bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Comparison of Perioperative Outcomes, Readmission, and Reoperation for Sacrospinous Ligament Fixation, Uterosacral Ligament Suspension, and Minimally Invasive Sacrocolpopexy
Authors: Yadav Ghanshyam S. , Gaddam Neha , Rahn David D. 
Published: February 2021

Objectives
Sacrospinous ligament fixation (SSLF), uterosacral ligament suspension (USLS), and minimally invasive sacrocolpopexy (MISC) are common routes for vaginal apical suspension. Comparative data analyzing perioperative adverse events among these 3 routes are sparse. Perioperative morbidity was compared among these 3 approaches.

Methods
The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients older than 18 years undergoing these surgical procedures from 2012 to 2018. Baseline characteristics, postoperative complications, and rates and timing of readmission/reoperation with identification of causes for either were extracted. Logistic regression was used to compare the odds of readmission or reoperation, adjusting for concurrent hysterectomy and the American Society of Anesthesiologists (ASA) score.

Results
There were 1,881 SSLFs, 975 USLSs, and 4,559 MISCs that were performed from 2012 to 2018. Vaginal approaches were more common in older, non-White women; women with comorbidities; and women with higher ASA scores and performed more often by gynecologists (vs urologists). More concomitant hysterectomies were performed with USLS and MISC than with SSLF (22% and 26% vs 5%). Increased postoperative blood transfusions, urinary tract infections, and overall complications were noted in the vaginal approaches (7% and 7% vs 5%). Minimally invasive sacrocolpopexy had longer operative times. More same-day discharges were observed in USLS and SSLF. Readmission (2%–3%) and reoperation (1%–2%) rates were similar across all routes when adjusted for concomitant hysterectomy and ASA class. The most common indications for readmission were related to bleeding, infection, or bowel issues (MISC). Hemorrhage/hematoma followed by intestinal obstruction was the most common indication for reoperation.

Conclusions
Overall perioperative safety is comparable in 3 common vaginal apical suspension routes. Readmission and reoperation remain rare after operative colpopexy regardless of route.
Changes in Morphology of the Urethral Rhabdosphincter Postpartum
Authors: Cramer Meagan S. , Boniface Emily R. , Holland Amanda , Gregory W. Thomas 
Published: February 2021

Objective
The aim of the study was to determine the effect of pregnancy on urethral rhabdosphincter cross-sectional area (CSA) and any association of CSA to urinary symptoms.

Methods
Nulliparous women planning pregnancy (N = 135) underwent standardized evaluations (symptom and quality of life [QOL] questionnaires, magnetic resonance imaging, ultrasonography, and neurophysiologic testing) between January 2008 and December 2013 (V1). The participants who became pregnant and gave birth underwent the same evaluations at 6 weeks (V2) and 6 months postpartum (V3). Participants who had magnetic resonance imaging data from both V1 and V3 were selected. We measured urethral rhabdosphincter CSA from high-resolution axial MRIs in a masked fashion. The mean CSA for each participant was calculated. The change from V1 to V3 was assessed.

Results
Sixty-eight women were evaluated. There was a significant decrease of 0.05 cm2 (interquartile range, −0.03 to 0.16 cm2; P = 0.002) in the median sphincter CSA between V1 and V3. There was a significant increase in the median Urinary Distress Inventory (UDI) subscore of the Pelvic Floor Distress Inventory (PFDI) from V1 to V3 (median increase of 0 [IQR, 0 to 8.3]; P = 0.033), but this was not significantly correlated with the change in the urethral CSA (Spearman correlation, 0.199; P = 0.107). Increasing fetal weight was correlated with a decrease in CSA postpartum after vaginal birth (Spearman correlation, −0.340; P = 0.017).

Conclusions
There is a decrease in urethral rhabdosphincter CSA with worsening Urinary Distress Inventory scores from prepregnancy to postpartum, but these two do not correlate in this cohort with low symptom levels. Among women who give birth vaginally, decrease in rhabdosphincter CSA is correlated with increasing fetal weight, perhaps with ramifications to be seen later in life.
Review of Malpractice Litigations Involving Vesicovaginal and Rectovaginal Fistulas Following Elective Hysterectomy for Benign Indications in the United States From 1970 to 2020
Authors: Kim Edward K. , Arya Lily A. , Andy Uduak U. , Cox Caroline K. , Harvie Heidi S. 
Published: February 2021

Objective
The aims of this study were to review malpractice litigations involving vesicovaginal and rectovaginal fistulas after elective hysterectomy for benign indications in the United States and identify the most common themes in allegations by the plaintiffs and defenses by the defendants.

