The Journal of surgical research
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Trauma-related disorders rank among the top five most costly medical conditions to the health care system. However, the impact of out-of-pocket (OOP) health expenses for traumatic conditions is not known. In this cross-sectional study, we use nationally representative data to investigate whether patients with a traumatic injury experienced financial hardship from OOP health expenses. ⋯ Households with an injured family member requiring hospitalization are significantly more vulnerable to financial hardship from OOP health expenses than the noninjured population. Prescription drug and inpatient costs were the most significant drivers of OOP health expenses.
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Although many patients with locally advanced rectal cancer undergo restaging imaging after neoadjuvant chemoradiotherapy and before surgery, the benefit of this practice is unclear. The purpose of this study was to examine the impact of reimaging on outcomes. ⋯ Imaging restaging after neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer rarely changes treatment and does not improve survival. In a subset of patients at higher risk for worse outcome, reimaging may be beneficial.
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Comparative Study
No Difference in Mortality Between Level I and II Trauma Centers for Combined Burn and Trauma.
Trauma patients with burn injuries have higher morbidity and mortality rates compared with patients who solely experience burn or trauma injuries. There is a paucity of data regarding burn-trauma (BT) patient outcomes at level I (LI) trauma centers compared with level II (LII) centers. We hypothesized that BT patients at LI trauma centers have lower mortality rates than those at LII trauma centers. ⋯ We report that LI trauma center BT patients had an increased hospital and ICU LOS compared with those at LII centers. However, there was no significant difference in mortality between patients cared for at LI and LII trauma centers in risk-adjusted models.
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Comparative Study Observational Study
Patient-Surgeon Agreement in Assessment of Frailty, Physical Function, & Social Activity.
The shared decision-making process between surgical providers and patients relies on a joint understanding about the risks of different treatment options based on a patient's individual health state. However, it is unclear whether a patient's perception of their own condition is congruent with the health state assigned by their surgical providers. This study was designed to compare provider assessment of frailty versus patient-reported outcome (PRO) measures of their own frailty status, physical function, and social activity level. ⋯ Patients are more likely to self-report being frail, having low physical function, and limited social activity than what is detected by their surgical providers. These findings suggest that low levels of patient activity and its associated risk may often be underappreciated by surgical providers. Efforts are needed to improve how PROs are incorporated into surgical decision-making and outcome assessment.
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Necrotizing soft tissue infections (NSTIs) are life-threatening surgical emergencies associated with high morbidity and mortality. Fungal NSTIs are considered rare and have been largely understudied. The purpose of this study was to study the impact of fungal NSTIs and antifungal therapy on mortality after NSTIs. ⋯ Fungal NSTIs are more common in patients taking immunosuppressive medications and are significantly associated with in-hospital mortality. Antifungal therapy is associated with decreased in-hospital mortality in those with fungal NSTIs. Consideration should be given to adding antifungals in empiric treatment regimens, especially in those taking immunosuppressive medications.