Urgent Surgeries Research Articles

A pregnant lady with compound bowel obstruction managed with thoracic epidural as sole anesthesia in a resource-restricted setting: a case report

BackgroundPreserving the mother’s safety, sustaining the pregnancy state, and achieving the optimal fetal outcome are the major priorities when managing obstetric patients for non-obstetric surgery. Only necessary and urgent surgeries are carried out during pregnancy due to the effects of anesthesia and surgery on the fetus. Compound bowel obstruction (small and large bowel obstruction) is rare, especially during the third trimester of pregnancy. Besides this, the procedure (laparotomy) was done with awake opioid-based thoracic epidural anesthesia as the sole anesthesia. This case report of awake laparotomy for major abdominal surgery is the first of its kind with an excellent feto-maternal outcome.Case presentationA 30-year-old African pregnant lady presented to the emergency department with a chief complaint of abdominal pain and vomiting for an 8-hour duration; associated with this, she had a history of blurred vision, lightheadedness, loss of appetite, low-grade fever, and constipation. Later, she was diagnosed with large bowel obstruction and underwent an emergency laparotomy, managed with a thoracic epidural sole anesthesia.ConclusionA multidisciplinary team approach is greatly recommended to safeguard a sufficient standard of care for both the mother and fetus. The provision of regional anesthesia for patients with high risks in perioperative periods is crucial for a better postoperative outcome. We have confidence that thoracic epidural anesthesia can be used as another anesthetic option for major abdominal surgery in a resource-restricted setting for patients who are expected to have a significant risk of perioperative adverse events under general anesthesia.

Association between preoperative blood pressure and outcomes in cardiac surgery: results of a prospectively planned cohort study.

It is unknown whether unwitnessed BP (UBP) measurement or ambulatory BP (ABP) monitoring improves the prediction of adverse events estimated by risk scores. We intended to study associations between preoperative BP measured through these two methods and the incidence of adverse outcomes in patients undergoing cardiac surgery. We included a cohort of 167 patients undergoing elective or urgent cardiac surgeries. Preoperative BP was measured by UBP and 24-hour ABP. Primary outcome was the combination of mortality from any cause, nonfatal myocardial infarction, nonfatal stroke, new hospital admission, and dialysis occurring within 30 days after surgery. The associations between preoperative BP and surgical outcomes were tested using the chi-square test and Analysis of Variance. A generalized linear model with a logistic link function and a robust estimator was used to adjust for the EuroScore-II risk estimation. The incidence of the primary outcome increased in parallel with the quartiles of the 24-hour ABP in participants submitted to CABG: 10% in the first quartile, 13% in the second, 37% in the third, and 53% in the fourth quartile (P for trend<0.01). Quartiles of overnight ABP were also significantly associated with postoperative complications in patients undergoing CABG (P=0.04). The risks in CABG patients were independent of the EuroScore-II. There was no association between BP and outcomes in patients submitted to other surgeries. High preoperative BP measured by ABP monitoring is a risk factor for postoperative complications in patients submitted to CABG.

Pregnancy outcomes in patients with portal cavernoma: A case series study.

Non-cirrhotic portal vein cavernoma (PVC) is a cause of portal hypertension (PH) frequently affecting women of childbearing age. Cavernous transformation of the portal vein is frequently associated with prothrombotic disorders and often entails multiple hemodynamic changes, porto-collateral shunt development and thrombopenia, all of which can affect the course of pregnancy. Our aim was to evaluate the risk of PH-related complications and pregnancy outcomes in patients with PVC. Retrospective case series study of patients with PVC undergoing pregnancy in a tertiary care hospital. Eight pregnancies fulfilled the eligibility criteria. All patients had a predisposing factor for PVC. One episode of variceal bleeding was reported at week 28. Six cesarean sections were scheduled to avoid labor while two urgent surgeries were indicated due to fetal distress and intrauterine growth restriction (IUGR). In all but one case, anticoagulation was prescribed after delivery. No hemorrhagic or thrombotic complications were reported. There were four cases of IUGR with no case of miscarriage or stillbirth. Pregnancy in patients with PVC has an overall favorable outcome albeit a higher risk of PH-derived complications, and IUGR may be expected. Hence, PVC must not be considered a contraindication for pregnancy although larger prospective studies are necessary.

