September 12, 2023
Literature selections curated by Lewis Flint, MD, FACS, and reviewed by the ACS Brief editorial board.
Sullivan GA, Reddy S, Reiter AJ, et al. Does Trauma Center Volume Account for the Association between Trauma Center Verification Level and In-Hospital Mortality among Children Injured by Firearms in California? J Am Coll Surg. 2023, in press.
This article reported an analysis of data from a statewide hospital discharge database. The intent of the study was to determine potential reasons for observed reductions in in-hospital mortality for children injured by firearm violence; these reductions had been documented for patients treated in ACS-verified trauma centers. The authors hypothesized that mortality benefits could be due to the level of ACS verification or from trauma center volume.
The study included 2,409 subjects, and overall mortality was 8.6%. The analysis showed that in-hospital mortality was related to the level of trauma center verification and not trauma center volume; adult, pediatric, and combined level 1 centers had the lowest mortality. Level II center mortality was slightly higher, and the authors suggested that this could be due to longer transport times to these facilities. They concluded that ACS verification was an effective method for achieving mortality reduction for children injured by firearm violence.
Campbell BT. Improved Survival for Children Injured by Firearms. J Am Coll Surg. 2023, in press.
In the accompanying editorial, Brendan Campbell, MD, FACS, stressed that these findings confirm that the investment required for achieving trauma center verification is returned when reductions in mortality are realized.
Douketis JD, Spyropolous AC. Perioperative Management of Anticoagulant and Antiplatelet Therapy. NEJM Evidence. 2023, 2(6).
This review article provides a valuable and clearly written source of information regarding optimum perioperative management of patients who are being treated with traditional anticoagulant agents (heparin, warfarin), direct oral anticoagulants, and antiplatelet agents.
A summary of the mechanism of action of each of the drugs is included in separate sections of the article. Helpful tables are provided that can assist clinicians in determining risk of bleeding and/or venous thromboembolism in patients who require various types of procedures. Also included are lists of recommended preoperative intervals for anticoagulant interruption, as well as examples of procedures where anticoagulant interruption is not indicated. A detailed discussion of indications and contraindications for heparin bridging is provided. Specific examples of situations where heparin bridging is not indicated (for example, patients with atrial fibrillation or mechanical cardiac valves) are discussed.
Surgeons are encouraged to review the entire article content.