Personalized Medicine in Acute Care Surgery: Postoperative Complications and Prognosis

A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Clinical Medicine, Cell, and Organism Physiology".

Deadline for manuscript submissions: closed (20 May 2023) | Viewed by 19321

Special Issue Editor


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Guest Editor
General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
Interests: acute care surgery; failure to rescue; hemorrhagic shock; intensive care; preventable death

Special Issue Information

Dear Colleagues,

Acute care surgery (ACS) and trauma surgery (TS) are associated with a high rate of postoperative complications and poor prognosis compared to elective surgery. In recent decades, failure to rescue (FTR), defined as the death of a patient who has experienced severe complications, has emerged as a quality metric for evaluating definitive outcomes in patients who have undergone emergency surgical procedures. This Special Issue focuses on the vast plethora of complications that can arise after emergency surgical procedures in trauma and non-trauma patients. Articles evaluating the reliability of prognostic clinical and radiological scores in ACS and TS will also be considered in this Special Issue to highlight the need for a standardized approach in the emergency setting.

Dr. Roberto Bini
Guest Editor

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Keywords

  • acute care surgery
  • trauma surgery
  • postoperative complications
  • prognosis

Published Papers (6 papers)

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Editorial

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3 pages, 181 KiB  
Editorial
Personalized Medicine in Acute Care Surgery: Are We Ready to Deal with Our Failures?
by Roberto Bini and Michele Altomare
J. Pers. Med. 2022, 12(8), 1322; https://doi.org/10.3390/jpm12081322 - 17 Aug 2022
Cited by 1 | Viewed by 957
Abstract
During the first decade of the 21st century, the American College of Surgeons Committee on Trauma (ACS—COT), the Western Trauma Association (WTA), the Eastern Association for the Surgery of Trauma (EAST), and the American Association for the Surgery of Trauma (AAST) established an [...] Read more.
During the first decade of the 21st century, the American College of Surgeons Committee on Trauma (ACS—COT), the Western Trauma Association (WTA), the Eastern Association for the Surgery of Trauma (EAST), and the American Association for the Surgery of Trauma (AAST) established an ad hoc committee to develop a new specialty that embraces trauma surgery, critical surgical care, and emergency surgery [...] Full article

