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Background The incidence of underlying malignancy in appendicitis ranges between 0.5% and 1.7%. We sought to identify the subset of patients with appendicitis who are at increased risk of appendiceal malignancy. Methods Using the Eastern Association for the Surgery of Trauma Multicenter Study of the Treatment of Appendicitis in America: Acute, Perforated, and Gangrenous database, we included all patients from 28 centers undergoing immediate, delayed, or interval appendectomy between 2017 and 2018. Univariate then multivariable analyses were performed to compare patients with and without malignancy and to identify independent demographic, clinical, laboratory, and/or radiological predictors of malignancy. Akaike information criteria for regression models were used to evaluate goodness of fit. Results A total of 3,293 patients were included. The median age was 38 (27–53) years, and 46.5% were female patients. On pathology, 48 (1.5%) had an underlying malignancy (adenocarcinoma [60.4%], neuroendocrine [37.5%], and lymphoma [2.1%]). Patients with malignancy were older (56 [34.5–67] vs 37 [27–52] years, P 40 years with an appendiceal diameter >10 mm on computed tomography was 2.95% compared with 0.97% in patients ≤40 years old with appendiceal diameter ≤10 mm. The corresponding risk ratio for that population was 3.03 (95% confidence interval: 1.24–7.42; P = .02). Conclusion The combination of age >40 and an appendiceal diameter >10 mm is associated with a greater than 3-fold increased risk of malignancy in patients presenting with appendicitis.

Background The Trauma Quality Improvement Program was designed by the American College of Surgeons to measure quality benchmarks across American College of Surgeons–certified trauma centers. The Hospital Consumer Assessment of Healthcare Providers and Systems survey was developed to report patient satisfaction with inpatient care and has been used as a surrogate for quality of care by the Affordable Care Act. The purpose of this study was to determine the correlation of hospitals’ Hospital Consumer Assessment of Healthcare Providers and Systems data to the Trauma Quality Improvement Program quality analysis. Methods A retrospective review of available Trauma Quality Improvement Program and Hospital Consumer Assessment of Healthcare Providers and Systems results from an American College of Surgeons level 1 trauma center 2016–2017 was performed. Trauma Quality Improvement Program and Hospital Consumer Assessment of Healthcare Providers and Systems data were represented as either above, at, or below the mean of national data and were analyzed using the Fisher exact test. Results Hospital Consumer Assessment of Healthcare Providers and Systems scores from wards participating in care of trauma patients were summarized by perceived level of quality. Trauma Quality Improvement Program data for risk-adjusted mortality were included in analysis for all trauma admissions. The Fisher exact test was used to analyze contingency tables of data and was found to support the null hypothesis ( P = .1109). Conclusion Overall Hospital Consumer Assessment of Healthcare Providers and Systems rating is most significant for hospitals because it is a global view of patient satisfaction and is used to determine a portion of hospital reimbursement. It is believed that higher patient satisfaction is correlated with lower readmission rates and improved outcomes, thus resulting in cost savings for hospitals. However, it appears that overall Hospital Consumer Assessment of Healthcare Providers and Systems rating does not correlate with measured outcomes in terms of risk-adjusted mortality for trauma admissions. It is suggested from these data that trauma patients be considered independently from other hospitalizations and that Hospital Consumer Assessment of Healthcare Providers and Systems may not be an appropriate tool to determine reimbursement for trauma admission.

Introduction Although hospital variation in costs and outcomes has been described for patients undergoing operation, the relationship between them is unknown. The purpose of this study was to evaluate this relationship among patients undergoing colon resection for cancer and identify characteristics of “high-quality, low-cost” hospitals. Methods We identified adult patients who underwent colon resection for cancer in California, Florida, and New York from 2009 to 2010. We estimated hospital-level, risk-standardized 30-day hospital costs, in-hospital mortality rates, and 30-day readmission rates by using hierarchical generalized linear models. Costs were compared between hospitals identified as low, average, and high performers. Results The final sample included 14,790 patients discharged from 389 hospitals. After adjusting for case mix, variation was noted in risk-standardized costs (median = $26,169, inter-quartile range [IQR] = $6,559), in-hospital mortality (median = 1.8%, IQR = 2.3%), and 30-day readmission (12.2%, IQR = 0.7%) rates. Minimal correlation was noted between a hospital's costs and outcomes, with similar costs noted across hospital performance groups (low = $25,994 vs average = $26,998 vs high = $25,794, P = .19). High-quality, low-cost hospitals treated a greater percentage of Medicare beneficiaries, approached fewer cases laparoscopically, and trended toward greater volume. Conclusion Hospital costs are not correlated with outcomes in this population. More work is needed to identify means of providing high-quality care at lesser costs.

Optimizing cerebral oxygenation is advocated to improve outcome in head-injured patients. The purpose of this study was to compare outcomes in brain-injured patients treated with 2 types of monitors.Patients with traumatic brain injury and a Glasgow Coma Scale score8 were identified on admission. A polarographic cerebral oxygen/pressure monitor (Licox) or fiberoptic intracranial pressure monitor (Camino) was inserted. An evidence-based algorithm for treatment was implemented. Elements from the prehospital and emergency department records and the first 10 days of intensive care unit (ICU) care were collected. Glasgow Outcome Scores (GOS) were determined every 3 months after discharge.Over a 3-year period, 145 patients were entered into the study; 81 patients in the Licox group and 64 patients in the Camino group. Mortality, hospital length of stay, and ICU length of stay were equivalent in the 2 groups. More patients in the Licox group achieved a moderate/recovered GOS at 3 months than in the Camino Group (79% vs 61%; P = .09).Three-month GOS revealed a clinically meaningful 18% benefit in patients undergoing cerebral oxygen monitoring and optimization. Six-month outcomes were also better. Unfortunately, these important differences did not reach significance. Continued study of the benefits of cerebral oxygen monitoring is warranted.