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

{"title":"Diversity in core surgical training: Trends between 2012 and 2022","authors":"Matthew Newman,&nbsp;Neil Scott,&nbsp;Phyo Kyaw Myint,&nbsp;Ricky Ellis","doi":"10.1016/j.surge.2025.09.002","DOIUrl":"10.1016/j.surge.2025.09.002","url":null,"abstract":"<div><h3>Background and purpose</h3><div>A diverse healthcare workforce is an important goal in ensuring that services reflect and meet the needs of a diverse population. Core Surgical Training (CST) is the first stage of surgical training in the UK, but diversity trends at this level have not been previously described. We aim to describe trends in gender, ethnicity, disability, and sexuality among successful CST applicants between 2012 and 2022.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted using anonymised data from the UK Medical Education Database (UKMED) for all successful CST applicants between 2012 and 2022. Chi-squared tests for trend were used to assess statistically significant changes in demographic characteristics over time. Data were categorised and missing data excluded as per pre-specified protocols.</div></div><div><h3>Results</h3><div>The proportion of Non-White CST entrants rose from 36.5 % in 2012 to 54.3 % in 2022 (X² = 124.421, p &lt; 0.001). Entrants declaring a disability increased from 4.8 % in 2016 to 10.4 % in 2019 (X² = 22.225, p = 0.014). No significant trends were observed for gender (X² = 15.338, p = 0.120) or sexuality (X² = 9.880, p = 0.451).</div></div><div><h3>Conclusions</h3><div>This study highlights positive trends in the ethnic and disability diversity of successful CST applicants over the past decade. However, gender and sexuality diversity showed no significant change. Further research is needed to explore barriers to entry and ensure continued progress towards an inclusive surgical workforce.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"24 1","pages":"Pages 1-7"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076477","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":"Systemic Inflammation Response Index and primary cancer site predict futility of pelvic exenteration surgery for locally advanced and recurrent pelvic malignancy","authors":"Sergei Bedrikovetski ,&nbsp;Ishraq Murshed ,&nbsp;Martin K. Oehler ,&nbsp;Jonathan Cho ,&nbsp;Marcus Wagstaff ,&nbsp;Ryash Vather ,&nbsp;Tarik Sammour","doi":"10.1016/j.surge.2025.10.003","DOIUrl":"10.1016/j.surge.2025.10.003","url":null,"abstract":"<div><h3>Background</h3><div>Pelvic exenteration (PE) is a major procedure typically performed for patients with locally advanced or recurrent pelvic malignancy. Appropriate patient selection is crucial to achieving good outcomes and obviating futile resections. The objective of this study was to establish the incidence and predictors of futile PE in patients with locally advanced or recurrent pelvic malignancy.</div></div><div><h3>Methods</h3><div>A retrospective analysis of a prospective database of patients undergoing PE for advanced or recurrent pelvic malignancy between 2008 and 2025 was performed. Patients with benign disease or less than 6 months’ follow-up were excluded, except those who died or recurred within 6 months, who were classified as futile PE. Futility in planned R0 (curative) resections was defined as death from any cause or recurrence (local or distant) within 6 months. Futility in planned R1/R2 (palliative) resections was defined as death from any cause within 6 months. Multivariable logistic regression was performed to identify predictors of futile PE.</div></div><div><h3>Results</h3><div>Of 224 patients identified, 172 were eligible for inclusion in the study and 25 (14.5 %) patients had a futile resection criteria. Multivariable analysis demonstrated Systemic Inflammation Response Index (SIRI ≥1.92) (OR, 7.06; 95 % CI, 1.58–31.57; P = 0.011) and cancer site (non-colorectal cancer) (OR, 4.68; 95 % CI, 1.81–12.10; P = 0.001) as independent risk factors for futile surgery.</div></div><div><h3>Conclusion</h3><div>Futile PE was observed in 14.5 % of patients. Key predictors of futility included non-colorectal cancers and elevated preoperative SIRI levels.