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51. Impact of enhanced recovery protocols after pancreatoduodenectomy: Meta-Analysis

Author

Kuemmerli, C, Tschuor, C, Kasai, M, Alseidi, A, Balzano, G, Bouwense, S, Braga, M, Coolsen, M, Daniel, S, Dervenis, C, Falconi, M, Hwang, D, Kagedan, D, Kim, S, Lavu, H, Liang, T, Nussbaum, D, Partelli, S, Passeri, M, Pecorelli, N, Pillai, S, Pillarisetty, V, Pucci, M, Su, W, Sutcliffe, R, Tingstedt, B, Van Der Kolk, M, Vrochides, D, Wei, A, Yeo, C, Zani, S, Zouros, E, Abu Hilal, M, Kuemmerli C., Tschuor C., Kasai M., Alseidi A. A., Balzano G., Bouwense S., Braga M., Coolsen M., Daniel S. K., Dervenis C., Falconi M., Hwang D. W., Kagedan D. J., Kim S. C., Lavu H., Liang T., Nussbaum D., Partelli S., Passeri M. J., Pecorelli N., Pillai S. A., Pillarisetty V. G., Pucci M. J., Su W., Sutcliffe R. P., Tingstedt B., Van Der Kolk M., Vrochides D., Wei A., Yeo C. J., Zani S., Zouros E., Abu Hilal M., Kuemmerli, C, Tschuor, C, Kasai, M, Alseidi, A, Balzano, G, Bouwense, S, Braga, M, Coolsen, M, Daniel, S, Dervenis, C, Falconi, M, Hwang, D, Kagedan, D, Kim, S, Lavu, H, Liang, T, Nussbaum, D, Partelli, S, Passeri, M, Pecorelli, N, Pillai, S, Pillarisetty, V, Pucci, M, Su, W, Sutcliffe, R, Tingstedt, B, Van Der Kolk, M, Vrochides, D, Wei, A, Yeo, C, Zani, S, Zouros, E, Abu Hilal, M, Kuemmerli C., Tschuor C., Kasai M., Alseidi A. A., Balzano G., Bouwense S., Braga M., Coolsen M., Daniel S. K., Dervenis C., Falconi M., Hwang D. W., Kagedan D. J., Kim S. C., Lavu H., Liang T., Nussbaum D., Partelli S., Passeri M. J., Pecorelli N., Pillai S. A., Pillarisetty V. G., Pucci M. J., Su W., Sutcliffe R. P., Tingstedt B., Van Der Kolk M., Vrochides D., Wei A., Yeo C. J., Zani S., Zouros E., and Abu Hilal M.

Abstract

Background: This individual-patient data meta-Analysis investigated the effects of enhanced recovery after surgery (ERAS) protocols compared with conventional care on postoperative outcomes in patients undergoing pancreatoduodenectomy. Methods: The Cochrane Library, MEDLINE, Embase, Scopus, and Web of Science were searched systematically for articles reporting outcomes of ERAS after pancreatoduodenectomy published up to August 2020. Comparative studies were included. Main outcomes were postoperative functional recovery elements, postoperative morbidity, duration of hospital stay, and readmission. Results: Individual-patient data were obtained from 17 of 31 eligible studies comprising 3108 patients. Time to liquid (mean difference (MD)-3.23 (95 per cent c.i.-4.62 to-1.85) days; P < 0.001) and solid (-3.84 (-5.09 to-2.60) days; P < 0.001) intake, time to passage of first stool (MD-1.38 (-1.82 to-0.94) days; P < 0.001) and time to removal of the nasogastric tube (3.03 (-4.87 to-1.18) days; P = 0.001) were reduced with ERAS. ERAS was associated with lower overall morbidity (risk difference (RD)-0.04, 95 per cent c.i.-0.08 to-0.01; P = 0.015), less delayed gastric emptying (RD-0.11,-0.22 to-0.01; P = 0.039) and a shorter duration of hospital stay (MD-2.33 (-2.98 to-1.69) days; P < 0.001) without a higher readmission rate. Conclusion: ERAS improved postoperative outcome after pancreatoduodenectomy. Implementation should be encouraged.

Published
2022

52. ERAS program adherence-institutionalization, major morbidity and anastomotic leakage after elective colorectal surgery: the iCral2 multicenter prospective study

Author

Catarci, M, Ruffo, G, Viola, M, Pirozzi, F, Delrio, P, Borghi, F, Garulli, G, Baldazzi, G, Marini, P, Sica, G, Guercioni, G, Ciano, P, Benedetti, M, Cicconi, S, Marziali, I, Bertocchi, E, Altamura, A, Rubichi, F, Sciuto, A, Pace, U, Fares Bucci, A, Cianflocca, D, Migliore, M, Pirrera, B, Alagna, V, Cassini, D, Attinà, G, Arcudi, C, Sensi, B, Bucci, A, Campagnacci, R, Maurizi, A, Basti, M, Frazzini, D, Caracino, V, Pedrazzani, C, Turri, G, Mancini, S, Sagnotta, A, Scatizzi, M, Pandolfini, L, Falsetto, A, Baiocchi, G, Molfino, S, Totis, M, Braga, M, Liverani, A, Cesare, T, Scabini, S, Martino, A, Luca, R, Simone, M, Carrara, A, Tirone, G, Motter, M, Caricato, M, Capolupo, G, Amodio, P, Palmieri, R, Pavanello, M, Marco, C, Muratore, A, Marsanic, P, Patriti, A, Sisti, V, Lucchi, A, Martorelli, G, Clementi, M, Guadagni, S, Longo, G, Tomassini, F, Santoni, S, Vettoretto, N, Botteri, E, Armellini, A, Brisinda, G, Chiarello, M, Cariati, M, Berti, S, Gennai, A, Anania, G, Rubino, S, Siquini, W, Cardinali, A, Catarci M., Ruffo G., Viola M. G., Pirozzi F., Delrio P., Borghi F., Garulli G., Baldazzi G., Marini P., Sica G., Guercioni G., Ciano P., Benedetti M., Cicconi S., Marziali I., Bertocchi E., Altamura A., Rubichi F., Sciuto A., Pace U., Fares Bucci A., Cianflocca D., Migliore M., Pirrera B., Alagna V., Cassini D., Attinà G. M., Arcudi C., Sensi B., Bucci A. F., Campagnacci R., Maurizi A., Basti M., Frazzini D., Caracino V., Pedrazzani C., Turri G., Mancini S., Sagnotta A., Scatizzi M., Pandolfini L., Falsetto A., Baiocchi G. L., Molfino S., Totis M., Braga M., Liverani A., Cesare T. D., Scabini S., Martino A., Luca R. D., Simone M., Carrara A., Tirone G., Motter M., Caricato M., Capolupo G. T., Amodio P., Palmieri R. M., Pavanello M., Marco C. D., Muratore A., Marsanic P., Patriti A., Sisti V., Lucchi A., Martorelli G., Clementi M., Guadagni S., Longo G., Tomassini F., Santoni S., Vettoretto N., Botteri E., Armellini A., Brisinda G., Chiarello M. M., Cariati M., Berti S., Gennai A., Anania G., Rubino S., Siquini W., Cardinali A., Catarci, M, Ruffo, G, Viola, M, Pirozzi, F, Delrio, P, Borghi, F, Garulli, G, Baldazzi, G, Marini, P, Sica, G, Guercioni, G, Ciano, P, Benedetti, M, Cicconi, S, Marziali, I, Bertocchi, E, Altamura, A, Rubichi, F, Sciuto, A, Pace, U, Fares Bucci, A, Cianflocca, D, Migliore, M, Pirrera, B, Alagna, V, Cassini, D, Attinà, G, Arcudi, C, Sensi, B, Bucci, A, Campagnacci, R, Maurizi, A, Basti, M, Frazzini, D, Caracino, V, Pedrazzani, C, Turri, G, Mancini, S, Sagnotta, A, Scatizzi, M, Pandolfini, L, Falsetto, A, Baiocchi, G, Molfino, S, Totis, M, Braga, M, Liverani, A, Cesare, T, Scabini, S, Martino, A, Luca, R, Simone, M, Carrara, A, Tirone, G, Motter, M, Caricato, M, Capolupo, G, Amodio, P, Palmieri, R, Pavanello, M, Marco, C, Muratore, A, Marsanic, P, Patriti, A, Sisti, V, Lucchi, A, Martorelli, G, Clementi, M, Guadagni, S, Longo, G, Tomassini, F, Santoni, S, Vettoretto, N, Botteri, E, Armellini, A, Brisinda, G, Chiarello, M, Cariati, M, Berti, S, Gennai, A, Anania, G, Rubino, S, Siquini, W, Cardinali, A, Catarci M., Ruffo G., Viola M. G., Pirozzi F., Delrio P., Borghi F., Garulli G., Baldazzi G., Marini P., Sica G., Guercioni G., Ciano P., Benedetti M., Cicconi S., Marziali I., Bertocchi E., Altamura A., Rubichi F., Sciuto A., Pace U., Fares Bucci A., Cianflocca D., Migliore M., Pirrera B., Alagna V., Cassini D., Attinà G. M., Arcudi C., Sensi B., Bucci A. F., Campagnacci R., Maurizi A., Basti M., Frazzini D., Caracino V., Pedrazzani C., Turri G., Mancini S., Sagnotta A., Scatizzi M., Pandolfini L., Falsetto A., Baiocchi G. L., Molfino S., Totis M., Braga M., Liverani A., Cesare T. D., Scabini S., Martino A., Luca R. D., Simone M., Carrara A., Tirone G., Motter M., Caricato M., Capolupo G. T., Amodio P., Palmieri R. M., Pavanello M., Marco C. D., Muratore A., Marsanic P., Patriti A., Sisti V., Lucchi A., Martorelli G., Clementi M., Guadagni S., Longo G., Tomassini F., Santoni S., Vettoretto N., Botteri E., Armellini A., Brisinda G., Chiarello M. M., Cariati M., Berti S., Gennai A., Anania G., Rubino S., Siquini W., and Cardinali A.

Abstract

Background: Enhanced recovery after surgery (ERAS) programs influence morbidity rates and length of stay after colorectal surgery (CRS), and may also impact major complications and anastomotic leakage rates. A prospective multicenter observational study to investigate the interactions between ERAS program adherence and early outcomes after elective CRS was carried out. Methods: Prospective enrolment of patients submitted to elective CRS with anastomosis in 18 months. Adherence to 21 items of ERAS program was measured upon explicit criteria in every case. After univariate analysis, independent predictors of primary endpoints [major morbidity (MM) and anastomotic leakage (AL) rates] were identified through logistic regression analyses including all significant variables, presenting odds ratios (OR). Results: Institutional ERAS protocol was declared by 27 out of 38 (71.0%) participating centers. Median overall adherence to ERAS program items was 71.4%. Among 3830 patients included in the study, MM and AL rates were 4.7% and 4.2%, respectively. MM rates were independently influenced by intra- and/or postoperative blood transfusions (OR 7.79, 95% CI 5.46–11.10; p < 0.0001) and standard anesthesia protocol (OR 0.68, 95% CI 0.48–0.96; p = 0.028). AL rates were independently influenced by male gender (OR 1.48, 95% CI 1.06–2.07; p = 0.021), intra- and/or postoperative blood transfusions (OR 4.29, 95% CI 2.93–6.50; p < 0.0001) and non-standard resections (OR 1.49, 95% CI 1.01–2.22; p = 0.049). Conclusions: This study disclosed wide room for improvement in compliance to several ERAS program items. It failed to detect any significant association between institutionalization and/or adherence rates to ERAS program with primary endpoints. These outcomes were independently influenced by gender, intra- and postoperative blood transfusions, non-standard resections, and standard anesthesia protocol.

