World Journal of Surgery最新文献

{"title":"Subtotal Gastrectomy for Clinical Stage I Remnant Gastric Cancer.","authors":"Ryuhei Aoyama, Shigeru Tsunoda, Ryosuke Okamura, Yoshito Yamashita, Hiroaki Hata, Yosuke Kinjo, Akira Miki, Seiichiro Kanaya, Michihiro Yamamoto, Koichi Matsuo, Dai Manaka, Eiji Tanaka, Hironori Kawada, Masato Kondo, Atsushi Itami, Takatsugu Kan, Yoshio Kadokawa, Tetsuo Ito, Kenjiro Hirai, Hisahiro Hosogi, Tatsuto Nishigori, Shigeo Hisamori, Nobuaki Hoshino, Kazutaka Obama","doi":"10.1002/wjs.12638","DOIUrl":"https://doi.org/10.1002/wjs.12638","url":null,"abstract":"<p><strong>Background: </strong>Subtotal gastrectomy (SG) is a surgical option for early remnant gastric cancer (RGC). However, reports evaluating the feasibility and oncological safety of SG for RGC are limited. Here, we aimed to evaluate the short- and long-term outcomes of SG for RGC.</p><p><strong>Methods: </strong>We conducted a multi-institutional retrospective cohort study and compared the outcomes between SG and completion gastrectomy (CG) of patients with clinical stage I RGC. The short- and long-term outcomes, body weight change, and serum albumin level at 1 year postoperatively were evaluated.</p><p><strong>Results: </strong>Twenty-two and 202 patients in the SG and CG groups, respectively, were included in the analysis. The risk ratios (95% confidence interval [CI]) were 0.90 (0.27, 2.22) and 0.51 (0.33, 2.47) for the overall and severe complications, respectively. No anastomotic leakage was observed in the SG group, while 6.4% of the CG group had anastomotic leakage (p = 0.62). The 3-year relapse-free survival rates were 79.8% and 78.8% in the SG and CG groups, respectively (hazard ratio [95% CI], 0.87 [0.31, 2.40]; p = 0.80). The median body weight changes at 1 year postoperatively from the preoperative level were significantly less in the SG group (96.4% and 90.4% in the SG and CG groups, respectively; p = 0.021), and the median serum albumin changes at 1 year postoperatively were + 0.01 and -0.04 g/dL, respectively (p = 0.551).</p><p><strong>Conclusion: </strong>SG might be one of the potential options for clinical stage I RGC, if the proximal margin is secured.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role and Performance of Postoperative Imaging After Repair of a Perforated Peptic Ulcer.","authors":"Veljko Strajina, Sarah B Lund, Rebecca Zhu, Ashish Khandelwal, Daniel Stephens, John M Zietlow, Stephanie F Heller, David Turay, Khalid H Mahmoud, William S Harmsen, Amin Mohamed Ahmed","doi":"10.1002/wjs.12622","DOIUrl":"https://doi.org/10.1002/wjs.12622","url":null,"abstract":"<p><strong>Background: </strong>We aimed to determine the performance of postoperative computed tomography (CT) and upper gastrointestinal series (UGI) in patients who underwent surgery for a perforated peptic ulcer and to assess the yield of routine postoperative studies.</p><p><strong>Methods: </strong>Retrospective, single-institution, chart-review study of patients who underwent a repair of a perforated gastric or duodenal ulcer between August 2004 and September 2021 at Mayo Clinic, Rochester, Minnesota.</p><p><strong>Results: </strong>We identified a total of 240 patients, 28 (12%) were found to have leaks. When any of the four findings (extraluminal gas or fluid collection adjacent to the repair, worsening pneumoperitoneum, or enteral contrast extravasation) was present on postoperative CT scan (n = 116) it had sensitivity of 76% (95% CI 53%-90%), with a specificity of 90% (95% CI 84%-91%). Upper gastrointestinal series (UGI, n = 150) showed a sensitivity of 57% (95% CI 25%-84%) and a specificity of 99% (95% CI 96%-100%). UGI demonstrated higher specificity compared to CT (p < 0.01); there was no significant difference in sensitivity (p = 0.34). The findings from CT scans led to changes in management for a significantly greater number of patients compared to UGI (20% vs. 4%, p < 0.01). The diagnostic yield for leak identification was 3% for routine postoperative CT (n = 63) and 2% for routine UGI studies (n = 141).</p><p><strong>Conclusions: </strong>Postoperative CT is more likely to change management in patients who underwent repair of a perforated peptic ulcer compared to postoperative upper gastrointestinal series. The yield of routine postoperative studies is low, and their benefit is uncertain.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization of a Trauma Quality Improvement Tool in a Clinical Trial: Effects When Tool Not Used.","authors":"Adam Gyedu, Adamu Issaka, Peter Donkor, Charles Mock","doi":"10.1002/wjs.12633","DOIUrl":"https://doi.org/10.1002/wjs.12633","url":null,"abstract":"<p><strong>Introduction: </strong>A standardized trauma intake form (TIF) with built-in memory prompts was previously shown to increase achievement of key performance indicators (KPIs) of trauma care. We sought to understand what differentiated patients who did and did not have the TIF used and how this affected care. We also sought to assess whether TIF introduction resulted in hospital-wide improvements in care, even in patients for whom the TIF was not used.