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Article ; Online: Management of acute diverticulitis in Stage 0-IIb: indications and risk factors for failure of conservative treatment in a series of 187 patients.

Agnes, Amedea L / Agnes, Annamaria / Di Grezia, Marta / Giambusso, Mauro / Savia, Eleonora / Grieco, Michele / Cozza, Valerio / Magalini, Sabina / Sganga, Gabriele

Scientific reports

2024 Volume 14, Issue 1, Page(s) 1501

Abstract: Left-sided acute diverticulitis in WSES Stage 0-IIb preferentially undergoes conservative management. However, there is limited understanding of the risk factors for failure of this approach. The aim of this study was to investigate the factors ... ...

Abstract	Left-sided acute diverticulitis in WSES Stage 0-IIb preferentially undergoes conservative management. However, there is limited understanding of the risk factors for failure of this approach. The aim of this study was to investigate the factors associated with the decision to perform conservative treatment as well as the predictors of its failure. We included patients with a diagnosis of WSES diverticulitis CT-driven classification Stage 0-IIb treated in the Emergency Surgery Unit of the Agostino Gemelli University Hospital Foundation between 2014 and 2020. The endpoints were the comparison between the characteristics and clinical outcomes of acute diverticulitis patients undergoing conservative versus operative treatment. We also identified predictors of conservative treatment failure. A set of multivariable backward logistic analyses were conducted for this purpose. The study included 187 patients. The choice for operative versus conservative treatment was associated with clinical presentation, older age, higher WSES grade, and previous conservative treatment. There were 21% who failed conservative treatment. Of those, major morbidity and mortality rates were 17.9% and 7.1%, respectively. A previously failed conservative treatment as well as a greater WSES grade and a lower hemoglobin value were significantly associated with failure of conservative treatment. WSES classification and hemoglobin value at admission were the best predictors of failure of conservative treatment. Patients failing conservative treatment had non-negligible morbidity and mortality. These results promote the consideration of a combined approach including baseline patients' characteristics, radiologic features, and laboratory biomarkers to predict conservative treatment failure and therefore optimize treatment of acute diverticulitis.
MeSH term(s)	Humans ; Conservative Treatment/methods ; Diverticulitis/therapy ; Diverticulitis/complications ; Risk Factors ; Treatment Failure ; Hemoglobins ; Retrospective Studies
Chemical Substances	Hemoglobins
Language	English
Publishing date	2024-01-17
Publishing country	England
Document type	Journal Article
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-024-51526-5
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Article ; Online: Prediction of postoperative nausea and vomiting by point-of-care gastric ultrasound: can we improve complications and length of stay in emergency surgery? A cohort study.

Cozza, Valerio / Barberis, Lorenzo / Altieri, Gaia / Donatelli, Mario / Sganga, Gabriele / La Greca, Antonio

BMC anesthesiology

2021 Volume 21, Issue 1, Page(s) 211

Abstract: Background: Postoperative nausea and vomiting and postoperative ileus are common after major digestive surgery and represent one of the significant problems in Acute Care Surgery. The delivery model of emergency surgery needs to be improved in order to ... ...

Abstract	Background: Postoperative nausea and vomiting and postoperative ileus are common after major digestive surgery and represent one of the significant problems in Acute Care Surgery. The delivery model of emergency surgery needs to be improved in order to foster a patient-centered care. The multimodal approach suggested by Enhanced Recovery After Surgery (ERAS®) Guidelines is gaining widespread acceptance but is difficult to apply to emergency surgery. Ultrasound examination of the gastric antrum allows a reliable assessment of gastric contents and volume and might help contribute to improve perioperative care in the emergency setting. Methods: Gastric ultrasound examinations were performed preoperatively and postoperatively on forty-one patients undergoing emergency abdominal surgery. Gastric cross-sectional area (CSA) was measured, in order to estimate the gastric volume. The data obtained were used to evaluate a possible relationship between delayed gastric emptying and postoperative adverse event. Results: Gastric antrum detection rate varied from 31.8% in open up to 78.9% in laparoscopic surgeries (p = 0.003). Six patients experienced adverse outcomes, had an antiemetic therapy administered and/or a nasogastric tube inserted. Mean CSA was significantly higher in this group (12.95 cm Conclusions: Sensitivity of gastric ultrasound varies depending on surgical technique. A dilated gastric antrum is significantly related to postoperative adverse outcomes and a careful ultrasound follow-up might help tailor postoperative nutrition and antiemetic therapy. In patients who experienced adverse events, antral CSA showed an average increase of more than 50% over a period of 72 h after surgery. A relative measure could be used to predict the risk of postoperative ileus. Overall, gastric ultrasound seems to be a promising diagnostic tool and a useful way to integrate ERAS® protocol in emergency abdominal surgery.
MeSH term(s)	Abdomen/surgery ; Aged ; Algorithms ; Antiemetics/therapeutic use ; Cohort Studies ; Emergencies ; Feasibility Studies ; Female ; Gastrointestinal Contents/diagnostic imaging ; Humans ; Intubation, Gastrointestinal ; Length of Stay ; Male ; Middle Aged ; Point-of-Care Systems ; Postoperative Nausea and Vomiting/prevention & control ; Risk Assessment ; Stomach/diagnostic imaging ; Ultrasonography
Chemical Substances	Antiemetics
Language	English
Publishing date	2021-08-31
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1471-2253
ISSN (online)	1471-2253
DOI	10.1186/s12871-021-01428-0
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Article ; Online: Are emergency surgical patients "collateral victims" of COVID-19 outbreak?