Published
2022

53. Prevalence and features of delirium in older patients admitted to rehabilitation facilities: a multicenter study

Author

Sidoli, C, Zambon, A, Tassistro, E, Rossi, E, Mossello, E, Inzitari, M, Cherubini, A, Marengoni, A, Morandi, A, Bellelli, G, Tarasconi, A, Sella, M, Paterno, G, Faggian, G, Lucarelli, C, De Grazia, N, Alberto, C, Porcella, L, Nardiello, I, Chimenti, E, Zeni, M, Romairone, E, Minaglia, C, Ceccotti, C, Guerra, G, Mantovani, G, Monacelli, F, Candiani, T, Santolini, F, Rosso, M, Bono, V, Sibilla, S, Dal Santo, P, Ceci, M, Barone, P, Schirinzi, T, Formenti, A, Nastasi, G, Isaia, G, Gonella, D, Battuello, A, Casson, S, Calvani, D, Boni, F, Ciaccio, A, Rosa, R, Sanna, G, Manfredini, S, Cortese, L, Rizzo, M, Prestano, R, Greco, A, Lauriola, M, Gelosa, G, Piras, V, Arena, M, Cosenza, D, Bellomo, A, Lamontagna, M, Gabbani, L, Lambertucci, L, Perego, S, Parati, G, Basile, G, Gallina, V, Pilone, G, Giudice, C, Pietrogrande, L, Mosca, M, Corazzin, I, Rossi, P, Nunziata, V, D'Amico, F, Grippa, A, Giardini, S, Barucci, R, Cossu, A, Fiorin, L, Distefano, M, Lunardelli, M, Brunori, M, Ruffini, I, Abraham, E, Varutti, A, Fabbro, E, Catalano, A, Martino, G, Leotta, D, Marchet, A, Dell'Aquila, G, Scrimieri, A, Davoli, M, Casella, M, Cartei, A, Polidori, G, Brischetto, D, Motta, S, Saponara, R, Perrone, P, Russo, G, Del, D, Car, C, Pirina, T, Franzoni, S, Cotroneo, A, Ghiggia, F, Volpi, G, Menichetti, C, Bo, M, Panico, A, Calogero, P, Corvalli, G, Mauri, M, Lupia, E, Manfredini, R, Fabbian, F, March, A, Pedrotti, M, Veronesi, M, Strocchi, E, Borghi, C, Bianchetti, A, Crucitti, A, Difrancesco, V, Fontana, G, Geriatria, A, Bonanni, L, Barbone, F, Serrati, C, Ballardini, G, Simoncelli, M, Ceschia, G, Scarpa, C, Brugiolo, R, Fusco, S, Ciarambino, T, Biagini, C, Tonon, E, Porta, M, Venuti, D, Delsette, M, Poeta, M, Barbagallo, G, Trovato, G, Delitala, A, Arosio, P, Reggiani, F, Zuliani, G, Ortolani, B, Mussio, E, Girardi, A, Coin, A, Ruotolo, G, Castagna, A, Masina, M, Cimino, R, Pinciaroli, A, Tripodi, G, Cassadonte, F, Vatrano, M, Scaglione, L, Fogliacco, P, Muzzuilini, C, Romano, F, Padovani, A, Rozzini, L, Cagnin, A, Fragiacomo, F, Desideri, G, Liberatore, E, Bruni, A, Orsitto, G, Franco, M, Bonfrate, L, Bonetto, M, Pizio, N, Magnani, G, Cecchetti, G, Longo, A, Bubba, V, Marinan, L, Cotelli, M, Turla, M, Sessa, M, Abruzzi, L, Castoldi, G, Lovetere, D, Musacchio, C, Novello, M, Cavarape, A, Bini, A, Leonardi, A, Seneci, F, Grimaldi, W, Fimognari, F, Bambar, V, Saitta, A, Corica, F, Braga, M, Servi, Ettorre, E, Camellini Bellelli, C, Annoni, G, Crescenzo, A, Noro, G, Turco, R, Ponzetto, M, Giuseppe, L, Mazzei, B, Maiuri, G, Costaggiu, D, Damato, R, Formilan, M, Patrizia, G, Santuar, L, Gallucci, M, Paragona, M, Bini, P, Modica, D, Abati, C, Clerici, M, Barbera, I, Nigroimperiale, F, Manni, A, Votino, C, Castiglioni, C, Di, M, Degl'Innocenti, M, Moscatelli, G, Guerini, S, Casini, C, Dini, D, Denotariis, S, Bonometti, F, Paolillo, C, Riccardi, A, Tiozzo, A, Samysalamafahmy, A, Dibari, M, Vanni, S, Scarpa, A, Zara, D, Ranieri, P, Alessandro, M, Di, F, Pezzoni, D, Platto, C, D'Ambrosio, V, Ivaldi, C, Milia, P, Desalvo, F, Solaro, C, Strazzacappa, M, Cazzadori, M, Grasso, M, Troisi, E, Guerini, V, Bernardini, B, Corsini, C, Boffelli, S, Filippi, A, Delpin, K, Faraci, B, Bertoletti, E, Vannucci, M, Crippa, P, Malighetti, A, Caltagirone, C, Disant, S, Bettini, D, Maltese, F, Abruzzese, G, Cosimo, D, Azzini, M, Colombo, M, Procino, G, Fascendini, S, Barocco, F, Del, P, Mazzone, A, Cottino, M, Vezzadini, G, Avanzi, S, Brambilla, C, Orini, S, Sgrilli, F, Mello, A, Lombardi Muti, L, Dijk, B, Fenu, S, Pes, C, Gareri, P, Passamonte, M, Rigo, R, Locusta, L, Caser, L, Rosso, G, Cesarini, S, Cozzi, R, Santini, C, Carbone, P, Cazzaniga, I, Lovati, R, Cantoni, A, Ranzani, P, Barra, D, Pompilio, G, Dimori, S, Cernesi, S, Ricco, C, Piazzolla, F, Capittini, E, Rota, C, Gottardi, F, Merla, L, Barelli, A, Millul, A, De, G, Morrone, G, Bigolari, M, Macchi, M, Zambon, F, Pizzorni, C, Dicasaleto, G, Menculini, G, Marcacci, M, Catanese, G, Sprini, D, Dicasalet, T, Bocci, M, Borga, S, Caironi, P, Cat, C, Cingolani, E, Avalli, L, Greco, G, Citerio, G, Gandini, L, Cornara, G, Lerda, R, Brazzi, L, Simeone, F, Caciorgna, M, Alampi, D, Francesconi, S, Beck, E, Antonini, B, Vettoretto, K, Meggiolaro, M, Garofalo, E, Notaro, S, Varutti, R, Bassi, F, Mistraletti, G, Marino, A, Rona, R, Rondelli, E, Riva, I, Cortegiani, A, Pistidda, L, D'Andrea, R, Querci, L, Gnesin, P, Todeschini, M, Lugano, M, Castelli, G, Ortolani, M, Cotoia, A, Maggiore, S, Ditizio, L, Graziani, R, Testa, I, Ferretti, E, Castioni, C, Lombardi, F, Caserta, R, Pasqua, M, Simoncini, S, Baccarini, F, Rispoli, M, Grossi, F, Cancelliere, L, Carnelli, M, Puccini, F, Biancofiore, G, Siniscalchi, A, Laici, C, Torrini, M, Pasetti, G, Palmese, S, Oggioni, R, Mangani, V, Pini, S, Martelli, M, Rigo, E, Zuccala, F, Cherri, A, Spina, R, Calamai, I, Petrucci, N, Caicedo, A, Ferri, F, Gritti, P, Brienza, N, Fonnesu, R, Dessena, M, Fullin, G, Saggioro, D, Sidoli C., Zambon A., Tassistro E., Rossi E., Mossello E., Inzitari M., Cherubini A., Marengoni A., Morandi A., Bellelli G., Tarasconi A., Sella M., Paterno G., Faggian G., Lucarelli C., De Grazia N., Alberto C., Porcella L., Nardiello I., Chimenti E., Zeni M., Romairone E., Minaglia C., Ceccotti C., Guerra G., Mantovani G., Monacelli F., Candiani T., Santolini F., Rosso M., Bono V., Sibilla S., Dal Santo P., Ceci M., Barone P., Schirinzi T., Formenti A., Nastasi G., Isaia G., Gonella D., Battuello A., Casson S., Calvani D., Boni F., Ciaccio A., Rosa R., Sanna G., Manfredini S., Cortese L., Rizzo M., Prestano R., Greco A., Lauriola M., Gelosa G., Piras V., Arena M., Cosenza D., Bellomo A., LaMontagna M., Gabbani L., Lambertucci L., Perego S., Parati G., Basile G., Gallina V., Pilone G., Giudice C., Pietrogrande L., Mosca M., Corazzin I., Rossi P., Nunziata V., D'Amico F., Grippa A., Giardini S., Barucci R., Cossu A., Fiorin L., Distefano M., Lunardelli M., Brunori M., Ruffini I., Abraham E., Varutti A., Fabbro E., Catalano A., Martino G., Leotta D., Marchet A., Dell'Aquila G., Scrimieri A., Davoli M., Casella M., Cartei A., Polidori G., Brischetto D., Motta S., Saponara R., Perrone P., Russo G., Del D., Car C., Pirina T., Franzoni S., Cotroneo A., Ghiggia F., Volpi G., Menichetti C., Bo M., Panico A., Calogero P., Corvalli G., Mauri M., Lupia E., Manfredini R., Fabbian F., March A., Pedrotti M., Veronesi M., Strocchi E., Borghi C., Bianchetti A., Crucitti A., DiFrancesco V., Fontana G., Geriatria A., Bonanni L., Barbone F., Serrati C., Ballardini G., Simoncelli M., Ceschia G., Scarpa C., Brugiolo R., Fusco S., Ciarambino T., Biagini C., Tonon E., Porta M., Venuti D., DelSette M., Poeta M., Barbagallo G., Trovato G., Delitala A., Arosio P., Reggiani F., Zuliani G., Ortolani B., Mussio E., Girardi A., Coin A., Ruotolo G., Castagna A., Masina M., Cimino R., Pinciaroli A., Tripodi G., Cassadonte F., Vatrano M., Scaglione L., Fogliacco P., Muzzuilini C., Romano F., Padovani A., Rozzini L., Cagnin A., Fragiacomo F., Desideri G., Liberatore E., Bruni A., Orsitto G., Franco M., Bonfrate L., Bonetto M., Pizio N., Magnani G., Cecchetti G., Longo A., Bubba V., Marinan L., Cotelli M., Turla M., Sessa M., Abruzzi L., Castoldi G., LoVetere D., Musacchio C., Novello M., Cavarape A., Bini A., Leonardi A., Seneci F., Grimaldi W., Fimognari F., Bambar V., Saitta A., Corica F., Braga M., Ettorre E., Camellini Bellelli C. G., Annoni G., Crescenzo A., Noro G., Turco R., Ponzetto M., Giuseppe L., Mazzei B., Maiuri G., Costaggiu D., Damato R., Formilan M., Patrizia G., Santuar L., Gallucci M., Paragona M., Bini P., Modica D., Abati C., Clerici M., Barbera I., NigroImperiale F., Manni A., Votino C., Castiglioni C., Di M., Degl'Innocenti M., Moscatelli G., Guerini S., Casini C., Dini D., DeNotariis S., Bonometti F., Paolillo C., Riccardi A., Tiozzo A., SamySalamaFahmy A., DiBari M., Vanni S., Scarpa A., Zara D., Ranieri P., Alessandro M., Di F., Pezzoni D., Platto C., D'Ambrosio V., Ivaldi C., Milia P., DeSalvo F., Solaro C., Strazzacappa M., Cazzadori M., Grasso M., Troisi E., Guerini V., Bernardini B., Corsini C., Boffelli S., Filippi A., Delpin K., Faraci B., Bertoletti E., Vannucci M., Crippa P., Malighetti A., Caltagirone C., DiSant S., Bettini D., Maltese F., Abruzzese G., Cosimo D., Azzini M., Colombo M., Procino G., Fascendini S., Barocco F., Del P., Mazzone A., Cottino M., Vezzadini G., Avanzi S., Brambilla C., Orini S., Sgrilli F., Mello A., Lombardi Muti L. E., Dijk B., Fenu S., Pes C., Gareri P., Passamonte M., Rigo R., Locusta L., Caser L., Rosso G., Cesarini S., Cozzi R., Santini C., Carbone P., Cazzaniga I., Lovati R., Cantoni A., Ranzani P., Barra D., Pompilio G., Dimori S., Cernesi S., Ricco C., Piazzolla F., Capittini E., Rota C., Gottardi F., Merla L., Barelli A., Millul A., De G., Morrone G., Bigolari M., Macchi M., Zambon F., Pizzorni C., DiCasaleto G., Menculini G., Marcacci M., Catanese G., Sprini D., DiCasalet T., Bocci M., Borga S., Caironi P., Cat C., Cingolani E., Avalli L., Greco G., Citerio G., Gandini L., Cornara G., Lerda R., Brazzi L., Simeone F., Caciorgna M., Alampi D., Francesconi S., Beck E., Antonini B., Vettoretto K., Meggiolaro M., Garofalo E., Notaro S., Varutti R., Bassi F., Mistraletti G., Marino A., Rona R., Rondelli E., Riva I., Cortegiani A., Pistidda L., D'Andrea R., Querci L., Gnesin P., Todeschini M., Lugano M., Castelli G., Ortolani M., Cotoia A., Maggiore S., DiTizio L., Graziani R., Testa I., Ferretti E., Castioni C., Lombardi F., Caserta R., Pasqua M., Simoncini S., Baccarini F., Rispoli M., Grossi F., Cancelliere L., Carnelli M., Puccini F., Biancofiore G., Siniscalchi A., Laici C., Torrini M., Pasetti G., Palmese S., Oggioni R., Mangani V., Pini S., Martelli M., Rigo E., Zuccala F., Cherri A., Spina R., Calamai I., Petrucci N., Caicedo A., Ferri F., Gritti P., Brienza N., Fonnesu R., Dessena M., Fullin G., Saggioro D., Sidoli, C, Zambon, A, Tassistro, E, Rossi, E, Mossello, E, Inzitari, M, Cherubini, A, Marengoni, A, Morandi, A, Bellelli, G, Tarasconi, A, Sella, M, Paterno, G, Faggian, G, Lucarelli, C, De Grazia, N, Alberto, C, Porcella, L, Nardiello, I, Chimenti, E, Zeni, M, Romairone, E, Minaglia, C, Ceccotti, C, Guerra, G, Mantovani, G, Monacelli, F, Candiani, T, Santolini, F, Rosso, M, Bono, V, Sibilla, S, Dal Santo, P, Ceci, M, Barone, P, Schirinzi, T, Formenti, A, Nastasi, G, Isaia, G, Gonella, D, Battuello, A, Casson, S, Calvani, D, Boni, F, Ciaccio, A, Rosa, R, Sanna, G, Manfredini, S, Cortese, L, Rizzo, M, Prestano, R, Greco, A, Lauriola, M, Gelosa, G, Piras, V, Arena, M, Cosenza, D, Bellomo, A, Lamontagna, M, Gabbani, L, Lambertucci, L, Perego, S, Parati, G, Basile, G, Gallina, V, Pilone, G, Giudice, C, Pietrogrande, L, Mosca, M, Corazzin, I, Rossi, P, Nunziata, V, D'Amico, F, Grippa, A, Giardini, S, Barucci, R, Cossu, A, Fiorin, L, Distefano, M, Lunardelli, M, Brunori, M, Ruffini, I, Abraham, E, Varutti, A, Fabbro, E, Catalano, A, Martino, G, Leotta, D, Marchet, A, Dell'Aquila, G, Scrimieri, A, Davoli, M, Casella, M, Cartei, A, Polidori, G, Brischetto, D, Motta, S, Saponara, R, Perrone, P, Russo, G, Del, D, Car, C, Pirina, T, Franzoni, S, Cotroneo, A, Ghiggia, F, Volpi, G, Menichetti, C, Bo, M, Panico, A, Calogero, P, Corvalli, G, Mauri, M, Lupia, E, Manfredini, R, Fabbian, F, March, A, Pedrotti, M, Veronesi, M, Strocchi, E, Borghi, C, Bianchetti, A, Crucitti, A, Difrancesco, V, Fontana, G, Geriatria, A, Bonanni, L, Barbone, F, Serrati, C, Ballardini, G, Simoncelli, M, Ceschia, G, Scarpa, C, Brugiolo, R, Fusco, S, Ciarambino, T, Biagini, C, Tonon, E, Porta, M, Venuti, D, Delsette, M, Poeta, M, Barbagallo, G, Trovato, G, Delitala, A, Arosio, P, Reggiani, F, Zuliani, G, Ortolani, B, Mussio, E, Girardi, A, Coin, A, Ruotolo, G, Castagna, A, Masina, M, Cimino, R, Pinciaroli, A, Tripodi, G, Cassadonte, F, Vatrano, M, Scaglione, L, Fogliacco, P, Muzzuilini, C, Romano, F, Padovani, A, Rozzini, L, Cagnin, A, Fragiacomo, F, Desideri, G, Liberatore, E, Bruni, A, Orsitto, G, Franco, M, Bonfrate, L, Bonetto, M, Pizio, N, Magnani, G, Cecchetti, G, Longo, A, Bubba, V, Marinan, L, Cotelli, M, Turla, M, Sessa, M, Abruzzi, L, Castoldi, G, Lovetere, D, Musacchio, C, Novello, M, Cavarape, A, Bini, A, Leonardi, A, Seneci, F, Grimaldi, W, Fimognari, F, Bambar, V, Saitta, A, Corica, F, Braga, M, Servi, Ettorre, E, Camellini Bellelli, C, Annoni, G, Crescenzo, A, Noro, G, Turco, R, Ponzetto, M, Giuseppe, L, Mazzei, B, Maiuri, G, Costaggiu, D, Damato, R, Formilan, M, Patrizia, G, Santuar, L, Gallucci, M, Paragona, M, Bini, P, Modica, D, Abati, C, Clerici, M, Barbera, I, Nigroimperiale, F, Manni, A, Votino, C, Castiglioni, C, Di, M, Degl'Innocenti, M, Moscatelli, G, Guerini, S, Casini, C, Dini, D, Denotariis, S, Bonometti, F, Paolillo, C, Riccardi, A, Tiozzo, A, Samysalamafahmy, A, Dibari, M, Vanni, S, Scarpa, A, Zara, D, Ranieri, P, Alessandro, M, Di, F, Pezzoni, D, Platto, C, D'Ambrosio, V, Ivaldi, C, Milia, P, Desalvo, F, Solaro, C, Strazzacappa, M, Cazzadori, M, Grasso, M, Troisi, E, Guerini, V, Bernardini, B, Corsini, C, Boffelli, S, Filippi, A, Delpin, K, Faraci, B, Bertoletti, E, Vannucci, M, Crippa, P, Malighetti, A, Caltagirone, C, Disant, S, Bettini, D, Maltese, F, Abruzzese, G, Cosimo, D, Azzini, M, Colombo, M, Procino, G, Fascendini, S, Barocco, F, Del, P, Mazzone, A, Cottino, M, Vezzadini, G, Avanzi, S, Brambilla, C, Orini, S, Sgrilli, F, Mello, A, Lombardi Muti, L, Dijk, B, Fenu, S, Pes, C, Gareri, P, Passamonte, M, Rigo, R, Locusta, L, Caser, L, Rosso, G, Cesarini, S, Cozzi, R, Santini, C, Carbone, P, Cazzaniga, I, Lovati, R, Cantoni, A, Ranzani, P, Barra, D, Pompilio, G, Dimori, S, Cernesi, S, Ricco, C, Piazzolla, F, Capittini, E, Rota, C, Gottardi, F, Merla, L, Barelli, A, Millul, A, De, G, Morrone, G, Bigolari, M, Macchi, M, Zambon, F, Pizzorni, C, Dicasaleto, G, Menculini, G, Marcacci, M, Catanese, G, Sprini, D, Dicasalet, T, Bocci, M, Borga, S, Caironi, P, Cat, C, Cingolani, E, Avalli, L, Greco, G, Citerio, G, Gandini, L, Cornara, G, Lerda, R, Brazzi, L, Simeone, F, Caciorgna, M, Alampi, D, Francesconi, S, Beck, E, Antonini, B, Vettoretto, K, Meggiolaro, M, Garofalo, E, Notaro, S, Varutti, R, Bassi, F, Mistraletti, G, Marino, A, Rona, R, Rondelli, E, Riva, I, Cortegiani, A, Pistidda, L, D'Andrea, R, Querci, L, Gnesin, P, Todeschini, M, Lugano, M, Castelli, G, Ortolani, M, Cotoia, A, Maggiore, S, Ditizio, L, Graziani, R, Testa, I, Ferretti, E, Castioni, C, Lombardi, F, Caserta, R, Pasqua, M, Simoncini, S, Baccarini, F, Rispoli, M, Grossi, F, Cancelliere, L, Carnelli, M, Puccini, F, Biancofiore, G, Siniscalchi, A, Laici, C, Torrini, M, Pasetti, G, Palmese, S, Oggioni, R, Mangani, V, Pini, S, Martelli, M, Rigo, E, Zuccala, F, Cherri, A, Spina, R, Calamai, I, Petrucci, N, Caicedo, A, Ferri, F, Gritti, P, Brienza, N, Fonnesu, R, Dessena, M, Fullin, G, Saggioro, D, Sidoli C., Zambon A., Tassistro E., Rossi E., Mossello E., Inzitari M., Cherubini A., Marengoni A., Morandi A., Bellelli G., Tarasconi A., Sella M., Paterno G., Faggian G., Lucarelli C., De Grazia N., Alberto C., Porcella L., Nardiello I., Chimenti E., Zeni M., Romairone E., Minaglia C., Ceccotti C., Guerra G., Mantovani G., Monacelli F., Candiani T., Santolini F., Rosso M., Bono V., Sibilla S., Dal Santo P., Ceci M., Barone P., Schirinzi T., Formenti A., Nastasi G., Isaia G., Gonella D., Battuello A., Casson S., Calvani D., Boni F., Ciaccio A., Rosa R., Sanna G., Manfredini S., Cortese L., Rizzo M., Prestano R., Greco A., Lauriola M., Gelosa G., Piras V., Arena M., Cosenza D., Bellomo A., LaMontagna M., Gabbani L., Lambertucci L., Perego S., Parati G., Basile G., Gallina V., Pilone G., Giudice C., Pietrogrande L., Mosca M., Corazzin I., Rossi P., Nunziata V., D'Amico F., Grippa A., Giardini S., Barucci R., Cossu A., Fiorin L., Distefano M., Lunardelli M., Brunori M., Ruffini I., Abraham E., Varutti A., Fabbro E., Catalano A., Martino G., Leotta D., Marchet A., Dell'Aquila G., Scrimieri A., Davoli M., Casella M., Cartei A., Polidori G., Brischetto D., Motta S., Saponara R., Perrone P., Russo G., Del D., Car C., Pirina T., Franzoni S., Cotroneo A., Ghiggia F., Volpi G., Menichetti C., Bo M., Panico A., Calogero P., Corvalli G., Mauri M., Lupia E., Manfredini R., Fabbian F., March A., Pedrotti M., Veronesi M., Strocchi E., Borghi C., Bianchetti A., Crucitti A., DiFrancesco V., Fontana G., Geriatria A., Bonanni L., Barbone F., Serrati C., Ballardini G., Simoncelli M., Ceschia G., Scarpa C., Brugiolo R., Fusco S., Ciarambino T., Biagini C., Tonon E., Porta M., Venuti D., DelSette M., Poeta M., Barbagallo G., Trovato G., Delitala A., Arosio P., Reggiani F., Zuliani G., Ortolani B., Mussio E., Girardi A., Coin A., Ruotolo G., Castagna A., Masina M., Cimino R., Pinciaroli A., Tripodi G., Cassadonte F., Vatrano M., Scaglione L., Fogliacco P., Muzzuilini C., Romano F., Padovani A., Rozzini L., Cagnin A., Fragiacomo F., Desideri G., Liberatore E., Bruni A., Orsitto G., Franco M., Bonfrate L., Bonetto M., Pizio N., Magnani G., Cecchetti G., Longo A., Bubba V., Marinan L., Cotelli M., Turla M., Sessa M., Abruzzi L., Castoldi G., LoVetere D., Musacchio C., Novello M., Cavarape A., Bini A., Leonardi A., Seneci F., Grimaldi W., Fimognari F., Bambar V., Saitta A., Corica F., Braga M., Ettorre E., Camellini Bellelli C. G., Annoni G., Crescenzo A., Noro G., Turco R., Ponzetto M., Giuseppe L., Mazzei B., Maiuri G., Costaggiu D., Damato R., Formilan M., Patrizia G., Santuar L., Gallucci M., Paragona M., Bini P., Modica D., Abati C., Clerici M., Barbera I., NigroImperiale F., Manni A., Votino C., Castiglioni C., Di M., Degl'Innocenti M., Moscatelli G., Guerini S., Casini C., Dini D., DeNotariis S., Bonometti F., Paolillo C., Riccardi A., Tiozzo A., SamySalamaFahmy A., DiBari M., Vanni S., Scarpa A., Zara D., Ranieri P., Alessandro M., Di F., Pezzoni D., Platto C., D'Ambrosio V., Ivaldi C., Milia P., DeSalvo F., Solaro C., Strazzacappa M., Cazzadori M., Grasso M., Troisi E., Guerini V., Bernardini B., Corsini C., Boffelli S., Filippi A., Delpin K., Faraci B., Bertoletti E., Vannucci M., Crippa P., Malighetti A., Caltagirone C., DiSant S., Bettini D., Maltese F., Abruzzese G., Cosimo D., Azzini M., Colombo M., Procino G., Fascendini S., Barocco F., Del P., Mazzone A., Cottino M., Vezzadini G., Avanzi S., Brambilla C., Orini S., Sgrilli F., Mello A., Lombardi Muti L. E., Dijk B., Fenu S., Pes C., Gareri P., Passamonte M., Rigo R., Locusta L., Caser L., Rosso G., Cesarini S., Cozzi R., Santini C., Carbone P., Cazzaniga I., Lovati R., Cantoni A., Ranzani P., Barra D., Pompilio G., Dimori S., Cernesi S., Ricco C., Piazzolla F., Capittini E., Rota C., Gottardi F., Merla L., Barelli A., Millul A., De G., Morrone G., Bigolari M., Macchi M., Zambon F., Pizzorni C., DiCasaleto G., Menculini G., Marcacci M., Catanese G., Sprini D., DiCasalet T., Bocci M., Borga S., Caironi P., Cat C., Cingolani E., Avalli L., Greco G., Citerio G., Gandini L., Cornara G., Lerda R., Brazzi L., Simeone F., Caciorgna M., Alampi D., Francesconi S., Beck E., Antonini B., Vettoretto K., Meggiolaro M., Garofalo E., Notaro S., Varutti R., Bassi F., Mistraletti G., Marino A., Rona R., Rondelli E., Riva I., Cortegiani A., Pistidda L., D'Andrea R., Querci L., Gnesin P., Todeschini M., Lugano M., Castelli G., Ortolani M., Cotoia A., Maggiore S., DiTizio L., Graziani R., Testa I., Ferretti E., Castioni C., Lombardi F., Caserta R., Pasqua M., Simoncini S., Baccarini F., Rispoli M., Grossi F., Cancelliere L., Carnelli M., Puccini F., Biancofiore G., Siniscalchi A., Laici C., Torrini M., Pasetti G., Palmese S., Oggioni R., Mangani V., Pini S., Martelli M., Rigo E., Zuccala F., Cherri A., Spina R., Calamai I., Petrucci N., Caicedo A., Ferri F., Gritti P., Brienza N., Fonnesu R., Dessena M., Fullin G., and Saggioro D.

Abstract

Background: Delirium is thought to be common across various settings of care; however, still little research has been conducted in rehabilitation. Aim: We investigated the prevalence of delirium, its features and motor subtypes in older patients admitted to rehabilitation facilities during the three editions of the “Delirium Day project”. Methods: We conducted a cross-sectional study in which 1237 older patients (age ≥ 65 years old) admitted to 50 Italian rehabilitation wards during the three editions of the “Delirium Day project” (2015 to 2017) were included. Delirium was evaluated through the 4AT and its motor subtype with the Delirium Motor Subtype Scale. Results: Delirium was detected in 226 patients (18%), and the most recurrent motor subtype was mixed (37%), followed by hypoactive (26%), hyperactive (21%) and non-motor one (16%). In a multivariate Poisson regression model with robust variance, factors associated with delirium were: disability in basic (PR 1.48, 95%CI: 1.17–1.9, p value 0.001) and instrumental activities of daily living (PR 1.58, 95%CI: 1.08–2.32, p value 0.018), dementia (PR 2.10, 95%CI: 1.62–2.73, p value < 0.0001), typical antipsychotics (PR 1.47, 95%CI: 1.10–1.95, p value 0.008), antidepressants other than selective serotonin reuptake inhibitors (PR 1.3, 95%CI: 1.02–1.66, p value 0.035), and physical restraints (PR 2.37, 95%CI: 1.68–3.36, p value < 0.0001). Conclusion: This multicenter study reports that 2 out 10 patients admitted to rehabilitations had delirium on the index day. Mixed delirium was the most prevalent subtype. Delirium was associated with unmodifiable (dementia, disability) and modifiable (physical restraints, medications) factors. Identification of these factors should prompt specific interventions aimed to prevent or mitigate delirium.

