Surgery in practice and science最新文献

{"title":"Preoperative waiting time and outcomes of non-traumatic emergency abdominal surgeries: Insights from a zonal referral hospital in northern Tanzania, a reference for health centers with similar capacities","authors":"Godfrey M. Mchele ,&nbsp;Ally H. Mwanga ,&nbsp;Daniel W. Kitua ,&nbsp;Samwel Chugulu","doi":"10.1016/j.sipas.2023.100202","DOIUrl":"10.1016/j.sipas.2023.100202","url":null,"abstract":"<div><h3>Background</h3><p>Non-traumatic emergency abdominal surgeries are common in most healthcare settings. To a significant extent, the outcomes of treatment are determined by the promptness of surgical interventions. However, the in-hospital waiting time which reflects perioperative promptness remains largely unexplored in developing countries.</p></div><div><h3>Objective</h3><p>To describe the preoperative waiting time, identify the causes of delays, and determine subsequent outcomes for non-traumatic emergency abdominal surgeries.</p></div><div><h3>Methods</h3><p>A cross-sectional study was conducted at a consultant zonal hospital in northern Tanzania from September 2012 to March 2013. Patients admitted and surgically treated for non-traumatic acute abdominal conditions were consecutively sampled. Sociodemographic and clinical data were obtained from medical records. Delays in surgical interventions were assessed based on observations at the Emergency Department and record analysis. Descriptive statistics and regression analysis were used to summarize the data and assess for factors influencing post-operative outcomes, respectively.</p></div><div><h3>Results</h3><p>The study included 111 participants with a median age of 29 years (IQR=18-53). The median in-hospital preoperative waiting was 10.5 hours (IQR=6.6-14.7), with a substantial majority (78.4%) experiencing delays beyond 6 hours. The frequent reasons for delayed surgery included personnel shortage (37.8%), unavailable theater space (31.5%), and investigation-related factors (28.8%). Delayed hospital presentation (symptoms ≥24 hours) (OR=3.9, 95% CI=1.0-14.9) and prolonged waiting time (&gt;6 hours) (OR=2.7, 95% CI=1.0-7.2) were significantly associated (<em>P</em> &lt; 0.05) with in-hospital complications that included wound dehiscence (0.9%), re-operation (3.6%), surgical site infection (18.0%), and complications necessitating Intensive Care Unit admission (36.9%). The in-hospital operative mortality rate was 18.0%. Age of ≤40 years (OR=0.1, 95% CI=0.04-0.4) and ASA-PS class I-II (OR=0.1, 95% CI=0.0-0.3) were identified as significant (<em>P</em> &lt; 0.001) protective factors against operative mortality.</p></div><div><h3>Conclusion</h3><p>These benchmark findings highlight the multifactorial nature of the reasons for delayed surgical interventions and its association with postoperative complications; offering a potential avenue to enhance surgical efficiency in the index and comparable settings.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100202"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46335749","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":"Evaluation of long-term oncological outcomes of inter-sphincter resection compared with abdominoperineal resection for treatment of ultra-low rectal cancers: a single center 5-year experience","authors":"FakhroSadat Anaraki ,&nbsp;Mahdi Alemrajabi ,&nbsp;Ramin Shekouhi ,&nbsp;Maryam Sohooli ,&nbsp;Seyed-Ali Sabz","doi":"10.1016/j.sipas.2023.100191","DOIUrl":"10.1016/j.sipas.2023.100191","url":null,"abstract":"<div><h3>Objectives</h3><p>Abdominoperineal resection (APR) is considered the gold standard surgical treatment for ultra-low rectal cancer. Anus-preserving alternative procedures have been tested to avoid the need for a permanent colostomy. The present study compares the functional and oncological outcomes of the traditional APR methods with inter-sphincteric resection (ISR).</p></div><div><h3>Methods</h3><p>Sixty patients with ultra-low rectal cancers that underwent tumor resection using the ISR and APR methods were compared retrospectively. Patients' demographic information as well as tumor characteristics were evaluated. All patients were followed after the operation every three months for two years, and then every six months for at least three years.</p></div><div><h3>Results</h3><p>Thirty-four (56.6%) patients were male, and 26 (43.3%) were females, which showed no statistical significance between the two groups. The mean tumor distance from the anal verge in the APR group was 5.11±0.06 cm and in the ISR group was 5.22±1.1 cm. In the APR group, 9 (30%) patients developed primary tumor recurrence, while in the ISR group, 10 (33.3%) patients had relapses. The observed difference was not statistically significant. However, the study showed that patients with a T stage of T2 or higher had a higher probability of tumor recurrence.