Trauma Surgery

Black patients have less access to elective and minimally invasive emergency general surgery, with worse outcomes

This national cohort of 2.44 million cholecystectomy, hernia, and colorectal procedures found substantial racial differences in access to elective and minimally invasive surgery. Black patients had higher adjusted odds of undergoing emergency versus elective procedures compared with White patients (aOR 1.29; 95% CI 1.28–1.30). In the emergency setting, Black patients also had higher odds of open versus minimally invasive surgery (aOR 1.06; 95% CI 1.03–1.08). Among minimally invasive emergency procedures, Black patients had higher 30-day readmission, longer length of stay, and higher conversion to open surgery. 1

Bayesian re-analysis suggests lower PEEP is likely safe, possibly beneficial, in ICU patients without ARDS

This Bayesian re-analysis of the RELAx trial reassessed lower (0–5 cm H2O) versus higher (8 cm H2O) PEEP in 980 invasively ventilated ICU patients without ARDS. Lower PEEP had an odds ratio of 1.08 (95% credible interval 0.87–1.35) for more ventilator-free days by day 28, with 75–78% probability of superiority. For 28-day mortality and duration of ventilation, probability of benefit with lower PEEP ranged from 72–89% and 11–28%, respectively. In patients admitted for non–cardiac arrest reasons or intubated for non–respiratory failure, probability of benefit from lower PEEP exceeded 90%. 2

Two-decade U.S. data show ARDS mortality gains reversed in the ICD-10 era

This National Inpatient Sample analysis included 205,393 adult non-elective mechanically ventilated ARDS admissions from 2000–2019. During the ICD-9 era, in-hospital mortality decreased over time (OR 0.96 per year; 95% CI 0.95–0.97; p<0.001). In the ICD-10 era, mortality instead increased annually (OR 1.05 per year; 95% CI 1.01–1.08; p=0.004). Length of stay and inflation-adjusted hospitalization charges decreased in the ICD-9 period but showed no significant improvement in the ICD-10 period. 3

Half of ICU patients are malnourished, most are underfed, and both malnutrition and sarcopenia worsen outcomes

In this prospective ICU cohort of 100 patients followed for seven days, malnutrition prevalence reached 50%, including 22% with severe malnutrition. Only 31% of patients received adequate caloric intake, and 84% had insufficient protein intake based on calculated requirements. Malnourished patients required intubation more often, had more difficulty weaning from oxygen, and developed pressure ulcers more frequently than non-malnourished patients. Sarcopenic patients showed similarly higher rates of intubation, oxygen weaning difficulty, and pressure ulcers compared with non-sarcopenic patients. 4