Pub Date : 2024-09-01DOI: 10.1016/j.sopen.2024.09.007
Peter Rubak , Ann-Eva Christensen , Mads Granlie , Karin Bundgaard
Objective
This study presents the results of a surgical instrument tray optimization process implemented across all surgical specialties within the largest university hospital in Denmark.
Methods
Data was extracted from a comprehensive instrument optimization process including all Operating Rooms at Aarhus University Hospital. Adopting a holistic perspective, the optimization process, involved aligning instrument trays across various surgical specialties. This included: a) Reduction in number of instruments, b) Consolidation or separation of trays, c) Modularization - introducing modular trays for specific purposes, and d) Standardization - standardizing commonly used instruments across specialties. Instruments per tray, total number of instruments, and changes in the number of trays were compared against existing tray contents to identify discipline-specific changes.
Results
Some specialties made substantial alterations to tray structures, while others primarily reduced number of instruments in existing trays. Across all specialties, optimization resulted in 17 % decrease in number of tray types (p = 0.01, 95%CI:1.0–6.8), 1 % increase in total number of trays (p = 0.36, 95%CI:-11.9–4.8), 18 % decrease in number of instruments per tray (p = 0.0002, 95%CI: 3.2–7.6) and 16 % reduction in total number of instruments for all specialties (p < 0.0001, 95%CI:404–758).
Conclusion
This study underscores complexity of instrument tray design. The approach employed at Aarhus University Hospital, involving interdisciplinary experts in an iterative design process, demonstrated the feasibility of redesigning instrument trays with significant reduction in content. Additionally, data suggests that reducing the number of instruments could lead to a decrease in workload within the Central Sterile Supply Specialty. This presents opportunity to minimize wasted resources and streamlining cleaning processes for unused instruments.
{"title":"Surgical instrument tray optimization process at a university hospital: A comprehensive overview","authors":"Peter Rubak , Ann-Eva Christensen , Mads Granlie , Karin Bundgaard","doi":"10.1016/j.sopen.2024.09.007","DOIUrl":"10.1016/j.sopen.2024.09.007","url":null,"abstract":"<div><h3>Objective</h3><div>This study presents the results of a surgical instrument tray optimization process implemented across all surgical specialties within the largest university hospital in Denmark.</div></div><div><h3>Methods</h3><div>Data was extracted from a comprehensive instrument optimization process including all Operating Rooms at Aarhus University Hospital. Adopting a holistic perspective, the optimization process, involved aligning instrument trays across various surgical specialties. This included: a) Reduction in number of instruments, b) Consolidation or separation of trays, c) Modularization - introducing modular trays for specific purposes, and d) Standardization - standardizing commonly used instruments across specialties. Instruments per tray, total number of instruments, and changes in the number of trays were compared against existing tray contents to identify discipline-specific changes.</div></div><div><h3>Results</h3><div>Some specialties made substantial alterations to tray structures, while others primarily reduced number of instruments in existing trays. Across all specialties, optimization resulted in 17 % decrease in number of tray types (<em>p</em> = 0.01, 95%CI:1.0–6.8), 1 % increase in total number of trays (<em>p</em> = 0.36, 95%CI:-11.9–4.8), 18 % decrease in number of instruments per tray (<em>p</em> = 0.0002, 95%CI: 3.2–7.6) and 16 % reduction in total number of instruments for all specialties (<em>p</em> < 0.0001, 95%CI:404–758).</div></div><div><h3>Conclusion</h3><div>This study underscores complexity of instrument tray design. The approach employed at Aarhus University Hospital, involving interdisciplinary experts in an iterative design process, demonstrated the feasibility of redesigning instrument trays with significant reduction in content. Additionally, data suggests that reducing the number of instruments could lead to a decrease in workload within the Central Sterile Supply Specialty. This presents opportunity to minimize wasted resources and streamlining cleaning processes for unused instruments.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"21 ","pages":"Pages 60-65"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426030","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 : 2024-09-01DOI: 10.1016/j.sopen.2024.09.003
Brandon Shin BS, David Shin BS, Yasmine Siagian BS, Jairo Campos BA, M. Daniel Wongworawat MD, Marti F. Baum MD
Background
Access to surgical specialty care differs based on geographic location, insurance status, and subspecialty type. This study uses the Inland Empire as a model to determine the relationship between Social Vulnerability Indices (SVIs), surgeon sex, and surgical subspecialty distribution.
Methods
823 census tracts from the Centers for Disease Control's (CDC) SVI 2018 database were compared against 992 surgeons within 30 distinct subspecialties. This data was retrieved from the American Medical Association's (AMA) 2018 Physician Masterfile. Spearman's bivariate and multiple regression were used to compare the relationship between SVI and number of surgical subspecialists within each census tract.
