World Journal of Emergency Surgery最新文献

{"title":"Alternative treatments to treat perforated peptic ulcer: a systematic review and network meta-analysis of randomized controlled trials","authors":"Paschalis Gavriilidis, Carlo Alberto Schena, Salomone Di Saverio, Larry Hromalik, Mehmet Eryilmaz, Fausto Catena, Nicola de’Angelis","doi":"10.1186/s13017-025-00599-2","DOIUrl":"https://doi.org/10.1186/s13017-025-00599-2","url":null,"abstract":"Perforated peptic ulcers (PPU) represent a critical surgical emergency. Despite the historical predominance of open surgical repair, laparoscopic and endoscopic approaches have shown promise in reducing morbidity and hospital stay. This study aimed to conduct a network meta-analysis comparing open, laparoscopic, and endoscopic interventions for PPU repair. A systematic search of Medline (PubMed), Embase, Cochrane Library, Google Scholar, and the National Institute for Health and Clinical Excellence (NICE) databases identified randomized controlled trials (RCTs) comparing these approaches. The primary outcomes were 30-day mortality and morbidity. Eight RCTs including 657 patients were analyzed. Endoscopic interventions were associated with fewer respiratory complications and shorter hospital stays, while the laparoscopic approach demonstrated fewer surgical site infections and less postoperative pain compared to open repair. Other outcomes demonstrated non-significant differences across interventions. Prompt resuscitation and surgical repair, either laparoscopic or open, remains the gold standard for PPU. Endoscopic techniques are viable alternatives for small perforations and in selected cases where general anesthesia is contraindicated.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"40 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143819414","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}

{"title":"Online extended focused assessment with sonography for trauma (EFAST) course enhanced knowledge and perceived confidence among medical trainees during the COVID-19 pandemic disaster","authors":"Arif Alper Cevik, Fikri M. Abu-Zidan","doi":"10.1186/s13017-025-00604-8","DOIUrl":"https://doi.org/10.1186/s13017-025-00604-8","url":null,"abstract":"The COVID-19 pandemic disrupted medical education worldwide, prompting the need for innovative e-learning solutions. This study evaluated the effectiveness of an online extended Focused Assessment with Sonography in Trauma (EFAST) course, delivered via the International Emergency Medicine Education Project’s platform, to improve participants’ knowledge and perceived confidence in EFAST procedure. A prospective observational study was conducted between May 17, 2020, and December 20, 2023. Pre- and post-course quizzes and surveys were used to assess participants’ knowledge and confidence. Participant demographics, quiz scores, and survey responses were collected. Quantitative data were analysed using the Wilcoxon Signed-Rank test and Cohen’s d to evaluate knowledge improvement and confidence changes. Thematic analysis of qualitative feedback was performed with the assistance of large language model AI tools for emerging themes. 1758 participants enrolled in the course. From 111 countries, 1515 started the course, and 1190 (78.6%) reached the final exam stage, with 96.1% achieving a passing score. 66.4% indicated they had never attended a prior ultrasound course. Most (81.1%) were medical students, interns, or residents. 36.5% of participants were from low- or lower-middle-income countries. 1175 (77.6%) participants completed both the pre- and post-course formative knowledge quizzes. The median (IQR) scores were 53.3 (40.0–66.7) pre-course and 86.7 (73.3–93.3) post-course (p < 0.001, effect size: -0.958). 771 participants completed both pre- and post-course surveys. Participants’ median (IQR) confidence in EFAST increased from 5 (3–7) to 8 (7–10) (p < 0.001, effect size: -0.844). Qualitative feedback showed that participants found the course practical, well-structured, and effective. They suggested improving video quality and simplifying content for clarity and engagement. The online EFAST course enhanced participants’ knowledge and perceived confidence, demonstrating the potential of online clinical education during global crises.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"4306 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143805773","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}

