International journal of surgery最新文献

{"title":"Multimodal large language models address clinical queries in laryngeal cancer surgery: a comparative evaluation of image interpretation across different models.","authors":"Bingyu Liang, Yifan Gao, Taibao Wang, Lei Zhang, Qin Wang","doi":"10.1097/JS9.0000000000002234","DOIUrl":"10.1097/JS9.0000000000002234","url":null,"abstract":"<p><strong>Background and objectives: </strong>Recent advances in multimodal large language models (MLLMs) have shown promise in medical image interpretation, yet their utility in surgical contexts remains unexplored. This study evaluates six MLLMs' performance in interpreting diverse imaging modalities for laryngeal cancer surgery.</p><p><strong>Methods: </strong>We analyzed 169 images (X-rays, CT scans, laryngoscopy, and pathology findings) from 50 patients using six state-of-the-art MLLMs. Model performance was assessed across 1084 clinically relevant questions by two independent physicians.</p><p><strong>Results: </strong>Claude 3.5 Sonnet achieves the highest accuracy (79.43%, 95% CI: 77.02%-81.84%). Performance varied significantly across imaging modalities and between commercial and open-source models, with a 19-percentage point gap between the best commercial and open-source solutions.</p><p><strong>Conclusion: </strong>Advanced MLLMs show promising potential as clinical decision support tools in laryngeal cancer surgery, while performance variations suggest the need for specialized model development and clinical workflow integration. Future research should focus on developing specialized MLLMs trained on large-scale multi-center laryngeal cancer datasets.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"2727-2730"},"PeriodicalIF":12.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevention strategies of esophageal stenosis after endoscopic resection for superficial esophageal cancer: a Bayesian network meta-analysis.","authors":"Yongqi Dong, Hongyan Xu, Wanli Yu, Zijing Liu, Gang Zhao, Zhihuan Zhang, Yuan Xia, Shiyong Xiao, Qianzhang Yi, Zebin Lin","doi":"10.1097/JS9.0000000000002241","DOIUrl":"10.1097/JS9.0000000000002241","url":null,"abstract":"<p><strong>Introduction: </strong>What interventions effectively prevent postoperative stenosis following endoscopic resection (ER) of superficial esophageal cancer? This study aimed to identify effective interventions or combinations through a systematic review and network meta-analysis.</p><p><strong>Methods: </strong>Six databases were systematically searched for eligible studies up to 30 April 2023, on interventions to prevent esophageal stenosis post-ER. Odds ratios (ORs) evaluated stenosis rate (primary outcome) and complications (secondary outcome), while mean differences (MD) evaluated endoscopic balloon dilatation (EBD) sessions post-stenosis.</p><p><strong>Results: </strong>Twenty-three studies involving 1271 patients and 11 different interventions were included. Eight interventions were effective in preventing post-ER stenosis: oral hydrocortisone sodium succinate and aluminum phosphate gel (OHA) (OR: 0.02, 95% credible interval [CrI]: 0.00-0.11), polyglycolic acid (PGA) + ST (OR: 0.02, 95% CrI: 0.00-0.23), oral tranilast (OT) + preemptive endoscopic balloon dilatation (PEBD) (OR: 0.08, 95% CrI: 0.01-0.77), botulinum toxin (BT) (OR: 0.10, 95% CrI: 0.03-0.32), ST (OR: 0.08, 95% CrI: 0.01-0.67), oral steroid (OS) (OR: 0.11, 95% CrI: 0.05-0.28), endoscopic triamcinolone injection (ETI) + OS (OR: 0.17, 95% CrI: 0.07-0.42), and ETI (OR: 0.18, 95% CrI: 0.11-0.30). Five interventions significantly reduced EBD sessions: PGA + ST (MD: -5.78, 95% CrI: -11.04 to -1.21), ETI + OS (MD: -3.27, 95% CrI: -5.37 to -0.72), OS (MD: -6.18, 95% CrI: -9.43 to -3.38), ETI (MD: -3.81, 95% CrI: -5.74 to -1.99), and BT (MD: -2.16, 95% CrI: -4.12 to -0.40). None of the interventions significantly increased complications.</p><p><strong>Conclusions: </strong>This study confirmed the efficacy of OS, ETI, and ETI + OS and verified five other interventions (OHA, PGA + ST, OT + PEBD, BT, and ST) in preventing stenosis. Notably, PGA + ST and BT also reduced the number of EBD sessions.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"2651-2661"},"PeriodicalIF":12.