Surgery in practice and science最新文献

{"title":"Impact of COVID-19 pandemic at a level 1 trauma center","authors":"Bernardo Galvan,&nbsp;Katherine G. Holder,&nbsp;Bridget Boeger,&nbsp;Abigail Raef,&nbsp;Karishma Desai,&nbsp;Kripa Shrestha,&nbsp;Ariel P. Santos,&nbsp;Dixon Santana","doi":"10.1016/j.sipas.2023.100189","DOIUrl":"10.1016/j.sipas.2023.100189","url":null,"abstract":"<div><h3>Introduction</h3><p>The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic commonly called COVID-19 brought new changes to healthcare delivery in the US. The purpose of this study is to identify the impact of COVID-19 on the delivery of acute surgical care for patients at a Level 1 trauma center during the lockdown period of the pandemic from March 13-May 1 2020.</p></div><div><h3>Methods</h3><p>All trauma admission to the University Medical Center Level 1 Trauma Center from March 13 to May 13, 2020, were retrospectively abstracted and compared to the same period during 2019. Analysis focused on the lockdown period of March 13-May 1, 2020, and compared to the same dates in 2019. Abstracted data included demographics, care timeframes, length of stay, and mortality. The data were analyzed using Chi-Square, Fisher Exact, and the Mann-Whitney U test.</p></div><div><h3>Results</h3><p>A total of 305 (2019) vs. 220 (2020) procedures were analyzed. No significant differences were seen in mean BMI, Injury Severity Score, American Society of Anesthesia Score, and Charlson Comorbidity Index between the two groups. Diagnosis time, interval to surgery, anesthesia time, surgical preparation time, operation time, transit time, mean hospital stay, and mortality were similar.</p></div><div><h3>Conclusion</h3><p>The results of this study demonstrate that the lockdown period of the COVID-19 pandemic did not significantly affect the trauma surgery service line, aside from case volume, at a Level 1 trauma center in West Texas during the lockdown period. Despite changes to healthcare delivery during the pandemic, care of surgical patients was conserved as timely and of high quality.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100189"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10245229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9662942","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":"Inpatient lung cancer surgery outcomes in Illinois","authors":"Ayaan Ahmed ,&nbsp;Charles D. Logan ,&nbsp;David D. Odell ,&nbsp;Joe Feinglass","doi":"10.1016/j.sipas.2023.100206","DOIUrl":"10.1016/j.sipas.2023.100206","url":null,"abstract":"<div><h3>Objective</h3><p>This study analyzed inpatient mortality and length of stay for lung cancer surgery in Illinois hospitals by patient clinical and demographic characteristics, procedure types, and hospital and surgeon volume.</p></div><div><h3>Methods</h3><p>The study analyzed lung cancer patients who underwent lobectomy or sublobar resection at Illinois hospitals from 2016 to June 2022. Trends in procedure type, inpatient mortality, one-day length of stay (LOS), and prolonged LOS (&gt;10 days) were evaluated. Regression models were used to determine the likelihood of inpatient death and length of stay while controlling for clinical, procedure, hospital, and surgeon characteristics.</p></div><div><h3>Results</h3><p>There were 9602 admissions for lung cancer surgery at 89 non-federal Illinois hospitals. Overall, 0.7% of patients died, 12.2% of patients had one-day LOS, and 7.4% patients had prolonged LOS. From 2016 to 2022, rates of one-day LOS increased from approximately 5% to 23%, prolonged LOS dropped from almost 18% to under 5%, robotic lobectomies increased from &lt;5% of procedures to over 40%, and VATS lobectomies went from almost 50% to 13%. The proportion of open lobectomy procedures remained stable. Robotic and VATS procedures were generally associated with better outcomes; however, VATS sublobar procedures were associated with worse LOS and mortality outcomes. Hospitals and surgeons with higher procedure volumes had significantly better outcomes.</p></div><div><h3>Conclusions</h3><p>Lung cancer surgery had low inpatient mortality and better LOS outcomes, with robotic steadily replacing VATS procedures. Higher hospital or surgeon volume was associated with better patient outcomes and may have been related to the greater utilization of Enhanced Recovery After Surgery Programs.