Underwent Emergency Surgery Research Articles

Comparison of the effects of femoral and axillary artery cannulation on ischemic cerebral injury in acute type A aortic dissection surgery: A retrospective study

Background: Acute Type A Aortic Dissection (ATAAD) is a life-threatening condition requiring emergency surgical intervention. This retrospective study evaluates the impact of femoral and axillary arterial cannulation techniques on ischemic neurological damage and mortality.Materials and Method: A total of 60 patients who underwent emergency surgery for ATAAD between 2016 and 2021 were analyzed. Patients were divided into two groups based on the arterial cannulation technique: Group A (axillary cannulation) and Group F (femoral cannulation). Preoperative, intraoperative, and postoperative variables were compared between the groups. The primary outcome was incidence of ischemic cerebral injury and secondary outcomes included 30-day all-cause mortality, intensive care unit and hospital length of stay and postoperative complications.Results: There were no statistically significant differences between the two groups in terms of ischemic cerebral injury (p=0.13). There was no significant difference in 30-day mortality between the groups (p= 0.27). Logistic regression analysis revealed that the cannulation type was a risk factor for ischemic cerebral injury development (OR [95% CI]; 119.034 [1.612–8791.314], p=0.029).Conclusions: Our findings indicate that the type of cannulation may be a risk factor for the development of ischemic cerebral injury. Further studies are needed to determine the optimal arterial cannulation technique for improving outcomes in ATAAD surgery.

Scheduled Surgery and Antibiotic Therapy in Catarrhal Acute Appendicitis

<i>Introduction: </i>Appendicitis is an acute inflammation of the appendix. Appendectomy remains one of the most frequently performed digestive surgeries in the world. The degree of urgency of this surgery and the increasingly proven efficacy of antibiotics still remains a debate. The main objectiveof our study is to compare the therapeutic results of a programmed appendectomy initially treated by antibiotic versus emergency appendectomies performed from the outset in casesof simple acute appendicitis. <i>Patients and method: </i>Our comparative study was carried out at the Joseph Ravoahangy Andrianavalona University Hospital from 01th August 2021 to 31th July 2022. Group A included simple acute appendicitis patients who underwent emergency surgery, while group B included patients who had been treated with antibiotics for ten days before undergoing surgery. <i>Results: </i>Our cohort of 95 patients comprised 70 patients (group A) versus 25 patients (group B). Twenty-three patients (92%) in group B had a Clavien-Dindo I score compared with 74.3% in group A. Parietal infections were 21% (group A) vs 4% (group B). There was no significant difference inpatient outcome between the two groups. <i>Conclusion: </i>Antibiotic therapy has already proved effective in the treatment of simple acute appendicitisin recent years, and means that emergency surgery can be avoided. However, the timingof surgery remains debatable in fragile patients.

Case Report: Acute Abdomen Due to Ruptured Ovarian Ectopic Pregnancy at 8 Weeks

Background Ovarian pregnancy is a rare type of ectopic pregnancy, accounting for 0.5% to 1% of all ectopic pregnancies, with an incidence ranging from 1 in 2,100 to 1 in 60,000 pregnancies. Due to its rarity and the lack of common risk factors, diagnosing ovarian pregnancy is often challenging and typically occurs during surgical exploration. Case Presentation We present the case of a 40-year-old woman who experienced severe pelvic pain, light vaginal bleeding, and 8 weeks of amenorrhea. Upon arrival at the hospital, she was hemodynamically unstable, with low blood pressure and a rapid heart rate. An ultrasound revealed an empty uterus, an irregular mass on her right ovary, and free fluid in the pelvis. Her beta-hCG level was elevated, and her hemoglobin level was low. Given the suspicion of an ectopic pregnancy, she underwent emergency surgery. During the operation, the surgical team discovered a large amount of clotted blood and a ruptured mass on her left ovary measuring 10 x 9.5 cm. Due to heavy bleeding, they performed a left oophorectomy and salpingectomy. Histopathological analysis later confirmed the diagnosis of ovarian pregnancy. Conclusion This case underscores the challenges in diagnosing ovarian pregnancy and highlights the necessity for prompt surgical intervention, particularly in unstable patients. Early detection and appropriate management are critical to prevent life-threatening complications.

