The Experts below are selected from a list of 8064 Experts worldwide ranked by ideXlab platform
Pradeep H Navsaria - One of the best experts on this subject based on the ideXlab platform.
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the effect of human immunodeficiency virus status on outcomes in penetrating abdominal trauma an interim analysis
2018Co-Authors: Deidre Mcpherson, Valentin Neuhaus, Rohin Dhar, Sorin Edu, Andrew J Nicol, Pradeep H NavsariaAbstract:Background The purpose of this study was to determine whether the outcomes of hemodynamically stable patients undergoing Exploratory Laparotomy for penetrating abdominal trauma differed as a result of their HIV status.
Matthew J Bradley - One of the best experts on this subject based on the ideXlab platform.
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risk factors for abdominal surgical site infection after Exploratory Laparotomy among combat casualties
2021Co-Authors: Joseph D Bozzay, Patrick F Walker, David W Schechtman, Faraz Shaikh, Laveta Stewart, Leigh M Carson, David R Tribble, Carlos J Rodriguez, Matthew J BradleyAbstract:BACKGROUND Surgical site infections (SSIs) are well-recognized complications after Exploratory Laparotomy for abdominal trauma; however, little is known about SSI development after exploration for battlefield abdominal trauma. We examined SSI risk factors after Exploratory Laparotomy among combat casualties. METHODS Military personnel with combat injuries sustained in Iraq and Afghanistan (June 2009 to May 2014) who underwent Laparotomy and were evacuated to participating US military hospitals were included. Log-binominal regression was used to identify SSI risk factors. RESULTS Of 4,304 combat casualties, 341 patients underwent a total of 1,053 laparotomies. Abdominal SSIs were diagnosed in 49 patients (14.4%): 8% with organ space SSI, 4% with deep incisional SSI, and 4% with superficial SSIs (4 patients had multiple SSIs). Patients with SSIs had more colorectal (p < 0.001), small bowel (p = 0.010), duodenum (p = 0.006), pancreas (p = 0.032), and abdominal vascular injuries (p = 0.040), as well as prolonged open abdomen (p = 0.004) and more infections diagnosed before the SSI (or final Exploratory Laparotomy) versus non-SSI patients (p < 0.001). Sustaining colorectal injuries (risk ratio [RR], 3.20; 95% confidence interval [CI], 1.58-6.45), duodenum injuries (RR, 6.71; 95% CI, 1.73-25.58), and being diagnosed with prior infections (RR, 10.34; 95% CI, 5.05-21.10) were independently associated with any SSI development. For either organ space or deep incisional SSIs, non-intra-abdominal infections, fecal diversion, and duodenum injuries were independently associated, while being injured via an improvised explosive device was associated with reduced likelihood compared with penetrating nonblast (e.g., gunshot wounds) injuries. Non-intra-abdominal infections and hypotension were independently associated with organ space SSIs development alone, while sustaining blast injuries were associated with reduced likelihood. CONCLUSION Despite severity of injuries and the battlefield environment, the combat casualty Laparotomy SSI rate is relatively low at 14%, with similar risk factors and rates reported following severe civilian trauma. LEVEL OF EVIDENCE Epidemiological, level III.
