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1. Perforated peptic ulcer (PPU) treatment: an Italian nationwide propensity score-matched cohort study investigating laparoscopic vs open approach

Author

Costa, Gianluca, Fransvea, Pietro, Lepre, Luca, Liotta, Gianluca, Mazzoni, Gianluca, Biloslavo, Alan, Bianchi, Valentina, Occhionorelli, Savino, Costa, Alessandro, Sganga, Gabriele, FACS on behalf of the IGo-GIPS study group (Agresta, F, Alemanno, G, Altieri, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Badessi, G, Baldazzi, G, Bergamini, C, Biloslavo, A, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Brisinda, G, Buonanno, Gm, Canini, T, Capolupo, Gt, Carannante, F, Cardella, S, Caricato, M, Carrara, G, Cascone, Ca, Cassini, D, Castriconi, M, Catarci, M, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cimino, F, Cirocchi, R, Cobuccio, L, Coccolini, C, Cocorullo, G, Colangelo, E, Colozzi, S, Cortese, F, Costa, A, Costa, G, Cozza, V, Crucitti, A, Cucinotta, E, D’Alessio, R, Dalla Caneva, P, De Manzini, N, de Manzoni Garberini, A, De Nisco, C, De Prizio, M, De Sol, A, De Stefano, M, Dibella, A, Di Cosimi, C, Di Grezia, M, Falcioni, T, Falco, N, Farina, C, Fico, V, Finotti, E, Fontana, T, Francioni, G, Fransvea, P, Frezza, B, Garbarino, Gm, Garulli, G, Genna, M, Giannessi, S, Gioffrè, A, Giordano, A, Gozzo, D, Grimaldi, S, Iacopini, V, Iarussi, T, Kurihara, H, La Greca, A, Laracca, Gg, Laterza, E, La Vaccara, V, Leonardi, A, Lepre, L, Liotta, G, Luridiana, G, Magalini, S, Malagnino, A, Mar, G, Mariani, D, Marini, P, Marzaioli, R, Macianà, G, Mazzoni, G, Mecarelli, V, Mercantini, P, Mingoli, A, Mirco, P, Montuori, M, Nigro, C, Occhionorelli, S, Paderno, N, Palini, Gm, Paradies, D, Paroli, M, Perrone, F, Pepe, G, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Pignata, G, Pinotti, E, Pisanu, A, Podda, M, Poillucci, G, Porfidia, R, Puccioni, C, Rocca, A, Rondelli, F, Rossi, G, Sacchi, M, Sapienza, P, Sganga, G, Spagnoli, A, Spinoglio, G, Sulis, R, Tartaglia, D, Tranà, C, Travaglino, A, Tomaiuolo, P, Tomassini, F, Tropeano, G, Valeri, A, Zago, M, and Zanoni, E. ).

Subjects
Surgical treatment, Laparoscopic approach, Perforated peptic ulcer
Published
2023

2. Metabolic Syndrome (MetS), Systemic Inflammatory Response Syndrome (SIRS), and Frailty: Is There any Room for Good Outcome in the Elderly Undergoing Emergency Surgery?

Author

Fransvea, P., Costa, G., Lepre, L., Capolupo, G. T., Carannante, F., Puccioni, C., Costa, A., La Greca, A., Giovinazzo, F., Agresta F, Sganga on behalf of the IGo-GIPS study group (G., Alemanno, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Baldazzi, G, Barbera, G, Bergamini, C, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buonanno, Gm, Canini, T, Capolupo, Gt, Carannante, F, Cardella, S, Caricato, M, Carrara, G, Cassini, D, Castriconi, M, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Costa, G, Crucitti, A, Cucinotta, E, D’Alessio, R, Dalla Caneva, P, 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, Gm, Garulli, G, Genna, M, Giannessi, S, Gioffrè, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Kurihara, H, Laracca, Gg, Laterza, E, Leonardi, A, Lepre, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Mariani, D, Marzaioli, R, Massa, G, Mecarelli, V, Mercantini, P, Mingoli, A, Miranda, G, Montuori, M, Occhionorelli, S, Paderno, N, Palini, Gm, Paradies, D, Paroli, M, Perrone, F, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Pignata, G, Pinotti, E, Pisanu, A, Podda, M, Poillucci, G, Porfidia, R, Rocca, A, Rondelli, F, Rossi, G, Spagnoli, A, Sulis, R, Tartaglia, D, Tranà, C, Travaglino, A, Tomaiuolo, P, Valeri, A, Zago, M, and Zanoni, E. ).

Subjects
acute care surgery, SIRS, elderly, frailty, metabolic syndrome
Abstract

Patients with MetS or SIRS experience higher rates of mortality and morbidity, across both cardiac and noncardiac surgery. Frailty assessment has acquired increasing importance in recent years as it predisposes elderly patients to a worse outcome. The aim of our study was to investigate the influence of MetS, SIRS, and with or without frailty on elderly patients undergoing emergency surgical procedures.We analyzed data of all patients with nonmalignant diseases requiring an emergency surgical procedure from January 2017 to December 2020. The occurrence of MetS was identified using modified definition criteria used by the NCEP-ATP III Expert Panel: obesity, hypertension, diabetes, or if medication for high triglycerides or for low HDL cholesterol was taken. Systemic inflammatory response syndrome (SIRS) was evaluated according to the original consensus study (Sepsis-1). The frailty profile was investigated by the 5-modified Frailty Index (5-mFI) and the Emergency Surgery Frailty Index (EmSFI). Postoperative complications have been reported and categorized according to the Clavien-Dindo (C-D) classification system. Morbidity and mortality have been mainly considered as the 30-day standard period definition.Of the 2,318 patients included in this study, 1,010 (43.6%) fulfilled the criteria for MetS (MetsG group). Both 5-Items score and EmsFI showed greater fragility in patients with MetS. All patients with MetS showed more frequently a CACI index greater than 6. The occurrence of SIRS was higher in MetSG. LOS was longer in patients with MetS (MetSG 11.4 ± 12 days vs.Impact of MetS and SIRS on elderly surgical patient outcomes has yet to be fully elucidated. The present study showed a 43.6% incidence of MetS in the elderly population. In conclusion, age per se should be not considered anymore as the main variable to estimate patient outcomes, while MetS and Frailty should have always a pivotal role.

Published
2022

3. 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

4. Gastro-intestinal emergency surgery: Evaluation of morbidity and mortality. Protocol of a prospective, multicenter study in Italy for evaluating the burden of abdominal emergency surgery in different age groups. (The GESEMM study)

Author

Costa, Gianluca, Fransvea, Pietro, Puccioni, Caterina, Giovinazzo, Francesco, Carannante, Filippo, Bianco, Gianfranco, Catamero, Alberto, Masciana, Gianluca, Miacci, Valentina, Caricato, Marco, Capolupo, Gabriella Teresa, Sganga, Gabriele on behalf of the IGo-GIPS Study Group (Agresta, F, Alemanno, G, Altieri, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Badessi, G, Baldazzi, G, Bergamini, C, Biloslavo, A, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Brisinda, G, Buonanno, Gm, Canini, T, Capolupo, Gt, Carannante, F, Cardella, S, Caricato, M, Carrara, G, Cascone, Ca, Cassini, D, Castriconi, M, Catarci, M, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cimino, F, Cirocchi, R, Cobuccio, L, Coccolini, C, Cocorullo, G, Colangelo, E, Colozzi, S, Cortese, F, Costa, A, Costa, G, Cozza, V, Crucitti, A, Cucinotta, E, D’Alessio, R, Dalla Caneva, P, De Manzini, N, de Manzoni Garberini, A, De Nisco, C, De Prizio, M, De Sol, A, De Stefano, M, Dibella, A, Di Cosimi, C, Di Grezia, M, Falcioni, T, Falco, N, Farina, C, Fico, V, Finotti, E, Fontana, T, Francioni, G, Fransvea, P, Frezza, B, Garbarino, Gm, Garulli, G, Genna, M, Giannessi, S, Gioffrè, A, Giordano, A, Gozzo, D, Grimaldi, S, Iacopini, V, Iarussi, T, Kurihara, H, La Greca, A, Laracca, Gg, Laterza, E, La Vaccara, V, Leonardi, A, Lepre, L, Liotta, G, Luridiana, G, Magalini, S, Malagnino, A, Mar, G, Mariani, D, Marini, P, Marzaioli, R, Macianà, G, Mazzoni, G, Mecarelli, V, Mercantini, P, Mingoli, A, Mirco, P, Montuori, M, Nigro, C, Occhionorelli, S, Paderno, N, Palini, Gm, Paradies, D, Paroli, M, Perrone, F, Pepe, G, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Pignata, G, Pinotti, E, Pisanu, A, Podda, M, Poillucci, G, Porfidia, R, Puccioni, C, Rocca, A, Rondelli, F, Rossi, G, Sacchi, M, Sapienza, P, Sganga, G, Spagnoli, A, Spinoglio, G, Sulis, R, Tartaglia, D, Tranà, C, Travaglino, A, Tomaiuolo, P, Tomassini, F, Tropeano, G, Valeri, A, Zago, M, and Zanoni, E. ).

Subjects
acute care, gastrointestinal emergency, morbidity, mortality, surgery, Settore MED/18 - CHIRURGIA GENERALE
Abstract

Gastrointestinal emergencies (GE) are frequently encountered in emergency department (ED), and patients can present with wide-ranging symptoms. more than 3 million patients admitted to US hospitals each year for EGS diagnoses, more than the sum of all new cancer diagnoses. In addition to the complexity of the urgent surgical patient (often suffering from multiple co-morbidities), there is the unpredictability and the severity of the event. In the light of this, these patients need a rapid decision-making process that allows a correct diagnosis and an adequate and timely treatment. The primary endpoint of this Italian nationwide study is to analyze the clinicopathological findings, management strategies and short-term outcomes of gastrointestinal emergency procedures performed in patients over 18. Secondary endpoints will be to evaluate to analyze the prognostic role of existing risk-scores to define the most suitable scoring system for gastro-intestinal surgical emergency. The primary outcomes are 30-day overall postoperative morbidity and mortality rates. Secondary outcomes are 30-day postoperative morbidity and mortality rates, stratified for each procedure or cause of intervention, length of hospital stay, admission and length of stay in ICU, and place of discharge (home or rehabilitation or care facility). In conclusion, to improve the level of care that should be reserved for these patients, we aim to analyze the clinicopathological findings, management strategies and short-term outcomes of gastrointestinal emergency procedures performed in patients over 18, to analyze the prognostic role of existing risk-scores and to define new tools suitable for EGS. This process could ameliorate outcomes and avoid futile treatments. These results may potentially influence the survival of many high-risk EGS procedure.

Published
2022

5. Risk factors for postoperative morbidity following appendectomy in the elderly: a nationwide prospective cohort study

Author

Poillucci, Gaetano, Podda, Mauro, Pisanu, Adolfo, Mortola, Lorenzo, Dalla Caneva, Patrizia, Massa, Giulia, Costa, Gianluca, Savastano, Riccardo, Cillara, Nicola, Collaborative Study Group endorsed by SICUT ACOI SICG SICE and Italian Chapter of WSES, 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, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Costa, G, Crucitti, A, Dalla Caneva, 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, Garulli, G, Genna, M, Giannessi, S, Gioffrè, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laterza, E, Leonardi, A, Lepre, L, Lorenzon, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Massa, G, Mecarelli, V, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, Palini, Gm, Paradies, D, Paroli, M, Perrone, F, 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, Zanoni, E., Poillucci G., Podda M., Pisanu A., Mortola L., Dalla Caneva P., Massa G., Costa G., Savastano R., Cillara N., 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., Ceresoli M., Chiarugi M., Cimino F., Cobuccio L., Cocorullo G., Colangelo E., Crucitti A., 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., Garulli G., Genna M., Giannessi S., Gioffre A., Giordano A., Gozzo D., Grimaldi S., Gulotta G., Iacopini V., Iarussi T., Laterza E., Leonardi A., Lepre L., Lorenzon L., Luridiana G., Malagnino A., Mar G., Marini P., Marzaioli R., Mecarelli V., Mingoli A., Nigri G., Occhionorelli S., Paderno N., Palini G.M., Paradies D., Paroli M., Perrone F., Petruzzelli L., Pezzolla A., Piazza D., Piazza V., Piccoli M., 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., Poillucci, G, Podda, M, Pisanu, A, Mortola, L, Dalla Caneva, P, Massa, G, Costa, G, Savastano, R, Cillara, N, 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, Ceresoli, M, Chiarugi, M, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Crucitti, A, 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, Garulli, G, Genna, M, Giannessi, S, Gioffre, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laterza, E, Leonardi, A, Lepre, L, Lorenzon, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Mecarelli, V, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, Palini, G, Paradies, D, Paroli, M, Perrone, F, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, M, 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, Multivariate analysis, Sports medicine, Settore MED/18 - CHIRURGIA GENERALE, Critical Care and Intensive Care Medicine, Acute appendicitis, Appendectomy, Elderly, Frail patients, Postoperative complications, NO, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Risk Factors, Acute appendicitis, Appendectomy, Elderly, Frail patients, Postoperative complications, Internal medicine, medicine, Humans, Frail patient, Orthopedics and Sports Medicine, In patient, Prospective Studies, Prospective cohort study, Aged, Retrospective Studies, 030222 orthopedics, Creatinine, business.industry, Postoperative complication, 030208 emergency & critical care medicine, Perioperative, Length of Stay, Appendicitis, chemistry, Emergency Medicine, Laparoscopy, Surgery, Acute appendiciti, Morbidity, Risk assessment, business
Abstract

Background: A limited number of studies investigating perioperative risk factors associated with emergency appendectomy in elderly patients have been published to date. Whether older age may be associated with poorer outcomes following appendectomy is still a matter of debate. The primary aim of this study was to determine the predictors of postoperative morbidity following appendectomy in patients aged ≥ 65years. Methods: Data regarding all elderly patients who underwent emergency appendectomy from January 2017 to June 2018 admitted 36 Italian surgical departments were prospectively collected and analyzed. Baseline demographics and perioperative variables were evaluated. Uni- and multivariate analyses adjusted for differences between groups were carried out to determine possible predictors of adverse outcomes after appendectomy. Results: Between January 2017 and June 2018, 135 patients aged ≥ 65years with a diagnosis of AA met the study inclusion criteria. Twenty-six patients (19.3%) were diagnosed with some type of postoperative complication. Decreasing the preoperative hemoglobin level showed a statistically significant association with postoperative complications (OR 0.77, CI 0.61–0.97, P = 0.03). Preoperative creatinine level (P = 0.02, OR 2.04, CI 1.12–3.72), and open appendectomy (P = 0.03, OR 2.67, CI 1.11–6.38) were significantly associated with postoperative morbidity. After adjustment, the only independent predictor of postoperative morbidity was preoperative creatinine level (P = 0.04, OR 2.01, CI 1.05–3.89). Conclusions: In elderly patients with AA, perioperative risk assessment in the emergency setting must be as accurate as possible to identify modifiable risk factors that can be addressed before surgery, such as preoperative hemoglobin and creatinine levels.

