World Journal of Emergency Surgery : WJES最新文献

{"title":"The uniportal VATS in the treatment of stage II pleural empyema: a safe and effective approach for adults and elderly patients-a single-center experience and literature review.","authors":"Claudio Luciani,&nbsp;Andrea Scacchi,&nbsp;Roberto Vaschetti,&nbsp;Giancarlo Di Marzo,&nbsp;Ilaria Fatica,&nbsp;Micaela Cappuccio,&nbsp;Germano Guerra,&nbsp;Graziano Ceccarelli,&nbsp;Pasquale Avella,&nbsp;Aldo Rocca","doi":"10.1186/s13017-022-00438-8","DOIUrl":"https://doi.org/10.1186/s13017-022-00438-8","url":null,"abstract":"<p><strong>Background: </strong>Pleural empyema (PE) is a frequent disease, associated with a high morbidity and mortality. Surgical approach is the standard of care for most patients with II-III stage PE. In the last years, the minimally invasive surgical revolution involved also thoracic surgery allowing the same outcomes in terms of safety and effectiveness combined to better pain management and early discharge. The aim of this study is to demonstrate through our experience on uniportal-video-assisted thoracoscopy (u-VATS) the effectiveness and safety of its approach in treatment of stage II PE. As secondary endpoint, we will evaluate the different pattern of indication of u-VATS in adult and elderly patients with literature review.</p><p><strong>Methods: </strong>We retrospectively reviewed our prospectively collected database of u-VATS procedures from November 2018 to February 2022, in our regional referral center for Thoracic Surgery of Regione Molise General Surgery Unit of \"A. Cardarelli\" Hospital, in Campobasso, Molise, Italy.</p><p><strong>Results: </strong>A total of 29 patients underwent u-VATS for II stage PE. Fifteen (51.72%) patients were younger than 70 years old, identified as \"adults,\" 14 (48.28%) patients were older than 70 years old, identified as \"elderly.\" No mortality was found. Mean operative time was 104.68 ± 39.01 min in the total population. The elderly group showed a longer operative time (115 ± 53.15 min) (p = 0.369). Chest tube was removed earlier in adults than in elderly group (5.56 ± 2.06 vs. 10.14 ± 5.58 p = 0.038). The Length of Stay (LOS) was shorter in the adults group (6.44 ± 2.35 vs. 12.29 ± 6.96 p = 0.033). Patients evaluated through Instrumental Activities of Daily Living (IADL) scale returned to normal activities of daily living after surgery.</p><p><strong>Conclusion: </strong>In addition, the u-VATS approach seems to be safe and effective ensuring a risk reduction of progression to stage III PE with a lower recurrence risk and septic complications also in elderly patients. Further comparative multicenter analysis are advocated to set the role of u-VATS approach in the treatment of PE in adults and elderly patients.</p>","PeriodicalId":290899,"journal":{"name":"World Journal of Emergency Surgery : WJES","volume":" ","pages":"46"},"PeriodicalIF":8.0,"publicationDate":"2022-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9423701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33446414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Minimally invasive surgery in emergency surgery: a WSES survey.","authors":"Marco Ceresoli,&nbsp;Michele Pisano,&nbsp;Fikri Abu-Zidan,&nbsp;Niccolò Allievi,&nbsp;Kurinchi Gurusamy,&nbsp;Walt L Biffl,&nbsp;Giovanni D Tebala,&nbsp;Fausto Catena,&nbsp;Luca Ansaloni,&nbsp;Massimo Sartelli,&nbsp;Yoram Kluger,&nbsp;Gianluca Baiocchi,&nbsp;Federico Coccolini","doi":"10.1186/s13017-022-00451-x","DOIUrl":"https://doi.org/10.1186/s13017-022-00451-x","url":null,"abstract":"","PeriodicalId":290899,"journal":{"name":"World Journal of Emergency Surgery : WJES","volume":" ","pages":"45"},"PeriodicalIF":8.0,"publicationDate":"2022-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9422089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33446583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diversity and ethics in trauma and acute care surgery teams: results from an international survey.","authors":"Lorenzo Cobianchi,&nbsp;Francesca Dal Mas,&nbsp;Maurizio Massaro,&nbsp;Walter Biffl,&nbsp;Fausto