Indication For Emergency Surgery Research Articles

Preoperative risk factors for 90-day postoperative mortality outcome in patients with non-occlusive mesenteric ischemia.

The mortality rate for non-occlusive mesenteric ischemia remains high even after patients survive the acute postoperative period with tremendous treatment efforts, including emergency surgery, which is challenging. The aim of this study was to explore the preoperative risk factors for 90-day postoperative mortality in patients with non-occlusive mesenteric ischemia. This single-center, retrospective cohort study included patients diagnosed with non-occlusive mesenteric ischemia who underwent emergency surgery between August 2014 and January 2023. All patients were divided into survival-to-discharge and mortality outcome groups at the 90-day postoperative follow-up. Preoperative factors, including comorbidities, preoperative status of vital signs and consciousness, blood gas analysis, blood test results, and computed tomography, were compared between the two groups. Twenty patients were eligible, and 90-day mortality was observed in 10 patients (50%). The mortality outcome group had significantly lower HCO3- (20.9 vs. 14.6, p = 0.006) and higher lactate (4.4 vs. 9.4, p = 0.023) levels than did the survival outcome group. The median postoperative time to death was 19 [2-69] days, and five patients (50%) died after postoperative day 30, mainly because hemodialysis was discontinued because of hemodynamic instability in patients requiring hemodialysis. Low preoperative HCO3- and high lactate levels may be preoperative risk factors for 90-day postoperative mortality in patients with non-occlusive mesenteric ischemia. However, patients on hemodialysis die from discontinuing hemodialysis even after surviving the acute postoperative phase. Therefore, indications for emergency surgery in patients with risk factors for postoperative mortality should be carefully determined.

Typhoid intestinal perforation in Francophone Africa, a scoping review.

Typhoid intestinal perforation (TIP) is a leading cause of peritonitis and indication for emergency surgery in Africa, with reported mortality rates up to 30% in pediatric patients. Currently, data on TIP in Western databases are primarily from countries that speak English, likely due to non-English publication and citation biases. Despite the high burden of infectious diseases in Francophone Africa, data from these countries regarding TIP remain limited. This study aims to highlight the incidence and morbidity of TIP in Francophone African countries using an extended search algorithm. We conducted a scoping review using the PubMed, EMBASE, and SCOPUS databases with the keywords "peritonitis", "non-traumatic ileal perforation", and "typhoid" in Francophone African countries. Additionally, we contacted surgeons in Africa and concurrently used citation chasing to obtain data not found in western databases. In total, 32 studies from 12 countries were identified and included in this review. A total of 22 publications were in French. Patient median age was 20 years and TIP caused a median of 35% of acute peritonitis cases. Mortality rates ranged from 6-37% (median: 16%). Rate of complications ranged from 15-92% (median: 46%). Ileostomy creation as a treatment for TIP varied between hospitals (0-79%), with the highest rates reported in Niger. In Francophone Africa, TIP is associated with high morbidity and mortality, most commonly in children and young adults. Interventions, including improved sanitation and the introduction of typhoid conjugate vaccines into routine vaccination programs, have the potential to significantly decrease typhoid fever and its complications.

Inadequate pregnancy-specific knowledge among patients with inflammatory bowel disease: A multicenter survey in China.

The perceptions and attitudes of inflammatory bowel disease (IBD) patients towards pregnancy may affect their fertility plan and disease progression. We performed a nationwide multicenter survey of pregnancy-related knowledge among gastroenterologists and IBD patients in China to investigate whether specific educational interventions could improve their understanding and broadly influence fertility plan. A cross-sectional questionnaire regarding pregnancy-specific knowledge was carried out among 63 IBD centers in China. Questionnaires were collected from 185 physicians and 609 patients. The patients then received education regarding pregnancy during IBD and filled in the same questionnaire again. Their knowledge regarding pregnancy during IBD was compared before and after education. Compared to physicians, patients' knowledge regarding fertility (39.1% vs 70.8%), imaging examinations (22.8% vs 72.4%), endoscopy performed during pregnancy (19.9% vs 71.4%), and vaccination for infants (16.6% vs 46.5%) was significantly more limited (all P < 0.001). There was a lack of knowledge among gastroenterologists regarding the delivery mode (36.8%), medications (36.8%), and emergency surgery (26.5%) during pregnancy in patients with IBD. After education, the patients showed significant improvement in knowledge regarding medications (26.7% vs 51.7%), fertility (45.0% vs 63.3%), heritability (40.0% vs 58.3%), indications for emergency surgery (15.0% vs 53.3%), imaging examinations during pregnancy (20.0% vs 40.0%), and vaccinations for infants (26.7% vs 45.0%) (all P < 0.05). Pregnancy-specific IBD knowledge needs to be improved among certain gastroenterologists and patients in China. Educational interventions can partially improve the knowledge levels of the patients.

