Surgery in practice and science最新文献

Emergency laparotomy preoperative risk assessment tool performance: A systematic review 急诊开腹手术术前风险评估工具的性能：系统回顾

IF 0.6 Q4 SURGERY

Surgery in practice and science

Pub Date : 2024-10-31 DOI: 10.1016/j.sipas.2024.100264

Joseph N. Hewitt , Thomas J. Milton , Jack Jeanes , Ishraq Murshed , Silas Nann , Susanne Wells , Aashray K. Gupta , Christopher D. Ovenden , Joshua G. Kovoor , Stephen Bacchi , Christopher Dobbins , Markus I. Trochsler

Background

Preoperative assessment of risk for emergency laparotomy may enhance decision making with regards to urgency or perioperative critical care admission and promote a more informed consent process for patients. Accordingly, we aimed to assess the performance of risk assessment tools in predicting mortality after emergency laparotomy.

Methods

PubMed, Embase, the Cochrane Library and CINAHL were searched to 12 February 2022 for observational studies reporting expected mortality based on a preoperative risk assessment and actual mortality after emergency laparotomy. Study screening, data extraction, and risk of bias using the Downs and Black checklist were performed in duplicate. Data on setting, operation undertaken, expected and actual mortality rates were extracted. Meta-analysis was planned but not possible due to heterogeneity. This study is registered with PROSPERO, CRD42022299227.

Results

From 10,168 records, 82 observational studies were included. 17 risk assessment tools were described, the most common of which were P-POSSUM (42 studies), POSSUM (13 studies), NELA (12 studies) and MPI (11 studies). Articles were published between 1990 and 2022 with the most common country of origin being the UK (33 studies) followed by India (11 studies). Meta-analysis was not possible. Observed mortality and expected mortality based on risk assessment is reported for each study and generally shows most studies show accurate risk prediction.

Conclusions

This review synthesises available literature to characterise the performance of various risk assessment tools in predicting mortality after emergency laparotomy. Findings from this study may benefit those undertaking emergency laparotomy and future research in risk prediction.

背景对急诊开腹手术的术前风险评估可加强对急诊或围术期重症监护入院的决策，并促进患者在更知情的情况下同意手术。因此，我们旨在评估风险评估工具在预测急诊开腹手术后死亡率方面的性能。方法检索了PubMed、Embase、Cochrane图书馆和CINAHL截至2022年2月12日的观察性研究，这些研究报告了基于术前风险评估的预期死亡率和急诊开腹手术后的实际死亡率。研究筛选、数据提取和使用 Downs and Black 检查表的偏倚风险均一式两份。提取了有关环境、手术、预期死亡率和实际死亡率的数据。计划进行 Meta 分析，但由于存在异质性而无法进行。本研究已在 PROSPERO 注册，CRD42022299227。结果从 10,168 条记录中，共纳入了 82 项观察性研究。描述了 17 种风险评估工具，其中最常见的是 P-POSSUM（42 项研究）、POSSUM（13 项研究）、NELA（12 项研究）和 MPI（11 项研究）。文章发表于 1990 年至 2022 年之间，最常见的来源国是英国（33 项研究），其次是印度（11 项研究）。无法进行元分析。每项研究都报告了基于风险评估的观察死亡率和预期死亡率，总体而言，大多数研究都显示出准确的风险预测。本研究的结果可能会对进行急诊开腹手术的人员和未来的风险预测研究有所裨益。

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引用次数: 0

Letter to the Editor on “The pulmonary contusion score: Development of asimple scoring system for blunt lung injury” 致编辑的信，主题为 "肺挫伤评分：钝性肺损伤简易评分系统的开发"

IF 0.6 Q4 SURGERY

Surgery in practice and science

Pub Date : 2024-10-18 DOI: 10.1016/j.sipas.2024.100263

Christopher F. Janowak , Devin M. Wakefield , Lauren M. Janowak , Amro Wafi

引用次数: 0

Prevalence and associated factors of acute postoperative pain in adult surgical patients: A prospective study 成人手术患者术后急性疼痛的发生率和相关因素：前瞻性研究

IF 0.6 Q4 SURGERY

Surgery in practice and science

Pub Date : 2024-10-17 DOI: 10.1016/j.sipas.2024.100262

Eyob Asefa Bekele , Tseganesh Berhanu Tulu , Yonathan Abebe Bulto , Gebeyehu Tessema Azibte , Waltengus Birhanu

Background

Pain, as defined by the International Association for the Study of Pain, is an unpleasant sensory and emotional experience associated with, or resembling, that is associated with actual or potential tissue damage. In Ethiopia, where healthcare facilities and offerings are expanding to handle countless patients requiring surgical intervention, managing acute postoperative pain is a serious concern.

