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

{"title":"Reprocessing capabilities of newly approved devices for use in surgery","authors":"Kala T. Pham ,&nbsp;Colby J. Hyland ,&nbsp;Andrew J. Malek ,&nbsp;Justin M. Broyles","doi":"10.1016/j.surge.2024.08.006","DOIUrl":"10.1016/j.surge.2024.08.006","url":null,"abstract":"<div><h3>Introduction</h3><p>Single-use medical devices used in surgery can create environmental waste and increased costs. Reprocessed medical devices may reduce cost and environmental impact. This study investigated the reprocessing capabilities of newly FDA-approved devices in surgery.</p></div><div><h3>Methods</h3><p>Devices were identified using the publicly-available FDA Releasable 510(k) Database from 2018 to 2023 using the instrument product codes for laparoscope, general, and plastic surgery (GCJ); and electrosurgical (GEI) devices. GCJ and GEI devices were categorized based on usage, and the number of devices (total, single, and reprocessed) were extracted. Costs were obtained from public websites.</p></div><div><h3>Results</h3><p>There were 658,510(k) applications for surgical devices, representing 3.8 % (658/16723) of total applications. Reprocessing capabilities existed for 29 % of GCJ devices and 14 % of GEI devices. Among GCJ devices, 5 (56 %) laparoscopy and 16 (38 %) camera devices had reprocessing capabilities. For GEI devices, 7 (50 %) laparoscopic and 5 (50 %) cable devices had reprocessing capabilities. Only one (6 %) tissue ablation device had reprocessing capabilities. The average cost of GCJ and GEI single-use devices ($11314; $8554, respectively) was less than reprocessed counterparts ($17206; $16134, respectively).</p></div><div><h3>Conclusion</h3><p>Reprocessing capabilities for newly approved surgical devices are variable and overall limited. To enhance adoption of reprocessing in surgical practice, future efforts will likely be needed to expand the reprocessing potential of new surgical devices.</p></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 5","pages":"Pages 262-266"},"PeriodicalIF":2.3,"publicationDate":"2024-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142005697","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 and patient outcomes following admission with acute cholecystitis in Ireland: A national registry-based study","authors":"R.M. O'Connell ,&nbsp;N. Hardy ,&nbsp;L. Ward ,&nbsp;F. Hand ,&nbsp;D. Maguire ,&nbsp;A. Stafford ,&nbsp;T.K. Gallagher ,&nbsp;E. Hoti ,&nbsp;A.W. O'Sullivan ,&nbsp;C.B. Ó Súilleabháin ,&nbsp;T. Gall ,&nbsp;G. McEntee ,&nbsp;J. Conneely","doi":"10.1016/j.surge.2024.08.004","DOIUrl":"10.1016/j.surge.2024.08.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute cholecystitis is a common general surgical emergency, accounting for 3–10 % of all patients attending with acute abdominal pain. International guidelines suggest that emergency cholecystectomy is the treatment of choice for uncomplicated acute cholecystitis where feasible. There is a paucity of published data on the uptake of emergency cholecystectomy in Ireland.</div></div><div><h3>Aim</h3><div>The aim of this study was to evaluate the management of acute cholecystitis in Ireland and to establish the rate of emergency cholecystectomy performed.</div></div><div><h3>Methods</h3><div>All patients with acute cholecystitis presenting to public hospitals in Ireland between January 2017 and July 2023 were identified using the National Quality Assurance and Improvement System (NQAIS). Data were collected on patient demographics, co-morbidities, length of stay, operative intervention, endoscopic intervention, critical care admissions, in-patient mortality, and readmissions. Propensity score matched analysis and logistic regression were performed to account for selection bias in comparing patients managed with cholecystectomy and those managed conservatively.</div></div><div><h3>Results</h3><div>20,886 admission episodes were identified involving 17,958 patients. 3585 (20 %) patients underwent emergency cholecystectomy in total. 3436 (96 %) of these were performed laparoscopically, with 140 (4 %) requiring conversion to an open procedure, and common bile duct injuries occurring in 4 (0.1 %) of patients. In comparison to patients treated conservatively, patients who underwent cholecystectomy were younger (median 50 v 60 years, p &lt; 0.001) and more likely to be female (64 % v 55 % p &lt; 0.001). Following propensity score matched analysis, those who had an emergency cholecystectomy had reduced length of stay (LOS) (median 5 days (IQR 3–8) v 6 days (interquartile range (IQR) 3–10), p &lt; 0.001) and fewer readmissions to hospital (282 (8 %) v 492 (14 %), p &lt; 0.001). On logistic regression, age &gt;65 (OR 1.526), CCI &gt;3 (OR 2.281) and non-operative management (OR 1.136) were significant risk factors for adverse outcome.