P754 Inadequate Pregnancy Specific Knowledge among Patients with Inflammatory Bowel Disease: A Multi-Center Survey in China

Abstract Background Perceptions and attitudes of inflammatory bowel disease patients on pregnancy may influence their fertility planning and disease progression. There was data published about knowledge as well as the impact of education in relation to inflammatory bowel disease and pregnancy. However, it is unknown in China. Facing the sharp decline in birth rate, we need to understand the pregnancy-specific knowledge of Chinese gastroenterologists and patients with inflammatory bowel disease and the significance of education. Methods A cross-sectional questionnaire, regarding pregnancy-specific knowledge, was carried out among China's 63 inflammatory bowel disease centers. 794 questionnaires were obtained, including 185 from physicians and 609 from patients. Our center then led the educational intervention. Results Compared to physicians, patients' knowledge levels of fertility (39.1% vs. 70.8%, p &amp;lt; 0.001), imaging examinations (22.8% vs. 72.4%, p &amp;lt; 0.001), and endoscopy performed during pregnancy (19.9% vs. 71.4%, p &amp;lt; 0.001) and vaccination (16.6% vs. 46.5%, p &amp;lt; 0.001) were significantly lower. There was a lack of knowledge among gastroenterologists regarding the delivery mode (36.8%), medications (36.8%), and emergency surgery (26.5%) during pregnancy in patients with inflammatory bowel disease. The following six aspects were significantly improved after education, including the medication (26.7% vs. 51.7%, p=0.005), fertility (45% vs. 63.3%, p=0.044), heritability (40% vs. 58.3%, p=0.045), indications for emergency surgery (15% vs. 53.3%, p&amp;lt;0.001), imaging examinations during pregnancy (20% vs. 40%, p=0.017) and vaccinations (26.7% vs. 45%, p=0.036). Conclusion Pregnancy-specific inflammatory bowel disease knowledge was lacking among certain gastroenterologists and inflammatory bowel disease patients in China. Educational interventions can partially improve the knowledge levels of patients in this area.

Pneumatosis cystoides intestinalis: a case report and literature review

Pneumatosis cystoides was first described by Du Vernay in 1783. This is a fairly rare disease with nonspecific symptoms and CT data on pneumoperitoneum. The authors present pneumatosis intestinalis in a patient with systemic connective tissue disorder. Free gas in abdominal cavity and dilated intestinal loops were an indication for emergency surgery with subsequent resection of intestine due to signs of ischemic damage. A review of clinical cases allows us to conclude that pneumoperitoneum requires careful differential diagnosis. Free gas in abdominal cavity in patients with cystic pneumatosis is an indication for emergency surgery only in case of complicated course of disease.

