Search

Abstract: Background: Complications after inferior vena cava (IVC) injury, including venous thromboembolism (VTE), are expected, but the exact incidence is poorly defined. The purpose of this study is to examine the VTE rate following ligation versus repair of IVC injuries. Materials and methods: The California State Inpatient Database was queried for all adult patients (age >14 y) admitted between 2005 and 2008 with IVC injuries. Demographic data, mechanism of injury, operative technique (ligation versus repair), and outcomes were recorded. Outcomes were compared according to operative technique. Results: A total of 308 patients with IVC injuries were evaluated. The study population was mostly male (81.2%), young (median age 24 y), and Hispanic (43.2%). Overall mortality was 37.3%. The mechanisms of injury included gunshot wounds (52.3%), stab wounds (14.0%), and motor vehicle collisions (14.9%). Associated injuries were present in 100% of cases, with duodenal injuries being the most common. The majority of injuries were managed by primary repair (76.6%), with ligation performed in 23.4%. Patients who underwent ligation had a longer hospital stay (median 9 versus 6 d, P = 0.04) and a trend towards a higher mortality (45.8% versus 34.8%, P = 0.10), with no difference in VTE rate (4.2% versus 1.7%, P > 0.99). Conclusions: As expected, IVC injuries carry a very high mortality rate and are always associated with other injuries. We demonstrated a surprisingly low rate of VTE after operative management for IVC injury, which was similar for patients undergoing ligation and repair. [Copyright &y& Elsevier]

Background: Recent evidence supports the beneficial effect of alcohol on patients with traumatic brain injury (TBI). Pneumonia is a known complication following TBI; thus, the purpose of this study was to evaluate the effects of alcohol on pneumonia rates following moderate to severe TBI. Methods: From 2005 to 2009, the Los Angeles County Trauma Database was queried for all patients ≥14 y of age with isolated moderate to severe TBI and admission serum alcohol levels. The incidence of pneumonia was compared between TBI patients with and without a positive blood alcohol concentration (BAC) level. The study population was then stratified into four BAC levels: None (0 mg/dL), low (0–100 mg/dL), moderate (100–230 mg/dL), and high (≥230 mg/dL). Pneumonia rates were compared across these levels. Results: A total of 3547 patients with isolated, moderate to severe TBI were evaluated. Nearly 66% tested positive for alcohol. The pneumonia rate was significantly lower in the TBI patients who tested positive for alcohol (2.5%) compared with those who tested negative (4.0%, P = 0.017). The pneumonia rate also decreased across increasing BAC levels (linear trend P = 0.03). After logistic regression analysis, a positive ethanol (ETOH) level was associated with a reduced incidence of pneumonia (AOR = 0.62; 95%CI: 0.41–0.93; P = 0.020). Conclusion: A positive serum alcohol level was associated with a significantly lower pneumonia rate in isolated, moderate to severe TBI patients. This may explain the observed mortality reduction in TBI patients who test positive for alcohol. Additional research is warranted to investigate the potential therapeutic implications of this association. [ABSTRACT FROM AUTHOR]

We sought to determine if the shift from open abdominal aortic repair to endovascular methods has affected the incidence of rupture of abdominal aortic aneurysms (rAAA). The Nationwide Inpatient Samples 2001 to 2007 was used. The incidence of rAAA and myocardial infarction (MI) as well as the number and type of aneurysm repairs were tabulated. There were no significant changes in the number of diagnosed (56,991 to 51,122; P = 0.26) and repaired (45,828 to 43,900; P = 0.79) abdominal aortic aneurysms between 2001 and 2007. Open abdominal aortic repair decreased from 31,989 to 13,876 (P < 0.001) whereas the number of endovascular aneurysm repairs increased from 13,839 to 30,025 (P < 0.001). In the same time, rAAA decreased from 7,749 to 5,267 (-32%, P < 0.001). The reduction of rAAA was greatest (-35.5%) in patients 65 to 84 years of age and less in patients 85 years and older (-15%). The number of MI decreased from 773,871 to 624,936 (P = 0.005). The decrease in rAAA was significantly correlated with decreases in MI (r = 0.97, P = 0.0003). Although endovascular aneurysm repair increased, the overall application of abdominal aortic aneurysms repair did not change and does not account for the reduction in rAAA. It is more likely that environmental or other risk factor modifications also predisposing to decreases in MI account for the reduction in rAAA. [ABSTRACT FROM AUTHOR]

Hypotension, defined as systolic blood pressure less than 90 mm Hg, is recognized as a sign of hemorrhagic shock and is a validated prognostic indicator. The definition of hypotension, particularly in the elderly population, deserves attention. We hypothesized that the systolic blood pressure associated with increased mortality resulting from hemorrhagic shock increases with increasing age. The Los Angeles County Trauma Database was queried for all moderate to severely injured patients without major head injuries admitted between 1998 and 2005. Several fit statistic analyses were performed for each systolic blood pressure from 50 to 180 mm Hg to identify the model that most accurately defined hypotension for three age groups. The optimal definition of hypotension for each group was determined from the best fit model. A total of 24,438 patients were analyzed. The optimal definition of hypotension was systolic blood pressure of 100 mm Hg for patients 20 to 49 years, 120 mm Hg for patients 50 to 69 years, and 140 mm Hg for patients 70 years and older. The optimal systolic blood pressure for improved mortality in hemorrhagic shock increases significantly with increasing age. Elderly trauma patients without major head injuries should be considered hypotensive for systolic blood pressure less than 140 mm Hg. [ABSTRACT FROM AUTHOR]

Objective: To determine whether the diameters of treated abdominal aortic aneurysms (AAAs) have changed during the last 10 years., Design, Setting, and Patients: A retrospective record review was completed on all patients undergoing any AAA repair from January 1, 2000, through December 31, 2009, at a single high-volume institution. All cases of repaired AAAs that had computed tomographic scans within 3 months of surgery were included. The mean and median maximal diameters of AAAs were noted. Correlation and regression analyses were used., Main Outcome Measures: The mean and median maximal diameters of AAAs., Results: Of 360 patients with treated AAAs, 339 met the inclusion criteria. The mean (SD) diameter of repaired AAAs decreased from 6.49 (1.46) cm (median, 6.40 cm) in 2000 to 5.83 (1.23) cm (median, 5.60 cm) in 2009. Correlation analysis confirmed a decrease in diameter across years (Pearson R = -0.141; P = .01). A fitted regression line also showed a decreasing trend (slope = -0.059 cm per year; P = .01)., Conclusions: The diameters of repaired AAAs at our hospital have decreased progressively during the last decade. This observation is consistent with a reduction in the expansion rates of AAAs and may account for the progressive decreases in the aneurysm rupture rate in the United States.