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"24 1","pages":"Pages 56-62"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314094","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":"A survey on the management of low anterior resection syndrome among Irish colorectal surgeons and trainees.","authors":"Meadhbh Ni Mhiochain de Grae, William P Duggan, Sean M Johnston, Shaheel Mohammad Sahebally","doi":"10.1016/j.surge.2025.12.008","DOIUrl":"https://doi.org/10.1016/j.surge.2025.12.008","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994592","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":"Abdominal aortic aneurysm (AAA) screening and the Irish context.","authors":"Morgan Thomas McLoughlin, Nawar Masarani, Mohammed Elkassaby, Gergely Gosi","doi":"10.1016/j.surge.2025.12.003","DOIUrl":"https://doi.org/10.1016/j.surge.2025.12.003","url":null,"abstract":"<p><strong>Introduction: </strong>The 2024 European Society for Vascular Surgery (ESVS) guidelines mark a paradigm shift in recommendations for abdominal aortic aneurysm (AAA) screening, moving from population-specific to risk-based criteria. Whilst the aim of this approach is to foster local adaptation, countries, like Ireland, have yet to develop corresponding national guidance.</p><p><strong>Aim: </strong>This commentary explores the implications of this shift, contrasts the 2019 and 2024 ESVS recommendations, and highlights the critical need for updates in Irish-specific screening framework grounded in local epidemiology and international best practice.</p><p><strong>Methods: </strong>The paper incorporates evidence from ESVS guidelines, systematic reviews, cost-benefit analyses, and international comparisons to create a narrative discussion on AAA screening in the Irish context and recommend proposals for change.</p><p><strong>Results: </strong>The results of this review support ultrasound screening for men aged 65 years or older with a smoking history or atherosclerotic disease risk factors. Screening should also be recommended for individuals with peripheral aneurysms or a history of organ transplantation. Individuals with a strong family history (i.e. first degree relative) should continue ultrasound screening at the age of 50.</p><p><strong>Conclusion: </strong>The shift in guidelines toward localised, high-risk screening frameworks requires countries to act. Ireland currently lacks the infrastructure and policy to support this change, leaving vulnerable populations at risk. Until a formal national screening strategy is implemented, informal and inconsistent screening will continue to depend on individual physician initiative. In this interim period, it is essential to equip clinicians with updated contemporary literature to accurately identify high-risk individuals who would benefit from screening.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835166","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":"Knowledge gaps and radiation exposure concerns: Time for a revamp of radiation training structures for trainee surgeons","authors":"Lylas Aljohmani ,&nbsp;Aoife Gaffney ,&nbsp;Linda Kelly ,&nbsp;Lucy-Anne O'Sullivan ,&nbsp;Eunice Leyva ,&nbsp;Michael O'Connor ,&nbsp;Jackie McCavana ,&nbsp;Eric Heffernan ,&nbsp;Christine Quinlan ,&nbsp;Roisin Dolan","doi":"10.1016/j.surge.2025.05.002","DOIUrl":"10.1016/j.surge.2025.05.002","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to assess surgical trainee knowledge of occupational radiation exposure, personal protection equipment (PPE) compliance, and prior radiation protection training.</div></div><div><h3>Design</h3><div>A cross-sectional quantitative study using a questionnaire-based survey.</div></div><div><h3>Setting</h3><div>Tertiary care hospitals in Ireland.</div></div><div><h3>Participants</h3><div>79 surgical trainees across six surgical disciplines, with a 70 % response rate.</div></div><div><h3>Results</h3><div><span>Seventy-nine of 112 surgical trainees (70 %) completed the survey. Most were specialist registrars (47 %), with orthopaedics<span>, plastic surgery, and urology comprising 70 % of respondents. Although 78 % had attended a radiation safety course, 40 % lacked fluoroscopy-specific training. Knowledge gaps were evident—60 % of questions were commonly answered incorrectly, with only 11 % correctly identifying CT radiation dose. Despite frequent </span></span>fluoroscopy<span> use, dosimeter use was poor: only 7.6 % always wore one. Prior training correlated with increased PPE use and awareness of long-term radiation risks, including fertility concerns. While 67 % expressed concern about exposure, only 21.5 % said it influenced speciality choice. The most used PPE was lead skirt/top (72 %), followed by thyroid shield (52 %), while lead glasses and gloves were rarely worn.