SURGICAL EMERGENCY IN INFANTS AND TODDLERS WITH ABDOMINAL AND MEDIASTINAL LYMPHATIC MALFORMATIONS

Background. Lymphatic malformations of thoracic and abdominal cavities can remain asymptomatic for a long time and can be revealed accidentally within examination for other medical reason. At the same time, the disease debut can manifest as critical condition requiring emergency surgical care. The aim of the study is to detect the life-threatening complications of thoracic and abdominal cavities LMs that require urgent surgical procedures. Materials and methods. 17 patients with LMs of thoracic cavity and 38 patients with LMs of abdominal cavity are included into the study. All patients underwent in-hospital treatment in Ohmatdyt specialized children’s hospital in a period since 2012 to 2021. Results. Visceral cavities were affected by LMs in 22.9% cases. Minimally invasive technologies were used in uncomplicated LMs, laparoscopic resection, which was performed in 22 (78.6%) patients, sclerotherapy (n=6; 15.8%) and mTOR inhibitors systemic therapy in one clinical case (2.6%). Planned laparotomy or conversion to open surgery was performed in 9 (23.7%) patients. One child underwent emergency laparotomy – a newborn with LM affecting bowel and mesentery, which developed total mesentery thrombosis. Treatment options applied in thoracic cavity LMs treatment were repetitive sclerotherapy procedures in 7 (36,8%), and a combination pf surgical resection and sclerotherapy in 6 (31,6%) cases. 4 (21,1%) patients required emergency surgeries, including pleural drain for chylothorax (n=1), and thoracotomy with LM resection (n=3) in patients with rapid LM volume increase resulted from intracystic hemorrhage following inflammation. Complicated LMs occurred in patients aged from 1 to 14 months.Conclusions. The highest risk of life-threatening complications in patients with visceral cystic LMs was observed during two first years of life. Indications for emergency surgery were mesenteric thrombosis in a child with abdominal LM and intrathoracic tension syndrome in children with mediastinal LMs.

The Golden Hour of Casualty Care: Rapid Handoff to Surgical Team is Associated With Improved Survival in War-injured US Service Members.

To examine time from injury to initiation of surgical care and association with survival in US military casualties. Although the advantage of trauma care within the "golden hour" after an injury is generally accepted, evidence is scarce. This retrospective, population-based cohort study included US military casualties injured in Afghanistan and Iraq, January 2007 to December 2015, alive at initial request for evacuation with maximum abbreviated injury scale scores ≥2 and documented 30-day survival status after injury. Interventions: (1) handoff alive to the surgical team, and (2) initiation of first surgery were analyzed as time-dependent covariates (elapsed time from injury) using sequential Cox proportional hazards regression to assess how intervention timing might affect mortality. Covariates included age, injury year, and injury severity. Among 5269 patients (median age, 24 years; 97% males; and 68% battle-injured), 728 died within 30 days of injury, 68% within 1 hour, and 90% within 4 hours. Only handoffs within 1 hour of injury and the resultant timely initiation of emergency surgery (adjusted also for prior advanced resuscitative interventions) were significantly associated with reduced 24-hour mortality compared with more delayed surgical care (adjusted hazard ratios: 0.34; 95% CI: 0.14-0.82; P = 0.02; and 0.40; 95% CI: 0.20-0.81; P = 0.01, respectively). In-hospital waits for surgery (mean: 1.1 hours; 95% CI; 1.0-1.2) scarcely contributed ( P = 0.67). Rapid handoff to the surgical team within 1 hour of injury may reduce mortality by 66% in US military casualties. In the subgroup of casualties with indications for emergency surgery, rapid handoff with timely surgical intervention may reduce mortality by 60%. To inform future research and trauma system planning, findings are pivotal.

Spontaneous Rapid Resolution of Acute Subdural Hematoma: Revelation in the Era of Modern Science

AbstractAcute subdural hematoma (SDH) with mass effect and midline shift is an indication for emergency surgery in neurotrauma. A very few case reports were present in the literature showing rapid resolution of acute SDH with improvement in clinical condition of the patient within hours after trauma. In this article, we presented a case of acute SDH that showed almost disappearance of hematoma within 5 hours after trauma.

