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  • 1.
    Ahl, Rebecka
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Division of Trauma and Emergency Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Phelan, Herb A
    Univ of Texas Southwestern Medical Center, Parkland Memorial Hospital, Dallas, USA.
    Dogan, Sinan
    Department of Surgery, Division of Trauma and Emergency Surgery, Örebro University Hospital, Örebro, Sweden.
    Cao, Yang
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Cook, Allyson C.
    UT-Southwestern Medical Center. Parkland Memorial Hospital, Dallas, USA.
    Mohseni, Shahin
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Surgery, Division of Trauma and Emergency Surgery, Örebro University Hospital, Örebro, Sweden; Department of Surgery, Division of Trauma and Emergency Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Predicting In-Hospital and 1-Year Mortality in Geriatric Trauma Patients Using Geriatric Trauma Outcome Score2017Ingår i: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, Vol. 224, nr 3, s. 264-269Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The Geriatric Trauma Outcome Score, GTOS (= [age] + [Injury Severity Score (ISS)x2.5] + 22 [if packed red blood cells (PRBC) transfused ≤24hrs of admission]), was developed and validated as a prognostic indicator for in-hospital mortality in elderly trauma patients. However, GTOS neither provides information regarding post-discharge outcomes, nor discriminates between patients dying with and without care restrictions. Isolating the latter, GTOS prediction performance was examined during admission and 1-year post-discharge in a mature European trauma registry.

    Study Design: All trauma admissions ≥65years in a university hospital during 2007-2011 were considered. Data regarding age, ISS, PRBC transfusion ≤24hrs, therapy restrictions, discharge disposition and mortality were collected. In-hospital deaths with therapy restrictions and patients discharged to hospice were excluded. GTOS was the sole predictor in a logistic regression model estimating mortality probabilities. Performance of the model was assessed by misclassification rate, Brier score and area under the curve (AUC).

    Results: The study population was 1080 subjects with a median age of 75 years, mean ISS of 10 and PRBC transfused in 8.2%). In-hospital mortality was 14.9% and 7.7% after exclusions. Misclassification rate fell from 14% to 6.5%, Brier score from 0.09 to 0.05. AUC increased from 0.87 to 0.88. Equivalent values for the original GTOS sample were 9.8%, 0.07, and 0.87. One-year mortality follow-up showed a misclassification rate of 17.6%, and Brier score of 0.13.

    Conclusion: Excluding patients with care restrictions and discharged to hospice improved GTOS performance for in-hospital mortality prediction. GTOS is not adept at predicting 1-year mortality.

  • 2.
    Bass, Gary Alan
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Forssten, Maximilian Peter
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Ryan, Eanna
    Biloslavo, Alan
    General Surgery Department, Cattinara University Hospital, Trieste, Italy.
    Tolonen, Matti
    Ahl, Rebecka
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Kurihara, Hayato
    Pourlotfi, Arvid
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Kaplan, Lewis J.
    Division of Trauma, Surgical Critical Care, and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, USA; Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia PA, USA.
    Mohseni, Shahin
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Techniques for Mesoappendix Transection and Appendix Resection When Performing Acute Appendectomy: Insights from the SnapAppy Group Audit2022Ingår i: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, Vol. 235, nr 5 Suppl. 2, s. S24-S24Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Introduction: Surgically managed appendicitis exhibits great heterogeneity regarding mesoappendix transection, and appendix amputation from its base. It is unclear whether a particular surgical technique provides an outcome benefit or reduces complication.

    Methods: We undertook a pre-specified subgroup analysis of all patients who underwent laparoscopic appendectomy at index admission during the SnapAppy time-bound prospective multi-institutional non-randomized observational cohort study between November 1st 2020 - August 31st 2021 at 71 centers in 14 countries. Poisson regression models were employed for investigating the association between different surgical techniques for mesoappendix as well as stump management and postoperative complication while adjusting for potential confounding.

    Results: A total of 2,252 patients were included in the analyses of the technique used for dividing the mesoappendix, 69% by electrocautery and 31% by energy device. 3,729 patients were included for analyses of the management of the stump. The appendix was amputated using looped ligatures in 37%, staples in 38%, and clips in 25% of cases. After adjusting for confounders, the risk of postoperative complication was reduced by 42% when an energy device was used for handling the mesoappendix [adjusted incidence rate ratio (95% CI): 0.58 (0.41-0.82), p = 0.002]; however, no difference was detected between the techniques used for dividing the appendix at its base.

    Conclusion: Safe mesoappendix transection and appendix resection are accomplished using heterogeneous techniques. Energy devices are associated with a lower rate of overall complication while no differences were observed when comparing the techniques used for dividing the appendix base.

  • 3.
    Blomberg, Hans
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Svennblad, Bodil
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Michaëlsson, Karl
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Byberg, Liisa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Johansson, Jakob
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Gedeborg, Rolf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Prehospital Trauma Life Support Training of Ambulance Caregivers and the Outcomes of Traffic-Injury Victims in Sweden2013Ingår i: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, Vol. 217, nr 6, s. 1010-1019Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:

    There is limited evidence that the widely implemented Prehospital Trauma Life Support (PHTLS) educational program improves patient outcomes. The primary aim of this national study in Sweden was to investigate the association between regional implementation of PHTLS training and mortality after traffic injuries.

