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24th European Congress of Trauma & Emergency Surgery 

Professor

Prof. Dr.

The use of plasma transfusion following traumatic injury in the pre-hospital setting

Trauma and Emergency surgery | Miscellaneous

Polytrauma

Introduction: We sought to conduct a meta-analysis to investigate whether pre-hospital plasma transfusion improves outcomes in trauma patients.Materials and Methods: The systematic review was conducted following the PRISMA guidelines to assess the effectiveness of prehospital plasma infusion in trauma patients. The literature search covered studies published between 2012 and 2024 using databases (PubMed, Embase, and Cochrane Library). The primary outcomes were mortality (early or late) and hemostatic indicators, including INR and TEG. Studies were excluded if they focused exclusively on pediatric patients, conducted in non-prehospital settings, and studies that examined fluid resuscitation using interventions other than plasma. The quality of included studies was assessed using the Newcastle-Ottawa Scale (NOS) for observational studies and the Cochrane Risk of Bias (ROB 2) tool for randomized controlled trials. Study characteristics were extracted and synthesized for analysis, including design, sample size, and outcomes.Results: We identified 242 studies from the search, of which 193 were unrelated to the topic. Thirteen studies were secondary analyses using data from 2 randomized controlled trials (RCT). 17 studies were included in the full-text analysis, of which two discussed only RBC transfusion, and five did not have any comparator group. Nine studies were included in the final analysis. 4 studies used the FFP by thawing them, and three used freeze-dried plasma (FDP). The 2 RCTs that used FDP did not have any positive impact, and the observational study that used FDP showed a short-term improved mortality of 24h, but this improvement was not observed for 30-day mortality. After sensitivity analysis, only five studies showed an effective risk ratio (RR) for 24h mortality of 0.75 (95%CI 0.63-0.88).Conclusion: The pooled results of 5 studies showed that pre-hospital plasma transfusion could improve survival in trauma. However, more high-quality RCTs are required.No

Oral presentation

NaROA: A National Registry of Open Abdomen as a multicenter observational prospective study to analyze the open abdomen Indications, prognostic factors, and morbidity and mortality in non-traumatic patients

Emergency surgery

Introduction: Technical aspects, the importance of intraoperative findings, and data on morbidity and mortality have not been rigorously described in the surgical indication of open abdomen (OA) in non-traumatic patients (NTP). Objective: To describe and analyze the indications, prognostic factors of morbidity and mortality, and the results of applying OA in NTP. Materials and Methods: This is an analytical, multicenter, prospective study. All NTP with an indication for emergency laparotomy between 2022 and 2023 were included. Patients were divided into two groups: those who had OA performed and those who did not, further subdivided by whether they had OA indication. Patients were followed for 90 days post-surgery. Data on demographic and clinical variables, indications, intraoperative findings, surgical technique, closure rate, complications, and mortality were registered. Results: OA was indicated in patients with peritonitis (n=121), vascular emergencies (n=86), pancreatitis (n=15), abdominal compartment syndrome (n=19), and others (n=10). The results suggest that diagnosis does not significantly affect survival in OA-indicated patients. There is insufficient sample size to analyze OA data between groups with and without OA indication.<table border="0" cellspacing="3" cellpadding="0"><tr><td><table border="1" cellspacing="0" cellpadding="0"><tr><td width="142" valign="top"></td><td width="142" valign="top">Deceased(n=101)</td><td width="142" valign="top">Not Deceased (n=144)</td><td width="142" valign="top">Total (n=245)</td></tr><tr><td width="142" valign="top">Peritonitis</td><td width="142" valign="top">50(49.5%)</td><td width="142" valign="top">71(49.3%)</td><td width="142" valign="top">121(49.6%)</td></tr><tr><td width="142" valign="top">Vascular emergency</td><td width="142" valign="top">37(36.6%)</td><td width="142" valign="top">49(34.0%)</td><td width="142" valign="top">86(35.0%)</td></tr><tr><td width="142" valign="top">Pancreatitis</td><td width="142" valign="top">6(5.9%)</td><td width="142" valign="top">9(6.3%)</td><td width="142" valign="top">15(6.1%)</td></tr><tr><td width="142" valign="top">Abdominal compartment syndrome</td><td width="142" valign="top">9(8.9%)</td><td width="142" valign="top">10(6.9%)</td><td width="142" valign="top">19(7.7%)</td></tr><tr><td width="142" valign="top">Others</td><td width="142" valign="top">5(5.0%)</td><td width="142" valign="top">5(3.5%)</td><td width="142" valign="top">10(4.1%)</td></tr></table></td><td> </td><td> </td></tr></table>Table 1. 90-day survival in patients with OA indication. Conclusions: OA is a controversial but safe surgical indication for selected NTP, despite high morbidity and mortality rates. Further data analysis is needed to clarify OA indications, prognostic factors, and morbidity/mortality in NTP.Disclosure: None of the authors have a significant financial interest, consultancy, or other relationships with products, manufacturers of products, or providers of services related to this abstract.

