British Journal of Surgery最新文献

{"title":"Implementation and short-term outcomes of minimally invasive liver surgery in France.","authors":"Stylianos Tzedakis, Diana Berzan, Ugo Marchese, Alexandre Challine, Vincent Mallet, Anthony Dohan, Heithem Jeddou, Alexandra Nassar, Sandrine Katsahian, David Fuks","doi":"10.1093/bjs/znaf017","DOIUrl":"https://doi.org/10.1093/bjs/znaf017","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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741776","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":"Prehospital triage of trauma patients: predicting major surgery using artificial intelligence as decision support.","authors":"Andreas S Millarch, Fredrik Folke, Søren S Rudolph, Haytham M Kaafarani, Martin Sillesen","doi":"10.1093/bjs/znaf058","DOIUrl":"https://doi.org/10.1093/bjs/znaf058","url":null,"abstract":"<p><strong>Background: </strong>Matching the necessary resources and facilities to attend to the needs of trauma patients is traditionally performed by clinicians using criteria-directed triage protocols. In the present study, it was hypothesized that an artificial intelligence (AI) model should be able to predict the need for major surgery based on data available at the scene.</p><p><strong>Methods: </strong>Prehospital and in-hospital electronic health record data were available for 4578 patients in the Danish Prehospital Trauma Data set. Data included demographics (age and sex), clinical scores (airway, breathing, circulation, disability (ABCD) and Glasgow Coma Scale scores), and sequential vital signs (heart rate, blood pressure, and oxygen saturation). The data from the first 5, 10, and 20 min of prehospital contact were used for predicting the need for surgery up to 12 h after hospital arrival. Surgeries were stratified into all major surgical procedures and specialty-specific procedures (neurosurgery, abdominal surgery, and vascular surgery). The data set was split into training (70%), validation (20%) and holdout test (10%) data sets. Three hybrid neural networks were trained and performance was evaluated on the holdout test data set using the area under the receiver operating characteristic curve (ROC-AUC).</p><p><strong>Results: </strong>Overall, the model achieved an ROC-AUC of 0.80-0.86 for predicting the need for major surgery. For predicting the need for major neurosurgery the ROC-AUC was 0.90-0.95, for predicting the need for major vascular surgery the ROC-AUC was 0.69-0.88, and for predicting the need for major abdominal surgery the ROC-AUC was 0.77-0.84.</p><p><strong>Conclusion: </strong>Utilizing AI early in the prehospital phase of a trauma patient's trajectory can predict specialized surgical needs. This approach has the potential to aid the early triage of trauma patients.</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":"143810276","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":"Non-technical error leading to patient fatalities in the Australian surgical population.","authors":"Jesse D Ey, Victoria Kollias, Octavia Lee, Kelly Hou, Matheesha B Herath, John B North, Ellie C Treloar, Martin H Bruening, Adam J Wells, Guy J Maddern","doi":"10.1093/bjs/znaf083","DOIUrl":"https://doi.org/10.1093/bjs/znaf083","url":null,"abstract":"<p><strong>Introduction: </strong>Many surgical adverse events are due to errors in non-technical skills (NTS); consequently, improving NTS is a priority. However, evidence to guide NTS improvement activities is lacking. This study aimed to investigate the incidence and characteristics of non-technical errors linked to fatalities in a large, representative surgical-patient population to guide future NTS improvement.</p><p><strong>Methods: </strong>All fatality cases with known or suspected adverse events reported to the Australian and New Zealand Audit of Surgical Mortality (ANZASM) between 2012 and 2019 were retrospectively assessed using a validated tool developed by the study authors. Outcomes included the incidence of non-technical errors linked to death (overall and by NTS domain), the identification of non-technical error predictors through multivariate analysis, and change in non-technical error incidence over time using statistical process control charts.