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Taheri BD, Fisher AD, Eisenhauer IF, April MD, Rizzo JA, Guliani SS, Flarity KM, Cripps M, Bebarta VS, Wohlauer MV, Schauer SG. The employment of resuscitative endovascular balloon occlusion of the aorta in deployed settings. Transfusion 2024. [PMID: 38581267 DOI: 10.1111/trf.17823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 03/17/2024] [Accepted: 03/25/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been often used in place of open aortic occlusion for management of hemorrhagic shock in trauma. There is a paucity of data evaluating REBOA usage in military settings. STUDY DESIGN AND METHODS We queried the Department of Defense Trauma Registry (DODTR) for all cases with at least one intervention or assessment available within the first 72 h after injury between 2007 and 2023. We used relevant procedural codes to identify the use of REBOA within the DODTR, and we used descriptive statistics to characterize its use. RESULTS We identified 17 cases of REBOA placed in combat settings from 2017 to 2019. The majority of these were placed in the operating room (76%) and in civilian patients (70%). A penetrating mechanism caused the injury in 94% of cases with predominantly the abdomen and extremities having serious injuries. All patients subsequently underwent an exploratory laparotomy after REBOA placement, with moderate numbers of patients having spleen, liver, and small bowel injuries. The majority (82%) of included patients survived to hospital discharge. DISCUSSION We describe 17 cases of REBOA within the DODTR from 2007 to 2023, adding to the limited documentation of patients undergoing REBOA in military settings. We identified patterns of injury in line with previous studies of patients undergoing REBOA in military settings. In this small sample of military casualties, we observed a high survival rate.
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Affiliation(s)
- Branson D Taheri
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
- Air Education and Training Command, Air Force Institute of Technology, Wright-Patterson Air Force Base, Dayton, Ohio, USA
- University of Colorado Center for Combat Medicine and Battlefield (COMBAT) Research, Aurora, Colorado, USA
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Andrew D Fisher
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
- Texas Army National Guard, Austin, Texas, USA
| | - Ian F Eisenhauer
- University of Colorado Center for Combat Medicine and Battlefield (COMBAT) Research, Aurora, Colorado, USA
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Emergency Medicine, Denver Health, Denver, Colorado, USA
- Navy Medicine Leader and Professional Development Command, Bethesda, Maryland, USA
| | - Michael D April
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- 14th Field Hospital, Fort Stewart, Georgia, USA
| | - Julie A Rizzo
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Brooke Army Medical Center, JBSA, Fort Sam Houston, Texas, USA
| | - Sundeep S Guliani
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Kathleen M Flarity
- University of Colorado Center for Combat Medicine and Battlefield (COMBAT) Research, Aurora, Colorado, USA
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Michael Cripps
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Vikhyat S Bebarta
- University of Colorado Center for Combat Medicine and Battlefield (COMBAT) Research, Aurora, Colorado, USA
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Max V Wohlauer
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Steven G Schauer
- University of Colorado Center for Combat Medicine and Battlefield (COMBAT) Research, Aurora, Colorado, USA
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado, USA
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Moore E, Wohlauer MV, Dorosh J, Kabeil M, Malgor RD, O'Banion LA, Lopez-Pena G, Gillette R, Colborn K, Cuff RF, Lucero L, Ali A, Koleilat I, Batarseh P, Talathi S, Rivera A, Humphries MD, Ly K, Harroun N, Smith BK, Darelli-Anderson AM, Choudhry A, Hammond E, Costanza M, Khetarpaul V, Cosentino A, Watson J, Afifi R, Mouawad NJ, Tan TW, Sharafuddin M, Quevedo JP, Nkansah R, Shibale P, Shalhub S, Lin JC. Impact of COVID-19 on patients undergoing scheduled procedures for chronic venous disease. Vascular 2024:17085381241240679. [PMID: 38520224 DOI: 10.1177/17085381241240679] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 03/25/2024]
Abstract
OBJECTIVE The COVID-19 pandemic has drastically altered the medical landscape. Various strategies have been employed to preserve hospital beds, personal protective equipment, and other resources to accommodate the surges of COVID-19 positive patients, hospital overcapacities, and staffing shortages. This has had a dramatic effect on vascular surgical practice. The objective of this study is to analyze the impact of the COVID-19 pandemic on surgical delays and adverse outcomes for patients with chronic venous disease scheduled to undergo elective operations. METHODS The Vascular Surgery COVID-19 Collaborative (VASCC) was founded in March 2020 to evaluate the outcomes of patients with vascular disease whose operations were delayed. Modules were developed by vascular surgeon working groups and tested before implementation. A data analysis of outcomes of patients with chronic venous disease whose surgeries were postponed during the COVID-19 pandemic from March 2020 through February 2021 was performed for this study. RESULTS A total of 150 patients from 12 institutions in the United States were included in the study. Indications for venous intervention were: 85.3% varicose veins, 10.7% varicose veins with venous ulceration, and 4.0% lipodermatosclerosis. One hundred two surgeries had successfully been completed at the time of data entry. The average length of the delay was 91 days, with a median of 78 days. Delays for venous ulceration procedures ranged from 38 to 208 days. No patients required an emergent intervention due to their venous disease, and no patients experienced major adverse events following their delayed surgeries. CONCLUSIONS Interventions may be safely delayed for patients with venous disease requiring elective surgical intervention during the COVID-19 pandemic. This finding supports the American College of Surgeons' recommendations for the management of elective vascular surgical procedures. Office-based labs may be safe locations for continued treatment when resources are limited. Although the interventions can be safely postponed, the negative impact on quality of life warrants further investigation.
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Affiliation(s)
- Ethan Moore
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Max V Wohlauer
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - James Dorosh
- Deparment of Surgery, McLaren Greater Lansing at Michigan State University, East Lansing, MI, USA
| | - Mahmood Kabeil
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rafael D Malgor
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Leigh A O'Banion
- Department of Surgery, University of California San Francisco Fresno, Fresno, CA, USA
| | - Gabriel Lopez-Pena
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Riley Gillette
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kathryn Colborn
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Robert F Cuff
- Department of Surgery, Spectrum Health/Michigan State University, Grand Rapids, MI, USA
| | - Leah Lucero
- Department of Surgery, University of California San Francisco Fresno, Fresno, CA, USA
| | - Amna Ali
- Department of Surgery, University of California San Francisco Fresno, Fresno, CA, USA
| | - Issam Koleilat
- Department of Surgery, RWJ/Barnabas Health, Toms River, NJ, USA
| | - Paola Batarseh
- Department of Surgery, Jacobi Medical Center, Albert Einstein School of Medicine, Bronx, NY, USA
| | - Sonia Talathi
- Department of Surgery, Jacobi Medical Center, Albert Einstein School of Medicine, Bronx, NY, USA
| | - Aksim Rivera
- Department of Surgery, Jacobi Medical Center, Albert Einstein School of Medicine, Bronx, NY, USA
| | - Misty D Humphries
- Department of Surgery, University of California Davis Health, Sacramento, CA, USA
| | - Kevin Ly
- Department of Surgery, University of California Davis Health, Sacramento, CA, USA
| | - Nikolai Harroun
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Brigitte K Smith
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Asad Choudhry
- Department of Surgery, SUNY Upstate University Hospital, Syracuse, NY, USA
| | - Eric Hammond
- Department of Surgery, SUNY Upstate University Hospital, Syracuse, NY, USA
| | - Michael Costanza
- Department of Surgery, SUNY Upstate University Hospital, Syracuse, NY, USA
| | - Vipul Khetarpaul
- Department of Surgery, Barnes Jewish Hospital, Washington University School of Medicine, St. Louis, MO, USA
| | - Ashley Cosentino
- Department of Surgery, Barnes Jewish Hospital, Washington University School of Medicine, St. Louis, MO, USA
| | - Jacob Watson
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Rana Afifi
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Nicolas J Mouawad
- Department of Vascular and Endovascular Surgery, McLaren Center for Research and Innovation, Bay City, MI, USA
| | - Tze-Woei Tan
- Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Mel Sharafuddin
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Judith P Quevedo
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Reggie Nkansah
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Palcah Shibale
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Sherene Shalhub
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Judith C Lin
- Deparment of Surgery, McLaren Greater Lansing at Michigan State University, East Lansing, MI, USA
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Kabeil M, Wohlauer MV, D'Oria M, Khetarpaul V, Gillette R, Moore E, Colborn K, Cuff RF, O'Banion LA, Koleilat I, Aziz F, Mouawad NJ. Carotid Artery Operation Delay During the Covid-19 Pandemic: Results of a Multicenter International Study. Ann Vasc Surg 2023; 96:44-56. [PMID: 37355018 DOI: 10.1016/j.avsg.2023.05.041] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/09/2023] [Accepted: 05/14/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND To measure the impact of the COVID-19 pandemic on the management of patients with carotid artery stenosis. METHODS We prospectively collected data from 25 centers (19 centers in the United States and 6 centers internationally) on postponed carotid artery operations between March 2020 and January 2022. We describe the characteristics of these patients and their planned operations, along with outcomes including mortality and neurological deterioration during the period of operative delay due to the COVID-19 pandemic. RESULTS A total of 1,220 vascular operations were postponed during the pandemic, of them 96 patients presented with significant carotid stenosis (median stenosis of 71%; interquartile range; 70-80) and 80% of them were planned for carotid endarterectomy. Most patients were asymptomatic (69%), and 31% of patients were symptomatic (16% of patients had a stroke, 15% of patients had a transient ischemic attack, and 1% of patients experienced amaurosis fugax). The median length of surgical delay was 71 days (interquartile range: 45.5, 115.5). At the data entry time, 62% of patients had their carotid operations postponed and successfully completed. Most postponements (72%) were due to institutional policies aimed at resource conservation. During the delay, no patient decompensated or required an urgent operation. A total of 5 patients (5%) with carotid stenosis died while awaiting operations due to COVID-19. CONCLUSIONS Our study of a cohort of patients with carotid artery stenosis who underwent a median delay of 71 days during the COVID-19 pandemic showed a disparate operation delay between US regions and internationally, most postponements were due to hospital policy, and none of the patients deteriorated or required an emergency surgery during the delay.
