General Surgery Operations Research Articles

Qualitative analysis of theses on laparoscopic cholecystectomy

Objectives: The purpose of this study was to examine bibliographically the theses on laparoscopic cholecystectomy in our country and to provide the researchers with a perspective on the elimination of the deficiencies in this field. Materials and methods: Content analysis and descriptive analysis methods, which are among qualitative research methods, were used in the study. The study group conducted research in the field of general surgery in Turkey until December 31, 2020, with the keyword “laparoscopic cholecystectomy” indexed in the National Thesis Center database of the Council of Higher Education (CoHE). A thesis review form was created to analyze theses with digital copies that can be accessed after a list of theses was created. The thesis supervisor, institution, research method, data analysis techniques, advisor titles, working group, and research subjects, as well as the year the theses were published, were all examined. Results: The research included 45 theses. It was determined that most theses were recorded between 1995 and 2000. Thirty-two of them (71.1%) were made in universities. The institution with the most theses on this subject was GATA/Haydarpaşa Training Hospital. There were 32 prospective and 39 clinical trials. Only two of the studies were randomized, while the other two were experimental. Conclusion: It was determined that the majority of the theses were about clinical research and operation results, but there were very few experimental and randomized controlled studies, and no animal experiments were found. It can be concluded that studies on this subject, which is one of the most common general surgery operations, are needed.

P144 SPERMATIC CORD LIPOSARCOMA - A VERY RARE FINDING DURING INGUINAL HERNIA SURGERY

Abstract Aim Repair of inguinal hernia is one of the most common operations in general surgery in industrialized countries. Isolated spermatic cord liposarcoma is a very rare soft tissue tumor. Despite standardized diagnostic algorithms for inguinal hernia, it could be difficult to predict such a rare finding. Material and Methods We report a case of inadvertent inguinal liposarcoma excision during hernia surgery in a 72-year-old male patient. Except for polyposis coli there were no further illnesses. Results After a minimal invasive transabdominal preperitoneal (TAPP) repair of a symptomatic inguinal hernia last year a persistent scrotal swelling developed. Computed tomography (CT) showed a protrusion of fatty tissue into the scrotal sac. Diagnosis of scrotal hernia was made. We performed an open Lichtenstein procedure. The final pathologic examination revealed a highly differentiated liposarcoma. Staging was completed and the case was presented to a multidisciplinary sarcoma tumor board at our institution. As recommended, a inguinal reoperation was performed with wide excision. Conclusions Although a very rare condition, spermatic cord liposarcoma should be considered as a possible differential diagnosis for inguinal hernia surgery.

Ondansetron for Prevention of Post-Operative Nausea and Vomiting (PONV) in General Surgery Patients

Aim: To determine the efficacy of single dose ondansetron in preventing PONV in patients.
 Methodology: In this cross sectional study 49 patients were given Ondansetron. Every patient was evaluated for PONV at 1, 2, 3, 6, 12 and 24 hours post operatively. This study was conducted at General surgery operation theatres and surgical wards I, II, III and Department of Anesthesia and SICU Peoples University of Medical & Health Sciences for women Nawabshah, District Shaheed Benazirabad, Sindh.
 Results: A sample of 49 patients with age between 20-60 years (mean age 43.72±5.67 years), 35% male and 65% female was included in this study. In this study ondansetron was given (N=49) 4 mg I/V before induction. Regarding complications there was not significant (p ≤0.05) POVN was observed.
 Conclusion: Our study results showed in patients who received ondansetron regarding frequency of post operative complications (PONV) showed insignificant results as no p-value is found to be ≤0.05.It was concluded that a single dose of ondansetron is very effective in preventing PONV in general surgery patients.

Hospital Volume of Emergency General Surgery and its Impact on Inpatient Mortality for Geriatric Patients: Analysis From 3994 Hospitals.

