The Acute Care Surgery (ACS) model has evolved to provide structured care across trauma, critical care, and emergency general surgery. This innovative model effectively addresses significant challenges within trauma care. Research indicates that trauma surgeons operating under this expanded scope deliver high-quality care while enjoying professional satisfaction. This article discusses the introduction of the ACS model in Taiwan. Before the 1990s, Taiwan’s trauma care system relied on general surgeons who operated under an “on-call” model, lacking dedicated trauma specialists. Significant reforms were initiated in 2009, when the government implemented a grading system for hospital emergency capabilities, categorizing hospitals into three levels: General (offering 24 h services), Intermediate (capable of managing stable trauma cases), and Advanced (providing comprehensive care for critically ill patients). All medical centers are classified as advanced level hospitals and are equipped with trauma teams. However, these trauma teams operate under various models, ranging from those focused exclusively on trauma to others with comprehensive responsibilities. The trauma center at Chang Gung Memorial Hospital (CGMH) adopted a comprehensive ACS model, encompassing the entire spectrum of care from emergency admission to discharge, all led by trauma surgeons. This approach ensures continuity and coordination in trauma patient care. Additionally, the model integrates emergency general surgery and surgical critical care, broadening the scope of practice for trauma surgeons and enhancing their overall capabilities, providing significant flexibility in their career paths. The ACS model implemented at CGMH has achieved remarkable success, establishing it as a leading trauma center in Taiwan. The emergence of the ACS model aims to reverse the decline in the trauma field that began decades ago. This model not only helps retain skilled professionals but also maintains the expertise of trauma surgeons, ensuring that trauma patients receive the highest quality of care.
{"title":"Total care of trauma patients from triage to discharge at Chang Gung Memorial Hospital: introducing the development of an iconic acute care surgery system in Taiwan","authors":"Chi-Hsun Hsieh, Chien-Hung Liao, Chi-Tung Cheng, Chih-Yuan Fu, Shih-Ching Kang, Yu-Pao Hsu, Chih-Po Hsu, Szu-An Chen, Chien-An Liao, Yu-Hao Wang, Ling-Wei Kuo, Chia-Cheng Wang, Yu-San Tee, Feng-Jen Hsieh, Chun-Hsiang Ou-Yang, Pei-Hua Li, Sheng-Yu Chan, Jen-Fu Huang, Yu-Tung Wu","doi":"10.1186/s13017-025-00603-9","DOIUrl":"https://doi.org/10.1186/s13017-025-00603-9","url":null,"abstract":"The Acute Care Surgery (ACS) model has evolved to provide structured care across trauma, critical care, and emergency general surgery. This innovative model effectively addresses significant challenges within trauma care. Research indicates that trauma surgeons operating under this expanded scope deliver high-quality care while enjoying professional satisfaction. This article discusses the introduction of the ACS model in Taiwan. Before the 1990s, Taiwan’s trauma care system relied on general surgeons who operated under an “on-call” model, lacking dedicated trauma specialists. Significant reforms were initiated in 2009, when the government implemented a grading system for hospital emergency capabilities, categorizing hospitals into three levels: General (offering 24 h services), Intermediate (capable of managing stable trauma cases), and Advanced (providing comprehensive care for critically ill patients). All medical centers are classified as advanced level hospitals and are equipped with trauma teams. However, these trauma teams operate under various models, ranging from those focused exclusively on trauma to others with comprehensive responsibilities. The trauma center at Chang Gung Memorial Hospital (CGMH) adopted a comprehensive ACS model, encompassing the entire spectrum of care from emergency admission to discharge, all led by trauma surgeons. This approach ensures continuity and coordination in trauma patient care. Additionally, the model integrates emergency general surgery and surgical critical care, broadening the scope of practice for trauma surgeons and enhancing their overall capabilities, providing significant flexibility in their career paths. The ACS model implemented at CGMH has achieved remarkable success, establishing it as a leading trauma center in Taiwan. The emergence of the ACS model aims to reverse the decline in the trauma field that began decades ago. This model not only helps retain skilled professionals but also maintains the expertise of trauma surgeons, ensuring that trauma patients receive the highest quality of care.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"28 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143758633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-29DOI: 10.1186/s13017-025-00598-3
Scott MacDonald, Anna Gallagher, Lauren McNicholl, Luke McElroy, Rebecca Hughes, Tara Quasim, Susan Moug
Restoration of intestinal continuity is a key consideration for patients having a stoma created under emergency conditions. There is contrasting evidence about the outcomes of stoma reversal for these patients. This research aims to describe the post-operative outcomes of stoma reversal after emergency formation, and whether these are affected by the timing of reversal. A retrospective review of a prospectively maintained emergency laparotomy (EmLap) database for 4 hospitals was performed between 2018 and 2021. Adult patients undergoing emergency stoma formation were identified and followed up until 2024. Those undergoing stoma reversal surgery were included in the final analysis. A Cox proportional-hazards model was created to identify factors associated with increased time to reversal. 1775 patients had an EmLap, with 505 (28.5%) having a stoma created. Of those patients with a stoma, 97 patients (19.2%) died within one year post-operatively. 146 (28.9%) of the emergency stoma patients underwent stoma reversal, with median time to reversal of 16.9 months. Median post-operative length of stay was 7 days, and 52.1% of patients sustained complications within 30 days post-operatively. Patients reversed within 18 months of stoma formation had fewer significant complications (7.9% v 35.1%, p < 0.001), a shorter length of stay (6 days v 7 days, p < 0.001), and reduced post-operative ileus rates (21.3% v 64.9%, p < 0.001) than those reversed after this period. Receiving adjuvant therapy for malignancy (adjusted Hazard ratio 0.36, 0.17–0.78, p = 0.001) and being male (adjusted Hazard ratio 0.69, 0.49–0.97, p = 0.032) were significantly associated with increased time to reversal. Emergency stoma formation is commonly performed during EmLap, but the majority of emergency stomas are never reversed. The complication profile for reversing these stomas is significant, but early reversal is associated with better post-operative outcomes. Standards of care for emergency stoma patients would be welcome in order to improve outcomes for this cohort.
