General Surgery Patients Research Articles

The Impact of Beta-Lactam Antibiotic Timing on Patient Outcomes in Post-Operative Sepsis Management: A Multi-Center Analysis of Orthopedic and General Surgery Cases

Background: Post-operative sepsis remains a significant cause of morbidity and mortality in surgical patients. While the importance of timely antibiotic administration in sepsis is established, the specific impact of beta-lactam timing on outcomes in post-operative sepsis has not been well characterized across different surgical populations. Methods: We conducted a multi-center retrospective cohort study of 150 patients (75 orthopedic and 75 general surgery) who developed sepsis within 30 days following surgery at five tertiary care hospitals between 2020-2023. The primary exposure was time from sepsis recognition to beta-lactam administration, categorized as ≤1 hour, 1-3 hours, 3-6 hours, and >6 hours. The primary outcome was 30-day mortality. Secondary outcomes included ICU and hospital length of stay, time to resolution of organ dysfunction, and functional status. Results: Median time to beta-lactam administration was 2.4 hours (IQR 1.3-4.7), with only 18.7% of patients receiving antibiotics within 1 hour. Thirty-day mortality was 19.3% overall, with a clear dose-response relationship across timing categories: 7.1% (≤1 hour), 15.3% (1-3 hours), 23.8% (3-6 hours), and 38.1% (>6 hours). In multivariable analysis, each hour delay in beta-lactam administration was associated with a 20% increase in the odds of 30-day mortality (adjusted OR 1.20, 95% CI 1.09-1.33, p<0.001). This association was stronger in general surgery patients (adjusted OR 1.28, 95% CI 1.13-1.46) compared to orthopedic surgery patients (adjusted OR 1.12, 95% CI 1.01-1.24). Delayed administration was also associated with prolonged ICU stay, hospital length of stay, and slower resolution of organ dysfunction. In the subset of patients with plasma drug measurements, achieving therapeutic concentrations within 2 hours was associated with improved survival (88.2% vs. 62.5%, p=0.027). Conclusions: In post-operative sepsis, each hour delay in beta-lactam administration is associated with a 20% increase in 30-day mortality, with a more pronounced effect in general surgery patients. These findings highlight the critical importance of early recognition and prompt antibiotic therapy for post-operative sepsis and suggest potential benefits from specialized sepsis protocols for surgical patients

Using Natural Language Processing in the LACE Index Scoring Tool to Predict Unplanned Trauma and Surgical Readmissions in South Africa.

Unplanned and potentially avoidable readmission within 30days post discharge is a major financial burden. To use text-based electronic patient records to calculate the Charlson Comorbidity Index (CCI) score using a natural language processing technique to establish the feasibility and usefulness of the text-based electronic patient records in identifying patients at risk for unplanned readmission. A retrospective review of electronic patient records for general and trauma surgery in a hospital in South Africa (2012-2022) was conducted using the LACE score. Validated sentiment analysis analyzed free text components of electronic patient records to compute the CCI score and to establish the feasibility and usefulness of the LACE score in identifying patients at risk for unplanned readmission. Trauma surgery patients had a mean LACE score of 5.91 (SD=2.41), with 8.44% scoring 10 or higher and a specificity and sensitivity of 91.63% and 13.81%, respectively. The general surgery patients had a mean LACE score of 7.75 (SD=3.04), with 10.63% scoring 10 or higher and a specificity of 71.47% and a sensitivity of 44.80%, respectively. Logistic regression analysis revealed that LACE scores significantly predicted unplanned readmissions in both trauma (β=0.11, p<0.001; OR=1.112, 95% CI [1.082, 1.143]) and general surgery (β=0.15, p<0.001; OR=1.162, 95% CI [1.130, 1.162]) patients. The LACE score demonstrated the predictive value for readmission in trauma and general surgery patients. The LACE score was relatively effective in identifying patients who were less likely to be readmitted but showed limitations in identifying patients at higher risk of readmission. However, the successful use of natural language processing for data extraction of comorbidities shows promise on addressing the challenges around text-based medical records.

RETRACTION: Incidence Rate and Risk Factors of Surgical Wound Infection in General Surgery Patients: A Cross-Sectional Study.