Published
2022

54. Early Postoperative Low Compliance to Enhanced Recovery Pathway in Rectal Cancer Patients

Author

Ceresoli, M, Pedrazzani, C, Pellegrino, L, Muratore, A, Ficari, F, Polastri, R, Scatizzi, M, Totis, M, Tamini, N, Ripamonti, L, Braga, M, Ceresoli M., Pedrazzani C., Pellegrino L., Muratore A., Ficari F., Polastri R., Scatizzi M., Totis M., Tamini N., Ripamonti L., Braga M., Ceresoli, M, Pedrazzani, C, Pellegrino, L, Muratore, A, Ficari, F, Polastri, R, Scatizzi, M, Totis, M, Tamini, N, Ripamonti, L, Braga, M, Ceresoli M., Pedrazzani C., Pellegrino L., Muratore A., Ficari F., Polastri R., Scatizzi M., Totis M., Tamini N., Ripamonti L., and Braga M.

Abstract

Early postoperative low compliance to enhanced recovery protocols has been associated with morbidity following colon surgery. The purpose of this study is to evaluate the possible causes of early postoperative low compliance to the enhanced recovery pathway and its relationship with morbidity following rectal surgery for cancer. A total of 439 consecutive patients who underwent elective surgery for rectal cancer have been included in the study. Compliance to enhanced recovery protocol on postoperative day (POD) 2 was evaluated in all patients. Indicators of compliance were naso-gastric tube and urinary catheter removal, recovery of both oral feeding and mobilization, and the stopping of intravenous fluids. Low compliance on POD 2 was defined as non- adherence to two or more items. One-third of patients had low compliance on POD 2. Removal of urinary catheter, intravenous fluids stop, and mobilization were the items with lowest adherence. Advanced age, duration of surgery, open surgery and diverting stoma were predictive factors of low compliance at multivariate analysis. Overall morbidity and major complications were significantly higher (p < 0.001) in patients with low compliance on POD 2. At multivariate analysis, failure to remove urinary catheter on POD 2 (OR = 1.83) was significantly correlated with postoperative complications. Low compliance to enhanced recovery protocol on POD 2 was significantly associated with morbidity. Failure to remove the urinary catheter was the most predictive indicator. Advanced age, long procedure, open surgery and diverting stoma were independent predictive factors of low compliance.

Published
2022

55. Early non compliance to enhanced recovery pathway might be an alert for underlying complications following colon surgery

Author

Ceresoli, M, Pedrazzani, C, Pellegrino, L, Ficari, F, Braga, M, Muratore, A, Tamini, N, Beretta, L, Azzola, M, Radrizzani, D, Borghi, F, Missana, G, Scatizzi, M, Totis, M, Crespi, M, Bima, C, Bouzari, H, Valenti, A, Ceretti, A, Polastri, R, Longhin, R, Maurizi, A, Cassini, D, Di Marzo, F, Fumagalli, S, Muratori, S, Casati, M, Ceresoli M., Pedrazzani C., Pellegrino L., Ficari F., Braga M., Muratore A., Tamini N., Beretta L., Azzola M., Radrizzani D., Borghi F., Missana G., Scatizzi M., Totis M., Crespi M., Bima C., Bouzari H., Valenti A., Ceretti A. P., Polastri R., Longhin R., Maurizi A., Cassini D., Di Marzo F., Fumagalli S., Muratori S., Casati M., Ceresoli, M, Pedrazzani, C, Pellegrino, L, Ficari, F, Braga, M, Muratore, A, Tamini, N, Beretta, L, Azzola, M, Radrizzani, D, Borghi, F, Missana, G, Scatizzi, M, Totis, M, Crespi, M, Bima, C, Bouzari, H, Valenti, A, Ceretti, A, Polastri, R, Longhin, R, Maurizi, A, Cassini, D, Di Marzo, F, Fumagalli, S, Muratori, S, Casati, M, Ceresoli M., Pedrazzani C., Pellegrino L., Ficari F., Braga M., Muratore A., Tamini N., Beretta L., Azzola M., Radrizzani D., Borghi F., Missana G., Scatizzi M., Totis M., Crespi M., Bima C., Bouzari H., Valenti A., Ceretti A. P., Polastri R., Longhin R., Maurizi A., Cassini D., Di Marzo F., Fumagalli S., Muratori S., and Casati M.

Abstract

Purpose: Early non compliance to postoperative ERAS pathway has been reported in 20–30% of patients who underwent elective colon surgery. The aim of the present study is to investigate the possible relationship between early non compliance and postoperative complications. Methods: We reviewed a prospective database including 1391 consecutively collected patients undergoing elective colon surgery in 22 Italian hospitals between January 2017 and June 2020. Early compliance to ERAS protocol was assessed on postoperative day (POD) 2. Failure of oral feeding, urinary catheter removal, intravenous fluids stop, and adequate mobilization were indicators of non compliance. Postoperative follow-up was carried out for 30 days after hospital discharge. The association among early postoperative ERAS compliance and the occurrence of complications was assessed with uni- and multivariate analysis. Results: A total of 1089 (78.3%) patients had malignancy and minimally invasive surgery was successfully performed in 1174 (84.3%) patients. Postoperative morbidity occurred in 403 (29.0%) patients. At multivariate analysis, male gender, open surgery, and each of the four non compliance indicators on POD 2 were significantly associated to postoperative complications. Morbidity progressively increased from 16.8% in patients with full compliance to ERAS protocol to 47.2% in patients with two non compliance indicators and 69.2% in patients with all four indicators (p < 0.001). Conclusions: Early non compliance to ERAS protocol was significantly associated with postoperative morbidity.

Published
2022

56. Minimally invasive surgery in emergency surgery: a WSES survey

Author

Ceresoli, M, Pisano, M, Abu-Zidan, F, Allievi, N, Gurusamy, K, Biffl, W, Tebala, G, Catena, F, Ansaloni, L, Sartelli, M, Kluger, Y, Baiocchi, G, Fette, A, Hecker, A, Litvin, A, Forgione, A, Leppaniemi, A, De Simone, B, Sakakushev, B, Palmatier, C, Bendinelli, C, Damascos, D, Picetti, E, Tan, E, Poiasina, E, Pikoulis, E, Cicuttin, E, Moore, E, Velmahos, G, Fraga, G, Van Goor, H, Civil, I, Wani, I, Di Carlo, I, Galante, J, Soreide, K, Degrate, L, Zorcolo, L, De Moya, M, Braga, M, Cereda, M, Sugrue, M, Chirica, M, De Angelis, N, Stahel, P, Ivatury, R, Ten Broek, R, Di Saverio, S, Beka, S, Magnone, S, Cui, Y, Balogh, Z, Kelly, M, Inaba, K, Coccolini, F, Ceresoli M., Pisano M., Abu-Zidan F., Allievi N., Gurusamy K., Biffl W. L., Tebala G. D., Catena F., Ansaloni L., Sartelli M., Kluger Y., Baiocchi G., Fette A., Hecker A., Litvin A., Forgione A., Leppaniemi A., De Simone B., Sakakushev B., Palmatier C. R., Bendinelli C., Damascos D., Picetti E., Tan E., Poiasina E., Pikoulis E., Cicuttin E., Moore E. E., Velmahos G., Fraga G., Van Goor H., Civil I., Wani I., Di Carlo I., Galante J., Soreide K., Degrate L., Zorcolo L., De Moya M., Braga M., Cereda M., Sugrue M., Chirica M., De Angelis N., Stahel P. F., Ivatury R., Ten Broek R., Di Saverio S., Beka S. G., Magnone S., Cui Y., Balogh Z. J., Kelly M. D., Inaba K., Coccolini F., Ceresoli, M, Pisano, M, Abu-Zidan, F, Allievi, N, Gurusamy, K, Biffl, W, Tebala, G, Catena, F, Ansaloni, L, Sartelli, M, Kluger, Y, Baiocchi, G, Fette, A, Hecker, A, Litvin, A, Forgione, A, Leppaniemi, A, De Simone, B, Sakakushev, B, Palmatier, C, Bendinelli, C, Damascos, D, Picetti, E, Tan, E, Poiasina, E, Pikoulis, E, Cicuttin, E, Moore, E, Velmahos, G, Fraga, G, Van Goor, H, Civil, I, Wani, I, Di Carlo, I, Galante, J, Soreide, K, Degrate, L, Zorcolo, L, De Moya, M, Braga, M, Cereda, M, Sugrue, M, Chirica, M, De Angelis, N, Stahel, P, Ivatury, R, Ten Broek, R, Di Saverio, S, Beka, S, Magnone, S, Cui, Y, Balogh, Z, Kelly, M, Inaba, K, Coccolini, F, Ceresoli M., Pisano M., Abu-Zidan F., Allievi N., Gurusamy K., Biffl W. L., Tebala G. D., Catena F., Ansaloni L., Sartelli M., Kluger Y., Baiocchi G., Fette A., Hecker A., Litvin A., Forgione A., Leppaniemi A., De Simone B., Sakakushev B., Palmatier C. R., Bendinelli C., Damascos D., Picetti E., Tan E., Poiasina E., Pikoulis E., Cicuttin E., Moore E. E., Velmahos G., Fraga G., Van Goor H., Civil I., Wani I., Di Carlo I., Galante J., Soreide K., Degrate L., Zorcolo L., De Moya M., Braga M., Cereda M., Sugrue M., Chirica M., De Angelis N., Stahel P. F., Ivatury R., Ten Broek R., Di Saverio S., Beka S. G., Magnone S., Cui Y., Balogh Z. J., Kelly M. D., Inaba K., and Coccolini F.

Abstract

Background: The diffusion of minimally invasive surgery in emergency surgery still represents a developing challenge. Evidence about the use of minimally invasive surgery shows its feasibility and safety; however, the diffusion of these techniques is still poor. The aims of the present survey were to explore the diffusion and variations in the use of minimally invasive surgery among surgeons in the emergency setting. Methods: This is a web-based survey administered to all the WSES members investigating the diffusion of minimally invasive surgery in emergency. The survey investigated personal characteristics of participants, hospital characteristics, personal confidence in the use of minimally invasive surgery in emergency, limitations in the use of it and limitations to prosecute minimally invasive surgery in emergency surgery. Characteristics related to the use of minimally invasive surgery were studied with a multivariate ordinal regression. Results: The survey collected a total of 415 answers; 42.2% of participants declared a working experience > 15 years and 69.4% of responders worked in tertiary level center or academic hospital. In primary emergencies, only 28,7% of participants declared the use of laparoscopy in more than 50% of times. Personal confidence with minimally invasive techniques was the highest for appendectomy and cholecystectomy. At multivariate ordinal regression, a longer professional experience, the use of laparoscopy in major elective surgery and bariatric surgery expertise were related to a higher use of laparoscopy in emergency surgery. Conclusions: The survey shows that minimally invasive techniques in emergency surgery are still underutilized. Greater focus should be placed on the development of dedicated training in laparoscopy among emergency surgeons.

Published
2022

57. Skeletal muscle wasting and long-term prognosis in patients undergoing rectal cancer surgery without neoadjuvant therapy

Author

Giani, A, Famularo, S, Fogliati, A, Riva, L, Tamini, N, Ippolito, D, Nespoli, L, Braga, M, Gianotti, L, Giani A., Famularo S., Fogliati A., Riva L., Tamini N., Ippolito D., Nespoli L., Braga M., Gianotti L., Giani, A, Famularo, S, Fogliati, A, Riva, L, Tamini, N, Ippolito, D, Nespoli, L, Braga, M, Gianotti, L, Giani A., Famularo S., Fogliati A., Riva L., Tamini N., Ippolito D., Nespoli L., Braga M., and Gianotti L.

Abstract

Background: Derangement of body composition has been associated with dismal long-term survival in several gastrointestinal cancers including rectal tumors treated with neoadjuvant therapies. The role of specific preoperative anthropometric indexes on the oncologic outcomes of patients undergoing upfront surgery for rectal cancer has not been investigated. The aim of the study is to evaluate the association of body composition and overall survival in this specific cohort. Methods: Lumbar computed tomography images, obtained within the 30 days previous to surgery, between January 2009 and December 2016, were used to calculate population-specific thresholds of muscle mass (sarcopenia), subcutaneous and visceral adiposity, visceral obesity, sarcopenic obesity, and myosteatosis. These body composition variables were related with overall survival (OS), tumor-specific survival (TSS), and disease-free survival (DFS). OS, TSS, and DFS were evaluated by the Kaplan-Meier method. Cox regression analysis was used to identify independent predictors of mortality, tumor-specific mortality, and recurrence, and data were presented as hazard ratio (HR) and 95% confidence interval (CI). Results: During the study period, 411 patients underwent rectal resection for cancer, and among these, 129 were without neoadjuvant chemoradiation. The median follow-up was 96.7 months. At the end of the follow-up, 41 patients (31.8%) had died; of these, 26 (20.1%) died for tumor-related reasons, and 36 (27.1%) experienced disease recurrence. One-, three-, and five-year OS was 95.7%, 86.0%, and 76.8% for non-sarcopenic patients versus 82.4%, 58.8%, and 40.0% for sarcopenic ones respectively (p < 0.001). Kaplan-Meier survival curves comparing sarcopenic and non-sarcopenic patients showed a significant difference in terms of OS (log-rank < 0.0001). Through multivariate Cox regression, overall mortality risk was associated only with sarcopenia (HR 1.96; 95%CI 1.03–3.74; p = 0.041). Disease stage IV a

Published
2022

58. The uncharted severity of complications after appendectomy for acute appendicitis in children: results from 348 consecutive patients

Author

Degrate, L, Chiappetta, M, Nigro, A, Fattori, L, Perrone, S, Garancini, M, Romano, F, Braga, M, Degrate L., Chiappetta M. F., Nigro A., Fattori L., Perrone S., Garancini M., Romano F., Braga M., Degrate, L, Chiappetta, M, Nigro, A, Fattori, L, Perrone, S, Garancini, M, Romano, F, Braga, M, Degrate L., Chiappetta M. F., Nigro A., Fattori L., Perrone S., Garancini M., Romano F., and Braga M.

Abstract

Appendectomy is the most frequently performed emergent procedure in paediatric patients. However, there is a wide heterogeneity in outcome definitions and, conversely, a lack of information about complications’ severity. This study aims to analyse the outcome of children operated for acute appendicitis, with reference to complications’ severity grading. This is a retrospective analysis of a prospectively collected database including all children who underwent emergent appendectomy between September 2013 and March 2020. Postoperative complications were defined according to standardized definitions and graded following Clavien–Dindo classification (CDC). The outcome was analysed in terms of postoperative morbidity, severity of complications, hospital readmission and length of hospital stay (LOS). 348 patients were analysed. Postoperative complications occurred in 18 (5.2%) patients; superficial and organ/space surgical site infections represented the most frequent complications (1.7% and 2.9%, respectively). Major complications (CDC ≥ IIIa) were seen in 4 (1.1%) patients. Median postoperative LOS was 4 (iqr 3–5) days, while hospital readmission was 1.1%. Postoperative complications, preoperative C-reactive protein values and presence of drainage were significantly associated with longer LOS at multivariate analysis. No difference in incidence and severity of complications was found in relation to children’s adolescent age. Major complications among paediatric patients undergoing appendectomy for acute appendicitis in a general surgery department are rare. The application of standardized definitions and severity-based grading of complications is crucial for outcome analysis: our results are a useful reference for comparison between forthcoming studies.

Published
2022

59. A snapshot of emergency neurology management in the Lombardy Region, Italy

Author

Zanferrari, C, Salmaggi, A, Belcastro, V, Domina, E, Beretta, S, Braga, M, Bonato, S, Ghione, I, Caputi, L, Brusaferri, F, Cavallini, A, Persico, A, Ciccone, A, Silvestrelli, G, Clerici, R, De Piazza, C, Conti, G, Cotelli, M, Turla, M, Dallocchio, C, Mazza, S, Ferrarese, C, Piatti, M, Ferraro, B, Carpo, M, Fanucchi, S, Fiacco, F, Maggio, P, Frediani, F, Tonietti, S, Grampa, G, Russo, L, Savio, F, Magni, E, Palmerini, F, Magoni, M, Marcheselli, S, Corato, M, Mattioli, M, Padovani, A, Pantoni, L, Baso, G, Prelle, A, Muscia, F, Priori, A, Tancredi, L, Santilli, I, Scaccabarozzi, C, Sessa, M, Gioia, S, Zanferrari C., Salmaggi A., Belcastro V., Domina E., Beretta S., Braga M., Bonato S., Ghione I., Caputi L., Brusaferri F., Cavallini A., Persico A., Ciccone A., Silvestrelli G., Clerici R., De Piazza C., Conti G., Cotelli M. S., Turla M., Dallocchio C., Mazza S., Ferrarese C., Piatti M. L., Ferraro B., Carpo M., Fanucchi S., Fiacco F., Maggio P., Frediani F., Tonietti S., Grampa G., Russo L. L., Savio F. L., Magni E., Palmerini F., Magoni M., Marcheselli S., Corato M., Mattioli M., Padovani A., Pantoni L., Baso G., Prelle A., Muscia F., Priori A., Tancredi L., Santilli I., Scaccabarozzi C., Sessa M., Gioia S. L., Zanferrari, C, Salmaggi, A, Belcastro, V, Domina, E, Beretta, S, Braga, M, Bonato, S, Ghione, I, Caputi, L, Brusaferri, F, Cavallini, A, Persico, A, Ciccone, A, Silvestrelli, G, Clerici, R, De Piazza, C, Conti, G, Cotelli, M, Turla, M, Dallocchio, C, Mazza, S, Ferrarese, C, Piatti, M, Ferraro, B, Carpo, M, Fanucchi, S, Fiacco, F, Maggio, P, Frediani, F, Tonietti, S, Grampa, G, Russo, L, Savio, F, Magni, E, Palmerini, F, Magoni, M, Marcheselli, S, Corato, M, Mattioli, M, Padovani, A, Pantoni, L, Baso, G, Prelle, A, Muscia, F, Priori, A, Tancredi, L, Santilli, I, Scaccabarozzi, C, Sessa, M, Gioia, S, Zanferrari C., Salmaggi A., Belcastro V., Domina E., Beretta S., Braga M., Bonato S., Ghione I., Caputi L., Brusaferri F., Cavallini A., Persico A., Ciccone A., Silvestrelli G., Clerici R., De Piazza C., Conti G., Cotelli M. S., Turla M., Dallocchio C., Mazza S., Ferrarese C., Piatti M. L., Ferraro B., Carpo M., Fanucchi S., Fiacco F., Maggio P., Frediani F., Tonietti S., Grampa G., Russo L. L., Savio F. L., Magni E., Palmerini F., Magoni M., Marcheselli S., Corato M., Mattioli M., Padovani A., Pantoni L., Baso G., Prelle A., Muscia F., Priori A., Tancredi L., Santilli I., Scaccabarozzi C., Sessa M., and Gioia S. L.

Abstract

Background: The assessment of human and diagnostic resources is a prerequisite to improving the management of emergency neurology. Objective: To provide a landscape on the organization of the Lombardy Region hospitals for emergency neurological care management. Methods: We designed an anonymized questionnaire including 6 sections with 21 questions on facilities, human and diagnostic resources, and intra- and between-hospital connections. The time needed to fill the questionnaire was estimated not to exceed 6 min. Results: The questionnaire was returned by 33/41 (80.5%) hospitals, 22 classified as level 1 (spoke), and 11 as level 2 (hub). Five of 33 (15%) did not have a neurology unit. The mean annual rate of neurological consultations accounted for 5–6% of all admissions (range 2–8%) and did not differ between levels 1 and 2 hospitals. Neurologists were 24-h available in 21/33 (64%) hospitals, 12-h and on call at night in 6 (18%), less than 12 h without nocturnal availability in 5 (15%), and neither present nor available in 1 (3%). Brain CT and CSF examinations were 24-h universally available, whereas EEG and neurosonology were not in most hospitals. Despite angio-CT was 24-h available in more than 75% of the hospitals, only 45% of them had 24-h availability of diffusion/perfusion imaging, and 43% were not available at any time. Only 12% of the hospitals had 24-h availability of neuroradiologists and 6% of interventional neuroradiologists. Conclusion: Our data, while emphasizing current critical issues, offer clues for identifying priorities and improving the management of emergency and time-dependent neurological diseases.

