Haytham M A Kaafarani

Haytham M A Kaafarani
Massachusetts General Hospital | MGH · Department of Surgery

MD, MPH

About

376
Publications
55,060
Reads
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4,618
Citations
Additional affiliations
January 2017 - January 2025
Massachusetts General Hospital
Position
  • Managing Director
July 2011 - present
Massachusetts General Hospital
Position
  • Professor (Assistant)

Publications

Publications (376)
Article
Background Socioeconomic status (SES) is defined as a total measure of an individual’s economic or social position in relation to others. Income and educational level are often used as quantifiable objective measures of SES but are inherently limited. Perceived SES (p-SES), refers to an individual’s perception of their own SES. Herein, we assess th...
Article
Introduction Intraoperative deaths (IODs) are rare but catastrophic. We systematically analyzed IODs to identify clinical and patient safety patterns. Methods IODs in a large academic center between 2015 and 2019 were included. Perioperative details were systematically reviewed, focusing on (1) identifying phenotypes of IOD, (2) describing emergin...
Article
Background: There is no consensus on the duration of antibiotic use after appendectomy. We hypothesized that restricted antibiotic use is associated with better clinical outcomes. Patients and Methods: We performed a post hoc analysis of the Eastern Association for the Surgery of Trauma (EAST) Multicenter Study of the Treatment of Appendicitis in A...
Article
Background: Abdominal wall hernias represent a common problem that can present as surgical emergencies with increased morbidity and mortality. The data examining outcomes in elderly patients with hernia emergencies is scant. Methods: The 2007-2017 ACS-NSQIP database was queried. Patients ≥65 years old with a diagnosis of acute complicated abdomi...
Article
Objective: To evaluate the Social Vulnerability Index (SVI) as a predictor of long-term outcomes after injury. Background: The SVI is a measure used in emergency preparedness to identify need for resources in the event of a disaster or hazardous event, ranking each census tract on 15 demographic/social factors. Methods: Moderate-severely injur...
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Full-text available
Background The education of civilians and first responders in prehospital tourniquet (PT) utilization has spread rapidly. We aimed to describe trends in emergency medical services (EMS) and non-EMS PT utilization, and their ability to identify proper clinical indications and to appropriately apply tourniquets in the field. Methods A retrospective...
Article
Background Artificial Intelligence (AI) applications aiming to support surgical decision-making processes are generating novel threats to ethical surgical care. To understand and address these threates, we summarize the main ethical issues that may arise from applying AI to surgery, starting from the Ethics Guidelines for Trustworthy Artificial Int...
Article
Objective: To determine whether the outcomes of postoperative patients admitted directly to an intensive care unit (ICU) differ based on the academic status of the institution and the total operative volume of the unit. Methods: This was a retrospective analysis using the eICU Collaborative Research Database v2.0, a national database from participa...
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Full-text available
Background Ischemic gastrointestinal complications (IGIC) following cardiac surgery are associated with high morbidity and mortality and remain difficult to predict. We evaluated perioperative risk factors for IGIC in patients undergoing open cardiac surgery. Methods All patients that underwent an open cardiac surgical procedure at a tertiary acad...
Article
Background Delays in admitting high-risk emergency surgery patients to the intensive care unit result in worse outcomes and increased health care costs. We aimed to use interpretable artificial intelligence technology to create a preoperative predictor for postoperative intensive care unit need in emergency surgery patients. Methods A novel, inter...
Article
Background: Balanced blood component administration during massive transfusion (MT) is standard of care. Most literature focuses on the impact of red blood cell (RBC):fresh frozen plasma (FFP) ratio while the value of balanced RBC:platelet (PLT) administration is less established. The aim of this study was to evaluate and quantify the independent...
Article
Background The American Association for the Surgery of Trauma (AAST) has developed a grading system for emergency general surgery (EGS) conditions. We sought to validate the AAST EGS grades for patients undergoing urgent/emergent colorectal resection. Methods Patients enrolled in the “Eastern Association for the Surgery of Trauma Multicenter Color...
Article
Background The COVID-19 pandemic has led to decreased access to care and social isolation, which have the potential for negative psychophysical effects. We examine the impact of the pandemic on physical and mental health outcomes after trauma. Methods Patients in a prospective study were included. The cohort injured during the pandemic was compare...
