Predicting mortality and morbidity in emergency general surgery patients in a Jordanian Tertiary Medical Center: a retrospective validation study of the Emergency Surgery Score (ESS).

OBJECTIVE: The Emergency Surgery Score (ESS) is a predictive tool used to assess morbidity and mortality rates in patients undergoing emergent surgery. This study explores the ESS's predictive ability and reliability in the Jordanian surgical population. DESIGN: A retrospective validation study. SETTING: A tertiary hospital in Jordan. PARTICIPANTS: A database was created including patients who underwent emergent surgery in King Abdullah University Hospital from January 2017 to June 2021. PRIMARY AND SECONDARY OUTCOME MEASURES: Relevant preoperative, intraoperative and postoperative variables were retrospectively and systematically gathered, and the ESS was calculated for each patient accordingly. In addition, a multivariable logistic regression analysis was performed to assess the correlations between the ESS and postoperative mortality and morbidity along with intensive care unit (ICU) admissions. RESULTS: Out of total of 1452 patients evaluated, 1322 patients were enrolled based on inclusion and exclusion criteria. The mean age of the population was 47.9 years old. 91.9% of the patients were admitted to the surgical ward through the emergency department, while the rest were referred from inpatient and outpatient facilities. The mortality and postoperative complication rates were 3.9% and 13.5%, respectively. Mortality rates increased as the ESS score gradually increased, and the ESS was evaluated as a strong predictor with a c-statistic value of 0.842 (95% CI 0.743 to 0.896). The postoperative complication and ICU admission rate also increased with reciprocal rises in the ESS. They were also evaluated as accurate predictors with a c-statistic value of 0.724 (95% CI 0.682 to 0.765) and a c-statistic value of 0.825 (95% CI 0.784 to 0.866), respectively. CONCLUSION: The ESS is a robust, accurate predictor of postoperative mortality and morbidity of emergency general surgery patients. Furthermore, it is an all-important tool to enhance emergency general surgery practices, in terms of mitigating risk, quality of care measures and patient counselling.

Comparison of 3 intranasal mists for anesthetizing maxillary teeth in adults: A randomized, double-masked, multicenter phase 3 clinical trial.

BACKGROUND: This double-masked, parallel-design, clinical trial assessed whether a combination nasal spray (K305; 3% tetracaine hydrochloride and 0.05% oxymetazoline hydrochloride) compared with a tetracaine-only spray and a placebo spray would be safer and superior in producing local anesthesia sufficient to complete a direct restorative procedure in maxillary nonmolar teeth. METHODS: The authors randomized eligible patients to receive K305 spray (n = 44), tetracaine hydrochloride spray (n = 44), or a placebo solution (n = 22). The authors compared the incidence of the primary efficacy end point-completion of the procedure without rescue local anesthetic-by means of a 1-tailed Fisher exact test. RESULTS: The end point incidence was 84.1% (95% confidence interval [CI], 69.9-93.4) with K305, 27.3% (95% CI, 15.0-42.8) with tetracaine only, and 27.3% (95% CI, 10.7-50.2) with placebo (P < .001 for K305 versus tetracaine only and versus placebo). Combination spray was associated with statistically significant but transient increases in blood pressure. The most frequent adverse events were rhinorrhea and nasal congestion, which resolved within 2 hours after treatment and occurred more often in the K305 group and tetracaine-only group. CONCLUSIONS: In this study population, the K305 combination nasal spray was safe and more effective in attaining pulpal anesthesia of maxillary teeth from premolar to premolar compared with tetracaine-only and placebo sprays. PRACTICAL IMPLICATIONS: The combination nasal spray might represent a valuable alternative to injected local anesthetic for patients undergoing invasive maxillary dental procedures. Clinicaltrials.gov: NCT01710787.