Totally implantable venous central access devices (TIVADs) can be implanted by open surgery or by direct puncture in the subclavian (ScV), internal jugular (IJV) or cephalic (CephV) veins.
Methods
A retrospective study was conducted in 201 patients. Thirty-day follow-up data was analyzed to compare the outcomes of different techniques and evaluation of risk factors.
Results
Complications were reported in 3.8 % of the patients with no overall differences between different vascular accesses. Direct puncture was associated with more accidental arterial punction (p = 0.01). History of previous catheters was a risk factor for immediate complications (p = 0.01) and patients with history of thoracic disease had more early and late complications (p = 0.03 and p = 0.04, respectively). Late complications were more common in patients over 60 years old (p = 0.04) and with chronic pain (p = 0.03).
Conclusion
There was no difference in overall complication rates between the implantation techniques. Further prospective randomized controlled trials would clarify the most effective technique.
背景可通过开放手术或直接穿刺锁骨下静脉（ScV）、颈内静脉（IJV）或头静脉（CephV）植入全植入式中央静脉通路装置（TIVAD）。结果3.8%的患者出现并发症，不同血管通路之间总体上没有差异。直接穿刺与更多的意外动脉穿刺有关（p = 0.01）。曾使用过导管是导致即刻并发症的一个风险因素（p = 0.01），而有胸腔疾病史的患者有更多的早期和晚期并发症（分别为 p = 0.03 和 p = 0.04）。结论两种植入技术的总体并发症发生率没有差异。进一步的前瞻性随机对照试验将明确最有效的技术。
{"title":"Totally implantable venous access devices: A restrospective analysis of morbidity and risk factors in a hospital with multi-technique approaches","authors":"Diogo Melo-Pinto , Tatiana Moreira-Marques , Emanuel Guerreiro , Marina Morais","doi":"10.1016/j.sipas.2024.100237","DOIUrl":"10.1016/j.sipas.2024.100237","url":null,"abstract":"<div><h3>Background</h3><p>Totally implantable venous central access devices (TIVADs) can be implanted by open surgery or by direct puncture in the subclavian (ScV), internal jugular (IJV) or cephalic (CephV) veins.</p></div><div><h3>Methods</h3><p>A retrospective study was conducted in 201 patients. Thirty-day follow-up data was analyzed to compare the outcomes of different techniques and evaluation of risk factors.</p></div><div><h3>Results</h3><p>Complications were reported in 3.8 % of the patients with no overall differences between different vascular accesses. Direct puncture was associated with more accidental arterial punction (<em>p</em> = 0.01). History of previous catheters was a risk factor for immediate complications (<em>p</em> = 0.01) and patients with history of thoracic disease had more early and late complications (<em>p</em> = 0.03 and <em>p</em> = 0.04, respectively). Late complications were more common in patients over 60 years old (<em>p</em> = 0.04) and with chronic pain (<em>p</em> = 0.03).</p></div><div><h3>Conclusion</h3><p>There was no difference in overall complication rates between the implantation techniques. Further prospective randomized controlled trials would clarify the most effective technique.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"16 ","pages":"Article 100237"},"PeriodicalIF":0.0,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000044/pdfft?md5=4a2c892ebed4924920e701b37020f8a4&pid=1-s2.0-S2666262024000044-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139823048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-06DOI: 10.1016/j.sipas.2024.100236
John C. Johnson , Trine Engebretsen , Muhammad Mujtaba , Heather L Stevenson , Rupak Kulkarni , A. Scott Lea , Akshata Moghe , Syed Hussain , Michael Kueht
Introduction
In renal transplantation, donor hepatitis C virus (HCV) status is crucial to consider when selecting a recipient given the high likelihood of transmission. We analyzed the effect of donor HCV status on post-renal transplant rejection and virologic infectious outcomes using electronic health record data from multiple US health care organizations.
Methods
Using real world data from electronic health records of renal transplant recipients, a propensity score-matched case-control study of one-year renal transplant outcomes was conducted on cohorts of HCV-negative recipients who received an organ from an HCV-positive donor (HCV D+/R-) versus from an HCV-negative donor (HCV D-/R-). Donor HCV positivity was defined as new recipient HCV positivity within 30 days post-transplant. Cohorts were matched by major risk factors for rejection including age, gender, race, etiologies of end-stage renal disease, dialysis dependence, donor type, induction immunosuppression, and virologic lab studies. The primary outcome was one-year incidence of rejection. Secondary outcomes included longitudinal measures of liver and kidney function, incidence of non-HCV viremia, and DAA treatment pathways and responses.
Results
Data from 900 renal transplant recipients were analyzed, 450 subjects per group (D+/R-, D-/R-). Mean age at transplant was 57.1 ± 11.9 years, 60 % were male, and 38 % were African American. Kaplan-Meier analysis showed a significantly increased incidence of one-year rejection for HCV D-/R- compared to HCV D+/R- (16.6% vs 22.8 %, p = 0.02). This difference did not persist on a sub-analysis excluding subjects with delayed graft function (DGF) (16.3% vs 19.2 %, p = 0.25). Although mean eGFR was initially higher in HCV D+/R-, there were no significant differences in liver or kidney allograft function at 12 months. There was no significant difference for composite viremia (CMV/EBV/BK; 37.66% vs 31.60 %, p = 0.07). The most common DAA regimen was glecaprevir/pibrentasvir (52.8 %). DAA treatment responses were excellent, with most subjects having a negative viral load by 90 days (mean: 1.7 ± 1.9 log units/mL).
Conclusion
Donor HCV positivity did not negatively impact one-year rejection outcomes post-renal transplantation. Importantly, this effect was not biased by age. Anti-HCV treatment was effective and liver and kidney function were excellent at one-year post-transplant. These data support the continued expansion of the donor pool by utilizing organs from HCV-positive donors in the era of anti-HCV direct-acting antiviral therapies.
