Rib fractures are frequently encountered in trauma care and are particularly hazardous for functionally dependent patients, leading to increased morbidity and mortality rates. Surgical stabilization of rib fractures (SSRF) improves outcomes in selected populations; however, its role in functionally dependent individuals remains underexplored. A retrospective cohort analysis was conducted using the American College of Surgeons-Trauma Quality Improvement Program dataset from 2020 to 2022. Patients with three or more rib fractures and AIS (Abbreviated Injury Scale) greater than 3 for the rib and thoracic wall, along with documented functional dependency, were included. Propensity score matching (3:1) was applied to reduce the selection bias between patients receiving SSRF and those managed conservatively. The main outcomes of interest were in-hospital mortality, acute respiratory distress syndrome, unplanned intensive care unit (ICU) admission, unplanned intubation, and ventilator-associated pneumonia (VAP). A subgroup analysis compared early (≤ 72 h) versus late SSRF. Among 18,643 eligible patients, 359 (1.9%) underwent SSRF. Before matching, patients with SSRF had higher Injury Severity Scores (ISS), ICU admissions, and complication rates. After matching (294 SSRF vs. 883 conservative patients), SSRF was associated with significantly lower mortality (4.8% vs. 8.7%, p = 0.038) despite higher rates of unplanned ICU admission (11.2% vs. 7.0%, p = 0.031), unplanned intubation (10.2% vs. 6.1%, p = 0.026), and VAP (3.1% vs. 0.6%, p = 0.002). In the subgroup analysis, early SSRF led to fewer ventilator days (p = 0.013), and shorter ICU (p < 0.001), and hospital length of stays (LOS, p < 0.001), with no difference in mortality compared with late SSRF. However, the late SSRF group still had significantly lower in-hospital mortality compared to the conservative treatment group (3.8% vs. 10.9%, p = 0.023). SSRF in functionally dependent trauma patients with multiple rib fractures and significant chest wall injury (AIS ≥ 3) is associated with a significant reduction in in-hospital mortality compared to conservative management, despite a higher incidence of complications and prolonged ICU LOS. Early SSRF further improves clinical outcomes by decreasing ventilator duration and overall hospital LOS. These findings support the consideration of SSRF—particularly when performed early—as a beneficial strategy for managing rib fractures in functionally dependent patients. Even when performed at a later stage, SSRF still offers advantages over conservative treatment in reducing mortality. prospective studies are warranted to validate these results and establish clear patient selection criteria.
肋骨骨折在创伤护理中经常遇到，对功能依赖的患者尤其危险，导致发病率和死亡率增加。肋骨骨折手术稳定（SSRF）改善了特定人群的预后；然而，它在功能依赖个体中的作用仍未得到充分探索。回顾性队列分析使用美国外科医师学会创伤质量改善计划数据集，时间为2020年至2022年。患者有三处或三处以上肋骨骨折，且肋骨和胸壁AIS（简略损伤评分）大于3分，并伴有记录的功能依赖。采用倾向评分匹配（3:1）来减少接受SSRF治疗的患者与保守治疗的患者之间的选择偏差。主要结局为住院死亡率、急性呼吸窘迫综合征、计划外重症监护病房（ICU）入院、计划外插管和呼吸机相关性肺炎（VAP）。亚组分析比较早期（≤72 h）和晚期SSRF。在18643例符合条件的患者中，359例（1.9%）接受了SSRF。配对前，SSRF患者的损伤严重程度评分（ISS）、ICU入院率和并发症发生率较高。配对后（294例SSRF对883例保守患者），SSRF与较低的死亡率（4.8%对8.7%,p = 0.038）相关，尽管非计划ICU入院率（11.2%对7.0%,p = 0.031）、非计划插管率（10.2%对6.1%,p = 0.026）和VAP（3.1%对0.6%,p = 0.002）较高。在亚组分析中，早期SSRF导致更少的呼吸机天数（p = 0.013），更短的ICU （p < 0.001）和住院时间（LOS, p < 0.001），与晚期SSRF相比，死亡率无差异。然而，与保守治疗组相比，晚期SSRF组的住院死亡率仍显著降低（3.8% vs. 10.9%, p = 0.023）。与保守治疗相比，SSRF治疗伴有多发肋骨骨折和严重胸壁损伤（AIS≥3）的功能依赖型创伤患者的住院死亡率显著降低，尽管并发症发生率较高，ICU LOS延长。早期SSRF通过减少呼吸机持续时间和整体医院LOS进一步改善临床结果。这些发现支持考虑ssrf -特别是在早期进行时-作为治疗功能依赖患者肋骨骨折的有益策略。即使在后期进行，SSRF在降低死亡率方面仍比保守治疗有优势。有必要进行前瞻性研究以验证这些结果并建立明确的患者选择标准。
{"title":"Surgical stabilization of rib fractures improves survival in functionally dependent trauma patients","authors":"Yi-Yu Lin, Yi-Jung Chen, Chih-Po Hsu, Jen-Fu Huang, Ya-Chiao Lin, Ling-Wei Kuo, Chi-Tung Cheng, Chien-Hung Liao","doi":"10.1186/s13017-025-00634-2","DOIUrl":"https://doi.org/10.1186/s13017-025-00634-2","url":null,"abstract":"Rib fractures are frequently encountered in trauma care and are particularly hazardous for functionally dependent patients, leading to increased morbidity and mortality rates. Surgical stabilization of rib fractures (SSRF) improves outcomes in selected populations; however, its role in functionally dependent individuals remains underexplored. A retrospective cohort analysis was conducted using the American College of Surgeons-Trauma Quality Improvement Program dataset from 2020 to 2022. Patients with three or more rib fractures and AIS (Abbreviated Injury Scale) greater than 3 for the rib and thoracic wall, along with documented functional dependency, were included. Propensity score matching (3:1) was applied to reduce the selection bias between patients receiving SSRF and those managed conservatively. The main outcomes of interest were in-hospital mortality, acute respiratory distress syndrome, unplanned intensive care unit (ICU) admission, unplanned intubation, and ventilator-associated pneumonia (VAP). A subgroup analysis compared early (≤ 72 h) versus late SSRF. Among 18,643 eligible patients, 359 (1.9%) underwent SSRF. Before matching, patients with SSRF had higher Injury Severity Scores (ISS), ICU admissions, and complication rates. After matching (294 SSRF vs. 883 conservative patients), SSRF was associated with significantly lower mortality (4.8% vs. 8.7%, p = 0.038) despite higher rates of unplanned ICU admission (11.2% vs. 7.0%, p = 0.031), unplanned intubation (10.2% vs. 6.1%, p = 0.026), and VAP (3.1% vs. 0.6%, p = 0.002). In the subgroup analysis, early SSRF led to fewer ventilator days (p = 0.013), and shorter ICU (p < 0.001), and hospital length of stays (LOS, p < 0.001), with no difference in mortality compared with late SSRF. However, the late SSRF group still had significantly lower in-hospital mortality compared to the conservative treatment group (3.8% vs. 10.9%, p = 0.023). SSRF in functionally dependent trauma patients with multiple rib fractures and significant chest wall injury (AIS ≥ 3) is associated with a significant reduction in in-hospital mortality compared to conservative management, despite a higher incidence of complications and prolonged ICU LOS. Early SSRF further improves clinical outcomes by decreasing ventilator duration and overall hospital LOS. These findings support the consideration of SSRF—particularly when performed early—as a beneficial strategy for managing rib fractures in functionally dependent patients. Even when performed at a later stage, SSRF still offers advantages over conservative treatment in reducing mortality. prospective studies are warranted to validate these results and establish clear patient selection criteria.