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2. Risk factors for postoperative morbidity following appendectomy in the elderly: a nationwide prospective cohort study

Author

Poillucci, G, Podda, M, Pisanu, A, Mortola, L, Dalla Caneva, P, Massa, G, Costa, G, Savastano, R, Cillara, N, Agresta, F, Alemanno, G, Anania, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Baldazzi, G, Balducci, G, Barbera, G, Bellanova, G, Bergamini, C, Bersigotti, L, Bianchi, P, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buonanno, G, Canini, T, Cardella, S, Carrara, G, Cassini, D, Castriconi, M, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Crucitti, A, De Luca, M, De Manzoni Garberini, A, De Nisco, C, De Prizio, M, De Sol, A, Dibella, A, Falcioni, T, Falco, N, Farina, C, Finotti, E, Fontana, T, Francioni, G, Fransvea, P, Frezza, B, Garulli, G, Genna, M, Giannessi, S, Gioffre, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laterza, E, Leonardi, A, Lepre, L, Lorenzon, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Mecarelli, V, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, Palini, G, Paradies, D, Paroli, M, Perrone, F, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, M, Porfidia, R, Rossi, G, Ruscelli, P, Spagnoli, A, Sulis, R, Tartaglia, D, Trana, C, Travaglino, A, Tomaiuolo, P, Valeri, A, Vasquez, G, Zago, M, Zanoni, E, Poillucci G., Podda M., Pisanu A., Mortola L., Dalla Caneva P., Massa G., Costa G., Savastano R., Cillara N., Agresta F., Alemanno G., Anania G., Antropoli M., Argenio G., Atzeni J., Avenia N., Azzinnaro A., Baldazzi G., Balducci G., Barbera G., Bellanova G., Bergamini C., Bersigotti L., Bianchi P. P., Bombardini C., Borzellino G., Bozzo S., Brachini G., Buonanno G. M., Canini T., Cardella S., Carrara G., Cassini D., Castriconi M., Ceccarelli G., Celi D., Ceresoli M., Chiarugi M., Cimino F., Cobuccio L., Cocorullo G., Colangelo E., Crucitti A., De Luca M., De Manzoni Garberini A., De Nisco C., De Prizio M., De Sol A., Dibella A., Falcioni T., Falco N., Farina C., Finotti E., Fontana T., Francioni G., Fransvea P., Frezza B., Garulli G., Genna M., Giannessi S., Gioffre A., Giordano A., Gozzo D., Grimaldi S., Gulotta G., Iacopini V., Iarussi T., Laterza E., Leonardi A., Lepre L., Lorenzon L., Luridiana G., Malagnino A., Mar G., Marini P., Marzaioli R., Mecarelli V., Mingoli A., Nigri G., Occhionorelli S., Paderno N., Palini G. M., Paradies D., Paroli M., Perrone F., Petruzzelli L., Pezzolla A., Piazza D., Piazza V., Piccoli M., Porfidia R., Rossi G., Ruscelli P., Spagnoli A., Sulis R., Tartaglia D., Trana C., Travaglino A., Tomaiuolo P., Valeri A., Vasquez G., Zago M., Zanoni E., Poillucci, G, Podda, M, Pisanu, A, Mortola, L, Dalla Caneva, P, Massa, G, Costa, G, Savastano, R, Cillara, N, Agresta, F, Alemanno, G, Anania, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Baldazzi, G, Balducci, G, Barbera, G, Bellanova, G, Bergamini, C, Bersigotti, L, Bianchi, P, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buonanno, G, Canini, T, Cardella, S, Carrara, G, Cassini, D, Castriconi, M, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Crucitti, A, De Luca, M, De Manzoni Garberini, A, De Nisco, C, De Prizio, M, De Sol, A, Dibella, A, Falcioni, T, Falco, N, Farina, C, Finotti, E, Fontana, T, Francioni, G, Fransvea, P, Frezza, B, Garulli, G, Genna, M, Giannessi, S, Gioffre, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laterza, E, Leonardi, A, Lepre, L, Lorenzon, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Mecarelli, V, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, Palini, G, Paradies, D, Paroli, M, Perrone, F, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, M, Porfidia, R, Rossi, G, Ruscelli, P, Spagnoli, A, Sulis, R, Tartaglia, D, Trana, C, Travaglino, A, Tomaiuolo, P, Valeri, A, Vasquez, G, Zago, M, Zanoni, E, Poillucci G., Podda M., Pisanu A., Mortola L., Dalla Caneva P., Massa G., Costa G., Savastano R., Cillara N., Agresta F., Alemanno G., Anania G., Antropoli M., Argenio G., Atzeni J., Avenia N., Azzinnaro A., Baldazzi G., Balducci G., Barbera G., Bellanova G., Bergamini C., Bersigotti L., Bianchi P. P., Bombardini C., Borzellino G., Bozzo S., Brachini G., Buonanno G. M., Canini T., Cardella S., Carrara G., Cassini D., Castriconi M., Ceccarelli G., Celi D., Ceresoli M., Chiarugi M., Cimino F., Cobuccio L., Cocorullo G., Colangelo E., Crucitti A., De Luca M., De Manzoni Garberini A., De Nisco C., De Prizio M., De Sol A., Dibella A., Falcioni T., Falco N., Farina C., Finotti E., Fontana T., Francioni G., Fransvea P., Frezza B., Garulli G., Genna M., Giannessi S., Gioffre A., Giordano A., Gozzo D., Grimaldi S., Gulotta G., Iacopini V., Iarussi T., Laterza E., Leonardi A., Lepre L., Lorenzon L., Luridiana G., Malagnino A., Mar G., Marini P., Marzaioli R., Mecarelli V., Mingoli A., Nigri G., Occhionorelli S., Paderno N., Palini G. M., Paradies D., Paroli M., Perrone F., Petruzzelli L., Pezzolla A., Piazza D., Piazza V., Piccoli M., Porfidia R., Rossi G., Ruscelli P., Spagnoli A., Sulis R., Tartaglia D., Trana C., Travaglino A., Tomaiuolo P., Valeri A., Vasquez G., Zago M., and Zanoni E.

Abstract

Background: A limited number of studies investigating perioperative risk factors associated with emergency appendectomy in elderly patients have been published to date. Whether older age may be associated with poorer outcomes following appendectomy is still a matter of debate. The primary aim of this study was to determine the predictors of postoperative morbidity following appendectomy in patients aged ≥ 65 years. Methods: Data regarding all elderly patients who underwent emergency appendectomy from January 2017 to June 2018 admitted 36 Italian surgical departments were prospectively collected and analyzed. Baseline demographics and perioperative variables were evaluated. Uni- and multivariate analyses adjusted for differences between groups were carried out to determine possible predictors of adverse outcomes after appendectomy. Results: Between January 2017 and June 2018, 135 patients aged ≥ 65 years with a diagnosis of AA met the study inclusion criteria. Twenty-six patients (19.3%) were diagnosed with some type of postoperative complication. Decreasing the preoperative hemoglobin level showed a statistically significant association with postoperative complications (OR 0.77, CI 0.61–0.97, P = 0.03). Preoperative creatinine level (P = 0.02, OR 2.04, CI 1.12–3.72), and open appendectomy (P = 0.03, OR 2.67, CI 1.11–6.38) were significantly associated with postoperative morbidity. After adjustment, the only independent predictor of postoperative morbidity was preoperative creatinine level (P = 0.04, OR 2.01, CI 1.05–3.89). Conclusions: In elderly patients with AA, perioperative risk assessment in the emergency setting must be as accurate as possible to identify modifiable risk factors that can be addressed before surgery, such as preoperative hemoglobin and creatinine levels.

Published
2021

3. The use of emergency laparoscopy for acute abdomen in the elderly: the FRAILESEL Italian Multicenter Prospective Cohort Study

Author

Costa, G, Fransvea, P, Podda, M, Pisanu, A, Carrano, F, Iossa, A, Balducci, G, Agresta, F, Alemanno, G, Anania, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Baldazzi, G, Barbera, G, Bellanova, G, Bergamini, C, Bersigotti, L, Bianchi, P, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buonanno, G, Canini, T, Cardella, S, Carrara, G, Cassini, D, Castriconi, M, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Crucitti, A, Dalla Caneva, P, De Luca, M, de Manzoni Garberini, A, De Nisco, C, De Prizio, M, De Sol, A, Dibella, A, Falcioni, T, Falco, N, Farina, C, Finotti, E, Fontana, T, Francioni, G, Frezza, B, Garulli, G, Genna, M, Giannessi, S, Gioffre, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laterza, E, Leonardi, A, Lepre, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Massa, G, Mecarelli, V, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, Palini, G, Paradies, D, Paroli, M, Perrone, F, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, M, Poillucci, G, Porfidia, R, Rossi, G, Ruscelli, P, Spagnoli, A, Sulis, R, Tartaglia, D, Trana, C, Travaglino, A, Tomaiuolo, P, Valeri, A, Vasquez, G, Zago, M, Zanoni, E, Costa G., Fransvea P., Podda M., Pisanu A., Carrano F. M., Iossa A., Balducci G., Agresta F., Alemanno G., Anania G., Antropoli M., Argenio G., Atzeni J., Avenia N., Azzinnaro A., Baldazzi G., Barbera G., Bellanova G., Bergamini C., Bersigotti L., Bianchi P. P., Bombardini C., Borzellino G., Bozzo S., Brachini G., Buonanno G. M., Canini T., Cardella S., Carrara G., Cassini D., Castriconi M., Ceccarelli G., Celi D., Ceresoli M., Chiarugi M., Cillara N., Cimino F., Cobuccio L., Cocorullo G., Colangelo E., Crucitti A., Dalla Caneva P., De Luca M., de Manzoni Garberini A., De Nisco C., De Prizio M., De Sol A., Dibella A., Falcioni T., Falco N., Farina C., Finotti E., Fontana T., Francioni G., Frezza B., Garulli G., Genna M., Giannessi S., Gioffre A., Giordano A., Gozzo D., Grimaldi S., Gulotta G., Iacopini V., Iarussi T., Laterza E., Leonardi A., Lepre L., Luridiana G., Malagnino A., Mar G., Marini P., Marzaioli R., Massa G., Mecarelli V., Mingoli A., Nigri G., Occhionorelli S., Paderno N., Palini G. M., Paradies D., Paroli M., Perrone F., Petruzzelli L., Pezzolla A., Piazza D., Piazza V., Piccoli M., Poillucci G., Porfidia R., Rossi G., Ruscelli P., Spagnoli A., Sulis R., Tartaglia D., Trana C., Travaglino A., Tomaiuolo P., Valeri A., Vasquez G., Zago M., Zanoni E., Costa, G, Fransvea, P, Podda, M, Pisanu, A, Carrano, F, Iossa, A, Balducci, G, Agresta, F, Alemanno, G, Anania, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Baldazzi, G, Barbera, G, Bellanova, G, Bergamini, C, Bersigotti, L, Bianchi, P, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buonanno, G, Canini, T, Cardella, S, Carrara, G, Cassini, D, Castriconi, M, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Crucitti, A, Dalla Caneva, P, De Luca, M, de Manzoni Garberini, A, De Nisco, C, De Prizio, M, De Sol, A, Dibella, A, Falcioni, T, Falco, N, Farina, C, Finotti, E, Fontana, T, Francioni, G, Frezza, B, Garulli, G, Genna, M, Giannessi, S, Gioffre, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laterza, E, Leonardi, A, Lepre, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Massa, G, Mecarelli, V, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, Palini, G, Paradies, D, Paroli, M, Perrone, F, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, M, Poillucci, G, Porfidia, R, Rossi, G, Ruscelli, P, Spagnoli, A, Sulis, R, Tartaglia, D, Trana, C, Travaglino, A, Tomaiuolo, P, Valeri, A, Vasquez, G, Zago, M, Zanoni, E, Costa G., Fransvea P., Podda M., Pisanu A., Carrano F. M., Iossa A., Balducci G., Agresta F., Alemanno G., Anania G., Antropoli M., Argenio G., Atzeni J., Avenia N., Azzinnaro A., Baldazzi G., Barbera G., Bellanova G., Bergamini C., Bersigotti L., Bianchi P. P., Bombardini C., Borzellino G., Bozzo S., Brachini G., Buonanno G. M., Canini T., Cardella S., Carrara G., Cassini D., Castriconi M., Ceccarelli G., Celi D., Ceresoli M., Chiarugi M., Cillara N., Cimino F., Cobuccio L., Cocorullo G., Colangelo E., Crucitti A., Dalla Caneva P., De Luca M., de Manzoni Garberini A., De Nisco C., De Prizio M., De Sol A., Dibella A., Falcioni T., Falco N., Farina C., Finotti E., Fontana T., Francioni G., Frezza B., Garulli G., Genna M., Giannessi S., Gioffre A., Giordano A., Gozzo D., Grimaldi S., Gulotta G., Iacopini V., Iarussi T., Laterza E., Leonardi A., Lepre L., Luridiana G., Malagnino A., Mar G., Marini P., Marzaioli R., Massa G., Mecarelli V., Mingoli A., Nigri G., Occhionorelli S., Paderno N., Palini G. M., Paradies D., Paroli M., Perrone F., Petruzzelli L., Pezzolla A., Piazza D., Piazza V., Piccoli M., Poillucci G., Porfidia R., Rossi G., Ruscelli P., Spagnoli A., Sulis R., Tartaglia D., Trana C., Travaglino A., Tomaiuolo P., Valeri A., Vasquez G., Zago M., and Zanoni E.

