Pub Date : 2024-08-01DOI: 10.1186/s13017-024-00556-5
Ye Won Jung, Jin Kim, Won Kyo Shin, Soo Youn Song, Jae Sung Choi, Suk Hwan Hyun, Young Bok Ko, Mina Lee, Byung Hun Kang, Bo Young Kim, Jin Hong Min, Yong Nam In, Sang Min Jung, Se Kwang Oh, Heon Jong Yoo
Background: No standard treatment guidelines have been established for postpartum hemorrhage (PPH). We aimed to assess the differences in outcomes and prognoses between patients with PPH who underwent surgical and non-surgical treatment.
Methods: This retrospective study included 230 patients diagnosed with PPH at two referral hospitals between August 2013 and October 2023. The patients were divided into non-surgical (group 1, n = 159) and surgical intervention groups (group 2, n = 71). A subgroup analysis was performed by dividing the surgical intervention group into immediate (n = 45) and delayed surgical intervention groups (n = 26).
Results: Initial lactic acid levels and shock index were significantly higher in group 2 (2.85 ± 1.37 vs. 4.54 ± 3.63 mmol/L, p = 0.001, and 0.83 ± 0.26 vs. 1.10 ± 0.51, p < 0.001, respectively). Conversely, initial heart rate and body temperature were significantly lower in group 2 (92.5 ± 21.0 vs. 109.0 ± 28.1 beat/min, p < 0.001, and 37.3 ± 0.8 °C vs. 37.0 ± 0.9 °C, p = 0.011, respectively). Logistic regression analysis identified low initial body temperature, high lactic acid level, and shock index as independent predictors of surgical intervention (p = 0.029, p = 0.027, and p = 0.049, respectively). Regarding the causes of PPH, tone was significantly more prevalent in group 1 (57.2% vs. 35.2%, p = 0.002), whereas trauma was significantly more prevalent in group 2 (24.5% vs. 39.4%, p = 0.030). Group 2 had worse overall outcomes and prognoses than group 1. The subgroup analysis showed significantly higher rates of uterine atony combined with other causes, hysterectomy, and disseminated intravascular coagulopathy in the delayed surgical intervention group than the immediate surgical intervention group (42.2% vs. 69.2%, p = 0.027; 51.1% vs. 73.1%, p = 0.049; and 17.8% vs. 46.2%, p = 0.018, respectively).
Conclusions: Patients with PPH presenting with increased lactic acid levels and shock index and decreased body temperature may be surgical candidates. Additionally, immediate surgical intervention in patients with uterine atony combined with other causes of PPH could improve prognosis and reduce postoperative complications.
{"title":"Outcomes and prognosis of postpartum hemorrhage according to management protocol: an 11-year retrospective study from two referral centers.","authors":"Ye Won Jung, Jin Kim, Won Kyo Shin, Soo Youn Song, Jae Sung Choi, Suk Hwan Hyun, Young Bok Ko, Mina Lee, Byung Hun Kang, Bo Young Kim, Jin Hong Min, Yong Nam In, Sang Min Jung, Se Kwang Oh, Heon Jong Yoo","doi":"10.1186/s13017-024-00556-5","DOIUrl":"10.1186/s13017-024-00556-5","url":null,"abstract":"<p><strong>Background: </strong>No standard treatment guidelines have been established for postpartum hemorrhage (PPH). We aimed to assess the differences in outcomes and prognoses between patients with PPH who underwent surgical and non-surgical treatment.</p><p><strong>Methods: </strong>This retrospective study included 230 patients diagnosed with PPH at two referral hospitals between August 2013 and October 2023. The patients were divided into non-surgical (group 1, n = 159) and surgical intervention groups (group 2, n = 71). A subgroup analysis was performed by dividing the surgical intervention group into immediate (n = 45) and delayed surgical intervention groups (n = 26).</p><p><strong>Results: </strong>Initial lactic acid levels and shock index were significantly higher in group 2 (2.85 ± 1.37 vs. 4.54 ± 3.63 mmol/L, p = 0.001, and 0.83 ± 0.26 vs. 1.10 ± 0.51, p < 0.001, respectively). Conversely, initial heart rate and body temperature were significantly lower in group 2 (92.5 ± 21.0 vs. 109.0 ± 28.1 beat/min, p < 0.001, and 37.3 ± 0.8 °C vs. 37.0 ± 0.9 °C, p = 0.011, respectively). Logistic regression analysis identified low initial body temperature, high lactic acid level, and shock index as independent predictors of surgical intervention (p = 0.029, p = 0.027, and p = 0.049, respectively). Regarding the causes of PPH, tone was significantly more prevalent in group 1 (57.2% vs. 35.2%, p = 0.002), whereas trauma was significantly more prevalent in group 2 (24.5% vs. 39.4%, p = 0.030). Group 2 had worse overall outcomes and prognoses than group 1. The subgroup analysis showed significantly higher rates of uterine atony combined with other causes, hysterectomy, and disseminated intravascular coagulopathy in the delayed surgical intervention group than the immediate surgical intervention group (42.2% vs. 69.2%, p = 0.027; 51.1% vs. 73.1%, p = 0.049; and 17.8% vs. 46.2%, p = 0.018, respectively).</p><p><strong>Conclusions: </strong>Patients with PPH presenting with increased lactic acid levels and shock index and decreased body temperature may be surgical candidates. Additionally, immediate surgical intervention in patients with uterine atony combined with other causes of PPH could improve prognosis and reduce postoperative complications.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"19 1","pages":"27"},"PeriodicalIF":6.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11293252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876440","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}
Pub Date : 2024-07-16DOI: 10.1186/s13017-024-00554-7
