2019
Top-tier emergency general surgery hospitals: Good at one operation, good at them all.
DeWane MP, Sukumar N, Stolar MJ, Gill TM, Maung AA, Schuster KM, Davis KA, Becher RD. Top-tier emergency general surgery hospitals: Good at one operation, good at them all. Journal Of Trauma And Acute Care Surgery 2019, 87: 289-296. PMID: 31349347, PMCID: PMC6771423, DOI: 10.1097/ta.0000000000002367.Peer-Reviewed Original ResearchConceptsRisk-adjusted mortalityEGS hospitalsHospital risk-adjusted mortalityOperation typeEGS operationsCalifornia State Inpatient DatabaseGeneral surgery hospitalsHospital-level factorsAcute care hospitalsState Inpatient DatabasesAmerican Hospital Association databasePoor-performing hospitalsSystems of careLow-risk operationAssessment of mortalityAdult patientsCare hospitalSurgery HospitalInpatient DatabaseHospital characteristicsMultinomial logistic regressionMortality rateHospitalLevel IIIZ-scoreThe EGS Grading Scale For Skin And Soft Tissue Infections Is Predictive Of Poor Outcomes
Savage SA, Li SW, Utter GH, Cox JA, Wydo SM, Cahill K, Sarani B, Holzmacher J, Duane TM, Gandhi RR, Zielinski MD, Ray-Zack M, Tierney J, Chapin T, Murphy PB, Vogt KN, Schroeppel TJ, Callaghan E, Kobayashi L, Coimbra R, Schuster KM, Gillaspie D, Timsina L, Louis A, Crandall M. The EGS Grading Scale For Skin And Soft Tissue Infections Is Predictive Of Poor Outcomes. Journal Of Trauma And Acute Care Surgery 2019, Publish Ahead of Print: &na;. PMID: 30601458, PMCID: PMC6433490, DOI: 10.1097/ta.0000000000002175.Peer-Reviewed Original ResearchConceptsSoft tissue infectionsLength of stayDisease processGrading scaleInter-rater reliabilityGrade IVEmergency general surgery (EGS) diseasesDisparate disease processesRetrospective multicenter trialLaboratory Risk IndicatorNecrotizing Fasciitis (LRINEC) scoreSurgery of TraumaMulti-institutional trialHigh gradeDifferent disease processesClinical disease processesOverall complicationsHospital lengthICU lengthFasciitis (LRINEC) scoreMulticenter trialTissue infectionsValidation studyPoor outcomeDisease characteristicsEvaluating mortality outlier hospitals to improve the quality of care in emergency general surgery.
Becher RD, DeWane MP, Sukumar N, Stolar MJ, Gill TM, Maung AA, Schuster KM, Davis KA. Evaluating mortality outlier hospitals to improve the quality of care in emergency general surgery. Journal Of Trauma And Acute Care Surgery 2019, 87: 297-306. PMID: 30908450, PMCID: PMC6660354, DOI: 10.1097/ta.0000000000002271.Peer-Reviewed Original ResearchConceptsStandardized mortality ratioOutlier hospitalsHospital variationMortality ratioStandardized mortalityEmergency general surgery operationsCalifornia State Inpatient DatabaseEGS operationsCommon EGS operationsSignificant hospital variationEmergency general surgeryHospital-level characteristicsHospital-level variablesSignificant excess mortalityGeneral surgery operationsState Inpatient DatabasesQuality improvement initiativesQuality of careHospital quality indicatorsNational Quality ForumEGS outcomesInpatient DatabaseExcess mortalityOnly hospitalEpidemiologic studiesEvaluation of Swallow Function Post-Extubation: Is It Necessary to Wait 24 Hours?
