British Journal of Surgery最新文献

{"title":"Respiratory complications after oesophagectomy using volatile or intravenous anaesthesia.","authors":"Yuki Hirano, Takaaki Konishi, Hidehiro Kaneko, Shotaro Aso, Satoru Matsuda, Hirofumi Kawakubo, Yuya Kimura, Hiroki Matsui, Kiyohide Fushimi, Hiroyuki Daiko, Osamu Itano, Hideo Yasunaga, Yuko Kitagawa","doi":"10.1093/bjs/znaf052","DOIUrl":"https://doi.org/10.1093/bjs/znaf052","url":null,"abstract":"<p><strong>Background: </strong>The anaesthesia regimen may affect the risk of postoperative respiratory complications. However, the optimal anaesthetic choice for oesophagectomy remains unclear. This retrospective study compared the effect of desflurane, sevoflurane, and propofol anaesthesia on short-term outcomes after oesophagectomy.</p><p><strong>Methods: </strong>Data of patients who underwent oesophagectomy for cancer during April 2012-March 2022 were extracted from a nationwide Japanese inpatient database. Propensity score matching weight analysis was conducted to compare respiratory complications, ventilatory failure, and in-hospital mortality between desflurane, sevoflurane, and propofol anaesthesia, adjusting for potential confounders. Sensitivity analyses were performed using multivariable logistic regression and instrumental variable analyses.</p><p><strong>Results: </strong>Among 21 080 included patients (desflurane group 7823, sevoflurane group 8932, and propofol group 4325 patients), respiratory complications and ventilatory failure occurred in 3399 (16.1%) and 960 (4.6%) patients respectively. Upon matching weight analysis, sevoflurane and propofol anaesthesia were significantly associated with higher incidences of respiratory complications (OR 1.13, 95% c.i. 1.03 to 1.24 and OR 1.43, 95% c.i. 1.28 to 1.58 respectively) and ventilatory failure (OR 1.21, 95% c.i. 1.02 to 1.43 and OR 1.29, 95% c.i. 1.06 to 1.56 respectively) compared with desflurane anaesthesia. In-hospital mortality after desflurane anaesthesia was the lowest of the three anaesthesia (1.6% and 1.8% versus 1.2%; OR 1.30, 95% c.i. 0.98 to 1.73 and OR 1.49, 95% c.i. 1.08 to 2.06 respectively). Multivariable logistic regression and instrumental variable analyses demonstrated similar results.</p><p><strong>Conclusions: </strong>Sevoflurane and propofol anaesthesia for oesophagectomy were associated with worse respiratory outcomes compared with desflurane anaesthesia.</p>","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 4","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing ward rounds: systematic review and meta-analysis of interventions to enhance patient safety.","authors":"Ellie C Treloar, Jesse D Ey, Matheesha Herath, Nicholas P R Edwardes, Suzanne Edwards, Martin H Bruening, Guy J Maddern","doi":"10.1093/bjs/znaf041","DOIUrl":"https://doi.org/10.1093/bjs/znaf041","url":null,"abstract":"<p><strong>Background: </strong>Poor quality ward rounds contribute to a large proportion of patient complications, delayed discharge, and increased hospital cost. This systematic review investigated all interventions aiming to improve patient and process-based outcomes in ward rounds.</p><p><strong>Methods: </strong>This systematic review was prospectively registered in PROSPERO, the international prospective register of systematic reviews (CRD42023394325). MEDLINE, Embase, Emcare, and PsycInfo were searched for studies with interventions aiming to improve ward round processes or patient outcomes in hospital settings. Studies were excluded if there was no baseline comparator or they were not in the ward round setting. Interventions were coded as checklist interventions (that is electronic or paper-based pro formas, templates, and checklists), structure interventions (that is defined rules or protocol to guide or standardize conduct), or other interventions. Outcomes were assessed via meta-analyses using the I2 statistic, Cochran's Q P value, and random-effects models. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool for RCTs and the Newcastle-Ottawa scale for non-randomized studies.</p><p><strong>Results: </strong>This review included 84 studies, from 18 countries, in 23 specialties, involving 43 570 patients. Checklist interventions significantly reduced ICU length of stay, improved overall documentation, and did not increase ward round duration. Structure interventions did not increase the time spent per patient or impact 30-day readmission rates or patient length of stay.</p><p><strong>Conclusion: </strong>This is the first systematic review with meta-analyses synthesizing the evidence of all ward round interventions targeted at improving patient and process outcomes. Results from this review should be used to inform guidelines for the 'ideal ward round'.