Pub Date : 2024-05-22DOI: 10.1097/as9.0000000000000436
Nathan Turley, Karolina Kogut, Barbara Burian, Rachel Moyal-Smith, James Etheridge, Yves Sonnay, William Berry, Alan Merry, Alexander Hannenberg, Alex B. Haynes, Roger D. Dias, Kathryn Hagen, George Molina, Lisa Spruce, Carla Williams, Mary E. Brindle
The proposed study aims to assess users’ perceptions of a surgical safety checklist (SSC) reimplementation toolkit and its impact on SSC attitudes and operating room (OR) culture, meaningful checklist use, measures of surgical safety, and OR efficiency at 3 different hospital sites. The High-Performance Checklist toolkit (toolkit) assists surgical teams in modifying and implementing or reimplementing the World Health Organization’s SSC. Through the explore, prepare, implement, and sustain implementation framework, the toolkit provides a process and set of tools to facilitate surgical teams’ modification, implementation, training on, and evaluation of the SSC. A pre–post intervention design will be used to assess the impact of the modified SSC on surgical processes, team culture, patient experience, and safety. This mixed-methods study includes quantitative and qualitative data derived from surveys, semi-structured interviews, patient focus groups, and SSC performance observations. Additionally, patient outcome and OR efficiency data will be collected from the study sites’ health surveillance systems. Statistical data will be analyzed using Statistical Product and Service Solutions, while qualitative data will be analyzed thematically using NVivo. Furthermore, interview data will be analyzed using the Consolidated Framework for Implementation Research and reach, effectiveness, adoption, implementation, maintenance implementation frameworks. The toolkit will be introduced at 3 diverse surgical sites in Alberta, Canada: an urban hospital, university hospital, and small regional hospital. We anticipate the results of this study will optimize SSC usage at the participating surgical sites, help shape and refine the toolkit, and improve its usability and application at future sites.
{"title":"Adapting the World Health Organization’s Surgical Safety Checklist to High-Income Settings: A Hybrid Effectiveness-Implementation Trial Protocol","authors":"Nathan Turley, Karolina Kogut, Barbara Burian, Rachel Moyal-Smith, James Etheridge, Yves Sonnay, William Berry, Alan Merry, Alexander Hannenberg, Alex B. Haynes, Roger D. Dias, Kathryn Hagen, George Molina, Lisa Spruce, Carla Williams, Mary E. Brindle","doi":"10.1097/as9.0000000000000436","DOIUrl":"https://doi.org/10.1097/as9.0000000000000436","url":null,"abstract":"\u0000 \u0000 The proposed study aims to assess users’ perceptions of a surgical safety checklist (SSC) reimplementation toolkit and its impact on SSC attitudes and operating room (OR) culture, meaningful checklist use, measures of surgical safety, and OR efficiency at 3 different hospital sites.\u0000 \u0000 \u0000 \u0000 The High-Performance Checklist toolkit (toolkit) assists surgical teams in modifying and implementing or reimplementing the World Health Organization’s SSC. Through the explore, prepare, implement, and sustain implementation framework, the toolkit provides a process and set of tools to facilitate surgical teams’ modification, implementation, training on, and evaluation of the SSC.\u0000 \u0000 \u0000 \u0000 A pre–post intervention design will be used to assess the impact of the modified SSC on surgical processes, team culture, patient experience, and safety. This mixed-methods study includes quantitative and qualitative data derived from surveys, semi-structured interviews, patient focus groups, and SSC performance observations. Additionally, patient outcome and OR efficiency data will be collected from the study sites’ health surveillance systems.\u0000 \u0000 \u0000 \u0000 Statistical data will be analyzed using Statistical Product and Service Solutions, while qualitative data will be analyzed thematically using NVivo. Furthermore, interview data will be analyzed using the Consolidated Framework for Implementation Research and reach, effectiveness, adoption, implementation, maintenance implementation frameworks.\u0000 \u0000 \u0000 \u0000 The toolkit will be introduced at 3 diverse surgical sites in Alberta, Canada: an urban hospital, university hospital, and small regional hospital.\u0000 \u0000 \u0000 \u0000 We anticipate the results of this study will optimize SSC usage at the participating surgical sites, help shape and refine the toolkit, and improve its usability and application at future sites.\u0000","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"8 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141113434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-20DOI: 10.1097/as9.0000000000000428