</p></div><div><h3>Conclusion</h3><p>There is no significant difference in the efficacy of the ISR method compared with the conventional APR for the treatment of ultra-low rectal cancer.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100191"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42565783","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":"Pre-operative bariatric patient characteristics driving hiatal hernia repair decision by operating surgeons","authors":"H. Zuercher ,&nbsp;B. Koussayer ,&nbsp;C. Wang ,&nbsp;B. Rachman ,&nbsp;V. Sands ,&nbsp;M. Sandhu ,&nbsp;C. McEwen ,&nbsp;R. Mhaskar ,&nbsp;C. DuCoin ,&nbsp;A. Mooney","doi":"10.1016/j.sipas.2023.100197","DOIUrl":"10.1016/j.sipas.2023.100197","url":null,"abstract":"<div><h3>Background</h3><p>Hiatal hernia (HH) is routinely reported in 40% of bariatric surgery patients. Left unrepaired, HH can lead to post-surgical reflux, regurgitation, and vomiting.</p></div><div><h3>Objectives</h3><p>We hypothesize that patients with pre-operative reflux symptoms and a higher body mass index (BMI) will receive hiatal hernia repairs (HHR) more often. The study aim was to analyze the variables that drive HHR decision by operating surgeons.</p></div><div><h3>Methods</h3><p>The records of 551 patients who underwent endoscopy in preparation for bariatric surgery were analyzed. Prevalence of HH was derived based on esophagogastroduodenoscopy (EGD) findings performed by a bariatric surgeon during patients’ bariatric surgery. The relationship between categorical participant attributes was calculated using a significance level of 0.05.</p></div><div><h3>Results</h3><p>The groups consisted of 295 Roux-en-Y gastric bypass (RYGB) and 264 sleeve gastrectomy (SG) patients with preoperative HH identified in 310 patients. SG and a decreased BMI were significant for receiving a HHR. Type II diabetes (T2D), duodenitis found on EGD and pathology report, esophagitis, and Roux-en-Y gastric bypass (RYGB) were significant for not receiving a HHR. Only duodenitis, RYGB, and SG were found to be significant factors after multivariate analysis.</p></div><div><h3>Conclusions</h3><p>While some pre-operative patient characteristics may not impact a surgeon's HHR decision in the bariatric population, our study suggests that duodenitis, SG, and RYGB may influence a surgeon's HHR decision.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100197"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44255304","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":"Whipple's procedure for pancreatic cancer: training and the hospital environment are more important than volume alone","authors":"Shamir O. Cawich ,&nbsp;Robyn Cabral ,&nbsp;Jacintha Douglas ,&nbsp;Dexter A. Thomas ,&nbsp;Fawwaz Z. Mohammed ,&nbsp;Vijay Naraynsingh ,&nbsp;Neil W. Pearce","doi":"10.1016/j.sipas.2023.100211","DOIUrl":"10.1016/j.sipas.2023.100211","url":null,"abstract":"<div><h3>Background</h3><p>In our center, patients with pancreatic cancer traditionally had Whipple's resections by general surgery teams until January 2013 when a hepatopancreatobiliary (HPB) was introduced. We compared outcomes before and after introduction of HPB teams.</p></div><div><h3>Methods</h3><p>Data were collected from the records of all patients booked for Whipple's resections over a 12-year period. The data were divided into two groups: Group A consisted of the 6-year period from January 1, 2007 to December 30, 2012 during which all resections were performed by GS teams. Group B comprised patients in the 6-year period from January 1, 2013 to December 30, 2019 during which operations were performed by HPB teams. All statistical analyses were carried out using SPSS ver 16.0 and a P Value &lt;0.05 was considered statistically significant.</p></div><div><h3>Results</h3><p>The patients selected for Whipple's resections in Group A had statistically better performance status and lower anaesthetic risk. Despite this, patients in Group A had higher conversions to palliative operations (66% vs 5.3%), longer mean operating time (517±25 vs 367±54 min; P&lt;0.0001), higher blood loss (3687±661 vs 1394±656 ml; P&lt;0.0001), greater transfusion requirements (4.3±1.3 vs 1.9±1.4 units; P&lt;0.001), greater likelihood of prolonged ICU stay (100% vs 40%; P=0.19), higher overall morbidity (75% vs 22.2%; P=0.02), higher major morbidity (75% vs 13.9%; P=0.013), more procedure-related complications (75% vs 9.7%; P=0.003) and higher mortality rates (75% vs 5.6%; P&lt;0.0001). The HPB teams were more likely to perform vein resection and reconstruction to achieve clear margins (26.4% vs 0; P=0.57).</p></div><div><h3>Conclusion</h3><p>This paper adds to the growing body of evidence that volume alone should not be used as a marker of quality for patients requiring Whipple's procedures.