Application of Evidence into Practice in Trauma: The Purpose to Practice (P2P) Approach to Consensus Generation.

Introduction: In trauma care, there is a need to increase communication to ensure evidence-informed, best practice care guidelines are easily accessible to all providers to yield continuity of care. Clinical guidance use is one way to address this need while employing a patient-centered team approach.

Methods: During year two of the conference series, participants gathered in person and virtually to further develop the Minimum Viable Product (MVP) created during year one.

Futility Thresholds for Emergency General Surgery in the Post-Cardiac Intensive Care Unit.

Introduction: Gastrointestinal complications requiring emergency general surgery (EGS) after cardiac surgery are associated with high morbidity and mortality. Identifying predictors of 30-d mortality and intuitive preoperative laboratory-based futility thresholds may enhance risk stratification and clinical decision-making.

Materials And Methods: We conducted a single-center retrospective cohort study of adults aged 18-90 y who underwent cardiac surgery between 2013 and 2023.

Trauma in pregnancy: A systematic review, meta-analysis, and practice management guideline from the Eastern Association for the Surgery of Trauma.

Background: The care of the injured pregnant patient presents unique challenges. There is no consensus on how best to approach certain aspects of injury during pregnancy. In this review, we aim to clarify the current care of the injured pregnant patient by reviewing the existing literature guided by clinical experience.

Ultrasound-guided percutaneous cryoneurolysis of intercostal nerves in traumatic rib fractures.

Background: Multimodal pain control is the cornerstone of managing acute traumatic rib fractures. We employed surgeon-administered, ultrasound-guided percutaneous cryoneurolysis of intercostal nerves (USPCNIN) as an adjunct opioid-sparing analgesic modality at the bedside.

Methods: This was a single-institution case series.

Prospective multicenter external validation of the rib fracture frailty index.

Background: The Rib Fracture Frailty (RFF) Index is an internally validated machine learning-based risk assessment tool for adult patients with rib fractures that requires minimal provider entry. Existing frailty risk scores have yet to undergo head-to-head performance comparison with age, a widely used proxy for frailty in clinical practice. Our aim was to externally validate the RFF Index in a small-scale implementation feasibility study.

Firearm-Related Injuries and the US Opioid and Other Substance Use Epidemic: A Nationwide Evaluation of Emergency Department Encounters.

Introduction: There has been a sharp climb in the Unites States' death rate among opioid and other substance abuse patients, as well as an increased prevalence in gun violence. We aimed to investigate the association between substance abuse and gun violence in a national sample of patients presenting to US emergency departments (EDs).

Methods: We queried the 2018-2019 Nationwide Emergency Department Sample for patients ≥18 years with substance abuse disorders (opioid and other) using International Classification of Diseases, 10th Revision, Clinical Modification codes.

Delayed hollow viscus injury with an occult seatbelt abrasion presenting as a small bowel obstruction.

We present the case of a previously healthy 29-year-old male who presented with a small bowel obstruction in the absence of previous abdominal surgery who was found to have evidence of an occult seatbeltabrasion and ultimately multifocal hollow viscus injury secondary to blunt abdominal trauma at the time of exploratory laparotomy. Hollow viscus injury is a rare, but potentially life-threatening, complication of blunt abdominal trauma. While cross-sectional imaging is an important diagnostic tool, results must be considered within a patient's clinical context as delays in surgical management can lead to significant morbidity and mortality.

Chest Wall Injury Society recommendation for surgical stabilization of nonunited rib fractures to decrease pain, reduce opiate use, and improve patient reported outcomes in patients with rib fracture nonunion after trauma.

Background: Rib fractures are common injuries which can be associated with acute pain and chronic disability. While most rib fractures ultimately go on to achieve bony union, a subset of patients may go on to develop non-union. Management of these nonunited rib fractures can be challenging and variability in management exists.

Small bowel obstruction managed without hospital admission: A safe way to reduce both cost and time in the hospital?

Background: Small bowel obstruction management has evolved to incorporate the Gastrografin challenge. We expanded its use to the emergency department observation unit, potentially avoiding hospital admission for highly select small bowel obstruction patients. We hypothesized that the emergency department observation unit small bowel obstruction protocol would reduce admissions, costs, and the total time spent in the hospital without compromising outcomes.

Predicting the Outcome of Non-operative Management of Splenic Trauma in South Africa.

Introduction: We aimed to expand on the global surgical discussion around splenic trauma in order to understand locally and clinically relevant factors for operative (OP) and non-operative management (NOM) of splenic trauma in a South African setting.

Methods: A retrospective cohort study was performed using 2013-2017 data from the Pietermaritzburg Metropolitan Trauma Service. All adult patients (≥15 years) were included.

Disease Severity and Cost in Adhesive Small Bowel Obstruction.

Background: Adhesive small bowel obstruction (ASBO) severity has been associated with important clinical outcomes. However, the impact of ASBO severity on hospitalization cost is unknown. The American Association for the Surgery of Trauma (AAST) developed an Emergency General Surgery (EGS) disease severity grading system for ASBO.

Opioid utilization in minimally invasive versus open inguinal hernia repair.

Background: Open inguinal hernia repair is thought to cause worse postoperative pain than minimally invasive surgery, and thus patients are often prescribed more opioids at discharge. This study evaluates opioid use in inguinal hernia repair patients to optimize discharge prescribing practices for this common procedure.

Methods: Opioid-naive adults undergoing open or minimally invasive surgery inguinal hernia repair were identified prospectively from 3 centers to complete a 29-question telephone interview after discharge as part of a larger initiative.

The cost burden of clinically significant esophageal anastomotic leaks-a steep price to pay.

Objective: The purpose of this retrospective cohort study was to evaluate resource consumption of clinically significant esophageal anastomotic leaks.

Methods: Between September 1, 2008, to December 31, 2014, a prospectively maintained database was queried to identify patients with grade III to IV anastomotic leaks after esophagectomy for esophageal cancer. Inflation-adjusted standardized costs were applied to billed services related to leak diagnosis and treatment, from time of leak detection to resumption of oral diet.

Comparing robotic lung resection with thoracotomy and video-assisted thoracoscopic surgery cases entered into the Society of Thoracic Surgeons database.

Objective: The use of robotic lung surgery has increased dramatically despite being a new, costly technology with undefined benefits over standard of care. There is a paucity of published comparative articles justifying its use or cost. Furthermore, outcomes regarding robotic lung resection are either from single institutions with in-house historical comparisons or based on limited numbers.

The laparoscopic Nissen-Hill hybrid: pilot study of a combined antireflux procedure.

Background: Laparoscopic antireflux surgery is highly effective in patients with uncomplicated gastroesophageal reflux disease (GERD). However, long-term failure rates in paraesophageal hernia (PEH) and Barrett's metaplasia (BE) are higher and warrant a more durable repair. Outcomes for the laparoscopic Nissen fundoplication (LNF) and Hill repair (LHR) are equivalent, but their anatomic components are different and may complement each other (Aye R Ann Thorac Surg, 2012).

A randomized multiinstitution comparison of the laparoscopic Nissen and Hill repairs.

Background: Laparoscopic Hill repair (LHR) and laparoscopic Nissen fundoplication (LNF) are established surgical antireflux procedures but have never been compared in a prospective trial. This trial was designed to compare the effectiveness of LHR against the gold-standard LNF.

Methods: Patients with uncomplicated gastroesophageal reflux from two esophageal centers were randomly assigned and blinded from 2003 to 2007.