{"title":"Stoma reversal after emergency stoma formation—the importance of timing: a multi-centre retrospective cohort study","authors":"Scott MacDonald, Anna Gallagher, Lauren McNicholl, Luke McElroy, Rebecca Hughes, Tara Quasim, Susan Moug","doi":"10.1186/s13017-025-00598-3","DOIUrl":"https://doi.org/10.1186/s13017-025-00598-3","url":null,"abstract":"Restoration of intestinal continuity is a key consideration for patients having a stoma created under emergency conditions. There is contrasting evidence about the outcomes of stoma reversal for these patients. This research aims to describe the post-operative outcomes of stoma reversal after emergency formation, and whether these are affected by the timing of reversal. A retrospective review of a prospectively maintained emergency laparotomy (EmLap) database for 4 hospitals was performed between 2018 and 2021. Adult patients undergoing emergency stoma formation were identified and followed up until 2024. Those undergoing stoma reversal surgery were included in the final analysis. A Cox proportional-hazards model was created to identify factors associated with increased time to reversal. 1775 patients had an EmLap, with 505 (28.5%) having a stoma created. Of those patients with a stoma, 97 patients (19.2%) died within one year post-operatively. 146 (28.9%) of the emergency stoma patients underwent stoma reversal, with median time to reversal of 16.9 months. Median post-operative length of stay was 7 days, and 52.1% of patients sustained complications within 30 days post-operatively. Patients reversed within 18 months of stoma formation had fewer significant complications (7.9% v 35.1%, p < 0.001), a shorter length of stay (6 days v 7 days, p < 0.001), and reduced post-operative ileus rates (21.3% v 64.9%, p < 0.001) than those reversed after this period. Receiving adjuvant therapy for malignancy (adjusted Hazard ratio 0.36, 0.17–0.78, p = 0.001) and being male (adjusted Hazard ratio 0.69, 0.49–0.97, p = 0.032) were significantly associated with increased time to reversal. Emergency stoma formation is commonly performed during EmLap, but the majority of emergency stomas are never reversed. The complication profile for reversing these stomas is significant, but early reversal is associated with better post-operative outcomes. Standards of care for emergency stoma patients would be welcome in order to improve outcomes for this cohort.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"217 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143734007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aims to provide a meta-analysis of randomized controlled trials (RCTs) comparing non-operative management (NOM) and operative management (OM) in a pediatric population with uncomplicated acute appendicitis. A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and Meta-analyses of Observational Studies in Epidemiology (MOOSE) guidelines. A comprehensive search was conducted in MEDLINE, Embase, and CENTRAL from inception to June 2024. Only randomized controlled trials (RCTs) were included, excluding studies involving adult patients and/or participants with complicated appendicitis. The variables considered were treatment complications, treatment efficacy during index admission and one-year follow-up, length of hospital stay (LOS), quality of life, and presence of appendicoliths. Three RCTs involving 269 participants (134 antibiotics/135 appendectomy) were included. There was no statistically significant difference between the two treatments in terms of complication risk (combined RD = − 0.03; 95% CI − 0.11; 0.06, p = 0.54), even including complications related to NOM failure. The risk of complication-free treatment success rate in the antibiotic group is lower than in the surgery group (combined RD = − 0.05; 95% CI − 0.13; − 0.04; p = 0.29). In patients without appendicolith, the combined risk difference of treatment success between NOM and OM was not statistically significant − 0.01 (IC − 0.17; 0.16; p value: 0.93). There is no statistical difference in terms of efficacy at 1 year, between NOM and OM (combined RD = − 0.06; 95% CI − 0.21; 0.09), p = 0.44). The LOS in the NOM group is significantly longer than in the OM group (difference of median = − 19.90 h; 95% CI − 29.27; − 10.53, p < .0001). This systematic review and meta-analysis provide evidence that NOM is safe and feasible for children with uncomplicated appendicitis and, in the group of patients without appendicolith, it is associated with a similar success rate to OM. However, more high-quality studies with adequate power and construction are still needed.