M. T. Ashoobi, M. R. Asgary, M. Sarafi, N. Fathalipour, A. Pirooz, Z. Jafaryparvar, E. Rafiei, M. Farzin, P. Samidoust, and M. S. E. Delshad, "Incidence Rate and Risk Factors of Surgical Wound Infection in General Surgery Patients: A Cross-Sectional Study," International Wound Journal 20, no. 7 (2023): 2640-2648, https://doi.org/10.1111/iwj.14137. The above article, published online on 10 March 2023, in Wiley Online Library (http://onlinelibrary.wiley.com/), has been retracted by agreement between the journal Editor in Chief, Professor Keith Harding; and John Wiley & Sons Ltd. A third party reported to the journal that they had found evidence of excessive self-citations in the reference list of this article. The publisher did not confirm the evidence of excessive self-citations. Upon further investigation, the publisher also concluded that this article was accepted solely on the basis of a compromised peer review process. In view of the clear evidence of compromised peer review, the parties agreed that the paper must be retracted. The authors did not respond to our notice regarding the retraction.

MiRNA sequencing identifies immune-associated miRNAs and highlights the role of miR-193b-5p in sepsis and septic shock progression

This study aimed to evaluate the diagnostic value of miR-193b-5p and miR-511-5p in sepsis and septic shock from the perspective of immune regulation. Initially, serum exosomal miRNA sequencing was conducted on patients with sepsis (n = 6), septic shock (n = 6), and healthy controls (n = 3). Using bioinformatics analysis, miR-193b-5p and miR-511-5p were identified as immune-related miRNAs differentiating sepsis from septic shock. Subsequently, quantitative real-time polymerase chain reaction (qRT-PCR) was performed to validate the identified miRNAs in a cohort of 90 participants, including 30 patients with sepsis, 30 with septic shock, and 30 general surgery patients serving as controls. The results indicated that miR-193b-5p expression level was significantly reduced in septic patients and septic shock patients compared with healthy controls. Both miR-193b-5p and miR-511-5p exhibited diagnostic potential, distinguishing sepsis from the control group, with area under the curve values of 0.797 and 0.795, respectively (P < 0.05). Furthermore, miR-193b-5p expression level was inversely correlated with C-reactive protein level (r = -0.40, P < 0.001), procalcitonin level (r = -0.31, P = 0.003), and interleukin-6 level (r = -0.39, P < 0.001). A positive correlation was identified between miR-193b-5p and lymphocyte count (r = 0.26, P = 0.014). In conclusion, serum miR-193b-5p demonstrated potential as a diagnostic biomarker for sepsis and was associated with inflammation and immune regulation in sepsis.

Direct Peritoneal Resuscitation in Critically Ill Patients with an Open Abdomen is Associated with Increased Risk of Intraperitoneal Fungal Infections.

Background: Damage control laparotomy (DCL) is a well-established tool to stabilize critically ill surgical patients. Direct peritoneal resuscitation (DPR), whereby the open abdomen is continuously irrigated with glucose-based hypertonic dialysate, is a valuable adjunct that improves abdominal closure rates and decreases wound complications. Infectious implications of its use remain underexplored. Objective: To assess the impact of DPR on the incidence intra-abdominal fungal infections (AFIs) in critically ill surgical patients. Methods: A retrospective chart review was performed of trauma and emergency general surgery patients undergoing DCL with and without DPR at our level 1 trauma center. The effect of DPR on the primary outcomes was assessed using two-stage logistic regression models. Classification and Regression Tree (CART) models were used to evaluate the leading factors contributing to the primary outcome. Results: A total of 169 patients were included in the study, 44% of which underwent DPR. Overall, patients who underwent DPR received a more frequent diagnosis of AFIs (28% vs. 13%, p = 0.012). After multi-variable adjustment, patients undergoing post-operative DPR had significantly higher odds of developing AFI (odds ratio [OR] = 5.0, 95% confidence interval [CI]: 1.3-18.5). In hybrid-logit CART models, DPR was again identified as being associated with an increased likelihood of developing AFI (OR = 2.4, 95% CI: 1.0-6.0). Conclusion: In this cohort, DPR patients had significantly higher chances of developing AFIs. This supports the need for further investigation into the clinical implications of AFIs in critically ill surgical patients and the need to develop risk mitigating strategies.