Viktor Åkerlund, M. Nikberg, Philippe Wagner, A. Chabok
The primary outcome was to compare overall postoperative surgical complications within 30 days after Hartmann’s procedure (HP) compared with intersphincteric abdominoperineal excision (iAPE). The secondary outcome was major surgical complications (Clavien-Dindo ≥ III). There is uncertainty regarding the optimal surgical method in patients with rectal cancer when an anastomosis is unsuitable. Rectal cancer patients with a tumor height >5 cm, registered in the Swedish Colorectal Cancer Registry who received HP or iAPE electively in 2017–2020 were included, (HP, n = 696; iAPE, n = 314). Logistic regression analysis adjusting for body mass index, American Society of Anesthesiologists classification, sex, age, preoperative radiotherapy, tumor height, cancer stage, operating hospital, and type of operation was performed. Patients in the HP group were older and had higher American Society of Anesthesiologists scores. The mean operating time was less for HP (290 vs 377 min). Intraoperative bowel perforations were less frequent in the HP group, 3.6% versus 10.2%. Overall surgical complication rates were 20.3% after HP and 15.9% after iAPE (P = 0.118). Major surgical complications were 7.5% after HP and 5.7% and after iAPE (P = 0.351). Multiple regression analysis indicated a higher risk of overall surgical complications after HP (odds ratio: 1.63; 95% confidence interval = 1.09–2.45). HP was associated with a higher risk of surgical complications compared with iAPE. In patients unfit for anastomosis, iAPE may be preferable. However, the lack of statistical power regarding major surgical complications, prolonged operating time, increased risk of bowel perforation, and lack of long-term outcomes, raises uncertainty regarding recommending intersphincteric abdominoperineal excision as the preferred surgical approach.
{"title":"Hartmann’s Procedure Versus Intersphincteric Abdominoperineal Excision in Patients with Rectal Cancer: Report from the Swedish Colorectal Cancer Registry (SCRCR)","authors":"Viktor Åkerlund, M. Nikberg, Philippe Wagner, A. Chabok","doi":"10.1097/as9.0000000000000428","DOIUrl":"https://doi.org/10.1097/as9.0000000000000428","url":null,"abstract":"\u0000 \u0000 The primary outcome was to compare overall postoperative surgical complications within 30 days after Hartmann’s procedure (HP) compared with intersphincteric abdominoperineal excision (iAPE). The secondary outcome was major surgical complications (Clavien-Dindo ≥ III).\u0000 \u0000 \u0000 \u0000 There is uncertainty regarding the optimal surgical method in patients with rectal cancer when an anastomosis is unsuitable.\u0000 \u0000 \u0000 \u0000 Rectal cancer patients with a tumor height >5 cm, registered in the Swedish Colorectal Cancer Registry who received HP or iAPE electively in 2017–2020 were included, (HP, n = 696; iAPE, n = 314). Logistic regression analysis adjusting for body mass index, American Society of Anesthesiologists classification, sex, age, preoperative radiotherapy, tumor height, cancer stage, operating hospital, and type of operation was performed.\u0000 \u0000 \u0000 \u0000 Patients in the HP group were older and had higher American Society of Anesthesiologists scores. The mean operating time was less for HP (290 vs 377 min). Intraoperative bowel perforations were less frequent in the HP group, 3.6% versus 10.2%. Overall surgical complication rates were 20.3% after HP and 15.9% after iAPE (P = 0.118). Major surgical complications were 7.5% after HP and 5.7% and after iAPE (P = 0.351). Multiple regression analysis indicated a higher risk of overall surgical complications after HP (odds ratio: 1.63; 95% confidence interval = 1.09–2.45).\u0000 \u0000 \u0000 \u0000 HP was associated with a higher risk of surgical complications compared with iAPE. In patients unfit for anastomosis, iAPE may be preferable. However, the lack of statistical power regarding major surgical complications, prolonged operating time, increased risk of bowel perforation, and lack of long-term outcomes, raises uncertainty regarding recommending intersphincteric abdominoperineal excision as the preferred surgical approach.