Surgery in practice and science最新文献_第8页

IF 0.8 Q4 SURGERY

Surgery in practice and science

Pub Date : 2025-01-01

引用次数: 0

IF 0.8 Q4 SURGERY

Surgery in practice and science

Pub Date : 2025-01-01

引用次数: 0

IF 0.8 Q4 SURGERY

Surgery in practice and science

Pub Date : 2025-01-01

引用次数: 0

IF 0.8 Q4 SURGERY

Surgery in practice and science

Pub Date : 2025-01-01

引用次数: 0

Surgical sharp debridement alongside maggot debridement therapy (MDT) for the treatment of diabetic foot ulcers (DFUs): A systematic review of case reports 手术尖锐清创联合蛆清创疗法（MDT）治疗糖尿病足溃疡（DFUs）：对病例报告的系统回顾。

IF 0.6 Q4 SURGERY

Surgery in practice and science

Pub Date : 2024-12-21 DOI: 10.1016/j.sipas.2024.100270

Babak Choobi Anzali , Anna Javanbakht , Maryam Rasouli , Nasim Talebiazar , Milad Hashemzadeh , Mir Amir Hossein Seyed Nazari

Objective

The objective of this systematic review of case reports is to evaluate the efficacy and safety of combining surgical sharp debridement with maggot debridement therapy (MDT) for the treatment of diabetic foot ulcers (DFUs).

Methods

A comprehensive literature search was conducted across multiple databases, including PubMed, Embase, Cochrane Library, and Web of Science. Inclusion criteria were studies that reported on the use of surgical sharp debridement alongside MDT for DFUs, while exclusion criteria included insufficient detail on treatment methods or patient outcomes, non-human studies, and non-English publications. Data were extracted using a standardized form, and the quality of case reports was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports. A narrative synthesis was conducted due to the anticipated heterogeneity of the case reports, and a sensitivity analysis was performed to assess the robustness of the findings.

Results

The review process began with 1003 records, which were narrowed down to 721 unique records after removing duplicates. Following title and abstract screening, and full-text assessment, 8 studies were selected for inclusion in the final analysis. The narrative synthesis identified several key findings, including significant wound size reduction, improved glycemic control, disappearance of foul odor, improved healing rates, infection control, granulation tissue formation, epithelialization, complete wound closure, avoidance of amputation, and pain alleviation. The combination therapy showed promise in managing DFUs effectively.

Conclusion

The systematic review of case reports presents evidence supporting the combined use of surgical sharp debridement and maggot debridement therapy in the management of diabetic foot ulcers. The findings suggest that this approach can lead to successful wound healing and limb preservation, offering a valuable addition to the clinician's toolkit for treating DFUs.

目的：本系统回顾病例报告的目的是评估手术尖锐清创联合蛆虫清创治疗糖尿病足溃疡（DFUs）的疗效和安全性。方法：在PubMed、Embase、Cochrane Library、Web of Science等多个数据库中进行综合文献检索。纳入标准是报道在MDT治疗DFUs的同时使用外科尖锐清创的研究，而排除标准包括治疗方法或患者结果的细节不足、非人类研究和非英语出版物。使用标准化表格提取数据，并使用乔安娜布里格斯研究所（JBI）病例报告关键评估清单评估病例报告的质量。由于预期病例报告的异质性，进行了叙述综合，并进行了敏感性分析以评估结果的稳健性。结果：审查过程从1003条记录开始，在删除重复记录后，将其缩小到721条唯一记录。经过题目、摘要筛选和全文评估，最终选择8项研究纳入最终分析。叙述综合确定了几个关键发现，包括伤口大小显著减小，血糖控制改善，恶臭消失，愈合率提高，感染控制，肉芽组织形成，上皮化，伤口完全闭合，避免截肢和疼痛减轻。联合治疗在有效治疗DFUs方面显示出希望。结论：系统回顾了病例报告，提供了支持手术锐创术和蛆创术联合应用于糖尿病足溃疡治疗的证据。研究结果表明，这种方法可以导致伤口成功愈合和肢体保存，为临床医生治疗DFUs提供了有价值的补充。

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引用次数: 0

Is there an impact of surgeon's experience on in-hospital outcome in patients with operatively treated proximal humerus and humerus shaft fractures? 外科医生的经验对手术治疗肱骨近端和肱骨干骨折患者的住院结果有影响吗？

IF 0.6 Q4 SURGERY

Surgery in practice and science

Pub Date : 2024-12-19 DOI: 10.1016/j.sipas.2024.100269

Andrew Adams , Christina Lorenz , Valentin Neuhaus , Hans-Christoph Pape , Claudio Canal

Background

Proximal humerus and shaft fractures are common, comprising 10–11 % of all fractures. Progress in their management includes refined surgical techniques and implants, coupled with a deeper understanding of fracture patterns.

