Pub Date : 2025-10-09DOI: 10.1016/j.sipas.2025.100312
Xin Li, Meng Han, Xiaoliang Wang, Wenjuan Lang, Kai Shi
Background
The association between minimum heart rate (MinHR) within 24 h of ICU admission and 1-month mortality in traumatic brain injury (TBI) patients remains unclear.
Methods
This retrospective cohort study analyzed 2267 TBI patients from the MIMIC-IV v3.1 database. Multivariable Cox regression, restricted cubic spline (RCS) analysis, and subgroup analyses evaluated relationships between 24-hour MinHR and mortality.
Results
The cohort (median age 67 [IQR 51–80] years; 62.6% female) had a median MinHR of 59 [52–68] bpm, with 248 deaths (10.94%). RCS analysis revealed a U-shaped association (P for nonlinear =0.001) with 59 bpm as the inflection point. MinHR ≥59 bpm independently predicted higher mortality after full adjustment (HR=1.84, 95%CI:1.31–2.60; P < 0.001). This association was pronounced in non-hypertensive patients (HR=1.50, 95%CI:1.08–2.08; P = 0.015).
Conclusions
A U-shaped association exists between 24-hour MinHR and 1-month mortality in TBI patients, with 59 bpm as the critical threshold. MinHR ≥59 bpm independently predicts increased mortality. These findings support using 59 bpm as an alert threshold for early intervention.
{"title":"Relationship between minimum heart rate and mortality in ICU patients with traumatic brain injury (TBI): a retrospective analysis based on the MIMIC-IV database","authors":"Xin Li, Meng Han, Xiaoliang Wang, Wenjuan Lang, Kai Shi","doi":"10.1016/j.sipas.2025.100312","DOIUrl":"10.1016/j.sipas.2025.100312","url":null,"abstract":"<div><h3>Background</h3><div>The association between minimum heart rate (MinHR) within 24 h of ICU admission and 1-month mortality in traumatic brain injury (TBI) patients remains unclear.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analyzed 2267 TBI patients from the MIMIC-IV v3.1 database. Multivariable Cox regression, restricted cubic spline (RCS) analysis, and subgroup analyses evaluated relationships between 24-hour MinHR and mortality.</div></div><div><h3>Results</h3><div>The cohort (median age 67 [IQR 51–80] years; 62.6% female) had a median MinHR of 59 [52–68] bpm, with 248 deaths (10.94%). RCS analysis revealed a U-shaped association (P for nonlinear =0.001) with 59 bpm as the inflection point. MinHR ≥59 bpm independently predicted higher mortality after full adjustment (HR=1.84, 95%CI:1.31–2.60; <em>P</em> < 0.001). This association was pronounced in non-hypertensive patients (HR=1.50, 95%CI:1.08–2.08; <em>P</em> = 0.015).</div></div><div><h3>Conclusions</h3><div>A U-shaped association exists between 24-hour MinHR and 1-month mortality in TBI patients, with 59 bpm as the critical threshold. MinHR ≥59 bpm independently predicts increased mortality. These findings support using 59 bpm as an alert threshold for early intervention.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"23 ","pages":"Article 100312"},"PeriodicalIF":0.8,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145363483","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 : 2025-09-21DOI: 10.1016/j.sipas.2025.100311
Joshua G. Kovoor , John M. Glynatsis , Nikolaos C. Glynatsis , Domenico Perrotta , Elyssa Chan , Timothy Daniell , Stephen Bacchi , Brandon Stretton , Daksh Tyagi , Joseph N. Hewitt , Angelyn L.W. Khong , Diana U. Siriwardena , David X.H. Ling , Christopher D. Ovenden , Rohan Arasu , Jonathan Henry W. Jacobsen , Suzanne Edwards , Matthew Marshall-Webb , Pramesh Kovoor , Benjamin A.J. Reddi , Aashray K. Gupta
Background
Acute aortic dissection (AAD) is an emergency associated with high mortality. Timely diagnosis is challenging, and delays may affect patient outcomes. We aimed to identify clinical and temporal factors associated with mortality after AAD.
Methodology
We performed a retrospective cohort study across four tertiary hospitals of type A and type B AADs diagnosed over a 20-year period. The outcomes of the study were in-hospital mortality, 30-day mortality, and mid-term (6-month) mortality. Univariate linear and bivariate logistic regression analyses were conducted to evaluate the relationship between mortality and demographic and clinical factors.
