Surgery open science最新文献_第8页

Feasibility of intraluminal oxygen delivery after minimally invasive esophagus resection 微创食管切除术后腔内供氧的可行性

IF 1.7 Q3 SURGERY

Surgery open science

Pub Date : 2025-07-30 DOI: 10.1016/j.sopen.2025.07.004

Douwe van der Steen MSc , Anne M. Leferink PhD , Frederieke A. Dijkstra MD , Boudewijn van Etten MD, PhD , Eric Keus MD, PhD , Rutger J. Spruit MD , Roy J.J. Verhage MD, PhD , Jeroen J. Kolkman MD , Jan Willem Haveman MD, PhD

Introduction

Anastomotic leakage (AL) is a severe complication after esophagectomy. Intraluminal oxygen delivery at the anastomosis site might improve the viability of the tissue and thereby reduce the incidence of AL. We present a feasibility study of intraluminal oxygen delivery after esophagectomy.

Methods

Eighteen patients scheduled for robot-assisted minimally invasive esophagectomy with an intrathoracic anastomosis were selected to receive an additional manometry catheter for intraluminal oxygen delivery at the anastomosis site. The primary endpoint was the feasibility of placing the catheter in the correct position and staying in situ for five days postoperatively. Intraluminal pressure was monitored during oxygen delivery at flow rates of 0 (control group), 1, 2, or 4 ml/min. Patients were questioned on the comfort of the catheter.

Results

In two patients, intraoperative placement of the catheter was unsuccessful. Two others replaced these patients according to the study protocol. 16 patients were analyzed. In five patients, the catheter was accidentally removed before the end of the study. The primary endpoint was successful in 11/16 patients (69 %). Intraluminal pressure in the 1 ml/min group did not differ from the control group. Intraluminal pressure in the 2 ml/min group increased substantially compared to the control group. Patients reported comfort rates that decreased over time.

Conclusion

This study shows that it is feasible to administer intraluminal oxygen in the first five days after esophagectomy and that a flow rate of 1 ml/min is not associated with increased intraluminal pressure. Future studies are required to study the effectiveness of intraluminal oxygen delivery in preventing AL.

吻合口漏是食管切除术后的严重并发症。吻合口腔内供氧可提高组织活力，从而减少AL的发生率。我们提出了食管切除术后腔内供氧的可行性研究。方法选择18例行机器人辅助微创食管切除术胸内吻合的患者，在吻合处附加测压导管供氧。主要终点是将导管放置在正确位置的可行性，并在术后5天内保持原位。以0（对照组）、1、2或4 ml/min的流速给氧时监测腔内压力。病人被询问导管的舒适度。结果2例患者术中置管不成功。根据研究方案，另外两名患者代替了这些患者。对16例患者进行分析。在五名患者中，导管在研究结束前被意外取出。主要终点有11/16（69%）患者成功。1 ml/min组的腔内压与对照组无差异。与对照组相比，2 ml/min组的腔内压显著升高。患者报告的舒适率随着时间的推移而下降。结论食管切除术后5天内给予腔内氧是可行的，1 ml/min的流速与腔内压力升高无关。需要进一步研究腔内供氧在预防AL中的有效性。

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引用次数: 0

Cost comparison of laparoscopic versus open surgery for common procedures in Rwandan teaching hospitals 卢旺达教学医院常见手术的腹腔镜与开放手术的成本比较

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-07-08 DOI: 10.1016/j.sopen.2025.07.001

King Kayondo , Martin Nyundo , Miguel Gasakure , Janvière Mutamuliza , Leon Ngeruka , Regis Hitimana , Julien Gashegu , Annie Robert

Objective

This study evaluates the economic and clinical impacts of minimally invasive surgery (MIS) compared to open surgery (Open S) for four common procedures—appendectomy, cholecystectomy, hernia repair, and ovarian cystectomy—at two major teaching hospitals in Rwanda, RMRTH and CHUK. The aim is to assess direct costs, hospital stays, complications, and recovery times for MIS versus Open S and to explore the role of health insurance in MIS accessibility.

Methods

A retrospective analysis was conducted on data from 206 patients treated between 2019 and 2022, with 100 undergoing Open S and 106 receiving MIS. Data included direct costs, hospital stay lengths, post-operative complications, and recovery times. The study also examined the correlation between MIS utilization and health insurance.

Results

The average patient age was 41.7 years, with nearly equal gender distribution (52.4 % male, 47.6 % female). Most patients (79.1 %) had Community-Based Health Insurance coverage. Laparoscopic cholecystectomy showed significant economic advantages, with shorter stays, fewer complications, and faster recovery (p < 0.02). MIS for hernia repair offered quicker recovery but incurred higher costs. For appendectomy and ovarian cystectomy, there was no significant cost difference between MIS and Open S. A strong positive correlation was found between MIS adoption rates and health insurance, supporting improved access.

