Eric J Ley

Cedars-Sinai Medical Center, Los Ángeles, California, United States

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Publications (102)206.95 Total impact

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    ABSTRACT: Splenectomy is associated with a life-long risk for overwhelming infections. The risk for early post-operative infectious complications following traumatic and elective splenectomy is, however, understudied. This investigation aimed to determine if splenectomy increases the risk for post-operative infections. This was a retrospective review of prospectively collected data on patients admitted to the surgical intensive care unit (SICU) between 1/2011 and 7/2013 investigating the risk for infectious complications in patients undergoing a splenectomy compared with those undergoing any other abdominal surgery. During the 30-month study period, a total of 1,884 patients were admitted to the SICU. Of those, 33 (2%) had a splenectomy and 493 (26%) had an abdominal surgery. The two groups were well balanced for age, APACHE IV score > 20, and past medical history, including diabetes mellitus, cardiac history, renal failure or immunosuppression. Patients undergoing splenectomy were more likely to have sustained a traumatic injury (30% vs. 7%, p<0.01). After adjustment, splenectomy was associated with increased risk for infectious complications (49% vs. 29%, Adjusted Odds Ratio (AOR) [95% CI]: 2.7 [1.3, 5.6], p=0.01), including intra-abdominal abscess (9% vs. 3%, AOR [95% CI]: 4.3 [1.1, 16.2], p=0.03). On a subgroup analysis, there were no differences between traumatic and elective splenectomy with regards to overall infectious complications (50% vs. 46%, p=0.84), although, abdominal abscess developed only in those who had an elective splenectomy (0% vs. 12%, p=0.55). Splenectomy increases the risk for post-operative infectious complications. Further studies identifying strategies to decrease the associated morbidity are necessary. Copyright © 2015. Published by Elsevier Ltd.
    International Journal of Surgery (London, England) 03/2015; 17. DOI:10.1016/j.ijsu.2015.03.007 · 1.65 Impact Factor
  • IEEE Transactions on Automation Science and Engineering 01/2015; 12(1):127-139. DOI:10.1109/TASE.2014.2329833 · 2.16 Impact Factor
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    ABSTRACT: Background Inflammatory bowel disease is associated with a higher risk for venous thromboembolism (VTE). Whether C. difficile infection similarly increases this risk is unknown. Methods This was a retrospective analysis of patients admitted to the surgical intensive care unit (ICU) at the Cedars-Sinai Medical Center from 02/2011 until 07/2013. The two groups were compared using standard statistical methodology. Results During the 30-month study period, a total of 1,728 patients were admitted to the surgical ICU. A total of 64 patients (3.7%) tested positive for C. difficile. The use of chemical prophylaxis for VTE was significantly higher in the C. difficile group (64.1% vs. 46.2%, p=0.005). Nonetheless, C. difficile patients had a higher risk for development of a VTE (23.4% vs. 11.0%, AOR [95% CI]: 1.87 [1.01, 3.48], p=0.048). In a forward logistic regression model, C. difficile was found to be independently associated with development of VTE (AOR [95% CI]: 1.87 [1.00, 3.47], p=0.049). Conclusion Clostridium difficile infection increases the risk for venous thromboembolism in surgical patients admitted to the intensive care unit.
    The American Journal of Surgery 11/2014; 208(5). DOI:10.1016/j.amjsurg.2014.05.025 · 2.41 Impact Factor
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    ABSTRACT: Background The criteria for organ acceptance remain inconsistent, which limits the ability to standardize critical care practices. We sought to examine predictors of liver graft utilization and survival, in order to better guide the management of potential organ donors. Study Design A prospective observational study of all donors managed by the eight organ procurement organizations in United Network for Organ Sharing Region 5 was conducted from July 2008 to March 2011. Critical care endpoints that reflect the normal hemodynamic, acid-base, respiratory, endocrine, and renal status of the donor were collected at three time points. Critical care and demographic data associated with liver transplantation rates as well as graft survival were first determined using univariate analyses, and then logistic regression was used to identify independent predictors of these two outcomes. Results In 961 donors, 730 (76%) livers were transplanted and 694 (95%) were functioning after 74±73 days of follow-up. After regression analysis, donor BMI (odds ratio [OR] = 0.94), male gender (OR = 1.9), glucose <150 (OR = 1.97), lower dopamine dose (OR = 0.95), vasopressin use (OR = 1.95), and ejection fraction >50% (OR = 1.77) remained as independent predictors of liver utilization. Graft survival was associated with lower donor BMI (OR = 0.91) and sodium levels (OR = 0.95). Conclusions After controlling for donor age, sex, and BMI, both hemodynamic and endocrine critical care endpoints were associated with increased liver graft utilization. Both donor BMI and lower sodium levels during the course of donor management were independently predictive of improved graft survival. These results may help guide the management and selection of potential organ donors after neurologic determination of death.
