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Changoor NR, Ortega G, Ekladios M, Zogg CK, Cornwell EE, Haider AH. Racial disparities in surgical outcomes: Does the level of resident surgeon play a role? Surgery 2015; 158:547-55. [DOI: 10.1016/j.surg.2015.03.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 03/13/2015] [Accepted: 03/14/2015] [Indexed: 12/21/2022]
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Haider AH, Piper LC, Zogg CK, Schneider EB, Orman JA, Butler FK, Gerhardt RT, Haut ER, Mather JP, MacKenzie EJ, Schwartz DA, Geyer DW, DuBose JJ, Rasmussen TE, Blackbourne LH. Military-to-civilian translation of battlefield innovations in operative trauma care. Surgery 2015. [PMID: 26210224 DOI: 10.1016/j.surg.2015.06.026] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Historic improvements in operative trauma care have been driven by war. It is unknown whether recent battlefield innovations stemming from conflicts in Iraq/Afghanistan will follow a similar trend. The objective of this study was to survey trauma medical directors (TMDs) at level 1-3 trauma centers across the United States and gauge the extent to which battlefield innovations have shaped civilian practice in 4 key domains of trauma care. METHODS Domains were determined by the use of a modified Delphi method based on multiple consultations with an expert physician/surgeon panel: (1) damage control resuscitation (DCR), (2) tourniquet use, (3) use of hemostatic agents, and (4) prehospital interventions, including intraosseous catheter access and needle thoracostomy. A corresponding 47-item electronic anonymous survey was developed/pilot tested before dissemination to all identifiable TMD at level 1-3 trauma centers across the US. RESULTS A total of 245 TMDs, representing nearly 40% of trauma centers in the United States, completed and returned the survey. More than half (n = 127; 51.8%) were verified by the American College of Surgeons. TMDs reported high civilian use of DCR: 95.1% of trauma centers had implemented massive transfusion protocols and the majority (67.7%) tended toward 1:1:1 packed red blood cell/fresh-frozen plasma/platelets ratios. For the other 3, mixed adoption corresponded to expressed concerns regarding the extent of concomitant civilian research to support military research and experience. In centers in which policies reflecting battlefield innovations were in use, previous military experience frequently was acknowledged. CONCLUSION This national survey of TMDs suggests that military data supporting DCR has altered civilian practice. Perceived relevance in other domains was less clear. Civilian academic efforts are needed to further research and enhance understandings that foster improved trauma surgeon awareness of military-to-civilian translation.
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Affiliation(s)
- Adil H Haider
- Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Department of Surgery, Brigham & Women's Hospital, Boston, MA.
| | - Lydia C Piper
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Cheryl K Zogg
- Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Department of Surgery, Brigham & Women's Hospital, Boston, MA
| | - Eric B Schneider
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jean A Orman
- Department of Medicine, Uniformed Services University of Health Sciences, Washington, DC
| | - Frank K Butler
- Department of Military and Emergency Medicine, Uniformed Services University of Health Sciences, Bethesda, MD
| | - Robert T Gerhardt
- Department of Emergency Medicine, Brooke Army Medical Center, JBSA-Fort Sam Houston, Houston, TX
| | - Elliott R Haut
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jacques P Mather
- Department of General Surgery, University of Miami/Jackson Memorial Medical Center, Miami, FL
| | - Ellen J MacKenzie
- Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Diane A Schwartz
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - David W Geyer
- Department of Anesthesiology, Reading Health System, West Reading, PA
| | - Joseph J DuBose
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Todd E Rasmussen
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Lorne H Blackbourne
- Department of Surgery, Brooke Army Medical Center, JBSA-Fort Sam Houston, Houston, TX
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203
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Zogg CK, Mungo B, Lidor AO, Stem M, Rios Diaz AJ, Haider AH, Molena D. Influence of body mass index on outcomes after major resection for cancer. Surgery 2015; 158:472-85. [PMID: 26008961 DOI: 10.1016/j.surg.2015.02.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 02/15/2015] [Accepted: 02/21/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Evidence supporting worse outcomes among obese patients is inconsistent. This study examined associations between body mass index (BMI) and outcomes after major resection for cancer. METHODS Data from the 2005-2012 ACS-NSQIP were used to identify cancer patients (≥18 years) undergoing 1 of 6 major resections: lung surgery, esophagectomy, hepatectomy, gastrectomy, colectomy, or pancreatectomy. We used crude and multivariable regression to compare differences in 30-day mortality, serious and overall morbidity, duration of stay, and operative time among 3 BMI cohorts defined by the World Health Organization: normal versus underweight, overweight-obese I, and obese II-III. Propensity-scored secondary assessment and resection type-specific stratified analyses corroborated results. RESULTS A total of 529,955 patients met inclusion criteria; 32.06% had normal BMI, 3.45% were underweight, 32.52% overweight, and 17.76%, 7.51%, and 4.94% obese I-III, respectively. Risk-adjusted outcomes for underweight patients consistently were worse. Overweight-obese I fared similarly to patients with normal BMI but had greater odds of isolated complications. Obese II-III patients experienced only marginally increased odds of morbidity. Analyses among propensity-scored cohorts and stratified by cancer-resection type reported similar trends. Worse outcomes were observed among morbidly obese hepatectomy and pancreatectomy patients. CONCLUSION Evidence-based assessment of outcomes after major resection for cancer suggests that obese patients should be treated with the aim for optimal oncologic standards without being hindered by a misleading perception of prohibitively increased perioperative risk. Underweight and certain types of morbidly obese patients require targeted provision of appropriate care.
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Affiliation(s)
- Cheryl K Zogg
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard School of Public Health, Boston, MA; Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Benedetto Mungo
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD
| | - Anne O Lidor
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Miloslawa Stem
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Arturo J Rios Diaz
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard School of Public Health, Boston, MA
| | - Adil H Haider
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard School of Public Health, Boston, MA
| | - Daniela Molena
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD.
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204
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Shah AA, Haider AH, Riviello R, Zogg CK, Zafar SN, Latif A, Rios Diaz AJ, Rehman Z, Zafar H. Geriatric emergency general surgery: Survival and outcomes in a low-middle income country. Surgery 2015; 158:562-9. [PMID: 25999249 DOI: 10.1016/j.surg.2015.03.045] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 03/20/2015] [Accepted: 03/31/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND Geriatric patients remain largely unstudied in low-middle income health care settings. The purpose of this study was to compare the epidemiology and outcomes of older versus younger adults with emergency general surgical conditions in South Asia. METHODS Discharge data from March 2009 to April 2014 were obtained for all adult patients (≥16 years) with an International Classification of Diseases, 9th revision, Clinical Modification diagnosis codes consistent with an emergency general surgery condition as defined by the American Association for the Surgery of Trauma. Multivariable regression analyses compared patients >65 years of age with patients ≤65 years for differences in all-cause mortality, major complications, and duration of hospital stay. Models were adjusted for potential confounding owing to patient demographic and clinical case-mix data with propensity scores. RESULTS We included 13,893 patients; patients >65 years constituted 15% (n = 2,123) of the cohort. Relative to younger patients, older adults were more likely to present with a number of emergency general surgery conditions, including gastrointestinal bleeding (odds ratio OR [95% CI], 2.63[1.99-3.46]), resuscitation (2.17 [1.67-2.80]), and peptic ulcer disease (2.09 [1.40-3.10]). They had an 89% greater risk-adjusted odds (1.89 [1.55-2.29]) of complications and a 63% greater odds (1.63 [1.21-2.20]) of mortality. Restricted to patients undergoing operative interventions, older adults had 95% greater odds (1.95 [1.29-2.94]) of complications and 117% greater odds (2.17 [1.62-2.91]) of mortality. CONCLUSION Understanding unique needs of geriatric patients is critical to enhancing the management and prioritization of appropriate care in developing settings.
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Affiliation(s)
- Adil A Shah
- Department of Surgery, Aga Khan University, Karachi, Pakistan; Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Adil H Haider
- Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA.
| | - Robert Riviello
- Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Cheryl K Zogg
- Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Syed Nabeel Zafar
- Department of Surgery, Howard University College of Medicine, Washington, DC
| | - Asad Latif
- Center for Global Health, Johns Hopkins University, Baltimore, MD
| | - Arturo J Rios Diaz
- Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Zia Rehman
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Hasnain Zafar
- Department of Surgery, Aga Khan University, Karachi, Pakistan
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Kodadek LM, Selvarajah S, Velopulos CG, Haut ER, Haider AH. Undertriage of older trauma patients: is this a national phenomenon? J Surg Res 2015; 199:220-9. [PMID: 26070496 DOI: 10.1016/j.jss.2015.05.017] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 03/01/2015] [Accepted: 05/12/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND Older age is associated with high rates of morbidity and mortality after injury. Statewide studies suggest significantly injured patients aged ≥55 y are commonly undertriaged to lower level trauma centers (TCs) or nontrauma centers (NTCs). This study determines whether undertriage is a national phenomenon. MATERIALS AND METHODS Using the 2011 Nationwide Emergency Department Sample, significantly injured patients aged ≥55 y were identified by diagnosis and new injury severity score (NISS) ≥9. Undertriage was defined as definitive care anywhere other than level I or II TCs. Weighted descriptive analysis compared characteristics of patients by triage status. Multivariable logistic regression determined predictors of undertriage, controlling for hospital characteristics, injury severity, and comorbidities. RESULTS Of 4,152,541 emergency department (ED) visits meeting inclusion criteria, 74.0% were treated at lower level TCs or NTCs. Patients at level I and II TCs more commonly had NISS ≥9 (22.2% versus 12.3%, P < 0.001), but among all patients with NISS ≥9, 61.3% were undertriaged to a lower level TC or a NTC. On multivariable logistic regression, factors independently associated with higher odds of being undertriaged were increasing age, female gender, and fall-related injuries. A subgroup analysis examined urban and suburban areas only where access to a TC is more likely and found that 55.8% of patients' age were undertriaged. CONCLUSIONS There is substantial undertriage of patients aged ≥55 y nationwide. Over half of significantly injured older patients are not treated at level I or II TCs. The impact of undertriage should be determined to ensure older patients receive trauma care at the optimal site.
