Surgery in practice and science最新文献

{"title":"Surgical site infection reduction bundle in stoma closure: A retrospective cohort study","authors":"Kentaro Goto ,&nbsp;Ryo Matsusue ,&nbsp;Kanako Degawa ,&nbsp;Akimori Miki ,&nbsp;Hiroki Nakanishi ,&nbsp;Hiroaki Hata ,&nbsp;Masato Narita ,&nbsp;Takashi Yamaguchi","doi":"10.1016/j.sipas.2025.100277","DOIUrl":"10.1016/j.sipas.2025.100277","url":null,"abstract":"<div><h3>Introduction</h3><div>Advances in minimally invasive surgeries and pre-operative treatments allow the preservation of anal function through lower anastomosis in patients with rectal cancer, often necessitating temporary diverting stomas owing to the risk of anastomotic leakage. Stoma closure is associated with a high rate of surgical site infections (SSIs). Various measures, including purse-string skin sutures and negative-pressure wound therapy, have been implemented, and some guidelines recommend purse-string skin sutures as the standard method of stoma closure. However, at our institution, we used linear skin closure with an SSI reduction bundle. This study describes our stoma closure method and retrospectively analyses surgical outcomes.</div></div><div><h3>Materials and Methods</h3><div>This retrospective study included patients aged ≥ 20 years who underwent loop stoma closure using linear skin sutures at our institution between January 2006 and March 2021. Our protocol emphasises the following: (1) pre-operative oral anti-microbials, (2) a surgical technique that distinctly separates clean and contaminated regions, and (3) wound closure to eliminate dead space. We evaluated the surgical outcomes, including the incidence of SSIs and other post-operative complications.</div></div><div><h3>Results</h3><div>Ninety-two patients (53 men, 39 women; mean age, 59.4 years) underwent loop stoma closure. SSIs occurred in two patients (2.2%). No risk factors for SSIs were identified.</div></div><div><h3>Conclusion</h3><div>In our department, the incidence of SSIs after linear skin closure of stomas was low. Adherence to proper infection prevention practices can effectively mitigate SSIs, even with linear skin closure.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"20 ","pages":"Article 100277"},"PeriodicalIF":0.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520618","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":"Simultaneous radical cystectomy and nephroureterectomy: A case series","authors":"Gavin G. Calpin ,&nbsp;Steven M. Anderson ,&nbsp;Mark Broe ,&nbsp;Ijaz Cheema ,&nbsp;Niall F. Davis ,&nbsp;Dilly Little","doi":"10.1016/j.sipas.2025.100276","DOIUrl":"10.1016/j.sipas.2025.100276","url":null,"abstract":"<div><h3>Introduction</h3><div>Simultaneous radical cystectomy and nephroureterectomy (RCNU) is a complex procedure. Although performed infrequently, RCNU may be indicated in certain cases of multifocal high grade urothelial carcinoma (UC) or muscle-invasive bladder cancer (MIBC) with an obstructed and atrophic kidney. The aim of this study was to review the indications, operative approach and outcomes for patients undergoing RCNU in our institution.</div></div><div><h3>Methods</h3><div>A single-centre, retrospective review was performed. Cases were identified by reviewing theatre logbooks. Chart reviews were conducted and clinicopathological outcomes were recorded and analysed.</div></div><div><h3>Results</h3><div>Eight patients were identified between 2015–2024. All were male and had a mean age of 66.4 ± 4.7 years. All patients underwent RCNU with ileal conduit formation. The surgical approach for the nephroureterectomy was laparoscopic in four cases and open in the remaining four. The mean post-operative length of stay was 11.6 ± 1.75 days. All patients had high grade UC, seven patients had MIBC at presentation. Only two patients received neoadjuvant chemotherapy, one of whom achieved a complete pathological response. In total, 62.5% (n=5) had T3/4 disease while 50% (n=4) had node positive disease. Two patients had synchronous upper tract urothelial carcinoma (UTUC) on final histology. The remaining cases had chronically obstructed and atrophic kidneys. Incidental primary prostate cancer was found in 62.5% (n=5). The mean follow-up was 31.6 ± 7 months, during which time there were four recurrences with three patients dying from metastatic disease. The mean overall survival was 21.8 ± 11.8 months and the mean disease-free survival was 19.3 ± 12.3 months.</div></div><div><h3>Conclusion</h3><div>The results from this study demonstrate that combined laparoscopic and open RCNU is an effective treatment for both panurothelial cancer and MIBC with severe upper tract dysfunction.