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Affiliation(s)
- Mahmood Kabeil
- Division of Vascular Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Max V Wohlauer
- Division of Vascular Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Vipul Khetarpaul
- Department of Surgery, Section of Vascular Surgery, Washington University School of Medicine, St. Louis, MO
| | - Riley Gillette
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Ethan Moore
- Division of Vascular Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kathryn Colborn
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Leigh Ann O'Banion
- Department of Surgery, University of California San Francisco (UCSF) Fresno, Fresno, CA
| | - Issam Koleilat
- Department of Surgery, RWJBH Community Medical Center, Toms River, NJ
| | - Faisal Aziz
- Division of Vascular Surgery, Department of Surgery, Penn State University, State College, PA
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Kabeil M, Kauvar DS, Bennett L, Wohlauer MV. Recent Advances and the Future of Abdominopelvic and Lower Extremity Vascular Injury Management. Semin Vasc Surg 2023. [DOI: 10.1053/j.semvascsurg.2023.03.005] [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: 04/08/2023]
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Pride L, Kabeil M, Alabi O, Minc SD, Fakorede FA, Ochoa LN, Wright AS, Wohlauer MV. A review of disparities in peripheral artery disease and diabetes-related amputations during the COVID-19 pandemic. Semin Vasc Surg 2023; 36:90-99. [PMID: 36958904 PMCID: PMC9780019 DOI: 10.1053/j.semvascsurg.2022.12.002] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/06/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
The COVID-19 pandemic has profoundly affected health care delivery. In addition to the significant morbidity and mortality associated with acute illness from COVID-19, the indirect impact has been far-reaching, including substantial disruptions in chronic disease care. As a result of pandemic disruptions in health care, vulnerable and minority populations have faced health inequalities. The aim of this review was to investigate how the COVID-19 pandemic has impacted vulnerable populations with limb-threatening peripheral artery disease and diabetic foot infections.
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Affiliation(s)
- Laura Pride
- Augusta University/University of Georgia Medical Partnership, Athens, GA
| | - Mahmood Kabeil
- Division of Vascular Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Olamide Alabi
- Division of Vascular Surgery and Endovascular Therapy, Emory University School of Medicine, Atlanta, GA
| | - Samantha D Minc
- Division of Vascular and Endovascular Surgery, Department of Cardiovascular and Thoracic Surgery, School of Medicine, Department of Occupational Health and Environmental Sciences, School of Public Health, West Virginia University, Morgantown, WV
| | | | - Lyssa N Ochoa
- San Antonio Vascular and Endovascular Clinic, San Antonio, TX
| | - A Sharee Wright
- Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC
| | - Max V Wohlauer
- Division of Vascular Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO.
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Kabeil M, Gillette R, Moore E, Cuff RF, Chuen J, Wohlauer MV. A primer on cohort studies in vascular surgery research. Semin Vasc Surg 2022; 35:404-412. [DOI: 10.1053/j.semvascsurg.2022.09.004] [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] [Received: 08/26/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 11/11/2022]
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Loo RJ, Wohlauer MV, Tarima SS, Weseman E, Nguyen JN, Mansukhani NA, Durand MJ. A Pilot Study Examining the Effects of Ischemic Conditioning on Walking Capacity and Lower Extremity Muscle Performance in Patients with Claudication. J Vasc Res 2022; 59:314-323. [PMID: 36067740 DOI: 10.1159/000525166] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 03/14/2022] [Accepted: 05/05/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION This study investigated whether a novel therapy called ischemic conditioning (IC) improves walking capacity and lower extremity muscle performance in patients with peripheral vascular disease who experience intermittent claudication. METHODS Forty-three patients with claudication were enrolled and received either IC or IC Sham for 2 weeks in this randomized, controlled, double-blinded, prospective study. IC sessions involved five cycles of alternating 5-min inflations of a blood pressure cuff to 225 mm Hg (25 mm Hg for IC Sham) and 5-min deflations, around the thigh of the affected lower extremity. RESULTS There was no difference in the change in claudication onset time (Δ = 114 ± 212 s IC vs. 104 ± 173 s IC Sham; p = 0.67) or peak walking time (Δ = 42 ± 139 s IC vs. 12 ± 148 s IC Sham; p = 0.35) between the IC and IC Sham groups. At the level of the knee, participants in the IC group performed more work (Δ = 3,029 ± 4,999 J IC vs. 345 ± 2,863 J IC Sham; p = 0.03) and displayed a greater time to muscle fatigue (Δ = 147 ± 221 s IC vs. -27 ± 236 s IC Sham; p = 0.01). DISCUSSION/CONCLUSION In patients with claudication, IC improved total work performed and time to fatigue at the knee but did not change walking parameters.
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Affiliation(s)
- Rory J Loo
- Division of Vascular and Endovascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Max V Wohlauer
- Division of Vascular Surgery, Department of Surgery, University of Colorado School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Sergey S Tarima
- Division of Biostatistics, Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Elizabeth Weseman
- Division of Vascular and Endovascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jennifer N Nguyen
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Neel A Mansukhani
- Division of Vascular and Endovascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Matthew J Durand
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Cardiovascular Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Attisani L, Bissacco D, Pucci A, Luoni G, Luzzani L, Pegorer MA, Settembrini AM, Wohlauer MV, Bellosta R. COVID-19 and limb ischemia: experience first. J Cardiovasc Surg (Torino) 2022; 63:537-538. [PMID: 35848872 DOI: 10.23736/s0021-9509.22.12314-1] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Luca Attisani
- Vascular and Endovascular Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Daniele Bissacco
- Vascular Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy -
| | - Alessandro Pucci
- Vascular and Endovascular Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Giorgio Luoni
- Vascular and Endovascular Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Luca Luzzani
- Vascular and Endovascular Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Matteo A Pegorer
- Vascular and Endovascular Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Alberto M Settembrini
- Vascular Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Max V Wohlauer
- Department of Vascular Surgery, University of Colorado, Denver, CO, USA
| | - Raffaello Bellosta
- Vascular and Endovascular Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
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Kabeil M, D'Oria M, Wohlauer MV, Khetarpaul V, Gillette R, Colborn K, Cuff RF, Mouawad NJ. Impact of COVID-19 on Patients Undergoing Scheduled Carotid Interventions. EJVES Vasc Forum 2022. [PMCID: PMC8940238 DOI: 10.1016/j.ejvsvf.2021.12.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Attisani L, Pucci A, Luoni G, Luzzani L, Pegorer MA, Settembrini AM, Bissacco D, Wohlauer MV, Piffaretti G, Bellosta R. COVID-19 and acute limb ischemia: a systematic review. J Cardiovasc Surg (Torino) 2021; 62:542-547. [PMID: 34581552 DOI: 10.23736/s0021-9509.21.12017-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The main goal of this systematic review is to analyze the outcomes of acute limb ischemia (ALI) in patients suffering from the novel Coronavirus COVID-19 (Sars-Cov-2). EVIDENCE OF ACQUISITION A systematic review on MEDLINE and Embase was conducted up to May 15, 2021. All papers were sorted by abstract and full text by two independent authors. Systematic reviews, commentaries, and studies that did not distinguish status of COVID-19 infection were excluded from review. Patient demographics were recorded along with modality of treatment (endovascular and/or surgical). We analyzed 30-day outcomes, including mortality. Primary outcome was to evaluate clinical characteristic of ALI in patients affected by SARS-CoV-2 in term of location of ischemia, treatment options and 30-day outcomes. EVINDENCE SYNTHESIS We selected 36 articles with a total of 194 patients. The majority of patients were male (80%) with a median age of 60 years old. The treatment most used was thromboembolectomy (31% of all surgical interventions). A total of 32 patients (19%) were not submitted to revascularization due to critical status. The rate of technical success was low (68%) and mortality rate was high (35%). CONCLUSIONS This review confirms that Sars-Cov-2 is associated with a high risk of ALI. Further studies are needed to investigate the association and elucidate potential mechanisms, which may include a hypercoagulable state and hyperactivation of the immune response. Furthermore, management of ALI is not standardized and depends on patient's condition and extension of the thrombosed segment. ALI in COVID-19 patients is associated with high risk of failure of revascularization and perioperative mortality.