{"title":"Donor hepatitis C status is not associated with an increased risk of acute rejection in kidney transplantation","authors":"John C. Johnson , Trine Engebretsen , Muhammad Mujtaba , Heather L Stevenson , Rupak Kulkarni , A. Scott Lea , Akshata Moghe , Syed Hussain , Michael Kueht","doi":"10.1016/j.sipas.2024.100236","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100236","url":null,"abstract":"<div><h3>Introduction</h3><p>In renal transplantation, donor hepatitis C virus (HCV) status is crucial to consider when selecting a recipient given the high likelihood of transmission. We analyzed the effect of donor HCV status on post-renal transplant rejection and virologic infectious outcomes using electronic health record data from multiple US health care organizations.</p></div><div><h3>Methods</h3><p>Using real world data from electronic health records of renal transplant recipients, a propensity score-matched case-control study of one-year renal transplant outcomes was conducted on cohorts of HCV-negative recipients who received an organ from an HCV-positive donor (HCV D+/R-) versus from an HCV-negative donor (HCV D-/R-). Donor HCV positivity was defined as new recipient HCV positivity within 30 days post-transplant. Cohorts were matched by major risk factors for rejection including age, gender, race, etiologies of end-stage renal disease, dialysis dependence, donor type, induction immunosuppression, and virologic lab studies. The primary outcome was one-year incidence of rejection. Secondary outcomes included longitudinal measures of liver and kidney function, incidence of non-HCV viremia, and DAA treatment pathways and responses.</p></div><div><h3>Results</h3><p>Data from 900 renal transplant recipients were analyzed, 450 subjects per group (D+/R-, <span>D</span>-/R-). Mean age at transplant was 57.1 ± 11.9 years, 60 % were male, and 38 % were African American. Kaplan-Meier analysis showed a significantly increased incidence of one-year rejection for HCV <span>D</span>-/R- compared to HCV D+/R- (16.6% vs 22.8 %, <em>p</em> = 0.02). This difference did not persist on a sub-analysis excluding subjects with delayed graft function (DGF) (16.3% vs 19.2 %, <em>p</em> = 0.25). Although mean eGFR was initially higher in HCV D+/R-, there were no significant differences in liver or kidney allograft function at 12 months. There was no significant difference for composite viremia (CMV/EBV/BK; 37.66% vs 31.60 %, <em>p</em> = 0.07). The most common DAA regimen was glecaprevir/pibrentasvir (52.8 %). DAA treatment responses were excellent, with most subjects having a negative viral load by 90 days (mean: 1.7 ± 1.9 log units/mL).</p></div><div><h3>Conclusion</h3><p>Donor HCV positivity did not negatively impact one-year rejection outcomes post-renal transplantation. Importantly, this effect was not biased by age. Anti-HCV treatment was effective and liver and kidney function were excellent at one-year post-transplant. These data support the continued expansion of the donor pool by utilizing organs from HCV-positive donors in the era of anti-HCV direct-acting antiviral therapies.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"16 ","pages":"Article 100236"},"PeriodicalIF":0.0,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000032/pdfft?md5=6c27ad30bf0f26896a955d37f73b7c63&pid=1-s2.0-S2666262024000032-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139718263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-23DOI: 10.1016/j.sipas.2024.100235
Anne P. Ehlers , Alex K. Hallway , Sean M. O'Neill , Brian T. Fry , Ryan A. Howard , Jenny M. Shao , Michael J. Englesbe , Justin B Dimick , Dana A Telem , Grace J Kim
Introduction
Repair of midsize (4–6 cm) ventral hernias is challenging given lack of guidelines. Within this context, we sought to characterize surgical approach among patients undergoing repair of midsize ventral hernias within the only population-level, clinically-nuanced hernia registry in the US.
Methods
Retrospective cohort study of patients undergoing ventral hernia repair in the Michigan Surgical Quality Collaborative Core Optimization Hernia Registry (MSQCCOHR). MSQCCOHR is the only US population-level registry that captures clinically-nuanced data pertaining to patient hernia characteristics. We included patients who underwent repair of a 4–6 cm hernia from January 1, 2020-June 30, 2022. We stratified repair type as open or minimally invasive and used a multivariable logistic regression model to identify factors associated with MIS approach. Secondary outcomes included complications rate.
Results
Among 771 patients, mean hernia width (SD) was 4.7 cm (0.8) and 339 (44 %) underwent MIS approach. Patients with MIS approach had lower BMI (33.5 vs 34.8, p = 0.02) and less often were ASA class III (47.5% vs 54.6 %, p = 0.02) or ASA class IV (2.4% vs 4.2 %, p = 0.02). MIS approach was associated with smaller mean hernia width (4.71 cm vs 4.84 cm, p = 0.02) and was used more often in the elective setting (94.4% vs 84.0 %, p < 0.01). In the multivariable logistic regression model, higher BMI (aOR 0.97, 95 % CI 0.94–0.99) and urgent/emergent surgery (aOR 0.43, 95 % CI 0.24–0.79) were associated with lower odds of MIS. We found no significant association between MIS and risk of complications (aOR 0.62, 95 % CI 0.37–1.04). Among patients undergoing MIS, more than half (n = 236, 69.6 %) had a robotic approach but there were few patient factors associated with this.
Conclusion
Among patients with midsize hernias, few patient-level factors are associated with approach. This may indicate that surgeon preference factors largely into this decision.
