Surgery open science最新文献

{"title":"A comprehensive study on venous endovascular management and stenting in deep veins occlusion and stenosis: A review study","authors":"Javad Salimi ,&nbsp;Fatemeh Chinisaz ,&nbsp;Seyed Amir Miratashi Yazdi","doi":"10.1016/j.sopen.2024.04.001","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.04.001","url":null,"abstract":"<div><h3>Background</h3><p>Patients with deep venous disease can be classified into two distinct categories: those with disease resulting from known deep vein thrombosis (DVT), which may subsequently lead to post-thrombotic syndrome (PTS), and those with disease caused by compressive factors or non-thrombotic iliac vein lesions (NIVL). The major factor causing the symptoms in patients with PTS and NIVL is venous hypertension which happens due to venous stenosis or venous obstruction. Nowadays Venous stenting offers a noninvasive approach for treatment of NIVL and PTS demonstrating high patency rate.</p></div><div><h3>Methods</h3><p>We comprehensively reviewed relevant published papers from 2008 to 2023 that surveyed various influencing factors including the site of occlusion and etiology of occlusions, proper diagnostic imaging, ideal characteristics of venous stents, different dedicated venous stents, pre-operative, concomitant, and post-operative interventions and factors that challenge stenting in both PTS and NIVL patients. The papers were identified by searching the keywords “venous stenting”, “PTS”, “NIVL”, “occlusion”, and “stenosis” in PubMed central library MEDLINE and Google Scholar.</p></div><div><h3>Results</h3><p>Patency rates, post-stent complications, and relevant data according to the patient's quality of life were included and analyzed from 476 identified studies. There is no validated protocol and guideline for using stents in patients with PTS and NIVL.</p></div><div><h3>Conclusion</h3><p>As there is no validated protocol and guideline for using stents in patients with PTS and NIVL, our study may provide comprehensive information to assist researchers interested in writing the protocol and give them insight.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"19 ","pages":"Pages 131-140"},"PeriodicalIF":1.4,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000526/pdfft?md5=2eb81b8db02320eabd4ceaa469ca60fa&pid=1-s2.0-S2589845024000526-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140644317","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":"Differences in outcomes by race/ethnicity after thoracic surgery in a large integrated health system","authors":"Kian C. Banks MD ,&nbsp;Julia Wei MPH ,&nbsp;Leyda Marrero Morales BS ,&nbsp;Zeuz A. Islas BS ,&nbsp;Nathan J. Alcasid MD ,&nbsp;Cynthia J. Susai MD ,&nbsp;Angela Sun BS ,&nbsp;Katemanee Burapachaisri BS ,&nbsp;Ashish R. Patel MD ,&nbsp;Simon K. Ashiku MD ,&nbsp;Jeffrey B. Velotta MD","doi":"10.1016/j.sopen.2024.04.002","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.04.002","url":null,"abstract":"<div><h3>Background</h3><p>Disparities exist throughout surgery. We aimed to assess for racial/ethnic disparities among outcomes in a large thoracic surgery patient population.</p></div><div><h3>Methods</h3><p>We reviewed all thoracic surgery patients treated at our integrated health system from January 1, 2016–December 31, 2020. Post-operative outcomes including length of stay (LOS), 30-day return to the emergency department (30d-ED), 30-day readmission, 30- and 90-day outpatient appointments, and 30- and 90-day mortality were compared by race/ethnicity. Bivariate analyses and multivariable logistic regression were performed. Our multivariable models adjusted for age, sex, body mass index, Charlson Comorbidity Index, surgery type, neighborhood deprivation index, insurance, and home region.</p></div><div><h3>Results</h3><p>Of 2730 included patients, 59.4 % were non-Hispanic White, 15.0 % were Asian, 11.9 % were Hispanic, 9.6 % were Black, and 4.1 % were Other. Median (Q1-Q3) LOS (in hours) was shortest among non-Hispanic White (37.3 (29.2–76.1)) and Other (36.5 (29.3–75.4)) patients followed by Hispanic (46.8 (29.9–78.1)) patients with Asian (51.3 (30.7–81.9)) and Black (53.7 (30.6–101.6)) patients experiencing the longest LOS (<em>p</em> &lt; 0.01). 