1
|
Kim M, Firek M, Coimbra BC, Allison-Aipa T, Zakhary B, Coimbra R. Impact of Cardiac Pacemaker Implantation in Patients With Acute Traumatic Cervical Spinal Cord Injury. Am Surg 2024:31348241250041. [PMID: 38686651 DOI: 10.1177/00031348241250041] [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: 05/02/2024]
Abstract
BACKGROUND Cardiac pacemaker implantation may be indicated in patients with refractory bradycardia following a cervical spinal cord injury (CSCI). However, evidence about the impact of this procedure on outcomes is lacking. We planned a study to assess whether the implantation of a pacemaker would decrease mortality and hospital resource utilization in patients with CSCI. METHODS Adult patients with CSCI in the Trauma Quality Improvement Program (TQIP) database between 2016 and 2019 were retrospectively analyzed. Patients were divided into "pacemaker" and "non-pacemaker" groups, and their baseline characteristics and clinical outcomes were analyzed. RESULTS A total of 6774 cases were analyzed. The pacemaker group showed higher in-hospital rates of cardiac arrest, myocardial infarction, and longer duration of mechanical ventilation and ICU stay than the non-pacemaker group. Nevertheless, pacemaker placement was associated with a significant decrease in mortality (4.2% vs 26.0%, P < .01). CONCLUSIONS Patients with CSCI requiring a pacemaker placement had better survival than those treated without a pacemaker. Pacemaker implantation should be highly considered in patients who develop refractory bradycardia after CSCI.
Collapse
Affiliation(s)
- Maru Kim
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA
- Department of Trauma Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Matthew Firek
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA
| | - Bruno Cammarota Coimbra
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Timothy Allison-Aipa
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA
| | - Bishoy Zakhary
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA
| | - Raul Coimbra
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA
| |
Collapse
|
2
|
Zakhary B, Coimbra BC, Kwon J, Allison-Aipa T, Firek M, Coimbra R. Procedure Risk vs Frailty in Outcomes for Elderly Emergency General Surgery Patients: Results of a National Analysis. J Am Coll Surg 2024:00019464-990000000-00952. [PMID: 38661145 DOI: 10.1097/xcs.0000000000001079] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND The direct association between procedure risk and outcomes in elderly emergency general surgery (EGS) patients has not been analyzed. Studies only highlight the importance of frailty. A comprehensive analysis of relevant risk factors and their association with outcomes in elderly EGS patients is lacking. We hypothesized that procedure risk has a stronger association with relevant outcomes in elderly EGS patients compared to frailty. STUDY DESIGN Elderly patients (age > 65) undergoing emergency general surgery operative procedures were identified in the NSQIP) database (2018 to 2020) and stratified based on the presence of frailty calculated by the Modified 5 Item Frailty Index (mFI-5; mFI 0 Non-Frail, mFI 1-2 Frail, and mFI ≥3 Severely Frail) and based on procedure risk. Multivariable regression models and Receiving Operative Curve (ROC) analysis were used to determine risk factors associated with outcomes. RESULTS A total of 59,633 elderly EGS patients were classified into non-frail (17,496; 29.3%), frail (39,588; 66.4%), and severely frail (2,549; 4.3%). There were 25,157 patients in the low-risk procedure group and 34,476 in the high-risk group.Frailty and procedure risk were associated with increased mortality, complications, failure to rescue, and readmissions. Differences in outcomes were greater when patients were stratified according to procedure risk compared to frailty stratification alone. Procedure risk had a stronger association with relevant outcomes in elderly EGS patients compared to frailty. CONCLUSIONS Assessing frailty in the elderly EGS patient population without adjusting for the type of procedure or procedure risk ultimately presents an incomplete representation of how frailty impacts patient-related outcomes.
