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Article ; Online: Which Volume Matters More? Systematic Review and Meta-Analysis of Hospital vs Surgeon Volume in Intra-Abdominal Emergency Surgery.

Rafaqat, Wardah / Lagazzi, Emanuele / Jehanzeb, Hamzah / Abiad, May / Hwabejire, John O / Parks, Jonathan J / Kaafarani, Haytham M / DeWane, Michael P

Journal of the American College of Surgeons

2023 Volume 238, Issue 3, Page(s) 332–346

MeSH term(s)	Humans ; Hospitals ; Surgeons ; Abdominal Cavity ; Hospitals, High-Volume
Language	English
Publishing date	2023-11-22
Publishing country	United States
Document type	Meta-Analysis ; Systematic Review ; Journal Article
ZDB-ID	1181115-8
ISSN	1879-1190 ; 1072-7515
ISSN (online)	1879-1190
ISSN	1072-7515
DOI	10.1097/XCS.0000000000000913
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Article ; Online: Does practice make perfect? The impact of hospital and surgeon volume on complications after intra-abdominal procedures.

Rafaqat, Wardah / Lagazzi, Emanuele / Jehanzeb, Hamzah / Abiad, May / Luckhurst, Casey M / Parks, Jonathan J / Albutt, Katherine H / Hwabejire, John O / DeWane, Michael P

Surgery

2024 Volume 175, Issue 5, Page(s) 1312–1320

Abstract: Background: There is increasing interest in the regionalization of surgical procedures. However, evidence on the volume-outcome relationship for emergency intra-abdominal surgery is not well-synthesized. This systematic review and meta-analysis ... ...

Abstract	Background: There is increasing interest in the regionalization of surgical procedures. However, evidence on the volume-outcome relationship for emergency intra-abdominal surgery is not well-synthesized. This systematic review and meta-analysis summarize evidence regarding the impact of hospital and surgeon volume on complications. Methods: We identified cohort studies assessing the impact of hospital/surgeon volume on postoperative complications after emergency intra-abdominal procedures, with data collected after the year 2000 through a literature search without language restriction in the PubMed, Web of Science, and Cochrane databases. A weighted overall complication rate was calculated, and a random effect regression model was used for a summary odds ratio. A sensitivity analysis with the removal of studies contributing to heterogeneity was performed (PROSPERO: CRD42022358879). Results: The search yielded 2,153 articles, of which 9 cohort studies were included and determined to be good quality according to the Newcastle Ottawa Scale. These studies reported outcomes for the following procedures: cholecystectomy, colectomy, appendectomy, small bowel resection, peptic ulcer repair, adhesiolysis, laparotomy, and hernia repair. Eight studies (2,358,093 patients) with available data were included in the meta-analysis. Low hospital volume was not significantly associated with higher complications. In the sensitivity analysis, low hospital volume was significantly associated with higher complications when appropriate heterogeneity was achieved. Low surgeon volume was associated with higher complications, and these findings remained consistent in the sensitivity analysis. Conclusion: We found that hospital and surgeon volume was significantly associated with higher complications in patients undergoing emergency intra-abdominal surgery when appropriate heterogeneity was achieved.
MeSH term(s)	Humans ; Hospitals ; Surgeons ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Abdomen/surgery ; Abdominal Cavity
Language	English
Publishing date	2024-02-28
Publishing country	United States
Document type	Meta-Analysis ; Systematic Review ; Journal Article
ZDB-ID	202467-6
ISSN	1532-7361 ; 0039-6060
ISSN (online)	1532-7361
ISSN	0039-6060
DOI	10.1016/j.surg.2024.01.011
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Article ; Online: The overlooked factor: The impact of disability on postoperative complications after emergency general surgery procedures.

Rafaqat, Wardah / Lagazzi, Emanuele / Abiad, May / Argandykov, Dias / Proaño-Zamudio, Jefferson A / Van Ee, Elaine P X / Velmahos, George C / Hwabejire, John O / Kaafarani, Haytham M A / DeWane, Michael P

Surgery

2024

Abstract: Background: Despite more than 61 million people in the United States living with a disability, studies on the impact of disability on health care disparities in surgical patients remain limited. Therefore, we aimed to understand the impact of disability ...

