Most trauma deaths happen before hospital arrival, highlighting urgent needs in trauma care. Of 3,089 adult trauma patients, 497 (16.1%) died; 77.1% died pre-hospital, typically within 12 minutes of injury. Hemorrhage and traumatic brain injury accounted for 81.9% of deaths, with 96.2% of hemorrhage deaths occurring pre-hospital. Surgeons should focus on improving pre-hospital interventions to […]
Category: Appendix, Gallbladder and Surgical Emergencies
Whole-blood transfusion cuts mortality in civilian trauma cases
Whole-blood transfusion significantly reduces mortality in adult trauma patients compared to component therapy, especially in civilian settings. 24-hour mortality odds ratio for whole-blood vs. component therapy: 0.76 (95% CI, 0.60-0.95). Civilian data shows absolute risk reduction of 4.6% with whole-blood (n=39,028), and a 30-day mortality odds ratio of 0.76 (95% CI, 0.60-0.98). Surgeons should consider […]
Laparoscopic Ultrasound During Emergency Cholecystectomy Cuts Costs
Using laparoscopic ultrasonography during emergency laparoscopic cholecystectomy for severe calculous cholecystitis can reduce hospital stays and costs. Patients undergoing emergency surgery with ultrasonography had a significantly shorter hospital stay compared to those who underwent routine surgery after imaging. Hospitalization costs were also lower for the emergency group without increased complications. Surgeons should consider this approach […]
Large Language Models Improve Trauma Triage Accuracy
Large language models enhance prehospital trauma triage, potentially improving patient outcomes. LLMs achieved 83.5% triage accuracy, outperforming human clinicians’ 78.9% accuracy (p<0.01). Under-triage with LLMs improved slightly to 4.8%, compared to 5.1% with human triage (p=0.73). Essential transcripts reduced communication length by 80.8% while maintaining accuracy. Integrating LLMs in trauma assessment can lead to better […]
Emergency Surgery Outcomes Worse at Non-Transplant Centers
Emergency surgeries in solid-organ transplant patients fare worse at non-transplant centers, particularly for kidney transplants. Among 2,679 cases, 30-day mortality was 4%, with 31% facing complications or mortality. Kidney transplant patients showed 3.52 times higher mortality at academic centers compared to transplant centers. Urgent surgical care for transplant patients should prioritize treatment at transplant centers […]
AI Platform Boosts Safety in Laparoscopic Cholecystectomy
An AI-based tool shows promise in improving the critical view of safety during laparoscopic cholecystectomy, reducing bile duct injury risks. The AI platform achieved impressive accuracy scores: 0.91 for CVS I, 0.86 for CVS II, and 0.73 for CVS III. Significant improvement in CVS assessment was observed post-deployment (p < 0.01). Surgeons reported high satisfaction, […]
Biliary Stents for Bile Leaks After Fenestrated Cholecystectomy Show No Difference
This study examines the effectiveness of different biliary stents for treating bile leaks post-fenestrated cholecystectomy, revealing significant implications for patient management. PCBL resolution rates were similar across stent types: 93.8% for 10 fr stents, 92.3% for 7 fr stents, and 88.9% for fully covered self-expanding metal stents. Plastic stents, including single and double pigtail options, […]
Cholecystectomy Outcomes: Complications Down, Complexity Up
Surgical complications in minimally invasive cholecystectomy have significantly decreased despite rising patient complexity. Overall complication rates fell from 21.5% in 2011 to 16.5% in 2021. Serious complications dropped from 12.3% to 7.0% in the same period. Surgery has improved, with specific gains in intraoperative hemorrhage (1.07% to 0.54%) and blood transfusions (5.47% to 1.87%). However, […]
Optimal Management of Severe Splenic Injuries in Trauma Patients
Salvaging the spleen shows lower mortality and complications than splenectomy in severe blunt splenic injuries for trauma patients. Mortality risk for splenic angioembolization (0.62) and observation (0.61) is significantly lower than for open splenectomy. Both angioembolization and observation have fewer complications compared to splenectomy, with odds ratios of 0.74 and 0.75, respectively. Spleen preservation should […]
Revised approach to gallbladder and sphincter disorders
More accurate diagnosis is shifting surgical practice for abdominal pain and pancreatitis. New criteria for dysfunctional gallbladder disorder (DGBD) focus on typical biliary pain and symptom persistence. Sphincter of Oddi disorder (SOD) now requires objective evidence of obstruction or pancreatitis. Surgeons should be cautious, as these disorders are often over-diagnosed, leading to unnecessary risky treatments. […]