</div></div><div><h3>Conclusion</h3><div>Uptake of emergency cholecystectomy in Ireland remains low, and is carried out on a younger, fitter cohort of patients. In those patients, however, it is associated with improved outcomes for cholecystitis compared to conservative management, including shorter LOS and reduced readmission rates for matched cohorts.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 6","pages":"Pages 364-368"},"PeriodicalIF":2.3,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983690","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":"No significant persistent symptoms from gallstones left in the abdomen after cholecystectomy","authors":"Åsa Edergren ,&nbsp;Gabriel Sandblom ,&nbsp;Henrik Renlund ,&nbsp;Thorhallur Agustsson ,&nbsp;Gona Jaafar","doi":"10.1016/j.surge.2024.08.002","DOIUrl":"10.1016/j.surge.2024.08.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Perforation of the gallbladder during cholecystectomy can lead to spillage of gallstones. The aim of this study was to examine if patients with gallstones left in the abdomen after cholecystectomy suffer persisting symptoms.</div></div><div><h3>Method</h3><div>This study was based on data from the Swedish Register for Gallstone Surgery. Patients with intraoperative gallbladder perforation where it is suspected that gallstones remain in the abdomen were matched with patients that had undergone a cholecystectomy with no suspicion of spilled gallstones. All patients were sent a validated questionnaire including 21 items concerning abdominal pain and inflammatory symptoms. Items were divided into four groups: abdominal pain, consequences of pain, gastrointestinal symptoms, and repeated operation. Mean scores were compared between the study group and the control group using a linear regression model.</div></div><div><h3>Results</h3><div>The questionnaire was sent to 4269 subjects, and the response rate was 66 %. No significant differences were seen between the study and control groups in the four domains. In the repeated operation domain, 7.1 % in the study group and 5.3 % in the control group underwent a repeated operation (p = 0.057).</div></div><div><h3>Conclusion</h3><div>Gallstones left in the abdomen are not associated with long-term symptoms. There was a tendency towards a repeat operation in the group that suffered perforation of the gallbladder, although this finding was not significant.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 6","pages":"Pages 369-372"},"PeriodicalIF":2.3,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989339","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":"Defining minimum work priorities in emergency general surgery in a national cohort","authors":"Tom V. McIntyre ,&nbsp;Paul F. Ridgway","doi":"10.1016/j.surge.2024.08.005","DOIUrl":"10.1016/j.surge.2024.08.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Emergency general surgery is typically delivered in addition to routine elective care. Models such as acute surgical assessment units and reduced elective working have been explored to reduce the conflict between these competing demands. We aim to identify the models used, the cohorts of patients seen, and the staffing levels in each system.</div></div><div><h3>Methods</h3><div>Data on general surgery activities were obtained from the National Quality Assurance and Improvement System (NQAIS) and previously published data. The mode of delivery of acute services in other countries was collated from national surgical bodies and published position statements.</div></div><div><h3>Results</h3><div>National on-call services are supra-elective or parallel to elective streams with little dedicated on-call. Internationally, many similar countries are moving to separate acute and elective care to ensure both are performing optimally. Staff in Model 3 hospitals are frequently on call with variable but small operative numbers but represent a combination of high and low acuity. These consultants need a wider breadth of surgical skills than Model 4 hospitals due to a lack of local specialists.</div></div><div><h3>Conclusion</h3><div>The majority of national hospitals still work a traditional on-call model, with limited adoption of separate on-call and elective workstreams. Preserving the elective workload is likely to require separation of these priorities, which is difficult with current staffing levels. The use of Acute Surgical Assessment Units (ASAUs) within emergency surgical networks may improve patient outcomes by regionalising the delivery of higher acuity care.