Pub Date : 2025-06-02DOI: 10.1186/s13017-025-00618-2
Paula Ferrada, Saima Shafique, Megan Brenner, Clay Burlew, Fausto Catena, Julia Coleman, Jamie Coleman, Demetrios Demetriades, Marc Demoya, Salomone Di Saverio, Sharmila Dissanaike, Tom Dransfield, Joseph DuBose, Juan Duchesne, Adel Elkbuli, Esteban Foianini, Josephine Gambardella, Alberto Garcia, Amy Goldberg, Eric Goralnick, John Holcomb, Messing Jonathan, Bellal Joseph, Lenworth Jacobs, Jeffrey Kerby, Robert Lawerance, Stefan Leichtle, Charles Lucas, Gustavo Machain, Jana Macleod, Zoe Maher, Matthew Martin, Napoleon Mendez, Carlos Menegozzo, Ilenia Merlini, Nicholas Namias, Mayur Narayan, Carlos Ordonez, Pablo Ottolino, Mayur Patel, Zaffer A. Qasim, Martha Quiodettis, LeAnne Sitari Young, Ashanti Ratnasekera, David Rayburn, Juan Salamea, Babak Sarani, Thomas Scalea, Mark Seamon, David Spain, Portia Steele, Sharven Taghavi, Leah Tatebe, Felipe Vega, George Velmahos, Tanya Zakrison, Walter L. Biffl, Dimitrios Damaskos, Federico Coccolini, Carlo Vallicelli, Ernest E. Moore, L..
Hemorrhage is one of the leading causes of preventable death in trauma patients. For decades, the Airway-Breathing-Circulation (ABC) approach has been the cornerstone of trauma care. However, emerging evidence suggests that prioritizing airway management in exsanguinating patients may worsen hypotension and increase mortality. This systematic review and meta-analysis aim to evaluate the effectiveness of the Circulation-Airway-Breathing (CAB) approach compared to the traditional ABC sequence in improving survival in trauma patients with severe hemorrhage. A systematic review was conducted in accordance with the PRISMA guidelines. Databases including PubMed and Ovid MEDLINE, SCOPUS, web of science and EMBASE were searched for studies published up to September 2024. Eligible studies included observational and comparative studies reporting outcomes of trauma patients with exsanguinating hemorrhage. The Newcastle–Ottawa Scale was used for risk of bias assessment. A meta-analysis was performed using a random-effects model to calculate pooled odds ratios (OR) for mortality, with 95% confidence intervals (CI). Subgroup analysis was conducted to compare the ABC and CAB approaches in prospective and retrospective studies. Six studies (N = 11,855 patients) met the inclusion criteria. The meta-analysis revealed a significant increase in mortality associated with the ABC approach (pooled OR: 3.65, 95% CI: 1.74–7.65). Subgroup analysis of prospective cohort studies found an even higher mortality risk (POR: 9.99, 95% CI: 5.59–17.85) when compared with POR of retrospective studies (POR: 2.42, 95%CI: 1.08–5.36). High heterogeneity (I2 = 92%) was observed across the studies, likely due to variations in patient populations and resuscitation protocols. Prioritizing circulation over airway management in trauma patients with exsanguinating injuries significantly reduces mortality compared to the traditional ABC approach. The present consensus paper, conducted according to the WSES methodology3, aims to provide a review of the literature comparing the CAB approach to the traditional ABC sequence in trauma patients with exsanguinating hemorrhage, to develop a shared consensus statement based on the currently available evidence
{"title":"Prioritizing circulation over airway to improve survival in trauma patients with exsanguinating injuries: a world society of emergency surgery-panamerican trauma consensus statement","authors":"Paula Ferrada, Saima Shafique, Megan Brenner, Clay Burlew, Fausto Catena, Julia Coleman, Jamie Coleman, Demetrios Demetriades, Marc Demoya, Salomone Di Saverio, Sharmila Dissanaike, Tom Dransfield, Joseph DuBose, Juan Duchesne, Adel Elkbuli, Esteban Foianini, Josephine Gambardella, Alberto Garcia, Amy Goldberg, Eric Goralnick, John Holcomb, Messing Jonathan, Bellal Joseph, Lenworth Jacobs, Jeffrey Kerby, Robert Lawerance, Stefan Leichtle, Charles Lucas, Gustavo Machain, Jana Macleod, Zoe Maher, Matthew Martin, Napoleon Mendez, Carlos Menegozzo, Ilenia Merlini, Nicholas Namias, Mayur Narayan, Carlos Ordonez, Pablo Ottolino, Mayur Patel, Zaffer A. Qasim, Martha Quiodettis, LeAnne Sitari Young, Ashanti Ratnasekera, David Rayburn, Juan Salamea, Babak Sarani, Thomas Scalea, Mark Seamon, David Spain, Portia Steele, Sharven Taghavi, Leah Tatebe, Felipe Vega, George Velmahos, Tanya Zakrison, Walter L. Biffl, Dimitrios Damaskos, Federico Coccolini, Carlo Vallicelli, Ernest E. Moore, L..","doi":"10.1186/s13017-025-00618-2","DOIUrl":"https://doi.org/10.1186/s13017-025-00618-2","url":null,"abstract":"Hemorrhage is one of the leading causes of preventable death in trauma patients. For decades, the Airway-Breathing-Circulation (ABC) approach has been the cornerstone of trauma care. However, emerging evidence suggests that prioritizing airway management in exsanguinating patients may worsen hypotension and increase mortality. This systematic review and meta-analysis aim to evaluate the effectiveness of the Circulation-Airway-Breathing (CAB) approach compared to the traditional ABC sequence in improving survival in trauma patients with severe hemorrhage. A systematic review was conducted in accordance with the PRISMA guidelines. Databases including PubMed and Ovid MEDLINE, SCOPUS, web of science