World Journal of Surgery最新文献

{"title":"An Implementation Gap of 120 Years: Complex Problems, Such as Family Planning, Pregnancy, and Parenthood in Surgical Training Require Suitable Research Paradigms and Innovative Change.","authors":"Rhea Liang","doi":"10.1002/wjs.12553","DOIUrl":"https://doi.org/10.1002/wjs.12553","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605750","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":"Correction to: Strengths and Opportunities for Improvement in Surgical Education in Ukraine: A Qualitative Study. Ali Dzhemiliev, Marta Antoniv, Inesa Huivaniuk, et al. World J Surg. 2024; https://doi.org/10.1002/wjs.12262.","authors":"","doi":"10.1002/wjs.12550","DOIUrl":"https://doi.org/10.1002/wjs.12550","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605896","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 Influence of the Clinical, Therapeutic and Socio-Personal Profile on the Quality of Life of Patients With Multiple Endocrine Neoplasia Type 1.","authors":"Beatriz Febrero, Esmeralda Teruel, Inmaculada Ros-Madrid, Pedro Segura, José M Rodríguez","doi":"10.1002/wjs.12522","DOIUrl":"https://doi.org/10.1002/wjs.12522","url":null,"abstract":"<p><strong>Introduction: </strong>Multiple endocrine neoplasia type 1 (MEN1) syndrome is characterized by presenting different pathologies with different degrees of tumor aggressiveness, which can greatly affect the quality of life of affected patients.</p><p><strong>Objectives: </strong>To determine the quality of life of MEN1 patients and to analyze the influence of socio-personal, clinical, and therapeutic variables.</p><p><strong>Methods: </strong>A study was conducted on MEN1 patients in a tertiary hospital [2018-2020]. The 36-Item Short Form Health Survey (SF-36) scores were compared with those of a control group (CG) of a healthy population.</p><p><strong>Statistical analysis: </strong>Student's t-test/ANOVA test or the Mann-Whitney U test/Kruskal-Wallis H test. A multivariate analysis was applied to assess the SP, clinical, and therapeutic variables affecting the quality of life.</p><p><strong>Results: </strong>The quality of life scores of 101 MEN 1 patients, who presented lower levels of quality of life in various dimensions compared to the control group, (p < 0.05) were analyzed. Patients with pancreatic pathology showed a worsening in most dimensions of the SF-36 questionnaire (p < 0.05). In addition, pancreatic surgery influenced 3/9 dimensions and the mental component score (MCS) (p < 0.05). In the multivariate analysis, occupational status and pancreatic surgery were the variables most related to the quality of life of patients with MEN1 (p < 0.05) in addition to the existence of a carcinoid tumor, which influenced the physical component score (PCS) (p < 0.05).</p><p><strong>Conclusion: </strong>MEN1 patients have a worse quality of life than the general population. Of the socio-personal variables analyzed, the best predictor is being unemployed. Pancreatic and carcinoid pathology affected quality of life. Pancreatic surgery fundamentally influences the mental component score, whereas total pancreatectomy influences the physical component score.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597954","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":"Using Natural Language Processing in the LACE Index Scoring Tool to Predict Unplanned Trauma and Surgical Readmissions in South Africa.","authors":"Umit Tokac, Jennifer Chipps, Petra Brysiewicz, John Bruce, Damian Clarke","doi":"10.1002/wjs.12523","DOIUrl":"https://doi.org/10.1002/wjs.12523","url":null,"abstract":"<p><strong>Background: </strong>Unplanned and potentially avoidable readmission within 30 days post discharge is a major financial burden.</p><p><strong>Aim: </strong>To use text-based electronic patient records to calculate the Charlson Comorbidity Index (CCI) score using a natural language processing technique to establish the feasibility and usefulness of the text-based electronic patient records in identifying patients at risk for unplanned readmission.</p><p><strong>Methods: </strong>A retrospective review of electronic patient records for general and trauma surgery in a hospital in South Africa (2012-2022) was conducted using the LACE score. Validated sentiment analysis analyzed free text components of electronic patient records to compute the CCI score and to establish the feasibility and usefulness of the LACE score in identifying patients at risk for unplanned readmission.</p><p><strong>Results: </strong>Trauma surgery patients had a mean LACE score of 5.91 (SD = 2.41), with 8.44% scoring 10 or higher and a specificity and sensitivity of 91.63% and 13.81%, respectively. The general surgery patients had a mean LACE score of 7.75 (SD = 3.04), with 10.63% scoring 10 or higher and a specificity of 71.47% and a sensitivity of 44.80%, respectively. Logistic regression analysis revealed that LACE scores significantly predicted unplanned readmissions in both trauma (β = 0.11, p < 0.001; OR = 1.112, 95% CI [1.082, 1.143]) and general surgery (β = 0.15, p < 0.001; OR = 1.162, 95% CI [1.130, 1.162]) patients.