{"title":"Correction: Trauma quality indicators: internationally approved core factors for trauma management quality evaluation","authors":"Federico Coccolini, Yoram Kluger, Ernest E. Moore, Ronald V. Maier, Raul Coimbra, Carlos Ordoñez, Rao Ivatury, Andrew W. Kirkpatrick, Walter Biffl, Massimo Sartelli, Andreas Hecker, Luca Ansaloni, Ari Leppaniemi, Viktor Reva, Ian Civil, Felipe Vega, Massimo Chiarugi, Alain Chichom-Mefire, Boris Sakakushev, Andrew Peitzman, Osvaldo Chiara, Fikri Abu-Zidan, Marc Maegele, Mario Miccoli, Mircea Chirica, Vladimir Khokha, Michael Sugrue, Gustavo P. Fraga, Yasuhiro Otomo, Gian Luca Baiocchi, Fausto Catena","doi":"10.1186/s13017-025-00577-8","DOIUrl":"https://doi.org/10.1186/s13017-025-00577-8","url":null,"abstract":"<p><b>Correction: World Journal of Emergency Surgery (2021) 16:6 </b><b>https://doi.org/10.1186/s13017-021-00350-7</b></p><p>Following publication of the original article [1], one of the collaborator names was incorrectly written as “Hossein Samadi Kaf” instead of “Hossein Samadi Kafil” in The WSES Trauma Quality Indicators Expert Panel. The incorrect and correct names are listed in this correction article.</p><p>Incorrect author name: Hossein Samadi Kaf</p><p>Correct author name: Hossein Samadi Kafil</p><p>The original article has been updated.</p><ol data-track-component=\"outbound reference\" data-track-context=\"references section\"><li data-counter=\"1.\"><p>Coccolini F, Kluger Y, Moore EE, et al. Trauma quality indicators: internationally approved core factors for trauma management quality evaluation. World J Emerg Surg. 2021;16:6. https://doi.org/10.1186/s13017-021-00350-7.</p><p>Article PubMed PubMed Central Google Scholar </p></li></ol><p>Download references<svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-download-medium\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></p><h3>Authors and Affiliations</h3><ol><li><p>General Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124, Pisa, Italy</p><p>Federico Coccolini &amp; Massimo Chiarugi</p></li><li><p>Division of General Surgery, Rambam Health Care Campus, Haifa, Israel</p><p>Yoram Kluger</p></li><li><p>Ernest E Moore Shock Trauma Center, Denver Health, Denver, CO, USA</p><p>Ernest E. Moore</p></li><li><p>Department of Surgery, Harborview Medical Center, University of Washington, Seattle, WA, USA</p><p>Ronald V. Maier</p></li><li><p>Riverside University Health System, Riverside, CA, USA</p><p>Raul Coimbra</p></li><li><p>Division of Trauma and Acute Care Surgery, Fundación Valle del Lili, Cali, Colombia</p><p>Carlos Ordoñez</p></li><li><p>VCU Medical Center, Richmond, VA, USA</p><p>Rao Ivatury</p></li><li><p>General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, Canada</p><p>Andrew W. Kirkpatrick</p></li><li><p>Department of Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, San Diego, CA, USA</p><p>Walter Biffl</p></li><li><p>General and Emergency Surgery, Macerata Hospital, Macerata, Italy</p><p>Massimo Sartelli</p></li><li><p>Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany</p><p>Andreas Hecker</p></li><li><p>General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy</p><p>Luca Ansaloni</p></li><li><p>Abdominal Center, Helsinki University Hospital, Helsinki, Finland</p><p>Ari Leppaniemi</p></li><li><p>Department of War Surgery, Kirov Military Medical Academy, Saint-Petersburg, Russia</p><p>Viktor Reva</p></li><li><p>General and Emergency Surgery Dept., Auckland City Hospital, Auckland, New Zealand</p><p>Ian Civil</p></li><li><p>Department of Surgery, ","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"37 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143790128","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}

{"title":"Functional outcomes following injury in centenarians: a nationwide retrospective observational study","authors":"Ryo Yamamoto, Brian J. Eastridge, Ramon F. Cestero, Keitaro Yajima, Akira Endo, Kazuma Yamakawa, Junichi Sasaki","doi":"10.1186/s13017-025-00595-6","DOIUrl":"https://doi.org/10.1186/s13017-025-00595-6","url":null,"abstract":"Advances in healthcare and the development of various technologies have improved disease-free longevity. Although the number of healthy centenarians is gradually increasing, studies on postinjury functions among centenarians are lacking. Therefore, we aimed to determine the clinical predictors of mortality and unfavorable functions after injury among centenarians. A retrospective study was conducted using a nationwide trauma database, and data from patients