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"21 ","pages":"Article 100276"},"PeriodicalIF":0.6,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143548014","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":"Disparities in the expansion of telemedicine in pediatric specialty care through the COVID-19 pandemic and beyond","authors":"Monalisa Attif Hassan,&nbsp;Jeffrey Fine,&nbsp;Kathleen Doyle,&nbsp;Emily Byrd,&nbsp;Minna M. Wieck","doi":"10.1016/j.sipas.2025.100275","DOIUrl":"10.1016/j.sipas.2025.100275","url":null,"abstract":"<div><h3>Introduction</h3><div>The COVID-19 pandemic resulted in the rapid expansion of telemedicine, including in specialties traditionally dependent on physical exams, such as pediatric surgery. Trends in its utilization as in-person visits resumed are not well understood, nor is its effect on mitigating disparities related to social determinants of health (SDOH). We hypothesize that telemedicine utilization increased after the pandemic and has remained higher compared to pre-pandemic levels. Additionally, we hypothesize that increased telemedicine use has contributed to lower no-show rates and more equitable access to care.</div></div><div><h3>Methods</h3><div>A retrospective cohort analysis was conducted of all outpatient visits at a single outpatient pediatric surgery clinic at a quaternary academic center from 01/02/2018 to 10/26/2022. Clinical variables extracted included demographic data, no-show rate (patient did not attend scheduled appointment), and visit type (in person vs telemedicine). Geocoded census data was used to determine SDOH variables such as internet and computer access. A mixed effect logistic regression model was performed to identify which variables were associated with differences in telemedicine usage.</div></div><div><h3>Results</h3><div>6339 encounters for 2735 patients were analyzed. Odds of presenting to a scheduled telemedicine visit compared to an in-person visit was 0.76 (CI 0.63-0.91, p-value &lt; 0.01). The odds of selecting a telemedicine visit decreased by 34 % for Spanish speakers and 63 % for ‘other’ language speakers compared to English speakers (p-value &lt; 0.01). The odds of choosing a telemedicine visit also decreased by 4 % for every one-unit increase in the probability of having access to the internet (p &lt; 0.01). There was no significant difference in the odds of choosing a telemedicine visit for insurance status, age, distance, or probability of having access to a computer.</div></div><div><h3>Discussion</h3><div>Telemedicine continues to be utilized at higher rates compared to pre-pandemic levels, but does not reduce no-show rates, which may reflect limits in its clinical utility. It is used less frequently by non-English speakers, which may contribute to ongoing disparities in access to specialty pediatric care.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"20 ","pages":"Article 100275"},"PeriodicalIF":0.6,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143421258","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":"Computed tomography in initially unstable thoracoabdominal trauma can safely enhance triage","authors":"Anna White ,&nbsp;Lindsey Loss ,&nbsp;John Carney ,&nbsp;Christopher Barrett ,&nbsp;Kazuhide Matsushima ,&nbsp;Kenji Inaba ,&nbsp;Aaron Strumwasser ,&nbsp;Reynold Henry","doi":"10.1016/j.sipas.2025.100274","DOIUrl":"10.1016/j.sipas.2025.100274","url":null,"abstract":"<div><h3>Introduction</h3><div>Computed tomography (CT) imaging of hemodynamically abnormal trauma patients undergoing aggressive resuscitation is controversial. Our study investigated outcomes for hemodynamically abnormal thoracoabdominal trauma undergoing CT prior to definitive therapy.</div></div><div><h3>Methods</h3><div>Hemodynamically abnormal (HR≥120 bpm, SBP&lt;90 mmHg) patients arriving to our Level I trauma center between 2015 and 2022 were reviewed. Patients with thoracoabdominal trauma achieving hemodynamic improvement (SBP≥90 mmHg) were included. Pediatric patients, pregnant patients, and traumatic arrests were excluded. After matching for baseline characteristics, CT findings, and operative details, clinical outcomes were tabulated. Primary outcomes included hospital length of stay (HLOS), intensive care unit length of stay (ICU LOS), ventilator days and mortality. Secondary outcomes included intraoperative data, transfusions, additional procedures, and complications</div></div><div><h3>Results</h3><div>A total of 235 patients met inclusion criteria. Thirty-six (15 %) were triaged directly to the OR while 199 (85 %) went to CT. The CT and OR groups were matched for injury burden (mean ISS OR group=21±2.6 vs. CT group=18.4 ± 0.8, <em>p</em> = 0.24). Overall, no difference in HLOS (<em>p</em> = 0.3), ICU LOS (<em>p</em> = 0.9), time on ventilator (<em>p</em> = 0.4) or mortality (<em>p</em> = 0.5) was observed. Patients undergoing CT needed less PRBCs (9.0 ± 2.6 vs. 3.4 ± 0.7 units) and FFP (5.1 ± 1.9 vs. 1.6 ± 0.4 units). The OR group patients had a higher probability of needing to undergo additional procedures (36 % vs. 12 %).</div></div><div><h3>Conclusion</h3><div>Hemodynamically abnormal thoracoabdominal trauma patients who are resuscitated to a SBP≥90 mmHg can safely undergo CT prior to definitive therapy.