Surgery open science最新文献

Changes in cardiothoracic surgery (CTS) workforce trends have affected training paradigms to include the establishment of integrated six-year CTS residency (I6) programs. This study aimed to determine commitment of selected I6 program applicants to the specialty.

Internal archives at a single institution were accessed to identify applicants interviewed for an I6 position from 2014 to 2016. A systematic internet search of publicly available information was performed to identify the trainee's current specialty. Descriptive analysis was performed.

Forty-seven applicants were identified. Successful search results were achieved for 97.9 % of the applicants. One applicant was excluded, resulting in a cohort of 45. 48.9 % of the applicants successfully matched into I6 programs. Of the 23 who did not match into an I6 program, 91.3 % began a General Surgery (GS) residency. When looking solely at the GS trainees, 71.4 % sought and matched into a traditional or 4/3 CTS residency. In total, 77.8 % of the cohort are currently pursuing careers in cardiothoracic surgery.

The study identified a strong continued interest in the field of CT Surgery among those interviewed for integrated residency. The methodology used in this study provided an effective way to follow career choice of applicants interviewed and could be applied by additional programs to further elucidate career choice and levels of commitment.

Background

In past studies, non-medical factors in the social-healthcare-patient triad associated with the prevalence of COVID-19 have led to delays in the presentation of patients with acute appendicitis and an increase in complications. However, as research progresses, there is increasing evidence of a clinical association between COVID-19 and the development of acute appendicitis.

Methods

The effect of COVID-19 prevalence and associated factors on acute appendicitis in the control (2016–2019) and exposed (2020−2023) groups was derived from a retrospective study of 3070 patients with acute appendicitis from 2016 to 2023.

Results

After the implementation of the restrictions, the rate of acute appendicitis visits in the exposed group compared to the control group dropped sharply in the initial period (P = 0.047) and recovered gradually with the relaxation of the restrictions. Similar changes occurred in the number of acute complicated appendicitis visits. In addition, after the lifting of restrictions and the COVID-19 outbreak, the proportion of acute complicated appendicitis in the exposed group increased significantly (P < 0.001) and an increase in the number of complicated appendicitis visits was observed (P < 0.001) compared with the control group. In addition, the age distribution of acute appendicitis during this period showed an ageing trend (P = 0.001).

Conclusion

COVID-19 infections may be more likely to progress to complicated appendicitis after an episode of appendicitis, even if they have been cured for the same period of time. In addition, the proportion of elderly patients with appendicitis increased after the COVID-19 epidemic.

Objectives

We developed a new simulator for hands-on teaching of vascular surgical skills, the Leipzig Latex Patch Model (LPM). This study aimed to quantify the effectiveness and acceptance of the LPM evaluated by students, as well as evaluation of the results by experienced vascular surgeons.

Methods

A prospective, single-center, single-blinded, randomized study was conducted. Fifty 5th-year medical students were randomized into two groups, first performing a patch suture on the LPM (study group) or established synthetic tissue model (control), then on porcine aorta. The second suture was videotaped and scored by two surgeons using a modified Objective Structured Assessment of Technical Skill (OSATS) score. We measured the time required for suturing; the participants completed questionnaires.

Results

Participants required significantly less time for the second suture than the first (median: LPM 30 min vs. control 28.5 min, p = 0.0026). There was no significant difference in suture time between the groups (median: 28 min vs. 30 min, p = 0.2958). There was an increase in confidence from 28 % of participants before to 58 % after the course (p < 0.0001). The cost of materials per participant was 1.05€ (LPM) vs. 8.68€ (control). The OSATS-scores of the LPM group did not differ significantly from those of the control (median: 20.5 points vs. 23.0 points, p = 0.2041).

Conclusions

This pilot study demonstrated an increase in technical skills and confidence through simulator-based teaching. Our data suggests comparable results of the LPM compared to the conventional model, as assessed by the OSATS-score. This low-cost, low-threshold training model for vascular suturing skills should make hands-on training more accessible to students and surgical residents.