Research

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17 pages, 930 KiB  
Article
A Novel Clinical Nomogram for Predicting Overall Survival in Patients with Emergency Surgery for Colorectal Cancer
by Georgiana Bianca Constantin, Dorel Firescu, Raul Mihailov, Iulian Constantin, Ioana Anca Ștefanopol, Daniel Andrei Iordan, Bogdan Ioan Ștefănescu, Rodica Bîrlă and Eugenia Panaitescu
J. Pers. Med. 2023, 13(4), 575; https://doi.org/10.3390/jpm13040575 - 24 Mar 2023
Cited by 2 | Viewed by 1649
Abstract
Background: Long-term survival after emergency colorectal cancer surgery is low, and its estimation is most frequently neglected, with priority given to the immediate prognosis. This study aimed to propose an effective nomogram to predict overall survival in these patients. Materials and methods: We [...] Read more.
Background: Long-term survival after emergency colorectal cancer surgery is low, and its estimation is most frequently neglected, with priority given to the immediate prognosis. This study aimed to propose an effective nomogram to predict overall survival in these patients. Materials and methods: We retrospectively studied 437 patients who underwent emergency surgery for colorectal cancer between 2008 and 2019, in whom we analyzed the clinical, paraclinical, and surgical parameters. Results: Only 30 patients (6.86%) survived until the end of the study. We identified the risk factors through the univariate Cox regression analysis and a multivariate Cox regression model. The model included the following eight independent prognostic factors: age > 63 years, Charlson score > 4, revised cardiac risk index (RCRI), LMR (lymphocytes/neutrophils ratio), tumor site, macroscopic tumoral invasion, surgery type, and lymph node dissection (p < 0.05 for all), with an AUC (area under the curve) of 0.831, with an ideal agreement between the predicted and observed probabilities. On this basis, we constructed a nomogram for prediction of overall survival. Conclusions: The nomogram created, on the basis of a multivariate logistic regression model, has a good individual prediction of overall survival for patients with emergency surgery for colon cancer and may support clinicians when informing patients about prognosis. Full article
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9 pages, 942 KiB  
Article
Early Hypocalcemia in Severe Trauma: An Independent Risk Factor for Coagulopathy and Massive Transfusion
by Marco Vettorello, Michele Altomare, Andrea Spota, Stefano Piero Bernardo Cioffi, Marta Rossmann, Andrea Mingoli, Osvaldo Chiara and Stefania Cimbanassi
J. Pers. Med. 2023, 13(1), 63; https://doi.org/10.3390/jpm13010063 - 28 Dec 2022
Cited by 3 | Viewed by 10702
Abstract
The rapid identification of patients at risk for massive blood transfusion is of paramount importance as uncontrolled exsanguination may lead to death within 2 to 6 h. The aim of this study was to analyze a cohort of severe trauma patients to identify [...] Read more.
The rapid identification of patients at risk for massive blood transfusion is of paramount importance as uncontrolled exsanguination may lead to death within 2 to 6 h. The aim of this study was to analyze a cohort of severe trauma patients to identify risk factors associated with massive transfusion requirements and hypocalcemia. All major trauma (ISS > 16) presented directly from the scene to the Niguarda hospital between 1 January 2015 and 31 December 2021 were analyzed. A total of 798 patients were eligible out of 1586 screened. Demographic data showed no significant difference between hypocalcemic (HC) and normocalcemic (NC) patients except for the presence of crush trauma, alcohol intake (27% vs. 15%, p < 0.01), and injury severity score (odds ratio 1.03, p = 0.03). ISS was higher in the HC group and was an independent, even if weak, predictor of hypocalcemia (odds ratio 1.03, p = 0.03). Prehospital data showed a lower mean systolic arterial pressure (SAP) and a higher heart rate (HR) in the HC group (105 vs. 127, p < 0.01; 100 vs. 92, p < 0.001, respectively), resulting in a higher shock index (SI) (1.1 vs. 0.8, p < 0.001). Only retrospective studies such as ours are available, and while hypocalcemia seems to be an independent predictor of mortality and massive transfusion, there is not enough evidence to support causation. Therefore, randomized prospective studies are suggested. Full article
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8 pages, 888 KiB  
Article
Predictors of Mortality in Bicycle-Related Trauma: An Eight-Year Experience in a Level One Trauma Center
by Elisa Reitano, Stefano Piero Bernardo Cioffi, Francesco Virdis, Michele Altomare, Andrea Spota, Osvaldo Chiara and Stefania Cimbanassi
J. Pers. Med. 2022, 12(11), 1936; https://doi.org/10.3390/jpm12111936 - 21 Nov 2022
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Abstract
Background: Bicycle-related trauma has increased during the last decades, mainly due to the antipollution environmental policies. This study investigates the outcome of bicycle-related trauma in our level-one trauma center over a period of eight years. Methods: Data from 446 consecutive bicycle-related trauma patients [...] Read more.
Background: Bicycle-related trauma has increased during the last decades, mainly due to the antipollution environmental policies. This study investigates the outcome of bicycle-related trauma in our level-one trauma center over a period of eight years. Methods: Data from 446 consecutive bicycle-related trauma patients admitted to our trauma center from 2011 to 2019 were selected and retrospectively analyzed. The sample was divided into three age groups: <18 years, 18–54 years, and ≥55 years. Mortality rates were obtained for the overall population and patients with an Injury Severity Score (ISS) ≥ 25. Month and seasonal patients’ distribution was described to provide an epidemiological overview of bike-related trauma over the years. Results: Patients ≥ 55 years showed a lower pre-hospital and in-hospital GCS (p ≤ 0.001), higher levels of lactates (p < 0.019) and higher ISS (p ≤ 0.001), probability of death (p ≤ 0.001), and overall mortality (p ≤ 0.001). The head and chest Abbreviated Injury Scale (AIS) ≥ 3 injuries were predictors of mortality, especially in patients over 55 years (p < 0.010). Bicycle-related trauma was more frequent during the summer (34%), particularly in July and August. Conclusions: Age over 55 years old, head and chest injuries, and an ISS > 25 were independent predictors of mortality. Full article
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8 pages, 620 KiB  
Article
Effect of Erector Spinae Plane Block on Postoperative Pain after Laparoscopic Colorectal Surgery: A Randomized Controlled Study
by Jung Ju Choi, Young Jin Chang, Dongchul Lee, Hye Won Kim and Hyun Jeong Kwak
J. Pers. Med. 2022, 12(10), 1717; https://doi.org/10.3390/jpm12101717 - 14 Oct 2022
Cited by 5 | Viewed by 1371
Abstract
The erector spinae plane (ESP) block can be used to reduce pain and opioid requirements after abdominal surgery. We evaluated the effect of the ESP block on postoperative pain score, analgesic use, and quality of recovery (QoR) score in patients undergoing laparoscopy. Fifty-nine [...] Read more.
The erector spinae plane (ESP) block can be used to reduce pain and opioid requirements after abdominal surgery. We evaluated the effect of the ESP block on postoperative pain score, analgesic use, and quality of recovery (QoR) score in patients undergoing laparoscopy. Fifty-nine patients undergoing elective laparoscopic colorectal surgery were randomly assigned to control (n = 30) or ESPB (n = 29) groups after anesthesia induction. In the ESPB group, an ultrasound-guided ESP block was performed immediately after induction using 20 mL of 0.5% ropivacaine bilaterally. The primary outcome was the postoperative pain score, which was evaluated using the 11-point numeric rating scale (NRS) (0 = no pain, 10 = worst imaginable pain), in the recovery room. NRS “at rest” and “on cough” and total dose of fentanyl rescue (in the recovery room) as well as NRS “at rest” and the cumulative administered fentanyl dose of patient-controlled analgesia (24 h post-surgery) were significantly lower in the ESPB group than in the control group. The postoperative QoR score did not differ between the groups. Bilateral ESP block after induction reduced pain scores and opioid requirements for 24 h postoperatively but did not improve the QoR in patients undergoing laparoscopic colorectal surgery. Full article
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Review

