Surgical Decision-making in Trauma and COVID

Presenter: Dr. Kia Nicholson (advisor: Drs. Ken Smith, Jason Perry, and Matthew Rosengart)        

Introduction of large-scale changes to practice in medicine often raises cost-related concerns. Anecdotally, cost is a significant barrier to the adoption of pre-hospital plasma transfusion during air transport of unstable trauma patients, despite evidence of 30-day mortality benefit in the PAMPer trial. In Dr. Nicholson's group's comprehensive cost-utility analysis, they demonstrate that pre-hospital plasma transfusion is highly cost-effective. In another, unrelated cost-effectiveness analysis, they explore the cost-effectiveness of post-discharge thromboprophylaxis, a practice that has been shown to be beneficial in a variety of other surgical populations, and demonstrate that thromboprophylaxis with rivaroxaban after discharge is cost-effective in a theoretical analysis.

Over a year into the COVID-19 pandemic, basic questions related to surgical populations have remained unanswered until recently, including the question of when operative risk returns to baseline after COVID-19 infection. Through their participation in the international multi-institutional COVIDSurg Collaborative, they have helped answer this and other questions around surgical decision-making during the COVID pandemic.