BACKGROUNDIndividualized management of early fluid therapy in acute pancreatitis (AP) remains challenging. Traditional studies primarily focus on static fluid balance, overlooking the heterogeneity of dynamic trajectories.METHODSBased on a single-center retrospective cohort, 3,142 AP patients admitted within 72 h of onset were included. Daily fluid therapy-to-body weight ratio (FWR) and CumFWR (trapezoidal AUC) were calculated. Latent Class Growth Modeling (LCGM) identified dynamic FWR trajectories within 72 h. Multivariate Cox regression analyzed the relationship between FWR and in-hospital mortality risk. Three-dimensional fitted surface plot analysis evaluated interactions between CumFWR and hematocrit.RESULTSLCGM successfully identified five distinct dynamic fluid therapy trajectories within 72 h, showing significant clinical differences: Low Stable Group (LSG1, n = 229, 7.3%), Low-Moderate Sustained Group (LMSG2, n = 340, 10.8%), Moderate Stable Group (MSG3, n = 2073, 66.0%), Moderate-High Fluctuating Group (MHFG4, n = 231, 7.4%), and High Sustained Group (HSG5, n = 269, 8.6%). Multivariate Cox regression revealed significantly increased in-hospital mortality risk compared to MSG3 for both MHFG4 (adjusted HR = 2.08, 95%CI 1.15-3.78) and HSG5 (adjusted HR = 2.91, 95%CI 1.77-4.79). Furthermore, each 1 standard deviation increase in CumFWR was associated with a 47% increased mortality risk (HR = 1.47, 95%CI 1.26-1.72). Three-dimensional fitted surface plot demonstrated high mortality risk between high CumFWR and abnormal hematocrit (low/high HCT), particularly prominent in the HSG5 group (p < 0.001).CONCLUSIONThis study reveals five distinct dynamic trajectory patterns of early fluid therapy in AP. High-load sustained or fluctuating therapy significantly increases mortality risk. Dynamic monitoring of HCT (within a 35-44% safety window) and therapy trajectories offers a potential strategy to optimize fluid management.
背景：急性胰腺炎（AP）早期液体治疗的个体化管理仍然具有挑战性。传统的研究主要集中在静态流体平衡上，忽视了动态轨迹的异质性。方法基于单中心回顾性队列，纳入发病72小时内入院的3142例AP患者。计算每日液体治疗体重比（FWR）和梯形AUC （CumFWR）。潜在类别增长模型（LCGM）确定了72小时内的动态FWR轨迹。多变量Cox回归分析了FWR与院内死亡风险之间的关系。三维拟合曲面分析评估了CumFWR与红细胞压积之间的相互作用。结果slcgm在72 h内成功识别出5种不同的动态流体治疗轨迹，临床差异具有显著性：低稳定组（LSG1, n = 229, 7.3%）、中低持续组（LMSG2, n = 340, 10.8%）、中稳定组（MSG3, n = 2073, 66.0%）、中高波动组（MHFG4, n = 231, 7.4%）和高持续组（HSG5, n = 269, 8.6%）。多因素Cox回归显示，与MSG3相比，MHFG4（校正HR = 2.08, 95%CI 1.15-3.78）和HSG5（校正HR = 2.91, 95%CI 1.77-4.79）的住院死亡风险均显著增加。此外，CumFWR每增加1个标准差，死亡风险增加47% （HR = 1.47, 95%CI 1.26-1.72）。三维拟合曲面图显示，高CumFWR和异常红细胞压积（低/高HCT）之间存在较高的死亡风险，特别是在HSG5组（p < 0.001）。结论本研究揭示了AP早期液体治疗的五种不同的动态轨迹模式。高负荷持续或波动治疗显著增加死亡风险。动态监测HCT（在35-44%的安全窗口内）和治疗轨迹为优化流体管理提供了潜在的策略。
{"title":"Early fluid therapy trajectories in acute pancreatitis: a retrospective cohort study.","authors":"Jianhua Wan,Shixuan Xiong,Yaoyu Zou,Maobin Kuang,Huajing Ke,Wenhua He,Yin Zhu,Nonghua Lu,Liang Xia","doi":"10.1186/s13017-025-00664-w","DOIUrl":"https://doi.org/10.1186/s13017-025-00664-w","url":null,"abstract":"BACKGROUNDIndividualized management of early fluid therapy in acute pancreatitis (AP) remains challenging. Traditional studies primarily focus on static fluid balance, overlooking the heterogeneity of dynamic trajectories.METHODSBased on a single-center retrospective cohort, 3,142 AP patients admitted within 72 h of onset were included. Daily fluid therapy-to-body weight ratio (FWR) and CumFWR (trapezoidal AUC) were calculated. Latent Class Growth Modeling (LCGM) identified dynamic FWR trajectories within 72 h. Multivariate Cox regression analyzed the relationship between FWR and in-hospital mortality risk. Three-dimensional fitted surface plot analysis evaluated interactions between CumFWR and hematocrit.RESULTSLCGM successfully identified five distinct dynamic fluid therapy trajectories within 72 h, showing significant clinical differences: Low Stable Group (LSG1, n = 229, 7.3%), Low-Moderate Sustained Group (LMSG2, n = 340, 10.8%), Moderate Stable Group (MSG3, n = 2073, 66.0%), Moderate-High Fluctuating Group (MHFG4, n = 231, 7.4%), and High Sustained Group (HSG5, n = 269, 8.6%). Multivariate Cox regression revealed significantly increased in-hospital mortality risk compared to MSG3 for both MHFG4 (adjusted HR = 2.08, 95%CI 1.15-3.78) and HSG5 (adjusted HR = 2.91, 95%CI 1.77-4.79). Furthermore, each 1 standard deviation increase in CumFWR was associated with a 47% increased mortality risk (HR = 1.47, 95%CI 1.26-1.72). Three-dimensional fitted surface plot demonstrated high mortality risk between high CumFWR and abnormal hematocrit (low/high HCT), particularly prominent in the HSG5 group (p < 0.001).CONCLUSIONThis study reveals five distinct dynamic trajectory patterns of early fluid therapy in AP. High-load sustained or fluctuating therapy significantly increases mortality risk. Dynamic monitoring of HCT (within a 35-44% safety window) and therapy trajectories offers a potential strategy to optimize fluid management.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"27 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145674418","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 : 2025-12-05DOI: 10.1186/s13017-025-00665-9
Fikri M Abu-Zidan,David O Alao,Arif Alper Cevik
