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Mohseni, Shahin
Publications (10 of 97) Show all publications
Mohammad Ismail, A., Forssten, M. P., Hildebrand, F., Sarani, B., Ioannidis, I., Cao, Y., . . . Mohseni, S. (2024). Cardiac risk stratification and adverse outcomes in surgically managed patients with isolated traumatic spine injuries. European Journal of Trauma and Emergency Surgery
Open this publication in new window or tab >>Cardiac risk stratification and adverse outcomes in surgically managed patients with isolated traumatic spine injuries
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2024 (English)In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941Article in journal (Refereed) Epub ahead of print
Abstract [en]

INTRODUCTION: As the incidence of traumatic spine injuries has been steadily increasing, especially in the elderly, the ability to categorize patients based on their underlying risk for the adverse outcomes could be of great value in clinical decision making. This study aimed to investigate the association between the Revised Cardiac Risk Index (RCRI) and adverse outcomes in patients who have undergone surgery for traumatic spine injuries.

METHODS: All adult patients (18 years or older) in the 2013-2019 TQIP database with isolated spine injuries resulting from blunt force trauma, who underwent spinal surgery, were eligible for inclusion in the study. The association between the RCRI and in-hospital mortality, cardiopulmonary complications, and failure-to-rescue (FTR) was determined using Poisson regression models with robust standard errors to adjust for potential confounding.

RESULTS: A total of 39,391 patients were included for further analysis. In the regression model, an RCRI ≥ 3 was associated with a threefold risk of in-hospital mortality [adjusted IRR (95% CI): 3.19 (2.30-4.43), p < 0.001] and cardiopulmonary complications [adjusted IRR (95% CI): 3.27 (2.46-4.34), p < 0.001], as well as a fourfold risk of FTR [adjusted IRR (95% CI): 4.27 (2.59-7.02), p < 0.001], compared to RCRI 0. The risk of all adverse outcomes increased stepwise along with each RCRI score.

CONCLUSION: The RCRI may be a useful tool for identifying patients with traumatic spine injuries who are at an increased risk of in-hospital mortality, cardiopulmonary complications, and failure-to-rescue after surgery.

Place, publisher, year, edition, pages
Urban und Vogel Medien und Medizin Verlagsgesellsc, 2024
Keywords
Cardiopulmonary complications, Mortality, Revised Cardiac Risk Index, Risk stratification, Traumatic spine injury
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:oru:diva-110622 (URN)10.1007/s00068-023-02413-7 (DOI)001135545400001 ()38170276 (PubMedID)2-s2.0-85181522328 (Scopus ID)
Funder
Örebro University
Available from: 2024-01-09 Created: 2024-01-09 Last updated: 2024-02-05Bibliographically approved
Bass, G. A., Kaplan, L. J., Gaarder, C., Coimbra, R., Klingensmith, N. J., Kurihara, H., . . . Marzi, I. (2024). European society for trauma and emergency surgery member-identified research priorities in emergency surgery: a roadmap for future clinical research opportunities. European Journal of Trauma and Emergency Surgery
Open this publication in new window or tab >>European society for trauma and emergency surgery member-identified research priorities in emergency surgery: a roadmap for future clinical research opportunities
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2024 (English)In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941Article, review/survey (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: European Society for Trauma and Emergency Surgery (ESTES) is the European community of clinicians providing care to the injured and critically ill surgical patient. ESTES has several interlinked missions - (1) the promotion of optimal emergency surgical care through networked advocacy, (2) promulgation of relevant clinical cognitive and technical skills, and (3) the advancement of scientific inquiry that closes knowledge gaps, iteratively improves upon surgical and perioperative practice, and guides decision-making rooted in scientific evidence. Faced with multitudinous opportunities for clinical research, ESTES undertook an exercise to determine member priorities for surgical research in the short-to-medium term; these research priorities were presented to a panel of experts to inform a 'road map' narrative review which anchored these research priorities in the contemporary surgical literature.

