Defining Rates and Risk Factors for Readmissions Following Emergency General Surgery

Defining Rates and Risk Factors for Readmissions Following Emergency General Surgery


Hospital readmission rates following surgery are increasingly being used as a marker of quality of care and are used in pay-for-performance metrics. To our knowledge, comprehensive data on readmissions to the initial hospital or a different hospital after emergency general surgery (EGS) procedures do not exist.

Objective  To define readmission rates and identify risk factors for readmission after common EGS procedures.

Design, Setting, and Participants  Patients undergoing EGS, as defined by the American Association for the Surgery of Trauma, were identified in the California State Inpatient Database (2007-2011) on January 15, 2015. Patients were 18 years and older. We identified the 5 most commonly performed EGS procedures in each of 11 EGS diagnosis groups. Patient demographics (sex, age, race/ethnicity, and insurance type) as well as Charlson Comorbidity Index score, length of stay, complications, and discharge disposition were collected. Factors associated with readmission were determined using multivariate logistic regression models analysis.

Main Outcomes and Measures  Thirty-day hospital readmission.

Results  Among 177 511 patients meeting inclusion criteria, 57.1% were white, 48.8% were privately insured, and most were 45 years and older (51.3%). Laparoscopic appendectomy (35.2%) and laparoscopic cholecystectomy (19.3%) were the most common procedures. The overall 30-day readmission rate was 5.91%. Readmission rates ranged from 4.1% (upper gastrointestinal) to 16.8% (cardiothoracic). Of readmitted patients, 16.8% were readmitted at a different hospital. Predictors of readmission included Charlson Comorbidity Index score of 2 or greater (adjusted odds ratio: 2.26 [95% CI, 2.14-2.39]), leaving against medical advice (adjusted odds ratio: 2.24 [95% CI, 1.89-2.66]), and public insurance (adusted odds ratio: 1.55 [95% CI, 1.47-1.64]). The most common reasons for readmission were surgical site infections (16.9%), gastrointestinal complications (11.3%), and pulmonary complications (3.6%).

Conclusions and Relevance  Readmission after EGS procedures is common and varies widely depending on patient factors and diagnosis categories. One in 5 readmitted patients will go to a different hospital, causing fragmentation of care and potentially obscuring the utility of readmission as a quality metric. Assisting socially vulnerable patients and reducing postoperative complications, including infections, are targets to reduce readmissions.

Posted in Hot Topics in Research, May

Mango Languages

Thanks to all who responded and provided feedback! Mango has been added to the PCOM Libary Collection!

Innovative online languages – learning with Mango.

mango languages logo

Mango teaches learners to think critically in a new language and retain what they’ve learned. Students, faculty, staff and alumni can learn from interactive conversational tutorials and from a collection of films that are streamed.

Over 70 foreign languages are available and some are presented in focused modules, for example Medical Spanish and Business Spanish.

Create an account to track your personal progress here.  Those who create an account can also use Mango on Apple, Android, and Kindle devices.

Contact us if you have any questions.

Posted in Front Page, Library News, New Resources

Low-Dose Acetylsalicylic Acid Treatment and Impact on Short-Term Mortality in Staphylococcus aureus Bloodstream Infection: A Propensity Score–Matched Cohort Study

Low-Dose Acetylsalicylic Acid Treatment and Impact on Short-Term Mortality in Staphylococcus aureus Bloodstream Infection: A Propensity Score–Matched Cohort Study


Objectives: Staphylococcus aureus bloodstream infection is associated with considerable mortality. Experimental models suggest a direct antistaphylococcal effect of acetylsalicylic acid, but evidence from human studies is scarce. We aimed to estimate the effect of low-dose acetylsalicylic acid therapy on mortality in bloodstream infections caused by S. aureus compared with Escherichia coli.

Design: Retrospective cohort study based on observational data from 838 and 602 episodes of S. aureus and E. coli bloodstream infection, respectively. Setting: Swiss tertiary referral center. Patients: Adult patients with S. aureus and E. coli bloodstream infection, respectively, categorized according to low-dose acetylsalicylic acid therapy as outpatient or inpatient before bacteremia.

Interventions: None.