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Affiliation(s)
- Lisa M Kodadek
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Shalini Selvarajah
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Catherine G Velopulos
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elliott R Haut
- Division of Trauma and Acute Care Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Adil H Haider
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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206
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Haring RS, Canner JK, Asemota AO, George BP, Selvarajah S, Haider AH, Schneider EB. Trends in incidence and severity of sports-related traumatic brain injury (TBI) in the emergency department, 2006-2011. Brain Inj 2015; 29:989-92. [PMID: 25962926 DOI: 10.3109/02699052.2015.1033014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To characterize and identify trends in sports-related traumatic brain injury (TBI) emergency department (ED) visits from 2006-2011. METHODS This study reviewed data on sports-related TBI among individuals under age 65 from the Nationwide Emergency Department Sample from 2006-2011. Visits were stratified by age, sex, injury severity, payer status and other criteria. Variations in incidence and severity were examined both between groups and over time. Odds of inpatient admission were calculated using regression modelling. RESULTS Over the period examined, 489 572 sports-related TBI ED visits were reported. The majority (62.2%) of these visits occurred among males under the age of 18. The average head Abbreviated Injury Severity score among these individuals was 1.93 (95% CI = 1.93-1.94) and tended to be lowest among those in middle school and high school age groups; these were also less likely to be admitted. The absolute annual number of visits grew 65.9% from 2006 until 2011, with the majority of this growth occurring among children under age 15. Hospitalization rates dropped 35.6% over the same period. CONCLUSION Changes in year-over-year presentation rates vs. hospitalization rates among young athletes suggest that players, coaches and parents may be more aware of sports-related TBI and have developed lower thresholds for seeking medical attention.
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Affiliation(s)
- R Sterling Haring
- Johns Hopkins Bloomberg School of Public Health , Baltimore, MD , USA
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207
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Losonczy LI, Weygandt PL, Villegas CV, Hall EC, Schneider EB, Cooper LA, Cornwell EE, Haut ER, Efron DT, Haider AH. The severity of disparity: increasing injury intensity accentuates disparate outcomes following trauma. J Health Care Poor Underserved 2015; 25:308-20. [PMID: 24509028 DOI: 10.1353/hpu.2014.0021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Studies have shown disparities in mortality among racial groups and among those with differing insurance coverage. Our goal was to determine if injury severity affects these disparities. METHODS We classified patients from the 2003-2008 National Trauma Data Banks suffering moderate to severe injuries into six groups based on race/ethnicity and insurance, stratifying by injury severity. Logistic regression compared odds of death between races-ethnicities/insurance groups within these strata. We adjusted for age, gender, Injury Severity Score, Glasgow Coma Scale motor component, hypotension, and mechanism of injury. RESULTS Patients meeting inclusion criteria numbered 760,598. Disparities between races-ethnicities/insurance groups increased as injury severity worsened. Odds of death for uninsured Black patients compared with insured Whites increased from 1.82 among moderately injured patients to 3.14 among severely injured, hypotensive patients. A similar pattern was seen among uninsured Hispanic patients. CONCLUSIONS Disparities in trauma mortality suffered by minority and uninsured patients, when compared with non-minority and insured patients, worsen with increasing injury.
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208
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Hall EC, Hashmi ZG, Zafar SN, Zogg CK, Cornwell EE, H. Haider A. Racial/ethnic disparities in emergency general surgery: explained by hospital-level characteristics? Am J Surg 2015; 209:604-9. [DOI: 10.1016/j.amjsurg.2014.11.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 09/24/2014] [Accepted: 11/13/2014] [Indexed: 10/24/2022]
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209
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Haider AH, Schneider EB, Sriram N, Scott VK, Swoboda SM, Zogg CK, Dhiman N, Haut ER, Efron DT, Pronovost PJ, Freischlag JA, Lipsett PA, Cornwell EE, MacKenzie EJ, Cooper LA. Unconscious Race and Class Biases among Registered Nurses: Vignette-Based Study Using Implicit Association Testing. J Am Coll Surg 2015; 220:1077-1086.e3. [PMID: 25998083 DOI: 10.1016/j.jamcollsurg.2015.01.065] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 01/21/2015] [Accepted: 01/26/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Implicit bias is an unconscious preference for a specific social group that can have adverse consequences for patient care. Acute care clinical vignettes were used to examine whether implicit race or class biases among registered nurses (RNs) impacted patient-management decisions. STUDY DESIGN In a prospective study conducted among surgical RNs at the Johns Hopkins Hospital, participants were presented 8 multi-stage clinical vignettes in which patients' race or social class were randomly altered. Registered nurses were administered implicit association tests (IATs) for social class and race. Ordered logistic regression was then used to examine associations among treatment differences, race, or social class, and RN's IAT scores. Spearman's rank coefficients comparing RN's implicit (IAT) and explicit (stated) preferences were also investigated. RESULTS Two hundred and forty-five RNs participated. The majority were female (n=217 [88.5%]) and white (n=203 [82.9%]). Most reported that they had no explicit race or class preferences (n=174 [71.0%] and n=108 [44.1%], respectively). However, only 36 nurses (14.7%) demonstrated no implicit race preference as measured by race IAT, and only 16 nurses (6.53%) displayed no implicit class preference on the class IAT. Implicit association tests scores did not statistically correlate with vignette-based clinical decision making. Spearman's rank coefficients comparing implicit (IAT) and explicit preferences also demonstrated no statistically significant correlation (r=-0.06; p=0.340 and r=-0.06; p=0.342, respectively). CONCLUSIONS The majority of RNs displayed implicit preferences toward white race and upper social class patients on IAT assessment. However, unlike published data on physicians, implicit biases among RNs did not correlate with clinical decision making.
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Affiliation(s)
- Adil H Haider
- Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA.
| | - Eric B Schneider
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Valerie K Scott
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sandra M Swoboda
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Cheryl K Zogg
- Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Nitasha Dhiman
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Elliott R Haut
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - David T Efron
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Peter J Pronovost
- Armstrong Institute of Patient Safety, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Julie A Freischlag
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Pamela A Lipsett
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Edward E Cornwell
- Department of Surgery, Howard University College of Medicine, Washington, DC
| | - Ellen J MacKenzie
- Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lisa A Cooper
- Center to Eliminate Cardiovascular Health Disparities, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
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Abstract
Minority cancer outcomes and treatment satisfaction can only be improved if physicians are knowledgeable about cultural differences and work to improve patient-physician communication and patient engagement.
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Affiliation(s)
- Tianqi Luo
- The Johns Hopkins University School of Medicine, Baltimore, MD; and Medical College of Wisconsin, Milwaukee, WI
| | - Gaya Spolverato
- The Johns Hopkins University School of Medicine, Baltimore, MD; and Medical College of Wisconsin, Milwaukee, WI
| | - Fabian Johnston
- The Johns Hopkins University School of Medicine, Baltimore, MD; and Medical College of Wisconsin, Milwaukee, WI
| | - Adil H Haider
- The Johns Hopkins University School of Medicine, Baltimore, MD; and Medical College of Wisconsin, Milwaukee, WI
| | - Timothy M Pawlik
- The Johns Hopkins University School of Medicine, Baltimore, MD; and Medical College of Wisconsin, Milwaukee, WI
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211
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Haring RS, Narang K, Canner JK, Asemota AO, George BP, Selvarajah S, Haider AH, Schneider EB. Traumatic brain injury in the elderly: morbidity and mortality trends and risk factors. J Surg Res 2015; 195:1-9. [PMID: 25724764 DOI: 10.1016/j.jss.2015.01.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 01/02/2015] [Accepted: 01/09/2015] [Indexed: 10/24/2022]
Abstract
An estimated 1.7 million people sustain a traumatic brain injury (TBI) annually in the United States. We sought to examine factors contributing to mortality among TBI patients aged ≥65 y in the United States. TBI data from the Nationwide Inpatient Sample were combined from 2000-2010. Patients were stratified by age, sex, mechanism of injury, payer status, comorbidity, injury severity, and other factors. Odds of death were explored using an adjusted multivariable logistic regression. A total of 950,132 TBI-related hospitalizations and 107,666 TBI-related deaths occurred among adults aged ≥65 y from 2000-2010. The most common mechanism of injury was falling, and falls were more common among the oldest age groups. Logistic regression analysis showed highest odds of death among male patients, those whose mechanism of injury was motor vehicle related, patients with three or more comorbidities, and patients who were designated as self-paying.
