World Journal of Emergency Surgery最新文献

{"title":"Perceptions and practices surrounding the perioperative management of frail emergency surgery patients: a WSES-endorsed cross-sectional qualitative survey.","authors":"Mallaika Viswanath, Darja Clinch, Marco Ceresoli, Jugdeep Dhesi, Mario D'Oria, Belinda De Simone, Mauro Podda, Salomone Di Saverio, Federico Coccolini, Massimo Sartelli, Fausto Catena, Ernest Moore, Deepa Rangar, Walter L Biffl, Dimitrios Damaskos","doi":"10.1186/s13017-022-00471-7","DOIUrl":"10.1186/s13017-022-00471-7","url":null,"abstract":"<p><strong>Background: </strong>Frailty is associated with poor post-operative outcomes in emergency surgical patients. Shared multidisciplinary models have been developed to provide a holistic, reactive model of care to improve outcomes for older people living with frailty. We aimed to describe current perioperative practices, and surgeons' awareness and perception of perioperative frailty management, and barriers to its implementation.</p><p><strong>Methods: </strong>A qualitative cross-sectional survey was sent via the World Society of Emergency Surgery e-letter to their members. Responses were analysed using descriptive statistics and reported by themes: risk scoring systems, frailty awareness and assessment and barriers to implementation.</p><p><strong>Result: </strong>Of 168/1000 respondents, 38% were aware of the terms \"Perioperative medicine for older people undergoing surgery\" (POPS) and Comprehensive Geriatric Assessment (CGA). 66.6% of respondents assessed perioperative risk, with 45.2% using the American Society of Anaesthesiologists Physical Status Classification System (ASA-PS). 77.8% of respondents mostly agreed or agreed with the statement that they routinely conducted medical comorbidity management, and pain and falls risk assessment during emergency surgical admissions. Although 98.2% of respondents agreed that frailty was important, only 2.4% performed CGA and 1.2% used a specific frailty screening tool. Clinical frailty score was the most commonly used tool by those who did. Screening was usually conducted by surgical trainees. Key barriers included a lack of knowledge about frailty assessment, a lack of clarity on who should be responsible for frailty screening, and a lack of trained staff.</p><p><strong>Conclusions: </strong>Our study highlights the ubiquitous lack of awareness regarding frailty assessment and the POPS model of care. More training and clear guidelines on frailty scoring, alongside support by multidisciplinary teams, may reduce the burden on surgical trainees, potentially improving rates of appropriate frailty assessment and management of the frailty syndrome in emergency surgical patients.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"7"},"PeriodicalIF":6.0,"publicationDate":"2023-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9850554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10737643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric trauma and emergency surgery: an international cross-sectional survey among WSES members.","authors":"Martin Reichert,&nbsp;Massimo Sartelli,&nbsp;Ingolf H Askevold,&nbsp;Jaqueline Braun,&nbsp;Markus A Weigand,&nbsp;Matthias Hecker,&nbsp;Vanni Agnoletti,&nbsp;Federico Coccolini,&nbsp;Fausto Catena,&nbsp;Winfried Padberg,&nbsp;Jens G Riedel,&nbsp;Andreas Hecker","doi":"10.1186/s13017-022-00473-5","DOIUrl":"https://doi.org/10.1186/s13017-022-00473-5","url":null,"abstract":"<p><strong>Background: </strong>In contrast to adults, the situation for pediatric trauma care from an international point of view and the global management of severely injured children remain rather unclear. The current study investigates structural management of pediatric trauma in centers of different trauma levels as well as experiences with pediatric trauma management around the world.</p><p><strong>Methods: </strong>A web-survey had been distributed to the global mailing list of the World Society of Emergency Surgery from 10/2021-03/2022, investigating characteristics of respondents and affiliated hospitals, case-load of pediatric trauma patients, capacities and infrastructure for critical care in children, trauma team composition, clinical work-up and individual experiences with pediatric trauma management in response to patients´ age. The collaboration group was subdivided regarding sizes of affiliated hospitals to allow comparisons concerning hospital volumes. Comparable results were conducted to statistical analysis.