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"21 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593914","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}
Pancreatic and extrahepatic biliary tree traumas are rare traumas, due to specific trauma dynamics. They may require both non-operative and operative management, according to the severity of injury. In the case of operative management, a multidisciplinary approach is crucial to improve clinical outcomes, to reduce complications and to ensure complete management of injuries. The case presented is an example of such a multidisciplinary approach in polytrauma, in which the combination of surgical and endoscopic approach allowed to manage severe common biliary duct and pancreatic head injury, creating a “neoampulla”. This is the first case described in literature of such an approach in common bile duct traumatic injury.
{"title":"Neoampulla of vater creation to treat traumatic intrapancreatic common bile duct injury","authors":"Ercolani Giorgio, Santandrea Giorgia, Fabbri Carlo, Bisulli Marcello, Agnoletti Vanni, Giampalma Emanuela, Vallicelli Carlo, Catena Fausto","doi":"10.1186/s13017-025-00621-7","DOIUrl":"https://doi.org/10.1186/s13017-025-00621-7","url":null,"abstract":"Pancreatic and extrahepatic biliary tree traumas are rare traumas, due to specific trauma dynamics. They may require both non-operative and operative management, according to the severity of injury. In the case of operative management, a multidisciplinary approach is crucial to improve clinical outcomes, to reduce complications and to ensure complete management of injuries. The case presented is an example of such a multidisciplinary approach in polytrauma, in which the combination of surgical and endoscopic approach allowed to manage severe common biliary duct and pancreatic head injury, creating a “neoampulla”. This is the first case described in literature of such an approach in common bile duct traumatic injury.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"685 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568810","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 : 2025-07-05DOI: 10.1186/s13017-025-00633-3
Ayman El-Menyar, Sandro Rizoli, Ahammed Mekkodathil, Mohammad Asim, Sajid Atique, Abdel-Aziz Hammo, Hisham Jogol, Ahad Kanbar, Khalid Ahmed, Rafael Consunji, Husham Abdelrahman, Asmaa Al-Atey, Ahmad Kloub, Fernando Spencer Netto, Gustav Strandvik, Hassan Al-Thani
Qatar is one of six neighboring countries in the Gulf Cooperation Council region that form a political and economic alliance to foster multilateral cooperation. Given the shared challenges in trauma care, there is a need for a collaborative network to develop region-specific injury prevention strategies. For example, this study examines the clinical patterns and predictors of hospital mortality among trauma patients in Qatar. A retrospective analysis of trauma-related deaths (2010–2023) was conducted. Patients were stratified into early hospital mortality (EHM, ≤ 48 h) and late hospital mortality (LHM, > 48 h) groups. Further analyses examined in-hospital mortality (24 h, 24–48 h, 3–7 days, and > 7 days), age groups, injury mechanisms, and severity. A multivariable regression analysis identified predictors of early mortality. Among 2,452 trauma-related deaths, 59% occurred in pre-hospital, while 41% occurred in-hospital. Compared to LHM (47%), EHM (53%) was associated with a younger age (35 vs. 39 years; p = 0.002), higher systolic blood pressure (0.82 vs. 0.67; p = 0.002), and diastolic blood pressure (2.03 vs. 1.75; p = 0.001). Motor vehicle crash (MVC) was the leading cause of death (35.3%), with vulnerable road users (VRU) the commonest in EHM (p = 0.004) and falls in LHM (p = 0.004). LHM was associated with a higher injury severity score (p = 0.001). On-admission systolic shock index independently predicted EHM (OR 2.23; 95% CI 1.09–4.52), while head (OR 7.14; 95% CI 2.44–20.00) and pelvic injuries (OR 3.70; 95% CI 1.19–11.11) and sepsis (OR 6.25; 95% CI 1.22–33.33) predicted LHM. In-hospital deaths exhibited a bimodal distribution, with peaks at 24 h (15%) and between the third and seventh days (10%). EHM showed an upward trend over the years (R² = 0.312), while LHM remained stable. Trauma-related mortality rates declined from 10.4 to 5.0 per 100,000 population (2011 and 2017) before rising to 9.7 by 2022. Pre-hospital deaths followed a similar pattern to the overall mortality, while the in-hospital rates remained steady. VRU-related injuries persisted at a high level, accounting for 26–43% of cases throughout the study period. This study highlights distinct trauma-related mortality patterns, with EHM linked to hemorrhage and shock, while LHM is associated with severe head injuries and sepsis. These findings underscore the need for targeted interventions to optimize bleeding control and address predictors such as shock indices for EHM and head injuries for LHM.
