The optimal timing for post traumatic Chest Wall Reconstruction (CWR) in severely injured / polytraumatized patients with severe chest wall instability remains a subject of debate. While early surgery within 72 h is associated with improved outcomes, the efficacy and safety of an even earlier “rapid sequence” approach on the day of admission are unclear. This study aims to compare outcomes of severely injured patients undergoing rapid sequence surgery (Day 0) versus early surgery (Days 1–3). A retrospective analysis was conducted using data from the TraumaRegister DGU® (2015–2023). Patients with serious chest wall injuries (AISThorax ≥3), an Injury Severity Score (ISS) ≥ 9, who survived the first 48 h and underwent CWR were included. Patients were stratified into a “Rapid Sequence” group (surgery on Day 0) and an “Early” group (surgery on Days 1–3). Propensity score matching (PSM) was performed to balance baseline characteristics, including injury patterns, demographics, and initial physiological status. Primary outcome was in-hospital mortality. Secondary outcomes included sepsis, multi-organ failure (MOF), and length of stay. From an initial cohort of 34,659 patients with severe chest wall injuries, 2,498 operatively treated patients with a known date of surgery were analyzed. 1,168 (46.8
Background Unresectable malignant distal biliary obstruction (MDBO) may be treated with endoscopic ultrasound-guided (EUS-BD) or percutaneous transhepatic (PTBD) biliary drainage if endoscopic retrograde cholangiopancreatography fails or is not feasible. This study compared EUS-BD and PTBD using an improved ultrasound-guided method with primary metal stenting. Methods A prospective, longitudinal (follow-up 6 months), nonrandomized, noninferiority (10% margin) trial was conducted. Patients were assigned to centers with high competence in one of the two techniques. The primary end point was technical success, with propensity score matching employed to balance differences. Differences in secondary end points were evaluated with two-sided superiority analyses. Results 209 patients (mean age 73 years) were enrolled between December 2018 and August 2024 from 14 European centers and were subsequently matched 1:1. Noninferiority of PTBD vs. EUS-BD could not be demonstrated with regard to technical success (91.2% vs. 97.1%; P = 0.17; 95%CI -2.3% to 15.1%). Clinical success (intention-to-treat: 73.5% vs. 55.9%; P = 0.05), procedure time, length of hospital stay, and rate of biliary reintervention within 30 days (0.03 vs. 0.31; P < 0.001) were significantly better in the EUS-BD cohort, driven mainly by EUS-guided choledochoduodenostomy (EUS-CDS). No significant differences were observed in adverse events (grades 1-4) (16.7% vs. 14.5%; P = 0.82), pain score, clinical success (per-protocol), rate of biliary reinterventions within 6 months, or overall survival. Conclusions EUS-BD, particularly EU-CDS, might be preferred over PTBD in unresectable MDBO owing to better clinical success and a lower biliary reintervention rate.
BACKGROUND:In otorhinolaryngology, the majority of specialist training takes place in inpatient facilities. Against the backdrop of current structural reforms in the hospital sector, it is necessary to collect fundamental structural data of these training institutions. To date, no centrally collected data exist that capture the number of inpatient training centers, the number of trainees and authorized trainers, or the scope of training accreditation. The aim of this study was therefore to establish a nationwide baseline assessment to support evaluation of the potential impact of the ongoing hospital reform. MATERIALS AND METHODS:The German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (DGHNO-KHC) conducted a nationwide digital survey among the heads of ENT departments in Germany. The survey collected structural and capacity-related parameters relevant to specialist training. RESULTS:A total of 95 fully completed questionnaires were returned (response rate 54.9%). All federal states were represented (32 university and 63 non-university hospitals). In 2024, 84 clinics (88,4 %) reported more than 1500 inpatient cases. On average, 1.5 physicians per institution held formal authorization to conduct specialist training. The number of trainees remained stable in 56.8% of clinics and increased in 32.6%. Overall, 96.8% of departments had full accreditation for the complete 5‑year training period. CONCLUSION:Otorhinolaryngology specialist training in Germany is broadly available and delivered at a consistently high level within hospitals. Based on the collected data, a stable and robust training structure can be expected to persist, even when considering potential effects of the Hospital Care Improvement Act (Krankenhausversorgungsverbesserungsgesetz, KHVVG). These training capacities remain essential for ensuring nationwide high-quality specialist care.