and EMBASE were searched for studies published up to September 2024. Eligible studies included observational and comparative studies reporting outcomes of trauma patients with exsanguinating hemorrhage. The Newcastle–Ottawa Scale was used for risk of bias assessment. A meta-analysis was performed using a random-effects model to calculate pooled odds ratios (OR) for mortality, with 95% confidence intervals (CI). Subgroup analysis was conducted to compare the ABC and CAB approaches in prospective and retrospective studies. Six studies (N = 11,855 patients) met the inclusion criteria. The meta-analysis revealed a significant increase in mortality associated with the ABC approach (pooled OR: 3.65, 95% CI: 1.74–7.65). Subgroup analysis of prospective cohort studies found an even higher mortality risk (POR: 9.99, 95% CI: 5.59–17.85) when compared with POR of retrospective studies (POR: 2.42, 95%CI: 1.08–5.36). High heterogeneity (I2 = 92%) was observed across the studies, likely due to variations in patient populations and resuscitation protocols. Prioritizing circulation over airway management in trauma patients with exsanguinating injuries significantly reduces mortality compared to the traditional ABC approach. The present consensus paper, conducted according to the WSES methodology3, aims to provide a review of the literature comparing the CAB approach to the traditional ABC sequence in trauma patients with exsanguinating hemorrhage, to develop a shared consensus statement based on the currently available evidence","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"7 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144193281","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 : 2025-06-02DOI: 10.1186/s13017-025-00616-4
Karri Kase, Annika Reintam Blaser, Merli Koitmäe, Peep Talving, Kadri Tamme, Stefan Acosta, Martin Björck, Miklosh Bala, Zsolt Bodnar, Martin Cahenzli, Dumitru Casian, Zaza Demetrashvili, Mario D’Oria, Virginia Durán Muñoz-Cruzado, Alastair Forbes, Morten Vetrhus, Moran Hellerman Itzhaki, Kristoffer Lein, Matthias Lindner, Cecilia I. Loudet, Dimitrios Damaskos, Alexandre Nuzzo, Sten Saar, Maximilian Scheiterle, Joel Starkopf, Anna-Liisa Voomets, Kenneth Voon, Mohammad Alif Yunus, Marko Murruste, Yves Castier, Maxime Ronot, Alan Biloslavo, Lucia Paiano, Gunnar Elke, Denise Nagel, David I. Radke, Jacqueline Vilca Becerra, María Elina Abeleyra, Benjamin Hess, Mikhail Kirov, Tatjana Semenkova, Anton Nikonov, Alexey Smetkin, Geir Ivar Nedredal, Øivind Irtun, Oded Cohen-Arazi, Asaf Keda, Gheorghe Rojnoveanu, Tatiana Malcova, Felipe Pareja Ciuró, Anabel García-Leon, Carlos Javier García-Sánchez, Lim Jia Hui, Loy Yuan Ling, Ilya Kagan, Pierre Singer, Edgar Lipping, Ana Tvaladze, Dami..
The optimal strategy for initial treatment of acute occlusion of superior mesenteric artery (SMA) is debated. The aim of the study was to compare the effectiveness, timelines and outcomes of endovascular versus open surgical treatment in patients with acute SMA occlusion. This was a preplanned substudy of the prospective observational multicenter AMESI (Acute MESenteric Ischaemia) study. Patients with SMA occlusion were divided into surgical and endovascular treatment groups. The surgical group included patients initially subjected to open surgical treatment with surgical or hybrid revascularization or intestinal resection only. The endovascular group included patients initially revascularized endovascularly and was further divided according to treatment effectiveness. Patients were also categorized according to revascularization or no revascularization, and subanalysis performed for different revascularization methods. Baseline and outcome comparisons were made using Fisher and Mann–Whitney U tests. Risk-factors for in-hospital mortality were analysed using a logistic regression model. Of 158 patients 107 had surgical and 51 endovascular treatment. The surgical group had higher baseline illness severity scores, higher C-reactive protein and lactate values. The mortality in the endovascular effective, endovascular insufficient as monotherapy and surgical groups was 2.9%, 41.2% and 45.8%, respectively. In multivariable analysis surgery was not an independent risk factor for in-hospital mortality. The rate of arterial embolism was higher in the endovascular revascularization as monotherapy insufficient treatment group (10/17) compared to the endovascular revascularization as monotherapy effective (5/34) and surgical (27/107) groups. We could not identify useful best thresholds for discriminating between effective and insufficient endovascular treatment. Analysis comparing the effect of any revascularization versus no revascularization on in-hospital mortality did not show a clear benefit of revascularization and the method of revascularization did not independently influence mortality. The beneficial effect of endovascular compared to surgical treatment in unadjusted analyses is largely explained by selection of patients. None of the compared management approaches had an independent effect on mortality. The choice between endovascular and surgical treatment should not be based solely on the time elapsed from symptom onset but rather on the patient’s general condition and possibly on the cause of SMA occlusion.
