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.

Surgical stabilization of rib fractures in conjunction with veno-venous ECMO for traumatic chest wall injury: a multi-institutional case series from the Chest Wall Injury Society (CWIS).

Introduction: Rib fractures are prevalent in 10% of blunt injury admissions and contribute significantly to trauma-related mortality. Severe cases, such as flail segments or multiple displaced fractures, frequently necessitate surgical stabilization of rib fractures (SSRF) to mitigate pain and improve outcomes. Pulmonary contusions, present in about 25% of chest wall injuries, can be exacerbated by severe rib fractures, leading to acute respiratory distress syndrome.

Factors associated with discharge to home after traumatic rib fractures.

Background: Chest wall injury is common among trauma patients. Generally, patients with more medical problems tend to have worse outcomes with rib fractures. Our aim was to determine if surgical stabilization of rib fractures (SSRF) increases the likelihood of discharge to home.

Surgical Infection Society Guidelines for Use of Antimicrobial Agent-Coated Suture to Reduce the Risk of Surgical Site Infection after Abdominal Operation.

Abdominal operation is common as are surgical site infections (SSIs). Triclosan (polychlorophenoxyphenol) is an antimicrobial antiseptic used in a variety of consumer products, including suture. The Surgical Infection Society's Therapeutics and Guidelines Committee convened to perform a systematic review and develop pragmatic recommendations for use of triclosan-coated suture in prevention of SSI after an abdominal surgical procedure.

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.

Thoracostomy for removal of excess fluid in surgical stabilization of rib fractures: the T-REX trial.

Background: Management of the pleural space during and after SSRF is a matter of debate. Tube thoracostomy (TT), intra-operative pleural lavage (PL) and video assisted thoracoscopic surgery (VATS) use varies between surgeons. The purpose of this study is to describe differences in practice patterns of pleural space management (TT, PL, VATS) after SSRF at institutions with extensive experience in chest wall reconstruction.

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.

Breaking waves and cartilage: Surgical management of costal cartilage injuries in surfing-related trauma.

Blunt thoracic trauma, often leading to rib fractures and costal cartilage injuries, is a significant cause of morbidity and mortality in trauma patients. Rib fractures, occurring in up to 40 % of cases, frequently accompany other injuries and are commonly diagnosed. Conversely, costal cartilage fractures are challenging to diagnose, often necessitating advanced imaging techniques, exist on a spectrum from a simple fracture to complete costal margin disruption, and are likely underreported.

Post-discharge complications and follow-up timing after hospitalization for traumatic rib fractures.

Purpose: To evaluate frequency and timing of post-discharge complications in patients with traumatic rib fractures undergoing operative or nonoperative management.

Methods: We retrospectively reviewed adult patients with rib fractures admitted to a Level 1 trauma center from 1/2020 to 12/2021. Outcomes included rib-related complications, pneumonia within 1 month, new diagnosis of opioid- or alcohol-use disorder, and all-cause mortality.

Pleural Space Management in Thoracic Trauma.

Thoracic injuries are common, occurring in up to 60% of polytrauma patients and represent 25% of trauma deaths. Thoracic trauma frequently involves injury to the pleural space resulting in hemothorax and pneumothorax-effective management of the pleural space is essential. Reviewed in this article is management of the pleural space in chest wall trauma (including pneumothorax and hemothorax), and chest tube placement, indications for video-assisted thoracoscopic surgery, management, and complications.

Chest Wall Injury Society recommendations for long-term follow-up after nonoperatively and operatively managed traumatic rib and sternal fractures.

Systematic Review/Meta-analysis; Level IV.

Time to surgical stabilization of rib fractures: does it impact outcomes?

Objectives: Rib fractures are common, morbid, and potentially lethal. Intuitively, if interventions to mitigate downstream effects of rib fractures can be implemented early, likelihood of developing these complications should be reduced. Surgical stabilization of rib fractures (SSRF) is one therapeutic intervention shown to be useful for mitigating complications of these common fractures.

Practical guide to building machine learning-based clinical prediction models using imbalanced datasets.

Clinical prediction models often aim to predict rare, high-risk events, but building such models requires robust understanding of imbalance datasets and their unique study design considerations. This practical guide highlights foundational prediction model principles for surgeon-data scientists and readers who encounter clinical prediction models, from feature engineering and algorithm selection strategies to model evaluation and design techniques specific to imbalanced datasets. We walk through a clinical example using readable code to highlight important considerations and common pitfalls in developing machine learning-based prediction models.

Predicting Increased Incidence of Common Antibiotic-Resistant and Antibiotic-Associated Pathogens Using Ensemble Species Distribution Modeling.

The Centers for Disease Control estimates antibiotic-associated pathogens result in 2.8 million infections and 38 000 deaths annually in the United States. This study applies species distribution modeling to elucidate the impact of environmental determinants of human infectious disease in an era of rapid global change.

An initiative to assess and improve the resources and patient care processes used among Chest Wall Injury Society collaborative centers study (CWIS-CC2).

Background: Over the last two decades, the acute management of rib fractures has changed significantly. In 2021, the Chest Wall injury Society (CWIS) began recognizing centers that epitomize their mission as CWIS Collaborative Centers. The primary aim of this study was to determine the resources, surgical expertise, access to care, and institutional support that are present among centers.

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.