World Journal of Emergency Surgery最新文献

{"title":"Tourniquet-related complications in extremity injuries: a scoping review of the literature.","authors":"Anaida Xacur-Trabulce,Gessner Casas-Fuentes,Veronica Ruiz-Vasconcelos,Marianne Marchini Reitz,Sharon M Henry,Thomas M Scalea,Marcelo A F Ribeiro","doi":"10.1186/s13017-025-00625-3","DOIUrl":"https://doi.org/10.1186/s13017-025-00625-3","url":null,"abstract":"BACKGROUNDTourniquets are crucial for controlling life-threatening hemorrhage and, therefore, in preventing avoidable deaths in both military and civilian settings. Its increased use since the launch of the Stop the Bleed campaign, however, has raised concerns regarding possible complications associated with its application, including limb ischemia and amputation. The objective of this study was to synthesize the existing evidence regarding complications associated with the use of tourniquets for extremity injuries and identify gaps in knowledge to guide future research on this topic.METHODSA review of the literature between 2016 and 2024 was performed including open access retrospective studies, case series, clinical cases, and systematic reviews that addressed tourniquet use in a civilian or military setting in patients with extremity injuries, following the PRISMA-ScR 2018 checklist. PubMed, ScienceDirect, and Cochrane databases were queried, identifying 1,398 articles on the use of extremity tourniquets in military and civilian contexts, focusing on complications. Of these, 1,343 articles were excluded due to duplication or irrelevance based on the title. From the 55 remaining, 37 were excluded after abstract review for not meeting inclusion criteria. Of the 18 full-text articles reviewed, 10 were excluded due to insufficient data, leaving 8 studies for detailed analysis.RESULTSProlonged application in emergency situations may lead to severe complications, such as nerve injuries, post-tourniquet syndrome and thromboembolic event risks. Nerve palsy has been identified as the most prevalent complication associated with prolonged tourniquet use.CONCLUSIONImproved training is essential to help providers accurately assess bleeding severity and apply appropriate interventions, reducing complications and enhancing outcomes. Future research opportunities should consider: (1) prospective interventional randomized controlled studies aiming to compare the use of tourniquets to different methods of hemorrhage control; (2) development and validation of easy-to-use scores predicting complications and the need of amputation in both civilian and military settings including upper and lower extremities, to better guide clinical decisions and future guidelines; (3) development of better ways to teach lay providers to recognize life threatening bleeding; and (4) development of guidelines for timing of tourniquet loosening, removal or conversion.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"45 1","pages":"57"},"PeriodicalIF":8.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Completely thoracoscopic surgical stabilization of rib fractures: balancing minimally invasive benefits against technique-specific complications: a single-center retrospective study","authors":"Yang Yang, Zexin Xie, Jiantao Zhang, Xuetao Zhou, Zheng Liang, Chunjuan Hou, Jin Zhang, Dongsheng Zhang","doi":"10.1186/s13017-025-00629-z","DOIUrl":"https://doi.org/10.1186/s13017-025-00629-z","url":null,"abstract":"This study aimed to investigate the surgical outcomes and complications of completely thoracoscopic surgical stabilization of rib fractures (cTSSRF) in patients with rib fractures in the posterior chest wall area. A retrospective analysis was conducted on 30 patients who underwent completely thoracoscopic surgical stabilization of rib fractures (cTSSRF) between September 2019 and October 2023. Clinical data were gathered to compare and analyze the clinical outcomes of complications of cTSSRF and open surgical stabilization of rib fractures (oSSRF). A total of 201 rib fractures were repaired in 30 patients, including 79 rib fractures in the posterior chest wall (an average of 2.63 rib fractures/person) that were fixed by cTSSRF, and 122 rib fractures (an average of 4.06 rib fractures/person) fixed by oSSRF. No obvious thoracic collapse deformity was observed postoperatively in any patient. The median duration of chest tube removal after surgery was 3 (3–4) days, and the chest drainage volume was 586.33 ± 232.4 ml. The numeric rating scale score (NRS) was 3 (2–3.25), which was significantly lower than the preoperative score of 7 (6–8), z = -4.826, P < 0.001). The