Israel Medical Association Journal

Background: Diverticulitis is a common cause of acute abdominal conditions, often requiring urgent or elective surgical intervention. Both psoas muscle area (PMA) and bone mineral density (BMD) have been linked to postoperative outcomes, but their role in diverticulitis remains unclear.

Objectives: To evaluate the relationship between PMA, BMD, and their combined effect on surgical outcomes in patients undergoing colectomy for diverticulitis.

Methods: In this retrospective, single-center study, we analyzed patients who underwent colectomy for diverticulitis. PMA and BMD were measured using preoperative computerized tomography. Statistical analysis assessed the association between postoperative outcomes and PMA, BMD, and their combined product (PMA × BMD).

Results: The cohort included 66 patients; median age 68.5 years (range 34–94); 41 (62.12%) females. Of the cases, 42 (63.63%) were urgent. Postoperative complications occurred in 38 patients (57.58%). Patients who developed major postoperative complications had lower PMA (1116.74 ± 716.31 mm² vs. 1948.01 ± 0.01 mm², P = 0.02). The area under the curve (AUC) for major postoperative complications was 0.94 for BMD. The AUC for postoperative ileus was 0.73, 0.69, and 0.76 for PMA, BMD, and PMA × BMD, respectively. The AUC for 30-day mortality was 0.66, 0.7, and 0.73. The AUC for ostomy reversal was 0.71, 0.71, and 0.76.

Conclusions: PMA and BMD were associated with postoperative complications after colectomy for diverticulitis. Their combined assessment may improve predictive accuracy. Current evidence regarding the impact of body composition on surgical outcomes in diverticulitis remains limited and inconsistent. Further research is warranted.

Background: The neutrophil to lymphocyte ratio (NLR) has demonstrated prognostic value in various malignant conditions, including gastric adenocarcinoma. However, chemotherapy may affect NLR.

Objectives: To evaluate the prognostic value of NLR as an accessory decision-making tool in terms of operating patients after neoadjuvant chemotherapy in patients with resectable gastric cancer.

Methods: We collected oncologic, perioperative, and survival data of patients with gastric adenocarcinoma who underwent curative intent gastrectomy and D2 lymphadenectomy between 2009 and 2016. The NLR was calculated from preoperative laboratory tests and classified as high (> 4) and low (≤ 4). The t-test, chi-square, Kaplan-Meier analysis, and Cox multivariate regression models were used to assess associations of clinical, histologic, and hematological variables with survival.

Results: For 124 patients the median follow-up was 23 months (range 1–88). High NLR was associated with greater rate of local complication (r=0.268, P < 0.01). The rate of major complications (Clavien-Dindo ≥ 3) was higher in the high NLR group (28% vs. 9%, P = 0.022). Among the 53 patients who received neoadjuvant chemotherapy, those with low NLR had significantly improved disease-free survival (DFS) (49.7 vs. 27.7 months, P = 0.025). Low NLR was not significantly associated with overall survival (mean survival, 51.2 vs. 42.3 months, P = 0.19). Multivariate regression identified NLR group (P = 0.013), male gender (P = 0.04), and body mass index (P = 0.026) as independently associated with DFS.

Conclusions: Among gastric cancer patients planned for curative intent surgery who underwent neoadjuvant chemotherapy, NLR may have prognostic value, particularly regarding DFS and postoperative complications.

Background: As part of the effort to control the coronavirus disease-19 (COVID-19) outbreak, strict emergency measures, including prolonged national curfews, have been imposed. Even in countries where healthcare systems still functioned, patients avoided visiting emergency departments (EDs) because of fears of exposure to COVID-19.

Objective: To describe the effects of the COVID-19 outbreak on admissions of surgical patients from the ED and characteristics of urgent operations performed.

Methods: A prospective registry study comparing all patients admitted for acute surgical and trauma care between 15 March and 14 April 2020 (COVID-19) with patients admitted in the parallel time a year previously (control) was conducted.

Results: The combined cohort included 606 patients. There were 25% fewer admissions during the COVID-19 period (P < 0.0001). The COVID-19 cohort had a longer time interval from onset of symptoms (P < 0.001) and presented in a worse clinical condition as expressed by accelerated heart rate (P = 0.023), leukocyte count disturbances (P = 0.005), higher creatinine, and CRP levels (P < 0.001) compared with the control cohort. More COVID-19 patients required urgent surgery (P = 0.03) and length of ED stay was longer (P = 0.003).

Conclusions: During the COVID-19 epidemic, fewer patients presented to the ED requiring acute surgical care. Those who did, often did so in a delayed fashion and in worse clinical condition. More patients required urgent surgical interventions compared to the control period. Governments and healthcare systems should emphasize to the public not to delay seeking medical attention, even in times of crises