Abstract

Background: During the coronavirus disease (COVID-19) pandemic, there has been a surge in cases of acute cholecystitis. The ChoCO-W global prospective study reported a higher incidence of gangrenous cholecystitis and adverse outcomes in COVID-19 patients. Through this secondary analysis of the ChoCO-W study data, we aim to identify significant risk factors for mortality in patients with acute cholecystitis during the COVID-19 pandemic, emphasizing the role of COVID-19 infection in patient outcomes and treatment efficacy."

Methods: The ChoCO-W global prospective study reported data from 2546 patients admitted with acute cholecystitis at 218 centers across 42 countries during the COVID-19 pandemic, from October 1, 2020, to October 31, 2021. Sixty-four of them died. Univariate nonparametric statistical analysis was performed to compare patients who died with those who survived. Significant factors were then entered into a logistic regression model to identify predictors of mortality.

Results: The significant independent factors that predicted death in the logistic regression model were COVID-19 infection (p < 0.001), postoperative complications (p < 0.001), and type (open/laparoscopic) of surgical intervention (p = 0.003). The odds of death increased 5 times with the COVID-19 infection, 6 times in the presence of complications, and were reduced by 86% with adequate source control. Survivors predominantly underwent urgent laparoscopic cholecystectomy (52.3% vs. 23.4%).

Conclusions: COVID-19 was an independent risk factor for death in patients with acute cholecystitis. Early laparoscopic cholecystectomy has emerged as the cornerstone of treatment for hemodynamically stable patients.

Trial registration: ClinicalTrials.gov NCT04542312.

Keywords: Acute cholecystitis; Covid-19; Emergency; Laparoscopic cholecystectomy; Management; Mortality; Sars-CoV-2.

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Abstract

Background: Small bowel obstruction (SBO) is a common surgical emergency associated with substantial morbidity, hospital length of stay (LOS), and healthcare costs. The World Society of Emergency Surgery (WSES) Bologna guidelines provide evidence-informed recommendations for managing adhesive SBO, promoting timely surgical intervention (or non-operative management (NOM) when ischaemia, strangulation, or peritonitis are absent). However, guideline adoption and its impact on outcomes remain understudied. Compliance with the Bologna guidelines was evaluated to assess its effect on outcomes.

Methods: SnapSBO, a prospective, multicentre, time-bound, observational cohort study, captured data on patients with adhesive SBO across diverse healthcare settings and patient populations. Patient care was categorized into: successful NOM, surgery after an unsuccessful appropriate trial of NOM (NOM-T), and direct-to-surgery (DTS). Compliance with diagnostic, therapeutic, and postoperative Bologna guideline recommendations was assessed as either complete or partial. Primary outcomes included adherence to the Bologna guidelines, LOS, complications, and the incidence of the composite metric 'optimal outcomes' (LOS ≤5 days, discharge without complications, and no readmission within 30 days).

Results: Among 982 patients with adhesive SBO, successful NOM occurred in 561 (57.1%), 224 (22.8%) underwent NOM-T, and 197 (20.1%) proceeded to DTS. The mean(s.d.) LOS was 5.3(9.0), 12.9(11.4), and 7.7(8.0) days respectively (P < 0.001). Optimal outcomes were achieved in 61.0%, 16.1%, and 37.6%, respectively (P < 0.001), and full guideline compliance was observed in 17.2%, 10.1%, and 0.4%, respectively.

Conclusion: Patients with adhesive SBO whose care aligned with the Bologna guidelines had shorter LOS and a higher rate of optimal outcomes. Addressing evidence-to-practice gaps by implementing strategies that account for contextual factors will enhance guideline adoption and patient outcomes.

Keywords: Small bowel obstruction (SBO), surgical emergency, hospital length of stay, Bologna guidelines, World Society of Emergency Surgery (WSES) 

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Abstract

Introduction: Considerable heterogeneity exists in the configuration and implementation maturity of trauma systems across European healthcare settings, and the opportunities for guideline-informed high-quality care vary considerably. Therefore, the European Society of Trauma and Emergency Surgery (ESTES), with its constituent national societies, has developed comprehensive consensus recommendations for care-context appropriate treatment of polytrauma patients in Europe, from the pre-hospital setting to the first surgical phase.

Methods: Adhering to the RAND/UCLA Appropriateness Method (RAM), ESTES conducted a three-round modified Delphi consensus. National society expert delegates assessed the Grade of Recommendation (GoR) A and Good Clinical Practice Points (GPP) elements of the German Society of Trauma Surgery (DGU) "S3 guidelines for polytrauma/severe injury management" for appropriateness and implementability within their respective healthcare systems.

Results: In the first consensus round, 82 GoR A and 57 GPP recommendations were analysed. Of these, seven GPPs were rephrased for clarity, and four were removed due to redundancy or conflicting content. Consequently, 135 recommendations (82 GoR A and 53 GPP) remained, with 128 (77 GoR A and 51 GPP) deemed appropriate and necessary, and seven as uncertain due to expert disagreement.

Conclusion: These ESTES recommendations constitute the first cohesive Europe-wide framework for managing the polytrauma patient from the prehospital setting to the end of the first surgical phase. They serve as a foundational tool for developing national guidelines, particularly in regions with evolving trauma systems, and promote alignment toward a uniform standard of care across Europe.

Keywords: Consensus; Guidelines; Injury; Polytrauma; Recommendations.