Leder SB, Warner HL, Suiter DM, Young NO, Bhattacharya B, Siner JM, Davis KA, Maerz LL, Rosenbaum SH, Marshall PS, Pisani MA, Siegel MD, Brennan JJ, Schuster KM. Evaluation of Swallow Function Post-Extubation: Is It Necessary to Wait 24 Hours? Annals Of Otology Rhinology & Laryngology 2019, 128: 619-624. PMID: 30841709, DOI: 10.1177/0003489419836115.Peer-Reviewed Original ResearchConceptsIntensive care unitSwallow evaluationDifferent intensive care unitsRe-intubation rateYale Swallow ProtocolMajority of patientsPost-extubation dysphagiaIntubation durationNosocomial pneumoniaPost extubationLonger hospitalizationCare unitProspective InvestigationSwallow ProtocolSwallowingHoursDysphagiaHospitalizationIntubationPneumoniaPatientsIncidenceEvaluationSymptomatic human immunodeficiency virus–infected patients have poorer outcomes following emergency general surgery
Sandler BJ, Davis KA, Schuster KM. Symptomatic human immunodeficiency virus–infected patients have poorer outcomes following emergency general surgery. Journal Of Trauma And Acute Care Surgery 2019, 86: 479-488. PMID: 30531208, DOI: 10.1097/ta.0000000000002161.Peer-Reviewed Original ResearchConceptsHIV/AIDS patientsHIV-negative patientsAsymptomatic HIV-positive patientsHIV-positive patientsActive antiretroviral therapyAIDS patientsAntiretroviral therapyHospital stayPostoperative complicationsHuman immunodeficiency virus-infected patientsEmergency general surgery proceduresHigher median total chargesImmune deficiency syndrome (AIDS) patientsHuman immunodeficiency virus (HIV) infectionEmergency general surgeryLonger hospital stayRetrospective cohort studyAcute renal failureHIV-negative controlsImmunodeficiency virus infectionVirus-infected patientsRecords of patientsUrinary tract infectionMedian total chargesNationwide Inpatient Sample
2018
Opioid dependency is independently associated with inferior clinical outcomes after trauma
Hsiang WR, McGeoch C, Lee S, Cheung W, Becher R, Davis KA, Schuster K. Opioid dependency is independently associated with inferior clinical outcomes after trauma. Injury 2018, 50: 192-196. PMID: 30342762, DOI: 10.1016/j.injury.2018.10.015.Peer-Reviewed Original ResearchConceptsNon-home dischargeOpioid-dependent patientsLength of stayInjury Severity ScoreOpioid dependencyVentilator daysMajor complicationsClinical outcomesPrescription abuseIllicit abuseLonger LOSChronic pain subgroupsMore ventilator daysOpioid-naïve patientsUse of opioidsAcademic Level IHigher readmission ratesInferior clinical outcomesChronic pain patientsOpioid subgroupsNaïve patientsAdult patientsPain subgroupsPatient demographicsReadmission ratesInsurance Status Biases Trauma-system Utilization and Appropriate Interfacility Transfer
Zogg CK, Schuster KM, Maung AA, Davis KA. Insurance Status Biases Trauma-system Utilization and Appropriate Interfacility Transfer. Annals Of Surgery 2018, 268: 681-689. PMID: 30004929, DOI: 10.1097/sla.0000000000002954.Peer-Reviewed Original ResearchConceptsNTC patientsMajor injuriesOlder adult trauma patientsNationwide Emergency Department SampleOptimal trauma careAdult trauma patientsEmergency department admissionsEmergency Department SampleTrauma center careTransfer of patientsComplex traumatic injuriesMultilevel logistic regressionTrauma patientsDepartment admissionsHigh morbidityTC careDirect admissionInsurance statusInterfacility transferUninsured patientsTrauma careTraumatic injuryOutcome measuresTrauma systemCenter careCan acute care surgeons perform while fatigued? An EAST multicenter study
Schuster KM, Hazelton JP, Rattigan D, Nguyen L, Kim D, Spence LH, Turay D, Luo-Owen X, Perez JM, Dayal S, Blatt M, Hill C, Bhattacharya B. Can acute care surgeons perform while fatigued? An EAST multicenter study. Journal Of Trauma And Acute Care Surgery 2018, 85: 476-484. PMID: 29787535, DOI: 10.1097/ta.0000000000001975.Peer-Reviewed Original ResearchConceptsAcute care surgeonsMajor morbidityPatient outcomesAcute care surgery serviceEAST multicenter studyPatient-level factorsEmergency casesFour-level ordinal scaleHours of sleepHierarchical logistic regression modelsImpact of fatigueLogistic regression modelsPatient factorsFemale patientsSurgery serviceMulticenter studyLevel IVImmediate operationPrognostic studiesSleep timePatient volumeSimilar outcomesMorbiditySurgeonsMortalityTransfer status
