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Jackson ML, Thomas SC, Joyner MR, Hu M, Larry Lee YL, Capasso T, Polite NM, Kinnard CM, Mbaka MI, Williams A, Simmons JD, Butts CC. Time to Mobility Is Associated With Pulmonary Complications in Patients With Spine Fractures. Am Surg 2024:31348241241702. [PMID: 38566605 DOI: 10.1177/00031348241241702] [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: 04/04/2024]
Abstract
INTRODUCTION Treatment of spine fractures may require periods of prolonged immobilization which prevents effective pulmonary toileting. We hypothesized that patients with longer time to mobilization, as measured by time to first physical therapy (PT) session, would have higher pulmonary complications. METHODS We performed a retrospective review of all trauma patients with cervical and thoracolumbar spinal fractures admitted to a level 1 trauma center over a 12-month period. Demographic data collection included age, gender, BMI, pulmonary comorbidities, concomitant rib fractures, admission GCS, Injury Severity Score (ISS), GCS at 24 h, treatment with cervical or thoracolumbar immobilization, and time to first PT evaluation. The primary outcome was the presence of any one of the following complications: unplanned intubation, pneumonia, or mortality at 30 days. Multivariable logistic regression analysis was used to assess significant predictors of pulmonary complication. RESULTS In total, 491 patients were identified. In terms of overall pulmonary complications, 10% developed pneumonia, 13% had unplanned intubation, and 6% died within 30 days. In total, 19% developed one or more complication. Overall, 25% of patients were seen by PT <48 h, 33% between 48 and 96 h, 19% at 96 h to 1 week, and 7% > 1 week. Multivariable logistic regression analysis showed that time to PT session (OR 1.010, 95% CI 1.005-1.016) and ISS (OR 1.063, 95% CI 1.026-1.102) were independently associated with pulmonary complication. CONCLUSION Time to mobility is independently associated with pulmonary complications in patients with spine fractures.
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Affiliation(s)
- Michael L Jackson
- General Surgery Residency Program, University of South Alabama, Mobile, AL, USA
| | - Samuel C Thomas
- General Surgery Residency Program, Brookwood Baptist Health, Birmingham, AL, USA
| | - Matthew R Joyner
- General Surgery Residency Program, University of Tennessee Knoxville, Knoxville, TN, USA
| | - Mengjie Hu
- Anesthesiology Residency Program, Wake Forest University, Winston-Salem, NC, USA
| | | | - Thomas Capasso
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Nathan M Polite
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | | | - Maryann I Mbaka
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Ashley Williams
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Jon D Simmons
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Charles C Butts
- Department of Surgery, University of South Alabama, Mobile, AL, USA
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Hart K, Thames MA, Massey AC, Capasso T, Lee YL, Mbaka M, Kinnard CM, Bright AC, Williams AY, Polite NM, Simmons JD, Butts CC. Diabetes in Trauma Patients: A Potential Gateway to a Medical Home. Am Surg 2024:31348241241615. [PMID: 38516800 DOI: 10.1177/00031348241241615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
BACKGROUND Diabetes is a major determinant of health outcomes. Trauma patients are disproportionately from lower socioeconomic status, where lack of access to health care prevents timely treatment. Trauma centers could play a role in identifying patients in need of improved glucose management, but the current burden of disease is not known. We assessed the incidence of patients in need of intervention that presented to a level 1 trauma center over a 6-month period. METHODS A retrospective chart review over 6 months of all trauma patients admitted to a level 1 trauma center was performed. Patients' past medical history (PMH), medication reconciliation, and hemoglobin A1c (HbA1c) were recorded on initial assessment; patients <18 years old, lacking an HbA1c, or missing PMH were excluded. Patients with PMH of diabetes or antihyperglycemic use were classified by HbA1c: well-controlled ≤8.0% or poorly controlled >8.0%. Patients with no history of diabetes or antihyperglycemic use were classified based on their HbA1c: non-diabetic <5.7%, pre-diabetic 5.7-6.4%, and undiagnosed diabetic ≥6.5%. RESULTS Overall, 1377 patients were identified. After exclusion criteria, 903 patients were classified as follows: 593 (66%) non-diabetics, 160 (18%) pre-diabetics, and 150 (17%) diabetics. Fifteen diabetics were undiagnosed; 39 of the diagnosed diabetics were poorly controlled. Including pre-diabetics, a total of 214 (24%) trauma patients were in need of improved glycemic control. DISCUSSION One in four trauma patients would benefit from improved outpatient glycemic management, representing a missed opportunity for preventative health care. Trauma centers should develop strategies to meet this need as part of their post-discharge care.
