Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland最新文献

{"title":"List of editors","authors":"","doi":"10.1016/S1479-666X(24)00139-2","DOIUrl":"10.1016/S1479-666X(24)00139-2","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 6","pages":"Page i"},"PeriodicalIF":2.3,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142702175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgeon ability to predict physical activity and sedentary time: Comparison of self-reported and measured activity","authors":"Stefanie Soelling ,&nbsp;Stephanie Polazzi ,&nbsp;Jean-Christophe Lifante ,&nbsp;Tanujit Dey ,&nbsp;Antoine Duclos","doi":"10.1016/j.surge.2024.09.008","DOIUrl":"10.1016/j.surge.2024.09.008","url":null,"abstract":"<div><h3>Background</h3><div>Prior work evaluated clinician work-related physical activity and found it does not meet recommended requirements. We aimed to assess more fully daily surgeon physical activity and compare it to self-reported activity.</div></div><div><h3>Methods</h3><div>This multispecialty prospective cohort study included attending surgeons from 14 surgical departments within four French university hospitals. Over a 14-month period (11/01/2020-12/31/2021), surgeons were continuously monitored 24/7 for their daily physical activity by wearing an accelerometer on their ankle. For each surgeon, measured parameters included the daily average of step counts and sedentary time, as well as the total weekly time of physical activity within the 30 days preceding surgeries. Surgeons self-reported the validated Global Physical Activity Questionnaire from the World Health Organization (WHO). The self-reported and measured physical activity of surgeons were described, and their correlation was assessed using Spearman rank correlation.</div></div><div><h3>Results</h3><div>Overall, there were 38 surgeons in the cohort and 8810 surgeries performed. Surgeons were 78.9 % male, median age was 46.1, and median BMI was 24.5. Median measured daily step count was 9439 (IQR: 7238–9918). The measured weekly total time of physical activity was 918 min (95 % CI: 767–990), while the corresponding self-reported median time was 1940 min (95 % CI: 1120–3600) (Spearman coefficient = 0.14, p = 0.41). The measured median daily sedentary time was 353 min (95 % CI: 316–374), compared to a self-reported median of 240 min (95 % CI: 210–300) (Spearman coefficient = 0.20, p = 0.24).</div></div><div><h3>Conclusions</h3><div>Surgeons may overestimate the sufficiency of their physical activity and underestimate their sedentary time. Increased awareness is needed to improve surgeon wellness.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 6","pages":"Pages 332-337"},"PeriodicalIF":2.3,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142702176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sensitivity and specificity of surgeons’ intra-operative diagnosis of appendicitis. A systematic review and meta-analysis","authors":"Ellen Barnes ,&nbsp;Rian Hayes ,&nbsp;Sarah Louise Halpin ,&nbsp;Sana Nasim","doi":"10.1016/j.surge.2024.10.006","DOIUrl":"10.1016/j.surge.2024.10.006","url":null,"abstract":"<div><h3>Background</h3><div>Appendicitis is a frequently encountered surgical condition, yet its diagnosis can be challenging. There is increasing research on the safety of leaving macroscopically normal appendices in situ, the necessity of routine histopathological assessment, and the impact of the intra-operative assessment on the post-operative course. We aimed to determine the sensitivity and specificity of the surgeon's intra-operative diagnosis of appendiceal pathology, which is an important factor in answering these questions.</div></div><div><h3>Methods</h3><div>Medline, Embase, the Cochrane Library and Web of Science were searched for studies listing the corresponding intra-operative and histopathological diagnoses of appendicectomies performed for suspected appendicitis. The primary outcome was the sensitivity and specificity of the surgeon at recognising an abnormal appendix, which we subjected to meta-analysis. Subgroup analysis was performed for paediatric and adult populations. Incidence of unexpected findings and if they were recognised intra-operatively was recorded.</div></div><div><h3>Result</h3><div>42 articles were included in the systematic review. 