Results
The study included 149 AAD patients. Of these, 103 (69.1 %) were Stanford type A and 46 (30.9 %) Stanford type B. In-hospital mortality was 29.1 % (n = 30) for type A vs 10.9 % (n = 5) for type B. For type A patients, every one-year increase in age increased odds of in-hospital mortality by 4 % (p = 0.0076), and odds of in-hospital mortality were 10.9 times greater with conservative management than surgical (p < 0.0001). Patients with type A dissection had odds of in-hospital mortality 3.0 times greater than type B (p = 0.0005). 30-day mortality rate was 29.1 % (n = 30) for type A dissection vs 10.9 % (n = 5) for type B. 6-month mortality rate was 30.1 % (n = 31) for type A dissection vs 10.9 % (n = 5) for type B. Predictors of 30-day and 6-month mortality were similar to those of in-hospital mortality.
Conclusion
Even with tertiary care AAD carries a high burden of mortality. Those with type A dissections, increased age, and non-surgical management are at an increased risk of mortality.
{"title":"Factors affecting acute aortic dissection mortality: A multicentre cohort study","authors":"Joshua G. Kovoor , John M. Glynatsis , Nikolaos C. Glynatsis , Domenico Perrotta , Elyssa Chan , Timothy Daniell , Stephen Bacchi , Brandon Stretton , Daksh Tyagi , Joseph N. Hewitt , Angelyn L.W. Khong , Diana U. Siriwardena , David X.H. Ling , Christopher D. Ovenden , Rohan Arasu , Jonathan Henry W. Jacobsen , Suzanne Edwards , Matthew Marshall-Webb , Pramesh Kovoor , Benjamin A.J. Reddi , Aashray K. Gupta","doi":"10.1016/j.sipas.2025.100311","DOIUrl":"10.1016/j.sipas.2025.100311","url":null,"abstract":"<div><h3>Background</h3><div>Acute aortic dissection (AAD) is an emergency associated with high mortality. Timely diagnosis is challenging, and delays may affect patient outcomes. We aimed to identify clinical and temporal factors associated with mortality after AAD.</div></div><div><h3>Methodology</h3><div>We performed a retrospective cohort study across four tertiary hospitals of type A and type B AADs diagnosed over a 20-year period. The outcomes of the study were in-hospital mortality, 30-day mortality, and mid-term (6-month) mortality. Univariate linear and bivariate logistic regression analyses were conducted to evaluate the relationship between mortality and demographic and clinical factors.</div></div><div><h3>Results</h3><div>The study included 149 AAD patients. Of these, 103 (69.1 %) were Stanford type A and 46 (30.9 %) Stanford type B. In-hospital mortality was 29.1 % (<em>n</em> = 30) for type A vs 10.9 % (<em>n</em> = 5) for type B. For type A patients, every one-year increase in age increased odds of in-hospital mortality by 4 % (<em>p</em> = 0.0076), and odds of in-hospital mortality were 10.9 times greater with conservative management than surgical (<em>p</em> < 0.0001). Patients with type A dissection had odds of in-hospital mortality 3.0 times greater than type B (<em>p</em> = 0.0005). 30-day mortality rate was 29.1 % (<em>n</em> = 30) for type A dissection vs 10.9 % (<em>n</em> = 5) for type B. 6-month mortality rate was 30.1 % (<em>n</em> = 31) for type A dissection vs 10.9 % (<em>n</em> = 5) for type B. Predictors of 30-day and 6-month mortality were similar to those of in-hospital mortality.</div></div><div><h3>Conclusion</h3><div>Even with tertiary care AAD carries a high burden of mortality. Those with type A dissections, increased age, and non-surgical management are at an increased risk of mortality.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"23 ","pages":"Article 100311"},"PeriodicalIF":0.8,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145222057","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 : 2025-09-20DOI: 10.1016/j.sipas.2025.100309
Ibrahim Nagmeldin Hassan , Mohamed Ibrahim , Siddig Yaqub , Muhsin Ibrahim , Haythem Abdalla , Ghada Aljaili , Wafa Osman , Nagmeldin Abuassa
Background
Informed consent is a cornerstone of ethical surgical practice, yet significant challenges persist in ensuring patients' comprehension, particularly in low-resource settings. Cultural norms, literacy barriers, and limited institutional support often hinder truly informed decision-making.