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the efficacy of neoadjuvant chemotherapy and neoadjuvant chemoradiotherapy in locally advanced rectal cancer patients: meta-analysis of randomized controlled trials.","authors":"De-Xin Zeng, Ruo-Nan Liu, Xian-Kun Ren, Peng Zhang, Ling-Han Tang, Ling Tan, Rehman Zia Ur, Mao-Ru Zhao, Peng Guo, Pan Zhang, Jun Du, Xian Qin, Shi-Yan Wan, Lu-Qian Deng, Ya-Jun Luo, Zi-Lin Liu, Jiang-Wei Xiao","doi":"10.1097/JS9.0000000000002262","DOIUrl":"10.1097/JS9.0000000000002262","url":null,"abstract":"<p><strong>Background: </strong>Preoperative neoadjuvant chemoradiotherapy (nCRT) is considered to be the standard treatment strategy for locally advanced rectal cancer (LARC); however, the risk of adverse events and postoperative recurrence remains significant. This study aimed to evaluate the non-inferiority of neoadjuvant chemotherapy (nCT) compared with nCRT in patients with LARC and to assess the possibility of eliminating radiotherapy on the basis of guaranteed efficacy.</p><p><strong>Materials and methods: </strong>We searched the PubMed, Embase, and Cochrane Library databases to identify randomized controlled trials (RCTs) comparing the efficacy of nCRT and nCT for LARC. The study protocol was registered with the Prospective Register of Systematic Reviews (PROSPERO).</p><p><strong>Results: </strong>A total of 2706 patients from seven studies were included in the meta-analysis. There was no significant difference in overall survival (OS) or disease-free survival (DFS) between the nCT and nCRT groups. This study demonstrated a lower rate of infection (OR = 0.53, 95% CI = 0.34-0.82; P = 0.005), anastomotic leak (OR = 0.55, 95% CI = 0.34-0.87; P = 0.01), tumor regression grade (TRG) 0-1 (OR = 0.50, 95% CI = 0.36-0.69; P < 0.0001), preventive diverting ileostomy (OR = 0.41, 95% CI = 0.17-1.02; P = 0.05), and leukopenia (OR = 0.50, 95% CI = 0.25-1.01; P = 0.05) in the nCT group. However, there was no significant difference in the other toxic events, such as intestinal obstruction, urinary complications, diarrhea, and surgical or pathological outcomes, such as clinical fistula, sphincter preservation, postoperative mortality (≤ 60 d), R0 resection, ypStage 0-I, positive circumferential resection margin (CRM+), or pathological complete response (pCR) between the two groups.</p><p><strong>Conclusion: </strong>This study indicated that OS and DFS were not lower in the nCT group than in the nCRT group. In addition, the nCT group had fewer complications. Preoperative nCT is expected to become a standard treatment option for most patients with stage II-III LARC. It is worth noting that radiotherapy cannot be ignored for some patients who need to ensure the conversion effect of neoadjuvant therapy and strongly request to preserve organ function.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"2686-2696"},"PeriodicalIF":12.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deciphering the impact of dietary habits and behavioral patterns on colorectal cancer.","authors":"Qihang Yuan, Jiahua Liu, Xinyu Wang, Chunchun Du, Yao Zhang, Lin Lin, Chengfang Wang, Zhijun Hong","doi":"10.1097/JS9.0000000000002229","DOIUrl":"10.1097/JS9.0000000000002229","url":null,"abstract":"<p><p>Colorectal cancer (CRC) is a malignant tumor that originates from the epithelial cells of the colon and rectum. Global epidemiological data shows that in 2020, the incidence and mortality rate of CRC ranked third and second, respectively, posing a serious threat to people's health and lives. The factors influencing CRC are numerous and can be broadly categorized as modifiable and non-modifiable based on whether they can be managed or intervened upon. Non-modifiable factors include age, gender, family history, among others. Among the modifiable factors, dietary habits and behavioral practices are the main intervention measures that people can take to prevent CRC. Numerous studies indicate that a high intake of red and processed meats, fats, as well as habits such as smoking, alcohol consumption, and prolonged sitting, increase the risk of developing CRC. Conversely, consuming ample vegetables, fruits, high dietary fiber, and engaging in moderate regular exercise may reduce the risk of CRC. This article primarily discusses the impact of dietary habits and behavioral practices on the occurrence and development of CRC, along with possible mechanisms, laying the foundation and providing direction for the prevention and control of CRC occurrence and development.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"2603-2612"},"PeriodicalIF":12.