Results
There were approximately 3.34 male and 0.35 female surgeons per census tract (t(267) = 7.74, p < 0.001). Significant inverse relationships existed between Cosmetic surgery, Urology and Minority status/language (ρ = −0.131 [95 % CI −1.000 to −0.028], p = 0.016; ρ = −0.142 [95 % CI −1.000 to −0.039], p = 0.010, respectively); General surgery, Socioeconomic status (ρ = −0.118 [95 % CI −1.000 to −0.014], p = 0.027), and Household composition/disability (ρ = −0.203 [95 % CI −1.000 to −0.102], p < 0.001); Hand surgery and Socioeconomic status (ρ = −0.114 [95 % CI −1.000 to −0.010], p = 0.031); Otolaryngology, Housing type/transportation (ρ = −0.102 [95 % CI −1.000 to 0.001], p = 0.047), and Overall Social Vulnerability (ρ = −0.105 [95 % CI −1.000 to −0.001], p = 0.043). Multiple regression analyses reinforced these findings.
Conclusions
This study concludes that social vulnerability is predictive of, and significantly linked to, differences in distribution of surgical subspecialty and surgeon gender. Future research should investigate recruitment of a diverse surgical workforce, infrastructural barriers to care, and differences in quality of care.
Key message
Our work demonstrates complex relationships between surgical subspecialist distribution, surgeon gender, and a census tract's various Social Vulnerability Indices. Thus, this research can serve to continue educating surgeons and other healthcare providers about the importance of social determinants of health in the construction of healthcare policy and practice, as well as incentivizing equitable recruitment of a diverse population of surgeons.
背景获得外科专科护理的机会因地理位置、保险状况和亚专科类型而异。本研究以内陆帝国为模型，确定社会弱势指数（SVI）、外科医生性别和外科亚专科分布之间的关系。方法将美国疾病控制中心（CDC）2018 年 SVI 数据库中的 823 个人口普查区与 30 个不同亚专科中的 992 名外科医生进行比较。这些数据取自美国医学会（AMA）2018 年医师主档案。斯皮尔曼双变量和多元回归用于比较每个人口普查区内 SVI 与外科亚专科医生数量之间的关系。结果每个人口普查区约有 3.34 名男性外科医生和 0.35 名女性外科医生（t(267) = 7.74，p <0.001）。美容外科、泌尿外科和少数民族身份/语言（ρ = -0.131 [95 % CI -1.000 to -0.028]，p = 0.016；ρ = -0.142 [95 % CI -1.000 to -0.039]，p = 0.010）；普通外科、社会经济地位（ρ = -0.118 [95 % CI -1.000 to -0.014]，p = 0.027）和家庭组成/残疾（ρ = -0.203 [95 % CI -1.000 to -0.102]，p < 0.001）；手部手术和社会经济地位（ρ = -0.114 [95 % CI -1.000 to -0.010]，p = 0.031）；耳鼻喉科、住房类型/交通（ρ = -0.102 [95 % CI -1.000 to 0.001]，p = 0.047）和整体社会脆弱性（ρ = -0.105 [95 % CI -1.000 to -0.001]，p = 0.043）。本研究得出结论，社会脆弱性可预测外科亚专业分布和外科医生性别的差异，并与之有显著联系。未来的研究应调查多元化外科队伍的招聘、医疗基础设施障碍以及医疗质量差异。关键信息我们的工作表明，外科亚专科分布、外科医生性别和人口普查区的各种社会脆弱性指数之间存在复杂的关系。因此，这项研究有助于继续教育外科医生和其他医疗服务提供者，让他们了解健康的社会决定因素在医疗政策和实践建设中的重要性，并激励他们公平地招聘多样化的外科医生。
{"title":"Surgical subspecialist distribution and Social Vulnerability Indices in the inland empire","authors":"Brandon Shin BS, David Shin BS, Yasmine Siagian BS, Jairo Campos BA, M. Daniel Wongworawat MD, Marti F. Baum MD","doi":"10.1016/j.sopen.2024.09.003","DOIUrl":"10.1016/j.sopen.2024.09.003","url":null,"abstract":"<div><h3>Background</h3><div>Access to surgical specialty care differs based on geographic location, insurance status, and subspecialty type. This study uses the Inland Empire as a model to determine the relationship between Social Vulnerability Indices (SVIs), surgeon sex, and surgical subspecialty distribution.</div></div><div><h3>Methods</h3><div>823 census tracts from the Centers for Disease Control's (CDC) SVI 2018 database were compared against 992 surgeons within 30 distinct subspecialties. This data was retrieved from the American Medical Association's (AMA) 2018 Physician Masterfile. Spearman's bivariate and multiple regression were used to compare the relationship between SVI and number of surgical subspecialists within each census tract.</div></div><div><h3>Results</h3><div>There were approximately 3.34 male and 0.35 female surgeons per census tract (<em>t</em>(267) = 7.74, <em>p</em> < 0.001). Significant inverse relationships existed between Cosmetic surgery, Urology and Minority status/language (ρ = −0.131 [95 % CI −1.000 to −0.028], <em>p</em> = 0.016; ρ = −0.142 [95 % CI −1.000 to −0.039], <em>p</em> = 0.010, respectively); General surgery, Socioeconomic status (ρ = −0.118 [95 % CI −1.000 to −0.014], <em>p</em> = 0.027), and Household composition/disability (ρ = −0.203 [95 % CI −1.000 to −0.102], <em>p</em> < 0.001); Hand surgery and Socioeconomic status (ρ = −0.114 [95 % CI −1.000 to −0.010], <em>p</em> = 0.031); Otolaryngology, Housing type/transportation (ρ = −0.102 [95 % CI −1.000 to 0.001], <em>p</em> = 0.047), and Overall Social Vulnerability (ρ = −0.105 [95 % CI −1.000 to −0.001], <em>p</em> = 0.043). Multiple regression analyses reinforced these findings.