</p><p><strong>Results: </strong>A total of 133 participants from 34 countries, i.e. 5 continents responded to the survey. They were most commonly affiliated with larger hospitals (> 500 beds in 72.9%) and with level I or II trauma centers (82.0%), respectively. 74.4% of hospitals offer unrestricted pediatric medical care, but only 63.2% and 42.9% of the participants had sufficient experiences with trauma care in children ≤ 10 and ≤ 5 years of age (p = 0.0014). This situation is aggravated in participants from smaller hospitals (p < 0.01). With regard to hospital size (≤ 500 versus > 500 in-hospital beds), larger hospitals were more likely affiliated with advanced trauma centers, more elaborated pediatric intensive care infrastructure (p < 0.0001), treated children at all ages more frequently (p = 0.0938) and have higher case-loads of severely injured children < 12 years of age (p = 0.0009). Therefore, the majority of larger hospitals reserve either pediatric surgery departments or board-certified pediatric surgeons (p < 0.0001) and in-hospital trauma management is conducted more multi-disciplinarily. However, the majority of respondents does not feel prepared for treatment of severe pediatric trauma and call for special educational and practical training courses (overall: 80.2% and 64.3%, respectively).</p><p><strong>Conclusions: </strong>Multi-professional management of pediatric trauma and individual experiences with severely injured children depend on volumes, level of trauma centers and infrastructure of the hospital. However, respondents from hospitals at all levels of trauma care complain about an alarming lack of knowledge on pediatric trauma management.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"6"},"PeriodicalIF":8.0,"publicationDate":"2023-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9840264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9305827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early management of isolated severe traumatic brain injury patients in a hospital without neurosurgical capabilities: a consensus and clinical recommendations of the World Society of Emergency Surgery (WSES).","authors":"Edoardo Picetti, Fausto Catena, Fikri Abu-Zidan, Luca Ansaloni, Rocco A Armonda, Miklosh Bala, Zsolt J Balogh, Alessandro Bertuccio, Walt L Biffl, Pierre Bouzat, Andras Buki, Davide Cerasti, Randall M Chesnut, Giuseppe Citerio, Federico Coccolini, Raul Coimbra, Carlo Coniglio, Enrico Fainardi, Deepak Gupta, Jennifer M Gurney, Gregory W J Hawryluk, Raimund Helbok, Peter J A Hutchinson, Corrado Iaccarino, Angelos Kolias, Ronald W Maier, Matthew J Martin, Geert Meyfroidt, David O Okonkwo, Frank Rasulo, Sandro Rizoli, Andres Rubiano, Juan Sahuquillo, Valerie G Sams, Franco Servadei, Deepak Sharma, Lori Shutter, Philip F Stahel, Fabio S Taccone, Andrew Udy, Tommaso Zoerle, Vanni Agnoletti, Francesca Bravi, Belinda De Simone, Yoram Kluger, Costanza Martino, Ernest E Moore, Massimo Sartelli, Dieter Weber, Chiara Robba","doi":"10.1186/s13017-022-00468-2","DOIUrl":"10.1186/s13017-022-00468-2","url":null,"abstract":"<p><strong>Background: </strong>Severe traumatic brain-injured (TBI) patients should be primarily admitted to a hub trauma center (hospital with neurosurgical capabilities) to allow immediate delivery of appropriate care in a specialized environment. Sometimes, severe TBI patients are admitted to a spoke hospital (hospital without neurosurgical capabilities), and scarce data are available regarding the optimal management of severe isolated TBI patients who do not have immediate access to neurosurgical care.</p><p><strong>Methods: </strong>A multidisciplinary consensus panel composed of 41 physicians selected for their established clinical and scientific expertise in the acute management of TBI patients with different specializations (anesthesia/intensive care, neurocritical care, acute care surgery, neurosurgery and neuroradiology) was established. The consensus was endorsed by the World Society of Emergency Surgery, and a modified Delphi approach was adopted.</p><p><strong>Results: </strong>A total of 28 statements were proposed and discussed. Consensus was reached on 22 strong recommendations and 3 weak recommendations. In three cases, where consensus was not reached, no recommendation was provided.