Étude Comparative des Modalités de la Price en Charge Périopératore Nutritionnelle Lors de la Chirurgie Digestive à Soissons (France) et à Tanambao (Madagascar)

L’état nutritionnel d’un individu influence sur sa morbi-mortalité périopératoire. Les complications postopératoires sont en augmentation jusqu’à 72% chez les patients présentant une dénutrition en périopératoire contre 29% chez ceux qui ne le sont pas. Le taux de mortalité en périopératoire de chirurgie digestive chez les sujets dénutris va jusqu’à 29%.  Objectif : Comparer les modalités de prise en charge nutritionnelle périopératoire de chirurgie digestive dans les centres hospitaliers de Soissons (France) et de Tanambao (Madagascar). Patients et méthode : Il s’agit d’une étude observationnelle prospective sur douze mois (mai 2018 à avril 2019). Les patients bénéficiant d’une chirurgie digestive par voie laparotomie médiane ont été inclus. Le test de Mann Whitney était utilisé pour la comparaison des variables portant sur les caractéristiques de la population d’étude, la prise en charge nutritionnelle périopératoire et la durée d’hospitalisation (XLSTAT® 2019.4.2). Une valeur de p inférieur à 0,05 était significative.  Résultats : Quarante-sept patients âgés de 63 [32- 100] ans ont été retenus à Soissons et 43 patients, âgés de 45 [18- 79] ans, à Tanambao. La population d’étude était à prédominance masculine (sex ratio = 1,5 à Soissons et 2,1 à Toliara). La durée du jeûne préopératoire (<2h versus ≥6h ; p<0,001), l’apport protéino-énergétique préopératoire (<25 kcal/kg/j versus sans apport ; p= 0,041 et apport protéique <1 g/kg/j versus sans apport ; p<0,001), l’apport protéino-énergétique postopératoire ([25- 30 Kcal/kg/j versus <25 Kcal/kg/j ; p<0,001 et apport protéique [1- 1,5 g/kg/j versus <1 g/kg/j ; p<0,001) et la durée d’hospitalisation (10j versus 14j ; p<0,001) étaient différents entre les deux centres hospitaliers. Le grade nutritionnel (GN 2, p= 0,244) et la morbi-mortalité étaient comparables entre les deux centres hospitaliers (absence de complications, p= 0,817). Conclusion : L’état nutritionnel périopératoire constitue l’un des déterminants d’une réhabilitation postopératoire optimale. La prescription du support nutritionnel et du jeûne préopératoire devrait être en fonction du grade nutritionnel et doit couvrir les besoins nutritionnels quotidiens.  A Soissons (France), mais aussi à Tanambao (Madagascar), cette prise en charge nutritionnelle reste à améliorer suivant les recommandations. L’état nutritionnel d’un individu influence sur sa morbi-mortalité périopératoire. Les complications postopératoires sont en augmentation jusqu’à 72% chez les patients présentant une dénutrition en périopératoire contre 29% chez ceux qui ne le sont pas. Le taux de mortalité en périopératoire de chirurgie digestive chez les sujets dénutris va jusqu’à 29%.   Objectif : Comparer les modalités de prise en charge nutritionnelle périopératoire de chirurgie digestive dans les centres hospitaliers de Soissons (France) et de Tanambao (Madagascar). Patients et méthode : Il s’agit d’une étude observationnelle prospective sur douze mois (mai 2018 à avril 2019). Les patients bénéficiant d’une chirurgie digestive par voie laparotomie médiane ont été inclus. Le test de Mann Whitney était utilisé pour la comparaison des variables portant sur les caractéristiques de la population d’étude, la prise en charge nutritionnelle périopératoire et la durée d’hospitalisation (XLSTAT® 2019.4.2). Une valeur de p inférieur à 0,05 était significative.  