2023
Routine post-operative labs and healthcare system burden in acute appendicitis
Sznol J, Becher R, Maung A, Bhattacharya B, Davis K, Schuster K. Routine post-operative labs and healthcare system burden in acute appendicitis. The American Journal Of Surgery 2023, 226: 571-577. PMID: 37291012, DOI: 10.1016/j.amjsurg.2023.06.005.Peer-Reviewed Original ResearchConceptsHealthcare system burdenSystem burdenHealth care costsAppendicitis managementIncreased LOSUncomplicated AAAcute appendicitisRetrospective cohortClinical courseClinical variablesPatient populationMinimal comorbiditiesMultivariable modelingHealthcare costsCare costsPatientsLaboratory utilizationNational Health Expenditure AccountsLab utilizationLaboratory testingBurdenLaboratory testsAppendicitisComorbiditiesCohort
2022
Effect of Antibiotic Duration in Emergency General Surgery Patients with Intra-Abdominal Infection Managed with Open vs Closed Abdomen.
Diaz JJ, Zielinski MD, Chipman AM, O'Meara L, Schroeppel T, Cullinane D, Shoultz T, Barnes SL, May AK, Maung AA. Effect of Antibiotic Duration in Emergency General Surgery Patients with Intra-Abdominal Infection Managed with Open vs Closed Abdomen. Journal Of The American College Of Surgeons 2022, 234: 419-427. PMID: 35290260, DOI: 10.1097/xcs.0000000000000126.Peer-Reviewed Original ResearchConceptsIntra-abdominal infectionsOpen abdomenSecondary infectionAntibiotic durationClosed abdomenOA patientsExact testHigher Sequential Organ Failure AssessmentSequential Organ Failure AssessmentEmergency general surgery patientsChi-square/Fisher's exact testDuration of antibioticsAPACHE II scoreGeneral surgery patientsOrgan Failure AssessmentHigh rateAnesthesiologists physical statusFisher's exact testTwenty-one centersII scoreSurgery patientsOverall mortalityPrimary outcomeMean durationAntibiotic treatmentThe extent to which geography explains one of trauma’s troubling trends: Insurance-based differences in appropriate interfacility transfer
Zogg CK, Schuster KM, Maung AA, Davis KA. The extent to which geography explains one of trauma’s troubling trends: Insurance-based differences in appropriate interfacility transfer. Journal Of Trauma And Acute Care Surgery 2022, 93: 686-694. PMID: 35293375, PMCID: PMC9470786, DOI: 10.1097/ta.0000000000003605.Peer-Reviewed Original ResearchConceptsNontrauma centersEmergency departmentMajor injuriesTrauma centerSignificant geographic variationInsurance-based differencesRisk-adjusted oddsLarge trauma centersNeighborhood socioeconomic disadvantageHierarchical logistic regressionInsured adultsTransfer patientsInsurance statusInterfacility transferStratified analysisED claimsUninsured adultsLevel IIISecondary objectiveTriage patternsDeprived populationsLogistic regressionInjurySocioeconomic disadvantageAdmission differencesAssessing the Race, Ethnicity, and Gender Inequities in Blood Alcohol Testing After Trauma
Jean RA, O'Neill KM, Johnson DC, Becher RD, Schuster KM, Davis KA, Maung AA. Assessing the Race, Ethnicity, and Gender Inequities in Blood Alcohol Testing After Trauma. Journal Of Surgical Research 2022, 273: 192-200. PMID: 35092878, DOI: 10.1016/j.jss.2021.12.032.Peer-Reviewed Original ResearchConceptsMultivariable logistic regressionWhite patientsOdds ratioInjury mechanismLogistic regressionParticipant User FileNon-Hispanic patientsSubstantial patient morbidityHealth care providersBlood alcohol testingPacific IslandersDemographic factorsHigh rateClinical factorsTrauma admissionsHispanic patientsScreening ratesPatient morbidityAlcohol screeningSerum alcoholInjury categoriesTrauma casesTraumatic injurySurgeons (ACS) verificationHigher odds
2021
Clinical significance of “positive” cervical spine MRI findings following a negative CT