Methods
A hospital-based cross-sectional study was conducted from September to December 2024 at a rural surgical center in Omdurman, Sudan. A total of 422 adult patients undergoing elective surgery were interviewed postoperatively using a validated, culturally adapted questionnaire. Descriptive and inferential statistics were applied to assess patient demographics, perceptions of the informed consent process, and associated barriers.
Results
The mean age of participants was 42.0 ± 14.3 years, with a near-equal gender distribution. Only 17.1% of patients signed their own surgical consent forms, with 80.6% of these self-signers being male. Among those whose consent was signed by relatives (82.9%), females were overrepresented (56.6%). While 91.5% recognized the importance of informed consent, only 33.6% understood its medico-legal significance. Consent explanations were predominantly delivered by residents or house officers (62.1%), and just 20.1% of patients felt that the discussion influenced their surgical decision. Self-signers were more likely to recall discussion of surgical complications (75.0% vs. 51.4%; p < 0.001), less likely to recall expected benefits (61.1% vs. 78.9%; p = 0.001), and showed no significant difference for consequences if surgery was not performed (80.6% vs. 82.9%; p = 1.0). Overall satisfaction with the consent process was high (87.7%), though this did not correlate with comprehension. Educational status significantly influenced autonomy, with illiterate participants disproportionately less likely to sign their own forms and more likely to cite language barriers and lack of information (p < 0.05).
Conclusion
Despite high reported satisfaction, substantial deficiencies exist in patients’ comprehension and autonomy in the informed consent process in Sudan. Gender disparities, literacy limitations, and systemic reliance on junior staff compromise the ethical validity of consent. Interventions tailored to cultural and educational contexts—such as provider training, simplified materials, and patient-centered communication—are urgently needed to enhance informed surgical decision-making in low-resource environments.
知情同意是外科伦理实践的基石，但在确保患者理解方面仍然存在重大挑战，特别是在资源匮乏的环境中。文化规范、识字障碍和有限的制度支持往往阻碍真正知情的决策。方法于2024年9月至12月在苏丹恩图曼的一家农村外科中心进行以医院为基础的横断面研究。共有422名接受择期手术的成年患者在术后接受了一份经过验证的、适应文化的问卷调查。描述性和推断性统计应用于评估患者人口统计学，知情同意过程的看法，以及相关的障碍。结果参与者的平均年龄为42.0±14.3岁，性别分布基本相等。只有17.1%的患者自己签署了手术同意书，其中80.6%的患者是男性。在亲属签署同意书的患者中（82.9%），女性比例过高（56.6%）。虽然91.5%的人认识到知情同意的重要性，但只有33.6%的人了解其医学-法律意义。同意解释主要由住院医生或住院医生（62.1%）提供，只有20.1%的患者认为讨论影响了他们的手术决定。自签名者更有可能回忆起手术并发症的讨论（75.0% vs. 51.4%; p < 0.001），不太可能回忆起预期的益处（61.1% vs. 78.9%; p = 0.001），如果不进行手术，其后果没有显着差异（80.6% vs. 82.9%; p = 1.0）。对同意过程的总体满意度很高（87.7%），尽管这与理解程度无关。教育程度显著影响自主性，不识字的参与者不太可能在自己的表格上签名，更有可能提到语言障碍和缺乏信息（p < 0.05）。结论尽管报告的满意度很高，但苏丹患者在知情同意过程中的理解和自主权存在实质性缺陷。性别差异、读写能力的限制以及对初级员工的系统性依赖损害了同意的道德有效性。在资源匮乏的环境中，迫切需要针对文化和教育背景的干预措施，如提供者培训、简化材料和以患者为中心的沟通，以提高知情的手术决策。
{"title":"Perceptions, practices, and barriers in surgical informed consent: A cross-sectional study from Sudan","authors":"Ibrahim Nagmeldin Hassan , Mohamed Ibrahim , Siddig Yaqub , Muhsin Ibrahim , Haythem Abdalla , Ghada Aljaili , Wafa Osman , Nagmeldin Abuassa","doi":"10.1016/j.sipas.2025.100309","DOIUrl":"10.1016/j.sipas.2025.100309","url":null,"abstract":"<div><h3>Background</h3><div>Informed consent is a cornerstone of ethical surgical practice, yet significant challenges persist in ensuring patients' comprehension, particularly in low-resource settings. Cultural norms, literacy barriers, and limited institutional support often hinder truly informed decision-making.</div></div><div><h3>Methods</h3><div>A hospital-based cross-sectional study was conducted from September to December 2024 at a rural surgical center in Omdurman, Sudan. A total of 422 adult patients undergoing elective surgery were interviewed postoperatively using a validated, culturally adapted questionnaire. Descriptive and inferential statistics were applied to assess patient demographics, perceptions of the informed consent process, and associated barriers.