Résultats : Quarante-sept patients âgés de 63 [32- 100] ans ont été retenus à Soissons et 43 patients, âgés de 45 [18- 79] ans, à Tanambao. La population d’étude était à prédominance masculine (sex ratio = 1,5 à Soissons et 2,1 à Toliara). La durée du jeûne préopératoire (<2h versus ≥6h ; p<0,001), l’apport protéino-énergétique préopératoire (<25 kcal/kg/j versus sans apport ; p= 0,041 et apport protéique <1 g/kg/j versus sans apport ; p<0,001), l’apport protéino-énergétique postopératoire ([25- 30 Kcal/kg/j versus <25 Kcal/kg/j ; p<0,001 et apport protéique [1- 1,5 g/kg/j versus <1 g/kg/j ; p<0,001) et la durée d’hospitalisation (10j versus 14j ; p<0,001) étaient différents entre les deux centres hospitaliers. Le grade nutritionnel (GN 2, p= 0,244) et la morbi-mortalité étaient comparables entre les deux centres hospitaliers (absence de complications, p= 0,817). Conclusion :L’état nutritionnel périopératoire constitue l’un des déterminants d’une réhabilitation postopératoire optimale. La prescription du support nutritionnel et du jeûne préopératoire devrait être en fonction du grade nutritionnel et doit couvrir les besoins nutritionnels quotidiens.  A Soissons (France), mais aussi à Tanambao (Madagascar), cette prise en charge nutritionnelle reste à améliorer suivant les recommandations.   Background: The nutritional state of a patient impacts on perioperative morbidity and mortality. Postoperative complications are up to 72% in patients with perioperative undernutrition against 29% against those who do not present undernutrition. The mortality rate in perioperative digestive surgery in malnourished subjects is up to 29%. Aim: To compare the modalities of perioperative nutritional management of digestive surgery in the hospitals of Soissons and Tanambao. Patients and methods: This is a prospective observational study over 12 months (May 2018 to April 2019). Patients undergoing digestive surgery via midline laparotomy were included. The Mann Whitney test was used to compare variables relating to the characteristics of the study population, perioperative nutritional management and length of hospital stay (XLSTAT® 2019.4.2). A p- value of less than 0,05 was considered significant. Results: Forty- seven patients aged 63 [32- 100] years old were retained in Soissons while the study population was 43 (aged 45 [18- 79] years old) in Tanambao. The study population was mostly male (sex ratio = 1,5 in Soissons and 2,1 in Toliara). The duration of the preoperative fast (<2h versus ≥6h ; p<0,001), the preoperative protein-energy intake (<25 kcal/kg/day versus no intake ; p= 0,041 and energy intake <1 g/kg/day versus no intake ; p<0,001), the postoperative protein-energy intake ([25- 30 kcal/kg/day versus <25 kcal/kg/day ; p<0,001 and and energy intake [1- 1,5  g/kg/day versus <1 g/kg/day ; p<0,001), and length of hospitalization (10 days versus 14 days ; p<0,001) were different between the two hospitals. The nutritional grade (NG 2, p= 0,244) and morbidity and mortality were comparable between the two groups (absence of complications, p= 0,817). Conclusion: Perioperative nutritional status is one of the elements of good postoperative rehabilitation. The prescription of nutritional support and preoperative fasting should be according to nutritional grade and should cover daily nutritional needs

