Publications by authors named "Jamie E Anderson"

62 Publications

Single-Examination Risk Prediction of Severe Retinopathy of Prematurity.

Pediatrics 2021 Nov 23. Epub 2021 Nov 23.

Departments of Ophthalmology.

Background And Objectives: Retinopathy of prematurity (ROP) is a leading cause of childhood blindness. Screening and treatment reduces this risk, but requires multiple examinations of infants, most of whom will not develop severe disease. Previous work has suggested that artificial intelligence may be able to detect incident severe disease (treatment-requiring retinopathy of prematurity [TR-ROP]) before clinical diagnosis. We aimed to build a risk model that combined artificial intelligence with clinical demographics to reduce the number of examinations without missing cases of TR-ROP.

Methods: Infants undergoing routine ROP screening examinations (1579 total eyes, 190 with TR-ROP) were recruited from 8 North American study centers. A vascular severity score (VSS) was derived from retinal fundus images obtained at 32 to 33 weeks' postmenstrual age. Seven ElasticNet logistic regression models were trained on all combinations of birth weight, gestational age, and VSS. The area under the precision-recall curve was used to identify the highest-performing model.

Results: The gestational age + VSS model had the highest performance (mean ± SD area under the precision-recall curve: 0.35 ± 0.11). On 2 different test data sets (n = 444 and n = 132), sensitivity was 100% (positive predictive value: 28.1% and 22.6%) and specificity was 48.9% and 80.8% (negative predictive value: 100.0%).

Conclusions: Using a single examination, this model identified all infants who developed TR-ROP, on average, >1 month before diagnosis with moderate to high specificity. This approach could lead to earlier identification of incident severe ROP, reducing late diagnosis and treatment while simultaneously reducing the number of ROP examinations and unnecessary physiologic stress for low-risk infants.
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http://dx.doi.org/10.1542/peds.2021-051772DOI Listing
November 2021

Misdiagnosis of Congenital Posterior Urethroperineal Fistula and Comparison With Urethral Duplications and Rectourethral Fistula.

Urology 2021 Oct 2. Epub 2021 Oct 2.

Division of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA.

Congenital posterior urethroperineal fistula (CUPF) is a urothelium-lined tract between the posterior urethra and perineum. This condition is rare and has been proposed to be a urethral duplication variant. A case of CUPF that was misdiagnosed and surgically treated as a rectourethral fistula is presented. The clinical presentation, diagnosis, and treatment of CUPF are discussed and compared with those of Y-type urethral duplications and H-type rectourethral fistulas.
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http://dx.doi.org/10.1016/j.urology.2021.09.013DOI Listing
October 2021

Challenges in Diagnosis and Treatment of Children With Multisystem Inflammatory Syndrome and Appendicitis.

JAMA Pediatr 2021 Nov;175(11):1180-1181

Division of General and Thoracic Pediatric Surgery, Seattle Children's Hospital, Seattle, Washington.

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http://dx.doi.org/10.1001/jamapediatrics.2021.2420DOI Listing
November 2021

COVID-19-associated multisystem inflammatory syndrome in children (MIS-C) presenting as appendicitis with shock.

J Pediatr Surg Case Rep 2021 Aug 19;71:101913. Epub 2021 May 19.

Division of General and Thoracic Pediatric Surgery, USA.

Multisystem inflammatory syndrome in children (MIS-C) is an identified complication of the COVID-19 infection. A common presentation of both COVID-19 and MIS-C is acute abdominal pain, sometimes mimicking appendicitis. We report two cases of patients initially diagnosed with appendicitis who either presented with or developed signs of shock and were found to have MIS-C. An 8-year-old girl who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcriptase-polymerase chain reaction (RT-PCR) presented with fever, abdominal pain, and shock with ultrasound findings consistent with acute appendicitis. After being treated for MIS-C, she underwent appendectomy and improved. Final pathology was consistent with acute appendicitis. A 9-year-old girl who tested negative for COVID RT-PCR presented with uncomplicated appendicitis and underwent laparoscopic appendectomy, but developed post-operative fever and shock. Antibody testing was positive and she responded to treatment for MIS-C. Histology showed lymphohistiocytic inflammation within the muscularis propria, mesoappendix and serosa without the typical neutrophil-rich inflammation and mucosal involvement of acute appendicitis. The diagnosis was MIS-C, not appendicitis. Given the new reality of the COVID-19 pandemic, pediatric surgeons must be aware of MIS-C as a possible diagnosis and should understand the diagnostic criteria and current treatment guidelines.
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http://dx.doi.org/10.1016/j.epsc.2021.101913DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8132508PMC
August 2021

Inclusion of Children's Surgery in National Surgical Plans and Child Health Programmes: the need and roadmap from Global Initiative for Children's Surgery.

Pediatr Surg Int 2021 May 5;37(5):529-537. Epub 2021 Jan 5.

Department of Surgery, National Hospital, Abuja, Nigeria.

About 1.7 billion children and adolescents, mostly in low- and middle-income countries (LMICs) lack access to surgical care. While some of these countries have developed surgical plans and others are in the process of developing theirs, children's surgery has not received the much-needed specific emphasis and focus in these plans. With the significant burden of children's surgical conditions especially in low- and middle-income countries, universal health coverage and the United Nations' (UN) Sustainable Development Goals (SDG) will not be achieved without deliberate efforts to scale up access to children's surgical care. Inclusion of children's surgery in National Surgical Obstetric and Anaesthesia Plans (NSOAPs) can be done using the Global Initiative for Children's Surgery (GICS)-modified Children's Surgical Assessment Tool (CSAT) tool for baseline assessment and the Optimal Resources for Children Surgical Care (OReCS) as a foundational tool for implementation.
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http://dx.doi.org/10.1007/s00383-020-04813-xDOI Listing
May 2021

A Survey of the Surgical Morbidity and Mortality Conference in the United States and Canada: A Dying Tradition or the Key to Modern Quality Improvement?

J Surg Educ 2021 May-Jun;78(3):927-933. Epub 2020 Nov 1.

Department of Surgery, University of California, Davis Medical Center, Sacramento, California.

Objective: We seek to identify the current role and practices of the surgery morbidity and mortality (M&M) conference in academic surgery departments in the United States and Canada.

Design, Setting, And Participants: All members of the Society of Surgical Chairs, a program of the American College of Surgeons, were e-mailed an IRB-approved 28-question electronic survey in fall 2017. Up to 3 reminders were sent.

Results: Responses from 129/186 (69%) departments of surgery were received. Nearly all departments (96%) continue to have a departmental M&M conference. The M&M conference is typically weekly (93%), between 7 and 9 AM (80%), on weekdays during which there are no scheduled elective operations (84%). Attendance is mandatory for residents (98%), but required for faculty in only 49% of departments. Fewer than half of all departments (44%) have written guidelines as to which complications should be reported to M&M. Most conferences are prepared case presentations (89%), but may include unprepared discussions (17%), case-based educational presentations (30%), or a combination (28%). The most common classification category was by root case of the error (60%) and preventability (58%). Most departments keep electronic and/or physical M&M reports, while 21% maintain a relational database and 25% do not retain records. While almost all (96%) departments reported participating in at least one national quality improvement program, these are not often linked to the M&M process.

Conclusions: M&M is predominantly seen as an educational conference based on a few select cases. Departmental quality is monitored with hospital-driven or national quality improvement efforts. Integration of hospital-based quality metric programs with surgery M&M conference is uncommon and represents an opportunity for hospital-department collaboration.
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http://dx.doi.org/10.1016/j.jsurg.2020.10.008DOI Listing
June 2021

Trauma as an Entry Point to the Health Care System.

JAMA Surg 2020 10;155(10):982-984

Division of Trauma and Acute Care Surgery, Department of Surgery, University of California Davis Medical Center, Sacramento.

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http://dx.doi.org/10.1001/jamasurg.2020.2178DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7407324PMC
October 2020

Practice, Practice, Practice! Effect of Resuscitative Endovascular Balloon Occlusion of the Aorta Volume on Outcomes: Data From the AAST AORTA Registry.

J Surg Res 2020 09 17;253:18-25. Epub 2020 Apr 17.

Division of Trauma, University of California Davis Medical Center, Acute Care, and General Surgery Sacramento, CA.

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an endovascular adjunct to hemorrhage control. Success relies on institutional support and focused training in arterial access. We hypothesized that hospitals with higher REBOA volumes will be more successful than low-volume hospitals at aortic occlusion with REBOA.

Methods: This is a retrospective study from the American Association for the Surgery of Trauma Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery Registry from November 2013 to January 2018. Patients aged ≥18 y who underwent REBOA were included. Successful placement of REBOA catheters (defined as hemodynamic improvement with balloon inflation) was compared between high-volume (≥80 cases; two hospitals), mid-volume (10-20 cases; four hospitals), and low-volume (<10 cases; 14 hospitals) hospitals, adjusting for patient factors.