rate of implant displacement of the cTSSRF was 6.33% (5/79), which was significantly higher than that in the oSSRF of 0(0/122), χ2 = 5.53, P = 0.019. The rates of fracture malalignment were high in the cTSSRF (21.52% [20/79] vs2.46% [3/122], P < 0.001). The incidence of postoperative encapsulated pleural effusion—defined as a maximum anteroposterior fluid thickness > 20 mm surrounding the internal fixation device on axial CT scans—was 46.7% (14/30 cases) during the 7–14 day postoperative period. All patients were followed-up in outpatient clinics or by telephone for 6–24 months, and all resumed their work capacity without obvious symptoms of chest discomfort. The application of cTSSRF is a safe, feasible and minimally invasive surgical option, particularly in cases of rib fractures in the posterior chest wall, which are challenging to address using conventional open surgery. However, the postoperative implant displacement and fracture malalignment rates are higher than those observed in conventional surgery, which still needs to require careful evaluation of the risks and benefits of routinely performing cTSSRF.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"25 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144371080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnitude, outcome, and predictors of mortality in perforated peptic ulcer disease: a retrospective study in Jigjiga town, Ethiopia","authors":"Abdirahman Burale, Bedhaasa Beyene, Musse Ahmed, Abdullahi Hussen, Mohamed Said Hassan, Shamsedin Mahdi Hassan, Hassan Sh Abdirahman Elmi","doi":"10.1186/s13017-025-00628-0","DOIUrl":"https://doi.org/10.1186/s13017-025-00628-0","url":null,"abstract":"Peptic ulcer perforation (PUP) is a surgical emergency and life-threatening complication affecting 2–10% of peptic ulcer disease (PUD) patients. Delayed diagnosis and surgical management are associated with significant morbidity and mortality. This study assessed the magnitude and outcome of PUP among patients operated on at two public hospitals in Jigjig town, Ethiopia. A 3-year hospital-based retrospective cross-sectional study was conducted on 130 patients operated for PUP at the study hospitals in Jigjig from April 1st, 2018, to July 30th, 2021. Data were collected from medical records. Bivariate analysis identified key factors impacting outcomes in PUP patients. The cohort had a male-to-female ratio of 8.7:1, and a mean age of 38 ± 13.3 years, with 48.8% smokers and 56.6% chat chewers. Duodenal perforations accounted for 93.7% of cases, with post-operative complications in 29.1% and an in-hospital mortality rate of 5.5%. Significant predictors of morbidity and mortality included advanced age (AOR 23.88), comorbidities (AOR 26.80), pre-operative hypotension (AOR 32.33), and delayed hospital presentation (AOR 30.10). Male predominance, younger age, high smoking and chat chewing rates, and primarily duodenal perforations are common in perforated peptic ulcer cases. Advanced age, comorbidities, pre-operative hypotension, and delayed hospital presentation significantly increase postoperative complications and mortality, emphasizing the need for timely intervention and targeted public health measures to improve patient outcomes. Early intervention and careful management of comorbidities are crucial to improve survival and reduce complications in patients with PUP.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"19 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144371072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Homocysteine(HCY), a novel biomarker for predicting irreversible transmural intestinal necrosis in patients with adhesive small bowel obstruction: results from a prospective observational study","authors":"Youlong Zhu, Ruming Liu, Xuan Geng, Dakun Li, Bin Quan, Feifei Kong, Defei Hong","doi":"10.1186/s13017-025-00632-4","DOIUrl":"https://doi.org/10.1186/s13017-025-00632-4","url":null,"abstract":"Whether elevated homocysteine level is causally associated with small bowel necrosis remains unestablished. We conducted a prospective observational study to analyze the value of serum homocysteine (HCY) in predicting irreversible transmural intestinal necrosis (ITIN) of adhesive small bowel obstruction (ASBO). This prospective observational study was performed between Feb 2023 and Feb 2025 in patients with adhesive small bowel obstruction. The primary outcome was the occurrence of ITIN. The serum levels of different biomarkers in different groups were calculated and compared. Univariable analysis and multivariable analysis were used to assess the