Surgery in practice and science最新文献_第6页

Development and validation of an objective assessment of surgical skill in arthroscopic management of meniscal tear: A pilot study 半月板撕裂关节镜手术技术客观评估的发展和验证：一项初步研究

Q4 SURGERY

Surgery in practice and science

Pub Date : 2023-09-01 DOI: 10.1016/j.sipas.2023.100198

Rachel S. Bronheim , Majd Marrache , Alexander E. Loeb , Johnathan A. Bernard , Dawn M. LaPorte

Introduction

As resident evaluation moves to a competency-based system, validated tools for assessment of surgical skill are increasingly important. We created and validated a checklist to measure resident surgical skill for arthroscopic management of meniscal tear.

Materials and Methods

Using a Delphi survey method, we created an objective, structured assessment of surgical skill for treatment of meniscal tears. The Meniscus Treatment Task List (MTTL) comprises 5 domains: diagnostic arthroscopy, medial meniscectomy, lateral meniscectomy, medial meniscal repair, and lateral meniscal repair. Orthopaedic surgery residents were recruited to perform diagnostic arthroscopy, partial meniscectomies, and all-inside meniscal repairs with cadaveric models. Arthroscopic videos were graded by fellowship-trained surgeons using the MTTL and the validated Arthroscopic Surgical Skill Evaluation Tool (ASSET) global rating scale (GRS). Postgraduate year (PGY), operative time, and case logs were recorded for each resident. Data were analysed using bivariate correlation, analysis of variance, pairwise comparison, Pearson's correlation coefficient, and intraclass correlation coefficient. α=0.05.

Results

Twenty-two orthopaedic surgery residents (PGY1–PGY4) participated. MTTL scores were higher in the PGY4 class than in the PGY1 class (mean difference, 11 points, p = 0.04). Operative time was inversely correlated with number of cases logged (r = –0.53, p = 0.01), number of arthroscopic cases logged (r = –0.50, p = 0.02), and MTTL score (r = –0.46, p = 0.03). MTTL score was positively correlated with number of cases (r = 0.44, p = 0.04) and number of arthroscopic cases logged (r = 0.50, p = 0.02). MTTL scores were positively correlated with the ASSET GRS (r = 0.71, p<0.001). Intraclass correlation coefficient of 0.89 and Pearson's correlation coefficient of 0.89 demonstrated strong interrater reliability of MTTL scores (p<0.01).

Conclusions

This pilot study demonstrates the validity and reliability of the MTTL for assessing resident proficiency in arthroscopic management of meniscal tears in cadaveric specimens. Expansion of this model to other orthopaedic procedures for objective assessment of surgical skill may be useful.

随着住院医师评估转向以能力为基础的系统，评估手术技能的有效工具变得越来越重要。我们创建并验证了一份检查表，以衡量关节镜治疗半月板撕裂的住院医师手术技能。材料与方法采用德尔菲调查法，对治疗半月板撕裂的手术技巧进行客观、结构化的评估。半月板治疗任务表(MTTL)包括5个领域:诊断性关节镜、内侧半月板切除术、外侧半月板切除术、内侧半月板修复和外侧半月板修复。招募骨科住院医师进行诊断性关节镜检查、部分半月板切除术和全内半月板修复。关节镜视频由接受奖学金培训的外科医生使用MTTL和经过验证的关节镜手术技能评估工具(ASSET)全局评定量表(GRS)进行评分。记录每位住院医师的研究生学年(PGY)、手术时间和病例日志。采用双变量相关、方差分析、两两比较、Pearson相关系数和类内相关系数对数据进行分析。α= 0.05。结果22名骨科住院医师(PGY1-PGY4)参与调查。PGY4组MTTL评分高于PGY1组(平均差11分，p = 0.04)。手术时间与登记病例数(r = -0.53, p = 0.01)、关节镜登记病例数(r = -0.50, p = 0.02)、MTTL评分(r = -0.46, p = 0.03)呈负相关。MTTL评分与病例数(r = 0.44, p = 0.04)和关节镜记录病例数(r = 0.50, p = 0.02)呈正相关。MTTL评分与ASSET GRS呈正相关(r = 0.71, p<0.001)。组内相关系数为0.89,Pearson相关系数为0.89，表明MTTL评分的组间信度较强(p<0.01)。结论本初步研究证明了MTTL在评估住院医师关节镜下处理尸体标本半月板撕裂的熟练程度方面的有效性和可靠性。将该模型扩展到其他骨科手术中，以客观评估手术技巧，这可能是有用的。

{"title":"Development and validation of an objective assessment of surgical skill in arthroscopic management of meniscal tear: A pilot study","authors":"Rachel S. Bronheim , Majd Marrache , Alexander E. Loeb , Johnathan A. Bernard , Dawn M. LaPorte","doi":"10.1016/j.sipas.2023.100198","DOIUrl":"10.1016/j.sipas.2023.100198","url":null,"abstract":"<div><h3>Introduction</h3><p>As resident evaluation moves to a competency-based system, validated tools for assessment of surgical skill are increasingly important. We created and validated a checklist to measure resident surgical skill for arthroscopic management of meniscal tear.</p></div><div><h3>Materials and Methods</h3><p>Using a Delphi survey method, we created an objective, structured assessment of surgical skill for treatment of meniscal tears. The Meniscus Treatment Task List (MTTL) comprises 5 domains: diagnostic arthroscopy, medial meniscectomy, lateral meniscectomy, medial meniscal repair, and lateral meniscal repair. Orthopaedic surgery residents were recruited to perform diagnostic arthroscopy, partial meniscectomies, and all-inside meniscal repairs with cadaveric models. Arthroscopic videos were graded by fellowship-trained surgeons using the MTTL and the validated Arthroscopic Surgical Skill Evaluation Tool (ASSET) global rating scale (GRS). Postgraduate year (PGY), operative time, and case logs were recorded for each resident. Data were analysed using bivariate correlation, analysis of variance, pairwise comparison, Pearson's correlation coefficient, and intraclass correlation coefficient. α=0.05.</p></div><div><h3>Results</h3><p>Twenty-two orthopaedic surgery residents (PGY1–PGY4) participated. MTTL scores were higher in the PGY4 class than in the PGY1 class (mean difference, 11 points, <em>p</em> = 0.04). Operative time was inversely correlated with number of cases logged (<em>r</em> = –0.53, <em>p</em> = 0.01), number of arthroscopic cases logged (<em>r</em> = –0.50, <em>p</em> = 0.02), and MTTL score (<em>r</em> = –0.46, <em>p</em> = 0.03). MTTL score was positively correlated with number of cases (<em>r</em> = 0.44, <em>p</em> = 0.04) and number of arthroscopic cases logged (<em>r</em> = 0.50, <em>p</em> = 0.02). MTTL scores were positively correlated with the ASSET GRS (<em>r</em> = 0.71, <em>p</em><0.001). Intraclass correlation coefficient of 0.89 and Pearson's correlation coefficient of 0.89 demonstrated strong interrater reliability of MTTL scores (<em>p</em><0.01).</p></div><div><h3>Conclusions</h3><p>This pilot study demonstrates the validity and reliability of the MTTL for assessing resident proficiency in arthroscopic management of meniscal tears in cadaveric specimens. Expansion of this model to other orthopaedic procedures for objective assessment of surgical skill may be useful.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100198"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47965261","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}

引用次数: 0

Lymph node harvest as a predictor of survival for colon cancer: A systematic review and meta-analysis 淋巴结收获作为癌症生存率的预测指标：一项系统综述和荟萃分析

Q4 SURGERY

Surgery in practice and science

Pub Date : 2023-09-01 DOI: 10.1016/j.sipas.2023.100190

Simarpreet Ichhpuniani , Tyler McKechnie , Jay Lee , Jeremy Biro , Yung Lee , Lily Park , Aristithes Doumouras , Dennis Hong , Cagla Eskicioglu

Background and Objectives

The number of lymph nodes found harboring metastasis can be impacted by the extent of harvest. Guidelines recommend 12 lymph nodes for adequate lymphadenectomy to predict long-term oncologic outcomes, yet different cut-offs remain unevaluated. The aim of this review was to determine cut-offs that may predict survival outcomes.

