Publications by authors named "Zachary Tran"

15 Publications

  • Page 1 of 1

National Trends in the Cost Burden of Pediatric Gunshot Wounds Across the United States.

J Pediatr 2021 May 12. Epub 2021 May 12.

Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles. Electronic address:

Objective: To characterize hospitalization costs attributable to gun-related injuries in children across the US.

Study Design: The 2005-2017 National Inpatient Sample (NIS) was used to identify all pediatric admissions for gunshot wounds (GSW). Patients were stratified by ICD-procedural codes for trauma-related operations. Annual trends in GSW hospitalizations and costs were analyzed with survey-weighted estimates. Multivariable regressions were used to identify factors associated with high-cost hospitalizations.

Results: Over the study period, an estimated 36,283 pediatric patients were admitted for a GSW with 43.1% undergoing an operative intervention during hospitalization. Admissions for pediatric firearm injuries decreased from 3,246 in 2005 to 3,185 in 2017 (NPtrend<0.001). The median inflation-adjusted cost was $12,408 (IQR $6,253-$24,585). Median costs rose significantly from $10,749 in 2005 to $16,157 in 2017 (P < .001). Compared with those who did not undergo surgical interventions, operative patients incurred increased median costs ($18,576 vs $8,942, P<0.001). Assault and self-harm injuries as well as several operations were independently associated with classification in the highest cost tertile.

Conclusions: Admissions for pediatric firearm injuries were associated with a significant socioeconomic burden in the US, with increasing resource use over time. Pediatric gun violence is a major public health crisis that warrants further research and advocacy to reduce its prevalence and social impact.
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http://dx.doi.org/10.1016/j.jpeds.2021.05.018DOI Listing
May 2021

Impact of frailty on acute outcomes of endovascular thoracic and abdominal aneurysm repair.

Surgery 2021 Apr 30. Epub 2021 Apr 30.

Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, CA. Electronic address:

Background: While coding-based frailty tools may readily identify at-risk patients, they have not been adopted into screening guidelines for endovascular abdominal aortic aneurysm repair or thoracic endovascular aortic repair at the national level. We aimed to characterize the impact of frailty on clinical outcomes and resource use after endovascular aneurysm repair and thoracic endovascular aortic repair using a nationally representative cohort.

Methods: The 2005 to 2018 National Inpatient Sample was queried to identify all adults undergoing elective endovascular abdominal aortic aneurysm repair or thoracic endovascular aortic repair. Patients were considered "frail" if they suffered from any frailty-defining diagnoses in the Johns Hopkins Adjusted Clinical Groups. Multivariable regression models were used to identify independent associations with outcomes of interest including in-hospital mortality, nonhome discharge, and hospitalization costs.

Results: Of an estimated 301,869 patients, 273,415 (90.6%) underwent endovascular aneurysm repair and the remainder thoracic endovascular aortic repair. Frailty prevalence was lower in the endovascular aneurysm repair cohort (2.3%) compared with thoracic endovascular aortic repair (4.7%). After adjustment, frailty was associated with higher in-hospital mortality (endovascular aneurysm repair odds ratio 4.0; thoracic endovascular aortic repair odds ratio 2.5), nonhome discharge rates (endovascular aneurysm repair odds ratio 7.2; thoracic endovascular aortic repair odds ratio 4.2), and predicted costs (endovascular aneurysm repair ß coefficient +$10.6K; thoracic endovascular aortic repair ß coefficient +$38.2K) for both cohorts.

Conclusion: Given that frailty portends inferior outcomes for both endovascular aneurysm repair and thoracic endovascular aortic repair, its inclusion in existing risk models may better inform shared decision-making.
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http://dx.doi.org/10.1016/j.surg.2021.03.053DOI Listing
April 2021

The obesity paradox: Underweight patients are at the greatest risk of mortality after cholecystectomy.

Surgery 2021 Apr 28. Epub 2021 Apr 28.

Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine, University of California, Los Angeles, CA. Electronic address:

Background: Elevated body mass index is a risk factor for gallstone disease and cholecystectomy, but outcomes for low body mass index patients remain uncharacterized. We examined the association of body mass index with morbidity, mortality, and resource use after cholecystectomy.

Methods: The 2005 to 2016 American College of Surgeons National Surgical Quality Improvement Program was retrospectively analyzed for adult patients undergoing laparoscopic and open cholecystectomy. Patients were stratified into 5 groups: body mass index <18.5 (underweight), body mass index 18.5 to 24.9 (normal weight), body mass index 25 to 29.9 (overweight), body mass index 30 to 34.9 (class I obesity), body mass index 35 to 39.9 (class II obesity), and body mass index ≥40 (class III obesity). Multivariable regressions identified independent associations of covariates with 30-day mortality, complications, and resource use.

Results: Of 327,473 cholecystectomy patients, 1.0% were underweight, 19.5% normal weight, 30.3% overweight, 24.0% class I obesity, 13.5% class II obesity, and 11.7% class III obesity. After multivariable analysis, underweight patients had a higher risk of mortality (adjusted odds ratio = 1.53; P = .029) and postoperative bleeding (adjusted odds ratio = 1.45; P = .011) relative to normal weight patients. Conversely, class III obesity patients had lower mortality (adjusted odds ratio = 0.66; P = .005) but increased operative time (β = 10.2 minutes; P < .001), wound infection (adjusted odds ratio = 1.38; P < .001), and wound dehiscence (adjusted odds ratio = 2.20; P < .001). Hospital duration of stay and readmission rates were highest for underweight patients.

Conclusion: Underweight patients experience increased risk of mortality and readmission, while class III obesity patients have higher rates of wound infection and dehiscence as well as prolonged operative time. These findings may guide choice of intervention.
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http://dx.doi.org/10.1016/j.surg.2021.03.034DOI Listing
April 2021

Impact of Postoperative Infections on Readmission and Resource Use in Elective Cardiac Surgery.

Ann Thorac Surg 2021 Apr 18. Epub 2021 Apr 18.

Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, California. Electronic address:

Background: Efforts to reduce postoperative infections have garnered national attention, leading to practice guidelines for cardiac surgical perioperative care. The present study characterized the impact of healthcare-acquired infection (HAI) on index hospitalization costs and post-discharge healthcare utilization.

Methods: Adults undergoing elective coronary artery bypass grafting (CABG) and/or valve operations were identified in the 2016-2018 Nationwide Readmissions Database. Infections were categorized into bloodstream, gastrointestinal, pulmonary, surgical site, or urinary tract infections. Generalized linear or flexible hazard models were used to assess associations between infections and outcomes. Observed-to-expected (O/E) ratios were generated to examine inter-hospital variation in HAI.

Results: Of an estimated 444,165 patients, 8.0% developed HAI. Patients with HAI were older, had a greater burden of chronic diseases, and more commonly underwent CABG/valve or multi-valve operations (all p<0.001). HAI was independently associated with mortality (odds ratio 4.02, 95% CI 3.67-4.40), non-home discharge (3.48, 95% CI 3.21-3.78), and a cost increase of $23,000 (95% CI 20,900-25,200). At 90 days, HAI was associated with greater hazard of readmission (1.29, 95% CI 1.24-1.35). Pulmonary infections had the greatest incremental impact on patient-level ($24,500, 95% CI 23,100-26,00) and annual cohort costs ($121.8 million, 95% CI 102.2-142.9 million). Significant hospital level variation in HAI was evident, with O/E ranging from 0.17 to 4.3 for cases performed in 2018.

Conclusions: Infections following cardiac surgery remain common and are associated with inferior outcomes and increased resource use. The presence of inter-hospital variation in this contemporary cohort emphasizes the ongoing need for systematic approaches in their prevention and management.
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http://dx.doi.org/10.1016/j.athoracsur.2021.04.013DOI Listing
April 2021

The Impact of Expedited Discharge on 30-Day Readmission Following Lung Resection: A National Study.