\u0000","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"61 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141121737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To determine whether socio-demographic and preoperative clinical factors contribute to the percent total body weight loss (%TBWL) after bariatric surgery (BS). BS is the most effective long-term treatment for medically complicated obesity. More information is needed about the factors that contribute to postoperative %TBWL in large and ethnically diverse cohorts. This retrospective study conducted in the Kaiser Permanente Northern California region included 7698 patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between January 2009 and March 2015. Trajectory analyses were conducted from 5-year follow-up data to assign patients to “low,” “average,” or “high” postoperative %TBWL groups. We then evaluated whether age, sex, race/ethnicity, neighborhood deprivation index and preoperative body mass index (BMI)/weight loss, diabetes, hypertension, and sleep apnea contributed to postoperative %TBWL using logistic regression models. Of 7698 patients (83.2% women), 48.6% underwent a RYGB and 51.4% underwent a SG. Postoperative %TBWL trajectories over 5 years were obtained in 6229 (81%) of 7698 eligible patients. About 27.8% and 29.3% of patients followed the “low” postoperative %TBWL trajectory, for RYGB and SG, respectively. Men, older patients, and Asian, Black, and Hispanic/Latino patients were more likely to be classified in the low postoperative %TBWL group. Patients showing lower postoperative %TBWL had a lower preoperative BMI (but lost less weight before surgery) and were more likely to have preoperative comorbidities. This study confirms and extends prior findings of the effects of several demographic and preoperative clinical factors on postoperative weight loss. Findings could improve the support of patients to achieve desired surgical outcomes.
{"title":"Socio-Demographic and Preoperative Clinical Factors Associated With 5-Year Weight Trajectories After Roux-en-Y Gastric Bypass and Sleeve Gastrectomy","authors":"Sahil Patel, Chen Jiang, Brandon Cowan, Jie Yin, Catherine Schaefer, Sanjoy Dutta, Rouzbeh Mostaedi, Hélène Choquet","doi":"10.1097/as9.0000000000000437","DOIUrl":"https://doi.org/10.1097/as9.0000000000000437","url":null,"abstract":"\u0000 \u0000 To determine whether socio-demographic and preoperative clinical factors contribute to the percent total body weight loss (%TBWL) after bariatric surgery (BS).\u0000 \u0000 \u0000 \u0000 BS is the most effective long-term treatment for medically complicated obesity. More information is needed about the factors that contribute to postoperative %TBWL in large and ethnically diverse cohorts.\u0000 \u0000 \u0000 \u0000 This retrospective study conducted in the Kaiser Permanente Northern California region included 7698 patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between January 2009 and March 2015. Trajectory analyses were conducted from 5-year follow-up data to assign patients to “low,” “average,” or “high” postoperative %TBWL groups. We then evaluated whether age, sex, race/ethnicity, neighborhood deprivation index and preoperative body mass index (BMI)/weight loss, diabetes, hypertension, and sleep apnea contributed to postoperative %TBWL using logistic regression models.\u0000 \u0000 \u0000 \u0000 Of 7698 patients (83.2% women), 48.6% underwent a RYGB and 51.4% underwent a SG. Postoperative %TBWL trajectories over 5 years were obtained in 6229 (81%) of 7698 eligible patients. About 27.8% and 29.3% of patients followed the “low” postoperative %TBWL trajectory, for RYGB and SG, respectively. Men, older patients, and Asian, Black, and Hispanic/Latino patients were more likely to be classified in the low postoperative %TBWL group. Patients showing lower postoperative %TBWL had a lower preoperative BMI (but lost less weight before surgery) and were more likely to have preoperative comorbidities.\u0000 \u0000 \u0000 \u0000 This study confirms and extends prior findings of the effects of several demographic and preoperative clinical factors on postoperative weight loss. Findings could improve the support of patients to achieve desired surgical outcomes.\u0000","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"107 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140968216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-16DOI: 10.1097/as9.0000000000000432