METHODS: Individual ESTES members in active emergency surgery practice were polled as a representative sample of end-users and were asked to rank potential areas of future research according to their personal perceptions of priority. Using the modified eDelphi method, an invited panel of ESTES-associated experts in academic emergency surgery then crafted a narrative review highlighting potential research priorities for the Society.

RESULTS: Seventy-two responding ESTES members from 23 countries provided feedback to guide the modified eDelphi expert consensus narrative review. Experts then crafted evidence-based mini-reviews highlighting knowledge gaps and areas of interest for future clinical research in emergency surgery: timing of surgery, inter-hospital transfer, diagnostic imaging in emergency surgery, the role of minimally-invasive surgical techniques and Enhanced Recovery After Surgery (ERAS) protocols, patient-reported outcome measures, risk-stratification methods, disparities in access to care, geriatric outcomes, data registry and snapshot audit evaluations, emerging technologies interrogation, and the delivery and benchmarking of emergency surgical training.

CONCLUSIONS: This manuscript presents the priorities for future clinical research in academic emergency surgery as determined by a sample of the membership of ESTES. While the precise basis for prioritization was not evident, it may be anchored in disease prevalence, controversy around aspects of current patient care, or indeed the identification of a knowledge gap. These expert-crafted evidence-based mini-reviews provide useful insights that may guide the direction of future academic emergency surgery research efforts.

Place, publisher, year, edition, pages
Urban und Vogel Medien und Medizin Verlagsgesellsc, 2024
Keywords
Delphi Technique, Diagnosis, Emergency Surgery, Implementation Science, Research, Treatment
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-112007 (URN)10.1007/s00068-023-02441-3 (DOI)38411700 (PubMedID)
Available from: 2024-02-28 Created: 2024-02-28 Last updated: 2024-02-28Bibliographically approved
Mohseni, S., Forssten, M. P., Mohammad Ismail, A., Cao, Y., Hildebrand, F., Sarani, B. & Ribeiro, M. A. (2024). Investigating the link between frailty and outcomes in geriatric patients with isolated rib fractures. Trauma surgery & acute care open, 9(1), Article ID e001206.
Open this publication in new window or tab >>Investigating the link between frailty and outcomes in geriatric patients with isolated rib fractures
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2024 (English)In: Trauma surgery & acute care open, E-ISSN 2397-5776, Vol. 9, no 1, article id e001206Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Studies have shown an increased risk of morbidity in elderly patients suffering rib fractures from blunt trauma. The association between frailty and rib fractures on adverse outcomes is still ill-defined. In the current investigation, we sought to delineate the association between frailty, measured using the Orthopedic Frailty Score (OFS), and outcomes in geriatric patients with isolated rib fractures.

METHODS: All geriatric (aged 65 years or older) patients registered in the 2013-2019 Trauma Quality Improvement database with a conservatively managed isolated rib fracture were considered for inclusion. An isolated rib fracture was defined as the presence of ≥1 rib fracture, a thorax Abbreviated Injury Scale (AIS) between 1 and 5, an AIS ≤1 in all other regions, as well as the absence of pneumothorax, hemothorax, or pulmonary contusion. Based on patients' OFS, patients were classified as non-frail (OFS 0), pre-frail (OFS 1), or frail (OFS ≥2). The prevalence ratio (PR) of composite complications, in-hospital mortality, failure-to-rescue (FTR), and intensive care unit (ICU) admission between the OFS groups was determined using Poisson regression models to adjust for potential confounding.

RESULTS: A total of 65 375 patients met the study's inclusion criteria of whom 60% were non-frail, 29% were pre-frail, and 11% were frail. There was a stepwise increased risk of complications, in-hospital mortality, and FTR from non-frail to pre-frail and frail. Compared with non-frail patients, frail patients exhibited a 87% increased risk of in-hospital mortality [adjusted PR (95% CI): 1.87 (1.52-2.31), p<0.001], a 44% increased risk of complications [adjusted PR (95% CI): 1.44 (1.23-1.67), p<0.001], a doubling in the risk of FTR [adjusted PR (95% CI): 2.08 (1.45-2.98), p<0.001], and a 17% increased risk of ICU admission [adjusted PR (95% CI): 1.17 (1.11-1.23), p<0.001].

