Heena P Santry

University of Massachusetts Medical School | UMMS · Department of Surgery

Background Prehospital transport time has been directly related to mortality for hemorrhaging trauma patients. ‘Trauma deserts’ were previously defined as being outside of a 5-mile radial distance of an urban trauma center. We postulated that the true ‘desert’ should be based on transport time rather than transport distance. Methods Using the Chic...

Purpose of Review To craft an approach to thwart early triggers of symptoms on the burnout continuum for trauma surgeons based on an understanding of drivers of burnout, second victim syndrome, peer-to-peer support, and trauma-informed care. Recent Findings Trauma surgeons are particularly vulnerable to risk factors of burnout such as work–life im...

Importance: Although nearly 1 million older patients are admitted for emergency general surgery (EGS) conditions yearly, long-term survival after these acute diseases is not well characterized. Many older patients with EGS conditions have preexisting complex multimorbidity defined as the co-occurrence of at least 2 of 3 key domains: chronic condit...

Background Although nearly 1 million older adults are admitted for emergency general surgery conditions yearly, the extent to which baseline health influences the development and treatment of emergency general surgery conditions is unknown. We evaluated baseline health and older patients with and without emergency general surgery conditions. Metho...

Background An increasing proportion of ventral hernia patients are over age 65. These patients are frequently offered watchful waiting rather than surgical intervention due to their frail state or perioperative risk. However, many in this age group suffer from significant quality of life impacts that are not well understood.Methods We performed a r...

Background Index cholecystectomy is the standard of care for gallstone pancreatitis. Hospital-level operative resources and implementation of an acute care surgery (ACS) model may impact the ability to perform index cholecystectomy. We aimed to determine the influence of structure and process measures related to operating room access on achieving i...

Background: Assess the relationship between availability of round-the-clock (RTC) in-house intensivists and patient outcomes in people who underwent surgery for a life-threatening emergency general surgery (LT-EGS) disease such as necrotizing soft-tissue infection, ischemic enteritis, perforated viscus, and toxic colitis. Methods: Data on hospit...

Background We aimed to predict practicing surgeon workforce size across ten specialties to provide an up-to-date, national perspective on future surgical workforce shortages or surpluses. Methods Twenty-one years of AMA Masterfile data (1997–2017) were used to predict surgeons practicing from 2030-2050. Published ratios of surgeons/100,000 populat...

Background: Falls are the leading cause of fatal injury, and the most common cause of nonfatal trauma, among older adults. However, patient perspectives on preferences for obtaining fall education are not well reported. Objective: To identify components of successful fall prevention education. Design: Prospective qualitative study. Setting:...

Background Patients presenting with acute abdominal pain often undergo a computed tomography (CT) scan as part of their diagnostic workup. We investigated the relationship between availability, timeliness, and interpretation of CT imaging and outcomes for life-threatening intra-abdominal diseases or “acute abdomen,” in older Americans. Methods Dat...

Background Emergency general surgery (EGS) patients are more socioeconomically vulnerable than elective counterparts. We hypothesized that a hospital's neighborhood disadvantage is associated with vulnerability of its EGS patients. Materials and methods Area deprivation index (ADI), a neighborhood-level measure of disadvantage, and key characteris...

Background: Getting effective fall prevention into the homes of medically and physically vulnerable individuals is a critical public health challenge. Community paramedicine is emerging globally as a new model of care that allows emergency medical service units to evaluate and treat patients in non-emergency contexts for prevention efforts and chro...

Introduction: Despite three million adults in the United States (US) being admitted annually for emergency general surgery (EGS) conditions, which disproportionately affect vulnerable populations, we lack an understanding of the barriers to round-the-clock EGS care. Our objective was to measure gaps in round-the-clock EGS care. Methods: From Aug...

Background Necrotizing soft-tissue infections (NSTIs) encompass a group of severe, life-threatening diseases with high morbidity and mortality. Evidence suggests advanced age is associated with worse outcomes. To date, no large data sets exist describing outcomes in older individuals, and risk factor identification is lacking. Methods Retrospectiv...

Background Falls are the leading cause of fatal injury, and most common cause of non-fatal trauma, among older adults. We sought to elicit older patient’s perspectives on fall risks for the general population as well as contributions to any personal falls to identify opportunities to improve fall education. Methods Ten patients with a history of f...