</div></div><div><h3>Conclusions</h3><div>This study concludes that social vulnerability is predictive of, and significantly linked to, differences in distribution of surgical subspecialty and surgeon gender. Future research should investigate recruitment of a diverse surgical workforce, infrastructural barriers to care, and differences in quality of care.</div></div><div><h3>Key message</h3><div>Our work demonstrates complex relationships between surgical subspecialist distribution, surgeon gender, and a census tract's various Social Vulnerability Indices. Thus, this research can serve to continue educating surgeons and other healthcare providers about the importance of social determinants of health in the construction of healthcare policy and practice, as well as incentivizing equitable recruitment of a diverse population of surgeons.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"21 ","pages":"Pages 27-34"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024001179/pdfft?md5=d02d874d0ad6d8dae3cb70e8afdd9626&pid=1-s2.0-S2589845024001179-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142310422","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 : 2024-09-01DOI: 10.1016/j.sopen.2024.09.002
Sergii Zemskov MD, PhD
{"title":"Challenges in developing academic surgery in a Ukrainian university clinic","authors":"Sergii Zemskov MD, PhD","doi":"10.1016/j.sopen.2024.09.002","DOIUrl":"10.1016/j.sopen.2024.09.002","url":null,"abstract":"","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"21 ","pages":"Pages 58-59"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142323266","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 : 2024-09-01DOI: 10.1016/j.sopen.2024.09.001
Liying Zhan , Jun Lin , Jingdi Chen , Yaojia Lao , Houshu Wang , Hang Gao , Li Liu , Wei Wu
Objective
To explore the application of enhanced recovery after surgery (ERAS) in the perioperative period of lung transplantation.
Methods
We retrospectively collected the clinical data of 27 lung transplant patients who underwent ERAS during the perioperative period, while 12 lung transplant patients receiving routine treatment served as controls. General information was collected, including the specific implementation plan of ERAS, the incidence of complications and survival rate during the perioperative period (<30 d), postoperative hospitalization indicators, the postoperative length of stay, and numerical rating scale (NRS) scores.
Results
Comparison of postoperative hospitalization indicators, the ERAS group compared with the control group, there were significant differences in postoperative ICU stay time (2.0(2.0,4.0) vs 4.5(3.0,6.0), p = 0.005), postoperative hospital stay time (18(15,26) vs 24(19.5,32.75), p = 0.016), duration of nasogastric tube (3(2,3) vs 4(2.25,4.75), p = 0.023), and first ambulation time (4(3,5) vs 5.8(4.5,7.5), p = 0.004). There was no significant difference in postoperative invasive mechanical ventilation time, time to eat after surgery, duration of urinary catheter and duration of chest tube between the ERAS group and the control group (p>0.05). The perioperative survival of the ERAS group was 81.5%, which was higher than the control group (66.7%), but there is no statistically significant difference. Comparison of post-extubation NRS scores, the ERAS group had lower NRS scores at 12 h (5.30 ± 0.14 vs 6.25 ± 0.75), 24 h (3.44 ± 0.64 vs 5.58 ± 0.9), 48 h (2.74 ± 0.66 vs 4.08 ± 0.79) and 72 h (1.11 ± 0.80 vs 2.33 ± 0.49) than the control group, the difference was statistically significant (p<0.01). Intra-group comparison, post-extubation 12 h comparison post-extubation 24 h, 48 h, 72 h, the NRS scores showed a gradual downward trend, the difference was statistically significant (p<0.01). In the comparison of perioperative complications, the ERAS group had a lower postoperative infection incidence than the control group, the difference was statistically significant (44.4% vs 83.3%, p = 0.037). The ERAS group had lower postoperative delirium incidence than the control group, the difference was statistically significant (11.1% vs 50%, p = 0.014). There was no significant difference in the incidence of acute rejection, primary graft loss (PGD), gastrointestinal (GI) complications and airway complications between two groups (p>0.05).
Conclusion
The ERAS can be applied to lung transplant patients to relieve postoperative pain, shorten postoperative tube time, and shorten postoperative stay. Perioperative pulmonary rehabilitation exercises are beneficial to reducing the occurrence of postoperative pulmonary complications.
