Correction to: Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

Background: The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods: A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results: 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis. Conclusions: The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years

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

The kinetic and nutritional intervention in overweight and obese women ages of 40-50 years old in health markers

Introduction. The excessive body weight gain has experienced rapid aggravation globally. to tackle this situation, the approach should be multidimensional and tailored to the daily needs of individuals for successful results. Purpose: To what extent can be applied to daily life and have similar effects a model of physical activity not organized-free in intensity over time compared with a corresponding program of physical activity which has joined the factor of intensity in relation to time. Method: The participants of the research were 49 women aged between 40 & 50 years old whose BMI ranged from 24,9 kg/m2 up to 39,9 kg/m2 and their way of life characterized sedentary, which resulted primarily from the kind of their work. There were 3 groups two of which were experimental, they were asked to follow this intrusive program that included physical activity intensity and tension accompanied by nutritional guide and a control group which followed the daily schedule without any intervention. The recommended type of exercise was walking with the aim of achieving 12,500 steps / day. The recording was done with the help of the pedometer type OMRON, Walking Style II HJ-113R-E. This was followed by weighing and measuring for the definition of body composition by BIA method with an electronic balance type TANITA BC-545, measurement of blood pressure, waist and hip circumference with the relevant instruments and biochemical tests. The intervention lasted a total of 5 months (20 weeks), involving intrusive supervision period of 3 months (12 weeks) and unsupervised period of two months (8 weeks) Results: The mean percentage of weight change per working group reaches 8.97% for group 1 and for group 2 the average moves to 5.13% while the control group shows an average weight gain 0.27%. The values of the average biochemical tests for the group 1 show a decrease in glucose values of an average 4.49%, the total cholesterol decreased by 22.01%, HDL increased significantly by 34.06%, LDL also decreases significantly by 35.1%, while triglycerides reach a 14.14% reduction. For group 2 glucose decreased on average 5.14%, total cholesterol by 18.29%, HDL increased by 21.82%, LDL decreased by 26.99% and triglycerides showed a reduction effect, finally triglycerides for group 2 show a significant decrease of 10.15%. For the control group the price changes of biochemical tests are reversed, with an increase in all of the studied blood components and reduction of HDL. Regarding the linear correlation percentage weight changes / fat / visceral fat / muscle mass for groups 1 and 2, for group 1 was a significant correlation is (R = 0,662) with a percentage change of 43.8% from the linear model (R square = 0.438). The index Sig. equals 0.04 <0.05 and thus the resulting model is valid. The same goes for group 2 correlation is even stronger (R = 0,762) with a percentage change of 58% from the linear model (R square = 0,580). The index Sig. equals 0.042 <0.05 and thus the resulting model is valid. Equaly important are also the results of the remaining research questions. For systolic pressure, where the target value is 12, group 1 decreased to 12.3 from 13.67, group 2 also reduced the systolic pressure, reaching 13.1 from 13.6 of the first measurement and control group showed minimal and not statistically significant increase in systolic pressure from 12.95 to 13. Regarding the diastolic pressure, group 1 shows a reduction of the mean value from 8.2 to 7.9, which is not particularly important, group 2 is similarly reduced from 8.7 to 8.4, while the control group increased the mean diastolic pressure again of approximately 0.2, from 8.71 to 8.93. Finally, the reduction in waist and hip circumference for group 1 decreased on average 6,5 cm and the circumference of the hip on average 6,44 cm. Group 2 had a decrease in average the circumference by an average 4,46 cm, the circumference of the hips average presents decrease of 5,15 cm. The change in mean waist and hip for the control group is zero. Steadily increased significantly and the change in metabolic age in relation to organic, where for group 1 the Pearson coefficient indicates a positive correlation between the two variables at the first measurement with a value of 0.485. The value of the correlation coefficient decreases slightly in the third measurement at 0.363. For group 2 Pearson correlation is 0.600 at the first measurement and increased to 0,667 during the last count. The Pearson coefficient for the control group tends to 0 for the variables of biological and metabolic age. Conclusions: As expected, the results presented by the group in the intervention program with the intensity of physical activity were better compared to the second group that was devoid of factor intensity. However, based on the results there are no strong and statistically significant differences between the two proposed programs which guides us to the belief that physical activity, walking without tension but with specific number of steps can not only find immediate application in everyday life but also have a long lasting effect.