CONCLUSION: There is a strong association between frailty, measured using the OFS, and adverse outcomes in geriatric patients managed conservatively for rib fractures.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2024
Keywords
Frailty, geriatrics, rib fractures
National Category
Geriatrics
Identifiers
urn:nbn:se:oru:diva-111653 (URN)10.1136/tsaco-2023-001206 (DOI)38347893 (PubMedID)2-s2.0-85184814992 (Scopus ID)
Available from: 2024-02-21 Created: 2024-02-21 Last updated: 2024-02-21Bibliographically approved
Forssten, M. P., Mohammad Ismail, A., Ioannidis, I., Wretenberg, P., Borg, T., Cao, Y., . . . Mohseni, S. (2023). A nationwide analysis on the interaction between frailty and beta-blocker therapy in hip fracture patients. European Journal of Trauma and Emergency Surgery, 49(3), 1485-1497
Open this publication in new window or tab >>A nationwide analysis on the interaction between frailty and beta-blocker therapy in hip fracture patients
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2023 (English)In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 49, no 3, p. 1485-1497Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Hip fracture patients, who are often frail, continue to be a challenge for healthcare systems with a high postoperative mortality rate. While beta-blocker therapy (BBt) has shown a strong association with reduced postoperative mortality, its effect in frail patients has yet to be determined. This study's aim is to investigate how frailty, measured using the Orthopedic Hip Frailty Score (OFS), modifies the effect of preadmission beta-blocker therapy on mortality in hip fracture patients.

METHODS: This retrospective register-based study included all adult patients in Sweden who suffered a traumatic hip fracture and subsequently underwent surgery between 2008 and 2017. Treatment effect was evaluated using the absolute risk reduction (ARR) in 30-day postoperative mortality when comparing patients with (BBt+) and without (BBt-) ongoing BBt. Inverse probability of treatment weighting (IPTW) was used to reduce potential confounding when examining the treatment effect. Patients were stratified based on their OFS (0, 1, 2, 3, 4 and 5) and the treatment effect was also assessed within each stratum.

RESULTS: A total of 127,305 patients were included, of whom 39% had BBt. When IPTW was performed, there were no residual differences in observed baseline characteristics between the BBt+ and BBt- groups, across all strata. This analysis found that there was a stepwise increase in the ARRs for each additional point on the OFS. Non-frail BBt+ patients (OFS 0) exhibited an ARR of 2.2% [95% confidence interval (CI) 2.0-2.4%, p < 0.001], while the most frail BBt+ patients (OFS 5) had an ARR of 24% [95% CI 18-30%, p < 0.001], compared to BBt- patients within the same stratum.

CONCLUSION: Beta-blocker therapy is associated with a reduced risk of 30-day postoperative mortality in frail hip fracture patients, with a greater effect being observed with higher Orthopedic Hip Frailty Scores.

Place, publisher, year, edition, pages
Urban und Vogel Medien und Medizin Verlagsgesellsc, 2023
Keywords
Beta-blocker therapy, Frailty, Hip fracture, Inverse probability of treatment weighting, Mortality, Orthopedic Hip Frailty Score
National Category
Orthopaedics
Identifiers
urn:nbn:se:oru:diva-103177 (URN)10.1007/s00068-023-02219-7 (DOI)000913478200001 ()36633610 (PubMedID)2-s2.0-85146172097 (Scopus ID)
Funder
Örebro University
Available from: 2023-01-23 Created: 2023-01-23 Last updated: 2023-06-28Bibliographically approved
Forssten, M. P., Sarani, B., Mohammad Ismail, A., Ioannidis, I., Cao, Y., Hildebrand, F., . . . Mohseni, S. (2023). Adverse Outcomes after Pelvic Fracture in Geriatric Patients: The Critical Role of Frailty. Paper presented at Owen H Wangensteen Scientific Forum, Clinical Congress, Boston, USA, October 22-25, 2023. Journal of the American College of Surgeons, 237(5), S557-S557
Open this publication in new window or tab >>Adverse Outcomes after Pelvic Fracture in Geriatric Patients: The Critical Role of Frailty
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2023 (English)In: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, Vol. 237, no 5, p. S557-S557Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Introduction: Pelvic fractures among the elderly are associated with an increased risk of adverse outcomes. Frailty, a condition of depleted physical reserves which increases with age, is likely a contributing factor for such unfavorable events. We endeavored to describe the association between frailty, measured using the Ortho-pedic Frailty Score (OFS), and adverse outcomes in geriatric pelvic fracture patients.