30d-ED rates were highest among Hispanic patients (21.3 %), followed by Black (19.2 %), non-Hispanic White (18.1 %), Asian (13.4 %), and Other (8.0 %) patients (p &lt; 0.01). On multivariable analysis, Hispanic ethnicity (Odds Ratio (OR) 1.43 (95 % CI 1.03–1.97)) and Medicaid insurance (OR 2.37 (95 % CI 1.48–3.81)) were associated with higher 30d-ED rates. No racial/ethnic disparities were found among other outcomes.</p></div><div><h3>Conclusions</h3><p>Despite parity across multiple surgical outcomes, disparities remain related to patient encounters within our system. Health systems must track such disparities in addition to standard clinical outcomes.</p></div><div><h3>Key message</h3><p>While our large integrated health system has been able to demonstrate parity across many major surgical outcomes among our thoracic surgery patients, race/ethnicity disparities persist including in the number of post-operative return trips to the emergency department. Tracking outcome disparities to a granular level such as return visits to the emergency department and number of follow up appointments is critical as health systems strive to achieve equitable care.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"19 ","pages":"Pages 118-124"},"PeriodicalIF":1.4,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S258984502400054X/pdfft?md5=b3814c0e5152901de1598f6fe2a7480f&pid=1-s2.0-S258984502400054X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140552374","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":"Machine learning based predictive modeling of readmissions following extracorporeal membrane oxygenation hospitalizations","authors":"Jeffrey Balian ,&nbsp;Sara Sakowitz MS, MPH ,&nbsp;Arjun Verma BS ,&nbsp;Amulya Vadlakonda BS ,&nbsp;Emma Cruz ,&nbsp;Konmal Ali ,&nbsp;Peyman Benharash MD","doi":"10.1016/j.sopen.2024.04.003","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.04.003","url":null,"abstract":"<div><h3>Background</h3><p>Despite increasing utilization and survival benefit over the last decade, extracorporeal membrane oxygenation (ECMO) remains resource-intensive with significant complications and rehospitalization risk. We thus utilized machine learning (ML) to develop prediction models for 90-day nonelective readmission following ECMO.</p></div><div><h3>Methods</h3><p>All adult patients receiving ECMO who survived index hospitalization were tabulated from the 2016–2020 Nationwide Readmissions Database. Extreme Gradient Boosting (XGBoost) models were developed to identify features associated with readmission following ECMO. Area under the receiver operating characteristic (AUROC), mean Average Precision (mAP), and the Brier score were calculated to estimate model performance relative to logistic regression (LR). Shapley Additive Explanation summary (SHAP) plots evaluated the relative impact of each factor on the model. An additional sensitivity analysis solely included patient comorbidities and indication for ECMO as potential model covariates.</p></div><div><h3>Results</h3><p>Of ∼22,947 patients, 4495 (19.6 %) were readmitted nonelectively within 90 days. The XGBoost model exhibited superior discrimination (AUROC 0.64 vs 0.49), classification accuracy (mAP 0.30 vs 0.20) and calibration (Brier score 0.154 vs 0.165, all P &lt; 0.001) in predicting readmission compared to LR. SHAP plots identified duration of index hospitalization, undergoing heart/lung transplantation, and Medicare insurance to be associated with increased odds of readmission. Upon sub-analysis, XGBoost demonstrated superior disclination compared to LR (AUROC 0.61 vs 0.60, P &lt; 0.05). Chronic liver disease and frailty were linked with increased odds of nonelective readmission.</p></div><div><h3>Conclusions</h3><p>ML outperformed LR in predicting readmission following ECMO. Future work is needed to identify other factors linked with readmission and further optimize post-ECMO care among this cohort.