导言：由于缺乏相关指南，中型（4-6 厘米）腹股沟疝的修补具有挑战性。在这种情况下，我们试图在美国唯一的人口级临床平衡疝气登记处对接受中型腹股沟疝修补术的患者的手术方法进行特征分析。方法对密歇根州外科质量协作核心优化疝气登记处（MSQCCOHR）中接受腹股沟疝修补术的患者进行回顾性队列研究。MSQCCOHR 是美国唯一的人口级注册机构，可获取与患者疝气特征相关的临床平衡数据。我们纳入了 2020 年 1 月 1 日至 2022 年 6 月 30 日期间接受 4-6 厘米疝修补术的患者。我们将修复类型分为开放式和微创式，并使用多变量逻辑回归模型确定与微创式方法相关的因素。结果771名患者中，疝的平均宽度（标清）为4.7厘米（0.8），339人（44%）接受了MIS方法。采用 MIS 方法的患者体重指数较低（33.5 vs 34.8，P = 0.02），ASA III 级（47.5% vs 54.6%，P = 0.02）或 ASA IV 级（2.4% vs 4.2%，P = 0.02）的患者较少。MIS 方法与疝的平均宽度较小（4.71 厘米 vs 4.84 厘米，p = 0.02）有关，且更多用于择期手术（94.4% vs 84.0%，p <0.01）。在多变量逻辑回归模型中，较高的体重指数（aOR 0.97，95 % CI 0.94-0.99）和紧急/急诊手术（aOR 0.43，95 % CI 0.24-0.79）与较低的 MIS 几率相关。我们发现 MIS 与并发症风险（aOR 0.62，95 % CI 0.37-1.04）之间无明显关联。在接受 MIS 的患者中，半数以上（n = 236，69.6%）采用了机器人手术方法，但与此相关的患者因素很少。结论在中型疝气患者中，患者层面的因素很少与手术方式相关，这可能表明外科医生的偏好在很大程度上影响了患者的决定。
{"title":"Variation in approach for midsize (4-6cm) ventral hernias across a statewide quality improvement collaborative","authors":"Anne P. Ehlers , Alex K. Hallway , Sean M. O'Neill , Brian T. Fry , Ryan A. Howard , Jenny M. Shao , Michael J. Englesbe , Justin B Dimick , Dana A Telem , Grace J Kim","doi":"10.1016/j.sipas.2024.100235","DOIUrl":"10.1016/j.sipas.2024.100235","url":null,"abstract":"<div><h3>Introduction</h3><p>Repair of midsize (4–6 cm) ventral hernias is challenging given lack of guidelines. Within this context, we sought to characterize surgical approach among patients undergoing repair of midsize ventral hernias within the only population-level, clinically-nuanced hernia registry in the US.</p></div><div><h3>Methods</h3><p>Retrospective cohort study of patients undergoing ventral hernia repair in the Michigan Surgical Quality Collaborative Core Optimization Hernia Registry (MSQC<img>COHR). MSQC<img>COHR is the only US population-level registry that captures clinically-nuanced data pertaining to patient hernia characteristics. We included patients who underwent repair of a 4–6 cm hernia from January 1, 2020-June 30, 2022. We stratified repair type as open or minimally invasive and used a multivariable logistic regression model to identify factors associated with MIS approach. Secondary outcomes included complications rate.</p></div><div><h3>Results</h3><p>Among 771 patients, mean hernia width (SD) was 4.7 cm (0.8) and 339 (44 %) underwent MIS approach. Patients with MIS approach had lower BMI (33.5 vs 34.8, <em>p</em> = 0.02) and less often were ASA class III (47.5% vs 54.6 %, <em>p</em> = 0.02) or ASA class IV (2.4% vs 4.2 %, <em>p</em> = 0.02). MIS approach was associated with smaller mean hernia width (4.71 cm vs 4.84 cm, <em>p</em> = 0.02) and was used more often in the elective setting (94.4% vs 84.0 %, <em>p</em> < 0.01). In the multivariable logistic regression model, higher BMI (aOR 0.97, 95 % CI 0.94–0.99) and urgent/emergent surgery (aOR 0.43, 95 % CI 0.24–0.79) were associated with lower odds of MIS. We found no significant association between MIS and risk of complications (aOR 0.62, 95 % CI 0.37–1.04). Among patients undergoing MIS, more than half (<em>n</em> = 236, 69.6 %) had a robotic approach but there were few patient factors associated with this.</p></div><div><h3>Conclusion</h3><p>Among patients with midsize hernias, few patient-level factors are associated with approach. This may indicate that surgeon preference factors largely into this decision.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"16 ","pages":"Article 100235"},"PeriodicalIF":0.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000020/pdfft?md5=61bbd733875b6999ed02afb740eb4712&pid=1-s2.0-S2666262024000020-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139635958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-10DOI: 10.1016/j.sipas.2024.100234
Joshua G. Kovoor , Stephen Bacchi , Brandon Stretton , Aashray K. Gupta , Jonathan Henry W. Jacobsen , Minh-Son To , Rudy Goh , Joseph N. Hewitt , Christopher D. Ovenden , Leigh Warren , Matthew Marshall-Webb , Karen L. Jones , Benjamin A. Reddi , Danny Liew , Christopher Dobbins , Robert T. Padbury , Peter J. Hewett , Thomas J. Hugh , Markus I. Trochsler , Guy J. Maddern
Introduction
Reference ranges for determining pathological versus normal postoperative return of bowel function are not well characterised for general surgery patients. This study aimed to characterise time to first postoperative passage of stool after general surgery; determine associations between clinical factors and delayed time to first postoperative stool; and evaluate the association between delay to first postoperative stool and prolonged length of hospital stay.
Methods
This study included consecutive admissions at two tertiary hospitals across a two-year period whom underwent a range of general surgery operations. Multivariable logistic regression analyses were conducted to determine associations between the explanatory variables and delayed first postoperative stool, and between delayed first postoperative stool and length of hospital stay. The previously specified explanatory variables were used, with the addition of the dichotomised ≥4-day delay to first postoperative stool. Prolonged length of hospital stay was considered ≥7 days.