</p><p><strong>Conclusions: </strong>This consensus provides practical recommendations to support clinician's decision making in the management of isolated severe TBI patients in centers without neurosurgical capabilities and during transfer to a hub center.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"5"},"PeriodicalIF":6.0,"publicationDate":"2023-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9830860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9374452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Who should operate patients presenting with emergent colon cancer? A comparison of short- and long-term outcome depending on surgical sub-specialization.","authors":"Örvar Arnarson,&nbsp;Ingvar Syk,&nbsp;Salma Tunå Butt","doi":"10.1186/s13017-023-00474-y","DOIUrl":"https://doi.org/10.1186/s13017-023-00474-y","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer presents as emergencies in 20% of the cases. Emergency resection is associated with high postoperative morbidity and mortality. The specialization of the operating team in the emergency settings differs from the elective setting, which may have an impact on outcome. The aim of this study was to evaluate short- and long-term outcomes following emergent colon cancer surgery depending on sub-specialization of the operating team.</p><p><strong>Methods: </strong>This is a retrospective population study based on data from the Swedish Colorectal Cancer Registry (SCRCR). In total, 656 patients undergoing emergent surgery for colon cancer between 2011 and 2016 were included. The cohort was divided in groups according to specialization of the operating team: (1) colorectal team (CRT); (2) emergency surgical team (EST); (3) general surgical team (GST). The impact of specialization on short- and long-term outcomes was analyzed.</p><p><strong>Results: </strong>No statistically significant difference in 5-year overall survival (CRT 48.3%; EST 45.7%; GST 42.5%; p = 0.60) or 3-year recurrence-free survival (CRT 80.7%; EST 84.1%; GST 77.7%21.1%; p = 0.44) was noted between the groups. Neither was any significant difference in 30-day mortality (4.4%; 8.1%; 5.5%, p = 0.20), 90-day mortality (8.8; 11.9; 7.9%, p = 0.37) or postoperative complication rate (35.5%, 35.9 30.7, p = 0.52) noted between the groups. Multivariate analysis adjusted for case-mix showed no difference in hazard ratios for long-term survival or postoperative complications. The rate of permanent stoma after 3 years was higher in the EST group compared to the CRT and GST groups (34.5% vs. 24.3% and 23.9%, respectively; p < 0.0.5).</p><p><strong>Conclusion: </strong>Surgical sub-specialization did not significantly affect postoperative complication rate, nor short- or long-term survival after emergent operation for colon cancer. Patients operated by emergency surgical teams were more likely to have a permanent stoma after 3 years.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"3"},"PeriodicalIF":8.0,"publicationDate":"2023-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9830814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10740988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypertonic saline infusion does not improve the chance of primary fascial closure after damage control laparotomy: a randomized controlled trial.","authors":"Alberto F García,&nbsp;Ramiro Manzano-Nunez,&nbsp;Diana Cristina Carrillo,&nbsp;Julian Chica-Yanten,&nbsp;María Paula Naranjo,&nbsp;Álvaro I Sánchez,&nbsp;Jorge Humberto Mejía,&nbsp;Gustavo Adolfo Ospina-Tascón,&nbsp;Carlos A Ordoñez,&nbsp;Juan Gabriel Bayona,&nbsp;Juan Carlos Puyana","doi":"10.1186/s13017-023-00475-x","DOIUrl":"https://doi.org/10.1186/s13017-023-00475-x","url":null,"abstract":"<p><strong>Background: </strong>Previous observational studies showed higher rates of abdominal wall closure with the use of hypertonic saline in trauma patients with abdominal injuries. However, no randomized controlled trials have been performed on this matter. This double-blind randomized clinical trial assessed the effect of 3% hypertonic saline (HS) solution on primary fascial closure and the timing of abdominal wall closure among patients who underwent damage control laparotomy for bleeding control.