Generalized peritonitis secondary to typhoid ileal perforation: Assessment of severity using modified APACHE II score

BACKGROUND: Generalized peritonitis from typhoid ileal perforation is a common cause of surgical emergency in the developing countries, associated with high morbidity and mortality. The severity assessment of a disease condition is often useful to prioritise treatment and reduce morbidity and mortality. High severity scores are usually associated with high morbidity and mortality; therefore, these patients may require more intensive treatment than those with low severity scores. AIM: The purpose of this study was to assess the severity of generalized peritonitis from typhoid ileal perforation using modified APACHE II score. SETTING AND STUDY DESIGN: A teaching hospital unit serving the rural and semi-urban Nigerian community. It is a prospective study of patients with generalized peritonitis from typhoid ileal perforation. MATERIALS AND METHODS: Over a period of 7 years, patients had severity of illness assessed using modified APACHE II score. Demographic, clinical, preoperative, operative and postoperative data on each patient were entered into a prepared proforma. Each patient had postoperative outcome and severity of illness were compared to determine the significance of the severity of illness on postoperative outcome. RESULTS: The mean age was of 23.6 \ub1 15.5 years, with 4:1 male: female ratio. Morbidity rate ranged from 8.8-71.3% and mortality in 17.5%. Modified APACHE II score ranged from 0-19, with a mean of 8.2 \ub1 4, 7.6 \ub1 4 for survivors and 9.4 \ub1 2 in those who died. There was no death among the patients who scored 0-4, whereas mortality was 13% in those who scored 5-9, 41.2% in those who scored 10-14, and 50% in patients who scored 15-19 (P<0.05). The modified APACHE II Score significantly influenced mortality, but did not influence the incidence of other postoperative complications. CONCLUSION: A high APACHE II score was associated with high mortality, but did not predict morbidity rate in the patients studied. More study is needed involving a larger number of patients to further validate our findings

2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias

Emergency repair of complicated abdominal wall hernias may be associated with worsen outcome and a significant rate of postoperative complications. There is no consensus on management of complicated abdominal hernias. The main matter of debate is about the use of mesh in case of intestinal resection and the type of mesh to be used. Wound infection is the most common complication encountered and represents an immense burden especially in the presence of a mesh. The recurrence rate is an important topic that influences the final outcome. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013 with the aim to define recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel. In 2016, the guidelines have been revised and updated according to the most recent available literature.Peer reviewe

WSES guidelines for emergency repair of complicated abdominal wall hernias

Emergency repair of complicated abdominal hernias is associated with poor prognosis and a high rate of post-operative complications. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013, during the 2nd Congress of the World Society of Emergency Surgery with the goal of defining recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel

Complicated intra-abdominal infections in a worldwide context: an observational prospective study (CIAOW Study)

Peer reviewe

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Complicated intra-abdominal infections worldwide : the definitive data of the CIAOW Study

Peer reviewe

WSES guidelines for emergency repair of complicated abdominal wall hernias

Peer reviewe

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries