British Journal of Surgery最新文献

{"title":"Prospective multicentre observational study evaluating acute lower limb ischaemia (PROMOTE-ALI).","authors":"Alexandra Gratl,Albert Busch,Caroline Caradu,Panagiotis Doukas,Katariina Noronen,Alexandru Predenciuc,Lan Tran,Christian Zielasek,Petar Zlatanovic,Florian K Enzmann,","doi":"10.1093/bjs/znae230","DOIUrl":"https://doi.org/10.1093/bjs/znae230","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"65 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142249982","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 value of splenectomy during left-sided pancreatectomy for pancreatic ductal adenocarcinoma: predefined subanalysis in the DIPLOMA randomized trial.","authors":"Caro L Bruna,Jony van Hilst,Alessandro Esposito,Dyre Kleive,Massimo Falconi,John N Primrose,Maarten Korrel,Denise Bianchi,Alessando Zerbi,Arto Kokkola,Giovanni Butturini,Bergthor Björnsson,Mario Morone,Riccardo Casadei,Ravi Marudanayagam,Marc G Besselink,Mohammad Abu Hilal,","doi":"10.1093/bjs/znae236","DOIUrl":"https://doi.org/10.1093/bjs/znae236","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"17 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142268112","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":"Nurse understaffing associated with adverse outcomes for surgical admissions.","authors":"Paul Meredith, Lesley Turner, Christina Saville, Peter Griffiths","doi":"10.1093/bjs/znae215","DOIUrl":"10.1093/bjs/znae215","url":null,"abstract":"<p><strong>Background: </strong>Nurses play a crucial role in maintaining the safety of surgical patients. Few nurse staffing studies have looked specifically at surgical patients to examine the impact of exposure to low staffing on patient outcomes.</p><p><strong>Methods: </strong>A longitudinal patient analysis was conducted in four organizations in England using routine data from 213 910 admissions to all surgical specialties. Patients' staffing exposures were modelled as counts of understaffed registered nurse and nurse assistant days in the first 5 inpatient days. Understaffing was identified when staffing per patient-day was below the mean for the ward. Cox models were used to examine mortality within 30 days of admission and readmission within 30 days of discharge. Generalized linear models were used to investigate duration of hospital stay and occurrence of hospital-acquired conditions.</p><p><strong>Results: </strong>Increased exposure to registered nurse understaffing was associated with longer hospital stay and increased risk of deep vein thrombosis, pneumonia, and pressure ulcers. This was also true for nurse assistant understaffing, but the effect sizes tended to be smaller. In the Cox models, there were similarly increased hazards of death for registered nurse understaffing (HR 1.09, 95% c.i. 1.07 to 1.12) and nurse assistant understaffing (HR 1.10, 1.08 to 1.13), whereas the effect size of registered nurse understaffing for readmission (HR 1.02, 1.02 to 1.03) was greater than that seen with nurse assistants (HR 1.01, 1.01 to 1.02).</p><p><strong>Conclusion: </strong>Understaffing by both registered nurses and nursing assistants is associated with increased risks of a range of adverse events, and generally larger effects are seen with registered nurse understaffing.</p>","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"111 9","pages":""},"PeriodicalIF":8.6,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11419734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142306749","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":"Enhancing the validity and applicability of study for health-related quality of life in patients with conditions affecting the hand: meta-analysis.","authors":"Yuquan Chen, Qi Zhang, Jiarong He, Mingming Zhang","doi":"10.1093/bjs/znae217","DOIUrl":"10.1093/bjs/znae217","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"111 9","pages":""},"PeriodicalIF":8.6,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142118511","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":"Perioperative glucocorticoids: friend or foe?","authors":"Henrik Kehlet","doi":"10.1093/bjs/znae232","DOIUrl":"https://doi.org/10.1093/bjs/znae232","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"111 9","pages":""},"PeriodicalIF":8.6,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142277515","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":"Acute diabetic foot disease.","authors":"Amy Jones, Robert Hinchliffe","doi":"10.1093/bjs/znae226","DOIUrl":"https://doi.org/10.1093/bjs/znae226","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"111 