Conclusion

MIS in Rwanda shows promise for economic savings, better patient outcomes, and expanded access through insurance. However, challenges like high consumable costs and limited expertise need to be addressed to fully optimize MIS benefits in Rwanda's healthcare system.

目的：本研究在卢旺达RMRTH和CHUK两家主要教学医院对四种常见手术（阑尾切除术、胆囊切除术、疝修补术和卵巢膀胱切除术）进行了微创手术（MIS）与开放手术（open S）的经济和临床影响进行了比较。目的是评估MIS与Open S的直接成本、住院时间、并发症和恢复时间，并探讨健康保险在MIS可及性中的作用。方法回顾性分析2019 - 2022年206例患者的数据，其中100例接受Open S治疗，106例接受MIS治疗。数据包括直接费用、住院时间、术后并发症和恢复时间。该研究还调查了信息管理系统使用与健康保险之间的相关性。结果患者平均年龄为41.7岁，性别分布基本均匀（男性52.4%，女性47.6%）。大多数患者（79.1%）享有社区医疗保险。腹腔镜胆囊切除术具有显著的经济优势，住院时间短，并发症少，恢复快(p <；0.02)。MIS疝气修补术恢复较快，但费用较高。对于阑尾切除术和卵巢囊肿切除术，MIS和Open s之间没有显著的成本差异，发现MIS采用率与健康保险之间存在强正相关，支持改善获取。结论卢旺达的信息管理系统有望节省经济，改善患者治疗效果，并通过保险扩大获取范围。然而，需要解决消耗品成本高和专业知识有限等挑战，以充分优化卢旺达医疗保健系统中的管理信息系统效益。

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引用次数: 0

Outcomes and costs in splenectomy after failed splenic arterial embolization for blunt splenic injury 钝性脾损伤脾动脉栓塞失败后脾切除术的结果和费用

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-07-02 DOI: 10.1016/j.sopen.2025.06.011

Nam Yong Cho BS , Bill Kwon MD , Esteban Aguayo MD , Zeyu Liu BS , Areti Tillou MD , Peyman Benharash MD

Background

Splenic injury (BSI) is present in nearly 45 % of abdominal blunt trauma cases in the US and splenic artery embolization (SAE) has been increasingly utilized to manage BSI in recent years. However, SAE failure necessitating delayed splenectomy remains a critical concern with significant implications for patient outcomes and healthcare resource utilization.

Methods

We conducted a retrospective cohort study utilizing the 2016–2021 Nationwide Readmissions Database. Adult patients (≥18 years) with BSI undergoing SAE or splenectomy were included. Early embolization was defined as SAE within 48 h of admission. Failure of SAE (FE) was defined as splenectomy following unsuccessful SAE during the index hospitalization or within 30 days post-discharge. Multivariable regression models were developed to assess the association of FE with in-hospital mortality, length of stay (LOS), and costs.

Results

Of 44,750 included patients, 17,921 (40.0 %) underwent SAE as an initial operative approach. Rates of failed embolization remained stable over the study period (2016: 8.1 % vs 2021: 9.4 %, nptrend = 0.86), as did mortality following FE (2016: 1.9 % vs 2021: 1.3 %, nptrend = 0.05). After risk adjustment, early embolization was associated with reduced odds of FE (AOR 0.78, 95%CI 0.64–0.95). FE was associated with significantly increased odds of mortality (AOR 2.52, 95 % CI 1.86–3.41), prolonged LOS by 4.8 days (95 % CI 4.0–5.5), and increased hospitalization costs by $27,600 (95 % CI $24,400-30,900).

Conclusions

Despite growing SAE utilization, its failure rate remains stable with FE being associated with inferior clinical and financial outcomes. Improve patient selection, increased availability of embolization and providing early embolization in select cases may enhance SAE outcomes.