</p><p><strong>Results: </strong>Some 30 971 cases of surgical fatality were reported between 2012 and 2019, of which 3829 met the inclusion criteria. Due to insufficient information, 134 were excluded, leaving 3695 for analysis. Non-technical errors associated with patient death were identified in 63.7%. Of these, 58.4% had Decision-Making errors, 56.4% had Situational Awareness errors, 15.2% had Communication/Teamwork errors, and 5.44% had Leadership errors. Statistically significant predictors of Communication/Teamwork, Decision-Making, and Situational Awareness errors were identified. The incidence of overall non-technical errors decreased significantly between 2012 and 2019 and periods of significant decrease in Communication/Teamwork and Leadership errors were demonstrated. No significant decrease in Decision-Making or Situational Awareness errors were demonstrated.</p><p><strong>Conclusion: </strong>The incidence of non-technical errors associated with surgical mortality rate is high. Future NTS improvement efforts should be targeted towards Decision-Making and Situational Awareness errors.</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":"143955257","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":"Endovascular treatment of peripheral arterial disease: Endo-STAR framework for the design, conduct, and reporting of trials.","authors":"Ewa M Zywicka, Andrew J Moore, Christopher Twine, Christian-Alexander Behrendt, Michel Bosiers, Marianne Brodmann, Edward Choke, Gert J deBorst, Athanasios Diamantopoulos, Florian Enzmann, Alik Farber, Gary Ansel, Dario Gattuso, Gerard S Goh, Goueffic Yann, Shirley Jansen, Mario Landini, Anne Lejay, Michael Lichtenberg, Matthew Menard, Peter Mezes, Joseph Mills, Jane Nixon, Joakim Nordanstig, Kelly O'Connell, Baris Ozdemir, Lorenzo Patrone, Sapna Puppala, Athanasios Saratzis, Eric A Secemsky, Nikol Sigrid, Konstantinos Stavroulakis, Sabine Steiner, Martin Teraa, Isabelle Van Herzeele, Maarit Venermo, Thomas Zeller, Ronelle Mouton, Robert J Hinchliffe","doi":"10.1093/bjs/znaf020","DOIUrl":"https://doi.org/10.1093/bjs/znaf020","url":null,"abstract":"<p><strong>Background: </strong>Endovascular technologies continue to evolve to meet the large and growing burden of peripheral arterial disease. The overall quality of published RCTs in endovascular treatments for peripheral arterial disease is low, resulting in uncertainty over treatment effectiveness. The aim of this study was to develop a framework to improve the design, conduct, and reporting of future clinical trials for infrainguinal endovascular treatments of peripheral arterial disease.</p><p><strong>Methods: </strong>The authors undertook the design, development, and pilot testing of a novel framework. The study comprised four distinct phases. Phase 1 represented the development of a preliminary framework using content analysis of endovascular interventions described in previously published RCTs. Phase 2 consisted of focus groups with key stakeholders to further develop, revise, and achieve initial consensus on the framework. Phase 3 corresponded to the creation of a modified Delphi questionnaire to achieve final consensus on the framework. Phase 4 included cognitive interviews with professionals designing or undertaking endovascular lower limb trials to pilot test the framework.</p><p><strong>Results: </strong>Content analysis of 228 endovascular interventions from 112 RCTs identified six key themes, relevant to endovascular peripheral arterial disease interventions, for the framework: expertise; setting; anaesthesia; imaging; intervention components (access; crossing lesion; treating lesion (lesion preparation; intervention; intervention optimization; bailout intervention; and treatment of non-target lesions); and closure of artery); and pharmacological interventions. Further refinements were made to the framework as a result of feedback from three focus groups and a Delphi questionnaire. The framework deconstructs an endovascular intervention into its component parts. The final framework can be accessed at www.endo-star.com. Pilot testing evaluated comprehension, clarity, and completeness of interpretation.</p><p><strong>Conclusion: </strong>The Endo-STAR framework deconstructs endovascular interventions into their key component parts and has been designed and pilot tested to enhance the quality of RCTs of endovascular interventions in peripheral arterial disease. It may be used to assist in developing future trial protocols, the standardization of infrainguinal endovascular interventions, the monitoring of adherence to the trial protocol, and as a standardized reporting guideline.