Stanley E Okosun

Interests

No activities entered.

Courses

No activities entered.

Scholarly Contributions

Journals/Publications

• Castillo-Diaz, F., Al Ma'ani, M., Khurshid, M. H., Hejazi, O., Colosimo, C., Nelson, A., Spencer, A. L., Okosun, S. E., Magnotti, L. J., & Joseph, B. (2025). Trends in the Management of Peripheral Arterial Injuries: A Five-Year National Analysis. Journal of Surgical Research, 313. doi:10.1016/j.jss.2025.06.076
  More info

  Introduction: Peripheral vascular injuries are rare with high rates of morbidity and long-term sequelae. The aim of this study is to study the trends in vascular injuries and management across American College of Surgeons–verified Level I trauma centers. Methods: We performed a 5-y retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program database for the years 2017-2021. We included all patients with peripheral arterial injuries (axillary, brachial, radial, ulnar, femoral, popliteal, and tibial arteries) that underwent open or endovascular repair. Trauma centers were stratified into tertiles based on the volume of these vascular injuries into low volume (LV), medium volume (MV), and high volume (HV) centers. The primary outcome was rates of open and endovascular repair. The secondary outcome was amputation. Descriptive statistics and trend analysis were performed. Results: We identified a total of 22,057 patients with peripheral arterial injuries managed at 340 trauma centers (243 LV; 73 MV; 24 HV). Overall, the mean age was 36 (16) y; 83% were male. Nearly 30% sustained blunt injuries with a median injury severity score of 9 [3-13]. HV centers deal with an average of 27 cases/y. The rates of open and endovascular repairs were 63% and 13%, respectively. HV centers were more likely to perform endovascular repair (LV 11% versus MV 12% versus HV 14%, P < 0.001). There was no clinically significant difference between the HV, MV, and LV centers in terms of amputations (HV: 2.9% versus MV: 3% versus LV: 2.5%). On linear regression analysis, the proportion of endovascular procedures has linearly increased from 12% in 2017 to 14% in 2021 (β = 0.013, 95% confidence interval = 0.010-0.016, P < 0.001). Conclusions: Peripheral arterial injuries remain a complex clinical challenge. Nearly one-third of the peripheral arterial injuries are due to blunt mechanisms. Open repair remains the most preferred method of management. However, the outcomes remain equivocal irrespective of volume. Current training programs need to identify ways to improve training in open repairs for vascular injuries.
• Castillo-Diaz, F., Al Ma'ani, M., Khurshid, M. H., Hejazi, O., Colosimo, C., Nelson, A., Spencer, A. L., Okosun, S. E., Magnotti, L. J., & Joseph, B. (2025). Trends in the Management of Peripheral Arterial Injuries: A Five-Year National Analysis. The Journal of surgical research, 313, 380-388.
  More info

  Peripheral vascular injuries are rare with high rates of morbidity and long-term sequelae. The aim of this study is to study the trends in vascular injuries and management across American College of Surgeons-verified Level I trauma centers.
• Hejazi, O., Stewart, C., Khurshid, M. H., Spencer, A. L., Castillo Diaz, F., Kunac, A., Al Ma'Ani, M., Okosun, S. E., Magnotti, L. J., & Joseph, B. (2025). Predictors of discharge against medical advice in pediatric trauma patients: A nationwide analysis. Journal of Trauma and Acute Care Surgery, 99(Issue 3). doi:10.1097/ta.0000000000004632
  More info

