General Surgery Service Research Articles

Overview of general surgery medical residency programs and prerequisite program in basic surgical area in Brazil: Historical review and update.

to describe vacancy regulation process by adding, describing the panorama of the General Surgery Residency Program (PRMCG) and the Basic Surgical Prerequisites Program (PRACB). descriptive, quali-quantitative, cross sectional study conducted from document analysis from National Commission of Medical Residency (CNRM). in 2018, after evaluation of the General Surgery Services for adequacy of the number of vacancies (DS), the PRACB was instituted as a modality of access to surgical specialties until definitive change in the time of the formation of the general surgeon for three years, in 2022. In the first addition of vacancies in 2018, 127 PRMCG were authorized with 736 vacancies of R1 and 290 PRACB (2 years) with 1.286 vacancies offered for R1. In the second addition in 2021, 423 PRM were authorized with 1.564 R1 vacancies in PRMCG. the regulation of the offer of vacancies for the formation of specialties in Brazil should align the evaluation of practice scenarios with the profile of skills. The PRACB modality was instituted for a certain time for budgetary preparation and practice scenarios until the complete transition to training in 3 years. Brazil by 2018 was the only country to grant the Board Certification to General Surgeon with only 2 years of training. After a transitional period the same analysis methodology for adding and regulating vacancies was applied to services.

Tracer indicators in patients with acute surgical abdomen

Introduction: The tracer indicators are elements to be taken into account by the surgical services to know the morbidity and mortality in the non-traumatic acute abdomen. Objective: To describe the characteristics of tracer diseases in the non-traumatic acute abdomen in the General Surgery service of the Manuel Ascunce Domenech University Hospital in Camagüey. Methodological design: A cross-sectional longitudinal descriptive observational study was carried out in 657 patients. The data came from the medical records and were processed using descriptive statistics, relating some variables in a non-inferential way. Results: 60.6% of the patients were men. 30.7% were between 40 and 59 years old. There were 334 patients with symptom evolution time between 24-47 hours. 42.5% presented acute appendicitis. There were 29.2% complications, 66.1% of them were infectious. Mortality was 10.2%. 37.3% of the deceased presented pulmonary thromboembolism, 50.7% presented intestinal occlusion. The reoperation and readmission rates were 5.3% and 7.6%, respectively. Conclusions: The study of tracer diseases shows that: Almost a tenth of the patients died, being pulmonary thromboembolism the cause of the deaths. The time of evolution greater than 24 hours, infectious complications, ages over 40 years and intestinal occlusion as a cause of acute abdomen seemed to influence the mortality of the sample studied. Evisceration and infection of the operative site were the causes of admissions and reoperations.

DOES THE FREQUENCY OF ACUTE CHOLECYSTITIS DECREASE DURING THE RAMADAN MONTH?

The pathophysiological mechanism of acute cholecystitis (AC), which is essentially the inflammation of the gallbladder, is blockage of the cystic duct, and its most common cause is gallstones. On the other hand, fasting held in Ramadan is a worship practised by Muslims within the period from dawn to sunset by avoiding any eating and drinking act. Within this framework, our study ultimately intends to reveal the variation of AC in two different time periods. We retrospectively compared the demographic characteristics, admittance times, biochemical parameters of the subjects diagnosed with AC and hospitalized in the general surgery between 2012 and 2018. We also evaluated diagnosis classification, length of hospitalization, presence of intensive care stay, presence of operation during hospitalization, and the underlying comorbid diseases of the subjects. 225 patients were hospitalized in the general surgery service after being diagnosed with AC in the ED over the course of six years, yet the total number of subjects recruited for the study is 46. Whereas 10 patients (21.7%) were admitted and hospitalized during the Ramadan month, 36 (78.3%) patients in the other group were hospitalized one month before and after the Ramadan. 16 (34.8%) of the hospitalized patients underwent emergency surgery, while 30 (65.2%) patients were operated electively. The comparison of the two cohorts in our study revealed no significant difference in relation to the demographic characteristics, laboratory findings, imaging methods, underlying comorbid diseases, and the length of hospital stay. Nevertheless, clinical investigations seem to have revealed a difference between groups.