Colecistectomias - análise dos casos operados em dois anos em um hospital escola: um estudo transvesal retrospectivo

Objectives: To select all cholecystectomies performed in the last two years, to analyze the epidemiological profile of patients and compare cases of elective or emergency surgery regarding the need for drainage, reoperation, incidence of postoperative complications and complications of the surgical wound. Materials and methods: 942 cholecystectomies were performed at Hospital Universitário Evangélico Mackenzie in Curitiba between 01/01/2018 and 12/31/2019. The data obtained were analyzed by graphs and frequency tables. For association calculations, ANOVA, Man-Whitney and chi- square tests were performed. Significance adopted: 5%. Results: Of the operated patients, 75.9% are women. On average, patients were 48.2 years old. Urgent surgeries were performed in 34.9% of patients, while elective surgeries occurred in 65.1% of cases. There was a greater need for placement of an abdominal drain in urgent procedures (p = 0.001). There was a greater need for reoperation in patients who needed an abdominal drain in the first surgery (p = 0.004). There were also more complications in the postoperative period in patients operated urgently (p = 0.004). There was even more complication in the postoperative period of patients who required a drain placement (p = 0.001). There was a greater need for reoperation in patients with postoperative complications (p = 0.001). There were more complications at the surgical wound of patients who underwent reoperation (p = 0.001). Conclusion: Patients undergoing elective surgery evolve with less need for drainage, postoperative complications, reoperation and complications of the surgical wound.

Value Assessment of Trauma Patients Who Underwent Urgent Surgical Procedures over a 12-Year Period at an Academic Health System

Abdelmasseh, Michael; Cuaranta, Araceli Dalma MD; Thompson, Errington C MD, FACSFCCM; Finley, Robert K III MD, FACS; Payne, Barbara RN, OCN, CCRP; Willis, Jonathan M MS; Kadiyala, Vineela MSCS; Sanabria, Juan R MD, MSc, FRCSC, FACS, FAASLD; Surgical Outcomes Team Author Information

Aortic Root Replacement Surgery-A Center Experience with Biological Valve Prostheses.

Outcomes after surgical aortic root replacement using different valved conduits are rarely reported. The present study shows the experience of a single center with the use of the partially biological LABCOR (LC) conduit and the fully biological BioIntegral (BI) conduit. Special attention was paid to preoperative endocarditis. All 266 patients who underwent aortic root replacement by an LC conduit (n = 193) or a BI conduit (n = 73) between 01/01/2014 and 31/12/2020 were studied retrospectively. Dependency on an extracorporeal life support system preoperatively and congenital heart disease were exclusion criteria. For patients with (n = 67) and without (n = 199) preoperative endocarditis subanalyses were made. Patients treated with a BI conduit were more likely to have diabetes mellitus (21.9 vs. 6.7%, p < 0.001), previous cardiac surgery (86.3 vs. 16.6%; p < 0.001), permanent pacemaker (21.9 vs. 2.1%; p < 0.001), and had a higher EuroSCORE II (14.9 vs. 4.1%; p < 0.001). The BI conduit was used more frequently for prosthetic endocarditis (75.3 vs. 3.6%; <0.001), and the LC conduit was used predominantly for ascending aortic aneurysms (80.3 vs. 41.1%; <0.001) and Stanford type A aortic dissections (24.9 vs. 9.6%; p = 0.006). The LC conduit was used more often for elective (61.7 vs. 47.9%; p = 0.043) and emergency (27.5 vs. 15.1%; p = 0-035) surgeries, and the BI conduit for urgent surgeries (37.0 vs. 10.9%; p < 0.001). Conduit sizes did not differ significantly, with a median of 25 mm in each case. Surgical times were longer in the BI group. In the LC group, coronary artery bypass grafting and proximal or total replacement of the aortic arch were combined more frequently, whereas in the BI group, partial replacement of the aortic arch were combined. In the BI group, ICU length of stay and duration of ventilation were longer, and rates of tracheostomy and atrioventricular block, pacemaker dependence, dialysis, and 30-day mortality were higher. Atrial fibrillation occurred more frequently in the LC group. Follow-up time was longer and rates of stroke and cardiac death were less frequent in the LC group. Postoperative echocardiographic findings at follow-up were not significantly different between conduits. Survival of LC patients was better than that of BI patients. In the subanalysis of patients with preoperative endocarditis, significant differences between the used conduits were found with respect to previous cardiac surgery, EuroSCORE II, aortic valve and prosthesis endocarditis, elective operation, duration of operation, and proximal aortic arch replacement. For patients without preoperative endocarditis, significant differences were observed concerning previous cardiac surgery, pacemaker implantation history, duration of procedure, and bypass time. The Kaplan-Meier curves for the subanalyses showed no significant differences between the used conduits. Both biological conduits studied here are equally suitable in principle for complete replacement of the aortic root in all aortic root pathologies. The BI conduit is often used in bail-out situations, especially in severe endocarditis, without being able to show a clinical advantage over the LC conduit in this context.