本研究旨在对随机对照试验（RCT）进行荟萃分析，比较非手术治疗（NOM）和手术治疗（OM）在无并发症急性阑尾炎儿科患者中的应用。根据《系统综述和元分析首选报告项目》（PRISMA）和《流行病学观察性研究元分析》（MOOSE）指南进行了系统性文献综述。从开始到 2024 年 6 月，我们在 MEDLINE、Embase 和 CENTRAL 中进行了全面检索。只纳入了随机对照试验（RCT），排除了涉及成年患者和/或患有复杂性阑尾炎的参与者的研究。研究考虑的变量包括治疗并发症、指标入院和一年随访期间的治疗效果、住院时间（LOS）、生活质量以及是否存在阑尾结石。共纳入了三项研究，涉及 269 名参与者（134 名抗生素患者/135 名阑尾切除术患者）。两种治疗方法在并发症风险方面没有统计学意义上的显著差异（合并 RD = - 0.03; 95% CI - 0.11; 0.06, p = 0.54），甚至包括与 NOM 失败相关的并发症。抗生素组的无并发症治疗成功率风险低于手术组（合并 RD = - 0.05; 95% CI - 0.13; - 0.04; p = 0.29）。在无阑尾结石的患者中，NOM 和 OM 治疗成功率的综合风险差异无统计学意义-0.01（IC - 0.17; 0.16; p 值：0.93）。就 1 年疗效而言，NOM 和 OM 没有统计学差异（合并 RD = - 0.06；95% CI - 0.21；0.09），P = 0.44）。NOM 组的 LOS 明显长于 OM 组（中位数差异 = - 19.90 h；95% CI - 29.27; - 10.53，p < .0001）。本系统综述和荟萃分析提供的证据表明，NOM 对无并发症阑尾炎患儿是安全可行的，而且在无阑尾结石的患者组中，其成功率与 OM 相似。不过，仍需进行更多高质量、有足够力量和结构的研究。
{"title":"Non-operative management of uncomplicated appendicitis in children, why not? A meta-analysis of randomized controlled trials","authors":"Francesco Brucchi, Claudia Filisetti, Ester Luconi, Paola Fugazzola, Dario Cattaneo, Luca Ansaloni, Gianvincenzo Zuccotti, Simona Ferraro, Piergiorgio Danelli, Gloria Pelizzo","doi":"10.1186/s13017-025-00584-9","DOIUrl":"https://doi.org/10.1186/s13017-025-00584-9","url":null,"abstract":"This study aims to provide a meta-analysis of randomized controlled trials (RCTs) comparing non-operative management (NOM) and operative management (OM) in a pediatric population with uncomplicated acute appendicitis. A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and Meta-analyses of Observational Studies in Epidemiology (MOOSE) guidelines. A comprehensive search was conducted in MEDLINE, Embase, and CENTRAL from inception to June 2024. Only randomized controlled trials (RCTs) were included, excluding studies involving adult patients and/or participants with complicated appendicitis. The variables considered were treatment complications, treatment efficacy during index admission and one-year follow-up, length of hospital stay (LOS), quality of life, and presence of appendicoliths. Three RCTs involving 269 participants (134 antibiotics/135 appendectomy) were included. There was no statistically significant difference between the two treatments in terms of complication risk (combined RD = − 0.03; 95% CI − 0.11; 0.06, p = 0.54), even including complications related to NOM failure. The risk of complication-free treatment success rate in the antibiotic group is lower than in the surgery group (combined RD = − 0.05; 95% CI − 0.13; − 0.04; p = 0.29). In patients without appendicolith, the combined risk difference of treatment success between NOM and OM was not statistically significant − 0.01 (IC − 0.17; 0.16; p value: 0.93). There is no statistical difference in terms of efficacy at 1 year, between NOM and OM (combined RD = − 0.06; 95% CI − 0.21; 0.09), p = 0.44). The LOS in the NOM group is significantly longer than in the OM group (difference of median = − 19.90 h; 95% CI − 29.27; − 10.53, p < .0001). This systematic review and meta-analysis provide evidence that NOM is safe and feasible for children with uncomplicated appendicitis and, in the group of patients without appendicolith, it is associated with a similar success rate to OM. However, more high-quality studies with adequate power and construction are still needed.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"1 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143695134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-20DOI: 10.1186/s13017-025-00600-y
Jiliang Shen, Chengcheng Wu, Xiaochen Zhang, Yaoting Xue, Jin Yang
Intestinal perforation and intestinal obstruction are common emergency surgeries in clinics which often require intestinal resection and anastomosis. Most intestinal anastomosis can be completed by laparoscopy. The wound closure module In the Fundamentals of Laparoscopic Surgery (FLS) program is traditionally used for laparoscopic suture and knotting training. However, many young surgeons tend to focus on practicing suture techniques from certain or a limited range of angles. This narrow approach increases the difficulty of complex suturing and knotting in clinical scenarios such as laparoscopic intestinal anastomosis. To address this issue, we designed a multi-angle suture module specifically for suture and knotting training. Thirty-six second-year surgical residents were recruited for the study. Twelve residents were randomly divided at a 1:1 ratio into the traditional suture group and the multi-angle suture group according to their basic laparoscopic surgical ability. After training, they were required to perform laparoscopic end-to-end anastomosis surgery on isolated swine intestines. The operation times, goal scores and surgical performance scores of the surgeries were collected and compared. Trainees who used the multi-angle suture training module shortened the operation time (3375.7 ± 1000 s vs. 4678.2 ± 684.7, p = 0.008) and achieved better surgical effects (operation performance score: 8.2 ± 1.5 vs. 6.83 ± 1.3, p = 0.041) in end‒end intestine anastomosis surgery than did those who used the traditional suture training module. The multi-angle suture training module effectively improved the laparoscopic suture skills of trainees and is therefore a better choice for laparoscopic suture and knotting training before doing laparoscopic intestinal anastomosis.