Results: Of 271 patients from 20 hospitals, 210 patients (77.5%) had successful REBOA placement. Most patients were male (76.0%) and sustained blunt trauma (78.1%). cardiopulmonary resuscitation (CPR) was ongoing at the time of REBOA placement in 34.5% of patients. Inpatient mortality was 67.4%, unchanged by hospital volume. Multivariable logistic regression found increased odds of successful REBOA placement at high-volume versus low-volume hospitals (odds ratio [OR], 7.50; 95% confidence interval [CI], 2.10-27.29; P = 0.002) and mid-volume versus low-volume hospitals (OR, 7.82; 95% CI, 1.52-40.31; P = 0.014) and decreased odds among patients undergoing CPR during REBOA placement (OR, 0.10; 95% CI, 0.03-0.34; P < 0.001) when adjusting for age, sex, mechanism of injury, prehospital CPR, CPR on admission, transfer status, hospital location of REBOA placement, Glasgow Coma Scale ≤ 13, and injury severity.

Conclusions: Hospitals with higher REBOA volumes were more likely to achieve hemodynamic improvement with REBOA inflation. However, mortality and complication rates were unchanged. Independent of hospital volume, ongoing CPR is associated with a decreased odds of successful REBOA placement.
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http://dx.doi.org/10.1016/j.jss.2020.03.027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7384927PMC
September 2020

In utero treatment of myelomeningocele with placental mesenchymal stromal cells - Selection of an optimal cell line in preparation for clinical trials.

J Pediatr Surg 2020 Sep 21;55(9):1941-1946. Epub 2019 Oct 21.

University of California-Davis, 4625 2nd Ave, Suite 3005, Sacramento, CA 95817, USA; Shriners Hospitals for Children Northern California, 2425 Stockton Blvd, Sacramento, CA 95817, USA. Electronic address:

Background: We determined whether in vitro potency assays inform which placental mesenchymal stromal cell (PMSC) lines produce high rates of ambulation following in utero treatment of myelomeningocele in an ovine model.

Methods: PMSC lines were created following explant culture of three early-gestation human placentas. In vitro neuroprotection was assessed with a neuronal apoptosis model. In vivo, myelomeningocele defects were created in 28 fetuses and repaired with PMSCs at 3 × 10 cells/cm of scaffold from Line A (n = 6), Line B (n = 7) and Line C (n = 5) and compared to no PMSCs (n = 10). Ambulation was scored as ≥13 on the Sheep Locomotor Rating Scale.

Results: In vitro, Line A and B had higher neuroprotective capability than no PMSCs (1.7 and 1.8 respectively vs 1, p = 0.02, ANOVA). In vivo, Line A and B had higher large neuron densities than no PMSCs (25.2 and 27.9 respectively vs 4.8, p = 0.03, ANOVA). Line C did not have higher neuroprotection or larger neuron density than no PMSCs. In vivo, Line A and B had ambulation rates of 83% and 71%, respectively, compared to 60% with Line C and 20% with no PMSCs.

Conclusion: The in vitro neuroprotection assay will facilitate selection of optimal PMSC lines for clinical use.

Level Of Evidence: n/a.

Type Of Study: Basic science.
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http://dx.doi.org/10.1016/j.jpedsurg.2019.09.029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170747PMC
September 2020

Trauma and acute care surgeons report prescribing less opioids over time.

Trauma Surg Acute Care Open 2019 27;4(1):e000255. Epub 2019 Mar 27.

Department of Surgery, University of California, Davis, Sacramento, California, USA.

Introduction: Confronted with the opioid epidemic, surgeons must play a larger role to reduce risk of opioid abuse while managing acute pain. Having a better understanding of the beliefs and practices of trauma and acute care surgeons regarding discharge pain management may offer potential targets for interventions beyond fixed legal mandates.

Methods: An Institutional Review Board-approved electronic survey was sent to trauma and acute care surgeons who are members of the American Association for the Surgery of Trauma, and trauma and acute care surgeons and nurse practitioners at a Level 1 trauma center in February 2018. The survey included four case-based scenarios and questions about discharge prescription practices and beliefs.

Results: Of 66 respondents, most (88.1%) were at academic institutions. Mean number of opioid tablets prescribed was 20-30 (range 5-90), with the fewest tablets prescribed for elective laparoscopic cholecystectomy and the most for rib fractures. Few prescribed both opioid and non-opioid medications (22.4% to 31.4 %). Most would not change the number/strength of medications (69.2%), dose (53.9%), or number of tablets of opioids (83.1%) prescribed if patients used opioids regularly prior to their operation. The most common factors that made providers more likely to prescribe opioids were high inpatient opioid use (32.4%), history of opioid use/abuse (24.5%), and if the patient lives far from the hospital (12.9%). Most providers in practice >5 years reported a decrease in opioids (71.9%) prescribed at discharge.

