After emergency laparotomy, the day delirium starts is the day to look for a complication

The edition in brief

A Danish prospective cohort of 752 patients after major emergency abdominal surgery found delirium in 23%. It was associated with a median Comprehensive Complication Index of 44 against 9, more ICU admission (36% vs 13%) and higher 30-day mortality (22% vs 8%), and complications were most frequent on the day delirium began. That makes new confusion a reason to look for a leak, collection or sepsis, not only a nursing problem. The IPAD trial randomised 158 pancreatoduodenectomy patients to side-to-side or end-to-side gastrojejunostomy and found no difference in delayed gastric emptying (38.0% vs 30.4%, RR 1.25, 0.81 to 1.94), so either configuration is reasonable. A US database study of 384,617 cholecystectomies for acute cholecystitis found robotic operations had slightly more bailouts (1.7% vs 1.4%), similar bile duct injury (1.6% both), fewer downstream interventions after a bailout, and higher one-year cost. The French PACTOL trial could not show transvaginal drainage non-inferior to laparoscopy for tubo-ovarian abscess: cure rates were 72.5% and 77.0%, reintervention was more common after drainage (13.0% vs 3.3%), but stays were a day shorter. The pearl covers the subtotal cholecystectomy as a planned safe exit.