Results
2,212 general surgery patients were included. Median time to first postoperative stool was 2.28 (IQR 1.06–3.96). Median length of stay was 7.19 (IQR 4.50–12.01). Several operative characteristics and medication exposures were associated with delayed first postoperative stool. There was a statistically significant association between delayed first postoperative stool (≥4 days) and prolonged length of stay (≥7 days) (OR 4.34, 95 %CI 3.27 to 5.77, p < 0.001).
Conclusions
This study characterised expected reference ranges for time to return of bowel function across various general surgery operations and determined associations with clinical factors that may improve efficiency and identification of pathology within the postoperative course.
{"title":"Delayed return of bowel function after general surgery in South Australia","authors":"Joshua G. Kovoor , Stephen Bacchi , Brandon Stretton , Aashray K. Gupta , Jonathan Henry W. Jacobsen , Minh-Son To , Rudy Goh , Joseph N. Hewitt , Christopher D. Ovenden , Leigh Warren , Matthew Marshall-Webb , Karen L. Jones , Benjamin A. Reddi , Danny Liew , Christopher Dobbins , Robert T. Padbury , Peter J. Hewett , Thomas J. Hugh , Markus I. Trochsler , Guy J. Maddern","doi":"10.1016/j.sipas.2024.100234","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100234","url":null,"abstract":"<div><h3>Introduction</h3><p>Reference ranges for determining pathological versus normal postoperative return of bowel function are not well characterised for general surgery patients. This study aimed to characterise time to first postoperative passage of stool after general surgery; determine associations between clinical factors and delayed time to first postoperative stool; and evaluate the association between delay to first postoperative stool and prolonged length of hospital stay.</p></div><div><h3>Methods</h3><p>This study included consecutive admissions at two tertiary hospitals across a two-year period whom underwent a range of general surgery operations. Multivariable logistic regression analyses were conducted to determine associations between the explanatory variables and delayed first postoperative stool, and between delayed first postoperative stool and length of hospital stay. The previously specified explanatory variables were used, with the addition of the dichotomised ≥4-day delay to first postoperative stool. Prolonged length of hospital stay was considered ≥7 days.</p></div><div><h3>Results</h3><p>2,212 general surgery patients were included. Median time to first postoperative stool was 2.28 (IQR 1.06–3.96). Median length of stay was 7.19 (IQR 4.50–12.01). Several operative characteristics and medication exposures were associated with delayed first postoperative stool. There was a statistically significant association between delayed first postoperative stool (≥4 days) and prolonged length of stay (≥7 days) (OR 4.34, 95 %CI 3.27 to 5.77, <em>p</em> < 0.001).</p></div><div><h3>Conclusions</h3><p>This study characterised expected reference ranges for time to return of bowel function across various general surgery operations and determined associations with clinical factors that may improve efficiency and identification of pathology within the postoperative course.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"16 ","pages":"Article 100234"},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000019/pdfft?md5=cdaebfe647c445c684835b5ed7869716&pid=1-s2.0-S2666262024000019-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139434624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-24DOI: 10.1016/j.sipas.2023.100233
Taylor N. Harris , Eric G. Johnson , Aric Schadler , Jitesh Patel , Ekaterina Fain , Laura M. Ebbitt
Introduction
Neuromuscular blockers (NMB) are used in surgical procedures to facilitate muscle relaxation and intubation. NMBs are then reversed at the end of the surgery with either an acetylcholinesterase inhibitor, such as neostigmine, or a modified cyclodextrin compound, such as sugammadex. Neostigmine and glycopyrrolate elicit counteracting cholinergic effects, potentially impairing postoperative gastrointestinal motility. This may have higher significance in colorectal surgery procedures given the baseline risk of delayed postoperative motility associated with some operations.
Methods
This is a retrospective, single-center, cohort review of open colorectal procedures that received either sugammadex alone, or neostigmine with glycopyrrolate. The primary outcome was time from end of colorectal procedure to time of first bowel movement. Secondary outcomes included incidence of postoperatively placed nasogastric tubes, nausea and vomiting, need for motility agents or TPN, hospital length of stay, 30-day hospital readmission or return to emergency department (ED).
Results
A total of 99 patients were included in the sugammadex group and 350 in the neostigmine + glycopyrrolate group. Time to first bowel movement was significantly faster in the sugammadex group (61.7 h) compared to the neostigmine group (71.9 h) (p = 0.03). Secondary outcomes were similar between the two groups, except for a higher incidence of postoperative nausea and vomiting in the sugammadex group (p = 0.04).
Discussion
These findings support that sugammadex may be utilized for open colorectal procedures to aid in earlier discharge which could lead to differences in length of stay. Using sugammadex did not result in patients requiring additional interventions or experiencing symptoms of post-operative ileus.
Conclusion
Compared to neostigmine and glycopyrrolate, patients receiving sugammadex for neuromuscular blockade reversal in open colorectal procedures experienced a shorter time to return of bowel function. The results from this study confirm the findings from previous retrospective studies that were conducted.
