The British journal of surgery最新文献

{"title":"Second victim syndrome in surgeons: systematic review and meta-analysis of the impact of adverse events on surgeons.","authors":"James Bryan, Adele Ketley, Kate Cavanagh, Carly Bisset, Susan Moug, Lynda Wyld, Jenna Morgan","doi":"10.1093/bjs/znaf258","DOIUrl":"10.1093/bjs/znaf258","url":null,"abstract":"<p><strong>Background: </strong>Second victim syndrome (SVS) is characterized by negative psychological and psychosomatic effects on a healthcare provider after an adverse care event. The aim of this systematic review and meta-analysis was to characterize the symptoms of SVS experienced by surgeons and factors affecting their impact, as well as understand common coping strategies that surgeons employ to deal with them.</p><p><strong>Methods: </strong>A systematic review of five electronic databases was conducted without restrictions on publication date or language in January 2025. Second victim syndrome, surgeon, and adverse event and their synonyms were used as search terms. Records were screened, quality assessed, and data extracted by two independent researchers. Both qualitative and quantitative studies were included and narratively synthesized. A meta-analysis was performed using a random effects model to calculate the overall prevalence rates of symptoms and coping methods.</p><p><strong>Results: </strong>A total of 36 papers were included in the analysis from 6629 retrieved records. Anxiety (56.3% (95% c.i. 45.8% to 66.3%)), guilt (53.8% (95% c.i. 41.3% to 65.8%)), sadness (48.3% (95% c.i. 34.6% to 62.3%)), and sleep disturbance (50.5% (95% c.i. 38.4% to 62.5%)) were the most commonly reported symptoms. Talking to either colleagues (72.5% (95% c.i. 65.6% to 78.4%)) or family/friends (52.0% (95% c.i. 40.6% to 63.2%)) were the most commonly employed coping strategies. The sex and level of experience of the surgeon and the severity of the event were identified as potential predictors of deleterious impact.</p><p><strong>Conclusion: </strong>SVS significantly impacts surgeons' global well-being, leading to burnout and attrition. Effective interventions require a multifaceted approach, including peer support, resilience training, and institutional changes that normalize emotional responses, encourage disclosure, and address barriers to seeking help. Targeted support for at-risk groups may also be necessary.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12777971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919726","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":"Anaphylaxis and perioperative drug reactions.","authors":"Panu Uusalo, Ronja Kuuskoski","doi":"10.1093/bjs/znaf287","DOIUrl":"https://doi.org/10.1093/bjs/znaf287","url":null,"abstract":"","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145879925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance indicators for organ donation and transplantation programmes in Europe: modified Delphi consensus study.","authors":"Simon Streit, George Wharton, Jasmine Mah, Robin van Kessel, Apostolos Prionas, Charlotte Johnston-Webber, John Boletis, Beatriz Domínguez-Gil, Anna Forsberg, Ana França, Dale Gardiner, Patrick Jeurissen, Irene Papanicolas, Oliver Pearcey, Allan Rasmussen, Jacopo Romagnoli, Elias Mossialos, Vassilios Papalois","doi":"10.1093/bjs/znaf293","DOIUrl":"10.1093/bjs/znaf293","url":null,"abstract":"<p><strong>Background: </strong>Health system performance assessment helps identify areas for improvement and guides policy initiatives. Although well-validated indicators exist for measuring organ donation and transplantation performance at the facility level, consensus on indicators for assessing national programmes is lacking. The aim of this study was to develop a comprehensive scorecard for evaluating national organ donation and transplantation programmes.</p><p><strong>Methods: </strong>A three-step approach was used. First, a targeted literature review identified potential indicators from regulatory documents, national transplant organization reports, and databases. Second, indicators were mapped to an established transplant system framework and refined through preliminary expert consultations. Third, a modified Delphi consensus process validated the indicators. The Delphi panel comprised international experts in health policy, organ donation, transplantation, and patient representation. Participants rated 168 indicators using a five-point Likert scale across two rounds (24 experts completed round 1 and 22 experts completed round 2). Consensus for inclusion required 80% agreement.