General Surgical Emergencies

McCord, Colin; Ozgediz, Doruk; Beard, Jessica H.; Debas, Haile T.

doi:10.1596/978-1-4648-0346-8_ch4

Cited by 26 publications

(22 citation statements)

References 36 publications

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“…In low and middle income countries (LMICs), studies has showed that at least 60 percent of the surgical operations are performed for emergency patients [9]. Our study also showed 61% of all major operations performed were for emergency conditions.…”

Section: Discussionsupporting

confidence: 68%

Audit of surgical services in a teaching hospital in Addis Ababa, Ethiopia

Gebresellassie¹,

Tamerat²

2019

BMC Res Notes

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ObjectiveThe aim of the study is descriptively analyze services in terms of surgical care, performance and outcome in department of surgery of ZMH which is a university affiliated general hospital in Addis Ababa, Ethiopia. Data on mode of admission, procedures done and outcome were collected from a monthly audit report, patients file. Information on the number of operating days missed and patients cancelled after being scheduled for surgery were collected from OR logo book.ResultEmergency operations constitute 57.4% of all operations. Appendectomy is the commonest emergency operation accounting for 41.5%. Thyroid and gallbladder surgeries were the most common elective operations accounting for 23.5% and 22% respectively. There were 26 and 2 deaths from the emergency and elective operations making the postoperative mortality rate of 2.8% and 0.02% respectively. The average hospital stay of a patient is 3.74 days. 23 of 211 (14.7%) operation dates were missed for various reasons. 81 of 693 (11.7%) elective operations were not done the first time they were scheduled. In conclusion this study showed emergency surgery out number elective surgeries, unacceptably high number of operation days are missed and scheduled surgeries are cancelled.

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Section: Discussionsupporting

confidence: 68%

Audit of surgical services in a teaching hospital in Addis Ababa, Ethiopia

Gebresellassie¹,

Tamerat²

2019

BMC Res Notes

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“… 1 2 In low-income and middle-income countries, this figure rises to 60%. 3 Current evidence shows patients undergoing emergency surgery are three times more likely to die than those undergoing elective surgery. For those who survive, they are twice as likely to suffer a complication.…”

Section: Introductionmentioning

confidence: 99%

Registration and publication of emergency and elective randomised controlled trials in surgery: a cohort study from trial registries

et al. 2018

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ObjectivesEmergency surgical practice constitutes 50% of the workload for surgeons, but there is a lack of high quality randomised controlled trials (RCTs) in emergency surgery. This study aims to establish the differences between the registration, completion and publication of emergency and elective surgical trials.DesignThe clinicaltrials.gov and ISRCTN.com trials registry databases were searched for RCTs between 12 July 2010 and 12 July 2012 using the keyword ‘surgery’. Publications were systematically searched for in Pubmed, MEDLINE and EMBASE.ParticipantsResults with no surgical interventions were excluded. The remaining results were manually categorised into ‘emergency’ or ‘elective’ and ‘surgical’ or ‘adjunct’ by two reviewers.Primary outcome measuresNumber of RCTs registered in emergency versus elective surgery.Secondary outcome measuresNumber of RCTs published in emergency versus elective surgery; reasons why trials remain unpublished; funding, sponsorship and impact of published articles; number of adjunct trials registered in emergency and elective surgery.Results2700 randomised trials were registered. 1173 trials were on a surgical population and of these, 414 trials were studying surgery. Only 9.4% (39/414) of surgical trials were in emergency surgery. The proportion of trials successfully published did not significantly differ between emergency and elective surgery (0.46 vs 0.52; mean difference (MD) −0.06, 95% CI −0.24 to 0.12). Unpublished emergency surgical trials were statistically equally likely to be terminated early compared with elective trials (0.33 vs 0.16; MD −0.18, 95% CI −0.06 to 0.41). Low accrual accounted for a similar majority in both groups (0.43 vs 0.46; MD −0.04, 95% CI −0.48 to 0.41). Unpublished trials in both groups were statistically equally likely to still be planning publication (0.52 vs 0.71; MD −0.18, 95% CI −0.43 to 0.07).ConclusionFewer RCTs are registered in emergency than elective surgery. Once trials are registered both groups are equally likely to be published.

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“…These addresses were added to lists and differentiated per federal state. From each list, 80 surgeons from first- and second-level hospitals (level I and II [community/general/regional hospitals]) and 20 surgeons from third-level hospitals (level III [central/University hospitals]) were randomly selected using the Microsoft Excel® function RANDBETWEEN(X;Y) [15]. The list of surgeons from “Bremen” was incorporated into “Lower Saxonia.” Another 80 + 20 surgeons were accordingly selected from hospitals in Germany’s 5 largest metropolitan areas (MET): Berlin, Munich, Hamburg, Cologne, and Frankfurt.…”

Section: Methodsmentioning

confidence: 99%

Nonoperative Antibiotic Treatment of Appendicitis in Adults: A Survey among Clinically Active Surgeons

et al. 2020

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Background: As a result of well-publicized studies, the nonsurgical antibiotic therapy of uncomplicated acute appendicitis has been propagated since 2006. A final assessment regarding efficiency and long-term results is not possible; however, nonoperative therapy of acute appendicitis is actually being discussed more diversely and receives a lot of attention. It is still unknown how far this therapy has found its way into everyday clinical care. Methods: An online questionnaire was sent to 1,400 randomly selected specialists for general/visceral surgery in Germany. Representativeness was achieved by a preselection according to the geographical origin and the care level of the hospitals. Results: 14% of surgeons stated that they methodically treat appendicitis conservatively. 38.1% do so in exceptional cases, while 48.8% reject this therapy. For methodically use, sonography or computed tomography is demanded beforehand. Nonoperative therapy is performed more often in metropolitan areas and maximum-care/university hospitals. Patients' request for antibiotic therapy is an important factor for conservative treatment. The main argument against this therapy is "medical doubts." 26% of the surgeons would treat their own appendicitis conservatively. There are distinct associations between the application of conservative therapy, satisfaction with it, and expectations about future development. The response rate was 19.9%. Conclusion: The nonoperative antibiotic therapy of appendicitis is part of clinical practice in Germany. There are differences in preconditions as well as in the acceptance of this therapeutic option with a high proportion of general rejection.

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General Surgical Emergencies

Cited by 26 publications

References 36 publications

Audit of surgical services in a teaching hospital in Addis Ababa, Ethiopia

Audit of surgical services in a teaching hospital in Addis Ababa, Ethiopia

Registration and publication of emergency and elective randomised controlled trials in surgery: a cohort study from trial registries

Nonoperative Antibiotic Treatment of Appendicitis in Adults: A Survey among Clinically Active Surgeons

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