Khurana B, Keraliya A, Velmahos G, Maung AA, Bono CM, Harris MB. Clinical significance of “positive” cervical spine MRI findings following a negative CT. Emergency Radiology 2021, 29: 307-316. PMID: 34850316, DOI: 10.1007/s10140-021-01992-5.Peer-Reviewed Original ResearchConceptsCareful retrospective reviewNeurological deficitsCervical spineTraumatic findingsClinical significanceUnevaluable patientsRetrospective reviewNegative CTCervical spine MRI findingsSub-cohort analysisAcute traumatic findingsPrevious multicenter studyNormal CTCStable injuriesSpine traumaMRI findingsMulticenter studyUnstable injuriesNegative CTCsEmergency radiologistsSignificant findingsPatientsSpine surgeonsSubtle findingsCervicalgiaIncreased mortality with resuscitative endovascular balloon occlusion of the aorta only mitigated by strong unmeasured confounding: An expanded analysis using the National Trauma Data Bank
Linderman GC, Lin W, Becher RD, Maung AA, Bhattacharya B, Davis KA, Schuster KM. Increased mortality with resuscitative endovascular balloon occlusion of the aorta only mitigated by strong unmeasured confounding: An expanded analysis using the National Trauma Data Bank. Journal Of Trauma And Acute Care Surgery 2021, 91: 790-797. PMID: 33951027, PMCID: PMC8547242, DOI: 10.1097/ta.0000000000003265.Peer-Reviewed Original ResearchConceptsAcute kidney injuryResuscitative endovascular balloon occlusionLower extremity amputationEndovascular balloon occlusionBalloon occlusionExtremity amputationTraumatic injuryTreatment weightingREBOA placementNational Trauma Data BankInverse probabilityPlacement of REBOATrauma Data BankSevere traumatic injuryMortality effectsUnmeasured confoundersNoncompressible torso hemorrhagePotent confounderTQIP dataTQIP databaseAortic injuryKidney injuryRetrospective studyInjury patternsBaseline variablesImproved outcomes using laparoscopy for emergency colectomy after mitigating bias by negative control exposure analysis
Linderman GC, Lin W, Sanghvi MR, Becher RD, Maung AA, Bhattacharya B, Davis KA, Schuster KM. Improved outcomes using laparoscopy for emergency colectomy after mitigating bias by negative control exposure analysis. Surgery 2021, 171: 305-311. PMID: 34332782, DOI: 10.1016/j.surg.2021.06.048.Peer-Reviewed Original ResearchConceptsOpen surgeryEmergency colectomyNational Surgical Quality Improvement Program dataQuality Improvement Program dataPostoperative septic shockLow-risk patientsSurgical site infectionPatients meeting criteriaColorectal emergenciesElective colectomyUnderwent laparoscopyHospital stayOverall morbidityNationwide registryAnastomotic leakColectomy casesConverted groupSeptic shockSite infectionPatient selectionBaseline variablesImproved outcomesLaparoscopic surgeryTreatment weightingColectomyAnticoagulation Is Associated with Increased Mortality in Splenic Injuries
Bhattacharya B, Becher RD, Schuster KM, Davis KA, Maung AA. Anticoagulation Is Associated with Increased Mortality in Splenic Injuries. Journal Of Surgical Research 2021, 266: 1-5. PMID: 33975026, DOI: 10.1016/j.jss.2021.04.002.Peer-Reviewed Original ResearchConceptsNon-ACS patientsSplenic injuryAC patientsMultivariable binary logistic regressionIndependent risk factorEffect of anticoagulationInjury Severity ScoreUnits of RBCsBinary logistic regressionHospital courseMedian LOSIncreased MortalitySeverity scoreRisk factorsWorse outcomesAnticoagulationSplenic surgeryAC groupPatientsHigh mortalityInjuryLogistic regressionMortalitySerious injuriesAngiographySex-based differences in helmet performance in bicycle trauma
Feler J, Maung AA, O'Connor R, Davis KA, Gerrard J. Sex-based differences in helmet performance in bicycle trauma. Journal Of Epidemiology & Community Health 2021, 75: 994-1000. PMID: 33827896, DOI: 10.1136/jech-2020-215544.Peer-Reviewed Original ResearchConceptsSex-based differencesBicycle traumaHead injuryHelmet useMultivariable logistic regression modelPatients 18 yearsRetrospective cohort studyNational Trauma DatabaseCervical spine fracturesSevere head injuryShort-term outcomesMotor vehicle collisionsSerious head injuryLogistic regression modelsAnticoagulant useCohort studyInjury overallIntracranial bleedingSpine fracturesTrauma databaseIntracranial hemorrhageCommon injuriesOdds reductionReduced oddsSkull fracture
2020
Choosing the Best Approach to Warfarin Reversal After Traumatic Intracranial Hemorrhage