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Affiliation(s)
- Luca Attisani
- Vascular and Endovascular Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy -
| | - Alessandro Pucci
- Vascular and Endovascular Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Giorgio Luoni
- Vascular and Endovascular Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Luca Luzzani
- Vascular and Endovascular Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Matteo A Pegorer
- Vascular and Endovascular Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | | | - Daniele Bissacco
- Vascular Surgery Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Max V Wohlauer
- Vascular Surgery, University of Colorado, Denver, CO, USA
| | | | - Raffaello Bellosta
- Vascular and Endovascular Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
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Dorosh J, Wohlauer MV, Kabeil M, Malgor RD, O'Banion LA, Lopez-Pena G, Gillette R, Colborn K, Cuff R, Lin JC. Impact of COVID-19 on Patients Undergoing Scheduled Operations for Venous Disease. J Vasc Surg 2021. [PMCID: PMC8376828 DOI: 10.1016/j.jvs.2021.06.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lopez-Pena G, Wohlauer MV, Hinojosa CA, Teran-Ellis SM, Cuff R, Chawla A, Gunawansa N, Sternbergh C, Gillette R, Colborn K, Guidry L. Impact of COVID-19 on Patients Undergoing Scheduled Hemodialysis Operations. J Vasc Surg 2021. [PMCID: PMC8376810 DOI: 10.1016/j.jvs.2021.06.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Aziz F, Behrendt CA, Sullivan K, Beck AW, Beiles CB, Boyle JR, Mani K, Benson RA, Wohlauer MV, Khashram M, Jorgensen JE, Lemmon GW. The impact of COVID-19 pandemic on vascular registries and clinical trials. Semin Vasc Surg 2021; 34:28-36. [PMID: 34144744 PMCID: PMC8137351 DOI: 10.1053/j.semvascsurg.2021.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/26/2021] [Accepted: 04/30/2021] [Indexed: 02/06/2023]
Abstract
Quality improvement programs and clinical trial research experienced disruption due to the coronavirus disease 2019 (COVID-19) pandemic. Vascular registries showed an immediate impact with significant declines in second-quarter vascular procedure volumes witnessed across Europe and the United States. To better understand the magnitude and impact of the pandemic, organizations and study groups sent grass roots surveys to vascular specialists for needs assessment. Several vascular registries responded quickly by insertion of COVID-19 variables into their data collection forms. More than 80% of clinical trials have been reported delayed or not started due to factors that included loss of enrollment from patient concerns or mandated institutional shutdowns, weighing the risk of trial participation on patient safety. Preliminary data of patients undergoing vascular surgery with active COVID-19 infection show inferior outcomes (morbidity) and increased mortality. Disease-specific vascular surgery study collaboratives about COVID-19 were created for the desire to study the disease in a more focused manner than possible through registry outcomes. This review describes the pandemic effect on multiple VASCUNET registries including Germany (GermanVasc), Sweden (SwedVasc), United Kingdom (UK National Vascular Registry), Australia and New Zealand (bi-national Australasian Vascular Audit), as well as the United States (Society for Vascular Surgery Vascular Quality Initiative). We will highlight the continued collaboration of VASCUNET with the Vascular Quality Initiative in the International Consortium of Vascular Registries as part of the Medical Device Epidemiology Network coordinated registry network. Vascular registries must remain flexible and responsive to new and future real-world problems affecting vascular patients.
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Affiliation(s)
- Faisal Aziz
- Integrated Vascular Surgery Program, Penn State Health Heart and Vascular Institute, Hershey, PA
| | | | | | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - C Barry Beiles
- Australian and New Zealand Society for Vascular Surgery, Australasian Vascular Audit, Melbourne, Victoria, Australia
| | - Jon R Boyle
- University of Cambridge, Cambridge, Cambridgeshire, UK; Vascular Society of Great Britain and Ireland, Staffordshire, UK
| | - Kevin Mani
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Ruth A Benson
- University Hospital Coventry and Warwickshire, West Midlands, UK
| | - Max V Wohlauer
- Vascular Surgery, University of Colorado, Denver, CO; Vascular Surgery COVID-19 Collaborative
| | - Manar Khashram
- Department of Surgery, University of Auckland, Auckland, NZ
| | - Jens Eldrup Jorgensen
- Tufts University School of Medicine, Boston, MA; Patient Safety Organization, Society for Vascular Surgery, Rosemont, IL
| | - Gary W Lemmon
- Patient Safety Organization, Society for Vascular Surgery, Rosemont, IL; Indiana University, 1801 N Senate Boulevard, D-3500, Indianapolis, IN 46202.
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Hekman KE, Sullivan BP, Bronsert M, Chang KZ, Reed A, Velazquez-Ramirez G, Wohlauer MV. Modifiable risk factors for burnout in vascular surgery trainees. J Vasc Surg 2021; 73:2155-2163.e3. [PMID: 33675887 DOI: 10.1016/j.jvs.2020.12.064] [Citation(s) in RCA: 6] [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] [Received: 06/25/2020] [Accepted: 12/05/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Burnout is prevalent among vascular surgery trainees. Here we aim to identify modifiable risk factors for burnout in vascular surgery training, to facilitate the development of programs to enhance and sustain trainee well-being. METHODS The Association of Program Directors in Vascular Surgery issued the Annual Training survey in the fall of 2018 to all trainees. The survey contained items to assess frequency of burnout, as well as mentorship, training environment, and stress coping mechanisms using an abbreviated COPE (Coping Orientation to Problems Experienced) inventory. RESULTS Of 628 surveys issued, the response rate was 30% (n = 188). Respondents indicated that the majority of programs offer mentorship opportunities (n = 150 [83%]) that are longitudinal throughout the duration of training (n = 140 [77%]). Fifty-eight percent (n = 109) indicated there was an appropriate balance between learning and productivity in their program, with more respondents leaning toward too much clinical productivity (n = 57) and fewer toward too much learning (n = 19). Forty-five percent of respondents indicated feeling burnout at least weekly (n = 81). The burnout group was less likely to report an appropriate balance between clinical productivity and learning (49.4% vs 67.7%; P < .001), as well as a lower frequency of mentorship opportunities (72.1% vs 92.7%; P < .001). Certain coping skills were used more frequently in the burnout group, including self-distraction, disengagement, humor, self-blame, and substance use. In multivariate analysis, frequent use of self-blame conferred a 9.847-fold increased risk (95% confidence interval, 2.114-45.871) of burnout (P = .003), while feeling appropriately challenged by the faculty was significantly protective (odds ratio for burnout, 0.158; 95% confidence interval, 0.031-0.820; P = .03). CONCLUSIONS The protective effect against vascular surgery trainee burnout conferred by the availability of mentorship suggests that an expansion and emphasis on mentorship in training may help to mitigate trainee burnout. Mentorship may also be a suitable channel to assess for an appropriate level of challenge, as well as for an appropriate balance between clinical productivity and learning that, when present, are also protective against burnout. Furthermore, the correlation between the frequent use of certain coping skills and burnout highlight this as an area for intervention, potentially through a combination of mentor modeling and formal training on healthy stress-related coping strategies.
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Affiliation(s)
- Katherine E Hekman
- Division of Vascular Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Brian P Sullivan
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, Mo
| | - Michael Bronsert
- SOAR (Surgical Outcomes and Applied Research) and ACCORDS (Adult and Child Consortium for Health Outcomes Research and Delivery Science), University of Colorado School of Medicine, University of Colorado, Aurora, Colo
| | - Kevin Z Chang
- Department of Vascular and Endovascular Surgery, Wake Forest Baptist Health, Winston-Salem, NC
| | - Amy Reed
- Vascular and Endovascular Surgery, University of Minnesota, Minneapolis, Minn
| | | | - Max V Wohlauer
- Division of Vascular Surgery, Department of Surgery, University of Colorado School of Medicine, University of Colorado, Aurora, Colo.