Background: Acute Care Surgery (ACS) was developed as a structured, team-based approach to providing round-the-clock emergency general surgery (EGS) care for adult patients needing treatment for diseases such as cholecystitis, gastrointestinal perforation, and necrotizing fasciitis. Lacking any prior evidence on optimizing outcomes for EGS patient...

Background Many hospitals have implemented visitor restriction policies in response to the COVID-19 pandemic. Since caregivers serve an important role in postoperative recovery, the purpose of this study was to evaluate the impact of visitor restrictions on the postoperative experience of COVID-negative patients undergoing surgery. Methods Patient...

Purpose We examined differences in critical care structures and processes between hospitals with Acute Care Surgery (ACS) versus general surgeon on call (GSOC) models for emergency general surgery (EGS) care. Methods 2811 EGS-capable hospitals were surveyed to examine structures and processes including critical care domains and ACS implementation....

Background In response to duty hour restrictions, hospitals expanded residency programs and added advanced practice providers (APPs). We sought to determine if type of clinical support was associated with emergency general surgery (EGS) outcomes. Methods As part of our 2015 survey of acute care hospitals, we asked hospitals whether residents and A...

Introduction Transferred emergency general surgery (EGS) patients are a vulnerable, high acuity population. The outcomes of and health care utilization among transferred (TRAN) as compared to directly admitted (DA) patients have been studied primarily using single institution or hospital system data which limits generalizability. We evaluated these...

The efficacy of neoadjuvant therapy (NT) versus surgery first (SF) for pancreatic ductal adenocarcinoma (PDAC) remains controversial. A random-effects meta-analysis of only prospective randomized controlled trials (RCTs) comparing NT versus SF for potentially resectable (PR) or borderline resectable (BR) PDAC was performed. Among six RCTs including...

Background Small bowel obstruction (SBO) no longer mandates urgent surgical evaluation raising the question of the role of operating room (OR) access on SBO outcomes.Methods Data from our 2015 survey on emergency general surgery (EGS) practices, including queries on OR availability and surgical staffing, were anonymously linked to adult SBO patient...

Background The role of changes in gut microflora on upper gastrointestinal (UGI) perforations is not known. We conducted a retrospective case-control study to examine the relationship between antibiotic exposure—a proxy for microbiome modulation—and UGI perforations in a national sample. Methods We queried a 5% random sample of Medicare (2009–2013...

Published Abstract: Journal of Vascular Surgery. 2019;70(3):E73. Objective: Concern regarding the vascular surgeon (VS) workforce persists. We aimed to predict future VS workforce size and capacity using contemporary data on the U.S. population and number, productivity, and practice patterns of VSs. Methods: Workforce size needed to maintain curr...

Objectives: To examine loss of community-dwelling status 9 months after hospitalization for high-acuity emergency general surgery (HA-EGS) disease among older Americans. Design: Retrospective analysis of claims data. Setting: US communities with Medicare beneficiaries. Participants: Medicare beneficiaries age 65 years or older hospitalized u...

Background: In parallel to women entering general surgery training, acute care surgery (ACS) has been developing as a team-based approach to emergency general surgery (EGS). We sought to examine predictors of women surgeons in EGS generally, and ACS particularly. Methods: From our national survey, we determined the proportion of women surgeons w...

Background: Emergency general surgery can have a profound impact on the functional status of even previously independent patients. The role and influence of discharging a patient to a skilled nursing facility, however, remains largely unknown. Methods: We queried the American College of Surgeons National Surgical Quality Improvement Program for...

Introduction: Timely access to the operating room (OR) for emergency general surgery (EGS) diseases is key to optimizing outcomes. We conducted a national survey on EGS structures and processes to examine if implementation of acute care surgery (ACS) would improve OR accessibility compared to a traditional general surgeon on call (GSOC) approach....

More than three million patients every year develop emergency general surgical (EGS) conditions and this number is rising. EGS diseases range from straightforward to potentially life-threatening, and if severe or complex may require extensive resources. Given the looming surgeon shortage and concerns about access to care, regionalization of EGS car...

Background: Few diseases truly require emergency surgery today. We investigated the relationship between access to OR and outcomes for patients with life-threatening emergency general surgery (LT-EGS) diseases at US hospitals. Methods: In 2015, we surveyed 2,811 US hospitals on EGS practices, including how OR access is assured (e.g., OR staffing...

Elderly falls are a healthcare epidemic. We aimed to identify risk factors of serious falls by linking data on functional status from the Global Longitudinal Study of Osteoporosis in Women (GLOW) and our institutional trauma registry. 124 of 5,091 local women enrolled in GLOW were evaluated by our trauma team for injuries related to a fall during t...