Methods
Using the Lexis Nexis legal database, we searched for and reviewed all U.S. malpractice litigations pertinent to this question between 1970 and 2020.

Results
Out of 82 cases that were identified and reviewed, 17 cases met our inclusion and exclusion criteria. These cases were decided between 1973 and 2019. Nine cases involved total abdominal hysterectomies, 1 involved total laparoscopic hysterectomy (TLH), 1 involved total vaginal hysterectomy (TVH), and the rest were not specified. Fifteen cases involved vesicovaginal fistulas and 2 involved rectovaginal fistulas. Three cases were ruled in favor of the plaintiffs, with monetary compensation ranging from $250,000 to $753,722 (approximately $364,120 to $1.8 million when adjusted for inflation), whereas 14 cases were ruled in favor of the defending surgeons. Common allegations were negligence in 15 cases and lack of informed consent in 2 cases. Factors that strengthened the defendants’ arguments were thorough documentation, informed consent, and prompt referral to specialists. Intraoperative cystoscopy may have benefited in some cases.

Conclusions
Thorough documentation, informed consent, and prompt referral to specialists strengthened the defendants’ legal arguments. Intraoperative cystoscopy may also be beneficial.
Perceptions of Mesh Use for Pelvic Floor Surgery in Latinas: Face Validity of a Spanish Questionnaire
Authors: Limtrakul Narinta , Florence Elizabeth , Sanchez Sheralyn , Montoya T. Ignacio , Maldonado Pedro A. 
Published: February 2021

Objective
The aim of the study was to validate a Spanish-translated survey assessing patients’ perceptions of mesh use in pelvic floor surgery.

Methods
An English-language survey evaluating perceptions of mesh use underwent a process of Spanish translation and validation, using a forward-backward translation validation protocol. Self-identified bilingual Latinas with symptoms of pelvic floor disorders were recruited to participate in cognitive interviews after completing the survey in English and Spanish. κ coefficient and Cronbach α were calculated for measurement of reliability and internal consistency in responses. A P value of 0.05 was considered statistically significant.

Results
A total of 30 women were randomized to complete the initial survey in either English or Spanish. Demographics for the 2 cohorts were similar. For the Spanish-translated survey overall, 86% described the questions as “somewhat easy” or “very easy” to understand, and 93% reported that it was “clear” or “very clear” that the survey aimed to investigate their thoughts regarding mesh use. Approximately 63% of the participants expressed confusion over the use of the Spanish medical term “cabestrillo,” translated for “sling.” There were no significant differences in the responses on cognitive interview between the 2 groups. Overall, the responses between English and Spanish versions of the survey demonstrated good reliability and internal consistency.

Conclusions
This study demonstrated face validity of a Spanish-translated survey assessing perceptions of mesh use in pelvic surgery in a Latina population. Participants’ feedback was crucial to optimizing the quality of the survey for future studies that will evaluate Spanish-speaking patients’ views of mesh implants in pelvic reconstructive surgery.
The Risk of Primary Uterine and Cervical Cancer After Hysteropexy
Authors: Kurian Rebecca , Kirchhoff-Rowald Amelia , Sahil Suman , Cheng An-Lin , Wang Xi , Shepherd Jonathan P. , Sutkin Gary 
Published: February 2021

Objective
The aim of the study was to determine the rate of subsequent uterine/cervical cancer after hysteropexy compared with hysterectomy with apical prolapse repair.

Methods
The study used a retrospective cohort of women with uterovaginal prolapse using the Cerner Health Facts database between 2010 and 2018. We identified sacrospinous or uterosacral ligament suspensions or sacral colpopexy/hysteropexy and excluded those with previous hysterectomy. We used the International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision codes for endometrial cancer/hyperplasia and cervical cancer and then reviewed each case, excluding those whose cancer existed at time of prolapse repair. Given that 0 cancer cases were identified, we used Wilson, Jeffreys, Agresti-Coull, Clopper-Pearson, and Rule of 3 to define 95% confidence intervals to estimate the highest possible rate of cancer in each cohort.