{"title":"Comparison between endovascular and surgical treatment of acute arterial occlusive mesenteric ischemia","authors":"Karri Kase, Annika Reintam Blaser, Merli Koitmäe, Peep Talving, Kadri Tamme, Stefan Acosta, Martin Björck, Miklosh Bala, Zsolt Bodnar, Martin Cahenzli, Dumitru Casian, Zaza Demetrashvili, Mario D’Oria, Virginia Durán Muñoz-Cruzado, Alastair Forbes, Morten Vetrhus, Moran Hellerman Itzhaki, Kristoffer Lein, Matthias Lindner, Cecilia I. Loudet, Dimitrios Damaskos, Alexandre Nuzzo, Sten Saar, Maximilian Scheiterle, Joel Starkopf, Anna-Liisa Voomets, Kenneth Voon, Mohammad Alif Yunus, Marko Murruste, Yves Castier, Maxime Ronot, Alan Biloslavo, Lucia Paiano, Gunnar Elke, Denise Nagel, David I. Radke, Jacqueline Vilca Becerra, María Elina Abeleyra, Benjamin Hess, Mikhail Kirov, Tatjana Semenkova, Anton Nikonov, Alexey Smetkin, Geir Ivar Nedredal, Øivind Irtun, Oded Cohen-Arazi, Asaf Keda, Gheorghe Rojnoveanu, Tatiana Malcova, Felipe Pareja Ciuró, Anabel García-Leon, Carlos Javier García-Sánchez, Lim Jia Hui, Loy Yuan Ling, Ilya Kagan, Pierre Singer, Edgar Lipping, Ana Tvaladze, Dami..","doi":"10.1186/s13017-025-00616-4","DOIUrl":"https://doi.org/10.1186/s13017-025-00616-4","url":null,"abstract":"The optimal strategy for initial treatment of acute occlusion of superior mesenteric artery (SMA) is debated. The aim of the study was to compare the effectiveness, timelines and outcomes of endovascular versus open surgical treatment in patients with acute SMA occlusion. This was a preplanned substudy of the prospective observational multicenter AMESI (Acute MESenteric Ischaemia) study. Patients with SMA occlusion were divided into surgical and endovascular treatment groups. The surgical group included patients initially subjected to open surgical treatment with surgical or hybrid revascularization or intestinal resection only. The endovascular group included patients initially revascularized endovascularly and was further divided according to treatment effectiveness. Patients were also categorized according to revascularization or no revascularization, and subanalysis performed for different revascularization methods. Baseline and outcome comparisons were made using Fisher and Mann–Whitney U tests. Risk-factors for in-hospital mortality were analysed using a logistic regression model. Of 158 patients 107 had surgical and 51 endovascular treatment. The surgical group had higher baseline illness severity scores, higher C-reactive protein and lactate values. The mortality in the endovascular effective, endovascular insufficient as monotherapy and surgical groups was 2.9%, 41.2% and 45.8%, respectively. In multivariable analysis surgery was not an independent risk factor for in-hospital mortality. The rate of arterial embolism was higher in the endovascular revascularization as monotherapy insufficient treatment group (10/17) compared to the endovascular revascularization as monotherapy effective (5/34) and surgical (27/107) groups. We could not identify useful best thresholds for discriminating between effective and insufficient endovascular treatment. Analysis comparing the effect of any revascularization versus no revascularization on in-hospital mortality did not show a clear benefit of revascularization and the method of revascularization did not independently influence mortality. The beneficial effect of endovascular compared to surgical treatment in unadjusted analyses is largely explained by selection of patients. None of the compared management approaches had an independent effect on mortality. The choice between endovascular and surgical treatment should not be based solely on the time elapsed from symptom onset but rather on the patient’s general condition and possibly on the cause of SMA occlusion.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"9 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144193283","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}
The decline in trauma cases and the increase in non-surgical treatments have reduced opportunities for trauma surgery training. This study examined the effectiveness of Cadaver-Based Educational Seminar for Trauma Surgery (C-BEST) as a lifelong educational tool for novice and experienced clinicians. From 2017 to 2023, 117 clinicians with varying levels of experience participated in the C-BEST program at Hokkaido University. Participants included novice clinicians (median years post-graduation: 5) and experienced clinicians (median years post-graduation: 19). Each participant assessed their confidence in 21 trauma techniques before, immediately after, and 6 months post-course using a self-assessment of confidence levels (SACL) scale. The analysis showed significant improvement in SACL scores immediately after the course, with confidence levels remaining sustained 6 months later. Novice clinicians demonstrated substantial skill acquisition, whereas experienced clinicians reported the reinforcement and refinement of existing skills. C-BEST seems valuable as a training tool for the acquisition and retention of trauma surgery skills, addressing practical needs in trauma care. C-BEST provides an effective and sustained approach to trauma surgery skill development and retention across career stages. Further research on its long-term impact and applicability in diverse clinical settings is recommended.
{"title":"Validation of cadaver-based trauma surgery training for lifelong skill development","authors":"Soichi Murakami, Toshiaki Shichinohe, Yo Kurashima, Kazufumi Okada, Yusuke Tsunetoshi, Ryoji Iizuka, Wataru Ishii, Kenji Kandori, Shinichiro Irabu, Naoki Shinyama, Hiroshi Homma, Masahiko Watanabe, Satoshi Hirano","doi":"10.1186/s13017-025-00608-4","DOIUrl":"https://doi.org/10.1186/s13017-025-00608-4","url":null,"abstract":"The decline in trauma cases and the increase in non-surgical treatments have reduced opportunities for trauma surgery training. This study examined the effectiveness of Cadaver-Based Educational Seminar for Trauma Surgery (C-BEST) as a lifelong educational tool for novice and experienced clinicians. From 2017 to 2023, 117 clinicians with varying levels of experience participated in the C-BEST program at Hokkaido University. Participants included novice clinicians (median years post-graduation: 5) and experienced clinicians (median years post-graduation: 19). Each participant assessed their confidence in 21 trauma techniques before, immediately after, and 6 months post-course using a self-assessment of confidence levels (SACL) scale. The analysis showed significant improvement in SACL scores immediately after the course, with confidence levels remaining sustained 6 months later. Novice clinicians demonstrated substantial skill acquisition, whereas experienced clinicians reported the reinforcement and refinement of existing skills. C-BEST seems valuable as a training tool for the acquisition and retention of trauma surgery skills, addressing practical needs in trauma care. C-BEST provides an effective and sustained approach to trauma surgery skill development and retention across career stages. Further research on its long-term impact and applicability in diverse clinical settings is recommended.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"9 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144165150","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 : 2025-05-28DOI: 10.1186/s13017-025-00624-4
Jingxian Wang, Wei Zhu, Ping Song, Peiyang Zhou, Peng An
The recent study by Thu et al. investigating the interplay between frailty, sarcopenia, and physical status in patients undergoing emergency laparotomy (EmLap) provides valuable insights into preoperative risk stratification. The authors’ efforts to disentangle these complex factors in predicting mortality are commendable, particularly their emphasis on frailty and poor physical status as independent prognostic markers. However, several underappreciated aspects of this relationship warrant further discussion to refine clinical applicability and guide future research (1).