Conclusion: Trauma and acute care surgeons and nurse practitioners reported decreasing the number/amount of opioids prescribed over time. Patients with high opioid use in the hospital, history of opioid use/abuse, or who live far from the provider may be prescribed more opioids at discharge.

Level Of Evidence: Level IV.
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http://dx.doi.org/10.1136/tsaco-2018-000255DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6461144PMC
March 2019

Correction to: Assessment of Capacity to Meet Lancet Commission on Global Surgery Indicators in the Federal Capital Territory, Abuja, Nigeria.

World J Surg 2019 03;43(3):715-716

Nigeria National Surgical, Obstetric, Anesthesia, Nursing Plan Committee, Abuja, Nigeria.

In the original article there is an error in Fig. 2. Following is the corrected figure.
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http://dx.doi.org/10.1007/s00268-018-04886-9DOI Listing
March 2019

Assessment of Capacity to Meet Lancet Commission on Global Surgery Indicators in the Federal Capital Territory, Abuja, Nigeria.

World J Surg 2019 Mar;43(3):704-714

Nigeria National Surgical, Obstetric, Anesthesia, Nursing Plan Committee, Abuja, Nigeria.

Background: This is a baseline assessment of surgical capacity in the Federal Capital Territory (FCT), in preparation for the creation of a National Surgical, Obstetric, Anesthesia, and Nursing Plan.

Methods: In October 2017, all 10 of the 11 secondary hospitals in FCT that provide surgical and/or obstetric care were surveyed using a modified World Health Organization Hospital Assessment Tool and a qualitative semi-structured hospital interview tool of the medical Director (MdD). This project received approval from the Nigeria Federal Ministry of Health and the FCT Department of Health and Human Services.

Results: The number of inpatient beds ranged from 35 to 140, and the number of admissions ranged from 1200 to 6400 patients per year. The mean number of surgeries performed in 2016 by these hospitals was 783 (range 235-1601). Cesarean section was the most common surgical procedure at each hospital. Only five hospitals regularly performed laparotomies. Only three hospitals regularly performed fixation of open fractures. Of 152 surgical, obstetric, and anesthesia providers, all hospitals had at least one consultant obstetrician, but only four hospitals had a general surgeon and three hospitals had a consultant anesthesiologist. Deficient physical space for inpatient admissions was the most common concern of MdDs.

Conclusions: The FCT reaches the target for 2-h access, with 80% of patients (on average) reaching the hospital within 2 h. However, SAO provider density, surgical volume, and tracking of the perioperative mortality rate were low. Data were lacking to comment on protection against impoverishing and catastrophic expenditures.
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http://dx.doi.org/10.1007/s00268-018-4835-zDOI Listing
March 2019

Epidemiology of Hirschsprung disease in California from 1995 to 2013.

Pediatr Surg Int 2018 Dec 15;34(12):1299-1303. Epub 2018 Oct 15.

Division of Pediatric General, Thoracic, and Fetal Surgery, University of California, Davis Medical Center, 2215 Stockton Boulevard, OP512, Sacramento, CA, 95817, USA.

Purpose: This study seeks to update current epidemiology of Hirschsprung disease (HD) in California.

Methods: Using data from the California Office of Statewide Health Planning and Development Linked Birth (1995-2012) and Patient Discharge Databases (1995-2013), patients from either dataset with an ICD-9 diagnosis code of HD (751.3) or procedure code of Soave (48.41), Duhamel (48.65), or Swenson/other pull-through (48.49) were included. Patients > age 18 during their first admission were excluded.

Results: Of 9.3 million births, 2,464 patients were identified. Incidence was 2.2 cases/10,000 live births, with rates peaking at 2.9/10,000 births in 2002. Incidence was highest among African American (4.1/10,000) and Asian/Pacific Islander (2.5/10,000) births. Most were male (n = 1652, 67.1%). Sixty patients (2.4%) had Down syndrome. The median gestational age at birth was 38 weeks 6 days (interquartile range [IQR] 37 weeks 1 day-40 weeks 1 day). Mortality during the first year of life was 1.7%. Median age at death was 14.5 days (IQR 0-113 days).