Methods

Medline, Embase, and CENTRAL were systematically searched. Articles were included if they compared overall survival (OS) or disease-free survival (DFS) above and below a lymph node harvest cut-off. Studies solely examining rectal cancer or stage-IV disease were excluded. Pairwise meta-analyses using inverse variance random effects were performed.

Results

From 2587 citations, 20 studies with 854,359 patients (51.9% female, mean age: 68.9) were included, with 19 studies included in quantitative synthesis. A lymph node harvest cut-off of 12 predicted improved five-year OS (7 studies; OR 1.11, 95% CI 1.08–1.14, p<0.00001). A cut-off as low as 7 was associated with improved five-year OS (2 studies; OR 1.16, 95% CI 1.08–1.25, p<0.0001) and DFS (3 studies; OR 1.66, 95% CI 1.32–2.10, p<0.00001). All cut-offs greater than 12 demonstrated improved survival.

Conclusions

A lymph node cut-off of 12 distinguishes differences in five-year oncologic outcomes. Contrarily, lymph node harvests other than 12 have not been rigorously studied and thus lack the statistical power to derive meaningful conclusions compared to the 12-lymph node cut-off. Nonetheless, it is possible that a lymph node harvest cut-offs less than 12 may be adequate in predicting long-term survival. Further prospective study evaluating cut-offs below 12 are warranted.

背景与目的发现有转移的淋巴结的数量可能受到采伐程度的影响。指南推荐12个淋巴结行充分的淋巴结切除术以预测长期肿瘤预后，但不同的切除范围仍未评估。本综述的目的是确定可能预测生存结果的截断值。方法系统检索medline、Embase和CENTRAL数据库。如果文章比较了总生存期(OS)或无病生存期(DFS)高于和低于淋巴结切除分界点，则纳入。仅检查直肠癌或iv期疾病的研究被排除在外。采用反方差随机效应进行两两荟萃分析。结果从2587篇引文中纳入20篇研究，共854,359例患者(51.9%为女性，平均年龄68.9岁)，其中19篇纳入定量综合。淋巴结切除的截断值为12，预测5年OS改善(7项研究;OR 1.11, 95% CI 1.08-1.14, p<0.00001)。截止值低至7与改善的5年OS相关(2项研究;OR 1.16, 95% CI 1.08-1.25, p<0.0001)和DFS(3项研究;OR 1.66, 95% CI 1.32-2.10, p<0.00001)。所有大于12的截断值均显示生存率提高。结论12例淋巴结切除在5年肿瘤预后上存在差异。相反，除12个淋巴结外的淋巴结切除没有经过严格的研究，因此与12个淋巴结切除相比，缺乏统计能力来得出有意义的结论。尽管如此，小于12个淋巴结切除可能足以预测长期生存。进一步的前瞻性研究评估的截止值低于12是必要的。

{"title":"Lymph node harvest as a predictor of survival for colon cancer: A systematic review and meta-analysis","authors":"Simarpreet Ichhpuniani , Tyler McKechnie , Jay Lee , Jeremy Biro , Yung Lee , Lily Park , Aristithes Doumouras , Dennis Hong , Cagla Eskicioglu","doi":"10.1016/j.sipas.2023.100190","DOIUrl":"10.1016/j.sipas.2023.100190","url":null,"abstract":"<div><h3>Background and Objectives</h3><p>The number of lymph nodes found harboring metastasis can be impacted by the extent of harvest. Guidelines recommend 12 lymph nodes for adequate lymphadenectomy to predict long-term oncologic outcomes, yet different cut-offs remain unevaluated. The aim of this review was to determine cut-offs that may predict survival outcomes.</p></div><div><h3>Methods</h3><p>Medline, Embase, and CENTRAL were systematically searched. Articles were included if they compared overall survival (OS) or disease-free survival (DFS) above and below a lymph node harvest cut-off. Studies solely examining rectal cancer or stage-IV disease were excluded. Pairwise meta-analyses using inverse variance random effects were performed.</p></div><div><h3>Results</h3><p>From 2587 citations, 20 studies with 854,359 patients (51.9% female, mean age: 68.9) were included, with 19 studies included in quantitative synthesis. A lymph node harvest cut-off of 12 predicted improved five-year OS (7 studies; OR 1.11, 95% CI 1.08–1.14, <em>p</em><0.00001). A cut-off as low as 7 was associated with improved five-year OS (2 studies; OR 1.16, 95% CI 1.08–1.25, <em>p</em><0.0001) and DFS (3 studies; OR 1.66, 95% CI 1.32–2.10, <em>p</em><0.00001). All cut-offs greater than 12 demonstrated improved survival.</p></div><div><h3>Conclusions</h3><p>A lymph node cut-off of 12 distinguishes differences in five-year oncologic outcomes. Contrarily, lymph node harvests other than 12 have not been rigorously studied and thus lack the statistical power to derive meaningful conclusions compared to the 12-lymph node cut-off. Nonetheless, it is possible that a lymph node harvest cut-offs less than 12 may be adequate in predicting long-term survival. Further prospective study evaluating cut-offs below 12 are warranted.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100190"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41583956","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}

引用次数: 0

A modern-day research model for large academic institutions: A fellow-based solution 大型学术机构的现代研究模式:基于同伴的解决方案

Q4 SURGERY

Surgery in practice and science

Pub Date : 2023-09-01 DOI: 10.1016/j.sipas.2023.100193

Alan Pang , Jad Zeitouni , Ferris Zeitouni , Jennifer Kesey , John Griswold

Introduction

In the aftermath of the United States Medical Licensing Examination (USMLE) Step 1 becoming pass/fail, research has become a more important component of residency applications. Time is a finite resource, and clinicians, both academic and private practice, struggle to balance research within their schedules. We aim to provide a model to produce impactful research efficiently.

Methods

We describe our experience in developing a modern-day research model that was developed to create a robust research program at our institution. A grassroots initiative of researchers, including academicians, a burn fellow, residents, and students, has become a research model that large academic institutions should leverage for efficiency and productivity.