{"title":"Uncharted factors in emergency laparotomy outcomes: a call for holistic assessment","authors":"Jingxian Wang, Wei Zhu, Ping Song, Peiyang Zhou, Peng An","doi":"10.1186/s13017-025-00624-4","DOIUrl":"https://doi.org/10.1186/s13017-025-00624-4","url":null,"abstract":"The recent study by Thu et al. investigating the interplay between frailty, sarcopenia, and physical status in patients undergoing emergency laparotomy (EmLap) provides valuable insights into preoperative risk stratification. The authors’ efforts to disentangle these complex factors in predicting mortality are commendable, particularly their emphasis on frailty and poor physical status as independent prognostic markers. However, several underappreciated aspects of this relationship warrant further discussion to refine clinical applicability and guide future research (1).","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"58 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144165151","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 : 2025-05-24DOI: 10.1186/s13017-025-00602-w
Giulia Bonavina, Gianluca Bonitta, Alberto Aiolfi, Noemi Salmeri, Massimo Candiani, Paolo Ivo Cavoretto, Luigi Bonavina, Alessandro Bulfoni
Preventing postpartum haemorrhage remains a high priority worldwide. We aimed to provide all available evidence comparing maternal and neonatal outcomes of different prophylactic endovascular procedures in patients with abnormal placentation. Pubmed, Embase and ClinicalTrials.gov databases were searched from inception to Nov, 2024, using relevant key words. Studies comparing outcomes of women undergoing or not prophylactic endovascular procedures in planned cesarean delivery in patients with antenatally suspected or confirmed PAS, placenta previa or both were included. An arm-based random effect frequentist network meta-analysis was performed. All available maternal and neonatal outcomes were evaluated. Three randomized controlled trials and 59 observational studies were eligible reporting on 6973 women (42.9% did not undergo any endovascular procedure, 26.7% underwent aortic balloon occlusion, REBOA, 16.6%, internal iliac balloon occlusion, PBO-IIA, 5.8%, common iliac artery occlusion, PBO-CIA, placement, and 7.8% underwent uterine artery embolization, UAE). The pooled network analysis showed that all prophylactic endovascular procedures were associated with reduced perioperative blood loss, with proximal balloon occlusion (REBOA) having the strongest effect (SMD −1.80 L, 95%CI −2.38;-1.21; I2 = 97.2%). Also, peripartum hysterectomy rates were significantly lower in women undergoing prophylactic UAE and REBOA compared to the control group; moreover, patients with placenta previa without any prophylactic endovascular procedure had a 4 to fivefold increased risk of peripartum hysterectomy compared to the REBOA group (I2 = 20.6%). REBOA was associated with a significant decrease in massive transfusion rates (I2 = 0%), surgery-related complications (I2 = 0%), ICU admissions (I2 = 40.3%), and units of red blood cells transfused (I2 = 92.8%), compared to PBO-IIA and control groups. The control group versus women undergoing prophylactic UAE showed a significant increase in total operative time (I2 = 96.5%) and Clavien-Dindo grade IV post-operative complications (I2 = 26%), compared to REBOA. All prophylactic endovascular procedures had a comparable risk ratio in terms of units of platelets transfused, maternal mortality, and use of additional post-operative bilateral uterine artery embolization among the treatment groups. As for neonatal outcomes, no significant differences were detected. Although the preponderance of observational studies suggests caution in interpreting the results of this meta-analysis, our findings suggest that prophylactic endovascular interventional procedures, particularly aortic balloon occlusion, may substantially improve clinical outcomes in women with PAS, placenta previa or both. CRD4202457398.
{"title":"Every minute counts: a network meta-analysis comparing the effect of prophylactic endovascular procedures in abnormal placentation","authors":"Giulia Bonavina, Gianluca Bonitta, Alberto Aiolfi, Noemi Salmeri, Massimo Candiani, Paolo Ivo Cavoretto, Luigi Bonavina, Alessandro Bulfoni","doi":"10.1186/s13017-025-00602-w","DOIUrl":"https://doi.org/10.1186/s13017-025-00602-w","url":null,"abstract":"Preventing postpartum haemorrhage remains a high priority worldwide. We aimed to provide all available evidence comparing maternal and neonatal outcomes of different prophylactic endovascular procedures in patients with abnormal placentation. Pubmed, Embase and ClinicalTrials.gov databases were searched from inception to Nov, 2024, using relevant key words. Studies comparing outcomes of women undergoing or not prophylactic endovascular procedures in planned cesarean delivery in patients with antenatally suspected or confirmed PAS, placenta previa or both were included. An arm-based random effect frequentist network meta-analysis was performed. All available maternal and neonatal outcomes were evaluated. Three randomized controlled trials and 59 observational studies were eligible reporting on 6973 women (42.9% did not undergo any endovascular procedure, 26.7% underwent aortic balloon occlusion, REBOA, 16.6%, internal iliac balloon occlusion, PBO-IIA, 5.8%, common iliac artery occlusion, PBO-CIA, placement, and 7.8% underwent uterine artery embolization, UAE). The pooled network analysis showed that all prophylactic endovascular procedures were associated with reduced perioperative blood loss, with proximal balloon occlusion (REBOA) having the strongest effect (SMD −1.80 L, 95%CI −2.38;-1.21; I2 = 97.2%). Also, peripartum hysterectomy rates were significantly lower in women undergoing prophylactic UAE and REBOA compared to the control group; moreover, patients with placenta previa without any prophylactic endovascular procedure had a 4 to fivefold increased risk of peripartum hysterectomy compared to the REBOA group (I2 = 20.6%). REBOA was associated with a significant decrease in massive transfusion rates (I2 = 0%), surgery-related complications (I2 = 0%), ICU admissions (I2 = 40.3%), and units of red blood cells transfused (I2 = 92.8%), compared to PBO-IIA and control groups. The control group versus women undergoing prophylactic UAE showed a significant increase in total operative time (I2 = 96.5%) and Clavien-Dindo grade IV post-operative complications (I2 = 26%), compared to REBOA. All prophylactic endovascular procedures had a comparable risk ratio in terms of units of platelets transfused, maternal mortality, and use of additional post-operative bilateral uterine artery embolization among the treatment groups. As for neonatal outcomes, no significant differences were detected. Although the preponderance of observational studies suggests caution in interpreting the results of this meta-analysis, our findings suggest that prophylactic endovascular interventional procedures, particularly aortic balloon occlusion, may substantially improve clinical outcomes in women with PAS, placenta previa or both. CRD4202457398.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"33 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144130299","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}