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Affiliation(s)
- R Sterling Haring
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, Florida; Department of Surgery, Center for Surgical Trials and Outcomes Research (CSTOR), Johns Hopkins University, Baltimore, Maryland
| | - Kunal Narang
- Department of Surgery, Center for Surgical Trials and Outcomes Research (CSTOR), Johns Hopkins University, Baltimore, Maryland
| | - Joseph K Canner
- Department of Surgery, Center for Surgical Trials and Outcomes Research (CSTOR), Johns Hopkins University, Baltimore, Maryland
| | - Anthony O Asemota
- Department of Surgery, Center for Surgical Trials and Outcomes Research (CSTOR), Johns Hopkins University, Baltimore, Maryland; Department of Neurology and Neurosurgery, Johns Hopkins University, Baltimore, Maryland
| | - Benjamin P George
- Department of Surgery, Center for Surgical Trials and Outcomes Research (CSTOR), Johns Hopkins University, Baltimore, Maryland; Department of Neurology, School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Shalini Selvarajah
- Department of Surgery, Center for Surgical Trials and Outcomes Research (CSTOR), Johns Hopkins University, Baltimore, Maryland
| | - Adil H Haider
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Surgery, Center for Surgical Trials and Outcomes Research (CSTOR), Johns Hopkins University, Baltimore, Maryland
| | - Eric B Schneider
- Department of Surgery, Center for Surgical Trials and Outcomes Research (CSTOR), Johns Hopkins University, Baltimore, Maryland.
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Crompton JG, Nacev BA, Upham T, Azoury SC, Eil R, Cameron DE, Haider AH. Traumatic ventricular septal defect resulting in severe pulmonary hypertension. J Surg Case Rep 2014; 2014:rju107. [PMID: 25326917 PMCID: PMC4201838 DOI: 10.1093/jscr/rju107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Traumatic ventricular septal defect (VSD) is a widely-recognized complication of both penetrating and blunt trauma. Most cases are repaired operatively without the long-term complications of pulmonary hypertension and heart failure that are associated with unrepaired congenital VSD in the pediatric population. To our knowledge, this is the first case report of a patient with a traumatic VSD who declined surgical repair at the time of injury and subsequently developed long-term complications of pulmonary hypertension and heart failure. With nearly 20 years of follow-up, this case demonstrates that the absence of surgical treatment in asymptomatic adult patients at the time of injury can lead to long-term complications associated with VSD. This case also shows that aggressive surgical treatment in patients with severe pulmonary vascular disease and heart failure secondary to traumatic VSD can be performed safely and should be considered in cases refractory to efficacious medical interventions.
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Affiliation(s)
- Joseph G Crompton
- Department of Surgery, University of California Los Angeles, Los Angeles, CA, USA National Institutes of Health, Surgery Branch, Bethesda, MD, USA
| | | | - Trevor Upham
- National Institutes of Health, Surgery Branch, Bethesda, MD, USA
| | - Saïd C Azoury
- National Institutes of Health, Surgery Branch, Bethesda, MD, USA Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Robert Eil
- National Institutes of Health, Surgery Branch, Bethesda, MD, USA
| | | | - Adil H Haider
- Johns Hopkins School of Medicine, Baltimore, MD, USA
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Selvarajah S, Schneider EB, Becker D, Sadowsky CL, Haider AH, Hammond ER. The Epidemiology of Childhood and Adolescent Traumatic Spinal Cord Injury in the United States: 2007–2010. J Neurotrauma 2014; 31:1548-60. [DOI: 10.1089/neu.2014.3332] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Shalini Selvarajah
- Center for Surgical Trials and Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric B. Schneider
- Center for Surgical Trials and Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel Becker
- Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland
- International Neurorehabilitation Institute, Lutherville, Maryland
| | - Cristina L. Sadowsky
- International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at Kennedy Krieger Institute, Baltimore, Maryland
| | - Adil H. Haider
- Center for Surgical Trials and Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Division of Acute Care Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Edward R. Hammond
- International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at Kennedy Krieger Institute, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Hicks CW, Hashmi ZG, Velopulos C, Efron DT, Schneider EB, Haut ER, Cornwell EE, Haider AH. Association between race and age in survival after trauma. JAMA Surg 2014; 149:642-7. [PMID: 24871941 DOI: 10.1001/jamasurg.2014.166] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
IMPORTANCE Racial disparities in survival after trauma are well described for patients younger than 65 years. Similar information among older patients is lacking because existing trauma databases do not include important patient comorbidity information. OBJECTIVE To determine whether racial disparities in trauma survival persist in patients 65 years or older. DESIGN, SETTING, AND PARTICIPANTS Trauma patients were identified from the Nationwide Inpatient Sample (January 1, 2003, through December 30, 2010) using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Injury severity was ascertained by applying the Trauma Mortality Prediction Model, and patient comorbidities were quantified using the Charlson Comorbidity Index. MAIN OUTCOMES AND MEASURES In-hospital mortality after trauma for blacks vs whites for younger (16-64 years of age) and older (≥65 years of age) patients was compared using 3 different statistical methods: univariable logistic regression, multivariable logistic regression with and without clustering for hospital effects, and coarsened exact matching. Model covariates included age, sex, insurance status, type and intent of injury, injury severity, head injury severity, and Charlson Comorbidity Index. RESULTS A total of 1,073,195 patients were included (502,167 patients 16-64 years of age and 571,028 patients ≥65 years of age). Most older patients were white (547,325 [95.8%]), female (406 158 [71.1%]), and insured (567,361 [99.4%]) and had Charlson Comorbidity Index scores of 1 or higher (323,741 [56.7%]). The unadjusted odds ratios (ORs) for death in blacks vs whites were 1.35 (95% CI, 1.28-1.42) for patients 16 to 64 years of age and 1.00 (95% CI, 0.93-1.08) for patients 65 years or older. After risk adjustment, racial disparities in survival persisted in the younger black group (OR, 1.21; 95% CI, 1.13-1.30) but were reversed in the older group (OR, 0.83; 95% CI, 0.76-0.90). This finding was consistent across all 3 statistical methods. CONCLUSIONS AND RELEVANCE Different racial disparities in survival after trauma exist between white and black patients depending on their age group. Although younger white patients have better outcomes after trauma than younger black patients, older black patients have better outcomes than older white patients. Exploration of this paradoxical finding may lead to a better understanding of the mechanisms that cause disparities in trauma outcomes.
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Affiliation(s)
- Caitlin W Hicks
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Zain G Hashmi
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Catherine Velopulos
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - David T Efron
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Eric B Schneider
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Elliott R Haut
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Edward E Cornwell
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Adil H Haider
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
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Zafar SN, Shah AA, Hashmi ZG, Iqbal A, Greene WR, Cornwell EE, Haider AH. Emergency General Surgery in Older Patients: A National Comparison of Presentation and Outcomes. J Am Coll Surg 2014. [DOI: 10.1016/j.jamcollsurg.2014.07.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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216
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Zafar SN, Haider AH, Stevens KA, Ray-Mazumder N, Kisat MT, Schneider EB, Chi A, Galvagno SM, Cornwell EE, Efron DT, Haut ER. Increased mortality associated with EMS transport of gunshot wound victims when compared to private vehicle transport. Injury 2014; 45:1320-6. [PMID: 24957424 DOI: 10.1016/j.injury.2014.05.032] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 05/11/2014] [Accepted: 05/28/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Recent studies suggest that mode of transport affects survival in penetrating trauma patients. We hypothesised that there is wide variation in transport mode for patients with gunshot wounds (GSW) and there may be a mortality difference for GSW patients transported by emergency medical services (EMS) vs. private vehicle (PV). STUDY DESIGN We studied adult (≥16 years) GSW patients in the National Trauma Data Bank (2007-2010). Level 1 and 2 trauma centres (TC) receiving ≥50 GSW patients per year were included. Proportions of patients arriving by each transport mode for each TC were examined. In-hospital mortality was compared between the two groups, PV and EMS, using multivariable regression analyses. Models were adjusted for patient demographics, injury severity, and were adjusted for clustering by facility. RESULTS 74,187 GSW patients were treated at 182 TCs. The majority (76%) were transported by EMS while 12.6% were transported by PV. By individual TC, the proportion of patients transported by each category varied widely: EMS (median 78%, interquartile range (IQR) 66-85%), PV (median 11%, IQR 7-17%), or others (median 7%, IQR 2-18%). Unadjusted mortality was significantly different between PV and EMS (2.1% vs. 9.7%, p<0.001). Multivariable analysis demonstrated that EMS transported patients had a greater than twofold odds of dying when compared to PV (OR=2.0, 95% CI 1.73-2.35). CONCLUSIONS Wide variation exists in transport mode for GSW patients across the United States. Mortality may be higher for GSW patients transported by EMS when compared to private vehicle transport. Further studies should be performed to examine this question.
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Affiliation(s)
- Syed Nabeel Zafar
- Department of Surgery, Howard University Hospital, Washington, DC, United States.
| | - Adil H Haider
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Anesthesiology/Critical Care Medicine (ACCM), The Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Health Policy and Management, The Johns Hopkins University Bloomberg School of Public Health, United States.
| | - Kent A Stevens
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Anesthesiology/Critical Care Medicine (ACCM), The Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Nik Ray-Mazumder
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Mehreen T Kisat
- Department of Surgery, University of Arizona, Tucson, AZ, United States.
| | - Eric B Schneider
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Albert Chi
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Samuel M Galvagno
- Department of Anesthesiology, Divisions of Trauma Anesthesiology and Adult Critical Care Medicine, University of Maryland & R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, United States.
| | - Edward E Cornwell
- Department of Surgery, Howard University College of Medicine, Washington, DC, United States.
| | - David T Efron
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Anesthesiology/Critical Care Medicine (ACCM), The Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Emergency Medicine, The Johns Hopkins University School of Medicine, United States.
| | - Elliott R Haut
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Anesthesiology/Critical Care Medicine (ACCM), The Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Emergency Medicine, The Johns Hopkins University School of Medicine, United States.