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 2","pages":"Pages 101-105"},"PeriodicalIF":2.3,"publicationDate":"2024-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972187","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":"The formidable challenges faced by surgeons in war zones","authors":"Rand Y. Omari","doi":"10.1016/j.surge.2024.08.003","DOIUrl":"10.1016/j.surge.2024.08.003","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 5","pages":"Page e188"},"PeriodicalIF":2.3,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914316","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":"Frailty and the incidence of surgical site infection after total hip or knee arthroplasty: A meta-analysis","authors":"Guangjiang Wu ,&nbsp;Can Cui ,&nbsp;Qingkun Song","doi":"10.1016/j.surge.2024.07.008","DOIUrl":"10.1016/j.surge.2024.07.008","url":null,"abstract":"<div><h3>Background</h3><div>Surgical site infection (SSI) remains a critical postoperative complication after total hip and knee arthroplasty (THA and TKA). Frailty, a condition characterized by decreased physiological reserve and increased vulnerability to stressors, may influence the risk of SSI in these patients. This meta-analysis aims to evaluate the association between frailty and the incidence of SSI following THA or TKA.</div></div><div><h3>Methods</h3><div>A systematic search of databases including PubMed, EMBASE, Web of Science, Wanfang, and CNKI was conducted to identify relevant studies. Data were extracted and pooled using a random-effects model to calculate the overall risk ratio (RR) and 95 % confidence intervals (CIs).</div></div><div><h3>Results</h3><div>A total of ten studies comprising 1,036,787 patients met the inclusion criteria. The meta-analysis revealed that frail patients undergoing THA or TKA had a significantly higher risk of developing SSI compared to non-frail patients (RR = 1.64, 95 % CI: 1.39–1.93, p &lt; 0.001, I² = 66 %). Subgroup analyses indicated that the type of arthroplasty (hip vs. knee) and the method of frailty assessment did not significantly alter the association. Further subgroup analysis suggested that frailty was significantly associated with a higher incidence of deep SSI including joint infection (RR = 1.77, 95 % CI: 1.27–1.48, p &lt; 0.001), but not the incidence of superficial SSI (RR = 1.57, 95 % CI: 0.45–5.42, p = 0.48). The association between frailty and SSI remains in subgroup of multivariate studies only (RR = 1.56, 95 % CI: 1.34 to 1.80, p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Frailty is a potential predictor of SSI following TKA/THA.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 6","pages":"Pages e221-e229"},"PeriodicalIF":2.3,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917901","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":"The journey of female surgeons in the arab region: A scoping review","authors":"Amani N. Alansari ,&nbsp;Nour W. Alhussaini ,&nbsp;Usra Elshaikh ,&nbsp;Raed M. Al-Zoubi","doi":"10.1016/j.surge.2024.07.009","DOIUrl":"10.1016/j.surge.2024.07.009","url":null,"abstract":"<div><h3>Background</h3><p>In the Arab region, there's a dearth of research on female surgeons' experiences and challenges. To address this gap, a scoping review aims to map existing literature. It seeks to understand the hurdles faced by female surgeons in Arab countries and examine any gender biases in public preferences for surgeons. No previous reviews were conducted on female surgeons in the Arab region. By identifying systemic barriers, the review aims to promote inclusivity and support for female surgeons in the Arab medical community.</p></div><div><h3>Methods</h3><p>A scoping review was performed and reported using the PRISMA extension for scoping reviews. Five databases were searched which include PubMed, Web of Science, Scopus, Embase, and ProQuest. The search strategy included three main strings that are “Women” AND “Surgeons” AND “Arab Country”. A priori-identified spreadsheet was used for data extraction.</p></div><div><h3>Results</h3><p>A total number of 23 studies were included in this review. The findings were categorized under several headings, such as the general public's preferred gender of surgeon and well-being, challenges, and experiences of female surgeons as well as career perspectives, choices, and satisfaction.</p></div><div><h3>Conclusions</h3><p>This scoping review explores experiences and challenges faced by female surgeons in the Arab region, emphasizing the need to address systemic barriers and promote inclusivity.