Patients Requiring Emergency Surgery Research Articles

Psoas attenuation and cross-sectional area improve performance of traditional sarcopenia measurements in predicting one-year mortality among elderly patients undergoing emergency abdominal surgery: a pilot study of five computed tomography techniques.

Risk stratification is challenging in the growing population of geriatric patients requiring emergency surgery. Sarcopenia, which assesses muscle bulk, is a surrogate for frailty and predicts 1-year mortality, but does not incorporate potentially valuable additional information about muscle quality. To describe five different CT methods of measuring sarcopenia and muscle quality and to determine which method has the greatest sensitivity for predicting 1-year mortality following emergency abdominal surgery in elderly patients. This retrospective study includes 297 patients 70years and older who underwent "urgent" or "emergent" laparotomy or laparoscopy for acute abdominal disease between 2006 and 2011 at a single quaternary academic medical center. All patients received a CT abdomen and pelvis with intravenous contrast within 1month of surgery. Five different methods were applied to the psoas muscles on CT: method 1 (total psoas index TPI, which is total psoas area TPA normalized by height), method 2 ("pseudoarea" = anterior-posterior × transverse dimensions), method 3 (average HU), method 4 (TPA × HU), and method 5 ("pseudoarea" × HU). For all five CT measures, mortality was greatest for the lowest quartile by univariate and adjusted Cox proportional hazard analyses at all time points up to 1-year. The C-statistic was highest for Method 4, using a composite index of TPA and Hounsfield Units, indicating the greatest predictive ability to estimate mortality at all time points. Muscle quality and muscle size can be used in tandem to refine risk assessment of older patients undergoing emergency abdominal surgery. Routine calculation of the composite score of psoas cross-sectional area and HU in the emergency room setting may provide surgeons and patients valuable insight on the risk of 1-year mortality to guide preoperative decision-making and counseling. Muscle quality and size, both strong independent predictors of surgical outcomes in older patients undergoing emergency abdominal surgery, may be used in tandem to refine risk assessment. A composite score of psoas muscle cross-sectional area and Hounsfield units on CT may provide insight on 1-year mortality in this patient population.

644. PREDICTORS OF ADVERSE CLINICAL EVENTS FOR CAUSTIC INGESTION IN ADULTS: A 20-YEAR CROSS-SECTIONAL STUDY

Abstract Caustic ingestion is an uncommon but potentially life-threatening condition. It can lead to various complications. There are limited epidemiological studies on caustic ingestion, especially in the Asian population. This study aims to review the clinical characteristics of corrosive ingestion in Hong Kong adults and look for predictors of adverse clinical events. Patients admitted for caustic ingestion at a tertiary referral center in Hong Kong between January 2001 and December 2021 were studied. Patients’ demographic and clinical characteristics, types of caustic substances ingested, Zargar endoscopic grading and clinical outcomes were obtained. Adverse clinical events are defined as the presence of any of the following outcomes: intensive-care-unit (ICU) admission, gastrointestinal (GI) complications (including stricture, ischemia, gangrene, perforation and fistulation), need for surgical or endoscopic intervention, in-hospital mortality, or length of hospital stay (LOS) more than 14 days. Relationships between patients’ factors and different outcomes were then evaluated. Among 69 patients, 45 (65.2%) were suicidal intent. Eight (11.6%) patients required emergency surgery (7 gastrectomies, and 1 esophagectomy). The most common GI complication was esophageal stricture (n=12, 17.4%). Eleven patients underwent endoscopic dilatation; 4 required elective esophagectomy. Patients with diabetes mellitus had a higher Zargar grading (OR=4.259, p=0.040). Adverse clinical events were associated with acid ingestion (OR=4.110, p=0.015) and suicidal intent (OR=3.635, p=0.027). Subgroup analysis showed that diabetes (OR=4.062, p=0.040), acid ingestion (OR=4.222, p=0.016) and suicidal intent (OR=15.932, p=0.009) had higher risks for ICU admission. The morbidity and mortality rates were 29.0% and 7.2% respectively. Caustic ingestion remains an important clinical problem in daily practice, with potential risks of developing severe complications. Suicidal attempt, acid ingestions and history of diabetes are predictors of adverse clinical events.