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Affiliation(s)
- Kaylee Hart
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Margaret A Thames
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Ashley Caroline Massey
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Thomas Capasso
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Yannlei L Lee
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Maryann Mbaka
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Christopher M Kinnard
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Andrew C Bright
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Ashley Y Williams
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Nathan M Polite
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Jon D Simmons
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - C Caleb Butts
- Division of Trauma, Acute Care Surgery, & Burns, Department of Surgery, University Hospital, University of South Alabama Frederick P. Whiddon College of Medicine, Mobile, AL, USA
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Punja V, Capasso T, Stokes L, Ray K, Narveson JR, Walters RW, Fernandez C, Patel ND, Ewing K, Kuncir E. The Impact of Relocating a Trauma Center: Retrospective Observations on Payer Demographics and Cost-Analysis. Am Surg 2023; 89:5682-5689. [PMID: 37139931 DOI: 10.1177/00031348231175482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Standardization of trauma centers improves quality of care, yet that comes with financial challenges. The decision to designate a trauma center typically focuses on access, quality of care, and the needs of the local community, but less often considers the financial viability of the trauma center. A level-1 trauma center was relocated in 2017 and this presented an opportunity to compare financial data at two separate locations in the same city. METHODS A retrospective review was performed on the local trauma registry and billing database in all patients aged ≥19 years on the trauma service before and after the move. RESULTS 3041 patients were included (pre-move: 1151; post-move: 1890). After the move, patients were older (9.5 years), and more were females (14.9%) and white (16.5%). Increases in blunt injuries (7.6%), falls (14.8%), and motor vehicle accidents (1.7%) were observed after the move. After the move, patients were less likely to be discharged home (6.5%) and more likely to go to a skilled nursing facility (3%) or inpatient rehabilitation (5.5%). Post-move more patients had Medicare (12.6%) or commercial (8.5%) insurance and charges per patient decreased by $2,833, while charges collected per patient increased by $2425. Patients were seen from a broader distribution of zip codes post-move. DISCUSSION Relocating a trauma center did improve financial viability for this institution. Future studies should consider the impact on the surrounding community and other trauma centers. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Viren Punja
- Department of Trauma Surgery and Critical Care, Creighton University Medical Center, Omaha, NE, USA
- Department of Surgery, Creighton University School of Medicine, Omaha, NE, USA
| | - Thomas Capasso
- Department of Trauma Surgery and Critical Care, Creighton University Medical Center, Omaha, NE, USA
- Department of Surgery, Creighton University School of Medicine, Omaha, NE, USA
| | - Laura Stokes
- Creighton University School of Medicine, Omaha, NE, USA
| | - Kelley Ray
- Creighton University School of Medicine, Omaha, NE, USA
| | - Joel R Narveson
- Department of Trauma Surgery and Critical Care, Creighton University Medical Center, Omaha, NE, USA
| | - Ryan W Walters
- Division of Clinical Research and Evaluative Sciences, Creighton University School of Medicine, Omaha, NE, USA
| | - Carlos Fernandez
- Department of Trauma Surgery and Critical Care, Creighton University Medical Center, Omaha, NE, USA
- Department of Surgery, Creighton University School of Medicine, Omaha, NE, USA
| | - Neil D Patel
- Department of Trauma Surgery and Critical Care, Creighton University Medical Center, Omaha, NE, USA
- Department of Surgery, Creighton University School of Medicine, Omaha, NE, USA
| | - Kaily Ewing
- Department of Trauma Surgery and Critical Care, Creighton University Medical Center, Omaha, NE, USA
- Department of Surgery, Creighton University School of Medicine, Omaha, NE, USA
| | - Eric Kuncir
- Department of Trauma Surgery and Critical Care, Creighton University Medical Center, Omaha, NE, USA
- Department of Surgery, Creighton University School of Medicine, Omaha, NE, USA
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Sheppard K, Roberts ME, Bernard J, Wood B, Lee YL, Williams AY, Capasso T, Butts CC, Polite N, Simmons JD, Bright A, Kinnard C, Mbaka M. A Multidisciplinary Approach for the Management of Portal Vein Thrombosis. Am Surg 2023; 89:3817-3819. [PMID: 37132031 DOI: 10.1177/00031348231173964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Portal venous thrombosis (PVT) is an uncommon disease associated with highly morbid conditions such as intestinal ischemia and portal hypertension. Patients at higher risk of developing PVT include those with cirrhosis, malignancy, or prothrombotic states. The mainstay of treatment is early initiation of anticoagulation. The first case is a 49-year-old female diagnosed with a cecal mass and PVT. She was started on anticoagulation and underwent a right hemicolectomy with several small bowel resections. She developed portal hypertension that required TIPS and mechanical thrombectomy. The second patient is a 65-year-old female found to have PVT. She was anticoagulated with heparin and given systemic TPA. She developed intestinal ischemia and portal hypertension requiring small bowel resection, TIPS, and mechanical thrombectomy. These cases give insight into the impact of a multidisciplinary team approach to PVT. The role and timing of endovascular treatment is not well established and needs to be further investigated.