Previous investigations have shown a positive association between hospital volume of operations and clinical outcomes. However, it is unclear whether such relationships also apply to emergency surgery. We sought to examine the association between hospital case volume and inpatient mortality for 7 common emergency general surgery (EGS) operations among geriatric patients. This is a population based retrospective cohort study using the Centers of Medicare and Medicaid Services (CMS) Limited Dataset Files (LDS) from 2011 to 2013. The 7 most common emergency surgeries included (1) partial colectomy, (2) small-bowel resection (SBR), (3) cholecystectomy, (4) appendectomy, (5) lysis of adhesions (LOA), (6) operative management of peptic ulcer disease (PUD), and (7) laparotomy with the primary outcome being inpatient mortality. Risk-adjusted inpatient mortality was plotted against operative volume. Subsequently an operative volume threshold was calculated using a best fit regression method. Based on these estimates, high- and low-volume hospitals were compared to examine significance of outcomes. Significance was defined as P-value < .05. The final cohort comprised of 414779 patients from 3994 hospitals. The standardized mortality ratio (SMR) for high-volume centers were lower in 6 out of 8 surgeries examined. Small-bowel resection and partial colectomy operations had a significant decrease in mortality based on a volume threshold. We observed decreased mortality with higher surgical volume for small-bowel resection and partial colectomy operations. Such differences may be related to practice patterns during the perioperative period, as complications related to the perioperative care were significantly lower for high-volume centers.

Expectation-setting and patient education about pain control in the perioperative setting: A qualitative study.

Interventions aimed at limiting opioid use are widespread. These are most often targeted toward prescribers or health systems. Patients' perspectives are too often absent during the creation of such interventions. This qualitative study aims to understand patient experiences with education about perioperative pain control, from preoperative expectation-setting to post-operative pain control strategies and ultimately opioid disposal. We performed semistructured interviews focused on patient experiences in the perioperative period. Content from interview transcripts was analyzed using a constant comparative method. All participants underwent surgery at a single, academic tertiary-care center. Adult patients who had a general surgery operation in the prior 60 days. Key themes from interviews about perioperative pain management, specifically related to preoperative expectation-setting and post-operative education. Patients identified gaps in communication and education in three main areas: preoperative expectation setting of post-operative pain; post-operative pain control strategies, including use of opioid medications; and the importance of appropriate opioid disposal. Failure to set expectations led to either significant patient anxiety preoperatively or poor preparation for home discharge. Poor education on pain control strategies led to misinformation on when and how to use opioids. Lack of education on opioid disposal led to most participants failing to properly dispose of leftover medication. Gaps in education surrounding post-operative pain and opioid use can lead to patient anxiety, inappropriate use of opioids, and poor disposal rates of leftover medications. Future interventions aimed at patient education to improve pain management and opioid stewardship should be created with an understanding of patient experiences and perceptions.

EP.FRI.374 Characteristics of Emergency General Surgery Operations at Night. An Avoidable Issue?

Abstract Aim Most hospitals mandate afterhours operations to permit only cases that are life or limb-threatening. This is in the interests of promoting patient safety and reducing surgical errors. The incidence and caseload of night-time operations has not been well defined in Australia. This study aims to investigate the characteristics emergency operations involving consultant general surgeons between 10pm to 7am in regional and rural hospitals. Methods A multicentre, prospectively collected health service database of all emergency general surgery operations performed over a 12-month period was reviewed. In particular, patient demographics, type of operation, primary surgeon and time of operation were analysed. Results There were a total of 2059 emergency operations performed with 1344 cases performed in the regional hospital and 715 performed in the rural hospital within the area health network. Consultant surgeons were involved in 62 cases at night beyond 10.00pm, of which majority were laparotomies (n = 26/62, 42%), appendicectomies (n = 21/62, 34%), and hernia repair ((n = 4/62, 6.5%). In comparison, surgeons in the rural hospital performed seven emergency cases at night comprising of 6 laparotomies and one abscess drainage. Conclusion Larger hospitals have higher volumes of emergency cases, which increases the likelihood of afterhours operating. The rural hospital does not have other subspecialty cover competing for emergency operating time. This allows most emergency cases to be performed in the evening. In order to promote safe working hours and improved patient safety, theatre availability and staffing could be increased in the evening to diminish necessity for midnight to morning consultant operations.