Bilateral Tubal Pregnancy Complicated by Rupture of the Left Fallopian Tube

Introduction: Bilateral ectopic pregnancy is a very rare condition which occurs in 1/725 - 1/1580 ectopic pregnancies, most commonly after induced assisted reproductive techniques. Aim: To present the case of spontaneous bilateral tubal pregnancy, and the problem of insufficiency of available diagnostic methods, which causes that an accurate diagnosis can mostly be made intraoperatively. Case Report: A 37-year-old female, nulliparous, comes at the Clinic of Gynecology and Obstetrics of CCUS, complains of intense suprapubic pain, and difficulty urinating. The expected menstruation was absent for more than 2 weeks. The Grav index test was positive. Beta hCG values were 6312 IU/L. On examination, the patient was extremely pale, hypotensive, gave the impression of hemorrhagic shock, and the abdomen was diffusely palpably painful. After emergency TV ultrasound, then ultrasound and CT of the abdomen and small pelvis, which indicate a moderate amount of thicker fluid in the abdomen and small pelvis in terms of hemoperitoneum and with the left contour of the uterus an oval zone most likely to correspond to ectopic pregnancy, an indication for emergency surgery was made. A laparotomy was performed, and partly liquid and partly coagulated blood was found in the abdomen. The left tube in the isthmic part was ruptured with active bleeding. Right Fallopian tube was pathologically changed, livid, with visible suspicious pregnancy in the ampullary part. Bilateral salpingectomy was performed, and samples are sent for PHD analysis that shows the presence of chorionic villi in both tubes. Conclusion: When ectopic pregnancy is suspected, the possibility of bilateral tubal pregnancy should always be kept in mind, especially in cases accompanied by acute pelvic pain with signs of hemorrhagic shock

Results of emergency salvage lung resection after chemo- and/or radiotherapy among patients with lung cancer.

This study aimed to elucidate the outcomes of emergency salvage surgery following life-threatening events (serious haemorrhage and/or infections) among patients with lung cancer who had undergone chemo- and/or radiotherapy. We analysed the data of patient from 2015 to 2020, retrospectively. The clinical characteristics, including preoperative treatment, perioperative outcomes and survival time, were analysed. Of the 862 patients who underwent primary lung cancer surgeries, 10 (1.2%) underwent emergency surgeries. The preoperative clinical characteristics were: median age, 63.7 years [interquartile range (IQR) 55-70.5]; sex (male/female), 9/1; clinical staging before initial treatment (I/II/III/IV), 1/1/3/5; initial treatment (chemoradiotherapy/chemotherapy/proton beam therapy), 5/4/1; and indications for emergency surgery (lung abscess/lung abscess with haemoptysis/haemoptysis/empyema), 5/3/1/1. The selected procedures and results were as follows: lobectomy/bilobectomy/pneumonectomy, 8/1/1 (all open thoracotomies); median operation time, 191.0 min (IQR 151-279); median blood loss, 1071.5 ml (IQR 540-1691.5); postoperative severe complications, 3 (30%); hospital mortality, none; median postoperative hospital stay, 37 days (12-125); control of infection and/or haemoptysis, all the cases; final outcome (alive/dead), 3/7 (all the cancer deaths); median postoperative survival, 9.4 months (IQR 4.3-20.4); and median survival from initial treatment, 19.4 months (IQR 8.0-66.9). Emergency salvage lung resection is a technically challenging procedure; however, the results were feasible and acceptable when the surgical indication, procedure and optimal timing were considered carefully by a multidisciplinary team. Although the aim was palliation, some patients who received additional chemotherapy afterwards and, thus, had additional survival time.

Report from 'ESCP 2021 Virtual': the 16th Scientific and Annual Conference of the European Society of Coloproctology, 22-24 September 2021.

Report from 'ESCP 2021 Virtual': the 16th Scientific and Annual Conference of the European Society of Coloproctology, 22-24 September 2021.

SYNCHRONOUS COLON CANCER PRESENTED AS ADULT ILEO-CAECAL INTUSSUSCEPTION, A RARE CASE REPORT

Colorectal cancer (CRC) is the third most common tumor type worldwide with approximately 1.8 million new cases diagnosed per year. Despite the high incidence of newly diagnosed cases, the majority (70%- 80%) of these tumors are respectable. These tumors can present as an incidental ndings on screening colonoscopy, with anemia symptoms such as general weakness and fatigue ( for right sided- tumors) or changes in bowel habits ( for left sided tumors). In advanced cases, loss of weight and loss of appetite are also common presenting symptoms. Less common, yet emergent presentations include large bowel obstruction, severe gastrointestinal hemorrhage and free intra-abdominal perforation. Synchronous CRC (SCRC) tumors, dened as two or more primary tumors existing independently of one another, have an incidence rate of 2.3% - 12.4% of overall CRC with male predominance. Presentation of these tumors is usually identical to presentation of solitary CRC. Emergency surgical presentation, with two different surgical indications for operation is very rare. Herein, we present a case of SCRC tumor in a 32-year-old man, with indication for emergent surgery being ileo-caecal intussusceptions but incidentally was diagnosed to have sigmoid colon growth .

