Surgery open science最新文献

Background

The aim of this study is to determine the correlation between the blood serum mean platelet volume (MPV) and the dynamics of the OF course during the early phase in patients with moderately severe and severe acute pancreatitis (AP).

Methods

The predetermined criterion was the presence of the OF according to the revised Atlanta criteria 2012 for moderately severe and severe AP. A prospective sample of patients was stratified by severity, and two groups were defined based on MPV. Demographic indicators, comorbidities and clinical outcomes were compared between these groups. Multifactorial analysis determined whether an elevated MPV is independently associated with early OF and other unfavorable outcomes.

Results

Out of 108 patients, 20 had moderately severe AP and 88 had severe AP. The blood serum MPV, measured within 72 h of the onset of AP symptoms was lower 11.8 fL in 32 patients and equal to or greater 11.8 fL in 76 patients. Patients with elevated MPV were older (63 vs. 48 years), had obesity (59.2 % vs. 25 %), diabetes mellitus (DM) (51.3 % vs. 12.5 %), ischemic heart disease (70.8 % vs. 28.1 %) and more frequently experienced persistent OF (93.4 % vs. 53.1 %) compared to those with MPV lower 11.8 fL. The incidence of early OF increased proportionally with the severity of MPV (81.6 % vs. 34.4 % in the group with MPV lower 11.8 fL, Ptrend < 0.0001). In multifactorial analysis, adjusted for body mass index and DM, MPV equal to or greater 11.8 fL was independently associated with early OF.

Conclusions

Elevated blood serum MPV of patients with AP are independently and proportionally correlated with early organ failure in patients with alcoholic and idiopathic etiology of AP.

Key message

The study provides an evaluation of MPV as a prognostic marker for organ failure within the initial 7 days following the onset of acute pancreatitis symptoms. Additionally, alterations in MPV were identified in patients with acute pancreatitis who had diabetes or ischemic heart disease within the first 24 h of hospitalization.

The goal of this article is to give an overview of intraoperative liver ultrasound, including the indications, different ultrasound techniques, and the ultrasound appearance of normal anatomy, more common anatomic variations, and common hepatic tumors.

With the increasing prevalence of diverticulitis, professional guidelines encourage the individualization of treatment. However, the frequency of treatment preferences of both surgeons, and patients, and the resultant impact of that preference on diverticulitis management is underexplored. We reviewed 27 consecutive patient visits of 3 colorectal surgeons at our institution to evaluate factors that drove their treatment, as well as their equipoise for patient randomization into medical or surgical treatments. Using standardized pre- and post-visit questionnaires, we investigated the impact of the clinic visit on treatment recommendations. Our results demonstrate that our surgeons have a practice bias towards complicated disease, and have a preference towards operative management of diverticulitis, in both complicated and uncomplicated disease. This preference was frequently unchanged after clinic visit, which has implications for guiding truly shared decision making, as it continues to be the recommendation.

Background

Near-peer teaching (NPT) involves teaching by peers who are at a close, but not the same, level of training. This study investigated whether a novel surgical NPT workshop, designed and delivered by junior doctors using simulation models for acute otolaryngology conditions, improved the knowledge and confidence level of senior medical students.

Methods

A one-day NPT workshop was held for medical students in their third year of a four-year postgraduate medical degree at the University of Notre Dame, Sydney, Australia. Four acute otolaryngology/head and neck surgery problems that might be encountered by junior doctors and require prompt management were chosen. These were post-operative neck swelling, epistaxis, and tracheostomy management (obstruction and bleeding). Six junior doctors facilitated didactic tutorials and practical skills training using models. Multiple choice question mini-tests and questionnaires were administered before and after the workshop to assess changes in students' knowledge and confidence in assessment, management, and practical skills.

Results

The most common reason for participation was to acquire knowledge and practical skills (93.2 %). Mean correct MCQ mini-test knowledge scores increased significantly from 60 % pre-workshop to 83.9 % post-workshop (p < 0.05). Students reported significantly increased confidence in recognition and management of all four conditions. All students favoured including the course in their curriculum and would recommend the course to others. The tutors subjectively reported valuable teaching experience.

Conclusion

NPT is an effective method for teaching medical students how to assess and manage acute otolaryngology/ENT surgery conditions that may present as emergencies for junior medical officers on the ward.

Objective

A pediatric surgery fellow is often regarded as a cornerstone of an academic children's hospital due to the need for their clinical services with overnight coverage being an important aspect of the care provided. There is little known about the objective sleep patterns and work-related communications of a pediatric surgery fellow during overnight home call. The aim of this study is to better understand the sleep patterns and interruptions of an on-call pediatric surgery fellow.

