Focus on emergency general surgery

Introduction: Pelvic long-term consequences on Health-related-Quality-of-Life (HRQoL). The main purpose of this study is to provide insight into short-term HRQoL in the first year after pelvic injury and identify short-term prognostic factors of decreased outcome. Material & methods : This is a prospective, observational, multicenter, follow-up cohort study in which HRQoL and functional outcome was assessed during 12 months follow-up within injured adult patients admitted to 1 of 10 hospitals in the county Noord- Brabant, the Netherlands. Data was collected by self-reported ques-tionnaires at 1 week (including preinjury assessment), and 1, 3, 6 and 12 months after injury. EuroQoL-5D (EQ-5D), Visual Analog Scale (VAS), Merle d‘‘aubigne Hip score (MAH) and the Majeed Pelvic Score (MPS) score were used. Multivariable mixed models were used to examine the course of HRQoL, prognostic factors for a decreased HRQoL and functional outcomes over time. Results : 184 patients with pelvic fractures were identified between 2015 and 2016; 71 Tile A, 44 Tile B and 10 Tile C fractures, and 59 acetabular fractures. At pre-injury, 1 week, 1, 3, 6 and 12 months after injury, the mean EQ-5D Index was respectively 0.90, 0.26, 0.45, 0.66, 0.77 and 0.80 and the mean EQ-VAS was respectively 83, 45, 57, 69, 75 and 75. At 6 and 12 months after injury ceiling effects were noticed regarding the different MPS and MAHS dimensions. The pre- injury score was an important prognostic factor for a decreased HRQoL. Females and patients with a higher ISS were associated with a lower score on the EQ-5D VAS ( b = – 6.66), ( b = – 7.09). Conclusions : Patients with pelvic fractures experience a reduction of their HRQoL. Most patients do not achieve their pre-injury state of HRQoL within 1 year after trauma. Prognostic factors for decreased HRQoL are a low pre-injury score, higher ISS and female gender. We do not recommend the MAHS and MPS in the mid/long-term follow- up of pelvic fractures. Material & methods : This retrospective, nationwide, population- based study was conducted with the help of the national health insurance database from the Belgian National Institute for Health and Disability Insurance (NIHDI-RIZIV-INAMI). Multiple codes that are used for the reimbursement of the diagnosis and treatment of pelvic and acetabular fractures were linked to the patients’’ age group, sex and region. Results : Between 1988 and 2018, 91.317 pelvic and acetabular fractures were diagnosed. The age-adjusted incidence increased from 15,8/100.000 persons per year in 1988 to 29,7/100.000 persons per year in 2006 and to 37,6/100.000 persons per year in 2018. The fracture incidence showed a bimodal incidence, with a small peak in children (particularly boys), and an increasing incidence in older adults, particularly in women. Between 2006 and 2018, 5.957 patients underwent surgical treatment for their pelvic fracture. 2.088 underwent an osteosynthesis of the acetabulum and 3869 underwent an osteosynthesis of the pelvic ring. There were 3622 (60.8%) in proportion of surgical treatment, but given the much higher incidence in older adults, there is a considerable amount of operations in older adults 31, 2017. Patients were extracted from the National Quality Registry for Hip Fracture (RIKSHO¨FT), and their electronic medical records were reviewed. The association between the type of anesthesia and postoperative severe complications (Clavien-Dindo C 3a) and 90-day mortality was analyzed using a Poisson regression model with robust standard errors, while the association with post-operative mortality up to 1-year was analyzed using Cox proportional hazards model. All analyses were preformed while adjusting for relevant demographic, preoperative comorbidities, specific fracture type, surgical method, as well as other clinical characteristics. Results: A total of 2437 hip fracture cases were included in the study, of whom 60% received spinal anesthesia. There was no statistically significant difference in the risk of severe complications [adj. IRR (95% CI): 1.24 (0.85–1.82), p = 0.273], 90-day postoperative mortality [adj. IRR (95% CI): 0.88 (0.70–1.11), p = 0.281], or 1-year postoperative mortality [adj. HR (95% CI): 1.13 (0.96–1.33), p = 0.155] when comparing general anesthesia with spinal anesthesia. Conclusions: The mode of anesthesia used for emergency hip fracture surgery was not associated with either postoperative severe complications or mortality up to 1-year postoperatively. hip fracture in two level II trauma teaching hospitals between 1 January 2018 and 11 January 2021 were included in this prospective cohort study. Delirium was diagnosed by an observatory judgment by geriatric medicine specialists combined with the Delirium Observation Screening Scale. Results : In total 2051 patients were enrolled in this study of which 326 patients (16%) developed a delirium during hospital stay. Mul- tivariable logistic regression showed a significant