About

Daniel N Holena, MD, MCSE, is an Adjunct Associate Professor of Surgery in the Department of Surgery at the University of Pennsylvania. He is board certified in General Surgery and Surgical Critical Care. Dr. Holena received his education with a B.Sc. in Biology from McGill University in 1995, an M.D. from the State University of New York at Stony Brook in 2002, and further specialized training in Clinical Research and Epidemiology at the University of Pennsylvania's Center for Clinical Epidemiology and Biostatistics, completing these in 2011 and 2015 respectively. His clinical expertise includes the treatment of traumatic injury, emergency general surgery conditions, and surgical critical care. His research interests focus on outcomes after emergency general surgery, triage biomarkers in acute trauma, and the methodology used for risk-adjusting trauma morbidity, mortality, and failure to rescue.

Research topics

• Medicine
• Pathology
• Engineering
• Operations management
• Emergency medicine
• Internal medicine
• Medical emergency
• Anesthesia

Selected publications

• Intraoperative Trauma Video Review: a Guide to Implementation

  Current Trauma Reports · 2026-04-06

  articleOpen accessSenior author

  Trauma video review (TVR) has been used for education, quality improvement, and research of the injured patient for over 3 decades, but less work has been done to explore the application of video review to other phases of injury care. While most injured patients do not require operative care, those who do are amongst the most injured and thus extension of video review programs into the operating room, or Intraoperative Trauma Video Review (IOTVR), represents a significant opportunity for further quality improvement and insight. Early experiences with IOTVR suggest that it is both technically feasible and valuable for capturing key intraoperative processes in trauma care. These include handoff quality, OR (operating room) readiness, and procedural execution. IOTVR provides objective, high-fidelity data that can highlight performance variability and uncover system-level challenges that may not be visible through traditional review methods. While initial studies show promise for using this approach to drive quality improvement and education, data demonstrating a direct impact on clinical outcomes remain limited. This guide outlines how to implement an IOTVR program in trauma centers, covering key steps like stakeholder engagement, policy development, workflow design, and governance. IOTVR captures a critical phase of injury care and offers new opportunities for quality improvement, education, and research.

  PublisherOA PDFDOI

• Standardized data definitions for adult trauma video review: an expert consensus report

  Trauma Surgery & Acute Care Open · 2026-01-01

  articleOpen access

  Background: Trauma video review (TVR) provides granular data for quality improvement, education, and research but is hampered by a lack of standardized data definitions, which limits multicenter collaboration, benchmarking, and the generalizability of findings. We aimed to develop a universal data dictionary and collection tool through an expert consensus process to standardize adult TVR data capture across institutions. Methods: The Trauma Video Review Collaborative convened a multidisciplinary panel of subject matter experts in trauma resuscitation from eight centers in the USA and Canada. Through a series of virtual meetings and discussions between May 2023 and July 2024, the group used a consensus-based process to identify and define core data elements. The development focused on core data elements directly observable from video, structured to mirror the clinical workflow of trauma resuscitation. Results: The final standardized data dictionary includes 95 items (44 categorical and 51 numeric/timestamps) with detailed definitions to ensure uniform collection. Categorical variables can be marked "unable to determine" to distinguish from missing data, as are the numeric/timestamps with a predefined timestamp. All timestamps are in military time format. Data points are pragmatically organized into five categories: (1) pre-arrival preparation, (2) handoff, (3) resuscitation period, (4) procedures and interventions, and (5) non-technical skills, incorporating the Trauma Non-Technical Skills tool. The dictionary is designed to link with registry data for patient demographics and outcomes. Conclusion: This work establishes the first expert consensus-driven, universal data dictionary for adult TVR. It provides a common lexicon to standardize data collection, facilitating robust multicenter research, enabling objective benchmarking, and lowering the barrier to entry for new TVR programs. This tool represents a critical foundational step toward creating a large-scale TVR data registry to advance the science and practice of trauma resuscitation.

  PublisherOA PDFDOI

• Under the lens: utilizing trauma video review for performance improvement, quality improvement and resident and fellow education

  Trauma Surgery & Acute Care Open · 2026-01-01

  articleOpen access

  Trauma video review (TVR) was first described in the 1980s by Dr Hoyt at the University of California, San Diego as a tool for quality improvement (QI). Since then, TVR has been utilized in numerous QI, performance improvement (PI) and education initiatives including resuscitation efficiency, procedural times and leadership skills of both the surgical and emergency medicine teams. To this effect, an American Association for the Surgery of Trauma (AAST) Annual Meeting lunch session was designed to serve as a roadmap for attendees to use to navigate both the implementation and utilization of TVR at their institution. This manuscript presents a summary of this session at the 2025 AAST Annual Meeting and reviews the basics of starting a TVR program, potential medicolegal issues that could arise and how to navigate them, and the various applications of TVR including QI, PI and resident and fellow education.