A propensity score-matched retrospective cohort study of hysterectomies for benign disease during the COVID-19 pandemic.

This study aimed to evaluate how the pandemic might have affected the number of elective and urgent hysterectomies for benign gynecological pathologies in a single-care tertiary center in the State of São Paulo, Brazil, and to identify if there were any changes in the need for blood transfusions. This is a single-center retrospective cohort study. It involved all non-puerperal and non-oncological hysterectomies from October 2018 to July 2021. Patients were divided into two groups, namely, the pandemic group (46 patients) and the control group (92 patients). Data were collected by reviewing the physical and electronic patient records. We carried out the statistical analysis using the RStudio software. The number of planned hysterectomies was 82 in the pre-pandemic group and 23 in the analysis group, representing a 71.9% decrease. When considering only urgent surgeries, 10 of them happened in the pre-pandemic group, while 23 occurred in the pandemic group, representing an increase of 130%. Elective hysterectomies may improve the quality of life of women, reducing abnormal bleeding and pelvic pain. Treatment delay can worsen patients' physiological and biological conditions, such as lower labor production, humor, and social aspects, increasing costs to the healthcare system.

Immediate Results after Multiple Arterial Grafts in Coronary Artery Bypass Graft Surgery in the São Paulo State: Cross Cohort Study.

The short-term results after using arterial grafts still raise questions and doubts for medical society. To compare the immediate outcomes of patients undergoing single arterial graft versus multiple arterial grafts coronary artery bypass grafting surgery. Cross-sectional cohort study in the São Paulo Registry of Cardiovascular Surgery II (REPLICCAR II). Perioperative data from 3122 patients were grouped by the number of arterial grafts used, and their outcomes were compared: reoperation, deep sternal wound infection (DSWI), stroke, acute kidney injury, prolonged intubation (>24 hours), short hospital stay (<6 days), prolonged hospital stay (>14 days), morbidity and mortality. Propensity Score Matching (PSM) matched 1062 patients, adjusted for the mortality risk. After PSM, the single arterial graft group showed patients with advanced age, more former smokers, hypertension, diabetes, stable angina, and previous myocardial infarction. In the multiple arterial grafts, there was a predominance of males, recent pneumonia, and urgent surgeries. After the procedure, there was a higher incidence of pleural effusion (p=0.042), pneumonia (p=0.01), reintubation (p=0.006), DSWI (p=0.007), and sternal debridement (p=0.015) in the multiple arterial grafts group, however, less need for blood transfusion (p=0.005), extremity infections (p=0.002) and shorter hospital stays (p=0.036). Bilateral use of the internal thoracic artery was not related to increased DSWI rate, but glycosylated hemoglobin >6.40% (p=0.048). Patients undergoing the multiarterial technique had a higher incidence of pulmonary complications, and DSWI, where glycosylated hemoglobin ≥6.40%, had a greater influence on the infectious outcome than the choice of grafts.

