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 IVFEV1Hospital 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
High-performance acute care hospitals: Excelling across multiple emergency general surgery operations in the geriatric patient.
DeWane MP, Sukumar N, Stolar MJ, Gill TM, Maung AA, Schuster KM, Davis KA, Becher RD. High-performance acute care hospitals: Excelling across multiple emergency general surgery operations in the geriatric patient. Journal Of Trauma And Acute Care Surgery 2019, 87: 140-146. PMID: 31259872, PMCID: PMC7656193, DOI: 10.1097/ta.0000000000002273.Peer-Reviewed Original ResearchConceptsCommon EGS operationsEmergency general surgeryOlder patientsGeriatric patientsEmergency general surgery operationsEGS operationsCalifornia State Inpatient DatabaseGeneral surgery hospitalsPatients 65 yearsRisk-adjusted mortalitySurvival rates 1State Inpatient DatabasesGeneral surgery operationsClusters of hospitalsOperation typeHospital performanceEGS patientsSurgery HospitalInpatient DatabaseGroup of hospitalsGeriatric populationGeneral surgeryPatientsHospitalLevel IIITop-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-scoreHospital 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 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 characteristicsEvaluation 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 dataInsurance 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 imagingCholecystitisBilirubinCholelithiasisPatientsInterventionColicLevelsVenous Thromboembolism-Related Readmission in Emergency General Surgery Patients: A Role for Prophylaxis on Discharge?
DeWane MP, Davis KA, Schuster KM, Maung AA, Becher RD. Venous Thromboembolism-Related Readmission in Emergency General Surgery Patients: A Role for Prophylaxis on Discharge? Journal Of The American College Of Surgeons 2018, 226: 1072-1077.e3. PMID: 29574180, DOI: 10.1016/j.jamcollsurg.2018.03.021.Peer-Reviewed Original ResearchConceptsVenous thromboembolismEmergency general surgery operationsPost-discharge venous thromboembolismEmergency general surgery patientsMultivariable logistic regression modelingCommon EGS operationsGeneral surgery patientsRate of readmissionUrinary tract infectionSurgeons NSQIP databaseHigh-risk groupGeneral surgery operationsLogistic regression modelingEGS operationsProphylactic anticoagulationVTE formationVTE prophylaxisVTE ratesEGS patientsPostoperative sepsisNSQIP databaseProlonged lengthSurgery patientsTract infectionsPredictive factorsRelationship 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 reviewThe older they are the harder they fall: Injury patterns and outcomes by age after ground level falls
Bhattacharya B, Maung A, Schuster K, Davis KA. The older they are the harder they fall: Injury patterns and outcomes by age after ground level falls. Injury 2016, 47: 1955-1959. PMID: 27346422, DOI: 10.1016/j.injury.2016.06.019.Peer-Reviewed Original ResearchMeSH KeywordsAccidental FallsAgedAged, 80 and overAnticoagulantsAspirinComorbidityFemaleFollow-Up StudiesFractures, BoneGeriatric AssessmentHospitalizationHumansInjury Severity ScoreIntracranial HemorrhagesMaleMultiple TraumaPlatelet Aggregation InhibitorsRetrospective StudiesSurvival AnalysisTrauma CentersTreatment OutcomeUnited StatesConceptsGround-level fallInjury patternsAnticoagulation useAspirin useIntracranial bleedAnticoagulation agentsAbdominal solid organ injuriesCertain injury patternsAdult trauma patientsSolid organ injuryAntiplatelet useHome dischargePatient characteristicsLife expectancy increasesMean ISSOrgan injuryOverall mortalityRetrospective reviewTrauma patientsGeriatric patientsSignificant morbidityTrauma centerPatient populationPelvic fracturesCervical spineOutcomes 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 factorsDaysHypotensionSepsis
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