Objectives

To assess the prevalence of acute postoperative pain and associated factors after elective surgery among adult patients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2023

Methodology

This is an institution-based cross-sectional study. A structured data collection format was used to collect data from 219 participants. Bivariable and multivariable logistic regression analyses described the association between independent and dependent variables.

Results

Of 219 patients, 180 (82.2 %) had acute postoperative pain. The prevalence of moderate to severe pain was 34.24 %. Preoperative anxiety, the use of intraoperative analgesics, and duration of surgery were the main factors associated with the prevalence of acute postoperative pain.

Conclusion

Our study revealed that the overall prevalence of postoperative pain was relatively low in the study area. This suggests that the attention given to postoperative pain recognition and management is better than that in other areas. However, the finding of a significant gap in managing postoperative pain underscores the need for further improvements in pain management practices. This should motivate us to commit to change, particularly in the identified areas of concern, such as preoperative anxiety, use of intraoperative analgesics, and duration of surgery.

背景根据国际疼痛研究协会（International Association for the Study of Pain）的定义，疼痛是一种与实际或潜在的组织损伤相关或相似的不愉快的感觉和情绪体验。在埃塞俄比亚，医疗设施和服务正在不断扩大，需要手术治疗的患者不计其数，因此术后急性疼痛的管理是一个令人严重关切的问题。 Objectives To assess the prevalence of acute postoperative pain and associated factors after elective surgery among adult patients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2023Methodology 这是一项以医院为基础的横断面研究。采用结构化数据收集格式收集了 219 名参与者的数据。双变量和多变量逻辑回归分析描述了自变量和因变量之间的关联。中度至重度疼痛的发生率为 34.24%。术前焦虑、术中镇痛剂的使用和手术持续时间是与急性术后疼痛发生率相关的主要因素。这表明该地区对术后疼痛识别和处理的重视程度优于其他地区。然而，在管理术后疼痛方面存在的巨大差距突出表明，有必要进一步改进疼痛管理方法。这应促使我们致力于改变，尤其是在已确定的关切领域，如术前焦虑、术中镇痛剂的使用和手术持续时间。

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引用次数: 0

Advances and results in omental patch repair of gastrointestinal perforations: A narrative review 胃肠道穿孔网膜修补术的进展和结果：叙述性综述

IF 0.6 Q4 SURGERY

Surgery in practice and science

Pub Date : 2024-10-05 DOI: 10.1016/j.sipas.2024.100261

Francesca Velasco-Velasco , Jordan Llerena-Velastegui

Omental patch repair is a crucial surgical procedure for managing gastrointestinal perforations, particularly those associated with peptic ulcers, necessitating a detailed review of its effectiveness and outcomes. This literature review aims to assess current knowledge on omental patch repair, focusing on advancements in surgical techniques and patient outcomes. Major medical databases, including PubMed, Scopus, and Web of Science, were searched for relevant studies published between 2020 and 2024, prioritizing those that explored omental patch repair, surgical methods, and associated clinical outcomes. The results provide insights into the pathophysiology of gastrointestinal perforations, the effectiveness of omental patch repair in promoting healing, and its role in reducing postoperative complications. Both open and laparoscopic techniques have demonstrated improved patient outcomes, including reduced mortality, morbidity, and faster recovery times. Additionally, alternative methods, such as the use of the falciform ligament, offer comparable efficacy in cases where the omentum is unavailable. This review underscores the importance of omental patch repair as a reliable surgical intervention adaptable to various clinical environments. However, further research is necessary to address gaps in long-term outcomes, particularly regarding recurrence rates and complications, highlighting the need for continued innovation and refinement of techniques to enhance patient care.

