Emergency General Surgery Transfers to Definitive Care: An Assessment of Patient and Systemic Factors in Appendicitis Referrals.

Patients presenting to the emergency department (ED) with an Emergency General Surgery (EGS) problem often require transfer to a tertiary facility. Issues impacting EGS mirror the same issues trauma surgery faced prior to the implementation of current trauma guidelines. This study analyzed the cost, time, and transport resource utilization of EGS patients with acute appendicitis when transferred from network hospitals to a level II trauma center. This was a retrospective study. Patients were transferred by a critical or specialty care transport team 62% of the time, although no skills performed required a critical or specialty care provider. The median time from decision to transfer to incision was 254 minutes, with an average transport time of 27 minutes. This study suggests that there is an opportunity to improve access to the operating room and to decrease resource utilization of specialty care and critical care transport for patients.

Patient-Reported Outcomes of Achilles Tendon Repair Using the Modified Gift-Box Technique With Nonabsorbable Suture Loop: A Consecutive Case Series.

We sought to determine the early range of motion, complication rates, and 1-year patient-reported outcomes following Achilles tendon repair, using a modified gift-box suture loop technique. Sixty consecutive patients (49 males, mean age 36.2 ± 9.9 years) who underwent Achilles tendon repair with a modified gift-box suture loop technique performed by a single surgeon were prospectively enrolled. The range of motion at the final follow-up visit (mean 6 months) and the Achilles tendon rupture score (ATRS) and the complication rates at 1 year were obtained with 83% follow-up. The predictors of complications and ATRS were assessed. The mean operative time was 63.1 ± 10.8 minutes, which decreased throughout the case series (r = 0.46, p < .001). The mean plantarflexion at the final office evaluation was 31.7° ± 6.2°, dorsiflexion was 11.7° ± 6.3°, and total ankle arc of motion was 43.6° ± 9.7°; longer length of follow-up was associated with greater dorsiflexion (p = .008) and the total arc of motion (p = .008) but not with plantarflexion (p = .16). The overall rerupture rate was 1.7% (1 patient), wound complication rate was 1.7% (1 patient), and the overall complication rate was 6.7% (4 patients). No predictors of complications were identified. Complication rates did not differ between the first 30 (6.7%) cases and second 30 (6.7%) cases. The mean ATRS at 1 year was 81.8 ± 16.8 points. The rerupture and overall complication rates by 1 year were low. The range of motion, particularly dorsiflexion, improved through at least 6 months. Diabetic patients had lower 1-year ATRS than nondiabetic patients using this technique.