{"title":"A retrospective cohort study of the effect of sugammadex versus neostigmine on postoperative gastrointestinal motility in open colorectal surgical procedures","authors":"Taylor N. Harris , Eric G. Johnson , Aric Schadler , Jitesh Patel , Ekaterina Fain , Laura M. Ebbitt","doi":"10.1016/j.sipas.2023.100233","DOIUrl":"https://doi.org/10.1016/j.sipas.2023.100233","url":null,"abstract":"<div><h3>Introduction</h3><p>Neuromuscular blockers (NMB) are used in surgical procedures to facilitate muscle relaxation and intubation. NMBs are then reversed at the end of the surgery with either an acetylcholinesterase inhibitor, such as neostigmine, or a modified cyclodextrin compound, such as sugammadex. Neostigmine and glycopyrrolate elicit counteracting cholinergic effects, potentially impairing postoperative gastrointestinal motility. This may have higher significance in colorectal surgery procedures given the baseline risk of delayed postoperative motility associated with some operations.</p></div><div><h3>Methods</h3><p>This is a retrospective, single-center, cohort review of open colorectal procedures that received either sugammadex alone, or neostigmine with glycopyrrolate. The primary outcome was time from end of colorectal procedure to time of first bowel movement. Secondary outcomes included incidence of postoperatively placed nasogastric tubes, nausea and vomiting, need for motility agents or TPN, hospital length of stay, 30-day hospital readmission or return to emergency department (ED).</p></div><div><h3>Results</h3><p>A total of 99 patients were included in the sugammadex group and 350 in the neostigmine + glycopyrrolate group. Time to first bowel movement was significantly faster in the sugammadex group (61.7 h) compared to the neostigmine group (71.9 h) (<em>p</em> = 0.03). Secondary outcomes were similar between the two groups, except for a higher incidence of postoperative nausea and vomiting in the sugammadex group (<em>p</em> = 0.04).</p></div><div><h3>Discussion</h3><p>These findings support that sugammadex may be utilized for open colorectal procedures to aid in earlier discharge which could lead to differences in length of stay. Using sugammadex did not result in patients requiring additional interventions or experiencing symptoms of post-operative ileus.</p></div><div><h3>Conclusion</h3><p>Compared to neostigmine and glycopyrrolate, patients receiving sugammadex for neuromuscular blockade reversal in open colorectal procedures experienced a shorter time to return of bowel function. The results from this study confirm the findings from previous retrospective studies that were conducted.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"16 ","pages":"Article 100233"},"PeriodicalIF":0.0,"publicationDate":"2023-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262023000797/pdfft?md5=a5a7b22dd1a4bea616ea77d980ee166d&pid=1-s2.0-S2666262023000797-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139099849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-21DOI: 10.1016/j.sipas.2023.100232
Kendall J. Tucker , YoungYoon Ham , Haley K. Holmer , Caitlin M. McCracken , Ellie Sukerman , James S. Lewis II , Jessina C. McGregor
Background
Beta-lactam antibiotics are first-line agents for most patients receiving antimicrobial prophylaxis in surgical procedures. Despite evidence showing low cross-reactivity between penicillins and cephalosporins, patients with beta-lactam allergies commonly receive vancomycin as an alternative to avoid allergic reaction.
Methods
Adult patients receiving vancomycin for surgical prophylaxis with a reported beta-lactam allergy at our institution between August 2017 to July 2018 were retrospectively evaluated for potential eligibility for penicillin allergy testing and/or receipt of standard prophylaxis.
Results
Among 830 patients who received vancomycin for surgical prophylaxis, 196 reported beta-lactam allergy and were included in the analysis. Approximately 40 % of surgeries were orthopedic. Of patients receiving vancomycin as first-line therapy, 189 (96.4 %) were potentially eligible for beta-lactam prophylaxis.
Conclusions
Patients with beta-lactam allergies often qualify for receipt of a first-line antibiotic. An opportunity exists for improved allergy assessment as an antimicrobial stewardship intervention in surgical prophylaxis.
{"title":"Utility of beta-lactam allergy assessment in patients receiving vancomycin for surgical prophylaxis","authors":"Kendall J. Tucker , YoungYoon Ham , Haley K. Holmer , Caitlin M. McCracken , Ellie Sukerman , James S. Lewis II , Jessina C. McGregor","doi":"10.1016/j.sipas.2023.100232","DOIUrl":"10.1016/j.sipas.2023.100232","url":null,"abstract":"<div><h3>Background</h3><p>Beta-lactam antibiotics are first-line agents for most patients receiving antimicrobial prophylaxis in surgical procedures. Despite evidence showing low cross-reactivity between penicillins and cephalosporins, patients with beta-lactam allergies commonly receive vancomycin as an alternative to avoid allergic reaction.</p></div><div><h3>Methods</h3><p>Adult patients receiving vancomycin for surgical prophylaxis with a reported beta-lactam allergy at our institution between August 2017 to July 2018 were retrospectively evaluated for potential eligibility for penicillin allergy testing and/or receipt of standard prophylaxis.</p></div><div><h3>Results</h3><p>Among 830 patients who received vancomycin for surgical prophylaxis, 196 reported beta-lactam allergy and were included in the analysis. Approximately 40 % of surgeries were orthopedic. Of patients receiving vancomycin as first-line therapy, 189 (96.4 %) were potentially eligible for beta-lactam prophylaxis.</p></div><div><h3>Conclusions</h3><p>Patients with beta-lactam allergies often qualify for receipt of a first-line antibiotic. An opportunity exists for improved allergy assessment as an antimicrobial stewardship intervention in surgical prophylaxis.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"16 ","pages":"Article 100232"},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262023000785/pdfft?md5=fb046a43043ffa7cf9a67c0f9f7597da&pid=1-s2.0-S2666262023000785-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139020262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-16DOI: 10.1016/j.sipas.2023.100231
Vincent MAYORAL , Dorothée COQUEREL-BEGHIN , Jean-Nicolas CORNU , Valérie BRIDOUX , Isabelle AUQUIT-AUCKBUR , Christian PFISTER
Introduction
Colostomy is usually proposed during the acute phase of Fournier Gangrene, nevertheless its impact on disease outcome remains still debated. We conducted a retrospective study in an academic center to determine the impact of fecal diversion on disease morbidity and specific survival.
