John Emerson Scarborough

John Emerson Scarborough
University of Wisconsin–Madison | UW · Department of Surgery

About

130
Publications
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3,213
Citations

Publications

Publications (130)
Article
Background: Prevention of hospital-acquired conditions (HAC) is a focus of trauma center quality improvement. The relative contributions of various HACs to post-injury hospital outcomes are unclear. We sought to quantify and compare the impacts of six HACs on early clinical outcomes and resource utilization in hospitalized trauma patients. Method...
Article
Background Gallbladder perforation is a known morbid sequela of acute cholecystitis, yet evidence for its optimal management remains conflicting. This study compares outcomes in patients with perforated cholecystitis who underwent cholecystectomy at the time of index hospital admission to those who underwent interval cholecystectomy. Study Design...
Article
Background: The objective of the study was to examine the effect of hypogastric revascularization maneuvers on the rate of postoperative ischemic colitis among patients undergoing endovascular aortoiliac aneurysm repair. Methods: Using the 2011-2018 Endovascular Aneurysm Repair Procedure-Targeted American College of Surgeons National Surgical Qu...
Article
Background: Patients undergoing pancreaticoduodenectomy are at risk for a variety of adverse postoperative events, including generic complications such as surgical site infection (SSI) and procedure-specific complications such as postoperative pancreatic fistula (POPF) and delayed gastric emptying (DGE). Knowing which complications have the greate...
Article
Background: Race and insurance status have been shown to predict outcomes in pediatric bicycle traumas. It is unknown how these factors influence outcomes in adult bicycle traumas. This study aims to evaluate the association, if any, between race and insurance status with mortality in adults. Methods: This retrospective cohort study used the Nat...
Article
Background: In an era of competency-based education and concern about graduating resident readiness for practice, early resident autonomy and the ability to safely teach junior residents is becoming increasingly important. In this study, we aimed to understand the effect of "teaching resident" (2 residents operating under the supervision of an att...
Article
Full-text available
Background and aims: Traumatic pancreatic injury is associated with high morbidity and mortality rates, and the management strategies associated with the best clinical outcomes are unknown. Our aims were to identify the incidence of traumatic pancreatic injury in adult patients in the United States using the National Trauma Data Bank, evaluate man...
Article
Objective: The objective of this study was to compare 30-day postoperative mortality for patients undergoing endovascular repair of ruptured abdominal aortic aneurysm (rAAA) using locoregional vs general anesthesia. Unlike the open approach, endovascular repair of rAAA can be performed using either locoregional or general anesthesia. We hypothesiz...
Article
Background: To determine whether utilization of a retrieval bag during laparoscopic appendectomy for uncomplicated and complicated appendicitis (perforation/abscess) is associated with postoperative surgical site infection rates. Methods: We studied patients presented in the database of the 2016 Appendectomy-Targeted American College of Surgeons...
Article
Background: Whether patients with necrotizing soft tissue infections (NSTI) who presented to under-resourced hospitals are best served by immediate debridement or expedited transfer is unknown. We examined whether interhospital transfer status impacts outcomes of patients requiring emergency debridement for NSTI. Methods and materials: We conduc...
Article
Objective: Our objective was to develop an alternate construct for reporting anticipated outcomes after emergency general surgery (EGS) that presents risk in terms of a composite measure. Background: Currently available prediction tools generate risk outputs for discrete as opposed to composite measures of postoperative outcomes. A construct to...
Article
Objective: The aim of this study was to investigate the volume-outcome relationship in kidney transplantation by examining graft and patient outcomes using standardized risk adjustment (observed-to-expected outcomes). A secondary objective was to examine the geographic proximity of low, medium, and high-volume kidney transplant centers in the Unit...
Article
Background Information about carotid artery stenting (CAS) is largely derived from clinical trials, consensus statements, and outcomes comparisons between CAS and carotid endarterectomy. Given these limitations, the goal of this study was to identify risk factors for adverse outcomes after CAS among hospitals participating in the CAS-targeted Ameri...
Article
Background: The optimal approach to carotid revascularization in female patients with carotid artery stenosis is widely debated. Information available is largely derived from clinical trials that include only highly selected patients. The goal of this study was to compare the early clinical outcomes in women who undergo carotid artery stenting (CA...