网膜修补术是治疗胃肠道穿孔（尤其是与消化性溃疡相关的穿孔）的重要手术方法，因此有必要对其效果和预后进行详细审查。本文献综述旨在评估目前有关网膜修补术的知识，重点关注手术技术的进步和患者的治疗效果。我们在主要医学数据库（包括 PubMed、Scopus 和 Web of Science）中搜索了 2020 年至 2024 年间发表的相关研究，优先选择了那些探讨网膜修补术、手术方法和相关临床结果的研究。研究结果为胃肠道穿孔的病理生理学、网膜修补在促进愈合方面的有效性及其在减少术后并发症方面的作用提供了深入的见解。开腹和腹腔镜技术都能改善患者的治疗效果，包括降低死亡率、发病率和缩短恢复时间。此外，在没有网膜的情况下，使用镰状韧带等替代方法也能提供相当的疗效。这篇综述强调了网膜修补作为一种可靠的外科干预方法的重要性，它可以适应各种临床环境。然而，有必要开展进一步的研究，以解决长期疗效方面的差距，尤其是复发率和并发症方面的差距，同时强调需要不断创新和改进技术，以加强对患者的护理。

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引用次数: 0

Practical evaluation of risk factors in patients with osteoporosis-induced thoracic and lumbar vertebral compression fractures requiring surgery 对需要手术治疗的骨质疏松症所致胸椎和腰椎压缩性骨折患者的风险因素进行实用评估

IF 0.6 Q4 SURGERY

Surgery in practice and science

Pub Date : 2024-09-05 DOI: 10.1016/j.sipas.2024.100260

Hung Manh Do , Ha Thi-Ngoc Doan , Son Ngoc Dinh

This descriptive longitudinal study aims to assess the risk factors for severe thoracic and lumbar vertebral compression fractures before and after surgery, contributing to preventive knowledge enhancement in communities and effective treatment management. The study involved 34 patients diagnosed with thoracic and lumbar vertebral compression fractures requiring surgery with bio-cement-augmented pedicle screws between June 2021 and June 2022. Postoperative complications, notably adjacent segment injury, were monitored, and patients received osteoporosis management post-surgery.

The majority of patients were female (61.8 %), with an average age of 66.4 ± 9.2 years. Daily life accidents were the most common cause of injuries (88.2 %). Most patients underwent surgery more than 3 months after injury (58.8 %), with a notable percentage seeking examination and treatment post-injury. Osteoporosis prevalence was high among patients at the time of spinal injury, indicating a need for improved osteoporosis management strategies post-surgery. Various comorbidities were observed, with a portion of patients having pre-existing conditions like diabetes, hypertension, and kidney failure. Changes in bone mineral density correlated with age, highlighting the increased fracture risk seen in older individuals. Two patients required vertebral body reconstruction due to adjacent vertebra damage post-surgery. A significant proportion of patients received osteoporosis treatment after the surgical intervention.

Patients with lumbar-thoracic osteoporosis fractures need a comprehensive assessment of clinical and paraclinical factors to select appropriate and effective treatment methods. Postoperatively, these patients also require osteoporosis management, regular monitoring, and evaluations to reduce postoperative complications, including the risk of adjacent segment injury and other vertebral compression fractures.

这项描述性纵向研究旨在评估严重胸椎和腰椎压缩性骨折手术前后的风险因素，从而促进社区预防知识的提高和有效的治疗管理。该研究涉及 34 名确诊为胸椎和腰椎压缩性骨折的患者，他们需要在 2021 年 6 月至 2022 年 6 月期间接受生物充填椎弓根螺钉手术。对术后并发症，尤其是邻近节段损伤进行了监测，患者术后接受了骨质疏松症治疗。日常生活意外是最常见的受伤原因（88.2%）。大多数患者在受伤后 3 个月以上接受手术（58.8%），其中有相当大比例的患者在受伤后寻求检查和治疗。脊柱受伤时骨质疏松症在患者中的发病率很高，这表明需要改进手术后的骨质疏松症管理策略。研究还发现了各种合并症，其中一部分患者在受伤前就患有糖尿病、高血压和肾衰竭等疾病。骨矿物质密度的变化与年龄相关，突显了老年人骨折风险的增加。两名患者因术后邻近椎体受损而需要重建椎体。腰胸椎骨质疏松症骨折患者需要对临床和辅助临床因素进行综合评估，以选择适当有效的治疗方法。术后，这些患者还需要进行骨质疏松症管理、定期监测和评估，以减少术后并发症，包括邻近节段损伤和其他椎体压缩性骨折的风险。