背景：在美国，近45%的腹部钝性创伤病例存在脾损伤（BSI），近年来脾动脉栓塞（SAE）越来越多地用于治疗BSI。然而，SAE失败需要延迟脾切除术仍然是一个关键问题，对患者预后和医疗资源利用具有重要影响。方法利用2016-2021年全国再入院数据库进行回顾性队列研究。包括接受SAE或脾切除术的成年BSI患者（≥18岁）。早期栓塞定义为入院48小时内的SAE。脾切除术失败（FE）定义为在住院期间或出院后30天内脾切除术失败。建立了多变量回归模型来评估FE与住院死亡率、住院时间（LOS）和费用的关系。结果在纳入的44,750例患者中，17,921例（40.0%）接受了SAE作为初始手术入路。在研究期间，栓塞失败率保持稳定（2016年：8.1%，2021年：9.4%,nptrend = 0.86），栓塞后死亡率也保持稳定（2016年：1.9%，2021年：1.3%,nptrend = 0.05）。风险调整后，早期栓塞与FE发生率降低相关（AOR 0.78, 95%CI 0.64-0.95）。FE与死亡率显著增加（AOR 2.52, 95% CI 1.86-3.41）、生存期延长4.8天（95% CI 4.0-5.5）以及住院费用增加27,600美元（95% CI 24,400-30,900美元）相关。结论：尽管SAE的应用越来越多，但其失败率保持稳定，FE与较差的临床和财务结果相关。改善患者选择，增加栓塞的可用性，并在选定的病例中提供早期栓塞可能会提高SAE的预后。

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引用次数: 0

Utilizing the Leap Motion Controller for skill tracking in surgical training: solving line-of-sight issues 利用Leap运动控制器进行手术训练中的技能跟踪：解决视线问题

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-06-25 DOI: 10.1016/j.sopen.2025.06.009

V.E.E. Kleinrensink , R.H.M. Goossens , J.F. Lange , L.W. Kranenburg , G.J. Kleinrensink

Background

Minimally invasive surgery (MIS) requires mastery of complex skills, for which diverse training methods have been developed. While some methods focus on precise instrument tracking and others on realistic practice scenarios, combining these aspects leads to increased costs and impractical setups.

The Leap Motion Controller (LMC) is a cost-effective device offering precise motion tracking, but previous studies found its utility in surgical training is limited by line-of-sight issues. This study aims to address this challenge.

Methods

A novel interface was developed for use of LMC for tracking MIS instruments during practice. To resolve the line-of-sight problem, the traditional enclosed working area was replaced with a single vertical barrier concealing the task while allowing the LMC to maintain a clear horizontal view of the instrument. Performance metrics included time to task completion and total path length of the instrument. Twenty-eight medical students participated, performing 40 consecutive trials each.

Results

The LMC provided precise tracking, effectively resolving line-of-sight issues. Participants improved significantly, with task completion time decreasing from 61 s (SD = 40) to 19 s (SD = 8) and path length from 2390 mm (SD = 2569) to 574 mm (SD = 348). Performance plateaued after 20 trials, with reduced variance for all outcomes.

Conclusions

The study successfully leveraged the LMC for tracking surgical instruments, overcoming previous limitations. The setup enables real-time monitoring, continuous movement tracking, and tactile interaction with physical objects. Its affordability and simplicity make it a promising tool for traditional and home-based MIS training, especially in resource-limited settings.

背景微创手术（MIS）需要掌握复杂的技能，为此已经开发了多种培训方法。虽然一些方法侧重于精确的仪器跟踪，而另一些方法则侧重于现实的实践场景，但将这些方面结合起来会导致成本增加和不切实际的设置。Leap运动控制器（LMC）是一种具有成本效益的设备，提供精确的运动跟踪，但先前的研究发现，它在外科训练中的应用受到视线问题的限制。本研究旨在解决这一挑战。方法开发了一种新的界面，使LMC能够在实际操作中跟踪MIS仪器。为了解决视线问题，传统的封闭工作区域被单一的垂直屏障所取代，同时允许LMC保持仪器的清晰水平视野。性能指标包括完成任务的时间和仪器的总路径长度。28名医学生参与其中，每人连续进行40次试验。结果LMC提供了精确的跟踪，有效地解决了视线问题。参与者显著改善，任务完成时间从61秒（SD = 40）减少到19秒（SD = 8），路径长度从2390毫米（SD = 2569）减少到574毫米（SD = 348）。20次试验后表现趋于平稳，所有结果的方差均减小。结论：该研究成功地利用LMC跟踪手术器械，克服了以往的局限性。该装置可实现实时监控、连续运动跟踪以及与物理对象的触觉交互。它的可负担性和简单性使其成为传统和家庭管理信息系统培训的一个很有前途的工具，特别是在资源有限的情况下。

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引用次数: 0

Chronic inflammation following hernia repair and cancer risk: A nationwide study 疝气修复后的慢性炎症与癌症风险：一项全国性研究

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-06-25 DOI: 10.1016/j.sopen.2025.06.004

Malene Broholm MD, PhD , Ismail Gögenur MD, DMSc , Lau Caspar Thygesen Cand.Scient.san.publ, PhD , Frederik Helgstrand MD, PhD

Purpose

Implantation of mesh in patients undergoing hernia surgery or prolonged inflammation due to postoperative complication may be associated with increased risk of cancer.

We aim to test whether implementation of mesh or complicated postoperative course with readmittance was associated with increased risk of cancer.