502 Emergency Giant Hiatus Hernia Surgery: Experiences with Post-Operative Complications

Abstract Aim Patients with giant hiatus hernias can present acutely with volvulus or strangulation. Early emergency surgical intervention with reduction of the hernia and hiatal repair is shown to reduce the mortality rate. However, surgery is not without risk or complications. This study assessed the rate of complications and length of hospital stay in patients requiring emergency surgery. Method A retrospective study was done looking at all patients who underwent emergency hiatal hernia surgery at a tertiary oesophagogastric centre. Over an eight-year period, 80 patients were identified. Their clinical course was evaluated from medical records, collecting data on their length of stay, complications, and mortality. Results Of the 80 patients, 30 patients (37.5%) had no documented complications from the surgery. 62.5% did have complications, of which respiratory complications were the most frequent (43%). 10% of patients had symptomatic recurrence of the hiatus hernia that required operative correction either during index admission or a subsequent admission. Median length of hospital stay was 8 days (IQR 5–16). There was a positive correlation between number of complications and length of stay. Post-operative mortality was 9%. Conclusions Emergency surgery for hiatus hernias has a high morbidity rate, as expected for an emergency procedure in acutely unwell patients. Despite the high rate of post-operative complications, the length of hospital stay was relatively short with low mortality, showing emergency surgery to be an effective lifesaving treatment.

SP2.1.6 A Systematic Review of the Incidence and Predictors of Incisional Hernias in Robotic Prostatectomy

Abstract Aims To conduct a systematic review of the literature to identify the incidence and predictors of incisional hernia (IH) following robotic prostatectomy; and to provide recommendations to reduce the risk factors for IH development post-operatively. Methods The review was performed adhering to PRISMA guidelines, using search terms pertaining to robotic prostatectomy and incidence of IH via electronic databases (MEDLINE, EMBASE and Cochrane database). All original peer-reviewed articles in English were assessed for inclusion and quality by two independent reviewers. A quantitative analysis was conducted to evaluate methodologies, patient demographics, and the incidence of IH following robotic prostatectomy. Results We included 18 studies with a total of 17,965 patients. Average age of patients was 61.83 years and with an average BMI of 27.35. A transperitoneal, 6 port technique was the commonest robotic approach. Main sites of herniation included supraumbilical and lateral ports. The estimated incidence of IH was 1.49% (95% CI 1.28 to 4.25). Studies examining risk factors found age, high BMI, previous hernia repair and wound infections to be contributory to IH development. Only 6 studies reported surgical repair of IH with 3 patients requiring emergency operations. 5 studies reported reduction in IH following modifications in surgical technique. Conclusions Incisional hernias following robotic prostatectomy are a rare complication which can result in high patient morbidity. Our review demonstrated a variable incidence rate with increasing age and high BMI as common potential risk factors. Prevention strategies can result in reduction of IH; however, the studies were heterogenous with inconsistent data quality.

