World Journal of Surgery最新文献

Background: The practice of day care surgery is less embraced in many low-middle-income countries (LMIC), and even less for some procedures considered major such as thyroidectomy. Here we examine the safety of day care thyroidectomy at Kyabirwa Surgical Center, a stand-alone day care surgery center in rural Eastern Uganda.

Methods: This was a retrospective cohort study conducted between 2019 and 2023. All patients who had day care thyroidectomy were included. Demographics, diagnosis, investigation findings, pathology reports, and surgery outcomes were collected. Postoperative follow-up data up to 30 days were also collected. Data were analyzed using R version 4.3.2.

Results: A total of 51 patients underwent same-day thyroidectomy, with an average age of 44.9 ± 12.1 years and 98% female. Procedures included total thyroidectomy (5, 9.8%), subtotal thyroidectomy (26, 51.0%), and lobectomy (20, 39.2%). Average size of the glands was 7.9 ± 2.21 cm. The majority 46 (90.2%) were of benign pathology. All patients were discharged by the evening of the same day. Complications encountered included hypocalcemia (1), hypertrophic scar (1), seroma (2), and transient recurrent laryngeal nerve injury (1). Overall complications rate was 9.8%. Gland size was statistically significant between patients with no complications (7.68 ± 2.06 cm) versus complications (9.90 ± 2.82, p < 0.05).

Conclusion: With overall low complication rates, these findings suggest that thyroidectomy can safely be performed on a day care basis in a rural LMIC setting with suboptimal health care delivery.

Background: Over the years, Vietnam has expanded its social health insurance (SHI) coverage to reduce health disparities. In this population-based study, we examined the differences in incidences of perforated appendix between rural and urban populations in Vietnam since the expansion of SHI coverage in 2015. We also identified risk factors for perforated appendix in these populations.

Method: The 2015-2019 SHI inpatient claims data from the Social Security Agency of Dong Thap Province were used to elaborate the final sample of 6863 patients aged 18 years or above who underwent an appendectomy. Multivariable probit and logistic regression model were employed to obtain adjusted estimates.

Results: An overall rate of 22.9% for perforated appendix among adults in Dong Thap was revealed. After the expansion of SHI, rural residents consistently had lower rates of perforated appendix than urban residents, but the differences between rural and urban residents were small and decreased over time, that is from 4.4% in 2015 to 3.4% in 2019. Older, male, and poor residents were at a higher risk of perforated appendix in both urban and rural areas. In rural areas, patients with comorbidities, patients who resided in remote communes bordering Cambodia, and patients who had district hospitals or commune facilities as their primary assigned providers were significantly more likely to develop perforated appendix.

Conclusion: Under the SHI in Vietnam, no significant difference was observed in perforated appendicitis incidence between urban and rural residents. Additional efforts are required to reduce poorer outcomes among other high-risk residents.

Introduction: The correlation between alcohol consumption and injury is undeniable. However, past research relying on self-reporting alcohol use likely resulted in underreporting and emphasizing the need to increase alcohol testing, especially in resource-limited settings where the burden of injuries is highest.

Methods: This is a prospective analysis of injured patients presenting to the trauma center at Kamuzu Central Hospital in Lilongwe, Malawi. We collected information including patient age, sex, admission date, mechanism of injury, breathalyzer test and Rapid Response^TM Alcohol Saliva Test Strips (AST) result, and survival.

Results: A total of 805 trauma patients were included. The overall prevalence of alcohol consumption in this trauma cohort is 18.3%. There was a 95.5% agreement between the AST and breathalyzer test with a Kappa coefficient of 0.83. The sensitivity and specificity of the AST were determined to be 78.5% (CI 75.7-81.2) and 99.3% (CI 98.7-99.9), respectively. ROC analyses showed the AST to have excellent discrimination with an area under the curve of 0.88 (95% CI 0.85-0.92).

Conclusion: The prevalence of alcohol-related injury is high in Malawi and the use of the Alcohol Saliva Test Strips is feasible and correlated with results derived from the breathalyzer. Routine alcohol testing for trauma patients presenting to a resource-limited setting is imperative and should be implemented.

Background: There has been a proliferation of global surgery assessment tools designed for use in low- and middle-income countries. This scoping review sought to categorize and organize the breadth of global surgery assessment tools in the literature.

Methods: The search was conducted using PubMed from October 2022 to April 2023 according to PRISMA extension for scoping review guidelines. The search terms were (("global surgery"[All Fields]) AND ("assessment"[All Fields]) OR (data collection)). Only tools published in English that detailed surgical assessment tools designed for low- and middle-income countries were included.

Results: The search resulted in 963 papers and 46 texts described unique tools that were included for the final review. Of these, 30 (65%) tools were quantitative, 1 (2%) qualitative, and 15 (33%) employed mixed-methods. 25 (54%) tools evaluated surgery in general, whereas 21 (46%) were focused on various surgical subspecialties. Qualitatively, major themes among the tools were noted. There was significant overlap of many tools.

Conclusions: Nonspecialty surgery was represented more than any specialty surgery and many specialties had little or no representation in the literature. Ideally, local leadership should be involved in surgical assessment tools. Different methodologies, such as checklists and observational studies, aimed to target varying aspects of surgery and had distinct strengths and weaknesses. Further efforts should focus on expanding tools in neglected specialties.

Introduction: This study aims to establish, execute, and assess the effectiveness of a perioperative enhanced recovery after surgery (ERAS) clinical care pathway in breast reconstruction patients with LD flap breast cancer treatment. The goal is to improve early recovery outcomes, reduce hospitalization time, and enhance patient satisfaction by implementing a standardized approach to postoperative care.

Methods: This study was conducted at the University of Malaya Medical Center. The outcomes of 21 breast cancer patients who underwent autologous reconstructive breast surgery with the latissimus dorsi (LD) flap within six months before the implementation of the ERAS pathway (pre-ERAS) were compared with 26 patients who underwent the same surgery with the ultrasound-guided erector spinae plane (ESP) block for the (ERAS protocol implementation) cohort. The study was conducted from November 2019 to October 2020. The length of hospital stay, amount of analgesic usage, and incidence of postoperative nausea vomiting (PONV) were recorded.

Results: The implementation of the ERAS clinical care pathway resulted in shorter hospital stays compared with the preceding care. On average, ERAS patients were mostly discharged on Day 2 post-surgery, whereas pre-ERAS patients were mostly discharged on Day 7. ERAS patients had a lower incidence of PONV from Days 1 to 5, starting with 88.5% not experiencing the condition on Days 1 and 2 and increasing to 100% on Day 5. All pre-ERAS patients experienced PONV in the first 5 days post-surgery. Fewer ERAS patients required antiemetics post-surgery (88.5%) compared with pre-ERAS patients (42.9%).

Conclusion: The implementation of the ERAS protocol as part of clinical care in autologous reconstructive breast surgery with the LD flap can improve recovery by shortening hospital stay, decreasing the use of analgesia, and alleviating PONV.