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De Simone B, Agnoletti V, Abu-Zidan FM, Biffl WL, Moore EE, Chouillard E, Coccolini F, Sartelli M, Podda M, Di Saverio S, Kaafarani H, Balogh ZJ, Bala M, Leppäniemi AK, Kirkpatrick AW, Pikoulis E, Rasa K, Rosato C, Sawyer R, Ansaloni L, de'Angelis N, Damaskos D, Stahel PF, Kluger Y, Coimbra R, Catena F. The Operating Room management for emergency Surgical Activity (ORSA) study: a WSES international survey. Updates Surg 2024; 76:687-698. [PMID: 38190080 DOI: 10.1007/s13304-023-01668-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/29/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Despite advances and improvements in the management of surgical patients, emergency and trauma surgery is associated with high morbidity and mortality. This may be due in part to delays in definitive surgical management in the operating room (OR). There is a lack of studies focused on OR prioritization and resource allocation in emergency surgery. The Operating Room management for emergency Surgical Activity (ORSA) study was conceived to assess the management of operating theatres and resources from a global perspective among expert international acute care surgeons. METHOD The ORSA study was conceived as an international web survey. The questionnaire was composed of 23 multiple-choice and open questions. Data were collected over 3 months. Participation in the survey was voluntary and anonymous. RESULTS One hundred forty-seven emergency and acute care surgeons answered the questionnaire; the response rate was 58.8%. The majority of the participants come from Europe. One hundred nineteen surgeons (81%; 119/147) declared to have at least one emergency OR in their hospital; for the other 20/147 surgeons (13.6%), there is not a dedicated emergency operating room. Forty-six (68/147)% of the surgeons use the elective OR to perform emergency procedures during the day. The planning of an emergency surgical procedure is done by phone by 70% (104/147) of the surgeons. CONCLUSIONS There is no dedicated emergency OR in the majority of hospitals internationally. Elective surgical procedures are usually postponed or even cancelled to perform emergency surgery. It is a priority to validate an effective universal triaging and scheduling system to allocate emergency surgical procedures. The new Timing in Acute Care Surgery (TACS) was recently proposed and validated by a Delphi consensus as a clear and reproducible triage tool to timely perform an emergency surgical procedure according to the clinical severity of the surgical disease. The new TACS needs to be prospectively validated in clinical practice. Logistics have to be assessed using a multi-disciplinary approach to improve patients' safety, optimise the use of resources, and decrease costs.
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Affiliation(s)
- Belinda De Simone
- Department of Emergency and Trauma Surgery, Villeneuve St Georges Academic Hospital, Villeneuve St Georges, France.
| | - Vanni Agnoletti
- Department of General and Emergency surgery, Level I Trauma Center, Bufalini Hospital, Cesena, Italy
| | - Fikri M Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Walter L Biffl
- Department of Emergency and Trauma Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Ernest E Moore
- Ernest E. Moore Shock Trauma Center, University of Colorado, Denver, USA
| | - Elie Chouillard
- Unit of Metabolic and General Surgery, Clinique St Louis, Poissy, France
| | - Federico Coccolini
- Department of General and Trauma Surgery, University Hospital of Pisa, Pisa, Italy
| | - Massimo Sartelli
- Department of General Surgery, Macerata Hospital, Macerata, Italy
| | - Mauro Podda
- Department of General Surgery, University Hospital of Cagliari, Cagliari, Italy
| | - Salomone Di Saverio
- Department of General Surgery, Santa Maria del Soccorso Hospital, San Benedetto del Tronto, Ascoli Piceno, Italy
| | - Haytham Kaafarani
- Department of Emergency and Trauma Surgery, Harvard Medical School & Massachusetts General Hospital, Boston, USA
| | - Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Miklosh Bala
- Acute Care Surgery and Trauma Unit, Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem Kiriat Hadassah, Jerusalem, Israel
| | - Ari K Leppäniemi
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Andrew W Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, AB, Canada
| | - Emmanouil Pikoulis
- Medical School, National and Kapodistrian University of Athens, (NKUA), Athens, Greece
| | - Kemal Rasa
- Department of Surgery, Anadolu Medical Center, Kocaali, Turkey
| | - Chiara Rosato
- Department of Emergency and General Surgery, Level I Trauma Center, Bufalini Hospital, Cesena, Italy
| | - Robert Sawyer
- General Surgery Department, Western Michigan University, Kalamazoo, MI, USA
| | - Luca Ansaloni
- Department of General Surgery, University Hospital of Pavia, Pavia, Italy
| | - Nicola de'Angelis
- Colorectal and Digestive Surgery Unit, DIGEST Department Beaujon University Hospital (AP-HP), University Paris Cité, Paris, France
| | - Dimitris Damaskos
- Department of General Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Philip F Stahel
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, 27834, USA
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Raul Coimbra
- Riverside University Health System Medical Center and Loma Linda University School of Medicine, Loma Linda, USA
| | - Fausto Catena
- Department of General and Emergency surgery, Level I Trauma Center, Bufalini Hospital, Cesena, Italy
- eCampus University, CREAS, Ser.In.Ar. Bologna University, Bologna, Italy
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Stahel PF, Belk KW, McInnis SJ, Holland K, Nanz R, Beals J, Gosnell J, Ogundele O, Mastriani KS. The Rothman Index predicts unplanned readmissions to intensive care associated with increased mortality and hospital length of stay: a propensity-matched cohort study. Patient Saf Surg 2024; 18:10. [PMID: 38454490 PMCID: PMC10921657 DOI: 10.1186/s13037-024-00391-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/16/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Patients with unplanned readmissions to the intensive care unit (ICU) are at high risk of preventable adverse events. The Rothman Index represents an objective real-time grading system of a patient's clinical condition and a predictive tool of clinical deterioration over time. This study was designed to test the hypothesis that the Rothman Index represents a sensitive predictor of unanticipated ICU readmissions. METHODS A retrospective propensity-matched cohort study was performed at a tertiary referral academic medical center in the United States from January 1, 2022, to December 31, 2022. Inclusion criteria were adult patients admitted to an ICU and readmitted within seven days of transfer to a lower level of care. The control group consisted of patients who were downgraded from ICU without a subsequent readmission. The primary outcome measure was in-hospital mortality or discharge to hospice for end-of-life care. Secondary outcome measures were overall hospital length of stay, ICU length of stay, and 30-day readmission rates. Propensity matching was used to control for differences between the study cohorts. Regression analyses were performed to determine independent risk factors of an unplanned readmission to ICU. RESULTS A total of 5,261 ICU patients met the inclusion criteria, of which 212 patients (4%) had an unanticipated readmission to the ICU within 7 days. The study cohort and control group were stratified by propensity matching into equal group sizes of n = 181. Lower Rothman Index scores (reflecting higher physiologic acuity) at the time of downgrade from the ICU were significantly associated with an unplanned readmission to the ICU (p < 0.0001). Patients readmitted to ICU had a lower mean Rothman Index score (p < 0.0001) and significantly increased rates of mortality (19.3% vs. 2.2%, p < 0.0001) and discharge to hospice (14.4% vs. 6.1%, p = 0.0073) compared to the control group of patients without ICU readmission. The overall length of ICU stay (mean 8.0 vs. 2.2 days, p < 0.0001) and total length of hospital stay (mean 15.8 vs. 7.3 days, p < 0.0001) were significantly increased in patients readmitted to ICU, compared to the control group. CONCLUSION The Rothman Index represents a sensitive predictor of unanticipated readmissions to ICU, associated with a significantly increased mortality and overall ICU and hospital length of stay. The Rothman Index should be considered as a real-time objective measure for prediction of a safe downgrade from ICU to a lower level of care.
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Affiliation(s)
- Philip F Stahel
- Department of Surgery, East Carolina University, Brody School of Medicine, 27834, Greenville, NC, USA.
- Rocky Vista University, College of Osteopathic Medicine, 80134, Parker, CO, USA.
- Mission Health, HCA Healthcare North Carolina Division, 28803, Asheville, NC, USA.
| | - Kathy W Belk
- Spacelabs Healthcare, 98065, Snoqualmie, WA, USA
| | | | - Kathryn Holland
- Mission Health, HCA Healthcare North Carolina Division, 28803, Asheville, NC, USA
| | - Roy Nanz
- Mission Health, HCA Healthcare North Carolina Division, 28803, Asheville, NC, USA
| | - Joseph Beals
- Spacelabs Healthcare, 98065, Snoqualmie, WA, USA
| | - Jaclyn Gosnell
- Mission Health, HCA Healthcare North Carolina Division, 28803, Asheville, NC, USA
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Stahel PF, Kaufman AM. Contemporary management of open extremity fractures: What You Need to Know. J Trauma Acute Care Surg 2024:01586154-990000000-00640. [PMID: 38374531 DOI: 10.1097/ta.0000000000004288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
ABSTRACT Open extremity fractures are high-risk injuries prone to significant complications, including soft tissue loss, bone defects, infection, infected nonunion, and the necessity for limb amputation. Large-scale multicenter prospective studies from the "Lower Extremity Assessment Project" (LEAP) and the "Major Extremity Trauma Consortium" (METRC) have provided novel scientific insights pertinent to the timeliness and appropriateness of specific treatment modalities aimed at improving outcomes of patients with open extremity injuries. These include the imperative for early administration of intravenous antibiotics within three hours of injury, preferably within one hour of hospital admission. Unlike the proven value of early antibiotics, the time to initial surgical débridement does not appear to affect infection rates and patient outcomes. Recent evidence-based consensus guidelines from the American Academy of Orthopaedic Surgeons (AAOS) provide scientific guidance for preventing surgical site infections in patients with open extremity fractures and support the decision-making of limb salvage versus amputation in critical open extremity injuries. Patient survival represents the overarching priority in the management of any trauma patient with associated orthopaedic injuries. Therefore, the timing and modality of managing open fractures must take into account the patient's physiology, response to resuscitation, and overall injury burden. The present review was designed to provide a state-of-the-art overview on the recommended diagnostic workup and management strategies for patients with open extremity fractures, based on the current scientific evidence.
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Affiliation(s)
| | - Adam M Kaufman
- Mission Health, HCA Healthcare, North Carolina Division, Asheville, NC
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Dal Mas F, Cobianchi L, Piccolo D, Balch J, Biancuzzi H, Biffl WL, Campostrini S, Cicuttin E, Coccolini F, Damaskos D, Filiberto AC, Filisetti C, Fraga G, Frassini S, Fugazzola P, Hardcastle T, Kaafarani HM, Kluger Y, Massaro M, Martellucci J, Moore E, Ruta F, Sartelli M, Stahel PF, Velmahos G, Weber DG, Catena F, Loftus TJ, Ansaloni L. Are we ready for "green surgery" to promote environmental sustainability in the operating room? Results from the WSES STAR investigation. World J Emerg Surg 2024; 19:5. [PMID: 38267949 PMCID: PMC10809586 DOI: 10.1186/s13017-024-00533-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/17/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND The importance of environmental sustainability is acknowledged in all sectors, including healthcare. To meet the United Nations Sustainable Development Goals 2030 Agenda, healthcare will need a paradigm shift toward more environmentally sustainable practices that will also impact clinical decision-making. The study investigates trauma and emergency surgeons' perception, acceptance, and employment of environmentally friendly habits. METHODS An online survey based on the most recent literature regarding environmental sustainability in healthcare and surgery was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was advertised to the 917 WSES members through the society's website and Twitter/X profile. RESULTS 450 surgeons from 55 countries participated in the survey. Results underline both a generally positive attitude toward environmental sustainability but also a lack of knowledge about several concepts and practices, especially concerning the potential contribution to patient care. DISCUSSION The topic of environmental sustainability in healthcare and surgery is still in its infancy. There is a clear lack of salient guidance and knowledge, and there is a critical need for governments, institutions, health agencies, and scientific societies to promote, disseminate, and report environmentally friendly initiatives and their potential impacts while employing an interdisciplinary approach.
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Affiliation(s)
- Francesca Dal Mas
- Collegium Medicum, University of Social Sciences, Łodz, Poland
- Department of Management, Ca' Foscari University, Venice, Italy
| | - Lorenzo Cobianchi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy.
- General Surgery, Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
| | - Daniele Piccolo
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy
- Unit of Neurosurgery, Department of Head-Neck and Neuroscience, ASUFC Santa Maria Della Misericordia, Udine, Italy
| | - Jeremy Balch
- Department of Surgery, University of Florida Health, Gainesville, FL, USA
| | | | - Walter L Biffl
- Division of Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, CA, USA
| | | | - Enrico Cicuttin
- General Surgery, Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Dept, Pisa University Hospital Pisa, Pisa, Italy
| | - Dimitris Damaskos
- General and Emergency Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Amanda C Filiberto
- Department of Surgery, University of Florida Health, Gainesville, FL, USA
| | - Claudia Filisetti
- Department of Pediatric Surgery, Buzzi Children's Hospital, Milan, Italy
| | - Gustavo Fraga
- Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP, Brazil
| | - Simone Frassini
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy
- General Surgery, Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Paola Fugazzola
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy
- General Surgery, Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Timothy Hardcastle
- Department of Surgical Sciences, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, 4001, South Africa
- Trauma and Burns Services, Inkosi Albert Luthuli Central Hospital, Mayville, 4058, South Africa
| | - Haytham M Kaafarani
- Harvard Medical School, Boston, MA, USA
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Yoran Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | | | | | - Ernest Moore
- Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO, USA
| | - Federico Ruta
- General Direction, ASL BAT (Health Agency), Andria, Italy
| | | | - Philip F Stahel
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - George Velmahos
- Harvard Medical School, Boston, MA, USA
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Dieter G Weber
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Fausto Catena
- Acute Care Surgery Unit, Department of Surgery and Trauma, Maurizio Bufalini Hospital, Cesena, Italy
| | - Tyler J Loftus
- Department of Surgery, University of Florida Health, Gainesville, FL, USA
| | - Luca Ansaloni
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy
- General Surgery, Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
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5
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Picetti E, Demetriades AK, Catena F, Aarabi B, Abu-Zidan FM, Alves OL, Ansaloni L, Armonda RA, Badenes R, Bala M, Balogh ZJ, Barbanera A, Bertuccio A, Biffl WL, Bouzat P, Buki A, Castano-Leon AM, Cerasti D, Citerio G, Coccolini F, Coimbra R, Coniglio C, Costa F, De Iure F, Depreitere B, Fainardi E, Fehlings MJ, Gabrovsky N, Godoy DA, Gruen P, Gupta D, Hawryluk GWJ, Helbok R, Hossain I, Hutchinson PJ, Iaccarino C, Inaba K, Ivanov M, Kaprovoy S, Kirkpatrick AW, Klein S, Kolias A, Konovalov NA, Lagares A, Lippa L, Loza-Gomez A, Luoto TM, Maas AIR, Maciejczak A, Maier RV, Marklund N, Martin MJ, Melloni I, Mendoza-Lattes S, Meyfroidt G, Munari M, Napolitano LM, Okonkwo DO, Otomo Y, Papadopoulos MC, Petr O, Peul WC, Pudkrong AK, Qasim Z, Rasulo F, Reizinho C, Ringel F, Rizoli S, Rostami E, Rubiano AM, Russo E, Sarwal A, Schwab JM, Servadei F, Sharma D, Sharif S, Shiban E, Shutter L, Stahel PF, Taccone FS, Terpolilli NA, Thomé C, Toth P, Tsitsopoulos PP, Udy A, Vaccaro AR, Varon AJ, Vavilala MS, Younsi A, Zackova M, Zoerle T, Robba C. Early management of adult traumatic spinal cord injury in patients with polytrauma: a consensus and clinical recommendations jointly developed by the World Society of Emergency Surgery (WSES) & the European Association of Neurosurgical Societies (EANS). World J Emerg Surg 2024; 19:4. [PMID: 38238783 PMCID: PMC10795357 DOI: 10.1186/s13017-023-00525-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 11/25/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND The early management of polytrauma patients with traumatic spinal cord injury (tSCI) is a major challenge. Sparse data is available to provide optimal care in this scenario and worldwide variability in clinical practice has been documented in recent studies. METHODS A multidisciplinary consensus panel of physicians selected for their established clinical and scientific expertise in the acute management of tSCI polytrauma patients with different specializations was established. The World Society of Emergency Surgery (WSES) and the European Association of Neurosurgical Societies (EANS) endorsed the consensus, and a modified Delphi approach was adopted. RESULTS A total of 17 statements were proposed and discussed. A consensus was reached generating 17 recommendations (16 strong and 1 weak). CONCLUSIONS This consensus provides practical recommendations to support a clinician's decision making in the management of tSCI polytrauma patients.
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Affiliation(s)
- Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy.