Lumas SG, Hsiang W, Becher RD, Maung AA, Davis KA, Schuster KM. Choosing the Best Approach to Warfarin Reversal After Traumatic Intracranial Hemorrhage. Journal Of Surgical Research 2020, 260: 369-376. PMID: 33388533, DOI: 10.1016/j.jss.2020.12.004.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overAnticoagulantsBlood Coagulation FactorsCoagulantsConnecticutFemaleFollow-Up StudiesHospital CostsHumansIntracranial Hemorrhage, TraumaticLinear ModelsLogistic ModelsMaleMultivariate AnalysisPlasmaPractice Patterns, Physicians'Retrospective StudiesTomography, X-Ray ComputedTrauma CentersTreatment OutcomeWarfarinConceptsProthrombin complex concentrateFresh frozen plasmaTraumatic intracranial hemorrhageIntracranial hemorrhageWarfarin reversalReversal agentsUse of FFPAcademic level 1 trauma centerFollow-up computed tomography scanProgression of ICHFollow-up computed tomographyLevel 1 trauma centerComputed tomography scanTerms of mortalityElectronic medical recordsPreinjury warfarinElderly patientsHospital lengthInitial bleedICH progressionICH patientsMultivariable analysisRetrospective studyTrauma centerSurgical interventionThe effect of anticoagulation on outcomes after liver and spleen injuries: A research consortium of New England centers for trauma (ReCONECT) study
Bhattacharya B, Askari R, Davis KA, Dorfman J, Eid AI, Elsharkawy AE, Kasotakis G, Mackey S, Odom S, Okafor BU, Rosenblatt M, Ruditsky A, Velmahos G, Maung AA. The effect of anticoagulation on outcomes after liver and spleen injuries: A research consortium of New England centers for trauma (ReCONECT) study. Injury 2020, 51: 1994-1998. PMID: 32482426, DOI: 10.1016/j.injury.2020.05.002.Peer-Reviewed Original ResearchConceptsNon-ACS patientsEffect of anticoagulationNon-operative managementSpleen injurySplenic injuryLiver injuryInitial non-operative managementSignificant differencesUse of anticoagulationBlood product transfusionMulticenter retrospective studyAC drugsMore PRBCsInjury gradeProduct transfusionCommon indicationAC patientsAtrial fibrillationRetrospective studyAnticoagulationSolid organsPatientsInjuryStudy periodLiverSurvivors of gun violence and the experience of recovery.
O'Neill KM, Vega C, Saint-Hilaire S, Jahad L, Violano P, Rosenthal MS, Maung AA, Becher RD, Dodington J. Survivors of gun violence and the experience of recovery. Journal Of Trauma And Acute Care Surgery 2020, 89: 29-35. PMID: 32118821, DOI: 10.1097/ta.0000000000002635.Peer-Reviewed Original ResearchConceptsGun violenceQualitative research studyCommunity-based organizationsCommunity-based participatory research approachInterview transcript dataParticipatory research approachSense of safetyExperience of recoveryRepeat violenceConstant comparison methodMental health treatmentViolenceCommunity membersViolent recidivismDepth oneResearch approachBlack menSocial restrictionsHealth treatmentSuboptimal supportRecovery experiencesQualitative analysisThemesHigh-risk populationInterviewsHospital 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
Regionalization of emergency general surgery operations: A simulation study.
Becher RD, Sukumar N, DeWane MP, Gill TM, Maung AA, Schuster KM, Stolar MJ, Davis KA. Regionalization of emergency general surgery operations: A simulation study. Journal Of Trauma And Acute Care Surgery 2019, 88: 366-371. PMID: 31804419, PMCID: PMC7472889, DOI: 10.1097/ta.0000000000002543.Peer-Reviewed Original ResearchConceptsEmergency general surgeryHigh-volume hospitalsEGS careEmergency general surgery operationsCalifornia inpatient databaseCommon EGS operationsRisk-adjusted deathsSignificant survival benefitLow-volume hospitalsUmbilical hernia repairSmall bowel resectionHigh-mortality hospitalsGeneral surgery operationsRegional trauma systemEGS operationsBowel resectionAdult patientsPrimary outcomeSurvival benefitInpatient DatabaseHernia repairTrauma systemLevel IVGeneral surgeryCare managementHigh-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 III
2013
Waveform analysis during mechanical ventilation
Maung AA, Kaplan LJ. Waveform analysis during mechanical ventilation. Current Problems In Surgery 2013, 50: 438-446. PMID: 24156841, DOI: 10.1067/j.cpsurg.2013.08.007.Peer-Reviewed Original ResearchRole of fibrinogen in massive injury.