    STUDY DESIGN:

    We extracted information from the Swedish National Patient Registry and the Cause of Death Registry on victims of motor-vehicle traffic injuries in Sweden from 2001 to 2004 (N = 28,041). During this time period, PHTLS training was implemented at a varying pace in different regions. To control for other influences on patient outcomes related to regional and hospital-level effects, such as variations in performance of trauma care systems, we used Bayesian hierarchical regression models to estimate odds ratios for prehospital mortality and 30-day mortality after hospital admission. We also controlled for the calendar year for each injury to account for period effects. We analyzed the time to death after hospital admission and time to return to work using Cox's proportional hazards frailty models.

    RESULTS:

    After multivariable adjustment, the odds ratio for prehospital mortality with PHTLS-trained prehospital staff was 1.54 (95% credibility interval, 1.07-2.13). For 30-day mortality among those surviving to hospital admission, the odds ratio was 0.85 (95% credibility interval, 0.45-1.48). There was no association between PHTLS training and time to death (hazard ratio = 0.99; 95% CI, 0.85-1.14) or time to return to work (hazard ratio = 0.98; 95% CI, 0.92-1.05).

    CONCLUSIONS:

    In this observational study, the implementation of PHTLS training did not appear to be associated with reduced mortality or ability to return to work after motor-vehicle traffic injuries.

  • 4.
    Davis, Catherine H.
    et al.
    Baylor Scott & White Hlth, TX USA.
    Augustinus, Simone
    Univ Amsterdam, Netherlands.
    de Graaf, Nine
    Univ Amsterdam, Netherlands.
    Wellner, Ulrich F.
    Pancreas & Clin Surg, Germany.
    Johansen, Karin
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten.
    Andersson, Bodil
    Lund Univ, Sweden; Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Beane, Joal D.
    Ohio State Univ, OH USA.
    Björnsson, Bergthor
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Busch, Olivier R.
    Univ Amsterdam, Netherlands.
    Gleeson, Elizabeth M.
    Univ N Carolina, NC USA.
    van Santvoort, Hjalmar C.
    Univ Med Ctr Utrecht, Netherlands.
    Tingstedt, Bobby
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Williamsson, Caroline
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Keck, Tobias
    Pancreas & Clin Surg, Germany.
    Besselink, Marc G.
    Univ Amsterdam, Netherlands.
    Koerkamp, Bas Groot
    Erasmus MC, Netherlands.
    Pitt, Henry A.
    Rutgers Robert Wood Johnson Med Sch, NJ USA; 125 Little Albany St, NJ 08901 USA.
    Impact of Neoadjuvant Therapy for Pancreatic Cancer: Transatlantic Trend and Postoperative Outcomes Analysis2024Ingår i: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, Vol. 238, nr 4, s. 613-621Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:The introduction of modern chemotherapy a decade ago has led to increased use of neoadjuvant therapy (NAT) in patients with pancreatic ductal adenocarcinoma (PDAC). A recent North American study demonstrated increased use of NAT and improved operative outcomes in patients with PDAC. The aims of this study were to compare the use of NAT and short-term outcomes in patients with PDAC undergoing pancreatoduodenectomy (PD) among registries from the US and Canada, Germany, the Netherlands, and Sweden. STUDY DESIGN:Databases from 2 multicenter (voluntary) and 2 nationwide (mandatory) registries were queried from 2018 to 2020. Patients undergoing PD for PDAC were compared based on the use of upfront surgery vs NAT. Adoption of NAT was measured in each country over time. Thirty-day outcomes, including the composite measure (ideal outcomes), were compared by multivariable analyses. Sensitivity analyses of patients undergoing vascular resection were performed. RESULTS:Overall, 11,402 patients underwent PD for PDAC with 33.7% of patients receiving NAT. The use of NAT increased steadily from 28.3% in 2018 to 38.5% in 2020 (p < 0.0001). However, use of NAT varied widely by country: the US (46.8%), the Netherlands (44.9%), Sweden (11.0%), and Germany (7.8%). On multivariable analysis, NAT was significantly (p < 0.01) associated with reduced rates of serious morbidity, clinically relevant pancreatic fistulae, reoperations, and increased ideal outcomes. These associations remained on sensitivity analysis of patients undergoing vascular resection. CONCLUSIONS:NAT before PD for pancreatic cancer varied widely among 4 Western audits yet increased by 26% during 3 years. NAT was associated with improved short-term outcomes.

  • 5.
    Enochsson, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Impact of Sedation in ERCP on Cannulation Success and Complications: A Prospective Nationwide Study of 31,001 ERCP Procedures2019Ingår i: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, Vol. 229, nr 4, s. E33-E33Artikel i tidskrift (Övrigt vetenskapligt)
  • 6.
    Forssten, Maximilian P.
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Sarani, Babak
    Mohammad Ismail, Ahmad
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Ioannidis, Ioannis
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Cao, Yang
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Hildebrand, Frank
    Ribeiro, Marcelo A., Jr.
    Mohseni, Shahin
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Adverse Outcomes after Pelvic Fracture in Geriatric Patients: The Critical Role of Frailty2023Ingår i: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, Vol. 237, nr 5, s. S557-S557Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Introduction: Pelvic fractures among the elderly are associated with an increased risk of adverse outcomes. Frailty, a condition of depleted physical reserves which increases with age, is likely a contributing factor for such unfavorable events. We endeavored to describe the association between frailty, measured using the Ortho-pedic Frailty Score (OFS), and adverse outcomes in geriatric pelvic fracture patients.