| | - Andreas K Demetriades
- Department of Neurosurgery, Royal Infirmary Edinburgh, Edinburgh, UK
- Leiden University Neurosurgical Centre Holland, HMC-HAGA The Hague & LUMC Leiden, Leiden, The Netherlands
| | - Fausto Catena
- Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | - Bizhan Aarabi
- Department of Neurosurgery, University of Maryland, Baltimore, MD, USA
| | - Fikri M Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Oscar L Alves
- Hospital Lusíadas Porto, Centro Hospitalar de Gaia/Espinho, Porto, Portugal
| | - Luca Ansaloni
- Department of Surgery, Pavia University Hospital, Pavia, Italy
| | - Rocco A Armonda
- Department of Neurosurgery, Georgetown University School of Medicine and MedStar Washington Hospital Center, Washington, DC, USA
| | - Rafael Badenes
- Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clínic Universitari de Valencia, University of Valencia, Valencia, Spain
| | - Miklosh Bala
- Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital, Hunter Medical Research Institute and University of Newcastle, Newcastle, Australia
| | - Andrea Barbanera
- Department of Neurosurgery, SS Antonio e Biagio e Cesare Arrigo Alessandria Hospital, Alessandria, Italy
| | - Alessandro Bertuccio
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Walter L Biffl
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Pierre Bouzat
- Universite Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | - Andras Buki
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | | | - Davide Cerasti
- Neuroradiology Unit, Parma University Hospital, Parma, Italy
| | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Neuroscience, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Raul Coimbra
- Division of Trauma and Acute Care Surgery, Riverside University Health System Medical Center, Riverside, CA, USA
| | - Carlo Coniglio
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Francesco Costa
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, University of Milan, Milan, Italy
| | - Federico De Iure
- Department of Spine Surgery, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Bart Depreitere
- Department of Neurosurgery, University Hospital KU Leuven, Louvain, Belgium
| | - Enrico Fainardi
- Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Michael J Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Krembil Research Institute, Toronto Western Hospital, Toronto, ON, Canada
| | - Nikolay Gabrovsky
- Clinic of Neurosurgery, University Hospital Pirogov, Sofia, Bulgaria
| | | | - Peter Gruen
- Department of Neurological Surgery, University of Southern California, Los Angeles, CA, USA
| | - Deepak Gupta
- Department of Neurosurgery, Neurosciences Centre and JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Gregory W J Hawryluk
- Neurological Institute, Cleveland Clinic, Akron General Hospital, Fairlawn, OH, USA
| | - Raimund Helbok
- Department of Neurology, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Iftakher Hossain
- Neurocenter, Department of Neurosurgery, Turku University Hospital, Turku, Finland
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Peter J Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Corrado Iaccarino
- Neurosurgery Unit, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Kenji Inaba
- Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Marcel Ivanov
- Neurosurgery Department, Royal Hallamshire Hospital, Sheffield, UK
| | - Stanislav Kaprovoy
- Department of Spinal and Peripheral Nerve Surgery Burdenko Neurosurgical Center, Moscow, Russia
| | - Andrew W Kirkpatrick
- Departments of Surgery and Critical Care Medicine, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - Sam Klein
- Department of Neurosurgery, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium
| | - Angelos Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
- ANAPLASI Rehabilitation Centre, Athens, Greece
- 1St Neurosurgery Department, Henry Dunant Hospital Center, Athens, Greece
| | - Nikolay A Konovalov
- Department of Spinal and Peripheral Nerve Surgery Burdenko Neurosurgical Center, Moscow, Russia
| | - Alfonso Lagares
- Neurosurgery Department, University Hospital "12 de Octubre", Madrid, Spain
| | - Laura Lippa
- Department of Neurosurgery, Ospedale Niguarda, Milan, Italy
| | - Angelica Loza-Gomez
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Teemu M Luoto
- Department of Neurosurgery, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Andrew I R Maas
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Andrzej Maciejczak
- Department of Neurosurgery, St Luke Hospital, University of Rzeszow, Tarnow, Poland
| | - Ronald V Maier
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Niklas Marklund
- Department of Clinical Sciences Lund, Neurosurgery, Lund University, Lund, Sweden
- Department of Neurosurgery, Skåne University Hospital, Lund, Sweden
| | | | - Ilaria Melloni
- Division of Neurosurgery, Department of Neurosciences (DINOGMI), IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Geert Meyfroidt
- Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven and KU Leuven, Louvain, Belgium
| | - Marina Munari
- Neuro-Intensive Care Unit, University Hospital of Padova, Padua, Italy
| | - Lena M Napolitano
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - Ondra Petr
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Wilco C Peul
- Leiden University Neurosurgical Centre Holland, HMC-HAGA The Hague & LUMC Leiden, Leiden, The Netherlands
| | - Aichholz K Pudkrong
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Zaffer Qasim
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Frank Rasulo
- Department of Neuroanesthesia and Neurocritical Care, Spedali Civili University Affiliated Hospital of Brescia, Brescia, Italy
| | - Carla Reizinho
- Departamento de Neurocirurgia, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Florian Ringel
- Department of Neurosurgery, University Hospital Mainz, Mainz, Germany
| | - Sandro Rizoli
- Trauma Surgery Department, Hamad General Hospital, HMC, Doha, Qatar
| | - Elham Rostami
- Section of Neurosurgery, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Emanuele Russo
- Anesthesia and Intensive Care Unit, AUSL Romagna, M.Bufalini Hospital, Cesena, Italy
| | - Aarti Sarwal
- Department of Neurology, Atrium Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Jan M Schwab
- Belford Center for Spinal Cord Injury and Departments of Neurology and Neuroscience, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Franco Servadei
- Humanitas Research Hospital-IRCCS & Humanitas University, Rozzano, Milan, Italy
| | - Deepak Sharma
- Neuroanesthesia & Perioperative Neuroscience, University of Washington, Seattle, WA, USA
| | - Salman Sharif
- Department of Neurosurgery, Liaquat National Hospital, Karachi, Pakistan
| | - Ehab Shiban
- Department of Neurosurgery, University Hospital Augsburg, Augsburg, Germany
| | - Lori Shutter
- Department of Critical Care Medicine, Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Philip F Stahel
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Fabio S Taccone
- Department of Intensive Care, Hopital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Nicole A Terpolilli
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Claudius Thomé
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Peter Toth
- Department of Neurosurgery, Medical School, University of Pecs, Pecs, Hungary
| | - Parmenion P Tsitsopoulos
- Department of Neurosurgery, Hippokration General Hospital, Aristotle University School of Medicine, Thessaloníki, Greece
| | - Andrew Udy
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, 3004, Australia
| | - Alexander R Vaccaro
- Department of Orthopedic Surgery, Delaware Valley Spinal Cord Injury Center, Rothman Orthopedics, Sidney Kimmel Medical Center of Thomas Jefferson University, Philadelphia, PA, USA
| | - Albert J Varon
- Department of Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami Miller School of Medicine/Ryder Trauma Center, Miami, FL, USA
| | - Monica S Vavilala
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Alexander Younsi
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Monika Zackova
- Division of Intensive Care and Neurology Unit, Montecatone Rehabilitation Institute, Imola, Italy
| | - Tommaso Zoerle
- Department of Pathophysiology and Transplantation, University of Milan, Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Robba
- IRCCS Policlinico San Martino, Dipartimento di Scienze Chirurgiche Diagnostiche e Integrate, Università di Genova, Genoa, Italy
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6
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Frassini S, Cobianchi L, Fugazzola P, Biffl WL, Coccolini F, Damaskos D, Moore EE, Kluger Y, Ceresoli M, Coimbra R, Davies J, Kirkpatrick A, Di Carlo I, Hardcastle TC, Isik A, Chiarugi M, Gurusamy K, Maier RV, Segovia Lohse HA, Jeekel H, Boermeester MA, Abu-Zidan F, Inaba K, Weber DG, Augustin G, Bonavina L, Velmahos G, Sartelli M, Di Saverio S, Ten Broek RPG, Granieri S, Dal Mas F, Farè CN, Peverada J, Zanghì S, Viganò J, Tomasoni M, Dominioni T, Cicuttin E, Hecker A, Tebala GD, Galante JM, Wani I, Khokha V, Sugrue M, Scalea TM, Tan E, Malangoni MA, Pararas N, Podda M, De Simone B, Ivatury R, Cui Y, Kashuk J, Peitzman A, Kim F, Pikoulis E, Sganga G, Chiara O, Kelly MD, Marzi I, Picetti E, Agnoletti V, De'Angelis N, Campanelli G, de Moya M, Litvin A, Martínez-Pérez A, Sall I, Rizoli S, Tomadze G, Sakakushev B, Stahel PF, Civil I, Shelat V, Costa D, Chichom-Mefire A, Latifi R, Chirica M, Amico F, Pardhan A, Seenarain V, Boyapati N, Hatz B, Ackermann T, Abeyasundara S, Fenton L, Plani F, Sarvepalli R, Rouhbakhshfar O, Caleo P, Ho-Ching Yau V, Clement K, Christou E, Castillo AMG, Gosal PKS, Balasubramaniam S, Hsu J, Banphawatanarak K, Pisano M, Toro A, Michele A, Cioffi SPB, Spota A, Catena F, Ansaloni L. Correction: ECLAPTE: Effective Closure of LAParoTomy in Emergency-2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings. World J Emerg Surg 2023; 18:52. [PMID: 38012756 PMCID: PMC10683098 DOI: 10.1186/s13017-023-00522-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 11/29/2023] Open
Affiliation(s)
- Simone Frassini
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy.
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy.
| | - Lorenzo Cobianchi
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Paola Fugazzola
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Walter L Biffl
- Department of Emergency and Trauma Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Dimitrios Damaskos
- General and Emergency Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ernest E Moore
- Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO, USA
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Marco Ceresoli
- General Surgery, Monza University Hospital, Monza, Italy
| | - Raul Coimbra
- Riverside University Health System Medical Center, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Claremont, CA, USA
| | - Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Andrew Kirkpatrick
- Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Canada
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies, General Surgery Unit, Cannizzaro Hospital, Catania, Italy
| | - Timothy C Hardcastle
- Department of Surgical Sciences, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, 4001, South Africa
- Trauma and Burns Services, Inkosi Albert Luthuli Central Hospital, Mayville, 4058, South Africa
| | - Arda Isik
- Division of General Surgery, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Kurinchi Gurusamy
- Division of Surgery and Interventional Science, Hampstead Campus, University College London, London, UK
| | - Ronald V Maier
- Department of Surgery, Harborview Medical Centre, University of Washington, Seattle, USA
| | - Helmut A Segovia Lohse
- II Cátedra de Clínica Quirúrgica, Hospital de Clínicas, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Hans Jeekel
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Marja A Boermeester
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, 1105AZ, Amsterdam, The Netherlands
| | - Fikri Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
| | - Kenji Inaba
- Los Angeles County + USC Medical Center, 2051 Marengo Street, Room C5L100, Los Angeles, CA, 90033, USA
| | - Dieter G Weber
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Goran Augustin
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Luigi Bonavina
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
| | - George Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Salomone Di Saverio
- Unit of General Surgery, San Benedetto del Tronto Hospital, av5 Asur Marche, San Benedetto del Tronto, Italy
| | | | - Stefano Granieri
- General Surgery Unit, ASST Vimercate, Via Santi Cosma E Damiano, 10, 20871, Vimercate, Italy
| | - Francesca Dal Mas
- Department of Management, Università Ca' Foscari, Dorsoduro 3246, 30123, Venezia, Italy
| | - Camilla Nikita Farè
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Jacopo Peverada
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Simone Zanghì
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Jacopo Viganò
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Matteo Tomasoni
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Tommaso Dominioni
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Enrico Cicuttin
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Andreas Hecker
- Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Giovanni D Tebala
- Department of Digestive and Emergency Surgery, S. Maria Hospital Trust, Terni, Italy
| | - Joseph M Galante
- Trauma Department, University of California, Davis, Sacramento, CA, USA
| | | | - Vladimir Khokha
- Department of Emergency Surgery, City Hospital, Mozyr, Belarus
| | - Michael Sugrue
- Donegal Clinical Research Academy Emergency Surgery Outcome Project, Letterkenny University Hospital, Donegal, Ireland
| | - Thomas M Scalea
- Cowley Shock Trauma Center at the University of Maryland, Baltimore, MD, USA
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark A Malangoni
- Department of Surgery, MetroHealth Medical Center Campus, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Nikolaos Pararas
- Third Department of Surgery, Attikon University Hospital, 15772, Athens, Greece
| | - Mauro Podda
- Department of Surgical Science, Cagliari State University, Cagliari, Italy
| | - Belinda De Simone
- Department of Emergency Surgery, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Rao Ivatury
- Virginia Commonwealth University, Richmond, VA, USA
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | - Jeffry Kashuk
- Department of Surgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Andrew Peitzman
- Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Fernando Kim
- Denver Health Medical Center, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Emmanouil Pikoulis
- Medical School, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Gabriele Sganga
- Fondazione Policlinico Universitario A.Gemelli IRCCS, Università Cattolica, Rome, Italy
| | - Osvaldo Chiara
- Trauma Center and Emergency Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Michael D Kelly
- Department of General Surgery, Albury Hospital, Albury, Australia
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, Ospedale M Bufalini, Cesena, Italy
| | - Nicola De'Angelis
- Service de Chirurgie Digestive et Hépato-Bilio-Pancréatique, Hôpital Henri Mondor, Université Paris Est, Créteil, France
| | - Giampiero Campanelli
- Division of General Surgery, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Insubria, Varese, Italy
| | - Marc de Moya
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrey Litvin
- AI Medica Hospital Center / Immanuel Kant Baltic Federal University, Kaliningrad, Russia
| | - Aleix Martínez-Pérez
- Faculty of Health Sciences, Valencian International University (VIU), Valencia, Spain
| | - Ibrahima Sall
- Department of General Surgery, Military Teaching Hospital, Hôpital Principal Dakar, Dakar, Senegal
| | | | - Gia Tomadze
- Department of Surgery, Tbilisi State Medical University, Tbilisi, Georgia
| | | | - Philip F Stahel
- Department of Orthopedic Surgery and Neurosurgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO, USA
| | - Ian Civil
- Trauma Service, Auckland City Hospital, Auckland, New Zealand
| | | | - David Costa
- Department of General y Digestive Surgery, "Dr. Balmis" Alicante General University Hospital, Alicante, Spain
| | | | - Rifat Latifi
- College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Mircea Chirica
- Service de Chirurgie Digestive, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Francesco Amico
- Department of Traumatology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | | | - Vidya Seenarain
- Acute Surgical Unit, Department of General Surgery, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Nikitha Boyapati
- Acute Surgical Unit, Department of General Surgery, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Basil Hatz
- State Major Trauma Unit, Royal Perth Hospital, Wellington Street, Perth, Australia
| | - Travis Ackermann
- General Surgery, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
| | - Sandun Abeyasundara
- Department of Colorectal Surgery, Logan Hospital, Meadowbrook, QLD, Australia
| | - Linda Fenton
- Maitland Private Hospital, East Maitland, Newcastle, NSW, Australia
| | - Frank Plani
- Chris Hani Baragwanath Hospital, Soweto, South Africa
| | - Rohit Sarvepalli
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Omid Rouhbakhshfar
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Pamela Caleo
- Nambour Selangor Private Hospital, Sunshine Coast University Private Hospital, Birtinya, QLD, Australia
| | | | - Kristenne Clement
- Department of Surgery, Nepean Hospital, Penrith, NSW, 2751, Australia
| | - Erasmia Christou
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | | | - Preet K S Gosal
- Department of General Surgery, Nepean Hospital, Sydney, NSW, Australia
| | - Sunder Balasubramaniam
- Department of Trauma, Westmead Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Jeremy Hsu
- Department of Trauma, Westmead Hospital, The University of Sydney, Sydney, NSW, Australia
| | | | - Michele Pisano
- General and Emergency Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Adriana Toro
- General Surgery, Augusta Hospital, Augusta, Italy
| | - Altomare Michele
- Trauma Center and Emergency Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stefano P B Cioffi
- Trauma Center and Emergency Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Spota
- Trauma Center and Emergency Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fausto Catena
- Acute Care Surgery Unit, Department of Surgery and Trauma, Maurizio Bufalini Hospital, Cesena, Italy
| | - Luca Ansaloni
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
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7
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Stahel PF, Weckbach S, Ziran N, Smith WR, Moore EE, Pape HC, Clavien PA. Patient Safety in Surgery - announcing the journal's first impact factor (3.7). Patient Saf Surg 2023; 17:22. [PMID: 37644592 PMCID: PMC10466761 DOI: 10.1186/s13037-023-00375-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Affiliation(s)
- Philip F. Stahel
- Mission Health, 50 Schenck Pkwy, Asheville, NC 28803 USA
- Department of Surgery, Brody School of Medicine, East Carolina University, E. 5th St., Greenville, NC 27858 USA
- Department of Specialty Medicine, College of Osteopathic Medicine, Rocky Vista University, Parker, CO USA
| | | | - Navid Ziran
- Department of Orthopedics, St. Joseph’s Medical Center, Phoenix, AZ USA
| | - Wade R. Smith
- Department of Orthopedics, Swedish Medical Center, Englewood, CO USA
| | - Ernest E. Moore
- Ernest E. Moore Shock Trauma Center, Denver Health, Denver, CO USA
| | - Hans-Christoph Pape
- Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
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8
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Frassini S, Cobianchi L, Fugazzola P, Biffl WL, Coccolini F, Damaskos D, Moore EE, Kluger Y, Ceresoli M, Coimbra R, Davies J, Kirkpatrick A, Di Carlo I, Hardcastle TC, Isik A, Chiarugi M, Gurusamy K, Maier RV, Segovia Lohse HA, Jeekel H, Boermeester MA, Abu-Zidan F, Inaba K, Weber DG, Augustin G, Bonavina L, Velmahos G, Sartelli M, Di Saverio S, Ten Broek RPG, Granieri S, Dal Mas F, Farè CN, Peverada J, Zanghì S, Viganò J, Tomasoni M, Dominioni T, Cicuttin E, Hecker A, Tebala GD, Galante JM, Wani I, Khokha V, Sugrue M, Scalea TM, Tan E, Malangoni MA, Pararas N, Podda M, De Simone B, Ivatury R, Cui Y, Kashuk J, Peitzman A, Kim F, Pikoulis E, Sganga G, Chiara O, Kelly MD, Marzi I, Picetti E, Agnoletti V, De'Angelis N, Campanelli G, de Moya M, Litvin A, Martínez-Pérez A, Sall I, Rizoli S, Tomadze G, Sakakushev B, Stahel PF, Civil I, Shelat V, Costa D, Chichom-Mefire A, Latifi R, Chirica M, Amico F, Pardhan A, Seenarain V, Boyapati N, Hatz B, Ackermann T, Abeyasundara S, Fenton L, Plani F, Sarvepalli R, Rouhbakhshfar O, Caleo P, Ho-Ching Yau V, Clement K, Christou E, Castillo AMG, Gosal PKS, Balasubramaniam S, Hsu J, Banphawatanarak K, Pisano M, Adriana T, Michele A, Cioffi SPB, Spota A, Catena F, Ansaloni L. ECLAPTE: Effective Closure of LAParoTomy in Emergency-2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings. World J Emerg Surg 2023; 18:42. [PMID: 37496068 PMCID: PMC10373269 DOI: 10.1186/s13017-023-00511-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/18/2023] [Indexed: 07/28/2023] Open
Abstract
Laparotomy incisions provide easy and rapid access to the peritoneal cavity in case of emergency surgery. Incisional hernia (IH) is a late manifestation of the failure of abdominal wall closure and represents frequent complication of any abdominal incision: IHs can cause pain and discomfort to the patients but also clinical serious sequelae like bowel obstruction, incarceration, strangulation, and necessity of reoperation. Previous guidelines and indications in the literature consider elective settings and evidence about laparotomy closure in emergency settings is lacking. This paper aims to present the World Society of Emergency Surgery (WSES) project called ECLAPTE (Effective Closure of LAParoTomy in Emergency): the final manuscript includes guidelines on the closure of emergency laparotomy.
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Affiliation(s)
- Simone Frassini
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy.