</p><p><strong>Methods: </strong>We used data from a prior randomized clinical trial at eight nontertiary hospitals (2020-2021) in Ghana. In this trial, there was a baseline (before) period, after which the TIF was introduced. TIF use and achievement of 16 KPIs were recorded by trained observers.</p><p><strong>Results: </strong>We enrolled 2067 patients (before period) and 2010 patients (after period), of whom 1720 had the TIF used and 290 did not. Patients who did not have the TIF used were more likely to be < 18 years, treated at first-level hospitals, treated during off-hours, and less likely to be seriously injured (ISS ≥ 9) than patients who had the TIF used (all p < 0.05). Patients who had the TIF used were more likely to have 11/16 KPIs performed compared to those who did not have the TIF used. For example, chest examination was performed in 99.5% of patients who had the TIF used versus 80% of those who did not (p < 0.001). Comparing all three groups as follows: Before the TIF (baseline), 2/16 KPIs were performed in ≥ 90% of patients. After TIF introduction, in the group in which the TIF was used, this increased to 15/16 KPIs being performed in ≥ 90% of patients. However, in the after period, but without TIF use, 4/16 KPIs were performed in ≥ 90% of patients, which was higher than baseline but not as high as with TIF use.</p><p><strong>Conclusions: </strong>TIF use led to improved care. Care of patients who did not have the TIF used improved compared to the before period, suggesting hospital-wide improvements. This improvement was modest, indicating that TIF use in all trauma patients remains the goal. Groups with low TIF usage should be the focus for efforts to improve TIF usage and trauma care in future trials and quality improvement efforts.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov: NCT04547192.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contrast-Enhanced Ultrasound Predicts Surgical Margin Positivity in Patients With Breast Cancer Who Underwent Partial Mastectomy.","authors":"Hiroaki Shima, Fukino Satomi, Daisuke Kyuno, Noriko Nishikawa, Satoko Uno, Yuta Kondo, Ai Noda, Takashi Nakamura, Toru Mizuguchi","doi":"10.1002/wjs.12628","DOIUrl":"https://doi.org/10.1002/wjs.12628","url":null,"abstract":"<p><strong>Background: </strong>The clinical disadvantage of positive margins in partial mastectomy for patients with operable breast cancer is clear and must be avoided; however, there is still room for improvement. The usefulness of contrast-enhanced ultrasound (CEUS) in diagnosing spread is currently well-known. The CEUS-enhanced area for breast cancer tends to be wider than that observed in B-mode US and probably includes cancer cells. Therefore, we focused on the difference obtained by subtracting the maximum diameter on B-mode US from that on CEUS. This parameter tends to be greater than zero. However, there are tricky cases in which such enhancements are not visible, and the enhanced area remains limited to a small region. This study aimed to analyze the correlation between characteristic findings and positive for margins in order to ultimately prove potential usefulness of CEUS in making the surgical margin negative.</p><p><strong>Methods: </strong>We retrospectively evaluated the data of consecutive 142 patients with breast cancer who underwent partial mastectomy to explore the effect on positive margins when the CEUS enhancing area was smaller than the B-mode US visualized mass (CEUS-B ≤ 0).</p><p><strong>Results: </strong>Positive surgical margins were observed in 14 out of 142 patients. CEUS-B ≤ 0 was associated with significantly more positive margins (p = 0.0467). CEUS-B was also extracted as an independent predictor on multivariate analysis.</p><p><strong>Conclusions: </strong>The findings of no enhancement outside the area of visible tumor on CEUS but not visualized outside the area of visible tumor on B-mode US might be a risk factor for a positive surgical margin.