Journal of Trauma and Acute Care Surgery最新文献

{"title":"Should we redefine the age of geriatric trauma? An insight from American College of Surgeons Trauma Quality Improvement Program database 30-day mortality risk.","authors":"Ahmed Noureldin, Mary Matecki, Renxi Li, Jayati Atahar, Sean M Lee, Susan Kartiko","doi":"10.1097/TA.0000000000004611","DOIUrl":"https://doi.org/10.1097/TA.0000000000004611","url":null,"abstract":"<p><strong>Background: </strong>Older injured patients have higher mortality compared with their younger counterparts, and their outcomes worsen with each decade of life. However, the exact age to classify a patient as \"geriatric\" is not universally defined. Identifying an evidence-based age cutoff for \"geriatric\" trauma activations is important to preserve hospital and human resources by not superfluously including younger patients but also not depriving older high-risk patients of resources needed to achieve their best recovery. The aim for our study is to define changes in mortality by age to determine the age at which patients are at risk of worse outcomes and should be classified as \"geriatric.\"</p><p><strong>Methods: </strong>This is a retrospective study of the American College of Surgeons Trauma Quality Improvement Program database. We obtained patients who had ground level fall (GLF) and sampling of patients with all trauma mechanism between the age of 17 and 89 years. Binary segmentation change-point analysis was used to calculate the optimized number and position of change points in mean unadjusted mortality by age for both GLF and all trauma groups.</p><p><strong>Results: </strong>A total of 1,360,160 GLF patients from the 2013-2021 American College of Surgeons Trauma Quality Improvement Program database were included. The random sample of all-trauma patients included 1,332,072 patients. Binary segmentation change-point analysis indicated that change point in mean unadjusted mortality occurs at 72 years of age for all trauma and 65 years of age for GLFs. All-trauma patients older than 72 years had an over four times increased odds of mortality, while GLF patients older than 65 years have a threefold increase in mortality compared with patients below those cutoffs.</p><p><strong>Discussion: </strong>We find that, for the elderly, mortality increases at different change points for all-trauma and GLF patients (72 and 65 years of age, respectively). Based on this finding, further study should be done using these two different age cutoff points based on mechanism of injury to mitigate mortality in geriatric trauma patients.</p><p><strong>Level of evidence: </strong>Prognostic and Epidemiologic Study; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel silica-based polymer hemostatic matrix improves vessel patency rates in a coagulopathic porcine model with penetrating arterial injury.","authors":"Lauren M Heyda, Adelle M Dagher, John A Mares, Justin D Hutzler, Patrick F Walker, Jason Radowsky, Matthew Bradley, David M Burmeister","doi":"10.1097/TA.0000000000004596","DOIUrl":"https://doi.org/10.1097/TA.0000000000004596","url":null,"abstract":"<p><strong>Background: </strong>Traumatic hemorrhage is the leading cause of preventable battlefield death and hemostatic agents can improve survival. We compared a novel, amorphous, silica dioxide-based fiber (SBF) hemostatic matrix to the criterion standard QuikClot Combat Gauze (QCCG) in treating a junctional arterial injury in hypocoagulable swine.</p><p><strong>Methods: </strong>Vascular access was obtained in 16 anesthetized swine, and hemodilution was achieved with 50% blood exchange with saline. A 5-mm arteriotomy was made in the common femoral artery. After 30 seconds of free bleeding, SBF or QCCG was applied, and pressure was held for 5 minutes. After 1 hour of monitoring, an angiogram and movement test were performed. Samples were drawn for blood count, chemistry, blood gas and rotational thromboelastography at various time points. The artery and hindlimb were collected for histology.</p><p><strong>Results: </strong>All animals (n = 8/group) survived. Hemodilution induced significant differences in hematocrit, platelets, clot formation time, and maximum clot firmness (p < 0.0001). There was no difference in blood counts or chemistries (p = 0.81-0.99) between groups at euthanasia. SBF required an average of 1.25 applications compared with 1.13 for QCCG (p > 0.99). SBF had significantly less blood loss (106.2 ± 66.6 mL) versus QCCG (189.6 ± 78.9 mL, p = 0.038). Angiography revealed patency with distal perfusion in all (8/8) SBF-treated animals. Alternatively, all QCCG-treated arteries were occluded without distal perfusion, which was statistically significant (p < 0.01). All animals remained hemostatic after the movement test. Blinded histopathological analysis revealed only two of eight cases of tunica intimal thickening and neutrophils in the QCCG group, which was not statistically different.