BMJ Surgery Interventions Health Technologies最新文献

{"title":"Safety of arthroscopic rotator cuff repair: using a core event set for clinician and patient assessment of risks in a multicenter cohort study.","authors":"Kushtrim Grezda, Laurent Audigé, Cornelia Baum, Sebastian Andreas Müller, Thomas Stojanov, David Schwappach, Holger Durchholz, Andreas Mueller","doi":"10.1136/bmjsit-2025-000400","DOIUrl":"10.1136/bmjsit-2025-000400","url":null,"abstract":"<p><strong>Objectives: </strong>Reporting standards for adverse events (AEs) in arthroscopic rotator cuff repair (ARCR) vary. A standardized \"core event set\" (CES) was developed to enhance AE documentation. This study describes AE risks in a large Swiss-German ARCR cohort, evaluates concordance between patient-reported and clinician-reported events, and investigates AE variability according to tear severity.</p><p><strong>Design: </strong>Prospective multicenter cohort study.</p><p><strong>Setting: </strong>Between June 2020 and November 2021, 973 patients were enrolled across 19 orthopedic centers and followed for 24 months.</p><p><strong>Participants: </strong>Adult patients with a rotator cuff tear.</p><p><strong>Interventions: </strong>Primary ARCR.</p><p><strong>Main outcome measures: </strong>AEs were documented using a structured CES and classified into five severity grades. AE reporting was compared between patients and clinical staff. AE cumulative risks (CR) were calculated by occurrence period, severity grade, and tear severity.</p><p><strong>Results: </strong>A total of 342 AEs were documented in 314 patients within 2 years. Of these, 41% were reported only by clinical staff, 40% only by patients, and 19% by both. The 2-year CR of AEs was 29.1%, with persistent pain (12.2%) and deep soft tissue complications (10.6%) being most common. Severity classification revealed 61.7% grade I, 24.3% grade II, 13.2% grade III, and 0.9% grade IV. Tear severity was inversely associated with overall AE risk, ranging from 41.5% in partial tears to 28% in massive tears.</p><p><strong>Conclusions: </strong>Standardized AE documentation using CES identified pain, deep soft tissue complications, and rotator cuff issues as the most frequent local AEs. Both clinicians and patients should be involved in AE reporting. Most AEs were mild, and tear severity predicted AE risk, highlighting the need for tailored postoperative strategies and further research on preventive measures.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"7 1","pages":"e000400"},"PeriodicalIF":1.6,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of intra-arterial thrombolysis after successful thrombectomy.","authors":"Bart Jeroen Emmer, Victor Durieux, Johannes Kaesmacher, Charles B L M Majoie, Albert J Yoo, Arturo Renú, Thomas Barthe, Anne-Laure Bocquet, Ángel Chamorro","doi":"10.1136/bmjsit-2024-000372","DOIUrl":"10.1136/bmjsit-2024-000372","url":null,"abstract":"<p><strong>Objectives: </strong>To study the cost-effectiveness of additional intra-arterial thrombolysis (IA lysis) after successful recanalization with endovascular thrombectomy (EVT).</p><p><strong>Design: </strong>A cost-effectiveness model was used to estimate both direct medical costs and quality-adjusted life years (QALYs) gained in six European countries (Spain, the Netherlands, Italy, the United Kingdom, France, Germany) and the USA.</p><p><strong>Setting: </strong>The model was based on published data from those countries on health economics.</p><p><strong>Participants: </strong>Cost of procedure as well as acute, mid-term and long-term care costs were estimated based on expected modified Rankin Scale (mRS) scores as reported in the Chemical Optimization of Cerebral Embolectomy (CHOICE) trial, which reported improved neurological outcomes after adjunctive IA lysis following EVT.</p><p><strong>Main outcome measures: </strong>QALYs in the model were calculated by mapping mRS outcomes from the CHOICE trial to EQ-5D utility values from a validated poststroke cohort, projecting these over a 20-year lifetime horizon with 3% annual discounting, assuming health state transitions only after recurrent stroke (always to a worse mRS) and no recurrent stroke risk in the first 90 days.</p><p><strong>Results: </strong>IA lysis was found to be a cost-effective option in seven different countries (Spain, the Netherlands, Italy, the United Kingdom, France, Germany and the USA). We found an incremental cost-effectiveness ratio ranging from US$-2350 per QALY gained in Germany to US$9628 per QALY gained in the USA. A cost-effectiveness acceptability curve showed 90% acceptability of IA lysis at the willingness to pay varying between US$10 000 and US$45 000 depending on the country.</p><p><strong>Conclusions: </strong>IA lysis after successful EVT was cost-efficient after reperfusion in the seven countries studied. The early termination, small sample and limited power of the CHOICE trial reduce generalizability of our results. Larger trials are needed to confirm cost-effectiveness of IA lysis after successful EVT.