Bayley A. Jones, Joshua Richman, Michael Rubyan, Lauren Wood, Alfonsus Adrian H. Harsono, Wendelyn Oslock, Nathan English, Burkely P. Smith, Robert Hollis, Larry R. Hearld, Isabel Scarinci, Daniel I Chu
This study evaluated the association between preoperative education and adherence to downstream components of enhanced recovery programs (ERPs) and surgical outcomes among patients undergoing elective colorectal surgery. ERPs improve outcomes for surgical patients. While preoperative education is an essential component of ERPs, its relationship with other components is unclear. This was a retrospective cohort study of all ERP patients undergoing elective colorectal surgery from 2019 to 2022. Our institutional ERP database was linked with American College of Surgeons National Surgical Quality Improvement Program data and stratified by adherence to preoperative education. Primary outcomes included adherence to individual ERP components and secondary outcomes included high-level ERP adherence (>70% of components), length of stay (LOS), readmissions, and 30-day complications. A total of 997 patients were included. The mean (SD) age was 56.5 (15.8) years, 686 (57.3%) were female, and 717 (71.9%) were white. On adjusted analysis, patients who received preoperative education (n = 877, 88%) had higher adherence rates for the following ERP components: no prolonged fasting (estimate = +19.6%; P < 0.001), preoperative blocks (+8.0%; P = 0.02), preoperative multimodal analgesia (+18.0%; P < 0.001), early regular diet (+15.9%; P < 0.001), and postoperative multimodal analgesia (+6.4%; P < 0.001). High-level ERP adherence was 13.4% higher (P < 0.01) and LOS was 2.0 days shorter (P < 0.001) for those who received preoperative education. Classification and regression tree analysis identified preoperative education as the first-level predictor for adherence to early regular diet, the second-level predictor for LOS, and the third-level predictor for ERP high-level adherence. Preoperative education is associated with adherence to ERP components and improved surgical outcomes.
{"title":"Preoperative Education is Associated with Adherence to Downstream Components and Outcomes in a Colorectal Surgery Enhanced Recovery Program","authors":"Bayley A. Jones, Joshua Richman, Michael Rubyan, Lauren Wood, Alfonsus Adrian H. Harsono, Wendelyn Oslock, Nathan English, Burkely P. Smith, Robert Hollis, Larry R. Hearld, Isabel Scarinci, Daniel I Chu","doi":"10.1097/as9.0000000000000432","DOIUrl":"https://doi.org/10.1097/as9.0000000000000432","url":null,"abstract":"\u0000 \u0000 This study evaluated the association between preoperative education and adherence to downstream components of enhanced recovery programs (ERPs) and surgical outcomes among patients undergoing elective colorectal surgery.\u0000 \u0000 \u0000 \u0000 ERPs improve outcomes for surgical patients. While preoperative education is an essential component of ERPs, its relationship with other components is unclear.\u0000 \u0000 \u0000 \u0000 This was a retrospective cohort study of all ERP patients undergoing elective colorectal surgery from 2019 to 2022. Our institutional ERP database was linked with American College of Surgeons National Surgical Quality Improvement Program data and stratified by adherence to preoperative education. Primary outcomes included adherence to individual ERP components and secondary outcomes included high-level ERP adherence (>70% of components), length of stay (LOS), readmissions, and 30-day complications.\u0000 \u0000 \u0000 \u0000 A total of 997 patients were included. The mean (SD) age was 56.5 (15.8) years, 686 (57.3%) were female, and 717 (71.9%) were white. On adjusted analysis, patients who received preoperative education (n = 877, 88%) had higher adherence rates for the following ERP components: no prolonged fasting (estimate = +19.6%; P < 0.001), preoperative blocks (+8.0%; P = 0.02), preoperative multimodal analgesia (+18.0%; P < 0.001), early regular diet (+15.9%; P < 0.001), and postoperative multimodal analgesia (+6.4%; P < 0.001). High-level ERP adherence was 13.4% higher (P < 0.01) and LOS was 2.0 days shorter (P < 0.001) for those who received preoperative education. Classification and regression tree analysis identified preoperative education as the first-level predictor for adherence to early regular diet, the second-level predictor for LOS, and the third-level predictor for ERP high-level adherence.\u0000 \u0000 \u0000 \u0000 Preoperative education is associated with adherence to ERP components and improved surgical outcomes.\u0000","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"22 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140969929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-14DOI: 10.1097/as9.0000000000000435