{"title":"A modified multi-angle suture training module for laparoscopic training curriculum on emergency intestinal surgery","authors":"Jiliang Shen, Chengcheng Wu, Xiaochen Zhang, Yaoting Xue, Jin Yang","doi":"10.1186/s13017-025-00600-y","DOIUrl":"https://doi.org/10.1186/s13017-025-00600-y","url":null,"abstract":"Intestinal perforation and intestinal obstruction are common emergency surgeries in clinics which often require intestinal resection and anastomosis. Most intestinal anastomosis can be completed by laparoscopy. The wound closure module In the Fundamentals of Laparoscopic Surgery (FLS) program is traditionally used for laparoscopic suture and knotting training. However, many young surgeons tend to focus on practicing suture techniques from certain or a limited range of angles. This narrow approach increases the difficulty of complex suturing and knotting in clinical scenarios such as laparoscopic intestinal anastomosis. To address this issue, we designed a multi-angle suture module specifically for suture and knotting training. Thirty-six second-year surgical residents were recruited for the study. Twelve residents were randomly divided at a 1:1 ratio into the traditional suture group and the multi-angle suture group according to their basic laparoscopic surgical ability. After training, they were required to perform laparoscopic end-to-end anastomosis surgery on isolated swine intestines. The operation times, goal scores and surgical performance scores of the surgeries were collected and compared. Trainees who used the multi-angle suture training module shortened the operation time (3375.7 ± 1000 s vs. 4678.2 ± 684.7, p = 0.008) and achieved better surgical effects (operation performance score: 8.2 ± 1.5 vs. 6.83 ± 1.3, p = 0.041) in end‒end intestine anastomosis surgery than did those who used the traditional suture training module. The multi-angle suture training module effectively improved the laparoscopic suture skills of trainees and is therefore a better choice for laparoscopic suture and knotting training before doing laparoscopic intestinal anastomosis.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"12 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-18DOI: 10.1186/s13017-025-00589-4
Aurélie Gouel-Chéron, Kankoe Sallah, Saiba Sawadogo, Axelle Dupont, Philippe Montravers
The COVID-19 pandemic significantly disrupted healthcare systems. In France, non-urgent procedures were postponed, leading to a 52% decrease in elective surgical activity in public hospitals in Paris during the first wave. We aimed to assess the impact on gastro-intestinal emergency surgeries of health strategies implemented during this pandemic. This multicenter retrospective cohort study enrolled patients from sixteen public hospitals over five periods: March and April, 2018, and 2019 (pre-pandemic), 2020 (first wave), 2021 (third wave), and 2022 (post-pandemic). All adult patients requiring urgent gastrointestinal surgery admitted through the Emergency Department were included. Statistical tests were performed with the chi-square test, ANOVA test, Student test, Kruskall Wallis or Fisher exact test. Univariate and multivariate logistic regression were performed to investigate the relationship between mortality at day 90 and the primary data recorded. 2692 patients’ stay were included: 54% male, median age 48 [32;68], 12% ICU admission rate, median Charlson score 2 [0;5], and 6% mortality rate at day 90. The number of abdominal emergency cases decreased during the first wave (− 37% in 2020 compared to 2019). In the multivariate regression model, ICU admission, Charlson comorbidity score, and surgery in 2020 were independently associated with mortality at day 90 (as hospital length of stay, to a lower extent). Undergoing emergency surgery during the first lockdown was an independent mortality risk factor, independent of the COVID-19 infectious status. Whatever major healthcare issue is ongoing, all efforts should be made to maintain healthcare access to all, including urgent surgical procedures. Trial registration: Not applicable.
{"title":"Impact of COVID-19 on urgent gastrointestinal surgery outcomes: increased mortality in 2020","authors":"Aurélie Gouel-Chéron, Kankoe Sallah, Saiba Sawadogo, Axelle Dupont, Philippe Montravers","doi":"10.1186/s13017-025-00589-4","DOIUrl":"https://doi.org/10.1186/s13017-025-00589-4","url":null,"abstract":"The COVID-19 pandemic significantly disrupted healthcare systems. In France, non-urgent procedures were postponed, leading to a 52% decrease in elective surgical activity in public hospitals in Paris during the first wave. We aimed to assess the impact on gastro-intestinal emergency surgeries of health strategies implemented during this pandemic. This multicenter retrospective cohort study enrolled patients from sixteen public hospitals over five periods: March and April, 2018, and 2019 (pre-pandemic), 2020 (first wave), 2021 (third wave), and 2022 (post-pandemic). All adult patients requiring urgent gastrointestinal surgery admitted through the Emergency Department were included. Statistical tests were performed with the chi-square test, ANOVA test, Student test, Kruskall Wallis or Fisher exact test. Univariate and multivariate logistic regression were performed to investigate the relationship between mortality at day 90 and the primary data recorded. 2692 patients’ stay were included: 54% male, median age 48 [32;68], 12% ICU admission rate, median Charlson score 2 [0;5], and 6% mortality rate at day 90. The number of abdominal emergency cases decreased during the first wave (− 37% in 2020 compared to 2019). In the multivariate regression model, ICU admission, Charlson comorbidity score, and surgery in 2020 were independently associated with mortality at day 90 (as hospital length of stay, to a lower extent). Undergoing emergency surgery during the first lockdown was an independent mortality risk factor, independent of the COVID-19 infectious status. Whatever major healthcare issue is ongoing, all efforts should be made to maintain healthcare access to all, including urgent surgical procedures. Trial registration: Not applicable.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"7 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143640860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-17DOI: 10.1186/s13017-025-00590-x
Federico Coccolini, Etrusca Brogi, Marco Ceresoli, Fausto Catena, Angela Gurrado, Francesco Forfori, Lorenzo Ghiadoni, Ettore Melai, Massimo Sartelli