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of short-and long-term outcomes between endovascular and open repair for descending thoracic aortic aneurysm: a systematic review and meta-analysis.","authors":"Junning Liu, Dan Gou, Kanglin Xu, Ziao Lu, Peidong Li, Yong Lei, Yongjie Wang, Yuting Yang, Shiqiang Liu, Guiying Zhu","doi":"10.1097/JS9.0000000000002230","DOIUrl":"10.1097/JS9.0000000000002230","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review and meta-analysis aimed to evaluate and compare the efficacy of endovascular versus open repair for the treatment of patients with descending thoracic aortic aneurysm (DTAA).</p><p><strong>Methods: </strong>A systematic search of the PubMed, Embase, and Cochrane Library databases for relevant studies was performed. Outcome data, including postoperative mortality and morbidity, operative details, all-cause survival, freedom from aortic-related survival and freedom from aortic-related re-intervention, were independently extracted by two authors in a standardized way.</p><p><strong>Results: </strong>Twenty-nine studies comprising 49 972 patients (22 049 endovascular repair; 27 923 open repair) were included. Endovascular repair was associated with a significantly lower postoperative mortality rate [odd ratio (OR): 0.57, 95% confidence interval (CI): 0.45-0.72; I 2  = 72.58%] and morbidity. In terms of long-term survival, endovascular repair yielded better freedom from aortic-related survival [hazard ratio (HR): 0.71, 95% CI: 0.54-0.93, P = 0.012] but inferior freedom from aortic-related reintervention (HR: 2.10, 95% CI: 1.45-3.04, P < 0.001). Landmark analysis revealed that the open repair group experienced better all-cause survival beyond 16 months (HR: 1.64, 95% CI: 1.53-1.75, P < 0.001). In addition, in the subgroup of patients with intact DTAA, those who underwent open repair exhibited a higher rate of postoperative mortality (OR: 0.58, 95% CI: 0.38-0.88; I 2  = 83.34%) but had better all-cause survival beyond 7 months (HR: 1.72, 95% CI: 1.61-1.84, P < 0.001) than those who underwent endovascular repair.</p><p><strong>Conclusion: </strong>Among patients treated for DTAA, endovascular repair was associated with better freedom from aortic-related survival, a lower risk for postoperative mortality and morbidity, and shorter lengths of intervention, intensive care unit stay, and hospital stay than those who underwent open repair. Open repair yielded significantly better long-term all-cause survival and freedom from aortic-related re-intervention than endovascular repair.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"2662-2674"},"PeriodicalIF":12.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of simulation training efficacy in improving microsurgical skills: a retrospective analysis.","authors":"Xuecheng He, Tao Gao, Jianfei Tang, Zengxin Jiang, Zeng Zhang, E Lin, Hengfeng Yuan","doi":"10.1097/JS9.0000000000002259","DOIUrl":"10.1097/JS9.0000000000002259","url":null,"abstract":"<p><strong>Background: </strong>Microsurgery demands an intensive period of skill acquisition due to its inherent complexity. The development and implementation of innovative training methods are essential for enhancing microsurgical outcomes. This study aimed to evaluate the impact of a simulation training program on the clinical results of fingertip replantation surgeries.</p><p><strong>Materials and methods: </strong>A total of 276 replanted digits from 232 patients were included in this study, with a follow-up period of 6 months. Surgeons were identified and divided into trained and control groups, with the trained group receiving the rat tail training program. Primary outcomes included survival rates, replantation duration for each fingertip, degrees of flexion, Semmes-Weinstein monofilament test results, static two-point discrimination scores, Michigan Hand Questionnaire (MHQ) scores, and the incidence rates of complications such as arterial insufficiency and pulp atrophy.</p><p><strong>Results: </strong>Out of 1191 patients screened, 232 met the criteria for analysis. The average patient age was 41.3 years, predominantly male (87.1%). Trained microsurgeons performing Zone 1A replantation had higher success rates, shorter surgery durations, and fewer arterial complications compared to their untrained counterparts. For Zone 1B, they also showed improved operation times, decreased venous congestion and pulp atrophy, and better sensation outcomes. The results of trained group remained consistent across both single and multiple replantation, while the control group's outcomes varied in multiple replantation with less favorable results. The trained group reported better scores on the MHQ at 6-month follow-ups, particularly regarding work performance, pain levels, aesthetics, and satisfaction.