9","pages":""},"PeriodicalIF":8.6,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142337732","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":"Baseline MRI predictors of successful organ preservation in the Organ Preservation in Rectal Adenocarcinoma (OPRA) trial.","authors":"Hannah Williams, Jonathan B Yuval, Floris S Verheij, Joao Miranda, Sabrina T Lin, Dana M Omer, Li-Xuan Qin, Marc J Gollub, Tae-Hyung Kim, Julio Garcia-Aguilar","doi":"10.1093/bjs/znae246","DOIUrl":"10.1093/bjs/znae246","url":null,"abstract":"<p><strong>Background: </strong>Prospective randomized trials have not yet identified baseline features predictive of organ preservation in locally advanced rectal cancers treated with total neoadjuvant therapy and a selective watch-and-wait strategy.</p><p><strong>Methods: </strong>This was a secondary analysis of the OPRA trial, which randomized patients with stage II-III rectal adenocarcinoma to receive either induction or consolidation total neoadjuvant therapy. Patients were recommended for total mesorectal excision, or watch and wait based on clinical response at 8 ± 4 weeks after completing treatment. Standardized baseline clinical and radiological variables were collected prospectively. Survival outcomes, including total mesorectal excision-free survival, disease-free survival, and overall survival, were assessed by intention-to-treat analysis. Cox proportional hazards models were used to evaluate associations between baseline variables and survival outcomes.</p><p><strong>Results: </strong>Of the 324 patients randomized for the OPRA trial, 38 (11.7%) had cT4 tumours, 230 (71.0%) cN-positive disease, 101 (32.5%) mesorectal fascia involvement, and 64 (19.8%) extramural venous invasion. Several baseline features were independently associated with recommendation for total mesorectal excision on multivariable analysis: nodal disease (HR 1.66, 95% c.i. 1.12 to 2.48), extramural venous invasion (HR 1.57, 1.07 to 2.29), mesorectal fascia involvement (HR 1.45, 1.01 to 2.09), and tumour length (HR 1.11, 1.00 to 1.22). Of these, nodal disease (HR 2.02, 1.15 to 3.53) and mesorectal fascia involvement (HR 2.02, 1.26 to 3.26) also predicted worse disease-free survival. Age (HR 1.03, 1.00 to 1.06) was associated with overall survival.</p><p><strong>Conclusion: </strong>Baseline MRI features, including nodal disease, extramural venous invasion, mesorectal fascia involvement, and tumour length, independently predict the likelihood of organ preservation after completion of total neoadjuvant therapy. Mesorectal fascia involvement and nodal disease are associated with disease-free survival.</p>","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"111 9","pages":""},"PeriodicalIF":8.6,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11422670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142337733","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":"Effect of tailoring biliopancreatic limb length based on total small bowel length versus standard limb length in one anastomosis gastric bypass: 1-year outcomes of the TAILOR randomized clinical superiority trial.","authors":"Nienke Slagter, Lindsy van der Laan, Loek J M de Heide, Ewoud H Jutte, Mirjam A Kaijser, Stefan L Damen, André P van Beek, Marloes Emous","doi":"10.1093/bjs/znae219","DOIUrl":"10.1093/bjs/znae219","url":null,"abstract":"<p><strong>Background: </strong>Tailoring the biliopancreatic limb length in one anastomosis gastric bypass is proposed as beneficial in retrospective studies, yet randomized trials are lacking. The aim of this double-blind, single-centre RCT was to ascertain whether tailoring biliopancreatic limb length based on total small bowel length (TSBL) results in superior outcomes after one anastomosis gastric bypass compared with a fixed 150 cm biliopancreatic limb length.</p><p><strong>Methods: </strong>Eligible patients, meeting International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) criteria for metabolic bariatric surgery, scheduled for primary one anastomosis gastric bypass surgery, and willing to be randomized, underwent TSBL measurement during surgery. When TSBL measurement was feasible, patients were randomly assigned to a standard 150 cm biliopancreatic limb length or a tailored biliopancreatic limb based on TSBL: TSBL less than 500 cm, biliopancreatic limb 150 cm; TSBL 500-700 cm, biliopancreatic limb 180 cm; and TSBL greater than 700 cm, biliopancreatic limb 210 cm. The primary outcome was percentage total weight loss at 5 years.