Textbook outcome in urgent early cholecystectomy for acute calculous cholecystitis: results post hoc of the S.P.Ri.M.A.C.C study

Introduction: A textbook outcome patient is one in which the operative course passes uneventful, without complications, readmission or mortality. There is a lack of publications in terms of TO on acute cholecystitis. Objetive: The objective of this study is to analyze the achievement of TO in patients with urgent early cholecystectomy (UEC) for Acute Cholecystitis. and to identify which factors are related to achieving TO. Materials and methods: This is a post hoc study of the SPRiMACC study. It ́s a prospective multicenter observational study run by WSES. The criteria to define TO in urgent early cholecystectomy (TOUEC) were no 30-day mortality, no 30-day postoperative complications, no readmission within 30 days, and hospital stay ≤ 7 days (75th percentile), and full laparoscopic surgery. Patients who met all these conditions were taken as presenting a TOUEC. Outcomes: 1246 urgent early cholecystectomies for ACC were included. In all, 789 patients (63.3%) achieved all TOUEC parameters, while 457 (36.6%) failed to achieve one or more parameters and were considered non-TOUEC. The patients who achieved TOUEC were younger had significantly lower scores on all the risk scales analyzed. In the serological tests, TOUEC patients had lower values for in a lot of variables than non-TOUEC patients. The TOUEC group had lower rates of complicated cholecystitis. Considering operative time, a shorter duration was also associated with a higher probability of reaching TOUEC. Conclusion: Knowledge of the factors that influence the TOUEC can allow us to improve our results in terms of textbook outcome

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

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

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

A retrospective audit of trauma surgery at a level 1 trauma centre in South Africa

Includes abstract. Includes bibliographical references

Trauma Systems: Development Strategies in Emerging Nations

Trauma is the leading cause of death and disability. Numerous studies have shown that trauma systems, which provide an organized approach to acutely injured patients from primary to advanced care, improve outcomes. The aim of the thesis is to look at various aspects of trauma systems in two emerging nations: Saudi Arabia, a high-income country, and South Africa, a middle-income country, particularly in the areas of prehospital, in-hospital, and rehabilitation. Part 1 describes the background and development of trauma systems in two developing nations: South Africa and Saudi Arabia. Chapter 2 discusses the historical and contemporary contexts in which trauma systems operate in both countries. Chapter 3 narrates the recent transformation of Saudi healthcare which laid the foundation for trauma system development in the Kingdom. Chapter 4 portrays the development of the Saudi Arabian trauma system. Part 2 describes the prehospital portion of trauma systems. Chapter 5 analyzes the effects of delays in emergency medical service responses on trauma outcomes. Chapter 6 explains that the administration of tranexamic acid in a hospital setting for bleeding trauma patients is often not feasible due to the longer prehospital time, especially in lower- and middle-income countries. In-hospital trauma management starts in the emergency department (ED). Part 3 concentrates on the improvement of trauma management in the ED. Chapter 7 emphasizes regular trauma resuscitation training for healthcare professionals managing trauma patients. Chapter 8 discusses the importance of the shock index—a simple calculation based on initial vital signs—as a screening tool in ED. Part 4 details various aspects of the management of admitted trauma patients. Chapter 9 describes the selective nonoperative management of liver gunshot injuries. Chapter 10 is a pilot randomized controlled trial on laparoscopy versus clinical follow-up to detect occult diaphragm injuries following left-sided thoracoabdominal stab wounds. Chapter 11 explains how to deal with lethal penetrating trauma to the mediastinal vessels, and Chapter 12 outlines how to diagnose and manage blunt cerebrovascular injury. Part 5 is a report on the complications of in-hospital trauma management. Chapter 13 describes surgical site infections following trauma laparotomy, and Chapter 14 describes the incidence and nature of venous thromboembolism in polytrauma patients. Part 6 describes the outcomes of in-hospital trauma management. Chapter 15 looks at the effects of a delay in surgery after scheduling, based on the emergency surgery triage system. Chapter 16 analyzes the outcomes of damage-control surgeries. Chapter 17 compares trauma management between two major trauma services in Riyadh, Saudi Arabia, and Melbourne, Australia. Finally, in Part 7, the rehabilitation portion of the trauma system is described. Chapter 18 emphasizes the early incorporation of acute intensive trauma rehabilitation into trauma programs. Chapter 19 summarizes the findings presented in this thesis and presents a general discussion and future perspectives. The future perspective focuses on improvement in certain areas of trauma systems in both South Africa and Saudi Arabia, implementing a national trauma database, research and development, and trauma quality improvements in care processes and outcomes

