Surgery
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Hyperfibrinolysis (HF) on admission is associated with increased mortality in adult patients with trauma. Several studies have demonstrated that 9% of severely injured adults present to the emergency department (ED) with HF. Our aim was to (1) define HF in pediatric patients and develop a relevant cut-point for therapeutic intervention (if any); (2) identify the prevalence of HF in severely injured pediatric patients; and (3) determine whether HF on admission is as lethal a phenomenon as it is in adults. ⋯ Similar to adults, admission HF appears to reach a critical threshold at a LY30 ≥3% in pediatric patients. Admission HF in pediatric patients occurs more frequently than in adults (24 vs 9%) but is associated similarly with a substantial increase in mortality (6-14%). When controlling for additional factors, we found that admission LY-30 ≥3% has an odds ratio of 6.2 (P < .001) for mortality among severely injured pediatric patients. HF on admission may serve to identify rapidly those injured children and adolescents likely to benefit from hemostatic resuscitation efforts and to guide antifibrinolytic therapy.
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Multicenter Study Observational Study
Splenectomy is associated with hypercoagulable thrombelastography values and increased risk of thromboembolism.
Previous investigators have demonstrated that postinjury thrombocytosis is associated with an increase in thromboembolic (TE) risk. Increased rates of thrombocytosis have been found specifically in patients after splenectomy for trauma. We hypothesized that patients undergoing splenectomy (1) would demonstrate a more hypercoagulable profile during their hospital stay and (2) that this hypercoagulable state would be associated with increased TE events. ⋯ This multicenter, prospective study demonstrates that patients undergoing splenectomy have a more hypercoagulable state than other trauma patients. This hypercoagulable state (identified by greater α-angle and mA values) begins at approximately 48 hours after injury and continues through at least day 5. Moreover, this hypercoagulable state is associated with increased risk of TE complications.
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Comparative Study
Cost effectiveness of nonoperative management versus laparoscopic appendectomy for acute uncomplicated appendicitis.
Appendectomy remains the gold standard in the treatment of acute, uncomplicated appendicitis in the United States. Nonetheless, there is growing evidence that nonoperative management is safe and efficacious. ⋯ Nonoperative management without IA is the least costly, most effective treatment for acute, uncomplicated appendicitis and warrants further evaluation in a disease thought to be definitively surgical.
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Little is reported about postdischarge complications after bariatric surgery. We sought to identify the rates of postdischarge complications, associated risk factors, and their influence on early hospital readmission. ⋯ Postdischarge complications after bariatric surgery represent a substantial source of patient morbidity and hospital readmissions. The majority of postdischarge complications are infection-related, including surgical-site infections and catheter-associated urinary tract infections. Adopting and implementing standardized pre- and postoperative strategies to decrease perioperative infection may help to decrease the rate of postdischarge complications and associated readmissions and enhance overall quality of care.
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Progressive hemorrhagic injury (PHI) in traumatic brain injury (TBI) patients is associated with poor outcomes. Early prediction of PHI is difficult yet vital. We hypothesize that TBI subtype and coagulation would be predictors of PHI. ⋯ This study demonstrates that older patients with coagulation abnormalities and IPC on admission are more likely to experience PHI, identifying a target population for earlier therapies.