Associate Professor

Professor Emeritus

Ultrasonic dissection versus electrocautery in laparoscopic cholecystectomy for acute cholecystitis: A randomized controlled trial (SONOCHOL-trial)

IntroductionLaparoscopic cholecystectomy with ultrasonic dissection is a compelling alternative to conventional electrocautery. The evidence for elective cholecystectomy supports the adoption of ultrasonic dissection, citing advantages such as reduced operating time, diminished bleeding, and shorter hospital stays. However, the efficacy of this procedure in acute cholecystitis remains uncertain. The aim of this study was to compare outcomes of electrocautery and ultrasonic dissection in patients with acute cholecystitis.Materials & MethodsA randomized, parallel, double-blinded, multicentre controlled trial was conducted across eight Swedish hospitals. Eligible participants were individuals aged ≥18 years with acute cholecystitis lasting ≤7 days. Random allocation to electrocautery or ultrasonic dissection was performed in a 1:1 ratio. The primary endpoint was the total complication rate, analysed using an intention-to-treat approach. The primary outcome was analysed using logistic generalized estimated equations. Patients, postoperative caregivers, and follow-up personnel were blinded to group assignment.ResultsFrom September 2019 to March 2023, 300 patients were enrolled and randomly assigned to electrocautery dissection (n=148) and ultrasonic dissection (n=152). No significant difference in complication rate was observed between the groups (RD 1.6%, 95% CI, − 7.2% to 10.4%, P=0.720). No significant disparities in operating time, conversion rate, hospital stay or readmission rates between the groups were noted. Haemostatic agents were more frequently used in electrocautery dissection (RD 10.6%, 95% CI, 1.3% to 19.8%, P=0.025).ConclusionsUltrasonic and electrocautery dissection demonstrate comparable risks for complications in patients with acute cholecystitis. Ultrasonic dissection is a viable alternative to electrocautery dissection or can be used as a complementary method in laparoscopic cholecystectomy for acute cholecystitis.My Blohm is an unpaid board member of the Swedish Registry of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography, as well as the Swedish Association for Emergency Surgery and Traumatology.

Open abdomen and incisional hernia: An indissoluble couple?

INTRODUCTION: Abdominal wall temporary closure with an open abdomen system is a useful resource in critical patients, though it carries risks, notably incisional hernia (IH), which affects quality of life. This study aimed to analyze the effect of open abdomen techniques on IH development.METHODS: Retrospective analysis of a continuous prospective database of the Open Abdomen Technique at a tertiary hospital, including patients who underwent emergency open abdomen surgery from 2020-2022. Each patient had at least a year of follow-up, with May 15, 2024, as the study endpoint. Key IH risk factors, including demographics (sex, age, smoking, frailty, diabetes, hypoproteinaemia), abdominal closure timing, and closure methods (sutures and mesh placement) were assessed.RESULTS: A total of 115 patients were included. Septic abdomen was the leading indication (44.35%), followed by "second look" surgery (29.57%). Surgical and systemic complications occurred in 72% and 83.5% of cases, respectively, with 49.56% mortality during follow-up. Among the 58 survivors, 27.58% developed IH. Incisional hernia was less common in trauma patients (10%) and more frequent in patients in decompression surgery for compartment syndrome (60%). Age, hypoproteinaemia, and postoperative evisceration were significantly associated with IH, while surgical site infection, surgical complications, mesh-mediated fascial traction, mesh placement, closure timing, and suturing technique showed no significant association with IH.CONCLUSIONS: Although trauma patients who undergo abdominal wall temporary closure seem to have a lower risk of incisional hernia, every patient should be actively followed to detect incisional hernia in short and medium-term. Patients operated to treat compartment syndrome could be considered candidates for prophylactic mesh placement.No