Efecto de la pandemia de COVID-19 en pacientes no COVID-19 que ingresan por Guardia en el Servicio de Cirugía, durante la fase estricta de la pandemia en Buenos Aires. Un estudio de cohorte.

Background: Emergency general surgery conditions require immediate evaluation and timely resolution, even during quarantine. Objective: to analyze variations in admissions, surgical outcomes and severity of the disease in nonCOVID-19 emergency admissions during the first months of the pandemic. Secondary objectives, to performed a sub-analysis of common surgical conditions, as appendicitis, biliary tract disease, diverticulitis and complicated tumors. Material and methods: An observational, ambispective study was carried out on a prospective cohort of patients who consulted with on-call surgical pathology and required hospitalization from March 20th, 2020 until July 31, 2020 referred to as Pandemic Group (PG), analyzed and compared with the same period of 2019, Control Group (CG). Results: We experienced an increase in the number of patients admitted at the ED during the pandemic PG vs CG (346 versus 305, p 0.157). Patients in the PG were found to be significantly more ill (58.1% versus 48,8%, p 0.018). A significant delay was found globally in both, time from onset of symptoms presentation to consultation (48 hours versus 24 hours, p &lt; 0.001), and time from diagnosis to surgery (23 hours versus 7 hours, p &lt; 0.001) in the PG, and an increase in the mean operative time (75 versus 60 minutes, p= 0,001). There was no significant difference in postoperative complications. Conclusion: During the pandemic we observed an increase in urgent surgical procedures due to biliary pathology and gastrointestinal tumors. The patients consulted with more advanced stages of disease, but this had no impact on postoperative morbidity or mortality, demonstrating that it was possible to maintain surgical outcomes despite delayed consultation.

SURGICAL EMERGENCY IN INFANTS AND TODDLERS WITH ABDOMINAL AND MEDIASTINAL LYMPHATIC MALFORMATIONS

Background. Lymphatic malformations of thoracic and abdominal cavities can remain asymptomatic for a long time and can be revealed accidentally within examination for other medical reason. At the same time, the disease debut can manifest as critical condition requiring emergency surgical care. The aim of the study is to detect the life-threatening complications of thoracic and abdominal cavities LMs that require urgent surgical procedures. Materials and methods. 17 patients with LMs of thoracic cavity and 38 patients with LMs of abdominal cavity are included into the study. All patients underwent in-hospital treatment in Ohmatdyt specialized children’s hospital in a period since 2012 to 2021. Results. Visceral cavities were affected by LMs in 22.9% cases. Minimally invasive technologies were used in uncomplicated LMs, laparoscopic resection, which was performed in 22 (78.6%) patients, sclerotherapy (n=6; 15.8%) and mTOR inhibitors systemic therapy in one clinical case (2.6%). Planned laparotomy or conversion to open surgery was performed in 9 (23.7%) patients. One child underwent emergency laparotomy – a newborn with LM affecting bowel and mesentery, which developed total mesentery thrombosis. Treatment options applied in thoracic cavity LMs treatment were repetitive sclerotherapy procedures in 7 (36,8%), and a combination pf surgical resection and sclerotherapy in 6 (31,6%) cases. 4 (21,1%) patients required emergency surgeries, including pleural drain for chylothorax (n=1), and thoracotomy with LM resection (n=3) in patients with rapid LM volume increase resulted from intracystic hemorrhage following inflammation. Complicated LMs occurred in patients aged from 1 to 14 months.Conclusions. The highest risk of life-threatening complications in patients with visceral cystic LMs was observed during two first years of life. Indications for emergency surgery were mesenteric thrombosis in a child with abdominal LM and intrathoracic tension syndrome in children with mediastinal LMs.