卡塔尔是海湾合作委员会地区的六个邻国之一，这些国家组成了政治和经济联盟，以促进多边合作。鉴于创伤护理的共同挑战，有必要建立一个协作网络来制定特定区域的伤害预防策略。例如，本研究考察了卡塔尔创伤患者住院死亡率的临床模式和预测因素。对2010-2023年创伤相关死亡病例进行回顾性分析。将患者分为早期住院死亡率（EHM,≤48 h）组和晚期住院死亡率（LHM,≤48 h）组。进一步的分析检查了住院死亡率（24小时、24 - 48小时、3-7天和10 - 7天）、年龄组、损伤机制和严重程度。多变量回归分析确定了早期死亡的预测因素。在2,452例创伤相关死亡中，59%发生在院前，41%发生在院内。与LHM（47%）相比，EHM（53%）与较年轻的年龄相关(35岁对39岁；P = 0.002)，收缩压升高(0.82 vs. 0.67；P = 0.002)，舒张压(2.03 vs. 1.75；p = 0.001)。机动车碰撞（MVC）是导致死亡的主要原因（35.3%），易受伤害的道路使用者（VRU）在EHM中最常见（p = 0.004），在LHM中下降（p = 0.004）。LHM与较高的损伤严重程度评分相关（p = 0.001）。入院时收缩期休克指数独立预测EHM (OR 2.23；95% CI 1.09-4.52)，而头部(OR 7.14；95% CI 2.44-20.00)和骨盆损伤(OR 3.70；95% CI 1.19-11.11)和脓毒症(OR 6.25；95% CI 1.22-33.33)预测LHM。院内死亡呈双峰分布，高峰出现在24小时（15%）和第3天至第7天（10%）。EHM呈逐年上升趋势（R²= 0.312），而LHM保持稳定。创伤相关死亡率从每10万人10.4人（2011年和2017年）下降到5.0人，然后到2022年上升到9.7人。院前死亡率与总体死亡率的模式相似，而住院死亡率则保持稳定。在整个研究期间，vru相关损伤持续处于高水平，占病例的26-43%。这项研究强调了不同的创伤相关死亡模式，EHM与出血和休克有关，而LHM与严重的头部损伤和败血症有关。这些发现强调了有针对性的干预措施的必要性，以优化出血控制和解决预测因素，如EHM的休克指数和LHM的头部损伤。
{"title":"Clinical patterns and predictors of trauma-related mortality over 13 years: a retrospective analysis from a Level 1 National trauma center","authors":"Ayman El-Menyar, Sandro Rizoli, Ahammed Mekkodathil, Mohammad Asim, Sajid Atique, Abdel-Aziz Hammo, Hisham Jogol, Ahad Kanbar, Khalid Ahmed, Rafael Consunji, Husham Abdelrahman, Asmaa Al-Atey, Ahmad Kloub, Fernando Spencer Netto, Gustav Strandvik, Hassan Al-Thani","doi":"10.1186/s13017-025-00633-3","DOIUrl":"https://doi.org/10.1186/s13017-025-00633-3","url":null,"abstract":"Qatar is one of six neighboring countries in the Gulf Cooperation Council region that form a political and economic alliance to foster multilateral cooperation. Given the shared challenges in trauma care, there is a need for a collaborative network to develop region-specific injury prevention strategies. For example, this study examines the clinical patterns and predictors of hospital mortality among trauma patients in Qatar. A retrospective analysis of trauma-related deaths (2010–2023) was conducted. Patients were stratified into early hospital mortality (EHM, ≤ 48 h) and late hospital mortality (LHM, > 48 h) groups. Further analyses examined in-hospital mortality (24 h, 24–48 h, 3–7 days, and > 7 days), age groups, injury mechanisms, and severity. A multivariable regression analysis identified predictors of early mortality. Among 2,452 trauma-related deaths, 59% occurred in pre-hospital, while 41% occurred in-hospital. Compared to LHM (47%), EHM (53%) was associated with a younger age (35 vs. 39 years; p = 0.002), higher systolic blood pressure (0.82 vs. 0.67; p = 0.002), and diastolic blood pressure (2.03 vs. 1.75; p = 0.001). Motor vehicle crash (MVC) was the leading cause of death (35.3%), with vulnerable road users (VRU) the commonest in EHM (p = 0.004) and falls in LHM (p = 0.004). LHM was associated with a higher injury severity score (p = 0.001). On-admission systolic shock index independently predicted EHM (OR 2.23; 95% CI 1.09–4.52), while head (OR 7.14; 95% CI 2.44–20.00) and pelvic injuries (OR 3.70; 95% CI 1.19–11.11) and sepsis (OR 6.25; 95% CI 1.22–33.33) predicted LHM. In-hospital deaths exhibited a bimodal distribution, with peaks at 24 h (15%) and between the third and seventh days (10%). EHM showed an upward trend over the years (R² = 0.312), while LHM remained stable. Trauma-related mortality rates declined from 10.4 to 5.0 per 100,000 population (2011 and 2017) before rising to 9.7 by 2022. Pre-hospital deaths followed a similar pattern to the overall mortality, while the in-hospital rates remained steady. VRU-related injuries persisted at a high level, accounting for 26–43% of cases throughout the study period. This study highlights distinct trauma-related mortality patterns, with EHM linked to hemorrhage and shock, while LHM is associated with severe head injuries and sepsis. These findings underscore the need for targeted interventions to optimize bleeding control and address predictors such as shock indices for EHM and head injuries for LHM.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"20 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565767","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 : 2025-07-05DOI: 10.1186/s13017-025-00627-1
Victor Rudondy, Pierre-Antoine Barral, Thibaut Markarian, Sophie Chopinet, Marine Barraud, Marine Gaudry, Jeremy Bourenne, Cyril Nafati, Benedicte Grigoresco, David Lagier, Alexandre Rossillon, Diane Mege
Acute mesenteric ischaemia (AMI) is an emergency with a poor prognosis. In France, a structure dedicated to AMI has been created in Paris in 2016 (SURVI), with promising results. A similar organization has been created in Marseille in 2021 (SOS AMI). Our aim was to compare the results of SOS AMI with those of a previous cohort of AMI patients managed without any dedicated structure. The first 100 patients with AMI, managed by the SOS AMI, between November 2021 and December 2023 were prospectively included. They were compared with 100 AMI patients from a previous retrospective cohort (from January 2017 to December 2020), managed without any dedicated structure in the same center. The first 100 AMI patients managed by SOS AMI have similar demographic characteristics to those previously managed without SOS. The vascular causes of AMI were also similar between groups: arterial occlusive (61 vs. 56%, p = 0.5), venous occlusive (17 vs. 13%, p = 0.5), or non occlusive (22 vs. 31%, p = 0.2). AMI patients managed by SOS AMI were more frequently transferred from another center (41 vs. 19%, p = 0.001), had a shorter median time between CT scan and intervention (4 [range, 1-129] vs. 5 [0-285] hours, p = 0.05), a higher revascularisation rate (61 vs. 28%, p = 0.02), and lower 30-day (32 vs. 58%, p < 0.001) and 90-day (45 vs. 62%, p = 0.02) mortality rates. The creation of SOS AMI has significantly improved the management of AMI patients, by better organizing the role of the various specialties involved, particularly in terms of revascularisation and survival rates. These promising results support the further development and expansion of this dedicated structure.