Aims

This study examines the effect of surgical education on in-hospital outcomes for operatively treated proximal and humerus shaft fractures, aiming to enhance patient care and results.

Material and Methods

This study analyzed cases from 1st of January 2010 until the 31st of December 2021 using data extracted from the Swiss working group for quality assurance in surgery, including patients with proximal humerus and shaft fractures who underwent surgical procedures like open reduction with internal fixation (ORIF), closed reduction with internal fixation (CRIF), external fixation, or prosthesis. Analysis included patient demographics, procedure details, and outcomes, comparing those with and without teaching of the surgical procedures. Binary logistic regression identified risk factors, with statistical significance set at p = 0.001.

Results

A total of 6,654 patients were analyzed. Most were treated with ORIF (74 %) or CRIF (17 %). The average hospital stay was 6.5 days. Teaching surgeries, comprising 5.4 % of all procedures, were more common among patients with fewer comorbidities and with public insurance coverage. These surgeries took slightly longer to perform compared to non-teaching cases (120±65 min vs. 113±60 min, p= <0.001). Public insurance coverage, absence of comorbidities, and certain surgical procedures (CRIF and ORIF vs. prosthesis) were associated with surgery being a teaching case. Complications occurred in 8 % of patients, with no significant difference between teaching and non-teaching groups. Predictors of complications included higher American Society of Anesthesiologists-score, antibiotic use, anticoagulation therapy, fracture of shaft, higher age, and longer surgery duration.

Conclusions

Educational status did not affect in-hospital mortality and morbidity in patients with a operatively treated shaft or proximal humeral fracture. However, teaching was an independent predictor of a prolonged duration of surgery. Despite the significant differences, the clinical outcome was comparable in both groups, therefore substantiating the advantages of teaching operations for both patient safety and resident education. They combine the competence of experienced surgeons with the training of residents, whilst ensuring the safety through oversight and best practices. Not only does this environment improve patient outcomes, but also provides residents with hands-on experience, thus helping them make critical decisions, building confidence and developing essential skills.

背景：肱骨近端和骨干骨折是常见的，占所有骨折的10- 11%。治疗方面的进步包括改进手术技术和植入物，以及对骨折类型的更深入了解。目的：本研究探讨手术教育对手术治疗的近端和肱骨干骨折住院疗效的影响，旨在提高患者护理和治疗效果。材料和方法：本研究分析了2010年1月1日至2021年12月31日的病例，使用瑞士手术质量保证工作组提取的数据，包括肱骨近端和骨干骨折患者，他们接受了手术治疗，如切开复位内固定（ORIF）、闭合复位内固定（CRIF）、外固定或假体。分析包括患者人口统计学、手术细节和结果，比较有和没有外科手术教学的患者。二元逻辑回归确定了危险因素，p = 0.001具有统计学意义。结果：共分析6654例患者。大多数患者接受ORIF（74%）或CRIF（17%）治疗。平均住院时间为6.5天。教学手术占所有手术的5.4%，在合并症较少且有公共保险覆盖的患者中更为常见。与非教学病例相比，这些手术需要稍长的时间（120±65分钟vs 113±60分钟），p=结论：教育程度不影响手术治疗的骨干或肱骨近端骨折患者的住院死亡率和发病率。然而，教学是延长手术时间的独立预测因子。尽管存在显著差异，但两组的临床结果具有可比性，因此证实了教学手术在患者安全和住院医师教育方面的优势。他们将经验丰富的外科医生的能力与住院医师的培训相结合，同时通过监督和最佳实践确保安全。这种环境不仅改善了患者的治疗效果，还为住院医生提供了实践经验，从而帮助他们做出关键决策，建立信心并发展基本技能。