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy.
| | - Lorenzo Cobianchi
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Paola Fugazzola
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Walter L Biffl
- Department of Emergency and Trauma Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Dimitrios Damaskos
- General and Emergency Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ernest E Moore
- Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO, USA
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Marco Ceresoli
- General Surgery, Monza University Hospital, Monza, Italy
| | - Raul Coimbra
- Riverside University Health System Medical Center, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Claremont, CA, USA
| | - Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Andrew Kirkpatrick
- Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Canada
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies, General Surgery Unit, Cannizzaro Hospital, Catania, Italy
| | - Timothy C Hardcastle
- Department of Surgical Sciences, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, 4001, South Africa
- Trauma and Burns Services, Inkosi Albert Luthuli Central Hospital, Mayville, 4058, South Africa
| | - Arda Isik
- Division of General Surgery, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Kurinchi Gurusamy
- Division of Surgery and Interventional Science, Hampstead Campus, University College London, London, UK
| | - Ronald V Maier
- Department of Surgery, Harborview Medical Centre, University of Washington, Seattle, USA
| | - Helmut A Segovia Lohse
- II Cátedra de Clínica Quirúrgica, Hospital de Clínicas, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Hans Jeekel
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Marja A Boermeester
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, 1105AZ, Amsterdam, The Netherlands
| | - Fikri Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
| | - Kenji Inaba
- Los Angeles County + USC Medical Center, 2051 Marengo Street, Room C5L100, Los Angeles, CA, 90033, USA
| | - Dieter G Weber
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Goran Augustin
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Luigi Bonavina
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
| | - George Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Salomone Di Saverio
- Unit of General Surgery, San Benedetto del Tronto Hospital, av5 Asur Marche, San Benedetto del Tronto, Italy
| | | | - Stefano Granieri
- General Surgery Unit, ASST Vimercate, Via Santi Cosma E Damiano, 10, 20871, Vimercate, Italy
| | - Francesca Dal Mas
- Department of Management, Università Ca' Foscari, Dorsoduro 3246, 30123, Venezia, Italy
| | - Camilla Nikita Farè
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Jacopo Peverada
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Simone Zanghì
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Jacopo Viganò
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Matteo Tomasoni
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Tommaso Dominioni
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Enrico Cicuttin
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Andreas Hecker
- Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Giovanni D Tebala
- Department of Digestive and Emergency Surgery, S. Maria Hospital Trust, Terni, Italy
| | - Joseph M Galante
- Trauma Department, University of California, Davis, Sacramento, CA, USA
| | | | - Vladimir Khokha
- Department of Emergency Surgery, City Hospital, Mozyr, Belarus
| | - Michael Sugrue
- Donegal Clinical Research Academy Emergency Surgery Outcome Project, Letterkenny University Hospital, Donegal, Ireland
| | - Thomas M Scalea
- Cowley Shock Trauma Center at the University of Maryland, Baltimore, MD, USA
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark A Malangoni
- Department of Surgery, MetroHealth Medical Center Campus, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Nikolaos Pararas
- Third Department of Surgery, Attikon University Hospital, 15772, Athens, Greece
| | - Mauro Podda
- Department of Surgical Science, Cagliari State University, Cagliari, Italy
| | - Belinda De Simone
- Department of Emergency Surgery, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Rao Ivatury
- Virginia Commonwealth University, Richmond, VA, USA
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | - Jeffry Kashuk
- Department of Surgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Andrew Peitzman
- Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Fernando Kim
- Denver Health Medical Center, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Emmanouil Pikoulis
- Medical School, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Gabriele Sganga
- Fondazione Policlinico Universitario A.Gemelli IRCCS, Università Cattolica, Rome, Italy
| | - Osvaldo Chiara
- Trauma Center and Emergency Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Michael D Kelly
- Department of General Surgery, Albury Hospital, Albury, Australia
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, Ospedale M Bufalini, Cesena, Italy
| | - Nicola De'Angelis
- Service de Chirurgie Digestive et Hépato-Bilio-Pancréatique, Hôpital Henri Mondor, Université Paris Est, Créteil, France
| | - Giampiero Campanelli
- Division of General Surgery, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Insubria, Varese, Italy
| | - Marc de Moya
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrey Litvin
- AI Medica Hospital Center / Immanuel Kant Baltic Federal University, Kaliningrad, Russia
| | - Aleix Martínez-Pérez
- Faculty of Health Sciences, Valencian International University (VIU), Valencia, Spain
| | - Ibrahima Sall
- Department of General Surgery, Military Teaching Hospital, Hôpital Principal Dakar, Dakar, Senegal
| | | | - Gia Tomadze
- Department of Surgery, Tbilisi State Medical University, Tbilisi, Georgia
| | | | - Philip F Stahel
- Department of Orthopedic Surgery and Neurosurgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO, USA
| | - Ian Civil
- Trauma Service, Auckland City Hospital, Auckland, New Zealand
| | | | - David Costa
- Department of General y Digestive Surgery, "Dr. Balmis" Alicante General University Hospital, Alicante, Spain
| | | | - Rifat Latifi
- College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Mircea Chirica
- Service de Chirurgie Digestive, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Francesco Amico
- Department of Traumatology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | | | - Vidya Seenarain
- Acute Surgical Unit, Department of General Surgery, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Nikitha Boyapati
- Acute Surgical Unit, Department of General Surgery, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Basil Hatz
- State Major Trauma Unit, Royal Perth Hospital, Wellington Street, Perth, Australia
| | - Travis Ackermann
- General Surgery, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
| | - Sandun Abeyasundara
- Department of Colorectal Surgery, Logan Hospital, Meadowbrook, QLD, Australia
| | - Linda Fenton
- Maitland Private Hospital, East Maitland, Newcastle, NSW, Australia
| | - Frank Plani
- Chris Hani Baragwanath Hospital, Soweto, South Africa
| | - Rohit Sarvepalli
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Omid Rouhbakhshfar
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Pamela Caleo
- Nambour Selangor Private Hospital, Sunshine Coast University Private Hospital, Birtinya, QLD, Australia
| | | | - Kristenne Clement
- Department of Surgery, Nepean Hospital, Penrith, NSW, 2751, Australia
| | - Erasmia Christou
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | | | - Preet K S Gosal
- Department of General Surgery, Nepean Hospital, Sydney, NSW, Australia
| | - Sunder Balasubramaniam
- Department of Trauma, Westmead Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Jeremy Hsu
- Department of Trauma, Westmead Hospital, The University of Sydney, Sydney, NSW, Australia
| | | | - Michele Pisano
- General and Emergency Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Toro Adriana
- General Surgery, Augusta Hospital, Augusta, Italy
| | - Altomare Michele
- Trauma Center and Emergency Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stefano P B Cioffi
- Trauma Center and Emergency Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Spota
- Trauma Center and Emergency Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fausto Catena
- Acute Care Surgery Unit, Department of Surgery and Trauma, Maurizio Bufalini Hospital, Cesena, Italy
| | - Luca Ansaloni
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
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9
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Tian BWCA, Stahel PF, Picetti E, Campanelli G, Di Saverio S, Moore E, Bensard D, Sakakushev B, Galante J, Fraga GP, Koike K, Di Carlo I, Tebala GD, Leppaniemi A, Tan E, Damaskos D, De'Angelis N, Hecker A, Pisano M, Maier RV, De Simone B, Amico F, Ceresoli M, Pikoulis M, Weber DG, Biffl W, Beka SG, Abu-Zidan FM, Valentino M, Coccolini F, Kluger Y, Sartelli M, Agnoletti V, Chirica M, Bravi F, Sall I, Catena F. Assessing and managing frailty in emergency laparotomy: a WSES position paper. World J Emerg Surg 2023; 18:38. [PMID: 37355698 DOI: 10.1186/s13017-023-00506-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/27/2023] [Indexed: 06/26/2023] Open
Abstract
Many countries are facing an aging population. As people live longer, surgeons face the prospect of operating on increasingly older patients. Traditional teaching is that with older age, these patients face an increased risk of mortality and morbidity, even to a level deemed too prohibitive for surgery. However, this is not always true. An active 90-year-old patient can be much fitter than an overweight, sedentary 65-year-old patient with comorbidities. Recent literature shows that frailty-an age-related cumulative decline in multiple physiological systems, is therefore a better predictor of mortality and morbidity than chronological age alone. Despite recognition of frailty as an important tool in identifying vulnerable surgical patients, many surgeons still shun objective tools. The aim of this position paper was to perform a review of the existing literature and to provide recommendations on emergency laparotomy and in frail patients. This position paper was reviewed by an international expert panel composed of 37 experts who were asked to critically revise the manuscript and position statements. The position paper was conducted according to the WSES methodology. We shall present the derived statements upon which a consensus was reached, specifying the quality of the supporting evidence and suggesting future research directions.
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Affiliation(s)
- Brian W C A Tian
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Philip F Stahel
- Department of Orthopedic Surgery and Department of Neurosurgery, Denver Health Medical Center and University of Colorado School of Medicine, Denver, CO, USA
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Parma, Parma, Italy
| | | | - Salomone Di Saverio
- Unit of General Surgery, San Benedetto del Tronto Hospital, av5 Asur Marche, San Benedetto del Tronto, Italy
| | - Ernest Moore
- Department of Surgery, Denver Health Medical Center, Denver, CO, USA
| | - Denis Bensard
- Department of Surgery, Denver Health Medical Center, Denver, CO, USA
| | - Boris Sakakushev
- Research Institute of Medical University Plovdiv/University Hospital St George Plovdiv, Plovdiv, Bulgaria
| | - Joseph Galante
- Trauma Department, University of California, Davis, Sacramento, CA, USA
| | - Gustavo P Fraga
- Faculdade de Ciências Médicas (FCM), Unicamp Campinas, Campinas, SP, Brazil
| | - Kaoru Koike
- Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Cannizzaro Hospital, Via Messina 829, 95126, Catania, Italy
| | - Giovanni D Tebala
- Oxford University Hospitals NHSFT John Radcliffe Hospital, Headley Way, HeadingtonOxford, OX3 9DU, UK
| | - Ari Leppaniemi
- General Surgery Department, Helsinki University Hospital, Helsinki, Finland
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Dimitris Damaskos
- General and Emergency Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Nicola De'Angelis
- Hôpital Henri Mondor, Université Paris Est, Service de Chirurgie Digestive et Hépato-Bilio-Pancréatique, Créteil, France
| | - Andreas Hecker
- Department of General and Thoracic Surgery, University Hospital, Giessen, Germany
| | - Michele Pisano
- General and Emergency Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Ron V Maier
- Department of Surgery, Harborview Medical Centre, University of Washington, Seattle, USA
| | - Belinda De Simone
- Department of Emergency Surgery, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Francesco Amico
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Marco Ceresoli
- General Surgery, Monza University Hospital, Monza, Italy
| | - Manos Pikoulis
- 3Rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Dieter G Weber
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Walt Biffl
- Department of Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, San Diego, CA, USA
| | - Solomon Gurmu Beka
- School of Medicine and Health Science, University of Otago, Wellington Campus, Wellington, New Zealand
| | - Fikri M Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
| | | | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | | | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy
| | - Mircea Chirica
- Service de Chirurgie Digestive, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Francesca Bravi
- Healthcare Administration, Santa Maria Delle Croci Hospital, Ravenna, Italy
| | - Ibrahima Sall
- Department of General Surgery, Military Teaching Hospital, Hôpital Principal Dakar, Dakar, Senegal.
| | - Fausto Catena
- Department of Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
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10
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De Simone B, Kluger Y, Moore EE, Sartelli M, Abu-Zidan FM, Coccolini F, Ansaloni L, Tebala GD, Di Saverio S, Di Carlo I, Sakakushev BE, Bonavina L, Sugrue M, Galante JM, Ivatury R, Picetti E, Chirica M, Wani I, Bala M, Sall I, Kirkpatrick AW, Shelat VG, Pikoulis E, Leppäniemi A, Tan E, Broek RPGT, Gurmu Beka S, Litvin A, Chouillard E, Coimbra R, Cui Y, De' Angelis N, Sganga G, Stahel PF, Agnoletti V, Rampini A, Testini M, Bravi F, Maier RV, Biffl WL, Catena F. The new timing in acute care surgery (new TACS) classification: a WSES Delphi consensus study. World J Emerg Surg 2023; 18:32. [PMID: 37118816 PMCID: PMC10147354 DOI: 10.1186/s13017-023-00499-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/13/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Timely access to the operating room for emergency general surgery (EGS) indications remains a challenge across the globe, largely driven by operating room availability and staffing constraints. The "timing in acute care surgery" (TACS) classification was previously published to introduce a new tool to triage the timely and appropriate access of EGS patients to the operating room. However, the clinical and operational effectiveness of the TACS classification has not been investigated in subsequent validation studies. This study aimed to improve the TACS classification and provide further consensus around the appropriate use of the new TACS classification through a standardized Delphi approach with international experts. METHODS This is a validation study of the new TACS by a selected international panel of experts using the Delphi method. The TACS questionnaire was designed as a web-based survey. The consensus agreement level was established to be ≥ 75%. The collective consensus agreement was defined as the sum of the percentage of the highest Likert scale levels (4-5) out of all participants. Surgical emergency diseases and correlated clinical scenarios were defined for each of the proposed classes. Subsequent rounds were carried out until a definitive level of consensus was reached. Frequencies and percentages were calculated to determine the degree of agreement for each surgical disease. RESULTS Four polling rounds were carried out. The new TACS classification provides 6 colour-code classes correlated to a precise timing to surgery, defined scenarios and surgical condition. The WHITE colour-code class was introduced to rapidly (within a week) reschedule cancelled or postponed surgical procedures. Haemodynamic stability is the main tool to stratify patients for immediate surgery or not in the presence of sepsis/septic shock. Fifty-one surgical diseases were included in the different colour-code classes of priority. CONCLUSION The new TACS classification is a comprehensive, simple, clear and reproducible triage system which can be used to assess the severity of the patient and the surgical disease, to reduce the time to access to the operating room, and to manage the emergency surgical patients within a "safe" timeframe. By including well-defined surgical diseases in the different colour-code classes of priority, validated through a Delphi consensus, the new TACS improves communication among surgeons, between surgeons and anaesthesiologists and decreases conflicts and waste and waiting time in accessing the operating room for emergency surgical patients.
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Affiliation(s)
- Belinda De Simone
- Department of General and Emergency Surgery, Guastalla Hospital, AUSL Reggio Emilia, Guastalla, Italy.
- Unit of General and Metabolic Surgery, Clinique de St Louis, Poissy, France.
| | - Yoram Kluger
- Department of General Surgery, The Rambam Academic Hospital, Haifa, Israel
| | - Ernest E Moore
- Ernest E. Moore Shock Trauma Center, University of Colorado, Denver, USA
| | - Massimo Sartelli
- Department of General Surgery, Macerata Hospital, Macerata, Italy
| | - Fikri M Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Federico Coccolini
- Department of General and Trauma Surgery, University Hospital of Pisa, Pisa, Italy
| | - Luca Ansaloni
- Department of General Surgery, University Hospital of Pavia, Pavia, Italy
| | - Giovanni D Tebala
- U.O.C. Chirurgia Digestiva e d'Urgenza, Azienda Ospedaliera S.Maria, Terni, Italy
| | - Salomone Di Saverio
- Department of General Surgery, Santa Maria del Soccorso Hospital, San Benedetto del Tronto, Ascoli Piceno, Italy
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies, University of Catania, Cannizzaro Hospital, Catania, Italy
| | - Boris E Sakakushev
- Research Institute at Medical University Plovdiv/University Hospital St George, Plovdiv, Bulgaria
| | - Luigi Bonavina
- Division of General and Foregut Surgery, University of Milan, IRCCS Policlinico San Donato, Milan, Italy
| | - Michael Sugrue
- Donegal Clinical Research Academy, Letterkenny University Hospital, Letterkenny, Ireland
| | - Joseph M Galante
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Rao Ivatury
- Virginia Commonwealth University, Richmond, VA, USA
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Mircea Chirica
- Department of Digestive Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
| | | | - Miklosh Bala
- Acute Care Surgery and Trauma Unit, Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem Kiriat Hadassah, Jerusalem, Israel
| | - Ibrahima Sall
- General Surgery Department, Military Teaching Hospital, Dakar, Senegal
| | - Andrew W Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, AB, Canada
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Novena, Singapore
| | - Emmanouil Pikoulis
- Medical School, National and Kapodistrian University of Athens, (NKUA), Athens, Greece
| | - Ari Leppäniemi
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Solomon Gurmu Beka
- Department of General and Trauma Surgery, Ethiopian Air Force Hospital, Bishoftu, Ethiopia.
| | - Andrey Litvin
- Department of Surgical Disciplines, Regional Clinical Hospital, Immanuel Kant Baltic Federal University, Kaliningrad, Russia
| | - Elie Chouillard
- Unit of General and Metabolic Surgery, Clinique de St Louis, Poissy, France
| | - Raul Coimbra
- CECORC Research Center, Riverside University Health System, Loma Linda University, Loma Linda, USA
| | - Yunfeng Cui
- Department of Surgery, Nankai Clinical School of Medicine, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin, China
| | - Nicola De' Angelis
- Colorectal and Digestive Surgery Unit - DIGEST Department, Beaujon University Hospital (AP-HP), Clichy, France
| | - Gabriele Sganga
- Department of Emergency Surgery, "A. Gemelli Hospital", Catholic University of Rome, Rome, Italy
| | - Philip F Stahel
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, USA
| | | | - Alessia Rampini
- Department of General and Emergency Surgery, Level I Trauma Center, Bufalini Hospital, Cesena, Italy
| | - Mario Testini
- Department of Surgery, University Hospital of Bari, Bari, Italy
| | - Francesca Bravi
- Healthcare Administration, Santa Maria Delle Croci Hospital, AUSL Romagna, Ravenna, Italy
| | - Ronald V Maier
- Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Walter L Biffl
- Department of Emergency and Trauma Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Fausto Catena
- Department of General Surgery, Level I Trauma Center, Bufalini Hospital, Cesena, eCampus University, CREAS, Ser.In.Ar. Bologna University, Cesena, Italy
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11
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Delgado AC, Cornett B, Choi YJ, Colosimo C, Stahel VP, Dziadkowiec O, Stahel PF. Investigational medications in 9,638 hospitalized patients with severe COVID-19: lessons from the "fail-and-learn" strategy during the first two waves of the pandemic in 2020. Patient Saf Surg 2023; 17:7. [PMID: 37041643 PMCID: PMC10088131 DOI: 10.1186/s13037-023-00358-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/23/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND The early surge of the novel coronavirus disease 2019 (COVID-19) pandemic introduced a significant clinical challenge due to the high case-fatality rate in absence of evidence-based recommendations. The empirical treatment modalities were relegated to historical expertise from the traditional management of acute respiratory distress syndrome (ARDS) in conjunction with off-label pharmaceutical agents endorsed under the "emergency use authorization" (EUA) paradigm by regulatory agencies. This study was designed to evaluate the insights from the "fail-and-learn" strategy in 2020 before the availability of COVID-19 vaccines and access to reliable insights from high-quality randomized controlled trials. METHODS A retrospective, multicenter, propensity-matched, case-control study was performed on a data registry comprising 186 hospitals from a national health care system in the United States, designed to investigate the efficacy of empirical treatment modalities during the early surge of the COVID-19 pandemic in 2020. Reflective of the time-windows of the initial two surges of the pandemic in 2020, patients were stratified into "Early 2020" (March 1-June 30) versus "Late 2020" (July 1-December 31) study cohorts. Logistic regression was applied to determine the efficacy of prevalent medications (remdesivir, azithromycin, hydroxychloroquine, corticosteroids, tocilizumab) and supplemental oxygen delivery modalities (invasive vs. non-invasive ventilation) on patient outcomes. The primary outcome measure was in-hospital mortality. Group comparisons were adjusted for covariates related to age, gender, ethnicity, body weight, comorbidities, and treatment modalities pertinent to organ failure replacement. RESULTS From a total of 87,788 patients in the multicenter data registry screened in this study, 9,638 patients were included who received 19,763 COVID-19 medications during the first two waves of the 2020 pandemic. The results showed a minimal, yet statistically significant, association with hydroxychloroquine in "Early 2020" and remdesivir in "Late 2020" with reduced odds of mortality (odds ratios 0.72 and 0.76, respectively; P = 0.01). Azithromycin was the only medication associated with decreased odds of mortality during both study time-windows (odds ratios 0.79 and 0.68, respectively; P < 0.01). In contrast, the necessity for oxygen supply showed significantly increased odds of mortality beyond the effect of all investigated medications. Of all the covariates associated with increased mortality, invasive mechanical ventilation had the highest odds ratios of 8.34 in the first surge and 9.46 in in the second surge of the pandemic (P < 0.01). CONCLUSION This retrospective multicenter observational cohort study on 9,638 hospitalized patients with severe COVID-19 during revealed that the necessity for invasive ventilation had the highest odds of mortality, beyond the variable effects observed by administration of the prevalent EUA-approved investigational drugs during the first two surges of the early 2020 pandemic in the United States.
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Affiliation(s)
- Adam C Delgado
- Department of Surgery, Sky Ridge Medical Center, Lone Tree, CO, 80124, USA
| | - Brendon Cornett
- Graduate Medical Education, HCA Healthcare Continental Division, Denver, CO, 80237, USA
| | - Ye Ji Choi
- Graduate Medical Education, HCA Healthcare Continental Division, Denver, CO, 80237, USA
| | - Christina Colosimo
- Department of Surgery, Sky Ridge Medical Center, Lone Tree, CO, 80124, USA
| | | | - Oliwier Dziadkowiec
- Graduate Medical Education, HCA Healthcare Continental Division, Denver, CO, 80237, USA
| | - Philip F Stahel
- Mission Health, HCA Healthcare North Carolina Division, Asheville, NC, 28803, USA.
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, 27858, USA.