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of ABI and API Versus CTA to Identify Surgically Significant Arterial Injury After Lower Extremity Trauma in a LMIC.","authors":"Rubinette Robbertze, Megan Lubout, Daniel Nicholas Prince, Isabella Margaretha Joubert, Maeyane S Moeng","doi":"10.1002/wjs.12623","DOIUrl":"https://doi.org/10.1002/wjs.12623","url":null,"abstract":"<p><strong>Background: </strong>South Africa faces a high burden of trauma-related vascular injury. Prompt diagnosis and management are crucial to limit morbidity and mortality. Literature recommends a thorough vascular examination of at-risk patients. Ankle brachial index (ABI) and arterial pressure index (API) are considered reliable screening tools for lower extremity vascular injury (LEVI) in the correct clinical scenario. Patients with an abnormal ABI/API warrant diagnostic imaging with computed tomography angiography (CTA). However, recent international literature demonstrates a trend toward potential CTA overuse in the work up for LEVI, when the internationally recommended vascular injury work-up guidelines are not followed correctly.</p><p><strong>Aim: </strong>To assess the reliability of ABI/API in trauma patients with suspected LEVI as a screening tool to safely avoid unnecessary CTA.</p><p><strong>Methods: </strong>A retrospective cohort study of all lower extremity trauma patients with soft signs of LEVI who presented to Charlotte Maxeke Johannesburg Academic Hospital from February 1, 2018 to January 31, 2020 was undertaken. Sensitivity, specificity, NPV, and PPV were calculated for ABI/API versus CTA and ABI/API/CTA versus surgically significant arterial injury. A p-value < 0.05 indicated statistical significance (confidence level = 95%).</p><p><strong>Results: </strong>Four hundred and thirty-three CTAs were performed for suspected traumatic LEVI. Two hundred and eighty-two were excluded due to missing data (precluding retrospective calculation of ABI/API) and 151 patients were included. To detect surgically significant injury, CTA had a 100% sensitivity, 97.2% specificity, 100% NPV, and 69.2% PPV; ABI and API had a 100% sensitivity, 83.8%-85.9% specificity, 100% NPV, and 28.1%-35.9% PPV, respectively. Neither ABI nor API missed surgically significant arterial injuries.</p><p><strong>Conclusion: </strong>This affirms the reliability of ABI/API as a screening tool to identify patients at risk of LEVI from penetrating trauma. Findings supported international data demonstrating CTA overuse in this subset of patients.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of the FASILA Score for Predicting Interventions and Outcomes in Traumatic Abdominal and Pelvic Injuries: A Prospective Clinical Study.","authors":"Ayman El-Menyar, Ahmed F Ramzee, Basel H Elmegabar, Mohammad Asim, Ruben Peralta, Vishwajit Verma, Husham Abdelrahman, Hisham Jogol, Muniba Afzal, Yasir Abdulrahman, Nuri Abdurraheim, Ahad Kanbar, Tariq Siddiqui, Sandro Rizoli, Hassan Al-Thani","doi":"10.1002/wjs.12632","DOIUrl":"https://doi.org/10.1002/wjs.12632","url":null,"abstract":"<p><strong>Background: </strong>The FASILA score is a 7-point scale comprising the FAST (focused assessment with sonography in trauma), shock index, and serum lactate. We aimed to validate this score prospectively in patients with abdominal and pelvic trauma to predict the need for massive blood transfusion, laparotomy, and inhospital mortality.</p><p><strong>Methods: </strong>This prospective study included all adult patients who sustained abdominal and/or pelvic trauma. Pediatric patients, prehospital cardiac arrest, and severe head injury were excluded. Data were analyzed and compared with low (< 4) versus high (≥ 4) FASILA scores.</p><p><strong>Results: </strong>A total of 400 patients (mean age 36.3 ± 12.7; 90% male; and 96% had blunt trauma) were enrolled between 2022 and 2024. Patients with higher FASILA scores (19.3%) had higher rates of exploratory laparotomy and radiological interventions and received more blood transfusions. They also had longer hospital stays, higher rates of sepsis, and mortality (p = 0.001). The FASILA scores significantly correlated with shock index (r = 0.75), ISS (r = 0.38), SOFA score (r = 0.36), and abdominal AIS (r = 0.27), TRISS (r = -0.19), RTS (r = -0.26), and fibrinogen levels (r = -0.12). A FASILA score ≥ 4 had a high specificity (85.5%) and negative predictive value (80%) for predicting the need for surgery. The FASILA score was an independent predictor of blood transfusion (odds ratio 1.92 and 95% CI 1.43-2.58) after adjusting for abdominal AIS, ISS, SOFA score, and fibrinogen level. AUROC curves were better for the FASILA score than ABC score and \"SI alone\" for the prediction of MTP and surgical interventions.</p><p><strong>Conclusion: </strong>The significant association between high FASILA scores and blood transfusions, surgical interventions, and mortality indicates its usefulness in early risk stratification in abdominopelvic trauma. Multicenter studies are recommended to enhance external validity across diverse populations and settings.