Stardust Pattern as Evolution of Pigmented Spitz Nevi During Childhood.

Spitz nevi (SN) are benign melanocytic proliferations frequently occurring in children. Some pigmented SN with a starburst pattern evolve into the "stardust" one, which is characterized by a central, black to gray, hyperpigmented area and remnants of a brown network at the periphery. These dermoscopy changes are often the first alert to induce excision. The aim of this study is to enlarge the case series of stardust SN in children, in order to increase confidence with this new dermoscopic pattern and reduce unnecessary excisions. This retrospective observational study was conducted with SN cases received from IDS members. The inclusion criteria were: clinical and/or histopathologic diagnosis of Spitz naevus with starburst appearance in children <12 years old, availability of a dermoscopic image at baseline and after follow-up of at least 1 year, availability of patient data. The dermoscopic images and their changes over time were assessed by three evaluators in consensus. 38 SN were enrolled, with a median age of 7 years and a median FUP duration of 15,5 months. Comparing the evolution with time of FUP, no significant differences were found between growing and involuting lesions in terms of patient age and sex, location and palpability of lesions. The long follow-up reported in our study could really support the concept of benignity of changing SN. A conservative approach is acceptable for nevi showing the stardust pattern, because it may be considered a physiological evolution of pigmented Spitz nevus, and urgent surgeries could be avoided.

A distractions capture tool for cardiac surgery and lung transplantation: impact on outcomes

ObjectivesSurgical distractions are associated with worse patient outcomes. Lung transplantation and cardiac surgery’s multi-disciplinary nature, and their inherent complexities render them more vulnerable to distractions. We aim to use a novel distractions capture tool to evaluate the severity of distractions during cardiac surgery (CS) and lung transplantation (LTx) and assess its impact on post-operative complications.MethodsA prospective ‘blinded’ study was undertaken by direct observation of distractions during CS and LTx. Events were identified using the Imperial College Error Capture tool (ICECAP). Number and severity of distractions were correlated with post-operative outcomes (ICU & hospital stay, bleeding and anastomotic complications).ResultsIn LTx, we observed 2059 distractions within 287 h across 41 surgeries. In CS, we observed 1089 distractions within 192 h across 62 surgeries. Surgeons were consciously aware of 19.2% (LTx) and 21.3% (CS) of recorded events. Distractions consisted of procedure-independent pressures (61% LTx vs 56% CS), equipment problems (15% LTx vs 23%CS), communication (12% LTx vs 12% CS), technical problems or patient safety concerns (12% LTx vs 9% CS). In CS, 91% of procedure-independent pressures were non-operative distractions whilst LTx recorded 83%. Staff absences at a critical moment of surgery were recorded at 9% (LTx) and 7% (CS). The number and severity of distractions correlated with bleeding (CS p < 0.001, LTx p < 0.01), prolonged ICU stay (CS p = 0.002, LTx p = 0.002), hospital stay (CS p < 0.001) and anastomotic complications(LTx p < 0.03).ConclusionsICECAP as a novel surgical distractions capture tool was effective & applicable to both elective cardiac and urgent transplant surgeries. Surgeons were unaware of a large number of distractions & interruptions. Distractions were associated with longer ICU stay and higher rate of bleeding.

Coronary disease and aortopathy in achondroplasia

Introduction. Achondroplasia is an inherited autosomal dominant disorder and the most prevalent cause of dwarfism in humans. Case Report. A 38-year-old male with achondroplasia required cardiothoracic surgical treatment. Standing at 150 cm, weighing 68 kg, with a body surface area index of 1.68 m?, he had a history of diagnosed hypertension and Chiari malformation. A transthoracic echocardiogram five years ago revealed mild aortic regurgitation. In the recent cardiac examination, moderate-to-severe aortic regurgitation, dilation of the Valsalva sinus, and coronary artery disease were observed. The elective cardiothoracic surgery included mechanical aortic valve replacement and myocardial revascularization with a single bypass. Histopathological analysis of the aortic wall indicated mucoid degeneration, atherosclerosis, and focal adventitial hemorrhages. The postoperative course was uneventful, and normal blood pressure values were confirmed with a Holter monitor. Conclusion. A comprehensive cardiac evaluation is crucial for patients with achondroplasia, emphasizing the significance of considering echocardiographic parameters in the context of anthropometric characteristics. The proficiency and readiness of adult physicians to consistently provide accurate diagnosis and treatment, especially in urgent interventions or surgical procedures, are essential.

