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New Insights into Acute Care and Emergency Surgery
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New Insights into Acute Care and Emergency Surgery

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "General Surgery".

Deadline for manuscript submissions: 17 July 2025 | Viewed by 8684

Special Issue Editors

Dr. Jacob Chen

E-Mail Website
Guest Editor
1. Hospital Management, Meir Medical Center, Kfar Saba, Israel
2. Trauma and Combat Medicine Branch, Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
Interests: emergency medicine; trauma surgery; emergency surgery; acute care
Dr. Avi Benov

E-Mail Website
Guest Editor
1. The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
2. The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
Interests: emergency medicine; trauma surgery; emergency surgery; acute care

Special Issue Information

Dear Colleagues,

Acute care and emergency surgery are vital components of clinical medicine, addressing urgent and life-threatening conditions that require immediate attention. This Special Issue aims to explore new insights and advancements in the field.

Over the years, significant progress has been made in the understanding and management of acute care and emergency surgical cases. Innovative treatment protocols, advancements in anesthesia and surgical techniques, and the use of advanced imaging and diagnostic tools have significantly improved patient outcomes. The integration of cutting-edge technologies has transformed acute care and emergency surgery practices. Telemedicine, point-of-care testing, and mobile healthcare solutions have facilitated rapid communication and diagnosis, especially in remote and resource-limited settings. Additionally, advancements in minimally invasive procedures and robotic surgery have revolutionized the approach to emergency surgical interventions.

We invite original research articles and comprehensive reviews that contribute to the growing knowledge of acute care and emergency surgery. We encourage research works both in the pre-hospital and in the in-hospital scenario. Manuscripts should focus on clinical insights, innovative approaches, and the application of new technologies in this field.

Dr. Jacob Chen
Dr. Avi Benov
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • trauma surgery
  • emergency surgery
  • acute care
  • anesthesia
  • ICU

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Published Papers (6 papers)