Published
2022

60. Patient characteristics, management, and outcomes of acute myocardial infarction due to unprotected left main stem occlusion: insights from a real-world multicentre registry over a 12-year period

Author

Alexandre, A, primary, Braga, M, additional, Campinas, A, additional, Dias-Frias, A, additional, Sa-Couto, D, additional, Calvao, J, additional, Brandao, M, additional, Passos Silva, M, additional, Pires De Morais, G, additional, Carlos Silva, J, additional, Santos, R, additional, Brochado, B, additional, Luz, A, additional, Silveira, J, additional, and Torres, S, additional

Published
2023
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61. Cardiac arrest in patients with acute left main coronary artery occlusion: a real-world multicenter registry

Author

Oliveira Campinas, A, primary, Braga, M B, additional, Alexandre, A A, additional, Costa, R C, additional, Frias, A F, additional, Calvao, J C, additional, Brandao, M B, additional, Carlos Silva, J C S, additional, Passos Silva, M S P, additional, Pires De Morais, G P M, additional, Brochado, B B, additional, Luz, A L, additional, Gomes, C G, additional, Silveira, J S, additional, and Severo, S T, additional

Published
2023
Full Text
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63. Association of chronic statin use, myopenia, myosteatosis and major morbidity in surgical patients with upper gastrointestinal cancer

Author

Cereda, M, Bernasconi, D, Uggeri, F, Ippolito, D, Di Lucca, G, Maino, C, Gandola, D, Braga, M, Sandini, M, Gianotti, L, Cereda, Marco, Bernasconi, Davide Paolo, Uggeri, Fabio, Ippolito, Davide, Di Lucca, Gabriele, Maino, Cesare, Gandola, Davide, Braga, Marco, Sandini, Marta, Gianotti, Luca, Cereda, M, Bernasconi, D, Uggeri, F, Ippolito, D, Di Lucca, G, Maino, C, Gandola, D, Braga, M, Sandini, M, Gianotti, L, Cereda, Marco, Bernasconi, Davide Paolo, Uggeri, Fabio, Ippolito, Davide, Di Lucca, Gabriele, Maino, Cesare, Gandola, Davide, Braga, Marco, Sandini, Marta, and Gianotti, Luca

Abstract

Derangements of body composition affect surgical outcomes. Chronic statin use may induce muscle wasting and impair muscle tissue quality. Aim of this study was to evaluate the association of chronic statin use, skeletal muscle area (SMA), myosteatosis and major postoperative morbidity. Between 2011 and 2021, patients undergoing pancreatoduodenectomy or total gastrectomy for cancer, and using statins since at least 1 year, were retrospective studied. SMA and myosteatosis were measured at CT scan. The cut-off for SMA and myosteatosis were determined using ROC curve and considering severe complications as the binary outcome. The presence of myopenia was defined when SMA was lower that the cut-off. A multivariable logistic regression was applied to assess the association between several factors and severe complications. After a matching procedure (1:1) for key baseline risk factors (ASA; age; Charlson comorbidity index; tumor site; intraoperative blood loss), a final sample of 104 patients, of which 52 treated and 52 not treated with statins, was obtained. The median age was 75 years, with an ASA score ≥ 3 in 63% of the cases. SMA (OR 5.119, 95% CI 1.053–24.865) and myosteatosis (OR 4.234, 95% CI 1.511–11.866) below the cut-off values were significantly associated with major morbidity. Statin use was predictive of major complication only in patients with preoperative myopenia (OR 5.449, 95% CI 1.054–28.158). Myopenia and myosteatosis were independently associated with an increased risk of severe complications. Statin use was associated with a higher risk of having major morbidity only in the subgroup of patients with myopenia.

Published
2023

64. Enhanced perioperative care in emergency general surgery: the WSES position paper.

Author

Ceresoli, M., Braga, M., Zanini, N., Abu-Zidan, F.M., Parini, D., Langer, T., Sartelli, M., Damaskos, D., Biffl, W.L., Amico, F., Ansaloni, L., Balogh, Z.J., Bonavina, L., Civil, I., Cicuttin, E., Chirica, M., Cui, Y., Simone, B. De, Carlo, I. Di, Fette, A., Foti, G., Fogliata, M., Fraga, G.P., Fugazzola, P., Galante, J.M., Beka, S.G., Hecker, A., Jeekel, J., Kirkpatrick, A.W., Koike, Kaoru, Leppäniemi, A., Marzi, I., Moore, E.E., Picetti, E., Pikoulis, E., Pisano, M., Podda, M., Sakakushev, B.E., Shelat, V.G., Tan, E.C.T.H., Tebala, G.D., Velmahos, G., Weber, D.G., Agnoletti, V., Kluger, Y., Baiocchi, G., Catena, F., Coccolini, F., Ceresoli, M., Braga, M., Zanini, N., Abu-Zidan, F.M., Parini, D., Langer, T., Sartelli, M., Damaskos, D., Biffl, W.L., Amico, F., Ansaloni, L., Balogh, Z.J., Bonavina, L., Civil, I., Cicuttin, E., Chirica, M., Cui, Y., Simone, B. De, Carlo, I. Di, Fette, A., Foti, G., Fogliata, M., Fraga, G.P., Fugazzola, P., Galante, J.M., Beka, S.G., Hecker, A., Jeekel, J., Kirkpatrick, A.W., Koike, Kaoru, Leppäniemi, A., Marzi, I., Moore, E.E., Picetti, E., Pikoulis, E., Pisano, M., Podda, M., Sakakushev, B.E., Shelat, V.G., Tan, E.C.T.H., Tebala, G.D., Velmahos, G., Weber, D.G., Agnoletti, V., Kluger, Y., Baiocchi, G., Catena, F., and Coccolini, F.

Abstract

Contains fulltext : 297347.pdf (Publisher’s version ) (Open Access), Enhanced perioperative care protocols become the standard of care in elective surgery with a significant improvement in patients' outcome. The key element of the enhanced perioperative care protocol is the multimodal and interdisciplinary approach targeted to the patient, focused on a holistic approach to reduce surgical stress and improve perioperative recovery. Enhanced perioperative care in emergency general surgery is still a debated topic with little evidence available. The present position paper illustrates the existing evidence about perioperative care in emergency surgery patients with a focus on each perioperative intervention in the preoperative, intraoperative and postoperative phase. For each item was proposed and approved a statement by the WSES collaborative group.

Published
2023

66. A national survey on the current status of minimally invasive gastric practice on behalf of GIRCG

Author

Milone, M, D'Amore, A, Alfieri, S, Ambrosio, M, Andreuccetti, J, Ansaloni, L, Antonucci, A, Arganini, M, Baiocchi, G, Barone, M, Bencini, L, Bencivenga, M, Boccia, L, Boni, L, Braga, M, Cianchi, F, Cipollari, C, Contine, A, Cotsoglou, C, D'Imporzano, S, De Manzoni, G, De Pascale, S, De Ruvo, N, Degiuli, M, Donini, A, Elmore, U, Ercolani, G, Ferrari, G, Fumagalli, R, Garulli, G, Gelmini, R, Graziosi, L, Gualtierotti, M, Guglielmi, A, Inama, M, Maffeis, F, Maione, F, Manigrasso, M, Marchesi, F, Marrelli, D, Massobrio, A, Moretto, G, Moukachar, A, Navarra, G, Nigri, G, Olmi, S, Palaia, R, Papis, D, Parise, P, Pedrazzani, C, Petri, R, Pignata, G, Pisano, M, Rausei, S, Reddavid, R, Rocco, G, Rosa, F, Rosati, R, Rossit, L, Rottoli, M, Roviello, F, Santi, S, Scabini, S, Scaringi, S, Solaini, L, Staderini, F, Taglietti, L, Torre, B, Ubiali, P, Uccelli, M, Uggeri, F, Vertaldi, S, Viganò, J, De Palma, G, Giacopuzzi, S, Milone, Marco, D'Amore, Anna, Alfieri, Sergio, Ambrosio, Maria Raffaella, Andreuccetti, Jacopo, Ansaloni, Luca, Antonucci, Adelmo, Arganini, Marco, Baiocchi, Gianluca, Barone, Mirko, Bencini, Lapo, Bencivenga, Maria, Boccia, Luigi, Boni, Luigi, Braga, Marco, Cianchi, Fabio, Cipollari, Chiara, Contine, Alessandro, Cotsoglou, Christian, D'Imporzano, Simone, De Manzoni, Giovanni, De Pascale, Stefano, De Ruvo, Nicola, Degiuli, Maurizio, Donini, Annibale, Elmore, Ugo, Ercolani, Giorgio, Ferrari, Giovanni, Fumagalli, Romario Uberto, Garulli, Gianluca, Gelmini, Roberta, Graziosi, Luigina, Gualtierotti, Monica, Guglielmi, Alfredo, Inama, Marco, Maffeis, Federica, Maione, Francesco, Manigrasso, Michele, Marchesi, Federico, Marrelli, Daniele, Massobrio, Andrea, Moretto, Gianluigi, Moukachar, Aballah, Navarra, Giuseppe, Nigri, Giuseppe, Olmi, Stefano, Palaia, Raffaele, Papis, Davide, Parise, Paolo, Pedrazzani, Corrado, Petri, Roberto, Pignata, Giusto, Pisano, Michele, Rausei, Stefano, Reddavid, Rossella, Rocco, Giuseppe, Rosa, Fausto, Rosati, Riccardo, Rossit, Luca, Rottoli, Matteo, Roviello, Franco, Santi, Stefano, Scabini, Stefano, Scaringi, Stefano, Solaini, Leonardo, Staderini, Fabio, Taglietti, Lucio, Torre, Beatrice, Ubiali, Paolo, Uccelli, Matteo, Uggeri, Fabio, Vertaldi, Sara, Viganò, Jacopo, De Palma, Giovanni Domenico, Giacopuzzi, Simone, Milone, M, D'Amore, A, Alfieri, S, Ambrosio, M, Andreuccetti, J, Ansaloni, L, Antonucci, A, Arganini, M, Baiocchi, G, Barone, M, Bencini, L, Bencivenga, M, Boccia, L, Boni, L, Braga, M, Cianchi, F, Cipollari, C, Contine, A, Cotsoglou, C, D'Imporzano, S, De Manzoni, G, De Pascale, S, De Ruvo, N, Degiuli, M, Donini, A, Elmore, U, Ercolani, G, Ferrari, G, Fumagalli, R, Garulli, G, Gelmini, R, Graziosi, L, Gualtierotti, M, Guglielmi, A, Inama, M, Maffeis, F, Maione, F, Manigrasso, M, Marchesi, F, Marrelli, D, Massobrio, A, Moretto, G, Moukachar, A, Navarra, G, Nigri, G, Olmi, S, Palaia, R, Papis, D, Parise, P, Pedrazzani, C, Petri, R, Pignata, G, Pisano, M, Rausei, S, Reddavid, R, Rocco, G, Rosa, F, Rosati, R, Rossit, L, Rottoli, M, Roviello, F, Santi, S, Scabini, S, Scaringi, S, Solaini, L, Staderini, F, Taglietti, L, Torre, B, Ubiali, P, Uccelli, M, Uggeri, F, Vertaldi, S, Viganò, J, De Palma, G, Giacopuzzi, S, Milone, Marco, D'Amore, Anna, Alfieri, Sergio, Ambrosio, Maria Raffaella, Andreuccetti, Jacopo, Ansaloni, Luca, Antonucci, Adelmo, Arganini, Marco, Baiocchi, Gianluca, Barone, Mirko, Bencini, Lapo, Bencivenga, Maria, Boccia, Luigi, Boni, Luigi, Braga, Marco, Cianchi, Fabio, Cipollari, Chiara, Contine, Alessandro, Cotsoglou, Christian, D'Imporzano, Simone, De Manzoni, Giovanni, De Pascale, Stefano, De Ruvo, Nicola, Degiuli, Maurizio, Donini, Annibale, Elmore, Ugo, Ercolani, Giorgio, Ferrari, Giovanni, Fumagalli, Romario Uberto, Garulli, Gianluca, Gelmini, Roberta, Graziosi, Luigina, Gualtierotti, Monica, Guglielmi, Alfredo, Inama, Marco, Maffeis, Federica, Maione, Francesco, Manigrasso, Michele, Marchesi, Federico, Marrelli, Daniele, Massobrio, Andrea, Moretto, Gianluigi, Moukachar, Aballah, Navarra, Giuseppe, Nigri, Giuseppe, Olmi, Stefano, Palaia, Raffaele, Papis, Davide, Parise, Paolo, Pedrazzani, Corrado, Petri, Roberto, Pignata, Giusto, Pisano, Michele, Rausei, Stefano, Reddavid, Rossella, Rocco, Giuseppe, Rosa, Fausto, Rosati, Riccardo, Rossit, Luca, Rottoli, Matteo, Roviello, Franco, Santi, Stefano, Scabini, Stefano, Scaringi, Stefano, Solaini, Leonardo, Staderini, Fabio, Taglietti, Lucio, Torre, Beatrice, Ubiali, Paolo, Uccelli, Matteo, Uggeri, Fabio, Vertaldi, Sara, Viganò, Jacopo, De Palma, Giovanni Domenico, and Giacopuzzi, Simone

Abstract

Italian Research Group for Gastric Cancer (GIRCG), during the 2013 annual Consensus Conference to gastric cancer, stated that laparoscopic or robotic approach should be limited only to early gastric cancer (EGC) and no further guidelines were currently available. However, accumulated evidences, mainly from eastern experiences, have supported the application of minimally invasive surgery also for locally advanced gastric cancer (AGC). The aim of our study is to give a snapshot of current surgical propensity of expert Italian upper gastrointestinal surgeons in performing minimally invasive techniques for the treatment of gastric cancer in order to answer to the question if clinical practice overcome the recommendation. Experts in the field among the Italian Research Group for Gastric Cancer (GIRCG) were invited to join a web 30-item survey through a formal e-mail from January 1st, 2020, to June 31st, 2020. Responses were collected from 46 participants out of 100 upper gastrointestinal surgeons. Percentage of surgeons choosing a minimally invasive approach to treat early and advanced gastric cancer was similar. Additionally analyzing data from the centers involved, we obtained that the percentage of minimally invasive total and partial gastrectomies in advanced cases augmented with the increase of surgical procedures performed per year (p=0.02 and p=0.04 respectively). It is reasonable to assume that there is a widening of indications given by the current national guideline into clinical practice. Propensity of expert Italian upper gastrointestinal surgeons was to perform minimally invasive surgery not only for early but also for advanced gastric cancer. Of interest volume activity correlated with the propensity of surgeons to select a minimally invasive approach.

Published
2023

68. Emergency hernia repair in the elderly: multivariate analysis of morbidity and mortality from an Italian registry

Author

Ceresoli, M, Carissimi, F, Nigro, A, Fransvea, P, Lepre, L, Braga, M, Costa, G, Agresta, F., Alemanno, G., Anania, G., Antropoli, M., Argenio, G., Atzeni, J., Avenia, N., Azzinnaro, A., Baldazzi, G., Balducci, G., Barbera, G., Bellanova, G., Bergamini, C., Bersigotti, L., Bianchi, Pp., Bombardini, C., Borzellino, G., Bozzo, S., Brachini, G., Buonanno, Gm., Canini, T., Cardella, S., Carrara, G., Cassini, D., Castriconi, M., Ceccarelli, G., Celi, D., Ceresoli, M., Chiappetta, M., Chiarugi, M., Cillara, N., Cimino, F., Cobuccio, L., Cocorullo, G., Colangelo, E., Costa, G., Crucitti, A., Dallacaneva, P., De Luca, M., de Manzoni Garberini, A., De Nisco, C., De Prizio, M., De Sol, A., Dibella, A., Falcioni, T., Falco, N., Farina, C., Finotti, E., Fontana, T., Francioni, G., Fransvea, P., Frezza, B., Garbarino, G., Garulli, G., Genna, M., Giannessi, S., Gioffrè, A., Giordano, A., Gozzo, D., Grimaldi, S., Gulotta, G., Iacopini, V., Iarussi, T., Laracca, G., Laterza, E., Leonardi, A., Lepre, L., Lorenzon, L., Luridiana, G., Malagnino, A., Mar, G., Marini, P., Marzaioli, R., Massa, G., Mecarelli, V., Mercantini, P., Mingoli, A., Nigri, G., Occhionorelli, S., Paderno, N., Palini, Gm., Paradies, D., Paroli, M., Perrone, F., Petrucciani, N., Petruzzelli, L., Pezzolla, A., Piazza, D., Piazza, V., Piccoli, M., Pisanu, A., Podda, M., Poillucci, G., Porfidia, R., Rossi, G., Ruscelli, P., Spagnoli, A., Sulis, R., Tartaglia, D., Tranà, C., Travaglino, A., Tomaiuolo, P., Valeri, A., Vasquez, G., Zago, M., E. Zanoni., Ceresoli M., Carissimi F., Nigro A., Fransvea P., Lepre L., Braga M., Costa G., Agresta F., Alemanno G., Anania G., Antropoli M., Argenio G., Atzeni J., Avenia N., Azzinnaro A., Baldazzi G., Balducci G., Barbera G., Bellanova G., Bergamini C., Bersigotti L., Bianchi P.P., Bombardini C., Borzellino G., Bozzo S., Brachini G., Buonanno G.M., Canini T., Cardella S., Carrara G., Cassini D., Castriconi M., Ceccarelli G., Celi D., Chiappetta M., Chiarugi M., Cillara N., Cimino F., Cobuccio L., Cocorullo G., Colangelo E., Crucitti A., DallaCaneva P., Luca M., de Manzoni Garberini A., De Nisco C., De Prizio M., De Sol A., Dibella A., Falcioni T., Falco N., Farina C., Finotti E., Fontana T., Francioni G., Frezza B., Garbarino G., Garulli G., Genna M., Giannessi S., Gioffre A., Giordano A., Gozzo D., Grimaldi S., Gulotta G., Iacopini V., Iarussi T., Laracca G., Laterza E., Leonardi A., Lorenzon L., Luridiana G., Malagnino A., Mar G., Marini P., Marzaioli R., Massa G., Mecarelli V., Mercantini P., Mingoli A., Nigri G., Occhionorelli S., Paderno N., Palini G.M., Paradies D., Paroli M., Perrone F., Petrucciani N., Petruzzelli L., Pezzolla A., Piazza D., Piazza V., Piccoli M., Pisanu A., Podda M., Poillucci G., Porfidia R., Rossi G., Ruscelli P., Spagnoli A., Sulis R., Tartaglia D., Trana C., Travaglino A., Tomaiuolo P., Valeri A., Vasquez G., Zago M., Zanoni E., Ceresoli, M, Carissimi, F, Nigro, A, Fransvea, P, Lepre, L, Braga, M, Costa, G, Agresta, F, Alemanno, G, Anania, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Baldazzi, G, Balducci, G, Barbera, G, Bellanova, G, Bergamini, C, Bersigotti, L, Bianchi, P, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buonanno, G, Canini, T, Cardella, S, Carrara, G, Cassini, D, Castriconi, M, Ceccarelli, G, Celi, D, Chiappetta, M, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Crucitti, A, Dallacaneva, P, Luca, M, de Manzoni Garberini, A, De Nisco, C, De Prizio, M, De Sol, A, Dibella, A, Falcioni, T, Falco, N, Farina, C, Finotti, E, Fontana, T, Francioni, G, Frezza, B, Garbarino, G, Garulli, G, Genna, M, Giannessi, S, Gioffre, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laracca, G, Laterza, E, Leonardi, A, Lorenzon, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Massa, G, Mecarelli, V, Mercantini, P, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, Palini, G, Paradies, D, Paroli, M, Perrone, F, Petrucciani, N, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, M, Pisanu, A, Podda, M, Poillucci, G, Porfidia, R, Rossi, G, Ruscelli, P, Spagnoli, A, Sulis, R, Tartaglia, D, Trana, C, Travaglino, A, Tomaiuolo, P, Valeri, A, Vasquez, G, Zago, M, and Zanoni, E

Subjects
medicine.medical_specialty, medicine.medical_treatment, Settore MED/18 - CHIRURGIA GENERALE, NO, Postoperative complications, Elderly, Laparotomy, medicine, Hernia, Incarcerated hernia, business.industry, Explorative laparotomy, Groin hernia · Incarcerated hernia · Elderly · Postoperative complications · Emergency surgery · Charlson’s comorbidity index, medicine.disease, Hernia repair, Comorbidity, Surgery, Groin hernia, Inguinal hernia, Charlson’s comorbidity index, Emergency surgery, business, Watchful waiting, Abdominal surgery
Abstract