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引用次数: 0

Operating room times differ for surgical fixation of metacarpal fractures: An analysis of two principally different techniques 掌骨骨折手术固定的手术室时间不同：两种主要不同技术的分析。

IF 0.6 Q4 SURGERY

Surgery in practice and science

Pub Date : 2024-12-06 DOI: 10.1016/j.sipas.2024.100266

Sohail R. Daulat , Viashen Moodley , Carina Ho , Michael Mazarei , Cina Karodeh , Nils A. Nystrom , Lloyd P. Champagne

Introduction

Time spent in the operating room (OR) has ramifications that impact patient outcomes and the economics of patients, physicians, surgery centers, and insurance industry. For that reason, there is an incentive to seek approaches that allow shorter times to be spent in the OR. To what extent varying routine techniques impact on operating times has not been extensively studied in metacarpal fixation literature, specifically investigating retrograde threaded intramedullary nail fixations (RTNF) and comparing it to open plating fixations (OPF). The present study was designed for the purpose of comparing OR times for different but broadly adopted techniques for internal stabilization of metacarpal shaft fractures.

Methods

A retrospective chart review was conducted for patients aged 18 and above, who over a 41-month period underwent internal fixation with RTNF or OPF for single, extra articular, closed fractures of the index through little finger metacarpals. We examined anesthesia records, which indicated total operating (“skin-to-skin”) times.

Results

A total of 81 charts remained for review after exclusions. Statistical analysis of the recorded data showed significantly shorter median OR time values for RTNF (17 minutes, IQR = 14 – 20.75) vs. OPF (36 minutes, IQR = 31.55 – 44; p < 0.001).

Conclusion

Statistical analysis of data shows significantly shorter operating times to achieve satisfactory fracture stabilization using RTNF compared to OPF. Since the differences in OR time significantly differ between the two principally different surgical techniques, it should be considered when choosing which surgical technique to use. However, further review of indications and clinical outcomes is necessary to develop definitive recommendations or guidelines on which technique should be preferred, especially when considering specific patient presentations.

Level of Evidence

Retrospective Comparative Study III

导读：在手术室（OR）花费的时间会影响患者的治疗结果以及患者、医生、手术中心和保险行业的经济效益。出于这个原因，有一种动机是寻求允许在手术室中花费更短时间的方法。在掌骨固定文献中，不同的常规技术对手术时间的影响程度尚未得到广泛的研究，特别是研究逆行螺纹髓内钉固定（RTNF）并将其与开放式钢板固定（OPF）进行比较。本研究的目的是比较不同但广泛采用的技术用于掌骨干骨折内固定的手术时间。方法：对年龄在18岁及以上，通过小指掌接受RTNF或OPF内固定治疗单关节外闭合性骨折41个月的患者进行回顾性分析。我们检查了麻醉记录，这些记录显示了总手术次数（“皮肤对皮肤”）。结果：排除后共保留81张图供复查。对记录数据的统计分析显示，RTNF的中位OR时间值（17分钟，IQR = 14 - 20.75）明显短于OPF(36分钟，IQR = 31.55 - 44；P < 0.001)。结论：统计分析数据显示，与OPF相比，RTNF获得满意的骨折稳定所需的手术时间明显缩短。由于两种主要不同的手术技术在手术时间上的差异有很大差异，因此在选择使用哪种手术技术时应考虑到这一点。然而，进一步审查适应症和临床结果是必要的，以制定明确的建议或指南，哪种技术应该首选，特别是考虑到特定的患者表现。证据水平：回顾性比较研究III。

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引用次数: 0

The CRP/PAB ratio outperforms the LRINEC score in early diagnosis of Fournier's gangrene CRP/PAB比值在早期诊断富尼耶坏疽方面优于LRINEC评分。

IF 0.6 Q4 SURGERY

Surgery in practice and science

Pub Date : 2024-12-01 DOI: 10.1016/j.sipas.2024.100267

Jin-Liang Zhu, Hong-Jian Gao, Zhi-Tao Yin

Background

Fournier's gangrene (FG) is scarce and potentially fatal disease. Although the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score was established in 2004, its reliability as a diagnostic tool to differentiate between FG and perianal abscess is still debated. The objective of this study was to assess the reliability of the LRINEC score and other relevant inflammatory markers. The diagnostic effectiveness of these inflammatory factors was evaluated and compared.

