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Variation in outcomes after metabolic bariatric surgery: multilevel analysis to assess the contribution of patient, surgeon, and hospital factors. 代谢减肥手术后结果的变化:多水平分析以评估患者、外科医生和医院因素的影响。
IF 9.6 1区 医学 Q1 SURGERY Pub Date : 2025-10-03 DOI: 10.1093/bjs/znaf186
Floris F E Bruinsma,Simon W Nienhuijs,Ronald S L Liem,Jan Willem M Greve,Perla J Marang-van de Mheen,
BACKGROUNDMetabolic bariatric surgery (MBS) quality registries monitor various outcomes, enabling the assessment of hospital performance in comparison with national benchmarks. However, if there is considerable between-surgeon outcome variation, surgeon-level feedback may be better suited. The aim of this study was to assess the extent to which patient-, surgeon-, and hospital-level factors contribute to the variation in outcomes after MBS.METHODSAll primary procedures registered in the Dutch MBS quality registry between 1 January 2020 and 31 December 2023 were included. Outcomes included severe postoperative complications, reoperation, prolonged length of stay (LOS), readmission, textbook outcome, and achieving ≥25% total weight loss within 1 year. Multilevel logistic regression models were built for each outcome, including all available patient characteristics, operating surgeon, and hospital, to determine the variance explained by patient-, surgeon-, and hospital-level factors.RESULTSIn total, 30 610 patients were included, operated on by 144 surgeons in 19 hospitals. Hospital-level factors contributed most to the explained variance for all outcomes, ranging from 59.6% for reoperation to 90.3% for prolonged LOS. Surgeon-level factors explained less variance, ranging from 3.2% for prolonged LOS to 28.2% for reoperation. Patient characteristics explained the least, ranging from 4.4% for textbook outcome to 13.1% for severe postoperative complications.CONCLUSIONVariation in outcomes is mostly explained by hospital factors, rather than surgeon factors, supporting hospital-based performance feedback. The results suggest that the pre- and postoperative trajectory and perioperative care may affect MBS outcomes more than patient characteristics or surgical team performance.
背景:代谢减肥手术(MBS)质量登记监测各种结果,使医院绩效评估能够与国家基准进行比较。然而,如果外科医生之间的结果有相当大的差异,外科医生水平的反馈可能更适合。本研究的目的是评估患者、外科医生和医院层面的因素对MBS术后结果变化的影响程度。方法纳入2020年1月1日至2023年12月31日期间在荷兰MBS质量登记处注册的所有初级程序。结果包括严重的术后并发症,再手术,延长住院时间(LOS),再入院,教科书结果,1年内总体重减轻≥25%。为每个结果建立了多水平logistic回归模型,包括所有可用的患者特征、手术医生和医院,以确定由患者、外科医生和医院水平因素解释的方差。结果共纳入患者30610例,由19家医院144名外科医生进行手术。医院层面的因素对所有结果的解释差异贡献最大,从再手术的59.6%到延长LOS的90.3%不等。外科医生水平的因素解释了较小的差异,从延长LOS的3.2%到再次手术的28.2%。患者特征解释最少,从4.4%的教科书结果到13.1%的严重术后并发症。结论结果的差异主要由医院因素而非外科因素解释,支持基于医院的绩效反馈。结果表明,术前和术后轨迹以及围手术期护理可能比患者特征或手术团队的表现更能影响MBS的预后。
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引用次数: 0
The NEON (Nerve rEpair Or Not) trial: a randomized controlled trial of microsurgical repair versus nerve alignment for digital nerve injury. NEON(神经修复与否)试验:指神经损伤的显微外科修复与神经对齐的随机对照试验。
IF 9.6 1区 医学 Q1 SURGERY Pub Date : 2025-09-02 DOI: 10.1093/bjs/znaf174
Justin C R Wormald,Matthew D Gardiner,Christina Jerosch-Herold,Jonathan Cook,Rafael Pinedo Villanueva,Ciaron O'Hanlon,Naomi Vides,Gianluca Fabiano,Scott Parsons,Loretta Davies,Heidi Fletcher,Molly Glaze,Cushla Cooper,Dominic Power,Abhilash Jain,David Beard,
BACKGROUNDDigital nerves provide sensibility to the fingers. They are commonly injured through accidental sharp laceration. The aim of the NEON (Nerve rEpair Or Not) study was to investigate whether microsurgical suture repair of lacerated digital nerves is superior to nerve alignment alone without suture repair.METHODSA two-arm, parallel group, double-blind, multicentre RCT was undertaken over 2 years. Participants with suspected unilateral digital nerve injury underwent surgical exploration and were randomized to microsurgical suture repair or nerve alignment alone. The primary outcome was the Impact of Hand Nerve Disorders (I-HaND v2) patient-reported outcome measure (PROM) at 12 months post-randomization. Secondary outcomes assessed were: objective neurosensory and functional recovery; health-related quality of life to examine cost-effectiveness; complications of surgery and clinically problematic neuroma rates (Elliot score). Both participants and assessors were blind to allocation.RESULTSA total of 122 adults were randomized to microsurgical suture repair (n = 61) or nerve alignment alone (n = 61). Primary outcome data using the I-HaND (v2) were available for 106 participants (87%) at 12 months. There were no statistically significant differences in I-HaND scores at all time points, including the 12-month primary end point (15.9 versus 20.2, P = 0.09; 95% c.i. [-0.9, 10.8]). There were also no differences in all secondary outcome measures, including Patient Evaluation Measure and EQ-5D-5L scores at 12 months. Complications were similar at 6 weeks and 12 months. The trial was closed early by the funder owing to slow recruitment and did not reach the intended sample size.CONCLUSIONBased on the available data from the NEON trial, there is no evidence to support the beneficial effect of suture repair over nerve alignment alone for isolated digital nerve injury. This multicentre RCT can be used to inform future trials, inform patients and guide clinical practice.FUNDINGNIHR Health Technology Assessment (NIHR127807-18/37).TRIAL REGISTRATION NUMBERISRCTN16211574.
