Background
Massive blood transfusion (MBT) following older adult trauma poses unique challenges. Despite extensive evidence on optimal resuscitative strategies in the younger adult patients, there is ...limited research in the older adult population.
Methods
We used the Trauma Quality Improvement Program (TQIP) database from 2013 to 2017 to identify all patients over 65 years old who received a MBT. We stratified our population into six fresh‐frozen plasma:packed red blood cell (FFP:pRBC) ratio cohorts (1:1, 1:2, 1:3, 1:4, 1:5, 1:6+). Our primary outcomes were 24‐h and 30‐day mortality. We constructed multivariable regression models with 1:1 group as the baseline and adjusted for confounders to estimate the independent effect of blood ratios on mortality.
Results
A total of 3134 patients met our inclusion criteria (median age 73 ± 7.6 years, 65% male). On risk‐adjusted multivariable analysis, 1:1 FFP:pRBC ratio was independently associated with lowest 24‐h mortality (1:2 odds ratio OR 1.60, 95% confidence interval CI 1.25–2.06, p < 0.001) and 30‐day mortality (1:2 OR 1.44, 95% CI 1.15–1.80, p = 0.002).
Conclusions
Compared to all other ratios, the 1:1 FFP:pRBC ratio had the lowest 24‐h and 30‐day mortality following older adult trauma consistent with findings in the younger adult population.
Abstract
Background
We investigated key risk factors for hospital admission related to powered scooters, which are modes of transportation with increasing accessibility across the United States (US).
...Methods
We queried the National Electronic Injury Surveillance System (NEISS) for injuries related to powered scooters, obtaining US population projections of injuries and hospital admissions. We determined mechanism of injury, characterized injury types, and performed multivariate regression analyses to determine factors associated with hospital admission.
Results
One thousand one hundred ninety-one patients sustained electric-motorized scooter (e-scooter) injuries and 10.9% (131) required hospitalization from 2013 to 2018. This extrapolated to a US annual total of 862 (95% CI:745–979) scooter injuries requiring hospitalization, with estimated annual mortality of 6.7 patients per year (95% CI:4.8–8.5). The incidence of hospital admissions increased by an average of 13.1% each year of the study period. Fall (79 60%) and motor vehicle collision (33 25%) were the most common mechanism. Injury locations included head (44 34%), lower extremity (22 17%), and lower trunk (16 12%). On multivariable analysis, significant factors associated with admission included increased age (OR 1.02, 95% CI:1.01–1.02), torso injuries (OR 6.19, 2.93–13.10), concussion (25.45, 5.88–110.18), fractures (21.98, 7.13–67.66), musculoskeletal injury (6.65, 1.20–36.99), and collision with vehicle (3.343, 2.009–5.562). Scooter speed, seasonality, and gender were not associated with risk of hospitalization.
Conclusion
Our findings show increased hospital admissions and mortality from powered scooter trauma, with fall and motor vehicle collisions as the most common mechanisms resulting in hospitalization. This calls for improved rider safety measures and regulation surrounding vehicular collision scenarios.
Total pancreatectomy with islet autotransplantation is a therapeutic surgical option for patients with chronic pancreatitis leading to significant reduction in pain, improvement in quality of life, ...and potential for preservation of partial to full endocrine function. Data on the factors associated with short-term morbidities are limited.
We queried the American College of Surgeons National Surgery Quality Improvement Project for patients undergoing total pancreatectomy with islet autotransplantation from 2005 to 2015. We determined 30-day morbidity and mortality and performed univariate and multivariate analysis to determine the preoperative and intraoperative factors associated with development of postoperative infectious complications.
The rate of 30-day postoperative morbidity in 384 patients undergoing total pancreatectomy with islet autotransplantation was 36% with an overall mortality of 1%. Postoperative infectious complications developed in 29% of patients and were associated with increased operative time (P = .016),and higher postoperative wound class (P = .045). After risk adjustment, only increased operative time was independently associated with increased rates of infectious complications (OR=1.1, 95% CI = 1.01-1.13, P = .02).
