Search Results (689)

Introduction: The role of Collis gastroplasty has traditionally been reserved for patients with a shortened esophagus due to chronic gastroesophageal reflux disease (GERD). However, its necessity has been questioned, leading to a decline in popularity. This systematic review and meta-analysis aimed to evaluate the efficacy of hiatal hernia repair with fundoplication, with versus without Collis gastroplasty. Methods: A systematic search of Ovid MEDLINE, Ovid Embase, Scopus, Web of Science Core Collection, and the Cochrane Library (via Wiley) was performed in May 2025. Studies were included if they compared outcomes or the safety profile of Collis gastroplasty versus no Collis gastroplasty during fundoplication for hiatal hernia repair. Meta-analyses were conducted using a random-effects model and restricted maximum likelihood. Results: Of 664 unique results, 17 studies comprising 4048 patients were included. There was a female predominance (65.4%), with a weighted mean age of 58.9 ± 14.0 years and follow-up of 43.5 ± 43.1 months. Patients who underwent Collis gastroplasty represented 35.8% of the cohort. Nissen fundoplication was the most common procedure in both the Collis (91.9%) and non-Collis (84.5%) groups. Most studies had selection bias, in which only patients who did not have sufficient intraoperative intra-abdominal esophageal length underwent Collis gastroplasty. Recurrence rates were similar (13.5% vs. 13.2%). Collis gastroplasty was not associated with a reduction in hiatal hernia recurrence (OR 0.53, 95% CI 0.23–1.22). Symptom outcomes, including regurgitation (OR 0.53, 95% CI 0.05–5.39), reflux (OR 0.81, 95% CI 0.03–22.12), dysphagia (OR 1.12, 95% CI 0.62–2.04), and use of antireflux medication on follow-up (OR 1.15, 95% CI 0.62–2.15), were not significantly different. However, Collis gastroplasty was associated with a higher risk of complications, including overall complications (OR 2.63, 95% CI 1.55–4.46), leak (OR 3.35, 95% CI 1.11–10.05), and surgical site infection (OR 8.28, 95% CI 1.16–59.10). There were no significant differences in abscess formation (OR 5.97, 95% CI 0.77–46.49), length of stay (mean difference 0.36 days, 95% CI −0.30 to 1.01), readmission (OR 1.13, 95% CI 0.36–3.60), reoperation (OR 1.24, 95% CI 0.64–2.41), or mortality (OR 1.08, 95% CI 0.45–2.57). Conclusions: Collis gastroplasty was not associated with a decreased risk of hiatal hernia recurrence or improvement in other efficacy measures, but this is in the context of a strong component of selection bias. In this context, there may be a role for Collis gastroplasty in difficult cases if the rate of recurrence does not differ from those with sufficient length, but this must be balanced against a significantly increased risk of complications. Full article