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"19 ","pages":"Pages 125-130"},"PeriodicalIF":1.4,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000538/pdfft?md5=b16fabd665e514f87c6396c48ad4addd&pid=1-s2.0-S2589845024000538-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140552375","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":"Education and information to improve rates for attendance to colorectal cancer screening programs","authors":"Raimondo Gabriele MD,&nbsp;Monica Campagnol MD,&nbsp;Immacolata Iannone MD,&nbsp;Valeria Borrelli PhD,&nbsp;Antonio V. Sterpetti MD","doi":"10.1016/j.sopen.2024.03.017","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.03.017","url":null,"abstract":"","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"19 ","pages":"Pages 105-107"},"PeriodicalIF":1.4,"publicationDate":"2024-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000514/pdfft?md5=43634e7018e1d956cefe8524ac6b8cc9&pid=1-s2.0-S2589845024000514-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140350095","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 CEA/PCI ratio is a superior prognosticator than mCOREP for colorectal cancer patients with peritoneal carcinomatosis","authors":"Phelopatir Anthony MD, MS ,&nbsp;Shoma Barat BSc, MSc ,&nbsp;Nima Ahmadi MBBS, FRACS ,&nbsp;David Lawson Morris MBChB, FRACS","doi":"10.1016/j.sopen.2024.03.014","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.03.014","url":null,"abstract":"<div><h3>Background</h3><p>The CEA/PCI ratio, which evaluates tumour marker and burden, has been demonstrated as a prognosticator for patients with colorectal cancer with peritoneal carcinomatosis. The aim of this study was to compare the CEA/PCI ratio with the Modified Colorectal Peritoneal Score (mCOREP) for overall survival (OS) and recurrence free survival (RFS). There is no literature currently comparing both markers for RFS.</p></div><div><h3>Methods</h3><p>Data was collected retrospectively for patients undergoing CRS and hyperthermic intraperitoneal chemotherapy (HIPEC) at the Peritonectomy Unit at St. George Hospital, NSW from January 2015 to December 2021.</p></div><div><h3>Results</h3><p>From 187 patients, an increase in CEA/PCI ratio was associated with reduced OS (<em>p</em> &lt; 0.01) and RFS (<em>p</em> &lt; 0.01), whereas mCOREP score did not demonstrate such association with OS (<em>p</em> = 0.5) nor RFS (<em>p</em> = 0.4). However, CEA/PCI ratio greater than the median of 0.63 was correlated with an increased OS (<em>p</em> = 0.01), whereas the mCOREP greater than the median of 4 correlated with reduced OS (<em>p</em> &lt; 0.01). Median mCOREP also demonstrated association with reduced RFS in patients with PCI &lt;15 (<em>p</em> = 0.03), whereas CEA/PCI ratio above 0.63 demonstrated association with reduced RFS in patients with PCI ≥ 15 (<em>p</em> = 0.02).</p></div><div><h3>Conclusion</h3><p>The CEA/PCI ratio is more associated with OS and RFS in patients with colorectal cancer with peritoneal carcinomatosis, when compared with mCOREP. CEA/PCI ratio above 0.63 was correlated with increased OS, whereas mCOREP above 4 is correlated with reduced OS. CEA/PCI ratio above 0.63 demonstrated reduced RFS for patients with higher PCIs. By contrast, mCOREP &gt;4 illustrated reduced RFS in patients with lower PCIs.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"19 ","pages":"Pages 28-31"},"PeriodicalIF":1.4,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000472/pdfft?md5=34d800eec5530d2d1bf43052f0e4b540&pid=1-s2.0-S2589845024000472-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140321499","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":"Assessing Ethiopia's surgical capacity in light of global surgery 2030 initiatives: Is there progress in the past decade?","authors":"Cherinet Osebo PhD ,&nbsp;Jeremy Grushka MD ,&nbsp;Dan Deckelbaum MD ,&nbsp;Tarek Razek MD","doi":"10.1016/j.sopen.2024.03.015","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.03.015","url":null,"abstract":"<div><h3>Background</h3><p>Surgical, anesthetic, and obstetric (SAO) care plays a crucial role in global health, recognized by the World Health Organization (WHO) and The Lancet Commission on Global Surgery (LCoGS). LCoGS outlines six indicators for integrating SAO services into a country's healthcare system through National Surgical Obstetrics and Anesthesia Plans (NSOAPs). In Ethiopia, surgical services progress lacks evaluation. This study assesses current Ethiopian surgical capacity using the LCoGS NSOAPs framework.