</span></div></div><div><h3>Conclusion</h3><div>Significant knowledge gaps and low PPE compliance were observed amongst surgical trainees. Given the strong desire for further training, we recommend a modernised, interactive national radiation safety training program tailored to surgical specialities.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 6","pages":"Pages 393-398"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188385","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":"Applied anatomy of accessory tendons of extensor hallucis longus muscle and hallux valgus deformity: a cadaveric and radiologic study","authors":"Mustafa Aydin ,&nbsp;Mehmet Aydin ,&nbsp;Ayhan Comert ,&nbsp;Emrah Koksal ,&nbsp;Necati Salman ,&nbsp;Emre Donmez ,&nbsp;Omer Levent Karadamar ,&nbsp;Begum Aslantas Kaplan ,&nbsp;Murat Igde ,&nbsp;Trifon Totlis ,&nbsp;Necdet Kocabıyık","doi":"10.1016/j.surge.2025.08.004","DOIUrl":"10.1016/j.surge.2025.08.004","url":null,"abstract":"<div><h3>Introduction</h3><div>The accessory tendon of the extensor hallucis longus (ATEHL) represents a common anatomical variant. However, the role of ATEHL in the etiology of hallux valgus (HV) has not yet been fully elucidated. This study aimed to determine the incidence and morphology of the ATEHL in cadavers and examine its possible correlation with the HV deformity presence and the relevant angular measurements of the feet.</div></div><div><h3>Materials and methods</h3><div>The study included 63 embalmed cadaveric feet. Following documentation of the demographic parameters of the cadavers, the dorsal aspect of the first ray was carefully dissected. The existence and morphological features of the ATEHL were recorded and analyzed. Subsequently, plain radiographs were taken to assess the hallux valgus angles (HVA) and intermetatarsal angles (IMA) without weight-bearing simulation. In this evaluation, HVA exceeding 15° and IMA exceeding 9° were characterized as hallux valgus (HV) deformity. Statistical analysis was used to examine any correlations between ATEHL existence and HV deformity presence, HVA degrees and IMA degrees.</div></div><div><h3>Results</h3><div>An ATEHL was found in 37 out of 63 cadaveric feet (58.73 %). A HV deformity was identified in 32 out of 63 cadaveric feet (50.79 %). The prevalence of the ATEHL was significantly higher in specimens with a HV deformity (26/32, 81.25 %) compared to specimens without a HV deformity (6/32, 18.75 %) (p &lt; 0.001). A positive correlation was found between ATEHL existence and both HVA and IMA degrees (p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>An ATEHL may be found in more than half of individuals. The current cadaveric and radiologic study revealed that ATEHL existence is significantly more common in feet with HV deformity and associated with increased HVA and IMA degrees. Further biomechanical studies are necessary to clarify the ATEHL role on the pathogenesis of HV deformity.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 6","pages":"Pages 381-386"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976479","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":"Feasibility of pancreaticoduodenectomy for octogenarian based on safety and postoperative nutritional recovery","authors":"Naoki Iwanaga,&nbsp;Hiroyuki Sugo,&nbsp;Takeshi Yamamoto,&nbsp;Takuji Noro,&nbsp;Michio Machida,&nbsp;Ikuo Watanobe","doi":"10.1016/j.surge.2025.07.005","DOIUrl":"10.1016/j.surge.2025.07.005","url":null,"abstract":"<div><h3>Background</h3><div>Pancreaticoduodenectomy (PD) for very elderly patients was still controversial. We evaluated the feasibility of PD for octogenarian (patients older than 80 years) from safety and postoperative nutritional changes including body composition.</div></div><div><h3>Methods</h3><div>We included 141 consecutive patients who underwent PD: 24 patients aged ≥80 years were assigned to the octogenarian group, and the remaining 117 were assigned to the non-octogenarian group. Surgical outcomes and the change in postoperative nutritional status (body weight and serum albumin level during 12 months post-surgery) were compared. Among latest 24 patients, the change of body composition was also evaluated using bioelectrical impedance analysis.