22nd European Congress of Trauma & Emergency Surgery

Chairs

Predicting quality of life after emergency laparotomy

Emergency surgery

Education

Abstract text (incl. references and figure legends) Introduction Emergency Laparotomy is a common procedure associated with high mortality. Many tools have been developed to predict mortality and are now routinely used in the pre-operative phase to aid shared decision making. Post survival quality of life is very important to patients but more difficult to quantify. This study investigated whether post-operative quality of life can be predicted using commonly available pre-operative variables. The aim is to present better information to patients to allow more nuanced decision making. Materials and Methods Patients undergoing emergency laparotomy at our institution are prospectively entered into an online databse for the National Emergency Laparotomy Audit (NELA). All NELA-registered patients are offered follow up with a nurse specialist who completes the EQ-5D-5L and SF-12 Quality of Life (QoL) questionnaires. Spearman's coefficients were calculated to identify correlation between pre-operative characteristics and their subsequent responses to the QoL questionnaires. Mann-Whitney U tests were performed to compare the responses of patients in groups found to have either good or poor post operative quality of life. Results 407 patients were prospectively entered into the NELA database between 03/05/2019 and 30/12/2020. 375 (92%) survived to discharge with 30 and 90 day mortality rates of 4% and 8% respectively. 65% (244) of survivors were followed up in the dedicated clinic and completed QoL questionnaires. Mean time to follow up was 321 days (59-404 days). Survivors had a lower QoL than expected for the general population. QoL is inversely correlated to: NELA predicted Mortality, ASA grade and Clinical Frailty Score (CFS). The following groups are predictative of poor QoL in survivors: NELA-predicted Mortality ≥5%, ASA≥3 CFS ≥2 Conclusions Risk of poor QoL can be ascertained preoperatively in emergency laparotomy patients and should be included in the consent process. Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) None

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Surgical management of acute appendicitis during the European Covid-19 second wave: Safe and effective

Abstract text (incl. references and figure legends) Introduction: The COVID-19 (SARS-CoV-2) pandemic drove acute care surgeons to pivot from long established practice patterns. Early safety concerns regarding increased postoperative complication risk in those with active COVID infection promoted antibiotic-driven non-operative therapy for select conditions ahead of an evidence-base. Our study assesses whether active or recent SARS-CoV-2 positivity increases hospital length of stay (LOS) or postoperative complications following appendectomy. Material &amp; Methods: Data was derived from the prospective, multi-institutional observational SnapAppy cohort study. This preplanned data analysis assessed consecutive patients aged ≥15 years who underwent appendectomy for appendicitis (November 2020 - May 2021). Patients were categorized based on SARS-CoV-2 seropositivity: no infection, active infection, and prior infection. Appendectomy method, LOS, and complications were abstracted. The association between SARS-CoV-2 seropositivity and complications was determined using Poisson regression, while the association with LOS was calculated using a quantile regression model. Results: Appendectomy for acute appendicitis was performed in 4047 patients during the 2nd and 3rd European COVID waves. The majority were SARS-CoV-2 uninfected (3861, 95.4%), while 70 (1.7%) were acutely SARS-CoV-2 positive, and 116 (2.8%) reported prior SARS-CoV-2 infection. After confounder adjustment, there was no statistically significant association between SARS-CoV-2 seropositivity and LOS, any complication, or severe complications. Conclusions: During sequential SARS-CoV-2 infection waves, neither active nor prior SARS-CoV-2 infection was associated with prolonged hospital LOS or postoperative complication. Despite early concerns regarding postoperative safety and outcome during active SARS-CoV-2 infection, no such association was noted for those with appendicitis who underwent operative management. Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) Nothing to disclose

Attitudes towards the adoption of eHealth amongst healthcare professionals in trauma surgery – The new digital normal?