    Journal of the American College of Surgeons 10/2014; DOI:10.1016/j.jamcollsurg.2014.09.020 · 4.45 Impact Factor
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    ABSTRACT: The purpose of the current study was to investigate the effect of early adrenergic hyperactivity as manifested by prehospital (emergency medical service [EMS]) hypertension on outcomes of traumatic brain injury (TBI) patients and to develop a prognostic model of the presence of TBI based on EMS and admission (emergency department [ED]) hypertension.
    Journal of Trauma and Acute Care Surgery 10/2014; 77(4):592-598. DOI:10.1097/TA.0000000000000382 · 1.97 Impact Factor
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    ABSTRACT: Early trauma-induced coagulopathy (ETIC) is abnormal coagulation detected on presentation, but a clear description is lacking. We used thromboelastography (TEG) to characterize ETIC. Data were prospectively collected on high-acuity trauma activations at an urban Level I trauma center between July 2012 and May 2013. Patients with admission TEG before any blood transfusion were stratified by Injury Severity Score (ISS): mild (less than 16), moderate (16 to 24), severe (25 or greater). TEG parameters were compared between groups. ETIC was defined as any abnormality detected on TEG. Fifty-two patients were included; mean age was 49 years and mean time to the emergency department was 26 minutes. Mean ISS for the cohort was 17 with 28 patients in mild, eight in moderate, and 16 in severe. Glasgow Coma Score was lower and head Abbreviated Injury Scale was higher in severe (P Document Type: Research Article Publication date: October 1, 2014 More about this publication? The Southeastern Surgical Congress owns and publishes The American Surgeon monthly. It is the official journal of the Congress and the Southern California Chapter of the American College of Surgeons, which all members receive each month. The journal brings up to date clinical advances in surgical knowledge in a popular reference format. In addition to publishing papers presented at the annual meetings of the associated organizations, the journal publishes selected unsolicited manuscripts. If you have a manuscript you'd like to see published in The American Surgeon select "Information for Authors" from the Related Information options below. A Copyright Release Form must accompany all manuscripts submitted. Information for Authors Submit a Paper Subscribe to this Title Membership Information Information for Advertisers Terms & Conditions Annual Scientific Meeting Brief Reports ingentaconnect is not responsible for the content or availability of external websites $(document).ready(function() { var shortdescription = $(".originaldescription").text().replace(/\\&/g, '&').replace(/\\, '<').replace(/\\>/g, '>').replace(/\\t/g, ' ').replace(/\\n/g, ''); if (shortdescription.length > 350){ shortdescription = "" + shortdescription.substring(0,250) + "... more"; } $(".descriptionitem").prepend(shortdescription); $(".shortdescription a").click(function() { $(".shortdescription").hide(); $(".originaldescription").slideDown(); return false; }); }); Related content In this: publication By this: publisher In this Subject: Surgery By this author: Liou, Douglas Z. ; Shafi, Hedyeh ; Bloom, Matthew B. ; Chung, Rex ; Ley, Eric J. ; Salim, Ali ; Tcherniantchouk, Oxana ; Margulies, Daniel R. GA_googleFillSlot("Horizontal_banner_bottom");
    The American surgeon 10/2014; 80(10). · 0.92 Impact Factor
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    ABSTRACT: The risk of venous thromboembolism (VTE) for patients taking an antiplatelet agent is largely unknown. This study aimed to investigate the association between antiplatelet agent use before admission with the risk of in-hospital VTE in surgical intensive care unit (ICU) patients. A retrospective review of all patients admitted to the surgical ICU at a Level I trauma center over 30 months was performed. Patients who underwent diagnostic imaging for VTE were selected. Patients were divided based on whether or not antiplatelet agents were used before admission (APTA vs NAPTA). The primary outcome was VTE occurrence. A forward logistic regression model was used to identify factors independently associated with the primary outcome. During the study period, 461 (24%) patients met inclusion criteria: 70 (15%) APTA and 391 (85%) NAPTA. After adjusting for confounding factors, APTA patients were at a significantly higher risk for developing VTE (59 vs 40%; adjusted odds ratio, 1.8; 95% confidence interval, 1.0 to 3.0; adjusted P = 0.04). Whether or not antiplatelet agents were resumed during the hospital stay and the day on which they were resumed did not affect VTE risk. In conclusion, surgical ICU patients receiving antiplatelet agents before admission are at a significantly higher risk for development of VTE.