Fransvea, Pietro / Di Grezia, Marta / La Greca, Antonio / Cozza, Valerio / Sganga, Gabriele

Injury

2020 Volume 51, Issue 10, Page(s) 2330–2331

MeSH term(s)	Betacoronavirus ; COVID-19 ; Coronavirus Infections/epidemiology ; Emergency Service, Hospital/statistics & numerical data ; Humans ; Pandemics ; Pneumonia, Viral/epidemiology ; SARS-CoV-2 ; Surgery Department, Hospital/organization & administration ; Surgical Procedures, Operative/statistics & numerical data
Keywords	covid19
Language	English
Publishing date	2020-06-24
Publishing country	Netherlands
Document type	Letter
ZDB-ID	218778-4
ISSN	1879-0267 ; 0020-1383
ISSN (online)	1879-0267
ISSN	0020-1383
DOI	10.1016/j.injury.2020.06.038
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Zs.A 778: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Spread and feasibility of non-operative management (NOM) of traumatic splenic injuries in adults: a national survey.

Visconti, Diego / Parini, Dario / Mariani, Diego / Biloslavo, Alan / Bellio, Gabriele / Ceolin, Martina / Cozza, Valerio / Musetti, Serena / Pivetta, Emanuele / Kurihara, Hayato / Zago, Mauro / Santarelli, Mauro / Chiarugi, Massimo

Updates in surgery

2023 Volume 76, Issue 1, Page(s) 245–253

Abstract: In hemodynamically stable adults sustaining a splenic trauma, non-operative management (NOM) represents the standard approach even in high-severity injuries. However, knowledge, structural, and logistic limitations still reduce its wider diffusion. This ... ...

Abstract	In hemodynamically stable adults sustaining a splenic trauma, non-operative management (NOM) represents the standard approach even in high-severity injuries. However, knowledge, structural, and logistic limitations still reduce its wider diffusion. This study aims to identify such issues to promote the safe and effective management of these injuries.A survey was developed using the SurveyMonkey
MeSH term(s)	Adult ; Humans ; Feasibility Studies ; Wounds, Nonpenetrating/diagnostic imaging ; Wounds, Nonpenetrating/therapy ; Spleen/diagnostic imaging ; Spleen/injuries ; Abdominal Injuries ; Tomography, X-Ray Computed ; Retrospective Studies
Language	English
Publishing date	2023-12-16
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2572692-4
ISSN	2038-3312 ; 2038-131X
ISSN (online)	2038-3312
ISSN	2038-131X
DOI	10.1007/s13304-023-01718-x
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Article: Management of Acute Cholecystitis in High-Risk Patients: Percutaneous Gallbladder Drainage as a Definitive Treatment vs. Emergency Cholecystectomy-Systematic Review and Meta-Analysis.

Cirocchi, Roberto / Amato, Lavinia / Ungania, Serena / Buononato, Massimo / Tebala, Giovanni Domenico / Cirillo, Bruno / Avenia, Stefano / Cozza, Valerio / Costa, Gianluca / Davies, Richard Justin / Sapienza, Paolo / Coccolini, Federico / Mingoli, Andrea / Chiarugi, Massimo / Brachini, Gioia

Journal of clinical medicine

2023 Volume 12, Issue 15

Abstract: Background: This systematic review aims to investigate whether percutaneous transhepatic gallbladder biliary drainage (PTGBD) is superior to emergency cholecystectomy (EC) as a definitive treatment in high-risk patients with acute cholecystitis (AC).: ...

