Tanya Anand

Interests

Research

Endotheliopathy of TraumaGeriatric TraumaHemorrhagic Shock and Resuscitation

Courses

Scholarly Contributions

Books

• Kacprzyk, J., Pal, N., Pérez, R., Corchado, E., Hagras, H., Kóczy, L. T., Kreinovich, V., Lin, C., Lu, J., Melín, P., Nedjah, N., Nguyên, N. T., Wang, J., Wang, J., Prasad, V. K., Reddy, K. H., Reddy, S., Reddy, C. B., Reddy, V. B., , Chandra, S., et al. (2022). Soft Computing and Signal Processing. doi:10.1007/978-981-16-1249-7

Chapters

• Anand, T., Asmar, S., & Joseph, B. (2021). Is it Time for REBOA to be Considered as an Equivalent to Resuscitative Thoracotomy?. In Is it Time for REBOA to be Considered as an Equivalent to Resuscitative Thoracotomy?. doi:10.1007/978-3-030-81667-4_5
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  In severe non-compressible torso hemorrhage (NCTH), proximal aortic control is needed for survival in many cases. The benchmark to obtain this control is typically achieved by emergency surgery coupled with a resuscitative thoracotomy (RT). Recently, a non-invasive method, resuscitative endovascular balloon occlusion of the aorta (REBOA), has become a feasible consideration for hemorrhage control. REBOA has emerged as an attractive tool when combined with whole blood resuscitation to temporize hemorrhage and extend the “golden hour.” However, REBOA’s ability to replace RT remains limited. Indications for RT vs. REBOA are primarily based on the patient’s injury pattern and physiological status at the presentation in the trauma bay. The current indications for REBOA remain speculative and are based on expert opinion with no complete consensus, while RT has stood the test of time. In its current state and indications, it is not time for REBOA to replace RT in patients with severe NCTH. However, there might be a future for REBOA, but it is with a specific patient population and a specific set of indications that will allow this procedure to succeed. Increased efforts should focus on integrating REBOA to RT instead of attempting to replace it.
• Anand, T. (2020). Is it time for REBOA to replace emergent resuscitative thoracotomies?. In Difficult Decisions in Trauma Surgery.