Étude Comparative des Modalités de la Prise en Change Périopératoire Nutritionnelle Lors de la Chirurgie Digestive à Soissons (France) et à Tanambao (Madagascar)

L’état nutritionnel d’un individu influence sa morbi-mortalité périopératoire. Les complications postopératoires sont en augmentation jusqu’à 72% chez les patients présentant une dénutrition en périopératoire contre 29% chez ceux qui ne le sont pas. Le taux de mortalité périopératoire en chirurgie digestive chez les sujets dénutris va jusqu’à 29%.  Objectif : Comparer les modalités de prise en charge nutritionnelle périopératoire en chirurgie digestive dans les centres hospitaliers de Soissons (France) et de Tanambao (Madagascar). Patients et méthode : Il s’est agi d’une étude observationnelle prospective sur douze mois (mai 2018 à avril 2019). Les patients bénéficiant d’une chirurgie digestive par voie laparotomique médiane ont été inclus. Le test de Mann Whitney était utilisé pour la comparaison des variables portant sur les caractéristiques de la population d’étude, la prise en charge nutritionnelle périopératoire et la durée d’hospitalisation (XLSTAT® 2019.4.2). Une valeur de p inférieur à 0,05 était significative.  Résultats : A Soissons, 47 patients âgés de 63 [32- 100] ans ont été inclus, à prédominance masculine (sex ratio = 1,5). Le jeûne préopératoire était de 8 heures [4- 18]. Dix-huit patients (38,3%) ont bénéficié d’un support nutritionnel pendant 4 jours [2- 14]. En postopératoire, les patients ont bénéficié d’un support nutritionnel durant 8 jours [1- 29]. L’alimentation entérale en postopératoire a été reprise au 6ème jour [1- 13]. Huit patients ont présenté des complications dont un décédé. La durée totale d’hospitalisation était de 10 jours [5- 29]. A Tanambao, 43 patients étaient inclus, âgés de 45 [18- 79] ans. La classe 1 et 2 de l’ASA étaient respectivement à 37,2% et à 39,5%. Le jeûne préopératoire durait 10 heures [3- 18]. Neuf patients ont reçu un support nutritionnel préopératoire pendant 3 jours [1- 7]. En postopératoire, l’alimentation entérale a été autorisée au 7ème jour [2- 14], un support nutritionnel était administré pendant 8 jours [3- 15]. Les patients restaient à l’hôpital pendant 15 jours [6- 30]. Conclusion : L’état nutritionnel périopératoire constitue l’un des déterminants d’une réhabilitation postopératoire optimale. La prescription du support nutritionnel et du jeûne préopératoire devrait être en fonction du grade nutritionnel et doit couvrir les besoins nutritionnels quotidiens.  A Soissons (France), mais aussi à Tanambao (Madagascar), cette prise en charge nutritionnelle reste à améliorer suivant les recommandations.   Background: The nutritional state of a patient impacts on perioperative morbidity and mortality. Postoperative complications are up to 72% in patients with perioperative undernutrition against 29% against those who do not present undernutrition. The mortality rate in perioperative digestive surgery in malnourished subjects is up to 29%. Aim: To compare the modalities of perioperative nutritional management of digestive surgery in the hospitals of Soissons and Tanambao. Patients and methods: This is a prospective observational study over 12 months (May 2018 to April 2019). Patients undergoing digestive surgery via midline laparotomy were included. The Mann Whitney test was used to compare variables relating to the characteristics of the study population, perioperative nutritional management and length of hospital stay (XLSTAT® 2019.4.2). A p- value of less than 0,05 was considered significant. Results: In Soissons, 47 patients aged 63 [32-100] years were included, predominantly male (sex ratio = 1.5). The preoperative fast was 8 hours [4-18]. Eighteen patients (38.3%) received nutritional support for 4 days [2-14]. Postoperatively, patients received nutritional support for 8 days [1-29]. Postoperative enteral feeding was resumed on the 6th day [1-13]. Eight patients presented complications, one of which died. The total duration of hospitalization was 10 days [5-29]. In Tanambao, 43 patients were included, aged 45 [18-79] years. ASA class 1 and 2 were at 37.2% and 39.5% respectively. The preoperative fast lasted 10 hours [3-18]. Nine patients received preoperative nutritional support for 3 days [1-7]. Postoperatively, enteral feeding was authorized on the 7th day [2-14], nutritional support was administered for 8 days [3-15]. The patients stayed in the hospital for 15 days [6-30]. Conclusion: Perioperative nutritional status is one of the elements of good postoperative rehabilitation. The prescription of nutritional support and preoperative fasting should be according to nutritional grade and should cover daily nutritional needs

Étude Comparative des Modalités de la Price en Charge Périopératore Nutritionnelle Lors de la Chirurgie Digestive à Soissons (France) et à Tanambao (Madagascar)

