World Journal of Surgery最新文献

{"title":"Spontaneous Retroperitoneal Hematoma: Clinical Profile and Predictors of Mortality.","authors":"Marta Durante, Maria Mascaro, Laura Calsina, Alina Velescu, Joan Ramon Masclans, Albert Clara","doi":"10.1002/wjs.12642","DOIUrl":"https://doi.org/10.1002/wjs.12642","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous retroperitoneal hematoma (SRPHs) is a serious disorder infrequently reported in the literature. Our aim was to analyze the clinical profile and management of a series of cases and to determine mortality predictors.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>We studied the consecutive series of patients with a SRPH at a university hospital from 2008 to 2023. Collected variables included clinical, physiological, and analytical characteristics as well as treatments provided. A modified Acute Physiology and Chronic Health Disease Classification System II (m-APACHE II) and Charlson scores were calculated. The association of these factors with mortality during hospital admission and follow-up were evaluated with logistic and Cox regression, respectively.</p><p><strong>Results: </strong>Eighty-five patients with SRPH (mean age 75 years, 62.4% males) were identified. Of these, 56 (65.9%) were admitted for reasons other than SRPH, 67 (78.8%) received anticoagulants, and 53 (62.4%) had active bleeding on a CT scan. Seven patients were treated with palliative care. In the remaining 78 patients, management included transfusion (71 cases, 91%), anticoagulation reversal (25 cases, 32.1%), vasoactive drugs (21 cases, 26.9%), and admission to intermediate or critical care units (40 cases, 51.3%). Angiography was indicated in 34 (43.6%) patients, including embolization in 30 of these cases. Surgical drainage was required in two cases. Nineteen patients (24.5%) died during admission. m-APACHE II score (OR = 1.21; 1.08-1.36) was a predictive factor. One- and 5-year survival rates among hospital survivors were 68.4% and 29.2%, respectively. Survival was independently associated with the Charlson Comorbidity Index score (HR = 1.36; 1.14-1.63) and polypharmacy (HR = 1.13; 1.02-1.24).</p><p><strong>Conclusion: </strong>SRPH is a serious disorder that requires complex therapeutic measures (critical care and angiography) in about half of patients. Several well-known scores are good predictors of mortality and could be useful in clinical decision-making.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing Pediatric Trauma Survival Prediction: Integrating ICISS and Glasgow Coma Scale for Greater Accuracy.","authors":"A De Los Ríos-Perez, A García Marin, A Giraldo Arboleda, A Fandiño-Losada","doi":"10.1002/wjs.12611","DOIUrl":"https://doi.org/10.1002/wjs.12611","url":null,"abstract":"<p><strong>Background: </strong>The mortality rate from injuries globally has declined but remains high in the Americas. Despite the proven efficacy of severity scores in improving injury outcomes, their use in Latin American children has been limited. We aimed to assess the predictive performance of the International Classification of Disease-based Injury Severity Score (ICISS) in children's survival and compare it with a novel predictive model.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted at a trauma center in Cali, Colombia, including children (< 18 years) with trauma-related diagnoses from 2011 to 2019, utilizing electronic health records from the Colombian national health system. A logistic regression model was developed to predict 30-day survival. Its performance was assessed by discrimination with the area under the receiver operating characteristic curve (AUROC) and calibration and was statistically compared with a new model incorporating the Glasgow Coma Score (GCS). The new model was internally validated by bootstrap resampling.</p><p><strong>Results: </strong>The study included 1047 children. The new model demonstrated superior discrimination (AUROC: 0.98, 95% CI: 0.97-0.99) compared to the ICISS-only model (AUROC: 0.94, 95% CI: 0.92-0.97), with a statistically significant difference (p = 0.01). Additionally, it exhibited better calibration (Hosmer-Lemeshow test: 6.7, p = 0.6 vs. 24.7, p < 0.01), indicating improved predictive accuracy. Following internal validation, the new model maintained excellent performance across all measures.</p><p><strong>Conclusions: </strong>Combining ICISS with the GCS significantly improved the accuracy of survival prediction in children.