AIMTo review the literature on the role of Point-of-care ultrasound (POCUS) in diagnosing rib fractures compared with other diagnostic modalities and to give recommendations on its role.METHODSBroad text PubMed database search was performed using general terms (rib, fracture, ultrasound, diagnosis) in English language without time restriction. Selected articles were critically read by three acute care physicians who have more than 20 years' experience in POCUS.RESULTSUltrasound, as shown by a recent meta-analysis, had a pooled sensitivity of 89.3%, a pooled specificity of 98.4%, and a pooled positive likelihood ratio of 55.7 without difference between emergency and radiology departments. The uncertainty of evidence was high due to (1) selection bias, (2) geographical bias, and (3) heterogeneity of the operator's experience. POCUS has certain advantages including: (1) it is dynamic so it can evaluate the rib displacement during respiration, (2) It is portable so that it can be used in prehospital setting and disaster situations, (3) it has no risk of radiation so that it can be used in pregnant women, children, and in repeated follow-up, and (4) it has good resolution to evaluate the soft tissues around fractures. In contrast, its limitations include: (1) it is operator dependant, (2) it takes a longer time, (3) it cannot diagnose ribs covered by bones like those under the scapula, and (4) it needs a conscious patient to guide the examination. Ultrasound-guided blocks, including intercostal nerve block, serratus anterior plane block, and erector spinae plane block were successful in controlling the pain of multiple rib fractures.CONCLUSIONSThis review supports the use of POCUS in diagnosing rib fractures, which can be extended into ultrasound-guided blocks for pain control. Nevertheless, it highlights the need for research with higher quality in this area. Ultrasound and CT scan should be complementary and not competitive.
{"title":"Point-of-care ultrasound (POCUS) diagnosis of rib fractures.","authors":"Fikri M Abu-Zidan,David O Alao,Arif Alper Cevik","doi":"10.1186/s13017-025-00665-9","DOIUrl":"https://doi.org/10.1186/s13017-025-00665-9","url":null,"abstract":"AIMTo review the literature on the role of Point-of-care ultrasound (POCUS) in diagnosing rib fractures compared with other diagnostic modalities and to give recommendations on its role.METHODSBroad text PubMed database search was performed using general terms (rib, fracture, ultrasound, diagnosis) in English language without time restriction. Selected articles were critically read by three acute care physicians who have more than 20 years' experience in POCUS.RESULTSUltrasound, as shown by a recent meta-analysis, had a pooled sensitivity of 89.3%, a pooled specificity of 98.4%, and a pooled positive likelihood ratio of 55.7 without difference between emergency and radiology departments. The uncertainty of evidence was high due to (1) selection bias, (2) geographical bias, and (3) heterogeneity of the operator's experience. POCUS has certain advantages including: (1) it is dynamic so it can evaluate the rib displacement during respiration, (2) It is portable so that it can be used in prehospital setting and disaster situations, (3) it has no risk of radiation so that it can be used in pregnant women, children, and in repeated follow-up, and (4) it has good resolution to evaluate the soft tissues around fractures. In contrast, its limitations include: (1) it is operator dependant, (2) it takes a longer time, (3) it cannot diagnose ribs covered by bones like those under the scapula, and (4) it needs a conscious patient to guide the examination. Ultrasound-guided blocks, including intercostal nerve block, serratus anterior plane block, and erector spinae plane block were successful in controlling the pain of multiple rib fractures.CONCLUSIONSThis review supports the use of POCUS in diagnosing rib fractures, which can be extended into ultrasound-guided blocks for pain control. Nevertheless, it highlights the need for research with higher quality in this area. Ultrasound and CT scan should be complementary and not competitive.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"1 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680612","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 : 2025-11-26DOI: 10.1186/s13017-025-00663-x
Dong Jin Park, Seung Min Baik, Kyung Sook Hong, Heejung Yi, Jae Gil Lee, Jae-Myeong Lee
{"title":"Correction: Development and external validation of an artificial intelligence model for predicting mortality and prolonged ICU stay in postoperative critically ill patients: a retrospective study.","authors":"Dong Jin Park, Seung Min Baik, Kyung Sook Hong, Heejung Yi, Jae Gil Lee, Jae-Myeong Lee","doi":"10.1186/s13017-025-00663-x","DOIUrl":"https://doi.org/10.1186/s13017-025-00663-x","url":null,"abstract":"","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"20 1","pages":"88"},"PeriodicalIF":5.8,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12648853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145641719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The optimal tube size for managing traumatic hemothorax, pneumothorax, or hemopneumothorax remains debated. While large-bore chest tubes (LCTs—≥ 28 Ch) are traditionally favored, emerging evidence suggests that small-caliber tubes (SCTs—≤ 14 Ch), such as pigtail catheters and small straight tubes, may offer similar efficacy with fewer complications. This study aimed to evaluate the comparative effectiveness and safety of SCTs versus LCTs from Randomized Controlled Trials (RCTs) in adult trauma patients and to assess the conclusiveness of the current evidence using trial sequential analysis (TSA). The study was conducted according to the Cochrane recommendations, searching the PubMed, Scopus, and EMBASE datasets up to 25th March 2025 without language restrictions (PROSPERO ID: CRD420251023165). The primary outcome was treatment failure; secondary outcomes included insertion-related complications, duration of drainage, and length of hospital stay. Random effects models based on restricted maximum