Methods
All medical charts of Fournier Gangrene cases in the past 30-years were reviewed. Mortality rate, hospitalization duration, time to complete healing and number of excision surgeries were compared between the stoma and the non-stoma groups. Time between initial diagnosis and stoma creation, type of fecal diversion, as well as specific morbidity were analyzed.
Results
Of 89 patients included, 59 had stoma creation. Stoma group had significant higher catecholamine drugs use. Mortality, time to complete healing and number of excision surgeries did not significantly differ between both groups. Hospitalization duration was significantly higher in the stoma group. Mortality and hospitalization duration were higher when loop transverse colostomy was performed, and when colostomy was done in the first 3-days. Morbidity occurred in 41 % of patients with colostomy, with 25 % life-threatening complications. 31 % of colostomies remained definitive, while median time to intestinal recovery was 159-days.
Discussion
Consistently with current literature, disease survival was not improved by colostomy creation although skewed. Colostomy creation was associated with a higher hospitalization duration and a significant morbidity including risk of definitive stoma. To limit over-indicated stoma and improve early results, a damage control strategy using colostomy creation is advised.
Conclusion
The benefit of colostomy during the acute phase of Fournier Gangrene was uncertain, with no clear impact on mortality. In fact, colostomy was associated with increased hospitalization duration and specific morbidity. Finally, when fecal diversion is deemed necessary, we advocate for coelioscopic delayed loop left colostomy. Alternative minimally invasive treatment as bowel catheters should also be discussed.
{"title":"Impact of fecal diversion in Perineal Necrotizing Soft Tissue Infection on disease survival: A large retrospective study","authors":"Vincent MAYORAL , Dorothée COQUEREL-BEGHIN , Jean-Nicolas CORNU , Valérie BRIDOUX , Isabelle AUQUIT-AUCKBUR , Christian PFISTER","doi":"10.1016/j.sipas.2023.100231","DOIUrl":"https://doi.org/10.1016/j.sipas.2023.100231","url":null,"abstract":"<div><h3>Introduction</h3><p>Colostomy is usually proposed during the acute phase of Fournier Gangrene, nevertheless its impact on disease outcome remains still debated. We conducted a retrospective study in an academic center to determine the impact of fecal diversion on disease morbidity and specific survival.</p></div><div><h3>Methods</h3><p>All medical charts of Fournier Gangrene cases in the past 30-years were reviewed. Mortality rate, hospitalization duration, time to complete healing and number of excision surgeries were compared between the stoma and the non-stoma groups. Time between initial diagnosis and stoma creation, type of fecal diversion, as well as specific morbidity were analyzed.</p></div><div><h3>Results</h3><p>Of 89 patients included, 59 had stoma creation. Stoma group had significant higher catecholamine drugs use. Mortality, time to complete healing and number of excision surgeries did not significantly differ between both groups. Hospitalization duration was significantly higher in the stoma group. Mortality and hospitalization duration were higher when loop transverse colostomy was performed, and when colostomy was done in the first 3-days. Morbidity occurred in 41 % of patients with colostomy, with 25 % life-threatening complications. 31 % of colostomies remained definitive, while median time to intestinal recovery was 159-days.</p></div><div><h3>Discussion</h3><p>Consistently with current literature, disease survival was not improved by colostomy creation although skewed. Colostomy creation was associated with a higher hospitalization duration and a significant morbidity including risk of definitive stoma. To limit over-indicated stoma and improve early results, a damage control strategy using colostomy creation is advised.</p></div><div><h3>Conclusion</h3><p>The benefit of colostomy during the acute phase of Fournier Gangrene was uncertain, with no clear impact on mortality. In fact, colostomy was associated with increased hospitalization duration and specific morbidity. Finally, when fecal diversion is deemed necessary, we advocate for coelioscopic delayed loop left colostomy. Alternative minimally invasive treatment as bowel catheters should also be discussed.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"16 ","pages":"Article 100231"},"PeriodicalIF":0.0,"publicationDate":"2023-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262023000773/pdfft?md5=f2419ded28a5f45a7b26bbab3031477f&pid=1-s2.0-S2666262023000773-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138838688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01DOI: 10.1016/j.sipas.2023.100227
Ece Ekici , Mehmet Özkeskin , Fatih Özden
Background
Current reviews have primarily focused on the effect of exercise on colorectal cancer patient's functional abilities and cardiorespiratory performance. There is a need for more comprehensive studies to determine the effects of exercise on different components. We aimed to investigate recent pre-operative and post-operative exercise interventions conducted in patients undergoing or scheduled for colorectal cancer surgery.
Methods
The PRISMA guidelines were followed. PubMed, Web-of-Science (WoS) and Scopus databases were searched. The Physiotherapy Evidence Database (PEDro) tool provided the methodological quality and risk of bias for the included trials. The review findings are presented using the principles of narrative synthesis. The synthesis process encompasses steps such as “developing a preliminary synthesis, exploring relationships within and between studies, and assessing the robustness of the synthesis.”
Results
The combined use of aerobic and resistance exercises reduces hospital stay in the preoperative period, long-term exercise interventions significantly improve functional parameters, and progressive relaxation exercises performed during the preoperative and postoperative periods reduce anxiety.
Conclusions
Long-term and combined (relaxation, aerobic and resistance) rehabilitation in colorectal cancer surgery is essential to improve the physical and psychological parameters of patients. Further studies should focus on more comprehensive, long-term exercise programs and separately investigate the effects of each exercise type.
