BACKGROUND: As the population ages, more older adults are presenting for surgery. Age-related declines in physiological reserve and functional capacity can result in frailty and poor outcomes after surgery. Hence, optimizing perioperative care in older patients is imperative. Enhanced Recovery After Surgery (ERAS) pathways and Minimally Invasive Surgery (MIS) may influence surgical outcomes, but current use and impact on older adults patients is unknown. The aim of this study was to provide evidence-based recommendations on perioperative care of older adults undergoing major abdominal surgery.
METHODS: Expert consensus determined working definitions for key terms and metrics related to perioperative care. A systematic literature review and meta-analysis was performed using the PubMed, Embase, Cochrane Library, and Clinicaltrials.gov databases for 24 pre-defined key questions in the topic areas of prehabilitation, MIS, and ERAS in major abdominal surgery (colorectal, upper gastrointestinal (UGI), Hernia, and hepatopancreatic biliary (HPB)) to generate evidence-based recommendations following the GRADE methodology.
RESULTS: Older adults were defined as 65 years and older. Over 20,000 articles were initially retrieved from search parameters. Evidence synthesis was performed across the three topic areas from 172 studies, with meta-analyses conducted for MIS and ERAS topics. The use of MIS and ERAS was recommended for older adult patients particularly when undergoing colorectal surgery. Expert opinion recommended prehabilitation, cessation of smoking and alcohol, and correction of anemia in all colorectal, UGI, Hernia, and HPB procedures in older adults. All recommendations were conditional, with low to very low certainty of evidence, with the exception of ERAS program in colorectal surgery.
CONCLUSIONS: MIS and ERAS are recommended in older adults undergoing major abdominal surgery, with evidence supporting use in colorectal surgery. Though expert opinion supported prehabilitation, there is insufficient evidence supporting use. This work has identified evidence gaps for further studies to optimize older adults undergoing major abdominal surgery.

BACKGROUND: Care for patients undergoing elective colectomy has become increasingly standardized using Enhanced Recovery Programs (ERP). ERP, encorporating minimally invasive surgery (MIS), decreased postoperative morbidity and length of stay (LOS). However, disruptive changes are needed to safely introduce colectomy in an ambulatory or same-day discharge (SDD) setting. Few research groups showed the feasibility of ambulatory colectomy. So far, no minimum standards for the quality of care of this procedure have been defined. This study aims to identify quality indicators (QIs) that assess the quality of care for ambulatory colectomy.
METHODS: A literature search was performed to identify recommendations for ambulatory colectomy. Based on that search, a set of QIs was identified and categorized into seven domains: preparation of the patient (pre-admission), anesthesia, surgery, in-hospital monitoring, home monitoring, feasibility, and clinical outcomes. This list was presented to a panel of international experts (surgeons and anesthesiologists) in a 1 round Delphi to assess the relevance of the proposed indicators.
RESULTS: Based on the literature search (2010-2021), 3841 results were screened on title and abstract for relevant information. Nine papers were withheld to identify the first set of QIs (n = 155). After excluding duplicates and outdated QIs, this longlist was narrowed down to 88 indicators. Afterward, consensus was reached in a 1 round Delphi on a final list of 32 QIs, aiming to be a comprehensive set to evaluate the quality of ambulatory colectomy care.
CONCLUSIONS: We propose a list of 32 QI to guide and evaluate the implementation of ambulatory colectomy.

