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Beyond structural outcomes: functional and biomechanical considerations in partial foot amputations 除了结构结果:部分足部截肢的功能和生物力学考虑。
IF 2.3 4区 医学 Q2 SURGERY Pub Date : 2025-09-22 DOI: 10.1016/j.surge.2025.09.004
Mingxuan Liu, Hanjun Ma, Ju Liao, Qunqiang Luo
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引用次数: 0
Letter to editor on “Primary closure versus Graham patch omentopexy in perforated peptic ulcer: A systematic review and meta-analysis” 致编辑关于“穿孔性消化性溃疡的初步闭合与格雷厄姆贴片网膜固定术:系统回顾和荟萃分析”的信。
IF 2.3 4区 医学 Q2 SURGERY Pub Date : 2025-09-22 DOI: 10.1016/j.surge.2025.09.005
Timotius Ivan Hariyanto
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引用次数: 0
Lumbar decompression surgery for cauda equina syndrome: A meta-analysis and systematic review of the safety of operating out of hours 腰椎减压手术治疗马尾综合征:非工作时间手术安全性的荟萃分析和系统评价。
IF 2.3 4区 医学 Q2 SURGERY Pub Date : 2025-09-17 DOI: 10.1016/j.surge.2025.08.003
Henry A. Crouch-Smith, Iain Feeley, Margaret K. Lee, Nicholas Carleton-Bland, Simon Clark, Matthew Wilby

Objectives

We conduct a systematic review and meta-analysis of the published literature regarding the impact of performing lumbar decompression for cauda equina syndrome (CES) out of hours compared to regular operating hours.

Methods

A search of databases including Medline, EMBASE and Cochrane Library was performed with two independent reviewers per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A senior author arbitrated in event of disagreement. MeSH terms [((cauda equina) OR (CES)) AND ((hours) OR OOH)] were used. Filters including date range (from January 01, 1990 to November 01, 2022) and the English language were applied. Inclusion criteria consisted of retrospective or prospective cohort studies, English or full translation available, surgical complication as primary or secondary outcome and out of hours surgery as an independent variable. Case reports and studies without complication frequency were excluded. There were no additional studies identified through a snowballing secondary search through references of identified articles. Operative metrics were compiled into ad-hoc tables. Statistical analysis was performed using RevMan 5.4. A difference in complication rates with a P value of < .05 was deemed statistically significant. Heterogeneity was reported using I2. Study quality was assessed using the Newcastle Ottawa Score (NOS).

Results

The search strategy yielded 363 articles. After duplicate removal and application of inclusion/exclusion criteria, 15 studies were sought for retrieval and full text review. Of these, 5 studies were included for qualitative synthesis. Of these, 4 studies underwent quantitative analysis with 581 datasets. Meta-analysis was undertaken on 3 studies comprising 495 datasets. A dichotomous outcome was modelled using the Mantel-Haenszel statistical method with fixed effect which demonstrated an odds ratio (OR) of 2.38 (95 % CI 1.39–4.07) for sustaining an adverse event from out of hours surgery compared to routine operative hours. I2 = 12 %, suggesting homogeneity between studies analysed.