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引用次数: 0

Elective hand surgery and concomitant corticosteroid injection: Confirming increased infection risk using A national dataset 手部择期手术并同时注射皮质类固醇：利用全国数据集确认感染风险增加

IF 0.6 Q4 SURGERY

Surgery in practice and science

Pub Date : 2024-09-04 DOI: 10.1016/j.sipas.2024.100259

Benjamin J. Kirby , Jashvant Poeran , Nicole Zubizarreta , Daniel A. London

Background

Recent studies demonstrate a link between corticosteroid injection and surgical complications when procedures occur shortly after steroid administration. These publications focus on single procedures like carpal tunnel release. This study seeks to demonstrate how surgical site infection risk changes across thirteen common elective hand procedures when steroid injection is performed contemporaneously.

Methods

The Truven MarketScan® database identified patients who had undergone elective hand surgery between 2015 and 2016. Two cohorts were created based on the administration, or absence thereof, of contemporaneous corticosteroid injection. The primary outcome measure was infection within 30 days of surgery as measured by antibiotic prescription or repeat surgical intervention. Multivariate logistic regression was performed to assess the association between concomitant corticosteroid injections and post-operative infections while controlling for demographics and comorbidities.

Results

149,689 patients underwent elective hand surgery. 6104 (4.1 %) received concomitant corticosteroid injection and 14,070 (9.4 %) received post-operative antibiotics or underwent secondary surgical intervention for infection. Treatment for post-operative infection was significantly higher in the corticosteroid group (10.2 % versus 9.3 %; p = 0.02) driven by difference in severe infection requiring surgical intervention (3.7 % versus 3.1 %; p = 0.03). This finding persisted when controlling for demographics and comorbidities with adjusted OR of 1.10 (CI 1.01–1.20) for all infections and 1.16 (CI 1.01–1.33) for severe infections.

Discussion

These results support prior findings that patients undergoing concurrent steroid injections and surgery have increased rates of infectious complications though the absolute risk remains small. Limitations of the database preclude further investigation into the details of each procedure (e.g. ipsilateral vs contralateral injection, peri-operative antibiotics) which may impact infection rates.

Conclusions

Concomitant steroid injection with elective hand surgery may increase the risk of postoperative infection, particularly severe infection. However, that relative increase lies between 1 and 33 percent and should be weighed against the benefit from intraoperative corticosteroid administration.

背景最近的研究表明，在注射类固醇后不久进行手术时，皮质类固醇注射与手术并发症之间存在联系。这些文章主要针对腕管松解术等单一手术。本研究旨在证明当类固醇注射同时进行时，13 种常见手部择期手术的手术部位感染风险会发生怎样的变化。方法Truven MarketScan® 数据库识别了 2015 年至 2016 年间接受手部择期手术的患者。根据是否同时注射皮质类固醇创建了两个队列。主要结果指标是手术后 30 天内的感染，以抗生素处方或重复手术干预来衡量。在控制人口统计学和合并症的情况下，进行了多变量逻辑回归以评估同时注射皮质类固醇与术后感染之间的关系。6104人（4.1%）同时接受了皮质类固醇注射，14070人（9.4%）术后接受了抗生素治疗或因感染接受了二次手术治疗。皮质类固醇组的术后感染治疗率明显更高（10.2% 对 9.3%；P = 0.02），这是因为需要手术干预的严重感染率不同（3.7% 对 3.1%；P = 0.03）。在控制人口统计学和合并症后，这一结果仍然存在，所有感染的调整 OR 为 1.10 (CI 1.01-1.20)，严重感染的调整 OR 为 1.16 (CI 1.01-1.33)。讨论这些结果支持了之前的研究结果，即同时接受类固醇注射和手术的患者感染并发症的发生率会增加，但绝对风险仍然很小。结论手部择期手术同时进行类固醇注射可能会增加术后感染的风险，尤其是严重感染。然而，这种相对增加率介于 1% 与 33% 之间，应根据术中使用皮质类固醇的益处进行权衡。

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引用次数: 0

Venous thromboembolic events following cytoreductive surgery for lower gastrointestinal neoplasia 下消化道肿瘤细胞减灭术后的静脉血栓栓塞事件

IF 0.6 Q4 SURGERY

Surgery in practice and science

Pub Date : 2024-07-14 DOI: 10.1016/j.sipas.2024.100257

Mina Guirgis , Simon Keelan , Philip McEntee , Margaret Han , Paul Moroz

Introduction

Cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) represent a high-risk for venous thromboembolism (VTE) due to malignancy, prolonged surgery and immobility. We investigated the incidence of and risk factors for VTE following CRS/IPC.

