1
|
King DR, Hwabejire JO, Pham QP, Elsharkawy AE, Eid AI, Duggan MJ, Gelsinger S, Fornaciari M, Sharma U. Self-expanding foam versus preperitoneal packing for exsanguinating pelvic hemorrhage. J Trauma Acute Care Surg 2024; 96:727-734. [PMID: 37700445 PMCID: PMC10932884 DOI: 10.1097/ta.0000000000004138] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
BACKGROUND Mortality for pelvic fracture patients presenting with hemorrhagic shock ranges from 21% to 57%. The objective of this study was to develop a lethal and clinically relevant pelvic hemorrhage animal model with and without bony fracture for evaluating therapeutic interventions. ResQFoam is a self-expanding foam that has previously been described to significantly decrease mortality in large-animal models of abdominal exsanguination. We hypothesized that administration of ResQFoam into the preperitoneal space could decrease mortality in exsanguinating pelvic hemorrhage. METHODS Two pelvic hemorrhage models were developed using noncoagulopathic swine. Pelvic hemorrhage model 1: bilateral, closed-cavity, major vascular retroperitoneal hemorrhage without bony pelvic fracture. After injury, animals received no treatment (control, n = 10), underwent preperitoneal packing using laparotomy pads (n = 11), or received ResQFoam (n = 10) injected into the preperitoneal space. Pelvic hemorrhage model 2: unilateral, closed-cavity, retroperitoneal hemorrhage injury (with intraperitoneal communication) combined with complex pelvic fracture. After injury, animals received resuscitation (control, n = 12), resuscitation with preperitoneal packing (n = 10) or with ResQFoam injection (n = 10) into the preperitoneal space. RESULTS For model 1, only ResQFoam provided a significant survival benefit. The median survival times were 50 minutes and 67 minutes for preperitoneal packing and ResQFoam, compared with 6 minutes with controls ( p = 0.002 and 0.057, respectively). Foam treatment facilitated hemodynamic stabilization and resulted in significantly less hemorrhage (21.5 ± 5.3 g/kg) relative to controls (31.6 ± 5.0 g/kg, p < 0.001) and preperitoneal packing (32.7 ± 5.4 g/kg, p < 0.001). For model 2, both ResQFoam and preperitoneal packing resulted in significant survival benefit compared with controls. The median survival times were 119 minutes and 124 minutes for the preperitoneal packing and ResQFoam groups, compared with 4 minutes with controls ( p = 0.004 and 0.013, respectively). CONCLUSION Percutaneous injection of ResQFoam into the preperitoneal space improved survival relative to controls, and similar survival benefit was achieved compared with standard preperitoneal pelvic packing. The technology has potential to augment the armamentarium of tools to treat pelvic hemorrhage.
Collapse
Affiliation(s)
- David Richard King
- From the Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital/Harvard Medical School, Boston, MA (D.R.K., J.O.H., A.E.E., M.J.D.); Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital/Harvard Medical School, Boston, MA & Emergency and Traumatology Department (Q.P.P., S.G., M.F., U.S.), Tanta University, Egypt (A.I.E.); and Arsenal Medical, Inc., Waltham, MA
| | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Bhattacharya B, Askari R, Davis KA, Dorfman J, Eid AI, Elsharkawy AE, Kasotakis G, Mackey S, Odom S, Okafor BU, Rosenblatt M, Ruditsky A, Velmahos G, Maung AA. The effect of anticoagulation on outcomes after liver and spleen injuries: A research consortium of New England centers for trauma (ReCONECT) study. Injury 2020; 51:1994-1998. [PMID: 32482426 DOI: 10.1016/j.injury.2020.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/26/2020] [Accepted: 05/01/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Liver and spleen injuries are the most commonly injured solid organs, the effects of anticoagulation on these injuries has not yet been well characterized. STUDY DESIGN Multicenter retrospective study. RESULT During the 4-year study period, 1254 patients, 64 (5%) on anticoagulation (AC), were admitted with liver and/or splenic injury. 58% of patients had a splenic injury, 53% had a liver injury and 11% had both. Patients on AC were older than non-AC patients (mean age 60.9 vs. 38.6 years, p < 0.001). The most common AC drug was warfarin (70%) with atrial fibrillation (47%) the most common indication for AC. There was no significant difference in AAST injury grade between AC and non-AC patients (median grade 2), but AC patients required a blood product transfusion more commonly (58 vs 40%, p = 0.007) particularly FFP (4 vs 19%, p < 0.01). Among those transfused, non-AC patients required slightly more PRBC (5.7 vs 3.8 units, p = 0.018) but similar amount of FFP (3.2 vs 3.1 units, p = 0.92). The two groups had no significant difference in the rates of initial non-operative management (50% (AC) vs 56% (non-AC), p = 0.3)) or failure of non-operative management (7 vs 4%, p = 0.16). AC patients were more likely to be managed initially with angiography (36 vs 20%, p = 0.001) while non-AC patients with surgery (24% vs 13%, p = 0.04). There was no significant difference in LOS and mortality. CONCLUSION The use of anticoagulation did not result in a difference in outcomes among patients with spleen and/or liver injuries.