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217
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Selvarajah S, Ahmed AA, Schneider EB, Canner JK, Pawlik TM, Abularrage CJ, Hui X, Schwartz DA, Hisam B, Haider AH. Cholecystectomy and wound complications: smoking worsens risk. J Surg Res 2014; 192:41-9. [PMID: 25015752 DOI: 10.1016/j.jss.2014.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 05/23/2014] [Accepted: 06/06/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND In the United States, approximately 800,000 cholecystectomies are performed annually. We sought to determine the influence of preoperative smoking on postcholecystectomy wound complication rates. MATERIALS AND METHODS Using the National Surgical Quality Improvement Program database (2005-2011), patients aged ≥18 y who underwent elective open or laparoscopic cholecystectomy (LC) for benign gallbladder disease were identified using current procedural terminology codes. Multivariate regression was performed to determine the association between smoking status and wound complications, by surgical approach. RESULTS Of 143,753 identified patients, 128,692 (89.5%) underwent LC, 27,788 (19.3%) were active smokers, and 100,710 (70.2%) were females. Active smokers were younger than nonsmokers (mean + standard deviation age: 44.2 (14.9) versus 51.6 (17.9) years); P < 0.001) and had fewer comorbidities. Within 30-d postcholecystectomy, wound complications were reported in 2011 (1.4%) patients. Compared with nonsmokers, active smokers demonstrated increased odds of wound complications after both open cholecystectomy (odds ratio 1.28; P = 0.010) and LC (odds ratio 1.20; P = 0.020) after adjustment for demographic and clinical characteristics. Having wound complications increased the average postoperative length of stay by 2-4 d (P <0.001). CONCLUSIONS Active smokers are more likely to develop wound complications after cholecystectomy, regardless of surgical approach. Occurrence of wound complications consequently increases postoperative length of stay. Smoking abstinence before cholecystectomy may reduce the burden associated with wound complications.
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Affiliation(s)
- Shalini Selvarajah
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Ammar A Ahmed
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric B Schneider
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph K Canner
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Timothy M Pawlik
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher J Abularrage
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xuan Hui
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Diane A Schwartz
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Butool Hisam
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Adil H Haider
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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218
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Selvarajah S, Black JH, Haider AH, Abularrage CJ. Racial disparity in early graft failure after infrainguinal bypass. J Surg Res 2014; 190:335-43. [DOI: 10.1016/j.jss.2014.04.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 04/08/2014] [Accepted: 04/15/2014] [Indexed: 10/25/2022]
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219
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Schneider EB, Calkins KL, Weiss MJ, Herman JM, Wolfgang CL, Makary MA, Ahuja N, Haider AH, Pawlik TM. Race-based differences in length of stay among patients undergoing pancreatoduodenectomy. Surgery 2014; 156:528-37. [PMID: 24973128 DOI: 10.1016/j.surg.2014.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 04/02/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Race-based disparities in operative morbidity and mortality have been demonstrated for various procedures, including pancreatoduodenectomy (PD). Race-based differences in hospital length-of-stay (LOS), especially related to provider volume at the surgeon and hospital level, remain poorly defined. METHODS Using the 2003-2009 Nationwide Inpatient Sample, we determined year-specific PD volumes for surgeons and hospitals and grouped them into terciles. Patient race (white, black, or Hispanic), age, sex, and comorbidities were examined. Median length of stay was calculated, and multivariable logistic regression was used to examine factors associated with increased LOS. RESULTS Among 4,319 eligible individuals, 3,502 (81.1%) were white, 423 (9.8%) were black, and 394 (9.1%) were Hispanic. Overall median LOS was 12 days (range, 0-234). Median annual surgeon volume was 8 (interquartile range [IQR], 2-19; range, 1-54). Annual hospital volume ranged from 1 to 129 (median, 19; IQR, 7-55). White patients were more likely to have been treated at medium- to high-volume hospitals (odds ratio [OR] 1.53, P < .001) and by medium- to high-volume surgeons (OR 1.62, P < .001) than black or Hispanic patients. After PD, white, black, and Hispanic patients demonstrated similar in-hospital mortality (5.1%, 5.7% and 7.2% respectively P = .250). After adjustment, black (OR 1.36, P = .010) and Hispanic (OR 1.68, P < .001) patients were more likely to have a greater LOS after PD. CONCLUSION Black and Hispanic PD patients were less likely than white patients to be treated at higher-volume hospitals and by higher-volume surgeons. Proportional mortality and LOS after PD were greater among black and Hispanic patients.
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Affiliation(s)
- Eric B Schneider
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Keri L Calkins
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Matthew J Weiss
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Joseph M Herman
- Department of Radiation Oncology, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Martin A Makary
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Nita Ahuja
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Adil H Haider
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Timothy M Pawlik
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD.
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220
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Schwartz DA, Hui X, Schneider EB, Ali MT, Canner JK, Leeper WR, Efron DT, Haut E, Haut ER, Velopulos CG, Pawlik TM, Haider AH. Worse outcomes among uninsured general surgery patients: does the need for an emergency operation explain these disparities? Surgery 2014; 156:345-51. [PMID: 24953267 DOI: 10.1016/j.surg.2014.04.039] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 04/17/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND We hypothesize that lack of access to care results in propensity toward emergent operative management and may be an important factor in worse outcomes for the uninsured population. The objective of this study is to investigate a possible link to worse outcomes in patients without insurance who undergo an emergent operation. METHODS A retrospective cross-sectional analysis was performed using the Nationwide Inpatient Sample (NIS) 2005-2011 dataset. Patients who underwent biliary, hernia, and colorectal operations were evaluated. Multivariate analyses were performed to assess the associations between insurance status, urgency of operation, and outcome. Covariates of age, sex, race, and comorbidities were controlled. RESULTS The uninsured group had greatest odds ratios of undergoing emergent operative management in biliary (OR 2.43), colorectal (3.54), and hernia (3.95) operations, P < .001. Emergent operation was most likely in the 25- to 34-year age bracket, black and Hispanic patients, men, and patients with at least one comorbidity. Postoperative complications in emergencies, however, were appreciated most frequently in the populations with government coverage. CONCLUSION Although the uninsured more frequently underwent emergent operations, patients with coverage through the government had more complications in most categories investigated. Young patients also carried significant risk of emergent operations with increased complication rates. Patients with government insurance tended toward worse outcomes, suggesting disparity for programs such as Medicaid. Disparity related to payor status implies need for policy revisions for equivalent health care access.
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Affiliation(s)
- Diane A Schwartz
- Center for Surgical Trials and Outcomes Research, Johns Hopkins School of Medicine, Baltimore, MD.
| | - Xuan Hui
- Center for Surgical Trials and Outcomes Research, Johns Hopkins School of Medicine, Baltimore, MD
| | - Eric B Schneider
- Center for Surgical Trials and Outcomes Research, Johns Hopkins School of Medicine, Baltimore, MD
| | - Mays T Ali
- Center for Surgical Trials and Outcomes Research, Johns Hopkins School of Medicine, Baltimore, MD
| | - Joseph K Canner
- Center for Surgical Trials and Outcomes Research, Johns Hopkins School of Medicine, Baltimore, MD
| | - William R Leeper
- Center for Surgical Trials and Outcomes Research, Johns Hopkins School of Medicine, Baltimore, MD
| | - David T Efron
- Center for Surgical Trials and Outcomes Research, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Elliot R Haut
- Center for Surgical Trials and Outcomes Research, Johns Hopkins School of Medicine, Baltimore, MD
| | - Catherine G Velopulos
- Center for Surgical Trials and Outcomes Research, Johns Hopkins School of Medicine, Baltimore, MD
| | - Timothy M Pawlik
- Center for Surgical Trials and Outcomes Research, Johns Hopkins School of Medicine, Baltimore, MD
| | - Adil H Haider
- Center for Surgical Trials and Outcomes Research, Johns Hopkins School of Medicine, Baltimore, MD
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221
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Haider AH, Young JH, Kisat M, Villegas CV, Scott VK, Ladha KS, Haut ER, Cornwell EE, MacKenzie EJ, Efron DT. Association between intentional injury and long-term survival after trauma. Ann Surg 2014; 259:985-92. [PMID: 24487746 PMCID: PMC5995318 DOI: 10.1097/sla.0000000000000486] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the risk-adjusted mortality of intentionally injured patients within 7 to 9 years postinjury, compared with unintentionally injured patients. BACKGROUND Violent injury contributes significantly to trauma mortality in the United States. Homicide is the second leading killer of American youth, aged 15 to 24 years. Long-term survival among intentionally injured patients has not been well studied. It is also unknown whether intentionally injured patients have worse long-term survival compared with unintentionally or accidentally injured patients with equivalent injuries. METHODS Adult trauma patients admitted for 24 hours or more and discharged alive from the Johns Hopkins Hospital from January 1, 1998, to December 31, 2000, were included. The primary outcome was mortality within 7 to 9 years postinjury. Long-term patient survival was determined using the National Death Index. The association between injury intentionality and mortality was investigated using a Cox proportional hazard regression model, adjusted for confounders such as injury severity and patient race, socioeconomic status, and comorbid conditions. Overall differences in survival between those with intentional versus unintentional injury were also determined by comparing adjusted Kaplan-Meier survival curves. RESULTS A total of 2062 patients met inclusion criteria. Of these, 56.4% were intentionally injured and 43.6% were unintentionally injured. Compared with unintentionally injured patients, intentionally injured patients were younger and more often male and from a zip code with low median household income. Approximately 15% of all patients had died within 7 to 9 years of follow-up. Older age and presence of comorbidities were associated with this outcome; however, intentional injury was not found to be significantly associated with long-term mortality rates. There was also no significant difference in survival curves between groups; intentionally injured patients were much more likely to die of a subsequent injury, whereas those with unintentional injury commonly died of noninjury causes. CONCLUSIONS There was no significant difference in mortality between intentionally injured and unintentionally injured patients within 7 to 9 years postinjury. These results confirm the long-term effectiveness of lifesaving trauma care for those with intentional injury. However, given that patients with intentional injuries were more likely to suffer a subsequent violent death, interventions focused on breaking the cycle of violence are needed.