aged ≥ 100 years across ≥ 250 institutions during 2019–2022 were analyzed. Patient demographics, comorbidities, mechanism of injury, injury severity, vital signs on arrival, and pre- and in-hospital treatments were compared between survivors and non-survivors as well as between survivors who had and did not have the ability to live independently at discharge, which was defined as Glasgow Outcome Scale (GCS) score of ≤ 3. Independent predictors of in-hospital mortality and unfavorable functions after injury were examined using a generalized estimating equation model to account for institutional and regional differences in the management and characteristics of centenarians. Of the 409 centenarians, 384 (93.9%) survived to discharge. Although 208 (50.9%) patients had lived independently before the injury, only 91 (22.2%) could live independently at discharge. All patients had blunt injury, and fall from standing was the most frequent (86.6%) mechanism. The injury severity score was 10 ± 5, and surgery/angiography was performed in < 2% of the centenarians, except for fracture fixation in the extremity/pelvis, which was conducted in 225 (55.0%) patients. The adjusted model revealed three independent predictors of in-hospital mortality: male gender, mechanism of injury other than fall from standing, and GCS score on arrival. In contrast, only injury severity in the extremity/pelvis was an independent predictor of unfavorable functions after injury. Male gender, mechanisms of injury other than fall from standing, and GCS on arrival were associated with higher in-hospital mortality. Injury severity in the extremity/pelvis was related to dependent living after injury among centenarians.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"23 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775588","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}

{"title":"Total care of trauma patients from triage to discharge at Chang Gung Memorial Hospital: introducing the development of an iconic acute care surgery system in Taiwan","authors":"Chi-Hsun Hsieh, Chien-Hung Liao, Chi-Tung Cheng, Chih-Yuan Fu, Shih-Ching Kang, Yu-Pao Hsu, Chih-Po Hsu, Szu-An Chen, Chien-An Liao, Yu-Hao Wang, Ling-Wei Kuo, Chia-Cheng Wang, Yu-San Tee, Feng-Jen Hsieh, Chun-Hsiang Ou-Yang, Pei-Hua Li, Sheng-Yu Chan, Jen-Fu Huang, Yu-Tung Wu","doi":"10.1186/s13017-025-00603-9","DOIUrl":"https://doi.org/10.1186/s13017-025-00603-9","url":null,"abstract":"The Acute Care Surgery (ACS) model has evolved to provide structured care across trauma, critical care, and emergency general surgery. This innovative model effectively addresses significant challenges within trauma care. Research indicates that trauma surgeons operating under this expanded scope deliver high-quality care while enjoying professional satisfaction. This article discusses the introduction of the ACS model in Taiwan. Before the 1990s, Taiwan’s trauma care system relied on general surgeons who operated under an “on-call” model, lacking dedicated trauma specialists. Significant reforms were initiated in 2009, when the government implemented a grading system for hospital emergency capabilities, categorizing hospitals into three levels: General (offering 24 h services), Intermediate (capable of managing stable trauma cases), and Advanced (providing comprehensive care for critically ill patients). All medical centers are classified as advanced level hospitals and are equipped with trauma teams. However, these trauma teams operate under various models, ranging from those focused exclusively on trauma to others with comprehensive responsibilities. The trauma center at Chang Gung Memorial Hospital (CGMH) adopted a comprehensive ACS model, encompassing the entire spectrum of care from emergency admission to discharge, all led by trauma surgeons. This approach ensures continuity and coordination in trauma patient care. Additionally, the model integrates emergency general surgery and surgical critical care, broadening the scope of practice for trauma surgeons and enhancing their overall capabilities, providing significant flexibility in their career paths. The ACS model implemented at CGMH has achieved remarkable success, establishing it as a leading trauma center in Taiwan. The emergence of the ACS model aims to reverse the decline in the trauma field that began decades ago. This model not only helps retain skilled professionals but also maintains the expertise of trauma surgeons, ensuring that trauma patients receive the highest quality of care.