Collapse
Affiliation(s)
| | - Reza Askari
- Brigham and Women's Hospital, Boston, MA, United States
| | | | - Jon Dorfman
- UMass Medical School, Worcester, MA, United States
| | - Ahmed I Eid
- Massachusetts General Hospital, Boston, MA, United States
| | | | | | | | - Stephen Odom
- Beth Israel Deaconess Medical Center, Boston, MA, United States
| | | | | | | | | | | |
Collapse
|
3
|
Luckhurst CM, El Hechi M, Elsharkawy AE, Eid AI, Maurer LR, Kaafarani HM, Thabet A, Forcione DG, Fernández-Del Castillo C, Lillemoe KD, Fagenholz PJ. Improved Mortality in Necrotizing Pancreatitis with a Multidisciplinary Minimally Invasive Step-Up Approach: Comparison with a Modern Open Necrosectomy Cohort. J Am Coll Surg 2020; 230:873-883. [DOI: 10.1016/j.jamcollsurg.2020.01.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/31/2019] [Accepted: 01/03/2020] [Indexed: 12/12/2022]
|
4
|
Vasileiou G, Eid AI, Qian S, Pust GD, Rattan R, Namias N, Larentzakis A, Kaafarani HMA, Yeh DD. Appendicitis in Pregnancy: A Post-Hoc Analysis of an EAST Multicenter Study. Surg Infect (Larchmt) 2019; 21:205-211. [PMID: 31687887 DOI: 10.1089/sur.2019.102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 10/25/2022] Open
Abstract
Objective: To compare the presentation, management, and outcomes of appendicitis in pregnant and non-pregnant females of childbearing age (18-45 years). Methods: This was a post-hoc analysis of a prospectively collected database (January 2017-June 2018) from 28 centers in America. We compared pregnant and non-pregnant females' demographics, clinical presentation, laboratory data, imaging findings, management, and clinical outcomes. Results: Of the 3,597 subjects, 1,010 (28%) were of childbearing age, and 41 were pregnant: The mean age of the pregnant subjects was 30 ± 8 years at a median gestational age of 15 (range 10-23) weeks. The two groups had similar demographics and clinical presentation, but there were differences in management and outcomes. For example, in pregnant subjects, abdominal ultrasound scans (US) plus magnetic resonance imaging (MRI) was the most frequently used imaging method (41%) followed by MRI alone (29%), US alone (22%), computed tomography (CT) (5%), and no imaging (2%). Despite similar American Association for the Surgery of Trauma Emergency General Surgery Clinical and Imaging Grade at presentation, pregnant subjects were more likely to be treated with antibiotics alone (15% versus 4%; p = 0.008). Pregnant subjects were less likely to have simple appendicitis and were more likely to have complicated (perforated or gangrenous) appendicitis or a normal appendix. With the exception of index hospital length of stay, there were no significant differences between the groups in clinical outcomes at index hospitalization or at 30 days. Conclusion: Almost 1 in 20 women of childbearing age presenting with appendicitis is pregnant. Appendicitis most commonly affects women in early to mid-pregnancy. Compared with non-pregnant women of childbearing age, pregnant women presenting with appendicitis undergo non-operative management more often and are less likely to have simple appendicitis. Compared with non-pregnant patients, they have similar clinical outcomes at both index hospitalization and 30 days after discharge.