L’état nutritionnel d’un individu influence sur sa morbi-mortalité périopératoire. Les complications postopératoires sont en augmentation jusqu’à 72% chez les patients présentant une dénutrition en périopératoire contre 29% chez ceux qui ne le sont pas. Le taux de mortalité en périopératoire de chirurgie digestive chez les sujets dénutris va jusqu’à 29%.  Objectif : Comparer les modalités de prise en charge nutritionnelle périopératoire de chirurgie digestive dans les centres hospitaliers de Soissons (France) et de Tanambao (Madagascar). Patients et méthode : Il s’agit d’une étude observationnelle prospective sur douze mois (mai 2018 à avril 2019). Les patients bénéficiant d’une chirurgie digestive par voie laparotomie médiane ont été inclus. Le test de Mann Whitney était utilisé pour la comparaison des variables portant sur les caractéristiques de la population d’étude, la prise en charge nutritionnelle périopératoire et la durée d’hospitalisation (XLSTAT® 2019.4.2). Une valeur de p inférieur à 0,05 était significative.  Résultats : Quarante-sept patients âgés de 63 [32- 100] ans ont été retenus à Soissons et 43 patients, âgés de 45 [18- 79] ans, à Tanambao. La population d’étude était à prédominance masculine (sex ratio = 1,5 à Soissons et 2,1 à Toliara). La durée du jeûne préopératoire (<2h versus ≥6h ; p<0,001), l’apport protéino-énergétique préopératoire (<25 kcal/kg/j versus sans apport ; p= 0,041 et apport protéique <1 g/kg/j versus sans apport ; p<0,001), l’apport protéino-énergétique postopératoire ([25- 30 Kcal/kg/j versus <25 Kcal/kg/j ; p<0,001 et apport protéique [1- 1,5 g/kg/j versus <1 g/kg/j ; p<0,001) et la durée d’hospitalisation (10j versus 14j ; p<0,001) étaient différents entre les deux centres hospitaliers. Le grade nutritionnel (GN 2, p= 0,244) et la morbi-mortalité étaient comparables entre les deux centres hospitaliers (absence de complications, p= 0,817). Conclusion : L’état nutritionnel périopératoire constitue l’un des déterminants d’une réhabilitation postopératoire optimale. La prescription du support nutritionnel et du jeûne préopératoire devrait être en fonction du grade nutritionnel et doit couvrir les besoins nutritionnels quotidiens.  A Soissons (France), mais aussi à Tanambao (Madagascar), cette prise en charge nutritionnelle reste à améliorer suivant les recommandations. L’état nutritionnel d’un individu influence sur sa morbi-mortalité périopératoire. Les complications postopératoires sont en augmentation jusqu’à 72% chez les patients présentant une dénutrition en périopératoire contre 29% chez ceux qui ne le sont pas. Le taux de mortalité en périopératoire de chirurgie digestive chez les sujets dénutris va jusqu’à 29%.   Objectif : Comparer les modalités de prise en charge nutritionnelle périopératoire de chirurgie digestive dans les centres hospitaliers de Soissons (France) et de Tanambao (Madagascar). Patients et méthode : Il s’agit d’une étude observationnelle prospective sur douze mois (mai 2018 à avril 2019). Les patients bénéficiant d’une chirurgie digestive par voie laparotomie médiane ont été inclus. Le test de Mann Whitney était utilisé pour la comparaison des variables portant sur les caractéristiques de la population d’étude, la prise en charge nutritionnelle périopératoire et la durée d’hospitalisation (XLSTAT® 2019.4.2). Une valeur de p inférieur à 0,05 était significative.  Résultats : Quarante-sept patients âgés de 63 [32- 100] ans ont été retenus à Soissons et 43 patients, âgés de 45 [18- 79] ans, à Tanambao. La population d’étude était à prédominance masculine (sex ratio = 1,5 à Soissons et 2,1 à Toliara). La durée du jeûne préopératoire (<2h versus ≥6h ; p<0,001), l’apport protéino-énergétique préopératoire (<25 kcal/kg/j versus sans apport ; p= 0,041 et apport protéique <1 g/kg/j versus sans apport ; p<0,001), l’apport protéino-énergétique postopératoire ([25- 30 Kcal/kg/j versus <25 Kcal/kg/j ; p<0,001 et apport protéique [1- 1,5 g/kg/j versus <1 g/kg/j ; p<0,001) et la durée d’hospitalisation (10j versus 14j ; p<0,001) étaient différents entre les deux centres hospitaliers. Le grade nutritionnel (GN 2, p= 0,244) et la morbi-mortalité étaient comparables entre les deux centres hospitaliers (absence de complications, p= 0,817). Conclusion :L’état nutritionnel périopératoire constitue l’un des déterminants d’une réhabilitation postopératoire optimale. La prescription du support nutritionnel et du jeûne préopératoire devrait être en fonction du grade nutritionnel et doit couvrir les besoins nutritionnels quotidiens.  A Soissons (France), mais aussi à Tanambao (Madagascar), cette prise en charge nutritionnelle reste à améliorer suivant les recommandations.   Background: The nutritional state of a patient impacts on perioperative morbidity and mortality. Postoperative complications are up to 72% in patients with perioperative undernutrition against 29% against those who do not present undernutrition. The mortality rate in perioperative digestive surgery in malnourished subjects is up to 29%. Aim: To compare the modalities of perioperative nutritional management of digestive surgery in the hospitals of Soissons and Tanambao. Patients and methods: This is a prospective observational study over 12 months (May 2018 to April 2019). Patients undergoing digestive surgery via midline laparotomy were included. The Mann Whitney test was used to compare variables relating to the characteristics of the study population, perioperative nutritional management and length of hospital stay (XLSTAT® 2019.4.2). A p- value of less than 0,05 was considered significant. Results: Forty- seven patients aged 63 [32- 100] years old were retained in Soissons while the study population was 43 (aged 45 [18- 79] years old) in Tanambao. The study population was mostly male (sex ratio = 1,5 in Soissons and 2,1 in Toliara). The duration of the preoperative fast (<2h versus ≥6h ; p<0,001), the preoperative protein-energy intake (<25 kcal/kg/day versus no intake ; p= 0,041 and energy intake <1 g/kg/day versus no intake ; p<0,001), the postoperative protein-energy intake ([25- 30 kcal/kg/day versus <25 kcal/kg/day ; p<0,001 and and energy intake [1- 1,5  g/kg/day versus <1 g/kg/day ; p<0,001), and length of hospitalization (10 days versus 14 days ; p<0,001) were different between the two hospitals. The nutritional grade (NG 2, p= 0,244) and morbidity and mortality were comparable between the two groups (absence of complications, p= 0,817). Conclusion: Perioperative nutritional status is one of the elements of good postoperative rehabilitation. The prescription of nutritional support and preoperative fasting should be according to nutritional grade and should cover daily nutritional needs