</p><p><strong>Conclusion: </strong>SBF and QCCG had comparable hemostatic efficacy and no difference in the number of applications, despite SBF packaging containing less material. There was no evidence of significant laboratory abnormalities at the study conclusion. Taken together, SBF may be an appropriate hemostatic agent for hemorrhagic injury and is able to maintain hemostasis following stressed movement. Its improved vessel patency suggests SBF may decrease tissue ischemia and improve limb salvage in vascular injuries.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pelvic fracture bleeding control: What you need to know.","authors":"Todd W Costantini, Clay Cothren Burlew, Whitney R Jenson, Roman Pfeifer, Felix Karl-Ludwig Klingebiel, Rishi Kundi, Thomas M Scalea, Raul Coimbra","doi":"10.1097/TA.0000000000004609","DOIUrl":"https://doi.org/10.1097/TA.0000000000004609","url":null,"abstract":"<p><strong>Abstract: </strong>Significant bleeding due to pelvic fracture is associated with high mortality and must be treated promptly to optimize outcomes. The initial evaluation should focus on hemostatic resuscitation, placement of a pelvic binder, and evaluation for additional nonpelvic sources of hemorrhage. There are several options for pelvic hemorrhage control including external fixator placement, angioembolization, preperitoneal pelvic packing, and open internal iliac ligation or surgical embolization of the internal iliac artery. The specific hemorrhage control intervention selected to control pelvic bleeding must be tailored to the patient's physiologic status and local resource availability. This article discusses \"What You Need to Know\" to provide optimal care for patients with hemorrhage due to severe pelvic fracture.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Semiautonomous ventilation in a porcine hemorrhage and lung injury model provides lung protective ventilation.","authors":"Ellen R Becker, Adam D Price, Rebecca M Schuster, Chelsea Caskey, Brian Harvey, Maia P Smith, Richard D Branson, Michael D Goodman, Thomas C Blakeman","doi":"10.1097/TA.0000000000004610","DOIUrl":"https://doi.org/10.1097/TA.0000000000004610","url":null,"abstract":"<p><strong>Background: </strong>Mechanical ventilation requires frequent reassessment from providers to ensure delivery of lung protective ventilation. However, in resource-limited settings, the time and attention lung protective ventilation requires are not always feasible. This study aimed to compare a physiologic closed-loop control (PCLC) ventilator capable of self-adjusting based on patient parameters against standard of care (SOC) ventilatory management in a porcine model.</p><p><strong>Methods: </strong>The study compared SOC (n = 15) with PCLC (n = 15) for three porcine injury models: hemorrhage, lung injury, and hemorrhage with lung injury. Hemorrhage animals were progressively bled to three mean arterial pressures (60, 50, and then 40 mm Hg) and monitored for 60 minutes after each bleed. Lung injury used saline surfactant washout to a targeted PO2/fraction of inspired oxygen (FiO2) ratio of <250 mm Hg. Hemorrhage with lung injury combined surfactant washout followed by hemorrhage. Study end points were defined by the percent of time spent within target values: Acute Respiratory Distress Syndrome Network concordance, oxygenation (>96% with FiO2 0.21% or oxygen saturation [SpO2] <92% on FiO2 1.00%), tidal volume (4 ≤ VT/kg ≤ 10 mL/kg), and plateau pressure (≤30 cm H2O).</p><p><strong>Results: </strong>Standard of care animals spent a lower percentage of time within targeted SpO2 range compared with PCLC (49% ± 25% vs. 68% ± 24% of time, p = 0.04) across all injury models, while all other parameters were comparable. In the hemorrhage group, the percentage of time within targeted SpO2 was also lower in SOC compared with PCLC (p = 0.01), while the remaining parameters, and all parameters within lung injury alone and hemorrhage with lung injury were otherwise equivalent (p > 0.05).</p><p><strong>Conclusion: </strong>Physiologic closed-loop control performed equally to or better than SOC during both hemorrhage and lung injury. Physiologic closed-loop control has the potential to provide intensive care unit-level ventilator management in resource-limited circumstances, both in civilian and military operations.