scholarly journals SP4.2.2 The hidden harm of conservative management in emergency general surgery during the COVID-19 pandemic

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Andrew Jackson ◽  
Oliver Ng ◽  
Balamurali Bharathan ◽  
Alastair Simpson ◽  
David Humes ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
General Surgery ◽  
Operative Management ◽  
Biliary Disease ◽  
Emergency General Surgery ◽  
Readmission Rates ◽  
Tertiary Centre ◽  
Lengths Of Stay ◽  
June July ◽  
Non Operative Management

Abstract Aims Appendicitis, biliary disease and abscesses make up almost half of the emergency general surgery (EGS) workload. Our aim was to establish whether the shift towards non-operative management during the COVID-19 pandemic for these conditions has led to adverse patient outcomes. Methods Patient data were analysed from a prospective EGS database at a large UK tertiary centre. Patients were grouped by admission date into quarters (January-March, April-June, July-September, October-December) and compared with the corresponding time period from the preceding year. Results EGS saw 8226 and 7589 patients in 2019 and 2020 respectively. Following the first lockdown EGS admissions fell by 31%. Operative management of appendicitis fell from nearly 100% in 2019 to 32.9% and 54.7% in two of the four study periods. Complicated appendicitis was more common in 2020 leading to a 50% rise in length of stay (LOS), 4.5 days average. 30 day readmissions increased by 228% (n = 7, 2019 v n = 16, 2020). Biliary disease was managed conservatively with 11 patients undergoing percutaneous drainage from Apr-Dec 2020.Very few patients received emergency cholecystectomy in 2019 or 2020 due to institution preference. Readmission rates and LOS remained similar between years. Fewer abscesses were seen and operated on in 2020 with similar readmission rates and LOS between years. Conclusions Non-operative management and delays in presentation of appendicitis during the pandemic has had an adverse effect on patient outcomes. The rise in more complex cases has led to higher readmission rates and longer lengths of stay. The outcomes for biliary disease and abscesses remained unchanged.

scholarly journals 38 Adapting an Emergency General Surgery Service in Response to the COVID-19 Pandemic

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
P Hickland ◽  
J Clements ◽  
L Convie ◽  
D McKay ◽  
K McElvanna
Keyword(s):  
Emergency Department ◽  
Patient Safety ◽  
General Surgery ◽  
Operative Management ◽  
Emergency General Surgery ◽  
Ambulatory Service ◽  
Before And After ◽  
Ambulatory Services ◽  
Non Operative Management

Abstract Introduction In response to the COVID-19 pandemic, our emergency general surgery (EGS) service established an enhanced ambulatory service and undertook non-operative management of selected pathologies. This study compares the activity of our service before and after these changes. Method Patients referred by the emergency department were prospectively identified over a four-week period beginning from the date of reconfiguration (COVID) and compared to patients retrospectively identified from the same period the previous year (Pre-COVID) and followed up for 30 days. Data was extracted from handover documents and electronic care records. Results There were 281 and 283 patients during the Pre-COVID and COVID periods, respectively. Rates of admission decreased (78.1% to 41.7%) whilst there were increased rates of ambulation (7.1% to 17.3%) and discharge (6% to 22.6%). Duration of admission decreased (6.9 to 4.8 days), and there were fewer operative and endoscopic interventions (78 to 40). There were increased ambulatory investigations (11 to 39), telephone reviews (0 to 39), and use of early CT to facilitate discharge (5% to 34.7%). There were no differences in 30-day readmission or mortality in any group. Conclusions Restructuring of our EGS service in response to COVID-19 facilitated an increased use of ambulatory services and imaging, whilst maintaining patient safety.

The Obesity Paradox in Emergency General Surgery Patients

2021 ◽  
pp. 000313482096852
Author(s):  
Sean R. Maloney ◽  
Caroline E. Reinke ◽  
Abdelrahman A. Nimeri ◽  
Sullivan A. Ayuso ◽  
A. Britton Christmas ◽  
...  
Keyword(s):  
General Surgery ◽  
Multivariable Analysis ◽  
Operative Management ◽  
Chronic Obstructive ◽  
High Morbidity ◽  
Emergency General Surgery ◽  
Common Procedure ◽  
Increased Risk ◽  
Social Security Death Index ◽  
The Impact