Methods: All geriatric (≥65yrs) patients registered in the 2013 to 2019 TQIP database with an isolated pelvic fracture following blunt trauma were considered for inclusion. An isolated pelvic fracture was defined as any fracture in the ilium, ischium, pubis, sacrum, coccyx, or acetabulum with an AIS ≤1 in all other regions except for abdominal and lower extremity. Patients were categorized as non-frail (OFS 0), pre-frail (OFS 1), or frail (OFS ≥2). Poisson regression models were employed to determine the association between the OFS and adverse outcomes adjusting for confounders including angiographical and surgical interventions.

Results: A total of 66,404 patients met inclusion criteria, of whom 52% were classified as non-frail, 32% as pre-frail, and 16% as frail. Compared to non-frail patients, frail patients exhibited 88% increased risk of in-hospital mortality [adjusted IRR (95% CI): 1.88 (1.54-2.30), p<0.001], a 25% increased risk of composite complications [adjusted IRR (95% CI): 1.25 (1.10-1.42), p<0.001], a 56% increased risk of failure to rescue [adjusted IRR (95% CI): 1.56 (1.14-2.14), p=0.006].

Conclusion: Frail geriatric patients suffering a pelvic fracture have disproportionately increased risk for complications, mortality, and failure-to-rescue. Additional measures are required to mitigate adverse events in this vulnerable population.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2023
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-110042 (URN)001100379000147 ()
Conference
Owen H Wangensteen Scientific Forum, Clinical Congress, Boston, USA, October 22-25, 2023
Available from: 2023-12-05 Created: 2023-12-05 Last updated: 2023-12-05Bibliographically approved
Forssten, M. P., Sarani, B., Mohammad Ismail, A., Ioannidis, I., Cao, Y., Hildebrand, F., . . . Mohseni, S. (2023). Adverse Outcomes after Pelvic Fracture in Geriatric Patients: The Critical Role of Frailty. Paper presented at 9th Annual Sessions of the American-College-of-Surgeons (ACS), Boston, MA, USA, October 22-25, 2023. Journal of the American College of Surgeons, 237(5), S557-S557
Open this publication in new window or tab >>Adverse Outcomes after Pelvic Fracture in Geriatric Patients: The Critical Role of Frailty
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2023 (English)In: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, Vol. 237, no 5, p. S557-S557Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Introduction: Pelvic fractures among the elderly are associated with an increased risk of adverse outcomes. Frailty, a condition of depleted physical reserves which increases with age, is likely a contributing factor for such unfavorable events. We endeavored to describe the association between frailty, measured using the Ortho-pedic Frailty Score (OFS), and adverse outcomes in geriatric pelvic fracture patients.

Methods: All geriatric (≥65yrs) patients registered in the 2013 to 2019 TQIP database with an isolated pelvic fracture following blunt trauma were considered for inclusion. An isolated pelvic fracture was defined as any fracture in the ilium, ischium, pubis, sacrum, coccyx, or acetabulum with an AIS ≤1 in all other regions except for abdominal and lower extremity. Patients were categorized as non-frail (OFS 0), pre-frail (OFS 1), or frail (OFS ≥2). Poisson regression models were employed to determine the association between the OFS and adverse outcomes adjusting for confounders including angiographical and surgical interventions.

Results: A total of 66,404 patients met inclusion criteria, of whom 52% were classified as non-frail, 32% as pre-frail, and 16% as frail. Compared to non-frail patients, frail patients exhibited 88% increased risk of in-hospital mortality [adjusted IRR (95% CI): 1.88 (1.54-2.30), p<0.001], a 25% increased risk of composite complications [adjusted IRR (95% CI): 1.25 (1.10-1.42), p<0.001], a 56% increased risk of failure to rescue [adjusted IRR (95% CI): 1.56 (1.14-2.14), p=0.006].