Clinical and radiological preoperative predictors of complicated acute appendicitis: Results from the ESTES snapappy snapshot audit of acute appendicitis care

Research

Introduction: Acute appendicitis (AA) represents the most prevalent abdominal surgical emergency worldwide[1]. Emerging evidence suggests that complicated and (CAA) and non complicated AA (UAA) may involve distinct pathophysiological mechanisms, with certain cases of UAA possibly resolving spontaneously. Clinical prediction tools, such as nomograms, may improve patient outcomes by accurately identifying those at highest risk for CAA. Material & Methods: This subgroup analysis is part of the ESTES SnapAppy study, a time-bound, multicenter, prospective observational cohort study[2]. It includes patients aged 15 years and above who underwent laparoscopic appendectomy during a 90-day observation period across multiple centers. Disease severity was classified according to the AAST grading system[3], comparing UAA (grade 1) with CAA (grades 2-5). Results: Data from 4,613 patients were analyzed. Significant preoperative predictors of CAA included male sex, age over 65, elevated C-reactive protein (CRP) levels, high Alvarado scores, and positive ultrasound findings. CAA patients exhibited higher rates of postoperative complications and prolonged hospital stays, reinforcing the clinical value of early risk identification. Conclusion: This study highlights the importance of preoperative clinical and radiological predictors in distinguishing CAA. The findings suggest that implementing structured prediction models, such as nomograms, could enhance decision-making processes by facilitating expedited care, mobilizing critical care resources when warranted, and improving overall patient outcomes through anticipatory management of complications. 1Jones, M. W., Lopez, R. A. & Deppen, J. G. Appendicitis. in StatPearls (StatPearls Publishing, Treasure Island (FL), 2023). 2Bass, G. A. et al. The snapshot audit methodology: design, implementation and analysis of prospective observational cohort studies in surgery. Eur. J. Trauma Emerg. Surg. 49, 5–15 3 Crandall, M. L. et al. Application of a uniform anatomic grading system to measure disease severity in eight emergency general surgical illnesses. J. Trauma Acute Care Surg. 77, 705–708 (2014).NO

Prof.

Impact of the COVID-19 pandemic on acute diverticulitis management: A retrospective observational study

Introduction The COVID-19 pandemic impacted managing several conditions, including acute diverticulitis (AD). This study aims to assess how it influenced hospital admission rates, patient characteristics, and treatment approaches, comparing pre-pandemic and pandemic periodsMaterials and Methods This retrospective observational study analyzed AD cases from January 2017 to May 2023, dividing patients into pre-COVID – PCG (January 2017–March 2020) and COVID - CG (March 2020–May 2023) groups. Data from electronic records included demographics, inflammatory markers, and disease severity (Hinchey classification). Management data covered diagnostic imaging, treatments (non-operative management NOM, percutaneous drainage, surgery), 90-day readmission.Results The study included 428 patients, with 235 in PCG and 193 in CG, showing a 21% reduction in admissions during the pandemic. While demographics were similar, prior abdominal surgeries were lower in CG (59% PCG vs. 45.5% CG, p=0.006). CRP levels were higher in CG (median 107.0 mg/dL vs. 71.2 mg/dL, p=0.010). NOM remained common but was less frequent in CG (81.3% vs. 88.5%, p=0.04), with increased percutaneous drainage and surgery. The 90-day readmission rate dropped in CG (13.5% vs. 24.7%, p=0.005), likely due to new outpatient follow-up systems introduced in 2021.Conclusion COVID-19 pandemic significantly impacted AD management, reducing hospital admissions and shifting treatment strategies. Despite similar patient demographics and disease severity, elevated CRP levels and more interventions in the COVID group suggest a different approach to managing patients at presentation. Lower readmission rates emphasize the value of structured outpatient follow-up.References Cirocchi R, Nascimbeni R, Burini G, Boselli C, Barberini F, Davies J, Di Saverio S, Cassini D, Amato B, Binda GA, Bassotti G. The Management of Acute Colonic Diverticulitis in the COVID-19 Era: A Scoping Review. Medicina (Kaunas). 2021 Oct 18;57(10):1127No