Ann Thorac Surg 2021 Apr 18. Epub 2021 Apr 18.

Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA. Electronic address:

Background: Expedited discharge (within 24 hours) following lung resection has received scrutiny due to concerns for higher readmissions and paradoxically increased costs. The present study examined the impact of expedited discharge on hospitalization costs and unplanned readmissions using a nationally-representative sample. In addition, we sought to determine inter-hospital practice variation.

Methods: Adults undergoing elective lobar or sublobar resection were identified using the 2016-2018 Nationwide Readmissions Database, while those with postoperative duration of hospitalization >5 days or experienced any perioperative complication, were excluded. Patients were classified as Expedited if postoperative hospitalization was 0 or 1 day and otherwise as Routine. Inverse probability of treatment weighing was utilized to adjust for intergroup differences. Hospitals were ranked according to risk-adjusted early discharge rates. Multivariable regression models were developed to assess the association of expedited discharge on nonelective 30-day readmissions as well as associated mortality and costs.

Results: Of an estimated 84,152 patients, 13,834 (16.4%) comprised the Expedited group. Compared to Routine, Expedited were younger, less likely to have chronic obstructive pulmonary disease and undergo open procedures. Following adjustment, early discharge was associated with lower incremental costs (β coefficient: -$3.6K, 95%CI: -4.4 - -2.8) as well as similar readmissions (odds ratio: 0.89, 95%CI: 0.70 - 1.13) and related-mortality. Nearly half (48.1%) of all hospitals performed zero early discharges.

Conclusions: Expedited discharge following lung resection is a feasible management strategy and is associated with decreased costs and similar readmission risk compared to the norm. Select individuals should be strongly considered for expedited discharge following lung resection.
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http://dx.doi.org/10.1016/j.athoracsur.2021.04.009DOI Listing
April 2021

Trends and Outcomes of Surgical Re-exploration Following Cardiac Operations in the United States.

Ann Thorac Surg 2021 Apr 17. Epub 2021 Apr 17.

Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles. Electronic address:

Background: Surgical re-exploration following cardiac surgery has been associated with increased in-hospital complications and mortality in limited series. The present study examined trends in reoperation and its impact on clinical outcomes and resource use in a nationally-representative cohort. We sought to determine patient and hospital factors associated with re-exploration and reoperative mortality, defined as failure-to-rescue-surgical (FTR-S).

Methods: Adult hospitalizations entailing cardiac operations (coronary artery bypass and/or valve) were identified using the 2005-2018 National Inpatient Sample. Procedures were tabulated using International Classification of Diseases codes. Hospitals were ranked into tertiles according to risk-adjusted mortality, with the lowest stratified as high-performing. Multivariable regression models examined factors associated with re-exploration as well as clinical outcomes including FTR-S and resource utilization.

Results: Of an estimated 3,490,245 hospitalizations, 78,003 (2.23%) required re-exploration with decreasing incidence over time. Valvular procedures, preoperative intra-aortic balloon pump and liver disease were associated with greater likelihood of re-exploration. Reoperation was associated with increased odds of mortality (adjusted odds ratio (AOR): 3.86, 95%CI: 3.61-4.12), perioperative complications and resource utilization. Increasing time from index operation to re-exploration was associated with higher odds of mortality (AOR:1.10/day, 95%CI: 1.07-1.12). High-performing hospitals were associated with lower odds of re-exploration (AOR: 0.88, 95%CI: 0.82-0.95) and FTR-S (AOR: 0.29, 95%CI: 0.23-0.35).