Abstract

As the world population is aging rapidly, emergency abdominal surgery for acute abdomen in the elderly represents a global issue, both in developed and developing countries. Data regarding all the elderly patients who underwent emergency abdominal surgery from January 2017 to December 2017 at 36 Italian surgical departments were analyzed with the aim to appraise the contemporary reality regarding the use of emergency laparoscopy for acute abdomen in the elderly. 1993 patients were enrolled. 1369 (68.7%) patients were operated with an open technique; whereas, 624 (31.3%) underwent a laparoscopic operation. The postoperative morbidity rate was 32.6%, with a statically significant difference between the open and the laparoscopic groups (36.2% versus 22.1%, p < 0.001). The reported mortality rate was 8.8%, with a statistically significant difference between the open and the laparoscopic groups (11.2% versus 2.2%, p < 0.001). Our results demonstrated that patients in the ASA II (58.1%), ASA III (68.7%) and ASA IV (88.5%) groups were operated with the traditional open technique in most of the cases. Only a small percentage of patients underwent laparoscopy for perforated gastro-duodenal ulcer repair (18.9%), adhesiolyses with/without small bowel resection (12.2%), and large bowel resection (10.7%). Conversion to open technique was associated with a higher mortality rate (11.1% versus 2.2%, p < 0.001) and overall morbidity (38.9% versus 22.1%, p = 0.001) compared with patients who did not undergo conversion. High creatinine (p < 0.001) and glycaemia (p = 0.006) levels, low hemoglobin levels (p < 0.001), oral anticoagulation therapy (p = 0.001), acute respiratory failure (p < 0.001), presence of malignancy (p = 0.001), SIRS (p < 0.001) and open surgical approach (p < 0.001) were associated with an increased risk of postoperative morbidity. Regardless of technical progress, elderly patients undergoing emergency surgery are at very high risk for in-hos

Published
2020

4. Emergency hernia repair in the elderly: multivariate analysis of morbidity and mortality from an Italian registry

Author

Ceresoli, M, Carissimi, F, Nigro, A, Fransvea, P, Lepre, L, Braga, M, Costa, G, Agresta, F, Alemanno, G, Anania, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Baldazzi, G, Balducci, G, Barbera, G, Bellanova, G, Bergamini, C, Bersigotti, L, Bianchi, P, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buonanno, G, Canini, T, Cardella, S, Carrara, G, Cassini, D, Castriconi, M, Ceccarelli, G, Celi, D, Chiappetta, M, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Crucitti, A, Dallacaneva, P, Luca, M, de Manzoni Garberini, A, De Nisco, C, De Prizio, M, De Sol, A, Dibella, A, Falcioni, T, Falco, N, Farina, C, Finotti, E, Fontana, T, Francioni, G, Frezza, B, Garbarino, G, Garulli, G, Genna, M, Giannessi, S, Gioffre, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laracca, G, Laterza, E, Leonardi, A, Lorenzon, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Massa, G, Mecarelli, V, Mercantini, P, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, Palini, G, Paradies, D, Paroli, M, Perrone, F, Petrucciani, N, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, M, Pisanu, A, Podda, M, Poillucci, G, Porfidia, R, Rossi, G, Ruscelli, P, Spagnoli, A, Sulis, R, Tartaglia, D, Trana, C, Travaglino, A, Tomaiuolo, P, Valeri, A, Vasquez, G, Zago, M, Zanoni, E, Ceresoli M., Carissimi F., Nigro A., Fransvea P., Lepre L., Braga M., Costa G., Agresta F., Alemanno G., Anania G., Antropoli M., Argenio G., Atzeni J., Avenia N., Azzinnaro A., Baldazzi G., Balducci G., Barbera G., Bellanova G., Bergamini C., Bersigotti L., Bianchi P. P., Bombardini C., Borzellino G., Bozzo S., Brachini G., Buonanno G. M., Canini T., Cardella S., Carrara G., Cassini D., Castriconi M., Ceccarelli G., Celi D., Chiappetta M., Chiarugi M., Cillara N., Cimino F., Cobuccio L., Cocorullo G., Colangelo E., Crucitti A., DallaCaneva P., Luca M., de Manzoni Garberini A., De Nisco C., De Prizio M., De Sol A., Dibella A., Falcioni T., Falco N., Farina C., Finotti E., Fontana T., Francioni G., Frezza B., Garbarino G., Garulli G., Genna M., Giannessi S., Gioffre A., Giordano A., Gozzo D., Grimaldi S., Gulotta G., Iacopini V., Iarussi T., Laracca G., Laterza E., Leonardi A., Lorenzon L., Luridiana G., Malagnino A., Mar G., Marini P., Marzaioli R., Massa G., Mecarelli V., Mercantini P., Mingoli A., Nigri G., Occhionorelli S., Paderno N., Palini G. M., Paradies D., Paroli M., Perrone F., Petrucciani N., Petruzzelli L., Pezzolla A., Piazza D., Piazza V., Piccoli M., Pisanu A., Podda M., Poillucci G., Porfidia R., Rossi G., Ruscelli P., Spagnoli A., Sulis R., Tartaglia D., Trana C., Travaglino A., Tomaiuolo P., Valeri A., Vasquez G., Zago M., Zanoni E., Ceresoli, M, Carissimi, F, Nigro, A, Fransvea, P, Lepre, L, Braga, M, Costa, G, Agresta, F, Alemanno, G, Anania, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Baldazzi, G, Balducci, G, Barbera, G, Bellanova, G, Bergamini, C, Bersigotti, L, Bianchi, P, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buonanno, G, Canini, T, Cardella, S, Carrara, G, Cassini, D, Castriconi, M, Ceccarelli, G, Celi, D, Chiappetta, M, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Crucitti, A, Dallacaneva, P, Luca, M, de Manzoni Garberini, A, De Nisco, C, De Prizio, M, De Sol, A, Dibella, A, Falcioni, T, Falco, N, Farina, C, Finotti, E, Fontana, T, Francioni, G, Frezza, B, Garbarino, G, Garulli, G, Genna, M, Giannessi, S, Gioffre, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laracca, G, Laterza, E, Leonardi, A, Lorenzon, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Massa, G, Mecarelli, V, Mercantini, P, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, Palini, G, Paradies, D, Paroli, M, Perrone, F, Petrucciani, N, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, M, Pisanu, A, Podda, M, Poillucci, G, Porfidia, R, Rossi, G, Ruscelli, P, Spagnoli, A, Sulis, R, Tartaglia, D, Trana, C, Travaglino, A, Tomaiuolo, P, Valeri, A, Vasquez, G, Zago, M, Zanoni, E, Ceresoli M., Carissimi F., Nigro A., Fransvea P., Lepre L., Braga M., Costa G., Agresta F., Alemanno G., Anania G., Antropoli M., Argenio G., Atzeni J., Avenia N., Azzinnaro A., Baldazzi G., Balducci G., Barbera G., Bellanova G., Bergamini C., Bersigotti L., Bianchi P. P., Bombardini C., Borzellino G., Bozzo S., Brachini G., Buonanno G. M., Canini T., Cardella S., Carrara G., Cassini D., Castriconi M., Ceccarelli G., Celi D., Chiappetta M., Chiarugi M., Cillara N., Cimino F., Cobuccio L., Cocorullo G., Colangelo E., Crucitti A., DallaCaneva P., Luca M., de Manzoni Garberini A., De Nisco C., De Prizio M., De Sol A., Dibella A., Falcioni T., Falco N., Farina C., Finotti E., Fontana T., Francioni G., Frezza B., Garbarino G., Garulli G., Genna M., Giannessi S., Gioffre A., Giordano A., Gozzo D., Grimaldi S., Gulotta G., Iacopini V., Iarussi T., Laracca G., Laterza E., Leonardi A., Lorenzon L., Luridiana G., Malagnino A., Mar G., Marini P., Marzaioli R., Massa G., Mecarelli V., Mercantini P., Mingoli A., Nigri G., Occhionorelli S., Paderno N., Palini G. M., Paradies D., Paroli M., Perrone F., Petrucciani N., Petruzzelli L., Pezzolla A., Piazza D., Piazza V., Piccoli M., Pisanu A., Podda M., Poillucci G., Porfidia R., Rossi G., Ruscelli P., Spagnoli A., Sulis R., Tartaglia D., Trana C., Travaglino A., Tomaiuolo P., Valeri A., Vasquez G., Zago M., and Zanoni E.