数字神经为手指提供敏感性。它们通常因意外的尖锐撕裂伤而受伤。NEON(神经修复或不修复)研究的目的是探讨显微外科缝合修复撕裂的指神经是否优于单纯神经对准而不缝合修复。方法采用双臂、平行组、双盲、多中心随机对照试验,时间超过2年。怀疑单侧指神经损伤的参与者接受手术探查,随机分为显微外科缝合修复组或单独神经对准组。主要结局是随机分组后12个月患者报告的手神经障碍(I-HaND v2)结果测量(PROM)的影响。评估的次要结局是:客观神经感觉和功能恢复;与健康有关的生活质量,以审查成本效益;手术并发症和临床问题神经瘤发生率(Elliot评分)。参与者和评估者都对分配视而不见。结果122例成人随机分为显微外科缝合修复组(n = 61)和单纯神经对准组(n = 61)。在12个月时,106名参与者(87%)使用I-HaND (v2)获得了主要结局数据。包括12个月主要终点在内的所有时间点I-HaND评分均无统计学差异(15.9比20.2,P = 0.09; 95% ci[-0.9, 10.8])。所有次要结局指标也没有差异,包括12个月时患者评价量表和EQ-5D-5L评分。6周和12个月时的并发症相似。由于招募缓慢,试验被资助者提前结束,没有达到预期的样本量。结论根据NEON试验的现有数据,没有证据支持缝线修复比单纯神经对准对孤立性指神经损伤的有益效果。该多中心随机对照试验可用于为未来的试验提供信息,为患者提供信息并指导临床实践。国家卫生研究院卫生技术评估(NIHR127807-18/37)。试验注册号为rctn16211574。
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引用次数: 0
Target trial emulation: harnessing real-world data to evaluate surgery and perioperative care interventions. 目标试验模拟:利用真实世界的数据来评估手术和围手术期护理干预措施。
IF 9.6 1区 医学 Q1 SURGERY Pub Date : 2025-09-02 DOI: 10.1093/bjs/znaf182
Kitty H F Wong,Robert J Hinchliffe
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引用次数: 0
Task sharing in elective inguinal hernia surgery in Ghana: a workforce model comparing surgeons and physicians. 加纳择期腹股沟疝手术的任务分担:比较外科医生和内科医生的劳动力模型。
IF 9.6 1区 医学 Q1 SURGERY Pub Date : 2025-09-02 DOI: 10.1093/bjs/znaf173
Mwayi Kachapila,Stephen Tabiri,Mark Monahan,Francis A Abantanga,Anita Eseenam Agbeko,Fareeda Agyei,Aneel Bhangu,Dion G Morton,Tracy E Roberts,Virginia Ledda,Mike Ohene-Yeboah,Raymond Oppong
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引用次数: 0
Recurrence rate and mesh bulging are reduced with primary fascial closure in ventral hernia repair: the PROSECO randomized clinical trial. 在腹疝修补中,初次筋膜闭合可降低复发率和补片膨出:PROSECO随机临床试验。
IF 9.6 1区 医学 Q1 SURGERY Pub Date : 2025-09-02 DOI: 10.1093/bjs/znaf169
Mikael Lindmark,Jael Tall,Bahman Darkahi,Johanna Österberg,Karin Strigård,Anders Thorell,Ulf Gunnarsson
BACKGROUNDLaparoscopic intraperitoneal onlay mesh repair using a bridging technique has shown high rates of hernia site complications. Primary fascial closure before mesh placement has been utilized to address this. This randomized, parallel, double-blind, multicentre controlled trial investigated whether primary fascial closure reduces hernia site complications.METHODSAdults undergoing laparoscopic intraperitoneal onlay mesh repair for a midline hernia were randomized to primary fascial closure or bridging. Clinical assessment and the Ventral Hernia Pain Questionnaire were completed preoperatively and at 3 and 12 months post-surgery. CT scans were performed pre- and 12 months post-surgery. It was hypothesized that non-resorbable suture closure would reduce complication rates from 30% to 13% at 12 months, requiring 180 patients for 80% power and 95% significance.RESULTSOne hundred and ninety-two patients were randomized (97 closure, 95 bridging), with 173 (90%) completing 1-year follow-up. At 12 months, overall hernia site complication rates showed no significant difference clinically (18% versus 20%, P = 0.85) or on CT (25% versus 28%, P = 0.50). However, recurrence and mesh bulging were significantly lower with fascial closure (4% versus 20%, P = 0.006). This group also reported significantly less pain at 12 months.CONCLUSIONAlthough there was no difference in the primary endpoint, fascial closure resulted in significantly lower rates of recurrence and mesh bulging, along with reduced postoperative pain. These findings suggest that primary fascial closure should be recommended alongside intraperitoneal onlay mesh repair in midline hernias.TRIAL REGISTRATIONThe trial was registered at the ISRCTN at the start of the trial (ISRCTN51495042).