Conclusions: Surgical re-exploration following cardiac surgery has declined over time. High performing hospitals demonstrated lower rates of re-exploration and subsequent failure-to-rescue. Although unable to identify specific practices, our study highlights the presence of significant variation in takeback rates and further study of underlying factors is warranted.
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http://dx.doi.org/10.1016/j.athoracsur.2021.04.011DOI Listing
April 2021

Clinical and Financial Outcomes Associated With Vocal Fold Paralysis in Congenital Cardiac Surgery.

J Cardiothorac Vasc Anesth 2021 Mar 8. Epub 2021 Mar 8.

Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA. Electronic address:

Objectives: Vocal fold paralysis (VFP) has proven to increase resource use in several surgical fields. However, its burden in congenital cardiac surgery, a specialty known to be associated with high resource use, has not yet been examined. The authors aimed to assess the impact of VFP on costs, lengths of stay, and readmissions following congenital cardiac surgery.

Design: A retrospective analysis of administrative data.

Setting: The 2010-2017 National Readmissions Database.

Participants: All pediatric patients undergoing congenital cardiac surgery.

Interventions: None.

Measurements And Main Results: Vocal fold paralysis was defined using International Classification of Diseases, Ninth and Tenth Revisions, diagnosis codes. The primary outcome of interest was 30-day nonelective readmissions and 90-day readmissions; costs, length of stay, and discharge status also were considered. Of an estimated 124,486 patients meeting study criteria, 2,868 (2.3%) were identified with VFP. Incidence of VFP increased during the study period (0.7% in 2010 to 3.2% in 2017, nptrend < 0.001). Rates of nonhome discharge (30.0% v 16.4%, p < 0.001), 30-day readmission (23.9% v 12.4%, p < 0.001), and 90-day readmission (8.3% v 4.4%, p = 0.03) were increased in the VFP cohort, as were lengths of stay (42.1 v 27.0 days, p < 0.001) and costs ($196,000 v $128,000, p < 0.001). After adjustment for patient and hospital factors, VFP was independently associated with greater odds of nonhome discharge (adjusted odds ratios [AOR], 1.66, 95% CI, 1.14-2.40), 30-day readmission (AOR, 1.58, 95% CI, 1.03-2.42), 90-day readmission (AOR, 2.07, 95% CI, 1.22-3.52), longer lengths of stay (+ 6.1 days, 95% CI, 1.3-10.8), and higher hospitalization costs (+$22,000, 95% CI, 3,000-39,000).

Conclusions: Readmission rates after congenital cardiac surgery are significantly greater among those with VFP, as are costs, lengths of stay, and nonhome discharges. Therefore, further efforts are necessary to increase awareness and reduce the incidence of VFP in this vulnerable population to minimize the financial burden of congenital cardiac surgery on the US medical system.
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http://dx.doi.org/10.1053/j.jvca.2021.03.008DOI Listing
March 2021

Impact of hospital volume on resource use after elective cardiac surgery: A contemporary analysis.

Surgery 2021 Apr 10. Epub 2021 Apr 10.

Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, CA. Electronic address:

Background: Institutional experience has been associated with reduced mortality after coronary artery bypass grafting and valve operations. Using a contemporary, national cohort, we examined the impact of hospital volume on hospitalization costs and postdischarge resource utilization after these operations.

Methods: Adults undergoing elective coronary artery bypass grafting or valve operations were identified in the 2016 to 2017 Nationwide Readmissions Database. Institutions were grouped into volume quartiles based on annual elective cardiac surgery caseload, and comparisons were made between the lowest and highest quartiles, using generalized linear models.

Results: Of an estimated 296,510 patients, 24.8% were treated at low-volume hospitals and 25.2% at high-volume hospitals. Compared with patients treated at low-volume hospitals, patients managed at high-volume hospitals were younger, had more comorbidities, and more frequently underwent combined coronary artery bypass grafting valve (13.0% vs 12.3%, P < .001) and multivalve operations (6.2% vs 3.1%, P < .001). After adjustment, operations at high-volume hospitals were associated with a $7,600 reduction (95% confidence interval $4,700-$10,500) in costs. High-volume hospitals were also associated with reduced odds of mortality, non-home discharge, and 30-day non-elective readmission compared to low-volume hospitals.