Journals/Publications

• Akl, M., El-Qawaqzeh, K., Anand, T., Hosseinpour, H., Colosimo, C., Nelson, A., Alizai, Q., Ditillo, M., Magnotti, L., & Joseph, B. (2024). Trauma Laparotomy for the Cirrhotic Patient: An Outcome-Based Analysis. Journal of Surgical Research, 294. doi:10.1016/j.jss.2023.09.008
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  Introduction: There is a lack of large-scale data on outcomes of cirrhotic patients undergoing trauma laparotomy. We aimed to compare outcomes of cirrhotic versus noncirrhotic trauma patients undergoing laparotomy. Methods: We analyzed 2018 American College of Surgeons Trauma Quality Improvement Program. We included blunt trauma patients (≥18 y) who underwent a laparotomy. Patients who were transferred, dead on arrival, or had penetrating injuries were excluded. Patients were matched in a 1:2 ratio (cirrhotic and noncirrhotic). Outcomes included mortality, complications, failure to rescue, transfusion requirements, and hospital and intensive care unit (ICU) lengths of stay. Multivariable backward stepwise regression analysis was performed. Results: Four hundred and seventy-one patients (cirrhotic, 157; noncirrhotic, 314) were matched. Mean age was 57 ± 15 y, 78% were male, and median injury severity score was 24. Cirrhotic patients had higher rates of mortality (60% versus 30%, P value
• Ali Farhan, S., Hasnain, N., Moorpani, M., Sajid, E. U., Shahid, I., Anand, T., & Khosa, F. (2024). Gender Disparity in Academic Trauma Surgery: The Current State of Affairs. The American surgeon, 31348241256080.
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  Despite the increasing number of female surgeons in general surgery programs, women are still inadequately represented in leadership positions. This study aims to investigate the magnitude of gender bias in university-based trauma surgery fellowship programs and leadership positions in the United States of America.
• Alizai, Q., Arif, M., Colosimo, C., Hosseinpour, H., Spencer, A., Bhogadi, S., Nelson, A., Anand, T., Ditillo, M., & Joseph, B. (2024). Beyond the short-term relief: Outcomes of geriatric rib fracture patients receiving paravertebral nerve blocks and epidural analgesia. Injury, 55(1). doi:10.1016/j.injury.2023.111184
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  Background: Adequate pain control is a critical component of rib fracture management. Our study aimed to evaluate the in-hospital and post-discharge outcomes of geriatric rib fracture patients who received paravertebral nerve block (PVNB) versus epidural analgesia (EA) on a national level. Methods: We performed a 5-year (2011–15) retrospective analysis of the Nationwide Readmission database. We included all the geriatric (≥65 years) blunt trauma patients with rib fractures who received a paravertebral nerve block (PVNB) or Epidural analgesia (EA) for chest injuries. We excluded patients who were dead on arrival, those with head AIS≥3, spine AIS >0, and those with cognitive impairment. Patients were stratified into two groups (PVNB and EA). A propensity score matching (1:2) was performed, and the two groups were compared. Our outcomes included delirium, hospital length of stay (LOS), 90-day readmissions, 90-day mechanical ventilation, and initial and 90-day mortality. Results: A total of 2,855 geriatric rib fracture patients were identified, out of which 352 (12 %) received PVNB and 2,503 (87 %) received EA. The mean (SD) age was 78 (8) years and 53 % were female. A total of 1,041 patients were matched (PVNB=347, EA=694 patients). The median [IQR] Injury severity score was 9 [3–15], median chest AIS was 3 [2–4], and 70 % had ≥3 rib fractures. The total mortality during index admission was 6 %, 13 % experienced delirium, and the median hospital LOS was 6 [4–10] days. There was no difference in the primary outcomes of the two groups including rates of index admission mortality (PVNB: 5.2% vs. EA:6.3 %, p = 0.548) and delirium (PVNB: 12.4% vs. EA:12.9 %, p = 0.862). We also found no statistically significant difference between these groups in terms of 90-day respiratory complications (p = 1.000), 90-day readmission (p = 0.111), 90-day mortality (p = 0.718), and 90-day need for mechanical ventilation (p = 1.000). Conclusion: The use of PVNB in geriatric trauma patients with multiple rib fractures is associated with comparable in-hospital and post-discharge outcomes relative to EA. PVNB is relatively easy to perform and has a better side effect profile. The use of PVNB as part of rib fracture management protocols warrants further consideration. Level of evidence: III Study type: Therapeutic/Care Management
• Anand, T., Crawford, A., Sjoquist, M., Hashmi, Z., Richter, R., Joseph, B., & Richter, J. (2024). Decreased Glycocalyx Shedding on Presentation in Hemorrhaging Geriatric Trauma Patients. Journal of Surgical Research, 293. doi:10.1016/j.jss.2023.09.047
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  Introduction: Plasma levels of syndecan-1 (Sdc-1), a biomarker of endothelial glycocalyx (EG) damage, correlate with worse outcomes in trauma patients. However, EG injury is not well characterized in injured older adults (OA). The aims of this study were to characterize Sdc-1 shedding in OA trauma patients relative to younger adults (YA) and determine associations with putative regulators of EG sheddases. Methods: We performed a secondary analysis of data from the Pragmatic, Randomized Optimal Platelet, and Plasma Ratios (PROPPR) trial, stratifying bluntly injured subjects into OA and YA groups based on upper age quartile (57 y). Plasma Sdc-1 levels were compared in OA and YA at hospital arrival through postinjury day 3, and the independent association between age and Sdc-1 level at arrival was determined after adjusting for differences in gender, shock index (SI), and pre-existing comorbidities. In a follow-up analysis, case-control matching was used to create populations of OA and YA with equivalent SI and injury severity score. Levels of Sdc-1 were compared between these matched groups, and the relationships with candidate regulators of EG shedding were assessed. Results: Of 680 subjects in the Pragmatic, Randomized Optimal Platelet, and Plasma Ratios trial, 350 (51%) had blunt injuries, and 92 (26.3%) of these were OA. Plasma Sdc-1 levels at arrival, 2 h, and 6 h were significantly lower in OA compared to YA (all P < 0.05). After adjusting for sex, pre-existing morbidities and SI, age was associated with decreased Sdc-1 levels at arrival. In the matched analyses, Sdc-1, high-mobility group box 1 and tissue inhibitor of metalloproteinase–2 levels were lower in OA compared to YA. Both high-mobility group box-1 and tissue inhibitor of metalloproteinase–2 significantly correlated with arrival Sdc-1 and were inversely associated with age. Conclusions: This study indicates that increased age is independently associated with decreased Sdc-1 levels among patients with blunt injuries. Suppressed plasma levels of sheddases in relation to diminished Sdc-1 shedding suggest that mechanisms regulating EG cleavage may be impaired in injured older adults. These findings provide novel insight into the age-dependent impact of injury on the vascular endothelium, which could have important implications for the clinical management of older adults following trauma.
• Anand, T., Hejazi, O., Conant, M., Joule, D., Lundy, M., Colosimo, C., Spencer, A., Nelson, A., Magnotti, L., & Joseph, B. (2024). Impact of resuscitation adjuncts on postintubation hypotension in patients with isolated traumatic brain injury. The journal of trauma and acute care surgery, 97(1), 112-118.
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  Postintubation hypotension (PIH) is a risk factor of endotracheal intubation (ETI) after injury. For those with traumatic brain injury (TBI), one episode of hypotension can potentiate that injury. This study aimed to identify the resuscitation adjuncts that may decrease the incidence of PIH in this patient population.
• Anand, T., Hejazi, O., Nelson, A., Litmanovich, B., Spencer, A. L., Khurshid, M. H., Ghaedi, A., Hosseinpour, H., Magnotti, L. J., & Joseph, B. (2024). Early Vasopressor Requirement Among Hypotensive Trauma Patients: Does It Cause More Harm Than Good?. The American surgeon, 31348241269425.
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  Optimal utilization of vasopressors during early post-injury resuscitation remains unclear. Our study aims to describe the relationship between the timing of vasopressor administration and outcomes among hypotensive trauma patients.
• Anand, T., Hosseinpour, H., Ditillo, M., Bhogadi, S. K., Akl, M. N., Collins, W. J., Magnotti, L. J., & Joseph, B. (2024). The Importance of Circulation in Airway Management: Preventing Post-Intubation Hypotension in The Trauma Bay. Annals of surgery.
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  To identify the modifiable and non-modifiable risk factors associated with post-intubation hypotension (PIH) among trauma patients who required endotracheal intubation (ETI) in the trauma bay.
• Bhogadi, S. K., Ditillo, M., Khurshid, M. H., Stewart, C., Hejazi, O., Spencer, A. L., Anand, T., Nelson, A., Magnotti, L. J., & Joseph, B. (2024). Development and Validation of Futility of Resuscitation Measure in Older Adult Trauma Patients. The Journal of surgical research, 301, 591-598.
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  This study aimed to develop and validate Futility of Resuscitation Measure (FoRM) for predicting the futility of resuscitation among older adult trauma patients.
• Bhogadi, S. K., El-Qawaqzeh, K., Colosimo, C., Hosseinpour, H., Magnotti, L. J., Spencer, A. L., Anand, T., Ditillo, M., Alizai, Q., Nelson, A., & Joseph, B. (2024). Pediatric Acute Compartment Syndrome in Long Bone Fractures: Who is at Risk?. The Journal of surgical research, 298, 53-62.
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  There is a paucity of large-scale data on the factors that suggest an impending or underlying extremity pediatric acute compartment syndrome (ACS). In addition, literature regarding the timing of operative fixation and the risk of ACS is mixed. We aimed to describe the factors associated with pediatric ACS.
• Bhogadi, S. K., Hejazi, O., Nelson, A., Stewart, C., Hosseinpour, H., Spencer, A. L., Anand, T., Ditillo, M., Magnotti, L. J., & Joseph, B. (2024). Surgical stabilization of rib fractures: The impact of volume and the need for standardized indications. American journal of surgery, 234, 112-116.
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  We aimed to examine impact of trauma center (TC) surgical stabilization of rib fracture (SSRF) volume on outcomes of patients undergoing SSRF.
• Bhogadi, S. K., Nelson, A., Hosseinpour, H., Anand, T., Hejazi, O., Colosimo, C., Spencer, A. L., Ditillo, M., Magnotti, L. J., & Joseph, B. (2024). Effect of PCC on outcomes of severe traumatic brain injury patients on preinjury anticoagulation. American journal of surgery, 232, 138-141.
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  This study aims to evaluate effect of 4-factor PCC on outcomes of severe TBI patients on preinjury anticoagulants undergoing craniotomy/craniectomy.
• Colosimo, C., Otaibi, B., Bhogadi, S. K., Nelson, A., Spencer, A. L., Anand, T., Stewart, C., Magnotti, L. J., & Joseph, B. (2024). Obesity is a predictor of abdominal computed tomography imaging in pediatric trauma patients. The journal of trauma and acute care surgery.
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  Computed tomography (CT) has helped to reduce the morbidity due to missed injuries. However, CT imaging is associated with radiation exposure and thus has limited indications in pediatric patients. In this study, we aimed to identify the association between obesity and abdominal CT imaging in pediatric trauma patients.
• Culbert, M. H., Bhogadi, S. K., Hosseinpour, H., Colosimo, C., Alizai, Q., Anand, T., Spencer, A. L., Ditillo, M., Magnotti, L. J., & Joseph, B. (2024). Predictors of Receiving Mental Health Services in Trauma Patients With Positive Drug Screen. The Journal of surgical research, 298, 7-13.
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  Initial interaction with health care system presents an important opportunity to provide substance use disorder (SUD) rehabilitation in the form of mental health services (MHSs). This study aims to identify predictors of receipt of MHSs among adult trauma patients with SUD and positive drug screen.
• Dhanasekara, C. S., Shrestha, K., Grossman, H., Garcia, L. M., Maqbool, B., Luppens, C., Dumas, R. P., Taveras Morales, L. R., Brahmbhatt, T. S., Haqqani, M., Lunevicius, R., Nzenwa, I. C., Griffiths, E., Almonib, A., Bradley, N. L., Lerner, E. P., Mohseni, S., Trivedi, D., Joseph, B. A., , Anand, T., et al. (2024). A comparison of outcomes including bile duct injury of subtotal cholecystectomy versus open total cholecystectomy as bailout procedures for severe cholecystitis: A multicenter real-world study. Surgery, 176(3), 605-613.
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  Dense inflammation obscuring the hepatocystic anatomy can hinder the ability to perform a safe standard laparoscopic cholecystectomy in severe cholecystitis, requiring use of a bailout procedure. We compared clinical outcomes of laparoscopic and open subtotal cholecystectomy against the traditional standard of open total cholecystectomy to identify the optimal bailout strategy for the difficult gallbladder.
• El-Qawaqzeh, K., Anand, T., Alizai, Q., Colosimo, C., Hosseinpour, H., Spencer, A., Ditillo, M., Magnotti, L., Stewart, C., & Joseph, B. (2024). Trauma in the Geriatric and the Super-Geriatric: Should They Be Treated the Same?. Journal of Surgical Research, 293. doi:10.1016/j.jss.2023.09.015
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  Introduction: There is paucity of studies comparing the characteristics of trauma in geriatrics and super-geriatrics. We aimed to explore the injury characteristics and outcomes of older adult trauma patients on a nationwide scale. Methods: This is a retrospective analysis of 2017-2019 American College of Surgeons Trauma Quality Improvement Program. We included moderate to severely injured (Injury Severity Score >8) older adult (≥65 y) trauma patients. Patients were stratified into geriatric (65 y ≤ Age