Materials and methods

Data was analysed on 130 CRS/IPC performed over a 6-year period at a single centre, the Western Australian Peritonectomy Service (WAPS), on lower gastrointestinal neoplasia: pseudomyxoma peritoneii (PMP), colorectal cancer (CRC) and appendix cancer (AC). Data was analysed by univariate and multivariate logistic regression to identify risk factors for VTE.

Results

31 patients (24 %) experienced a VTE. The percentages of VTE among patients with PMP (n = 50), CRC (n = 53) and AC (n = 27) were 36 %, 17 % and 15 % respectively. 60 % of these cases were asymptomatic. The odds of VTE were higher for PMP patients than in patients with a other histopathology (OR=2.9, p = 0.01). Other significant risk factors for VTE on univariate analysis were PCI (OR=1.07, p = 0.001), pelvic dissection (OR=5.52, p = 0.001) and operation time (OR=1.36, p = 0.001).

Conclusion

This study demonstrates high rates of VTE in patients undergoing CRS/IPC. Patients with PMP have a three-fold higher risk of VTE compared to other malignancies (CRC+AC). As most VTE cases were asymptomatic, aggressive early investigation and intervention is indicated for patients undergoing CRS/IPC.

导言由于恶性肿瘤、手术时间过长和行动不便，膀胱生殖手术（CRS）和腹腔内化疗（IPC）是静脉血栓栓塞症（VTE）的高风险因素。我们对 CRS/IPC 术后 VTE 的发生率和风险因素进行了调查。材料和方法对西澳大利亚腹膜切除服务（WAPS）单个中心在 6 年内进行的 130 例 CRS/IPC 进行了数据分析，这些 CRS/IPC 的对象是下消化道肿瘤：腹膜假性肌瘤 (PMP)、结直肠癌 (CRC) 和阑尾癌 (AC)。通过单变量和多变量逻辑回归对数据进行分析，以确定导致 VTE 的风险因素。PMP（50 例）、CRC（53 例）和 AC（27 例）患者中发生 VTE 的比例分别为 36%、17% 和 15%。这些病例中有 60% 无症状。PMP 患者发生 VTE 的几率高于其他组织病理学患者（OR=2.9，P=0.01）。单变量分析显示，VTE 的其他重要风险因素包括 PCI（OR=1.07，P=0.001）、盆腔剥离（OR=5.52，P=0.001）和手术时间（OR=1.36，P=0.001）。与其他恶性肿瘤（CRC+AC）相比，PMP 患者发生 VTE 的风险高出三倍。由于大多数 VTE 病例无症状，因此对接受 CRS/IPC 治疗的患者应进行积极的早期检查和干预。

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引用次数: 0

Primary medullary adenocarcinoma of the colon: Literature review and case series 结肠原发性髓样腺癌：文献综述和病例系列

IF 0.6 Q4 SURGERY

Surgery in practice and science

Pub Date : 2024-07-04 DOI: 10.1016/j.sipas.2024.100254

Hein Maung , Oliver Gregory , Thomas De Hoog , Matthew Hutchinson , Dr. Pith Beh Soh , Matthew Marino , Tobias Evans , Adrian Yeoh , Richard C. Turner

Aims

Medullary carcinoma of the colon is a rare subtype of adenocarcinoma, first described in 1999. Clinically known to have a favourable prognosis in comparison to poorly differentiated cancers, it is associated with deficient mismatch repair. This is an observational single center study of patients with medullary cancer, and comparison with the current literature.

Methods

We performed a search of the pathological database at our institution for medullary adenocarcinomas between the years of 2016–2023 and reviewed their clinical information to collect all relevant data including patient history, hospital admissions. surgery and clinic visits. We then performed a literature search using Pubmed for search terms medullary cancer/carcinoma of the colon/colorectum.

