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  1. Article ; Online: Colorectal Anastomosis Versus Colostomy Creation in High MELD Patients: An ACS-NSQIP Analysis.

    Karim, S Ahsan / Turcotte, Justin J / Rehrig, Scott T / Feather, Cristina B / Klune, J Robert

    The American surgeon

    2024  , Page(s) 31348241248787

    Abstract: Background: Liver failure patients are at increased risk of surgical complications. The decision to perform a colonic anastomosis vs a colostomy in urgent colorectal surgery remains unclear.: Methods: The ACS-NSQIP database was queried for patients ... ...

    Abstract Background: Liver failure patients are at increased risk of surgical complications. The decision to perform a colonic anastomosis vs a colostomy in urgent colorectal surgery remains unclear.
    Methods: The ACS-NSQIP database was queried for patients undergoing nonelective colorectal surgery between 2016 and 2018. MELD score was calculated and stratified into 3 groups. Subgroup analysis of the high-MELD group was performed.
    Results: Higher MELD scores were associated with significantly higher mortality. Colostomy formation was consistent between intermediate and high-MELD groups. In high-MELD patients, colonic anastomosis was associated with higher mortality than those receiving colostomy (41.1% vs 28.4%,
    Discussion: High-MELD patients undergoing nonelective colorectal surgery have increased risk of complications such as mortality. Patients in this group receiving an anastomosis have increased complications and mortality, and may benefit from colostomy formation.
    Language English
    Publishing date 2024-04-24
    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 10.1177/00031348241248787
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Open and Closed Approaches to Skin Closure After Nonelective Open Colorectal Operations.

    Turcotte, Justin J / Allen, Rebecca S / Klune, J Robert / Feather, Cristina B

    The American surgeon

    2022  Volume 89, Issue 6, Page(s) 2520–2528

    Abstract: Introduction: Optimal wound management strategies to reduce surgical site infections (SSIs) in nonelective open colorectal surgery (NOCS) remain controversial and variable. Our aim is to describe SSI and other 30-day outcome measures among patients with ...

    Abstract Introduction: Optimal wound management strategies to reduce surgical site infections (SSIs) in nonelective open colorectal surgery (NOCS) remain controversial and variable. Our aim is to describe SSI and other 30-day outcome measures among patients with varying wound management techniques undergoing NOCS.
    Methods: All NOCS patients were extracted from the 2016 to 2018 ACS-NSQIP database. Outcomes of patients managed with all layers closed (ALC) were compared to patients managed with skin open (SO), using propensity score matching (PSM) to control for significant confounding risk factors for SSI.
    Results: A total of 40,820 patients were included; 4622 patients managed with SO and 36,198 managed with ALC. Patients in the SO group were more likely to have a history of hypertension, renal failure, chronic obstructive pulmonary disease, smoking, obesity, and sepsis on presentation (P < .001). After PSM, no differences in risk factors remained; 4622 and 4344 patients were included in the SO and ALC cohorts, respectively. While ALC patients experienced a higher rate of superficial SSI (1.4% vs 7.3%, P < .001) and any wound complications (6.8% vs 10.8%, P < .001), the SO group had higher wound dehiscence (4.4% vs 2.8%, P < .001). There were no significant differences in deep wound infection. The SO group had longer average length of stay (14.7 vs 13.1 days, P < .001), higher non-wound-related complications, discharge to SNF, and in-hospital mortality.
    Discussion: Significant differences in SSI rates among NOCS patients with differing wound management techniques were observed. More notably, other important quality measures, such as length of stay, disposition, mortality, and non-wound-related complications were also significantly impacted by wound management strategy.
    MeSH term(s) Humans ; Colorectal Surgery ; Skin ; Digestive System Surgical Procedures/adverse effects ; Surgical Wound Infection/epidemiology ; Surgical Wound Infection/prevention & control ; Surgical Wound Infection/etiology ; Risk Factors ; Colorectal Neoplasms
    Language English
    Publishing date 2022-05-17
    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 10.1177/00031348221101578
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  3. Article: Impact of Frailty Upon Surgical Decision-Making for Left-Sided Colon Cancer.