association between different biomarkers and ITIN. The Receiver Operating Characteristic Curve (ROC) was used to assess the value for predicting ITIN. The patients comprised 129(58.37%) male and 92(41.63%) female with a median age of 70(60–78)(range 18–85 years). Of the 221 patients included, 88(39.82%) received non-operative treatment, and 133(60.18%) underwent surgery. Intestinal resection and ITIN concerned 89(66.92%) and 68(51.13%) of patients who underwent surgery, respectively. Patients underwent surgery had significantly higher serum levels of HCY, ENDOTOXIN, IL-5, IL-6, Hs-CRP, IL-1β, and PCT (p<0.0001, respectively) than patients receiving non-operative treatment. The levels of the above seven markers (p<0.05, respectively) in patients with ITIN were significantly higher than in patients with non-necrosis. Univariable analysis and multivariable analysis showed that HCY、ENDOTOXIN and Hs-CRP were independent predictors for small bowel necrosis (odds ratio = 1.420, 1.061 and 1.032; p = 0 0.000, p = 0.001 and, p = 0.019, respectively). The AUC of HCY (0.9253, p<0.0001) was higher compared with ENDOTOXIN (0.8291, p<0.0001) and Hs-CRP (0.7023, p<0.0001). HCY had highest sensitivity (89.71%) and specificity (83.03%) compared with ENDOTOXIN (82.83%, 62.08%) and CRP (73.53%, 50.77%) for predicting small bowel necrosis. The serum HCY cutoff level for the diagnosis of small bowel necrosis was 15.53µmol/L. This study provides compelling evidence that homocysteine (HCY) levels can be a useful predictor of irreversible transmural intestinal necrosis that necessitates surgical resection in the setting of adhesive small bowel obstruction. Close monitoring of the HCY serum level could help avoid unnecessary laparotomy and resection, as well as complications due to unnnecessary surgery, and potentially decrease overall mortality rates.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"66 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144371074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic appendectomy as the gold standard: What role remains for open surgery, conversion, and disease severity?","authors":"Claus Schildberg, Ulrike Weber, Volker König, Marius Linnartz, Sophie Heisler, Jennifer Hafkesbrink, Marcia Fricke, René Mantke","doi":"10.1186/s13017-025-00626-2","DOIUrl":"https://doi.org/10.1186/s13017-025-00626-2","url":null,"abstract":"Acute appendicitis is a common abdominal surgical emergency and is a major cause of acute abdomen in more than 20% of cases. Although various studies have been conducted in recent years on topics such as surgical techniques and antibiotic treatment of appendicitis, today there is a lack of large-scale studies focused on the different severity levels of acute appendicitis and their management. The study aimed to analyze the severity, types of surgical techniques, and mortality associated with acute appendicitis to identify possible developments. We conducted a retrospective multicenter observational study based on routine data from 2010 to 2022. Patients over 18 years old with acute appendicitis were included and the following data were collected: patient demographics, comorbidities, type of surgery, complications, admission to ICU, length of stay, and in-hospital mortality. A total of 31,988 patients were included in the study. At the end of the study, 97.0% (P < .001) of the patients underwent laparoscopic appendectomy, with 86% of cases involving closure of the appendix stump by stapler (P < .001). It was only from 2014 onwards that more than 90% of surgeries were performed laparoscopically, and from 2017, this figure rose to 95%. Complicated appendicitis was present in 27.4% of cases. The distribution of severity was as follows: unspecified acute appendicitis in 39.5%, appendicitis with local peritonitis in 33.1%, appendicitis with local peritonitis and perforation in 17.1%, appendicitis with peritoneal abscess in 5.4%, and appendicitis with generalized peritonitis in 4.9%. Women had a significantly lower risk for conversion to an open operation than men (P < .001). The highest morbidity was observed in the group that converted from laparoscopy to open surgery (P <.001). Non-surgical treatment of appendicitis was not relevant, accounting for only 4% of cases. Since 2017, primary laparoscopic appendectomy has been the gold standard for even complicated acute appendicitis (> 95% annually). Over three-quarters of patients undergo an appendectomy with a stapler, making this surgical technique the preferred method of laparoscopic surgery in Germany. Patients who undergo an interoperative switch to open therapy should be considered a subgroup at risk of increased mortality. ClinicalTrials.gov ID: NCT06558760.