方法 回顾性收集27例肺移植患者围手术期接受ERAS治疗的临床资料，12例肺移植患者接受常规治疗作为对照组。收集的一般资料包括ERAS的具体实施方案、围手术期（30 d）并发症发生率和存活率、术后住院指标、术后住院时间和数字评分量表（NRS）评分。结果比较术后住院指标，ERAS组与对照组相比，在术后ICU住院时间（2.0(2.0,4.0) vs 4.5(3.0,6.0)，P = 0.005）、术后住院时间（18（15,26） vs 24（19.5,32.75），p = 0.016）、鼻胃管持续时间（3（2,3） vs 4（2.25,4.75），p = 0.023）和首次下床活动时间（4（3,5） vs 5.8（4.5,7.5），p = 0.004）有显著差异。ERAS组与对照组在术后有创机械通气时间、术后进食时间、导尿时间和胸管插管时间上无明显差异（p>0.05）。ERAS组围手术期存活率为81.5%，高于对照组（66.7%），但差异无统计学意义。拔管后NRS评分比较，ERAS组在12 h（5.30±0.14 vs 6.25±0.75）、24 h（3.44±0.64 vs 5.58±0.9）、48 h（2.74±0.66 vs 4.08±0.79）和72 h（1.11±0.80 vs 2.33±0.49）的NRS评分均低于对照组，差异有统计学意义（P<0.01）。组内比较，拔管后12 h与拔管后24 h、48 h、72 h比较，NRS评分呈逐渐下降趋势，差异有统计学意义（P<0.01）。在围手术期并发症的比较中，ERAS组的术后感染发生率低于对照组，差异有统计学意义（44.4% vs 83.3%，P = 0.037）。ERAS组的术后谵妄发生率低于对照组，差异有统计学意义（11.1% vs 50%，P = 0.014）。结论 ERAS可用于肺移植患者，缓解术后疼痛，缩短术后插管时间，缩短术后住院时间。围手术期肺康复锻炼有利于减少术后肺部并发症的发生。
{"title":"The application of ERAS in the perioperative period management of patients for lung transplantation","authors":"Liying Zhan , Jun Lin , Jingdi Chen , Yaojia Lao , Houshu Wang , Hang Gao , Li Liu , Wei Wu","doi":"10.1016/j.sopen.2024.09.001","DOIUrl":"10.1016/j.sopen.2024.09.001","url":null,"abstract":"<div><h3>Objective</h3><p>To explore the application of enhanced recovery after surgery (ERAS) in the perioperative period of lung transplantation.</p></div><div><h3>Methods</h3><p>We retrospectively collected the clinical data of 27 lung transplant patients who underwent ERAS during the perioperative period, while 12 lung transplant patients receiving routine treatment served as controls. General information was collected, including the specific implementation plan of ERAS, the incidence of complications and survival rate during the perioperative period (<30 d), postoperative hospitalization indicators, the postoperative length of stay, and numerical rating scale (NRS) scores.</p></div><div><h3>Results</h3><p>Comparison of postoperative hospitalization indicators, the ERAS group compared with the control group, there were significant differences in postoperative ICU stay time (2.0(2.0,4.0) vs 4.5(3.0,6.0), <em>p</em> = 0.005), postoperative hospital stay time (18(15,26) vs 24(19.5,32.75), <em>p</em> = 0.016), duration of nasogastric tube (3(2,3) vs 4(2.25,4.75), <em>p</em> = 0.023), and first ambulation time (4(3,5) vs 5.8(4.5,7.5), <em>p</em> = 0.004). There was no significant difference in postoperative invasive mechanical ventilation time, time to eat after surgery, duration of urinary catheter and duration of chest tube between the ERAS group and the control group (p>0.05). The perioperative survival of the ERAS group was 81.5%, which was higher than the control group (66.7%), but there is no statistically significant difference. Comparison of post-extubation NRS scores, the ERAS group had lower NRS scores at 12 h (5.30 ± 0.14 vs 6.25 ± 0.75), 24 h (3.44 ± 0.64 vs 5.58 ± 0.9), 48 h (2.74 ± 0.66 vs 4.08 ± 0.79) and 72 h (1.11 ± 0.80 vs 2.33 ± 0.49) than the control group, the difference was statistically significant (p<0.01). Intra-group comparison, post-extubation 12 h comparison post-extubation 24 h, 48 h, 72 h, the NRS scores showed a gradual downward trend, the difference was statistically significant (p<0.01). In the comparison of perioperative complications, the ERAS group had a lower postoperative infection incidence than the control group, the difference was statistically significant (44.4% vs 83.3%, <em>p</em> = 0.037). The ERAS group had lower postoperative delirium incidence than the control group, the difference was statistically significant (11.1% vs 50%, <em>p</em> = 0.014). There was no significant difference in the incidence of acute rejection, primary graft loss (PGD), gastrointestinal (GI) complications and airway complications between two groups (p>0.05).</p></div><div><h3>Conclusion</h3><p>The ERAS can be applied to lung transplant patients to relieve postoperative pain, shorten postoperative tube time, and shorten postoperative stay. Perioperative pulmonary rehabilitation exercises are beneficial to reducing the occurrence of postoperative pulmonary complications.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"21 ","pages":"Pages 22-26"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024001155/pdfft?md5=a61cf345e9a21a88faaf156e518f38aa&pid=1-s2.0-S2589845024001155-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142239398","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 : 2024-09-01DOI: 10.1016/j.sopen.2024.09.006
Sydney C. Bertram , F. Riley Nichols , Lauren E. Cox , Deepak K. Ozhathil , Mike M. Mallah
Patients with limited English proficiency (LEP) experience reduced pain assessment and treatment, less comprehensive physical exams, and fewer explanations of the next steps in care. These disparities persist in hospitals with staffed professional interpreters, raising questions about interpreter access and the impact on outcomes. A retrospective review of 1133 trauma activations at a single center Level 1 Trauma Center in 2021–2022 was conducted. Demographic, injury, and outcome data were drawn from the institutional trauma registry, and patient-preferred language was pulled from EMR data. Early interpreter use was defined as documentation of professional interpreter use within 24 h of arrival. LOS and ICU LOS were compared between language groups using Cox regression, and mortality was compared using Fischer's exact test. 1114 patients had data available on initial injury severity and preferred language. Of the 70 LEP patients, 62 (88.6 %) required an interpreter, and 41 of those (66.1 %) had evidence of professional interpreter use within 24 h of arrival. LEP patients who lacked early interpreter use had longer hospital stays than both English proficient (EP) patients (HR 0.59, p < 0.05) and LEP patients with early interpreter use (HR 0.51, p < 0.05) when stratified by ISS and controlling for GCS and patient age. There is no difference in LOS between LEP trauma patients who used an interpreter and EP patients, suggesting that early use of an interpreter may improve the length of stay in LEP trauma patients.