Abstract

Purpose: The incidence of inguinal hernia is higher in elderly because of aging-related diseases like prostatism, bronchitis, collagen laxity. A conservative management is common in elderly to reduce surgery-related risks, however watchful waiting can expose to obstruction and strangulation. The aim of the present study was to assess the impact of emergency surgery in a large series of elderly with complicated groin hernia and to identify the independent risk factors for postoperative morbidity and mortality. The predictive performance of prognostic risk scores has been also assessed. Methods: This is a prospective observational study carried out between January 2017 and June 2018 in elderly patients who underwent emergency surgery for complicated hernia in 38 Italian hospitals. Pre-operative, surgical and postoperative data were recorded for each patient. ASA score, Charlson’s comorbidity index, P-POSSUM and CR-POSSUM were assessed. Results: 259 patients were recruited, mean age was 80 years. A direct repair without mesh was performed in 62 (23.9%) patients. Explorative laparotomy was performed in 56 (21.6%) patients and bowel resection was necessary in 44 (17%). Mortality occurred in seven (2.8%) patients. Fifty-five (21.2%) patients developed complications, 12 of whom had a major one. At univariate and multivariate analyses, Charlson’s comorbidity index ≥ 6, altered mental status, and need for laparotomy were associated with major complications and mortality Conclusion: Emergency surgery for complicated hernia is burdened by high morbidity and mortality in elderly patients. Preoperative comorbidity played a pivotal role in predicting complications and mortality and therefore Charlson’s comorbidity index could be adopted to select patients for elective operation.

Published
2020

5. Emergency hernia repair in the elderly: multivariate analysis of morbidity and mortality from an Italian registry

Author

Ceresoli, M., Carissimi, F., Nigro, A., Fransvea, Pietro, Lepre, Luca, Braga, M., Costa, G., Agresta, F., Alemanno, G., Anania, G., Antropoli, M., Argenio, G., Atzeni, J., Avenia, N., Azzinnaro, A., Baldazzi, G., Balducci, G., Barbera, Giorgio, Bellanova, G., Bergamini, C., Bersigotti, L., Bianchi, P. P., Bombardini, C., Borzellino, G., Bozzo, S., Brachini, G., Buonanno, G. M., Canini, T., Cardella, S., Carrara, Giancarlo, Cassini, D., Castriconi, M., Ceccarelli, Giovanni Maria, Celi, D., Chiappetta, M., Chiarugi, M., Cillara, N., Cimino, Filippo Alessandro, Cobuccio, L., Cocorullo, G., Colangelo, E., Crucitti, Antonio, Dallacaneva, P., Luca, M., de Manzoni Garberini, A., De Nisco, C., De Prizio, M., De Sol, A., Dibella, A., Falcioni, T., Falco, N., Farina, C., Finotti, E., Fontana, T., Francioni, Gianfranco, Frezza, B., Garbarino, G., Garulli, G., Genna, M., Giannessi, S., Gioffre, A., Giordano, Alessandro, Gozzo, D., Grimaldi, S., Gulotta, G., Iacopini, V., Iarussi, T., Laracca, G., Laterza, E., Leonardi, Marco Antonio, Lorenzon, Laura, Luridiana, G., Malagnino, A., Mar, G., Marini, P., Marzaioli, R., Massa, G., Mecarelli, V., Mercantini, P., Mingoli, A., Nigri, G., Occhionorelli, S., Paderno, N., Palini, G. M., Paradies, D., Paroli, M., Perrone, F., Petrucciani, N., Petruzzelli, L., Pezzolla, A., Piazza, D., Piazza, V., Piccoli, M., Pisanu, A., Podda, Maria Vittoria, Poillucci, G., Porfidia, R., Rossi, G., Ruscelli, P., Spagnoli, A., Sulis, R., Tartaglia, D., Trana, C., Travaglino, A., Tomaiuolo, P., Valeri, A., Vasquez, G., Zago, M., Zanoni, E., Fransvea P. (ORCID:0000-0003-4969-3373), Lepre L., Barbera G. (ORCID:0000-0003-1581-0500), Carrara G., Ceccarelli G., Cimino F., Crucitti A. (ORCID:0000-0003-3496-4185), Francioni G., Giordano A. (ORCID:0000-0002-6978-0880), Leonardi A., Lorenzon L. (ORCID:0000-0001-6736-0383), Podda M. (ORCID:0000-0002-2779-8417), Ceresoli, M., Carissimi, F., Nigro, A., Fransvea, Pietro, Lepre, Luca, Braga, M., Costa, G., Agresta, F., Alemanno, G., Anania, G., Antropoli, M., Argenio, G., Atzeni, J., Avenia, N., Azzinnaro, A., Baldazzi, G., Balducci, G., Barbera, Giorgio, Bellanova, G., Bergamini, C., Bersigotti, L., Bianchi, P. P., Bombardini, C., Borzellino, G., Bozzo, S., Brachini, G., Buonanno, G. M., Canini, T., Cardella, S., Carrara, Giancarlo, Cassini, D., Castriconi, M., Ceccarelli, Giovanni Maria, Celi, D., Chiappetta, M., Chiarugi, M., Cillara, N., Cimino, Filippo Alessandro, Cobuccio, L., Cocorullo, G., Colangelo, E., Crucitti, Antonio, Dallacaneva, P., Luca, M., de Manzoni Garberini, A., De Nisco, C., De Prizio, M., De Sol, A., Dibella, A., Falcioni, T., Falco, N., Farina, C., Finotti, E., Fontana, T., Francioni, Gianfranco, Frezza, B., Garbarino, G., Garulli, G., Genna, M., Giannessi, S., Gioffre, A., Giordano, Alessandro, Gozzo, D., Grimaldi, S., Gulotta, G., Iacopini, V., Iarussi, T., Laracca, G., Laterza, E., Leonardi, Marco Antonio, Lorenzon, Laura, Luridiana, G., Malagnino, A., Mar, G., Marini, P., Marzaioli, R., Massa, G., Mecarelli, V., Mercantini, P., Mingoli, A., Nigri, G., Occhionorelli, S., Paderno, N., Palini, G. M., Paradies, D., Paroli, M., Perrone, F., Petrucciani, N., Petruzzelli, L., Pezzolla, A., Piazza, D., Piazza, V., Piccoli, M., Pisanu, A., Podda, Maria Vittoria, Poillucci, G., Porfidia, R., Rossi, G., Ruscelli, P., Spagnoli, A., Sulis, R., Tartaglia, D., Trana, C., Travaglino, A., Tomaiuolo, P., Valeri, A., Vasquez, G., Zago, M., Zanoni, E., Fransvea P. (ORCID:0000-0003-4969-3373), Lepre L., Barbera G. (ORCID:0000-0003-1581-0500), Carrara G., Ceccarelli G., Cimino F., Crucitti A. (ORCID:0000-0003-3496-4185), Francioni G., Giordano A. (ORCID:0000-0002-6978-0880), Leonardi A., Lorenzon L. (ORCID:0000-0001-6736-0383), and Podda M. (ORCID:0000-0002-2779-8417)

Abstract

Purpose: The incidence of inguinal hernia is higher in elderly because of aging-related diseases like prostatism, bronchitis, collagen laxity. A conservative management is common in elderly to reduce surgery-related risks, however watchful waiting can expose to obstruction and strangulation. The aim of the present study was to assess the impact of emergency surgery in a large series of elderly with complicated groin hernia and to identify the independent risk factors for postoperative morbidity and mortality. The predictive performance of prognostic risk scores has been also assessed. Methods: This is a prospective observational study carried out between January 2017 and June 2018 in elderly patients who underwent emergency surgery for complicated hernia in 38 Italian hospitals. Pre-operative, surgical and postoperative data were recorded for each patient. ASA score, Charlson’s comorbidity index, P-POSSUM and CR-POSSUM were assessed. Results: 259 patients were recruited, mean age was 80 years. A direct repair without mesh was performed in 62 (23.9%) patients. Explorative laparotomy was performed in 56 (21.6%) patients and bowel resection was necessary in 44 (17%). Mortality occurred in seven (2.8%) patients. Fifty-five (21.2%) patients developed complications, 12 of whom had a major one. At univariate and multivariate analyses, Charlson’s comorbidity index ≥ 6, altered mental status, and need for laparotomy were associated with major complications and mortality Conclusion: Emergency surgery for complicated hernia is burdened by high morbidity and mortality in elderly patients. Preoperative comorbidity played a pivotal role in predicting complications and mortality and therefore Charlson’s comorbidity index could be adopted to select patients for elective operation.

Published
2020

6. The use of emergency laparoscopy for acute abdomen in the elderly: the FRAILESEL Italian Multicenter Prospective Cohort Study

