Simone Frassini

Background/Objectives: Continuous trauma-system monitoring is limited by the lack of scalable, low-cost tools. The Pavia Trauma Management Epidemiology (PaTraME) project uses routinely collected ICD-9-CM discharge data (SDO) and the Trauma Mortality Probability Model (TMPM) to derive Injury Severity Score (XISS) and probability of death (TMPM-POD), creating a cost-free surveillance framework for regional trauma networks. Methods: We conducted a retrospective study of all major-trauma admissions (XISS > 15) in Pavia Province from 2014 to 2021. Anonymized SDO records were linked with emergency department flows and mortality registries. XISS and TMPM-POD were computed for each case. Case volumes, severity distributions, hub-centralization, and mortality (in-hospital, 30-day, and 180-day) were analyzed using trend and regression models (p < 0.05). Conclusions: We identified 1959 major-trauma admissions. Volumes increased up to 2019, dropped during the COVID-19 pandemic, and partially recovered in 2021 (p < 0.001). Overall, 61.5% of patients were admitted to hub centers, with an upward trend (p < 0.001). Hubs treated more severe trauma (median XISS 17 vs. 16; TMPM-POD 0.06 vs. 0.05, both p < 0.001). In-hospital mortality remained stable (8.2–11.4%, p = 0.828). TMPM-POD showed strong agreement with observed in-hospital mortality (Lin’s concordance correlation coefficient 0.81), though calibration worsened at higher risk levels. PaTraME confirms TMPM-POD as a valid mortality predictor and demonstrates a reproducible administrative-data framework for trauma surveillance. Rising hub admissions and stable mortality despite increasing complexity suggest improved system performance. Stratification of XISS and TMPM-POD between hub and spoke centers highlights peripheral hospitals managing disproportionately severe cases, informing targeted resource allocation and supporting quality improvement via automated dashboards.

Acute necrotic cholecystitis (ANC), marked by gallbladder wall necrosis, carries high morbidity if diagnosis and treatment are delayed. Ultrasound is the first-line imaging for suspected cholecystitis, but its sensitivity for necrosis is limited. This case underscores the value of surgical ultrasound competency in emergency decision-making. A 57-year-old woman with diabetes, asthma, and hypothyroidism presented with severe epigastric pain and systemic inflammation. Emergency ultrasound showed gallbladder wall thickening, pericholecystic fluid, and gallstones. CT confirmed necrosis with possible microperforation. An informal ultrasound by surgical residents later that day identified microperforations, expediting the decision for subtotal laparoscopic cholecystectomy. Surgery was successful, and recovery was uneventful. Ultrasound, when performed by trained surgical teams, enables rapid diagnosis and management of complex cholecystitis. Structured ultrasound training during residency could enhance diagnostic accuracy, reduce treatment delays, and improve outcomes in acute surgical emergencies.

Background: Acute calculous cholecystitis (ACC) is a common surgical emergency globally, with laparoscopic cholecystectomy (LC) representing the gold standard treatment. However, access to LC varies significantly across countries with different income levels, reflecting broader global disparities in surgical care. This study aims to compare the clinical characteristics and perioperative outcomes of ACC patients undergoing cholecystectomy across high-, middle-, and low-income countries, with a focus on laparoscopic surgery. Methods: This is a post hoc analysis of the prospective SPRiMACC study, which included 1253 patients from 79 centers across 19 countries. Patients were stratified into two groups based on World Bank income classifications: high-income countries (HICs) and middle-/low-income countries (LMICs). Propensity score matching (PSM) was used to balance patient characteristics across groups. Outcomes assessed included complication rates, mortality, length of hospital stay (LOS), use of bail-out procedures, and conversion to open surgery. Results: Prior to matching, significant differences were observed in comorbidity indices (including the Charlson comorbidity index and the American Society of Anesthesiologists index) and ACC severity between HICs and LMICs. After PSM, 366 matched patients were analyzed. No significant differences were found in intraoperative complications, conversion rates, or mortality. However, LOS > 10 days was more frequent in HICs (12.6% vs. 3.8%, p = 0.004), while bail-out procedures were more common in LMICs (11.5% vs. 3.3%, p = 0.004). These findings suggest that surgical outcomes are largely comparable, though they are influenced by contextual factors such as resource availability and health system capacity. Conclusions: This study highlights the feasibility of safe laparoscopic surgery for ACC across diverse economic settings while also exposing persistent disparities in access, surgical strategies, and health system efficiency. Expanding access to laparoscopic techniques in resource-limited settings will require targeted investments in training, infrastructure, and policy reform. These efforts align with global surgery goals and the Sustainable Development Goals, particularly SDG 3 (Good Health and Well-Being) and SDG 10 (Reduced Inequalities).