Collapse
Affiliation(s)
- Georgia Vasileiou
- DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Ahmed I Eid
- Department of Emergency and Traumatology, Tanta University, Tanta, Egypt
| | - Sinong Qian
- DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Gerd D Pust
- DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Rishi Rattan
- DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Nicholas Namias
- DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Andreas Larentzakis
- 1st Propaedeutic Surgical Clinic, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Haytham M A Kaafarani
- Department of Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - D Dante Yeh
- DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | | |
Collapse
|
5
|
Nordestgaard AT, Rasmussen LS, Sillesen M, Steinmetz J, Eid AI, Meier K, Kaafarani HMA, Velmahos GC. Red blood cell transfusion in surgery: an observational study of the trends in the USA from 2011 to 2016. Anaesthesia 2019; 75:455-463. [PMID: 31667830 DOI: 10.1111/anae.14900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2019] [Indexed: 01/28/2023]
Abstract
Guidelines recommend restrictive red blood cell transfusion strategies. We conducted an observational study to examine whether the rate of peri-operative red blood cell transfusion in the USA had declined during the period from 01 January 2011 to 31 December 2016. We included 4,273,168 patients from all surgical subspecialties. We examined parallel trends in rates of the following: pre-operative transfusion; prevalence of bleeding disorders and coagulopathy; and minimally invasive procedures. To account for changes in population and procedure characteristics, we performed multivariable logistic regression to assess whether the risk of receiving a transfusion had declined over the study period. Clinical outcomes included peri-operative myocardial infarction, stroke and all-cause mortality at 30 days. Peri-operative red blood cell transfusion rates declined from 37,040/441,255 (8.4%) in 2011 to 46,845/1,000,195 (4.6%) in 2016 (p < 0.001) across all subspecialties. Compared with 2011, the corresponding adjusted OR (95%CI) for red blood cell transfusion decreased gradually from 0.88 (0.86-0.90) in 2012 to 0.51 (0.50-0.51) in 2016 (p < 0.001). Pre-operative red blood cell transfusion rates and the prevalence of bleeding disorders decreased, whereas haematocrit levels and the proportion of minimally invasive procedures increased. Compared with 2011, the adjusted hazard ratios (95%CI) in 2012 and 2016 were 0.96 (0.90-1.02) and 1.05 (0.99-1.11) for myocardial infarction, 0.91 (0.83-0.99) and 0.99 (0.92-1.07) for stroke and 0.98 (0.94-1.02) and 0.99 (0.96-1.03) for all-cause mortality. Use of peri-operative red blood cell transfusion declined from 2011 to 2016. This was not associated with an increase in adverse clinical outcomes.
Collapse
Affiliation(s)
- A T Nordestgaard
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Anaesthesia, Centre of Head and Orthopaedics 4231, Rigshospitalet, University of Copenhagen, Denmark
| | - L S Rasmussen
- Department of Anaesthesia, Centre of Head and Orthopaedics 4231, Rigshospitalet, University of Copenhagen, Denmark
| | - M Sillesen
- Department of Surgical Gastroenterology and Institute for Inflammation Research, Rigshospitalet, University of Copenhagen, Denmark
| | - J Steinmetz
- Department of Anaesthesia, Centre of Head and Orthopaedics 4231, Rigshospitalet, University of Copenhagen, Denmark
| | - A I Eid
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - K Meier
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - H M A Kaafarani
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - G C Velmahos
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
6
|
Eid AI, Mueller P, Thabet A, Castillo CFD, Fagenholz P. A Step-Up Approach to Infected Abdominal Fluid Collections: Not Just for Pancreatitis. Surg Infect (Larchmt) 2019; 21:54-61. [PMID: 31429662 DOI: 10.1089/sur.2019.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: More than 145,500 abdominal abscesses occur annually in the U.S. Percutaneous catheter drainage (PCD) is the primary treatment for clinically significant intra-abdominal collections (IACs), but only approximately 90% of all IACs are treatable with PCD. This leaves a significant number of patients facing long courses of management, including multiple interventions. Minimally invasive debridement techniques are now employed regularly for the treatment of infected necrosis caused by acute pancreatitis. We describe the use of minimally invasive videoscopic debridement techniques employed as part of a "step-up" approach to resolve IACs of other etiologies that are unresponsive to PCD. Methods: Data of all patients undergoing this procedure at a tertiary referral academic center from 2015 to 2017 after failure of different PCD techniques were analyzed retrospectively. Results: Four men and two women, mean age 54.6 years (range 26-70 years), with refractory IACs (mean drainage time 91.3 days; mean number of drainage procedures 4.6) following a variety of surgical interventions and inflammatory conditions underwent either video-assisted retroperitoneal debridement or sinus tract endoscopic debridement with a rigid or flexible endoscope. Technical success was achieved in all cases, and clinical success was observed in five cases. No immediate procedural complications were detected. The mean hospital stay and post-procedure drainage times were 5.5 and 25.2 days, respectively. There were no recurrent IACs. Conclusion: Minimally invasive debridement techniques can safely resolve IACs refractory to standard PCD techniques. Employment of these techniques as part of a step-up approach may reduce the morbidity and duration of drainage for the thousands of patients treated annually who have refractory IACs, whatever their etiology.