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"7 1","pages":"e000372"},"PeriodicalIF":1.6,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12352252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone conduction hearing implants (BCHIs); life-changing surgery. A quality of life (QoL) study reporting the impact of BCHI surgery on 163 patients' well-being.","authors":"Rachael Collins, Junaid Hanif, John S Phillips, Ian Nunney, Amanda Collett","doi":"10.1136/bmjsit-2024-000303","DOIUrl":"10.1136/bmjsit-2024-000303","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to review the impact of bone conduction hearing implants (BCHIs) surgery on patients' quality of life (QoL) across general, physical, social and overall well-being domains.</p><p><strong>Design: </strong>A prospective correlational study.</p><p><strong>Setting: </strong>Single tertiary referral center in the UK.</p><p><strong>Participants: </strong>All adult patients undergoing their first BCHI over a 10-year and 6-month period (between June 1, 2012, and December 31, 2022). A total of 163 were included out of 195 potentially eligible participants.</p><p><strong>Main outcome measure: </strong>The Glasgow Health Status Inventory (GHSI) was used to assess patients' QoL pre and post BCHI surgery.</p><p><strong>Results: </strong>BCHI surgery showed significant improvements across all GHSI QoL domains; total (p<0.0001), general (p<0.0001), social (p<0.0001) and physical (p<0.0001).</p><p><strong>Conclusion: </strong>The largest of its kind, this study recognizes the wide-reaching impact of BCHIs on patients' QoL, evidencing them as a highly effective and life-improving surgical intervention.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"7 1","pages":"e000303"},"PeriodicalIF":1.6,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes of initial thoracic endovascular repair versus medical therapy in acute uncomplicated type B aortic dissection: real-world evidence from a nationwide claims database in Japan - a retrospective cohort study.","authors":"Yuki Kimura, Hiroshi Ohtsu, Naohiro Yonemoto, Nobuyoshi Azuma, Kazuhiro Sase","doi":"10.1136/bmjsit-2024-000361","DOIUrl":"10.1136/bmjsit-2024-000361","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the long-term outcomes of initial thoracic endovascular aortic repair (TEVAR) versus initial medical therapy (iMT) in patients with acute uncomplicated type B aortic dissection (uTBAD), using real-world evidence from a nationwide claims database in Japan. This study aligns with stage 4 of the Idea, Development, Exploration, Assessment, and Long-term Study (IDEAL) framework for surgical innovation.</p><p><strong>Design: </strong>A retrospective cohort study using propensity score matching (PSM) to balance baseline characteristics.</p><p><strong>Setting: </strong>Japanese nationwide health insurance claims database, between 1 January 2015 and 31 December 2023.</p><p><strong>Participants: </strong>Among 40 229 cases with tentative codes for aortic dissection (International Classification of Diseases-10: I71.0), 4995 met all eligibility criteria for acute uTBAD. Among these patients, 96 underwent TEVAR in the subacute phase (15-90 days post diagnosis), while 4899 were managed with iMT. After PSM, 96 TEVAR cases were matched to 480 iMT cases in a 1:5 ratio.</p><p><strong>Main outcome measures: </strong>The primary outcomes were aorta-related events and all-cause mortality. The secondary outcome was the frequency of follow-up CT imaging every year.</p><p><strong>Results: </strong>After PSM, the baseline characteristics of both groups were balanced. Median age was 56 years (IQR: 50-62 years) in both groups, and follow-up duration was similar (TEVAR: 31 months; iMT: 28 months, p=0.84).At 60 months, Kaplan-Meier estimates showed an aorta-related event rate of 21.9% (95% CI: 12.6% to 36.4%) for TEVAR and 19.9% (95% CI: 15.6% to 25.2%) for iMT (p=0.99).All-cause mortality was 4.4% (95% CI: 1.4% to 13.6%) for TEVAR and 6.6% (95% CI: 4.0% to 10.6%) for iMT (p=0.70). No significant differences were observed.</p><p><strong>Conclusions: </strong>While aorta-related events accumulated steadily in the crude iMT group, no survival benefit was observed for subacute TEVAR. These findings support ongoing randomized controlled trials and show the utility of claims-based analyses in IDEAL Stage 4.