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"20 ","pages":"Article 100274"},"PeriodicalIF":0.6,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143421257","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":"Costs of surgical futility in emergency laparotomy","authors":"C.L. Downey,&nbsp;D.G. Jayne","doi":"10.1016/j.sipas.2025.100273","DOIUrl":"10.1016/j.sipas.2025.100273","url":null,"abstract":"<div><h3>Background</h3><div>Surgical futility has been defined as death within 72 h of emergency laparotomy. It is associated with patient distress, moral injury and opportunity costs. This study aimed to determine the rates of surgical futility after emergency laparotomy at a single high-volume centre, and to attribute costs to cases of surgical futility.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted between 1st August 2021 and 1st August 2023 at a single high-volume acute hospital trust in the United Kingdom. A national patient-level costings system was used to determine the costs of hospital care from the day of surgery to the time of death.</div></div><div><h3>Results</h3><div>In a cohort of 741 patients, there was a 3.6 % surgical futility rate. Most of these patients died within 24 h of surgery. The median total cost of admission for each patient was £14,118 (range £6,618 to £29,583). The median cost per day of admission was £6,004 (range £1,324 to £15,255).</div></div><div><h3>Conclusion</h3><div>This is the first study to report the costs of surgical futility in the emergency laparotomy setting. Futile surgery appears to cost more and require more resource than non-futile laparotomies. Further research should focus on how to better predict surgical futility, reduce inappropriate interventions and improve patient care.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"20 ","pages":"Article 100273"},"PeriodicalIF":0.6,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143262682","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":"Respiratory dysfunction in whiplash associated disorders (WAD) with cervical plexus syndrome – A case report","authors":"NA Nystrom ,&nbsp;SR Daulat ,&nbsp;A Zakaria ,&nbsp;M Petersen ,&nbsp;VM Moodley ,&nbsp;LP. Champagne","doi":"10.1016/j.sipas.2025.100271","DOIUrl":"10.1016/j.sipas.2025.100271","url":null,"abstract":"<div><div>Whiplash Associated Disorders (WAD) represents a chronic post-traumatic pain syndrome from indirect flexion-extension trauma to the neck. The condition exhibits significant variability among affected individuals and can involve numerous secondary symptoms, including but not limited to myalgia, central sensitization, migraines, photophobia, jaw pain, dysphagia, joint stiffness, and tinnitus, while significant breathing problems are not commonly associated with or prominently considered in WAD.</div><div>Herein, we present the diagnosis and successful surgical treatment of severe respiratory dysfunction and staccato speech in a patient with WAD, who over a period of more than ten years underwent multiple spirometry evaluations for breathing difficulties that correlated with the severity of neck pain. In 2019, his condition deteriorated, with significantly increased pain and dyspnea leading to further evaluations that included laboratory studies and consultations with specialists in neurosurgery, neurology, pulmonology, neurophysiology, ENT, general internal medicine, cardiology, radiology, speech pathology, physical medicine, orthopedic surgery, and hand surgery at three separate academic centers in Norway.</div><div>Eventually, the patient was diagnosed with a condition that is regularly observed among patients referred to our office for evaluation and surgical treatment of chronic, whiplash related pain, and that we propose to label Cervical Plexus Syndrome.</div><div>One year following exploration and neurolysis of sensory nerves to the right and left superficial cervical plexus, the patient remains pain free, with unimpeded speech and breathing as demonstrated by postoperative spirometry and video recordings.</div><div>Although the underlying pathophysiology remains unclear, we report what we believe to be the first successful surgical treatment of serious respiratory dysfunction from pain generators in tissue that historically is considered anatomically and functionally separate from the mechanics of breathing. Further investigation will be needed to determine prevalence of respiratory dysfunction in chronic neck pain.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"20 ","pages":"Article 100271"},"PeriodicalIF":0.6,"publicationDate":"2025-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143162861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical sharp debridement alongside maggot debridement therapy (MDT) for the treatment of diabetic foot ulcers (DFUs): A systematic review of case reports","authors":"Babak Choobi Anzali ,&nbsp;Anna Javanbakht ,&nbsp;Maryam Rasouli ,&nbsp;Nasim Talebiazar ,&nbsp;Milad Hashemzadeh ,&nbsp;Mir Amir Hossein Seyed Nazari","doi":"10.1016/j.sipas.2024.100270","DOIUrl":"10.1016/j.sipas.2024.100270","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of this systematic review of case reports is to evaluate the efficacy and safety of combining surgical sharp debridement with maggot debridement therapy (MDT) for the treatment of diabetic foot ulcers (DFUs).