ARROSIVE BLEEDING FROM THE APPENDICULAR ARTERY IN ACUTE DESTRUCTIVE APPENDICITIS

Summary. Objective of the study: to present to the surgical community a rather rare complication of severe destructive appendicitis – arrosive bleeding and the cause of its development.&#x0D; Material and methods. Published a rare clinical case from prac-tice — the development of perforation of the appendix and arrosive bleeding from the appendicular artery in a patient with acute gangrenous appendicitis.&#x0D; Results and its discussion. The atypical course of acute appendicitis of undulating nature under the mask of acute adnexitis and antibacterial therapy has led to a prolonged delay with surgery in the surgical department. Only the appendicular abscess, which spontaneously opened into the abdominal cavity, made it possible to diagnose acute appendicitis and determine indications for emergency surgery, during which arrosive bleeding was diagnosed. The favorable outcome of the disease is due to the local purulent-necrotic process and small hemoperitoneum.&#x0D; Findings. Timely diagnosis of acute appendicitis, with the involvement of additional research methods in unclear cases, and subsequent appendectomy, are the prevention of a rather rare complication — arrosive bleeding from the appendicular artery in the development of severe complicated forms of acute destructive appendicitis.

Diferentes formas de apresentação radiológica da perfuração intestinal na Enterocolite Necrosante

Objetivo: Relatar as diferentes formas de apresentação radiológica da necrose e da perfuração intestinal na Enterocolite Necrosante (ECN) em sete recém-nascidos internados em UTI neonatal. Detalhamento de Caso: Foram avaliados os RX Simples do abdome de sete RNs com ECN, sendo que todos estavam na fase 3 de Bell. Achados radiológicos: opacificação completa do abdome; bolha de ar acima do fígado; sinal da bola de futebol; imagens hipertransparentes sem o formato de víscera oca; Sinal de Rigler; e ar peritoneal livre destacando estruturas intraperitoneais. Considerações Finais: A ECN tem etiologia multifatorial, associado a três fatores principais: a imaturidade intestinal, proliferação bacteriana e dieta via oral com fórmula. O agravamento do quadro clínico, presença de sinais de instabilidade hemodinâmica, plaquetopenia e a acidose metabólica associados as alterações radiológicas específicas, podem propiciar o diagnóstico de uma ECN avançada. A indicação para a cirurgia de urgência é a presença de necrose e/ou perfuração intestinal. É fundamental reconhecer os diferentes modos de apresentação radiológica destas complicações, de forma rápida e precisa, pois, isso implicará na decisão terapêutica de uma cirurgia imediata e, consequentemente, terá impacto na qualidade de vida e na sobrevida desses neonatos.

Surgical treatment and operation time in human immunodeficiency virus-negative cryptococcal meningitis.

