30-Second Takeaway
- Maintain higher admission hemoglobin in moderate‑to‑severe TBI is associated with lower ICU mortality.
- Housing instability identifies patients at markedly higher postoperative risk after AAA repair, largely due to urgent presentation.
Week ending May 30, 2026
Grand Rounds: Five recent trauma‑surgery–relevant studies with direct clinical implications
Higher admission hemoglobin linked to lower ICU mortality after moderate‑to‑severe TBI; no sex interaction
In a bicentric retrospective cohort of 5,513 moderate‑to‑severe TBI patients, each 1 g/dL higher admission hemoglobin associated with 31% lower odds of ICU mortality (OR 0.69; 97.5% CI 0.52–0.91; p=0.0027). Predicted ICU mortality was lower in females across Hb ranges, but causal adjustment found no sex‑specific effect at equivalent admission hemoglobin (adjusted OR 1.01; 95% CI 0.85–1.19; p=0.936). The sex × hemoglobin interaction was non‑significant (OR 1.04; 97.5% CI 0.91–1.19), so sex‑differentiated admission Hb transfusion thresholds are not supported by these data. Findings apply to adult ICU TBI patients but are observational and do not establish transfusion causality; prospective trials are needed.
Immunonutrition shows selective benefit in severely malnourished major GI surgery patients
This review summarizes heterogeneous RCTs and meta‑analyses of arginine/glutamine/omega‑3/nucleotide formulas in elective surgery, with mixed results and variable product protocols. Evidence suggests potential benefit when given perioperatively to severely malnourished patients undergoing major gastrointestinal surgery, but overall certainty is moderate. Recent investigator‑led trials without industry funding have challenged earlier positive signals, highlighting inconsistency across populations and formulations. Immunonutrition should be considered selectively in high‑risk malnourished patients while prioritizing basic perioperative nutritional optimization.
Unhoused status predicts worse survival after infrarenal AAA repair; urgency and procedure choice matter
In a VQI cohort (n=99,733; 127 unhoused), unhoused patients more often presented symptomatic/ruptured and underwent open repair more frequently. Unadjusted mean postoperative survival was shorter for unhoused patients, but adjustment for urgency, age, and comorbidity attenuated the survival gap. Among unhoused patients ≥65 years, 1‑year survival was ~45% after open repair versus ~85% after EVAR, suggesting procedure choice matters in this group. Screen for housing instability preoperatively and favor EVAR when feasible in older unhoused patients; address upstream factors driving urgent presentation.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.