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Frailty has been increasingly recognized as a risk factor for inferior surgical outcomes and greater resource use. The present study evaluated the impact of a coding-based frailty tool on outcomes of elective colectomy in a national cohort.

Adults undergoing elective colectomy were identified in the 2016-17 Nationwide Readmissions Database. Frailty was defined using the Johns Hopkins 10-domain coding-based binary tool. Generalized linear models were used to examine the association of frailty with in-hospital mortality, nonhome discharge, hospitalization duration (LOS), and inflation-adjusted costs. Kaplan-Meier survival analysis and log-rank test was used to compare readmissions up to 1-year.

Of 133175 patients, 10.6% were considered frail. The most common resections were sigmoid (43.9%) and right (34.7%) while total colectomy was least common (2.8%). After adjustment, frailty was associated with greater odds of mortality (3.2, 95% CI 2.8-3.8) and nonhome discharge (6.0, 95% CI 5.5-6.4) as well as a $13,400-increment (95% CI 12,400-14,400) in costs and 4.4-day (95% CI 4.1-4.6) increase in LOS. Nonelective readmissions at 30 days were greater in frail than non-frail groups (14.7% vs. 10.4%,

< .001).

Frailty is associated with inferior clinical outcomes and increased resource use following elective colectomy. Inclusion of frailty in risk models may facilitate risk stratification and shared decision-making.

Frailty is associated with inferior clinical outcomes and increased resource use following elective colectomy. Inclusion of frailty in risk models may facilitate risk stratification and shared decision-making.

Shark-related injuries (SRIs) are a dreaded, but rare, source of injury that have not been well described. read more The present study aims to examine the incidence, injuries, and outcomes of SRIs presenting to US trauma centers.

The National Trauma Data Bank was queried from 2015 to 2018 to identify SRIs using ICD-10 e-codes W56.41XA, W56.42XA, and W56.49XA. Descriptive analyses were conducted on patient demographics, injuries, hospital course, procedures, and outcomes.

Fifty-three patients were identified with a mechanism of injury that was shark-related. The median age was 29years (range 3-67) and median injury severity score was 5 (IQR 3-10). The majority of patients (96%) were admitted to the hospital (median length of stay (LOS) 4.0days, IQR 3.0-8.0), 55% went directly to the operating room, and 53% required intensive care unit (ICU) admission (median ICU LOS 4.5days, IQR 1.3-7.0). Extremity injuries were common 47% suffered lower extremity injuries, 40% had upper extremity injuries, and 13% had both. The majority of patients underwent surgical procedures 83% had soft tissue injuries requiring debridement, flap coverage, or skin grafting; 28% suffered neurovascular injuries (17% requiring nerve repair and 2% requiring arterial bypass); and 59% required orthopedic intervention. Six patients (11%) required amputation(s). All patients survived to discharge.

Although an exceedingly rare source of trauma, SRIs are frequently associated with devastating injuries. Given the severity of injuries and associated procedures required, these patients warrant referral to a trauma center capable of providing comprehensive care.

Although an exceedingly rare source of trauma, SRIs are frequently associated with devastating injuries. Given the severity of injuries and associated procedures required, these patients warrant referral to a trauma center capable of providing comprehensive care.The unprecedented threat of COVID-19 has taken its toll on the field of cancer research, with trial accrual rates seeing a sharp decline since the beginning of the pandemic. Recent evidence has suggested that decreased participation appears to be more pronounced in women than men, which raises concerns about an exacerbation of gender bias in research. The following manuscript is a commentary article to the recent study by Fox et al, who aimed at investigating the concerns of patients with regard to participating to cancer research, as well as examining potential gender disparities within their sample population. We provide a brief critique of their work, especially focusing on important limitations concerning sample size and under-representation of ethnic minority groups, before discussing their findings in light of current literature on gender differences in anxiety and risk perception, how this might be interpreted in the context of the current pandemic, and its impact on participation in cancer research. We present multiple lines of evidence which support the idea that women might experience greater anxiety during the COVID-19 pandemic which could have a significant impact on cancer research participation and consequently the external validity of studies in the field. The first attempts to tackle these challenges have shown promise, but further research is required to perfect this process and target those groups who are at greatest need of intervention.

Providing temporary cardiopulmonary support, extracorporeal membrane oxygenation (ECMO) carries a high risk of mortality. Palliative care (PC) may facilitate a patient-centered approach to end-of-life care in order to aid symptom management and provide psychosocial support to families. The present study aimed to identify factors associated with PC consultation and its impact on resource utilization in ECMO.

All adults placed on ECMO at a PC capable center were identified in the 2006-2017 National Inpatient Sample. Indications for ECMO were identified using diagnosis codes and classified into postcardiotomy syndrome, respiratory failure, cardiogenic shock, mixed cardiopulmonary failure, and transplant related.

Of 41122 patients undergoing ECMO, 20514 (49.9%) died in the same hospitalization. Of those, 3951 (19.3%) received a PC consult. Use of PC consults increased significantly from 5.5% in 2006 to 22.8% in 2017 (nptrend<.001). After multivariable risk adjustment, PC consults did not affect costs (β -$7341, 95% CI -22572 to +7888) or duration of hospitalizations (β -.37days, 95% CI -2.76 to +2.02).

Utilization of PC does not appear to negatively influence resource utilization among non-survivors of ECMO. Increased adaptation of PC in ECMO may improve end-of-life care, a factor that deserves future study.

Utilization of PC does not appear to negatively influence resource utilization among non-survivors of ECMO. Increased adaptation of PC in ECMO may improve end-of-life care, a factor that deserves future study.