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Socioeconomic Factors Associated with Surgical Therapy, Stage, and Survival in Patients with Early Hepatocellular Carcinoma
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Scientific Poster Presentations: 2016 Clinical Congress
CONCLUSIONS: Prehospital care and time to admission is prolonged in Maputo and is associated with significant mortality. This data can help determine how best to improve prehospital care to reduce transfer times and reduce mortality rate among trauma patients in Maputo. Questioning the Standard: Does Nonoperative Management of Blunt Abdominal Trauma Apply in Resource Limited Settings? Willy Fils Jean-Louis, MD, Jean Louis Mac Lee, MD, Andre Patrick Jeudy, MD, Neema C Kaseje, MD Hopital Universitaire, Mirebalais, Haiti, Children’s Hospital, Boston MA, University Hospitals, Geneva, Switzerland INTRODUCTION: Nonoperative management of hemodynamically stable blunt abdominal trauma patients is the current standard of care. However, the majority of studies justifying this standard were performed in high-income countries with different abdominal trauma patterns and more resources including blood products and interventional radiology. Our aim was to retrospectively review abdominal traumas seen at a tertiary hospital in Haiti. Our hypothesis was that the rate of perforated hollow viscus injuries requiring laparotomy after blunt abdominal trauma was higher than the <10% quoted in the literature. METHODS: We retrospectively reviewed patients admitted between January 2014 and November 2015 with abdominal trauma. We examined demographic characteristics, mechanisms of trauma, operative notes, and outcome measures including postoperative complications and mortality. We used 95% confidence intervals to determine statistical significance. RESULTS: We captured 52 abdominal traumas in our records; of these 59.6% were secondary to blunt trauma. Most patients were male (79%); and mean age was 28.5 years. The most common mechanism of blunt abdominal trauma was motor vehicle accidents 57.6%. Eighty-four percent of our blunt abdominal trauma patients underwent laparotomy. Of these, 30% had perforated hollow viscus injuries (CI 0.13-0.49); 35% had solid organ injuries (CI 0.16-0.53); and 19% had negative laparotomies (CI 0.04-0.34). Overall complication and mortality rates were: 19% (CI 0.05-0.33), and 9.6% (CI 0.02-0.18) respectively. CONCLUSIONS: A significant proportion of our blunt abdominal trauma patients had perforated hollow viscus injuries requiring laparotomy. Nonoperative management of blunt abdominal trauma should be used with caution in resource limited settings. Socioeconomic Factors Associated with Surgical Therapy, Stage, and Survival in Patients with Early Hepatocellular Carcinoma Niek A Peters, Ammar A Javed, MD, Kenzo Hirose, MD, FACS, Jin He, MD, Timothy Pawlik, MD, PhD, MPH, Christopher L Wolfgang, MD, FACS, Matthew J Weiss, MD, FACS Johns Hopkins University School of Medicine, Baltimore, MD
J Am Coll Surg
INTRODUCTION: Underutilization of potential curative surgical treatment remains a problem in management of hepatocellular carcinoma (HCC). Demographic and socioeconomic disparities continue to be important factors which may affect underutilization, and potential factors remain largely unclarified. Studying these factors may provide an opportunity to increase access to healthcare and improve survival of early stage HCC. METHODS: We performed a retrospective cohort study using SEER-database to assess patients with early-stage HCC diagnosed between 2004 and 2013. We defined early-stage HCC as T1 or T2 disease without extrahepatic manifestation (AJCC 7th-edition). Demographic and socioeconomic factors were analyzed to assess associations with utilization of treatment, stage of presentation and disease-specific-survival (DSS). RESULTS: A total of 13,694 patients were included of which only 45.6% underwent surgical treatment for early-stage HCC. Surgical treatment options included resection (10.6%), transplantation (15.5%), and ablation (19.5%). African Americans were less likely to receive liver transplantation (RRR¼0.54;95% CI, 0.36-0.79) compared to no surgical therapy than white patients, and more likely to receive surgical resection (RRR¼1.67; 95% CI,1.13-2.48). Patients from the Pacific West were less likely to undergo liver transplantation compared to no surgical therapy versus patients from the Southeast (RRR¼0.68; 95% CI,0.500.93). Both insured and married patients were more likely to receive liver transplantation. Young age (HR¼1.02; 95% CI,1.00-1.03; p¼0.025) and positive marital status (HR¼0.71; 95% CI,0.55-0.92; p¼0.010) were both independently associated with increased DSS. CONCLUSIONS: A majority of patients with early-stage HCC do not undergo surgical therapy. Demographic and socioeconomic factors are associated with treatment modality utilization after controlling for confounders. Of these age and marital status are independently associated with increased DSS.
Surgical Care for Civilians Provided by Military Medical Teams in Iraq and Afghanistan: A Systematic Review Yuanting Zha, Barclay T Stewart, MD, Eugenia E Lee, MD, Kyle N Remick, MD, FACS, Sherry M Wren, MD, FACS, Adam Kushner, MD, MPH, FACS Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, University of California-Irvine School of Medicine, Irvine, CA INTRODUCTION: The US Department of Defense Trauma Registry (DoDTR) was established to improve care delivery and outcomes for wounded soldiers. Significant advancements in battlefield care have been reported for US and NATO forces in Iraq and Afghanistan. However, military care for civilian populations living amid conflict has not been well-described. We aimed to review the literature on surgical care for civilians provided by military teams.