    Sibia, Udai S / Badve, Shivani B / Istl, Alexandra C / Klune, J Robert / Riker, Adam I

    The Ochsner journal

    2023  Volume 23, Issue 2, Page(s) 120–128

    Abstract: Background: ...

    Abstract Background:
    Language English
    Publishing date 2023-05-31
    Publishing country United States
    Document type Journal Article
    ISSN 1524-5012
    ISSN 1524-5012
    DOI 10.31486/toj.22.0120
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  4. Article ; Online: Interfacility Transfer for Nonelective Cholecystectomy in High MELD Patients: An ACS-NSQIP Analysis.

    Turcotte, Justin J / Weltz, Adam S / Bussey, Ian / Abrams, Peter L / Feather, Cristina B / Klune, J Robert

    The Journal of surgical research

    2022  Volume 279, Page(s) 127–134

    Abstract: Introduction: Interfacility transfer to a referral center is often considered for patients with liver disease undergoing nonelective cholecystectomy given management complexities and perioperative risk. We sought to determine the association between the ...

    Abstract Introduction: Interfacility transfer to a referral center is often considered for patients with liver disease undergoing nonelective cholecystectomy given management complexities and perioperative risk. We sought to determine the association between the Model for End Stage Liver Disease (MELD) score, transfer frequency, and outcomes in those patients using a national database.
    Materials and methods: The ACS-NSQIP participant use files were queried for nonelective open or laparoscopic cholecystectomy from 2016 to 2018. Patients were grouped according to low (6-11), intermediate (12-18), or high (>18) MELD. In the high MELD group, patient characteristics and outcomes were compared between transferred and nontransferred patients and multivariate regression was performed to evaluate independent predictors of outcomes. Outcomes included in-hospital mortality, complications, length-of-stay (LOS), and 30-d reoperation and readmission.
    Results: 30,171 subjects were included. Transfer was more likely as MELD increased (19.5% high versus 12.1% low, P < 0.001). High MELD patients had increased LOS, reoperation, readmission, and mortality rates compared to low MELD. In high MELD patients (n = 1016), those transferred were more likely older, white, obese, and septic. Transferred patients had increased mortality (7.6% versus 4.2%, P = 0.044), LOS, reoperation, and complications. After controlling for differences between transferred and nontransferred patients, transfer status was not independently associated with mortality (OR = 1.593, P = 0.177), postoperative complications or LOS, but was associated with increased risk for reoperation. Sepsis and laparoscopic surgery were independently associated with higher and lower mortality, respectively.
    Conclusions: Transfer status is not independently associated with mortality, postoperative complications, or prolonged LOS, suggesting patients with advanced liver disease undergoing acute cholecystectomy may not benefit from interfacility transfer.
    MeSH term(s) Cholecystectomy/adverse effects ; Cholecystectomy, Laparoscopic/adverse effects ; End Stage Liver Disease/complications ; End Stage Liver Disease/surgery ; Humans ; Length of Stay ; Liver Diseases/complications ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Retrospective Studies ; Severity of Illness Index
    Language English
    Publishing date 2022-06-24
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80170-7
    ISSN 1095-8673 ; 0022-4804
    ISSN (online) 1095-8673
    ISSN 0022-4804
    DOI 10.1016/j.jss.2022.05.021
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  5. Article ; Online: Indocyanine green does not decrease the need for bail-out operation in an acute care surgery population.

    Turcotte, Justin / Leydorf, S Daniel / Ali, Moneim / Feather, Cristina / Klune, J Robert

    Surgery

    2020  Volume 169, Issue 2, Page(s) 227–231

    Abstract: Background: The use of indocyanine green during laparoscopic cholecystectomy has been postulated to help to define anatomy. Studies have not specifically evaluated patients with acute cholecystitis. We sought to assess whether use of indocyanine green ... ...