A Review of Phenobarbital for Alcohol Withdrawal Syndrome

Background: Alcohol use disorder represents a serious health problem worldwide which is increasing in pervasiveness. Alcohol withdrawal syndrome is a common clinical problem encountered in emergency departments and inpatient settings, including intensive care units. While benzodiazepines are the most widely used class of medication for the treatment of alcohol withdrawal, in recent years, there is renewed interest in using phenobarbital, a barbiturate, in the treatment of refractory alcohol withdrawal. Objective: This review provides an overview of phenobarbital in the treatment of alcohol withdrawal, as well as clinical outcomes in patients, while also outlining some of the limitations of existing studies in comparing phenobarbital to benzodiazepines. Methods: PubMed, Ovid MEDLINE, and Cochrane databases were searched using the terms phenobarbital, barbiturates, and alcohol withdrawal syndrome. Prospective and retrospective trials comparing phenobarbital with benzodiazepines to treat alcohol withdrawal in English were included. Results: Two prospective randomized controlled and eleven retrospective cohort trials were identified. Phenobarbital is safe alone and as an adjunct to benzodiazepine in the emergency department, intensive care units, general medical units and acute trauma surgery service. In a randomized controlled trial, one dose of phenobarbital in the emergency department significantly reduced the intensive care admission rate. There is some evidence that phenobarbital may be effective in the treatment of benzodiazepine- refractory alcohol withdrawal. Conclusion: Although existing knowledge and practice regarding phenobarbital for the treatment of alcohol withdrawal are increasing, there currently remains limited evidence in support of phenobarbital over benzodiazepines in superior efficacy and outcomes.

High dietary ω-6:ω-3 PUFA ratio and simple carbohydrates as a potential risk factors for gallstone disease: A cross-sectional study

Background & aimsGallstone disease (GD) is a major cause for consultation at general surgery services worldwide. In fact, GD has a strong relationship with environmental factors. However, specific characteristics in the Mexican population have not been established. The aim of this study was to compare the dietary components, physical activity, body composition and serum lipids in women with and without GD. Methods54 women with GD and 75 without GD from West Mexico were enrolled in a cross-sectional study. Dietary intake was obtained through a habitual day food record and analyzed using the Nutritionist Pro™ software. Physical activity was evaluated in accordance with WHO recommendations. Body fat percentage (BF%) was estimated by bioimpedance (InBody 370) and serum lipids were measured using dry chemistry (Vitros-250 Analyzer). Student's t-test and binary logistic regression model were used. ResultsWomen with GD presented a higher BF% (40 ± 8.7 vs 35.21 ± 9.8%, p = 0.004), an elevated dietary ω-6:ω-3 polyunsaturated fatty acids (PUFA) ratio (18.0 ± 11.4 vs 10.9 ± 4.7, p<0.001) and a higher simple carbohydrates (sCH) intake (28.3 ± 17.8 vs 13.23 ± 8.2%, p<0.001) as well as lower HDL-cholesterol levels (37.43 ± 8.5 vs 46.6 ± 12.02 mg/dL, p<0.001) compared with women without GD. Furthermore, it was foun d a higher ω-6:ω-3 PUFA ratio (OR: 3.9, 95% CI 1.52–10.38, p = 0.005) and excessive sCH consumption (OR: 7.4, 95% CI 1.92–28.65, p = 0.004). ConclusionWe suggest that a high dietary ω-6:ω-3 PUFA ratio and an excessive sCH intake are associated with an increased risk of GD in women.

Reducing Health Care Burden of Emergency General Surgery with a 24-Hour Dedicated Emergency General Surgery Service.