Conclusion: Frail geriatric patients suffering a pelvic fracture have disproportionately increased risk for complications, mortality, and failure-to-rescue. Additional measures are required to mitigate adverse events in this vulnerable population.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2023
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-111754 (URN)001094086301612 ()
Conference
9th Annual Sessions of the American-College-of-Surgeons (ACS), Boston, MA, USA, October 22-25, 2023
Available from: 2024-02-20 Created: 2024-02-20 Last updated: 2024-02-20Bibliographically approved
Forssten, M. P., Sarani, B., Mohammad Ismail, A., Cao, Y., Ribeiro, M. A. F., Hildebrand, F. & Mohseni, S. (2023). Adverse outcomes following pelvic fracture: the critical role of frailty. European Journal of Trauma and Emergency Surgery, 49(6), 2623-2631
Open this publication in new window or tab >>Adverse outcomes following pelvic fracture: the critical role of frailty
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2023 (English)In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 49, no 6, p. 2623-2631Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Pelvic fractures among older adults are associated with an increased risk of adverse outcomes, with frailty likely being a contributing factor. The current study endeavors to describe the association between frailty, measured using the Orthopedic Frailty Score (OFS), and adverse outcomes in geriatric pelvic fracture patients.

METHODS: All geriatric (65 years or older) patients registered in the 2013-2019 Trauma Quality Improvement Program database with an isolated pelvic fracture following blunt trauma were considered for inclusion. An isolated pelvic fracture was defined as any fracture in the pelvis with a lower extremity AIS ≥ 2, any abdomen AIS, and an AIS ≤ 1 in all other regions. Poisson regression models were employed to determine the association between the OFS and adverse outcomes.

RESULTS: A total of 66,404 patients were included for further analysis. 52% (N = 34,292) were classified as non-frail (OFS 0), 32% (N = 21,467) were pre-frail (OFS 1), and 16% (N = 10,645) were classified as frail (OFS ≥ 2). Compared to non-frail patients, frail patients exhibited a 88% increased risk of in-hospital mortality [adjusted IRR (95% CI): 1.88 (1.54-2.30), p < 0.001], a 25% increased risk of complications [adjusted IRR (95% CI): 1.25 (1.10-1.42), p < 0.001], a 56% increased risk of failure-to-rescue [adjusted IRR (95% CI): 1.56 (1.14-2.14), p = 0.006], and a 10% increased risk of ICU admission [adjusted IRR (95% CI): 1.10 (1.02-1.18), p = 0.014].

CONCLUSION: Frail pelvic fracture patients suffer from a disproportionately increased risk of mortality, complications, failure-to-rescue, and ICU admission. Additional measures are required to mitigate adverse events in this vulnerable patient population.

Place, publisher, year, edition, pages
Urban und Vogel Medien und Medizin Verlagsgesellsc, 2023
Keywords
Failure-to-rescue, Frailty, Geriatric patients, Morbidity, Mortality, Pelvic fracture
National Category
Orthopaedics Geriatrics
Identifiers
urn:nbn:se:oru:diva-107959 (URN)10.1007/s00068-023-02355-0 (DOI)001063912100002 ()37644193 (PubMedID)2-s2.0-85168886270 (Scopus ID)
Funder
Örebro University
Available from: 2023-08-30 Created: 2023-08-30 Last updated: 2024-01-12Bibliographically approved
Bass, G. A., Mohseni, S., Ryan, É. J., Forssten, M. P., Tolonen, M., Cao, Y. & Kaplan, L. J. (2023). Clinical practice selectively follows acute appendicitis guidelines. European Journal of Trauma and Emergency Surgery, 49(1), 45-56
Open this publication in new window or tab >>Clinical practice selectively follows acute appendicitis guidelines
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2023 (English)In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 49, no 1, p. 45-56Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Acute appendicitis is a common surgical emergency, and the standard approach to diagnosis and management has been codified in several practice guidelines. Adherence to these guidelines provides insight into independent surgical practice patterns and institutional resource constraints as impediments to best practice. We explored data from the recent ESTES SnapAppy observational cohort study to determine guideline compliance in contemporary practice to identify opportunities to close evidence-to-practice gaps.

