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Purpose Acute care surgery (ACS) has been shown to improve patient outcome and treatment efficiency in the U.S. ACS was introduced to the Department of Surgery, Yonsei University College of Medicine, Seoul to solve the problems associated with delays in surgical evaluation of non-trauma patients who needed emergency surgery, and to offer exposure to a wide variety of surgical cases to general surgical fellows and residents. The objective of this study was to describe the 10-year experience of the ACS department in a single center. Methods A retrospective chart review was conducted at the Department of Surgery, Yonsei University College of Medicine, Seoul, for all patients admitted from March 2008 to February 2018. Patients were grouped into either the trauma or non-trauma group, and were further classified according to their diagnosis, and the type of operations they had undergone. Results There was a total of 2,805 patients, including 1,001 trauma patients and 1,804 non-trauma patients. The average hospital length of stay was 14 days and the total in-hospital mortality rate was 3.6%. Trauma mechanisms included blunt (92.6%), penetrating (7.0%) and burn (0.4%) trauma. The majority of non-trauma patients were admitted for appendicitis (37.1%), followed by cholecystitis (21.7%). There was a total of 1,561 operations conducted. The most frequent operations were appendectomy (38.3%) and cholecystectomy (19.5%), followed by adhesiolysis (7.8%). Conclusion A working ACS department has been implemented in a Korean medical center.

Purpose: Research comparing the effectiveness of different doses of antibiotics prior to surgery for preventing infection is sparse. This study examines whether a single dose of preoperative antibiotics suffices to treat uncomplicated appendicitis via laparoscopic appendectomy. Methods: This study retrospectively reviewed the medical records of 149 patients who underwent laparoscopic appendectomy from July 2013 to December 2014 in a single institution. The participants were divided into two groups; group A (n=99) was given a single dose of prophylactic antibiotics before surgery, and group B (n=50) was given both preoperative and postoperative antibiotics. Clinical factors and surgical outcomes were compared between two groups. Results: The mean length of hospital stay for group A (2.5 days) was shorter than for group B (3.2 days) (p

Purpose: The aim of this study is to investigate the clinical characteristics and epidemiology of stab wound in a single center for 5 years. Methods: Eighty-seven patients visited the emergency room with stab wounds between March 2008 and October 2013. Patient demographics, location of the wound, injured internal organ, and clinical parameters were reviewed. Results: Among eighty seven patients, 59 were male, and the mean age was 45.6 years old (range, 18∼85 years old). The most common age group was fifth and sixth decades. The most common cause of stab injury was self-infliction (32 cases), followed by violence (31 cases) and accident (23 cases). Self-infliction injuries were associated with underlying psychological problems in 20 patients. The most common injured sites were abdomen (48 cases), followed by thorax (20 cases) and neck (12 cases). Emergent exploration was required in 37 patients. Four patients (4.6%) were dead due to hypovolemic shock after injury of the thorax (lung) or neck (transection of carotid artery and transection of trachea). The length of hospital stay was 3 days (0∼6.5 days) and the injury severity score (ISS) was 4 points (1∼9 points). ISS was associated with the length of hospital stay (p

Background: Chloride is important for maintaining acid-base balance, muscular activity, osmosis and immunomodulation. In patients with major trauma, chloride levels increase after fluid therapy; this is associated with poor clinical outcomes. The purpose of this study was to determine whether hyperchloremia was associated with increased mortality in patients who had sustained major trauma. Methods: This study enrolled 266 major trauma patients by retrospective chart review, from January 2011 to December 2015. Patients were older than 16 years; were admitted to an intensive care unit; survived more than 48 h; and had sustained major trauma, defined as an injury severity score ⩾ 16. Hyperchloremia was defined as a chloride level > 110mEq/L. Delta chloride (Δchloride) was defined as the difference between the serum chloride level measured 48-h post-admission and the initial level. Clinical and laboratory variables were compared between survivors (n = 235) and non-survivors (n = 31). A multivariate logistic regression analysis was performed to assess the association between hyperchloremia 48-h post-admission (hyperchloremia-48) and 30-day mortality. Results: The overall 30-day mortality was 11.7 % (n = 31). Hyperchloremia-48 occurred in 65 patients (24.4 %) and the incidence was significantly different between survivors and non-survivors (19.6 vs. 61.3 %, respectively, p < 0.001). Multivariate logistic analysis identified hyperchloremia-48 and Δchloride as independent predictive factors for 30-day mortality in major trauma patients. Discussion: Infusion of chloride-rich solutions, such as normal saline, is itself associated with hyperchloremia, which has been associated with poor patient outcomes. Patients receiving normal saline were more likely to suffer major postoperative complications, acute kidney injury, and infections. Moreover, large changes in serum chloride levels correlated with greater in-hospital mortality. Conclusion: Hyperchloremia 48-h post-admission and Δchloride was associated with 30-day mortality in major trauma patients. These indices may be useful prognostic markers. [ABSTRACT FROM AUTHOR]

Purpose: Herein, we firstly present the robotic single-site cholecystectomy (RSSC) as performed in Asia and evaluate whether it could overcome the limitations of conventional laparoscopic single-site cholecystectomy. Materials and Methods: From October 2013 to November 2013, RSSC for benign gallbladder (GB) disease was firstly performed consecutively in five patients. We evaluated these early experiences of RSSC and compared factors including clinicopathologic factors and operative outcomes with our initial cases of single-fulcrum laparoscopic cholecystectomy (SFLC). Results: Four female patients and one male patient underwent RSSC. Neither open conversion nor bile duct injury or bile spillage was noted during surgery. In comparisons with SFLC, patient-related factors in terms of age, sex, Body Mass Index, diagnosis, and American Society of Anesthesiologist score showed no significant differences between two groups. There were no significant differences in the operative outcomes regarding intraoperative blood loss, bile spillage during operation, postoperative pain scale values, postoperative complications, and hospital stay between the two groups (p<0.05). Actual dissection time (p=0.003) and total operation time (p=0.001) were significantly longer in RSSC than in SFLC. There were no drain insertion or open conversion cases in either group. Conclusion: RSSC provides a comfortable environment and improved ergonomics to laparoscopic single-site cholecystectomy; however, this technique needs to be modified to allow for more effective intracorporeal movement. As experience and technical innovations continue, RSSC will soon be alternative procedure for well-selected benign GB disease. [ABSTRACT FROM AUTHOR]