Collapse
Affiliation(s)
- Bishoy Zakhary
- Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Riverside University Health System, Moreno Valley, CA
| | - Bruno C Coimbra
- Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Riverside University Health System, Moreno Valley, CA
- George Washington University School of Medicine and Health Sciences, Washington DC
| | - Junsik Kwon
- Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Riverside University Health System, Moreno Valley, CA
- Department of Trauma Surgery, Ajou University School of Medicine, Seoul, Republic of Korea
| | - Timothy Allison-Aipa
- Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Riverside University Health System, Moreno Valley, CA
| | - Matthew Firek
- Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Riverside University Health System, Moreno Valley, CA
| | - Raul Coimbra
- Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Riverside University Health System, Moreno Valley, CA
- Division of Trauma and Acute Care Surgery, Riverside University Health System Medical Center, Moreno Valley, CA
- Department of Surgery, Loma Linda University School of Medicine, Loma Linda, CA
| |
Collapse
|
3
|
Coimbra R, Kim M, Allison-Aipa T, Zakhary B, Kwon J, Firek M, Coimbra BC, Costantini TW, Haynes LN, Edwards SB. Deaths After Readmissions are Mostly Attributable to Failure-to-Rescue in EGS Patients. Am Surg 2024:31348241248796. [PMID: 38656140 DOI: 10.1177/00031348241248796] [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: 04/26/2024]
Abstract
INTRODUCTION We have recently shown that readmission after EGS procedures carries a 4-fold higher mortality rate when compared to those not readmitted. Understanding factors associated with death after readmission is paramount to improving outcomes for EGS patients. We aimed to identify risk factors contributing to failure-to-rescue (FTR) during readmission after EGS. We hypothesized that most post-readmission deaths in EGS are attributable to FTR. METHODS A retrospective cohort study using the NSQIP database 2013-2019 was performed. Patients who underwent 1 of 9 urgent/emergent surgical procedures representing 80% of EGS burden of disease, who were readmitted within 30 days post-procedure were identified. The procedures were classified as low- and high-risk. Patient characteristics analyzed included age, sex, BMI, ASA score comorbidities, postoperative complications, frailty, and FTR. The population was assessed for risk factors associated with mortality and FTR by uni- and multivariate logistic regression. RESULTS Of 312,862 EGS cases, 16,306 required readmission. Of those, 10,748 (3.4%) developed a postoperative complication. Overall mortality after readmission was 2.4%, with 90.6% of deaths attributable to FTR. Frailty, high-risk procedures, pulmonary complications, AKI, sepsis, and the need for reoperation increased the risk of FTR. DISCUSSION Death after a complication is common in EGS readmissions. The impact of FTR could be minimized with the implementation of measures to allow early identification and intervention or prevention of infectious, respiratory, and renal complications.
Collapse
Affiliation(s)
- Raul Coimbra
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA
- Division of Trauma and Acute Care Surgery, Riverside University Health System Medical Center, Department of Surgery, University of California Riverside, Moreno Valley, CA, USA
| | - Maru Kim
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA
- Department of Trauma Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Timothy Allison-Aipa
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA
| | - Bishoy Zakhary
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA
| | - Junsik Kwon
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA
- Department of Trauma Surgery, Ajou University School of Medicine, Seoul, Republic of Korea
| | - Matthew Firek
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA
| | - Bruno Cammarota Coimbra
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Todd W Costantini
- Division of Trauma, Surgical Critical Care and Burns, Department of Surgery, University of California San Diego, San Diego, CA, USA
| | - Laura N Haynes
- Division of Trauma, Surgical Critical Care and Burns, Department of Surgery, University of California San Diego, San Diego, CA, USA
| | - Sara B Edwards
- Division of Trauma and Acute Care Surgery, Riverside University Health System Medical Center, Department of Surgery, University of California Riverside, Moreno Valley, CA, USA
| |
Collapse
|
4
|
Silva TS, Tavassoli M, Lee E, Annie Nguyen LA, Vu B, Sinjali K, Allison-Aipa T, Molina DC, Lum S. Timeliness of Multimodal Care for At-Risk Breast Cancer Patients at a Safety Net Institution. J Surg Res 2023; 291:367-373. [PMID: 37516043 DOI: 10.1016/j.jss.2023.06.023] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 05/05/2023] [Accepted: 06/18/2023] [Indexed: 07/31/2023]
Abstract
INTRODUCTION Because limited data exist, we sought to evaluate timeliness of multimodal treatments in a safety net breast cancer population. METHODS Breast cancer patients treated at a safety net hospital from 2016 to 2020 were analyzed retrospectively. Time intervals were defined as primary time (PT) from diagnosis to initiation of primary intervention, secondary time (ST) from completion of primary to initiation of secondary intervention, and tertiary time (TT) from completion of secondary to initiation of tertiary intervention. Variables included primary language, insurance type, and race. RESULTS Of 223 patients, 99 (44.4%) primarily spoke Spanish, 29 (13.0%) were of Black race, and 184 (82.5%) had Medicaid or uninsured status. Median (IQR) age at diagnosis was 55 (48-62) years. Primary intervention was surgical in 127/216 (58.8%); secondary intervention was systemic in 38/169 (22.5%); and tertiary intervention was radiation in 67/80 (83.8%). Overall, median days (IQR) for PT were 69 (53, 98), ST were 65 (42, 95), and TT were 69 (43, 88). PT was significantly longer in Black [105 (76, 142) days] patients compared to non-Hispanic White patients [68 (51, 107) days, P = 0.031)] and White Hispanic patients [65 (53,91) days, P = 0.014]. There were no significant differences in PT, ST, or TT by spoken language or insurance type. CONCLUSIONS Black patients remain at risk due to prolonged time to intervention. Spanish-speaking status was not associated with inferior timeliness or completion of multimodal care at a safety net hospital. Identifying safety net hospital barriers to achieving benchmarks for timely completion of all phases of multimodal care warrants further attention.