Background: Significant concern emerged at the beginning of the SARS-CoV-2 pandemic regarding the safety and practicality of robotic-assisted surgery (RAS). We aimed to review reported surgical practice and peer-reviewed published review recommendations and guidelines relating to RAS during the pandemic. Methods: A systematic review was performed in keeping with PRISMA guidelines. This study was registered on Open Science Framework. Databases were searched using the following search terms: \'robotic surgery\', \'robotics\', \'COVID-19\', and \'SARS-CoV-2\'. Firstly, articles describing any outcome from or reference to robotic surgery during the COVID-19/SARS-CoV-2 pandemic were considered for inclusion. Guidelines or review articles that outlined recommendations were included if published in a peer-reviewed journal and incorporating direct reference to RAS practice during the pandemic. The ROBINS-I (Risk of Bias in Non-Randomised Studies of Intervention) tool was used to assess the quality of surgical practice articles and guidelines and recommendation publications were assessed using the AGREE-II reporting tool. Publication trends, median time from submission to acceptance were reported along with clinical outcomes and practice recommendations. Results: Twenty-nine articles were included: 15 reporting RAS practice and 14 comprising peer-reviewed guidelines or review recommendations related to RAS during the pandemic, with multiple specialities (i.e., urology, colorectal, digestive surgery, and general minimally invasive surgery) covered. Included articles were published April 2020-December 2021, and the median interval from first submission to acceptance was 92 days. All surgical practice studies scored \'low\' or \'moderate\' risk of bias on the ROBINS-I assessment. All guidelines and recommendations scored \'moderately well\' on the AGREE-II assessment; however, all underperformed in the domain of public and patient involvement. Overall, there were no increases in perioperative complication rates or mortalities in patients who underwent RAS compared to that expected in non-COVID practice. RAS was deemed safe, with recommendations for mitigation of risk of viral transmission. Conclusions: Continuation of RAS was feasible and safe during the SARS-CoV-2 pandemic where resources permitted. Post-pandemic reflections upon published robotic data and publication patterns allows us to better prepare for future events and to enhance urgent guideline design processes.

Surgical site infections (SSIs), i.e., surgery-related infections that occur within 30 days after surgery without an implant and within one year if an implant is placed, complicate surgical procedures in up to 10% of cases, but an underestimation of the data is possible since about 50% of SSIs occur after the hospital discharge. Gastrointestinal surgical procedures are among the surgical procedures with the highest risk of SSIs, especially when colon surgery is considered. Data that were collected from children seem to indicate that the risk of SSIs can be higher than in adults. This consensus document describes the use of preoperative antibiotic prophylaxis in neonates and children that are undergoing abdominal surgery and has the purpose of providing guidance to healthcare professionals who take care of children to avoid unnecessary and dangerous use of antibiotics in these patients. The following surgical procedures were analyzed: (1) gastrointestinal endoscopy; (2) abdominal surgery with a laparoscopic or laparotomy approach; (3) small bowel surgery; (4) appendectomy; (5) abdominal wall defect correction interventions; (6) ileo-colic perforation; (7) colorectal procedures; (8) biliary tract procedures; and (9) surgery on the liver or pancreas. Thanks to the multidisciplinary contribution of experts belonging to the most important Italian scientific societies that take care of neonates and children, this document presents an invaluable reference tool for perioperative antibiotic prophylaxis in the paediatric and neonatal populations.

UNASSIGNED: Prophylactic use of antibiotics before surgery is evidence-based practice for prevention of surgical site infections (SSIs).
UNASSIGNED: To investigate adherence to and surgeons\' perception of antibiotic prophylaxis guidelines.
UNASSIGNED: A two-phase, cross-sectional prospective study conducted in two teaching hospitals. Phase 1: 6-month audit of prescriptions to investigate adherence rate to evidence-based guidelines. The important information was collected from medical charts through a predesigned proforma. Phase 2: self-administration questionnaire was used to investigate the surgeons\' perception. Descriptive statistics, independent-sample Kruskal-Wallis test and multivariate linear regression analysis were performed using SPSS version 21.0.
UNASSIGNED: A total of 866 eligible surgical cases (acute appendectomy; n = 418; 48.2%), laparoscopic cholecystectomy (n = 278; 32.1%) and inguinal hernia (n = 170; 19.7%) were investigated. Surgical antibiotic prophylaxis was prescribed in 97.5% of procedures. Out of these, 9.5% adhered to guidelines with respect to correct choice, 40% for timing, and 100% for dose and route (optimal value 100%). Most patients received ceftriaxone (n = 503; 59.5%) as prophylactic antibiotic. The questionnaire (good internal consistency; α ≥ 0.7) was filled out by 200 surgeons. More than half (69%) of participants thought that antibiotics were overused. Most surgeons perceive that poor adherence to treatment guidelines is due to poor awareness, underestimation of infection, lack of consensus, and disagreement with guidelines recommendations.