Appendectomy for suspected appendicitis during pregnancy– a retrospective comparative study of 99 pregnant and 1796 non-pregnant women

IntroductionSuspected appendicitis is the most common indication for non-obstetric surgery during pregnancy. Diagnosis and management of these patients can be challenging. Atypical clinical presentation has been described before, but the current literature consists mostly of small case series. Therefore, we conducted a large retrospective study to analyze the frequency and diagnostic accuracy of clinical signs, laboratory findings and imaging modalities in pregnant woman undergoing surgery for suspected appendicitis compared to a control group of non-pregnant women of childbearing age. We further describe intra- and postoperative findings in both groups.MethodsData from consecutive patients who underwent appendectomy for suspected appendicitis during pregnancy were retrieved from the electronic patient database and analyzed. Preoperative clinical, laboratory and imaging findings as well as intra- and postoperative characteristics were compared between pregnant and non-pregnant women.ResultsBetween January 2008 and June 2023, 99 pregnant woman and 1796 non-pregnant woman between the ages of 16 and 49 underwent emergency surgery for suspected appendicitis. Pregnant women were less likely to have right lower quadrant tenderness (p = 0.002), guarding (p = 0.011) and rebound tenderness (p = 0.097). A greater percentage of pregnant women had a symptom duration of more than 24 h before presentation (p = 0.003) Abdominal ultrasound showed a reduced diagnostic accuracy in pregnant women (p = 0.004). MRI was used in eight pregnant women and showed a diagnostic accuracy of 100%. Pregnant women had a longer operating time (p = 0.006), a higher rate of open appendectomies or conversion (p < 0.001) and a longer postoperative hospital stay (3.2 days vs. 2.2 days, p < 0.001). The perforation rate was also higher in pregnant women at 16% vs. 10% (p = 0.048).ConclusionThe diagnosis of acute appendicitis during pregnancy presents a challenge for the clinician. Our data confirm the paradigm of “atypical presentation” which should lead to an extended diagnostic workup. Ultrasound showed less diagnostic accuracy in pregnant women in our study. MRI is a useful tool to reduce uncertainty and the rate of negative appendectomies.

C-reactive Protein/Albumin Ratio Predicts Short-term Postoperative Outcomes and Intraabdominal Abscess Formation in Colorectal Perforation.

This study aimed to investigate preoperative factors, including the C-reactive protein (CRP)/albumin ratio (CAR), associated with postoperative outcomes in patients with colorectal perforation who underwent emergency surgery to improve postoperative prognosis. Twenty-eight consecutive patients who underwent emergency surgery for colorectal perforations were included. We retrospectively investigated the clinical factors associated with their postoperative outcomes. The median patient age was 69.5 years (range, 46.0-93.0 years); 13 patients (46.4%) were males and 15 (53.6%) were females. Colorectal cancer (8 [28.6%]) was the most common cause of colorectal perforation. Postoperative complications were diagnosed in 18 patients (64.3%), with intraabdominal abscess as the most common (6 [21.4%]). Multivariate analysis revealed that CAR (odds ratio, 1.357; 95% confidence interval, 1.056-1.743; p=0.017) was an independent risk factor for postoperative complications. A cutoff value of 4.9 was selected to predict the development of postoperative complications based on the CAR. The proportion of all postoperative complications (p=0.016), postoperative complications of Clavien-Dindo classification grade II or higher (p=0.002), and death during hospitalization (p=0.049) were significantly higher in the group of patients with CAR ≥ 4.9 than in those with CAR < 4.9. Additionally, intraabdominal abscess (p=0.049) was significantly higher in the group of patients with a non-improvement in CAR on postoperative day 3 than in those with an improvement in CAR on postoperative day 3. Perioperative CAR could be a predictor of perioperative complications and death and might be useful in improving the postoperative prognosis of colorectal perforations.