METHODS: We undertook a preplanned analysis of the ESTES SnapAppy observational cohort study, identifying, at a patient level, congruence with, or deviation from WSES Jerusalem guidelines for the diagnosis and management of acute appendicitis and the Surviving Sepsis Campaign in our cohort. Compliance was then correlated with the incidence of postoperative complications.

RESULTS: Four thousand six hundred and thirteen (4613) consecutive adult and adolescent patients with acute appendicitis were followed from date of admission (November 1, 2020, and May 28, 2021) for 90 days. Patient-level compliance with guideline elements allowed patients to be grouped into those with full compliance (all 5 elements: 13%), partial compliance (1-4 elements: 87%) or noncompliance (0 elements: 0.2%). We identified an excess postoperative complication rate in patients who received noncompliant and partially compliant care, compared with those who received fully guideline-compliant care (36% and 16%, versus 7.3%, p < 0.001).

CONCLUSIONS: The observed diagnostic and treatment practices of the participating institutions displayed variability in compliance with key recommendations from existing guidelines. In general, practice was congruent with recommendations for preoperative antibiotic surgical site infection prophylaxis administration, time to surgery, and operative approach. However, there remains opportunities for improvement in the choice of diagnostic imaging modality, postoperative antibiotic stewardship to timely discontinue prophylactic antibiotics, and the implementation of ambulatory treatment pathways for uncomplicated appendicitis in the healthy young adult.

Place, publisher, year, edition, pages
Urban und Vogel Medien und Medizin Verlagsgesellsc, 2023
Keywords
Acute appendicitis, Appendectomy, Guidelines, Observational cohort
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-103946 (URN)10.1007/s00068-022-02208-2 (DOI)000932352100001 ()36719428 (PubMedID)2-s2.0-85148113039 (Scopus ID)
Funder
Örebro University
Available from: 2023-02-01 Created: 2023-02-01 Last updated: 2023-03-08Bibliographically approved
Scott, M. J., Aggarwal, G., Aitken, R. J., Anderson, I. D., Balfour, A., Foss, N. B., . . . Peden, C. J. (2023). Consensus Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS®) Society Recommendations Part 2-Emergency Laparotomy: Intra- and Postoperative Care. World Journal of Surgery, 47(8), 1850-1880
Open this publication in new window or tab >>Consensus Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS®) Society Recommendations Part 2-Emergency Laparotomy: Intra- and Postoperative Care
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2023 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 47, no 8, p. 1850-1880Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND: This is Part 2 of the first consensus guidelines for optimal care of patients undergoing emergency laparotomy (EL) using an Enhanced Recovery After Surgery (ERAS) approach. This paper addresses intra- and postoperative aspects of care.

METHODS: Experts in aspects of management of high-risk and emergency general surgical patients were invited to contribute by the International ERAS® Society. PubMed, Cochrane, Embase, and Medline database searches were performed for ERAS elements and relevant specific topics. Studies on each item were selected with particular attention to randomized clinical trials, systematic reviews, meta-analyses, and large cohort studies and reviewed and graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Recommendations were made on the best level of evidence, or extrapolation from studies on elective patients when appropriate. A modified Delphi method was used to validate final recommendations. Some ERAS® components covered in other guideline papers are outlined only briefly, with the bulk of the text focusing on key areas pertaining specifically to EL.

RESULTS: Twenty-three components of intraoperative and postoperative care were defined. Consensus was reached after three rounds of a modified Delphi Process.

CONCLUSIONS: These guidelines are based on best available evidence for an ERAS® approach to patients undergoing EL. These guidelines are not exhaustive but pull together evidence on important components of care for this high-risk patient population. As much of the evidence is extrapolated from elective surgery or emergency general surgery (not specifically laparotomy), many of the components need further evaluation in future studies.