Collapse
Affiliation(s)
- Ahmed I Eid
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Peter Mueller
- Division of Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ashraf Thabet
- Division of Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Peter Fagenholz
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
7
|
Meier K, Nordestgaard AT, Eid AI, Kongkaewpaisan N, Lee JM, Kongwibulwut M, Han KR, Kokoroskos N, Mendoza AE, Saillant N, King DR, Velmahos GC, Kaafarani HMA. Obesity as protective against, rather than a risk factor for, postoperative Clostridium difficile infection: A nationwide retrospective analysis of 1,426,807 surgical patients. J Trauma Acute Care Surg 2019; 86:1001-1009. [PMID: 31124898 DOI: 10.1097/ta.0000000000002249] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 01/04/2023]
Abstract
BACKGROUND Recent studies suggest that obesity is a risk factor for Clostridium difficile infection, possibly due to disruptions in the intestinal microbiome composition. We hypothesized that body mass index (BMI) is associated with increased incidence of C. difficile infection in surgical patients. METHODS In this nationwide retrospective cohort study in 680 American College of Surgeons National Surgical Quality Improvement Program participating sites across the United States, the occurrence of C. difficile infection within 30 days postoperatively between different BMI groups was compared. All American College of Surgeons National Surgical Quality Improvement Program patients between 2015 and 2016 were classified as underweight, normal-weight, overweight, or obese class I-III if their BMI was less than 18.5, 18.5 to 25, 25 to 30, 30 to 35, 35 to 40 or greater than 40, respectively. RESULTS A total of 1,426,807 patients were included; median age was 58 years, 43.4% were male, and 82.9% were white. The postoperative incidence of C. difficile infection was 0.42% overall: 1.11%, 0.56%, 0.39%, 0.35%, 0.33% and 0.36% from the lowest to the highest BMI group, respectively (p < 0.001 for trend). In univariate then multivariable logistic regression analyses, adjusting for patient demographics (e.g., age, sex), comorbidities (e.g., diabetes, systemic sepsis, immunosuppression), preoperative laboratory values (e.g., albumin, white blood cell count), procedure complexity (work relative unit as a proxy) and procedure characteristics (e.g., emergency, type of surgery [general, vascular, other]), compared with patients with normal BMI, high BMI was inversely and incrementally correlated with the postoperative occurrence of C. difficile infection. The underweight were at increased risk (odds ratio, 1.15 [1.00-1.32]) while the class III obese were at the lowest risk (odds ratio, 0.73 [0.65-0.81]). CONCLUSION In this nationwide retrospective cohort study, obesity is independently and in a stepwise fashion associated with a decreased risk of postoperative C. difficile infection. Further studies are warranted to explore the potential and unexpected association. LEVEL OF EVIDENCE Prognostic/Epidemiologic, Level IV.