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Affiliation(s)
- Kyle Sheppard
- Division of Trauma, Acute Care Surgery, Department of Surgery, University Hospital, University of South Alabama, Mobile, AL, USA
| | - Morgan E Roberts
- Division of Trauma, Acute Care Surgery, Department of Surgery, University Hospital, University of South Alabama, Mobile, AL, USA
| | - Jonathan Bernard
- Division of Trauma, Acute Care Surgery, Department of Surgery, University Hospital, University of South Alabama, Mobile, AL, USA
| | - Brian Wood
- Division of Trauma, Acute Care Surgery, Department of Surgery, University Hospital, University of South Alabama, Mobile, AL, USA
| | - Yannlei L Lee
- Division of Trauma, Acute Care Surgery, Department of Surgery, University Hospital, University of South Alabama, Mobile, AL, USA
| | - Ashley Y Williams
- Division of Trauma, Acute Care Surgery, Department of Surgery, University Hospital, University of South Alabama, Mobile, AL, USA
| | - Thomas Capasso
- Division of Trauma, Acute Care Surgery, Department of Surgery, University Hospital, University of South Alabama, Mobile, AL, USA
| | - Caleb C Butts
- Division of Trauma, Acute Care Surgery, Department of Surgery, University Hospital, University of South Alabama, Mobile, AL, USA
| | - Nathan Polite
- Division of Trauma, Acute Care Surgery, Department of Surgery, University Hospital, University of South Alabama, Mobile, AL, USA
| | - John D Simmons
- Division of Trauma, Acute Care Surgery, Department of Surgery, University Hospital, University of South Alabama, Mobile, AL, USA
| | - Andrew Bright
- Division of Trauma, Acute Care Surgery, Department of Surgery, University Hospital, University of South Alabama, Mobile, AL, USA
| | - Christopher Kinnard
- Division of Trauma, Acute Care Surgery, Department of Surgery, University Hospital, University of South Alabama, Mobile, AL, USA
| | - Maryann Mbaka
- Division of Trauma, Acute Care Surgery, Department of Surgery, University Hospital, University of South Alabama, Mobile, AL, USA
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Vines K, Ward M, Butts C, Capasso T, Bright A, Lee YL, Polite N, Kinnard C, Simmons J, Maltese C, Williams A, Mbaka M. Aortic Injury From High-Speed Deceleration Against a Lap Belt in a 10-year-Old. Am Surg 2023:31348231161670. [PMID: 36893761 DOI: 10.1177/00031348231161670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Traumatic aortic injuries in children and adolescents are rare, and even more rare are blunt traumatic injury to the abdominal aorta in this population. Therefore, there are few reports discussing the presentation and repair of such injuries, especially within the pediatric population. We report the successful repair of traumatic abdominal aortic transection in a 10-year-old female after a high speed MVC. She arrived in extremis with a seatbelt sign and was taken emergently for damage control laparotomy with subsequent postoperative CT findings of aortic transection/dissection at L3 with active extravasation. She immediately underwent open thrombectomy of the bilateral iliac arteries, and repair of her aortic injury with a 12 × 7 mm Hemashield interposition graft extending just distal to the IMA and 1 cm proximal to the aortic bifurcation. There are little data regarding long-term outcomes of pediatric patients undergoing different aortic repair techniques, and further research is needed.