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Affiliation(s)
- Adil H Haider
- *Department of Surgery, Center for Surgical Trials and Outcomes Research, The Johns Hopkins University School of Medicine, Baltimore, MD †Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD ‡Department of Surgery, Howard University College of Medicine, Washington, DC §Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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222
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Oyetunji TA, Fisher MA, Onguti SK, Cornwell EE, Qureshi FG, Abdullah F, Haider AH, Nwomeh BC. Pediatric helmet use in residential areas. Am Surg 2014; 80:511-513. [PMID: 24887733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Tolulope A Oyetunji
- Department of Surgery, Howard University College of Medicine, Washington, DC, USA
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223
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Oyetunji TA, Fisher MA, Onguti SK, Cornwell EE, Qureshi FG, Abdullah F, Haider AH, Nwomeh BC. Pediatric Helmet Use in Residential Areas. Am Surg 2014. [DOI: 10.1177/000313481408000525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | - Sharon K. Onguti
- Department of Surgery, Howard University College of Medicine, Washington, DC
| | - Edward E. Cornwell
- Department of Surgery, Howard University College of Medicine, Washington, DC
| | - Faisal G. Qureshi
- Department of Surgery, Children's National Medical Center, Washington, DC
| | - Fizan Abdullah
- Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Adil H. Haider
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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224
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Juo YY, Hyder O, Haider AH, Camp M, Lidor A, Ahuja N. Is minimally invasive colon resection better than traditional approaches?: First comprehensive national examination with propensity score matching. JAMA Surg 2014; 149:177-84. [PMID: 24352653 DOI: 10.1001/jamasurg.2013.3660] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Minimally invasive colectomies are increasingly popular options for colon resection. OBJECTIVE To compare the perioperative outcomes and costs of robot-assisted colectomy (RC), laparoscopic colectomy (LC), and open colectomy (OC). DESIGN, SETTING, AND PARTICIPANTS The US Nationwide Inpatient Sample database was used to examine outcomes and costs before and after propensity score matching across the 3 surgical approaches. This study involved a sample of US hospital discharges from 2008 to 2010 and all patients 21 years of age or older who underwent elective colectomy. MAIN OUTCOMES AND MEASURES In-hospital mortality, complications, ostomy rates, conversion to open procedure, length of stay, discharge disposition, and cost. RESULTS Of the 244129 colectomies performed during the study period, 126284 (51.7%) were OCs, 116261 (47.6%) were LCs, and 1584 (0.6%) were RCs. In comparison with OC, LC was associated with a lower mortality rate (0.4% vs 2.0%), lower complication rate (19.8% vs 33.2%), lower ostomy rate (3.5 vs 13.0%), shorter median length of stay (4 vs 6 days), a higher routine discharge rate (86.1% vs 68.4%), and lower overall cost than OC ($11742 vs $13666) (all P<.05). Comparison between RC and LC showed no significant differences with respect to in-hospital mortality (0.0% vs 0.7%), complication rates (14.7% vs 18.5%), ostomy rates (3.0% vs 5.1%), conversions to open procedure (5.7% vs 9.9%), and routine discharge rates (88.7% vs 88.5%) (all P>.05). However, RC incurred a higher overall hospitalization cost than LC ($14847 vs $11966, P<.001). CONCLUSIONS AND RELEVANCE In this nationwide comparison of minimally invasive approaches for colon resection, LC demonstrated favorable clinical outcomes and lower cost than OC. Robot-assisted colectomy was equivalent in most clinical outcomes to LC but incurred a higher cost.
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Affiliation(s)
- Yen-Yi Juo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Omar Hyder
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Adil H Haider
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Melissa Camp
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anne Lidor
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nita Ahuja
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland2Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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225
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Oyetunji TA, Haider AH, Obirieze AC, Fisher M, Cornwell EE, Qureshi FG, Abdullah F, Nwomeh BC. Epidemiology of 577 pediatric firearm fatalities: a 2-year review of the National Trauma Data Bank. Am Surg 2014; 80:366-371. [PMID: 24887667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The purpose of this study was to delineate the epidemiology of pediatric firearm injuries, including ethno-demographic patterns with impact on years of potential life lost (YPLL). A 2-year review of the National Trauma Data Bank (2007 to 2008) was conducted. Firearm fatalities in records of patients younger than 18 years were identified. Data were analyzed by demographic and injury characteristics and YPLL was calculated by ethnicity. A total of 577 deaths were identified in the pediatric group. Blacks accounted for 49.7 per cent of the fatalities; Hispanics, 19.2 per cent; whites, 17.7 per cent, and other ethnicity, 13.4 per cent. Median Injury Severity Score was 25 with a median Glasgow Coma Scale score of 3. Traumatic brain injury was present in 84.2 per cent of the records. Assault accounted for 72.8 per cent, self-inflicted injury 12.7 per cent, and unintentional injuries were 8.2 per cent. Most firearm fatalities occurred at home (33.6%). By emergency department (ED) disposition, 29.3 per cent died in the ED, 32.9 per cent were admitted to the intensive care unit, and 30.0 per cent taken to the operating room. Blacks had a total of 17,446 YPLL, Hispanics 6,776 YPLL, and whites 6,718 YPLL. Pediatric firearm fatalities still remain an important public health concern. Inclusive gun control policies focused on primary prevention of accidental injuries may be more effective in mitigating its impact.
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Affiliation(s)
- Tolulope A Oyetunji
- Department of Surgery, Howard University College of Medicine,Washington, DC, USA
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226
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Canner JK, Haider AH, Selvarajah S, Hui X, Wang H, Efron DT, Haut ER, Velopulos CG, Schwartz DA, Chi A, Schneider EB. US emergency department visits for fireworks injuries, 2006-2010. J Surg Res 2014; 190:305-11. [PMID: 24766725 DOI: 10.1016/j.jss.2014.03.066] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 03/11/2014] [Accepted: 03/21/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Most literature regarding fireworks injuries are from outside the United States, whereas US-based reports focus primarily on children and are based on datasets which cannot provide accurate estimates for subgroups of the US population. METHODS The 2006-2010 Nationwide Emergency Department Sample was used to identify patients with fireworks injury using International Classification of Diseases, Ninth Revision, Clinical Modification external cause of injury code E923.0. International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes were examined to determine the mechanism, type, and location of injury. Sampling weights were applied during analysis to obtain US population estimates. RESULTS There were 25,691 emergency department visits for fireworks-related injuries between 2006 and 2010. There was no consistent trend in annual injury rates during the 5-y period. The majority of visits (50.1%) were in patients aged <20 y. Most injuries were among males (76.4%) and were treated in hospitals in the Midwest and South (42.0% and 36.4%, respectively) than in the West and Northeast (13.3% and 8.3%, respectively) census regions. Fireworks-related injuries were most common in July (68.1%), followed by June (8.3%), January (6.6%), December (3.4%), and August (3.1%). The most common injuries (26.7%) were burns of the wrist, hand, and finger, followed by contusion or superficial injuries to the eye (10.3%), open wounds of the wrist, hand, and finger (6.5%), and burns of the eye (4.6%). CONCLUSIONS Emergency department visits for fireworks injuries are concentrated around major national holidays and are more prevalent in certain parts of the country and among young males. This suggests that targeted interventions may be effective in combating this public health problem.
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Affiliation(s)
- Joseph K Canner
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Adil H Haider
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shalini Selvarajah
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xuan Hui
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Han Wang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David T Efron
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elliott R Haut
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Catherine G Velopulos
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Diane A Schwartz
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Albert Chi
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric B Schneider
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Wong EG, Gupta S, Deckelbaum DL, Razek T, Kamara TB, Nwomeh BC, Haider AH, Kushner AL. The International Assessment of Capacity for Trauma (INTACT): an index for trauma capacity in low-income countries. J Surg Res 2014; 190:522-7. [PMID: 24594216 DOI: 10.1016/j.jss.2014.01.060] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 01/30/2014] [Accepted: 01/31/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Injury remains a leading cause of death worldwide with a disproportionate impact in the developing world. Capabilities for trauma care remain limited in these settings. We propose the implementation of the International Assessment of Capacity for Trauma (INTACT) index to provide a standardized way of assessing a health care facility's capacity to provide adequate trauma care. MATERIALS AND METHODS A retrospective review of the trauma capacity of 10 government hospitals (district, secondary, regional, maternity, and tertiary facilities) in Sierra Leone was performed using data collected during on-site visits in August 2011. The index incorporates 40 key elements, including resuscitation, laparotomy, chest tube insertion, fracture repair, and burn management capabilities. The INTACT index was calculated on a scale of 0-10 and compared with a previously published index of surgical capacity, the personnel, infrastructure, equipment, and supplies (PIPES) index. RESULTS Connaught Hospital, the only tertiary referral center, had the highest index (9.0), consistent with it being the best equipped and staffed of the country. The three district hospitals assessed had the lowest scores from 3.5 to 4.3. INTACT and PIPES scores were correlated overall (r = 0.88). The proportionate difference compared with the PIPES survey was 30% for the maternity hospital and 1% for the tertiary center, suggesting that the INTACT index may be specific for trauma. Deficiencies are especially prominent in personnel, imaging, fracture repair, and burn management. CONCLUSIONS The INTACT index is a simple tool designed to specifically assess trauma capacity from initial resuscitation to definitive care. Shortcomings in trauma capacity remain prominent and the INTACT index could be used to assess trauma care deficiencies in developing countries.