Measurements and Main Results: Thirty-day all-cause mortality was analyzed in a total of 314 propensity score-matched S. aureus bloodstream infection and in 268 E. coli bloodstream infection patients, respectively (1:1 match of low-dose acetylsalicylic acid users and nonusers). S. aureus bloodstream infection cases and controls were equally matched for relevant confounders except treatment with statins, which was strongly associated with a low-dose acetylsalicylic acid use (p < 0.001). At day 30, 12.1% of cases and 27.4% of controls had died (hazard ratio, 0.40; p < 0.001). Low-dose acetylsalicylic acid use was associated with a reduced 30-day all-cause mortality in multivariate analysis (hazard ratio, 0.38; 95% CI, 0.21-0.69; p = 0.001) of matched patients and also of the entire cohort (n = 689) after adjustment for the propensity score (hazard ratio, 0.58, 95% CI, 0.34-0.98; p = 0.04). In contrast, low-dose acetylsalicylic acid use was not associated with the primary endpoint in patients with E. coli bloodstream infection (hazard ratio, 0.78; 95% CI, 0.40-1.55; p = 0.8).

Conclusions: Low-dose acetylsalicylic acid at the time of bloodstream infection was strongly associated with a reduced short-term mortality in patients with S. aureus bloodstream infection. Future studies are required to investigate if early low-dose acetylsalicylic acid is a suitable treatment in patients with S. aureus bloodstream infection.

Osthoff, Michael MD; Sidler, Jan A. MD; Lakatos, Botond MD; Frei, Reno MD; Dangel, Marc MPH; Weisser, Maja MD; Battegay, Manuel MD; Widmer, Andreas F. MD, MS

Copyright (C) by 2016 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

Posted in April, Cardiology, Hot Topics in Research Tagged with: , ,

Association of Child Poverty, Brain Development, and Academic Achievement

Association of Child Poverty, Brain Development, and Academic Achievement

Importance  Children living in poverty generally perform poorly in school, with markedly lower standardized test scores and lower educational attainment. The longer children live in poverty, the greater their academic deficits. These patterns persist to adulthood, contributing to lifetime-reduced occupational attainment.

Objective  To determine whether atypical patterns of structural brain development mediate the relationship between household poverty and impaired academic performance.

Design, Setting, and Participants  Longitudinal cohort study analyzing 823 magnetic resonance imaging scans of 389 typically developing children and adolescents aged 4 to 22 years from the National Institutes of Health Magnetic Resonance Imaging Study of Normal Brain Development with complete sociodemographic and neuroimaging data. Data collection began in November 2001 and ended in August 2007. Participants were screened for a variety of factors suspected to adversely affect brain development, recruited at 6 data collection sites across the United States, assessed at baseline, and followed up at 24-month intervals for a total of 3 periods. Each study center used community-based sampling to reflect regional and overall US demographics of income, race, and ethnicity based on the US Department of Housing and Urban Development definitions of area income. One-quarter of sample households reported the total family income below 200% of the federal poverty level. Repeated observations were available for 301 participants.

Exposure  Household poverty measured by family income and adjusted for family size as a percentage of the federal poverty level.

Main Outcomes and Measures  Children’s scores on cognitive and academic achievement assessments and brain tissue, including gray matter of the total brain, frontal lobe, temporal lobe, and hippocampus.

Results  Poverty is tied to structural differences in several areas of the brain associated with school readiness skills, with the largest influence observed among children from the poorest households. Regional gray matter volumes of children below 1.5 times the federal poverty level were 3 to 4 percentage points below the developmental norm (P < .05). A larger gap of 8 to 10 percentage points was observed for children below the federal poverty level (P < .05). These developmental differences had consequences for children’s academic achievement. On average, children from low-income households scored 4 to 7 points lower on standardized tests (P < .05). As much as 20% of the gap in test scores could be explained by maturational lags in the frontal and temporal lobes.

Conclusions and Relevance  The influence of poverty on children’s learning and achievement is mediated by structural brain development. To avoid long-term costs of impaired academic functioning, households below 150% of the federal poverty level should be targeted for additional resources aimed at remediating early childhood environments.

Nicole L. Hair, PhD; Jamie L. Hanson, PhD; Barbara L. Wolfe, PhD; Seth D. Pollak, PhD

JAMA Pediatr. 2015;169(9):822-829. doi:10.1001/jamapediatrics.2015.1475.