TU8.9 Emergency Giant Hiatus hernia repair, Single Centre Experience

Abstract Aim Patients with giant hiatus hernias can present acutely with volvulus or strangulation. Early emergency surgical intervention with reduction of the hernia and hiatal repair reduces the mortality rate. However, surgery is not without risk or complications. This study assessed the rate of complications and length of hospital stay in patients requiring emergency surgery. Method A retrospective study looked at all patients who underwent emergency hiatal hernia surgery at a tertiary oesophagogastric centre. Over an eight-year period, 80 patients were identified. Their clinical course was evaluated from medical records, collecting data on their length of stay, complications and mortality. Results Of the 80 patients, 30 patients (37.5%) had no documented complications from the surgery. 62.5% did have complications, of which respiratory complications were the most frequent (43%). 10% of patients had a symptomatic recurrence of the hiatus hernia that required operative correction during index admission or subsequent admission. The median length of hospital stay was eight days (IQR 5–16). There was a positive correlation between the number of complications and length of stay. Post-operative mortality was 9%. Conclusion Emergency surgery for hiatus hernias has a high morbidity rate, as expected for an emergency procedure in acutely unwell patients. Despite the high rate of post-operative complications, the length of hospital stay was relatively short with low mortality, showing emergency surgery to be an effective lifesaving treatment.

SP3.1.1 Follow-up After Acute Diverticulitis: Can We Reduce the Burden on Endoscopy Services?

Abstract Background Acute diverticulitis (AD) is a common cause of presentation to emergency surgical services. Follow-up with endoluminal investigation to exclude colorectal cancer (CRC) remains controversial. Guidelines are increasingly moving to a more restrictive follow up based on severity of disease and age. The purpose of this study was to assess the prevalence of CRC in AD patients and the impact of follow-up on endoscopy services. Methods Patients admitted with a diagnosis of AD over a 2-year period were reviewed. The proportion of patients undergoing endoscopic follow-up and the CRC detection rate were recorded. The potential impact of a more conservative approach to follow-up was evaluated. Results There were 484 patients with AD presenting 546 times (M:F = 198:286; median age = 63 years). 80% of admissions were aged 50 or older. There were 43 emergency interventions in 39 patients (10 percutaneous drain; 33 surgery). The remainder were managed conservatively. 28 patients (5.1%) underwent colonic resection with cancer found in one specimen (3.6%). 286 patients underwent endoluminal follow-up with cancer diagnosed in 3 cases (1.0%). There was no significant difference in the prevalence of CRC between patients requiring emergency surgery and those managed conservatively, or between patients with complicated versus uncomplicated diverticulitis. Conclusion CRC masquerading as acute diverticulitis is rare. The incidence of neoplasia both at endoscopic follow-up and in patients requiring emergency intervention is low. Conservative follow-up strategies appear safe, but their effectiveness in reducing the burden on endoscopy services may be limited by current age-based recommendations.

A Retrospective Analysis of Patients in Urgent Need of General Surgery during the COVID-19 Pandemic

Introduction: Various restrictions were adopted across the world in order to prevent the COVID-19 pandemic, and health systems were reorganized in order to cope with increasing COVID-19 patient numbers. The purpose of this study was to examine the effect of the COVID-19 pandemic on the number of patients presenting to our emergency department with emergency surgical diseases and requiring urgent general surgery. Methods: This research examining the approach to emergency general surgery during the COVID-19 pandemic was planned as a retrospective, single-center, clinical study. Patients presenting to the emergency department of a tertiary training and research hospital between 11 March and 1 June, 2020 and requiring urgent general surgical evaluation constituted the study group. The control group consisted of patients presenting to the emergency department and requiring urgent general surgical evaluation during the same period in the previous year. We planned to compare the numbers of patients, their demographic data, the clinical findings, diagnoses, and surgical interventions between the two periods. Results: A 12% decrease was observed in the numbers of patients presenting in the study group during the COVID-19 pandemic compared to the control group. Decisions to operate (p=0.001) and types of operation(p=0.004) differed significantly between the patient and control groups, but no significant difference was observed in terms of hospital presentation times, length of hospital stay, or mortality. Conclusion: The COVID-19 pandemic has affected the management of patients requiring emergency surgery. In terms of the treatment regimen, fewer surgical methods were employed in the study group than in the control group. However, despite the preference for medical therapeutic methods, this did not eliminate the need for surgical treatment for appropriate indications.

Outcomes of Emergency Abdominal Wall Hernia Repair: Experience Over a Decade.