Emergency general surgery (EGS) diagnoses account for 11% of surgical admissions and 50% of surgical mortality. In this population, 7 specific operations are associated with 80.3% of deaths, 78.9% of complications, and 80.2% of hospital costs. In 2016, our institution established a comprehensive in-house EGS service. Herein, we hypothesize that formation of a dedicated EGS service is associated with a significant reduction in morbidity for patients undergoing the most common EGS procedures. All patients undergoing one of the most common EGS procedures within 2 days of admission were identified from 1/1/2013 to 5/9/2019 via a retrospective chart review. Patients were cohorted as pre- and post-EGS implementation. The primary outcome measure was the overall complication rate. Secondary endpoints included mortality, individual complication rate, time to operation, overnight operation, and length of stay. Finally, both cohorts were benchmarked to national outcomes. 718 patients met inclusion criteria (pre-EGS = 409 and post-EGS = 309). Overall complication rate decreased significantly (19.8% vs 13.9%, P = .0387) and overnight operations increased significantly in the post-EGS group (7.8%-16.5%, P = .0003). Pre-EGS complications were higher than national data in all but 1 procedure group, whereas post-EGS complications rates were lower in all but 2 categories. Implementation of a dedicated EGS service line was associated with a significant decrease in complication rate among the most complication-prone EGS procedures. Number of operations within 24 hours did not increase significantly; however, overnight operations did increase. Our results indicate that establishing a service-specific EGS line is reasonable and beneficial.

Tubo-Ovarian Inguinal Hernia with Ruptured Bleeding Follicle: A Case Report

Introduction: Hernias are abnormal protrusions of any abdominal-pelvic or fat organ, which are produced by a defect in the abdominal wall, the most frequent are inguinal hernias and their content is generally of the omentum or intestinal loops, the presence of pelvic organs is very infrequent and the majority of cases described are in children under five years of age. Objective: To analyze the entity in connection with a case of a patient with a tubo-ovarian inguinal hernia. Clinical case: The case of a 34-year-old female patient is presented, who was under follow-up by the gynecology service due to the presence of a left ovarian cyst, with symptoms of pain in the left iliac fossa for more than 6 months of evolution. which is performed an ultrasound, which reports left inguinal hernia for what is electively scheduled by the general surgery service, when performing the herniorrhaphy incarcerated hernia with left ovary with bleeding follicle and fallopian tube is evidenced. Conclusions: These types of findings are infrequent, documented in the literature with a global incidence of Tubo-ovarian inguinal hernias ranging from 0-8-4.4%, however it is worth clarifying that these studies are in infant patients, so its presentation in adults associated with a hemorrhagic follicle is anecdotal as in this case.

The Impact of Concurrent Multi-Service Coverage on Quality and Safety in Trauma Care

At many trauma centers in the United States, one acute care surgeon is responsible for overnight coverage of both the emergency general surgery (EGS) and trauma services. The impact of this scheduling phenomenon on the quality and safety of trauma care has not been studied. Overnight (12:00 AM to 7:00 AM) trauma admissions to an academic Level 1 trauma center from 2013-2015 were studied after the institution adopted this scheduling phenomenon. Admissions were divided into two groups based on whether the admitting surgeon covered only the trauma service, or both the trauma and EGS services ("multi-service coverage"). Four major outcomes (e.g., mortality and complications), six quality metrics (e.g., time to first OR visit and unplanned transfers to the ICU), and procedural utilization patterns were compared. A total of 1046 admissions were included. There were no differences in any major outcomes between the two exposure groups, including any National Trauma Data Bank-defined complication (OR 1.1, 95% CI 0.8-1.5, P= 0.5). Quality metrics dependent on the admitting surgeon remained unchanged, including attending presence at the highest-level trauma activations within 15 min of arrival (93% versus 86%, P= 0.07) and time to urgent operative intervention (68 min versus 82 min, P= 0.9). There were no differences in the number of laboratory and imaging studies (4.1 versus 4.1, P= 0.9) or bedside interventions (1.8 versus 2.1, P= 0.4) performed per patient by the admitting surgeon. Multivariate logistic regression did not identify multi-service coverage as an independent risk factor for adverse patient outcomes or quality metrics. Trauma admissions under a surgeon covering multiple services simultaneously had similar outcomes, quality metrics, and procedural utilization patterns compared to trauma admissions under surgeons covering only the trauma service. Despite concerns that multiple-service coverage may overburden one acute care surgeon, time-dependent quality metrics and studies done during the initial workup of trauma patients remained unchanged. These findings suggest that simultaneous trauma and EGS service coverage by one acute care surgeon does not adversely impact trauma patient care.