Conclusions

This study provides clinical evidence that out of hours surgery for lumbar decompression for CES is associated with a higher rate of surgical complications. The spinal surgeon should appropriately counsel the patient with CES that while it is important to do the surgery as soon as possible, operating out of hours carries a higher risk of surgical complications.
目的:我们对已发表的文献进行了系统回顾和荟萃分析,这些文献是关于在非工作时间进行马尾综合征(CES)腰椎减压手术与常规手术时间相比的影响。方法:根据系统评价和荟萃分析(PRISMA)指南,由两名独立审稿人对Medline、EMBASE和Cochrane Library等数据库进行检索。一位资深作家在意见不合的情况下进行仲裁。使用MeSH术语[((马尾)或(CES))和((小时)或OOH)]。过滤器包括日期范围(从1990年1月1日到2022年11月1日)和英语语言。纳入标准包括回顾性或前瞻性队列研究,可提供英文或完整翻译,手术并发症作为主要或次要结局,非工作时间手术作为独立变量。排除无并发症发生率的病例报告和研究。通过对已确定文章的参考文献进行滚雪球式的二次检索,没有发现其他研究。操作指标被编译成特别的表格。采用RevMan 5.4进行统计分析。并发症发生率的差异P值为2。采用纽卡斯尔渥太华评分(NOS)评估研究质量。结果:搜索策略产生了363篇文章。在删除重复并应用纳入/排除标准后,我们检索了15项研究并对其全文进行了回顾。其中5项研究纳入定性综合。其中,4项研究对581个数据集进行了定量分析。对包含495个数据集的3项研究进行了荟萃分析。采用固定效应的Mantel-Haenszel统计方法对二分类结果进行建模,结果表明,与常规手术时间相比,非工作时间手术发生不良事件的优势比(OR)为2.38 (95% CI 1.39-4.07)。I2 = 12%,表明所分析的研究之间存在同质性。结论:本研究提供了临床证据,证明非手术时间腰椎减压治疗CES与较高的手术并发症发生率相关。脊柱外科医生应适当地告知患有CES的患者,尽管尽快进行手术很重要,但在几个小时之外进行手术会带来更高的手术并发症风险。
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引用次数: 0
The role of Cerament® (Antibiotic impregnated bone void filler) in lower limb salvage for diabetic foot patients with osteomyelitis, a scoping review. Cerament®(抗生素浸透骨空洞填充物)在糖尿病足骨髓炎患者下肢抢救中的作用。
IF 2.3 4区 医学 Q2 SURGERY Pub Date : 2025-09-16 DOI: 10.1016/j.surge.2025.09.001
Ramy Elkady, Seamus McHugh, Elrasheid Kheirelseid, Peter Naughton, Daragh Moneley, Sayed Aly, Stewart Redmond Walsh

Background: Diabetic foot osteomyelitis (DFO) is a principal cause of non-traumatic lower limb amputation, contributing substantially to morbidity, healthcare costs, and reduced quality of life. Salvage optimization strategies have included the use of local antibiotic carriers to promote healing and reduce infection recurrence. Cerament, either G (gentamicin) or V (vancomycin), resorbable antibiotic-loaded bone graft substitute, has shown potential, but evidence has not been systematically mapped.

Objective: This scoping review aimed to map and summarize the available literature on the role of Cerament G and V in lower limb salvage among patients with DFO.

Methods: A systematic search of PubMed, Embase, the Cochrane library, and Google scholar [December 2024]. Studies reporting outcomes of Cerament G or V in the management of DFO were eligible. Data were charted according to PRISMA-ScR guidelines, focusing on study design, intervention details, and key findings.

Results: A total of 20 studies were identified, including [case reports, case series, retrospective reviews, and prospective cohorts]. Population within the studies ranged from 1 to 136. Reported outcomes included wound healing, eradication of infection, weight bearing, new bone formation and high antibiotic concentration without systemic toxicity. Amputation rates ranged from 2.6 % to 25 %. Evidence is limited by small sample sizes, heterogeneity in outcome reporting, and lack of randomized controlled trials.

Conclusion: Current evidence suggests that Cerament G and V may be safe and effective adjuncts for limb salvage in DFO, but high-quality comparative studies are lacking. Further research is needed to support its broader use in daily practice.

