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  1. Article ; Online: Procedure Risk vs Frailty in Outcomes for Elderly Emergency General Surgery Patients: Results of a National Analysis.

    Zakhary, Bishoy / Coimbra, Bruno C / Kwon, Junsik / Allison-Aipa, Timothy / Firek, Matthew / Coimbra, Raul

    Journal of the American College of Surgeons

    2024  

    Abstract: Background: The direct association between procedure risk and outcomes in elderly emergency general surgery (EGS) patients has not been analyzed. Studies only highlight the importance of frailty. A comprehensive analysis of relevant risk factors and ... ...

    Abstract Background: The direct association between procedure risk and outcomes in elderly emergency general surgery (EGS) patients has not been analyzed. Studies only highlight the importance of frailty. A comprehensive analysis of relevant risk factors and their association with outcomes in elderly EGS patients is lacking. We hypothesized that procedure risk has a stronger association with relevant outcomes in elderly EGS patients compared to frailty.
    Study design: Elderly patients (age > 65) undergoing emergency general surgery operative procedures were identified in the NSQIP) database (2018 to 2020) and stratified based on the presence of frailty calculated by the Modified 5 Item Frailty Index (mFI-5; mFI 0 Non-Frail, mFI 1-2 Frail, and mFI ≥3 Severely Frail) and based on procedure risk. Multivariable regression models and Receiving Operative Curve (ROC) analysis were used to determine risk factors associated with outcomes.
    Results: A total of 59,633 elderly EGS patients were classified into non-frail (17,496; 29.3%), frail (39,588; 66.4%), and severely frail (2,549; 4.3%). There were 25,157 patients in the low-risk procedure group and 34,476 in the high-risk group.Frailty and procedure risk were associated with increased mortality, complications, failure to rescue, and readmissions. Differences in outcomes were greater when patients were stratified according to procedure risk compared to frailty stratification alone. Procedure risk had a stronger association with relevant outcomes in elderly EGS patients compared to frailty.
    Conclusions: Assessing frailty in the elderly EGS patient population without adjusting for the type of procedure or procedure risk ultimately presents an incomplete representation of how frailty impacts patient-related outcomes.
    Language English
    Publishing date 2024-04-25
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1181115-8
    ISSN 1879-1190 ; 1072-7515
    ISSN (online) 1879-1190
    ISSN 1072-7515
    DOI 10.1097/XCS.0000000000001079
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Endovascular repair is a feasible option for superficial femoral artery injuries: a comparative effectiveness analysis.

    Degmetich, Sean / Brenner, Megan / Firek, Matthew / Zakhary, Bishoy / Coimbra, Bruno C / Coimbra, Raul

    European journal of trauma and emergency surgery : official publication of the European Trauma Society

    2020  Volume 48, Issue 1, Page(s) 321–328

    Abstract: Purpose: To compare outcomes between open (OR) and endovascular repair following superficial femoral artery (SFA) injuries.: Methods: This is a cross-sectional study querying the 2012-2014 National Inpatient Sample for SFA injuries. Patients were ... ...

    Abstract Purpose: To compare outcomes between open (OR) and endovascular repair following superficial femoral artery (SFA) injuries.
    Methods: This is a cross-sectional study querying the 2012-2014 National Inpatient Sample for SFA injuries. Patients were grouped into OR and stent-graft placement (SGP). Primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay (HLOS), fasciotomy and amputation rate, and cost. Wilcoxon rank-sum, Kruskal-Wallis, Chi-squared test with Bonferroni adjustment were used as appropriate; p < 0.05 was significant.
    Results: 255 Patients were identified. Mean age was 34.6 years and majority were males. OR was performed in 82.7%. Overall mortality rate was 3.7%. Median HLOS was 8 days. Fasciotomies were performed in 31% and lower limb amputations in 3.7%. Males more often underwent OR (89.0% vs. 73.1%, p < 0.01). SGP patients were significantly older (44.9 vs. 32.5 years; p < 0.01), and with Medicare insurance (20.5% vs. 6.5%; p < 0.01. Mortality, HLOS, and hospitalization cost were not significantly different. OR patients had higher rate of fasciotomy (35.4% vs. 15.4%; p < 0.01).
    Conclusions: Endovascular management is not inferior to OR following SFA injuries and both carry a low amputation rate. OR is associated with a higher fasciotomy rate. Endovascular repair should be considered when technically feasible.
    MeSH term(s) Adult ; Aged ; Amputation ; Cross-Sectional Studies ; Endovascular Procedures ; Femoral Artery/surgery ; Humans ; Limb Salvage ; Male ; Medicare ; Retrospective Studies ; Risk Factors ; Treatment Outcome ; United States/epidemiology
    Language English
    Publishing date 2020-11-05
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 2275480-5
    ISSN 1863-9941 ; 1863-9933
    ISSN (online) 1863-9941
    ISSN 1863-9933
    DOI 10.1007/s00068-020-01536-5
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    Zs.MO 607: Show issues

