Heena P. Santry

Over 3 million patients are admitted to hospitals annually with high-acuity conditions mandating emergency abdominal or skin/soft-tissue operations. Patients with these high-acuity emergency general surgery (HA-EGS) diseases experience significant morbidity and mortality, yet the quality-of-life impact on survivors is not well studied. Acuity, transfer patterns, and adverse social determinants of health documented in epidemiologic studies are cited reasons for inability to measure patient-reported outcomes among HA-EGS survivors. We conducted a feasibility study to understand facilitators/barriers to conducting prospective studies of changes in quality of life after surviving HA-EGS. From September 2019 to April 2021, we collected baseline (preadmission) and 30/60 days’ postsurgery data on activities of daily living, depression, self-efficacy, resilience, pain, work limitations, social support, and substance use from patients who enrolled in the study during index hospitalization. One hundred patients consented to participate (71.9% enrollment rate). The retention rate was 65.9% for 30-day follow-up telephone calls and 53.8% for 60-day follow-up calls. Median time needed to complete each time point remained under 25 minutes. Patients with a longer length of stay and nicotine users had higher odds of not completing their 30­day interview, while those with systemic complications had higher odds of not completing their 60­day interview. These results lay the foundation for future patient-reported outcome studies.

Background: Chronic subdural hematoma (cSDH) is a common sequela of traumatic brain injury. Middle meningeal artery embolization (MMAE) has shown promising results as an emerging minimally invasive alternative treatment. The purpose of this study is to examine the safety and efficacy of MMAE performed in patients with cSDH, acute-on-chronic, and subacute SDH with a traumatic etiology. Methods: This retrospective study included cases performed at a Level II Trauma Center between January 2019 and December 2020 for MMAE of cSDHs. Data collected included patient demographic characteristics and comorbidities, SDH characteristics, complications, and efficacy outcomes. The lesion measurements were collected before the procedure, 4–6 weeks and 3–6 months post-procedure. Results: In our patient population, 78% (39) either had lesions improve or completely resolved. The sample included 50 patients with a mean age of 74 years old. Statistically significant reductions in lesion size were found from pre- to post-procedure in the left lesions, right lesions, and midline shifts. The left lesions decreased from 13.88 ± 5.70 mm to 3.19 ± 4.89 mm at 3–6 months with P < 0.001. The right lesions decreased from 13.74 ± 5.28 mm to 4.93 ± 7.46 mm at 3–6 months with P = 0.02. Midline shifts decreased from 3.78 ± 3.98 mm to 0.48 ± 1.31 mm at 3–6 months with P = 0.02. No complications were experienced for bleeding, hematoma, worsening SDH, pseudoaneurysm, or stroke. Conclusion: Our pilot study from a single center utilizing MMAE demonstrates that MMAE is successful without increasing treatment-related complications not only for cSDH but also in acute-on-cSDH and SDH with a subacute component.

Background Assess the relationship between availability of round-the-clock (RTC) in-house intensivists and patient outcomes in people who underwent surgery for a life-threatening emergency general surgery (LT-EGS) disease such as necrotizing soft-tissue infection, ischemic enteritis, perforated viscus, and toxic colitis. Methods Data on hospital-level critical care structures and processes from a 2015 survey of 2,811 United States (US) hospitals were linked to patient-level data from 17 State Inpatient Databases (SID). Patients who were admitted with a primary diagnosis code for an LT-EGS disease of interest and underwent surgery on date of admission were included in analyses. Results We identified 3,620 unique LT-EGS admissions at 368 hospitals. 83.5% (n = 3,021) of patients at 66% (n = 243) hospitals were treated at hospitals with RTC intensivist-led care. These facilities were more likely to have in-house respiratory therapists and protocols to ensure availability of blood products or adherence to Surviving Sepsis Guidelines. When accounting for other key factors including overnight surgeon availability, perioperative staffing, and annual EGS case volume, not having a protocol to ensure adherence to Surviving Sepsis Guidelines (aOR 2.10, 95% CI 1.12-3.94) was associated with increased odds of mortality. Conclusions Our results suggest that focused treatment of sepsis along with surgical source control, rather than round-the-clock intensivist presence, are key features of optimizing EGS patient outcomes. Level of Evidence III, Therapeutic

Introduction: Despite 3 million adults in the United States being admitted annually for emergency general surgery (EGS) conditions, which disproportionately affect vulnerable populations, we lack an understanding of the barriers to round-the-clock EGS care. Our objective was to measure gaps in round-the-clock EGS care. Methods: From August 2015 to December 2015, we surveyed all US-based adult acute care general hospitals that have an emergency room and ≥1 operating room and provided EGS care, utilizing paper and electronic methods. Surgeons or chief medical officers were queried regarding EGS practices. Results: Of 2811 hospitals, 1634 (58.1%) responded; 279 (17.1%) were unable to always provide round-the-clock EGS care. Rural location, smaller bed size, and nonteaching status were associated with lack of round-the-clock care. Inconsistent surgeon coverage was the primary reason for lacking round-the-clock EGS care (n = 162; 58.1%). However, lack of a tiered system for booking emergency cases, no anesthesia availability overnight, and no stipend for EGS call were also associated with the inability to provide round-the-clock EGS care. Discussion: We found significant gaps in access to EGS care, often attributable to workforce deficiencies.