EP.FRI.9Meta-analysis of mortality risk in octogenarians undergoing emergency General Surgery operations

Abstract Aims To quantify the risk of perioperative mortality in octogenarians undergoing emergency general surgical operations and to compare such risk between octogenarians and non-octogenarians. Methods A systematic review was performed in accordance with the PRISMA statement standards to identify studies reporting the mortality risk in patients aged over 80 years undergoing emergency general surgery operations. The certainty of evidence was assessed using the GRADE system. Random-effects models were applied to calculate pooled outcome data. Results Analysis of 66701 octogenarians from 22 studies showed that the risk of 30-day mortality was 26% (95% CI 18-34%) for all operations;29% (95% CI 25-33%) for emergency laparotomy,9% (95% CI 1-23%) for non-laparotomy emergency operations;21% (95% CI 13-30%) for colon resection;17% (95% CI 11-25%) for small bowel resection;9% (95% CI 7-11%) for adhesiolysis;6% (95% CI 5.9-6.8%) for perforated ulcer repair;3% (95% CI 2.6-4%) for appendicectomy;3% (95% CI 2.8-3.3%) for cholecystectomy;5% (95% CI 0.2-14%) for hernia repair. When stratified based on ASA status, the risk was 11% (95% CI 4-20%) for ASA 2, 22% (95% CI 10-36%) for ASA 3, 39% (95% CI 29-48%) for ASA 4, and 94% (95% CI 77-100%) for ASA 5. The risk was higher in octogenarians compared with non-octogenarians (OR:4.07,95% CI 2.40-6.89), patients aged 70-79 (OR:1.21,95% CI 1.13-1.31), and patients aged 50-79 (OR:2.03,95% CI 1.68-2.45). Conclusions The risk of perioperative death in octogenarians undergoing emergency general surgical operations is higher than the risk in younger patients. Laparotomy, bowel resection, and ASA status above 3 carry the highest risk.

Multimorbid Black Patients Have Lower Rates of Death or Major Morbidity Following an Emergency General Surgery Operation

Multimorbid Black Patients Have Lower Rates of Death or Major Morbidity Following an Emergency General Surgery Operation

Bacterial Profile of Bile Culture from Patients Undergoing Cholecystectomy

Laparoscopic cholecystectomy is the most commonly performed routine surgical operation in general surgery. There is a debate about utility of prophylactic antibiotic therapy following cholecystectomy. The aim of the study was to investigate bacterial growth in bile culture from patients after laparoscopic cholecystectomy. Methods. This study included 80 patients who undergone laparoscopic cholecystectomy. All gallbladder specimens were sent for histopathology. A bile sample from each case was cultured on Brain heart infusion broth, MacConkey agar, and chocolate agar. Analytical profile indices were used for identification of isolated bacteria. Results. Six histopathological abnormalities were detected, of which chronic cholecystitis was the most common abnormality (58.75%) followed by acute cholecystitis with mucocele (11.25%). Thirty one bile samples (38.75%) were positive for bacterial growth. The overall bacterial isolates from bile samples showed Escherichia coli, 13.75%, Pseudomonas aeruginosa, 8.75%, Enterococcus faecium, 5%, Citrobacter freundii, 3.7%, Staphylococcus epidermidis, 3.75%, Lactobacillus gasseri, 2.5% and Bifiidobacterium, 1.25%. Bacterial colonization of gallbladder was significantly associated with acute cholecystitis with mucocele and empyema. Conclusions. More than one third of patients with cholelithiasis are positive for bacterial culture. Bacterial infection of stoned gallbladder associated with the development of empyema. Thus, prophylactic antibiotic therapy is recommended for patients undergoing cholecystectomy due to gallbladder stone.

LMA PROSEAL: AN ALTERNATIVE TO ENDOTRACHEAL IN- TUBATION IN OPEN APPENDECTOMY OPERATION.' IN THE DEPARTMENT OF ANESTHESIOLOGY, MEDICAL COLLEGE, KOLKATA