likelihood and Hartung-Knapp correction were developed. Sensitivity analysis was conducted to detect sources of heterogeneity. The risk of bias was assessed using the Cochrane RoB 2 tool. TSA was used to evaluate the risk of random error and to determine whether the required information size (RIS) had been reached. Four RCTs (n = 676 patients) were included. Pooled analysis showed no significant difference in failure rates between SCTs and LCTs (RR 0.95, 95% CI 0.66–1.35, I2 = 0%). No significant differences were observed in complication rates or hospital stay. Duration of tube placement was significantly shorter in the SCT group (MD − 0.49 days, p = 0.02). TSA indicated that the cumulative evidence was underpowered, achieving only 22% of the RIS (3110 patients). The Z-curve did not cross thresholds for benefit, harm, or futility. SCTs appear to be as effective and safe as LCTs for selected trauma patients with uncomplicated thoracic injuries. However, due to limited sample size and heterogeneity across trials, current evidence is inconclusive. Larger, high-quality RCTs are warranted to confirm these findings and guide clinical practice.
{"title":"Small versus large bore chest tube in traumatic hemothorax, hemopneumothorax, and pneumothorax: a meta-analysis of randomized controlled trials with trial sequential analysis","authors":"Stefano Granieri, Stefano Piero Bernardo Cioffi, Alessandro Asaro, Michele Altomare, Andrea Spota, Francesco Virdis, Roberto Bini, Shailvi Gupta, Kimberly Davis, Stefania Cimbanassi","doi":"10.1186/s13017-025-00655-x","DOIUrl":"https://doi.org/10.1186/s13017-025-00655-x","url":null,"abstract":"The optimal tube size for managing traumatic hemothorax, pneumothorax, or hemopneumothorax remains debated. While large-bore chest tubes (LCTs—≥ 28 Ch) are traditionally favored, emerging evidence suggests that small-caliber tubes (SCTs—≤ 14 Ch), such as pigtail catheters and small straight tubes, may offer similar efficacy with fewer complications. This study aimed to evaluate the comparative effectiveness and safety of SCTs versus LCTs from Randomized Controlled Trials (RCTs) in adult trauma patients and to assess the conclusiveness of the current evidence using trial sequential analysis (TSA). The study was conducted according to the Cochrane recommendations, searching the PubMed, Scopus, and EMBASE datasets up to 25th March 2025 without language restrictions (PROSPERO ID: CRD420251023165). The primary outcome was treatment failure; secondary outcomes included insertion-related complications, duration of drainage, and length of hospital stay. Random effects models based on restricted maximum likelihood and Hartung-Knapp correction were developed. Sensitivity analysis was conducted to detect sources of heterogeneity. The risk of bias was assessed using the Cochrane RoB 2 tool. TSA was used to evaluate the risk of random error and to determine whether the required information size (RIS) had been reached. Four RCTs (n = 676 patients) were included. Pooled analysis showed no significant difference in failure rates between SCTs and LCTs (RR 0.95, 95% CI 0.66–1.35, I2 = 0%). No significant differences were observed in complication rates or hospital stay. Duration of tube placement was significantly shorter in the SCT group (MD − 0.49 days, p = 0.02). TSA indicated that the cumulative evidence was underpowered, achieving only 22% of the RIS (3110 patients). The Z-curve did not cross thresholds for benefit, harm, or futility. SCTs appear to be as effective and safe as LCTs for selected trauma patients with uncomplicated thoracic injuries. However, due to limited sample size and heterogeneity across trials, current evidence is inconclusive. Larger, high-quality RCTs are warranted to confirm these findings and guide clinical practice.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"151 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145583532","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}
Implementing Enhanced Recovery After Surgery (ERAS) protocol in elective surgeries has improved outcomes. Evidence for a similar role in emergency surgeries must be explored, particularly in patients with peptic perforation. This research aims to study the safety and efficacy of ERAS in patients undergoing surgery for peptic perforation peritonitis. Our study was an open-labeled, randomized, controlled superiority trial conducted on 60 patients of peptic perforation, restricted to first and second category of ASA and distributed equally between the Conventional and ERAS arms. The key interventions in the ERAS arm were intraoperative rectus sheath blockade, encouraging early ambulation, early removal of indwelling catheters and tubes, and early initiation of oral fluid and solid diet. The median length of hospital stay was significantly shorter in the ERAS arm (3 vs 5 days). The patients in the ERAS group were free from all the indwelling catheters within 24 h of the surgery. The time to ambulate (21 h vs 48 h) and initiation of unrestricted clear liquids (after 6 h of surgery) was significantly quicker in the ERAS arm. The surgical site infection (10 vs 5) and pneumonia (5 vs 1) rates were higher in the conventional group. This was clinically significant, even though it failed to attain statistical significance. The comprehensive complication index was significantly higher in the conventional arm. In this study, there was 100% compliance with seven out of eight ERAS interventions. The ERAS protocol helped shorten the time needed to attain the preoperative physiological parameters, including bowel functions and reduced the LOHS in patients operated for peptic perforation.