Results
A total of 8,927 patients underwent apical prolapse surgery. Of 4,510 with uterovaginal prolapse, 755 (16.7%) underwent hysteropexy. Seventy one with hysterectomy and 5 with hysteropexy had codes for subsequent gynecologic cancer but were excluded on further review. This left 0 gynecologic cancer cases with the largest 95% confidence interval of 0%–0.61% for hysteropexy versus 0%–0.13% for hysterectomy (P > 0.05). The hysteropexy cohort was older (62.6 years vs 57.3 years, P < 0.0001), more likely to have public insurance (51.0% vs 37.9%, P < 0.0001), and less likely to smoke (4.5% vs 7.6%, P = 0.0026). Median follow-up was longer after hysteropexy (1,480 days vs 1,164 days, P < 0.0009).

Conclusions
We can say with 95% certainty that uterine or cervical cancer will develop after hysteropexy in fewer than 0.61% of women, which was not different if hysterectomy was performed. This should be included in preoperative counseling for hysteropexy. Studying longer follow-up after hysteropexy may capture more cases of subsequent cancer development.
Time to operating room matters in modern management of pancreatic injuries: A national review on the management of adult pancreatic injury at Canadian level 1 trauma centers
Authors: Joos Emilie , de Jong Nenke , Ball Chad G. , Quigley Stephen , Trottier Vincent , Massé Marianne , Engels Paul T. , Rao Jagadish , Gillman Lawrence M. , Visser Robin , Widder Sandy , Hameed Morad S. , Vogt Kelly N. ,   on behalf of the Canadian Collaborative on Urgent Care Surgery (CANUCS)
Published: February 2021

BACKGROUND
Pancreatic injuries are rare, difficult to diagnose, and complex to manage despite multiple published guidelines. This study was undertaken to evaluate the current diagnosis and management of pancreatic trauma in Canadian trauma centers.

METHODS
This is a multi-institutional retrospective study from 2009 to 2014 including patients from eight level 1 trauma centers across Canada. All patients with a diagnosis of pancreatic trauma were included. Demographics, injury characteristics, vital signs on admission, and type of management were collected. Outcomes measured were mortality and pancreas-related morbidity.

RESULTS
Two hundred seventy-nine patients were included. The median age was 29 years (interquartile range, 21–43 years), 72% were male, and 79% sustained blunt trauma. Pancreatic injury included the following grades: I, 26%; II, 28%; III, 33%; IV, 9%; and V, 4%. The overall mortality rate was 11%, and the pancreas-related complication rate was 25%. The majority (88%) of injuries were diagnosed within 24 hours of injury, primarily (80%) with a computed tomography scan. The remaining injuries were diagnosed with ultrasound (6%) and magnetic resonance cholangiopancreatography (MRCP) (2%) and at the time of laparotomy or autopsy (12%). One hundred seventy-five patients (63%) underwent an operative intervention, most commonly a distal pancreatectomy (44%); however, there was great variability in operative procedure chosen even when considering grade of injury.

CONCLUSION
Pancreatic injuries are associated with multiple other injuries and have significant morbidity and mortality. Their management demonstrates significant practice variation within a national trauma system.

LEVEL OF EVIDENCE
Therapeutic/care management, level V; Prognostic and epidemiological, level IV.
Managing acute uncomplicated appendicitis in frail geriatric patients: A second hit may be too much
Authors: Chehab Mohamad , Ditillo Michael , Khurrum Muhammad , Gries Lynn , Asmar Samer , Douglas Molly , Bible Letitia , Kulvatunyou Narong , Joseph Bellal 
Published: February 2021

INTRODUCTION
Studies have proposed the use of antibiotics only in cases of acute uncomplicated appendicitis (AUA). However, there remains a paucity of data evaluating this nonoperative approach in the vulnerable frail geriatric population. The aim of this study was to examine long-term outcomes of frail geriatric patients with AUA treated with appendectomy compared with initial nonoperative management (NOP).