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100206"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42497149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Audit of upper gastrointestinal tract series examinations for diagnosing intestinal malrotation in a resource-limited radiology department in Southern Africa","authors":"Dr Lauren Nicole Keenan ,&nbsp;Dr Tanusha Sewchuran","doi":"10.1016/j.sipas.2023.100183","DOIUrl":"10.1016/j.sipas.2023.100183","url":null,"abstract":"<div><h3>Background</h3><p>Intestinal malrotation is a congenitally acquired condition of abnormally rotated proximal small bowel in neonates and infants. Prompt recognition prevents lifethreatening complications. A structured approach to diagnosing malrotation at UGIS is required for accurate diagnosis.</p></div><div><h3>Objectives</h3><p>Retrospective analysis of the images and radiological reports of UGIS, with the aim of identifying potential shortfalls in diagnosing malrotation. A secondary objective is to formulate a reporting template to improve overall quality of UGIS reports, specifically in cases of suspected malrotation.</p></div><div><h3>Method</h3><p>Identification and retrospective review of UGIS studies which were subsequently re-read by a blinded consultant radiologist using the proposed reporting template adapted from the literature.</p></div><div><h3>Results</h3><p>367 UGIS studies between 1 January 2016 and 31 December 2021 were included in the study cohort, which were then re-read. Using McNemar's chi-square test, we found discrepancy between the number of studies positive for malrotation on the original reports versus the re-read studies, highlighting shortfalls in our current practise.</p></div><div><h3>Conclusion</h3><p>A structured approach is paramount to the correct diagnosis of malrotation at UGIS. The position of the DJ-flexure (on frontal and lateral projections) proves most sensitive and specific in the diagnosis of malrotation at UGIS. Dedicated true lateral images were often found to be excluded in daily practise. We propose a structured inclusive reporting template.</p></div><div><h3>Contribution</h3><p>Our proposed standardized reporting template aims to improve radiological, clinical, and surgical outcomes at UGIS, specifically in patients with suspected malrotation.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100183"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43514989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Free jejunum transfers in oncologic reconstruction","authors":"Satoshi Onoda,&nbsp;Kahori Tsukura","doi":"10.1016/j.sipas.2023.100187","DOIUrl":"10.1016/j.sipas.2023.100187","url":null,"abstract":"<div><p>Methods of pharyngoesophageal reconstruction include gastric pull-up, colon or jejunal interposition, and transfer of a free anterolateral thigh flap. The most popular method at our institution is transfer of a free jejunal graft. The free jejunum transfer was first described in 1957 by Seidenberg. The advantage of this procedure is a decreased risk of fistula, because the pharyngoesophagus is physiologically reconstructed with bowel-type reconstruction material. There are few reports about the operative methods of free jejunum transfer in detail and the operative methods vary greatly by institution. We performed free jejunum transfers for several hundred patients in the past and reported the characteristics and intraoperative and postoperative matters that require attention. Here, we summarize free jejunum transfer in oncologic reconstruction with relation to the points of safety, recipient vessels and microsurgical anastomosis, intestinal anastomosis and postoperative complications based on our experience and published reports.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100187"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48232669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Administering prophylactic alpha-blockade to reduce urinary retention post inguinal hernia repair: A systematic review and meta-analysis of randomised control trials","authors":"Gavin G. Calpin ,&nbsp;Alice M. O'Neill ,&nbsp;Matthew G. Davey ,&nbsp;Peggy Miller ,&nbsp;William P. Joyce","doi":"10.1016/j.sipas.2023.100204","DOIUrl":"10.1016/j.sipas.2023.100204","url":null,"abstract":"<div><h3>Introduction</h3><p>The incidence of post-operative urinary retention (POUR) following inguinal hernia repair (IHR) is approximately 0.4% - 22.0%. POUR may lead to patient discomfort and catheter-related complications including urinary tract infection, urethral trauma, bladder overdistension and subsequent permanent bladder dysfunction. We aimed to perform a systematic review and meta-analysis of randomised control trials (RCT) evaluating the impact of administration of perioperative alpha-blockade to reduce the incidence of acute POUR following IHR.