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Concomittant Traumatic Brain Injury and Burns in Combat Trauma
Vol. 223, No. 4S2, October 2016
CONCLUSIONS: Perioperative gabapentin was not effective in decreasing chronic pain after IHR, but patient perception of physical health, as measured by SF-12v2, did improve. Military vs Civilian Centers for Index Cancer Operations: Are 30-Day Outcomes Really that Different? CPT John M McClellan, MD, Vance Sohn, MD, FACS Madigan Army Medical Center, Tacoma, WA INTRODUCTION: A growing body of literature suggests that highvolume centers have better outcomes and lower complication rates in major oncologic procedures. However, no Department of Defense (DoD) facility meets the high-volume threshold and yet performs these resections. The goal of this analysis was to determine differences in 30-day outcomes for major oncologic resections using the NSQIP database. METHODS: Using the NSQIP database, we extracted 30-day outcomes data for all postoperative recurrences in 4 major index procedures: colectomy, pancreatectomy, hepatectomy, and esophagectomy. RESULTS: From January 2010 to April 2014, there were a total of 1,338 DoD and 266,654 civilian cases. Within this group, 434 DoD patients and 89,069 civilian patients experienced a postoperative occurrence (32.4% vs 33.4%). The demographics and preoperative health of both the DoD and civilian patient populations were similar in all 4 surgical groups. Postoperatively, DoD hospitals reported more readmissions within 30 days (23.5% vs 21.9%) and unplanned reoperations (23.3% and 14.1%), but, overall, the DoD had less mortality within 30 days (8.8% vs 9.9%). Both have a similar mean number of postoperative occurrences (1.7 DoD vs 1.8 civilian), 45% of those being wound complications in DoD group vs 42% in the civilian population. However, patients undergoing surgery within the DoD did have significantly less postoperative sepsis rates (13.1% vs 20.4%). CONCLUSIONS: In modern outcomes-based medicine, our data suggest that many oncologic procedures can be safely performed at low volume, DoD hospitals, with overall similar morbidity and less mortality than civilian hospitals.
Concomittant Traumatic Brain Injury and Burns in Combat Trauma MAJ MC John Christopher Graybill, MD, FACS, Jay Aden, PhD, MAJ MC Julie Ann Rizzo, MD, CAPT Michael Clemens, MD, Jud Janak, PhD, COL MC Christopher White, MD, FACS, MAJ MC Ian Driscoll, MD, LTC(P) MC Kevin Chung, MD, FCCM San Antonio Military Medical Center, San Antonio, TX, United States Army Institute of Surgical Research Burn Center, San Antonio, TX INTRODUCTION: Traumatic brain injury (TBI) and burns are common injuries that independently increase mortality, however
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they infrequently occur together. The impact and outcome of combined traumatic brain injury and burn trauma is unknown. METHODS: This study analyzed morbidity and mortality outcomes of service members treated at the US Institute of Surgical Research (USAISR) burn center from injuries sustained in combat operations in Iraq and Afghanistan between 2003 and 2013. Burn patients with and without TBI were compared. We hypothesized that TBI independently increases mortality in burn patients. Statistical analysis was performed using the chi-squared and MannWhitney U tests. RESULTS: Nine hundred fifty-one US service members and allied forces were treated at the USAISR, 713 (75%) from blast injury. Among this patient cohort, 95 sustained concomitant traumatic brain injuries. Age, percent total body surface area (% TBSA) burn, inhalational injury, and injury severity score (ISS) were independently associated with increased mortality (p<0.001). Traumatic brain injury was not significant for mortality (p<0.78). Concomitant TBI and burns was associated (p<0.05) with increased risk of ICU stay, hospital stay, ventilator days, episodes of shock, concomitant extremity or torso injury, amputation, bacteremia, urinary tract infection, wound infection, and thromboembolism. Traumatic brain injury did not increase the risk for inhalational injury, pneumonia, or transfusion requirement. Neurosurgical intervention need was not influence by TBI, however only 5 patients required neurosurgical intervention, CONCLUSIONS: Traumatic brain injury independently increases the risk of many complications when sustained with burns, but not mortality. Burns remain the highest risk of mortality in patients with TBI and burns.
International Military and Civilian Partnerships MAJ Ryan E Earnest, MD, MAJ Mary F Finn, MD United States Air Force, RAF Lakenheath, Brandon, Suffolk, United Kingdom INTRODUCTION: Currency and competency are persistent challenges for military surgeons. To augment surgical caseloads, partnerships have developed between military and civilian hospitals in the US. Historically, language and accreditation barriers have impeded these partnerships in overseas locations. We describe a partnership formed between an American Medical Treatment Facility (MTF) and the National Health Service (NHS) of the United Kingdom to maintain surgical currency at an overseas location. METHODS: At the Royal Air Force Lakenheath from August 2012 to December 2015, fifteen United States Air Force (USAF) surgeons from 4 specialties obtained registration with the General Medical Council (GMC) to work within the NHS system. Surgeons maintained logs of procedures performed and case logs for NHS and in-garrison surgeries were compared.