Methods

This register-based nationwide observational cohort study included 48,392 and 127,756 patients undergoing ventral and inguinal hernia surgery, respectively, during 1996–2004, with follow-up until Dec. 2014. In total, 16,909 patients undergoing ventral hernia repair with mesh, and 31,483 undergoing sutured repair, as well as 106,342 patients undergoing inguinal hernia repair with mesh and 21,414 undergoing sutured repair were included. Patients were matched with a reference cohort from the general Danish population and were followed in the Danish Cancer Registry.

Results

For ventral hernia surgery, there was a significant association between mesh repair and risk of cancers, [(vs general population), HR 1.09 (95%CI, 1.00–1.18)]. Thirty-day readmission after mesh and sutured repair was associated with developing cancer [HR 1.15 (0.99–1.34) and 1.14 (1.00–1.31), respectively]. However, the association for suture repair (HR 1.14) did not reach statistical significance (p = 0.055). For inguinal hernia surgery, mesh repair was not associated with increased risk of cancer [(vs. general population), HR 1.00 (95%CI, 0.97–1.02)]. For both mesh and sutured repair, there was an increased risk for developing cancer after 30-day readmission, [HR 1.21 (1.12–1.31) and 1.24 (1.07–1.43), respectively].

Conclusion

Patients undergoing ventral hernia repair with mesh and patients readmitted after inguinal or ventral hernia repair may have higher risk of developing cancer than the general population.

These exploratory findings do not establish causality, but the association warrants further investigations in other populations.

目的疝手术或术后并发症引起的长期炎症患者植入补片可能会增加患癌风险。我们的目的是测试是否实施补片或复杂的术后再接纳过程与癌症风险增加有关。方法：这项基于登记的全国观察队列研究纳入了1996-2004年间分别接受腹疝和腹股沟疝手术的48,392和127,756例患者，随访至2014年12月。共纳入腹侧疝补片修补术16909例，缝合修补术31483例，腹股沟疝补片修补术106342例，缝合修补术21414例。患者与来自丹麦普通人群的参考队列相匹配，并在丹麦癌症登记处进行随访。结果对于腹疝手术，补片修复与癌症风险之间存在显著关联[（与一般人群相比），HR 1.09 (95%CI, 1.00-1.18)]。补片和缝合修复后30天再入院与发生癌症相关[HR分别为1.15（0.99-1.34）和1.14(1.00-1.31)]。但缝线修复相关性（HR 1.14）无统计学意义（p = 0.055）。对于腹股沟疝手术，补片修复与癌症风险增加无关[（与一般人群相比），相对危险度1.00 (95%CI, 0.97-1.02)]。对于补片和缝合修复，30天再入院后发生癌症的风险增加，[HR分别为1.21（1.12-1.31）和1.24(1.07-1.43)]。结论腹股沟疝修补术及腹股沟疝修补术或腹股沟疝修补术后再入院的患者发生肿瘤的风险高于一般人群。这些探索性的发现并没有建立因果关系，但这种联系值得在其他人群中进一步调查。

{"title":"Chronic inflammation following hernia repair and cancer risk: A nationwide study","authors":"Malene Broholm MD, PhD , Ismail Gögenur MD, DMSc , Lau Caspar Thygesen Cand.Scient.san.publ, PhD , Frederik Helgstrand MD, PhD","doi":"10.1016/j.sopen.2025.06.004","DOIUrl":"10.1016/j.sopen.2025.06.004","url":null,"abstract":"<div><h3>Purpose</h3><div>Implantation of mesh in patients undergoing hernia surgery or prolonged inflammation due to postoperative complication may be associated with increased risk of cancer.</div><div>We aim to test whether implementation of mesh or complicated postoperative course with readmittance was associated with increased risk of cancer.</div></div><div><h3>Methods</h3><div>This register-based nationwide observational cohort study included 48,392 and 127,756 patients undergoing ventral and inguinal hernia surgery, respectively, during 1996–2004, with follow-up until Dec. 2014. In total, 16,909 patients undergoing ventral hernia repair with mesh, and 31,483 undergoing sutured repair, as well as 106,342 patients undergoing inguinal hernia repair with mesh and 21,414 undergoing sutured repair were included. Patients were matched with a reference cohort from the general Danish population and were followed in the Danish Cancer Registry.</div></div><div><h3>Results</h3><div>For ventral hernia surgery, there was a significant association between mesh repair and risk of cancers, [(vs general population), HR 1.09 (95%CI, 1.00–1.18)]. Thirty-day readmission after mesh and sutured repair was associated with developing cancer [HR 1.15 (0.99–1.34) and 1.14 (1.00–1.31), respectively]. However, the association for suture repair (HR 1.14) did not reach statistical significance (<em>p</em> = 0.055). For inguinal hernia surgery, mesh repair was not associated with increased risk of cancer [(vs. general population), HR 1.00 (95%CI, 0.97–1.02)]. For both mesh and sutured repair, there was an increased risk for developing cancer after 30-day readmission, [HR 1.21 (1.12–1.31) and 1.24 (1.07–1.43), respectively].</div></div><div><h3>Conclusion</h3><div>Patients undergoing ventral hernia repair with mesh and patients readmitted after inguinal or ventral hernia repair may have higher risk of developing cancer than the general population.</div><div>These exploratory findings do not establish causality, but the association warrants further investigations in other populations.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"27 ","pages":"Pages 88-93"},"PeriodicalIF":1.4,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144653539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-06-20 DOI: 10.1016/j.sopen.2025.06.008