Collapse
Affiliation(s)
- Trevor S Silva
- Department of Surgery, Riverside University Health System, Moreno Valley, California
| | - Morvarid Tavassoli
- Department of Surgery, Riverside University Health System, Moreno Valley, California
| | - Esther Lee
- Department of Surgery, Riverside University Health System, Moreno Valley, California
| | - Lan-Anh Annie Nguyen
- Department of Surgery, Riverside University Health System, Moreno Valley, California
| | - Brandon Vu
- Department of Surgery, Riverside University Health System, Moreno Valley, California
| | - Kiran Sinjali
- Department of Radiology, Loma Linda University Health, Loma Linda, California
| | - Timothy Allison-Aipa
- Comparative Effectiveness and Clinical Outcomes Research Center (CECORC), Riverside University Health System, Moreno Valley, California
| | - David Caba Molina
- Department of Surgery, Riverside University Health System, Moreno Valley, California; Department of Surgery, Loma Linda University Health, Loma Linda, California
| | - Sharon Lum
- Department of Surgery, Riverside University Health System, Moreno Valley, California; Department of Surgery, Loma Linda University Health, Loma Linda, California.
| |
Collapse
|
5
|
Kim M, Allison-Aipa T, Zakary B, Firek M, Coimbra R. Open Versus Percutaneous Tracheostomy in Patients With Liver Cirrhosis: Analysis of a Nationwide Database. Am Surg 2023; 89:4153-4159. [PMID: 37264591 DOI: 10.1177/00031348231180918] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Evidence for the appropriate type of tracheostomy in patients with liver cirrhosis is lacking. A retrospective analysis of the National Inpatient Sample (NIS) was performed. METHODS Adult patients with liver cirrhosis undergoing tracheostomy while on mechanical ventilation for respiratory failure were abstracted from the NIS database between 2016 and 2018 and analyzed. Patients were divided according to the type of tracheostomy performed into open tracheostomy (OT) and percutaneous tracheostomy (PT) and analyzed for tracheostomy complications and clinical outcomes. Subgroup analyses were performed for patients with compensated cirrhosis (CC) and decompensated cirrhosis (DC). RESULTS A total of 44745 cases were analyzed. The OT group had a higher rate of overall tracheostomy-related complications (TC) (5.1% vs 3.5%; P < .001), hemorrhage from the tracheostomy site (HC) (2.7% vs 1.8%; P = .008) and other complications (OC) (2.7% vs 1.8%, P = .003). Multivariate analyses showed that OT was a risk factor for TC (Adjusted odds ratio (AOR) 1.50, P < .001), HC (AOR 1.46, P = .009), and OC (AOR 1.55, P = .003). Similarly, in subgroup analyses, OT cases, compared to PT, were associated with increased TC (5.0% vs 3.4%, P < .001), HC (2.7% vs 1.7%, P = .002) and OC (2.6% vs 1.8%, P = .020) in DC patients. DISCUSSION OT is associated with a significantly higher rate of complications. OT was also associated with more complications in DC patients, suggesting that a percutaneous approach may be the best option in cirrhotic patients when feasible.
Collapse
Affiliation(s)
- Maru Kim
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA
- Department of Trauma Surgery, Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Timothy Allison-Aipa
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA
| | - Bishoy Zakary
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA
| | - Matthew Firek
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA
| | - Raul Coimbra
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| |
Collapse
|
6
|
Oko-Odoi A, Bergvall E, Kolakowski D, Allison-Aipa T. Implementing a Fall Prevention Protocol to Reduce Fall Rates Among Inpatients With Cancer. Clin J Oncol Nurs 2023; 27:533-538. [PMID: 37729450 DOI: 10.1188/23.cjon.533-538] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
BACKGROUND Globally in healthcare delivery, inpatient falls and fall-related injuries contribute to unsafe patient care environments. On two inpatient oncology units, the frequency of patient falls had increased, despite the use of a fall screening tool. OBJECTIVES This project aimed to determine whether implementing the Agency for Healthcare Research and Quality (AHRQ) 3B Scheduled Rounding Protocol would reduce the average daily fall rate and number of fall-related injuries on two adult inpatient oncology units. METHODS This quantitative, quasi-experimental quality improvement project evaluated the implementation of the AHRQ protocol to reduce the average fall rate and number of fall-related injuries for adult patients with cancer. FINDINGS The average daily fall rate decreased following implementation of the AHRQ protocol, indicating clinical significance. This project's results suggest that implementing a standard fall prevention protocol can reduce the rate of patient falls.