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Low Colorectal/Coloanal Anastomotic Leak: Results of a French National Intergroups Practice Survey (FRENCH-GRECCAR-SFCD).","authors":"Clément Pastier, Wafa Ben Hmida, Jérémie H Lefèvre, Quentin Denost, Lilian Schwarz, Stéphane Berdah, Eddy Cotte, Mehdi Karoui, Léon Maggiori, Solafah Abdalla, Antoine Brouquet, Stéphane Benoist","doi":"10.1002/wjs.12634","DOIUrl":"https://doi.org/10.1002/wjs.12634","url":null,"abstract":"<p><strong>Aims: </strong>Anastomotic leakage (AL) impacts short-term and long-term outcomes after colorectal surgery, yet no consensus exists regarding its diagnosis and management. The aim was to establish a proactive consensus-based approach for diagnosing and treating AL following rectal cancer surgery through a national survey.</p><p><strong>Methods: </strong>A questionnaire was designed to assess 24 clinical scenarios related to the diagnosis and management of fistulas in low colorectal (LCA) or coloanal anastomosis (CAA) with a diverting ileostomy.</p><p><strong>Results: </strong>A total of 203 surgeons from three surgical societies participated. Consensus was reached on four key indicators warranting further investigation of AL: CRP > 250 mg/L, fever ≥ 38.5°C, tachycardia > 100 bpm, and diffuse abdominal pain. In the presence of any warning sign, 87% recommended an urgent contrast-enhanced abdominopelvic CT scan without routine rectal contrast as the first-line diagnostic tool. Isolated extra-digestive air bubbles or uncollected effusions without air bubbles were managed with antibiotics (61%-78%). A perianastomotic collection required an anal examination under general anesthesia (70%). For treatment, transanal drainage (56%) was preferred over image-guided percutaneous drainage, combined with endoluminal vacuum therapy and at least 7 days of antibiotics (97%). Drain removal was recommended (64%) when imaging confirmed the absence of residual collection.</p><p><strong>Conclusions: </strong>This national survey established a consensus-driven proactive management algorithm for LCA/CAA fistulas. Further validation controlled trial is needed to confirm the effectiveness in reducing AL-related complications.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subtotal Gastrectomy for Clinical Stage I Remnant Gastric Cancer.","authors":"Ryuhei Aoyama, Shigeru Tsunoda, Ryosuke Okamura, Yoshito Yamashita, Hiroaki Hata, Yosuke Kinjo, Akira Miki, Seiichiro Kanaya, Michihiro Yamamoto, Koichi Matsuo, Dai Manaka, Eiji Tanaka, Hironori Kawada, Masato Kondo, Atsushi Itami, Takatsugu Kan, Yoshio Kadokawa, Tetsuo Ito, Kenjiro Hirai, Hisahiro Hosogi, Tatsuto Nishigori, Shigeo Hisamori, Nobuaki Hoshino, Kazutaka Obama","doi":"10.1002/wjs.12638","DOIUrl":"https://doi.org/10.1002/wjs.12638","url":null,"abstract":"<p><strong>Background: </strong>Subtotal gastrectomy (SG) is a surgical option for early remnant gastric cancer (RGC). However, reports evaluating the feasibility and oncological safety of SG for RGC are limited. Here, we aimed to evaluate the short- and long-term outcomes of SG for RGC.</p><p><strong>Methods: </strong>We conducted a multi-institutional retrospective cohort study and compared the outcomes between SG and completion gastrectomy (CG) of patients with clinical stage I RGC. The short- and long-term outcomes, body weight change, and serum albumin level at 1 year postoperatively were evaluated.</p><p><strong>Results: </strong>Twenty-two and 202 patients in the SG and CG groups, respectively, were included in the analysis. The risk ratios (95% confidence interval [CI]) were 0.90 (0.27, 2.22) and 0.51 (0.33, 2.47) for the overall and severe complications, respectively. No anastomotic leakage was observed in the SG group, while 6.4% of the CG group had anastomotic leakage (p = 0.62). The 3-year relapse-free survival rates were 79.8% and 78.8% in the SG and CG groups, respectively (hazard ratio [95% CI], 0.87 [0.31, 2.40]; p = 0.80). The median body weight changes at 1 year postoperatively from the preoperative level were significantly less in the SG group (96.4% and 90.4% in the SG and CG groups, respectively; p = 0.021), and the median serum albumin changes at 1 year postoperatively were + 0.01 and -0.04 g/dL, respectively (p = 0.551).</p><p><strong>Conclusion: </strong>SG might be one of the potential options for clinical stage I RGC, if the proximal margin is secured.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role and Performance of Postoperative Imaging After Repair of a Perforated Peptic Ulcer.","authors":"Veljko Strajina, Sarah B Lund, Rebecca Zhu, Ashish Khandelwal, Daniel Stephens, John M Zietlow, Stephanie F Heller, David Turay, Khalid H Mahmoud, William S Harmsen, Amin Mohamed Ahmed","doi":"10.1002/wjs.12622","DOIUrl":"https://doi.org/10.1002/wjs.12622","url":null,"abstract":"<p><strong>Background: </strong>We aimed to determine the performance of postoperative computed tomography (CT) and upper gastrointestinal series (UGI) in patients who underwent surgery for a perforated peptic ulcer and to assess the yield of routine postoperative studies.