</div></div><div><h3>Results</h3><div>The mean age of participants was 42.0 ± 14.3 years, with a near-equal gender distribution. Only 17.1% of patients signed their own surgical consent forms, with 80.6% of these self-signers being male. Among those whose consent was signed by relatives (82.9%), females were overrepresented (56.6%). While 91.5% recognized the importance of informed consent, only 33.6% understood its medico-legal significance. Consent explanations were predominantly delivered by residents or house officers (62.1%), and just 20.1% of patients felt that the discussion influenced their surgical decision. Self-signers were more likely to recall discussion of surgical complications (75.0% vs. 51.4%; <em>p</em> < 0.001), less likely to recall expected benefits (61.1% vs. 78.9%; <em>p</em> = 0.001), and showed no significant difference for consequences if surgery was not performed (80.6% vs. 82.9%; <em>p</em> = 1.0). Overall satisfaction with the consent process was high (87.7%), though this did not correlate with comprehension. Educational status significantly influenced autonomy, with illiterate participants disproportionately less likely to sign their own forms and more likely to cite language barriers and lack of information (<em>p</em> < 0.05).</div></div><div><h3>Conclusion</h3><div>Despite high reported satisfaction, substantial deficiencies exist in patients’ comprehension and autonomy in the informed consent process in Sudan. Gender disparities, literacy limitations, and systemic reliance on junior staff compromise the ethical validity of consent. Interventions tailored to cultural and educational contexts—such as provider training, simplified materials, and patient-centered communication—are urgently needed to enhance informed surgical decision-making in low-resource environments.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"23 ","pages":"Article 100309"},"PeriodicalIF":0.8,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159829","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 : 2025-09-20DOI: 10.1016/j.sipas.2025.100310
Kevin Joseph Jacob, Mohammad Naeem Mangal, Jack W M Lamb, Ahmad Abdallatif, Keshav Mathur, Mohammed Elmajee
Introduction
Informed consent represents a cornerstone of ethical and legal surgical practice across numerous healthcare systems, including that of the United Kingdom. Despite its recognised importance, achieving consistency and comprehensiveness in the consent process remains a persistent challenge, particularly within busy and time-constrained clinical environments. This study critically evaluates existing consenting practices in the Department of Trauma and Orthopaedics at Worcestershire Acute Hospitals. It also presents the department’s experience with implementing electronic consent (e-consent) forms as a replacement for traditional handwritten documentation.
Methodology
A two-phase study was conducted at a single National Health Service (NHS) trust. In the first phase, 102 handwritten surgical consent forms were retrospectively audited against national guidelines to assess compliance in areas such as timing of consent, legibility, provision of information, and documentation of risks and alternatives. The second phase involved a structured survey of clinicians within the orthopaedic department to explore their experiences with the current process and their perceptions of electronic alternatives.
Results
The audit revealed major shortcomings in the handwritten consent process: only 21 % of forms were completed well in advance of surgery, fewer than half provided adequate procedural information, and just 17 % documented all available treatment options. Over 60 % were poorly legible, and most lacked complete documentation of risks and benefits. Survey results indicated widespread clinician dissatisfaction and a strong preference for e-consent systems to improve legibility, clarity, and patient engagement.
Conclusion
The study highlights significant deficiencies in handwritten consent practices and supports adopting standardised e-consent systems to enhance communication, patient comprehension, and medico-legal protection.