</p></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 5","pages":"Pages 307-318"},"PeriodicalIF":2.3,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1479666X24000805/pdfft?md5=b6be17c1af2e8f765d6e0525857eaea1&pid=1-s2.0-S1479666X24000805-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898747","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":"Examining the transition from print to electronic journals through the lens of sustainability","authors":"","doi":"10.1016/j.surge.2023.12.003","DOIUrl":"10.1016/j.surge.2023.12.003","url":null,"abstract":"<div><p>This paper presents a comparative analysis of the sustainability aspects between print and electronic journals. A narrative synthesis is presented under the three key areas of environmental impact, social impact, and impact on research practices. Over the past decades, the gradual transition from print to electronic media has facilitated greater global access to academic research, reshaped research methodologies through innovative tools and systems, and arguably, reduced the ecological footprint of academia.</p></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 4","pages":"Pages 209-211"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139510516","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":"Waste management in the operating theatre","authors":"","doi":"10.1016/j.surge.2024.06.004","DOIUrl":"10.1016/j.surge.2024.06.004","url":null,"abstract":"<div><h3>Introduction</h3><p>Poor clinical waste management<span> and its effect on the environment is an increasingly recognised concern for global healthcare systems. Approximately two thirds of waste produced in healthcare is from the operating theatre. In the Republic of Ireland, an estimated 580,977 tonnes of hazardous waste<span> was produced in 2019. The cost of incineration of this hazardous waste is approximately €2,125 per tonne and €935 per tonne for sterilisation. Pollution from incineration is substantial and harmful.</span></span></p></div><div><h3>Methods</h3><p>A literature review was performed on the topic of hospital waste management, specifically looking at the Republic of Ireland. A comparison could then be drawn between Ireland, Europe and the United States of America. Observation of our current operating theatre environment and practices were carried out.</p></div><div><h3>Discussion</h3><p>An increased focus towards sustainability and reusable equipment means that there is potentially a decreased amount of waste for disposal, but an increase in the process of sterilisation. Approximately 66% of healthcare related waste is inappropriately contaminated, meaning that significant savings are possible if correct segregation and recycling were to occur. An increase in the amount of bins, identification labels above bins and education of staff results in an increased likelihood of successful segregation of waste. Clear and concise hospital guidelines of what is considered hazardous versus non-hazardous waste will decrease the amount of inappropriately disposed items.</p></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 4","pages":"Pages 248-252"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141535746","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":"Sustainable orthopaedic surgery: Initiatives to improve our environmental, social and economic impact","authors":"","doi":"10.1016/j.surge.2023.06.005","DOIUrl":"10.1016/j.surge.2023.06.005","url":null,"abstract":"<div><p>In response to appeals from the WHO and The Lancet, a collaborative statement from over 200 medical journals was published in September 2021, advising international governments to combat the “catastrophic harm to health” from climate change. Healthcare, specifically surgery, constitutes a major contributor to environmental harm that remains unaddressed. This article provides practical guidance that can be instituted at a departmental, hospital and national level to institute transformative, sustainable efforts into practice. We also aim to provoke healthcare leaders to discuss policy-making with respect to this issue and highlight the necessity for sustainability to become a core domain of quality improvement.</p><p><span>The average orthopaedic service produces 60% more waste than any other surgical specialty. Fortunately, simple measures such as a comprehensive education programme can decrease waste disposal costs by 20-fold. Other simple and effective “green” measures include integrating carbon literacy into surgical training, prioritising </span>regional anaesthesia<span> and conducting recycling audits. Furthermore, industry must take accountability and be incentivised to limit the use of single-item packaging and single-use items. National policymakers should consider the benefits of reusable implants, reusable surgical drapes and refurbishing crutches as these are proven cost and climate-effective interventions. It is crucial to establish a local sustainability committee to maintain these interventions and to bridge the gap between clinicians, industry and policymakers.</span></p></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 4","pages":"Pages 215-220"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9836651","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}