Place, publisher, year, edition, pages
Springer, 2023
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-106373 (URN)10.1007/s00268-023-07020-6 (DOI)001003943800002 ()37277507 (PubMedID)2-s2.0-85160731029 (Scopus ID)
Available from: 2023-06-26 Created: 2023-06-26 Last updated: 2023-08-02Bibliographically approved
Cao, Y., Forssten, M. P., Sarani, B., Montgomery, S. & Mohseni, S. (2023). Development and Validation of an XGBoost-Algorithm-Powered Survival Model for Predicting In-Hospital Mortality Based on 545,388 Isolated Severe Traumatic Brain Injury Patients from the TQIP Database. Journal of Personalized Medicine, 13(9), Article ID 1401.
Open this publication in new window or tab >>Development and Validation of an XGBoost-Algorithm-Powered Survival Model for Predicting In-Hospital Mortality Based on 545,388 Isolated Severe Traumatic Brain Injury Patients from the TQIP Database
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2023 (English)In: Journal of Personalized Medicine, E-ISSN 2075-4426, Vol. 13, no 9, article id 1401Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Traumatic brain injury (TBI) represents a significant global health issue; the traditional tools such as the Glasgow Coma Scale (GCS) and Abbreviated Injury Scale (AIS) which have been used for injury severity grading, struggle to capture outcomes after TBI.

AIM AND METHODS: This paper aims to implement extreme gradient boosting (XGBoost), a powerful machine learning algorithm that combines the predictions of multiple weak models to create a strong predictive model with high accuracy and efficiency, in order to develop and validate a predictive model for in-hospital mortality in patients with isolated severe traumatic brain injury and to identify the most influential predictors. In total, 545,388 patients from the 2013-2021 American College of Surgeons Trauma Quality Improvement Program (TQIP) database were included in the current study, with 80% of the patients used for model training and 20% of the patients for the final model test. The primary outcome of the study was in-hospital mortality. Predictors were patients' demographics, admission status, as well as comorbidities, and clinical characteristics. Penalized Cox regression models were used to investigate the associations between the survival outcomes and the predictors and select the best predictors. An extreme gradient boosting (XGBoost)-powered Cox regression model was then used to predict the survival outcome. The performance of the models was evaluated using the Harrell's concordance index (C-index). The time-dependent area under the receiver operating characteristic curve (AUC) was used to evaluate the dynamic cumulative performance of the models. The importance of the predictors in the final prediction model was evaluated using the Shapley additive explanations (SHAP) value.

RESULTS: On average, the final XGBoost-powered Cox regression model performed at an acceptable level for patients with a length of stay up to 250 days (mean time-dependent AUC = 0.713) in the test dataset. However, for patients with a length of stay between 20 and 213 days, the performance of the model was relatively poor (time-dependent AUC < 0.7). When limited to patients with a length of stay ≤20 days, which accounts for 95.4% of all the patients, the model achieved an excellent performance (mean time-dependent AUC = 0.813). When further limited to patients with a length of stay ≤5 days, which accounts for two-thirds of all the patients, the model achieved an outstanding performance (mean time-dependent AUC = 0.917).

CONCLUSION: The XGBoost-powered Cox regression model can achieve an outstanding predictive ability for in-hospital mortality during the first 5 days, primarily based on the severity of the injury, the GCS on admission, and the patient's age. These variables continue to demonstrate an excellent predictive ability up to 20 days after admission, a period of care that accounts for over 95% of severe TBI patients. Past 20 days of care, other factors appear to be the primary drivers of in-hospital mortality, indicating a potential window of opportunity for improving outcomes.

Place, publisher, year, edition, pages
MDPI, 2023
Keywords
Trauma Quality Improvement Program (TQIP), extreme gradient boosting (XGBoost), machine learning, prediction model, survival analysis, traumatic brain injury
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:oru:diva-108668 (URN)10.3390/jpm13091401 (DOI)001082963300001 ()37763168 (PubMedID)2-s2.0-85172865755 (Scopus ID)
Available from: 2023-10-02 Created: 2023-10-02 Last updated: 2023-10-31Bibliographically approved
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