BackgroundAbdominal wall hernias are a common surgical entity encountered by the general surgeon. Approximately 10% of abdominal wall hernia patients require emergency surgery. However, these surgeries are associated with a high rate of postoperative morbidity and mortality. This study aimed to analyze the morbidity and mortality in patients undergoing emergency abdominal wall hernia repair and to determine the factors associated with surgical site infection (SSI) and recurrence in these patients attending a tertiary care hospital in south India.MethodologyOur study was a single-centered, 10-year retrospective and a one-year prospective study conducted in a tertiary care center in India. All patients who underwent emergency abdominal wall hernia repair between April 2009 and May 2020 were included. Patients’ demographic details, comorbidities, intraoperative findings, 30-day surgical outcomes including SSI, and recurrence were studied.ResultsOut of 383 patients in our study, 63.9% had an inguinal hernia, and 54% of the patients underwent tissue repair. SSI was the most common morbidity (21.9%). Postoperative sepsis was the only independent factor associated with perioperative mortality according to the logistic regression analysis (odds ratio = 22.73, p = 0.022).ConclusionsTissue repair for emergency hernia surgery has better outcomes than mesh repair in clean-contaminated cases.

Outcomes of emergency laparoscopy in the elderly.

This paper assessed the association between operative approach and postoperative in-hospital mortality in elderly patients undergoing emergency abdominal surgery. Patients undergoing emergency laparotomy have high morbidity and mortality rates. One-third of patients requiring emergency surgery are over 75 years old, and their in-hospital mortality rate exceeds 17%. Fewer than 20% of emergency abdominal operations in the UK are attempted laparoscopically, and only 10% are completed laparoscopically. Little is known about how laparoscopic emergency surgery in the elderly might affect outcomes. An observational UK study was performed using the prospectively maintained National Emergency Laparotomy Audit (NELA) database. Operative approach, NELA risk-prediction score and in-hospital mortality were recorded. The effect of operative approach on in-hospital mortality was analysed, both on a national basis and in a high-volume laparoscopic centre. A total of 47,667 patients were included in the study, of whom 15,068 were over 75 years of age. Nationally, surgery was completed by the laparoscopic approach in 7.8% of patients aged over 75; both crude mortality (9.2%) and risk-adjusted mortality (7.1%) were significantly reduced (p<0.0001). In our unit, surgery was completed laparoscopically in 48.4% of patients aged over 75; both crude mortality (6.6%) and risk-adjusted mortality (3.3%) were significantly reduced (p<0.0001). Laparoscopy in emergency surgery has been shown in this study to significantly reduce in-hospital mortality in elderly patients and should be embraced in every centre dealing with emergency abdominal surgery.

Preoperative intravenous iron treatment reduces postoperative complications and postoperative anemia in preoperatively anemic patients with colon carcinoma

PurposeAnemia is common among patients with colorectal cancer and is associated with an increased risk of complications and poorer survival rate. The main objective of our study was to determine the effect of preoperative intravenous iron supplementation therapy on the need for red blood cell transfusions, other postoperative complications, and length of hospital stay in colon cancer patients undergoing colon resection.MethodsIn this retrospective cohort study, data were collected from medical records of all 549 colon carcinoma patients who underwent a colon resection in Helsinki University Hospital during the years 2017 and 2018. The patients were divided into two cohorts: one with anemic patients treated with preoperative intravenous iron supplementation therapy (180 patients) and one with anemic patients without preoperative intravenous iron supplementation therapy (138 patients). Non-anemic patients and patients requiring emergency surgery were excluded (231 patients).ResultsPatients treated with intravenous iron had less postoperative complications (33.9% vs. 45.9%, p = 0.045) and a lower prevalence of anemia at 1 month after surgery (38.7% vs. 65.3%, p < 0.01) when compared with patients without preoperative iv iron treatment. No difference was found in the amount of red blood cell transfusions, length of stay, or mortality between the groups.ConclusionThis is the first study demonstrating a significant decrease in postoperative complications in anemic colon cancer patients receiving preoperative intravenous iron supplementation therapy. This treatment also diminishes the rate of postoperative anemia, which is often associated with a facilitated recovery.