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100211"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48441411","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":"Developing a novel tonsillitis pathway to reduce pressures on front-door services: A multi-phase quality improvement project in a large UK teaching hospital","authors":"Lucy M.S. Hoade ,&nbsp;Elliott N. Rees","doi":"10.1016/j.sipas.2023.100214","DOIUrl":"10.1016/j.sipas.2023.100214","url":null,"abstract":"<div><h3>Background</h3><p>Tonsillitis places a significant strain on healthcare services, with rising admission rates over recent years. There is an urgent need for strategies to alleviate unprecedented demand on secondary care via safe alternatives to hospital admission. This quality improvement project demonstrates development of an early discharge pathway in combination with an ENT-led Surgical Same Day Emergency Care (SDEC) unit.</p></div><div><h3>Methods</h3><p>All cases of acute tonsillitis (<em>n</em> = 127) and peritonsillar abscess (<em>n =</em> 43) were reviewed across two intervention phases (Aug-Oct 2021 and June-Oct 2022), which each involved a retrospective baseline audit, followed by post-intervention prospective audit cycles to assess hospital length of stay (LOS) and readmission rates.</p></div><div><h3>Results</h3><p>Introduction of a tonsillitis management protocol resulted in a reduction in mean LOS from 22 to 12 h (<em>p</em> = 0.004). Mean LOS reverted to 20 h in the second baseline audit. Further audit cycles demonstrated a sustained reduction in mean LOS to 13 h (<em>p</em> = 0.017) with use of the SDEC. Readmission rates remained low through all audit cycles.</p></div><div><h3>Conclusion</h3><p>Patients with acute tonsillitis can be safely managed via an early discharge pathway. Use of SDEC to deliver this protocol reduces pressure on front-door services, reduces LOS and does not affect readmission rate.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100214"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45563244","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":"ChatGPT: Friend or foe in medical writing? An example of how ChatGPT can be utilized in writing case reports","authors":"Wai Lone Jonathan Ho ,&nbsp;Bilal Koussayer ,&nbsp;Joseph Sujka","doi":"10.1016/j.sipas.2023.100185","DOIUrl":"10.1016/j.sipas.2023.100185","url":null,"abstract":"<div><p>ChatGPT is a chatbot built on a natural language processing model which can generate human-like responses to prompts given to it. Despite its lack of domain-specific training, ChatGPT has developed remarkable accuracy in interpreting clinical information. In this article, we aim to assess what role ChatGPT can serve in medical writing. We recruited a first-year medical student with no prior experience in writing case reports to write a case report on a complex surgery with the assistance of ChatGPT. After a thorough evaluation of its responses, we believe that ChatGPT is a powerful medical writing tool that can be used to generate summaries, proofread, and provide valuable medical insight. However, ChatGPT is not a substitute for a study author due to several significant limitations, and should instead be used in conjunction with the author during the writing process. As the impact of natural language processing models such as ChatGPT grows, we suggest that guidelines be established on how to better utilize this technology to improve clinical research rather than outright prohibiting its usage.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100185"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45153827","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":"A comparison of open or laparoscopic colectomy outcomes for the management of ischemic colitis using the ACS-NSQIP database","authors":"Ben S. Duggan ,&nbsp;Tim Becker ,&nbsp;Genaro A. DeLeon ,&nbsp;Varun Rao ,&nbsp;Kevin Y. Pei","doi":"10.1016/j.sipas.2023.100188","DOIUrl":"10.1016/j.sipas.2023.100188","url":null,"abstract":"<div><h3>Introduction</h3><p>Ischemic colitis is a common manifestation of intestinal ischemia and is potentially a surgical emergency. Although such surgical emergencies were historically approached via open exploration, it is uncertain if there is a role for minimally invasive techniques. This study compares open vs laparoscopic colectomy techniques in the management of ischemic colitis.</p></div><div><h3>Methods</h3><p>Using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database, patients with ischemic colitis undergoing colectomy from 2005 to 2019 were compared. The primary outcome of interest was 30-day mortality. Additional outcomes of interest were procedure related readmission, procedure related reoperation, length of stay, surgical site infections (SSI), septic shock, and other complications. Outcomes of interest were compared using multivariate logistic regression.