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Affiliation(s)
- Evan G Wong
- Centre for Global Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Surgeons OverSeas, New York, New York.
| | - Shailvi Gupta
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Surgeons OverSeas, New York, New York; Department of Surgery, University of California, San Francisco, East Bay
| | - Dan L Deckelbaum
- Centre for Global Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Tarek Razek
- Centre for Global Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Thaim B Kamara
- Department of Surgery, Connaught Hospital, Freetown, Sierra Leone; College of Medicine and Allied Health Science, Freetown, Sierra Leone
| | - Benedict C Nwomeh
- Surgeons OverSeas, New York, New York; Nationwide Children's Hospital, Ohio State University, Columbus, Ohio
| | - Adil H Haider
- Center for Surgical Trials and Outcomes Research (CSTOR), Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Adam L Kushner
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Surgeons OverSeas, New York, New York; Department of Surgery, Columbia University, New York, New York
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228
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Crompton JG, Oyetunji TA, Haut ER, Cornwell EE, Haider AH. Systematically Tabulated Outcomes Research Matrix (STORM): a methodology to generate research hypotheses. Surgery 2014; 155:541-4. [PMID: 24439742 DOI: 10.1016/j.surg.2013.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 10/11/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Here we describe the Systematically Tabulated Outcomes Research Matrix (STORM) method to generate research questions from pre-existing databases with the aim of improving patient outcomes. MATERIALS AND METHODS STORM can be applied to a database by tabulating its variables into a matrix of independent variables (y-axis) and dependent variables (x-axis) and then applying each unique pairing of an independent and dependent variable to a patient population to generate potentially meaningful research questions. RESULTS To demonstrate this methodology and establish proof-of-principle, STORM was applied on a small scale to the National Trauma Data Bank and generated at least seven clinically meaningful research questions. CONCLUSION When coupled with rigorous clinical judgment, the STORM approach complements the traditional method of hypothesis formation and can be generalized to outcomes research using registry databases across different medical specialties.
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Affiliation(s)
- Joseph G Crompton
- Department of Surgery, University of California-Los Angeles, Los Angeles, CA.
| | - Tolulope A Oyetunji
- Department of Surgery, Howard University College of Medicine, Washington, DC
| | - Elliott R Haut
- Center for Surgical Trials and Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, MD; Graduate Training Program in Clinical Investigation [GTPCI] at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Edward E Cornwell
- Department of Surgery, Howard University College of Medicine, Washington, DC
| | - Adil H Haider
- Center for Surgical Trials and Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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229
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Selvarajah S, Hammond ER, Haider AH, Abularrage CJ, Becker D, Dhiman N, Hyder O, Gupta D, Black JH, Schneider EB. The burden of acute traumatic spinal cord injury among adults in the united states: an update. J Neurotrauma 2014; 31:228-38. [PMID: 24138672 DOI: 10.1089/neu.2013.3098] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The current incidence estimate of 40 traumatic spinal cord injuries (TSCI) per million population/year in the United States (U.S.) is based on data from the 1990s. We sought to update the incidence and epidemiology of TSCI in U.S adults by using the Nationwide Emergency Department Sample (NEDS), the largest all-payer emergency department (ED) database in the United States. Adult ED visits between 2007 and 2009 with a principal diagnosis of TSCI were identified using International Classification of Diseases (ICD)-9 codes (806.0-806.9 and 952.0-952.9). We describe TSCI cumulative incidence, mortality, discharge disposition, and hospital charges weighted to the U.S. population. The estimated 3-year cumulative incidence of TSCI was 56.4 per million adults. Cumulative incidence of TSCI in older adults increased from 79.4 per million older adults in 2007 to 87.7 by the end of 2009, but remained steady among younger adults. Overall, falls were the leading cause of TSCI (41.5%). ED charges rose by 20% over the study period, and death occurred in 5.7% of patients. Compared with younger adults, older adults demonstrated higher adjusted odds of mortality in the ED (adjusted odds ratio [AOR]=4.4; 95% confidence interval [CI]: 1.1-16.6), mortality during hospitalization (AOR=5.9; 95% CI: 4.7-7.4), and being discharged to chronic care (AOR=3.7; 95% CI: 3.0-4.5). The incidence of TSCI is higher than previously reported with a progressive increase among older adults who also experience worse outcomes compared with younger adults. ED-related TSCI charges are also increasing. These updated national estimates support the development of customized prevention strategies based on age-specific risk factors.
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Affiliation(s)
- Shalini Selvarajah
- 1 Center for Surgical Trials and Outcomes Research (CSTOR), Department of Surgery, Johns Hopkins University School of Medicine , Baltimore, Maryland
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230
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Affiliation(s)
- Adil H Haider
- Center for Surgical Trials and Outcomes Research, Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
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231
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Haider AH, Figura RH, Ladha K, Johnston M, Noll KM, Heptinstall SR, Haut ER, Efron DT. Can we decrease the number of trauma patients 'missing in action'? A prospective pilot intervention to improve trauma patient compliance with outpatient follow-up at an urban Level I trauma center. Am Surg 2014; 80:96-98. [PMID: 24401525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Adil H Haider
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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232
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Stroh DA, Ray-Mazumder N, Norman JA, Haider AH, Stevens KA, Chi A, Rushing AP, Efron DT, Haut ER. Influencing medical student education via a voluntary shadowing program for trauma and acute care surgery. JAMA Surg 2013; 148:968-70. [PMID: 23925491 DOI: 10.1001/jamasurg.2013.363] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Decreasing application into trauma surgery may be attributed to decreased exposure during medical school. We instituted a voluntary trauma call program for students to provide exposure to the field. After 3 years, participants completed a survey to gauge their experience. Of 126 students who participated, 68 completed the survey (54%). Interest in trauma surgery among students not previously planning on a career in surgery (n = 48) improved after the experience (4.4-5.3 of 10 points; P < .005). Operative experience, exposure to a higher number of trauma cases, and time with residents were associated with increased interest in trauma surgery. Witnessing patient death for the first time was associated with decreased interest in trauma surgery. A voluntary overnight shadowing program improves medical students' perceptions of trauma surgery and increases their reported likelihood to apply into a surgical residency.
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Affiliation(s)
- D Alex Stroh
- The Johns Hopkins University School of Medicine, Baltimore, Maryland
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234
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Asemota AO, George BP, Cumpsty-Fowler CJ, Haider AH, Schneider EB. Race and insurance disparities in discharge to rehabilitation for patients with traumatic brain injury. J Neurotrauma 2013; 30:2057-65. [PMID: 23972035 DOI: 10.1089/neu.2013.3091] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Post-acute inpatient rehabilitation services are associated with improved functional outcomes among persons with traumatic brain injury (TBI). We sought to investigate racial and insurance-based disparities in access to rehabilitation. Data from the Nationwide Inpatient Sample from 2005-2010 were analyzed using standard descriptive methods and multivariable logistic regression to assess race- and insurance-based differences in access to inpatient rehabilitation after TBI, controlling for patient- and hospital-level variables. Patients with moderate to severe TBI aged 18-64 years with complete data on race and insurance status discharged alive from inpatient care were eligible for study. Among 307,675 TBI survivors meeting study criteria and potentially eligible for discharge to rehabilitation, 66% were white, 12% black, 15% Hispanic, 2% Asian, and 5% other ethnic minorities. Most whites (70%), Asians (70%), blacks (59%), and many Hispanics (49%) had insurance. Compared with insured whites, insured blacks had reduced odds of discharge to rehabilitation (odds ratio [OR] 0.84; 95% confidence interval [CI] 0.75-0.95). Also, insured Hispanics (OR 0.52; 95% CI 0.44-0.60) and insured Asians (OR 0.54; 95% CI 0.39-0.73) were less likely to be discharged to rehabilitation than insured whites. Compared with insured whites, uninsured whites (OR 0.57; 95% CI 0.51-0.63), uninsured blacks (OR 0.33; 95% CI 0.26-0.42), uninsured Hispanics (OR 0.27; 95% CI 0.22-0.33), and uninsured Asians (OR 0.40; 95% CI 0.22-0.73) were less likely to be discharged to rehabilitation. Race and insurance are strong predictors of discharge to rehabilitation among adult TBI survivors in the United States. Efforts are needed to understand and eliminate disparities in access to rehabilitation after TBI.