Article
As hospital systems plan for health care utilization surges and stress, understanding the necessary resources of a trauma system are essential for planning capacity. We aimed to describe trends in high intensity resource utilization (operating room [OR] usage and intensive care unit [ICU] admissions) for trauma care during the initial months of the...
Article
Background: The principles of antimicrobial stewardship promote the appropriate prescribing of agents with respect to efficacy, safety, duration, and cost. Antibiotic resistance often results from inappropriate use (e.g., indication, selection, duration). We evaluated practice variability in duration of antimicrobials in surgical infection treatmen...
Article
Purpose: Enteral nutrition is associated with improved outcomes in acute pancreatitis (AP), but previous studies have not focused on critically-ill patients. Our purpose was to determine the association between nutritional support and infectious complications in ICU-admitted patients with AP. Methods: A retrospective analysis of patients with AP...
Article
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Objectives: The outcomes of emergency general surgery (EGS) patients with concomitant COVID-19 infection remain unknown. With a multicenter study in 361 hospitals from 52 countries, we sought to study the mortality and pulmonary complications of COVID-19 patients undergoing EGS. Methods: All patients aged ≥17 years and diagnosed preoperatively w...
Article
Background There are significant practice variations in antibiotic treatment for appendicitis, ranging from short-course narrow spectrum to long-course broad-spectrum. We sought to describe the modern microbial epidemiology of acute and perforated appendicitis in adults to help inform appropriate empiric coverage and support antibiotic stewardship...
Article
Background Balanced blood product transfusion improves the outcomes of trauma patients with exsanguinating hemorrhage, but it remains unclear whether administering cryoprecipitate improves mortality. We aimed to examine the impact of early cryoprecipitate transfusion on the outcomes of the trauma patients needing massive transfusion (MT). Methods...
Article
Background: Grading systems for acute cholecystitis are essential to compare outcomes, improve quality and advance research. The American Association for the Surgery of Trauma (AAST) grading system for acute cholecystitis was only moderately discriminant when predicting multiple outcomes and underperformed the Tokyo guidelines and Parkland grade....
Article
Objective: To characterize the rates and variability in substance screening among adult trauma patients in the U.S. Summary background data: Emergency Department trauma visits provide a unique opportunity to identify patients with substance use disorders. Despite the existence of screening guidelines, underscreening and variability in screening...
Article
Background Several studies have demonstrated that low-molecular weight heparin (LMWH) is superior to unfractionated heparin (UFH) in trauma patients. The superiority of either one has not been established for the elderly. In this study, we compared LMWH to UFH in elderly trauma patients. Methods A retrospective analysis of the American College of...
Article
Background The Trauma Outcomes Predictor tool was recently derived using a machine learning methodology called optimal classification trees and validated for prediction of outcomes in trauma patients. The Trauma Outcomes Predictor is available as an interactive smartphone application. In this study, we sought to assess the performance of the Trauma...
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Full-text available
This is a multicenter study that reports the demographics, injury characteristics, hospital management, and outcomes of the injured patients in the Beirut blast. We demonstrated that the severity of injury was inversely correlated with the distance from the blast, and mildly injured patients overwhelmed the ED in the early hours. Objective: This...
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Objective: To report the 30-day outcomes of patients with perioperative SARS-CoV-2 infection undergoing surgery in the USA. Summary background data: Uncertainty regarding the postoperative risks of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exists. Methods: As part of the COVIDSurg multicenter study, all patient...
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Background COVID-19 is a deadly multisystemic disease, and bowel ischemia, the most consequential gastrointestinal manifestation, remains poorly described. Our goal is to describe our institution’s surgical experience with management of bowel ischemia due to COVID-19 infection over a one-year period. Methods All patients admitted to our institutio...
Article
Background The mortality rate from mesenteric ischemia is reported to be as high as 80%. The goal of our study was to identify demographic and clinical predictors of post-operative mortality and discharge disposition among elderly patients with mesenteric ischemia. Methods All patients 65 years and older who underwent emergency surgery (ES) for th...
Article
Background: Despite the ubiquity of rib fractures in patients with blunt chest trauma, long-term outcomes for patients with this injury pattern are not well described. Methods: The Functional Outcomes and Recovery after Trauma Emergencies (FORTE) project has established a multi-center prospective registry with 6 to 12-month follow-up for trauma...
