The Experts below are selected from a list of 156 Experts worldwide ranked by ideXlab platform
H. Waleczek - One of the best experts on this subject based on the ideXlab platform.
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Strategien zur Vermeidung negativer Appendektomien
Der Chirurg, 2009Co-Authors: M.n. Wente, H. WaleczekAbstract:Appendectomy is the most commonly performed Emergency Surgical Procedure. Even in the era of laparoscopic surgery and modern computed tomography, the rate of negative appendectomies, defined as the removal of a non-inflamed appendix, remains high (10–15%). The general problem and incidence, as well as the influence of modern diagnostic modalities on the rate of negative appendectomies are of particular clinical relevance. Several clinical scoring systems have been developed, but they did not find their way into the daily clinical routine. A proposed diagnostic algorithm could support further efforts to reduce the rate of negative appendectomies. The risk of overtreatment in the reduction of the negative appendectomy rate might potentially lead to acceptance of a higher perforation rate. Bei der Appendektomie handelt es sich um die am häufigsten durchgeführte nichtelektive Operation. Auch in der Ära der laparoskopischen Chirurgie und der modernen Computertomographie gibt es noch immer eine nicht unerhebliche Rate an negativen Appendektomien (10–15%), also der Entfernung eines in der histopathologischen Aufarbeitung nicht akut entzündlich veränderten Wurmfortsatzes. Sowohl die Problemstellung und Inzidenz als auch der Einfluss moderner diagnostischer Modalitäten auf die Rate der negativen Appendektomie sind von klinischer Relevanz. Verschiedene klinische Scoring-Systeme, die zur Diagnosestellung der akuten Appendizitis entwickelt wurden, haben keinen Einzug in den klinischen Alltag gefunden. Ein diagnostischer Algorithmus kann Hilfestellung zur Verminderung der Rate negativer Appendektomien geben; die Gefahr der Überanspruchung der negativen Appendektomierate liegt möglicherweise in der Inkaufnahme einer höheren Perforationsrate.
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Strategien zur Vermeidung negativer Appendektomien
Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen, 2009Co-Authors: M.n. Wente, H. WaleczekAbstract:Appendectomy is the most commonly performed Emergency Surgical Procedure. Even in the era of laparoscopic surgery and modern computed tomography, the rate of negative appendectomies, defined as the removal of a non-inflamed appendix, remains high (10-15%). The general problem and incidence, as well as the influence of modern diagnostic modalities on the rate of negative appendectomies are of particular clinical relevance. Several clinical scoring systems have been developed, but they did not find their way into the daily clinical routine. A proposed diagnostic algorithm could support further efforts to reduce the rate of negative appendectomies. The risk of overtreatment in the reduction of the negative appendectomy rate might potentially lead to acceptance of a higher perforation rate.
G. L. Laing - One of the best experts on this subject based on the ideXlab platform.
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The Combined SIRS + qSOFA (qSIRS) Score is More Accurate Than qSOFA Alone in Predicting Mortality in Patients with Surgical Sepsis in an LMIC Emergency Department
World Journal of Surgery, 2020Co-Authors: S. L. Green, M. T. D. Smith, C. Cairns, D. L. Clarke, J. Bruce, W. Bekker, V. Kong, G. L. LaingAbstract:Background qSOFA has been proposed as a prognostic tool in patients with sepsis. This study set out to assess the sensitivity of several scores, namely: the pre-ICU qSOFA, the qSOFA with lactate (qSOFA L), SIRS score, qSOFA + SIRS score (qSIRS) and qSIRS with lactate (qSIRS L) in predicting in-hospital mortality in patients with Surgical sepsis as well as the sensitivity of these scores in predicting high-grade sepsis. The secondary aim was to determine which of these scores is best suited to predict high-grade Surgical sepsis. Methods This was a retrospective cohort study that was conducted between December 2012 and August 2017 in a public metropolitan Surgical service. Data from patients aged > 13 years, who were admitted to the hospital and who had an Emergency Surgical Procedure for source control were retrieved from a prospectively maintained hybrid electronic database. The qSOFA, qSOFA plus lactate (qSOFA L), SIRS