</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted across multiple databases, including PubMed, Embase, Cochrane Library, and Web of Science. Inclusion criteria were studies that reported on the use of surgical sharp debridement alongside MDT for DFUs, while exclusion criteria included insufficient detail on treatment methods or patient outcomes, non-human studies, and non-English publications. Data were extracted using a standardized form, and the quality of case reports was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports. A narrative synthesis was conducted due to the anticipated heterogeneity of the case reports, and a sensitivity analysis was performed to assess the robustness of the findings.</div></div><div><h3>Results</h3><div>The review process began with 1003 records, which were narrowed down to 721 unique records after removing duplicates. Following title and abstract screening, and full-text assessment, 8 studies were selected for inclusion in the final analysis. The narrative synthesis identified several key findings, including significant wound size reduction, improved glycemic control, disappearance of foul odor, improved healing rates, infection control, granulation tissue formation, epithelialization, complete wound closure, avoidance of amputation, and pain alleviation. The combination therapy showed promise in managing DFUs effectively.</div></div><div><h3>Conclusion</h3><div>The systematic review of case reports presents evidence supporting the combined use of surgical sharp debridement and maggot debridement therapy in the management of diabetic foot ulcers. The findings suggest that this approach can lead to successful wound healing and limb preservation, offering a valuable addition to the clinician's toolkit for treating DFUs.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"20 ","pages":"Article 100270"},"PeriodicalIF":0.6,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025998","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":"Is there an impact of surgeon's experience on in-hospital outcome in patients with operatively treated proximal humerus and humerus shaft fractures?","authors":"Andrew Adams ,&nbsp;Christina Lorenz ,&nbsp;Valentin Neuhaus ,&nbsp;Hans-Christoph Pape ,&nbsp;Claudio Canal","doi":"10.1016/j.sipas.2024.100269","DOIUrl":"10.1016/j.sipas.2024.100269","url":null,"abstract":"<div><h3>Background</h3><div>Proximal humerus and shaft fractures are common, comprising 10–11 % of all fractures. Progress in their management includes refined surgical techniques and implants, coupled with a deeper understanding of fracture patterns.</div></div><div><h3>Aims</h3><div>This study examines the effect of surgical education on in-hospital outcomes for operatively treated proximal and humerus shaft fractures, aiming to enhance patient care and results.</div></div><div><h3>Material and Methods</h3><div>This study analyzed cases from 1st of January 2010 until the 31st of December 2021 using data extracted from the Swiss working group for quality assurance in surgery, including patients with proximal humerus and shaft fractures who underwent surgical procedures like open reduction with internal fixation (ORIF), closed reduction with internal fixation (CRIF), external fixation, or prosthesis. Analysis included patient demographics, procedure details, and outcomes, comparing those with and without teaching of the surgical procedures. Binary logistic regression identified risk factors, with statistical significance set at <em>p</em> = 0.001.</div></div><div><h3>Results</h3><div>A total of 6,654 patients were analyzed. Most were treated with ORIF (74 %) or CRIF (17 %). The average hospital stay was 6.5 days. Teaching surgeries, comprising 5.4 % of all procedures, were more common among patients with fewer comorbidities and with public insurance coverage. These surgeries took slightly longer to perform compared to non-teaching cases (120±65 min vs. 113±60 min, <em>p</em>= &lt;0.001). Public insurance coverage, absence of comorbidities, and certain surgical procedures (CRIF and ORIF vs. prosthesis) were associated with surgery being a teaching case. Complications occurred in 8 % of patients, with no significant difference between teaching and non-teaching groups. Predictors of complications included higher American Society of Anesthesiologists-score, antibiotic use, anticoagulation therapy, fracture of shaft, higher age, and longer surgery duration.</div></div><div><h3>Conclusions</h3><div>Educational status did not affect in-hospital mortality and morbidity in patients with a operatively treated shaft or proximal humeral fracture. However, teaching was an independent predictor of a prolonged duration of surgery. Despite the significant differences, the clinical outcome was comparable in both groups, therefore substantiating the advantages of teaching operations for both patient safety and resident education. They combine the competence of experienced surgeons with the training of residents, whilst ensuring the safety through oversight and best practices. Not only does this environment improve patient outcomes, but also provides residents with hands-on experience, thus helping them make critical decisions, building confidence and developing essential skills.