- Department of Specialty Medicine, College of Osteopathic Medicine, Rocky Vista University, Parker, CO, 80134, USA.
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12
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Picetti E, Catena F, Abu-Zidan F, Ansaloni L, Armonda RA, Bala M, Balogh ZJ, Bertuccio A, Biffl WL, Bouzat P, Buki A, Cerasti D, Chesnut RM, Citerio G, Coccolini F, Coimbra R, Coniglio C, Fainardi E, Gupta D, Gurney JM, Hawryluk GWJ, Helbok R, Hutchinson PJA, Iaccarino C, Kolias A, Maier RW, Martin MJ, Meyfroidt G, Okonkwo DO, Rasulo F, Rizoli S, Rubiano A, Sahuquillo J, Sams VG, Servadei F, Sharma D, Shutter L, Stahel PF, Taccone FS, Udy A, Zoerle T, Agnoletti V, Bravi F, De Simone B, Kluger Y, Martino C, Moore EE, Sartelli M, Weber D, Robba C. Correction: Early management of isolated severe traumatic brain injury patients in a hospital without neurosurgical capabilities: a consensus and clinical recommendations of the World Society of Emergency Surgery (WSES). World J Emerg Surg 2023; 18:29. [PMID: 37024937 PMCID: PMC10080738 DOI: 10.1186/s13017-023-00489-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 04/08/2023] Open
Affiliation(s)
- Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy.
| | - Fausto Catena
- Department of General and Emergency Surgery, Bufalini Hospital, Cesena, Italy
| | - Fikri Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Luca Ansaloni
- Unit of General Surgery, San Matteo Hospital Pavia, University of Pavia, Pavia, Italy
| | - Rocco A Armonda
- Department of Neurosurgery, 71541MedStar Georgetown University Hospital, Washington, DC, USA
- Department of Neurosurgery, 8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Miklosh Bala
- Acute Care Surgery and Trauma Unit, Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem Kiriat Hadassah, Jerusalem, Israel
| | - Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital, Hunter Medical Research Institute and University of Newcastle, Newcastle, NSW, Australia
| | - Alessandro Bertuccio
- Department of Neurosurgery, SS Antonio E Biagio E Cesare Arrigo Alessandria Hospital, Alessandria, Italy
| | | | - Pierre Bouzat
- Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Andras Buki
- Department of Neurosurgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Davide Cerasti
- Neuroradiology Unit, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Randall M Chesnut
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Neuroscience Department, NeuroIntensive Care Unit, Hospital San Gerardo, ASST Monza, Monza, Italy
| | - Federico Coccolini
- Department of Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Raul Coimbra
- Riverside University Health System Medical Center, Loma Linda University School of Medicine, Riverside, CA, USA
| | - Carlo Coniglio
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Enrico Fainardi
- Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Deepak Gupta
- Department of Neurosurgery, Neurosciences Centre and JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Jennifer M Gurney
- Department of Trauma, San Antonio Military Medical Center and the U.S. Army Institute of Surgical Research, San Antonio, TX, 78234, USA
- The Department of Defense Center of Excellence for Trauma, Joint Trauma System (JTS), JBSA Fort Sam Houston, San Antonio, TX, 78234, USA
| | | | - Raimund Helbok
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter J A Hutchinson
- Department of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Corrado Iaccarino
- Neurosurgery Unit, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Angelos Kolias
- National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital,, University of Cambridge, Cambridge, UK
| | - Ronald W Maier
- Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Matthew J Martin
- Division of Trauma and Acute Care Surgery, Los Angeles County + USC Medical Center, Los Angeles, CA, USA
| | - Geert Meyfroidt
- Department of Intensive Care, University Hospitals Leuven, Louvain, Belgium
- Laboratory of Intensive Care Medicine, Katholieke Universiteit Leuven, Louvain, Belgium
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Frank Rasulo
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
| | - Sandro Rizoli
- Surgery Department, Section of Trauma Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Andres Rubiano
- INUB-MEDITECH Research Group, Institute of Neurosciences, Universidad El Bosque, Bogotá, Colombia
| | - Juan Sahuquillo
- Department of Neurosurgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Valerie G Sams
- Trauma Critical Care and Acute Care Surgery, Air Force Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Franco Servadei
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Deepak Sharma
- Department of Anesthesiology and Pain Medicine and Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Lori Shutter
- Department of Critical Care Medicine, UPMC/University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Philip F Stahel
- College of Osteopathic Medicine, Rocky Vista University, Parker, CO, USA
| | - Fabio S Taccone
- Department of Intensive Care, Hôpital Universitaire de Bruxelles, Brussels, Belgium
| | - Andrew Udy
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, 3004, Australia
| | - Tommaso Zoerle
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy
| | - Francesca Bravi
- Healthcare Administration, Santa Maria Delle Croci Hospital, Ravenna, Italy
| | - Belinda De Simone
- Department of General, Digestive and Metabolic Minimally Invasive Surgery, Centre Hospitalier Intercommunal De Poissy/St Germain en Laye, Poissy, France
| | - Yoram Kluger
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Costanza Martino
- Department of Anesthesiology and Acute Care, Umberto I Hospital of Lugo, Ausl Della Romagna, Lugo, Italy
| | - Ernest E Moore
- Ernest E Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA
| | | | - Dieter Weber
- Department of General Surgery, Royal Perth Hospital, The University of Western Australia, Perth, Australia
| | - Chiara Robba
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
- Department of Surgical Sciences and Integrated Sciences, University of Genoa, Genoa, Italy
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13
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Stahel PF, Weckbach S, Huber-Lang MS, Stahel VP, Barnum SR. Editorial: The impact of COVID-19 on immune system-related complications in surgical patients. Front Surg 2023; 10:1132752. [PMID: 36793320 PMCID: PMC9923122 DOI: 10.3389/fsurg.2023.1132752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 01/06/2023] [Indexed: 01/31/2023] Open
Affiliation(s)
- Philip F. Stahel
- Department of Surgery, East Carolina University, Brody School of Medicine, Greenville, NC, United States,Department of Specialty Medicine, Rocky Vista University, College of Osteopathic Medicine, Parker, CO, United States,Correspondence: Philip F. Stahel
| | | | - Markus S. Huber-Lang
- Institute for Clinical and Experimental Trauma-Immunology, University Hospital Ulm, Ulm, Germany
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14
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Picetti E, Catena F, Abu-Zidan F, Ansaloni L, Armonda RA, Bala M, Balogh ZJ, Bertuccio A, Biffl WL, Bouzat P, Buki A, Cerasti D, Chesnut RM, Citerio G, Coccolini F, Coimbra R, Coniglio C, Fainardi E, Gupta D, Gurney JM, Hawrylux GWJ, Helbok R, Hutchinson PJA, Iaccarino C, Kolias A, Maier RW, Martin MJ, Meyfroidt G, Okonkwo DO, Rasulo F, Rizoli S, Rubiano A, Sahuquillo J, Sams VG, Servadei F, Sharma D, Shutter L, Stahel PF, Taccone FS, Udy A, Zoerle T, Agnoletti V, Bravi F, De Simone B, Kluger Y, Martino C, Moore EE, Sartelli M, Weber D, Robba C. Early management of isolated severe traumatic brain injury patients in a hospital without neurosurgical capabilities: a consensus and clinical recommendations of the World Society of Emergency Surgery (WSES). World J Emerg Surg 2023; 18:5. [PMID: 36624517 PMCID: PMC9830860 DOI: 10.1186/s13017-022-00468-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 12/01/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Severe traumatic brain-injured (TBI) patients should be primarily admitted to a hub trauma center (hospital with neurosurgical capabilities) to allow immediate delivery of appropriate care in a specialized environment. Sometimes, severe TBI patients are admitted to a spoke hospital (hospital without neurosurgical capabilities), and scarce data are available regarding the optimal management of severe isolated TBI patients who do not have immediate access to neurosurgical care. METHODS A multidisciplinary consensus panel composed of 41 physicians selected for their established clinical and scientific expertise in the acute management of TBI patients with different specializations (anesthesia/intensive care, neurocritical care, acute care surgery, neurosurgery and neuroradiology) was established. The consensus was endorsed by the World Society of Emergency Surgery, and a modified Delphi approach was adopted. RESULTS A total of 28 statements were proposed and discussed. Consensus was reached on 22 strong recommendations and 3 weak recommendations. In three cases, where consensus was not reached, no recommendation was provided. CONCLUSIONS This consensus provides practical recommendations to support clinician's decision making in the management of isolated severe TBI patients in centers without neurosurgical capabilities and during transfer to a hub center.
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Affiliation(s)
- Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy.
| | - Fausto Catena
- grid.414682.d0000 0004 1758 8744Department of General and Emergency Surgery, Bufalini Hospital, Cesena, Italy
| | - Fikri Abu-Zidan
- grid.43519.3a0000 0001 2193 6666The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Luca Ansaloni
- grid.8982.b0000 0004 1762 5736Unit of General Surgery, San Matteo Hospital Pavia, University of Pavia, Pavia, Italy
| | - Rocco A. Armonda
- grid.411663.70000 0000 8937 0972Department of Neurosurgery, 71541MedStar Georgetown University Hospital, Washington, DC USA ,grid.415235.40000 0000 8585 5745Department of Neurosurgery, 8405MedStar Washington Hospital Center, Washington, DC USA
| | - Miklosh Bala
- grid.9619.70000 0004 1937 0538Acute Care Surgery and Trauma Unit, Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem Kiriat Hadassah, Jerusalem, Israel
| | - Zsolt J. Balogh
- grid.413648.cDepartment of Traumatology, John Hunter Hospital, Hunter Medical Research Institute and University of Newcastle, Newcastle, NSW Australia
| | - Alessandro Bertuccio
- Department of Neurosurgery, SS Antonio E Biagio E Cesare Arrigo Alessandria Hospital, Alessandria, Italy
| | - Walt L. Biffl
- grid.415401.5Scripps Clinic Medical Group, La Jolla, CA USA
| | - Pierre Bouzat
- grid.450308.a0000 0004 0369 268XInserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Andras Buki
- grid.15895.300000 0001 0738 8966Department of Neurosurgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Davide Cerasti
- grid.411482.aNeuroradiology Unit, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Randall M. Chesnut
- grid.34477.330000000122986657Department of Neurological Surgery, University of Washington, Seattle, WA USA ,grid.34477.330000000122986657Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA USA ,grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, WA USA
| | - Giuseppe Citerio
- grid.7563.70000 0001 2174 1754School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy ,grid.415025.70000 0004 1756 8604Neuroscience Department, NeuroIntensive Care Unit, Hospital San Gerardo, ASST Monza, Monza, Italy
| | - Federico Coccolini
- grid.144189.10000 0004 1756 8209Department of Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Raul Coimbra
- grid.43582.380000 0000 9852 649XRiverside University Health System Medical Center, Loma Linda University School of Medicine, Riverside, CA USA
| | - Carlo Coniglio
- grid.416290.80000 0004 1759 7093Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Enrico Fainardi
- grid.8404.80000 0004 1757 2304Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Deepak Gupta
- grid.413618.90000 0004 1767 6103Department of Neurosurgery, Neurosciences Centre and JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Jennifer M. Gurney
- grid.420328.f0000 0001 2110 0308Department of Trauma, San Antonio Military Medical Center and the U.S. Army Institute of Surgical Research, San Antonio, TX 78234 USA ,grid.461685.80000 0004 0467 8038The Department of Defense Center of Excellence for Trauma, Joint Trauma System (JTS), JBSA Fort Sam Houston, San Antonio, TX 78234 USA
| | - Gregory W. J. Hawrylux
- grid.239578.20000 0001 0675 4725Cleveland Clinic, 762 S. Cleveland-Massillon Rd, Akron, OH 44333 USA
| | - Raimund Helbok
- grid.5361.10000 0000 8853 2677Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter J. A. Hutchinson
- grid.5335.00000000121885934Department of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Corrado Iaccarino
- grid.413363.00000 0004 1769 5275Neurosurgery Unit, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Angelos Kolias
- grid.5335.00000000121885934National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK ,grid.5335.00000000121885934Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital,, University of Cambridge, Cambridge, UK
| | - Ronald W. Maier
- grid.34477.330000000122986657Harborview Medical Center, University of Washington, Seattle, WA USA
| | - Matthew J. Martin
- grid.42505.360000 0001 2156 6853Division of Trauma and Acute Care Surgery, Los Angeles County + USC Medical Center, Los Angeles, CA USA
| | - Geert Meyfroidt
- grid.410569.f0000 0004 0626 3338Department of Intensive Care, University Hospitals Leuven, Louvain, Belgium ,grid.5596.f0000 0001 0668 7884Laboratory of Intensive Care Medicine, Katholieke Universiteit Leuven, Louvain, Belgium
| | - David O. Okonkwo
- grid.412689.00000 0001 0650 7433Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Frank Rasulo
- grid.412725.7Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
| | - Sandro Rizoli
- grid.413542.50000 0004 0637 437XSurgery Department, Section of Trauma Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Andres Rubiano
- grid.412195.a0000 0004 1761 4447INUB-MEDITECH Research Group, Institute of Neurosciences, Universidad El Bosque, Bogotá, Colombia
| | - Juan Sahuquillo
- grid.7080.f0000 0001 2296 0625Department of Neurosurgery, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Valerie G. Sams
- grid.413561.40000 0000 9881 9161Trauma Critical Care and Acute Care Surgery, Air Force Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati Medical Center, Cincinnati, OH USA
| | - Franco Servadei
- grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy ,grid.417728.f0000 0004 1756 8807Department of Neurosurgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Deepak Sharma
- grid.34477.330000000122986657Department of Anesthesiology and Pain Medicine and Neurological Surgery, University of Washington, Seattle, WA USA
| | - Lori Shutter
- grid.21925.3d0000 0004 1936 9000Department of Critical Care Medicine, UPMC/University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Philip F. Stahel
- grid.461417.10000 0004 0445 646XCollege of Osteopathic Medicine, Rocky Vista University, Parker, CO USA
| | - Fabio S. Taccone
- grid.410566.00000 0004 0626 3303Department of Intensive Care, Hôpital Universitaire de Bruxelles, Brussels, Belgium
| | - Andrew Udy
- grid.1623.60000 0004 0432 511XDepartment of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC 3004 Australia
| | - Tommaso Zoerle
- grid.4708.b0000 0004 1757 2822Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy ,grid.414818.00000 0004 1757 8749Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Vanni Agnoletti
- grid.414682.d0000 0004 1758 8744Anesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy
| | - Francesca Bravi
- grid.415207.50000 0004 1760 3756Healthcare Administration, Santa Maria Delle Croci Hospital, Ravenna, Italy
| | - Belinda De Simone
- grid.418056.e0000 0004 1765 2558Department of General, Digestive and Metabolic Minimally Invasive Surgery, Centre Hospitalier Intercommunal De Poissy/St Germain en Laye, Poissy, France
| | - Yoram Kluger
- grid.413731.30000 0000 9950 8111Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Costanza Martino
- Department of Anesthesiology and Acute Care, Umberto I Hospital of Lugo, Ausl Della Romagna, Lugo, Italy
| | - Ernest E. Moore
- grid.241116.10000000107903411Ernest E Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO USA
| | | | - Dieter Weber
- grid.1012.20000 0004 1936 7910Department of General Surgery, Royal Perth Hospital, The University of Western Australia, Perth, Australia
| | - Chiara Robba
- grid.410345.70000 0004 1756 7871Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy ,grid.5606.50000 0001 2151 3065Department of Surgical Sciences and Integrated Sciences, University of Genoa, Genoa, Italy
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15
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Bala M, Catena F, Kashuk J, De Simone B, Gomes CA, Weber D, Sartelli M, Coccolini F, Kluger Y, Abu-Zidan FM, Picetti E, Ansaloni L, Augustin G, Biffl WL, Ceresoli M, Chiara O, Chiarugi M, Coimbra R, Cui Y, Damaskos D, Di Saverio S, Galante JM, Khokha V, Kirkpatrick AW, Inaba K, Leppäniemi A, Litvin A, Peitzman AB, Shelat VG, Sugrue M, Tolonen M, Rizoli S, Sall I, Beka SG, Di Carlo I, Ten Broek R, Mircea C, Tebala G, Pisano M, van Goor H, Maier RV, Jeekel H, Civil I, Hecker A, Tan E, Soreide K, Lee MJ, Wani I, Bonavina L, Malangoni MA, Koike K, Velmahos GC, Fraga GP, Fette A, de'Angelis N, Balogh ZJ, Scalea TM, Sganga G, Kelly MD, Khan J, Stahel PF, Moore EE. Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery. World J Emerg Surg 2022; 17:54. [PMID: 36261857 PMCID: PMC9580452 DOI: 10.1186/s13017-022-00443-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 06/17/2022] [Indexed: 02/08/2023] Open
Abstract
Acute mesenteric ischemia (AMI) is a group of diseases characterized by an interruption of the blood supply to varying portions of the intestine, leading to ischemia and secondary inflammatory changes. If untreated, this process may progress to life-threatening intestinal necrosis. The incidence is low, estimated at 0.09-0.2% of all acute surgical admissions, but increases with age. Although the entity is an uncommon cause of abdominal pain, diligence is required because if untreated, mortality remains in the range of 50%. Early diagnosis and timely surgical intervention are the cornerstones of modern treatment to reduce the high mortality associated with this entity. The advent of endovascular approaches in parallel with modern imaging techniques is evolving and provides new treatment options. Lastly, a focused multidisciplinary approach based on early diagnosis and individualized treatment is essential. Thus, we believe that updated guidelines from World Society of Emergency Surgery are warranted, in order to provide the most recent and practical recommendations for diagnosis and treatment of AMI.