An T Ngo-Huang, Nathan H. Parker, Keri L. Schadler, Matthew H G Katz
{"title":"Response to: Comment on “Effects of a Pragmatic Home-Based Exercise Program Concurrent With Neoadjuvant Therapy on Physical Function of Patients With Pancreatic Cancer: The PancFit Randomized Clinical Trial”","authors":"An T Ngo-Huang, Nathan H. Parker, Keri L. Schadler, Matthew H G Katz","doi":"10.1097/as9.0000000000000435","DOIUrl":"https://doi.org/10.1097/as9.0000000000000435","url":null,"abstract":"","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"36 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140981225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-14DOI: 10.1097/as9.0000000000000440
Ton Wang, H. G. Welch, Lesly A. Dossett
{"title":"Operative Standards for Cancer Surgery: Will Synoptic Reporting Really Improve Cancer Outcomes?","authors":"Ton Wang, H. G. Welch, Lesly A. Dossett","doi":"10.1097/as9.0000000000000440","DOIUrl":"https://doi.org/10.1097/as9.0000000000000440","url":null,"abstract":"","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"37 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140979161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-13DOI: 10.1097/as9.0000000000000442
M. Tolsgaard, A. Feragen, Lawrence Grierson
{"title":"Leveraging Education Science for AI-Clinician Collaboration in the Patient Care Ecosystem","authors":"M. Tolsgaard, A. Feragen, Lawrence Grierson","doi":"10.1097/as9.0000000000000442","DOIUrl":"https://doi.org/10.1097/as9.0000000000000442","url":null,"abstract":"","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"121 33","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140985353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-13DOI: 10.1097/as9.0000000000000439
M. Katlic, Joshua Wolf, S. J. Demos, Ronnie A. Rosenthal
{"title":"Making a Financial Case for the Geriatric Surgery Verification Program","authors":"M. Katlic, Joshua Wolf, S. J. Demos, Ronnie A. Rosenthal","doi":"10.1097/as9.0000000000000439","DOIUrl":"https://doi.org/10.1097/as9.0000000000000439","url":null,"abstract":"","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"78 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140984490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-13DOI: 10.1097/as9.0000000000000433
Andreas Samuelsson, D. Bock, M. Prytz, C. Ehrencrona, A. Wedin, E. Angenete, E. Haglind
To compare long-term outcomes after laparoscopic lavage with resection surgery for perforated diverticulitis, Hinchey grade III as practiced in Sweden for 3 years. Laparoscopic lavage has been studied in 3 randomized controlled trials. Long-term results indicate that additional surgery and a remaining stoma are less common after lavage compared with resection, but data from routine care and larger cohorts are needed to get a more complete picture. LapLav is a national cohort study with nearly complete coverage of all patients operated in Sweden between 2016 and 2018. The cohort was retrieved from the national patient register by a definition based on the Classification of Diseases and Related Health Problems-10 code plus the surgical procedural code. All medical records have been reviewed and data retrieved in addition to registry data. Propensity score with inverse probability weighting was used to balance the 2 groups, that is, laparoscopic lavage vs resection surgery. Before the propensity score was applied, the cohort consisted of 499 patients. Additional surgery was more common in the resection group [odds ratio, 0.714; 95% confidence interval (CI) = 0.529–0.962; P = 0.0271]. Mortality did not differ between the groups (hazard ratio, 1.20; 95% CI = 0.69–2.07; P = 0.516). In the lavage group, 27% of patients went on to have resection surgery. In Swedish routine care, laparoscopic lavage was feasible and safe for the surgical treatment of perforated diverticulitis, Hinchey grade III. Our results indicate that laparoscopic lavage can be used as a first-choice treatment.