{"title":"Improving consenting practice in trauma and orthopaedics: A single centre original mixed methods study","authors":"Kevin Joseph Jacob, Mohammad Naeem Mangal, Jack W M Lamb, Ahmad Abdallatif, Keshav Mathur, Mohammed Elmajee","doi":"10.1016/j.sipas.2025.100310","DOIUrl":"10.1016/j.sipas.2025.100310","url":null,"abstract":"<div><h3>Introduction</h3><div>Informed consent represents a cornerstone of ethical and legal surgical practice across numerous healthcare systems, including that of the United Kingdom. Despite its recognised importance, achieving consistency and comprehensiveness in the consent process remains a persistent challenge, particularly within busy and time-constrained clinical environments. This study critically evaluates existing consenting practices in the Department of Trauma and Orthopaedics at Worcestershire Acute Hospitals. It also presents the department’s experience with implementing electronic consent (e-consent) forms as a replacement for traditional handwritten documentation.</div></div><div><h3>Methodology</h3><div>A two-phase study was conducted at a single National Health Service (NHS) trust. In the first phase, 102 handwritten surgical consent forms were retrospectively audited against national guidelines to assess compliance in areas such as timing of consent, legibility, provision of information, and documentation of risks and alternatives. The second phase involved a structured survey of clinicians within the orthopaedic department to explore their experiences with the current process and their perceptions of electronic alternatives.</div></div><div><h3>Results</h3><div>The audit revealed major shortcomings in the handwritten consent process: only 21 % of forms were completed well in advance of surgery, fewer than half provided adequate procedural information, and just 17 % documented all available treatment options. Over 60 % were poorly legible, and most lacked complete documentation of risks and benefits. Survey results indicated widespread clinician dissatisfaction and a strong preference for e-consent systems to improve legibility, clarity, and patient engagement.</div></div><div><h3>Conclusion</h3><div>The study highlights significant deficiencies in handwritten consent practices and supports adopting standardised e-consent systems to enhance communication, patient comprehension, and medico-legal protection.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"23 ","pages":"Article 100310"},"PeriodicalIF":0.8,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145121160","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 : 2025-09-08DOI: 10.1016/j.sipas.2025.100307
Mirza Sivro, Tarik Branković
Purpose
The aim of this study was to compare the influence of two different methods of distal screw insertion during intramedullary nailing of humeral shaft fractures on radiation exposure and operative time.
Methods
A single-center retrospective study, which included 44 patients, was conducted. Patients were divided into the Freehand and Calibration groups according to the technique used for distal screw insertion. Medical records were used to collect baseline characteristics of patients and complications, and operative reports were used to collect data for outcomes which included number of expositions, dose area product (DAP), fluoroscopy time and operation time. Operation time was defined as time from skin incision to final suture.
Results
There were no significant differences noted between the groups in gender, age, fracture side and fracture type distribution. The mean DAP in the Calibration group measured 232.8 ± 130.1 μGy·m2, and was lower than in the Freehand group where measured value was 305.4 ± 141.6 μGy·m2, without significant difference between the groups (p = 0.084). Mean fluoroscopy time was also lower in the Calibration group of patients (32.3 ± 12.7 s) than in the Freehand group (39.4 ± 14.6 s), with p = 0.094. Mean operative time was shorter in the Calibration group (68.8 ± 27.1 min) in comparison with the Freehand group (76.5 ± 17.7 min), but without statistically significant difference (p = 0.272).
Conclusion
The usage of calibration technique for distal locking screw insertion has similar operative time and intraoperative radiation exposure during intramedullary nailing of humeral shaft fractures compared with the freehand technique.
{"title":"Does calibration technique for distal locking screw insertion reduce radiation exposure and operative time during intramedullary nailing of humeral shaft fractures in comparison with freehand technique?","authors":"Mirza Sivro, Tarik Branković","doi":"10.1016/j.sipas.2025.100307","DOIUrl":"10.1016/j.sipas.2025.100307","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim of this study was to compare the influence of two different methods of distal screw insertion during intramedullary nailing of humeral shaft fractures on radiation exposure and operative time.</div></div><div><h3>Methods</h3><div>A single-center retrospective study, which included 44 patients, was conducted. Patients were divided into the Freehand and Calibration groups according to the technique used for distal screw insertion. Medical records were used to collect baseline characteristics of patients and complications, and operative reports were used to collect data for outcomes which included number of expositions, dose area product (DAP), fluoroscopy time and operation time. Operation time was defined as time from skin incision to final suture.</div></div><div><h3>Results</h3><div>There were no significant differences noted between the groups in gender, age, fracture side and fracture type distribution. The mean DAP in the Calibration group measured 232.8 ± 130.1 μGy·m2, and was lower than in the Freehand group where measured value was 305.4 ± 141.6 μGy·m2, without significant difference between the groups (<em>p</em> = 0.084). Mean fluoroscopy time was also lower in the Calibration group of patients (32.3 ± 12.7 s) than in the Freehand group (39.4 ± 14.6 s), with <em>p</em> = 0.094. Mean operative time was shorter in the Calibration group (68.8 ± 27.1 min) in comparison with the Freehand group (76.5 ± 17.7 min), but without statistically significant difference (<em>p</em> = 0.272).</div></div><div><h3>Conclusion</h3><div>The usage of calibration technique for distal locking screw insertion has similar operative time and intraoperative radiation exposure during intramedullary nailing of humeral shaft fractures compared with the freehand technique.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"23 ","pages":"Article 100307"},"PeriodicalIF":0.8,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050533","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}
Sleeve gastrectomy is one of the most commonly performed bariatric procedures worldwide, particularly in the Middle East, where obesity rates are among the highest globally. However, despite being effective for initial weight loss, a significant proportion of patients experiences weight regain after some time. We analyzed the prevalence of weight regain after sleeve gastrectomy in the Middle East and its association with patients' demographic characteristics, preoperative body mass index (BMI), and comorbidities.