{"title":"Enhanced recovery after surgery versus conventional approach in peptic perforation- a Randomized Controlled Trial- “ERASE trial”","authors":"Swastik Sourav Mishra, Tushar Subhadarshan Mishra, Pankaj Kumar, Pradeep Kumar Singh, Prakash Kumar Sasmal, Upendra Hansda, Shritosh Kumar, Mahesh Kumar Sethi","doi":"10.1186/s13017-025-00639-x","DOIUrl":"https://doi.org/10.1186/s13017-025-00639-x","url":null,"abstract":"Implementing Enhanced Recovery After Surgery (ERAS) protocol in elective surgeries has improved outcomes. Evidence for a similar role in emergency surgeries must be explored, particularly in patients with peptic perforation. This research aims to study the safety and efficacy of ERAS in patients undergoing surgery for peptic perforation peritonitis. Our study was an open-labeled, randomized, controlled superiority trial conducted on 60 patients of peptic perforation, restricted to first and second category of ASA and distributed equally between the Conventional and ERAS arms. The key interventions in the ERAS arm were intraoperative rectus sheath blockade, encouraging early ambulation, early removal of indwelling catheters and tubes, and early initiation of oral fluid and solid diet. The median length of hospital stay was significantly shorter in the ERAS arm (3 vs 5 days). The patients in the ERAS group were free from all the indwelling catheters within 24 h of the surgery. The time to ambulate (21 h vs 48 h) and initiation of unrestricted clear liquids (after 6 h of surgery) was significantly quicker in the ERAS arm. The surgical site infection (10 vs 5) and pneumonia (5 vs 1) rates were higher in the conventional group. This was clinically significant, even though it failed to attain statistical significance. The comprehensive complication index was significantly higher in the conventional arm. In this study, there was 100% compliance with seven out of eight ERAS interventions. The ERAS protocol helped shorten the time needed to attain the preoperative physiological parameters, including bowel functions and reduced the LOHS in patients operated for peptic perforation.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"57 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145559393","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 : 2025-11-18DOI: 10.1186/s13017-025-00658-8
Emily Francesca Smith, Michael Okocha
Laparoscopic surgery (LS) is well established in the United Kingdom (UK), while robotic surgery (RS) is increasingly adopted in elective practice. However, its role in emergency general surgery (EGS) remains undefined. This study provides the first national estimates of RS use in UK EGS, evaluating trends in utilisation, outcomes, and workforce capacity. Two rounds of Freedom of Information (FOI) requests were submitted to all NHS acute trusts and boards providing EGS services across Great Britain, covering 1 January 2019–1 January 2023 and 1 January 2023–1 January 2025. Data collected included robotic system ownership, numbers and types of robotic procedures, length of stay (LOS), complication rates, and staffing. LOS data were reported as mean ± standard deviation, with differences between approaches assessed using Welch’s t-tests. Response rates were 83% (113/136 trusts, 2019–2023) and 65% (91/140 trusts, 2023–2025). Robotic availability increased from 36 to 91 systems nationally (147% rise), with the number of trusts performing emergency RS doubling (13 to 26). A total of 1816 emergency robotic procedures were performed in 2023–2025, alongside 9232 elective cases. Cholecystectomy was the most frequent emergency procedure, increasing almost sixfold (200 → 1396). Complications were infrequent, with device-related issues (n = 18) and tissue injury (n = 27) most common. LOS was consistently shorter for RS compared with open surgery across all procedures (all p < 0.01), with particularly marked reductions in cholecystectomy, Hartmann’s procedures, and small bowel resections. Comparisons with LS were procedure-specific: RS was shorter in cholecystectomy and hernia repair, equivalent in small bowel resection, and longer in appendectomy. Workforce capacity remained a limiting factor, with median in-hours trained staff unchanged (11 vs 10), but out-of-hours staff rising from 3 to 24 across all trusts. Robotic surgery in UK emergency general surgery is feasible, safe, and expanding, though utilisation continues to lag behind elective practice. RS offers clear LOS advantages over open surgery, with variable benefits compared to laparoscopy. Scaling adoption will require addressing cost, system heterogeneity, and the shortage of trained out-of-hours staff. National policy must prioritise training, standardised data collection, and equitable access to ensure safe integration of RS into routine emergency care.