</p><p><strong>Conclusions: </strong>The simulation training program using a rat tail model has proven effective in enhancing the skills necessary for improved fingertip replantation. Participants in the program performed surgeries more efficiently and achieved better clinical outcomes. The structure of the training has demonstrated benefits, which may lead to improvements in various microsurgical procedures, positively impacting trainee surgeons, patient care, and the broader medical community.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"2570-2577"},"PeriodicalIF":12.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The influence of familiarity between the surgeon and their assistant on patient outcomes: a prospective observational cohort study.","authors":"Daniel R Stelzl, Stephanie Polazzi, Jean-Christophe Lifante, Tanujit Dey, Antoine Duclos","doi":"10.1097/JS9.0000000000002269","DOIUrl":"10.1097/JS9.0000000000002269","url":null,"abstract":"<p><strong>Background: </strong>The inverse relationship between increased surgical team familiarity and reduced operative time is established, but its effect on patient outcomes remains uncertain.</p><p><strong>Materials and methods: </strong>A prospective cohort study including operations by attending surgeons between 1 November 2020 and 31 December 2021 across fourteen surgical departments from four French university hospitals. Surgical team familiarity was measured as the cumulative number of previous operations performed by the same dyad of attending and assisting surgeons. Composite of adverse events within 30 days of surgery encompassed major surgical complication, unplanned reoperation, extended ICU stay, and death. We used multivariable generally estimated equations to model the association between patient outcomes and surgical team familiarity, using a logarithmic function. The model considered the clustering of operations within surgeons.</p><p><strong>Results: </strong>Our analysis included 8546 operations by 1109 surgical team dyads, involving 45 attending surgeons and 369 assisting surgeons. We observed a significant inverse association between surgical team familiarity and composite adverse events odds ratio [OR] 0.92 (95% confidence interval [95% CI] 0.87-0.98), major surgical complications OR 0.93 (95% CI 0.88-0.99), and unplanned reoperations OR 0.88 (95% CI 0.78-0.99), with non-significant trends observed for extended ICU stays OR 0.88 (95% CI 0.75-1.04) and deaths OR 0.87 (95% CI 0.74-1.03). Within the first 15 collaborations, this was illustrated by a reduction in the occurrence of composite adverse events from 23.0% (95% CI 22.1%-24.0%) to 16.5% (95% CI 14.1%-18.8%), major surgical complications from 21.3% (95% CI 20.3%-22.2%) to 15.3% (95% CI 13.0%-17.5%), unplanned reoperations from 8.8% (95% CI 8.6%-9.1%) to 5.2% (95%CI 4.2%-6.1%), extended ICU stays from 4.3% (95% CI 4.1%-4.5%) to 3.1% (95% CI 2.0%-4.1%), and deaths from 2.3% (95% CI 2.1%-2.5%) to 1.4% (95% CI 0.9%-1.8%).</p><p><strong>Conclusions and relevance: </strong>This study emphasizes that heightened familiarity among surgical teams is associated with a significant reduction in major adverse events. Building stable operating room teams should be a management priority to enhance patient outcomes.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"2525-2534"},"PeriodicalIF":12.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of virtual reality intervention on hospitalized patients with acute pain after thoracoscopic surgery: a pilot randomized clinical trial.","authors":"Weibo Cao, Fan Ren, Tong Li, Fei Ma, Yuan Shi, Xuanguang Li, Cancan Cao, Ning Zhou, Hanyi Li, Haochuan Yu, Fuling Mao, Gang Chen, Lingling Zu, Li Wei, Qing Li, Yuanyuan Zhang, Lin Su, Wei Cui, Li Wu, Yuxin Zheng, Jing Li, Chunyan Wang, Renhua Ju, Chongliang Fang, Ling Yin, Yi Lu, Qiang Zhang, Song Xu","doi":"10.1097/JS9.0000000000002264","DOIUrl":"10.1097/JS9.0000000000002264","url":null,"abstract":"<p><p>The study investigates the effectiveness of immersive virtual reality (VR) as a nonpharmaceutical approach to manage postoperative pain in patients following thoracoscopic surgery. In this single-center, triple-arm pilot randomized controlled trial (RCT), 61 postsurgical patients with a postoperative pain numerical rating scale (NRS) score ≥4 after receiving standard analgesia were included and assigned to either a quantum clinics-VR (QTC-VR) group, a Placebo-VR group, or a control group. The QTC-VR group engaged in a daily 10-minute interactive pain relief 3D-VR program, while the Placebo-VR group watched a daily 10-minute relaxation-based 2D film through VR headsets for three days following surgery. 