Secondary peritonitis is a serious condition with significant morbidity and mortality. Its management requires emergency laparotomy for source control. Vacuum-assisted closure (VAC) and primary abdominal closure (PAC) are the main strategies for managing the laparostomy after source control. Despite the increasing use of VAC, concerns persist regarding its complications and long-term outcomes compared with PAC. This systematic review followed PRISMA 2020 and MOOSE. The Cochrane Risk of Bias (RoB 2) tool, MINORS and GRADE framework assessed study quality and evidence certainty. The protocol was registered in PROSPERO (CRD42022304724). A comprehensive search of MEDLINE, Embase, and the Cochrane Library from January 2004 to August 2024 identified studies reporting postoperative outcomes following VAC or PAC after laparotomy for secondary peritonitis. The included studies had to report at least two key outcomes: mortality, postoperative complications, incisional hernia, secondary fascial closure, and hospital or intensive care unit (ICU) length of stay. Thirty-three studies including 4,520 patients were analyzed. Mortality was 31.1% in VAC and 22.2% in PAC (p = 0.327). Postoperative complications were higher with VAC (71.0% vs. 39.3%, p = 0.001). Incisional hernia rates were similar (21.3% vs. 20.8%, p = 0.958). Secondary fascial closure rate was significantly lower with VAC (58.1% vs. 85.9%, p < 0.001). VAC patients had longer ICU stays (21.1 vs. 9.7 days, p = 0.04), while hospital stay did not differ. Most studies had a high risk of bias, and GRADE assessment showed low to very low evidence certainty. VAC therapy was associated with more postoperative complications, a lower fascial closure rate, and a longer ICU length of stay compared with PAC. Thirty-day mortality rates did not differ between the approaches. However, most of studies included were subject to serious risk of bias and a low level of certainty in evidence.
继发性腹膜炎是一种严重的疾病，发病率和死亡率都很高。其管理需要紧急剖腹手术来控制源头。真空辅助闭合（VAC）和初级腹部闭合（PAC）是源头控制后处理剖腹造口的主要策略。尽管VAC的使用越来越多，但与PAC相比，人们对其并发症和长期预后的担忧仍然存在。该系统综述是在PRISMA 2020和MOOSE之后进行的。Cochrane偏倚风险（RoB 2）工具、minor和GRADE框架评估了研究质量和证据确定性。该协议已在PROSPERO （CRD42022304724）中注册。2004年1月至2024年8月对MEDLINE、Embase和Cochrane图书馆进行了全面检索，确定了报告继发性腹膜炎剖腹手术后VAC或PAC术后结果的研究。纳入的研究必须报告至少两个关键结果：死亡率、术后并发症、切口疝、继发性筋膜闭合和住院或重症监护病房（ICU）的住院时间。共分析了33项研究，包括4520名患者。VAC组死亡率为31.1%，PAC组死亡率为22.2% （p = 0.327）。VAC组术后并发症较高（71.0% vs 39.3%, p = 0.001）。切口疝发生率相似（21.3% vs. 20.8%, p = 0.958）。二次筋膜闭合率明显低于VAC组（58.1%比85.9%,p < 0.001）。VAC患者在ICU的住院时间更长（21.1天vs 9.7天，p = 0.04），而住院时间无差异。大多数研究具有高偏倚风险，GRADE评估显示低至极低的证据确定性。与PAC相比，VAC治疗与更多的术后并发症、更低的筋膜闭合率和更长的ICU住院时间相关。30天死亡率在两种方法之间没有差异。然而，纳入的大多数研究存在严重的偏倚风险，证据的确定性较低。
{"title":"Vacuum-assisted closure or primary closure with relaparotomy on-demand in patients with secondary peritonitis: a systematic review and meta-analysis","authors":"Pooya Rajabaleyan, Pedja Cuk, Sören Möller, Niels Qvist, Mark Bremholm Ellebæk","doi":"10.1186/s13017-025-00615-5","DOIUrl":"https://doi.org/10.1186/s13017-025-00615-5","url":null,"abstract":"Secondary peritonitis is a serious condition with significant morbidity and mortality. Its management requires emergency laparotomy for source control. Vacuum-assisted closure (VAC) and primary abdominal closure (PAC) are the main strategies for managing the laparostomy after source control. Despite the increasing use of VAC, concerns persist regarding its complications and long-term outcomes compared with PAC. This systematic review followed PRISMA 2020 and MOOSE. The Cochrane Risk of Bias (RoB 2) tool, MINORS and GRADE framework assessed study quality and evidence certainty. The protocol was registered in PROSPERO (CRD42022304724). A comprehensive search of MEDLINE, Embase, and the Cochrane Library from January 2004 to August 2024 identified studies reporting postoperative outcomes following VAC or PAC after laparotomy for secondary peritonitis. The included studies had to report at least two key outcomes: mortality, postoperative complications, incisional hernia, secondary fascial closure, and hospital or intensive care unit (ICU) length of stay. Thirty-three studies including 4,520 patients were analyzed. Mortality was 31.1% in VAC and 22.2% in PAC (p = 0.327). Postoperative complications were higher with VAC (71.0% vs. 39.3%, p = 0.001). Incisional hernia rates were similar (21.3% vs. 20.8%, p = 0.958). Secondary fascial closure rate was significantly lower with VAC (58.1% vs. 85.9%, p < 0.001). VAC patients had longer ICU stays (21.1 vs. 9.7 days, p = 0.04), while hospital stay did not differ. Most studies had a high risk of bias, and GRADE assessment showed low to very low evidence certainty. VAC therapy was associated with more postoperative complications, a lower fascial closure rate, and a longer ICU length of stay compared with PAC. Thirty-day mortality rates did not differ between the approaches. However, most of studies included were subject to serious risk of bias and a low level of certainty in evidence.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"14 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113949","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 : 2025-05-19DOI: 10.1186/s13017-025-00617-3
Carlos Manterola, Enrique Biel, Josue Rivadeneira, Manuel Pera, Luis Grande