Published
2019

6. The use of emergency laparoscopy for acute abdomen in the elderly: the FRAILESEL Italian Multicenter Prospective Cohort Study

Author

Costa, Gianluca, Fransvea, Pietro, Podda, Mauro, Pisanu, Adolfo, Carrano, Francesco Maria, Iossa, Angelo, Balducci, Genoveffa, Agresta, Ferdinando Collaborative Study Group: 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, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Costa, G, Crucitti, A, Dalla Caneva, 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, Garulli, G, Genna, M, Giannessi, S, Gioffrè, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laterza, E, Leonardi, A, Lepre, L, Lorenzon, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Massa, G, Mecarelli, V, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, Palini, Gm, Paradies, D, Paroli, M, Perrone, F, 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, Zanoni, E., Costa G., Fransvea P., Podda M., Pisanu A., Carrano F.M., Iossa A., Balducci G., Agresta F., Alemanno G., Anania G., Antropoli M., Argenio G., Atzeni J., Avenia N., Azzinnaro A., Baldazzi 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., Ceresoli M., Chiarugi M., Cillara N., Cimino F., Cobuccio L., Cocorullo G., Colangelo E., Crucitti A., Dalla Caneva 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., Frezza B., Garulli G., Genna M., Giannessi S., Gioffre A., Giordano A., Gozzo D., Grimaldi S., Gulotta G., Iacopini V., Iarussi T., Laterza E., Leonardi A., Lepre L., Luridiana G., Malagnino A., Mar G., Marini P., Marzaioli R., Massa G., Mecarelli V., Mingoli A., Nigri G., Occhionorelli S., Paderno N., Palini G.M., Paradies D., Paroli M., Perrone F., Petruzzelli L., Pezzolla A., Piazza D., Piazza V., Piccoli 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., Costa, G, Fransvea, P, Podda, M, Pisanu, A, Carrano, F, Iossa, A, Balducci, G, Agresta, F, Alemanno, G, Anania, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Baldazzi, 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, Ceresoli, M, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Crucitti, A, Dalla Caneva, 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, Frezza, B, Garulli, G, Genna, M, Giannessi, S, Gioffre, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laterza, E, Leonardi, A, Lepre, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Massa, G, Mecarelli, V, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, Palini, G, Paradies, D, Paroli, M, Perrone, F, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, 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
Male, Settore MED/18 - CHIRURGIA GENERALE, Endoscopy, Gastrointestinal, Cohort Studies, 0302 clinical medicine, Postoperative Complications, Elderly, Abdomen, 80 and over, Medicine, Prospective Studies, Prospective cohort study, Laparoscopy, Abdomen, Acute, Aged, 80 and over, medicine.diagnostic_test, Mortality rate, Age Factors, Prognosis, Multicenter study, Italy, Acute abdomen, 030220 oncology & carcinogenesis, Emergency surgery, 030211 gastroenterology & hepatology, Female, medicine.symptom, Cohort study, Risk, Gastrointestinal, medicine.medical_specialty, Acute, Malignancy, NO, 03 medical and health sciences, Humans, Aged, business.industry, acute abdomen, elderly, emergency surgery, laparoscopy, multicenter study, Endoscopy, medicine.disease, Surgery, Emergencies, Morbidity, business, Procedures and Techniques Utilization, Abdominal surgery
Abstract

As the world population is aging rapidly, emergency abdominal surgery for acute abdomen in the elderly represents a global issue, both in developed and developing countries. Data regarding all the elderly patients who underwent emergency abdominal surgery from January 2017 to December 2017 at 36 Italian surgical departments were analyzed with the aim to appraise the contemporary reality regarding the use of emergency laparoscopy for acute abdomen in the elderly. 1993 patients were enrolled. 1369 (68.7%) patients were operated with an open technique; whereas, 624 (31.3%) underwent a laparoscopic operation. The postoperative morbidity rate was 32.6%, with a statically significant difference between the open and the laparoscopic groups (36.2% versus 22.1%, p < 0.001). The reported mortality rate was 8.8%, with a statistically significant difference between the open and the laparoscopic groups (11.2% versus 2.2%, p < 0.001). Our results demonstrated that patients in the ASA II (58.1%), ASA III (68.7%) and ASA IV (88.5%) groups were operated with the traditional open technique in most of the cases. Only a small percentage of patients underwent laparoscopy for perforated gastro-duodenal ulcer repair (18.9%), adhesiolyses with/without small bowel resection (12.2%), and large bowel resection (10.7%). Conversion to open technique was associated with a higher mortality rate (11.1% versus 2.2%, p < 0.001) and overall morbidity (38.9% versus 22.1%, p = 0.001) compared with patients who did not undergo conversion. High creatinine (p < 0.001) and glycaemia (p = 0.006) levels, low hemoglobin levels (p < 0.001), oral anticoagulation therapy (p = 0.001), acute respiratory failure (p < 0.001), presence of malignancy (p = 0.001), SIRS (p < 0.001) and open surgical approach (p < 0.001) were associated with an increased risk of postoperative morbidity. Regardless of technical progress, elderly patients undergoing emergency surgery are at very high risk for in-hospital complications. A detailed analysis of complications and mortality in the present study showed that almost 9% of elderly patients died after surgery for acute abdomen, and over 32% developed complications.

Published
2020

7. The Emergency Surgery Frailty Index (EmSFI): development and internal validation of a novel simple bedside risk score for elderly patients undergoing emergency surgery

Author

Costa, Gianluca, Bersigotti, Laura, Massa, Giulia, Lepre, Luca, Fransvea, Pietro, Lucarini, Alessio, Mercantini, Paolo, Balducci, Genoveffa, Sganga, Gabriele, Crucitti, ERASO (Elderly Risk Assessment, Surgical Outcome) Collaborative Study Group:, F Agresta, 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, P Bianchi, P, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, M Buonanno, G, Canini, T, Cardella, S, Carrara, G, Cassini, D, Castriconi, M, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Costa, G, Crucitti, A, P Dalla Caneva, M De Luca, A de Manzoni Garberini, C De Nisco, M De Prizio, A De Sol, 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, M 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, Tranà, C, Travaglino, A, Tomaiuolo, P, Valeri, A, Vasquez, G, Zago, M, Zanoni, E, Costa, G, Bersigotti, L, Massa, G, Lepre, L, Fransvea, P, Lucarini, A, Mercantini, P, Balducci, G, Sganga, G, Crucitti, A, Agresta, F, Alemanno, G, Anania, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Baldazzi, G, Barbera, G, Bellanova, G, Bergamini, C, 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, Ceresoli, M, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Dallacaneva, P, Deluca, M, deManzoni Garberini, A, Denisco, C, Deprizio, M, Desol, 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, Mecarelli, V, 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
Aging, medicine.medical_specialty, Frail Elderly, Frailty Index, Emergency surgery, Frailty, Predictive tool, Procedure-specific morbidity, Procedure-specifc morbidity, Logistic regression, Risk Assessment, NO, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Risk Factors, medicine, Humans, Prospective Studies, 030212 general & internal medicine, Internal validation, Aged, Frailty, Emergency surgery, Predictive tool, Procedure-specifc morbidity, Univariate analysis, Framingham Risk Score, Receiver operating characteristic, business.industry, Test (assessment), Italy, 030220 oncology & carcinogenesis, Emergency medicine, Original Article, Geriatrics and Gerontology, business
Abstract

Background Frailty assessment has acquired an increasing importance in recent years and it has been demonstrated that this vulnerable profile predisposes elderly patients to a worse outcome after surgery. Therefore, it becomes paramount to perform an accurate stratification of surgical risk in elderly undergoing emergency surgery. Study design 1024 patients older than 65 years who required urgent surgical procedures were prospectively recruited from 38 Italian centers participating to the multicentric FRAILESEL (Frailty and Emergency Surgery in the Elderly) study, between December 2016 and May 2017. A univariate analysis was carried out, with the purpose of developing a frailty index in emergency surgery called “EmSFI”. Receiver operating characteristic curve analysis was then performed to test the accuracy of our predictive score. Results 784 elderly patients were consecutively enrolled, constituting the development set and results were validated considering further 240 consecutive patients undergoing colorectal surgical procedures. A logistic regression analysis was performed identifying different EmSFI risk classes. The model exhibited good accuracy as regard to mortality for both the development set (AUC = 0.731 [95% CI 0.654–0.772]; HL test χ2 = 6.780; p = 0.238) and the validation set (AUC = 0.762 [95% CI 0.682–0.842]; HL test χ2 = 7.238; p = 0.299). As concern morbidity, our model showed a moderate accuracy in the development group, whereas a poor discrimination ability was observed in the validation cohort. Conclusions The validated EmSFI represents a reliable and time-sparing tool, despite its discriminative value decreased regarding complications. Thus, further studies are needed to investigate specifically surgical settings, validating the EmSFI prognostic role in assessing the procedure-related morbidity risk.

Published
2020

8. 2018 WSES/SIS-E consensus conference: Recommendations for the management of skin and soft-tissue infections

Author

Sartelli, M. Guirao, X. Hardcastle, T.C. Kluger, Y. Boermeester, M.A. Raşa, K. Ansaloni, L. Coccolini, F. Montravers, P. Abu-Zidan, F.M. Bartoletti, M. Bassetti, M. Ben-Ishay, O. Biffl, W.L. Chiara, O. Chiarugi, M. Coimbra, R. De Rosa, F.G. De Simone, B. Di Saverio, S. Giannella, M. Gkiokas, G. Khokha, V. Labricciosa, F.M. Leppäniemi, A. Litvin, A. Moore, E.E. Negoi, I. Pagani, L. Peghin, M. Picetti, E. Pintar, T. Pupelis, G. Rubio-Perez, I. Sakakushev, B. Segovia-Lohse, H. Sganga, G. Shelat, V. Sugrue, M. Tarasconi, A. Tranà, C. Ulrych, J. Viale, P. Catena, F.

Abstract

Skin and soft-tissue infections (SSTIs) encompass a variety of pathological conditions that involve the skin and underlying subcutaneous tissue, fascia, or muscle, ranging from simple superficial infections to severe necrotizing infections. SSTIs are a frequent clinical problem in surgical departments. In order to clarify key issues in the management of SSTIs, a task force of experts met in Bertinoro, Italy, on June 28, 2018, for a specialist multidisciplinary consensus conference under the auspices of the World Society of Emergency Surgery (WSES) and the Surgical Infection Society Europe (SIS-E). The multifaceted nature of these infections has led to a collaboration among general and emergency surgeons, intensivists, and infectious disease specialists, who have shared these clinical practice recommendations. © 2018 The Author(s).

Published
2018

9. Frailty and emergency surgery in the elderly: protocol of a prospective, multicenter study in Italy for evaluating perioperative outcome (The FRAILESEL Study)

Author

Mingoli, A, Costa, Gianluca, Massa, Giulia, Agresta, F., Anania, G., Ansaloni, L., Antropoli, M., Argenio, G., Atzeni, J., Avenia, N., Azzinnaro, A., Balani, A., Baldazzi, G., Balducci, G., Barbera, G., Bellanova, G., Bergamini, C., Bersigotti, L., Bianchi, P. P., Bombardini, C., Borzellino, G., Bozzo, S., Brachini, G., Buccoliero, F., Buonanno, G. M., Buononato, M., Campanile, F. C., Canini, T., Cardella, S., Carrara, G., Cascini, F., Cassini, D., Castriconi, M., Catalini, G., Catena, F., Ceccarelli, G., Celi, D., Ceresoli, M., Chiarugi, M., Cillara, N., Cimino, F., Cobuccio, L., Coccolini, F., Cocorullo, G., Colangelo, E., Costa, G., Crafa, F., Crucitti, A., Dalla Caneva, P., De&nbsp, Luca, M., de&nbsp, Manzoni Garberini, A., De Nisco, C., Sol, A., Falcioni, T., Falco, N., Farina, C., Filippone, G., Finotti, E., Fiume, S., Fontana, T., Francioni, G., Fransvea, P., Frezza, B., Gemini, Simone, Genna, M., Giannessi, S., Gioffrè, A., Giordano, A., Gozzo, D., Grimaldi, S., Gulotta, G., Iarussi, T., Laterza, E., Lepre, L., Lorenzon, L., Lotti, R., Luridiana, G., Marini, P., Marzaioli, R., Massa, G., Mulas, S., Nagliati, C., Nigri, G., Niolu, P., Noviello, A., Occhionorelli, S., Paderno, N., Palini, G. M., Paradies, D., Paroli, M., Perrone, F., Petruzzelli, L., Pezzolla, A., Piazza, D., Piazza, V., Piccoli, M., Pisanu, A., Podda, M., Poillucci, Gaetano, Porfidia, R., Rossi, G., Ruscelli, P., Santella, S., Sartelli, M., Spagnoli, A., Sulis, R., Tarasconi, A., Tranà, C., Travaglino, A., Valeri, A., Vasquez, G., Zago, Michela, Zanoni, E., Costa, G, Massa, G, Anania, G, Atzeni, J, Cardella, S, Cimino, F, Cocorullo, G, Falco, N, Farina, M, Fontana, T, Gulotta, G, Piazza, D, Agresta, F, Ansaloni, L, Antropoli, M, Argenio, G, Avenia, N, Azzinnaro, A, Balani, A, Baldazzi, G, Balducci, G, Barbera, G, Bellanova, G, Bergamini, C, Bersigotti, L, Bianchi, P, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buccoliero, F, Buonanno, G, Buononato, M, Campanile, F, Canini, T, Carrara, G, Cascini, F, Cassini, D, Castriconi, M, Catalini, G, Catena, F, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cillara, N, Cobuccio, L, Coccolini, F, Colangelo, E, Crafa, F, Crucitti, A, Dalla Caneva, P, Deluca, M, deManzoni Garberini, A, De Nisco, C, Desol, A, Falcioni, T, Farina, C, Filippone, G, Finotti, E, Fiume, S, Francioni, G, Fransvea, P, Frezza, B, Gemini, S, Genna, M, Giannessi, S, Gioffre, A, Giordano, A, Gozzo, D, Grimaldi, S, Iarussi, T, Laterza, E, Lepre, L, Lorenzon, L, Lotti, R, Luridiana, G, Marini, P, Marzaioli, R, Mingoli, A, Mulas, S, Nagliati, C, Nigri, G, Niolu, P, Noviello, A, Occhionorelli, S, Paderno, N, Palini, G, Paradies, D, Paroli, M, Perrone, F, Petruzzelli, L, Pezzolla, A, Piazza, V, Piccoli, M, Pisanu, A, Podda, M, Poillucci, G, Porfidia, R, Rossi, G, Ruscelli, P, Santella, S, Sartelli, M, Spagnoli, A, Sulis, R, Tarasconi, A, Trana, C, Travaglino, A, Valeri, A, Vasquez, G, Zago, M, and Zanoni, E

Subjects
Elderly patient, Emergency surgery, Frailty, Geriatric, Risk assessment, Scores, Aged, Aged, 80 and over, Clinical Protocols, Emergencies, Female, Humans, Italy, Logistic Models, Male, Multivariate Analysis, Outcome Assessment, Health Care, Postoperative Complications, Prognosis, Prospective Studies, ROC Curve, Risk Assessment, Frail Elderly, Outcome Assessment, 030230 surgery, law.invention, 0302 clinical medicine, Quality of life, law, 80 and over, Prospective cohort study, Multivariate Analysi, Emergencie, Mortality rate, Score, Intensive care unit, Outcome Assessment (Health Care), 030220 oncology & carcinogenesis, elderly patient, emergency surgery, frailty, geriatric, risk assessment, scores, Human, medicine.medical_specialty, Logistic Model, Prognosi, NO, 03 medical and health sciences, medicine, Clinical Protocol, business.industry, Perioperative, Surgery, Health Care, Prospective Studie, Settore MED/18 - Chirurgia Generale, Emergency medicine, Life expectancy, Observational study, Postoperative Complication, business
Abstract

Improvements in living conditions and progress in medical management have resulted in better quality of life and longer life expectancy. Therefore, the number of older people undergoing surgery is increasing. Frailty is often described as a syndrome in aged patients where there is augmented vulnerability due to progressive loss of functional reserves. Studies suggest that frailty predisposes elderly to worsening outcome after surgery. Since emergency surgery is associated with higher mortality rates, it is paramount to have an accurate stratification of surgical risk in such patients. The aim of our study is to characterize the clinicopathological findings, management, and short-term outcome of elderly patients undergoing emergency surgery. The secondary objectives are to evaluate the presence and influence of frailty and analyze the prognostic role of existing risk-scores. The final FRAILESEL protocol was approved by the Ethical Committee of “Sapienza” University of Rome, Italy. The FRAILESEL study is a nationwide, Italian, multicenter, observational study conducted through a resident-led model. Patients over 65years of age who require emergency surgical procedures will be included in this study. The primary outcome measures are 30-day postoperative mortality and morbidity rates. The Clavien-Dindo classification system is used to categorize complications. The secondary outcome measures include length of hospital stay, length of stay in intensive care unit, and predictive value for morbidity and mortality of several frailty and surgical risk-scores. The results of the FRAILESEL study will be disseminated through national and international conference presentations and peer-reviewed journals. The study is also registered at ClinicalTrials.gov (ClinicalTrials.gov identifier: NCT02825082).

Published
2018

10. 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias

Author

Birindelli, A. (Arianna), Sartelli, M. (Massimo), Di Saverio, S. (Salomone), Coccolini, F. (Federico), Ansaloni, L. (Luca), Ramshorst, G.H. (Gabrielle) van, Campanelli, G. (Giampiero), Khokha, V. (Vladimir), Moore, E.E. (Ernest), Peitzman, A.B. (Andrew), Velmahos, G.C. (George ), Moore, F.A. (Frederick), Leppaniemi, A. (Ari), Burlew, C.C. (Clay), Biffl, W.L. (Walter), Koike, K. (Kaoru), Kluger, Y. (Yoram), Fraga, G.P. (Gustavo), Ordonez, C.A. (Carlos A.), Novello, M. (Matteo), Agresta, F., Sakakushev, B. (Boris), Gerych, I. (Igor), Wani, I. (Imtiaz), Kelly, M.D. (Michael D.), Gomes, C.A. (Carlos Augusto), Faro Jr., M.P. (Mario), Tarasconi, A. (Antonio), Demetrashvili, Z. (Zaza), Lee, J.G. (Jae Gil), Vettoretto, N. (Nereo), Guercioni, G. (Gianluca), Persiani, R. (Roberto), Tranà, C. (Cristian), Cui, Y. (Yunfeng), Kok, K.Y.Y. (Kenneth), Ghnnam, W.M. (Wagih), Abbas, A.E.-S. (Ashraf El-Sayed), Sato, N. (Norio), Marwah, S. (Sanjay), Rangarajan, M. (Muthukumaran), Ben-Ishay, O. (Offir), Adesunkanmi, A.R.K. (Abdul Rashid), Lohse, H.A.S. (Helmut Alfredo Segovia), Kenig, J. (Jakub), Mandalà, V. (Vincenzo), Coimbra, R. (Raul), Bhangu, A. (Aneel), Suggett, N. (Nigel), Biondi, A. (Antonio), Portolani, N. (Nazario), Baiocchi, G. (Gianluca), Kirkpatrick, A.W. (Andrew W.), Scibé, R. (Rodolfo), Sugrue, M. (Michael), Chiara, O. (Osvaldo), Catena, F. (Fausto), Birindelli, A. (Arianna), Sartelli, M. (Massimo), Di Saverio, S. (Salomone), Coccolini, F. (Federico), Ansaloni, L. (Luca), Ramshorst, G.H. (Gabrielle) van, Campanelli, G. (Giampiero), Khokha, V. (Vladimir), Moore, E.E. (Ernest), Peitzman, A.B. (Andrew), Velmahos, G.C. (George ), Moore, F.A. (Frederick), Leppaniemi, A. (Ari), Burlew, C.C. (Clay), Biffl, W.L. (Walter), Koike, K. (Kaoru), Kluger, Y. (Yoram), Fraga, G.P. (Gustavo), Ordonez, C.A. (Carlos A.), Novello, M. (Matteo), Agresta, F., Sakakushev, B. (Boris), Gerych, I. (Igor), Wani, I. (Imtiaz), Kelly, M.D. (Michael D.), Gomes, C.A. (Carlos Augusto), Faro Jr., M.P. (Mario), Tarasconi, A. (Antonio), Demetrashvili, Z. (Zaza), Lee, J.G. (Jae Gil), Vettoretto, N. (Nereo), Guercioni, G. (Gianluca), Persiani, R. (Roberto), Tranà, C. (Cristian), Cui, Y. (Yunfeng), Kok, K.Y.Y. (Kenneth), Ghnnam, W.M. (Wagih), Abbas, A.E.-S. (Ashraf El-Sayed), Sato, N. (Norio), Marwah, S. (Sanjay), Rangarajan, M. (Muthukumaran), Ben-Ishay, O. (Offir), Adesunkanmi, A.R.K. (Abdul Rashid), Lohse, H.A.S. (Helmut Alfredo Segovia), Kenig, J. (Jakub), Mandalà, V. (Vincenzo), Coimbra, R. (Raul), Bhangu, A. (Aneel), Suggett, N. (Nigel), Biondi, A. (Antonio), Portolani, N. (Nazario), Baiocchi, G. (Gianluca), Kirkpatrick, A.W. (Andrew W.), Scibé, R. (Rodolfo), Sugrue, M. (Michael), Chiara, O. (Osvaldo), and Catena, F. (Fausto)