Federico Coccolini, Aryeh Shander, Marco Ceresoli, Ernest Moore, Brian Tian, Dario Parini, Massimo Sartelli, Boris Sakakushev, Krstina Doklestich, Fikri Abu-Zidan, Tal Horer, Vishal Shelat, Timothy Hardcastle, Elena Bignami, Andrew Kirkpatrick, Dieter Weber, Igor Kryvoruchko, Ari Leppaniemi, Edward Tan, Boris Kessel, Arda Isik, Camilla Cremonini, Francesco Forfori, Lorenzo Ghiadoni, Massimo Chiarugi, Chad Ball, Pablo Ottolino, Andreas Hecker, Diego Mariani, Ettore Melai, Manu Malbrain, Vanessa Agostini, Mauro Podda, Edoardo Picetti, Yoram Kluger, Sandro Rizoli, Andrey Litvin, Ron Maier, Solomon Gurmu Beka, Belinda De Simone, Miklosh Bala, Aleix Martinez Perez, Carlos Ordonez, Zenon Bodnaruk, Yunfeng Cui, Augusto Perez Calatayud, Nicola de Angelis, Francesco Amico, Emmanouil Pikoulis, Dimitris Damaskos, Raul Coimbra, Mircea Chirica, Walter L Biffl, Fausto Catena
Emergency general surgeons often provide care to severely ill patients requiring surgical interventions and intensive support. One of the primary drivers of morbidity and mortality is perioperative bleeding. In general, when addressing life threatening haemorrhage, blood transfusion can become an essential part of overall resuscitation. However, under all circumstances, indications for blood transfusion must be accurately evaluated. When patients decline blood transfusions, regardless of the reason, surgeons should aim to provide optimal care and respect and accommodate each patient's values and target the best outcome possible given the patient's desires and his/her clinical condition. The aim of this position paper was to perform a review of the existing literature and to provide comprehensive recommendations on organizational, surgical, anaesthetic, and haemostatic strategies that can be used to provide optimal peri-operative blood management, reduce, or avoid blood transfusions and ultimately improve patient outcomes.
{"title":"Strategies to prevent blood loss and reduce transfusion in emergency general surgery, WSES-AAST consensus paper.","authors":"Federico Coccolini, Aryeh Shander, Marco Ceresoli, Ernest Moore, Brian Tian, Dario Parini, Massimo Sartelli, Boris Sakakushev, Krstina Doklestich, Fikri Abu-Zidan, Tal Horer, Vishal Shelat, Timothy Hardcastle, Elena Bignami, Andrew Kirkpatrick, Dieter Weber, Igor Kryvoruchko, Ari Leppaniemi, Edward Tan, Boris Kessel, Arda Isik, Camilla Cremonini, Francesco Forfori, Lorenzo Ghiadoni, Massimo Chiarugi, Chad Ball, Pablo Ottolino, Andreas Hecker, Diego Mariani, Ettore Melai, Manu Malbrain, Vanessa Agostini, Mauro Podda, Edoardo Picetti, Yoram Kluger, Sandro Rizoli, Andrey Litvin, Ron Maier, Solomon Gurmu Beka, Belinda De Simone, Miklosh Bala, Aleix Martinez Perez, Carlos Ordonez, Zenon Bodnaruk, Yunfeng Cui, Augusto Perez Calatayud, Nicola de Angelis, Francesco Amico, Emmanouil Pikoulis, Dimitris Damaskos, Raul Coimbra, Mircea Chirica, Walter L Biffl, Fausto Catena","doi":"10.1186/s13017-024-00554-7","DOIUrl":"10.1186/s13017-024-00554-7","url":null,"abstract":"<p><p>Emergency general surgeons often provide care to severely ill patients requiring surgical interventions and intensive support. One of the primary drivers of morbidity and mortality is perioperative bleeding. In general, when addressing life threatening haemorrhage, blood transfusion can become an essential part of overall resuscitation. However, under all circumstances, indications for blood transfusion must be accurately evaluated. When patients decline blood transfusions, regardless of the reason, surgeons should aim to provide optimal care and respect and accommodate each patient's values and target the best outcome possible given the patient's desires and his/her clinical condition. The aim of this position paper was to perform a review of the existing literature and to provide comprehensive recommendations on organizational, surgical, anaesthetic, and haemostatic strategies that can be used to provide optimal peri-operative blood management, reduce, or avoid blood transfusions and ultimately improve patient outcomes.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"19 1","pages":"26"},"PeriodicalIF":6.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11251377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141621254","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}
Monitoring Intraabdominal Pressure (IAP) is essential in critical care, as elevated IAP can lead to severe complications, including Abdominal Compartment Syndrome (ACS). Advances in technology, such as digital capsules, have opened new avenues for measuring IAP non-invasively. This study assesses the feasibility and effectiveness of using a capsular device for IAP measurement in an animal model. In our controlled experiment, we anesthetized pigs and simulated elevated IAP conditions by infusing CO2 into the peritoneal cavity. We compared IAP measurements obtained from three different methods: an intravesical catheter (IAPivp), a capsular device (IAPdot), and a direct peritoneal catheter (IAPdir). The data from these methods were analyzed to evaluate agreement and accuracy. The capsular sensor (IAPdot) provided continuous and accurate detection of IAP over 144 h, with a total of 53,065,487 measurement triplets recorded. The correlation coefficient (R²) between IAPdot and IAPdir was excellent at 0.9241, demonstrating high agreement. Similarly, IAPivp and IAPdir showed strong correlation with an R² of 0.9168. The use of capsular sensors for continuous and accurate assessment of IAP marks a significant advancement in the field of critical care monitoring. The high correlation between measurements from different locations and methods underscores the potential of capsular devices to transform clinical practices by providing reliable, non-invasive IAP monitoring.