26 studies featuring 17,374 patients were included in the meta-analysis, which found that surgeons’ intra-operative diagnosis was 95.2 % (95 % CI 94.8–95.5 %) sensitive and 60 % (95 % CI 58.1–62 %) specific. Surgeons are slightly more sensitive and specific in paediatric populations (sensitivity 95.7 % (95 % CI 95–96.4 %), specificity 64.1 % (95 % CI 60–68 %)) compared with adult populations (sensitivity 93 % (95 % CI 91.3–94.5 %), specificity 56.5 % (95 % CI 50.1–62.6 %)), however, this difference was only statistically significant in sensitivity. 1.7 % of appendicectomy specimens had unexpected histopathological findings, of which very few were suspected intra-operatively.</div></div><div><h3>Conclusion</h3><div>Surgeons are highly sensitive but not very specific at recognising abnormal appendices intra-operatively.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 2","pages":"Pages e63-e70"},"PeriodicalIF":2.3,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical predictors of recurrent cholecystitis in non-operative management: A systematic review & meta-analysis","authors":"Ahmed Salama ,&nbsp;Gavin G. Calpin ,&nbsp;Raymond Fuller ,&nbsp;Arnold D.K. Hill","doi":"10.1016/j.surge.2024.11.004","DOIUrl":"10.1016/j.surge.2024.11.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Gallstone disease is prevalent and carries substantial implications for morbidity and healthcare resource utilization. While early laparoscopic cholecystectomy (LC) is often preferred, its feasibility may be limited in some cases. As a result, many patients undergo conservative management.</div></div><div><h3>Aims</h3><div>To conduct a systematic review of the current literature to identify studies reporting on clinical predictors of recurrence in patients who undergo non-operative management of acute cholecystitis.</div></div><div><h3>Methods</h3><div>A systematic review was performed as per PRISMA and MOOSE guidelines. Studies comparing variables in patients who had acute cholecystitis recurrence (ACR) were included.</div></div><div><h3>Results</h3><div>Three studies were included in the review. There were 678 patients in total with a 28.5 % recurrence rate. Age, history of biliary disease, and severity of cholecystitis were identified as potential predictors of ACR. Biochemical results, such as inflammatory markers, white cells, and albumin levels, may also play a role. Radiological findings, including gallbladder wall thickness and stone characteristics, showed potential as predictors.</div></div><div><h3>Conclusion</h3><div>Identifying patients at risk of recurrent cholecystitis is important in guiding clinical decision-making. While certain findings show promise as predictors, the available evidence is limited and inconclusive. Larger studies are needed to develop risk stratification tools for better management of gallstone disease.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 2","pages":"Pages 106-113"},"PeriodicalIF":2.3,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“We are very family like”: How do relationships with colleagues affect career satisfaction for surgeons?","authors":"Leeat Granek ,&nbsp;Abhaya V. Kulkarni ,&nbsp;David J. Barron ,&nbsp;Agnes M.F. Wong","doi":"10.1016/j.surge.2024.11.005","DOIUrl":"10.1016/j.surge.2024.11.005","url":null,"abstract":"<div><h3>Purpose</h3><div>The objective of this research was to explore the role of surgeon relationships with their colleagues on career satisfaction.</div></div><div><h3>Methods</h3><div>This qualitative study employed a thematic analysis based on the core elements of The Grounded Theory Method. Forty-two pediatric neurosurgeons, cardio-thoracic surgeons and ophthalmologists were recruited from 9 countries around the globe and interviewed in-depth about the role of their collegial relationships on their career satisfaction. Data was coded line-by-line to extract themes and to identify patterns across the interviews.</div></div><div><h3>Results</h3><div>Career satisfaction was greatly enhanced by having a cohesive and healthy team. ‘Healthy’ teams were described as those that were emotionally supportive of each other, where colleagues could be trusted to back each other up, where communication was open and transparent, and where collaboration was the departmental norm. Career satisfaction was greatly diminished when there were interpersonal conflicts and personality clashes between surgeons, where there was poor departmental leadership creating a culture of fear and insecurity, when colleagues were perceived as egotistical, in competitive departments, where there was perceived to be an unequal distribution of work, and when surgeons felt alone and unsupported.