</p><p><strong>Conclusion: </strong>The LACE score demonstrated the predictive value for readmission in trauma and general surgery patients. The LACE score was relatively effective in identifying patients who were less likely to be readmitted but showed limitations in identifying patients at higher risk of readmission. However, the successful use of natural language processing for data extraction of comorbidities shows promise on addressing the challenges around text-based medical records.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587477","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":"Trends, Outcomes, and Costs of Surgical Excisional Biopsy for Fibroadenoma of the Breast.","authors":"Piyush Rath, Mahtab Vasigh, Tahereh Soleimani, David M Euhus","doi":"10.1002/wjs.12542","DOIUrl":"https://doi.org/10.1002/wjs.12542","url":null,"abstract":"<p><strong>Background: </strong>De-escalating the management of fibroadenoma of the breast has been encouraged, but it is not known whether this has been successful. A better understanding of the costs and benefits of surgical excisional biopsy is essential for managing individual patients and health systems.</p><p><strong>Methods: </strong>Prospectively maintained data sources from the Johns Hopkins regional health system were used to capture trends in the rate of diagnosis and excision of fibroadenoma of the breast. Reasons for excision and the outcomes of those excisions were assessed. These data, together with national population and breast imaging data, were used to estimate the number that are excised in the United States each year. Costs were estimated from commercial payor benchmarking of Medicare reimbursement schedules.</p><p><strong>Results: </strong>It is estimated that 81,548 excisional breast biopsies are performed in the United States each year for fibroadenoma. The cost for these excisions is conservatively estimated at $662 million. Though the number of image-guided core needle biopsies performed is increasing in the Johns Hopkins system, the number of surgical excisions for fibroadenoma is decreasing. Excisional biopsy of 201 fibroadenomas diagnosed on core biopsy returned one (0.5%) benign phyllodes and one (0.5%) borderline phyllodes. Neither of these was distinguishable from the fibroadenomas based on size or growth. The most common reason for excision was patient preference.</p><p><strong>Conclusions: </strong>Neither size nor growth is sufficient to mandate excision of a fibroadenoma. Because the presence of a breast lump will continue to drive demand for excisions, development of less expensive office-based alternatives would be extremely valuable.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587475","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":"A Matched Comparison of Patient Outcomes in Emergency General Surgery Conditions: Understanding Variability in Operative and Nonoperative Cases.","authors":"Komal Abdul Rahim, Saad Bin Zafar Mahmood, Kinzah Razzak Ghazi, Aiman Arif, Kantesh Kumar, Saqib Kamran Bakhshi, Mushayda Ali, Zainab Samad, Adil Haider","doi":"10.1002/wjs.12539","DOIUrl":"10.1002/wjs.12539","url":null,"abstract":"<p><strong>Background: </strong>Emergency general surgery (EGS) is a subset of acute care surgery that can be managed surgically and conservatively. Various factors influence decisions regarding operative or nonoperative management. Our study aimed to identify EGS patients who underwent surgical intervention and compare their outcomes to those who underwent nonoperative management.</p><p><strong>Methods: </strong>Data from patients aged ≥ 18 years with primary index admission and EGS conditions defined by the American Association for the Surgery of Trauma from Pakistan's first Joint Commission International Accredited Center were analyzed from 2010 to 2019. The primary exposure was surgical intervention. Differences in inpatient mortality, complications, and length of stay (LOS) were compared using logistic and generalized-linear models after coarsened exact matching.</p><p><strong>Results: </strong>Records from 32,280 primary index admissions showed a higher number of younger patients (mean 47.83 vs. 52.40 years) and no preexisting conditions (60.22% vs. 42.30%) in the operated group compared to the nonoperated group. There were relatively higher uninsured individuals in the nonoperated group compared to the operated group (84.36% vs. 74.22%), respectively. Risk-adjusted differences in outcomes showed higher odds of complication (AOR 1.34 and 95% CI 1.20 and 1.48) and prolonged LOS (β 0.78 and 95% CI 0.65 and 0.91) in operated patients. The risk-adjusted observed/expected rates showed lower inpatient mortality rates in operated patients across all EGS diagnoses.