Massachusetts Chapter of the American College of Surgeons

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The Hidden Victims of the Vaping Epidemic: Children
Robert L. Parisien MD1, Itai Gans MD1, Kevin Pirruccio BS2, Martin Griffis MD1, Jason F. Hine MD3
1University of Pennsylvania & The Children’s Hospital of Philadelphia 2Perelman School of Medicine at the University of Pennsylvania 3Tufts University School of Medicine & Maine Medical Center

Background: The burden of surgical disease from elderly patients is expected to increase in coming decades and elderly patients with frailty syndrome have a greater risk of poor post-operative outcomes. In this study, we sought to implement an assessment tool to identify frail patients as well as an intervention to provide targeted interventions.
Methods: The intervention in this study was the implementation of a five-question frailty score for elderly surgical patients admitted to the general and vascular surgery departments in an urban, safety-net hospital from January 2018 to December 2019. Frail patients received a bundled set of evidence-based clinical orders and nursing interventions tailored to optimize recovery. Implementation effectiveness was assessed through provider and nurse surveys, floor audits, and chart review.
Results: Out of 1158 patients who were included in the study, the frailty assessment was completed on 696 patients. There were 611 patients scored as frail. Frail patients were significantly more likely to receive bundled interventions. Lack of time was the largest barrier to assessment completion by providers. Floor audits showed that there was high variation in completion of care plan components by nursing staff. Frail patients had higher inpatient complications and less favorable discharge dispositions but no differences in 30-day mortality.
Conclusion: A frailty assessment was able to identify elderly patients at high risk of post-operative complications, but limited uptake of the assessment by providers and completion of care plan components by nursing staff were significant barriers in implementation. <0.05 considered significant.
Results: The annualized average number of vaping-associated cases between 2014 and 2018 was identified as 1,176. Injuries were observed in white (62.4%), black (4%) and Hispanic patients (2.1%) with nearly one-third (28.0%) classified as race not specified. More than half of patients (58.5%) sustained a PAVI in their own home with 8.2% of patients requiring hospital admission. PAVIs most commonly occurred in patients 0 to 3 years of age (59.8%) and the average age of patients who sustained a PAVI secondary to ingestion of liquid products was 2.0 years. Poisoning and burn injuries afflicted 61.5% and 29.0% of patients, respectively. Mechanisms of injuries were mainly accidental ingestion of liquid vaping-associated products (61.5%) and explosions of vaping-associated products while in patients’ pant pocket (22.4%).
Conclusion: We recommend careful and comprehensive reporting of all VAIs to distinctly identify and understand the true scope of this surging public health crisis. Only then may we begin to construct detailed initiatives and campaigns to protect the hidden victims of the vaping epidemic: children.


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