Skeletal trauma and sports medicine

Abstract text (incl. references and figure legends) Introduction The COVID-pandemic disrupted established routines and services, and accelerated the digital transformation in healthcare. Little is known about the need for durable adoption of eHealth in trauma surgery. This study aimed to collect physicians' attitudes towards use, needs, adoption, and implementation of eHealth in (orthopedic) surgeons after the third COVID-wave. Method A web-based survey among (orthopedic) surgeons on the attitudes toward eHealth was conducted between November 2021 and March 2022. The primary outcomes of this study were &quot;change of opinion of the usefulness of eHealth after the COVID-19 pandemic&quot; on a 5-point Likert scale (1 meaning absolutely not, and 5 meaning absolutely) and &quot;likelihood of using a safe digital alternative to face-to-face outpatient follow-up&quot;(scale 0-100). Secondary outcomes included &quot;current use&quot;, &quot;applicability of eHealth in daily practice&quot;, and &quot;implementation barriers of eHealth&quot;. Results Ninety-six physicians completed the survey. All participants owned a smartphone, a mean age of 39 (SD 18), and 59 (53%) were male. 83% (80/96) use eHealth in daily practice. The mean change of opinion towards the usefulness of eHealth was 3.7 (SD 0.85). Physicians would treat 58% (SD 21) of all patients with eHealth if proven safe. Dominant barriers were lack of short-term (3.49, 0.79) and long-term (3.43, 0.81) financial support, and complex laws and regulations (3.46, 0.72). Desired specifications were free of charge (4.39, 0.72), telemonitoring (4.32, 0,.56), living rules (4.25), and low complex usability (4.24, 0.68). Conclusion This study shows that physicians in (orthopedic) surgery use eHealth in daily practice and have a positively changed opinion on the usefulness of eHealth after the COVID-pandemic. If proven a safe mode of care, physicians would treat more than half of their patients digitally. The lack of funding during implementation and financial compensation for digital care are the most dominant barriers.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) For this study we have received a grand from ZonMw.

Value of early Procalcitonin kinetics in predicting infectious complications post-appendectomy

Abstract text (incl. references and figure legends) Introduction The occurrence of intra-abdominal abscesses is the most severe post-operative infectious complication after appendectomy. Several research has been conducted in an attempt to identify the patients most at risk. Procalcitonin (PCT) was initially described as an early, sensitive and specific marker for sepsis associated with bacterial infection. We therefore hypothesized that PCT could serve as markers predictive of the development of intraabdominal abscesses after surgery for uncomplicated appendicitis. Materials and methods: This study is a prospective, single-centre, observational cohort study in patients with uncomplicated appendicectomy. PCT values were obtained preoperatively (T0), after the procedure (T1) at 24 hours (T2), 48 hours (T3) and 5 days (T3) after the procedure with blood analysis and with test point of care (POC Results The primary aim of this study was to assess the diagnostic accuracy of Point-of-Care tests for PCT in identifying post-appendectomy abscess. The secondary objective was to determine diagnostic accuracy in identifying any infectious complications Conclusions: We expect the incidence of abscess and infectious complication to be increased in the high PCT group compared to the control group. Previous investigations indicate that the overall morbidity related to infectious complication is about 1-10% in patients undergoing laparoscopic appendectomy. Our pilot study revealed that the incidence could reach up to 15% in patients with prolonged high PCT values. Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) no

Association between troponin I levels and mortality among patients undergoing acute high-risk abdominal surgery