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15 pages, 2231 KiB  
Review
Negative Pressure Wound Therapy for the Treatment of Fournier’s Gangrene: A Rare Case with Rectal Fistula and Systematic Review of the Literature
by Michele Altomare, Laura Benuzzi, Mattia Molteni, Francesco Virdis, Andrea Spota, Stefano Piero Bernardo Cioffi, Elisa Reitano, Federica Renzi, Osvaldo Chiara, Giovanni Sesana and Stefania Cimbanassi
J. Pers. Med. 2022, 12(10), 1695; https://doi.org/10.3390/jpm12101695 - 11 Oct 2022
Cited by 2 | Viewed by 2590
Abstract
Fournier’s gangrene (FG) is a Necrotizing Soft Tissue Infection (NSTI) of the perineal region characterized by high morbidity and mortality even if appropriately treated. The main treatment strategies are surgical debridement, broad-spectrum antibiotics, hyperbaric oxygen therapy, NPWT (Negative Pressure Wound Therapy), and plastic [...] Read more.
Fournier’s gangrene (FG) is a Necrotizing Soft Tissue Infection (NSTI) of the perineal region characterized by high morbidity and mortality even if appropriately treated. The main treatment strategies are surgical debridement, broad-spectrum antibiotics, hyperbaric oxygen therapy, NPWT (Negative Pressure Wound Therapy), and plastic surgery reconstruction. We present the case of a 50-year-old woman with an NSTI of the abdomen, pelvis, and perineal region associated with a rectal fistula referred to our department. After surgical debridement and a diverting blow-out colostomy, an NPWT system composed of two sponges connected by a bridge through a rectal fistula was performed. Our target was to obtain healing in a lateral-to-medial direction instead of depth-to-surface to prevent the enlargement of the rectal fistula, promoting granulation tissue growth towards the rectum. This eso-endo-NPWT technique allowed for the primary suture of the perineal wounds bilaterally, simultaneously treating the rectal fistula and the perineum lesions. A systematic review of the literature underlines the spreading of NPWT and its effects. Full article
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