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  3. Article ; Online: Lights off, camera on! Laparoscopic cholecystectomy improves outcomes in cirrhotic patients with acute cholecystitis.

    Finco, Tiago / Firek, Matthew / Coimbra, Bruno C / Brenner, Megan / Coimbra, Raul

    Journal of hepato-biliary-pancreatic sciences

    2020  Volume 29, Issue 3, Page(s) 338–348

    Abstract: Background: The best surgical approach to treat acute cholecystitis (AC) in cirrhotic patients is controversial. This study aimed to evaluate treatment options in cirrhotic patients with AC. We hypothesized that laparoscopic cholecystectomy (LC) would ... ...

    Abstract Background: The best surgical approach to treat acute cholecystitis (AC) in cirrhotic patients is controversial. This study aimed to evaluate treatment options in cirrhotic patients with AC. We hypothesized that laparoscopic cholecystectomy (LC) would lead to better clinical outcomes when compared to non-operative management (NOM) and open cholecystectomy (OC), independent of the severity of liver cirrhosis.
    Methods: Patients from the National Inpatient Sample diagnosed with AC were stratified into no cirrhosis (NC), compensated cirrhosis (CC), and decompensated cirrhosis (DC) and analyzed according to treatment: NOM, OC, and LC. Primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay (HLOS), cost, and surgical complications. Univariate and multivariate analyses using generalized linear models were performed. A P < 0.05 was deemed significant.
    Results: Of 1 367 495 AC patients, 49 030 (3.6%) had cirrhosis; 23 260 had CC, and 25 770 had DC. LC (12 080 in CC group and 4840 in DC group) was accompanied by significantly lower mortality, HLOS, complications, and cost when compared to OC and NOM. OC was significantly associated with higher mortality, increased HLOS, total cost, and postoperative complications, independent of the presence or severity of cirrhosis.
    Conclusions: LC in cirrhotic patients leads to superior outcomes compared to OC and NOM regardless of the severity of cirrhosis.
    MeSH term(s) Cholecystectomy/adverse effects ; Cholecystectomy, Laparoscopic/adverse effects ; Cholecystitis, Acute/etiology ; Cholecystitis, Acute/surgery ; Humans ; Length of Stay ; Liver Cirrhosis/complications ; Liver Cirrhosis/surgery ; Postoperative Complications/surgery ; Treatment Outcome
    Language English
    Publishing date 2020-11-10
    Publishing country Japan
    Document type Journal Article
    ZDB-ID 2536236-7
    ISSN 1868-6982 ; 1868-6974
    ISSN (online) 1868-6982
    ISSN 1868-6974
    DOI 10.1002/jhbp.852
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  4. Article ; Online: European Society of Trauma and Emergency Surgery (ESTES) recommendations for trauma and emergency surgery preparation during times of COVID-19 infection.

    Coimbra, Raul / Edwards, Sara / Kurihara, Hayato / Bass, Gary Alan / Balogh, Zsolt J / Tilsed, Jonathan / Faccincani, Roberto / Carlucci, Michele / Martínez Casas, Isidro / Gaarder, Christine / Tabuenca, Arnold / Coimbra, Bruno C / Marzi, Ingo

    European journal of trauma and emergency surgery : official publication of the European Trauma Society

    2020  Volume 46, Issue 3, Page(s) 505–510

    Abstract: A series of recommendations regarding hospital perioperative preparation for the COVID-19 pandemic were compiled to inform surgeons worldwide on how to provide emergency surgery and trauma care during enduring times.The recommendations are divided into ... ...