    Abstract Background: The use of indocyanine green during laparoscopic cholecystectomy has been postulated to help to define anatomy. Studies have not specifically evaluated patients with acute cholecystitis. We sought to assess whether use of indocyanine green can decrease the rate of bail-out operation (subtotal cholecystectomy or conversion to an open operation) in an acute care surgery population where acute cholecystitis is more frequent.
    Methods: Using a retrospective cohort design, we examined all inpatient cholecystectomies performed by the acute care surgery service under urgent or semiurgent (biliary colic as the presentation in the emergency room) conditions at a single institution from 7/1/18 to 6/30/19 during which indocyanine green was available for use at the surgeon's discretion.
    Results: A total of 198 patients were included in the analysis. Demographic variables were similar in groups receiving indocyanine green versus not. Pathology confirmed acute cholecystitis was present in 96 of 198 (48.5%) patients; of those, 55 (57.2%) received indocyanine green. Indocyanine green did not change the rate of bail-out operation between patients who received indocyanine green and those who did not (6.7% vs 4.3%, P = .468). No significant differences in complications were observed. Bail-out operation was more likely in cases of acute cholecystitis (9.4%) versus nonacute cholecystitis (2.0%) (odds ratio = 5.172, P = .039). In patients with acute cholecystitis, indocyanine green did not change the rate of bail-out operation (indocyanine green: 12.7% vs no indocyanine green: 4.9%, P = .293).
    Conclusion: This is the first series looking at the use of indocyanine green specifically in an acute care surgery population. Indocyanine green did not decrease operative time or need for a bail-out operation in acute cholecystitis. Further study is needed to determine whether indocyanine green use is justified in this population.
    MeSH term(s) Adult ; Aged ; Bile Ducts/diagnostic imaging ; Bile Ducts/injuries ; Cholecystectomy, Laparoscopic/adverse effects ; Cholecystectomy, Laparoscopic/methods ; Cholecystectomy, Laparoscopic/statistics & numerical data ; Cholecystitis, Acute/surgery ; Coloring Agents/administration & dosage ; Conversion to Open Surgery/statistics & numerical data ; Emergency Treatment/adverse effects ; Emergency Treatment/methods ; Emergency Treatment/statistics & numerical data ; Feasibility Studies ; Female ; Gallbladder/surgery ; Humans ; Indocyanine Green/administration & dosage ; Intraoperative Complications/epidemiology ; Intraoperative Complications/etiology ; Intraoperative Complications/prevention & control ; Male ; Middle Aged ; Operative Time ; Retrospective Studies
    Chemical Substances Coloring Agents ; Indocyanine Green (IX6J1063HV)
    Language English
    Publishing date 2020-07-24
    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.2020.05.045
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  6. Article ; Online: Does Wound Management Technique Impact Surgical Site Infection in Open Emergency Colon Procedures?

    Turcotte, Justin J / Boord, Andrea / Antognoli, Lauren / Klune, J Robert / Feather, Cristina B

    The American surgeon

    2020  Volume 88, Issue 1, Page(s) 140–145

    Abstract: Background: Emergency open large bowel procedures have higher rates of intraoperative contamination and increased risk of surgical site infection (SSI) than elective colon surgeries. Several wound management strategies have been proposed, such as vacuum- ...

