Rate Of Emergency Surgery Research Articles

Pediatric tracheotomy: clinical analysis of 95 cases with different etiology

Objective:To disscuss the changes in indications, surgical opportunity and post-operative management of pediatric tracheotomy. Methods:Retrospective cohort study of pediatric patients undergoing tracheostomy between January 2016 and December 2020 at Children's Hospital of Fudan University. Ninety-five patients were divided into four groups according to their primary indication. Group A: neuromuscular disease（n=36, 37.9%）, Group B: congenital abnormality（n=30, 31.6%）, Group C: accidental injury（n=15, 15.8%）, Group D: tumor（n=14, 14.7%）. Results:By the comparison between four groups, children in group A had higher incidence of Severe pneumonia（47.2%）, higher usage of mechanical ventilation（97.2%）, longer hospitalization days（=84.9 days） and higher rate of Ventilator dependence（66.7%）; children in group B had higher rate of emergency surgery（4.2%）, lower age（median age 2 months） and lower usage of mechanical ventilation（30.0%）; Mortality of the children in group D was the highest（42.9%）. In the recent five years, we saw a increasing tendency in the proportion of group A（28.6%, 35.0%, 38.5%, 44.4%, 43.5%）, and a decreasing tendency of group B（57.1%, 30.0%, 38.5%, 33.3%, 21.7%）. On discharge, 50.5% of children（48 of 95）spontaneously breathe with the tracheos tomy in situ, 29.5% of children（28 of 95）had ventilator-dependence, tracheostomy decannulation was successful in 6.3% of children （6 of 95） and all-cause mortality was 13.7% （13 of 95）. Conclusion:Most paediatric tracheotomies were performed due to chronic underlying diseases. Pediatric tracheostomy should be considered as a long-term intervention in many children. Earlier tracheotomy can shorten the duration of post-tracheotomy mechanical ventilation in several conditions.

Emergency to Elective Surgery Ratio as a Disparities Sensitive Surgical Access Metric, A Study of Low Socioeconomic Status in Australia.

The emergency to elective surgery ratio is a proposed indicator for global access to surgical care. There is a well-established link between low socioeconomic status and increased morbidity and mortality. This study examined the emergency to elective surgery ratios for low socioeconomic patients utilising both self-reported unemployment and the neighbourhood Index of Economic Resources (IER). A retrospective study was conducted at a regional tertiary care centre in Australia, including data over a ten-year period (2008-2018). Multivariable logistic regression adjusting for year, age, sex, Charlson Comorbidity Index, rurality, and if surgeries were due to trauma or injuries, was performed. 84,014 patients underwent a surgical procedure in the period examined; 29.0% underwent emergency surgery, 5.31% were unemployed, and 26.6% lived in neighbourhoods with the lowest IER. Following multivariable testing, the rate of emergency surgery was higher for unemployed patients (OR 1.42 [1.32-1.52], p < 0.001), and for those from the lowest IER (OR 1.13 [1.08-1.19], p < 0.001). For unemployed patients, this disparity increased during the study period (OR 1.32 [2008-2012], OR 1.48 [2013-2018]). When stratified by specialty, most (7/11) had significant disparities for unemployed patients: Cardiac/Cardiothoracic, Otolaryngology, Maxillofacial/Dental, Obstetrics/Gynaecology, Orthopaedics, Plastics, and Vascular surgery. Unemployed Australians and those residing in the most disadvantaged IER neighbourhoods had higher emergency to elective surgery rates. The disparity in emergency to elective surgery rates for unemployed patients was found in most surgical specialties and increased over the period examined. This suggests a widespread and potentially increasing disparity in access to surgical care for patients of socioeconomic disadvantage, specifically for those who are unemployed.