P073 SYNCHRONOUS VERSUS DELAYED SURGICAL TREATMENT OF MORBID OBESITY AND VENTRAL HERNIA. PRELIMINARY RESULTS OF A RETROSPECTIVE SINGLE CENTER STUDY

Abstract Aim The worldwide increase in morbid obese patients raises controverises regarding the best timing of treatment for concomitant ventral hernias (VH). We present the preliminary experience at a referral center for bariatric surgery (BS): synchronous versus delayed ventral hernia repair (S-VHR, D-VHR) have been compared. Material and Methods From 2009, 40 consecutive morbid obese patients eligible for BS presented with concomitant VH. Symptoms and characteristics of the VH were evaluated to choose between S-VHR (28 patients), primary (n = 12) or mesh augmented (n = 16), and D-VHR (12 patients). 90-day postoperative complications and hernia recurrence were evaluated. Results 3 patients out of 16 in the mesh group experienced superficial surgical site infections. 4 patients in the D-VHR had a bowel incarceration within 20 days after BS and required emergency surgery with mesh implantation. No complications occurred in the primary repair group. The recurrence rate was around 19% in both groups of the S-VHR. Nonetheless the group that received mesh repair had a significant higher mean value of the defect. In the D-VHR cohort 1 patient was lost at follow up while 3 patients were not operated on due to inadequate weight loss. No recurrences occurred in the 4 patients requiring emergency surgery. Conclusions: D-VHR is associated with worse early postoperative outcomes; primary suture repair should be considered in preventing bowel incarceration but synchronous mesh repair is preferred in large symptomatic hernias for its acceptable postoperative morbidity and hernia recurrence at 1 year.

Impact of emergency physician-staffed ambulances on preoperative time course and survival among injured patients requiring emergency surgery or transarterial embolization: A retrospective cohort study at a community emergency department in Japan.

Injured patients requiring definitive intervention, such as surgery or transarterial embolization (TAE), are an extremely time-sensitive population. The effect of an emergency physician (EP) patient care delivery system in this important trauma subset remains unclear. We aimed to clarify whether the preoperative time course and mortality among injured patients differ between ambulances staffed by EPs and those staffed by emergency life-saving technicians (ELST). This was a retrospective cohort study at a community emergency department (ED) in Japan. We included all injured patients requiring emergency surgery or TAE who were transported directly from the ED to the operating room from January 2002 to December 2019. The primary exposure was dispatch of an EP-staffed ambulance to the prehospital scene. The primary outcome measures were preoperative time course including prehospital length of stay (LOS), ED LOS, and total time to definitive intervention. The other outcome of interest was in-hospital mortality. One-to-one propensity score matching was performed to compare these outcomes between the groups. Of the 1,020 eligible patients, 353 (34.6%) were transported to the ED by an EP-staffed ambulance. In the propensity score-matched analysis with 295 pairs, the EP group showed a significant increase in median prehospital LOS (71.0 min vs. 41.0 min, P < 0.001) and total time to definitive intervention (189.0 min vs. 177.0 min, P = 0.002) in comparison with the ELST group. Conversely, ED LOS was significantly shorter in the EP group than in the ELST group (120.0 min vs. 131.0 min, P = 0.043). There was no significant difference in mortality between the two groups (8.8% vs.9.8%, P = 0.671). At a community hospital in Japan, EP-staffed ambulances were found to be associated with prolonged prehospital time, delay in definitive treatment, and did not improve survival among injured patients needing definitive hemostatic procedures compared with ELST-staffed ambulances.