{"title":"Impact on the prognosis with the creation of a dedicated stroke to mesenteric ischaemia","authors":"Victor Rudondy, Pierre-Antoine Barral, Thibaut Markarian, Sophie Chopinet, Marine Barraud, Marine Gaudry, Jeremy Bourenne, Cyril Nafati, Benedicte Grigoresco, David Lagier, Alexandre Rossillon, Diane Mege","doi":"10.1186/s13017-025-00627-1","DOIUrl":"https://doi.org/10.1186/s13017-025-00627-1","url":null,"abstract":"Acute mesenteric ischaemia (AMI) is an emergency with a poor prognosis. In France, a structure dedicated to AMI has been created in Paris in 2016 (SURVI), with promising results. A similar organization has been created in Marseille in 2021 (SOS AMI). Our aim was to compare the results of SOS AMI with those of a previous cohort of AMI patients managed without any dedicated structure. The first 100 patients with AMI, managed by the SOS AMI, between November 2021 and December 2023 were prospectively included. They were compared with 100 AMI patients from a previous retrospective cohort (from January 2017 to December 2020), managed without any dedicated structure in the same center. The first 100 AMI patients managed by SOS AMI have similar demographic characteristics to those previously managed without SOS. The vascular causes of AMI were also similar between groups: arterial occlusive (61 vs. 56%, p = 0.5), venous occlusive (17 vs. 13%, p = 0.5), or non occlusive (22 vs. 31%, p = 0.2). AMI patients managed by SOS AMI were more frequently transferred from another center (41 vs. 19%, p = 0.001), had a shorter median time between CT scan and intervention (4 [range, 1-129] vs. 5 [0-285] hours, p = 0.05), a higher revascularisation rate (61 vs. 28%, p = 0.02), and lower 30-day (32 vs. 58%, p < 0.001) and 90-day (45 vs. 62%, p = 0.02) mortality rates. The creation of SOS AMI has significantly improved the management of AMI patients, by better organizing the role of the various specialties involved, particularly in terms of revascularisation and survival rates. These promising results support the further development and expansion of this dedicated structure.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"74 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565768","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 : 2025-06-25DOI: 10.1186/s13017-025-00625-3
Anaida Xacur-Trabulce,Gessner Casas-Fuentes,Veronica Ruiz-Vasconcelos,Marianne Marchini Reitz,Sharon M Henry,Thomas M Scalea,Marcelo A F Ribeiro
BACKGROUNDTourniquets are crucial for controlling life-threatening hemorrhage and, therefore, in preventing avoidable deaths in both military and civilian settings. Its increased use since the launch of the Stop the Bleed campaign, however, has raised concerns regarding possible complications associated with its application, including limb ischemia and amputation. The objective of this study was to synthesize the existing evidence regarding complications associated with the use of tourniquets for extremity injuries and identify gaps in knowledge to guide future research on this topic.METHODSA review of the literature between 2016 and 2024 was performed including open access retrospective studies, case series, clinical cases, and systematic reviews that addressed tourniquet use in a civilian or military setting in patients with extremity injuries, following the PRISMA-ScR 2018 checklist. PubMed, ScienceDirect, and Cochrane databases were queried, identifying 1,398 articles on the use of extremity tourniquets in military and civilian contexts, focusing on complications. Of these, 1,343 articles were excluded due to duplication or irrelevance based on the title. From the 55 remaining, 37 were excluded after abstract review for not meeting inclusion criteria. Of the 18 full-text articles reviewed, 10 were excluded due to insufficient data, leaving 8 studies for detailed analysis.RESULTSProlonged application in emergency situations may lead to severe complications, such as nerve injuries, post-tourniquet syndrome and thromboembolic event risks. Nerve palsy has been identified as the most prevalent complication associated with prolonged tourniquet use.CONCLUSIONImproved training is essential to help providers accurately assess bleeding severity and apply appropriate interventions, reducing complications and enhancing outcomes. Future research opportunities should consider: (1) prospective interventional randomized controlled studies aiming to compare the use of tourniquets to different methods of hemorrhage control; (2) development and validation of easy-to-use scores predicting complications and the need of amputation in both civilian and military settings including upper and lower extremities, to better guide clinical decisions and future guidelines; (3) development of better ways to teach lay providers to recognize life threatening bleeding; and (4) development of guidelines for timing of tourniquet loosening, removal or conversion.