Anna Ekström , Victoria Fomichov , Bergthor Björnsson , Carina Wennerholm , Per Sandström , Jenny Drott

Purpose

Patients with cancer in the liver, pancreas, or bile ducts often experience stressful situations. These patients frequently perceive a variety of symptoms that affect their health both before and after surgery. This study aimed to investigate the health-related quality of life of patients undergoing hepato-pancreato-biliary cancer surgery and to compare pre- and postoperative patient-reported outcomes.

Method

A prospective study was conducted using a consecutive sampling procedure. The inclusion criteria were patients aged over 18 years with malignant tumours in the liver, bile ducts, or pancreas, who were treated with curative cancer surgery.

Results

Of the 77 included patients, 50.6 % were men, and 55.8 % were 70 years or older. The results are based on 154 completed EQ-5D-5L questionnaires, analyzed preoperatively and postoperatively. The overall mobility and anxiety dimensions did not change between the pre- and postoperative assessments. The overall self-care dimension increased over time (p = 0.001), as did the usual activities and pain dimensions (p < 0.001). More men reported no problems with mobility one month postoperatively. Our results showed that patients undergoing HPB cancer surgery had a lower overall health-related quality of life postoperatively, with significant differences in the dimensions of pain, activity, and self-care.

Conclusions

Clinically significant results include no changes in mobility and anxiety between the pre- and postoperative assessments. Men reported higher rates of no problems with mobility postoperatively. The differences in mobility between women and men are important clinical findings, suggesting the need for more attention to support patients for equitable and safe postoperative cancer care.

目的肝癌、胰腺癌或胆管癌患者经常经历压力状态。这些患者在手术前后经常会出现各种影响其健康的症状。本研究旨在调查接受肝-胰-胆道癌手术患者的健康相关生活质量，并比较患者报告的术前和术后结局。方法采用连续抽样方法进行前瞻性研究。纳入标准是年龄在18岁以上的肝脏、胆管或胰腺恶性肿瘤患者，他们接受了治愈性癌症手术治疗。结果纳入的77例患者中，50.6%为男性，55.8%为70岁及以上。结果基于154份完整的EQ-5D-5L问卷，并在术前和术后进行分析。总体活动能力和焦虑维度在术前和术后评估之间没有变化。整体自我照顾维度随时间增加（p = 0.001），日常活动和疼痛维度也是如此(p <；0.001)。更多的男性报告术后一个月没有活动障碍。我们的研究结果显示，接受HPB癌症手术的患者术后总体健康相关生活质量较低，在疼痛、活动和自我护理方面存在显著差异。结论：在术前和术后评估中，具有临床意义的结果包括活动能力和焦虑没有变化。男性报告术后活动能力无问题的比例更高。女性和男性在移动性上的差异是重要的临床发现，表明需要更多的关注来支持患者公平和安全的癌症术后护理。