{"title":"Early use of professional interpreters improves trauma outcomes: Results of a single-center retrospective study","authors":"Sydney C. Bertram , F. Riley Nichols , Lauren E. Cox , Deepak K. Ozhathil , Mike M. Mallah","doi":"10.1016/j.sopen.2024.09.006","DOIUrl":"10.1016/j.sopen.2024.09.006","url":null,"abstract":"<div><div>Patients with limited English proficiency (LEP) experience reduced pain assessment and treatment, less comprehensive physical exams, and fewer explanations of the next steps in care. These disparities persist in hospitals with staffed professional interpreters, raising questions about interpreter access and the impact on outcomes. A retrospective review of 1133 trauma activations at a single center Level 1 Trauma Center in 2021–2022 was conducted. Demographic, injury, and outcome data were drawn from the institutional trauma registry, and patient-preferred language was pulled from EMR data. Early interpreter use was defined as documentation of professional interpreter use within 24 h of arrival. LOS and ICU LOS were compared between language groups using Cox regression, and mortality was compared using Fischer's exact test. 1114 patients had data available on initial injury severity and preferred language. Of the 70 LEP patients, 62 (88.6 %) required an interpreter, and 41 of those (66.1 %) had evidence of professional interpreter use within 24 h of arrival. LEP patients who lacked early interpreter use had longer hospital stays than both English proficient (EP) patients (HR 0.59, <em>p</em> < 0.05) and LEP patients with early interpreter use (HR 0.51, <em>p</em> < 0.05) when stratified by ISS and controlling for GCS and patient age. There is no difference in LOS between LEP trauma patients who used an interpreter and EP patients, suggesting that early use of an interpreter may improve the length of stay in LEP trauma patients.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"21 ","pages":"Pages 52-57"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142323267","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 : 2024-09-01DOI: 10.1016/j.sopen.2024.08.001
Nicole Martin MD, MPH , Areg Grigorian MD , Francesca A. Kimelman MD, MPH , Zeljka Jutric MD , Stephen Stopenski MD , David K. Imagawa MD, PhD , Ron F. Wolf MD , Shimul Shah MD, MHCM , Jeffry Nahmias MD, MHPE
Background
The role of neoadjuvant therapy (NAT) in gallbladder cancer (GBC) is not well established. We sought to evaluate the effect of NAT on postoperative outcomes following surgical resection of GBC. We hypothesized that patients receiving NAT would have similar rates of 30-day mortality, readmission, and postoperative complications (e.g. bile leakage and liver failure) compared to those who did not receive NAT.
Methods
The 2014–2017 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Procedure-Targeted Hepatectomy database was queried for patients that underwent surgery for GBC. Propensity scores were calculated to match patients in a 1:2 ratio based on age, comorbidities, functional status, and tumor staging.
Results
A total of 37 patients undergoing NAT were matched to 74 patients without NAT. There was no difference in any matched characteristics. Compared to the NAT group, the no NAT cohort had similar rates of postoperative bile leakage (NAT 13.5 % vs. no NAT 10.8 %, p = 0.31), postoperative liver failure (5.4 %, vs. 8.1 %, p = 0.60), 30-day readmission (10.8 % vs. 10.8 %, p = 1.00), and 30-day mortality (10.8 % vs. 2.7 %, p = 0.075). All 30-day complications were similar except for a higher rate of postoperative blood transfusion (NAT 32.4 % vs. no NAT 10.8 %, p = 0.005).