Abstract

Emergency repair of complicated abdominal wall hernias may be associated with worsen outcome and a significant rate of postoperative complications. There is no consensus on management of complicated abdominal hernias. The main matter of debate is about the use of mesh in case of intestinal resection and the type of mesh to be used. Wound infe

Published
2017
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11. Complicated intrabdominal infections in europe: preliminary data from the first three months of the CIAO study

Author

Sartelli M, Catena F, Ansaloni L, Leppaniemi A, Taviloglu K, van Goor H, Viale P, Lazzareschi DV, Marrelli D, Colizza S, Scibé R, Alis H, Torer N, Navarro S, Catani M, Kauhanen S, Augustin G, Sakakushev B, Massalou D, Pletinckx P, Kenig J, Di Saverio S, Guercioni G, Rausei S, Laine S, Major P, Skrovina M, Angst E, Pittet O, Gerych I, Tepp J, Weiss G, Vasquez G, Vladov N, Tranà C, Vettoretto N, Delibegovic S, Dziki A, Giraudo G, Pereira J, Poiasina E, Tzerbinis H, Hutan M, Vereczkei A, Krasniqi A, Seretis C, Diaz Nieto R, Mesina C, Rems M, Campanile FC, Agresta F, Coletta P, Uotila Nieminen M, Dente M, Bouliaris K, Lasithiotakis K, Khokha V, Zivanović D, Smirnov D, Marinis A, Negoi I, Ney L, Bini R, Leon M, Aloia S, Huchon C, Moldovanu R, de Melo RB, Giakoustidis D, Ioannidis O, Cucchi M, Pintar T, Jovine E., DE WERRA, CARLO, Sartelli, M, Catena, F, Ansaloni, L, Leppaniemi, A, Taviloglu, K, van Goor, H, Viale, P, Lazzareschi, Dv, DE WERRA, Carlo, Marrelli, D, Colizza, S, Scibé, R, Alis, H, Torer, N, Navarro, S, Catani, M, Kauhanen, S, Augustin, G, Sakakushev, B, Massalou, D, Pletinckx, P, Kenig, J, Di Saverio, S, Guercioni, G, Rausei, S, Laine, S, Major, P, Skrovina, M, Angst, E, Pittet, O, Gerych, I, Tepp, J, Weiss, G, Vasquez, G, Vladov, N, Tranà, C, Vettoretto, N, Delibegovic, S, Dziki, A, Giraudo, G, Pereira, J, Poiasina, E, Tzerbinis, H, Hutan, M, Vereczkei, A, Krasniqi, A, Seretis, C, Diaz Nieto, R, Mesina, C, Rems, M, Campanile, Fc, Agresta, F, Coletta, P, Uotila Nieminen, M, Dente, M, Bouliaris, K, Lasithiotakis, K, Khokha, V, Zivanović, D, Smirnov, D, Marinis, A, Negoi, I, Ney, L, Bini, R, Leon, M, Aloia, S, Huchon, C, Moldovanu, R, de Melo, Rb, Giakoustidis, D, Ioannidis, O, Cucchi, M, Pintar, T, and Jovine, E.

Published
2012

13. World society of emergency surgery (WSES) guidelines for management of skin and soft tissue infections

Author

Sartelli, M, Malangoni, MA, May, AK, Viale, P, Kao, LS, Catena, F, Ansaloni, L, Moore, EE, Moore, FA, Peitzman, AB, Coimbra, R, Leppaniemi, A, Kluger, Y, Biffl, W, Koike, K, Girardis, M, Ordonez, CA, Tavola, M, Cainzos, M, Saverio, SD, Fraga, GP, Gerych, I, Kelly, MD, Taviloglu, K, Wani, I, Marwah, S, Bala, M, Ghnnam, W, Shaikh, N, Chiara, O, Faro, MP, Pereira, GA, Gomes, CA, Coccolini, F, Tranà, C, Corbella, D, Brambillasca, P, Cui, Y, Lohse, HAS, Khokha, V, Kok, KYY, Hong, SK, Yuan, KC, Sartelli, M, Malangoni, MA, May, AK, Viale, P, Kao, LS, Catena, F, Ansaloni, L, Moore, EE, Moore, FA, Peitzman, AB, Coimbra, R, Leppaniemi, A, Kluger, Y, Biffl, W, Koike, K, Girardis, M, Ordonez, CA, Tavola, M, Cainzos, M, Saverio, SD, Fraga, GP, Gerych, I, Kelly, MD, Taviloglu, K, Wani, I, Marwah, S, Bala, M, Ghnnam, W, Shaikh, N, Chiara, O, Faro, MP, Pereira, GA, Gomes, CA, Coccolini, F, Tranà, C, Corbella, D, Brambillasca, P, Cui, Y, Lohse, HAS, Khokha, V, Kok, KYY, Hong, SK, and Yuan, KC

Abstract

Skin and soft tissue infections (SSTIs) encompass a variety of pathological conditions ranging from simple superficial infections to severe necrotizing soft tissue infections. Necrotizing soft tissue infections (NSTIs) are potentially life-threatening infections of any layer of the soft tissue compartment associated with widespread necrosis and systemic toxicity. Successful management of NSTIs involves prompt recognition, timely surgical debridement or drainage, resuscitation and appropriate antibiotic therapy. A worldwide international panel of experts developed evidence-based guidelines for management of soft tissue infections. The multifaceted nature of these infections has led to a collaboration among surgeons, intensive care and infectious diseases specialists, who have shared these guidelines, implementing clinical practice recommendations.

Published
2014

14. WSES guidelines for emergency repair of complicated abdominal wall hernias

Author

Sartelli, M. (Massimo), Coccolini, F. (Federico), Ramshorst, G.H. (Gabrielle) van, Campanelli, G. (Giampiero), Mandala, V., Ansaloni, L. (Luca), Moore, E.E. (Ernest), Peitzman, A. (Andrew), Velmahos, G.C. (George ), Moore, F.A. (Fredrick), Leppaniemi, A. (Ari), Burlew, C.C. (Clay), Biffl, W.L. (Walter), Koike, K. (Kaoru), Kluger, Y. (Yoram), Fraga, G.P. (Gustavo), Ordonez, C.A. (Carlos), Di Saverio, S. (Salomone), Agresta, F., Sakakushev, B. (Boris), Gerych, I. (Igor), Wani, I. (Imtiaz), Kelly, M.D. (Michael ), Gomes, C.A. (Carlos), Faro Jr., M.P. (Mario), Taviloglu, K. (Korhan), Demetrashvili, Z. (Zaza), Lee, J.G. (Jeong ), Vettoretto, N. (Nereo), Guercioni, G. (Gianluca), Tranà, C. (Cristian), Cui, Y. (Yijun), Kok, K.Y.Y. (Kenneth), Ghnnam, W.M. (Wagih), Abbas, A.E.S. (Ashraf El-Sayed), Sato, N. (Norio), Marwah, S. (Sanjay), Rangarajan, M. (Muthukumaran), Ben-Ishay, O. (Offir), Adesunkanmi, A.R.K. (Abdul Rashid), Segovia Lohse, H.A. (Helmut), Kenig, J. (Jakub), Mandalà, V. (Vincenzo), Patrizi, A. (Andrea), Scibé, R. (Rodolfo), Catena, F. (Fausto), Sartelli, M. (Massimo), Coccolini, F. (Federico), Ramshorst, G.H. (Gabrielle) van, Campanelli, G. (Giampiero), Mandala, V., Ansaloni, L. (Luca), Moore, E.E. (Ernest), Peitzman, A. (Andrew), Velmahos, G.C. (George ), Moore, F.A. (Fredrick), Leppaniemi, A. (Ari), Burlew, C.C. (Clay), Biffl, W.L. (Walter), Koike, K. (Kaoru), Kluger, Y. (Yoram), Fraga, G.P. (Gustavo), Ordonez, C.A. (Carlos), Di Saverio, S. (Salomone), Agresta, F., Sakakushev, B. (Boris), Gerych, I. (Igor), Wani, I. (Imtiaz), Kelly, M.D. (Michael ), Gomes, C.A. (Carlos), Faro Jr., M.P. (Mario), Taviloglu, K. (Korhan), Demetrashvili, Z. (Zaza), Lee, J.G. (Jeong ), Vettoretto, N. (Nereo), Guercioni, G. (Gianluca), Tranà, C. (Cristian), Cui, Y. (Yijun), Kok, K.Y.Y. (Kenneth), Ghnnam, W.M. (Wagih), Abbas, A.E.S. (Ashraf El-Sayed), Sato, N. (Norio), Marwah, S. (Sanjay), Rangarajan, M. (Muthukumaran), Ben-Ishay, O. (Offir), Adesunkanmi, A.R.K. (Abdul Rashid), Segovia Lohse, H.A. (Helmut), Kenig, J. (Jakub), Mandalà, V. (Vincenzo), Patrizi, A. (Andrea), Scibé, R. (Rodolfo), and Catena, F. (Fausto)

Abstract

Emergency repair of complicated abdominal hernias is associated with poor prognosis and a high rate of post-operative complications. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013, during the 2nd Congress of the World Society of Emergency Surgery with the goal of defining recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel.

Published
2013
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15. 2013 WSES guidelines for management of intra-abdominal infections

Author

Sartelli, M, Viale, P, Catena, F, Ansaloni, L, Moore, E, Malangoni, M, Moore, FA, Velmahos, G, Coimbra, R, Ivatury, R, Peitzman, A, Koike, K, Leppaniemi, A, Biffl, W, Burlew, CC, Balogh, ZJ, Boffard, K, Bendinelli, C, Gupta, S, Kluger, Y, Agresta, F, Di Saverio, S, Wani, I, Escalona, A, Ordonez, C, Fraga, GP, Junior, GAP, Bala, M, Cui, Y, Marwah, S, Sakakushev, B, Kong, V, Naidoo, N, Ahmed, A, Abbas, A, Guercioni, G, Vettoretto, N, Díaz-Nieto, R, Gerych, I, Tranà, C, Faro, MP, Yuan, KC, Kok, KYY, Mefire, AC, Lee, JG, Hong, SK, Ghnnam, W, Siribumrungwong, B, Sato, N, Murata, K, Irahara, T, Coccolini, F, Lohse, HAS, Verni, A, Shoko, T, Sartelli, M, Viale, P, Catena, F, Ansaloni, L, Moore, E, Malangoni, M, Moore, FA, Velmahos, G, Coimbra, R, Ivatury, R, Peitzman, A, Koike, K, Leppaniemi, A, Biffl, W, Burlew, CC, Balogh, ZJ, Boffard, K, Bendinelli, C, Gupta, S, Kluger, Y, Agresta, F, Di Saverio, S, Wani, I, Escalona, A, Ordonez, C, Fraga, GP, Junior, GAP, Bala, M, Cui, Y, Marwah, S, Sakakushev, B, Kong, V, Naidoo, N, Ahmed, A, Abbas, A, Guercioni, G, Vettoretto, N, Díaz-Nieto, R, Gerych, I, Tranà, C, Faro, MP, Yuan, KC, Kok, KYY, Mefire, AC, Lee, JG, Hong, SK, Ghnnam, W, Siribumrungwong, B, Sato, N, Murata, K, Irahara, T, Coccolini, F, Lohse, HAS, Verni, A, and Shoko, T

Abstract

Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high. The 2013 update of the World Society of Emergency Surgery (WSES) guidelines for the management of intra-abdominal infections contains evidence-based recommendations for management of patients with intra-abdominal infections.© 2013 Sartelli et al.; licensee BioMed Central Ltd.

Published
2013

16. WSES consensus conference: Guidelines for first-line management of intra-abdominal infections

Author

Sartelli, M, Viale, P, Koike, K, Pea, F, Tumietto, F, Van Goor, H, Guercioni, G, Nespoli, A, Tranà, C, Catena, F, Ansaloni, L, Leppaniemi, A, Biffl, W, Moore, F, Poggetti, R, Pinna, A, Moore, E, NESPOLI, ANGELO, Moore, FA, Pinna, AD, Moore, EE, Sartelli, M, Viale, P, Koike, K, Pea, F, Tumietto, F, Van Goor, H, Guercioni, G, Nespoli, A, Tranà, C, Catena, F, Ansaloni, L, Leppaniemi, A, Biffl, W, Moore, F, Poggetti, R, Pinna, A, Moore, E, NESPOLI, ANGELO, Moore, FA, Pinna, AD, and Moore, EE

Abstract

Intra-abdominal infections are still associated with high rate of morbidity and mortality.A multidisciplinary approach to the management of patients with intra-abdominal infections may be an important factor in the quality of care. The presence of a team of health professionals from various disciplines, working in concert, may improve efficiency, outcome, and the cost of care.A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bologna on July 2010, during the 1st congress of the WSES, involving surgeons, infectious disease specialists, pharmacologists, radiologists and intensivists with the goal of defining recommendations for the early management of intra-abdominal infections. This document represents the executive summary of the final guidelines approved by the consensus conference. © 2011 Sartelli et al; licensee BioMed Central Ltd.