{"title":"Tourniquet-related complications in extremity injuries: a scoping review of the literature.","authors":"Anaida Xacur-Trabulce,Gessner Casas-Fuentes,Veronica Ruiz-Vasconcelos,Marianne Marchini Reitz,Sharon M Henry,Thomas M Scalea,Marcelo A F Ribeiro","doi":"10.1186/s13017-025-00625-3","DOIUrl":"https://doi.org/10.1186/s13017-025-00625-3","url":null,"abstract":"BACKGROUNDTourniquets are crucial for controlling life-threatening hemorrhage and, therefore, in preventing avoidable deaths in both military and civilian settings. Its increased use since the launch of the Stop the Bleed campaign, however, has raised concerns regarding possible complications associated with its application, including limb ischemia and amputation. The objective of this study was to synthesize the existing evidence regarding complications associated with the use of tourniquets for extremity injuries and identify gaps in knowledge to guide future research on this topic.METHODSA review of the literature between 2016 and 2024 was performed including open access retrospective studies, case series, clinical cases, and systematic reviews that addressed tourniquet use in a civilian or military setting in patients with extremity injuries, following the PRISMA-ScR 2018 checklist. PubMed, ScienceDirect, and Cochrane databases were queried, identifying 1,398 articles on the use of extremity tourniquets in military and civilian contexts, focusing on complications. Of these, 1,343 articles were excluded due to duplication or irrelevance based on the title. From the 55 remaining, 37 were excluded after abstract review for not meeting inclusion criteria. Of the 18 full-text articles reviewed, 10 were excluded due to insufficient data, leaving 8 studies for detailed analysis.RESULTSProlonged application in emergency situations may lead to severe complications, such as nerve injuries, post-tourniquet syndrome and thromboembolic event risks. Nerve palsy has been identified as the most prevalent complication associated with prolonged tourniquet use.CONCLUSIONImproved training is essential to help providers accurately assess bleeding severity and apply appropriate interventions, reducing complications and enhancing outcomes. Future research opportunities should consider: (1) prospective interventional randomized controlled studies aiming to compare the use of tourniquets to different methods of hemorrhage control; (2) development and validation of easy-to-use scores predicting complications and the need of amputation in both civilian and military settings including upper and lower extremities, to better guide clinical decisions and future guidelines; (3) development of better ways to teach lay providers to recognize life threatening bleeding; and (4) development of guidelines for timing of tourniquet loosening, removal or conversion.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"45 1","pages":"57"},"PeriodicalIF":8.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478765","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 : 2025-06-24DOI: 10.1186/s13017-025-00629-z
Yang Yang, Zexin Xie, Jiantao Zhang, Xuetao Zhou, Zheng Liang, Chunjuan Hou, Jin Zhang, Dongsheng Zhang
This study aimed to investigate the surgical outcomes and complications of completely thoracoscopic surgical stabilization of rib fractures (cTSSRF) in patients with rib fractures in the posterior chest wall area. A retrospective analysis was conducted on 30 patients who underwent completely thoracoscopic surgical stabilization of rib fractures (cTSSRF) between September 2019 and October 2023. Clinical data were gathered to compare and analyze the clinical outcomes of complications of cTSSRF and open surgical stabilization of rib fractures (oSSRF). A total of 201 rib fractures were repaired in 30 patients, including 79 rib fractures in the posterior chest wall (an average of 2.63 rib fractures/person) that were fixed by cTSSRF, and 122 rib fractures (an average of 4.06 rib fractures/person) fixed by oSSRF. No obvious thoracic collapse deformity was observed postoperatively in any patient. The median duration of chest tube removal after surgery was 3 (3–4) days, and the chest drainage volume was 586.33 ± 232.4 ml. The numeric rating scale score (NRS) was 3 (2–3.25), which was significantly lower than the preoperative score of 7 (6–8), z = -4.826, P < 0.001). The rate of implant displacement of the cTSSRF was 6.33% (5/79), which was significantly higher than that in the oSSRF of 0(0/122), χ2 = 5.53, P = 0.019. The rates of fracture malalignment were high in the cTSSRF (21.52% [20/79] vs2.46% [3/122], P < 0.001). The incidence of postoperative encapsulated pleural effusion—defined as a maximum anteroposterior fluid thickness > 20 mm surrounding the internal fixation device on axial CT scans—was 46.7% (14/30 cases) during the 7–14 day postoperative period. All patients were followed-up in outpatient clinics or by telephone for 6–24 months, and all resumed their work capacity without obvious symptoms of chest discomfort. The application of cTSSRF is a safe, feasible and minimally invasive surgical option, particularly in cases of rib fractures in the posterior chest wall, which are challenging to address using conventional open surgery. However, the postoperative implant displacement and fracture malalignment rates are higher than those observed in conventional surgery, which still needs to require careful evaluation of the risks and benefits of routinely performing cTSSRF.
{"title":"Completely thoracoscopic surgical stabilization of rib fractures: balancing minimally invasive benefits against technique-specific complications: a single-center retrospective study","authors":"Yang Yang, Zexin Xie, Jiantao Zhang, Xuetao Zhou, Zheng Liang, Chunjuan Hou, Jin Zhang, Dongsheng Zhang","doi":"10.1186/s13017-025-00629-z","DOIUrl":"https://doi.org/10.1186/s13017-025-00629-z","url":null,"abstract":"This study aimed to investigate the surgical outcomes and complications of completely thoracoscopic surgical stabilization of rib fractures (cTSSRF) in patients with rib fractures in the posterior chest wall area. A retrospective analysis was conducted on 30 patients who underwent completely thoracoscopic surgical stabilization of rib fractures (cTSSRF) between September 2019 and October 2023. Clinical data were gathered to compare and analyze the clinical outcomes of complications of cTSSRF and open surgical stabilization of rib fractures (oSSRF). A total of 201 rib fractures were repaired in 30 patients, including 79 rib fractures in the posterior chest wall (an average of 2.63 rib fractures/person) that were fixed by cTSSRF, and 122 rib fractures (an average of 4.06 rib fractures/person) fixed by oSSRF. No obvious thoracic collapse deformity was observed postoperatively in any patient. The median duration of chest tube removal after surgery was 3 (3–4) days, and the chest drainage volume was 586.33 ± 232.4 ml. The numeric rating scale score (NRS) was 3 (2–3.25), which was significantly lower than the preoperative score of 7 (6–8), z = -4.826, P < 0.001). The rate of implant displacement of the cTSSRF was 6.33% (5/79), which was significantly higher than that in the oSSRF of 0(0/122), χ2 = 5.53, P = 0.019. The rates of fracture malalignment were high in the cTSSRF (21.52% [20/79] vs2.46% [3/122], P < 0.001). The incidence of postoperative encapsulated pleural effusion—defined as a maximum anteroposterior fluid thickness > 20 mm surrounding the internal fixation device on axial CT scans—was 46.7% (14/30 cases) during the 7–14 day postoperative period. All patients were followed-up in outpatient clinics or by telephone for 6–24 months, and all resumed their work capacity without obvious symptoms of chest discomfort. The application of cTSSRF is a safe, feasible and minimally invasive surgical option, particularly in cases of rib fractures in the posterior chest wall, which are challenging to address using conventional open surgery. However, the postoperative implant displacement and fracture malalignment rates are higher than those observed in conventional surgery, which still needs to require careful evaluation of the risks and benefits of routinely performing cTSSRF.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"25 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144371080","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 : 2025-06-24DOI: 10.1186/s13017-025-00628-0