and qSOFA + SIRS (qSIRS), as well as the qSIRS plus lactate (qSIRS L), were calculated for each patient. A lactate level that was greater than 2mmol/L was deemed to be a positive finding. Any score ≥2 was deemed to be a positive score. The outcome measure was in-hospital mortality. The prognostic value of qSOFA, qSOFA L, SIRS, qSIRS and qSIRS L was studied. Receiver operating characteristic analyses were performed to determine the area under the curve (AUC), sensitivity, specificity and positive and negative likelihood ratios for positive qSOFA, qSOFA L, SIRS, qSIRS, and qSIRS L. Contingency tables were used to calculate the sensitivity, specificity, PPV and NPV for predicting severe or high-grade Surgical sepsis. Results There were a total number of 1884 patients in the sample group of whom 855 were female (45.4%). The median patient age was 36 years (IQR 23–56). A total of 1489 patients (79%) were deemed to have high-grade sepsis based on an advanced EGS AAST grading, whilst 395 patients (21%) had low-grade sepsis. A total of 71 patients died (3.8%). Of these patients who died, 67 (94.4%) had high-grade sepsis and 4 (5.6%) had low-grade sepsis. The mortality rate in the high-grade sepsis group was 4.5%, whilst the mortality rate in the low-grade sepsis group was 1%. The scores with the greatest accuracy in predicting mortality were qSIRS (AUROC 0.731, 95% CI 0.68–0.78), followed by SIRS (AUROC 0.70, 95% CI 0.65–0.75). The qSOFA and qSOFA L were the least accurate in predicting mortality (AUROC 0.684, 95% CI 0.63–0.74 for both). The addition of lactate had no significant effect on the accuracy of the five scores in predicting mortality. Patients with a qSOFA ≥ 2 have an increased risk of dying (OR 5.8), as do patients with a SIRS score ≥2 (OR 2.7). qSIRS L had the highest sensitivity (69%) in predicting the presence of high-grade Surgical sepsis, followed by qSIRS (65.5% sensitivity). qSOFA showed a very low sensitivity of only 4.5% and a high specificity of 99.2%. The addition of lactate to the score marginally improved the sensitivity. Lactate of 2mmol/L or more was also an independent predictor of high-grade sepsis. Conclusion The qSIRS score is most accurate in predicting mortality in Surgical sepsis. The qSOFA score is inferior to both the SIRS and the qSIRS scores in predicting mortality. The qSIRS score with the addition of lactate to the qSIRS score made it the most sensitive score in predicting high-grade Surgical sepsis.
M.n. Wente - One of the best experts on this subject based on the ideXlab platform.
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Strategien zur Vermeidung negativer Appendektomien
Der Chirurg, 2009Co-Authors: M.n. Wente, H. WaleczekAbstract:Appendectomy is the most commonly performed Emergency Surgical Procedure. Even in the era of laparoscopic surgery and modern computed tomography, the rate of negative appendectomies, defined as the removal of a non-inflamed appendix, remains high (10–15%). The general problem and incidence, as well as the influence of modern diagnostic modalities on the rate of negative appendectomies are of particular clinical relevance. Several clinical scoring systems have been developed, but they did not find their way into the daily clinical routine. A proposed diagnostic algorithm could support further efforts to reduce the rate of negative appendectomies. The risk of overtreatment in the reduction of the negative appendectomy rate might potentially lead to acceptance of a higher perforation rate. Bei der Appendektomie handelt es sich um die am häufigsten durchgeführte nichtelektive Operation. Auch in der Ära der laparoskopischen Chirurgie und der modernen Computertomographie gibt es noch immer eine nicht unerhebliche Rate an negativen Appendektomien (10–15%), also der Entfernung eines in der histopathologischen Aufarbeitung nicht akut entzündlich veränderten Wurmfortsatzes. Sowohl die Problemstellung und Inzidenz als auch der Einfluss moderner diagnostischer Modalitäten auf die Rate der negativen Appendektomie sind von klinischer Relevanz. Verschiedene klinische Scoring-Systeme, die zur Diagnosestellung der akuten Appendizitis entwickelt wurden, haben keinen Einzug in den klinischen Alltag gefunden. Ein diagnostischer Algorithmus kann Hilfestellung zur Verminderung der Rate negativer Appendektomien geben; die Gefahr der Überanspruchung der negativen Appendektomierate liegt möglicherweise in der Inkaufnahme einer höheren Perforationsrate.