    Methods: All geriatric (≥65yrs) patients registered in the 2013 to 2019 TQIP database with an isolated pelvic fracture following blunt trauma were considered for inclusion. An isolated pelvic fracture was defined as any fracture in the ilium, ischium, pubis, sacrum, coccyx, or acetabulum with an AIS ≤1 in all other regions except for abdominal and lower extremity. Patients were categorized as non-frail (OFS 0), pre-frail (OFS 1), or frail (OFS ≥2). Poisson regression models were employed to determine the association between the OFS and adverse outcomes adjusting for confounders including angiographical and surgical interventions.

    Results: A total of 66,404 patients met inclusion criteria, of whom 52% were classified as non-frail, 32% as pre-frail, and 16% as frail. Compared to non-frail patients, frail patients exhibited 88% increased risk of in-hospital mortality [adjusted IRR (95% CI): 1.88 (1.54-2.30), p<0.001], a 25% increased risk of composite complications [adjusted IRR (95% CI): 1.25 (1.10-1.42), p<0.001], a 56% increased risk of failure to rescue [adjusted IRR (95% CI): 1.56 (1.14-2.14), p=0.006].

    Conclusion: Frail geriatric patients suffering a pelvic fracture have disproportionately increased risk for complications, mortality, and failure-to-rescue. Additional measures are required to mitigate adverse events in this vulnerable population.

  • 7.
    Forssten, Maximilian Peter
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Sarani, Babak
    Mohammad Ismail, Ahmad
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Ioannidis, Ioannis
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Cao, Yang
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Hildebrand, Frank
    Ribeiro, Marcelo A., Jr.
    Mohseni, Shahin
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Adverse Outcomes after Pelvic Fracture in Geriatric Patients: The Critical Role of Frailty2023Ingår i: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, Vol. 237, nr 5, s. S557-S557Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Introduction: Pelvic fractures among the elderly are associated with an increased risk of adverse outcomes. Frailty, a condition of depleted physical reserves which increases with age, is likely a contributing factor for such unfavorable events. We endeavored to describe the association between frailty, measured using the Ortho-pedic Frailty Score (OFS), and adverse outcomes in geriatric pelvic fracture patients.

    Methods: All geriatric (≥65yrs) patients registered in the 2013 to 2019 TQIP database with an isolated pelvic fracture following blunt trauma were considered for inclusion. An isolated pelvic fracture was defined as any fracture in the ilium, ischium, pubis, sacrum, coccyx, or acetabulum with an AIS ≤1 in all other regions except for abdominal and lower extremity. Patients were categorized as non-frail (OFS 0), pre-frail (OFS 1), or frail (OFS ≥2). Poisson regression models were employed to determine the association between the OFS and adverse outcomes adjusting for confounders including angiographical and surgical interventions.

    Results: A total of 66,404 patients met inclusion criteria, of whom 52% were classified as non-frail, 32% as pre-frail, and 16% as frail. Compared to non-frail patients, frail patients exhibited 88% increased risk of in-hospital mortality [adjusted IRR (95% CI): 1.88 (1.54-2.30), p<0.001], a 25% increased risk of composite complications [adjusted IRR (95% CI): 1.25 (1.10-1.42), p<0.001], a 56% increased risk of failure to rescue [adjusted IRR (95% CI): 1.56 (1.14-2.14), p=0.006].

    Conclusion: Frail geriatric patients suffering a pelvic fracture have disproportionately increased risk for complications, mortality, and failure-to-rescue. Additional measures are required to mitigate adverse events in this vulnerable population.

  • 8.
    Gannerdahl, Per E.
    et al.
    Dept. of Anesth. and Intensive Care, Karolinska Institute, Karolinska, Sweden; .
    Edner, Magnus M.
    Department of Cardiology, Karolinska Institute, Karolinska, Sweden; Danderyd Hospitals, Stockholm, Sweden.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Karolinska Institute, Karolinska, Sweden.
    Computerizedvectorcardio-graphy for improved perioperative cardiac monitoring in vascularsurgery1996Ingår i: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, Vol. 182, nr 6, s. 530-536Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:

    Postoperative cardiac complications occur frequently after noncardiac operations in high-risk patients. Routine cardiac monitoring is usually done by electrocardiographic (ECG) methods. The present analysis shows that computerizedvectorcardiography (VCG) is superior to traditional ECG monitoring in predicting postoperative cardiac complications.

    STUDY DESIGN:

    Thirty-eight patients scheduled for abdominal aortic operations were monitored intraoperatively and for 48 hours postoperatively using VCG. These data were analyzed in a blinded fashion, and compared to cardiac outcome and regularly calculated 12-lead ECGs.

    RESULTS:

    Thirteen patients suffered from cardiac events: myocardial infarction (n = 3), cardiac death (n = 1), recurrent myocardial ischemia (n = 1), arrhythmias (n = 2), congestive heart failure (n = 2), and arrhythmias combined with congestive heart failure (n = 4). Thirty of 38 patients had ischemia recorded on their VCG, including all 13 patients with cardiac events. Only seven of the 13 patients had ischemic changes on the V5-lead alone and ten on the three leads II, V4, V5, yielding a sensitivity of 54 percent (V5), 77 percent (II, V4, V5) and 100 percent (VCG). Signs of ischemia appeared 400 +/- 690 (mean plus or minus standard deviation) minutes earlier (median 78 minutes, with a range of zero to 2,284 minutes), and never later on the VCG compared to the three leads II, V4, V5.

    CONCLUSIONS:

    Vectorcardiography in this risk group shows increased sensitivity in predicting perioperative cardiac complications and earlier ischemia detection than the most sensitive scalar leads. Vectorcardiography substantially improves the possibility of earlier intervention, potentially reducing the incidence of postoperative cardiac complications.