Visceral trauma

Abstract text (incl. references and figure legends) Introduction Patients undergoing acute high-risk abdominal (AHA) surgery are at risk of developing myocardial injury after non-cardiac surgery (MINS). MINS is a prognostic relevant myocardial tissue injury and an independent predictor of 30-day mortality1. MINS is diagnosed by an elevated plasma troponin (TnI). We aim to determine the incidence and mortality of MINS among AHA-patients. Material &amp; Methods Patients aged 50 and over undergoing surgery for perforation, obstruction or mesenterial ischemia at Copenhagen University Hospital – North Zealand from March 2019 to February 2021 were included. Plasma-TnI was measured preoperatively, 6-12 hours and on day 1–4 postoperatively. Patients with TnI &gt;59 were diagnosed with MINS and assessed individually to decide further treatment and level of care. Data on vital status was collected from the Civil Registration System. The cumulative incidences were calculated using competing risk analysis and all-cause mortality analysed using logistic regression. Results A total of 355 patients were included. Postoperative TnI was measured in 314 patients, 81 patients (25,8%) developed MINS. Patients with MINS were generally older (71.875 vs 781, p&lt;0.001) and had a higher ASA-score (&lt;0.001). The absolute unadjusted risk of all-cause mortality was 21.0% [CI: 121–29.9%] for patients with MINS versus 3.0% [CI: 0.8–5.2] for patients without. Adjusted by Inverse Probability Weighting for ASA, age, BMI, cardiovascular diseases, type of procedure, resection of organ, and diagnosis, the 30-day mean risk of death was 24.1% [CI: 126–35,5%] for patients with MINS and 4.0% [CI: 1.5–6.5] for patients without MINS, p=0.0008. Conclusions MINS is significantly associated with 30-day mortality. References 1. Botto et al. Myocardial injury after noncardiac surgery: a large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes. Anesthesiology 2014;120:564–780Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) The authors declare no conflict of interest.

Dr. med.

PD Dr. Dr.

Prof. Dr. med.

Pre- and in-hospital time management in the elderly trauma patients: A retrospective analysis

Polytrauma

Abstract text (incl. references and figure legends) Introduction: Trauma to the elderly age segment accounts for an increasing proportion of admissions to trauma centers. Despite the well-known increased risk for morbidity and mortality of elderly compared to younger patients, disparities in the care of geriatric trauma patients have been documented in multiple studies. The aim of our study was to analyze the differences in time management in the pre- and in-hospital setting of elderly compared to younger patients. Material &amp; Methods: Retrospective analysis of all trauma patients primarily admitted to our shock room from 01/2015 to 07/2022. Demographics, clinical and physiological parameters, and time intervals in the pre- and early in-hospital period were compared between elderly (≥65 years) and younger (&lt;65 years) patients. Results: A total of 972 patients (elderly, n=326) were included in this study. Compared to the younger population, elderly patients presented with significantly higher ISS (20.5 ± 10.6 vs. 14.3 ± 12.0; p&lt;0.001) and a lower GCS score (10.2 ± 4.8 vs. 12.6 ± 4.2; p&lt;0.001). After controlling for injury characteristics and pre-hospital procedures, geriatric patients experienced significantly longer pre-hospital scene times compared to their younger counterparts (48.8 ± 18.0 vs. 43.9 ± 17.6 minutes; p&lt;0.001). In-hospital time management, however, did not show any statistical significant differences between the two groups (Time from shock room admission until FAST examination: elderly 7.6 ± 7.3 vs. younger patients 7.1 ± 8.6 minutes; p=0.36. Time from admission until whole-body CT scan: 29.4 ± 22.0 vs. 28.1 ± 15.5 minutes; p=0.39). Conclusions: Despite being more severely injured, elderly patients experience longer pre-hospital scene times compared to younger patients. However, no time differences between the groups were found in the early in-hospital setting. Reasons for this disparity in pre-hospital times may include delayed recognition of injury severity in the elderly trauma population.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Live animal use in surgical trauma training: Looking beyond skills with a scalpel