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Appendectomy: Predictive Factors for Major Resections in Adult Patients With Acute Appendicitis.","authors":"Manuela Monrabal Lezama, María Gracia Álvarez Jurado, Camila Bras Harriott, Maria A Casas, Francisco Schlottmann","doi":"10.1002/wjs.12588","DOIUrl":"https://doi.org/10.1002/wjs.12588","url":null,"abstract":"<p><strong>Background: </strong>Certain patients with acute appendicitis require more extensive resections due to an extensive inflammatory process. We aimed to identify predictive factors for major resections (MR) in patients undergoing laparoscopic appendectomy (LA) and determine its surgical outcomes.</p><p><strong>Material & methods: </strong>We performed a retrospective analysis of a consecutive series of adult patients (> 16 years) undergoing LA from 2006 to 2023. The cohort was divided into two groups: LA only versus MR (i.e., partial cecectomy, ileocecectomy or right colectomy). Demographics, perioperative variables and postoperative outcomes were compared. Independent risk factors for MR were determined by multivariable logistic regression analysis.</p><p><strong>Results: </strong>A total of 2319 patients were included for analysis; 2279 (98.3%) underwent LA and 40 (1.7%) MR. Patients undergoing MR were significantly older (mean age 50.1 vs. 36.2 years, p < 0.0001). Obesity prevalence was higher in MR patients (20% vs. 7.0%, p = 0.02). The median interval time from symptom onset to medical consultation was also significantly higher in MR patients (99.4 vs. 40.7 h, p < 0.0001). The presence of pneumoperitoneum, free abdominal fluid, and cecal wall thickening in CT scan were significantly more frequent in MR patients (p < 0.0001). Conversion to open surgery was more common in MR patients (30% vs. 2.1%, p < 0.0001). Overall morbidity (52.5% vs. 13.5%, p < 0.0001), Clavien III-IV complications (22.5% vs. 3.9%, p < 0.0001) and median length of stay (6.6 vs. 1.6 days, p < 0.0001) were significantly higher in the MR group. Free abdominal fluid (OR 4.9 95% CI 2.1-11.1), pneumoperitoneum (OR 7.2 95% CI 1.6-31.9) and cecal wall thickening in CT scan (OR 6.2 95% CI 2.2-17.1) were identified as independent risk factors for MR.</p><p><strong>Conclusions: </strong>Major resections for acute appendicitis are associated with significantly higher overall and major morbidity, as compared to LA. Clinical and imaging predictors of MR can help in improving surgical planning and informing patients about the higher risks of the operation.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Perioperative Mortality Rate Data Capture in Hawassa, Ethiopia: A Mixed-Methods Study.","authors":"Ajiel Mae F Basmayor, Jerusalem Fissehatsion, Biruk Woisha, Asegid M Ergete, Maria V Sgro, Kayleigh Cook, Qausarat Ogunneye, Belay Mellese, Taylor J Jaraczewski, Chris Dodgion, Atkilt Michael, Andualem Beyene, Katherine R Iverson","doi":"10.1002/wjs.12625","DOIUrl":"https://doi.org/10.1002/wjs.12625","url":null,"abstract":"<p><strong>Background: </strong>In 2015, Ethiopia created a national strategic plan aimed at increasing surgical capacity. This encompassed a set of surgical indicators collected at each hospital, which facilitates assessment of the current state of surgical practices and enables monitoring of progress towards improving outcomes. This project aimed to investigate one of these key surgical indicators, the perioperative mortality rate (POMR), in the largest referral hospital in the Sidama region.</p><p><strong>Methods: </strong>Perioperative mortality was defined as death after major surgery prior to hospital discharge. The number of surgical deaths and surgical volume for the most recent reporting year (July 2022-May 2023) were extracted from registries and discharge information. POMR was compared between the following data sources: (1) paper registries from the operating rooms, surgical wards, ICU, (2) aggregate discharge information from the Liaison Office, (3) monthly indicator reports to the health management information system (HMIS), and (4) reports on the national data collection system (DHIS2). Additionally, qualitative interviews with healthcare professionals and data officers were conducted to evaluate current practices and challenges in collecting POMR.</p><p><strong>Results: </strong>The aggregate reported 1-year POMR was 0.9% (56/6438) for registries, 0.9% (57/6336) for discharge information, 0.5% (33/6437) for HMIS reports, and 0.6% (35/5935) for DHIS2 reports. Qualitative interviews (n = 17) reported regular tracking of perioperative deaths within surgical departments and surgical data quality checks by quality officers. However, many interviewees identified the lack of an electronic system as a significant barrier to accurate, timely data collection. Other proposed solutions include implementing closer monitoring of data quality, providing additional equipment and training for staff on data entry, and promoting timely completion of monthly reports.