Article
Background Body mass index (BMI) does not reliably predict Surgical site infections (SSI). We hypothesize that abdominal wall thickness (AWT) would serve as a better predictor of SSI for patients undergoing emergency colon operations. Methods We retrospectively evaluated our Emergency Surgery Database (2007-2018). Emergency colon operations for an...
Article
As opportunities for artificial intelligence to augment surgical care expand, the accompanying surge in published literature has generated both substantial enthusiasm and grave concern regarding the safety and efficacy of artificial intelligence in surgery. For surgeons and surgical data scientists, it is increasingly important to understand the st...
Article
Background: Necrotizing soft tissue infections (NSTIs) are rapidly progressing, life-threatening diseases associated with substantial morbidity and mortality, especially in patients 65 years or older. We aimed to evaluate clinical factors associated with mortality and discharge disposition after NSTIs in elderly patients. Patients and Methods: Retr...
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Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates an...
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We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which pati...
Article
Background: Infections represent a major component of surgical practice. Risk mitigation, seeking eradication and optimal patient outcomes, require a concerted, multifocal effort to understand disease and microbiology, prevent infections, and treat them. The present study was undertaken to re-define the Surgical Infection Society (SIS) research age...
Article
Background: The use of machine learning (ML) and artificial intelligence (AI) in medical research continues to grow as the amount and availability of clinical data expands. These techniques allow complex interpretation of data and capture non-linear relations not immediately apparent by classic statistical techniques. Methods: This review of the ML...
Article
Purpose: Violence continues to be a significant public health burden, but little is known about the long-term outcomes of these patients. Our goal was to determine the impact of violence-related trauma on long-term functional and psychosocial outcomes. Methods: We identified trauma patients with moderate to severe injuries (Injury Severity Score...
Article
Importance The familial aspect of acute appendicitis (AA) has been proposed, but its hereditary basis remains undetermined. Objective To identify genomic variants associated with AA. Design, Setting, and Participants This genome-wide association study, conducted from June 21, 2019, to February 4, 2020, used a multi-institutional biobank to retros...
Article
Background The Syrian conflict has produced one of the largest refugee crises in modern times. Lebanon has taken in more Syrian refugees per capita than any other nation. We aimed to study the burden of surgical disease and access to surgical care among Syrian refugees in Lebanon.Methods This study was designed as a convenient cross-sectional clust...
Article
Background There is little research evaluating outcomes from sepsis in intensive care units (ICUs) with lower sepsis patient volumes as compared to ICUs with higher sepsis patient volumes. Our objective was to compare the outcomes of septic patients admitted to ICUs with different sepsis patient volumes. Materials and Methods We included all patie...
Article
Background: Facial trauma can have long-lasting consequences on an individual's physical, mental, and social well-being. The authors sought to assess the long-term outcomes of patients with facial injuries. Methods: This is a prospective multicenter cohort study of patients with face abbreviated injury scores ≥1 within the Functional Outcomes an...
Article
Objective: We aimed to compare discharge opioid prescriptions pre- and post-Enhanced Recovery After Surgery (ERAS) implementation. Summary background data: ERAS programs decrease inpatient opioid use, but their relationship with post-discharge opioids remains unclear. Methods: All patients undergoing hysterectomy between October 2016-November...
Article
Full-text available
Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Su...
Article
Background: The Emergency Surgery Score was recently validated in a prospective multicenter study as an accurate predictor of mortality in emergency general surgery patients. The Emergency Surgery Score is easily calculated using multiple demographic, comorbidity, laboratory, and acuity of disease variables. We aimed to investigate whether the Eme...
Article
Objectives: To combine evidence on andexanet alfa and prothrombin complex concentrates for factor Xa inhibitor-associated bleeding to guide clinicians on reversal strategies. Data sources: Embase, Pubmed, Web of Science, and the Cochrane Library. Study selection: Observational studies and randomized clinical trials studying hemostatic effectiv...
Article
Background: Obesity has long been considered a risk factor for postoperative adverse events in surgery. We sought to study the impact of body mass index (BMI) on the clinical outcomes of the high-risk emergency general surgery (EGS) elderly patients. Methods: All EGS ≥65 years old patients in the 2007-2016 ACS-NSQIP database, identified using th...