Maung AA, Kaplan LJ. Role of fibrinogen in massive injury. Minerva Anestesiologica 2013, 80: 89-95. PMID: 23857437.Peer-Reviewed Original ResearchConceptsRole of fibrinogenTrauma associated coagulopathyAcute traumatic coagulopathyEffect of acidosisLow fibrinogen concentrationAssociated coagulopathyControl hemorrhageTraumatic coagulopathyMassive hemorrhageFactor consumptionRotational thromboelastometryHyperfibrinolysisTherapeutic interventionsCoagulopathyInjuryFibrinogen concentrationMassive injuryHemorrhageComplex cascadeHypofibrinogenemiaPneumatosis Intestinalis Predictive Evaluation Study (PIPES)
DuBose JJ, Lissauer M, Maung AA, Piper GL, O’Callaghan T, Luo-Owen X, Inaba K, Okoye O, Shestopalov A, Fielder WD, Ferrada P, Wilson A, Channel J, Moore FO, Paul DB, Johnson S. Pneumatosis Intestinalis Predictive Evaluation Study (PIPES). Journal Of Trauma And Acute Care Surgery 2013, 75: 15-23. PMID: 23778433, DOI: 10.1097/ta.0b013e318298486e.Peer-Reviewed Original ResearchMeSH KeywordsAdultAge DistributionAgedAnalysis of VarianceCause of DeathCohort StudiesCombined Modality TherapyDigestive System Surgical ProceduresFemaleHospital MortalityHumansIncidenceLogistic ModelsMaleMiddle AgedPneumatosis Cystoides IntestinalisPredictive Value of TestsPrognosisRetrospective StudiesRisk AssessmentSeverity of Illness IndexSex DistributionSocieties, MedicalSurvival AnalysisTomography, X-Ray ComputedConceptsPathologic pneumatosis intestinalisPneumatosis intestinalisClinical prediction ruleIndependent predictorsPrediction ruleAcute renal failureRetrospective multicenter studySmall retrospective seriesStrong independent predictorRegression tree analysisAbsent bowelVasopressor needVasopressor useRenal failurePrimary outcomeClinical presentationRetrospective seriesBenign diseaseMechanical ventilationMulticenter studyTransmural ischemiaCase reportMedical historyClinical significanceProspective validation
2012
Evaluation and management of small-bowel obstruction
Maung AA, Johnson DC, Piper GL, Barbosa RR, Rowell SE, Bokhari F, Collins JN, Gordon JR, Ra JH, Kerwin AJ. Evaluation and management of small-bowel obstruction. Journal Of Trauma And Acute Care Surgery 2012, 73: s362-s369. PMID: 23114494, DOI: 10.1097/ta.0b013e31827019de.Peer-Reviewed Original ResearchConceptsSmall bowel obstructionManagement of SBODate evidence-based recommendationsComplete small bowel obstructionWater-soluble contrast studyRemainder of patientsEvidence of ischemiaEvaluation of patientsLevel I evidenceInitial nonoperative managementSurgery of TraumaEvidence-based recommendationsClinical deteriorationContinuous painGeneralized peritonitisLaparoscopic treatmentSurgical admissionsNonoperative managementI evidenceMetabolic acidosisTomographic scanSurgical techniqueContrast studiesCritical carePlain filmsMechanical Ventilation After Injury
Maung AA, Kaplan LJ. Mechanical Ventilation After Injury. Journal Of Intensive Care Medicine 2012, 29: 128-137. PMID: 22956744, DOI: 10.1177/0885066612457339.Peer-Reviewed Original ResearchConceptsMechanical ventilationPrimary respiratory failureTraumatic brain injuryMultiple organ systemsImpact of injuryConcomitant tissue injuryRespiratory failureCritical illnessVentilator strategiesBronchopleural fistulaVentilator managementBrain injuryPhysiologic changesTissue injuryBlast injuryInjuryThermal injuryOrgan systemsPatientsMajor causeVentilationSpecial considerationFistulaIllness