Background: Acute care surgery (ACS) was proposed to address a general surgery workforce crisis; however, the ACS workforce composition is unknown. A national survey was conducted to determine the differences in the emergency general surgery (EGS) workforce between ACS and non-ACS hospitals. Methods: The American Hospital Association (AHA) Annua...

Background: Acute care surgery (ACS) was proposed to improve emergency general surgery (EGS) care; however, the extent of ACS model adoption in the United States is unknown. A national survey was conducted to ascertain factors associated with variations in EGS models of care, with particular focus on ACS use. Methods: A hybrid mail/electronic su...

Background: An association between lack of insurance and inferior outcomes has been well described for a number of surgical emergencies, yet little is known about the relationship of payor status and outcomes of patients undergoing emergent surgical repair for upper gastrointestinal (UGI) perforations. We evaluated the association of payor status...

Background: Care transitions are a topic of increasing interest as researchers and clinicians focus their effects on patient outcomes. Engaging caregivers, who play important roles in care transitions, may yield valuable insight into how care transition processes can be improved. Methods: We conducted semi-structured interviews, focusing on caregiv...

Objective: To examine national adherence to emergency general surgery (EGS) best practices. Background: There is a national crisis in access to high-quality care for general surgery emergencies. Acute care surgery (ACS), a specialty leveraging strengths of trauma systems, may ameliorate this crisis. A critical component of trauma care is adheren...

Although operative intervention is infrequently required, upper gastrointestinal bleeding (UGIB) is a common reason for general surgery consultation. Patients typically present with coffee ground emesis or frank hematemesis; however, patients with bright red blood per rectum may also be hemorrhaging from an upper gastrointestinal location, which is...

Serious, potentially life-threatening injury mandates expeditious emergency medical services (EMS) transportation to the hospital for urgent evaluation and stabilization. Transporting patients via helicopter EMS (HEMS) offers several obvious advantages vs ground transportation with regard to speed and access; however, these advantages are associate...

Importance Owing to lack of adequate emergency care infrastructure and decline in general surgery workforce, the United States faces a crisis in access to emergency general surgery (EGS) care. Acute care surgery (ACS), an organized system of trauma, general surgery, and critical care, is a proposed solution; however, ACS diffusion remains poorly un...

Background: As fewer surgeons take emergency general surgery call and hospitals decrease emergency services, a crisis in access looms in the United States. We examined national emergency general surgery capacity and county-level determinants of access to emergency general surgery care with special attention to disparities. Methods: To identify p...

Background: C. difficile (CDI) has surpassed methicillin-resistant staph aureus as the most common nosocomial infection with recurrence reaching 30% and the elderly being disproportionately affected. We hypothesized that post-discharge antibiotic therapy for continued CDI treatment reduces readmissions. Study design: We queried a 5% random sampl...

Background Elderly Americans suffer increased mortality from sepsis. Given that beta-blockers have been shown to be cardioprotective in critical care, we investigated outpatient beta-blocker prescriptions and mortality among Medicare beneficiaries admitted for sepsis. Methods We queried a 5% random sample of Medicare beneficiaries for patients adm...

Patient-centered care is lauded as a cornerstone of patient satisfaction.¹ The literature supporting this is largely derived from studies in clinical settings where there is no imminent life threat, typically within the primary care, cancer, or chronic illness domains.² In this issue of JAMA Surgery, Kaufman and colleagues³ report their findings fr...

Objective: More than 266 million courses of antibiotics are dispensed to outpatients annually in the US, with the rising elderly population consuming a substantial number of antibiotics. At least 30% of these antibiotics prescribed are unnecessary. Alterations in gut microbiome are known to cause stomach and small intestine (SSI) perforations. Howe...

Background: As the U.S. population ages and the number of emergent surgical repairs for perforated peptic ulcer disease (PUD) rise, contemporary national data evaluating operative outcomes for open surgical repair for perforated PUD among the elderly are lacking. Materials and methods: The National Surgical Quality Improvement Program (2007-2014...

In the modern era, while the majority of patients presenting with splenic injury are victims of blunt trauma, up to 14 % are victims of penetrating trauma. Conversely, for victims of penetrating trauma, the spleen has been reported to be one of the most infrequently injured organs, ranging from 7 to 9 %.