Purpose The incidence of inguinal hernia is higher in elderly because of aging-related diseases like prostatism, bronchitis, collagen laxity. A conservative management is common in elderly to reduce surgery-related risks, however watchful waiting can expose to obstruction and strangulation. The aim of the present study was to assess the impact of emergency surgery in a large series of elderly with complicated groin hernia and to identify the independent risk factors for postoperative morbidity and mortality. The predictive performance of prognostic risk scores has been also assessed. Methods This is a prospective observational study carried out between January 2017 and June 2018 in elderly patients who underwent emergency surgery for complicated hernia in 38 Italian hospitals. Pre-operative, surgical and postoperative data were recorded for each patient. ASA score, Charlson’s comorbidity index, P-POSSUM and CR-POSSUM were assessed. Results 259 patients were recruited, mean age was 80 years. A direct repair without mesh was performed in 62 (23.9%) patients. Explorative laparotomy was performed in 56 (21.6%) patients and bowel resection was necessary in 44 (17%). Mortality occurred in seven (2.8%) patients. Fifty-five (21.2%) patients developed complications, 12 of whom had a major one. At univariate and multivariate analyses, Charlson’s comorbidity index ≥ 6, altered mental status, and need for laparotomy were associated with major complications and mortality Conclusion Emergency surgery for complicated hernia is burdened by high morbidity and mortality in elderly patients. Preoperative comorbidity played a pivotal role in predicting complications and mortality and therefore Charlson’s comorbidity index could be adopted to select patients for elective operation

Published
2022

75. Acute total occlusion of the unprotected left main coronary artery – patient characteristics and outcomes

Author

Calvao, J, primary, Braga, M, additional, Brandao, M, additional, Campinas, A, additional, Alexandre, A, additional, Amador, A F, additional, Costa, C, additional, Carvalho, M M, additional, Pinto, R A, additional, Proenca, T, additional, Silva, J C, additional, Pires-Morais, G, additional, Silva, M P, additional, Brochado, B, additional, and Macedo, F, additional

Published
2022
Full Text
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76. Mechanical circulatory support devices in left main occlusion: a multicenter study from 2008 to 2020

Author

Oliveira Campinas, A, primary, Braga, M, additional, Alexandre, A, additional, Costa, R, additional, Dias De Frias, A, additional, Calvao, J, additional, Brandao, M, additional, Passos Silva, M, additional, Pires De Morais, G, additional, Carlos Silva, J, additional, Brochado, B, additional, Luz, A, additional, Silveira, J, additional, Gomes, C, additional, and Torres, S, additional

Published
2022
Full Text
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80. Minimally invasive surgery in emergency surgery: a WSES survey

Author

Ceresoli M., Pisano M., Abu-Zidan F., Allievi N., Gurusamy K., Biffl W. L., Tebala G. D., Catena F., Ansaloni L., Sartelli M., Kluger Y., Baiocchi G., Fette A., Hecker A., Litvin A., Forgione A., Leppaniemi A., De Simone B., Sakakushev B., Palmatier C. R., Bendinelli C., Damascos D., Picetti E., Tan E., Poiasina E., Pikoulis E., Cicuttin E., Moore E. E., Velmahos G., Fraga G., Van Goor H., Civil I., Wani I., Di Carlo I., Galante J., Soreide K., Degrate L., Zorcolo L., De Moya M., Braga M., Cereda M., Sugrue M., Chirica M., De Angelis N., Stahel P. F., Ivatury R., Ten Broek R., Di Saverio S., Beka S. G., Magnone S., Cui Y., Balogh Z. J., Kelly M. D., Inaba K., Coccolini F., Ceresoli, M, Pisano, M, Abu-Zidan, F, Allievi, N, Gurusamy, K, Biffl, W, Tebala, G, Catena, F, Ansaloni, L, Sartelli, M, Kluger, Y, Baiocchi, G, Fette, A, Hecker, A, Litvin, A, Forgione, A, Leppaniemi, A, De Simone, B, Sakakushev, B, Palmatier, C, Bendinelli, C, Damascos, D, Picetti, E, Tan, E, Poiasina, E, Pikoulis, E, Cicuttin, E, Moore, E, Velmahos, G, Fraga, G, Van Goor, H, Civil, I, Wani, I, Di Carlo, I, Galante, J, Soreide, K, Degrate, L, Zorcolo, L, De Moya, M, Braga, M, Cereda, M, Sugrue, M, Chirica, M, De Angelis, N, Stahel, P, Ivatury, R, Ten Broek, R, Di Saverio, S, Beka, S, Magnone, S, Cui, Y, Balogh, Z, Kelly, M, Inaba, K, and Coccolini, F

Subjects
Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], All institutes and research themes of the Radboud University Medical Center, Minimally invasive surgery, Emergency Medicine, Emergency surgery, Surgery, Laparoscopy, Survey
Abstract

Background The diffusion of minimally invasive surgery in emergency surgery still represents a developing challenge. Evidence about the use of minimally invasive surgery shows its feasibility and safety; however, the diffusion of these techniques is still poor. The aims of the present survey were to explore the diffusion and variations in the use of minimally invasive surgery among surgeons in the emergency setting. Methods This is a web-based survey administered to all the WSES members investigating the diffusion of minimally invasive surgery in emergency. The survey investigated personal characteristics of participants, hospital characteristics, personal confidence in the use of minimally invasive surgery in emergency, limitations in the use of it and limitations to prosecute minimally invasive surgery in emergency surgery. Characteristics related to the use of minimally invasive surgery were studied with a multivariate ordinal regression. Results The survey collected a total of 415 answers; 42.2% of participants declared a working experience > 15 years and 69.4% of responders worked in tertiary level center or academic hospital. In primary emergencies, only 28,7% of participants declared the use of laparoscopy in more than 50% of times. Personal confidence with minimally invasive techniques was the highest for appendectomy and cholecystectomy. At multivariate ordinal regression, a longer professional experience, the use of laparoscopy in major elective surgery and bariatric surgery expertise were related to a higher use of laparoscopy in emergency surgery. Conclusions The survey shows that minimally invasive techniques in emergency surgery are still underutilized. Greater focus should be placed on the development of dedicated training in laparoscopy among emergency surgeons.

Published
2022

81. Correction to: The decrease of non-complicated acute appendicitis and the negative appendectomy rate during pandemic (European Journal of Trauma and Emergency Surgery, (2021), 47, 5, (1359-1365), 10.1007/s00068-021-01663-7)

Author

Ceresoli, M, Coccolini, F, Magnone, S, Lucianetti, A, Bisagni, P, Armao, T, Ansaloni, L, Zago, M, Chiarugi, M, Catena, F, Braga, M, Nizzardo, M, Nespoli, L, Fattori, L, Degrate, L, Perrone, S, Cereda, M, Pisano, M, Poiasina, E, Bertoli, P, Ballabio, M, Braga, S, Graziano, G, Tartaglia, D, Arces, F, Mariani, M, Tagliabue, F, Perrone, G, Annicchiarico, A, Giuffrida, M, Ferrari, G, Benedetti, A, Allievi, N, Ciocca, M, Pinotti, E, Montuori, M, Carlucci, M, Tomajer, V, Fugazzola, P, Ceresoli M., Coccolini F., Magnone S., Lucianetti A., Bisagni P., Armao T., Ansaloni L., Zago M., Chiarugi M., Catena F., Braga M., Nizzardo M., Nespoli L., Fattori L., Degrate L., Perrone S., Cereda M., Pisano M., Poiasina E., Bertoli P., Ballabio M., Braga S., Graziano G., Tartaglia D., Arces F., Mariani M., Tagliabue F., Perrone G., Annicchiarico A., Giuffrida M., Ferrari G., Benedetti A., Allievi N., Ciocca M., Pinotti E., Montuori M., Carlucci M., Tomajer V., Fugazzola P., Ceresoli, M, Coccolini, F, Magnone, S, Lucianetti, A, Bisagni, P, Armao, T, Ansaloni, L, Zago, M, Chiarugi, M, Catena, F, Braga, M, Nizzardo, M, Nespoli, L, Fattori, L, Degrate, L, Perrone, S, Cereda, M, Pisano, M, Poiasina, E, Bertoli, P, Ballabio, M, Braga, S, Graziano, G, Tartaglia, D, Arces, F, Mariani, M, Tagliabue, F, Perrone, G, Annicchiarico, A, Giuffrida, M, Ferrari, G, Benedetti, A, Allievi, N, Ciocca, M, Pinotti, E, Montuori, M, Carlucci, M, Tomajer, V, Fugazzola, P, Ceresoli M., Coccolini F., Magnone S., Lucianetti A., Bisagni P., Armao T., Ansaloni L., Zago M., Chiarugi M., Catena F., Braga M., Nizzardo M., Nespoli L., Fattori L., Degrate L., Perrone S., Cereda M., Pisano M., Poiasina E., Bertoli P., Ballabio M., Braga S., Graziano G., Tartaglia D., Arces F., Mariani M., Tagliabue F., Perrone G., Annicchiarico A., Giuffrida M., Ferrari G., Benedetti A., Allievi N., Ciocca M., Pinotti E., Montuori M., Carlucci M., Tomajer V., and Fugazzola P.

Abstract

The original version of this article unfortunately contained a mistake. The Acknowledgement with the members of the Appendicitis- COVID study group is missing. The correct version of is given below. Acknowledgements Members of the Appendicitis-COVID study group: Monza: Marco Nizzardo, Luca Nespoli, Luca Fattori, Luca Degrate, Stefano Perrone, Marco Cereda Bergamo: Michele Pisano, Elia Poiasina, Paolo Bertoli Lodi: Michele Ballabio, Stefano Braga Pavia: Giorgio Graziano Pisa: DarioTartaglia, Francesco Arces Lecco: Marco Mariani, Fulvio Tagliabue Parma: Gennaro Perrone, Alfredo Annicchiarico, Mario Giuffrida Legnano: Giovanni Ferrari, Antonio Benedetti, Niccolò Allievi Ponte San Pietro: Michele Ciocca, Enrico Pinotti, Mauro Montuori San Raffaele: Michele Carlucci, Valentina Tomajer Cesena: Paola Fugazzola The original article has been corrected.

Published
2021

82. Does preoperative stent positioning in obstructive left sided colon cancer increase the risk of perineural invasion?

Author

Tamini, N, Angrisani, M, Alde, S, Nespoli, L, Oldani, M, Braga, M, Gianotti, L, Tamini N., Angrisani M., Alde S., Nespoli L., Oldani M., Braga M., Gianotti L., Tamini, N, Angrisani, M, Alde, S, Nespoli, L, Oldani, M, Braga, M, Gianotti, L, Tamini N., Angrisani M., Alde S., Nespoli L., Oldani M., Braga M., and Gianotti L.

Abstract

Colonic stenting as a bridge to surgery has been shown to be a safe and effective treatment for left-sided malignant colonic obstruction depending on local expertise. However, concerns still exist regarding its oncological safety. In particular, several reports showed an increased prevalence of perineural tumor invasion following stent placement. Since perineural invasion negatively affects oncological outcomes, the present study sought to evaluate this controversial association. We retrospectively reviewed 114 patients presenting with left-side obstructing colon cancer over a 10-year period. The relationship between perineural invasion and colonic stenting was analyzed using univariate and multivariate analyses. Perineural invasion was found to be strongly associated with pathological features, including TNM stage, (p < 0.001), poor differentiation (p = 0.002), vascular invasion (p < 0.001), lymphatic invasion (p < 0.001), whereas no significant association with preoperative stenting was observed (p = 0.918) after performing univariate analysis. In the multivariate model, only TNM stage III–IV (OR: 6.810, 95% CI 1.972–23.518, p = 0.002) and venous invasion (OR: 5.325, 95% CI 1.911–14.840, p = 0.001) were independently associated with perineural invasion. The results of this study suggest no association between preoperative colonic stenting and perineural invasion.

Published
2021

83. Is It Just a Matter of Surgical Extension to Achieve the Cure of Hepatocarcinoma? A Meta-Analysis of Propensity-Matched and Randomized Studies for Anatomic Versus Parenchyma-Sparing Liver Resection

Author

Famularo, S, Ceresoli, M, Giani, A, Ciulli, C, Pinotti, E, Romano, F, Braga, M, De Carlis, L, Gianotti, L, Famularo S., Ceresoli M., Giani A., Ciulli C., Pinotti E., Romano F., Braga M., De Carlis L., Gianotti L., Famularo, S, Ceresoli, M, Giani, A, Ciulli, C, Pinotti, E, Romano, F, Braga, M, De Carlis, L, Gianotti, L, Famularo S., Ceresoli M., Giani A., Ciulli C., Pinotti E., Romano F., Braga M., De Carlis L., and Gianotti L.

Abstract

Background: The benefit of anatomic (AR) versus parenchyma-sparing resection (PSR) in hepatocarcinoma (HCC) is still debated. The aim of the study was to compare AR vs. PSR in terms of overall survival (OS) and disease-free survival (DFS). Methods: A systematic review was conducted using Medline and Google Scholar. To reduce intra- and inter-study heterogeneity, only propensity-matched studies and randomized clinical trials (RCT) were evaluated and a generic inverse variance meta-analysis was run. A sub-analysis was performed in case of tumor microvascular invasion (MVI). Results: Eleven propensity-matched and one RCT were evaluated, with a total of 3445 patients (AR = 1776 and PSR = 1669). Tumor burden and liver function were comparable among studies (I2 < 50%, p > 0.5). OS was similar between AR and PSR (HR 0.93; 95%CI, 0.75–1.15; p = 0.50, I2 = 41%). DFS was improved in AR at 1 year (RR 0.84; 95%CI, 0.72–0.97; p = 0.02; I2 = 36%) and 3 years (RR 0.90; 95%CI, 0.83–0.98; p = 0.02; I2 = 40%) but not at 5 years (RR 0.94; 95%CI, 0.87–1.01; p = 0.07; I2 = 41%). Furthermore, in the presence of MVI, no difference in OS and DFS was observed between AR and PSR. Conclusion: When liver function and tumor burden are comparable, AR and PSR achieved similar overall survival. AR improved local control in the early period after surgery. Furthermore, in the presence of MVI, the extension of surgery was not associated with better OS and DFS.

Published
2021

84. The decrease of non-complicated acute appendicitis and the negative appendectomy rate during pandemic

Author

Ceresoli, M, Coccolini, F, Magnone, S, Lucianetti, A, Bisagni, P, Armao, T, Ansaloni, L, Zago, M, Chiarugi, M, Catena, F, Braga, M, Nizzardo, M, Nespoli, L, Fattori, L, Degrate, L, Perrone, S, Cereda, M, Pisano, M, Poiasina, E, Bertoli, P, Ballabio, M, Braga, S, Graziano, G, Tartaglia, D, Arces, F, Mariani, M, Tagliabue, F, Perrone, G, Annicchiarico, A, Giuffrida, M, Ferrari, G, Benedetti, A, Allievi, N, Ciocca, M, Pinotti, E, Montuori, M, Carlucci, M, Tomajer, V, Fugazzola, P, Ceresoli M., Coccolini F., Magnone S., Lucianetti A., Bisagni P., Armao T., Ansaloni L., Zago M., Chiarugi M., Catena F., Braga M., Nizzardo M., Nespoli L., Fattori L., Degrate L., Perrone S., Cereda M., Pisano M., Poiasina E., Bertoli P., Ballabio M., Braga S., Graziano G., Tartaglia D., Arces F., Mariani M., Tagliabue F., Perrone G., Annicchiarico A., Giuffrida M., Ferrari G., Benedetti A., Allievi N., Ciocca M., Pinotti E., Montuori M., Carlucci M., Tomajer V., Fugazzola P., Ceresoli, M, Coccolini, F, Magnone, S, Lucianetti, A, Bisagni, P, Armao, T, Ansaloni, L, Zago, M, Chiarugi, M, Catena, F, Braga, M, Nizzardo, M, Nespoli, L, Fattori, L, Degrate, L, Perrone, S, Cereda, M, Pisano, M, Poiasina, E, Bertoli, P, Ballabio, M, Braga, S, Graziano, G, Tartaglia, D, Arces, F, Mariani, M, Tagliabue, F, Perrone, G, Annicchiarico, A, Giuffrida, M, Ferrari, G, Benedetti, A, Allievi, N, Ciocca, M, Pinotti, E, Montuori, M, Carlucci, M, Tomajer, V, Fugazzola, P, Ceresoli M., Coccolini F., Magnone S., Lucianetti A., Bisagni P., Armao T., Ansaloni L., Zago M., Chiarugi M., Catena F., Braga M., Nizzardo M., Nespoli L., Fattori L., Degrate L., Perrone S., Cereda M., Pisano M., Poiasina E., Bertoli P., Ballabio M., Braga S., Graziano G., Tartaglia D., Arces F., Mariani M., Tagliabue F., Perrone G., Annicchiarico A., Giuffrida M., Ferrari G., Benedetti A., Allievi N., Ciocca M., Pinotti E., Montuori M., Carlucci M., Tomajer V., and Fugazzola P.

Abstract

Background: During pandemic, admissions for surgical emergencies dropped down dramatically. Also acute appendicitis decreased. The aim of the present study was to evaluate the change in volume and clinical presentation of patients with acute appendicitis during pandemic and the variation in treatment. Methods: This is a retrospective study of patients admitted in 11 Italian hospital for acute appendicitis during the lockdown period (March–April 2020) compared with the same period of the previous 2 years (2018–2019). The number and the rate of complicated and non-complicated acute appendicitis were recorded and compared between the two study periods; non-operative vs operative treatment and negative appendectomy rate were also recorded. Results: The study included 532 patients, 112 in the study period and 420 in the control period; Hospital admission for acute appendicitis dropped by 46% (OR 0.516 95% CI 0.411–0.648 p < 0.001) during the 2020 lockdown. The number of complicated acute appendicitis did not change (− 18%, OR 0.763 95% CI 0.517–1.124 p = 0.1719), whereas the number of non-complicated acute appendicitis significantly decreased (− 56%, OR 0.424 95% CI 0.319–0.564 p < 0.001). Non-operative treatment rate remained similar (12.1% vs. 11.6% p = 0.434). The negative appendectomy rate also significantly decreased (6.1% vs. 17.3%, p = 0.006). Conclusions: The present study found a significant reduction of both admissions for non-complicated acute appendicitis and negative appendectomy rate during the pandemic period. Conversely, admissions for complicated acute appendicitis did not change. Trial registration: NCT04649996.

Published
2021

85. Answer to letter: The decrease of non-complicated acute appendicitis and the negative appendectomy rate during pandemic

Author

Ceresoli, M, Coccolini, F, Magnone, S, Lucianetti, A, Bisagni, P, Armao, T, Ansaloni, L, Zago, M, Chiarugi, M, Catena, F, Braga, M, Ceresoli M., Coccolini F., Magnone S., Lucianetti A., Bisagni P., Armao T., Ansaloni L., Zago M., Chiarugi M., Catena F., Braga M., Ceresoli, M, Coccolini, F, Magnone, S, Lucianetti, A, Bisagni, P, Armao, T, Ansaloni, L, Zago, M, Chiarugi, M, Catena, F, Braga, M, Ceresoli M., Coccolini F., Magnone S., Lucianetti A., Bisagni P., Armao T., Ansaloni L., Zago M., Chiarugi M., Catena F., and Braga M.

Published
2021

86. Is bmi a factor in compliance to adjuvant chemotherapy for locally advanced rectal cancer? a multicenter retrospective analysis and comparison with non-obese patients

Author

Mari, G, Crippa, J, Pietro, A, Maggioni, D, Costanzi, A, Scotti, M, Braga, M, Cocozza, E, Borroni, G, Benzoni, I, Totaro, L, Origi, M, Ferrari, G, Ziccarelli, A, Petri, R, Bagnardi, V, Mari G. M., Crippa J., Pietro A., Maggioni D., Costanzi A., Scotti M. A., Braga M., Cocozza E., Borroni G., Benzoni I., Totaro L., Origi M., Ferrari G., Ziccarelli A., Petri R., Bagnardi V., Mari, G, Crippa, J, Pietro, A, Maggioni, D, Costanzi, A, Scotti, M, Braga, M, Cocozza, E, Borroni, G, Benzoni, I, Totaro, L, Origi, M, Ferrari, G, Ziccarelli, A, Petri, R, Bagnardi, V, Mari G. M., Crippa J., Pietro A., Maggioni D., Costanzi A., Scotti M. A., Braga M., Cocozza E., Borroni G., Benzoni I., Totaro L., Origi M., Ferrari G., Ziccarelli A., Petri R., and Bagnardi V.