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16
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Mouawad NJ, Woo K, Malgor RD, Wohlauer MV, Johnson AP, Cuff RF, Coleman DM, Coogan SM, Sheahan MG, Shalhub S. The impact of the COVID-19 pandemic on vascular surgery practice in the United States. J Vasc Surg 2021; 73:772-779.e4. [PMID: 32889073 PMCID: PMC7462594 DOI: 10.1016/j.jvs.2020.08.036] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/02/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has led to widespread postponement and cancelation of elective surgeries in the United States. We designed and administered a global survey to examine the impact of COVID-19 on vascular surgeons. We describe the impact of the pandemic on the practices of vascular surgeons in the United States. METHODS The Pandemic Practice, Anxiety, Coping, and Support Survey for Vascular Surgeons is an anonymous cross-sectional survey sponsored by the Society for Vascular Surgery Wellness Task Force disseminated April 14 to 24, 2020. This analysis focuses on pattern changes in vascular surgery practices in the United States including the inpatient setting, ambulatory, and vascular laboratory setting. Specific questions regarding occupational exposure to COVID-19, adequacy of personal protective equipment, elective surgical practice, changes in call schedule, and redeployment to nonvascular surgery duties were also included in the survey. Regional variation was assessed. The survey data were collected using REDCap and analyzed using descriptive statistics. RESULTS A total of 535 vascular surgeons responded to the survey from 45 states. Most of the respondents were male (73.1%), white (70.7%), practiced in urban settings (81.7%), and in teaching hospitals (66.8%). Almost one-half were in hospitals with more than 400 beds (46.4%). There was no regional variation in the presence of preoperative COVID-19 testing, COVID-19 OR protocols, adherence to national surgical standards, or the availability of personal protective equipment. The overwhelming majority of respondents (91.7%) noted elective surgery cancellation, with the Northeast and Southeast regions having the most case cancellations 94.2% and 95.8%, respectively. The Northeast region reported the highest percentage of operations or procedures on patients with COVID-19, which was either identified at the time of the surgery or later in the hospital course (82.7%). Ambulatory visits were performed via telehealth (81.3%), with 71.1% having restricted hours. More than one-half of office-based laboratories (OBLs) were closed, although there was regional variation with more than 80% in the Midwest being closed. Cases performed in OBLs focused on critical limb ischemia (42.9%) and dialysis access maintenance (39.9%). Call schedules modifications were common, although the number of call days remained the same (45.8%). CONCLUSIONS Vascular surgeons in the United States report substantial impact on their practices during the COVID-19 pandemic, and regional variations are demonstrated, particularly in OBL use, intensive care bed availability, and COVID-19 exposure at work.
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Affiliation(s)
- Nicolas J. Mouawad
- Division of Vascular & Endovascular Surgery, McLaren Health System, Bay City, Mich,Division of Vascular Surgery, Michigan State University, Lansing, Mich
| | - Karen Woo
- Division of Vascular Surgery, University of California Los Angeles, Los Angeles, Calif
| | - Rafael D. Malgor
- Division of Vascular Surgery and Endovascular Therapy, The University of Colorado, Anschutz Medical Center, Aurora, Colo
| | - Max V. Wohlauer
- Division of Vascular Surgery and Endovascular Therapy, The University of Colorado, Anschutz Medical Center, Aurora, Colo
| | - Adam P. Johnson
- New York/Presbyterian Weill Cornell School of Medicine, New York, NY
| | - Robert F. Cuff
- Vascular Surgery, Spectrum Health Medical Group, Grand Rapids, Mich
| | - Dawn M. Coleman
- Department of Surgery, University of Michigan, Ann Arbor, Mich
| | - Sheila M. Coogan
- Department of Cardiovascular Surgery, University of Texas at Houston, Houston, Tex
| | - Malachi G. Sheahan
- Division of Vascular and Endovascular Surgery, Louisiana State University Health Sciences Center, New Orleans, La
| | - Sherene Shalhub
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash.
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17
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Shalhub S, Mouawad NJ, Malgor RD, Johnson AP, Wohlauer MV, Coogan SM, Loveland KA, Cuff RF, Leonardi C, Coleman DM, Sheahan MG, Woo K. Global vascular surgeons' experience, stressors, and coping during the coronavirus disease 2019 pandemic. J Vasc Surg 2021; 73:762-771.e4. [PMID: 32882345 PMCID: PMC7457940 DOI: 10.1016/j.jvs.2020.08.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/01/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented challenges for health care systems globally. We designed and administered a global survey to examine the effects of COVID-19 on vascular surgeons and explore the COVID-19-related stressors faced, coping strategies used, and support structures available. METHODS The Pandemic Practice, Anxiety, Coping, and Support Survey for Vascular Surgeons was an anonymous cross-sectional survey sponsored by the Society for Vascular Surgery Wellness Task Force. The survey analysis evaluated the effects of COVID-19-related stressors on vascular surgeons measured using the Generalized Anxiety Disorder 7-item scale. The 28-item Brief Coping Orientation to Problems Experienced inventory was used to assess the active and avoidant coping strategies. Survey data were collected using REDCap (Research Electronic Data Capture) from April 14, 2020 to April 24, 2020 inclusive. Additional qualitative data were collected using open-ended questions. Univariable and multivariable analyses of the factors associated with the anxiety levels and qualitative analysis were performed. RESULTS A total of 1609 survey responses (70.5% male; 82.5% vascular surgeons in practice) from 58 countries (43.4% from United States; 43.4% from Brazil) were eligible for analysis. Some degree of anxiety was reported by 54.5% of the respondents, and 23.3% reported moderate or severe anxiety. Most respondents (∼60%) reported using active coping strategies and the avoidant coping strategy of "self-distraction," and 20% used other avoidant coping strategies. Multivariable analysis identified the following factors as significantly associated with increased self-reported anxiety levels: staying in a separate room at home or staying at the hospital or a hotel after work (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.08-1.79), donning and doffing personal protective equipment (OR, 1.81; 95% CI, 1.41-2.33), worry about potential adverse patient outcomes due to care delay (OR, 1.47; 95% CI, 1.16-1.87), and financial concerns (OR, 1.90; 95% CI, 1.49-2.42). The factors significantly associated with decreased self-reported anxiety levels were hospital support (OR, 0.83; 95% CI, 0.76-0.91) and the use of positive reframing as an active coping strategy (OR, 0.88; 95% CI, 0.81-0.95). CONCLUSIONS Vascular surgeons globally have been experiencing multiple COVID-19-related stressors during this devastating crisis. These findings have highlighted the continued need for hospital systems to support their vascular surgeons and the importance of national societies to continue to invest in peer-support programs as paramount to promoting the well-being of vascular surgeons during and after the COVID-19 pandemic.
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Affiliation(s)
- Sherene Shalhub
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash.
| | - Nicolas J. Mouawad
- Department of Vascular and Endovascular Surgery, McLaren Health System, Bay City, Mich
| | - Rafael D. Malgor
- Division of Vascular Surgery and Endovascular Therapy, The University of Colorado Anschutz Medical Center, Aurora, Colo
| | - Adam P. Johnson
- New York/Presbyterian Weill Cornell School of Medicine, New York, NY
| | - Max V. Wohlauer
- Division of Vascular Surgery and Endovascular Therapy, The University of Colorado Anschutz Medical Center, Aurora, Colo
| | - Sheila M. Coogan
- Department of Cardiovascular Surgery, University of Texas at Houston, Houston, Tex
| | - Katherine A. Loveland
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Tex
| | - Robert F. Cuff
- Department of Vascular Surgery, Spectrum Health Medical Group, Grand Rapids, Mich
| | - Claudia Leonardi
- Department of Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, La
| | - Dawn M. Coleman
- Department of Surgery, University of Michigan, Ann Arbor, Mich
| | - Malachi G. Sheahan
- Division of Vascular and Endovascular Surgery, Louisiana State University Health Sciences Center, New Orleans, La
| | - Karen Woo
- Division of Vascular Surgery, University of California, Los Angeles, Los Angeles, Calif
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18
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Johnson AP, Wohlauer MV, Mouawad NJ, Malgor RD, Coogan SM, Sheahan MG, Singh N, Cuff RF, Woo K, Coleman DM, Shalhub S. The Impact of the COVID-19 Pandemic on Vascular Surgery Trainees in the United States. Ann Vasc Surg 2020; 72:182-190. [PMID: 33157252 PMCID: PMC7608023 DOI: 10.1016/j.avsg.2020.09.045] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/13/2020] [Accepted: 09/16/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The impact of the coronavirus disease 19 (COVID-19) pandemic on health care workers has been substantial. However, the impact on vascular surgery (VS) trainees has not yet been determined. The goals of our study were to gauge the impact of COVID-19 on VS trainees' personal and professional life and to assess stressors, coping, and support structures involved in these trainees' response to the COVID-19 pandemic. METHODS This was an anonymous online survey administered in April 12-24, 2020 during the surge phase of the global COVID-19 pandemic. It is a subset analysis of the cross-sectional Society for Vascular Surgery Wellness Committee Pandemic Practice, Anxiety, Coping, and Support Survey. The cohort surveyed was VS trainees, integrated residents and fellows, in the United States of America. Assessment of the personal impact of the pandemic on VS trainees and the coping strategies used by them was based on the validated Generalized Anxiety Disorder 7-item (GAD-7) scale and the validated 28-time Brief Coping Orientation to Problems Experienced inventory. RESULTS A total of 145 VS trainees responded to the survey, with a 23% response rate (145/638). Significant changes were made to the clinical responsibilities of VS trainees, with 111 (91%) reporting cancellation of elective procedures, 101 (82%) with call schedule changes, 34 (24%) with duties other than related to VS, and 29 (24%) participation in outpatient care delivery. Over one-third (52/144) reported they had performed a procedure on a patient with confirmed COVID-19; 37 (25.7%) reported they were unaware of the COVID-19 status at the time. The majority continued to work after exposure (29/34, 78%). Major stressors included concerns about professional development, infection risk to family/friends, and impact of care delay on patients. The median score for GAD-7 was 4 (interquartile range 1-8), which corresponds to no or low self-reported anxiety levels. VS trainees employed mostly active coping and rarely avoidant coping mechanisms, and the majority were aware and used social media and online support systems. No significant difference was observed between integrated residents and fellows, or by gender. CONCLUSIONS The pandemic has had significant impact on VS trainees. Trainees reported significant changes to clinical responsibilities, exposure to COVID-19, and pandemic-related stressors but demonstrated healthy coping mechanisms with low self-reported anxiety levels. The VS community should maintain awareness of the impact of the pandemic on the professional and personal development of surgeons in training. We recommend adaptive evolution in training to accommodate the changing learning environment for trainees.