Conclusion: This is one of the largest population-based studies of HD. In California, the incidence of HD is stable, risk is highest among African American children, and the mortality rate is < 2%.
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http://dx.doi.org/10.1007/s00383-018-4363-9DOI Listing
December 2018

Epidemiology of gastroschisis: A population-based study in California from 1995 to 2012.

J Pediatr Surg 2018 Dec 4;53(12):2399-2403. Epub 2018 Sep 4.

Division of Pediatric General, Thoracic, and Fetal Surgery, University of California, Davis Medical Center, Sacramento, CA.

Background: Although the incidence of gastroschisis is increasing, risk factors are not clearly identified.

Methods: Using the Linked Birth Database from the California Office of Statewide Health Planning and Development from 1995 to 2012, patients with gastroschisis were identified by ICD-9 diagnosis/procedure code or birth certificate designation. Logistic regressions examined demographics, birth factors, and maternal exposures on risk of gastroschisis.

Results: The prevalence of gastroschisis was 2.7 cases per 10,000 live births. Patients with gastroschisis had no difference in fetal exposure to alcohol (p = 0.609), narcotics (p = 0.072), hallucinogenics (p = 0.239), or cocaine (p = 0.777), but had higher exposure to unspecified/other noxious substances (OR 3.27, p = 0.040; OR 2.02, p = 0.002). Gastroschisis was associated with low/very low birthweight (OR 5.08-16.21, p < 0.001) and preterm birth (OR 3.26-10.0, p < 0.001). Multivariable analysis showed lower risk in black (OR 0.44, p < 0.001), Asian/Pacific Islander (OR 0.76, p = 0.003), and Hispanic patients (OR 0.72, p < 0.001) compared to white patients. Risk was higher in rural areas (OR 1.24-1.76, p = 0.001). Compared to women age < 20, risk decreased with advancing maternal age (OR 0.49-OR 0.03, p < 0.001). Patients with gastroschisis had increased total charges ($336,270 vs. $9012, p < 0.001) and length of stay (38.1 vs. 2.9 days, p < 0.001). Mortality was 4.6%.

Conclusions: This is the largest population-based study summarizing current epidemiology of gastroschisis in California.

Type Of Study: Retrospective comparative cohort study.

Level Of Evidence: III.
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http://dx.doi.org/10.1016/j.jpedsurg.2018.08.035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6327946PMC
December 2018

Long-term impact of abusive head trauma in young children.

Child Abuse Negl 2018 11 23;85:39-46. Epub 2018 Aug 23.

Department of Neurosurgery, University of Louisville, Louisville, KY, USA.

Objective: Abusive head trauma is the leading cause of physical abuse deaths in children under the age of 5 and is associated with severe long-lasting health problems and developmental disabilities. This study evaluates the long-term impact of AHT and identifies factors associated with poor long-term outcomes (LTOs).

Methods: We used the Truven Health MarketScan Research Claims Database (2000-2015) to identify children diagnosed with AHT and follow them up until they turn 5. We identified the incidence of behavioral disorders, communication deficits, developmental delays, epilepsy, learning disorders, motor deficits, and visual impairment as our primary outcomes.

Results: The incidence of any disability was 72% (676/940) at 5 years post-injury. The rate of developmental delays was 47%, followed by 42% learning disorders, and 36% epilepsy. Additional disabilities included motor deficits (34%), behavioral disorders (30%), visual impairment (30%), and communication deficits (11%). Children covered by Medicaid experienced significantly greater long-term disability than cases with private insurance. In a propensity-matched cohort that differ primarily by insurance, the risk of behavioral disorders (RD 36%), learning disorders (RD 30%), developmental delays (RD 30%), epilepsy (RD 18%), and visual impairment (RD 12%) was significantly higher in children with Medicaid than kids with private insurance.

Conclusion: AHT is associated with a significant long-term disability (72%). Children insured by Medicaid have a disproportionally higher risk of long-term disability. Efforts to identify and reduce barriers to health care access for children enrolled in Medicaid are critical for the improvement of outcomes and quality of life.
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http://dx.doi.org/10.1016/j.chiabu.2018.08.011DOI Listing
November 2018

Incidence of Gastroschisis in California.

JAMA Surg 2018 11;153(11):1053-1055

Division of Pediatric General, Thoracic, and Fetal Surgery, University of California Davis Medical Center, Sacramento.

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http://dx.doi.org/10.1001/jamasurg.2018.1744DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6583072PMC
November 2018

Duty-Hour Flexibility Trial in Internal Medicine.