</p></div><div><h3>Methods</h3><p>A systematic review was performed as per PRISMA guidelines. The incidence of POUR in the alpha-blocker and control groups were expressed as dichotomous outcomes, reported as odds ratios (ORs) expressed with 95% confidence intervals (CIs) following estimation using the Mantel-Haenszel method.</p></div><div><h3>Results</h3><p>Eight RCTs with a combined total of 918 patients were included. Of these, 53.7% (493/918) received alpha-blockers while 46.3% (425/918) did not. Five studies used tamsulosin, two used prazosin and one used phenoxybenzamine. Overall, the prescription of prophylactic alpha-blockers in the preoperative setting significantly reduced POUR compared to the control group (7.9% (39/493) vs 21.2% (90/425), OR: 0.31, 95% CI: 0.12–0.80, <em>P</em> = 0.020).</p></div><div><h3>Conclusion</h3><p>Preoperative prescription of alpha-blockers reduced the incidence of POUR following inguinal hernia repair. The next generation of prospective randomised trials may identify which patients should be prescribed this medication prior to surgery.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100204"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46167551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“Choice of surgical approach for the treatment of acute small bowel obstruction: A retrospective analysis from a high-volume single center in Milan, Northern Italy”","authors":"E. Ortolano ,&nbsp;C. Maina ,&nbsp;A. D'Addiego ,&nbsp;C. Ciuffa ,&nbsp;S.I. Rocchetti ,&nbsp;A.A. Beneduce ,&nbsp;M. Carlucci","doi":"10.1016/j.sipas.2023.100213","DOIUrl":"10.1016/j.sipas.2023.100213","url":null,"abstract":"<div><h3>Background</h3><p>Acute small bowel obstruction (aSBO) is the most common cause (76%) of acute intestinal obstruction. Laparoscopy use is still controversial in aSBO and indications not yet clearly defined. The aim of this study was to demonstrate the effectiveness and safety of a laparoscopic approach in aSBO by using specific pre-operative criteria for appropriate patient selection.</p></div><div><h3>Methods</h3><p>We retrospectively analyzed medical records of patients accepted at the Emergency Department for aSBO between January 2016 and March 2021 and performed a comparative analysis between types of treatment, considering demographics, clinical and radiological presentation, non-operative vs. operative management, intraoperative outcome, and postoperative course. We used a logistic regression to identify the variables related to surgical approach and built a predictive score upon the multivariable predictive model: the “SABO score”.</p></div><div><h3>Results</h3><p>198 patients were included in the study, of which 145 underwent surgery and 43 were successfully treated laparoscopically. Age and comorbidities were associated with open surgery (OR 3.2, 95% CI: 1.4–7.2, <em>p</em> = 0.006 and OR 2.7, 95% CI: 1.1–6.5, <em>p</em> = 0.023). A SABO score ≥ 0 identified an open approach with a sensitivity of 75.4% and a specificity of 69.8%.</p></div><div><h3>Conclusions</h3><p>Laparoscopy is growing in importance even in emergency settings. Our analysis suggests that a laparoscopic approach can be safe and feasible in aSBO management. Correct patient selection appears to be the key for a successful minimally invasive approach. SABO score therefore could be helpful in choosing the correct surgical strategy for patients with aSBO.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100213"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48561766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome of debridement, antibiotics and implant retention for streptococcal hip and knee prosthetic joint infections: A systematic review and meta-analysis","authors":"Laura M. Gerritsen ,&nbsp;Henk Scheper ,&nbsp;Mark G.J. de Boer ,&nbsp;Jan W. Schoones ,&nbsp;Rob G.H.H. Nelissen ,&nbsp;Bart G.C. Pijls","doi":"10.1016/j.sipas.2023.100201","DOIUrl":"10.1016/j.sipas.2023.100201","url":null,"abstract":"<div><h3>PROSPERO registration ID</h3><p>367411</p></div><div><h3>Objectives</h3><p>This systematic review and meta-analysis was conducted to assess the outcome of streptococcal hip and knee prosthetic joint infection (PJI) treated with Debridement, Antibiotics and Implant Retention (DAIR) and to evaluate risk factors associated with failure.