{"title":"Robotic surgery in emergency general surgery: an overview of UK practice","authors":"Emily Francesca Smith, Michael Okocha","doi":"10.1186/s13017-025-00658-8","DOIUrl":"https://doi.org/10.1186/s13017-025-00658-8","url":null,"abstract":"Laparoscopic surgery (LS) is well established in the United Kingdom (UK), while robotic surgery (RS) is increasingly adopted in elective practice. However, its role in emergency general surgery (EGS) remains undefined. This study provides the first national estimates of RS use in UK EGS, evaluating trends in utilisation, outcomes, and workforce capacity. Two rounds of Freedom of Information (FOI) requests were submitted to all NHS acute trusts and boards providing EGS services across Great Britain, covering 1 January 2019–1 January 2023 and 1 January 2023–1 January 2025. Data collected included robotic system ownership, numbers and types of robotic procedures, length of stay (LOS), complication rates, and staffing. LOS data were reported as mean ± standard deviation, with differences between approaches assessed using Welch’s t-tests. Response rates were 83% (113/136 trusts, 2019–2023) and 65% (91/140 trusts, 2023–2025). Robotic availability increased from 36 to 91 systems nationally (147% rise), with the number of trusts performing emergency RS doubling (13 to 26). A total of 1816 emergency robotic procedures were performed in 2023–2025, alongside 9232 elective cases. Cholecystectomy was the most frequent emergency procedure, increasing almost sixfold (200 → 1396). Complications were infrequent, with device-related issues (n = 18) and tissue injury (n = 27) most common. LOS was consistently shorter for RS compared with open surgery across all procedures (all p < 0.01), with particularly marked reductions in cholecystectomy, Hartmann’s procedures, and small bowel resections. Comparisons with LS were procedure-specific: RS was shorter in cholecystectomy and hernia repair, equivalent in small bowel resection, and longer in appendectomy. Workforce capacity remained a limiting factor, with median in-hours trained staff unchanged (11 vs 10), but out-of-hours staff rising from 3 to 24 across all trusts. Robotic surgery in UK emergency general surgery is feasible, safe, and expanding, though utilisation continues to lag behind elective practice. RS offers clear LOS advantages over open surgery, with variable benefits compared to laparoscopy. Scaling adoption will require addressing cost, system heterogeneity, and the shortage of trained out-of-hours staff. National policy must prioritise training, standardised data collection, and equitable access to ensure safe integration of RS into routine emergency care.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"5 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145535319","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 : 2025-11-10DOI: 10.1186/s13017-025-00656-w
Massimo Sartelli, Elias Mossialos, Federico Coccolini, Ib Jammer, Francesco M. Labricciosa, Philip Barie, Walter L. Biffl, Ziad A. Memish, Markus Maeurer, Gary P. Kobinger, Giuseppe Ippolito, Alimuddin Zumla, Fausto Catena
The world is currently facing an unprecedented convergence of crises that threaten the core pillars of public health, scientific integrity, and social stability. These challenges are profoundly interconnected and have the potential to exacerbate global inequalities, jeopardize health security, and undermine the progress achieved through decades of international collaboration. Our viewpoint declaration, developed by 366 healthcare workers and scientists from 119 countries across six continents, highlights the urgent need for global solidarity and collective action to address these interconnected global health challenges. As healthcare workers and scientists, we must prioritize the protection of scientific integrity, combat political interference, and restore public trust in the scientific process. This will require a commitment to transparency, ethical responsibility, and evidence-based decision-making that can stand strong in the face of political and social adversity. The COVID-19 pandemic has underscored the critical importance of resilient healthcare systems, emphasizing that preparedness, capacity building and coherent leadership and coordination are essential for future global health crises. In addition, our call for a One Health approach, acknowledging the intricate relationship between human, animal, and environmental health, has never been more pressing, especially as zoonotic diseases and antimicrobial resistance spread across borders. As we confront ongoing wars, environmental destruction, and global persistent health inequalities, it is only through unity, solidarity, collaboration, and innovation that we hope to build a healthier, more equitable world. Together, we must ensure that science and medicine remain a force for good, capable of addressing both the immediate and long-term needs and challenges facing our shared future.