</p><p><strong>Conclusion: </strong>Explanations behind the discrepancies in POMR between data sources in this study include inconsistencies in data entry, lack of consolidation of postoperative deaths from different service points (wards, ICU), and reports generated without a mechanism to include updated registry or discharge counts. These findings, along with the diverse perspectives from our interviews, point toward the need for a well-trained workforce and the development of a digital record system to improve POMR data capture.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Is the Need for and Access to Trauma Surgery in Low- and Middle-Income Countries? A Scoping Review.","authors":"Thomas Edmiston, Michael F Bath, Amila Ratnayake, Luis Felipe Reyes, Eleanor Reffin, Zhongheng Zhang, Raoof Saleh, Eder Caceres, Joachim Amoako, Isla Kuhn, Brandon G Smith, Lekaashree Rambabu, Orla Mantle, Vedha Penmetcha, Laura Hobbs, Katharina Kohler, Timothy C Hardcastle, Thomas G Weiser, Tom Bashford","doi":"10.1002/wjs.12626","DOIUrl":"https://doi.org/10.1002/wjs.12626","url":null,"abstract":"<p><strong>Introduction: </strong>Trauma is a major source of morbidity and mortality globally, but low- and middle-income countries (LMICs) are disproportionately affected by higher volumes of trauma and worse health outcomes. Despite this, there are limited data describing how many individuals in these regions need trauma surgery, and how many are able to access it.</p><p><strong>Methods: </strong>We performed a scoping review to examine the current available evidence on the need for, and access to, trauma surgery in LMICs in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. We included studies published after 2000, across all languages, that reported data on LMICs, as defined by the Organization for Economic Cooperation and Development.</p><p><strong>Results: </strong>We identified 32 articles describing the need for trauma surgery and 24 articles describing the access to trauma surgery, representing 27 LMICs overall. The median rate of trauma need was 7361 individuals per 100,000 per year (IQR 6313-9461), whereas the median rate of trauma surgery was 64.8 procedures per 100,000 per year.</p><p><strong>Conclusion: </strong>Our study suggests that the need for trauma surgery is far greater than the access provided in LMICs. Indeed, the median rate of trauma surgery currently performed in the represented LMICs was 20 times less than the Lancet Commission on Global Surgery's benchmark. This scoping review illustrates the pressing requirement to generate high-quality prospective data to describe trauma care in LMICs.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Unmet Critical Care Burden at a Central Hospital in a Resource-Limited Setting: A Point Prevalence Study.","authors":"Xinyi Luo, Chimwemwe Nkhonjera, Jotham Gondwe, Melissa Issa-Boube, Anthony Charles","doi":"10.1002/wjs.12624","DOIUrl":"https://doi.org/10.1002/wjs.12624","url":null,"abstract":"<p><strong>Introduction: </strong>The unmet burden of critical illness in low-resource settings is unknown. The Modified Early Warning Score (MEWS) is a validated tool that quantifies patient risk for critical illness and higher level of care. This study evaluates the burden of critical illness outside of the ICU using MEWS and predictors of mortality among adult inpatients at a central hospital in Malawi, where ICU capacity is limited.</p><p><strong>Methods: </strong>We conducted a prospective cohort study among adult inpatients (≥ 13 years) across medical, surgical, and obstetrics-gynecology wards. MEWS was used to assess critical illness based on respiratory and heart rates, temperature, systolic blood pressure, and mental status. Data were collected over three days in 2024, with follow-ups on Day 7 and Day 30. Statistical analyses included chi-squared, Mann-Whitney, and logistic regression.</p><p><strong>Results: </strong>Among 315 patients, 62.9% were female, median age was 33 (24-48) years, and 17.5% met critical illness criteria outside of an ICU setting. Critically ill patients had significantly higher inhospital mortality (18.2% vs. 5.4% and p = 0.001) and 30-day mortality (20% vs. 7.3% and p = 0.004). Increasing MEWS strongly predicted mortality (OR = 1.38, 95% CI [1.15, 1.65], and p = 0.001). MEWS is the strongest predictor of critical illness in surgical patients, with the highest mortality increase compared to medicine patients who had similar mortality between both groups.</p><p><strong>Conclusion: </strong>There is a high-unmet burden of critical illness outside of the ICU in our setting, with a resulting high mortality. MEWS effectively stratifies patient risk, particularly in surgical patients. Early identification and intervention and increasing critical care capacity are imperative.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}