Chelsea Caplan

Introduction: Cottonmouths, also known as water moccasins, are responsible for <10% of the ∼5000 snakebites reported to America's Poison Centers annually. Envenomations are characterized primarily by local findings. Gastrointestinal signs and hematologic abnormalities have been reported. There are currently 2 antivenoms that are approved by the Food and Drug Administration for the treatment of cottonmouth envenomations. The purpose of this study was to describe the clinical features and antivenom use in the treatment of Northern Cottonmouth envenomations in Texas that were reported to the North American Snakebite Registry. Methods: We reviewed cottonmouth bites reported between January 1, 2013, and December 31, 2024. Data regarding the circumstances, patient demographics, clinical features, treatment, and outcomes were reviewed. Results: Sixty patients, with a mean patient age of 26 y, were included. Females accounted for 20 cases (33.3%). Lower extremity bites accounted for 35 cases (58.3%). Swelling was observed in 56 cases (93.3%). Emesis was reported in 10 cases (16.7%). Two patients (3.3%) experienced diarrhea. Hematologic laboratory abnormalities were present in 10 patients (16.7%). Antivenom was administered in 47 cases (78.3%), including 22 pediatric patients (84.6%). Three patients (6.4%) who received antivenom experienced minor acute hypersensitivity reactions. Conclusions: Cottonmouth envenomations are characterized primarily by local tissue injury. Gastrointestinal signs and hematologic toxicity are observed less commonly. Antivenom is often administered for cottonmouth bites and is associated with a low incidence of acute hypersensitivity reactions. There is a trend toward treating pediatric patients more aggressively.

Background/Objectives: Colorectal surgeons continue to care for an aging cancer population with increasing comorbidities and frailty. Frailty, characterized by a systemic physiologic decline associated with aging, is an increasingly popular focus in surgical outcomes research. This retrospective study investigates how frailty impacts outcomes in the octogenarian and nonagenarian populations undergoing surgical treatment for colon cancer. Methods: Data from the National Surgical Quality Improvement Program (NSQIP) colectomy-targeted variables dataset from 2015 to 2021 were utilized for this analysis, including patients 80 years of age and older. Frailty was assessed using the five-factor modified frailty index (mFI-5). The study examined post-operative outcomes across frailty groups in this population. Results: From 2015–2021, there were 10,671 patients aged 80 years and older who underwent colectomy for colon cancer, of whom 1259 (11.8%) were 90 years or older and 2844 (26.7%) were severely frail. Frailty significantly impacted post-operative colectomy outcomes in this population. On univariate analysis, frail patients had higher rates of pneumonia (p = 0.015), unplanned intubation (p = 0.012), stroke (p < 0.001), myocardial infarction (p = 0.011), readmission (p < 0.001), long length of stay (p < 0.001), and mortality (p < 0.001) compared to non-frail patients. On multivariate analysis, severe frailty (mFI-5 of 2 or more) was associated with an increased odds of unplanned intubation (aOR 2.41, 95% CI 1.27–4.59), long length of stay (aOR 1.73, 95% CI 1.44–2.09), readmission (aOR 1.84, 95% CI 1.42–2.39), and mortality (aOR 1.95, 95% CI 1.20–3.15) compared to non-frail patients. Conclusions: Frailty plays a critical role in influencing the outcomes of octogenarians and nonagenarians undergoing colectomy for colon cancer within the NSQIP dataset. Future work should investigate whether addressing frailty prior to surgery in this population can improve patients’ post-operative courses.

Background/Objectives: Colorectal surgeons continue to care for an aging cancer population with increasing co-morbidities and frailty. Frailty, characterized by a systemic physiologic decline associated with aging, is an increasingly popular focus in surgical outcomes research. This retrospective study aimed to investigate the impact of frailty on outcomes in the octogenarian and nonagenarian populations undergoing surgical treatment for colon cancer. Methods: Data from the National Surgical Quality Improvement Program (NSQIP) colectomy-targeted variables dataset from 2015 to 2021 were utilized for this analysis. Inclusion criteria included patients 80 years of age and older. Frailty was assessed using the 5-factor modified frailty index (mFI-5). The study examined post-operative outcomes across frailty groups in this population. Results: From 2015-2021, 10,815 patients >=80 years old with colon cancer underwent colectomy, 11.9% (n=1,285) were 90 years or older. Frailty significantly impacted post-operative colectomy outcomes in this population. On univariate analysis, frail patients had higher rates of pneumonia (p=0.002), unplanned intubation (p48 hours (p=0.027), stroke (p5 days (p<0.001), readmission (p<0.001), and mortality (p=0.007) compared to non-frail patients. Conclusions: Frailty plays a critical role in influencing the outcomes of octogenarians and nonagenarians undergoing colectomy for colon cancer within the NSQIP dataset. Future work should investigate whether addressing frailty prior to surgery in this population can improve patient’s post-operative course.