SP10.1.7 The Important Role of In-Situ Simulation in Preparing Surgeons for the COVID-19 Pandemic

Abstract Background Effective training is vital when facing viral outbreaks such as the SARS Coronavirus 2 (SARS-CoV-2) outbreak of 2019. The objective of this study was to measure the impact of in-situ simulation on the confidence of the surgical teams of two hospitals in assessing and managing acutely unwell surgical patients who are high-risk or confirmed to have COVID-19. Methods This was a quasi-experimental study with a pretest-posttest design. The surgical teams at each hospital participated in multi-disciplinary simulation sessions to explore the assessment and management of a patient requiring emergency surgery who is high risk for COVID-19. The participants were surveyed before and after receiving simulation training to determine their level of confidence on a Visual Analog Scale (VAS) for the premise stated in each of the nine questions in the survey, which represented multiple aspects of the care of these patients. Results 27 participants responded the pre-simulation survey and 24 the one post-simulation. The level of confidence (VAS score) were statistically significantly higher for all nine questions after the simulation. Specific themes were identified for further training and changes in policy. Conclusion In-situ simulation is an effective training method. Its versatility allows it to be set up quickly as rapid-response training in the face of an imminent threat. In this study, it improved the preparedness of two surgical teams for the challenges of the COVID-19 pandemic.

Temporal fluctuations of post-tonsillectomy haemorrhage

PurposeAlthough haemorrhage is a common and in some cases life-threatening complication after tonsillectomy, surprisingly little is known about the temporal fluctuations of the onset of bleeding. The purpose of this study was to assess circadian and seasonal rhythms of post-tonsillectomy haemorrhage (PTH) and potential ramifications to educate patients and health care staff.MethodsThis retrospective study carried out at a tertiary referral hospital included paediatric and adult patients requiring emergency surgery due to severe PTH between 1993 and 2019. Medical records were reviewed and patient demographics, details regarding the initial procedure, postoperative day of haemorrhage, and start time of emergency surgery were extracted. Descriptive statistics, Kruskal–Wallis test, Mann–Whitney U test, and Chi-square goodness of fit tests were used to detect potential differences.ResultsA total of 300 patients with severe PTH and subsequent emergency surgery were identified. The median postoperative duration until PTH was 6 (range: < 1–19) days. 64.7% (n = 194) of all emergency surgeries had to be performed during evening and night hours (6 pm—6 am) (p < 0.0001). Compared to diurnal incidents, the risk of a nocturnal PTH event increased, the longer ago the initial surgery was (p < 0.0001). No seasonal variations were identified. Age, sex, and details of the initial procedure had no significant influence on the start time according to the surgical protocol.ConclusionThe discovered temporal fluctuations of PTH are of relevance for patient awareness and preoperative education. Due to possible life-threatening complications, management of severe PTH requires specific resources and trained medical staff on call.

Preoperative monocytosis is predictable at diagnosis for RT-PCR negative COVİD-19 paediatric cardiac surgery patients.

Other markers investigated in this population have gained importance in the diagnosis of the disease since the course of COVID-19 disease is atypical in the paediatric population and PCR may be misleading. The leukocyte profile is one of these biochemical tests. Children did not have lymphopenia in hemogram count, whereas relatively neutropenia and monocytosis were detected, unlike the adult population. The reason why children do not have lymphopenia is thought to be due to the fact that the thymus is more active in the first years of life.Two-hundred and four patients operated in our paediatric cardiac surgery clinic from 11March, 2020 to 1 April, 2021 were retrospectively examined and 11 patients with preoperative asymptomatic and PCR (-), but with PCR (+) in the post-operative period (patients with incubation period or false PCR negativity) were included in our study. Patients requiring emergency operation and operated from PCR (+) patients in the preoperative period were excluded from the study.The neutrophil ratio in the lymphocytic series of 7 patients out of 11 patients was slightly below the normal range in the preoperative period, the lymphocyte ratio of 3 patients was slightly above the normal range, and the relative monocyte ratio of 10 patients was slightly above the normal range.We think that evaluating the leukocyte profile combined with RT-PCR will give more accurate results in the diagnosis of incubation period and false RT-PCR negative patients. In addition, we believe that the algorithms for non-complex paediatric cardiac surgery procedures and timing in the paediatric population with a better course of COVID-19 disease with a positive post-operative course.