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"28 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143758633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stoma reversal after emergency stoma formation—the importance of timing: a multi-centre retrospective cohort study","authors":"Scott MacDonald, Anna Gallagher, Lauren McNicholl, Luke McElroy, Rebecca Hughes, Tara Quasim, Susan Moug","doi":"10.1186/s13017-025-00598-3","DOIUrl":"https://doi.org/10.1186/s13017-025-00598-3","url":null,"abstract":"Restoration of intestinal continuity is a key consideration for patients having a stoma created under emergency conditions. There is contrasting evidence about the outcomes of stoma reversal for these patients. This research aims to describe the post-operative outcomes of stoma reversal after emergency formation, and whether these are affected by the timing of reversal. A retrospective review of a prospectively maintained emergency laparotomy (EmLap) database for 4 hospitals was performed between 2018 and 2021. Adult patients undergoing emergency stoma formation were identified and followed up until 2024. Those undergoing stoma reversal surgery were included in the final analysis. A Cox proportional-hazards model was created to identify factors associated with increased time to reversal. 1775 patients had an EmLap, with 505 (28.5%) having a stoma created. Of those patients with a stoma, 97 patients (19.2%) died within one year post-operatively. 146 (28.9%) of the emergency stoma patients underwent stoma reversal, with median time to reversal of 16.9 months. Median post-operative length of stay was 7 days, and 52.1% of patients sustained complications within 30 days post-operatively. Patients reversed within 18 months of stoma formation had fewer significant complications (7.9% v 35.1%, p < 0.001), a shorter length of stay (6 days v 7 days, p < 0.001), and reduced post-operative ileus rates (21.3% v 64.9%, p < 0.001) than those reversed after this period. Receiving adjuvant therapy for malignancy (adjusted Hazard ratio 0.36, 0.17–0.78, p = 0.001) and being male (adjusted Hazard ratio 0.69, 0.49–0.97, p = 0.032) were significantly associated with increased time to reversal. Emergency stoma formation is commonly performed during EmLap, but the majority of emergency stomas are never reversed. The complication profile for reversing these stomas is significant, but early reversal is associated with better post-operative outcomes. Standards of care for emergency stoma patients would be welcome in order to improve outcomes for this cohort.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"217 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143734007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-operative management of uncomplicated appendicitis in children, why not? A meta-analysis of randomized controlled trials","authors":"Francesco Brucchi, Claudia Filisetti, Ester Luconi, Paola Fugazzola, Dario Cattaneo, Luca Ansaloni, Gianvincenzo Zuccotti, Simona Ferraro, Piergiorgio Danelli, Gloria Pelizzo","doi":"10.1186/s13017-025-00584-9","DOIUrl":"https://doi.org/10.1186/s13017-025-00584-9","url":null,"abstract":"This study aims to provide a meta-analysis of randomized controlled trials (RCTs) comparing non-operative management (NOM) and operative management (OM) in a pediatric population with uncomplicated acute appendicitis. A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and Meta-analyses of Observational Studies in Epidemiology (MOOSE) guidelines. A comprehensive search was conducted in MEDLINE, Embase, and CENTRAL from inception to June 2024. Only randomized controlled trials (RCTs) were included, excluding studies involving adult patients and/or participants with complicated appendicitis. The variables considered were treatment complications, treatment efficacy during index admission and one-year follow-up, length of hospital stay (LOS), quality of life, and presence of appendicoliths. Three RCTs involving 269 participants (134 antibiotics/135 appendectomy) were included. There was no statistically significant difference between the two treatments in terms of complication risk (combined RD = − 0.03; 95% CI − 0.11; 0.06, p = 0.54), even including complications related to NOM failure. The risk of complication-free treatment success rate in the antibiotic group is lower than in the surgery group (combined RD = − 0.05; 95% CI − 0.13; − 0.04; p = 0.29). In patients without