Abstract

Background: Compliance to adjuvant chemotherapy (AC) for patients undergoing rectal surgery ranges from 43% to 73.6%. Reasons reported for not initiating or completing AC include onset of postoperative complications, drug toxicity, disease progression and/or patient preferences. Little is known regarding the impact of obesity on the compliance to AC in this setting. Methods: This multicenter, retrospective study analyzed compliance to AC and treatment-related morbidity in 511 patients having undergone surgery with curative intent for rectal cancer in six Italian colorectal centers between January 2013 and December 2017. Results:70 patients were obese (BMI > 30 kg/m2). The proportion of open procedures (22.9% vs. 13.4%) and conversions (14.3% vs. 4.8%) was greater in obese compared to non-obese patients (p<0.001). Median hospital stay was one day longer for obese patients (9 days vs. 10 days, p=0.038) while there was no statistically significant difference in the complication rate, whether overall (58.6% in obese vs. 52.3% in non-obese) or with a Clavien-Dindo score ≥ 3 (17.1% vs 10.9%). AC was offered to 49/70 (70%) patients in the obese group and 306/441 (69.4%) in the non-obese group (p=0.43). There was no statistically significant difference in AC compliance: 18.4% and 22.9% did not start AC, while 36.7% and 34.6%, started AC but did not complete the scheduled treatment (p=0.79) in the obese and non-obese group, respectively. Overall, 55% of patients who started AC successfully completed their adjuvant treatment. Conclusion: Obesity did not impact compliance to AC for locally advanced rectal cancer: Compliance was poor in obese and non-obese patients with no statistically significant difference between the two groups. Major complication rate was not statistically significantly affected by increased BMI.

Published
2021

87. Do preoperative transfusions impact prognosis in moderate to severe anaemic surgical patients with colon cancer?

Author

Tamini, N, Gianotti, L, Darwish, S, Petitto, S, Bernasconi, D, Oldani, M, Uggeri, F, Braga, M, Nespoli, L, Tamini N., Gianotti L., Darwish S., Petitto S., Bernasconi D., Oldani M., Uggeri F., Braga M., Nespoli L., Tamini, N, Gianotti, L, Darwish, S, Petitto, S, Bernasconi, D, Oldani, M, Uggeri, F, Braga, M, Nespoli, L, Tamini N., Gianotti L., Darwish S., Petitto S., Bernasconi D., Oldani M., Uggeri F., Braga M., and Nespoli L.

Abstract

(1) Background: Anaemia is a common finding in patients with colon cancer and is commonly corrected by blood transfusion prior to surgery. However, the prognostic role of perioperative transfusions is still debated. The aim of the present study was to investigate the role of preoperative anaemia and preoperative blood transfusion in influencing the prognosis in colon cancer. (2) Patients and Methods: Patients undergoing elective surgery for colon cancer at a tertiary referral university hospital between January 2010 and December 2018 were included in a retrospective review of a prospectively collected database. Univariate and regression analyses were performed to identify the prognostic role of preoperative anaemia and preoperative transfusions in this homogeneous cohort of patients. (3) Results: A total of 780 patients were included in the final analysis. The estimated five-year overall survival rate was significantly worse in the anaemic group (83.8% in non-anaemic patients, 60.6% in mild anaemic patients, 61.3% in moderate anaemic patients and 58.4% in severe anaemic patients; log-rank < 0.001 vs. non-anaemic patients). Anaemic status was found to be an independent adverse prognostic factor (hazard ratio (HR): 1.46; 95% confidence interval (CI): 1.02–2.07) during multivariate analysis. Among moderate to severe anaemic patients, no significant association was found between preoperative transfusions and the risk of mortality or recurrence. (4) Conclusions: Preoperative anaemia, regardless of its severity, and not preoperative blood transfu-sion, was independently associated with a worse prognosis after surgery in patients with colonic cancer.

Published
2021

88. Appendectomy during the COVID-19 pandemic in Italy: a multicenter ambispective cohort study by the Italian Society of Endoscopic Surgery and new technologies (the CRAC study)

Author

Sartori, A, Podda, M, Botteri, E, Passera, R, Agresta, F, Arezzo, A, Guerrieri, M, Ortenzi, M, Cavallo, F, Zese, M, Prando, D, Restini, E, Cianci, P, Millo, P, Brachet Contul, R, Serrao, A, Abatini, F, Altomare, D, Picciariello, A, Chetta, G, Lattanzio, F, Tonini, V, Gori, A, Jovine, E, Mastrangelo, L, Sartarelli, L, Frena, A, Malpaga, A, Bertelli, F, Pignata, G, Andreuccetti, J, Sanna, S, Lares, B, Sechi, R, Cillara, N, Pisanu, A, Delogu, D, Ciaccio, G, Farulla, M, Casati, M, Laface, L, De Luca, M, Russello, D, Latteri, S, Longoni, M, Masci, E, Vigna, S, Campanile, F, Foti, N, Lepiane, P, Balla, A, Cantore, F, Raveglia, V, Borghi, F, Giraudo, G, Verzelli, A, Budassi, A, Patriti, A, Foghetti, D, Montin, U, Amadio, L, Anania, G, Bombardini, C, Fabbri, N, Feo, C, Cianchi, F, Manetti, A, Lucchese, M, Soricelli, E, Ceccarelli, G, Patiti, M, Frascio, M, Stabilini, C, Filauro, M, Barberis, A, Troian, M, Nagliati, C, Campagnacci, R, Maurizi, A, Berti, S, Gennai, A, Marvaso, A, D'Antonio, D, Mazzola, L, Selvaggi, F, Carini, S, Costanzo, F, Boccia, L, Pascariello, A, Perrotta, N, Celiento, M, Opocher, E, Giovenzana, M, Stella, M, Ferrara, F, Boni, L, Abate, E, Da Lio, C, Valli, V, Gelmini, R, Serra, F, Piccoli, M, Gozzo, D, Gattolin, A, Sasia, D, Balani, A, Petronio, B, Calo, P, Canu, G, Contarini, E, Piatto, G, Vettoretto, N, Caprioli, M, Braga, M, Chiappetta, M, Maida, P, Tammaro, P, De Palma, G, Milone, M, Bottino, V, Canfora, A, Bagaglini, G, Agrusa, A, Barone, M, Mirabella, A, Marino, M, Gulotta, G, Romano, G, Sorrentino, M, Ferfoglia, S, Papagni, V, Eramo, S, Boselli, C, Basti, M, Caracino, V, Moretto, G, Inama, M, Capelli, P, Conti, L, Muratore, A, Cuoghi, M, Zerbinati, A, Corso, S, Vasino, M, Montuori, M, Fidanza, F, Lucchetta, A, Giuliani, A, Dinatale, G, Zanzi, F, Guariniello, A, Bonilauri, S, Frazzetta, G, Garino, M, Marafante, C, Gioffre, A, Del Monte, S, Sganga, G, Fransvea, P, Grande, M, Siragusa, L, Sica, G, Paola, M, Passantino, D, Catani, M, Ricci, F, Lauro, E, Facci, E, Parini, D, Armellino, M, Argenio, G, Porcu, A, Perra, T, Bordoni, P, Fleres, F, Parisi, A, Rossi, S, Saracco, R, Bono, D, Viora, T, Orlando, F, Ferrero, A, Fontana, A, De Paolis, P, Visconti, D, Quaglino, F, Festa, F, Palagi, S, Lo Secco, G, Morino, M, Allaix, M, Salzano, A, Tirone, G, Motter, M, Zanus, G, Passuello, N, Massani, M, Tutino, R, Manzini, N, Terranova, S, Merenda, R, Nordio, S, Zonta, S, Lovisetto, F, Guglielmi, A, Campagnaro, T, Amedeo, E, Scollica, M, Amodio, P, Giannotti, D, Olmi, S, Oldani, A, Sartori A., Podda M., Botteri E., Passera R., Agresta F., Arezzo A., Guerrieri M., Ortenzi M., Cavallo F., Zese M., Prando D., Restini E., Cianci P., Millo P., Brachet Contul R., Serrao A., Abatini F., Altomare D. F., Picciariello A., Chetta G., Lattanzio F., Tonini V., Gori A., Jovine E., Mastrangelo L., Sartarelli L., Frena A., Malpaga A., Bertelli F., Pignata G., Andreuccetti J., Sanna S., Lares B., Sechi R., Cillara N., Pisanu A., Delogu D., Ciaccio G., Farulla M., Casati M., Laface L., De Luca M., Russello D., Latteri S., Longoni M., Masci E., Vigna S., Campanile F. C., Foti N., Lepiane P., Balla A., Cantore F., Raveglia V., Borghi F., Giraudo G., Verzelli A., Budassi A., Patriti A., Foghetti D., Montin U., Amadio L., Anania G., Bombardini C., Fabbri N., Feo C., Cianchi F., Manetti A., Lucchese M., Soricelli E., Ceccarelli G., Patiti M., Frascio M., Stabilini C., Filauro M., Barberis A., Troian M., Nagliati C., Campagnacci R., Maurizi A., Berti S., Gennai A., Marvaso A., D'Antonio D., Feo C. V., Mazzola L., Selvaggi F., Carini S., Costanzo F., Boccia L., Pascariello A., Perrotta N., Celiento M., Opocher E., Giovenzana M., Stella M., Ferrara F., Boni L., Abate E., Da Lio C., Valli V., Gelmini R., Serra F., Piccoli M., Gozzo D., Gattolin A., Sasia D., Balani A., Petronio B., Calo P. G., Canu G. L., Contarini E., Piatto G., Vettoretto N., Caprioli M., Braga M., Chiappetta M. F., Maida P., Tammaro P., De Palma G., Milone M., Bottino V., Canfora A., Bagaglini G., Agrusa A., Barone M., Mirabella A., Marino M. V., Gulotta G., Romano G., Sorrentino M., Ferfoglia S., Papagni V., Eramo S., Boselli C., Basti M., Caracino V., Moretto G., Inama M., Capelli P., Conti L., Muratore A., Cuoghi M. M., Zerbinati A., Corso S., Vasino M. C., Montuori M., Fidanza F., Lucchetta A., Giuliani A., Dinatale G., Zanzi F., Guariniello A., Bonilauri S., Frazzetta G., Garino M., Marafante C., Gioffre A., Del Monte S. R., Sganga G., Fransvea P., Grande M., Siragusa L., Sica G., Paola M., Passantino D. G., Catani M., Ricci F., Lauro E., Facci E., Parini D., Armellino M. F., Argenio G., Porcu A., Perra T., Bordoni P., Fleres F., Parisi A., Rossi S., Saracco R., Bono D., Viora T., Orlando F., Ferrero A., Fontana A. P., De Paolis P., Visconti D., Quaglino F., Festa F., Palagi S., Lo Secco G., Morino M., Allaix M. E., Salzano A., Tirone G., Motter M., Zanus G., Passuello N., Massani M., Tutino R., Manzini N., Terranova S., Merenda R., Nordio S., Zonta S., Lovisetto F., Guglielmi A., Campagnaro T., Amedeo E., Scollica M., Amodio P., Giannotti D., Olmi S., Oldani A., Sartori, A, Podda, M, Botteri, E, Passera, R, Agresta, F, Arezzo, A, Guerrieri, M, Ortenzi, M, Cavallo, F, Zese, M, Prando, D, Restini, E, Cianci, P, Millo, P, Brachet Contul, R, Serrao, A, Abatini, F, Altomare, D, Picciariello, A, Chetta, G, Lattanzio, F, Tonini, V, Gori, A, Jovine, E, Mastrangelo, L, Sartarelli, L, Frena, A, Malpaga, A, Bertelli, F, Pignata, G, Andreuccetti, J, Sanna, S, Lares, B, Sechi, R, Cillara, N, Pisanu, A, Delogu, D, Ciaccio, G, Farulla, M, Casati, M, Laface, L, De Luca, M, Russello, D, Latteri, S, Longoni, M, Masci, E, Vigna, S, Campanile, F, Foti, N, Lepiane, P, Balla, A, Cantore, F, Raveglia, V, Borghi, F, Giraudo, G, Verzelli, A, Budassi, A, Patriti, A, Foghetti, D, Montin, U, Amadio, L, Anania, G, Bombardini, C, Fabbri, N, Feo, C, Cianchi, F, Manetti, A, Lucchese, M, Soricelli, E, Ceccarelli, G, Patiti, M, Frascio, M, Stabilini, C, Filauro, M, Barberis, A, Troian, M, Nagliati, C, Campagnacci, R, Maurizi, A, Berti, S, Gennai, A, Marvaso, A, D'Antonio, D, Mazzola, L, Selvaggi, F, Carini, S, Costanzo, F, Boccia, L, Pascariello, A, Perrotta, N, Celiento, M, Opocher, E, Giovenzana, M, Stella, M, Ferrara, F, Boni, L, Abate, E, Da Lio, C, Valli, V, Gelmini, R, Serra, F, Piccoli, M, Gozzo, D, Gattolin, A, Sasia, D, Balani, A, Petronio, B, Calo, P, Canu, G, Contarini, E, Piatto, G, Vettoretto, N, Caprioli, M, Braga, M, Chiappetta, M, Maida, P, Tammaro, P, De Palma, G, Milone, M, Bottino, V, Canfora, A, Bagaglini, G, Agrusa, A, Barone, M, Mirabella, A, Marino, M, Gulotta, G, Romano, G, Sorrentino, M, Ferfoglia, S, Papagni, V, Eramo, S, Boselli, C, Basti, M, Caracino, V, Moretto, G, Inama, M, Capelli, P, Conti, L, Muratore, A, Cuoghi, M, Zerbinati, A, Corso, S, Vasino, M, Montuori, M, Fidanza, F, Lucchetta, A, Giuliani, A, Dinatale, G, Zanzi, F, Guariniello, A, Bonilauri, S, Frazzetta, G, Garino, M, Marafante, C, Gioffre, A, Del Monte, S, Sganga, G, Fransvea, P, Grande, M, Siragusa, L, Sica, G, Paola, M, Passantino, D, Catani, M, Ricci, F, Lauro, E, Facci, E, Parini, D, Armellino, M, Argenio, G, Porcu, A, Perra, T, Bordoni, P, Fleres, F, Parisi, A, Rossi, S, Saracco, R, Bono, D, Viora, T, Orlando, F, Ferrero, A, Fontana, A, De Paolis, P, Visconti, D, Quaglino, F, Festa, F, Palagi, S, Lo Secco, G, Morino, M, Allaix, M, Salzano, A, Tirone, G, Motter, M, Zanus, G, Passuello, N, Massani, M, Tutino, R, Manzini, N, Terranova, S, Merenda, R, Nordio, S, Zonta, S, Lovisetto, F, Guglielmi, A, Campagnaro, T, Amedeo, E, Scollica, M, Amodio, P, Giannotti, D, Olmi, S, Oldani, A, Sartori A., Podda M., Botteri E., Passera R., Agresta F., Arezzo A., Guerrieri M., Ortenzi M., Cavallo F., Zese M., Prando D., Restini E., Cianci P., Millo P., Brachet Contul R., Serrao A., Abatini F., Altomare D. F., Picciariello A., Chetta G., Lattanzio F., Tonini V., Gori A., Jovine E., Mastrangelo L., Sartarelli L., Frena A., Malpaga A., Bertelli F., Pignata G., Andreuccetti J., Sanna S., Lares B., Sechi R., Cillara N., Pisanu A., Delogu D., Ciaccio G., Farulla M., Casati M., Laface L., De Luca M., Russello D., Latteri S., Longoni M., Masci E., Vigna S., Campanile F. C., Foti N., Lepiane P., Balla A., Cantore F., Raveglia V., Borghi F., Giraudo G., Verzelli A., Budassi A., Patriti A., Foghetti D., Montin U., Amadio L., Anania G., Bombardini C., Fabbri N., Feo C., Cianchi F., Manetti A., Lucchese M., Soricelli E., Ceccarelli G., Patiti M., Frascio M., Stabilini C., Filauro M., Barberis A., Troian M., Nagliati C., Campagnacci R., Maurizi A., Berti S., Gennai A., Marvaso A., D'Antonio D., Feo C. V., Mazzola L., Selvaggi F., Carini S., Costanzo F., Boccia L., Pascariello A., Perrotta N., Celiento M., Opocher E., Giovenzana M., Stella M., Ferrara F., Boni L., Abate E., Da Lio C., Valli V., Gelmini R., Serra F., Piccoli M., Gozzo D., Gattolin A., Sasia D., Balani A., Petronio B., Calo P. G., Canu G. L., Contarini E., Piatto G., Vettoretto N., Caprioli M., Braga M., Chiappetta M. F., Maida P., Tammaro P., De Palma G., Milone M., Bottino V., Canfora A., Bagaglini G., Agrusa A., Barone M., Mirabella A., Marino M. V., Gulotta G., Romano G., Sorrentino M., Ferfoglia S., Papagni V., Eramo S., Boselli C., Basti M., Caracino V., Moretto G., Inama M., Capelli P., Conti L., Muratore A., Cuoghi M. M., Zerbinati A., Corso S., Vasino M. C., Montuori M., Fidanza F., Lucchetta A., Giuliani A., Dinatale G., Zanzi F., Guariniello A., Bonilauri S., Frazzetta G., Garino M., Marafante C., Gioffre A., Del Monte S. R., Sganga G., Fransvea P., Grande M., Siragusa L., Sica G., Paola M., Passantino D. G., Catani M., Ricci F., Lauro E., Facci E., Parini D., Armellino M. F., Argenio G., Porcu A., Perra T., Bordoni P., Fleres F., Parisi A., Rossi S., Saracco R., Bono D., Viora T., Orlando F., Ferrero A., Fontana A. P., De Paolis P., Visconti D., Quaglino F., Festa F., Palagi S., Lo Secco G., Morino M., Allaix M. E., Salzano A., Tirone G., Motter M., Zanus G., Passuello N., Massani M., Tutino R., Manzini N., Terranova S., Merenda R., Nordio S., Zonta S., Lovisetto F., Guglielmi A., Campagnaro T., Amedeo E., Scollica M., Amodio P., Giannotti D., Olmi S., and Oldani A.

Abstract

Major surgical societies advised using non-operative management of appendicitis and suggested against laparoscopy during the COVID-19 pandemic. The hypothesis is that a significant reduction in the number of emergent appendectomies was observed during the pandemic, restricted to complex cases. The study aimed to analyse emergent surgical appendectomies during pandemic on a national basis and compare it to the same period of the previous year. This is a multicentre, retrospective, observational study investigating the outcomes of patients undergoing emergent appendectomy in March–April 2019 vs March–April 2020. The primary outcome was the number of appendectomies performed, classified according to the American Association for the Surgery of Trauma (AAST) score. Secondary outcomes were the type of surgical technique employed (laparoscopic vs open) and the complication rates. One thousand five hundred forty one patients with acute appendicitis underwent surgery during the two study periods. 1337 (86.8%) patients met the inclusion criteria: 546 (40.8%) patients underwent surgery for acute appendicitis in 2020 and 791 (59.2%) in 2019. According to AAST, patients with complicated appendicitis operated in 2019 were 30.3% vs 39.9% in 2020 (p = 0.001). We observed an increase in the number of post-operative complications in 2020 (15.9%) compared to 2019 (9.6%) (p < 0.001). The following determinants increased the likelihood of complication occurrence: undergoing surgery during 2020 (+ 67%), the increase of a unit in the AAST score (+ 26%), surgery performed > 24 h after admission (+ 58%), open surgery (+ 112%) and conversion to open surgery (+ 166%). In Italian hospitals, in March and April 2020, the number of appendectomies has drastically dropped. During the first pandemic wave, patients undergoing surgery were more frequently affected by more severe appendicitis than the previous year's timeframe and experienced a higher number of complications. Trial registrat

Published
2021

89. ESPEN practical guideline: Clinical nutrition in surgery

Author

Weimann, A, Braga, M, Carli, F, Higashiguchi, T, Hubner, M, Klek, S, Laviano, A, Ljungqvist, O, Lobo, D, Martindale, R, Waitzberg, D, Bischoff, S, Singer, P, Weimann A., Braga M., Carli F., Higashiguchi T., Hubner M., Klek S., Laviano A., Ljungqvist O., Lobo D. N., Martindale R. G., Waitzberg D., Bischoff S. C., Singer P., Weimann, A, Braga, M, Carli, F, Higashiguchi, T, Hubner, M, Klek, S, Laviano, A, Ljungqvist, O, Lobo, D, Martindale, R, Waitzberg, D, Bischoff, S, Singer, P, Weimann A., Braga M., Carli F., Higashiguchi T., Hubner M., Klek S., Laviano A., Ljungqvist O., Lobo D. N., Martindale R. G., Waitzberg D., Bischoff S. C., and Singer P.