Catena,&nbsp;Federico Coccolini,&nbsp;Beatrice Dionigi,&nbsp;Paolo Dionigi,&nbsp;Salomone Di Saverio,&nbsp;Paola Fugazzola,&nbsp;Yoram Kluger,&nbsp;Ari Leppäniemi,&nbsp;Ernest E Moore,&nbsp;Massimo Sartelli,&nbsp;George Velmahos,&nbsp;Sarah Woltz,&nbsp;Peter Angelos,&nbsp;Luca Ansaloni","doi":"10.1186/s13017-022-00446-8","DOIUrl":"https://doi.org/10.1186/s13017-022-00446-8","url":null,"abstract":"<p><strong>Background: </strong>Investigating the context of trauma and acute care surgery, the article aims at understanding the factors that can enhance some ethical aspects, namely the importance of patient consent, the perceptiveness of the ethical role of the trauma leader, and the perceived importance of ethics as an educational subject.</p><p><strong>Methods: </strong>The article employs an international questionnaire promoted by the World Society of Emergency Surgery.</p><p><strong>Results: </strong>Through the analysis of 402 fully filled questionnaires by surgeons from 72 different countries, the three main ethical topics are investigated through the lens of gender, membership of an academic or non-academic institution, an official trauma team, and a diverse group. In general terms, results highlight greater attention paid by surgeons belonging to academic institutions, official trauma teams, and diverse groups.</p><p><strong>Conclusions: </strong>Our results underline that some organizational factors (e.g., the fact that the team belongs to a university context or is more diverse) might lead to the development of a higher sensibility on ethical matters. Embracing cultural diversity forces trauma teams to deal with different mindsets. Organizations should, therefore, consider those elements in defining their organizational procedures.</p><p><strong>Level of evidence: </strong>Trauma and acute care teams work under tremendous pressure and complex circumstances, with their members needing to make ethical decisions quickly. The international survey allowed to shed light on how team assembly decisions might represent an opportunity to coordinate team member actions and increase performance.</p>","PeriodicalId":290899,"journal":{"name":"World Journal of Emergency Surgery : WJES","volume":" ","pages":"44"},"PeriodicalIF":8.0,"publicationDate":"2022-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9364511/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40708033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome of necrotizing fasciitis and Fournier's gangrene with and without hyperbaric oxygen therapy: a retrospective analysis over 10 years.","authors":"Assen Mladenov,&nbsp;Katharina Diehl,&nbsp;Oliver Müller,&nbsp;Christian von Heymann,&nbsp;Susanne Kopp,&nbsp;Wiebke K Peitsch","doi":"10.1186/s13017-022-00448-6","DOIUrl":"https://doi.org/10.1186/s13017-022-00448-6","url":null,"abstract":"<p><strong>Background: </strong>Necrotizing soft tissue infections (NSTI) require immediate radical debridement, broad-spectrum antibiotics and intensive care. Hyperbaric oxygen therapy (HBOT) may be performed adjunctively, but unequivocal evidence for its benefits is still lacking.</p><p><strong>Methods: </strong>We performed a retrospective single-center study including 192 patients with necrotizing fasciitis or Fournier's gangrene to assess in-hospital mortality and outcome dependent on patient, disease and treatment characteristics with or without HBOT.</p><p><strong>Results: </strong>The in-hospital mortality rate was 27.6%. Factors associated with increased mortality according to multivariate analysis were higher age, affection of multiple or problem localizations (odds ratio (OR) = 2.88, P = 0.003), ineligibility for HBOT despite clinical indication (OR = 8.59, P = 0.005), pathogens in blood cultures (OR = 3.36, P = 0.002), complications (OR = 10.35, P < 0.001) and sepsis/organ dysfunction (OR = 19.58, P < 0.001). Factors associated with better survival included vacuum-assisted wound closure (OR = 0.17, P < 0.001), larger number of debridements (OR = 0.83, P < 0.001) and defect closure with mesh graft (OR = 0.06, P < 0.001) or flap (OR = 0.09, P = 0.024). When participants were stratified into subgroups without requirement of HBOT (n = 98), treated with HBOT (n = 83) and ineligible for HBOT due to contraindications (n = 11), the first two groups had similar survival rates (75.5% vs. 73.5%) and comparable outcome, although patients with HBOT suffered from more severe NSTI, reflected by more frequent affection of multiple localizations (P < 0.001), sepsis at admission (P < 0.001) and intensive care treatment (P < 0.001), more debridements (P < 0.001) and a larger number of antibiotics (P = 0.001). In the subgroup ineligible for HBOT, survival was significantly worse (36.4%, P = 0.022).</p><p><strong>Conclusion: </strong>These results point to a benefit from HBOT for treatment of NSTI in critically ill patients.</p>","PeriodicalId":290899,"journal":{"name":"World Journal of Emergency Surgery : WJES","volume":" ","pages":"43"},"PeriodicalIF":8.0,"publicationDate":"2022-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9356491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40585228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine learning-based prediction of emergency neurosurgery within 24 h after moderate to severe traumatic brain injury.","authors":"Jean-Denis Moyer,&nbsp;Patrick Lee,&nbsp;Charles Bernard,&nbsp;Lois Henry,&nbsp;Elodie Lang,&nbsp;Fabrice Cook,&nbsp;Fanny Planquart,&nbsp;Mathieu Boutonnet,&nbsp;Anatole Harrois,&nbsp;Tobias Gauss","doi":"10.1186/s13017-022-00449-5","DOIUrl":"https://doi.org/10.1186/s13017-022-00449-5","url":null,"abstract":"<p><strong>Background: </strong>Rapid referral of traumatic brain injury (TBI) patients requiring emergency neurosurgery to a specialized trauma center can significantly reduce morbidity and mortality. Currently, no model has been reported to predict the need for acute neurosurgery in severe to moderate TBI patients. This study aims to evaluate the performance of Machine Learning-based models to establish to predict the need for neurosurgery procedure within 24 h after moderate to severe TBI.</p><p><strong>Methods: </strong>Retrospective multicenter cohort study using data from a national trauma registry (Traumabase®) from November 2011 to December 2020. Inclusion criteria correspond to patients over 18 years old with moderate or severe TBI (Glasgow coma score ≤ 12) during prehospital assessment. Patients who died within the first 24 h after hospital admission and secondary transfers were excluded. The population was divided into a train set (80% of patients) and a test set (20% of patients). Several approaches were used to define the best prognostic model (linear nearest neighbor or ensemble model). The Shapley Value was used to identify the most relevant pre-hospital variables for prediction.</p><p><strong>Results: </strong>2159 patients were included in the study. 914 patients (42%) required neurosurgical intervention within 24 h. The population was predominantly male (77%), young (median age 35 years [IQR 24-52]) with severe head injury (median GCS 6 [3-9]). Based on the evaluation of the predictive model on the test set, the logistic regression model had an AUC of 0.76. The best predictive model was obtained with the CatBoost technique (AUC 0.81). According to the Shapley values method, the most predictive variables in the CatBoost were a low initial Glasgow coma score, the regression of pupillary abnormality after osmotherapy, a high blood pressure and a low heart rate.</p><p><strong>Conclusion: </strong>Machine learning-based models could predict the need for emergency neurosurgery within 24 h after moderate and severe head injury. Potential clinical benefits of such models as a decision-making tool deserve further assessment. The performance in real-life setting and the impact on clinical decision-making of the model requires workflow integration and prospective assessment.