• El-Qawaqzeh, K., Magnotti, L., Hosseinpour, H., Nelson, A., Spencer, A., Anand, T., Bhogadi, S., Alizai, Q., Ditillo, M., & Joseph, B. (2024). Geriatric trauma, frailty, and ACS trauma center verification level: Are there any correlations with outcomes? Outcomes of Geriatric Patients in Trauma Centers. Injury, 55(1). doi:10.1016/j.injury.2023.110972
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  Introduction: It remains unclear whether geriatrics benefit from care at higher-level trauma centers (TCs). We aimed to assess the impact of the TC verification level on frail geriatric trauma patients’ outcomes. We hypothesized that frail patients cared for at higher-level TCs would have improved outcomes. Study Design: Patients ≥65 years were identified from the Trauma Quality Improvement Program (TQIP) database (2017–2019). Patients transferred, discharged from emergency department (ED), and those with head abbreviated injury scale >3 were excluded. 11-factor modified frailty index was utilized. Propensity score matching (1:1) was performed. Outcomes included discharge to skilled nursing facility or rehab (SNF/rehab), withdrawal of life-supporting treatment (WLST), mortality, complications, failure-to-rescue, intensive care unit (ICU) admission, hospital length of stay (LOS), and ventilator days. Results: 110,680 patients were matched (Frail:55,340, Non-Frail:55,340). Mean age was 79 (7), 90% presented following falls, and median ISS was 5 [2–9]. Level-I/II TCs had lower rates of discharge to SNF/rehab (52.6% vs. 55.8% vs. 60.9%; p < 0.001), failure-to-rescue (0.5% vs. 0.4% vs. 0.6%;p = 0.005), and higher rates of WLST (2.4% vs. 2.1% vs. 0.3%; p < 0.001) compared to level-III regardless of injury severity and frailty. Compared to Level-III centers, Level-I/II centers had higher complications among moderate-to-severely injured patients (4.1% vs. 3.3% vs. 2.7%; p < 0.001), and lower mortality only among frail patients regardless of injury severity (1.8% vs. 1.5% vs. 2.6%; p < 0.001). Patients at Level-I TCs were more likely to be admitted to ICU, and had longer hospital LOS and ventilator days compared to Level-II and III TCs (p < 0.05). Conclusion: Frailty may play an important role when triaging geriatric trauma patients. In fact, the benefit of care at higher-level TCs is particularly evident for patients who are frail. Level III centers may be underperforming in providing access to palliative and end-of-life care.
• Hejazi, O., Spencer, A. L., Khurshid, M. H., Nelson, A., Hosseinpour, H., Anand, T., Bhogadi, S. K., Matthews, M. R., Magnotti, L. J., & Joseph, B. (2024). Failure to Rescue in Geriatric Ground-Level Falls: The Role of Frailty on Not-So-Minor Injuries. The Journal of surgical research, 302, 891-896.
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  The measure of mortality following a major complication (failure to rescue [FTR]) provides a quantifiable assessment of the level of care provided by trauma centers. However, there is a lack of data on the effects of patient-related factors on FTR incidence. The aim of this study was to identify the role of frailty on FTR incidence among geriatric trauma patients with ground-level falls (GLFs).
• Hosseinpour, H., Anand, T., Bhogadi, S. K., Nelson, A., Hejazi, O., Castanon, L., Ghaedi, A., Khurshid, M. H., Magnotti, L. J., Joseph, B., & , A. F. (2024). The implications of poor nutritional status on outcomes of geriatric trauma patients. Surgery, 176(4), 1281-1288.
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  Malnutrition is shown to be associated with worse outcomes among surgical patients, yet its postdischarge outcomes in trauma patients are not clear. This study aimed to evaluate both index admission and postdischarge outcomes of geriatric trauma patients who are at risk of poor nutritional status.
• Hosseinpour, H., Anand, T., Hejazi, O., Colosimo, C., Bhogadi, S. K., Spencer, A., Nelson, A., Ditillo, M., Magnotti, L. J., & Joseph, B. (2024). The Role of Whole Blood Hemostatic Resuscitation in Bleeding Geriatric Trauma Patients. The Journal of surgical research, 299, 26-33.
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  Whole blood (WB) has recently gained increased popularity as an adjunct to the resuscitation of hemorrhaging civilian trauma patients. We aimed to assess the nationwide outcomes of using WB as an adjunct to component therapy (CT) versus CT alone in resuscitating geriatric trauma patients.
• Hosseinpour, H., Magnotti, L. J., Huang, D. D., Weinberg, J. A., Tang, A., Hejazi, O., Stewart, C., Bhogadi, S. K., Anand, T., & Joseph, B. (2024). The role of number of affected vessels on radiologic and clinical outcomes of patients with blunt cerebrovascular injury. Journal of vascular surgery, 80(3), 685-692.
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  There is a lack of data on the role of characteristics of injured vessels on the outcomes of patients with blunt cerebrovascular injuries (BCVIs). The aim of this study was to assess the effect of the number (single vs multiple) of injured vessels on outcomes.
• Hosseinpour, H., Nelson, A., Bhogadi, S. K., Magnotti, L. J., Alizai, Q., Colosimo, C., Hage, K., Ditillo, M., Anand, T., & Joseph, B. (2024). Should We Keep or Transfer Our Severely Injured Geriatric Patients to Higher Levels of Care?. The Journal of surgical research, 300, 15-24.
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  Interfacility transfer to higher levels of care is becoming increasingly common. This study aims to evaluate the association between transfer to higher levels of care and prolonged transfer times with outcomes of severely injured geriatric trauma patients compared to those who are managed definitively at lower-level trauma centers.
• Joseph, B., Hosseinpour, H., Sakran, J., Anand, T., Colosimo, C., Nelson, A., Stewart, C., Spencer, A. L., Zhang, B., & Magnotti, L. J. (2024). Defining the Problem: 53 Years of Firearm Violence Afflicting America's Schools. Journal of the American College of Surgeons, 238(4), 671-678.
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  Firearm violence and school shootings remain a significant public health problem. This study aimed to examine how publicly available data from all 50 states might improve our understanding of the situation, firearm type, and demographics surrounding school shootings.
• Magnotti, L. J., Bhogadi, S. K., Anand, T., Stewart, C., Colosimo, C., Spencer, A. L., Nelson, A., & Joseph, B. (2024). Less Is More: Dissecting Trauma Centers by Procedural Volume. Annals of surgery, 280(4), 667-675.
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  This study aims to examine the relationship between procedural volume and annual trauma volume (ATV) of ACS Level I trauma centers (TC).
• O'Connor, D., Hejazi, O., Colosimo, C., Stewart, C., Hosseinpour, H., Khurshid, M., Nelson, A. C., Joseph, B., Bhogadi, S. K., Anand, T., Spencer, A. L., & Magnotti, L. J. (2024). Role of endovascular management on outcomes in patients with traumatic inferior vena cava injuries. American journal of surgery, 238, 115836.
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  The aim of this study was to examine the association between the injury mechanism and repair type with outcomes in patients with traumatic inferior vena cava injuries.
• Saljuqi, A., Anand, T., & Joseph, B. (2024). Reassessing the economic burden of geriatric falls: a call for preventive action. Trauma Surgery and Acute Care Open, 9(1). doi:10.1136/tsaco-2024-001591
• Spencer, A. L., Hosseinpour, H., Nelson, A., Hejazi, O., Anand, T., Khurshid, M. H., Ghaedi, A., Bhogadi, S. K., Magnotti, L. J., & Joseph, B. (2024). Predicting the time of mortality among older adult trauma patients: Is frailty the answer?. American journal of surgery, 237, 115768.
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  This study aims to evaluate the temporal trends of mortality among frail versus non-frail older adult trauma patients during index hospitalization.
• Zambetti, B. R., Nelson, A. C., Hosseinpour, H., Anand, T., Colosimo, C., Spencer, A. L., Stewart, C., Bhogadi, S. K., Hejazi, O., Joseph, B., & Magnotti, L. J. (2024). The optimal management of blunt aortic injury in the young. American journal of surgery, 237, 115943.
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  Blunt aortic injury (BAI) is relatively uncommon in the pediatric population. The goal of this study was to examine the management of BAI in both children and adolescents, using a large national dataset.
• Akl, M. N., El-Qawaqzeh, K., Anand, T., Hosseinpour, H., Colosimo, C., Nelson, A., Alizai, Q., Ditillo, M., Magnotti, L. J., & Joseph, B. (2023). Trauma Laparotomy for the Cirrhotic Patient: An Outcome-Based Analysis. The Journal of surgical research, 294, 128-136.
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  There is a lack of large-scale data on outcomes of cirrhotic patients undergoing trauma laparotomy. We aimed to compare outcomes of cirrhotic versus noncirrhotic trauma patients undergoing laparotomy.
• Alizai, Q., Anand, T., Bhogadi, S. K., Nelson, A., Hosseinpour, H., Stewart, C., Spencer, A. L., Colosimo, C., Ditillo, M., & Joseph, B. (2023). From surveillance to surgery: The delayed implications of non-operative and operative management of pancreatic injuries. American journal of surgery, 226(5), 682-687.
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  Our study compares the delayed outcomes of operative versus nonoperative management of pancreatic injuries.
• Alizai, Q., Arif, M. S., Colosimo, C., Hosseinpour, H., Spencer, A. L., Bhogadi, S. K., Nelson, A., Anand, T., Ditillo, M., & Joseph, B. (2023). Beyond the short-term relief: Outcomes of geriatric rib fracture patients receiving paravertebral nerve blocks and epidural analgesia. Injury, 111184.
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  Adequate pain control is a critical component of rib fracture management. Our study aimed to evaluate the in-hospital and post-discharge outcomes of geriatric rib fracture patients who received paravertebral nerve block (PVNB) versus epidural analgesia (EA) on a national level.
• Anand, T., & Joseph, B. (2023). Linguistic discordance: Factors go beyond language. American journal of surgery, 225(6), 946-947.
• Anand, T., Crawford, A. E., Sjoquist, M., Hashmi, Z. G., Richter, R. P., Joseph, B., & Richter, J. R. (2023). Decreased Glycocalyx Shedding on Presentation in Hemorrhaging Geriatric Trauma Patients. The Journal of surgical research, 293, 709-716.
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  Plasma levels of syndecan-1 (Sdc-1), a biomarker of endothelial glycocalyx (EG) damage, correlate with worse outcomes in trauma patients. However, EG injury is not well characterized in injured older adults (OA). The aims of this study were to characterize Sdc-1 shedding in OA trauma patients relative to younger adults (YA) and determine associations with putative regulators of EG sheddases.
• Anand, T., El-Qawaqzeh, K., Nelson, A., Hosseinpour, H., Ditillo, M., Gries, L., Castanon, L., & Joseph, B. (2023). Association Between Hemorrhage Control Interventions and Mortality in US Trauma Patients With Hemodynamically Unstable Pelvic Fractures. JAMA surgery, 158(1), 63-71.
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  Management of hemodynamically unstable pelvic fractures remains a challenge. Hemostatic interventions are used alone or in combination. There is a paucity of data on the association between the pattern of hemorrhage control interventions and outcomes after a severe pelvic fracture.
• Anand, T., Reyes, A. A., Sjoquist, M. C., Magnotti, L., & Joseph, B. (2023). Resuscitating the Endothelial Glycocalyx in Trauma and Hemorrhagic Shock. Annals of surgery open : perspectives of surgical history, education, and clinical approaches, 4(3), e298.
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  The endothelium is lined by a protective mesh of proteins and carbohydrates called the endothelial glycocalyx (EG). This layer creates a negatively charged gel-like barrier between the vascular environment and the surface of the endothelial cell. When intact the EG serves multiple functions, including mechanotransduction, cell signaling, regulation of permeability and fluid exchange across the microvasculature, and management of cell-cell interactions. In trauma and/or hemorrhagic shock, the glycocalyx is broken down, resulting in the shedding of its individual components. The shedding of the EG is associated with increased systemic inflammation, microvascular permeability, and flow-induced vasodilation, leading to further physiologic derangements. Animal and human studies have shown that the greater the severity of the injury, the greater the degree of shedding, which is associated with poor patient outcomes. Additional studies have shown that prioritizing certain resuscitation fluids, such as plasma, cryoprecipitate, and whole blood over crystalloid shows improved outcomes in hemorrhaging patients, potentially through a decrease in EG shedding impacting downstream signaling. The purpose of the following paragraphs is to briefly describe the EG, review the impact of EG shedding and hemorrhagic shock, and begin entertaining the notion of directed resuscitation. Directed resuscitation emphasizes transitioning from macroscopic 1:1 resuscitation to efforts that focus on minimizing EG shedding and maximizing its reconstitution.
• Avila, M., Bhogadi, S. K., Nelson, A., Hosseinpour, H., Ditillo, M., Akl, M., Anand, T., Spencer, A. L., Magnotti, L. J., & Joseph, B. (2023). The long-term risks of venous thromboembolism among non-operatively managed spinal fracture patients: A nationwide analysis. American journal of surgery, 225(6), 1086-1090.
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  Long-term readmission data for venous thromboembolism (VTE) after spinal fractures is limited. We aimed to evaluate the 1-month and 6-month VTE readmission rates in non-operatively managed traumatic spinal fractures.
• Barach, P., Ahmed, R., Agarwal, G., Olson, K., Welch, J. L., Chernoby, K., Hein, C., Anand, T., Joseph, B., Rosenstein, D. L., Sotto-Santiago, S., Hartsock, J. A., Holmes, E., Schroeder, K., & Hartwell, J. L. (2023). Navigating Personal Health Crises, Imposter Syndrome, Sexual Harassment, Clinical Mistakes and Leadership Challenges: Lessons for Work-Life Wellness in Academic Medicine: Part 3 of 3. Kansas Journal of Medicine. doi:10.17161/kjm.vol16.19954