  BACKGROUND Discharge from hospital against medical advice (AMA) carries a significant risk of readmission and has increased rates of morbidity and mortality. Little is known about the characteristics of pediatric trauma patients discharged AMA. We aimed to identify predictors for discharge AMA in pediatric trauma patients. METHODS A 3-year retrospective cohort analysis of the 2017-2019 American College of Surgeons (ACS) Trauma Quality Improvement Program was performed. All pediatric (younger than 18 years) trauma patients were included. Patients with missing data on hospital discharge disposition were excluded. Two groups were compared: those discharged AMA and those who were not. Bivariate analysis using χ2 test was performed. A multivariable logistic regression analysis was performed to identify predictors for discharge AMA adjusting for age, sex, race, ethnicity, comorbidities, positive drug or alcohol screen, insurance status, injury severity, 4-hour packed red blood cells requirements, vitals, mechanisms of injury, and ACS Pediatric Trauma Center Verification Level. RESULTS A total of 259,363 pediatric trauma patients were identified; 436 (0.2%) were discharged AMA. Patients discharged AMA were older (mean age, 13 vs. 10 years; p < 0.001) and were more likely to be males (70% vs. 65%, p < 0.001), Black (31% vs. 18%, p < 0.001), and uninsured; to have a penetrating mechanism of injury (17% vs. 9%, p < 0.001); to be a victim of an assault; and to be treated at a non-pediatric-ACS-verified trauma center. Patients discharged AMA were more likely to test positive for alcohol or illicit drugs at time of admission. They were also more likely to undergo an abuse investigation and to be reported to Child Protective Services. CONCLUSION Discharge AMA is affected by different patient- and system-related factors. Understanding these factors could enable targeted interventions in clinical practice and policy. Our findings highlight the important role of pediatric trauma centers in addressing the needs of injured children. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
• Hejazi, O., Stewart, C., Khurshid, M. H., Spencer, A. L., Castillo Diaz, F., Kunac, A., Al Ma'ani, M., Okosun, S. E., Magnotti, L. J., & Joseph, B. (2025). Predictors of discharge against medical advice in pediatric trauma patients: A nationwide analysis. The journal of trauma and acute care surgery, 99(3), 433-438.
  More info

  Discharge from hospital against medical advice (AMA) carries a significant risk of readmission and has increased rates of morbidity and mortality. Little is known about the characteristics of pediatric trauma patients discharged AMA. We aimed to identify predictors for discharge AMA in pediatric trauma patients.
• Huang, R., Hejazi, O., Khurshid, M. H., Nelson, A., Stewart, C., Anand, T., Matthews, M. R., Okosun, S. E., Magnotti, L. J., & Joseph, B. (2025). Diversity in crisis: The impact of race and ethnicity on failure to rescue among geriatric trauma patients over the years. Journal of Trauma and Acute Care Surgery, 99(Issue 2). doi:10.1097/ta.0000000000004514
  More info

  BACKGROUND Failure to rescue (FTR) is an indicator of the quality of care provided by trauma centers. The aim of this study was to examine the trends of FTR incidence in geriatric trauma patients over the years and to determine whether race, ethnicity, and sex impact the FTR incidence. METHODS This is a retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program database over 4 years (2017-2020). All geriatric (≥60 years) trauma patients were included. Patients who died within 24 hours of admission or whose length of stay was ≤1 day were excluded. Trend analysis was performed. Patients were stratified based on race, ethnicity, and sex, and multivariable regression analyses were performed. RESULTS Over the course of 4 years, 1,105,651 geriatric patients were identified, of whom 30,984 (2.8%) developed major complications and 10,684 (34.5% of those with complications) had FTR. The mean (SD) age was 75 (9) years, 46% were male, 86% were White, and 6% were Hispanic. The median (interquartile range) Injury Severity Score was 9 (4-10) with no change over the years (p = 0.364) and 96.8% sustained a blunt injury. Over the 4 years, the rate of FTR increased from 0.55% in 2017 to 1.04% in 2020 (p < 0.001). An analysis of trends in FTR patients revealed no significant difference in the proportion of males and females over the years (p = 0.482). However, there was a notable increase in the proportion of Black and Hispanic patients in comparison with White (p < 0.001) and non-Hispanic patients (p = 0.023), respectively. The odds of developing FTR have been increasing over the years, with Black race and Hispanic ethnicity identified as the independent risk factors for FTR. CONCLUSION The risk-adjusted odds of developing FTR have been increasing over the years, with one in every three patients who developed complications not surviving to discharge. Our findings demonstrate that racial and ethnic factors significantly impact the incidence of FTR.
• Khurshid, M. H., Al Ma'ani, M., Hejazi, O., Castillo Diaz, F., Nelson, A., Anand, T., Colosimo, C., Okosun, S. E., Magnotti, L. J., & Joseph, B. (2025). Fibrinogen in Resuscitation of Older Adult Trauma Patients: Are They Too Old to Receive New Adjuncts?. Journal of Surgical Research, 315. doi:10.1016/j.jss.2025.09.045
  More info