appendicolith, the combined risk difference of treatment success between NOM and OM was not statistically significant − 0.01 (IC − 0.17; 0.16; p value: 0.93). There is no statistical difference in terms of efficacy at 1 year, between NOM and OM (combined RD = − 0.06; 95% CI − 0.21; 0.09), p = 0.44). The LOS in the NOM group is significantly longer than in the OM group (difference of median = − 19.90 h; 95% CI − 29.27; − 10.53, p < .0001). This systematic review and meta-analysis provide evidence that NOM is safe and feasible for children with uncomplicated appendicitis and, in the group of patients without appendicolith, it is associated with a similar success rate to OM. However, more high-quality studies with adequate power and construction are still needed.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"1 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143695134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A modified multi-angle suture training module for laparoscopic training curriculum on emergency intestinal surgery","authors":"Jiliang Shen, Chengcheng Wu, Xiaochen Zhang, Yaoting Xue, Jin Yang","doi":"10.1186/s13017-025-00600-y","DOIUrl":"https://doi.org/10.1186/s13017-025-00600-y","url":null,"abstract":"Intestinal perforation and intestinal obstruction are common emergency surgeries in clinics which often require intestinal resection and anastomosis. Most intestinal anastomosis can be completed by laparoscopy. The wound closure module In the Fundamentals of Laparoscopic Surgery (FLS) program is traditionally used for laparoscopic suture and knotting training. However, many young surgeons tend to focus on practicing suture techniques from certain or a limited range of angles. This narrow approach increases the difficulty of complex suturing and knotting in clinical scenarios such as laparoscopic intestinal anastomosis. To address this issue, we designed a multi-angle suture module specifically for suture and knotting training. Thirty-six second-year surgical residents were recruited for the study. Twelve residents were randomly divided at a 1:1 ratio into the traditional suture group and the multi-angle suture group according to their basic laparoscopic surgical ability. After training, they were required to perform laparoscopic end-to-end anastomosis surgery on isolated swine intestines. The operation times, goal scores and surgical performance scores of the surgeries were collected and compared. Trainees who used the multi-angle suture training module shortened the operation time (3375.7 ± 1000 s vs. 4678.2 ± 684.7, p = 0.008) and achieved better surgical effects (operation performance score: 8.2 ± 1.5 vs. 6.83 ± 1.3, p = 0.041) in end‒end intestine anastomosis surgery than did those who used the traditional suture training module. The multi-angle suture training module effectively improved the laparoscopic suture skills of trainees and is therefore a better choice for laparoscopic suture and knotting training before doing laparoscopic intestinal anastomosis.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"12 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of COVID-19 on urgent gastrointestinal surgery outcomes: increased mortality in 2020","authors":"Aurélie Gouel-Chéron, Kankoe Sallah, Saiba Sawadogo, Axelle Dupont, Philippe Montravers","doi":"10.1186/s13017-025-00589-4","DOIUrl":"https://doi.org/10.1186/s13017-025-00589-4","url":null,"abstract":"The COVID-19 pandemic significantly disrupted healthcare systems. In France, non-urgent procedures were postponed, leading to a 52% decrease in elective surgical activity in public hospitals in Paris during the first wave. We aimed to assess the impact on gastro-intestinal emergency surgeries of health strategies implemented during this pandemic. This multicenter retrospective cohort study enrolled patients from sixteen public hospitals over five periods: March and April, 2018, and 2019 (pre-pandemic), 2020 (first wave), 2021 (third wave), and 2022 (post-pandemic). All adult patients requiring urgent gastrointestinal surgery admitted through the Emergency Department were included. Statistical tests were performed with the chi-square test, ANOVA test, Student test, Kruskall Wallis or Fisher exact test. Univariate and multivariate logistic regression were performed to investigate the relationship between mortality at day 90 and the primary data recorded. 