Worldwide snapshot of trauma team structure and training: an international survey.

INTRODUCTION: Trauma teams (TTs) are a key tool in trauma care, as they bring a multidisciplinary approach to the trauma patient, improving outcomes. Excellent teamwork (TW) requires not only individual skills but also training at non-technical skills (NTS). Although there is evidence supporting TTs, there is little information regarding how they are organized and trained. With this study, we intend to assess the reality of TTs all over the world, focusing on how they are organized and trained. MATERIALS AND METHODS: We composed a 42-question sheet on Google Forms, in four different languages (English, Polish, Portuguese, and Spanish). The questions regarded the respondents' background, and their respective hospitals' trauma patient management, TT features and its training, NTS and TW. The survey was shared on social media, through the International Assessment Group of Online Surgical & Trauma Education community, and the European Society of Trauma and Emergency Surgery. Statistical analysis was performed on Statistical Package for the Social Sciences (SPSS®) version 27. RESULTS: We obtained 296 answers from 52 different countries, with 6 having at least 10 answers (Brazil, Portugal, Poland, Spain, Italy, and USA). While the majority of the respondents (97%) agreed that TTs can improve outcomes, only 61% have a TT in their hospital, with 69% of these being dedicated TTs. General surgery (76%), trauma surgery (68%), and anesthesia (66%) were the three most common specialties in the teams. Teams performed briefings and debriefings with a frequency of, at least, "often" in only 49% and 38%, respectively. Only 50% and 33% of the respondents stated that their hospital provided trauma management courses focusing on individual technical skills, and TT training courses, respectively. The Advanced Trauma Life Support (85%), the Definitive Surgical and Anesthetic Trauma Care (38%), and the European Trauma Course (31%) were the three trauma management courses of choice. Regarding TT training courses, the European Trauma Course (52%) and local/in-house (42%) courses were the most common ones. Most participants (93%) stated that NTS were highly important in trauma care. However, only 60% of the respondents had postgraduate training on NTS and TW, and only 24% had this type of training on an undergraduate level. CONCLUSION: The number of TTs worldwide does not match their relevance in trauma care. Institutions are not providing enough trauma courses, particularly TT training courses and NTS teaching. Implementing TT should include promotion of team courses, as well as team briefings and debriefings.

Type 2 Diabetes Mellitus and Preoperative HbA1c Level Have no Consequence on Outcomes after Laparoscopic Sleeve Gastrectomy-a Cohort Study.

INTRODUCTION: Available clinical data on the influence of baseline HbA1c postoperative morbidity and readmission after laparoscopic sleeve gastrectomy is scarce. This prompted us to conduct a multicenter retrospective study evaluating the influence of chronic hyperglycemia on postoperative course among patients undergoing laparoscopic sleeve gastrectomy (SG). We aimed to investigate the influence of baseline HbA1c levels on postoperative outcomes in patients after SG. MATERIAL AND METHODS: We conducted a multicenter retrospective cohort study of consecutive patients who underwent SG from March 2017 to March 2018 in seven referral centers for bariatric surgery. Exclusion criteria were revision surgeries, different bariatric interventions, SG combined with other procedures, and lack of necessary data. Patients were divided into three groups depending on their preoperative glycated hemoglobin level (HbA1c) < 5.7%, 5.7-6.4%, and ≥ 6.5%. Primary endpoints were influence of HbA1c on early and late postoperative morbidity, impact on prolonged length of hospital stay (LOS), and readmission rate. RESULTS: The HbA1c < 5.7% group comprised 842 (49%) patients, HbA1c 5.7-6.4% comprised 587 (34%), and HbA1c ≥ 6.5% comprised 289 (17%). Overall morbidity was 6.23%; this did not differ among groups (p = 0.571). Three patients died postoperatively. Late postoperative morbidity was comparable among groups (p = 0.312). The ratio of prolonged LOS and readmission did not differ among groups (p = 0.363 and 0.571). ROC analysis revealed that HbA1c > 7.3% increased OR for hospital readmission (p = 0.007). CONCLUSION: Preoperative HbA1c does not affect postoperative morbidity and prolonged LOS after SG. Patients with HbA1c > 7.3% have an increased chance of hospital readmission.

Emergency surgery in older patients.