Profiles and Clinical Outcomes of Perforated Peptic Ulcer with Boey Score 3 Treated with External Drainage in Indonesia

The treatment of peptic ulcers has changed substantially, and the rate of elective surgery for gastroduodenal peptic ulcers has fallen significantly; as a result, the rate of emergency surgery for perforated peptic ulcers has slightly increased. The Boey score is one of the most widely used prognostic scoring systems for predicting death in peptic ulcer perforation patients. The Boey scoring system has a positive connection with mortality risk. Patients with Boey Score 3 are patients who meet the high-risk criteria and have high morbidity and mortality rates. Conservative therapy can be utilized as an alternative to surgery in some cases with perforated gastroduodenal ulcers. In this study, we presented a clinical case of perforated peptic ulcer patient with Boey score 3 treated with external drainage for the conservative treatment.

Manual Reduction of Incarcerated Abdominal Wall Hernias. A Feasible Option during COVID-19 Pandemic: A Prospective Study.

Background Incarcerated hernia is a common surgical emergency with considerable morbidity or even mortality. Manual reduction (taxis) and elective surgery could be an alternative management approach. This study examines the role of taxis with the adjuvant use of the visual analogue scale (VAS) score in treating incarcerated hernias and thereby decreasing the emergency surgery rate, especially during the novel coronavirus disease 2019 (COVID-19) pandemic. Methods All adult patients admitted to the emergency department of our hospital with incarcerated hernias of anterior abdominal wall were prospectively submitted to hernia manual reduction. The VAS score was used as an adjuvant tool for monitoring the success of this maneuver. Patients with successful taxis and low VAS score were hospitalized for a 24-hour period of observation. On their discharge, they were scheduled for an elective hernia repair. Patients with unsuccessful taxis or with less than a 50% reduction in VAS score after successful taxis were submitted to emergency surgical repair. Age, sex, type of hernias, time until taxis, VAS scores before and after taxis, length of hospital stay, and adverse events for both groups were recorded. Results Between September 2018 and September 2020, 86 patients with incarcerated hernias were included. The types of hernias were incisional in 8 patients, umbilical in 15 patients, inguinal in 56 patients, and femoral in 7 patients. Taxis was successful in 66% of patients with a mean reduction in VAS score from 83 to 17 mm. Following successful taxis, patients were hospitalized for a 24-hour period of observation. No taxis-related complications were observed. Fifty-two patients were safely discharged from hospital and scheduled for an elective repair during the first month. Thirty-four patients were operated emergently. Five patients had successful taxis but with a reduction of posttaxis VAS score less than 50% (a mean reduction from 86 to 62 mm), while taxis failed in twenty-nine patients. Patients with emergency surgery had longer time until reduction and longer stay of hospitalization. In this group, two patients required admission to the intensive care unit while one patient died. Conclusion In this protocolized approach, taxis is a safe and feasible option for most patients with incarcerated hernias. It should be kept in our armament, especially in times when emergency surgery capabilities are under strain like the ongoing COVID-19 pandemic.

Effectiveness of the implementation of pediatric intussusception clinical pathway: A pre- and postintervention trial.

Intussusception is common among children at the pediatric emergency department (ED) with acute abdomen. Diagnosis and treatment delay remain a challenge. This study aimed to evaluate the impact of intussusception clinical pathways (CPs) implementation, including bedside point-of-care ultrasonography, on patient management in a pediatric ED.In January 2017, an intussusception management protocol was implemented for children with symptoms of intussusception. We retrospectively examined the charts of patients diagnosed with intussusception during the preprotocol (January 2015 to December 2016) and postprotocol (January 2017 to January 2019) periods and compared their outcomes.A total of 106 and 108 patients were included in the preprotocol and postprotocol groups, respectively. After CP implementation, the median door-to-ultrasonography time decreased from 66.5 (range: 13, 761) to 54 (20, 191) minutes; meanwhile, door-to-reduction time decreased from 121.5 (37, 1077) to 80.5 (40, 285) minutes; the median ED length of stay decreased from 440 to 303.5 minutes; and finally, admission rate increased from 18.9% to 40.7% (P < .01). There was no between-group difference in the rates of complications, readmission, emergency surgery, or reduction failure.The implementation of an intussusception CP decreased time-to-diagnosis, time-to-treatment, and ED length of stay estimates among children screened using point-of-care ultrasonography. The present findings suggest that the implementation of an intussusception CP may improve the efficiency of time and resource use.