INTRODUCTION One of the important responsibilities of an Anaesthesiologist is to maintain a patent airway during any surgical procedure. Since the early days of Anaesthesia, various efforts have been made to dispel the problem of airway maintenance. AIMS AND OBJECTIVES The study entitled “LMAProSeal: An alternative to endotracheal intubation in open appendicectomy operation” was conducted with the aims to compare the efcacy of LMA ProSeal and Endotracheal Tube in patients undergoing Open Appendectomy under General Anaesthesia. MATERIALAND METHODS Study Area: This study was conducted in Medical College, Kolkata (West Bengal), under the department of Anaesthesiology in General Surgery Operation Theatre (C. B. Top OT/ Green OTComplex), after clearance from the Hospital ethical committee, during the period from 1st may 2013 to 31st January 2014. Awritten informed consent was taken from all patients included in the study. StudyPopulation:Patients postedforopenAppendicectomyoperationwithBMIbetween18.50–24.99kg/m2andbodyweightbetween30—60kg. Sample Size: 100 RESULTS AND OBSERVATIONS The effects were observed by monitoring heart rate, blood pressure and SPO2 preoperatively (as baseline), after intubation or placement of LMAProSeal at 1 min, 3 mins, 5mins and every 5 mins thereafter till the reading at removal of the device. For both the groups baseline ETCO2 was taken from connection of ETCO2 cable following placement of airway devices. SUMMARY AND CONCLUSION The study revealed that both the airway devices (ET tube and LMA ProSeal) were successful in operative procedure (open appendicectomy) in all the patients without any signicant complication. In experienced hands and following a strict protocol of insertion, the LMA ProSeal can prove to be an efcient and safe alternative to endotracheal tube for airway management of elective patients undergoing laparotomy procedure like open appendicectomy.

A Comparative Study among three University Hospitals to Identify the Effect of Designing Nursing Protocol on Infection Control in Operating Room.

Abstract Background: The nurses are the most important member of the medical team responsible for protecting patients from infection inside the operating room. Therefore, nurses must have great knowledge and strict adherence to infection control measures. Aims: To assess the effect of a designing nursing infection control protocol on operating room nurses performance. Design: Pre and post-test quasi- experimental design utilize in this study. Setting: The study conducted in the operating room at three hospitals: main university hospital (general surgery operation), Urology and Woman Health University Hospital. Subject all nurses (60) working in the operating room at the selected setting in the three university hospitals with at list one year of experience. Results: There was a significant improvement in the mean and standard deviation among nurses' knowledge in the three university hospitals after the application of the designed nursing protocol with (p=0.001). Conclusion: The study findings revealed that level of nurses' knowledge regarding infection control measures improved after the application of the design nursing protocol. Recommendations: Nurses should have continuous education through programs, workshops, seminars and/or training courses to maintain high quality care.

57. RAPT score as a predictor of nonhome discharge after adult spinal deformity surgery

<h3>BACKGROUND CONTEXT</h3> Discharge location is an important step in the continuum of care for adults who undergo surgery for spinal deformity (ASD). Insight into which patients are at risk for nonhome discharge (acute rehabilitation and skilled nursing facility [SNF]) is essential for preoperative planning and counseling. The Risk Assessment and Prediction Tool (RAPT) score has been demonstrated to be a predictor of nonhome discharges following orthopedic and general surgery operations, but has not been evaluated in a cohort of ASD patients. <h3>PURPOSE</h3> To assess factors, including RAPT score, predictive of nonhome discharges following ASD operations. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort analysis. <h3>PATIENT SAMPLE</h3> Adult patients who underwent thoracolumbar instrumented fusions to the pelvis for ASD at a single institution (1/2019-1/2020) were retrospectively reviewed. <h3>OUTCOME MEASURES</h3> See Methods section below. <h3>METHODS</h3> Patient demographics, including preoperative RAPT metrics (scale 1-12), hospital length of stay (LOS), operative details (revision vs primary, anterior vs anterior-posterior, type of interbodies, 3-column osteotomy [3CO]), and complications (total, major, minor) were compared between patients discharged home and nonhome using Chi-squared statistics. Univariate and multivariate analyses were performed using linear regression to determine relative risk of nonhome discharge. Area under the receiver operating characteristic curve (AUROC) for RAPT score and nonhome discharge was also determined. <h3>RESULTS</h3> Ninety-nine patients (average age: 68±9 years; female-64; average RAPT score 8.6±2.2) were analyzed. Operations were characterized by the following: average number of levels fused 11±3, revisions 54%, anterior-posterior 70%, 3CO 23%. Average hospital LOS was 8.5±3.6 days. The majority of patients (75.8%) had nonhome discharges. Patients discharged to rehab/SNF had significantly lower total RAPT scores (8.3 v. 9.6; p=0.016), more advanced age (70±8 v. 63±11; p=0.0052), and higher Charlson comorbidity indices (CCI; 3.6±1.5 v. 2.5±1.7; p=0.0014) compared to home discharges. On univariate analysis, factors significantly associated with nonhome discharge were age (particularly >60 years) (RR 1.094; 95%CI 1.035-1.163; p=0.0024), higher CCI (RR 1.730; 95%CI 1.214-2.621; p=0.005), total # levels fused (RR 1.244; 95%CI 1.026-1.599; p=0.047), and lower RAPT scores (RR 0.710; 95%CI 0.528-0.914; p=0.014). A RAPT score<8 was most predictive of nonhome discharge (RR 4.865; 95%CI 1.283-31.952l; p=0.042). An AUROC relating RAPT scores and nonhome discharge was 0.7. <h3>CONCLUSIONS</h3> Nonhome discharges (rehab/SNF) after ASD operations are common. Of the 4 factors associated with nonhome discharges (elderly age, higher CCI, greater total number of levels fused, lower preoperative RAPT score), a RAPT score <8 was most predictive. The RAPT score holds promising utility for preoperative patient counseling and discharge planning for adults undergoing operations for spinal deformity. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