</p><p><strong>Level of evidence: </strong>Therapeutic Study; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of nights and weekends and patterns of interfacility transfer and mortality for emergency general surgery patients.","authors":"Jeremy H Levin, Jason T C Lee, Jill Castor, Rachel Rodriguez, Lava Timsina, Peter Jenkins","doi":"10.1097/TA.0000000000004600","DOIUrl":"https://doi.org/10.1097/TA.0000000000004600","url":null,"abstract":"<p><strong>Background: </strong>Presentation during nights and weekends has been associated with variations in care and poor outcomes for many time-sensitive conditions such as trauma, stroke, and cardiac arrest. We sought to determine whether variation in clinical care and outcomes exists for patients treated by the emergency general surgery service at our trauma center.</p><p><strong>Methods: </strong>We performed a retrospective cohort study at a Level 1 trauma center (2017-2022) of emergency general surgery patients who transferred from other facilities or presented directly to the emergency department. The primary exposure variable was presentation during nights and weekends versus weekdays. To test for changes in the volume of interfacility transfers, the primary outcome was transfer status. The secondary outcome was mortality. We performed risk adjustment using demographic data, payer status, and preexisting conditions. We conducted subgroup analyses for predominant diagnoses and sensitivity analyses by defining \"off-hours\" using alternative times.</p><p><strong>Results: </strong>The study included 7,274 patients, including 5,303 (72.9%) who arrived during off-hours and 3,195 (43.9%) transfers. Mortality was 6.5% (n = 472 patients). Off-hour presentations were associated with a significantly greater risk-adjusted likelihood of presenting as a transfer (adjusted odds ratio, 2.11; 95% confidence interval, 1.87-2.40), a finding consistent across all subgroups except for patients with appendicitis, choledocholithiasis, or pancreatitis. Increases in age, interfacility transfer, decreases in initial systolic blood pressure, and increases in initial heart rate were all associated with a statistically significant increased risk of mortality. However, we found no difference in mortality based on timing of presentation (adjusted odds ratio, 0.80; confidence interval, 0.63-1.01). All findings were robust to sensitivity analyses.</p><p><strong>Conclusion: </strong>Nights and weekends were associated with increased rates of interfacility transfer, although mortality was no greater than during weekdays. These findings have implications for staffing at both the referral and referring hospitals to optimize the timely treatment of patients with surgical emergencies.</p><p><strong>Level of evidence: </strong>Care Management; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of the proportion of low-titer O whole blood for resuscitation in pediatric trauma patients on 6-, 12- and 24-hour survival.","authors":"Ethan M Petersen, Andrew D Fisher, Michael D April, Mark H Yazer, Maxwell A Braverman, Matthew A Borgman, Steven G Schauer","doi":"10.1097/TA.0000000000004564","DOIUrl":"10.1097/TA.0000000000004564","url":null,"abstract":"<p><strong>Introduction: </strong>Hemorrhage is a leading cause of death in pediatric patients. Accumulating data suggest that low-titer group O whole blood (LTOWB) improves clinical outcomes in the pediatric population. We examined what ratio of LTOWB to total blood product conferred a survival benefit in transfused pediatric trauma patients.</p><p><strong>Methods: </strong>We retrospectively examined a cohort of injured subjects younger than 18 years from the Trauma Quality Improvement Program database who received any quantity of LTOWB and no documented prehospital cardiac arrest. We created a variable representing the volume of transfused LTOWB divided by the total volume of all transfused blood products administered within the first 4 hours of admission, that is, the proportion of LTOWB transfused. We analyzed increasing proportions of transfused LTOWB to determine whether there was an inflection point conferring increased survival.</p><p><strong>Results: </strong>From 2020 to 2022, 1,122 subjects were included in the analysis. The median (interquartile range) age was 16 (14-17) years. Firearms were the most common mechanism at 47% followed by collisions at 44%. The median composite injury severity score was 25 (16-34). Survival was 91% at 6 hours, 89% at 12 hours, and 88% at 24 hours. We noted an inflection point with improved survival at an LTOWB proportion of ≥30% of total volume of blood products received. The odds of survival at 6, 12, and 24 hours for those receiving ≥30% LTOWB was 1.85 (1.02-3.38), 2.09 (1.20-3.36), and 1.80 (1.06-3.08), and 3.55 (1.66-7.58), 3.71 (1.89-7.27), and 2.69 (1.44-5.02) when excluding those who died within 1 hour, respectively.