</p><p><strong>Methods: </strong>Retrospective, single-institution, chart-review study of patients who underwent a repair of a perforated gastric or duodenal ulcer between August 2004 and September 2021 at Mayo Clinic, Rochester, Minnesota.</p><p><strong>Results: </strong>We identified a total of 240 patients, 28 (12%) were found to have leaks. When any of the four findings (extraluminal gas or fluid collection adjacent to the repair, worsening pneumoperitoneum, or enteral contrast extravasation) was present on postoperative CT scan (n = 116) it had sensitivity of 76% (95% CI 53%-90%), with a specificity of 90% (95% CI 84%-91%). Upper gastrointestinal series (UGI, n = 150) showed a sensitivity of 57% (95% CI 25%-84%) and a specificity of 99% (95% CI 96%-100%). UGI demonstrated higher specificity compared to CT (p < 0.01); there was no significant difference in sensitivity (p = 0.34). The findings from CT scans led to changes in management for a significantly greater number of patients compared to UGI (20% vs. 4%, p < 0.01). The diagnostic yield for leak identification was 3% for routine postoperative CT (n = 63) and 2% for routine UGI studies (n = 141).</p><p><strong>Conclusions: </strong>Postoperative CT is more likely to change management in patients who underwent repair of a perforated peptic ulcer compared to postoperative upper gastrointestinal series. The yield of routine postoperative studies is low, and their benefit is uncertain.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization of a Trauma Quality Improvement Tool in a Clinical Trial: Effects When Tool Not Used.","authors":"Adam Gyedu, Adamu Issaka, Peter Donkor, Charles Mock","doi":"10.1002/wjs.12633","DOIUrl":"https://doi.org/10.1002/wjs.12633","url":null,"abstract":"<p><strong>Introduction: </strong>A standardized trauma intake form (TIF) with built-in memory prompts was previously shown to increase achievement of key performance indicators (KPIs) of trauma care. We sought to understand what differentiated patients who did and did not have the TIF used and how this affected care. We also sought to assess whether TIF introduction resulted in hospital-wide improvements in care, even in patients for whom the TIF was not used.</p><p><strong>Methods: </strong>We used data from a prior randomized clinical trial at eight nontertiary hospitals (2020-2021) in Ghana. In this trial, there was a baseline (before) period, after which the TIF was introduced. TIF use and achievement of 16 KPIs were recorded by trained observers.</p><p><strong>Results: </strong>We enrolled 2067 patients (before period) and 2010 patients (after period), of whom 1720 had the TIF used and 290 did not. Patients who did not have the TIF used were more likely to be < 18 years, treated at first-level hospitals, treated during off-hours, and less likely to be seriously injured (ISS ≥ 9) than patients who had the TIF used (all p < 0.05). Patients who had the TIF used were more likely to have 11/16 KPIs performed compared to those who did not have the TIF used. For example, chest examination was performed in 99.5% of patients who had the TIF used versus 80% of those who did not (p < 0.001). Comparing all three groups as follows: Before the TIF (baseline), 2/16 KPIs were performed in ≥ 90% of patients. After TIF introduction, in the group in which the TIF was used, this increased to 15/16 KPIs being performed in ≥ 90% of patients. However, in the after period, but without TIF use, 4/16 KPIs were performed in ≥ 90% of patients, which was higher than baseline but not as high as with TIF use.</p><p><strong>Conclusions: </strong>TIF use led to improved care. Care of patients who did not have the TIF used improved compared to the before period, suggesting hospital-wide improvements. This improvement was modest, indicating that TIF use in all trauma patients remains the goal. Groups with low TIF usage should be the focus for efforts to improve TIF usage and trauma care in future trials and quality improvement efforts.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov: NCT04547192.