{"title":"Validation of continuous intraabdominal pressure measurement: feasibility and accuracy assessment using a capsular device in in-vivo studies","authors":"Dong-Ru Ho, Chi-Tung Cheng, Chun-Hsiang Ouyang, Wei-Cheng Lin, Chien-Hung Liao","doi":"10.1186/s13017-024-00553-8","DOIUrl":"https://doi.org/10.1186/s13017-024-00553-8","url":null,"abstract":"Monitoring Intraabdominal Pressure (IAP) is essential in critical care, as elevated IAP can lead to severe complications, including Abdominal Compartment Syndrome (ACS). Advances in technology, such as digital capsules, have opened new avenues for measuring IAP non-invasively. This study assesses the feasibility and effectiveness of using a capsular device for IAP measurement in an animal model. In our controlled experiment, we anesthetized pigs and simulated elevated IAP conditions by infusing CO2 into the peritoneal cavity. We compared IAP measurements obtained from three different methods: an intravesical catheter (IAPivp), a capsular device (IAPdot), and a direct peritoneal catheter (IAPdir). The data from these methods were analyzed to evaluate agreement and accuracy. The capsular sensor (IAPdot) provided continuous and accurate detection of IAP over 144 h, with a total of 53,065,487 measurement triplets recorded. The correlation coefficient (R²) between IAPdot and IAPdir was excellent at 0.9241, demonstrating high agreement. Similarly, IAPivp and IAPdir showed strong correlation with an R² of 0.9168. The use of capsular sensors for continuous and accurate assessment of IAP marks a significant advancement in the field of critical care monitoring. The high correlation between measurements from different locations and methods underscores the potential of capsular devices to transform clinical practices by providing reliable, non-invasive IAP monitoring.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"17 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452954","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 : 2024-06-14DOI: 10.1186/s13017-024-00549-4
Gavin G. Calpin, Sandra Hembrecht, Katie Giblin, Cian Hehir, Gavin P. Dowling, Arnold D.K. Hill
Appendicectomy remains the standard treatment for appendicitis. There is a lack of clarity on the timeframe in which surgery should be performed to avoid unfavourable outcomes. To perform a systematic review and network meta-analysis to evaluate the impact the (1)time-of-day surgery is performed (2), time elapsed from symptom onset to hospital presentation (patient time) (3), time elapsed from hospital presentation to surgery (hospital time), and (4)time elapsed from symptom onset to surgery (total time) have on appendicectomy outcomes. A systematic review was performed as per PRISMA-NMA guidelines. The time-of-day which surgery was done was divided into day, evening and night. The other groups were divided into < 24 h, 24–48 h and > 48 h. The rate of complicated appendicitis, operative time, perforation, post-operative complications, surgical site infection (SSI), length of stay (LOS), readmission and mortality rates were analysed. Sixteen studies were included with a total of 232,678 patients. The time of day at which surgery was performed had no impact on outcomes. The incidence of complicated appendicitis, post-operative complications and LOS were significantly better when the hospital time and total time were < 24 h. Readmission and mortality rates were significantly better when the hospital time was < 48 h. SSI, operative time, and the rate of perforation were comparable in all groups. Appendicectomy within 24 h of hospital admission is associated with improved outcomes compared to patients having surgery 24–48 and > 48 h after admission. The time-of-day which surgery is performed does not impact outcomes.
{"title":"The impact of timing on outcomes in appendicectomy: a systematic review and network meta-analysis","authors":"Gavin G. Calpin, Sandra Hembrecht, Katie Giblin, Cian Hehir, Gavin P. Dowling, Arnold D.K. Hill","doi":"10.1186/s13017-024-00549-4","DOIUrl":"https://doi.org/10.1186/s13017-024-00549-4","url":null,"abstract":"Appendicectomy remains the standard treatment for appendicitis. There is a lack of clarity on the timeframe in which surgery should be performed to avoid unfavourable outcomes. To perform a systematic review and network meta-analysis to evaluate the impact the (1)time-of-day surgery is performed (2), time elapsed from symptom onset to hospital presentation (patient time) (3), time elapsed from hospital presentation to surgery (hospital time), and (4)time elapsed from symptom onset to surgery (total time) have on appendicectomy outcomes. A systematic review was performed as per PRISMA-NMA guidelines. The time-of-day which surgery was done was divided into day, evening and night. The other groups were divided into < 24 h, 24–48 h and > 48 h. The rate of complicated appendicitis, operative time, perforation, post-operative complications, surgical site infection (SSI), length of stay (LOS), readmission and mortality rates were analysed. Sixteen studies were included with a total of 232,678 patients. The time of day at which surgery was performed had no impact on outcomes. The incidence of complicated appendicitis, post-operative complications and LOS were significantly better when the hospital time and total time were < 24 h. Readmission and mortality rates were significantly better when the hospital time was < 48 h. SSI, operative time, and the rate of perforation were comparable in all groups. Appendicectomy within 24 h of hospital admission is associated with improved outcomes compared to patients having surgery 24–48 and > 48 h after admission. The time-of-day which surgery is performed does not impact outcomes.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"8 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141319767","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 : 2024-06-08DOI: 10.1186/s13017-024-00551-w
Massimo Sartelli, Carlo Tascini, Federico Coccolini, Fabiana Dellai, Luca Ansaloni, Massimo Antonelli, Michele Bartoletti, Matteo Bassetti, Federico Boncagni, Massimo Carlini, Anna Maria Cattelan, Arturo Cavaliere, Marco Ceresoli, Alessandro Cipriano, Andrea Cortegiani, Francesco Cortese, Francesco Cristini, Eugenio Cucinotta, Lidia Dalfino, Gennaro De Pascale, Francesco Giuseppe De Rosa, Marco Falcone, Francesco Forfori, Paola Fugazzola, Milo Gatti, Ivan Gentile, Lorenzo Ghiadoni, Maddalena Giannella, Antonino Giarratano, Alessio Giordano, Massimo Girardis, Claudio Mastroianni, Gianpaola Monti, Giulia Montori, Miriam Palmieri, Marcello Pani, Ciro Paolillo, Dario Parini, Giustino Parruti, Daniela Pasero, Federico Pea, Maddalena Peghin, Nicola Petrosillo, Mauro Podda, Caterina Rizzo, Gian Maria Rossolini, Alessandro Russo, Loredana Scoccia, Gabriele Sganga, Liana Signorini, Stefania Stefani, Mario Tumbarello, Fabio Tumietto, Massimo Valentino, Mario Venditti, Bruno Viaggi, Fra..