Impact of the COVID-19 Pandemic on Access to Cancer Surgery: Analysis of Surgical Wait Times in British Columbia, Canada.

As coronavirus disease 2019 (COVID-19) spread, efforts were made to preserve resources for the anticipated surge of COVID-19 patients in British Columbia, Canada. However, the relationship between COVID-19 hospitalizations and access to cancer surgery is unclear. In this project, we analyze the impact of COVID-19 patient volumes on wait time for cancer surgery. We conducted a retrospective study using population-based datasets of regional surgical wait times and COVID-19 patient volumes. Weekly median wait times for urgent, nonurgent, cancer, and noncancer surgeries, and maximum volumes of hospitalized patients with COVID-19 were studied. The results were qualitatively analyzed. A sustained association between weekly median wait time for priority and other cancer surgeries and increase hospital COVID-19 patient volumes was not qualitatively discernable. In response to the first phase of COVID-19 patient volumes, relative to pre-COVID-19 pandemic levels, wait time were shortened for urgent cancer surgery but increased for nonurgent surgeries. During the second phase, for all diagnostic groups, wait times returned to pre-COVID-19 pandemic levels. During the third phase, wait times for all surgeries increased. Cancer surgery access may have been influenced by other factors, such as policy directives and local resource issues, independent of hospitalized COVID-19 patient volumes. The initial access limitations gradually improved with provincial and institutional resilience, and vaccine rollout.

Endovascular aortic repair with Cardiatis® multilayer flow modulator in a patient undergone ascending aortic replacement for type I aortic dissection

Aortic dissection and aneurysms are one of the most important life-threatening diseases. After ascending aortic replacement, one of the life-saving urgent surgeries for Type I aortic dissection, aneurysmatic dilatation is usually observed in the remaining portions of the aorta over time. Open surgical repair for these patients still carries a 30% mortality rate despite improvements in open surgical methods, graft materials, and technological options. Endovascular repair provides promising results in high-risk patients. A 72-year-old female patient who underwent ascending aortic replacement for type 1 aortic dissection 9 years ago was admitted to our clinic with the diagnosis of symptomatic aneurysmal dilatation in the thoracic and abdominal aortic segments. We present this case in which we used the Cardiatis® Multilayer Flow Modulator stent to conduct endovascular repair.

Gallbladder wall thickness adversely impacts the surgical outcome.

To evaluate surgical outcomes of patients with gallbladder wall thickness (GBWT) > 5 mm. Patients who underwent cholecystectomy were classified into two groups according to their GBWT status (GBWT+ vs. GBWT-). Among 1,211 patients who underwent cholecystectomy, GBWT+ was seen in 177 (14.6%). The GBWT+ group was significantly older with more males, higher ASA score, higher alkaline phosphatase level, higher international normalized ratio, and lower albumin level than the GBWT- group. On ultrasound, GBWT+ patients had larger stone size, more pericholecystic fluid, more common bile duct stone, and more biliary pancreatitis. Compared with the GBWT- group, the GBWT+ group had more urgent surgeries (12.4% vs. 3.2%, p = 0.001), higher conversion rate (4.5% vs. 0.3%, p = 0.001), prolonged operative time (67 ± 38 vs. 54 ± 29 min; p = 0.001), more bleeding (3.4% vs. 0.5%, p = 0.002), and more need of drain (21.5% vs. 10.5%, p = 0.001). By multivariate analysis, factors associated with increased length of hospital stay were GBWT+ (HR: 1.97, 95% CI: 1.19-3.25, p = 0.008), urgent surgery (HR: 10.2, 95% CI: 4.07-25.92, p = 0.001), prolonged surgery (HR: 1.01, 95% CI: 1.0-1.02, p = 0.001), and postoperative drain (HR: 11.3, 95% CI: 6.40-20.0, p = 0.001). Variables such as GBWT ≥ 5 mm, urgent prolonged operation, and postoperative drains are independent predictors of extended hospital stay. GBWT+ patients are twice likely to stay in hospital for more than 72 hours and more prone to develop complications than GBWT- patients.

