World Journal of Surgery最新文献

{"title":"Choosing Wisely: Evidence-Based Support for the Efficacy and Safety of Tap Water Versus Normal Saline for Wound Cleansing.","authors":"Pin-Ru Shih, Yi-Ting Huang, Ka-Wai Tam, Yun-Yun Chou, Ming-Chi Hu","doi":"10.1002/wjs.70079","DOIUrl":"10.1002/wjs.70079","url":null,"abstract":"<p><strong>Background: </strong>Although normal saline is widely applied in wound irrigation, evidence suggests that tap water irrigation does not increase the risk of wound infection. In this study, the gap between current evidence and clinicians' awareness regarding wound care practice was examined.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted of trials published before July 2025 in the PubMed, Embase, and Cochrane Library databases. Individual effect sizes were standardized, and a meta-analysis was performed to estimate the pooled effect size through random-effects models. The primary and secondary outcomes were wound infection and healing, respectively. On the basis of the meta-analysis findings, a survey was conducted to assess the gap between current evidence and clinical practice among health care providers.</p><p><strong>Results: </strong>This study reviewed 12 trials involving 3330 patients with 3352 wounds. The risk of wound infection did not differ significantly between the tap water and normal saline groups (risk ratio, 0.78; 95% confidence interval, 0.59-1.03). In the trial sequential analysis for wound infection, the Z curve remained within the O'Brien-Fleming boundaries, even after the 11th interim significance test. A subsequent survey indicated that many clinicians exposed to these findings remained unwilling to practice tap water irrigation.</p><p><strong>Conclusions: </strong>Tap water irrigation does not increase the risk of wound infection. Despite widely available evidence, many clinicians remained reluctant to practice tap water irrigation. To facilitate broader acceptance of this irrigation approach, institutional guidelines, endorsement from key opinion leaders, and social media promotion are recommended.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2742-2751"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971686","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 Surgical Technique for Preventing Parastomal Hernia.","authors":"Yongfang Guo, Weiguo Liu, Zhigang Qiu, Jianli Zhang, Zhenqing Sun","doi":"10.1002/wjs.12682","DOIUrl":"10.1002/wjs.12682","url":null,"abstract":"<p><strong>Background: </strong>Parastomal hernia (PSH) is a frequent complication of enterostomy, often resulting from the gradual expansion of the abdominal wall aperture. This retrospective study evaluated a novel surgical technique designed to reduce PSH incidence by stabilizing aperture size over time.</p><p><strong>Methods: </strong>Patients who underwent permanent colostomies at the Department of Gastroenterology, Qingdao University Affiliated Hospital, between March 2020 and December 2023 were retrospectively reviewed. The primary outcome was PSH incidence at follow-up. The secondary outcome was the change in the maximum abdominal wall aperture diameter, measured by imaging at multiple time points.</p><p><strong>Results: </strong>Ninety-two patients were included: 42 underwent the novel purse-string suture technique, and 50 received the conventional approach. Baseline characteristics and surgical outcomes were comparable. The novel group had a significantly lower PSH incidence (2.3% vs. 32%, p = 0.001). In the conventional group, the aperture diameter significantly increased from 6 to 24 months (29.5 ± 3.2 mm, 33.9 ± 3.9 mm, 35.4 ± 4.0 mm, and 36.7 ± 4.5 mm; p = 0.025, 0.039, and 0.046, respectively). In contrast, the novel group maintained stable aperture diameters throughout follow-up.</p><p><strong>Conclusion: </strong>The novel technique appears to effectively prevent PSH by maintaining a consistent aperture size. This simple and safe method shows promising results, though further multicenter studies are needed to validate these findings.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2717-2723"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971629","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":"Does Time Matter? Impact of Residency Start Month on EGS Outcome in Pakistan.","authors":"Komal Abdul Rahim, Kantesh Kumar, Aiman Arif, Kinzah Razzak Ghazi, Saad Bin Zafar Mahmood, Saqib Kamran Bakhshi, Mushayda Ali, Zainab Samad, Adil Haider","doi":"10.1002/wjs.70049","DOIUrl":"10.1002/wjs.70049","url":null,"abstract":"<p><strong>Background: </strong>Trainee turnover in hospitals with induction of new, less experienced residents and changeover in the clinical teams has been considered an essential factor for increased morbidity and mortality. In high-income countries (HICs), this is known as the July effect-the time for new inductees. We aim to study the January effect (time of new inductees in our setting) and patient outcomes in an Emergency General Surgery (EGS) cohort.