Trauma Systems: Development Strategies in Emerging Nations

Trauma is the leading cause of death and disability. Numerous studies have shown that trauma systems, which provide an organized approach to acutely injured patients from primary to advanced care, improve outcomes. The aim of the thesis is to look at various aspects of trauma systems in two emerging nations: Saudi Arabia, a high-income country, and South Africa, a middle-income country, particularly in the areas of prehospital, in-hospital, and rehabilitation. Part 1 describes the background and development of trauma systems in two developing nations: South Africa and Saudi Arabia. Chapter 2 discusses the historical and contemporary contexts in which trauma systems operate in both countries. Chapter 3 narrates the recent transformation of Saudi healthcare which laid the foundation for trauma system development in the Kingdom. Chapter 4 portrays the development of the Saudi Arabian trauma system. Part 2 describes the prehospital portion of trauma systems. Chapter 5 analyzes the effects of delays in emergency medical service responses on trauma outcomes. Chapter 6 explains that the administration of tranexamic acid in a hospital setting for bleeding trauma patients is often not feasible due to the longer prehospital time, especially in lower- and middle-income countries. In-hospital trauma management starts in the emergency department (ED). Part 3 concentrates on the improvement of trauma management in the ED. Chapter 7 emphasizes regular trauma resuscitation training for healthcare professionals managing trauma patients. Chapter 8 discusses the importance of the shock index—a simple calculation based on initial vital signs—as a screening tool in ED. Part 4 details various aspects of the management of admitted trauma patients. Chapter 9 describes the selective nonoperative management of liver gunshot injuries. Chapter 10 is a pilot randomized controlled trial on laparoscopy versus clinical follow-up to detect occult diaphragm injuries following left-sided thoracoabdominal stab wounds. Chapter 11 explains how to deal with lethal penetrating trauma to the mediastinal vessels, and Chapter 12 outlines how to diagnose and manage blunt cerebrovascular injury. Part 5 is a report on the complications of in-hospital trauma management. Chapter 13 describes surgical site infections following trauma laparotomy, and Chapter 14 describes the incidence and nature of venous thromboembolism in polytrauma patients. Part 6 describes the outcomes of in-hospital trauma management. Chapter 15 looks at the effects of a delay in surgery after scheduling, based on the emergency surgery triage system. Chapter 16 analyzes the outcomes of damage-control surgeries. Chapter 17 compares trauma management between two major trauma services in Riyadh, Saudi Arabia, and Melbourne, Australia. Finally, in Part 7, the rehabilitation portion of the trauma system is described. Chapter 18 emphasizes the early incorporation of acute intensive trauma rehabilitation into trauma programs. Chapter 19 summarizes the findings presented in this thesis and presents a general discussion and future perspectives. The future perspective focuses on improvement in certain areas of trauma systems in both South Africa and Saudi Arabia, implementing a national trauma database, research and development, and trauma quality improvements in care processes and outcomes

Surgical site infections after trauma laparotomy. An observational study from a major trauma center in Saudi Arabia