背景:采用桥接技术的腹腔镜腹腔内补片修补术显示出疝气部位并发症的高发生率。在补片放置前进行初级筋膜闭合已被用来解决这个问题。这项随机、平行、双盲、多中心对照试验调查了初级筋膜闭合是否能减少疝部位并发症。方法接受腹腔镜腹膜内补片修补中线疝的成人患者随机分为初级筋膜闭合组和桥接组。术前、术后3个月和12个月分别完成临床评估和腹疝疼痛问卷。术前和术后12个月分别进行CT扫描。假设不可吸收缝线闭合可将12个月的并发症发生率从30%降低到13%,需要180例患者达到80%的疗效和95%的显著性。结果随机抽取192例患者(闭合97例,桥接95例),其中173例(90%)完成1年随访。在12个月时,总的疝部位并发症发生率在临床(18%对20%,P = 0.85)或CT(25%对28%,P = 0.50)上无显著差异。然而,筋膜闭合后复发率和补片膨出率明显降低(4%比20%,P = 0.006)。该组在12个月时疼痛也明显减轻。结论虽然主要终点没有差异,但筋膜闭合导致复发率和补片膨出率明显降低,术后疼痛减轻。这些结果表明,在中线疝中,应推荐初级筋膜闭合和腹腔内补片修复。试验注册在试验开始时在ISRCTN注册(ISRCTN51495042)。
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引用次数: 0
Staging laparoscopy for gastric cancer: European consensus. 胃癌腹腔镜分期:欧洲共识。
IF 9.6 1区 医学 Q1 SURGERY Pub Date : 2025-09-02 DOI: 10.1093/bjs/znaf144
Sander J M van Hootegem,Niels A D Guchelaar,Karen van der Sluis,Lianne Triemstra,Stefan P Mönig,Karol Rawicz-Pruszyński,Riccardo Rosati,Paolo Morgagni,Maria Erodotou,Leonardo Solaini,Giovanni De Manzoni,Wojciech Polkowski,Francesco Puccetti,Simone Giacopuzzi,Suzanne S Gisbertz,Jimmy B Y So,Jelle P Ruurda,Pieter S L van der Sluis,Sjoerd M Lagarde,Johanna W van Sandick,Bas P L Wijnhoven,
{"title":"Staging laparoscopy for gastric cancer: European consensus.","authors":"Sander J M van Hootegem,Niels A D Guchelaar,Karen van der Sluis,Lianne Triemstra,Stefan P Mönig,Karol Rawicz-Pruszyński,Riccardo Rosati,Paolo Morgagni,Maria Erodotou,Leonardo Solaini,Giovanni De Manzoni,Wojciech Polkowski,Francesco Puccetti,Simone Giacopuzzi,Suzanne S Gisbertz,Jimmy B Y So,Jelle P Ruurda,Pieter S L van der Sluis,Sjoerd M Lagarde,Johanna W van Sandick,Bas P L Wijnhoven, ","doi":"10.1093/bjs/znaf144","DOIUrl":"https://doi.org/10.1093/bjs/znaf144","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"15 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Challenges of decision-making after treatment with immunotherapy in metastatic deficient DNA mismatch repair/microsatellite unstable colorectal cancer. 转移性DNA错配修复缺陷/微卫星不稳定结直肠癌免疫治疗后决策的挑战
IF 9.6 1区 医学 Q1 SURGERY Pub Date : 2025-09-02 DOI: 10.1093/bjs/znaf178
Julien Taieb,Mehdi Karoui
{"title":"Challenges of decision-making after treatment with immunotherapy in metastatic deficient DNA mismatch repair/microsatellite unstable colorectal cancer.","authors":"Julien Taieb,Mehdi Karoui","doi":"10.1093/bjs/znaf178","DOIUrl":"https://doi.org/10.1093/bjs/znaf178","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"163 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reporting guideline for chatbot health advice studies: the Chatbot Assessment Reporting Tool (CHART) statement. 聊天机器人健康建议研究报告指南:聊天机器人评估报告工具(CHART)声明。
IF 9.6 1区 医学 Q1 SURGERY Pub Date : 2025-08-01 DOI: 10.1093/bjs/znaf142