Abstract	Background: Despite more than 61 million people in the United States living with a disability, studies on the impact of disability on health care disparities in surgical patients remain limited. Therefore, we aimed to understand the impact of disability on postoperative outcomes. Methods: We performed a retrospective cohort study using the Nationwide Readmission Database (2019). We compared patients ≥18 years undergoing emergency general surgery procedures with a disability condition with those without a disability. In accordance with the Centers for Disease Control and Prevention, disability was defined as severe hearing, visual, intellectual, or motor impairment/caregiver dependency. The primary outcome was 30-day readmission rates. Secondary outcomes included hospital length of stay and 30-day complications and mortality. Patients were 1:1 propensity-matched using patient, procedure, and hospital characteristics. Results: Among our population of 378,733 patients, 5,877 (1.6%) patients had at least 1 disability condition. A higher proportion of patients with a disability had low household income, $1 to $45,999, and an Elixhauser Comorbidity score ≥3. Among 5,768 matched pairs, patients with a disability had a significantly higher incidence of 30-day readmission (17.2% vs 12.7%; P < .001), infectious complications (29.8% vs 19.5%; P < .001), and a longer length of stay (8 vs 6 days; P < .001). Motor impairment, the most common disability, was associated with the greatest increase in patient readmission, morbidity, and length of stay. Conclusion: Severe intellectual, hearing, visual, or motor impairments were associated with higher readmission, morbidity, and longer length of stay. Further research is needed to understand the mechanisms responsible for these disparities and to develop interventions to ameliorate them.
Language	English
Publishing date	2024-03-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	202467-6
ISSN	1532-7361 ; 0039-6060
ISSN (online)	1532-7361
ISSN	0039-6060
DOI	10.1016/j.surg.2024.01.037
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Article ; Online: Patience is key: Association of surgical timing with clinical outcomes in elderly patients with sigmoid volvulus.

Arnold, Suzanne C / Rafaqat, Wardah / Abiad, May / Lagazzi, Emanuele / Hoekman, Anne H / Panossian, Vahe S / Nzenwa, Ikemsinachi C / Paranjape, Charudutt N / Velmahos, George C / Kaafarani, Haytham M A / Hwabejire, John O

American journal of surgery

2024 Volume 232, Page(s) 81–86

Abstract: Background: Current guidelines for sigmoid volvulus recommend endoscopy as a first line of treatment for decompression, followed by colectomy as early as possible. Timing of the latter varies greatly. This study compared early (≤2 days) versus delayed (> ...

Abstract	Background: Current guidelines for sigmoid volvulus recommend endoscopy as a first line of treatment for decompression, followed by colectomy as early as possible. Timing of the latter varies greatly. This study compared early (≤2 days) versus delayed (>2 days) sigmoid colectomy. Methods: 2016-2019 NRD database was queried to identify patients aged ≥65 years admitted for sigmoid volvulus who underwent sequential endoscopic decompression and sigmoid colectomy. Outcomes included mortality, complications, hospital length of stay, readmissions, and hospital costs. Results: 842 patients were included, of which 409 (48.6 %) underwent delayed sigmoid colectomy. Delayed sigmoid colectomy was associated with reduced cardiac complications (1.1 % vs 0.0 %, p = 0.045), reduced ostomy rate (38.3 % vs 29.4 %, p = 0.013), an increased overall length of stay (12 days vs 8 days, p < 0.001) and increased overall costs (27,764 dollar vs. 24,472 dollar, p < 0.001). Conclusion: In geriatric patient with sigmoid volvulus, delayed surgical resection after decompression is associated with reduced cardiac complications and reduced ostomy rate, while increasing overall hospital length of stay and costs.
MeSH term(s)	Humans ; Intestinal Volvulus/surgery ; Aged ; Female ; Male ; Colectomy/methods ; Colectomy/economics ; Sigmoid Diseases/surgery ; Aged, 80 and over ; Decompression, Surgical/economics ; Decompression, Surgical/methods ; Length of Stay/statistics & numerical data ; Retrospective Studies ; Treatment Outcome ; Postoperative Complications/epidemiology ; Time-to-Treatment/statistics & numerical data ; Time Factors
Language	English
Publishing date	2024-01-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2024.01.007
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Article ; Online: Traumatic lower extremity amputation as a risk factor for venous thromboembolism.

