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Several abstracts related to trauma and military surgery are presented including surgical options to control laparotomy, study on electrolyte variability in military trauma patients and psychological effects of extracorporeal hemofiltration in hind limb ischemia-reperfusion injury in Sus scrofa.

Background Pseudomonas aeruginosa is one of the most common pathogens in surgical site infections (SSIs). However, comprehensive epidemiological and antibiotic resistance details for P aeruginosa in Chinese SSIs are lacking. We evaluated the proportions and antimicrobial resistance of P aeruginosa among patients with SSIs in China. Methods Relevant papers from January 2010 to August 2022 were searched in databases including PubMed, Embase, Web of Science, China Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang, and Weipu. A meta-analysis was performed to analyze the proportions and 95% confidence interval (CIs) of P aeruginosa among patients with SSIs. Meta-regression analysis was used to investigate the proportion difference among different subgroups and antimicrobial resistance. Results A total of 72 studies met inclusion criteria, involving 33 050 isolated strains. The overall proportion of P aeruginosa among patients with SSIs was 16.0% (95% CI, 13.9%–18.2%). Subgroup analysis showed higher proportions in orthopedic (18.3% [95% CI, 15.6%–21.0%]) and abdominal surgery (17.3% [95% CI, 9.9%–26.2%]). The proportion in the central region (18.6% [95% CI, 15.3%–22.1%]) was slightly higher than that in other regions. Antibiotic resistance rates significantly increased after 2015: cefoperazone (36.2%), ceftriaxone (38.9%), levofloxacin (20.5%), and aztreonam (24.0%). Notably, P aeruginosa resistance to ampicillin and cefazolin exceeded 90.0%. Conclusions The proportion of P aeruginosa infection among patients with SSIs was higher than the data reported by the Chinese Antimicrobial Resistance Surveillance System, indicating rising antimicrobial resistance. The existing antimicrobial drug management plan should be strengthened to prevent a hospital epidemic of drug-resistant P aeruginosa strains. [ABSTRACT FROM AUTHOR]

Background: Australia's unique national surgical mortality audit has had a long-term focus on the avoidance of futile surgery. The 30-day mortality rate after emergency laparotomy in Australia is lower than in other countries. Early death (within 72 h) after emergency laparotomy may reflect futile surgery. This paper considers whether Australia's national mortality audit is the reason for its lower mortality rate after emergency laparotomy. Methods: Data were extracted from the Australia and New Zealand Emergency Laparotomy Audit--Quality Improvement (ANZELA-QI) from 2018 to 2022. The time elapsed from emergency laparotomy to death was determined for each patient. The cumulative daily mortality rate was calculated for the first 30 days and expressed as a proportion of all emergency laparotomies, and 30-day and inhospital mortality. Mortality data were compared with those in the only three similar overseas studies. The mortality rate after emergency laparotomy for patients who required but did not undergo surgery was calculated for each hospital. The proportion of patients with high-risk characteristics was compared with that in the National Emergency Laparotomy Audit (NELA). Results: Compared with overseas studies, there was a lower early (within 72 h) mortality rate in ANZELA-QI. Although the lower mortality rate in ANZELA-QI persisted to 30 days, there was a relative increase after 14 days that likely reflected known poor compliance with care standards. Australian patients had fewer high-risk characteristics than those in NELA. Conclusion: The present findings support the hypothesis that the lower mortality rate after emergency laparotomy in Australia is likely a consequence of its national mortality audit and the avoidance of futile surgery. [ABSTRACT FROM AUTHOR]

Umbilical lumps are a common presentation that can represent a diagnostic challenge as the differentials are broad. Epidermal inclusion cysts occur when epidermal cells are implanted in the dermis following trauma, or surgery. Although epidermal inclusion cysts are common, they are rarely cause of umbilical mass, with less than 10 cases described in the literature. Very few cases have been reported following abdominal surgery and none following laparoscopy. These lesions can occur with or without pain, mass, redness or spontaneous discharge and symptoms can persist for years. This paper reports a case of an umbilical epidermal inclusion cyst in a 52-year-old female presenting with a 6-week history of a painful, red umbilical lump on a background of two previous diagnostic laparoscopies. This was successfully treated with complete excision of the lesion. [ABSTRACT FROM AUTHOR]

Background older patients aged ≥65 years constitute the majority of the National Emergency Laparotomy Audit (NELA) population. To better understand this group and inform future service changes, this paper aims to describe patient characteristics, outcomes and process measures across age cohorts and temporally in the 4-year period (2014–2017) since NELA was established. Methods patient-level data were populated from the NELA data set years 1–4 and linked with Office of National Statistics mortality data. Descriptive data were compared between groups delineated by age, NELA year and geriatrician review. Primary outcomes were 30- and 90-day mortality, length of stay (LOS) and discharge to care-home accommodation. Results in total, 93,415 NELA patients were included in the analysis. The median age was 67 years. Patients aged ≥65 years had higher 30-day (15.3 versus 4.9%, P  < 0.001) and 90-day mortality (20.4 versus 7.2%, P  < 0.001) rates, longer LOS (median 15.2 versus 11.3 days, P  < 0.001) and greater likelihood of discharge to care-home accommodation compared with younger patients (6.7 versus 1.9%, P  < 0.001). Mortality rate reduction over time was greater in older compared with younger patients. The proportion of older NELA patients seen by a geriatrician post-operatively increased over years 1–4 (8.5 to 16.5%, P  < 0.001). Post-operative geriatrician review was associated with reduced mortality (30-day odds ratio [OR] 0.38, confidence interval [CI] 0.35–0.42, P  < 0.001; 90-day OR 0.6, CI 0.56–0.65, P  < 0.001). Conclusions older NELA patients have poorer post-operative outcomes. The greatest reduction in mortality rates over time were observed in the oldest cohorts. This may be due to several interventions including increased perioperative geriatrician input. [ABSTRACT FROM AUTHOR]

Background Surgical task-sharing may be central to expanding the provision of surgical care in low-resource settings. The aims of this paper were to describe the set-up of a new surgical task-sharing training programme for associate clinicians and junior doctors in Sierra Leone, assess its productivity and safety, and estimate its future role in contributing to surgical volume. Methods This prospective observational study from a consortium of 16 hospitals evaluated crude in-hospital mortality over 5 years and productivity of operations performed during and after completion of a 3-year surgical training programme. Results Some 48 trainees and nine graduated surgical assistant community health officers ( SACHOs) participated in 27 216 supervised operations between January 2011 and July 2016. During training, trainees attended a median of 822 operations. SACHOs performed a median of 173 operations annually. Caesarean section, hernia repair and laparotomy were the most common procedures during and after training. Crude in-hospital mortality rates after caesarean sections and laparotomies were 0·7 per cent (13 of 1915) and 4·3 per cent (7 of 164) respectively for operations performed by trainees, and 0·4 per cent (5 of 1169) and 8·0 per cent (11 of 137) for those carried out by SACHOs. Adjusted for patient sex, surgical procedure, urgency and hospital, mortality was lower for operations performed by trainees ( OR 0·47, 95 per cent c.i. 0·32 to 0·71; P < 0·001) and SACHOs ( OR 0·16, 0·07 to 0·41; P < 0·001) compared with those conducted by trainers and supervisors. Conclusion SACHOs rapidly and safely achieved substantial increases in surgical volume in Sierra Leone. [ABSTRACT FROM AUTHOR]