Results

What began as one attending, one fellow, four medical students, and one burn center grew in several months to include over 170 students, a student organization, five fellows from varying specialties, seven residents, and 22 faculty members in 15 disciplines. In addition, our collaboration includes interdisciplinary research involving other institutional departments such as mathematics, medical education, biostatistics, industrial engineering, and computer engineering. Tenably, we have over 150 projects in the works, 22 publications, 47 podium presentations, 47 poster presentations, and over 150 approved IRB proposals, along with four grants— all in 16 months.

Discussion

As we move into the era of the ungraded medical student, the importance of research experience and productivity is rising. Academic institutions that adapt to this change in the medical education landscape have the opportunity to increase innovation and their institution's contributions to academic medicine while producing well-rounded graduates with skills vital to efficacious patient care.

Conclusion

This research model allows for interdisciplinary collaboration and efficient research productivity in large academic institutions. We aim to inspire other institutions to consider implementing a similar research model and continue to contribute to the innovation and advancement of medicine.

在美国医疗执照考试(USMLE)第1步成为通过/不通过之后，研究已成为住院医师申请中更重要的组成部分。时间是一种有限的资源，临床医生，无论是学术还是私人执业，都努力在他们的时间表内平衡研究。我们的目标是提供一种模式，有效地产生有影响力的研究。方法我们描述了我们在开发现代研究模型方面的经验，该模型是为了在我们的机构创建一个强大的研究项目而开发的。包括院士、研究员、居民和学生在内的研究人员的基层倡议，已经成为大型学术机构应该利用的一种研究模式，以提高效率和生产力。结果从一名主治医生、一名研究员、四名医学生和一所烧伤中心开始，几个月后发展到包括170多名学生、一个学生组织、来自不同专业的五名研究员、七名住院医生和15个学科的22名教员。此外，我们的合作还包括涉及其他机构部门的跨学科研究，如数学、医学教育、生物统计学、工业工程和计算机工程。目前，我们有超过150个项目在进行中，22个出版物，47个讲台演讲，47个海报演讲，150多个IRB批准的提案，以及4个拨款-所有这些都在16个月内完成。随着我们进入不评分医学院学生的时代，研究经验和生产力的重要性正在上升。适应这种医学教育格局变化的学术机构有机会增加创新和他们的机构对学术医学的贡献，同时培养全面发展的毕业生，他们具备有效的病人护理技能。结论该研究模式有利于大型学术机构的跨学科合作和高效的研究生产力。我们的目标是激励其他机构考虑实施类似的研究模式，并继续为医学的创新和进步做出贡献。

{"title":"A modern-day research model for large academic institutions: A fellow-based solution","authors":"Alan Pang , Jad Zeitouni , Ferris Zeitouni , Jennifer Kesey , John Griswold","doi":"10.1016/j.sipas.2023.100193","DOIUrl":"10.1016/j.sipas.2023.100193","url":null,"abstract":"<div><h3>Introduction</h3><p>In the aftermath of the United States Medical Licensing Examination (USMLE) Step 1 becoming pass/fail, research has become a more important component of residency applications. Time is a finite resource, and clinicians, both academic and private practice, struggle to balance research within their schedules. We aim to provide a model to produce impactful research efficiently.</p></div><div><h3>Methods</h3><p>We describe our experience in developing a modern-day research model that was developed to create a robust research program at our institution. A grassroots initiative of researchers, including academicians, a burn fellow, residents, and students, has become a research model that large academic institutions should leverage for efficiency and productivity.</p></div><div><h3>Results</h3><p>What began as one attending, one fellow, four medical students, and one burn center grew in several months to include over 170 students, a student organization, five fellows from varying specialties, seven residents, and 22 faculty members in 15 disciplines. In addition, our collaboration includes interdisciplinary research involving other institutional departments such as mathematics, medical education, biostatistics, industrial engineering, and computer engineering. Tenably, we have over 150 projects in the works, 22 publications, 47 podium presentations, 47 poster presentations, and over 150 approved IRB proposals, along with four grants— all in 16 months.</p></div><div><h3>Discussion</h3><p>As we move into the era of the ungraded medical student, the importance of research experience and productivity is rising. Academic institutions that adapt to this change in the medical education landscape have the opportunity to increase innovation and their institution's contributions to academic medicine while producing well-rounded graduates with skills vital to efficacious patient care.</p></div><div><h3>Conclusion</h3><p>This research model allows for interdisciplinary collaboration and efficient research productivity in large academic institutions. We aim to inspire other institutions to consider implementing a similar research model and continue to contribute to the innovation and advancement of medicine.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100193"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41690635","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}

引用次数: 0

Characteristics of image defined risk factors on outcomes for primary resection of neuroblastoma 影像学确定的神经母细胞瘤原发性切除术预后危险因素的特点

Q4 SURGERY

Surgery in practice and science

Pub Date : 2023-09-01 DOI: 10.1016/j.sipas.2023.100195

Charbel Chidiac , Andrew Hu , Emily Dunn , Daniel S. Rhee

Background

The presence of image‑defined risk factors (IDRF) in neuroblastoma plays a large role in decision making for primary resection versus neoadjuvant chemotherapy. This study investigates how the number and type of IDRFs affect surgical outcomes for primary resection of neuroblastoma.

Materials and methods

A retrospective review was performed including patients diagnosed with neuroblastoma with at least one IDRF who underwent primary resection of their tumor between 2003 and 2017. Cross sectional imaging was reviewed by a single pediatric radiologist for determination of IDRFs. Surgical outcomes were compared by <5 versus ≥5 IDRFs and vascular or non‑vascular involvement.

Results

A total of 28 patients were included in the study, 18 with <5 IDRFs and 10 with ≥5 IDRFs. Fifteen patients had vascular involvement and 13 did not. Nine were adrenal, 6 were cervicothoracic, and 5 were abdominal non-adrenal. Patients with ≥5 IDRFs were found to have an increased rate of complications (40% vs 0%; p<0.01), operative time (318 vs 148 min; p<0.01), estimated blood loss (187 mL vs 45 mL; p<0.01), length of stay (9.6 vs 4.9 days; p<0.01), and hospital readmission (20% vs 0%; p = 0.04). No differences were found in degree of resection (p = 0.06). All complications occurred with vascular involvement IDRFs compared to non‑vascular IDRFs (27% vs 0%; p = 0.04).

Conclusion

The presence of ≥5 IDRFs and vascular involvement increases complications associated with primary resection of neuroblastoma. Our findings underscore the importance of neoadjuvant chemotherapy prior to resection. Further studies are required to determine how different IDRFs influence surgical risk.