Background: Peripheral muscle electrostimulation (PME), encompassing neuromuscular electrical stimulation (NMES) and functional electrical stimulation (FES), has been increasingly acknowledged as an effective adjunctive or complementary treatment to voluntary exercise in elderly cardiac patients who cannot perform sufficient amounts of exercise, for whom there is limited research on optimal protocols. Sarcopenia, defined as a progressive decrease in muscle mass, strength and function, affects approximately 34% of heart failure (HF) patients and considerably worsens their prognosis. The objective of this systematic review is to summarize current evidence on the theoretical mechanisms, physiological pathways, safety and efficacy of PME in older adults within a cardiac rehabilitation (CR) setting, with a specific emphasis on sarcopenia reversal. Methods: We performed a systematic review following the PRISMA 2020 guidelines. A systematic search was conducted on the PubMed, Embase, Cochrane Library, CINAHL and PEDro databases from inception until December 2025. We searched for randomized controlled trials (RCTs) and controlled clinical trials focusing on PME in patients with cardiac diseases aged 65 years or older. The main outcomes were physical function (assessed with the Short Physical Performance Battery [SPPB] and 6 min walk distance [6MWD]), muscle strength, muscle mass and safety. The Cochrane Risk of Bias tool was used to evaluate the quality of the studies. Results: Eight studies were included, with 387 participants and a mean age between 78 and 85 years. PME consistently improved lower-extremity muscle strength (MD: 5.2% body weight, 95% CI = 1.2–9.1, p = 0.013) along with SPPB scores, which ranged from +2.3 to +2.67 points (all p < 0.05). Home-based PME (NMES) achieved 100% adherence rates, and no cardiovascular adverse events were reported. The mechanisms by which PME is beneficial involve peripheral skeletal muscle adaptations without eliciting central hemodynamic stress, increased endothelial function, aerobic enzyme activity, protein anabolism stimulation or muscle proteolysis inhibition. No significant effects were observed on BNP levels, hospital readmissions or mortality. PME has been shown to attenuate the progression of sarcopenia through hypertrophy of type I and II muscle fibers, as well as mitochondrial biogenesis. Conclusions: PME is a safe, feasible adjunct to conventional CR in frail, elderly cardiac patients, particularly those with exercise intolerance and sarcopenia. It improves peripheral muscle function, physical performance, and muscle protein balance without cardiovascular stress. Larger multicenter trials are needed to establish optimal protocols and long-term clinical outcomes. Full article

Background and Objectives: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are widely performed procedures with high success rates but relevant postoperative complications. Preoperative nutritional status is a key modifiable risk factor influencing surgical outcomes. This study aimed to map and synthesize the available evidence on the association between preoperative nutritional status and postoperative complications in patients undergoing primary THA or TKA. Materials and Methods: A scoping review was conducted following PRISMA-ScR guidelines. A comprehensive search was performed in PubMed, ScienceDirect, and Scopus, with the last update conducted in April 2026. Studies published between 2015 and 2026 in English and Spanish were included. Eligibility criteria followed the PCC framework. Randomized controlled trials and observational studies were included. Risk of bias was assessed using the Newcastle–Ottawa Scale for observational studies and the Cochrane Risk of Bias tool for randomized trials. Results: A total of 1126 records were identified, and 23 studies were included, comprising 447,852 patients. Nutritional status was mainly assessed using serum biomarkers, particularly albumin, followed by anthropometric measures, combined indices, and micronutrients. Poor nutritional status, especially hypoalbuminemia, vitamin D deficiency, and low BMI, was associated with higher rates of infectious complications, prolonged hospital stay, increased readmissions and mortality, and worse functional recovery. Conclusions: Preoperative nutritional assessment is essential for perioperative risk stratification in THA and TKA. Integrating biomarkers, indices, and targeted interventions may improve outcomes and reduce postoperative complications. Full article

Background: Radical cystectomy (RC) remains associated with substantial perioperative morbidity despite advances in minimally invasive surgery and reconstructive techniques. Comparisons between intracorporeal reconstruction, robotic-assisted approaches, and urinary diversion strategies are frequently confounded by clinical heterogeneity and patient selection. This study aimed to perform a stratified surgical systematic review evaluating perioperative outcomes across distinct reconstructive pathways following RC. Methods: A PRISMA-guided systematic review identified comparative studies evaluating intracorporeal versus extracorporeal/open orthotopic neobladder reconstruction, robotic-assisted versus open radical cystectomy in frail patients undergoing ureterocutaneostomy, and ileal conduit versus orthotopic urinary diversion. Analyses were performed within predefined clinical modules to preserve surgical context. Outcomes were expressed as odds ratios (ORs) with 95% confidence intervals (CIs), complemented by rare-event sensitivity analyses and exploratory absolute risk metrics, including number needed to treat or harm (NNT/NNH). Continuous outcomes such as estimated blood loss and length of hospital stay were assessed descriptively. Results: Three comparative observational cohorts met inclusion criteria. Intracorporeal neobladder reconstruction and robotic-assisted cystectomy demonstrated consistent reductions in transfusion rates and favourable trends in perioperative morbidity. In frail patient populations, robotic surgery showed reduced intraoperative burden without increased readmission or mortality. Ileal conduit diversion was associated with increased wound-related complications and infectious outcomes; however, these findings likely reflect baseline differences in patient frailty and selection. Rare-event sensitivity analyses confirmed directional consistency of treatment effects despite wide confidence intervals. Integration of absolute risk differences and NNT/NNH metrics provided clinically interpretable context for stratified outcomes. Conclusions: Minimally invasive and intracorporeal strategies following radical cystectomy may reduce perioperative burden, whereas diversion type primarily influences complication patterns rather than overall morbidity. A stratified analytical framework integrating relative and absolute effect measures may offer a more clinically meaningful approach to evaluating reconstructive strategies in heterogeneous surgical populations. Full article