Published
2011

18. Complicated intra-abdominal infections worldwide : the definitive data of the CIAOW Study

Author

Sartelli, Massimo, Catena, Fausto, Ansaloni, Luca, Coccolini, Frederico, Corbella, Davide, Moore, Ernest, Malangoni, Mark, Velmahos, George, Coimbra, Raul, Koike, Kaoru, Leppaniemi, Ari, Biffl, Walter, Balogh, Zsolt, Bendinelli, Cino, Gupta, Sanjay, Kluger, Yoram, Agresta, Ferdinando, Di Saverio, Salmone, Tugnoli, Gregorio, Jovine, Elio, Ordonez, Carlos, Whelan, James, Fraga, Gustavo, Carlos, Gomes, Augusto, Pereira, Gerson, Yuan, Kuo-Ching, Bala, Miklosh, Peev, Miroslav, Ben-Ishay, Offir, Cui, Yunfeng, Marwah, Sanjay, Zachariah, Sanoop, Wani Imtiaz, Rangarajan, Muthukumaran, Sakakushev, Boris, Kong, Victor, Ahmed, Adamu, Abbas, Ashraf, Gonsaga, Ricardo, Guercioni, Gianluca, Vettoretto, Nereo, Poiasina, Elia, Díaz-Nieto, Rafael, Massalou, Damien, Skrovina, Matej, Gerych, Ihor, Augustin, Goran, Kenig, Jakub, Khokha, Vladimir, Tranà, Cristian, Kok, Kenneth, Mefire, Alain, Lee, Jae, Hong, Suk-Kyung, Lohse, Helmut, Ghnnam, Wagih, Verni, Alfredo, Lohsiriwat, Varut, Siribumrungwong, Boonying, El Zalabany, Tamer, Tavares, Alberto, Baiocchi, Gianluca, Das, Koray, Jarry, Julien, Zida, Maurice, Sato, Norio, Murata, Kiyoshi, Shoko, Tomohisa, Irahara, Takayuki, Hamedelneel, Ahmed, Naidoo, Noel, Adesunkanmi, Abdul, Kobe, Yoshiro, Ishii, Wataru, Oka, Kazuyuki, Izawa, Yoshimitsu, Hamid, Hytham, Khan, Iqbal, Attri, AK, Sharma, Rajeev, Sanjuan, Juan, Badiel, Marisol, Barnabé, Rita, II kirurgian klinikka, [Sartelli, M] Department of Surgery, Macerata Hospital, Macerata, Italy. [Catena, F] Emergency Surgery, Maggiore Parma Hospital, Parma, Italy. [Ansaloni, L, Coccolini, F, Poiasina, E] Department of General Surgery, Ospedali Riuniti, Bergamo, Italy. [Corbella, D] Department of Anestesiology, Ospedali Riuniti, Bergamo, Italy. [Moore, EE, Biffl, W] Department of Surgery, Denver Health Medical Center, Denver, USA. [Malangoni, M] American Board of Surgery, Philadelphia, USA. [Velmahos, G, Peev, MP] Division of Trauma, Emergency Surgery and Surgical Critical Care, Harvard Medical School, Massachusetts General Hospital, Massachusetts, USA. [Coimbra, R] Department of Surgery, UC San Diego Health System, San Diego, USA. [Koike, K] Department of Primary Care & Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan. [Leppaniemi, A] Department of Abdominal Surgery, University Hospital Meilahti, Helsinki, Finland. [Balogh, Z, Bendinelli, C] Department of Surgery, University of Newcastle, Newcastle, NSW, Australia. [Gupta, S] Department of Surgery, Govt Medical College and Hospital, Chandigarh, India. [Kluger, Y, Ben-Ishay, O, Attri, A, Sharma, R] Department of General Surgery, Rambam Health Care Campus, Haifa, Israel. [Agresta, F] Department of Surgery, Adria Hospital Adria, Adria, Italy. [Di Saverio, S, Tugnoli, G] Trauma Surgery Unit, Maggiore Hospital, Bologna, Italy. [Jovine, E, Bananbé, R] Department of Surgery, Maggiore Hospital, Bologna, Italy. [Ordoñez, CA, Sanjuán, J, Badiel, M] Department of Surgery, Fundación Valle del Lilí, Cali, Colombia. [Whelan, JF] Division of Trauma/Critical Care Department of Surgery Virginia Commonwealth University, Richmond, VA, USA. [Fraga, GP] Division of Trauma Surgery, Campinas University, Campinas, Brazil. [Gomes, CA] Department of Surgery, Monte Sinai Hospital, Juiz de Fora, Brazil. [Pereira, CA] Department of Surgery, Emergency Unit, Ribeirão Preto, Brazil. [Yuan, KC]Department of Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan. [Bala, M] Department of General Surgery, Hadassah Medical Center, Jerusalem, Israel. [Cui, Y] Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China. [Marwah, S] Department of Surgery, Pt BDS Post-graduate Institute of Medical Sciences, Rohtak, India. [Zachariah, S] Department of Surgery, MOSC Medical College, Cochin, India. [Wani, I] Department of Surgery, SKIMS, Srinagar, India. [Rangarajan, M] Department of Surgery, Kovai Medical Center, Coimbatore, India. [Shakakusev, B] First Clinic of General Surgery, University Hospital/UMBAL/St George Plovdiv, Plovdiv, Bulgaria. [Kong, V] Department of Surgery, Edendale Surgery, Pietermaritzburg, Republic of South Africa. [Ahmed, A] Department of Surgery, Ahmadu Bello University Teaching Hospital Zaria, Kaduna, Nigeria. [Abbas, A, Ghnnam, W] Department of Surgery, Mansoura University Hospital, Mansoura, Egypt. [Gonsaga, RA] Department of Surgery, Faculdades Integradas Padre Albino, Catanduva, Brazil. [Guercioni, G] Department of Surgery, Mazzoni Hospital, Ascoli Piceno, Italy. [Vettoretto, N] Department of Surgery, Mellini Hospital, Chiari, BS, Italy. [Díaz-Nieto, R] Department of General and Digestive Surgery, Virgen de la Victoria, University Hospital, Málaga, Spain. [Massalou, D] Department of General Surgery and Surgical Oncology, Université de Nice Sophia-Antipolis, Universitary Hospital of Nice, Nice, France. [Skrovina, M] Department of Surgery, Hospital and Oncological Centre, Novy Jicin, Czech Republic. [Gerych, I] Department of General Surgery, Lviv Emergency Hospital, Lviv, Ukraine. [Augustin, G] Department of Surgery, University Hospital Center Zagreb, Zagreb, Croatia. [Kenig, J] 3rd Department of General Surger Jagiellonian Univeristy, Narutowicz Hospital, Krakow, Poland. [Khokha, V] Department of Surgery, Mozyr City Hospital, Mozyr, Belarus. [Tranà, C] Department of Surgery, Ancona University, Ancona, Italy. [Kok, KY] Department of Surgery, Ripas Hospital, Bandar Seri Begawan, Brunei. [Mefire, AC] Clinical Sciences, Regional Hospitals Limbe and Buea, Limbe, Cameroon. [Lee, JG] Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. [Hong, SK] Division of Trauma and Surgical Critical Care, Department of Surgery, University of Ulsan, Seoul, Republic of Korea. [Lohse, HA] II Cátedra de Clínica Quirúrgica, Hospital de Clínicas, Asuncion, Paraguay. [Verni, A] Department of Surgery, Cutral Có Clinic, Cutral Có, Argentina. [Lohsiriwat, V] Department of Surgery, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand. [Siribumrungwong, B] Department of Surgery, Thammasat University Hospital, Pathumthani, Thailand. [El Zalabany, T] Department of Surgery, Bahrain Defence Force Hospital, Manama, Bahrain. [Tavares, A] Department of Surgery, Hospital Regional de Alta Especialidad del Bajio, Leon, Mexico. [Baiocchi, G] Clinical and Experimental Sciences, Brescia Ospedali Civili, Brescia, Italy. [Das, K] General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey. [Jarry, J] Visceral Surgery, Military Hospital Desgenettes, Lyon, France. [Zida, M] Visceral Surgery, Teaching Hospital Yalgado Ouedraogo, Ouedraogo, Burkina Faso. [Murata, K] Department of Acute and Critical care medicine, Tokyo Medical and Dental University, Tokyo, Japan. [Shoko, T] he Shock Trauma and Emergency Medical Center, Matsudo City Hospital, Chiba, Japan. [Irahara, T] Emergency and Critical Care Center of Nippon Medical School, Tama-Nagayama Hospital, Tokyo, Japan. [Hamedelneel, AO] Department of Surgery, Our Lady of Lourdes Hospital, Drogheda, Ireland. [Naidoo, N] Department of Surgery, Port Shepstone Hospital, Port Shepstone, South Africa. [Adesunkanmi, AR] Department of Surgery, Obafemi Awolowo UNiversity Hospital, Ile-Ife, Nigeria. [Kobe, Y] Department of Emergency and Critical Care Medicine, Chiba University Hospital, Chiba, Japan. [Ishii, W] Department of Emergency and Critical Care Medicine, Chiba University Hospital, Chiba, Japan, and Depatment of Emergency Medicine, Kyoto Second Red Cross Hospital, Kyoto, Japan. [Oka, K] Tajima emergency & Critical Care Medical Center, Toyooka Public Hospital, Toyooka, Hyogo, Japan. [Izawa, Y] Emergency and Critical Care Medicine, Jichi Medical University, Shimotsuke, Japan. [Hamid, H] Department of Surgery, Mayo General Hospital Castlebar Co. Mayo, Castlebar, Ireland.

Subjects
Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Digestive System Surgical Procedures [Medical Subject Headings], APPENDICEAL ABSCESS, medicine.medical_treatment, Diseases::Bacterial Infections and Mycoses::Infection::Cross Infection [Medical Subject Headings], Phenomena and Processes::Microbiological Phenomena::Drug Resistance, Microbial [Medical Subject Headings], Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Drainage [Medical Subject Headings], Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Reoperation [Medical Subject Headings], Study Protocol, Infección hospitalaria, Procedimientos quirúrgicos del sistema digestivo, Diseases::Bacterial Infections and Mycoses::Infection::Sepsis [Medical Subject Headings], Publication Characteristics::Study Characteristics::Multicenter Study [Medical Subject Headings], Enfermedad crítica, Adulto, Mortality rate, Farmacoresistencia microbiana, Immunosuppression, Diverticulitis, Humanos, 3. Good health, Emergency Medicine, Diseases::Digestive System Diseases::Peritoneal Diseases::Peritonitis [Medical Subject Headings], KLEBSIELLA-PNEUMONIAE, Reoperación, Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Disease Attributes::Critical Illness [Medical Subject Headings], medicine.medical_specialty, CHOLECYSTECTOMY, education, Peritonitis, RELAPAROTOMY, Diseases::Bacterial Infections and Mycoses::Infection::Suppuration::Abscess::Abdominal Abscess [Medical Subject Headings], SECONDARY PERITONITIS, Internal medicine, complicated intra-abdomina infections, appendicitis, cholecystitis, postoperative, colonic perforation, gastroduodenal perforation, diverticulitis, small bowel perforation, Named Groups::Persons::Age Groups::Adult [Medical Subject Headings], medicine, MANAGEMENT, METAANALYSIS, Estudio multicéntrico, Diseases::Bacterial Infections and Mycoses::Infection::Intraabdominal Infections [Medical Subject Headings], SEPSIS, business.industry, Abdominal Infection, Absceso abdominal, ACUTE CHOLECYSTITIS, medicine.disease, 3126 Surgery, anesthesiology, intensive care, radiology, Infecciones intraabdominales, Appendicitis, Surgery, Cholecystitis, Drenaje, Cholecystectomy, business, DIVERTICULITIS
Abstract

Journal Article; The CIAOW study (Complicated intra-abdominal infections worldwide observational study) is a multicenter observational study underwent in 68 medical institutions worldwide during a six-month study period (October 2012-March 2013). The study included patients older than 18 years undergoing surgery or interventional drainage to address complicated intra-abdominal infections (IAIs). 1898 patients with a mean age of 51.6 years (range 18-99) were enrolled in the study. 777 patients (41%) were women and 1,121 (59%) were men. Among these patients, 1,645 (86.7%) were affected by community-acquired IAIs while the remaining 253 (13.3%) suffered from healthcare-associated infections. Intraperitoneal specimens were collected from 1,190 (62.7%) of the enrolled patients. 827 patients (43.6%) were affected by generalized peritonitis while 1071 (56.4%) suffered from localized peritonitis or abscesses. The overall mortality rate was 10.5% (199/1898). According to stepwise multivariate analysis (PR = 0.005 and PE = 0.001), several criteria were found to be independent variables predictive of mortality, including patient age (OR = 1.1; 95%CI = 1.0-1.1; p

Published
2014

19. Complicated intra-abdominal infections in a worldwide context: an observational prospective study (CIAOW Study)

Author

Ashraf Abbas, Cristian Tranà, Offir Ben-Ishay, Sanjay Gupta, Kenneth Y.Y. Kok, Kuo Ching Yuan, Khalid Al Khalifa, Kaoru Koike, Alberto Tavares, Tomohisa Shoko, Zsolt J. Balogh, Maurice Zida, Gian Luca Baiocchi, Alain Chichom Mefire, Sanoop K. Zachariah, Rafael Díaz-Nieto, Mark A. Malangoni, Rita Barnabé, Walter L. Biffl, Abdul Rashid K. Adesunkanmi, Ari Leppäniemi, Goran Augustin, Luca Ansaloni, Boris Sakakushev, Noel Naidoo, Federico Coccolini, Wataru Ishii, Rajeev Sharma, Nereo Vettoretto, Miroslav P. Peev, Carlos A. Ordoñez, Miklosh Bala, Suk-Kyung Hong, Ashok K. Attri, Massimo Sartelli, Ferdinando Agresta, Yoshiro Kobe, Koray Das, Norio Sato, Carlos Augusto Gomes, Ricardo Alessandro Teixeira Gonsaga, Tamer El Zalabany, Cino Bendinelli, Helmut Alfredo Segovia Lohse, Alfredo Verni, Ahmed O. Hamedelneel, Takayuki Irahara, Adamu Ahmed, Gregorio Tugnoli, Yoram Kluger, Damien Massalou, Julien Jarry, Matej Skrovina, Jae Gil Lee, Ernest E. Moore, Yunfeng Cui, Elia Poiasina, Varut Lohsiriwat, Raul Coimbra, Sanjay Marwah, Vladimir Khokha, Jakub Kenig, Wagih Ghnnam, Juan Sanjuan, Ihor Gerych, Kiyoshi Murata, Gianluca Guercioni, Victor Y. Kong, George C. Velmahos, Fausto Catena, Salomone Di Saverio, Boonying Siribumrungwong, Elio Jovine, Gerson Alves Pereira Júnior, [Sartelli,M] Department of Surgery, Macerata Hospital, Macerata, Italy. [Catena,F] Emergency Surgery, Maggiore Parma Hospital, Parma, Italy. [Ansaloni,L, Poiasina,E, Coccolini,F] Department of General Surgery, Ospedali Riuniti, Bergamo, Italy. [Moore,E, Biffl,W] Department of Surgery, Denver Health Medical Center, Denver, CO, USA. [Malangoni,M] American Board of Surgery, Philadelphia, PA, USA. [Velmahos,G, Peev,MP] Harvard Medical School, Division of Trauma, Emergency Surgery and Surgical Critical Care Massachusetts General Hospital, Boston, MA, USA. [Coimbra,R] Department of Surgery, UC San Diego Health System, San Diego, CA, USA. [Koike,K, Sato,N] Department of Primary Care & Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan. [Leppaniemi,A] Department of Abdominal Surgery, University Hospital Meilahti, Helsinki, Finland. [Balogh,Z, Bendinelli,C] Department of Surgery, University of Newcastle, Newcastle, NSW, Australia. [Gupta,S, Attri,AK, Sharma,R] Department of Surgery, Govt Medical College and Hospital, Chandigarh, India. [Kluger,Y, Ben-Ishay,O] Department of General Surgery, Rambam Health Care Campus, Haifa, Israel. [Agresta,F] Department of Surgery, Adria Hospital, Adria, Italy. [Saverio,S di, Tugnoli,G] Trauma Surgery Unit, Maggiore Hospital, Bologna, Italy. [Jovine,E, Barnabé,R] Department of Surgery, Maggiore Hospital, Bologna, Italy. [Ordonez,C, Sanjuán,J] Department of Surgery, Universidad del Valle, Fundación Valle del Lili, Cali, Colombia. [Gomes,A] Department of Surgery, Monte Sinai Hospital, Juiz de Fora, Brazil. [Pereira Junior,GA] Emergency Unit, Department of Surgery, Ribeirão Preto, Brazil . [Yuan,K-CH] Department of Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan. [Bala,M] Department of General Surgery, Hadassah Medical Center, Jerusalem, Israel. [Cui,Y] Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China. [Marwah,S] Department of Surgery, Pt BDS Post-graduate Institute of Medical Sciences, Rohtak, India. [Zachariah,S] Department of Surgery, MOSC medical college, Cochin, India. [Sakakushev,B] First Clinic of General Surgery, University Hospital /UMBAL/ St George Plovdiv, Plovdiv, Bulgaria. [Sakakushev,B] General Surgery Clinic, Medical University/University Hospital St.George, Plovdiv, Bulgaria. [Kong,V] Department of Surgery, Edendale Hospital, Pietermaritzburg, Republic of South Africa. [Ahmed,A] Department of Surgery, Ahmadu Bello University Teaching Hospital Zaria, Kaduna, Nigeria. [Abbas,A] Department of Surgery, Mansoura University Hospital, Mansoura, Egypt . [Teixeira Gonsaga,RA] Department of Surgery, Faculdades Integradas Padre Albino, Catanduva, Brazil. [Guercioni,G] Department of Surgery, Mazzoni Hospital, Ascoli Piceno, Italy. [Vettoretto,N] Department of Surgery, Mellini Hospital, Chiari (BS), Italy. [Díaz Nieto,R] Department of General and Digestive Surgery, Hospital Universitario Virgen de la Victoria, Málaga, Spain. [Massalou,D] Department of General Surgery and Surgical Oncology, Université de Nice Sophia-Antipolis, Universitary Hospital of Nice, France. [Skrovina,M] Department of Surgery, Hospital and Oncological Centre, Novy Jicin, Czech Republic. [Gerych,I] Department of General Surgery, Lviv Emergency Hospital, Lviv, Ukraine. [Agustin,G] Department of Surgery, University Hospital Center Zagreb, Zagreb, Croatia. [Kenig,J] 3rd Department of General Surger Jagiellonian Univeristy, Narutowicz Hospital, Krakow, Poland. [Khokha,V] Department of Surgery, Mozyr City Hospital, Mozyr, Belarus. [Tranà,C] Department of Surgery, Ancona University, Ancona, Italy. [Yen Kok,KY] Department of Surgery, Ripas Hospital, Bandar Seri Begawan, Brunei. [Mefire,ACH] Clinical Sciences, Regional Hospitals Limbe and Buea, Limbe, Cameroon. [Lee,JG] Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. [Hong,S-K] Division of Trauma and Surgical Critical Care, Department of Surgery, University of Ulsan, Seoul, Republic of Korea . [Segovia Lohse,HA] II Cátedra de Clínica Quirúrgica, Hospital de Clínicas, Asunción, Paraguay. [Ghnnam,W] Department of Surgery, Khamis Mushayt General Hospital, Khamis Mushayt, Saudi Arabia. [Verni,A] Department of Surgery, Cutral Co Clinic, Neuquen, Argentina. [Lohsiriwat,W] Department of Surgery, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand. [Siribumrungwong,B] Department of Surgery, Thammasat University Hospital, Pathumthani, Thailand. [Tavares,A] Department of Surgery, Hospital Regional de Alta Especialidad del Bajio, León, México. [Baiocchi,G] Department of Clinical and Experimental Sciences, Brescia University, Brescia, Italy. [Das,K] General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey. [Jarry,J] Visceral Surgery, Military Hospital Desgenettes, Lyon, France. [Zida,M] Visceral Surgery, Teaching Hospital Yalgado Ouedraogo, Ouagadougou, Burkina Faso. [Murata,K] Department of Acute and Critical care medicine, Tokyo Medical and Dental University, Tokyo, Japan. [Shoko,T] The Shock Trauma and Emergency Medical Center, Matsudo City Hospital, Chiba, Japan. [Irahara,T] Emergency and Critical Care Center of Nippon Medical School, Tama-Nagayama Hospital, Tokyo, Japan. [Hamedelneel,AO] Department of Surgery, Our Lady of Lourdes Hospital, Drogheda, Ireland. [Naidoo,N] Department of Surgery, Port Shepstone Hospital, Port Shepstone, South Africa. [Kayode Adesunkanmi,AR] Department of Surgery, College of Health Sciences, Obafemi Awolowo University Hospital, Ile-Ife, Nigeria. [Kobe,Y] Department of Emergency and Critical Care Medicine, Chiba University Hospital, Chiba, Japan. [El Zalabany,T, and Khalifa,K Al] Department of Surgery, Bahrain Defence Force Hospital, Manama, Bahrain. [Ishii,W] Department of Emergency Medicine, Kyoto Second Red Cross Hospital, Kyoto, Japan.

