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 […]
Category: Appendix, Gallbladder and Surgical Emergencies
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 […]
Effective Tourniquet Management Could Save Limbs
Prolonged tourniquet use in combat can lead to serious complications like limb loss; reassessment is crucial. Current practices often overlook timely reassessment, increasing risk of avoidable morbidity. Data shows that tourniquet conversion and optimization are rarely implemented in the field. Emphasizing these skills as essential for all personnel can drastically improve patient outcomes. Recommendations include […]
Vulnerable Patients in ED Risk Higher Mortality, ICU Admissions
Identifying vulnerability markers at triage can improve outcomes for emergency department patients. Cognitive impairment increases 30-day mortality odds by 2.24 times. ICU admission is more likely for patients with immunosuppression (4.13 times), substance use disorder (1.82 times), and diabetes (1.73 times). Surgeons should consider these vulnerability factors when making surgical decisions post-ED assessment. Hospital admission […]
Robotic Repair Outshines Open for Biliary Duct Injuries
Robotic repair of iatrogenic biliary duct injuries offers significant advantages over traditional open surgery. Significantly less blood loss with robotic repair: 51 ml vs. 314 ml (p < 0.001). Shorter hospital stays: 4 days vs. 16 days (p < 0.001). Robotic procedures had similar complication rates to open repairs with no bile leaks or strictures […]
Management Strategies for Acute Cholecystitis in Surgical Non-Candidates
Surgeons need to adapt to novel treatments for acute cholecystitis (AC) when surgery isn’t an option. Percutaneous cholecystostomy is recommended for patients unfit for lumen-apposing metal stents, aiming to transition to cholecystectomy. Endoscopic ultrasound-guided gallbladder drainage is advised for never-surgical candidates if conditions allow monitored anesthesia. Multidisciplinary protocols are essential, though variability exists in institutional […]
Minimally Invasive Surgery Cuts Risks in Colorectal Resection
Minimally invasive surgery significantly reduces adhesive small bowel obstructions after colorectal cancer resections. Adhesive small bowel obstruction occurs 42% less often with minimally invasive techniques (relative risk 0.58). The study analyzed data from 23,032 patients across 10 studies, with 36.5% in the minimally invasive group. Surgeons can consider minimally invasive approaches to improve postoperative outcomes […]
Effective biliary stenting improves choledocholithiasis outcomes
Using a self-detachable biliary stent for closure after choledochotomy enhances recovery. Patients with primary duct closure experienced a shorter hospital stay—reduced by several days—compared to those with t-tube drainage. Complication rates were significantly lower in the stent group, indicating a safer alternative to traditional methods. Surgeons may consider this approach to reduce postoperative issues and […]
Preoperative CRP Levels Predict Difficult Laparoscopic Appendectomy
Elevated preoperative C-reactive protein levels can predict the complexity of laparoscopic appendectomy, aiding in better patient selection. A CRP cut-off of 220 mg/l indicates an 87% sensitivity and 90% specificity for predicting conversion to open surgery. The area under the ROC curve is 0.941, demonstrating strong diagnostic accuracy. This information can guide surgeons in deciding […]