Journal of Acute Care Surgery

Comparison of outcomes of nonoperative management with versus without interval appendectomy for periappendiceal abscess in Korea: a retrospective cohort study: Jae Gil Lee, Chang Sung Park, Im Kyung Kim; J Acute Care Surg 2025;15(3):108-115. Published online November 30, 2025; DOI: https://doi.org/10.17479/jacs.2025.0037

Abstract
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Purpose
Nonoperative management (NOM) with percutaneous drainage is widely used for periappendiceal abscesses, but the necessity of interval appendectomy (IA) remains debated. This study evaluated the feasibility of NOM without IA and compared outcomes with IA after NOM.
Methods
A retrospective review was conducted of 53 patients who underwent percutaneous drainage for periappendiceal abscess between January 2009 and December 2019 at Ewha Womans University Mokdong Hospital. Patients were categorized into NOM only (n=26) and IA after NOM (n=27). Clinical data, including demographics, abscess characteristics, laboratory findings, treatment course, and follow-up outcomes, were analyzed.
Results
The recurrence rate after NOM was 7.7%, with all recurrent cases successfully treated surgically and no malignancies detected. Patients in the NOM group were older (62.4±11.5 years vs. 49.5±21.9 years, P=0.007) and had more comorbidities (76.9% vs. 33.3%, P=0.004). The IA group had larger abscesses and higher inflammatory markers. NOM patients had shorter hospital stays (7.9±5.6 days vs. 12.9±6.6 days, P=0.003) and a shorter total antibiotic duration (median [interquartile range]: 15 days [12–18 days] vs. 21 days [15–27 days]; P=0.005). No drainage-related complications occurred.
Conclusion
NOM without IA appears to be a feasible option for selected patients with periappendiceal abscess. Larger prospective studies are warranted to validate these findings and refine patient selection.

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Nutrition, System

The Status of Protein Supply to Patients in the Trauma and Surgical Intensive Care Units and the Effects of Feedback on Protein Supply: A Multicenter Study: Seung-Young Oh, Jae-Myeong Lee, Han Young Lee, Junsik Kwon, Hak-Jae Lee, Nak-Jun Choi, Jae Gil Lee, Im-Kyung Kim, Min Chang Kang, Hyung Won Kim, Seok Hwa Youn; J Acute Care Surg 2022;12(3):132-137. Published online November 23, 2022; DOI: https://doi.org/10.17479/jacs.2022.12.3.132

Purpose
To investigate the status of protein supply by comparing the recommended amount with the delivered amount of protein in patients in the trauma and surgical intensive care units (ICU). Feedback on the protein supply status was presented to each hospital, and we evaluated whether the protein supply had increased to an appropriate level.
Methods
In this retrospective observational multicenter study, nutritional information on patients in the trauma and surgical ICUs who had received nutritional support intervention was collected on the 1st Wednesday of each month at two-month intervals from August 2020 to June 2021, from nine domestic hospitals in Korea. Every two months, the nutritional status of each hospital was shared with all hospitals, and each nutritional support team received feedback on protein supply status.
Results
There were 246 patients from nine hospitals included in this study, and data over the study period from six protein days, were analyzed. The mean ratios of delivered calories to calculated required calories were 74.0%, 80.8%, 85.4%, 77.9%, 71.3%, and 82.1% on Protein Days 1, 2, 3, 4, 5, and 6, respectively. The mean ratios of delivered protein to calculated required protein were 73.0%, 77.2%, 78.9%, 79.3%, 69.4%, and 89.6% on Protein Days 1, 2, 3, 4, 5, and 6, respectively.
Conclusion
Protein supply increased to an appropriate level, feedback on protein supply status may have increased the protein supply ratio and promoted appropriate protein supply and nutritional support for patients in the trauma and surgical ICUs.

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Early Adequate Nutrition in ICU Is Associated with Survival Gain : Retrospective Cohort Study in Patient with Traumatic Brain Injury
Junseo Oh, Jingyeong Kim, Jihyeon Ahn, Sunghoon Choi, Hyung Min Kim, Jaeim Lee, Hang Joo Cho, Maru Kim
Journal of Korean Neurosurgical Society.2025; 68(2): 177. CrossRef

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Trauma, Organ(liver, bowel, kideny etc.)

Management of Traumatic Duodenal Injuries: A Report from a Single-Center: Seok Min Kang, Im-kyung Kim, Jae Gil Lee; J Acute Care Surg 2022;12(1):24-28. Published online March 24, 2022; DOI: https://doi.org/10.17479/jacs.2022.12.1.24