Variation in the rates of emergency surgery amongst emergency admissions to hospital for common acute conditions.

BackgroundThis paper assesses variation in rates of emergency surgery (ES) amongst emergency admissions to hospital in patients with acute appendicitis, cholelithiasis, diverticular disease, abdominal wall hernia, and intestinal obstruction.MethodsRecords of emergency admissions between 1 April 2010 and 31 December 2019 for the five conditions were extracted from Hospital Episode Statistics for 136 acute National Health Service (NHS) trusts in England. Patients who had ES were identified using Office of Population Censuses and Surveys (OPCS) procedure codes, selected by consensus of a clinical panel. The differences in ES rates according to patient characteristics, and unexplained variations across NHS trusts were estimated by multilevel logistic regression, adjusting for year of emergency admission, age, sex, ethnicity, diagnostic subcategories, index of multiple deprivation, number of co-morbidities, and frailty.ResultsThe cohort sizes ranged from 107 325 (hernia) to 268 253 (appendicitis) patients, and the proportion of patients who received ES from 11.0 per cent (diverticular disease) to 92.3 per cent (appendicitis). Older patients were generally less likely to receive ES, with adjusted odds ratios (ORs) of ES for those aged 75–79 versus those aged 45–49 years: 0.34 (appendicitis), 0.49 (cholelithiasis), 0.87 (hernia), and 0.91 (intestinal obstruction). Patients with diverticular disease aged 75–79 were more likely to receive ES than those aged 45–49 (OR 1.40). Variation in ES rates across NHS trusts remained after case mix adjustment and was greatest for cholelithiasis (trust median 18 per cent, 10th to 90th centile 7–35 per cent).ConclusionFor patients presenting as emergency hospital admissions with common acute conditions, variation in ES rates between NHS trusts remained after adjustment for demographic and clinical characteristics. Age was strongly associated with the likelihood of ES receipt for some procedures.

555 Should All Acutely Presenting Gallstone Disease Be Managed Surgically?

Abstract Aim This audit aims to assess if gallstone complications can be prevented by performing an emergency cholecystectomy in acutely presenting gallstone disease. Factors taken into consideration include number of presentations to hospital before surgery, secondary admissions of pancreatitis or cholangitis, subsequent requirements of ERCP as well as complication rates of elective and emergency surgery. Method Retrospective audit looking at 387 cholecystectomies carried out, within a year, at Walsall Manor Hospital. Results Approximately 20% of patients had an emergency cholecystectomy. A total of 192 patients had at least one admission, with 17% having a minimum second. Seven patients went on to develop gallstone pancreatitis subsequently, as well as eight requiring at least a minimum of one ERCP. The complication rate in elective surgery was higher at 4.1% compared to 2.7% in emergency cases. Long waiting times for surgery put patients at greater risk of complications. 96% (26/27) of elective cholecystectomy patients, who suffered an attack of pancreatitis, had to wait more than four weeks. Furthermore, 39% (47/119) of those who had a minimum of one admission had to wait more than 20 weeks. On the other hand, three-quarters of patients who were operated in emergency went home within 48 hours, with the figures being not too dissimilar from elective cases with a history of admission (76%). Conclusions Performing emergency cholecystectomies in the same admission or on a dedicated hot list would not only decrease the risk, but also the potential risk of developing gallstone complications.

Impact of anticoagulation and antiplatelet drugs on surgery rates and mortality in trauma patients