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Affiliation(s)
- Miklosh Bala
- Director of Acute Care Surgery and Trauma Unit, Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem Kiriat Hadassah, POB 12000, 91120, Jerusalem, Israel.
| | - Fausto Catena
- General and Emergency Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Jeffry Kashuk
- Tel Aviv Sackler School of Medicine, Tel Aviv, Israel
| | - Belinda De Simone
- Department of General, Digestive and Metabolic Minimally Invasive Surgery, Centre Hospitalier Intercommunal De Poissy/St Germain en Laye, Poissy, France
| | - Carlos Augusto Gomes
- Department of Surgery, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Hospital Universitário Terezinha de Jesus, Juiz de Fora, Brazil
| | - Dieter Weber
- Department of General Surgery, Royal Perth Hospital, The University of Western Australia, Perth, Australia
| | | | - Federico Coccolini
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Yoram Kluger
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Parma, Parma, Italy
| | - Luca Ansaloni
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Goran Augustin
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Walter L Biffl
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Marco Ceresoli
- Emergency and General Surgery Department, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Osvaldo Chiara
- Emergency Department, Niguarda Ca'Granda Hospital, Milan, Italy
| | - Massimo Chiarugi
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Raul Coimbra
- CECORC Research Center, Riverside University Health System, Loma Linda University, Loma Linda, USA
| | - Yunfeng Cui
- Department of Surgery, Nankai Clinical School of Medicine, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin, China
| | | | - Salomone Di Saverio
- General Surgery Department Hospital of San Benedetto del Tronto, Marche region, Italy
| | - Joseph M Galante
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Vladimir Khokha
- Department of Emergency Surgery, City Hospital, Mozyr, Belarus
| | - Andrew W Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, AB, Canada
| | - Kenji Inaba
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Ari Leppäniemi
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Andrey Litvin
- Department of Surgical Disciplines, Regional Clinical Hospital, Immanuel Kant Baltic Federal University, Kaliningrad, Russia
| | - Andrew B Peitzman
- Department of Surgery, University of Pittsburgh School of Medicine, UPMC-Presbyterian, Pittsburgh, USA
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Novena, Singapore
| | - Michael Sugrue
- Donegal Clinical Research Academy Emergency Surgery Outcome Project, Letterkenny University Hospital, Donegal, Ireland
| | - Matti Tolonen
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sandro Rizoli
- Surgery Department, Section of Trauma Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Ibrahima Sall
- General Surgery Department, Military Teaching Hospital, Dakar, Senegal
| | | | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Richard Ten Broek
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Chirika Mircea
- Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Giovanni Tebala
- Department of Digestive and Emergency Surgery, S.Maria Hospital Trust, Terni, Italy
| | - Michele Pisano
- General and Emergency Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ronald V Maier
- Harborview Medical Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Hans Jeekel
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Ian Civil
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Andreas Hecker
- Emergency Medicine Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kjetil Soreide
- HPB Unit, Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Matthew J Lee
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | | - Luigi Bonavina
- Department of Surgery, IRCCS Policlinico San Donato, University of Milano, Milano, Italy
| | - Mark A Malangoni
- Case Western Reserve University School of Medicine, Cleveland, USA
| | | | - George C Velmahos
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, PA, USA
| | - Gustavo P Fraga
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, Brazil
| | - Andreas Fette
- Pediatric Surgery, Children's Care Center, SRH Klinikum Suhl, Suhl, Thueringen, Germany
| | - Nicola de'Angelis
- Unit of Digestive and HPB Surgery, Faculty of Medicine, University of Paris, Paris, France
| | - Zsolt J Balogh
- John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Thomas M Scalea
- Cowley Shock Trauma Center at the University of Maryland, Baltimore, MD, USA
| | - Gabriele Sganga
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michael D Kelly
- Department of General Surgery, Albury Hospital, Albury, Australia
| | - Jim Khan
- University of Portsmouth, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Philip F Stahel
- College of Osteopathic Medicine, Rocky Vista University, Parker, CO, USA
| | - Ernest E Moore
- Ernest E Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA
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16
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Picetti E, Iaccarino C, Coimbra R, Abu-Zidan F, Tebala GD, Balogh ZJ, Biffl WL, Coccolini F, Gupta D, Maier RV, Marzi I, Robba C, Sartelli M, Servadei F, Stahel PF, Taccone FS, Unterberg AW, Antonini MV, Galante JM, Ansaloni L, Kirkpatrick AW, Rizoli S, Leppaniemi A, Chiara O, De Simone B, Chirica M, Shelat VG, Fraga GP, Ceresoli M, Cattani L, Minardi F, Tan E, Wani I, Petranca M, Domenichelli F, Cui Y, Malchiodi L, Sani E, Litvin A, Hecker A, Montanaro V, Beka SG, Di Saverio S, Rossi S, Catena F. The acute phase management of spinal cord injury affecting polytrauma patients: the ASAP study. World J Emerg Surg 2022; 17:20. [PMID: 35468806 PMCID: PMC9036814 DOI: 10.1186/s13017-022-00422-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/28/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Few data on the management of acute phase of traumatic spinal cord injury (tSCI) in patients suffering polytrauma are available. As the therapeutic choices in the first hours may have a deep impact on outcome of tSCI patients, we conducted an international survey investigating this topic. METHODS The survey was composed of 29 items. The main endpoints of the survey were to examine: (1) the hemodynamic and respiratory management, (2) the coagulation management, (3) the timing of magnetic resonance imaging (MRI) and spinal surgery, (4) the use of corticosteroid therapy, (5) the role of intraspinal pressure (ISP)/spinal cord perfusion pressure (SCPP) monitoring and (6) the utilization of therapeutic hypothermia. RESULTS There were 171 respondents from 139 centers worldwide. A target mean arterial pressure (MAP) target of 80-90 mmHg was chosen in almost half of the cases [n = 84 (49.1%)]. A temporary reduction in the target MAP, for the time strictly necessary to achieve bleeding control in polytrauma, was accepted by most respondents [n = 100 (58.5%)]. Sixty-one respondents (35.7%) considered acceptable a hemoglobin (Hb) level of 7 g/dl in tSCI polytraumatized patients. An arterial partial pressure of oxygen (PaO2) of 80-100 mmHg [n = 94 (55%)] and an arterial partial pressure of carbon dioxide (PaCO2) of 35-40 mmHg [n = 130 (76%)] were chosen in most cases. A little more than half of respondents considered safe a platelet (PLT) count > 100.000/mm3 [n = 99 (57.9%)] and prothrombin time (PT)/activated partial thromboplastin time (aPTT) < 1.5 times the normal control [n = 85 (49.7%)] in patients needing spinal surgery. MRI [n = 160 (93.6%)] and spinal surgery [n = 158 (92.4%)] should be performed after intracranial, hemodynamic, and respiratory stabilization by most respondents. Corticosteroids [n = 103 (60.2%)], ISP/SCPP monitoring [n = 148 (86.5%)], and therapeutic hypothermia [n = 137 (80%)] were not utilized by most respondents. CONCLUSIONS Our survey has shown a great worldwide variability in clinical practices for acute phase management of tSCI patients with polytrauma. These findings can be helpful to define future research in order to optimize the care of patients suffering tSCI.
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Affiliation(s)
- Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Via Gramsci 14, 43100, Parma, Italy.
| | - Corrado Iaccarino
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Reggio Emilia, Italy
| | - Raul Coimbra
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center, Moreno Valley, CA, USA
- Department of Surgery, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Fikri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Giovanni D Tebala
- Department of General Surgery, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, UK
| | - Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital, Newcastle, NSW, Australia
- Discipline of Surgery, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Walter L Biffl
- Department of Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA
| | | | - Deepak Gupta
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ronald V Maier
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University Frankfurt Am Main, Frankfurt am Main, Germany
| | - Chiara Robba
- Department of Anaesthesia and Intensive Care, Policlinico San Martino, IRCCS for Oncology and Neuroscience, Genova, Italy
- Dipartimento Di Scienze Chirurgiche Diagnostiche Integrate, University of Genova, Genova, Italy
| | - Massimo Sartelli
- Department of General Surgery, Macerata Hospital, Macerata, Italy
| | - Franco Servadei
- Humanitas University, Pieve Emanuele, Milan, Italy
- Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Philip F Stahel
- College of Osteopathic Medicine, Rocky Vista University, Parker, CO, USA
- The Medical Center of Aurora, Aurora, CO, USA
| | - Fabio S Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Marta Velia Antonini
- ECMO Team, Bufalini Hospital, Cesena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Reggio Emilia, Italy
| | - Joseph M Galante
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Luca Ansaloni
- Department of General Surgery, University Hospital of Pavia, Pavia, Italy
| | - Andrew W Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, AB, Canada
| | - Sandro Rizoli
- Surgery Department, Section of Trauma Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Ari Leppaniemi
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Osvaldo Chiara
- General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Milan, Italy
| | - Belinda De Simone
- Department of General and Metabolic Surgery, Poissy and Saint-Germain-en-Laye Hospitals, Poissy, France
| | - Mircea Chirica
- Department of Digestive Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Gustavo P Fraga
- Surgery Department, Faculdade de Ciências Médicas (FCM), Unicamp Campinas, Campinas, SP, Brazil
| | - Marco Ceresoli
- General Surgery Department, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
| | - Luca Cattani
- Department of Anesthesia and Intensive Care, Parma University Hospital, Via Gramsci 14, 43100, Parma, Italy
| | - Francesco Minardi
- Department of Anesthesia and Intensive Care, Parma University Hospital, Via Gramsci 14, 43100, Parma, Italy
| | - Edward Tan
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Imtiaz Wani
- Department of Minimal Access and General Surgery, Government Gousia Hospital, Srinagar, Kashmir, India
| | - Massimo Petranca
- Department of Anesthesia and Intensive Care, Parma University Hospital, Via Gramsci 14, 43100, Parma, Italy
| | - Francesco Domenichelli
- Department of Anesthesia and Intensive Care, Parma University Hospital, Via Gramsci 14, 43100, Parma, Italy
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | - Laura Malchiodi
- Department of Anesthesia and Intensive Care, Parma University Hospital, Via Gramsci 14, 43100, Parma, Italy
| | - Emanuele Sani
- Department of Anesthesia and Intensive Care, Parma University Hospital, Via Gramsci 14, 43100, Parma, Italy
| | - Andrey Litvin
- Department of Surgical Disciplines, Immanuel Kant Baltic Federal University, Regional Clinical Hospital, Kaliningrad, Russia
| | - Andreas Hecker
- Department of General and Thoracic Surgery, University Hospital Giessen, Giessen, Germany
| | - Vito Montanaro
- Department of Anesthesia and Intensive Care, Parma University Hospital, Via Gramsci 14, 43100, Parma, Italy
| | | | - Salomone Di Saverio
- Department of General Surgery, Ospedale Civile "Madonna del Soccorso", San Benedetto del Tronto, AP, Italy
| | - Sandra Rossi
- Department of Anesthesia and Intensive Care, Parma University Hospital, Via Gramsci 14, 43100, Parma, Italy
| | - Fausto Catena
- Department of General and Emergency Surgery, "M. Bufalini" Hospital, Cesena, Italy
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17
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Stahel PF, Cobianchi L, Dal Mas F, Paterson-Brown S, Sakakushev BE, Nguyen C, Fraga GP, Yule S, Damaskos D, Healey AJ, Biffl W, Ansaloni L, Catena F. The role of teamwork and non-technical skills for improving emergency surgical outcomes: an international perspective. Patient Saf Surg 2022; 16:8. [PMID: 35135584 PMCID: PMC8822725 DOI: 10.1186/s13037-022-00317-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/22/2022] [Indexed: 11/10/2022] Open
Abstract
The assurance of patient safety in emergency general surgery remains challenging due to the patients’ high-risk underlying conditions and the wide variability in emergency surgical care provided around the globe. The authors of this article convened as an expert panel on patient safety in surgery at the 8th International Conference of the World Society of Emergency Surgery (WSES) in Edinburgh, Scotland, on September 7–10, 2021. This review article represents the proceedings from the expert panel discussions at the WSES congress and was designed to provide an international perspective on optimizing teamwork and non-technical skills in emergency general surgery.
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18
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Chaudhry YP, Papadelis E, Hayes H, Stahel PF, Hasenboehler EA. Fusion versus fixation in complex comminuted C3-type tibial pilon fractures: a systematic review. Patient Saf Surg 2021; 15:35. [PMID: 34663412 PMCID: PMC8524981 DOI: 10.1186/s13037-021-00298-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Comminuted intra-articular tibial pilon fractures can be challenging to manage, with high revision rates and poor functional outcomes. This study reviewed [1] treatment, complications, and clinical outcomes in studies of complex comminuted tibial pilon fractures (type AO43-C3); and [2] primary ankle arthrodesis as a management option for these types of complex injuries. METHODS A systematic literature search was performed on PubMed from 1990 to 2020 to determine complications and outcomes after staged fracture fixation and primary ankle joint arthrodesis for comminuted C3-type tibial pilon fractures. The search was conducted in compliance with the PRISMA guidelines, using the following MeSH terms: "tibial pilon"/"pilon fracture"/"plafond fracture"/"distal tibial"/"43-C3"/"ankle fracture"/"ankle fusion"/"primary ankle arthrodesis"/"pilon fracture staged"/"pilon external fixation" and "pilon open reduction internal fixation." Inclusion criteria were restricted to original articles in English language on adult patients ≥18 years of age. Eligibility criteria for retrieved publications were determined using a "PICO" approach (population, intervention/exposure, comparison, outcomes). Weighted analysis was used to compare treatment groups on time to definitive treatment, follow-up time, range of motion, fracture classification, and complications. RESULTS The systematic literature review using the defined MeSH terms yielded 72 original articles. Of these, 13 articles met the eligibility criteria based on the PICO statements, of which 8 publications investigated the outcomes of a staged fixation approach in 308 cumulative patients, and 5 articles focused on primary ankle arthrodesis in 69 cumulative patients. For staged treatment, the mean wound complication rate was 14.6%, and the malunion/nonunion rate was 9.9%. For primary arthrodesis, the mean wound complication rate was 2.9%, and the malunion/nonunion rate was 2.9%. After risk stratification for fracture type and severity, the small cumulative cohort of patients included in the primary arthrodesis publications did not provide sufficient power to determine a clinically relevant difference in complications and long-term patient outcomes compared to the staged surgical fixation group. CONCLUSIONS At present, there is insufficient evidence in the published literature to provide guidance towards consideration of ankle arthrodesis for complex comminuted C3-type tibial pilon fractures, compared to the standard treatment by staged surgical fracture fixation.
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Affiliation(s)
- Yash P. Chaudhry
- Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA 19131 USA
| | - Efstratios Papadelis
- Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA 19131 USA
| | - Hunter Hayes
- Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA 19131 USA
| | - Philip F. Stahel
- Department of Specialty Medicine, Rocky Vista University, College of Osteopathic Medicine, Parker, CO 80134 USA
| | - Erik A. Hasenboehler
- Department of Orthopaedic Surgery, The Johns Hopkins University, Johns Hopkins Bayview Medical Center, 4940 Eastern Ave. #A667, Baltimore, MD 21224 USA
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19
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Colosimo C, Bhuller S, Cornett B, Dziadkowiec O, Yon JR, Weaver J, Stahel PF. Perioperative mortality in SARS-CoV-2-positive surgical patients during the first wave of the novel coronavirus pandemic. Br J Surg 2021; 108:e201-e202. [PMID: 33769457 PMCID: PMC8083642 DOI: 10.1093/bjs/znab058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/26/2021] [Indexed: 11/13/2022]
Affiliation(s)
- C Colosimo
- Department of Surgery, Sky Ridge Medical Center, Lone Tree, Colorado, USA
| | - S Bhuller
- Department of Surgery, Sky Ridge Medical Center, Lone Tree, Colorado, USA
| | - B Cornett
- Graduate Medical Education, HCA Healthcare Continental Division, Denver, Colorado, USA
| | - O Dziadkowiec
- Graduate Medical Education, HCA Healthcare Continental Division, Denver, Colorado, USA
| | - J R Yon
- Division of Acute Care Surgery, New Hanover Regional Medical Center, Wilmington, North Carolina, USA
| | - J Weaver
- Department of Surgery, Sky Ridge Medical Center, Lone Tree, Colorado, USA
| | - P F Stahel
- Department of Specialty Medicine, Rocky Vista University, College of Osteopathic Medicine, Parker, Colorado, USA
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20
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Affiliation(s)
- Philip F Stahel
- Department of Specialty Medicine, College of Osteopathic Medicine, Rocky Vista University, 8401 S. Chambers Rd., Parker, CO 80134 USA
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21
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Stahel PF, Barnum SR. Complement Inhibition in Coronavirus Disease (COVID)-19: A Neglected Therapeutic Option. Front Immunol 2020; 11:1661. [PMID: 32733489 PMCID: PMC7358522 DOI: 10.3389/fimmu.2020.01661] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/22/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Philip F Stahel
- Department of Specialty Medicine, College of Osteopathic Medicine, Rocky Vista University, Parker, CO, United States
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22
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Hill E, Crockett C, Circh RW, Lansville F, Stahel PF. Introducing the "Corona Curtain": an innovative technique to prevent airborne COVID-19 exposure during emergent intubations. Patient Saf Surg 2020; 14:22. [PMID: 32431756 PMCID: PMC7220616 DOI: 10.1186/s13037-020-00247-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/05/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic places healthcare workers at risk of exposure to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Emergency department (ED) staff are particularly vulnerable when managing patients with acute respiratory distress due to the aerosolization of the virus during endotracheal intubation. A simple and innovative intubation tent was designed with the intent of decreasing the risk of accidental viral transmission from emergent intubations during the COVID-19 pandemic. PRESENTATION OF TECHNIQUE The materials and assembly process of the novel "Corona Curtain" are described in technical detail, with the intent of allowing other providers to template the concept at their respective facilities. RESULTS A total of 36 intubation tents were mounted in the ED at the Medical Center of Aurora, Colorado, on April 7, 2020, and thereafter consistently used for all intubations during the ongoing COVID-19 outbreak. The cost of raw materials and labor for the initial assembly averaged US $ 8.00 per construct. The price of the single-use plastic cover is variable depending on the vendor source. CONCLUSION The new "Corona Curtain" was designed to improve the safety of ED staff when performing urgent/emergent intubations during the current COVID-19 pandemic. The concept can easily be adopted to other patient care areas, including perioperative and intensive care units. Future validation studies are needed to determine the safety and efficacy of the intubation tents by quantifying the pre-/post-intubation exposure through "point-of-care" SARS-CoV-2 testing once these resources are more widely available.
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Affiliation(s)
- Eric Hill
- The Medical Center of Aurora, 1501 South Potomac St, Aurora, CO 80012 USA
| | - Christopher Crockett
- Covenant Health, Methodist Medical Center of Oak Ridge, 990 Oak Ridge Turnpike, Oak Ridge, TN 37831 USA
| | - Ryan W. Circh
- The Medical Center of Aurora, 1501 South Potomac St, Aurora, CO 80012 USA
| | - Frank Lansville
- The Medical Center of Aurora, 1501 South Potomac St, Aurora, CO 80012 USA
| | - Philip F. Stahel
- The Medical Center of Aurora, 1501 South Potomac St, Aurora, CO 80012 USA
- Department of Specialty Medicine, Rocky Vista University, College of Osteopathic Medicine, Parker, CO 80134 USA
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23
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Firstenberg MS, Stahel PF, Hanna J, Kotaru C, Crossno J, Forrester J. Successful COVID-19 rescue therapy by extra-corporeal membrane oxygenation (ECMO) for respiratory failure: a case report. Patient Saf Surg 2020; 14:20. [PMID: 32395179 PMCID: PMC7206578 DOI: 10.1186/s13037-020-00245-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/28/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The value of extracorporeal membrane oxygenation (ECMO) for patients suffering from novel coronavirus disease 2019 (COVID-19) as a rescue therapy for respiratory failure remains controversial and associated with high mortality rates of 50 to 82% in early reports from Wuhan, China. We hypothesized that patient outcomes would be improved at our tertiary cardiothoracic surgery referral center with a protocolized team-approach for ECMO treatment of patients with severe COVID-19 disease. CASE PRESENTATION A 51-year-old healthy female developed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) bilateral pneumonia while vacationing in Colorado with her family. She was transferred to our facility for a higher level of care. Her respiratory status continued to deteriorate despite maximized critical care, including prone positioning ventilation and nitric oxide inhalation therapy. Veno-venous ECMO was initiated on hospital day 7 in conjunction with a 10-day course of compassionate use antiviral treatment with remdesivir. The patient's condition improved significantly and she was decannulated from ECMO on hospital day 17 (ECMO day 11). She was successfully extubated and eventually discharged to rehabilitation on hospital day 28. CONCLUSION This case report demonstrates a positive outcome in a young patient with COVID-19 treated by the judicious application of ECMO in conjunction with compassionate use antiviral treatment (remdesivir). Future prospective multi-center studies are needed to validate these findings in a larger cohort of patients.
