Stanley E Okosun

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• 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
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  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
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  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.
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  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.
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  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.