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11 pages, 1330 KiB  
Article
Minimally Invasive Surgery in Acute Bowel Obstruction: Should It Become the Standard of Care? A Prospective, Single Center, Observational Study
by Hannes Hoi, Martin Grünbart, Michael de Cillia, Robert Uzel, Hannah Hofer, Lisa Schlosser, Peter Tschann, Helmut Weiss and Christof Mittermair
J. Clin. Med. 2024, 13(24), 7852; https://doi.org/10.3390/jcm13247852 - 23 Dec 2024
Viewed by 786
Abstract
Background/Objectives: This study was conducted to determine whether a structured clinical pathway can help to safely implement minimally invasive surgery (MIS) as the standard approach in surgery for acute bowel obstruction (ABO). Methods: A prospective analysis was performed on consecutive patients [...] Read more.
Background/Objectives: This study was conducted to determine whether a structured clinical pathway can help to safely implement minimally invasive surgery (MIS) as the standard approach in surgery for acute bowel obstruction (ABO). Methods: A prospective analysis was performed on consecutive patients undergoing MIS for ABO at a single center in 2021 and 2022. Prior to the study onset, a structured treatment pathway was defined to apply MIS in all patients. The rate of success in the MIS and patient-, surgeon- and outcome-specific parameters with a focus on complication and conversion rates were analyzed. Results: Compared to a historical control group, the conversion rate from MIS to open surgery (OS) nearly doubled from 20.4% to 36.4% (p = 0.14). The complication rate in converted patients was 43.8% vs. 7.15% in non-converted patients (p < 0.05). Conclusions: A structured clinical pathway, including technical standardization and preoperative decisional processes, can be used to implement MIS as a primary surgical treatment in ABO. This is accompanied by high conversion rates and a significant increase in postoperative complications in patients undergoing conversion. Individual decision-making concerning the surgical approach remains paramount to prevent complications and high conversion rates. Full article
(This article belongs to the Special Issue New Insights into Acute Care and Emergency Surgery)
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18 pages, 1428 KiB  
Article
The EUPEMEN (EUropean PErioperative MEdical Networking) Protocol for Acute Appendicitis: Recommendations for Perioperative Care
by Orestis Ioannidis, Elissavet Anestiadou, Jose M. Ramirez, Nicolò Fabbri, Javier Martínez Ubieto, Carlo Vittorio Feo, Antonio Pesce, Kristyna Rosetzka, Antonio Arroyo, Petr Kocián, Luis Sánchez-Guillén, Ana Pascual Bellosta, Adam Whitley, Alejandro Bona Enguita, Marta Teresa-Fernandéz, Stefanos Bitsianis and Savvas Symeonidis
J. Clin. Med. 2024, 13(22), 6943; https://doi.org/10.3390/jcm13226943 - 18 Nov 2024
Cited by 1 | Viewed by 1319
Abstract
Background/Objectives: Acute appendicitis (AA) is one of the most common causes of emergency department visits due to acute abdominal pain, with a lifetime risk of 7–8%. Managing AA presents significant challenges, particularly among vulnerable patient groups, due to its association with substantial morbidity [...] Read more.
Background/Objectives: Acute appendicitis (AA) is one of the most common causes of emergency department visits due to acute abdominal pain, with a lifetime risk of 7–8%. Managing AA presents significant challenges, particularly among vulnerable patient groups, due to its association with substantial morbidity and mortality. Methods: The EUPEMEN (European PErioperative MEdical Networking) project aims to optimize perioperative care for AA by developing multidisciplinary guidelines that integrate theoretical knowledge and clinical expertise from five European countries. This study presents the key elements of the EUPEMEN protocol, which focuses on reducing surgical stress, optimizing perioperative care, and enhancing postoperative recovery. Results: Through this standardized approach, the protocol aims to lower postoperative morbidity and mortality, shorten hospital stays, and improve overall patient outcomes. The recommendations are tailored to address the variability in clinical practice across Europe and are designed to be widely implementable in diverse healthcare settings. Conclusions: The conclusions drawn from this study highlight the potential for the EUPEMEN protocol to significantly improve perioperative care standards for AA, demonstrating its value as a practical, adaptable tool for clinicians. Full article
(This article belongs to the Special Issue New Insights into Acute Care and Emergency Surgery)
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9 pages, 202 KiB  
Article
Poor Compliance to Clinical Guidelines in the Diagnosis of Acute Appendicitis: Insights from a National Survey
by Nir Messer, Avi Benov, Adi Rov, Tali Bar-On, Oran Zlotnik, Jacob Chen and Haim Paran
J. Clin. Med. 2024, 13(10), 2862; https://doi.org/10.3390/jcm13102862 - 13 May 2024
Viewed by 1301
Abstract
Background: Many scoring systems, algorithms, and guidelines have been developed to aid in the evaluation and diagnosis of acute appendicitis (AA). Many of these algorithms advocate against the routine use of radiological investigations when there is a high clinical suspicion of AA. [...] Read more.
Background: Many scoring systems, algorithms, and guidelines have been developed to aid in the evaluation and diagnosis of acute appendicitis (AA). Many of these algorithms advocate against the routine use of radiological investigations when there is a high clinical suspicion of AA. However, there has been a significant rise in the use of imaging techniques for diagnosing AA in the past two decades. This is a national study aimed at assessing the adherence of residents assigned to the emergency department to the clinical guidelines for diagnosing AA. Methods: We introduced a case study of a male patient with highly suspicious clinical findings of AA to all surgical and emergency medicine residents assigned to the emergency department with the autonomy to make critical decisions to determine the preferred way of diagnosing AA. Results: A total of 62.4% of all relevant residents participated in this survey; 69.6% reported that the Alvarado score was eight or higher, and 82.1% estimated that the next step recommended by most clinical guidelines was appendectomy without further abdominal imaging tests. However, 83.4% chose to perform an imaging test to establish the diagnosis of AA. Conclusions: Our study revealed a notable non-adherence to clinical guidelines in diagnosing AA. Given the significance of these guidelines, we assert that adopting medical recommendations should not solely depend on individual education but should also be incorporated as a departmental policy. Full article
(This article belongs to the Special Issue New Insights into Acute Care and Emergency Surgery)
10 pages, 219 KiB  
Article
Acute Appendicitis in the Elderly: A Nationwide Retrospective Analysis
by Malkiely Gal, Paran Maya, Kobo Ofer, Khan Mansoor, Abbou Benyamine and Kessel Boris
