To leave or not to leave: American Association for the Surgery of Trauma (AAST) panel discussion on personal, parental, and family leave.

Navigating planned and emergent leave during medical practice is very confusing to most physicians. This is especially challenging to the trauma and acute care surgeon, whose practice is unique due to overnight in-hospital call, alternating coverage of different services, and trauma center's staffing challenges. This is further compounded by a surgical culture that promotes the image of a 'tough' surgeon and forgoing one's personal needs on behalf of patients and colleagues. Frequently, surgeons find themselves having to make a choice at the crossroads of personal and family needs with work obligations: to leave or not to leave. Often, surgeons prioritize their professional commitment over personal wellness and family support. Extensive research has been conducted on the topic of maternity leave and inequality towards female surgeons, primarily focused on trainees. The value of paternity leave has been increasingly recognized recently. Consequently, significant policy changes have been implemented to support trainees. Practicing surgeon, however, often lack such policy support, and thus may default to local culture or contractual agreement. A panel session at the American Association for the Surgery of Trauma 2022 annual meeting was held to discuss the current status of planned or unanticipated leave for practicing surgeons. Experiences, perspectives, and propositions for change were discussed, and are presented here.

An Analysis of Outcomes After Trauma in Obstetric Patients.

Traumatic injury in obstetric patients has been shown to correlate with adverse fetal outcomes; however, data predates modern resuscitation and imaging techniques. A single center retrospective review was performed analyzing risk factors for obstetric outcomes for pregnant patients seen at a Level 1 Trauma Center from 2010 to 2020. 571 pregnant patients were compared to nonpregnant child-bearing age women. Injury Severity Scores (ISS) were higher in nonpregnant patients (5 vs 0, P < .001), with similar mortality (P = .07). 558 (98%) injured pregnant patients had an ISS < 9. 122 (21%) pregnant patients suffered obstetric or fetal complications, had higher ISS (P < .001), higher abbreviated injury scales (AIS) for thorax, abdomen, spine, lower extremities (P < .05), and lower gestational age (P = .005). Age, Glasgow Coma Score (GCS), AIS Abdomen and Lower Extremity, and preterm pregnancy were predictive of adverse outcomes. Non-caucasian race, higher gestational age, and term pregnancy were predictive of labor during admission.

Successful laparoscopic cholecystectomy at 32 weeks of pregnancy - A case report.

INTRODUCTION AND IMPORTANCE: During gestation, laparoscopic procedures, if needed, are generally considered most ideal within the second trimester. There are less reports of successful laparoscopic procedures in the third trimester of pregnancy due to performance hesitancy with concerns of preterm labor and/or other complications. While it is rare for laparoscopic cholecystectomy to be performed within the third trimester, it should not be delayed if needed, and excellent outcomes can be achieved with proper port placement and procedure. CASE PRESENTATION: We present the case of a 22-year-old female thirty-two weeks and six days into gestation who underwent a laparoscopic cholecystectomy with intraoperative cholangiogram after presenting with acute-on-chronic cholecystitis. The procedure was without complications, and both the patient and fetus remained stable following surgery, and were discharged on postoperative day 2. CLINICAL DISCUSSION: The long-established belief is laparoscopic procedures should ideally be attempted in the second trimester to decrease the risk of preterm labor or spontaneous abortion in obstetric patients. Per SAGES guidelines, when clearly indicated, laparoscopic cholecystectomy should not be avoided in any trimester. CONCLUSION: This case highlights the relative safety of a laparoscopic cholecystectomy in the third trimester of pregnancy with emphasis on standard technique and proper port placement based on uterus size.

Breast Hematoma: An Under-Recognized and Under-Reported Female-Specific Traumatic Injury and Its Clinical Significance.

Female-specific traumatic injury patterns have not been well researched and are potentially not well documented. Our aim was to examine the prevalence of breast hematomas (BHs) after blunt chest trauma, and to evaluate if there were risk factors associated with BH requiring intervention. A retrospective review from 2013 to 2018 was performed, identifying female patients ≥18 years sustaining blunt chest trauma. BH was defined as the presence of a collection of blood within the breast parenchyma, and clinically significant breast hematoma (CSBH) as BH requiring blood transfusion, surgical, or interventional radiology intervention. Univariate analysis was performed comparing CSBH with BH in terms of demographics, injury severity, antithrombotic agent use, and body mass index (BMI). Of 871 female patients meeting criteria, 59 (7%) had BH. Of these, 10 (17%) had CSBH (transfusion only, n = 3; angioembolization, n = 4; operation, n = 3). Compared to BH not requiring intervention, CSBH patients were older (mean age, 80 vs 69, P = .006), but had similar rates of motor vehicle crashes (90% vs 78%), seatbelt use (70% vs 71%), antiplatelet use (10% vs 12%), and anticoagulant use (10% vs 6%). Median Injury Severity Scores and median BMI (34 vs 34) were similar between the groups.