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  In this final manuscript of the three-part series, the authors address issues of imposter syndrome, pregnancy, and parental leave, second victim phenomenon, sexual harassment, response to suicide, and managing a budget while advancing diversity, equity, and inclusion. The case scenarios have learners and non-clinicians as their main characters, bringing attention to the cross-cutting nature of the complex issues we see both in and around a career in medicine.
• Bhogadi, S. K., Magnotti, L. J., Hosseinpour, H., Anand, T., El-Qawaqzeh, K., Nelson, A., Colosimo, C., Spencer, A. L., Friese, R., & Joseph, B. (2023). The final decision among the injured elderly, to stop or to continue? Predictors of withdrawal of life supporting treatment. The journal of trauma and acute care surgery, 94(6), 778-783.
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  There is a paucity of data on factors that influence the decision regarding withdrawal of life supporting treatment (WLST) in geriatric trauma patients. We aimed to identify predictors of WLST in geriatric trauma patients.
• Bhogadi, S. K., Nelson, A., El-Qawaqzeh, K., Spencer, A. L., Hosseinpour, H., Castanon, L., Anand, T., Ditillo, M., Magnotti, L. J., & Joseph, B. (2023). Does preinjury anticoagulation worsen outcomes among traumatic hemothorax patients? A nationwide retrospective analysis. Injury, 54(9), 110850.
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  Up to a quarter of all traumatic deaths are due to thoracic injuries. Current guidelines recommend consideration of evacuation of all hemothoraces with tube thoracostomy. The aim of our study was to determine the impact of pre-injury anticoagulation on outcomes of traumatic hemothorax patients.
• Castanon, L., Bhogadi, S. K., Anand, T., Hosseinpour, H., Nelson, A., Colosimo, C., Spencer, A. L., Gries, L., Ditillo, M., & Joseph, B. (2023). The Association Between the Timing of Initiation of Pharmacologic Venous Thromboembolism Prophylaxis with Outcomes in Burns Patients. Journal of burn care & research : official publication of the American Burn Association, 44(6), 1311-1315.
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  Hospitalized burn patients are at increased risk for venous thromboembolism (VTE). Guidelines regarding thromboprophylaxis in burn patients are unclear. This study aims to compare the outcomes of early versus late thromboprophylaxis initiation in burn patients. In this 3-year analysis of 2017-2019 ACS-TQIP, adult(18-64years) burn patients were identified after applying inclusion/exclusion criteria and stratified based on timing of initiation of VTE prophylaxis: Early(24 hours). Outcomes were deep venous thrombosis(DVT), pulmonary embolism(PE), unplanned return to operating room (OR), unplanned intensive care unit (ICU) admission, post-prophylaxis packed red blood cells (PRBC) transfusion, and mortality. Nine thousand two hundred and seventy-two patients were identified. Overall, median age was 41years, 71.5% were male, and median[IQR] injury severity score was 3[1-8]. 53% had second-degree burns, and 80% had less than 40% of total body surface area affected. Median time to thromboprophylaxis initiation was 11[6-20.6]hours. Overall VTE rate was 0.9% (DVT-0.7%, PE-0.2%). On univariable analysis, early prophylaxis group had lower rates of DVT(0.6% vs 1.1%, P = .025), and PE(0.1% vs 0.6%, P < .001). On multivariable regression, late prophylaxis was associated with 1.8 times higher odds of DVT (aOR = 1.8, 95% CI = 1.04-3.11, P = .03), 4.8 times higher odds of PE(aOR = 4.8, 95% CI = 1.9-11.9, P 
• Collins, W., El-Qawaqzeh, K., Ditillo, M., Hosseinpour, H., Nelson, A., Bhogadi, S., Castanon, L., Gries, L., Anand, T., & Joseph, B. (2023). Minimally Invasive Surgery for Genitourinary Trauma: A Nationwide Outcomes-Based Analysis. Journal of Surgical Research, 282. doi:10.1016/j.jss.2022.09.015
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  Introduction: Bladder and ureteral injuries are uncommon in trauma patients but are associated with increased morbidity and mortality. Patients presenting with such injuries may undergo either open surgical repair or laparoscopic repair. We aimed to compare outcomes of open surgical approach and laparoscopy in trauma patients with isolated bladder and ureteral injury. We hypothesized that laparoscopy is associated with improved outcomes. Methods: We performed a 2017 review of American College of Surgeons Trauma Quality Improvement Program and identified trauma patients with bladder and ureteral injury who underwent open surgical repair or laparoscopy. A 1:1 propensity score matching was performed adjusting for demographics, emergency department vitals (systolic blood pressure, heart rate, Glasgow Coma Scale), mechanism of injury, Injury Severity Score, each body region Abbreviated Injury Scale score, and transfusion units. Outcomes were rates of in-hospital major complications and mortality. Results: Of the 1,004,440 trauma patients, 384 patients (open: 192 and laparoscopy: 192) were matched and included. The mean age was 36 ± 15 y, Injury Severity Score was 27 [27-48], 77% were males, and 56% of patients had a blunt mechanism of injury, and 44% had penetrating injuries. Overall mortality was 7.3%. On univariate analysis, mortality was lower in the open group as compared to the laparoscopy group (10.4% versus 4.2%, P = 0.019) and survivor-only hospital length of stay was longer in the open group (8 [8-9] versus 7 [5-11], P = 0.008). There was no difference in overall major complications (23% versus 21%, P = 0.621). On multivariate analysis, open surgical repair was independently associated with lower odds of mortality (adjusted odds ratio: 0.405, 95% confidence interval: [0.17-0.95], P-value = 0.038) Conclusions: In our analysis open surgical repair of bladder and ureteral injuries was associated with lower mortality with other outcomes being similar when compared to laparoscopy. Laparoscopic surgical repair may not have an advantage over the open surgical repair for bladder and ureteral injuries. Further prospective studies are needed to delineate the ideal surgical approach for these injuries.
• El-Qawaqzeh, K., Anand, T., Alizai, Q., Colosimo, C., Hosseinpour, H., Spencer, A., Ditillo, M., Magnotti, L. J., Stewart, C., & Joseph, B. (2023). Trauma in the Geriatric and the Super-Geriatric: Should They Be Treated the Same?. The Journal of surgical research, 293, 316-326.
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  There is paucity of studies comparing the characteristics of trauma in geriatrics and super-geriatrics. We aimed to explore the injury characteristics and outcomes of older adult trauma patients on a nationwide scale.
• El-Qawaqzeh, K., Anand, T., Richards, J., Hosseinpour, H., Nelson, A., Akl, M., Obaid, O., Ditillo, M., Friese, R., & Joseph, B. (2023). Predictors of Mortality in Blunt Cardiac Injury: A Nationwide Analysis. Journal of Surgical Research, 281. doi:10.1016/j.jss.2022.07.047
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  Introduction: Blunt thoracic injury (BTI) is one of the most common causes of trauma admission in the United States and is uncommonly associated with cardiac injuries. Blunt cardiac injury (BCI) after blunt thoracic trauma is infrequent but carries a substantial risk of morbidity and sudden mortality. Our study aims to identify predictors of concomitant cardiac contusion among BTI patients and the predictors of mortality among patients presenting with BCI on a national level. Materials and Methods: We performed a 1-y (2017) analysis of the American College of Surgeons Trauma Quality Improvement Program. We included all adults (aged ≥ 18 y) with the diagnosis of BTI. We excluded patients who were transferred, had a penetrating mechanism of injury, and who were dead on arrival. Our primary outcomes were the independent predictors of concomitant cardiac contusions among BTI patients and the predictors of mortality among BCI patients. Our secondary outcome measures were in-hospital complications, differences in injury patterns, and injury severity between the survivors and nonsurvivors of BCI. Results: A total of 125,696 patients with BTI were identified, of which 2368 patients had BCI. Mean age was 52 ± 20 y, 67% were male, and median injury severity score was 14 [9-21]. The most common type of cardiac injury was cardiac contusion (43%). Age ≥ 65 y, higher 4-h packed red blood cell requirements, motor vehicle collision mechanism of injury, and concomitant thoracic injuries (hemothorax, flail chest, lung contusion, sternal fracture, diaphragmatic injury, and thoracic aortic injuries) were independently associated with concomitant cardiac contusion among BTI patients (P value < 0.05). Age ≥ 65 y, thoracic aortic injury, diaphragmatic injury, hemothorax, and a history of congestive heart failure were independently associated with mortality in BCI patients (P value < 0.05). Conclusions: Predictors of concomitant cardiac contusion among BTI patients and mortality among BCI patients were identified. Guidelines on the management of BCI should incorporate these predictors for timely identification of high-risk patients.
• El-Qawaqzeh, K., Colosimo, C., Bhogadi, S. K., Magnotti, L. J., Hosseinpour, H., Castanon, L., Nelson, A., Ditillo, M., Anand, T., & Joseph, B. (2023). Unequal Treatment? Confronting Racial, Ethnic, and Socioeconomic Disparity in Management of Survivors of Violent Suicide Attempt. Journal of the American College of Surgeons, 237(1), 68-78.
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  Psychiatric inpatient hospitalization is nearly always indicated for patients with recent suicidal behavior. We aimed to assess the factors associated with receiving mental health services during hospitalization or on discharge among survivors of suicide attempts in trauma centers.
• El-Qawaqzeh, K., Hosseinpour, H., Gries, L., Magnotti, L. J., Bhogadi, S. K., Anand, T., Ditillo, M., Stewart, C., Cooper, Z., & Joseph, B. (2023). Dealing with the elder abuse epidemic: Disparities in interventions against elder abuse in trauma centers. Journal of the American Geriatrics Society, 71(6), 1735-1748.
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  Elder abuse is a major cause of injury, morbidity, and death. We aimed to identify the factors associated with interventions against suspected physical abuse in older adults.
• El-Qawaqzeh, K., Magnotti, L. J., Hosseinpour, H., Nelson, A., Spencer, A. L., Anand, T., Bhogadi, S. K., Alizai, Q., Ditillo, M., & Joseph, B. (2023). Geriatric trauma, frailty, and ACS trauma center verification level: Are there any correlations with outcomes?. Injury, 110972.
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  It remains unclear whether geriatrics benefit from care at higher-level trauma centers (TCs). We aimed to assess the impact of the TC verification level on frail geriatric trauma patients' outcomes. We hypothesized that frail patients cared for at higher-level TCs would have improved outcomes.
• Hosseinpour, H., Anand, T., Bhogadi, S. K., Colosimo, C., El-Qawaqzeh, K., Spencer, A. L., Castanon, L., Ditillo, M., Magnotti, L. J., & Joseph, B. (2023). Emergency Department Shock Index Outperforms Prehospital and Delta Shock Indices in Predicting Outcomes of Trauma Patients. The Journal of surgical research, 291, 204-212.
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  Multiple shock indices (SIs), including prehospital, emergency department (ED), and delta (ED SI - Prehospital SI) have been developed to predict outcomes among trauma patients. This study aims to compare the predictive abilities of these SIs for outcomes of polytrauma patients on a national level.
• Hosseinpour, H., El-Qawaqzeh, K., Magnotti, L. J., Bhogadi, S. K., Ghneim, M., Nelson, A., Spencer, A. L., Colosimo, C., Anand, T., Ditillo, M., & Joseph, B. (2023). The unexpected paradox of geriatric traumatic brain injury outcomes: Uncovering racial and ethnic disparities. American journal of surgery, 226(2), 271-277.
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  Healthcare disparities have always challenged surgical care in the US. We aimed to assess the influence of disparities on cerebral monitor placement and outcomes of geriatric TBI patients.
• Hosseinpour, H., Magnotti, L. J., Bhogadi, S. K., Anand, T., El-Qawaqzeh, K., Ditillo, M., Colosimo, C., Spencer, A., Nelson, A., & Joseph, B. (2023). Time to Whole Blood Transfusion in Hemorrhaging Civilian Trauma Patients: There Is Always Room for Improvement. Journal of the American College of Surgeons, 237(1), 24-34.
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  Whole blood (WB) is becoming the preferred product for the resuscitation of hemorrhaging trauma patients. However, there is a lack of data on the optimum timing of receiving WB. We aimed to assess the effect of time to WB transfusion on the outcomes of trauma patients.
• Hosseinpour, H., Magnotti, L. J., Bhogadi, S. K., Colosimo, C., El-Qawaqzeh, K., Spencer, A. L., Anand, T., Ditillo, M., Nelson, A., & Joseph, B. (2023). Interfacility transfer of pediatric trauma patients to higher levels of care: The effect of transfer time and level of receiving trauma center. The journal of trauma and acute care surgery, 95(3), 383-390.
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  Interfacility transfer of pediatric trauma patients to pediatric trauma centers (PTCs) after evaluation in nontertiary centers is associated with improved outcomes. We aimed to assess the outcomes of transferred pediatric patients based on their severity of the injury, transfer time, and level of receiving PTCs.
• Hosseinpour, H., Nelson, A., Bhogadi, S. K., Spencer, A. L., Alizai, Q., Colosimo, C., Anand, T., Ditillo, M., Magnotti, L. J., & Joseph, B. (2023). Delayed versus early hepatic resection among patients with severe traumatic liver injuries undergoing damage control laparotomy. American journal of surgery.
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  We aimed to assess the effect of time to hepatic resection on the outcomes of patients with high-grade liver injuries who underwent damage control laparotomy (DCL).
• Nelson, A. C., Bhogadi, S. K., Hosseinpour, H., Stewart, C., Anand, T., Spencer, A. L., Colosimo, C., Magnotti, L. J., & Joseph, B. (2023). There Is No Such Thing as Too Soon: Long-Term Outcomes of Early Cholecystectomy for Frail Geriatric Patients with Acute Biliary Pancreatitis. Journal of the American College of Surgeons, 237(5), 712-718.