There are still no unified guidelines of surgical treatment and timing for human immunodeficiency virus (HIV)-negative patients with cryptococcal meningitis (CM).The clinical data and follow-up data were collected from HIV-negative CM patients in Xiangya Hospital of Central South University from January 2009 to November 2018, and 42 patients who were treated with surgical intervention were enrolled in the present study. These 42 patients were divided into ventriculoatrial (VA) group, ventriculoperitoneal group, external ventricle drainage (EVD) group, hydrocephalus (HYC) group, non-HYC group, EVD group, and non-EVD group (VA/ ventriculoperitoneal) according to different surgical procedures. Statistical analyses were conducted using SPSS (version 19.0, Chicago, IL).Signs of headache, fever, and loss of consciousness in the VA group were significantly improved compared with the EVD group at 1 week after operation (P < .05). The mortality rate of the VA group was significantly lower than that of the EVD group (P < .05). Moreover, male patients were more prone to have HYC (P < .05). Younger patients tended to develop HYC (P < .05). Cerebrospinal fluid sugar in the non-HYC group was significantly lower compared with the HYC group (P < .05). Time of CM-to-operation in the non-HYC group was markedly shorter compared with the HYC group (P < .01).VA procedure could be one of the first choices for the treatment of uncontrollable intracranial hypertension caused by CM. Severe uncontrollable headache, loss of consciousness, and cerebral hernia were indications of emergency surgery. Repeated headache, hearing impairment, and especially progressive loss of vision were indications of early surgery to avoid permanent damage to nerve functions of HIV-negative CM patients.

A Correlation of Blood Panel Results and Histologically Confirmed Appendicitis.

BackgroundAppendicitis is the most common indication for emergency surgery in the world. There is no one laboratory or radiological test that is used to diagnose it. Various routine and novel blood markers have been identified, however none have proved to be conclusive. The aim of this study was to combine routine blood markers to increase the sensitivity and specificity in diagnosing histologically confirmed appendicitis.MethodsWe retrospectively reviewed the theatre logs for the calendar year of 2015 to identify all of the appendectomies which were performed. We reviewed all of the admission bloods for the patients - including their white blood cell (WBC) count, their neutrophil count, and their C-Reactive protein (CRP) value. We also reviewed all of the histology to identify the inflamed appendices, and analysed all of this information together.ResultsThe neutrophil count is the most sensitive of the three blood markers with a score of 82%. It has a specificity of 63%. The CRP value is the most specific of the three blood markers with a value of 67% and a sensitivity of 76%. WBC has a sensitivity of 75% and a specificity of 63%. Combining all of the blood values (i.e. elevated white blood cell count or elevated neutrophil count or elevated CRP) demonstrates a sensitivity of 96% and a specificity of 45%.ConclusionCombining routine admission blood markers (WBC, neutrophil count, and CRP) can assist in diagnosing appendicitis in unwell patients with abdominal pain.

Mesenteric ischemia with pneumatosis intestinalis and portal vein gas associated with enteral nutrition: a series of three patients.

Enteral nutrition is usually associated with a low risk of intestinal complications. We report three non-critically ill patients who received enteral nutrition and developed mesenteric ischemia with pneumatosis intestinalis and hepatic portal vein gas. These findings are often considered to be indications for emergency surgery. In these three patients, prompt cessation of enteral nutrition avoided progression to intestinal necrosis obviating the need for intestinal resection, although one patient underwent surgical exploration. Follow-up computed tomography scan showed resolution of the radiologic findings, and all patients started enteral nutrition again without complications. All patients had comorbidities associated with atherosclerosis, which may have led to a mismatch between oxygen delivery and demand in the bowel, resulting in ischemia. To the best of our knowledge, this is the first report of successful management of mesenteric ischemia related to enteral nutrition in non-critically ill patients without resection. If the cause of mesenteric ischemia such as enteral nutrition, can be eliminated quickly, non-resectional and possibly nonoperative management can be a reasonable management option, with close follow-up and readiness for resection.

A retrospective analysis of emergency surgery for cases of acute abdomen during cancer chemotherapy. Case series

