Mihai Paduraru; Luca Ponchietti; Isidro Martinez Casas; Peter Svenningsen; Mauro Zago
Volume 5, Issue 2 , April 2017, , Pages 70-78
Abstract
Objective: To evaluate the current scientific evidence for the applicability, safety and effectiveness of pathways of enhanced recovery after emergency surgery (ERAS).Methods: We undertook a search using PubMed and Cochrane databases for ERAS protocols in emergency cases. The search generated 65 titles; ...
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Objective: To evaluate the current scientific evidence for the applicability, safety and effectiveness of pathways of enhanced recovery after emergency surgery (ERAS).Methods: We undertook a search using PubMed and Cochrane databases for ERAS protocols in emergency cases. The search generated 65 titles; after eliminating the papers not meeting search criteria, we selected 4 cohort studies and 1 randomized clinical trial (RCT). Data extracted for analysis consisted of: patient age, type of surgery performed, ERAS elements implemented, surgical outcomes in terms of postoperative complications, mortality, length of stay (LOS) and readmission rate.Results: The number of ERAS items applied was good, ranging from 11 to 18 of the 20 recommended by the ERAS Society. The implementation resulted in fewer postoperative complications. LOS for ES patients was shorter when compared to conventional care.Mortality, specifically reported in three studies, was equal or lower with ERAS. Readmission rates varied widely and were generally higher for the intervention group but without statistical significance.Conclusions: The studies reviewed agreed that ERAS in emergency surgery (ES) was feasible and safe with generally better outcomes. Lower compliance with some of the ERAS items shows the need for the protocol to be adapted to ES patients. More evidence is clearly required as to what can improve outcomes and how this can be formulated into an effective care pathway for the heterogeneous ES patient.
Isidro Martínez Casas; María Auxiliadora Amador Marchante; Mihai Paduraru; Ana Isabel Fabregues Olea; Andreu Nolasco Bonmatí; Juan Carlos Medina
Volume 4, Issue 3 , July 2016, , Pages 150-155
Abstract
Objective: To determine the predictive and diagnostic value of thorax trauma severity score (TTSS) in a population of thoracic trauma patients admitted to a secondary level trauma center.Methods: A Retrospective analysis of patients admitted over a period of two years with IDC-9 codes related to thoracic ...
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Objective: To determine the predictive and diagnostic value of thorax trauma severity score (TTSS) in a population of thoracic trauma patients admitted to a secondary level trauma center.Methods: A Retrospective analysis of patients admitted over a period of two years with IDC-9 codes related to thoracic trauma was undertaken. The association of TTSS with complications and mortality was evaluated. We also determined the predictive value of TTSS using receiver operating characteristic curve (ROC).Results: 238 patients with thoracic trauma, mostly middle-aged (62.2 ± 15 years), were included. The main mechanisms of injury were falls and traffic accidents. Thirty-three patients had important extra-thoracic injuries, but only 9 presented an ISS> 15. The average ISS was 3 ± 5; Morbidity was 2.5% and mortality was 2.1% as a result of thoracic injury and these patients had significantly higherTTSS values. Each score component was analyzed separately, showing significant association with complications and mortality. The area under the curve for TTSS was significant for predicting complications (0.848) and mortality (0.856) values. TTSS with a cut off value of 8 points had a sensitivity of 66% and specificity of 94% to predict complications and 80% sensitivity and 94% specificity for predicting mortality.Conclusions: The TTSS is an appropriate and feasible tool to predict the development of complications or mortality in a population of mostly mild thoracic trauma.
