2023
Changes in Older Adult Trauma Quality When Evaluated Using Longer-Term Outcomes vs In-Hospital Mortality
Zogg C, Cooper Z, Peduzzi P, Falvey J, Castillo-Angeles M, Kodadek L, Staudenmayer K, Davis K, Tinetti M, Lichtman J. Changes in Older Adult Trauma Quality When Evaluated Using Longer-Term Outcomes vs In-Hospital Mortality. JAMA Surgery 2023, 158: e234856. PMID: 37792354, PMCID: PMC10551815, DOI: 10.1001/jamasurg.2023.4856.Peer-Reviewed Original ResearchConceptsHospital-level factorsTraumatic brain injurySevere traumatic brain injuryHospital mortalityTrauma QualityOlder adultsHip fractureComposite scoreHigher risk-adjusted oddsLevel 1 trauma centerIn-Hospital MortalityRisk-adjusted oddsLong-term outcomesMultivariable logistic regressionNontrauma centersTrauma patientsTerm outcomesTrauma centerPrimary diagnosisBrain injuryTrauma systemMAIN OUTCOMEMedicare feeService claimsForms of trauma
2020
Spirometry not pain level predicts outcomes in geriatric patients with isolated rib fractures.
Schuster KM, Sanghvi M, O'Connor R, Becher R, Maung AA, Davis KA. Spirometry not pain level predicts outcomes in geriatric patients with isolated rib fractures. Journal Of Trauma And Acute Care Surgery 2020, 89: 947-954. PMID: 32467465, DOI: 10.1097/ta.0000000000002795.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overEmergency Service, HospitalFemaleHand StrengthHospitals, RehabilitationHumansIntensive Care UnitsLength of StayMalePainPain ManagementPain MeasurementPatient DischargePatient TransferPredictive Value of TestsProspective StudiesRib FracturesSpirometryTrauma CentersTreatment OutcomeConceptsLength of stayIsolated rib fracturesNegative inspiratory forceUnplanned ICU admissionRib fracturesPain levelsDay 1ICU admissionInspiratory forceGrip strengthMedian LOSHospital day 1Expiratory volume 1Complete spirometryPain controlDischarge dispositionPulmonary functionEarly dischargeGeriatric patientsVital capacityMean ageSpirometry measuresPulmonary capacityLevel IVFEV1Mapping the increasing interest in acute care surgery-Who, why and which fellowship?
Gayed BN, Zarzaur BL, Livingston DH, Chiu WC, Davis KA, Tisherman SA, Alam HB, Spain DA. Mapping the increasing interest in acute care surgery-Who, why and which fellowship? Journal Of Trauma And Acute Care Surgery 2020, 88: 629-635. PMID: 32320176, DOI: 10.1097/ta.0000000000002585.Peer-Reviewed Original ResearchConceptsAcute care surgerySurgery of TraumaPractice patternsCare surgeryFellowship typeClinical interestSurgical critical careFellowship yearDifferent fellowshipPrimary clinical interestAmerican AssociationFisher's exactCritical careLevel IVPearson χFellowship program directorsTrauma surgeryResponse rateSurgeryOperative experienceFellowship pathwaysTrauma trainingMost fellowsRecent traineesFellowship choicesHospital Variation in Geriatric Surgical Safety for Emergency Operation
Becher RD, Sukumar N, DeWane MP, Stolar MJ, Gill TM, Schuster KM, Maung AA, Zogg CK, Davis KA. Hospital Variation in Geriatric Surgical Safety for Emergency Operation. Journal Of The American College Of Surgeons 2020, 230: 966-973.e10. PMID: 32032720, PMCID: PMC7409563, DOI: 10.1016/j.jamcollsurg.2019.10.018.Peer-Reviewed Original ResearchConceptsStandardized mortality ratioHospital-level characteristicsGeneral surgery operationsGeriatric patientsEmergency operationHospital variationEmergency general surgery operationsMean standardized mortality ratioCalifornia State Inpatient DatabaseHospital-based mortalitySignificant hospital variationPatients 65 yearsSubstantial excess mortalitySurgery operationsState Inpatient DatabasesMixed effects logistic regression modelsCommon general surgery operationsLow-mortality outliersLogistic regression modelsPostoperative mortalityHospital deathOlder patientsInpatient DatabaseMortality outcomesNonelective operations
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-scoreContemporary management of spontaneous retroperitoneal and rectus sheath hematomas
Warren MH, Bhattacharya B, Maung AA, Davis KA. Contemporary management of spontaneous retroperitoneal and rectus sheath hematomas. The American Journal Of Surgery 2019, 219: 707-710. PMID: 31109633, DOI: 10.1016/j.amjsurg.2019.05.002.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overAngiographyAnticoagulantsBlood Component TransfusionEmbolization, TherapeuticFemaleHematomaHumansInternational Normalized RatioLength of StayMaleMiddle AgedPlatelet Aggregation InhibitorsProthrombin TimeRectal DiseasesRetroperitoneal SpaceRetrospective StudiesShock, HemorrhagicTomography, X-Ray ComputedConceptsSheath hematomaSurgical interventionBlood product transfusionOptimal treatment strategySpontaneous retroperitonealIntravenous heparinProduct transfusionAdult patientsMedian ageAntiplatelet agentsHemorrhagic shockDisease progressionBlood productsTreatment strategiesCT scanHematomaOutcome dataPatientsOne-year periodContemporary managementSpecific agentsAngioembolizationRetroperitonealInterventionAgentsAssociation of Medicaid Expansion With Access to Rehabilitative Care in Adult Trauma Patients