Technological implementation in General Surgery services in Spain. National survey and results

Technology is one of the pillars of surgery in the 21st century and is a key factor in achieving better surgical results. The current surgical process involves not only surgical techniques, but also a very high degree of specialisation and the knowledge and use of techniques and devices from other fields. In Spain, there are no studies published at a national level in this regard.From the Minimally Invasive Surgery and Technological Innovation section of the Spanish Association of Surgeons we have designed a study whose main objective is to evaluate the degree of technological implantation in the specialty of General Surgery in Spain, as well as to analyze the devices available in the different centres of the country. We propose to make a detailed description of the applications of these devices and techniques by areas of interest, pointing out the pathologies and procedures in which this technology is used.

Does the COVID-19 Pandemic Affect Morbidity and Mortality Rates of Emergency General Surgery? A Retrospective Study from a Single-Center Tertiary Greek Hospital.

Background and Objectives: The outbreak of the COVID-19 pandemic had a major impact on all aspects of health care. Few up-to-date studies have actually assessed the impact of COVID-19 on emergency surgeries. The aim of this study was to provide an overview of the impact of the pandemic relating to the emergency surgery performed, as well as morbidity and mortality rates during the first year of the pandemic (March 2020–February 2021) and during the control period. In this period, the first propaedeutic surgery department and the third surgery department of the University General Hospital of Thessaloniki “AHEPA” in Greece provided continuous emergency general surgery services. Material and Methods: The study is in a retrospective cohort and included patients who were admitted to the Emergency Department and underwent emergency general surgery during the control period (n = 456), March 2019–February 2020 and during the first year of the pandemic (n = 223), March 2020–February 2021. Gender, age, type of surgical operation (morbidity), ICU need, the patient’s outcome, and days of hospitalization were compared. Results: A total of 679 emergency surgeries were included. Statistically significant differences emerged between the two time periods in the total number of emergency surgeries performed (p < 0.001). The most common type of surgery in the control period was associated with soft tissue infection while, during the pandemic period, the most common type of surgery was associated with the hepatobiliary system. In addition, the mortality rates nearly doubled during the pandemic period (2.2% vs. 4%). Finally, the mean age of our sample was 50.6 ± 17.5 and the majority of the participants in both time periods were males. Conclusions: The COVID-19 pandemic changed significantly the total number of emergency general surgeries performed. Mortality rates doubled and morbidity rates were affected between the control and pandemic periods. Finally, age, gender, length of hospitalization, intensive care unit hospitalization, and laparoscopy use in patients undergoing emergency surgery during the pandemic were stable.

A SURGICAL AUDIT OF GENERAL SURGERY CASES IN A TERTIARY CARE HOSPITAL AND THE IMPACT OF COVID-19 ON THE SAME

BACKGROUND: After the COVID-19 pandemic was declared on March 11, 2020 by the World Health Organization (WHO), routine clinical and surgical practices were affected, including General Surgery services. We aimed to compare how our General Surgery department was affected during this time period of Covid, we have included various parameters, we have also statistically shown how the elective and emergency services were before the Covid outbreak and during the COVID-19 pandemic in our institution. MATERIAL AND METHODS: We retro spectively compared General Surgery practices, including elective, emergency and septic surgeries in a surgical unit of Sir JJ Group of Hospitals over a span of 3 years (April 2018 - March 2021), including the era before and during Covid. RESULTS: The frequency of all the surgeries performed during the pandemic was lower as compared to previous two years before the pandemic in our study, also there was a signicant drop in the number of laparoscopic surgeries. CONCLUSION: The General Surgery practices in our institution have been drastically affected by the COVID-19 pandemic. This setback needs a denite strategy to be formulated to decrease the morbidity and mortality from the neglected elective surgical cases, the real risk-benet ratio must be met before operating such cases.