61 postsurgical patients were randomized and allocated (21 in the QTC-VR group, 20 in the Placebo-VR group, and 20 in the control group) in the final intention-to-treat (ITT) analyses. Compared with patients receiving Placebo-VR intervention, patients reported significantly lower pain scores following the daily QTC-VR intervention on postoperative days 1 (mean difference, -0.889; 95% CI, -1.464 to -0.314; P < 0.001), 2 (mean difference, -0.631; 95% CI, -1.211 to -0.051; P = 0.014), and 3 (mean difference, -0.798; 95% CI, -1.345 to -0.251; P < 0.001), respectively. Additionally, patients receiving QTC-VR intervention also reported high satisfaction and tolerable adverse events with their treatment. In conclusion, this pilot RCT demonstrates that QTC-VR might be a promising intervention for pain management post-thoracoscopic surgery, warranting further validation in ongoing phase III trials.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"2752-2756"},"PeriodicalIF":12.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor: \"A systematic review and network meta-analysis comparing upfront surgery with neoadjuvant treatments in pancreatic cancer\".","authors":"Qiang Yi, Gangfeng Zhu, Jinghua Zhong","doi":"10.1097/JS9.0000000000002226","DOIUrl":"10.1097/JS9.0000000000002226","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"2757-2758"},"PeriodicalIF":12.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The incidence and outcomes of hyperacute cardiovascular dysfunction following isolated traumatic brain injury: an observational cohort study.","authors":"Flora Bird, Mark Wilson, Shadman Aziz, Moustafa Shebl, Alexander Pickard, David Sims, Gareth Grier, David Lockey, Ross Davenport","doi":"10.1097/JS9.0000000000002266","DOIUrl":"10.1097/JS9.0000000000002266","url":null,"abstract":"<p><strong>Background: </strong>The relationship between early cardiovascular dysfunction (CVD) in isolated traumatic brain injury (iTBI) and outcome has not been fully described. We aimed to (1) determine the prevalence and phenotype of CVD after iTBI in the hyper-acute phase and (2) compare treatment and outcomes in those with CVD vs non-CVD.</p><p><strong>Methods: </strong>An observational cohort database study of severe iTBI patients (Head AIS 3+) at a level 1 trauma centre (2008-2019) and physician-led air ambulance service (2019-2020). CV dysfunction was defined as tachycardia or bradycardia, with hypotension. Physiology, laboratory results, 24-hour transfusion, and computer-topography (CT) findings were recorded. Outcomes were 28-day mortality and Glasgow Outcome Score (GOS).</p><p><strong>Results: </strong>A total of 168 patients met inclusion criteria, average age 46 years (IQR 30-61), 77% male, median ISS 25 (IQR 17-29) with 51% Head AIS 5. Time from injury to pre-hospital assessment was 31 minutes (IQR 20-42) with 20% demonstrating CVD on initial observations. The CVD group were more shocked (lactate 6.1 (1.7-10.9) vs. 2.4 (1.4-3.3), P < 0.001) and coagulopathic (43% vs. 15%, P = 0.001). There was no difference in Head AIS or CT findings between groups, except frequency of hypoxic ischemic encephalopathy (HIE) (CVD: 21% vs. non-CVD: 1%, P < 0.001). 24-hour transfusion was higher in CVD patients: 3 (0-8) vs. 0 (0-0) units, P < 0.001. Mortality was greater in CVD vs non-CVD iTBI (61% vs. 31%, P = 0.002), but in patients with AIS 5 there was no difference ( P = 0.262). One-third of CVD survivors (13/33) were discharged home, and 4/18 patients with recorded GOS had good neurological outcome.</p><p><strong>Conclusion: </strong>One in five patients with severe iTBI develop early CVD, associated with increased mortality, coagulopathy, and HIE. However, mortality and neurological outcome is highly variable in those with CVD across the iTBI severity spectrum. Further research is needed to define the pathophysiology and optimal treatment to improve outcomes for this subgroup of iTBI.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":" ","pages":"2516-2524"},"PeriodicalIF":12.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}