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Affiliation(s)
- Anthony O Asemota
- 1 Department of Neurology/Neurosurgery, Johns Hopkins School of Medicine , Baltimore, Maryland
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235
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Ali MT, Hui X, Hashmi ZG, Dhiman N, Scott VK, Efron DT, Schneider EB, Haider AH. Socioeconomic disparity in inpatient mortality after traumatic injury in adults. Surgery 2013; 154:461-7. [PMID: 23972652 DOI: 10.1016/j.surg.2013.05.036] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 05/28/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prior studies have demonstrated that race and insurance status predict inpatient trauma mortality, but have been limited by their inability to adjust for direct measures of socioeconomic status (SES) and comorbidities. Our study aimed to identify whether a relationship exists between SES and inpatient trauma mortality after adjusting for known confounders. METHODS Trauma patients aged 18-65 years with an Injury Severity Scores (ISS) of ≥9 were identified using the 2003-2009 Nationwide Inpatient Sample. Median household income (MHI) by zip code, available by quartiles, was used to measure SES. Multiple logistic regression analyses were performed to determine odds of inpatient mortality by MHI quartile, adjusting for ISS, type of injury, comorbidities, and patient demographics. RESULTS In all, 267,621 patients met inclusion criteria. Patients in lower wealth quartiles had significantly greater unadjusted inpatient mortality compared with the wealthiest quartile. Adjusted odds of death were also higher compared with the wealthiest quartile for Q1 (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.06-1.20), Q2 (OR, 1.09; 95% CI, 1.02-1.17), and Q3 (OR, 1.11; 95% CI, 1.04-1.19). CONCLUSION MHI predicts inpatient mortality after adult trauma, even after adjusting for race, insurance status, and comorbidities. Efforts to mitigate trauma disparities should address SES as an independent predictor of outcomes.
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Affiliation(s)
- Mays T Ali
- Center for Surgical Trials and Outcomes Research, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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236
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Alnasser M, Schneider EB, Gearhart SL, Wick EC, Fang SH, Haider AH, Efron JE. National disparities in laparoscopic colorectal procedures for colon cancer. Surg Endosc 2013; 28:49-57. [PMID: 24002916 DOI: 10.1007/s00464-013-3160-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 07/25/2013] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Racial disparity in the treatment of colorectal cancer (CRC) has been cited as a potential cause for differences in mortality. This study compares the rates of laparoscopy according to race, insurance status, geographic location, and hospital size. METHODS The 2009 Healthcare Cost and Utilization Project: Nationwide Inpatient Sample (HCUP-NIS) database was queried to identify patients with the diagnosis of CRC by the International Classification of Diseases, Ninth Revision (ICD-9) codes. Multivariate logistic regression was performed to look at age, gender, insurance coverage, academic versus nonacademic affiliated institutions, rural versus urban settings, location, and proportional differences in laparoscopic procedures according to race. RESULTS A total of 14,502 patients were identified; 4,691 (32.35 %) underwent laparoscopic colorectal procedures and 9,811 (67.65 %) underwent open procedures. The proportion of laparoscopic procedures did not differ significantly by race: Caucasian 32.4 %, African-American 30.04 %, Hispanic 33.99 %, and Asian-Pacific Islander 35.12 (P = 0.08). Among Caucasian and African-American patients, those covered by private insurers were more likely to undergo laparoscopic procedures compared to other insurance types (P ≤ 0.001). The odds of receiving laparoscopic procedure at teaching hospitals was 1.39 times greater than in nonteaching hospitals (95 % confidence interval [CI] 1.29-1.48) and did not differ across race groups. Patients in urban hospitals demonstrated higher odds of laparoscopic surgery (2.24, 95 % CI 1.96-2.56) than in rural hospitals; this relationship was consistent within races. The odds of undergoing laparoscopic surgeries was lowest in the Midwest region (0.89, 95 % CI 0.81-0.97) but higher in the Southern region (1.14, 95 % CI 1.06-1.22) compared with the other regions. CONCLUSIONS Nearly one-third of all CRC surgeries are laparoscopic. Race does not appear to play a significant role in the selection of a laparoscopic CRC operation. However, there are significant differences in the selection of laparoscopy for CRC patients based on insurance status, geographic location, and hospital type.
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Affiliation(s)
- Monirah Alnasser
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA,
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237
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Hashmi ZG, Haider AH, Zafar SN, Kisat M, Moosa A, Siddiqui F, Pardhan A, Latif A, Zafar H. Hospital-based trauma quality improvement initiatives: first step toward improving trauma outcomes in the developing world. J Trauma Acute Care Surg 2013; 75:60-8; discussion 68. [PMID: 23778440 DOI: 10.1097/ta.0b013e31829880a0] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Injuries remain a leading cause of death in the developing world. Whereas new investments are welcome, quality improvement (QI) at the currently available trauma care facilities is essential. The objective of this study was to determine the effect and long-term sustainability of trauma QI initiatives on in-hospital mortality and complications at a large tertiary hospital in a developing country. METHODS In 2002, a specialized trauma team was formed (members trained using advanced trauma life support), and a western style trauma program established including a registry and quality assurance program. Patients from 1998 onward were entered in to this registry, enabling a preimplementation and postimplementation study. Adults (>15 years) with blunt or penetrating trauma were analyzed. The main outcomes of interest were (1) in-hospital mortality and (2) occurrence of any complication. Multiple logistic regression was performed to assess the impact of formalized trauma care on outcomes, controlling for covariates reaching significance in the bivariate analyses. RESULTS A total of 1,227 patient records were analyzed. Patient demographics and injury characteristics are described in Table 1. Overall in-hospital mortality rate was 6.4%, and the complication rate was 11.1%. On multivariate analysis, patients admitted during the trauma service years were 4.9 times less likely to die (95% confidence interval, 1.77-13.57) and 2.60 times (odds ratio; 95% confidence interval, 1.29-5.21) less likely to have a complication compared with those treated in the pretrauma service years. CONCLUSION Despite significant delays in hospital transit and lack of prehospital trauma care, hospital level implementation of trauma QI program greatly decreases mortality and complication rates in the developing world. LEVEL OF EVIDENCE Care management study, level IV.
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Affiliation(s)
- Zain G Hashmi
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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238
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Hicks CW, Hashmi ZG, Hui X, Velopulos CG, Efron DT, Schneider EB, Cooper L, Cornwell EE, Haider AH. Explaining racial disparities in survival after trauma: the role of the treating facility. J Am Coll Surg 2013. [DOI: 10.1016/j.jamcollsurg.2013.07.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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239
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Kisat M, Morrison JJ, Hashmi ZG, Efron DT, Rasmussen TE, Haider AH. Epidemiology and outcomes of non-compressible torso hemorrhage. J Surg Res 2013; 184:414-21. [DOI: 10.1016/j.jss.2013.05.099] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 04/15/2013] [Accepted: 05/30/2013] [Indexed: 10/26/2022]
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240
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Dhiman N, Chi A, Pawlik TM, Efron DT, Haut ER, Schneider EB, Hashmi ZG, Scott VK, Hui X, Ali MT, Haider AH. Increased complications after appendectomy in patients with cerebral palsy: Are special needs patients at risk for disparities in outcomes? Surgery 2013; 154:479-85. [DOI: 10.1016/j.surg.2013.05.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 05/28/2013] [Indexed: 11/29/2022]
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241
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Ray-Mazumder N, Lau BD, Haider AH, Scalea TM, Kim P, Martin ND, Santora TA, Benoit SR, Efron DT, Haut ER. Pre-hospital care of urban gunshot wound patients: a tale of two cities. J Am Coll Surg 2013. [DOI: 10.1016/j.jamcollsurg.2013.07.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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242
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Schneider EB, Hyder O, Wolfgang CL, Dodson RM, Haider AH, Herman JM, Pawlik TM. Provider versus patient factors impacting hospital length of stay after pancreaticoduodenectomy. Surgery 2013; 154:152-61. [DOI: 10.1016/j.surg.2013.03.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 03/28/2013] [Indexed: 11/24/2022]
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Hui X, Haider AH, Hashmi ZG, Rushing AP, Dhiman N, Scott VK, Selvarajah S, Haut ER, Efron DT, Schneider EB. Increased risk of pneumonia among ventilated patients with traumatic brain injury: every day counts! J Surg Res 2013; 184:438-43. [PMID: 23816243 DOI: 10.1016/j.jss.2013.05.072] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 05/08/2013] [Accepted: 05/16/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients with traumatic brain injury (TBI) frequently require mechanical ventilation (MV). The objective of this study was to examine the association between time spent on MV and the development of pneumonia among patients with TBI. MATERIALS AND METHODS Patients older than 18 y with head abbreviated injury scale (AIS) scores coded 1-6 requiring MV in the National Trauma Data Bank 2007-2010 data set were included. The study was limited to hospitals reporting pneumonia cases. AIS scores were calculated using ICDMAP-90 software. Patients with injuries in any other region with AIS score >3, significant burns, or a hospital length of stay >30 d were excluded. A generalized linear model was used to determine the approximate relative risk of developing all-cause pneumonia (aspiration pneumonia, ventilator-associated pneumonia [VAP], and infectious pneumonia identified by the International Classification of Disease, Ninth Revision, diagnosis code) for each day of MV, controlling for age, gender, Glasgow coma scale motor score, comorbidity (Charlson comorbidity index) score, insurance status, and injury type and severity. RESULTS Among the 24,525 patients with TBI who required MV included in this study, 1593 (6.5%) developed all-cause pneumonia. After controlling for demographic and injury factors, each additional day on the ventilator was associated with a 7% increase in the risk of pneumonia (risk ratio 1.07, 95% confidence interval 1.07-1.08). CONCLUSIONS Patients who have sustained TBIs and require MV are at higher risk for VAP than individuals extubated earlier; therefore, shortening MV exposure will likely reduce the risk of VAP. As patients with TBI frequently require MV because of neurologic impairment, it is key to develop aggressive strategies to expedite ventilator independence.