Abstract	Background: This systematic review aims to investigate whether percutaneous transhepatic gallbladder biliary drainage (PTGBD) is superior to emergency cholecystectomy (EC) as a definitive treatment in high-risk patients with acute cholecystitis (AC). Material and methods: A systematic literature search was performed until December 2022 using the Scopus, Medline/PubMed and Web of Science databases. Results: Seventeen studies have been included with a total of 783,672 patients (32,634 treated with PTGBD vs. 4663 who underwent laparoscopic cholecystectomy, 343 who had open cholecystectomy and 746,032 who had some form of cholecystectomy, but without laparoscopic or open approach being specified). An analysis of the results shows that PTGBD, despite being less invasive, is not associated with lower morbidity with respect to EC (RR 0.77 95% CI [0.44 to 1.34]; I Conclusions: In our systematic review, the majority of studies have very low-quality evidence and more RCTs are needed; furthermore, PTGBD is inferior in the treatment of AC in high-risk patients. The definition of high-risk patients is important in interpreting the results, but the methods of assessment and definitions differ between studies. The results of our systematic review and meta-analysis failed to demonstrate any advantage of using PTGBD over ER as a definitive treatment of AC in critically ill patients, which suggests that EC should be considered as the treatment of choice even in very high-risk patients. Most likely, the inferiority of PTGBD versus early LC for high-risk patients is related to an association of various patient-side factor conditions and the severity of acute cholecystitis.
Language	English
Publishing date	2023-07-26
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12154903
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Article ; Online: Clinical-pathological features and treatment of acute appendicitis in the very elderly: an interim analysis of the FRAILESEL Italian multicentre prospective study.

Fransvea, Pietro / Fico, Valeria / Cozza, Valerio / Costa, Gianluca / Lepre, Luca / Mercantini, Paolo / La Greca, Antonio / Sganga, Gabriele

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

2021 Volume 48, Issue 2, Page(s) 1177–1188

Abstract: Background: Emergency abdominal surgery in the elderly represents a global issue. Diagnosis of AA in old patients is often more difficult. Appendectomy remains the gold standard of treatment and, even though it is performed almost exclusively with a ... ...

Abstract	Background: Emergency abdominal surgery in the elderly represents a global issue. Diagnosis of AA in old patients is often more difficult. Appendectomy remains the gold standard of treatment and, even though it is performed almost exclusively with a minimally invasive technique, it can still represent a great risk for the elderly patient, especially above 80 years of age. A careful selection of elderly patients to be directed to surgery is, therefore, fundamental. The primary aim was to critically appraise and compare the clinical-pathological characteristics and the outcomes between oldest old (≥ 80 years) and elderly (65-79 years) patients with Acute Appendicitis (AA). Methods: The FRAILESEL is a large, nationwide, multicentre, prospective study investigating the perioperative outcomes of patients aged ≥ 65 years who underwent emergency abdominal surgery. Particular focus has been directed to the clinical and biochemical presentation as well as to the need for operative procedures, type of surgical approach, morbidity and mortality, and in-hospital length of stay. Two multivariate logistic regression analyses were performed to assess perioperative risk factors for morbidity and mortality. Results: 182 patients fulfilled the inclusion criteria. Mean age, ileocecal resection, OAD and ASA score ≥ 3 were related with both overall and major complication. The multivariate analysis showed that MPI and complicated appendicitis were independent factors associated with overall complications. OAD and ASA scores ≥ 3 were independent factors for both overall and major complications. Conclusions: Age ≥ 80 years is not an independent risk factor for morbidities. POCUS is safe and effective for the diagnosis; however, a CECT is often needed. Having the oldest old a smaller functional organ reserve, an earlier intervention should be considered especially because they often show a delay in presentation and frequently exhibit a complicated appendicitis.
MeSH term(s)	Acute Disease ; Aged ; Aged, 80 and over ; Appendectomy/methods ; Appendicitis/complications ; Humans ; Laparoscopy/methods ; Length of Stay ; Postoperative Complications/surgery ; Prospective Studies ; Retrospective Studies
Language	English
Publishing date	2021-03-18
Publishing country	Germany
Document type	Journal Article ; Multicenter Study
ZDB-ID	2275480-5
ISSN	1863-9941 ; 1863-9933
ISSN (online)	1863-9941
ISSN	1863-9933
DOI	10.1007/s00068-021-01645-9
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Zs.A 1221: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Early Procalcitonin Assessment in the Emergency Department in Patients with Intra-Abdominal Infection: An Excess or a Need?

