Multidisciplinary Panel Develops Consensus Recommendations for Healthcare Response to Mass Shootings
Goolsby C, Schuler K, Krohmer J, et al. Mass Shootings in America: Consensus Recommendations for Healthcare Response. J Am Coll Surg. 2022, in press.
Mass shootings are now a facet of everyday life in the US. Unfortunately, many of these events occur at locations away from trauma centers. Hence, communities could benefit from a pre-event, coordinated healthcare response. To provide a useful outline of the optimum medical response to a mass shooting, the authors convened an expert panel to produce a series of consensus statements. The suggestions for an acceptable healthcare response were based on mass shooting events that occurred in six locations in the US.
Panel members represented multiple areas of the healthcare response, including emergency medical services, emergency medicine, and surgery. Recommendations were offered in the following areas: readiness training, public education, triage, communication, patient tracking, medical records, family reunification, and mental health services for patients and healthcare personnel. Additional recommendations specific to certain response areas were added in the final phase of the consensus development. Clear descriptions of each area of recommendations are provided in the article. Readers are encouraged to review these suggestions in detail. The authors recommended that healthcare response teams (clinicians, hospital administrators, and healthcare system leaders) consider these recommendations when forming a response plan.
The recent inaugural episode of the JACS podcast, The Operative Word, provided further insights on the research from research coauthor Craig Goolsby, MD, MEd, FACEP, professor and vice-chair of emergency medicine at the Uniformed Services University of the Health Sciences and Science Director at the National Center for Disaster Medicine and Public Health in Bethesda, MD.
Delayed Operation in Complicated Acute Appendicitis Can Be Worth the Wait for Some Patients
de Almeida Leite RM, de Souza AV, Bay CP, et al. Delayed Operative Management in Complicated Acute Appendicitis—Is Avoiding Extended Resection Worth the Wait? Results from a Global Cohort Study. J Gastrointest Surg. Jul 2022;26(7):1482-1489.
Current clinical practice guidelines recommend watchful waiting with early antibiotic therapy and delayed appendectomy, abscess drainage, and debridement (as necessary) for patients who present with complicated appendicitis (perforation, abscess), are hemodynamically stable and have no signs of diffuse, severe peritonitis. One important objective of the delayed approach is to avoid “extended” appendectomy (partial/total cecal resection and/or right hemicolectomy).
Data to confirm improved outcomes with the delayed approach are scarce. The authors used information from the ACS National Surgical Quality Improvement Program database to compare outcomes in matched patients who underwent early (less than 24 hours) or delayed (greater than 24 hours) appendectomy. End points of interest included mortality, morbidity, and the need for extended appendectomy. The data analysis showed that delayed appendectomy was associated with a significant reduction in the need for extended surgical procedures, hospital length of stay, operative time, and risk for postoperative abscess. A trend toward reduced mortality in the delayed operation group was identified, but it was not statistically significant. The authors concluded that their data supported guideline recommendations for delayed operation in carefully selected patients.
Delaying Elective Procedures after Ischemic Stroke May Lead to Reduced Risk of Postoperative Stroke
Glance LG, Benesch CG, Holloway RG, et al. Association of Time Elapsed since Ischemic Stroke with Risk of Recurrent Stroke in Older Patients Undergoing Elective Nonneurologic, Noncardiac Surgery. JAMA Surg. 2022.
The risk for postoperative stroke is substantial in patients who have suffered an ischemic stroke before a planned surgical procedure. Hence, guidance regarding the appropriate interval between an ischemic stroke and an elective operation is needed. The authors queried national Medicare databases to determine the relationship of the interval between an ischemic stroke and an elective operation with the risk for postoperative stroke.
Data were available for more than 5 million patients. A preoperative ischemic stroke occurred in 54,033 patients. The data showed that patients who had suffered an ischemic stroke less than 30 days before an elective operation were at a significantly elevated risk for postoperative stroke. The risk of postoperative stroke declined steadily from 30 days to 90 days following an ischemic stroke.
The authors concluded that delaying elective procedures after an ischemic stroke was associated with reduced risk of postoperative stroke. To ensure that the risk of postoperative stroke is minimized following an ischemic stroke, the authors recommended that elective surgical procedures be delayed for 90 days following an ischemic stroke.
