The new world order caused by COVID-19 virus, associated with severe acute respiratory syndrome, multiple organ failure, and very high mortality, has brought about many changes to our world. ...Suddenly, the medical community, and those who finance the health care sector, realized that telemedicine and telepresence are applicable, desirable, acceptable, and much sought after by our patients and we can manage just about every disease and condition. Although, by and large, telemedicine has faced challenges and perhaps some resistance, despite its great potential, it has become evident that telemedicine can provide rapid, safe, and high-quality care remotely during this pandemic, the largest one since 1918. Perhaps one benefit of suffering through the COVID-19 pandemic will be the establishment of a new virtual medical world order, and that telemedicine has taken its deserving place in health care: prime time and a center stage.
Background
The objective of this study was to evaluate the current body of evidence on the use of telemedicine in surgical subspecialties during the COVID-19 pandemic.
Methods
This was a scoping ...review conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). MEDLINE via Ovid, PubMed, and EMBASE were systematically searched for any reports discussing telemedicine use in surgery and surgical specialties during the first period (February 2020–August 8, 2020) and second 6-month period (August 9–March 4, 2021) of the COVID-19 pandemic.
Results
Of 466 articles screened through full text, 277 articles were included for possible qualitative and/or quantitative data synthesis. The majority of publications in the first 6 months were in orthopedic surgery, followed by general surgery and neurosurgery, whereas in the second 6 months of COVID-19 pandemic, urology and neurosurgery were the most productive, followed by transplant and plastic surgery. Most publications in the first 6 months were opinion papers (80%), which decreased to 33% in the second 6 months. The role of telemedicine in different aspects of surgical care and surgical education was summarized stratifying by specialty.
Conclusion
Telemedicine has increased access to care of surgical patients during the COVID-19 pandemic, but whether this practice will continue post-pandemic remains unknown.
Background
In recent decades, biologic mesh (BM) has become an important adjunct to surgical practice. Recent evidence-based clinical applications of BM include but are not limited to: reconstruction ...of abdominal wall defects; breast reconstruction; face, head and neck surgery; periodontal surgery; other hernia repairs (diaphragmatic, hiatal/paraesophageal, inguinal and perineal); hand surgery; and shoulder arthroplasty. Prior systematic reviews of BM in complex abdominal wall hernia repair had several shortcomings that our comprehensive review seeks to address, including exclusion of laparoscopic repair, assessment of risk of bias, use of an acceptable meta-analytic method and review of risk factors identified in multivariable regression analyses.
Materials and methods
We sought articles of BM for open ventral hernia repair reporting on early complications, late complications or recurrences and included minimum of 50. We used the quality in prognostic studies risk of bias assessment tool. Random effects meta-analysis was applied.
Results
This comprehensive review selected 62 articles from 51 studies that included 6,079 patients. Meta-analytic pooling found that early complications are present in about 50%, surgical site occurrences (SSOs) in 37%, surgical site infections (SSIs) in 18%, reoperation in 7%, readmission in 20% and mortality in 3%. Meta-analytic estimates of late outcomes included overall complications (42%), SSOs (40%) and SSIs (22%). Specific SSOs included seroma (14%), hematoma (4%), abscess (10%), necrosis (5%), dehiscence (8%) and fistula formation (5%). Reoperation occurred in about 17%, mesh explantation in 9% and recurrence in 36%.
Conclusion
Estimates of nearly all outcomes from individual studies were highly heterogeneous and sensitivity analyses and meta-regressions generally failed to explain this heterogeneity. Recurrence is the only outcome for which there are consistent findings for risk factors. Bridge placement of BM is associated with higher risk of recurrence. Prior hernia repair, history of reintervention and history of mesh removal were also risk factors for increased recurrence.
The organizing and publishing a journal takes enormous efforts from scientific community, takes trust by all of us, and hard work. In a view of new industry of open access journals, this becomes even ...harder. Surgical journals, most frequently are publishers and are supported by membership organization such as ASTES. The importance of this conference, that has been changed now to The Congress of Trauma and Emergency Surgery, above all is not only the scientific merits, but the fact that has initiated a multidisciplinary meeting of all clinical and pre-hospital services services and providers who care for trauma and injured patients and those who are are in need for an emergency surgery. In ad-dition, the AJTES , as it continue to build an co-alition of partners, will elevate not only scientific consciousness, but will spearhead the building of the organization of the scientific and political mi-lieu and become an important voice and adviser the government in leading and influencing the training, education and wellbeing of new gen-eration of surgeons, anesthesiologist, intensivist, emergency medicine providers, and overall sub-stantially effect strategic developments of health-care system.