</p><p><strong>Methods: </strong>Double-blind randomized clinical trial. Patients with abdominal injuries requiring damage control laparotomy (DCL) were randomly allocated to receive a 72-h infusion (rate: 50 mL/h) of 3% HS or 0.9 N isotonic saline (NS) after the index DCL. The primary endpoint was the proportion of patients with abdominal wall closure in the first seven days after the index DCL.</p><p><strong>Results: </strong>The study was suspended in the first interim analysis because of futility. A total of 52 patients were included. Of these, 27 and 25 were randomly allocated to NS and HS, respectively. There were no significant differences in the rates of abdominal wall closure between groups (HS: 19 [79.2%] vs. NS: 17 [70.8%]; p = 0.71). In contrast, significantly higher hypernatremia rates were observed in the HS group (HS: 11 [44%] vs. NS: 1 [3.7%]; p < 0.001).</p><p><strong>Conclusion: </strong>This double-blind randomized clinical trial showed no benefit of HS solution in primary fascial closure rates. Patients randomized to HS had higher sodium concentrations after the first day and were more likely to present hypernatremia. We do not recommend using HS in patients undergoing damage control laparotomy. Trial registration The trial protocol was registered in clinicaltrials.gov (identifier: NCT02542241).</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"4"},"PeriodicalIF":8.0,"publicationDate":"2023-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9830760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10740989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Structured approach with primary and secondary survey for major trauma care: an overview of reviews.","authors":"Silvia Gianola,&nbsp;Silvia Bargeri,&nbsp;Annalisa Biffi,&nbsp;Stefania Cimbanassi,&nbsp;Daniela D'Angelo,&nbsp;Daniela Coclite,&nbsp;Gabriella Facchinetti,&nbsp;Alice Josephine Fauci,&nbsp;Carla Ferrara,&nbsp;Marco Di Nitto,&nbsp;Antonello Napoletano,&nbsp;Ornella Punzo,&nbsp;Katya Ranzato,&nbsp;Alina Tratsevich,&nbsp;Primiano Iannone,&nbsp;Greta Castellini,&nbsp;Osvaldo Chiara","doi":"10.1186/s13017-022-00472-6","DOIUrl":"https://doi.org/10.1186/s13017-022-00472-6","url":null,"abstract":"<p><strong>Background: </strong>A structured approach involves systematic management of trauma patients. We aim to conduct an overview of reviews about the clinical efficacy and safety of structured approach (i.e., primary and secondary survey) by guideline checklist compared to non-structured approach (i.e. clinical examination); moreover, routine screening whole-body computer tomography (WBCT) was compared to non-routine WBCT in patients with suspected major trauma.</p><p><strong>Methods: </strong>We systematically searched MEDLINE (PubMed), EMBASE and Cochrane Database of Systematic Reviews up to 3 May 2022. Systematic reviews (SRs) that investigated the use of a structured approach compared to a non-structured approach were eligible. Two authors independently extracted data, managed the overlapping of primary studies belonging to the included SRs and calculated the corrected covered area (CCA). The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.</p><p><strong>Results: </strong>We included nine SRs investigating two comparisons in stable trauma patients: structured approach vs non-structured approach (n = 1) and routine WBCT vs non-routine WBCT (n = 8). The overlap of included primary studies was generally high across outcomes (CCA ranged between 20.85 and 42.86%) with some discrepancies in the directions of effects across reviews. The application of a structured approach by checklist may improve adherence to guidelines (e.g. Advanced Trauma Life Support) during resuscitation and might lead to a reduction in mortality among severely injured patients as compared to clinical examination (Adjusted OR 0.51; 95% CI 0.30-0.89; p = 0.018; low certainty of evidence). The use of routine WBCT seems to offer little to no effects in reducing mortality and time spent in emergency room or department, whereas non-routine WBCT seems to offer little to no effects in reducing radiation dose, intensive care unit length of stay (LOS) and hospital LOS (low-to-moderate certainty of evidence).</p><p><strong>Conclusions: </strong>The application of structured approach by checklist during trauma resuscitation may improve patient- and process-related outcomes. Including non-routine WBCT seems to offer the best trade-offs between benefits and harm. Clinicians should consider these findings in the light of their clinical context, the volume of patients in their facilities, the need for time management, and costs.