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Affiliation(s)
- Adam P Johnson
- New York-Presbyterian Weill Cornell School of Medicine, New York, NY
| | - Max V Wohlauer
- Division of Vascular Surgery and Endovascular Therapy, The University of Colorado, Anschutz Medical Center, Aurora, CO
| | - Nicolas J Mouawad
- Vascular & Endovascular Surgery, McLaren Health System, Bay City, MI
| | - Rafael D Malgor
- Division of Vascular Surgery and Endovascular Therapy, The University of Colorado, Anschutz Medical Center, Aurora, CO
| | - Sheila M Coogan
- Department of Cardiovascular Surgery, University of Texas at Houston, Houston, TX
| | - Malachi G Sheahan
- Division of Vascular and Endovascular Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Niten Singh
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA
| | - Robert F Cuff
- Vascular Surgery, Spectrum Health Medical Group, Grand Rapids, MI
| | - Karen Woo
- Division of Vascular Surgery, University of California Los Angeles, Los Angeles, CA
| | - Dawn M Coleman
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Sherene Shalhub
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA.
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Malgor RD, Sobreira ML, Mouawad NJ, Johnson AP, Wohlauer MV, Coogan SM, Cuff RF, Coleman DM, Sheahan MG, Woo K, Shalhub S. Brazilian vascular surgeons experience during the coronavirus (COVID-19) pandemic. Vascular 2020; 29:451-460. [PMID: 33019914 PMCID: PMC7539231 DOI: 10.1177/1708538120954961] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The COVID-19 pandemic has made a significant impact on all spheres of
society. The objective of this study was to examine the impact of COVID-19
on the practices, finances, and social aspects of Brazilian vascular
surgeons’ lives. Methods This is a descriptive analysis of the responses from Brazilian vascular
surgeons to the cross-sectional anonymous Society for Vascular Surgery
Wellness Task Force Pandemic Practice, Anxiety, Coping, and Support Survey
for Vascular Surgeons disseminated 14–24 April 2020. Survey dissemination in
Brazil occurred mainly via the Brazilian Society of Angiology and Vascular
Surgery (SBACV) and social media. The survey evaluated the impact of the
COVID-19 pandemic on vascular surgeons’ lives by assessing COVID-19-related
stressors, anxiety using theGeneral Anxiety Disorder (GAD)-7 scale, and
coping strategies using the Brief Coping Orientation to Problems Experienced
(Brief-COPE) inventory. Results A total of 452 responses were recorded from Brazil, with 335 (74%)
respondents completing the entire survey. The majority of respondents were
males (N = 301, 67%) and practiced in an urban hospitals.
The majority of respondents considered themselves at high risk to be
infected with COVID-19 (N = 251, 55.8%), and just over half
the respondents noted that they had adequate PPE at their primary hospital
(N = 171, 54%). One hundred and nine (35%) surgeons
confirmed that their hospitals followed professional surgical society
guidelines for prioritizing surgeries during the pandemic. At the time of
the survey, only 33 (10%) surgeons stated they have pre-operative testing of
patients for COVID-19 available at their hospital. Academic vascular
surgeons reported being redeployed more often to help with other
non-vascular duties compared to community-based or solo practitioners (43%
vs. 30% vs. 21% respectively, P = .01). Severe anxiety due
to pandemic-related financial concerns was similar in those surgeons
practicing solo compared to those in community- or academic-based/group
practice (46% vs. 38% vs. 22%; P = .54). The respondents
reported their anxiety levels as mild based on the stressors investigated
instead of moderate-severe (54% vs. 46%; P = .04). Social
media was utilized heavily during the pandemic, with video gatherings being
the most commonly used tool (76%). Self-distraction (60%) and situational
acceptance (81%) were the most frequently reported coping mechanisms used
among Brazilian vascular surgeons. Conclusion The COVID pandemic has greatly affected healthcare providers around the
world. At the time of this survey, Brazilian vascular surgeons are reporting
low anxiety levels during this time and are using mostly active coping
mechanisms.
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Affiliation(s)
- Rafael D Malgor
- Anschutz Medical Center, Division of Vascular Surgery and Endovascular Therapy, The University of Colorado, Aurora, CO, USA
| | - Marcone Lima Sobreira
- Division of Vascular Surgery, Botucatu School of Medicine, Sao Paulo State University, Botucatu, Brazil
| | - Nicolas J Mouawad
- Vascular & Endovascular Surgery, McLaren Health System, Bay City, MI, USA
| | - Adam P Johnson
- New York/Presbyterian Weill Cornell School of Medicine, New York, NY, USA
| | - Max V Wohlauer
- Anschutz Medical Center, Division of Vascular Surgery and Endovascular Therapy, The University of Colorado, Aurora, CO, USA
| | - Sheila M Coogan
- Department of Cardiovascular Surgery, University of Texas at Houston, Houston, TX, USA
| | - Robert F Cuff
- Vascular Surgery, Spectrum Health Medical Group, Grand Rapids, MI, USA
| | - Dawn M Coleman
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Malachi G Sheahan
- Division of Vascular and Endovascular Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Karen Woo
- Division of Vascular Surgery. University of California Los Angeles, Los Angeles, CA, USA
| | - Sherene Shalhub
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA, USA
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Siada SS, Al-Musawi MH, Wohlauer MV, Zarkowsky DS, Yi JA, Eun JC, Jacobs DL, Nehler MR. Acute Limb Ischemia: An Administrative Code Combination With Near Perfect Diagnostic Specificity. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.04.249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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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Wright FL, Vogler TO, Moore EE, Moore HB, Wohlauer MV, Urban S, Nydam TL, Moore PK, McIntyre RC. Fibrinolysis Shutdown Correlation with Thromboembolic Events in Severe COVID-19 Infection. J Am Coll Surg 2020; 231:193-203.e1. [PMID: 32422349 PMCID: PMC7227511 DOI: 10.1016/j.jamcollsurg.2020.05.007] [Citation(s) in RCA: 277] [Impact Index Per Article: 69.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 01/08/2023]
Abstract
Background COVID-19 predisposes patients to a prothrombotic state with demonstrated microvascular involvement. The degree of hypercoagulability appears to correlate with outcomes; however, optimal criteria to assess for the highest-risk patients for thrombotic events remain unclear; we hypothesized that deranged thromboelastography measurements of coagulation would correlate with thromboembolic events. Study Design Patients admitted to an ICU with COVID-19 diagnoses who had thromboelastography analyses performed were studied. Conventional coagulation assays, d-dimer levels, and viscoelastic measurements were analyzed using a receiver operating characteristic curve to predict thromboembolic outcomes and new-onset renal failure. Results Forty-four patients with COVID-19 were included in the analysis. Derangements in coagulation laboratory values, including elevated d-dimer, fibrinogen, prothrombin time, and partial thromboplastin time, were confirmed; viscoelastic measurements showed an elevated maximum amplitude and low lysis of clot at 30 minutes. A complete lack of lysis of clot at 30 minutes was seen in 57% of patients and predicted venous thromboembolic events with an area under the receiver operating characteristic curve of 0.742 (p = 0.021). A d-dimer cutoff of 2,600 ng/mL predicted need for dialysis with an area under the receiver operating characteristic curve of 0.779 (p = 0.005). Overall, patients with no lysis of clot at 30 minutes and a d-dimer > 2,600 ng/mL had a venous thromboembolic event rate of 50% compared with 0% for patients with neither risk factor (p = 0.008), and had a hemodialysis rate of 80% compared with 14% (p = 0.004). Conclusions Fibrinolysis shutdown, as evidenced by elevated d-dimer and complete failure of clot lysis at 30 minutes on thromboelastography predicts thromboembolic events and need for hemodialysis in critically ill patients with COVID-19. Additional clinical trials are required to ascertain the need for early therapeutic anticoagulation or fibrinolytic therapy to address this state of fibrinolysis shutdown.