Preinjury anticoagulation therapy (AT) is associated with a higher risk for major bleeding. We aimed to evaluated the influence of preinjury anticoagulant medication on the clinical course after moderate and severe trauma. Patients in the TraumaRegister DGU ≥ 55 years who received AT were matched with patients not receiving AT. Pairs were grouped according to the drug used: Antiplatelet drugs (APD), vitamin K antagonists (VKA) and direct oral anticoagulants (DOAC). The primary end points were early (< 24 h) and total in-hospital mortality. Secondary endpoints included emergency surgical procedure rates and surgery rates. The APD group matched 1759 pairs, the VKA group 677 pairs, and the DOAC group 437 pairs. Surgery rates were statistically significant higher in the AT groups compared to controls (APD group: 51.8% vs. 47.8%, p = 0.015; VKA group: 52.4% vs. 44.8%, p = 0.005; DOAC group: 52.6% vs. 41.0%, p = 0.001). Patients on VKA had higher total in-hospital mortality (23.9% vs. 19.5%, p = 0.026), whereas APD patients showed a significantly higher early mortality compared to controls (5.3% vs. 3.5%, p = 0.011). Standard operating procedures should be developed to avoid lethal under-triage. Further studies should focus on detailed information about complications, secondary surgical procedures and preventable risk factors in relation to mortality.

Retinal detachment surgery: trends over 15years

The aim of the study was to investigate the changes in the treatment of patients with retinal detachment over the past 15years. Files of all 5101 patients hospitalized for retinal detachment surgery between January 2005 and March 2020 were retrospectively analyzed. The number of retinal detachment surgeries over the past 15years increased continually from 150 to 600 per annum. During the summer months an increased incidence of retinal detachment of approximately 20% could be observed compared to the winter months. Anatomical success rates of emergency surgery carried out at weekends were not lower than those of scheduled routine procedures performed during the week. The relative proportion of buckle surgery decreased significantly from more than 60% down to 5% between 2005 and 2019. While initially an additional encircling buckle was employed in most cases of primary vitrectomy, this technique has almost completely disappeared in recent years without a deterioration of success rates. Liquid silicone tamponade was applied less frequently over the years. The overall anatomical success rates showed aslight trend towards improved results over the past 15years. The strategies for surgical repair of retinal detachment have changed considerably in recent years: less buckle surgery, more vitrectomy, less add-on encircling buckles and less silicone tamponade. Aslight trend towards better anatomical success rates could be observed.

Conservative treatment of uncomplicated right-sided diverticulitis: a systematic review and meta-analysis.

Right-sided diverticulitis has different epidemiologic features compared to left-sided diverticulitis. However, data on the appropriate treatment of right-sided diverticulitis are lacking. This systematic review aimed to examine the outcomes of conservative treatment for uncomplicated right-sided diverticulitis. MEDLINE, Embase, and the Cochrane Library were searched for articles published from January 1, 1990, to May 31, 2020. A total of 21 studies were included in the systematic review. We calculated proportions and 95% confidence intervals (CIs) to assess the outcomes of individual studies and pooled the results using a random effects model. A total of 2811 patients (59.1% men; mean and median age, 37-54 years) with right-sided diverticulitis were included. The pooled rate of treatment failure was 2.5% (95% CI 1.2-4.3%; p <0.01; I2 = 64.0%). The recurrence rate ranged from 0 to 26.9%, and the pooled recurrence rate was 10.9% (95% CI 8.1-14.1%; p <0.01; I2 = 78.2%). The pooled rate of complicated diverticulitis at recurrence was 4.4% (95% CI 1.4-9.0%; p = 0.84; I2 = 0%). The pooled rate of emergency surgery at recurrence was 9.0% (95% CI 4.6-14.7%; p = 0.12; I2 = 30.3%). Conservative treatment of uncomplicated right-sided diverticulitis results in a low rate of recurrence and complicated diverticulitis at recurrence. Based on these results, unnecessary surgery may be avoided and a new treatment paradigm for uncomplicated right-sided diverticulitis may be introduced.

Sociodemographic factors related with emergency colorectal cancer surgery at a referral center in Mexico.

Diagnosis of colorectal cancer (CRC) after emergency presentation is associated with a worse prognosis. The aim of the study was to determine the sociodemographic factors related with emergency CRC surgery at our institution. From January 2009 to December 2017, patients that underwent CRC surgery at our institution were included in the study. Univariate and multivariate logistic regression were used to determine the effect of the potential risk factors on the rate of emergency surgery. A total of 247 patients underwent CRC surgery at our institution. The rate of emergency surgery was 7.7%. On univariate analysis, patients without a family history of cancer (odds ratio [OR]: 4.95), living in a rural area (OR: 3.7), and late clinical cancer stage (OR: 5.06) were associated with emergent surgery. Mid-income status was a protective factor for emergency surgery (OR: 0.14, p = 0.003). On multivariate analysis, late clinical cancer stage (OR: 4.41, 95% CI 1.21-16.05, p = 0.024) and mid-income economic status (OR: 0.41, 95% CI 0.04-0.55, p = 0.004) were identified as independent risk factors for emergency surgery. Social, economic, and demographic factors were identified as predictors for emergent CRC surgery.