Argandykov, Dias / Lagazzi, Emanuele / Proaño-Zamudio, Jefferson A / Rafaqat, Wardah / Abiad, May / DeWane, Michael / Paranjape, Charudutt N / Kaafarani, Haytham M A / Velmahos, George C / Hwabejire, John O

American journal of surgery

2024 Volume 232, Page(s) 95–101

Abstract: Background: This study aimed to evaluate whether lower extremity (LE) amputation among civilian casualties is a risk factor for venous thromboembolism.: Methods: All patients with severe LE injuries (AIS ≥3) derived from the ACS-TQIP (2013-2020) were ...

Abstract	Background: This study aimed to evaluate whether lower extremity (LE) amputation among civilian casualties is a risk factor for venous thromboembolism. Methods: All patients with severe LE injuries (AIS ≥3) derived from the ACS-TQIP (2013-2020) were divided into those who underwent trauma-associated amputation and those with limb salvage. Propensity score matching was used to mitigate selection bias and confounding and compare the rates of pulmonary embolism (PE) and deep vein thrombosis (DVT). Results: A total of 145,667 patients with severe LE injuries were included, with 3443 patients requiring LE amputation. After successful matching, patients sustaining LE amputation still experienced significantly higher rates of PE (4.2% vs. 2.5%, p < 0.001) and DVT (6.5% vs. 3.4%, p < 0.001). A sensitivity analysis examining patients with isolated major LE trauma similarly showed a higher rate of thromboembolic complications, including higher incidences of PE (3.2% vs. 2.0%, p = 0.015) and DVT (4.7% vs. 2.6%, p < 0.001). Conclusions: In this nationwide analysis, traumatic lower extremity amputation is associated with a significantly higher risk of VTE events, including PE and DVT.
MeSH term(s)	Humans ; Male ; Female ; Risk Factors ; Venous Thromboembolism/epidemiology ; Venous Thromboembolism/etiology ; Adult ; Middle Aged ; Propensity Score ; Lower Extremity/blood supply ; Lower Extremity/injuries ; Amputation, Traumatic/epidemiology ; Amputation, Traumatic/complications ; Amputation, Traumatic/surgery ; Retrospective Studies ; Incidence ; Pulmonary Embolism/epidemiology ; Pulmonary Embolism/etiology ; Amputation, Surgical/statistics & numerical data ; Venous Thrombosis/epidemiology ; Venous Thrombosis/etiology ; Aged ; United States/epidemiology ; Limb Salvage/statistics & numerical data ; Limb Salvage/methods
Language	English
Publishing date	2024-02-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2024.01.011
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Article ; Online: The association of disability conditions with access to minimally invasive general surgery.

Rafaqat, Wardah / Abiad, May / Lagazzi, Emanuele / Argandykov, Dias / Proaño-Zamudio, Jefferson A / Van Ee, Elaine P X / Velmahos, George C / Hwabejire, John O / Kaafarani, Haytham M A / DeWane, Michael P

Disability and health journal

2024 , Page(s) 101586

Abstract: Background: Despite the high prevalence of disability conditions in the US, their association with access to minimally invasive surgery (MIS) remains under-characterized.: Objective: To understand the association of disability conditions with rates ... ...

Abstract	Background: Despite the high prevalence of disability conditions in the US, their association with access to minimally invasive surgery (MIS) remains under-characterized. Objective: To understand the association of disability conditions with rates of MIS and describe nationwide temporal trends in MIS in patients with disability conditions. Methods: We conducted a retrospective cohort study using the Nationwide Readmission Database (2016-2019). We included patients ≥18 years undergoing general surgery procedures. Our primary outcome was the impact of disability conditions on the rate of MIS. We performed 1:1 propensity matching, comparing patients with disability conditions with those without and adjusting for patient, procedure, and hospital characteristics. We performed a subgroup analysis among patients<65 years and with patients with each type of disability. We evaluated temporal trends of MIS in patients with disabilities. We identified predictors of undergoing MIS using mixed effects regression analysis. Results: In the propensity-matched comparison, a lower proportion of patients with disabilities had MIS. In the sub-group analyses, the rate of MIS was significantly lower in patients below 65 years with disabilities and among patients with motor and intellectual impairments. There was an increasing trend in the proportion of patients with disabilities undergoing MIS (p < 0.005). The regression analysis confirmed that the presence of a disability was associated with decreased odds of undergoing MIS. Conclusions: This study characterizes the negative association of disability conditions with access to MIS. As the healthcare landscape evolves, considerations on how to equitably share new treatment modalities with a wide range of patient populations are necessary.
Language	English
Publishing date	2024-01-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	2414615-8
ISSN	1876-7583 ; 1936-6574
ISSN (online)	1876-7583
ISSN	1936-6574
DOI	10.1016/j.dhjo.2024.101586
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Article ; Online: The Invisible Scars: Unseen Financial Complications Worsen Every Aspect of Long-Term Health in Trauma Survivors.

