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Akinyemi OA, Weldeslase TA, Andine TF, Fasokun M, Griffiths Y, Odusanya E, Williams M, Hughes K, Cornwell E, Fullum T. Race, Insurance, and Socioeconomic Influences on Outcomes Following Roux-En-Y Gastric Bypass. Am Surg 2024:31348241248803. [PMID: 38647079 DOI: 10.1177/00031348241248803] [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: 04/25/2024]
Abstract
The effectiveness of Roux-en-Y gastric bypass (RYGB) might be shadowed by disparities in outcomes related to patient race and insurance type. We determine the influence of patient race/ethnicity and insurance types on complications following RYGB. We performed a retrospective analysis using data sourced from the National Inpatient Sample Database (2010 to 2019). A multivariate analysis was employed to determine the relationship between patient race/ethnicity and insurance type on RYGB complications. The analysis determined the interaction between race/ethnicity and insurance type on RYGB outcomes. We analyzed 277714 patients who underwent RYGB. Most of these patients were White (64.5%) and female (77.3%), with a median age of 46 years (IQR 36-55). Medicaid beneficiaries displayed less favorable outcomes than those under private insurance: Extended hospital stay (OR = 1.68; 95% CI 1.58-1.78), GIT Leak (OR = 1.83; 95% CI 1.35-2.47), postoperative wound infection (OR = 1.88; 95% CI 1.38-2.55), and in-hospital mortality (OR = 2.74; 95% CI 1.90-3.95).
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Affiliation(s)
- Oluwasegun A Akinyemi
- Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, USA
| | - Terhas A Weldeslase
- Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, USA
| | - Tsion F Andine
- Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, USA
| | - Mojisola Fasokun
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Yasmine Griffiths
- Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, USA
| | - Eunice Odusanya
- Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, USA
| | - Mallory Williams
- Department of Surgery, Howard University Hospital, Washington, DC, USA
| | - Kakra Hughes
- Department of Surgery, Howard University Hospital, Washington, DC, USA
| | - Edward Cornwell
- Department of Surgery, Howard University Hospital, Washington, DC, USA
| | - Terrence Fullum
- Department of Surgery, Howard University Hospital, Washington, DC, USA
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Morningstar MD, Timme NM, Ma B, Cornwell E, Galbari T, Lapish CC. Proactive Versus Reactive Control Strategies Differentially Mediate Alcohol Drinking in Male Wistars and P Rats. eNeuro 2024; 11:ENEURO.0385-23.2024. [PMID: 38423790 PMCID: PMC10972740 DOI: 10.1523/eneuro.0385-23.2024] [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] [Received: 10/04/2023] [Revised: 12/13/2023] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
Problematic alcohol consumption is associated with deficits in decision-making and alterations in prefrontal cortex neural activity likely contribute. We hypothesized that the differences in cognitive control would be evident between male Wistars and a model of genetic risk: alcohol-preferring P rats. Cognitive control is split into proactive and reactive components. Proactive control maintains goal-directed behavior independent of a stimulus, whereas reactive control elicits goal-directed behavior at the time of a stimulus. We hypothesized that Wistars would show proactive control over alcohol seeking whereas P rats would show reactive control over alcohol seeking. Neural activity was recorded from the prefrontal cortex during an alcohol seeking task with two session types. On congruent sessions, the conditioned stimulus (CS+) was on the same side as alcohol access. Incongruent sessions presented alcohol opposite the CS+. Wistars, but not P rats, made more incorrect approaches during incongruent sessions, suggesting that Wistars utilized the previously learned rule. This motivated the hypothesis that neural activity reflecting proactive control would be observable in Wistars but not P rats. While P rats showed differences in neural activity at times of alcohol access, Wistars showed differences prior to approaching the sipper. These results support our hypothesis that Wistars are more likely to engage in proactive cognitive control strategies whereas P rats are more likely to engage in reactive cognitive control strategies. Although P rats were bred to prefer alcohol, the differences in cognitive control may reflect a sequela of behaviors that mirror those in humans at risk for an AUD.
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Affiliation(s)
- M D Morningstar
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana 46202
| | - N M Timme
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana 46202
| | - B Ma
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana 46202
| | - E Cornwell
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana 46202
| | - T Galbari
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana 46202
| | - C C Lapish
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana 46202
- Department of Anatomy, Cell Biology, and Physiology, Stark Neurosciences, Indiana University School of Medicine, Indianapolis, Indiana 46202
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Akinyemi O, Ogundare T, Weldeslase T, Andine T, Fasokun M, Odusanya E, Hughes K, Mallory W, Luo G, Cornwell E. The association between community-level economic deprivation and incidences of emergency department visits on account of attempted suicides in Maryland. Front Public Health 2024; 12:1353283. [PMID: 38384877 PMCID: PMC10879598 DOI: 10.3389/fpubh.2024.1353283] [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: 12/10/2023] [Accepted: 01/24/2024] [Indexed: 02/23/2024] Open
Abstract
Background Suicide is a major cause of mortality in the United States, accounting for 14.5 deaths per 100,000 population. Many emergency department (ED) visits in the United States are due to attempted suicides. Suicide attempts predict subsequent completed suicides. Socioeconomic factors, such as community-level socioeconomic deprivation, significantly affect many traditional risk factors for attempted suicides and suicides. Aim To determine the association between community-level socioeconomic deprivation and ED visits for attempted suicide in Maryland. Methods A retrospective analysis of attempted suicides in the Maryland State Emergency Department Database from January 2018 to December 2020. Community-level socioeconomic deprivation was measured using the Distress Community Index (DCI). Multivariate regression analyses were conducted to identify the association between DCI and attempted suicides/self-harm. Results There were 3,564,987 ED visits reported in the study period, with DCI data available for 3,236,568 ED visits; 86.8% were younger than 45 years, 64.8% were females, and 54.6% non-Hispanic Whites. Over the study period, the proportion of ED visits due to attempted suicide was 0.3%. In the multivariate logistic regression, compared to prosperous zones, those in comfortable (OR = 0.80, 95% CI: 0.73-0.88, p < 0.01), Mid-Tier (OR = 0.76, 95%CI:0.67-0.86, p < 0.01), At-Risk (OR = 0.77; 95%CI: 0.65-0.92, p < 0.01) and Distressed zones (OR = 0.53; 95% CI:0.42-0.66, p < 0.01) were less likely to visit the ED for attempted suicide. Conclusion Prosperous communities had the highest rate of attempted suicides, with the risk of attempted suicide increasing as individuals move from the least prosperous to more prosperous areas.