Methods
A quantitative cross-sectional study conducted between 2023 and 2024 using an online questionnaire distributed via social media platforms, and through personal networks, targeted adults from Arabic-speaking Middle Eastern countries who had undergone sleeve gastrectomy 12+ months ago. Data collected included sociodemographics, medical conditions, country of residency, highest and lowest weight before and after surgery, current weight, and time required to reach lowest weight after surgery.
Result
Among 225 participants, mean BMI dropped in 1 year from 43.8 to 28.7. Younger patients achieved higher excess weight loss compared to those >45 years old (74.1% vs 61.2 %). the average was 72.9 % at 12 months after the surgery, but declined to 66.6 % as time progressed. While 22.7 % were still losing weight and 31.8 % maintained their weight 12 months postoperatively, weight regain was observed in 45.5 % and was higher in those >45 years old.
Conclusion
Despite favorable short-term outcomes, around half of the patients experienced weight regain within the first year, which was shown to be correlated with older age group, while preoperative BMI and gender showed no significant impact. These findings highlight the multifactorial nature of weight regain and emphasize the need for long-term follow-up. Conducting future studies with a larger population and longer follow up periods is expected to gain more accurate results.
{"title":"The prevalence of weight regain after sleeve gastrectomy in the middle east","authors":"Raad Dowais , Nour Shatnawe, Sondos Ahmad, Alaa Hayajneh, Amneh Abu-Asbeh, Dania Odat, Batool Jaradat","doi":"10.1016/j.sipas.2025.100306","DOIUrl":"10.1016/j.sipas.2025.100306","url":null,"abstract":"<div><h3>Background</h3><div>Sleeve gastrectomy is one of the most commonly performed bariatric procedures worldwide, particularly in the Middle East, where obesity rates are among the highest globally. However, despite being effective for initial weight loss, a significant proportion of patients experiences weight regain after some time<strong>.</strong> We analyzed the prevalence of weight regain after sleeve gastrectomy in the Middle East and its association with patients' demographic characteristics, preoperative body mass index (BMI), and comorbidities.</div></div><div><h3>Methods</h3><div>A quantitative cross-sectional study conducted between 2023 and 2024 using an online questionnaire distributed via social media platforms, and through personal networks, targeted adults from Arabic-speaking Middle Eastern countries who had undergone sleeve gastrectomy 12+ months ago. Data collected included sociodemographics, medical conditions, country of residency, highest and lowest weight before and after surgery, current weight, and time required to reach lowest weight after surgery.</div></div><div><h3>Result</h3><div>Among 225 participants, mean BMI dropped in 1 year from 43.8 to 28.7. Younger patients achieved higher excess weight loss compared to those >45 years old (74.1% vs 61.2 %). the average was 72.9 % at 12 months after the surgery, but declined to 66.6 % as time progressed. While 22.7 % were still losing weight and 31.8 % maintained their weight 12 months postoperatively, weight regain was observed in 45.5 % and was higher in those >45 years old.</div></div><div><h3>Conclusion</h3><div>Despite favorable short-term outcomes, around half of the patients experienced weight regain within the first year, which was shown to be correlated with older age group, while preoperative BMI and gender showed no significant impact. These findings highlight the multifactorial nature of weight regain and emphasize the need for long-term follow-up. Conducting future studies with a larger population and longer follow up periods is expected to gain more accurate results.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"22 ","pages":"Article 100306"},"PeriodicalIF":0.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145026350","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 : 2025-09-01DOI: 10.1016/j.sipas.2025.100291
Jorg Kleeff, Artur Rebelo
{"title":"Major Milestones for Surgery in Practice and Science","authors":"Jorg Kleeff, Artur Rebelo","doi":"10.1016/j.sipas.2025.100291","DOIUrl":"10.1016/j.sipas.2025.100291","url":null,"abstract":"","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"22 ","pages":"Article 100291"},"PeriodicalIF":0.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145094732","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 : 2025-08-31DOI: 10.1016/j.sipas.2025.100305
Ramiro Fernández-Placencia , Francisco Berrospi , Carlos Luque-Vásquez , Eduarda Bustamante , Néstor Sánchez , Eloy Ruiz , Vanesa Huamán , Eduardo Payet , Juan Celis
Background
Vascular resection and reconstruction during pancreatic surgery has become increasingly common in high-volume centers. However, the impact of intraoperative vascular events and complex venous reconstructions on severe morbidity remains understudied.