</p></div><div><h3>Methods</h3><p>We conducted a narrative review of published literature on critical LCoGS NSAOPs metrics to extract information on key domains; service delivery, workforce, infrastructure, finance, and information management.</p></div><div><h3>Results</h3><p>Ethiopia's surgical services face challenges, including a low surgical volume (43) and a scarcity of specialist SOA physicians (0.5) per 100,000 population. Over half of Ethiopians reside outside the 2-hour radius of surgery-ready hospitals, and 98 % face surgery-related impoverished expenditures. Lacking the LCoGS-recommended SOA reporting systems, approximately 44 % of facilities exist for handling bellwether procedures. Despite the prevalence of essential surgeries, primary district hospitals have limited operative infrastructures, resulting in disparities in the surgical landscape. Most surgery-ready facilities are concentrated in cities, leaving Ethiopia's 80 % rural population with inadequate access to surgical care.</p></div><div><h3>Conclusion</h3><p>Ethiopia's surgical capacity falls below LCoGS NSOAPs recommendations, with challenges in infrastructure, personnel, and data retrieval. Critical measures include scaling up access, workforce, public insurance, and information management to enhance SAO services. Ethiopia pioneered in Sub-Saharan Africa by establishing Saving Lives Through Safe Surgery (SaLTS) in response to NSOAPs, but progress lags behind LCoGS recommendations.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"19 ","pages":"Pages 70-79"},"PeriodicalIF":1.4,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000502/pdfft?md5=647e42b3c9e57d0f608610789be2e8f9&pid=1-s2.0-S2589845024000502-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140339547","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":"NSQIP 5-factor modified frailty index and complications after ileal anal pouch anastomosis for ulcerative colitis","authors":"Dakota T. Thompson MD ,&nbsp;Ethan G. Breyfogle ,&nbsp;Catherine G. Tran MD ,&nbsp;Mohammed O. Suraju MD ,&nbsp;Aditi Mishra MD ,&nbsp;Hussain A. Lanewalla ,&nbsp;Paolo Goffredo MD ,&nbsp;Imran Hassan MD","doi":"10.1016/j.sopen.2024.03.011","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.03.011","url":null,"abstract":"<div><h3>Background</h3><p>Frailty has been associated with worse postoperative outcomes. The 5-factor modified frailty index (mFI-5) is an objective measure although its validity in measuring frailty in patients undergoing ileal pouch-anal anastomosis (IPAA) for chronic ulcerative colitis (CUC) has not been reported.</p></div><div><h3>Methods</h3><p>This study used the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) targeted proctectomy database. The mFI-5 was calculated by five preoperative diagnoses: insulin-dependent or noninsulin-dependent diabetes, congestive heart failure, hypertension, chronic obstructive pulmonary disease, and dependent or partially dependent functional status. The impact of mFI-5 on minor and major postoperative morbidity in CUC patients undergoing IPAA was analyzed.</p></div><div><h3>Results</h3><p>The cohort included 1454 patients (median age 38 years, median body mass index [BMI] 26 kg/m2) of which 87 % had a mFI-5 = 0, 11 % had a mFI-5 = 1, and 2.5 % a mFI-5 ≥ 2. In multivariable logistic regression, mFI-5 ≥ 2 was significantly associated with minor complications (OR = 2.29, 95 % CI [1.00–5.22], <em>p</em> = 0.049), but not with major complications (<em>p</em> = 0.860).</p></div><div><h3>Conclusion</h3><p>IPAA for CUC is associated with high postoperative morbidity, however, the mFI-5 alone has limited utility in determining which patients are at a higher risk of complications due to frailty. These observations suggest there is a need for more relevant instruments to measure frailty in this patient cohort.