</p><p><strong>Conclusion: </strong>Among LTOWB recipients, we found that a strategy of using LTOWB comprising at least 30% of the total transfusion volume within the first 4 hours was associated with improved survival at 6, 12, and 24 hours.</p><p><strong>Level of evidence: </strong>Therapeutic/Care Management; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"587-592"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical spine clearance in the pediatric trauma population: What you need to know.","authors":"Katie W Russell, Anastasia Kahan, R Scott Eldredge","doi":"10.1097/TA.0000000000004460","DOIUrl":"10.1097/TA.0000000000004460","url":null,"abstract":"<p><strong>Abstract: </strong>Evaluation of the pediatric cervical spine after blunt trauma is an important topic that requires special consideration. In this article, we will review background information and differences between the pediatric and adult cervical spine. We will then give up-to-date guidance on best practice for screening and clearance of the cervical spine in children, including the advantages and disadvantages of different imaging techniques. Finally, we will introduce current topics of study and surmise what changes or innovations may be coming in the future.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"541-549"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early versus delayed laparoscopic cholecystectomy for gallbladder perforation.","authors":"Renqing Wu, Ryan P Dumas, Vanessa Nomellini","doi":"10.1097/TA.0000000000004491","DOIUrl":"10.1097/TA.0000000000004491","url":null,"abstract":"<p><strong>Background: </strong>Gallbladder perforation occurs in 2% to 11% of patients with acute cholecystitis, with associated mortality estimated to be at 12% to 42%. Because of its low incidence, the data on management remain sparse. There is a lack of evidence to suggest whether early or delayed cholecystectomy is superior in the treatment of perforated cholecystitis. We hypothesize that an early definitive operation is associated with decreased total hospital length of stay (THLOS).</p><p><strong>Methods: </strong>Using the National Surgical Quality Improvement Program database from the American College of Surgery, we identified patients who underwent laparoscopic cholecystectomy for gallbladder perforation on an urgent or emergent basis from 2012 to 2021. We divided them into those who underwent early (<2 days from the date of admission to the date of operation) and delayed cholecystectomy (≥2 days from the date of admission to the date of operation). Our primary outcome was the THLOS. We created multivariate regression models to assess for the association of early versus delayed operation and THLOS.</p><p><strong>Results: </strong>The THLOS was found to be 2.94 days longer in the delayed group compared with the early group (p < 0.05). In those who did not present with sepsis on admission, the THLOS was noted to be 4.71 days longer in the delayed group compared with the early group (p < 0.05). Early versus delayed operation was not associated with a difference in the postoperative length of stay, 30-day postoperative complications, rate of readmission, and reoperation, regardless of preoperative sepsis status.</p><p><strong>Conclusion: </strong>Early laparoscopic cholecystectomy for gallbladder perforation is associated with decreased THLOS, and there were no other differences in outcomes compared with delayed laparoscopic cholecystectomy. Patients with gallbladder perforation would likely benefit from an early operation within 2 days of admission.</p><p><strong>Level of evidence: </strong>Therapeutic/Care management; Level IV.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":"98 4","pages":"642-648"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital-based violence intervention programs: An analysis of costs and key components.","authors":"Megan J O'Toole, Kathryn Schnippel, Bruce Larson","doi":"10.1097/TA.0000000000004498","DOIUrl":"10.1097/TA.0000000000004498","url":null,"abstract":"<p><strong>Background: </strong>Firearm assaults contribute to nearly 18,000 deaths and at least twice as many injuries annually, with immense human and financial costs. Gun violence survivors especially face unique and long-term physical, mental, economic, and safety-related challenges. Hospital-based violence intervention programs (HVIPs) connect survivors with violence prevention professionals at their hospital bedsides, then provide them with wraparound services in the months to come. Promising research shows that HVIPs reduce risks of reinjury, retaliation, and recidivism.