Acute gastric volvulus (AGV), is an uncommon complication of large paraesophageal hernias (PEH), resulting in closed-loop obstruction that may lead to incarceration and strangulation. The aim of this study was to summarize the evidence on clinical characteristics, surgical treatment, postoperative complications (POC), recurrence, and 30-day mortality (30DM), in patients undergoing surgery for AGV secondary to PEH. A systematic review including studies on AGV secondary to PEH was conducted. Searches were performed in WoS, Embase, Medline, Scopus, BIREME-BV and SciELO. Primary outcomes included POC, 30DM and recurrence. Secondary outcomes comprised publication date, study origin and design, number of patients, volvulus type, hospital stay length, treatments; and methodological quality (MQ) of studies assessed using MInCir-T and MInCir-Pr2 scales. Descriptive statistics, weighted averages (WA), least squares logistic regression for comparisons, and meta-analysis of POC prevalence and HM were applied. Of 1049 studies 171 met selection criteria, encompassing 15,178 patients. The WA age of patients was 75.3 ± 13.9 years, with 51.3% female. Most studies originated from USA (31.6%), with 52.6% published in the last decade. The WA of hospital stay was 7.9 ± 5.3 days. Among patients, 32.0% experienced POC, 7.6% required reinterventions and HM was 5.7%. MQ scores averaged 8.9 ± 2.3 (MInCir-T) and 13.4 ± 5.4 (MInCir-Pr2). When comparing 1990–2014 and 2015–2024 periods, there were significant differences in age, reinterventions, readmissions and recurrence rates. Despite surgical and resuscitative advancements, AGV prognosis remains poor, with high POC rates, prolonged hospitalization and significant 30DM. These findings emphasize the importance of early diagnosis and timely intervention for acute PEH to improve surgical outcomes.
{"title":"Acute paraesophageal hernia with gastric volvulus. Results of surgical treatment: a systematic review and meta-analysis","authors":"Carlos Manterola, Enrique Biel, Josue Rivadeneira, Manuel Pera, Luis Grande","doi":"10.1186/s13017-025-00617-3","DOIUrl":"https://doi.org/10.1186/s13017-025-00617-3","url":null,"abstract":"Acute gastric volvulus (AGV), is an uncommon complication of large paraesophageal hernias (PEH), resulting in closed-loop obstruction that may lead to incarceration and strangulation. The aim of this study was to summarize the evidence on clinical characteristics, surgical treatment, postoperative complications (POC), recurrence, and 30-day mortality (30DM), in patients undergoing surgery for AGV secondary to PEH. A systematic review including studies on AGV secondary to PEH was conducted. Searches were performed in WoS, Embase, Medline, Scopus, BIREME-BV and SciELO. Primary outcomes included POC, 30DM and recurrence. Secondary outcomes comprised publication date, study origin and design, number of patients, volvulus type, hospital stay length, treatments; and methodological quality (MQ) of studies assessed using MInCir-T and MInCir-Pr2 scales. Descriptive statistics, weighted averages (WA), least squares logistic regression for comparisons, and meta-analysis of POC prevalence and HM were applied. Of 1049 studies 171 met selection criteria, encompassing 15,178 patients. The WA age of patients was 75.3 ± 13.9 years, with 51.3% female. Most studies originated from USA (31.6%), with 52.6% published in the last decade. The WA of hospital stay was 7.9 ± 5.3 days. Among patients, 32.0% experienced POC, 7.6% required reinterventions and HM was 5.7%. MQ scores averaged 8.9 ± 2.3 (MInCir-T) and 13.4 ± 5.4 (MInCir-Pr2). When comparing 1990–2014 and 2015–2024 periods, there were significant differences in age, reinterventions, readmissions and recurrence rates. Despite surgical and resuscitative advancements, AGV prognosis remains poor, with high POC rates, prolonged hospitalization and significant 30DM. These findings emphasize the importance of early diagnosis and timely intervention for acute PEH to improve surgical outcomes.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"44 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144088263","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 : 2025-05-19DOI: 10.1186/s13017-025-00613-7
Suhaib J S Ahmad,Jason R Degiannis,Marion Head,Ahmed R Ahmed,Edgar Gelber,Sherif Hakky,Armin Kieser,Martin Müller,John Darling,Dominik A Jakob,Ioannis Panagiotis Kyriazidis,Konstantinos Degiannis,Patrick Dorn,Anil Lala,Christopher Bowman,Danielle Wilkinson,Graham Whiteley,Umair Hassan,Younis Mohamed,Kai Hui Loo,Ynyr Dewi Davies,Richard Egan,Sjaak Pouwels,Amber Coulthard,Lowri Churchill,Kiran Bhavra,Christopher Bailey,Ian Johnson,Ifan Rees,Dafydd Williams,Shahab Hajibandeh,Wah Yang,Christian Peter Subbe,Amy Owen,David Rawaf,Ameer Khamise,Ali Waleed Khalid,Chetan Parmar,J Agustin Soler,Miriam Khalil,Ata Mohajer-Bastami,Sarah Moin,Rami Archid,Mohamed Abdulmajed,Rosalind Jones,Vignesh Balasubaramaniam,Rawa Al-Salihi,Arran Shoker,Mei-Ju Hwang,Olga Griffiths,Sushil Pandey,Lucy Lee-Smith,Aristomenis K Exadaktylos
BACKGROUNDTension pneumothorax (TP) is a life-threatening condition. The immediate recommended management is needle decompression (ND), followed by the insertion of an intercostal chest drain. The European Trauma Course (ETC) and the Advanced Trauma Life Support (ATLS) guidelines differ on needle size and decompression site, creating clinical uncertainty. This meta-analysis aims to explore the optimal approach for emergency needle decompression in TP.METHODSThis meta-analysis followed the PRISMA 2020 guidelines. It included English-language RCTs, cohort, case-control, cross-sectional studies, and case series with more than six patients. Studies on adults undergoing needle decompression therapy for TP or with chest wall thickness measurements were included. Ovid MEDLINE, Embase, and Web of Science databases were searched until May 31, 2024. Data were extracted, assessed for quality using OCEBM and GRADE, and analyzed using SPSS and OpenMeta with random-effects models.PRIMARY OUTCOMEneedle decompression failure rate.SECONDARY OUTCOMESpatient demographics, cannula size, and chest wall thickness comparisons.RESULTSThis review analyzed 51 studies on needle decompression for TP, with a weighted mean patient age of 36.67 years. Radiological data from 24 studies (n = 8046) indicated a 32.84% failure rate for needle penetration into the pleural cavity (I2: 99.72%). Increased needle length reduced failure rates by 7.76% per cm. No significant differences in chest wall thickness between genders were observed (T-test, p = 0.77), but thickness at the 5th anterior axillary line (5AAL) and 5th midaxillary line (5MAL) was less than at the 2nd midclavicular line (2MCL). Injury rates were higher at 5AAL than 5MAL, with strong positive correlations between needle length and injury at these sites (0.88, 0.91).CONCLUSIONBased on our meta-analysis, a 7 cm needle may be appropriate for decompression of right-sided tension pneumothorax at either the 5th intercostal space along the midaxillary line or the 2nd intercostal space along the midclavicular line. For left-sided cases, given the potential risk of cardiac injury, the 2nd midclavicular line is a safer option. However, these recommendations should be interpreted with caution due to considerable heterogeneity among the included studies, potential risk of bias, and variability in measurement techniques. Clinical decisions should always be individualized, taking into account patient-specific factors.