Article
Background Thoracic outlet syndrome (TOS) and its management are relatively controversial topics. Most of the literature reporting the outcomes of surgical decompression for TOS derives from single-center experiences. The objective of our study was to describe the current state of TOS surgery among hospitals that participate in the American College...
Article
Objective: This study was conducted to identify the most clinically relevant and costly perioperative complications occurring in vascular surgery patients. Methods: The analysis included patients in the 2012 to 2014 National Surgical Quality Improvement Program database undergoing one of four high-risk vascular procedures. The procedures-aortic...
Article
Full-text available
Importance: Numerous quality initiatives have been implemented in an effort to minimize the onus of postoperative complications on clinical and economic outcomes after major surgery. It is unknown which complications have the greatest overall effect on these outcomes. Objective: To quantify the associations of specific postoperative complication...
Article
Background: There have been conflicting reports regarding whether the number of rib fractures sustained in blunt trauma is associated independently with worse patient outcomes. We sought to investigate this risk-adjusted relationship among the lesser-studied population of older adults. Methods: A retrospective review of the National Trauma Data...
Article
Purpose: The role of helicopter emergency medical services (HEMS) in pediatric trauma remains controversial. We examined its use in pediatric trauma and its effectiveness in children with moderate/severe injuries. Methods: All blunt/penetrating trauma patients ≤18years old in the National Trauma Data Bank were evaluated for use of HEMS and in-ho...
Article
Background: There is increasing evidence that race and socioeconomic factors affect patient outcomes after traumatic brain injury (TBI). Our goal was to assess the effect of race, ethnicity and insurance status on hospital length of stay, procedures performed, mortality, and discharge disposition after TBI. Methods: This was a retrospective coho...
Article
Purpose: This study aims to examine the current management strategies and outcomes after blunt pancreatic trauma in children using a national patient registry. Methods: Using the National Trauma Data Bank (NTDB) from 2007-2011, we identified all patients ≤18years old who suffered blunt pancreatic trauma. Patients were categorized as undergoing n...
Article
Background: The comparative effectiveness of non-operative management (NOS) versus immediate splenectomy (IS) for hemodynamically stable adult patients with grade IV or V blunt splenic injury (BSI) has not been clearly established in the literature. Study design: Retrospective analysis of adult patients from the 2013-2014 American College of Sur...
Article
Full-text available
Background: Because preoperative risk factor modification is generally not possible in the emergency setting, complication prevention represents an important focus for quality improvement in emergency general surgery (EGS). The objective of our study was to determine the overall impact that specific postoperative complications have in this patient...
Article
Background: Groin wound infection is a costly and morbid event after lower extremity revascularization. To date, a comprehensive and validated method for identifying patients who are at greatest risk for this complication has yet to be developed. Methods: Our retrospective analysis included all patients at a single institution who underwent lowe...
Article
There are little data currently available to guide surgical decision making regarding emergent surgical interventions in leukopenic patients. The purpose of this study was to investigate the impact of leukopenia among patients undergoing emergency abdominal operations to better guide preoperative decision making. The 2005 to 2012 American College o...
Article
Despite nationwide campaigns to increase the use of helmets among pediatric cyclists, many children continue to be injured while riding without a helmet. To determine where programs and policies intended to promote helmet use should be directed, we surveyed a large national dataset to identify variables associated with helmet use. The National Trau...
Article
The relative contribution of specific postoperative complications on mortality after emergency operations has not been previously described. Identifying specific contributors to postoperative mortality following acute care surgery will allow for significant improvement in the care of these patients. Patients from the 2005 to 2011 American College o...
Article
Although numerous studies have described the incidence of postoperative cranial nerve injury (CNI) after carotid endarterectomy (CEA), there have been few attempts to identify risk factors for this complication. The 2012 CEA-targeted American College of Surgeons National Surgical Quality Improvement Program database was used to determine the incide...
Article
Controversy exists over optimal timing of tracheostomy in patients with respiratory failure after blunt trauma. The study aimed to determine whether the timing of tracheostomy affects mortality in this population. The 2008-2011 National Trauma Data Bank was queried to identify blunt trauma patients without concomitant head injury who required trach...