Collapse
|
7
|
Salari A, Singh MK, Ayouby S, George S, Nguyen K, Peverini GD, Lam N, Allison-Aipa T, Zamarripa S, Tsang S, Firek A. Active Medical Learner Engagement Results in the Discovery That One Size Does Not Fit All in Overcoming COVID-19 Vaccine Hesitancy. Vaccines (Basel) 2023; 11:1140. [PMID: 37514956 PMCID: PMC10385578 DOI: 10.3390/vaccines11071140] [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: 05/13/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 07/30/2023] Open
Abstract
Vaccine hesitancy is an ongoing public health concern defined as the refusal of a vaccine that is readily available. Therefore, we developed a project to explore why patients in a safety net medical center were hesitant or refused the COVID-19 vaccine. The project was conducted by healthcare learners to promote "learning by doing". Responses were collected through a previously developed and ongoing survey among both hospitalized and ambulatory patients that had no previous history of COVID-19 infection, were currently infected, or had recovered from COVID-19. Results were analyzed using a priori power analysis and Chi-squared test. We discovered that different self-reported ethnic groups had different reasons for vaccine hesitancy; specifically, 69% of Black/African American respondents stated that their main reason for hesitancy was vaccine safety compared to 13.9% of non-Hispanic Whites (p = 0.005). Furthermore, our cohort was significantly more likely to disagree rather than agree with the statement: "getting vaccinated is important for the health of others in my community"(p = 0.016). The learners discovered that a more specific approach to vaccine education would be required to understand and overcome vaccine hesitancy in our cohort of socioeconomic and ethnically diverse groups.
Collapse
Affiliation(s)
- Arash Salari
- Department of Family Medicine, Riverside University Health System, Moreno Valley, CA 92555, USA
| | - Manpreet K Singh
- Riverside School of Medicine, University of California, Riverside, CA 92507, USA
| | - Shuja Ayouby
- Department of Family Medicine, Riverside University Health System, Moreno Valley, CA 92555, USA
| | - Sanmisola George
- Department of Family Medicine, Riverside University Health System, Moreno Valley, CA 92555, USA
| | - Kimngan Nguyen
- Department of Family Medicine, Riverside University Health System, Moreno Valley, CA 92555, USA
| | - Guillermo Daniel Peverini
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA 92555, USA
| | - Nicolette Lam
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA 92555, USA
| | - Timothy Allison-Aipa
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA 92555, USA
| | - Susanna Zamarripa
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA 92555, USA
| | - Shunling Tsang
- Department of Family Medicine, Riverside University Health System, Moreno Valley, CA 92555, USA
| | - Anthony Firek
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA 92555, USA
| |
Collapse
|
8
|
Silva TS, Singh A, Sinjali K, Gochi A, Allison-Aipa T, Luca F, Plasencia A, Lum S, Solomon N, Molina C. Spanish-Speaking Status: A Protective Factor in Colorectal Cancer Presentation at a Safety-Net Hospital. J Surg Res 2022; 280:404-410. [PMID: 36041340 DOI: 10.1016/j.jss.2022.06.060] [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: 12/03/2021] [Revised: 06/16/2022] [Accepted: 06/29/2022] [Indexed: 12/04/2022]
Abstract
INTRODUCTION Lower screening rates and poorer outcomes for colorectal cancer have been associated with Hispanic ethnicity and Spanish-speaking status, respectively. METHODS We reviewed sequential colorectal cancer patients evaluated by the surgical service at a safety-net hospital (SNH) (2016-2019). Insurance type, stage, cancer type, surgery class (elective/urgent), initial surgeon contact setting (outpatient clinic/inpatient consult), operation (resection/diversion), and follow-up were compared by patient-reported primary spoken language. RESULTS Of 157 patients, 85 (54.1%) were men, 91 (58.0%) had colon cancer, 67 (42.7%) primarily spoke Spanish, and late stage (III or IV) presentations occurred in 83 (52.9%) patients. The median age was 58 y, cancer resection was completed in 48 (30.6%) patients, and 51 (32.5%) patients were initially seen as inpatient consults. On univariate analysis, Spanish-speaking status was significantly associated with female sex, Medicaid insurance, being seen as an outpatient consult, and undergoing elective and resection surgery. On multivariable logistic regression, Spanish-speaking patients had higher odds of having Medicaid insurance (AOR 2.28, P = 0.019), receiving a resection (AOR 3.96, P = 0.006), and undergoing an elective surgery (AOR 3.24, P = 0.025). Spanish-speaking patients also had lower odds of undergoing an initial inpatient consult (AOR 0.34, P = 0.046). CONCLUSIONS Spanish-speaking status was associated with a lower likelihood of emergent presentation and need for palliative surgery among SNH colorectal cancer patients. Further research is needed to determine if culturally competent infrastructure in the SNH setting translates into Spanish-speaking status as a potentially protective factor.
