Analysis of pre-admission risk factors for unplanned reintubation in geriatric trauma patients.

INTRODUCTION: Reintubation in unplanned scenarios, carries inherent risks and potential complications particularly in vulnerable populations such as geriatric trauma patients. We sought to identify preadmission risk factors for unplanned re-intubation (URI) in geriatric trauma patients and its effects on outcomes. METHODS: Analysis of TQIP (2017-2019) of intubated geriatric trauma patients, classified into two groups, those who were successfully extubated and those who required URI. We used logistic regression to assess for preadmission risk factors of URI. RESULTS: Among 23,572 patients, 20.2 â€‹% underwent URI. URI had higher mortality (13.7%vs.8.1 â€‹%, p â€‹< â€‹0.001), in-hospital complications (p â€‹< â€‹0.05), longer hospital and ICU LOS (p â€‹< â€‹0.001 for both). Higher age (OR â€‹= â€‹1.017), smoking (OR â€‹= â€‹1.418), CRF(OR â€‹= â€‹1.414), COPD (OR â€‹= â€‹1.410), alcohol use (OR â€‹= â€‹1.365), functionally dependent health status (OR â€‹= â€‹1.339), and anticoagulant use (OR â€‹= â€‹1.148), increased the risks of URI (p â€‹< â€‹0.05 for all). CONCLUSION: Geriatric patients with comorbidities including age, smoking, CRF, COPD, alcohol use, dependent status, and anticoagulant use are at higher risks of URI that could in turn, be associated with increased rates of mortality, complications, and longer hospital and ICU length of stay. LEVEL OF EVIDENCE: Level III retrospective study.

Step-by-step roadmap to building a robotic acute care surgery program (RACSP) in a level I trauma center: outcomes and lessons learned after 1-year implementation.

Minimally invasive surgical techniques have demonstrated superior outcomes across various elective procedures. Laparoscopic surgery (LS) is established in general surgery with laparoscopic operations for acute appendicitis and cholecystitis being the standard of care. Robotic surgery (RS) has been associated with equivalent or improved postoperative outcomes compared with LS. This increasing uptake of RS in emergency general surgery has encouraged the adoption of robotic acute care programs across the world. The key elements required to build a sustainable RS program are an enthusiastic surgical team, intensive training, resources and marketing. This review is a comprehensive layout elaborating the step-by-step process that has helped our high-volume level I trauma center in establishing a successful robotic acute care surgery program.

Benign Mesenteric Lesion Presenting with Features of a Malignant Mass.

Encapsulated fat necrosis (EFN), most commonly, is an asymptomatic entity and is often found incidentally in images. However, in the abdomen, it may present as an acute abdomen. Mesenteric fat necrosis is part of a larger disease spectrum called collectively mesenteric sclerosis. It results in forming of a mass that can be confused with other pathologies such as liposarcoma, carcinoma of the cecum, and other more benign conditions such as appendagitis of the epiplon. We present the case of an 82-year-old male who presented with an asymptomatic right lower quadrant mass with concerning computed tomography findings with no previous abdominal surgery or trauma history. Diagnosing EFN is crucial as it can mimic bowel cancer and immune-related mesenteric pathology such as sclerosing mesenteritis, the management of which is far more extreme and aggressive than EFN.

A Rare Presentation of Duodenal Diverticulum Causing Obstructive Jaundice: Lemmel's Syndrome.

Lemmel syndrome is an uncommon pancreaticobiliary consequence of duodenal diverticula. We herein present a case of an 80-year-old male who presented with upper abdominal discomfort. Based on lab values and relevant clinical history, a diagnosis of obstructive jaundice was made. A contrast-enhanced CT scan of the abdomen revealed gross dilatation of intra-hepatic and extra-hepatic bile duct, cystic duct, common bile duct, major and minor pancreatic duct. A contrast-filled outpouching was seen from the medial wall of the second part of the duodenum with duodenal diverticulum and papilla within it. The abrupt termination of the common bile duct and main pancreatic duct adjacent to the thickened wall of the diverticulum was the cause of the patient's pancreaticobiliary obstruction. In the absence of cholelithiasis or tumor, the duodenal diverticulum that manifests as obstructive jaundice is known as Lemmel syndrome. Prompt identification of Lemmel syndrome can avoid dangerous complications and unnecessary investigations. Gallstones, cholangitis, and bile duct stones are more common in patients with duodenal diverticula. Treatment depends on patient presentation and may involve conservative management, surgical procedures in the form of excision of the diverticulum, or even endoscopic sphincterotomy or stenting.