Article
To determine the association between preoperative bowel preparation and 30-day outcomes after elective colorectal resection. Patients from the 2012 Colectomy-Targeted American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database who underwent elective colorectal resection were included for analysis and assigned to...
Conference Paper
Splenic angioembolization (SAE) is increasingly used in the management of splenic injuries in adults, although its value in pediatric trauma is unclear. We sought to assess outcomes related to splenectomy vs SAE. The National Trauma Data Bank was queried for patients 0 to 15 years of age from 2007 to 2011. Subgroup analysis of splenectomy vs SAE wa...
Article
Background: Although the need for intraoperative shunting during carotid endarterectomy (CEA) is intensely debated, relatively few studies have compared the neurologic outcomes of patients undergoing CEA with or without shunts. The objective of our analysis was to determine the impact of intraoperative shunting during CEA on the incidence of posto...
Article
Objective: This study used a recently released procedure-targeted multicenter data source to determine independent predictors of postoperative stroke or death in patients undergoing carotid endarterectomy (CEA) for carotid artery stenosis. Methods: The 2012 CEA-targeted American College of Surgeons (ACS) National Surgical Quality Improvement Pro...
Article
Objective: The objective of this study was to describe the outcomes of surgical revascularization for lower extremity arterial thromboembolism in patients with advanced malignancy. Methods: The 2005-2011 American College of Surgeons National Surgical Quality Improvement Program database was used for this study. Preoperative characteristics and p...
Article
IntroductionThe drive to improve outcomes and the inevitability of mandated public reporting necessitate uniform documentation and accurate databases. The reporting of wound classification in patients undergoing hepato-pancreatico-biliary (HPB) surgery and the impact of inconsistencies on quality metrics were investigated.Methods The 2005–2011 Nati...
Article
Background: Controversy exists over how long trials of nonoperative management should be pursued in patients with uncomplicated adhesive small bowel obstructions (ASBOs) before deciding to proceed with surgery. The purpose of this study was to determine the effect of incremental delays in surgery on the 30-day postoperative outcomes of patients un...
Article
Objective: To describe the outcomes of functionally dependent patients who undergo major general or vascular surgery and to determine the relationship between functional health status and early postoperative outcomes. Background: In contrast to frailty, functional health status is a relatively easy entity to define and to measure and therefore m...
Article
Background: Nonelective procedure status is the greatest risk factor for postoperative morbidity and mortality in patients undergoing thoracic aortic operations. We hypothesized that uninsured patients were more likely to require nonelective thoracic aortic operation due to decreased access to preventative care and elective surgical services. Met...
Article
Background Despite the rising incidence of hepatocellular carcinoma (HCC), challenges and controversy persist in optimizing treatment. As recent randomized trials suggest that ablation may have oncologic equivalence compared to resection for early HCC, the relative morbidity of the two approaches is a central issue in treatment decisions. Although...
Article
To compare early postoperative outcomes of patients undergoing different types of emergency procedures for bleeding or perforated gastroduodenal ulcers. Although definitive acid-reducing procedures are being used less frequently during emergency ulcer surgery, there is little published data to support this change in practice. A retrospective analys...
Article
Although the relationship between psychoactive substance use and injury is known, evidence remains conflicting on the impact of substance use on clinical outcomes after injury. We hypothesized that preinjury substance use would negatively impact clinical outcomes. National Trauma Registry American College of Surgeons identified patients (n = 9793)...
Article
The use and need of helicopter aeromedical transport systems (HEMSs) in health care today is based on the basic belief that early definitive care improves outcomes. Helicopter aeromedical transport system is perceived to be safer than ground transport (GT) for the interfacility transfer of patients who have sustained spinal injury because of the co...
Article
Various predictors of perioperative risk for patients with rectal cancer undergoing radical resection have been well described, but no simple scoring system for surgeons to estimate this risk currently exists. The objective of this study was to develop a system for more accurate preoperative evaluations of competing risks and more informed shared d...
Article
Elderly patients who have preexisting DNR orders experience a high incidence of mortality and major morbidity within 30 days after emergency general surgery. Although not a risk factor for major morbidity, preoperative DNR status does represent an independent risk factor for mortality after emergency general surgery. The most plausible reason for t...