Subjects
Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Drainage [Medical Subject Headings], Pediatrics, medicine.medical_specialty, Infecciones Intraabdominales, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Digestive System Surgical Procedures [Medical Subject Headings], Infección Hospitalaria, Diseases::Bacterial Infections and Mycoses::Infection::Cross Infection [Medical Subject Headings], MEDLINE, Peritonitis, Context (language use), Absceso Abdominal, Phenomena and Processes::Microbiological Phenomena::Drug Resistance, Microbial [Medical Subject Headings], Review, 030230 surgery, Enfermedad Crítica, Diseases::Bacterial Infections and Mycoses::Infection::Suppuration::Abscess::Abdominal Abscess [Medical Subject Headings], Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Reoperation [Medical Subject Headings], 03 medical and health sciences, 0302 clinical medicine, Named Groups::Persons::Age Groups::Adult [Medical Subject Headings], Medicine, intra-abdominal infections, Prospective cohort study, Diseases::Bacterial Infections and Mycoses::Infection::Sepsis [Medical Subject Headings], Estudio Multicéntrico, Publication Characteristics::Study Characteristics::Multicenter Study [Medical Subject Headings], Diseases::Bacterial Infections and Mycoses::Infection::Intraabdominal Infections [Medical Subject Headings], business.industry, Adulto, Mortality rate, Abdominal Infection, Mean age, Farmacoresistencia microbiana, medicine.disease, 3. Good health, Humanos, Procedimientos Quirúrgicos del Sistema Digestivo, 030220 oncology & carcinogenesis, Emergency Medicine, DOENÇAS INFECCIOSAS, Observational study, Surgery, Drenaje, Diseases::Digestive System Diseases::Peritoneal Diseases::Peritonitis [Medical Subject Headings], business, Reoperación, Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Disease Attributes::Critical Illness [Medical Subject Headings]
Abstract

Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high. The World Society of Emergency Surgery (WSES) has designed the CIAOW study in order to describe the clinical, microbiological, and management-related profiles of both community- and healthcare-acquired complicated intra-abdominal infections in a worldwide context. The CIAOW study (Complicated Intra-Abdominal infection Observational Worldwide Study) is a multicenter observational study currently underway in 57 medical institutions worldwide. The study includes patients undergoing surgery or interventional drainage to address complicated intra-abdominal infections. This preliminary report includes all data from almost the first two months of the six-month study period. Patients who met inclusion criteria with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study. 702 patients with a mean age of 49.2 years (range 18–98) were enrolled in the study. 272 patients (38.7%) were women and 430 (62.3%) were men. Among these patients, 615 (87.6%) were affected by community-acquired IAIs while the remaining 87 (12.4%) suffered from healthcare-associated infections. Generalized peritonitis was observed in 304 patients (43.3%), whereas localized peritonitis or abscesses was registered in 398 (57.7%) patients. The overall mortality rate was 10.1% (71/702). The final results of the CIAOW Study will be published following the conclusion of the study period in March 2013.

Published
2013

20. Complicated intra-abdominal infections in Europe: a comprehensive review of the CIAO study

Author

Salvador Navarro, Giorgio Giraudo, Harry van Goor, Sergio Aloia, Saila Kauhanen, Luca Ansaloni, Miran Rems, Cyrille Huchon, Rodolfo Scibé, Stefano Rausei, Ihor Herych, Damien Massalou, Ferdinando Agresta, Gianluca Guercioni, Fausto Catena, Cristian Mesina, Olivier Pittet, Ionut Negoi, Konstantinos Bouliaris, Cristian Tranà, Elia Poiasina, András Vereczkei, Marco Catani, Jorge Pereira, Mario Dente, Vladimir Khokha, Zoran Krivokapic, Alessandro Ferrero, Daniele Marrelli, Federico Coccolini, Pietro Coletta, Athanasios Marinis, Radu Moldovanu, Dmitry Smirnov, Dimitrios Giakoustidis, Daniel Lazzareschi, Jelena Petrović, Matej Skrovina, Samipetteri Laine, Fabio Cesare Campanile, Ludwig Ney, Martin Hutan, P. Pletinckx, Michele Cucchi, Adam Dziki, Korhan Taviloğlu, Günter Weiss, Mirjami Uotila-Nieminen, Salomone Di Saverio, Pierluigi Viale, Davide Corbella, Avdyl Krasniqi, Dragoljub Zivanovic, Elio Jovine, Piotr Major, Nikola Vladov, Ari Leppäniemi, Nurkan Törer, Sergio Colizza, Carlo De Werra, Charalampos Seretis, Orestis Ioannidis, Nereo Vettoretto, Jaan Tepp, Eliane Angst, Konstantinos Lasithiotakis, Jakub Kenig, Massimo Sartelli, Goran Augustin, Giorgio Vasquez, Helen Tzerbinis, Tadeja Pintar, Miguel Leon, Renato Bessa Melo, Halil Alis, Rafael Díaz-Nieto, Roberto Bini, Boris Sakakushev, David van Dellen, Samir Delibegovic, [Sartelli,M, Lazzareschi,DV, Scibè,R] Department of Surgery, Macerata Hospital, Macerata, Italy. [Catena,F, Cucchi,M] Emergency Surgery, Maggiore Parma Hospital, Parma, Italy. [Ansaloni,L, Coccolini,F, Poiasina,E] Department of General Surgery, Ospedali Riuniti, Bergamo, Italy. [Leppaniemi,A] Department of Abdominal Surgery, University Hospital Meilahti, Helsinki, Finland. [Taviloglu,K] Department of Surgery, Sisli Florence Nigtingale Hospital, Istanbul, Turkey. [van Goor,H] Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands. [Viale,P] Department of Internal Medicine Geriatrics and Nephrologic Diseases, Clinic of Infectious Diseases, St Orsola-Malpighi University Hospital, Bologna, Italy. [Corbela,D] Department of Anestesiology, Ospedali Riuniti, Bergamo, Italy. [de Werra,C, Aloia,S] General, Oncological, Geriatrical Surgery and advanced Technology, University Federico II, Naples, Italy. [Marrelli,D] Department of Human Pathology and Oncology, Policlinico le Scotte, University Hospital, Siena, Italy. [Colizza,S] Department of Surgery, Fatebenefratelli Isola Tiberina hospital, Rome, Italy. [Alis,H] Department of General Surgery, Bakirkoy Training Research Hospital, Istanbul, Turkey. [Torer,N] Department of General Surgery, Baskent University Faculty of Medicine, Adana, Turkey. [Navarro,S] Department of Surgery, Parc Tauli University Hospital, Barcelona, Spain. [Sakakushev,B] First General Surgery Clinic, University Hospital St. George/Chair of Surgical Propedeutics, Medical Faculty, Medical University Plovdiv, Plovdic, Bulgaria. [Massalou,D] Department of Emergency Surgery, University Hospital of Nice, University of Nice Sophia-Antipolis, Sophia-Antipolis, France. [Augustin,G] Department of Surgery, University Hospital Center, Zagreb, Croatia. [Catani,M] Emergency Department, Umberto I Hospital, 'La Sapienza' University of Rome, Rome, Italy. [Kauhanen,S] Department of Gastroenterological surgery Turku, University Central Hospital, Turku, Finland. [Pletinckx,P] Department of Surgery, AZ Maria Middelares, Ghent, Belgium. [Kenig,J] 3rd Department of Generał Surgery, Narutowicz Hospital, Krakow, Połand. [Di Saverio,S, Jovine,E] Department of Surgery, Maggiore Hospital, Bologna, Italy. [Guercioni,G] Department of Surgery, Mazzoni Hospital, Ascoli Piceno, Italy. [Skrovina,M] Department of Surgery Hospital and Oncological Centre Novy Jicin, Novy Jicin, Czech republic. [Díaz-Nieto,R] Department of General and Digestive Surgery, Hospital Universitario Virgen de la Victoria, Málaga, Spain. [Ferrero,A] Department of Surgery, Mauriziano Hospital, Torino, Italy. [Rausei,S] Department of Surgery (Chief Renzo Dionigi), University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy. [Laine,S] Department GI-surgery, Kuopio University Hospital, Kuopio, Finland. [Major,P] 2nd Department of Surgery, Jagiellonian University, Krakow, Poland. [Angst,E] Department of Visceral Surgery and Medicine, Inselspital Bern, University of Bern, Bern, Switzerland. [Pittet,O] Department of Visceral Surgery Centre Hospitalier Universitaire Vaudois, CHUV, Lausanne, Switzerland. [Herych,I] Department of General Surgery, Lviv Emergency Hospital, Lviv, Ukraine. [Agresta,F] Department of General Surgery, Ospedale Civile, Adria (RO), Italy. [Vettoretto,N] General and Vascular Surgery, M.Mellini Hospital, Chiari, Italy. [Tepp,J] First General Surgery, North Estonia Regional Hospital, Tallinn, Estonia. [Weiss,G] Intensive Care Klinikum, Magdeburg gGmbH, Magdeburg, Germany. [Vasquez,G] Department of Emergency Surgery Azienda Ospedaliero-Universitaria S.Anna, Ferrara, Italy. [Vladov,N] Department of Hepato-biliary and Pancreatic surgery and Transplantology, Military Medical Hospital, Sofia, Bulgaria. [Tranà,C] Department of Surgery, Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy. [Delivegovic,S] Department of surgery, University Clinic Center Tuzla, Tuzla, Bosnia and Herzegovina. [Dziki,A] Department of General and Colorectal Surgery, University Hospital, Central Veterans Hospital, Lodz, Poland. [Giraudo,G] Surgical Department Santa Croce e Carle hospital, Cuneo, Italy. [Pereira,J] Department of Surgery, São Teotónio Hospital, Viseu, Portugal. [Tzerbinis,H] Department of HPB and Liver Transplant Surgery, Royal Free Hospital, London, United Kingdom. [van Dellen,D] Department of Surgery, Manchester Royal Infirmare, Manchester, UK. [Hutan,M] IInd Surgical department of Medical faculty Comenius University, University Hospital Bratislava, st. Cyril and Methodius Hospital, Bratislava, Slovakia. [Vereczkei,A] Department of Surgery, Medical School University of Pécs, Pécs, Hungary. [Krasniqi,A] Department of Abdominal Surgery, University Clinical Centre of Kosovo, Prishtina, Kosovo. [Seretis,Ch] 2nd Department of Surgery, General Army Hospital of Athens, Athens, Greece. [Mesina,C] Second Surgical Clinic, Emergency Hospital of Craiova, Craiova, Roumanie. [Rems,M] Surgical Department, General hospital Jesenice, Jesenice, Slovenia. [Campanile,FC] Department of surgery, Andosilla Hospital, Civita Castellana, Italy. [Coletta,P] Department of Surgery, Jesi Hospital, Jesi, Italy. [Uotila-Nieminen,M] Department of Gastrointestinal Surgery, North Carelian Central Hospital, Joensuu, Finland. [Dente,M] Oncologic, Digestive and Emergency Surgery, Bocage Hospital, Dijon, France. [Bouliaris,K] Surgical Department General Hospital of Larissa, Larissa, Greece. [Lasithiotakis,K] Department of General Surgery, University Hospital of Heraklion, Heraklion, Greece. [KhoKha,V] Surgical Department, Mozyr, Belarus. [Zivanovic,D] Department of Pediatric surgery, Paediatric surgery and orthopaedic Clinic, Nis, Serbia. [Smirnov,D] General Surgery, Clinical Hospital at Chelyabinsk Station OJSC 'Russian Railroads', Chelyabinsk City, Russian Federation. [Marinis,A] First Department of Surgery, Tzanion General Hospital, Piraeus, Greece. [Negoi,I] Department of General Surgery, Emergency Hospital of Bucharest, Bucharest, Romania. [Ney,L] Deparment of Surgery, Downtown Campus, University Hospital of Munich, Munich, Germany. [Bini,R] General and emergency surgery, SG Bosco Hospital, Torino, Italy. [León,M] Department of General Surgery, Hospital La Paz, Madrid, Spain. [Huchon,C] Department of Gynecology and Obstetrics, CHI Poissy-St-Germain-En-Laye, France and University Versailles Saint-Quentin, Versailles, France. [Moldovanu,R] Chirurgie Viscerale, Digestive et Oncologique Hospital Prive, Arras les Bonnettes, Arras, France. [de Melo,RB] Department of General Surgery, Hospital São João Porto, Porto, Portugal. [Giakoustidis,D] Division of Transplantation, Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece. [Ioannidis,O] 1st Surgical Department, General Regional Hospital 'George Papanikolaou', Thessaloniki, Greece. [Pintar,T] Department of Abdominal Surgery, umc Ljubljana, Ljubljana, Slovenia. [Krivokapic,Z, Petrovic,J] First Surgical clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade 8, Belgrade, Serbia., and II kirurgian klinikka

Subjects
Infecciones Intraabdominales, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Digestive System Surgical Procedures [Medical Subject Headings], Diseases::Bacterial Infections and Mycoses::Infection::Cross Infection [Medical Subject Headings], Phenomena and Processes::Microbiological Phenomena::Drug Resistance, Microbial [Medical Subject Headings], 030230 surgery, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Drainage [Medical Subject Headings], Abceso Abdominal, Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Reoperation [Medical Subject Headings], 0302 clinical medicine, Epidemiology, Farmacoresistencia Microbiana, Medicine, Diseases::Bacterial Infections and Mycoses::Infection::Sepsis [Medical Subject Headings], PRIMARY ANASTOMOSIS, Publication Characteristics::Study Characteristics::Multicenter Study [Medical Subject Headings], Adulto, Mortality rate, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Diverticulitis, 3. Good health, Humanos, Procedimientos Quirúrgicos del Sistema Digestivo, 030220 oncology & carcinogenesis, Emergency Medicine, Diseases::Digestive System Diseases::Peritoneal Diseases::Peritonitis [Medical Subject Headings], Reoperación, Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Disease Attributes::Critical Illness [Medical Subject Headings], Research Article, medicine.medical_specialty, Perforation (oil well), education, Infección Hospitalaria, lcsh:Surgery, APPENDECTOMY, Enfermedad Crítica, Diseases::Bacterial Infections and Mycoses::Infection::Suppuration::Abscess::Abdominal Abscess [Medical Subject Headings], Sepsis, 03 medical and health sciences, Internal medicine, HARTMANNS PROCEDURE, MANAGEMENT, Named Groups::Persons::Age Groups::Adult [Medical Subject Headings], Estudio Multicéntrico, Diseases::Bacterial Infections and Mycoses::Infection::Intraabdominal Infections [Medical Subject Headings], business.industry, Septic shock, Abdominal Infection, lcsh:RD1-811, lcsh:RC86-88.9, medicine.disease, 3126 Surgery, anesthesiology, intensive care, radiology, PRIMARY RESECTION, Emergency medicine, Observational study, Surgery, business, DIVERTICULITIS
Abstract

The CIAO Study (“Complicated Intra-Abdominal infection Observational” Study) is a multicenter investigation performed in 68 medical institutions throughout Europe over the course of a 6-month observational period (January-June 2012). Patients with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study. 2,152 patients with a mean age of 53.8 years (range: 4–98 years) were enrolled in the study. 46.3% of the patients were women and 53.7% were men. Intraperitoneal specimens were collected from 62.2% of the enrolled patients, and from these samples, a variety of microorganisms were collectively identified. The overall mortality rate was 7.5% (163/2.152). According to multivariate analysis of the compiled data, several criteria were found to be independent variables predictive of patient mortality, including patient age, the presence of an intestinal non-appendicular source of infection (colonic non-diverticular perforation, complicated diverticulitis, small bowel perforation), a delayed initial intervention (a delay exceeding 24 hours), sepsis and septic shock in the immediate post-operative period, and ICU admission. Given the sweeping geographical distribution of the participating medical centers, the CIAO Study gives an accurate description of the epidemiological, clinical, microbiological, and treatment profiles of complicated intra-abdominal infections (IAIs) throughout Europe.

Published
2012

21. WSES consensus conference: Guidelines for first-line management of intra-abdominal infections

Author

Fausto Catena, Renato Sérgio Poggetti, Luca Ansaloni, Ari Leppäniemi, Federico Pea, Cristian Tranà, Walter L. Biffl, Frederick A. Moore, Harry van Goor, Pierluigi Viale, Massimo Sartelli, Fabio Tumietto, Ernest E. Moore, Angelo Nespoli, Gianluca Guercioni, Kaoru Koike, Antonio Daniele Pinna, Sartelli, M, Viale, P, Koike, K, Pea, F, Tumietto, F, Van Goor, H, Guercioni, G, Nespoli, A, Tranà, C, Catena, F, Ansaloni, L, Leppaniemi, A, Biffl, W, Moore, F, Poggetti, R, Pinna, A, Moore, E, Sartelli M, Viale P, Koike K, Pea F, Tumietto F, Van Goor H, Guercioni G, Nespoli A, Trana C, Catena F, Ansaloni L, Leppaniemi A, Biffl W, Moore FA, Poggetti R, Pinna AD, and Moore EE.