Disaster and military medicine

Abstract text (incl. references and figure legends) Introduction "Live tissue training" (LTT) uses terminally-anaesthetised animals as human patient simulator models, for medical professionals to learn surgical techniques. Despite increasing availability and variety of alternative simulators, and clear ethical implications, many assert that LTT is the trauma simulation "gold standard". The educational benefit of LTT is unclear, in terms of tangible outcomes for learners or improved health outcomes for patients. The aim was to explore how LTT is used in surgical trauma simulation to determine educational merit. Material &amp; Methods A systematic review was performed according to PRISMA guidelines. A combination of narrative synthesis and reflexive thematic analysis were used to identify key attributes of LTT which contribute to educational attainment for learners. Results LTT is primarily used to practice psychomotor surgical skills and to apply knowledge of trauma management. The focus is either an individual practitioner"s performance of simple "ATLS" skills in the pre-hospital environment or complex "damage control" skills conducted by surgeons as part of a team. Strong empirical evidence which demonstrates that LTT is more beneficial than alternative simulation modalities was not identified; nevertheless, it is preferred and strongly supported by learners. Thematic analysis indicated that the critical and dynamic nature of haemorrhage, a realistic environment, and an invoked emotional response to training may influence learner perception of self-efficacy relating to clinical knowledge and skill performance. Conclusion There is insufficient evidence to support superiority of live animals over other modalities for skills training. However, there appears to be some evidence in the literature that for experienced learners involved in complex surgical (team) training, LTT has potentially unique educational value in terms of learner psychology which may impact subsequent clinical performance.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Traumatic pulmonary arteriovenous fistula in a patient with penetrating stab wound of the chest

Abstract text (incl. references and figure legends) Case history: A 28-year old male was admitted to the Emergency Unit after he was stabbed in the chest and found by the side of the road. Clinical findings: Upon admission patient presented with 2 cm long entry wound approximately 2 cm superior to the xyphoid and the clinical signs of haemorrhagic shock. Investigation/Results: A chest X-ray and FAST revealed massive right haemothorax and cardiac tamponade. Diagnosis: According to the clinical findings and imaging investigations the baseline diagnosis was heart wound with subsequent cardiac tamponade and massive right haemothorax that indicated emergency surgery. Therapy and Progressions: During the emergency total sternotomy two wounds in the heart were found and sutured. Additionally, massive right haemothorax was evacuated and small lung laceration close to the right hilum was sutured. Total blood loss was 5 litres. The next day patient presented with persisting hypoxemia despite the ventilation with 100 % oxygen. TEE showed the posibility of right-to-left shunt at the level of pulmonary circulation and CT pulmonary angiography confirmed fistula between the right pulmonary artery and upper pulmonary vein. A multidisciplinary team decided to resolve the fistula surgically. Fistula was closed with suture through the right hemiclamshell incision after assuring intrapericardial control of PA trunk and pulmonary vein with a vascular sling. After fistula closure hypoxemia immediately resolved and patient gradually recovered and was discharged on day 12 after fistula closure. Comments: Traumatic pulmonary AV fistula is extremely rare condition. In our case fistula became clinically apparent very early after the trauma and caused severe hypoxemia. It was successfully resolved by surgical closure. Adequate clinical judgement and use of right diagnostic tools play key role in the successful management.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Supplementing internationally accredited courses – Organization, conduct, and results of the "theoretical and practical points of osteosynthesis" introduced for the surgical "skill training" specialist candidate course

Abstract text (incl. references and figure legends) Introduction: in recent years, in the training process of manual professions, the so-called skill training have become common, which are implemented through the experimental subject institute of the given university. Students perform basic surgical interventions on living creatures. The partially negative feedbacks of long-established courses (AO, ATLS) are well known. Method: the mentioned schools have timeless results in the field of traumatology education, but at the same time, based on the feedbacks, a new, practical course is introduced. While various suturing techniques and general surgical interventions are part of the thematics of these exercises, other, potentially more specialized skeletal system interventions are not highlighted. The creators of the course - both having AO and ATLS faculty certification - took into account the AO principles and designed a training system that complements the existing courses, taking into account needs that are closer to a person, practice, and question-and-answer oriented. Results: in addition to the difficulties (such as financial resources), we also had to face specific problems, such as the acquisition of relatively expensive traumatology/orthopedic implants, bridging the differences between the used surgical organism (pig) and human anatomy. Another problem was that we had to solve the modeled X-ray-intensive surgeries without an imaging procedure - in order to avoid radiation exposure. Summary: with the help of a kind of clinician-university-manufacturer cooperation, based on the student feedback, we successfully conducted the osteosynthesis practical days at the Surgical Practice and Research Laboratory in Hungary. Based on student feedback, the training raised fewer lingering questions or problems compared to the AO courses. Conclusion: in addition to the different - already proven - forms of training, the new type of small group and practice-oriented training provides better results and clearly better feedback.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Prof. Dr.