Hemorrhage accounts for up to 40 % of trauma-related deaths. As hemorrhage has been increasingly recognized over the last century as both a disease of decreased perfusion and a disease of altered immunity, the approach to trauma resuscitation has evolved substantially. While the initial approach to the management of the penetrating trauma patient r...

Clostridium difficile infection (CDI) is increasingly prevalent among community dwelling Americans. Older Americans are particularly vulnerable to community-acquired Clostridium difficile (CACD), in part to increasing use of antibiotics. We studied the association between outpatient antibiotics and CACD among Medicare beneficiaries. Case-control st...

While the benefits of early tracheostomy in ventilator dependent patients are well established, the reasons for variation in time from intubation to tracheostomy remain unclear. We identified clinical and demographic disparities in time-to-tracheostomy. We performed a level III retrospective prognostic study by querying the University HealthSystem...

Acute appendicitis is the most common indication for emergency general surgery (EGS) in the United States. We examined the role of acute care surgery (ACS) on interventions and outcomes for acute appendicitis at a national sample of university-affiliated hospitals. We surveyed senior surgeons responsible for EGS coverage at University HealthSystems...

To determine the effect of aeromedical transport on trauma mortality when accounting for geographic factors. The existing literature on the mortality benefit of aeromedical transport on trauma mortality is controversial. Studies examining patient and injury characteristics find higher mortality, whereas studies measuring injury severity find a prot...

Patterns of adoption of acute care surgery (ACS) as a strategy for emergency general surgery (EGS) care are unknown. We conducted a qualitative study comprising face-to-face interviews with senior surgeons responsible for ACS at 18 teaching hospitals chosen to ensure diversity of opinions and practice environment (three practice types [community, p...

To date, no studies have reported nationwide adoption of acute care surgery (ACS) or identified structural and/or process variations for the care of emergency general surgery (EGS) patients within such models. We surveyed surgeons responsible for EGS coverage at University Health Systems Consortium hospitals using an eight-page postal/e-mail questi...

Patterns of death after trauma are changing due to advances in critical care. We examined mortality in critically injured patients who survived index hospitalization. Retrospective analysis of adults admitted to a Level-1 trauma center (1/1/2000-12/31/2010) with critical injury was conducted comparing patient characteristics, injury, and resource u...

Rates of Clostridium difficile (CD) infections are increasing. Elderly patients may be at particular risk of recurrent CD infection. Little is known about the risk for CD readmission specifically in this age group. A 5 % random sample of Medicare data (2009-2011) was queried for patients surviving a hospitalization for CD by ICD-9 code. Demographic...

Background Elderly Americans are at increased risk of head trauma, particularly fall-related. The effect of warfarin on head trauma outcomes remains controversial. Methods Medicare beneficiaries with head injuries from 2009-2011 were identified by ICD-9 code. Pre-injury warfarin use was determined using Part D claims. Multiple logistic regression...

Background The incidence of community-acquired Clostridium difficile (CACD) is increasing in the US. Many CACD infections occur in the elderly who are predisposed to poor outcomes. We aimed to describe the epidemiology and outcomes of CACD in a nationally representative sample of Medicare beneficiaries. Study Design We queried a 5% random sample o...

Objectives: We determined how preinjury insurance status and injury-related outcomes among able-bodied, community-dwelling adults treated at a Level I Trauma Center in central Massachusetts changed after health care reform. Methods: We compared insurance status at time of injury among non-Medicare-eligible adult Massachusetts residents before (2...

BACKGROUND: The utility of hyperbaric oxygen therapy (HBOT) in the treatment of necrotizing soft tissue infections (NSTIs) has not been proved. Previous studies have been subject to substantial selection bias because HBOT is not available universally at all medical centers, and there is often considerable delay associated with its initiation. We ex...

Surgeon volume may be an important predictor of quality and cost outcomes. We evaluated the association between surgeon volume and quality and cost of surgical care in patients with colon cancer. We performed a retrospective study of patients who underwent resection for colon cancer, using data from the University HealthSystem Consortium from 2008...

Background Surgeon volume may be an important predictor of quality and cost outcomes. We evaluated the association between surgeon volume and quality and cost of surgical care in patients with colon cancer. Study Design We performed a retrospective study of patients who underwent resection for colon cancer using data from the University HealthSyst...