Conclusion: Despite increased complexity at high-volume centers, greater operative volume was independently associated with reduced hospitalization costs and mortality after elective cardiac operations. Reduction in non-home discharge and readmissions suggests this effect to extend beyond acute hospitalization, which may guide value-based care paradigms.
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http://dx.doi.org/10.1016/j.surg.2021.03.004DOI Listing
April 2021

Association of Hospital Safety Net Status With Outcomes and Resource Use for Extracorporeal Membrane Oxygenation in the United States.

J Intensive Care Med 2021 Mar 30:8850666211007062. Epub 2021 Mar 30.

Divisions of Cardiac Surgery, Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

Purpose: Safety net hospitals (SNH) have been associated with inferior surgical outcomes and increased resource use. Utilization and outcomes for extracorporeal membrane oxygenation (ECMO), a rescue modality for patients with respiratory or cardiac failure, may vary by safety net status. We hypothesized SNH to be associated with inferior outcomes and costs of ECMO in a national cohort.

Materials And Methods: The 2008-2017 National Inpatient Sample was queried for ECMO hospitalizations and safety net hospitals were identified. Multivariable regression was used to perform risk-adjusted comparisons of mortality, complications and resource utilization at safety net and non-safety net hospitals.

Results: Of 36,491 ECMO hospitalizations, 28.2% were at SNH. On adjusted comparison SNH was associated with increased odds of mortality (AOR: 1.23), tracheostomy use (AOR: 1.51), intracranial hemorrhage (AOR: 1.39), as well as infectious complications (AOR: 1.21, all < .05), with NSNH as reference. SNH was also associated with increased hospitalization duration (β=+4.5 days) and hospitalization costs (β=+$32,880, all < .01).

Conclusions: We have found SNH to be associated with inferior survival, increased complications, and higher costs compared to NSNH. These disparate outcomes warrant further studies examining systemic and hospital-level factors that may impact outcomes and resource use of ECMO at SNH.
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http://dx.doi.org/10.1177/08850666211007062DOI Listing
March 2021

Failure to rescue after surgical re-exploration in lung resection.

Surgery 2021 Mar 25. Epub 2021 Mar 25.

Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, CA. Electronic address:

Background: Surgical re-exploration after lung resection remains poorly characterized, although institutional series have previously reported its association with greater mortality and complications. The present study sought to examine the impact of institutional lung-resection volume on the incidence of and short-term outcomes after surgical re-exploration.

Methods: The 2007 to 2018 National Inpatient Sample was used to identify all adults who underwent lobectomy or pneumonectomy. Hospitals were divided into tertiles based on institutional lung-resection caseload. Multivariable regressions were used to identify associations between independent covariates on clinical outcomes.

Results: Of an estimated 329,273 patients, 3,592 (1.09%) were re-explored with decreasing incidence over time. Open and minimal access pneumonectomy among other factors were associated with greater odds of reoperation. Those re-explored had greater odds of mortality and complications as well as increased duration of stay and adjusted costs. Although risk of re-exploration was similar across hospital tertiles, reoperative mortality was significantly lower at high-volume hospitals.

Conclusion: Re-exploration after lung resection is uncommon; however, when occurring, it is associated with worse clinical outcomes. After re-exploration, high-volume center status was associated with reduced odds of mortality relative to low volume. Failure to rescue at lower-volume centers suggests the need for optimization of perioperative factors to decrease incidence of reoperation.
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http://dx.doi.org/10.1016/j.surg.2021.02.023DOI Listing
March 2021

Impact of the Coronavirus Disease 2019 Pandemic on Utilization of Mechanical Circulatory Support As Bridge to Heart Transplantation.

ASAIO J 2021 04;67(4):382-384

From the Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine University of California, Los Angeles, Los Angeles, California.

