterns and Sylvian fissures). This pilot study was performed to provide more information on the validity of our hypothesis. ⋯ These preliminary data support a more selective approach to screening CTAs in patients with tSAH. CTA should be used in those patients with CSH regardless of mechanism of injury. A more restrictive approach should be used in patients with only peripheral subarachnoid hemorrhage.