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Affiliation(s)
- Oluwasegun Akinyemi
- Clive O Callender Department of Surgery, Howard University College of Medicine, Washington, DC, United States
| | - Temitope Ogundare
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Terhas Weldeslase
- Department of Surgery, Howard University College of Medicine, Washington, DC, United States
| | - Tsion Andine
- Department of Surgery, Howard University College of Medicine, Washington, DC, United States
| | - Mojisola Fasokun
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Eunice Odusanya
- Department of Surgery, Howard University College of Medicine, Washington, DC, United States
| | - Kakra Hughes
- Department of Surgery, Howard University College of Medicine, Washington, DC, United States
| | - Williams Mallory
- Department of Surgery, Howard University College of Medicine, Washington, DC, United States
| | - Guoyang Luo
- Department of Obstetrics and Gynecology, Howard University College of Medicine, Washington, DC, United States
| | - Edward Cornwell
- Department of Surgery, Howard University College of Medicine, Washington, DC, United States
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Akinyemi OA, Weldeslase TA, Fasokun M, Griffiths Y, Andine T, Odusanya E, Williams M, Hughes K, Cornwell E, Fullum T. The impact of the affordable care act on access to bariatric surgery in Maryland. Am J Surg 2023:S0002-9610(23)00667-0. [PMID: 38171943 DOI: 10.1016/j.amjsurg.2023.12.021] [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: 10/30/2023] [Revised: 11/30/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION This study aims to investigate the influence of the Affordable Care Act (ACA) on the utilization of Roux-en-Y gastric bypass (RYGB) procedures in Maryland. METHODS Using the Maryland State Inpatient Database, this retrospective study compared all patients undergoing RYGB during the pre-ACA (2007-2009) and post-ACA (2018-2020) periods, including patient demographic factors, pre-existing conditions, and socioeconomic factors. RESULTS A total of 16,494 RYGB procedures were performed during the study period, of which 12,089 (73.3 %) were post-ACA. This was a 179.2 % increase in patients undergoing RYGB post-ACA; nearly triple that of the pre-ACA period. There was a significant decrease in uninsured patients (5.6 %-1.5 %, p < 0.01) an increase in Black patients (32.1 %-46.8 %, p < 0.01) and Medicaid beneficiaries (6.0 % pre-ACA to 17.8 % post-ACA, p < 0.01). There were significant reductions in adverse outcomes (long hospital stays, hemorrhage, GIT leaks, and mortality) across all insurance types (all p < 0.01). CONCLUSION The ACA increased access to RYGB procedures, especially in Black and Medicaid recipients in Maryland, enhancing healthcare across all insurance types.
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Affiliation(s)
- Oluwasegun A Akinyemi
- Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, USA.
| | - Terhas A Weldeslase
- Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, USA
| | - Mojisola Fasokun
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, USA
| | - Yasmin Griffiths
- Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, USA
| | - Tsion Andine
- Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, USA
| | - Eunice Odusanya
- Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, USA
| | - Mallory Williams
- Department of Surgery, Howard University College of Medicine, Washington, DC, USA
| | - Kakra Hughes
- Department of Surgery, Howard University College of Medicine, Washington, DC, USA
| | - Edward Cornwell
- Department of Surgery, Howard University College of Medicine, Washington, DC, USA
| | - Terrence Fullum
- Department of Surgery, Howard University College of Medicine, Washington, DC, USA
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Morningstar M, Timme N, Ma B, Cornwell E, Galbari T, Lapish C. Proactive Versus Reactive Control Strategies Differentially Mediate Alcohol Drinking in Wistar and P rats. bioRxiv 2023:2023.06.08.544260. [PMID: 37333222 PMCID: PMC10274887 DOI: 10.1101/2023.06.08.544260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Problematic alcohol consumption is associated with deficits in decision-making, and alterations in prefrontal cortex neural activity likely contributes. We hypothesized that differences in cognitive control would be evident between male Wistar rats and a model for genetic risk for alcohol use disorder (alcohol-preferring P rats). Cognitive control can be split into proactive and reactive components. Proactive control maintains goal-directed behavior independent of a stimulus whereas reactive control elicits goal-directed behavior at the time of a stimulus. We hypothesized that Wistars would show proactive control over alcohol-seeking whereas P rats would show reactive control over alcohol-seeking. Neural ensembles were recorded from prefrontal cortex during an alcohol seeking task that utilized two session types. On congruent sessions the CS+ was on the same side as alcohol access. Incongruent sessions presented alcohol opposite the CS+. Wistars, but not P rats, exhibited an increase in incorrect approaches during incongruent sessions, suggesting that Wistars utilized the previously learned task-rule. This motivated the hypothesis that ensemble activity reflecting proactive control would be observable in Wistars but not P rats. While P rats showed differences in neural activity at times relevant for alcohol delivery, Wistars showed differences prior to approaching the sipper. These results support our hypothesis that Wistars are more likely to engage proactive cognitive-control strategies whereas P rats are more likely to engage reactive cognitive control strategies. Although P rats were bred to prefer alcohol, differences in cognitive control may reflect a sequela of behaviors that mirror those in humans at risk for an AUD.
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Affiliation(s)
- M.D. Morningstar
- Indiana University-Purdue University Indianapolis. Department of Psychology. Indianapolis, IN, 46202. United States of America
| | - N.M. Timme
- Indiana University-Purdue University Indianapolis. Department of Psychology. Indianapolis, IN, 46202. United States of America
| | - B. Ma
- Indiana University-Purdue University Indianapolis. Department of Psychology. Indianapolis, IN, 46202. United States of America
| | - E. Cornwell
- Indiana University-Purdue University Indianapolis. Department of Psychology. Indianapolis, IN, 46202. United States of America
| | - T. Galbari
- Indiana University-Purdue University Indianapolis. Department of Psychology. Indianapolis, IN, 46202. United States of America
| | - C.C. Lapish
- Indiana University-Purdue University Indianapolis. Department of Psychology. Indianapolis, IN, 46202. United States of America
- Indiana University School of Medicine. Stark Neurosciences. Department of Anatomy, Cell Biology, and Physiology. Indianapolis, IN, 46202. United States of America
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Akinyemi OA, Weldeslase TA, Williams M, Tran D, Rose D, Cornwell E, Hughes K. Association Between Neighborhood Socioeconomic Deprivation and Likelihood Of Lower Extremity Arterial Revascularization Versus Amputation. Ann Vasc Surg 2023. [DOI: 10.1016/j.avsg.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Shah AA, Zuberi M, Cornwell E, Williams M, Manicone P, Kane T, Sandler A, Petrosyan M. Gaps in access to comprehensive rehabilitation following traumatic injuries in children: A nationwide examination. J Pediatr Surg 2019; 54:2369-2374. [PMID: 31255326 DOI: 10.1016/j.jpedsurg.2019.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 02/06/2019] [Revised: 05/31/2019] [Accepted: 06/04/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Acute rehabilitation following traumatic injuries is associated with improved functional recovery. Access is often limited to patients at the time of hospital discharge. This phenomenon remains less well described in children, who may have more to benefit with rehabilitation posttrauma. This study aims to determine factors influencing access to rehabilitation among children with traumatic injuries utilizing a nationally representative sample. METHODS The Kids Inpatient Database (2000-2012) was queried for trauma patients. The outcome measure of interest was discharge with rehabilitative services [acute rehabilitation facilities or home healthcare (HHC)]. Patients that did not survive and those that did not meet hospital admission criteria were excluded. Multivariable models adjusted for age, race/ethnicity, gender, insurance-status, income, injury severity score, year, children's hospital designation, hospital-volume, teaching status, location, and geographical region. RESULTS A total of 811,941 records were included. These were predominantly male (65.9%) with an average age of 11.6 (±6.7) years. 4.2% were discharged to rehabilitation facilities, and 3.9% were discharged with HHC. African-American and Hispanic patients were less likely to be placed/have access to rehabilitation facilities (p < 0.001). Similarly, uninsured patients were less likely to receive these services postdischarge (p < 0.05). However, patients with government insurance, those in the highest income-quartile, those treated at children's hospitals, and those treated at teaching and urban hospitals were more likely to be placed/have access to rehabilitation services. CONCLUSION Race/ethnicity and insurance status are associated with disparities in access to postdischarge rehabilitation in pediatric trauma patients. Moreover, treatment at designated children's, teaching and urban hospitals better-facilitates discharge planning with rehabilitative services.