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http://dx.doi.org/10.1097/MAT.0000000000001387DOI Listing
April 2021

Frailty is Independently Associated with Worse Outcomes Following Elective Anatomic Lung Resection.

Ann Thorac Surg 2020 Nov 27. Epub 2020 Nov 27.

Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles (UCLA), Los Angeles, CA; Division of Cardiac Surgery, Department of Surgery, UCLA, Los Angeles, CA. Electronic address:

Background: Frailty has been widely recognized as a predictor of postoperative outcomes. Given the paucity of standardized frailty measurements in thoracic procedures, we aimed to determine the impact of coding-based frailty on clinical outcomes and resource utilization following anatomic lung resection.

Methods: All adults undergoing elective, anatomic lung resections (segmentectomy, lobectomy, pneumonectomy) from 2005-2014 were identified using the National Inpatient Sample. Patients were categorized as Frail or Non-Frail based on the presence of any frailty-defining diagnoses defined by the Johns Hopkins Adjusted Clinical Groups. Multivariable models were used to assess the independent association of frailty with in-hospital mortality, non-home discharge, complications, duration of stay and costs.

Results: Of an estimated 366,357 hospitalizations for elective lung resection during the study period, 4.4% were Frail. Patients who underwent pneumonectomy or were treated at low-volume hospitals were more commonly frail. Relative to Non-Frail, frailty was associated with increased unadjusted mortality (9.1% vs 1.7%, p<0.001) and non-home discharge (44.7% vs 10.5%, p<0.001). Frail patients had 3.47 increased adjusted odds of mortality across resection types (95% CI 2.94-4.09). Frailty conferred the greatest increase in mortality, complications and resource use following pneumonectomy relative to lobectomy or segmentectomy, though significant differences were evident for all three.

Conclusions: Frailty exhibits a strong association with inferior clinical outcomes and increased resource utilization following elective lung resection, particularly pneumonectomy. This readily available tool may improve preoperative risk assessment and allow for better selection of treatment modalities for frail patients with pulmonary pathologies.
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http://dx.doi.org/10.1016/j.athoracsur.2020.11.004DOI Listing
November 2020

National Trends and Cost Burden of Surgically Treated Gunshot Wounds in the US.

J Am Coll Surg 2020 10 10;231(4):448-459.e4. Epub 2020 Aug 10.

Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA. Electronic address:

Background: Gun violence remains a major burden on the US healthcare system, with annual cost exceeding $170 billion. Literature on the national trends in cost and survival of gun violence victims requiring operative interventions is lacking.

Study Design: All adults admitted with a diagnosis of gunshot wound requiring operative intervention were identified using the 2005-2016 National Inpatient Sample. The ICD Injury Severity Score, a validated prediction tool, was used to quantify the extent of traumatic injuries. Survey-weighted methodology was used to provide national estimates. Hospitalizations exceeding the 66th percentile of annual cost were considered as high-cost tertile. Multivariable logistic regressions with stepwise forward selection were used to identify factors associated with mortality and high-cost tertile.

Results: During the study period, 262,098 admissions met inclusion criteria with a significant increase in annual frequency and decrease in ICD Injury Severity Scores. A decline in mortality (8.6% to 7.6%; parametric test of trend = 0.03) was accompanied by increasing mean cost ($25,900 to $33,000; nonparametric test of trend < 0.001). After adjusting for patient and hospital characteristics, head and neck (adjusted odds ratio 31.2; 95% CI, 11.0 to 88.4; p < 0.001), vascular operations (adjusted odds ratio 24.5; 95% CI, 19.2 to 31.1; p < 0.001), and gastrointestinal (adjusted odds ratio 27.8; 95% CI, 17.2 to 44.8; p < 0.001) were independently associated with high-cost tertile designation compared with patients who did not undergo these operations.