Total operative time is independently associated with increased postoperative infectious complications in total pancreatectomy with islet autotransplantation. Future interventions aimed at optimizing islet isolation, surgical approach, and refinement of patient selection criteria present opportunities for reducing operative time and potentially reducing the morbidity of this surgical procedure.
•Chronic pancreatitis can result in lifelong debilitating pain.•Total pancreatectomy with islet autotransplantation (TPIAT) is a unique option for those with intractable pain.•TPIAT is associated with high postoperative morbidity due to infectious complications.•Preoperative electrolyte imbalances are associated with postoperative infection.•Operative time is an independent predictor of infectious complications.
We report long‐term follow‐up of a patient who underwent a tailored laparoscopic procedure for symptomatic cholelithiasis, massive splenomegaly, and a planned pregnancy. There were no complications, ...and the patient remained symptom‐free at the 5‐year follow‐up. We supplemented our case report with national surgical data demonstrating the safety of laparoscopic splenectomy.
Laparoscopic splenectomy is a safe and effective approach for patients with immune thrombocytopenic purpura, even those with massive splenomegaly. We highlight the benefits of tailoring the surgical approach to address the patient's surgical needs.
The administration of 4-factor prothrombin complex concentrate (4F-PCC) has expanded beyond its Food and Drug Administration (FDA)-approved indication for the emergent reversal of vitamin K ...antagonists (VKAs). Therefore, this study aimed to evaluate the risks and benefits associated with the expanded use of 4F-PCC. We conducted a single-center retrospective review of 4F-PCC administrations at our university hospital. Of the 159 patients who received 4F-PCC, 76% (n = 121) and 24% (n = 38) received it for the FDA-approved indication in the vitamin K-related coagulopathy (VKA) group and for expanded use in the nonvitamin K-related coagulopathy (nVKA) group, respectively. The expanded use of 4F-PCC was associated with a less robust reduction in the international normalized ratio (INR) (INR of −0.7 ± 1.3 vs INR of −1.6 ± 1.8, P = .002), and fewer patients in the nVKA group achieved a postadministration INR of less than1.5 (11% vs 79%, P = .001) than those in the VKA group. Furthermore, the 30-day mortality rate was significantly higher in the nVKA cohort than in the VKA cohort (42% vs 20%, P = .04). Notably, based on our data, underlying differences in the patient’s comorbidities, particularly advanced liver disease, may have contributed to the observed outcome variations, including mortality rate. Therefore, factors, including comorbidities and the underlying etiology of coagulopathy, should be considered when deciding on the expanded use of 4F-PCC. Further research is needed to better understand the potential risks and benefits of 4F-PCC in expanded use scenarios, and the clinical decision to use 4F-PCC outside its FDA-approved indication should be made carefully, considering this information.
Urgent abdominal colectomy is indicated for patients with fulminant
infection (CDI) when other medical therapies fail, yet mortality remains high. Fecal microbiota transplant is a less invasive ...alternative approach for patients with fulminant CDI. We report the 30-day complications of patients with fulminant CDI who underwent either abdominal colectomy, fecal microbiota transplantation (FMT), or FMT followed by abdominal colectomy (FMT-CO). Methods
We performed a single-center, retrospective case review of combined medical and surgical patients with CDI at a large academic medical center between 2008 and 2016. Cohorts were identified as patients with fulminant CDI who underwent total abdominal colectomy alone (CO), FMT alone (FMT), or FMT-CO. We analyzed patient demographics, history, comorbidities, clinical and laboratory variables, CDI severity scores, and mortality outcomes at 30 days. Results
We identified 5,150 patients with CDI at our center during the review period; 16 patients met the criteria for fulminant CDI and were included in this study, with four patients in the CO cohort, eight patients in the FMT cohort, and four patients in the FMT-CO cohort. Demographics and CDI severity scores were similar for all three groups, although the selected comorbidity profiles differed significantly among the three cohorts. The 30-day mortality rates for patients in the CO, FMT, and FMT-CO groups were 25%, 12.5%, and 25%, respectively.
FMT is an alternative or adjunctive therapy to colectomy for patients with fulminant CDI that is not associated with increased mortality. Implementation of FMT protocols in clinical practice would be dependent on the availability of qualified transplant material and successful early identification of patients likely to benefit from FMT.
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