</p>","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 4","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic intersphincteric resection with en-bloc prostatectomy for rectal cancer invading the prostate.","authors":"Kenji Kawada,Ryo Iguchi,Hiroya Matsuoka,Yukio Inamura,Mitsuru Yokota,Kazuyuki Kawamoto","doi":"10.1093/bjs/znaf064","DOIUrl":"https://doi.org/10.1093/bjs/znaf064","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"101 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a patient-reported outcome measure for gastrointestinal recovery after surgery (PRO-diGI).","authors":"Matthew J Lee,Daniel M Baker,Debby Hawkins,Sue Blackwell,Robert Arnott,Deena Harji,Gabrielle Thorpe,Stephen J Chapman,Georgina L Jones,","doi":"10.1093/bjs/znaf055","DOIUrl":"https://doi.org/10.1093/bjs/znaf055","url":null,"abstract":"BACKGROUNDAfter major abdominal surgery, patients may experience significant gastrointestinal dysfunction, including postoperative ileus. Many clinical tools are used to measure this dysfunction, but there is no patient-reported outcome measure (PROM) specific to this group. The aim of this study was to develop a new PROM for this common condition.METHODSA four-stage approach was undertaken. Stage 1 used semi-structured interviews with 29 patients to explore experiences of gastrointestinal recovery and develop a draft questionnaire. Stage 2 solicited feedback from 18 patients and 15 clinical experts on the face validity of the proposed tool using the Questionnaire on Questionnaires (QQ-10). Stage 3 recruited 297 patients to complete the questionnaire. Principal component analysis reduced the items and identified the domain structure. Test-retest reliability and a pilot assessment of responsiveness were assessed in stage 4 in a sample of 100 patients and in a sample of 68 patients respectively.RESULTSThe interviews generated 26 subthemes across gastrointestinal recovery and general well-being. An initial questionnaire containing 44 items was developed. The QQ-10 demonstrated high value and low burden, supporting face validity. Tests to reduce the items and identify the domain structure resulted in a 15-item questionnaire across four domains (nausea, eating, well-being, and bowels). Test-retest reliability showed intraclass correlation coefficient values ≥0.7 for all domains. Pilot responsiveness was demonstrated through differences in pre- and post-surgical scores.CONCLUSIONPRO-diGI is a PROM for gastrointestinal dysfunction after major abdominal surgery that shows good psychometric properties and demonstrates face validity, reliability, and responsiveness. This now needs external validation to facilitate broader implementation.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"60 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143819369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of postoperative complications on clinical outcomes after gastrectomy for cancer: multicentre study.","authors":"Sander J M van Hootegem, Margrietha van der Linde, Marcel A Schneider, Jeesun Kim, Felix Berlth, Yutaka Sugita, Peter P Grimminger, Gian Luca Baiocchi, Giovanni De Manzoni, Maria Bencivenga, Suzanne Gisbertz, Souya Nunobe, Han-Kwang Yang, Christian A Gutschow, Sjoerd M Lagarde, Hester F Lingsma, Bas P L Wijnhoven","doi":"10.1093/bjs/znaf043","DOIUrl":"https://doi.org/10.1093/bjs/znaf043","url":null,"abstract":"<p><strong>Background: </strong>To reduce the clinical and economic burden of complications after gastrectomy for gastric cancer, specific complications should be targeted to effectively allocate healthcare resources for quality improvement and preventive measures. The aim of this study was to assess the impact of complications on clinical outcomes.</p><p><strong>Methods: </strong>This was a retrospective multicentre study of patients who underwent (sub)total gastrectomy for gastric or junctional adenocarcinoma at 43 centres in 16 countries between 2017 and 2021. Outcomes were escalation of care, reoperation, prolonged hospital stay (greater than the 75th percentile), readmission, and 30-day mortality. Adjusted relative risks and population attributable fractions were estimated for specific complication-outcome pairs. The population attributable fraction represents the percentage reduction in the frequency of an adverse outcome if a complication could be completely prevented in the population.