背景:糖尿病足骨髓炎(DFO)是导致非创伤性下肢截肢的主要原因,是导致发病率、医疗费用和生活质量下降的主要原因。抢救优化策略包括使用局部抗生素载体来促进愈合和减少感染复发。G(庆大霉素)或V(万古霉素),可吸收的含抗生素的骨移植替代物,已显示出潜力,但证据尚未系统地绘制。目的:本综述旨在绘制和总结现有文献中关于静脉G和静脉V在DFO患者下肢挽救中的作用。方法:系统检索PubMed、Embase、Cochrane图书馆和谷歌scholar[2024年12月]。报告G或V基因在DFO治疗中的结果的研究是合格的。根据PRISMA-ScR指南绘制数据图表,重点关注研究设计、干预细节和主要发现。结果:共纳入20项研究,包括[病例报告、病例系列、回顾性评价和前瞻性队列]。研究对象的数量从1到136人不等。报道的结果包括伤口愈合,感染根除,体重减轻,新骨形成和高抗生素浓度,无全身毒性。截肢率从2.6%到25%不等。证据受到样本量小、结果报告的异质性和缺乏随机对照试验的限制。结论:目前的证据表明,G和V可能是DFO保肢安全有效的辅助材料,但缺乏高质量的比较研究。需要进一步的研究来支持其在日常实践中的广泛应用。
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引用次数: 0
Diversity in core surgical training: Trends between 2012 and 2022 核心外科培训的多样性:2012年至2022年的趋势。
IF 2.3 4区 医学 Q2 SURGERY Pub Date : 2025-09-16 DOI: 10.1016/j.surge.2025.09.002
Matthew Newman, Neil Scott, Phyo Kyaw Myint, Ricky Ellis

Background and purpose

A diverse healthcare workforce is an important goal in ensuring that services reflect and meet the needs of a diverse population. Core Surgical Training (CST) is the first stage of surgical training in the UK, but diversity trends at this level have not been previously described. We aim to describe trends in gender, ethnicity, disability, and sexuality among successful CST applicants between 2012 and 2022.

Methods

A retrospective cohort study was conducted using anonymised data from the UK Medical Education Database (UKMED) for all successful CST applicants between 2012 and 2022. Chi-squared tests for trend were used to assess statistically significant changes in demographic characteristics over time. Data were categorised and missing data excluded as per pre-specified protocols.

Results

The proportion of Non-White CST entrants rose from 36.5 % in 2012 to 54.3 % in 2022 (X2 = 124.421, p < 0.001). Entrants declaring a disability increased from 4.8 % in 2016 to 10.4 % in 2019 (X2 = 22.225, p = 0.014). No significant trends were observed for gender (X2 = 15.338, p = 0.120) or sexuality (X2 = 9.880, p = 0.451).

Conclusions

This study highlights positive trends in the ethnic and disability diversity of successful CST applicants over the past decade. However, gender and sexuality diversity showed no significant change. Further research is needed to explore barriers to entry and ensure continued progress towards an inclusive surgical workforce.
背景和目的:多样化的医疗保健工作队伍是确保服务反映和满足多样化人口需求的一个重要目标。核心外科培训(CST)是英国外科培训的第一阶段,但这一阶段的多样性趋势以前没有描述过。我们的目标是描述2012年至2022年间成功的CST申请者在性别、种族、残疾和性取向方面的趋势。方法:回顾性队列研究使用来自英国医学教育数据库(UKMED)的匿名数据,对2012年至2022年间所有成功申请CST的患者进行研究。趋势的卡方检验用于评估人口统计学特征随时间的显著变化。根据预先指定的方案对数据进行分类并排除缺失数据。结果:非白人CST进入者比例由2012年的36.5%上升至2022年的54.3% (X2 = 124.421, p 2 = 22.225, p = 0.014)。性别(X2 = 15.338, p = 0.120)和性向(X2 = 9.880, p = 0.451)无明显变化趋势。结论:这项研究突出了过去十年中成功申请CST的申请人的种族和残疾多样性的积极趋势。然而,性别和性向多样性没有明显变化。需要进一步的研究来探索进入壁垒,并确保向包容性外科劳动力的持续发展。
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引用次数: 0
Are pelvic binders an effective measure to lower mortality and decrease blood loss after high energy pelvic ring injuries? A systematic review 骨盆粘合剂是降低高能骨盆环损伤后死亡率和减少失血的有效措施吗?系统回顾。
IF 2.3 4区 医学 Q2 SURGERY Pub Date : 2025-09-15 DOI: 10.1016/j.surge.2025.08.002
Andreas Papaleontiou , Andréa M. Poupard , Paul Parker

Introduction

Pelvic binders are routinely used in the pre-hospital management of high energy pelvic ring injuries with a low threshold for utilisation. Current literature is inconclusive regarding the effectiveness of pelvic binders in controlling haemorrhage and decreasing mortality. The aim of this study is to investigate whether using such devices decrease mortality, blood loss, pain and complications.