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Affiliation(s)
- Michael S. Firstenberg
- The Medical Center of Aurora, 1501 South Potomac St, Aurora, CO 80012 USA
- Cardiothoracic and Vascular Surgery, The Medical Center of Aurora, 1444 S. Potomac Street, Suite 200, Aurora, CO 80012 USA
| | - Philip F. Stahel
- The Medical Center of Aurora, 1501 South Potomac St, Aurora, CO 80012 USA
- Department of Specialty Medicine, College of Osteopathic Medicine, Rocky Vista University, Parker, CO 80134 USA
| | - Jennifer Hanna
- The Medical Center of Aurora, 1501 South Potomac St, Aurora, CO 80012 USA
| | - Chakradhar Kotaru
- The Medical Center of Aurora, 1501 South Potomac St, Aurora, CO 80012 USA
| | - Joseph Crossno
- The Medical Center of Aurora, 1501 South Potomac St, Aurora, CO 80012 USA
| | - Joseph Forrester
- The Medical Center of Aurora, 1501 South Potomac St, Aurora, CO 80012 USA
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24
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Affiliation(s)
- Philip F Stahel
- Department of Specialty Medicine, Rocky Vista University, College of Osteopathic Medicine, Parker, CO 80134 USA
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25
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Picetti E, Rossi S, Abu-Zidan FM, Ansaloni L, Armonda R, Baiocchi GL, Bala M, Balogh ZJ, Berardino M, Biffl WL, Bouzat P, Buki A, Ceresoli M, Chesnut RM, Chiara O, Citerio G, Coccolini F, Coimbra R, Di Saverio S, Fraga GP, Gupta D, Helbok R, Hutchinson PJ, Kirkpatrick AW, Kinoshita T, Kluger Y, Leppaniemi A, Maas AIR, Maier RV, Minardi F, Moore EE, Myburgh JA, Okonkwo DO, Otomo Y, Rizoli S, Rubiano AM, Sahuquillo J, Sartelli M, Scalea TM, Servadei F, Stahel PF, Stocchetti N, Taccone FS, Tonetti T, Velmahos G, Weber D, Catena F. WSES consensus conference guidelines: monitoring and management of severe adult traumatic brain injury patients with polytrauma in the first 24 hours. World J Emerg Surg 2019; 14:53. [PMID: 31798673 PMCID: PMC6884766 DOI: 10.1186/s13017-019-0270-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/04/2019] [Indexed: 12/11/2022] Open
Abstract
The acute phase management of patients with severe traumatic brain injury (TBI) and polytrauma represents a major challenge. Guidelines for the care of these complex patients are lacking, and worldwide variability in clinical practice has been documented in recent studies. Consequently, the World Society of Emergency Surgery (WSES) decided to organize an international consensus conference regarding the monitoring and management of severe adult TBI polytrauma patients during the first 24 hours after injury. A modified Delphi approach was adopted, with an agreement cut-off of 70%. Forty experts in this field (emergency surgeons, neurosurgeons, and intensivists) participated in the online consensus process. Sixteen recommendations were generated, with the aim of promoting rational care in this difficult setting.
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Affiliation(s)
- Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Via Gramsci 14, 43100 Parma, Italy
| | - Sandra Rossi
- Department of Anesthesia and Intensive Care, Parma University Hospital, Via Gramsci 14, 43100 Parma, Italy
| | - Fikri M. Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Luca Ansaloni
- Department of General and Emergency Surgery, Bufalini Hospital, Cesena, Italy
| | - Rocco Armonda
- Department of Neurosurgery, Georgetown University School of Medicine, Washington, DC USA
| | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Miklosh Bala
- Trauma and Acute Care Surgery Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Zsolt J. Balogh
- Department of Traumatology, John Hunter Hospital, University of Newcastle, Newcastle, NSW Australia
| | | | - Walter L. Biffl
- Division of Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA USA
| | - Pierre Bouzat
- Department of Anaesthesiology and Critical Care, Grenoble Alps Trauma Center, University Hospital of Grenoble-Alpes, Grenoble Cedex, France
| | - Andras Buki
- Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary
- János Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Marco Ceresoli
- Department of General and Emergency Surgery, ASST, San Gerardo Hospital, Monza, Italy
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Randall M. Chesnut
- Department of Neurological Surgery, University of Washington, Harborview Medical Center, Seattle, WA USA
| | - Osvaldo Chiara
- General Surgery and Trauma Team, University of Milano, ASST Niguarda Milano, Milan, Italy
| | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
- Neuro-Intensive Care, Department of Emergency and Intensive Care, ASST, San Gerardo Hospital, Monza, Italy
| | - Federico Coccolini
- Department of General and Emergency Surgery, Bufalini Hospital, Cesena, Italy
| | - Raul Coimbra
- Riverside University Health System Medical Center, Loma Linda University School of Medicine, Moreno Valley, CA USA
| | - Salomone Di Saverio
- Colorectal Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Gustavo P. Fraga
- Division of Trauma Surgery, Hospital de Clinicas, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Deepak Gupta
- Department of Neurosurgery, All India Institute of Medical Sciences and associated Jai Prakash Narain Apex Trauma Centre, New Delhi, India
| | - Raimund Helbok
- Department of Neurology, Neurocritical Care Unit, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter J. Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Andrew W. Kirkpatrick
- Departments of General Acute Care, Abdominal Wall Reconstruction and Trauma Surgery, Foothills Medical Centre, Calgary, AB Canada
| | - Takahiro Kinoshita
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Yoram Kluger
- Department of General Surgery, Rambam Health Campus, Haifa, Israel
| | - Ari Leppaniemi
- Abdominal Center, Helsinki University Hospital Meilahti, Helsinki, Finland
| | - Andrew I. R. Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Ronald V. Maier
- Department of Surgery, Harborview Medical Centre, University of Washington School of Medicine, Seattle, WA USA
| | - Francesco Minardi
- Department of Anesthesia and Intensive Care, Parma University Hospital, Via Gramsci 14, 43100 Parma, Italy
| | | | - John A. Myburgh
- Department of Intensive Care Medicine, St. George Clinical School, University of New South Wales and The George Institute for Global Health, Sydney, Australia
| | - David O. Okonkwo
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sandro Rizoli
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Andres M. Rubiano
- INUB/MEDITECH Research Group, El Bosque University, Bogotá, Colombia
- MEDITECH Foundation, Clinical Research, Cali, Colombia
| | - Juan Sahuquillo
- Neurosurgery Department, Vall d’Hebron University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | - Thomas M. Scalea
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD USA
| | - Franco Servadei
- Department of Neurosurgery, Humanitas University and Research Hospital, Milan, Italy
| | - Philip F. Stahel
- College of Osteopathic Medicine, Rocky Vista University, Parker, CO USA
| | - Nino Stocchetti
- Neuro ICU Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Physiopathology and Transplantation, Milan University, Milan, Italy
| | - Fabio S. Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Tommaso Tonetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Via Gramsci 14, 43100 Parma, Italy
| | - George Velmahos
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - Dieter Weber
- Trauma and General Surgery, Royal Perth Hospital, Perth, Australia
| | - Fausto Catena
- Department of Emergency Surgery, Parma University Hospital, Parma, Italy
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26
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Stahel PF, Wang P, Hutfless S, McCarty E, Mehler PS, Osgood GM, Makary MA. Surgeon Practice Patterns of Arthroscopic Partial Meniscectomy for Degenerative Disease in the United States: A Measure of Low-Value Care. JAMA Surg 2019; 153:494-496. [PMID: 29490362 DOI: 10.1001/jamasurg.2017.6235] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Philip F Stahel
- Department of Orthopaedics, Rocky Vista University, College of Osteopathic Medicine, Parker, Colorado.,Department of Orthopaedics, University of Colorado School of Medicine, Aurora
| | - Peiqi Wang
- Gastrointestinal Epidemiology Research Center, Division of Gastroenterology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Susan Hutfless
- Gastrointestinal Epidemiology Research Center, Division of Gastroenterology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eric McCarty
- Department of Orthopaedics, University of Colorado School of Medicine, Aurora
| | - Philip S Mehler
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Greg Michael Osgood
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Martin A Makary
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Amin RM, Loeb AE, Hasenboehler EA, Levin AS, Osgood GM, Sterling RS, Stahel PF, Shafiq B. Reducing routine laboratory tests in patients with isolated extremity fractures: a prospective safety and feasibility study in 246 patients. Patient Saf Surg 2019; 13:22. [PMID: 31249624 PMCID: PMC6570870 DOI: 10.1186/s13037-019-0203-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/04/2019] [Indexed: 11/10/2022] Open
Abstract
Background Daily routine laboratory testing is unnecessary in most admitted patients. The opportunity to reduce daily laboratory testing in orthopaedic trauma patients has not been previously investigated. Methods A prospective observational study was performed based on a new laboratory testing reduction protocol for 12 months at two tertiary care trauma centers. Admitted patients with surgically treated isolated upper or lower extremity fractures were included (n = 246). The testing protocol consisted of a complete blood count (CBC) and basic metabolic panel (BMP) on postoperative day 2. Thereafter, tests were obtained at individual providers' discretion. Patients were followed for 30 days postoperatively. The primary outcome was number of laboratory tests reduced. Secondary outcomes included provider protocol compliance, and adverse patient outcomes. Chi-squared tests were used to compare differences in categorical variables among the cohorts. Analysis of variance tests were used for continuous variables. The relative reductions in testing utilization were calculated using our division's standard-of-care before program implementation (1 CBC and 1 BMP per patient per inpatient day). Significance was defined as P < 0.05. Results Of the 246 patients, there were 45 protocol fall outs due to provider deviation (n = 24) or medically justified necessity for additional testing (n = 21). Across all groups, a total of 778 CBC or BMP tests were avoided, amounting to a 69% reduction in testing compared to the pre-implementation baseline. Ninety-five percent of protocol group patients were safely discharged either without laboratory testing or with one set of tests obtained on postoperative day 2. There were no 30-day readmissions or reported complications associated with the new laboratory testing protocol. Conclusions In patients with surgically treated fractures about the elbow and knee, obtaining a single set of laboratory tests on postoperative day 2 is safe and efficacious in terms of reducing inappropriate resource utilization. Trial registration retrospectively registered.
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Affiliation(s)
- Raj M Amin
- 1Department of Orthopaedic Surgery, The Johns Hopkins Medical Institutions, 601 N Caroline Street, 5th Floor, Baltimore, MD 21287 USA
| | - Alexander E Loeb
- 1Department of Orthopaedic Surgery, The Johns Hopkins Medical Institutions, 601 N Caroline Street, 5th Floor, Baltimore, MD 21287 USA
| | - Erik A Hasenboehler
- 1Department of Orthopaedic Surgery, The Johns Hopkins Medical Institutions, 601 N Caroline Street, 5th Floor, Baltimore, MD 21287 USA
| | - Adam S Levin
- 1Department of Orthopaedic Surgery, The Johns Hopkins Medical Institutions, 601 N Caroline Street, 5th Floor, Baltimore, MD 21287 USA
| | - Greg M Osgood
- 1Department of Orthopaedic Surgery, The Johns Hopkins Medical Institutions, 601 N Caroline Street, 5th Floor, Baltimore, MD 21287 USA
| | - Robert S Sterling
- 1Department of Orthopaedic Surgery, The Johns Hopkins Medical Institutions, 601 N Caroline Street, 5th Floor, Baltimore, MD 21287 USA
| | - Philip F Stahel
- 2Department of Specialty Medicine, Rocky Vista University College of Osteopathic Medicine, 777 Bannock St., Denver, CO 80204 Parker USA
| | - Babar Shafiq
- 1Department of Orthopaedic Surgery, The Johns Hopkins Medical Institutions, 601 N Caroline Street, 5th Floor, Baltimore, MD 21287 USA
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Picetti E, Maier RV, Rossi S, Kirkpatrick AW, Biffl WL, Stahel PF, Moore EE, Kluger Y, Baiocchi GL, Ansaloni L, Agnoletti V, Catena F. Preserve encephalus in surgery of trauma: online survey. (P.E.S.T.O). World J Emerg Surg 2019; 14:9. [PMID: 30873217 PMCID: PMC6399949 DOI: 10.1186/s13017-019-0229-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/19/2019] [Indexed: 12/21/2022] Open
Abstract
Background Traumatic brain injury (TBI) is a global health problem. Extracranial hemorrhagic lesions needing emergency surgery adversely affect the outcome of TBI. We conducted an international survey regarding the acute phase management practices in TBI polytrauma patients. Methods A questionnaire was available on the World Society of Emergency Surgery website between December 2017 and February 2018. The main endpoints were the evaluation of (1) intracranial pressure (ICP) monitoring during extracranial emergency surgery (EES), (2) hemodynamic management without ICP monitoring during EES, (3) coagulation management, and (4) utilization of simultaneous multisystem surgery (SMS). Results The respondents were 122 representing 105 trauma centers worldwide. ICP monitoring was utilized in 10–30% of patients at risk of intracranial hypertension (IH) undergoing EES from about a third of the respondents [n = 35 (29%)]. The respondents reported that the safest values of systolic blood pressure during EES in patients at risk of IH were 90–100 mmHg [n = 35 (29%)] and 100–110 mmHg [n = 35 (29%)]. The safest values of mean arterial pressure during EES in patients at risk of IH were > 70 mmHg [n = 44 (36%)] and > 80 mmHg [n = 32 (26%)]. Regarding ICP placement, a large percentage of respondents considered a platelet (PLT) count > 50,000/mm3 [n = 57 (47%)] and a prothrombin time (PT)/activated partial thromboplastin time (aPTT) < 1.5 times the normal control [n = 73 (60%)] to be the safest parameters. For craniotomy, the majority of respondents considered PLT count > 100,000/mm3 [n = 67 (55%)] and a PT/aPTT < 1.5 times the normal control [n = 76 (62%)] to be the safest parameters. Almost half of the respondents [n = 53 (43%)], reported that they transfused red blood cells (RBCs)/plasma (P)/PLTs at a ratio of 1/1/1 in TBI polytrauma patients. SMS was performed in 5–19% of patients, requiring both an emergency neurosurgical operation and EES, by almost half of the respondents [n = 49 (40%)]. Conclusions A great variability in practices during the acute phase management of polytrauma patients with severe TBI was identified. These findings may be helpful for future investigations and educational purposes. Electronic supplementary material The online version of this article (10.1186/s13017-019-0229-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Edoardo Picetti
- 1Department of Anesthesia and Intensive Care, Parma University Hospital, Via Gramsci 14, 43100 Parma, Italy
| | - Ronald V Maier
- 2Department of Surgery, Harborview Medical Center, Seattle, USA
| | - Sandra Rossi
- 1Department of Anesthesia and Intensive Care, Parma University Hospital, Via Gramsci 14, 43100 Parma, Italy
| | - Andrew W Kirkpatrick
- 3Departments of General Acute Care, Abdominal Wall Reconstruction and Trauma Surgery, Foothills Medical Centre, Calgary, Canada
| | - Walter L Biffl
- 4Division of Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, California, USA
| | - Philip F Stahel
- 5College of Osteopathic Medicine, Rocky Vista University, Parker, CO USA
| | - Ernest E Moore
- 6Department of Trauma Surgery, Denver Health, Denver, CO USA
| | - Yoram Kluger
- 7Department of General Surgery, Rambam Health Campus, Haifa, Israel
| | - Gian Luca Baiocchi
- 8Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Luca Ansaloni
- 9Department of General and Emergency Surgery, Bufalini Hospital, Cesena, Italy
| | - Vanni Agnoletti
- 10Department of Anesthesia and Intensive Care, Bufalini Hospital, Cesena, Italy
| | - Fausto Catena
- 11Department of Emergency Surgery, Parma University Hospital, Parma, Italy
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Zelle BA, Stahel PF. Lessons learned for postoperative wound healing: respect the past and embrace the future. Patient Saf Surg 2019; 13:5. [PMID: 30697348 PMCID: PMC6346540 DOI: 10.1186/s13037-019-0185-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 01/14/2019] [Indexed: 01/18/2023] Open
Affiliation(s)
- Boris A Zelle
- 1Department of Orthopaedics, University of Texas Health, 7703 Floyd Curl Dr.,MC-7774, San Antonio, TX 78229 USA
| | - Philip F Stahel
- 2Rocky Vista University, College of Osteopathic Medicine, Parker, CO 80134 USA
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30
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Gaunder CL, Zhao Z, Henderson C, McKinney BR, Stahel PF, Zelle BA. Wound complications after open reduction and internal fixation of tibial plateau fractures in the elderly: a multicentre study. Int Orthop 2018; 43:461-465. [PMID: 29744646 DOI: 10.1007/s00264-018-3940-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/05/2018] [Indexed: 01/12/2023]
Abstract
PURPOSE The incidence of wound complications after open reduction with internal fixation (ORIF) of tibial plateau fractures in young patients has been reported to range from approximately 5 to 15%. Reports on wound complication rates in the elderly patients are limited. This study investigates the incidence of post-operative wound complications in elderly patients undergoing ORIF of their tibial plateau fractures. METHODS A retrospective study was performed within three accredited level 1 trauma centres. Patients > 60 years of age undergoing open reduction and internal fixation of their tibial plateau fractures were included. The primary outcome measure was wound complications of the surgical site. These were divided into superficial infections versus deep infections. RESULTS One hundred two patients matched the inclusion criteria. Of these, 16 patients (15.7%) developed a post-operative wound infection. The analysis of underlying co-morbidities and risk factors revealed that patients with American Society of Anaesthesiologists (ASA) classes 3 and 4 were at significantly increased risk of sustaining a wound complications as compared to ASA classes 1 and 2 (23.7 versus 5.1%, p = 0.015). CONCLUSIONS The overall infection rates in elderly patients undergoing ORIF for tibial plateau fractures is in a similar range to published data on younger patient populations. In particular, elderly patients without significant co-morbidities seem to be appropriate candidates for ORIF of their tibial plateau fractures. However, elderly patients with significant co-morbidities must be considered as high risk and alternative treatment options, such as nonoperative treatment or less invasive surgical options, should be explored in these patients.
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Affiliation(s)
- Christopher L Gaunder
- Department of Orthopaedics and Rehabilitation, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, San Antonio, TX, 78234, USA
| | - Zibin Zhao
- Department of Orthopaedic Surgery, UT Health San Antonio, 7703 Floyd Curl Dr, MC-7774, San Antonio, TX, 78229, USA
| | - Corey Henderson
- Rocky Vista University, 8401 S. Chambers Road, Parker, CO, 80134, USA
| | - Brandon R McKinney
- Department of Orthopaedics and Rehabilitation, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, San Antonio, TX, 78234, USA
| | - Philip F Stahel
- Rocky Vista University, 8401 S. Chambers Road, Parker, CO, 80134, USA
| | - Boris A Zelle
- Department of Orthopaedic Surgery, UT Health San Antonio, 7703 Floyd Curl Dr, MC-7774, San Antonio, TX, 78229, USA.