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"35 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144312180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The clinical efficacy and safety of ERCP in traumatic pancreatic injuries: a systematic review and meta-analysis","authors":"Hulusi Can Karpuzcu, Çağdaş Erdoğan","doi":"10.1186/s13017-025-00631-5","DOIUrl":"https://doi.org/10.1186/s13017-025-00631-5","url":null,"abstract":"Traumatic pancreatic injuries (TPI) are rare, critical complications increasingly managed by minimally invasive Endoscopic Retrograde Cholangiopancreatography (ERCP). We systematically reviewed and meta-analyzed ERCP’s efficacy and safety for TPI regarding pancreatic duct integrity and clinical outcomes in diverse populations. PubMed, Scopus, Cochrane Library, and Web of Science were searched (2000–2024) for studies reporting on ERCP for TPI. Primary outcomes were pancreatic duct integrity and complications; secondary outcomes included mortality and hospital stay. Pediatric and adult populations were compared via subgroup analysis. Publication bias was assessed. Fifteen studies comprising 1,823 patients (54% male, 32% pediatric) were included in the meta-analysis. ERCP demonstrated a pooled clinical success rate of 89% (95% CI: 83–93%) and significantly improved pancreatic duct integrity (OR for pancreatic duct integrity: 9.17, 95% CI: 6.73–12.49). Complication rates ranged from 4 to 17%, with pancreatitis and bleeding being the most common adverse events. Mortality rates were low (3–5%), and ERCP significantly reduced hospital stay by an average of 3.1 days compared to surgical interventions. Pediatric patients had slightly lower success rates (OR: 6.73, 95% CI: 4.01–11.31) compared to adults (OR: 10.87, 95% CI: 7.40–15.98). ERCP is an effective and safe modality for managing TPI in both pediatric and adult patients, yielding high success rates in maintaining ductal integrity and reducing complications, although interpretation requires caution due to potential publication bias. Further prospective studies are required to optimize standardized protocols.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"5 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing percutaneous treatment and cholecystectomy outcomes in acute cholecystitis patients: a systematic review and meta-analysis","authors":"Gabriele Fanciulli, Giuliana Favara, Andrea Maugeri, Martina Barchitta, Antonella Agodi, Guido Basile","doi":"10.1186/s13017-025-00622-6","DOIUrl":"https://doi.org/10.1186/s13017-025-00622-6","url":null,"abstract":"Acute cholecystitis (AC) is a common and serious condition characterized by gallbladder inflammation, most often caused by cystic duct obstruction due to gallstones. Although laparoscopic cholecystectomy (CC) is the preferred surgical treatment, percutaneous cholecystostomy (PC) is frequently considered for high-risk surgical patients. The optimal management strategy for these patients remains a topic of debate. These systematic review and meta-analysis aim to provide an updated evaluation of studies comparing the clinical outcomes of AC patients treated with PC versus those undergoing CC, as well as the outcomes of CC alone versus PC followed by CC. A literature search was carried out across Web of Science, Medline, Embase, and PubMed up to April 2024. Observational studies comparing patients undergoing PC versus CC, as well as CC versus PC followed by CC, and reporting mortality, morbidity, and readmission were included. Data extraction and quality assessment were independently performed by two reviewers, with bias risk evaluated using the Newcastle-Ottawa Quality Scale. The pooled odds ratio (OR) was obtained through meta-analyses by using STATA software (Version 18). A total of 27 studies were included, with 16 comparing PC versus CC and 11 assessing PC followed by CC versus CC alone. Meta-analyses revealed that CC was associated with significantly lower mortality (OR = 0.26; 95% CI = 0.14–0.48) and readmission rates (OR = 0.37; 95% CI = 0.18–0.75) compared to PC. The benefits of laparoscopic cholecystectomy over percutaneous cholecystostomy were particularly evident for mortality (OR = 0.17; 95% CI = 0.09–0.33), while a non-significant trend towards reduced readmission rates was also observed (OR = 0.28; 95% CI = 0.07–1.13). However, PC was identified as a viable alternative in high-risk surgical patients. Studies examining PC followed by CC versus CC alone showed diverse results, with some indicating reduced surgical complications and improved outcomes, while others reported no significant benefits. This work highlights that CC is associated with better outcomes, including lower mortality and readmission rates, compared to both PC alone and PC followed by CC. The combined approach did not show a significant advantage over immediate CC. Further research with larger studies and standardized protocols is needed to refine treatment strategies for high-risk AC patients.