Posted in April, Brain, Hot Topics in Research

Association Between Treatment at a High-Volume Facility and Improved Survival for Radiation-Treated Men With High-Risk Prostate Cancer

Association Between Treatment at a High-Volume Facility and Improved Survival for Radiation-Treated Men With High-Risk Prostate Cancer

Purpose: Although the association between higher hospital volume and improved outcomes has been well-documented in surgery, there is little data about whether this effect exists for radiation-treated patients. We investigated whether treatment at a radiation facility that treats a high volume of prostate cancer patients is associated with improved survival for men with high-risk prostate cancer. Methods and Materials: We used the National Cancer Database (NCDB) to identity patients diagnosed with prostate cancer from 2004 to 2006. The radiation case volume (RCV) of each hospital was based on its number of radiation-treated prostate cancer patients. We used propensity-score based analysis to compare the overall survival (OS) of high-risk prostate cancer patients in high versus low RCV hospitals. Primary endpoint is overall survival. Covariates adjusted for were tumor characteristics, sociodemographic factors, radiation type, and use of androgen deprivation therapy (ADT). Results: A total of 19,565 radiation-treated high-risk patients were identified. Median follow-up was 81.0 months (range: 1-108 months). When RCV was coded as a continuous variable, each increment of 100 radiation-managed patients was associated with improved OS (adjusted hazard ratio [AHR]: 0.97; 95% confidence interval [CI]: 0.95- 0.98; P<.0001) after adjusting for known confounders. For illustrative purposes, when RCV was dichotomized at the 80th percentile (43 patients/year), high RCV was associated with improved OS (7-year overall survival 76% vs 74%, log-rank test PZ.0005; AHR: 0.91, 95% CI: 0.86-0.96, PZ.0005). This association remained significant when RCV was dichotomized at 75th (37 patients/year), 90th (60 patients/year), and 95th (84 patients/year) percentiles but not the 50th (19 patients/year). Conclusions: Our results suggest that treatment at centers with higher prostate cancer radiation case volume is associated with improved OS for radiation-treated men with high-risk prostate cancer. 

Int J Radiation Oncol Biol Phys, Vol. 94, No. 4, pp. 683e690, 2016

Copyright: 2016 The Authors

Yu-Wei Chen, MD, MS, Brandon A. Mahal, MD, Vinayak Muralidhar, MSc, Michelle Nezolosky, BA, Clair J. Beard, MD, Robert B. Den, MD, Felix Y. Feng, MD,Karen E. Hoffman, MD, MPH, MHSc, Neil E. Martin, MD, MPH, Peter F. Orio, DO, MS, and Paul L. Nguyen, MD

Posted in April, Hot Topics in Research, Oncology, Prostate Tagged with: ,

Visualization of regional tau deposits using 3H-THK5117 in Alzheimer brain tissue

Visualization of regional tau deposits using 3H-THK5117 in Alzheimer brain tissue


 The accumulation of neurofibrillary tangles, composed of aggregated hyperphosphorylated tau protein, starts spreading early in specific regions in the course of Alzheimer’s disease (AD), correlating with the progression of memory dysfunction. The non-invasive imaging of tau could therefore facilitate the early diagnosis of AD, differentiate it from other dementing disorders and allow evaluation of tau immunization therapy outcomes. In this study we characterized the in vitro binding properties of THK5117, a tentative radiotracer for positron emission tomography (PET) imaging of tau brain deposits.


Saturation and competition binding studies of 3H-THK5117 in post-mortem AD brain tissue showed the presence of multiple binding sites. THK5117 binding was significantly higher in hippocampal (p < 0.001) and temporal (p < 0.01) tissue homogenates in AD compared to controls. Autoradiography studies with 3H-THK5117 was performed on large frozen brain sections from three AD cases who had been followed clinically and earlier undergone in vivo 18F-FDG PET investigations. The three AD cases showed distinct differences in regional THK5117 binding that were also observed in tau immunohistopathology as well as in clinical presentation. A negative correlation between in vivo 18F-FDG PET and in vitro 3H-THK5117 autoradiography was observed in two of the three AD cases.


This study supports that new tau PET tracers will provide further understanding on the role of tau pathology in the diversity of the clinical presentation in AD.