</p><p><strong>Results: </strong>Between September 2020 and August 2022, 212 patients were randomized into the standard biliopancreatic limb group (105 patients) or the tailored biliopancreatic limb group (107 patients). The mean(s.d.) TSBL was 657(128) cm (range 295-1020 cm). In the tailored group, 150, 180, and 210 cm biliopancreatic limb lengths were applied to 8.4%, 53.3%, and 38.3% of patients respectively. The mean(s.d.) 1-year percentage total weight loss was 32.8(6.9)% in the standard group and 33.1(6.2)% in the tailored group (P = 0.787). Nutritional deficiencies and short-term complications showed no significant differences.</p><p><strong>Conclusion: </strong>Tailoring biliopancreatic limb length based on TSBL is safe and feasible. One year after surgery, it is not superior to a standard biliopancreatic limb length of 150 cm in terms of percentage total weight loss.</p><p><strong>Registration number: </strong>Dutch Trial Register, NL7945.</p>","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"111 9","pages":""},"PeriodicalIF":8.6,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11363871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142102484","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":"Emergency care of metabolic bariatric surgery patients.","authors":"Roxanna Zakeri,Ellen Andersson,Cynthia M Borg,Ronald S L Liem","doi":"10.1093/bjs/znae233","DOIUrl":"https://doi.org/10.1093/bjs/znae233","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"6 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142170850","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":"Disease-specific survival outcomes for patients after locoregional treatment for ductal carcinoma in situ: observational cohort study.","authors":"Sabrina M Wang, Yan Li, Amanda Nash, Yi Ren, Samantha M Thomas, Amanda B Francescatti, Anne Barber, Thomas Lynch, Elizabeth S Frank, Lars J Grimm, Alastair M Thompson, Ann H Partridge, Terry Hyslop, E Shelley Hwang, Marc D Ryser","doi":"10.1093/bjs/znae198","DOIUrl":"10.1093/bjs/znae198","url":null,"abstract":"<p><strong>Background: </strong>Breast-conserving surgery alone, breast-conserving surgery with adjuvant radiation treatment, and mastectomy are guideline-concordant treatments for ductal carcinoma in situ. The aim of this study was to compare survival outcomes between these treatment options.</p><p><strong>Methods: </strong>A stratified random sample of patients diagnosed with pure ductal carcinoma in situ between 2008 and 2014 was selected from 1330 sites in the USA. Data on diagnosis, treatment, and follow-up were abstracted by local cancer registrars. Population-averaged marginal estimates of disease-specific survival and overall survival for breast-conserving surgery alone, breast-conserving surgery with radiation treatment, and mastectomy were obtained by combining sampling and overlap weights.</p><p><strong>Results: </strong>A total of 18 442 women were included, with a median follow-up of 67.8 (interquartile range 46.1-93.5) months. A total of 35 women died from breast cancer, at a median age of 62 (interquartile range 50-74) years. Population-averaged 8-year rates of disease-specific survival were 99.6% or higher for all treatment groups, with no significant differences between groups (breast-conserving surgery alone versus breast-conserving surgery with radiation treatment, HR 1.19 (95% c.i. 0.29 to 4.85); and mastectomy versus breast-conserving surgery with radiation treatment, HR 1.74 (95% c.i. 0.53 to 5.72). There was no difference in overall survival between the patients who underwent a mastectomy and the patients who underwent breast-conserving surgery with radiation treatment (HR 1.09 (95% c.i. 0.83 to 1.43)). Patients who underwent breast-conserving surgery alone had lower overall survival compared with the patients who underwent breast-conserving surgery with radiation treatment (HR 1.29 (95% c.i. 1.00 to 1.67)). This survival difference vanished for all but one subgroup, namely patients less than 65 years (HR 1.86 (95% c.i. 1.15 to 3.00)).</p><p><strong>Conclusion: </strong>There was no statistically significant difference in disease-specific survival between women operated with breast-conserving surgery alone, breast-conserving surgery with radiation treatment, or mastectomy for ductal carcinoma in situ. Given the low absolute risk of disease-specific mortality, these results provide confidence in offering individualized locoregional treatment without fear of compromising survival.</p>","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"111 9","pages":""},"PeriodicalIF":8.6,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142102483","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}