Clinical and economic burden of surgical complications during hospitalization for digestive cancer surgery in France.

BACKGROUND: Surgical complications and particularly infections after digestive cancer surgery remain a major health and economic problem and its burden in France is not well documented. AIMS: The aim of this study was to analyse recent data regarding surgical complications in patients undergoing major digestive cancer surgery, and to estimate its burden for the French society. METHODS AND RESULTS: Using the 2018 French hospital discharge database and 2017 National CostStudy we studied hospital stays for surgical resection in patients withdigestive cancer. The population was divided into three groups based onpostoperative outcomes: no complications (NC), related infectious complications (RIC) and other complications. The main analysis compared the length and cost per stay between RIC and NC. Forty-Four thousand one hundred and twenty-three stays following a digestive cancer resection were identified. Lower gastro-intestinal cancers were the most prevalent representing 74.8% of stays, the rate of malnutrition was 32.8% and 15.8% of patients presented RIC. Mean (SD) length of stay varied from 11,7 (9.0) days for NC to 25,5 days (19.5) for RIC (p < 0.01). The mean cost per patients' stay (SD) varied from €10 641 (€ 5897) for the NC to €18 720 (€7905) for RIC (p < .01). CONCLUSION: The risk of RIC after digestive cancer resection remains high (>15%) and was associated with significantly longer length of stay and higher cost per stay. Although important prevention plans have been implemented in recent years, care strategies are still needed to alleviate the burden on patients and the healthcare system.

Association of symptoms following mild traumatic brain injury with posttraumatic stress disorder vs. postconcussion syndrome.

IMPORTANCE: A proportion of patients experience long-lasting symptoms following mild traumatic brain injury (MTBI). The postconcussion syndrome (PCS), included in the DSM-IV, has been proposed to describe this condition. Because these symptoms are subjective and common to other conditions, there is controversy whether PCS deserves to be identified as a diagnostic syndrome. OBJECTIVE: To assess whether persistent symptoms 3 months following head injury are specific to MTBI or whether they are better described as part of posttraumatic stress disorder (PTSD). DESIGN, SETTING, AND PARTICIPANTS: We conducted a prospective cohort study of injured patients recruited at the adult emergency department of the University Hospital of Bordeaux from December 4, 2007, to February 25, 2009. MAIN OUTCOMES AND MEASURES: At 3-month follow-up, we compared the prevalence and risk factors for PCS and PTSD. Multiple correspondence analyses were used to assess clustering of symptoms and their associations with the type of injury. RESULTS: We included 534 patients with head injury and 827 control patients with other nonhead injuries. Three months following the trauma, 21.2% of head-injured and 16.3% of nonhead-injured patients fulfilled the DSM-IV diagnosis of PCS; 8.8% of head-injured patients fulfilled the diagnostic criteria for PTSD compared with 2.2% of control patients. In multivariate analysis, MTBI was a predictor of PTSD (odds ratio, 4.47; 95% CI, 2.38-8.40) but not of PCS (odds ratio, 1.13; 95% CI, 0.82-1.55). Correspondence analysis suggested that symptoms considered part of PCS behave similarly to PTSD symptoms in the hyperarousal dimension. None of these 22 symptoms showed any pattern of clustering, and no clear proximity with head or nonhead injury status could be found. CONCLUSIONS AND RELEVANCE: Persistent subjective symptoms frequently reported 3 months after MTBI are not specific enough to be identified as a unique PCS and should be considered part of the hyperarousal dimension of PTSD.

Specificity of postconcussion symptoms at 3 months after mild traumatic brain injury: results from a comparative cohort study.

OBJECTIVE: To assess the specificity of symptoms included in various symptom lists used to identify postconcussion syndrome (PCS), by using follow-up data comparing patients with mild traumatic brain injury (MTBI) and control patients during the month prior to injury and 3 months later. SETTING: The adult emergency department of a teaching hospital in Bordeaux, France. PARTICIPANTS: A cohort of patients with MTBI (n = 536) and a comparison group with nonhead injuries (n = 946). MAIN MEASURES: Postconcussion symptoms listed in the Rivermead Postconcussion Symptoms Questionnaire (RPQ), the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), and the 10th International Classification of Diseases (ICD-10). RESULTS: Analyses were performed comparing symptom occurrence in patients with MTBI and controls, before and 3 months after injury. Eight symptoms were identified as being specific to MTBI: headache, dizziness, intolerance of stress, forgetfulness, poor concentration, taking longer to think, blurred vision, and personality change. CONCLUSION: The relevance of symptoms proposed to constitute PCS should be reviewed. A more specific definition of PCS would make diagnosis easier and facilitate prevention as well as treatment of patients with MTBI.

