{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"22 ","pages":"Article 100289"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146243410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"22 ","pages":"Article 100291"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146243412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"22 ","pages":"Article 100298"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146243413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"22 ","pages":"Article 100297"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146243419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-21DOI: 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。
{"title":"Surgical sharp debridement alongside maggot debridement therapy (MDT) for the treatment of diabetic foot ulcers (DFUs): A systematic review of case reports","authors":"Babak Choobi Anzali , Anna Javanbakht , Maryam Rasouli , Nasim Talebiazar , Milad Hashemzadeh , Mir Amir Hossein Seyed Nazari","doi":"10.1016/j.sipas.2024.100270","DOIUrl":"10.1016/j.sipas.2024.100270","url":null,"abstract":"<div><h3>Objective</h3><div>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).</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"20 ","pages":"Article 100270"},"PeriodicalIF":0.6,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025998","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 : 2024-12-19DOI: 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.
{"title":"Is there an impact of surgeon's experience on in-hospital outcome in patients with operatively treated proximal humerus and humerus shaft fractures?","authors":"Andrew Adams , Christina Lorenz , Valentin Neuhaus , Hans-Christoph Pape , Claudio Canal","doi":"10.1016/j.sipas.2024.100269","DOIUrl":"10.1016/j.sipas.2024.100269","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Aims</h3><div>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.</div></div><div><h3>Material and Methods</h3><div>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 <em>p</em> = 0.001.</div></div><div><h3>Results</h3><div>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, <em>p</em>= <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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"20 ","pages":"Article 100269"},"PeriodicalIF":0.6,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11750012/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025966","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 : 2024-12-06DOI: 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.
{"title":"Operating room times differ for surgical fixation of metacarpal fractures: An analysis of two principally different techniques","authors":"Sohail R. Daulat , Viashen Moodley , Carina Ho , Michael Mazarei , Cina Karodeh , Nils A. Nystrom , Lloyd P. Champagne","doi":"10.1016/j.sipas.2024.100266","DOIUrl":"10.1016/j.sipas.2024.100266","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusion</h3><div>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.</div></div><div><h3>Level of Evidence</h3><div>Retrospective Comparative Study III</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"20 ","pages":"Article 100266"},"PeriodicalIF":0.6,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025994","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 : 2024-12-01DOI: 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.
{"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}
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。
{"title":"Higher compliance with the enhanced recovery after surgery protocol improves postoperative recovery and 6-month mortality in upper gastrointestinal surgery","authors":"Thammawat Parakonthun , Gritin Gonggetyai , Chawisa Nampoolsuksan , Tharathorn Suwatthanarak , Thikhamporn Tawantanakorn , Jirawat Swangsri , Asada Methasate","doi":"10.1016/j.sipas.2024.100265","DOIUrl":"10.1016/j.sipas.2024.100265","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Materials and Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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; <em>p</em> = 0.034), recovery of GI function (72 vs 96 vs 61 h; <em>p</em> = 0.001) and median LOS (12.5 vs 10 vs 6 days; <em>p</em> < 0.001). Postoperative overall (<em>p</em> = 0.08) and major complications (<em>p</em> = 0.09) were not significantly different. Non-surgical complications were lower in the HC group (31.0 % vs 54.5 % vs 25.4 %; <em>p</em> = 0.013). The 28-day readmission rate was not different (8.6 % vs 3.0 % vs 1.5 %; <em>p</em> = 0.14). The 30-day postoperative mortality was not different (0 % vs 3.1 % vs 0 %; <em>p</em> = 0.15), but the 6-month mortality rate was significantly lower in the HC group (13.8 % vs 15.2 % vs 0 %; <em>p</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"19 ","pages":"Article 100265"},"PeriodicalIF":0.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025959","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 : 2024-10-31DOI: 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。
{"title":"Emergency laparotomy preoperative risk assessment tool performance: A systematic review","authors":"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","doi":"10.1016/j.sipas.2024.100264","DOIUrl":"10.1016/j.sipas.2024.100264","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"19 ","pages":"Article 100264"},"PeriodicalIF":0.6,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142573231","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}