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PURPOSE: Due to the mixed population enrolled in different studies i.e., medical and surgical cases, conflicting data exists about the accuracy of quick sequential organ failure assessment (qSOFA) and systemic inflammatory response syndrome (SIRS) scores in predicting adverse outcomes in patients with suspected sepsis presenting to the surgical emergency. METHOD: A prospective observational study was done in the department of surgery of a tertiary teaching hospital, India from June 2018 to July 2019. Consecutive patients who visited the surgical emergency department with suspected sepsis were included. Patients were followed up until hospital discharge or death. RESULTS: Of the 410 patients screened, 287 were included in the analysis. The median age was 52 years (interquartile range, 41 to 61years) and 208 (72.8%) were men. Around 56.8% of patients had intra-abdominal pathology, and 43.2% had skin and soft -tissue infection. Sixty-nine (24%) patients died during their hospitalization, 98 (34.1%) patients had organ dysfunction, and 168 (58.5%) patients needed admission to the intensive care unit (ICU). A higher qSOFA score (≥2) was associated with organ dysfunction, ICU admission, and in-hospital mortality. The specificity, positive predictive value and diagnostic accuracy of qSOFA for organ dysfunction (85.7%, 67.8%, 76.3%), ICU admission (92.4%, 89.3%, 64.5%), and in-hospital mortality (81.6%, 52.4%, 77.4%) was higher than SIRS. The area under the receiver operating characteristic curve for qSOFA for these variables was also higher than for SIRS (0.826 vs. 0.524, 0.823 vs. 0.577, and 0.823 vs. 0.555, respectively). CONCLUSION: qSOFA is a better model for predicting adverse outcomes and mortality, organ dysfunction, and ICU admission in surgical patients. However, SIRS indicates intervention requirements in a surgical patient better than qSOFA.
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Introduction Gallbladder (GB) retrieval is an important cause of postoperative pain (POP) after laparoscopic cholecystectomy (LC). Retrieval is through the epigastric or umbilical port based on the surgeon's preference. There is limited evidence to support the superiority of one port over the other in terms of POP. This study was done to compare POP between epigastric and umbilical ports after GB retrieval in LC for symptomatic cholelithiasis. Material and methods All patients who underwent elective LC for symptomatic cholelithiasis were randomized for GB retrieval either through the umbilical (n = 15) or epigastric (n = 15) port. Postoperatively, the retrieval difficulty score by the operating surgeon, visual analog scale (VAS) scores for pain, and surgical site infection (SSI) by postoperative day (POD) 10 and 30 were assessed. Results The mean visual analog scores at the umbilical port at 1, 6, 12, 24, and 36 hours postoperatively were 5.20 ± 0.86, 4.60 ± 0.74, 4.00 ± 0.53, 3.40 ± 0.08, and 2.73 ± 0.82, which were significantly less than the visual analog scores at the epigastric port at the same time intervals, measuring 6.06 ± 1.34, 5.87 ± 1.30, 5.27 ± 1.16, 4.73 ± 1.10, and 3.93 ± 1.03, respectively. The difference was statistically significant between the two arms (p-value < 0.05). The mean retrieval difficulty score was significantly less for the umbilical port (4.40 ± 0.74) when compared with the epigastric port (5.13 ± 0.55). The overall SSI rate in the present study was 10%, and three (20%) patients in the epigastric port group developed SSI by POD 10, while none in the umbilical port group developed SSI. Conclusion GB retrieval from the umbilical port is associated with less POP, SSI, and retrieval difficulty when compared with GB retrieval from the epigastric port after elective LC for symptomatic cholelithiasis. Titration of analgesic use can also be done appropriately, reducing the dose of analgesics after 12-24 hours.