Author

Costa, G., Fransvea, P., Podda, M., Pisanu, A., Carrano, F. M., Iossa, A., Balducci, G., Agresta, F., Alemanno, G., Anania, G., Antropoli, M., Argenio, G., Atzeni, J., Avenia, N., Azzinnaro, A., Baldazzi, G., Barbera, G., Bellanova, G., Bergamini, C., Bersigotti, L., Bianchi, P. P., Bombardini, C., Borzellino, G., Bozzo, S., Brachini, G., Buonanno, G. M., Canini, T., Cardella, S., Carrara, G., Cassini, D., Castriconi, M., Ceccarelli, G., Celi, D., Ceresoli, M., Chiarugi, M., Cillara, N., Cimino, F., Cobuccio, L., Cocorullo, G., Colangelo, E., Crucitti, Antonio, Dalla Caneva, P., De Luca, M., de Manzoni Garberini, A., De Nisco, C., De Prizio, M., De Sol, A., Dibella, A., Falcioni, T., Falco, N., Farina, C., Finotti, E., Fontana, T., Francioni, G., Frezza, B., Garulli, G., Genna, M., Giannessi, S., Gioffre, A., Giordano, Alessandro, Gozzo, D., Grimaldi, S., Gulotta, G., Iacopini, V., Iarussi, T., Laterza, E., Leonardi, A., Lepre, L., Luridiana, G., Malagnino, A., Mar, G., Marini, P., Marzaioli, R., Massa, G., Mecarelli, V., Mingoli, A., Nigri, G., Occhionorelli, S., Paderno, N., Palini, G. M., Paradies, D., Paroli, M., Perrone, F., Petruzzelli, L., Pezzolla, A., Piazza, D., Piazza, V., Piccoli, M., Poillucci, G., Porfidia, R., Rossi, G., Ruscelli, P., Spagnoli, A., Sulis, R., Tartaglia, D., Trana, C., Travaglino, A., Tomaiuolo, P., Valeri, A., Vasquez, G., Zago, M., Zanoni, E., Crucitti A. (ORCID:0000-0003-3496-4185), Costa, G., Fransvea, P., Podda, M., Pisanu, A., Carrano, F. M., Iossa, A., Balducci, G., Agresta, F., Alemanno, G., Anania, G., Antropoli, M., Argenio, G., Atzeni, J., Avenia, N., Azzinnaro, A., Baldazzi, G., Barbera, G., Bellanova, G., Bergamini, C., Bersigotti, L., Bianchi, P. P., Bombardini, C., Borzellino, G., Bozzo, S., Brachini, G., Buonanno, G. M., Canini, T., Cardella, S., Carrara, G., Cassini, D., Castriconi, M., Ceccarelli, G., Celi, D., Ceresoli, M., Chiarugi, M., Cillara, N., Cimino, F., Cobuccio, L., Cocorullo, G., Colangelo, E., Crucitti, Antonio, Dalla Caneva, P., De Luca, M., de Manzoni Garberini, A., De Nisco, C., De Prizio, M., De Sol, A., Dibella, A., Falcioni, T., Falco, N., Farina, C., Finotti, E., Fontana, T., Francioni, G., Frezza, B., Garulli, G., Genna, M., Giannessi, S., Gioffre, A., Giordano, Alessandro, Gozzo, D., Grimaldi, S., Gulotta, G., Iacopini, V., Iarussi, T., Laterza, E., Leonardi, A., Lepre, L., Luridiana, G., Malagnino, A., Mar, G., Marini, P., Marzaioli, R., Massa, G., Mecarelli, V., Mingoli, A., Nigri, G., Occhionorelli, S., Paderno, N., Palini, G. M., Paradies, D., Paroli, M., Perrone, F., Petruzzelli, L., Pezzolla, A., Piazza, D., Piazza, V., Piccoli, M., Poillucci, G., Porfidia, R., Rossi, G., Ruscelli, P., Spagnoli, A., Sulis, R., Tartaglia, D., Trana, C., Travaglino, A., Tomaiuolo, P., Valeri, A., Vasquez, G., Zago, M., Zanoni, E., and Crucitti A. (ORCID:0000-0003-3496-4185)

Abstract

As the world population is aging rapidly, emergency abdominal surgery for acute abdomen in the elderly represents a global issue, both in developed and developing countries. Data regarding all the elderly patients who underwent emergency abdominal surgery from January 2017 to December 2017 at 36 Italian surgical departments were analyzed with the aim to appraise the contemporary reality regarding the use of emergency laparoscopy for acute abdomen in the elderly. 1993 patients were enrolled. 1369 (68.7%) patients were operated with an open technique; whereas, 624 (31.3%) underwent a laparoscopic operation. The postoperative morbidity rate was 32.6%, with a statically significant difference between the open and the laparoscopic groups (36.2% versus 22.1%, p < 0.001). The reported mortality rate was 8.8%, with a statistically significant difference between the open and the laparoscopic groups (11.2% versus 2.2%, p < 0.001). Our results demonstrated that patients in the ASA II (58.1%), ASA III (68.7%) and ASA IV (88.5%) groups were operated with the traditional open technique in most of the cases. Only a small percentage of patients underwent laparoscopy for perforated gastro-duodenal ulcer repair (18.9%), adhesiolyses with/without small bowel resection (12.2%), and large bowel resection (10.7%). Conversion to open technique was associated with a higher mortality rate (11.1% versus 2.2%, p < 0.001) and overall morbidity (38.9% versus 22.1%, p = 0.001) compared with patients who did not undergo conversion. High creatinine (p < 0.001) and glycaemia (p = 0.006) levels, low hemoglobin levels (p < 0.001), oral anticoagulation therapy (p = 0.001), acute respiratory failure (p < 0.001), presence of malignancy (p = 0.001), SIRS (p < 0.001) and open surgical approach (p < 0.001) were associated with an increased risk of postoperative morbidity. Regardless of technical progress, elderly patients undergoing emergency surgery are at very high risk for in-hospital complications. A d

Published
2020

7. Risk factors for postoperative morbidity following appendectomy in the elderly: a nationwide prospective cohort study

Author

Poillucci, G., Podda, M., Pisanu, A., Mortola, L., Dalla Caneva, P., Massa, G., Costa, G., Savastano, R., Cillara, N., Agresta, F., Alemanno, G., Anania, G., Antropoli, M., Argenio, G., Atzeni, J., Avenia, N., Azzinnaro, A., Baldazzi, G., Balducci, G., Barbera, G., Bellanova, G., Bergamini, C., Bersigotti, L., Bianchi, P. P., Bombardini, C., Borzellino, G., Bozzo, S., Brachini, G., Buonanno, G. M., Canini, T., Cardella, S., Carrara, G., Cassini, D., Castriconi, M., Ceccarelli, G., Celi, D., Ceresoli, M., Chiarugi, M., Cimino, F., Cobuccio, L., Cocorullo, G., Colangelo, E., Crucitti, Antonio, De Luca, M., De Manzoni Garberini, A., De Nisco, C., De Prizio, M., De Sol, A., Dibella, A., Falcioni, T., Falco, N., Farina, C., Finotti, E., Fontana, T., Francioni, G., Fransvea, P., Frezza, B., Garulli, G., Genna, M., Giannessi, S., Gioffre, A., Giordano, Alessandro, Gozzo, D., Grimaldi, S., Gulotta, G., Iacopini, V., Iarussi, T., Laterza, E., Leonardi, A., Lepre, L., Lorenzon, Laura, Luridiana, G., Malagnino, A., Mar, G., Marini, P., Marzaioli, R., Mecarelli, V., Mingoli, A., Nigri, G., Occhionorelli, S., Paderno, N., Palini, G. M., Paradies, D., Paroli, M., Perrone, F., Petruzzelli, L., Pezzolla, A., Piazza, D., Piazza, V., Piccoli, M., Porfidia, R., Rossi, G., Ruscelli, P., Spagnoli, A., Sulis, R., Tartaglia, D., Trana, C., Travaglino, A., Tomaiuolo, P., Valeri, A., Vasquez, G., Zago, M., Zanoni, E., Crucitti A. (ORCID:0000-0003-3496-4185), Giordano A. (ORCID:0000-0002-6978-0880), Lorenzon L. (ORCID:0000-0001-6736-0383), Poillucci, G., Podda, M., Pisanu, A., Mortola, L., Dalla Caneva, P., Massa, G., Costa, G., Savastano, R., Cillara, N., Agresta, F., Alemanno, G., Anania, G., Antropoli, M., Argenio, G., Atzeni, J., Avenia, N., Azzinnaro, A., Baldazzi, G., Balducci, G., Barbera, G., Bellanova, G., Bergamini, C., Bersigotti, L., Bianchi, P. P., Bombardini, C., Borzellino, G., Bozzo, S., Brachini, G., Buonanno, G. M., Canini, T., Cardella, S., Carrara, G., Cassini, D., Castriconi, M., Ceccarelli, G., Celi, D., Ceresoli, M., Chiarugi, M., Cimino, F., Cobuccio, L., Cocorullo, G., Colangelo, E., Crucitti, Antonio, De Luca, M., De Manzoni Garberini, A., De Nisco, C., De Prizio, M., De Sol, A., Dibella, A., Falcioni, T., Falco, N., Farina, C., Finotti, E., Fontana, T., Francioni, G., Fransvea, P., Frezza, B., Garulli, G., Genna, M., Giannessi, S., Gioffre, A., Giordano, Alessandro, Gozzo, D., Grimaldi, S., Gulotta, G., Iacopini, V., Iarussi, T., Laterza, E., Leonardi, A., Lepre, L., Lorenzon, Laura, Luridiana, G., Malagnino, A., Mar, G., Marini, P., Marzaioli, R., Mecarelli, V., Mingoli, A., Nigri, G., Occhionorelli, S., Paderno, N., Palini, G. M., Paradies, D., Paroli, M., Perrone, F., Petruzzelli, L., Pezzolla, A., Piazza, D., Piazza, V., Piccoli, M., Porfidia, R., Rossi, G., Ruscelli, P., Spagnoli, A., Sulis, R., Tartaglia, D., Trana, C., Travaglino, A., Tomaiuolo, P., Valeri, A., Vasquez, G., Zago, M., Zanoni, E., Crucitti A. (ORCID:0000-0003-3496-4185), Giordano A. (ORCID:0000-0002-6978-0880), and Lorenzon L. (ORCID:0000-0001-6736-0383)

Abstract

Background: A limited number of studies investigating perioperative risk factors associated with emergency appendectomy in elderly patients have been published to date. Whether older age may be associated with poorer outcomes following appendectomy is still a matter of debate. The primary aim of this study was to determine the predictors of postoperative morbidity following appendectomy in patients aged ≥ 65 years. Methods: Data regarding all elderly patients who underwent emergency appendectomy from January 2017 to June 2018 admitted 36 Italian surgical departments were prospectively collected and analyzed. Baseline demographics and perioperative variables were evaluated. Uni- and multivariate analyses adjusted for differences between groups were carried out to determine possible predictors of adverse outcomes after appendectomy. Results: Between January 2017 and June 2018, 135 patients aged ≥ 65 years with a diagnosis of AA met the study inclusion criteria. Twenty-six patients (19.3%) were diagnosed with some type of postoperative complication. Decreasing the preoperative hemoglobin level showed a statistically significant association with postoperative complications (OR 0.77, CI 0.61–0.97, P = 0.03). Preoperative creatinine level (P = 0.02, OR 2.04, CI 1.12–3.72), and open appendectomy (P = 0.03, OR 2.67, CI 1.11–6.38) were significantly associated with postoperative morbidity. After adjustment, the only independent predictor of postoperative morbidity was preoperative creatinine level (P = 0.04, OR 2.01, CI 1.05–3.89). Conclusions: In elderly patients with AA, perioperative risk assessment in the emergency setting must be as accurate as possible to identify modifiable risk factors that can be addressed before surgery, such as preoperative hemoglobin and creatinine levels.