BackgroundTreatment for acute abdomen during chemotherapy is frequently difficult because of the complicated status of the patients, and there have been only a few case series summarizing the outcomes of emergent surgery during chemotherapy. The aim of this study was to clarify the clinical outcomes of emergency surgery for acute abdomen during chemotherapy and identify predictive factors associated with mortality. MethodsWe retrospectively analyzed the records of patients who underwent emergency surgery for acute abdomen within 30-days after anti-cancer drugs administration between 2009 and 2020. ResultsThirty patients were identified. The primary malignancies were hematological (n = 7), colorectal (n = 4), lung (n = 4), stomach (n = 2), breast (n = 2), prostate (n = 2) and others (n = 5). Fifteen patients were treated with the regimen, including molecular-targeted anti-cancer drugs (Bevacizumab: 8 cases, Rituximab: 4, Ramucirumab: 2, and Gefitinib: 1). Indications for emergency surgery were perforation of the gastrointestinal tract (n = 24), appendicitis (n = 3), bowel obstruction (n = 2), and gallbladder perforation (n = 1). Severe morbidity (Clavien-Dindo IIIa or more) occurred in 8 cases (27%), and there were 6 in-hospital deaths (20%). Significant factors related to in-hospital death were age >70 years old (P = 0.029), poor performance status (ECOG score 1 or 2) (P = 0.0088), and serum albumin level <2.6 g/dl (P = 0.026). The incidence of acute abdomen (odds ratio 5.31, P = 0.00017) was significantly higher in the patients receiving anti-VEGF drugs than in those without anti-VEGF drugs. ConclusionThis study identified three predictive factors associated with in-hospital death after emergency surgery during chemotherapy: an older age, poor performance status, and low serum albumin level.

Recommendations of protective measures for orthopedic surgeons during COVID-19 pandemic.

PurposeIt was the primary purpose of the present systematic review to identify the optimal protection measures during COVID-19 pandemic and provide guidance of protective measures for orthopedic surgeons. The secondary purpose was to report the protection experience of an orthopedic trauma center in Wuhan, China during the pandemic.MethodsA systematic search of the PubMed, Cochrane, Web of Science, Google Scholar was performed for studies about COVID-19, fracture, trauma, orthopedic, healthcare workers, protection, telemedicine. The appropriate protective measures for orthopedic surgeons and patients were reviewed (on-site first aid, emergency room, operating room, isolation wards, general ward, etc.) during the entire diagnosis and treatment process of traumatic patients.ResultsEighteen studies were included, and most studies (13/18) emphasized that orthopedic surgeons should pay attention to prevent cross-infection. Only four studies have reported in detail how orthopedic surgeons should be protected during surgery in the operating room. No detailed studies on multidisciplinary cooperation, strict protection, protection training, indications of emergency surgery, first aid on-site and protection in orthopedic wards were found.ConclusionStrict protection at every step in the patient pathway is important to reduce the risk of cross-infection. Lessons learnt from our experience provide some recommendations of protective measures during the entire diagnosis and treatment process of traumatic patients and help others to manage orthopedic patients with COVID-19, to reduce the risk of cross-infection between patients and to protect healthcare workers during work.Level of evidenceIV.

Comparison of POMPP Scoring System with PULP Score, Boey Score, and ASA Scoring Systems to Predict Mortality in Peptic Perforation

Perforated peptic ulcer represents the most frequent indication for emergency surgery for peptic ulcer disease. The mortality from perforated peptic ulcer remains up to 27%. We compare predictive score of mortality in perforated peptic ulcer (POMPP) scoring system with peptic ulcer perforation (PULP) score, Boey score, and American Society of Anesthesiologists (ASA) score to predict mortality. Hundred consecutive patients were operated for peptic perforation from May 2018 to May 2019 in our institute. For prediction of mortality, scoring was done by POMPP score, PULP score, Boey score, and ASA score. Comparative analysis of different score was done. Mean age was 40.7 years and male to female ratio was 32.3:1. Post-operative morbidity was 27% and mortality rate was 11%. Of the 10 patients of high POMPP score, 8 patients died (p value 0.000001) with accuracy of 80%. Receiver operating characteristic curve analysis showed that area under curve was 0.964 for POMPP score, 0.980 for PULP score, 0.960 for Boey score, and 0.906 for ASA score. The specificity of Boey score, POMPP score, and PULP score was 88.7%, 97.7%, and 100% respectively. Boey score had accuracy of 44.4% and PULP score had 100% accuracy in predicting mortality but it is complex with more number of components. POMPP score is based on objective data and its components are age and routinely measured values (blood urea nitrogen and serum albumin). It is simple and easily applicable scoring system for predicting mortality in peptic perforation peritonitis patients with accuracy of 80%.