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"170 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144237427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of the lavage through fistula in treatment of spontaneous esophageal rupture by combined thoracoscopic and gastroscopic management","authors":"Zhao Huang, Penglong Zhao, Bingmei Qiu, Chuan Gao, Zhao Chen, Nan Yang, Yang Xu, Zhiqiang Zou, Yi Shen, Liwen Hu","doi":"10.1186/s13017-025-00630-6","DOIUrl":"https://doi.org/10.1186/s13017-025-00630-6","url":null,"abstract":"Spontaneous esophageal rupture (SER) is a rare and severe emergency with high mortality, and the treatment algorithm remains controversial. This retrospective study analyzed SER cases that underwent VATS debridement and drainage in Jinling Hospital from January 2014 to July 2024. Patients were divided into Lavage-Drainage and Drainage groups based on whether they received a lavage tube cathetering through the esophageal fistula under gastroscope. Preoperative fluid resuscitation, thoracoscopic mediastinotomy, and thoracic debridement were performed. Post-operative management included fasting, enteral nutrition, anti-infective agents, and fluid and electrolyte balance maintenance. Monitoring indicators included vital signs, laboratory test results, postoperative complications, and other relevant factors. A total of 24 patients were enrolled, with 11 in the Lavage-Drainage group and 13 in the Drainage group. The Lavage-Drainage group had lower 30-day mortality, fewer complications and adverse events, and a faster reduction in inflammatory factors, but a higher cost. There was no significant difference in the length of mechanical ventilation, hospital stay, and ICU stay. The Lavage-Drainage approach enhanced the drainage efficiency, reduced the inflammation level, and improved the prognosis of SER. However, this study has some limitations, and further multi-center prospective studies are needed to optimize the treatment and reduce costs.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"138 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144237426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How confident are the general surgeons in Hokkaido region in performing essential trauma skills: a cross-sectional questionnaire survey","authors":"Kazuyuki Hirose, Saseem Poudel, Soichi Murakami, Yo Kurashima, Nagato Sato, Hiroyasu Tojima, Isao Yokota, Kazufumi Okada, Toshiaki Shichinohe, Satoshi Hirano","doi":"10.1186/s13017-025-00623-5","DOIUrl":"https://doi.org/10.1186/s13017-025-00623-5","url":null,"abstract":"In Japan—particularly in the Hokkaido region—a limited number of dedicated trauma surgeons often compels general surgeons to serve as frontline providers of trauma care. However, their ability to perform critical trauma procedures and their level of confidence remain unclear. Understanding this gap is vital for guiding targeted training programs aimed at improving patient outcomes. Although conducted in one region, these findings may inform strategies in other remote or resource-limited settings worldwide, where timely surgical intervention significantly affects survival. Therefore, the objective of this study was to evaluate the experience and confidence of general surgeons in Hokkaido in performing 35 essential trauma procedures. This prospective observational study surveyed all general surgeons and surgical residents working in hospitals that regularly perform surgical procedures in Hokkaido. Participants provided demographic information, trauma training history, and self-assessed confidence and experience in performing 35 procedures identified via a previous Delphi study. Confidence was defined as a Likert scale rating of 4 or 5. Comparisons were made between respondents with and without advanced trauma training (e.g., ATOM, DSTC) and between those who had managed more than 50 trauma cases versus fewer than 50. Of 730 eligible participants, 444 completed the survey (62.2%). Over half (57.9%) reported fewer than 10 lifetime trauma surgeries, and 64.4% had not managed a trauma case in the