Results

11 patients were found in our database, 34 studies in the literature, 19 retrospective cohort studies (3144 patients) and 13 case reports. 81.8% (vs. 73.22% in cohort studies) were female patients. 8/11 patients' tumours had lympho-vascular invasion with 2/11 perineural involvement. Immunohistochemistry demonstrated 11/11 patients’ tumours with MLH1 and PMS2 loss, and presence of MSH2 and MSH6. Cohort studies demonstrated 302/1897 (15.92%) tumours had perineural invasion with 1133/2151 (52.67%) demonstrating lympho-vascular invasion. MLH1 testing was available for 192 patients, with 93.75% having loss of MLH1.

Conclusion

Our cohort of medullary cancer patients were similar to that in the literature, with regards to demographics, staging and tumour characteristics. A longer follow-up time is required for our cohort to analyze long term survival outcomes.

目的结肠髓样癌是腺癌的一种罕见亚型，于 1999 年首次被描述。临床上，与分化不良的癌症相比，髓样癌的预后较好，但它与错配修复缺陷有关。这是一项针对髓样癌患者的单中心观察性研究，并与现有文献进行了比较。方法我们在本机构的病理数据库中搜索了2016-2023年间的髓样腺癌患者，并回顾了他们的临床信息，收集了所有相关数据，包括患者病史、入院情况、手术情况和门诊情况。然后，我们使用 Pubmed 进行了文献检索，检索词为髓样癌/结肠癌/结直肠癌。结果在我们的数据库中发现了 11 名患者，文献中有 34 项研究，19 项回顾性队列研究（3144 名患者）和 13 项病例报告。81.8%（队列研究中为 73.22%）的患者为女性。8/11例患者的肿瘤有淋巴管侵犯，2/11例有神经周围受累。免疫组化结果显示，11/11 例患者的肿瘤有 MLH1 和 PMS2 缺失，但存在 MSH2 和 MSH6。队列研究显示，302/1897（15.92%）例肿瘤有神经周围侵犯，1133/2151（52.67%）例肿瘤有淋巴管侵犯。192名患者接受了MLH1检测，93.75%的患者存在MLH1缺失。我们的队列需要更长的随访时间来分析长期生存结果。

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引用次数: 0

Assessment of complications in third molar surgery performed by resident surgeons: A comprehensive analysis 评估由住院外科医生实施的第三磨牙手术的并发症：综合分析

IF 0.6 Q4 SURGERY

Surgery in practice and science

Pub Date : 2024-06-28 DOI: 10.1016/j.sipas.2024.100256

João Mendes de Abreu , Érica Cerqueira , Anabela Quitério , Tiago Nunes , José Figueiredo , Ana Corte-Real

Introduction

Third molar extractions present a wide spectrum of reported complications, spanning from 2.6 % to 30.9 %, making it challenging to predict outcomes for individual patients.

This study seeks to evaluate third molar extractions conducted exclusively by stomatology or maxillofacial surgery residents, examining associated complications. Its aim also extends to delineating the related risks concerning epidemiological and clinical factors, juxtaposed against findings in the existing literature.

Materials and methods

An observational prospective cohort study was conducted at the Clinical and Academic Centre of Coimbra, Portugal, from July 2021 to December 2023. Descriptive statistics were used considering the adequate statistical parameters. Inferential statistical analysis was performed using Student's t-test, the Chi-squared test, and Spearman rank correlation to analyze the relationship between study variables. A p-value of less than 0.05 was considered statistically significant.

Results

485 patients underwent third molar extractions performed exclusively by stomatology and maxillofacial surgery residents, comprising a total of 686 extracted teeth and resulting in 71 reported complications (14.6 % per patient and 10.3 % per extracted tooth). Results revealed that patients undergoing lower third molar extraction faced a 3.7 times higher risk of complications compared to those undergoing upper third molar extraction. Teeth categorized as “IIIC” by Pell and Gregory's classification and those undergoing osteotomy and odontosection also exhibited a higher-than-expected complication rate with statistically significant differences being observed. No other variables showed a positive or negative statistically significant correlation with complication occurrence.

Discussion and conclusion

Despite the expectation of a heightened complication rate, this study revealed that a successful and comprehensive training regimen results in encountering complication rates akin to those documented in established literature.

These findings also underscore the importance of recognizing that a resident's surgical accomplishment is intrinsically tied to acknowledging and respecting their learning curve.