METHODS
We conducted a 1-year (2017) analysis of the Nationwide Readmissions Database and included all frail geriatric patients(age, ≥65 years) with a diagnosis of AUA. Frailty was assessed using the five-factor modified frailty index. Patients were stratified into those undergoing appendectomy at index admission (operative management) versus those receiving antibiotics only without operative intervention (NOP). Propensity score matching in a 1:1 ratio was performed adjusting for patient- and hospital-related factors.

RESULTS
A total of 5,562 frail geriatric patients with AUA were identified from which a matched cohort of 1,320 patients in each group was obtained. Patients in the NOP and operative management were comparable in terms of age (75.5 ± 7.7 vs. 75.5 ± 7.4 years; p = 0.882) and modified frailty index (0.4 [0.4–0.6] vs. 0.4 [0.4–0.6]; p = 0.526). Failure of NOP management was reported in 18% of patients, 95% of which eventually underwent appendectomy. Over the 6-month follow-up period, patients in the NOP group had significantly higher rates of Clostridium difficile enterocolitis (3% vs. 1%; p < 0.001), greater number of overall hospitalized days (5 [3–9] vs. 4 [2–7] days; p < 0.001), and higher overall costs (US $16,000 [12,000–25,000] vs. US $11,000 [8,000–19,000]; p < 0.001). Patients undergoing appendectomy after failed NOP had significantly higher rates of complications (20% vs. 11%; p < 0.001), mortality (4% vs. 2%; p = 0.019), and appendiceal neoplasm (3% vs. 1%; p = 0.027).

CONCLUSION
One in six patients failed NOP within 6 months and required appendectomy with subsequent more complications and higher mortality. Appendectomy may offer better outcomes in managing AUA in the frail geriatric population.

LEVEL OF EVIDENCE
Therapeutic, level IV.
Association between access to pediatric trauma care and motor vehicle crash death in children: An ecologic analysis of United States counties
Authors: Byrne James P. , Nance Michael L. , Scantling Dane R. , Holena Daniel N. , Kaufman Elinore J. , Nathens Avery B. , Reilly Patrick M. , Seamon Mark J. 
Published: February 2021

BACKGROUND
Access to pediatric trauma care is highly variable across the United States. The purpose of this study was to measure the association between pediatric trauma center care and motor vehicle crash (MVC) mortality in children (<15 years) at the US county level for 5 years (2014–2018).

METHODS
The exposure was defined as the highest level of pediatric trauma care present within each county: (1) pediatric trauma center, (2) adult level 1/2, (3) adult level 3, or (4) no trauma center. Pediatric deaths due to passenger vehicle crashes on public roads were identified from the NHTSA Fatality Analysis Reporting System. Hierarchical negative binomial modeling measured the relationship between highest level of pediatric trauma care and pediatric MVC mortality within counties. Adjusted analyses accounted for population age and sex, emergency medical service response times, helicopter ambulance availability, state traffic safety laws, and measures of rurality.

RESULTS
During the study period 3,067 children died in fatal crashes. We identified 188 pediatric trauma centers in 141 counties. Significant disparities in access to pediatric trauma care were observed. Specifically, 99% of pediatric trauma centers were situated in population-dense urban counties, while 28% of children lived in counties no trauma center. After risk adjustment, counties with pediatric trauma centers had significantly lower rates of pediatric MVC death than those with no trauma center: 0.7 versus 3.2 deaths/100,000 child-years; mortality rate ratio, 0.58; and 95% confidence interval, 0.39 to 0.86. In counties where pediatric trauma centers were absent, adult level 1/2 trauma centers were associated with comparable risk reduction.

CONCLUSION
The presence of pediatric trauma centers was associated with lower rates of MVC death in children. Adult level 1/2 trauma centers appear to offer comparable risk reduction. Where population differences in pediatric trauma mortality are observed, addressing disparities in county-level access to pediatric trauma care may serve as a viable target for system-level improvement.