{"title":"Global health at crossroads: uniting together to overcome challenges, restore trust and advance priorities for a sustainable future","authors":"Massimo Sartelli, Elias Mossialos, Federico Coccolini, Ib Jammer, Francesco M. Labricciosa, Philip Barie, Walter L. Biffl, Ziad A. Memish, Markus Maeurer, Gary P. Kobinger, Giuseppe Ippolito, Alimuddin Zumla, Fausto Catena","doi":"10.1186/s13017-025-00656-w","DOIUrl":"https://doi.org/10.1186/s13017-025-00656-w","url":null,"abstract":"The world is currently facing an unprecedented convergence of crises that threaten the core pillars of public health, scientific integrity, and social stability. These challenges are profoundly interconnected and have the potential to exacerbate global inequalities, jeopardize health security, and undermine the progress achieved through decades of international collaboration. Our viewpoint declaration, developed by 366 healthcare workers and scientists from 119 countries across six continents, highlights the urgent need for global solidarity and collective action to address these interconnected global health challenges. As healthcare workers and scientists, we must prioritize the protection of scientific integrity, combat political interference, and restore public trust in the scientific process. This will require a commitment to transparency, ethical responsibility, and evidence-based decision-making that can stand strong in the face of political and social adversity. The COVID-19 pandemic has underscored the critical importance of resilient healthcare systems, emphasizing that preparedness, capacity building and coherent leadership and coordination are essential for future global health crises. In addition, our call for a One Health approach, acknowledging the intricate relationship between human, animal, and environmental health, has never been more pressing, especially as zoonotic diseases and antimicrobial resistance spread across borders. As we confront ongoing wars, environmental destruction, and global persistent health inequalities, it is only through unity, solidarity, collaboration, and innovation that we hope to build a healthier, more equitable world. Together, we must ensure that science and medicine remain a force for good, capable of addressing both the immediate and long-term needs and challenges facing our shared future.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"43 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145478397","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 : 2025-11-05DOI: 10.1186/s13017-025-00659-7
Shen Li, Tian Geng, Zhongyue Li
To evaluate the clinical efficacy of endoscopic retrograde appendicitis therapy (ERAT) in the management of acute appendicitis in pediatric patients. A comprehensive search was conducted across seven electronic databases. Methodological quality of included studies was assessed using the Cochrane risk of bias tool. Statistical analyses were performed using RevMan 5.3 and Stata 13 software. Ten studies involving 1,372 pediatric patients were included (ERAT group: 660; control group: 712). Compared to the control group, the ERAT group demonstrated significant advantages in multiple outcomes: shorter operative time [WMD = − 9.98, 95%CI: (-17.47, − 2.49); P = 0.009], higher fecalith detection rate [RR = 1.81, 95%CI: (1.43, 2.30); P < 0.00001], shorter postoperative feeding time [SMD = − 3.21, 95%CI: (− 4.04, − 2.38); P < 0.00001], lower postoperative white blood cell count [WMD = − 1.45, 95%CI: (− 1.93, − 0.96); P < 0.00001], faster normalization of white blood cell levels [WMD = − 1.62, 95%CI: (− 2.03, − 1.20); P < 0.00001], quicker resolution of fever [WMD = − 1.15, 95%CI: (− 1.48, − 0.81); P < 0.00001], shorter duration of abdominal pain relief [SMD = − 1.18, 95%CI: (− 1.59, − 0.77); P < 0.00001], reduced bed rest time [WMD = − 1.39, 95%CI: (− 1.61, − 1.18); P < 0.00001], fewer complications [RR = 0.27, 95%CI: (0.18, 0.39); P < 0.00001], higher initial treatment success rate [RR = 1.11, 95%CI: (1.06, 1.16); P < 0.0001], shorter hospital stay [WMD = − 2.21, 95%CI: (− 2.69, − 1.73); P < 0.00001], and lower hospitalization costs [SMD = − 2.84, 95%CI: (− 3.47, − 2.20); P < 0.00001]. However, no statistically significant difference was observed in recurrence rates between groups [RR = 0.78, 95%CI: (0.51, 1.19); P = 0.24]. ERAT demonstrates unique advantages in pediatric acute appendicitis, including alleviating symptoms, accelerating recovery, reducing hospitalization duration and costs, minimizing complications, preserving appendiceal function, and optimizing healthcare resource utilization. Nevertheless, postoperative recurrence remains a concern, necessitating further validation through multicenter, large-scale randomized controlled trials. PROSPERO CRD420251020742, date of registration: March 27th, 2025.
{"title":"Clinical efficacy and safety of endoscopic retrograde appendicitis treatment for acute appendicitis in children: a systematic review and meta-analysis","authors":"Shen Li, Tian Geng, Zhongyue Li","doi":"10.1186/s13017-025-00659-7","DOIUrl":"https://doi.org/10.1186/s13017-025-00659-7","url":null,"abstract":"To evaluate the clinical efficacy of endoscopic retrograde appendicitis therapy (ERAT) in the management of acute appendicitis in pediatric patients. A comprehensive search was conducted across seven electronic databases. Methodological quality of included studies was assessed using the Cochrane risk of bias tool. Statistical analyses were performed using RevMan 5.3 and Stata 13 software. Ten studies involving 1,372 pediatric patients were included (ERAT group: 660; control group: 712). Compared to the control group, the ERAT group demonstrated significant advantages in multiple outcomes: shorter operative time [WMD = − 9.98, 95%CI: (-17.47, − 2.49); P = 0.009], higher fecalith detection rate [RR = 1.81, 95%CI: (1.43, 2.30); P < 0.00001], shorter postoperative feeding time [SMD = − 3.21, 95%CI: (− 4.04, − 2.38); P < 0.00001], lower postoperative white blood cell count [WMD = − 1.45, 95%CI: (− 1.93, − 0.96); P < 0.00001], faster normalization of white