Among adults admitted for trauma in Washington State, 3-year cumulative mortality was 16% despite a decline in in-hospital deaths. Discharge to a skilled nursing facility at any age following trauma admission was associated with a higher risk of subsequent mortality.

No abstract

Significant geographic variation in the management, outcome, and costs for splenic injury exists in the United States, and may reflect differences in quality of care. Inclusive trauma systems seem to improve outcomes without increasing hospital costs.

Background Our aim is to assess state variation in renal trauma outcomes. We hypothesize that states with more hospitals participating in a trauma system will have lower nephrectomy and mortality rates. Methods The Heathcare Cost and Utilization Project State Inpatient Database was utilized to conduct a retrospective cohort study of all patients hospitalized with renal injury from partnering states during 2001, 2004, and 2007. State trauma systems were categorized based on the proportion of all acute care hospitals designated as a trauma center (level I-V), with higher proportions correlating to a more inclusive system. Poisson regression for relative risks of inpatient nephrectomy and case fatality were performed adjusting for patient and state level factors. Results Patients in states with the “most inclusive” trauma systems had a 30% lower risk of nephrectomy (RR 0.70 95% CI 0.56, 0.88) and a 2.06% lower unadjusted inpatient case fatality rate compared to states with “exclusive” trauma systems. Inpatient case fatality risk varied significantly by trauma system inclusiveness. Patients treated in states with either a “more inclusive” (RR 0.85, 95% CI 0.74, 0.97) or “most inclusive” (0.74, 95% CI 0.64, 0.85) trauma system were independently associated with a lower inpatient case fatality risk compared to states with “exclusive” systems. Conclusions A reduced risk of nephrectomy and inpatient case fatality are more common among states that have a higher proportion of acute care hospitals participating as a trauma center (level I-V). Standardization of care may correlate with improved patient outcomes following renal trauma.

This is a case of a 4-cm left extrathoracic subclavian artery aneurysm (SCAA) in a 58-year-old man with an aortic root and abdominal aortic aneurysm. The patient had features suggestive of genetic arteriopathy, including vertebral artery tortuosity, pectus excavatum, tall stature, and scoliosis. The SCAA was successfully repaired with an inline prosthetic graft and anastomotic pledgets via a supraclavicular approach. Genetic testing revealed an FBN1 pathogenic variant consistent with Marfan syndrome. Repair is satisfactory 2 years later. Patients with SCAA should include consideration of genetic arteriopathy. Open repair of the extrathoracic SCAA in Marfan syndrome is recommended.

have established that rib resection can be beneficial. We sought to determine long-term, objective functional outcomes using the shortened Disabilities of the Arm, Shoulder, and Hand survey in patients with TOS who underwent rib resection.Methods: Clinical records for patients who underwent rib resection for TOS at a single institution were reviewed. All patients were contacted by telephone, and long-term functional outcome was assessed by the 11item version of the Disabilities of the Arm, Shoulder, and Hand questionnaire. Patients were also asked whether they returned to baseline activity and whether they were subjectively better postoperatively.Results: From 2000 to 2018, there were 261 patients who underwent rib resection surgery; 170 (65.1%) were reached by telephone for long-term follow-up. A total of 188 operations (102 neurogenic TOS, 82 venous TOS, 4 arterial TOS) were performed in these 170 patients. The Table summarizes our findings. The mean follow-up time for the cohort was 5.3 years (range, 1-18 years). Overall, 167 (88.9%) patients returned to baseline activity postoperatively.Conclusions: Rib resection for all forms of TOS is a durable surgical treatment that results in excellent long-term functional outcomes. This is the longest follow-up reported of any TOS series in the literature; our results confirm that the majority of patients have both an objectively measured benefit and subjectively reported return to baseline functional activity during a period as long as 18 years after rib resection.Background: This video describes a patient with clinical findings consistent with a genetically triggered arteriopathy with an enlarging left subclavian artery aneurysm. This video reviews the approach to open surgical repair of the extrathoracic distal subclavian artery.

No abstract

No abstract