  • 9. Georgiou, Konstantinos
    et al.
    Boyanov, Nikola
    Toutouzas, Konstantinos
    Oussi, Ninos
    Thanasas, Dimitrios
    Marinov, Blagoi
    Enochsson, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Non-Invasive Stress Indices Response During Simulator Basic Skills Training Correlate with Novice Surgeons' Performance2020Ingår i: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, Vol. 231, nr 4, s. S253-S253Artikel i tidskrift (Övrigt vetenskapligt)
  • 10. Georgiou, Konstantinos
    et al.
    Oussi, Ninos
    Thanasas, Dimitrios
    Enochsson, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Larentzakis, Andreas
    Papavassiliou, Athanasios G.
    Assessing Various Non-Invasive Stress Indices to Predict Novice Surgeons' Performance During Basic Skills Training in a High-End Simulator2019Ingår i: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, Vol. 229, nr 4, s. S236-S236Artikel i tidskrift (Övrigt vetenskapligt)
  • 11.
    Goolsby, Craig
    et al.
    UCLA, CA USA; UCLA, CA 90502 USA.
    Jonson, Carl-Oscar
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Regionledningskontoret, Katastrofmedicinskt centrum.
    Goralnick, Eric
    Harvard Med Sch, MA USA.
    Dacuyan-Faucher, Nicole
    Natl Ctr Disaster Med & Publ Hlth Med, MD USA; Henry M Jackson Fdn Advancement Mil Med Inc, MD USA.
    Schuler, Keke
    Natl Ctr Disaster Med & Publ Hlth Med, MD USA; Henry M Jackson Fdn Advancement Mil Med Inc, MD USA.
    Kothera, Curt
    InnoVital Syst Inc, MD USA.
    Shah, Amit
    InnoVital Syst Inc, MD USA.
    Cannon, Jeremy
    Univ Penn, PA USA.
    Prytz, Erik
    Linköpings universitet, Institutionen för datavetenskap, Interaktiva och kognitiva system. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Regionledningskontoret, Katastrofmedicinskt centrum.
    The Untrained Publics Ability to Apply the Layperson Audiovisual Assist Tourniquet vs a Combat Application Tourniquet: A Randomized Controlled Trial2023Ingår i: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, Vol. 236, nr 1, s. 178-186Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Although the Stop the Bleed campaigns impact is encouraging, gaps remain. These gaps include rapid skill decay, a lack of easy-to-use tourniquets for the untrained public, and training barriers that prevent scalability. A team of academic and industry partners developed the Layperson Audiovisual Assist Tourniquet (LAVA TQ)& mdash;the first audiovisual-enabled tourniquet for public use. LAVA TQ addresses known tourniquet application challenges and is novel in its design and technology. STUDY DESIGN: This study is a prospective, randomized, superiority trial comparing the ability of the untrained public to apply LAVA TQ to a simulated leg vs their ability to apply a Combat Application Tourniquet (CAT). The study team enrolled participants in Boston, MA; Frederick, MD; and Linkoping, Sweden in 2022. The primary outcome was the proportion of successful applications of each tourniquet. Secondary outcomes included: mean time to application, placement position, reasons for failed application, and comfort with the devices. RESULTS: Participants applied the novel LAVA TQ successfully 93% (n = 66 of 71) of the time compared with 22% (n = 16 of 73) success applying CAT (relative risk 4.24 [95% CI 2.74 to 6.57]; p &lt; 0.001). Participants applied LAVA TQ faster (74.1 seconds) than CAT (126 seconds ; p &lt; 0.001) and experienced a greater gain in comfort using LAVA TQ than CAT. CONCLUSIONS: The untrained public is 4 times more likely to apply LAVA TQ correctly than CAT. The public also applies LAVA TQ faster than CAT and has more favorable opinions about its usability. LAVA TQs highly intuitive design and built-in audiovisual guidance solve known problems of layperson education and skill retention and could improve public bleeding control. (c) 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

  • 12.
    Hörer, Tal M.
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Nilsson, Kristofer F.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Wikström, Maria B.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Invited Commentary: Vena Cava Balloon Occlusion for Traumatic Bleeding2023Ingår i: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, Vol. 236, nr 2, s. e7-e8Artikel i tidskrift (Övrigt vetenskapligt)
  • 13.
    Kiwanuka, Elizabeth
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi.
    Hackl, Florian
    Philip, Justin
    Caterson, Edward J.
    Junker, Johan P. E.
    Eriksson, Elof
    Comparison of Healing Parameters in Porcine Full-Thickness Wounds Transplanted with Skin Micrografts, Split-Thickness Skin Grafts, and Cultured Keratinocytes2011Ingår i: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, Vol. 213, nr 6, s. 728-735Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Transplantation of skin micrografts (MGs), split-thickness skin grafts (STSGs), or cultured autologous keratinocytes (CKs) enhances the healing of large full-thickness wounds. This study compares these methods in a porcine wound model, investigating the utility of micrograft transplantation in skin restoration.

    STUDY DESIGN: Full-thickness wounds were created on Yorkshire pigs and assigned to one of the following treatment groups: MGs, STSGs, CKs, wet nontransplanted, or dry nontransplanted. Dry wounds were covered with gauze and the other groups' wounds were enclosed in a polyurethane chamber containing saline. Biopsies were collected 6, 12, and 18 days after wounding. Quantitative and qualitative wound healing parameters including macroscopic scar appearance, wound contraction, neoepidermal maturation, rete ridge formation, granulation tissue thickness and width, and scar tissue formation were studied.