Methods

Retrospective observational study of patients with FG or with perianal abscess. Fifty-two patients with FG and 39 patients with perianal abscess treated in Shenyang Coloproctology Hospital between January 2019 and December 2023 were enrolled in the study.

Results

The area under the ROC curve (C-statistic) of a LRINEC score ≥6 for diagnosing FG was 0.736. Inflammatory markers, including C-reactive protein (CRP), procalcitonin (PCT), prealbumin (PAB), neutrophil-to-lymphocyte ratio (NLR), and systemic immune inflammation index (SII), demonstrated better diagnostic ability compared to the LRINEC score. Particularly, the compound inflammatory factor of CRP-to-PAB (CRP/PAB) ratio exhibited superior diagnostic ability compared to other markers (C-statistic: 0.908; p < 0.001).

Conclusions

The LRINEC score demonstrated only modest discriminative performance in this study. Patients with PAB< 91mg/L and a CRP/PAB≥ 1.52 should undergo careful evaluation for the presence of FG. The elevated CRP/PAB ratio is considered an early indicator for FG, particularly in distinguishing it from deep perianal abscesses. Further investigation is warranted in future studies to support these findings.

背景：富尼耶坏疽是一种罕见且具有潜在致命性的疾病。尽管坏死性筋膜炎实验室风险指标（LRINEC）评分于2004年建立，但其作为鉴别FG和肛周脓肿的诊断工具的可靠性仍存在争议。本研究的目的是评估LRINEC评分和其他相关炎症标志物的可靠性。对这些炎症因子的诊断效果进行评价和比较。方法：回顾性观察FG或肛周脓肿患者。研究纳入2019年1月至2023年12月在沈阳直肠科医院治疗的52例FG患者和39例肛周脓肿患者。结果：LRINEC评分≥6分诊断FG的ROC曲线下面积（C-statistic）为0.736。炎症标志物，包括c反应蛋白（CRP）、降钙素原（PCT）、白蛋白前（PAB）、中性粒细胞与淋巴细胞比率（NLR）和全身免疫炎症指数（SII），与LRINEC评分相比，显示出更好的诊断能力。其中，CRP-to-PAB复合炎症因子（CRP/PAB）比的诊断能力优于其他指标(C-statistic: 0.908；P < 0.001)。结论：LRINEC评分在本研究中仅表现出适度的区分表现。PAB患者

{"title":"The CRP/PAB ratio outperforms the LRINEC score in early diagnosis of Fournier's gangrene","authors":"Jin-Liang Zhu, Hong-Jian Gao, Zhi-Tao Yin","doi":"10.1016/j.sipas.2024.100267","DOIUrl":"10.1016/j.sipas.2024.100267","url":null,"abstract":"<div><h3>Background</h3><div>Fournier's gangrene (FG) is scarce and potentially fatal disease. Although the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score was established in 2004, its reliability as a diagnostic tool to differentiate between FG and perianal abscess is still debated. The objective of this study was to assess the reliability of the LRINEC score and other relevant inflammatory markers. The diagnostic effectiveness of these inflammatory factors was evaluated and compared.</div></div><div><h3>Methods</h3><div>Retrospective observational study of patients with FG or with perianal abscess. Fifty-two patients with FG and 39 patients with perianal abscess treated in Shenyang Coloproctology Hospital between January 2019 and December 2023 were enrolled in the study.</div></div><div><h3>Results</h3><div>The area under the ROC curve (C-statistic) of a LRINEC score ≥6 for diagnosing FG was 0.736. Inflammatory markers, including C-reactive protein (CRP), procalcitonin (PCT), prealbumin (PAB), neutrophil-to-lymphocyte ratio (NLR), and systemic immune inflammation index (SII), demonstrated better diagnostic ability compared to the LRINEC score. Particularly, the compound inflammatory factor of CRP-to-PAB (CRP/PAB) ratio exhibited superior diagnostic ability compared to other markers (C-statistic: 0.908; <em>p</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>The LRINEC score demonstrated only modest discriminative performance in this study. Patients with PAB< 91mg/L and a CRP/PAB≥ 1.52 should undergo careful evaluation for the presence of FG. The elevated CRP/PAB ratio is considered an early indicator for FG, particularly in distinguishing it from deep perianal abscesses. Further investigation is warranted in future studies to support these findings.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"19 ","pages":"Article 100267"},"PeriodicalIF":0.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025964","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}