Published
2019

8. Frailty and emergency surgery in the elderly: protocol of a prospective, multicenter study in Italy for evaluating perioperative outcome (The FRAILESEL Study)

Author

Mingoli, A, Costa, Gianluca, Massa, Giulia, Agresta, F., Anania, G., Ansaloni, L., Antropoli, M., Argenio, G., Atzeni, J., Avenia, N., Azzinnaro, A., Balani, A., Baldazzi, G., Balducci, G., Barbera, G., Bellanova, G., Bergamini, C., Bersigotti, L., Bianchi, P. P., Bombardini, C., Borzellino, G., Bozzo, S., Brachini, G., Buccoliero, F., Buonanno, G. M., Buononato, M., Campanile, F. C., Canini, T., Cardella, S., Carrara, G., Cascini, F., Cassini, D., Castriconi, M., Catalini, G., Catena, F., Ceccarelli, G., Celi, D., Ceresoli, M., Chiarugi, M., Cillara, N., Cimino, F., Cobuccio, L., Coccolini, F., Cocorullo, G., Colangelo, E., Costa, G., Crafa, F., Crucitti, A., Dalla Caneva, P., De&nbsp, Luca, M., de&nbsp, Manzoni Garberini, A., De Nisco, C., Sol, A., Falcioni, T., Falco, N., Farina, C., Filippone, G., Finotti, E., Fiume, S., Fontana, T., Francioni, G., Fransvea, P., Frezza, B., Gemini, Simone, Genna, M., Giannessi, S., Gioffrè, A., Giordano, A., Gozzo, D., Grimaldi, S., Gulotta, G., Iarussi, T., Laterza, E., Lepre, L., Lorenzon, L., Lotti, R., Luridiana, G., Marini, P., Marzaioli, R., Massa, G., Mulas, S., Nagliati, C., Nigri, G., Niolu, P., Noviello, A., Occhionorelli, S., Paderno, N., Palini, G. M., Paradies, D., Paroli, M., Perrone, F., Petruzzelli, L., Pezzolla, A., Piazza, D., Piazza, V., Piccoli, M., Pisanu, A., Podda, M., Poillucci, Gaetano, Porfidia, R., Rossi, G., Ruscelli, P., Santella, S., Sartelli, M., Spagnoli, A., Sulis, R., Tarasconi, A., Tranà, C., Travaglino, A., Valeri, A., Vasquez, G., Zago, Michela, Zanoni, E., Costa, G, Massa, G, Anania, G, Atzeni, J, Cardella, S, Cimino, F, Cocorullo, G, Falco, N, Farina, M, Fontana, T, Gulotta, G, Piazza, D, Agresta, F, Ansaloni, L, Antropoli, M, Argenio, G, Avenia, N, Azzinnaro, A, Balani, A, Baldazzi, G, Balducci, G, Barbera, G, Bellanova, G, Bergamini, C, Bersigotti, L, Bianchi, P, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buccoliero, F, Buonanno, G, Buononato, M, Campanile, F, Canini, T, Carrara, G, Cascini, F, Cassini, D, Castriconi, M, Catalini, G, Catena, F, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cillara, N, Cobuccio, L, Coccolini, F, Colangelo, E, Crafa, F, Crucitti, A, Dalla Caneva, P, Deluca, M, deManzoni Garberini, A, De Nisco, C, Desol, A, Falcioni, T, Farina, C, Filippone, G, Finotti, E, Fiume, S, Francioni, G, Fransvea, P, Frezza, B, Gemini, S, Genna, M, Giannessi, S, Gioffre, A, Giordano, A, Gozzo, D, Grimaldi, S, Iarussi, T, Laterza, E, Lepre, L, Lorenzon, L, Lotti, R, Luridiana, G, Marini, P, Marzaioli, R, Mingoli, A, Mulas, S, Nagliati, C, Nigri, G, Niolu, P, Noviello, A, Occhionorelli, S, Paderno, N, Palini, G, Paradies, D, Paroli, M, Perrone, F, Petruzzelli, L, Pezzolla, A, Piazza, V, Piccoli, M, Pisanu, A, Podda, M, Poillucci, G, Porfidia, R, Rossi, G, Ruscelli, P, Santella, S, Sartelli, M, Spagnoli, A, Sulis, R, Tarasconi, A, Trana, C, Travaglino, A, Valeri, A, Vasquez, G, Zago, M, and Zanoni, E

Subjects
Elderly patient, Emergency surgery, Frailty, Geriatric, Risk assessment, Scores, Aged, Aged, 80 and over, Clinical Protocols, Emergencies, Female, Humans, Italy, Logistic Models, Male, Multivariate Analysis, Outcome Assessment, Health Care, Postoperative Complications, Prognosis, Prospective Studies, ROC Curve, Risk Assessment, Frail Elderly, Outcome Assessment, 030230 surgery, law.invention, 0302 clinical medicine, Quality of life, law, 80 and over, Prospective cohort study, Multivariate Analysi, Emergencie, Mortality rate, Score, Intensive care unit, Outcome Assessment (Health Care), 030220 oncology & carcinogenesis, elderly patient, emergency surgery, frailty, geriatric, risk assessment, scores, Human, medicine.medical_specialty, Logistic Model, Prognosi, NO, 03 medical and health sciences, medicine, Clinical Protocol, business.industry, Perioperative, Surgery, Health Care, Prospective Studie, Settore MED/18 - Chirurgia Generale, Emergency medicine, Life expectancy, Observational study, Postoperative Complication, business
Abstract

Improvements in living conditions and progress in medical management have resulted in better quality of life and longer life expectancy. Therefore, the number of older people undergoing surgery is increasing. Frailty is often described as a syndrome in aged patients where there is augmented vulnerability due to progressive loss of functional reserves. Studies suggest that frailty predisposes elderly to worsening outcome after surgery. Since emergency surgery is associated with higher mortality rates, it is paramount to have an accurate stratification of surgical risk in such patients. The aim of our study is to characterize the clinicopathological findings, management, and short-term outcome of elderly patients undergoing emergency surgery. The secondary objectives are to evaluate the presence and influence of frailty and analyze the prognostic role of existing risk-scores. The final FRAILESEL protocol was approved by the Ethical Committee of “Sapienza” University of Rome, Italy. The FRAILESEL study is a nationwide, Italian, multicenter, observational study conducted through a resident-led model. Patients over 65years of age who require emergency surgical procedures will be included in this study. The primary outcome measures are 30-day postoperative mortality and morbidity rates. The Clavien-Dindo classification system is used to categorize complications. The secondary outcome measures include length of hospital stay, length of stay in intensive care unit, and predictive value for morbidity and mortality of several frailty and surgical risk-scores. The results of the FRAILESEL study will be disseminated through national and international conference presentations and peer-reviewed journals. The study is also registered at ClinicalTrials.gov (ClinicalTrials.gov identifier: NCT02825082).

Published
2018

9. Frailty and emergency surgery in the elderly: protocol of a prospective, multicenter study in Italy for evaluating perioperative outcome (The FRAILESEL Study)

Author

Costa, G, Massa, G, Agresta, F, Anania, G, Ansaloni, L, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Balani, A, Baldazzi, G, Balducci, G, Barbera, G, Bellanova, G, Bergamini, C, Bersigotti, L, Bianchi, P, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buccoliero, F, Buonanno, G, Buononato, M, Campanile, F, Canini, T, Cardella, S, Carrara, G, Cascini, F, Cassini, D, Castriconi, M, Catalini, G, Catena, F, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Coccolini, F, Cocorullo, G, Colangelo, E, Crafa, F, Crucitti, A, Dalla Caneva, P, Deluca, M, deManzoni Garberini, A, De Nisco, C, Desol, A, Falcioni, T, Falco, N, Farina, C, Filippone, G, Finotti, E, Fiume, S, Fontana, T, Francioni, G, Fransvea, P, Frezza, B, Gemini, S, Genna, M, Giannessi, S, Gioffre, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iarussi, T, Laterza, E, Lepre, L, Lorenzon, L, Lotti, R, Luridiana, G, Marini, P, Marzaioli, R, Mingoli, A, Mulas, S, Nagliati, C, Nigri, G, Niolu, P, Noviello, A, Occhionorelli, S, Paderno, N, Palini, G, Paradies, D, Paroli, M, Perrone, F, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, M, Pisanu, A, Podda, M, Poillucci, G, Porfidia, R, Rossi, G, Ruscelli, P, Santella, S, Sartelli, M, Spagnoli, A, Sulis, R, Tarasconi, A, Trana, C, Travaglino, A, Valeri, A, Vasquez, G, Zago, M, Zanoni, E, Costa G., Massa G., Agresta F., Anania G., Ansaloni L., Antropoli M., Argenio G., Atzeni J., Avenia N., Azzinnaro A., Balani A., Baldazzi G., Balducci G., Barbera G., Bellanova G., Bergamini C., Bersigotti L., Bianchi P. P., Bombardini C., Borzellino G., Bozzo S., Brachini G., Buccoliero F., Buonanno G. M., Buononato M., Campanile F. C., Canini T., Cardella S., Carrara G., Cascini F., Cassini D., Castriconi M., Catalini G., Catena F., Ceccarelli G., Celi D., Ceresoli M., Chiarugi M., Cillara N., Cimino F., Cobuccio L., Coccolini F., Cocorullo G., Colangelo E., Crafa F., Crucitti A., Dalla Caneva P., DeLuca M., deManzoni Garberini A., De Nisco C., DeSol A., Falcioni T., Falco N., Farina C., Filippone G., Finotti E., Fiume S., Fontana T., Francioni G., Fransvea P., Frezza B., Gemini S., Genna M., Giannessi S., Gioffre A., Giordano A., Gozzo D., Grimaldi S., Gulotta G., Iarussi T., Laterza E., Lepre L., Lorenzon L., Lotti R., Luridiana G., Marini P., Marzaioli R., Mingoli A., Mulas S., Nagliati C., Nigri G., Niolu P., Noviello A., Occhionorelli S., Paderno N., Palini G. M., Paradies D., Paroli M., Perrone F., Petruzzelli L., Pezzolla A., Piazza D., Piazza V., Piccoli M., Pisanu A., Podda M., Poillucci G., Porfidia R., Rossi G., Ruscelli P., Santella S., Sartelli M., Spagnoli A., Sulis R., Tarasconi A., Trana C., Travaglino A., Valeri A., Vasquez G., Zago M., Zanoni E., Costa, G, Massa, G, Agresta, F, Anania, G, Ansaloni, L, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Balani, A, Baldazzi, G, Balducci, G, Barbera, G, Bellanova, G, Bergamini, C, Bersigotti, L, Bianchi, P, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buccoliero, F, Buonanno, G, Buononato, M, Campanile, F, Canini, T, Cardella, S, Carrara, G, Cascini, F, Cassini, D, Castriconi, M, Catalini, G, Catena, F, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Coccolini, F, Cocorullo, G, Colangelo, E, Crafa, F, Crucitti, A, Dalla Caneva, P, Deluca, M, deManzoni Garberini, A, De Nisco, C, Desol, A, Falcioni, T, Falco, N, Farina, C, Filippone, G, Finotti, E, Fiume, S, Fontana, T, Francioni, G, Fransvea, P, Frezza, B, Gemini, S, Genna, M, Giannessi, S, Gioffre, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iarussi, T, Laterza, E, Lepre, L, Lorenzon, L, Lotti, R, Luridiana, G, Marini, P, Marzaioli, R, Mingoli, A, Mulas, S, Nagliati, C, Nigri, G, Niolu, P, Noviello, A, Occhionorelli, S, Paderno, N, Palini, G, Paradies, D, Paroli, M, Perrone, F, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, M, Pisanu, A, Podda, M, Poillucci, G, Porfidia, R, Rossi, G, Ruscelli, P, Santella, S, Sartelli, M, Spagnoli, A, Sulis, R, Tarasconi, A, Trana, C, Travaglino, A, Valeri, A, Vasquez, G, Zago, M, Zanoni, E, Costa G., Massa G., Agresta F., Anania G., Ansaloni L., Antropoli M., Argenio G., Atzeni J., Avenia N., Azzinnaro A., Balani A., Baldazzi G., Balducci G., Barbera G., Bellanova G., Bergamini C., Bersigotti L., Bianchi P. P., Bombardini C., Borzellino G., Bozzo S., Brachini G., Buccoliero F., Buonanno G. M., Buononato M., Campanile F. C., Canini T., Cardella S., Carrara G., Cascini F., Cassini D., Castriconi M., Catalini G., Catena F., Ceccarelli G., Celi D., Ceresoli M., Chiarugi M., Cillara N., Cimino F., Cobuccio L., Coccolini F., Cocorullo G., Colangelo E., Crafa F., Crucitti A., Dalla Caneva P., DeLuca M., deManzoni Garberini A., De Nisco C., DeSol A., Falcioni T., Falco N., Farina C., Filippone G., Finotti E., Fiume S., Fontana T., Francioni G., Fransvea P., Frezza B., Gemini S., Genna M., Giannessi S., Gioffre A., Giordano A., Gozzo D., Grimaldi S., Gulotta G., Iarussi T., Laterza E., Lepre L., Lorenzon L., Lotti R., Luridiana G., Marini P., Marzaioli R., Mingoli A., Mulas S., Nagliati C., Nigri G., Niolu P., Noviello A., Occhionorelli S., Paderno N., Palini G. M., Paradies D., Paroli M., Perrone F., Petruzzelli L., Pezzolla A., Piazza D., Piazza V., Piccoli M., Pisanu A., Podda M., Poillucci G., Porfidia R., Rossi G., Ruscelli P., Santella S., Sartelli M., Spagnoli A., Sulis R., Tarasconi A., Trana C., Travaglino A., Valeri A., Vasquez G., Zago M., and Zanoni E.