    RESULTS: Transplanted wounds scored lower on the Vancouver Scar Scale compared with nontransplanted wounds, indicating a better healing outcome. All transplanted wounds exhibited significantly lower contraction compared with nontransplanted wounds. Wounds transplanted with either MGs, STSGs, or CKs showed a significant increase in re-epithelialization compared with nontransplanted wounds. Wounds transplanted with MGs or STSGs exhibited improved epidermal healing compared with nongrafted wounds. Furthermore, transplantation with STSGs or MGs led to less scar tissue formation compared with the nontransplanted wounds. No significant impact on scar formation was observed after transplantation of CKs.

    CONCLUSIONS: Qualitative and quantitative measurements collected from full-thickness porcine wounds show that transplantation of MGs improve wound healing parameters and is comparable to treatment with STSGs.

  • 14. Kiwanuka, Elizabeth
    et al.
    Johan, Junker P. E.
    Caterson, Edward J.
    Gerdin, Bengt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi.
    Eriksson, Elof
    Connective tissue growth factor enhances keratinocyte adhesion to fibronectin and promotes migration through integrin alpha5/beta12012Ingår i: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, Vol. 215, nr 3, s. S81-S82Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Introduction: We have previously shown that connective tissue growth factor (CTGF) promotes keratinocyte migration during re-epithelialization. In this study, we investigated whether the CTGF-driven migration involved integrin alpha-5/beta-1 - the principal ligand for fibronectin (FN).

    Methods: Adhesions assays were performed by coating wells with 10 ug/mL FN or phosphate buffered saline (PBS). Keratinocytes were seeded in the presence or absence of 200 ng/mL CTGF, 5 mmol/L EDTA, 10 mmol/L Mg2+, 10 ug/mL anti-integrin alpha-5/beta-1-blocking antibody. Chemotaxsis assays were performed using a modified Boyden chamber. Keratinocytes were pre-incubated with alpha-5/beta-1-antibodies or mouse-IgG for 30 minute, and migration in the absence or presence of 200 ng/mL CTGF was measured. Cells were stained and absorbance was measured at 570 nm. A value of 1 was assigned to untreated cells.

    Results: Cell adhesion increased 1.5 ± 0.3 folds in wells coated with FN compared to PBS. CTGF enhanced cell adhesion 2.1 ± 0.3 folds, while EDTA reduced CTGF mediated cell adhesion to baseline (1.1 ± 0.2). The addition of the divalent cation Mg2+ restored CTGF-induced adhesion, indicating involvement of integrins. Integrin alpha-5/beta-1-blocking antibodies reversed CTGF-enhanced binding (1.1 ± 0.2). Consistent with the cell adhesion data, CTGF-induced migration was reduced to 1.5 ± 0.3 by anti-integrin alpha-5/beta-1 antibodies compared to the 2.0 ± 0.6 fold increase seen with 200 ng/mL CTGF.

  • 15.
    Ljungqvist, Olle
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Thorell, Anders
    Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Gutniak, Mark K. M.
    Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Häggmark, Tom
    Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Efendic, Suad
    Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Glucose infusion instead of preoperative fasting reduces postoperative insulin resistance1994Ingår i: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, s. 329-336Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In severe catabolic states, such as burn injury, sepsis and accidental injury, a state of marked insulin resistance is encountered. Insulin resistance is also present after elective surgical treatment, more pronounced with increasingly greater magnitude of operation performed. Results of recent animal experiments have shown that even short periods of food deprivation, reducing carbohydrate reserves, alter responses to stress. This notion resulted in our questioning the rationale of carbohydrate depletion associated with overnight preoperative fasting. Twelve patients undergoing elective open cholecystectomy were randomly given no infusion (control group) or 5 milligrams per kilogram per minute of glucose infusion (glucose group) during preoperative overnight fasting. Insulin sensitivity (M value, milligram per kilogram per minute) was determined using the hyperinsulinemic normoglycemic clamp (plasma insulin level, 65 microunits per milliliter and blood glucose level, 4.5 millimoles per liter) before and the first postoperative day. Preoperative insulin sensitivity was similar in the two groups. Postoperatively, M values decreased by 55±3 percent (control group) and by 32±5 percent (glucose group) (p<0.01). Plasma levels of insulin, c- peptide, glucagon, growth hormone, catecholamines and cortisol in connection with clamps were similar in both groups preoperatively and postoperatively. The present results indicate that active preoperative carbohydrate preservation may improve postoperative metabolism because postoperative occurrence of insulin resistance was reduced with preoperative glucose infusion.

  • 16.
    Novik, Bengt
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Sandblom, Gabriel
    Ansorge, Christoph
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Thorell, Anders
    Association of Mesh and Fixation Options with Reoperation Risk after Laparoscopic Groin Hernia Surgery: A Swedish Hernia Registry Study of 25,190 Totally Extraperitoneal and Transabdominal Preperitoneal Repairs.2022Ingår i: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, Vol. 234, nr 3, s. 311-325Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: International guidelines concerning mesh and mesh fixation options in laparoscopic totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) groin hernia repair are based on studies focusing on either mesh or fixation. We hypothesized that the value of such recommendations is limited by lacking knowledge on how mesh and fixation interact. The current registry-based nationwide cohort study compared different mesh/fixation combinations for relative risks for reoperation after TEP and TAPP groin hernia repair.