Funnel plots a graphical instrument for the evaluation of population performance and quality of trauma care: A blueprint of implementation

Abstract text (incl. references and figure legends) Using patient outcomes to monitor medical centre performance has become an essential part of modern health care. However, classic league tables generally inflict stigmatization on centres rated as &quot;poor performers&quot;, which has a negative effect on public trust and professional morale. In the present study, we aim to illustrate that funnel plots, including trends over time, can be used as a method to control the quality of data and to monitor and assure the quality of trauma care. Moreover, we aimed to present a set of regulations on how to interpret and act on underperformance or overperformance trends presented in funnel plots. A retrospective observational cohort study was performed using the Dutch National Trauma Registry (DNTR). Two separate datasets were created to assess the effects of healthy and multiple imputations to cope with missing values. Funnel plots displaying the performance of all trauma-receiving hospitals in 2020 were generated, and in-hospital mortality was used as the main indicator of centre performance. Indirect standardization was used to correct for differences in the types of cases. Comet plots were generated displaying the performance trends of two level-I trauma centres since 2017. Results Funnel plots based on data using healthy imputation for missing values can highlight centres lacking good data quality. A comet plot illustrates the performance trend over multiple years, which is more indicative of a centre&quot;s performance compared to a single measurement. Trends analysis offers the opportunity to closely monitor an individual centres&quot; performance and direct evaluation of initiated improvement strategies. This study describes the use of funnel and comet plots as a method to monitor and assure high-quality data and to evaluate trauma centre performance over multiple years. Moreover, this is the first study to provide a regulatory blueprint on how to interpret and act on the under or overperformance of trauma centres.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) All authors declare to have no conflict of interest, including financial, consultant, institutional, and other relationships that might lead to bias or a conflict of interest.

Digitalization of major incident rescue

Abstract text (incl. references and figure legends) Introduction Rescue in a major incident (MI) is a complex activity, which includes the organization of the rescue and medical treatment of many injured people. It is necessary to coordinate the work of emergency medical service (EMS) teams and other services (firemen, police, civil protection...). Good information support provides fresh data about the condition, treatment and location of the injured. Material &amp; Methods In Slovenia, we are developing a digital application for major incidents (AMI). AMI has been tested in MI exercises. All data about the injured is entered by the EMS teams on a smartphone, tablet or laptop. Anyone who treats the patient can see how the care has gone up to that point and add their own data about the treatment of the patient. Results The Medical Incident Commander (MIC) always has fresh data on the number of injured, their triage category and their location. MIC also has fresh lists of patients who have been or will be transferred to a particular hospital. This data is updated automatically, eliminating the need for communication via radio or mobile phones. Hospitals have a complete overview of which patients who are still in the field will be sent to them, what injuries they have and what care they have received. AMI gives hospitals more time to prepare for patient admission. We are also developing an upgrade of the AMI with a communication environment (CE) that will enable multimedia connection within the healthcare sector and also between other services. The CE will include the possibility of voice or video communication, the transfer of short messages or longer texts, maps, web pages, documents, photos and video transmission. All traffic in the CE can be recorded (traceability), which enables retrospective analysis of the course of the intervention in an exercise or in a real MI. Conclusions Digitalization of emergency rescue is key to improving the care of injured persons and a more efficient organization of emergency rescue in MI.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) AMI is a product of a cooperation between MediaInteractive (IT company) and Zdravstveni dom Kranj (Community health centre Kranj). Authors have no financial benefit from their participation.

Is selective histopathology post cholecystectomy an appropriate and safe screening tool for gallbladder malignancy or its precursors?