TP10.1.5The reorganisation of Emergency General Surgery services during the COVID-19 pandemic in the UK: Outcomes of delayed presentation, mortality and BAME patients

Abstract Background The COVID-19 pandemic is a global public health emergency. The reconfiguration of local healthcare systems to accommodate the increase in Critical Care capacity has put strain on ‘non-COVID’ specialities. This study characterises the utilisation of Emergency General Surgery (EGS) services at a busy UK university teaching hospital during the COVID-19 lockdown period to evaluate outcomes and to identify patient groups with worse outcomes. Method This retrospective study compares EGS admissions during the UK’s lockdown period (23rd March-28th May 2020) to the same period in 2019. Patient demographics were recorded together with details of their hospital stay and treatment outcomes. Results A total of 645 patients were included, comprising 223 in the COVID-19 and 422 in the non-COVID-19 periods. There was no difference in age, sex, co-morbidity or socioeconomical status. A lower proportion of Black, Asian and Minority Ethnic (BAME) patients were admitted during the COVID-19 period (20.6% vs 35.4%, p &amp;lt; 0.05). The duration of symptoms prior to presentation were longer, and admission Early Warning Scores and serum inflammatory markers were higher. More patients present with acute kidney injury (9.9% vs 4.7%, p = 0.012). There was no difference in perioperative outcomes or 30-day mortality, but more patients were readmitted following conservative management (10.6% vs 4.7%, p = 0.023). Conclusion We show that the UK reorganisation of EGS services has been successful in terms of outcomes and access to services despite a more unwell population. There was a lower proportion of BAME admissions suggesting additional barriers to access to healthcare under pandemic lockdown conditions.

Clinical Characteristics of Patients with Colon Cancer

Background: Colon cancer is the third leading cause of cancer morbidity and mortality in the world. Objectives: To investigate the clinical characteristics of patients with colon cancer. Methods: A cross-sectional descriptive study was used to analyze the characteristics of colon cancer patients in the Service of General Surgery of Military Hospital Octavio de la Concepción y la Pedraja from October 2013 to August 2017. The universe consisted of 61 patients with colon cancer. Results: The study was mainly female, and the patients over 60 years old accounted for the majority, especially the patients in the age group of 70–79 years old. Villous adenoma was the most common history. Low gastrointestinal bleeding was the main manifestation of left tumor patients. Most cancers were well differentiated. Adenocarcinoma was the most common histological type. Conclusion: Villous adenoma was the main pathological history of women aged 70–79. Lower gastrointestinal bleeding was the most common clinical manifestation, which was related to left position. Some patients need surgical treatment, and the most commonly used technique was left hemicolectomy. Most tumors were well differentiated with chronic inflammation.

NASA-TLX assessment of workload in resident physicians and faculty surgeons covering trauma, surgical intensive care unit, and emergency general surgery services

BackgroundHigher workload is associated with burnout and lower performance. Therefore, we aim to assess shift-related factors associated with higher workload on EGS, ICU, and trauma surgery services. MethodsIn this prospective cohort study, faculty surgeons and surgery residents completed a survey after each EGS, ICU, or trauma shift, including shift details and a modified NASA-TLX. ResultsSeventeen faculty and 12 residents completed 174 and 48 surveys after working scheduled 12-h and 24-h shifts, respectively (response rates: faculty – 62%, residents – 42%). NASA-TLX was significantly increased with a higher physician subjective fatigue level. Further, seeing more consults or performing more operations than average significantly increased workload. Finally, NASA-TLX was significantly higher for faculty when they felt their shift was more difficult than expected. ConclusionsHigher volume clinical responsibilities and higher subjective fatigue levels are independently associated with higher workload. Designing shift coverage to expand on busier days may decrease workload, impacting burnout and shift performance.