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Strategien zur Vermeidung negativer Appendektomien
Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen, 2009Co-Authors: M.n. Wente, H. WaleczekAbstract:Appendectomy is the most commonly performed Emergency Surgical Procedure. Even in the era of laparoscopic surgery and modern computed tomography, the rate of negative appendectomies, defined as the removal of a non-inflamed appendix, remains high (10-15%). The general problem and incidence, as well as the influence of modern diagnostic modalities on the rate of negative appendectomies are of particular clinical relevance. Several clinical scoring systems have been developed, but they did not find their way into the daily clinical routine. A proposed diagnostic algorithm could support further efforts to reduce the rate of negative appendectomies. The risk of overtreatment in the reduction of the negative appendectomy rate might potentially lead to acceptance of a higher perforation rate.
David A. K. Watters - One of the best experts on this subject based on the ideXlab platform.
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mortality of patients with covid 19 who undergo an elective or Emergency Surgical Procedure a systematic review and meta analysis
Anz Journal of Surgery, 2021Co-Authors: Wendy A. Brown, Eileen M Moore, David A. K. WattersAbstract:Background There have been several reports that co-infection with the novel coronavirus severe acute respiratory syndrome coronavirus 2 at the time of surgery increases mortality. The aim of this study was to estimate the effect size of coronavirus disease 2019 (COVID-19) on post-operative mortality by performing a systematic review and meta-analysis of the literature. Methods A systematic review and meta-analysis of the literature was performed. A search was undertaken using electronic bibliographic databases MEDLINE, EMBASE, PubMed and Cochrane Library to identify eligible studies published from 1 November 2019 until 21 August 2020. Eligible papers for meta-analysis were those that provided mortality rates following elective and Emergency surgery in both COVID-19 positive and negative patients. Forest plots and estimates of odds of death related to having COVID-19 were formed using MedCalc version 9.6 software. Funnel plots to assess for publication bias and heterogeneity were formed in Meta-Essentials. Results There were 140 records screened for inclusion. Full texts of 39 articles were reviewed, and 36 articles were included in the qualitative synthesis. There were eight studies eligible for meta-analysis. There was a total of 193 operations performed on patients with a concurrent COVID-19 infection and 910 performed on patients who were COVID-19 negative. The odds ratio for mortality in patients who underwent a Surgical Procedure while COVID-19 positive was 7.9 (95% confidence interval: 3.2-19.4). Conclusion This meta-analysis confirms that concurrent COVID-19 infection increases the risk of Surgical mortality. The magnitude of this risk mandates that strategies are developed to mitigate the risk at both an individual and system level.
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Mortality of patients with COVID-19 who undergo an elective or Emergency Surgical Procedure: a systematic review and meta-analysis.
ANZ journal of surgery, 2020Co-Authors: Wendy A. Brown, Eileen M Moore, David A. K. WattersAbstract:There have been several reports that co-infection with the novel coronavirus severe acute respiratory syndrome coronavirus 2 at the time of surgery increases mortality. The aim of this study was to estimate the effect size of coronavirus disease 2019 (COVID-19) on post-operative mortality by performing a systematic review and meta-analysis of the literature. A systematic review and meta-analysis of the literature was performed. A search was undertaken using electronic bibliographic databases MEDLINE, EMBASE, PubMed and Cochrane Library to identify eligible studies published from 1 November 2019 until 21 August 2020. Eligible papers for meta-analysis were those that provided mortality rates following elective and Emergency surgery in both COVID-19 positive and negative patients. Forest plots and estimates of odds of death related to having COVID-19 were formed using MedCalc version 9.6 software. Funnel plots to assess for publication bias and heterogeneity were formed in Meta-Essentials. There were 140 records screened for inclusion. Full texts of 39 articles were reviewed, and 36 articles were included in the qualitative synthesis. There were eight studies eligible for meta-analysis. There was a total of 193 operations performed on patients with a concurrent COVID-19 infection and 910 performed on patients who were COVID-19 negative. The odds ratio for mortality in patients who underwent a Surgical Procedure while COVID-19 positive was 7.9 (95% confidence interval: 3.2-19.4). This meta-analysis confirms that concurrent COVID-19 infection increases the risk of Surgical mortality. The magnitude of this risk mandates that strategies are developed to mitigate the risk at both an individual and system level. © 2020 Royal Australasian College of Surgeons.