背景神经母细胞瘤中图像定义危险因素（IDRF）的存在在一期切除与新辅助化疗的决策中起着重要作用。本研究调查了IDRF的数量和类型如何影响神经母细胞瘤一期切除的手术结果。材料和方法进行回顾性审查，包括2003年至2017年间接受肿瘤一期切除的被诊断为至少有一例IDRF的神经母细胞瘤患者。由一名儿科放射科医生对横断面成像进行审查，以确定IDRF。通过<；5与≥5 IDRF以及血管或非血管受累。结果本研究共纳入28例患者，其中18例<；5个IDRF，10个IDRF≥5。15名患者有血管受累，13名没有。肾上腺9例，颈胸6例，腹部非肾上腺5例。发现IDRF≥5的患者并发症发生率增加（40%对0%；p＜0.01）、手术时间增加（318对148分钟；p＜0.05）、估计失血量增加（187毫升对45毫升；p＜0.001）、住院时间增加（9.6对4.9天；p＜0.01，和再次入院（20%vs 0%；p=0.04）。切除程度无差异（p=0.06）。与非血管性IDRF（27%vs 0%；p=0.04）相比，所有并发症均发生在血管受累的IDRF中。结论≥5个IDRF和血管受累增加了与神经母细胞瘤一期切除相关的并发症。我们的研究结果强调了切除术前新辅助化疗的重要性。需要进一步的研究来确定不同的IDRF如何影响手术风险。

{"title":"Characteristics of image defined risk factors on outcomes for primary resection of neuroblastoma","authors":"Charbel Chidiac , Andrew Hu , Emily Dunn , Daniel S. Rhee","doi":"10.1016/j.sipas.2023.100195","DOIUrl":"https://doi.org/10.1016/j.sipas.2023.100195","url":null,"abstract":"<div><h3>Background</h3><p>The presence of image‑defined risk factors (IDRF) in neuroblastoma plays a large role in decision making for primary resection versus neoadjuvant chemotherapy. This study investigates how the number and type of IDRFs affect surgical outcomes for primary resection of neuroblastoma.</p></div><div><h3>Materials and methods</h3><p>A retrospective review was performed including patients diagnosed with neuroblastoma with at least one IDRF who underwent primary resection of their tumor between 2003 and 2017. Cross sectional imaging was reviewed by a single pediatric radiologist for determination of IDRFs. Surgical outcomes were compared by <5 versus ≥5 IDRFs and vascular or non‑vascular involvement.</p></div><div><h3>Results</h3><p>A total of 28 patients were included in the study, 18 with <5 IDRFs and 10 with ≥5 IDRFs. Fifteen patients had vascular involvement and 13 did not. Nine were adrenal, 6 were cervicothoracic, and 5 were abdominal non-adrenal. Patients with ≥5 IDRFs were found to have an increased rate of complications (40% vs 0%; <em>p</em><0.01), operative time (318 vs 148 min; <em>p</em><0.01), estimated blood loss (187 mL vs 45 mL; <em>p</em><0.01), length of stay (9.6 vs 4.9 days; <em>p</em><0.01), and hospital readmission (20% vs 0%; <em>p</em> = 0.04). No differences were found in degree of resection (<em>p</em> = 0.06). All complications occurred with vascular involvement IDRFs compared to non‑vascular IDRFs (27% vs 0%; <em>p</em> = 0.04).</p></div><div><h3>Conclusion</h3><p>The presence of ≥5 IDRFs and vascular involvement increases complications associated with primary resection of neuroblastoma. Our findings underscore the importance of neoadjuvant chemotherapy prior to resection. Further studies are required to determine how different IDRFs influence surgical risk.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100195"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49775418","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}

引用次数: 0

Assessment of YouTube as an online educational tool in teaching laparoscopic Roux-en-Y gastric bypass: A LAP-VEGaS study 评估YouTube作为在线教育工具在腹腔镜Roux-en-Y胃旁路术教学:一项LAP-VEGaS研究

Q4 SURGERY

Surgery in practice and science

Pub Date : 2023-09-01 DOI: 10.1016/j.sipas.2023.100199

Armaun D. Rouhi , Jeffrey L. Roberson , Emily Kindall , Yazid K. Ghanem , William S. Yi , Noel N. Williams , Kristoffel R. Dumon

Background

General surgery residents frequently access YouTube® for educational walkthroughs of surgical procedures. The aim of this study is to evaluate the educational quality of YouTube® video walkthroughs on Laparoscopic Roux-en-Y gastric bypass (LRYGB) using a validated video assessment tool.

Methods

A retrospective review of YouTube® videos was conducted for “laparoscopic Roux-en-Y gastric bypass”, “laparoscopic RYGB”, and “laparoscopic gastric bypass.” The top 100 videos from three YouTube® searches were gathered and duplicates were removed. Included videos were categorized as Physician (produced by individual physician), Academic (university/medical school), or Society (professional surgical society) and rated by three independent investigators using the LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS) video assessment tool (0–18). The data were analyzed using one-way ANOVA with Bonferroni correction and Spearman's correlation test.

Results

Of 300 videos gathered, 31 unique videos met selection criteria and were analyzed. The average LAP-VEGaS score was 8.67 (SD 3.51). Society videos demonstrated a significantly higher mean LAP-VEGaS score than Physician videos (p = 0.023). Most videos lacked formal case presentation (71%), intraoperative findings (81%), and operative time (76%). No correlation was demonstrated between LAP-VEGaS scores and number of likes or views, video length, or upload date.

Conclusions

LRYGB training videos on YouTube® generally do not adhere to the LAP-VEGaS guidelines and are of poor educational quality, signaling areas of improvement for educators.

普通外科住院医师经常访问YouTube®以获得外科手术的教育演练。本研究的目的是使用经过验证的视频评估工具评估YouTube®腹腔镜Roux-en-Y胃旁路术(LRYGB)视频演练的教育质量。方法回顾性分析“腹腔镜Roux-en-Y胃旁路术”、“腹腔镜RYGB胃旁路术”和“腹腔镜胃旁路术”的YouTube视频。从三个YouTube®搜索中收集前100个视频，并删除重复的视频。纳入的视频被分类为医师(由医生个人制作)、学术(大学/医学院)或社会(专业外科学会)，并由三名独立调查员使用腹腔镜手术视频教育指南(LAP-VEGaS)视频评估工具(0-18)进行评分。数据分析采用Bonferroni校正和Spearman相关检验的单因素方差分析。结果在收集到的300个视频中，有31个独特的视频符合选择标准并进行了分析。平均LAP-VEGaS评分为8.67 (SD 3.51)。社会视频的LAP-VEGaS平均评分明显高于医师视频(p = 0.023)。大多数视频缺乏正式的病例介绍(71%)，术中发现(81%)和手术时间(76%)。LAP-VEGaS评分与点赞或观看次数、视频长度或上传日期之间没有相关性。结论:YouTube®上的slrygb培训视频通常不遵守LAP-VEGaS指南，教育质量较差，这表明教育工作者需要改进。