</p><p><strong>Methods: </strong>We used secondary data from adult patients with EGS diagnosis from a tertiary care center in Pakistan (2010-2019). The outcomes of interest were severe adverse events (SAEs), inpatient mortality, length of stay [LOS], and failure to rescue (FTR). Multiple logistic and linear regressions was performed to assess their association.</p><p><strong>Results: </strong>Of the 32,280 patients analyzed, 7.94% were admitted in January. There was significantly higher elective admission (61.06% vs. 53.51%) and surgical interventions (74.80% vs. 72.92%) in January compared to other months. Inpatient mortality, SAEs, FTRs, and LOS did not significantly differ between the two groups. Multivariable analysis showed no significant association of January admission with SAE (AOR 1.06; 95% CI 0.97-1.16), inpatient mortality (AOR 1.09; 95% CI 0.83-1.43), FTR (AOR 1.04; 95% CI 0.78-1.38), and LOS (β 0.12; 95% CI -0.05-0.29).</p><p><strong>Conclusion: </strong>The results of the study, which has no evidence of the January effect for EGS patients, suggest that this effect is not universally applicable, necessitating context-specific evaluation to understand the temporal trends in the overall health outcomes of the admitted patients.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2752-2759"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862520","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":"Evaluating Proficiency in Trauma Surgery: A Nationwide Survey of Trainees and Surgeons.","authors":"Muhamad Izwan Ismail, Yuzaidi Mohamad, Rizal Imran Alwi","doi":"10.1002/wjs.70069","DOIUrl":"10.1002/wjs.70069","url":null,"abstract":"<p><strong>Background: </strong>The limited exposure of Malaysian surgical trainees and junior general surgeons to trauma surgery poses multifaceted challenges within surgical education and healthcare delivery. With the nascent state of the trauma surgery subspecialty and a scarcity of trauma surgeons, addressing deficiencies in trauma surgery training is imperative. This study assesses the confidence levels of individuals in general emergency trauma surgery and gauges the interest of trainees and junior general surgeons in pursuing a career in trauma surgery.</p><p><strong>Methods: </strong>Data were collected through an online survey of surgical trainees and experienced surgeons. Data included demographics, training levels, and participation in trauma-related courses. Self-reported competencies were assessed using a 1-10 confidence rating scale.</p><p><strong>Results: </strong>Of the 400 surgical trainees and surgeons contacted, 169 (42.3%) responded. Only 32% of trainees and 63.9% of surgeons had experience with trauma thoracotomies. The comprehensive study evaluated 32 self-reported competencies in trauma surgery, revealing significant deficiencies across both trainees and experienced surgeons. Although trainees displayed lower confidence levels, even experienced surgeons reported suboptimal scores, falling below 5, in several key competencies. Limited participation in trauma courses and a lack of access to specific courses were also observed.</p><p><strong>Conclusion: </strong>The study highlights the pressing need for comprehensive trauma surgery training in Malaysia, emphasizing the establishment of dedicated training pathways, curriculum enhancements and increased engagement in trauma courses. The enthusiasm of trainees can be harnessed to cultivate competent trauma surgeons, and continuous professional development is crucial for sustaining and enhancing trauma surgery competencies.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2952-2958"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971664","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":"Early Postoperative Value of C-Reactive Protein: A Tool for Predicting or Excluding Complications After Elective Hepatectomy?","authors":"Michele Paterno, Thibaud Bertrand, Nicolas Golse, Daniel Pietrasz, Antoinette Lemoine, Eric Vibert, Daniel Cherqui, Marc Antoine Allard","doi":"10.1002/wjs.70054","DOIUrl":"10.1002/wjs.70054","url":null,"abstract":"<p><strong>Background: </strong>The predictive value of C-reactive protein (CRP) for anticipating or ruling out complications after elective abdominal surgery has been extensively studied. However, its role following elective liver resection (LR) remains poorly explored. This study aimed to evaluate the performance of CRP levels after LR.