Conclusion
In patients undergoing surgical resection for GBC, those with and without NAT had similar rates of readmission and 30-day mortality, however NAT was associated with an increased risk for transfusion. Despite use of a large national database, this study may be underpowered to adequately assess the effect of NAT on perioperative GBC outcomes and thus warrants further investigation.
{"title":"Analysis of neoadjuvant therapy effect on 30-day postoperative outcomes in gallbladder cancer","authors":"Nicole Martin MD, MPH , Areg Grigorian MD , Francesca A. Kimelman MD, MPH , Zeljka Jutric MD , Stephen Stopenski MD , David K. Imagawa MD, PhD , Ron F. Wolf MD , Shimul Shah MD, MHCM , Jeffry Nahmias MD, MHPE","doi":"10.1016/j.sopen.2024.08.001","DOIUrl":"10.1016/j.sopen.2024.08.001","url":null,"abstract":"<div><h3>Background</h3><p>The role of neoadjuvant therapy (NAT) in gallbladder cancer (GBC) is not well established. We sought to evaluate the effect of NAT on postoperative outcomes following surgical resection of GBC. We hypothesized that patients receiving NAT would have similar rates of 30-day mortality, readmission, and postoperative complications (e.g. bile leakage and liver failure) compared to those who did not receive NAT.</p></div><div><h3>Methods</h3><p>The 2014–2017 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Procedure-Targeted Hepatectomy database was queried for patients that underwent surgery for GBC. Propensity scores were calculated to match patients in a 1:2 ratio based on age, comorbidities, functional status, and tumor staging.</p></div><div><h3>Results</h3><p>A total of 37 patients undergoing NAT were matched to 74 patients without NAT. There was no difference in any matched characteristics. Compared to the NAT group, the no NAT cohort had similar rates of postoperative bile leakage (NAT 13.5 % vs. no NAT 10.8 %, <em>p</em> = 0.31), postoperative liver failure (5.4 %, vs. 8.1 %, <em>p</em> = 0.60), 30-day readmission (10.8 % vs. 10.8 %, <em>p</em> = 1.00), and 30-day mortality (10.8 % vs. 2.7 %, <em>p</em> = 0.075). All 30-day complications were similar except for a higher rate of postoperative blood transfusion (NAT 32.4 % vs. no NAT 10.8 %, <em>p</em> = 0.005).</p></div><div><h3>Conclusion</h3><p>In patients undergoing surgical resection for GBC, those with and without NAT had similar rates of readmission and 30-day mortality, however NAT was associated with an increased risk for transfusion. Despite use of a large national database, this study may be underpowered to adequately assess the effect of NAT on perioperative GBC outcomes and thus warrants further investigation.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"21 ","pages":"Pages 17-21"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024001118/pdfft?md5=9aa8a8ec2d9b1d9f6e321b27db3ed5ec&pid=1-s2.0-S2589845024001118-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142122098","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}
Postoperative delirium (POD) is an acute postoperative syndrome of the central nervous system that seriously affects the prognosis of patients. Many vital advances have been made in the study of the management of POD. We conducted a bibliometric analysis of research on the prevention and treatment of POD over the past 20 years to consolidate current research focal points and emerging trends in this domain.
Methods
We searched the Web of Science Core Collection database for literature published between 2004 and 2023. VOSviewer, CiteSpace, Microsoft Excel, Scimago Graphica, and the R tool “bibliometrix” were used to analyze and visualize annual publications, countries, organizations, journals, authors, keywords, and references.
Results
A total of 1848 eligible publications were identified, with a general uptrend observed in both annual publications and citations. The USA was the most profitable country, ranking first in total publications. The most active institution was Harvard Medical School. Inouye, Sharon K was the most prolific scholar due to her numerous publications and citations. According to the co-occurrence network, the strongest citation bursts and co-cited references analysis fresh hot topics included “dexmedetomidine,” “neuroinflammation,” “haloperidol prophylaxis,” and “guideline.”
Conclusions
Research on prevention and treatment of POD is gaining significant momentum worldwide. Current hot spots include early perioperative prevention strategies and integrated multi-method treatments. Effective drugs for it is one of the directions in the future. The management of pediatric patients with POD has caused concern in recent years. This bibliometric analysis is poised to guide future research trajectories in this field.