</p><p><strong>Methods: </strong>This report provides a cost analysis of HVIPs, to inform researchers and implementers of the budget and key resources necessary for the first three years of implementation. Researchers employ an ingredients-based costing approach and base-case assumptions for a hospital-linked HVIP situated in a mid-sized city emergency department, serving 100 participants annually.</p><p><strong>Results: </strong>Results indicate that this base-case HVIP costs an estimated $1.1 million annually, or just under $10,800 per participant. Staffing accounts for the majority of HVIP budgets, followed by operations, crisis support, and finally transportation. Upfront costs are limited to technical assistance, first-time equipment, and accreditation courses, leaving annual costs relatively stable across the first 3 years of implementation. A customizable workbook is provided, through which users can adjust this study's assumptions to reflect their own program's specifications, which may vary.</p><p><strong>Conclusion: </strong>While a full cost-savings analysis remains needed, HVIP enrollment costs less per person than a single year of medical fees for nonfatal firearm assault-related injuries. This research can inform future cost, benefit, and savings analyses, and empower more communities to implement lifesaving HVIPs.</p><p><strong>Level of evidence: </strong>Economic and Value-Based Evaluation; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":"98 4","pages":"655-661"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A little goes a long way: A comparison of enterolithotomy versus single-stage cholecystectomy in the management of gallstone ileus.","authors":"Muhammad Haris Khurshid, Omar Hejazi, Audrey L Spencer, Adam Nelson, Collin Stewart, Christina Colosimo, Micheal Ditillo, Marc R Matthews, Louis J Magnotti, Bellal Joseph","doi":"10.1097/TA.0000000000004497","DOIUrl":"10.1097/TA.0000000000004497","url":null,"abstract":"<p><strong>Introduction: </strong>Gallstone ileus is an infrequent complication of cholelithiasis with no specific guidelines for its management. This study aims to compare the outcomes of patients with gallstone ileus managed with both enterolithotomy with cholecystectomy (EL-CCY) versus those managed with enterolithotomy (EL) only.</p><p><strong>Methods: </strong>In this retrospective analysis of 2011-2017 Nationwide Readmissions Database, all patients with an index admission diagnosis of gallstone ileus were included. Patients were stratified based on the type of intervention received for gallstone ileus into those who underwent EL-CCY and those who underwent EL alone and compared. Primary outcomes were in-hospital complications (surgical site infections, sepsis, pneumonia, cardiac arrest, deep vein thrombosis, intestinal obstruction) and mortality. Secondary outcomes were hospital length of stay, hospital costs, and readmissions rate and cause of readmissions. Multivariable logistic regression analysis was performed.</p><p><strong>Results: </strong>A total of 1,960 patients were identified. The mean age was 67 years and 67% were female. Two hundred eighty-nine patients (14.7%) were managed with EL-CCY, whereas 1,671 patients (85.3%) underwent EL only. Overall, the readmission rate was 4.8%, whereas mortality was 4.2%. There was no significant difference between groups in terms of index-admission complications (24.8% vs. 21.7%, p = 0.415), mortality (6.2% vs. 3.9%, p = 0.068), rates of readmission (3.5% vs. 5.1%, p = 0.22), and cause of readmission ( p > 0.05). Enterolithotomy and cholecystectomy group had significantly longer hospital length of stay (10 vs. 8 days, p < 0.001) and median hospital costs ($70,959 vs. $52,147, p < 0.001). On multivariable logistic regression analysis, female sex was a predictor of undergoing EL-CCY, whereas increasing age and higher grade of all-patient redefined diagnosis-related groups risk of mortality were independently associated with lower odds of undergoing EL-CCY.</p><p><strong>Conclusion: </strong>Our findings suggest no difference between EL compared with EL-CCY in terms of complications, readmissions, and mortality. However, patients managed with EL-CCY had a longer hospital stay and higher hospital costs compared with EL. Further prospective studies are needed to validate these findings and develop management protocols for gallstone ileus.</p><p><strong>Level of evidence: </strong>Therapeutic/Care Management; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"649-654"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}