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  Early cholecystectomy (CCY) for acute biliary pancreatitis (ABP) is recommended but there is a paucity of data assessing this approach in frail geriatric patients. This study compares outcomes of frail geriatric ABP patients undergoing index admission CCY vs nonoperative management (NOM) with endoscopic retrograde cholangiopancreatography (ERCP).
• Weaver, J. L., Cannada, L., Anand, T., Dream, S., Park, P. K., Altieri, M. S., Tasnim, S., Reyna, C., & , A. o. (2023). The importance of allyship in Academic Surgery. American journal of surgery, 225(4), 805-807.
• Zambetti, B. R., Patel, D. D., Stuber, J. D., Zickler, W. P., Hosseinpour, H., Anand, T., Nelson, A. C., Stewart, C., Joseph, B., & Magnotti, L. J. (2023). Role of Endovascular Stenting in Patients with Traumatic Iliac Artery Injury. Journal of the American College of Surgeons, 236(4), 753-759.
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  Common and external iliac artery injuries (IAI) portend significant morbidity and mortality. The goal of this study was to examine the impact of mechanism of injury and type of repair on outcomes and identify the optimal repair for patients with traumatic IAI using a large, national dataset.
• Akl, M., Anand, T., Reina, R., El-Qawaqzeh, K., Ditillo, M., Hosseinpour, H., Nelson, A., Obaid, O., Friese, R., & Joseph, B. (2022). Balanced hemostatic resuscitation for bleeding pediatric trauma patients: A nationwide quantitative analysis of outcomes. Journal of pediatric surgery.
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  The administration of balanced component therapy has been associated with improvements in outcomes in adult trauma. There is little to no specific data to guide transfusion ratios in children. The aim of our study is to compare outcomes among different transfusion strategies in pediatric trauma patients.
• Anand, T., Castanon, L., Ditillo, M., El-Qawaqzeh, K., Gries, L., Hosseinpour, H., Joseph, B., & Nelson, A. (2022). Association Between Hemorrhage Control Interventions and Mortality in US Trauma Patients With Hemodynamically Unstable Pelvic Fractures. JAMA Surgery. doi:10.1001/jamasurg.2022.5772
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  Importance Management of hemodynamically unstable pelvic fractures remains a challenge. Hemostatic interventions are used alone or in combination. There is a paucity of data on the association between the pattern of hemorrhage control interventions and outcomes after a severe pelvic fracture. Objective To characterize clinical outcomes and study the patterns of hemorrhage control interventions in hemodynamically unstable pelvic fractures. Design, Setting, and Participants In this cohort study, a retrospective review was performed of data from the 2017 American College of Surgeons Trauma Quality Improvement Program database, a national multi-institutional database of trauma patients in the United States. Adult patients (aged ≥18 years) with pelvic fractures who received early transfusions (≥4 units of packed red blood cells in 4 hours) and underwent intervention for pelvic hemorrhage control were identified. Use and order of preperitoneal pelvic packing (PP), pelvic angioembolization (AE), and resuscitative endovascular balloon occlusion of the aorta (REBOA) in zone 3 were examined and compared against the primary outcome of mortality. The associations between intervention patterns and mortality, complications, and 24-hour transfusions were further examined by backward stepwise regression analyses. Data analyses were performed in September 2021. Main Outcomes and Measures Primary outcomes were rates of 24-hour, emergency department, and in-hospital mortality. Secondary outcomes were major in-hospital complications. Results A total of 1396 patients were identified. Mean (SD) age was 47 (19) years, 975 (70%) were male, and the mean (SD) lowest systolic blood pressure was 71 (25) mm Hg. The median (IQR) Injury Severity Score was 24 (14-34), with a 24-hour mortality of 217 patients (15.5%), ED mortality of 10 patients (0.7%), in-hospital mortality of 501 patients (36%), and complication rate of 574 patients (41%). Pelvic AE was the most used intervention (774 [55%]), followed by preperitoneal PP (659 [47%]) and REBOA zone 3 (126 [9%]). Among the cohort, 1236 patients (89%) had 1 intervention, 157 (11%) had 2 interventions, and 3 (0.2%) had 3 interventions. On regression analyses, only pelvic AE was associated with a mortality reduction (odds ratio [OR], 0.62; 95% CI, 0.47 to 0.82; P < .001). Preperitoneal PP was associated with increased odds of complications (OR, 1.39; 95% CI, 1.07 to 1.80; P = .01). Increasing number of interventions was associated with increased 24-hour transfusions (β = +5.4; 95% CI, +3.5 to +7.5; P < .001) and mortality (OR, 1.57; 95% CI, 1.05 to 2.37; P = .03), but not with complications. Conclusions and Relevance This study found that among patients with pelvic fracture who received early transfusions and at least 1 invasive pelvic hemorrhage control intervention, more than 1 in 3 died, despite the availability of advanced hemorrhage control interventions. Only pelvic AE was associated with a reduction in mortality.
• Anand, T., Nelson, A. C., Obaid, O., Ditillo, M. F., El-Qawaqzeh, K. W., Stewart, C., Reina Limon, R. F., Hosseinpour, H., Nguyen, L., & Joseph, B. (2022). Futility of Resuscitation among Geriatric Trauma Patients: Do We Need to Define When to Withdraw Care?. Journal of the American College of Surgeons, 235(5), S92-S93. doi:10.1097/01.xcs.0000896516.60590.12
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  Introduction: Survival15) geriatric trauma patients(≥65yrs). FR was. Patients were stratified into decades of age and resuscitative endpoints and intervention employed were identified. Outcome was FR (any intervention/endpoint that was associated with >90% mortality). Results: 46,339 patients were identified (65-75yrs: 42%; 75-85yrs: 40%; ≥85yrs: 18%). Mortality was 18%, ISS was 21[17-26], 57% male, and 85% blunt-injury. ED-thoracotomy among those >65yrs, and prehospital cardiac-arrest and REBOA among those >85yrs were associated with FR. Transfusion of >40U PRBC or FFP within 24hrs was associated with FR. 4-hour PRBC volumes associated with FR were: 65-75yrs:>30U; 75-85yrs:>27U; >85yrs:>21U. Increasing age was associated with increasing mortality among those who received emergency laparotomy or vasopressors, but did not reach FR. Lowest in-hospital SBP < 50mmHg was associated with FR among those>85yrs. Conclusion: ED-thoracotomy and transfusions >40U of product are futile in anyone over 65. REBOA is futile in anyone over 85. Resuscitation is futile in all super-elderly with prehospital cardiac arrest or an episode of profound hypotension. Further studies redefining FR among the geriatric trauma patient population to include lower mortality rates may be warranted.
• Collins, W. J., El-Qawaqzeh, K., Ditillo, M., Hosseinpour, H., Nelson, A., Bhogadi, S. K., Castanon, L., Gries, L., Anand, T., & Joseph, B. (2022). Minimally Invasive Surgery for Genitourinary Trauma: A Nationwide Outcomes-Based Analysis. The Journal of surgical research, 282, 129-136.
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  Bladder and ureteral injuries are uncommon in trauma patients but are associated with increased morbidity and mortality. Patients presenting with such injuries may undergo either open surgical repair or laparoscopic repair. We aimed to compare outcomes of open surgical approach and laparoscopy in trauma patients with isolated bladder and ureteral injury. We hypothesized that laparoscopy is associated with improved outcomes.
• Culbert, M. H., Nelson, A., Obaid, O., Castanon, L., Hosseinpour, H., Anand, T., El-Qawaqzeh, K., Stewart, C., Reina, R., & Joseph, B. (2022). Failure-to-rescue and mortality after emergent pediatric trauma laparotomy: How are the children doing?. Journal of pediatric surgery.
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  Emergent trauma laparotomy is associated with mortality rates of up to 40%. There is a paucity of data on the outcomes of emergent trauma laparotomies performed in the pediatric population. The aim of our study was to describe the outcomes, including mortality and FTR, among pediatric trauma patients undergoing emergent laparotomy and identify factors associated with failure-to-rescue (FTR).
• Ditillo, M., Tang, A., Saljuqi, T., Obaid, O., Nelson, A., Joseph, B., Hammad, A., Ditillo, M., Asmar, S., & Anand, T. (2022). Marijuana and thromboembolic events in geriatric trauma patients: The cannabinoids clots correlation!. American journal of surgery, 223(4), 798-803. doi:10.1016/j.amjsurg.2021.07.036
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  Tetrahydrocannabinol (THC) can alter the coagulation cascade resulting in hypercoagulability. The aim of our study is to evaluate the impact of THC use on thromboembolic complications (TEC) in geriatric trauma patients (GTP)..This is a 2017 analysis of the TQIP database including all GTP (age ≥65 years). Patients were stratified based on THC use. Propensity score matching (1:2 ratio) was performed..A total of 2,835 patients were matched (THC+: 945 and THC-: 1,890). Mean age was 70 ± 6 years, 94% sustained blunt injuries, and median ISS was 22[12-27]. Sixty-two percent of patients received thromboprophylaxis, with median time to initiation of 27 h from admission. Overall, the rate of TEC was 2.1% and mortality was 6.0%. THC + patients had significantly higher rates of TEC compared to THC- patients (3.0% vs. 1.7%; p = 0.01). Rates of DVT (2.2% vs 0.6%, p < 0.01) and PE (1.4% vs 0.4%, p < 0.01) were higher in the THC + group..THC exposure increases the risk of TEC in GTP. Incorporation of THC use into risk assessment protocols merits serious consideration in GTP.
• Douglas, M., Obaid, O., Castanon, L., Reina, R., Ditillo, M., Nelson, A., Bible, L., Anand, T., Gries, L., & Joseph, B. (2022). After 9,000 laparotomies for blunt trauma, resuscitation is becoming more balanced and time to intervention shorter: Evidence in action. The journal of trauma and acute care surgery, 93(3), 307-315.
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  Several advancements in hemorrhage control have been advocated for in the past decade, including balanced transfusions and earlier times to intervention. The aim of this study was to examine the effect of these advancements on outcomes of blunt trauma patients undergoing emergency laparotomy.
• El-Qawaqzeh, K., Anand, T., Hosseinpour, H., Ditillo, M., Obaid, O., Nelson, A., Stewart, C., Nguyen, L., Limon, R. F., & Joseph, B. (2022). Nationwide Analysis of Outcomes after Resuscitative Endovascular Balloon Occlusion of the Aorta: Is There a Need for Age-Specific Considerations?. JAMA Surgery. doi:10.1097/01.xcs.0000895276.04948.e7
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  INTRODUCTION: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a temporizing adjunctive hemorrhage control intervention. However, there is conflicting evidence on any survival benefits associated with REBOA. We aimed to assess the outcomes of adjunctive REBOA among different age groups. METHODS: We analyzed the 2017 to 2018 American College of Surgeons TQIP including adults (18 years or older) who received early transfusions and emergency hemorrhage control surgery (thoracotomy/laparotomy within 24 hours). After stratification into REBOA and no-REBOA, propensity score matching was performed. Patients were stratified into 4 age categories. Outcomes were in 24 hours, in-hospital mortality, major complications, and survivor hospital length of stay. RESULTS: We identified 19,984 patients, among whom 2,388 patients (REBOA: 796; no-REBOA: 1,592) were matched. The mean age was 42 ± 18 years, the mean lowest systolic blood pressure was 67 ± 35 mmHg, and the median Injury Severity Score was 29 [19 to 38]. The median time to hemorrhage control surgery was 48 [29 to 86] minutes. Overall, in-hospital mortality was 51%, the major complication rate was 34%, and the median length of stay among survivors was 19 [11 to 31] days. Univariate analysis is provided in figure. On multivariate regression, geriatric patients (65 years and older) in the REBOA group had significantly higher adjusted odds of both 24-hour mortality (adjusted odds ratio 2.05, p = 0.01) and in-hospital mortality (adjusted odds ratio 2.42, p = 0.01; Table). REBOA was independently associated with higher odds of major complications (adjusted odds ratio 1.25, p = 0.01) and longer hospital length of stay (β +3.37, p < 0.001) compared with no-REBOA.CONCLUSION: Adjunctive REBOA did not confer any survival benefit in patients undergoing emergency hemorrhage control surgery among all age groups. In fact, REBOA was independently associated with higher mortality in geriatric patients (65 years and older). There is a need for a concerted effort to clearly delineate which subset of patients will benefit from this resuscitation strategy.
• El-Qawaqzeh, K., Anand, T., Richards, J., Hosseinpour, H., Nelson, A., Akl, M. N., Obaid, O., Ditillo, M., Friese, R., & Joseph, B. (2022). Predictors of Mortality in Blunt Cardiac Injury: A Nationwide Analysis. The Journal of surgical research, 281, 22-32.
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  Blunt thoracic injury (BTI) is one of the most common causes of trauma admission in the United States and is uncommonly associated with cardiac injuries. Blunt cardiac injury (BCI) after blunt thoracic trauma is infrequent but carries a substantial risk of morbidity and sudden mortality. Our study aims to identify predictors of concomitant cardiac contusion among BTI patients and the predictors of mortality among patients presenting with BCI on a national level.
• Hosseinpour, H., El-Qawaqzeh, K., Stewart, C., Akl, M. N., Anand, T., Culbert, M. H., Nelson, A., Bhogadi, S. K., & Joseph, B. (2022). Emergency readmissions following geriatric ground-level falls: How does frailty factor in?. Injury, 53(11), 3723-3728.
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  Ground-level falls (GLFs) in older adults are increasing as life expectancy increases, and more patients are being discharged to skilled nursing facilities (SNFs) for continuity of care. However, GLF patients are not a homogenous cohort, and the role of frailty remains to be assessed. Thus, the aim of this study is to examine the impact of frailty on the in-hospital and 30-day outcomes of GLF patients.