Intra-abdominal infections (IAIs) are common surgical emergencies and are an important cause of morbidity and mortality in hospital settings, particularly if poorly managed. The cornerstones of effective IAIs management include early diagnosis, adequate source control, appropriate antimicrobial therapy, and early physiologic stabilization using intravenous fluids and vasopressor agents in critically ill patients. Adequate empiric antimicrobial therapy in patients with IAIs is of paramount importance because inappropriate antimicrobial therapy is associated with poor outcomes. Optimizing antimicrobial prescriptions improves treatment effectiveness, increases patients’ safety, and minimizes the risk of opportunistic infections (such as Clostridioides difficile) and antimicrobial resistance selection. The growing emergence of multi-drug resistant organisms has caused an impending crisis with alarming implications, especially regarding Gram-negative bacteria. The Multidisciplinary and Intersociety Italian Council for the Optimization of Antimicrobial Use promoted a consensus conference on the antimicrobial management of IAIs, including emergency medicine specialists, radiologists, surgeons, intensivists, infectious disease specialists, clinical pharmacologists, hospital pharmacists, microbiologists and public health specialists. Relevant clinical questions were constructed by the Organizational Committee in order to investigate the topic. The expert panel produced recommendation statements based on the best scientific evidence from PubMed and EMBASE Library and experts’ opinions. The statements were planned and graded according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence. On November 10, 2023, the experts met in Mestre (Italy) to debate the statements. After the approval of the statements, the expert panel met via email and virtual meetings to prepare and revise the definitive document. This document represents the executive summary of the consensus conference and comprises three sections. The first section focuses on the general principles of diagnosis and treatment of IAIs. The second section provides twenty-three evidence-based recommendations for the antimicrobial therapy of IAIs. The third section presents eight clinical diagnostic-therapeutic pathways for the most common IAIs. The document has been endorsed by the Italian Society of Surgery.
{"title":"Management of intra-abdominal infections: recommendations by the Italian council for the optimization of antimicrobial use","authors":"Massimo Sartelli, Carlo Tascini, Federico Coccolini, Fabiana Dellai, Luca Ansaloni, Massimo Antonelli, Michele Bartoletti, Matteo Bassetti, Federico Boncagni, Massimo Carlini, Anna Maria Cattelan, Arturo Cavaliere, Marco Ceresoli, Alessandro Cipriano, Andrea Cortegiani, Francesco Cortese, Francesco Cristini, Eugenio Cucinotta, Lidia Dalfino, Gennaro De Pascale, Francesco Giuseppe De Rosa, Marco Falcone, Francesco Forfori, Paola Fugazzola, Milo Gatti, Ivan Gentile, Lorenzo Ghiadoni, Maddalena Giannella, Antonino Giarratano, Alessio Giordano, Massimo Girardis, Claudio Mastroianni, Gianpaola Monti, Giulia Montori, Miriam Palmieri, Marcello Pani, Ciro Paolillo, Dario Parini, Giustino Parruti, Daniela Pasero, Federico Pea, Maddalena Peghin, Nicola Petrosillo, Mauro Podda, Caterina Rizzo, Gian Maria Rossolini, Alessandro Russo, Loredana Scoccia, Gabriele Sganga, Liana Signorini, Stefania Stefani, Mario Tumbarello, Fabio Tumietto, Massimo Valentino, Mario Venditti, Bruno Viaggi, Fra..","doi":"10.1186/s13017-024-00551-w","DOIUrl":"https://doi.org/10.1186/s13017-024-00551-w","url":null,"abstract":"Intra-abdominal infections (IAIs) are common surgical emergencies and are an important cause of morbidity and mortality in hospital settings, particularly if poorly managed. The cornerstones of effective IAIs management include early diagnosis, adequate source control, appropriate antimicrobial therapy, and early physiologic stabilization using intravenous fluids and vasopressor agents in critically ill patients. Adequate empiric antimicrobial therapy in patients with IAIs is of paramount importance because inappropriate antimicrobial therapy is associated with poor outcomes. Optimizing antimicrobial prescriptions improves treatment effectiveness, increases patients’ safety, and minimizes the risk of opportunistic infections (such as Clostridioides difficile) and antimicrobial resistance selection. The growing emergence of multi-drug resistant organisms has caused an impending crisis with alarming implications, especially regarding Gram-negative bacteria. The Multidisciplinary and Intersociety Italian Council for the Optimization of Antimicrobial Use promoted a consensus conference on the antimicrobial management of IAIs, including emergency medicine specialists, radiologists, surgeons, intensivists, infectious disease specialists, clinical pharmacologists, hospital pharmacists, microbiologists and public health specialists. Relevant clinical questions were constructed by the Organizational Committee in order to investigate the topic. The expert panel produced recommendation statements based on the best scientific evidence from PubMed and EMBASE Library and experts’ opinions. The statements were planned and graded according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence. On November 10, 2023, the experts met in Mestre (Italy) to debate the statements. After the approval of the statements, the expert panel met via email and virtual meetings to prepare and revise the definitive document. This document represents the executive summary of the consensus conference and comprises three sections. The first section focuses on the general principles of diagnosis and treatment of IAIs. The second section provides twenty-three evidence-based recommendations for the antimicrobial therapy of IAIs. The third section presents eight clinical diagnostic-therapeutic pathways for the most common IAIs. The document has been endorsed by the Italian Society of Surgery.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"314 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141292684","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 : 2024-06-08DOI: 10.1186/s13017-024-00552-9