UNASSIGNED: Surgeons have positive perception that antibiotics should be used according to guidelines recommendations. However, we found poor treatment adherence to antibiotic prophylaxis guidelines.
مراجعة استعمال المضادات الحيوية الوقائية ومدى امتثال الجراحين للمبادئ التوجيهية القياسية في الإجراءات الجراحية المعتادة في منطقة البطن.
ذاكر خان، نافيد أحمد، شايستا ظفار، عاصم الرحمن، فايز الله خان، محمد صقلان، سُهيل قامران، حاضر رحمن.
UNASSIGNED: يُعتبر استعمال المضادات الحيوية على سبيل الوقاية قبل الجراحة من الممارسات المُسنَدة بالبيّنات للوقاية من حدوث عدوى المواضع الجراحية.
UNASSIGNED: هدفت هذه الدراسة إلى تحرّي مدى الامتثال للمبادئ التوجيهية الخاصة باستعمال المضادات الحيوية الوقائية ومنظور الجراحين في هذا الشأن.
UNASSIGNED: أُجريت دراسة استباقية مقطعية على مرحلتين في اثنين من المستشفيات الجامعية. المرحلة 1: مراجعة الوصفات الطبية التي حُررت على مدار 6 أشهر لتحري معدل الامتثال بالمبادئ التوجيهية المُسنَدة بالبيّنات. وجُعت المعلومات المهمة من المخططات الطبية للمرضى باستخدام استمارة مُصمَّمة مسبقاً لهذا الغرض. المرحلة 2: استخدام استبيان يُستكمل ذاتياً لتحرِّي منظور الجراحين في هذا الشأن. وقد استُخدم الإصدار 21.0 من برنامج SPSS لإجراء إحصاءات وصفية، واختبار كروسكال واليس القائم على العينات المستقلة، وتحليل الانحدار الخطي المتعدد المتغيرات.
UNASSIGNED: بلغ مجموع الحالات الجراحية التي تصلح للخضوع لهذه الدراسة 866 حالة، تراوحت بين استئصال الزائدة الدودية الملتهبة التهاباً حاداً (العدد=418؛ 48.2٪)، واستئصال المرارة بالمنظار (العدد= 278؛ 32.1٪)، والفتق الأُربي (العدد=170؛ 19.7٪). وقد وُصفت المضادات الحيوية الوقائية في 97.5٪ من الإجراءات الجراحية. ومن بين هذه الإجراءات الجراحية، كانت نسبة الامتثال للمبادئ التوجيهية من حيث الاختيار الصحيح، والتوقيت، والجرعة والمسار 9.5٪، و 40٪، و 100٪ على التوالي (القيمة المُثلى 100٪). وتلقى معظم المرضى دواء سيفترياكسون (العدد= 503؛ 59.5٪)، بوصفه أحد المضادات الحيوية الوقائية. وقد أجاب عن الاستبيان 200 جراح (اتساق داخلي جيد؛ α ≥ 0.7). ورأى أكثر من نصف الجراحين المشاركين في الاستبيان (69 ٪) أن هناك زيادة في استعمال المضادات الحيوية. كما رأى معظم الجراحين أن السبب وراء ضعف الامتثال بالمبادئ التوجيهية للعلاج يرجع إلى ضعف الوعي، وعدم تقدير الحجم الحقيقي للعدوى، وغياب التوافق في الآراء، والاختلاف مع التوصيات الخاصة بالمبادئ التوجيهية.
UNASSIGNED: لدى الجراحين منظور إيجابي بشأن ضرورة استعمال المضادات الحيوية وفقاً لما ورد في التوصيات الخاصة بالمبادئ التوجيهية، لكن لوحظ ضعف الامتثال للمبادئ التوجيهية الخاصة بالعلاج بالمضادات الحيوية الوقائية.
Audit de l’antibioprophylaxie et de l’observance des lignes directrices standard par les chirurgiens dans les actes courants de chirurgie abdominale.