blood cell levels [WMD = − 1.62, 95%CI: (− 2.03, − 1.20); P < 0.00001], quicker resolution of fever [WMD = − 1.15, 95%CI: (− 1.48, − 0.81); P < 0.00001], shorter duration of abdominal pain relief [SMD = − 1.18, 95%CI: (− 1.59, − 0.77); P < 0.00001], reduced bed rest time [WMD = − 1.39, 95%CI: (− 1.61, − 1.18); P < 0.00001], fewer complications [RR = 0.27, 95%CI: (0.18, 0.39); P < 0.00001], higher initial treatment success rate [RR = 1.11, 95%CI: (1.06, 1.16); P < 0.0001], shorter hospital stay [WMD = − 2.21, 95%CI: (− 2.69, − 1.73); P < 0.00001], and lower hospitalization costs [SMD = − 2.84, 95%CI: (− 3.47, − 2.20); P < 0.00001]. However, no statistically significant difference was observed in recurrence rates between groups [RR = 0.78, 95%CI: (0.51, 1.19); P = 0.24]. ERAT demonstrates unique advantages in pediatric acute appendicitis, including alleviating symptoms, accelerating recovery, reducing hospitalization duration and costs, minimizing complications, preserving appendiceal function, and optimizing healthcare resource utilization. Nevertheless, postoperative recurrence remains a concern, necessitating further validation through multicenter, large-scale randomized controlled trials. PROSPERO CRD420251020742, date of registration: March 27th, 2025.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"13 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145441229","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 : 2025-10-29DOI: 10.1186/s13017-025-00657-9
Dongmin Seo, Hye Young Woo, Inhae Heo, Kyoungwon Jung, Hohyung Jung
Damage control surgery (DCS) is the standard approach for managing severely injured patients with trauma who present with extreme physiological derangements. The optimal timing for planned reoperation after the initial DCS remains contentious. Although traditional guidelines recommend reoperation within 24–48 h, emerging evidence suggests this interval may not be appropriate for all patients. This systematic review and meta-analysis evaluated the impact of early versus delayed planned reoperations on the clinical outcomes in patients with trauma following DCS. This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines (PROSPERO registration: CRD420251049990). PubMed, Embase, and the Cochrane Library were searched from inception to 28 July 2025. Eligible studies compared early (≤ 48 h) with delayed (> 48 h) planned reoperation after DCS in adult patients with trauma. The primary outcome was re-bleeding; secondary outcomes were in-hospital mortality and infection rates. Study quality was assessed using the Newcastle–Ottawa Scale, and the certainty of evidence was graded using the GRADE approach. Meta-analysis was conducted using random-effects models. Seven retrospective cohort studies involving 965 patients met the inclusion criteria. No prospective or randomised controlled trials were identified. Early planned reoperation was associated with significantly higher re-bleeding rates (OR 3.01; 95% CI 1.21–7.51; P = 0.02), indicating three-fold higher odds of re-bleeding with early intervention compared to delayed reoperation. No significant differences were observed in mortality (OR 0.79; 95% CI 0.51–1.23; P = 0.29; I2 = 0%) or infection rates (OR 1.05; 95% CI 0.54–2.05; P = 0.89; I2 = 65%). Delayed planned reoperation beyond 48 h after DCS significantly reduces the risk of re-bleeding, without increasing mortality or infection rates. These findings support an individualised approach to reoperation timing guided by patient physiology, rather than rigid adherence to conventional 24- to 48-h protocols.
损伤控制手术（DCS）是标准的方法来管理严重受伤的创伤患者谁目前的极端生理紊乱。初始DCS后计划再操作的最佳时机仍然存在争议。虽然传统的指南建议在24-48小时内再次手术，但新出现的证据表明，这个时间间隔可能并不适合所有患者。本系统综述和荟萃分析评估了早期与延迟计划再手术对DCS后创伤患者临床结果的影响。本综述遵循系统评价和荟萃分析首选报告项目（PRISMA） 2020指南（PROSPERO注册号：CRD420251049990）。PubMed， Embase和Cochrane图书馆从成立到2025年7月28日被检索。符合条件的研究比较了创伤成人患者DCS术后早期（≤48 h）和延迟（> 48 h）计划再手术。主要结局是再出血；次要结局是住院死亡率和感染率。使用纽卡斯尔-渥太华量表评估研究质量，使用GRADE方法对证据的确定性进行评分。采用随机效应模型进行meta分析。7项涉及965例患者的回顾性队列研究符合纳入标准。未发现前瞻性或随机对照试验。早期计划的再手术与更高的再出血率相关（OR 3.01; 95% CI 1.21-7.51; P = 0.02），表明早期干预的再出血几率比延迟再手术高3倍。死亡率（OR 0.79; 95% CI 0.51-1.23; P = 0.29; I2 = 0%）和感染率（OR 1.05; 95% CI 0.54-2.05; P = 0.89; I2 = 65%）无显著差异。DCS术后48小时后延迟计划再手术可显著降低再出血风险，且不增加死亡率或感染率。这些发现支持以患者生理为指导的个性化再手术时机的方法，而不是严格遵守传统的24至48小时方案。
{"title":"Timing of planned reoperation after damage control surgery in patients with trauma: a systematic review and meta-analysis","authors":"Dongmin Seo, Hye Young Woo, Inhae Heo, Kyoungwon Jung, Hohyung Jung","doi":"10.1186/s13017-025-00657-9","DOIUrl":"https://doi.org/10.1186/s13017-025-00657-9","url":null,"abstract":"Damage control surgery (DCS) is the standard approach for managing severely injured patients with trauma who present with extreme physiological derangements. The optimal timing for planned reoperation after the initial DCS remains contentious. Although traditional guidelines recommend reoperation within 24–48 h, emerging evidence suggests this interval may not be appropriate for all patients. This systematic review and meta-analysis evaluated the impact of early versus delayed planned reoperations on the clinical outcomes in patients with trauma following DCS. This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines (PROSPERO registration: CRD420251049990). PubMed, Embase, and the Cochrane Library were searched from inception to 28 July 2025. Eligible studies compared early (≤ 48 h) with delayed (> 48 h) planned reoperation after DCS in adult patients with trauma. The primary outcome was re-bleeding; secondary outcomes were in-hospital mortality and infection rates. Study quality was assessed using the Newcastle–Ottawa Scale, and the certainty of evidence was graded using the GRADE approach. Meta-analysis was conducted using random-effects models. Seven retrospective cohort studies involving 965 patients met the inclusion criteria. No prospective or randomised controlled trials were identified. Early planned reoperation was associated with significantly higher re-bleeding rates (OR 3.01; 95% CI 1.21–7.51; P = 0.02), indicating three-fold higher odds of re-bleeding with early intervention compared to delayed reoperation. No significant differences were observed in mortality (OR 0.79; 95% CI 0.51–1.23; P = 0.29; I2 = 0%) or infection rates (OR 1.05; 95% CI 0.54–2.05; P = 0.89; I2 = 65%). Delayed planned reoperation beyond 48 h after DCS significantly reduces the risk of re-bleeding, without increasing mortality or infection rates. These findings support an individualised approach to reoperation timing guided by patient physiology, rather than rigid adherence to conventional 24- to 48-h protocols.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"32 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145397991","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 : 2025-10-27DOI: 10.1186/s13017-025-00647-x