Numerous studies have shown that remote monitoring of heart failure patients can reduce hospital readmission rates and mortality. This dataset includes multimodal physiological and inertial signals (acceleration and angular velocity data) recorded with PerHeart—a remote health monitoring platform intended for heart failure patients. In the pilot, which took place in Poland, 27 participants’ health was monitored for one month using the platform with commercially available devices (blood pressure meters, pulse oximeters, bathroom scales, thermometers, and glucometers), resulting in over four thousand physiological measurements. Eight adults were additionally monitored for gait and activity analysis using custom wrist sensors with inertial measurement units, yielding 2536 h of movement data collected over 204 days with almost 690,000 steps detected. Full article

Background/Objectives: Laparoscopic subtotal cholecystectomy (LSC) can be performed using either the fenestrating or reconstituting method. In the fenestrating method, some surgeons additionally perform suture closure of the cystic duct orifice, whereas others do not. However, evidence regarding the clinical significance of suture closure remains limited. Methods: Between April 2018 and December 2023, 934 patients underwent cholecystectomy at our institution. Among them, 37 underwent LSC because standard cystic duct control could not be achieved intraoperatively. Of these, 34 were treated with the fenestrating method. Among these 34 patients, 27 did not undergo suture closure of the cystic duct orifice (non-suture group), while 7 underwent suture closure (suture group). Perioperative outcomes were retrospectively compared between the groups. Results: No statistically significant differences were observed between the groups in operative time, drain retention period, postoperative hospital stay, postoperative bile leakage, or the need for postoperative endoscopic treatment. Similar findings were observed in exploratory subgroup analyses among patients with intraoperative bile flow from the cystic duct orifice (IBF) and within the non-suture group according to the presence or absence of IBF. No reoperations, readmissions, or deaths occurred in either group. However, postoperative bile leakage (11/27 [40.7%] vs. 1/7 [14.3%]) and endoscopic treatment (7/27 [25.9%] vs. 1/7 [14.3%]) were more frequent in the non-suture group, although not statistically significant. Conclusions: In this small retrospective single-institution cohort, no statistically significant differences in perioperative outcomes were observed between patients with or without suture closure of the cystic duct orifice during fenestrating LSC. However, the non-suture group showed a trend toward higher rates of postoperative bile leakage and endoscopic treatment. These hypothesis-generating findings should be interpreted cautiously. Full article

