Diversity and Expertise Among Authors of U.S. Surgical Society Clinical Guidelines.

BackgroundClinical practice guidelines (CPGs) shape surgical care and outcomes, but concerns persist regarding the diversity and expertise of their authors. Whether U.S.

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.

Factors associated with in-hospital amputation after revascularization for lower extremity trauma.

ObjectivesWhile concomitant vascular injury is associated with an increased risk of amputation following lower extremity trauma, risk factors for amputation after attempted revascularization are lesser known. In centers where dedicated vascular traumatic expertise is not available, a lack of guidance regarding high-risk vascular trauma may limit efforts to appropriately triage and transfer patients to a higher level of care. We identified factors associated with in-hospital amputation after revascularization for isolated lower extremity trauma.

CT pan-scanning versus targeted imaging among older adults after ground level falls.

Background: Ground level falls (GLFs) among older adults are responsible for millions of injuries. Routine pan-scanning (CT imaging of the head, chest, abdomen and pelvis) is commonly employed; however, we lack robust evidence of its benefit. We investigated whether pan-scanning identifies a larger proportion of patients with significant injury or injury requiring procedural intervention and hypothesized resuscitation area findings-including radiographs, ultrasound, and external signs of injury-would detect these injuries.

Racial and Ethnic Disparities in Child Abuse Identification and Inpatient Treatment.

Importance: Child abuse is a leading cause of morbidity in early childhood. Accurate detection remains challenging.

Objective: To describe racial and ethnic disproportionalities in suspicion for child abuse (SCA) in pediatric patients admitted after traumatic injury.

Comparative Analysis of Frailty Scores for Predicting Adverse Outcomes in Hip Fracture Patients: Insights from the United States National Inpatient Sample.

The aim of the current investigation was to compare the ability of several frailty scores to predict adverse outcomes in hip fracture patients. All adult patients (18 years or older) who suffered a hip fracture due to a fall and underwent surgical fixation were extracted from the 2019 National Inpatient Sample (NIS) Database. A combination of logistic regression and bootstrapping was used to compare the predictive ability of the Orthopedic Frailty Score (OFS), the Nottingham Hip Fracture Score (NHFS), the 11-factor modified Frailty Index (11-mFI) and 5-factor (5-mFI) modified Frailty Index, as well as the Johns Hopkins Frailty Indicator.

The burden of readmissions after rib fractures among older adults.

Background: The index hospitalization morbidity and mortality of rib fractures among older adults (aged ≥65 years) is well-known, yet the burden and risks for readmissions after rib fractures in this vulnerable population remain understudied. We aimed to characterize the burdens and etiologies associated with 3-month readmissions among older adults who suffer rib fractures. We hypothesized that readmissions would be common and associated with modifiable etiologies.

Palliative Intervention for Malignant Bowel Obstruction Comes at a Cost: A National Inpatient Study.

Malignant bowel obstruction (MBO) due to peritoneal carcinomatosis (PC) is associated with poor outcomes. Optimal management for palliation remains unclear. This study aims to characterize nonoperative, procedural, and operative management strategies for MBO and evaluate its association with mortality and cost.

Angioembolization for splenic injuries: does it help? Retrospective evaluation of grade III-V splenic injuries at two level I trauma centers.

Background: Splenic angioembolization (SAE) has increased in utilization for blunt splenic injuries. We hypothesized lower SAE usage would not correlate with higher rates of additional intervention or mortality when choosing initial non-operative management (NOM) or surgery.

Study Design: Trauma registries from two level I trauma centers from 2010 to 2020 were used to identify patients aged >18 years with grade III-V blunt splenic injuries.

Management of Uncomplicated Appendicitis in Adults: A Nationwide Analysis From 2018 to 2019.

Introduction: Nonoperative management (NOM) of uncomplicated appendicitis (UA) has been increasingly utilized in recent years. The aim of this study was to describe nationwide trends of sociodemographic characteristics, outcomes, and costs of patients undergoing medical versus surgical management for UA.

Methods: The 2018-2019 National (Nationwide) Inpatient Sample was queried for adults (age ≥18 y) with UA; diagnosis, as well as laparoscopic and open appendectomy, were defined by the International Classification of Diseases, 10th Revision, Clinical Modification codes.

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.

Rates and risk factors for anastomotic leak following blunt trauma-associated bucket handle intestinal injuries: a multicenter study.

Objectives: The risk factors for anastomotic leak (AL) after resection and primary anastomosis for traumatic bucket handle injury (BHI) have not been previously defined. This multicenter study was conducted to address this knowledge gap.

Methods: This is a multicenter retrospective study on small intestine and colonic BHIs from blunt trauma between 2010 and 2021.

The relationship and predictive value of dementia and frailty for mortality in patients with surgically managed hip fractures.

Background: Both dementia and frailty have been associated with worse outcomes in patients with hip fractures. However, the interrelation and predictive value of these two entities has yet to be clarified. The current study aimed to investigate the predictive relationship between dementia, frailty, and in-hospital mortality after hip fracture surgery.