</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/PMC12003854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960714","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":"Laparoscopic spleen-preserving pancreatic tail resection: innovative surgical techniques and strategies.","authors":"Haoyang Huang, Dingwei Xu, Jie Huang","doi":"10.1093/bjs/znaf069","DOIUrl":"https://doi.org/10.1093/bjs/znaf069","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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953993","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":"Addressing global inequities in surgery with the FAIR and CARE principles.","authors":"Justin W Collins, Prokar Dasgupta","doi":"10.1093/bjs/znaf026","DOIUrl":"10.1093/bjs/znaf026","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 3","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571775","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":"Defining resectability criteria for primary retroperitoneal sarcoma: a challenging imperative.","authors":"Fahima Dossa, Carol J Swallow","doi":"10.1093/bjs/znaf044","DOIUrl":"https://doi.org/10.1093/bjs/znaf044","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 3","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646626","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":"Pathological staging predicts survival more accurately than clinical staging in locally advanced rectal cancer following total neoadjuvant therapy.","authors":"Jyi Cheng Ng, Richard Sassun, Annaclara Sileo, William R G Perry, Kellie L Mathis, David W Larson","doi":"10.1093/bjs/znaf034","DOIUrl":"https://doi.org/10.1093/bjs/znaf034","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 3","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603154","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 and external validation of prediction risk scores (STRISK and NOFA) to predict immediate surgical need in adhesive small bowel obstruction: an observational prospective multicentre study.","authors":"Panu Räty, Akseli Bonsdorff, Helka Parviainen, Eila Lantto, Thomas Hackenberg, Hanna Lampela, Taina Nykänen, Ilana Lyytinen, Panu Mentula, Ville Sallinen","doi":"10.1093/bjs/znaf025","DOIUrl":"10.1093/bjs/znaf025","url":null,"abstract":"<p><strong>Background: </strong>Adhesive small bowel obstruction (SBO) is a common cause of emergency admission. Identification of patients at high risk of strangulation or failure of non-operative treatment is difficult. In this multicentre prospective observational study, prediction models for strangulation and non-operative treatment failure in adhesive SBO were developed.</p><p><strong>Method: </strong>This study was carried out in three Finnish hospitals between June 2014 to May 2022. Patients with CT-confirmed adhesive SBO and prospective case report forms were included. The main outcomes were strangulation defined by operative finding of any intestinal ischaemia and failure of non-operative treatment within 30 days from admission. The model was developed using binary logistic regression, internally validated by bootstrapping and then externally validated.</p><p><strong>Results: </strong>Of 626 patients, 481 were included; 355 patients formed the model development group and 126 formed the external validation group. Strangulation occurred in 58 (16%) patients and non-operative treatment failed in 93 (31%) patients in development cohort. The following six variables were included in the risk model for strangulation and non-operative treatment failure: neutrophil-leucocyte ratio, number of previous SBOs, abdominal guarding, mesenteric changes and free abdominal fluid, closed loop sign, and faeces sign on CT. In the development cohort, the optimism corrected area under the receiver operator characteristics curve for the strangulation model was 0.860 (95% c.i. 0.808-0.917), and 0.751 (95% c.i. 0.694-0.816) for the non-operative treatment failure model respectively. At external validation, the models retained their discrimination and demonstrated stable calibration.</p><p><strong>Conclusion: </strong>A clinically relevant prediction model to predict strangulation and non-operative treatment failure in adhesive small bowel obstruction has been developed.</p>","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 3","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655704","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":"Development of a surgical complexity score to predict postoperative morbidity following primary retroperitoneal sarcoma resection: a collaborative study from the Transatlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG).","authors":"Mark Fairweather, Joshua S Jolissaint, Marco Fiore, Dirk Strauss, Sylvie Bonvalot, Samuel J Ford, Winan J van Houdt, Carol Swallow, Piotr Rutkowski, Alessandro Gronchi, Chandrajit P Raut","doi":"10.1093/bjs/znaf029","DOIUrl":"https://doi.org/10.1093/bjs/znaf029","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 3","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661652","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}