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Affiliation(s)
- Adil A Shah
- Department of Surgery, Howard University Hospital and College of Medicine, Washington, DC; Department of General and Thoracic Surgery, Children's National Health System, Washington, DC
| | - Maaz Zuberi
- Department of Surgery, Howard University Hospital and College of Medicine, Washington, DC
| | - Edward Cornwell
- Department of Surgery, Howard University Hospital and College of Medicine, Washington, DC
| | - Mallory Williams
- Department of Surgery, Howard University Hospital and College of Medicine, Washington, DC
| | - Paul Manicone
- Department of Pediatrics, Children's National Health System, Washington, DC
| | - Timothy Kane
- Department of General and Thoracic Surgery, Children's National Health System, Washington, DC
| | - Anthony Sandler
- Department of General and Thoracic Surgery, Children's National Health System, Washington, DC
| | - Mikael Petrosyan
- Department of General and Thoracic Surgery, Children's National Health System, Washington, DC.
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Hashmi ZG, Jarman MP, Uribe-Leitz T, Goralnick E, Newgard CD, Salim A, Cornwell E, Haider AH. Access Delayed Is Access Denied: Relationship Between Access to Trauma Center Care and Pre-Hospital Death. J Am Coll Surg 2019; 228:9-20. [DOI: 10.1016/j.jamcollsurg.2018.09.015] [Citation(s) in RCA: 24] [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: 07/01/2018] [Revised: 08/30/2018] [Accepted: 09/14/2018] [Indexed: 11/28/2022]
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Abu-Bonsrah N, Goodwin CR, Ortega G, Abdullah F, Cornwell E, De la Garza-Ramos R, Groves ML, Ain M, Sponseller PD, Sciubba DM. Risk factors associated with short-term complications and mortality after pediatric spinal arthrodesis. Neurosurg Focus 2018; 43:E7. [PMID: 28965454 DOI: 10.3171/2017.7.focus17313] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 11/06/2022]
Abstract
OBJECTIVE Spinal arthrodesis is routinely performed in the pediatric population. However, there is limited information on the short-term outcomes of pediatric patients who have undergone spine fusion. Thus, the authors conducted a retrospective review of the Pediatric National Surgical Quality Improvement Program (NSQIP) database to determine the short-term mortality, complication, reoperation, and readmission rates of pediatric patients who underwent spinal arthrodesis for all indications. METHODS The Pediatric NSQIP database was queried for all patients who underwent spinal arthrodesis between 2012 and 2014. Patient demographics, comorbidities, body mass index, American Society of Anesthesiologists classification, and operative time were abstracted. Short-term mortality, reoperation, and readmission rates and complications were also noted. Univariate and multivariate analyses were performed to delineate patient risk factors that influence short-term mortality, complications, reoperation, and readmission rates. RESULTS A total of 4420 pediatric patients who underwent spinal fusion were identified. Common indications for surgical intervention included acquired/idiopathic scoliosis or kyphoscoliosis (71.2%) and genetic/syndromic scoliosis (10.7%). The mean patient age was 13.7 ± 2.9 years, and 70% of patients were female. The overall 30-day mortality was 0.14%. Multivariate analysis showed that female sex and pulmonary comorbidities significantly increased the odds of reoperation, with odds ratios of 1.43 and 1.78, respectively. CONCLUSIONS In the NSQIP database for pediatric patients undergoing spinal arthrodesis for all causes, there was a 3.6% unplanned reoperation rate, a 3.96% unplanned readmission rate, and a 9.0% complication rate. This analysis provides data for risk stratification of pediatric patients undergoing spinal arthrodesis, allowing for optimized care.
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Affiliation(s)
| | - C Rory Goodwin
- Departments of 1 Neurosurgery and.,Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Gezzer Ortega
- Department of Surgery, Howard University School of Medicine, Washington, DC; and
| | - Fizan Abdullah
- Department of Pediatric Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Edward Cornwell
- Department of Surgery, Howard University School of Medicine, Washington, DC; and
| | | | | | - Michael Ain
- Orthopedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Paul D Sponseller
- Orthopedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Hamdi A, Al-Zubeidy B, Obirieze A, Rose D, Tran D, Cornwell E, Obisesan T, Hughes K. Lower Extremity Arterial Reconstruction in Octogenarians and Older. Ann Vasc Surg 2016; 34:171-7. [PMID: 27177700 PMCID: PMC4930703 DOI: 10.1016/j.avsg.2015.12.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 12/02/2015] [Accepted: 12/12/2015] [Indexed: 10/21/2022]
Abstract
BACKGROUND Despite previous single-institution studies showing that lower extremity arterial reconstruction (LEAR) in octogenarians and older patients may be undertaken with acceptable postoperative morbidity and mortality, there continues to be significant reluctance, in the vascular surgical community, to undertaking these complex revascularization procedures in this very elderly population. We undertook this study in an effort to determine the outcomes of LEAR in octogenarians and older patients on a national level. METHODS The American College of Surgeons' National Surgical Quality Improvement Program database was queried to identify all patients who underwent LEAR between January 1, 2005 and December 31, 2009. Patient demographics and presenting comorbidities were recorded, and multivariate analyses were performed to compare outcomes in patients 80 and older to those in younger patients. RESULTS There were 19,028 patients who underwent open infrainguinal LEAR during this time period. Patients ≥80 comprised 18% (3,486 patients), and patients <80 years comprised 82% (15,542 patients). Multivariate analysis demonstrated that patients aged ≥80 years had an increased likelihood of mortality (odds ratio [OR] 1.79; 95% confidence interval [CI] 1.42-2.26), cardiovascular (OR, 1.46; 95% CI, 1.12-1.89), respiratory (OR, 1.37; 95% CI, 1.12-1.67), and renal (OR, 1.57; 95% CI, 1.27-1.95) complications. There was, however, no significant difference in the likelihood of graft failure (OR, 1.04; 95% CI, 0.86-1.27), wound infection (OR, 0.92; 95% CI, 0.79-1.06), or major amputation (OR, 0.59; 95% CI, 0.13-2.74) between these 2 groups. CONCLUSIONS LEAR in octogenarians is associated with an increased risk of postoperative morbidity and mortality but no increased risk of wound infection, amputation, or graft failure.