• Joseph, B., Sakran, J. V., Obaid, O., Hosseinpour, H., Ditillo, M., Anand, T., & Zakrison, T. L. (2022). Nationwide Management of Trauma in Child Abuse: Exploring the Racial, Ethnic, and Socioeconomic Disparities. Annals of surgery, 276(3), 500-510.
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  Child abuse is a major cause of childhood injury, morbidity, and death. There is a paucity of data on the practice of abuse interventions among this vulnerable population. The aim of our study was to identify the factors associated with interventions for child abuse on a national scale.
• Joseph, B., Saljuqi, A. T., Amos, J. D., Teichman, A., Whitmill, M. L., Anand, T., Hosseinpour, H., Burruss, S. K., Dunn, J. A., Najafi, K., Godat, L. N., Enniss, T. M., Shoultz, T. H., Egodage, T., Bongiovanni, T., Hazelton, J. P., Colling, K. P., Costantini, T. W., Stein, D. M., , Schroeppel, T. J., et al. (2022). Prospective Validation and Application of the Trauma Specific Frailty Index (TSFI): Results of an AAST Multi-Institutional Observational Trial. The journal of trauma and acute care surgery.
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  The Frailty Index is a known predictor of adverse outcomes in geriatric patients. Trauma Specific Frailty Index (TSFI) was created and validated at a single center to accurately identify frailty and reliably predict worse outcomes among geriatric trauma patients. This study aims to prospectively validate the TSFI in a multi-institutional cohort of geriatric trauma patients.
• Kapadia, M., Obaid, O., Nelson, A., Hammad, A., Kitts, D. J., Anand, T., Ditillo, M., Douglas, M., & Joseph, B. (2022). Evaluation of Frailty Assessment Compliance in Acute Care Surgery: Changing Trends, Lessons Learned. The Journal of surgical research, 270, 236-244.
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  Routine frailty assessment has emerged recently in the surgical literature and is an important prognostication and risk stratification tool. The aim of our study was to review our 7-y experience with two frailty assessment tools and changing trends in their use.
• Nguyen, L., Ditillo, M. F., Reina Limon, R. F., Anand, T., Hosseinpour, H., Nelson, A. C., El-Qawaqzeh, K. W., Stewart, C., Obaid, O., & Joseph, B. (2022). Operative Management of Penetrating Colon Injury: Gone Are the Days of the Diverting Colostomy. Journal of the American College of Surgeons, 235(5), S49-S50. doi:10.1097/01.xcs.0000893292.12016.2e
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  INTRODUCTION: There is continued controversy regarding the optimal operative management of penetrating colon injury (PCI). The aim of our study is to compare outcomes of initial diverting operation (DO) vs primary repair and anastomosis (PRA) for PCI. METHODS: A 2017-2018 American College of Surgeons TQIP analysis. All adult trauma patients with operatively managed PCI were included. Transferred, dead ≤24 hours, or burn patients were excluded. Patients were stratified into DO or PRA. Outcomes measures were superficial and deep operative site infection (SSI) rate, intraabdominal abscess, sepsis, infectious complication, and failure of operative management (FOM; unplanned operating room return or subsequent diversion), hospital and ICU length of stay (LOS), and mortality. Multivariate regression was performed to identify predictors of infectious complication. RESULTS: A total of 4,504 patients were identified, of whom 357 (8%) underwent DO and 4,147 (92%) PRA. Mean age was 34 ± 13 years, 4,029(90%) were men, median Injury Severity Score was 16 [9-25]. The most common mechanism of injury was firearm (82%). Left-sided colon was most commonly affected (38%), and 56% had an American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS) grade III PCI or higher. A total of 599b(13%) patients had an infectious complication. DO group had higher superficial SSI rate (5.0% vs 2.4%; p = 0.003) and infectious complication (19.0% v s12.8%; p < 0.001), but no difference in deep SSI rate, intra-abdominal abscess, sepsis, FOM, mortality, hospital and ICU LOS between both groups (p > 0.05). Independent predictors of infectious complication are described in the Table. CONCLUSION: One in 7 patients with PCI developed an infectious complication, most commonly an intra-abdominal abscess. DO is independently associated with increased risk of infectious complication, along with left-sided PCI, concomitant gastric or small intestinal injuries, firearm injury, and AAST-OIS grade of PCI. PRA should be the preferred operative management for PCI.Table
• Obaid, O., Anand, T., Nelson, A., Reina, R., Ditillo, M., Stewart, C., Douglas, M., Friese, R., Gries, L., & Joseph, B. (2022). Fibrinogen supplementation for the trauma patient: Should you choose fibrinogen concentrate over cryoprecipitate?. The journal of trauma and acute care surgery, 93(4), 453-460.
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  Trauma-induced coagulopathy is frequently associated with hypofibrinogenemia. Cryoprecipitate (Cryo), and fibrinogen concentrate (FC) are both potential means of fibrinogen supplementation. The aim of this study was to compare the outcomes of traumatic hemorrhagic patients who received fibrinogen supplementation using FC versus Cryo.
• Obaid, O., Nelson, A., Kitts, D. J., Kapadia, M., Joseph, B., Hammad, A., Douglas, M., Ditillo, M., & Anand, T. (2022). Evaluation of Frailty Assessment Compliance in Acute Care Surgery: Changing Trends, Lessons Learned.. The Journal of surgical research, 270, 236-244. doi:10.1016/j.jss.2021.09.019
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  Routine frailty assessment has emerged recently in the surgical literature and is an important prognostication and risk stratification tool. The aim of our study was to review our 7-y experience with two frailty assessment tools and changing trends in their use..We performed a 7-y (2011-2017) analysis of our prospectively maintained frailty database. Frail patients were identified using the emergency general surgery and trauma specific frailty indices. Outcome measures were rates of compliance with frailty assessment, overall complications, discharge to skilled nursing facility (SNF)/rehab, and mortality over the study period. Multivariate logistic regression and Cochran-Armitage trend analyses were performed..We evaluated a total of 1045 geriatric patients (Trauma: 587, EGS: 458). Mean age was 74.5 ± 7.9 y, 74% were males, and 81% were white. Overall, 34% of the patients were frail. Compared to non-frail patients, frail patients had higher adjusted rates of complications (OR 2.4 [1.9-2.9]), mortality (OR 1.8 [1.4-2.3]), and rehab/SNF disposition (OR 3.7 [3.1-4.3]). The compliance rate of measuring frailty increased from 12% in 2011 to 78% in 2017, P < 0.001 (Figure). The complication rate decreased (33% versus 21%, P < 0.001), while the rate of discharge disposition to SNF/Rehab increased (41% versus 58%, P < 0.001). There was no difference in mortality (11% versus 9.8%, P = 0.48) over the study period..Adherence to frailty measurement increased over the study period. This was accompanied by a significant decline in overall in-hospital complications. Frailty indices can be utilized to identify high-risk patients and develop post-operative strategies to improve outcomes in acute care surgery.
• Pretorius, D., Richter, R. P., Anand, T., Cardenas, J. C., & Richter, J. R. (2022). Alterations in heparan sulfate proteoglycan synthesis and sulfation and the impact on vascular endothelial function. Matrix biology plus, 16, 100121.
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  The glycocalyx attached to the apical surface of vascular endothelial cells is a rich network of proteoglycans, glycosaminoglycans, and glycoproteins with instrumental roles in vascular homeostasis. Given their molecular complexity and ability to interact with the intra- and extracellular environment, heparan sulfate proteoglycans uniquely contribute to the glycocalyx's role in regulating endothelial permeability, mechanosignaling, and ligand recognition by cognate cell surface receptors. Much attention has recently been devoted to the enzymatic shedding of heparan sulfate proteoglycans from the endothelial glycocalyx and its impact on vascular function. However, other molecular modifications to heparan sulfate proteoglycans are possible and may have equal or complementary clinical significance. In this narrative review, we focus on putative mechanisms driving non-proteolytic changes in heparan sulfate proteoglycan expression and alterations in the sulfation of heparan sulfate side chains within the endothelial glycocalyx. We then discuss how these specific changes to the endothelial glycocalyx impact endothelial cell function and highlight therapeutic strategies to target or potentially reverse these pathologic changes.
• Reina, R., Anand, T., Bhogadi, S. K., Nelson, A., Hosseinpour, H., Ditillo, M., El-Qawaqzeh, K., Castanon, L., Stewart, C., & Joseph, B. (2022). Nonoperative management of blunt abdominal solid organ injury: Are we paying enough attention to patients on preinjury anticoagulation?. American journal of surgery.
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  This study aims to assess the impact of pre-injury anticoagulant use on outcomes of isolated blunt abdominal SOI patients who underwent NOM.
• Reina, R., Obaid, O., Nelson, A., Joseph, B., Gries, L., Douglas, M., Ditillo, M., Castanon, L., Bible, L., & Anand, T. (2022). After 9,000 Laparotomies for Blunt Trauma, Resuscitation Is Becoming More Balanced and Time to Intervention Shorter: Evidence in Action.. The journal of trauma and acute care surgery, Publish Ahead of Print. doi:10.1097/ta.0000000000003574
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  Several advancements in hemorrhage control have been advocated for in the past decade, including balanced transfusions and earlier times to intervention. The aim of this study is to examine the effect of these advancements on outcomes of blunt trauma patients undergoing emergency laparotomy..This is a 5-year (2013-2017) analysis of the Trauma Quality Improvement Program. Adult (age ≥ 18 years) blunt trauma patients with early (≤4 hours) PRBC and FFP transfusions and an emergency (≤4 hours) laparotomy for hemorrhage control were identified. Time-trend analysis of 24-hour mortality, PRBC/FFP ratio, and time to laparotomy was performed over the study period. The association between mortality and PRBC/FFP ratio, patient demographics, injury characteristics, transfusion volumes, and ACS verification level was examined by hierarchical regression analysis adjusting for inter-year variability..A total of 9,773 blunt trauma patients with emergency laparotomy were identified. Mean age was 44 ± 18 years, 67.5% were male, and median ISS was 34 [24-43]. Mean SBP at presentation was 73 ± 28 mm Hg, and median transfusion requirements were PRBC 9 [5-17] and FFP 6 [3-12]. During the 5-year analysis, time to laparotomy decreased from 1.87 hours to 1.37 hours (p < 0.001), PRBC/FFP ratio at 4 hours decreased from 1.93 to 1.71 (p < 0.001), and 24-hour mortality decreased from 23.0% to 19.3% (p = 0.014). (Figure) On multivariate analysis, decreased PRBC/FFP ratio was independently associated with decreased 24-hour mortality (OR 0.88; p < 0.001) and in-hospital mortality (OR 0.89; p < 0.001)..Resuscitation is becoming more balanced and time to emergency laparotomy shorter in blunt trauma patients, with a significant improvement in mortality. Future efforts should be directed towards incorporating transfusion practices and timely surgical interventions as markers of trauma center quality..Level III.
• Reina, R., Obaid, O., Northcutt, A., Nelson, A., Joseph, B., Gries, L., Ditillo, M., Castanon, L., Bible, L., & Anand, T. (2022). Prospective Validation of The Rib Injury Guidelines (RIG) For Traumatic Rib Fractures.. The journal of trauma and acute care surgery, Publish Ahead of Print. doi:10.1097/ta.0000000000003535
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  The Rib Injury Guidelines (RIG) were developed to guide triage of traumatic rib fracture patients to home, regular floor, or ICU and standardize care. The RIG score is based on patient history, physical examination, and imaging findings. The aim of this study is to evaluate triage effectiveness and healthcare resources utilization following RIG implementation..This is a prospective analysis at a Level I trauma center from October 2017 to January 2020. Adult (age ≥ 18 years) blunt trauma patients with a diagnosis of at least one rib fracture on CT imaging were included. Patients before (PRE) and after (POST) implementation of RIG were compared. In the POST group, patients were divided into RIG 1, RIG 2, and RIG 3 based on their RIG score. Outcomes were readmission for RIG 1 patients, unplanned ICU admission for RIG 2 patients, and overall ICU admission. Secondary outcomes were hospital length of stay (LOS) and mortality..A total of 1100 patients were identified (PRE: 754; POST: 346). Mean age was 56 ± 19 years, 788 (71.6%) were male, and median ISS was 14 [10-22]. The most common mechanism of injury was motor vehicle collision (554; 50.3%), 253 (22.9%) patients had ≥5 rib fractures, and 53 (4.8%) patients had a flail chest. In the POST group, 74 patients (21.1%) were RIG 1, 121 (35.2%) RIG 2, and 151 (43.7%) RIG 3. No patient in RIG 1 was readmitted following initial discharge, and 2 (1.6%) patients in RIG 2 had an unplanned ICU admission (both for alcohol withdrawal syndrome). POST patients had shorter hospital LOS (3 [1-6] vs. 4 [1-7] days; p = 0.019) and no difference in mortality (5.8% vs. 7.7%; p = 0.252). On multivariate analysis, RIG implementation was associated with decreased ICU admission (aOR 0.55 [0.36-0.82]; p = 0.004)..RIG is safe and effectively defines triage of rib fracture patients with an overall reduction in ICU admissions, shorter hospital LOS, and no readmissions..Level III.
• Sumra, H., Riner, A. N., Arjani, S., Tasnim, S., Zope, M., Reyna, C., & Anand, T. (2022). Minimizing implicit bias in search committees. American journal of surgery, 224(4), 1179-1181.
• Zope, M., Tasnim, S., Sumra, H., Riner, A. N., Reyna, C., Henry, M., Arjani, S., & Anand, T. (2022). It begins with the search committee: Promoting faculty diversity at the source.. American journal of surgery, 223(2), 432-435. doi:10.1016/j.amjsurg.2021.08.027
• Anand, T., Khurrum, M., Chehab, M., Bible, L., Asmar, S., Douglas, M., Ditillo, M., Gries, L., & Joseph, B. (2021). Racial and Ethnic Disparities in Frail Geriatric Trauma Patients. World journal of surgery, 45(5), 1330-1339.