Intra-abdominal infections (IAIs) are common and severe surgical emergencies associated with high morbidity and mortality. In recent years, there has been a worldwide increase in antimicrobial resistance associated with intra-abdominal infections, responsible for a significant increase in mortality rates. To improve the quality of treatment, it is crucial to understand the underlying local epidemiology, clinical implications, and proper management of antimicrobial resistance, for both community- and hospital-acquired infections. The IRIS study (Italian Register of Complicated Intra-abdominal InfectionS) aims to investigate the epidemiology and initial management of complicated IAIs (cIAIs) in Italy. This is a prospective, observational, nationwide (Italy), multicentre study. approved by the coordinating centre ethic committee (Local Research Ethics Committee of Pisa (Prot n 56478//2019). All consecutively hospitalized patients (older than 16 years of age) with diagnosis of cIAIs undergoing surgery, interventional drainage or conservative treatment have been included. 4530 patients included from 23 different Italian hospitals. Community Acquired infection represented the 70.9% of all the cases. Among appendicitis, we found that 98.2% of the cases were community acquired (CA) and 1.8% Healthcare-associated (HA) infections. We observed that CA represented the 94.2% and HA 5.8% of Gastro Duodenal perforation cases. The majority of HA infections were represented by colonic perforation and diverticulitis (28.3%) followed by small bowel occlusion (19%) and intestinal ischemia (18%). 27.8% of patients presented in septic shock. Microbiological Samples were collected from 3208 (70.8%) patients. Among 3041 intrabdominal sample 48.8% resulted positive. The major pathogens involved in intra-abdominal infections were found to be E.coli (45.6%). During hospital stay, empiric antimicrobial therapy was administered in 78.4% of patients. Amoxicillin/clavulanate was the most common antibiotic used (in 30.1% appendicitis, 30% bowel occlusion, 30.5% of cholecystitis, 51% complicated abdominal wall hernia, 55% small bowel perforation) followed by piperacillin/tazobactam (13.3% colonic perforation and diverticulitis, 22.6% cholecystitis, 24.2% intestinal ischemia, 28.6% pancreatitis). Empiric antifungal therapy was administered in 2.6% of patients with no sign of sepsis, 3.1% of patients with clinical sign of sepsis and 4.1% of patients with septic shock. Azoles was administered in 49.2% of patients that received empiric antifungal therapy. The overall mortality rate was 5.13% (235/4350). 16.5% of patients required ICU (748/4350). In accordance with mortality, it is important to highlight that 35.7% of small bowel perforation, 27.6% of colonic perforation and diverticulitis, 25.6% of intestinal ischemia and 24.6% of gastroduodenal complications required ICU. Antibiotic stewardship programs and correct antimicrobial and antimycotic prescription campaigns are necessary
{"title":"Epidemiological analysis of intra-abdominal infections in Italy from the Italian register of complicated intra-abdominal infections—the IRIS study: a prospective observational nationwide study","authors":"Federico Coccolini, Etrusca Brogi, Marco Ceresoli, Fausto Catena, Angela Gurrado, Francesco Forfori, Lorenzo Ghiadoni, Ettore Melai, Massimo Sartelli","doi":"10.1186/s13017-025-00590-x","DOIUrl":"https://doi.org/10.1186/s13017-025-00590-x","url":null,"abstract":"Intra-abdominal infections (IAIs) are common and severe surgical emergencies associated with high morbidity and mortality. In recent years, there has been a worldwide increase in antimicrobial resistance associated with intra-abdominal infections, responsible for a significant increase in mortality rates. To improve the quality of treatment, it is crucial to understand the underlying local epidemiology, clinical implications, and proper management of antimicrobial resistance, for both community- and hospital-acquired infections. The IRIS study (Italian Register of Complicated Intra-abdominal InfectionS) aims to investigate the epidemiology and initial management of complicated IAIs (cIAIs) in Italy. This is a prospective, observational, nationwide (Italy), multicentre study. approved by the coordinating centre ethic committee (Local Research Ethics Committee of Pisa (Prot n 56478//2019). All consecutively hospitalized patients (older than 16 years of age) with diagnosis of cIAIs undergoing surgery, interventional drainage or conservative treatment have been included. 4530 patients included from 23 different Italian hospitals. Community Acquired infection represented the 70.9% of all the cases. Among appendicitis, we found that 98.2% of the cases were community acquired (CA) and 1.8% Healthcare-associated (HA) infections. We observed that CA represented the 94.2% and HA 5.8% of Gastro Duodenal perforation cases. The majority of HA infections were represented by colonic perforation and diverticulitis (28.3%) followed by small bowel occlusion (19%) and intestinal ischemia (18%). 27.8% of patients presented in septic shock. Microbiological Samples were collected from 3208 (70.8%) patients. Among 3041 intrabdominal sample 48.8% resulted positive. The major pathogens involved in intra-abdominal infections were found to be E.coli (45.6%). During hospital stay, empiric antimicrobial therapy was administered in 78.4% of patients. Amoxicillin/clavulanate was the most common antibiotic used (in 30.1% appendicitis, 30% bowel occlusion, 30.5% of cholecystitis, 51% complicated abdominal wall hernia, 55% small bowel perforation) followed by piperacillin/tazobactam (13.3% colonic perforation and diverticulitis, 22.6% cholecystitis, 24.2% intestinal ischemia, 28.6% pancreatitis). Empiric antifungal therapy was administered in 2.6% of patients with no sign of sepsis, 3.1% of patients with clinical sign of sepsis and 4.1% of patients with septic shock. Azoles was administered in 49.2% of patients that received empiric antifungal therapy. The overall mortality rate was 5.13% (235/4350). 16.5% of patients required ICU (748/4350). In accordance with mortality, it is important to highlight that 35.7% of small bowel perforation, 27.6% of colonic perforation and diverticulitis, 25.6% of intestinal ischemia and 24.6% of gastroduodenal complications required ICU. Antibiotic stewardship programs and correct antimicrobial and antimycotic prescription campaigns are necessary ","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"69 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143635684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-11DOI: 10.1186/s13017-025-00596-5
Larissa Sztulman, Aileen Ritter, Roberta de Rosa, Victoria Pfeiffer, Liudmila Leppik, Lewin-Caspar Busse, Elena Kontaxi, Philipp Störmann, René Verboket, Elisabeth Adam, Ingo Marzi, Birte Weber