UNASSIGNED: L’usage prophylactique des antibiotiques préalablement à un acte chirurgical est une pratique fondée sur des données probantes, qui permet de prévenir les infections du site opératoire (ISO).
UNASSIGNED: Étudier l’observance des lignes directrices en matière d’antibioprophylaxie et le point de vue des chirurgiens sur cette pratique.
UNASSIGNED: Une étude prospective transversale en deux phases, a été menée dans deux hôpitaux universitaires. Phase 1 : Audit des ordonnances sur six mois, afin d’évaluer le taux de d’observance des lignes directrices fondées sur des données probantes. Les informations importantes ont été recueillies à partir des dossiers médicaux au moyen d’un formulaire conçu à cet effet. Phase 2 : un auto-questionnaire a été utilisé pour étudier le point de vue des chirurgiens. Des statistiques descriptives ont été produites, un test de Kruskal-Wallis sur échantillons indépendants et une analyse de régression linéaire multivariée ont été réalisés à l’aide du logiciel SPPS, version 21.0.
UNASSIGNED: Au total, 866 cas chirurgicaux répondant aux critères de l’étude ont été examinés : appendicectomies aiguës, (n = 418, soit 48,2 %), cholécystectomies laparoscopiques, (n = 278, soit 32,1 %) et hernies inguinales (n = 170, soit 19,7 %). Une antibioprophylaxie chirurgicale a été prescrite dans 97,5 % des interventions. Parmi ces dernières, le respect des lignes directrices était de 9,5 % pour le choix de l’antibiotique, de 40 % pour le moment de l’administration et de 100 % pour la dose et la voie d’administration, la valeur optimale étant 100 %. La majorité des patients ont reçu de la ceftriaxone (n = 503, soit 59,5 %) comme antibiotique prophylactique. Le questionnaire a été rempli par 200 chirurgiens, avec une cohérence interne satisfaisante (α ≥ 0,7). Plus de la moitié (69 %) des participants estimaient que les antibiotiques étaient surutilisés. La majorité des chirurgiens pensent que l’observance médiocre des lignes directrices de traitement est due à un manque de sensibilisation, à une sous-estimation de l’infection, à l’absence d’un consensus et à un désaccord avec les recommandations de ces lignes directrices.
UNASSIGNED: Les chirurgiens approuvent l’usage des antibiotiques conformément aux recommandations des lignes directrices de traitement. Cependant, notre étude révèle une observance médiocre de ces textes dans les traitements d’antibioprophylaxie.

Vacuum sealing drainage (VSD) is frequently used in abdominal surgeries. However, relevant guidelines are rare. Chinese Trauma Surgeon Association organized a committee composed of 28 experts across China in July 2017, aiming to provide an evidence-based recommendation for the application of VSD in abdominal surgeries. Eleven questions regarding the use of VSD in abdominal surgeries were addressed: (1) which type of materials should be respectively chosen for the intraperitoneal cavity, retroperitoneal cavity and superficial incisions? (2) Can VSD be preventively used for a high-risk abdominal incision with primary suture? (3) Can VSD be used in severely contaminated/infected abdominal surgical sites? (4) Can VSD be used for temporary abdominal cavity closure under some special conditions such as severe abdominal trauma, infection, liver transplantation and intra-abdominal volume increment in abdominal compartment syndrome? (5) Can VSD be used in abdominal organ inflammation, injury, or postoperative drainage? (6) Can VSD be used in the treatment of intestinal fistula and pancreatic fistula? (7) Can VSD be used in the treatment of intra-abdominal and extra-peritoneal abscess? (8) Can VSD be used in the treatment of abdominal wall wounds, wound cavity, and defects? (9) Does VSD increase the risk of bleeding? (10) Does VSD increase the risk of intestinal wall injury? (11) Does VSD increase the risk of peritoneal adhesion? Focusing on these questions, evidence-based recommendations were given accordingly. VSD was strongly recommended regarding the questions 2-4. Weak recommendations were made regarding questions 1 and 5-11. Proper use of VSD in abdominal surgeries can lower the risk of infection in abdominal incisions with primary suture, treat severely contaminated/infected surgical sites and facilitate temporary abdominal cavity closure.