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Affiliation(s)
| | | | - Ernest E Moore
- Departments of Surgery; Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO
| | | | | | - Shane Urban
- University of Colorado Anschutz Medical Campus, UCHealth, University of Colorado Hospital, Aurora
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Abstract
Although management paradigms for certain arterial trauma, such as aortic injuries, have moved towards an endovascular approach, the application of endovascular techniques for the treatment of peripheral arterial injuries continues to be debated. In the realm of peripheral vascular trauma, popliteal arterial injuries remain a devastating condition with significant rates of limb loss. Expedient management is essential and surgical revascularization has been the gold standard. Initial clinical assessment of vascular injury is aided by readily available imaging techniques such as duplex ultrasonography and high resolution computed tomographic angiography. Conventional catheter based angiography, however, remain the gold standard in the determination of vascular injury. There are limited data examining the outcomes of endovascular techniques to address popliteal arterial injuries. In this review, we examine the imaging modalities and current approaches and data regarding endovascular techniques for the management popliteal arterial trauma.
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Affiliation(s)
- Cheong J Lee
- 1 Division of Vascular Surgery, Medical College of Wisconsin, Milwaukee, USA
| | - Rory Loo
- 1 Division of Vascular Surgery, Medical College of Wisconsin, Milwaukee, USA
| | - Max V Wohlauer
- 1 Division of Vascular Surgery, Medical College of Wisconsin, Milwaukee, USA
| | - Parag J Patel
- 2 Division of Interventional Radiology, Medical College of Wisconsin, Milwaukee, USA
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Wohlauer MV, George B, Lawrence PF, Pugh CM, Van Eaton EG, Darosa D. Review of influential articles in surgical education: 2002-2012. J Grad Med Educ 2013; 5:219-26. [PMID: 24404263 PMCID: PMC3693684 DOI: 10.4300/jgme-05-02-39] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 03/26/2013] [Accepted: 04/04/2013] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Exploring the trends in surgical education research offers insight into concerns, developments, and questions researchers are exploring that are relevant to teaching and learning in surgical specialties. OBJECTIVE We conducted a review of the surgical education literature published between 2002 and 2012. The purpose was 2-fold: to provide an overview of the most frequently cited articles in the field of surgical education during the last decade and to describe the study designs and themes featured in these articles. METHODS Articles were identified through Web of Science by using "surgical education" and "English language" as search terms. Using a feature in Web of Science, we tracked the number of citations of any publication. Of the 800 articles produced by the initial search, we initially selected 23 articles with 45 or more citations, and ultimately chose the 20 articles that were most frequently cited for our analysis. RESULTS Analysis of the most frequently cited articles published in US journals between the years 2002-2012 identified 7 research themes and presented them in order of frequency with which they appear: use of simulation, issues in student/resident assessment, specialty choice, patient safety, team training, clinical competence assessment, and teaching the clinical sciences, with surgical simulation being the central theme. Researchers primarily used descriptive methods. CONCLUSIONS Popular themes in surgical education research illuminate the information needs of surgical educators as well as topics of high interest to the surgical community.
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Wohlauer MV, McManus M, Fukami N, Gajdos C. Intraductal oncocytic papillary neoplasm of the pancreas: report of a case requiring completion pancreatectomy. JOP 2013; 14:77-80. [PMID: 23306340 DOI: 10.6092/1590-8577/1259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 11/04/2012] [Accepted: 11/05/2012] [Indexed: 11/10/2022]
Abstract
CONTEXT Cystic tumors of the pancreas have been diagnosed with increasing frequency. Intraductal oncocytic papillary neoplasm is a rare type of cystic pancreatic tumor. Intraductal oncocytic papillary neoplasm is considered a distinct entity with the potential of developing into invasive carcinoma and it should be differentiated from other cystic tumors of the pancreas, including mucinous cystic neoplasm and other forms of intraductal papillary mucinous neoplasm (IPMN). Histologically, the formation of oncocytic cells and the complex morphology of the papillae distinguish intraductal oncocytic papillary neoplasm from IPMN. While the number of publications addressing the diagnosis, management and follow-up of patients with IPMN has been increasing, the behavior differences between IPMN and intraductal oncocytic papillary neoplasm have not been elucidated, secondary to very limited clinical experience. CASE REPORT Here, we are presenting a case of a patient with the diagnosis of intraductal oncocytic papillary neoplasm of the pancreas developing into invasive cancer. CONCLUSION This case stresses the necessity for lifelong surveillance of the remnant pancreas following partial pancreatectomy for intraductal oncocytic papillary neoplasm, due to the risk of developing multifocal disease.
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Affiliation(s)
- Max V Wohlauer
- Section of GI, Tumor and Endocrine Surgery, Department of Surgery, University of Colorado at Denver, Aurora, CO 80045, USA
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Affiliation(s)
- James G Chandler
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO 80045, USA.
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Wohlauer MV, McManus MC, Brauer B, Hedges J, Gajdos C. Synchronous presentation of ampullary adenocarcinoma and common bile duct cancer: report of a case and review of literature. JOP 2012; 13:536-9. [PMID: 22964962 DOI: 10.6092/1590-8577/836] [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] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
CONTEXT Ampullary adenocarcinomas and bile duct cancers represent a very small minority of all gastrointestinal malignancies. Synchronous presentation of both malignancies is extremely rare. CASE REPORT We report a case of a 76-year-old male who presented with painless jaundice. His work-up showed an ampullary mass and a separate common bile duct stricture. Attempted endoscopic resection established the diagnosis of ampullary adenocarcinoma. Pathologic examination of the Whipple specimen identified a separate focus of bile duct cancer. CONCLUSION Synchronous presentation of an ampullary mass and separate distal bile duct stricture, especially in elderly patients, should raise concern for both lesions representing malignancies. In the absence of conclusive evidence for survival advantage in resected early stage ampullary and biliary cancers, close observation should be considered a valid alternative to adjuvant chemotherapy and radiation.
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Affiliation(s)
- Max V Wohlauer
- Section of GI, Tumor and Endocrine Surgery, Department of Surgery, University of Colorado at Denver, Aurora, CO 80045, USA
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Wohlauer MV, Thomas SG, Moore EE, Walsh M, Musunuru H, Davis PK, Evans E, Howard JC, Ploplis VA, Castellino FJ. Platelet dysfunction as an early marker for traumatic brain induced coagulopathy in the absence of platelet inhibitors. J Am Coll Surg 2012. [DOI: 10.1016/j.jamcollsurg.2012.06.169] [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: 10/28/2022]
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Harr JN, Moore EE, Stringham J, Wohlauer MV, Fragoso M, Jones WL, Gamboni F, Silliman CC, Banerjee A. Isoflurane prevents acute lung injury through ADP-mediated platelet inhibition. Surgery 2012; 152:270-6. [PMID: 22828148 PMCID: PMC3419262 DOI: 10.1016/j.surg.2012.05.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [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: 01/06/2012] [Accepted: 05/10/2012] [Indexed: 12/29/2022]
Abstract
BACKGROUND Growing evidence suggests platelets are essential in posttraumatic, acute lung injury (ALI). Halogenated ethers interfere with the formation of platelet-granulocyte aggregates. The potential benefit of halogenated ethers has not been investigated in models of trauma/hemorrhagic shock (T/HS). Therefore, we hypothesized that isoflurane decreases T/HS-mediated ALI through platelet inhibition. METHODS Sprague-Dawley rats (n = 47) were anesthetized by either pentobarbital or inhaled isoflurane and placed into (1) control, (2) trauma (laparotomy) sham shock, (3) T/HS (mean arterial pressure, 30 mmHg × 45 min), (4) pretreatment with an ADP receptor antagonist, or (5) T/HS with isoflurane initiated during resuscitation groups. ALI was determined by protein and pulmonary immunofluorescence bronchoalveolar lavage (BAL) fluid. Platelet Mapping specifically evaluated thrombin-independent inhibition of the ADP and AA pathways of platelet activation. RESULTS Pretreatment with isoflurane abrogated ALI as measured by both BAL fluid protein and pulmonary immunofluorescence (P < .001). Platelet Mapping revealed specific inhibition of the platelet ADP-pathway with isoflurane (P < .001). Pretreatment with an ADP receptor antagonist decreased ALI to sham levels, confirming that specific platelet ADP inhibition decreases ALI. Isoflurane initiated during resuscitation also decreased ALI (P < .001). CONCLUSION Isoflurane attenuates ALI through an antiplatelet mechanism, in part, through inhibition of the platelet ADP pathway. Isoflurane given postinjury also protects against ALI, and highlights the potential applications of this therapy in various clinical scenarios of ischemia/reperfusion.