Efficacy of continuous intravenous infusion of lidocaine on postoperative sore throat after laryngeal mask insertion: a randomized controlled trial

BackgroundThis randomized controlled trial was performed to explore efficacy of continuous intravenous infusion of lidocaine on postoperative sore throat after laryngeal mask insertion.MethodsIn this prospective trial one hundred and sixty general anesthesia surgery patients (20 to 60 years) using laryngeal mask airway were randomly divided into control group (Group C, saline as placebo), lidocaine gel group (Group LG, lidocaine gel applied to the surface of the laryngeal mask), single intravenous lidocaine group (Group SL, intravenous lidocaine 1.5 mg/kg at induction of anesthesia) and continuous infusion of lidocaine group (Group CL, a bolus of 1.5 mg/kg, followed by an infusion of 2 mg/kg/h until the end of the surgical). The primary outcomes were the incidence and severity of POST at the time of laryngeal mask removal (T1), 2 h (T2), 6 h (T3), and 24 h (T4) after removal. The secondary outcomes included the incidence of adverse events such as hoarseness, cough, and tongue numbness.ResultWithin 24 h after extubation, the incidence and severity of POST was significantly lower in group CL than that in group C at all time points. In contrast, compared with group C, the incidence and severity of POST in group SL was lower only at T1. The incidence of hoarseness and cough in group CL were significantly lower than that in group C at T1 and T2. In group SL, the incidence of hoarseness and cough was lower than that in the group C only at T1. In group LG, the incidence of tongue numbness was significantly higher than that in group C only at T1, and there were no significant difference in the four groups at the other time points.ConclusionContinuous infusion of lidocaine is effective in reducing the incidence and severity of POST after laryngeal mask ventilation, as well as reducing the incidence of adverse effects such as hoarseness and cough.Trial RegistrationChinese Clinical Trial Registry (ChiCTR2300070339,04/10/2023).

The Effect of Music Therapy on Anxiety Levels in General Surgery Preoperative Patients: A Systematic Review

Anxiety is a condition commonly experienced on the eve of surgery and has the potential to impact the condition and outcome of surgery negatively. Management strategies include pharmacological and non-pharmacological approaches, such as music therapy. Music The aim is to be a complementary alternative to pharmacological treatments to reduce patient anxiety. This systematic review analyzes nonpharmacological therapies used in the application of music therapy to general surgery patients with anxiety at the preoperative stage. The method uses articles published from 2014-2024 sourced from Science Direct, Pubmed, Cochrane Library, and Google Scholar databases. Article assessment was carried out using instruments from the Joana Briggs Institute. The result is based on seven articles that have been reviewed related to music therapy management to minimize anxiety scores owned by patients before undergoing surgical operations at the preoperative stage. Some articles explain that duration, type of music selection (natural sound), Turkish classical music, classical music from the West, jazz music, and religious music can reduce anxiety scores, maintain hemodynamic status, and maintain normal cortisol levels. In conclusion, music therapy is recommended as a nonpharmacologic method for anxiety management in preoperative patients.

Development and validation of a preoperative prediction model for geriatric emergency general surgery

PurposeThe aim of this study was to establish a scoring system for preoperative assessment of postoperative mortality in elderly patients undergoing emergency general surgery.MethodsA retrospectively database of geriatric emergency general surgery (EGS) patients who underwent emergency surgery was used for the development of the scoring system.ResultsIn total, 1500 patients were enrolled with mean age of 69.8 years in the study. Through the development and comparison of models, we ultimately derived a rating scale known as GES (Geriatric Emergency Surgery Score). This score has a c-statistic of 0.892 for mortality (95% CI 0.854–0.931). The observed probability of mortality in hospital gradually increased from 1.1% at a score of 0 to 30.3% at a score of 5 and 100% at a score of 8.ConclusionThe GES scoring model in this study will accurately predict the mortality risk of elderly patients with acute abdomen, optimize the allocation of medical resources, and standardize the assessment of patients' conditions based on scientific criteria. Further prospective multicenter trials are needed to externally validate the model developed.