N Engl J Med 2018 07;379(3):299

University of California, Davis, Medical Center, Sacramento, CA

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http://dx.doi.org/10.1056/NEJMc1806648DOI Listing
July 2018

Surgeon-Reported Complications vs AHRQ Patient Safety Indicators: A Comparison of Two Approaches to Identifying Adverse Events.

J Am Coll Surg 2018 09 5;227(3):313-320. Epub 2018 Jul 5.

Department of Surgery, UC Davis Medical Center, Sacramento, CA.

Background: Traditionally, clinicians present complications at surgical morbidity and mortality (M&M) conferences, and the AHRQ Patient Safety Indicators (PSIs) use inpatient administrative data to identify certain adverse outcomes. Although both methods are used to identify adverse events and inform quality improvement efforts, these 2 methods might not overlap.

Study Design: This is a retrospective observational study of all hospitalizations at a single academic department of surgery (including subspecialties) in 2016 involving a PSI-defined event (PSIs 03, 05 to 15) identified by surgery faculty and residents for review by departmental M&M conference or administrative data (according to AHRQ, version 6.0). Pediatric cases were excluded. We analyzed the degree to which these 2 processes captured PSI-defined events and reasons for exclusion by each process.

Results: Among 6,563 surgical hospitalizations, 647 hospitalizations (9.9%) had at least 1 complication identified by the M&M process or the PSIs (or both). Of these hospitalizations, 116 had at least 1 PSI-defined event (for a total of 149 PSI-defined events) captured by either M&M or the PSIs. Most complications (n = 82 [88.2%]) identified by M&M alone were excluded by PSI criteria (as intended), but 11 true PSI events (ie false negatives) were identified by M&M only. In contrast, pressure ulcers and central venous catheter-related bloodstream infections were detected exclusively by the PSIs and not reported via M&M. There was limited overlap, with 18 events (12.1%) captured by both processes.

Conclusions: Surgical M&M and the PSIs are complementary approaches to identifying complications. Both case-finding processes should be used to inform quality improvement efforts.
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http://dx.doi.org/10.1016/j.jamcollsurg.2018.06.008DOI Listing
September 2018

Association of Patient Frailty With Increased Risk of Complications After Adrenalectomy.

JAMA Surg 2018 10;153(10):966-967

Department of Surgery, University of California Davis Medical Center, Sacramento.

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http://dx.doi.org/10.1001/jamasurg.2018.1749DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6233782PMC
October 2018

Prenatal and Postnatal Intervention for a Congenital Lung Mass.

JAMA Surg 2018 10;153(10):961-962

Fetal Care and Treatment Center, Division of Pediatric General, Thoracic and Fetal Surgery, University of California, Davis.

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http://dx.doi.org/10.1001/jamasurg.2018.0889DOI Listing
October 2018

As trauma surgeons, let's call "non-accidental trauma" what it is: Blunt force or penetrating trauma.

J Trauma Acute Care Surg 2018 09;85(3):642-643

From the Department of Surgery (J.E.A., D.L.F., J.M.G.), University of California, Davis, Sacramento, California.

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http://dx.doi.org/10.1097/TA.0000000000001996DOI Listing
September 2018

Questioning the Benefits of Private Vehicle Transportation vs Emergency Medical Services Transportation.

JAMA Surg 2018 06;153(6):596

Division of Trauma and Acute Care Surgery, University of California Davis Medical Center, Sacramento.

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http://dx.doi.org/10.1001/jamasurg.2018.0108DOI Listing
June 2018

Addressing paediatric surgical care on World Birth Defects Day.

Lancet 2018 03 2;391(10125):1019. Epub 2018 Mar 2.

Global Initiative for Children's Surgery, Portland, OR, USA; Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh.

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http://dx.doi.org/10.1016/S0140-6736(18)30501-4DOI Listing
March 2018

Nonocclusive mesenteric ischemia in patients with methamphetamine use.

J Trauma Acute Care Surg 2018 06;84(6):885-892

From the Department of Surgery (J.E.A., I.E.B., K.I., C.S.C., J.M.G.), and Department of Pathology, (K.A.O.), University of California Davis Health, Sacramento, California.

Background: Data suggest that methamphetamine may increase the risk of nonocclusive mesenteric ischemia (NOMI). We describe patterns of presentation and outcomes of patients with methamphetamine use who present with NOMI to a single institution.

Methods: This is an observational study of patients from January 2015 to September 2017 with methamphetamine use who presented with NOMI at an academic medical center in Northern California. We summarize patient comorbidities, clinical presentation, operative findings, pathologic findings, hospital course, and survival.