Dr. med.

PD Dr. med.

PD Dr.

Prof. Dr. med.

Pelvic ring fracture simulator to practice emergency interventions of unstable pelvic ring fractures

IntroductionThe management of hemodynamically unstable pelvic ring injuries necessitates surgical intervention, often involving procedures such as external fixation and percutaneous screw placement for which regular training is imperative to ensure readiness for emergencies. Our study aimed to adapt and validate a realistic simulation model for stabilizing unstable pelvic ring injuries.Material & MethodsA standardized simulator of an unstable pelvic ring utilizing synthetic pelvic bones featuring complete disruption of the symphysis and sacroiliac joint, with simulated soft tissue coverage, was developed. Trauma surgeons affiliated with a level one academic hospital were invited to perform external fixation and emergency sacroiliac screw application under C-arm guidance. Prior to and following the simulation session, participants completed a subjective questionnaire assessing their confidence in emergency interventions on a 10-point Likert scale (10-LS). Objective parameters, such as intraoperative imaging quality, reduction accuracy, and the positioning of screws, wires, and external fixators, were also evaluated.ResultsFifteen trauma surgeons (10 residents, 5 consultants) participated in the simulation over the course of one day. The confidence for emergency SI-Screw placement increased significantly after the simulator (10-LS: Before=3.8±3.08 vs. After=5.67±2.35; p=0.002) as well as after external fixation (10-LS: Before=3.93±2.79 vs. After=6.07±2.52; p=0.002). In addition, confidence in (intraoperative) pelvic imaging increased significantly (10-LS: Before=4.60±3.0 vs. After=6.53±2.39; p=0.011). Overall, the model was rated as a realistic simulation of clinical practice (10-LS=7.87±1.13).ConclusionsOur unstable pelvis fracture model is a tool to practice emergency interventions such as external fixation and percutaneous techniques. Participants benefitted from this in terms of technical instrumentation as well as intraoperative imaging.No

Evaluating sustainable practices in emergency surgery: Insights from the intercollegiate green theatre checklist

Introduction Healthcare, especially in operating rooms, contributes significantly to environmental pollution. Using the Intercollegiate Green Theatre Checklist, this study evaluated emergency surgeries at our center to identify practices for reducing CO₂ emissions.Materials & Methods Data were prospectively collected from emergency surgeries between September 23rd and October 11th, 2024. Parameters included surgical approach, staff composition, anesthesia type, use of single-use vs. reusable items. Environmental impact was measured by calculating kgCO₂e emissions from items like gowns, drapes, and catheters, with energy-saving actions like powering off equipment when not in use also tracked.Results 20 emergency surgeries were analyzed. All patients received general anesthesia, with total intravenous anesthesia used in 55% of cases, contributing to lower CO₂ emissions. We achieved 100% use of reusable gowns and drapes; reusable hats were employed in 71.9% of cases (110/153), approximately 7.8 kg CO₂e was produced. If reusable hats had been used in 100% of cases, 4.13 kg CO₂e would have been saved. Single-use catheters, however, were used in 45% of cases, adding 0.863 kg CO₂e per unit. In 25% of cases, unnecessary instruments were opened, indicating potential for waste reduction. Post-operatively, partial recycling was performed (only plastic and paper).Conclusion Applying the Green Theatre Checklist in emergency surgeries revealed strong adherence to reusable materials and minimized CO₂ emissions, especially in gown and drape usage. Opportunities remain in reducing unnecessary instrument use and increasing post-operative recycling. These findings support the need for targeted strategies to further reduce the environmental footprint in surgery.References: Green Theatre Checklist|RCSEd [Internet][cited 2024 Oct 1]Available from: https://www.rcsed.ac.uk/professional-support-development-resources/environmental-sustainability-and-surgery/green-theatre-checklistNo

Univ. Prof. Dr. med.