</p><p><strong>Results: </strong>In total, 7829 patients were included. Postoperative complications occurred in 1884 patients (24.1%). The most frequent complications were pulmonary complications (436 patients (5.6%)), anastomotic leakage (363 patients (4.6%)), and abdominal collection (301 patients (3.8%)). Anastomotic leakage, cardiac complications, and pulmonary complications had the greatest impact on 30-day mortality (population attributable fraction 26.6% (95% c.i. 14.5% to 38.6%), 18.7% (95% c.i. 9.4% to 28.0%), and 15.6% (95% c.i. 12.0% to 30.0%) respectively). Anastomotic leakage and pulmonary complications had the greatest impact on escalation of care (population attributable fraction 26.3% (95% c.i. 20.6% to 32.0%) and 18.4% (95% c.i. 11.7% to 25.2%) respectively), whereas anastomotic leakage and intra-abdominal bleeding had the greatest impact on reoperation (population attributable fraction 31.6% (95% c.i. 26.4% to 36.9%) and 8.5% (95% c.i. 5.5% to 11.5%) respectively). Most of the studied complications contributed to a prolonged hospital stay, whereas the contribution of complications to readmission did not exceed 15.9%. Subgroup analysis showed regional variation in the impact of complications.</p><p><strong>Conclusion: </strong>Anastomotic leakage had the largest overall negative impact on clinical outcomes after gastrectomy for gastric adenocarcinoma. Reducing the incidence of anastomotic leakage and pulmonary complications would have the most impact on the burden of complications.</p>","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 4","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11953074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Symmetrization in therapeutic mammoplasty for breast cancer: si non nunc quandro.","authors":"Daniel R Leff, Paul T R Thiruchelvam","doi":"10.1093/bjs/znaf060","DOIUrl":"10.1093/bjs/znaf060","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 4","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The future of liver surgery-why it should be minimally invasive.","authors":"Ismaël Chaoui,Mathieu D'Hondt","doi":"10.1093/bjs/znaf053","DOIUrl":"https://doi.org/10.1093/bjs/znaf053","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"60 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The future of liver surgery-open access should still be the front runner.","authors":"Guido Torzilli","doi":"10.1093/bjs/znaf046","DOIUrl":"https://doi.org/10.1093/bjs/znaf046","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"25 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total robotic inter-sphincteric dissection with transanal transection and single stapled anastomosis-a video vignette.","authors":"Chee Hoe Koo,María Sánchez-Rodríguez,Vincent Assenat,Marc-Oliver Francois,Patricia Tejedor,Quentin Denost","doi":"10.1093/bjs/znae308","DOIUrl":"https://doi.org/10.1093/bjs/znae308","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"197 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143819371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National implementation of Watch-and-Wait in patients with rectal cancer.","authors":"Barbara M Geubels, Brechtje A Grotenhuis, Aart-Jan van den Esschert, Doenja M J Lambregts, Monique Maas, Corrie A M Marijnen, Regina G H Beets-Tan, Geerard L Beets","doi":"10.1093/bjs/znaf040","DOIUrl":"10.1093/bjs/znaf040","url":null,"abstract":"<p><strong>Introduction: </strong>Most reports on the outcome of Watch-and-Wait (W&W) in rectal cancer come from expert centres. This study reports on a broad implementation in the Netherlands.</p><p><strong>Material and methods: </strong>The process of W&W implementation is described and the outcome of patients in a W&W registry between 2004 and 2022 analysed (regrowth, metastases, survival, and organ preservation). Three equally sized chronological cohorts were compared to capture any differences during implementation over time.</p><p><strong>Results: </strong>W&W was gradually implemented in 18 high-volume hospitals coordinated by a single expert centre. One thousand and eighty patients with a clinical good response after (chemo)radiotherapy were included, with a median follow-up of 42 months (95% c.i. 40 to 44). At first response evaluation, 45% had a clinical complete response (cCR) and 55% near-complete reponse (nCR). In patients with nCR, 75% eventually achieved cCR, 14% underwent local excision, 2% received additional contact X-ray brachytherapy, and 10% underwent total mesorectal excision (TME) for persistent residual disease. Three-year actuarial local regrowth incidence was 23%. Three-year organ preservation rate was 76%. The 3-year distant metastases rate and overall survival were 10% and 97%. There were no significant differences in 3-year local regrowth or distant metastases between the three consecutive cohorts. In the two more recent cohorts more patients underwent TME for residual disease (13% versus 3%), likely due to a more liberal inclusion of patients with nCR.</p><p><strong>Conclusion: </strong>The results of W&W in rectal cancer patients in high-volume hospitals mirror those of expert centres.</p>","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 4","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}