CONCLUSIONS: Perioperative gabapentin was not effective in decreasing chronic pain after IHR, but patient perception of physical health, as measured by SF-12v2, did improve. Military vs Civilian Centers for Index Cancer Operations: Are 30-Day Outcomes Really that Different? CPT John M McClellan, MD, Vance Sohn, MD, FACS Madigan Army Medical Center, Tacoma, WA INTRODUCTION: A growing body of literature suggests that highvolume centers have better outcomes and lower complication rates in major oncologic procedures. However, no Department of Defense (DoD) facility meets the high-volume threshold and yet performs these resections. The goal of this analysis was to determine differences in 30-day outcomes for major oncologic resections using the NSQIP database. METHODS: Using the NSQIP database, we extracted 30-day outcomes data for all postoperative recurrences in 4 major index procedures: colectomy, pancreatectomy, hepatectomy, and esophagectomy. RESULTS: From January 2010 to April 2014, there were a total of 1,338 DoD and 266,654 civilian cases. Within this group, 434 DoD patients and 89,069 civilian patients experienced a postoperative occurrence (32.4% vs 33.4%). The demographics and preoperative health of both the DoD and civilian patient populations were similar in all 4 surgical groups. Postoperatively, DoD hospitals reported more readmissions within 30 days (23.5% vs 21.9%) and unplanned reoperations (23.3% and 14.1%), but, overall, the DoD had less mortality within 30 days (8.8% vs 9.9%). Both have a similar mean number of postoperative occurrences (1.7 DoD vs 1.8 civilian), 45% of those being wound complications in DoD group vs 42% in the civilian population. However, patients undergoing surgery within the DoD did have significantly less postoperative sepsis rates (13.1% vs 20.4%). CONCLUSIONS: In modern outcomes-based medicine, our data suggest that many oncologic procedures can be safely performed at low volume, DoD hospitals, with overall similar morbidity and less mortality than civilian hospitals.
Concomittant Traumatic Brain Injury and Burns in Combat Trauma MAJ MC John Christopher Graybill, MD, FACS, Jay Aden, PhD, MAJ MC Julie Ann Rizzo, MD, CAPT Michael Clemens, MD, Jud Janak, PhD, COL MC Christopher White, MD, FACS, MAJ MC Ian Driscoll, MD, LTC(P) MC Kevin Chung, MD, FCCM San Antonio Military Medical Center, San Antonio, TX, United States Army Institute of Surgical Research Burn Center, San Antonio, TX INTRODUCTION: Traumatic brain injury (TBI) and burns are common injuries that independently increase mortality, however
Scientific Poster Presentations: 2016 Clinical Congress
e217
they infrequently occur together. The impact and outcome of combined traumatic brain injury and burn trauma is unknown. METHODS: This study analyzed morbidity and mortality outcomes of service members treated at the US Institute of Surgical Research (USAISR) burn center from injuries sustained in combat operations in Iraq and Afghanistan between 2003 and 2013. Burn patients with and without TBI were compared. We hypothesized that TBI independently increases mortality in burn patients. Statistical analysis was performed using the chi-squared and MannWhitney U tests. RESULTS: Nine hundred fifty-one US service members and allied forces were treated at the USAISR, 713 (75%) from blast injury. Among this patient cohort, 95 sustained concomitant traumatic brain injuries. Age, percent total body surface area (% TBSA) burn, inhalational injury, and injury severity score (ISS) were independently associated with increased mortality (p<0.001). Traumatic brain injury was not significant for mortality (p<0.78). Concomitant TBI and burns was associated (p<0.05) with increased risk of ICU stay, hospital stay, ventilator days, episodes of shock, concomitant extremity or torso injury, amputation, bacteremia, urinary tract infection, wound infection, and thromboembolism. Traumatic brain injury did not increase the risk for inhalational injury, pneumonia, or transfusion requirement. Neurosurgical intervention need was not influence by TBI, however only 5 patients required neurosurgical intervention, CONCLUSIONS: Traumatic brain injury independently increases the risk of many complications when sustained with burns, but not mortality. Burns remain the highest risk of mortality in patients with TBI and burns.
International Military and Civilian Partnerships MAJ Ryan E Earnest, MD, MAJ Mary F Finn, MD United States Air Force, RAF Lakenheath, Brandon, Suffolk, United Kingdom INTRODUCTION: Currency and competency are persistent challenges for military surgeons. To augment surgical caseloads, partnerships have developed between military and civilian hospitals in the US. Historically, language and accreditation barriers have impeded these partnerships in overseas locations. We describe a partnership formed between an American Medical Treatment Facility (MTF) and the National Health Service (NHS) of the United Kingdom to maintain surgical currency at an overseas location. METHODS: At the Royal Air Force Lakenheath from August 2012 to December 2015, fifteen United States Air Force (USAF) surgeons from 4 specialties obtained registration with the General Medical Council (GMC) to work within the NHS system. Surgeons maintained logs of procedures performed and case logs for NHS and in-garrison surgeries were compared.