26876 Prevalence of scars: Results of the first international study

Scars are visible marks on the skin due to skin injury, burn, or inflammatory dermatosis like acne or shingles. Surgical procedures induce systematically a scar that is a criterion of success or failure both for the patient and the surgeon. To our knowledge, no international evaluation of the prevalence of scars has been carried out. A total of 11,000 individuals’ representative of the population of their country were included from 5 countries: China (3050), Brazil (2000), the United States (2050), Russia (2000), and France (2000). Nearly one in two (48.5%) individuals reported having a scar on their body. Percentages were as follows: China (37%), Brazil (46%), the USA (53%), Russia (61%), and France (51%). The location most often reported by women is the stomach [n = 1148, 20.4%] and the face [n = 895, 15.9%]; among men the most frequent location is the face [n = 1025, 18.7%] followed by the stomach [n = 724, 13.2%]. The location of the scar on the hand(s) is different according to gender: 13.3% of men claim a scar on the hand, an only 8.4% of women claim a scar on their hands [P < .00001]. In more than half of the cases, the origin of the most recent scar is an accident or an illness that has left a scar [women = 50.8% vs men 60.5%, P < .0001]. 35% of women (and 28% of men) say that a general or orthopedic surgery operation is the cause of the scar [P < .0001]. Cosmetic or reconstructive surgery is claimed by only 4.6% of women [4.7% of men]. The presence of a scar is much more frequent than we thought.

Evaluation of emergency general surgery operations in COVID-19 patients in a pandemic hospital: a single center experience

Background: During the pandemic, the decision on delaying elective surgeries was implemented country-wide, and emergency surgeries were excluded from this scope. In this study, the patients diagnosed with COVID-19 and who underwent an emergency general surgery operation were evaluated regarding indications, demographic characteristics, and preoperative and postoperative clinical features.Methods: In the study, emergency surgeries performed by the department of general surgery between 1st June and 30th September, when our center cared only patients diagnosed with COVID-19, were reviewed retrospectively.Results: A total of 13 patients, 7 women and 6 men, were included in this study. The most common surgical diagnosis was acute appendicitis (9/13). For all of the patients with appendicitis, a conventional appendectomy procedure was performed. 2 patients were diagnosed with an incarcerated femoral hernia and then operated (2/13). One patient was operated on due to a sharp object injury, and one due to an acute abdomen caused by a perforation. Only 3 of the operated patients developed postoperative wound site complications (23%). No mortality was observed by the end of a 15-day follow-up.Conclusions: The most common cause of emergency surgeries during the pandemic, changelessly, remains to be acute appendicitis. Besides, cases of trauma, perforated peptic ulcer, and incarcerated hernia are also commonly encountered. While the pandemic continues full steam, these conditions that are associated with the pandemic but among causes of mortality and morbidity other than COVID-19 and that may require an emergency surgery should be considered. All emergency surgical procedures should continue to be performed punctually by using necessary protective types of equipment.