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  Frailty in geriatric trauma patients is commonly associated with adverse outcomes. Racial disparities in geriatric trauma patients are previously described in the literature. We aimed to assess whether race and ethnicity influence outcomes in frail geriatric trauma patients.
• Anand, T., Obaid, O., Nelson, A., Chehab, M., Ditillo, M., Hammad, A., Douglas, M., Bible, L., & Joseph, B. (2021). Whole Blood Hemostatic Resuscitation in Pediatric Trauma: A Nationwide Propensity-Matched Analysis. The journal of trauma and acute care surgery.
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  Whole blood (WB) has shown promise in pediatric trauma resuscitation following its prominent role in the resuscitation of adult trauma patients. Although WB in children has been shown to be feasible, its effectiveness has yet to be explored. The aim of this study is to examine the outcomes of WB transfusion as an adjunct to component therapy (CT) compared to CT only as early resuscitation for pediatric trauma patients.
• Arjani, S., Tasnim, S., Sumra, H., Zope, M., Riner, A. N., Reyna, C., Henry, M., & Anand, T. (2021). It begins with the search committee: Promoting faculty diversity at the source. American journal of surgery.
• Asmar, S., Bible, L., Obaid, O., Anand, T., Chehab, M., Ditillo, M., Castanon, L., Nelson, A., & Joseph, B. (2021). Frail geriatric patients with acute calculous cholecystitis: Operative versus nonoperative management?. The journal of trauma and acute care surgery, 91(1), 219-225.
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  Nonoperative management of acute calculous cholecystitis (ACC) in the frail geriatric population is underexplored. The aim of our study was to examine long-term outcomes of frail geriatric patients with ACC treated with cholecystectomy compared with initial nonoperative management.
• Asmar, S., Nelson, A., Anand, T., Hammad, A., Obaid, O., Ditillo, M., Saljuqi, T., Tang, A., & Joseph, B. (2021). Marijuana and thromboembolic events in geriatric trauma patients: The cannabinoids clots correlation!. American journal of surgery.
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  Tetrahydrocannabinol (THC) can alter the coagulation cascade resulting in hypercoagulability. The aim of our study is to evaluate the impact of THC use on thromboembolic complications (TEC) in geriatric trauma patients (GTP).
• Bible, L., Anand, T., Obaid, O., Kitts, D. J., Khurrum, M., Kapadia, M., Joseph, B., Hammad, A., Goh, M., Bible, L., & Anand, T. (2021). Pre-Hospital Administration of Opioids in Trauma Patients: Is Dose Associated With Outcomes?. The Journal of surgical research, 268, 634-642. doi:10.1016/j.jss.2021.08.001
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  Opioids are commonly used as an analgesic agent in the prehospital setting. Current efforts to prevent and control prescription opioid overuse are focused on the in-hospital and post-discharge phases. The aim of our study was to assess the associations between pre-hospital opioids use and in-hospital outcomes among trauma patients..We performed a 2 year (2016-2017) retrospective analysis of our Level-I trauma center database. We included all adult trauma patients (age > 18y) who received pre-hospital opioids (Fentanyl (F) or Morphine-Sulfate (MS)). Outcome measures were emergency-department (ED) hypotension (SPB < 90 mmHg), ED intubation, prescription opioid medication upon discharge, and mortality. Multivariate logistic regression was performed..In total, 709 patients were included in the analysis. Cutoff values of 200 mcg F and 15 mg MS were significantly associated with adverse outcomes. Overall, the ED hypotension rate was 14.4%, ED intubation rate was 6%, and ED mortality rate was 3.1%. On regression analysis, higher dosages of both pre-hospital F and pre-hospital MS were independently associated with increased odds of ED hypotension, ED intubation, and discharge on opioid medications, but not with ED mortality..Pre-hospital administration of high dose opioids is associated with increased odds of adverse outcomes. Collaborative efforts to standardize and control the overuse of opioids should target the pre-hospital setting to limit opioid associated adverse effects.
• Bible, L., Obaid, O., Khurrum, M., Goh, M., Hammad, A., Kitts, D. J., Anand, T., Kapadia, M., & Joseph, B. (2021). Pre-Hospital Administration of Opioids in Trauma Patients: Is Dose Associated With Outcomes?. The Journal of surgical research, 268, 634-642.
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  Opioids are commonly used as an analgesic agent in the prehospital setting. Current efforts to prevent and control prescription opioid overuse are focused on the in-hospital and post-discharge phases. The aim of our study was to assess the associations between pre-hospital opioids use and in-hospital outcomes among trauma patients.
• Chehab, M., Ditillo, M., Obaid, O., Nelson, A., Poppe, B., Douglas, M., Anand, T., Bible, L., & Joseph, B. (2021). Never-frozen liquid plasma transfusion in civilian trauma: a nationwide propensity-matched analysis. The journal of trauma and acute care surgery, 91(1), 200-205.
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  Never-frozen liquid plasma (LQP) was found to reduce component waste, decrease health care expenses, and have a superior hemostatic profile compared with fresh frozen plasma (FFP). Although transfusing LQP in hemorrhaging patients has become more common, its clinical effectiveness remains to be explored. This study aims to examine outcomes of trauma patients transfused with LQP compared with thawed FFP.
• Khurrum, M., Ditillo, M., Obaid, O., Anand, T., Nelson, A., Chehab, M., Kitts, D. J., Douglas, M., Bible, L., & Joseph, B. (2021). Four-factor prothrombin complex concentrate in adjunct to whole blood in trauma-related hemorrhage: Does whole blood replace the need for factors?. The journal of trauma and acute care surgery, 91(1), 34-39.
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  The use of whole blood (WB) for the treatment of hemorrhagic shock and coagulopathy is increasing in civilian trauma patients. Four-factor prothrombin complex concentrate (4-PCC) in adjunct to component therapy showed improved outcomes in trauma patients. Our study aims to evaluate the outcomes of trauma patients who received 4-PCC and WB (4-PCC-WB) compared with WB alone.
• Obaid, O., Hammad, A., Bible, L., Ditillo, M., Castanon, L., Douglas, M., Anand, T., Nelson, A., & Joseph, B. (2021). Open Versus Laparoscopic Repair of Traumatic Diaphragmatic Injury: A Nationwide Propensity-Matched Analysis. The Journal of surgical research, 268, 452-458.
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  Minimally invasive surgical techniques have become routinely applied in the evaluation and treatment of patients with isolated traumatic diaphragmatic injuries (TDI). However, there remains a paucity of data that compares the laparoscopic repair to the open repair approach. The aim of our study is to examine patient outcomes between TDI patients managed laparoscopically versus those managed using open repair.
• Anand, T., Hanna, K., Kulvatunyou, N., Zeeshan, M., Ditillo, M., Castanon, L., Tang, A., Gries, L., & Joseph, B. (2020). Time to tracheostomy impacts overall outcomes in patients with cervical spinal cord injury. The journal of trauma and acute care surgery, 89(2), 358-364.
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  The morbidity associated with cervical spine injury increases in the setting of concomitant cervical spinal cord injury (CSCI). A significant proportion of these patients require placement of a tracheostomy. However, it remains unclear if timing to tracheostomy following traumatic CSCI can impact outcomes. The aim of our study was to characterize outcomes associated with tracheostomy timing following traumatic CSCI.
• Anand, T., Ditillo, M., Kulvatunyou, N., Tang, A. L., Saljuqi, A. T., Northcutt, A., Kulvatunyou, N., Joseph, B., Hamidi, M. K., Haddadin, Z., Gries, L. M., Ditillo, M., & Anand, T. (2019). Association of Racial, Ethnic Disparities, and Frailty in Geriatric Trauma Patients. Journal of The American College of Surgeons, 229(4), S119. doi:10.1016/j.jamcollsurg.2019.08.265
• Anand, T., Roller, L. K., & Jurkovich, G. J. (2019). Vitamin C in surgical sepsis. Current opinion in critical care, 25(6), 712-716.
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  The current review discusses the supplemental use of vitamin C as an adjunct in the management of sepsis and septic shock.
• Anand, T., Tang, A., Joseph, B., & Anand, T. (2019). Penetrating Neck Trauma: a Review. Current Trauma Reports, 5(1), 12-18. doi:10.1007/s40719-019-0154-6
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  This review focuses on the management of penetrating neck trauma and its evolution over the last several decades. Our increased experience with high-resolution computed tomography has changed the management of penetrating neck trauma from an anatomically zone-based approach to a “no zone” approach. Physical signs and symptoms of vascular, airway, and digestive track injuries still guide the basis of further radiographic and surgical workup. With the advancement and greater availability of multi-detector computed tomography (MDCT) technology, assessment of injuries has become easier and far more accurate. The hemodynamically stable patient may now be approached in a “no-zone” manner, and in certain cases managed safely with conservative measures. Wartime experience and improved technology played major roles in the evolution of penetrating neck injury management. Aggressive surgical exploration had given way to selective management based on anatomical neck zones, to most currently a “no zone” approach.
• Anand, T., & Skinner, R. (2018). Vitamin C in burns, sepsis, and trauma. The journal of trauma and acute care surgery, 85(4), 782-787.
• Anand, T., Ponce, S., Pakula, A., Norville, C., Kallish, D., Martin, M., & Skinner, R. (2018). Results from a Quality Improvement Project to Decrease Infection-Related Ventilator Events in Trauma Patients at a Community Teaching Hospital. The American surgeon, 84(10), 1701-1704.
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  Ventilator-associated pneumonia (VAP) is linked to increased morbidity and mortality and clinical protocols (VAP bundles) have evolved to minimize VAP. In 2009, a quality improvement project was implemented at our institution to decrease VAP rates in adult trauma patients. A VAP prevention committee was developed, and formal evidence-based education for the nursing and physician staff was introduced. During the study period (2009-2016), 2380 patients required ICU admission to our Level II trauma center. The mean Injury Severity Score was 33 + 12, and there were 17 per cent penetrating and 83 per cent blunt injuries. The early compliance (2010) with the VAP bundle was 65 per cent. Within one year of the implementation of VAP prevention, the compliance increased to >90 per cent. Compliance has been carefully trended and has remained at 100 per cent. All of the aforementioned interventions have resulted in a sustained dramatic decline in VAP, from 12 per cent in 2009 to 0 per cent in 2016. Ongoing education and ICU policy development has become the mainstay of our trauma ICU program. The introduction of evidence-based care education imparted a culture of excellence resulting in favorable outcomes in high-risk trauma patients related to VAP prevention. Ongoing monitoring and education is required to sustain these promising outcomes.
• Anand, T., Ramnanan, R., Skinner, R., & Martin, M. (2016). Impact of Massive Transfusion and Aging Blood in Acute Trauma. The American surgeon, 82(10), 957-959.
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  Blood transfusions cause altered immunity and the duration of storage is contributory. In the era of massive transfusion protocols (MTPs) this impact is unclear, particularly as it relates to balanced transfusions. Trauma patients requiring our MTP after admission to our Level II trauma center were studied. The average age of blood transfused was calculated; old blood was a storage time of ≥14 days versus new blood 1:1. Infections, organ dysfunction multiorgan injury (MOI), and death were compared based on ratios and blood storage times. Of 2200 trauma admissions, 89 patients required MTP. Penetrating injuries were the majority, n = 53; and Injury Severity Score was 33 ± 14. Overall mortality was 31 per cent and sepsis was 28 per cent. Outcomes (storage time): Patients receiving old versus new blood had comparable age and Injury Severity Score. Sepsis rates, multiorgan injury and mortality were similar. Outcomes (packed red blood cells:fresh frozen plasma): Balanced transfusions (ratios of 1:1) demonstrated significant survival benefit and less infections compared with ratios >1:1. These data underscore the complexity of transfusion-related morbidity. In the modern era of MTP and balanced transfusions, the age of stored blood may not impact outcomes as demonstrated historically.
• Anand, T., vanSonnenberg, E., Gadani, K., & Skinner, R. (2016). A snapshot of circulation failure following acute traumatic injury: The expansion of computed tomography beyond injury diagnosis. Injury, 47(1), 50-2.
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  CT scans with a flat Inferior Vena Cava (IVC) suggest hypovolemia, and the presence of shock bowel implies hypoperfusion. The purpose of this study is to correlate injury severity, resuscitation needs, and clinical outcomes with CT indices of hypovolemia and hypoperfusion.
• Anand, T., Vansonnenberg, E., Gadani, K., & Skinner, R. (2013). 248: CT BEYOND TRAUMA DIAGNOSIS. Critical Care Medicine, 41, A56-A57. doi:10.1097/01.ccm.0000439395.65611.f8
• Anand, T., & Skinner, R. (2012). Arginine vasopressin: the future of pressure-support resuscitation in hemorrhagic shock. The Journal of surgical research, 178(1), 321-9.
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  Arginine vasopressin (AVP) is a key player in maintaining the intravascular volume and pressure during hemorrhagic shock. During the past 2 decades, animal studies, case reports, and reviews have documented the minimized blood loss and improved perfusion pressures in those receiving pressure support with AVP.