Background: Esophagectomy is associated with substantial postoperative morbidity, with infectious complications remaining a leading cause of mortality. Septic shock represents the most severe infectious complication; however, data on its perioperative predictors and long-term impact after esophagectomy are limited. Methods: We conducted a retrospective observational study including consecutive adult patients who underwent esophagectomy with curative intent for esophageal cancer between January 2015 and December 2024 at a tertiary referral center. Postoperative septic shock was defined according to Sepsis-3 criteria. Demographic, clinical, surgical, laboratory, and oncological variables were analyzed. Independent risk factors for septic shock were identified using multivariate logistic regression. Overall survival was assessed using Kaplan–Meier analysis. Results: Among 106 patients, 19 (17.9%) developed postoperative septic shock. These patients had a lower body mass index, reduced preoperative and postoperative albumin levels, and a higher incidence of advanced lymph node involvement. Septic shock was strongly associated with severe postoperative complications, including anastomotic leakage, hemorrhagic shock, acute respiratory distress syndrome, acute kidney failure, and increased rates of PICU readmission. In multivariate analysis, lower albumin levels at PICU admission (OR 0.54; 95% CI 0.29–0.99) and advanced nodal stage (OR 4.98; 95% CI 1.36–18.3) were independently associated with the development of septic shock. Patients who developed septic shock had significantly higher in-hospital mortality (31.6% vs. 1.1%, p < 0.001) and markedly reduced long-term survival, even among those discharged alive. Conclusions: Postoperative septic shock after esophagectomy is a devastating complication with a profound negative impact on both short- and long-term survival. Hypoalbuminemia and advanced lymph node involvement are independent predictors of septic shock. These findings support the integration of simple clinical and laboratory markers into personalized perioperative risk stratification models, enabling individualized management strategies to reduce severe postoperative complications. Full article

Background and Objectives: Breast cancer surgery is increasingly performed in older patients with multimorbidity, in whom cardiovascular disease and frailty may substantially modify perioperative risk, including vulnerability to heart failure decompensation and other major medical complications. However, most available studies report global perioperative complication rates and composite medical endpoints, with heart failure events only rarely captured as dedicated outcomes, and operative technique, cardiovascular comorbidity, and frailty are often treated as separate domains rather than components of an integrated risk framework. Materials and Methods: We conducted a systematized narrative review with a structured literature search in PubMed/MEDLINE, Scopus, and Web of Science from inception to 31 January 2026, including original studies of adult patients undergoing breast-conserving surgery, mastectomy, and/or reconstruction that reported early postoperative outcomes in relation to comorbidities, cardiovascular risk, or frailty. Eligibility assessment, data extraction, and qualitative synthesis followed key PRISMA 2020 principles, and findings were organized into three prespecified domains: surgical complexity, cardiovascular vulnerability (including patients with heart failure where reported), and frailty. Results: Nineteen studies (retrospective cohorts, registry-based analyses, and large database studies, primarily ACS NSQIP) met inclusion criteria, encompassing diverse breast surgery populations, including elderly, metastatic, and reconstructive cohorts. Across datasets, escalation from breast-conserving surgery to mastectomy and then to increasingly complex reconstruction was associated with a stepwise increase in perioperative complications, reoperations, bleeding, and, in selected series, catastrophic events. Preexisting cardiovascular disease and systemic vascular pathology significantly amplified postoperative morbidity even in procedures considered low or intermediate cardiac risk, with signals that patients with underlying heart failure carry particularly heightened vulnerability, although HF-specific events were infrequently reported as separate endpoints. Frailty, mainly assessed using modified frailty indices, consistently emerged as a strong, age-independent predictor of 30-day complications, mortality, and readmissions across surgical types, including both breast-conserving and reconstructive procedures. Conclusions: Early postoperative outcomes after breast cancer surgery are associated with the interaction between surgical complexity, cardiovascular comorbidity (with limited HF-specific reporting), and frailty rather than by operative technique alone. In this context, our synthesis primarily reflects overall cardiovascular vulnerability in comorbid and frail patients, with heart failure risk inferred indirectly from the available data. These findings support a patient-centered, risk-adapted surgical strategy in which the extent and timing of surgery and reconstruction are tailored to each patient’s cardiovascular profile and frailty status, with preferential use of breast-conserving or less complex procedures in vulnerable individuals. Integrating standardized frailty assessment and cardio-oncologic evaluation into preoperative workflows, and prospectively validating this tri-axial framework in dedicated cohorts, may improve perioperative risk stratification and reduce the burden of postoperative medical complications in an aging breast cancer population. Full article