Method

A systematic review was carried out using modern era articles published between January 2016 and May 2024 on two databases, investigating the effectiveness of pelvic binders in trauma patients in decreasing mortality, blood product requirement, pain level and complication rate.

Results

Five retrospective cohort studies, one interventional study with retrospective control and one RCT compared early binder application to late/no application and were included for analysis. were included. No clear superiority of pelvic binder application, regarding blood product requirements, mortality, pain and complications was demonstrated. Overall mortality in binder groups was 17.4 % and 15.7 % in the no/late binder groups. Only one study found a statistically significant superiority of pelvic binders regarding mortality when adjusted for confounding variables. Overall patients transfused were 35.6 % in the binder group and 25 % in the no/late binder group. Three out of seven studies reported a significantly lower blood product requirement in pelvic binder groups.

Conclusion

There is no clear superiority of early pelvic binder application over no/late binder use. The evidence is limited and lacks larger RCTs. Current widespread use of pelvic binders should be reevaluated, and alternative/adjunct devices should be further investigated for their effectiveness.
盆腔粘合剂通常用于高能盆腔环损伤的院前处理,使用门槛低。目前的文献对骨盆粘连剂在控制出血和降低死亡率方面的有效性尚无定论。这项研究的目的是调查使用这种装置是否能降低死亡率、失血、疼痛和并发症。方法:系统回顾2016年1月至2024年5月在两个数据库中发表的现代文献,探讨盆腔粘合剂在降低创伤患者死亡率、血液制品需求、疼痛程度和并发症发生率方面的效果。结果:五项回顾性队列研究,一项回顾性对照的介入研究和一项RCT比较了早期应用粘合剂和晚期/未应用粘合剂,并纳入分析。被包括在内。在血液制品要求、死亡率、疼痛和并发症方面,盆腔粘合剂应用没有明显的优势。黏合剂组的总死亡率为17.4%,无黏合剂组和晚期黏合剂组的总死亡率为15.7%。只有一项研究发现,在调整混杂变量后,骨盆粘合剂在死亡率方面具有统计学上显著的优势。总输注患者中,黏合剂组占35.6%,无/晚期黏合剂组占25%。七项研究中有三项报告了盆腔黏合剂组的血液制品需求显著降低。结论:早期应用骨盆结合剂比不使用或晚期使用骨盆结合剂没有明显的优势。证据有限,缺乏更大的随机对照试验。应重新评估目前广泛使用的骨盆固定物,并进一步研究替代/辅助装置的有效性。
{"title":"Are pelvic binders an effective measure to lower mortality and decrease blood loss after high energy pelvic ring injuries? A systematic review","authors":"Andreas Papaleontiou ,&nbsp;Andréa M. Poupard ,&nbsp;Paul Parker","doi":"10.1016/j.surge.2025.08.002","DOIUrl":"10.1016/j.surge.2025.08.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Pelvic binders are routinely used in the pre-hospital management of high energy pelvic ring injuries with a low threshold for utilisation. Current literature is inconclusive regarding the effectiveness of pelvic binders in controlling haemorrhage and decreasing mortality. The aim of this study is to investigate whether using such devices decrease mortality, blood loss, pain and complications.</div></div><div><h3>Method</h3><div>A systematic review was carried out using modern era articles published between January 2016 and May 2024 on two databases, investigating the effectiveness of pelvic binders in trauma patients in decreasing mortality, blood product requirement, pain level and complication rate.</div></div><div><h3>Results</h3><div>Five retrospective cohort studies, one interventional study with retrospective control and one RCT compared early binder application to late/no application and were included for analysis. were included. No clear superiority of pelvic binder application, regarding blood product requirements, mortality, pain and complications was demonstrated. Overall mortality in binder groups was 17.4 % and 15.7 % in the no/late binder groups. Only one study found a statistically significant superiority of pelvic binders regarding mortality when adjusted for confounding variables. Overall patients transfused were 35.6 % in the binder group and 25 % in the no/late binder group. Three out of seven studies reported a significantly lower blood product requirement in pelvic binder groups.