Ilkhani, Saba / Naus, Abbie E / Pinkes, Nathaniel / Rafaqat, Wardah / Grobman, Ben / Valverde, Madeline D / Sanchez, Sabrina E / Hwabejire, John O / Ranganathan, Kavitha / Scott, John W / Herrera-Escobar, Juan P / Salim, Ali / Anderson, Geoffrey A

The journal of trauma and acute care surgery

2024

Abstract: Introduction: Trauma survivors are susceptible to experiencing financial toxicity (FT). Studies have shown the negative impact of FT on chronic illness outcomes. However, there is a notable lack of data on FT in the context of trauma. We aimed to better ...

Abstract	Introduction: Trauma survivors are susceptible to experiencing financial toxicity (FT). Studies have shown the negative impact of FT on chronic illness outcomes. However, there is a notable lack of data on FT in the context of trauma. We aimed to better understand prevalence, risk factors, and impact of FT on trauma long-term outcomes. Methods: Adult trauma patients with an Injury severity score (ISS) ≥9 treated at level-1 trauma centers were interviewed 6-14 months after discharge. FT was considered positive if patients reported any of the following due to the injury: income loss, lack of care, newly applied/qualified for governmental assistance, new financial problems, or work loss. The Impact of FT on Patient Reported Outcome Measure Index System (PROMIS) health domains was investigated. Results: Of 577 total patients, 44% (254/567) suffered some form of FT. In the adjusted model, older age (OR 0.4 [95% CI: 0.2 - 0.81]) and stronger social support networks (OR 0.44 [ 95% CI: 0.26 - 0.74]) were protective against FT. In contrast, having two or more comorbidities (OR 1.81 [1.01 - 3.28), lower education levels (OR = 1.95, [CI 95%: 1.26 - 3.03]), and injury mechanisms, including road accidents (OR 2.69 [1.51 -4.77]) and intentional injuries (OR 4.31 [1.44 -12.86]) were associated with higher toxicity. No significant relationship was found with ISS, sex, or single-family household. Patients with FT had worse outcomes across all domains of health. There was a negative linear relationship between the severity of FT and worse mental and physical health scores. Conclusion: FT is associated with long-term outcomes. Incorporating FT risk assessment into recovery care planning may help to identify patients most in need of mitigative interventions across the trauma care continuum to improve trauma recovery. Further investigations to better understand, define, and address FT in trauma care are warranted. Level of evidence: Prognostic cohort study, level III.
Language	English
Publishing date	2024-01-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	2651070-4
ISSN	2163-0763 ; 2163-0755
ISSN (online)	2163-0763
ISSN	2163-0755
DOI	10.1097/TA.0000000000004247
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Article ; Online: Analyzing the Impact of Concomitant COVID-19 Infection on Outcomes in Trauma Patients.

Rafaqat, Wardah / Abiad, May / Lagazzi, Emanuele / Argandykov, Dias / Proaño-Zamudio, Jefferson A / Velmahos, George C / Hwabejire, John O / Parks, Jonathan J / Luckhurst, Casey M / DeWane, Michael P

The American surgeon

2024 Volume 90, Issue 6, Page(s) 1599–1607

Abstract: Background: The impact of COVID-19 infection at the time of traumatic injury remains understudied. Previous studies demonstrate that the rate of COVID-19 vaccination among trauma patients remains lower than in the general population. This study aims to ... ...