Proctitis distal to colorectal anastomosis: a retrospective cohort study of an underreported complication after sigmoidectomy.

Proctitis distal to colorectal anastomosis is rare and infrequently reported. We evaluated the incidence, symptoms, treatment, and potential risk factors associated with this condition. We conducted a retrospective population-based cohort study in Västmanland County, Sweden. This investigation included all patients who underwent sigmoidectomy with colorectal anastomosis between 2008 and 2020. We excluded patients without an anastomosis and those with inflammatory bowel disease. Of the 546 patients identified, 233 fulfilled the inclusion criteria, of whom 26 (11.2%) developed proctitis distal to colorectal anastomosis. The most frequent symptoms included urgency (n=16, 61.5%), increased stool frequency (n=12, 46.2%), and anorectal pain (n=12, 46.2%). Endoscopic balloon dilation was performed in 20 cases (76.9%), with 10 requiring only a single therapeutic procedure. The median number of dilations was 3 (range, 1-8). Multivariable analysis revealed that surgery due to malignancy and emergency surgery were associated with elevated risk of proctitis. A subgroup analysis of patients who underwent surgery due to malignancy indicated that smoking (odds ratio, 3.9; 95% confidence interval, 1.1-14.0) and emergency surgery (odds ratio, 6.5; 95% confidence interval, 1.1-37.1) were also associated with increased proctitis risk. Proctitis distal to colorectal anastomosis is not uncommon following sigmoidectomy. Patients undergoing emergency surgery or surgery due to malignancy and who had a history of smoking displayed an increased risk of developing proctitis. Due to the paucity of symptoms observed, particularly in patients with a diverting stoma, routine endoscopic rectal examination should be performed during follow-up after sigmoidectomy.

Effects of Multimodal Analgesia Combined with Comfort Management on Pain and Stress Indexes in Patients with Orthopedic Trauma after Intervention: A Retrospective Study.

This study aims to assess the impact of combining multimodal analgesia with comfort care on pain levels, stress, negative emotions, and quality of life in individuals recovering from traumatic fractures. This retrospective study analyzed clinical data from traumatic fracture patients who underwent emergency operations at our hospital between June 2022 and February 2024. Patients were divided into two groups based on their postoperative pain management: the control group, which received standard measures, and the exposure group, which received a combination of multimodal analgesia and comfort-based care. We compared these groups for pain intensity (baseline and activity Visual Analog Scale (VAS) scores), serum stress biomarkers (norepinephrine, adrenaline, cortisol), emotional distress (self-rating depression scale (SDS), and the self-rating anxiety scale (SAS)), and overall quality of life (Comprehensive Quality of Life Assessment Questionnaire (GQOLI-74) score). Overall, this study evaluated differences in postoperative complications between the two pain management approaches. In this study, we included 101 participants, 41 in the exposed group and 60 in the control group. Before the intervention, baseline characteristics were similar between the two groups (p > 0.05). However, one week after the intervention, the resting and active VAS scores were significantly reduced in the exposed group than in the control group (p < 0.05). Furthermore, one week after the intervention, the exposed group had lower levels of serum sodium, epinephrine, cortisol, stress, and anxiety, as well as higher physical and mental health scores on the GQOLI-74 scale. During the intervention period, there was no significant difference in postoperative complications between the two groups (p > 0.05). Combining multi-mode analgesia with comfort management for patients with traumatic fractures significantly reduces postoperative pain and stress levels. Additionally, this approach can effectively enhance patients' negative emotions and improve their quality of life. This approach holds significant promise for practical use in clinical settings.

Analysis of the outcomes of postdiverticulitis investigations: a multicentre cohort study including 1,120 patients.