  Introduction: Trauma-induced coagulopathy occurs in a quarter of injured patients and increases the risk of mortality. Recent studies suggest that fibrinogen supplementation (FS), when used as an adjunct for resuscitation, is associated with improved outcomes. There is a lack of data on the role of pharmacologic adjuncts in hemorrhaging older adult (OA) trauma patients. The aim of our study was to compare the outcomes of patients receiving FS as an adjunct to the standard of care among OA versus young adult (YA) trauma patients. Methods: We performed a 4-y (2017-2020) retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program database. All adult (age ≥18 y) trauma patients with a shock index > 1 who received early (≤4 h) FS, including fibrinogen concentrate (FC) or cryoprecipitate (Cryo), were included. We excluded patients dead on arrival, those transferred from other facilities, those with bleeding disorders or chronic liver disease, and those on preinjury anticoagulation. Patients were stratified into YA (18-64 y) and OA (≥ 65 y). Primary outcomes were 6-h and 24-h mortality. Secondary outcomes were included in-hospital mortality, major complications, and 4-h blood transfusion requirements. Multivariable regression analyses were performed to identify the independent association of age on the outcomes. Results: A total of 7103 patients were identified, of which 999 (14.06%) were OA. On presentation, the mean shock index was 1.4, and both study groups had comparable median Injury Severity Score. The median time to FC and Cryo administration was 59 and 120 min, respectively. Overall, the rates of 6-h, 24-h, and in-hospital mortality were 11.1%, 20.6%, and 38.9%, respectively. On multivariable regression analysis, age was not associated with 6-h mortality (adjusted odds ratio [aOR]: 1.20, 95% confidence interval [CI] [0.95-1.52], P = 0.125), 24-h mortality (aOR: 1.12, 95% CI [0.87-1.43], P = 0.379), and major complications (aOR: 0.79, 95% CI [0.83-1.27], P = 0.125). However, OA had independently higher risk-adjusted odds of in-hospital mortality (aOR: 1.96, 95% CI [1.59-2.41], P < 0.001). Notably, older age was associated with a 5.27-unit decrease in packed red blood cell, 2.82-unit decrease in fresh frozen plasma, and 1.63-unit decrease in platelet requirements at 4 h. A subanalysis of patients receiving Cryo (n = 6409) or FC (n = 694) showed the same trend of outcomes. Conclusions: FS was associated with early outcomes that were broadly comparable between OA and YA. Despite higher in-hospital mortality, older age was associated with a reduction in blood product transfusion compared with younger patients.
• Khurshid, M. H., Al Ma'ani, M., Hejazi, O., Castillo Diaz, F., Nelson, A., Anand, T., Colosimo, C., Okosun, S. E., Magnotti, L. J., & Joseph, B. (2025). Fibrinogen in Resuscitation of Older Adult Trauma Patients: Are They Too Old to Receive New Adjuncts?. The Journal of surgical research, 315, 426-434.
  More info

  Trauma-induced coagulopathy occurs in a quarter of injured patients and increases the risk of mortality. Recent studies suggest that fibrinogen supplementation (FS), when used as an adjunct for resuscitation, is associated with improved outcomes. There is a lack of data on the role of pharmacologic adjuncts in hemorrhaging older adult (OA) trauma patients. The aim of our study was to compare the outcomes of patients receiving FS as an adjunct to the standard of care among OA versus young adult (YA) trauma patients.
• Akl, M., Hejazi, O., Nelson, A., Khurshid, M., Stewart, C., Hosseinpour, H., Okosun, S., Magnotti, L., Bhogadi, S., & Joseph, B. (2024). From Procedure to Prognosis: The Association Between Obesity and Outcomes of Iliac Artery Injuries. Journal of Surgical Research, 302. doi:10.1016/j.jss.2024.07.085
  More info

  Introduction: The management of injuries to the iliac artery presents a challenging clinical scenario due to the impeded anatomical access. Obesity is a common comorbid condition known to affect the outcomes of trauma patients; however, there is a paucity of data on the association of obesity with the treatment and outcomes of iliac artery injuries. The aim of this study was to assess the association between body mass index (BMI) on the management and outcomes of patients with iliac artery injuries. Methods: This is a retrospective analysis of the American College of Surgeons–Trauma Quality Improvement Program (2017-2020). All adult (aged ≥18 y) trauma patients with iliac artery injuries who underwent open or endovascular repair were included. Patients were divided based on BMI (normal: BMI
• Hage, K., Nelson, A., Khurshid, M., Stewart, C., Hosseinpour, H., Okosun, S., Hejazi, O., Magnotti, L., Bhogadi, S., & Joseph, B. (2024). Diagnostic Laparoscopy in Trauma Patients: Do We Need to Open and See if We Can See Without Opening?. Journal of Surgical Research, 303. doi:10.1016/j.jss.2024.08.014
  More info