J. Clin. Med. 2024, 13(7), 2139; https://doi.org/10.3390/jcm13072139 - 8 Apr 2024
Cited by 2 | Viewed by 2408
Abstract
Background: Acute appendicitis (AA) in older individuals remains understudied. We aimed to assess AA characteristics in patients older than 60 years and evaluate the impact of comorbidities. Methods: This retrospective study analyzed data from the American National Inpatient Sample between 2016 and 2019 [...] Read more.
Background: Acute appendicitis (AA) in older individuals remains understudied. We aimed to assess AA characteristics in patients older than 60 years and evaluate the impact of comorbidities. Methods: This retrospective study analyzed data from the American National Inpatient Sample between 2016 and 2019 to compare AA characteristics in patients younger and older than 60 years. Results: Of the 538,400 patients included, 27.5% were older than 60 years. Younger patients had a higher appendectomy rate (p < 0.01), while the complicated appendicitis rate was higher in older patients. Superficial wound infection, systemic infection, and mortality rates were higher in older patients (p < 0.01). Risk factors for superficial wound infection in patients younger than 60 years included cerebrovascular disease, chronic kidney disease, hypertension, heart failure, and obesity, whereas only heart failure was a risk factor in older patients. Risk factors for systemic infection in young patients included hypertension, heart failure, obesity, and diabetes mellitus, while in older patients they included hypertension, heart failure, and obesity. Complicated appendicitis was not a risk factor for infections in either group. Conclusions: This study highlights a higher incidence of AA in older individuals than previously reported, with comorbidities posing differing risks for infections between age groups. Full article
(This article belongs to the Special Issue New Insights into Acute Care and Emergency Surgery)
11 pages, 517 KiB  
Article
Predictors of Short-Term Trauma Laparotomy Outcomes in an Integrated Military–Civilian Health System: A 23-Year Retrospective Cohort Study
by Sami Gendler, Shaul Gelikas, Tomer Talmy, Roy Nadler, Avishai M. Tsur, Irina Radomislensky, Moran Bodas, Elon Glassberg, Ofer Almog, Avi Benov and Jacob Chen
J. Clin. Med. 2024, 13(7), 1830; https://doi.org/10.3390/jcm13071830 - 22 Mar 2024
Cited by 1 | Viewed by 1256
Abstract
Background: Trauma laparotomy (TL) remains a cornerstone of trauma care. We aimed to investigate prehospital measures associated with in-hospital mortality among casualties subsequently undergoing TLs in civilian hospitals. Methods: This retrospective cohort study cross-referenced the prehospital and hospitalization data of casualties [...] Read more.
Background: Trauma laparotomy (TL) remains a cornerstone of trauma care. We aimed to investigate prehospital measures associated with in-hospital mortality among casualties subsequently undergoing TLs in civilian hospitals. Methods: This retrospective cohort study cross-referenced the prehospital and hospitalization data of casualties treated by Israel Defense Forces-Medical Corps teams who later underwent TLs in civilian hospitals between 1997 and 2020. Results: Overall, we identified 217 casualties treated by IDF-MC teams that subsequently underwent a TL, with a mortality rate of 15.2% (33/217). The main mechanism of injury was documented as penetrating for 121/217 (55.8%). The median heart rate and blood pressure were within the normal limit for the entire cohort, with a low blood pressure predicting mortality (65 vs. 127, p < 0.001). In a multivariate analysis, prehospital endotracheal intubation (ETI), emergency department Glasgow coma scores of 3–8, and the need for a thoracotomy or bowel-related procedures were significantly associated with mortality (OR 6.8, p < 0.001, OR = 48.5, p < 0.001, and OR = 4.61, p = 0.002, respectively). Conclusions: Prehospital interventions introduced throughout the study period did not lead to an improvement in survival. Survival was negatively influenced by prehospital ETI, reinforcing previous observations of the potential deleterious effects of definitive airways on hemorrhaging trauma casualties. While a low blood pressure was a predictor of mortality, the median systolic blood pressure for even the sickest patients (ISS > 16) was within normal limits, highlighting the challenges in triage and risk stratification for trauma casualties. Full article
(This article belongs to the Special Issue New Insights into Acute Care and Emergency Surgery)
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18 pages, 1042 KiB  
Perspective
Balancing Ethics and Innovation: Can Artificial Intelligence Safely Transform Emergency Surgery? A Narrative Perspective
by Belinda De Simone, Genevieve Deeken and Fausto Catena
J. Clin. Med. 2025, 14(9), 3111; https://doi.org/10.3390/jcm14093111 - 30 Apr 2025
Viewed by 255
Abstract
Background: Artificial intelligence (AI) is increasingly shaping the landscape of emergency surgery by offering real-time decision support, enhancing diagnostic accuracy, and optimizing workflows. However, its implementation raises significant ethical concerns, particularly regarding accountability, transparency, patient autonomy, and bias. Objective: This perspective paper, grounded [...] Read more.
Background: Artificial intelligence (AI) is increasingly shaping the landscape of emergency surgery by offering real-time decision support, enhancing diagnostic accuracy, and optimizing workflows. However, its implementation raises significant ethical concerns, particularly regarding accountability, transparency, patient autonomy, and bias. Objective: This perspective paper, grounded in a narrative review, explores the ethical dilemmas associated with AI in emergency surgery and proposes future directions for its responsible and equitable integration. Methods: A comprehensive narrative review was conducted using PubMed, Scopus, Web of Science, and Google Scholar, covering the literature published from January 2010 to December 2024. We focused on peer-reviewed articles discussing AI in surgical or emergency care and highlighting ethical, legal, or regulatory issues. A thematic analysis was used to synthesize the main ethical challenges. Results: Key ethical concerns identified include issues of accountability in AI-assisted decision-making, the “black box” effect and bias in algorithmic design, data privacy and protection, and the lack of global regulatory coherence. Thematic domains were developed around autonomy, beneficence, justice, transparency, and informed consent. Conclusions: Responsible AI implementation in emergency surgery requires transparent and explainable models, diverse and representative datasets, robust consent frameworks, and clear guidelines for liability and oversight. Interdisciplinary collaboration is essential to align technological innovation with patient-centered and ethically sound clinical practice. Full article
(This article belongs to the Special Issue New Insights into Acute Care and Emergency Surgery)
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