Safety and Efficacy of Tranexamic Acid in General Surgery

Perioperative bleeding is common in general surgery. The POISE-3 (Perioperative Ischemic Evaluation-3) trial demonstrated efficacy of prophylactic tranexamic acid (TXA) compared with placebo in preventing major bleeding without increasing vascular outcomes in noncardiac surgery. To determine the safety and efficacy of prophylactic TXA, specifically in general surgery. Subgroup analyses were conducted that compared randomized treatment with TXA vs placebo according to whether patients underwent general surgery or nongeneral surgery in the POISE-3 blinded, international, multicenter randomized clinical trial. Participants were 45 years or older, were undergoing noncardiac surgery, had increased cardiovascular risk, and were expected to require at least an overnight hospital admission after surgery. Among 26 581 eligible patients identified, 17 046 were excluded, resulting in 9535 patients randomized to the POISE-3 trial. Participants were enrolled from June 2018 through July 2021. The data were analyzed during December 2023. Prophylactic, 1-g bolus of intravenous TXA or placebo at the start and end of surgery. The primary efficacy outcome was a composite of life-threatening bleeding, major bleeding, or bleeding into a critical organ. The primary safety outcome was a composite of myocardial injury after noncardiac surgery, nonhemorrhagic stroke, peripheral arterial thrombosis, or symptomatic proximal venous thromboembolism at 30 days. Cox proportional hazards models were conducted, incorporating tests of interaction. Among 9535 POISE-3 participants, 3260 underwent a general surgery procedure. Mean age was 68.6 (SD, 9.6) years, 1740 were male (53.4%), and 1520 were female (46.6%). Among general surgery patients, 8.0% and 10.5% in the TXA and placebo groups, respectively, had the primary efficacy outcome (hazard ratio [HR], 0.74; 95% CI, 0.59-0.93; P = .01) and 11.9% and 12.5% in the TXA and placebo groups, respectively, had the primary safety outcome (HR, 0.95; 95% CI, 0.78-1.16; P = .63). There was no significant interaction by type of surgery (general surgery vs nongeneral surgery) on the primary efficacy (P for interaction = .81) and safety (P for interaction = .37) outcomes. Across subtypes of general surgery, TXA decreased the composite bleeding outcome in hepatopancreaticobiliary surgery (HR, 0.55; 95% CI, 0.34-0.91 [n = 332]) and colorectal surgery (HR, 0.67; 95% CI, 0.45-0.98 [n = 940]). There was no significant interaction across subtypes of general surgery (P for interaction = .68). In this study, TXA significantly reduced the risk of perioperative bleeding without increasing cardiovascular risk in patients undergoing general surgery procedures. ClinicalTrials.gov Identifier: NCT03505723.

Predictors against discharge to home in geriatric emergency general surgery patients.

This study aims to identify predictors of discharge to post-acute care in geriatric emergency general surgery (EGS) patients. This is a retrospective study of geriatric emergency general surgery (EGS) patients at a tertiary care facility between 2017 and 2018. Inclusion criteria were ≥ 65years old and presented directly from home. Non-survivors or those admitted from a healthcare facility were excluded. The primary outcome was discharge to home versus post-acute care. Out of 577 patients, the median age was 74, and 36.9% were discharged to a post-acute care facility. Factors predicting discharge to post-acute care were: mobility aid use (1.92, [1.19-3.11], p = 0.008), cerebrovascular accident (4.67, [1.99-10.94], p < 0.001), delirium (11.06, [2.29-53.43], p = 0.003), pre-operative transfusion (2.39, [1.13-5.08], p = 0.023), fall history (3.74, [1.90-7.36], p < 0.001), AKI (5.42, [2.61-11.25], p < 0.001), and lack of capacity to consent (4.11, [2.10-8.02], p < 0.001). Non-operative management was protective against discharge to post-acute care (0.38, [0.24-0.60], p < 0.001). Early recognition of the role of these factors in influencing discharge disposition may help with clinical decision-making and discharge planning.

Role of Opioid-Sparing Techniques in Pain Management for General Surgery Patients With Hepatic Dysfunction: An Observational Cohort Study.