Scientific Poster Presentations: 2016 Clinical Congress
CONCLUSIONS: Prehospital care and time to admission is prolonged in Maputo and is associated with significant mortality. This data can help determine how best to improve prehospital care to reduce transfer times and reduce mortality rate among trauma patients in Maputo. Questioning the Standard: Does Nonoperative Management of Blunt Abdominal Trauma Apply in Resource Limited Settings? Willy Fils Jean-Louis, MD, Jean Louis Mac Lee, MD, Andre Patrick Jeudy, MD, Neema C Kaseje, MD Hopital Universitaire, Mirebalais, Haiti, Children’s Hospital, Boston MA, University Hospitals, Geneva, Switzerland INTRODUCTION: Nonoperative management of hemodynamically stable blunt abdominal trauma patients is the current standard of care. However, the majority of studies justifying this standard were performed in high-income countries with different abdominal trauma patterns and more resources including blood products and interventional radiology. Our aim was to retrospectively review abdominal traumas seen at a tertiary hospital in Haiti. Our hypothesis was that the rate of perforated hollow viscus injuries requiring laparotomy after blunt abdominal trauma was higher than the <10% quoted in the literature. METHODS: We retrospectively reviewed patients admitted between January 2014 and November 2015 with abdominal trauma. We examined demographic characteristics, mechanisms of trauma, operative notes, and outcome measures including postoperative complications and mortality. We used 95% confidence intervals to determine statistical significance. RESULTS: We captured 52 abdominal traumas in our records; of these 59.6% were secondary to blunt trauma. Most patients were male (79%); and mean age was 28.5 years. The most common mechanism of blunt abdominal trauma was motor vehicle accidents 57.6%. Eighty-four percent of our blunt abdominal trauma patients underwent laparotomy. Of these, 30% had perforated hollow viscus injuries (CI 0.13-0.49); 35% had solid organ injuries (CI 0.16-0.53); and 19% had negative laparotomies (CI 0.04-0.34). Overall complication and mortality rates were: 19% (CI 0.05-0.33), and 9.6% (CI 0.02-0.18) respectively. CONCLUSIONS: A significant proportion of our blunt abdominal trauma patients had perforated hollow viscus injuries requiring laparotomy. Nonoperative management of blunt abdominal trauma should be used with caution in resource limited settings. Socioeconomic Factors Associated with Surgical Therapy, Stage, and Survival in Patients with Early Hepatocellular Carcinoma Niek A Peters, Ammar A Javed, MD, Kenzo Hirose, MD, FACS, Jin He, MD, Timothy Pawlik, MD, PhD, MPH, Christopher L Wolfgang, MD, FACS, Matthew J Weiss, MD, FACS Johns Hopkins University School of Medicine, Baltimore, MD
J Am Coll Surg
INTRODUCTION: Underutilization of potential curative surgical treatment remains a problem in management of hepatocellular carcinoma (HCC). Demographic and socioeconomic disparities continue to be important factors which may affect underutilization, and potential factors remain largely unclarified. Studying these factors may provide an opportunity to increase access to healthcare and improve survival of early stage HCC. METHODS: We performed a retrospective cohort study using SEER-database to assess patients with early-stage HCC diagnosed between 2004 and 2013. We defined early-stage HCC as T1 or T2 disease without extrahepatic manifestation (AJCC 7th-edition). Demographic and socioeconomic factors were analyzed to assess associations with utilization of treatment, stage of presentation and disease-specific-survival (DSS). RESULTS: A total of 13,694 patients were included of which only 45.6% underwent surgical treatment for early-stage HCC. Surgical treatment options included resection (10.6%), transplantation (15.5%), and ablation (19.5%). African Americans were less likely to receive liver transplantation (RRR¼0.54;95% CI, 0.36-0.79) compared to no surgical therapy than white patients, and more likely to receive surgical resection (RRR¼1.67; 95% CI,1.13-2.48). Patients from the Pacific West were less likely to undergo liver transplantation compared to no surgical therapy versus patients from the Southeast (RRR¼0.68; 95% CI,0.500.93). Both insured and married patients were more likely to receive liver transplantation. Young age (HR¼1.02; 95% CI,1.00-1.03; p¼0.025) and positive marital status (HR¼0.71; 95% CI,0.55-0.92; p¼0.010) were both independently associated with increased DSS. CONCLUSIONS: A majority of patients with early-stage HCC do not undergo surgical therapy. Demographic and socioeconomic factors are associated with treatment modality utilization after controlling for confounders. Of these age and marital status are independently associated with increased DSS.
Surgical Care for Civilians Provided by Military Medical Teams in Iraq and Afghanistan: A Systematic Review Yuanting Zha, Barclay T Stewart, MD, Eugenia E Lee, MD, Kyle N Remick, MD, FACS, Sherry M Wren, MD, FACS, Adam Kushner, MD, MPH, FACS Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, University of California-Irvine School of Medicine, Irvine, CA INTRODUCTION: The US Department of Defense Trauma Registry (DoDTR) was established to improve care delivery and outcomes for wounded soldiers. Significant advancements in battlefield care have been reported for US and NATO forces in Iraq and Afghanistan. However, military care for civilian populations living amid conflict has not been well-described. We aimed to review the literature on surgical care for civilians provided by military teams.