Trauma, EGS, and Long-Term Outcomes

Trauma, Emergency General Surgery, and Long-Term Outcomes

Problem

Trauma is the leading cause of death for individuals up to the age of 45 years, and the fourth most prevalent cause of death overall. Emergency General Surgery (EGS) has become a critical national health issue with more cases per year than new diagnoses of cancer or diabetes in the U.S. Trauma and EGS patients are a vulnerable and important population, and research is needed to reduce the human and societal burden of these diseases and improve their outcomes.

Approach

The Division of Trauma, Burn, Surgical Critical Care and Emergency General Surgery investigates the burden and outcomes of this vulnerable group of patients and aims to implement systems and processes to positively affect these outcomes. Using a patient-first approach, our goal is to define the best evidence to improve short-term and long-term outcomes and reduce the impact on patients and healthcare systems of trauma and emergency general surgery.

Impact

Trauma and EGS patients represent unique populations of the most at-risk surgical patients, facing a disproportionate burden of medical errors, complications, and death. Our research focuses on identifying factors that affect mortality and morbidity and evaluating ways to modify those factors to improve outcomes. Our work has helped guide the national research priorities within the field of Emergency General Surgery. We are learning how to improve organ donation rates among minorities, decrease the incidence of surgical site infections, and better care for older and frail patients.

Affiliate Faculty

Staff

Katherine Armstrong, MPH – Senior Project Manager

Elizabeth Bacon, MPH, CPH – Research Project Manager

Barbara Okafor, MBA – Clinical Research Associate

Fellows

Manuel Castillo-Angeles, MD, MPH

The Division of Trauma, Burns, Surgical Critical Care, and Emergency General surgery has a robust clinical and research presence within the Department of Surgery at Brigham and Women’s Hospital. The division collaborates closely with the CSPH in research endeavors, including multiple TBSCC faculty that lead CSPH research cores. The division is proud to contribute both intellectual and administrative resources in helping to shape the forward progress of CSPH’s research mission.

Emergency General Surgery (EGS)

EGS patients represent a unique population of the most at-risk surgical patients who face a disproportionate burden of medical errors, complications and death. Research focuses on identifying factors that affect morbidity and mortality from EGS and evaluating ways to modify those factors to improve outcomes. As a group we have defined the emergency procedures that cause the greatest societal burden. Projects include the creation and testing of a pre-operative checklist and intra-operative huddle specific to EGS patients and developing optimal resource guidelines for institutions that conduct emergency general surgery.

Nutrition

Critically ill patients are often nutritionally compromised, which leads to poorer health outcomes. Research in this area includes description of patients at greatest risk of postoperative aspiration and evaluation of routine screening procedures, characterization of infectious complications in immunosuppressed patients who have received total parenteral nutrition, and a randomized clinical trial to evaluate the safety and effectiveness of an aggressive feeding protocol in critically ill surgical patients.

Geriatrics

Research in this area focuses on improving care for traumatically injured geriatric patients, with an emphasis on integration of palliative care for this population. Projects include evaluating the efficacy of using preoperative muscle volume to predict postoperative outcomes in elderly emergency abdominal surgery patients, assessment of palliative care needs of older adults undergoing surgery, and creation of best practice guidelines for the treatment of older injured patients.

Surgical Infection

Decreasing the incidence of infection can improve care for all surgical patients, particularly in trauma patients who are already acutely ill. Research in this area includes a retrospective study evaluating surgical interventions for C. Diff infection, a phase 3 clinical trial evaluating the efficacy of a new drug to improve outcomes in patients with necrotizing soft tissue infection (NSTI), and studies exploring the relationship between NSTI and nutrition.

Traumatic Injury & Organ Donation

Our division also studies the management and outcomes of many types of traumatic injury in the service of advancing knowledge and improving patient care. This includes genitourinary trauma, rectal trauma, and traumatic brain injury, as well as assessment of different types of trauma systems and workforces. We also have a focus on improving rates of organ donor registration, particularly among Hispanic Americans.

Pregnancy during Surgical Training

Women remain underrepresented in the surgical field, and some prior studies have suggested that the desire to have a family may deter women from a surgical career. The current support of pregnant residents by training programs is variable, and most women surgeons report negative stigma is associated with pregnancy during residency. Our division is currently working to characterize the experience of women surgeons who have undergone pregnancy during training, including identification of challenges and areas with the greatest potential for improvement.