DeWane MP, Davis KA, Schuster KM, Erwin SP, Maung AA, Becher RD. Transfer status. Journal Of Trauma And Acute Care Surgery 2018, 85: 348-353. PMID: 29664889, DOI: 10.1097/ta.0000000000001939.Peer-Reviewed Original ResearchConceptsOutside emergency departmentHospital inpatient unitsEmergency departmentNursing homesInpatient unitTransfer statusSurgeons National Surgical Quality Improvement Program databaseNational Surgical Quality Improvement Program databaseBackward multivariable logistic regressionOutside hospital emergency departmentEmergency general surgery patientsQuality Improvement Program databaseMultivariate Cox regression analysisEmergency colon surgeryGeneral surgery patientsThirty-day mortalityImprovement Program databaseChronic care facilitiesCox regression analysisRates of morbidityTransfer of patientsHospital emergency departmentHospital inpatient wardsEmergent colectomyPhysiologic decompensationTotal bilirubin trend as a predictor of common bile duct stones in acute cholecystitis and symptomatic cholelithiasis
Gillaspie DB, Davis KA, Schuster KM. Total bilirubin trend as a predictor of common bile duct stones in acute cholecystitis and symptomatic cholelithiasis. The American Journal Of Surgery 2018, 217: 98-102. PMID: 29929909, DOI: 10.1016/j.amjsurg.2018.06.011.Peer-Reviewed Original ResearchConceptsCommon bile duct stonesBile duct stonesAcute cholecystitisSymptomatic cholelithiasisDuct stonesBilirubin levelsProcedural interventionTotal bilirubinPresence of CBDSElevated total bilirubinTotal bilirubin levelsElevated serum bilirubinBiliary colicAdult patientsSerum bilirubinSerum makersImmediate imagingCholecystitisBilirubinCholelithiasisPatientsInterventionColicLevelsValidation of a new American Association for the Surgery of Trauma (AAST) anatomic severity grading system for acute cholecystitis
Vera K, Pei KY, Schuster KM, Davis KA. Validation of a new American Association for the Surgery of Trauma (AAST) anatomic severity grading system for acute cholecystitis. Journal Of Trauma And Acute Care Surgery 2018, 84: 650-654. PMID: 29271871, DOI: 10.1097/ta.0000000000001762.Peer-Reviewed Original ResearchConceptsLength of stayAcute cholecystitisICU useGrade 2Anatomic gradingAdverse eventsGrade 1Longer LOSAnatomic grading systemGrade 1 diseaseEmergency general surgeryGrade 3 patientsRetrospective cohort studyIncidence of complicationsMajority of patientsTertiary medical centerLow-grade diseaseSurgery of TraumaRisk-adjusted outcomesGood inter-rater reliabilityAAST gradeAmerican AssociationCholecystitis severityCohort studyConsecutive patientsRelationship between duration of preoperative symptoms and postoperative ileus for small bowel obstruction
Brandt WS, Wood J, Bhattacharya B, Pei K, Davis KA, Schuster K. Relationship between duration of preoperative symptoms and postoperative ileus for small bowel obstruction. Journal Of Surgical Research 2018, 225: 40-44. PMID: 29605033, DOI: 10.1016/j.jss.2017.12.031.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAged, 80 and overAscitesEquipment and Supplies UtilizationFemaleFood IntoleranceHumansIleusIntensive Care UnitsIntestinal ObstructionIntestine, SmallLength of StayMaleMiddle AgedParenteral NutritionPostoperative ComplicationsPreoperative PeriodRetrospective StudiesRisk FactorsTime FactorsTime-to-TreatmentYoung AdultConceptsTolerance of dietSmall bowel obstructionPreoperative symptomsLength of stayPostoperative ileusUnivariable analysisTotal durationIntensive care unit admissionTotal parenteral nutrition useParenteral nutrition useCare unit admissionIntensive care unitPreoperative ascitesBowel obstructionPrimary endpointSecondary endpointsSymptom durationUnit admissionMedian durationOperative interventionPostoperative outcomesCare unitMultivariable analysisRetrospective reviewNutrition use
2017
Uncertainty Among Acute Care Surgery Providers Does Not Change with Experience.