    STUDY DESIGN: All TEP and TAPP registered in the Swedish Hernia Registry 2005 to 2017 with standard polypropylene (StdPPM) or lightweight (LWM) flat mesh, having tack, fibrin glue, or no fixation, were included. The endpoint was reoperation due to recurrence as of December 31, 2018. Multivariable Cox regression rendered relative risk differences between the exposures, expressed as hazard ratios (HR) with 95% CIs.

    RESULTS: Of 25,190 repairs, 924 (3.7%) were later reoperated for recurrence. The lowest, mutually equivalent, reoperation risks were associated with StdPPM without fixation (HR 1), StdPPM with metal tacks (HR 0.8, CI 0.4 to 1.4), StdPPM with fibrin glue (HR 1.1, CI 0.7 to 1.6), and LWM with fibrin glue (HR 1.2, CI 0.97 to 1.6). Except for with fibrin glue, LWM correlated with increased risk, whether affixed with metal (HR 1.7, CI 1.1 to 2.7), or absorbable tacks (HR 2.4, CI 1.8 to 3.1), or deployed without fixation (HR 2.0, CI 1.6 to 2.6).

    CONCLUSIONS: With StdPPM, neither mechanical nor glue fixation seemed to improve outcomes. Thus, for this mesh category, we recommend nonfixation. With LWM, we recommend fibrin glue fixation, which was the only LWM alternative on par with nonaffixed StdPPM.

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  • 17. Rangelova, Elena B.
    et al.
    Ebrahim, Fereshte
    Sharp, Lena
    Henriksson, Roger
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Segersvärd, Ralf
    Centralization Improves Survival of Pancreatic Cancer by Increased Operative Indication and Resection Rate: A Population-Based Study2020Ingår i: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, Vol. 231, nr 4, s. E53-E53Artikel i tidskrift (Refereegranskat)
  • 18.
    Stenberg, Erik
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Surgery.
    Ottosson, Johan
    Department of Surgery.
    Näslund, Erik
    Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Remission of Obesity-Related Sleep Apnea and Its Effect on Mortality and Cardiovascular Events After Metabolic and Bariatric Surgery: A Propensity Matched Cohort Study2024Ingår i: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: While obstructive sleep apnea (OSA) is common among patients with obesity and linked to cardiovascular disease, there is a lack of studies evaluating the effects of reaching remission from OSA after metabolic and bariatric surgery (MBS).

    STUDY DESIGN: A registry-based nationwide study including patients operated with sleeve gastrectomy or Roux-en-Y gastric bypass from 2007 until 2019 in Sweden. Patients who reached remission of OSA were compared to those who did not reach remission, and a propensity score matched control group of patients without OSA at the time of operation. Main outcome was overall mortality, secondary outcome was major cardiovascular events (MACE).

    RESULTS: In total, 5892 patients with OSA and 11,552 matched patients without OSA completed a 1-year follow-up and were followed for a median of 6.8 years. Remission of OSA was seen for 4334 patients (74%). Patients in remission had a lower risk for overall mortality (cumulative incidence 6.0% v. 9.1%;p<0.001) and MACE (cumulative incidence 3.4% vs 5.8%;p<0.001) at 10-years after operation compared to those who did not reach remission. The risk was similar to that of the control group without OSA at baseline (cumulative incidence for mortality 6.0%, p=0.493, for MACE 3.7%, p=0.251).

    CONCLUSION: The remission rate of OSA was high after MBS. This was in turn associated with reduced risk for death and MACE compared to patients who did not achieve remission reaching a similar risk seen among patients without OSA at baseline. A diligent follow-up of patients who do not reach remission remains important.

  • 19.
    Sugawara, Toshitaka
    et al.
    University of Colorado School of Medicine, Aurora, Colorado, USA; Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan .
    Rodriguez Franco, Salvador
    University of Colorado School of Medicine, Aurora, Colorado, USA.
    Franklin, Oskar
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. University of Colorado School of Medicine, Aurora, Colorado, USA.
    Kirsch, Michael J.
    University of Colorado School of Medicine, Aurora, Colorado, USA.
    Colborn, Kathryn L.
    University of Colorado School of Medicine, Aurora, Colorado, USA.
    Del Chiaro, Marco
    University of Colorado School of Medicine, Aurora, Colorado, USA.
    Schulick, Richard D.
    University of Colorado School of Medicine, Aurora, Colorado, USA.
    Management of localized small- and large-cell pancreatic neuroendocrine carcinoma in the national cancer database2023Ingår i: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, Vol. 237, nr 3, s. 515-524Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The role of curative-intent resection and perioperative chemotherapy for nonmetastatic pancreatic neuroendocrine carcinoma (PanNEC) remains unclear due to their biological aggressiveness and rarity. This study aimed to evaluate the association of resection and perioperative chemotherapy with overall survival for nonmetastatic PanNEC.

    STUDY DESIGN: Patients with localized (cT1-3, M0), small- and large-cell PanNEC were identified in the National Cancer Database from 2004 to 2017. The changing trends in terms of the annual proportions of resection and adjuvant chemotherapy were assessed. The survival of patients who received resection and those who received adjuvant chemotherapy were investigated using Kaplan-Meier estimates and Cox regression models.