</p><p><strong>Methods: </strong>The CRP values on postoperative day (POD) 1, 3 and 5 in a cohort of patients undergoing elective LR at a single tertiary center were retrospectively analyzed. Analyses were performed for laparoscopic and major LR subgroups.</p><p><strong>Results: </strong>A total of 448 LR (392 patients), including 134 laparoscopic LR and 169 major LR, were analyzed. Severe morbidity (Clavien-Dindo grade ≥ III) occurred in 56 cases (12.4%) with an overall 90-day mortality rate of 2% (n = 9). Peak CRP levels were observed on POD 3. On POD 3, CRP levels were lower in the laparoscopic subgroup compared to open LR and lower after major LR compared to limited LR. In the overall cohort, the predictive CRP value on POD 1, 2, 3 remained poor for detecting major complications or any complications, with all calculated area under the curve (AUCs) below 0.65. Among the 69 patients with a POD 3 CRP value < 100 mg/L, only 2 developed major complications.</p><p><strong>Conclusion: </strong>Unlike other abdominal procedures, CRP levels on POD 1, 3 and 5 after LR have insufficient predictive value for guiding postoperative management. The role of alternative biomarkers or early imaging strategies should be investigated.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2863-2872"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971707","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":"Burn Care: A Review-Part 1: First 48 Hours.","authors":"David G Greenhalgh, Vinita Puri","doi":"10.1002/wjs.70044","DOIUrl":"10.1002/wjs.70044","url":null,"abstract":"<p><strong>Background: </strong>The purpose of part one of this review is to provide basic information about the initial treatment of all burns.</p><p><strong>Methods: </strong>The current literature and experience of the author were used to provide guidelines for treating burns in all parts of the world. No artificial intelligence was used to create this manuscript.</p><p><strong>Results: </strong>Although survival has improved, burns often lead to significant scarring and disabilities. While there are new and expensive technologic advances, basic burn care can be performed with relatively few resources. Early treatment can have a significant impact on outcomes. This review describes guidelines for worldwide use and introduces the newest technologies for treating burns. Because it is difficult to include all information in one paper, the review will be divided into two sections, the first section describing epidemiology, pathophysiology and the initial 48 h of treatment. The second part will cover care after 2 days.</p><p><strong>Conclusion: </strong>Any caregiver should be able to manage the first 48 h. The real challenge starts after 48 h when care, at least for large burns, can last years.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2651-2661"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862519","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":"Assessment of Hospitals Readiness in Implementing a Non-Technical Skills for Surgery Training Program: A Mixed-Methods Study.","authors":"Egide Abahuje, Christophe Mpirimbanyi, Gilbert Rutayisire, Dyna Umutoni, Miguel Gasakure, Emmy A Nkusi, Juliet Lumati, Faustin Ntirenganya, Shehnaz Alidina, George Ntakiyiruta, Robert Riviello, Lisa Hirschhorn, Anne Stey","doi":"10.1002/wjs.70067","DOIUrl":"10.1002/wjs.70067","url":null,"abstract":"<p><strong>Background: </strong>Non-technical skills for Surgeons (NOTSS) lead to safer intraoperative patient care. There is a need to understand how to sustain the implementation of NOTSS training programs. The study aims were (1) to quantitatively assess perioperative care providers perceptions of the hospitals' readiness to sustain implementation of a NOTSS training program, and (2) to qualitatively investigate factors associated with hospitals' readiness to implement a NOTSS training program.</p><p><strong>Methods: </strong>This Mixed Methods study was conducted in 11 Rwandan hospitals from March 2022 to October 2023. Perioperative care providers previously trained in NOTSS were invited to attend a two-hour NOTSS refresher course. Immediately after the course, quantitative data were collected from participants using the paper-based Safe Surgery Organizational Readiness Tool (SSORT), and Safety Attitude Questionnaire. Qualitative data were collected via semi-structured interviews and focus groups.