Massimo Sartelli, Philip Barie, Vanni Agnoletti, Majdi N. Al-Hasan, Luca Ansaloni, Walter Biffl, Luis Buonomo, Stijn Blot, William G. Cheadle, Raul Coimbra, Belinda De Simone, Therese M. Duane, Paola Fugazzola, Helen Giamarellou, Timothy C. Hardcastle, Andreas Hecker, Kenji Inaba, Andrew W. Kirkpatrick, Francesco M. Labricciosa, Marc Leone, Ignacio Martin-Loeches, Ronald V. Maier, Sanjay Marwah, Ryan C. Maves, Andrea Mingoli, Philippe Montravers, Carlos A. Ordóñez, Miriam Palmieri, Mauro Podda, Jordi Rello, Robert G. Sawyer, Gabriele Sganga, Pierre Tattevin, Dipendra Thapaliya, Jeffrey Tessier, Matti Tolonen, Jan Ulrych, Carlo Vallicelli, Richard R. Watkins, Fausto Catena, Federico Coccolini
Intra-abdominal infections (IAIs) are an important cause of morbidity and mortality in hospital settings worldwide. The cornerstones of IAI management include rapid, accurate diagnostics; timely, adequate source control; appropriate, short-duration antimicrobial therapy administered according to the principles of pharmacokinetics/pharmacodynamics and antimicrobial stewardship; and hemodynamic and organ functional support with intravenous fluid and adjunctive vasopressor agents for critical illness (sepsis/organ dysfunction or septic shock after correction of hypovolemia). In patients with IAIs, a personalized approach is crucial to optimize outcomes and should be based on multiple aspects that require careful clinical assessment. The anatomic extent of infection, the presumed pathogens involved and risk factors for antimicrobial resistance, the origin and extent of the infection, the patient’s clinical condition, and the host’s immune status should be assessed continuously to optimize the management of patients with complicated IAIs.
{"title":"Intra-abdominal infections survival guide: a position statement by the Global Alliance For Infections In Surgery","authors":"Massimo Sartelli, Philip Barie, Vanni Agnoletti, Majdi N. Al-Hasan, Luca Ansaloni, Walter Biffl, Luis Buonomo, Stijn Blot, William G. Cheadle, Raul Coimbra, Belinda De Simone, Therese M. Duane, Paola Fugazzola, Helen Giamarellou, Timothy C. Hardcastle, Andreas Hecker, Kenji Inaba, Andrew W. Kirkpatrick, Francesco M. Labricciosa, Marc Leone, Ignacio Martin-Loeches, Ronald V. Maier, Sanjay Marwah, Ryan C. Maves, Andrea Mingoli, Philippe Montravers, Carlos A. Ordóñez, Miriam Palmieri, Mauro Podda, Jordi Rello, Robert G. Sawyer, Gabriele Sganga, Pierre Tattevin, Dipendra Thapaliya, Jeffrey Tessier, Matti Tolonen, Jan Ulrych, Carlo Vallicelli, Richard R. Watkins, Fausto Catena, Federico Coccolini","doi":"10.1186/s13017-024-00552-9","DOIUrl":"https://doi.org/10.1186/s13017-024-00552-9","url":null,"abstract":"Intra-abdominal infections (IAIs) are an important cause of morbidity and mortality in hospital settings worldwide. The cornerstones of IAI management include rapid, accurate diagnostics; timely, adequate source control; appropriate, short-duration antimicrobial therapy administered according to the principles of pharmacokinetics/pharmacodynamics and antimicrobial stewardship; and hemodynamic and organ functional support with intravenous fluid and adjunctive vasopressor agents for critical illness (sepsis/organ dysfunction or septic shock after correction of hypovolemia). In patients with IAIs, a personalized approach is crucial to optimize outcomes and should be based on multiple aspects that require careful clinical assessment. The anatomic extent of infection, the presumed pathogens involved and risk factors for antimicrobial resistance, the origin and extent of the infection, the patient’s clinical condition, and the host’s immune status should be assessed continuously to optimize the management of patients with complicated IAIs.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"80 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141292753","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 : 2024-06-05DOI: 10.1186/s13017-024-00550-x
A. L. Amati, R. Ebert, L. Maier, A. K. Panah, T. Schwandner, M. Sander, M. Reichert, V. Grau, S. Petzoldt, A. Hecker
The high rate of stoma placement during emergency laparotomy for secondary peritonitis is a paradigm in need of change in the current fast-track surgical setting. Despite growing evidence for the feasibility of primary bowel reconstruction in a peritonitic environment, little data substantiate a surgeons’ choice between a stoma and an anastomosis. The aim of this retrospective analysis is to identify pre- and intraoperative parameters that predict the leakage risk for enteric sutures placed during source control surgery (SCS) for secondary peritonitis. Between January 2014 and December 2020, 497 patients underwent SCS for secondary peritonitis, of whom 187 received a primary reconstruction of the lower gastro-intestinal tract without a diverting stoma. In 47 (25.1%) patients postoperative leakage of the enteric sutures was directly confirmed during revision surgery or by computed tomography. Quantifiable predictors of intestinal suture outcome were detected by multivariate analysis. Length of intensive care, in-hospital mortality and failure of release to the initial home environment were significantly higher in patients with enteric suture leakage following SCS compared to patients with intact anastomoses (p < 0.0001, p = 0.0026 and p =0.0009, respectively). Reduced serum choline esterase (sCHE) levels and a high extent of peritonitis were identified as independent risk factors for insufficiency of enteric sutures placed during emergency laparotomy. A preoperative sCHE < 4.5 kU/L and generalized fecal peritonitis associate with a significantly higher incidence of enteric suture insufficiency after primary reconstruction of the lower gastro-intestinal tract in a peritonitic abdomen. These parameters may guide surgeons when choosing the optimal surgical procedure in the emergency setting.