Design

A prospective observational study of 60 call nights and 60 non-call nights of a pediatric surgery senior fellow was performed from September 2022 to February 2023.

Setting

An academic Children's Hospital.

Participant

An ACGME-accredited clinical pediatric surgery fellow.

Results

On average, the pediatric surgery fellow spent 6.9 and 5.8 total hours in bed and asleep each night, respectively. The total sleep time was less for call nights compared to non-call nights (5.4 versus 6.3 h, p < 0.0001). The mean number of work-related communications per 12-hour night shift was four. The majority of communications were regarding new consults (63.8 %). The pediatric surgery fellow spent an average of 5.9 min per communication and approximately 23.8 min total during each 12-hour night shift. Approximately half of these communications occurred during sleep hours.

Conclusions

This study reveals overall sleep duration was below recommended levels. There were significant alterations in sleep patterns during call nights. Work-related communications further compounded sleep disturbances. Further research and interventions in this area are warranted.

Objective

Closure of the appendix stump after appendectomy is considered one of the most important parts of laparoscopic appendectomy. Various techniques are used during this surgery, commonly including endoclips and ligatures. Therefore, this study was conducted to compare endoclips with intra-corporeal ligatures in closing the appendix stump during laparoscopic appendectomy.

Methods

This retrospective study was conducted using data from 50 patients with acute appendicitis who underwent uncomplicated laparoscopic appendectomy. The data from patients whose stumps were closed using endoclips in 25 patients (Group I) and with intra-corporeal ligatures in 25 patients (Group II) were extracted and compared regarding the occurrence of intraoperative and postoperative complications.

Results

There were no differences between the two methods in terms of intraoperative and postoperative complications. The duration of surgery in the ligature group was significantly longer than in the clip group (p = 0.044). The hospital stay duration was clinically longer in the ligature group, but this difference was not statistically significant (p > 0.05).

Conclusion

Endoclips for closing the appendix stump are safer with a shorter operating time and also a simpler method. Therefore, they could be a reliable alternative to the method of closing the appendix stump with ligatures.

Background

Operative blood loss is associated with postoperative morbidity and mortality in surgery. Hemostatic agents are used as adjuncts for hemostasis during surgery and help to prevent postoperative bleeding. We evaluated the safety and efficacy of an investigational polysaccharide hemostatic (PH) topical product compared to a U.S. Food and Drug Administration (FDA)-approved control in clinical use comprising microporous polysaccharide hemospheres (MPH) to achieve hemostasis of bleeding surfaces during surgery.

Study design

This prospective multicenter trial enrolled patients undergoing open elective cardiac, general, or urologic surgery. Patients were stratified by bleeding severity and therapeutic area, then randomized 1:1 to receive PH or MPH. Bleeding assessments occurred intraoperatively using a novel bleeding assessment methodology. Primary endpoint was noninferiority as compared with control via effective hemostasis at 7 min. Patients were monitored and followed daily in the postoperative period until time of discharge and again at 6 weeks. Overall survival was assessed in oncology patients at 24 months. Safety of PH vs. MPH was determined by comparing relative incidence of adverse events.

Results

Across 19 centers, 324 (161 PH, 163 MPH) patients were randomized (48 % general surgery, 27 % cardiac surgery, and 25 % urologic surgery). PH was noninferior to MPH and met the primary endpoint of hemostatic success at 7 min at a non-inferiority margin of 10 %. No significant differences were found in adverse event rates. Six deaths were reported within the 6-week follow-up period. No difference in overall survival was observed at 2 years (76 % PH vs. 74 % MPH, P = .66) for patients undergoing cancer operations.

Conclusion

Across three therapeutic areas, PH was noninferior to MPH at all hemostasis assessment time points with no safety concerns. PH is an effective alternative to MPH for hemostasis during surgery.

ClinicalTrials.gov Identifier: NCT02359994

Background

An alternative method to standard laparoscopic cholecystectomy (SLC) is the “fundus first” method (FFLC). Concerns have been raised that FFLC can lead to misinterpretation of important anatomical structures, thus causing complications of a more serious kind than SLC. Comparisons between the methods are complicated by the fact that FFLC is often used as a rescue procedure in complicated cases. To avoid confounding related to this we conducted a population-based study with comparisons on the surgeon level.