Introduction Patients with hepatic dysfunction undergoing general surgery face significant perioperative risks due to the liver's critical role in drug metabolism and systemic homeostasis. Opioid-sparing techniques may mitigate these risks by reducing opioid consumption and minimizing hepatic complications. Objective The objective of the study was to evaluate the effectiveness of opioid-sparing techniques in pain management for general surgery patients with hepatic dysfunction and their impact on postoperative outcomes. Methodology This observational cohort study was conducted at Lady Reading Hospital, Peshawar, Pakistan, from November 2023 to October 2024. A total of 100 patients with hepatic dysfunction undergoing elective general surgeries were included, with 50 managed using opioid-sparing techniques and 50 receiving opioid-based analgesia. Pain was assessed using the Numeric Rating Scale (NRS) at six, 12, 24, and 48 hours post-surgery. Opioid consumption was quantified as morphine-equivalent doses over 48 hours. Hepatic function parameters (aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin) and postoperative outcomes, including complications and hospital stay, were analyzed. Results Postoperative pain scores were significantly lower in the opioid-sparing group across all time points (e.g., NRS at six hours: 2.9 ± 0.8 vs. 4.5 ± 1.1, p < 0.001). Opioid consumption was reduced by 67% in the opioid-sparing group (4.1 ± 1.5 mg vs. 12.6 ± 3.8 mg,p < 0.001). Hepatic function parameters remained stable in both groups. The opioid-sparing group had shorter hospital stays (3.8 ± 0.9 days vs. 5.1 ± 1.2 days, p < 0.001) and fewer complications, including nausea (12% vs. 30%, p = 0.02) and respiratory depression (0% vs. 10%, p = 0.04). Conclusion Opioid-sparing techniques improve pain management, reduce opioid consumption, and minimize postoperative complications in patients with hepatic dysfunction undergoing general surgery. These findings support incorporating opioid-sparing protocols into perioperative care for this high-risk population.

EP66 Do emergency general surgery patients know their consultant? An audit based on the Francis Report

eP66 Do emergency general surgery patients know their consultant? An audit based on the Francis Report

EP23 Do Early Registrar Reviews Shorten Advanced Imaging Completion Times for Emergency General Surgery Patients?

eP23 Do Early Registrar Reviews Shorten Advanced Imaging Completion Times for Emergency General Surgery Patients?

Evaluating the Impact of Preoperative Nutritional Status on Surgical Outcomes and Public Health Implications in General Surgery Patients.

Malnutrition is linked to more postoperative problems, a longer recovery period, and a higher death rate; preoperative nutritional condition is a critical factor in surgical outcomes. This study aimed to evaluate the impact of preoperative nutritional status on surgical outcomes in general surgery patients and explore its broader public health implications. A two-year observational research with 440 adult patients undergoing general surgery was carried out between January 2022 and December 2023. Based on preoperative nutritional tests, such as Nutritional Risk Screening (NRS-2002), Body Mass Index (BMI), and blood albumin levels, participants were divided into two groups: nutritionally sufficient and nutritionally compromised. Postoperative problems, such as infections, wound healing, duration of hospital stay, readmissions, and 30-day mortality, were examined in the data. Nutritionally compromised patients exhibited significantly worse outcomes, including higher rates of postoperative infections (80 out of 220, 36.36% vs. 30 out of 220, 13.64%), delayed wound healing (50 out of 220, 22.73% vs. 20 out of 220, 9.09%), longer hospital stays (9.87 ± 3.58 vs. 6.53 ± 2.31 days), increased readmission rates (40 out of 220, 18.18% vs. 10 out of 220, 4.55%), and higher 30-day mortality (25 out of 220, 11.36% vs. 5 out of 220, 2.27%) compared to the nutritionally adequate group. Long-term follow-up showed persistent differences in infection rates and wound healing, supporting the prolonged impact of poor nutritional status. Preoperative malnutrition significantly affects surgical outcomes, emphasizing the importance of nutritional optimization in preoperative care to enhance recovery and minimize complications.

Assessing the value of deep neural networks for postoperative complication prediction in pancreaticoduodenectomy patients.

Pancreaticoduodenectomy (PD) for patients with pancreatic ductal adenocarcinoma (PDAC) is associated with a high risk of postoperative complications (PoCs) and risk prediction of these is therefore critical for optimal treatment planning. We hypothesize that novel deep learning network approaches through transfer learning may be superior to legacy approaches for PoC risk prediction in the PDAC surgical setting. Data from the US National Surgical Quality Improvement Program (NSQIP) 2002-2018 were used, with a total of 5,881,881 million patients, including 31,728 PD patients. Modelling approaches comprised of a model trained on a general surgery patient cohort and then tested on a PD specific cohort (general model), a transfer learning model trained on the general surgery patients with subsequent transfer and retraining on a PD-specific patient cohort (transfer learning model), a model trained and tested exclusively on the PD-specific patient cohort (direct model), and a benchmark random forest model trained on the PD patient cohort (RF model). The models were subsequently compared against the American College of Surgeons (ACS) surgical risk calculator (SRC) in terms of predicting mortality and morbidity risk. Both the general model and transfer learning model outperformed the RF model in 14 and 16 out of 19 prediction tasks, respectively. Additionally, both models outperformed the direct model on 17 out of the 19 tasks. The transfer learning model also outperformed the general model on 11 out of the 19 prediction tasks. The transfer learning model outperformed the ACS-SRC regarding mortality and all the models outperformed the ACS-SRC regarding the morbidity prediction with the general model achieving the highest Receiver Operator Area Under the Curve (ROC-AUC) of 0.668 compared to the 0.524 of the ACS SRC. DNNs deployed using a transfer learning approach may be of value for PoC risk prediction in the PD setting.