Kris R Wiendels,Joris Lemson,Manouk Backes,Erik Hermans,Jan Bollen,Diederik P J Smeeing,Stijn D Nelen,
BACKGROUNDDamage Control Surgery is a technique aimed at reducing mortality in trauma patients, but its use in pediatric patients lacks standardized indications. Proper patient selection is essential to mitigate morbidity associated with Damage Control Surgery.OBJECTIVEThis review aims to clarify the reported indications for Damage Control Surgery in pediatric trauma patients.METHODSA systematic search of PubMed and Embase was conducted without publication year restrictions to identify studies reporting indications for performing Damage Control Surgery in pediatric trauma patients. Backward citation analysis was performed on identified review articles that were excluded. Indications or patient characteristics guiding surgical decision-making in the emergency department were extracted and categorized.RESULTSForty studies were included: 25 case reports, 13 case series, and 2 observational studies. The case reports and case series involved 98 patients with 368 reported indications, with severe trauma (26.1%), hemodynamic instability (18.2%), and radiological or clinical evidence of severe hemorrhage or contamination (28.2%) being the most observed. The observational studies found a higher Injury Severity Score, lower systolic blood pressure, decreased Glasgow Coma Scale, lower body temperature, and more frequent blood transfusions in the Damage Control Surgery groups compared to the control groups.CONCLUSIONS AND RELEVANCESevere trauma, hemodynamic instability, and injuries related to severe hemorrhage or contamination emerged as key indications for Damage Control Surgery in pediatric trauma, consistent with findings in adult trauma populations. However, the lethal triad of acidosis, hypothermia and coagulopathy was infrequently reported as a primary indication for Damage Control Surgery in children. This may reflect the greater compensatory capacity of pediatric patients, potentially delaying the manifestation of these physiological derangements. Our findings suggest that early intervention with Damage Control Surgery in cases of severe trauma, exsanguination, gross contamination, and hemodynamic instability may help prevent the progression to critical physiological states such as the lethal triad. This underscores the importance of timely recognition and intervention in pediatric trauma management.
{"title":"Indications to perform damage control surgery in pediatric trauma: a scoping review-Are children little adults?","authors":"Kris R Wiendels,Joris Lemson,Manouk Backes,Erik Hermans,Jan Bollen,Diederik P J Smeeing,Stijn D Nelen, ","doi":"10.1186/s13017-025-00647-x","DOIUrl":"https://doi.org/10.1186/s13017-025-00647-x","url":null,"abstract":"BACKGROUNDDamage Control Surgery is a technique aimed at reducing mortality in trauma patients, but its use in pediatric patients lacks standardized indications. Proper patient selection is essential to mitigate morbidity associated with Damage Control Surgery.OBJECTIVEThis review aims to clarify the reported indications for Damage Control Surgery in pediatric trauma patients.METHODSA systematic search of PubMed and Embase was conducted without publication year restrictions to identify studies reporting indications for performing Damage Control Surgery in pediatric trauma patients. Backward citation analysis was performed on identified review articles that were excluded. Indications or patient characteristics guiding surgical decision-making in the emergency department were extracted and categorized.RESULTSForty studies were included: 25 case reports, 13 case series, and 2 observational studies. The case reports and case series involved 98 patients with 368 reported indications, with severe trauma (26.1%), hemodynamic instability (18.2%), and radiological or clinical evidence of severe hemorrhage or contamination (28.2%) being the most observed. The observational studies found a higher Injury Severity Score, lower systolic blood pressure, decreased Glasgow Coma Scale, lower body temperature, and more frequent blood transfusions in the Damage Control Surgery groups compared to the control groups.CONCLUSIONS AND RELEVANCESevere trauma, hemodynamic instability, and injuries related to severe hemorrhage or contamination emerged as key indications for Damage Control Surgery in pediatric trauma, consistent with findings in adult trauma populations. However, the lethal triad of acidosis, hypothermia and coagulopathy was infrequently reported as a primary indication for Damage Control Surgery in children. This may reflect the greater compensatory capacity of pediatric patients, potentially delaying the manifestation of these physiological derangements. Our findings suggest that early intervention with Damage Control Surgery in cases of severe trauma, exsanguination, gross contamination, and hemodynamic instability may help prevent the progression to critical physiological states such as the lethal triad. This underscores the importance of timely recognition and intervention in pediatric trauma management.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"21 1","pages":"81"},"PeriodicalIF":8.0,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145373691","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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