</div></div><div><h3>Results</h3><div>Preoperatively, the octogenarian group had a significantly lower Katz index score for Activities of Daily Living (<em>P</em> = 0.038), higher incidence of <strong>comorbidities (</strong><em>P</em> &lt; 0.05), lower serum albumin levels (<em>P</em> = 0.033), and lower body weight (<em>P</em> = 0.017) than the non-octogenarian patients; however, the incidence of morbidity and mortality was the same in both groups. Overall survival rates were lower in the octogenarian group, even without significant difference. Multivariate analysis showed that the diagnosis of pancreatic cancer (<em>P</em> = 0.022), the serum albumin level (<em>P</em> = 0.018), and the UICC stage (<em>P</em> = 0.009) were useful to be an independent and significant predictor of overall survival. In assessment of postoperative nutritional status including body composition, the octogenarian group was not inferior compared to the non-octogenarian group.</div></div><div><h3>Conclusions</h3><div>In this study, PD for octogenarian was safe and feasible including nutritional aspects. Although careful patient selection and optimal perioperative care are necessary to consider whether PD is indicated for elderly patients, the advanced age alone should not be an exclusion criterion in considering of PD.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 6","pages":"Pages 365-370"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769152","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":"Are pelvic binders an effective measure to lower mortality and decrease blood loss after high energy pelvic ring injuries? A systematic review","authors":"Andreas Papaleontiou ,&nbsp;Andréa M. Poupard ,&nbsp;Paul Parker","doi":"10.1016/j.surge.2025.08.002","DOIUrl":"10.1016/j.surge.2025.08.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Pelvic binders are routinely used in the pre-hospital management of high energy pelvic ring injuries with a low threshold for utilisation. Current literature is inconclusive regarding the effectiveness of pelvic binders in controlling haemorrhage and decreasing mortality. The aim of this study is to investigate whether using such devices decrease mortality, blood loss, pain and complications.</div></div><div><h3>Method</h3><div>A systematic review was carried out using modern era articles published between January 2016 and May 2024 on two databases, investigating the effectiveness of pelvic binders in trauma patients in decreasing mortality, blood product requirement, pain level and complication rate.</div></div><div><h3>Results</h3><div>Five retrospective cohort studies, one interventional study with retrospective control and one RCT compared early binder application to late/no application and were included for analysis. were included. No clear superiority of pelvic binder application, regarding blood product requirements, mortality, pain and complications was demonstrated. Overall mortality in binder groups was 17.4 % and 15.7 % in the no/late binder groups. Only one study found a statistically significant superiority of pelvic binders regarding mortality when adjusted for confounding variables. Overall patients transfused were 35.6 % in the binder group and 25 % in the no/late binder group. Three out of seven studies reported a significantly lower blood product requirement in pelvic binder groups.</div></div><div><h3>Conclusion</h3><div>There is no clear superiority of early pelvic binder application over no/late binder use. The evidence is limited and lacks larger RCTs. Current widespread use of pelvic binders should be reevaluated, and alternative/adjunct devices should be further investigated for their effectiveness.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 6","pages":"Pages 371-380"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076454","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":"Venous thromboembolism (VTE) prevention in the trauma patient: A national survey of practice","authors":"Bibi Ayesha Bassa ,&nbsp;Michele Fernandes ,&nbsp;Elizabeth Little ,&nbsp;Kaitlin Alexander ,&nbsp;Frank Lyons ,&nbsp;Valeria Lima Passos ,&nbsp;Fionnuala Ni Ainle ,&nbsp;Etimbuk Umana","doi":"10.1016/j.surge.2025.06.001","DOIUrl":"10.1016/j.surge.2025.06.001","url":null,"abstract":"<div><h3>Aim</h3><div>Due to complex injury patterns, the safe timing of venous thromboembolism (VTE) prophylaxis in trauma patients is challenging. The purpose of this study was to characterize current thromboprophylaxis practice in trauma patients amongst trauma providers in Ireland.</div></div><div><h3>Methods</h3><div>We conducted a national, cross-sectional survey of trauma providers. The survey was sponsored by the Irish Network for VTE Research (INViTE) and disseminated through the national trauma and VTE office. The survey was a 35-item questionnaire and collected information regarding non-pharmacologic prophylaxis practice, preferred pharmacologic agent and dose, timing to initiation of prophylaxis in high-risk patients and selection of patients for extended thromboprophylaxis post discharge.