    RESULTS: In total, 199 patients with localized small- and large-cell PanNEC were identified; 50.3% of those were resected, and 45.0% of the resected patients received adjuvant chemotherapy. Rate of resection and adjuvant treatment has trended upward since 2011. The resected group was younger, was more often treated at academic institutions, had more distal tumors, and had a lower number of small-cell PanNEC. The median overall survival was longer in the resected group compared to the unresected group (29.4 months vs 8.6 months, p < 0.001). Resection was associated with improved survival in a multivariable Cox regression model adjusting for preoperative factors (adjusted hazard ratio 0.58, 95% CI 0.37 to 0.92), while adjuvant therapy was not.

    CONCLUSIONS: This nationwide retrospective study suggests that resection is associated with improved survival in patients with localized PanNEC. The role of adjuvant chemotherapy needs more investigation.

  • 20.
    Uustal Fornell, Eva K.
    et al.
    Linköpings universitet, Institutionen för molekylär och klinisk medicin, Obstetrik och gynekologi. Linköpings universitet, Hälsouniversitetet.
    Berg, Göran
    Linköpings universitet, Institutionen för molekylär och klinisk medicin, Obstetrik och gynekologi. Linköpings universitet, Hälsouniversitetet.
    Haalböök, Olof
    Linköpings universitet, Institutionen för molekylär och klinisk medicin, Gastroenterologi och hepatologi. Linköpings universitet, Hälsouniversitetet.
    Matthiesen, Leif S.
    Linköpings universitet, Institutionen för molekylär och klinisk medicin, Obstetrik och gynekologi. Linköpings universitet, Hälsouniversitetet.
    Sjödahl, Rune
    Linköpings universitet, Institutionen för molekylär och klinisk medicin, Gastroenterologi och hepatologi. Linköpings universitet, Hälsouniversitetet.
    Clinical consequences of anal sphincter rupture during vaginal delivery1996Ingår i: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, Vol. 183, nr 6, s. 553-558Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:

    Rupture of the anal sphincters at childbirth is considered rare in obstetric literature. Long-term effects are sparingly mentioned. In clinical practice, however, it is not uncommon to meet women with anal incontinence. The aim of our study was to record the incidence and to evaluate the consequences of rupture of the anal sphincter at childbirth.

    STUDY DESIGN:

    Fifty-one consecutive women with primarily sutured anal sphincter rupture and 31 women without anal sphincter rupture were prospectively studied after vaginal delivery. All were assessed clinically at 3 days, 6 weeks, and 6 months after delivery. After 6 months, all women underwent anorectal manometry and answered a questionnaire about incontinence, social function, and general health.

    RESULTS:

    The overall incidence of sphincter rupture was 2.4 percent. Significantly lower values were found for maximum anal squeeze pressure and squeeze pressure area 6 months postpartum in the women with sphincter rupture compared with those without rupture. The resting pressures did not differ between groups. Approximately 40 percent of the women in both groups had noted some fecal incontinence by 6 months postpartum. Symptoms were significantly more severe in patients with sphincter rupture.

    CONCLUSIONS:

    Anal sphincter rupture was 2.4 times as common as reported in Swedish birth statistics. The high incidence of fecal incontinence by 6 months postpartum in all women is surprising and deserves further investigation, specifically regarding occult sphincter rupture.

  • 21.
    Yang, Liyun
    et al.
    KTH, Skolan för kemi, bioteknologi och hälsa (CBH), Medicinteknik och hälsosystem, Ergonomi. Mayo Clin, Dept Hlth Sci Res, 200 First St SW, Rochester, MN 55905 USA.;Mayo Clin, Robert D & Patricia E Kern Ctr Sci Hlth Care Deli, Rochester, MN 55905 USA..
    Money, Samuel R.
    Mayo Clin, Phoenix, AZ USA..
    Morrow, Melissa M.
    Mayo Clin, Dept Hlth Sci Res, 200 First St SW, Rochester, MN 55905 USA.;Mayo Clin, Robert D & Patricia E Kern Ctr Sci Hlth Care Deli, Rochester, MN 55905 USA..
    Lowndes, Bethany R.
    Mayo Clin, Dept Hlth Sci Res, 200 First St SW, Rochester, MN 55905 USA.;Mayo Clin, Robert D & Patricia E Kern Ctr Sci Hlth Care Deli, Rochester, MN 55905 USA.;Univ Nebraska Med Ctr, Dept Neurol Sci, Omaha, NE USA..
    Weidner, Tiffany K.
    Mayo Clin, Phoenix, AZ USA..
    Fortune, Emma
    Mayo Clin, Dept Hlth Sci Res, 200 First St SW, Rochester, MN 55905 USA.;Mayo Clin, Robert D & Patricia E Kern Ctr Sci Hlth Care Deli, Rochester, MN 55905 USA..
    Davila, Victor J.
    Mayo Clin, Phoenix, AZ USA..
    Meltzer, Andrew J.
    Mayo Clin, Phoenix, AZ USA..
    Stone, William M.
    Mayo Clin, Phoenix, AZ USA..
    Hallbeck, M. Susan
    Mayo Clin, Dept Hlth Sci Res, 200 First St SW, Rochester, MN 55905 USA.;Mayo Clin, Dept Surg, 200 First St SW, Rochester, MN 55905 USA.;Mayo Clin, Robert D & Patricia E Kern Ctr Sci Hlth Care Deli, Rochester, MN 55905 USA..
    Impact of Procedure Type, Case Duration, and Adjunctive Equipment on Surgeon Intraoperative Musculoskeletal Discomfort2020Ingår i: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, Vol. 230, nr 4, s. 554-560Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Surgeons are at high risk of developing musculoskeletal disorders. STUDY DESIGN: This study was designed to identify risk factors and assess intraoperative physical stressors using subjective and objective measures, including type of procedure and equipment used. Wearable sensors and pre- and postoperation surveys were analyzed. RESULTS: Data from 116 cases (34 male and 19 female surgeons) were collected across surgical specialties. Surgeons reported increased pain in the neck, upper, and lower back both during and after operations. High-stress intraoperative postures were also revealed by the real-time measurement in the neck and back. Surgical duration also impacted physical pain and fatigue. Open procedures had more stressful physical postures than laparoscopic procedures. Loupe usage negatively impacted neck postures. CONCLUSIONS: This study highlights the fact that musculoskeletal disorders are common in surgeons and characterizes surgeons' intraoperative posture as well as surgeon pain and fatigue across specialties. Defining intraoperative ((C) 2020 The Author(s). Published by Elsevier Inc. on behalf of the American College of Surgeons.