Abstract
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Purpose
Traumatic duodenal injury is uncommon and due to its difficult diagnosis and accessibility there is an increased risk of mortality and morbidity.
Methods
Electronic medical records of a single center were reviewed retrospectively from March 2008 to December 2020 and a total of 7 cases of traumatic duodenal injury were managed by surgical exploration. The site of duodenal perforation, injury mechanisms, operation method, and postoperative outcomes were assessed.
Results
The mean age was 55.72 years (range, 34-78), and there were 5 men in the study. The most common mechanism was in-car traffic accident (4 cases), and 1 case each of pedestrian accident, accident during work, and self-injured stab wound. The most common site of injury was between the 3rd and 4th portion (3 cases), followed by the bulb and 1st portion (2 cases), and 2nd portion (2 cases). Segmental resection of the duodenum and primary anastomosis was performed in the 3rd and 4th portion perforation. In cases of 1st and 2nd portion, injury was managed by primary repair or pylorus preserving pancreaticoduodenectomy. Complications developed in 4 patients, and the most common complication was a problem with the wound; wound seromas developed in 4 cases, entero-cutaneous fistula in 1, and biliary complications in 2 cases. Two patients suffered from intraperitoneal abscess or fluid collection managed by percutaneous drainage. The mean duration of hospital stay was 34 days, and postoperative mortality did not develop.
Conclusion
Favorable clinical outcomes were observed in patients with traumatic duodenal injury managed by various surgical approaches.

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Emergency surgery

10 Years of Acute Care Surgery: Experiences in a Single Tertiary University Hospital in Korea: Tae Hyun Kim, Jung Yun Park, Yun Tae Jung, Seung Hwan Lee, Myung Jae Jung, Jae Gil Lee; J Acute Care Surg 2020;10(3):96-100. Published online November 20, 2020; DOI: https://doi.org/10.17479/jacs.2020.10.3.96

Abstract
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Purpose
Acute care surgery (ACS) has been shown to improve patient outcome and treatment efficiency in the U.S. ACS was introduced to the Department of Surgery, Yonsei University College of Medicine, Seoul to solve the problems associated with delays in surgical evaluation of non-trauma patients who needed emergency surgery, and to offer exposure to a wide variety of surgical cases to general surgical fellows and residents. The objective of this study was to describe the 10-year experience of the ACS department in a single center.
Methods
A retrospective chart review was conducted at the Department of Surgery, Yonsei University College of Medicine, Seoul, for all patients admitted from March 2008 to February 2018. Patients were grouped into either the trauma or non-trauma group, and were further classified according to their diagnosis, and the type of operations they had undergone.
Results
There was a total of 2,805 patients, including 1,001 trauma patients and 1,804 non-trauma patients. The average hospital length of stay was 14 days and the total in-hospital mortality rate was 3.6%. Trauma mechanisms included blunt (92.6%), penetrating (7.0%) and burn (0.4%) trauma. The majority of non-trauma patients were admitted for appendicitis (37.1%), followed by cholecystitis (21.7%). There was a total of 1,561 operations conducted. The most frequent operations were appendectomy (38.3%) and cholecystectomy (19.5%), followed by adhesiolysis (7.8%).
Conclusion
A working ACS department has been implemented in a Korean medical center.

Citations

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Development of an ICT Laparoscopy System with Motion-Tracking Technology for Solo Laparoscopic Surgery: A Feasibility Study
Miso Lee, Jinwoo Oh, Taegeon Kang, Suhyun Lim, Munhwan Jo, Min-Jae Jeon, Hoyul Lee, Inhwan Hwang, Shinwon Kang, Jin-Hee Moon, Jae-Seok Min
Applied Sciences.2024; 14(11): 4622. CrossRef
Difficult Small Bowel Bleeding in Surgical View
Jung Min Bae
Journal of Acute Care Surgery.2024; 14(2): 41. CrossRef
Clinical significance of acute care surgery system as a part of hospital medical emergency team for hospitalized patients
Kyoung Won Yoon, Kyoungjin Choi, Keesang Yoo, Eunmi Gil, Chi-Min Park
Annals of Surgical Treatment and Research.2023; 104(1): 43. CrossRef

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Critical care, Infection/Sepsis

Management of an Open Abdomen Considering Trauma and Abdominal Sepsis: A Single-Center Experience: Young Un Choi, Seung Hwan Lee, Jae Gil Lee; J Acute Care Surg 2019;9(2):39-44. Published online October 30, 2019; DOI: https://doi.org/10.17479/jacs.2019.9.2.39

Abstract
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Purpose
To describe the experience of patients over a 7-year period who have had open abdomen (OA) surgery, at a tertiary university hospital.
Methods
The medical records of 59 patients, who were managed with OA after a laparotomy between March 2009 and December 2015, were reviewed retrospectively. The data collected included demographics, indication for OA, abdominal closure methods, abdominal closure rate, the intensive care unit stay duration, mechanical ventilation duration, hospital stay duration, and complications.
Results
Forty-seven patients (37 males, 78.7%) with a mean age of 52.2 ± 16.7 years were reviewed in the study. The indications for OA were traumatic intra-abdominal bleeding in 23 patients (48.9%), nontraumatic bowel perforation in 10 (21.3%), non-traumatic bleeding in 7 (14.9%), and bowel infarction in 6 (12.8%). The abdominal wall was closed in 38 patients (80.9%). Primary closures and fascial closure using an artificial mesh were performed on 21 (44.7%) and 12 patients (25.5%), respectively. The median number of dressing changes was 0 (interquartile range 0 - 1). The median duration of the intensive care unit and hospital stays were 12.0 and 32.0 days, respectively. The median interval to abdominal closure was 4 days (interquartile range 2 - 10.3 days). Twenty-seven patients developed complications, including uncontrolled sepsis (21.3%), entero-atmospheric fistula (19.1%), ventral hernia (8.5%), bleeding (4.3%), and lateralization (4.3%). The mortality rate was 44.7% with sepsis being the main cause of death (61.9%).
Conclusion
Traumatic intra-abdominal bleeding was a common indication for OA. Primary closure was performed in most patients, and frequent complications resulted in poor patient outcomes.

