摘要 :
Abstract The use of robotic technology in general surgery continues to increase, though its utility for emergency general surgery remains under-studied. This study explores the current trends in patient outcomes and cost of roboti...
展开
Abstract The use of robotic technology in general surgery continues to increase, though its utility for emergency general surgery remains under-studied. This study explores the current trends in patient outcomes and cost of robotic emergency general surgery (REGS). The Florida Agency for Healthcare Administration database (2018–2020) was queried for adult patients undergoing intra-abdominal emergency general surgery within 24?h of admission and linked to CMS Cost Reports/Hospital Compare, American Hospital Association, and Rand Corporation Hospital datasets. Patients from the four most common REGS procedures were propensity matched to laparoscopic equivalents for hospital cost analysis. A telephone survey was performed with the top 10 REGS hospitals to identify key qualities for successful REGS programs. 181 hospitals (119 REGS, 62 non-REGS) performed 60,733 emergency surgeries. Six-percent were REGS. The most common REGS were cholecystectomy, appendectomy, inguinal and ventral hernia repairs. Before and after propensity matching, total cost for these four procedures were significantly higher than their laparoscopic equivalents, which was due to higher surgical cost as the non-operative costs did not differ. There were no differences in mortality, individual complications, or length of stay for most of the four procedures. REGS volume significantly increased each year. The survey found that 8/10 hospitals have robotic-trained staff available 24/7. Although REGS volume is increasing in Florida, cost remains significantly higher than laparoscopy. Given higher costs and lack of significantly improved outcomes, further study should be undertaken to better inform which specific patient populations would benefit from REGS.
收起
摘要 :
At our institution, we recognized a need for a standardized, efficient approach to safely evaluate, prepare, and transport patients in need of emergent surgery. With the establishment of an Emergency Surgery Transport and Assessme...
展开
At our institution, we recognized a need for a standardized, efficient approach to safely evaluate, prepare, and transport patients in need of emergent surgery. With the establishment of an Emergency Surgery Transport and Assessment Team, we were able to substantially reduce our median transport time to the OR. We believe other institutions can establish an efficient team using existing resources to expedite care of the emergent surgical patient.
收起
摘要 :
Although patients who present for emergency medical care have a broad spectrum of symptoms, such events can generally be categorized as internal medicine, surgical, and pediatric emergency cases. Indications for emergency surgery ...
展开
Although patients who present for emergency medical care have a broad spectrum of symptoms, such events can generally be categorized as internal medicine, surgical, and pediatric emergency cases. Indications for emergency surgery are estimated to be infrequent compared with the overall number of patients admitted for emergency care. This study investigated the indications for emergency surgery in patients (612 of 8422 patients who sought emergency care) admitted to the surgical division of the emergency department at Konya City Hospital between January and July of 2002. This retrospective study, which investigated reasons for surgical procedures and relevant branch distribution, comprised 405 men (65%) and 207 women (35%). Ages of enrolled patients ranged from 6 months to 70 years. Most of the patients (n=280, 46%) who underwent surgery at the emergency clinic were treated for acute abdomen. Emergency indications for neurosurgery (n=71, 12%) were the second most common reason for emergency procedures. Epidural hematoma and depressed fracture were the most apparent indications for neurosurgery. Surgery of the thorax was the third most common emergency surgery performed (n=44, 7%). Patients who had emergency surgery indications and who underwent surgery account for approximately 7% of the total number of patients who presented for emergency care. Acute abdomen and trauma were the most frequently reported precipitating events.
收起
摘要 :
BACKGROUND: The Emergency Surgery Score (ESS) was recently validated as a scoring system to predict mortality in emergency surgery (ES) patients. We sought to examine the ability of ESS to predict the occurrence of 30-day postoper...
展开
BACKGROUND: The Emergency Surgery Score (ESS) was recently validated as a scoring system to predict mortality in emergency surgery (ES) patients. We sought to examine the ability of ESS to predict the occurrence of 30-day postoperative complications in ES.
收起
摘要 :
? 2022 Elsevier Inc.Introduction: Emergency general surgery among cardiac surgery patients is increasingly common and consequential. We sought to characterize the true burden of emergency general surgery among hospitalized complex...