ObjectivesData from the Centers for Disease Control and Prevention (CDC) show that firearm deaths are increasing in the USA. The aims of this study were to determine the magnitude of potential years ...of life lost due to firearms and to examine the evolution of firearm deaths on the basis of sex, race, and geographical location within the USA.MethodsData was extracted (2009–2018) from the National Vital Statistics Reports from the CDC and the Web-based Injury Statistics Query and Reporting System database. Years of potential life lost was calculated by the CDC standard of subtracting the age at death from the standard year of 80, and then summing the individual years of potential life lost (YPLL) across each cause of death.ResultsThe YPLL in 2017 and 2018 was higher for firearms than motor vehicle crashes (MVCs). In 2018, the YPLL for firearms was 1.42 million and 1.34 million for MVC. Males comprised the majority (85.4%) of the 38 929 firearm deaths. White males had the most YPLL due to suicide, with 4.95 million YPLL during the course of the 10-year period; black males had the most YPLL due to homicide with 3.2 million YPLL during the same time period. The largest number of suicides by firearms was in older white males. Firearm-related injury deaths were highest in the South, followed by the West, Midwest, and Northeast, respectively.ConclusionFirearms are now the leading cause of YPLL in trauma. Firearm deaths have overtaken MVC as the mechanism for the main cause of potential years of life lost since 2017. Suicide in white males accounts for more YPLL than homicides. Deaths related to firearms are potentially preventable causes of death and prevention efforts should be redirected.Level of evidenceLevel III—Descriptive Study.
Background
To analyze and report on the changes in epidemiology traumatic causes of death in the USA.
Methods
Data were extracted from the annual National Vital Statistics Reports (2008–2017) from ...Center for Disease Control and analyzed for trends during the time period given. Generalized additive model was applied to evaluate the significance of trend using R software.
Results
Firearm deaths (39,790) and firearm death rate (12.2/100,000) in 2017 were the highest reported, and this increasing trend was significant (
p
< 0.001) the last ten years. Deaths from motor vehicle crash (MVC) and firearm homicides did not change significantly during the same time period. Firearm deaths were lower than MVC deaths by 21% (8,197/39,790) in 2008, but after 10 years, the difference was only 1% (458/40,231). Years of life lost from firearms is now higher than MVC. Suicides by firearm in 2017 were the highest reported at 23,854/39,773 (60%). In 2017, suicides by firearm victims were predominantly white 20,328/23,562 (85%), men 20,362/23,562 (86%), and the largest group was between the ages of 55–64.
Conclusions
Death from firearms in the USA is increasing and endemic. They were the highest ever reported in 2017 by the CDC. While deaths from MVC used to be the main cause of traumatic death in the USA, deaths from firearms now almost equal it. Calculated years of life lost from firearms is now more than from MVC. Most firearm deaths are not from homicides but are from suicides, and they are predominantly in white older males of the baby boomer generation (born 1946–1964).
Background
Hospital readmissions are recognized as indicators of poor healthcare services which further increase patient morbidity. The aim of this study is to analyze predicting factors for the ...30-day and 90-day readmissions after a complex abdominal wall reconstruction (CAWR).
Methods
A pooled analysis of the prospective study and retrospective database patients undergoing CAWR with acellular porcine dermis from 2012 to 2019 was carried out. Independent
t
test for continuous variables and Chi-square and Fischer's exact tests for categorical variables were used. A multivariable logistic regression model and linear regression analysis were used to analyze the independent predictors of 30-day and 90-day readmissions.
Results
A total of 232 patients underwent CAWR, and the readmission rate (RR) was 16.8% (
n
= 40). The 30-day and 90-day RR was 11.3% (
n
= 23) and 13.3% (
n
= 33), respectively. There were no statistical differences in age, frailty, and gender distribution between the two groups. There was no difference in ASA score, type of component separation, ventral hernia working group class, size of the biological mesh, placement of mesh, and intestinal resection rate. The Clavien–Dindo complications and mean comprehensive complication index (CCI) were higher in the readmission group as compared to no readmission group (
p
< 0.01). Readmitted patients had higher surgical site infections (
p
< 0.01) and wound necrosis (
p
= 0.01). Higher CCI, past or concomitant pelvic surgery, and the presence of enterocutaneous fistula were independent predictors of earlier days to readmission.
Conclusion
Surgical site occurrences were associated with 30-day and 90-day readmissions after CAWR, while the presence of ascites and dialysis was associated with 90-day readmissions.
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