Background: Despite significant advances in heart failure (HF) management, mortality and readmission rates remain persistently high. Low adherence has been recognised as a contributing factor, although supporting data remain limited. Objective: This study aimed to evaluate the impact of medication adherence on outcome following a HF hospitalisation. Methods: Patients who were discharged after HF hospitalisation were included in the study from a national multicentre HF cohort, and their records were matched with the National Healthcare System database, which includes all health-related claims and clinical events. Adherence to beta blockers, renin-angiotensin system inhibitors, and mineralocorticoid receptor antagonists were measured using the proportion of days covered (PDC). Low adherence was defined by PDC < 80% for at least one of the three HF drug classes. We then analysed the relationship between the PDC and outcome during a two-year follow-up period. Results: A total of 448 patients (median age: 73 years; 67% male; mean ejection fraction: 40%) were included. Of these patients, 152 (34%) were classified as having low adherence. The two-year mortality rate was comparable between the two groups (16.9% vs. 19.1% in adherent and low-adherent groups, respectively, p = 0.6). However, the rates of all-cause and HF rehospitalisations at two years were lower in the adherent group than in the group with low adherence (85.9% vs. 92.8%, p ≤ 0.01; 48.5% vs. 58.2%, p = 0.04, respectively). Conclusions: In patients discharged after acute HF, low adherence to HF drugs is frequent and worsens outcome, particularly the risk of rehospitalisation. Full article

Background/Objectives: Inpatient clinical deterioration is a major contributor to adverse hospital outcomes, such as unplanned intensive care unit (ICU) admissions and death. Rapid response systems aim to address this challenge by enabling early identification and intervention in at-risk patients. This study evaluated the impact of implementing a mobile intensive care team on clinical outcomes in surgical patients. Methods: A retrospective observational cohort study was conducted in a tertiary care hospital, comparing two consecutive periods: a pre-intervention phase (PRETIM) and a post-intervention phase (TIM). The study included 17,156 adult surgical patients. The TIM consisted of a proactive outreach team composed of one attending intensivist and two resident physicians, focusing on post-ICU monitoring and early identification of clinical deterioration on surgical wards. The primary outcome was in-hospital mortality. Secondary outcomes included ICU readmission and length of stay. Multivariable logistic regression adjusted for age, sex and surgical section was performed, along with subgroup and sensitivity analyses excluding early non-modifiable deaths. Results: Baseline characteristics were comparable between groups. In-hospital mortality decreased significantly following implementation of the TIM (8.0% vs. 5.3%; p < 0.001), corresponding to an absolute risk reduction of 2.7% and a number needed to treat of 37. ICU readmission rates did not differ significantly between groups. Sensitivity analysis excluding early deaths confirmed the mortality reduction. Subgroup analysis demonstrated consistent effects across surgical specialties, with the largest reductions observed in neurosurgery and general surgery. Conclusions: The implementation of a mobile intensive care team was associated with a significant and clinically meaningful reduction in in-hospital mortality among surgical patients. The findings support the role of proactive post-ICU monitoring and early intervention strategies in improving patient outcomes in high-risk hospital populations. Full article