</p>","PeriodicalId":290899,"journal":{"name":"World Journal of Emergency Surgery : WJES","volume":" ","pages":"42"},"PeriodicalIF":8.0,"publicationDate":"2022-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9351267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40689954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The LIFE TRIAD of emergency general surgery.","authors":"Federico Coccolini,&nbsp;Massimo Sartelli,&nbsp;Yoram Kluger,&nbsp;Aleksei Osipov,&nbsp;Yunfeng Cui,&nbsp;Solomon Gurmu Beka,&nbsp;Andrew Kirkpatrick,&nbsp;Ibrahima Sall,&nbsp;Ernest E Moore,&nbsp;Walter L Biffl,&nbsp;Andrey Litvin,&nbsp;Michele Pisano,&nbsp;Stefano Magnone,&nbsp;Edoardo Picetti,&nbsp;Nicola de Angelis,&nbsp;Philip Stahel,&nbsp;Luca Ansaloni,&nbsp;Edward Tan,&nbsp;Fikri Abu-Zidan,&nbsp;Marco Ceresoli,&nbsp;Andreas Hecker,&nbsp;Osvaldo Chiara,&nbsp;Gabriele Sganga,&nbsp;Vladimir Khokha,&nbsp;Salomone di Saverio,&nbsp;Boris Sakakushev,&nbsp;Giampiero Campanelli,&nbsp;Gustavo Fraga,&nbsp;Imtiaz Wani,&nbsp;Richard Ten Broek,&nbsp;Enrico Cicuttin,&nbsp;Camilla Cremonini,&nbsp;Dario Tartaglia,&nbsp;Kjetil Soreide,&nbsp;Joseph Galante,&nbsp;Marc de Moya,&nbsp;Kaoru Koike,&nbsp;Belinda De Simone,&nbsp;Zsolt Balogh,&nbsp;Francesco Amico,&nbsp;Vishal Shelat,&nbsp;Emmanouil Pikoulis,&nbsp;Isidoro Di Carlo,&nbsp;Luigi Bonavina,&nbsp;Ari Leppaniemi,&nbsp;Ingo Marzi,&nbsp;Rao Ivatury,&nbsp;Jim Khan,&nbsp;Ronald V Maier,&nbsp;Timothy C Hardcastle,&nbsp;Arda Isik,&nbsp;Mauro Podda,&nbsp;Matti Tolonen,&nbsp;Kemal Rasa,&nbsp;Pradeep H Navsaria,&nbsp;Zaza Demetrashvili,&nbsp;Antonio Tarasconi,&nbsp;Paolo Carcoforo,&nbsp;Maria Grazia Sibilla,&nbsp;Gian Luca Baiocchi,&nbsp;Nikolaos Pararas,&nbsp;Dieter Weber,&nbsp;Massimo Chiarugi,&nbsp;Fausto Catena","doi":"10.1186/s13017-022-00447-7","DOIUrl":"https://doi.org/10.1186/s13017-022-00447-7","url":null,"abstract":"<p><p>Emergency General Surgery (EGS) was identified as multidisciplinary surgery performed for traumatic and non-traumatic acute conditions during the same admission in the hospital by general emergency surgeons and other specialists. It is the most diffused surgical discipline in the world. To live and grow strong EGS necessitates three fundamental parts: emergency and elective continuous surgical practice, evidence generation through clinical registries and data accrual, and indications and guidelines production: the LIFE TRIAD.</p>","PeriodicalId":290899,"journal":{"name":"World Journal of Emergency Surgery : WJES","volume":" ","pages":"41"},"PeriodicalIF":8.0,"publicationDate":"2022-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9317062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40539646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members.","authors":"Martin Reichert,&nbsp;Massimo Sartelli,&nbsp;Markus A Weigand,&nbsp;Matthias Hecker,&nbsp;Philip U Oppelt,&nbsp;Julia Noll,&nbsp;Ingolf H Askevold,&nbsp;Juliane Liese,&nbsp;Winfried Padberg,&nbsp;Federico Coccolini,&nbsp;Fausto Catena,&nbsp;Andreas Hecker","doi":"10.1186/s13017-022-00442-y","DOIUrl":"https://doi.org/10.1186/s13017-022-00442-y","url":null,"abstract":"","PeriodicalId":290899,"journal":{"name":"World Journal of Emergency Surgery : WJES","volume":" ","pages":"39"},"PeriodicalIF":8.0,"publicationDate":"2022-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9270731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40596784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do we need repeated CT imaging in uncomplicated blunt renal injuries? Experiences of a high-volume urological trauma centre.","authors":"Andrea Katharina Lindner,&nbsp;Anna Katharina Luger,&nbsp;Josef Fritz,&nbsp;Johannes Stäblein,&nbsp;Christian Radmayr,&nbsp;Friedrich Aigner,&nbsp;Peter Rehder,&nbsp;Gennadi Tulchiner,&nbsp;Wolfgang Horninger,&nbsp;Renate Pichler","doi":"10.1186/s13017-022-00445-9","DOIUrl":"https://doi.org/10.1186/s13017-022-00445-9","url":null,"abstract":"<p><strong>Background: </strong>Current guidelines recommend repeat computed tomography (CT) imaging in high-grade blunt renal injury within 48-96 h, yet diagnostic value and clinical significance remain controversial. The aim of this work was to determine the possible gain of CT re-imaging in uncomplicated patients with blunt renal trauma at 48 h after injury, presenting one of the largest case series.