Abstract

Improvements in living conditions and progress in medical management have resulted in better quality of life and longer life expectancy. Therefore, the number of older people undergoing surgery is increasing. Frailty is often described as a syndrome in aged patients where there is augmented vulnerability due to progressive loss of functional reserves. Studies suggest that frailty predisposes elderly to worsening outcome after surgery. Since emergency surgery is associated with higher mortality rates, it is paramount to have an accurate stratification of surgical risk in such patients. The aim of our study is to characterize the clinicopathological findings, management, and short-term outcome of elderly patients undergoing emergency surgery. The secondary objectives are to evaluate the presence and influence of frailty and analyze the prognostic role of existing risk-scores. The final FRAILESEL protocol was approved by the Ethical Committee of “Sapienza” University of Rome, Italy. The FRAILESEL study is a nationwide, Italian, multicenter, observational study conducted through a resident-led model. Patients over 65 years of age who require emergency surgical procedures will be included in this study. The primary outcome measures are 30-day postoperative mortality and morbidity rates. The Clavien-Dindo classification system is used to categorize complications. The secondary outcome measures include length of hospital stay, length of stay in intensive care unit, and predictive value for morbidity and mortality of several frailty and surgical risk-scores. The results of the FRAILESEL study will be disseminated through national and international conference presentations and peer-reviewed journals. The study is also registered at ClinicalTrials.gov (ClinicalTrials.gov identifier: NCT02825082).

Published
2018

10. Frailty and emergency surgery in the elderly: protocol of a prospective, multicenter study in Italy for evaluating perioperative outcome (The FRAILESEL Study)

Author

Costa, G., Massa, G., Agresta, F., Anania, G., Ansaloni, L., Antropoli, M., Argenio, G., Atzeni, J., Avenia, N., Azzinnaro, A., Balani, A., Baldazzi, G., Balducci, G., Barbera, G., Bellanova, G., Bergamini, C., Bersigotti, L., Bianchi, P. P., Bombardini, C., Borzellino, G., Bozzo, S., Brachini, G., Buccoliero, F., Buonanno, G. M., Buononato, M., Campanile, F. C., Canini, T., Cardella, S., Carrara, G., Cascini, F., Cassini, D., Castriconi, M., Catalini, G., Catena, F., Ceccarelli, G., Celi, D., Ceresoli, M., Chiarugi, M., Cillara, N., Cimino, F., Cobuccio, L., Coccolini, F., Cocorullo, G., Colangelo, E., Crafa, F., Crucitti, Antonio, Dalla Caneva, P., Deluca, M., deManzoni Garberini, A., De Nisco, C., Desol, A., Falcioni, T., Falco, N., Farina, C., Filippone, G., Finotti, E., Fiume, S., Fontana, T., Francioni, G., Fransvea, P., Frezza, B., Gemini, S., Genna, M., Giannessi, S., Gioffre, A., Giordano, Alessandro, Gozzo, D., Grimaldi, S., Gulotta, G., Iarussi, T., Laterza, E., Lepre, L., Lorenzon, Laura, Lotti, R., Luridiana, G., Marini, P., Marzaioli, R., Mingoli, A., Mulas, S., Nagliati, C., Nigri, G., Niolu, P., Noviello, A., Occhionorelli, S., Paderno, N., Palini, G. M., Paradies, D., Paroli, M., Perrone, F., Petruzzelli, L., Pezzolla, A., Piazza, D., Piazza, V., Piccoli, M., Pisanu, A., Podda, M., Poillucci, G., Porfidia, R., Rossi, G., Ruscelli, P., Santella, S., Sartelli, M., Spagnoli, A., Sulis, R., Tarasconi, A., Trana, C., Travaglino, A., Valeri, A., Vasquez, G., Zago, M., Zanoni, E., Crucitti A. (ORCID:0000-0003-3496-4185), Giordano A. (ORCID:0000-0002-6978-0880), Lorenzon L. (ORCID:0000-0001-6736-0383), Costa, G., Massa, G., Agresta, F., Anania, G., Ansaloni, L., Antropoli, M., Argenio, G., Atzeni, J., Avenia, N., Azzinnaro, A., Balani, A., Baldazzi, G., Balducci, G., Barbera, G., Bellanova, G., Bergamini, C., Bersigotti, L., Bianchi, P. P., Bombardini, C., Borzellino, G., Bozzo, S., Brachini, G., Buccoliero, F., Buonanno, G. M., Buononato, M., Campanile, F. C., Canini, T., Cardella, S., Carrara, G., Cascini, F., Cassini, D., Castriconi, M., Catalini, G., Catena, F., Ceccarelli, G., Celi, D., Ceresoli, M., Chiarugi, M., Cillara, N., Cimino, F., Cobuccio, L., Coccolini, F., Cocorullo, G., Colangelo, E., Crafa, F., Crucitti, Antonio, Dalla Caneva, P., Deluca, M., deManzoni Garberini, A., De Nisco, C., Desol, A., Falcioni, T., Falco, N., Farina, C., Filippone, G., Finotti, E., Fiume, S., Fontana, T., Francioni, G., Fransvea, P., Frezza, B., Gemini, S., Genna, M., Giannessi, S., Gioffre, A., Giordano, Alessandro, Gozzo, D., Grimaldi, S., Gulotta, G., Iarussi, T., Laterza, E., Lepre, L., Lorenzon, Laura, Lotti, R., Luridiana, G., Marini, P., Marzaioli, R., Mingoli, A., Mulas, S., Nagliati, C., Nigri, G., Niolu, P., Noviello, A., Occhionorelli, S., Paderno, N., Palini, G. M., Paradies, D., Paroli, M., Perrone, F., Petruzzelli, L., Pezzolla, A., Piazza, D., Piazza, V., Piccoli, M., Pisanu, A., Podda, M., Poillucci, G., Porfidia, R., Rossi, G., Ruscelli, P., Santella, S., Sartelli, M., Spagnoli, A., Sulis, R., Tarasconi, A., Trana, C., Travaglino, A., Valeri, A., Vasquez, G., Zago, M., Zanoni, E., Crucitti A. (ORCID:0000-0003-3496-4185), Giordano A. (ORCID:0000-0002-6978-0880), and Lorenzon L. (ORCID:0000-0001-6736-0383)

Abstract

Improvements in living conditions and progress in medical management have resulted in better quality of life and longer life expectancy. Therefore, the number of older people undergoing surgery is increasing. Frailty is often described as a syndrome in aged patients where there is augmented vulnerability due to progressive loss of functional reserves. Studies suggest that frailty predisposes elderly to worsening outcome after surgery. Since emergency surgery is associated with higher mortality rates, it is paramount to have an accurate stratification of surgical risk in such patients. The aim of our study is to characterize the clinicopathological findings, management, and short-term outcome of elderly patients undergoing emergency surgery. The secondary objectives are to evaluate the presence and influence of frailty and analyze the prognostic role of existing risk-scores. The final FRAILESEL protocol was approved by the Ethical Committee of “Sapienza” University of Rome, Italy. The FRAILESEL study is a nationwide, Italian, multicenter, observational study conducted through a resident-led model. Patients over 65 years of age who require emergency surgical procedures will be included in this study. The primary outcome measures are 30-day postoperative mortality and morbidity rates. The Clavien-Dindo classification system is used to categorize complications. The secondary outcome measures include length of hospital stay, length of stay in intensive care unit, and predictive value for morbidity and mortality of several frailty and surgical risk-scores. The results of the FRAILESEL study will be disseminated through national and international conference presentations and peer-reviewed journals. The study is also registered at ClinicalTrials.gov (ClinicalTrials.gov identifier: NCT02825082).