Article
Background The Emergency Surgery Score (ESS) has been previously validated as a reliable tool to predict postoperative outcomes in emergency general surgery (EGS). The purpose of this study is to assess the differential performance of the ESS in specific EGS procedures. Methods The American College of Surgeons’ National Surgical Quality Improvemen...
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Dissemination Committee (alphabetical by country):
Article
Background: Post-operative infectious complications after repair of intestinal-cutaneous fistulas (ICF) represent a substantial burden and these outcomes vary widely in the literature. We aimed to evaluate the use of the modified frailty index-5 (mFI-5) to account for physiologic reserve to predict infectious complications in patients with ICF unde...
Article
Background: We sought to assess the efficacy of prophylactic abdominal drainage to prevent complications after appendectomy for perforated appendicitis. Methods: In this post hoc analysis of a prospective multi-center study of appendicitis in adults (≥ 18 years), we included patients with perforated appendicitis diagnosed intra-operatively. The 63...
Article
Objective : Prehospital tourniquet (PHT) utilization has increased in response to mass casualty events. We aimed to describe the incidence, therapeutic effectiveness and morbidity associated with tourniquet placement in all patients treated with PHT application. Methods: A retrospective observational cohort study was performed to evaluate all adul...
Article
Background: The strength of one's social support network is a potentially modifiable factor that may have a significant impact on recovery after injury. We sought to assess the association between one's perceived social support (PSS) and physical and mental health outcomes 6-12 months post-injury. Methods: Moderate-to-severely injured patients a...
Article
Background: Damage-control laparotomy (DCL) has been used for traumatic and nontraumatic indications. We studied factors associated with delirium and outcome in this population. Methods: We reviewed DCL patients at 15 centers for 2 years, including demographics, Charlson Comorbidity Index (CCI), diagnosis, operations, and outcomes. We compared 3...
Article
Background Optimal use of interventional procedures and diagnostic tests for patients with suspected choledocholithiasis depends on accurate pretest risk estimation. We sought to define sensitivity/specificity of transaminases in identifying choledocholithiasis and to incorporate them into a biochemical marker composite score that could accurately...
Article
Background: Classic risk assessment tools often treat patients' risk factors as linear and additive. Clinical reality suggests that the presence of certain risk factors can alter the impact of other factors; in other words, risk modelling is not linear. We aimed to use Artificial Intelligence (AI) technology to design and validate a nonlinear risk...
Article
Background: In-field triage tools for trauma patients are limited by availability of information, linear risk classification, and a lack of confidence reporting. We therefore set out to develop and test a machine learning algorithm that can overcome these limitations by accurately and confidently making predictions to support in-field triage in th...
Article
Abstract Background: Bedside experience and studies of critically ill patients with coronavirus disease 2019 (COVID-19) indicate COVID-19 to be a devastating multisystem disease. We aim to describe the incidence, associated variables, and outcomes of rhabdomyolysis in critically illCOVID-19 patients. Materials and Methods: Data for all critically...
Article
Full-text available
Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Su...
Article
Full-text available
Purpose of Review To provide an overview of the most recent research in geriatric trauma outcomes, specifically highlighting advances in risk prediction for the elderly injured patient. Recent Findings Geriatric-specific evidence and best practices continue to evolve for older adult trauma patients. There are a number of risk stratification system...
Article
Background Peri-operative blood transfusion (BT) may lead to transfusion-induced immunomodulation. We aimed to investigate the association between peri-operative BT and infectious complications in patients undergoing intestinal-cutaneous fistulas (ICF) repair. Methods We queried the ACS-NSQIP 2006–2017 database to include patients who underwent IC...
Conference Paper
Full-text available
Background Refugees are prone to increased risks of injury frequency and severity. In this study, we systematically quantified the prevalence of injuries and burns among refugees in Lebanon and examined injury characteristics, risk factors and outcomes. Method We conducted a cluster-based population survey across 21 refugee camps in Lebanon from F...
Article
Artificial intelligence (AI) has made increasing inroads in clinical medicine. In surgery, machine learning–based algorithms are being studied for use as decision aids in risk prediction and even for intraoperative applications, including image recognition and video analysis. While AI has great promise in surgery, these algorithms come with a serie...