</p></div><div><h3>Results</h3><p>7,928 patients had ischemic colitis with 7,209 undergoing open colectomy and 719 undergoing laparoscopic colectomy. The mortality rate was significantly lower using a laparoscopic approach compared to open (6.4% vs 26%, <em>p</em>=&lt;0.001) and associated with a lower odd of mortality (OR 0.58; 95% CI [0.35, 0.95]). Procedure related reoperation was lower in the laparoscopic group (6.5% vs 11%, <em>p</em>&lt;0.001), but multivariate analysis was not significant (OR 0.65; 95% CI [0.43,1]). Readmission rates were not statistically different (12% vs 10%, <em>p</em> = 0.2). Postoperative length of stay (7 vs 12 days, <em>p</em>=&lt;0.001), septic shock (6.7% vs 27%, <em>p</em>=&lt;0.001), and organ space SSI (3.2% vs 6.9%, <em>p</em>=&lt;0.001) were significantly decreased using a laparoscopic approach.</p></div><div><h3>Discussion</h3><p>30-day postoperative mortality was significantly lower using a laparoscopic. Patients that had a laparoscopic colectomy had shorter hospital stays. While patients that underwent laparoscopic procedures tended to be less sick, multivariate analysis showed decreased rates of sepsis and surgical site infections compared to open colectomies when correcting for these factors.</p></div><div><h3>Conclusion</h3><p>Laparoscopic colectomy may be a better surgical approach for patients with ischemic colitis compared to open colectomy.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100188"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46403271","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":"Evidence for a case-based module in the low-resource setting to teach ectopic pregnancy management","authors":"Isabel J. Hsu ,&nbsp;Jayna Lenders ,&nbsp;Mikaelah A. Johnson-Griggs ,&nbsp;Hallie Gist ,&nbsp;Neil Vaishampayan ,&nbsp;Yoonhee Ryder ,&nbsp;Joy Obayemi ,&nbsp;Phillip J. Hsu ,&nbsp;David Jeffcoach ,&nbsp;Melanie Barnard ,&nbsp;Muse Freneh ,&nbsp;Mark Snell ,&nbsp;Deborah M. Rooney ,&nbsp;Grace J. Kim","doi":"10.1016/j.sipas.2023.100209","DOIUrl":"10.1016/j.sipas.2023.100209","url":null,"abstract":"<div><h3>Introduction</h3><p>Case-based learning (CBL) utilizes authentic clinical cases that connect theory to practice. CBL has been shown to result in deeper learning and high engagement of adult learners. An open-source, web-based CBL module was created to help learners develop the cognitive foundation of ectopic pregnancy management in the low-resource setting. We present psychometric evidence that supports the use of this web-based CBL in the low-resource setting.</p></div><div><h3>Methods</h3><p>The case scenario comprising 20 topics in ectopic pregnancy management was created by an Ethiopian team member and hosted on an interactive web-based platform. The module was reviewed by Ethiopian, Cameroonian, and US surgeons and OB/GYN team members for content, relevance, and clarity, followed by a psychometrician for clarity, bias, relevance, and alignment. Twenty participants (3-Mbingo Baptist Hospital-Cameroon, 6-Soddo Christian Hospital-Ethiopia, 3-Southern Illinois University (SIU), and 8-University of Michigan (UM)) then completed the module. Four attending surgeons (2 OB/GYN, 2 general surgery) were designated experts while 10 medical students and 6 residents were designated novices. The module included a 10-item dichotomously scored pre-test, the CBL content, and the same, but shuffled, post-test. Pre- and post-test summed scores were compared using paired Student's <em>t</em>-tests, while differences in scores across participants' experience levels and sites were analyzed using a many-facet Rasch model.</p></div><div><h3>Results</h3><p>Findings indicated a statistically significant improvement in participants’ mean summed scores from pre-test (<em>M</em> = 6.7, <em>SD</em> = 2.2) to post-test (<em>M</em> = 9.0, <em>SD</em> = 1.5), t(20) = – 4.76, <em>P</em> &lt; 0.0001 and confirmed by Rasch analysis, <em>P</em> &lt; 0.001. An adequate distribution of difficulty was demonstrated and 80% of questions had high discrimination value between experts and novices, <em>d</em> = | 0.87, 1.40 |. There was no difference in scores across specialties. Following the module, expert scores (<em>M</em> = 9.7) were higher than novice scores (<em>M</em> = 9.0), but the difference was not statistically significant.</p></div><div><h3>Conclusion</h3><p>Our findings suggest that using a web-based CBL module could be used to effectively improve understanding of the management of ectopic pregnancy in the low-resource setting, especially for nascent surgeons. The concept of a web-based CBL module has special attraction in the low-resource setting as it may target the adult surgical learner in remote regions where established technologies and existing experts are unavailable.