Changes in Elective and Urgent Surgery Among TRICARE Beneficiaries During the COVID-19 Pandemic.

COVID-19 is known to have altered the capacity to perform surgical procedures in numerous health care settings. The impact of this change within the direct and private-sector settings of the Military Health System has not been effectively explored, particularly as it pertains to disparities in surgical access and shifting of services between sectors. We sought to characterize how the COVID-19 pandemic influenced access to care for surgical procedures within the direct and private-sector settings of the Military Health System. We retrospectively evaluated claims for patients receiving urgent and elective surgical procedures in March-September 2017, 2019, and 2020. The pre-COVID period consisted of 2017 and 2019 and was compared to 2020. We adjusted for sociodemographic characteristics, medical comorbidities, and region of care using multivariable Poisson regression. Subanalyses considered the impact of race and sponsor rank as a proxy for socioeconomic status. During the period of the COVID-19 pandemic, there was no significant difference in the adjusted rate of urgent surgical procedures in direct (risk ratio, 1.00; 95% CI, 0.97-1.03) or private-sector (risk ratio, 0.99; 95% CI, 0.97-1.02) care. This was also true for elective surgeries in both settings. No significant disparities were identified in any of the racial subgroups or proxies for socioeconomic status we considered in direct or private-sector care. We found a similar performance of elective and urgent surgeries in both the private sector and direct care during the first 6 months of the COVID-19 pandemic. Importantly, no racial disparities were identified in either care setting.

ERECTOR SPINAE PLANE BLOCK CATHETER: A GOAL STANDARD FOR THORACIC ANAESTHESIA?

<h3>Background</h3> Recent advances in Enhanced Recovery post Thoracic surgery has introduced various fascial plane blocking techniques that block dorsal, lateral, and anterior cutaneous nerves of the thorax and abdomen. Erector spinae plane (ESP) block is a relatively novel truncal nerve plane block increasing used in thoracic analgesia. Blockage of dorsal and ventral rami of the thoracic nerves allows for effective pain management post open thoracotomies and video assisted thoracic surgery. Due to limitation by duration of action of single shot nerve blocks,(paravertebral and ESP block), continuous pain relief using catheters have been widely used with good patient outcome. <h3>Method</h3> Patients undergoing elective and urgent thoracic surgeries under general anaesthesia in a single thoracic and trauma unit in the United Kingdom were appropriately selected based on comorbidities, performance status, and indication plus duration of thoracic surgery. Retrospective data on single shot nerve block injections and patient-controlled analgesia (PCA) use was collected for fifty patients. Prospectively, ESP catheter was inserted in fifty patients by consultant anaesthetist or thoracic surgeon pre procedure and post routine intraoperative anaesthesia care and multimodal analgesia. We compared total opioid consumption, postoperative pain scores (visual analog scale), mobility with physiotherapy, complications, and length of stay. <h3>Results</h3> Forty patients were included in both groups. Five cases were removed due to incomplete data. Total opioid consumption over 24 hours and 48 hours was measured. Total opiod consumption was significantly low in patients receiving continuous ESP catheters. Pain score was lower in the recovery and post operative ward in patients with ESP catheters. Pain nurse review in ESP catheter group day 1 postoperatively allowed for better optimisation of analgesia, improved adherence to documentation of acute pain observation chart. ESP catheter did not affect physiotherapy care and patients completed 100m in less than 48 hours. There was no statistically significant difference in adverse effects between single shot vs catheter patients, however, increased PCA use in single shot blocks contributed to post operative drowsiness and nausea in five patients. <h3>Conclusion</h3> ESP catheter has shown to provide safe and effective analgesia post thoracic surgery while decreasing opioid consumption. We could demonstrate a significant improvement in patient outcome, with the ESP catheters when compared to single shot blocks. Early physiotherapy and good analgesics provided early mobilization and less days in hospital stay and reduced complications. On account of technical ease and low procedural risk of ESP block under ultrasound guidance, it is favorable for use in thoracic surgery compared to more invasive nerve blocks. More education, compliance and multimodal care is required to utilize ESP catheter for successful postoperative pain management.