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"7 1","pages":"e000361"},"PeriodicalIF":1.6,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12323521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Society of cardiothoracic surgery in great Britain and Ireland guidance for adult mitral valve disease and interventions.","authors":"Hunaid A Vohra, Samuel Burton, Rashmi Yadav, Rana Sayeed, Narain Moorjani","doi":"10.1136/bmjsit-2024-000328","DOIUrl":"10.1136/bmjsit-2024-000328","url":null,"abstract":"<p><p>The Society of Cardiothoracic Surgery (SCTS) in Great Britain and Ireland provides comprehensive guidelines for the management of adult mitral valve disease, addressing both surgical and transcatheter interventions. These guidelines serve as a resource for healthcare professionals, supplementing existing clinical guidelines. They emphasize the evolving complexity of mitral valve disease management, influenced by the development of new technologies, ongoing research, and randomized trials. The guidelines detail a thorough methodology, incorporating an extensive literature review and evidence assessment conducted by a clinical guidelines team. They outline best practices of preinterventional patient assessment and indications of mitral interventions, while considering the management of patient comorbidities and concomitant diseases. Detailed repair techniques for mitral regurgitation and rheumatic valve disease are provided, along with a summary of indications for emerging transcatheter and hybrid procedures, including transcatheter edge-to-edge repair, transapical neo-chordee placement, transcatheter aortic valve mitral implantation, and percutaneous mitral annuloplasty. The guidelines address postoperative mitral complications and prosthesis considerations, including up-to-date recommendations for antithrombotic management. These guidelines aim to improve patient outcomes through detailed, evidence-based recommendations and encourage the development of specialized mitral MDTs within UK practice. They provide an educational resource, clarifying the implementation of recent technologies and supporting clinical decision-making in the management of adult mitral valve disease.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"7 1","pages":"e000328"},"PeriodicalIF":1.6,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144745280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical quality and health utilization of gastric cancer surgery in China: a post hoc analysis of the Prevalence of Abdominal Complications After Gastroenterological Surgery study.","authors":"Zhouqiao Wu, Tingfei Gu, Xin Wang, Tianxiao Wei, Fei Shan, Ziyu Li, Jiafa Ji","doi":"10.1136/bmjsit-2024-000332","DOIUrl":"10.1136/bmjsit-2024-000332","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to assess the surgical quality, safety, and healthcare utilization associated with gastric cancer surgery in China, using international studies for benchmarking.</p><p><strong>Design: </strong>A prospective registered study was conducted utilizing data from the Prevalence of Abdominal Complications After Gastroenterological Surgery study, comprised of 1859 patients without postoperative complications (non-POC group) and 412 patients with at least one POC group. Baseline characteristics, surgical outcomes, and healthcare utilization were compared between groups, and results were further contextualized through a review of international multicenter studies.</p><p><strong>Setting: </strong>20 centers across China, with data collected from December 2018 to December 2020.</p><p><strong>Participants: </strong>2271 patients who underwent gastrectomy for gastric cancer, including 1859 in the non-POC group and 412 in the POC group.</p><p><strong>Main outcome measures: </strong>POC incidence, postoperative hospital stay, healthcare costs, and cross-regional comparisons of surgical quality.</p><p><strong>Results: </strong>Patients with POCs exhibited distinct baseline and intraoperative profiles compared with those without. The most frequent complications were respiratory infections, anastomotic leakage, and non-leak intra-abdominal infections. Among surgical types, proximal gastrectomy had the highest POC incidence. Costs and postoperative hospital stay were significantly higher in patients with these complications. Compared with international cohorts, China demonstrated comparable surgical quality and complication profiles. However, the cost burden associated with major POCs was substantially lower in China, despite similar hospital stays.</p><p><strong>Conclusion: </strong>China's gastric cancer surgery outcomes align with international standards in terms of surgical quality and complication rates. Notably, major complications were associated with significantly lower costs than those reported internationally, suggesting greater cost advantages in postoperative management. These findings highlight the value of robust complication reporting systems and evidence-based management protocols in delivering cost-effective, high-quality surgical care.</p><p><strong>Trial registration number: </strong>NCT03828266.