Objectives: To determine the incidence of surgical site infection (SSI) after trauma laparotomy and evaluate variables on presentation to the emergency department (ED) associated with the development of SSI. Methods: A retrospective cohort study was undertaken of patients presenting directly from the scene who underwent trauma laparotomy between January 2016 and December 2017. The primary outcome variable was SSI, as defined by the Centers for Disease Control and Prevention guideline. A univariate assessment with demographics, vital signs, and acute management was reported. Results: A total of 70 patients were included for data analysis. Of these, 9 (12.9%; 95% confidence interval (CI): 6.9-22.7%) patients developed SSI, including 5 patients with bowel injury (small bowel; n=3, colonic injuries; n=2). Most cases were diagnosed after 7 days in the hospital. All patients developed superficial incisional (skin and subcutaneous tissue) SSI. No predetermined variables, including bowel injury (p=0.08) or duration of surgery (p=0.09), demonstrated a statistically significant association with the development of SSI. Conclusion: Rates of SSI after trauma laparotomy were similar to previous reports from other centers. Surgical site infection after trauma laparotomy was diagnosed at a delayed time point after surgery, and patient demographics, injury characteristics, and acute surgical management did not appear to be associated with subsequent diagnosis of SSI

Design optimization and validation of UV-C illumination chamber for filtering facepiece respirators

In this study, we constructed an UV-C illumination chamber using commercially available germicidal lamps and other locally available low-cost components for general-purpose biological decontamination purposes. The illumination chamber provides uniform illumination of around 1 J/cm2 in under 5 min across the chamber. The control mechanism was developed to automate the on/off process and make it more secure minimizing health and other electrical safety. To validate the decontamination efficacy of the UV-C Illumination Chamber we performed the Geobacillus spore strip culture assay. Additionally, we performed the viral load measurement by identifying the COVID-19-specific N-gene and ORF1 gene on surgical masks. The gold standard RT-qPCR measurement was performed to detect and quantify the COVID-19-specific gene on the mask sample. The biochemical assay was conducted on the control and test group to identify the presence of different types of bacteria, and fungi before and after exposure under the illumination chamber. The findings of our study revealed satisfactory decontamination efficacy test results. Therefore, it could be an excellent device in healthcare settings as a disinfection tool for biological decontamination such as SAR-CoV-2 virus, personal protection equipment (PPE), (including n95, k95 respirators, and surgical masks), and other common pathogens

Significant bleeding from Meckel’s diverticulum after blunt abdominal trauma: a case report

Abstract Background Meckel’s diverticulum, with an incidence of 2%, is the most common congenital anomaly in the gastrointestinal tract. Its main complications are perforation, obstruction, and bleeding. A few studies have reported that blunt abdominal trauma may result in perforation or obstruction to Meckel’s diverticulum. However, reports of significant major intestinal bleeding from Meckel’s diverticulum as a complication of blunt abdominal trauma is rare. This paper present what we believe to be the first reported case of significant intestinal bleeding from a Meckel’s diverticulum following blunt abdominal trauma. Case presentation A 12-year-old Saudi boy of Arab ethnicity presented to the King Saud Medical City emergency department with bleeding per rectum and mild abdominal pain following blunt trauma to his abdomen. On examination, his abdomen was slightly tender, bowel sounds were present, and he was hemodynamically stable. During admission, rectal bleeding was ongoing. On day 3 he deteriorated with decreasing blood pressure and hemoglobin, and increasing pulse rate with fever. After resuscitation and stabilization, he was urgently taken to the operating room for further diagnostic management and treatment. His nasogastric tube revealed bile without blood, and an intraoperative colonoscopy revealed altered blood within his whole colon and terminal ileum without a definite bleeding site. A laparotomy was performed, and an injured branch of the mesenteric artery supplying the Meckel’s diverticulum was identified as the source of the significant arterial bleeding. Suture ligation controlled the bleeding, and the Meckel’s diverticulum was resected. The patient remained stable after that until discharge without any further intestinal bleeding. Conclusion Identifying bleeding as a complicated Meckel’s diverticulum following blunt trauma to the abdomen can be challenging due to its low incidence and difficulties while making the diagnosis