</p></div><div><h3>Methods</h3><p>We conducted a systematic literature search on PubMed, Embase, Web of Science, and Cochrane library from inception until October 2021. Random effects meta-analyses (i.e. relative risk) were used to estimate the success rate at the study level and its association with possible risk factors for failure with a specific focus on the use of rifampicin.</p></div><div><h3>Results</h3><p>25 observational studies were included, incorporating 1367 patients with streptococcal PJIs treated with DAIR. An overall pooled success rate of 71% (95% confidence interval (95%CI) 64–77%) was found for streptococcal PJI treated with DAIR. Treatment success was 76% (95%CI 62% to 91%) for knee PJI and 58% (95%CI 52% to 65%) for hip PJI. Treatment success differed for patients receiving rifampicin (84%, 95% CI 78% to 90%) compared to patients not receiving rifampicin (74%, 95% CI 63% to 85%), but this effect was no longer present in subsequent meta-analyses.</p></div><div><h3>Conclusions</h3><p>The meta-analysis showed no clear benefit for rifampicin administration after DAIR for streptococcal PJI. Better outcome was observed for knee PJI compared to hip PJI.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100201"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44145561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association of closed-collaborative SICU modeling on emergency general surgery patient outcomes","authors":"Joshua W. Bennett ,&nbsp;Kiley R. Schlortt ,&nbsp;Tianyuan Yao ,&nbsp;Hanna K. Jensen ,&nbsp;Rebecca J. Reif ,&nbsp;Judy L. Bennett ,&nbsp;Saleema A. Karim ,&nbsp;Mary K. Kimbrough ,&nbsp;Avi Bhavaraju","doi":"10.1016/j.sipas.2023.100194","DOIUrl":"10.1016/j.sipas.2023.100194","url":null,"abstract":"<div><h3>Objective</h3><p>Surgical intensive care unit (SICU) optimization is a critical factor impacting patient outcomes and resource utilization. SICUs operate using an open or closed model, where the surgeon or intensivist, respectively, manages critically-ill patients. In 2017, we adopted a closed-collaborative model. This study aimed to compare patient outcomes in the closed-collaborative model vs. the previous open model in a cohort of emergency general surgery (EGS) patients.</p></div><div><h3>Methods</h3><p>A retrospective review of EGS SICU patients from August 2015 to July 2019 was performed. Patients were divided into \"Open\" and \"Closed\" cohorts before or after closed-collaborative model implementation on August 1, 2017. Demographic variables and clinical outcomes were analyzed.</p></div><div><h3>Results</h3><p>We identified 434 patients (O:191; C:243). While no significant demographic differences were observed, there was a higher proportion of patients with qSOFA scores greater than 2 in the closed cohort. There were no differences regarding sepsis, cerebrovascular accident, myocardial infarction, venous thromboembolism, anemia, SICU length of stay (LOS), SICU costs, ventilation requirements, or ventilator duration; mortality rate was higher, but hospital LOS was shorter in the closed cohort.</p></div><div><h3>Conclusion</h3><p>Overall, outcomes were not statistically different between the two models, despite sicker patients in the closed group, which we suspect accounts for the higher mortality in this group. We expect the decreased hospital LOS observed in the closed cohort improved bed management, patient flow, and ultimately led to institutional cost savings. Further investigation is warranted to examine SICU modeling effects in other surgical specialties and to evaluate potential hospital-level administrative benefits.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100194"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41541981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The sandwich technique to treat aortoiliac aneurysms: How to size the parallel graft","authors":"Bilal Koussayer ,&nbsp;Louai Zaidan ,&nbsp;Anas Atassi ,&nbsp;Bassam Khalil ,&nbsp;Samer Koussayer","doi":"10.1016/j.sipas.2023.100208","DOIUrl":"10.1016/j.sipas.2023.100208","url":null,"abstract":"<div><h3>Introduction</h3><p>The current gold standard of treatment aortoiliac aneurysms are through endovascular aneurysm repairs which can result in occluding the internal iliac artery. An alternative that preserves internal iliac artery blood flow is the sandwich technique. This is when two covered stents of the internal and external iliac arteries are placed inside the main limb of common iliac artery stent. The complexity of such task is complicated by efficiently calculating the size of the stent grafts to ensure a proper fit.