Publications by authors named "Charudutt N Paranjape"
Background: The quantitative effect of frailty on post-operative complications in older adults undergoing surgical emergencies is not well understood.
Methods: The 2013-2019ACS-NSQIP database was used to identify emergency laparotomy patients≥65 years. Frailty was measured using the modified-frailty-index-5 factors (mFI-5).
Objective: Although data concerning resident involvement in emergency general surgery (EGS) procedures is abundant, its impact on outcomes in the vulnerable older adult population has not been explored. This study aimed to assess the impact of resident involvement on postoperative outcomes in older adult patients undergoing EGS.
Design: Propensity-score matched cohort study.
Background: Pulmonary contusion (PC) is considered a relative contraindication to surgical stabilization of rib fractures (SSRF). This study compared outcomes in patients undergoing SSRF vs. non-operative management (NOM).
View Article and Find Full Text PDFBackground: Emergency resuscitative thoracotomy survival rates range widely depending on the mechanism of injury and signs of life at presentation. Given ongoing shortages of blood products, we sought to examine blood product use across this patient population and corresponding survival.
Methods: We identified patients in the American College of Surgeons-Trauma Quality and Improvement Program (2017-2019) undergoing an emergency resuscitative thoracotomy within 30 minutes of hospital arrival.
Background: Intraoperative adverse events (iAEs) during general surgery can lead to significant morbidity and healthcare burden, yet their impact remains underexplored. We aimed to estimate the nationwide incidence of iAEs in general surgery and explore their associations with mortality, complications, length of stay, and costs.
Methods: We conducted a retrospective cohort study using the Nationwide Readmissions Database 2019 and included adult patients (aged 18 years and older) who underwent general surgical procedures.
Background: The Predictive Optimal Trees in Emergency Surgery Risk (POTTER) calculator, a widely used interpretable artificial intelligence risk calculator, has been validated in population-based studies and shown to predict outcomes in patients who underwent emergency general surgery better than surgeons. We sought to prospectively validate POTTER.
Study Design: Patients undergoing an emergency exploratory laparotomy for nontrauma indications at 2 academic medical centers between June 2020 and March 2022 were included.
Introduction: Racial and ethnic disparities in emergency general surgery (EGS) patients have been well described in the literature. Nonetheless, the burden of these disparities, specifically within the more vulnerable older adult population, is relatively unknown. This study aims to investigate racial and ethnic disparities in clinical outcomes among older adult patients undergoing EGS.
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- Obesity is a growing issue, particularly in emergency general surgery (EGS), where its effects on postoperative outcomes and decision-making are not fully understood.
- Analyzed data from nearly 79,000 EGS patients revealed that higher obesity classes, especially class III, increased risks for postoperative complications, prolonged surgeries, and longer hospital stays.
- The study indicates a clear link between obesity class and various surgical outcomes, highlighting the need for further research on how BMI influences surgical strategies and costs.
Article Synopsis
- Care fragmentation in elderly patients post-hospital discharge is linked to higher morbidity and mortality, necessitating a study to identify contributing factors and their relation to mortality rates.
- A retrospective analysis of over 447,000 patients showed that 24.3% faced unplanned readmissions within 90 days, with 20.8% experiencing care fragmentation, particularly among older females.
- Factors like living in rural areas, low-income neighborhoods, and specific discharge decisions significantly predicted care fragmentation, which correlates with increased mortality rates in this population.
Background: Emergency general surgery performed among patients over 65 years of age represents a particularly high-risk population. Although interhospital transfer has been linked to higher mortality in emergency general surgery patients, its impact on outcomes in the geriatric population remains uncertain. We aimed to establish the effect of interhospital transfer on postoperative outcomes in geriatric emergency general surgery patients.
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- This study investigated if lower extremity amputation in civilian injuries increases the risk of venous thromboembolism (VTE), specifically pulmonary embolism (PE) and deep vein thrombosis (DVT).
- Researchers analyzed data from over 145,000 patients with severe leg injuries, comparing those who underwent amputation with those who had limb salvage.