Heart injuries following polytrauma (PT) are identified as a predictor of poor outcome. The diagnostic algorithm of cardiac damage after trauma consists of the systemic measurement of cardiac damage markers, a 3-channel ECG and if there are any suspicious findings, the conduction of a transthoracic echocardiography (TTE). The aim of this study was to implement a systematic analysis of cardiac function using TTE in PT-patients. This study is a prospective non-randomized study, conducted in a German Level 1 Trauma Centre between January and July 2024. All polytraumatized patients with an ISS ≥ 16 were included immediately after entering the emergency department. Blood samples were withdrawn at 6 timepoints, at the Emergency room, 24 h, 48 h, three, five and ten days after admission to the hospital. Cardiac damage was measured by Troponin T (TnT) ECLIA, as well as NT-proBNP measurements. Entering the intensive care unit, transthoracic echocardiography was performed at two time points (day 1 and 2), by an experienced Cardiologist. During the pilot phase, cardiac contusion was detected in 14.3% of patients, with significantly elevated TnT levels on arrival, after 24 (**p ≤ 0.01) and 48 h (*p ≤ 0.05) compared to patients without cardiac contusion. Echocardiographic findings revealed that 25% of all patients had wall motion abnormalities, and 20% showed relaxation disorders. Right ventricular function, measured by TAPSE (tricuspid annular plane systolic excursion), RVEDD (right ventricular end diastolic diameter) and sPAP (systolic pulmonary arterial pressure), was slightly impaired in trauma patients, while the left ventricular function (ejection fraction (EF) and left ventricular end diastolic diameter (LVEDD)) was preserved. We observed the increase of TnT and an increase of the heart failure marker NT-proBNP over the time. These biomarkers were associated with pre-existing cardiac risk factors, the ISS and changes in the right or left ventricular function. Mitral valve insufficiency (grade 1) was present in 50% and tricuspid valve (grade 1) insufficiency in 30%. Taken together, we conducted for the first time of our knowledge, a systematic TTE analysis in PT-patients. We observed a slightly reduced right ventricular function, as well as mitral and tricuspid valve regurgitations in the patients.
{"title":"Cardiac damage after polytrauma: the role of systematic transthoracic echocardiography - a pilot study","authors":"Larissa Sztulman, Aileen Ritter, Roberta de Rosa, Victoria Pfeiffer, Liudmila Leppik, Lewin-Caspar Busse, Elena Kontaxi, Philipp Störmann, René Verboket, Elisabeth Adam, Ingo Marzi, Birte Weber","doi":"10.1186/s13017-025-00596-5","DOIUrl":"https://doi.org/10.1186/s13017-025-00596-5","url":null,"abstract":"Heart injuries following polytrauma (PT) are identified as a predictor of poor outcome. The diagnostic algorithm of cardiac damage after trauma consists of the systemic measurement of cardiac damage markers, a 3-channel ECG and if there are any suspicious findings, the conduction of a transthoracic echocardiography (TTE). The aim of this study was to implement a systematic analysis of cardiac function using TTE in PT-patients. This study is a prospective non-randomized study, conducted in a German Level 1 Trauma Centre between January and July 2024. All polytraumatized patients with an ISS ≥ 16 were included immediately after entering the emergency department. Blood samples were withdrawn at 6 timepoints, at the Emergency room, 24 h, 48 h, three, five and ten days after admission to the hospital. Cardiac damage was measured by Troponin T (TnT) ECLIA, as well as NT-proBNP measurements. Entering the intensive care unit, transthoracic echocardiography was performed at two time points (day 1 and 2), by an experienced Cardiologist. During the pilot phase, cardiac contusion was detected in 14.3% of patients, with significantly elevated TnT levels on arrival, after 24 (**p ≤ 0.01) and 48 h (*p ≤ 0.05) compared to patients without cardiac contusion. Echocardiographic findings revealed that 25% of all patients had wall motion abnormalities, and 20% showed relaxation disorders. Right ventricular function, measured by TAPSE (tricuspid annular plane systolic excursion), RVEDD (right ventricular end diastolic diameter) and sPAP (systolic pulmonary arterial pressure), was slightly impaired in trauma patients, while the left ventricular function (ejection fraction (EF) and left ventricular end diastolic diameter (LVEDD)) was preserved. We observed the increase of TnT and an increase of the heart failure marker NT-proBNP over the time. These biomarkers were associated with pre-existing cardiac risk factors, the ISS and changes in the right or left ventricular function. Mitral valve insufficiency (grade 1) was present in 50% and tricuspid valve (grade 1) insufficiency in 30%. Taken together, we conducted for the first time of our knowledge, a systematic TTE analysis in PT-patients. We observed a slightly reduced right ventricular function, as well as mitral and tricuspid valve regurgitations in the patients.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"192 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143589749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-10DOI: 10.1186/s13017-025-00597-4
Deena P. Harji, Ben Griffiths, Deborah Stocken, Rupert Pearse, Jane Blazeby, Julia M. Brown
Emergency laparotomy (EmLap) is a complex clinical arena, delivering time-sensitive, definitive care to a high-risk patient cohort, with significant rates of post-operative morbidity and mortality. Embedding perioperative care pathways within this complex setting has the potential to improve post-operative outcomes, however, requires an in-depth understanding of their design, delivery and outcome assessment. Delivering and implementing complex interventions such as perioperative pathways require transparent reporting with detailed and indepth description of all components during the assessment and evaluation phase. The aim of this systematic review was to identify the current design and reporting of perioperative pathways in the EmLap setting. The OVID SP versions of MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched between January 1950 and December 2023. All randomised and non-randomised cohort studies reporting outcomes on perioperative care pathways in adult patients (> 18 years old) undergoing major emergency abdominal surgery were included. A narrative description of all perioperative pathways included was reported to identify design and description of the pathway including the delivery and timing of component interventions. All pathways were evaluated against the Template for Intervention Description and Replication (TIDieR) checklist. Eleven RCTs and 19 non-randomised studies were identified, with most studies considered to be at moderate risk of bias. Twenty-six unique pathways were identified and described, delivering a total of 400 component interventions across 44,055 patients. Component interventions were classified into 24 domains across the perioperative pathway. Twenty studies (66.6%) did not report the TIDieR framework items, with thirteen studies reporting less than 50% of all items. Two hundred and fifty individual outcomes were reported across pathways, with the most commonly reported outcomes related to morbidity, mortality and length of stay. Current perioperative pathways in EmLap setting are underpinned by variable component interventions, with a lack of in-depth intervention reporting and evaluation. Future studies should incorporate the TIDieR checklist when reporting on perioperative pathways in the EmLap setting. Not applicable.