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Affiliation(s)
- Abdulrahman Hamdi
- Department of Surgery, Howard University College of Medicine and Hospital, Washington, DC
| | - Batul Al-Zubeidy
- Department of Surgery, Howard University College of Medicine and Hospital, Washington, DC
| | - Augustine Obirieze
- Department of Surgery, Howard University College of Medicine and Hospital, Washington, DC
| | - David Rose
- Department of Surgery, Howard University College of Medicine and Hospital, Washington, DC
| | - Daniel Tran
- Department of Surgery, Howard University College of Medicine and Hospital, Washington, DC
| | - Edward Cornwell
- Department of Surgery, Howard University College of Medicine and Hospital, Washington, DC
| | - Thomas Obisesan
- Department of Medicine, Howard University College of Medicine and Hospital, Washington, DC
| | - Kakra Hughes
- Department of Surgery, Howard University College of Medicine and Hospital, Washington, DC.
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Kendall J, Ortega G, Williams K, Hughes K, Cornwell E, Fullum T, Tran D. Revisional Bariatric Surgery in African Americans: Short Term Outcomes. Surg Obes Relat Dis 2015. [DOI: 10.1016/j.soard.2015.08.288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mbadiwe T, Prevatt E, Duerinckx A, Cornwell E, Fullum T, Davis B. Assessing the value of routine upper gastrointestinal contrast studies following bariatric surgery: a systematic review and meta-analysis. Am J Surg 2015; 209:616-22. [DOI: 10.1016/j.amjsurg.2014.11.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 10/01/2014] [Accepted: 11/13/2014] [Indexed: 01/05/2023]
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Hughes K, Boyd C, Oyetunji T, Tran D, Chang D, Rose D, Siram S, Cornwell E, Obisesan T. Racial/Ethnic Disparities in Revascularization for Limb Salvage. Vasc Endovascular Surg 2014; 48:402-5. [DOI: 10.1177/1538574414543276] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Previous reports have suggested that black patients have a higher rate of major lower extremity amputation and a lower rate of revascularization for limb salvage when compared to white patients. Objective: We undertook this study to determine the extent of this ethnic disparity in recent years and to evaluate whether the widespread adoption of endovascular techniques has had an impact on this disparity. Methods: The American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) database was queried to identify all patients who had undergone an above- or below-knee amputation as well as all patients who had undergone an open or endovascular revascularization procedure for critical limb ischemia for the years 2005 to 2006. Patient demographics and 30-day outcomes were recorded, and comparisons were made among the different ethnic groups. Results: There were 1568 patients identified in the NSQIP database as having undergone a major lower extremity amputation in 2005 and 2006. Of these patients, 54% were white, 29% black, 8% Hispanic, and 0.7% Asian. Eight percent of patients did not have identifying ethnic data. The group undergoing amputation was primarily male (61%) with a mean age of 65. Median length of stay was 11 days, and 30-day mortality was 9% following amputation. During this same time period, 4191 patients underwent an open surgical procedure and 569 patients underwent an endovascular procedure for the purposes of limb salvage. Of those patients undergoing an open procedure, 74% were white, 12% black, 4% Hispanic, 0.4% Asian, and 10% did not have identifying ethnic data. Open surgical patients were primarily male (63%) with a mean age of 66. Median length of stay was 6 days, and 30-day mortality was 3.3%. Of those patients undergoing an endovascular procedure, 79% were white, 10% black, 2% Hispanic, 1% Asian, and 8% did not have identifying ethnic data. The endovascular group was also primarily male (61%) with a mean age of 68. Median length of stay was 5 days, and 30-day mortality was 4%. Conclusion: There remains a significant ethnic disparity in limb-salvage revascularization. Blacks comprise 29% of patients undergoing a major lower extremity amputation, but only 12% of those undergoing an open surgical procedure and 10% of those undergoing an endovascular procedure for limb salvage. The widespread adoption of endovascular revascularization techniques appears not to have had much impact on this disparity.
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Affiliation(s)
- Kakra Hughes
- Department of Surgery, Howard University, Washington, DC, USA
| | | | | | - Daniel Tran
- Department of Surgery, Howard University, Washington, DC, USA
| | - David Chang
- Department of Surgery, University of California, San Diego, CA, USA
| | - David Rose
- Department of Surgery, Howard University, Washington, DC, USA
| | | | - Edward Cornwell
- Department of Surgery, Howard University, Washington, DC, USA
| | - Thomas Obisesan
- Department of Internal Medicine, Howard University, Washington, DC, USA
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Hughes K, Guerrier J, Obirieze A, Ngwang D, Rose D, Tran D, Cornwell E, Obisesan T, Preventza O. Open Versus Endovascular Repair of Thoracic Aortic Aneurysms. Vasc Endovascular Surg 2014; 48:383-7. [DOI: 10.1177/1538574414540484] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: Endovascular repair of descending thoracic aortic aneurysms has become an acceptable surgical option over the past decade. We sought to compare the results of open versus endovascular repair of thoracic aortic aneurysms (TEVAR) in the United States. Methods: The Nationwide Inpatient Sample (NIS) database was queried to identify all patients undergoing elective repair of a thoracic aortic aneurysm from 1998 to 2007 in the United States. Patient demographic data, preoperative comorbidities, and postoperative complications were recorded. Statistical analyses were performed comparing open versus endovascular repair. Multivariate analyses were conducted controlling for preoperative comorbidities including the presence of diabetes mellitus, cardiac, respiratory, and renal comorbidities as well as patient’s age, gender, and ethnicity. The primary end point was mortality. Secondary end points were postoperative neurologic, cardiac, and respiratory complications. Results: There were 8967 patients who met the inclusion criteria. Of these patients, 8255 (92%) had an open repair and 712 (8%) had an endovascular repair. The overall mortality was 4.5% (4.6% for open and 3.6% for endovascular). On multivariate analysis, the odds of death were reduced by 46% among patients undergoing endovascular repair when compared to open repair (odds ratio [OR]: 0.54; P = .016). There was also reduced odds of a postoperative neurologic complication (OR: 0.48; P = .015), cardiac complication (OR: 0.24; P < .001), and respiratory complication (OR: 0.38: P = .001) in the endovascular group. Conclusions: Nationwide data comparing open and TEVAR in the United States reveal decreased postoperative mortality and a decreased incidence of postoperative neurologic, cardiac, and respiratory complications for TEVAR.