{"title":"The effect of exercise in patients with colorectal cancer surgery: A systematic review","authors":"Ece Ekici , Mehmet Özkeskin , Fatih Özden","doi":"10.1016/j.sipas.2023.100227","DOIUrl":"https://doi.org/10.1016/j.sipas.2023.100227","url":null,"abstract":"<div><h3>Background</h3><p>Current reviews have primarily focused on the effect of exercise on colorectal cancer patient's functional abilities and cardiorespiratory performance. There is a need for more comprehensive studies to determine the effects of exercise on different components. We aimed to investigate recent pre-operative and post-operative exercise interventions conducted in patients undergoing or scheduled for colorectal cancer surgery.</p></div><div><h3>Methods</h3><p>The PRISMA guidelines were followed. PubMed, Web-of-Science (WoS) and Scopus databases were searched. The Physiotherapy Evidence Database (PEDro) tool provided the methodological quality and risk of bias for the included trials. The review findings are presented using the principles of narrative synthesis. The synthesis process encompasses steps such as “developing a preliminary synthesis, exploring relationships within and between studies, and assessing the robustness of the synthesis.”</p></div><div><h3>Results</h3><p>The combined use of aerobic and resistance exercises reduces hospital stay in the preoperative period, long-term exercise interventions significantly improve functional parameters, and progressive relaxation exercises performed during the preoperative and postoperative periods reduce anxiety.</p></div><div><h3>Conclusions</h3><p>Long-term and combined (relaxation, aerobic and resistance) rehabilitation in colorectal cancer surgery is essential to improve the physical and psychological parameters of patients. Further studies should focus on more comprehensive, long-term exercise programs and separately investigate the effects of each exercise type.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"15 ","pages":"Article 100227"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262023000736/pdfft?md5=b6c793e71cc82fee9d0192fcb82c3b59&pid=1-s2.0-S2666262023000736-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138490910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01DOI: 10.1016/j.sipas.2023.100230
Brandon Stretton , Philip Harford , Joshua Kovoor , Stephen Bacchi , Aashray Gupta , Jaspreet Sandhu , Hollie Moran , Suzanne Edwards , Jonathon Henry W. Jacobsen , Guy Maddern , Mark Boyd
Introduction
Current guidelines suggest preoperative direct oral anticoagulant levels of < 30–50 ng/ml. However, there is limited evidence to guide this expert consensus. Reviewing assay titres and clinical outcomes may be able to inform perioperative care of the anticoagulated patient. This review aimed to determine whether DOAC assay plasma concentrations are associated with bleeding or systemic embolic events to better appreciate a possible therapeutic or hazardous reference range.
Methods
Systematic search, performed by an information specialist using a peer-reviewed search. Main search concepts were direct oral anticoagulant therapy for atrial fibrillation or venous thromboembolism. Data synthesised in narrative and tabular format whilst data that could be pooled was subjected to meta-analysis, using a random effects model. Meta regression was conducted for DOAC peak levels and clinical events. PRISMA guidelines were adhered to.
Results
Of 6717 retrieved publications, a total of 17 studies were included in the systematic review and 14 in the meta-analysis/regression. Studies report clinical outcome follow up ranging from 28 to 128 weeks. For every 10 ng/ml increase in DOAC assay trough and peak levels, the mean number of bleeding cases increases by 0.03(95 %CI: –0.32 –0.38, P = 0.84) and 0.09(95 %CI: –3.4 –5.3, P = 0.55) respectively, the mean number of major bleed cases increases by 0.01(95 %CI: –0.05 –0.07, P = 0.62) and 0.011(95 %CI: –0.32 –0.34, P = 0.74) respectively and the mean number of systemic embolic event cases decreases by 0.00039(95 %CI: –0.06 –0.0054, P = 0.88) and 0.04(95 %CI: –0.56 –0.48, P = 0.77) respectively.
Conclusion
There exists no significant, independent relationship, as determined by a univariate meta regression, between DOAC assay concentrations and a patient's risk of bleeding or systemic embolic embolism. This review also highlights the possibility of an absolute, patient specific DOAC assay concentration that may indicate adequate anticoagulation, above which further increases do not confer an increased risk of bleeding. However, further research to characterise this and its utility in the perioperative setting is required.
{"title":"Association between direct oral anticoagulant concentrations and clinical outcomes: A systematic review and meta-analysis","authors":"Brandon Stretton , Philip Harford , Joshua Kovoor , Stephen Bacchi , Aashray Gupta , Jaspreet Sandhu , Hollie Moran , Suzanne Edwards , Jonathon Henry W. Jacobsen , Guy Maddern , Mark Boyd","doi":"10.1016/j.sipas.2023.100230","DOIUrl":"https://doi.org/10.1016/j.sipas.2023.100230","url":null,"abstract":"<div><h3>Introduction</h3><p>Current guidelines suggest preoperative direct oral anticoagulant levels of < 30–50 ng/ml. However, there is limited evidence to guide this expert consensus. Reviewing assay titres and clinical outcomes may be able to inform perioperative care of the anticoagulated patient. This review aimed to determine whether DOAC assay plasma concentrations are associated with bleeding or systemic embolic events to better appreciate a possible therapeutic or hazardous reference range.</p></div><div><h3>Methods</h3><p>Systematic search, performed by an information specialist using a peer-reviewed search. Main search concepts were direct oral anticoagulant therapy for atrial fibrillation or venous thromboembolism. Data synthesised in narrative and tabular format whilst data that could be pooled was subjected to meta-analysis, using a random effects model. Meta regression was conducted for DOAC peak levels and clinical events. PRISMA guidelines were adhered to.