{"title":"Assessment of YouTube as an online educational tool in teaching laparoscopic Roux-en-Y gastric bypass: A LAP-VEGaS study","authors":"Armaun D. Rouhi , Jeffrey L. Roberson , Emily Kindall , Yazid K. Ghanem , William S. Yi , Noel N. Williams , Kristoffel R. Dumon","doi":"10.1016/j.sipas.2023.100199","DOIUrl":"10.1016/j.sipas.2023.100199","url":null,"abstract":"<div><h3>Background</h3><p>General surgery residents frequently access YouTube® for educational walkthroughs of surgical procedures. The aim of this study is to evaluate the educational quality of YouTube® video walkthroughs on Laparoscopic Roux-en-Y gastric bypass (LRYGB) using a validated video assessment tool.</p></div><div><h3>Methods</h3><p>A retrospective review of YouTube® videos was conducted for “laparoscopic Roux-en-Y gastric bypass”, “laparoscopic RYGB”, and “laparoscopic gastric bypass.” The top 100 videos from three YouTube® searches were gathered and duplicates were removed. Included videos were categorized as Physician (produced by individual physician), Academic (university/medical school), or Society (professional surgical society) and rated by three independent investigators using the LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS) video assessment tool (0–18). The data were analyzed using one-way ANOVA with Bonferroni correction and Spearman's correlation test.</p></div><div><h3>Results</h3><p>Of 300 videos gathered, 31 unique videos met selection criteria and were analyzed. The average LAP-VEGaS score was 8.67 (SD 3.51). Society videos demonstrated a significantly higher mean LAP-VEGaS score than Physician videos (<em>p</em> = 0.023). Most videos lacked formal case presentation (71%), intraoperative findings (81%), and operative time (76%). No correlation was demonstrated between LAP-VEGaS scores and number of likes or views, video length, or upload date.</p></div><div><h3>Conclusions</h3><p>LRYGB training videos on YouTube® generally do not adhere to the LAP-VEGaS guidelines and are of poor educational quality, signaling areas of improvement for educators.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100199"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42384742","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}

引用次数: 0

Preoperative waiting time and outcomes of non-traumatic emergency abdominal surgeries: Insights from a zonal referral hospital in northern Tanzania, a reference for health centers with similar capacities 非创伤性紧急腹部手术的术前等待时间和结果:来自坦桑尼亚北部地区转诊医院的见解，为具有类似能力的卫生中心提供参考

Q4 SURGERY

Surgery in practice and science

Pub Date : 2023-09-01 DOI: 10.1016/j.sipas.2023.100202

Godfrey M. Mchele , Ally H. Mwanga , Daniel W. Kitua , Samwel Chugulu

Background

Non-traumatic emergency abdominal surgeries are common in most healthcare settings. To a significant extent, the outcomes of treatment are determined by the promptness of surgical interventions. However, the in-hospital waiting time which reflects perioperative promptness remains largely unexplored in developing countries.

Objective

To describe the preoperative waiting time, identify the causes of delays, and determine subsequent outcomes for non-traumatic emergency abdominal surgeries.

Methods

A cross-sectional study was conducted at a consultant zonal hospital in northern Tanzania from September 2012 to March 2013. Patients admitted and surgically treated for non-traumatic acute abdominal conditions were consecutively sampled. Sociodemographic and clinical data were obtained from medical records. Delays in surgical interventions were assessed based on observations at the Emergency Department and record analysis. Descriptive statistics and regression analysis were used to summarize the data and assess for factors influencing post-operative outcomes, respectively.

Results

The study included 111 participants with a median age of 29 years (IQR=18-53). The median in-hospital preoperative waiting was 10.5 hours (IQR=6.6-14.7), with a substantial majority (78.4%) experiencing delays beyond 6 hours. The frequent reasons for delayed surgery included personnel shortage (37.8%), unavailable theater space (31.5%), and investigation-related factors (28.8%). Delayed hospital presentation (symptoms ≥24 hours) (OR=3.9, 95% CI=1.0-14.9) and prolonged waiting time (>6 hours) (OR=2.7, 95% CI=1.0-7.2) were significantly associated (P < 0.05) with in-hospital complications that included wound dehiscence (0.9%), re-operation (3.6%), surgical site infection (18.0%), and complications necessitating Intensive Care Unit admission (36.9%). The in-hospital operative mortality rate was 18.0%. Age of ≤40 years (OR=0.1, 95% CI=0.04-0.4) and ASA-PS class I-II (OR=0.1, 95% CI=0.0-0.3) were identified as significant (P < 0.001) protective factors against operative mortality.

Conclusion

These benchmark findings highlight the multifactorial nature of the reasons for delayed surgical interventions and its association with postoperative complications; offering a potential avenue to enhance surgical efficiency in the index and comparable settings.

背景:非创伤性紧急腹部手术在大多数医疗机构中很常见。在很大程度上，手术干预的及时性决定了治疗的结果。然而，在发展中国家，反映围手术期及时性的住院等待时间在很大程度上仍未得到探索。目的描述非创伤性紧急腹部手术的术前等待时间，确定延误的原因，并确定随后的结果。方法于2012年9月至2013年3月在坦桑尼亚北部地区一家咨询医院进行横断面研究。非创伤性急腹症住院和手术治疗的患者连续取样。从医疗记录中获得社会人口学和临床数据。根据在急诊科的观察和记录分析评估手术干预的延误。采用描述性统计和回归分析对资料进行总结，对影响术后疗效的因素进行评估。结果研究纳入111例参与者，中位年龄29岁(IQR=18-53)。住院术前等待时间中位数为10.5小时(IQR=6.6-14.7)，绝大多数(78.4%)患者的等待时间超过6小时。延迟手术的常见原因包括人员短缺(37.8%)、没有手术室空间(31.5%)和调查相关因素(28.8%)。延迟住院(症状≥24小时)(OR=3.9, 95% CI=1.0-14.9)和延长等待时间(>6小时)(OR=2.7, 95% CI=1.0-7.2)显著相关(P <0.05)，住院并发症包括伤口裂开(0.9%)、再次手术(3.6%)、手术部位感染(18.0%)和需要入住重症监护病房的并发症(36.9%)。住院手术死亡率为18.0%。年龄≤40岁(OR=0.1, 95% CI=0.04-0.4)和ASA-PS I-II级(OR=0.1, 95% CI=0.0-0.3)被认为具有显著性(P <0.001)手术死亡率的保护因素。结论这些基准研究结果突出了延迟手术干预的多因素性质及其与术后并发症的关系;提供一个潜在的途径，以提高手术效率在指数和可比设置。

{"title":"Preoperative waiting time and outcomes of non-traumatic emergency abdominal surgeries: Insights from a zonal referral hospital in northern Tanzania, a reference for health centers with similar capacities","authors":"Godfrey M. Mchele , Ally H. Mwanga , Daniel W. Kitua , Samwel Chugulu","doi":"10.1016/j.sipas.2023.100202","DOIUrl":"10.1016/j.sipas.2023.100202","url":null,"abstract":"<div><h3>Background</h3><p>Non-traumatic emergency abdominal surgeries are common in most healthcare settings. To a significant extent, the outcomes of treatment are determined by the promptness of surgical interventions. However, the in-hospital waiting time which reflects perioperative promptness remains largely unexplored in developing countries.</p></div><div><h3>Objective</h3><p>To describe the preoperative waiting time, identify the causes of delays, and determine subsequent outcomes for non-traumatic emergency abdominal surgeries.</p></div><div><h3>Methods</h3><p>A cross-sectional study was conducted at a consultant zonal hospital in northern Tanzania from September 2012 to March 2013. Patients admitted and surgically treated for non-traumatic acute abdominal conditions were consecutively sampled. Sociodemographic and clinical data were obtained from medical records. Delays in surgical interventions were assessed based on observations at the Emergency Department and record analysis. Descriptive statistics and regression analysis were used to summarize the data and assess for factors influencing post-operative outcomes, respectively.</p></div><div><h3>Results</h3><p>The study included 111 participants with a median age of 29 years (IQR=18-53). The median in-hospital preoperative waiting was 10.5 hours (IQR=6.6-14.7), with a substantial majority (78.4%) experiencing delays beyond 6 hours. The frequent reasons for delayed surgery included personnel shortage (37.8%), unavailable theater space (31.5%), and investigation-related factors (28.8%). Delayed hospital presentation (symptoms ≥24 hours) (OR=3.9, 95% CI=1.0-14.9) and prolonged waiting time (>6 hours) (OR=2.7, 95% CI=1.0-7.2) were significantly associated (<em>P</em> < 0.05) with in-hospital complications that included wound dehiscence (0.9%), re-operation (3.6%), surgical site infection (18.0%), and complications necessitating Intensive Care Unit admission (36.9%). The in-hospital operative mortality rate was 18.0%. Age of ≤40 years (OR=0.1, 95% CI=0.04-0.4) and ASA-PS class I-II (OR=0.1, 95% CI=0.0-0.3) were identified as significant (<em>P</em> < 0.001) protective factors against operative mortality.</p></div><div><h3>Conclusion</h3><p>These benchmark findings highlight the multifactorial nature of the reasons for delayed surgical interventions and its association with postoperative complications; offering a potential avenue to enhance surgical efficiency in the index and comparable settings.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100202"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46335749","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}