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Affiliation(s)
- Kakra Hughes
- Department of Surgery, Howard University College of Medicine, Washington, DC, USA
| | - Jean Guerrier
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Augustine Obirieze
- Department of Surgery, Howard University College of Medicine, Washington, DC, USA
| | - Dora Ngwang
- Department of Anesthesiology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - David Rose
- Department of Surgery, Howard University College of Medicine, Washington, DC, USA
| | - Daniel Tran
- Department of Surgery, Howard University College of Medicine, Washington, DC, USA
| | - Edward Cornwell
- Department of Surgery, Howard University College of Medicine, Washington, DC, USA
| | - Thomas Obisesan
- Department of Medicine, Howard University College of Medicine, Washington, DC, USA
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Texas Heart Institute, Houston, TX, USA
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Hughes K, Padilla L, Al-zubeidy B, Bolorunduro O, Rose D, Cornwell E, Turner P, Greene W. Diabetes is not associated with an increased peri-operative mortality or non-infectious morbidity following lower extremity arterial reconstruction. Am J Surg 2014; 207:573-7. [DOI: 10.1016/j.amjsurg.2013.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 03/21/2013] [Accepted: 03/21/2013] [Indexed: 11/25/2022]
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Robinson D, Preventza O, Obirieze A, Rose D, Cornwell E, Hughes K. Endovascular Repair of Thoracic Aortic Aneurysms in Octogenarians and Older. J Surg Res 2014. [DOI: 10.1016/j.jss.2013.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hughes K, Seetahal S, Oyetunji T, Rose D, Greene W, Chang D, Cornwell E, Obisesan T. Racial/Ethnic Disparities in Amputation and Revascularization. Vasc Endovascular Surg 2013; 48:34-7. [DOI: 10.1177/1538574413510618] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study investigates whether ethnic minorities presenting with critical limb ischemia (CLI) are more likely to undergo major limb amputation compared to white patients. The Nationwide Inpatient Sample (NIS) database was used to identify all patients admitted with CLI; lower extremity revascularization; and major lower extremity amputation from 1998 to 2005. The NIS identified 240 139 patients presenting with CLI—68.2% white, 19.5% black, 9.0% Hispanic, and 1.24% Asian. In all, 83 328 patients underwent revascularization—73.7% white, 15.9% black, 7.4% Hispanic, and 1.1% Asian. The majority of the interventions were open. In all, 111 548 patients underwent a major lower extremity amputation—61% white, 25.4% black, 10.1% Hispanic, and 1.1% Asian. The mean Charlson comorbidity scores for amputation were 2.1 for whites, 2.0 for blacks, 2.3 for Hispanics, and 2.5 for Asians (for all data, P < .05).Blacks make up a disproportionately higher proportion of patients admitted for CLI and undergoing amputation, with a lower proportion undergoing revascularization.
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Affiliation(s)
- Kakra Hughes
- Department of Surgery, Howard University, Washington, DC, USA
| | - Shiva Seetahal
- Department of Surgery, Howard University, Washington, DC, USA
| | | | - David Rose
- Department of Surgery, Howard University, Washington, DC, USA
| | - Wendy Greene
- Department of Surgery, Howard University, Washington, DC, USA
| | - David Chang
- Department of Surgery, University of California at San Diego, San Diego, CA, USA
| | - Edward Cornwell
- Department of Surgery, Howard University, Washington, DC, USA
| | - Thomas Obisesan
- Department of Medicine, Howard University, Washington, DC, USA
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Rao V, Rosenberg P, Bertrand M, Salehinia S, Spiro J, Vaishnavi S, Rastogi P, Noll K, Schretlen DJ, Brandt J, Cornwell E, Makley M, Miles QS. Aggression after traumatic brain injury: prevalence and correlates. J Neuropsychiatry Clin Neurosci 2009; 21:420-9. [PMID: 19996251 PMCID: PMC2918269 DOI: 10.1176/jnp.2009.21.4.420] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Aggression after traumatic brain injury (TBI) is common but not well defined. Sixty-seven participants with first-time TBI were evaluated for aggression within 3 months of injury. The prevalence of aggression was found to be 28.4%, predominantly verbal aggression. Post-TBI aggression was associated with new-onset major depression (p=0.02), poorer social functioning (p=0.04), and increased dependency in activities of daily living (p=0.03), but not with a history of substance abuse or adult/childhood behavioral problems. Implications of the study include early screening for aggression, evaluation for depression, and consideration of psychosocial support in aggressive patients.
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Affiliation(s)
- Vani Rao
- Division of Neuropsychiatry & Geriatric Psychiatry, Dept. of Psychiatry, Johns Hopkins University, 5300 Alpha Commons Dr., 4th Floor, #444, Baltimore, MD 21224, USA.
| | - Paul Rosenberg
- Division of Geriatric Psychiatry & Neuropsychiatry, Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD
| | - Melaine Bertrand
- Division of Geriatric Psychiatry & Neuropsychiatry, Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD
| | - Saeed Salehinia
- Division of Geriatric Psychiatry & Neuropsychiatry, Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jennifer Spiro
- Division of Geriatric Psychiatry & Neuropsychiatry, Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD
| | - Sandeep Vaishnavi
- Division of Neuropsychiatry, Alexian Neurosciences Institute Alexian Brothers Behavioral Health Hospital, Chicago, IL
| | - Pramit Rastogi
- Division of Geriatric Psychiatry & Neuropsychiatry, Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD
| | - Kathy Noll
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - David J Schretlen
- Division of Medical Psychology, Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jason Brandt
- Division of Medical Psychology, Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD
| | - Edward Cornwell
- Department of Surgery Howard University College of Medicine, Washington D.C
| | | | - Quincy Samus Miles
- Division of Geriatric Psychiatry & Neuropsychiatry, Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD
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Rao V, Spiro J, Vaishnavi S, Rastogi P, Mielke M, Noll K, Cornwell E, Schretlen D, Makley M. Prevalence and types of sleep disturbances acutely after traumatic brain injury. Brain Inj 2008; 22:381-6. [PMID: 18415718 DOI: 10.1080/02699050801935260] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PRIMARY OBJECTIVE To assess the prevalence of and risk factors for sleep disturbances in the acute post-traumatic brain injury (TBI) period. RESEARCH DESIGN Longitudinal, observational study. METHODS AND PROCEDURES Fifty-four first time closed-head injury patients were recruited and evaluated within 3 months after injury. Pre-injury and post-injury sleep disturbances were compared on the Medical Outcome Scale for Sleep. The subjects were also assessed on anxiety, depression, medical comorbidity and severity of TBI. MAIN OUTCOMES AND RESULTS Subjects were worse on most sleep measures after TBI compared to before TBI. Anxiety disorder secondary to TBI was the most consistent significant risk factor to be associated with worsening sleep status. CONCLUSIONS Anxiety is associated with sleep disturbances after TBI. Further studies need to be done to evaluate if this is a causal relationship.
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Affiliation(s)
- Vani Rao
- Division of Geriatric Psychiatry & Neuropsychiatry, Department of Psychiatry, Baltimore, MD, USA.