Abstract	Background: The impact of COVID-19 infection at the time of traumatic injury remains understudied. Previous studies demonstrate that the rate of COVID-19 vaccination among trauma patients remains lower than in the general population. This study aims to understand the impact of concomitant COVID-19 infection on outcomes in trauma patients. Methods: We conducted a retrospective cohort study of patients ≥18 years old admitted to a level I trauma center from March 2020 to December 2022. Patients tested for COVID-19 infection using a rapid antigen/PCR test were included. We matched patients using 2:1 propensity accounting for age, gender, race, comorbidities, vaccination status, injury severity score (ISS), type and mechanism of injury, and GCS at arrival. The primary outcome was inpatient mortality. Secondary outcomes included hospital length of stay (LOS), Intensive Care Unit (ICU) LOS, 30-day readmission, and major complications. Results: Of the 4448 patients included, 168 (3.8%) were positive (COV+). Compared with COVID-19-negative (COV-) patients, COV+ patients were similar in age, sex, BMI, ISS, type of injury, and regional AIS. The proportion of White and non-Hispanic patients was higher in COV- patients. Following matching, 154 COV+ and 308 COV- patients were identified. COVID-19-positive patients had a higher rate of mortality (7.8% vs 2.6%; Conclusions: Trauma patients with concomitant COVID-19 infection have higher mortality and morbidity in the matched population. Focused interventions aimed at recognizing this high-risk group and preventing COVID-19 infection within it should be undertaken.
MeSH term(s)	Humans ; COVID-19/complications ; COVID-19/mortality ; COVID-19/epidemiology ; Male ; Female ; Retrospective Studies ; Middle Aged ; Wounds and Injuries/complications ; Wounds and Injuries/mortality ; Length of Stay/statistics & numerical data ; Adult ; Hospital Mortality ; Trauma Centers/statistics & numerical data ; Aged ; Injury Severity Score ; Patient Readmission/statistics & numerical data ; Intensive Care Units/statistics & numerical data ; SARS-CoV-2
Language	English
Publishing date	2024-04-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/00031348241246176
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Article ; Online: Non-operative management of adhesive small bowel obstruction: Should there be a time limit after which surgery is performed?

Hwabejire, John O / Tran, Daniel D / Fullum, Terrence M

American journal of surgery

2018 Volume 215, Issue 6, Page(s) 1068–1070

Abstract: The management of adhesive small bowel obstruction (ASBO) has evolved from "the sun should not rise and set on a small bowel obstruction", implying mandatory immediate surgical exploration to selective non-operative management. Not every patient with ... ...

Abstract	The management of adhesive small bowel obstruction (ASBO) has evolved from "the sun should not rise and set on a small bowel obstruction", implying mandatory immediate surgical exploration to selective non-operative management. Not every patient with adhesive small bowel obstruction meets criteria for non-operative management and treating all comers the same way can lead to catastrophic outcomes. Water Soluble Contrast Medium (WSCM) has important diagnostic and therapeutic utility in the management of ASBO and should be employed ab initio. Laparoscopy has emerged as a reasonable and safe alternative to laparotomy for surgical management of ASBO in carefully selected patients and has distinct advantages.
MeSH term(s)	Humans ; Intestinal Obstruction/diagnosis ; Intestinal Obstruction/etiology ; Intestinal Obstruction/surgery ; Intestine, Small/diagnostic imaging ; Intestine, Small/surgery ; Laparoscopy/methods ; Tissue Adhesions/complications ; Tissue Adhesions/surgery ; Tomography, X-Ray Computed ; Treatment Outcome
Language	English
Publishing date	2018-03-07
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2018.03.010
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Article ; Online: Mesenteric Ischemia in Patients with Coronavirus 2019: A Scoping Review.

Gebran, Anthony / El Moheb, Mohamad / Argandykov, Dias / Mashbari, Hassan / Gartland, Rajshri M / Hwabejire, John O / Velmahos, George C / Kaafarani, Haytham M A

Surgical infections

2022 Volume 23, Issue 9, Page(s) 781–786

Abstract: Background: ...

Abstract	Background:
MeSH term(s)	Adult ; Humans ; Male ; Middle Aged ; Female ; Mesenteric Ischemia/epidemiology ; Mesenteric Ischemia/diagnosis ; COVID-19/complications ; Acute Disease ; Laparotomy ; Digestive System Surgical Procedures/adverse effects ; Ischemia/diagnosis ; Ischemia/etiology ; Ischemia/surgery
Language	English
Publishing date	2022-10-13
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	1440120-4
ISSN	1557-8674 ; 1096-2964
ISSN (online)	1557-8674
ISSN	1096-2964
DOI	10.1089/sur.2022.154
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