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outcomes of Exploratory Laparotomy and abdominal infections among combat casualties
2021Co-Authors: Joseph D Bozzay, Patrick F Walker, David W Schechtman, Faraz Shaikh, Laveta Stewart, David R Tribble, Matthew J BradleyAbstract:Abstract Background Abdominal injuries historically account for 13% of battlefield surgical procedures. We examined the occurrence of Exploratory laparotomies and subsequent abdominal surgical site infections (SSIs) among combat casualties. Methods Military personnel injured during deployment (2009-2014) were included if they required a Laparotomy for combat-related trauma and were evacuated to Landstuhl Regional Medical Center, Germany, before being transferred to participating US military hospitals. Results Of 4304 combat casualties, 341 (7.9%) underwent Laparotomy. Including re-explorations, 1053 laparotomies (median, 2; interquartile range, 1-3; range, 1-28) were performed with 58% occurring within the combat zone. Forty-nine (14.4%) patients had abdominal SSIs (four with multiple SSIs): 27 (7.9%) with deep space SSIs, 14 (4.1%) with a deep incisional SSI, and 12 (3.5%) a superficial incisional SSI. Patients with abdominal SSIs had larger volume of blood transfusions (median, 24 versus 14 units), more laparotomies (median, 4 versus 2), and more hollow viscus injuries (74% versus 45%) than patients without abdominal SSIs. Abdominal closure occurred after 10 d for 12% of the patients with SSI versus 2% of patients without SSI. Mesh adjuncts were used to achieve fascial closure in 20.4% and 2.1% of patients with and without SSI, respectively. Survival was 98% and 96% in patients with and without SSIs, respectively. Conclusions Less than 10% of combat casualties in the modern era required abdominal exploration and most were severely injured with hollow viscus injuries and required massive transfusions. Despite the extensive contamination from battlefield injuries, the SSI proportion is consistent with civilian rates and survival was high.
John R Richards - One of the best experts on this subject based on the ideXlab platform.
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the utility of sonography for the triage of blunt abdominal trauma patients to Exploratory Laparotomy
2007Co-Authors: Brett C Lee, Eleanor L Ormsby, John P Mcgahan, Giselle Melendres, John R RichardsAbstract:OBJECTIVE. The purpose of this study was to assess the utility of focused abdominal sonography for trauma (FAST) in the triage of hypotensive and normotensive blunt abdominal trauma patients to Exploratory Laparotomy.MATERIALS AND METHODS. Data entered in a trauma registry database were retrospectively reviewed and were correlated with medical records, radiology reports, and surgical Laparotomy reports. In the setting of blunt abdominal trauma, hypotensive patients were compared with normotensive patients who underwent FAST.RESULTS. During the 6-year study period, 4,029 patients with blunt abdominal trauma underwent sonography, 122 of whom were hypotensive on arrival and underwent FAST. Of 87 hypotensive patients with positive findings on FAST, 69 (79%) were taken directly to Exploratory Laparotomy without the need for CT. In predicting the need for therapeutic Laparotomy in hypotensive patients, the sensitivity of FAST was 85%, specificity was 60%, and accuracy was 77%. Of the 3,907 normotensive patients...
David G Mutch - One of the best experts on this subject based on the ideXlab platform.
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continuous epidural infusion in gynecologic oncology patients undergoing Exploratory Laparotomy the new standard for decreased postoperative pain and opioid use
2019Co-Authors: S P Huepenbecker, S E Cusworth, Lindsay M Kuroki, Christelle D K Samen, Candice Woolfolk, Rosa Deterding, Leping Wan, Daniel L Helsten, Michael M Bottros, David G MutchAbstract:Abstract Objective To compare the incidence of postoperative complications and opioid pain medication usage in gynecologic oncology patients who did and did not receive an epidural prior to undergoing Exploratory Laparotomy. Methods Retrospective cohort study of all patients undergoing Exploratory Laparotomy with the gynecologic oncology division at Washington University in St Louis between January 2012 and October 2015. Data on demographics, pathology, postoperative pain and opioid use, and incidence of postoperative complications were collected. Results Five hundred and sixty-one patients underwent Laparotomy, 305 with an epidural and 256 without. Patients with an epidural used significantly less hydromorphone in the post-anesthesia care unit (PACU) (p = 0.003) and on postoperative day (POD)#1 (p = 0.05), less total opioids on POD#0 (p Conclusions Perioperative epidurals used in patients undergoing major abdominal surgery correlate with decreased postoperative opioid use, increased use of non-opioid pain medications, and improved pain relief postoperatively with acceptable postoperative risks and should be standard of care for these patients.
Forster Amponsahmanu - One of the best experts on this subject based on the ideXlab platform.