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"7 1","pages":"e000332"},"PeriodicalIF":2.1,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12265801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Randomized controlled bilateral comparison of femtosecond laser-assisted cataract surgery versus conventional phacoemulsification.","authors":"Marina Casazza, Sophia A Reifeltshammer, Nino Hirnschall, Siegfried Mariacher, Peter Laubichler, René Siska, Jascha Wendelstein, Matthias Bolz","doi":"10.1136/bmjsit-2024-000342","DOIUrl":"10.1136/bmjsit-2024-000342","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the influence of femtosecond laser-assisted cataract surgery (FLACS) on the post-operative capsular bag and visual performance using a novel aspheric hydrophobic intraocular lens (IOL).</p><p><strong>Design: </strong>Randomized controlled bilateral study.</p><p><strong>Setting: </strong>Department of Ophthalmology and Optometry, Kepler University Hospital, Linz, Austria.</p><p><strong>Participants: </strong>Patients scheduled for bilateral cataract surgery.</p><p><strong>Interventions: </strong>Patients were scheduled either for conventional cataract surgery or femtolaser-assisted cataract surgery.</p><p><strong>Main outcome measures: </strong>Anterior chamber depth, IOL tilt, IOL decentration, best-corrected distance visual acuity, uncorrected distance visual acuity.</p><p><strong>Results: </strong>In total, 100 eyes of 50 patients were included in this study. After 6 months, there was no relevant difference between the FLACS and the conventional cataract group regarding anterior chamber depth (4.56±1.68 mm and 4.60±0.26 mm; p=0.903), tilt (4.87°±2.17° and 4.37°±1.62°; p=0.124) or decentration (0.28±0.14 mm and 0.33±0.20 mm; p=0.414), respectively. The postoperative mean spherical equivalent showed a slight hyperopic shift with no relevant difference between both groups (+0.17±0.49 D and +0.19±0.50 D; p=0.996) with a target refraction of emmetropia or myopia (-2.5 D).</p><p><strong>Conclusions: </strong>FLACS was not superior to manual cataract surgery regarding capsular bag or visual performance, and the investigated IOL was safe and stable.</p><p><strong>Trial registration number: </strong>NCT06069752.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"7 1","pages":"e000342"},"PeriodicalIF":2.1,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding and quantifying the environmental impact of sterile medical devices: a carbon footprint study of single-use electrosurgical scalpels and their reusable alternatives.","authors":"Annabel Goubil, Kimberley Lefèvre, Chloé Couret, Mireille Ferlita, David Feldman, Johann Clouet, Elise Rochais","doi":"10.1136/bmjsit-2024-000348","DOIUrl":"10.1136/bmjsit-2024-000348","url":null,"abstract":"<p><strong>Abstract: </strong></p><p><strong>Background: </strong>In France, 25% of healthcare emissions are attributed to the supply of medical devices, underscoring the necessity for the development of more sustainable procurement policies. However, comparing the carbon footprint of different devices, especially single-use devices versus reusable ones, presents challenges.</p><p><strong>Objective: </strong>To assess the carbon footprint of single-use and reusable electrosurgical scalpels over 1 year of use in our hospital setting.</p><p><strong>Design: </strong>A cradle-to-grave analysis was conducted from May 1, 2022, to April 30, 2023.</p><p><strong>Setting: </strong>Nantes University Hospital, France.</p><p><strong>Main outcome measures: </strong>The study quantifies carbon emissions across all life cycle stages: raw material extraction, manufacturing, transportation, use, maintenance, and disposal. For reusable devices, sterilization emissions were allocated based on the total annual workload of the Central Sterile Services Department. Carbon footprint values were derived from direct measurements, manufacturer and supplier data, and literature, with conversions using a public and national database (Base Empreinte, ADEME).</p><p><strong>Results: </strong>The carbon footprint of single-use devices was estimated at 4291 kg of carbon dioxide equivalent (CO₂e), with 94% attributed to the production of the device itself. The carbon footprint related to the reusable device was estimated at 494 kg CO₂e, with 86% stemming from handling at our sterilization unit.</p><p><strong>Conclusions: </strong>These findings are contingent on our hospital's practices and may vary based on several factors. Beyond estimating these carbon footprints, it provides a practical, decision-oriented analysis accessible for hospital leadership and healthcare professionals, supporting institutional change.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"7 1","pages":"e000348"},"PeriodicalIF":2.1,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12226936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neural network models for predicting readmission among patients undergoing peripheral vascular intervention using electronic health record data and clinical registry data.","authors":"Jialin Mao, Philip Goodney, Samprit Banerjee, Zoran Kostic, Kim Smolderen, Carlos Mena-Hurtado, Michael E Matheny","doi":"10.1136/bmjsit-2025-000387","DOIUrl":"10.1136/bmjsit-2025-000387","url":null,"abstract":"<p><strong>Objectives: </strong>To determine whether neural network models based on electronic health record (EHR) data can match and augment the performance of models based on clinical registry data in predicting readmission after peripheral vascular intervention (PVI).