{"title":"Health-related quality of life in patients undergoing hepato-pancreato biliary cancer surgery: A prospective follow-up study","authors":"Anna Ekström , Victoria Fomichov , Bergthor Björnsson , Carina Wennerholm , Per Sandström , Jenny Drott","doi":"10.1016/j.sopen.2025.06.008","DOIUrl":"10.1016/j.sopen.2025.06.008","url":null,"abstract":"<div><h3>Purpose</h3><div>Patients with cancer in the liver, pancreas, or bile ducts often experience stressful situations. These patients frequently perceive a variety of symptoms that affect their health both before and after surgery. This study aimed to investigate the health-related quality of life of patients undergoing hepato-pancreato-biliary cancer surgery and to compare pre- and postoperative patient-reported outcomes.</div></div><div><h3>Method</h3><div>A prospective study was conducted using a consecutive sampling procedure. The inclusion criteria were patients aged over 18 years with malignant tumours in the liver, bile ducts, or pancreas, who were treated with curative cancer surgery.</div></div><div><h3>Results</h3><div>Of the 77 included patients, 50.6 % were men, and 55.8 % were 70 years or older. The results are based on 154 completed EQ-5D-5L questionnaires, analyzed preoperatively and postoperatively. The overall mobility and anxiety dimensions did not change between the pre- and postoperative assessments. The overall self-care dimension increased over time (<em>p</em> = 0.001), as did the usual activities and pain dimensions (<em>p</em> < 0.001). More men reported no problems with mobility one month postoperatively. Our results showed that patients undergoing HPB cancer surgery had a lower overall health-related quality of life postoperatively, with significant differences in the dimensions of pain, activity, and self-care.</div></div><div><h3>Conclusions</h3><div>Clinically significant results include no changes in mobility and anxiety between the pre- and postoperative assessments. Men reported higher rates of no problems with mobility postoperatively. The differences in mobility between women and men are important clinical findings, suggesting the need for more attention to support patients for equitable and safe postoperative cancer care.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"27 ","pages":"Pages 45-51"},"PeriodicalIF":1.4,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144481482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Indications, sub-types and complications of surgically treated thyroid disease in Africa: A systematic review and meta-analysis 非洲手术治疗甲状腺疾病的适应症、亚型和并发症：系统回顾和荟萃分析

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-06-18 DOI: 10.1016/j.sopen.2025.06.006

Bekalu Getachew , Mekbeb Afework , Girmaye Tamrat

Objectives

Thyroidectomy is a surgical procedure that reduces or removes the thyroid gland the aim of this systematic review and meta-analysis was to assess the pooled prevalence and sub-types of thyroidectomy and characterize its postoperative complications in some low and middle income African countries.

Methods

The studies were identified through an exhaustive search of reputable databases Twenty-two studies were selected based on the inclusion and exclusion criteria. Data were extracted using a standardized and pre-tested data extraction checklist, and the analysis was done using STATA version 14 statistical software. Heterogeneity was assessed using I² statistics.

Result

Toxic goiters were the most common indication for thyroidectomy accounting for 46.62 % of cases. Cosmetic reasons (41.07 %) and suspicion of malignancy (11.30 %) were the other common indications. Regarding surgical procedures, sub-total thyroidectomy (39.27 %) was the predominant surgical procedure, followed by lobectomy and isthmusectomy (34.88 %) and near-total thyroidectomy (34.77 %) respectively. The pooled prevalence of postoperative complications following thyroidectomy was 26.6 % [95%CI, 18.3–34.89]. Hypoparathyroidism (8.49 %) was the most common complication, followed by recurrent laryngeal nerve injury (7.96 %) and dysphonia (7.28 %).

Conclusion

A toxic goiter was the most common indication for thyroidectomy. The pooled prevalence of postoperative complications was comparably higher than international figures. Hypoparathyroidism was the predominant postoperative complication.

甲状腺切除术是一种减少或切除甲状腺的外科手术。本系统综述和荟萃分析的目的是评估一些中低收入非洲国家甲状腺切除术的总患病率和亚型，并描述其术后并发症。方法通过对知名数据库的全面检索，根据纳入和排除标准筛选出22项研究。使用标准化和预测试的数据提取清单提取数据，并使用STATA version 14统计软件进行分析。采用I2统计量评估异质性。结果中毒性甲状腺肿是甲状腺切除术最常见的指征，占46.62%。美容原因（41.07%）和怀疑恶性肿瘤（11.30%）是其他常见的适应症。手术方式以甲状腺次全切除术（39.27%）为主，其次为肺叶切除术、峡部切除术（34.88%）和近甲状腺全切除术（34.77%）。甲状腺切除术后并发症的总发生率为26.6% [95%CI, 18.3-34.89]。最常见的并发症是甲状旁腺功能减退（8.49%），其次是喉返神经损伤（7.96%）和发音障碍（7.28%）。结论中毒性甲状腺肿是甲状腺切除术最常见的指征。术后并发症的总发生率相对高于国际数据。甲状旁腺功能减退是主要的术后并发症。

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引用次数: 0

The outcomes of right and left complicated colonic diverticulitis 左、右合并结肠憩室炎的预后

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-06-15 DOI: 10.1016/j.sopen.2025.06.005

Anh Tuan Nguyen , Quang Tien Pham , Hoi Van Tran , Hoang Viet Truong , Loc Huynh Tran

Background

The incidence of complicated colonic diverticulitis is increasing in Asia, with notable differences in management between right-sided (RCD) and left-sided (LCD) cases. This study compared treatment outcomes and identified risk factors for complications.

Methods

A retrospective analysis was performed on 181 patients diagnosed with complicated colonic diverculitis from January 2022 to September 2024, including 99 RCD and 82 LCD cases.