Barriers faced by surgeons in identifying and managing malnutrition in emergency general surgery: A qualitative study.

Many patients undergoing emergency surgery are malnourished. Identifying malnutrition is a prerequisite to offering targeted nutritional support. Guidelines exist but little is known regarding exactly how surgeons identify malnutrition, or the barriers that influence surgeons' clinical decision-making. The aim of this work was to explore how consultant surgeons identify malnutrition in emergency general surgery (EGS) patients and the barriers to nutritional assessment and intervention. Consultant surgeons with emergency surgery duties were invited to participate. Semi-structured interviews were conducted online, audiovisually recorded and transcribed. An inductive approach was used for data analysis using the framework method. Coding and analysis were performed by two independent researchers using NVivo software. Themes were developed and reviewed with the supervising team. Interviews continued until data saturation was reached. Ethical approval was gained prior to interviews. Eighteen interviews were conducted across three hospital settings. Identification of malnutrition consisted of three themes: 'The surgeon' (knowledge, experience, planning ahead); 'The patient' (selection, composition, clinical progress, operative considerations); and 'The institution' (collaboration, extended surgical team). Three themes encompassed barriers experienced: 'The surgeon' (understanding, culture, ownership, time constraints); 'The institution' (provision, staffing, conflict, hospital setting); and 'The wider context' (research, external factors). These influenced clinical decision-making, which had two themes: 'To join or not to join' (risk taking, site of anastomosis) and 'Nutritional support' (timing, referral pathways). The identification and management of malnutrition in EGS is fraught with barriers, impacting operative and clinical decision-making. Improvements in surgeon education, culture, collaborative working and resources are needed.

Thrombotic complications post liver transplantation: Etiology and management.

Liver transplantation (LT) is the life saving therapeutic option for patients with acute and chronic end stage liver disease. This is a routine procedure with excellent outcomes in terms of patient survival and quality of life post LT. Orthotopic LT (OLT) patients require a critical care as they are prone to variety of post-operative vascular, cardiovascular, biliary, pulmonary and abdominal complications. Thrombotic complications (both arterial and venous) are not uncommon post liver transplant surgery. Such vascular problems lead to increased morbidity and mortality in both donor and graft recipient. Although thromboprophylaxis is recommended in general surgery patients, no such standards exist for liver transplant patients. Drastic advancements of surgical and anesthetic procedures have improvised survival rates of patients post OLT. Despite these, haemostatic imbalance leading to thrombotic events post OLT cause significant graft loss and morbidity and even lead to patient's death. Thus it is extremely important to understand pathophysiology of thrombosis in LT patients and shorten the timing of its diagnosis to avoid morbidity and mortality in both donor and graft recipient. Present review summarizes the current knowledge of vascular complications associated with LT to highlight their impact on short and long-term morbidity and mortality post LT. Also, present report discusses the lacunae existing in the literature regarding the risk factors leading to arterial and venous thrombosis in LT patients.

Clinical utility of routine postoperative labs in emergency general surgery patients

BackgroundMorning postoperative labs are often obtained for emergency general surgery (EGS) patients. Studies in other surgical fields indicate that routine postoperative day 1 (POD1) labs are sometimes being performed excessively...

Response to: Comment on: Nutritional support for the trauma and emergency general surgery patient: What you need to know.

Response to: Comment on: Nutritional support for the trauma and emergency general surgery patient: What you need to know.

Comment on: Nutritional support for the trauma and emergency general surgery patient: What you need to know.

Comment on: Nutritional support for the trauma and emergency general surgery patient: What you need to know.