Covino, Marcello / Fransvea, Pietro / Rosa, Fausto / Cozza, Valerio / Quero, Giuseppe / Simeoni, Benedetta / Gasbarrini, Antonio / Alfieri, Sergio / Franceschi, Francesco / Sganga, Gabriele

Surgical infections

2021 Volume 22, Issue 8, Page(s) 787–796

Abstract: Background: ...

Abstract	Background:
MeSH term(s)	Biomarkers ; Emergency Service, Hospital ; Hospital Mortality ; Humans ; Intraabdominal Infections/diagnosis ; Procalcitonin ; Prognosis ; Retrospective Studies ; Sepsis/diagnosis
Chemical Substances	Biomarkers ; Procalcitonin
Language	English
Publishing date	2021-02-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	1440120-4
ISSN	1557-8674 ; 1096-2964
ISSN (online)	1557-8674
ISSN	1096-2964
DOI	10.1089/sur.2020.373
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Article ; Online: Gastric emergencies in older adults: not always the same old story! A tertiary care emergency department observational cohort study.

Rosa, Fausto / Covino, Marcello / Fransvea, Pietro / Cozza, Valerio / Quero, Giuseppe / Fiorillo, Claudio / Simeoni, Benedetta / La Greca, Antonio / Sganga, Gabriele / Gasbarrini, Antonio / Franceschi, Francesco / Costamagna, Guido / Alfieri, Sergio

BMJ open

2022 Volume 12, Issue 1, Page(s) e056981

Abstract: Objective: To analyse and compare the clinical outcomes between patients ≥80 years and 65-79 years, who presented to our emergency department (ED) with the two most common gastric emergency (GE) clinical presentation, that is, gastric bleeding and ... ...

Abstract	Objective: To analyse and compare the clinical outcomes between patients ≥80 years and 65-79 years, who presented to our emergency department (ED) with the two most common gastric emergency (GE) clinical presentation, that is, gastric bleeding and gastric perforation. Design: Single-centre retrospective cohort study. Participants: A total of 1011 patients were enrolled: 421 patients aged ≥80 years were compared with a group of 590 patients aged 65-79 years. Primary and secondary outcome measures: The primary outcome was to compare the overall mortality. Secondary outcomes included major complications, in-hospital length of stay (LOS) and need for surgical procedures. Results: Patients ≥80 years with GE had different presentations at ED compared with younger patients: they had higher gastrointestinal bleeding (24.9% vs 16.3%, p=0.001), anemisation (14.5% vs 8.8%, p Conclusions: Patients ≥80 years with GE did not have a higher mortality rate and cumulative major complications as compared to younger elderly patients. Invasive treatments were not associated with a different prognosis in this age group.
MeSH term(s)	Aged ; Aged, 80 and over ; Cohort Studies ; Emergencies ; Emergency Service, Hospital ; Humans ; Length of Stay ; Retrospective Studies ; Tertiary Healthcare
Language	English
Publishing date	2022-01-25
Publishing country	England
Document type	Journal Article ; Observational Study
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2021-056981
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Article: Percutaneous cholecystostomy as bridge to surgery vs surgery in unfit patients with acute calculous cholecystitis: A systematic review and meta-analysis.

Cirocchi, Roberto / Cozza, Valerio / Sapienza, Paolo / Tebala, Gianni / Cianci, Maria Chiara / Burini, Gloria / Costa, Gianluca / Coccolini, Federico / Chiarugi, Massimo / Mingoli, Andrea

The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

2022 Volume 21, Issue 4, Page(s) e201–e223

Abstract: Background: Acute cholecystitis is one of the most common causes of acute abdomen. Early laparoscopic cholecystectomy is the gold standard treatment, still burdened by a risk of intraoperative biliary duct injury. An alternative strategy to manage ... ...