Determining the Association Between Unplanned Reoperation and Readmission in Selected General Surgery Operations

BackgroundUnplanned reoperations and unplanned readmissions can increase morbidity and mortality. Few studies however, have explored the association of reoperation and readmission among general surgery patients. Our aim was to examine this relationship in selected abdominal operations. MethodsData from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Participant Use Data Files from 2014 to 2018 were utilized. Six groups of operations, defined by ACS NSQIP procedure codes for ventral hernia repair, colectomy, appendectomy, proctectomy, small bowel resection, and gastrectomy, were assessed. Patients discharged ≤ 14 days after operation were included in the study. This time period was selected to reduce ACS NSQIP 30 day post-surgery follow-up bias. Unplanned reoperations were defined as those occurring during the index hospitalization. The primary outcome was unplanned readmission that occurred ≤ 14 days from the date of discharge. Logistic regression models were used to examine variables associated with unplanned readmission for each procedure group. ResultsA total of 787,118 patients were included: ventral hernia repair 35.2%, colectomy 30.6%, appendectomy 26.5%, proctectomy 3.7%, small bowel resection 3.2%, and gastrectomy 0.8%. Unplanned reoperation was independently associated with unplanned readmission for ventral hernia repair (OR 2.84, 95% CI 2.28-3.54, P < 0.001), colectomy (OR 1.58, CI 1.42- 1.76, P < 0.001), appendectomy (OR 2.91, CI 2.21-3.84, P < 0.001), and proctectomy (OR 1.41, CI 1.10-1.81, P = 0.006). Other clinically relevant covariates associated with readmission were partially dependent functional status before colectomy (OR 1.34, CI 1.23-1.46, P < 0.001), ventral hernia repair (OR 1.79, CI 1.54-2.09, P < 0.001), and small bowel resection (OR 1.44, CI 1.18-1.77, P < 0.001; and ASA 4/5 classification for colectomy (OR 2.71, CI 2.36-3.11, P < 0.001), proctectomy (OR 2.10, CI 1.48-2.97, P < 0.001), ventral hernia repair (OR 8.19, CI 6.78-9.88, P < 0.001), appendectomy (OR 2.80, CI 2.35-3.34, P < 0.001), and small bowel resection (OR 3.42, CI 2.20-5.32, P < 0.001). ASA 2, ASA 3 classification, age, and sex were also associated with unplanned readmission for most procedures. ConclusionsUnplanned reoperations are associated with an increase in unplanned readmission after selected abdominal operations included in this study. This factor should be considered in discharge and follow-up planning to help reduce unplanned readmissions.

Factors Associated with Malnutrition and Its Impact on Postoperative Outcomes in Older Patients

Malnutrition is associated with dismal treatment outcomes in older patients but its impact in geriatric surgery has not been studied extensively. Herein, we report the prevalence of malnutrition risk, its risk factors and its association with postoperative outcomes in older patients undergoing operations of general surgery. This is a retrospective analysis of a prospectively maintained database including patients older than 65 years who were to undergo general surgery operations between 2012 and 2017. The Malnutrition Universal Screening Tool (MUST) was used for nutritional risk. Demographics, socioeconomic data, site and magnitude of the operation, various measures of comorbidity and functional dependence as well as postoperative complications based on Clavien–Dindo classification and length of stay were recorded. There were 501 patients. A total of 28.6% of them were at intermediate malnutrition risk (MUST = 1) and 14.6% were at high malnutrition risk (MUST ≥ 2). Variables independently associated with malnutrition risk (MUST ≥ 1) were smoking (Odds Ratio, OR:1.6, p = 0.041), upper gastrointestinal (GI) tract surgery (OR:20.4, p < 0.001), hepatobiliary-pancreatic surgery (OR:3.7, p = 0.001), lower GI surgery (OR:5.2, p < 0.001) and American Society of Anesthesiologists (ASA) class III/IV (OR:2.8, p = 0.001). In the multiple regression analysis adjusted for several confounding variables, the MUST score was significantly associated with postoperative death (OR:9.1, p = 0.047 for MUST = 1 and OR:11.9, p = 0.035 for MUST score ≥ 2) and postoperative hospital stay (adjusted incidence rate ratio, 1.3, p = 0.041 for MUST = 1 and 1.7, p < 0.001 for MUST ≥ 2). Malnutrition risk was highly prevalent in this sample, particularly in patients with operations of the gastrointestinal tract, in patients with poor physical status and it was associated with postoperative mortality and length of stay.

Morbidity and mortality analysis in general surgery operations. Is there any room for improvement?

