30-Second Takeaway
- Timely operative care and reduced prehospital delays lower early orthopaedic trauma mortality in resource-limited settings.
- EHR clinical decision support can substantially reduce opioid MME at discharge after surgery.
Week ending May 23, 2026
Grand Rounds: Recent trauma‑surgery evidence impacting systems, perioperative risk, opioid stewardship, and ICU prevention tools
Delays, transfers, and rural residence increase early orthopaedic trauma mortality in Tanzania
Prospective cohort of 7,121 orthopaedic trauma patients in five Tanzanian hospitals found 14‑day mortality 10.8%, higher for open fractures (16.4%). Interfacility transfer (aOR 1.99), rural residence (aOR 1.80) and longer prehospital delay independently predicted higher mortality. Timely surgery was associated with lower mortality (aOR 0.87). Among surgical patients, 22.2% had complications; functional recovery at discharge occurred in 72.8% of survivors.
State designation concordance with ACS‑COT varies and links to for‑profit trauma center expansion
Cross‑sectional analysis of 464 newly designated US trauma centers (2013–2022) found state concordance with ACS‑COT standards ranged 31.1%–100%. Lower concordance correlated with greater expansion of for‑profit trauma centers (rs = -0.39; P = .004) but not nonprofit expansion. Most new centers (81.9%) were Level III–IV, where concordance tended to be lower.
PROTECT: large multicenter geriatric perioperative cohort for risk modeling
Ambispective perioperative cohort enrolled 61,289 inpatients aged ≥65 across three tertiary centers with high follow‑up (96.5% at 48h). Median age was 71; 52.2% ASA III or higher; 30‑day mortality was 0.7%. PROTECT includes standardized preop, intraop, and postoperative assessments and has produced prediction models for major postoperative complications.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.