  PublisherOA PDFDOI

• Stick Or Switch: The Diminishing Returns Of Repeated Peripheral Intravenous Access Attempts In Hypotensive Trauma Patients

  Journal of the American College of Surgeons · 2026-05-07

  articleSenior author

  BACKGROUND: Peripheral intravenous (PIV) access is the first-line approach to vascular access in trauma patients. There is no evidence to guide clinicians on when to abandon PIV attempts in favor of alternative access. We sought to characterize PIV success rates, identify factors associated with success, and determine the marginal yield of sequential PIV attempts in hypotensive trauma patients. STUDY DESIGN: We analyzed data from audiovisual recordings of trauma resuscitations from a multicenter prospective study of vascular access in hypotensive (SBP <90mmHg) patients. The primary outcome was PIV attempt success rate. Secondary outcomes included attempt duration and cumulative patient-level success across sequential attempts. Generalized estimating equations with exchangeable correlation structure were used to account for clustering of attempts within patients. RESULTS: A total of 886 PIV attempts occurred in 471 patients across 18 centers. The overall PIV success rate was 67.1%. Male patient sex (adjusted OR 1.92, 95% CI 1.22-3.03, p=0.005) and the presence of a measurable initial systolic blood pressure (adjusted OR 1.84, 95% CI 1.06-3.20, p=0.03) were independently associated with PIV success. The first PIV attempt was successful in 70% of patients, and cumulative success reached 83% by the second attempt. The marginal success rate among patients without prior success dropped from 70% on the first attempt to 54% on the second and 39% on the third. CONCLUSIONS: PIV access in hypotensive trauma patients succeeds approximately two-thirds of the time. The marginal yield of sequential PIV attempts declines substantially after two failed attempts. These findings support a practice in which alternate vascular access such as intraosseous access is actively considered after a single failed PIV attempt in patients without a measurable blood pressure.

  PublisherDOI

• Transfer Status: A Driver of Failure-to-Rescue in Emergency General Surgery

  The American Surgeon · 2025-09-17

  articleSenior authorCorresponding

  Background Emergency general surgery (EGS) patients who undergo interfacility transfer (IFT) experience higher rates of complications and mortality compared to those directly admitted (DA) to a hospital. However, their failure-to-rescue (FTR) rates—defined as mortality following a major complication—remain less studied. Given the increased burden of adverse outcomes in this population, we hypothesized that IFT patients would have higher risk-adjusted FTR rates than DA patients. Methods We performed a 5-year (2016-2020) retrospective analysis using the National Surgical Quality Improvement Program (NSQIP) database, focusing on patients aged 18 years and older undergoing high-risk EGS procedures, including enterectomy, colectomy, peptic ulcer surgery, and laparotomy. To assess the impact of IFT, we employed multivariable logistic regression models, adjusting for demographic factors, comorbidities, and procedure type. Results Among 70 028 patients (52% female, 66% white, median age 66), 15 032 (21.4%) underwent IFT. After risk adjustment, IFT patients demonstrated significantly higher odds of major complications (OR 1.09, 95% CI 1.04-1.14), mortality (OR 1.23, 95% CI 1.16-1.31), and FTR (OR 1.12, 95% CI 1.04-1.19), suggesting that transferred patients are at a distinct disadvantage compared to DA patients. Discussion: Interfacility transfer is independently associated with worse outcomes in EGS patients, including higher FTR rates. These findings identify a vulnerable subpopulation of EGS patients that are readily identified by clinicians and highlights the need for future research to identify modifiable risk factors contributing to this disparity.

  PublisherDOI

• Intraoperative Trauma Video Review

  JAMA Surgery · 2025-04-16 · 4 citations

  article1st authorCorresponding

  This Surgical Innovation describes the use of video review of intraoperative trauma care and the potential to improve the quality of trauma care and create opportunities for coaching.

  PublisherDOI

• Addressing the Use of Mechanical Compression Devices in Traumatic Out-of-Hospital Circulatory Arrest

  Prehospital Emergency Care · 2025-05-05

  article
  PublisherDOI

• Utilizing Intraoperative Trauma Video Review to Assess Operating Room Preparedness for Emergent Trauma Surgery Cases

  Journal of Surgical Research · 2025-08-18 · 1 citations

  articleSenior author
  PublisherDOI

• An evaluation of emergency general surgery 30-day readmissions: Are they preventable?

  The American Journal of Surgery · 2025-08-13

  article
  PublisherDOI

• Trauma Video Review: A Guide To Implementation

  Current Trauma Reports · 2025-08-15

  articleSenior author
  PublisherDOI

Recent grants

• NIH Grant R03HL141521

  NIH · $161k · 2021

• NIH Grant K08HL131995

  NIH · $509k · 2019

Frequent coauthors

• Ryan P. Dumas

  The University of Texas Southwestern Medical Center

  3047 shared

• Michael A. Vella

  General University Hospital of Patras

  3031 shared

• Mark J. Seamon

  University of Pennsylvania

  2997 shared

• Dane Scantling

  2991 shared

• Jessica H. Beard

  Temple University

  2969 shared

• Jeffry Nahmias

  University of California, Irvine Medical Center

  2968 shared

• Jane Keating

  Lancaster General Hospital

  2967 shared

• Jacqueline J. Blank

  University of Pennsylvania

  2967 shared

Education

• MSCE, Center for Clinical Epidemiology and Biostatistics

  University of Pennsylvania

  2015

• Fellowship, Trauma & Surgical Critical Care, Division of Traumatology, Surgical Critical Care, and Emergency General Surgery

  University of Pennsylvania

  2009

• Residency, General Surgey, Surgery

  NewYork-Presbyterian Hospital/Weill Cornell Medical Center

  2007

• MD, School of Medicine

  State University of New York at Stony Brook

  2002

• BSc, Biology

  McGill University

  1996