Trends in Robotic Port Closure and Hernia Risk by Surgical Specialty

<h3>Study Objective</h3> Determine if the rate of robotic fascial port closure differs by surgical specialty and assess the relationship between fascial closure and port-site hernias after a robotic-assisted surgery. <h3>Design</h3> Retrospective chart review of patients undergoing robotic surgery by gynecologists, urologists and general surgeons in which a 10 mm assistant port was used. <h3>Setting</h3> Urban Teaching Hospital with dual-console robotic teaching program. <h3>Patients or Participants</h3> Patients on the Gynecology, Urology, and General Surgery services at the University of Colorado between in 2019 who underwent a robot-assisted surgical procedure with or without fascial closure. <h3>Interventions</h3> Fascial closure or non-closure of the 10 mm laparoscopic port sites. <h3>Measurements and Main Results</h3> A total of 361 patients underwent robotic-assisted laparoscopy for gynecologic, urologic and general surgery procedures during the study period. Gynecologists were most likely to suture close the 10 mm fascial ports with 99% closure rate. General Surgeons closed the fascial port 87% of the time. Urologists were significantly less likely to close the 10 mm fascial port site with a 26% closure rate (P<0.001). The overall hernia rate was low for all cases at 0.6%. The fascial hernia rate was 0% for Gynecological procedures, 0.8% for Urological procedures, and 0% for General Surgery procedures. There was no difference in the hernia rates between the surgical specialties (P=0.89). There also no difference between the hernia rates whether the fascial port was closed or not (0% vs 1.1%, P=0.64). <h3>Conclusion</h3> There are differences between surgical specialties in the decision to close a 10 mm laparoscopic port with Gynecologists and General Surgeons suturing the fascia closed more commonly than Urologists. Despite this difference in practice, the hernia risk is very low in robotic surgery.

Finding Installed Capacity For Practical Training Of A Designated Medical Specialty At A University Hospital

Objective: Propose a methodology to determine the number of medical students who can rotate, for the practice of medicine, in a university hospital, so that the quality of training processes and in-patient care are assured. Materials and Methods: A three-step procedure is presented, in order to find the number of students that the institution can accept simultaneously. Results: The method is based on an integer linear model and it was implemented to assess installed capacity of General Surgery service at Hospital Universitario Clínica San Rafael, increasing in two students (33 %) the training capacity. Conclusions: The proposed methodology not only guaranties the quality of training processes and in-patient care, but also generates other intangible results such as having a more agile way of planning, reducing the planification time. The methodology is easily extended to other services within hospitals.

Digital Professionalism in Patient Care: A Case Based Survey of Patients

The objective of this study was to obtain the perception of patients on the use of portable digital media devices by providers during patient care and compare the findings to a previous study that examined providers' perceptions on the use of these devices. This was a cross-sectional survey study. This study took place at a large tertiary referral center. Participants were identified via inpatient lists from general surgery services. Of those eligible to participate, 70% completed the questionnaire. While some situations were seen as less appropriate, the overall consensus from participants was that informing the patient of why the physician is using a digital media device made it more appropriate. Patients recognize digital device use in healthcare is appropriate and professional when discussed with them in advance. Overall, patients and providers are in agreement that portable digital technology can improve patient care and open communication about the use improves the provider-patient relationship. There is some risk to patient trust in using digital devices in their presence.

387 Outcome Predictors of Interhospital Transferred Patients to Emergency General Surgery Service: Does Transfer Location Matter?