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"2"},"PeriodicalIF":8.0,"publicationDate":"2023-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9814503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10730131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgeons' perspectives on artificial intelligence to support clinical decision-making in trauma and emergency contexts: results from an international survey.","authors":"Lorenzo Cobianchi, Daniele Piccolo, Francesca Dal Mas, Vanni Agnoletti, Luca Ansaloni, Jeremy Balch, Walter Biffl, Giovanni Butturini, Fausto Catena, Federico Coccolini, Stefano Denicolai, Belinda De Simone, Isabella Frigerio, Paola Fugazzola, Gianluigi Marseglia, Giuseppe Roberto Marseglia, Jacopo Martellucci, Mirko Modenese, Pietro Previtali, Federico Ruta, Alessandro Venturi, Haytham M Kaafarani, Tyler J Loftus","doi":"10.1186/s13017-022-00467-3","DOIUrl":"10.1186/s13017-022-00467-3","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) is gaining traction in medicine and surgery. AI-based applications can offer tools to examine high-volume data to inform predictive analytics that supports complex decision-making processes. Time-sensitive trauma and emergency contexts are often challenging. The study aims to investigate trauma and emergency surgeons' knowledge and perception of using AI-based tools in clinical decision-making processes.</p><p><strong>Methods: </strong>An online survey grounded on literature regarding AI-enabled surgical decision-making aids was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was advertised to 917 WSES members through the society's website and Twitter profile.</p><p><strong>Results: </strong>650 surgeons from 71 countries in five continents participated in the survey. Results depict the presence of technology enthusiasts and skeptics and surgeons' preference toward more classical decision-making aids like clinical guidelines, traditional training, and the support of their multidisciplinary colleagues. A lack of knowledge about several AI-related aspects emerges and is associated with mistrust.</p><p><strong>Discussion: </strong>The trauma and emergency surgical community is divided into those who firmly believe in the potential of AI and those who do not understand or trust AI-enabled surgical decision-making aids. Academic societies and surgical training programs should promote a foundational, working knowledge of clinical AI.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"1"},"PeriodicalIF":6.0,"publicationDate":"2023-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9811693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9516007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The ChoCO-W prospective observational global study: Does COVID-19 increase gangrenous cholecystitis?","authors":"Belinda De Simone,&nbsp;Fikri M Abu-Zidan,&nbsp;Elie Chouillard,&nbsp;Salomone Di Saverio,&nbsp;Massimo Sartelli,&nbsp;Mauro Podda,&nbsp;Carlos Augusto Gomes,&nbsp;Ernest E Moore,&nbsp;Susan J Moug,&nbsp;Luca Ansaloni,&nbsp;Yoram Kluger,&nbsp;Federico Coccolini,&nbsp;Aitor Landaluce-Olavarria,&nbsp;Begoña Estraviz-Mateos,&nbsp;Ana Uriguen-Etxeberria,&nbsp;Alessio Giordano,&nbsp;Alfonso Palmieri Luna,&nbsp;Luz Adriana Hernández Amín,&nbsp;Adriana María Palmieri Hernández,&nbsp;Amanda Shabana,&nbsp;Zakaria Andee Dzulkarnaen,&nbsp;Muhammad Asyraf Othman,&nbsp;Mohamad Ikhwan Sani,&nbsp;Andrea Balla,&nbsp;Rosa Scaramuzzo,&nbsp;Pasquale Lepiane,&nbsp;Andrea Bottari,&nbsp;Fabio Staderini,&nbsp;Fabio Cianchi,&nbsp;Andrea Cavallaro,&nbsp;Antonio Zanghì,&nbsp;Alessandro Cappellani,&nbsp;Roberto Campagnacci,&nbsp;Angela Maurizi,&nbsp;Mario Martinotti,&nbsp;Annamaria Ruggieri,&nbsp;Asri Che Jusoh,&nbsp;Karim Abdul Rahman,&nbsp;Anis Suraya M Zulkifli,&nbsp;Barbara Petronio,&nbsp;Belén Matías-García,&nbsp;Ana Quiroga-Valcárcel,&nbsp;Fernando Mendoza-Moreno,&nbsp;Boyko Atanasov,&nbsp;Fabio Cesare Campanile,&nbsp;Ilaria Vecchioni,&nbsp;Luca Cardinali,&nbsp;Grazia Travaglini,&nbsp;Elisa Sebastiani,&nbsp;Serge Chooklin,&nbsp;Serhii Chuklin,&nbsp;Pasquale Cianci,&nbsp;Enrico Restini,&nbsp;Sabino Capuzzolo,&nbsp;Giuseppe Currò,&nbsp;Rosalinda Filippo,&nbsp;Michele Rispoli,&nbsp;Daniel Aparicio-Sánchez,&nbsp;Virginia Durán