SHOULD QUALITY OF LIFE BE A CONSIDERATION TO OPERATE LARGE VENTRAL HERNIAS: A PROSPECTIVE STUDY

Context: Advances in Abdominal Wall Reconstruction including abdominal component separation techniques have enabled repair of complex ventral hernias whereas patients may have been denied surgery earlier. Traditionally the reason to operate ventral hernias has been the risk of strangulation. Something that is under studied is the effect of complex ventral hernias on Quality of Life (QoL) and how does it change after surgery.Whether techniques that require division of abdominal wall components impair abdominal wall function and consequently affect QoL is not determined. Aim:To assess the change in QOL at three months after surgery and compare it to the QOL immediately before surgery. Apart from the primary outcome of change in QOL, short term complications were also studied.A subgroup analysis of change in QOL after component separation technique was also done Settings and Design:A prospective analysis was carried out on consecutive patients undergoing open complex ventral hernia surgery over two-year period at our institution,a tertiary care hospital. Methods and Material:Patients with complex ventral hernias including those with hernia defect diameter more than 6 cm, recurrent hernia, multiple Swiss cheese defects, or patients requiring abdominal component separation were studied. Patients requiring emergency surgery and laparoscopic surgeries were excluded from study. The “HerniaRelated Quality-of-Life Survey”(HerQLes) which is a validated instrument was used. Statistical analysis used: After sample size estimation by a statistician forty-five consecutive patients meeting the study criteria between April 2017 and March 2019 were included in the study.Statistical analyses were done using SPSS version 24 software. Results:Of the 45 patients enrolled in the study,19 (42.2%) required abdominal component separation.The mean size of 2 the defect was 130 cm in component separation (CS) group and 39.0 cm2 in non-component separation (NCS) group. The mean preoperative QoL score in CS group was 53.9±11.2, while in the NCS group it was 45.7±13.6. QoL score postoperatively in CS group was 16.4±4, while in NCS group it was 13.8±1.5. There was a statistically significant improvement in QoL three months after surgery in both the groups (p-0.0001). Conclusion: In our study we found complex ventral hernias to be associated with a poor Quality of Life.The Quality of Life was seen to improve significantly within three months after surgery.Use of a component separation technique does not seem to impair the Quality of life.

Factors Associated with Early Postoperative Results of Total Anomalous Pulmonary Venous Connection Repair: Findings from Retrospective Single-Institution Data in Vietnam.

IntroductionThere are scanty reports of the risk factors for pulmonary hypertensive crisis and low cardiac output syndrome after the operative repair of total anomalous pulmonary venous connection (TAPVC). We aim to evaluate early surgical outcomes of TAPVC and risk factors for pulmonary hypertensive crisis and low cardiac output syndrome.MethodsWe conducted a retrospective medical record review for all patients undergoing operative repair of TAPVC within 5 years. Outcome variables included pulmonary hypertensive crisis, low cardiac output syndrome and early mortality.ResultsOf 58 patients, we documented 77.59% supracardiac, 20.69% cardiac and 1.72% mixed site of connection. About 86.21% patients underwent elective surgery, and 13.79% patients required emergency surgery. Incidence rates were 27.59% for pulmonary hypertensive crisis and 6.90% for low cardiac output syndrome. Body weight below 6 kg, pneumonia, tachycardia, hepatomegaly, preoperative pulmonary congestion on chest x-ray, preoperative elevated mean pulmonary artery pressure, preoperative pulmonary venous obstruction, emergency surgery and prolonged aortic cross-clamping time were significant risk factors for postoperative pulmonary hypertensive crisis. Significant risk factors for postoperative low cardiac output syndrome included pneumonia, prolonged duration of preoperative mechanical ventilation and prolonged aortic cross-clamping time.ConclusionThe early outcome of surgical repair of TAPVC was acceptable, with 96.55% survival rate. This current analysis suggests that a thorough evaluation of all preoperative and operative characteristics is imperative to achieve best medical and surgical outcomes.