The aim of this study was to assess the yield of the endoscopic investigations performed following the resolution of acute diverticulitis. A retrospective multicentre study included patients with multislice computed tomography (MSCT)-proven diverticulitis, in four NHS hospitals, between January 2016 and April 2023. The primary outcome was the rate of colonic cancer in the diseased segment. Secondary outcomes included the rate of malignancy in the nondiseased colonic segments, the benign colonic polyp detection rate, the rate of malignancy in the resected surgical specimens in patients who underwent an emergency surgery on the index admission and the rate of complications in the investigated group. A total of 1,120 patients were included in the study, out of which 604 were females, with a median age of 61 years; 731 patients (65%) had uncomplicated diverticulitis (Hinchey 1A) while 389 (35%) had complicated diverticulitis (Hinchey 1B-4). Following the acute episode, 757 (74%) patients had subsequent endoscopic evaluation. The incidence of colorectal cancer (CRC) or advanced adenomas (AA) in patients with uncomplicated diverticulitis was 0.14%. In the complicated diverticulitis group, the incidence of CRC/AA in patients with Hinchey 1b and Hinchey 2 was 1.4% and 5.4%, respectively. Out of the 102 patients who underwent emergency colonic resection for suspected perforated diverticulitis, 18 (17.6%) had histological evidence of colonic malignancy. Endoscopic investigations following uncomplicated diverticulitis have a low yield for sinister colonic pathology. Colonoscopy should be planned following complicated diverticulitis and in patients with uncomplicated diverticulitis with suspicious radiological finding on index imaging or in patients with ongoing clinical manifestations. In patients who undergo emergency surgery, oncological principles should be applied whenever possible.

Machine Learning Approaches for the Prediction of Postoperative Major Complications in Patients Undergoing Surgery for Bowel Obstruction.

Performing emergency surgery for bowel obstruction continues to place a significant strain on the healthcare system. Conventional assessment methods for outcomes in bowel obstruction cases often concentrate on isolated factors, and the evaluation of results for individuals with bowel obstruction remains poorly studied. This study aimed to examine the risk factors associated with major postoperative complications. We retrospectively analyzed 99 patients undergoing surgery from 2015 to 2022. We divided the patients into two groups: (1) benign-related obstruction (n = 68) and (2) cancer-related obstruction (n = 31). We used logistic regression, KNN, and XGBOOST. We calculated the receiver operating characteristic curve and accuracy of the model. Colon obstructions were more frequent in the cancer group (p = 0.005). Operative time, intestinal resection, and stoma were significantly more frequent in the cancer group. Major complications were at 41% for the cancer group vs. 20% in the benign group (p = 0.03). Uni- and multivariate analysis showed that the significant risk factors for major complications were cancer-related obstruction and CRP. The best model was KNN, with an accuracy of 0.82. Colonic obstruction is associated with tumor-related blockage. Malignant cancer and an increase in C-reactive protein (CRP) are significant risk factors for patients who have undergone emergency surgery due to major complications. KNN could improve the process of counseling and the perioperative management of patients with intestinal obstruction in emergency settings.

Cisto do canal de Nuck: Um relato de caso

Introduction: Nuck canal cyst is a rare condition that occurs due to the patency of the vaginal process in women, manifesting as indirect inguinal hernia. Clinically, it presents as a tumor in the inguinal region, which can extend to the labia majora. Case report: we present a report of a young female patient who was admitted to the emergency room with severe pain associated with tumoration in the left inguinal and umbilical region, with suspected incarcerated umbilical and/or femoral hernia, having undergone emergency surgery. Conclusion: Due to the rarity of the case, little is known about it, since there are few reports in the literature, and therefore it is often undiagnosed.