Proceedings Publications

• Bhogadi, S., Colosimo, C., Hosseinpour, H., Nelson, A., Rose, M., Calvillo, A., Anand, T., Ditillo, M., Magnotti, L., & Joseph, B. (2023). The undisclosed disclosures: The dollar-outcome relationship in resuscitative endovascular balloon occlusion of the aorta. In Western Trauma Association.
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  BACKGROUND Despite its rapid evolution, resuscitative endovascular balloon occlusion of the aorta (REBOA) remains a controversial intervention that continues to generate active research. Proper conflict of interest (COI) disclosure helps to ensure that research is conducted objectively, without bias. We aimed to identify the accuracy of COI disclosures in REBOA research. METHODS Literature search was performed using the keyword "REBOA"on PubMed. Studies on REBOA with at least one American author published between 2017 and 2022 were identified. The Centers for Medicare and Medicaid Services Open Payments database was used to extract information regarding payments to the authors from the industry. This was compared with the COI section reported in the manuscripts. Conflict of interest disclosure was defined as inaccurate if the authors failed to disclose any amount of money received from the industry. Descriptive statistics were performed. RESULTS We reviewed a total of 524 articles, of which 288 articles met the inclusion criteria. At least one author received payments in 57% (165) of the articles. Overall, 59 authors had a history of payment from the industry. Conflict of interest disclosure was inaccurate in 88% (145) of the articles where the authors received payment. CONCLUSION Conflict of interest reports are highly inaccurate in REBOA studies. There needs to be standardization of reporting of conflicts of interest to avoid potential bias. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.
• Joseph, B., Saljuqi, A., Amos, J., Teichman, A., Whitmill, M., Anand, T., Hosseinpour, H., Burruss, S., Dunn, J., Najafi, K., Godat, L., Enniss, T., Shoultz, T., Egodage, T., Bongiovanni, T., Hazelton, J., Colling, K., Costantini, T., Stein, D., , Thomas, J., et al. (2023). Prospective validation and application of the Trauma-Specific Frailty Index: Results of an American Association for the Surgery of Trauma multi-institutional observational trial. In AAST.
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  BACKGROUND: The frailty index is a known predictor of adverse outcomes in geriatric patients. Trauma-Specific Frailty Index (TSFI) was created and validated at a single center to accurately identify frailty and reliably predict worse outcomes among geriatric trauma patients. This study aims to prospectively validate the TSFI in a multi-institutional cohort of geriatric trauma patients. METHODS: This is a prospective, observational, multi-institutional trial across 17 American College of Surgeons Levels I, II, and III trauma centers. All geriatric trauma patients (65 years and older) presenting during a 3-year period were included. Frailty status was measured within 24 hours of admission using the TSFI (15 variables), and patients were stratified into nonfrail (TSFI, ≤0.12), prefrail (TSFI, 0.13–0.25), and frail (TSFI, >0.25) groups. Outcome measures included index admission mortality, discharge to rehabilitation centers or skilled nursing facilities (rehab/SNFs), and 3-month postdischarge readmissions, fall recurrences, complications, and mortality among survivors of index admission. RESULTS: A total of 1,321 geriatric trauma patients were identified and enrolled for validation of TSFI (nonfrail, 435 [33%]; prefrail, 392 [30%]; frail, 494 [37%]). The mean ± SD age was 77 ± 8 years; the median (interquartile range) Injury Severity Score was 9 (5–13). Overall, 179 patients (14%) had a major complication, 554 (42%) were discharged to rehab/SNFs, and 63 (5%) died during the index admission. Compared with nonfrail patients, frail patients had significantly higher odds of mortality (adjusted odds ratio [aOR], 1.93; p = 0.018), major complications (aOR, 3.55; p < 0.001), and discharge to rehab/SNFs (aOR, 1.98; p < 0.001). In addition, frailty was significantly associated with higher adjusted odds of mortality, major complications, readmissions, and fall recurrence at 3 months postdischarge (p < 0.05). CONCLUSION: External applicability of the TSFI (15 variables) was evident at a multicenter cohort of 17 American College of Surgeons trauma centers in geriatric trauma patients. The TSFI emerged as an independent predictor of worse outcomes, both in the short-term and 3-month postdischarge.
• Joseph, B., Obaid, O., Dultz, L., Black, G., Campbell, M., Berndtson, A., Costantini, T., Kerwin, A., Skarupa, D., Burruss, S., Delgado, L., Gomez, M., Mederos, D., Winfield, R., Cullinane, D., Chehab, M., Anand, T., Nelson, A., Kim, S., & Luo-Owen, X. (2022). Validating the Brain Injury Guidelines: Results of an American Association for the Surgery of Trauma prospective multi-institutional trial. In AAST.
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  INTRODUCTION Brain Injury Guidelines (BIG) was developed to effectively use health care resources including repeat head computed tomography (RHCT) scan and neurosurgical consultation in traumatic brain injury (TBI) patients. The aim of this study was to prospectively validate BIG at a multi-institutional level. METHODS This is a prospective, observational, multi-institutional trial across nine Levels I and II trauma centers. Adult (16 years or older) blunt TBI patients with a positive initial head computed tomography (CT) scan were identified and categorized into BIG 1, 2, and 3 based on their neurologic examination, alcohol intoxication, antiplatelet/anticoagulant use, and head CT scan findings. The primary outcome was neurosurgical intervention. The secondary outcomes were neurologic worsening, RHCT progression, postdischarge emergency department visit, and 30-day readmission. RESULTS A total of 2,432 patients met the inclusion criteria, of which 2,033 had no missing information and were categorized into BIG 1 (301 [14.8%]), BIG 2 (295 [14.5%]), and BIG 3 (1,437 [70.7%]). In BIG 1, no patient worsened clinically, 4 of 301 patients (1.3%) had progression on RHCT with no change in management, and none required neurosurgical intervention. In BIG 2, 2 of 295 patients (0.7%) worsened clinically, and 21 of 295 patients (7.1%) had progression on RHCT. Overall, 7 of 295 patients (2.4%) would have required upgrade from BIG 2 to 3 because of neurologic examination worsening or progression on RHCT, but no patient required neurosurgical intervention. There were no TBI-related postdischarge emergency department visits or 30-day readmissions in BIG 1 and 2 patients. All patients who required neurosurgical intervention were BIG 3 (280 of 1,437 patients [19.5%]). Agreement between assigned and final BIG categories was excellent (κ = 99%). In this cohort, implementing BIG would have decreased CT scan utilization and neurosurgical consultation by 29% overall, with a 100% reduction in BIG 1 patients and a 98% reduction in BIG 2 patients. CONCLUSION Brain Injury Guidelines is safe and defines the management of TBI patients by trauma and acute care surgeons without the routine need for RHCT and neurosurgical consultation. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.

Reviews

• Bhogadi, S. K., Colosimo, C., Hosseinpour, H., Nelson, A., Rose, M. I., Calvillo, A. R., Anand, T., Ditillo, M., Magnotti, L. J., & Joseph, B. (2023. The undisclosed disclosures: The dollar-outcome relationship in resuscitative endovascular balloon occlusion of the aorta(pp 726-730).
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  Despite its rapid evolution, resuscitative endovascular balloon occlusion of the aorta (REBOA) remains a controversial intervention that continues to generate active research. Proper conflict of interest (COI) disclosure helps to ensure that research is conducted objectively, without bias. We aimed to identify the accuracy of COI disclosures in REBOA research.

Others

• Anand, T. (2024, September). Pediatrics and Injury Prevention
  Poster Professor. AAST.