Results: Ten patients with methamphetamine use and severe NOMI were identified. One patient was readmitted with a perforated duodenal ulcer, for a total of 11 encounters. Most presented with acute (n = 3) or acute-on-chronic (n = 4) abdominal pain. Distribution of ischemia ranged from perforated duodenal ulcer (n = 3), ischemia of the distal ileum (n = 1), ischemia of entire small bowel (n = 2), and patchy necrosis of entire small bowel and colon (n = 5). Six patients died, three within 1 week of admission and three between 3 months and 8 months.

Conclusion: Methamphetamine use may be associated with significant microvascular compromise, increasing the risk of mesenteric ischemia. Providers in areas with high prevalence of methamphetamine use should have a high index of suspicion for intestinal ischemia in this patient population. Patients with methamphetamine use admitted for trauma or other pathology may be at particular risk of ischemia and septic shock, especially in the setting of dehydration. Use of vasoconstrictors in this patient population may also exacerbate intestinal ischemia.

Level Of Evidence: Therapeutic Case series study, level V.
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http://dx.doi.org/10.1097/TA.0000000000001855DOI Listing
June 2018

Restrictions on surgical resident shift length does not impact type of medical errors.

J Surg Res 2017 05 6;212:8-14. Epub 2017 Jan 6.

Department of Surgery, UC Davis Medical Center, Sacramento, California.

Background: In 2011, resident duty hours were restricted in an attempt to improve patient safety and resident education. With the goal of reducing fatigue, shorter shift length leads to more patient handoffs, raising concerns about adverse effects on patient safety. This study seeks to determine whether differences in duty-hour restrictions influence types of errors made by residents.

Materials And Methods: This is a nested retrospective cohort study at a surgery department in an academic medical center. During 2013-14, standard 2011 duty hours were in place for residents. In 2014-15, duty-hour restrictions at the study site were relaxed ("flexible") with no restrictions on shift length. We reviewed all morbidity and mortality submissions from July 1, 2013-June 30, 2015 and compared differences in types of errors between these periods.

Results: A total of 383 patients experienced adverse events, including 59 deaths (15.4%). Comparing standard versus flexible periods, there was no difference in mortality (15.7% versus 12.6%, P = 0.479) or complication rates (2.6% versus 2.5%, P = 0.696). There was no difference in types of errors between periods (P = 0.050-0.808). The most number of errors were due to cognitive failures (229, 59.6%), whereas the fewest number of errors were due to team failure (127, 33.2%). By subset, technical errors resulted in the highest number of errors (169, 44.1%). There were no differences between types of errors of cases that were nonelective, at night, or involving residents.

Conclusions: Among adverse events reported in this departmental surgical morbidity and mortality, there were no differences in types of errors when resident duty hours were less restrictive.
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http://dx.doi.org/10.1016/j.jss.2016.12.038DOI Listing
May 2017

Defining recovery neurobiology of injured spinal cord by synthetic matrix-assisted hMSC implantation.

Proc Natl Acad Sci U S A 2017 01 17;114(5):E820-E829. Epub 2017 Jan 17.

Division of SCI Research, Veterans Affairs Boston Healthcare System, Boston, MA 02130;

Mesenchymal stromal stem cells (MSCs) isolated from adult tissues offer tangible potential for regenerative medicine, given their feasibility for autologous transplantation. MSC research shows encouraging results in experimental stroke, amyotrophic lateral sclerosis, and neurotrauma models. However, further translational progress has been hampered by poor MSC graft survival, jeopardizing cellular and molecular bases for neural repair in vivo. We have devised an adult human bone marrow MSC (hMSC) delivery formula by investigating molecular events involving hMSCs incorporated in a uniquely designed poly(lactic-co-glycolic) acid scaffold, a clinically safe polymer, following inflammatory exposures in a dorsal root ganglion organotypic coculture system. Also, in rat T9-T10 hemisection spinal cord injury (SCI), we demonstrated that the tailored scaffolding maintained hMSC stemness, engraftment, and led to robust motosensory improvement, neuropathic pain and tissue damage mitigation, and myelin preservation. The scaffolded nontransdifferentiated hMSCs exerted multimodal effects of neurotrophism, angiogenesis, neurogenesis, antiautoimmunity, and antiinflammation. Hindlimb locomotion was restored by reestablished integrity of submidbrain circuits of serotonergic reticulospinal innervation at lumbar levels, the propriospinal projection network, neuromuscular junction, and central pattern generator, providing a platform for investigating molecular events underlying the repair impact of nondifferentiated hMSCs. Our approach enabled investigation of recovery neurobiology components for injured adult mammalian spinal cord that are different from those involved in normal neural function. The uncovered neural circuits and their molecular and cellular targets offer a biological underpinning for development of clinical rehabilitation therapies to treat disabilities and complications of SCI.
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http://dx.doi.org/10.1073/pnas.1616340114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5293074PMC
January 2017

Pediatric surgical readmissions: Are they truly preventable?