Key message

We developed and validated a low-cost, low-threshold training model for vascular suturing skills. This should make hands-on training more accessible to medical students and surgical residents in the future.

Background

Minimally invasive hemorrhoid surgeries like Doppler-Guided Hemorrhoidal Artery Ligation (DGHAL) and Stapled Hemorrhoidopexy (PPH) offer benefits over traditional methods. This study investigated public perceptions and attitudes towards these surgeries, exploring awareness, preferences, and influencing factors.

Methods

A detailed questionnaire was disseminated to 2011 participants from various regions of Taiwan in December 2023, gathering data on demographics, understanding of minimally invasive surgery, and attitudes towards hemorrhoid surgery. Chi-square tests were used for analysis (p < 0.05).

Results

Hemorrhoid prevalence was similar across sexes and age groups. About 70 % preferred medical centers or district hospitals for surgery. Postoperative complications were a primary concern, with significant sex differences. Approximately 70 % preferred minimally invasive surgery if costs were below NT$50,000. Medical personnel showed higher awareness of minimally invasive surgery benefits. Most participants relied on personal networks and medical social media for information.

Conclusions

The study revealed generally positive perceptions of minimally invasive hemorrhoid surgery, with cost being a significant factor. Knowledge gaps exist, particularly among non-medical personnel. Future initiatives should aim to enhance public awareness of minimally invasive surgery benefits, and policy considerations should address financial aspects of healthcare decisions.

Background

Previous reports identified an association between obese adolescents (OAs) and lower extremity (LE) fractures after blunt trauma. However, the type of LE fracture remains unclear. We hypothesized that OAs presenting after motor vehicle collision (MVC) have a higher risk of severe LE fracture and will require a longer length of stay (LOS) and more support services upon discharge, compared to non-OAs.

Methods

The 2017–2019 Trauma Quality Improvement Program database was queried for adolescents (12–17-years-old) presenting after MVC. The primary outcome was LE fracture. A severe fracture was defined by abbreviated injury scale ≥3. OAs were defined by a body mass index (BMI) ≥30.

Results

From 22,610 MVCs, 3325 (14.7 %) included OAs. The rate of any LE fracture was higher for OAs (21.6 % vs. 18.8 %, p < 0.001). On subset analysis the only LE fracture at higher risk in OAs was a femur fracture (13 % vs. 9.1 %, p < 0.001). After adjusting for sex and age, the risk for severe LE fracture (OR 1.34, CI 1.18–1.53, p < 0.001) was higher for OAs. OAs with a femur fracture had a longer median LOS (5 vs. 4 days, p = 0.003) and were more likely discharged with additional support services including home-health or inpatient rehabilitation (30.6 % vs. 21.4 %, p < 0.001).

Conclusion

OAs sustaining MVCs have increased associated risk of femur fractures. OAs are more likely to have a higher-grade LE injury, experience a longer LOS, and require additional support services upon discharge. Future research is needed to determine if early disposition planning with social work assistance can help shorten LOS.

Objectives

The optimal management of perforated appendicitis remains controversial. Many studies advocate for antibiotics and an interval appendectomy whereas others suggest that performing an appendectomy at the time of presentation decreases post-operative morbidity. Confounding this argument further are the patients who fail non-operative management and end up requiring surgery during their initial hospitalization. This study aims to determine if early operative intervention should be considered for perforated appendicitis.

Methods

This was a retrospective review of all patients who underwent an appendectomy (both laparoscopic or open) for perforated appendicitis between 2015 and 2020 at our institution.

Results

A total of 271 patients met inclusion criteria for this study. Of this group, 250 patients underwent an immediate appendectomy whereas the remaining 21 patients underwent a trial of non-operative management and eventually required an appendectomy during their initial admission. When comparing the immediate versus delayed operative groups, there were no differences in demographic data including age and gender, and no differences in various imaging findings including AAST Grade IV or V appendicitis. Operatively, patients in the delayed group had a longer operative time (83.1 ± 32.9 vs. 64.1 ± 26.2, p = 0.01), were more likely to require an open operation (23.8 % vs. 2.8 %, p < 0.0001), and were more likely to have a drain placed intra-operatively (42.9 % vs 14.4 %, p = 0.004). While there were no differences in 30-day readmission rates, patients in the delayed group had a significantly longer hospital length of stay than patients in the immediate group (9.4 ± 7.4 vs. 3.1 ± 3.3, p = 0.008).