Muñóz-Cruzado,&nbsp;Sandra Dios Barbeito,&nbsp;Samir Delibegovic,&nbsp;Amar Kesetovic,&nbsp;Diego Sasia,&nbsp;Felice Borghi,&nbsp;Giorgio Giraudo,&nbsp;Diego Visconti,&nbsp;Emanuele Doria,&nbsp;Mauro Santarelli,&nbsp;Davide Luppi,&nbsp;Stefano Bonilauri,&nbsp;Ugo Grossi,&nbsp;Giacomo Zanus,&nbsp;Alberto Sartori,&nbsp;Giacomo Piatto,&nbsp;Maurizio De Luca,&nbsp;Domenico Vita,&nbsp;Luigi Conti,&nbsp;Patrizio Capelli,&nbsp;Gaetano Maria Cattaneo,&nbsp;Athanasios Marinis,&nbsp;Styliani-Aikaterini Vederaki,&nbsp;Mehmet Bayrak,&nbsp;Yasemin Altıntas,&nbsp;Mustafa Yener Uzunoglu,&nbsp;Iskender Eren Demirbas,&nbsp;Yuksel Altinel,&nbsp;Serhat Meric,&nbsp;Yunus Emre Aktimur,&nbsp;Derya Salim Uymaz,&nbsp;Nail Omarov,&nbsp;Ibrahim Azamat,&nbsp;Eftychios Lostoridis,&nbsp;Eleni-Aikaterini Nagorni,&nbsp;Antonio Pujante,&nbsp;Gabriele Anania,&nbsp;Cristina Bombardini,&nbsp;Francesco Bagolini,&nbsp;Emre Gonullu,&nbsp;Baris Mantoglu,&nbsp;Recayi Capoglu,&nbsp;Stefano Cappato,&nbsp;Elena Muzio,&nbsp;Elif Colak,&nbsp;Suleyman Polat,&nbsp;Zehra Alan Koylu,&nbsp;Fatih Altintoprak,&nbsp;Zülfü Bayhan,&nbsp;Emrah Akin,&nbsp;Enrico Andolfi,&nbsp;Sulce Rezart,&nbsp;Jae Il Kim,&nbsp;Sung Won Jung,&nbsp;Yong Chan Shin,&nbsp;Octavian Enciu,&nbsp;Elena Adelina Toma,&nbsp;Fabio Medas,&nbsp;Gian Luigi Canu,&nbsp;Federico Cappellacci,&nbsp;Fabrizio D'Acapito,&nbsp;Giorgio Ercolani,&nbsp;Leonardo Solaini,&nbsp;Francesco Roscio,&nbsp;Federico Clerici,&nbsp;Roberta Gelmini,&nbsp;Francesco Serra,&nbsp;Elena Giulia Rossi,&nbsp;Francesco Fleres,&nbsp;Guglielmo Clarizia,&nbsp;Alessandro Spolini,&nbsp;Francesco Ferrara,&nbsp;Gabriela Nita,&nbsp;Jlenia Sarnari,&nbsp;Mahir Gachabayov,&nbsp;Abakar Abdullaev,&nbsp;Gaetano Poillucci,&nbsp;Gian Marco Palini,&nbsp;Simone Veneroni,&nbsp;Gianluca Garulli,&nbsp;Micaela Piccoli,&nbsp;Gianmaria Casoni Pattacini,&nbsp;Francesca Pecchini,&nbsp;Giulio Argenio,&nbsp;Mariano Fortunato Armellino,&nbsp;Giuseppe Brisinda,&nbsp;Silvia Tedesco,&nbsp;Pietro Fransvea,&nbsp;Giuseppe Ietto,&nbsp;Caterina Franchi,&nbsp;Giulio Carcano,&nbsp;Gennaro Martines,&nbsp;Giuseppe Trigiante,&nbsp;Giulia Negro,&nbsp;Gustavo Machain Vega,&nbsp;Agustín Rodríguez González,&nbsp;Leonardo Ojeda,&nbsp;Gaetano Piccolo,&nbsp;Andrea Bondurri,&nbsp;Anna Maffioli,&nbsp;Claudio Guerci,&nbsp;Boo Han Sin,&nbsp;Zamri Zuhdi,&nbsp;Azlanudin Azman,&nbsp;Hussam Mousa,&nbsp;Shadi Al Bahri,&nbsp;Goran Augustin,&nbsp;Ivan Romic,&nbsp;Trpimir Moric,&nbsp;Ioannis Nikolopoulos,&nbsp;Jacopo Andreuccetti,&nbsp;Giusto Pignata,&nbsp;Rossella D'Alessio,&nbsp;Jakub Kenig,&nbsp;Urszula Skorus,&nbsp;Gustavo Pereira Fraga,&nbsp;Elcio Shiyoiti Hirano,&nbsp;Jackson Vinícius de Lima Bertuol,&nbsp;Arda Isik,&nbsp;Eray Kurnaz,&nbsp;Mohammad Sohail Asghar,&nbsp;Ameer Afzal,&nbsp;Ali Akbar,&nbsp;Taxiarchis Konstantinos Nikolouzakis,&nbsp;Konstantinos Lasithiotakis,&nbsp;Emmanuel Chrysos,&nbsp;Koray Das,&nbsp;Nazmi Özer,&nbsp;Ahmet Seker,&nbsp;Mohamed Ibrahim,&nbsp;Hytham K S Hamid,&nbsp;Ahmed Babiker,&nbsp;Konstantinos Bouliaris,&nbsp;George Koukoulis,&nbsp;Chrysoula-Christina Kolla,&nbsp;Andrea Lucchi,&nbsp;Laura Agostinelli,&nbsp;Antonio Taddei,&nbsp;Laura Fortuna,&nbsp;Carlotta Agostini,&nbsp;Leo Licari,&nbsp;Simona Viola,&nbsp;Cosimo Callari,&nbsp;Letizia Laface,&nbsp;Emmanuele Abate,&nbsp;Massimiliano Casati,&nbsp;Alessandro Anastasi,&nbsp;Giuseppe Canonico,&nbsp;Linda Gabellini,&nbsp;Lorenzo Tosi,&nbsp;Anna Guariniello,&nbsp;Federico Zanzi,&nbsp;Lovenish Bains,&nbsp;Larysa Sydorchuk,&nbsp;Oksana Iftoda,&nbsp;Andrii Sydorchuk,&nbsp;Michele Malerba,&nbsp;Federico Costanzo,&nbsp;Raffaele Galleano,&nbsp;Michela Monteleone,&nbsp;Andrea Costanzi,&nbsp;Carlo Riva,&nbsp;Maciej Walędziak,&nbsp;Andrzej Kwiatkowski,&nbsp;Łukasz Czyżykowski,&nbsp;Piotr Major,&nbsp;Marcin Strzałka,&nbsp;Maciej Matyja,&nbsp;Michal Natkaniec,&nbsp;Maria Rosaria Valenti,&nbsp;Maria Domenica Pia Di Vita,&nbsp;Maria Sotiropoulou,&nbsp;Stylianos Kapiris,&nbsp;Damien Massalou,&nbsp;Massimiliano Veroux,&nbsp;Alessio Volpicelli,&nbsp;Rossella Gioco,&nbsp;Matteo Uccelli,&nbsp;Marta Bonaldi,&nbsp;Stefano Olmi,&nbsp;Matteo Nardi,&nbsp;Giada Livadoti,&nbsp;Cristian Mesina,&nbsp;Theodor Viorel Dumitrescu,&nbsp;Mihai Calin Ciorbagiu,&nbsp;Michele Ammendola,&nbsp;Giorgio Ammerata,&nbsp;Roberto Romano,&nbsp;Mihail Slavchev,&nbsp;Evangelos P Misiakos,&nbsp;Emmanouil Pikoulis,&nbsp;Dimitrios Papaconstantinou,&nbsp;Mohamed Elbahnasawy,&nbsp;Sherief