Collapse
Affiliation(s)
- Karien Meier
- From the Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery (K.M., A.T.N., A.I.E., N.K., J.M.L., M.K., K.R.H., N.K., A.E.M., N.S., D.R.K., G.C.V., H.M.A.K.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, Department of Trauma Surgery (K.M.), Leiden University Medical Center, Leiden University, The Netherlands; and Department of Anaesthesia (A.T.N.), Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Denmark
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Han K, Lee JM, Achanta A, Kongkaewpaisan N, Kongwibulwut M, Eid AI, Kokoroskos N, van Wijck S, Meier K, Nordestgaard A, Rodriguez G, Jia Z, Lee J, King D, Fagenholz P, Saillant N, Mendoza A, Rosenthal M, Velmahos G, Kaafarani HMA. Emergency Surgery Score Accurately Predicts the Risk of Post-Operative Infection in Emergency General Surgery. Surg Infect (Larchmt) 2018; 20:4-9. [PMID: 30272533 DOI: 10.1089/sur.2018.101] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Emergency Surgery Score (ESS) was validated recently as an accurate and user-friendly post-operative mortality risk calculator specific for Emergency General Surgery (EGS). ESS is calculated by adding one to three integer points for each of 22 pre-operative variables (demographics, co-morbidities, and pre-operative laboratory values); increasing scores accurately and gradually predict higher mortality rates. We sought to evaluate whether ESS can predict the occurrence of post-operative infectious complications in EGS patients. PATIENTS AND METHODS Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2007-2015, all EGS patients were identified by using the "emergent" ACS-NSQIP variable and a concomitant surgery Current Procedural Terminology code for "digestive system." Patients with any missing ESS variables or those who died within 72 hours from the surgical procedure were excluded. A composite variable, post-operative infection, was created and defined as the post-operative occurrence of one or more of the following: superficial, deep incisional or organ/space surgical site infection, surgical site disruption, pneumonia, sepsis, septic shock, or urinary tract infection. ESS was calculated for all included patients, and the correlation between ESS and post-operative infection was examined using c-statistics. RESULTS Of a total of 4,456,809 patients, 90,412 patients were included. The mean age of the population was 56 years, 51% were female, and 70% were white; 22% developed one or more post-operative infections, most commonly sepsis/septic shock (12.2%), surgical site infection (9%), and pneumonia (5.7%). The ESS gradually and consistently predicted infectious complications; post-operative infections developed in 7%, 24%, and 49% of patients with an ESS of 1, 5, and 10, respectively. The c-statistics for overall post-operative infection, post-operative sepsis/septic shock, and pneumonia were 0.73, 0.75, and 0.80, respectively. CONCLUSION The ESS accurately predicts the occurrence of post-operative infectious complications in EGS patients and could be used for pre-operative clinical decision-making as well as quality benchmarking of infection rates in EGS.
Collapse
Affiliation(s)
- Kelsey Han
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - Jae Moo Lee
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - Aditya Achanta
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - Napaporn Kongkaewpaisan
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - Manasnun Kongwibulwut
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - Ahmed I Eid
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - Nikolaos Kokoroskos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - Suzanne van Wijck
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - Karien Meier
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - Ask Nordestgaard
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - Gabriel Rodriguez
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - Zhenyi Jia
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - Jarone Lee
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - David King
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - Peter Fagenholz
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - Noelle Saillant
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - April Mendoza
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - Martin Rosenthal
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - George Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital , Boston, Massachusetts
| |
Collapse
|
9
|
Kongkaewpaisan N, Lee JM, Eid AI, Kongwibulwut M, Han K, King D, Saillant N, Mendoza AE, Velmahos G, Kaafarani HMA. Can the emergency surgery score (ESS) be used as a triage tool predicting the postoperative need for an ICU admission? Am J Surg 2018; 217:24-28. [PMID: 30172358 DOI: 10.1016/j.amjsurg.2018.08.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/10/2018] [Accepted: 08/14/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The emergency surgery score (ESS) is a preoperative risk calculator recently validated as a mortality predictor in emergency surgery (ES) patients. We sought to evaluate the utility of ESS as an ICU admission triage tool. METHODS A four-step methodology was designed. First, the 2007-2015 ACS-NSQIP database was examined to identify all ES patients using the "emergent" variable and CPT codes for "digestive system". Second, we created a composite variable called ICUneed, defined as death or the development of one or more postoperative complication warranting critical care (e.g. unplanned intubation, ventilator dependent ≥48 h, cardiac arrest, septic shock and coma ≥24 h). Third, for each patient, ESS was calculated. Fourth, the correlation between ESS and ICUneed was assessed by calculating the model c-statistics (AUROC). RESULTS Out of a total of 4,456,809 patients, 65,989 patients were included. The mean population age was 56 years; 51% were female, and 71% were white. The overall 30-day postoperative mortality and morbidity were 8.2% and 31.7%, respectively. ESS gradually and accurately predicted ICUneed, with 1%, 40% and 98% of patients with ESS of 2, 9 and 16 requiring critical care, respectively. Only 6.2% of patients with ESS ≤7 had an ICUneed, while 97.2% of patients with ESS ≥15 had an ICUneed. The c-statistic of the predictive model was 0.90. CONCLUSIONS ESS accurately predicts the need for postoperative critical care and ICU admission. In resource-limited settings, ESS may prove useful as an ICU triage tool ensuring a prompt rescue of the clinically deteriorating patient without unnecessary and burdensome ICU admissions.