背景术后谵妄（POD）是中枢神经系统的一种急性术后综合征，严重影响患者的预后。术后谵妄的治疗研究取得了许多重要进展。我们对过去 20 年中有关 POD 预防和治疗的研究进行了文献计量分析，以整合该领域当前的研究重点和新趋势。我们使用 VOSviewer、CiteSpace、Microsoft Excel、Scimago Graphica 和 R 工具 "bibliometrix "对年度出版物、国家、组织、期刊、作者、关键词和参考文献进行了分析和可视化。美国是发表论文最多的国家，论文总数排名第一。最活跃的机构是哈佛大学医学院。Inouye, Sharon K是最多产的学者，因为她发表了大量论文并被引用。根据共现网络，最强的引文爆发和共引参考文献分析新鲜的热点话题包括 "右美托咪定"、"神经炎症"、"氟哌啶醇预防 "和 "指南"。目前的研究热点包括围术期早期预防策略和多种方法的综合治疗。有效的治疗药物是未来的发展方向之一。近年来，儿科 POD 患者的管理引起了人们的关注。这项文献计量分析将为该领域未来的研究轨迹提供指导。
{"title":"The hot spots and global trends of prevention and treatment in postoperative delirium (POD) from 2004 to 2023: A bibliometric analysis","authors":"Changshuo Jiang , Zijun Tian , Ming Jiang , Chenyang Xu, Mingjie Mao, Shanwu Feng, Hongmei Yuan","doi":"10.1016/j.sopen.2024.09.005","DOIUrl":"10.1016/j.sopen.2024.09.005","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative delirium (POD) is an acute postoperative syndrome of the central nervous system that seriously affects the prognosis of patients. Many vital advances have been made in the study of the management of POD. We conducted a bibliometric analysis of research on the prevention and treatment of POD over the past 20 years to consolidate current research focal points and emerging trends in this domain.</div></div><div><h3>Methods</h3><div>We searched the Web of Science Core Collection database for literature published between 2004 and 2023. VOSviewer, CiteSpace, Microsoft Excel, Scimago Graphica, and the R tool “bibliometrix” were used to analyze and visualize annual publications, countries, organizations, journals, authors, keywords, and references.</div></div><div><h3>Results</h3><div>A total of 1848 eligible publications were identified, with a general uptrend observed in both annual publications and citations. The USA was the most profitable country, ranking first in total publications. The most active institution was Harvard Medical School. Inouye, Sharon K was the most prolific scholar due to her numerous publications and citations. According to the co-occurrence network, the strongest citation bursts and co-cited references analysis fresh hot topics included “dexmedetomidine,” “neuroinflammation,” “haloperidol prophylaxis,” and “guideline.”</div></div><div><h3>Conclusions</h3><div>Research on prevention and treatment of POD is gaining significant momentum worldwide. Current hot spots include early perioperative prevention strategies and integrated multi-method treatments. Effective drugs for it is one of the directions in the future. The management of pediatric patients with POD has caused concern in recent years. This bibliometric analysis is poised to guide future research trajectories in this field.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"21 ","pages":"Pages 35-44"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024001209/pdfft?md5=2e1d34c265e0347aab7bdf15e6e9c2db&pid=1-s2.0-S2589845024001209-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142310423","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 : 2024-09-01DOI: 10.1016/j.sopen.2024.09.004
Fassil Mihretu , Telake Azale , Foziya Mohammed , Amare Agumas , Sara Timerga , Aynalem Befikadu
Introduction
Postoperative myalgia in surgical patients is mainly caused by the routinely administered depolarizing muscle relaxant, Succinylcholine. There are many proposed strategies but no one were indicated as ideal preventive mechanisms for Succinylcholine induced post-operative myalgia. Even if data were sparse, Lidocaine pretreatment can reduce postoperative myalgia which requires further supportive evidences urging the initiation of this study.
Methods
Prospective longitudinal cohort study was conducted from March to May 2021 at Dessie Comprehensive Specialized Hospital on 208 adult surgical patients. Patients pretreated with Lidocaine preoperatively were grouped as exposed and others as unexposed. Patients meeting the inclusion criteria during the study period were selected sequentially from the daily operation schedule list. Postoperative myalgia level was measured using post-operative myalgia survey repeatedly. The result was analyzed by Cochran's Q test and generalized estimating equation (GEE). Adjusted odds ratio with 95 % confidence interval and p value < 0.05 was used to show the difference, direction and strength of association.
Result
Exposure specific incidence rate showed that 22 %, 22 % and 29.8 % of patients exposed to Lidocaine and 40.6 %, 42.7 % and 34 % not exposed to Lidocaine developed myalgia at 12, 24, and 48 h respectively. There is no significant difference in the incidence of myalgia over time between the repeated measurements in Lidocaine exposed patients (p = 0.513) but in non-exposed patients (p = 0.003). Also, there is no difference in the distribution of other predictors between Lidocaine exposed and non-exposed groups (p > 0.05). Exposure to Lidocaine reduces postoperative myalgia significantly [AOR = 0.33, 95 % CI = (0.17,0.66)]. Multimodal analgesia [AOR = 0.32, 95 % CI = (0.18,0.55)], non-steroidal anti-inflammatory drugs alone [AOR = 0.47, 95 % CI = (0.29,0.76)], postoperative immobility [AOR = 0.61, 95 % CI = (0.47,0.8)], and being male [AOR = 0.48, 95 % CI = (0.26,0.87)] were other determinants in reducing Succinylcholine induced postoperative myalgia.
Conclusion
Lidocaine pretreatment can significantly reduce the occurrence of Succinylcholine induced postoperative myalgia. Additionally, usage of multimodal analgesia with non-steroidal anti-inflammatory drugs or even only non-steroidal anti-inflammatory drugs in the intraoperative and postoperative period can reduce Succinylcholine induced postoperative myalgia.