Abdel-Elsalam,&nbsp;Daniel M Felsenreich,&nbsp;Julia Jedamzik,&nbsp;Nikolaos V Michalopoulos,&nbsp;Theodoros A Sidiropoulos,&nbsp;Maria Papadoliopoulou,&nbsp;Nicola Cillara,&nbsp;Antonello Deserra,&nbsp;Alessandro Cannavera,&nbsp;Ionuţ Negoi,&nbsp;Dimitrios Schizas,&nbsp;Athanasios Syllaios,&nbsp;Ilias Vagios,&nbsp;Stavros Gourgiotis,&nbsp;Nick Dai,&nbsp;Rekha Gurung,&nbsp;Marcus Norrey,&nbsp;Antonio Pesce,&nbsp;Carlo Vittorio Feo,&nbsp;Nicolo' Fabbri,&nbsp;Nikolaos Machairas,&nbsp;Panagiotis Dorovinis,&nbsp;Myrto D Keramida,&nbsp;Francesk Mulita,&nbsp;Georgios Ioannis Verras,&nbsp;Michail Vailas,&nbsp;Omer Yalkin,&nbsp;Nidal Iflazoglu,&nbsp;Direnc Yigit,&nbsp;Oussama Baraket,&nbsp;Karim Ayed,&nbsp;Mohamed Hedi Ghalloussi,&nbsp;Parmenion Patias,&nbsp;Georgios Ntokos,&nbsp;Razrim Rahim,&nbsp;Miklosh Bala,&nbsp;Asaf Kedar,&nbsp;Robert G Sawyer,&nbsp;Anna Trinh,&nbsp;Kelsey Miller,&nbsp;Ruslan Sydorchuk,&nbsp;Ruslan Knut,&nbsp;Oleksandr Plehutsa,&nbsp;Rumeysa Kevser Liman,&nbsp;Zeynep Ozkan,&nbsp;Saleh Abdel Kader,&nbsp;Sanjay Gupta,&nbsp;Monika Gureh,&nbsp;Sara Saeidi,&nbsp;Mohsen Aliakbarian,&nbsp;Amin Dalili,&nbsp;Tomohisa Shoko,&nbsp;Mitsuaki Kojima,&nbsp;Raira Nakamoto,&nbsp;Semra Demirli Atici,&nbsp;Gizem Kilinc Tuncer,&nbsp;Tayfun Kaya,&nbsp;Spiros G Delis,&nbsp;Stefano Rossi,&nbsp;Biagio Picardi,&nbsp;Simone Rossi Del Monte,&nbsp;Tania Triantafyllou,&nbsp;Dimitrios Theodorou,&nbsp;Tadeja Pintar,&nbsp;Jure Salobir,&nbsp;Dimitrios K Manatakis,&nbsp;Nikolaos Tasis,&nbsp;Vasileios Acheimastos,&nbsp;Orestis Ioannidis,&nbsp;Lydia Loutzidou,&nbsp;Savvas Symeonidis,&nbsp;Tiago Correia de Sá,&nbsp;Mónica Rocha,&nbsp;Tommaso Guagni,&nbsp;Desiré Pantalone,&nbsp;Gherardo Maltinti,&nbsp;Vladimir Khokha,&nbsp;Wafaa Abdel-Elsalam,&nbsp;Basma Ghoneim,&nbsp;José Antonio López-Ruiz,&nbsp;Yasin Kara,&nbsp;Syaza Zainudin,&nbsp;Firdaus Hayati,&nbsp;Nornazirah Azizan,&nbsp;Victoria Tan Phooi Khei,&nbsp;Rebecca Choy Xin Yi,&nbsp;Harivinthan Sellappan,&nbsp;Zaza Demetrashvili,&nbsp;Nika Lekiashvili,&nbsp;Ana Tvaladze,&nbsp;Caterina Froiio,&nbsp;Daniele Bernardi,&nbsp;Luigi Bonavina,&nbsp;Angeles Gil-Olarte,&nbsp;Sebastiano Grassia,&nbsp;Estela Romero-Vargas,&nbsp;Francesco Bianco,&nbsp;Andrew A Gumbs,&nbsp;Agron Dogjani,&nbsp;Ferdinando Agresta,&nbsp;Andrey Litvin,&nbsp;Zsolt J Balogh,&nbsp;George Gendrikson,&nbsp;Costanza Martino,&nbsp;Dimitrios Damaskos,&nbsp;Nikolaos Pararas,&nbsp;Andrew Kirkpatrick,&nbsp;Mikhail Kurtenkov,&nbsp;Felipe Couto Gomes,&nbsp;Adolfo Pisanu,&nbsp;Oreste Nardello,&nbsp;Fabrizio Gambarini,&nbsp;Hager Aref,&nbsp;Nicola De' Angelis,&nbsp;Vanni Agnoletti,&nbsp;Antonio Biondi,&nbsp;Marco Vacante,&nbsp;Giulia Griggio,&nbsp;Roberta Tutino,&nbsp;Marco Massani,&nbsp;Giovanni Bisetto,&nbsp;Savino Occhionorelli,&nbsp;Dario Andreotti,&nbsp;Domenico Lacavalla,&nbsp;Walter L Biffl,&nbsp;Fausto Catena","doi":"10.1186/s13017-022-00466-4","DOIUrl":"https://doi.org/10.1186/s13017-022-00466-4","url":null,"abstract":"<p><strong>Background: </strong>The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not.</p><p><strong>Methods: </strong>Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not.</p><p><strong>Results: </strong>A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001].</p><p><strong>Conclusions: </strong>The incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID-19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"17 1","pages":"61"},"PeriodicalIF":8.0,"publicationDate":"2022-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9755784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10525453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decreasing use of pancreatic necrosectomy and NSQIP predictors of complications and mortality.","authors":"Amy E Liepert,&nbsp;George Ventro,&nbsp;Jessica L Weaver,&nbsp;Allison E Berndtson,&nbsp;Laura N Godat,&nbsp;Laura M Adams,&nbsp;Jarrett Santorelli,&nbsp;Todd W Costantini,&nbsp;Jay J Doucet","doi":"10.1186/s13017-022-00462-8","DOIUrl":"https://doi.org/10.1186/s13017-022-00462-8","url":null,"abstract":"<p><strong>Background: </strong>Surgical pancreatic necrosectomy (SPN) is an option for the management of infected pancreatic necrosis. The literature indicates that an escalating, combined endoscopic, interventional radiology and minimally invasive surgery \"step-up\" approach, such as video-assisted retroperitoneal debridement, may reduce the number of required SPNs and ICU complications, such as multiple organ failure. We hypothesized that complications for surgically treated severe necrotizing pancreatitis patients decreased during the period of adoption of the \"step-up\" approach.