Acta Neuropathologica Communications20153:40, DOI: 10.1186/s40478-015-0220-4; Lemoine et al. 2015; Received: 14 June 2015; Accepted: 15 June 2015; Published: 2 July 2015
Posted in Alzheimer Disease, April, Hot Topics in Research

Library OneSearch+ Reading Lists

We are proud to announce the availability of Library OneSearch+ Reading Lists!

PCOM Library OneSearch+ Reading Lists offers faculty an easy way to create and manage course reading lists directly inside Blackboard.

Library OneSearch+ Reading Lists brings the world of quality full-text ebooks and other digital resources from the library’s online collection easily and directly into the online learning environment for faculty and students.

Contact us or see the Library OneSearch+ Reading List guide for more information.

Posted in Front Page, Library News

6th Annual PCOM Research Day

We are proud to announce the 6th Annual PCOM Research Days! All members of the PCOM community are invited to a celebration of Research, Innovation, Scholarship and Creativity with a day of poster presentations on the Georgia and Philadelphia Campuses, sponsored by the CCDA, the PCOM chapter of Sigma Xi, the National Research Honor Society and the Division of Research.

2016 research day schedule outline

Georgia Campus

Georgia’s poster session will be held May 10, 2016.

The official poster competition will be from 1:00 pm – 4:00 pm in the Atrium. Judging will commence at 1:00 pm.

The 6th Annual PCOM Research Day Georgia keynote speaker will be Dr. Donald Harn of University of Georgia who will deliver the keynote lecture from noon -1:00 pm in Lecture Hall A.

Georgia poster boards are 3 feet in height and 4 feet in width, so the posters will need to be a little smaller than the boards.

For more information on poster guidelines click here.

You can submit the PCOM marketing research poster request form here. Alternatively, you can access a pdf version of the request form here.

Philadelphia Campus

Philadelphia’s poster session will be held on May 11, 2016.

The official poster competition will be from 1:00 – 4:00 pm in the OMM Lab of Evans Hall. Lunch will be provided throughout the poster session and judging will commence at 1:00 pm.

The 6th Annual PCOM Research Day Philadelphia keynote speaker will be Dr. Maria T. Schultheis of Drexel University who will deliver the keynote lecture from noon – 1:00 pm in Zedeck Auditorium on “Clinical Application of Virtual Reality Technology: the Good, the Bad and … the Challenging.”

Philadelphia poster dimensions may not exceed 4’x6’ (48”x72”).

For more information on poster guidelines click here.

You can submit the PCOM marketing research poster request form here. Alternatively, you can access a pdf version of the request form here.

Posted in Front Page, Library News

Scheduled Refworks Downtime – March 12, 2016

On Saturday, March 12, 2016, ProQuest will be upgrading its systems infrastructure. ProQuest platforms (including Refworks and Digital Dissertations) will be unavailable beginning at at 10:00 PM Eastern Standard Time and will last for 8 hours.

Posted in Service Disruptions

The Yellow Wall-Paper Traveling Exhibit

The Literature of Prescription: Charlotte Perkins Gilman and “The Yellow Wall-Paper,” a National Library of Medicine traveling exhibit, reviews the role of late nineteenth-century medical and scientific experts in using the idea of female weakness to discourage women from participating in professional, creative, and intellectual life. The exhibit explores the story behind Charlotte Perkins Gilman’s indictment of the medical profession and the social conventions restricting women’s professional and creative opportunities.

To preserve her health, Gilman was advised by a physician to “live as domestic a life as far as possible… And never touch pen, brush, or pencil again” as long as she lived. After three months of following the advice of her physician, she returned to writing. In two days she wrote “The Yellow Wall-Paper,” a story about a young woman driven mad by the “rest cure” advocated by the medical profession. Readers found the story to be intriguing and disturbing; today, it is considered a classic of feminist literature. Gilman became an influential writer and speaker about women’s rights and economic independence. A digital version of “The Yellow Wall-Paper” from the January 1892 issue of The New England Magazine is available, courtesy of the National Library of Medicine.

The exhibit will be on display Monday, March 7, through Saturday, April 16 in the GA-PCOM Atrium. For more information about the exhibit, please contact Skye Bickett at 678-225-7541 or

Posted in Front Page, Library News

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