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Haider AH, Chang D, Efron D, Haut E, Handly N, Cornwell E. Minority and under-insured patients experience worse survival after moderate to severe trauma: An analysis of the National Trauma Databank. J Am Coll Surg 2007. [DOI: 10.1016/j.jamcollsurg.2007.06.169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Haider AH, Efron D, Haut E, DiRusso S, Sullivan T, Cornwell E. African American children experience worse clinical and functional outcomes after traumatic brain injury: An analysis of the national pediatric trauma registry. J Am Coll Surg 2006. [DOI: 10.1016/j.jamcollsurg.2006.05.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Cornwell E, Cordano G. DESIGN OF A QSRR: E INDEX WITH HIGH MOLECULAR INFORMATION CONTENT TO DIFFERENCIATE CIS AND TRANS ALQUENES. J Chil Chem Soc 2004. [DOI: 10.4067/s0717-97072004000100016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cornwell E, Larrazábal G, Decinti A. ELECTROTOPOLOGICAL STATE STUDIES OF COPPER(II) COMPLEXES WITH alpha-AMINOACIDATES. J Chil Chem Soc 2003. [DOI: 10.4067/s0717-97072003000200005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cornwell E, Cordano G. TWO NEW TOPOLOGICAL INDICES TO DIFFERENTIATEHIGH AND LOW INHIBITORY ACTIVITY OF DIPHENYL SULFONE DERIVATIVES. J Chil Chem Soc 2003. [DOI: 10.4067/s0717-97072003000200004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lipsett PA, Swoboda SM, Campbell KA, Cornwell E, Dorman T, Pronovost PJ. Sickness Impact Profile Score versus a Modified Short-Form survey for functional outcome assessment: acceptability, reliability, and validity in critically ill patients with prolonged intensive care unit stays. J Trauma 2000; 49:737-43. [PMID: 11038094 DOI: 10.1097/00005373-200010000-00024] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Quality of life after surgical critical illness is an important measure of outcome. The Sickness Impact Profile Score (SIP) has been validated in critically ill patients, but the Modified Short-Form (MSF) has not been directly compared with it. METHODS The SIP and MSF-36 were coadministered to 127 patients (surrogates) with a prolonged surgical critical illness at baseline at 1, 3, 6, and 12 months. Reliability, validity, and acceptability were determined for overall and subscores at each time point. RESULTS The overall SIP and eight subscores, including physical health and psychosocial health, were all significantly improved at 1 year compared with baseline (p < 0.05). However, the MSF-36 was improved only in health perception (p < 0.05), but pain scores were higher (p < 0.05) than at baseline. Internal consistency of the MSF-36 was poor at 1 and 3 months. Correlation between the tools was excellent at baseline and 1 year but variable in overall and subscores at other time points. CONCLUSION The SIP is more comprehensive, reliable, and acceptable in determining specific quality-of-life abnormalities, but the MSF-36 is easier to administer and correlates well at baseline and 1 year in patients with a prolonged critical illness.
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Affiliation(s)
- P A Lipsett
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Asensio JA, Murray J, Demetriades D, Berne J, Cornwell E, Velmahos G, Gomez H, Berne TV. Penetrating cardiac injuries: a prospective study of variables predicting outcomes. J Am Coll Surg 1998; 186:24-34. [PMID: 9449597 DOI: 10.1016/s1072-7515(97)00144-0] [Citation(s) in RCA: 116] [Impact Index Per Article: 4.5] [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: 02/05/2023]
Abstract
BACKGROUND Penetrating cardiac injuries are one of the leading causes of death from urban violence. STUDY DESIGN This is a prospective, 1-year study in a Level I Trauma Center with the objective of analyzing: (1) the parameters measuring the physiologic condition of patients sustaining penetrating cardiac injuries in the field during transport and on arrival, (2) the cardiovascular-respiratory score (CVRS) component of the trauma score, (3) the mechanism and anatomic site of injury, (4) the presence or absence of tamponade, and (5) the cardiac rhythm as a predictor of outcomes. We attempted to correlate cardiac injury grade (AAST-OIS) with mortality. Our main intervention was thoracotomy for resuscitation and definitive repair of cardiac injury. Main outcomes measures were all parameters measuring the physiologic condition of patients, CVRS, mechanism and anatomic site of injury, operative findings and maneuvers, mortality, and grade of injury. RESULTS The study consisted of 60 patients sustaining penetrating cardiac injuries, 35 gunshot wound (58%) and 25 stab wounds (42%). The injury severity score (ISS) was > 30 in 22 patients; overall survival was 22 of 60 (36.6%); gunshot wound (GSW) survival, 5 of 35 (14%); and stab wound (SW) survival, 17 of 25 (68%). An emergency department thoracotomy was performed in 37 of 60 (61.7%) with 6 of 37 survivors (16%). CVRS: 96% mortality (25 of 26) when CVRS = 0; 67% mortality (6 of 9) when CVRS = 1-3; and 25% mortality (7 of 25) when CVRS > 4 (p < 0.001). Mechanism of injury, and presence of sinus rhythm when pericardium opened predict outcomes (p < 0.001). Anatomic site of injury and tamponade do not predict outcomes (not significant). AAST-OIS injury grade and mortality: grade IV, 31 of 60 (52%); grade V, 20 of 60 (75%), and grade VI, 6 of 60 (100%). CONCLUSIONS Parameters measuring physiologic condition, CVRS, and mechanism of injury plus initial rhythm are significant predictors of outcomes in penetrating cardiac injuries. The need for aortic crossclamping and the inability to restore an organized rhythm or blood pressure after thoracotomy were also predictors of outcomes. The presence of pericardial tamponade was not.
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Affiliation(s)
- J A Asensio
- Department of Surgery, University of Southern California and the Los Angeles County/University of Southern California Medical Center, 90033-4525, USA
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Demetriades D, Velmahos G, Cornwell E, Berne TV, Cober S, Bhasin PS, Belzberg H, Asensio J. Selective nonoperative management of gunshot wounds of the anterior abdomen. Arch Surg 1997; 132:178-83. [PMID: 9041923 DOI: 10.1001/archsurg.1997.01430260076017] [Citation(s) in RCA: 139] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the role of selective nonoperative management of gunshot wounds to the abdomen. DESIGN A prospective, protocol-guided study including all gunshot wounds of the anterior abdomen. PATIENTS AND METHODS The patients were assessed and managed according to a written protocol. Patients with hemodynamic instability or peritonitis or associated spinal cord or head injury or requiring a general anesthetic for an extra-abdominal injury were managed by laparotomy. The test of the patients were selected for initial nonoperative management with serial physical examinations. RESULTS During a 16-month period, 309 patients with gunshot wounds of the anterior abdomen were treated. Eighteen patients in extremis (5.8%) underwent an emergency department-performed thoracotomy. Another 185 patients (59.9%) met the criteria for operation and underwent a laparotomy. The incidence of nontherapeutic operations was 2.2%, and that of negative operations was 8.6%. One hundred six patients (34.3%) were selected for observation. Fourteen of the initially observed patients underwent a late operation, but it was therapeutic in only 5. Overall, 92 patients (29.8%) were successfully managed nonoperatively. The overall sensitivity of the initial physical examination was 97.1%. The estimated bullet trajectory was not reliable in identifying the need for operation because of 224 patients with likely peritoneal penetration only 169 (75.4%) had significant injuries requiring surgical repair. CONCLUSION In the appropriate environment, many civilian abdominal gunshot wounds can be managed non-operatively.