Collapse
Affiliation(s)
- Trevor S Silva
- Riverside University Health System, Moreno Valley, California
| | - Anika Singh
- Riverside University Health System, Moreno Valley, California
| | - Kiran Sinjali
- University of California Riverside School of Medicine, Riverside, California
| | - Andrea Gochi
- University of California Riverside School of Medicine, Riverside, California
| | - Timothy Allison-Aipa
- Comparative Effectiveness and Clinical Outcomes Research Center (CECORC), Riverside University Health System, Moreno Valley, California
| | - Fabrizio Luca
- Loma Linda University Health, Loma Linda, California
| | - Alexis Plasencia
- Riverside University Health System, Moreno Valley, California; Loma Linda University Health, Loma Linda, California
| | - Sharon Lum
- Riverside University Health System, Moreno Valley, California; University of California Riverside School of Medicine, Riverside, California; Loma Linda University Health, Loma Linda, California
| | | | - Caba Molina
- Riverside University Health System, Moreno Valley, California; University of California Riverside School of Medicine, Riverside, California; Loma Linda University Health, Loma Linda, California.
| |
Collapse
|
9
|
Coimbra R, Barrientos R, Allison-Aipa T, Zakhary B, Firek M. The unequal impact of interhospital transfers on emergency general surgery patients: Procedure risk and time to surgery matter. J Trauma Acute Care Surg 2022; 92:296-304. [PMID: 35081097 DOI: 10.1097/ta.0000000000003463] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The impact of interhospital transfer on outcomes of patients undergoing emergency general surgery (EGS) procedures is incompletely studied. We set out to determine if transfer before definitive surgical care leads to worse outcomes in EGS patients. METHODS Using the National Surgical Quality Improvement Project database (2013-2019), a retrospective cohort study was conducted including nine surgical procedures encompassing 80% of the burden of EGS diseases, performed on an urgent/emergent basis. The procedures were classified as low risk (open and laparoscopic appendectomy and laparoscopic cholecystectomy) and high risk (open cholecystectomy, laparoscopic and open colectomy, lysis of adhesions, perforated ulcer repair, small bowel resection, and exploratory laparotomy). Time to surgery was recorded in days. The impact of interhospital transfer on outcomes (mortality, major complications, 30-day reoperations, and 30-day readmissions) and length of stay, according to procedure risk and time to surgery, were analyzed by multivariate logistic regression and inverse probability treatment of the weighting with treatment effect in the treated. RESULTS A total of 329,613 patients were included in the study (284,783 direct admission and 44,830 transfers). Adjusted mortality (3.1% vs. 10.4%; adjusted odds ratio [AOR], 1.28; p < 0.001), major complications (6.7% vs. 18.9%; AOR, 1.39; p < 0.001), 30-day reoperations (3.1% vs. 6.4%; AOR, 1.22; p < 0.001), and length of stay (2 vs. 5) were higher in transferred patients. Transfer had no effect on 30-day readmissions (6% vs. 8.5%; AOR, 1.04; p = 0.063). These results were also observed in high-risk surgery patients and in the late surgery group. The results were further confirmed after robust propensity score weighting was performed. CONCLUSION We have demonstrated that delays to surgical intervention affect outcomes and that interhospital transfer of EGS patients for definitive surgical care has a negative impact on mortality, development of postoperative complications, and reoperations in patients undergoing high-risk EGS procedures. These findings may have important implications for regionalization of EGS care. LEVEL OF EVIDENCE Prognostic/epidemiological, level III.
Collapse
Affiliation(s)
- Raul Coimbra
- From the Comparative Effectiveness and Clinical Outcomes Research Center (R.C., R.B., T.A.-A., B.Z., M.F.), Riverside University Health System Medical Center, Moreno Valley, California; Department of Surgery (R.C., T.A.-A.), Loma Linda University School of Medicine, Loma Linda, California; University of California Riverside School of Medicine (R.B.), Riverside, California
| | | | | | | | | |
Collapse
|