Background and Objectives: Acute cholecystitis is a common indication for emergency surgery. While acute calculous cholecystitis (ACC) is most common, acute acalculous cholecystitis (AAC) occurs without gallstones and is often associated with severe systemic illness. We compared early postoperative outcomes after cholecystectomy for AAC versus ACC, with emphasis on complication severity and overall morbidity burden. Materials and Methods: We performed a single-center retrospective cohort study of consecutive adults undergoing urgent or emergent cholecystectomy for acute cholecystitis between December 2020 and April 2025. Patients with chronic cholecystitis, duplicate records, missing group assignment, or incomplete 30-day follow-up were excluded. The primary 30-day endpoints were postoperative complications, their severity (assessed with Clavien–Dindo scale), and cumulative morbidity assessed using the Comprehensive Complication Index. Secondary outcomes included operative approach, postoperative length of stay, 30-day readmission, and mortality. Results: A total of 221 patients were analyzed (181 ACC, 40 AAC). Patients with AAC were older and more frequently male. Any complication within 30 days occurred substantially more often in AAC patients than in ACC patients. Morbidity severity also differed markedly, with higher-grade complications occurring more frequently in the AAC group. AAC patients exhibited a substantially greater overall morbidity burden, indicating not only more frequent complications but also a heavier cumulative impact. Thirty-day mortality was considerably higher in AAC. Open surgery was more commonly required in AAC, whereas postoperative length of stay and 30-day readmission rates were similar between groups. Conclusions: In this cohort, AAC was associated with substantially worse early outcomes after cholecystectomy than ACC, characterized by a pronounced increase in clinically significant complications (Clavien–Dindo ≥ IIIa), greater cumulative morbidity (CCI), and markedly higher 30-day mortality. These findings support treating AAC as a high-risk phenotype warranting intensified perioperative optimization and vigilant postoperative monitoring. Full article

Background/Objectives: Nursing assessment frameworks play a critical role in guiding holistic patient evaluations, standardizing documentation, and supporting organizational quality and safety initiatives. Among these, Gordon’s Functional Health Patterns (FHPs) offer a comprehensive and widely used framework for nursing assessment. However, no review has synthesized evidence on their association with outcomes. This scoping review aimed to map evidence on the use of FHPs in relation to patient and organizational outcomes, and to examine their integration into electronic health records (EHRs) and the analytical methods employed. Method: A scoping review was conducted following Joanna Briggs Institute methodology and PRISMA-ScR guidelines. PubMed, CINAHL, and Scopus were searched for quantitative primary studies reporting associations between FHPs and outcomes, and the final search was conducted on 22 March 2024. Three reviewers independently screened abstracts and full texts and extracted data. Results: Seven studies met the inclusion criteria. FHPs’ use was associated with improvements in several patient outcomes, including quality of life, psychological well-being, clinical parameters, self-management, dependency level, and functional performance. Organizational outcomes included reduced hospital readmission rates and a positive association between FHP-derived nursing diagnoses and nursing workload. Most studies used standardized nursing terminologies such as NANDA-I, NOC, or NIC, in conjunction with FHPs. Over half of the studies used EHR-based nursing documentation, reflecting increasing digital integration and enabling more structured and interoperable nursing data. Methodological approaches varied widely: most studies used associative analyses, two employed experimental designs, and one investigated the predictive utility of FHP-based assessment data. Conclusions: FHPs provide a structured framework for nursing practice with potential benefits for patient and organizational outcomes. Their increasing integration into EHRs supports standardized documentation and data-driven nursing practice, enhancing assessment quality, diagnostic accuracy, and the availability of structured data for clinical and managerial decision-making in health information systems. Further experimental and longitudinal research is needed to strengthen causal evidence and guide implementation. Full article

Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is among the most common inherited enzymatic disorders worldwide and is an important risk factor for neonatal hyperbilirubinemia. Regional data from Western Saudi Arabia based on universal newborn screening remain limited. Objectives: To determine the prevalence of G6PD deficiency among newborns delivered at a tertiary center in Jeddah, Saudi Arabia, and to evaluate its association with clinically relevant outcomes, including early-onset jaundice (<24 h), need for phototherapy, admission for hyperbilirubinemia management, and readmission after discharge. Methods: We conducted a retrospective cohort study at King Abdulaziz Medical City, Western Region, Jeddah, Saudi Arabia, between January 2020 and May 2025. Cord blood samples from live-born infants were screened using a qualitative fluorescent spot test. Demographic variables (sex, gestational age, birth weight) and jaundice-related outcomes were extracted from the electronic medical record. Categorical variables were compared using chi-square testing, with p < 0.05 considered statistically significant. Results: Among 14,964 screened newborns, 489 were identified as G6PD deficient, yielding a prevalence of 3.3%. Prevalence was higher in males than in females (5.6% vs. 0.9%). Among the G6PD-deficient infants, early-onset jaundice occurred in 17.2%, phototherapy was required in 36.0%, and 16.5% were admitted for hyperbilirubinemia management. Readmission for worsening jaundice requiring phototherapy occurred in 11.0%, and no exchange transfusions were required. Compared with term infants, late preterm infants had higher rates of early-onset jaundice (11/49, 22.4% vs. 73/440, 16.6%) and phototherapy use (22/49, 45.0% vs. 154/440, 35.0%) (p < 0.01). Conclusions: G6PD deficiency was identified in a substantial proportion of newborns in this large screened cohort and was associated with clinically significant jaundice-related outcomes, particularly among late preterm infants. These findings underscore the importance of universal screening and structured postnatal follow-up to reduce the risk of severe hyperbilirubinemia and its complications. Early identification of G6PD-deficient infants should be accompanied by careful bilirubin monitoring, clear discharge planning, and timely post-discharge follow-up, especially for those born late preterm. Full article