J Pediatr Surg 2017 Jan 28;52(1):161-165. Epub 2016 Oct 28.

University of California, Davis Health System, Sacramento, CA, USA.

Background/purpose: Reimbursement penalties for excess hospital readmissions have begun for the pediatric population. Therefore, research determining incidence and predictors is critical.

Methods: A retrospective review of University HealthSystem Consortium database (N=258 hospitals; 2,723,621 patients) for pediatric patients (age 0-17years) hospitalized from 9/2011 to 3/2015 was performed. Outcome measures were 7-, 14-, and 30-day readmission rates. Hospital and patient characteristics were evaluated to identify predictors of readmission.

Results: Readmission rates at 7, 14, and 30days were 2.1%, 3.1%, and 4.4%. For pediatric surgery patients (N=260,042), neither index hospitalization length of stay (LOS) nor presence of a complication predicted higher readmissions. Appendectomy was the most common procedure leading to readmission. Evaluating institutional data (N=5785), patients admitted for spine surgery, neurosurgery, transplant, or surgical oncology had higher readmission rates. Readmission diagnoses were most commonly infectious (37.2%) or for nausea/vomiting/dehydration (51.1%). Patients with chronic medical conditions comprised 55.8% of patients readmitted within 7days. 92.0% of patients requiring multiple rehospitalizations had comorbidities.

Conclusions: Readmission rates for pediatric patients are significantly lower than adults. Risk factors for adult readmissions do not predict pediatric readmissions. Readmission may be a misnomer for the pediatric surgical population, as most are related to chronic medical conditions and other nonmodifiable risk factors.

Level Of Evidence: Level IV.
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http://dx.doi.org/10.1016/j.jpedsurg.2016.10.037DOI Listing
January 2017

Getting a better look: Outcomes of laparoscopic versus transdiaphragmatic pericardial window for penetrating thoracoabdominal trauma at a Level I trauma center.

J Trauma Acute Care Surg 2016 12;81(6):1035-1038

From the Department of Surgery, UC Davis Medical Center, Sacramento, California.

Background: In penetrating thoracoabdominal trauma, it is necessary to evaluate both the pericardial fluid and the diaphragm directly. Transdiaphragmatic pericardial windows (TDWs) provide direct access to the pericardium and diaphragm but expose the patient to the risks of laparotomy. We hypothesize that transabdominal laparoscopic pericardial windows (LPWs) are a safe and effective alternative to TDWs in stable patients.

Methods: This is a retrospective observational study of stable patients with thoracoabdominal penetrating trauma at a level I trauma center between January 2007 and June 2015, comparing outcomes after TDW versus LPW.

Results: A total of 99 patients with penetrating trauma had a diagnostic pericardial window, 33 of which were laparoscopic. Stab wounds were most common (80, 80.8%) compared with gunshot wounds (19, 19.2%). Of 11 patients who had a positive pericardial window, 10 (90.9%) were associated with a cardiac injury. There was no difference in the ratio of positive pericardial windows for patients who had TDW versus LPW (8/66, 12.1% vs. 3/33, 9.1%; p = 0.651). One patient had a complication related to a negative pericardial window in the laparoscopic group. There was no difference in complication rates between TDW and LPW (p = 0.155). Mean length of stay was longer in TDW compared with LPW (12 vs. 5 days, p = 0.046). One patient died during index admission in the TDW group, but there was no difference in mortality rates between TDW and LPW during the index admission (p = 0.477). Median length of follow-up was 29 days (range, 0-2,709). On long-term follow-up, there was also no difference in mortality rates between TDW and LPW (2/66, 3.0% vs. 2/33, 6.1%; p = 0.470).

Conclusion: In hemodynamically stable patients with thoracoabdominal injuries, LPW is a safe and effective technique in evaluating both pericardial fluid and the diaphragm. LPW is a viable alternative to exploratory laparotomy and TDWs.

Level Of Evidence: Therapeutic study, level IV.
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http://dx.doi.org/10.1097/TA.0000000000001173DOI Listing
December 2016
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