Results

The mean age in the RCD group was 43.31 ± 14.6 years, compared to 63.9 ± 12.9 years in the LCD group. Recurrence rates were higher in LCD than RCD (19.5 % vs. 7.1 %). Surgical intervention was more frequent in LCD cases (63.4 % vs. 9.2 %), with longer hospital stay (9.3 vs 4.9 days). All RCD perforations were managed with primary anastomosis. Hartmann's procedure was the most common approach for LCD, with primary resection and anastomosis performed in 26.9 %. Postoperative complications occurred in 27.8 % of LCD patients, including wound infections, intra-abdominal abscesses, and pneumonia. Three patients in the LCD group died during hospitalization. Fever, elevated CRP levels, surgery type, and prolonged hospital stays were independent risk factors.

Conclusion

Patients with complicated RCD were younger than those with LCD. Conservative treatment for RCD had a high success rate, while complicated LCD often required surgery due to peritonitis. Fever, CRP level, type of surgery, and hospital stay were independent risk factors for complications.

亚洲地区复杂结肠憩室炎的发病率正在上升，右侧（RCD）和左侧（LCD）病例在治疗上存在显著差异。这项研究比较了治疗结果并确定了并发症的危险因素。方法回顾性分析2022年1月至2024年9月诊断为复杂性结肠憩室炎的181例患者，其中RCD 99例，LCD 82例。结果RCD组患者平均年龄43.31±14.6岁，LCD组患者平均年龄63.9±12.9岁。LCD的复发率高于RCD（19.5%比7.1%）。LCD患者手术干预更频繁（63.4% vs 9.2%），住院时间更长（9.3 vs 4.9天）。所有RCD穿孔均采用一期吻合。Hartmann手术是LCD最常见的手术方式，26.9%的患者进行了一次切除和吻合。术后并发症发生率为27.8%，包括伤口感染、腹内脓肿和肺炎。LCD组3例患者在住院期间死亡。发热、CRP水平升高、手术类型和住院时间延长是独立的危险因素。结论合并RCD患者年龄明显小于合并LCD患者。RCD的保守治疗成功率高，而复杂的LCD往往因腹膜炎需要手术治疗。发热、CRP水平、手术类型和住院时间是并发症的独立危险因素。

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引用次数: 0

Comparison of machine learning and Cox regression models for prognostic analysis in hepatocellular carcinoma patients with distant metastasis 机器学习与Cox回归模型在肝细胞癌远处转移患者预后分析中的比较

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-06-15 DOI: 10.1016/j.sopen.2025.06.007

Hailan Li , Junbo Wang , Xin Ming , Mingsha Zhou , Li Zhou

Background

With the development of conversion therapy, there has been a significant improvement in advanced stage hepatocellular carcinoma (HCC) patients' survival outcomes. Accurate prognostic assessment of patients with distant metastasis (DM) is therefore pivotal in improving quality of life, guiding treatment, and optimizing patient management.

Methods

This study extracted patients with distant metastatic HCC from the Surveillance, Epidemiology, and End Results database. Univariate and multivariate Cox regression were used to identify prognostic factors. Then, Cox regression, DeepSurv, Decision Tree, and Random Survival Forests models were used to predict overall survival. Model performance was evaluated by area under the curve (AUC), decision curve analysis, calibration curve, and Brier score. The visualization of Cox regression and machine learning algorithms utilized nomogram and Shapley additive explanations, respectively.

Results

The study included 3051 HCC patients with DM. Factors such as tumor size, lung metastasis, N stage, ace, chemotherapy, radiotherapy, AFP, fibrosis, treatment interval, and number of metastases were independently associated with patient prognosis. Among all models, Cox regression and Random Survival Forest models showed stable performance, achieving AUCs of 0.746/0.760, 0.745/0.749, and 0.729/0.718 at 3, 6, and 12 months, respectively. Meanwhile, Cox regression showed the lowest Brier score (0.180 and 0.125) at 6 and 12 months.

Conclusions

Cox regression and Random Survival Forest models demonstrated robust prognostic performance for HCC, with Cox regression exhibiting superior temporal stability. The Cox-based nomogram provides an intuitive tool for rapid 3-, 6-, and 12-month survival stratification in metastatic HCC patients.