Article
Complex, oncologic surgery is an important component of resident education. Our objective was to evaluate the impact of resident participation in oncologic procedures on overall 30-day morbidity and mortality. A retrospective cohort analysis was performed using the National Surgical Quality Improvement Program Participant User Files for 2005-2009....
Article
Background: With the aging population and increasing incidence of hepatic malignancies in elderly patients, establishing the safety of hepatic resections is crucial. The present study investigates early postoperative morbidity and mortality in elderly patients undergoing hepatic resection using a nationally validated database. Methods: The Natio...
Article
Background: Although surgical management remains the mainstay of therapy for gallstone ileus, the optimal approach--enterolithotomy alone or combined with biliary-enteric fistula disruption--is controversial because of the reliance on small single-center series to describe outcomes. Using the American College of Surgeons' National Surgical Quality...
Article
Background: Although the existing literature suggests that laparoscopic adrenalectomy may be associated with less postoperative morbidity than open adrenalectomy, a comparison of the two approaches has not been published using American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data. The objective of our analysis...
Article
There are very few data currently published on risk factors for early failure of lower extremity amputation procedures. All patients from the 2005-2010 American College of Surgeons NSQIP database who underwent isolated lower extremity amputation were included for analysis (excluding patients with earlier operation within 30 days, patients undergoin...
Article
Objective: To assess trends in the frequency of concomitant vascular reconstructions (VRs) from 2000 through 2009 among patients who underwent pancreatectomy, as well as to compare the short-term outcomes between patients who underwent pancreatic resection with and without VR. Design: Single-center series have been conducted to evaluate the shor...
Article
Objective To describe the outcomes and the expected postoperative course for patients with do-not-resuscitate (DNR) orders (DNR patients) who undergo emergency surgical management of bowel obstruction. Design We retrospectively identified all patients who underwent emergency surgical management of intestinal obstruction and who were classified prev...
Article
Background: A laparoscopic approach has been proposed to reduce the high morbidity and mortality associated with the Hartmann procedure for the emergency treatment of diverticulitis. Objective: The objective of our study was to determine whether a laparoscopic Hartmann procedure reduces early morbidity or mortality for patients undergoing an eme...
Article
The objective of our analysis was to determine the optimal timing of cholecystectomy during admission for acute cholecystitis. All patients from the American College of Surgeons National Surgical Quality Improvement Program Participant User Files from 2005 through 2010 who underwent emergency cholecystectomy within 7 days of hospital admission for...
Article
Background: Although a concomitant diaphragm resection might be required at the time of hepatectomy to achieve tumor-free surgical margins, studies addressing its effect on postoperative morbidity and mortality have been inconclusive. The objective of this study was to determine whether the need for diaphragm resection at the time of hepatectomy t...
Article
Placement of a feeding jejunostomy tube (FJ) is often performed during pancreaticoduodenectomy (PD). Few studies, however, have sought to determine whether such placement affects postoperative outcomes after PD. This is a retrospective analysis of the National Surgical Quality Improvement Program (NSQIP) database to determine the 30-d-postoperative...
Article
Background: An endovascular approach is increasingly used for the treatment of peripheral arterial trauma (PAT), but evidence supporting this approach is lacking. The objective of our study was to assess outcomes for endovascular repair (ER) versus operative repair (OR) in PAT. Methods: We used the National Trauma Data Bank from 2007 to 2009 for...
Article
The objectives of our study were to determine the association between age and postoperative outcomes after emergency surgery for diverticulitis and to identify risk factors for postoperative mortality among elderly patients. All patients from the American College of Surgeons National Surgical Quality Improvement Program 2005-2009 Participant User F...
Article
Background: Several single-center reports suggest that vascular resection (VR) during pancreaticoduodenectomy (PD) for patients with pancreatic adenocarcinoma is feasible without affecting early postoperative mortality or morbidity. Our objective is to review the outcomes associated with VR during PD using a large multicenter data source. Methods...
Article
To describe the outcomes of elderly patients with do-not-resuscitate (DNR) status who undergo emergency general surgery and to improve understanding of the relationship between preoperative DNR status and postoperative mortality. Preoperative DNR status has previously been shown to predict increased postoperative mortality, although the reasons for...