</div></div><div><h3>Results</h3><div>A total of 116 trauma providers responded (estimated response rate among surgical specialities 11 %). Majority of respondents (72/116; 65 %) were consultant doctors or fellows. Thirty-seven percent of respondents (43/116) reported having a VTE guideline for trauma patients at their institution. Majority of respondents (115/116; 99 %) reported using some form of mechanical prophylaxis. The most common pharmacologic dosing regimen reported was enoxaparin 40 mg 24-hourly (44/116; 38 %). Forty-four percent of respondents (51/116) indicated adjusting doses in patients with obesity. A high degree of variability in initial timing of prophylaxis following traumatic brain injury, solid organ injury, and spinal column injuries was observed.</div></div><div><h3>Conclusion</h3><div>There is variable VTE prevention practice among trauma providers in Ireland. A standardized, national approach to VTE prevention in trauma care is needed.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 6","pages":"Pages 412-419"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512639","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":"Lumbar decompression surgery for cauda equina syndrome: A meta-analysis and systematic review of the safety of operating out of hours","authors":"Henry A. Crouch-Smith,&nbsp;Iain Feeley,&nbsp;Margaret K. Lee,&nbsp;Nicholas Carleton-Bland,&nbsp;Simon Clark,&nbsp;Matthew Wilby","doi":"10.1016/j.surge.2025.08.003","DOIUrl":"10.1016/j.surge.2025.08.003","url":null,"abstract":"<div><h3>Objectives</h3><div>We conduct a systematic review and meta-analysis of the published literature regarding the impact of performing lumbar decompression for cauda equina syndrome (CES) out of hours compared to regular operating hours.</div></div><div><h3>Methods</h3><div>A search of databases including Medline, EMBASE and Cochrane Library was performed with two independent reviewers per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A senior author arbitrated in event of disagreement. MeSH terms [((cauda equina) OR (CES)) AND ((hours) OR OOH)] were used. Filters including date range (from January 01, 1990 to November 01, 2022) and the English language were applied. Inclusion criteria consisted of retrospective or prospective cohort studies, English or full translation available, surgical complication as primary or secondary outcome and out of hours surgery as an independent variable. Case reports and studies without complication frequency were excluded. There were no additional studies identified through a snowballing secondary search through references of identified articles. Operative metrics were compiled into ad-hoc tables. Statistical analysis was performed using RevMan 5.4. A difference in complication rates with a P value of &lt; .05 was deemed statistically significant. Heterogeneity was reported using I². Study quality was assessed using the Newcastle Ottawa Score (NOS).</div></div><div><h3>Results</h3><div>The search strategy yielded 363 articles. After duplicate removal and application of inclusion/exclusion criteria, 15 studies were sought for retrieval and full text review. Of these, 5 studies were included for qualitative synthesis. Of these, 4 studies underwent quantitative analysis with 581 datasets. Meta-analysis was undertaken on 3 studies comprising 495 datasets. A dichotomous outcome was modelled using the Mantel-Haenszel statistical method with fixed effect which demonstrated an odds ratio (OR) of 2.38 (95 % CI 1.39–4.07) for sustaining an adverse event from out of hours surgery compared to routine operative hours. I² = 12 %, suggesting homogeneity between studies analysed.</div></div><div><h3>Conclusions</h3><div>This study provides clinical evidence that out of hours surgery for lumbar decompression for CES is associated with a higher rate of surgical complications. The spinal surgeon should appropriately counsel the patient with CES that while it is important to do the surgery as soon as possible, operating out of hours carries a higher risk of surgical complications.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 6","pages":"Pages 352-358"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087831","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}