    Abstract A series of recommendations regarding hospital perioperative preparation for the COVID-19 pandemic were compiled to inform surgeons worldwide on how to provide emergency surgery and trauma care during enduring times.The recommendations are divided into eight domains: (1) General recommendation for surgical services; (2) Emergency Surgery for critically ill COVID-19 positive or suspected patients -Preoperative planning and case selection; (3) Operating Room setup; (4) patient transport to the OR; (5) Surgical staff preparation; (6) Anesthesia considerations; (7) Surgical approach; and (8) Case Completion.The European Society of Emergency Surgery board endorsed these recommendations.
    MeSH term(s) Betacoronavirus/isolation & purification ; COVID-19 ; Comorbidity ; Coronavirus Infections/diagnosis ; Coronavirus Infections/epidemiology ; Emergency Treatment/methods ; Humans ; Infection Control/methods ; Pandemics ; Perioperative Care/methods ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/epidemiology ; SARS-CoV-2 ; Surgical Procedures, Operative/methods ; Wounds and Injuries/epidemiology ; Wounds and Injuries/surgery
    Keywords covid19
    Language English
    Publishing date 2020-04-17
    Publishing country Germany
    Document type Journal Article ; Review
    ZDB-ID 2275480-5
    ISSN 1863-9941 ; 1863-9933
    ISSN (online) 1863-9941
    ISSN 1863-9933
    DOI 10.1007/s00068-020-01364-7
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: European Society of Trauma and Emergency Surgery (ESTES) recommendations for trauma and emergency surgery preparation during times of COVID-19 infection

    Coimbra, Raul / Edwards, Sara / Kurihara, Hayato / Bass, Gary Alan / Balogh, Zsolt J / Tilsed, Jonathan / Faccincani, Roberto / Carlucci, Michele / Martínez Casas, Isidro / Gaarder, Christine / Tabuenca, Arnold / Coimbra, Bruno C / Marzi, Ingo

    Eur J Trauma Emerg Surg

    Abstract: A series of recommendations regarding hospital perioperative preparation for the COVID-19 pandemic were compiled to inform surgeons worldwide on how to provide emergency surgery and trauma care during enduring times.The recommendations are divided into ... ...

    Abstract A series of recommendations regarding hospital perioperative preparation for the COVID-19 pandemic were compiled to inform surgeons worldwide on how to provide emergency surgery and trauma care during enduring times.The recommendations are divided into eight domains: (1) General recommendation for surgical services; (2) Emergency Surgery for critically ill COVID-19 positive or suspected patients -Preoperative planning and case selection; (3) Operating Room setup; (4) patient transport to the OR; (5) Surgical staff preparation; (6) Anesthesia considerations; (7) Surgical approach; and (8) Case Completion.The European Society of Emergency Surgery board endorsed these recommendations.
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #72258
    Database COVID19

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  6. Article ; Online: European Society of Trauma and Emergency Surgery (ESTES) recommendations for trauma and emergency surgery preparation during times of COVID-19 infection

    Coimbra, Raul / Edwards, Sara / Kurihara, Hayato / Bass, Gary Alan / Balogh, Zsolt J. / Tilsed, Jonathan / Faccincani, Roberto / Carlucci, Michele / Martínez Casas, Isidro / Gaarder, Christine / Tabuenca, Arnold / Coimbra, Bruno C. / Marzi, Ingo

    European Journal of Trauma and Emergency Surgery

    2020  Volume 46, Issue 3, Page(s) 505–510

    Keywords Surgery ; Critical Care and Intensive Care Medicine ; Emergency Medicine ; Orthopedics and Sports Medicine ; covid19
    Language English
    Publisher Springer Science and Business Media LLC
    Publishing country us
    Document type Article ; Online
    ZDB-ID 2275480-5
    ISSN 1863-9941 ; 1863-9933
    ISSN (online) 1863-9941
    ISSN 1863-9933
    DOI 10.1007/s00068-020-01364-7
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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