{"title":"Meta-analysis of the optimal needle length and decompression site for tension pneumothorax and consensus recommendations on current ATLS and ETC guidelines.","authors":"Suhaib J S Ahmad,Jason R Degiannis,Marion Head,Ahmed R Ahmed,Edgar Gelber,Sherif Hakky,Armin Kieser,Martin Müller,John Darling,Dominik A Jakob,Ioannis Panagiotis Kyriazidis,Konstantinos Degiannis,Patrick Dorn,Anil Lala,Christopher Bowman,Danielle Wilkinson,Graham Whiteley,Umair Hassan,Younis Mohamed,Kai Hui Loo,Ynyr Dewi Davies,Richard Egan,Sjaak Pouwels,Amber Coulthard,Lowri Churchill,Kiran Bhavra,Christopher Bailey,Ian Johnson,Ifan Rees,Dafydd Williams,Shahab Hajibandeh,Wah Yang,Christian Peter Subbe,Amy Owen,David Rawaf,Ameer Khamise,Ali Waleed Khalid,Chetan Parmar,J Agustin Soler,Miriam Khalil,Ata Mohajer-Bastami,Sarah Moin,Rami Archid,Mohamed Abdulmajed,Rosalind Jones,Vignesh Balasubaramaniam,Rawa Al-Salihi,Arran Shoker,Mei-Ju Hwang,Olga Griffiths,Sushil Pandey,Lucy Lee-Smith,Aristomenis K Exadaktylos","doi":"10.1186/s13017-025-00613-7","DOIUrl":"https://doi.org/10.1186/s13017-025-00613-7","url":null,"abstract":"BACKGROUNDTension pneumothorax (TP) is a life-threatening condition. The immediate recommended management is needle decompression (ND), followed by the insertion of an intercostal chest drain. The European Trauma Course (ETC) and the Advanced Trauma Life Support (ATLS) guidelines differ on needle size and decompression site, creating clinical uncertainty. This meta-analysis aims to explore the optimal approach for emergency needle decompression in TP.METHODSThis meta-analysis followed the PRISMA 2020 guidelines. It included English-language RCTs, cohort, case-control, cross-sectional studies, and case series with more than six patients. Studies on adults undergoing needle decompression therapy for TP or with chest wall thickness measurements were included. Ovid MEDLINE, Embase, and Web of Science databases were searched until May 31, 2024. Data were extracted, assessed for quality using OCEBM and GRADE, and analyzed using SPSS and OpenMeta with random-effects models.PRIMARY OUTCOMEneedle decompression failure rate.SECONDARY OUTCOMESpatient demographics, cannula size, and chest wall thickness comparisons.RESULTSThis review analyzed 51 studies on needle decompression for TP, with a weighted mean patient age of 36.67 years. Radiological data from 24 studies (n = 8046) indicated a 32.84% failure rate for needle penetration into the pleural cavity (I2: 99.72%). Increased needle length reduced failure rates by 7.76% per cm. No significant differences in chest wall thickness between genders were observed (T-test, p = 0.77), but thickness at the 5th anterior axillary line (5AAL) and 5th midaxillary line (5MAL) was less than at the 2nd midclavicular line (2MCL). Injury rates were higher at 5AAL than 5MAL, with strong positive correlations between needle length and injury at these sites (0.88, 0.91).CONCLUSIONBased on our meta-analysis, a 7 cm needle may be appropriate for decompression of right-sided tension pneumothorax at either the 5th intercostal space along the midaxillary line or the 2nd intercostal space along the midclavicular line. For left-sided cases, given the potential risk of cardiac injury, the 2nd midclavicular line is a safer option. However, these recommendations should be interpreted with caution due to considerable heterogeneity among the included studies, potential risk of bias, and variability in measurement techniques. Clinical decisions should always be individualized, taking into account patient-specific factors.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"32 1","pages":"39"},"PeriodicalIF":8.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087511","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}
Rib fractures are common chest wall injuries with conservative treatment and surgical stabilization of rib fractures (SSRF) as treatment options. We retrospectively compared the efficacy and long-term prognosis of conservative treatment and SSRF as treatment options for rib fractures. This retrospective study was conducted at a single trauma center in Taiwan. The study population comprised patients with rib fractures who underwent conservative treatment or SSRF at the National Taiwan University Hospital between 2017 and 2022. We analyzed the outcomes between the operative and non-operative groups, including the length of intensive care unit and hospital stays, pain scales at admission and follow-up, and post-operative complication rates. Of the 217 patients with rib fractures in this study, 103 received SSRF, and 114 received conservative treatment. Patients in the operative group had worse consciousness statuses and higher injury severity scores than those in the non-operative group. In addition, patients in the operative group had more preoperative chest complications than those in the non-operative group. Regarding outcomes and long-term prognoses, patients in the operative group had longer intensive care unit and hospital stays than those in the non-operative group; however, patients in the operative group had better recovery quality than those in the non-operative group. Our study showed that, in patients who meet the surgical indications, SSRF is an effective and safe way to relieve acute pain after thoracic injury and achieve better recovery and quality of life after surgical intervention.