2692 patients’ stay were included: 54% male, median age 48 [32;68], 12% ICU admission rate, median Charlson score 2 [0;5], and 6% mortality rate at day 90. The number of abdominal emergency cases decreased during the first wave (− 37% in 2020 compared to 2019). In the multivariate regression model, ICU admission, Charlson comorbidity score, and surgery in 2020 were independently associated with mortality at day 90 (as hospital length of stay, to a lower extent). Undergoing emergency surgery during the first lockdown was an independent mortality risk factor, independent of the COVID-19 infectious status. Whatever major healthcare issue is ongoing, all efforts should be made to maintain healthcare access to all, including urgent surgical procedures. Trial registration: Not applicable.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"7 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143640860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiological analysis of intra-abdominal infections in Italy from the Italian register of complicated intra-abdominal infections—the IRIS study: a prospective observational nationwide study","authors":"Federico Coccolini, Etrusca Brogi, Marco Ceresoli, Fausto Catena, Angela Gurrado, Francesco Forfori, Lorenzo Ghiadoni, Ettore Melai, Massimo Sartelli","doi":"10.1186/s13017-025-00590-x","DOIUrl":"https://doi.org/10.1186/s13017-025-00590-x","url":null,"abstract":"Intra-abdominal infections (IAIs) are common and severe surgical emergencies associated with high morbidity and mortality. In recent years, there has been a worldwide increase in antimicrobial resistance associated with intra-abdominal infections, responsible for a significant increase in mortality rates. To improve the quality of treatment, it is crucial to understand the underlying local epidemiology, clinical implications, and proper management of antimicrobial resistance, for both community- and hospital-acquired infections. The IRIS study (Italian Register of Complicated Intra-abdominal InfectionS) aims to investigate the epidemiology and initial management of complicated IAIs (cIAIs) in Italy. This is a prospective, observational, nationwide (Italy), multicentre study. approved by the coordinating centre ethic committee (Local Research Ethics Committee of Pisa (Prot n 56478//2019). All consecutively hospitalized patients (older than 16 years of age) with diagnosis of cIAIs undergoing surgery, interventional drainage or conservative treatment have been included. 4530 patients included from 23 different Italian hospitals. Community Acquired infection represented the 70.9% of all the cases. Among appendicitis, we found that 98.2% of the cases were community acquired (CA) and 1.8% Healthcare-associated (HA) infections. We observed that CA represented the 94.2% and HA 5.8% of Gastro Duodenal perforation cases. The majority of HA infections were represented by colonic perforation and diverticulitis (28.3%) followed by small bowel occlusion (19%) and intestinal ischemia (18%). 27.8% of patients presented in septic shock. Microbiological Samples were collected from 3208 (70.8%) patients. Among 3041 intrabdominal sample 48.8% resulted positive. The major pathogens involved in intra-abdominal infections were found to be E.coli (45.6%). During hospital stay, empiric antimicrobial therapy was administered in 78.4% of patients. Amoxicillin/clavulanate was the most common antibiotic used (in 30.1% appendicitis, 30% bowel occlusion, 30.5% of cholecystitis, 51% complicated abdominal wall hernia, 55% small bowel perforation) followed by piperacillin/tazobactam (13.3% colonic perforation and diverticulitis, 22.6% cholecystitis, 24.2% intestinal ischemia, 28.6% pancreatitis). Empiric antifungal therapy was administered in 2.6% of patients with no sign of sepsis, 3.1% of patients with clinical sign of sepsis and 4.1% of patients with septic shock. Azoles was administered in 49.2% of patients that received empiric antifungal therapy. The overall mortality rate was 5.13% (235/4350). 16.5% of patients required ICU (748/4350). In accordance with mortality, it is important to highlight that 35.7% of small bowel perforation, 27.6% of colonic perforation and diverticulitis, 25.6% of intestinal ischemia and 24.6% of gastroduodenal complications required ICU. Antibiotic stewardship programs and correct antimicrobial and antimycotic prescription campaigns are necessary ","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"69 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143635684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}