Methods
We conducted a retrospective cohort study including 77 patients who underwent pancreatic resection with vascular reconstruction at a high-volume tertiary care center between January 2010 and December 2024. Perioperative factors were evaluated through univariate and multivariate analyses.
Results
Intraoperative events occurred in 25 % of the patients; severe morbidity (≥ IIIb according to the Clavien–Dindo classification) was observed in 31 %, and the mortality rate was 3.9 %. Severe morbidity was significantly influenced by intraoperative events (OR=4.3, 95 % CI 1.3–14.6, p = 0.016) and type 4 venous reconstruction (OR=12.7, 95 % CI 1.5–280, p = 0.037). Despite the increasing proportion of type 3 and type 4 venous reconstructions performed over the years, the rates of severe morbidity have remained stable. A notable improvement in the R0 resection rate for pancreatic ductal adenocarcinoma was observed after 2019, with a significant shift toward more complex venous reconstructions.
Conclusion
Intraoperative events and type 4 venous reconstruction significantly increase the risk of severe morbidity in pancreatic surgery. These findings underscore the importance of surgical planning, expertise in vascular procedures, and multidisciplinary care to improve outcomes.
背景：胰腺手术中血管切除和重建在大容量中心越来越普遍。然而，术中血管事件和复杂静脉重建对严重并发症的影响仍未得到充分研究。方法：我们进行了一项回顾性队列研究，包括2010年1月至2024年12月在一家大容量三级医疗中心接受胰腺切除术和血管重建的77例患者。通过单因素和多因素分析评估围手术期因素。结果术中事件发生率为25%；重度发病（按Clavien-Dindo分级≥IIIb）占31%，死亡率为3.9%。术中事件（OR=4.3, 95% CI 1.3 ~ 14.6, p = 0.016）和4型静脉重建（OR=12.7, 95% CI 1.5 ~ 280, p = 0.037）显著影响重症发病率。尽管近年来进行的3型和4型静脉重建的比例不断增加，但严重发病率保持稳定。2019年之后，胰腺导管腺癌的R0切除率显著提高，并向更复杂的静脉重建方向转变。结论术中事件和4型静脉重建明显增加胰腺手术严重并发症的发生风险。这些发现强调了手术计划、血管手术专业知识和多学科护理对改善预后的重要性。
{"title":"Severe morbidity following pancreatectomy with vascular reconstruction: impact of intraoperative vascular events and grafted venous reconstructions","authors":"Ramiro Fernández-Placencia , Francisco Berrospi , Carlos Luque-Vásquez , Eduarda Bustamante , Néstor Sánchez , Eloy Ruiz , Vanesa Huamán , Eduardo Payet , Juan Celis","doi":"10.1016/j.sipas.2025.100305","DOIUrl":"10.1016/j.sipas.2025.100305","url":null,"abstract":"<div><h3>Background</h3><div>Vascular resection and reconstruction during pancreatic surgery has become increasingly common in high-volume centers. However, the impact of intraoperative vascular events and complex venous reconstructions on severe morbidity remains understudied.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study including 77 patients who underwent pancreatic resection with vascular reconstruction at a high-volume tertiary care center between January 2010 and December 2024. Perioperative factors were evaluated through univariate and multivariate analyses.</div></div><div><h3>Results</h3><div>Intraoperative events occurred in 25 % of the patients; severe morbidity (≥ IIIb according to the Clavien–Dindo classification) was observed in 31 %, and the mortality rate was 3.9 %. Severe morbidity was significantly influenced by intraoperative events (OR=4.3, 95 % CI 1.3–14.6, <em>p</em> = 0.016) and type 4 venous reconstruction (OR=12.7, 95 % CI 1.5–280, <em>p</em> = 0.037). Despite the increasing proportion of type 3 and type 4 venous reconstructions performed over the years, the rates of severe morbidity have remained stable. A notable improvement in the R0 resection rate for pancreatic ductal adenocarcinoma was observed after 2019, with a significant shift toward more complex venous reconstructions.</div></div><div><h3>Conclusion</h3><div>Intraoperative events and type 4 venous reconstruction significantly increase the risk of severe morbidity in pancreatic surgery. These findings underscore the importance of surgical planning, expertise in vascular procedures, and multidisciplinary care to improve outcomes.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"23 ","pages":"Article 100305"},"PeriodicalIF":0.8,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050532","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}