Sekwencja szybkiej intubacji. Aktualny stan wiedzy

Rapid sequence intubation is a widely practiced method for handling the airway during anaesthesia induction in patients with gastric problems or those susceptible to regurgitation or aspiration. Preparation involves gathering essential equipment and medications for emergency intubation, including oxygen, suction, bag-valve mask, laryngoscope, endotracheal tubes with stylets, resuscitation gear, and rescue tools. Despite its consistent use for over five decades, debates persist regarding the efficacy of specific elements of the method, such as cricoid pressure and the assessment of fasting in urgent surgical cases. The absence of standardised rapid sequence intubation techniques and universally accepted guidelines has resulted in discrepancies in published data. Cricoid pressure, also known as the Sellick manoeuvre, is a controversial element of rapid sequence intubation that has both supporters and critics. While it has been used for decades and is recommended by many countries to prevent pulmonary aspiration during anaesthesia, recent research has raised questions about its effectiveness. In patients undergoing emergency surgery, ultrasound of the gastric antrum may help evaluate the size of gastric contents in order to minimise the risk of aspiration pneumonia. Techniques and variants of anaesthetic induction in the rapid sequence intubation algorithm should be adapted to a wide range of clinical groups – particularly in children, obese patients and pregnant women. In paediatric anaesthesia and for obese patients, the traditional rapid sequence intubation with apnoea is not commonly used due to their limited respiratory reserve. Despite its numerous side effects, succinylcholine remains the most frequently employed drug for rapid sequence intubation.

Assessment of diagnostic value of ultrasound and multi-slice spiral computed tomography in acute appendicitis: a retrospective study.

Ultrasound and multi-slice spiral computed tomography (CT) are frequently used to assist the diagnosis of acute appendicitis (AA), and the examination results may vary among different demographics. This study aimed to compare the diagnostic accuracy of ultrasound and CT for AA. We performed a retrospective analysis of patients diagnosed with AA who underwent emergency surgery at our hospital from March 2021 to August 2023, with postoperative pathological results as the gold standard. Differences in the diagnostic accuracy of ultrasound and CT for different types of AA, age groups, and body mass index (BMI) values were then analyzed. The overall sample comprised 279 confirmed cases of AA, with 64 cases of simple appendicitis, 127 cases of suppurative appendicitis, and 88 cases of gangrenous appendicitis. For these three pathological classifications, the diagnostic accuracy of ultrasound was 68.75% (44/64), 73.22% (93/127), and 81.81% (72/88), respectively, while the diagnostic accuracy of CT was 71.87% (46/64), 82.67% (105/127), and 90.90% (80/88), respectively. There was no statistically significant difference in the overall diagnostic accuracy between the two methods (P > 0.05). Subgroup analysis showed no difference in diagnostic accuracy between the two methods for patients with normal BMI (P > 0.05). However, for overweight, obese, and elderly patients, CT provided significantly better diagnostic accuracy than ultrasound (P < 0.05). While ultrasound and CT have similar diagnostic accuracy for different pathological types of AA, CT is more accurate for overweight, obese, and elderly patients.

Association of neutrophil-to-lymphocyte ratio with age and 180-day mortality after emergency surgery

BackgroundTo examine the relationship between neutrophil-to-lymphocyte ratio (NLR), age, and mortality rates after emergency surgery.MethodsIn this observational study, a total of 851 patients undergoing emergency surgery between January 2022 and January 2023 were retrospective examined. Using 30 and 180 days mortality data, NLR differences and receiver operating characteristic (ROC) curves were analyzed using a 65-year threshold. A multiple logistic regression model was constructed incorporating age and NLR. Finally, Kaplan–Meier curves were constructed for mortality.ResultsAmong 851 patients, the 30 and 180 days mortality rates were 5.2% and 10.8%, respectively. Median NLR in 30 days was 5.6 (3.1 to 9.6) in survivors and 8.7 (4.6 to 13.4) in deceased patients (p < 0.0001); in 180 days, it was 5.5 (3.1 to 9.8) and 8.8 (4.8 to 14.5), respectively (p < 0.0001). In the 30- and 180-days mortality analyses, median NLRs were 5.1 (2.9 to 8.9) and 4.9 (2.9 to 8.8) in survivors and 10.6 (6.9 to 16.6) and 9.3 (5.4 to 14.9) in deceased patients aged < 65 years, respectively. The ROC AUC in patients younger than 65 years was higher for 30 days (AUC 0.75; 95% CI 0.72 to 0.87) and 180 days (AUC 0.73; 95% CI 0.64 to 0.81). Multivariate logistic regression revealed that the NLR (odds ratio, 1.03 [95% CI 1.005 to 1.053; p = 0.0133) and age (odds ratio, 1.05 [95% CI 1.034 to 1.064; p < 0.0001) significantly contributed to the model. Survival analysis revealed differences in the 180 days mortality (p = 0.0006).ConclusionWe observed differences in preoperative NLR between patients who survived and those who died after emergency surgery. Age impacts the use of NLR as a mortality risk factor.Trial registrationNCT06549101, retrospectively registered.