展开
? 2022 Elsevier Inc.Introduction: Emergency general surgery among cardiac surgery patients is increasingly common and consequential. We sought to characterize the true burden of emergency general surgery among hospitalized complex cardiac patients. Methods: We performed a retrospective analysis of the 2016-2017 National Inpatient Sample. We included adult patients with a primary diagnosis of complex cardiac disease. We then compared patients who underwent emergency general surgery (GS-OR) with those who did not (non–GS-OR). The primary outcome was mortality; secondary outcomes included length of stay and hospitalization costs. Results: We identified 10.2 million patients with a primary diagnosis of complex cardiac disease, of which 148,309 (1.4%) underwent GS-OR. Mortality rates were significantly higher in the GS-OR group (11.0% versus 5.0%, P < 0.001). Among all cardiac patients, GS-OR was associated with 2.2 times increased odds of death (aOR: 2.2, P < 0.001). GS-OR patients also had longer length of stays (14.1 versus 5.8 d, P < 0.001). Among all cardiac patients, GS-OR was associated with an 8.1-day longer length of stay (P < 0.001). GS-OR patients were less often routinely discharged home (31.7% versus 45.3%, P < 0.001) and incurred higher inpatient costs ($46,136 versus $16,303, P < 0.001). Among all cardiac patients, GS-OR patients incurred $30,102 higher hospitalization costs (P < 0.001). Conclusions: Emergency general surgery among cardiac surgery patients is associated with a greater than two-fold increase in mortality, longer length of stays, higher rates of nonroutine discharge, and higher hospitalization costs. Emergency general surgery complications account for 4.0% of total inpatient costs of cardiac surgery patients and merit further study.
收起
摘要 :
Background: Recently, the laparoscopic or minimally invasive approach has become common practice for planned colorectal malignancies. Its use in the emergency setting is limited by various factors, including resource availability ...
展开
Background: Recently, the laparoscopic or minimally invasive approach has become common practice for planned colorectal malignancies. Its use in the emergency setting is limited by various factors, including resource availability and surgical expertise. However, more recent evidence suggests a laparoscopic approach to colorectal emergencies, which is comparable with laparoscopic routine work, and often promising. In this study, authors have investigated the outcome of the laparoscopic approach in both benign and malignant colorectal emergencies. Method: Retrospective analysis of prospectively collected data (theater records, histology database, and discharge records) over the course of 9 years. The standard surgical approach included conventional laparoscopic and single-port technique (single-incision laparoscopic surgery). The outcome variables included in the final analysis were: success of the minimally invasive approach, conversion rate, postoperative complications, return to theater, and mortality. Results: A total of 202 (males, 110 and females, 92) emergency patients with a median age of 59 years underwent surgery between December 2009 and 2019. The mean operating time was 169 minutes and median American Society of Anesthesiology grade III. Single-incision laparoscopic surgery was used in 19 patients (9.4%). The conversion to open surgery was 12.3% (n=25). The majority of them had primary anastomosis (n= 132, 65.3%). The complications from most to least frequent were: Postoperative ileus (35%). Postoperative respiratory complications (7.4%). Intra-abdominal collection (9%); half of which were anastomotic leak (4.5%). Major wound infection (3.9%). Return to theater for laparotomy (2.9%). Conclusion: The favorable results obtained in this study underline the theme that with the availability of resources and expertise, it is possible to offer minimal invasive approach to emergency colonic pathology.
收起
摘要 :
Abstract Purpose Emergency pancreaticoduodenectomy (EPD) is an uncommon surgical procedure; usually, it is performed in traumatic cases, with non-traumatic indications being very rare. Our review aimed to offer a comprehensive des...