association between delirium and age (OR 1.07, p \ 0.001), female gender (OR 0.50, p \ 0.001), dementia (OR 1.63, p = 0.001), Parkinson‘‘s disease (OR 2.44, p \ 0.001), KATZ-ADL score (OR 1.07, p = 0.02), infection during admission (OR 3.64, p \ 0.001) and haemoglobin loss (OR 1.20, p = 0.013). Patients with a postoperative delirium had a sig- nificant longer admission duration (9 (6–14)days versus 6 (4–9)days). patients delirium had significant higher in-hospital (10% vs. 2%, p \ 0.001), 30-day (16% vs. 6%, p \ 0.001) and 1-year mortality (42% vs. 22%), p \ 0.001). Conclusions : Risk factors for development of delirium during admission were age, male gender, dementia, Parkinson’’s disease, KATZ-ADL, infection during admission and haemoglobin loss. Patients with delirium had longer hospital admission and higher in- hospital, 30-day and 1-year mortality. Material & methods : Bilateral CT scans of fifty-four patients with unilateral displaced calcaneal fracture were obtained before and after osteosynthesis. Orientation angle of the posterior subtalar joint facet (PTC) of displaced intra-articular calcaneal fractures of 54 patients was measured on segmented 3 D images before and after surgery and compared to the uninjured side. This orientation angle (OAC) is the average of every normal vector of each point of the PTC, a 3D measure for displacement is introduced and correlated to risks on conversion to total knee arthroplasty (TKA). Material & methods: A cross-sectional study was performed including 534 patients treated for a tibial plateau fracture between 2003–2018, with a mean follow-up of 6.7 ± 3.6 years. Fifty-eight (10.8%) patients developed severe posttraumatic arthritis and received a TKA. For each patient, a 3D model was created using the pre-operative CT. The 3D gap area (mm 2 ) was determined in order to quantify the degree of initial fracture displacement. A critical cut-off value was determined using ROC curves. Multivariate analysis was performed to assess the association of 3D gap area with conversion to TKA. Subgroups with increasing levels of 3D gap area were identified and Kaplan Meier survival curves were plotted to assess Conclusions: The treatment with trans sacral bar provides at least similar stability as a conventional SI screws in FFP IIIc fractures. (13.04%). Conclusions: The hidden neoplasm in the appendicular plastron in Spain is not as high as that reported by other European countries. However, it would be necessary to define in which patients interval appendectomy is mandatory and which postoperative tests we must request to follow up patients who do not undergo surgery. and clinical data obtained evaluate and elderly patients with the of Multivariable generalized additive model (GAM) and multivariable logistic regression model with backward elimination were used to identify association of predictors and in-hospital mortality. fistula for predicting MT and identify the best trigger for MTP. Multicentric retrospective study from the of the (cid:2) Association. Severe (Injury predictive MT stored products show a significantly (P \ 0.001) lower product content and recovery (290 9 109 [69] and 70% [11] compared to long stored platelets (311 9 109 [76] and 77% [14]). Conclusions: DTCs used by the Dutch Armed Forces are compliant to European guidelines. Platelet recovery and content was stable from 0.5 up to six years of frozen storage, suggesting expansion of the current shelf life to beyond four years. Material & methods : Twenty-four adult male pigs standardized unilateral fracturing of the femoral bone. Animals were exposed to different protocols of IMN. Fractures were treated with conventional reamed femoral nailing (RFN); unreamed femoral nailing (UFN); reaming with a reamer irrigator aspirator device (RIA). Fracture hematoma was collected 6 h after reaming and immune cells were studied by flowcytometry. FH-cell apoptosis and neutrophil receptor expression (Mac-1/CD11b and Fc c RIII/CD16) were studied. Results : All animals survived the observation period. Apoptosis-rates of FH-immune cells were significantly lower in group RIA (3.50 ± 0.53%) when compared with non-RIA groups: (group UFN 12.50 ± 5.22%, p = 0.028 UFN vs. RIA), (group RFN 13.30 ± 3.18%, P \ 0.001, RFN vs. RIA). Moreover, RIA-FH showed lower neutrophil CD11b/CD16 expression when compared strategies influence immunologic cellular FH-content. Reamed Irri-gation-Aspiration-augmented protocols are associated with decreased FH-immune cell apoptosis and reduced activation of FH-neutrophils and thereby with optimized FH-immune cell content. This underlines the important role of IMN in optimizing local cellular immune homeostasis during the formationphase of early fracture hematoma. Lipidomic analysis shows significant changes in circulating Di- and Triglycerides after intramedullary reaming in a porcine Polytrauma model a femur fracture. polytrauma model help understand the role of lipids in acute trauma and treatment. Collation with data from the clinica