Delta neutrophil index and symptomatic time are effective factors for predicting perforated appendicitis.

Appendicitis is a common intra-abdominal inflammatory disease, and morbidity increases with age when perforation occurs. Because, not all patients require emergency surgery, there have been numerous studies on factors for predicting perforated appendicitis. In this study, we aimed to confirm whether the delta neutrophil index (DNI) and the time from symptom onset to surgery are effective predictors for perforated appendicitis in different age groups.This was a retrospective study conducted on 542 appendicitis patients who underwent surgery at Kangdong Sacred Heart Hospital. The simple group consisted of 431 subjects, and the perforation group consisted of 111 subjects.Multiple logistic regression analyses demonstrated that age, neutrophil percentage, DNI, C-reactive protein (CRP), and symptomatic time were significant predictors of perforation. Analysis of the receiver-operating characteristic curve showed that the DNI was the most reliable predictive value. In the analyses according to age, the perforation rate was higher in the >65-year-age group; these patients also had a higher DNI, CRP, and symptomatic time. In the DNI analysis using receiver operating characteristic (ROC) analysis, the area under the curve was higher in the >65-year-age group than in other age groups. In addition, the cutoff values have been determined and perforation occurred significantly in the group with a DNI value of 2.1 or higher and a symptomatic time of 33 hours or longer.DNI is effective in predicting perforation in patients with appendicitis compared with other inflammatory factors. Furthermore, the simultaneous measurement of symptomatic time and DNI is helpful in predicting perforation and determining whether emergency surgery is necessary.

SARS‐CoV‐2 identified by universal preoperative COVID‐19 testing prior to emergency surgery: Case of an asymptomatic pediatric patient requiring emergency surgery

AbstractThis case highlights the importance of identifying SARS‐CoV‐2 preoperatively, irrespective of symptoms, as symptoms may be mild, especially in children compared to adults, and asymptomatic carriers can have high viral loads and be infectious.

New approaches in providing care to surgical patients under conditions of COVID-19 pandemic on the basis of Military medical clinical center of Central region

Annotation. Nowadays, in coronavirus disease pandemic, the conditions for emergency surgery have changed. The aim of the work was to improve the provision of emergency surgical care under conditions of COVID-19 pandemic by developing and implementing clinical pathway of patients, using the remodeled infectious disease unit with a specially equipped operating room. To improve emergency surgical care under conditions of coronavirus pandemic, clinical pathways have been developed and implemented for management of patients with acute surgical pathology: the pathway of the patient requiring emergency surgery with suspected COVID-19 during self-presentation, the patient delivered by ambulance, in mass admission of patients, in admission of servicemen. Part of the hospital stock was restructured into isolated off-line infectious disease unit for treatment of patients with COVID-19 in a separate two-story building. Specially equipped operating room of the off-line infectious disease unit has separate entrances for patients and medical staff, which ensures the distribution of patient flows in the operating room. Clinical pathways for providing emergency care to patients with acute surgical pathology, developed by the authors, made it possible to divide them into flows and minimize possible risks of coronavirus infection in medical staff and other groups of patients. Under pandemic conditions, restructuring of hospital stock along with creation of off-line units with the use of existing staff seems to be warranted. Appropriate training of medical personnel in the restructured units working with COVID-19 infection as well as the development of rotational system mechanism for medical personnel are urgently required. Clinical results of treatment of patients with acute surgical pathology in the off-line infectious disease unit for patients with COVID-19 will be the object of future studies.