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100209"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43800979","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":"Comparing outcomes of operative management of intestinal obstruction due to gallstone ileus using NSQIP database","authors":"Varun Rao ,&nbsp;Genaro DeLeon ,&nbsp;Timothy Becker ,&nbsp;Benjamin Duggan ,&nbsp;Kevin Y. Pei","doi":"10.1016/j.sipas.2023.100203","DOIUrl":"https://doi.org/10.1016/j.sipas.2023.100203","url":null,"abstract":"<div><h3>Introduction</h3><p>Gallstone ileus is an uncommon etiology of intestinal obstruction, although many cases require surgical repair. There is no consensus regarding the necessity of concomitant cholecystectomy. (CCY) at the time of index surgery. This study aimed to evaluate the outcomes of gallstone ileus in patients with and without CCY.</p></div><div><h3>Methods</h3><p>Using the ACS NSQIP database from 2005 to 2019, we included patients who underwent surgical management of gallstone ileus (enterolithotomy) with or without CCY. The primary outcomes of interest were surgical site infection (SSI) and 30-day mortality. Additional outcomes of interest included readmissions related to the procedure, length of hospital stay (LOS), return to the operating room, and sepsis. Demographics were evaluated using univariate analysis, whereas outcomes of interest were analyzed using multivariate logistic regression.</p></div><div><h3>Results</h3><p>A total of 825 cases of gallstone ileus were identified among 118 patients who underwent cholecystectomy. Patient characteristics were similar between the groups. No concomitant cholecystectomy was associated with a longer hospital stay (8 days vs. five days, <em>p</em>&lt;0.01) and tended to be more likely to return to the operating room (45 cases vs. 4 cases, <em>p</em> = 0.08), but this was not statistically significant. No concomitant CCY was associated with increased SSI rates, readmissions related to the procedure, 30-day mortality, or sepsis.</p></div><div><h3>Conclusion</h3><p>Surgical management of gallstone ileus with or without CCY has similar short-term postoperative outcomes.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100203"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49864397","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":"Improving the preoperative assessment of older adults considering surgery: The need for a structured curriculum during surgery residency","authors":"Samuel M. Miller ,&nbsp;Claire Morton ,&nbsp;Kimberly M. Glerum ,&nbsp;Erin M. White ,&nbsp;Robert D. Becher ,&nbsp;Peter S. Yoo ,&nbsp;Ronnie A. Rosenthal ,&nbsp;Mary E. Tinetti","doi":"10.1016/j.sipas.2023.100205","DOIUrl":"10.1016/j.sipas.2023.100205","url":null,"abstract":"<div><h3>Background</h3><p>Over half of surgeries in the United States are performed on older adults. The aims of this study were to quantify geriatric-relevant discussion topics and assessments during the consent process and to assess the need for a structured approach to consent older patients.</p></div><div><h3>Methods</h3><p>General surgery residents at a single institution answered questions about content of the informed consent process and preoperative assessment in adult and geriatric (&gt; 65) patients. Questions addressed frequency of geriatric- relevant discussions, assessments and consultations for the two patient groups.</p></div><div><h3>Results</h3><p>Part 1 was completed by 66/75 residents (88.0%). Most residents received training in informed consent during medical school or residency (95%). Common avenues for training were direct observation of attending surgeons or senior residents (85%), followed by didactic teaching (47%) and independent reading (30%). Only three residents (two PGY1s and one PGY2) reported receiving specific training in how to achieve informed consent in older patients. Part 2 was completed by 47/56 eligible residents (83.9%). Postoperative expectations (85.1%), living situation (53.2%), postoperative goals (53.2%), and advanced directives (42.6%) were most commonly discussed. Cognitive testing (19.1%), geriatrics consults (14.9%), and frailty scores (4.3%) were rarely addressed. There were no correlations between discussion of this information with resident age, level in residency, self-identified gender, or self-identification as a member of a racial or ethnic minority.</p></div><div><h3>Conclusions</h3><p>Geriatric-relevant topics and assessments occurred sporadically during the resident-led informed consent process and were more common with senior residents. Training in geriatric relevant informed consent rarely occurs during residency. These results, if generalizable across surgical training sites, highlight the need for a structured curriculum to address geriatric-relevant perioperative concerns.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"14 ","pages":"Article 100205"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47148141","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}