Introduction Although high rates of in-hospital mortality have been described in older patients undergoing emergency laparotomy (EL), less is known about longer-term outcomes in this population. We describe factors present at the time of hospital admission that influence 12-month survival in older patients. Methods Observational study of patients aged 75 years and over, who underwent EL at our hospital between 8th September 2014 and 30th March 2017. Results 113 patients were included. Average age was 81.9 ± 4.7 years, female predominance (60/113), 3 (2.6%) lived in a care home, 103 (91.2%) and 79 (69.1%) were independent of personal and instrumental activities of daily living (ADLs) and 8 (7.1%) had cognitive impairment. Median length of stay was 16 days ± 29.9 (0–269); in-hospital mortality 22.1% (25/113), post-operative 30-day, 90-day and 12-month mortality rates 19.5% (22), 24.8% (28) and 38.9% (44). 30-day and 12-month readmission rates 5.7% (5/88) and 40.9% (36). 12-month readmission was higher in frail patients, using the Clinical Frailty Scale (CFS) score (64% 5–8 vs 31.7% 1–4, p = 0.006). Dependency for personal ADLs (6/10 (60%) dependent vs. 38/103 (36.8%) independent, p = 0.119) and cognitive impairment (5/8 (62.5%) impaired vs. 39/105 (37.1%) no impairment, p = 0.116) showed a trend towards higher 12-month mortality. On multivariate analysis, 12-month mortality was strongly associated with CFS 5–9 (HR 5.0403 (95% CI 1.719–16.982) and ASA classes III–V (HR 2.704 95% CI 1.032–7.081). Conclusion Frailty and high ASA class predict increased mortality at 12 months after emergency laparotomy. We advocate early engagement of multi-professional teams experienced in perioperative care of older patients.

A review of the operation and pathology reports from 500 consecutive childhood appendicectomies by one surgeon revealed true acute appendicitis in 64% of patients, other pathology in 19.8% and normal operation findings and histology in 16.2%. When a normal appendix was found at operation, search of the adjacent peritoneal cavity produced a positive yield in 14% of searches. including abnormality in the small bowel in 4%. in the omentum or mesentery in 3% and in the female pelvic organs in 7%. Of appendices deemed normal by the surgeon 8.7% were histologically inflamed and of those deemed infldmed by the surgeon 3.5% were histologically normal. These figures emphasize the need for a more critical approach to the diagnosis of appendicitis both preand peroperatively and of the importance of histological examination of the organ.

currently lack rigorous methods for assessing surgical skill and often rely on biased tools of evaluation.OBJECTIVES To evaluate which techniques used in mastoidectomy can serve as indicators of surgeon level (defined as the level of training) and whether these determinations of technique can be made based solely on the movement of the drill head or suction. DESIGN, SETTING, AND PARTICIPANTSIn this prospective, observational study conducted from January 1, 2015, to December 31, 2019, at a single tertiary care institution, 3 independent observers made blinded evaluations on 24 intraoperative recordings of surgeons (6 junior residents, 4 senior residents, and 2 attending surgeons) performing mastoidectomies. MAIN OUTCOMES AND MEASURESObservers assessed drill stroke count, drilling efficiency, stroke pattern, use of suction and irrigation, and estimated surgeon level. Assessments were made on both original videos and animated videos that show only the path of the burr head or suction as dots against a white background. RESULTS Among the 24 recorded mastoidectomies performed by the 12 study surgeons, intraclass correlation was excellent for original video assessment of drill stroke count (0.98 [95% CI, 0.97-1.00]), use of suction (0.75 [95% CI, 0.52-0.89]), use of irrigation (0.83 [95% CI, 0.66-0.92]), and estimated surgeon level (0.82 [95% CI, 0.64-0.92]) and fair for drilling efficiency (0.54 [95% CI, 0.09-0.79]) and stroke pattern (0.49 [95% CI, −0.02 to 0.76]). Intraclass correlation was excellent for animated video assessment of drill stroke count per unit time (0.98 [95% CI, 0.96-0.99]) and drilling efficiency (0.80 [95% CI, 0.60-0.91]), good for stroke pattern (0.68 [95% CI,) and estimated surgeon level (based on path of drill) (0.69 [95% CI, 0.38-0.85]), and fair for use of suction (0.58 [95% CI, 0.16-0.80]) and estimated surgeon level (based on path of suction) (0.58 [95% CI, 0.17-0.80]). On evaluation of original videos, junior residents had lower drill stroke count compared with senior residents and attending surgeons (6.0 [interquartile range (IQR), 3.

ObjectiveTo measure surgical instrument movement during resident mastoidectomies and identify metrics that correlate with experience.Study DesignRetrospective case series.SettingTertiary care center.SubjectsTen postgraduate year (PGY) 2, 6 PGY3, 7 PGY4, and 19 PGY5 recordings of mastoidectomy performed by otolaryngology residents.InterventionsOne-minute intraoperative recordings of mastoidectomies performed during cochlear implantation were collected. Drill and suction-irrigator motion were analyzed with sports motion tracking software.Main Outcome MeasuresMean instrument speed, angle, and angular velocity were calculated. Mann-Whitney U tests compared mean instrument metrics between PGY levels. Change in drill speed for seven residents between their PGY2 to PGY5 years was individually analyzed.ResultsMean drill speed was significantly greater for PGY5 residents compared with PGY2s (2.9 versus 1.8 cm/s, p = 0.001). Compared with PGY2 residents, suction speed was greater as a PGY5 (1.2 versus 0.9 cm/s; p = 0.201) and significantly greater as a PGY4 (1.5 versus 0.9 cm/s, p = 0.039). Of the seven residents individually analyzed, group mean drill speed increased by 0.4 cm/s, yearly.ConclusionsDrill and suction-irrigator movement during the second minute of drilling of a cortical mastoidectomy seems to increase with resident level. Objective video analysis is a potential adjunct for differentiating novices from more experienced surgeons and monitoring surgical skills progress.

No abstract