Bhattacharya B, Maung A, Schuster K, Davis KA. Uncertainty Among Acute Care Surgery Providers Does Not Change with Experience. Connecticut Medicine 2017, 81: 133-139. PMID: 29772154.Peer-Reviewed Original Research
2016
Trauma patients on new oral anticoagulation agents have lower mortality than those on warfarin
Maung AA, Bhattacharya B, Schuster KM, Davis KA. Trauma patients on new oral anticoagulation agents have lower mortality than those on warfarin. Journal Of Trauma And Acute Care Surgery 2016, 81: 652-657. PMID: 27438683, DOI: 10.1097/ta.0000000000001189.Peer-Reviewed Original ResearchConceptsNew oral agentsNew oral anticoagulation agentsOral anticoagulation agentsAnticoagulation agentsControl groupLevel 1 trauma center databaseLower mortalityTrauma-related mortalityInjury Severity ScoreMechanism of injuryIntensive care unitMultivariable logistic regressionHigher overall mortalityTrauma center databaseTraumatic brain injuryElectronic medical recordsWarfarin groupHospital courseOral agentsControl patientsIndependent predictorsOverall mortalityTrauma patientsCare unitRetrospective reviewOutcomes of acute care surgical cases performed at night
Dalton MK, McDonald E, Bhatia P, Davis KA, Schuster KM. Outcomes of acute care surgical cases performed at night. The American Journal Of Surgery 2016, 212: 831-836. PMID: 27263405, DOI: 10.1016/j.amjsurg.2016.02.024.Peer-Reviewed Original ResearchConceptsAcute care surgeonsRetrospective cohort studyConditional logistic regressionMore hypotensionCohort studyOperative interventionOperative delayDay casesSurgical careOutcome differencesSurgical casesEmergency operationLogistic regressionSurgeonsPotent predictorTeam fatigueComorbiditiesSimilar degreeConfoundersOutcomesMortalityUnmeasured factorsDaysHypotensionSepsisMulticenter validation of American Association for the Surgery of Trauma grading system for acute colonic diverticulitis and its use for emergency general surgery quality improvement program
Shafi S, Priest EL, Crandall ML, Klekar CS, Nazim A, Aboutanos M, Agarwal S, Bhattacharya B, Byrge N, Dhillon TS, Eboli DJ, Fielder D, Guillamondegui O, Gunter O, Inaba K, Mowery NT, Nirula R, Ross SE, Savage SA, Schuster KM, Schmoker RK, Siboni S, Siparsky N, Trust MD, Utter GH, Whelan J, Feliciano DV, Rozycki G. Multicenter validation of American Association for the Surgery of Trauma grading system for acute colonic diverticulitis and its use for emergency general surgery quality improvement program. Journal Of Trauma And Acute Care Surgery 2016, 80: 405-411. PMID: 26670116, DOI: 10.1097/ta.0000000000000943.Peer-Reviewed Original ResearchConceptsAcute colonic diverticulitisQuality Improvement ProgramAAST gradeLength of stayColonic diverticulitisGrade IClinical eventsNational Surgical Quality Improvement ProgramEmergency general surgery (EGS) diseasesPhysiologic statusSurgical Quality Improvement ProgramGrading systemTrauma grading systemRisk of deathTime of admissionSurgery of TraumaNew grading systemHigher disease gradeRegression analysisAmerican AssociationEGS careEGS registryAdverse eventsMedian ageClinical outcomes
2014
Gun buyback programs