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"19 ","pages":"Pages 95-100"},"PeriodicalIF":1.4,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000459/pdfft?md5=bb5eef8c60b05c45a8739116a5521b93&pid=1-s2.0-S2589845024000459-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140347202","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":"Patient reported outcome measures (PRO) in colorectal surgery","authors":"Kathia E. Nitsch BS,&nbsp;Srinivas J. Ivatury MD, MHA, FACS, FASCRS","doi":"10.1016/j.sopen.2024.03.013","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.03.013","url":null,"abstract":"<div><p>Patient reported outcomes refer to, “Any report of the status of a patient's health condition that comes directly from the patient, without interpretation of the patient's response by a clinician or anyone else” (US Food and Drug Administration, 2009) [<span>1</span>]. These outcomes can include anything that matters to patients including quality of life, pain, number of bowel movements. Patient reported outcome measures refer to tools or instruments that help to measure these outcomes. These measures can be done using validated tools, those that have undergone rigorous testing and psychometric validation, and non-validated tools such as may exist in a practice to rate practice or physician/staff care quality. For this paper, we will discuss the role of patient reported outcomes measures in colon and rectal surgery.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"19 ","pages":"Pages 66-69"},"PeriodicalIF":1.4,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000460/pdfft?md5=0b2c0499a665866c28ee5ddf6edbc1d2&pid=1-s2.0-S2589845024000460-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140339548","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":"Pelvic packing or endovascular interventions: Which should be given priority in managing hemodynamically unstable pelvic fractures? A systematic review and a meta-analysis","authors":"Dong Zhang MD ,&nbsp;Gong-zi Zhang MD ,&nbsp;Ye Peng MD ,&nbsp;Shu-wei Zhang MD ,&nbsp;Meng Li MD ,&nbsp;Yv Jiang MD ,&nbsp;Lihai Zhang MD","doi":"10.1016/j.sopen.2024.03.016","DOIUrl":"10.1016/j.sopen.2024.03.016","url":null,"abstract":"<div><h3>Background</h3><p>Pelvic fractures in trauma patients can be associated with substantial massive hemorrhage. Hemostasis interventions mainly consist of pelvic packing (PP) and endovascular intervention (EI), such as angiography-embolization (AE) and resuscitative endovascular balloon occlusion of the aorta (REBOA). Whether PP or EI should be prioritized for the management of hemodynamic unstable patients with pelvic fractures remains under debate. This meta-analysis aimed to establish the evidence-based recommendations for the management of hemodynamic unstable patients.</p></div><div><h3>Materials and methods</h3><p>PubMed, CENTRAL, and EMBASE databases were searched for articles published from January 1, 2000 to January 31, 2023. Eligible studies, such as retrospective cohort studies, propensity score matching studies, prospective cohort studies, observational cohort studies, quasi-randomized clinical trials evaluating PP and EI (AE or REBOA) for the management of patients with hemodynamically unstable pelvic fractures, were included. Mean Difference (MD), relative risk (RR), and 95 % confidence intervals (CI) were calculated using fixed- or random-effects models depending on the heterogeneity of included trials. We compared the effectiveness of the two methods in terms of mortality, unstable fracture pattens, injury severity score (ISS), systolic blood pressure (SBP), lactate (LA), base deficiency (BE), hemoglobin preoperatively, blood transfusion requirement, the time to and of operation, complications.