展开
Abstract Purpose Emergency pancreaticoduodenectomy (EPD) is an uncommon surgical procedure; usually, it is performed in traumatic cases, with non-traumatic indications being very rare. Our review aimed to offer a comprehensive descriptive overview of the characteristics of EPD in non-traumatic settings.Methods Our study is a review of individual participant data. PubMed, Cochrane, Google Scholar and Embase databases were searched. The last search was conducted in March 2022; studies that reported EPD for non-traumatic indications were included in the analysis.Results Twenty-six articles were identified, twenty-five providing individual participant data; 17 articles (68%) were case reports. One article was a large retrospective study on the NSQIP (American College of Surgeons National Surgical Quality Improvement) database, which enrolled 409 patients that underwent EPD for malignant causes. From the other studies, we extracted individual participant data for a total of 66 patients. The patients were divided in subgroups, based on the indication for surgery: malignant causes (39.39%), uncontrollable bleeding (19.69%), iatrogenic injuries (30.3%), perforations (4.54%), or ischemic causes (6.06%). The postoperative morbidity was higher for the perforation subgroup. Postoperative pancreatic fistula is the most common complication reported (21.21%); higher rates were reported in the malignant and bleeding subgroups, with no special mention of this complication in the NSQIP database study. Mortality rate was 10.3% in the NSQIP database and higher, 19.69% in the 66-patient cohort; the highest mortality rates were registered in the perforation and ischemic subgroup.Conclusion EPD is a complex surgical intervention, with important associated morbidity and mortality rates, higher than that in elective settings, although it can be a life-saving procedure in selected cases and should be performed only in high-experience centres.
收起
摘要 :
Почти 60% детей с хирургическими заболеваниями, требующими неотложного вмешательства, оперируют в 11РБ общие хирурги. Недостат...
展开
Почти 60% детей с хирургическими заболеваниями, требующими неотложного вмешательства, оперируют в 11РБ общие хирурги. Недостаточные знания особенностей детского возраста приводят к большому количеству тактических и технических ошибок. 15 лет назад в регионе проведена регламентация районных лечебно-профилактических учреждений в зависимости от их возможностей оказания экстренной хирургической помощи детям разного возраста и состояния. Это позволило значительно улучшить результаты лечения таких больных.
收起
摘要 :
Почти 60% детей с хирургическими заболеваниями, требующими неотложного вмешательства, оперируют в 11РБ общие хирурги. Недостат...
展开
Почти 60% детей с хирургическими заболеваниями, требующими неотложного вмешательства, оперируют в 11РБ общие хирурги. Недостаточные знания особенностей детского возраста приводят к большому количеству тактических и технических ошибок. 15 лет назад в регионе проведена регламентация районных лечебно-профилактических учреждений в зависимости от их возможностей оказания экстренной хирургической помощи детям разного возраста и состояния. Это позволило значительно улучшить результаты лечения таких больных.
收起
摘要 :
Introduction The traditional 24-h call model faces pressure from competing needs between emergency and elective services. Recognizing this, a dedicated ESAT service was developed in Khoo Teck Puat Hospital in Singapore, with impro...
展开
Introduction The traditional 24-h call model faces pressure from competing needs between emergency and elective services. Recognizing this, a dedicated ESAT service was developed in Khoo Teck Puat Hospital in Singapore, with improved clinical outcomes. It was initially led by a single consultant (SC) in 2014, and subsequently evolved to a weekly consultant rotation (WC) roster in 2017 to achieve sustainability. Methods Each consultant led the ESAT WC service for a week and maintained ownership of their patients thereafter. All emergency surgical admissions between two distinct 6-month periods were reviewed, from May to October 2014 (pre-ESAT) and January to June 2017 (ESAT WC). Patient demographics, diagnoses, and operations were compared. Efficiency and clinical outcomes were evaluated. Results There were 1248 and 1284 patients in the pre-ESAT and ESAT WC group, respectively. Majority were males and in their 50s. Acute appendicitis, gallstone conditions, and soft-tissue infections made up half of the admissions. Trauma workload was comparable (7.8% pre-ESAT vs 9.5% ESAT WC). Cholecystectomies doubled during the ESAT period, 14.2% vs 7.2%, (p = 0.01). More consultants were involved in major cases (95.9% vs 86%), (p = 0.01) and more operations were performed during the day (52.1% vs 47.9%), (p = 0.01). Average time to OT was shorter and there were less major surgical complications (p = 0.02). Mortality (p = 0.08) and length of stay were reduced (4 vs 4.5 days), (p = 0.01). Conclusion The ESAT WC service has sustained improved outcomes in our institution.
收起
原文获取