Violano P, Driscoll C, Chaudhary NK, Schuster KM, Davis KA, Borer E, Winters JK, Hirsh MP. Gun buyback programs. Journal Of Trauma And Acute Care Surgery 2014, 77: s46-s50. PMID: 25153055, DOI: 10.1097/ta.0000000000000319.Peer-Reviewed Original ResearchConceptsGun buyback programsAverage median household incomeForging of relationshipsLocal policeBuyback programsGun violenceLaw enforcementUnintentional firearm-related injuriesCriminal actsGun ownersMore firearmsSchool communityGun locksInterpersonal violenceInjury Free CoalitionChildren's accessViolenceFirearms trainingFirearmsUnited StatesHousehold incomeWeaponsMedian household incomeSurvey resultsFormal trainingPredictive factors for failure of nonoperative management in perforated appendicitis
Maxfield MW, Schuster KM, Bokhari J, McGillicuddy EA, Davis KA. Predictive factors for failure of nonoperative management in perforated appendicitis. Journal Of Trauma And Acute Care Surgery 2014, 76: 976-981. PMID: 24662860, DOI: 10.1097/ta.0000000000000187.Peer-Reviewed Original ResearchConceptsNonoperative managementAbdominal tendernessFailure groupIntensive care unit careUniversity tertiary care hospitalTertiary care hospitalLength of stayUnit careCare hospitalDefinitive treatmentLaboratory markersPerforated appendicitisNonsurgical treatmentClinical findingsPredictive factorsRadiographic findingsTomographic scanTherapeutic studiesAppendicitisEarly operationLevel IIIPatientsAbscessPhlegmonTachycardiaContinuous glucose monitoring in the surgical intensive care unit
Schuster KM, Barre K, Inzucchi SE, Udelsman R, Davis KA. Continuous glucose monitoring in the surgical intensive care unit. Journal Of Trauma And Acute Care Surgery 2014, 76: 798-803. PMID: 24553551, DOI: 10.1097/ta.0000000000000127.Peer-Reviewed Original ResearchMeSH KeywordsBlood GlucoseCapillariesCritical CareFemaleHumansMaleMiddle AgedMonitoring, IntraoperativeConceptsSurgical intensive care unitIntensive glycemic controlContinuous glucose monitoring systemIntensive care unitCare unitInsulin infusionCapillary blood glucose readingsDoses of vasopressorsLarge volume resuscitationBlood glucose readingsContinuous glucose monitoringCBG readingsGlycemic controlBland-Altman plotsClinical outcomesGlucose monitoring systemFluid balanceSubcutaneous tissueLevel IIIGlucose readingsDiagnostic studiesGlucose monitoringAbsolute differenceError grid analysisMedian absolute difference
2013
Repositioning endotracheal tubes in the intensive care unit
Wang ML, Schuster KM, Bhattacharya B, Maung AA, Kaplan LJ, Davis KA. Repositioning endotracheal tubes in the intensive care unit. Journal Of Trauma And Acute Care Surgery 2013, 75: 146-149. PMID: 23940860, DOI: 10.1097/ta.0b013e31829849cd.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedChi-Square DistributionCohort StudiesCritical CareCritical IllnessFemaleFollow-Up StudiesHumansIntensive Care UnitsIntubation, IntratrachealLinear ModelsMaleMiddle AgedMonitoring, PhysiologicMultivariate AnalysisPatient PositioningProspective StudiesRadiography, ThoracicRetreatmentRisk AssessmentTracheaConceptsEndotracheal tubeSurgical intensive care unit patientsIntensive care unit patientsChest X-ray studyRoutine chest radiographCare unit patientsProspective observational studyIntensive care unitInterquartile rangeUnit patientsCare unitWithdrawal groupRespiratory therapistsChest radiographsObservational studyInclusion criteriaMedian withdrawalET withdrawalMean differencePatientsSuboptimal positioningInterventionIncisorsMedianWithdrawal