引用次数: 0

Higher compliance with the enhanced recovery after surgery protocol improves postoperative recovery and 6-month mortality in upper gastrointestinal surgery 术后增强恢复方案的高依从性提高了上消化道手术的术后恢复和6个月死亡率。

IF 0.6 Q4 SURGERY

Surgery in practice and science

Pub Date : 2024-12-01 DOI: 10.1016/j.sipas.2024.100265

Thammawat Parakonthun , Gritin Gonggetyai , Chawisa Nampoolsuksan , Tharathorn Suwatthanarak , Thikhamporn Tawantanakorn , Jirawat Swangsri , Asada Methasate

Introduction

The enhanced recovery after surgery (ERAS) protocol has been proven to accelerate recovery without increasing morbidity, but few data are available from developing countries. We aimed to demonstrate the correlation between compliance with the ERAS protocol and short-term outcomes in upper gastrointestinal (UGI) surgery.

Materials and Methods

Patients that underwent esophageal and gastric surgeries during March 2019 to June 2021 were prospectively enrolled in this nonrandomized cohort study. The ERAS protocol was applied based on patient-doctor agreement. Patients were categorized into conventional care (CC), moderate-compliance (MC), and high-compliance (HC) groups. Short-term outcomes including gastrointestinal (GI) function recovery, length of hospital stay (LOS), postoperative complications and mortality rate were compared.

Results

158 patients were enrolled: 58 in the CC, 33 in the MC, and 67 in the HC group. The HC group demonstrated reduced time to tolerate oral diet (8 vs 7 vs 3 days; p = 0.034), recovery of GI function (72 vs 96 vs 61 h; p = 0.001) and median LOS (12.5 vs 10 vs 6 days; p < 0.001). Postoperative overall (p = 0.08) and major complications (p = 0.09) were not significantly different. Non-surgical complications were lower in the HC group (31.0 % vs 54.5 % vs 25.4 %; p = 0.013). The 28-day readmission rate was not different (8.6 % vs 3.0 % vs 1.5 %; p = 0.14). The 30-day postoperative mortality was not different (0 % vs 3.1 % vs 0 %; p = 0.15), but the 6-month mortality rate was significantly lower in the HC group (13.8 % vs 15.2 % vs 0 %; p < 0.001).

Conclusion

The level of compliance with the ERAS protocol is associated with improved short-term postoperative outcome in UGI surgery. High compliance patients recovered faster, were discharged sooner, and had better 6-month survival.

引言：手术后增强恢复（ERAS）方案已被证明可以加速恢复而不增加发病率，但发展中国家的数据很少。我们的目的是证明ERAS方案的依从性与上胃肠道（UGI）手术的短期结果之间的相关性。材料和方法：前瞻性纳入2019年3月至2021年6月期间接受食管和胃手术的患者。ERAS方案的应用基于医患协议。患者被分为常规治疗组（CC）、中等依从性组（MC）和高依从性组（HC）。比较两组患者的短期预后，包括胃肠功能恢复、住院时间、术后并发症和死亡率。结果：158例患者入组：CC组58例，MC组33例，HC组67例。HC组表现出口服饮食耐受时间缩短(8天vs 7天vs 3天；p = 0.034)，胃肠道功能恢复(72小时vs 96小时vs 61小时；p = 0.001)和中位LOS(12.5天vs 10天vs 6天；P < 0.001)。术后总体（p = 0.08）和主要并发症（p = 0.09）差异无统计学意义。HC组非手术并发症较低(31.0% vs 54.5% vs 25.4%；P = 0.013)。28天再入院率无差异(8.6% vs 3.0% vs 1.5%；P = 0.14)。术后30天死亡率无差异(0% vs 3.1% vs 0%；p = 0.15)，但HC组6个月死亡率显著降低(13.8% vs 15.2% vs 0%；P < 0.001)。结论：在UGI手术中，ERAS方案的依从性水平与改善的短期术后预后有关。高依从性患者恢复快，出院早，6个月生存率高。

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引用次数: 0

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

IF 0.6 Q4 SURGERY

Surgery in practice and science

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

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

Background

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

Methods

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

Results

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

Conclusions

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

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

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引用次数: 0