Operative management of emergency general surgery (EGS) diagnoses involves a range of procedures which can carry high morbidity and mortality. Little is known about the impact of obesity on patient outcomes. The aim of this study was to examine the association between body mass index (BMI) >30 kg/m2 and mortality for EGS patients. We hypothesized that obese patients would have increased mortality rates. A regional integrated health system EGS registry derived from The American Association for the Surgery of Trauma EGS ICD-9 codes was analyzed from January 2013 to October 2015. Patients were stratified into BMI categories based on WHO classifications. The primary outcome was 30-day mortality. Longer-term mortality with linkage to the Social Security Death Index was also examined. Univariate and multivariable analyses were performed. A total of 60 604 encounters were identified and 7183 (11.9%) underwent operative intervention. Patient characteristics include 53% women, mean age 58.2 ± 18.7 years, 64.2% >BMI 30 kg/m2, 30.2% with chronic obstructive pulmonary disease, 19% with congestive heart failure, and 31.1% with diabetes. The most common procedure was laparoscopic cholecystectomy (36.4%). Overall, 90-day mortality was 10.9%. In multivariable analysis, all classes of obesity were protective against mortality compared to normal BMI. Underweight patients had increased risk of inpatient (OR = 1.9, CI = 1.7-2.3), 30-day (OR = 1.9, CI = 1.7-2.1), 90-day (OR = 1.8, CI 1.6-2.0), 1-year (OR = 1.8, CI = 1.7-2.0), and 3-year mortality (OR = 1.7, CI = 1.6-1.9). When stratified by BMI, underweight EGS patients have the highest odds of death. Paradoxically, obesity appears protective against death, even when controlling for potentially confounding factors. Increased rates of nonoperative management in the obese population may impact these findings.

scholarly journals Emergency general surgery in Rwandan district hospitals: a cross-sectional study of spectrum, management, and patient outcomes

BMC Surgery ◽  
2017 ◽  
Vol 17 (1) ◽  
Author(s):  
Christophe Mpirimbanyi ◽  
Alexandre Nyirimodoka ◽  
Yihan Lin ◽  
Bethany L. Hedt-Gauthier ◽  
Jackline Odhiambo ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
General Surgery ◽  
Cross Sectional Study ◽  
Spectrum Management ◽  
Sectional Study ◽  
Emergency General Surgery ◽  
Cross Sectional ◽  
District Hospitals

Impact of interhospital transfer on patient outcomes in emergency general surgery

Surgery ◽  
2020 ◽  
Author(s):  
Laura Allen ◽  
Kelly Vogt ◽  
Emilie Joos ◽  
Rardi van Heest ◽  
Fady Saleh ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
General Surgery ◽  
Emergency General Surgery ◽  
Interhospital Transfer

scholarly journals Posterolateral corner knee injuries: a narrative review

2021 ◽  
Vol 6 (8) ◽  
pp. 676-685
Author(s):  
Francisco Figueroa ◽  
David Figueroa ◽  
Sven Putnis ◽  
Rodrigo Guiloff ◽  
Patricio Caro ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Knee Injuries ◽  
Operative Management ◽  
Posterolateral Corner ◽  
Dark Side ◽  
Reconstruction Technique ◽  
Orthopaedic Literature ◽  
And Function ◽  
Non Operative Management ◽  
Case Basis

Limited knowledge of the anatomy and biomechanics of the posterolateral corner (PLC) of the knee, coupled with poor patient outcomes with non-operative management, resulted in the PLC often being labelled as the ‘dark side’ of the knee. In the last two decades, extensive research has resulted in a better understanding of the anatomy and function of the PLC, and has led to the development of anatomic reconstructions that have resulted in improved patient outcomes. Despite considerable attention in the clinical orthopaedic literature (nearly 400 articles published in the last decade), a standardized algorithm for the diagnosis and treatment of the PLC is still lacking, and much controversy remains. Considering the literature review, there is not a reconstruction technique that clearly prevails over the others. As anatomic, biomechanical, and clinical knowledge of PLC injuries continues to progress, finding the balance between re-creating native anatomy and safely performing PLC reconstruction provides a big challenge. Treatment decisions should be made on a case-by-case basis. Cite this article: EFORT Open Rev 2021;6:676-685. DOI: 10.1302/2058-5241.6.200096

Biliary disorders

2021 ◽  
pp. 72-100
Author(s):  
Thomas Marjot
Keyword(s):  
Biliary Tract ◽  
Core Curriculum ◽  
Operative Management ◽  
Percutaneous Transhepatic Cholangiography ◽  
Biliary Colic ◽  
Biliary Disease ◽  
Bile Formation ◽  
Gallbladder Polyps ◽  
Non Operative Management ◽  
Indications And Complications