S. L. Green - One of the best experts on this subject based on the ideXlab platform.
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The Combined SIRS + qSOFA (qSIRS) Score is More Accurate Than qSOFA Alone in Predicting Mortality in Patients with Surgical Sepsis in an LMIC Emergency Department
World Journal of Surgery, 2020Co-Authors: S. L. Green, M. T. D. Smith, C. Cairns, D. L. Clarke, J. Bruce, W. Bekker, V. Kong, G. L. LaingAbstract:Background qSOFA has been proposed as a prognostic tool in patients with sepsis. This study set out to assess the sensitivity of several scores, namely: the pre-ICU qSOFA, the qSOFA with lactate (qSOFA L), SIRS score, qSOFA + SIRS score (qSIRS) and qSIRS with lactate (qSIRS L) in predicting in-hospital mortality in patients with Surgical sepsis as well as the sensitivity of these scores in predicting high-grade sepsis. The secondary aim was to determine which of these scores is best suited to predict high-grade Surgical sepsis. Methods This was a retrospective cohort study that was conducted between December 2012 and August 2017 in a public metropolitan Surgical service. Data from patients aged > 13 years, who were admitted to the hospital and who had an Emergency Surgical Procedure for source control were retrieved from a prospectively maintained hybrid electronic database. The qSOFA, qSOFA plus lactate (qSOFA L), SIRS and qSOFA + SIRS (qSIRS), as well as the qSIRS plus lactate (qSIRS L), were calculated for each patient. A lactate level that was greater than 2mmol/L was deemed to be a positive finding. Any score ≥2 was deemed to be a positive score. The outcome measure was in-hospital mortality. The prognostic value of qSOFA, qSOFA L, SIRS, qSIRS and qSIRS L was studied. Receiver operating characteristic analyses were performed to determine the area under the curve (AUC), sensitivity, specificity and positive and negative likelihood ratios for positive qSOFA, qSOFA L, SIRS, qSIRS, and qSIRS L. Contingency tables were used to calculate the sensitivity, specificity, PPV and NPV for predicting severe or high-grade Surgical sepsis. Results There were a total number of 1884 patients in the sample group of whom 855 were female (45.4%). The median patient age was 36 years (IQR 23–56). A total of 1489 patients (79%) were deemed to have high-grade sepsis based on an advanced EGS AAST grading, whilst 395 patients (21%) had low-grade sepsis. A total of 71 patients died (3.8%). Of these patients who died, 67 (94.4%) had high-grade sepsis and 4 (5.6%) had low-grade sepsis. The mortality rate in the high-grade sepsis group was 4.5%, whilst the mortality rate in the low-grade sepsis group was 1%. The scores with the greatest accuracy in predicting mortality were qSIRS (AUROC 0.731, 95% CI 0.68–0.78), followed by SIRS (AUROC 0.70, 95% CI 0.65–0.75). The qSOFA and qSOFA L were the least accurate in predicting mortality (AUROC 0.684, 95% CI 0.63–0.74 for both). The addition of lactate had no significant effect on the accuracy of the five scores in predicting mortality. Patients with a qSOFA ≥ 2 have an increased risk of dying (OR 5.8), as do patients with a SIRS score ≥2 (OR 2.7). qSIRS L had the highest sensitivity (69%) in predicting the presence of high-grade Surgical sepsis, followed by qSIRS (65.5% sensitivity). qSOFA showed a very low sensitivity of only 4.5% and a high specificity of 99.2%. The addition of lactate to the score marginally improved the sensitivity. Lactate of 2mmol/L or more was also an independent predictor of high-grade sepsis. Conclusion The qSIRS score is most accurate in predicting mortality in Surgical sepsis. The qSOFA score is inferior to both the SIRS and the qSIRS scores in predicting mortality. The qSIRS score with the addition of lactate to the qSIRS score made it the most sensitive score in predicting high-grade Surgical sepsis.