The Chatbot Assessment Reporting Tool (CHART) is a reporting guideline developed to provide reporting recommendations for studies evaluating the performance of generative artificial intelligence (AI)-driven chatbots when summarizing clinical evidence and providing health advice, referred to as chatbot health advice studies. CHART was developed in several phases after performing a comprehensive systematic review to identify variation in the conduct, reporting, and method in chatbot health advice studies. Findings from the review were used to develop a draft checklist that was revised through an international, multidisciplinary, modified, asynchronous Delphi consensus process of 531 stakeholders, three synchronous panel consensus meetings of 48 stakeholders, and subsequent pilot testing of the checklist. CHART includes 12 items and 39 subitems to promote transparent and comprehensive reporting of chatbot health advice studies. These include title (subitem 1a), abstract/summary (subitem 1b), background (subitems 2a,b), model identifiers (subitems 3a,b), model details (subitems 4a-c), prompt engineering (subitems 5a,b), query strategy (subitems 6a-d), performance evaluation (subitems 7a,b), sample size (subitem 8), data analysis subitem 9a), results (subitems 10a-c), discussion (subitems 11a-c), disclosures (subitem 12a), funding (subitem 12b), ethics (subitem 12c), protocol (subitem 12d), and data availability (subitem 12e). The CHART checklist and corresponding diagram of the method were designed to support key stakeholders including clinicians, researchers, editors, peer reviewers, and readers in reporting, understanding, and interpreting the findings of chatbot health advice studies.
聊天机器人评估报告工具(CHART)是一份报告指南,旨在为评估生成式人工智能(AI)驱动的聊天机器人在总结临床证据和提供健康建议时的表现的研究提供报告建议,称为聊天机器人健康建议研究。在对聊天机器人健康咨询研究的行为、报告和方法进行了全面的系统审查后,分几个阶段开发了CHART。通过531个利益相关者的国际、多学科、修改的、异步德尔菲共识过程、48个利益相关者的三次同步小组共识会议,以及随后的清单试点测试,审查结果被用于制定清单草案。图表包括12个项目和39个分项,以促进聊天机器人健康咨询研究的透明和全面报告。这些包括标题(子项1a),摘要/摘要(子项1b),背景(子项2a,b),模型标识(子项3a,b),模型细节(子项4a-c),提示工程(子项5a,b),查询策略(子项6a-d),绩效评估(子项7a,b),样本量(子项8),数据分析子项9a),结果(子项10a-c),讨论(子项11a-c),披露(子项12a),资金(子项12b),道德(子项12c),协议(子项12d),数据可得性(分项目12e)。该方法的CHART清单和相应图表旨在支持包括临床医生、研究人员、编辑、同行评审和读者在内的关键利益相关者报告、理解和解释聊天机器人健康建议研究的结果。
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引用次数: 0
Protocol for the GOLF trial: randomized clinical trial on the LINX management system versus fundoplication for the surgical treatment of gastro-oesophageal reflux disease. GOLF试验方案:LINX管理系统与手术治疗胃食管反流病的对照随机临床试验。
IF 9.6 1区 医学 Q1 SURGERY Pub Date : 2025-07-03 DOI: 10.1093/bjs/znaf141
Sheraz R Markar,Begum Zeybek Saglam,Nainika Menon,Ahmed Ahmed,Nick Maynard,James Gossage,Filipa Landeiro,Jane Blazeby,Nicola Mills,Tim Underwood,Mimi McCord,T Martyn Hill,Amy Taylor,Natalie Blencowe,Jesper Lagergren
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引用次数: 0
Potential for error when relying on administrative data. 依赖管理数据时可能出现错误。
IF 9.6 1区 医学 Q1 SURGERY Pub Date : 2025-07-03 DOI: 10.1093/bjs/znaf139
Hila Zelicha,Douglas S Bell,Yijun Chen,Edward H Livingston
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引用次数: 0
期刊
British Journal of Surgery
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