</p></div><div><h3>Results</h3><p>Of 6717 retrieved publications, a total of 17 studies were included in the systematic review and 14 in the meta-analysis/regression. Studies report clinical outcome follow up ranging from 28 to 128 weeks. For every 10 ng/ml increase in DOAC assay trough and peak levels, the mean number of bleeding cases increases by 0.03(95 %CI: –0.32 –0.38, <em>P</em> = 0.84) and 0.09(95 %CI: –3.4 –5.3, <em>P</em> = 0.55) respectively, the mean number of major bleed cases increases by 0.01(95 %CI: –0.05 –0.07, <em>P</em> = 0.62) and 0.011(95 %CI: –0.32 –0.34, <em>P</em> = 0.74) respectively and the mean number of systemic embolic event cases decreases by 0.00039(95 %CI: –0.06 –0.0054, <em>P</em> = 0.88) and 0.04(95 %CI: –0.56 –0.48, <em>P</em> = 0.77) respectively.</p></div><div><h3>Conclusion</h3><p>There exists no significant, independent relationship, as determined by a univariate meta regression, between DOAC assay concentrations and a patient's risk of bleeding or systemic embolic embolism. This review also highlights the possibility of an absolute, patient specific DOAC assay concentration that may indicate adequate anticoagulation, above which further increases do not confer an increased risk of bleeding. However, further research to characterise this and its utility in the perioperative setting is required.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"15 ","pages":"Article 100230"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262023000761/pdfft?md5=1e85e8f844c1c4eeefc625019c2f54e8&pid=1-s2.0-S2666262023000761-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138549865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01DOI: 10.1016/j.sipas.2023.100228
Christopher P. Bellaire , Emily M. Graham , Lauren M. Bracey , Harrison R. Ferlauto , Caleigh Weliver , Shaun D. Mendenhall , Eitan Melamed
Background
Hand surgery is a competitive fellowship that draws applicants from orthopedic, plastic, and general surgery. In 2010, recommendations from the American Academy of Orthopaedic Surgeons (AAOS) Board of Specialty Societies Match Oversight Committee and the American Society of Plastic Surgeons (ASPS) Plastic Surgery Workforce Task Force led to significant reforms to their respective workforces and training. This study characterizes trends in hand fellowship applicants and programs since these recommendations (2010–2023).
Materials and methods
We queried hand fellowship applicant and program data from the American Society for Surgery of the Hand (ASSH), the National Resident Matching Program (NRMP), and the Accreditation Council for Graduate Medical Education (ACGME).
Results, discussion and conclusions
From 2010 to 2023, the number of ACGME-accredited hand fellowship programs increased across specialties (orthopedic surgery, 58 to 74 (27.6 % increase, R = 0.97, p < 0.001); plastic surgery, 14 to 19 (35.7 % increase, R = 0.91, p < 0.001); general surgery, 1 to 2 (50 % increase, R = 0.71, p = 0.004). The number of available fellowship positions commensurately increased by 38.8 % over the same time period. The number of applicants did not significantly change between 2010 (155 applicants) and 2023 (198 applicants) (R = 0.32, p = 0.27). The ratio of applicants-to-positions significantly decreased from 2010 (1.12 applicants per position) to 2023 (1.04 applicants per position) (R = -0.74, p = 0.003). Yet, applicants ranked nearly twice as many programs in 2023 (14.9 programs per applicant) compared to in 2010 (7.5 programs per applicant) (R = 0.98, p < 0.001). In light of the American Orthopaedic Association endorsing signal preferencing in the 2022–2023 residency Match, strategies to optimize rank lists in the fellowship application process should be further explored.
{"title":"Recent trends in hand surgery fellowship applicants and programs","authors":"Christopher P. Bellaire , Emily M. Graham , Lauren M. Bracey , Harrison R. Ferlauto , Caleigh Weliver , Shaun D. Mendenhall , Eitan Melamed","doi":"10.1016/j.sipas.2023.100228","DOIUrl":"https://doi.org/10.1016/j.sipas.2023.100228","url":null,"abstract":"<div><h3>Background</h3><p>Hand surgery is a competitive fellowship that draws applicants from orthopedic, plastic, and general surgery. In 2010, recommendations from the American Academy of Orthopaedic Surgeons (AAOS) Board of Specialty Societies Match Oversight Committee and the American Society of Plastic Surgeons (ASPS) Plastic Surgery Workforce Task Force led to significant reforms to their respective workforces and training. This study characterizes trends in hand fellowship applicants and programs since these recommendations (2010–2023).</p></div><div><h3>Materials and methods</h3><p>We queried hand fellowship applicant and program data from the American Society for Surgery of the Hand (ASSH), the National Resident Matching Program (NRMP), and the Accreditation Council for Graduate Medical Education (ACGME).</p></div><div><h3>Results, discussion and conclusions</h3><p>From 2010 to 2023, the number of ACGME-accredited hand fellowship programs increased across specialties (orthopedic surgery, 58 to 74 (27.6 % increase, <em>R</em> = 0.97, <em>p</em> < 0.001); plastic surgery, 14 to 19 (35.7 % increase, <em>R</em> = 0.91, <em>p</em> < 0.001); general surgery, 1 to 2 (50 % increase, <em>R</em> = 0.71, <em>p</em> = 0.004). The number of available fellowship positions commensurately increased by 38.8 % over the same time period. The number of applicants did not significantly change between 2010 (155 applicants) and 2023 (198 applicants) (<em>R</em> = 0.32, <em>p</em> = 0.27). The ratio of applicants-to-positions significantly decreased from 2010 (1.12 applicants per position) to 2023 (1.04 applicants per position) (<em>R</em> = -0.74, <em>p</em> = 0.003). Yet, applicants ranked nearly twice as many programs in 2023 (14.9 programs per applicant) compared to in 2010 (7.5 programs per applicant) (<em>R</em> = 0.98, <em>p</em> < 0.001). In light of the American Orthopaedic Association endorsing signal preferencing in the 2022–2023 residency Match, strategies to optimize rank lists in the fellowship application process should be further explored.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"15 ","pages":"Article 100228"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262023000748/pdfft?md5=a1c3593a9c1c08e75190861726667475&pid=1-s2.0-S2666262023000748-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138577636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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