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Epidemiology and survival of colon cancer among Egyptians: a retrospective study

Introduction: Colorectal cancer is the 4th commonest cancer in the world. Studies had shown different tumor behavior depending on the site, pathology and stage. However the characters of Egyptian colon cancer patients are not well addressed. Method: Computerized registry of a tertiary cancer hospital in Egypt was searched for colon cancer cases. Demographic, pathologic and treatment data were collected and analyzed using SPSS program. Results: About 360 colon cancer patients attended our center in the last 12 years. Tumor characters showed great diverse from that of developed countries, with especially different prognosis and survival. Conclusion: Egyptians have unique tumor characters and behavior, and different compliance with treatment regimens. Multicenter prospective studies, as well as evolving Egyptian treatment guidelines are needed to address this. Resumo: Introdução: Câncer colorretal é a quarta neoplasia mais comum a nível mundial. Estudos demonstraram diferentes comportamentos do tumor, dependendo do local, da patologia e do estágio. Contudo, ainda não estão devidamente definidas as características dos pacientes egípcios com câncer de cólon. Métodos: Foi realizada pesquisa no registro computadorizado de um hospital terciário para pacientes com câncer, à busca de casos de câncer de cólon. Foi feita coleta de dados demográficos, patológicos e terapêuticos. Tais dados foram então submetidos à análise com o programa SPSS. Resultados: Nos últimos 12 anos, cerca de 360 pacientes portadores de câncer de cólon foram atendidos em nosso Centro. As características dos tumores demonstraram grandes diferenças em comparação com os achados de países desenvolvidos e, em especial, com relação ao prognóstico e à sobrevida. Conclusão: Os egípcios exibem características e comportamentos singulares com relação aos tumores, além de diferentes graus de cooperação com os regimes terapêuticos. Para que tais aspectos sejam sanados, há necessidade de mais estudos prospectivos multicêntricos, bem como de um aprimoramento das diretrizes terapêuticas para os egípcios. Keywords: Colon cancer, Registry, Incidence, Survival, Recurrence, Palavras-chave: Câncer de cólon, Registro, Incidência, Sobrevida, Recorrênci

coMpliAnce with evideNce-based cliniCal guidelines in the managemenT of acute biliaRy pancreAtitis): The MANCTRA-1 international audit