Analysis of the Clinical Effect and Complication Rate of Emergency Surgery for Severe Chest Trauma with Traumatic Shock

Objective: To analyze the clinical effect and complication rate of emergency surgery for severe chest trauma with traumatic shock. Method: A total of 100 patients with severe chest trauma and traumatic shock admitted to our hospital from November 2017 to November 2018 were randomly selected. All the patients were divided into the reference group (50 cases, elective surgical treatment) and the study group (50 cases, emergency surgical treatment) according to the difference in surgical treatment time. At the same time, the effect of surgical treatment, incidence of complications (organ failure, respiratory distress syndrome, empyema, pulmonary infection) and clinical indicators (recovery time of respiratory function, mortality) of patients in the two groups were compared and analyzed. Consequence: The total effective rate of clinical efficacy in the control group and the treatment group was 98% and 86%, so treatment group was significantly higher than the control group. The incidence of adverse reactions in the control group and the treatment group was 4% and 12%, so treatment group was significantly lower than the control group, and the recovery time and mortality of respiratory function in the treatment group were lower than those in the control group, with significant differences in all comparisons (P &amp;lt; 0.05). Conclusion: Emergency surgery for patients with severe chest trauma and traumatic shock has a significant therapeutic effect, which can effectively reduce the risk of postoperative complications, improve the prognosis of patients and reduce the short-term mortality of patients.

Risk of colectomy after conservative treatment of diverticulitis of the left hemicolon complicated by abdominal or pelvic abscess: protocol of a systematic review and meta-analysis

IntroductionAcute diverticulitis of the sigmoid colon is increasingly treated by a non-operative approach. The need for colectomy after recovery from a flare of acute diverticulitis of the left colon, complicated...

61 Characteristics of Ectopic Pregnancies Presenting to an Urban Academic Emergency Department at a Tertiary Care Center for Obstetrics

To identify the clinical utility of Beta Human Chorionic Gonadotropin levels and the overall rate of medical treatment failure, hemodynamic instability, and emergent surgery for ectopic pregnancies in the ED. An interim analysis of a retrospective case review of patients seen in an urban academic Emergency Department specializing in obstetrical care from January 1, 2015 to December 31, 2017 with the diagnosis of ectopic pregnancy. Data from the chart was extracted for multiple variables including presentation, treatment, adverse outcomes and rates of rupture. In this cohort, 367 unique ectopic pregnancies were identified. 23.7% of these patients initially presented with evidence of rupture on pelvic ultrasound. Additionally, 16.2% showed evidence of hemodynamic instability (Heart rate>100, SBP<90 or evidence of significant blood loss). 18.5% (n-113) of patients who received single-dose methotrexate failed medical management and required surgical intervention. For patients who received multi-dose methotrexate, 45.1% (n-29) failed medical management. Ultimately, 53.4% of patients required operative management of their ectopic pregnancy. Although the mean Beta Human Chorionic Gonadotropin (ß-HCG) level at initial presentation was 6515 mlU/ml (SD 16291 mlU/ml) with a median of 1274 mlU/ml, 51.7% of ectopic pregnancies presented with ß-HCG levels less than the standard discriminatory zone of 1500 mlU/ml. Additionally, 40% of the patients who presented with evidence of ectopic rupture had ß-HCG levels less than 1500mlU/ml. When comparing the size of the ectopic pregnancy (based on maximum dimension) to ß-HCG levels, this comparison failed to show any correlation between the size of the ectopic pregnancy and the ß-HCG level. Furthermore, detection of ectopic pregnancies by ultrasound was also independent of ß-HCG levels. ß-HCG levels do not correlate with the presence or size of an ectopic pregnancy. This further supports the need to perform appropriate diagnostic imaging regardless of ß-HCG level in patients with suspicion for ectopic pregnancy. Almost a fifth of patients present with evidence of hemodynamic instability, and approximately one quarter of patients presented with a ruptured ectopic pregnancy requiring emergent operative management. Close follow-up is essential for medically treated ectopic pregnancies as many patients will require surgical intervention for definitive management. Ultimately, more than 50% of patients still require an operative procedure to definitively manage their ectopic pregnancy.

S3394 A Case Report of Atypical Ulcerative Colitis

INTRODUCTION: Ulcerative colitis(UC) and Crohns disease usually have specific presentation on colonoscopy with some overlap seen in select cases. UC predominantly involves colon, with almost always involving the rectum and rarely involving the ileum. However, in about 5% of the cases, IBD can present in atypical way labelled as “indeterminate” or “unclassified”. In these cases, UC can present with skip lesions with rectal sparing which can pose a diagnostic challenge if only visual diagnosis is focused upon. CASE DESCRIPTION/METHODS: 27 year old female presented to GI clinic with rectal pain and diarrhea for several months. On the rectal exam, there was pinhole like opening and ulceration. Outpatient colonoscopy was performed and revealed few skip lesions of erythematous, friable and ulcerated mucosa in the transverse colon and terminal ileum. The pathology showed mild acute, focal inflammation and crypt abscess in terminal ileum, transverse, descending and sigmoid colon. Rectal biopsy showed normal findings. The stool studies were sent and C diff test came positive. After the 2week course of oral vancomycin, symptoms were significantly improved. Subsequently, she was placed on Mesalamine. 8 months later, repeat colonoscopy revealed inflamed, erythematous, congested skip lesions at terminal ileum and transverse colon. UC was confirmed again with the presence of mild inflammation and cryptitis. DISCUSSION: Patients who have RST(rectal sparing of UC) represent resistance to treatment, prolong duration of active disease and increased rate of recurrence. It might be a prediction for future colectomy given the severity of the disease. Severity of the disease was significantly worse in patients with RST compared to the control group and 24/46 pts with RST required urgent surgery compared with 107/436 non RST group. These patients have also seen to have a lack of response to conventional pharmacotherapy. Frequency of PSC (primary sclerosing cholangitis) with and without rectal sparing is also studied. The reported incidence showed a mean(30.9% vs 9.9%) in PSC with rectal sparing, compared with the group without rectal sparing. Overall, incidence of PSC was 3 times higher in rectal sparing group. In conclusion, the presence of relative or absolute RST in patients with UC is an atypical presentation. This group of patients should be selectively reclassified due to worse prognosis with higher incidence rate of emergent surgery, primary sclerosing cholangitis and refractoriness of pharmacologist therapies.Figure 1.: Congested, erythematous, friable and inflamed terminal ileum.Figure 2.: Rectum with normal appearing mucosa.

Neonatal surgical outcomes after prenatal diagnosis of complex congenital heart disease: experiences of a perinatal integrated diagnosis and treatment program.

This study aimedto evaluate neonatal surgical outcomes of patients diagnosed with complex congenital heart disease (CHD) during pregnancy and treated by the newly initiated "perinatal integrated diagnosis and treatment program (PIDTP)". We reviewed clinical data of 207 neonates (surgical age ≤ 28days) who underwent cardiac surgeries in a single center from January 2017 to December 2018, including 31 patients with referrals from the "PIDTP" (integration group) and 176 patients with routine referral treatment (non-integrated group). In the integration group, median admission age was 0days and median age at surgery was 4days. In the non-integrated group, median admission age was 8days (P = 0.001) and median age at surgery was 13days (P = 0.001). The emergency surgery rate in patients with duct-dependent defects was 36% in the integration group and 59% (P = 0.042) in the non-integrated group, respectively. The in-hospital mortality was 16% in the integration group and 14% (P = 0.78) in the non-integrated group. The 2-year cumulative survival rate after surgery was 83.9% ± 6.6% in the integration group and 80.3% ± 3.1% (P = 0.744) in the non-integrated group. According to multivariable regression analysis, independent risk factors for early mortality of overall neonatal cardiac surgery were low body weight, high serum lactate level, postoperative extracorporeal membrane oxygenation (ECMO) support and prolonged cardiopulmonary bypass (CPB) time. PIDTP shortens the postnatal transit interval, reduces the emergency operation rate of neonatal critical CHD, and provides better preoperative status for surgery. Patients treated by the PIDTP tend to have more complicated anatomical deformity and a greater requirement for the operation and postoperative management, but early outcome and follow-up prognosis are satisfactory.