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Affiliation(s)
- D Demetriades
- Department of Surgery, School of Medicine, University of Southern California, Los Angeles, USA
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Demetriades D, Theodorou D, Cornwell E, Berne TV, Asensio J, Belzberg H, Velmahos G, Weaver F, Yellin A. Evaluation of penetrating injuries of the neck: prospective study of 223 patients. World J Surg 1997; 21:41-7; discussion 47-8. [PMID: 8943176 DOI: 10.1007/s002689900191] [Citation(s) in RCA: 204] [Impact Index Per Article: 7.6] [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: 02/03/2023]
Abstract
The objective of this study was to assess the role of clinical examination, angiography, color flow Doppler imaging, and other diagnostic tests in identifying injuries to the vascular or aerodigestive structures in patients with penetrating injuries to the neck. A prospective study was made of patients with penetrating neck injuries. All patients had a careful physical examination according to a written protocol. Stable patients underwent routine four-vessel angiography and color flow Doppler imaging. Esophagography and endoscopy were performed for proximity injuries. The sensitivity, specificity, and predictive values of physical examination, color flow Doppler studies, and other diagnostic tests were assessed during the evaluation of vascular and aerodigestive tract structures in the neck. Altogether 223 patients were entered in the study. After physical examination 176 patients underwent angiography and 99 of them underwent color flow Doppler imaging. Angiographic abnormalities were seen in 34 patients for an incidence of 19.3%, but only 14 (8.0%) required treatment. Color flow Doppler imaging was performed on 99 patients with a sensitivity of 91.7%, specificity 100%, positive predictive value (PPV) 100%, and negative predictive value (NPV) 99%. These values were all 100% when only injuries requiring treatment were considered. None of the 160 patients without clinical signs of vascular injury had serious vascular trauma requiring treatment (NPV 100%), although angiography in 127 showed 11 vascular lesions not requiring treatment. "Hard" signs on clinical examination (large expanding hematomas, severe active bleeding, shock not responding to fluids, diminished radial pulse, bruit) reliably predicted major vascular trauma requiring treatment. Among 34 of the 223 total patients (15.2%) admitted with "soft" signs, 8 had angiographically detected injuries, but only one required treatment. An esophagogram was performed on 98 patients because of proximity injuries (49 patients) or suspicious clinical signs (49 patients), and two of them showed esophageal perforations. None of the 167 patients without clinical signs of esophageal trauma had an esophageal injury requiring treatment. It was concluded that physical examination is reliable for identifying those patients with penetrating injuries of the neck who require vascular or esophageal diagnostic studies. Color flow Doppler imaging is a dependable alternative to angiography. An algorithm for the initial assessment of neck injuries is suggested.
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Affiliation(s)
- D Demetriades
- Division of Trauma and Critical Care, School of Medicine, University of Southern California, 1510 San Pablo Street, Los Angeles, California 90033, USA
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Demetriades D, Theodorou D, Cornwell E, Asensio J, Belzberg H, Velmahos G, Murray J, Berne TV. Transcervical gunshot injuries: mandatory operation is not necessary. J Trauma 1996; 40:758-60. [PMID: 8614075 DOI: 10.1097/00005373-199605000-00012] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND It has been suggested that all transcervical gunshot wounds should be explored surgically because of the high incidence of injuries to vital structures. The present prospective study investigated the clinical presentation, the role of various diagnostic investigations, and the need for surgery in patients with transcervical gunshot injuries. METHODS Ninety-seven patients sustained gunshot injuries to the neck and 33 of them (34%) were transcervical. All victims were assessed clinically according to a written protocol and subsequently were evaluated angiographically, and, in the appropriate case, by means of endoscopy and esophagography. RESULTS Overall, 24 (73%) of the 33 patients with transcervical gunshot wounds had injuries to cervical structures. Vascular injuries were found in 48%, spinal cord injuries in 24%, and aerodigestive tract injuries in 6% of patients with transcervical injuries. In the 64 patients without midline crossing, the incidence of cervical structure injuries was 31%. Despite the high incidence of injuries to cervical structures in transcervical wounds, only 21% of the patients had a therapeutic operation. The overall mortality was 3%. There were no in-hospital deaths or local complications in the nonoperatively managed group. CONCLUSIONS The results of the present study do not support the current recommendations of mandatory operation for all transcervical gunshot wounds. A careful clinical examination combined with the appropriate diagnostic investigations should determine the treatment modality. About 80% of these patients can safely be managed nonoperatively.
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Affiliation(s)
- D Demetriades
- Division of Trauma, Los Angeles County/University of Southern California Medical Center, 90033, USA
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Demetriades D, Chan L, Cornwell E, Belzberg H, Berne TV, Asensio J, Chan D, Eckstein M, Alo K. Paramedic vs private transportation of trauma patients. Effect on outcome. Arch Surg 1996; 131:133-8. [PMID: 8611068 DOI: 10.1001/archsurg.1996.01430140023007] [Citation(s) in RCA: 163] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Prehospital emergency medical services (EMS) play a major role in any trauma system. However, there is very little information regarding the role of prehospital emergency care in trauma. To investigate this issue, we compared the outcome of severely injured patients transported by paramedics (EMS group) with the outcome of those transported by friends, relatives, bystanders, or police (non-EMS group). DESIGN We compared 4856 EMS patients with 926 non-EMS patients. General linear model analysis was performed to test the hypothesis that hospital mortality is the same in EMS and non-EMS cases, controlling for the following confounding factors, which are not affected by mode of transportation: age, gender, mechanism of injury, cause of injury, Injury Severity Score (ISS), and severe head injury. Crude, specific, and adjusted mortality rates and relative risks were also derived for the EMS and non-EMS groups. SETTING Large, urban, academic level I trauma center. PATIENTS All patients meeting the criteria for major trauma. RESULTS The two groups were similar with regard to mechanism of injury and the need for surgery or intensive care unit admission. The crude mortality rate was 9.3% in the EMS group and 4.0% in the non-EMS group (relative risk, 2.32; P < .001). After adjustment for ISS, the relative risk was 1.60 (P = .002). Subgroup analysis showed that among patients with ISS greater than 15, those in the EMS group had a mortality rate twice that of those in the non-EMS group (28.8% vs 14.1%). After controlling for confounding factors, the adjusted mortality among patients with ISS greater than 15 was 28.2% for the EMS group and 17.9% for the non-EMS group (P < .001). CONCLUSIONS Patients with severe trauma transported by private means in this setting have better survival than those transported via the EMS system. Large prospective studies are needed to identify the factors responsible for this difference.