</p><p><strong>Methods: </strong>A retrospective database of patients admitted to our centre with isolated blunt renal trauma due to sporting injuries was analysed for a period of 20 years (2000-2020). We included only patients who underwent repeat imaging at 48 h after trauma irrespective of AAST renal injury grading (grade 1-5) and initial management. The primary outcome was intervention rates after CT imaging at 48 h in uncomplicated patients versus CT scan at the time of clinical symptoms.</p><p><strong>Results: </strong>A total of 280 patients (mean age: 37.8 years; 244 (87.1%) male) with repeat CT after 48 h were included. 150 (53.6%) patients were classified as low-grade (grade 1-3) and 130 (46.4%) as high-grade (grade 4-5) trauma. Immediate intervention at trauma was necessary in 59 (21.1%) patients with high-grade injuries: minimally invasive therapy in 48 (81.4%) and open surgery in 11 (18.6%) patients, respectively. In only 16 (5.7%) cases, intervention was performed based on CT re-imaging at 48 h (low-grade vs. high-grade: 3.3% vs. 8.5%; p = 0.075). On the contrary, intervention rate due to clinical symptoms was 12.5% (n = 35). Onset of clinical progress was on average (range) 5.3 (1-17) days post trauma. High-grade trauma (odds ratio [OR]_{grade 4 vs. grade 3}, 14.62; p < 0.001; OR_{grade 5 vs. grade 3}, 22.88, p = 0.004) and intervention performed at the day of trauma (OR 3.22; p = 0.014) were powerful predictors of occurrence of clinical progress.</p><p><strong>Conclusion: </strong>Our data suggest that routine CT imaging 48 h post trauma can be safely omitted for patients with low- and high-grade blunt renal injury as long as they remain clinically stable. Patients with high-grade renal injury have the highest risk for clinical progress; thus, close surveillance should be considered especially in this group.</p>","PeriodicalId":290899,"journal":{"name":"World Journal of Emergency Surgery : WJES","volume":" ","pages":"38"},"PeriodicalIF":8.0,"publicationDate":"2022-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9264658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40592739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of sarcopenia in predicting postoperative mortality in emergency laparotomy: a systematic review and meta-analysis.","authors":"Tao-Ran Yang,&nbsp;Kai Luo,&nbsp;Xiao Deng,&nbsp;Le Xu,&nbsp;Ru-Rong Wang,&nbsp;Peng Ji","doi":"10.1186/s13017-022-00440-0","DOIUrl":"https://doi.org/10.1186/s13017-022-00440-0","url":null,"abstract":"<p><strong>Background: </strong>While emergency laparotomy has been associated with high rates of postoperative mortality and adverse events, preoperative systematic evaluation of patients may improve perioperative outcomes. However, due to the critical condition of the patient and the limited operation time, it is challenging to conduct a comprehensive evaluation. In recent years, sarcopenia is considered a health problem associated with an increased incidence of poor prognosis. This study aimed to investigate the effect of sarcopenia on 30-day mortality and postoperative adverse events in patients undergoing emergency laparotomy.</p><p><strong>Methods: </strong>We systematically searched databases including PubMed, Embase, and Cochrane for all studies comparing emergency laparotomy in patients with and without sarcopenia up to March 1, 2022. The primary outcome was of 30-day postoperative mortality. Secondary outcomes were the length of hospital stay, the incidence of adverse events, number of postoperative intensive care unit (ICU) admissions, and ICU length of stay. Study and outcome-specific risk of bias were assessed using the Quality in Prognosis Studies (QUIPS) tool. We rated the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE).</p><p><strong>Result: </strong>A total of 11 eligible studies were included in this study. The results showed that patients with sarcopenia had a higher risk of death 30 days after surgery (OR = 2.42, 95% CI = 1.93-3.05, P < 0.00001). More patients were admitted to ICU after surgery (OR = 1.58, 95% CI = 1.11-2.25, P = 0.01). Both the ICU length of stay (MD = 0.55, 95% CI = 0.05-1.06, P = 0.03) and hospital length of stay (MD = 2.33, 95% CI = 1.33-3.32, P < 0.00001) were longer in the sarcopenia group. The incidence of postoperative complications was also significantly higher in patients with sarcopenia (OR = 1.78, 95% CI = 1.41-2.26, P < 0.00001).</p><p><strong>Conclusion: </strong>In emergency laparotomy, sarcopenia was associated with increased 30-day postoperative mortality. Both the lengths of stay in the ICU and the total length of hospital stay were significantly higher than those in non-sarcopenic patients. Therefore, we concluded that sarcopenia can be used as a tool to identify preoperative high-risk patients, which can be considered to develop new postoperative risk prediction models. Registration number Registered on Prospero with the registration number of CRD42022300132.</p>","PeriodicalId":290899,"journal":{"name":"World Journal of Emergency Surgery : WJES","volume":" ","pages":"36"},"PeriodicalIF":8.0,"publicationDate":"2022-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9233792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40399362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Penetrating renal injuries: an observational study of non-operative management and the impact of opening Gerota's fascia.","authors":"Thomas W Clements,&nbsp;Chad G Ball,&nbsp;Andrew J Nicol,&nbsp;Sorin Edu,&nbsp;Andrew W Kirkpatrick,&nbsp;Pradeep Navsaria","doi":"10.1186/s13017-022-00439-7","DOIUrl":"https://doi.org/10.1186/s13017-022-00439-7","url":null,"abstract":"<p><strong>Background: </strong>Non-operative management has become increasingly popular in the treatment of renal trauma. While data are robust in blunt mechanisms, the role of non-operative management in penetrating trauma is less clear. Additionally, there is a paucity of data comparing gunshot and stab wounds.</p><p><strong>Methods: </strong>A retrospective review of patients admitted to a high-volume level 1 trauma center (Groote Schuur Hospital, Cape Town) with penetrating abdominal trauma was performed. Patients with renal injuries were identified and compared based on mechanism [gunshot (GSW) vs. stab] and management strategy (operative vs. non-operative). Primary outcomes of interest were mortality and failure of non-operative management. Secondary outcomes of interest were nephrectomy rates, Clavien-Dindo complication rate, hospital length of stay, and overall morbidity rate.</p><p><strong>Results: </strong>A total of 150 patients with renal injuries were identified (82 GSW, 68 stab). Overall, 55.2% of patients required emergent/urgent laparotomy. GSWs were more likely to cause grade V injury and concurrent intra-abdominal injuries (p > 0.05). The success rate of non-operative management was 91.6% (89.9% GSW, 92.8% stab, p = 0.64). The absence of hematuria on point of care testing demonstrated a negative predictive value of 98.4% (95% CI 96.8-99.2%). All but 1 patient who failed non-operative management had associated intra-abdominal injuries requiring surgical intervention. Opening of Gerota's fascia resulted in nephrectomy in 55.6% of cases. There were no statistically significant risk factors for failure of non-operative management identified on univariate logistic regression.</p><p><strong>Conclusions: </strong>NOM of penetrating renal injuries can be safely and effectively instituted in both gunshot and stab wounds with a very low number of patients progressing to laparotomy. Most patients fail NOM for associated injuries. During laparotomy, the opening of Gerota's fascia may lead to increased risk of nephrectomy. Ongoing study with larger populations is required to develop effective predictive models of patients who will fail NOM.</p>","PeriodicalId":290899,"journal":{"name":"World Journal of Emergency Surgery : WJES","volume":" ","pages":"35"},"PeriodicalIF":8.0,"publicationDate":"2022-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9208135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40105100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}