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contrast-Enhanced Ultrasound Predicts Surgical Margin Positivity in Patients With Breast Cancer Who Underwent Partial Mastectomy.","authors":"Hiroaki Shima, Fukino Satomi, Daisuke Kyuno, Noriko Nishikawa, Satoko Uno, Yuta Kondo, Ai Noda, Takashi Nakamura, Toru Mizuguchi","doi":"10.1002/wjs.12628","DOIUrl":"https://doi.org/10.1002/wjs.12628","url":null,"abstract":"<p><strong>Background: </strong>The clinical disadvantage of positive margins in partial mastectomy for patients with operable breast cancer is clear and must be avoided; however, there is still room for improvement. The usefulness of contrast-enhanced ultrasound (CEUS) in diagnosing spread is currently well-known. The CEUS-enhanced area for breast cancer tends to be wider than that observed in B-mode US and probably includes cancer cells. Therefore, we focused on the difference obtained by subtracting the maximum diameter on B-mode US from that on CEUS. This parameter tends to be greater than zero. However, there are tricky cases in which such enhancements are not visible, and the enhanced area remains limited to a small region. This study aimed to analyze the correlation between characteristic findings and positive for margins in order to ultimately prove potential usefulness of CEUS in making the surgical margin negative.</p><p><strong>Methods: </strong>We retrospectively evaluated the data of consecutive 142 patients with breast cancer who underwent partial mastectomy to explore the effect on positive margins when the CEUS enhancing area was smaller than the B-mode US visualized mass (CEUS-B ≤ 0).</p><p><strong>Results: </strong>Positive surgical margins were observed in 14 out of 142 patients. CEUS-B ≤ 0 was associated with significantly more positive margins (p = 0.0467). CEUS-B was also extracted as an independent predictor on multivariate analysis.</p><p><strong>Conclusions: </strong>The findings of no enhancement outside the area of visible tumor on CEUS but not visualized outside the area of visible tumor on B-mode US might be a risk factor for a positive surgical margin.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of ABI and API Versus CTA to Identify Surgically Significant Arterial Injury After Lower Extremity Trauma in a LMIC.","authors":"Rubinette Robbertze, Megan Lubout, Daniel Nicholas Prince, Isabella Margaretha Joubert, Maeyane S Moeng","doi":"10.1002/wjs.12623","DOIUrl":"https://doi.org/10.1002/wjs.12623","url":null,"abstract":"<p><strong>Background: </strong>South Africa faces a high burden of trauma-related vascular injury. Prompt diagnosis and management are crucial to limit morbidity and mortality. Literature recommends a thorough vascular examination of at-risk patients. Ankle brachial index (ABI) and arterial pressure index (API) are considered reliable screening tools for lower extremity vascular injury (LEVI) in the correct clinical scenario. Patients with an abnormal ABI/API warrant diagnostic imaging with computed tomography angiography (CTA). However, recent international literature demonstrates a trend toward potential CTA overuse in the work up for LEVI, when the internationally recommended vascular injury work-up guidelines are not followed correctly.</p><p><strong>Aim: </strong>To assess the reliability of ABI/API in trauma patients with suspected LEVI as a screening tool to safely avoid unnecessary CTA.</p><p><strong>Methods: </strong>A retrospective cohort study of all lower extremity trauma patients with soft signs of LEVI who presented to Charlotte Maxeke Johannesburg Academic Hospital from February 1, 2018 to January 31, 2020 was undertaken. Sensitivity, specificity, NPV, and PPV were calculated for ABI/API versus CTA and ABI/API/CTA versus surgically significant arterial injury. A p-value < 0.05 indicated statistical significance (confidence level = 95%).</p><p><strong>Results: </strong>Four hundred and thirty-three CTAs were performed for suspected traumatic LEVI. Two hundred and eighty-two were excluded due to missing data (precluding retrospective calculation of ABI/API) and 151 patients were included. To detect surgically significant injury, CTA had a 100% sensitivity, 97.2% specificity, 100% NPV, and 69.2% PPV; ABI and API had a 100% sensitivity, 83.8%-85.9% specificity, 100% NPV, and 28.1%-35.9% PPV, respectively. Neither ABI nor API missed surgically significant arterial injuries.</p><p><strong>Conclusion: </strong>This affirms the reliability of ABI/API as a screening tool to identify patients at risk of LEVI from penetrating trauma. Findings supported international data demonstrating CTA overuse in this subset of patients.