</div></div><div><h3>Conclusions</h3><div>Our study found that healthy teams had very specific qualities that could be cultivated and enhanced on surgical teams by making a conscious effort to improve the workplace culture and psychological safety among the team. In the conclusions, a number of recommendations are made on how to go about achieving this goal.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 2","pages":"Pages 67-72"},"PeriodicalIF":2.3,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of bone and soft tissue vs. visceral synovial sarcoma: Demographic, clinical, and survival outcomes; a retrospective population-based study","authors":"Asad Ullah ,&nbsp;Mya Goodbee ,&nbsp;Kali Malham ,&nbsp;Abdul Qahar Khan Yasinzai ,&nbsp;Muhammad Bilal Mirza ,&nbsp;Bisma Tareen ,&nbsp;Aimal Khan ,&nbsp;Kamran Idrees","doi":"10.1016/j.surge.2024.11.003","DOIUrl":"10.1016/j.surge.2024.11.003","url":null,"abstract":"<div><h3>Background</h3><div>Synovial sarcoma (SS) is typically diagnoses in young adults and usually appears in the extremities and soft tissues. However, it can sometimes arise in visceral organs. This study examines the differences in patient demographics, clinical features, and survival rates between soft tissue and visceral synovial sarcoma.</div></div><div><h3>Methods</h3><div>We analyzed data from the Surveillance, Epidemiology, and End Results (SEER) database spanning 2000–2018. ANOVA (analysis of variance) was used to identify significant factors for multivariate analysis. Cox regression modeling was used to determine independent risk factors for survival.</div></div><div><h3>Results</h3><div>Of the 2,776 SS patients included, the median age was 39.0 years, predominating male (53.0 %) and white (81.3 %). Bone and soft tissue sarcomas were more common, accounting for 86.4 % of cases (p-value&lt;0.001), while the rest were diagnosed as visceral sarcomas. Visceral SS patients were typically older (p-value&lt;0.001), male (56.8 %), and white (84.8 %). They also presented more frequently with distant metastasis (HR 3.8, 95 % CI, 2.4-6.1), had larger tumors on average (HR for tumors &gt;10 cm: 2.9, 95 % CI, 2.0-4.1), and were less likely to undergo surgery (HR 0.4, 95 % CI, 0.3-0.6). Despite receiving multimodal treatments, including surgery, radiation, and/or chemotherapy, visceral SS patients exhibited poorer overall survival compared to their bone and soft tissue SS counterparts (p-value&lt;0.001).</div></div><div><h3>Conclusion</h3><div>Visceral SS often presents in older patients with advanced-stage and larger tumor size as compared to bone and soft tissue SS, which likely contributes to poorer survival. Advanced age, regional spread, and larger tumor size were all found to worsen outcomes, while surgery and radiation were found to be protective factors.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 3","pages":"Pages 167-173"},"PeriodicalIF":2.3,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of post-iliac crest bone harvesting hernias: Insights from a case series and systematic review","authors":"Kirengo Thomas Onyango,&nbsp;Azhar Zubair,&nbsp;Maraqa Abdelrahman,&nbsp;Mazumdar Eshan,&nbsp;Rafiq Sarmad,&nbsp;Ramanand Bangalore","doi":"10.1016/j.surge.2024.11.001","DOIUrl":"10.1016/j.surge.2024.11.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Hernias following iliac bone grafting are a rare but significant complication, with the earliest case reported in 1945. Repairing these hernias is challenging. Appropriate repair techniques are needed to minimise morbidity and recurrence. We present our experience with three cases of post-iliac graft hernia repair with mesh anchored to titanium mini-plates and a systematic review of current literature.</div></div><div><h3>Method</h3><div>We conducted a systematic review of the literature in February 2024 on two online databases, PubMed®/MEDLINE and EMBASE, in accordance with PRISMA guidelines. Keywords used were “Hernia,” “Iliac,” and “Graft.” Data on demographics, initial pathology, time to presentation, type of hernia repair, and outcome were collected. Studies not in English and related to other types of hernia were excluded.