The aim of this work is to examine the performance of surgeries, by evaluating the results. The evaluation of the results, with particular attention to complications, is the corner stone to identify the causes leading to correction of any predisposing factors and reducing risks, to improve quality of care. We performed a retrospective analysis of 952 consecutive patients who had elective or emergency surgery from November 1, 2018, to October 31, 2019. We classified surgical intervention according to their complexity. The Clavien Dindo classification was used to categorize the complications. We performed a stepwise multivariate logistic-regression analysis, with the presence of postoperative complications as dependent variable and age, gender, BMI, ASA, type of surgery procedures, complexity of surgery, operative time as covariates. A total of 952 surgical procedures were included in this study. Abdominal procedures were the most frequent type of surgery performed (52.1%). Postoperative complications occurred in 120 surgical procedures (12.6%), these are related to the increase of the ASA score and the longer average operative time, with an increase of developing complication of 5% for each additional 10 minutes of surgery. Many factors influence postoperative morbidity and mortality. Particular attention was due to complication's evaluation, about all in abdominal surgery and high complexity procedures. We argue that key factors which influence the favorable surgical outcome are compliance with standardized safety procedures, volume of activity of the structure, presence of interdisciplinary care groups, and ability of health professionals in recognizing and promptly treating complications.

EMERGENCY SURGERY DURING COVID 19 AT K.A.P.V GOVERNMENT MEDICAL COLLEGE AND MGMGH , TRICHY

COVID 19 pandemic was declared by WHO as public health emergency on January 30,2020. Health system was reorganised with the aim to cope with the new disease and maintain essential health service. Many patients suffered from ARDS which lead to the modication of clinical and surgical activity. Current impact of COVID 19 outbreak on emergency surgical practice is still not developed. Varied presentation, diagnostic uncertainity, lack of guidelines present challenges to surgeons. AIM: The aim of our study was to evaluate the impact of the COVID-19 pandemic on emergency general surgery admissions and operations in our institution METHODS: We conducted a retrospective study in K.A.P.V.G.M.C. and M.G.M.G.H., Trichy from march 2020 to December 2020. All general surgical emergency admissions to KAPVGMC and MGMGH, district general hospital were included from march to December 2020.The details of diagnosis and subsequent management were retrieved from records. CONCLUSION: It was observed thatclinical decisions were made based on urgency of each case while simultaneously evaluating their COVID 19 status. The number of surgicalcases during COVID 19 period were signicantly reduced. Recognising asymptomatic carriers and need of emergency surgical intervention were the challenges faced by the surgeons. Effective communication between microbiologist, radiologist, anaesthetist and surgeon was necessary to attain a favourable outcome. .Inspite of challenges faced 80% had postoperative uneventful period other than prolonged duration of stay and were discharged and followed up. Covid 19 pneumonia and ARDS attributed to majority of death among the 20 % of deceased , other than septicemia

Literature Review for Office-Based Anesthesia

Literature Review for Office-Based Anesthesia

Estimating the surgical backlog from the COVID-19 lockdown in South Africa: A retrospective analysis of six government hospitals.

The COVID-19 pandemic reached South Africa (SA) in March 2020. A national lockdown began on 27 March 2020, andhealth facilities reduced non-essential activity, including many surgical services. to estimate the COVID-19 surgical backlog in Western Cape Province, SA, by comparing 2019 and 2020general surgery operative volume and proportion at six district and regional hospitals. to compare the operative volumeof appendicectomy, laparoscopic cholecystectomy, cancer and trauma between the 2 years. This was a retrospective study of general surgery operations from six SA government hospitals in the Western Cape. Data wereobtained from electronic operative databases or operative theatre logbooks from 1 April to 31 July 2019 and 1 April to 31 July 2020. Total general surgery operations decreased by 44% between 2019 (n=3 247) and 2020 (n=1 810) (p&lt;0.001). Elective operationsdecreased by 74% (n=1 379 v. n=362; p&lt;0.001), and one common elective procedure, laparoscopic cholecystectomy, decreased by 68%(p&lt;0.001). Emergency operations decreased by 22% (n=1 868 v. n=1 448; p&lt;0.001) and trauma operations by 42% (n=325 v. n=190;p&lt;0.001). However, non-trauma emergency operations such as appendicectomy and cancer did not decrease. The surgical backlog forelective operations after 4 months from these six hospitals is 1 017 cases, which will take between 4 and 14 months to address if each hospitalcan do one additional operation per weekday. The COVID-19 pandemic has created large backlogs of elective operations that will need to be addressed urgently. Clear andstructured guidelines need to be developed in order to streamline the reintroduction of full surgical healthcare services as SA slowly recoversfrom this unprecedented pandemic.