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of the FASILA Score for Predicting Interventions and Outcomes in Traumatic Abdominal and Pelvic Injuries: A Prospective Clinical Study.","authors":"Ayman El-Menyar, Ahmed F Ramzee, Basel H Elmegabar, Mohammad Asim, Ruben Peralta, Vishwajit Verma, Husham Abdelrahman, Hisham Jogol, Muniba Afzal, Yasir Abdulrahman, Nuri Abdurraheim, Ahad Kanbar, Tariq Siddiqui, Sandro Rizoli, Hassan Al-Thani","doi":"10.1002/wjs.12632","DOIUrl":"https://doi.org/10.1002/wjs.12632","url":null,"abstract":"<p><strong>Background: </strong>The FASILA score is a 7-point scale comprising the FAST (focused assessment with sonography in trauma), shock index, and serum lactate. We aimed to validate this score prospectively in patients with abdominal and pelvic trauma to predict the need for massive blood transfusion, laparotomy, and inhospital mortality.</p><p><strong>Methods: </strong>This prospective study included all adult patients who sustained abdominal and/or pelvic trauma. Pediatric patients, prehospital cardiac arrest, and severe head injury were excluded. Data were analyzed and compared with low (< 4) versus high (≥ 4) FASILA scores.</p><p><strong>Results: </strong>A total of 400 patients (mean age 36.3 ± 12.7; 90% male; and 96% had blunt trauma) were enrolled between 2022 and 2024. Patients with higher FASILA scores (19.3%) had higher rates of exploratory laparotomy and radiological interventions and received more blood transfusions. They also had longer hospital stays, higher rates of sepsis, and mortality (p = 0.001). The FASILA scores significantly correlated with shock index (r = 0.75), ISS (r = 0.38), SOFA score (r = 0.36), and abdominal AIS (r = 0.27), TRISS (r = -0.19), RTS (r = -0.26), and fibrinogen levels (r = -0.12). A FASILA score ≥ 4 had a high specificity (85.5%) and negative predictive value (80%) for predicting the need for surgery. The FASILA score was an independent predictor of blood transfusion (odds ratio 1.92 and 95% CI 1.43-2.58) after adjusting for abdominal AIS, ISS, SOFA score, and fibrinogen level. AUROC curves were better for the FASILA score than ABC score and \"SI alone\" for the prediction of MTP and surgical interventions.</p><p><strong>Conclusion: </strong>The significant association between high FASILA scores and blood transfusions, surgical interventions, and mortality indicates its usefulness in early risk stratification in abdominopelvic trauma. Multicenter studies are recommended to enhance external validity across diverse populations and settings.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Appendectomy: Predictive Factors for Major Resections in Adult Patients With Acute Appendicitis.","authors":"Manuela Monrabal Lezama, María Gracia Álvarez Jurado, Camila Bras Harriott, Maria A Casas, Francisco Schlottmann","doi":"10.1002/wjs.12588","DOIUrl":"https://doi.org/10.1002/wjs.12588","url":null,"abstract":"<p><strong>Background: </strong>Certain patients with acute appendicitis require more extensive resections due to an extensive inflammatory process. We aimed to identify predictive factors for major resections (MR) in patients undergoing laparoscopic appendectomy (LA) and determine its surgical outcomes.</p><p><strong>Material & methods: </strong>We performed a retrospective analysis of a consecutive series of adult patients (> 16 years) undergoing LA from 2006 to 2023. The cohort was divided into two groups: LA only versus MR (i.e., partial cecectomy, ileocecectomy or right colectomy). Demographics, perioperative variables and postoperative outcomes were compared. Independent risk factors for MR were determined by multivariable logistic regression analysis.</p><p><strong>Results: </strong>A total of 2319 patients were included for analysis; 2279 (98.3%) underwent LA and 40 (1.7%) MR. Patients undergoing MR were significantly older (mean age 50.1 vs. 36.2 years, p < 0.0001). Obesity prevalence was higher in MR patients (20% vs. 7.0%, p = 0.02). The median interval time from symptom onset to medical consultation was also significantly higher in MR patients (99.4 vs. 40.7 h, p < 0.0001). The presence of pneumoperitoneum, free abdominal fluid, and cecal wall thickening in CT scan were significantly more frequent in MR patients (p < 0.0001). Conversion to open surgery was more common in MR patients (30% vs. 2.1%, p < 0.0001). Overall morbidity (52.5% vs. 13.5%, p < 0.0001), Clavien III-IV complications (22.5% vs. 3.9%, p < 0.0001) and median length of stay (6.6 vs. 1.6 days, p < 0.0001) were significantly higher in the MR group. Free abdominal fluid (OR 4.9 95% CI 2.1-11.1), pneumoperitoneum (OR 7.2 95% CI 1.6-31.9) and cecal wall thickening in CT scan (OR 6.2 95% CI 2.2-17.1) were identified as independent risk factors for MR.</p><p><strong>Conclusions: </strong>Major resections for acute appendicitis are associated with significantly higher overall and major morbidity, as compared to LA. Clinical and imaging predictors of MR can help in improving surgical planning and informing patients about the higher risks of the operation.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}