</div></div><div><h3>Results</h3><div>We included 30 studies out of 751 results, spanning from 1975 to 2023. There were 40 reported cases of hernias post iliac bone grafting. The age distribution ranged from 37 to 88 years, with a median age of 60. The majority of patients (40 %) presented within one year. Fracture management, accounting for 19 cases (47.5 %), was the main indication for bone grafting. Mesh repair was performed in 31 cases (77.5 %). Seven cases (17.5 %) of recurrence were reported.</div></div><div><h3>Conclusion</h3><div>Recurrence is a common complication in patients with post-iliac graft hernias. Open mesh repair is the most frequently performed surgery and involves various techniques. While titanium mini-plates as anchors enable a pre-peritoneal plane mesh repair, long-term follow-up and comparative studies are needed to evaluate its efficacy compared to simple mesh.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 2","pages":"Pages e71-e80"},"PeriodicalIF":2.3,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thirty-day outcomes of Asian Americans in endovascular repair of intact infrarenal abdominal aortic aneurysm","authors":"Renxi Li ,&nbsp;Anton Sidawy ,&nbsp;Bao-Ngoc Nguyen","doi":"10.1016/j.surge.2024.10.005","DOIUrl":"10.1016/j.surge.2024.10.005","url":null,"abstract":"<div><h3>Background</h3><div>Endovascular aneurysm repair (EVAR) has become the predominant treatment for Abdominal aortic aneurysm (AAA). Racial disparity has been observed in EVAR but Asian Americans have been largely excluded from previous studies. This study aimed to comprehensively evaluate 30-day outcomes of Asian Americans undergoing EVAR for intact infrarenal AAA using a multi-institutional national database.</div></div><div><h3>Methods</h3><div>Patients who underwent infrarenal EVAR from 2012 to 2022 were identified in the ACS-NSQIP database. Exclusion criteria included age less than 18 years, emergency presentation, and acute intraoperative conversion to open. A 1:3 propensity-score matching was applied to Asian Americans and Caucasians to match their demographics, comorbidities, aneurysm diameter, distant extent of the aneurysm, anesthesia, and concomitant procedures. Thirty-day postoperative outcomes were examined.</div></div><div><h3>Results</h3><div>Among 16,463 patients who underwent EVAR for non-ruptured infrarenal AAA, 302 (1.83 %) were Asian Americans and 12,373 (75.16 %) were Caucasians. Asian Americans had older age and higher burdens of medical comorbidities. After propensity-score matching, Asian American and Caucasian patients had comparable 30-day outcomes including mortality (1.99 % vs 1.34 %, p = 0.42), cardiac complications (2.32 % vs 1.56 %, p = 0.45), pulmonary complications (2.32 % vs 1.89 %, p = 0.64), and renal complications (1.99 % vs 0.89 %, p = 0.13). However, Asian American patients had a longer operative time (155.80 ± 84.59 vs 136.60 ± 69.60 min, p &lt; 0.01) and length of stay (3.60 ± 6.16 vs 2.71 ± 4.50 days, p = 0.01). All other 30-day outcomes were comparable between Asian American and Caucasian patients.</div></div><div><h3>Conclusion</h3><div>Asian Americans might be underrepresented in EVAR due to limited healthcare access or a more insidious disease progression. After propensity-score matching, Asian Americans showed similar 30-day outcomes as their Caucasian counterparts. Thus, when given access, EVAR can be as effective and safe for Asian American patients. Future research should investigate the long-term prognosis for Asian Americans after EVAR.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 2","pages":"Pages e81-e85"},"PeriodicalIF":2.3,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142523467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcatheter arterial embolisation (TAE) to treat acute upper gastrointestinal bleeding secondary to gastric cancer: A systematic review and meta-analysis","authors":"Tamzin Hall ,&nbsp;Hugo C. Temperley ,&nbsp;Benjamin M. Mac Curtain ,&nbsp;Niall J. O'Sullivan ,&nbsp;Ned Quirke ,&nbsp;Niall McEniff ,&nbsp;Ian Brennan ,&nbsp;Kevin Sheahan ,&nbsp;Noel E. Donlon","doi":"10.1016/j.surge.2024.09.009","DOIUrl":"10.1016/j.surge.2024.09.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute upper gastrointestinal bleeding (UGIB) secondary to gastric cancer presents a significant clinical challenge due to its high morbidity and mortality rates. Transcatheter arterial embolisation (TAE) has emerged as a potential therapeutic option for managing this condition, especially in the context of failed endoscopic management. This systematic review aims to evaluate the efficacy and safety of TAE in treating acute upper gastrointestinal (GI) bleeding caused by gastric cancer.