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The mortality rate of patients with open abdomen and contributing factors – a three-year audit in a major academic trauma unit
E van der Merwe, MS Moeng, M Joubert, M Nel
South African Journal of Surgery.2023; 61(3): 21. CrossRef

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Trauma

Single Center Experience of Stab Wound Management: Myoung Jun Kim, Tae Hwa Hong, Myung Jae Jung, Seung Hwan Lee, Jae Gil Lee; J Acute Care Surg 2015;5(2):64-68. Published online October 31, 2015; DOI: https://doi.org/10.17479/jacs.2015.5.2.64

Abstract
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Purpose:

The aim of this study is to investigate the clinical characteristics and epidemiology of stab wound in a single center for 5 years.

Methods:

Eighty-seven patients visited the emergency room with stab wounds between March 2008 and October 2013. Patient demographics, location of the wound, injured internal organ, and clinical parameters were reviewed.

Results:

Among eighty seven patients, 59 were male, and the mean age was 45.6 years old (range, 18∼85 years old). The most common age group was fifth and sixth decades. The most common cause of stab injury was self-infliction (32 cases), followed by violence (31 cases) and accident (23 cases). Self-infliction injuries were associated with underlying psychological problems in 20 patients. The most common injured sites were abdomen (48 cases), followed by thorax (20 cases) and neck (12 cases). Emergent exploration was required in 37 patients. Four patients (4.6%) were dead due to hypovolemic shock after injury of the thorax (lung) or neck (transection of carotid artery and transection of trachea). The length of hospital stay was 3 days (0∼6.5 days) and the injury severity score (ISS) was 4 points (1∼9 points). ISS was associated with the length of hospital stay (p<0.001) and emergency exploration (p=0.001).

Conclusion:

Self-inflicted injury was the most common cause of stab injury and it was related to psychologic problems. The most common injured site was abdomen.

Citations

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Epidemiology of Knife Injuries at Ain Shams University Hospital Emergency Department from 2018 to 2019: A Cross-Sectional Study
Manar M Ellaban, Eman Afifi, Moustafa El Houssinie, Jon Mark Hirshon, Mohamed El-Shinawi, Maged El-Setouhy
Open Access Emergency Medicine.2021; Volume 13: 561. CrossRef

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Infection/Sepsis, Emergency surgery

Is Single Administration of Prophylactic Antibiotics Enough after Laparoscopic Appendectomy for Uncomplicated Appendicitis?: Soon Min Choi, Seung Hwan Lee, Ji Young Jang, Hyung Won Kim, Myung Jae Jung, Jae Gil Lee; J Acute Care Surg 2015;5(2):59-63. Published online October 31, 2015; DOI: https://doi.org/10.17479/jacs.2015.5.2.59

Abstract
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Purpose:

Research comparing the effectiveness of different doses of antibiotics prior to surgery for preventing infection is sparse. This study examines whether a single dose of preoperative antibiotics suffices to treat uncomplicated appendicitis via laparoscopic appendectomy.

Methods:

This study retrospectively reviewed the medical records of 149 patients who underwent laparoscopic appendectomy from July 2013 to December 2014 in a single institution. The participants were divided into two groups; group A (n=99) was given a single dose of prophylactic antibiotics before surgery, and group B (n=50) was given both preoperative and postoperative antibiotics. Clinical factors and surgical outcomes were compared between two groups.

Results:

The mean length of hospital stay for group A (2.5 days) was shorter than for group B (3.2 days) (p<0.001). Average operation time was 58.7 minutes for group A, longer than for group B (52.2 minutes, p=0.027). There was no difference in pathologic results and postoperative complications, such as surgical site infection (SSI) between the two groups. In groups A and B, 4.0% of patients had superficial SSIs. One patient (2.0%) in group B had deep/organ SSI.

Conclusion:

A single dose of prophylactic antibiotics administration to patients undergoing laparoscopic appendectomy is acceptable as a treatment in uncomplicated appendicitis.

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Đánh giá vai trò của kháng sinh dự phòng và kháng sinh sau mổ trong ngăn ngừa nhiễm trùng sau phẫu thuật nội soi điều trị viêm ruột thừa cấp chưa biến chứng
Nguyễn Thanh Xuân, Phạm Minh Đức , Nguyễn Minh Thảo
Tạp chí Y học lâm sàng Bệnh viện Trung Ương Huế.2024; (90): 18. CrossRef