</p></div><div><h3>Methods</h3><p>We have developed a mathematical proof that depends on the arterial circumferences to size the three stents needed for the sandwich technique: <span><math><mrow><mi>D</mi><mo>≅</mo><mo>[</mo><mrow><mn>0.68</mn><mo>*</mo><mo>(</mo><mrow><msub><mi>d</mi><mn>1</mn></msub><mo>+</mo><msub><mi>d</mi><mn>2</mn></msub></mrow><mo>)</mo></mrow><mo>]</mo><mo>+</mo><mn>2</mn></mrow></math></span>. D is the diameter of the common iliac stent, d₁ and d₂ is the diameter of the internal and external iliac artery stent. We added 2 mm to account for the thickness of stents.</p></div><div><h3>Results</h3><p>We have treated 10 common iliac artery aneurysms using this formula. Patients were followed up by CTA scans three, six and twelve months after the procedure. Seven of ten had complete sealing and no type III endoleaks intraoperatively. The other three had a small, limited type III endoleak at completion angiogram, that disappeared completely on the three months follow-up. At one-year follow up only one patient developed moderate claudication and erectile dysfunction.</p></div><div><h3>Conclusion</h3><p>ST is considered a practical and feasible approach, as it is easy to implement and can be utilized in most cases, especially in emergencies. It is also cost effective due the use of standard grafts without the need for specialized stents. Our aiming by improving this surgical technique is that we will be able to help standardize practice leading to reduced waste, maintain longer-term repair and therefore reduce complication risks.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100208"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47017692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between rural or urban setting and outcomes in geriatric trauma patients in South Africa: a retrospective cohort study","authors":"Bogo Lee ,&nbsp;Victor Kong ,&nbsp;Cynthia Cheung ,&nbsp;Nigel Rajaretnam ,&nbsp;John Bruce ,&nbsp;Vasel Manchev ,&nbsp;Robert Mills ,&nbsp;Damian Clarke","doi":"10.1016/j.sipas.2023.100184","DOIUrl":"10.1016/j.sipas.2023.100184","url":null,"abstract":"<div><h3>Introduction</h3><p>This study compares outcomes between rural and urban geriatric trauma patients at a major trauma centre in South Africa.</p></div><div><h3>Materials and Methods</h3><p>This retrospective cohort study from a prospectively entered data set, reviewed all patients aged 65 years or above admitted between January 2013 to December 2020 to our trauma centre at Grey's Hospital, South Africa.</p></div><div><h3>Results</h3><p>Over the 8-year study period, a total of 323 patients aged ≥ 65 years were included (201 males (62%), mean age: 72 years. Mechanism of injury: 257 blunt (80%), 52 penetrating (16%) and 14 others (4%). The median Injury Severity Score (ISS) was 9. The median Charlson Comorbidity Index (CCI) for all 323 cases was 3. The median length of hospital stay was two days. The overall mortality was 12%. The crude odds ratio (OR) for death in rural vs urban patients was 2.51 (95% CI 1.27 – 4.94). After propensity score stratification for ISS, heart rate (HR), respiratory rate (RR), Glasgow Coma Scale (GCS) and temperature, and adjustment for mechanism, operation, Intensive Care Unit (ICU) and need for mechanical ventilation, the risk of death among the rural patients remained higher than in urban patients at 2.46 times (p=0.063), however, it was not statistically significant. Those who were operated on were significantly less likely to die after adjustment for confounding factors. Admission to ICU and the need for mechanical ventilation were significantly associated with mortality.</p></div><div><h3>Conclusion</h3><p>Rural geriatric trauma patients have worse outcomes than urban geriatric trauma even after adjustment for differences in demographic and injury profile.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100184"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49510911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}