The Changing Face of Emergency General Surgery : A 20-Year Analysis of Secular Trends in Demographics, Diagnoses, Operations and Outcomes

ACKNOWLEDGMENTS The authors thank Dr Neil Scott and Mrs Rute Vieira for their statistical expertise. There were no financial or material contribution from any source for this work. We would also like to thank the Information Services Division of the NHS in Scotland for extracting the data, and the Data Safehaven at the University of Aberdeen for hosting it. This study was funded by NHS Grampian Endowments, Aberdeen, UK. No funding was received from the National Institutes of Health, Wellcome Trust or Howard Hughes Medical InstitutePeer reviewedPublisher PD

Thrombolysis for acute graft occlusion during elective endovascular aortic aneurysm repair.

A 65-year-old man developed acute arterial thrombosis with stent graft occlusion, during elective endovascular aneurysm repair, with bilateral acute lower limb ischaemia. We describe successful endovascular and pharmacological management using a combination of mechanical disruption of the thrombus (using the access sheaths) followed by intra-arterial thrombolysis (Actilyse) infusion. Within 4-h the endograft had completely re-canalized. The patient made an uncomplicated recovery and was discharged on the second post-operative day

Trends in missed presentations and late HIV diagnosis in a UK teaching hospital: a retrospective comparative cohort study

<p>Abstract</p> <p>Background</p> <p>Late diagnosis is an important cause of HIV-related morbidity, mortality and healthcare costs in the UK and undiagnosed infection limits efforts to reduce transmission. National guidelines provide recommendations to increase HIV testing in all healthcare settings. We evaluated progress towards these recommendations by comparing missed opportunities for HIV testing and late diagnosis in two six year cohorts from North East Scotland.</p> <p>Methods</p> <p>We reviewed diagnostic pathways of all patients newly diagnosed with HIV referred to infectious diseases and genito-urinary medicine services between 1995 and 2000 (n = 48) and 2004 to 2009 (n = 117). Missed presentations (failure to diagnose ≤ 1 month of a clinical or non-clinical indicator for testing), late diagnosis (CD4 < 350 cells/mm³), and time to diagnosis (months from first presentation to diagnosis) were compared between cohorts using <it>χ</it>²and log-rank tests. Determinants of missed presentation were explored by multivariate logistic regression. Breslow-Day tests assessed change in diagnostic performance by patient subgroup.</p> <p>Results</p> <p>There were significant decreases in missed presentations (33% to 17%; <it>P </it>= 0.02) and time to diagnosis (mean 17 months to 4 months; <it>P </it>= 0.005) but not in late diagnosis (56% vs. 60%; <it>P </it>= 0.57) between earlier and later cohorts. In the later cohort patients were significantly more likely to have acquired HIV abroad and presented with early HIV disease, and testing was more likely to be indicated by transmission risk or contact with GUM services than by clinical presentation. Missed presentation remained significantly less likely in the later cohort (OR = 0.28, 95% CI 0.11 to 0.72; <it>P </it>= 0.008) after adjustment for age, transmission risks and number of clinical indicators. Reductions in missed presentation were greater in patients < 40 years, of non-UK origin, living in least deprived neighbourhoods and with early disease at presentation (<it>P </it>< 0.05). 27% of missed presentations occurred in primary care and 46% in general secondary care.</p> <p>Conclusions</p> <p>While early diagnosis has improved in epidemiological risk groups, clinical indications for HIV testing continue to be missed, particularly in patients who are older, of UK origin and from more deprived communities. Increasing testing in non-specialist services is a priority.</p

Twenty‐year study of in‐hospital and postdischarge mortality following emergency general surgical admission

We are grateful to Lizzie Nicholson, and the team at the Information Services Division, Scotland for their support in providing us with these data and the Data Safehaven Department of the University of Aberdeen for its storage. The authors would also like to thanks Dr Neil Scott and Dr Rute Vieira of the Department of Medical Statistics, University of Aberdeen for their advice in conducting this research.Peer reviewedPublisher PD

Impact of deprivation and comorbidity on outcomes in emergency general surgery: an epidemiological study.

BACKGROUND: The impact of socioeconomic deprivation and comorbidities on the outcome of patients who require emergency general surgery (EGS) admission is poorly understood. The aim of this study was to examine the effect of deprivation and comorbidity on mortality, discharge destination and length of hospital stay (LOS) in patients undergoing EGS in Scotland. METHODS: Prospectively collected data from all Scottish adult patients (aged >15 years) requiring EGS admitted between 1997 and 2016 were obtained from the Scottish Government. Data included age, sex, Scottish Index of Multiple Deprivation (SIMD), 5-year Charlson Comorbidity Index (CCI), whether an operation took place and outcomes including mortality, discharge destination and LOS. Logistic regression was used for the analysis of mortality and discharge destination and Poisson regression was used for LOS. RESULTS: 1 477 810 EGS admissions were analyzed. 16.2% were in the most deprived SIMD decile and 5.6% in the least deprived SIMD decile. 75.6% had no comorbidity, 20.3% had mild comorbidity, 2.5% had moderate comorbidity and 1.6% had severe comorbidity. 78.6% were discharged directly home. Inpatient, 30-day, 90-day and 1-year crude mortality was 1.7%, 3.7%, 7.2% and 12.4%, respectively. Logistic regression showed that severe comorbidity was associated with not being discharged directly to home (OR 0.38, 95% CI 0.37 to 0.39) and higher inpatient mortality (OR 13.74, 95% CI 13.09 to 14.42). Compared with the most affluent population, the most deprived population were less likely to be discharged directly to home (OR 0.97, 95% CI 0.95 to 0.99) and had higher inpatient mortality (OR 1.36, 95% CI 1.8 to 1.46). Poisson analysis showed that severe comorbidity (OR 1.69, 95% CI 1.68 to 1.69) and socioeconomic deprivation (OR 1.11, 95% CI 1.11 to 1.12) were associated with longer LOS. DISCUSSION: Increased levels of comorbidity and, to a lesser extent, socioeconomic deprivation are key drivers of mortality, discharge destination and LOS following admission to an EGS service. LEVEL OF EVIDENCE: III (prospective/retrospective with up to two negative criteria). STUDY TYPE: Epidemiological/prognostic

Impact of deprivation and comorbidity on outcomes in emergency general surgery : an epidemiological study

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.Peer reviewedPublisher PD

Current and projected financial burden of emergency general surgery for adults in Scotland’s single payer healthcare system : a cost analysis of hospital admissions

No funding received, including none from National Institutes of Health, Wellcome Trust or Howard Hughes Medical Institute. The authors report no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.annalsofsurgery.com).Peer reviewedPostprintPostprin

Comprehensive assessment of the management of acute cholecystitis in Scotland : population-wide cohort study

Funding The study was funded by an NHS Grampian endowment fund (NER 11062). © The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd. Elements of this paper were presented as an oral presentation at the Surgical Research Society in Nottingham, UK on 25 March 2023. Data from this paper have also been presented in the Moynihan prize presentation section of the Association of Surgeons of Great Britain and Ireland, Harrogate, UK on 18 May 2023Peer reviewedPublisher PD

Congenital absence of the deep inferior epigastric system : a case report

Open Access via the Springer Compact AgreementPeer reviewedPublisher PD