    The American surgeon 10/2014; 80(10). · 0.92 Impact Factor
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    ABSTRACT: Patients sustaining traumatic injuries are at risk for development of rhabdomyolysis. The effect of obesity on this risk is unknown. This study attempted to characterize the role of obesity in the development of rhabdomyolysis after trauma. This was a retrospective review of all trauma patients with creatine kinase (CK) levels admitted to the surgical intensive care unit (SICU) at a Level I trauma center from February 2011 until July 2013. Patients were divided based on their body mass index (BMI): overweight/obese group with BMI 25 kg/m2 or greater and nonoverweight/obese group with BMI less than 25 kg/m2. Primary outcome was CK greater than 10,000 U/L. During the 30-month study period, 198 trauma patients with available CK levels were admitted to the SICU. The majority (27.8%) of patients were involved in a motor vehicle collision. There were 96 patients (48.4%) with BMI 25 kg/m2 or greater and 102 (51.5%) with BMI less than 25 kg/m2. There was no difference in creatinine levels between the two groups (1.5 ± 1.2 mg/dL vs 1.5 ± 1.4 mg/dL, P = 0.83). BMI 25 kg/m2 or greater was independently associated with the development of CK greater than 10,000 U/L (14.6 vs 4.9%; adjusted odds ratio, 3.03; P = 0.04). Patients with BMI 25 kg/m2 or greater are at a significantly higher risk for rhabdomyolysis after trauma. Aggressive CK level monitoring to prevent rhabdomyolysis in this population is strongly encouraged.
    The American surgeon 10/2014; 80(10). · 0.92 Impact Factor
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    ABSTRACT: Objective Offering undergraduate students research opportunities may enhance their interest in pursuing a surgical career and lead to increased academic productivity. We characterize the benefits of participating in the Trauma Research Associates Program. Design A 19-point Web-based survey. Setting Academic Level I Trauma Center. Participants A total of 29 active and former members of the Trauma Research Associates Program. Main Outcome Measure(s) Academic activities and predictors associated with interest in a surgical career and research productivity. Results Surveys were completed on 26 of 29 (90%) participants. Clinical experience was the most highly ranked motivation to join the program (65%), followed by pursuing a research experience (46%). During their involvement, 73% of participants observed surgical intensive care unit rounds, 65% observed acute care surgery rounds, and 35% observed a surgical procedure in the operating room. In addition, 46% submitted at least one abstract to a surgical meeting coauthored with the Division’s faculty. Furthermore, 58% reported that they enrolled in a medical school, whereas 17% pursued a full-time research job. The program influenced the interest in a surgical career in 39% of all members, and 73% reported that they would incorporate research in their medical career. Observing a surgical procedure was independently associated with development of a high interest in a surgical career (adjusted odds ratio: 6.50; 95% CI: 1.09, 38.63; p = 0.04), whereas volunteering for more than 15 hours per week predicted submission of at least 1 abstract to a surgical conference by the participant (adjusted odds ratio: 13.00; 95% CI: 1.27, 133.29; p = 0.03). Conclusions and Relevance Development of a structured research program for undergraduate students is beneficial to both the participants and sponsoring institution. Undergraduate exposure to academic surgery enhances interest in pursuing a surgical specialty and leads to academic productivity.
    Journal of Surgical Education 09/2014; DOI:10.1016/j.jsurg.2014.08.012 · 1.39 Impact Factor
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    ABSTRACT: A physician-centered approach to systems design is fundamental to ameliorating the causes of many errors, inefficiencies, and reliability problems.
    08/2014; 149(9). DOI:10.1001/jamasurg.2014.1208
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    ABSTRACT: IMPORTANCE The need for suitable organs for transplantation is especially pronounced in minority populations such as Hispanic Americans owing to disproportionately high rates of diabetes mellitus and kidney disease. Considerable barriers exist for Hispanic Americans consent to donation, resulting in significantly lower donation rates compared with white individuals. OBJECTIVE To investigate the effect of an aggressive outreach intervention during a 5-year period aimed at improving organ donation rates among Hispanic Americans. DESIGN, SETTING, AND PARTICIPANTS Prospective longitudinal observation study of organ donors treated at a major metropolitan level I trauma center. The center provides most of the medical care to the 4 Southern California neighborhoods with a high percentage of Hispanic Americans that were included in the study. INTERVENTIONS Television and radio media campaigns and culturally sensitive educational programs implemented at high schools, churches, and medical clinics in the target neighborhoods. MAIN OUTCOME AND MEASURE Consent rate for organ donation recorded during the study. RESULTS Outreach interventions started in 2007 and were completed by 2012. Of 268 potential donors, 155 total donors (106 Hispanic Americans) provided consent during this time. A significant increase in consent rate was noted among Hispanic Americans, from 56% in 2005 to 83% in 2011 (P = .004); this increase was not evident in the population that was not Hispanic (67% in 2005 and 79% in 2011; P = .21). CONCLUSIONS AND RELEVANCE Aggressive outreach programs can reduce the disparity between organ supply and demand by improving the consent rate among the target group.