</p><p><strong>Design: </strong>Observational cohort study.</p><p><strong>Setting: </strong>Vascular Quality Initiative registry and INSIGHT Clinical Research Network EHR data from multiple academic institutions in New York City.</p><p><strong>Participants: </strong>Patients undergoing PVI during January 1, 2013 to September 30, 2021.</p><p><strong>Main outcome measures: </strong>Our outcome variable was 90-day readmission. We developed logistic regression (LR), multilevel perceptron (MLP), and recurrent neural network (RNN) models using registry alone, EHR data alone, and combined registry-EHR data. EHR data were evaluated using derived variables to match registry variables (EHR-derived data) and clinically meaningful code aggregation (EHR-direct data). Models were evaluated using area under the curve (AUC) for discrimination, Spiegelhalter z score for calibration, and Brier score for overall performance.</p><p><strong>Results: </strong>The analytical cohort included 2348 patients undergoing PVI (mean age: 69.9±11.5 years). 832 (35%) patients were readmitted within 90 days. LR to predict 90-day readmission based on registry data alone had an AUC of 0.710, Spiegelhalter z score of 1.021, and Brier score of 0.211. MLP based on registry data alone had similar performance. MLP and RNN based on EHR-direct data (MLP: AUC=0.742, Spiegelhalter z=0.933, Brier=0.204; RNN: AUC=0.737, Spiegelhalter z=1.026, Brier=0.206) and registry+EHR-direct data (MLP: AUC=0.756, Spiegelhalter z=0.794, Brier=0.199; RNN: AUC=0.751, Spiegelhalter z=1.057, Brier=0.200) had improved performances. LR based on EHR-direct data and combined registry+EHR-direct data had worse performances.</p><p><strong>Conclusions: </strong>EHR data, when used with neural network models, can be useful to establish readmission predictive models or augment clinical registry data. EHR-based models can be potentially embedded in the clinical workflow, but model performance may be constrained by the absence of certain information in clinical encounters, such as social determinants of health.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"7 1","pages":"e000387"},"PeriodicalIF":2.1,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel approach to meniscal vascularity evaluation using indocyanine green fluorescence-guided knee arthroscopy.","authors":"Tamiko Kamimura","doi":"10.1136/bmjsit-2024-000351","DOIUrl":"10.1136/bmjsit-2024-000351","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to use indocyanine green (ICG) fluorescence-guided knee arthroscopy to observe the meniscus and surrounding tissue vascularity and determine correlation with the patients' backgrounds. Currently, no data are available on the clinical application of ICG fluorescence-guided knee arthroscopy in assessing meniscal vascularity.</p><p><strong>Design: </strong>Prospective, case series.</p><p><strong>Setting: </strong>In-hospital settings.</p><p><strong>Participants: </strong>41 knees of 34 patients were examined. 4 knees of 4 patients were included in a pilot study for technique refinement only, while the remaining 37 knees of 30 patients were included in the study.</p><p><strong>Main outcome measures: </strong>The times from ICG administration to fluorescence onset and fluorescence duration from onset to complete attenuation were recorded. The fluorescence intensity at the anterior, middle, and posterior segments of the meniscus was evaluated on a 4-point scale. The younger and older and smoker and non-smoker groups were compared.</p><p><strong>Results: </strong>The average fluorescence onset time was 32.05 s, whereas the average fluorescence duration was 11 min 14 s. The age groups aged≤45 and ≥46 years showed an onset of 30±24.9 and 33.17±16.2 s and a duration of 12 min 54 s and 10 min 20 s, respectively. The smoking and non-smoking groups exhibited an onset of 28.33±14.4 and 33.84±21.5 s and a duration of 10 min 37 s and 11 min 32 s, respectively. All segments of the lateral meniscus showed higher fluorescence intensities than the medial. The posterior segment of the lateral meniscus at ≤45 was markedly more fluorescent and significantly different from ≥46.</p><p><strong>Conclusions: </strong>Fluorescence was observed for approximately 30 s after intravenous ICG injection and lasted approximately 10 min. Fluorescence intensity was brighter in the posterior segment of the lateral meniscus, particularly at ≤45. ICG fluorescence-guided knee arthroscopy may assist in case-specific hemodynamics and real-time surgical evaluation of the meniscus in living humans.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"7 1","pages":"e000351"},"PeriodicalIF":2.1,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144508718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}