Abdirahman Burale, Bedhaasa Beyene, Musse Ahmed, Abdullahi Hussen, Mohamed Said Hassan, Shamsedin Mahdi Hassan, Hassan Sh Abdirahman Elmi
Peptic ulcer perforation (PUP) is a surgical emergency and life-threatening complication affecting 2–10% of peptic ulcer disease (PUD) patients. Delayed diagnosis and surgical management are associated with significant morbidity and mortality. This study assessed the magnitude and outcome of PUP among patients operated on at two public hospitals in Jigjig town, Ethiopia. A 3-year hospital-based retrospective cross-sectional study was conducted on 130 patients operated for PUP at the study hospitals in Jigjig from April 1st, 2018, to July 30th, 2021. Data were collected from medical records. Bivariate analysis identified key factors impacting outcomes in PUP patients. The cohort had a male-to-female ratio of 8.7:1, and a mean age of 38 ± 13.3 years, with 48.8% smokers and 56.6% chat chewers. Duodenal perforations accounted for 93.7% of cases, with post-operative complications in 29.1% and an in-hospital mortality rate of 5.5%. Significant predictors of morbidity and mortality included advanced age (AOR 23.88), comorbidities (AOR 26.80), pre-operative hypotension (AOR 32.33), and delayed hospital presentation (AOR 30.10). Male predominance, younger age, high smoking and chat chewing rates, and primarily duodenal perforations are common in perforated peptic ulcer cases. Advanced age, comorbidities, pre-operative hypotension, and delayed hospital presentation significantly increase postoperative complications and mortality, emphasizing the need for timely intervention and targeted public health measures to improve patient outcomes. Early intervention and careful management of comorbidities are crucial to improve survival and reduce complications in patients with PUP.
{"title":"Magnitude, outcome, and predictors of mortality in perforated peptic ulcer disease: a retrospective study in Jigjiga town, Ethiopia","authors":"Abdirahman Burale, Bedhaasa Beyene, Musse Ahmed, Abdullahi Hussen, Mohamed Said Hassan, Shamsedin Mahdi Hassan, Hassan Sh Abdirahman Elmi","doi":"10.1186/s13017-025-00628-0","DOIUrl":"https://doi.org/10.1186/s13017-025-00628-0","url":null,"abstract":"Peptic ulcer perforation (PUP) is a surgical emergency and life-threatening complication affecting 2–10% of peptic ulcer disease (PUD) patients. Delayed diagnosis and surgical management are associated with significant morbidity and mortality. This study assessed the magnitude and outcome of PUP among patients operated on at two public hospitals in Jigjig town, Ethiopia. A 3-year hospital-based retrospective cross-sectional study was conducted on 130 patients operated for PUP at the study hospitals in Jigjig from April 1st, 2018, to July 30th, 2021. Data were collected from medical records. Bivariate analysis identified key factors impacting outcomes in PUP patients. The cohort had a male-to-female ratio of 8.7:1, and a mean age of 38 ± 13.3 years, with 48.8% smokers and 56.6% chat chewers. Duodenal perforations accounted for 93.7% of cases, with post-operative complications in 29.1% and an in-hospital mortality rate of 5.5%. Significant predictors of morbidity and mortality included advanced age (AOR 23.88), comorbidities (AOR 26.80), pre-operative hypotension (AOR 32.33), and delayed hospital presentation (AOR 30.10). Male predominance, younger age, high smoking and chat chewing rates, and primarily duodenal perforations are common in perforated peptic ulcer cases. Advanced age, comorbidities, pre-operative hypotension, and delayed hospital presentation significantly increase postoperative complications and mortality, emphasizing the need for timely intervention and targeted public health measures to improve patient outcomes. Early intervention and careful management of comorbidities are crucial to improve survival and reduce complications in patients with PUP.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"19 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144371072","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 : 2025-06-24DOI: 10.1186/s13017-025-00632-4
Youlong Zhu, Ruming Liu, Xuan Geng, Dakun Li, Bin Quan, Feifei Kong, Defei Hong
Whether elevated homocysteine level is causally associated with small bowel necrosis remains unestablished. We conducted a prospective observational study to analyze the value of serum homocysteine (HCY) in predicting irreversible transmural intestinal necrosis (ITIN) of adhesive small bowel obstruction (ASBO). This prospective observational study was performed between Feb 2023 and Feb 2025 in patients with adhesive small bowel obstruction. The primary outcome was the occurrence of ITIN. The serum levels of different biomarkers in different groups were calculated and compared. Univariable analysis and multivariable analysis were used to assess the association between different biomarkers and ITIN. The Receiver Operating Characteristic Curve (ROC) was used to assess the value for predicting ITIN. The patients comprised 129(58.37%) male and 92(41.63%) female with a median age of 70(60–78)(range 18–85 years). Of the 221 patients included, 88(39.82%) received non-operative treatment, and 133(60.18%) underwent surgery. Intestinal resection and ITIN concerned 89(66.92%) and 68(51.13%) of patients who underwent surgery, respectively. Patients underwent surgery had significantly higher serum levels of HCY, ENDOTOXIN, IL-5, IL-6, Hs-CRP, IL-1β, and PCT (p<0.0001, respectively) than patients receiving non-operative treatment. The levels of the above seven markers (p<0.05, respectively) in patients with ITIN were significantly higher than in patients with non-necrosis. Univariable analysis and multivariable analysis showed that HCY、ENDOTOXIN and Hs-CRP were independent predictors for small bowel necrosis (odds ratio = 1.420, 1.061 and 1.032; p = 0 0.000, p = 0.001 and, p = 0.019, respectively). The AUC of HCY (0.9253, p<0.0001) was higher compared with ENDOTOXIN (0.8291, p<0.0001) and Hs-CRP (0.7023, p<0.0001). HCY had highest sensitivity (89.71%) and specificity (83.03%) compared with ENDOTOXIN (82.83%, 62.08%) and CRP (73.53%, 50.77%) for predicting small bowel necrosis. The serum HCY cutoff level for the diagnosis of small bowel necrosis was 15.53µmol/L. This study provides compelling evidence that homocysteine (HCY) levels can be a useful predictor of irreversible transmural intestinal necrosis that necessitates surgical resection in the setting of adhesive small bowel obstruction. Close monitoring of the HCY serum level could help avoid unnecessary laparotomy and resection, as well as complications due to unnnecessary surgery, and potentially decrease overall mortality rates.