</p><p><strong>Methods: </strong>The American college of surgeons national surgery quality improvement program database (ACS-NSQIP) was used to find SPN cases from 2007 to 2019 in ACS-NSQIP submitting hospitals. Mortality and Clavien-Dindo class 4 (CD4) ICU complications were collected. Predictors of outcomes were identified by univariate and multivariate analyses.</p><p><strong>Results: </strong>There were 2457 SPN cases. SPN cases decreased from 0.09% in 2007 to 0.01% in 2019 of NSQIP operative cases (p < 0.001). Overall mortality was 8.5% and did not decrease with time. CD4 complications decreased from 40 to 27% (p < 0.001). There was a 65% reduction in SPN cases requiring a return to the operating room. Multivariate predictors of complications were emergency general surgery (EGS, p < 0.001), serum albumin (p < 0.0001) and modified frailty index (mFI) (p < 0.0001). Multivariate predictors of mortality were EGS (p < 0.0001), serum albumin (p < 0.0001), and mFI (p < 0.04). The mFI decreased after 2010 (p < 0.001).</p><p><strong>Conclusion: </strong>SPNs decreased after 2010, with decreasing CD4 complications, decreasing reoperation rates and stable mortality rates, likely indicating broad adoption of a \"step-up\" approach. Larger, prospective studies to compare indications and outcomes for \"step up\" versus open SPN are warranted.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"17 1","pages":"60"},"PeriodicalIF":8.0,"publicationDate":"2022-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9743619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10356277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outpatient management of acute uncomplicated appendicitis after laparoscopic appendectomy: a randomized controlled trial.","authors":"Jordi Elvira López,&nbsp;Ricard Sales Mallafré,&nbsp;Erlinda Padilla Zegarra,&nbsp;Luis Carrillo Luna,&nbsp;Joan Ferreres Serafini,&nbsp;Roisin Tully,&nbsp;Robert Memba Ikuga,&nbsp;Rosa Jorba Martin","doi":"10.1186/s13017-022-00465-5","DOIUrl":"https://doi.org/10.1186/s13017-022-00465-5","url":null,"abstract":"<p><strong>Objective: </strong>To confirm the safety and efficacy of outpatient management of laparoscopic appendectomy, with an enhanced recovery after surgery (ERAS) protocol, in adult patients with uncomplicated acute appendicitis. Outpatient laparoscopic appendectomy is feasible and secure in selected patients in observational studies. The benefits include reduced length of stay (LOS) and postoperative complications. This is the first randomized controlled trial of outpatient management following ERAS protocol.</p><p><strong>Methods: </strong>Patients admitted from the emergency department with acute appendicitis were randomized into one of two groups: standard care within the hospital (HG) or the outpatient group (OG). An ERAS protocol was followed for both groups. Patients in the HG were admitted to the surgical ward. Patients in the OG were referred to the day-surgery unit. The primary endpoint was the length of stay.</p><p><strong>Results: </strong>Ninety-seven patients were included: 49 in the OG and 48 in the HG. LOS was significantly shorter in the OG (mean 8.82 h) than in the HG (mean 43.53 h), p < 0.001. There was no difference in readmission rates (p = 0.320); we observed only one readmission in the OG. No further emergency consultations or complications were observed. The cost saving was $516.52/patient as a result of the intervention.</p><p><strong>Conclusion: </strong>Outpatient management of appendectomy is safe and feasible procedure in selected patients. This approach could become the standard of care for patients with uncomplicated appendicitis, showing fewer complications, lower LOS and cost.</p><p><strong>Trial registration: </strong>Registration: www.</p><p><strong>Clinicaltrials: </strong>gov (NCT05401188) Clinical Trial ID: NCT05401188.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"17 1","pages":"59"},"PeriodicalIF":8.0,"publicationDate":"2022-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9685067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10579734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}