Subjects
medicine.medical_specialty, ANTIMICROBIALS, First line, MEDLINE, lcsh:Surgery, Review, 030230 surgery, PERITONITIS, 03 medical and health sciences, 0302 clinical medicine, Multidisciplinary approach, medicine, surgery, infections, guidelines, High rate, Executive summary, SEPSIS, business.industry, Abdominal Infection, Consensus conference, lcsh:Medical emergencies. Critical care. Intensive care. First aid, lcsh:RD1-811, lcsh:RC86-88.9, medicine.disease, 3. Good health, Evaluation of complex medical interventions [NCEBP 2], Infectious disease (medical specialty), 030220 oncology & carcinogenesis, Family medicine, Surgery, Emergency Medicine, Medical emergency, business
Abstract

Contains fulltext : 96517.pdf (Publisher’s version ) (Open Access) Intra-abdominal infections are still associated with high rate of morbidity and mortality.A multidisciplinary approach to the management of patients with intra-abdominal infections may be an important factor in the quality of care. The presence of a team of health professionals from various disciplines, working in concert, may improve efficiency, outcome, and the cost of care.A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bologna on July 2010, during the 1st congress of the WSES, involving surgeons, infectious disease specialists, pharmacologists, radiologists and intensivists with the goal of defining recommendations for the early management of intra-abdominal infections.This document represents the executive summary of the final guidelines approved by the consensus conference.

Published
2011

22. A proposal for a comprehensive approach to infections across the surgical pathway.

Author

Sartelli M, Pagani L, Iannazzo S, Moro ML, Viale P, Pan A, Ansaloni L, Coccolini F, D'Errico MM, Agreiter I, Amadio Nespola G, Barchiesi F, Benigni V, Binazzi R, Cappanera S, Chiodera A, Cola V, Corsi D, Cortese F, Crapis M, Cristini F, D'Arpino A, De Simone B, Di Bella S, Di Marzo F, Donati A, Elisei D, Fantoni M, Ferrari A, Foghetti D, Francisci D, Gattuso G, Giacometti A, Gesuelli GC, Marmorale C, Martini E, Meledandri M, Murri R, Padrini D, Palmieri D, Pauri P, Rebagliati C, Ricchizzi E, Sambri V, Schimizzi AM, Siquini W, Scoccia L, Scoppettuolo G, Sganga G, Storti N, Tavio M, Toccafondi G, Tumietto F, Viaggi B, Vivarelli M, Tranà C, Raso M, Labricciosa FM, Dhingra S, and Catena F

Subjects
Humans, Anti-Bacterial Agents therapeutic use, Antimicrobial Stewardship, Infection Control standards, Surgical Wound Infection prevention & control
Abstract

Despite evidence supporting the effectiveness of best practices in infection prevention and management, many healthcare workers fail to implement them and evidence-based practices tend to be underused in routine practice. Prevention and management of infections across the surgical pathway should always focus on collaboration among all healthcare workers sharing knowledge of best practices. To clarify key issues in the prevention and management of infections across the surgical pathway, a multidisciplinary task force of experts convened in Ancona, Italy, on May 31, 2019, for a national meeting. This document represents the executive summary of the final statements approved by the expert panel.

Published
2020
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23. Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) Study: a WSES observational study.

Author

Sartelli M, Abu-Zidan FM, Labricciosa FM, Kluger Y, Coccolini F, Ansaloni L, Leppäniemi A, Kirkpatrick AW, Tolonen M, Tranà C, Regimbeau JM, Hardcastle T, Koshy RM, Abbas A, Aday U, Adesunkanmi ARK, Ajibade A, Akhmeteli L, Akın E, Akkapulu N, Alotaibi A, Altintoprak F, Anyfantakis D, Atanasov B, Augustin G, Azevedo C, Bala M, Balalis D, Baraket O, Baral S, Barkai O, Beltran M, Bini R, Bouliaris K, Caballero AB, Calu V, Catani M, Ceresoli M, Charalampakis V, Jusoh AC, Chiarugi M, Cillara N, Cuesta RC, Cobuccio L, Cocorullo G, Colak E, Conti L, Cui Y, De Simone B, Delibegovic S, Demetrashvili Z, Demetriades D, Dimova A, Dogjani A, Enani M, Farina F, Ferrara F, Foghetti D, Fontana T, Fraga GP, Gachabayov M, Gérard G, Ghnnam W, Maurel TG, Gkiokas G, Gomes CA, Guner A, Gupta S, Hecker A, Hirano ES, Hodonou A, Hutan M, Ilaschuk I, Ioannidis O, Isik A, Ivakhov G, Jain S, Jokubauskas M, Karamarkovic A, Kaushik R, Kenig J, Khokha V, Khokha D, Kim JI, Kong V, Korkolis D, Kruger VF, Kshirsagar A, Simões RL, Lanaia A, Lasithiotakis K, Leão P, Arellano ML, Listle H, Litvin A, Lizarazu Pérez A, Lopez-Tomassetti Fernandez E, Lostoridis E, Luppi D, Machain V GM, Major P, Manatakis D, Reitz MM, Marinis A, Marrelli D, Martínez-Pérez A, Marwah S, McFarlane M, Mesic M, Mesina C, Michalopoulos N, Misiakos E, Moreira FG, Mouaqit O, Muhtaroglu A, Naidoo N, Negoi I, Nikitina Z, Nikolopoulos I, Nita GE, Occhionorelli S, Olaoye I, Ordoñez CA, Ozkan Z, Pal A, Palini GM, Papageorgiou K, Papagoras D, Pata F, Pędziwiatr M, Pereira J, Pereira Junior GA, Perrone G, Pintar T, Pisarska M, Plehutsa O, Podda M, Poillucci G, Quiodettis M, Rahim T, Rios-Cruz D, Rodrigues G, Rozov D, Sakakushev B, Sall I, Sazhin A, Semião M, Sharda T, Shelat V, Sinibaldi G, Skicko D, Skrovina M, Stamatiou D, Stella M, Strzałka M, Sydorchuk R, Teixeira Gonsaga RA, Tochie JN, Tomadze G, Ugoletti L, Ulrych J, Ümarik T, Uzunoglu MY, Vasilescu A, Vaz O, Vereczkei A, Vlad N, Walędziak M, Yahya AI, Yalkin O, Yilmaz TU, Ünal AE, Yuan KC, Zachariah SK, Žilinskas J, Zizzo M, Pattonieri V, Baiocchi GL, and Catena F

Subjects
Abdomen abnormalities, Adult, Aged, Chi-Square Distribution, Female, Hospital Mortality, Humans, Injury Severity Score, Logistic Models, Male, Middle Aged, Risk Factors, Sepsis physiopathology, Abdomen physiopathology, Prognosis, Sepsis diagnosis
Abstract

Background: Timing and adequacy of peritoneal source control are the most important pillars in the management of patients with acute peritonitis. Therefore, early prognostic evaluation of acute peritonitis is paramount to assess the severity and establish a prompt and appropriate treatment. The objectives of this study were to identify clinical and laboratory predictors for in-hospital mortality in patients with acute peritonitis and to develop a warning score system, based on easily recognizable and assessable variables, globally accepted., Methods: This worldwide multicentre observational study included 153 surgical departments across 56 countries over a 4-month study period between February 1, 2018, and May 31, 2018., Results: A total of 3137 patients were included, with 1815 (57.9%) men and 1322 (42.1%) women, with a median age of 47 years (interquartile range [IQR] 28-66). The overall in-hospital mortality rate was 8.9%, with a median length of stay of 6 days (IQR 4-10). Using multivariable logistic regression, independent variables associated with in-hospital mortality were identified: age > 80 years, malignancy, severe cardiovascular disease, severe chronic kidney disease, respiratory rate ≥ 22 breaths/min, systolic blood pressure < 100 mmHg, AVPU responsiveness scale (voice and unresponsive), blood oxygen saturation level (SpO 2 ) < 90% in air, platelet count < 50,000 cells/mm3, and lactate > 4 mmol/l. These variables were used to create the PIPAS Severity Score, a bedside early warning score for patients with acute peritonitis. The overall mortality was 2.9% for patients who had scores of 0-1, 22.7% for those who had scores of 2-3, 46.8% for those who had scores of 4-5, and 86.7% for those who have scores of 7-8., Conclusions: The simple PIPAS Severity Score can be used on a global level and can help clinicians to identify patients at high risk for treatment failure and mortality., Competing Interests: Competing interestsThe authors declare that they have no competing interests.

Published
2019
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24. 2019 update of the WSES guidelines for management of Clostridioides ( Clostridium ) difficile infection in surgical patients.

Author

Sartelli M, Di Bella S, McFarland LV, Khanna S, Furuya-Kanamori L, Abuzeid N, Abu-Zidan FM, Ansaloni L, Augustin G, Bala M, Ben-Ishay O, Biffl WL, Brecher SM, Camacho-Ortiz A, Caínzos MA, Chan S, Cherry-Bukowiec JR, Clanton J, Coccolini F, Cocuz ME, Coimbra R, Cortese F, Cui Y, Czepiel J, Demetrashvili Z, Di Carlo I, Di Saverio S, Dumitru IM, Eckmann C, Eiland EH, Forrester JD, Fraga GP, Frossard JL, Fry DE, Galeiras R, Ghnnam W, Gomes CA, Griffiths EA, Guirao X, Ahmed MH, Herzog T, Kim JI, Iqbal T, Isik A, Itani KMF, Labricciosa FM, Lee YY, Juang P, Karamarkovic A, Kim PK, Kluger Y, Leppaniemi A, Lohsiriwat V, Machain GM, Marwah S, Mazuski JE, Metan G, Moore EE, Moore FA, Ordoñez CA, Pagani L, Petrosillo N, Portela F, Rasa K, Rems M, Sakakushev BE, Segovia-Lohse H, Sganga G, Shelat VG, Spigaglia P, Tattevin P, Tranà C, Urbánek L, Ulrych J, Viale P, Baiocchi GL, and Catena F

Subjects
Anti-Bacterial Agents therapeutic use, Antimicrobial Stewardship, Clostridium Infections diagnosis, Enterocolitis, Pseudomembranous etiology, Enterocolitis, Pseudomembranous prevention & control, Fecal Microbiota Transplantation methods, Fecal Microbiota Transplantation trends, Guidelines as Topic, Humans, Incidence, Infection Control methods, Infection Control trends, Risk Factors, Clostridioides difficile pathogenicity, Clostridium Infections therapy, Postoperative Complications therapy
Abstract

In the last three decades, Clostridium difficile infection (CDI) has increased in incidence and severity in many countries worldwide. The increase in CDI incidence has been particularly apparent among surgical patients. Therefore, prevention of CDI and optimization of management in the surgical patient are paramount. An international multidisciplinary panel of experts from the World Society of Emergency Surgery (WSES) updated its guidelines for management of CDI in surgical patients according to the most recent available literature. The update includes recent changes introduced in the management of this infection., Competing Interests: Not applicable.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Published
2019
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25. 2018 WSES/SIS-E consensus conference: recommendations for the management of skin and soft-tissue infections.

Author

Sartelli M, Guirao X, Hardcastle TC, Kluger Y, Boermeester MA, Raşa K, Ansaloni L, Coccolini F, Montravers P, Abu-Zidan FM, Bartoletti M, Bassetti M, Ben-Ishay O, Biffl WL, Chiara O, Chiarugi M, Coimbra R, De Rosa FG, De Simone B, Di Saverio S, Giannella M, Gkiokas G, Khokha V, Labricciosa FM, Leppäniemi A, Litvin A, Moore EE, Negoi I, Pagani L, Peghin M, Picetti E, Pintar T, Pupelis G, Rubio-Perez I, Sakakushev B, Segovia-Lohse H, Sganga G, Shelat V, Sugrue M, Tarasconi A, Tranà C, Ulrych J, Viale P, and Catena F

Subjects
Guidelines as Topic, Humans, Italy, Congresses as Topic trends, Consensus, Soft Tissue Infections therapy
Abstract

Skin and soft-tissue infections (SSTIs) encompass a variety of pathological conditions that involve the skin and underlying subcutaneous tissue, fascia, or muscle, ranging from simple superficial infections to severe necrotizing infections. SSTIs are a frequent clinical problem in surgical departments. In order to clarify key issues in the management of SSTIs, a task force of experts met in Bertinoro, Italy, on June 28, 2018, for a specialist multidisciplinary consensus conference under the auspices of the World Society of Emergency Surgery (WSES) and the Surgical Infection Society Europe (SIS-E). The multifaceted nature of these infections has led to a collaboration among general and emergency surgeons, intensivists, and infectious disease specialists, who have shared these clinical practice recommendations., Competing Interests: Not applicable.Not applicable.In the past 5 years, MB has participated in advisory boards and/or received speaker honoraria from Achaogen, Angelini, Astellas, AstraZeneca, Bayer, Basilea, Cidara, Gilead, Melinta, Menarini, MSD, Nabriva, Paratek, Pfizer, Roche, The Medicine Company, Shionogi, Tetraphase, VenatoRX, and Vifor. All other authors declared no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Published
2018
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26. Prospective Observational Study on acute Appendicitis Worldwide (POSAW).

Author

Sartelli M, Baiocchi GL, Di Saverio S, Ferrara F, Labricciosa FM, Ansaloni L, Coccolini F, Vijayan D, Abbas A, Abongwa HK, Agboola J, Ahmed A, Akhmeteli L, Akkapulu N, Akkucuk S, Altintoprak F, Andreiev AL, Anyfantakis D, Atanasov B, Bala M, Balalis D, Baraket O, Bellanova G, Beltran M, Melo RB, Bini R, Bouliaris K, Brunelli D, Castillo A, Catani M, Che Jusoh A, Chichom-Mefire A, Cocorullo G, Coimbra R, Colak E, Costa S, Das K, Delibegovic S, Demetrashvili Z, Di Carlo I, Kiseleva N, El Zalabany T, Faro M, Ferreira M, Fraga GP, Gachabayov M, Ghnnam WM, Giménez Maurel T, Gkiokas G, Gomes CA, Griffiths E, Guner A, Gupta S, Hecker A, Hirano ES, Hodonou A, Hutan M, Ioannidis O, Isik A, Ivakhov G, Jain S, Jokubauskas M, Karamarkovic A, Kauhanen S, Kaushik R, Kavalakat A, Kenig J, Khokha V, Khor D, Kim D, Kim JI, Kong V, Lasithiotakis K, Leão P, Leon M, Litvin A, Lohsiriwat V, López-Tomassetti Fernandez E, Lostoridis E, Maciel J, Major P, Dimova A, Manatakis D, Marinis A, Martinez-Perez A, Marwah S, McFarlane M, Mesina C, Pędziwiatr M, Michalopoulos N, Misiakos E, Mohamedahmed A, Moldovanu R, Montori G, Mysore Narayana R, Negoi I, Nikolopoulos I, Novelli G, Novikovs V, Olaoye I, Omari A, Ordoñez CA, Ouadii M, Ozkan Z, Pal A, Palini GM, Partecke LI, Pata F, Pędziwiatr M, Pereira Júnior GA, Pintar T, Pisarska M, Ploneda-Valencia CF, Pouggouras K, Prabhu V, Ramakrishnapillai P, Regimbeau JM, Reitz M, Rios-Cruz D, Saar S, Sakakushev B, Seretis C, Sazhin A, Shelat V, Skrovina M, Smirnov D, Spyropoulos C, Strzałka M, Talving P, Teixeira Gonsaga RA, Theobald G, Tomadze G, Torba M, Tranà C, Ulrych J, Uzunoğlu MY, Vasilescu A, Occhionorelli S, Venara A, Vereczkei A, Vettoretto N, Vlad N, Walędziak M, Yilmaz TU, Yuan KC, Yunfeng C, Zilinskas J, Grelpois G, and Catena F

Subjects
Acute Disease therapy, Adult, Appendectomy adverse effects, Appendectomy methods, Chi-Square Distribution, Female, Hospitalization statistics & numerical data, Humans, Laparoscopy methods, Laparoscopy statistics & numerical data, Length of Stay statistics & numerical data, Logistic Models, Male, Prospective Studies, Tomography, X-Ray Computed methods, Treatment Outcome, Appendectomy standards, Appendicitis surgery
Abstract

Background: Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis. The aim of this study is to describe the worldwide clinical and diagnostic work-up and management of AA in surgical departments., Methods: This prospective multicenter observational study was performed in 116 worldwide surgical departments from 44 countries over a 6-month period (April 1, 2016-September 30, 2016). All consecutive patients admitted to surgical departments with a clinical diagnosis of AA were included in the study., Results: A total of 4282 patients were enrolled in the POSAW study, 1928 (45%) women and 2354 (55%) men, with a median age of 29 years. Nine hundred and seven (21.2%) patients underwent an abdominal CT scan, 1856 (43.3%) patients an US, and 285 (6.7%) patients both CT scan and US. A total of 4097 (95.7%) patients underwent surgery; 1809 (42.2%) underwent open appendectomy and 2215 (51.7%) had laparoscopic appendectomy. One hundred eighty-five (4.3%) patients were managed conservatively. Major complications occurred in 199 patients (4.6%). The overall mortality rate was 0.28%., Conclusions: The results of the present study confirm the clinical value of imaging techniques and prognostic scores. Appendectomy remains the most effective treatment of acute appendicitis. Mortality rate is low., Competing Interests: The data was completely anonymized, and no patient or hospital information was collected in the database. The study protocol was approved by the board of the WSES, and the study was conducted under its supervision. The board of the WSES grants the proper ethical conduct of the study.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Published
2018
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27. Raising concerns about the Sepsis-3 definitions.