Εισαγωγή: Η υπερβάλλουσα αύξηση του σωματικού βάρους παρουσιάζει ραγδαία επιδείνωση σε παγκόσμιο επίπεδο. Για να αντιμετωπιστεί θα πρέπει η προσέγγιση της να είναι πολυδιάστατη και προσαρμοσμένη στις ανάγκες της ατομικής καθημερινότητας για επιτυχή αποτελέσματα. Σκοπός: Κατά πόσο μπορεί να εφαρμοστεί στην καθημερινότητα και να έχει αντίστοιχα αποτελέσματα ένα μοντέλο φυσικής δραστηριότητας μη οργανωμένο-ελεύθερο όσον αφορά την ένταση σε σχέση με το χρόνο εν συγκρίσει με αντίστοιχο πρόγραμμα φυσικής δραστηριότητας στο οποίο έχει ενταχθεί ο παράγοντας της έντασης σε σχέση με το χρόνο. Μέθοδος: Στην έρευνα συμμετείχαν 49 γυναίκες ηλικίας 40-50χρ των οποίων ο ΔΜΣ κυμάνθηκε από 24,9 kg/m 2 έως και 39,9 kg/m 2 και ο τρόπος ζωής τους χαρακτηρίστηκε καθιστικός, κάτι που προέκυψε κατά κύριο λόγο από το είδος της εργασίας τους. Υπήρξαν 3 ομάδες εκ των οποίων οι δυο ήταν πειραματικές όπου και κλήθηκαν να ακολουθήσουν συγκεκριμένο παρεμβατικό πρόγραμμα το οποίο περιελάμβανε φυσική δραστηριότητα με ένταση και χωρίς ένταση συνοδευόμενη από διατροφικό οδηγό και μια ομάδα ελέγχου η οποία ακολούθησε το καθημερινό πρόγραμμα της χωρίς καμία παρέμβαση. Η προτεινόμενη μορφή άσκησης ήταν το περπάτημα με στόχο την πραγμάτωση 12.500 βημάτων/ημέρα. Η καταγραφή τους γινόταν με τη βοήθεια βηματομέτρου τύπου OMRON, Walking Style II HJ-113R-E. Ακολούθησε ζύγιση και μέτρηση για τον ορισμό σύστασης του σώματος μέσω της μεθόδου ΒΙΑ με τον ηλεκτρονικό ζυγό τύπου ΤΑΝΙΤΑ BC-545. Μέτρηση αρτηριακής πίεσης, περιφέρειας μέσης και ισχύων με τα αντίστοιχα όργανα και βιοχημικές εξετάσεις. Η παρέμβαση διήρκησε συνολικά 5 μήνες (20 εβδομάδες), με επίβλεψη 3 μήνες (12 εβδομάδες) και χωρίς επίβλεψη 2 μήνες (8 εβδομάδες) Αποτελέσματα: Ο μέσος όρος της ποσοστιαίας μεταβολής βάρους ανά ομάδα εργασίας φτάνει το 8,97% για την ομάδα 1, για τηn ομάδα 2 ο Μ.Ο κινείται στο 5,13% ενώ η ομάδα ελέγχου παρουσιάζει αύξηση του βάρους της κατά Μ.Ο. 0,27%. Οι τιμές του Μ.Ο. των βιοχημικών εξετάσεων για την ομάδα 1 παρουσιάζει μείωση της τιμή της γλυκόζης κατά Μ.Ο. 4,49%, η ολική χοληστερίνη μειώνεται κατά 22,01%, η HDL αυξάνεται σημαντικά κατά 34,06%, η LDL μειώνεται επίσης σημαντικά, σε ποσοστό 35,1%, ενώ τα τριγλυκερίδια φτάνουν σε μείωση το 14,14%. Για τη ομάδα 2 η γλυκόζη μειώθηκε κατά Μ.Ο. 5,14%, η ολική χοληστερίνη κατά 18,29%, η HDL ενισχύθηκε κατά 21,82%, η LDL μειώθηκε κατά 26,99% και τα τριγλυκερίδια παρουσίασαν φαινομενικά μείωση, τέλος τα τριγλυκερίδια για την ομάδα 2 παρουσιάζουν μια σημαντική μείωση κατά 10,15%. Για την ομάδα ελέγχου οι μεταβολές των τιμών των βιοχημικών εξετάσεων αντιστρέφονται, με αύξηση όλων των υπό μελέτη συστατικών του αίματος και μείωση της HDL. Όσον αφορά τη Γραμμική Συσχέτιση Ποσοστιαίας Μεταβολή Βάρους / Λίπους / Σπλαχνικού Λίπους / Μυϊκής Μάζας για τις Ομάδες 1 και 2, για την ομάδα 1 η συσχέτιση είναι ισχυρή (R=0,662) και η μεταβολή εξηγείται κατά 43,8% από το γραμμικό μοντέλο (R square=0,438). Ο δείκτης Sig. ισούται με 0,04<0,05 και συνεπώς το μοντέλο που προκύπτει είναι έγκυρο. Το ίδιο ισχύει και για την ομάδα 2 η συσχέτιση είναι ακόμη ισχυρότερη (R=0,762) και η μεταβολή εξηγείται κατά 58% από το γραμμικό μοντέλο (R square=0,580). Ο δείκτης Sig. ισούται με 0,042<0,05 και συνεπώς το μοντέλο που προκύπτει είναι έγκυρο. Παρόμοιου βεληνεκούς είναι και τα αποτελέσματα που παρουσιάζουν τα λοιπά ερευνητικά ερωτήματα. Για τη συστολική πίεση, όπου η τιμή στόχος είναι 12, η ομάδα 1 παρουσίασε μείωση σε 12,3 από 13,67, η ομάδα 2 επίσης μείωσε την τιμή της συστολικής της πίεσης, φτάνοντας στο 13,1 από το 13,6 της πρώτης μέτρησης και η ομάδα ελέγχου παρουσίασε ελάχιστη και όχι στατιστικά σημαντική αύξηση στη μέση τιμή της συστολικής της πίεσης σε 13 από 12,95. Όσον αφορά τη διαστολική πίεση, η ομάδα 1 παρουσιάζει μείωση της μέσης τιμής σε 7,9 από 8,2, η οποία δεν είναι ιδιαίτερα σημαντική, η ομάδα 2 παρουσιάζει παρόμοια μείωση σε 8,4 από 8,7, ενώ η ομάδα ελέγχου αυξάνει και πάλι τη μέση τιμή της διαστολικής πίεσης κατά περίπου 0,2, από 8,71 σε 8,93. Τέλος η μείωση της περιφέρειας μέσης και ισχύων όσον αφορά την ομάδα 1 η περιφέρεια της μέσης η περίμετρος μειώθηκε κατά Μ.Ο 6,5 cm ενώ η περιφέρεια κατά 6,44 cm. Η ομάδα 2 παρουσίασε μείωση του Μ.Ο. της περιμέτρου για τη μέση στα 4,46 cm, η περίμετρος των γοφών κατά Μ.Ο. παρουσιάζει μείωση της τάξεως των 5,15 cm. Η μεταβολή της μέσης τιμής της περιμέτρου μέσης και γοφών για την ομάδα ελέγχου είναι μηδενική. Σταθερά σημαντική αύξηση παρουσίασε και η μεταβολή της μεταβολικής ηλικίας σε σχέση με τη βιολογική, όπου για την ομάδα 1 ο συντελεστής Pearson υποδεικνύει θετική συσχέτιση ανάμεσα στις δύο μεταβλητές κατά την πρώτη μέτρηση με τιμή 0,485. Η τιμή αυτή του συντελεστή συσχέτισης μειώνεται ελαφρώς κατά την τρίτη μέτρηση σε 0,363. Για την ομάδα 2 ο συντελεστής συσχέτισης Pearson είναι 0,600 κατά την πρώτη μέτρηση και αυξάνεται σε 0,667 κατά την τελευταία μέτρηση. Ο συντελεστής Pearson για την ομάδα ελέγχου τείνει στο 0 για τις μεταβλητές της βιολογικής και μεταβολικής ηλικίας. Συμπεράσματα: Όπως ήταν αναμενόμενο τα αποτελέσματα που παρουσίασε η ομάδα που ακολούθησε το παρεμβατικό πρόγραμμα με την ένταση στη φυσική δραστηριότητα ήταν καλύτερα εν συγκρίσει με τη δεύτερη ομάδα όπου απουσίαζε ο παράγοντας της έντασης. Παρόλα αυτά, βάσει των αποτελεσμάτων δεν παρουσιάζεται έντονη και στατιστικά σημαντική διαφορά μεταξύ των δυο προτεινόμενων προγραμμάτων γεγονός που μας δίνει την πεποίθηση πως η φυσική δραστηριότητα, περπάτημα χωρίς ένταση αλλά συγκεκριμένος αριθμός βημάτων όχι μόνο μπορεί να βρει άμεση εφαρμογή στην καθημερινότητα αλλά να είναι επιτυχής και να έχει διάρκεια στο χρόνο