</p><p><strong>Conclusion: </strong>The results showed that patients who underwent surgery had lower risk-adjusted mortality even though they had more complications across all EGS diagnoses, which highlights the urgent need to improve surgical access in developing countries due to higher uninsured individuals in the nonoperated group. Also, the findings stress the need for risk stratification and further studies to mitigate risks and optimize patient recovery based on patient-level factors.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582370","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":"A Novel 4-Tier Classification for Tumor Budding and the Importance of Tumor Invasive Patterns in the Prognosis of Colorectal Cancer.","authors":"Tejus V NagiReddy, Samir Gupta, Rupali Bavikar, Mangesh Londhe, Prasant Chandra, Advait A Vaidya","doi":"10.1002/wjs.12534","DOIUrl":"10.1002/wjs.12534","url":null,"abstract":"<p><strong>Background: </strong>Colorectal carcinoma (CRC) is a major global health issue, with significant morbidity and mortality. Although the TNM staging system remains the standard for prognosticating CRC, it fails to capture the full complexity of tumor behavior. Tumor budding (TB) and tumor invasive patterns (TIPs) are emerging as promising histopathological markers that may provide additional prognostic insights, particularly in predicting the nodal metastasis (N), lymphovascular invasion (LVI), and perineural invasion (PNI). This study aims to assess the correlation between TB, TIP, and CRC prognosis.</p><p><strong>Materials and methods: </strong>This ambidirectional observational study, conducted at our tertiary care center, included 60 biopsy-proven CRC patients, the majority of whom were at stages 2 and 3. Histopathological evaluation of TB and TIP were performed on Hematoxylin and Eosin (H&E) stained slides. TB and TIP categories are then compared against various histopathological parameters. Statistical analysis was performed.</p><p><strong>Results: </strong>In the 60 CRC cases studied, low TB was observed in 60% of cases, whereas high TB was seen in 5%. TIP analysis showed that 57% of cases had expansile patterns and 35% of cases had infiltrative patterns. A significant association was found between TB and N (p - 0.018) as well as TIP and PNI (p - 0.016). Multivariate analysis revealed that TB remained a strong predictor for N (OR (odds ratio) = 12.8 and p < 0.001). Although not statistically significant, distinct trends were observed between low and zero TB. Our study's findings on TB and TIP align with several historical studies, reinforcing their prognostic significance in CRC. Despite being a small cohort, our study aligns with these findings, emphasizing TB and TIP as critical prognostic markers in CRC.</p><p><strong>Conclusion: </strong>TB and TIP are valuable prognostic tools in CRC, offering insights into tumor behavior and metastasis potential. Their incorporation into routine histopathological evaluation could enhance prognostic accuracy.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582371","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":"Risk Factors in Elective Colon Surgery for the Elderly: A Retrospective Cohort Analysis From the Swedish Part of the International ERAS Database.","authors":"Felix Bjerregaard, Naseer Baloch, Daniel Asklid, Olle Ljungqvist, Klas Pekkari, Anders H Elliot, Ulf O Gustafsson","doi":"10.1002/wjs.12535","DOIUrl":"10.1002/wjs.12535","url":null,"abstract":"<p><strong>Background: </strong>The growing proportion of older individuals worldwide is anticipated to lead to an increase in the number of elderly patients requiring surgery for colon cancer. Consequently, it is crucial to identify specific risk factors for mortality and complications after colon surgery in this age group.</p><p><strong>Methods: </strong>The Swedish part of the ERAS registry (EIAS) between 2009 and 2022 was used. Patients aged ≥ 75 years undergoing colon surgery were compared with younger patients regarding risk factors for severe complications and mortality after multivariate regression analysis.</p><p><strong>Results: </strong>After adjusting for potential confounders, three risk factors specifically associated with severe complications in elderly patients were identified: severe pulmonary disease (OR 1.64; 95% CI 1.04-2.58), recent immunosuppressive treatment (OR 1.92; 95% CI 1.12-3.30), and left hemicolectomy (OR 1.43; 95% CI 1.04-1.97). Furthermore, four risk factors for mortality, statistically significant only in the older age group, were found: male sex (OR 1.73; 95% CI 1.08-2.76), ASA ≥ 3 (OR 2.92; 95% CI 1.66-5.15), severe pulmonary disease (OR 2.28; 95% CI 1.02-5.06), and open surgery (OR 1.68; 95% CI 1.04-2.73).</p><p><strong>Conclusion: </strong>Several risk factors for severe complications and 30-day mortality specific to the elderly group were identified. Among these, severe pulmonary disease was associated with both severe complications and mortality.