Impact of Medicaid Expansion and Firearm Legislation on Cost of Firearm Injuries.

Introduction: Firearm injury-related hospitalizations in the U.S. cost $900 million annually.

Validation of the orthopedic frailty score for measuring frailty in hip fracture patients: a cohort study based on the United States National inpatient sample.

Background: The Orthopedic Frailty Score (OFS) has been proposed as a tool for measuring frailty in order to predict short-term postoperative mortality in hip fracture patients. This study aims to validate the OFS using a large national patient register to determine its relationship with adverse outcomes as well as length of stay and cost of hospital stay.

Methods: All adult patients (18 years or older) registered in the 2019 National Inpatient Sample Database who underwent emergency hip fracture surgery following a traumatic fall were eligible for inclusion.

Anastomotic leak rates after repair of mesenteric bucket-handle injuries: A multi-center retrospective cohort study.

Background: Primary aim was to assess the relative risk (RR) of anastomotic leak (AL) in intestinal bucket-handle (BH) compared to non-BH injury.

Methods: Multi-center study comparing AL in BH from blunt trauma 2010-2021 compared to non-BH intestinal injuries. RR was calculated for small bowel and colonic injury using R.

Disparities in detection of suspected child abuse.

Background: Child abuse is a significant cause of injury and death among children, but accurate identification is often challenging. This study aims to assess whether racial disparities exist in the identification of child abuse.

Methods: The 2010-2014 and 2016-2017 National Trauma Data Bank was queried for trauma patients ages 1-17.

A National Evaluation of Emergency General Surgery Outcomes Among Hospitalized Cardiac Patients.

Introduction: Emergency general surgery among cardiac surgery patients is increasingly common and consequential. We sought to characterize the true burden of emergency general surgery among hospitalized complex cardiac patients.

Methods: We performed a retrospective analysis of the 2016-2017 National Inpatient Sample.

DeepBackRib: Deep learning to understand factors associated with readmissions after rib fractures.

Background: Deep neural networks yield high predictive performance, yet obscure interpretability limits clinical applicability. We aimed to build an explainable deep neural network that elucidates factors associated with readmissions after rib fractures among nonelderly adults, termed DeepBackRib . We hypothesized that DeepBackRib could accurately predict readmissions and a game theoretic approach to elucidate how predictions are made would facilitate model explainability.

Explainable Machine Learning to Bring Database to the Bedside: Development and Validation of the TROUT (Trauma fRailty OUTcomes) Index, a Point-of-Care Tool to Prognosticate Outcomes After Traumatic Injury Based on Frailty.

Objective: Exemplify an explainable machine learning framework to bring database to the bedside; develop and validate a point-of-care frailty assessment tool to prognosticate outcomes after injury.

Background: A geriatric trauma frailty index that captures only baseline conditions, is readily-implementable, and validated nationwide remains underexplored. We hypothesized Trauma fRailty OUTcomes (TROUT) Index could prognosticate major adverse outcomes with minimal implementation barriers.

Effect of Seasonality on Variation Among Patients Presenting With Rib Fractures in the United States.

Background: A prior single-site study from the Midwest exploring seasonality of traumatic rib fractures found injuries are more common during summer months and lower in winter months. There have been no modern studies evaluating seasonality of these common injuries nationally. Our aim was to describe temporal and spatial distribution of rib fractures in the United States.

A decade of hospital costs for firearm injuries in the United States by region, 2005-2015: government healthcare costs and firearm policies.

Background: Firearm injuries are a costly, national public health emergency, and government-sponsored programs frequently pay these hospital costs. Understanding regional differences in firearm injury burden may be useful for crafting appropriate policies, especially with widely varying state gun laws.

Objective: To estimate the volume of, and hospital costs for, fatal and non-fatal firearm injuries from 2005 to 2015 for each region of the United States and analyze the proportionate cost by payer status.

Infection with Two Multi-Drug-Resistant Organisms in Solid Organ Transplant Patients Is Associated with Increased Mortality and Prolonged Hospitalization.

Solid organ transplant recipients have several risk factors for peri-operative multi-drug-resistant infection: their immune system is dampened as a result of critical illness and surgical stress that may be further impaired by induction immunotherapy and broad-spectrum antibiotic prophylaxis promotes selection for resistant pathogens. Infection with multi-drug-resistant organisms (MDRO) results in morbidity and mortality for solid organ transplant recipients. To assess in-hospital mortality and hospitalization duration associated with these infections, we analyzed cross-sectional, retrospective data from the 2016 Agency for Healthcare and Quality, Healthcare Cost and Utilization Project's National Inpatient Sample.

Building a Trainee-led Research Community to Propel Academic Productivity in Health Services Research.

Academic productivity is an increasingly important asset for trainees pursuing academic careers. Medical schools and graduate medical education programs offer structured research programs, but providing longitudinal and individualized health services research education remains challenging. Whereas in basic science research, members at multiple training levels support each other within a dedicated community (the laboratory), health services research projects frequently occur within individual faculty-trainee relationships.