Background and Objectives: Early cholecystectomy (EC) is widely regarded as the first-line treatment for acute calculous cholecystitis (ACC). Current debate centers on the feasibility of EC as an option even for elderly patients. This study aims to determine whether age alone is an independent risk prediction factor for prognosis after EC for ACC. Materials and Methods: This study is a post-hoc analysis of the S.P.Ri.M.A.C.C. WSES prospective international multicenter observational study database, including patients with ACC undergoing EC. Univariate and multivariate analyses were conducted, examining different risk factors for major morbidity and mortality after EC. Results: In the univariate analyses, age was found to be a statistically significant risk factor for both 30-day major complications (p < 0.001) and 30-day mortality (p = 0.003). However, in the multivariate analysis, age alone was not a significant predictor for either outcome, with p-values of 0.419 and 0.094, respectively. The only significant risk factor associated with both 30-day mortality and major morbidity in the multivariate model was the POSSUM Physiological Score (PS). Conclusions: Age alone cannot be considered a reliable risk predictor for a complicated postoperative course after EC in patients with ACC. Frailty, rather than chronological age, should be assessed to predict the outcome of these patients.

Colorectal cancer (CRC) is the third most diagnosed cancer worldwide and the second most common cause of cancer death. About 20% of patients diagnosed with rectal cancer present with emergency symptoms. Typical symptoms include acute bleeding, obstruction, and perforation. These emergency situations can be life-threatening and may lead to decreased life expectancy and quality of life. Bowel perforation is the most common cause of emergency presentation, followed by obstruction and acute bleeding. This narrative review analyzes the existing literature regarding the acute presentation of rectal cancer, producing three flow charts for the management of the main rectal emergencies. The treatment of acute bleeding differs based on the hemodynamic status. Treatment for bowel perforation or occlusion differs depending on whether the lesion is intraperitoneal or extraperitoneal. Emergency presentations seem to be strongly associated with several poor prognostic factors, including lymphovascular invasion, perineural invasion, and high-grade or poorly differentiated tumors. An association between emergency presentation and larger tumor size, advanced tumor stage, node-positive disease, and metastatic disease is reported in the literature. The difference between colon and rectal cancer, both in terms of treatment and prognosis, has been widely acknowledged. Thus, comprehensive studies and dedicated guidelines are needed, considering the lack of literature published about rectal cancer in an emergency setting.

Background Despite improved awareness of blunt traumatic hollow viscus and mesenteric injuries (THVMI), the accuracy of contrast-enhanced CT (CECT) varies considerably among studies. This systematic review and meta-analysis of test accuracy aims to explore the diagnostic performance of CECT in detecting THVMI in blunt trauma. Methods The study was conducted according to the Cochrane recommendations searching the PubMed, Scopus, and Cochrane Library datasets from 2000 to 8 September 2023 (PROSPERO ID: CRD42023473041). Surgical exploration, autopsy, and discharge from the hospital after monitoring were set as reference standard. To explore the diagnostic accuracy of CECT in detecting THVMI hierarchical models were developed. The risk of bias in individual studies was assessed with the QUADAS-2 tool. Sensitivity analysis was conducted to detect sources of heterogeneity. Results Twelve studies, for a total of 4537 patients, were deemed eligible. After identification of outliers and sensitivity analysis, the pooled sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio were 0.85 (95% CI: 0.69–0.93), 0.94 (95% CI: 0.8–0.98), 14.65 (95% CI: 4.22–50.85), 0.16 (95% CI: 0.07–0.34), 92.3 (95% CI: 29.75-286.34), respectively. The Area under the HSROC curve was 0.95 (95% CI: 0.92–0.96). Meta-regression analysis identified the year of publication as a covariate significantly associated with heterogeneity. A high risk of bias was detected in the “patient selection” domains. Conclusion CECT has a fundamental role in identifying THVMI with high specificity but suboptimal sensitivity. Clinical criteria are still of paramount importance, especially in cases of ambiguous initial CECT images.

Prophylactic mesh augmentation placement in the closure of midline laparotomy is a technique with promising clinical results, but at the same time, many surgeons remain concerned due to infections and surgical complications. Our group demonstrated in this recent systematic review and meta-analysis that prophylactic mesh placement has a significant decrease in incisional hernia (IH) rate at 1-, 2-, 3- and 4-year follow-up; at the same time, our results identified a trend of higher rates of wound dehiscence, wound complications and seroma but not reaching any statistical significance¹.

Complete mesogastric excision (CME) has been advocated to allow for a more extensive retrieval of lymph nodes, as well as lowering loco-regional recurrence rates. This study aims to analyze the short-term outcomes of D2 radical gastrectomy with CME compared to standard D2 gastrectomy. A systematic review of the literature was conducted according to the Cochrane recommendations until 2 July 2023 (PROSPERO ID: CRD42023443361). The primary outcome, expressed as mean difference (MD) and 95% confidence intervals (CI), was the number of harvested lymph nodes (LNs). Meta-analyses of means and binary outcomes were developed using random effects models to assess heterogeneity. The risk of bias in included studies was assessed with the RoB 2 and ROBINS-I tools. There were 13 studies involving 2009 patients that were included, revealing a significantly higher mean number of harvested LNs in the CME group (MD: 2.55; 95% CI: 0.25–4.86; 95%; p = 0.033). The CME group also experienced significantly lower intraoperative blood loss, a lower length of stay, and a shorter operative time. Three studies showed a serious risk of bias, and between-study heterogeneity was mostly moderate or high. Radical gastrectomy with CME may offer a safe and more radical lymphadenectomy, but long-term outcomes and the applicability of this technique in the West are still to be proven.