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Affiliation(s)
- Xuan Hui
- Department of Surgery, Center for Surgical Trials and Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
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Velopulos CG, Enwerem NY, Obirieze A, Hui X, Hashmi ZG, Scott VK, Cornwell EE, Schneider EB, Haider AH. National cost of trauma care by payer status. J Surg Res 2013; 184:444-9. [PMID: 23800441 DOI: 10.1016/j.jss.2013.05.068] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 05/10/2013] [Accepted: 05/15/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND Several studies have described the burden of trauma care, but few have explored the economic burden of trauma inpatient costs from a payer's perspective or highlighted the differences in the average costs per person by payer status. The present study provides a conservative inpatient national trauma cost estimate and describes the variation in average inpatient trauma cost by payer status. METHODS A retrospective analysis of patients who had received trauma care at hospitals in the Nationwide Inpatient Sample from 2005-2010 was conducted. Our sample patients were selected using the appropriate "International Classification of Diseases, Ninth Revision, Clinical Modification" codes to identify admissions due to traumatic injury. The data were weighted to provide national population estimates, and all cost and charges were converted to 2010 US dollar equivalents. Generalized linear models were used to describe the costs by payer status, adjusting for patient characteristics, such as age, gender, and race, and hospital characteristics, such as location, teaching status, and patient case mix. RESULTS A total of 2,542,551 patients were eligible for the present study, with the payer status as follows: 672,960 patients (26.47%) with private insurance, 1,244,817 (48.96%) with Medicare, 262,256 (10.31%) with Medicaid, 195,056 (7.67%) with self-pay, 18,506 (0.73%) with no charge, and 150,956 (5.94%) with other types of insurance. The estimated yearly trauma inpatient cost burden was highest for Medicare at $17,551,393,082 (46.79%), followed by private insurance ($10,772,025,421 [28.72%]), Medicaid ($3,711,686,012 [9.89%], self-pay ($2,831,438,460 [7.55%]), and other payer types ($2,370,187,494 [6.32%]. The estimated yearly trauma inpatient cost burden was $274,598,190 (0.73%) for patients who were not charged for their inpatient trauma treatment. Our adjusted national inpatient trauma yearly costs were estimated at $37,511,328,659 US dollars. Privately insured patients had a significantly higher mean cost per person than did the Medicare, Medicaid, self-pay, or no charge patients. CONCLUSIONS The results of the present study have demonstrated that the distribution of trauma burden across payers is significantly different from that of the overall healthcare system and suggest that although the burden of trauma is high, the burden of self-pay or nonreimbursed inpatient services is actually lower than that of overall medical care.
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Affiliation(s)
- Catherine G Velopulos
- Department of Surgery, Center for Surgical Trials and Outcomes Research, Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA
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Scott VK, Hashmi ZG, Schneider EB, Hui X, Efron DT, Cornwell EE, Cooper LA, Haider AH. Counting the lives lost: how many black trauma deaths are attributable to disparities? J Surg Res 2013; 184:480-7. [PMID: 23827793 DOI: 10.1016/j.jss.2013.04.080] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 04/23/2013] [Accepted: 04/30/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The number of black trauma deaths attributable to racial disparities is unknown. The objective of this study was to quantify the excess mortality experienced by black patients given disparities in the risk of mortality. MATERIALS AND METHODS We performed a retrospective analysis of patients aged 16-65 y with blunt and penetrating injuries, who were included in the National Trauma Data Bank from 2007-2010. Generalized linear modeling estimated the relative risk of death for black patients versus white patients, adjusting for known confounders. This analysis determined the difference in the observed number of black trauma deaths at Level I and II centers and the expected number of deaths if the risk of mortality for black patients had been equivalent to that of white patients. RESULTS A total of 1.06 million patients were included. Among patients with blunt and penetrating injuries at Level I trauma centers, white males and females had a relative risk of death of 0.82 (95% confidence interval [CI], 0.80-0.85) and 0.78 (95% CI, 0.74-0.83), respectively, compared with black patients. Similarly, at Level II trauma centers, white males and females had a relative risk of death of 0.84 (95% CI, 0.80-0.88) and 0.82 (95% CI, 0.73-0.91). Overall, of the estimated 41,613 deaths that occurred at Level I and II centers, 2206 (5.3%) were excess deaths among black patients. CONCLUSIONS Over a 4-y period, approximately 5% of trauma center deaths could be attributed to racial disparities in trauma outcomes. These data underscore the need to better understand and intervene against the mechanisms that lead to trauma outcomes disparities.
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Affiliation(s)
- Valerie K Scott
- Center for Surgical Trials and Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
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Bolorunduro OB, Haider AH, Oyetunji TA, Khoury A, Cubangbang M, Haut ER, Greene WR, Chang DC, Cornwell EE, Siram SM. Disparities in trauma care: are fewer diagnostic tests conducted for uninsured patients with pelvic fracture? Am J Surg 2013; 205:365-70. [DOI: 10.1016/j.amjsurg.2012.10.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Revised: 08/31/2012] [Accepted: 10/08/2012] [Indexed: 11/29/2022]
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Kisat M, Villegas CV, Onguti S, Zafar SN, Latif A, Efron DT, Haut ER, Schneider EB, Lipsett PA, Zafar H, Haider AH. Predictors of sepsis in moderately severely injured patients: an analysis of the National Trauma Data Bank. Surg Infect (Larchmt) 2013; 14:62-8. [PMID: 23461696 DOI: 10.1089/sur.2012.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Post-traumatic sepsis is a significant cause of in-hospital death. However, socio-demographic and clinical characteristics that may predict sepsis in injured patients are not well known. The objective of this study was to identify risk factors that may be associated with post-traumatic sepsis. METHODS Retrospective analysis of patients in the National Trauma Data Bank for 2007-2008. Patients older than 16 years of age with an Injury Severity Score (ISS) ≥ 9 points were included. Multivariable logistic regression was used to determine association of sepsis with patient (age, gender, ethnicity, and insurance status), injury (mechanism, ISS, injury type, hypotension), and clinical (major surgical procedure, intensive care unit admission) characteristics. RESULTS Of a total of 1.3 million patients, 373,370 met the study criteria, and 1.4% developed sepsis, with an associated mortality rate of approximately 20%. Age, male gender, African-American race, hypotension on emergency department presentation, and motor vehicle crash as the injury mechanism were independently associated with post-traumatic sepsis. CONCLUSIONS Socio-demographic and injury factors, such as age, race, hypotension on admission, and severity and mechanism of injury predict post-traumatic sepsis significantly. Further exploration to explain why these patient groups are at increased risk is warranted in order to understand better and potentially prevent this life-threatening complication.
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Affiliation(s)
- Mehreen Kisat
- Center for Surgery Trials and Outcomes Research, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21212, USA
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Haider AH. Preventing trauma surgeons from becoming family doctors. Ann Intern Med 2013; 158:291-2. [PMID: 23420239 DOI: 10.7326/0003-4819-158-4-201302190-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Schneider EB, Haider AH, Hyder O, Efron JE, Lidor AO, Pawlik TM. Assessing short- and long-term outcomes among black vs white Medicare patients undergoing resection of colorectal cancer. Am J Surg 2013; 205:402-8. [PMID: 23375764 DOI: 10.1016/j.amjsurg.2012.08.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 08/16/2012] [Accepted: 08/27/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND We sought to identify differences among black and white Medicare-insured patients with colorectal cancer who underwent resection. METHODS Surveillance, Epidemiology and End Results-Medicare (SEER-Medicare) linked inpatient data from 1986 to 2005 were examined. Differences in short- and long-term outcomes among black vs white patients were investigated. RESULTS There were 125,676 (92.4%) white and 9,891 (7.6%) black patients who met the criteria. Black patients were younger (75.5 vs 77.2 years; P < .001) but had more comorbidities than did white patients (mean Charlson comorbidity index score 3.99 vs 3.87; P < .001). Black patients demonstrated greater odds of in-hospital mortality (odds ratio [OR], 1.43; 95% confidence interval [CI], 1.30 to 1.56) and readmission within 30 days (OR, 1.26; 95% CI, 1.18 to 1.34). Comparing 1986 to 1990 vs 2001 to 2005, black patients had greater odds of 30-day readmission (OR, 1.12 vs 1.31) but reduced odds of index in-hospital mortality (OR, 1.84 vs 1.28). Black patients had worse long-term survival after colorectal surgery (hazard ratio [HR], 1.21; 95% CI, 1.17 to 1.25; P < .001). CONCLUSIONS Black patients with colorectal cancer demonstrated increased risk of mortality and readmission after controlling for age, sex, and comorbidities. Although black vs white differences in perioperative mortality decreased over time, disparities in readmission and long-term survival persisted.
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Affiliation(s)
- Eric B Schneider
- Department of Surgery, Center for Surgical Trials and Outcomes Research, Johns Hopkins University School of Medicine, Blalock 688, 600 N. Wolfe Street, Baltimore, MD 21287, USA
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Asemota AO, George BP, Bowman SM, Haider AH, Schneider EB. Causes and Trends in Traumatic Brain Injury for United States Adolescents. J Neurotrauma 2013; 30:67-75. [DOI: 10.1089/neu.2012.2605] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anthony O. Asemota
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Benjamin P. George
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Steven M. Bowman
- Department of Community Health, National University Technology and Health Sciences Center, San Diego, California
| | - Adil H. Haider
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eric B. Schneider
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
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