Published
2018

11. Surgical management of acute pancreatitis in Italy: lessons from a prospective multicentre study

Author

De Rai, Paolo, Zerbi, Alessandro, Castoldi, Laura, Bassi, Claudio, Frulloni, Luca, Uomo, Generoso, Gabbrielli, Armando, Pezzilli, Raffaele, Cavallini, Giorgio, Di Carlo, Valerio, Agugiaro, S., Turri, L., Bartoli, A., Barberini, F., Cavazzoni, G., Bartolo, F., Della Papa, D., Bassi, N., Massani, M., Benedetti, A., Macarri, G., Piergallini, L., Briani, G., Bartolasi, L., Bugnano, L., Buonanno, G. M., Esposito, C., Cordovana, A., Cavina, E., Seccia, M., Lippolis, P., Musco, B., Barletta, M., Chilovi, E., De Guelfi, A., Chirletti, P., Caronna, R., Scozzafava, S., Cardi, M., Cirino, E., Buffone, A., Colangelo, E., Caracino, V., Cortese, F., Casentini, A., Costamagna, G., Trincali, A., Curzio, M., Clivio, S., Segato, S., D'Alessandro, A., Ambrosiani, V., D'Ambrosio, B., Chiodo, C., Dicillo, M., Reale, L., Grandolfo, A., Fabbrucci, P., Bruscino, A., Mugnaini, P., Ferrarese, S., Ugenti, I., Forte, G. B., Rocco, P., Franzè, A., Bertelè, A., Sereni, G., Friedman, Daniele, Mariani, L., Morelli, F., Gai, V., Antro, C., Garcea, D., Gardini, A., Lucci, E., Giulianotti, P. C., Sbrana, F., Balestracci, T., Giulini, S. M., Pellizzari, A., Ronconi, M., Cimaschi, S., Grassini, M., Lacignola, S., Calandro, L., Mazzitelli, L., Costarella, S. M., Egidio, A., Mello Teggia, P., Stefano, E., Cassini, P., Modica, G., Lupo, F., Giraci, G., Mosca, F., Del Chiaro, M., Mosella, G., Benassai, G., Nanni, M., D'Aristotile, A., Negro, P., Pirazzoli, A., Rabitti, P. G., Romano, C., Gerardi, G., Troianello, B., Russello, D., Di Stefano, A., Avelli, S., Salval, N., Bellini, N., Scalon, P., Staudacher, C., Parolini, D., Strazzabosco, M., Signorelli, S., Tedeschi, U., Testoni, P. A., Masci, E., Mariani, A., Torelli, E., Garcea, M. R., Lombardi, V., Lecconi, L., Valeri, L., Presenti, L., Alessio, F., Ventrucci, M., Virzi, S., Cipolla, A., De Rai, P, Zerbi, A, Castoldi, L, Bassi, C, Frulloni, L, Uomo, G, Gabbrielli, A, Pezzilli, R, Cavallini, G, Di Carlo, V, Proinf, Aisp, and Testoni, PIER ALBERTO

Subjects
Male, Time Factors, Pancreatitis, Alcoholic, medicine.medical_treatment, Acute pancreatitis, Surgery, Aged, Biliary Tract Diseases, Chi-Square Distribution, Cholangiopancreatography, Endoscopic Retrograde, Cholecystectomy, Laparoscopic, Female, Guideline Adherence, Humans, Italy, Pancreatitis, Pancreatitis, Acute Necrotizing, Practice Guidelines as Topic, Prospective Studies, Risk Assessment, Risk Factors, Severity of Illness Index, Treatment Outcome, Cholecystectomy, Jejunostomy, Pancreatectomy, Practice Patterns, Physicians', Hepatology, Gastroenterology, Physician's Practice Patterns, Practice Patterns, surgery, Endoscopic Retrograde, Medicine, Cholangiopancreatography, Laparoscopic, Acute Necrotizing, Alcoholic, Prospective cohort study, health care economics and organizations, acute pancreatitis, Corrigendum, Risk assessment, medicine.medical_specialty, education, Severity of illness, Intensive care medicine, Physicians', business.industry, General surgery, Original Articles, medicine.disease, business
Abstract

OBJECTIVE: This study aimed to evaluate the surgical treatment of acute pancreatitis in Italy and to assess compliance with international guidelines. METHODS: A series of 1173 patients in 56 hospitals were prospectively enrolled and their data analysed. RESULTS: Twenty-nine patients with severe pancreatitis underwent surgical intervention. Necrosectomy was performed in 26 patients, associated with postoperative lavage in 70% of cases. A feeding jejunostomy was added in 37% of cases. Mortality was 21%. Of the patients with mild pancreatitis, 714 patients with a biliary aetiology were evaluated. Prophylactic treatment of relapses was carried out in 212 patients (36%) by cholecystectomy and in 161 using a laparoscopic approach. Preoperative endoscopic retrograde cholangiopancreatography was associated with cholecystectomy in 83 patients (39%). Forty-seven patients (22%) were treated at a second admission, with a median delay of 31 days from the onset of pancreatitis. Eighteen patients with severe pancreatitis underwent cholecystectomy 37.9 days after the first admission. There were no deaths. DISCUSSION: The results indicate poor compliance with published guidelines. In severe pancreatitis, early surgical intervention is frequently performed and enteral feeding is seldom used. Only a small number of patients with mild biliary pancreatitis undergo definitive treatment (i.e. cholecystectomy) within 4 weeks of the onset of pancreatitis.

Published
2010
Full Text
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13. Diagnostic assessment and outcome of acute pancreatitis in Italy: results of a prospective multicentre study. ProInf-AISP: Progetto informatizzato pancreatite acuta, Associazione Italiana Studio Pancreas, phase II

Author

Uomo, G, Pezzilli, R., Gabbrielli, A., Castoldi, L., Zerbi, A., Frulloni, L., De Rai, P., Cavallini, G., Di Carlo, V., Agugiaro, S., Turri, L., Bartoli, A., Barberini, F., Cavazoni, G., Bartolo, F., Della Papa, D., Bassi, C., Bassi, N., Massani, M., Benedetti, A., Macarri, G., Piergallini, L., Briani, G., Bartolasi, L., Brugnano, L., Buonanno, G. M., Esposito, C., Cardovana, A., Cavina, E., Seccia, M., Lipollis, P., Musco, B., Barletta, M., Chilovi, E., De Guelmi, A., Chirletti, P., Caronna, R., Scozzafava, S., Cardi, M., Cirrino, E., Buffone, A., Colangelo, E., Caracino, V., Cortese, F., Cosentini, A., Costamagna, G., Tringali, A., Curzio, M., Clivio, S., Segato, S., D'Alessandro, A., Ambrosini, V., D'Amborsio, B., Chiodo, C., Dicillo, M., Reale, L., Grandolfo, A., Fabbrucci, P., Bruscino, A., Mugnaini, P., Ferrarese, S., Ugenti, I., Forte, G. B., Rocco, P., Franzè, A., Bertelè, A., Sereni, G., Friedman, Daniele, Mariani, L. M., Murelli, Federica, Gai, V., Antro, C., Garcea, D., Gardini, A., Lucci, E., Giulianotti, P. C., Sbrana, F., Balestracci, T., Giulini, S. M., Pellizzari, A., Ronconi, M., Cimaschi, S., Grassini, M., Lacitignola, S., Caliandro, L., Mazzitelli, R., Costarella, S. M., Egidio, A., Mello Teggia, P., Stefano, E., Cassini, P., Modica, G., Lupo, F., Giraci, G., Mosca, F., Del Chiaro, M., Mosella, G., Benassai, G., Nanni, M., D'Aristotile, A., Negro, P., Pirazzoli, A., Rabitti, P. G., Romano, C., Gerardi, G., Troianello, B., Russello, D., Di Stefano, A., Avelli, S., Salvai, M., Bellini, N., Scalon, P., Staudacher, C., Parolini, D., Strazzabosco, M., Signorelli, S., Tedeschi, U., Testoni, P. A., Masci, E., Mariani, A., Torelli, E., Garcea, M. R., Lombardi, V., Cecconi, L., Valeri, A., Presenti, L., Alessio, F., Ventrucci, M., Virzì, S., and Cipolla, A.

Subjects
Adult, Male, Pancreatic necrosis, Severity of Illness Index, Body Mass Index, Acute Pancreatitis, Clinical outcome, Computed tomography, Diagnosis, Pancreatitis, Prognosis, Ultrasonography, Aged, Aged, 80 and over, Cholangiopancreatography, Endoscopic Retrograde, Creatinine, Female, Humans, Italy, Middle Aged, Prospective Studies, Treatment Outcome, Hepatology, Gastroenterology, Endoscopic Retrograde, 80 and over, treatment, Medicine (all), Cholangiopancreatography, acute pancreatitis, diagnosis
Abstract

Up till now, only one study providing practically complete information on acute pancreatitis in Italy has been published. The aim of this prospective study was to evaluate the clinical characteristics, in terms of diagnostic assessment and outcome, of a large series of patients affected by acute pancreatitis in Italy.The study involved 56 Italian centres, homogeneously distributed throughout the entire national territory. Each participating centre was furnished with an ad hoc software including 530 items along with subsequent collection, tabulation and quality control of the data.One thousand five hundred and forty case report forms of patients affected by acute pancreatitis were collected but 367 of them (24%) were subsequently eliminated from the final analysis. Therefore, 1173 patients (581 females and 592 males) were recruited. Mean age of patients was 62.0+/-18.2 years (95% confidence interval, 60.9-63.0). On the basis of Atlanta classification, 1006 patients (85.8%) were defined as mild and 167 (14.2%) as severe pancreatitis. Biliary forms represented the most frequent aetiological category (813 cases, 69.3%) while alcoholic forms only 6.6% (77 cases); the remaining aetiologies accounted for 7.1% (83 cases) while 200 cases (17.1%) remained without a definite aetiological factor. Complete recovery was achieved in 1016 patients (86.6%) whereas morphological sequelae were found in 121 patients (10.3%) and mortality in 36 patients (3.1%; 0.4% in mild and 19.2% in severe acute pancreatitis). Ultrasonography was largely utilised as a first line diagnostic tool in all patients, with valuable visualisation of the pancreas in 85% of patients. Computer tomography scan was also widely used, with 66.7% of exams in mild and 33.3% in severe pancreatitis. Patients affected by biliary pancreatitis presented more severe (p=0.004) and necrotizing forms (p=0.021). Mortality was significantly related (p0.001) with the extension of pancreatic necrosis and with an age of over 70 years. Body mass index presented significantly greater values in severe than in mild forms (p0.001).Association of creatinine serum level over 2mg/dl with an abnormal chest X-ray showed a high significant correlation with a more severe outcome in terms of morphological sequelae and mortality (p=0.0001). Acute pancreatitis in Italy more commonly presents biliary aetiology and favourable outcome with low rate of complications and mortality. From a cost-effectiveness standpoint, diagnostic approach to this disease needs to be better standardised.

