Arshish Dua

A Novel Protocol Obviates Endoscope Sampling for Carbapenem-Resistant Enterobacteriaceae: Experience of a Center with a Prior Outbreak

BackgroundNumerous published outbreaks, including one from our institution, have described endoscope-associated transmission of multidrug-resistant organisms (MDROs). Individual centers have adopted their own protocols to address this issue, including endoscope culture and sequestration. Endoscope culturing has drawbacks and may allow residual bacteria, including MDROs, to go undetected after high-level disinfection.AimTo report the outcome of our novel protocol, which does not utilize endoscope culturing, to address our outbreak.MethodsAll patients undergoing procedures with elevator-containing endoscopes were asked to permit performance of a rectal swab. All endoscopes underwent high-level disinfection according to updated manufacturer’s guidance. Additionally, ethylene oxide (EtO) sterilization was done in the high-risk settings of (1) positive response to a pre-procedure risk stratification questionnaire, (2) positive or indeterminate CRE polymerase chain reaction (PCR) from rectal swab, (3) refusal to consent for PCR or questionnaire, (4) purulent cholangitis or infected pancreatic fluid collections. Two endoscopes per weekend were sterilized on a rotational basis.ResultsFrom September 1, 2015 to April 30, 2016, 556 endoscopy sessions were performed using elevator-containing endoscopes. Prompted EtO sterilization was done on 46 (8.3%) instances, 3 from positive/indeterminate PCR tests out of 530 samples (0.6%). No CRE transmission was observed during the study period. Damage or altered performance of endoscopes related to EtO was not observed.ConclusionIn this pilot study, prompted EtO sterilization in high-risk patients has thus far eliminated endoscope-associated MDRO transmission, although no CRE infections were noted throughout the institution during the study period. Further studies and a larger patient sample will be required to validate these findings.

Predicting outcomes using the National Trauma Data Bank: optimum management of traumatic blunt carotid and blunt thoracic injury.

INTRODUCTION We used the National Trauma Data Bank (NTDB) to examine the incidence of blunt thoracic and carotid trauma nationally and survival outcomes based on treatment approach. METHODS All vascular traumas were identified from the 2008 NTDB. International Classification of Diseases, 9th Revision (ICD-9) diagnosis coding was used to identify 178 blunt thoracic aortic injuries and 313 traumatic blunt carotid injuries. RESULTS In all, 2089 vascular traumas were identified. Patients with blunt thoracic trauma within the highest injury severity score (ISS) range (61-75) had a significant survival advantage when observation was compared with endovascular management (P < .05). In the carotid trauma cohort, those with the highest ISS range (61-75) had a significant survival advantage with open surgery compared with observation (P < .01). CONCLUSION Patients with traumatic blunt thoracic injury and an ISS > 61 appeared to benefit from endovascular approaches compared with open management. Patients with blunt carotid trauma and an ISS > 61 appeared to benefit from open surgical management.

The impact of co-morbid conditions and insurance status on trauma patient outcomes

Introduction This study aimed to determine the correlation between trauma patient co-morbidities, insurance status and final disposition. Methods We evaluated the impact of co-morbid conditions and insurance status on trauma patient outcomes utilising the National Trauma Data Bank. Paired T-tests were used to determine significance (P < 0.05). Results Patients who were discharged to home had the highest rate of private insurance (27%, P < 0.01), while those sent to a facility had the highest rate of public insurance such as Medicare or Medicaid (50%, P < 0.01) and the lowest rate of no insurance (5%, P < 0.01). Patients who died had the lowest rate of private insurance (17%, P < 0.01) and 15% had no insurance (P < 0.01). Complications and co-morbidities were significantly more common in patients who died compared to those sent to another facility or home. Conclusion Improving access to private insurance is associated with improved trauma-related morbidity and mortality.

Gender based differences in management and outcomes of cholecystitis.

BACKGROUND During the reproductive years, women have a 4-fold higher prevalence of gallstones than men, making gallbladder disease a critically important topic in womens health. Among age-matched women and men hospitalized for cholecystitis, gender based differences in demographics, management, and economic and clinical outcomes were identified. METHODS A cross-sectional study was conducted using the Nationwide Inpatient Sample. Outcomes were mortality, complications, length of stay, and cost. RESULTS Women accounted for 65% of admissions for cholecystitis, with women more likely to have shorter time to surgery (1.6 vs. 1.9 days) and laparoscopy (86 vs. 76%) (P < .05). After cholecystectomy, women had lower mortality (.6% vs. 1.1%), fewer complications (16.9 vs. 24.1), shorter lengths of stay (4.2 vs. 5.4 days), and lower costs (

Comparative effect of the sites of anterior cervical pressure on the geometry of the upper esophageal sphincter high-pressure zone

10,556 vs.

The Impact of Race on Advanced Chronic Venous Insufficiency

13,201) (P < .05). On multivariate analysis of age-matched patients, women had lower odds of mortality (odds ratio [OR], .75), complications (OR, .86), length of stay (OR, .95), and cost (OR, .93). Longer time to surgery and open cholecystectomy were independent predictors of worse outcomes. CONCLUSIONS In cholecystitis and cholecystectomy, women have better clinical and economic outcomes then age-matched men.

Surgical Site Infections after Lower Extremity Revascularization Procedures Involving Groin Incisions

External cricoid pressure is increasingly used to augment the upper esophageal sphincter (UES). Our objective was to determine the effect of 1) pressures applied to cricoid, supracricoid, and subcricoid regions on the length and amplitude of the UES high‐pressure zone (UESHPZ), and 2) the external cricoid pressure on lower esophageal sphincter (LES) tone.

National trends in utilization of inferior vena cava filters in the United States, 2000-2009.

Background: The study aimed to determine the association between race and patient variables, hospital covariates, and outcomes in patients presenting with advanced chronic venous insufficiency. Methods: The National Inpatient Sample was queried to identify all Caucasian and AfricanAmerican patients with a primary International Classification of Diseases, Ninth Revision (ICD-9) diagnosis code for venous stasis with ulceration (454.0), inflammation (454.1), or complications (454.2) from 1998 to 2011. CEAP scores were correlated with ICD-9 diagnosis. Demographics, CEAP classification, management, cost of care, length of stay (LOS), and inpatient mortality were compared between races. Statistical analysis was via descriptive statistics, Student’s t-test, and the Fisher’s exact test. Trend analysis was completed using the ManneKendall test. Results: A total of 20,648 patients were identified of which 85% were Caucasian and 15% were African-American. Debridement procedures had the highest costs at

National Trends in Utilization of IVC Filters over a Decade in the United States, 2000-2009

6,096 followed by skin grafting at

Older Age Reduces Upper Esophageal Sphincter and Esophageal Body Responses to Simulated Slow and Ultraslow Reflux Events and Post-Reflux Residue

4,089. There was an overall decrease in the number of ulcer debridements, vein stripping, and sclerotherapy procedures between 1998 and 2011 (P < 0.05) for both groups. However, African-American patients had significantly more ulcer debridements than their Caucasian counterparts. Conclusions: African-American patients with a primary diagnosis of venous stasis present with more advanced venous disease at a younger age compared with their Caucasian counterparts. This is associated with increased ulcer debridement, deep vein thrombosis rates and hospital charges in the African-American cohort. There are no differences in sclerotherapy or skin grafting procedures, LOS or inpatient mortality between races.