Collapse
Affiliation(s)
- Napaporn Kongkaewpaisan
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA; Division of Acute Care and Ambulatory Surgery, Siriraj Hospital, Mahidol University, 2, Wanglang Rd, Sayammin Building 12th Floor, Department of Surgery, Bangkoknoi, Bangkok, 10700, Thailand.
| | - Jae Moo Lee
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.
| | - Ahmed I Eid
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.
| | - Manasnun Kongwibulwut
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.
| | - Kelsey Han
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.
| | - David King
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.
| | - Noelle Saillant
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.
| | - April E Mendoza
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.
| | - George Velmahos
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.
| |
Collapse
|
10
|
Eid AI, DePesa C, Nordestgaard AT, Kongkaewpaisan N, Lee JM, Kongwibulwut M, Han K, Mendoza A, Rosenthal M, Saillant N, Lee J, Fagenholz P, King D, Velmahos G, Kaafarani HMA. Variation of Opioid Prescribing Patterns among Patients undergoing Similar Surgery on the Same Acute Care Surgery Service of the Same Institution: Time for Standardization? Surgery 2018; 164:926-930. [PMID: 30049481 DOI: 10.1016/j.surg.2018.05.047] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/11/2018] [Accepted: 05/26/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Diversion of unused prescription opioids is a major contributor to the current United States opioid epidemic. We aimed to study the variation of opioid prescribing in emergency surgery. METHODS Between October 2016 and March 2017, all patients undergoing laparoscopic appendectomy, laparoscopic cholecystectomy, or inguinal hernia repair in the acute care surgery service of 1 academic center were included. For each patient, we systematically reviewed the electronic medical record and the prescribing pharmacy platform to identify: (1) history of opioid abuse, (2) opioid intake 3 months preoperatively, (3) number of opioid pills prescribed, (4) prescription of nonopioid pain medications (eg, acetaminophen, ibuprofen), and (5) the need for opioid prescription refills. The mean and range of opioid pills prescribed, as well as their oral morphine equivalent, were calculated. RESULTS A total of 255 patients were included (43.5% laparoscopic appendectomy, 44.3% laparoscopic cholecystectomy, and 12.1% inguinal hernia repair). The mean age was 47.5 years, 52.1% were female, 11.4% had a history of opioid use, and 92.5% received opioid prescriptions upon hospital discharge. Only 70.9% of patients were instructed to use nonopioid pain medications. The mean and range of opioid pills prescribed were 17.4; 0-56 (laparoscopic appendectomy), 17.1; 0-75 (laparoscopic cholecystectomy), and 20.9; 0-50 (inguinal hernia repair), while the range of prescribed oral morphine equivalent was 0-600 mg for laparoscopic appendectomy/laparoscopic cholecystectomy and 0-375 mg for inguinal hernia repair. No patients required any opioid medication refills. CONCLUSION Even within the same surgical service, wide variation of opioid prescription was observed. Guidelines that standardize pain management may help prevent opioid overprescribing.
Collapse
Affiliation(s)
- Ahmed I Eid
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School
| | - Christopher DePesa
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School
| | - Ask T Nordestgaard
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School
| | - Napaporn Kongkaewpaisan
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School
| | - Jae Moo Lee
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School
| | - Manasnun Kongwibulwut
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School
| | - Kelsey Han
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School
| | - April Mendoza
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School
| | - Martin Rosenthal
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School
| | - Noelle Saillant
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School
| | - Jarone Lee
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School
| | - Peter Fagenholz
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School
| | - David King
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School
| | - George Velmahos
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School.
| |
Collapse
|
11
|
Eid AI, Ragab FA, el-Ansary SL, el-Gazayerly SM, Mourad FE. Synthesis of new 7-substituted 4-methylcoumarin derivatives of antimicrobial activity. Arch Pharm (Weinheim) 1994; 327:211-3. [PMID: 8204021 DOI: 10.1002/ardp.19943270404] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [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: 01/29/2023]
Abstract
New cyclic derivatives derived from 4-methyl-7-coumarinyloxyacetic acid hydrazide have been synthesized. Some representative examples were screened for antimicrobial activity.
Collapse
Affiliation(s)
- A I Eid
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Cairo University Egypt
| | | | | | | | | |
Collapse
|
12
|
Eid AI, Kira MA, Fahmy HH. Synthesis of new pyrazolones as potent anti-inflammatory agents. J Pharm Belg 1978; 33:303-11. [PMID: 745029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
13
|
Eid AI. Synthesis of some antipyrine derivatives of expected analgesic properties. J Pharm Belg 1974; 29:460-6. [PMID: 4465434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|