同型半胱氨酸水平升高是否与小肠坏死有因果关系尚不清楚。我们进行了一项前瞻性观察研究，分析血清同型半胱氨酸（HCY）在预测粘连性小肠梗阻（ASBO）的不可逆跨壁肠坏死（ITIN）中的价值。这项前瞻性观察性研究于2023年2月至2025年2月在粘连性小肠梗阻患者中进行。主要结局是ITIN的发生。计算并比较各组不同生物标志物的血清水平。采用单变量分析和多变量分析评估不同生物标志物与ITIN的相关性。采用受试者工作特征曲线（ROC）评价ITIN的预测价值。其中男性129例（58.37%），女性92例（41.63%），中位年龄70岁（60 ~ 78岁），年龄范围18 ~ 85岁。221例患者中，88例（39.82%）接受非手术治疗，133例（60.18%）接受手术治疗。手术患者肠切除术和ITIN分别为89例（66.92%）和68例（51.13%）。手术组患者血清HCY、内毒素、IL-5、IL-6、Hs-CRP、IL-1β、PCT水平均显著高于非手术组（p<0.0001）。ITIN组患者上述7项指标均显著高于非坏死组（p<0.05）。单变量分析和多变量分析显示，HCY、内毒素和Hs-CRP是小肠坏死的独立预测因子(优势比分别为1.420、1.061和1.032；p = 0 0.000, p = 0.001, p = 0.019)。HCY的AUC （0.9253, p<0.0001）高于内毒素（0.8291,p<0.0001）和Hs-CRP （0.7023, p<0.0001）。HCY预测小肠坏死的敏感性（89.71%）和特异性（83.03%）高于内毒素（82.83%,62.08%）和CRP（73.53%, 50.77%）。诊断小肠坏死的血清HCY临界值为15.53µmol/L。这项研究提供了令人信服的证据，表明同型半胱氨酸（HCY）水平可以有效地预测不可逆的跨壁肠坏死，这种坏死需要在粘连性小肠梗阻的情况下进行手术切除。密切监测HCY血清水平有助于避免不必要的剖腹手术和切除，以及不必要的手术引起的并发症，并有可能降低总体死亡率。
{"title":"Homocysteine(HCY), a novel biomarker for predicting irreversible transmural intestinal necrosis in patients with adhesive small bowel obstruction: results from a prospective observational study","authors":"Youlong Zhu, Ruming Liu, Xuan Geng, Dakun Li, Bin Quan, Feifei Kong, Defei Hong","doi":"10.1186/s13017-025-00632-4","DOIUrl":"https://doi.org/10.1186/s13017-025-00632-4","url":null,"abstract":"Whether elevated homocysteine level is causally associated with small bowel necrosis remains unestablished. We conducted a prospective observational study to analyze the value of serum homocysteine (HCY) in predicting irreversible transmural intestinal necrosis (ITIN) of adhesive small bowel obstruction (ASBO). This prospective observational study was performed between Feb 2023 and Feb 2025 in patients with adhesive small bowel obstruction. The primary outcome was the occurrence of ITIN. The serum levels of different biomarkers in different groups were calculated and compared. Univariable analysis and multivariable analysis were used to assess the association between different biomarkers and ITIN. The Receiver Operating Characteristic Curve (ROC) was used to assess the value for predicting ITIN. The patients comprised 129(58.37%) male and 92(41.63%) female with a median age of 70(60–78)(range 18–85 years). Of the 221 patients included, 88(39.82%) received non-operative treatment, and 133(60.18%) underwent surgery. Intestinal resection and ITIN concerned 89(66.92%) and 68(51.13%) of patients who underwent surgery, respectively. Patients underwent surgery had significantly higher serum levels of HCY, ENDOTOXIN, IL-5, IL-6, Hs-CRP, IL-1β, and PCT (p<0.0001, respectively) than patients receiving non-operative treatment. The levels of the above seven markers (p<0.05, respectively) in patients with ITIN were significantly higher than in patients with non-necrosis. Univariable analysis and multivariable analysis showed that HCY、ENDOTOXIN and Hs-CRP were independent predictors for small bowel necrosis (odds ratio = 1.420, 1.061 and 1.032; p = 0 0.000, p = 0.001 and, p = 0.019, respectively). The AUC of HCY (0.9253, p<0.0001) was higher compared with ENDOTOXIN (0.8291, p<0.0001) and Hs-CRP (0.7023, p<0.0001). HCY had highest sensitivity (89.71%) and specificity (83.03%) compared with ENDOTOXIN (82.83%, 62.08%) and CRP (73.53%, 50.77%) for predicting small bowel necrosis. The serum HCY cutoff level for the diagnosis of small bowel necrosis was 15.53µmol/L. This study provides compelling evidence that homocysteine (HCY) levels can be a useful predictor of irreversible transmural intestinal necrosis that necessitates surgical resection in the setting of adhesive small bowel obstruction. Close monitoring of the HCY serum level could help avoid unnecessary laparotomy and resection, as well as complications due to unnnecessary surgery, and potentially decrease overall mortality rates.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"66 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144371074","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 : 2025-06-18DOI: 10.1186/s13017-025-00626-2
Claus Schildberg, Ulrike Weber, Volker König, Marius Linnartz, Sophie Heisler, Jennifer Hafkesbrink, Marcia Fricke, René Mantke
Acute appendicitis is a common abdominal surgical emergency and is a major cause of acute abdomen in more than 20% of cases. Although various studies have been conducted in recent years on topics such as surgical techniques and antibiotic treatment of appendicitis, today there is a lack of large-scale studies focused on the different severity levels of acute appendicitis and their management. The study aimed to analyze the severity, types of surgical techniques, and mortality associated with acute appendicitis to identify possible developments. We conducted a retrospective multicenter observational study based on routine data from 2010 to 2022. Patients over 18 years old with acute appendicitis were included and the following data were collected: patient demographics, comorbidities, type of surgery, complications, admission to ICU, length of stay, and in-hospital mortality. A total of 31,988 patients were included in the study. At the end of the study, 97.0% (P < .001) of the patients underwent laparoscopic appendectomy, with 86% of cases involving closure of the appendix stump by stapler (P < .001). It was only from 2014 onwards that more than 90% of surgeries were performed laparoscopically, and from 2017, this figure rose to 95%. Complicated appendicitis was present in 27.4% of cases. The distribution of severity was as follows: unspecified acute appendicitis in 39.5%, appendicitis with local peritonitis in 33.1%, appendicitis with