Delays over 4 hours for emergency department to ICU transfers significantly increase in-hospital mortality. In-hospital mortality is at 54.3% for patients needing ICU-level care. Transfers lasting over 4 hours have a 1.78 times higher mortality risk. Timely transfers are essential; optimizing care during ED boarding can improve outcomes. Additional mortality predictors include advanced age and […]
Category: Appendix, Gallbladder and Surgical Emergencies
Early Cholecystostomy Reduces Risks in High-Risk Patients
Timing matters in acute calculous cholecystitis, particularly for high-risk patients. Percutaneous cholecystostomy within 48 hours leads to a shorter stay: 7 days vs. 13 days (p<0.001). Mortality drops significantly when performed early: 5.9% at 90 days vs. 22.6% (p=0.037). Delayed procedures linked to 4.80 times higher odds of longer hospital stays. Early intervention can significantly […]
Machine learning predicts complications in acute cholecystitis
Machine learning tools can now help surgeons assess the risk of postoperative complications in acute calculous cholecystitis patients. Cholesurgrisk I achieved an AUC-ROC of 0.8456, while Cholesurgrisk II, which includes intraoperative data, improved this to 0.8903. A web-based version of Cholesurgrisk I offers real-time, patient-specific risk estimates. Integrating these models into practice could enhance preoperative […]
Enhancing Laparoscopic Cholecystectomy Safety with Ultrasound
Intraoperative ultrasound significantly improves safety during complex laparoscopic cholecystectomy. Intraoperative ultrasound reduced intraoperative iatrogenic rupture from 17.11% to 3.95% (p = 0.017). It improved differentiation between cystic duct stones and adhered structures. Integrating ultrasound with the modified gallbladder reporting and data system enhances decision-making, especially in higher-risk cases. The rate of atypical hyperplasia increased significantly […]
Endoscopic Ultrasound for Acute Cholecystitis Shows Strong Results
EUS-guided gallbladder drainage is a viable option for high-risk patients with acute cholecystitis, offering both safety and effectiveness. Technical and clinical success rates were high at 95.8%. The study analyzed data from 701 patients across 18 studies with over a year of follow-up. Surgeons can consider EUS-GBD as a first-line treatment for patients unfit for […]
Surgical Resection Reduces Sigmoid Volvulus Recurrence
Resection significantly lowers recurrence in sigmoid volvulus but comes with increased mortality risks. Resection reduced recurrence rates to 12% compared to 69% in non-resection (NNT 6). Mortality increased by 69% with resection, necessitating careful patient selection (NNH 17). In non-gangrenous cases, resection prevents recurrence with no significant mortality increase. Optimizing patient selection and perioperative care […]
Assessing Trauma Care Capacity in Burkina Faso
A new tool evaluates trauma care in low-resource conflict settings, crucial for improving surgical outcomes. Only 30.6% of facilities can perform damage control laparotomy, with a stark contrast between regions (70%) and districts (15.4%). While 75% have blood banks, just 44.4% access tranexamic acid, and 33.3% have essential hemostatic supplies. This data highlights urgent needs […]
Trauma Scoring Systems Help Predict Transfusion Needs and Mortality
Rapid assessment tools can enhance early trauma management and improve patient outcomes. Massive transfusion was needed in 19.7% of trauma patients, primarily due to firearm injuries. The shock index showed the best predictive accuracy for transfusion needs (AUC=0.911). The trauma-related injury severity score (TRISS) was the most effective for predicting in-hospital mortality (AUC=0.975). These findings […]
High Trauma Volume Hospitals Cut Delays in Blunt Intestinal Injuries
Patients with blunt intestinal injuries benefit from surgery in high-volume trauma centers, reducing delays and complications. Patients in low-volume hospitals had an average surgery wait of 18 hours, compared to 15 hours in high-volume centers (p<0.001). High-volume facilities saw a 42% lower risk of post-injury sepsis (aOR 0.58). Surgeons should prioritize referral to high-volume centers […]
Increase in Laparoscopic Surgery for Small Bowel Obstruction
Minimally invasive surgery (MIS) for adhesive small bowel obstruction (SBO) has surged and leads to better outcomes than open surgery. MIS usage rose from 27% to 45% from 2011 to 2021. Complications dropped significantly with MIS (15.2% vs. 27.7% for open, p < 0.001). Patients had shorter hospital stays with MIS (4 days vs. 8 […]