</div></div><div><h3>Methods</h3><div>A systematic search of medical databases, including PubMed, MEDLINE, and EMBASE, was conducted for studies published between 2000 and 2023. Included studies reported on the use of TAE for acute upper GI bleeding specifically due to gastric cancer, including retrospective analyses, case reports, and cohort studies. Demographics and clinical outcomes were reported.</div></div><div><h3>Results</h3><div>A total of 7 studies met the inclusion criteria, all being retrospective in nature. The overall technical success rate of TAE was 94.9 %. Overall clinical success rates were 72 % with a 95 % confidence interval (CI) of 66–79 %. Overall rebleeding rates were 11 % with a 95 % CI of 3–18 %. Major complications were reported in 2.4 % of patients, including ischemic complications and organ perforation. The overall 30-day mortality rate was 26.4 %, primarily due to underlying disease progression rather than procedural complications.</div></div><div><h3>Conclusion</h3><div>TAE is an effective and safe intervention for managing acute upper GI bleeding secondary to gastric cancer, with high success rates. TAE should be considered a viable treatment modality for this challenging condition, particularly for patients who are being considered for neoadjuvant therapy or indeed those not suitable candidates for curative surgical intervention.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 6","pages":"Pages e213-e220"},"PeriodicalIF":2.3,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilising a modified accelerated Delphi process to develop a national multidisciplinary consensus on peri-operative optimisation of patients with obesity undergoing non-bariatric surgery","authors":"C. Cullinane ,&nbsp;A. Edwards-Murphy ,&nbsp;C. Kennedy ,&nbsp;C. Toale ,&nbsp;M. Al Azzawi ,&nbsp;M. Davey ,&nbsp;N. Donlon ,&nbsp;S. Croghan ,&nbsp;J. Elliott ,&nbsp;C. Fleming","doi":"10.1016/j.surge.2024.09.005","DOIUrl":"10.1016/j.surge.2024.09.005","url":null,"abstract":"<div><h3>Background</h3><div>In the last three decades, the worldwide prevalence of obesity has increased by threefold. Using a modified Delphi consensus technique, the Irish Surgical Research Collaborative (ISRC) aimed to formulate consensus guidelines on the peri-operative optimisation of patients with obesity undergoing non-bariatric surgery.</div></div><div><h3>Methods</h3><div>Subgroups within the ISRC were established to formulate consensus statements using a nominal group technique (NGT) to address the three domains of pre-operative, intra-operative and post-operative care. Three Delphi rounds were circulated nationally to multidisciplinary members of the peri-operative team via electronic survey. Consensus was considered achieved for any statement with &gt;80 % agreement. Data was analysed using Microsoft Excel (Microsoft Corp, Redmond, WA).</div></div><div><h3>Results</h3><div>Following three Delphi rounds, a total of 94 statements centred around optimising peri-operative care for patients with obesity undergoing non-bariatric surgery reached consensus. Pre-operatively, access to prehabilitation, use of pre-operative risk stratification tools and strategies to reduce obesity-related co-morbidities were all deemed important along with nomination of a hospital obesity lead. Intra-operatively, the prioritised domains were involvement of consultant anaesthetist and surgeon for safe and considered patient positioning, utilisation of minimally invasive surgical techniques, adherence to venous thromboembolism prophylaxis and surgical site infection prevention strategies as well as adoption of multimodal analgesia. Appropriate analgesia prescription, nutritional support, enhanced recovery after surgery and the role of physiotherapy were all deemed essential elements of post-operative care.</div></div><div><h3>Conclusion</h3><div>As a multidisciplinary peri-operative group, through Delphi consensus, we report agreed perioperative standards to optimise the perioperative care of patients with obesity undergoing non-bariatric surgery. This consensus can be utilised to standardise clinical practice and identify areas for quality improvement.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 2","pages":"Pages e86-e91"},"PeriodicalIF":2.3,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}