{"title":"Key interventions and outcomes in perioperative care pathways in emergency laparotomy: a systematic review","authors":"Deena P. Harji, Ben Griffiths, Deborah Stocken, Rupert Pearse, Jane Blazeby, Julia M. Brown","doi":"10.1186/s13017-025-00597-4","DOIUrl":"https://doi.org/10.1186/s13017-025-00597-4","url":null,"abstract":"Emergency laparotomy (EmLap) is a complex clinical arena, delivering time-sensitive, definitive care to a high-risk patient cohort, with significant rates of post-operative morbidity and mortality. Embedding perioperative care pathways within this complex setting has the potential to improve post-operative outcomes, however, requires an in-depth understanding of their design, delivery and outcome assessment. Delivering and implementing complex interventions such as perioperative pathways require transparent reporting with detailed and indepth description of all components during the assessment and evaluation phase. The aim of this systematic review was to identify the current design and reporting of perioperative pathways in the EmLap setting. The OVID SP versions of MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched between January 1950 and December 2023. All randomised and non-randomised cohort studies reporting outcomes on perioperative care pathways in adult patients (> 18 years old) undergoing major emergency abdominal surgery were included. A narrative description of all perioperative pathways included was reported to identify design and description of the pathway including the delivery and timing of component interventions. All pathways were evaluated against the Template for Intervention Description and Replication (TIDieR) checklist. Eleven RCTs and 19 non-randomised studies were identified, with most studies considered to be at moderate risk of bias. Twenty-six unique pathways were identified and described, delivering a total of 400 component interventions across 44,055 patients. Component interventions were classified into 24 domains across the perioperative pathway. Twenty studies (66.6%) did not report the TIDieR framework items, with thirteen studies reporting less than 50% of all items. Two hundred and fifty individual outcomes were reported across pathways, with the most commonly reported outcomes related to morbidity, mortality and length of stay. Current perioperative pathways in EmLap setting are underpinned by variable component interventions, with a lack of in-depth intervention reporting and evaluation. Future studies should incorporate the TIDieR checklist when reporting on perioperative pathways in the EmLap setting. Not applicable.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"21 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Coagulopathy, inflammation and organ failure are common complications in trauma patients. This study aimed to explore the possible role of muscle injury indicators in early coagulopathy, systemic inflammatory response syndrome (SIRS), and acute kidney injury (AKI) in patients with severe multiple trauma. A retrospective analysis was performed using trauma center patient data from 2020 to 2023. The incidence of coagulopathy, SIRS and AKI in patients with multiple injuries were assessed. The relationship between Myoglobin, creatine kinase (CK), lactate dehydrogenase (LDH) and trauma severity was investigated, and the influence of these three muscle injury indicators on patient adverse outcomes was analyzed. A total of 312 patients with severe multiple injuries were included in this study, with an average age of 51.7 and a median Injury Severity Score (ISS) of 22.5. Among them, 115 patients developed coagulopathy, 169 patients developed SIRS, 26 patients developed AKI, and 11 patients died during hospitalization. We found that Myoglobin (r = 0.225, P < 0.001), CK (r = 0.204, P < 0.001), LDH (r = 0.175, P = 0.002) were positively correlated with ISS. Myoglobin is an independent risk factor for coagulopathy (OR = 1.90, 95%CI: 1.45–2.49), SIRS (OR = 1.41, 95%CI: 1.10–1.79), and AKI (OR = 4.17, 95%CI: 2.19–7.95). CK is an independent risk factor for coagulopathy (OR = 1.30, 95%CI: 1.00-1.67), while LDH is an independent risk factor for SIRS (OR = 1.49, 95%CI: 1.17–1.89) and AKI (OR = 2.30, 95%CI: 1.43–3.69). Especially for AKI, Myoglobin had a good predictive effect (AUC = 0.804, 95%CI:0.716–0.891). The best cut-off value is when the Myoglobin value is 931.11 µg/L, at which point the sensitivity is 61.53% and the specificity is 87.41%. The admission muscle injury index can predict trauma complications such as AKI, early coagulation disease, and SIRS, especially AKI. Compared to CK and LDH, admission myoglobin can predict complications remarkably, even better than ISS, especially AKI. Routine testing of muscle injury indicators upon admission is meaningful and can help physicians identify and prevent the occurrence of complications.