Abstract	Background: Acute cholecystitis is one of the most common causes of acute abdomen. Early laparoscopic cholecystectomy is the gold standard treatment, still burdened by a risk of intraoperative biliary duct injury. An alternative strategy to manage patients with severe acute cholecystitis is the percutaneous gallbladder drainage (PGBD). Methods: The Italian Society of Emergency Surgery and Trauma performed a systematic review and meta-analysis with the aim to clarify controversies about the preoperative use of PGBD. We extracted 32 studies: 9 Randomized Control Trial Studies (RCTs) and 23 no RCTs. Results of critical outcomes: The incidence of post-operative complications was lower in the PGBD associated at LC than in the LC alone (RCTs: RR 0.28, 95% CI 0.14 to 0.56, I2 = 63%). The incidence of the post-operative biliary leakage was higher in late PGBD' group (RCTs: RR 0.18, 95% CI 0.04 to 0.80). Results of other outcomes: The incidence of intraabdominal abscess, blood loss, conversion to open, subtotal cholecystectomy, operative time and wound infection was lower in PGBD' group. The total hospital stay was the same. Conclusion: A strong recommendation is performed to the use of the PGBD + LC than upfront LC to reduce biliary leakage (recommendation "strong positive") in high risk acute cholecystitis especially in patients with higher perioperative risks or longstanding acute cholecystitis. For post-operative complications a recommendation "positive weak" suggests that PGBD + LC could be used than upfront LC to reduce the rate of post-operative complications.
MeSH term(s)	Humans ; Cholecystostomy ; Cholecystitis, Acute/surgery ; Cholecystectomy/adverse effects ; Cholecystectomy, Laparoscopic/adverse effects ; Drainage/methods ; Postoperative Complications/etiology ; Treatment Outcome ; Retrospective Studies
Language	English
Publishing date	2022-12-27
Publishing country	Scotland
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Review
ZDB-ID	2102927-1
ISSN	1479-666X
ISSN	1479-666X
DOI	10.1016/j.surge.2022.12.003
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Article ; Online: I-ACTSS-COVID-19-the Italian acute care and trauma surgery survey for COVID-19 pandemic outbreak.

Cozza, Valerio / Fransvea, Pietro / La Greca, Antonio / De Paolis, Paolo / Marini, Pierluigi / Zago, Mauro / Sganga, Gabriele

Updates in surgery

2020 Volume 72, Issue 2, Page(s) 297–304

Abstract: The sudden COVID-19 outbreak in Italy has challenged our health systems and doctors faced the challenge of treating a large number of critically ill patients in a short time interval. Acute care surgeons, although not directly involved in treating COVID- ... ...

Abstract	The sudden COVID-19 outbreak in Italy has challenged our health systems and doctors faced the challenge of treating a large number of critically ill patients in a short time interval. Acute care surgeons, although not directly involved in treating COVID-19 + patients, have often modified their daily activity to help in this crisis. We have designed the first Italian survey on the effect of COVID-19 outbreak on Acute Care Surgery activity and submitted it to emergency surgeons in all the country to evaluate the experiences, trends, attitudes and possible educational outcomes that this emergency brought to light. A total of 532 valid surveys were collected during the study period. Lombardy and Lazio had the major answer rate. 96% of responders noticed a decrease in surgical emergencies. The outbreak affected regions and hospitals in different ways depending on the local incidence of infection. Half of responders modified their approach to intra-abdominal infections towards a more conservative treatment. 43% of responders, mainly in the North, were shifted to assist non-surgical patients. There has been a direct but non-homogeneous involvement of emergency surgeons. Almost all hospitals have responded with specific pathways and training. Both emergency surgery and trauma activity have changed and generally decreased but the majority of surgeons have operated on suspected COVID-19 patients.
MeSH term(s)	Acute Disease ; COVID-19 ; Coronavirus Infections ; Critical Care/statistics & numerical data ; Disease Outbreaks ; Emergency Treatment/statistics & numerical data ; Health Care Surveys ; Humans ; Italy/epidemiology ; Pandemics ; Pneumonia, Viral ; Surgical Procedures, Operative/statistics & numerical data ; Wounds and Injuries/surgery
Keywords	covid19
Language	English
Publishing date	2020-06-24
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2572692-4
ISSN	2038-3312 ; 2038-131X
ISSN (online)	2038-3312
ISSN	2038-131X
DOI	10.1007/s13304-020-00832-4
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