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Affiliation(s)
- Katie Vines
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 21691University of South Alabama, Mobile, AL, USA
| | - Mark Ward
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 21691University of South Alabama, Mobile, AL, USA
| | - Charles Butts
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 21691University of South Alabama, Mobile, AL, USA
| | - Thomas Capasso
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 21691University of South Alabama, Mobile, AL, USA
| | - Andrew Bright
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 21691University of South Alabama, Mobile, AL, USA
| | - Yann-Leei Lee
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 21691University of South Alabama, Mobile, AL, USA
| | - Nathan Polite
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 21691University of South Alabama, Mobile, AL, USA
| | - Christopher Kinnard
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 21691University of South Alabama, Mobile, AL, USA
| | - Jon Simmons
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 21691University of South Alabama, Mobile, AL, USA
| | - Carl Maltese
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 21691University of South Alabama, Mobile, AL, USA
| | - Ashley Williams
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 21691University of South Alabama, Mobile, AL, USA
| | - Maryann Mbaka
- Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, University Hospital, 21691University of South Alabama, Mobile, AL, USA
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Barnes BM, Bouillon V, Haiflich A, Butts CC, Capasso T, Bright A, Polite N, Williams AY, Kinnard C, Simmons JD, Lee YL, Mbaka M. Blunt Cerebrovascular Injury (BCVI) Management: Is There a Right Answer? Am Surg 2023:31348231161684. [PMID: 36869309 DOI: 10.1177/00031348231161684] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Blunt cerebrovascular injury (BCVI) results from blunt trauma causing injury to the carotid and/or vertebral arteries. Its most severe manifestation is stroke. The purpose of this study was to evaluate the incidence, management, and outcomes of BCVI at a level one trauma/stroke center. Data on patients diagnosed with BCVI from 2016 to 2021 were extracted from the USA Health trauma registry with associated intervention performed and patient outcomes. Of the 97 patients identified, 16.5% presented with stroke-like symptoms (SS). Medical management was employed for 75%. Intravascular stent alone was utilized for 18.8%. The mean age of symptomatic BCVI patients was 37.6 with a mean injury severity score (ISS) of 38.2. Within the asymptomatic population, 58% received medical management and 3.7% underwent combination therapy. The mean age of asymptomatic BCVI patients was 46.9 with a mean ISS of 20.3. There were 6 mortalities, only one BCVI related.
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Affiliation(s)
- Brandon Michael Barnes
- Department of Surgery, Division of Trauma, 5557University of South Alabama, Mobile, AL, USA
| | - Victoria Bouillon
- Department of Surgery, Division of Trauma, 5557University of South Alabama, Mobile, AL, USA
| | - Andrew Haiflich
- Department of Surgery, Division of Trauma, 5557University of South Alabama, Mobile, AL, USA
| | - C Caleb Butts
- Department of Surgery, Division of Trauma, 5557University of South Alabama, Mobile, AL, USA
| | - Thomas Capasso
- Department of Surgery, Division of Trauma, 5557University of South Alabama, Mobile, AL, USA
| | - Andrew Bright
- Department of Surgery, Division of Trauma, 5557University of South Alabama, Mobile, AL, USA
| | - Nathan Polite
- Department of Surgery, Division of Trauma, 5557University of South Alabama, Mobile, AL, USA
| | - Ashley Y Williams
- Department of Surgery, Division of Trauma, 5557University of South Alabama, Mobile, AL, USA
| | - Christopher Kinnard
- Department of Surgery, Division of Trauma, 5557University of South Alabama, Mobile, AL, USA
| | - Jon D Simmons
- Department of Surgery, Division of Trauma, 5557University of South Alabama, Mobile, AL, USA
| | - Yannlei L Lee
- Department of Surgery, Division of Trauma, 5557University of South Alabama, Mobile, AL, USA
| | - Maryann Mbaka
- Department of Surgery, Division of Trauma, 5557University of South Alabama, Mobile, AL, USA
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Rosenthal AA, Solomon RJ, Capasso T, Eyerly-Webb SA. Sestamibi Scanning and Intraoperative Parathyroid Hormone Results for Parathyroid Resection in Primary Hyperparathyroidism. Am Surg 2018. [DOI: 10.1177/000313481808400822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Andrew A. Rosenthal
- Division of Acute Care Surgery and Trauma Memorial Regional Hospital Hollywood, Florida
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Rosenthal AA, Solomon RJ, Capasso T, Eyerly-Webb SA. Sestamibi Scanning and Intraoperative Parathyroid Hormone Results for Parathyroid Resection in Primary Hyperparathyroidism. Am Surg 2018; 84:e325-e327. [PMID: 30454465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Andrew A Rosenthal
- Division of Acute Care Surgery and Trauma, Memorial Regional Hospital, Hollywood, Florida, USA
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