引用次数: 0

Evaluation of long-term oncological outcomes of inter-sphincter resection compared with abdominoperineal resection for treatment of ultra-low rectal cancers: a single center 5-year experience 括约肌间切除术与腹会阴切除术治疗超低直肠癌的长期肿瘤学结果评估：单中心5年经验

Q4 SURGERY

Surgery in practice and science

Pub Date : 2023-09-01 DOI: 10.1016/j.sipas.2023.100191

FakhroSadat Anaraki , Mahdi Alemrajabi , Ramin Shekouhi , Maryam Sohooli , Seyed-Ali Sabz

Objectives

Abdominoperineal resection (APR) is considered the gold standard surgical treatment for ultra-low rectal cancer. Anus-preserving alternative procedures have been tested to avoid the need for a permanent colostomy. The present study compares the functional and oncological outcomes of the traditional APR methods with inter-sphincteric resection (ISR).

Methods

Sixty patients with ultra-low rectal cancers that underwent tumor resection using the ISR and APR methods were compared retrospectively. Patients' demographic information as well as tumor characteristics were evaluated. All patients were followed after the operation every three months for two years, and then every six months for at least three years.

Results

Thirty-four (56.6%) patients were male, and 26 (43.3%) were females, which showed no statistical significance between the two groups. The mean tumor distance from the anal verge in the APR group was 5.11±0.06 cm and in the ISR group was 5.22±1.1 cm. In the APR group, 9 (30%) patients developed primary tumor recurrence, while in the ISR group, 10 (33.3%) patients had relapses. The observed difference was not statistically significant. However, the study showed that patients with a T stage of T2 or higher had a higher probability of tumor recurrence.

Conclusion

There is no significant difference in the efficacy of the ISR method compared with the conventional APR for the treatment of ultra-low rectal cancer.

目的腹会阴切除术(APR)被认为是超低位直肠癌的金标准手术治疗方法。为了避免永久性结肠造口手术的需要，已经测试了保留肛门的替代方法。本研究比较了传统APR方法与括约肌间切除术(ISR)的功能和肿瘤结果。方法对60例超低位直肠癌行ISR法和APR法切除的患者进行回顾性比较。评估患者的人口统计学信息及肿瘤特征。所有患者术后每3个月随访2年，然后每6个月随访至少3年。结果男性34例(56.6%)，女性26例(43.3%)，两组比较差异无统计学意义。APR组肿瘤距肛缘平均距离5.11±0.06 cm, ISR组肿瘤距肛缘平均距离5.22±1.1 cm。在APR组中，9例(30%)患者发生原发性肿瘤复发，而在ISR组中，10例(33.3%)患者复发。观察到的差异无统计学意义。然而，研究表明，T期为T2或更高的患者肿瘤复发的可能性更高。结论ISR法与常规APR法治疗超低位直肠癌的疗效无显著差异。

{"title":"Evaluation of long-term oncological outcomes of inter-sphincter resection compared with abdominoperineal resection for treatment of ultra-low rectal cancers: a single center 5-year experience","authors":"FakhroSadat Anaraki , Mahdi Alemrajabi , Ramin Shekouhi , Maryam Sohooli , Seyed-Ali Sabz","doi":"10.1016/j.sipas.2023.100191","DOIUrl":"10.1016/j.sipas.2023.100191","url":null,"abstract":"<div><h3>Objectives</h3><p>Abdominoperineal resection (APR) is considered the gold standard surgical treatment for ultra-low rectal cancer. Anus-preserving alternative procedures have been tested to avoid the need for a permanent colostomy. The present study compares the functional and oncological outcomes of the traditional APR methods with inter-sphincteric resection (ISR).</p></div><div><h3>Methods</h3><p>Sixty patients with ultra-low rectal cancers that underwent tumor resection using the ISR and APR methods were compared retrospectively. Patients' demographic information as well as tumor characteristics were evaluated. All patients were followed after the operation every three months for two years, and then every six months for at least three years.</p></div><div><h3>Results</h3><p>Thirty-four (56.6%) patients were male, and 26 (43.3%) were females, which showed no statistical significance between the two groups. The mean tumor distance from the anal verge in the APR group was 5.11±0.06 cm and in the ISR group was 5.22±1.1 cm. In the APR group, 9 (30%) patients developed primary tumor recurrence, while in the ISR group, 10 (33.3%) patients had relapses. The observed difference was not statistically significant. However, the study showed that patients with a T stage of T2 or higher had a higher probability of tumor recurrence.</p></div><div><h3>Conclusion</h3><p>There is no significant difference in the efficacy of the ISR method compared with the conventional APR for the treatment of ultra-low rectal cancer.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100191"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42565783","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}

引用次数: 0

Pre-operative bariatric patient characteristics driving hiatal hernia repair decision by operating surgeons 术前肥胖患者特征驱动手术外科医生对裂孔疝修复的决定

Q4 SURGERY

Surgery in practice and science

Pub Date : 2023-09-01 DOI: 10.1016/j.sipas.2023.100197

H. Zuercher , B. Koussayer , C. Wang , B. Rachman , V. Sands , M. Sandhu , C. McEwen , R. Mhaskar , C. DuCoin , A. Mooney

Background

Hiatal hernia (HH) is routinely reported in 40% of bariatric surgery patients. Left unrepaired, HH can lead to post-surgical reflux, regurgitation, and vomiting.

Objectives

We hypothesize that patients with pre-operative reflux symptoms and a higher body mass index (BMI) will receive hiatal hernia repairs (HHR) more often. The study aim was to analyze the variables that drive HHR decision by operating surgeons.

Methods

The records of 551 patients who underwent endoscopy in preparation for bariatric surgery were analyzed. Prevalence of HH was derived based on esophagogastroduodenoscopy (EGD) findings performed by a bariatric surgeon during patients’ bariatric surgery. The relationship between categorical participant attributes was calculated using a significance level of 0.05.