目的：比较瑞典 3 年来采用腹腔镜灌洗和切除手术治疗穿孔性憩室（Hinchey III 级）的长期疗效。 3 项随机对照试验对腹腔镜灌洗术进行了研究。长期结果表明，与切除术相比，灌洗术后进行额外手术和残留造口的情况较少，但要获得更全面的信息，还需要常规护理和更大规模队列的数据。 LapLav是一项全国性队列研究，几乎完全覆盖了2016年至2018年间在瑞典接受手术的所有患者。根据疾病和相关健康问题分类-10代码加上手术程序代码的定义，从全国患者登记册中检索出队列。除登记数据外，还审查了所有医疗记录并检索了数据。为了平衡腹腔镜灌洗手术和切除手术这两组患者，采用了反概率加权倾向评分法。 在使用倾向评分前，组群中有 499 名患者。切除手术组患者更常接受额外手术[几率比 0.714；95% 置信区间 (CI) = 0.529-0.962；P = 0.0271]。两组死亡率无差异（危险比为 1.20；95% CI = 0.69-2.07；P = 0.516）。在灌洗组中，27%的患者继续接受切除手术。 在瑞典的常规治疗中，腹腔镜灌洗术在手术治疗穿孔性憩室（Hinchey III 级）方面是可行且安全的。我们的研究结果表明，腹腔镜灌洗术可作为首选治疗方法。
{"title":"Long-Term Results After Laparoscopic Lavage for Perforated Diverticulitis Purulent Peritonitis in Sweden: A Population-Based Observational Study","authors":"Andreas Samuelsson, D. Bock, M. Prytz, C. Ehrencrona, A. Wedin, E. Angenete, E. Haglind","doi":"10.1097/as9.0000000000000433","DOIUrl":"https://doi.org/10.1097/as9.0000000000000433","url":null,"abstract":"\u0000 \u0000 To compare long-term outcomes after laparoscopic lavage with resection surgery for perforated diverticulitis, Hinchey grade III as practiced in Sweden for 3 years.\u0000 \u0000 \u0000 \u0000 Laparoscopic lavage has been studied in 3 randomized controlled trials. Long-term results indicate that additional surgery and a remaining stoma are less common after lavage compared with resection, but data from routine care and larger cohorts are needed to get a more complete picture.\u0000 \u0000 \u0000 \u0000 LapLav is a national cohort study with nearly complete coverage of all patients operated in Sweden between 2016 and 2018. The cohort was retrieved from the national patient register by a definition based on the Classification of Diseases and Related Health Problems-10 code plus the surgical procedural code. All medical records have been reviewed and data retrieved in addition to registry data. Propensity score with inverse probability weighting was used to balance the 2 groups, that is, laparoscopic lavage vs resection surgery.\u0000 \u0000 \u0000 \u0000 Before the propensity score was applied, the cohort consisted of 499 patients. Additional surgery was more common in the resection group [odds ratio, 0.714; 95% confidence interval (CI) = 0.529–0.962; P = 0.0271]. Mortality did not differ between the groups (hazard ratio, 1.20; 95% CI = 0.69–2.07; P = 0.516). In the lavage group, 27% of patients went on to have resection surgery.\u0000 \u0000 \u0000 \u0000 In Swedish routine care, laparoscopic lavage was feasible and safe for the surgical treatment of perforated diverticulitis, Hinchey grade III. Our results indicate that laparoscopic lavage can be used as a first-choice treatment.\u0000","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"124 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140985190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-13DOI: 10.1097/as9.0000000000000444
Joohyun Kim, Michael T. Zimmermann, A. Mathison, G. Lomberk, Raul Urrutia, Johnny C. Hong