Author

Sartelli M, Kluger Y, Ansaloni L, Hardcastle TC, Rello J, Watkins RR, Bassetti M, Giamarellou E, Coccolini F, Abu-Zidan FM, Adesunkanmi AK, Augustin G, Baiocchi GL, Bala M, Baraket O, Beltran MA, Jusoh AC, Demetrashvili Z, De Simone B, de Souza HP, Cui Y, Davies RJ, Dhingra S, Diaz JJ, Di Saverio S, Dogjani A, Elmangory MM, Enani MA, Ferrada P, Fraga GP, Frattima S, Ghnnam W, Gomes CA, Kanj SS, Karamarkovic A, Kenig J, Khamis F, Khokha V, Koike K, Kok KYY, Isik A, Labricciosa FM, Latifi R, Lee JG, Litvin A, Machain GM, Manzano-Nunez R, Major P, Marwah S, McFarlane M, Memish ZA, Mesina C, Moore EE, Moore FA, Naidoo N, Negoi I, Ofori-Asenso R, Olaoye I, Ordoñez CA, Ouadii M, Paolillo C, Picetti E, Pintar T, Ponce-de-Leon A, Pupelis G, Reis T, Sakakushev B, Kafil HS, Sato N, Shah JN, Siribumrungwong B, Talving P, Tranà C, Ulrych J, Yuan KC, and Catena F

Subjects
Arterial Pressure, Consensus, Glasgow Coma Scale, Humans, Organ Dysfunction Scores, Sensitivity and Specificity, Sepsis mortality, Data Accuracy, Sepsis classification, Severity of Illness Index
Abstract

The Global Alliance for Infections in Surgery appreciates the great effort of the task force who derived and validated the Sepsis-3 definitions and considers the new definitions an important step forward in the evolution of our understanding of sepsis. Nevertheless, more than a year after their publication, we have a few concerns regarding the use of the Sepsis-3 definitions., Competing Interests: Not applicable.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Published
2018
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28. 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias.

Author

Birindelli A, Sartelli M, Di Saverio S, Coccolini F, Ansaloni L, van Ramshorst GH, Campanelli G, Khokha V, Moore EE, Peitzman A, Velmahos G, Moore FA, Leppaniemi A, Burlew CC, Biffl WL, Koike K, Kluger Y, Fraga GP, Ordonez CA, Novello M, Agresta F, Sakakushev B, Gerych I, Wani I, Kelly MD, Gomes CA, Faro MP Jr, Tarasconi A, Demetrashvili Z, Lee JG, Vettoretto N, Guercioni G, Persiani R, Tranà C, Cui Y, Kok KYY, Ghnnam WM, Abbas AE, Sato N, Marwah S, Rangarajan M, Ben-Ishay O, Adesunkanmi ARK, Lohse HAS, Kenig J, Mandalà S, Coimbra R, Bhangu A, Suggett N, Biondi A, Portolani N, Baiocchi G, Kirkpatrick AW, Scibé R, Sugrue M, Chiara O, and Catena F

Subjects
Abdominal Wall surgery, Disease Management, Emergency Medical Services trends, Humans, Polypropylenes therapeutic use, Surgical Mesh trends, Treatment Outcome, Emergency Medical Services methods, Guidelines as Topic, Hernia, Abdominal surgery
Abstract

Emergency repair of complicated abdominal wall hernias may be associated with worsen outcome and a significant rate of postoperative complications. There is no consensus on management of complicated abdominal hernias. The main matter of debate is about the use of mesh in case of intestinal resection and the type of mesh to be used. Wound infection is the most common complication encountered and represents an immense burden especially in the presence of a mesh. The recurrence rate is an important topic that influences the final outcome. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013 with the aim to define recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel. In 2016, the guidelines have been revised and updated according to the most recent available literature.

Published
2017
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29. Laparoscopic management of intra-abdominal infections: Systematic review of the literature.

Author

Coccolini F, Tranà C, Sartelli M, Catena F, Di Saverio S, Manfredi R, Montori G, Ceresoli M, Falcone C, and Ansaloni L

Abstract

Aim: To investigate the role of laparoscopy in diagnosis and treatment of intra abdominal infections., Methods: A systematic review of the literature was performed including studies where intra abdominal infections were treated laparoscopically., Results: Early laparoscopic approaches have become the standard surgical technique for treating acute cholecystitis. The laparoscopic appendectomy has been demonstrated to be superior to open surgery in acute appendicitis. In the event of diverticulitis, laparoscopic resections have proven to be safe and effective procedures for experienced laparoscopic surgeons and may be performed without adversely affecting morbidity and mortality rates. However laparoscopic resection has not been accepted by the medical community as the primary treatment of choice. In high-risk patients, laparoscopic approach may be used for exploration or peritoneal lavage and drainage. The successful laparoscopic repair of perforated peptic ulcers for experienced surgeons, is demonstrated to be safe and effective. Regarding small bowel perforations, comparative studies contrasting open and laparoscopic surgeries have not yet been conducted. Successful laparoscopic resections addressing iatrogenic colonic perforation have been reported despite a lack of literature-based evidence supporting such procedures. In post-operative infections, laparoscopic approaches may be useful in preventing diagnostic delay and controlling the source., Conclusion: Laparoscopy has a good diagnostic accuracy and enables to better identify the causative pathology; laparoscopy may be recommended for the treatment of many intra-abdominal infections.

Published
2015
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30. WSES guidelines for management of Clostridium difficile infection in surgical patients.

Author

Sartelli M, Malangoni MA, Abu-Zidan FM, Griffiths EA, Di Bella S, McFarland LV, Eltringham I, Shelat VG, Velmahos GC, Kelly CP, Khanna S, Abdelsattar ZM, Alrahmani L, Ansaloni L, Augustin G, Bala M, Barbut F, Ben-Ishay O, Bhangu A, Biffl WL, Brecher SM, Camacho-Ortiz A, Caínzos MA, Canterbury LA, Catena F, Chan S, Cherry-Bukowiec JR, Clanton J, Coccolini F, Cocuz ME, Coimbra R, Cook CH, Cui Y, Czepiel J, Das K, Demetrashvili Z, Di Carlo I, Di Saverio S, Dumitru IM, Eckert C, Eckmann C, Eiland EH, Enani MA, Faro M, Ferrada P, Forrester JD, Fraga GP, Frossard JL, Galeiras R, Ghnnam W, Gomes CA, Gorrepati V, Ahmed MH, Herzog T, Humphrey F, Kim JI, Isik A, Ivatury R, Lee YY, Juang P, Furuya-Kanamori L, Karamarkovic A, Kim PK, Kluger Y, Ko WC, LaBarbera FD, Lee JG, Leppaniemi A, Lohsiriwat V, Marwah S, Mazuski JE, Metan G, Moore EE, Moore FA, Nord CE, Ordoñez CA, Júnior GA, Petrosillo N, Portela F, Puri BK, Ray A, Raza M, Rems M, Sakakushev BE, Sganga G, Spigaglia P, Stewart DB, Tattevin P, Timsit JF, To KB, Tranà C, Uhl W, Urbánek L, van Goor H, Vassallo A, Zahar JR, Caproli E, and Viale P

Abstract

In the last two decades there have been dramatic changes in the epidemiology of Clostridium difficile infection (CDI), with increases in incidence and severity of disease in many countries worldwide. The incidence of CDI has also increased in surgical patients. Optimization of management of C difficile, has therefore become increasingly urgent. An international multidisciplinary panel of experts prepared evidenced-based World Society of Emergency Surgery (WSES) guidelines for management of CDI in surgical patients.

Published
2015
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31. The Challenge of Antimicrobial Resistance in Managing Intra-Abdominal Infections.

Author

Sartelli M, Catena F, di Saverio S, Ansaloni L, Coccolini F, Tranà C, and Kirkby-Bott J

Subjects
Bacterial Infections microbiology, Bacterial Infections mortality, Candidiasis microbiology, Candidiasis mortality, Drug Resistance, Multiple, Intraabdominal Infections microbiology, Intraabdominal Infections mortality, Prevalence, Bacterial Infections drug therapy, Bacterial Infections epidemiology, Candidiasis drug therapy, Candidiasis epidemiology, Drug Resistance, Microbial, Intraabdominal Infections drug therapy, Intraabdominal Infections epidemiology
Abstract

Background: In recent years, there has been a worldwide increase in infections caused by microorganisms resistant to multiple antimicrobial agents., Methods: In the past few decades, an increased prevalence of infections caused by antibiotic-resistant pathogens, including Enterococcus spp., carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter baumannii, extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella spp., carbapenemase-producing Klebsiella pneumoniae, and resistant Candida spp., also has been observed among intra-abdominal infections (IAIs)., Results: The increasing prevalence of multi-drug resistance is responsible for a substantial increase in morbidity and mortality rates associated with IAIs., Conclusions: It is necessary for every surgeon treating IAIs to understand the underlying epidemiology and clinical consequences of antimicrobial resistance. Emergence of drug resistance, combined with the lack of new agents in the drug development pipeline, indicates that judicious antimicrobial management will be necessary to preserve the utility of the drugs available currently.

Published
2015
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32. Risk stratification systems for surgically treated localized primary Gastrointestinal Stromal Tumors (GIST). Review of literature and comparison of the three prognostic criteria: MSKCC Nomogramm, NIH-Fletcher and AFIP-Miettinen.

Author

Belfiori G, Sartelli M, Cardinali L, Tranà C, Bracci R, Gesuita R, and Marmorale C

Subjects
Humans, Neoplasm Recurrence, Local, Prognosis, Retrospective Studies, Risk Assessment, Gastrointestinal Stromal Tumors diagnosis, Gastrointestinal Stromal Tumors surgery, Nomograms
Abstract

Purpose: The discovery of Imatinib mesylate (Gleevec®) has revolutionized the treatment of GIST, increasing diseasefree survival (DFS) after complete surgical resection of a primary localized GIST and extending overall survival in metastatic disease. The definition of an accurate prognostic system is critical for the therapeutic decision making process. In literature, there are three main prognostic criteria F/NIH consensus, AFIP standards and modified NIH standards. In recent years were added various risk identification methods applying mathematical calculation model, including MSKCC risk nomogram, Rossi nomogram and Joensuu high Hotline Dengjun. Despite all these attempts, it seems that the recurrence risk probability still cannot be predicted accurately. The aim of our study was to assess and compare the real ability of these prognostic instruments in our single-centre clinical experience, and to define if the use of the MSKCC nomogram can bring benefits in the therapeutic decision., Methods: All data regarding 37 GIST, who underwent surgical resection from 1996 to 2011 in our institution were retrospectively reviewed. We selected only primary GIST without metastatic disease who underwent a radical resection (R0) but no other therapy. The literature data concerning GISTs prognostication criteria were reviewed. All patients were classified according to the three prognostic criteria (NIH, AFIP and Nomogram MSKCC) and the three instruments were compared with the Kaplan-Meier method. Then we compared the three criteria for their c-index value and we assessed the performance of the nomogram with the calibration test., Results: We observed 9 recurrences (24%) with an average time to relapse of 43 months; the median follow-up was 65 months. In the study selected sample occurred 5 relapses. The probability of relapsing after radical surgery was 7.9% (95% CI 0 - 17.3) at 2 years and 13.3% at 5 years (95% CI 0 - 26.4). The C-Index of the three risk assessment tools was 0.93 (95% CI 0.83-1) for the Nomogram at 5 years, 0.86 (95% CI 0.76-0.95) for the NIH risk criteria and 0.88 (95% CI 0.74-1) for the AFIP risk criteria. The calibration analysis of the nomogram showed an overestimating trend both at 2 and 5 years., Conclusion: MSKCC nomogram seems to perform better than NIH, NIH modified and AFIP in our sample and can be used in clinical practice to predict the risk of recurrence, being especially helpful for the therapeutic decision making since it is at the same time simple to use and accurate. As showed from calibration, MSKCC doesn't seem to neglect relapses, even though it is not impeccable in predicting the RFS. Among the 2 older criteria AFIP was more precise than NIH, but considering size in not linear way represented a limit in comparison with the MSKCC Nomogram. All the three risk assessement tools criteria con sidered are capable to predict recurrence in high-risk GISTs while they performed worse in those with lower risk. MSKCC nomogram main limit remains the not linear consideration of mitotic count.

Published
2015

33. A proposal for a CT driven classification of left colon acute diverticulitis.

Author

Sartelli M, Moore FA, Ansaloni L, Di Saverio S, Coccolini F, Griffiths EA, Coimbra R, Agresta F, Sakakushev B, Ordoñez CA, Abu-Zidan FM, Karamarkovic A, Augustin G, Costa Navarro D, Ulrych J, Demetrashvili Z, Melo RB, Marwah S, Zachariah SK, Wani I, Shelat VG, Kim JI, McFarlane M, Pintar T, Rems M, Bala M, Ben-Ishay O, Gomes CA, Faro MP, Pereira GA Jr, Catani M, Baiocchi G, Bini R, Anania G, Negoi I, Kecbaja Z, Omari AH, Cui Y, Kenig J, Sato N, Vereczkei A, Skrovina M, Das K, Bellanova G, Di Carlo I, Segovia Lohse HA, Kong V, Kok KY, Massalou D, Smirnov D, Gachabayov M, Gkiokas G, Marinis A, Spyropoulos C, Nikolopoulos I, Bouliaris K, Tepp J, Lohsiriwat V, Çolak E, Isik A, Rios-Cruz D, Soto R, Abbas A, Tranà C, Caproli E, Soldatenkova D, Corcione F, Piazza D, and Catena F

Abstract

Computed tomography (CT) imaging is the most appropriate diagnostic tool to confirm suspected left colonic diverticulitis. However, the utility of CT imaging goes beyond accurate diagnosis of diverticulitis; the grade of severity on CT imaging may drive treatment planning of patients presenting with acute diverticulitis. The appropriate management of left colon acute diverticulitis remains still debated because of the vast spectrum of clinical presentations and different approaches to treatment proposed. The authors present a new simple classification system based on both CT scan results driving decisions making management of acute diverticulitis that may be universally accepted for day to day practice.

Published
2015
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34. Use of floseal hemostatic matrix for control of hemostasis during laparoscopic cholecystectomy for acute cholecystitis: a multicenter historical control group comparison (the GLA study gelatin matrix for acute cholecystitis).

Author

Sartelli M, Catena F, Biancafarina A, Tranà C, Piccardo A, Ceccarelli G, Tirone G, Agresta F, Di Giorgio A, Catani M, Tricarico F, Buonanno M, and Piazza L

Subjects
Adult, Aged, Cholecystectomy, Laparoscopic methods, Cohort Studies, Female, Hemostatics pharmacology, Humans, Male, Middle Aged, Prospective Studies, Young Adult, Blood Loss, Surgical prevention & control, Cholecystitis, Acute surgery, Gelatin Sponge, Absorbable pharmacology, Hemostatic Techniques, Postoperative Hemorrhage prevention & control
Abstract

Background: In patients with acute cholecystitis undergoing laparoscopic cholecystectomy, bleeding is a common complication that can reduce procedural visibility and worsen outcome. Insufficient hemostasis can also lead to postoperative bleeding that can, in rare cases, be fatal. Topical hemostatic agents are used to ensure adequate hemostasis during laparoscopic cholecystectomy., Subjects and Methods: This prospective, open-label, nonrandomized, historical control group study investigated the use of Floseal(®) (Baxter International, Inc., Deerfield, IL) hemostatic matrix as an adjunct to surgical techniques to achieve hemostasis of the resected areas in patients undergoing laparoscopic cholecystectomy for acute cholecystitis. The primary end point was the rate of complete hemostasis 10 minutes after laparoscopic application of Floseal to the gallbladder bed. Secondary end points included complete hemostasis rates at 2, 4, and 6 minutes, surgery time, laparoscopic procedure to open laparotomy conversion rate, postoperative bleeding rate, and mortality and safety outcomes over the entire follow-up period., Results: From April to November 2011, 101 consecutive patients were enrolled (51 men; mean age, 61.5±6.2 years). The historical control group of 100 age- and gender-matched patients with acute cholecystitis had undergone laparoscopic cholecystectomy without hemostatic agent. In the Floseal group, bleeding ceased within 10 minutes after laparoscopic application of the hemostatic agent to the gallbladder bed in all patients. The conversion rate was significantly lower in the Floseal group than in the control group (4 versus 12 patients, P<.05)., Conclusions: Floseal in acute cholecystitis is safe, is effective in controlling bleeding, and results in a lower conversion rate compared with cholecystectomy without hemostatic agents.

Published
2014
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35. World Society of Emergency Surgery (WSES) guidelines for management of skin and soft tissue infections.

Author

Sartelli M, Malangoni MA, May AK, Viale P, Kao LS, Catena F, Ansaloni L, Moore EE, Moore FA, Peitzman AB, Coimbra R, Leppaniemi A, Kluger Y, Biffl W, Koike K, Girardis M, Ordonez CA, Tavola M, Cainzos M, Di Saverio S, Fraga GP, Gerych I, Kelly MD, Taviloglu K, Wani I, Marwah S, Bala M, Ghnnam W, Shaikh N, Chiara O, Faro MP Jr, Pereira GA Jr, Gomes CA, Coccolini F, Tranà C, Corbella D, Brambillasca P, Cui Y, Segovia Lohse HA, Khokha V, Kok KY, Hong SK, and Yuan KC

Abstract

Skin and soft tissue infections (SSTIs) encompass a variety of pathological conditions ranging from simple superficial infections to severe necrotizing soft tissue infections. Necrotizing soft tissue infections (NSTIs) are potentially life-threatening infections of any layer of the soft tissue compartment associated with widespread necrosis and systemic toxicity. Successful management of NSTIs involves prompt recognition, timely surgical debridement or drainage, resuscitation and appropriate antibiotic therapy. A worldwide international panel of experts developed evidence-based guidelines for management of soft tissue infections. The multifaceted nature of these infections has led to a collaboration among surgeons, intensive care and infectious diseases specialists, who have shared these guidelines, implementing clinical practice recommendations.