{"title":"Reduced preoperative serum choline esterase levels and fecal peritoneal contamination as potential predictors for the leakage of intestinal sutures after source control in secondary peritonitis","authors":"A. L. Amati, R. Ebert, L. Maier, A. K. Panah, T. Schwandner, M. Sander, M. Reichert, V. Grau, S. Petzoldt, A. Hecker","doi":"10.1186/s13017-024-00550-x","DOIUrl":"https://doi.org/10.1186/s13017-024-00550-x","url":null,"abstract":"The high rate of stoma placement during emergency laparotomy for secondary peritonitis is a paradigm in need of change in the current fast-track surgical setting. Despite growing evidence for the feasibility of primary bowel reconstruction in a peritonitic environment, little data substantiate a surgeons’ choice between a stoma and an anastomosis. The aim of this retrospective analysis is to identify pre- and intraoperative parameters that predict the leakage risk for enteric sutures placed during source control surgery (SCS) for secondary peritonitis. Between January 2014 and December 2020, 497 patients underwent SCS for secondary peritonitis, of whom 187 received a primary reconstruction of the lower gastro-intestinal tract without a diverting stoma. In 47 (25.1%) patients postoperative leakage of the enteric sutures was directly confirmed during revision surgery or by computed tomography. Quantifiable predictors of intestinal suture outcome were detected by multivariate analysis. Length of intensive care, in-hospital mortality and failure of release to the initial home environment were significantly higher in patients with enteric suture leakage following SCS compared to patients with intact anastomoses (p < 0.0001, p = 0.0026 and p =0.0009, respectively). Reduced serum choline esterase (sCHE) levels and a high extent of peritonitis were identified as independent risk factors for insufficiency of enteric sutures placed during emergency laparotomy. A preoperative sCHE < 4.5 kU/L and generalized fecal peritonitis associate with a significantly higher incidence of enteric suture insufficiency after primary reconstruction of the lower gastro-intestinal tract in a peritonitic abdomen. These parameters may guide surgeons when choosing the optimal surgical procedure in the emergency setting.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"101 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141251719","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 : 2024-06-04DOI: 10.1186/s13017-024-00542-x
Marco Milone, Pietro Anoldo, Nicola de’Angelis, Federico Coccolini, Jim Khan, Yoram Kluger, Massimo Sartelli, Luca Ansaloni, Luca Morelli, Nicola Zanini, Carlo Vallicelli, Gabriele Vigutto, Ernest E. Moore, Walter Biffl, Fausto Catena
Robotic surgery has gained widespread acceptance in elective interventions, yet its role in emergency procedures remains underexplored. While the 2021 WSES position paper discussed limited studies on the application of robotics in emergency general surgery, it recommended strict patient selection, adequate training, and improved platform accessibility. This prospective study aims to define the role of robotic surgery in emergency settings, evaluating intraoperative and postoperative outcomes and assessing its feasibility and safety. The ROEM study is an observational, prospective, multicentre, international analysis of clinically stable adult patients undergoing robotic surgery for emergency treatment of acute pathologies including diverticulitis, cholecystitis, and obstructed hernias. Data collection includes patient demographics and intervention details. Furthermore, data relating to the operating theatre team and the surgical instruments used will be collected in order to conduct a cost analysis. The study plans to enrol at least 500 patients from 50 participating centres, with each centre having a local lead and collaborators. All data will be collected and stored online through a secure server running the Research Electronic Data Capture (REDCap) web application. Ethical considerations and data governance will be paramount, requiring local ethical committee approvals from participating centres. Current literature and expert consensus suggest the feasibility of robotic surgery in emergencies with proper support. However, challenges include staff training, scheduling conflicts with elective surgeries, and increased costs. The ROEM study seeks to contribute valuable data on the safety, feasibility, and cost-effectiveness of robotic surgery in emergency settings, focusing on specific pathologies. Previous studies on cholecystitis, abdominal hernias, and diverticulitis provide insights into the benefits and challenges of robotic approaches. It is necessary to identify patient populations that benefit most from robotic emergency surgery to optimize outcomes and justify costs.