  • 22.
    Zebley, James A.
    et al.
    The Center for Trauma and Critical Care, Department of Surgery, George Washington University, Washington, DC, USA.
    Estroff, Jordan M.
    The Center for Trauma and Critical Care, Department of Surgery, George Washington University, Washington, DC, USA.
    Forssten, Maximilian Peter
    Örebro universitet, Institutionen för medicinska vetenskaper. Division of Trauma & Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Leighton, Nicolas
    The Center for Trauma and Critical Care, Department of Surgery, George Washington University, Washington, DC, USA.
    Bass, Gary Alan
    Örebro universitet, Institutionen för medicinska vetenskaper. Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, USA.
    Sarani, Babak
    The Center for Trauma and Critical Care, Department of Surgery, George Washington University, Washington, DC, USA.
    Mohseni, Shahin
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Division of Trauma & Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden .
    Racial Disparity in Placement of Intracranial Pressure Monitoring: A TQIP Analysis2023Ingår i: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, Vol. 236, nr 1, s. 81-92Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The Brain Trauma Foundation recommends intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (TBI). Race is associated with worse outcomes after TBI. The reasons for racial disparities in clinical decision-making around ICP monitor placement remain unclear.

    STUDY DESIGN: We queried the TQIP database from 2017 to 2019 and included patients 16 years or older, with blunt severe TBI, defined as a head abbreviated injury score 3 or greater. Exclusion criteria were missing race, those without signs of life on admission, length of stay 1 day or less, and AIS of 6 in any body region. The primary outcome was ICP monitor placement, which was calculated using a Poisson regression model with robust SEs while adjusting for confounders.

    RESULTS: A total of 260,814 patients were included: 218,939 White, 29,873 Black, 8,322 Asian, 2,884 American Indian, and 796 Native Hawaiian or Other Pacific Islander. Asian and American Indian patients had the highest rates of midline shift (16.5% and 16.9%). Native Hawaiian or Other Pacific Islanders had the highest rates of neurosurgical intervention (19.3%) and ICP monitor placement (6.5%). Asian patients were found to be 19% more likely to receive ICP monitoring (adjusted incident rate ratio 1.19; 95% CI 1.06 to 1.33; p = 0.003], and American Indian patients were 38% less likely (adjusted incident rate ratio 0.62; 95% CI 0.49 to 0.79; p < 0.001), compared with White patients, respectively. No differences were detected between White and Black patients.

    CONCLUSIONS: ICP monitoring use differs by race. Further work is needed to elucidate modifiable causes of this difference in the management of severe TBI.

  • 23.
    Zebley, James Andrew
    et al.
    Center for Trauma and Critical Care, Department of Surgery, George Washington University, Washington DC, USA.
    Estroff, Jordan M.
    Center for Trauma and Critical Care, Department of Surgery, George Washington University, Washington DC, USA.
    Forssten, Maximilian Peter
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Bass, Gary Alan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Sarani, Babak
    Center for Trauma and Critical Care, Department of Surgery, George Washington University, Washington DC, USA.
    Mohseni, Shahin
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Racial Disparities in the Placement of Intracranial Monitoring: A TQIP Analysis2022Ingår i: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, Vol. 235, nr 5 Suppl. 2, s. S96-S96Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Introduction: The Brain Trauma Foundation recommends intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (TBI). Race is associated with worse outcomes after TBI. The reasons for racial disparities in clinical decision-making around ICP monitor placement remain unclear.

    Methods: We queried the Trauma Quality Improvement Project (TQIP) database from 2017-2019 and included patients ≥16 years old, with blunt severe TBI. Exclusion criteria was no recorded race, those without signs of life, had length of stay <1 day and AIS=6 in any body region. Variables included demographic, clinical, and outcome characteristics. The primary outcome was probability of ICP-monitor placement. We calculated incidence rate ratios for ICP monitor placement using a Poisson regression model to adjust for confounders.

    Results: A total of 260,814 patients were included: 218,939 White, 29,873 Black, 8,322 Asian, 2,884 Native American, and 796 Pacific Islander. Asian and Native American patients had the highest rates of midline shift (16.5% and 16.9%). Pacific Islanders had the highest rates of neurosurgical intervention (19.3%) and ICP monitor placement (6.5%). Asian patients were found to be 19% more likely to receive ICP monitoring [adjusted IRR 1.19 (95%CI: 1.06-1.33), p = 0.003], while Native American patients were 38% less likely [adjusted IRR 0.62 (95%CI: 0.49-0.79), p < 0.001], compared with White patients, respectively. No differences were detected between White and Black patients.

    Conclusion: ICP monitoring use differs significantly by race. Further work is needed to elucidate modifiable causes of this difference in the management of severe TBI.

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