Results

The groups consisted of 295 Roux-en-Y gastric bypass (RYGB) and 264 sleeve gastrectomy (SG) patients with preoperative HH identified in 310 patients. SG and a decreased BMI were significant for receiving a HHR. Type II diabetes (T2D), duodenitis found on EGD and pathology report, esophagitis, and Roux-en-Y gastric bypass (RYGB) were significant for not receiving a HHR. Only duodenitis, RYGB, and SG were found to be significant factors after multivariate analysis.

Conclusions

While some pre-operative patient characteristics may not impact a surgeon's HHR decision in the bariatric population, our study suggests that duodenitis, SG, and RYGB may influence a surgeon's HHR decision.

背景:裂孔疝(HH)在40%的减肥手术患者中被常规报道。如果不进行修复，HH可导致术后反流、反流和呕吐。目的:我们假设术前有反流症状和较高体重指数(BMI)的患者更容易接受裂孔疝修补术(HHR)。本研究的目的是分析外科医生决定HHR的变量。方法对551例在减肥手术前行内窥镜检查的患者资料进行分析。HH的患病率是根据减肥外科医生在患者减肥手术期间进行的食管胃十二指肠镜检查(EGD)结果得出的。分类参与者属性之间的关系采用0.05的显著性水平计算。结果共纳入Roux-en-Y胃旁路术(RYGB) 295例，套筒胃切除术(SG) 264例，术前HH 310例。SG和BMI下降对于接受HHR具有重要意义。2型糖尿病(T2D)、EGD和病理报告中发现的十二指肠炎、食管炎和Roux-en-Y胃旁路术(RYGB)在未接受HHR的患者中具有重要意义。多因素分析后发现只有十二指肠炎、RYGB和SG是显著因素。结论:虽然肥胖人群的一些术前患者特征可能不会影响外科医生的HHR决定，但我们的研究表明，十二指肠炎、SG和RYGB可能会影响外科医生的HHR决定。

{"title":"Pre-operative bariatric patient characteristics driving hiatal hernia repair decision by operating surgeons","authors":"H. Zuercher , B. Koussayer , C. Wang , B. Rachman , V. Sands , M. Sandhu , C. McEwen , R. Mhaskar , C. DuCoin , A. Mooney","doi":"10.1016/j.sipas.2023.100197","DOIUrl":"10.1016/j.sipas.2023.100197","url":null,"abstract":"<div><h3>Background</h3><p>Hiatal hernia (HH) is routinely reported in 40% of bariatric surgery patients. Left unrepaired, HH can lead to post-surgical reflux, regurgitation, and vomiting.</p></div><div><h3>Objectives</h3><p>We hypothesize that patients with pre-operative reflux symptoms and a higher body mass index (BMI) will receive hiatal hernia repairs (HHR) more often. The study aim was to analyze the variables that drive HHR decision by operating surgeons.</p></div><div><h3>Methods</h3><p>The records of 551 patients who underwent endoscopy in preparation for bariatric surgery were analyzed. Prevalence of HH was derived based on esophagogastroduodenoscopy (EGD) findings performed by a bariatric surgeon during patients’ bariatric surgery. The relationship between categorical participant attributes was calculated using a significance level of 0.05.</p></div><div><h3>Results</h3><p>The groups consisted of 295 Roux-en-Y gastric bypass (RYGB) and 264 sleeve gastrectomy (SG) patients with preoperative HH identified in 310 patients. SG and a decreased BMI were significant for receiving a HHR. Type II diabetes (T2D), duodenitis found on EGD and pathology report, esophagitis, and Roux-en-Y gastric bypass (RYGB) were significant for not receiving a HHR. Only duodenitis, RYGB, and SG were found to be significant factors after multivariate analysis.</p></div><div><h3>Conclusions</h3><p>While some pre-operative patient characteristics may not impact a surgeon's HHR decision in the bariatric population, our study suggests that duodenitis, SG, and RYGB may influence a surgeon's HHR decision.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100197"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44255304","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}

引用次数: 0

Whipple's procedure for pancreatic cancer: training and the hospital environment are more important than volume alone 惠普尔胰腺癌癌症手术：训练和医院环境比单独治疗更重要

Q4 SURGERY

Surgery in practice and science

Pub Date : 2023-09-01 DOI: 10.1016/j.sipas.2023.100211

Shamir O. Cawich , Robyn Cabral , Jacintha Douglas , Dexter A. Thomas , Fawwaz Z. Mohammed , Vijay Naraynsingh , Neil W. Pearce

Background

In our center, patients with pancreatic cancer traditionally had Whipple's resections by general surgery teams until January 2013 when a hepatopancreatobiliary (HPB) was introduced. We compared outcomes before and after introduction of HPB teams.

Methods

Data were collected from the records of all patients booked for Whipple's resections over a 12-year period. The data were divided into two groups: Group A consisted of the 6-year period from January 1, 2007 to December 30, 2012 during which all resections were performed by GS teams. Group B comprised patients in the 6-year period from January 1, 2013 to December 30, 2019 during which operations were performed by HPB teams. All statistical analyses were carried out using SPSS ver 16.0 and a P Value <0.05 was considered statistically significant.

Results

The patients selected for Whipple's resections in Group A had statistically better performance status and lower anaesthetic risk. Despite this, patients in Group A had higher conversions to palliative operations (66% vs 5.3%), longer mean operating time (517±25 vs 367±54 min; P<0.0001), higher blood loss (3687±661 vs 1394±656 ml; P<0.0001), greater transfusion requirements (4.3±1.3 vs 1.9±1.4 units; P<0.001), greater likelihood of prolonged ICU stay (100% vs 40%; P=0.19), higher overall morbidity (75% vs 22.2%; P=0.02), higher major morbidity (75% vs 13.9%; P=0.013), more procedure-related complications (75% vs 9.7%; P=0.003) and higher mortality rates (75% vs 5.6%; P<0.0001). The HPB teams were more likely to perform vein resection and reconstruction to achieve clear margins (26.4% vs 0; P=0.57).

Conclusion

This paper adds to the growing body of evidence that volume alone should not be used as a marker of quality for patients requiring Whipple's procedures.