{"title":"Lidocaine pre-treatment for Succinylcholine induced postoperative myalgia and associated factors: Longitudinal study","authors":"Fassil Mihretu , Telake Azale , Foziya Mohammed , Amare Agumas , Sara Timerga , Aynalem Befikadu","doi":"10.1016/j.sopen.2024.09.004","DOIUrl":"10.1016/j.sopen.2024.09.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Postoperative myalgia in surgical patients is mainly caused by the routinely administered depolarizing muscle relaxant, Succinylcholine. There are many proposed strategies but no one were indicated as ideal preventive mechanisms for Succinylcholine induced post-operative myalgia. Even if data were sparse, Lidocaine pretreatment can reduce postoperative myalgia which requires further supportive evidences urging the initiation of this study.</div></div><div><h3>Methods</h3><div>Prospective longitudinal cohort study was conducted from March to May 2021 at Dessie Comprehensive Specialized Hospital on 208 adult surgical patients. Patients pretreated with Lidocaine preoperatively were grouped as exposed and others as unexposed. Patients meeting the inclusion criteria during the study period were selected sequentially from the daily operation schedule list. Postoperative myalgia level was measured using post-operative myalgia survey repeatedly. The result was analyzed by Cochran's Q test and generalized estimating equation (GEE). Adjusted odds ratio with 95 % confidence interval and <em>p</em> value < 0.05 was used to show the difference, direction and strength of association.</div></div><div><h3>Result</h3><div>Exposure specific incidence rate showed that 22 %, 22 % and 29.8 % of patients exposed to Lidocaine and 40.6 %, 42.7 % and 34 % not exposed to Lidocaine developed myalgia at 12, 24, and 48 h respectively. There is no significant difference in the incidence of myalgia over time between the repeated measurements in Lidocaine exposed patients (<em>p</em> = 0.513) but in non-exposed patients (<em>p</em> = 0.003). Also, there is no difference in the distribution of other predictors between Lidocaine exposed and non-exposed groups (<em>p</em> > 0.05). Exposure to Lidocaine reduces postoperative myalgia significantly [AOR = 0.33, 95 % CI = (0.17,0.66)]. Multimodal analgesia [AOR = 0.32, 95 % CI = (0.18,0.55)], non-steroidal anti-inflammatory drugs alone [AOR = 0.47, 95 % CI = (0.29,0.76)], postoperative immobility [AOR = 0.61, 95 % CI = (0.47,0.8)], and being male [AOR = 0.48, 95 % CI = (0.26,0.87)] were other determinants in reducing Succinylcholine induced postoperative myalgia.</div></div><div><h3>Conclusion</h3><div>Lidocaine pretreatment can significantly reduce the occurrence of Succinylcholine induced postoperative myalgia. Additionally, usage of multimodal analgesia with non-steroidal anti-inflammatory drugs or even only non-steroidal anti-inflammatory drugs in the intraoperative and postoperative period can reduce Succinylcholine induced postoperative myalgia.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"21 ","pages":"Pages 45-51"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024001180/pdfft?md5=21859384b67984b733588bdadcf7520e&pid=1-s2.0-S2589845024001180-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315034","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 : 2024-08-26DOI: 10.1016/j.sopen.2024.08.004
Olivier Sibomana
Surgical conditions account for 11 % of the global burden of disease, with over 313 million surgical procedures performed worldwide each year. This underscores the critical need to train more surgeons, particularly in low- and middle-income countries (LMICs), where disparities in access to surgical services persist due to a limited number of trained professionals. However, in resource-restricted settings, surgical education is often hampered by ethical, logistical, and financial challenges associated with the use of cadavers, leading to significant skill gaps that can negatively impact patient outcomes and exacerbate healthcare disparities. The advent of advanced technologies, such as Virtual Reality (VR), offers a promising alternative for enhancing surgical training. This paper explores the potential of VR to revolutionize surgical education in resource-constrained environments and addresses key considerations for its effective implementation.
{"title":"Could virtual reality be a solution in surgical trainings in resource-restricted settings? A perspective","authors":"Olivier Sibomana","doi":"10.1016/j.sopen.2024.08.004","DOIUrl":"10.1016/j.sopen.2024.08.004","url":null,"abstract":"<div><p>Surgical conditions account for 11 % of the global burden of disease, with over 313 million surgical procedures performed worldwide each year. This underscores the critical need to train more surgeons, particularly in low- and middle-income countries (LMICs), where disparities in access to surgical services persist due to a limited number of trained professionals. However, in resource-restricted settings, surgical education is often hampered by ethical, logistical, and financial challenges associated with the use of cadavers, leading to significant skill gaps that can negatively impact patient outcomes and exacerbate healthcare disparities. The advent of advanced technologies, such as Virtual Reality (VR), offers a promising alternative for enhancing surgical training. This paper explores the potential of VR to revolutionize surgical education in resource-constrained environments and addresses key considerations for its effective implementation.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"21 ","pages":"Pages 14-16"},"PeriodicalIF":1.4,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024001143/pdfft?md5=3295df3781c5e54575810774055575fb&pid=1-s2.0-S2589845024001143-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142083630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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