The adverse effects of ischemia-reperfusion injury (IRI) remain a principal barrier to a successful outcome after lifesaving orthotopic liver transplantation (OLT). Gene expression during different phases of IRI is dynamic and modified by individual exposures, making it attractive for identifying potential therapeutic targets for improving the number of suitable organs for transplantation and patient outcomes. However, data remain limited on the functional landscape of gene expression during liver graft IRI, spanning procurement to reperfusion and recovery. Therefore, we sought to characterize transcriptomic profiles of IRI during multiple phases in human OLT. We conducted clinical data analyses, histologic evaluation, and RNA sequencing of 17 consecutive human primary OLT. We performed liver allograft biopsies at 4 time points: baseline (B, before donor cross-clamp), at the end of cold ischemia (CI), during early reperfusion (ER, after revascularization), and during late reperfusion (LR). Data were generated and then recipients grouped by post-OLT outcomes categories: immediate allograft function (IAF; n = 11) versus early allograft dysfunction (EAD; n = 6) groups. We observed that CI (vs B) modified a transcriptomic landscape enriched for a metabolic and immune process. Expression levels of hallmark inflammatory response genes were higher transitioning from CI to ER and decreased from ER to LR. IAF group predominantly showed higher bile and fatty acid metabolism activity during LR compared with EAD group, while EAD group maintained more immunomodulatory activities. Throughout all time points, EAD specimens exhibited decreased metabolic activity in both bile and fatty acid pathways. We report transcriptomic profiles of human liver allograft IRI from prepreservation in the donor to posttransplantation in the recipient. Immunomodulatory and metabolic landscapes across ER and LR phases were different between IAF and EAD allografts. Our study also highlights marker genes for these biological processes that we plan to explore as novel therapeutic targets or surrogate markers for severe allograft injury in clinical OLT.
缺血再灌注损伤（IRI）的不良影响仍然是阻碍正位肝移植（OLT）成功的主要障碍。缺血再灌注损伤不同阶段的基因表达是动态的，并受个体暴露的影响而改变，这使其在确定潜在治疗靶点以提高适合移植的器官数量和患者预后方面具有吸引力。然而，关于肝脏移植物 IRI 期间（从取材到再灌注和恢复）基因表达的功能图谱的数据仍然有限。因此，我们试图描述人OLT多个阶段中IRI的转录组特征。 我们对 17 例连续的人类原发性 OLT 进行了临床数据分析、组织学评估和 RNA 测序。我们在 4 个时间点进行了肝脏异体活检：基线（B，供体交叉钳夹前）、冷缺血结束时（CI）、早期再灌注（ER，血管重建后）和晚期再灌注（LR）。数据生成后，受者按器官移植后的结果分组：即刻同种异体功能组（IAF；n = 11）和早期同种异体功能障碍组（EAD；n = 6）。 我们观察到，CI（vs B）改变了富含代谢和免疫过程的转录组格局。从 CI 过渡到 ER 时，标志性炎症反应基因的表达水平较高，而从 ER 过渡到 LR 时则有所下降。与 EAD 组相比，IAF 组在 LR 期间主要表现出更高的胆汁和脂肪酸代谢活性，而 EAD 组则保持了更多的免疫调节活性。在所有时间点上，EAD 标本在胆汁和脂肪酸途径上的代谢活性都有所下降。 我们报告了人类肝脏异体IRI从供体预处理到受体移植后的转录组学特征。IAF和EAD异体移植物在ER和LR阶段的免疫调节和新陈代谢情况各不相同。我们的研究还强调了这些生物过程的标记基因，我们计划将其作为新的治疗靶点或临床 OLT 中严重同种异体移植损伤的替代标记物进行探索。
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