在我们的中心，胰腺癌患者传统上由普通外科团队进行惠普尔切除术，直到2013年1月引入肝胰胆管(HPB)。我们比较了引入HPB团队前后的结果。方法收集12年来所有惠普尔切除患者的资料。数据分为两组:A组为2007年1月1日至2012年12月30日的6年期间，所有手术均由GS组进行。B组为2013年1月1日至2019年12月30日6年期间由HPB团队进行手术的患者。所有统计分析均使用SPSS 16.0版本进行，P值<0.05认为有统计学意义。结果A组行Whipple切除术患者的手术表现较好，麻醉风险较低。尽管如此，A组患者转向姑息性手术的比例较高(66%对5.3%)，平均手术时间较长(517±25对367±54分钟);P<0.0001)，较高的失血量(3687±661 vs 1394±656 ml;P<0.0001)，更大的输血需求(4.3±1.3 vs 1.9±1.4单位;P<0.001)，延长ICU住院的可能性更大(100% vs 40%;P=0.19)，总体发病率较高(75% vs 22.2%;P=0.02)，较高的主要发病率(75% vs 13.9%;P=0.013)，手术相关并发症较多(75% vs 9.7%;P=0.003)和更高的死亡率(75% vs 5.6%;术中,0.0001)。HPB组更有可能进行静脉切除和重建以获得清晰的边缘(26.4%比0;P = 0.57)。结论这篇论文增加了越来越多的证据，即体积不应该单独作为需要惠普尔手术的患者质量的标志。

{"title":"Whipple's procedure for pancreatic cancer: training and the hospital environment are more important than volume alone","authors":"Shamir O. Cawich , Robyn Cabral , Jacintha Douglas , Dexter A. Thomas , Fawwaz Z. Mohammed , Vijay Naraynsingh , Neil W. Pearce","doi":"10.1016/j.sipas.2023.100211","DOIUrl":"10.1016/j.sipas.2023.100211","url":null,"abstract":"<div><h3>Background</h3><p>In our center, patients with pancreatic cancer traditionally had Whipple's resections by general surgery teams until January 2013 when a hepatopancreatobiliary (HPB) was introduced. We compared outcomes before and after introduction of HPB teams.</p></div><div><h3>Methods</h3><p>Data were collected from the records of all patients booked for Whipple's resections over a 12-year period. The data were divided into two groups: Group A consisted of the 6-year period from January 1, 2007 to December 30, 2012 during which all resections were performed by GS teams. Group B comprised patients in the 6-year period from January 1, 2013 to December 30, 2019 during which operations were performed by HPB teams. All statistical analyses were carried out using SPSS ver 16.0 and a P Value <0.05 was considered statistically significant.</p></div><div><h3>Results</h3><p>The patients selected for Whipple's resections in Group A had statistically better performance status and lower anaesthetic risk. Despite this, patients in Group A had higher conversions to palliative operations (66% vs 5.3%), longer mean operating time (517±25 vs 367±54 min; P<0.0001), higher blood loss (3687±661 vs 1394±656 ml; P<0.0001), greater transfusion requirements (4.3±1.3 vs 1.9±1.4 units; P<0.001), greater likelihood of prolonged ICU stay (100% vs 40%; P=0.19), higher overall morbidity (75% vs 22.2%; P=0.02), higher major morbidity (75% vs 13.9%; P=0.013), more procedure-related complications (75% vs 9.7%; P=0.003) and higher mortality rates (75% vs 5.6%; P<0.0001). The HPB teams were more likely to perform vein resection and reconstruction to achieve clear margins (26.4% vs 0; P=0.57).</p></div><div><h3>Conclusion</h3><p>This paper adds to the growing body of evidence that volume alone should not be used as a marker of quality for patients requiring Whipple's procedures.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100211"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48441411","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}

引用次数: 1

Developing a novel tonsillitis pathway to reduce pressures on front-door services: A multi-phase quality improvement project in a large UK teaching hospital 开发一种新的扁桃体炎途径，以减少前门服务的压力:英国一家大型教学医院的多阶段质量改进项目

Q4 SURGERY

Surgery in practice and science

Pub Date : 2023-09-01 DOI: 10.1016/j.sipas.2023.100214

Lucy M.S. Hoade , Elliott N. Rees

Background

Tonsillitis places a significant strain on healthcare services, with rising admission rates over recent years. There is an urgent need for strategies to alleviate unprecedented demand on secondary care via safe alternatives to hospital admission. This quality improvement project demonstrates development of an early discharge pathway in combination with an ENT-led Surgical Same Day Emergency Care (SDEC) unit.

Methods

All cases of acute tonsillitis (n = 127) and peritonsillar abscess (n = 43) were reviewed across two intervention phases (Aug-Oct 2021 and June-Oct 2022), which each involved a retrospective baseline audit, followed by post-intervention prospective audit cycles to assess hospital length of stay (LOS) and readmission rates.

Results

Introduction of a tonsillitis management protocol resulted in a reduction in mean LOS from 22 to 12 h (p = 0.004). Mean LOS reverted to 20 h in the second baseline audit. Further audit cycles demonstrated a sustained reduction in mean LOS to 13 h (p = 0.017) with use of the SDEC. Readmission rates remained low through all audit cycles.

Conclusion

Patients with acute tonsillitis can be safely managed via an early discharge pathway. Use of SDEC to deliver this protocol reduces pressure on front-door services, reduces LOS and does not affect readmission rate.

背景扁桃体炎给医疗保健服务带来了巨大压力，近年来入院率不断上升。迫切需要制定战略，通过安全替代住院治疗来缓解对二级保健的空前需求。这一质量改进项目展示了与ent领导的外科当日紧急护理(SDEC)单元相结合的早期出院途径的发展。方法回顾了所有急性扁桃体炎(127例)和扁桃体周围脓肿(43例)的两个干预阶段(2021年8月至10月和2022年6月至10月)，每个阶段都包括回顾性基线审计，然后是干预后前瞻性审计周期，以评估住院时间(LOS)和再入院率。结果扁桃体炎管理方案的引入使平均LOS从22小时减少到12小时(p = 0.004)。在第二次基线审计中，平均LOS恢复到20小时。进一步的审计周期表明，使用SDEC，平均LOS持续减少到13小时(p = 0.017)。在所有审计周期中，再入院率仍然很低。结论急性扁桃体炎患者可通过早期出院途径进行安全治疗。使用SDEC提供该协议减少了对前门服务的压力，降低了LOS，并且不影响再入院率。

{"title":"Developing a novel tonsillitis pathway to reduce pressures on front-door services: A multi-phase quality improvement project in a large UK teaching hospital","authors":"Lucy M.S. Hoade , Elliott N. Rees","doi":"10.1016/j.sipas.2023.100214","DOIUrl":"10.1016/j.sipas.2023.100214","url":null,"abstract":"<div><h3>Background</h3><p>Tonsillitis places a significant strain on healthcare services, with rising admission rates over recent years. There is an urgent need for strategies to alleviate unprecedented demand on secondary care via safe alternatives to hospital admission. This quality improvement project demonstrates development of an early discharge pathway in combination with an ENT-led Surgical Same Day Emergency Care (SDEC) unit.</p></div><div><h3>Methods</h3><p>All cases of acute tonsillitis (<em>n</em> = 127) and peritonsillar abscess (<em>n =</em> 43) were reviewed across two intervention phases (Aug-Oct 2021 and June-Oct 2022), which each involved a retrospective baseline audit, followed by post-intervention prospective audit cycles to assess hospital length of stay (LOS) and readmission rates.</p></div><div><h3>Results</h3><p>Introduction of a tonsillitis management protocol resulted in a reduction in mean LOS from 22 to 12 h (<em>p</em> = 0.004). Mean LOS reverted to 20 h in the second baseline audit. Further audit cycles demonstrated a sustained reduction in mean LOS to 13 h (<em>p</em> = 0.017) with use of the SDEC. Readmission rates remained low through all audit cycles.</p></div><div><h3>Conclusion</h3><p>Patients with acute tonsillitis can be safely managed via an early discharge pathway. Use of SDEC to deliver this protocol reduces pressure on front-door services, reduces LOS and does not affect readmission rate.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100214"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45563244","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}

引用次数: 0