Primary thyroid teratoma in adults: A case report and systematic review of the literature

Extragonadal germ cell tumors are uncommon in adults and only 2-5% of teratomas develop in extragonadal sites. Primary thyroid teratomas represent &lt;0.1% of all primary thyroid gland neoplasms. In the present report, a case of primary thyroid teratoma in a 6.5-year-old female is described. Furthermore, the current literature regarding patients who were diagnosed with primary thyroid teratoma and underwent surgical resection was systematically reviewed. A total of 15 studies of 27 patients (age range, 17-65 years). Growing mass or neck swelling were the primary symptoms in 14 patients (51.8%). Only one (5.5%) patient was preoperatively diagnosed with malignant thyroid teratoma. All patients underwent thyroidectomy, but 6 cases had more advanced surgery, including lymph node dissection. A total of 12 patients received a combination of adjuvant chemoradiation postoperatively, 10 (45.4%) patients reported recurrence of disease and 8 (29.6%) were postoperatively diagnosed with distant metastases. A total of 9 (39.1%) patients died due to progression of the disease. In conclusion, primary thyroid teratomas are rare and difficult to diagnose preoperatively. In particular, malignant cases are very aggressive tumors with a considerably poor prognosis, even after surgical resection combined with adjuvant chemoradiation

Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

Background The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey , a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis. Conclusions The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

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

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: 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. Funding: National Institute for Health and Care Research