</p><p><strong>Results: </strong>Of 168 indicators evaluated, 103 achieved consensus for inclusion. After consolidation of organ-specific indicators, the final set contained 84 indicators across seven domains: monitoring and reporting (8 indicators), prevention and need (9 indicators), waiting lists (11 indicators), consent (4 indicators), donation (28 indicators), transplantation (14 indicators), and follow-up (10 indicators). The indicator set incorporates established metrics such as waiting list statistics, donation rates, and complication rates alongside novel system-level indicators addressing structural factors, patient-centredness, and equity in care delivery.</p><p><strong>Conclusion: </strong>This validated indicator set provides a standardized tool for assessing and comparing transplant system performance across European countries, supporting performance benchmarking and evidence-informed policy development.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12825608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021280","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":"Health-related quality of life of patients undergoing active surveillance versus standard surgery for oesophageal cancer (SANO trial).","authors":"Sanjiv S G Gangaram Panday, Berend J van der Wilk, Ben M Eyck, Sjoerd M Lagarde, Camiel Rosman, Bo J Noordman, Maria J Valkema, Tanya M Bisseling, Peter-Paul L O Coene, Marc J van Det, Jan W T Dekker, Jolanda M van Dieren, Michail Doukas, Stijn van Esser, W Edward Fiets, Henk H Hartgrink, Joos Heisterkamp, I Lisanne Holster, Olga Husson, Bastiaan Klarenbeek, Eva Kouw, Ewout A Kouwenhoven, Misha D Luyer, Bianca Mostert, Grard A P Nieuwenhuijzen, Liekele E Oostenbrug, Jean-Pierre Pierie, Johanna W van Sandick, Meindert N Sosef, Manon C W Spaander, Ewout W Steyerberg, Roelf Valkema, Edwin S van der Zaag, Hester F Lingsma, David van Klaveren, J Jan B van Lanschot, Bas P L Wijnhoven","doi":"10.1093/bjs/znaf286","DOIUrl":"10.1093/bjs/znaf286","url":null,"abstract":"<p><strong>Background: </strong>The SANO trial demonstrated that active surveillance after neoadjuvant chemoradiotherapy (nCRT) has non-inferior 2-year overall survival compared with standard surgery in patients with locally advanced oesophageal cancer. This aim of this study was to compare health-related quality of life (HRQoL) in both groups.</p><p><strong>Methods: </strong>Patients with a cCR after nCRT were included and randomized within the stepped-wedge cluster-randomized SANO trial to active surveillance or surgery. HRQoL was measured using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30) and the EORTC Quality of Life Questionnaire-Oesophago-Gastric Module (QLQ-OG25) before nCRT (baseline) and at 3 (before surgery), 6, 9, 12, 16, 20, and 24 months after nCRT. Predefined endpoints included dysphagia (QLQ-OG25), as well as dyspnoea, fatigue, physical functioning, and emotional functioning (all QLQ-C30). Repeated measures analysis was used to assess between-group differences. Cohen's d (CD) >0.5 was considered clinically relevant.</p><p><strong>Results: </strong>A total of 274 patients were included, with a response rate of 85.4% (234 patients responded in total; 169 active surveillance patients and 65 standard surgery patients). At 6 months after nCRT, scores for dysphagia, dyspnoea, fatigue, and physical functioning were significantly better in the active surveillance group (CD of -1.09, -0.63, -0.70, and 0.77 respectively; all P ≤ 0.001). Dysphagia remained significantly better in the active surveillance group at 9, 12, and 24 months after nCRT (CD of -0.60 (P = 0.001), -0.46 (P = 0.015), and -0.79 (P < 0.001) respectively). No differences were found for other domains.</p><p><strong>Conclusion: </strong>Active surveillance patients experienced less dysphagia, dyspnoea, and fatigue, as well as better physical functioning, at 6 months after nCRT compared with standard surgery patients. Dysphagia remained improved at 2 years. These results support an active surveillance approach in patients with oesophageal cancer who attain a cCR after nCRT.</p><p><strong>Registration number: </strong>NTR-6803 (Netherlands Trial Register).