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Affiliation(s)
- D Demetriades
- Department of Surgery, Los Angeles Medical Center, Los Angeles, USA
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Demetriades D, Theodorou D, Cornwell E, Weaver F, Yellin A, Velmahos G, Berne TV. Penetrating injuries of the neck in patients in stable condition. Physical examination, angiography, or color flow Doppler imaging. Arch Surg 1995; 130:971-5. [PMID: 7661682 DOI: 10.1001/archsurg.1995.01430090057019] [Citation(s) in RCA: 84] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The initial assessment of penetrating injuries of the neck is controversial, with angiography remaining the gold standard for identifying vascular injuries. Recent reports suggest that physical examination might be an accurate way to evaluate these injuries. Color flow Doppler imaging has been used with promising results to assess extremity injuries, but the role of color flow Doppler imaging in neck injuries has not been studied. OBJECTIVE To evaluate and compare the roles of physical examination, color flow Doppler imaging, and angiography in the identification and management of penetrating neck injuries. STUDY DESIGN A prospective study of patients in stable condition with penetrating injuries of the neck. All study patients were examined according to a written clinical protocol and subsequently underwent angiography and color flow Doppler imaging. The sensitivity and specificity of physical examination and color flow Doppler imaging were compared with those of angiography. RESULTS Eighty-two patients fulfilled the criteria for inclusion in the study. Angiography demonstrated vascular lesions in 11 patients (13.4%), but only two (2.4%) of them required treatment. Serious injuries were detected or suspected during physical examination, but six lesions not requiring treatment were missed. When injuries not requiring treatment were excluded, the sensitivity was 100% and the specificity was 91%. With color flow Doppler imaging, 10 of the 11 injuries were identified, for a sensitivity of 91% and a specificity of 98.6%. The sensitivity and specificity were 100% for clinically important lesions. CONCLUSION The combination of a careful physical examination and color flow Doppler imaging provides a reliable way to assess penetrating neck trauma and may be a safe alternative to routine contrast angiography.
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Affiliation(s)
- D Demetriades
- Department of Surgery, University of Southern California School of Medicine, Los Angeles, USA
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Jackson AL, Cornwell E, Daniels F. Hemopneumothorax in an intravenous drug abuser. J Natl Med Assoc 1995; 87:309-11. [PMID: 7752286 PMCID: PMC2607807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This article reports a case of an intravenous drug abuser who presented with a hemopneumothorax, which is a rare complication of jugular vein self-injection. The patient achieved an inadvertent subclavian arterotomy, causing tingling and numbness in the hand and arm, an unusual "high," and blood filling the pleura, collapsing the lung. With an increase in pulmonary complications among intravenous drug abusers from infections in the immunocompromised state, pulmonary complaints related to trauma sustained from their activity must not be overlooked.
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Affiliation(s)
- A L Jackson
- Department of Surgery, Howard University Hospital, Washington, DC, USA
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Demetriades D, Berne TV, Belzberg H, Asensio J, Cornwell E, Dougherty W, Alo K, DeMeester TR. The impact of a dedicated trauma program on outcome in severely injured patients. Arch Surg 1995; 130:216-20. [PMID: 7848094 DOI: 10.1001/archsurg.1995.01430020106020] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND In recent years, many trauma centers have been closing or scaling down their operations because of financial losses and lack of commitment by the relevant authorities. OBJECTIVE To investigate the effect of commitment to trauma and the establishment of a dedicated trauma program on injury outcome. DESIGN In 1992, a well-funded dedicated trauma program was implemented at the Los Angeles County--University of Southern California Medical Center, Los Angeles. We analyzed the outcome in severely injured patients (Injury Severity Score [ISS] > 15) before and after implementation of the program (1991 and 1993). SETTING Large, urban, level 1 trauma center. PATIENTS Patients with trauma and an ISS higher than 15. RESULTS There were 737 patients with an ISS higher than 15 in 1991 and 812 patients with an ISS higher than 15 in 1993. The overall mortality rate was 30% in 1991 and 24.5% in 1993 (P = .018), which is a reduction by 18.3%. In patients with blunt trauma and an ISS higher than 15, mortality was reduced by 33% (mortality rate of 31.1% in 1991 vs 20.8% in 1993) (P < .002). Mortality in patients with penetrating trauma and an ISS higher than 30 was reduced by 42.7% (mortality rate of 59.3% in 1991 vs 34% in 1993) (P = .019). There was also a trend toward lower permanent disabilities among survivors with an ISS higher than 15 (14.7% in 1991 vs 11.3% in 1993). CONCLUSION Commitment of financial and human resources for the establishment of a dedicated trauma program is a sound investment in terms of improved survival and fewer permanent disabilities in critically injured patients.
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Affiliation(s)
- D Demetriades
- Department of Surgery, Los Angeles County--University of Southern California Medical Center
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Abstract
Blood samples taken from the ear vein of 1037 sows two to three weeks after service were assayed the same day using Ovucheck 'Sowside' kits. Colour development was compared with oestrous and pregnancy controls. Reliable data on reproductive performance were obtained from 908 sows sampled 17 to 20 days after service. The accuracy of identification of 796 pregnant and 12 non-pregnant sows was 94.6 per cent and 35.7 per cent, respectively. Excluding animals which returned outside the normal range of 18 to 24 days, 52.1 per cent of 48 empty sows were identified by the test. Problems with blood sampling were reported on seven of 18 farms and this may explain the low accuracy of the kit on some farms.
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Cornwell E, Sherry KM. Iatrogenic hypotension. Anaesthesia 1986; 41:766-7. [PMID: 3489421 DOI: 10.1111/j.1365-2044.1986.tb12867.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Arancibia A, Borie G, Cornwell E, Medrano C. Pharmacokinetic study on the percutaneous absorption of p-aminobenzoic acid from three sunscreen preparations. Farmaco Prat 1981; 36:357-65. [PMID: 6974098] [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: 01/22/2023]
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Goldson AL, Ashaveri E, Espinoza MC, Roux V, Cornwell E, Rayford L, McLaren M, Nibhanupudy R, Mahan A, Taylor HF, Hemphil N, Pearson O. Single high dose intraoperative electrons for advanced stage pancreatic cancer: phase I pilot study. Int J Radiat Oncol Biol Phys 1981; 7:869-74. [PMID: 6171552 DOI: 10.1016/0360-3016(81)90002-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Abstract
Cell-free extract supernatant fluids of Pseudomonas aeruginosa were shown to lack malic dehydrogenase but possess a nicotinamide adenine dinucleotide (NAD)- or NAD phosphate (NADP)-dependent enzymatic activity, with properties suggesting a malic enzyme (malate + NAD (NADP) --> pyruvate + reduced NAD (NADH) (reduced NADP [NADPH] + CO(2)), in agreement with earlier findings. This was confirmed by determining the nature and stoichiometry of the reaction products. Differences in heat stability and partial purification of these activities demonstrated the existence of two malic enzymes, one specific for NAD and the other for NADP. Both enzymes require bivalent metal cations for activity, Mn(2+) being more effective than Mg(2+). The NADP-dependent enzyme is activated by K(+) and low concentrations of NH(4) (+). Both reactions are reversible, as shown by incubation with pyruvate, CO(2), NADH, or NADPH and Mn(2+). The molecular weights of the enzymes were estimated by gel filtration (270,000 for the NAD enzyme and 68,000 for the NADP enzyme) and by sucrose density gradient centrifugation (about 200,000 and 90,000, respectively).
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