The Journal of surgical research
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Whether patients with necrotizing soft tissue infections (NSTI) who presented to under-resourced hospitals are best served by immediate debridement or expedited transfer is unknown. We examined whether interhospital transfer status impacts outcomes of patients requiring emergency debridement for NSTI. ⋯ Our results suggest that interhospital transfer status is not an independent risk factor for mortality or morbidity after surgical management of NSTI. Although expedient debridement remains a basic tenet of NSTI management, our findings provide some reassurance that transfer before initial debridement will not significantly jeopardize patient outcomes should such transfer be deemed necessary.
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Observational Study
The long-term outcomes of thyroid function after subtotal thyroidectomy for Graves' hyperthyroidism.
Surgical management of Graves' disease (GD) is changing from subtotal to total thyroidectomy because the latter eliminates the risk of recurrence. However, to preserve thyroid function in a euthyroid state, subtotal thyroidectomy is still performed for GD in non-Western countries. Therefore, we designed a study to investigate the long-term outcomes in GD patients after subtotal thyroidectomy and the correlation between remnant weight and postoperative thyroid function. ⋯ Subtotal thyroidectomy with the intent to maintain a euthyroid state is not an optimal surgical strategy for the definitive treatment of GD because the persistence or recurrence rate is high and the euthyroid rate is lower than expected.
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Global disparities in trauma care contribute to significant morbidity and mortality (M&M) in low- and middle-income countries. Implementation of quality improvement (QI) programs has been shown to be a cost-effective strategy to improve trauma care quality. In this study, we aim to characterize the trauma QI programs in a broad range of low- to high-income countries in the Americas to assess areas for targeted improvement in global trauma QI efforts. ⋯ This survey demonstrated an encouraging pattern of widespread adoption of trauma QI programs in several countries in North and South America. However, there continue to be significant disparities in the structure and function of trauma QI efforts in low- and middle-income countries in the Americas. There are several potential areas for development and improvement of trauma care systems, including standardization of case selection and follow-up for M&M conferences and increased use of medical literature to improve evidence-based care.
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Massive transfusion (MT) is frequently required during liver transplantation. Risk stratification of transplant patients at risk for MT is an appealing concept but remains poorly developed. Thrombelastography (TEG) has recently been shown to reduce mortality when used for trauma resuscitation. We hypothesize that preoperative TEG can be used to risk stratify patients for MT. ⋯ TEG MA has a high predictability of MT during liver transplantation. The use of TEG preoperatively may help guide more cost effective blood bank preparation for this procedure as only a third of patients required a MT.