</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146055904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is the future for the management of thoraco-abdominal aortic aneurysms in the UK?","authors":"Donald Adam, Eshan Senanayake, Paul Clift","doi":"10.1093/bjs/znaf248","DOIUrl":"https://doi.org/10.1093/bjs/znaf248","url":null,"abstract":"","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146055868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Open thoracoabdominal aortic aneurysm repair: results from a national service.","authors":"Allison C Winarski, Rachael O Forsythe, Ian J Young, Keegan Chua, Mysoon Alabdah, Euan McGregor, Russell W Jamieson, Andrew L Tambyraja, Roderick T A Chalmers, Orwa Falah","doi":"10.1093/bjs/znaf184","DOIUrl":"10.1093/bjs/znaf184","url":null,"abstract":"<p><strong>Background: </strong>Open surgery is a durable approach to thoracoabdominal aortic aneurysm (TAAA) repair. It carries a substantial risk of major perioperative complications, including death. The aim of this study was to describe the outcomes of open repairs undertaken by the Scottish National TAAA Service since its inception 25 years ago.</p><p><strong>Methods: </strong>Procedural details and clinical outcomes of all open TAAA repairs between 1999 and 2023 were reviewed. The primary outcome was in-hospital mortality, with secondary outcomes including overall and aneurysm-related survival, as well as rates of permanent spinal cord ischaemia (SCI), renal replacement therapy, and other major operative complications. Survival of patients requiring a thoracolaparotomy (Crawford extent I-III and V repair) versus that of patients requiring a laparotomy (Crawford extent IV repair) was assessed using Kaplan-Meier analysis.</p><p><strong>Results: </strong>Of 424 patients (mean(s.d.) age 65.86(10.86) years, mean(s.d.) aneurysm diameter 63.89(17.52) mm, 5.7% with a connective tissue disorder, and 72.8% male), 148 patients underwent thoracolaparotomy and 276 underwent laparotomy. While 4.5% of operations were for ruptures, most (297 (70.0%)) were for asymptomatic TAAAs. Elective and overall in-hospital mortality were 10.1% and 13.4% respectively. Patients who underwent repair requiring a thoracolaparotomy (148 patients) were younger (mean age 59.7 years versus 69.1 years; P < 0.001), had higher 30-day mortality (23.6% versus 6.5%; P < 0.001), and had a higher rate of permanent SCI (8.8% versus 0.7%; P < 0.001) compared with those who underwent repair requiring a laparotomy. Patients who underwent extent II repairs had the highest overall and elective 30-day mortality (30.2% and 26.6% respectively) and had the highest rate of permanent SCI (14.3%). The estimated overall 5-year survival was 68.3% and the estimated elective 5-year survival was 70.2%, 67.5%, and 71.3% for the entire cohort, the extent I-III and V cohort, and the extent IV cohort respectively.</p><p><strong>Conclusion: </strong>Open TAAA repair is associated with significant operative risk, which varies depending on the extent of aneurysm repair.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146055877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parallel Endografting And Chimney Endovascular (PEACE) registry outcomes in emergency repair of complex abdominal aortic aneurysms.","authors":"Angelos Karelis, Donald Adam, Michele Piazza, Giovanni Tinelli, Enrico Gallito, Miltiadis Matsagkas, Barend Mees, Kevin Mani, Mario D'Oria, Wassim Mansour, Enrico Cieri, Tilo Kölbel, Björn Sonesson, Nuno V Dias","doi":"10.1093/bjs/znaf278","DOIUrl":"10.1093/bjs/znaf278","url":null,"abstract":"<p><strong>Background: </strong>Chimney endovascular aneurysm repair (chEVAR) techniques have been described to manage a group of patients who are unsuitable for either open aortic aneurysm surgery or a variety of standard endovascular repair techniques. The aim of this study was to assess the long-term clinical outcomes of chEVAR in emergency settings for patients with abdominal aortic aneurysms that have complex morphology.</p><p><strong>Methods: </strong>This was a multicentre retrospective study that included all consecutive patients undergoing urgent chEVAR with at least one chimney/parallel graft up to June 2021. Outcomes that were captured included 30-day mortality, long-term overall survival, aneurysm-related mortality, chimney-related complications, and target vessel patency.</p><p><strong>Results: </strong>Some 118 patients (mean(s.d.) age of 77(8) years; 72.0% male) underwent urgent or emergency chEVAR, 78 (66.1%) due to aortic rupture. The mean(s.d.) number of chimneys used per patient was 1.6(0.7). Technical success was achieved in 90.6% of patients, with a 30-day mortality rate of 17.7%. The mean follow-up was 4(3) years. Estimated overall survival was 69 ± 5% at 3 years, 45 ± 6% at 5 years, and 32 ± 6% at 7 years. Freedom from aneurysm-related mortality was 58 ± 6% at 5 years and 53 ± 6% at 7 years. In patients surviving the perioperative 30-day interval, freedom from aneurysm-related mortality was 73 ± 6% at 5 years and 66 ± 7% at 7 years. Primary target vessel patency at 5 and 7 years was 87 ± 4%, with renal arteries most frequently affected. Late reinterventions occurred in 16.1% of patients, mostly for type Ia endoleaks (8 of 25 reinterventions (32%)) and type Ib endoleaks (5 of 25 reinterventions (20%)).