INTRODUCTION: At present, emergency guidelines do not differentiate between younger adults and older persons. The changing socioeconomic situation associated with the aging population will be challenging for the healthcare system and requires new medical guidelines to best accommodate it. AIM: To analyze whether the age and comorbidities of a patient affect acute care surgical outcomes. MATERIAL AND METHODS: We performed a retrospective study of 161 patients who were admitted in emergency to the Department of General, Minimally Invasive and Elderly Surgery in Olsztyn between May and October 2017. Patients were divided into three age groups. Outcomes in patients older than 80 years were compared with corresponding statistical predictions of morbidity and mortality, as calculated using the Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM). RESULTS: Patients in the 80+ age group had a higher mortality rate in comparison with those in the other age groups, and a higher number of comorbidities (p = 0.002 and p = 0.001, respectively). The POSSUM morbidity and mortality rates were significantly higher for the older patients who died than for the older patients who were discharged (p = 0.013 and p = 0.003, respectively). CONCLUSIONS: Decisions about suitable therapy in the acute care setting should be made after consideration of the overall health of a patient. This study shows that age itself has a huge impact on postoperative results. The older the patient is, the higher the risk of perioperative death. We recommend patient evaluation using the POSSUM scale to better predict this risk.

Correction to: Type 2 Diabetes Mellitus and Preoperative HbA1c Level Have no Consequence on Outcomes after Laparoscopic Sleeve Gastrectomy-a Cohort Study.

Some of the author affiliations were incorrectly assigned in the original article. They are correct here.

Surgical treatment of acute appendicitis in older patients.

INTRODUCTION: Acute appendicitis (AA) is the most common indication for emergency surgery and it occurs more often in children and young adults than in patients of advanced age. AA in older patients is a challenging surgical problem because of its atypical presentation. This study was performed to determine whether the age of a patient impacts the outcomes and whether laparoscopic appendectomy (LA) is a feasible method for treatment of patients > 65 years. MATERIAL AND METHODS: We performed a retrospective study of 355 patients with AA who were admitted to the Department of General, Minimally Invasive and Elderly Surgery in Olsztyn from 2014 to 2017. The patients were divided into three age groups: 18 to 40, 41 to 65 and >65 years. The histopathological diagnoses were divided into three types: simple AA, phlegmonous AA, and gangrenous AA. RESULTS: LA was performed in 96% of young adults and in 67% of older patients. The patients older than 65 years had higher preoperative white blood cell counts, higher C-reactive protein (CRP) levels and had a longer length of stay (LOS) than younger patients (P=0.05, P=0.03, and P=0.03, respectively). We found a positive correlation among the CRP levels, open appendectomy (OA), and gangrenous appendicitis. CONCLUSIONS: Patients older than 65 years more frequently underwent OA than LA, had higher preoperative CRP levels and had a longer LOS than younger patients. Higher CRP levels were associated with a greater risk of gangrenous appendicitis. LA is a safe and feasible treatment method for patients older than 65 years.

Co-expression of caspase-3 or caspase-8 with galanin in the human stomach section affected by carcinoma.

Neoplastic process may cause distinct changes in the morphology, i.e. size and number of the neurons of the neuronal plexuses forming the enteric nervous system (ENS) of the human intestine. Moreover, it was also reported that these changes were not directly associated with apoptosis. Thus, the main aim of this study was to determine the atrophic changes of myenteric plexuses (MPs) in the vicinity of cancer invasion and the potential reason which may be responsible for these changes if they occur. Tissue samples from the stomach were collected from ten patients which undergo organ resection due to cancer diagnosis. Samples were taken from the margin of cancer invasion and from a macroscopically-unchanged part of the stomach wall. Triple-immunofluorescence staining of the 10-µm-thick cryostat sections was used to visualize the co-expression of caspase-3 (CASP3) or caspase-8 (CASP8) with galanin (GAL) in the MPs of ENS. Microscopic observations of MPs located closely to gastric cancer invasion showed that they were significantly smaller than plexuses located distally. The percentage of neurons containing CASP3 within MPs located close to cancer-affected regions of the stomach was higher, while containing CASP8 was lower compared to the unchanged regions. Additionally, elevated high expression of CASP3 or CASP8 in the neurons from MPs was accompanied by a decreased expression of GAL. To our knowledge, this is the first report describing the decomposition of MPs within cancer-affected human stomach wall and the possible role of apoptosis in this process.