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Affiliation(s)
- Jeffrey N. Harr
- Department of Surgery, University of Colorado Denver, Aurora, CO
| | - Ernest E. Moore
- Department of Surgery, University of Colorado Denver, Aurora, CO
- Department of Surgery, Denver Health Medical Center, Denver, CO
- Trauma Research Center, University of Colorado Denver, Aurora, CO
| | - John Stringham
- Department of Surgery, University of Colorado Denver, Aurora, CO
| | - Max V. Wohlauer
- Department of Surgery, University of Colorado Denver, Aurora, CO
| | - Miguel Fragoso
- Department of Surgery, Denver Health Medical Center, Denver, CO
| | | | - Fabia Gamboni
- Trauma Research Center, University of Colorado Denver, Aurora, CO
| | - Christopher C. Silliman
- Trauma Research Center, University of Colorado Denver, Aurora, CO
- Department of Pediatrics, University of Colorado Denver, Aurora, CO
- Research Department, Bonfils Blood Center, Denver, CO
| | - Anirban Banerjee
- Trauma Research Center, University of Colorado Denver, Aurora, CO
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Davis PK, Musunuru H, Walsh M, Cassady R, Yount R, Losiniecki A, Moore EE, Wohlauer MV, Howard J, Ploplis VA, Castellino FJ, Thomas SG. Platelet Dysfunction is an Early Marker for Traumatic Brain Injury-Induced Coagulopathy. Neurocrit Care 2012; 18:201-8. [DOI: 10.1007/s12028-012-9745-6] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Morton AP, Moore EE, Wohlauer MV, Lo K, Silliman CC, Burlew CC, Banerjee A. Revisiting early postinjury mortality: are they bleeding because they are dying or dying because they are bleeding? J Surg Res 2012; 179:5-9. [PMID: 23138049 DOI: 10.1016/j.jss.2012.05.054] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Revised: 04/13/2012] [Accepted: 05/16/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Intense debate continues in the search of the optimal ratio of blood components to deliver preemptively in the critically injured patient anticipated to require a massive transfusion. A major challenge is distinguishing patients with refractory coagulopathy versus those with overwhelming injuries who will perish irrespective of blood component administration. The hypothesis of this clinical study is that a predominant number of early deaths from hemorrhage are irretrievable despite an aggressive transfusion policy. MATERIALS AND METHODS During the 7-y period ending in December 2009, there were 772 in-hospital trauma deaths. Each of these deaths had been assigned a cause of death via concurrent review by the multidisciplinary hospital trauma quality improvement committee. Emergency department deaths and patients arriving from outside facilities were excluded from this study. RESULTS Of the 382 patients (49.5% of total) who died secondary to acute blood loss, 84 (22.0%) survived beyond the ED; of these 84, 68 (81%) were male, mean age was 31 y, and 30 (36%) sustained blunt trauma. Cause of death was determined to be exsanguination in 63 (75%), coagulopathy in 13 (15%), metabolic failure in 5 (6%), and indeterminate in 3 patients (4%). CONCLUSION These data indicate that 75% of patients who succumb to postinjury acute blood loss are bleeding because they are dying rather than dying because they are bleeding. Conversely, only 13 (2%) of the hospital deaths were attributed to refractory coagulopathy. These critical facts need to be considered in designing studies to determine optimal massive transfusion protocols.
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Wohlauer MV, Moore EE, Thomas S, Sauaia A, Evans E, Harr J, Silliman CC, Ploplis V, Castellino FJ, Walsh M. Early platelet dysfunction: an unrecognized role in the acute coagulopathy of trauma. J Am Coll Surg 2012; 214:739-46. [PMID: 22520693 PMCID: PMC3348700 DOI: 10.1016/j.jamcollsurg.2012.01.050] [Citation(s) in RCA: 230] [Impact Index Per Article: 19.2] [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: 11/06/2011] [Revised: 01/09/2012] [Accepted: 01/09/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND Our aim was to determine the prevalence of platelet dysfunction using an end point of assembly into a stable thrombus after severe injury. Although the current debate on acute traumatic coagulopathy has focused on the consumption or inhibition of coagulation factors, the question of early platelet dysfunction in this setting remains unclear. STUDY DESIGN Prospective platelet function in assembly and stability of the thrombus was determined within 30 minutes of injury using whole blood samples from trauma patients at the point of care using thrombelastography-based platelet functional analysis. RESULTS There were 51 patients in the study. There were significant differences in the platelet response between trauma patients and healthy volunteers, such that there was impaired aggregation to these agonists. In trauma patients, the median ADP inhibition of platelet function was 86.1% (interquartile range [IQR] 38.6% to 97.7%) compared with 4.2 % (IQR 0 to 18.2%) in healthy volunteers. After trauma, the impairment of platelet function in response to arachidonic acid was 44.9% (IQR 26.6% to 59.3%) compared with 0.5% (IQR 0 to 3.02%) in volunteers (Wilcoxon nonparametric test, p < 0.0001 for both tests). CONCLUSIONS In this study, we show that platelet dysfunction is manifest after major trauma and before substantial fluid or blood administration. These data suggest a potential role for early platelet transfusion in severely injured patients at risk for postinjury coagulopathy.
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Affiliation(s)
- Max V Wohlauer
- Department of Surgery, University of Colorado Denver, Denver, CO, USA
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Wohlauer MV, Arora VM, Horwitz LI, Bass EJ, Mahar SE, Philibert I. The patient handoff: a comprehensive curricular blueprint for resident education to improve continuity of care. Acad Med 2012; 87:411-8. [PMID: 22361791 PMCID: PMC3409830 DOI: 10.1097/acm.0b013e318248e766] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
In 2010, the Accreditation Council for Graduate Medical Education released its resident duty hours restrictions, requiring that faculty monitor their residents' patient handoffs to ensure that residents are competent in handoff communications. Although studies have reported the need to improve the effectiveness of the handoff and a variety of curricula have been suggested and implemented, a common method for teaching and evaluating handoff skills has not been developed. Also in 2010, engineers, informaticians, and physicians interested in patient handoffs attended a symposium in Savannah, Georgia, hosted by the Association for Computing Machinery, entitled Handovers and Handoffs: Collaborating in Turns. As a result of this symposium, a workgroup formed to develop practical and readily implementable educational materials for medical educators involved in teaching patient handoffs to residents. In this article, the result of that yearlong collaboration, the authors aim to provide clarity on the definition of the patient handoff, to review the barriers to performing effective handoffs in academic health centers, to identify available solutions to improve handoffs, and to provide a structured approach to educating residents on handoffs via a curricular blueprint. The authors' blueprint was developed to guide educators in customizing handoff education programs to fit their specific, local needs. Hopefully, it also will provide a starting point for future research into improving the patient handoff. Increasingly complex patient care environments require both innovations in handoff education and improvements in patient care systems to improve continuity of care.
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Affiliation(s)
- Max V Wohlauer
- Department of Surgery, University of Colorado Denver School of Medicine, Aurora, Colorado 80045, USA.