Background/Objectives: The objective of this study was to evaluate, for the first time, the effectiveness and safety of 4% icodextrin solution by detecting the incidence of adhesion-related morbidities (adhesion-related hospital readmissions, including reoperations) when used as an adhesion prophylactic agent during laparoscopic gynecologic surgery. Methods: The study was a single-arm, two-center, retrospective study. The incidence of hospital readmissions that were directly or possibly related to adhesions following the use of 4% icodextrin in laparoscopic gynecologic surgery, 2 years from the date of index surgery, was assessed either via chart review alone or, when found necessary, in combination with patient-completed questionnaires. Patient safety was evaluated through reported adverse events. The relationship between clinical events and the use of 4% icodextrin was assessed by investigators based on patient-level data. Results: After 149 patients were screened, the study finally included 123 patients; 4 (3.3%; 95% CI: 0.89%, 8.12%) had at least one reoperation or readmission that was directly or possibly related to adhesion within 2 years of index surgery. In the supplemental analysis (67 patients using chart and questionnaire data), this incidence rate was 10.4% (95% CI: 4.30%, 20.35%). No adverse events related to the use of 4% icodextrin were reported. Conclusions: This is the first study ever evaluating hospital readmission/reoperation rates after application of a specific adhesion prophylactic agent. The results indicate that 4% icodextrin is safe and effective when used as an intraperitoneal instillate for reduction in adhesions in gynecological laparoscopic procedures. It has a lower readmission and reoperation rate compared to meta-analysis data in the international literature. Full article

Objectives: Complex patients in need of an urgent medical assessment can contribute to crowding in the Emergency Department (ED). Optimising access to geriatric expertise for this patient group is known as ‘Geriatric Emergency Departments’. Methods: A parallel care pathway was designed to redirect frail older patients to an Urgent Geriatric Care (UGC) service rather than the ED. The UGC has access to the diagnostic facilities of the ED. This descriptive analysis reports on delivered care, diagnostics, admissions rates, discharge policy, and 30-day and 6-month outcomes concerning hospital (re)admissions, ED visits, and mortality. Results: 269 patients were analysed. The median age was 83 years, 68% had polypharmacy, 51% cognitive disorders, and 83% a gait disturbance. A median of four conclusions was drawn per patient. Evaluation at the UGC often leads to medication regimen changes (81%), initiation or expansion of care at home (46%), and initiation of dementia care (18%). The hospital admission rate was 13%; the rate of ED visits within 30 days was 5% and, within 6 months, an additional 16%; the rate of hospital readmissions within 30 days was 7%, and 11% after 6 months. The mortality rates were 9% within 30 days and 12% within 6 months. Conclusions: Evaluation of patients at the UGC led to a high degree of medication regimen changes, initiation of care at home, and multiple conclusions or diagnoses per patient. Readmission or revisiting rates were low. A direct comparison to care delivered at the ED should be made in a future study. Full article