The regionalization of medicine further stresses emergency departments (ED) around the country. This paradigm shift that concentrates subspecialties to large academic institutions has increased the need to transfer patients from their initial, primary hospital. The interhospital-transferred (IHT) patients are associated with higher resource utilization and mortality. It is crucial to understand the differences that transferring IHT patients have on their outcome and identify specific clinical indicators that put them at increased risk of morbidity and mortality. We sought to understand the differences in predictors for outcomes between patients who were transferred from other hospitals’ EDs or inpatient units to a tertiary care center for surgical evaluation. We conducted a three-year retrospective analysis from 01/2014 to 12/2016. Adult patients who were transferred to our quaternary academic center’s emergency general surgery (EGS) service as the primary admitting service, were eligible. Our primary outcome was mortality and secondary outcomes were patients’ hospital dispositions and survivors’ hospital length of stay (HLOS). We used multivariable logistic and ordinal regressions to assess the associations of patients’ clinical factors at arrival to our medical center and their outcomes. We analyzed a total of 708 patients, 175 (25%) from the ED, 280 (39%) from the intensive care unit (ICU), and 253 (36%) from the ward. Compared to the ED patients, patients transferred from the ICU had a higher mean (SD) Sequential Organ Failure Assessment (SOFA) score [5.7 (4.5) vs. 2.39 (2), P<0.001], higher mortality, and longer HLOS. Transferring patients from the ICU (OR 2.95, 95% CI 1.36-6.41, P=0.006), requiring laparotomy (OR 1.96, 95% CI 1.04-3.70, P=0.039), and SOFA score (OR 1.22, 95% CI 1.13-1.32, P<0.001) were associated with higher mortality while gastrointestinal bleed was associated with lower mortality. Transfer from the ED was significantly associated with short HLOS (corr. coeff. 0.46, 95% CI 1.07-2.33, P=0.021) and favorable discharge disposition, discharge home (corr. coeff. 0.63, 95% CI 1.13-3.09, P=0.015). We found that ED patients are nested between ICU and intermediate care unit/floor originating transfers when comparing markers of decompensation (lactate, WBC count, SOFA score). At our academic center, patients who were transferred from other hospitals’ ED were less critically ill, had shorter HLOS, and lower mortality compared to patients from the ICU. We identified that SOFA score at admission was strongly associated with patients’ outcomes. It is important to not overlook the origin of a transfer when determining the needs of a patient. While awaiting future studies’ results, emergency physicians should use readily available scoring mechanisms like the SOFA score to further assess a patient’s risk of decompensation to facilitate earlier transfer to a higher-level care facility. Future research should analyze the contributing factors to patients’ decompensation and increased mortality following transfer to a higher care facility.

Quality of rural colonoscopy-A prospective single-centre pilot study.