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582373","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":"Tray Rationalization in Pediatric Day Surgery: A Sustainable Quality Improvement Project.","authors":"Eleanor Ferris, Yara Hazem Zaky, Emmy-Lou Elder, Søren Kudsk-Iversen, Kokila Lakhoo","doi":"10.1002/wjs.12530","DOIUrl":"10.1002/wjs.12530","url":null,"abstract":"<p><strong>Background: </strong>Climate change poses a major threat to human health. The decontamination of used surgical equipment has been identified as a \"carbon hotspot\" in theaters. Surgical tray rationalization, which removes enough instruments to shrink the tray size, has a significant impact on carbon footprint, providing that there is not an increase in individually wrapped instruments used.</p><p><strong>Methods: </strong>Using the sustainability in quality improvement framework, we rationalized the surgical tray used for pediatric open herniotomies at the Oxford University Hospitals John Radcliffe site. Data on instrument utilization and individually wrapped instruments were prospectively collected. Our tray redesign had no threshold utilization rate for instrument exclusion and focused on removing enough instruments to reduce the tray size. To calculate impact, we used established data on carbon emissions and financial cost and surveyed staff attitudes toward the redesigned tray.</p><p><strong>Results: </strong>The tray at baseline included 55 instruments. The tray size was reduced by 50% with the removal of 22 instruments. Following our intervention, the median instrument utilization rate increased from 27% to 74% with no significant increase in individually wrapped instruments. The redesigned tray reduced carbon emissions from 4243 gCO₂e to 2559 gCO₂e and reduced financial cost from £48.66 to £29.63 per tray per decontamination cycle, approximating to 383,952 gCO₂e and £4338.84 saved annually. All surveyed staff members (n = 25) agreed that the redesigned tray was easy to prepare and felt positive about the effort to reduce environmental impact.</p><p><strong>Conclusions: </strong>This quality improvement project shows the impact possible by using an established simple and effective framework that can be replicated by healthcare professionals without a background in planetary health to ensure future surgical tray rationalization efforts that maximize environmental impact.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582374","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":"Cost Saving Analysis of an Enhanced Recovery After Surgery (ERAS) Program for Elective Colorectal Surgery in an ERAS Qualified and Training Center.","authors":"Elisa Bertocchi, Davide Brunelli, Thomas Squaranti, Diego Campagnola, Sara Camparsi, Roberto Tessari, Nicola Menestrina, Irene Gentile, Lorenza Sanfilippo, Nicoletta De Santis, Massimo Guerriero, Giacomo Ruffo","doi":"10.1002/wjs.12548","DOIUrl":"10.1002/wjs.12548","url":null,"abstract":"<p><strong>Background: </strong>To ascertain the costs of implementing an enhanced recovery after surgery (ERAS) protocol in elective colorectal surgery throughout all perioperative phases in an Italian ERAS Qualified and Training Center.</p><p><strong>Methods: </strong>Consecutive patients who had undergone elective colorectal surgery in 2022, the first year of our facility being an ERAS Qualified Center (n 204; ERAS group), were compared to a control group (n 203; pre-ERAS group) that had undergone elective colorectal surgery in 2017, the last year before the internal ERAS implementation. The primary endpoint was the cost-effectiveness of the ERAS protocol as determined by evaluating perioperative costs. Secondary endpoints were postoperative clinical outcomes.</p><p><strong>Results: </strong>In the ERAS group, fewer postoperative complications (p < 0.001), a shorter length of stay (LOS) (p < 0.001), and a decreased 30-day readmission rate (p 0.047) were reported. The mean cost saving for elective colorectal surgery in the ERAS setting was about €3676.73 per patient. The preoperative costs in the ERAS group were 45% higher than in the control group. The intraoperative phase showed a small but significant decrease in costs (-€324.04, SD 1683.81, and p 0.002). The postoperative phase also had a significant decrease in costs (-€3439.30, SD 6903.07, and p < 0.001), which was especially apparent in patients with severe complications.</p><p><strong>Conclusions: </strong>Despite significantly increased costs in the preoperative phase, the ERAS protocol, when highly complied with, may lead to significantly decreased patient pathway costs due to a reduction of postoperative complications, a shorter LOS, and the more targeted use of medication and blood transfusions.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582372","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}