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Stahel PF, Smith WR, Moore EE, Mehler PS, Weckbach S, Kim FJ, Butler N, Pape HC, Clarke TJ, Makary MA, Clavien PA. The 10 th anniversary of patient safety in surgery. Patient Saf Surg 2017; 11:27. [PMID: 29259657 PMCID: PMC5731067 DOI: 10.1186/s13037-017-0145-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 12/05/2017] [Indexed: 11/20/2022] Open
Affiliation(s)
- Philip F Stahel
- Orthopaedics and Neurosurgery, Rocky Vista University, College of Osteopathic Medicine, Parker, CO 80134 USA
| | - Wade R Smith
- Mountain Orthopedic Trauma Surgeons (MOTUS), Swedish Medical Center, Englewood, CO 80113 USA
| | - Ernest E Moore
- Department of Surgery, University of Colorado School of Medicine, Denver, CO 80045 USA
| | - Philip S Mehler
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045 USA
| | | | - Fernando J Kim
- Department of Surgery, University of Colorado School of Medicine, Denver, CO 80045 USA
| | - Nathan Butler
- West Virginia School of Osteopathic Medicine, Lewisburg, WV 24901 USA
| | - Hans-Christoph Pape
- Department of Trauma Surgery, University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Ted J Clarke
- Colorado Physician Insurance Companies, Denver, CO 80320 USA
| | - Martin A Makary
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21287 USA
| | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, CH-8091 Zurich, Switzerland
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Botolin S, VanderHeiden TF, Moore EE, Fried H, Stahel PF. The role of pre-reduction MRI in the management of complex cervical spine fracture-dislocations: an ongoing controversy? Patient Saf Surg 2017; 11:23. [PMID: 28904564 PMCID: PMC5591568 DOI: 10.1186/s13037-017-0139-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 09/05/2017] [Indexed: 11/17/2022] Open
Abstract
Background Cervical spine fracture-dislocations in neurologically intact patients represent a surgical challenge due to the risk of inflicting iatrogenic spinal cord compression by closed reduction maneuvers. The use of MRI for early advanced imaging in these injuries remains controversially debated. Case presentation A 54-year old man sustained a fall over the handlebars of his racing bicycle. The helmeted patient sustained a fall on his head which resulted in a hyperflexion injury of the neck. He was neurologically intact on presentation. Initial CT imaging revealed a complex multisegmental cervical spine injury with a left-sided C6/C7 perched facet, a right sided C7/T1 fracture-dislocation, and a right-sided C6 and C7 traumatic laminotomy. The initial management consisted of temporary external Halo fixator application without closed reduction maneuver, to mitigate the risk of a delayed spinal cord injury. Subsequent advanced imaging by MRI revealed an acute traumatic C7/T1 disc herniation, with the intervertebral disc completely extruded into the spinal canal. Definitive surgical management was then accomplished by employing a three-stage anterior-posterior-anterior spinal decompression, realignment, fixation and fusion C4-T2 in one operative session. The patient recovered well and retained full neurological function. He resumed bicycle street racing within 10 months of the injury following successful spinal reconstruction. Conclusions The diagnostic evaluation of cervical fracture-dislocations should include advanced imaging by MRI in order to fully understand the injury pattern prior to proceeding with spinal reduction maneuvers which may impose the imminent threat of a devastating iatrogenic injury to the spinal cord. The presented staged management by initial Halo fixation without attempts for spinal reduction, followed by a surgical decompression and multilevel fusion, appears to represent a feasible and safe strategy for patients at risk of a delayed neurological injury.
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Affiliation(s)
- Sergiu Botolin
- Department of Orthopaedics, University of Colorado, School of Medicine and Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204 USA
| | - Todd F VanderHeiden
- Department of Orthopaedics, University of Colorado, School of Medicine and Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204 USA
| | - Ernest E Moore
- Department of Surgery, University of Colorado, School of Medicine and Denver Health Medical Center, Denver, CO 80204 USA
| | - Herbert Fried
- Department of Neurosurgery, University of Colorado, School of Medicine and Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204 USA
| | - Philip F Stahel
- Department of Orthopaedics, University of Colorado, School of Medicine and Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204 USA.,Department of Neurosurgery, University of Colorado, School of Medicine and Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204 USA
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Stahel PF, Alfonso NA, Henderson C, Baldini T. Introducing the "Bone-Screw-Fastener" for improved screw fixation in orthopedic surgery: a revolutionary paradigm shift? Patient Saf Surg 2017; 11:6. [PMID: 28321265 PMCID: PMC5358039 DOI: 10.1186/s13037-017-0121-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 03/17/2017] [Indexed: 11/10/2022] Open
Abstract
Background Conventional screws used for fracture fixation in orthopedic surgery continue to rely on the historic buttress thread design. While buttress screws generally provide solid resistance against unidirectional axial loading forces, their design suffers from several limitations, as the buttress thread does not adequately resist multiaxial forces. Furthermore, the buttress screw is prone to stripping at the bone-screw interface and can cause microfracturing of the surrounding bone due to its thread design. Standard buttress screws are therefore at risk of adverse postoperative outcomes secondary to failure of bone fixation. A new patented Bone-Screw-Fastener was recently designed that is based on an interlocking thread technology. This new fastener provides distributive forces from the threads onto the bone and therefore resists loads in multiple directions. The underlying concept is represented by a “female thread” bone cutting technology designed to maximize bone volume, preserve bone architecture, and create a circumferential interlocking interface between the implant and bone that protects the thread from stripping and from failing to multiaxial forces. Presentation of the hypothesis We hypothesize that the new Bone-Screw-Fastener overcomes the classic shortcomings of conventional orthopedic screws with buttress threads by ease of insertion, improved bone preservation, increased resistance to off-axis multidirectional loading forces and to stripping of the threads. These advanced biomechanical and biological properties can potentially mitigate the classic limitations of conventional buttress screws by providing better resistance to implant failure under physiological loads, preserving bone biology, and thus potentially improving patient outcomes in the future. Testing the hypothesis The presumed superiority of the new fastener will require testing and validation in well-designed prospective multicenter randomized controlled trials (RCTs), using the conventional buttress screw as control. Implications of the hypothesis Once validated in multicenter RCTs, the new Bone-Screw-Fastener may drive a change in paradigm with regard to its innovative biomechanical principles and biologic bone preservation for surgical applications requiring screw fixation.
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Affiliation(s)
- Philip F Stahel
- Department of Orthopaedic Surgery, Denver Health Medical Center, Denver, CO 80204 USA.,Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, CO 80045 USA
| | - Nicholas A Alfonso
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, CO 80045 USA
| | - Corey Henderson
- Department of Orthopaedic Surgery, Denver Health Medical Center, Denver, CO 80204 USA
| | - Todd Baldini
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, CO 80045 USA
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Abstract
In the USA alone, around 22 million patients annually discuss the need for surgical procedure with their surgeon. On a global scale, more than 200 million patients are exposed to the risk of undergoing a surgical procedure every year. A crucial part of the informed consent process for surgery is the understanding of risk, the probability of complications, and the predicted occurrence of adverse events. Ironically, risk quantification, risk stratification, and risk management are not necessarily part of a surgeon's core skillset, considering the lengthy surgical training curriculum towards technical excellence. The present review was designed to provide a concise historic perspective on the evolution of our current understanding of risk and probability, which represent the key underlying pillars of the shared decision-making process between surgeons and patients when discussing surgical treatment options.
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Affiliation(s)
- Philip F Stahel
- Department of Orthopaedics, University of Colorado, School of Medicine and Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204 USA.,Department of Neurosurgery, University of Colorado, School of Medicine and Denver Health Medical Center, Denver, CO 80204 USA
| | - Ivor S Douglas
- Department of Medicine, Division of Pulmonary Sciences and Critical Care, University of Colorado, School of Medicine and Denver Health Medical Center, Denver, CO 80204 USA
| | - Todd F VanderHeiden
- Department of Orthopaedics, University of Colorado, School of Medicine and Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204 USA
| | - Sebastian Weckbach
- Department of Orthopaedics, University Hospital Ulm, D-89081 Ulm, Germany
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35
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Coccolini F, Stahel PF, Montori G, Biffl W, Horer TM, Catena F, Kluger Y, Moore EE, Peitzman AB, Ivatury R, Coimbra R, Fraga GP, Pereira B, Rizoli S, Kirkpatrick A, Leppaniemi A, Manfredi R, Magnone S, Chiara O, Solaini L, Ceresoli M, Allievi N, Arvieux C, Velmahos G, Balogh Z, Naidoo N, Weber D, Abu-Zidan F, Sartelli M, Ansaloni L. Pelvic trauma: WSES classification and guidelines. World J Emerg Surg 2017; 12:5. [PMID: 28115984 PMCID: PMC5241998 DOI: 10.1186/s13017-017-0117-6] [Citation(s) in RCA: 209] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 01/12/2017] [Indexed: 01/24/2023] Open
Abstract
Complex pelvic injuries are among the most dangerous and deadly trauma related lesions. Different classification systems exist, some are based on the mechanism of injury, some on anatomic patterns and some are focusing on the resulting instability requiring operative fixation. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic impairment of pelvic ring function and the associated injuries. The management of pelvic trauma patients aims definitively to restore the homeostasis and the normal physiopathology associated to the mechanical stability of the pelvic ring. Thus the management of pelvic trauma must be multidisciplinary and should be ultimately based on the physiology of the patient and the anatomy of the injury. This paper presents the World Society of Emergency Surgery (WSES) classification of pelvic trauma and the management Guidelines.
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Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Philip F Stahel
- Department of Orthopedic Surgery and Department of Neurosurgery, Denver Health Medical Center and University of Colorado School of Medicine, Denver, CO USA
| | - Giulia Montori
- General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Walter Biffl
- Acute Care Surgery, The Queen's Medical Center, Honolulu, HI USA
| | - Tal M Horer
- Dept. of Cardiothoracic and Vascular Surgery & Dept. Of Surgery Örebro University Hospital and Örebro University, Örebro, Sweden
| | - Fausto Catena
- Emergency and Trauma Surgery, Maggiore Hospital, Parma, Italy
| | - Yoram Kluger
- Division of General Surgery Rambam Health Care Campus Haifa, Haifa, Israel
| | | | - Andrew B Peitzman
- Surgery Department, University of Pittsburgh, Pittsburgh, Pensylvania USA
| | - Rao Ivatury
- Virginia Commonwealth University, Richmond, VA USA
| | - Raul Coimbra
- Department of Surgery, UC San Diego Health System, San Diego, USA
| | | | - Bruno Pereira
- Faculdade de Ciências Médicas (FCM) - Unicamp, Campinas, SP Brazil
| | - Sandro Rizoli
- Trauma & Acute Care Service, St Michael's Hospital, Toronto, ON Canada
| | - Andrew Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery Foothills Medical Centre, Calgary, AB Canada
| | - Ari Leppaniemi
- Abdominal Center, University Hospital Meilahti, Helsinki, Finland
| | - Roberto Manfredi
- General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Stefano Magnone
- General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Osvaldo Chiara
- Emergency and Trauma Surgery, Niguarda Hospital, Milan, Italy
| | - Leonardo Solaini
- General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Marco Ceresoli
- General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Niccolò Allievi
- General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Catherine Arvieux
- Digestive and Emergency Surgery, UGA-Université Grenoble Alpes, Grenoble, France
| | - George Velmahos
- Harvard Medical School, Division of Trauma, Emergency Surgery and Surgical Critical Care Massachusetts General Hospital, Boston, MA USA
| | - Zsolt Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW Australia
| | - Noel Naidoo
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - Dieter Weber
- Department of General Surgery, Royal Perth Hospital, Perth, Australia
| | - Fikri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Massimo Sartelli
- General and Emergency Surgery, Macerata Hospital, Macerata, Italy
| | - Luca Ansaloni
- General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
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Affiliation(s)
- Philip F Stahel
- Department of Orthopaedics, and Department of Neurosurgery, University of Colorado School of Medicine, Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204 USA ; Department of Neurosurgery, University of Colorado, School of Medicine, Denver Health Medical Center, Denver, CO 80204 USA
| | - Todd F VanderHeiden
- Department of Orthopaedics, and Department of Neurosurgery, University of Colorado School of Medicine, Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204 USA
| | - Fernando J Kim
- Division of Urology, Department of Surgery, University of Colorado, School of Medicine, Denver Health Medical Center, Denver, CO 80204 USA
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Smith WR, Stoneback JW, Morgan SJ, Stahel PF. Is immediate weight bearing safe for periprosthetic distal femur fractures treated by locked plating? A feasibility study in 52 consecutive patients. Patient Saf Surg 2016; 10:26. [PMID: 27980675 PMCID: PMC5142343 DOI: 10.1186/s13037-016-0114-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 12/01/2016] [Indexed: 12/27/2022] Open
Abstract
Background Periprosthetic distal femur fractures associated with total knee replacement are increasing in incidence. We hypothesized that a standardized management protocol would result in few implant failures and a low rate of postoperative complications. Methods Retrospective observational cohort study at an urban level 1 trauma center and academic level 2 trauma center. Consecutive patients with periprosthetic distal femur fractures and stable total knee arthroplasty were included between January 1, 2011 and December 31, 2014. Patients were managed by a standardized protocol of co-management by a hospitalist service, fracture fixation within 24 h of admission by less-invasive locked bridge plating, and immediate unrestricted postoperative weight bearing. The primary outcome measure was the rate of postoperative complications. Secondary outcome measures included time to surgery, intraoperative blood loss, duration of surgery, length of hospital stay, time to full weight bearing, and time to radiographic fracture healing. Results Fifty four fractures were treated in 52 patients. There were three implant failures, one deep infection, one nonunion and two patients with symptomatic malunion. One patient had knee pain due to patellar component instability associated with valgus alignment. There were ten thromboembolic complications despite consistent anticoagulation. Two patients died within 12 months of injury. Thirty-eight patients had returned to their pre-injury ambulation status at 1 year follow-up. Conclusion A standardized approach of less-invasive locked plating fixation and immediate unrestricted weight bearing appears safe and feasible in the management of this vulnerable patient cohort. Trial registration number This is a retrospective observational study without a Trial registration number.
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Affiliation(s)
- Wade R Smith
- Mountain Orthopaedic Trauma Surgeons (MOTUS), Swedish Medical Center, Englewood, CO USA
| | - Jason W Stoneback
- Department of Orthopaedics, University of Colorado School of Medicine, Aurora, CO USA
| | - Steven J Morgan
- Mountain Orthopaedic Trauma Surgeons (MOTUS), Swedish Medical Center, Englewood, CO USA
| | - Philip F Stahel
- Department of Orthopaedics, University of Colorado School of Medicine, Aurora, CO USA ; Department of Orthopaedics, Denver Health Medical Center, 777 Bannock St, Denver, CO 80204 USA
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Stahel PF, Clavien PA. Patient Safety in Surgery reviewer acknowledgement 2015. Patient Saf Surg 2016. [PMCID: PMC4790059 DOI: 10.1186/s13037-016-0099-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The editors of Patient Safety in Surgery would like to thank all of our reviewers who have contributed to the journal in Volume 9 (2015).
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Ansaloni L, Pisano M, Coccolini F, Peitzmann AB, Fingerhut A, Catena F, Agresta F, Allegri A, Bailey I, Balogh ZJ, Bendinelli C, Biffl W, Bonavina L, Borzellino G, Brunetti F, Burlew CC, Camapanelli G, Campanile FC, Ceresoli M, Chiara O, Civil I, Coimbra R, De Moya M, Di Saverio S, Fraga GP, Gupta S, Kashuk J, Kelly MD, Khokha V, Jeekel H, Latifi R, Leppaniemi A, Maier RV, Marzi I, Moore F, Piazzalunga D, Sakakushev B, Sartelli M, Scalea T, Stahel PF, Taviloglu K, Tugnoli G, Uraneus S, Velmahos GC, Wani I, Weber DG, Viale P, Sugrue M, Ivatury R, Kluger Y, Gurusamy KS, Moore EE. Erratum to: 2016 WSES guidelines on acute calculous cholecystitis. World J Emerg Surg 2016; 11:52. [PMID: 27822294 PMCID: PMC5097400 DOI: 10.1186/s13017-016-0088-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 07/21/2016] [Indexed: 12/24/2022] Open
Abstract
[This corrects the article DOI: 10.1186/s13017-016-0082-5.].
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Affiliation(s)
- L Ansaloni
- General Surgery I, Papa Giovanni XXIII Hospital, Piazza OMS 1, Bergamo, 24127 Italy
| | - M Pisano
- General Surgery I, Papa Giovanni XXIII Hospital, Piazza OMS 1, Bergamo, 24127 Italy
| | - F Coccolini
- General Surgery I, Papa Giovanni XXIII Hospital, Piazza OMS 1, Bergamo, 24127 Italy
| | - A B Peitzmann
- Department of Surgery, UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - A Fingerhut
- Department of Surgical Research, Medical Univeristy of Graz, Graz, Austria
| | - F Catena
- Department of Emergency and Trauma Surgery of the University Hospital of Parma, Parma, Italy
| | - F Agresta
- Department of General Surgery, Adria Civil Hospital, Adria, RO Italy
| | - A Allegri
- General Surgery I, Papa Giovanni XXIII Hospital, Piazza OMS 1, Bergamo, 24127 Italy
| | - I Bailey
- University Hospital Southampton, Southampton, UK
| | - Z J Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW Australia
| | - C Bendinelli
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW Australia
| | - W Biffl
- Acute Care Surgery, Queen's Medical Center, School of Medicine of the University of Hawaii, Honolulu, HI USA
| | - L Bonavina
- Department of Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy
| | | | - F Brunetti
- Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital AP-HP, Université Paris Est-UPEC, Créteil, France
| | - C C Burlew
- Surgical Intensive Care Unit, Department of Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, USA
| | - G Camapanelli
- General Surgery - Day Surgery Istituto Clinico Sant'Ambrogio, Insubria University, Milan, Italy
| | - F C Campanile
- Ospedale San Giovanni Decollato - Andosilla, Civita Castellana, Italy
| | - M Ceresoli
- General Surgery I, Papa Giovanni XXIII Hospital, Piazza OMS 1, Bergamo, 24127 Italy
| | - O Chiara
- Emergency Department, Trauma Center, Niguarda Hospital, Milan, Italy
| | - I Civil
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
| | - R Coimbra
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, University of California San Diego Health Sciences, San Diego, CA USA
| | - M De Moya
- Harvard University, Cambridge, MA USA
| | - S Di Saverio
- General, Emergency and Trauma Surgery, Maggiore Hospital Trauma Center, Bologna, Italy
| | - G P Fraga
- Division of Trauma Surgery, University of Campinas, Campinas, SP Brazil
| | - S Gupta
- Department of Surgery, Government Medical College, Chandigarh, India
| | - J Kashuk
- Tel Aviv University Sackler School of Medicine, Assia Medical Group, Tel Aviv, Israel
| | - M D Kelly
- Acute Surgical Unit, Canberra Hospital, Canberra, ACT Australia
| | - V Khokha
- Surgical Department, Mozyr City Hospital, Mozyr, Belarus
| | - H Jeekel
- Erasmus MC Rotterdam, Rotterdam, Holland Netherlands
| | - R Latifi
- University of Arizona, Tucson, AZ USA
| | | | - R V Maier
- Department of Surgery, Harborview Medical Center, Seattle, WA USA
| | - I Marzi
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital, Goethe-University Frankfurt, Frankfurt, Germany
| | - F Moore
- Department of Surgery, University of Florida, Gainesville, FL USA
| | - D Piazzalunga
- General Surgery I, Papa Giovanni XXIII Hospital, Piazza OMS 1, Bergamo, 24127 Italy
| | - B Sakakushev
- First General Surgery Clinic, University Hospital St. George/Medical University, Plovdiv, Bulgaria
| | - M Sartelli
- Department of Surgery, Macerata Hospital, Macerata, Italy
| | - T Scalea
- Shock Trauma Center, Critical Care Services, University of Maryland School of Medicine, Baltimore, MD USA
| | - P F Stahel
- Denver Health Medical Center, Denver, CO USA
| | - K Taviloglu
- Taviloglu Proctology Center, Istanbul, Turkey
| | - G Tugnoli
- General, Emergency and Trauma Surgery, Maggiore Hospital Trauma Center, Bologna, Italy
| | - S Uraneus
- Department of Surgery, Medical University of Graz, Graz, Austria
| | - G C Velmahos
- Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA USA
| | - I Wani
- DHS, Srinagar, Kashmir India
| | - D G Weber
- Trauma and General Surgery & The University of Western Australia, Royal Perth Hospital, Perth, Australia
| | - P Viale
- Infectious Disease Unit, Teaching Hospital, S. Orsola-Malpighi Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - M Sugrue
- Letterkenny University Hospital & Donegal Clinical Research Academy, Donegal, Ireland
| | - R Ivatury
- Virginia Commonwealth University, Richmond, VA USA
| | - Y Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - K S Gurusamy
- Royal Free Campus, University College London, London, UK
| | - E E Moore
- Taviloglu Proctology Center, Istanbul, Turkey
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40
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Stornelli N, Wydra FB, Mitchell JJ, Stahel PF, Fabbri S. The dangers of lithotomy positioning in the operating room: case report of bilateral lower extremity compartment syndrome after a 90-minutes surgical procedure. Patient Saf Surg 2016; 10:18. [PMID: 27462369 PMCID: PMC4960854 DOI: 10.1186/s13037-016-0106-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/12/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Lower extremity acute compartment syndrome after gynecologic surgery in the lithotomy position is a rare, yet potentially devastating complication. A high level of suspicion is paramount for early recognition and mitigation of acute compartment syndrome originating from prolonged surgery in lithotomy position. CASE PRESENTATION A 23-year-old female, gravida 1, para 0, underwent a laparoscopic salpingectomy for a ruptured ectopic pregnancy. Surgical time was 90 min. Postoperatively, the patient developed acute compartment syndrome of both legs necessitating emergent bilateral four-compartment fasciotomies, with repeated returns to the operating room for 2nd look procedures and delayed wound closures. The patient regained full function within 3 months and returned to an unrestricted baseline activity level. CONCLUSION Technical diligence in applying a lithotomy position is paramount for preventing postoperative lower extremity compartment syndrome. A high level of suspicion for this severe complication in conjunction with early recognition and immediate surgical management can mitigate long-term adverse sequelae and improve postoperative outcomes.