</p><p><strong>Conclusion: </strong>In this Parallel Endografting And Chimney Endovascular (PEACE) registry study, chEVAR was associated with a high rate of technical success and acceptable early outcomes, but, in the longer term, was associated with high rates of reintervention and mortality. It appears to represent a reasonable alternative technique for patients presenting as an emergency with complex aortic aneurysm morphology when standard open and endovascular techniques are not feasible.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12750328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145859790","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":"Neocolonialism: should it concern surgeons?","authors":"Rennie Qin, Desmond T Jumbam, Nobhojit Roy","doi":"10.1093/bjs/znaf203","DOIUrl":"10.1093/bjs/znaf203","url":null,"abstract":"<p><p>Global health that addresses the burden of surgical care, particularly in low- and middle-income countries (LMICs), is a simple definition of 'global surgery'. In recent years, researchers and global health practitioners, particularly those from LMICs, have drawn attention to the inequitable practices, reminiscent of colonial medicine and tropical medicine, that persist within global health. Herein, the concept of neocolonialism in global surgery is introduced and suggestions for how to approach global surgery in more equitable and inclusive ways are provided. Surgical care delivery through short-term surgical missions has faced challenges in providing high-quality surgical care with limited follow-up and sustainability. Similarly, skills gained in short-term training programmes may be misaligned with the disease burden of communities. In the context of surgical training, surgeons from colonized lands have historically travelled to high-income countries (HICs) to have their local experience validated through European or North American examinations. The master craftsman/trainer guild model remains in many parts of the world and is expensive and designed for the replacement of the workforce in HICs. It is also the rate-limiting factor for scaling up surgical education to address exponential population growth and the unmet need for surgery in LMICs. Global North domination of knowledge around national surgical plans (NSPs) and policy development has several negative consequences. The NSP development process needs to be bottom-up with wide stakeholder involvement for developing shorter-term, more focused plans to galvanize stakeholders.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"112 Supplement_15","pages":"xv30-xv34"},"PeriodicalIF":8.8,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145717144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative cardiac arrest.","authors":"Richard A Armstrong, Jasmeet Soar","doi":"10.1093/bjs/znaf262","DOIUrl":"10.1093/bjs/znaf262","url":null,"abstract":"","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"112 12","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12667257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145650747","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":"Global benchmarks for minimally invasive right hemicolectomy for cancer.","authors":"Fariba Abbassi, Michaela Ramser, Matthias Pfister, Roxane D Staiger, Sun J Kim, Ji W Park, Bart C T van de Laar, Marcos Gonzalez, Vittoria Perano, Georgette Camilleri, David Merino, Justin Dourado, Anjelli Wignakumar, Kohei Shigeta, Tomás Mansur Duarte de Miranda Marques, Daniel Leonard, Kai-Yin Lee, Avanish Saklani, Kilian G M Brown, Fabio Butti, Ivana Raguz, Carlo Alberto Schena, Daichi Kitaguchi, Desmond C Winter, Masaaki Ito, Nicola de'Angelis, Dieter Hahnloser, Jennifer Vu, Ashwin Desouza, Bei-En Siew, Ker-Kan Tan, Alex Kartheuser, Samuel Aguiar, Koji Okabayashi, Carl J Brown, Steven Wexner, Sebastiano Biondo, Danilo Miskovic, Antonino Spinelli, Carlos A Vaccaro, Esther C J Consten, Byung S Min, Milo A Puhan, Matthias Turina","doi":"10.1093/bjs/znaf259","DOIUrl":"10.1093/bjs/znaf259","url":null,"abstract":"","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"112 12","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12706472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145764974","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}