Contrast-enhanced computed tomography in polytrauma patients: Which predictors matter?

Introduction Contrast-enhanced computed tomography (ceCT) is widely used in the evaluation and management of polytrauma patients. Although guidelines exist on when ceCT is indicated, clinical practice, often in the hectic setting of the trauma bay, shows inconsistent use of this diagnostic modality. Keeping into account the potential harmful side effects of ceCT, the aim of this study was to investigate predictors that may allow more accurate application of ceCT in the polytrauma patient.Materials & methods Patients with an ISS ≥ 16 who were admitted through the trauma bay of the level 1 trauma centre of RWTH Aachen University Hospital between 2010 and 2017 were included in this study. The following parameters were obtained: patient demographics, mechanism of injury, trauma severity, vital parameters, blood work, medical imaging results, length of stay (both in hospital and in the intensive care unit), and mortality. Results A total of 651 polytrauma patients were included in this study. In 73% (n=478), a ceCT was performed in the trauma bay. Of these 478 patients, 23% had clinically relevant abnormalities in the ceCT, such as active bleeding or vessel dissection/occlusion, while 77% did not. Specific clinical parameters, such as concomitant thoracic trauma, penetrating trauma, falls from great heights (>3m), or lower extremity fractures, were found to have significant predictive power in relation to clinically relevant findings in ceCT"s.Conclusion This study is among the first in its scale to quantify the unmet need for better predictive indicators in guiding the use of ceCT in the trauma bay. Specific patient characteristics and trauma mechanisms were shown to be strong predictors for clinically relevant findings in ceCT, and may help guide decision-making in the trauma bay, thereby reducing radiation exposure to our patients.No

Presentations, management, and outcomes of traumatic carotid and vertebral arteries injuries

Introduction: Traumatic injuries to carotid and vertebral arteries (CVAI), though relatively rare, pose significant clinical challenges. These injuries pose potential risks for ischemic stroke, disability, and mortality and are not well studied. We evaluated the presentations and factors that influence the management, neurological, and mortality outcomes of traumatic CVAI.Materials & Methods: This is a retrospective analysis of a prospectively maintained Qatar trauma registry of adult patients admitted with a diagnosis of CVAI. The study was conducted at a Level 1 Trauma Center in a Middle Eastern country and encompassed a comprehensive analysis of 73 patients who sustained CVAIs between December 2008 and February 2023. The study categorized injuries using the Biffl classification and assessed various clinical parameters, including injury severity scores, vital signs, associated injuries, management, and outcomes (mortality and morbidity).Results: Carotid artery injuries were observed in 35 patients, predominantly caused by traffic accidents (45.7%). The injuries were classified into different grades, with Grade IV (occlusion of the ICA) being the most common. Vertebral artery injuries were identified in 38 patients, with cervical spine fractures in 94.7% of cases. The most frequent mechanisms of injury included traffic-related incidents (60.5%) and falls from height (18.4%). Despite immediate interventions, mortality rates remained high, particularly in patients with severe injuries and complications such as cerebrovascular accidents.Conclusions: This is Qatar's first study addressing carotid and vertebral artery injuries. Traumatic injuries to the carotid and vertebral arteries pose a significant risk for severe neurological outcomes and mortality. Continued research and refinement of clinical guidelines are essential in enhancing the care of patients with CVAI.no

Oral session 1
Emergency surgery

Appointment

Chairs

Topic

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Oral session 1Emergency surgery

Appointment

Chairs

Topic

Programme

Oral session 1
Emergency surgery