Zogg CK, Scott JW, Metcalfe D, Gluck AR, Curfman GD, Davis KA, Dimick JB, Haider AH. Association of Medicaid Expansion With Access to Rehabilitative Care in Adult Trauma Patients. JAMA Surgery 2019, 154: 402-411. PMID: 30601888, PMCID: PMC6537775, DOI: 10.1001/jamasurg.2018.5177.Peer-Reviewed Original ResearchConceptsAdult trauma patientsTrauma patientsMedicaid expansionNonexpansion statesInsurance coverageAffordable Care ActExpansion statesPatient ProtectionInpatient rehabilitation facilityCare ActSkilled nursing facilitiesMedicaid expansion statesSex-based disparitiesHome health agenciesRace/ethnicityPostdischarge careTrauma populationFunctional outcomeRehabilitation gainsLeading causeRehabilitative careTrauma outcomesMAIN OUTCOMENursing facilitiesRehabilitation facilityHospital Operative Volume and Quality Indication for General Surgery Operations Performed Emergently in Geriatric Patients
Becher RD, DeWane MP, Sukumar N, Stolar MJ, Gill TM, Becher RM, Maung AA, Schuster KM, Davis KA. Hospital Operative Volume and Quality Indication for General Surgery Operations Performed Emergently in Geriatric Patients. Journal Of The American College Of Surgeons 2019, 228: 910-923. PMID: 31005629, PMCID: PMC6582986, DOI: 10.1016/j.jamcollsurg.2019.02.053.Peer-Reviewed Original ResearchConceptsHospital operative volumeGeneral surgery operationsGeriatric patientsOperative volumeEmergency operationHospital volumeProbability of survivalEmergency general surgery operationsCalifornia State Inpatient DatabaseRetrospective cohort studySurgery operationsState Inpatient DatabasesHigher operative volumesAverage mortality riskOlder patientsCohort studyInpatient DatabaseGeriatric populationSurgical careSurgical qualityAmerican CollegeMortality riskOptimizing outcomesStandardized increasePatientsThe Economic Footprint of Acute Care Surgery in the United States
Knowlton LM, Minei J, Tennakoon L, Davis KA, Doucet J, Bernard A, Haider A, Scherer L, Spain DA, Staudenmayer KL. The Economic Footprint of Acute Care Surgery in the United States. Journal Of Trauma And Acute Care Surgery 2019, Publish Ahead of Print: &na;. PMID: 30589750, PMCID: PMC6433481, DOI: 10.1097/ta.0000000000002181.Peer-Reviewed Original ResearchConceptsAcute care surgeryEmergency general surgeryACS patientsClinical Modification diagnosisInpatient populationInternational ClassificationAdult ACS patientsNon-surgical patientsHealth care utilizationHigher mean costSurgical critical careNonoperative conditionsACS diagnosisAdult patientsPatient characteristicsCare surgeryCare utilizationAdult admissionsEGS conditionsInpatient costsInpatient hospitalizationCritical careGeneral surgeryMean costPatientsEvaluating 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
Racial/Ethnic Disparities in Longer-term Outcomes Among Emergency General Surgery Patients
Zogg CK, Jiang W, Ottesen TD, Shafi S, Schuster K, Becher R, Davis KA, Haider AH. Racial/Ethnic Disparities in Longer-term Outcomes Among Emergency General Surgery Patients. Annals Of Surgery 2018, 268: 968-979. PMID: 28742704, PMCID: PMC5783796, DOI: 10.1097/sla.0000000000002449.Peer-Reviewed Original ResearchConceptsEmergency general surgery patientsNon-Hispanic whitesGeneral surgery patientsLong-term outcomesNon-Hispanic blacksNon-Hispanic AsiansMinority patientsMajor morbidityUnplanned readmissionSurgery patientsOlder adultsRisk-adjusted Cox proportional hazards modelsEthnic disparitiesCox proportional hazards modelDiagnostic categoriesRacial/Ethnic DisparitiesUS population agesProportional hazards modelNHB patientsNonagenarian patientsNHW patientsBACKGROUND DATAHospital's percentageMortality differencesMedicare dataImpact of Affordable Care Act Insurance Expansion on Pre-Hospital Access to Care: Changes in Adult Perforated Appendix Admission Rates after Medicaid Expansion and the Dependent Coverage Provision
Zogg CK, Scott JW, Bhulani N, Gluck AR, Curfman GD, Davis KA, Dimick JB, Haider AH. Impact of Affordable Care Act Insurance Expansion on Pre-Hospital Access to Care: Changes in Adult Perforated Appendix Admission Rates after Medicaid Expansion and the Dependent Coverage Provision. Journal Of The American College Of Surgeons 2018, 228: 29-43.e1. PMID: 30359835, DOI: 10.1016/j.jamcollsurg.2018.09.022.Peer-Reviewed Original ResearchConceptsMedicaid expansionAffordable Care ActAdmission ratesPerforation rateInsurance coverageAffordable Care Act's insurance expansionInsurance expansionYoung adultsAcute surgical careDependent coverage provisionBetter patient outcomesFederal poverty levelRace/ethnicityAcute appendicitisHospitalized adultsAcute careParents' insuranceInpatient claimsPatient outcomesACA's impactSurgical careRisk populationsNonexpansion statesPrivileged patientsAge 26Opioid 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 careTransfer 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 imagingCholecystitisBilirubinCholelithiasisPatientsInterventionColicLevelsThe effect of insurance type on access to inguinal hernia repair under the Affordable Care Act
Hsiang W, McGeoch C, Lee S, Cheung W, Becher R, Davis KA, Schuster KM. The effect of insurance type on access to inguinal hernia repair under the Affordable Care Act. Surgery 2018, 164: 201-205. PMID: 29747862, DOI: 10.1016/j.surg.2018.03.013.Peer-Reviewed Original ResearchValidation 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 patients