Peter C. Jenkins

Increasing Incidence of and Increased Mortality Associated With Clostridium difficile–Associated Megacolon

Methods | Using the Nationwide Inpatient Sample (20002010) and International Classification of Diseases, Ninth Revision (ICD-9) codes, we identified patients with both C difficile infection and megacolon. Patients without both diagnoses were excluded. The study cohort included patients who were managed with surgery and those who were managed without surgery. This study used deidentified data and is exempt from institutional review board approval. The outcome measures were length of stay, inflation-adjusted cost of hospitalization, transitional care needs, and in-hospital mortality.1 Analyses were performed with χ2 tests and analysis of variance. P > .05 was considered statistically significant.

Prevalence of cardiovascular and respiratory complications following trauma in patients with obesity

Background It is generally accepted that obesity puts patients at an increased risk for cardiovascular and respiratory complications after surgical procedures. However, in the setting of trauma, there have been mixed findings in regards to whether obesity increases the risk for additional complications. Objective The aim of this study was to identify whether obese patients suffer an increased risk of cardiac and respiratory complications following traumatic injury. Methods A retrospective analysis of 275,393 patients was conducted using the 2012 National Trauma Data Bank. Hierarchical regression modeling was performed to determine the probability of experiencing a cardiac or respiratory complication. Results Patients with obesity were at a significantly higher risk of cardiac and respiratory complications compared to patients without obesity [OR: 1.81; CI: 1.72–1.91]. Prevalence of cardiovascular and respiratory complications for patients with obesity was 12.6% compared to 5.2% for non‐obese patients. Conclusions Obesity is predictive of an increased risk for cardiovascular and respiratory complications following trauma.

Hospital variation in outcomes following appendectomy in a regional quality improvement program

BACKGROUND The aim of this study was to determine hospital variation in clinical outcomes after appendectomy for acute appendicitis. METHODS Using data from the Michigan Surgical Quality Collaborative, we selected patients with procedure codes for open or laparoscopic appendectomy with a diagnosis of acute appendicitis (2006 to 2011). We used multivariate regression models for risk adjustment of patient-level factors and reliability adjustment for sample size differences between hospitals. Adjusted rates of outcomes for each hospital were generated by multiplying ratios of observed to expected events by overall mean event rates. RESULTS During the study period, 12,410 patients underwent appendectomies in 49 participating Michigan Surgical Quality Collaborative hospitals. Neither the mortality rate nor the rate of superficial or deep surgical site infection demonstrated significant variation. However, significant variation was observed for all other clinical outcomes, including a 14-fold difference of the rate of postoperative sepsis and septic shock. CONCLUSIONS We found significant hospital variation in outcomes after appendectomy and identified missing variables that could help to explain the observed variation. These findings have been used to enhance ongoing quality improvement efforts across the state of Michigan.

Clinical indicators of hemorrhagic shock in pregnancy

Background Several hemodynamic parameters have been promoted to help establish a rapid diagnosis of hemorrhagic shock, but they have not been well validated in the pregnant population. In this study, we examined the association between three measures of shock and early blood transfusion requirements among pregnant trauma patients. Methods This study included 81 pregnant trauma patients admitted to a level 1 trauma center (2010–2015). In separate logistic regression models, we tested the relationship between exposure variables—initial systolic blood pressure (SBP), shock index (SI), and rate over pressure evaluation (ROPE)—and the outcome of transfusion of blood products within 24 hours of admission. To test the predictive ability of each measure, we used receiver operating characteristic (ROC) curves. Results A total of 10% of patients received blood products in the patient cohort. No patients had an initial SBP≤90, so the SBP measure was excluded from analysis. We found that patients with SI>1 were significantly more likely to receive blood transfusions compared with patients with SI<1 (OR 10.35; 95% CI 1.80 to 59.62), whereas ROPE>3 was not associated with blood transfusion compared with ROPE≤3 (OR 2.92; 95% CI 0.28 to 30.42). Furthermore, comparison of area under the ROC curve for SI (0.68) and ROPE (0.54) suggested that SI was more predictive than ROPE of blood transfusion. Conclusion We found that an elevated SI was more closely associated with early blood product transfusion than SBP and ROPE in injured pregnant patients. Level of evidence Prognostic, level III

Invited Commentary: Meeting Our Obligation to Equal Surgical Care for All

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