Abstract

Early oral feeding is the preferred mode of nutrition for surgical patients. Avoidance of any nutritional therapy bears the risk of underfeeding during the postoperative course after major surgery. Considering that malnutrition and underfeeding are risk factors for postoperative complications, early enteral feeding is especially relevant for any surgical patient at nutritional risk, especially for those undergoing upper gastrointestinal surgery. The focus of this guideline is to cover both nutritional aspects of the Enhanced Recovery After Surgery (ERAS) concept and the special nutritional needs of patients undergoing major surgery, e.g. for cancer, and of those developing severe complications despite best perioperative care. From a metabolic and nutritional point of view, the key aspects of perioperative care include the integration of nutrition into the overall management of the patient, avoidance of long periods of preoperative fasting, re-establishment of oral feeding as early as possible after surgery, the start of nutritional therapy immediately if a nutritional risk becomes apparent, metabolic control e.g. of blood glucose, reduction of factors which exacerbate stress-related catabolism or impaired gastrointestinal function, minimized time on paralytic agents for ventilator management in the postoperative period, and early mobilization to facilitate protein synthesis and muscle function.

Published
2021

90. Scored-GLIM as an effective tool to assess nutrition status and predict survival in patients with cancer

Author

Zhang, Q, Zhang, K, Zhang, X, Tang, M, Song, C, Cong, M, Guo, Z, Ding, J, Braga, M, Cederholm, T, Xu, H, Li, W, Barazzoni, R, Shi, H, Zhang Q., Zhang K. -P., Zhang X., Tang M., Song C. -H., Cong M. -H., Guo Z. -Q., Ding J. -S., Braga M., Cederholm T., Xu H. -X., Li W., Barazzoni R., Shi H. -P., Zhang, Q, Zhang, K, Zhang, X, Tang, M, Song, C, Cong, M, Guo, Z, Ding, J, Braga, M, Cederholm, T, Xu, H, Li, W, Barazzoni, R, Shi, H, Zhang Q., Zhang K. -P., Zhang X., Tang M., Song C. -H., Cong M. -H., Guo Z. -Q., Ding J. -S., Braga M., Cederholm T., Xu H. -X., Li W., Barazzoni R., and Shi H. -P.

Abstract

Background & aims: The Global Leadership Initiative on Malnutrition (GLIM) released new universal criteria for diagnosing and grading malnutrition, and calls for further investigations not only in different clinical setting but also in GLIM itself including reference value, combination and weight of different GLIM criteria. This study aimed to weigh the GLIM criteria and develop a scored-GLIM system, and then validate as well as evaluate its application in nutritional assessment and survival prediction for patients with cancer. Design: A total of 3547 patients in the primary cohort and 415 patients in the validation cohort were included in the study. Patients’ nutritional status were retrospectively assessed using the GLIM criteria. Kaplan–Meier survival curves and multivariate Cox regression analyses were performed to analyze the association between nutritional status and overall survival (OS). A nomogram was produced to quantify the GLIM criteria and develop the scored-GLIM system. C-index, receiver operating characteristic (ROC) curve and calibration curve analyses were performed to validate the predictive accuracy and discriminatory capacity of the scored-GLIM. Finally, a decision curve was applied to assess the clinical utility of the scored-GLIM system. Results: In the primary cohort, 70.3% of patients were diagnosed as malnutrition. The malnutrition severity grading according to the GLIM criteria were associated with the prognosis of patients with cancer (HR 1.42, 1.23 to 1.65 for moderate malnutrition; HR 1.80,1.84 to 2.09 for severe malnutrition). The weight of each GLIM criteria was calculated, and unintentional weight loss was the most determining factor acting upon mortality (HR 1.82, 1.64 to 2.10 for stage II and HR 1.50, 1.31 to 1.73 for stage I). A nomogram was constructed by four factors of GLIM to weigh the GLIM criteria. The areas under the ROC curve were 65.3 (1-year ROC) and 65.5 (3-year ROC), and the C-index was 0.62, and the calibration cur

Published
2021

91. Cost-effectiveness of the adherence with recommendations for clinical monitoring of patients with diabetes

Author

Corrao, G, Rea, F, Mancia, G, Perseghin, G, Merlino, L, Martini, N, Carbone, S, Carle, F, Bucci, A, Dajko, M, Arca, S, Bellentani, D, Bruno, V, Ceccolini, C, De Feo, A, Lispi, L, Mariniello, R, Masullo, M, Medici, F, Pisanti, P, Visca, M, Zanini, R, Di Fiandra, T, Magliocchetti, N, Romano, G, Cantarutti, A, Pugni, P, Davoli, M, Di Martino, M, Lallo, A, Vittori, P, Vuillermin, G, Bernardo, A, Fusciante, A, Belotti, L, De Palma, R, Di Felice, E, Chiandetti, R, Clagnan, E, Del Zotto, S, Di Lenarda, A, Mariotto, A, Prezza, M, Zanier, L, Fusco, D, Marinacci, C, Lora, A, Spazzafumo, L, Pizzi, S, Simiele, M, Massaro, G, Attolini, E, Lepore, V, Petrarolo, V, De Luca, G, Fantaci, G, Pollina Addario, S, Scondotto, S, Bellomo, F, Braga, M, Di Fabrizio, V, Forni, S, Francesconi, P, Profili, F, Avossa, F, Corradin, M, Vigna, S, Dondi, L, Pedrini, A, Piccinni, C, Cosentino, M, Marvulli, M, Maggioni, A, Corrao G., Rea F., Mancia G., Perseghin G., Merlino L., Martini N., Carbone S., Carle F., Bucci A., Dajko M., Arca S., Bellentani D., Bruno V., Ceccolini C., De Feo A., Lispi L., Mariniello R., Masullo M., Medici F., Pisanti P., Visca M., Zanini R., Di Fiandra T., Magliocchetti N., Romano G., Cantarutti A., Pugni P., Davoli M., Di Martino M., Lallo A., Vittori P., Vuillermin G., Bernardo A., Fusciante A., Belotti L., De Palma R., Di Felice E., Chiandetti R., Clagnan E., Del Zotto S., Di Lenarda A., Mariotto A., Prezza M., Zanier L., Fusco D., Marinacci C., Lora A., Spazzafumo L., Pizzi S., Simiele M., Massaro G., Attolini E., Lepore V., Petrarolo V., De Luca G., Fantaci G., Pollina Addario S., Scondotto S., Bellomo F., Braga M., Di Fabrizio V., Forni S., Francesconi P., Profili F., Avossa F., Corradin M., Vigna S., Dondi L., Pedrini A., Piccinni C., Cosentino M., Marvulli M. G., Maggioni A., Corrao, G, Rea, F, Mancia, G, Perseghin, G, Merlino, L, Martini, N, Carbone, S, Carle, F, Bucci, A, Dajko, M, Arca, S, Bellentani, D, Bruno, V, Ceccolini, C, De Feo, A, Lispi, L, Mariniello, R, Masullo, M, Medici, F, Pisanti, P, Visca, M, Zanini, R, Di Fiandra, T, Magliocchetti, N, Romano, G, Cantarutti, A, Pugni, P, Davoli, M, Di Martino, M, Lallo, A, Vittori, P, Vuillermin, G, Bernardo, A, Fusciante, A, Belotti, L, De Palma, R, Di Felice, E, Chiandetti, R, Clagnan, E, Del Zotto, S, Di Lenarda, A, Mariotto, A, Prezza, M, Zanier, L, Fusco, D, Marinacci, C, Lora, A, Spazzafumo, L, Pizzi, S, Simiele, M, Massaro, G, Attolini, E, Lepore, V, Petrarolo, V, De Luca, G, Fantaci, G, Pollina Addario, S, Scondotto, S, Bellomo, F, Braga, M, Di Fabrizio, V, Forni, S, Francesconi, P, Profili, F, Avossa, F, Corradin, M, Vigna, S, Dondi, L, Pedrini, A, Piccinni, C, Cosentino, M, Marvulli, M, Maggioni, A, Corrao G., Rea F., Mancia G., Perseghin G., Merlino L., Martini N., Carbone S., Carle F., Bucci A., Dajko M., Arca S., Bellentani D., Bruno V., Ceccolini C., De Feo A., Lispi L., Mariniello R., Masullo M., Medici F., Pisanti P., Visca M., Zanini R., Di Fiandra T., Magliocchetti N., Romano G., Cantarutti A., Pugni P., Davoli M., Di Martino M., Lallo A., Vittori P., Vuillermin G., Bernardo A., Fusciante A., Belotti L., De Palma R., Di Felice E., Chiandetti R., Clagnan E., Del Zotto S., Di Lenarda A., Mariotto A., Prezza M., Zanier L., Fusco D., Marinacci C., Lora A., Spazzafumo L., Pizzi S., Simiele M., Massaro G., Attolini E., Lepore V., Petrarolo V., De Luca G., Fantaci G., Pollina Addario S., Scondotto S., Bellomo F., Braga M., Di Fabrizio V., Forni S., Francesconi P., Profili F., Avossa F., Corradin M., Vigna S., Dondi L., Pedrini A., Piccinni C., Cosentino M., Marvulli M. G., and Maggioni A.

Abstract

Background and aims: To validate a set of indicators for monitoring the quality of care of patients with diabetes in ‘real-life’ practice through its relationship with measurable clinical outcomes and healthcare costs. Methods and results: A population-based cohort study was carried out by including the 20,635 patients, residents in the Lombardy Region (Italy), who in the year 2012 were newly taken-in-care for diabetes. Adherence with clinical recommendations (i.e., controls for glycated haemoglobin, lipid profile, urine albumin excretion and serum creatinine) was recorded during the first year after the patient was taken-in-care, and categorized according whether he/she complied with none or almost none (0 or 1), just some (2) or all or almost all (3 or 4) the recommendations, respectively denoted as poor, intermediate and high adherence. Short- and long-term complications of diabetes, and healthcare cost incurred by the National Health Service, were assessed during follow-up. Compared with patients with poor adherence, those with intermediate and high adherence respectively showed (i) a delay in outcome occurrence of 13 days (95% CI, −2 to 27) and 23 days (9–38), and (ii) a lower healthcare cost of 54 € and 77 €. In average, a gain of 18 Euros and 15 Euros for each day free from diabetic complication by increasing adherence respectively from poor to intermediate and from poor to high were observed. Conclusion: Close control of patients with diabetes through regular clinical examinations must be considered the cornerstone of national guidance, national audits, and quality improvement incentive schemes.

Published
2021

92. Clinical validation of the comprehensive complication index in colon cancer surgery

Author

Tamini, N, Bernasconi, D, Ripamonti, L, Bianco, G, Braga, M, Nespoli, L, Tamini N., Bernasconi D., Ripamonti L., Bianco G. L., Braga M., Nespoli L., Tamini, N, Bernasconi, D, Ripamonti, L, Bianco, G, Braga, M, Nespoli, L, Tamini N., Bernasconi D., Ripamonti L., Bianco G. L., Braga M., and Nespoli L.

Abstract

(1) Introduction: To date, the sensitivity of the Comprehensive Complication Index (CCI) in a homogeneous cohort of colonic resections for oncologic purposes has not been reported. The present study aims to compare the CCI with the conventional Clavien–Dindo classification (CDC) in colon cancer patients. (2) Methods: The clinical data of patients submitted to an elective colectomy for adenocarcinoma were retrieved from a prospectively maintained database. Postoperative complications and length of stay were reviewed, and CDC and CCI scores were calculated for each patient. The association of the CCI and the CDC with the length of stay, prolongation of stay and readmission rate were assessed and compared. (3) Results: The overall postoperative morbidity was 26.9%. In particular, 157 (20.4%) patients had more than one complication. A strong correlation between the two scoring systems was observed (r = 99.4%; 95%CI: 99.3–99.5%). In multivariate analysis, CCI had a higher predictive ability for all endpoints. Regarding subgroup analysis, the difference between the CCI and CDC was progressively increased when evaluating outcome measures in complicated and multi-complicated patients. (4) Conclusion: Both scoring systems adequately report the overall burden of postoperative complications. The CCI showed a greater ability than the CDC to predict hospital stay, particularly in patients with multiple postoperative complications.

Published
2021

93. The GLIM criteria as an effective tool for nutrition assessment and survival prediction in older adult cancer patients

Author

Zhang, X, Tang, M, Zhang, Q, Zhang, K, Guo, Z, Xu, H, Yuan, K, Yu, M, Braga, M, Cederholm, T, Li, W, Barazzoni, R, Shi, H, Zhang X., Tang M., Zhang Q., Zhang K. -P., Guo Z. -Q., Xu H. -X., Yuan K. -T., Yu M., Braga M., Cederholm T., Li W., Barazzoni R., Shi H. -P., Zhang, X, Tang, M, Zhang, Q, Zhang, K, Guo, Z, Xu, H, Yuan, K, Yu, M, Braga, M, Cederholm, T, Li, W, Barazzoni, R, Shi, H, Zhang X., Tang M., Zhang Q., Zhang K. -P., Guo Z. -Q., Xu H. -X., Yuan K. -T., Yu M., Braga M., Cederholm T., Li W., Barazzoni R., and Shi H. -P.

Abstract

Background & aims: Elderly cancer patients are at particularly high risk for malnutrition because both the disease and the old age threaten their nutritional status. The Global Leadership Initiative on Malnutrition (GLIM) released new universal criteria for diagnosing and grading malnutrition, but the validation of these criteria in elderly cancer population is not well documented. Our objective was to investigate the application of the GLIM criteria in nutrition assessment and survival prediction in elderly cancer patients. Methods: This retrospective cohort analysis was conducted on a primary cohort of 1192 cancer patients aged 65 years or older enrolled from a multi-institutional registry, and a validation cohort of 300 elderly cancer patients treated at the First Affiliated Hospital of Sun Yat-sen University. Patients considered at-risk for malnutrition based on the NRS-2002 were assessed using the GLIM criteria. The association between the nutritional status and patients' overall survival (OS) was then analyzed by the Kaplan–Meier method and a Cox model. A nomogram was also established that included additional independent clinical prognostic variables. To determine the predictive accuracy and discriminatory capacity of the nomogram, the C-index, receiver operating characteristic (ROC) curve and calibration curve were evaluated. Results: The percentage of patients considered “at-risk” for malnutrition was 64.8% and 67.3% for the primary and validation cohorts, respectively. GLIM-defined malnutrition was diagnosed in 48.4% of patients in the primary cohort and 46.0% in the validation cohort. In the primary cohort, patients at risk of malnutrition (NRS-2002 ≥ 3) showed a worse OS than those with a NRS-2002 < 3 (HR 1.34, 1.10–1.64; p = 0.003). Additionally, patients with GLIM-defined severe malnutrition (HR1.71, 1.37–2.14; p < 0.001) or moderate malnutrition (HR1.35, 1.09–1.66; p = 0.006) showed a significantly shorter OS compared to those without malnutr

Published
2021

94. Colon Cancer Surgery: Does Preoperative Blood Transfusion Influence Short-Term Postoperative Outcomes?

Author

Tamini, N, Deghi, G, Gianotti, L, Braga, M, Nespoli, L, Tamini N., Deghi G., Gianotti L., Braga M., Nespoli L., Tamini, N, Deghi, G, Gianotti, L, Braga, M, Nespoli, L, Tamini N., Deghi G., Gianotti L., Braga M., and Nespoli L.

Abstract

Background: While perioperative red blood cell transfusion has been widely associated with poor surgical outcomes, few studies have focused specifically on the preoperative transfusional risk–benefit ratio. The aim of the present study was to evaluate the effects of preoperative red blood cell transfusion on short-term surgical outcomes in a cohort of anemic colon cancer patients. Methods: Moderate and severe anemic patients undergoing colectomy for cancer were divided into two groups based upon the receipt of preoperative transfusion and compared in terms of short-term outcomes. Results: A total of 271 patients with moderate or severe anemia were identified, 93 (34.3%) of whom were preoperatively transfused with a median of two units of packed red blood cells per patient (interquartile range: 2–4 units). The overall morbidity rate did not differ significantly between the two groups (35.5% vs. 36.2%; p = 0.63), while an increased incidence of major morbidity (Clavien–Dindo grade > 3a) observed in transfused patients [14% vs. 6.2% respectively; odds ratio (OR): 2.47, 95% confidence interval (CI): 1.06–5.75; p = 0.03]. The increase in major morbidity was confirmed by multivariate analysis, adjusted for potential confounders (OR: 3.45; 95% CI: 1.32–9.04; p = 0.01). Conclusions: Preoperative blood transfusion is associated with severe postoperative complications following colectomy in moderate and severe anemic cancer patients. Further studies are needed to establish an optimal preoperative transfusional cutoff value to optimize postoperative outcomes and balance clinical costs.

Published
2021

96. Appendectomy during the COVID-19 pandemic in Italy: a multicenter ambispective cohort study by the Italian Society of Endoscopic Surgery and new technologies (the CRAC study)