LEVEL OF EVIDENCE
Epidemiological, level III; Care management, level III.
Variation in neurosurgical intervention for severe traumatic brain injury: The challenge of measuring quality in trauma center verification
Authors: Truong Evelyn I. , Stanley Samuel P. , DeMario Belinda S. , Tseng Esther S. , Como John J. , Ho Vanessa P. , Kelly Michael L. 
Published: February 2021

BACKGROUND
Intracranial pressure monitor (ICPm) procedure rates are a quality metric for American College of Surgeons trauma center verification. However, ICPm procedure rates may not accurately reflect the quality of care in TBI. We hypothesized that ICPm and craniotomy/craniectomy procedure rates for severe TBI vary across the United States by geography and institution.

METHODS
We identified all patients with a severe traumatic brain injury (head Abbreviated Injury Scale, ≥3) from the 2016 Trauma Quality Improvement Program data set. Patients who received surgical decompression or ICPm were identified via International Classification of Diseases codes. Hospital factors included neurosurgeon group size, geographic region, teaching status, and trauma center level. Two multiple logistic regression models were performed identifying factors associated with (1) craniotomy with or without ICPm or (2) ICPm alone. Data are presented as medians (interquartile range) and odds ratios (ORs) (95% confidence interval).

RESULTS
We identified 75,690 patients (66.4% male; age, 59 [36–77] years) with a median Injury Severity Score of 17 (11–25). Overall, 6.1% had surgical decompression, and 4.8% had ICPm placement. Logistic regression analysis showed that region of the country was significantly associated with procedure type: hospitals in the West were more likely to use ICPm (OR, 1.34 [1.20–1.50]), while Northeastern (OR, 0.80 [0.72–0.89]), Southern (OR, 0.84 [0.78–0.92]), and Western (OR, 0.88 [0.80–0.96]) hospitals were less likely to perform surgical decompression. Hospitals with small neurosurgeon groups (<3) were more likely to perform surgical intervention. Community hospitals are associated with higher odds of surgical decompression but lower odds of ICPm placement.

CONCLUSION
Both geographic differences and hospital characteristics are independent predictors for surgical intervention in severe traumatic brain injury. This suggests that nonpatient factors drive procedural decisions, indicating that ICPm rate is not an ideal quality metric for American College of Surgeons trauma center verification.

LEVEL OF EVIDENCE
Epidemiological, level III; Care management/Therapeutic level III.
Is a chest radiograph indicated after chest tube removal in trauma patients? A systematic review
Authors: Sweet Arthur A.R. , Beks Reinier B. , de Jong Mirjam B. , van Baal Mark C.P.M. , IJpma Frank F.A. , Hietbrink Falco , Beeres Frank J.P. , Leenen Luke P.H. , Groenwold Rolf H.H. , Houwert Roderick M. 
Published: February 2021

PURPOSE
The aim of this systematic review was to assess the necessity of routine chest radiographs after chest tube removal in ventilated and nonventilated trauma patients.

METHODS
A systematic literature search was conducted in MEDLINE, Embase, CENTRAL, and CINAHL on May 15, 2020. Quality assessment was performed using the Methodological Index for Nonrandomized Studies criteria. Primary outcome measures were abnormalities on postremoval chest radiograph (e.g., recurrence of a pneumothorax, hemothorax, pleural effusion) and reintervention after chest tube removal. Secondary outcome measures were emergence of new clinical symptoms or vital signs after chest tube removal.

RESULTS
Fourteen studies were included, consisting of seven studies on nonventilated patients and seven studies on combined cohorts of ventilated and nonventilated patients, all together containing 1,855 patients. Nonventilated patients had abnormalities on postremoval chest radiograph in 10% (range across studies, 0–38%) of all chest tubes and 24% (range, 0–78%) of those underwent reintervention. In the studies that reported on clinical symptoms after chest tube removal, all patients who underwent reintervention also had symptoms of recurrent pathology. Combined cohorts of ventilated and nonventilated patients had abnormalities on postremoval chest radiograph in 20% (range, 6–49%) of all chest tubes and 45% (range, 8–63%) of those underwent reintervention.

CONCLUSION
In nonventilated patients, one in ten developed recurrent pathology after chest tube removal and almost a quarter of them underwent reintervention. In two studies that reported on clinical symptoms, all reinterventions were performed in patients with symptoms of recurrent pathology. In these two studies, omission of routine postremoval chest radiograph seemed safe. However, current literature remains insufficient to draw definitive conclusions on this matter, and future studies are needed.

LEVEL OF EVIDENCE
Systematic review study, level IV.