local peritonitis and perforation in 17.1%, appendicitis with peritoneal abscess in 5.4%, and appendicitis with generalized peritonitis in 4.9%. Women had a significantly lower risk for conversion to an open operation than men (P < .001). The highest morbidity was observed in the group that converted from laparoscopy to open surgery (P <.001). Non-surgical treatment of appendicitis was not relevant, accounting for only 4% of cases. Since 2017, primary laparoscopic appendectomy has been the gold standard for even complicated acute appendicitis (> 95% annually). Over three-quarters of patients undergo an appendectomy with a stapler, making this surgical technique the preferred method of laparoscopic surgery in Germany. Patients who undergo an interoperative switch to open therapy should be considered a subgroup at risk of increased mortality. ClinicalTrials.gov ID: NCT06558760.
{"title":"Laparoscopic appendectomy as the gold standard: What role remains for open surgery, conversion, and disease severity?","authors":"Claus Schildberg, Ulrike Weber, Volker König, Marius Linnartz, Sophie Heisler, Jennifer Hafkesbrink, Marcia Fricke, René Mantke","doi":"10.1186/s13017-025-00626-2","DOIUrl":"https://doi.org/10.1186/s13017-025-00626-2","url":null,"abstract":"Acute appendicitis is a common abdominal surgical emergency and is a major cause of acute abdomen in more than 20% of cases. Although various studies have been conducted in recent years on topics such as surgical techniques and antibiotic treatment of appendicitis, today there is a lack of large-scale studies focused on the different severity levels of acute appendicitis and their management. The study aimed to analyze the severity, types of surgical techniques, and mortality associated with acute appendicitis to identify possible developments. We conducted a retrospective multicenter observational study based on routine data from 2010 to 2022. Patients over 18 years old with acute appendicitis were included and the following data were collected: patient demographics, comorbidities, type of surgery, complications, admission to ICU, length of stay, and in-hospital mortality. A total of 31,988 patients were included in the study. At the end of the study, 97.0% (P < .001) of the patients underwent laparoscopic appendectomy, with 86% of cases involving closure of the appendix stump by stapler (P < .001). It was only from 2014 onwards that more than 90% of surgeries were performed laparoscopically, and from 2017, this figure rose to 95%. Complicated appendicitis was present in 27.4% of cases. The distribution of severity was as follows: unspecified acute appendicitis in 39.5%, appendicitis with local peritonitis in 33.1%, appendicitis with local peritonitis and perforation in 17.1%, appendicitis with peritoneal abscess in 5.4%, and appendicitis with generalized peritonitis in 4.9%. Women had a significantly lower risk for conversion to an open operation than men (P < .001). The highest morbidity was observed in the group that converted from laparoscopy to open surgery (P <.001). Non-surgical treatment of appendicitis was not relevant, accounting for only 4% of cases. Since 2017, primary laparoscopic appendectomy has been the gold standard for even complicated acute appendicitis (> 95% annually). Over three-quarters of patients undergo an appendectomy with a stapler, making this surgical technique the preferred method of laparoscopic surgery in Germany. Patients who undergo an interoperative switch to open therapy should be considered a subgroup at risk of increased mortality. ClinicalTrials.gov ID: NCT06558760.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"35 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144312180","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 : 2025-06-18DOI: 10.1186/s13017-025-00631-5
Hulusi Can Karpuzcu, Çağdaş Erdoğan
Traumatic pancreatic injuries (TPI) are rare, critical complications increasingly managed by minimally invasive Endoscopic Retrograde Cholangiopancreatography (ERCP). We systematically reviewed and meta-analyzed ERCP’s efficacy and safety for TPI regarding pancreatic duct integrity and clinical outcomes in diverse populations. PubMed, Scopus, Cochrane Library, and Web of Science were searched (2000–2024) for studies reporting on ERCP for TPI. Primary outcomes were pancreatic duct integrity and complications; secondary outcomes included mortality and hospital stay. Pediatric and adult populations were compared via subgroup analysis. Publication bias was assessed. Fifteen studies comprising 1,823 patients (54% male, 32% pediatric) were included in the meta-analysis. ERCP demonstrated a pooled clinical success rate of 89% (95% CI: 83–93%) and significantly improved pancreatic duct integrity (OR for pancreatic duct integrity: 9.17, 95% CI: 6.73–12.49). Complication rates ranged from 4 to 17%, with pancreatitis and bleeding being the most common adverse events. Mortality rates were low (3–5%), and ERCP significantly reduced hospital stay by an average of 3.1 days compared to surgical interventions. Pediatric patients had slightly lower success rates (OR: 6.73, 95% CI: 4.01–11.31) compared to adults (OR: 10.87, 95% CI: 7.40–15.98). ERCP is an effective and safe modality for managing TPI in both pediatric and adult patients, yielding high success rates in maintaining ductal integrity and reducing complications, although interpretation requires caution due to potential publication bias. Further prospective studies are required to optimize standardized protocols.
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