- Findings showed that amputee patients had significantly higher rates of both PE (4.2% vs. 2.5%) and DVT (6.5% vs. 3.4%), highlighting the increased risk of VTE after traumatic limb loss.
Background: Current guidelines for sigmoid volvulus recommend endoscopy as a first line of treatment for decompression, followed by colectomy as early as possible. Timing of the latter varies greatly. This study compared early (≤2 days) versus delayed (>2 days) sigmoid colectomy.
View Article and Find Full Text PDFBackground: Early surgical stabilization of rib fractures (SSRF) is associated with improved inpatient outcomes in patients with multiple rib fractures. However, there is still a paucity of data examining the optimal timing of SSRF in patients with concomitant traumatic brain injury (TBI). This study aimed to assess whether earlier SSRF was associated with improved outcomes in patients with multiple rib fractures and TBI.
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- Patients undergoing lower limb amputation after trauma have a high risk of venous thromboembolism (VTE), leading to a debate on the best medication for prevention.
- Researchers analyzed data from over 4,100 trauma patients who received either unfractionated heparin or low-molecular-weight heparin to see which was more effective at preventing VTE.
- The study concluded that low-molecular-weight heparin significantly reduced the rates of VTE compared to unfractionated heparin, making it the better choice for thromboprophylaxis in this patient group.
Background: Complex machine learning (ML) models have revolutionized predictions in clinical care. However, for laparoscopic colectomy (LC), prediction of morbidity by ML has not been adequately analyzed nor compared against traditional logistic regression (LR) models.
Methods: All LC patients, between 2017 and 2019, in the National Surgical Quality Improvement Program (NSQIP) were identified.
Introduction: Elderly patients are frequently presenting with emergency surgical conditions. The open abdomen technique is widely used in abdominal emergencies needing rapid control of intrabdominal contamination. However, specific predictors of mortality identifying candidates for comfort care are understudied.
View Article and Find Full Text PDFRevisiting abdominal closure in mesenteric ischemia: is there an association with outcome?
Eur J Trauma Emerg Surg
October 2023
Purpose: Current guidelines advocate liberal use of delayed abdominal closure in patients with acute mesenteric ischemia (AMI) undergoing laparotomy. Few studies have systematically examined this practice. The goal of this study was to evaluate the effect of delayed abdominal closure on postoperative morbidity and mortality in patients with AMI.
View Article and Find Full Text PDFTiming and choice of systemic anticoagulation in the setting of extremity arterial injury repair.
Eur J Trauma Emerg Surg
February 2023
Purpose: The role of perioperative anticoagulation in the setting of peripheral arterial injury remains unclear. We hypothesized that early initiation of anticoagulation is associated with a reduced amputation rate without increasing bleeding complications.
Methods: Using the 2016-2019 ACS-TQIP database, adult patients with upper and lower extremity vascular injuries who underwent open arterial repair and received anticoagulation were included.
Background: Abdominal wall hernias represent a common problem that can present as surgical emergencies with increased morbidity and mortality. The data examining outcomes in elderly patients with hernia emergencies is scant.
Methods: The 2007-2017 ACS-NSQIP database was queried.
Background: COVID-19 is a deadly multisystemic disease, and bowel ischemia, the most consequential gastrointestinal manifestation, remains poorly described. Our goal is to describe our institution's surgical experience with management of bowel ischemia due to COVID-19 infection over a one-year period.
Methods: All patients admitted to our institution between March 2020 and March 2021 for treatment of COVID-19 infection and who underwent exploratory laparotomy with intra-operative confirmation of bowel ischemia were included.
Preventable Morbidity and Mortality Among Non-trauma Emergency Surgery Patients: The Role of Personal Performance and System Flaws in Adverse Events.
World J Surg
March 2021
Background: Preventable morbidity and mortality among emergency surgery patients is not adequately analyzed. We aim to describe and classify preventable complications and deaths in this population.
Methods: The medical records and quality control documents of patients with emergency, non-trauma, surgical disease admitted between September 1, 2006, and August 31, 2018, and recorded to have a preventable or potentially preventable morbidity and mortality were reviewed.