Published
2007

14. A prospective multicentre survey on the treatment of acute pancreatitis in Italy

Author

Pezzilli, R, Uomo, G., Gabbrielli, A., Zerbi, A., Frulloni, L., De Rai, P., Castoldi, L., Cavallini, G., Di Carlo, V., Agugiaro, S., Turri, L., Bartoli, A., Barberini, F., Cavazoni, G., Bartolo, F., Della Papa, D., Bassi, C., Bassi, N., Massani, M., Benedetti, A., Macarri, G., Piergallini, L., Briani, G., Bartolasi, L., Brugnano, L., Buonanno, G. M., Esposito, C., Cardovana, A., Cavina, E., Seccia, M., Lipollis, P., Musco, B., Barletta, M., Chilovi, E., De Guelmi, A., Chirletti, Piero, Caronna, Roberto, Scozzafava, S., Cardi, Maurizio, Cirino, E., Buffone, A., Colangelo, E., Caracino, V., Cortese, F., Cosentini, A., Costamagna, G., Tringali, A., Curzio, M., Clivio, S., Segato, S., D'Alessandro, A., Ambrosini, V., D'Amborsio, B., Chiodo, C., Dicillo, M., Reale, L., Grandolfo, A., Fabbrucci, P., Bruscino, A., Mugnaini, P., Ferrarese, S., Ugenti, I., Forte, G. B., Rocco, P., Franzè, A., Bertelè, A., Sereni, G., Friedman, D., Mariani, L. M., Murelli, F., Gai, V., Antro, C., Garcea, D., Gardini, A., Lucci, E., Giulianotti, P. C., Sbrana, F., Balestracci, T., Giulini, S. M., Pellizzari, A., Ronconi, M., Cimaschi, S., Grassini, M., Lacitignola, S., Caliandro, L., Mazzitelli, R., Costarella, S. M., Egidio, A., Mello Teggia, P., Stefano, E., Cassini, P., Modica, G., Lupo, F., Giraci, G., Mosca, F., Del Chiaro, M., Mosella, G., Benassai, G., Nanni, M., D'Aristotile, A., Negro, P., Pirazzoli, A., Rabitti, P. G., Romano, C., Gerardi, G., Troianello, B., Russello, D., Di Stefano, A., Avelli, S., Salvai, M., Bellini, N., Scalon, P., Staudacher, C., Parolini, D., Strazzabosco, M., Signorelli, S., Tedeschi, U., Testoni, P. A., Masci, E., Mariani, A., Torelli, E., Garcea, M. R., Lombardi, V., Cecconi, L., Valeri, A., Presenti, L., Alessio, F., Ventrucci, M., Virzi, S., and Cipolla, A.

Subjects
Adult, Male, medicine.medical_specialty, ERCP, Pancreatitis, Pancreatitis acute necrotising, Aged, Aged, 80 and over, Analgesics, Anti-Bacterial Agents, Digestive System Surgical Procedures, Female, Histamine Antagonists, Humans, Italy, Middle Aged, Prospective Studies, Severity of Illness Index, Treatment Outcome, Medicine (all), Hepatology, Gastroenterology, Therapeutic approach, Internal medicine, Severity of illness, 80 and over, Medicine, Prospective cohort study, business.industry, medicine.disease, Surgery, medicine.anatomical_structure, Acute pancreatitis, Tramadol, business, Pancreas, medicine.drug
Abstract

The Italian Association for the Study of the Pancreas released a diagnostic and therapeutic algorithm for acute pancreatitis in 1999.This study focused on the analysis of the therapeutic approach for the treatment of acute pancreatitis in Italy.One thousand, one hundred and seventy-three patients were recruited: 1006 patients (85.8%) had mild acute pancreatitis (MAP) and 167 (14.2%) had the severe acute pancreatitis (SAP); 161 patients showed pancreatic necrosis at computed tomography; 121 patients (10.3%) had sequelae and 36 (3.1%) died.Non-steroidal anti-inflammatory drugs and tramadol were used more frequently in patients with the MAP whereas opioids and the association schedules were used more frequently in patients with the SAP (P0.001). Gabexate mesilate was utilised in 831 out of 1173 patients (70.8%); in particular, gabexate mesilate was used in 70.6% patients with MAP and in 73.1% of those with SAP (P=0.521). The duration of the drug administration was significantly shorter in those having MAP than in those having the SAP (P0.001). The antibiotics most frequently used for the prophylaxis against infection from pancreatic necrosis (43.1%) were carbapenems. Only a small number of patients received enteral nutrition (4.7%). Endoscopic retrograde cholangiopancreatography was carried out in 344 of the 1173 patients (29.3%). Surgery was performed in 48 with SAP (19 had elective biliary surgery and 29 had pancreatic surgery).The results of this survey indicate a lack of compliance with the guidelines which regard the indications mainly for interventional endoscopy and surgery.

Published
2007

15. Open tension-free Lichtenstein repair of inguinal hernia: use of fibrin glue versus sutures for mesh fixation

Author

Negro, P., primary, Basile, F., additional, Brescia, A., additional, Buonanno, G. M., additional, Campanelli, G., additional, Canonico, S., additional, Cavalli, M., additional, Corrado, G., additional, Coscarella, G., additional, Di Lorenzo, N., additional, Falletto, E., additional, Fei, L., additional, Francucci, M., additional, Fronticelli Baldelli, C., additional, Gaspari, A. L., additional, Gianetta, E., additional, Marvaso, A., additional, Palumbo, P., additional, Pellegrino, N., additional, Piazzai, R., additional, Salvi, P. F., additional, Stabilini, C., additional, and Zanghì, G., additional

Published
2010
Full Text
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16. Clinical strategies for the management of intestinal obstruction and pseudo-obstruction

Author

Costa, G., Ruscelli, P., Balducci, G., Buccoliero, F., Lorenzon, L., Frezza, B., Chirletti, P., Stagnitti, F., Miniello, S., Stella, F., Agresta, F., Ansaloni, L., Basile, G., Bellanova, G., Blandamura, V., Buonanno, G. M., Calderale, S. M., Caronna, R., Casciaro, G., Catena, F., Ceci, F., Chiara, O., Chiarugi, M., Cimbanassi, S., Coccolini, F., Gianfranco Cocorullo, Manzoni, G., Di Grezia, G., Frego, M., Fusco, B., Giulini, S. M., Greco, M., Gulotta, G., Lippolis, P. V., Mandala, V., Marini, P., Martino, A., Marzaioli, R., Mecarelli, V., Mingoli, A., Mirabella, A., Morelli, M. M., Padalino, P., Picardi, N., Portolani, N., Ribaldi, S., Ricci, G., Salamone, G., Sartelli, M., Staudacher, C., Tonelli, P., Tricarico, F., Trojaniello, B., Tugnoli, G., Valeri, A., Venezia, P., Zago, M., and Obow-Sicut, The Collaborative Study Group

18. RIGHT LOBECTOMY FOR LIVER TRAUMA.

Author

DE SENA, G., BUONANNO, G. M., AMATUCCI, G., FESTA, P., BORRIERO, S., CHIANESE, F., BRIGANTE, A., DE RIENZO, L., SANTA MARIA, A., CROCCO, L., MANSI, L., LOMBARDI, C., and FIORDIENZI, G.

Published
1992

19. Open tension-free Lichtenstein repair of inguinal hernia: use of fibrin glue versus sutures for mesh fixation

Author

Cesare Stabilini, P. F. Salvi, Francesco Basile, C. Fronticelli Baldelli, Coscarella G, G. Corrado, Landino Fei, P. Palumbo, R. Piazzai, M. Cavalli, A. Marvaso, M. Francucci, Silvestro Canonico, Paolo Negro, A. Brescia, Giampiero Campanelli, N Di Lorenzo, Achille L. Gaspari, G. M. Buonanno, Ezio Gianetta, Guido Zanghì, N. Pellegrino, E. Falletto, Negro, P, Basile, F, Brescia, A, Buonanno, G. M., Campanelli, G, Canonico, Silvestro, Cavalli, M, Corrado, G, Coscarella, G, DI LORENZO, N, Falletto, E, Fei, Landino, Francucci, M, FRONTICELLI BALDELLI, C, Gaspari, A. L., Gianetta, E, Marvaso, A, Palumbo, P, Pellegrino, N, Piazzai, R, Salvi, P. F., Stabilini, C, and Zanghì, G.

Subjects
medicine.medical_specialty, Ecchymosis, Fibrin, Hematoma, Suture (anatomy), Human fibrin glue, Inguinal hernia, Mesh fixation, Postoperative pain, Tension-free hernia repair, Tissucol/Tisseel, Surgery, medicine, Hernia, Settore CHIM/01 - Chimica Analitica, Fibrin glue, mesh fixation, tension-free hernia repair, Inguinal hernia, Tension-free hernia repair, Human fibrin glue, Tissucol/Tisseel, Mesh fixation, Postoperative pain, human fibrin glue, biology, business.industry, medicine.disease, Surgical mesh, tissucol/tisseel, inguinal hernia, Anesthesia, biology.protein, postoperative pain, medicine.symptom, business
Abstract

Purpose To investigate pain and other complications following inguinal hernioplasty performed by the Lichtenstein technique with mesh fixation by fibrin glue or sutures. Methods Five hundred and twenty patients were enrolled in this 12-month observational multicenter study and received either sutures or fibrin glue (Tissucol/Tisseel) based on the preference of the surgeon. Pain, numbness, discomfort, recurrence, and other complications were assessed postoperatively and at 1, 3, 6, and 12 months. Pain intensity was assessed by a visual analog scale VAS; 0 [no pain] to 10 [worst pain]). Results One hundred and seventy-one patients received sutures and 349 received fibrin glue. During the early postoperative phase, 87.4% of patients in the fibrin glue group and 76.6% of patients in the sutures group were complication-free (P = 0.001). Patients who received fibrin glue were also less likely to experience hematoma/ecchymosis than those in the suture group (both P = 0.001). The mean pain score was significantly lower in the fibrin group than the sutures group (2.5 vs. 3.2, P

Published
2010

20. A simple vascular access for hemodialysis in 'desperate' cases

Author

De Rosa P, Romano G, Gm, Buonanno, Enrico DI SALVO, De Rosa, P., Romano, G., Buonanno, G. M., and DI SALVO, Enrico

Subjects
Femoral Artery, Arteriovenous Shunt, Surgical, Renal Dialysis, Humans, Saphenous Vein
Abstract

Direct anastomosis between the distal superficial femoral artery and the saphenous vein for hemodialysis is a valid option whenever, after exhausting the upper extremities as a site for vascular access, an alternative procedure is required. The procedure is simple, safe and reliable. It provides excellent accessibility and long term patency rate.

Published
1986

21. [Aneurysm of the hepatic artery. A case report].

Author

Amatucci G, Del Mastro G, Buonanno GM, D'Andrea A, Zito ES, and Lenzi E

Subjects
Humans, Jaundice etiology, Male, Middle Aged, Aneurysm complications, Aneurysm diagnosis, Aneurysm surgery, Hepatic Artery
Abstract

The authors describe the case of the sixty-one-year-old man admitted to hospital because of a growing jaundice that after the surgical operation proved to be caused by a compression of the PBV determined by a voluminous aneurysm of the hepatic artery. The integrity of the gastroduodenal artery made it possible to make a simple aneurysmectomy with clinic. The patient was discharged from hospital after fifteen days from the surgical operation; he was surgically healed and with normal enzymatic values. The follow-up two years after discharge confirmed a hematochemical state within normal limits.

Published
1995

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