Conclusions: During the past decade, the increase in gun violence and severity has resulted in higher cost. Operations involving selected surgical treatments incurred higher in-hospital cost. Given the profound economic and social impact of surgically treated gunshot wounds, policy and public health efforts to reduce gun violence are imperative.
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http://dx.doi.org/10.1016/j.jamcollsurg.2020.06.022DOI Listing
October 2020

Reporting and Abstracting Variability in Technical Standards for Breast Cancer Operations.

J Surg Res 2020 09 23;253:79-85. Epub 2020 Apr 23.

Department of Surgery, Loma Linda University Medical Center, Loma Linda, California; Department of Surgery, University of California, Riverside School of Medicine, Riverside, California. Electronic address:

Background: The American College of Surgeons Commission on Cancer has incorporated documentation of critical elements outlined in Operative Standards for Cancer Surgery into revised standards for cancer center accreditation. This study assessed the current documentation of critical elements in partial mastectomy (PM) and sentinel lymph node biopsy (SLNB) operative reports.

Materials And Methods: Operative reports for PM + SLNB at a single academic institution from 2013 to 2018 were reviewed for compliance and surveyor interobserver reliability with the Oncologic Elements of Operative Record defined in Operative Standards and compared with a nonredundant American Society of Breast Surgeons Mastery of Breast Surgery (MBS) quality measure for specimen orientation.

Results: Ten reviewers each evaluated 66 PM + SLNB operative reports for 13 Oncologic Elements and one MBS measure. No operative records reported all critical elements for PM + SLNB or PM alone. Residents completed 36.4% of operative reports: Element documentation was similar for PM but varied significantly for SLNB between resident and attending authorship. Combined reporting performance and interrater reliability varied across all elements and was highest for the use of SLNB tracer (97.1% and κ = 0.95, respectively) and lowest for intraoperative assessment of SLNB (30.6%, κ = 0.43). MBS specimen orientation had both high proportion reported (87.0%) and interrater reliability (κ = 0.84).

Conclusions: Adherence to reporting critical elements for PM and SLNB varied. Whether differential compliance was tied to discrepancies in documentation or reviewer abstraction, clarification of synoptic choices may improve reporting consistency. Evolving techniques or technologies will require continuous appraisal of mandated reporting for breast surgery.
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http://dx.doi.org/10.1016/j.jss.2020.03.041DOI Listing
September 2020

Immediate Auditory Feedback is Superior to Other Types of Feedback for Basic Surgical Skills Acquisition.

J Surg Educ 2017 Nov - Dec;74(6):e55-e61. Epub 2017 Aug 31.

Department of Surgery, University of Texas Health Science Center at San Antonio, School of Medicine, San Antonio, Texas.

Objective: We examined the effect of timing and type of feedback on medical students' knot-tying performance using visual versus auditory and immediate versus delayed feedback. We hypothesized that participants who received immediate auditory feedback would outperform those who received delayed and visual feedback.

Methods: Sixty-nine first- and second-year medical students were taught to tie 2-handed knots. All participants completed 3 pretest knot-tying trials without feedback. Participants were instructed to tie a knot sufficiently tight to stop the "blood" flow while minimizing the amount of force applied to the vessel. Task completion time was not a criterion. Participants were stratified and randomly assigned to 5 experimental groups based on type (auditory versus visual) and timing (immediate versus delayed) of feedback. The control group did not receive feedback. All groups trained to proficiency. Participants completed 3 posttest trials without feedback.

Results: There were fewer trials with leak (p < 0.01) and less force applied (p < 0.01) on the posttest compared to the pretest, regardless of study group. The immediate auditory feedback group required fewer trials to achieve proficiency than each of the other groups (p < 0.01) and had fewer leaks than the control, delayed auditory, and delayed visual groups (p < 0.02).

Conclusions: In a surgical force feedback simulation model, immediate auditory feedback resulted in fewer training trials to reach proficiency and fewer leaks compared to visual and delayed forms of feedback.
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http://dx.doi.org/10.1016/j.jsurg.2017.08.005DOI Listing
August 2018