Distraction and driving: results from a case-control responsibility study of traffic crash injured drivers interviewed at the emergency room.

BACKGROUND: Use of cellular phones has been shown to be associated with crashes but many external distractions remain to be studied. OBJECTIVE: To assess the risk associated with diversion of attention due to unexpected events or secondary tasks at the wheel. DESIGN: Responsibility case-control study. SETTING: Adult emergency department of the Bordeaux University Hospital (France) from April 2010 to August 2011. PARTICIPANTS: 955 injured drivers presenting as a result of motor vehicle crash. MAIN OUTCOME MEASURES: The main outcome variable was responsibility for the crash. Exposures were external distraction, alcohol use, psychotropic medicine use, and sleep deprivation. Potential confounders were sociodemographic and crash characteristics. RESULTS: Beyond classical risk factor found to be associated with responsibility, results showed that distracting events inside the vehicle (picking up an object), distraction due to driver activity (smoking) and distracting events occurring outside were associated with an increased probability of being at fault. These distraction-related factors accounted for 8% of injurious road crashes. LIMITATIONS: Retrospective responsibility self-assessment. CONCLUSIONS: Diverted attention may carry more risk than expected. Our results are supporting recent research efforts to detect periods of driving vulnerability related to inattention.

Mind wandering and driving: responsibility case-control study.

OBJECTIVE: To assess the association between mind wandering (thinking unrelated to the task at hand) and the risk of being responsible for a motor vehicle crash. DESIGN: Responsibility case-control study. SETTING: Adult emergency department of a university hospital in France, April 2010 to August 2011. PARTICIPANTS: 955 drivers injured in a motor vehicle crash. MAIN OUTCOME MEASURES: Responsibility for the crash, mind wandering, external distraction, negative affect, alcohol use, psychotropic drug use, and sleep deprivation. Potential confounders were sociodemographic and crash characteristics. RESULTS: Intense mind wandering (highly disrupting/distracting content) was associated with responsibility for a traffic crash (17% (78 of 453 crashes in which the driver was thought to be responsible) v 9% (43 of 502 crashes in which the driver was not thought to be responsible); adjusted odds ratio 2.12, 95% confidence interval 1.37 to 3.28). CONCLUSIONS: Mind wandering while driving, by decoupling attention from visual and auditory perceptions, can jeopardise the ability of the driver to incorporate information from the environment, thereby threatening safety on the roads.

S100-B protein as a screening tool for the early assessment of minor head injury.

STUDY OBJECTIVE: A computed tomography (CT) scan has high sensitivity in detecting intracranial injury in patients with minor head injury but is costly, exposes patients to high radiation doses, and reveals clinically relevant lesions in less than 10% of cases. We evaluate S100-B protein measurement as a screening tool in a large population of patients with minor head injury. METHODS: We conducted a prospective observational study in the emergency department of a teaching hospital (Bordeaux, France). Patients with minor head injury (2,128) were consecutively included from December 2007 to February 2009. CT scans and plasma S100-B levels were compared for 1,560 patients. The main outcome was to evaluate the diagnostic value of the S100-B test, focusing on the negative predictive value and the negative likelihood ratio. RESULTS: CT scan revealed intracranial lesions in 111 (7%) participants, and their median S100-B protein plasma level was 0.46 µg/L (interquartile range [IQR] 0.27 to 0.72) versus 0.22 µg/L (IQR 0.14 to 0.36) in the other 1,449 patients. With a cutoff of 0.12 µg/L, traumatic brain injuries on CT were identified with a sensitivity of 99.1% (95% confidence interval [CI] 95.0% to 100%), a specificity of 19.7% (95% CI 17.7% to 21.9%), a negative predictive value of 99.7% (95% CI 98.1% to 100%), a positive likelihood ratio of 1.24 (95% CI 1.20 to 1.28), and a negative likelihood ratio of 0.04 (95% CI 0.006 to 0.32). CONCLUSION: Measurement of plasma S100-B on admission of patients with minor head injury is a promising screening tool that may be of help to support the clinician's decision not to perform CT imaging in certain cases of low-risk head injury.