</p></div><div><h3>Results</h3><p>Overall, 15 trials enrolling 1136 patients were analyzed, showing a total mortality rate of 28.4 % (323/1136). No effect of PP preference on the ISS (PP 36.4 ± 10.4 vs. EI 34.5 ± 12.7), SBP (PP 81.1 ± 24.3 mmHg vs. EI 94.2 ± 32.4 mmHg), LA (PP 4.66 ± 2.72 mmol/L vs. 4.85 ± 3.45 mmol/L), BE (PP 8.14 ± 5.64 mmol/L vs. 6.66 ± 5.68 mmol/L), and unstable fracture patterns (RR = 1.10, 95 % CI [0.63, 1.92]) was observed. PP application was associated with lower preoperative hemoglobin level (PP 8.11 ± 2.28 g/dL vs. EI 8.43 ± 2.43 g/dL, p &lt; 0.05), more preoperative transfusion (MD = 2.53, 95 % CI [0.01, 5.06]), less postoperative transfusion within the first 24 h (MD = −1.09, 95 % CI [−1.96, −0.22]), shorter waiting time to intervention (MD = −0.93, 95 % CI [−1.54, −0.31]), and shorter operation time of intervention (MD = −0.41, 95 % CI [−0.52, −0.30]). PP had lower mortality rate owing to uncontrolled hemorrhage in the acute phase (RR = 0.41, 95 % CI [0.22, 0.79]). There was neither difference in mortality due to other complications (RR = 1.60, 95 % CI [0.79, 3.24]), nor in total mortality (RR = 0.92, 95%CI [0.49, 1.74]) (p &gt; 0.05).</p></div><div><h3>Conclusions</h3><p>PP showed advantages of reducing the amount of postoperative transfusion, shortening the time of waiting and operating, and decreasing mortality due to uncontrolled hemorrhage in the acute phase without raising the odds of mortality due t","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"19 ","pages":"Pages 146-157"},"PeriodicalIF":1.4,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000484/pdfft?md5=9e1a010f5fd17a8f7e4064512342f7bc&pid=1-s2.0-S2589845024000484-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140399941","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":"Comparison of negative pressure wound therapy against normal dressing after vascular surgeries for inguinal wounds: A systematic review and meta-analysis","authors":"Oshan Shrestha ,&nbsp;Sunil Basukala ,&nbsp;Nabaraj Bhugai ,&nbsp;Sujan Bohara ,&nbsp;Niranjan Thapa ,&nbsp;Sushanta Paudel ,&nbsp;Suvam Lahera ,&nbsp;Sumit Kumar Sah ,&nbsp;Sujata Ghimire ,&nbsp;Bishal Kunwor ,&nbsp;Suchit Thapa Chhetri","doi":"10.1016/j.sopen.2024.03.018","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.03.018","url":null,"abstract":"<div><h3>Background</h3><p>Negative Pressure Wound Therapy (NPWT) is a therapeutic technique of applying sub-atmospheric pressure to a wound to reduce inflammation, manage exudate, and promote the formation of granulation tissue. It aims to optimise the natural physiological processes of wound healing for more effective recovery, and NPWT has emerged as a promising alternative to traditional dressings.</p></div><div><h3>Methods</h3><p>The protocol followed in the study was prospectively registered. Appropriate search terms and Boolean operators were used to search electronic databases for relevant articles. Screening of articles was performed, and data extraction was done. The effect measure was chosen according to the nature of the variable, and the effect model was chosen as per heterogeneity. Forest plot was used to give visual feedback.</p></div><div><h3>Results</h3><p>This study included 11 randomized controlled trials (13 publications) with a total of 1310 patients (1497 inguinal wounds). The NPWT group had lesser odds of developing surgical site infection (OR: 0.40; 95 % CI: 0.29–0.54; <em>n</em> = 1491; I² = 20 %; <em>p</em>-value ≤0.00001) and lesser odds of needing surgical wound revision (OR: 0.48; 95 % CI: 0.26–0.91; <em>n</em> = 856; I² = 0 %; p-value = 0.02) as compared to the normal dressing group. No significant difference was observed in duration of hospital stay, cost of care, wound healing time, or other complications.</p></div><div><h3>Conclusion</h3><p>NPWT application in inguinal wounds significantly reduces the surgical site infection and the need for wound revision in patients who have undergone vascular surgery.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"19 ","pages":"Pages 32-43"},"PeriodicalIF":1.4,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000496/pdfft?md5=c7be345835f0e440661b31cabc8909d8&pid=1-s2.0-S2589845024000496-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140321468","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}