The impact of the COVID-19 pandemic on ectopic pregnancy presentation and treatment: A retrospective cohort study

ObjectiveWe examined ectopic pregnancy (EP) incidence, presentation and management, before and during the COVID-19 pandemic, and following initiation of vaccination against COVID-19. Study designIn a single-center retrospective cohort study, we compared incidence, presentation and management of EP, between 98 women who presented during the pandemic (March 1 2020 to August 31, 2021), and 94 women diagnosed earlier (March 1 2018 to August 31, 2019). Sub-periods before and after introduction of the vaccination were compared. ResultsAge and parity were similar between the periods. For the pandemic compared to the earlier period, the median gestational age at EP presentation was higher (6.24 ± 1.25 vs. 5.59 ± 1.24, P<0.001), and the proportions were higher of symptomatic women (42.9% vs. 27.7%, p = 0.035) and urgent laparoscopies (42.9% vs. 24.5%, p = 0.038). In a multivariable linear model, women who presented during the pandemic were more likely to undergo an urgent laparoscopy [OR 2.30, 95%CI (1.20–4.41)], P = 0.012. In urgent surgeries performed during the pandemic compared to the earlier period, the proportion of women with a hemoglobin drop >2 gr/dL was greater (60% vs. 30%, p = 0.024). Statistically significant differences were not found in sonographic or laboratory findings, in rupture or massive hemoperitoneum rates, or in the need for blood transfusion in urgent laparoscopy. Outcomes were similar before and after introduction of vaccinations. ConclusionDuring the pandemic, and even after the introduction of vaccination, women with EP were more likely to undergo urgent surgery, and blood loss was greater. This is likely due to delayed diagnosis.

P-107 DOES BARBED SUTURE REDUCE THE RATE OF EVISCERATIONS IN EMERGENCY MIDLINE LAPAROTOMIES?

Abstract Introduction Evisceration is a frequent consequence after performing midline laparotomies (ML) in urgent abdominal surgeries. The aim of this study was to compare and evaluate the results obtained after the introduction of barbed sutures in abdominal wall closure. Materials and methods We performed a retrospective analysis of patients undergoing emergency surgery in our hospital following a midline laparotomy approach in the last 5 years. Preoperative variables were compared between both groups and related to early surgical wound complications, depending on the type of abdominal wall closure performed. Results 222 patients underwent surgery (Polydioxanone (P); 128; Barbed (B); 94) after ruling out exclusion factors such as neuromuscular disease, recent abdominal surgeries and whose follow-up had been lost. There were no significant differences between the two groups in terms of preoperative baseline characteristics or associated comorbidities. Furthermore, there were no statistically significant differences in type of surgery performed; the most frequent was small bowel obstruction. After data analysis, no differences were found in terms of hospital stay (P; 7.43 days vs B; 6.05 days, p=0.421) or mortality (P; 3.125% vs B; 4.25, p=0.655). Concerning immediate complications, there were no differences regarding surgical wound infection (P; 18.75% vs B; 10.63%, p=0.061) and seroma (P; 3.125% vs B; 2.12, p=0.651). Evisceration rates turned out to be more frequent in the polydioxanone group (P; 20.31% vs B; 8.51%, p=0.016). Conclusions The use of barbed sutures reduced the incidence of evisceration, therefore it can be considered as recommended sutures for aponeurotic closure in emergent ML.