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epidemiology and perioperative mortality of Exploratory Laparotomy in rural ghana
2020Co-Authors: Brandon S Hendriksen, Laura Keeney, David Morrell, Xavier Candela, Christopher S Hollenbeak, Temitope E Arkorful, Richard Ofosuakromah, Evans K Marfo, Forster AmponsahmanuAbstract:Background: Perioperative mortality rate (POMR) has been identified as an important measure of access to safe surgical and anesthesia care in global surgery. There has been limited study on this measure in rural Ghana. In order to identify areas for future quality improvement efforts, we aimed to assess the epidemiology of Exploratory Laparotomy and to investigate POMR as a benchmark quality measure. Methods: Surgical records were reviewed at a regional referral hospital in Eastern Region, Ghana to identify cases of Exploratory Laparotomy from July 2017 through June 2018. Patient demographics, health information, and outcomes data were collected. Logistic regression was used to identify predictors of perioperative mortality. Findings: The study included operations for 286 adult and 60 pediatric patients. Only 60% of patients were covered by National Health Insurance (NHI). The overall POMR was 11.5% (12.6% adults; 6.7% pediatric). Sixty percent of mortalities were referrals from outside hospitals and the mortality rate for referrals was 13.5%. Odds of mortality was 13 times greater with perforated peptic ulcer disease (OR = 13.1, p = 0.025) and 12 times greater with trauma (OR = 11.7, p = 0.042) when compared to the most common operation. Female sex (OR = 0.3, p = 0.016) and NHI (OR = 0.4, p = 0.031) were protective variables. Individuals 60 years and older (OR = 3.3, p = 0.016) had higher mortality. Conclusion: POMR can be an important outcome and quality indicator for rural populations. Interventions aimed at decreasing emergent hernia repair, preventing perforation of peptic ulcer disease, improving rural infrastructure for response to major trauma, and increasing NHI coverage may improve POMR in rural Ghana.
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risk factors for readmission and length of inpatient stay in rural ghana following Exploratory Laparotomy
2018Co-Authors: Brandon S Hendriksen, Laura Keeney, David Morrell, Xavier Candela, Christopher S Hollenbeak, Temitope E Arkorful, C Newton, Forster AmponsahmanuAbstract:Background Increased inpatient length of stay (LOS) and readmission represent significant economic burden on patients and families faced with surgical disease in low-middle income countries given limited surgical access, infrastructure, and variable insurance status. Study aim Identify risk factors for readmission and inpatient LOS in postoperative care in the Eastern Regional Hospital, Ghana. Study design Retrospective case series. Setting Eastern Regional Hospital, Koforidua, Ghana. Methods Data for Exploratory Laparotomy procedures were obtained from surgical case logs collected at the regional referral hospital in Koforidua, Eastern Region, Ghana from July 2017 to June 2018. This information was combined with the hospital electronic medical records to collect demographic data, laboratory values, and outcomes. Multivariable analyses were used to model LOS and readmission. Results The study included 346 Exploratory Laparotomy procedures (286 adult, 60 pediatric) for various surgical diseases. The overall 30-day readmission rate was 9.2%. Average LOS was 12.0±20.4 days for readmitted patients and 6.7±5.5 days for patients without readmission. Readmitted patients were more likely to have had preoperative anemia (p=0.009), surgical site infection (P=0.001), or a re-Laparotomy (p=0.005). Preoperative anemia (OR=3.5 [95% CI 1.54-7.96], p=0.003) and surgical site infection (OR=3.68 [95% CI 1.36-10.00], p=0.011) were associated with increased odds of readmission. Preoperative anemia was also associated with about 3.0 additional inpatient days (p=0.001). Conclusion Preoperative anemia and surgical site infections represent risk factors for readmission in rural Ghana. Anemia is also associated with longer LOS. Future interventions aimed at treating anemia and preventing surgical site infections may reduce some of the post-operative burden placed on patients and their families.