    Abstract Background: Emergency open large bowel procedures have higher rates of intraoperative contamination and increased risk of surgical site infection (SSI) than elective colon surgeries. Several wound management strategies have been proposed, such as vacuum-assisted closure (VAC) therapy and delayed primary closure to improve results. The purpose of this study is to evaluate the relationship between wound management technique and SSI and other quality measures.
    Methods: We performed a retrospective review of patients undergoing open emergency colon surgery from January 2017 to December 2018 by our acute care surgery service. The primary outcome measure was incidence of SSI. Secondary outcome measures included length of stay, reoperation, and 30-day readmission.
    Results: A total of 118 patients were included in the study, with a mean age of 62.8 years and mean BMI of 28.8. Overall incidence of SSI was 19.5%. There was no significant difference in incidence of SSI, reoperation, or 30-day readmission when stratifying by wound management technique or procedure type after controlling for confounding variables. Notably, patients managed with VAC therapy had a statistically significant longer average length of stay and higher total postoperative antibiotic days (both
    Discussion: We conclude from our data that wound management technique does not seem to influence rate of SSI, but wound management may influence length of stay or antibiotic duration. These findings suggest that there may not be an advantage to alternative methods of wound management in this high-risk population. Further prospective evaluation should be performed to confirm these findings.
    MeSH term(s) Anti-Bacterial Agents/therapeutic use ; Appendectomy/statistics & numerical data ; Body Mass Index ; Colon/surgery ; Emergencies ; Female ; Humans ; Incidence ; Length of Stay ; Male ; Middle Aged ; Negative-Pressure Wound Therapy ; Outcome Assessment, Health Care ; Patient Readmission/statistics & numerical data ; Reoperation/statistics & numerical data ; Retrospective Studies ; Surgical Wound Infection/drug therapy ; Surgical Wound Infection/epidemiology ; Surgical Wound Infection/etiology ; Wound Closure Techniques
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2020-12-31
    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 10.1177/0003134820982565
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  7. Article ; Online: To close or not to close? Wound management in emergent colorectal surgery, an EAST Multicenter prospective cohort study.

    Feather, Cristina B / Rehrig, Scott / Allen, Rebecca / Barth, Nadine / Kugler, Emmalee M / Cullinane, Daniel C / Falank, Carolyne R / Bhattacharya, Bishwajit / Maung, Adrian A / Seng, Sirivan / Ratnasekera, Asanthi / Bass, Gary Alan / Butler, Dale / Pascual, Jose L / Srikureja, Daniel / Winicki, Nolan / Lynde, Jennifer / Nowak, Brittany / Azar, Faris /
    Thompson, Lauren A / Nahmias, Jeffry / Manasa, Morgan / Tesoriero, Ronald / Kumar, Sandhya B / Collom, Morgan / Kincaid, Michelle / Sperwer, Kimberly / Santos, Ariel P / Klune, J Robert / Turcotte, Justin

    The journal of trauma and acute care surgery

    2024  

    Abstract: Background: To determine the clinical impact of wound management technique on surgical site infection (SSI), hospital length of stay (LOS) and mortality in emergent colorectal surgery.: Methods: A prospective observational study (2021-2023) of urgent ...

    Abstract Background: To determine the clinical impact of wound management technique on surgical site infection (SSI), hospital length of stay (LOS) and mortality in emergent colorectal surgery.
    Methods: A prospective observational study (2021-2023) of urgent or emergent colorectal surgery patients at 15 institutions was conducted. Pediatric patients and traumatic colorectal injuries were excluded. Patients were classified by wound closure technique: skin closed (SC), skin loosely closed (SLC), or skin open (SO). Primary outcomes were SSI, hospital LOS and in-hospital mortality rates. Multivariable regression was used to assess the effect of wound closure on outcomes after controlling for demographics, patient characteristics, ICU admission, vasopressor use, procedure details and wound class. A priori power analysis indicated that 138 patients per group were required to detect a 10% difference in mortality rates.
    Results: In total, 557 patients were included (SC n = 262, SLC n = 124, SO n = 171). Statistically significant differences in BMI, race/ethnicity, ASA scores, EBL, ICU admission, vasopressor therapy, procedure details, and wound class were observed across groups (Table 1). Overall, average LOS was 16.9 ± 16.4 days, and rates of in-hospital mortality and SSI were 7.9% and 18.5%, respectively, with the lowest rates observed in the SC group (Table 2). After risk adjustment, SO was associated with increased risk of mortality (OR = 3.003, p = 0.028 in comparison to the SC group. SLC was associated with increased risk of superficial SSI (OR = 3.439, p = 0.014), after risk adjustment.
    Conclusion: When compared to the SC group, the SO group was associated with mortality, but comparable when considering all other outcomes, while the SLC was associated with increased superficial SSI. Complete skin closure may be a viable wound management technique in emergent colorectal surgery.
    Study type: Level III Therapeutic/Care Management.
    Language English
    Publishing date 2024-03-25
    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.0000000000004321
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