  Background: Diagnostic laparoscopy (DL) has been advocated to reduce the incidence of nontherapeutic laparotomies (NL) among stable trauma patients. This study aimed to compare the outcomes of hemodynamically stable trauma patients undergoing DL versus NL. Methods: This is a retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program database over 4 y (2017-2020). Hemodynamically stable (systolic blood pressure >90 & heart rate < 120) adult (≥18 y) trauma patients undergoing DL or NL were included. Patients were stratified into DL and NL and substratified based on the mechanism of injury (blunt versus penetrating) and compared. Results: Over 4 y, 3801 patients were identified, of which, 997 (26.2%) underwent DL. Overall, 25.6% sustained blunt injuries. The mean (SD) age was 39 (16) and 79.5% were male. The median injury severity score and abdominal abbreviated injury scale were 4 [4-9] and 1 [1-2], with no difference among study groups (P ≥ 0.05). The overall mortality and major complication rates were 2.8% and 13.2%, respectively. After controlling for potential confounding factors, DL was independently associated with lower odds of mortality (adjusted odds ratio: 0.10, 95% CI [0.04-0.29], P < 0.001) and major complications (adjusted odds ratio: 0.38, 95% CI [0.29-0.50], P < 0.001) and shorter hospital length of stay (β: −1.22, 95% CI [-1.78 to −0.67], P < 0.001). The trends toward improved outcomes in the DL group remained the same in the subanalysis of patients with penetrating and blunt injuries. Conclusions: With advances in minimally invasive surgery, unnecessary exploratory laparotomy can be avoided in many trauma patients. Our study shows that hemodynamically stable patients undergoing DL had superior outcomes compared to those with NL.
• Hosseinpour, H., Stewart, C., Hejazi, O., Okosun, S. E., Khurshid, M. H., Nelson, A., Bhogadi, S. K., Ditillo, M., Magnotti, L. J., & Joseph, B. (2024). FINDING THE SWEET SPOT: THE ASSOCIATION BETWEEN WHOLE BLOOD TO RED BLOOD CELLS RATIO AND OUTCOMES OF HEMORRHAGING CIVILIAN TRAUMA PATIENTS. Shock (Augusta, Ga.), 62(3), 344-350.
  More info

  Purpose: To evaluate the dose-dependent effect of whole blood (WB) on the outcomes of civilian trauma patients with hemorrhagic shock. Methods: We performed a 2-year (2020-2021) retrospective analysis of the ACS-TQIP dataset. Adult (≥18) trauma patients with a shock index (SI) >1 who received at least 5 units of PRBC and one unit of WB within the first 4 h of admission were included. Primary outcomes were 6-h, 24-h, and in-hospital mortality. Secondary outcomes were major complications and hospital and intensive care unit length of stay. Results: A total of 830 trauma patients with a mean (SD) age of 38 (16) were identified. The median [IQR] 4-h WB and PRBC requirements were 2 [2-4] U and 10 [7-15] U, respectively, with a median WB:RBC ratio of 0.2 [0.1-0.3]. Every 0.1 increase in WB:RBC ratio was associated with decreased odds of 24-h mortality (aOR: 0.916, P = 0.035) and in-hospital mortality (aOR: 0.878, P < 0.001). Youden's index identified 0.25 (1 U of WB for every 4 U of PRBC) as the optimal WB:PRBC ratio to reduce 24-h mortality. High ratio (≥0.25) group had lower adjusted odds of 24-h mortality (aOR: 0.678, P = 0.021) and in-hospital mortality (aOR: 0.618, P < 0.001) compared to the low ratio group. Conclusions: A higher WB:PRBC ratio was associated with improved early and late mortality in trauma patients with hemorrhagic shock. Given the availability of WB in trauma centers across the United States, at least one unit of WB for every 4 units of packed red blood cells may be administered to improve the survival of hemorrhaging civilian trauma patients.
• Huang, R., Hejazi, O., Khurshid, M. H., Nelson, A., Stewart, C., Anand, T., Matthews, M. R., Okosun, S. E., Magnotti, L. J., & Joseph, B. (2024). Diversity in crisis: The impact of race and ethnicity on failure to rescue among geriatric trauma patients over the years. The journal of trauma and acute care surgery.
  More info

  Failure to rescue (FTR) is an indicator of the quality of care provided by trauma centers. The aim of this study was to examine the trends of FTR incidence in geriatric trauma patients over the years and to determine whether race, ethnicity, and sex impact the FTR incidence.