    08/2014; 149(9). DOI:10.1001/jamasurg.2014.1014
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    ABSTRACT: Purpose: The purpose of this study is to determine the effect of postoperative fluid balance (FB) on subsequent outcomes in acute care surgery (ACS) patients admitted to the surgical intensive care unit (ICU). Material and methods: Acute care surgery patients admitted to the surgical ICU from 06/2012 to 01/2013 were followed up prospectively. Patients were stratified by FB into FB-positive (+) and FB-negative (-) groups by surgical ICU day 5 or day of discharge from the surgical ICU. Results: A total of 144 ACS patients met inclusion criteria. Although there was no statistically significant difference in crude mortality (11% for FB [-] vs 15.5% for FB [+]; P = .422], after adjusting for confounding factors, achieving an FB (-) status by day 5 during the surgical ICU stay was associated with an almost 70% survival benefit (adjusted odds ratio [95% confidence interval], 0.31 [0.13, 0.76]; P = .010). In addition, achieving a fluid negative status by day 1 provided a protective effect for both overall and infectious complications (adjusted odds ratio [95% confidence interval], 0.63 [0.45, 0.88]; P = .006 and 0.64 [0.46, 0.90]; P = .010, respectively). Conclusions: In a cohort of critically ill ACS patients, achieving FB (-) status early during surgical ICU admission was associated with a nearly 70% reduction in the risk for mortality.
    Journal of Critical Care 07/2014; 29(6). DOI:10.1016/j.jcrc.2014.06.023 · 2.19 Impact Factor
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    ABSTRACT: Vancomycin-resistant Enterococcus (VRE) screening is routine practice in many intensive care units despite the question of its clinical significance. The value of VRE screening at predicting subsequent VRE or other hospital-acquired infection (HAI) is unknown. The purpose of this investigation was to examine the rate of subsequent VRE HAI in patients undergoing VRE screening. This study was conducted in a 24-bed surgical intensive care unit (SICU) at a Level I trauma center. Patients admitted to the SICU between February and August 2011 who had rectal swab for VRE screening within 72 hours were followed prospectively for the development of VRE and other HAIs. Demographics, clinical characteristics, and infection rates were compared between VRE-positive and VRE-negative patients. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of VRE screening for predicting subsequent VRE HAI were calculated. A total of 341 patients had VRE screening within 72 hours of SICU admission, with 32 VRE-positive (9%) and 309 VRE-negative (91%) patients. VRE-positive patients had a higher incidence of any HAI (78% vs. 35%, p < 0.001). Eight VRE-positive patients (25%) developed VRE HAI compared with only 3 VRE-negative patients (1%) (p < 0.001). VRE screening had a 73% sensitivity, 93% specificity, 25% PPV, and 99% NPV for determining subsequent VRE HAI. VRE colonization was present in 9% of SICU patients at admission. Negative VRE screen result had a high specificity and NPV for the development of subsequent VRE HAI. Empiric treatment of VRE infection may be unnecessary in VRE-negative patients. Prognostic/epidemiologic study, level III. Therapeutic study, level IV.
    05/2014; 76(5):1192-200. DOI:10.1097/TA.0000000000000203
  • The American surgeon 03/2014; 80(3):310-2. · 0.92 Impact Factor
  • Journal of Surgical Research 02/2014; 186(2):687. DOI:10.1016/j.jss.2013.11.1001 · 2.12 Impact Factor
  • Journal of Surgical Research 02/2014; 186(2):690. DOI:10.1016/j.jss.2013.11.1050 · 2.12 Impact Factor
  • Journal of Surgical Research 02/2014; 186(2):510. DOI:10.1016/j.jss.2013.11.290 · 2.12 Impact Factor
  • Journal of Surgical Research 02/2014; 186(2):690. DOI:10.1016/j.jss.2013.11.1041 · 2.12 Impact Factor
  • Journal of Surgical Research 02/2014; 186(2):687. DOI:10.1016/j.jss.2013.11.997 · 2.12 Impact Factor
  • Journal of Surgical Research 02/2014; 186(2):677. DOI:10.1016/j.jss.2013.11.859 · 2.12 Impact Factor

Publication Stats

450 Citations
206.95 Total Impact Points

Institutions

  • 2010–2014
    • Cedars-Sinai Medical Center
      • • Department of Surgery
      • • Cedars Sinai Medical Center
      Los Ángeles, California, United States
  • 2013
    • University of California, Los Angeles
      • Department of Surgery
      Los Angeles, California, United States