</p><p><strong>Results: </strong>Of the 477 participants (94.5% response rate) who completed the survey, 248 (51.9%) were female. The overall participants' SSORT score was 4.01, Interquartile range (IQR): 3.68-4.28. Most participants perceived that NOTSS training was appropriate Median 5, IQR: 4.5-5. Participants who reported satisfaction with hospital readiness to sustain the implementation of the NOTSS training program (overall SSORT score) were also satisfied with safety climate, adjusted odds Ratio (aOR): 1.02, 95% CI: 1.01-1.040), and teamwork climate, aOR: 1.05, 95% CI: 1.03-1.06. Qualitatively, four themes emerged: (1) the NOTSS training program was appropriate to improve patient safety, (2) understaffing compromised implementation of the quality improvement, (3) Hospital leaders supported quality improvement projects, and (4) there was a lack of enough resources for the hospital to support quality improvement projects.</p><p><strong>Conclusion: </strong>Perioperative care providers in Rwanda perceived that NOTSS training programs were appropriate and supported by leadership. Insufficient financial resources and work overload led to participants' lower satisfaction with the capacity of their hospitals to implement NOTSS training programs.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2760-2768"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971556","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":"Development of a Decision Aid for Patients With Low-Risk Thyroid Cancer: A Mixed-Methods Analysis of Feedback From Both Patient and Clinicians.","authors":"Christine J O'Neill, Ahmad Alam, Michelle Chapman, Melissa Carlson, Suzanne Clark-Pitrolo, Elizabeth A Fradgley, Christine Paul, Nicholas Zdenkowski, Christopher W Rowe","doi":"10.1002/wjs.70064","DOIUrl":"10.1002/wjs.70064","url":null,"abstract":"<p><strong>Introduction: </strong>Guideline-driven de-escalation of the extent of surgery for low-risk thyroid cancer has made treatment decisions more complex. Shared decision-making (SDM) is more involved than informed consent, improves patient satisfaction, and is considered standard of care. Patient decision aids (DA) can facilitate SDM but appropriate resources are lacking.</p><p><strong>Methods: </strong>DA development occurred in 3 main phases. First, a prototype DA was developed and refined by a working group (clinicians, behavioral scientists, nurses, and trained consumer). Nationwide clinician consultation sessions obtained mixed-methods feedback leading to a hybrid paper-web DA ready for patient testing. Second, the paper DA was used within clinically appropriate consultations (Bethesda 3-6 thyroid nodules) and patient feedback obtained with the Ottawa acceptability and decisional conflict scales. Three cycles of iterative changes were made to the DA. Patient focus groups led to further refinements. Third, 40 clinicians were invited to review DA materials, providing mixed-methods feedback.</p><p><strong>Results: </strong>Initial clinician consultation sessions (n = 113) revealed that surgeons used information resources more frequently in, and were more satisfied with, their current patient discussions around thyroid cancer management compared with endocrinologists (88% vs. 32% and 95% vs. 46% respectively, p < 0.01 for both). 95% of clinicians were open to using the DA, but concerns regarding availability, appropriateness, flexibility, credibility and potential to lengthen consultations, were raised. Patients reported that the DA was useful (97% paper, 100% web) and sufficient (85% paper, 100% web). Decisional conflict was low (17 paper vs. 12 web). Qualitative feedback led to changes to improve visual appeal, readability and minimize emotive responses. Clinician review of DA (60% response) reported no bias (73% paper, 79% web) and 86% felt the DA would be easily incorporated into practice.</p><p><strong>Conclusion: </strong>We present a hybrid paper and web-DA ready for wider testing in patients with low-risk thyroid cancer to complement SDM regarding the extent of surgery.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2782-2793"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12515032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nationwide Analysis of Failure to Rescue After Liver Transplantation.","authors":"Kamil Hanna, Peyton Seda, Brian C Longbottom, Shengliang He, Inkyu Lee, Avery Wilson, Kenji Okumura, David Axelrod, Hassan Aziz","doi":"10.1002/wjs.70075","DOIUrl":"10.1002/wjs.70075","url":null,"abstract":"<p><strong>Introduction: </strong>Failure to rescue (FTR) is mortality after a major complication. FTR may be an effective quality metric in liver transplantation (LT). However, there is a paucity of nationwide data on the rates and effects of FTR on outcomes. Our study aims to determine the nationwide rate of FTR and its impact on outcomes after LT.