Collateral Effect of Coronavirus Disease 2019 Pandemic on Hospitalizations and Clinical Outcomes in Gastrointestinal and Liver Diseases: A Territory-wide Observational Study in Hong Kong

Background The Coronavirus Disease 2019 (COVID-19) pandemic had a huge impact on healthcare systems globally. Decline in hospital admissions for common medical emergencies was observed. We investigated its collateral effect on hospitalizations and clinical outcomes in patients with gastrointestinal (GI) and liver diseases in Hong Kong. Methods We performed a territory-wide retrospective cohort study in Hong Kong from January 1, 2019, to May 31, 2020. Data were retrieved through Clinical Data Analysis and Reporting System. We included patients admitted to hospitals with top diagnoses of luminal GI cancers, pancreatico-hepatobiliary cancers, benign pancreaticobiliary disorders, liver diseases, non-infective enteritis and colitis, non-variceal and variceal upper gastrointestinal bleeding (UGIB). We excluded patient-based hospital admissions without emergency department attendance and length of stay equal to or shorter than one day. The primary endpoint was the total number of index hospital admissions related to these diagnoses at different time points. The secondary endpoints were in-hospital mortality, intensive care unit admission, elective or emergency operations and endoscopy. The COVID-19 period was defined as the time after the first local case in January 2020, week 4. Results We recorded a total of 195,867 hospital admissions related to GI diseases during the study period, and 125,049 of them were included in the final analysis. Comparing the same pre-COVID19 and COVID-19 periods, we observed a significant decline in the average number of hospitalizations for GI diseases (17.0% reduction, P Conclusions The number of hospitalizations related to GI diseases reduced drastically during the COVID-19 epidemic, yet no excessive in-hospital mortality was observed. More emergency endoscopies and operations were required, particularly for UGIB and benign pancreaticobiliary conditions.

Transdiaphragmatic herniation after transthoracic esophagectomy: an underestimated problem.

Diaphragmatic transposition of intestinal organs is a major complication after esophagectomy and can be associated with significant morbidity and mortality. This study aims of to analyze a large series of patients with this condition in a single high-volume center for esophageal surgery and to suggest a novel treatment algorithm. Patients who received surgery for postesophagectomy diaphragmatic herniation between October 2003 and December 2017 were included. Retrospective analysis of demographic, clinical and surgical data was performed. Outcomes of measure were initial clinical presentation, postoperative complications, in-hospital mortality and herniation recurrence. A total of 39 patients who had surgery for postesophagectomy diaphragmatic herniation were identified. Diaphragmatic herniation occurred after a median time of 259days following esophagectomy with the highest prevalence between 1 and 12months. A total of 84.6% of the patients had neoadjuvant radiochemotherapy prior to esophagectomy. The predominantly effected organ was the transverse colon (87.2%) prolapsing into the left hemithorax (81.6%). A total of 20 patients required emergency surgery. Surgery always consisted of reposition of the intestinal organs and closure of the hiatal orifice; a laparoscopic approach was used in 25.6%. Major complications (Dindo-Clavien ≥ IIIb) were observed in 35.9%, hospital mortality rate was 7.7%. Three patients developed recurrent diaphragmatic herniation during follow-up. Postesophagectomy diaphragmatic herniation is a functional complication of the late postoperative course and predominantly occurs in patients with locally advanced adenocarcinoma having chemoradiation before Ivor-Lewis esophagectomy. Due to a high rate of emergency surgery with life-threatening complications not a 'wait-and-see' strategy but early surgical repair may be indicated.