随着转化疗法的发展，晚期肝细胞癌（HCC）患者的生存预后有了显著改善。因此，对远处转移（DM）患者进行准确的预后评估对于改善生活质量、指导治疗和优化患者管理至关重要。方法本研究从监测、流行病学和最终结果数据库中提取远处转移性HCC患者。采用单因素和多因素Cox回归分析确定预后因素。然后，使用Cox回归、DeepSurv、决策树和随机生存森林模型预测总生存率。通过曲线下面积（AUC）、决策曲线分析、校准曲线和Brier评分来评价模型的性能。Cox回归和机器学习算法的可视化分别使用了nomogram和Shapley additive解释。结果本研究共纳入3051例合并糖尿病的HCC患者，肿瘤大小、肺转移、N分期、ace、化疗、放疗、AFP、纤维化、治疗间隔、转移数等因素与患者预后独立相关。在所有模型中，Cox回归和随机生存森林模型表现稳定，在3个月、6个月和12个月的auc分别为0.746/0.760、0.745/0.749和0.729/0.718。Cox回归分析显示，第6个月和第12个月Brier评分最低，分别为0.180和0.125。结论：Cox回归模型和随机生存森林模型对HCC的预后具有良好的效果，Cox回归模型具有较好的时间稳定性。cox为转移性HCC患者提供了快速3、6、12个月生存分层的直观工具。

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引用次数: 0

Association of hospital for-profit status with clinical and financial outcomes following emergency general surgery 医院盈利状况与急诊普通外科手术后临床和财务结果的关系

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-06-12 DOI: 10.1016/j.sopen.2025.06.003

Izhar Mbarani MD , Sara Sakowitz MD, MBA , Amulya Vadlakonda MD , Troy Coaston MSCR , Esteban Aguayo MD , Syed Shaheer Ali , Konmal Ali , Saad Mallick MD , Peyman Benharash MD MS

Background

The impact of for-profit (FP) hospital ownership on healthcare outcomes has garnered increasing attention in recent years with limited work linking FP status with lower quality of care and higher costs. However, outcomes emergency general surgery (EGS) at FP hospitals remains unknown.

Methods

All non-elective adult (≥18 years) hospitalizations entailing EGS (appendectomy, cholecystectomy, laparotomy, large bowel resection, perforated ulcer repair, or small bowel resection), within 2 days of admission, were tabulated from the 2016 to 2021 National Inpatient Sample. Multivariable models were constructed to evaluate the independent associations between hospital FP status with key clinical and financial outcomes.

Results

Of an estimated 2,124,394 patients, 337,950 (16 %) were classified as FP. Compared to others, the FP cohort was younger, of lower comorbidity burden, and more frequently in the lowest income quartile. After risk adjustment, care at FP hospitals was associated with a greater likelihood of in-hospital mortality or any major complication (Adjusted Odds Ratio [AOR] 1.15, 95 % Confidence Interval [CI] 1.12–1.18), including infectious (AOR 1.22, 95 % CI 1.18–1.26), respiratory (AOR 1.26, 95 % CI 1.21–1.31), and renal sequelae (AOR 1.12, 95 % CI 1.08–1.16). While associated with reduced per-patient hospitalization costs (β -$2910, 95 % CI -3180,-2640), treatment at FP institutions was associated with increased odds of non-home discharge (AOR 1.09, 95 % CI 1.05–1.13).

Conclusions

Care at for-profit hospitals appears to be associated with greater risk of morbidity and nonhome discharge. Future work is needed to consider the factors contributing to greater morbidity, and developing interventions aimed at improving quality of care.

近年来，营利性（FP）医院所有权对医疗保健结果的影响引起了越来越多的关注，将FP状态与较低的护理质量和较高的成本联系起来的工作有限。然而，在计划生育医院进行急诊普通外科手术（EGS）的结果尚不清楚。方法将2016年至2021年全国住院患者样本中所有入院2天内接受EGS（阑尾切除术、胆囊切除术、剖腹手术、大肠切除术、穿孔溃疡修复术或小肠切除术）的非选择性成人（≥18岁）纳入统计。我们构建了多变量模型来评估医院计划生育状况与关键临床和财务结果之间的独立关联。结果在估计的2,124,394例患者中，337,950例（16%）被归类为FP。与其他队列相比，计划生育队列更年轻，合并症负担更低，并且在最低收入四分位数中更常见。风险调整后，在计划生育医院的护理与院内死亡或任何主要并发症的可能性较大相关（调整优势比[AOR] 1.15, 95%可信区间[CI] 1.12 - 1.18），包括感染性（AOR 1.22, 95% CI 1.18-1.26）、呼吸道（AOR 1.26, 95% CI 1.21-1.31）和肾脏后遗症（AOR 1.12, 95% CI 1.08-1.16）。虽然与每位患者住院费用降低相关（β -$2910, 95% CI -3180,-2640），但在计划生育机构接受治疗与非家庭出院的几率增加相关（AOR 1.09, 95% CI 1.05-1.13）。结论营利性医院的恐慌似乎与更高的发病率和非家庭出院风险相关。未来的工作需要考虑导致更高发病率的因素，并制定旨在提高护理质量的干预措施。

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引用次数: 0