Epidemiological analysis of a 10-year retrospective study of pediatric trauma in intensive care

Pediatric trauma plays a crucial role in pediatric mortality, with traffic injuries and falls frequently cited as leading causes of significant injuries among children. A comprehensive investigation, including geographical factors, is essential for developing effective strategies to prevent injuries and alleviate the burden of pediatric trauma. This study involved a retrospective analysis of clinical data from pediatric patients admitted to our hospital’s intensive care unit (ICU) due to trauma over a 10-year period. Comprehensive analyses were conducted to elucidate trends, demographics, injury patterns, and risk factors associated with these admissions. This retrospective study included 951 pediatric patients (mean age: 4.79 ± 3.24 years; mean weight: 18.45 ± 9.02 kg; median time to ICU admission post-injury: 10.86 ± 14.95 h). Among these patients, 422 (44.4%) underwent emergency surgery, and 466 (49%) required mechanical ventilation support, with a mean duration of 70.19 ± 146.62 h. The mean duration of ICU stay was 6.24 ± 8.01 days, and the overall mean hospitalization duration was 16.08 ± 15.56 days. The predominant cause of unintentional injury was traffic accidents (47.9%), followed by falls (42.5%) and burns/scalds (5.3%). Most incidents involved children aged 0–6 years (70.7%), with males comprising 60.0% of patients. Injury incidents predominantly occurred between 12 and 6 PM (44.5%) and on non-workdays (37.6%). The most common locations where injuries occurred were roadsides (49%) and rural areas (64.35%). Single-site injuries (58.78%) were more prevalent than multiple-site injuries (41.22%), and head injuries were the most common among single-site injuries (81.57%). At ICU admission, the mean injury severity score was 18.49 ± 8.86. Following active intervention, 871 patients (91.59%) showed improvement, while 80 (8.41%) succumbed to their injuries. Traffic injuries remain the primary cause of pediatric trauma leading to ICU admission, underscoring the importance of using appropriate child restraint systems and protective gear as fundamental preventive measures. The increased incidence of injuries among children aged < 6 years and those residing in rural areas highlights the need for targeted preventive strategies, necessitating tailored interventions and public policy formulations that address these high-risk populations.

Improving risk models for patients having emergency bowel cancer surgery using linked electronic health records: a national cohort study

ObjectiveTo investigate whether accuracy of a risk model for colorectal cancer (CRC) patients undergoing emergency surgery, including patient and tumour characteristics from disease-specific data, was improved by inclusion of physiological and surgical measures from linked treatment-specific data. ApproachLinked, routinely-collected data on patients undergoing emergency CRC surgery in England between December 2016 and November 2019 were used to develop a risk model for 90-day mortality. Backwards selection identified a 'selected model' of physiological and surgical measures in addition to patient and tumour characteristics. Model performance was assessed compared to a 'basic model' including only patient and tumour characteristics. Missing data was multiply imputed. Results846 of 10,578 (8.0%) patients died within 90 days of surgery. The selected model included seven pre-operative physiological and surgical measures (pulse rate, systolic blood pressure, breathlessness, sodium, urea, albumin, and predicted peritoneal soiling), in addition to the ten patient and tumour characteristics in the basic model (year of surgery, age, sex, ASA grade, cancer site, number of comorbidities, emergency admission, TNM T stage, N stage and M stage). The selected model had considerably better discrimination than the basic model (C-statistic: 0.824 versus 0.783, respectively). ConclusionLinkage of disease-specific and treatment-specific datasets allowed the inclusion of physiological and surgical measures in a risk model alongside patient and tumour characteristics, which improved the accuracy of predictions. ImplicationsOur new accurate and relatively simple risk prediction model for patients undergoing emergency CRC surgery will allow more accurate performance monitoring of healthcare providers and enhance clinical care planning.