The rigor of handoffs is increasingly scrutinized in the era of shift-based patient care. Acute care surgery (ACS) embraced such a model of care; however, little is known about handoffs in ACS programs. Eighteen open-ended interviews were conducted with ACS leaders representing diverse geographic and practice settings. Two independent reviewers ana...

Pancreaticoduodenal trauma (PDT) is associated with substantial mortality and morbidity. In this study, contemporary trends were analysed using national data. The Nationwide Inpatient Sample for 1998-2009 was queried for patients with PDT. Interventions including any operation (Any-Op) and pancreas-specific surgery (PSURG) were identified. Trends i...

Background: Specialized procedures such as hepatectomy are performed by a variety of specialties in surgery. We aimed to determine whether variation exists among utilization of resources, cost, and patient outcomes by specialty, surgeon case volume, and center case volume for hepatectomy. Methods: We queried centers (n = 50) in the University He...

Introduction: Patterns of death after trauma are changing due to diagnostic and treatment advances. We examined mortality in critically injured patients at risk of death after discharge. Methods: We reviewed all critically injured (Injury Severity Score≥25 AND death in Emergency Room , death within 24hrs, OR ICU admission>24hrs) adults (age≥18) adm...

Introduction: The effect of warfarin on outcomes of head injured patients remains controversial. Yet more than 2 million Americans, many of them elderly, are started on warfarin annually. Meanwhile, with the aging US population, elderly Americans are becoming an increasingly large proportion of head injured patients. We studied a national cohort of...

INTRODUCTION: Unlike many other interventions for trauma, the utilization of transport services are directly impacted by environmental factors such as geography and weather. The previous literature on aeromedical transport for trauma patients has not accounted for the variability in patient selection based on these factors. Furthermore, travel dist...

Purpose: Surgeon and hospital factors have a significant impact on treatment outcomes for colorectal cancer (CRC). Limited research has been done to assess cost and quality of treatment by surgeon-volume. We aim to identify the surgeon factors impacting cost and quality of surgical care for CRC. Methods: The University HealthSystem Consortium datab...

Background: Necrotizing soft-tissue infections (NSTI) are rare, potentially fatal, operative emergencies. We studied a national cohort of patients to determine recent trends in incidence, treatment, and outcomes for NSTI. Methods: We queried the Nationwide Inpatient Sample (1998-2010) for patients with a primary diagnosis of NSTI. Temporal trend...

Introduction: Intraoperative cholangiogram (IOC) can define biliary ductal anatomy. Routine IOC has been proposed previously. However, current surgeon IOC utilization practice patterns and outcomes are unclear. Methods: Nationwide Inpatient Sample 2004-2009 was queried for patients with acute biliary disease undergoing cholecystectomy (CCY). Ana...

Background Since Acute Care Surgery (ACS) was conceptualized a decade ago, the specialty has been widely adopted. Little is known about the structure and function of ACS teams. Methods We conducted 18 open-ended interviews with ACS leaders (representing geographic [New England, Northeast, Mid-Atlantic, South, West, Midwest] and practice [Public/Ch...

We thank Dr. Carson for his constructive criticism. We described the limitations of this study in our discussion. Because of inadequate databases at the outlying community hospitals (OCHs), we could not compare entire cohorts and therefore were forced to use our single-institution Acute Care Surgery Database. However, our goal is to help OCHs impro...

Nonprofessionals routinely perform high-risk home maintenance activities otherwise regulated by the Occupational Health and Safety Administration when professionals perform the same work. Reducing the risks taken by these "weekend warriors" has not been the focus of injury prevention efforts. This study describes injury patterns and outcomes for no...

Introduction: Since Acute Care Surgery (ACS) was first conceptualized as a specialty a decade ago, ACS teams have been widely adopted. Little is known about the structure and function of these teams. Methods: We conducted 18 open-ended interviews with ACS leaders (1 interview/center representing geographic [New England, Northeast, Mid-Atlantic, Sou...

Background: Gallbladder cancer (GBC) is an often lethal malignancy with variable distribution. Incidence in the United States is low. However, in areas of Central/South America, Central Europe, Japan, and the Indian subcontinent, GBC is a major cause of cancer death. Cholecystectomy is safe and commonly performed worldwide. Thus, prophylactic chole...

Aggressive treatment of colorectal liver metastases (CRLM) after colectomy is increasing in the last two decades with reports of improved survival. Multiple treatment options are available for CRLM but their use and utility remains unknown. Methods: Using SEER-Medicare linked database (1991-2005), we identified 7131 patients who had undergone colec...