Simplified risk-prediction for benchmarking and quality improvement in emergency general surgery. Prospective, multicenter, observational cohort study.

BACKGROUND AND AIMS: Emergency General Surgery (EGS) conditions account for millions of deaths worldwide, yet it is practiced without benchmarking-based quality improvement programs. The aim of this observational, prospective, multicenter, nationwide study was to determine the best benchmark cutoff points in EGS, as a reference to guide improvement measures. METHODS: Over a 6-month period, 38 centers (5% of all public hospitals) attending EGS patients on a 24-h, 7-days a week basis, enrolled consecutive patients requiring an emergent/urgent surgical procedure. Patients were stratified into cohorts of low (i.e., expected morbidity risk <33%), middle and high risk using the novel m-LUCENTUM calculator. RESULTS: A total of 7258 patients were included; age (mean ± SD) was 51.1 ± 21.5 years, 43.2% were female. Benchmark cutoffs in the low-risk cohort (5639 patients, 77.7% of total) were: use of laparoscopy ≥40.9%, length of hospital stays ≤3 days, any complication within 30 days ≤ 17.7%, and 30-day mortality ≤1.1%. The variables with the greatest impact were septicemia on length of hospital stay (21 days; adjusted beta coefficient 16.8; 95% CI: 15.3 to 18.3; P < .001), and respiratory failure on mortality (risk-adjusted population attributable fraction 44.6%, 95% CI 29.6 to 59.6, P < .001). Use of laparoscopy (odds ratio 0.764, 95% CI 0.678 to 0.861; P < .001), and intraoperative blood loss (101-500 mL: odds ratio 2.699, 95% CI 2.152 to 3.380; P < .001; and 500-1000 mL: odds ratio 2.875, 95% CI 1.403 to 5.858; P = .013) were associated with increased morbidity. CONCLUSIONS: This study offers, for the first time, clinically-based benchmark values in EGS and identifies measures for improvement.

Migración de fragmento de bezoar gástrico gigante como causa de obstrucción intestinal distal / Giant gastric bezoar fragment migration as a cause of distal intestinal obstruction

Introducción. Comunicar un caso clínico poco habitual y revisar el manejo. Material y Métodos. Presentación de un caso clínicoResultados. La obstrucción intestinal es una urgencia frecuente. La impactación de un bezoar es una etiología poco habitual.Cuando el bezoar intestinal asocia un bezoar gástrico se generan dudas sobre la etiología del bezoar intestinal, fragmentación y migración versus formación primaria en intestino delgado, y sobre la actitud a tomar con el bezoar gástrico, que generalmente es asintomático. Conclusiones. La enterotomía y extracción del bezoar intestinal es el tratamiento de elección. Debe asociar la extracción de los bezoares en otras localizaciones. (AU)

Introduction. Report an unusual clinical case and review the management. Material and methods. Presentation of a clinical caseResults. Bowel obstruction is a common emergency. Bezoar impaction is an unusual etiology. When the intestinal bezoar associates a gastric bezoar, doubts are raised about the etiology of the intestinal bezoar, fragmentation and migration versus primary formation in the small intestine, and about the attitude to take with the gastric bezoar, which is generally asymptomatic. Conclusions. Enterotomy and removal of the intestinal bezoar is the treatment of choice. It must associate the extraction of the bezoars in other locations. (AU)