SP1.10 - Patient Perceptions of Shared Decision-Making in Emergency Surgery

Abstract Background Shared decision-making (SDM), a concept becoming increasingly more prevalent in medical practice, is now considered the ‘gold standard’ approach. Research into patient perceptions of SDM is lacking and barriers to its implementation remain, specifically in emergency general surgery. Considering procedures with high mortality risks makes research into patients understanding of SDM here a critical step for its implementation. Aim Explore what emergency surgery patients understand about SDM and their experience of it. Methods A literature review and scoping review determined the quantity and quality of research in this area enabling long-listing of known SDM concepts. This developed questions and structured discussions for the patient and public involvement (PPI) exercise. This exercise was developed following research, patient representative input and discussions with experienced researchers. Twenty-five participants, identified from the local ELLSA database, were invited with their support-person. Small-group discussions considered how surgeons make decisions, what SDM means to patients, and improving this process. Responses were transcribed, then analysed. Results Nine patients and four supporters attended the exercise. Thematic analysis identified two key themes: patient perceptions of how surgeons make decisions, and patient experiences of emergency surgical decision-making. Subtheme analysis showed participants weren’t aware of surgeons’ use of “30-day mortality” and couldn’t quantify surgical risk, feeling time pressures and out-of-control. They relied on surgeons to make their decision. Conclusions Patients who’ve undergone emergency surgery don’t understand how surgeons make emergency surgical decisions. Many reported not experiencing SDM at all. This work provides the first patient-insights into an area requiring more research – on a larger scale.

WP5.5 - Investigating the Optimal Timing for Definitive Treatment in Sigmoid Volvulus: A Retrospective Cohort Study

Abstract Aims The evidence base is replete of guidance on the optimal timing for definitive surgical management of acute sigmoid volvulus (ASV), with limited understanding or long-term outcomes for those managed conservatively. This study aimed to assess the management and outcomes of this understudied patient population. Methods A retrospective cohort study was conducted in a UK tertiary centre between January 2018 and December 2022. Results 69 patients presented with ASV (54M:15F, age 73.7 SD +/- 15.0 years). The median number of acute admissions per patient was 2 (IQR 1-4.5), with 29 patients (42.0%) presenting only once. 44 patients (63.8%) were managed conservatively. Of those patients, 22 (50.0%) were readmitted within the study period. 25 patients (26.2%) underwent operative management, with 18 (72.0%) of these patients undergoing emergency surgery (6 during their index admission, 33.3%). Elective surgical management was performed in 7 patients after an average of 3 previous admissions. All-cause mortality amongst the cohort was 47.8% (n=33), with a median life span of 1.1 years from index admission (IQR 0.3-2.6); 24.0% in the operative group (5 acute, 1 elective) versus 61.4% in the conservatively managed group. Conservatively managed patients were at greater odds of mortality compared to acutely operated patients (OR 4.129, 95% CI 1.25-13.67, p=0.02) and electively operated patients (OR 9.529, 95% CI 1.05-86.20, p=0.045). Acute operations had no significant greater odds of mortality compared to elective operations (p=0.49). Conclusions Conservative management of ASV was associated with greater odds of all-cause mortality compared to patients who received an operation. Operations performed in the acute setting had no greater mortality odds than in the elective setting.

Risk Factors for Postoperative Major Morbidity, Anastomotic Leakage, Re-Surgery and Mortality in Patients with Colonic Perforation.