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Marvin MR, Prager KM, Wohlauer MV, Chandler JG. Sanctity and organ donation's societal value. Bull Am Coll Surg 2012; 97:12-23. [PMID: 22315878] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Harr JN, Moore EE, Wohlauer MV, Fragoso M, Gamboni F, Liang X, Banerjee A, Silliman CC. Activated platelets in heparinized shed blood: the "second hit" of acute lung injury in trauma/hemorrhagic shock models. Shock 2011; 36:595-603. [PMID: 21841533 PMCID: PMC3220733 DOI: 10.1097/shk.0b013e318231ee76] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [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] [Indexed: 12/30/2022]
Abstract
The return of heparinized shed blood (SB) in trauma/hemorrhagic shock (T/HS) models remains controversial because of potential anti-inflammatory properties. Although ubiquitous as an anticoagulant, heparin is ineffective on cellular coagulation as an antithrombotic agent. Therefore, we hypothesized that returning heparinized SB would paradoxically enhance acute lung injury (ALI) after T/HS because of the infusion of activated platelets. Sprague-Dawley rats, anesthetized with pentobarbital, underwent laparotomy and hemorrhage-induced shock (MAP of 30 mmHg × 45 min). Animals were resuscitated with a combination of normal saline and returned SB. Shed blood was collected in either 80 U/kg of heparin, 800 U/kg of heparin, or citrate or diluted 1:8 with normal saline. An additional group of animals were pretreated with a platelet P2Y12 receptor antagonist (clopidogrel) before T/HS. Bronchoalveolar lavage, lung myeloperoxidase assays, pulmonary immunofluorescence, and blood smears were conducted. Bronchoalveolar lavage protein increased in animals resuscitated with heparinized SB (T/HS + 80 U/kg Hep 1.62 ± 0.29, T/HS + 800 U/kg Hep 1.30 ± 0.15 vs. T/SS 0.51 ± 0.16 and T/HS Citrate 0.7 ± 0.09) (P < 0.0001). Blood smears and platelet function assays revealed platelet aggregates and increased platelet activation. Animals pretreated with a platelet P2Y12 receptor antagonist were protected from postinjury ALI (P < 0.0001). Animals with return of SB had increased pulmonary polymorphonuclear leukocyte sequestration (P < 0.0001). Pulmonary immunofluorescence demonstrated microthrombi only in the T/HS group receiving heparinized SB (P < 0.0001). The return of heparinized SB functions as a "second hit" to enhance ALI, with activated platelets propagating microthrombi and pulmonary polymorphonuclear leukocyte recruitment.
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Affiliation(s)
- Jeffrey N. Harr
- Department of Surgery, University of Colorado Denver, Aurora, CO
| | - Ernest E. Moore
- Department of Surgery, University of Colorado Denver, Aurora, CO
- Department of Surgery, Denver Health Medical Center, Denver, CO
- Trauma Research Center, University of Colorado Denver, Aurora, CO
| | - Max V. Wohlauer
- Department of Surgery, University of Colorado Denver, Aurora, CO
| | - Miguel Fragoso
- Department of Surgery, Denver Health Medical Center, Denver, CO
| | - Fabia Gamboni
- Trauma Research Center, University of Colorado Denver, Aurora, CO
| | - Xiayuan Liang
- Department of Pathology, University of Colorado Denver, Aurora, CO
| | - Anirban Banerjee
- Trauma Research Center, University of Colorado Denver, Aurora, CO
| | - Christopher C. Silliman
- Trauma Research Center, University of Colorado Denver, Aurora, CO
- Department of Pediatrics, University of Colorado Denver, Aurora, CO
- Research Department, Bonfils Blood Center, Denver, CO
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Farias SE, Heidenreich KA, Wohlauer MV, Murphy RC, Moore EE. Lipid Mediators in Cerebral Spinal Fluid of Traumatic Brain Injured Patients. ACTA ACUST UNITED AC 2011; 71:1211-8. [DOI: 10.1097/ta.0b013e3182092c62] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Harr JN, Moore EE, Wohlauer MV, Droz N, Fragoso M, Banerjee A, Silliman CC. The acute coagulopathy of trauma is due to impaired initial thrombin generation but not clot formation or clot strength. J Surg Res 2011; 170:319-24. [PMID: 21550061 PMCID: PMC3154997 DOI: 10.1016/j.jss.2011.03.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [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: 01/08/2011] [Revised: 02/26/2011] [Accepted: 03/17/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Acute coagulopathy of trauma (ACOT) has been described as a very early hypocoagulable state, but the mechanism remains controversial. One proposed mechanism is tissue hypoperfusion leading to protein C activation, with subsequent inhibition of Factors V and VIII. Variability in trauma has impeded the use of clinical data towards the elucidation of the mechanisms of ACOT, but thrombelastography (TEG) may provide insight by assessing hemostatic function from initial thrombin activation to fibrinolysis. We hypothesized that in a controlled animal model of trauma/hemorrhagic shock, clotting factor dysfunction is the predominant mechanism in early ACOT. METHODS Rats anesthetized by inhaled isoflurane (n = 6) underwent laparotomy, and hemorrhage was induced to maintain a MAP of 35 mm Hg for 30 min. Rats were then resuscitated with twice their shed blood volume in normal saline. TEG was performed at baseline, shock, and post-resuscitation periods. No heparin was given. Statistical analysis was performed by ANOVA with post-hoc Fisher's test. RESULTS Coagulation factor function was significantly impaired in the early stages of trauma/hemorrhagic shock. TEG R and SP-values were significantly increased from baseline to shock (P < 0.001) and from shock to post-resuscitation periods (P < 0.05). Delta (R-SP), a measure of thrombin generation, showed a significant increase (P < 0.05) from baseline to shock. No significant changes were found in K, Angle, MA, and LY30 values. CONCLUSION Clotting factor derangement leading to impaired thrombin generation is the principle etiology of ACOT in this model and not the dynamics of clot formation, fibrin cross-linking, clot strength/platelet function, or fibrinolysis.
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Affiliation(s)
- Jeffrey N. Harr
- Department of Surgery, University of Colorado Denver, Aurora, CO
| | - Ernest E. Moore
- Department of Surgery, University of Colorado Denver, Aurora, CO
- Department of Surgery, Denver Health Medical Center, Denver, CO
| | - Max V. Wohlauer
- Department of Surgery, University of Colorado Denver, Aurora, CO
| | - Nathan Droz
- Creighton University School of Medicine, Omaha, NE
| | - Miguel Fragoso
- Department of Surgery, Denver Health Medical Center, Denver, CO
| | | | - Christopher C. Silliman
- Department of Pediatrics, University of Colorado, Denver, Aurora, CO
- Research Department, Bonfils Blood Center, Denver, CO
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Wohlauer MV, Rove KO, Pshak TJ, Raeburn CD, Moore EE, Chenoweth C, Srivastava A, Pell J, Meacham RB, Nehler MR. The computerized rounding report: implementation of a model system to support transitions of care. J Surg Res 2011; 172:11-7. [PMID: 21777923 DOI: 10.1016/j.jss.2011.04.015] [Citation(s) in RCA: 23] [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] [Received: 01/11/2011] [Revised: 03/16/2011] [Accepted: 04/06/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES In response to ACGME work-hour restrictions, residency programs that require continuous inpatient clinical care for educational objectives will be forced to increase the proportion of junior resident experience involved in shift work. Maintaining the balance of education over service at these levels will be a challenge, where a considerable amount of time must be spent gathering data for morning rounds and signing out patients at shift change. Patient safety is an issue with this new paradigm. We hypothesized that computerized sign-out would improve resident efficiency. MATERIALS AND METHODS A multidisciplinary clinical team collaborated to design a computerized rounding and sign-out (CSO) program to automate collection of clinical information in addition to a brief narrative describing ongoing care issues. Residents returned a self-administered questionnaire before (n = 168) and after implementation (n = 83) examining: pre-rounding time, missed patients, handoff quality, and duty hours. RESULTS Residents reported spending 11 fewer min/d pre-rounding (P = 0.006). After implementation, residents missed fewer patients on rounds (P = 0.01). A majority (70%) of responders stated that the new program helped them with duty hours. CONCLUSION The current study demonstrates the reproducibility of the University of Washington model system for rounding and sign-out at an independent site, using basic infrastructure and leadership common to all residency programs. Developing a CSO was associated with a modest reduction in pre-rounding time and fewer patients missed on rounds. Although automating resident tasks may improve workflow in an increasingly complex hospital environment, structured handoff education and other institutional changes are necessary.
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Affiliation(s)
- Max V Wohlauer
- Department of Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, USA.
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Wohlauer MV, Moore EE, Haenel JB, Burlew CC, Barnett CC. Selective Intrabronchial Air Insufflation for Acute Lobar Collapse in the Surgical Intensive Care Unit. J Surg Radiol 2011; 2:178-180. [PMID: 21687834 PMCID: PMC3116229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OVERVIEW: The horseshoe kidney is more prone to blunt abdominal trauma because of its low position and the presence of the isthmus across the midline. This is a rare case of complete transection of a horseshoe kidney at the isthmus due to blunt abdominal trauma with two sites of active extravasation on initial CT imaging. This extravasation was successfully treated by embolization with coils. Superselective embolization may be used for effective, minimally invasive control of active extravasation due to blunt renal trauma, even in kidneys with congenital malformations such as the horseshoe kidney.
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Affiliation(s)
- Max V Wohlauer
- Denver Health Medical Center and University of Colorado Denver, Denver, Colorado
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