Background/objectives: Reports about the implementation of recommendations from acute pancreatitis guidelines are scant. This study aimed to evaluate, on a patient-data basis, the contemporary practice patterns of management of biliary acute pancreatitis and to compare these practices with the recommendations by the most updated guidelines. Methods: All consecutive patients admitted to any of the 150 participating general surgery (GS), hepatopancreatobiliary surgery (HPB), internal medicine (IM) and gastroenterology (GA) departments with a diagnosis of biliary acute pancreatitis between 01/01/2019 and 31/12/2020 were included in the study. Categorical data were reported as percentages representing the proportion of all study patients or different and well-defined cohorts for each variable. Continuous data were expressed as mean and standard deviation. Differences between the compliance obtained in the four different subgroups were compared using the Mann-Whitney U, Student's t, ANOVA or Kruskal-Wallis tests for continuous data, and the Chi-square test or the Fisher's exact test for categorical data. Results: Complete data were available for 5275 patients. The most commonly discordant gaps between daily clinical practice and recommendations included the optimal timing for the index CT scan (6.1%, χ2 6.71, P = 0.081), use of prophylactic antibiotics (44.2%, χ2 221.05, P < 0.00001), early enteral feeding (33.2%, χ2 11.51, P = 0.009), and the implementation of early cholecystectomy strategies (29%, χ2 354.64, P < 0.00001), with wide variability based on the admitting speciality. Conclusions: The results of this study showed an overall poor compliance with evidence-based guidelines in the management of ABP, with wide variability based on the admitting speciality. Study protocol registered in ClinicalTrials.Gov (ID Number NCT04747990). © 2022 IAP and EP

coMpliAnce with evideNce-based cliniCal guidelines in the managemenT of acute biliaRy pancreAtitis): The MANCTRA-1 international audit

Background/objectives: Reports about the implementation of recommendations from acute pancreatitis guidelines are scant. This study aimed to evaluate, on a patient-data basis, the contemporary practice patterns of management of biliary acute pancreatitis and to compare these practices with the recommendations by the most updated guidelines. Methods: All consecutive patients admitted to any of the 150 participating general surgery (GS), hepatopancreatobiliary surgery (HPB), internal medicine (IM) and gastroenterology (GA) departments with a diagnosis of biliary acute pancreatitis between 01/01/2019 and 31/12/2020 were included in the study. Categorical data were reported as percentages representing the proportion of all study patients or different and well-defined cohorts for each variable. Continuous data were expressed as mean and standard deviation. Differences between the compliance obtained in the four different subgroups were compared using the Mann-Whitney U, Student's t, ANOVA or Kruskal-Wallis tests for continuous data, and the Chi-square test or the Fisher's exact test for categorical data. Results: Complete data were available for 5275 patients. The most commonly discordant gaps between daily clinical practice and recommendations included the optimal timing for the index CT scan (6.1%, χ2 6.71, P = 0.081), use of prophylactic antibiotics (44.2%, χ2 221.05, P < 0.00001), early enteral feeding (33.2%, χ2 11.51, P = 0.009), and the implementation of early cholecystectomy strategies (29%, χ2 354.64, P < 0.00001), with wide variability based on the admitting speciality. Conclusions: The results of this study showed an overall poor compliance with evidence-based guidelines in the management of ABP, with wide variability based on the admitting speciality. Study protocol registered in ClinicalTrials.Gov (ID Number NCT04747990)

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135–15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359–5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138–5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184–5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598–9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090–6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286–5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912–7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138–0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143–0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990). Graphical abstract: [Figure not available: see fulltext.]

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background: Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods: The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results: A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion: Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)