{"title":"The role of RObotic surgery in EMergency setting (ROEM): protocol for a multicentre, observational, prospective international study on the use of robotic platform in emergency surgery","authors":"Marco Milone, Pietro Anoldo, Nicola de’Angelis, Federico Coccolini, Jim Khan, Yoram Kluger, Massimo Sartelli, Luca Ansaloni, Luca Morelli, Nicola Zanini, Carlo Vallicelli, Gabriele Vigutto, Ernest E. Moore, Walter Biffl, Fausto Catena","doi":"10.1186/s13017-024-00542-x","DOIUrl":"https://doi.org/10.1186/s13017-024-00542-x","url":null,"abstract":"Robotic surgery has gained widespread acceptance in elective interventions, yet its role in emergency procedures remains underexplored. While the 2021 WSES position paper discussed limited studies on the application of robotics in emergency general surgery, it recommended strict patient selection, adequate training, and improved platform accessibility. This prospective study aims to define the role of robotic surgery in emergency settings, evaluating intraoperative and postoperative outcomes and assessing its feasibility and safety. The ROEM study is an observational, prospective, multicentre, international analysis of clinically stable adult patients undergoing robotic surgery for emergency treatment of acute pathologies including diverticulitis, cholecystitis, and obstructed hernias. Data collection includes patient demographics and intervention details. Furthermore, data relating to the operating theatre team and the surgical instruments used will be collected in order to conduct a cost analysis. The study plans to enrol at least 500 patients from 50 participating centres, with each centre having a local lead and collaborators. All data will be collected and stored online through a secure server running the Research Electronic Data Capture (REDCap) web application. Ethical considerations and data governance will be paramount, requiring local ethical committee approvals from participating centres. Current literature and expert consensus suggest the feasibility of robotic surgery in emergencies with proper support. However, challenges include staff training, scheduling conflicts with elective surgeries, and increased costs. The ROEM study seeks to contribute valuable data on the safety, feasibility, and cost-effectiveness of robotic surgery in emergency settings, focusing on specific pathologies. Previous studies on cholecystitis, abdominal hernias, and diverticulitis provide insights into the benefits and challenges of robotic approaches. It is necessary to identify patient populations that benefit most from robotic emergency surgery to optimize outcomes and justify costs.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"307 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141246550","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 : 2024-05-31DOI: 10.1186/s13017-024-00537-8
Belinda De Simone, Elie Chouillard, Mauro Podda, Nikolaos Pararas, Gustavo de Carvalho Duarte, Paola Fugazzola, Arianna Birindelli, Federico Coccolini, Andrea Polistena, Maria Grazia Sibilla, Vitor Kruger, Gustavo P Fraga, Giulia Montori, Emanuele Russo, Tadeja Pintar, Luca Ansaloni, Nicola Avenia, Salomone Di Saverio, Ari Leppäniemi, Andrea Lauretta, Massimo Sartelli, Alessandro Puzziello, Paolo Carcoforo, Vanni Agnoletti, Luca Bissoni, Arda Isik, Yoram Kluger, Ernest E Moore, Oreste Marco Romeo, Fikri M Abu-Zidan, Solomon Gurmu Beka, Dieter G Weber, Edward C T H Tan, Ciro Paolillo, Yunfeng Cui, Fernando Kim, Edoardo Picetti, Isidoro Di Carlo, Adriana Toro, Gabriele Sganga, Federica Sganga, Mario Testini, Giovanna Di Meo, Andrew W Kirkpatrick, Ingo Marzi, Nicola déAngelis, Michael Denis Kelly, Imtiaz Wani, Boris Sakakushev, Miklosh Bala, Luigi Bonavina, Joseph M Galante, Vishal G Shelat, Lorenzo Cobianchi, Francesca Dal Mas, Manos Pikoulis, Dimitrios Damaskos, Raul Coimbra, Jugdeep Dhesi, Melissa Red Hoffman, Philip F Stahel, Ronald V Maier, Andrey Litvin, Rifat Latifi, Walter L Biffl, Fausto Catena
Background: The trauma mortality rate is higher in the elderly compared with younger patients. Ageing is associated with physiological changes in multiple systems and correlated with frailty. Frailty is a risk factor for mortality in elderly trauma patients. We aim to provide evidence-based guidelines for the management of geriatric trauma patients to improve it and reduce futile procedures.
Methods: Six working groups of expert acute care and trauma surgeons reviewed extensively the literature according to the topic and the PICO question assigned. Statements and recommendations were assessed according to the GRADE methodology and approved by a consensus of experts in the field at the 10th international congress of the WSES in 2023.
Results: The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage, including drug history, frailty assessment, nutritional status, and early activation of trauma protocol to improve outcomes. Acute trauma pain in the elderly has to be managed in a multimodal analgesic approach, to avoid side effects of opioid use. Antibiotic prophylaxis is recommended in penetrating (abdominal, thoracic) trauma, in severely burned and in open fractures elderly patients to decrease septic complications. Antibiotics are not recommended in blunt trauma in the absence of signs of sepsis and septic shock. Venous thromboembolism prophylaxis with LMWH or UFH should be administrated as soon as possible in high and moderate-risk elderly trauma patients according to the renal function, weight of the patient and bleeding risk. A palliative care team should be involved as soon as possible to discuss the end of life in a multidisciplinary approach considering the patient's directives, family feelings and representatives' desires, and all decisions should be shared.
Conclusions: The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage based on assessing frailty and early activation of trauma protocol to improve outcomes. Geriatric Intensive Care Units are needed to care for elderly and frail trauma patients in a multidisciplinary approach to decrease mortality and improve outcomes.