{"title":"Letter to Editor on “Functional and radiological outcomes following sacroiliac screw fixation of posterior pelvic ring injuries: A retrospective study”","authors":"Dr․Parth Aphale , Himanshu Shekhar , Shashank Dokania","doi":"10.1016/j.sipas.2025.100304","DOIUrl":"10.1016/j.sipas.2025.100304","url":null,"abstract":"","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"22 ","pages":"Article 100304"},"PeriodicalIF":0.8,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144885609","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 : 2025-08-18DOI: 10.1016/j.sipas.2025.100303
Hui Peng , Yunxian Xian , Jie Zhang
Objective
To evaluate the effectiveness of BS in improving UI among elderly obese women and compare it to pelvic floor muscle exercises (PFME).
Methods
This retrospective case-control study included 46 women diagnosed with UI, all patients underwent laparoscopic sleeve gastrectomy. These patients were compared to a matched cohort of 46 women who performed PFME and 92 control women who received no intervention. The primary outcome was assessed using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Secondary outcomes included UI rehabilitation and sleep quality, measured by the Pittsburgh Sleep Quality Index (PSQI). Statistical analyses included univariate and multivariate logistic regression.
Results
Both the BS and PFME groups showed significant improvements in UI and sleep quality compared to the control group. The PFME group had the best UI outcomes, with most participants reporting ICIQ-SF scores between 1 and 7 at 12 months. The BS group reported scores between 7.1 and 14, while the control group had scores mostly above 14.1. Postoperative complications, particularly diarrhea, significantly impacted the effectiveness of UI improvement in the BS group.
Conclusion
Bariatric surgery can effectively improve UI in elderly obese women, although its impact is not as significant as PFME. Postoperative diarrhea is a risk factor that reduces the effectiveness of UI improvement after BS. Further research through multicenter, long-term, large-scale randomized controlled trials is recommended to validate these findings and explore the relationship between mental and physical conditions and UI improvement post-BS.
{"title":"Comparison of the effects of bariatric surgery and pelvic floor muscle training on urinary incontinence in elderly women with obesity","authors":"Hui Peng , Yunxian Xian , Jie Zhang","doi":"10.1016/j.sipas.2025.100303","DOIUrl":"10.1016/j.sipas.2025.100303","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the effectiveness of BS in improving UI among elderly obese women and compare it to pelvic floor muscle exercises (PFME).</div></div><div><h3>Methods</h3><div>This retrospective case-control study included 46 women diagnosed with UI, all patients underwent laparoscopic sleeve gastrectomy. These patients were compared to a matched cohort of 46 women who performed PFME and 92 control women who received no intervention. The primary outcome was assessed using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Secondary outcomes included UI rehabilitation and sleep quality, measured by the Pittsburgh Sleep Quality Index (PSQI). Statistical analyses included univariate and multivariate logistic regression.</div></div><div><h3>Results</h3><div>Both the BS and PFME groups showed significant improvements in UI and sleep quality compared to the control group. The PFME group had the best UI outcomes, with most participants reporting ICIQ-SF scores between 1 and 7 at 12 months. The BS group reported scores between 7.1 and 14, while the control group had scores mostly above 14.1. Postoperative complications, particularly diarrhea, significantly impacted the effectiveness of UI improvement in the BS group.</div></div><div><h3>Conclusion</h3><div>Bariatric surgery can effectively improve UI in elderly obese women, although its impact is not as significant as PFME. Postoperative diarrhea is a risk factor that reduces the effectiveness of UI improvement after BS. Further research through multicenter, long-term, large-scale randomized controlled trials is recommended to validate these findings and explore the relationship between mental and physical conditions and UI improvement post-BS.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"22 ","pages":"Article 100303"},"PeriodicalIF":0.8,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144892231","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}
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