This chapter covers core curriculum topics relating to disorders of the biliary tract including physiology and biochemistry of bile formation and the pathogenesis of gallstones; complications of gallstones disease including biliary colic, acute cholecystitis, biliary obstruction, and cholangitis, and options for operative and non-operative management. Material is also provided on conditions of the gallbladder including adenomyomatosis, gallbladder polyps, and porcelain gallbladder; primary sclerosing cholangitis and other causes of cholangitistumours of the bile duct, gall bladder, and ampulla; indications and complications of endoscopic and radiological treatment of biliary disease including endoscopic retrograde choalngiopancreatography, cholangioscopy, and Percutaneous transhepatic cholangiography. There is also discussion on the diagnosis and management of biliary complications after liver transplantation. Additional curriculum material regarding disorders of the biliary tract will also be covered in the mock examination chapter.

scholarly journals The association between ICU admission and emergency hospital readmission following emergency general surgery

2019 ◽  
Vol 20 (4) ◽  
pp. 316-326 ◽  
Author(s):  
Michael A Gillies ◽  
Sadia Ghaffar ◽  
Ewen Harrison ◽  
Catriona Haddow ◽  
Lorraine Smyth ◽  
...  
Keyword(s):  
General Surgery ◽  
Hospital Readmission ◽  
Emergency General Surgery ◽  
Readmission Rates ◽  
Emergency Hospital ◽  
Icu Admission ◽  
Hospital Readmission Rates ◽  
Postoperative Intensive Care ◽  
Initial Care ◽  
Admission Status

Background The relationship between postoperative intensive care (ICU) admission following emergency general surgery (EGS) and emergency hospital readmission has not been widely investigated. Methods Retrospective analysis of registry data for patients undergoing EGS in Scotland, 2005–2007. Exposure of interest was ICU admission status (direct from theatre; indirect after initial care on ward; no ICU admission). The primary outcome was emergency hospital readmission within 30 days of discharge. Results Thirty-seven thousand one hundred seventy-three patients were included in the analysis. Overall emergency readmission rate was 8% ( n = 2983): 2756 (7.8%) in patients without postoperative ICU admission; 155 (12.1%) with direct ICU admission and 65 (14.7%) with indirect ICU admission. Indirect ICU admission was associated with increased hospital readmission rates (HR 1.24 [1.03, 1.49]; p = 0.024) compared with direct ICU admission. ICU admission was associated with increased three-year readmission rates ( p = 0.006) and costs ( p < 0.001) compared with initial ward care. Conclusion Indirect ICU admission is associated with increased emergency hospital readmission and healthcare costs for patients undergoing EGS.

scholarly journals Impact of the acute care surgery model on resident operative experience in emergency general surgery

2021 ◽  
Vol 64 (3) ◽  
pp. E298-E306
Author(s):  
Michael T. Meschino ◽  
Andrew E. Giles ◽  
Paul T. Engels ◽  
Timothy J. Rice ◽  
Rahima Nenshi ◽  
...  
Keyword(s):  
Acute Care ◽  
General Surgery ◽  
Acute Care Surgery ◽  
Biliary Disease ◽  
Emergency General Surgery ◽  
Primary Operator ◽  
After Hours ◽  
Operative Experience ◽  
Care Surgery ◽  
Junior Residents

Background: The acute care surgery (ACS) model has been shown to improve patient, hospital and surgeon-specific outcomes. To date, however, little has been published on its impact on residency training. Our study compared the emergency general surgery (EGS) operative experiences of residents assigned to ACS versus elective surgical rotations. Methods: Resident-reported EGS case logs were prospectively collected over a 9-month period across 3 teaching hospitals. Descriptive statistics were tabulated and group comparisons were made using χ2 statistics for categorical data and t tests for continuous data. Results: Overall, 1061 cases were reported. Resident participation exceeded 90%). Appendiceal and biliary disease accounted for 49.7% of EGS cases. Residents on ACS rotations reported participating in twice as many EGS cases per block as residents on elective rotations (12.64 v. 6.30 cases, p < 0.01). Most cases occurred after hours while residents were on call rather than during daytime ACS hours (78.8% v. 21.1%, p < 0.01). Senior residents were more likely than junior residents to report having a primary operator role (71.3% v. 32.0%, p < 0.01). Although the timing of cases made no difference in the operative role of senior residents, junior residents assumed the primary operator role more often during the daytime than after hours (50.0% v. 33.1%, p = 0.01). Conclusion: Despite implementation of the ACS model, residents in our program obtained most of their EGS operative experience after hours while on call. Although further research is needed, our study suggests that improved daytime access to the operating room may represent an opportunity to improve the quantity and quality of the EGS operative experience at our academic network.

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