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"20 ","pages":"Article 100269"},"PeriodicalIF":0.6,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11750012/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025966","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":"Operating room times differ for surgical fixation of metacarpal fractures: An analysis of two principally different techniques","authors":"Sohail R. Daulat ,&nbsp;Viashen Moodley ,&nbsp;Carina Ho ,&nbsp;Michael Mazarei ,&nbsp;Cina Karodeh ,&nbsp;Nils A. Nystrom ,&nbsp;Lloyd P. Champagne","doi":"10.1016/j.sipas.2024.100266","DOIUrl":"10.1016/j.sipas.2024.100266","url":null,"abstract":"<div><h3>Introduction</h3><div>Time spent in the operating room (OR) has ramifications that impact patient outcomes and the economics of patients, physicians, surgery centers, and insurance industry. For that reason, there is an incentive to seek approaches that allow shorter times to be spent in the OR. To what extent varying routine techniques impact on operating times has not been extensively studied in metacarpal fixation literature, specifically investigating retrograde threaded intramedullary nail fixations (RTNF) and comparing it to open plating fixations (OPF). The present study was designed for the purpose of comparing OR times for different but broadly adopted techniques for internal stabilization of metacarpal shaft fractures.</div></div><div><h3>Methods</h3><div>A retrospective chart review was conducted for patients aged 18 and above, who over a 41-month period underwent internal fixation with RTNF or OPF for single, extra articular, closed fractures of the index through little finger metacarpals. We examined anesthesia records, which indicated total operating (“skin-to-skin”) times.</div></div><div><h3>Results</h3><div>A total of 81 charts remained for review after exclusions. Statistical analysis of the recorded data showed significantly shorter median OR time values for RTNF (17 minutes, IQR = 14 – 20.75) vs. OPF (36 minutes, IQR = 31.55 – 44; p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Statistical analysis of data shows significantly shorter operating times to achieve satisfactory fracture stabilization using RTNF compared to OPF. Since the differences in OR time significantly differ between the two principally different surgical techniques, it should be considered when choosing which surgical technique to use. However, further review of indications and clinical outcomes is necessary to develop definitive recommendations or guidelines on which technique should be preferred, especially when considering specific patient presentations.</div></div><div><h3>Level of Evidence</h3><div>Retrospective Comparative Study III</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"20 ","pages":"Article 100266"},"PeriodicalIF":0.6,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025994","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":"The CRP/PAB ratio outperforms the LRINEC score in early diagnosis of Fournier's gangrene","authors":"Jin-Liang Zhu,&nbsp;Hong-Jian Gao,&nbsp;Zhi-Tao Yin","doi":"10.1016/j.sipas.2024.100267","DOIUrl":"10.1016/j.sipas.2024.100267","url":null,"abstract":"<div><h3>Background</h3><div>Fournier's gangrene (FG) is scarce and potentially fatal disease. Although the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score was established in 2004, its reliability as a diagnostic tool to differentiate between FG and perianal abscess is still debated. The objective of this study was to assess the reliability of the LRINEC score and other relevant inflammatory markers. The diagnostic effectiveness of these inflammatory factors was evaluated and compared.</div></div><div><h3>Methods</h3><div>Retrospective observational study of patients with FG or with perianal abscess. Fifty-two patients with FG and 39 patients with perianal abscess treated in Shenyang Coloproctology Hospital between January 2019 and December 2023 were enrolled in the study.</div></div><div><h3>Results</h3><div>The area under the ROC curve (C-statistic) of a LRINEC score ≥6 for diagnosing FG was 0.736. Inflammatory markers, including C-reactive protein (CRP), procalcitonin (PCT), prealbumin (PAB), neutrophil-to-lymphocyte ratio (NLR), and systemic immune inflammation index (SII), demonstrated better diagnostic ability compared to the LRINEC score. Particularly, the compound inflammatory factor of CRP-to-PAB (CRP/PAB) ratio exhibited superior diagnostic ability compared to other markers (C-statistic: 0.908; <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>The LRINEC score demonstrated only modest discriminative performance in this study. Patients with PAB&lt; 91mg/L and a CRP/PAB≥ 1.52 should undergo careful evaluation for the presence of FG. The elevated CRP/PAB ratio is considered an early indicator for FG, particularly in distinguishing it from deep perianal abscesses. Further investigation is warranted in future studies to support these findings.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"19 ","pages":"Article 100267"},"PeriodicalIF":0.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025964","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}