Background/Objectives: This study aimed to determine the risk factors associated with postoperative major morbidity, anastomotic/suture leakage, re-surgery and mortality in patients undergoing emergency surgery for colonic perforation. Methods: A total of 204 adult patients treated surgically for colonic perforation from 2016 to 2021 at the University Hospital Erlangen were included in a retrospective analysis. Patient demographics and pre-, intra- and postoperative parameters were obtained and evaluated among various outcome groups (in-hospital major morbidity, anastomotic/suture leakage, re-surgery and 90-day mortality). Results: Postoperative in-hospital major morbidity, anastomotic/suture leakage, need of re-surgery and 90-day mortality occurred in 45%, 12%, 25% and 12% of the included patients, respectively. Independent risk factors for in-hospital major morbidity were identified and included the presence of any comorbidity, a significantly reduced preoperative general condition, the localization of perforation in the right hemicolon and the need for an intraoperative blood transfusion. The only independent risk factor for anastomotic/suture leakage was the presence of any comorbidity, whereas no independent risk factors for re-surgery were found. An age > 65 years, a significantly reduced preoperative general condition and the need for an intraoperative blood transfusion were independent risk factors for 90-day mortality. Conclusions: Our study identified risk factors impacting postoperative outcomes in patients undergoing emergency surgery for colonic perforation. These patients should receive enhanced postoperative care and may benefit from individualized and targeted therapeutic approaches.

Neuraxial anesthesia for non-neurological emergency surgery in a patient with acute ischemic stroke: a case report

BackgroundThe recent guidelines recommend delaying elective non-neurological surgery after an index stroke, but there is a lack of consensus regarding emergency surgery in patients with a recent stroke. Impaired cerebral autoregulation and altered baroreceptor function elevate the risk of recurrent stroke in this group. Moreover, the impact of anesthesia type (general vs. regional) for non-cardiovascular, non-neurological surgery in patients with an index stroke remains inconclusive.Case presentationA 67-year-old male with an acute mild ischemic stroke underwent emergency surgery for an obstructed right-sided direct inguinal hernia under combined spinal-epidural anesthesia. Pre-operative assessment showed stable hemodynamics, and perioperative measures were taken to ensure stable blood pressure. Neuraxial anesthesia was employed successfully, and the patient remained hemodynamically stable throughout the surgery and postoperative period. No neurological deficits were observed post-surgery, and follow-up up to 3 months revealed no cognitive impairment or neurological decline.ConclusionsNeuraxial anesthesia can be considered for patients with acute mild strokes requiring urgent non-neurological surgery, provided they are hemodynamically stable and without coagulopathy. However, the choice of anesthesia should be individualized based on factors such as neurological status, stroke severity, coagulation, and existing disabilities. This case highlights the importance of a personalized approach to anesthesia in emergency surgery for stroke patients.

A New Self-Expandable Metallic Stent with Low Axial Force and a High Axial Force Zero-Border Shows a Very Low Perforation Rate in Malignant Colorectal Obstruction: A Japanese Multicenter Prospective Study.

Background: Recently, there has been a significant increase in the utilization of self-expandable metallic stents (SEMSs) for treating malignant colorectal obstructions through colorectal stenting. The mechanical properties of SEMSs are usually considered to affect clinical outcomes of patients with malignant colorectal obstructions. Methods: This single-arm, prospective, multicenter study of SEMS with a lower axial force and high axial force zero-border included 200 patients with malignant colorectal obstruction. Technical and clinical success, stent patency, and adverse events associated with SEMS placement were evaluated. Results: One patient was excluded, and 199 patients were evaluated. The treatment intent was bridge-to-surgery in 129 and palliation in 70 patients. Technical and clinical success rates were 99.5% and 97.0%, respectively. The percentage of the ColoRectal Obstruction Scoring System scores of 3 or higher improved significantly from 19.2% before placement to 93.9% after placement. Clinical success was not achieved in five patients due to insufficient stent expansion in four patients and stent occlusion in one patient. Only one patient underwent emergency surgery for perforation of the proximal colon, far from where the stent was placed; the rescue procedure was not performed, despite no improvement in proximal dilatation due to insufficient stent expansion. Among the palliation cohort, 15 patients received chemotherapy, including molecular-targeted agents such as bevacizumab. There were no fatal cases related to stent placement. Conclusions: For management of malignant colorectal obstruction, this newly developed SEMS with low axial force and a high axial force zero-border showed high technical and clinical success rates, and an extremely low perforation rate (0.5%).