Method

In GallRiks, the Swedish registry for Gallbladder surgery, we stratified all cholecystectomies performed 2006–2020 in three groups: surgeries carried out by surgeons that uses FFLC in <20 % of the cases (N = 150,119), in 20–79 % of the cases (N = 10,212) and in 80 % or more of the cases (N = 3176). We compared the groups with logistic regression, adjusting for sex, age, surgical experience, year of surgery and history of acute cholecystitis. All surgical complications (bleeding, gallbladder perforation, visceral perforation, infection, and bile duct injury) were included as outcome. A separate analysis was done with regards to operation time.

Results

No difference in incidence of all surgical complications or bile duct injury were seen between groups. The rates of bleeding (OR 0.34 [0.14–0.86]) and gallbladder perforation (OR 0.61 [0.45–0.82]) were significantly lower in the “fundus first > 80% group” and the operative time was shorter (OR 0.76 [0.69–0.83]).

Conclusion

In this study including >160,000 cholecystectomies, both methods was found to be equally safe.

Key message

During laparoscopic cholecystectomy, the standard method of dissection and fundus first dissection are equally safe surgical techniques. Surgeons need to learn both methods to be able to use the one most appropriate for each individual case.

Background

Patients with deep venous disease can be classified into two distinct categories: those with disease resulting from known deep vein thrombosis (DVT), which may subsequently lead to post-thrombotic syndrome (PTS), and those with disease caused by compressive factors or non-thrombotic iliac vein lesions (NIVL). The major factor causing the symptoms in patients with PTS and NIVL is venous hypertension which happens due to venous stenosis or venous obstruction. Nowadays Venous stenting offers a noninvasive approach for treatment of NIVL and PTS demonstrating high patency rate.

Methods

We comprehensively reviewed relevant published papers from 2008 to 2023 that surveyed various influencing factors including the site of occlusion and etiology of occlusions, proper diagnostic imaging, ideal characteristics of venous stents, different dedicated venous stents, pre-operative, concomitant, and post-operative interventions and factors that challenge stenting in both PTS and NIVL patients. The papers were identified by searching the keywords “venous stenting”, “PTS”, “NIVL”, “occlusion”, and “stenosis” in PubMed central library MEDLINE and Google Scholar.

Results

Patency rates, post-stent complications, and relevant data according to the patient's quality of life were included and analyzed from 476 identified studies. There is no validated protocol and guideline for using stents in patients with PTS and NIVL.

Conclusion

As there is no validated protocol and guideline for using stents in patients with PTS and NIVL, our study may provide comprehensive information to assist researchers interested in writing the protocol and give them insight.

Background

Disparities exist throughout surgery. We aimed to assess for racial/ethnic disparities among outcomes in a large thoracic surgery patient population.

Methods

We reviewed all thoracic surgery patients treated at our integrated health system from January 1, 2016–December 31, 2020. Post-operative outcomes including length of stay (LOS), 30-day return to the emergency department (30d-ED), 30-day readmission, 30- and 90-day outpatient appointments, and 30- and 90-day mortality were compared by race/ethnicity. Bivariate analyses and multivariable logistic regression were performed. Our multivariable models adjusted for age, sex, body mass index, Charlson Comorbidity Index, surgery type, neighborhood deprivation index, insurance, and home region.

Results

Of 2730 included patients, 59.4 % were non-Hispanic White, 15.0 % were Asian, 11.9 % were Hispanic, 9.6 % were Black, and 4.1 % were Other. Median (Q1-Q3) LOS (in hours) was shortest among non-Hispanic White (37.3 (29.2–76.1)) and Other (36.5 (29.3–75.4)) patients followed by Hispanic (46.8 (29.9–78.1)) patients with Asian (51.3 (30.7–81.9)) and Black (53.7 (30.6–101.6)) patients experiencing the longest LOS (p < 0.01). 30d-ED rates were highest among Hispanic patients (21.3 %), followed by Black (19.2 %), non-Hispanic White (18.1 %), Asian (13.4 %), and Other (8.0 %) patients (p < 0.01). On multivariable analysis, Hispanic ethnicity (Odds Ratio (OR) 1.43 (95 % CI 1.03–1.97)) and Medicaid insurance (OR 2.37 (95 % CI 1.48–3.81)) were associated with higher 30d-ED rates. No racial/ethnic disparities were found among other outcomes.

Conclusions

Despite parity across multiple surgical outcomes, disparities remain related to patient encounters within our system. Health systems must track such disparities in addition to standard clinical outcomes.

Key message

While our large integrated health system has been able to demonstrate parity across many major surgical outcomes among our thoracic surgery patients, race/ethnicity disparities persist including in the number of post-operative return trips to the emergency department. Tracking outcome disparities to a granular level such as return visits to the emergency department and number of follow up appointments is critical as health systems strive to achieve equitable care.