past year. Only six procedures were rated confidently (≥ 4) by more than half the respondents, including endotracheal intubation, chest tube placement, and selected gastrointestinal procedures. Subgroup analyses indicated that surgeons generally had higher confidence in procedures related to their subspecialty, whereas less frequent or advanced trauma skills remained areas of concern. Surgeons with advanced trauma training or a higher trauma case volume (> 50) demonstrated significantly greater confidence in multiple trauma-specific skills. General surgeons in Hokkaido lack confidence in most essential trauma procedures, particularly those encountered infrequently. Although these findings originate from one region, they underscore training gaps potentially relevant to other remote or resource-limited areas, where frontline trauma care demands targeted, high-yield interventions to improve outcomes.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"59 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144218929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary closure and prophylactic antibiotics for treatment of traumatic wounds caused by mammals, a systematic review and meta-analysis","authors":"Meng Cui, Yiqing Jia, Zhaoyang Chen, Jie Qu, Zonghong Zhu, Yan Xu, Shuyuan Liu, Ruifeng Chen, Yi Shan","doi":"10.1186/s13017-025-00619-1","DOIUrl":"https://doi.org/10.1186/s13017-025-00619-1","url":null,"abstract":"To compare primary closure (PC) with delayed/no closure (DC/NC), and compare prophylactic use of antibiotics (PUA) with no use of antibiotics (NUA) in the treatment of traumatic wounds caused by mammals by a systematic review and meta-analysis. PubMed and Embase databases were searched for eligible randomized clinical trials (RCTs) and observational studies. Qualities of RCTs were assessed according to Cochrane risk of bias tool, qualities of observational studies were assessed according to Newcastle–Ottawa Scale. Primary outcomes included the incidence of wound infection or poor wound healing and the rate of wound cosmesis satisfaction. The relative risks (RRs) of RCTs, odds ratios (ORs) of observational studies and their 95% confidence interval (CI) were extracted directly from included studies or calculated according to the 2 × 2 table obtained by the incidence. The sensitivity analysis, meta-regression and subgroup analysis were performed to identify clinical factors that caused the heterogeneity between studies. Of 26 included studies, 17 studies (8 RCTs and 9 observational studies, 8091 patients) compared PC with DC/NC and 14 studies (7 RCTs and 7 observational studies, 2508 patients) compared PUA with NUA. The pooled OR of all studies (PC versus DC/NC) for wound infection or poor wound healing was 0.79 (95%CI: 0.54, 1.17), the pooled RR of RCTs for wound infection was 0.73 (0.51, 1.06). The pooled OR for cosmesis satisfaction was 3.68 (1.27, 10.68) of 2 studies (PC versus DC) that did not use the negative pressure sealing drainage technique. Subgroup analysis demonstrated that the pooled OR was significant under specific clinical conditions: (1) comparison of PC and DC (pooled OR: 0.49 [0.27, 0.90]), (2) prophylactic use of antibiotics (0.56 [0.33, 0.94]), (3) no use of antibiotics (0.63 [0.41, 0.98]), (4) wounds located in limbs/trunk (0.41 [0.23, 0.73]), (5) time to the first medical presentation (TTP) ≤ 10 h (0.59 [0.39, 0.89]). While the pooled OR (PC versus NC) was not significant (0.84 [0.51, 1.37]). The pooled OR of all studies for wound infection (PUA versus NUA) was 0.73 (95%CI: 0.46, 1.17), the pooled RR of RCTs for wound infection was 0.81 (0.46, 1.44). No included studies (PUA versus NUA) reported the outcome of wound cosmesis. Subgroup analysis demonstrated that the pooled OR was significant under specific clinical conditions: (1) injury caused by other type of mammals other than dog (pooled OR: 0.24 [0.06–0.98]), (2) wounds located in face/head (0.13 [0.03, 0.52]). Regardless of whether prophylactic antibiotics are used or not, compared to delayed closure, primary closure should be given priority in treating traumatic wounds caused by mammals which can decrease the incidence of wound infection or poor wound healing and obtain the better wound cosmesis, but it does not show the superiority compared to no closure, unless under some specific clinical conditions. Prophylactic use of antibiotics may not benefit in prevention of wo","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"62 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144211271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}