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Affiliation(s)
- Nicole Stornelli
- Department of Obstetrics and Gynecology, Denver Health Medical Center and University of Colorado School of Medicine, Denver, CO 80204 USA
| | - Frank B Wydra
- Department of Orthopaedic Surgery, Denver Health Medical Center and University of Colorado School of Medicine, Denver, CO 80204 USA
| | - Justin J Mitchell
- Department of Orthopaedic Surgery, Denver Health Medical Center and University of Colorado School of Medicine, Denver, CO 80204 USA
| | - Philip F Stahel
- Department of Orthopaedic Surgery, Denver Health Medical Center and University of Colorado School of Medicine, Denver, CO 80204 USA
| | - Stefka Fabbri
- Department of Obstetrics and Gynecology, Denver Health Medical Center and University of Colorado School of Medicine, Denver, CO 80204 USA
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41
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Affiliation(s)
- Philip F Stahel
- Department of Orthopaedic Surgery and Department of Neurosurgery University of Colorado, School of Medicine Denver Health Medical Center, Denver, CO, USA.
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42
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Ansaloni L, Pisano M, Coccolini F, Peitzmann AB, Fingerhut A, Catena F, Agresta F, Allegri A, Bailey I, Balogh ZJ, Bendinelli C, Biffl W, Bonavina L, Borzellino G, Brunetti F, Burlew CC, Camapanelli G, Campanile FC, Ceresoli M, Chiara O, Civil I, Coimbra R, De Moya M, Di Saverio S, Fraga GP, Gupta S, Kashuk J, Kelly MD, Koka V, Jeekel H, Latifi R, Leppaniemi A, Maier RV, Marzi I, Moore F, Piazzalunga D, Sakakushev B, Sartelli M, Scalea T, Stahel PF, Taviloglu K, Tugnoli G, Uraneus S, Velmahos GC, Wani I, Weber DG, Viale P, Sugrue M, Ivatury R, Kluger Y, Gurusamy KS, Moore EE. 2016 WSES guidelines on acute calculous cholecystitis. World J Emerg Surg 2016; 11:25. [PMID: 27307785 PMCID: PMC4908702 DOI: 10.1186/s13017-016-0082-5] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 06/02/2016] [Indexed: 12/12/2022] Open
Abstract
Acute calculus cholecystitis is a very common disease with several area of uncertainty. The World Society of Emergency Surgery developed extensive guidelines in order to cover grey areas. The diagnostic criteria, the antimicrobial therapy, the evaluation of associated common bile duct stones, the identification of “high risk” patients, the surgical timing, the type of surgery, and the alternatives to surgery are discussed. Moreover the algorithm is proposed: as soon as diagnosis is made and after the evaluation of choledocholitiasis risk, laparoscopic cholecystectomy should be offered to all patients exception of those with high risk of morbidity or mortality. These Guidelines must be considered as an adjunctive tool for decision but they are not substitute of the clinical judgement for the individual patient.
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Affiliation(s)
- L Ansaloni
- General Surgery I, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
| | - M Pisano
- General Surgery I, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
| | - F Coccolini
- General Surgery I, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
| | - A B Peitzmann
- Department of Surgery, UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - A Fingerhut
- Department of Surgical Research, Medical Univeristy of Graz, Graz, Austria
| | - F Catena
- Department of Emergency and Trauma Surgery of the University Hospital of Parma, Parma, Italy
| | - F Agresta
- Department of General Surgery, Adria Civil Hospital, Adria (RO), Italy
| | - A Allegri
- General Surgery I, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
| | - I Bailey
- University Hospital Southampton, Southampton, UK
| | - Z J Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW Australia
| | - C Bendinelli
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW Australia
| | - W Biffl
- Acute Care Surgery, Queen's Medical Center, School of Medicine of the University of Hawaii, Honolulu, HI USA
| | - L Bonavina
- Department of Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy
| | | | - F Brunetti
- Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital AP-HP, Université Paris Est-UPEC, Créteil, France
| | - C C Burlew
- Surgical Intensive Care Unit, Department of Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, USA
| | - G Camapanelli
- General Surgery - Day Surgery Istituto Clinico Sant'Ambrogio, Insubria University, Milan, Italy
| | - F C Campanile
- Ospedale San Giovanni Decollato - Andosilla, Civita Castellana, Italy
| | - M Ceresoli
- General Surgery I, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
| | - O Chiara
- Emergency Department, Trauma Center, Niguarda Hospital, Milan, Italy
| | - I Civil
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
| | - R Coimbra
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, University of California San Diego Health Sciences, San Diego, CA USA
| | - M De Moya
- Harvard University, Cambridge, MA USA
| | - S Di Saverio
- General, Emergency and Trauma Surgery, Maggiore Hospital Trauma Center, Bologna, Italy
| | - G P Fraga
- Division of Trauma Surgery, University of Campinas, Campinas, SP Brazil
| | - S Gupta
- Department of Surgery, Government Medical College, Chandigarh, India
| | - J Kashuk
- Tel Aviv University Sackler School of Medicine, Assia Medical Group, Tel Aviv, Israel
| | - M D Kelly
- Acute Surgical Unit, Canberra Hospital, Canberra, ACT Australia
| | - V Koka
- Surgical Department, Mozyr City Hospital, Mozyr, Belarus
| | - H Jeekel
- Erasmus MC Rotterdam, Rotterdam, Holland Netherlands
| | - R Latifi
- University of Arizona, Tucson, AZ USA
| | | | - R V Maier
- Department of Surgery, Harborview Medical Center, Seattle, WA USA
| | - I Marzi
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital, Goethe-University Frankfurt, Frankfurt, Germany
| | - F Moore
- Department of Surgery, University of Florida, Gainesville, FL USA
| | - D Piazzalunga
- General Surgery I, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
| | - B Sakakushev
- First General Surgery Clinic, University Hospital St. George/Medical University, Plovdiv, Bulgaria
| | - M Sartelli
- Department of Surgery, Macerata Hospital, Macerata, Italy
| | - T Scalea
- Shock Trauma Center, Critical Care Services, University of Maryland School of Medicine, Baltimore, MD USA
| | - P F Stahel
- Denver Health Medical Center, Denver, CO USA
| | - K Taviloglu
- Taviloglu Proctology Center, Istanbul, Turkey
| | - G Tugnoli
- General, Emergency and Trauma Surgery, Maggiore Hospital Trauma Center, Bologna, Italy
| | - S Uraneus
- Department of Surgery, Medical University of Graz, Graz, Austria
| | - G C Velmahos
- Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA USA
| | - I Wani
- DHS, Srinagar, Kashmir India
| | - D G Weber
- Trauma and General Surgery & The University of Western Australia, Royal Perth Hospital, Perth, Australia
| | - P Viale
- Infectious Disease Unit, Teaching Hospital, S. Orsola-Malpighi Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - M Sugrue
- Letterkenny University Hospital & Donegal Clinical Research Academy, Donegal, Ireland
| | - R Ivatury
- Virginia Commonwealth University, Richmond, VA USA
| | - Y Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - K S Gurusamy
- Royal Free Campus, University College London, London, UK
| | - E E Moore
- Taviloglu Proctology Center, Istanbul, Turkey
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Abstract
High-energy pelvic fractures represent potentially life-threatening injuries due to the risk of acute exsanguinating retroperitoneal hemorrhage. The first report of a severe pelvic ring disruption dates back to Charles Hewitt Moore’s seminal publication from 1851. Significant advantages in the understanding of injury mechanisms and treatment concepts of pelvic ring injuries evolved in the 20th century, and provided the basis to current classification-guided treatment and life-saving “damage control” concepts. However, there is a paucity of reports in the current literature focused on the historic background on the treatment of pelvic ring injuries. The present review was designed to summarize the history and evolution of our current understanding of the mechanisms and management strategies for severe pelvic ring injuries (excluding acetabular fractures which represent a different entity outside of the scope of this article).
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Affiliation(s)
- Philip F Stahel
- Department of Orthopaedics, Univesity of Colorado, School of Medicine, Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204 USA ; Department of Neurosurgery, Univesity of Colorado, School of Medicine, Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204 USA
| | - E Mark Hammerberg
- Department of Orthopaedics, Univesity of Colorado, School of Medicine, Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204 USA
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44
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Rich MC, Keene CN, Neher MD, Johnson K, Yu ZX, Ganivet A, Holers VM, Stahel PF. Site-targeted complement inhibition by a complement receptor 2-conjugated inhibitor (mTT30) ameliorates post-injury neuropathology in mouse brains. Neurosci Lett 2016; 617:188-94. [PMID: 26892188 DOI: 10.1016/j.neulet.2016.02.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 02/10/2016] [Accepted: 02/12/2016] [Indexed: 11/26/2022]
Abstract
Intracerebral complement activation after severe traumatic brain injury (TBI) leads to a cascade of neuroinflammatory pathological sequelae that propagate host-mediated secondary brain injury and adverse outcomes. There are currently no specific pharmacological agents on the market to prevent or mitigate the development of secondary cerebral insults after TBI. A novel chimeric CR2-fH compound (mTT30) provides targeted inhibition of the alternative complement pathway at the site of tissue injury. This experimental study was designed to test the neuroprotective effects of mTT30 in a mouse model of closed head injury. The administration of 500 μg mTT30 i.v. at 1 h, 4 h and 24 h after head injury attenuated complement C3 deposition in injured brains, reduced the extent of neuronal cell death, and decreased post-injury microglial activation, compared to vehicle-injected placebo controls. These data imply that site-targeted alternative pathway complement inhibition may represent a new promising therapeutic avenue for the future management of severe TBI.
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Affiliation(s)
- Megan C Rich
- Department of Orthopaedic Surgery, Denver Health Medical Center and University of Colorado School of Medicine, Denver, CO 80204, USA
| | - Chesleigh N Keene
- Department of Orthopaedic Surgery, Denver Health Medical Center and University of Colorado School of Medicine, Denver, CO 80204, USA
| | - Miriam D Neher
- Department of Orthopaedic Surgery, Denver Health Medical Center and University of Colorado School of Medicine, Denver, CO 80204, USA
| | | | - Zhao-Xue Yu
- Alexion Pharmaceuticals, Cheshire, CT 06410, USA
| | - Antoine Ganivet
- Department of Orthopaedic Surgery, Denver Health Medical Center and University of Colorado School of Medicine, Denver, CO 80204, USA
| | - V Michael Holers
- Department of Medicine and Department of Immunology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Philip F Stahel
- Department of Orthopaedic Surgery, Denver Health Medical Center and University of Colorado School of Medicine, Denver, CO 80204, USA; Department of Neurosurgery, University of Colorado School of Medicine, Denver, CO 80204, USA.
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45
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Abstract
Reviewing a surgical manuscript is not an easy task, and there is no formal training available for young referees in the early stage of their careers. Accepting a peer review assignment represents a personal honor for the invited referee and a fundamental ethical responsibility towards the scientific community. Designated reviewers must be accomplished and knowledgeable in the area of the respective topic of investigation. More importantly, they must be aware and cognizant about the cardinal ethical responsibility and stewardship for ensuring the preservation of scientific knowledge of unbiased and unquestionable accuracy in the published literature. Accepting a review assignment should never be taken lightly or considered a simple task, regardless of the reviewer's level of seniority and expertise. Indeed, there are multiple challenges, difficulties, and 'hidden dangers' that jeopardize the completion of a high-quality review, particularly in the hands of less experienced or novice reviewers. The present article was designed to provide a brief, concise, and practical guide on how to review manuscripts for the 'junior referee' in the field of surgery.
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Affiliation(s)
- Philip F Stahel
- Department of Orthopedics and Department of Neurosurgery, University of Colorado, School of Medicine, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA.
| | - Ernest E Moore
- Department of Surgery, University of Colorado, School of Medicine, Denver Health Medical Center, Denver, CO, USA.
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46
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Abstract
Reamed locked intramedullary nailing remains the standard treatment for displaced tibial shaft fractures. Supra-patellar tibial nailing in the semiextended position has been suggested as a safe and effective surgical technique that allows mitigating certain challenges of the standard subpatellar approach. Suprapatellar nailing seems to facilitate achieving and maintaining fracture reduction, particularly in proximal third tibia fractures. Preliminary investigations have suggested that this technique is associated with a low rate of complications, including a reduced incidence of postoperative anterior knee pain. Further clinical investigations are necessary to establish overall complication rates and long-term subjective outcomes.
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Abstract
Optimizing stability of femoral neck fracture fixation is important in obtaining a successful outcome. The mechanical problems and strategies for achieving optimal stability differ depending on patients' age and degree of osteoporosis. Femoral neck fractures in younger adults usually result from high-energy trauma and have a vertical fracture pattern. Strategies for optimizing fixation stability in this group include placing additional screws at right angles to the fracture plane and medial buttress plate augmentation. In elderly patients, screw position relative to the intact cortical femoral neck bone is of critical importance. Additional strategies for optimizing fixation stability in this group include the concept of length stable fixation, use of adjunctive calcium phosphate cement, and use of novel fixed angle fixation implants.
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48
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Quispe JC, Herbert B, Chadayammuri VP, Kim JW, Hao J, Hake M, Hak DJ, Stahel PF, Mauffrey C. Transarticular plating for acute posterior sternoclavicular joint dislocations: a valid treatment option? Int Orthop 2015; 40:1503-8. [PMID: 26257278 DOI: 10.1007/s00264-015-2952-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 07/27/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Restoration of the sternoclavicular joint after posterior dislocation is important for upper limb function. The proximity of neuro-vascular mediastinal structures makes open reduction and internal fixation (ORIF) a high-risk procedure. The ideal treatment strategy is still debated. Our aim is to review the treatment of acute posterior sternoclavicular joint dislocation with a locking compression plate. MATERIALS AND METHODS We present our experience of transarticular plating using a locking compression plate for the treatment of three consecutive patients with posterior sternoclavicular dislocation (SCD). Our primary outcome measure was objective functional outcome using DASH (disability of the arm, shoulder and hand) and PROMIS (patient-reported outcomes measurement information system) questionnaires. All patients had a minimum follow-up of six months, and serial radiographs were reviewed to evaluate maintenance of reduction. RESULTS All three patients presented a posterior SCD with instability refractory to closed reduction. In all three patients, we opted for surgical management using open reduction and fixation with a locking compression plate and allowed early mobilization at two weeks postoperatively. No complications were encountered during follow-up. Good functional outcomes were evidenced by DASH scores of 7.5, 20 and 30, and PROMIS scores were 53.8, 53.8 and 38.1 in each patient, respectively. CONCLUSION Our experience of transarticular plating using a locking compression plate for posterior SCD is positive, as it allows early mobilization and resulted in good functional outcomes.
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Affiliation(s)
- Juan C Quispe
- Department of Orthopaedics, Denver Health Medical Centre, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO, 80204, USA
| | - Benoit Herbert
- Department of Orthopaedics, Denver Health Medical Centre, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO, 80204, USA
| | - Vivek P Chadayammuri
- Department of Orthopaedics, Denver Health Medical Centre, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO, 80204, USA
| | - Ji Wan Kim
- Department of Orthopaedic Surgery, Haeundae Paik Hospital, Inje University, College of Medicine, 1435, Jwa-dong, Haeundae-gu, Busan, 612-862, Republic of Korea
| | - Jiandong Hao
- Department of Orthopaedics, Denver Health Medical Centre, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO, 80204, USA
| | - Mark Hake
- Department of Orthopaedics, Denver Health Medical Centre, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO, 80204, USA
| | - David J Hak
- Department of Orthopaedics, Denver Health Medical Centre, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO, 80204, USA
| | - Philip F Stahel
- Department of Orthopaedics, Denver Health Medical Centre, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO, 80204, USA
| | - Cyril Mauffrey
- Department of Orthopaedics, Denver Health Medical Centre, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO, 80204, USA.
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Abstract
Subtrochanteric femur fractures present significant treatment challenges. The deforming muscle forces make fracture reduction difficult. Treatment options include cephalomedullary nailing and various types of plate fixation. There is a high rate of treatment complications, including malunion, delayed union, nonunion, and implant failure.
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Surgucheva I, He S, Rich MC, Sharma R, Ninkina NN, Stahel PF, Surguchov A. Role of synucleins in traumatic brain injury — an experimental in vitro and in vivo study in mice. Mol Cell Neurosci 2015; 63:114-23. [PMID: 25447944 DOI: 10.1016/j.mcn.2014.10.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 10/16/2014] [Accepted: 10/23/2014] [Indexed: 11/25/2022] Open
Abstract
Synucleins are small prone to aggregate proteins associated with several neurodegenerative diseases (NDDs), however their role in traumatic brain injury (TBI) is an emerging area of investigation. Using in vitro scratch injury model and in vivo mouse weight-drop model we have found that the injury causes alterations in the expression and localization of synucleins near the damaged area. Before injury, α-synuclein is diffused in the cytoplasm of neurons and γ-synuclein is both in the cytoplasm and nucleus of oligodendrocytes. After the scratch injury of the mixed neuronal and glial culture, α-synuclein forms punctate structures in the cytoplasm of neurons and γ-synuclein is almost completely localized to the nucleus of the oligodendrocytes. Furthermore, the amount of post-translationally modified Met38-oxidized γ-synuclein is increased 3.8 fold 24 h after the scratch. α- and γ-synuclein containing cells increased in the initially cell free scratch zone up to 24 h after the scratch.Intracellular expression and localization of synucleins are also changed in a mouse model of focal closed head injury, using a standardized weight drop device. γ-Synuclein goes from diffuse to punctate staining in a piriform cortex near the amygdala, which may reflect the first steps in the formation of deposits/inclusions. Surprisingly, oxidized γ-synuclein co-localizes with cofilin-actin rods in the thalamus, which are absent in all other regions of the brain. These structures reach their peak amounts 7 days after injury. The changes in γ-synuclein localization are accompanied by injury-induced alterations in the morphology of both astrocytes and neurons.
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