Australian Journal of Rural HealthEarly View SHORT REPORT Quality of rural colonoscopy—A prospective single-centre pilot study Matthew M. Watson MS, Corresponding Author Matthew M. Watson MS matthew.mcmahon.watson@gmail.com orcid.org/0000-0002-9751-6200 Department of General Surgery, Mount Gambier and Districts Health Service, Mount Gambier, SA, Australia The Queen Elizabeth Hospital, University of Adelaide Discipline of Surgery, Woodville, SA, Australia Correspondence Matthew M. Watson, Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, SA 5011, Australia. Email: matthew.mcmahon.watson@gmail.comSearch for more papers by this authorGuy J. Maddern PhD, Guy J. Maddern PhD The Queen Elizabeth Hospital, University of Adelaide Discipline of Surgery, Woodville, SA, Australia Contribution: Conceptualization, Methodology, Writing - review & editingSearch for more papers by this authorTimothy K. McCullough FRACS, Timothy K. McCullough FRACS Department of General Surgery, Mount Gambier and Districts Health Service, Mount Gambier, SA, Australia Contribution: ​InvestigationSearch for more papers by this authorThomas Gunning FRACS, Thomas Gunning FRACS Department of General Surgery, Mount Gambier and Districts Health Service, Mount Gambier, SA, Australia Contribution: ​InvestigationSearch for more papers by this authorEben Beukes FRACS, Eben Beukes FRACS Department of General Surgery, Mount Gambier and Districts Health Service, Mount Gambier, SA, Australia Contribution: ​InvestigationSearch for more papers by this authorMatthias W. Wichmann FRACS, Matthias W. Wichmann FRACS Department of General Surgery, Mount Gambier and Districts Health Service, Mount Gambier, SA, Australia The Queen Elizabeth Hospital, University of Adelaide Discipline of Surgery, Woodville, SA, Australia Flinders University Rural Health South Australia, Flinders University, Adelaide, SA, Australia Contribution: Conceptualization, ​Investigation, Methodology, Writing - review & editingSearch for more papers by this author Matthew M. Watson MS, Corresponding Author Matthew M. Watson MS matthew.mcmahon.watson@gmail.com orcid.org/0000-0002-9751-6200 Department of General Surgery, Mount Gambier and Districts Health Service, Mount Gambier, SA, Australia The Queen Elizabeth Hospital, University of Adelaide Discipline of Surgery, Woodville, SA, Australia Correspondence Matthew M. Watson, Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, SA 5011, Australia. Email: matthew.mcmahon.watson@gmail.comSearch for more papers by this authorGuy J. Maddern PhD, Guy J. Maddern PhD The Queen Elizabeth Hospital, University of Adelaide Discipline of Surgery, Woodville, SA, Australia Contribution: Conceptualization, Methodology, Writing - review & editingSearch for more papers by this authorTimothy K. McCullough FRACS, Timothy K. McCullough FRACS Department of General Surgery, Mount Gambier and Districts Health Service, Mount Gambier, SA, Australia Contribution: ​InvestigationSearch for more papers by this authorThomas Gunning FRACS, Thomas Gunning FRACS Department of General Surgery, Mount Gambier and Districts Health Service, Mount Gambier, SA, Australia Contribution: ​InvestigationSearch for more papers by this authorEben Beukes FRACS, Eben Beukes FRACS Department of General Surgery, Mount Gambier and Districts Health Service, Mount Gambier, SA, Australia Contribution: ​InvestigationSearch for more papers by this authorMatthias W. Wichmann FRACS, Matthias W. Wichmann FRACS Department of General Surgery, Mount Gambier and Districts Health Service, Mount Gambier, SA, Australia The Queen Elizabeth Hospital, University of Adelaide Discipline of Surgery, Woodville, SA, Australia Flinders University Rural Health South Australia, Flinders University, Adelaide, SA, Australia Contribution: Conceptualization, ​Investigation, Methodology, Writing - review & editingSearch for more papers by this author First published: 08 September 2021 https://doi.org/10.1111/ajr.12751 This paper will be submitted as a short report. This paper is not based on previous communication to a society or meeting. This paper is not a recipient of a research scholarship. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Implementation of a Frailty Assessment and Targeted Care Interventions and Its Association with Reduced Postoperative Complications in Elderly Surgical Patients

Older patients with frailty syndrome have a greater risk of poor postoperative outcomes. In this study, we used a RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to implement an assessment tool to identify frail patients and targeted interventions to improve their outcomes. We implemented a 5-question frailty assessment tool for patients 65 years and older admitted to the general and vascular surgery services from January 1, 2018 to December 31, 2019. Identified frail patients received evidence-based clinical orders and nursing care plan interventions tailored to optimize recovery. A RE-AIM framework was used to assess implementation effectiveness through provider and nurse surveys, floor audits, and chart review. Of 1,158 patients included in this study, 696 (60.1%) were assessed for frailty. Among these, 611 patients (87.8%) scored as frail or intermediately frail. After implementation, there were significant increases in the completion rates of frailty-specific care orders for frail patients, including delirium precautions (52.1% vs 30.7%; p < 0.001), aspiration precautions (50.0% vs 26.9%; p < 0.001), and avoidance of overnight vitals (32.5% vs 0%). Floor audits, however, showed high variability in completion of care plan components by nursing staff. Multivariate analysis showed significant decreases in 30-day complication rates (odds ratio 0.532; p < 0.001) after implementation. A frailty assessment was able to identify elderly patients for provision of targeted, evidence-based frailty care. Despite limited uptake of the assessment by providers and completion of care plan components by nursing staff, implementation of the assessment and care interventions was associated with substantial decreases in complications among elderly surgical patients.