Related Experiment Video
Updated: Aug 14, 2025
06:48
Emergency Undocking in Robotic Surgery: A Simulation Curriculum
Published on: May 20, 2018
9.4K
Acute Care Surgery and Surgical Rescue: Expanding the Definition
Jose J Diaz1, Stephen Barnes2, Lindsay O'Meara3
1From the University of Maryland School of Medicine, Baltimore, MD (Diaz, Chipman, Kufera, Vesselinov).
Journal of the American College of Surgeons
|January 12, 2023
Summary
Surgical rescue for intra-abdominal infections is critical for inpatients (IP) and transferred patients (TP), who face higher mortality. Severity of illness, not transfer status, significantly impacts survival outcomes.
Area of Science:
- Surgical critical care
- Abdominal surgery outcomes
- Patient transfer protocols
Background:
- Surgical rescue (SR) addresses complications from emergency surgery (ES).
- Patients transferred (TP) or inpatients (IP) on nonsurgical services may require ES for intra-abdominal infection (IAI).
- Characterizing SR populations by ES consultation site, open abdomen (OA) use, and mortality risk is essential.
Purpose of the Study:
- To analyze the characteristics of patients undergoing surgical rescue for intra-abdominal infections.
- To compare outcomes based on the initial site of emergency surgery consultation (clinic/ED, inpatient, or transferred).
- To identify factors influencing mortality risk in the surgical rescue population.
Main Methods:
- International, multi-institutional prospective observational study.
- Exclusion of patients with prior laparotomy before transfer.
- Patient stratification into clinic/ED, inpatient (IP), or transferred (TP) groups; data collection on demographics, severity of illness (SOI), procedures, OA, and laparotomies; multivariable logistic regression for mortality analysis.
Main Results:
- 752 patients studied; IP group exhibited worse SOI scores.
- Higher rates of open abdomen (OA) and relaparotomies in IP and TP groups compared to clinic/ED.
- Unadjusted mortality was highest in IP (25.0%) and TP (16.5%) versus clinic/ED (14.2%); only SOI impacted mortality risk upon adjustment.
Conclusions:
- Inpatients (IP) and transferred patients (TP) have higher unadjusted mortality following emergency surgery for intra-abdominal infections.
- Severity of illness (SOI) is the primary driver of mortality risk in surgical rescue.
- Surgical rescue protocols should be extended to inpatients for earlier intra-abdominal infection recognition.
Related Concept Videos
01:30Cardiopulmonary Resuscitation V: Advanced Airway Management Techniques
44
Airway management is essential in emergency and surgical medicine, ensuring ventilation and oxygenation in patients who cannot maintain their own airway. Clinicians use a range of techniques and devices to secure the airway, depending on the patient’s condition and the clinical context. Key methods include endotracheal intubation, rapid sequence intubation (RSI), supraglottic airway devices, and advanced visualization aids. In cases where these approaches fail, surgical airway...
44
01:19Restorative Care
2.0K
Restorative care is provided once a patient has been discharged from a healthcare facility and requires additional services. The additional services include home care, rehabilitation programs, and extended care. Restorative care centers help the patient regain their previous level of functioning or acquire a new level of functioning due to the incapacitating effects of a disease or a disability. It aims to assist patients in enhancing their quality of life by encouraging independence,...
2.0K
01:26Aneurysm III: Interprofessional Care
17
Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
17
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management
53
Airway management is a key skill in emergency and critical care settings, as maintaining a clear airway is essential for adequate oxygenation and ventilation.Head Tilt-Chin Lift TechniqueThe head tilt-chin lift maneuver is an essential technique primarily used in patients without suspected cervical spine injuries. To perform this maneuver, one hand is placed on the patient’s forehead, and gentle pressure is applied backward to tilt the head. The fingertips of the other hand are positioned...
53
01:22Standards of Care I
747
Federal statutes profoundly impact nursing practice, providing critical guidelines to ensure patient care is equitable, accessible, and of the highest quality. The following laws address distinct aspects of healthcare provision and patient rights:
747
01:29Acute Respiratory Failure-V
181
The treatment for acute respiratory failure varies based on factors like the underlying cause, overall health, and severity. A collaborative healthcare team is essential for early detection, often through arterial blood gas analysis. Identifying the cause is the primary goal, with treatment strategies adjusted for ventilation/perfusion (V/Q) mismatch, shunting, or diffusion impairment.
Ensure that patients are monitored continuously for their response to therapy, including changes in...
Ensure that patients are monitored continuously for their response to therapy, including changes in...
181