</p><p><strong>Methods: </strong>We analyzed the 2015-2017 Nationwide Readmissions Database, including all patients with LT. Patients were stratified into terciles of average center mortality of < 1% for low (L), 1%-5.76% for intermediate (I), and > 5.76% for high (H). Postoperative complications were identified. Primary outcomes were the rate of FTR and the predictors of FTR. Multivariable regression analysis was performed.</p><p><strong>Results: </strong>A total of 12,134 patients with LT were identified at 82 centers. The sample was stratified into L: 1770 (14.6%), I: 5914 (48.7%), and H: 4450 (36.7%). The mean age was 52.2 ± 16.6 years, and 63.1% were male. Of these, 99.7% underwent deceased-donor LT, most commonly due to alcoholic cirrhosis (31.9%), followed by metabolic steatohepatitis (20.7%). The rate of FTR was 5%, with the most common complication being renal failure at 60.6%, followed by respiratory failure at 43.1%. FTR rate differences were significant (H: 8.8% vs. I: 3.6% vs. L: 1.3%; p < 0.01). Multivariable logistic regression demonstrated an independent association between FTR and H (odds ratio [OR] 1.79 [1.52-1.89]). The predictors of FTR were both patient- and center-related: low-income quartile (OR 1.23 [1.11-1.39]), malnutrition (OR 1.22 [1.09-1.29]), presenting diagnosis of biliary atresia (OR 3.39 [1.95-5.93]), presenting diagnosis of acute liver failure (OR 5.01 [4.09-6.15]), Charlson Comorbidity Index [CCI] (OR 1.24 [1.18-1.31]), frailty (OR 1.58 [1.46-1.73]), LT at a low-volume center (< 20 cases/year) (OR 1.83 [1.78-2.01]), and readmission to a different hospital (OR 2.08 [1.78-2.11]). Protective factors were LT at a metropolitan teaching hospital (OR 0.96 [0.87-0.99]), presenting a diagnosis of primary hepatic malignancy (OR 0.66 [0.52-0.86]), high-income quartile (OR 0.74 [0.57-0.96]), disposition to rehab (OR 0.09 [0.03-0.26]), and high-volume centers (> 50 cases/year) (OR 0.32 [0.20-0.49]).</p><p><strong>Conclusions: </strong>FTR remains a critical issue in LT, with significant variability across centers. These findings demonstrate associations, not causation, between center- and patient-level factors and FTR rates. Identifying and addressing modifiable predictors of FTR presents opportunities for improving perioperative management and postoperative care.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2901-2908"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12515030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 48-hour Symptom Threshold Predicts Perforated Appendicitis: Development of a Clinical Risk Model.","authors":"Masato Fujino, Shingo Ochiai, Tadao Kubota","doi":"10.1002/wjs.70062","DOIUrl":"10.1002/wjs.70062","url":null,"abstract":"<p><strong>Background: </strong>Predicting the likelihood of perforation in acute appendicitis at the time of hospital admission is essential for guiding treatment strategies. This study assesses the impact of time from symptom onset to hospital presentation on the risk of perforation and incorporates these findings into a predictive model.</p><p><strong>Methods: </strong>This retrospective study analyzed the occurrence of perforation in patients who underwent appendectomy for acute appendicitis. The patients were categorized into six groups based on the duration from symptom onset to hospital presentation: less than 12, 12-24, 24-48, 48-72, 72-96, and more than 96 h.</p><p><strong>Results: </strong>Data from 414 patients across two hospitals revealed that most patients presented within 12-24 h (125 cases), followed by the 24-48 h group (121 cases). The risk of perforated appendicitis increased with longer time intervals (p < 0.01). Receiver operating characteristic (ROC) analysis demonstrated good predictive accuracy of the time intervals for perforation (area under the curve (AUC) 0.76, 95% confidence interval (CI) 0.71-0.82). A time interval of 48 h or more was found to be an independent risk factor for perforation (adjusted odds ratio (adj OR) = 3.30, 95% CI: 1.54-6.21). Elevated CRP levels (adj OR = 5.12, 95% CI: 2.97-8.73) and the presence of appendicolith (adj OR = 2.38, 95% CI: 1.47-3.83) were also associated with increased risk.</p><p><strong>Conclusion: </strong>A 48-h interval from symptom onset is a useful cutoff for predicting perforation in acute appendicitis. A predictive model incorporating the 48-h time lapse, C-reactive protein (CRP) levels, and presence of appendicolith is proposed.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2724-2732"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971586","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}