Abstract text (incl. references and figure legends) Introduction Routine histopathology is current practice following cholecystectomy in the UK, screening for incidental gallbladder carcinoma or its precursors. There are variations in practice globally, with the Netherlands recently adopting a selective approach, which includes macroscopic evaluation of the gallbladder specimen post extraction and subsequent selective histological analysis. The specimens are analysed for abnormalities indicating pre-malignant or malignant pathology. Many retrospective and prospective analyses exist to date, however none are randomised or blinded. We aim to evaluate our experience retrospectively as to whether selective histopathology is a safe approach Material &amp; Methods A retrospective analysis from June 2017 – June 2022 was conducted and histology reports from specimens from all patients who underwent cholecystectomy (elective, emergency, laparoscopic or open) were analysed, looking for the incidence of high grade dysplasia, polyps, carcinoma, or intracholecystic papillary neoplasm (ICPN). If any such lesions were found, their clinical course was evaluated further. Results 23/2232 patients (0.01%) were found to have a positive finding: polyps (n = 13), high grade dysplasia (n = 1), ICPN (n = 2), carcinoma (n = 7). Of these, 16/23 (69.6%) had a pre-operative suspicision of a potential malignant diagnosis and hence would have been sent for histological analysis. Independently, 15/23 (65.2%) had abnormal macroscopic histology. If a selective approach was adopted, specimens would not have been sent in 4 cases and would have suffered the consequences of a lack of an earlier diagnosis and intervention. Conclusions To justify any screening programme, certain criteria need to be met, with screening for gallbladder malignancy failing to meet these. A double-blinded randomised multi-centre study may elucidate the use of selective histopathology as a more economically efficient screening tool, without adverse clinical outcomes. ReferencesDisclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Impact of Covid 19 pandemic on colorectal emergency surgery: A multicentric retrospective study

Abstract text (incl. references and figure legends) Introduction: Surgical management of patients with colorectal cancer (CCR) was altered during the COVID pandemic. We hypothesise that the number of colorectal cancer patients treated in emergency increased compared to pre-pandemic period. Material and methods: We performed a multicentric retrospective study which included patients with colorectal cancer which were admitted and surgically treated in 8 centers in Romania from 2018 to 2021. We compared the data of cases from the prepandemic years 2018 and 2019 to the pandemic years of 2020 and 2021. Results: out of total of 3522 CCR patients, 1336 cases were acute cases: 693 (51.87%) in the prepandemic years and 643 (48.13%) in the pandemic years. For right colon cancer, hemorrhagic (114 vs 50, 39.02% difference) and perforating complications (39 vs 22, 27.87% difference) where more prevalent in the pandemic years. Right hemicolectomy was performed in all cases, anastomosis in 140 cases in the prepandemic years and in 138 cases in the pandemic years (0.78% difference), while a terminal ileostomy without anastomosis was performed in 17 cases prepandemic versus 26 cases pandemic (20.93% difference). For transverse colon tumors, obstructive tumors where more prevalent in the prepandemic years (54 vs 46, difference 8%); but hemorrhagic cases (12 vs 8 cases, difference of 20%) and perforation occured more frequently in the pandemic years (3 vs 5, difference of 25%). Resection with anastomosis was performed more frequently in the prepandemic years (37 vs 32 cases, difference of 7.25%) and resection with an ostomy was performed in 9.09% more cases in the pandemic years (10 cases in the prepandemic years vs 12 cases in the pandemic years).Regarding left colon (descending/sigmoid colon) obstruction was more frequent in the prepandemic years (328 vs 288; 6.49% difference). Colonic resection with anastomosis (136 vs 119 cases, 6.67% difference), with ostomy (201 vs 187 cases, 3.61% difference) and diverting stomas without resection (26 vs 20 cases, 13.04% difference) where all more prevalent in the prepandemic years. For rectal tumors, obstructive (305 vs 221, 15.97% difference) and hemorrhagic complications were more frequent in prepandemic, while perforation was higher in the pandemic years (5 vs 15 cases, 50% difference). Conclusions. We expected to find a higher proportion of acute cases during pandemic years, but the results were surprisingly reverse. One possible explanation is the differences in regulations between centers regarding admission and surgery of cancer patients.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) ---

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