Author

Sartori A., Podda M., Botteri E., Passera R., Agresta F., Arezzo A., Guerrieri M., Ortenzi M., Cavallo F., Zese M., Prando D., Restini E., Cianci P., Millo P., Brachet Contul R., Serrao A., Abatini F., Altomare D. F., Picciariello A., Chetta G., Lattanzio F., Tonini V., Gori A., Jovine E., Mastrangelo L., Sartarelli L., Frena A., Malpaga A., Bertelli F., Pignata G., Andreuccetti J., Sanna S., Lares B., Sechi R., Cillara N., Pisanu A., Delogu D., Ciaccio G., Farulla M., Casati M., Laface L., De Luca M., Russello D., Latteri S., Longoni M., Masci E., Vigna S., Campanile F. C., Foti N., Lepiane P., Balla A., Cantore F., Raveglia V., Borghi F., Giraudo G., Verzelli A., Budassi A., Patriti A., Foghetti D., Montin U., Amadio L., Anania G., Bombardini C., Fabbri N., Feo C., Cianchi F., Manetti A., Lucchese M., Soricelli E., Ceccarelli G., Patiti M., Frascio M., Stabilini C., Filauro M., Barberis A., Troian M., Nagliati C., Campagnacci R., Maurizi A., Berti S., Gennai A., Marvaso A., D'Antonio D., Feo C. V., Mazzola L., Selvaggi F., Carini S., Costanzo F., Boccia L., Pascariello A., Perrotta N., Celiento M., Opocher E., Giovenzana M., Stella M., Ferrara F., Boni L., Abate E., Da Lio C., Valli V., Gelmini R., Serra F., Piccoli M., Gozzo D., Gattolin A., Sasia D., Balani A., Petronio B., Calo P. G., Canu G. L., Contarini E., Piatto G., Vettoretto N., Caprioli M., Braga M., Chiappetta M. F., Maida P., Tammaro P., De Palma G., Milone M., Bottino V., Canfora A., Bagaglini G., Agrusa A., Barone M., Mirabella A., Marino M. V., Gulotta G., Romano G., Sorrentino M., Ferfoglia S., Papagni V., Eramo S., Boselli C., Basti M., Caracino V., Moretto G., Inama M., Capelli P., Conti L., Muratore A., Cuoghi M. M., Zerbinati A., Corso S., Vasino M. C., Montuori M., Fidanza F., Lucchetta A., Giuliani A., Dinatale G., Zanzi F., Guariniello A., Bonilauri S., Frazzetta G., Garino M., Marafante C., Gioffre A., Del Monte S. R., Sganga G., Fransvea P., Grande M., Siragusa L., Sica G., Paola M., Passantino D. G., Catani M., Ricci F., Lauro E., Facci E., Parini D., Armellino M. F., Argenio G., Porcu A., Perra T., Bordoni P., Fleres F., Parisi A., Rossi S., Saracco R., Bono D., Viora T., Orlando F., Ferrero A., Fontana A. P., De Paolis P., Visconti D., Quaglino F., Festa F., Palagi S., Lo Secco G., Morino M., Allaix M. E., Salzano A., Tirone G., Motter M., Zanus G., Passuello N., Massani M., Tutino R., Manzini N., Terranova S., Merenda R., Nordio S., Zonta S., Lovisetto F., Guglielmi A., Campagnaro T., Amedeo E., Scollica M., Amodio P., Giannotti D., Olmi S., Oldani A., Sartori, A., Podda, M., Botteri, E., Passera, R., Agresta, F., Arezzo, A., Guerrieri, M., Ortenzi, M., Cavallo, F., Zese, M., Prando, D., Restini, E., Cianci, P., Millo, P., Brachet Contul, R., Serrao, A., Abatini, F., Altomare, D. F., Picciariello, A., Chetta, G., Lattanzio, F., Tonini, V., Gori, A., Jovine, E., Mastrangelo, L., Sartarelli, L., Frena, A., Malpaga, A., Bertelli, F., Pignata, G., Andreuccetti, J., Sanna, S., Lares, B., Sechi, R., Cillara, N., Pisanu, A., Delogu, D., Ciaccio, G., Farulla, M., Casati, M., Laface, L., De Luca, M., Russello, D., Latteri, S., Longoni, M., Masci, E., Vigna, S., Campanile, F. C., Foti, N., Lepiane, P., Balla, A., Cantore, F., Raveglia, V., Borghi, F., Giraudo, G., Verzelli, A., Budassi, A., Patriti, A., Foghetti, D., Montin, U., Amadio, L., Anania, G., Bombardini, C., Fabbri, N., Feo, C., Cianchi, F., Manetti, A., Lucchese, M., Soricelli, E., Ceccarelli, G., Patiti, M., Frascio, M., Stabilini, C., Filauro, M., Barberis, A., Troian, M., Nagliati, C., Campagnacci, R., Maurizi, A., Berti, S., Gennai, A., Marvaso, A., D'Antonio, D., Feo, C. V., Mazzola, L., Selvaggi, F., Carini, S., Costanzo, F., Boccia, L., Pascariello, A., Perrotta, N., Celiento, M., Opocher, E., Giovenzana, M., Stella, M., Ferrara, F., Boni, L., Abate, E., Da Lio, C., Valli, V., Gelmini, R., Serra, F., Piccoli, M., Gozzo, D., Gattolin, A., Sasia, D., Balani, A., Petronio, B., Calo, P. G., Canu, G. L., Contarini, E., Piatto, G., Vettoretto, N., Caprioli, M., Braga, M., Chiappetta, M. F., Maida, P., Tammaro, P., De Palma, G., Milone, M., Bottino, V., Canfora, A., Bagaglini, G., Agrusa, A., Barone, M., Mirabella, A., Marino, M. V., Gulotta, G., Romano, G., Sorrentino, M., Ferfoglia, S., Papagni, V., Eramo, S., Boselli, C., Basti, M., Caracino, V., Moretto, G., Inama, M., Capelli, P., Conti, L., Muratore, A., Cuoghi, M. M., Zerbinati, A., Corso, S., Vasino, M. C., Montuori, M., Fidanza, F., Lucchetta, A., Giuliani, A., Dinatale, G., Zanzi, F., Guariniello, A., Bonilauri, S., Frazzetta, G., Garino, M., Marafante, C., Gioffre, A., Del Monte, S. R., Sganga, G., Fransvea, P., Grande, M., Siragusa, L., Sica, G., Paola, M., Passantino, D. G., Catani, M., Ricci, F., Lauro, E., Facci, E., Parini, D., Armellino, M. F., Argenio, G., Porcu, A., Perra, T., Bordoni, P., Fleres, F., Parisi, A., Rossi, S., Saracco, R., Bono, D., Viora, T., Orlando, F., Ferrero, A., Fontana, A. P., De Paolis, P., Visconti, D., Quaglino, F., Festa, F., Palagi, S., Lo Secco, G., Morino, M., Allaix, M. E., Salzano, A., Tirone, G., Motter, M., Zanus, G., Passuello, N., Massani, M., Tutino, R., Manzini, N., Terranova, S., Merenda, R., Nordio, S., Zonta, S., Lovisetto, F., Guglielmi, A., Campagnaro, T., Amedeo, E., Scollica, M., Amodio, P., Giannotti, D., Olmi, S., Oldani, A., Sartori A., Podda M., Botteri E., Passera R., Agresta F., Arezzo A., Guerrieri M., Ortenzi M., Cavallo F., Zese M., Prando D., Restini E., Cianci P., Millo P., Brachet Contul R., Serrao A., Abatini F., Altomare D.F., Picciariello A., Chetta G., Lattanzio F., Tonini V., Gori A., Jovine E., Mastrangelo L., Sartarelli L., Frena A., Malpaga A., Bertelli F., Pignata G., Andreuccetti J., Sanna S., Lares B., Sechi R., Cillara N., Pisanu A., Delogu D., Ciaccio G., Farulla M., Casati M., Laface L., De Luca M., Russello D., Latteri S., Longoni M., Masci E., Vigna S., Campanile F.C., Foti N., Lepiane P., Balla A., Cantore F., Raveglia V., Borghi F., Giraudo G., Verzelli A., Budassi A., Patriti A., Foghetti D., Montin U., Amadio L., Anania G., Bombardini C., Fabbri N., Feo C., Cianchi F., Manetti A., Lucchese M., Soricelli E., Ceccarelli G., Patiti M., Frascio M., Stabilini C., Filauro M., Barberis A., Troian M., Nagliati C., Campagnacci R., Maurizi A., Berti S., Gennai A., Marvaso A., D'Antonio D., Feo C.V., Mazzola L., Selvaggi F., Carini S., Costanzo F., Boccia L., Pascariello A., Perrotta N., Celiento M., Opocher E., Giovenzana M., Stella M., Ferrara F., Boni L., Abate E., Da Lio C., Valli V., Gelmini R., Serra F., Piccoli M., Gozzo D., Gattolin A., Sasia D., Balani A., Petronio B., Calo P.G., Canu G.L., Contarini E., Piatto G., Vettoretto N., Caprioli M., Braga M., Chiappetta M.F., Maida P., Tammaro P., De Palma G., Milone M., Bottino V., Canfora A., Bagaglini G., Agrusa A., Barone M., Mirabella A., Marino M.V., Gulotta G., Romano G., Sorrentino M., Ferfoglia S., Papagni V., Eramo S., Boselli C., Basti M., Caracino V., Moretto G., Inama M., Capelli P., Conti L., Muratore A., Cuoghi M.M., Zerbinati A., Corso S., Vasino M.C., Montuori M., Fidanza F., Lucchetta A., Giuliani A., Dinatale G., Zanzi F., Guariniello A., Bonilauri S., Frazzetta G., Garino M., Marafante C., Gioffre A., Del Monte S.R., Sganga G., Fransvea P., Grande M., Siragusa L., Sica G., Paola M., Passantino D.G., Catani M., Ricci F., Lauro E., Facci E., Parini D., Armellino M.F., Argenio G., Porcu A., Perra T., Bordoni P., Fleres F., Parisi A., Rossi S., Saracco R., Bono D., Viora T., Orlando F., Ferrero A., Fontana A.P., De Paolis P., Visconti D., Quaglino F., Festa F., Palagi S., Lo Secco G., Morino M., Allaix M.E., Salzano A., Tirone G., Motter M., Zanus G., Passuello N., Massani M., Tutino R., Manzini N., Terranova S., Merenda R., Nordio S., Zonta S., Lovisetto F., Guglielmi A., Campagnaro T., Amedeo E., Scollica M., Amodio P., Giannotti D., Olmi S., Oldani A., Sartori, Alberto, Podda, Mauro, Botteri, Emanuele, Passera, Roberto, Agresta, Ferdinando, Arezzo, Alberto, M Guerrieri, M Ortenzi, F Cavallo, M Zese, D Prando, E Restini, P Cianci, P Millo, R Brachet Contul, A Serrao, F Abatini, D F Altomare, A Picciariello, G Chetta, F Lattanzio, V Tonini, A Gori, E Jovine, L Mastrangelo, L Sartarelli, A Frena, A Malpaga, F Bertelli, G Pignata, J Andreuccetti, S Sanna, B Lares, R Sechi, N Cillara, A Pisanu, D Delogu, G Ciaccio, M Farulla, M Casati, L Laface, M De Luca, D Russello, S Latteri, M Longoni, E Masci, S Vigna, F C Campanile, N Foti, P Lepiane, A Balla, F Cantore, V Raveglia, F Borghi, G Giraudo, A Verzelli, A Budassi, A Patriti, D Foghetti, U Montin, L Amadio, G Anania, C Bombardini, Niccolò Fabbri, Carlo Feo, F Cianchi, A Manetti, M Lucchese, E Soricelli, G Ceccarelli, M Patiti, M Frascio, C Stabilini, M Filauro, A Barberis, M Troian, C Nagliati, R Campagnacci, A Maurizi, S Berti, A Gennai, A Marvaso, D D'Antonio, C V Feo, N Fabbri, L Mazzola, F Selvaggi, S Carini, F Costanzo, L Boccia, A Pascariello, N Perrotta, M Celiento, E Opocher, M Giovenzana, M Stella, F Ferrara, L Boni, E Abate, C Da Lio, V Valli, R Gelmini, F Serra, M Piccoli, D Gozzo, A Gattolin, D Sasia, A Balani, B Petronio, P G Calò, G L Canu, E Contarini, G Piatto, N Vettoretto, M Caprioli, M Braga, M F Chiappetta, P Maida, P Tammaro, G De Palma, M Milone, V Bottino, A Canfora, F Selvaggi, G Bagaglini, A Agrusa, M Barone, A Mirabella, M V Marino, G Gulotta, G Romano, M Sorrentino, S Ferfoglia, V Papagni, S Eramo, C Boselli, M Basti, V Caracino, G Moretto, M Inama, P Capelli, L Conti, A Muratore, M M Cuoghi, A Zerbinati, S Corso, M C Vasino, M Montuori, F Fidanza, A Lucchetta, A Giuliani, G Dinatale, F Zanzi, A Guariniello, S Bonilauri, G Frazzetta, M Garino, C Marafante, A Gioffrè, S R Del Monte, G Sganga, P Fransvea, M Grande, L Siragusa, G Sica, M Paola, D G Passantino, Marco Catani, F Ricci, E Lauro, E Facci, D Parini, M F Armellino, G Argenio, A Porcu, T Perra, P Bordoni, F Fleres, A Parisi, S Rossi, R Saracco, D Bono, T Viora, F Orlando, A Ferrero, A P Fontana, P De Paolis, D Visconti, F Quaglino, F Festa, S Palagi, G Lo Secco, M Morino, M E Allaix, A Salzano, G Tirone, M Motter, G Zanus, N Passuello, M Massani, R Tutino, N Manzini, S Terranova, R Merenda, S Nordio, S Zonta, F Lovisetto, A Guglielmi, T Campagnaro, E Amedeo, M Scollica, P Amodio, D Giannotti, S Olmi, A Oldani, Sartori, A, Podda, M, Botteri, E, Passera, R, Agresta, F, Arezzo, A, Guerrieri, M, Ortenzi, M, Cavallo, F, Zese, M, Prando, D, Restini, E, Cianci, P, Millo, P, Brachet Contul, R, Serrao, A, Abatini, F, Altomare, D, Picciariello, A, Chetta, G, Lattanzio, F, Tonini, V, Gori, A, Jovine, E, Mastrangelo, L, Sartarelli, L, Frena, A, Malpaga, A, Bertelli, F, Pignata, G, Andreuccetti, J, Sanna, S, Lares, B, Sechi, R, Cillara, N, Pisanu, A, Delogu, D, Ciaccio, G, Farulla, M, Casati, M, Laface, L, De Luca, M, Russello, D, Latteri, S, Longoni, M, Masci, E, Vigna, S, Campanile, F, Foti, N, Lepiane, P, Balla, A, Cantore, F, Raveglia, V, Borghi, F, Giraudo, G, Verzelli, A, Budassi, A, Patriti, A, Foghetti, D, Montin, U, Amadio, L, Anania, G, Bombardini, C, Fabbri, N, Feo, C, Cianchi, F, Manetti, A, Lucchese, M, Soricelli, E, Ceccarelli, G, Patiti, M, Frascio, M, Stabilini, C, Filauro, M, Barberis, A, Troian, M, Nagliati, C, Campagnacci, R, Maurizi, A, Berti, S, Gennai, A, Marvaso, A, D'Antonio, D, Mazzola, L, Selvaggi, F, Carini, S, Costanzo, F, Boccia, L, Pascariello, A, Perrotta, N, Celiento, M, Opocher, E, Giovenzana, M, Stella, M, Ferrara, F, Boni, L, Abate, E, Da Lio, C, Valli, V, Gelmini, R, Serra, F, Piccoli, M, Gozzo, D, Gattolin, A, Sasia, D, Balani, A, Petronio, B, Calo, P, Canu, G, Contarini, E, Piatto, G, Vettoretto, N, Caprioli, M, Braga, M, Chiappetta, M, Maida, P, Tammaro, P, De Palma, G, Milone, M, Bottino, V, Canfora, A, Bagaglini, G, Agrusa, A, Barone, M, Mirabella, A, Marino, M, Gulotta, G, Romano, G, Sorrentino, M, Ferfoglia, S, Papagni, V, Eramo, S, Boselli, C, Basti, M, Caracino, V, Moretto, G, Inama, M, Capelli, P, Conti, L, Muratore, A, Cuoghi, M, Zerbinati, A, Corso, S, Vasino, M, Montuori, M, Fidanza, F, Lucchetta, A, Giuliani, A, Dinatale, G, Zanzi, F, Guariniello, A, Bonilauri, S, Frazzetta, G, Garino, M, Marafante, C, Gioffre, A, Del Monte, S, Sganga, G, Fransvea, P, Grande, M, Siragusa, L, Sica, G, Paola, M, Passantino, D, Catani, M, Ricci, F, Lauro, E, Facci, E, Parini, D, Armellino, M, Argenio, G, Porcu, A, Perra, T, Bordoni, P, Fleres, F, Parisi, A, Rossi, S, Saracco, R, Bono, D, Viora, T, Orlando, F, Ferrero, A, Fontana, A, De Paolis, P, Visconti, D, Quaglino, F, Festa, F, Palagi, S, Lo Secco, G, Morino, M, Allaix, M, Salzano, A, Tirone, G, Motter, M, Zanus, G, Passuello, N, Massani, M, Tutino, R, Manzini, N, Terranova, S, Merenda, R, Nordio, S, Zonta, S, Lovisetto, F, Guglielmi, A, Campagnaro, T, Amedeo, E, Scollica, M, Amodio, P, Giannotti, D, Olmi, S, and Oldani, A

Subjects
medicine.medical_specialty, COVID-19 Pandemic, Coronavirus disease 2019 (COVID-19), Endoscopic surgery, NO, Appendectomy, Appendicitis, Machine learning, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Retrospective Studie, Pandemic, medicine, Humans, Appendiciti, Laparoscopy, Pandemics, Retrospective Studies, medicine.diagnostic_test, business.industry, COVID-19 Pandemic, Appendicitis, Appendicectomy, Machine learning, SARS-CoV-2, COVID-19, Length of Stay, medicine.disease, Settore MED/18, Surgery, Italy, 030220 oncology & carcinogenesis, appendicitis, COVID-19 pandemic, machine learning, appendectomy, cohort studies, humans, length of stay, pandemics, postoperative complications, retrospective studies, laparoscopy, 030211 gastroenterology & hepatology, Observational study, Original Article, Postoperative Complication, Appendicectomy, Cohort Studie, business, Complication, Cohort study, Human
Abstract

Major surgical societies advised using non-operative management of appendicitis and suggested against laparoscopy during the COVID-19 pandemic. The hypothesis is that a significant reduction in the number of emergent appendectomies was observed during the pandemic, restricted to complex cases. The study aimed to analyse emergent surgical appendectomies during pandemic on a national basis and compare it to the same period of the previous year. This is a multicentre, retrospective, observational study investigating the outcomes of patients undergoing emergent appendectomy in March–April 2019 vs March–April 2020. The primary outcome was the number of appendectomies performed, classified according to the American Association for the Surgery of Trauma (AAST) score. Secondary outcomes were the type of surgical technique employed (laparoscopic vs open) and the complication rates. One thousand five hundred forty one patients with acute appendicitis underwent surgery during the two study periods. 1337 (86.8%) patients met the inclusion criteria: 546 (40.8%) patients underwent surgery for acute appendicitis in 2020 and 791 (59.2%) in 2019. According to AAST, patients with complicated appendicitis operated in 2019 were 30.3% vs 39.9% in 2020 (p = 0.001). We observed an increase in the number of post-operative complications in 2020 (15.9%) compared to 2019 (9.6%) (p 24 h after admission (+ 58%), open surgery (+ 112%) and conversion to open surgery (+ 166%). In Italian hospitals, in March and April 2020, the number of appendectomies has drastically dropped. During the first pandemic wave, patients undergoing surgery were more frequently affected by more severe appendicitis than the previous year's timeframe and experienced a higher number of complications. Trial registration number and date: Research Registry ID 5789, May 7th, 2020

Published
2021

98. Photosensitive organic insulator photo-cell monitoring through advanced macro inspection

Author

Adan, Ofer, Corno, A, Bordogna, A, Braga, M, Pescalli, A, Ferrario, F, Iessi, U, Canestrari, P, Sharma, P, Salamone, M, Parisi, P, Groos, T, Corno A., Bordogna A., Braga M., Pescalli A., Ferrario F., Iessi U., Canestrari P., Sharma P., Salamone M., Parisi P., Groos T., Adan, Ofer, Corno, A, Bordogna, A, Braga, M, Pescalli, A, Ferrario, F, Iessi, U, Canestrari, P, Sharma, P, Salamone, M, Parisi, P, Groos, T, Corno A., Bordogna A., Braga M., Pescalli A., Ferrario F., Iessi U., Canestrari P., Sharma P., Salamone M., Parisi P., and Groos T.

Abstract

In microelectronic device manufacturing, photosensitive organic insulators (POIs) are widely used during passivation steps to protect and preserve the chips from damage due to subsequent processes and from the external environment. To ensure high performance and to maintain chip quality, a well-controlled POI lithography process and corresponding defectivity monitoring are needed. In this work, we present an automated method developed by STMicroelectronics and KLA for POI defectivity and process control employing a KLA 8 Series inspection system with illumination in the visible range. The highly sensitive macro inspection tool with dedicated analysis approaches and solutions successfully enabled the detection of the principal defects of interest, the identification of defectivity root causes through automatic classification and review, and the evaluation of the layer thickness and uniformity through reflected intensity heatmaps. For several months, this protocol has been applied to the production environment, proving to be effective in detecting even small deviations from the standard process. Here, we present some promising results obtained with this strategy, highlighting the benefits in terms of rework reduction and improved equipment management.

Published
2020

99. The presence of deep venous thrombosis in association with skin manifestations at the right upper leg, may be an indicator of a clinical presentation of necrotic appendicitis?

Author

Angrisani, M, Tamini, N, Pinotti, E, Braga, M, Uggeri, F, Braga , M, Uggeri, F., Angrisani, M, Tamini, N, Pinotti, E, Braga, M, Uggeri, F, Braga , M, and Uggeri, F.

Abstract

Various infectious process with intra-abdominal source can rarely show itself as infections of the skin or of the soft tissue, in the right upper leg and sometimes they represent a diagnostic dilemma. In this uncommon case report, we describe the case of a 75-year-old woman with a clinical history of recent deep vein thrombosis of the right leg, due to mass effect of an abscess of psoas muscle itself caused to a perforated acute appendicitis.

Published
2020

100. Understanding short bowel syndrome: Current status and future perspectives

Author

Massironi, S, Cavalcoli, F, Rausa, E, Invernizzi, P, Braga, M, Vecchi, M, Massironi S., Cavalcoli F., Rausa E., Invernizzi P., Braga M., Vecchi M., Massironi, S, Cavalcoli, F, Rausa, E, Invernizzi, P, Braga, M, Vecchi, M, Massironi S., Cavalcoli F., Rausa E., Invernizzi P., Braga M., and Vecchi M.

Abstract

Short bowel syndrome (SBS) is a rare malabsorptive disorder as a result of the loss of bowel mass mostly secondary to surgical resection of the small intestine. Other causes are vascular diseases, neoplasms or inflammatory bowel disease. The spectrum of the disease is widely variable from single micronutrient malabsorption to complete intestinal failure, depending on the remaining length of the small intestine, the anatomical portion of intestine and the function of the remnant bowel. Over the last years, the management of affected patients has remarkably improved with the increase in patients’ quality of life and survival, mainly thanks to advances in home-based parenteral nutrition (PN). In the last ten years new treatment strategies have become available together with increasing experience and the encouraging results with new drugs, such as teduglutide, have added a new dimension to the management of SBS. This review aims to summarize the knowledge available in the current literature on SBS epidemiology, pathophysiology, and its surgical (including intestinal lengthening procedures and intestinal transplantation) and medical management with emphasis on the recent advances. Moreover, this review attempts to provide the new understanding and recent approaches to SBS complications such as sepsis, catheter thrombosis, and intestinal failure-associated liver disease.

Published
2020

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