Conclusions

Patients undergoing an immediate appendectomy for perforated appendicitis can discharge from the hospital sooner and demonstrate no increase in post-operative morbidity suggesting that surgeons can initially manage this disease process in an operative fashion.

Background

Patients with resectable (R) or borderline resectable (BR) pancreatic ductal adenocarcinoma (PDAC) sometimes show unexpected liver, peritoneal, and para-aortic lymph node metastases intraoperatively. Despite radical pancreatectomy, a nonnegligible number of patients relapse within 6 months after surgery. The aim of this study was to identify the preoperative predictors of occult metastases (OM), defined as intraoperative distant metastases or within 6 months after pancreatectomy.

Materials and methods

This study included patients with R and BR PDAC who underwent curative-intent pancreatectomy or staging laparoscopy between 2006 and 2021. Multivariate logistic regression and Cox hazard analyses were performed to identify the preoperative predictors of OM and to assess the impact of these factors on prognosis after pancreatectomy.

Results

Of the 279 patients, OM was observed intraoperatively in 47 and postoperatively in 34. In the OM group, there were no differences in prognosis between patients who had intraoperative metastases and recurrence within 6 months (median survival time [MST], 18.1 vs. 12.9 months), and between patients who underwent pancreatectomy and those who did not (MST, 13.9 vs. 18.1 months). Preoperative tumor size ≥22 mm (odds ratio [OR], 2.03; 95 % confidence interval [CI], 1.16–3.53; p = 0.013) and preoperative CA19–9 level ≥ 118.8 U/mL (OR, 2.64; 95 % CI, 1.22–5.73; p = 0.014) were significant predictors of OM. Additionally, positive OM predictors were strong independent prognostic factors for overall survival after pancreatectomy (hazard ratio, 2.47; 95 % CI, 1.54–3.98; p < 0.001).

Conclusion

Multidisciplinary treatment strategies should be considered for patients with predictors of OM to avoid inappropriate surgical interventions.

Background

There is a paucity of literature guiding trauma surgeons in the care of patients with active metastatic cancer (MC). Even less is known regarding outcomes for MC patients requiring emergent surgery after trauma. We hypothesized that trauma patients with active Metastatic Cancer (MC) have an increased mortality rate and undergo increased rates of withdrawal of care (WoC) within 72-hours following emergent operations, compared to similarly matched patients without MC.

Methods

Patients with active MC at the time of traumatic injury were matched 1:2 against patients without active MC based on demographics, comorbidities, vital signs on admission, and injury profile.

Results

From 43,826 patients, 0.2 % had MC. After matching 39 MC patients to 78 without MC, there was no difference in demographics, comorbidities, injury severity score, mechanism of injury, vitals on admission (blood pressure, heart rate, respiration rate) and need for blood transfusion (all p > 0.05). Compared to patients without MC, patients with MC had higher rates and associated risk of death during index hospitalization (38.5 % vs. 15.2 %, p = 0.005; OR 3.49, CI 1.43–8.51, p = 0.006), as well as a higher rate and associated risk of WoC within 72-hours (12.8 % vs. 1.3 %, p = 0.007; OR 11.47, CI 1.29–101.93, p = 0.029).

Conclusion

Trauma patients with MC requiring emergent thoracic or abdominal surgery have a high risk of death and an over ten-fold higher associated risk for WoC within the first three days. In some cases, palliative care consultation should be considered, and counseling should be offered to this high-risk trauma population to enable individualized and patient-centric decisions.

Key message

This research highlights the importance of a multidisciplinary team consisting of trauma surgeons, oncologist, and palliative care physicians in caring for the high-risk trauma patients with disseminated cancer requiring urgent surgery.