{"title":"Role of the admission muscle injury indicators in early coagulopathy, inflammation and acute kidney injury in patients with severe multiple injuries","authors":"Liuquan Mu, Haideng Song, Mengdi Jin, Kaige Li, Yushan Guo, Nan Jiang","doi":"10.1186/s13017-025-00593-8","DOIUrl":"https://doi.org/10.1186/s13017-025-00593-8","url":null,"abstract":"Coagulopathy, inflammation and organ failure are common complications in trauma patients. This study aimed to explore the possible role of muscle injury indicators in early coagulopathy, systemic inflammatory response syndrome (SIRS), and acute kidney injury (AKI) in patients with severe multiple trauma. A retrospective analysis was performed using trauma center patient data from 2020 to 2023. The incidence of coagulopathy, SIRS and AKI in patients with multiple injuries were assessed. The relationship between Myoglobin, creatine kinase (CK), lactate dehydrogenase (LDH) and trauma severity was investigated, and the influence of these three muscle injury indicators on patient adverse outcomes was analyzed. A total of 312 patients with severe multiple injuries were included in this study, with an average age of 51.7 and a median Injury Severity Score (ISS) of 22.5. Among them, 115 patients developed coagulopathy, 169 patients developed SIRS, 26 patients developed AKI, and 11 patients died during hospitalization. We found that Myoglobin (r = 0.225, P < 0.001), CK (r = 0.204, P < 0.001), LDH (r = 0.175, P = 0.002) were positively correlated with ISS. Myoglobin is an independent risk factor for coagulopathy (OR = 1.90, 95%CI: 1.45–2.49), SIRS (OR = 1.41, 95%CI: 1.10–1.79), and AKI (OR = 4.17, 95%CI: 2.19–7.95). CK is an independent risk factor for coagulopathy (OR = 1.30, 95%CI: 1.00-1.67), while LDH is an independent risk factor for SIRS (OR = 1.49, 95%CI: 1.17–1.89) and AKI (OR = 2.30, 95%CI: 1.43–3.69). Especially for AKI, Myoglobin had a good predictive effect (AUC = 0.804, 95%CI:0.716–0.891). The best cut-off value is when the Myoglobin value is 931.11 µg/L, at which point the sensitivity is 61.53% and the specificity is 87.41%. The admission muscle injury index can predict trauma complications such as AKI, early coagulation disease, and SIRS, especially AKI. Compared to CK and LDH, admission myoglobin can predict complications remarkably, even better than ISS, especially AKI. Routine testing of muscle injury indicators upon admission is meaningful and can help physicians identify and prevent the occurrence of complications.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"37 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143569457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-06DOI: 10.1186/s13017-025-00579-6
Emily Kelly, Angus Lloyd, Daniah Alsaadi, Ian Stephens, Michael Sugrue
There has been a slow uptake of wound bundles and prophylactic mesh augmentation (PMA) strategies despite evidence supporting their role in reducing burst abdomens and incisional hernias (IH). This study evaluates outcomes of resorbable synthetic prophylactic mesh augmentation in reducing these rates and assesses the complication profile in emergency abdominal surgery. A retrospective ethically approved observational study of all patients who underwent emergency open abdominal surgery using supplemental prophylactic onlay TIGR® Mesh at Letterkenny University Hospital between September 2017 and April 2024 was undertaken to assess safety, complication profiles and outcomes. Comprehensive wound bundles and subcutaneous space closure were used. Of the 49 patients included, the mean age was 64 years (± 16.4, 31–86), 33/49 (67%) were female, and the mean body mass index (BMI) was 27 (± 7.4,17.3–45). 20% of patients had previous abdominal surgery. 19/49 (38%) patients experienced postoperative complications, of these 8 (42%) were Clavien-Dindo Grade I-II, and 11 (58%) were Grade III-IV. There were 7 in-hospital post-operative deaths (Grade V). 8 patients had open abdomens. Thirteen surgical site occurrences (SSO) were identified in 9 (18%) patients. There were no burst abdomens. Four of the superficial SSIs responded to antibiotics while one required opening and wound NPWT. Three patients (6%) developed an incisional hernia, which was detected at a mean follow-up of 353 days. A comprehensive, evidence-based wound bundle using onlay PMA with a synthetic resorbable mesh, achieves efficacious, safe abdominal wall closure in high-risk, emergency laparotomy patients, including those who require delayed abdominal wall closure.
{"title":"Safety and efficacy of prophylactic onlay resorbable synthetic mesh with a comprehensive wound bundle at laparotomy closure in high-risk emergency abdominal surgery: an observational study","authors":"Emily Kelly, Angus Lloyd, Daniah Alsaadi, Ian Stephens, Michael Sugrue","doi":"10.1186/s13017-025-00579-6","DOIUrl":"https://doi.org/10.1186/s13017-025-00579-6","url":null,"abstract":"There has been a slow uptake of wound bundles and prophylactic mesh augmentation (PMA) strategies despite evidence supporting their role in reducing burst abdomens and incisional hernias (IH). This study evaluates outcomes of resorbable synthetic prophylactic mesh augmentation in reducing these rates and assesses the complication profile in emergency abdominal surgery. A retrospective ethically approved observational study of all patients who underwent emergency open abdominal surgery using supplemental prophylactic onlay TIGR® Mesh at Letterkenny University Hospital between September 2017 and April 2024 was undertaken to assess safety, complication profiles and outcomes. Comprehensive wound bundles and subcutaneous space closure were used. Of the 49 patients included, the mean age was 64 years (± 16.4, 31–86), 33/49 (67%) were female, and the mean body mass index (BMI) was 27 (± 7.4,17.3–45). 20% of patients had previous abdominal surgery. 19/49 (38%) patients experienced postoperative complications, of these 8 (42%) were Clavien-Dindo Grade I-II, and 11 (58%) were Grade III-IV. There were 7 in-hospital post-operative deaths (Grade V). 8 patients had open abdomens. Thirteen surgical site occurrences (SSO) were identified in 9 (18%) patients. There were no burst abdomens. Four of the superficial SSIs responded to antibiotics while one required opening and wound NPWT. Three patients (6%) developed an incisional hernia, which was detected at a mean follow-up of 353 days. A comprehensive, evidence-based wound bundle using onlay PMA with a synthetic resorbable mesh, achieves efficacious, safe abdominal wall closure in high-risk, emergency laparotomy patients, including those who require delayed abdominal wall closure.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"53 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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