Published
2014
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36. The pedagogic evolution in Surgery: the University at the centre of a training which becomes territorialized The model of the region Marche.

Author

Patrizi A, Tranà C, Baldoni A, Coletta P, and Marmorale C

Subjects
Humans, Italy, General Surgery education, General Surgery standards, Internship and Residency standards, Universities organization & administration
Abstract

Aim: We want to show a new organisational model of General Surgery training, in act in Università Politecnica delle Marche, which sees its strength in the territorial formative network., Material of Study: In our Athenaeum, this organization is not a recent realization, but the firsts to have benefited completely of this system are the four residents who have completed the General Surgery formation in March 2014, for this reason we report their experience., Results: The four residents benefited of the two years in the peripheral structures, two also performed a period in a foreign country, two chose to spend other 6 months in the peripheral structure to prepare the thesis of specialization; surgical activity has been, for each resident, of 400 interventions on average as first operator (237-476) distributed in great surgery 44 (13-80), middle 172 (129-268) and small 209 (70-378)., Discussion: The Formative NETWORK becomes an essential strength at the service of the academic world, the network foresees a continuous update, it can be easily standardized for every resident and it doesn't raise barriers to the foreign countries experiences., Conclusions: With the purpose to conform the model of specialistic formation in General Surgery, we propose a new tailored italian organizational model, tested the lasts 6 years, which seems to give good results and conform to the european standard of surgical training., Key Words: Formative network, General Surgery, Resident, Training.

Published
2014

37. Complicated intra-abdominal infections worldwide: the definitive data of the CIAOW Study.

Author

Sartelli M, Catena F, Ansaloni L, Coccolini F, Corbella D, Moore EE, Malangoni M, Velmahos G, Coimbra R, Koike K, Leppaniemi A, Biffl W, Balogh Z, Bendinelli C, Gupta S, Kluger Y, Agresta F, Di Saverio S, Tugnoli G, Jovine E, Ordonez CA, Whelan JF, Fraga GP, Gomes CA, Pereira GA, Yuan KC, Bala M, Peev MP, Ben-Ishay O, Cui Y, Marwah S, Zachariah S, Wani I, Rangarajan M, Sakakushev B, Kong V, Ahmed A, Abbas A, Gonsaga RA, Guercioni G, Vettoretto N, Poiasina E, Díaz-Nieto R, Massalou D, Skrovina M, Gerych I, Augustin G, Kenig J, Khokha V, Tranà C, Kok KY, Mefire AC, Lee JG, Hong SK, Lohse HA, Ghnnam W, Verni A, Lohsiriwat V, Siribumrungwong B, El Zalabany T, Tavares A, Baiocchi G, Das K, Jarry J, Zida M, Sato N, Murata K, Shoko T, Irahara T, Hamedelneel AO, Naidoo N, Adesunkanmi AR, Kobe Y, Ishii W, Oka K, Izawa Y, Hamid H, Khan I, Attri A, Sharma R, Sanjuan J, Badiel M, and Barnabé R

Abstract

The CIAOW study (Complicated intra-abdominal infections worldwide observational study) is a multicenter observational study underwent in 68 medical institutions worldwide during a six-month study period (October 2012-March 2013). The study included patients older than 18 years undergoing surgery or interventional drainage to address complicated intra-abdominal infections (IAIs). 1898 patients with a mean age of 51.6 years (range 18-99) were enrolled in the study. 777 patients (41%) were women and 1,121 (59%) were men. Among these patients, 1,645 (86.7%) were affected by community-acquired IAIs while the remaining 253 (13.3%) suffered from healthcare-associated infections. Intraperitoneal specimens were collected from 1,190 (62.7%) of the enrolled patients. 827 patients (43.6%) were affected by generalized peritonitis while 1071 (56.4%) suffered from localized peritonitis or abscesses. The overall mortality rate was 10.5% (199/1898). According to stepwise multivariate analysis (PR = 0.005 and PE = 0.001), several criteria were found to be independent variables predictive of mortality, including patient age (OR = 1.1; 95%CI = 1.0-1.1; p < 0.0001), the presence of small bowel perforation (OR = 2.8; 95%CI = 1.5-5.3; p < 0.0001), a delayed initial intervention (a delay exceeding 24 hours) (OR = 1.8; 95%CI = 1.5-3.7; p < 0.0001), ICU admission (OR = 5.9; 95%CI = 3.6-9.5; p < 0.0001) and patient immunosuppression (OR = 3.8; 95%CI = 2.1-6.7; p < 0.0001).

Published
2014
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38. Current concept of abdominal sepsis: WSES position paper.

Author

Sartelli M, Catena F, Di Saverio S, Ansaloni L, Malangoni M, Moore EE, Moore FA, Ivatury R, Coimbra R, Leppaniemi A, Biffl W, Kluger Y, Fraga GP, Ordonez CA, Marwah S, Gerych I, Lee JG, Tranà C, Coccolini F, Corradetti F, and Kirkby-Bott J

Abstract

Although sepsis is a systemic process, the pathophysiological cascade of events may vary from region to region.Abdominal sepsis represents the host's systemic inflammatory response to bacterial peritonitis.It is associated with significant morbidity and mortality rates, and is the second most common cause of sepsis-related mortality in the intensive care unit.The review focuses on sepsis in the specific setting of severe peritonitis.

Published
2014
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39. WSES guidelines for emergency repair of complicated abdominal wall hernias.

Author

Sartelli M, Coccolini F, van Ramshorst GH, Campanelli G, Mandalà V, Ansaloni L, Moore EE, Peitzman A, Velmahos G, Moore FA, Leppaniemi A, Burlew CC, Biffl W, Koike K, Kluger Y, Fraga GP, Ordonez CA, Di Saverio S, Agresta F, Sakakushev B, Gerych I, Wani I, Kelly MD, Gomes CA, Faro MP Jr, Taviloglu K, Demetrashvili Z, Lee JG, Vettoretto N, Guercioni G, Tranà C, Cui Y, Kok KY, Ghnnam WM, Abbas Ael-S, Sato N, Marwah S, Rangarajan M, Ben-Ishay O, Adesunkanmi AR, Segovia Lohse HA, Kenig J, Mandalà S, Patrizi A, Scibé R, and Catena F

Abstract

Emergency repair of complicated abdominal hernias is associated with poor prognosis and a high rate of post-operative complications.A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013, during the 2nd Congress of the World Society of Emergency Surgery with the goal of defining recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel.

Published
2013
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40. World society of emergency surgery study group initiative on Timing of Acute Care Surgery classification (TACS).

Author

Kluger Y, Ben-Ishay O, Sartelli M, Ansaloni L, Abbas AE, Agresta F, Biffl WL, Baiocchi L, Bala M, Catena F, Coimbra R, Cui Y, Di Saverio S, Das K, El Zalabany T, Fraga GP, Gomes CA, Gonsaga RA, Kenig J, Leppäniemi A, Marwah S, Junior GA, Sakakushev B, Siribumrungwong B, Sato N, Tranà C, Vettoretto N, and Moore EE

Abstract

Timing of surgical intervention is critical for outcomes of patients diagnosed with surgical emergencies. Facing the challenge of multiple patients requiring emergency surgery, or of limited resource availability, the acute care surgeon must triage patients according to their disease process and physiological state. Emergency operations from all surgical disciplines should be scheduled by an agreed time frame that is based on accumulated data of outcomes related to time elapsed from diagnosis to surgery. Although literature exists regarding the optimal timing of various surgical interventions, implementation of protocols for triage of surgical emergencies is lacking. For institutions of a repetitive triage mechanism, further discussion on optimal timing of surgery in diverse surgical emergencies should be encouraged. Standardizing timing of interventions in surgical emergencies will promote clinical investigation as well as a commitment by administrative authorities to proper operating theater provision for acute care surgery.

Published
2013
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41. 2013 WSES guidelines for management of intra-abdominal infections.

Author

Sartelli M, Viale P, Catena F, Ansaloni L, Moore E, Malangoni M, Moore FA, Velmahos G, Coimbra R, Ivatury R, Peitzman A, Koike K, Leppaniemi A, Biffl W, Burlew CC, Balogh ZJ, Boffard K, Bendinelli C, Gupta S, Kluger Y, Agresta F, Di Saverio S, Wani I, Escalona A, Ordonez C, Fraga GP, Junior GA, Bala M, Cui Y, Marwah S, Sakakushev B, Kong V, Naidoo N, Ahmed A, Abbas A, Guercioni G, Vettoretto N, Díaz-Nieto R, Gerych I, Tranà C, Faro MP, Yuan KC, Kok KY, Mefire AC, Lee JG, Hong SK, Ghnnam W, Siribumrungwong B, Sato N, Murata K, Irahara T, Coccolini F, Segovia Lohse HA, Verni A, and Shoko T

Abstract

Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high.The 2013 update of the World Society of Emergency Surgery (WSES) guidelines for the management of intra-abdominal infections contains evidence-based recommendations for management of patients with intra-abdominal infections.

Published
2013
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42. Complicated intra-abdominal infections in a worldwide context: an observational prospective study (CIAOW Study).

Author

Sartelli M, Catena F, Ansaloni L, Moore E, Malangoni M, Velmahos G, Coimbra R, Koike K, Leppaniemi A, Biffl W, Balogh Z, Bendinelli C, Gupta S, Kluger Y, Agresta F, Di Saverio S, Tugnoli G, Jovine E, Ordonez C, Gomes CA, Junior GA, Yuan KC, Bala M, Peev MP, Cui Y, Marwah S, Zachariah S, Sakakushev B, Kong V, Ahmed A, Abbas A, Gonsaga RA, Guercioni G, Vettoretto N, Poiasina E, Ben-Ishay O, Díaz-Nieto R, Massalou D, Skrovina M, Gerych I, Augustin G, Kenig J, Khokha V, Tranà C, Kok KY, Mefire AC, Lee JG, Hong SK, Segovia Lohse HA, Ghnnam W, Verni A, Lohsiriwat V, Siribumrungwong B, Tavares A, Baiocchi G, Das K, Jarry J, Zida M, Sato N, Murata K, Shoko T, Irahara T, Hamedelneel AO, Naidoo N, Adesunkanmi AR, Kobe Y, Attri A, Sharma R, Coccolini F, El Zalabany T, Khalifa KA, Sanjuan J, Barnabé R, and Ishii W

Abstract

Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high. The World Society of Emergency Surgery (WSES) has designed the CIAOW study in order to describe the clinical, microbiological, and management-related profiles of both community- and healthcare-acquired complicated intra-abdominal infections in a worldwide context. The CIAOW study (Complicated Intra-Abdominal infection Observational Worldwide Study) is a multicenter observational study currently underway in 57 medical institutions worldwide. The study includes patients undergoing surgery or interventional drainage to address complicated intra-abdominal infections. This preliminary report includes all data from almost the first two months of the six-month study period. Patients who met inclusion criteria with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study. 702 patients with a mean age of 49.2 years (range 18-98) were enrolled in the study. 272 patients (38.7%) were women and 430 (62.3%) were men. Among these patients, 615 (87.6%) were affected by community-acquired IAIs while the remaining 87 (12.4%) suffered from healthcare-associated infections. Generalized peritonitis was observed in 304 patients (43.3%), whereas localized peritonitis or abscesses was registered in 398 (57.7%) patients.The overall mortality rate was 10.1% (71/702). The final results of the CIAOW Study will be published following the conclusion of the study period in March 2013.

Published
2013
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43. Complicated intra-abdominal infections in Europe: a comprehensive review of the CIAO study.

Author

Sartelli M, Catena F, Ansaloni L, Leppaniemi A, Taviloglu K, van Goor H, Viale P, Lazzareschi DV, Coccolini F, Corbella D, de Werra C, Marrelli D, Colizza S, Scibè R, Alis H, Torer N, Navarro S, Sakakushev B, Massalou D, Augustin G, Catani M, Kauhanen S, Pletinckx P, Kenig J, Di Saverio S, Jovine E, Guercioni G, Skrovina M, Diaz-Nieto R, Ferrero A, Rausei S, Laine S, Major P, Angst E, Pittet O, Herych I, Agresta F, Vettoretto N, Poiasina E, Tepp J, Weiss G, Vasquez G, Vladov N, Tranà C, Delibegovic S, Dziki A, Giraudo G, Pereira J, Tzerbinis H, van Dellen D, Hutan M, Vereczkei A, Krasniqi A, Seretis C, Mesina C, Rems M, Campanile FC, Coletta P, Uotila-Nieminen M, Dente M, Bouliaris K, Lasithiotakis K, Khokha V, Zivanovic D, Smirnov D, Marinis A, Negoi I, Ney L, Bini R, Leon M, Aloia S, Huchon C, Moldovanu R, de Melo RB, Giakoustidis D, Ioannidis O, Cucchi M, Pintar T, Krivokapic Z, and Petrovic J

Abstract

The CIAO Study ("Complicated Intra-Abdominal infection Observational" Study) is a multicenter investigation performed in 68 medical institutions throughout Europe over the course of a 6-month observational period (January-June 2012).Patients with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study.2,152 patients with a mean age of 53.8 years (range: 4-98 years) were enrolled in the study. 46.3% of the patients were women and 53.7% were men. Intraperitoneal specimens were collected from 62.2% of the enrolled patients, and from these samples, a variety of microorganisms were collectively identified.The overall mortality rate was 7.5% (163/2.152).According to multivariate analysis of the compiled data, several criteria were found to be independent variables predictive of patient mortality, including patient age, the presence of an intestinal non-appendicular source of infection (colonic non-diverticular perforation, complicated diverticulitis, small bowel perforation), a delayed initial intervention (a delay exceeding 24 hours), sepsis and septic shock in the immediate post-operative period, and ICU admission.Given the sweeping geographical distribution of the participating medical centers, the CIAO Study gives an accurate description of the epidemiological, clinical, microbiological, and treatment profiles of complicated intra-abdominal infections (IAIs) throughout Europe.

Published
2012
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44. Complicated intra-abdominal infections in Europe: preliminary data from the first three months of the CIAO Study.

Author

Sartelli M, Catena F, Ansaloni L, Leppaniemi A, Taviloglu K, van Goor H, Viale P, Lazzareschi DV, de Werra C, Marrelli D, Colizza S, Scibé R, Alis H, Torer N, Navarro S, Catani M, Kauhanen S, Augustin G, Sakakushev B, Massalou D, Pletinckx P, Kenig J, Di Saverio S, Guercioni G, Rausei S, Laine S, Major P, Skrovina M, Angst E, Pittet O, Gerych I, Tepp J, Weiss G, Vasquez G, Vladov N, Tranà C, Vettoretto N, Delibegovic S, Dziki A, Giraudo G, Pereira J, Poiasina E, Tzerbinis H, Hutan M, Vereczkei A, Krasniqi A, Seretis C, Diaz-Nieto R, Mesina C, Rems M, Campanile FC, Agresta F, Coletta P, Uotila-Nieminen M, Dente M, Bouliaris K, Lasithiotakis K, Khokha V, Zivanović D, Smirnov D, Marinis A, Negoi I, Ney L, Bini R, Leon M, Aloia S, Huchon C, Moldovanu R, de Melo RB, Giakoustidis D, Ioannidis O, Cucchi M, Pintar T, and Jovine E

Abstract

The CIAO Study is a multicenter observational study currently underway in 66 European medical institutions over the course of a six-month study period (January-June 2012).This preliminary report overviews the findings of the first half of the study, which includes all data from the first three months of the six-month study period.Patients with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study.912 patients with a mean age of 54.4 years (range 4-98) were enrolled in the study during the first three-month period. 47.7% of the patients were women and 52.3% were men. Among these patients, 83.3% were affected by community-acquired IAIs while the remaining 16.7% presented with healthcare-associated infections. Intraperitoneal specimens were collected from 64.2% of the enrolled patients, and from these samples, 825 microorganisms were collectively identified.The overall mortality rate was 6.4% (58/912). According to univariate statistical analysis of the data, critical clinical condition of the patient upon hospital admission (defined by severe sepsis and septic shock) as well as healthcare-associated infections, non-appendicular origin, generalized peritonitis, and serious comorbidities such as malignancy and severe cardiovascular disease were all significant risk factors for patient mortality.White Blood Cell counts (WBCs) greater than 12,000 or less than 4,000 and core body temperatures exceeding 38°C or less than 36°C by the third post-operative day were statistically significant indicators of patient mortality.

Published
2012
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45. WSES consensus conference: Guidelines for first-line management of intra-abdominal infections.

Author

Sartelli M, Viale P, Koike K, Pea F, Tumietto F, van Goor H, Guercioni G, Nespoli A, Tranà C, Catena F, Ansaloni L, Leppaniemi A, Biffl W, Moore FA, Poggetti R, Pinna AD, and Moore EE

Abstract

Intra-abdominal infections are still associated with high rate of morbidity and mortality.A multidisciplinary approach to the management of patients with intra-abdominal infections may be an important factor in the quality of care. The presence of a team of health professionals from various disciplines, working in concert, may improve efficiency, outcome, and the cost of care.A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bologna on July 2010, during the 1st congress of the WSES, involving surgeons, infectious disease specialists, pharmacologists, radiologists and intensivists with the goal of defining recommendations for the early management of intra-abdominal infections.This document represents the executive summary of the final guidelines approved by the consensus conference.

Published
2011
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