Short-Term Clinical Outcomes after Using Novel Deeper Intubation Technique (DIT) of Ileus Tube for Acute Bowel Obstruction Patients.

Background The ileus tube has been widely used for the treatment of acute small bowel obstruction. However, it is difficult to get the tube sufficiently adjacent to the obstruction site due to various reasons. Methods We developed a novel intubation technique, named Deeper Intubation Technique (DIT), by using the Zebra Urological Guidewire and digital gastrointestinal fluoroscopy, where we deepened the catheter intubation, and further compared the effects of DIT with the Traditional Intubation Technique (TIT) on the short-term clinical outcomes of 183 patients. Results The average intubation depth of DIT apparently exceeds that of TIT (213.89 ± 31.11 vs. 134.67 ± 18.22 cm, P < 0.001). Compared with patients in the TIT group, patients in the DIT group got a lower pain score (P < 0.001), shorter recovery time for anal exhaust defecation (2.87 ± 1.50 vs. 3.37 ± 1.52 d, P = 0.040), higher recovery rate in anal exhaust defecation (24 h, 16.8% vs. 5.7%, P = 0.021; 48 h, 46.3% vs. 27.3%, P = 0.009), better symptomatic remission rate and imaging relief rate (P < 0.05), and increased drainage volume (1006.88 ± 583.45 vs. 821.02 ± 358.73 ml, P = 0.009). Importantly, the emergency surgery rate in the DIT group was lower than that in the TIT group (3.2% vs. 13.6%, P = 0.014). In addition, the DIT procedure was effective for patients with adhesive obstruction but not for cancerous and stercoral bowel obstruction. Conclusion Compared to TIT, DIT produced better short-term clinical outcomes, indicating that DIT is a safe and feasible technique for the treatment of adhesive intestinal obstruction.

Risk of Emergency Surgery or Death After Initial Nonoperative Management of Complicated Diverticulitis in Scotland and Switzerland

National guidelines on interval resection for prevention of recurrence after complicated diverticulitis are inconsistent. Although US and German guidelines favor interval colonic resection to prevent a perceived high risk of recurrence, UK guidelines do not. To investigate patient management and outcomes after an index inpatient episode of nonoperatively managed complicated diverticulitis in Switzerland and Scotland and determine whether interval resection was associated with the rate of disease-specific emergency surgery or death in either country. This secondary analysis of anonymized complete national inpatient data sets included all patients with an inpatient episode of successfully nonoperatively managed complicated diverticulitis in Switzerland and Scotland from January 1, 2005, to December 31, 2015. The 2 countries have contrasting health care systems: Switzerland is insurance funded, while Scotland is state funded. Statistical analysis was conducted from February 1, 2018, to October 17, 2019. The primary end point defined a priori before the analysis was adverse outcome, defined as any disease-specific emergency surgical intervention or inpatient death after the initial successful nonsurgical inpatient management of an episode of complicated diverticulitis, including complications from interval elective surgery. The study cohort comprised 13 861 inpatients in Switzerland (6967 women) and 5129 inpatients in Scotland (2804 women) with an index episode of complicated acute diverticulitis managed nonoperatively. The primary end point was observed in 698 Swiss patients (5.0%) and 255 Scottish patients (5.0%) (odds ratio, 0.98; 95% CI, 0.81-1.19). Elective interval colonic resection was undertaken in 3280 Swiss patients (23.7%; median follow-up, 53 months [interquartile range, 24-90 months]) and 231 Scottish patients (4.5%; median follow-up, 57 months [interquartile range, 27-91 months]). Death after urgent readmission for recurrent diverticulitis occurred in 104 patients (0.8%) in Switzerland and 65 patients (1.3%) in Scotland. None of the investigated confounders had a significant association with the outcome apart from comorbidity. This study found no difference in the rate of adverse outcome (emergency surgery and/or inpatient death) despite a 5-fold difference in interval resection rates.