</div></div><div><h3>Conclusion</h3><div>There is no clear superiority of early pelvic binder application over no/late binder use. The evidence is limited and lacks larger RCTs. Current widespread use of pelvic binders should be reevaluated, and alternative/adjunct devices should be further investigated for their effectiveness.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 6","pages":"Pages 371-380"},"PeriodicalIF":2.3,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
The survival of patients with invasive ductal and invasive lobular breast cancer and its epidemiological and biological differences 浸润性导管癌与浸润性小叶癌患者的生存率及其流行病学和生物学差异
IF 2.3 4区 医学 Q2 SURGERY Pub Date : 2025-09-12 DOI: 10.1016/j.surge.2025.04.017
Dr Ansu Joseph , Dr Kapilraj Ravendran
{"title":"The survival of patients with invasive ductal and invasive lobular breast cancer and its epidemiological and biological differences","authors":"Dr Ansu Joseph ,&nbsp;Dr Kapilraj Ravendran","doi":"10.1016/j.surge.2025.04.017","DOIUrl":"10.1016/j.surge.2025.04.017","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 5","pages":"Page 328"},"PeriodicalIF":2.3,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145044243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
Comparative Study of Metal vs. Ceramic Implants in Joint Arthroplasty: Longevity and Complication Rates 金属与陶瓷假体在关节置换术中的比较研究:寿命和并发症发生率
IF 2.3 4区 医学 Q2 SURGERY Pub Date : 2025-09-12 DOI: 10.1016/j.surge.2025.04.026
Mr. Taufiq Qurrohman , Dr. Chairul Wahjudi
{"title":"Comparative Study of Metal vs. Ceramic Implants in Joint Arthroplasty: Longevity and Complication Rates","authors":"Mr. Taufiq Qurrohman ,&nbsp;Dr. Chairul Wahjudi","doi":"10.1016/j.surge.2025.04.026","DOIUrl":"10.1016/j.surge.2025.04.026","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 5","pages":"Page 331"},"PeriodicalIF":2.3,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145044134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
VTE Prophylaxis in Trauma Unit 创伤科静脉血栓栓塞预防
IF 2.3 4区 医学 Q2 SURGERY Pub Date : 2025-09-12 DOI: 10.1016/j.surge.2025.04.020
Dr Vincent Dundas-Smith
{"title":"VTE Prophylaxis in Trauma Unit","authors":"Dr Vincent Dundas-Smith","doi":"10.1016/j.surge.2025.04.020","DOIUrl":"10.1016/j.surge.2025.04.020","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 5","pages":"Page 329"},"PeriodicalIF":2.3,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145044246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
PAPAYA Study (Paediatric Appendicitis Pathway and Audit Yield Assessment) 木瓜研究(儿科阑尾炎途径和审计收益评估)
IF 2.3 4区 医学 Q2 SURGERY Pub Date : 2025-09-12 DOI: 10.1016/j.surge.2025.04.024
Mr Georgios Karagiannidis , Evie Banham , Jie Ying Tee
{"title":"PAPAYA Study (Paediatric Appendicitis Pathway and Audit Yield Assessment)","authors":"Mr Georgios Karagiannidis ,&nbsp;Evie Banham ,&nbsp;Jie Ying Tee","doi":"10.1016/j.surge.2025.04.024","DOIUrl":"10.1016/j.surge.2025.04.024","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 5","pages":"Page 330"},"PeriodicalIF":2.3,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
期刊
Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
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