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S45Vol. 209, No. 3S, September 2009 Surgical Forum Abstracts

IFLE classification is predictive of increasedortality in critically injured patients

eed B Kuehn MD, Kelly M Bochicchio RN, MS,rant V Bochicchio MS, RN, Xiao Y Yu MS,homas M Scalea MD, FACS, Olanrewaju Olaoye MDAdams Cowley Shock Trauma Center, Baltimore, MD

NTRODUCTION: RIFLE score, a newly developed classificationor acute kidney injury, defines 3 grades of severity—Risk, Injury,nd Failure based on serum creatinine or urine output. Our objectiveas to evaluate the efficacy of this system in predicting outcome in

rauma patients.

ETHODS: Prospective data were collected on 203 critically in-ured patients admitted to the ICU over a 7-month period in whichhe RIFLE classification was assigned. Patients with traumatic ana-omical renal injury were excluded.

ESULTS: By using urine output, 17 patients (8.5%) were in theisk category, 35 (17.4%) in the Injury category, and 8 (4%) in theailure category. By using creatinine change, 22 patients (10.9%)ere in the Risk category, 11 (5.5%) were in the Injury category, and(3.5%) were in the Failure category. When analyzed by logistic

egression analysis, RIFLE classification of Failure by urine outputas highly predictive of mortality (odds ratio [OR] � 17.9,�0.001). When using creatinine change, Injury was most predic-ive of mortality (OR � 12.6; p�0.001) When controlling for age,SS, race, sex, and mechanism, PRBC transfusion (OR � 1.1;�0.025), FFP transfusion in the first 24 hours (OR � 1.1;�0.004), and open abdomen (OR� 60.2; p�0.001) were predic-ive of Failure by using urine output. When using creatinine changen the model, open abdomen (OR � 16.1; p�0.006) and plateletransfusion (OR � 2.36; p�0.006) were most predictive of Failure.

ONCLUSIONS: RIFLE score is an effective tool in predictingcute renal failure in critically injured trauma patients.

rends in obesity and implications on the burdenrom crash injury: A prospective studywori J Hayanga MD, MPH, Brian S Knipp MD,hristopher J Pannucci MD, Stewart C Wang MD, PhD, FACSniversity of Michigan, Ann Arbor, MI

NTRODUCTION: Obesity is epidemic worldwide. United Statesrash injury data (CIREN) suggest that a growing proportion of

ubjects injured in motor vehicle crashes are obese.

ETHODS: Prospective study performed on 355 adult patients re-ruited into the Crash Injury Research Engineering Network (CI-EN) study between 1998 and 2004. Each had sustained 1 injuryith AIS � 3 or 2 injuries with AIS � 2 in any 2 body regions. A

rash reconstruction team collected data to determine the crash se-erity.

ESULTS: 355 occupants involved in motor vehicle crashesMVCs) were recruited. BMI was calculated for each. 4% were un-erweight (BMI � 18.5), 36% normal weight (18.5 � BMI � 25),4% overweight (25 � BMI � 30), and 26% were obese (30 �

MI). There was no difference in crash severity between the normal e

nd obese groups (OG). The OG sustained a significantly greaterumber of lower extremity (LE) fractures than the normal BMIroup (p�.01). Following frontal impact, MAIS trended lower inhe OG than in normal BMI occupants with the exception of the LE,here the MAIS was higher. Obesity was thus significantly associatedith decreased MAIS of the head (p�.03) and face (p �.0140) but

ncreased for lower extremities (p�.05). In the side-impact group,owever, abdominal MAIS was significantly higher in OG (p�.05),s was upper extremity MAIS (p � .001).

ONCLUSIONS: Obesity is associated with large differences in in-ury patterns to different body regions, and the increased risk andeverity of injury has clinical and motor vehicle–design implications.

ow-molecular-weight heparin prophylaxis does notffect perioperative venous thromboembolismuliya Yurko, MD, Dimitris Stefanidis MD, Amy Lincourt PhD,onald Sing MD, B Todd Heniford MD, FACSarolinas Medical Center, Charlotte, NC

NTRODUCTION: Venous thromboembolism (VTE) is a majorause of morbidity and mortality among surgical patients. Our ob-ective was to assess the comparative effectiveness of 2 perioperativerophylactic regimens.

ETHODS: Records for hospitalized patients undergoing surgery be-ween 2003 and 2008 and having at least 1 risk factor for VTE wereeviewed. Patients younger than 40 years and those with proceduresasting �45 minutes were excluded. Patients were divided in 2 groups:hose receiving sequential compression devices (SCD) only and thoseeceiving SCD and low-molecular-weight heparin (LMWH). Standard-ose LMWH was administered before surgery and resumed within 12 to4 hours postoperatively. Patient age, BMI, ASA, OR time, EBL, LOS,nd postoperative VTE incidence were compared between the groupsor laparoscopic and open procedures.

ESULTS: Of 1,222 included patients, 831 received SCD only and91 received LMWH. For laparoscopic procedures, patients receivingMWH had greater EBL (138.4 vs 73.5 mL; p�0.001) and a higher

ncidence of postoperative VTE (4.5% vs 0.78%; p�0.04). For openases, VTE incidence was higher in the LMWH group but not statisti-ally different compared with the SCD group (4.9% vs 2.0%;�0.4).All patients considered, the incidence of VTE was higher in theMWH group (2.6% in Lovenox group vs 0.36% in SCD; p�0.001).

ONCLUSIONS: In this study, we found a surprising higher incidencef VTE in surgical patients receiving VTE prophylaxis with LMWHompared with SCD alone. These findings question the routine use ofMWH perioperatively, but further study is needed to verify these findings.

cute alcohol intoxication attenuates theeuroinflammatory response to traumatic brain injuryichael D Goodman, MD, Amy T Makley MD,

lex B Lentsch PhD, Timothy A Pritts MD, PhDniversity of Cincinnati, Cincinnati, OH

NTRODUCTION: Traumatic brain injury (TBI) initiates an endog-

nous neuroinflammatory response that increases the risk of TBI-