{"title":"Clinical outcomes of rib fracture stabilization and conservative treatment in a high-volume Asian trauma center: a propensity score-matched retrospective study","authors":"Chia-Cheng Kao, Ke-Cheng Chen, Xu-Heng Chiang, Jen-Hao Chuang, Chao-Wen Lu, Wei-Ling Hsiao, Tzu-Hsin Lin, Hsien-Chi Liao","doi":"10.1186/s13017-025-00620-8","DOIUrl":"https://doi.org/10.1186/s13017-025-00620-8","url":null,"abstract":"Rib fractures are common chest wall injuries with conservative treatment and surgical stabilization of rib fractures (SSRF) as treatment options. We retrospectively compared the efficacy and long-term prognosis of conservative treatment and SSRF as treatment options for rib fractures. This retrospective study was conducted at a single trauma center in Taiwan. The study population comprised patients with rib fractures who underwent conservative treatment or SSRF at the National Taiwan University Hospital between 2017 and 2022. We analyzed the outcomes between the operative and non-operative groups, including the length of intensive care unit and hospital stays, pain scales at admission and follow-up, and post-operative complication rates. Of the 217 patients with rib fractures in this study, 103 received SSRF, and 114 received conservative treatment. Patients in the operative group had worse consciousness statuses and higher injury severity scores than those in the non-operative group. In addition, patients in the operative group had more preoperative chest complications than those in the non-operative group. Regarding outcomes and long-term prognoses, patients in the operative group had longer intensive care unit and hospital stays than those in the non-operative group; however, patients in the operative group had better recovery quality than those in the non-operative group. Our study showed that, in patients who meet the surgical indications, SSRF is an effective and safe way to relieve acute pain after thoracic injury and achieve better recovery and quality of life after surgical intervention.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"41 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144088265","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 : 2025-04-30DOI: 10.1186/s13017-025-00588-5
May Myat Thu, Hwei Jene Ng, Susan Moug
Frailty and sarcopenia have been independently shown to predict mortality in emergency laparotomy (EmLap), and both can be indicative of poor physical status. We aim to assess the prevalence of frailty, sarcopenia, and physical status in EmLap and explore the relationship between these factors and 30-day, 90-day and 1-year mortality. Retrospective analysis was performed on prospectively maintained Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA) database (2017–2019) which included patients ≥ 18 years who underwent EmLap. Clinical frailty scale (CFS) was used to classify frailty (score ≥ 4 as frail). Sarcopenia was assessed using total psoas index (TPI). Poor physical status (PPS) was defined by American Society of Anaesthesiologists physical status classification (ASA) ≥ 4. Binary logistic regression and fisher’s exact tests were used for statistical analysis. 215 patients were included in the study, with 57.2% female and median age of 64 years. Frailty was present in 17.2%, sarcopenia in 25.1% and 14.4% had PPS; 3.3% had all three factors. Frail patients had significantly higher risk for 30-day (p = 0.003), 90-day (p = 0.006) and 1-year mortality (p = 0.032). Patients with poor physical status also showed significantly higher mortality at 30-day (p < 0.001), 90-day (p < 0.001) and 1-year (p = 0.001). Sarcopenic patients did not show significant differences in mortality risks up to 1 year. Patients with all three factors had significantly higher 30-day (p = 0.003), 90-day (p = 0.046) and 1-year mortality (p = 0.108) compared to patients who had none of the factors. Frailty, sarcopenia, and PPS are prevalent in EmLap. Frailty and PPS were independently associated with short and long-term mortality, but not sarcopenia. While overlap exists between three factors, more research is required to understand the complex interplay.
{"title":"The influence between frailty, sarcopenia and physical status on mortality in patients undergoing emergency laparotomy","authors":"May Myat Thu, Hwei Jene Ng, Susan Moug","doi":"10.1186/s13017-025-00588-5","DOIUrl":"https://doi.org/10.1186/s13017-025-00588-5","url":null,"abstract":"Frailty and sarcopenia have been independently shown to predict mortality in emergency laparotomy (EmLap), and both can be indicative of poor physical status. We aim to assess the prevalence of frailty, sarcopenia, and physical status in EmLap and explore the relationship between these factors and 30-day, 90-day and 1-year mortality. Retrospective analysis was performed on prospectively maintained Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA) database (2017–2019) which included patients ≥ 18 years who underwent EmLap. Clinical frailty scale (CFS) was used to classify frailty (score ≥ 4 as frail). Sarcopenia was assessed using total psoas index (TPI). Poor physical status (PPS) was defined by American Society of Anaesthesiologists physical status classification (ASA) ≥ 4. Binary logistic regression and fisher’s exact tests were used for statistical analysis. 215 patients were included in the study, with 57.2% female and median age of 64 years. Frailty was present in 17.2%, sarcopenia in 25.1% and 14.4% had PPS; 3.3% had all three factors. Frail patients had significantly higher risk for 30-day (p = 0.003), 90-day (p = 0.006) and 1-year mortality (p = 0.032). Patients with poor physical status also showed significantly higher mortality at 30-day (p < 0.001), 90-day (p < 0.001) and 1-year (p = 0.001). Sarcopenic patients did not show significant differences in mortality risks up to 1 year. Patients with all three factors had significantly higher 30-day (p = 0.003), 90-day (p = 0.046) and 1-year mortality (p = 0.108) compared to patients who had none of the factors. Frailty, sarcopenia, and PPS are prevalent in EmLap. Frailty and PPS were independently associated with short and long-term mortality, but not sarcopenia. While overlap exists between three factors, more research is required to understand the complex interplay.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"31 6 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889623","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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