导言据报道，第三磨牙拔除术的并发症范围很广，从2.6%到30.9%不等，因此预测个别患者的预后具有挑战性。本研究旨在评估完全由口腔科或颌面外科住院医师进行的第三磨牙拔除术，检查相关并发症。材料与方法2021年7月至2023年12月，在葡萄牙科英布拉临床与学术中心开展了一项前瞻性队列观察研究。研究使用了描述性统计方法，并考虑了适当的统计参数。使用学生 t 检验、卡方检验和斯皮尔曼等级相关性进行推断统计分析，以分析研究变量之间的关系。结果485名患者接受了完全由口腔颌面外科住院医师实施的第三磨牙拔除术，共拔除了686颗牙齿，报告并发症71例（每位患者14.6%，每颗拔除牙齿10.3%）。结果显示，下第三磨牙拔除术患者面临的并发症风险是上第三磨牙拔除术患者的 3.7 倍。根据佩尔和格雷戈里的分类，被归类为 "IIIC "的牙齿以及接受截骨术和牙槽骨切除术的牙齿的并发症发生率也高于预期，并且在统计学上存在显著差异。讨论和结论尽管预期并发症发生率会升高，但本研究表明，成功而全面的培训计划会导致并发症发生率与已有文献记载的并发症发生率相近。这些发现还强调了认识到住院医师的手术成就与承认和尊重其学习曲线有着内在联系的重要性。

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引用次数: 0

The effect of Guided imagery on perioperative anxiety in hospitalized adult patients: A systematic review of randomized controlled trials 引导想象对住院成年患者围手术期焦虑的影响：随机对照试验的系统回顾

IF 0.6 Q4 SURGERY

Surgery in practice and science

Pub Date : 2024-06-27 DOI: 10.1016/j.sipas.2024.100255

Mahdiyeh Arjmandy Anamagh , Mohammad Shafiei Kouhpayeh , Shahab Khezri , Rasoul Goli , Navid Faraji , Babak Choobi Anzali , Himan Maroofi , Nima Eskandari , Fereshteh Ghahremanzad

Objective

Guided imagery is a relaxation technique that uses mental visualization to help individuals relax and focus their minds. This systematic review examines the effect of guided imagery on perioperative anxiety in hospitalized adult patients. The aim is to provide a comprehensive analysis of the existing evidence on the efficacy of guided imagery as an intervention for reducing perioperative anxiety.

Methods

A systematic search was conducted on databases including Web of Science, PubMed, Scopus, and PsycINFO. After screening titles and abstracts, full-text articles were assessed for eligibility. The selected studies were analyzed for their findings related to the effect of guided imagery on perioperative anxiety in adult patients.

Results

Nine studies met the inclusion criteria and provided sufficient data for analysis. The majority of the included studies reported a statistically significant reduction in perioperative anxiety following guided imagery interventions. The variations in intervention protocols, such as the content, duration, and frequency of guided imagery, were observed across the studies. Patient satisfaction and acceptance of guided imagery interventions were generally high.

Conclusion

The findings of this systematic review suggest that guided imagery is an effective intervention for reducing perioperative anxiety in hospitalized adult patients. Despite the limitations of small sample sizes and variability in measurement tools, the consistent positive results and high patient satisfaction indicate the potential benefits of incorporating guided imagery into perioperative care protocols. More comprehensive research with bigger samples and standardized tools is essential for guiding imagery integration in clinical practice.

目的引导想象是一种放松技巧，它利用心理可视化来帮助人们放松和集中注意力。本系统综述研究了引导想象对住院成年患者围手术期焦虑的影响。方法在 Web of Science、PubMed、Scopus 和 PsycINFO 等数据库中进行了系统检索。在筛选了标题和摘要后，对全文进行了资格评估。结果9项研究符合纳入标准，并提供了足够的数据用于分析。所纳入的大多数研究报告称，在引导想象干预后，围手术期焦虑症在统计学上有明显减轻。各项研究的干预方案存在差异，如引导想象的内容、持续时间和频率。患者对引导式意象干预的满意度和接受度普遍较高。结论：本系统综述的研究结果表明，引导式意象是减少住院成年患者围手术期焦虑的有效干预方法。尽管存在样本量小和测量工具不同的局限性，但一致的积极结果和较高的患者满意度表明，将引导式意象疗法纳入围手术期护理方案具有潜在的益处。使用更大样本和标准化工具进行更全面的研究对于指导将意象疗法纳入临床实践至关重要。

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