Objective: To assess how the COVID-19 outbreak has affected emergency general surgery (EGS) care during the pandemic, indications for surgery, types of procedures, perioperative course, and final outcomes.
Methods: This is a retrospective study of EGS patients during the pandemic period. The main outcome was 30-day morbidity and mortality according to severity and COVID-19 infection status. Secondary outcomes were changes in overall management. A logistic regression analysis was done to assess factors predictive of mortality.
Results: One hundred and fifty-three patients were included. Half of the patients with an abdominal ultrasound and/or CT scan had signs of severity at diagnosis, four times higher than the previous year. Non-COVID patients underwent surgery more often than the COVID group. Over 1/3 of 100 operated patients had postoperative morbidity, versus only 15% the previous year. The most common complications were septic shock, pneumonia, and ARDS. ICU care was required in 17% of patients, and was most often required in the SARS-CoV-2-infected group, which also had a higher morbidity and mortality. The 30-day mortality in the surgical series was of 7%, with no differences with the previous year. The strongest independent predictors of overall mortality were age > 70 years, ASA III-IV, ESS > 9, and SARS-CoV-2 infection.
Conclusions: Non-operative management (NOM) was undertaken in a third of patients, and only 14% of operated patients had a perioperative confirmation of -CoV-2 infection. The severity and morbidity of COVID-19-infected patients was much higher. Late presentations for medical care may have added to the high morbidity of the series.
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http://dx.doi.org/10.1007/s00068-020-01558-z | DOI Listing |
J Inflamm Res
December 2024
Shandong Provincial Clinical Research Center for Immune Diseases and Gout, Qingdao, People's Republic of China.
Purpose: Previous studies have linked high-density lipoprotein cholesterol (HDL-C) to gout, but little is known about the dose-effect relationship between serum HDL-C levels and gout flares. This study aimed to quantify the association between the two during urate-lowering therapy initiation and develop a regression equation to predict gout flares.
Patients And Methods: We conducted a prospective, observational, single-center cohort study of men with gout.
Cureus
December 2024
General Surgery, Sunshine Coast University Hospital, Birtinya, AUS.
Cholecystectomy is one of the most commonly performed surgical operations worldwide. A rare complication following this procedure is the migration of surgical clips used to secure the cystic duct and artery. Herein, we report the migration of a metallic surgical clip into the common bile duct of a 75-year-old gentleman who underwent a laparoscopic cholecystectomy 24 years prior.
View Article and Find Full Text PDFSalmonella infections are widely known to cause gastroenteritis, especially in areas of poor hygiene and sanitation. Common symptoms include sustained fever, chills, and abdominal pain. Sepsis, disseminated intravascular coagulation (DIC), various neurological manifestations, and multiorgan failure are other uncommon presentations.
View Article and Find Full Text PDFCureus
November 2024
Department of Nephrology, Toho University Sakura Medical Center, Sakura, JPN.
Hyperchloremic metabolic acidosis is a known complication following ileal conduit urinary diversion, often arising from urinary reabsorption in the ileum, which leads to chloride retention and bicarbonate loss and, though often asymptomatic, can produce clinically significant symptoms, particularly in patients with underlying renal impairment. A 75-year-old woman with a history of bladder cancer underwent cystectomy with ileal conduit diversion and presented on postoperative day 47 with anorexia, hypotension, and weight loss; laboratory findings revealed hyperchloremic metabolic acidosis with elevated serum chloride. The patient's acidosis gradually improved with sodium bicarbonate and Ringer's solution, stabilizing her blood pressure, creatinine, and acid-base balance, and she was discharged with outpatient follow-up.
View Article and Find Full Text PDFCureus
November 2024
Department of Otolaryngology, Rutgers University New Jersey Medical School, Newark, USA.
Introduction: Every year, 530,000 tonsillectomies are performed in the United States. Many patients use social media for medical advice and support. This study investigates Reddit perspectives to identify the current needs of tonsillectomy patients.
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