{"title":"The 2023 WSES guidelines on the management of trauma in elderly and frail patients.","authors":"Belinda De Simone, Elie Chouillard, Mauro Podda, Nikolaos Pararas, Gustavo de Carvalho Duarte, Paola Fugazzola, Arianna Birindelli, Federico Coccolini, Andrea Polistena, Maria Grazia Sibilla, Vitor Kruger, Gustavo P Fraga, Giulia Montori, Emanuele Russo, Tadeja Pintar, Luca Ansaloni, Nicola Avenia, Salomone Di Saverio, Ari Leppäniemi, Andrea Lauretta, Massimo Sartelli, Alessandro Puzziello, Paolo Carcoforo, Vanni Agnoletti, Luca Bissoni, Arda Isik, Yoram Kluger, Ernest E Moore, Oreste Marco Romeo, Fikri M Abu-Zidan, Solomon Gurmu Beka, Dieter G Weber, Edward C T H Tan, Ciro Paolillo, Yunfeng Cui, Fernando Kim, Edoardo Picetti, Isidoro Di Carlo, Adriana Toro, Gabriele Sganga, Federica Sganga, Mario Testini, Giovanna Di Meo, Andrew W Kirkpatrick, Ingo Marzi, Nicola déAngelis, Michael Denis Kelly, Imtiaz Wani, Boris Sakakushev, Miklosh Bala, Luigi Bonavina, Joseph M Galante, Vishal G Shelat, Lorenzo Cobianchi, Francesca Dal Mas, Manos Pikoulis, Dimitrios Damaskos, Raul Coimbra, Jugdeep Dhesi, Melissa Red Hoffman, Philip F Stahel, Ronald V Maier, Andrey Litvin, Rifat Latifi, Walter L Biffl, Fausto Catena","doi":"10.1186/s13017-024-00537-8","DOIUrl":"10.1186/s13017-024-00537-8","url":null,"abstract":"<p><strong>Background: </strong>The trauma mortality rate is higher in the elderly compared with younger patients. Ageing is associated with physiological changes in multiple systems and correlated with frailty. Frailty is a risk factor for mortality in elderly trauma patients. We aim to provide evidence-based guidelines for the management of geriatric trauma patients to improve it and reduce futile procedures.</p><p><strong>Methods: </strong>Six working groups of expert acute care and trauma surgeons reviewed extensively the literature according to the topic and the PICO question assigned. Statements and recommendations were assessed according to the GRADE methodology and approved by a consensus of experts in the field at the 10th international congress of the WSES in 2023.</p><p><strong>Results: </strong>The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage, including drug history, frailty assessment, nutritional status, and early activation of trauma protocol to improve outcomes. Acute trauma pain in the elderly has to be managed in a multimodal analgesic approach, to avoid side effects of opioid use. Antibiotic prophylaxis is recommended in penetrating (abdominal, thoracic) trauma, in severely burned and in open fractures elderly patients to decrease septic complications. Antibiotics are not recommended in blunt trauma in the absence of signs of sepsis and septic shock. Venous thromboembolism prophylaxis with LMWH or UFH should be administrated as soon as possible in high and moderate-risk elderly trauma patients according to the renal function, weight of the patient and bleeding risk. A palliative care team should be involved as soon as possible to discuss the end of life in a multidisciplinary approach considering the patient's directives, family feelings and representatives' desires, and all decisions should be shared.</p><p><strong>Conclusions: </strong>The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage based on assessing frailty and early activation of trauma protocol to improve outcomes. Geriatric Intensive Care Units are needed to care for elderly and frail trauma patients in a multidisciplinary approach to decrease mortality and improve outcomes.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"19 1","pages":"18"},"PeriodicalIF":8.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11140935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141181181","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}
Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used to control massive hemorrhages. Although there is no consensus on the efficacy of REBOA, it remains an option as a bridging therapy in non-trauma centers where trauma surgeons are not available. To better understand the current landscape of REBOA application, we examined changes in its usage, target population, and treatment outcomes in Japan, where immediate hemostasis procedures sometimes cannot be performed. This retrospective observational study used the Japan Trauma Data Bank data. All cases in which REBOA was performed between January 2004 and December 2021 were included. The primary outcome was the in-hospital mortality rate. We analyzed mortality trends over time according to the number of cases, number of centers, severity of injury, and overall and subgroup mortality associated with REBOA usage. We performed a logistic analysis of mortality trends over time, adjusting for probability of survival based on the trauma and injury severity score. Overall, 2557 patients were treated with REBOA and were deemed eligible for inclusion. The median age of the participants was 55 years, and male patients constituted 65.3% of the study population. Blunt trauma accounted for approximately 93.0% of the cases. The number of cases and facilities that used REBOA increased until 2019. While the injury severity score and revised trauma score did not change throughout the observation period, the hospital mortality rate decreased from 91.3 to 50.9%. The REBOA group without severe head or spine injuries showed greater improvement in mortality than the all-patient group using REBOA and all-trauma patient group. The greatest improvement in mortality was observed in patients with systolic blood pressure ≥ 80 mmHg. The adjusted odds ratios for hospital mortality steadily declined, even after adjusting for the probability of survival. While there was no significant change in patient severity, mortality of patients treated with REBOA decreased over time. Further research is required to determine the reasons for these improvements in trauma care.
{"title":"Use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for trauma and its performance in Japan over the past 18 years: a nationwide descriptive study","authors":"Hiromasa Hoshi, Akira Endo, Ryo Yamamoto, Kazuma Yamakawa, Keisuke Suzuki, Tomohiro Akutsu, Koji Morishita","doi":"10.1186/s13017-024-00548-5","DOIUrl":"https://doi.org/10.1186/s13017-024-00548-5","url":null,"abstract":"Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used to control massive hemorrhages. Although there is no consensus on the efficacy of REBOA, it remains an option as a bridging therapy in non-trauma centers where trauma surgeons are not available. To better understand the current landscape of REBOA application, we examined changes in its usage, target population, and treatment outcomes in Japan, where immediate hemostasis procedures sometimes cannot be performed. This retrospective observational study used the Japan Trauma Data Bank data. All cases in which REBOA was performed between January 2004 and December 2021 were included. The primary outcome was the in-hospital mortality rate. We analyzed mortality trends over time according to the number of cases, number of centers, severity of injury, and overall and subgroup mortality associated with REBOA usage. We performed a logistic analysis of mortality trends over time, adjusting for probability of survival based on the trauma and injury severity score. Overall, 2557 patients were treated with REBOA and were deemed eligible for inclusion. The median age of the participants was 55 years, and male patients constituted 65.3% of the study population. Blunt trauma accounted for approximately 93.0% of the cases. The number of cases and facilities that used REBOA increased until 2019. While the injury severity score and revised trauma score did not change throughout the observation period, the hospital mortality rate decreased from 91.3 to 50.9%. The REBOA group without severe head or spine injuries showed greater improvement in mortality than the all-patient group using REBOA and all-trauma patient group. The greatest improvement in mortality was observed in patients with systolic blood pressure ≥ 80 mmHg. The adjusted odds ratios for hospital mortality steadily declined, even after adjusting for the probability of survival. While there was no significant change in patient severity, mortality of patients treated with REBOA decreased over time. Further research is required to determine the reasons for these improvements in trauma care.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"22 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141182449","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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