Annals of the Royal College of Surgeons of England最新文献

{"title":"Preoperative transthoracic echocardiogram and delay to geriatric hip fracture surgery.","authors":"K Muller, J Xu, F Pathan, M Symes, B Sivakumar","doi":"10.1308/rcsann.2026.0086","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0086","url":null,"abstract":"<p><strong>Introduction: </strong>Delays to surgery confer increased morbidity and mortality in elderly patients who have sustained hip fractures. Preoperative investigations including transthoracic echocardiography (TTE) are often requested. The aim of this study was to determine whether there were delays to surgery when these patients underwent preoperative TTE.</p><p><strong>Methods: </strong>Electronic databases were searched from inception until April 2025. All relevant studies were identified with data extracted and meta-analysed.</p><p><strong>Findings: </strong>A total cohort of 2,581 patients was extracted from 5 studies; 865 (34%) patients received a preoperative TTE, and 1,716 (66%) patients did not. Baseline characteristics of age, sex, fracture pattern and treatment were similar. Patients receiving a preoperative TTE were more likely to have coronary artery disease (CAD), congestive cardiac failure (CCF) and arrythmia. The mean time to surgery was 9.4h (<i>p</i> = 0.09) shorter in the group not receiving a TTE. The mean length of hospital stay was 0.6 days (<i>p</i> = 0.03) shorter in those who did not receive a preoperative TTE.</p><p><strong>Conclusions: </strong>The available evidence did not demonstrate a statistically significant association between time to surgery and preoperative TTE. However, the data available are limited by heterogeneity, confounding and insufficient statistical power. In general, improving access to, and efficiency in TTE could help minimise delays to surgery, particularly in centres with limited resources. Strict adherence to American College of Cardiology guidelines for preoperative TTE indications is recommended.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes for operative and nonoperative management for gastrointestinal emergencies.","authors":"A R Darbyshire, I Kostakis, P F Meredith, C Kovacs, D Prytherch, J Briggs, Skc Toh","doi":"10.1308/rcsann.2026.0081","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0081","url":null,"abstract":"<p><strong>Background: </strong>Gastrointestinal (GI) conditions requiring emergency laparotomy are common, but it has been increasingly recognised that many patients never undergo surgery. This study used electronic healthcare records (EHRs) to provide an insight into the number of patients admitted with GI emergencies at a population level. In this paper we present condition specific outcomes for nine common diagnoses that may require emergency laparotomy.</p><p><strong>Methods: </strong>A single-centre retrospective cohort study was conducted at a tertiary public hospital (1 December 2013-31 January 2020). Patients were identified using diagnosis codes for GI emergencies, based on the inclusion criteria for the National Emergency Laparotomy Audit. Relevant data were extracted from EHRs.</p><p><strong>Results: </strong>Approximately half of the 2,274 patients included received non-operative management, and its use was notably high for intestinal ischaemia (72.3%) and complex diverticulitis (60.5%). Perforated peptic ulcers (92.9%), volvulus (70.4%) and adhesional small bowel obstruction (61.9%) were most likely to require surgery. Emergency laparoscopy rates were high (56.4%) and rate of conversion relatively low (29.5%). Median length of stay was shorter for nonoperative management than for surgery (5.8 days versus 10-16 days). Also, 30-day mortality for nonoperative management was much higher than for surgery (24.7% versus 12.5%). Patients classified as clinically unstable using vital signs/routine blood tests had a much higher 30-day mortality rate than those who were stable (38.7% versus 5.8%), notably in the nonoperative group (46.6% versus 6.4%).</p><p><strong>Conclusions: </strong>A higher proportion of GI emergencies are treated with nonoperative management than might be expected. However, mortality rates for nonoperative management were higher than for surgery, particularly in clinically unstable patients.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Skull base osteomyelitis (Necrotising otitis externa) following temporal bone resection and flap reconstruction.","authors":"Cal Fernandes, M W Mather, D Saleh, A McQueen, H Mohammed","doi":"10.1308/rcsann.2026.0099","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0099","url":null,"abstract":"<p><p>Necrotising otitis externa (NOE) is a life-threatening infection of the external auditory canal with skull base involvement. We report a case of <i>Citrobacter koseri</i> skull base osteomyelitis with NOE-like features, presenting three months following skull base surgery. A 69-year-old man underwent a left lateral temporal bone resection and pinnectomy with thoracodorsal artery perforator flap reconstruction for extensive basal cell carcinoma. Interval computed tomography and magnetic resonance imaging demonstrated enhancement deep to the flap with skull base and nasopharyngeal involvement, raising concern for recurrence. A postnasal space biopsy excluded malignancy, but cultures isolated <i>C. koseri</i>. Following multidisciplinary review, NOE was diagnosed, and oral cotrimoxazole was initiated, with clinical and radiological improvement. This case highlights the challenges in diagnosing postoperative infection after complex skull-base reconstruction.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary embolism in shoulder arthroplasty: a National Joint Registry Study.","authors":"M Hamawandi, O O'Malley, A Davies, A Rangan, S Sabharwal, P Reilly","doi":"10.1308/rcsann.2026.0104","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0104","url":null,"abstract":"<p><strong>Introduction: </strong>In the UK, there is no specific guidance on prophylaxis for venous thromboembolism (VTE) following shoulder arthroplasty (SA). This study reviews the current incidence of pulmonary embolism (PE) and prophylaxis practices following SA in England.</p><p><strong>Methods: </strong>Data were obtained from the National Joint Registry (NJR) for all SAs from 1 April 2012 to 31 March 2022 and linked with Hospital Episode Statistics (HES). ICD-10 codes identified incidence of PE at 30 and 90 days from arthroplasty. Incidence for PE was calculated by cohort and implant type at 30 and 90 days postoperatively. Multivariable logistic regression identified factors associated independently with PE.</p><p><strong>Results: </strong>A total of 47,145 procedures were included in the NJR HES linked database; 26,403 reverse SAs (RSAs), 12,736 total SAs (TSAs) and 8,006 hemiarthroplasties (HAs). The cumulative incidence of PE was 0.25% at 30 days and 0.33% at 90 days. By implant type, the cumulative incidence was 0.32% following RSA, 0.15% following TSA and 0.18% following HA at 30 days, and 0.41%, 0.21% and 0.25%, respectively, at 90 days. Chemical VTE prophylaxis was received following 74.55% of procedures and mechanical prophylaxis following 96.27%. Most common chemical prophylaxis was low molecular weight heparin (91.34%). Congestive cardiac failure, peripheral vascular disease, metastatic disease and trauma indication were associated independently with PE.</p><p><strong>Conclusions: </strong>Although uncommon, PE remains an important postoperative complication given its associated morbidity and mortality. Despite most patients receiving some form of prophylaxis no agreed guidance exists in SA and further studies are needed to inform such guidance.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From bench to theatre: coronary anastomosis simulation in early UK cardiothoracic training - a review.","authors":"F S Mubarak, Y Haqzad, B Evans","doi":"10.1308/rcsann.2026.0102","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0102","url":null,"abstract":"<p><strong>Introduction: </strong>Coronary anastomosis and artery bypass grafting remain fundamental components of cardiothoracic surgical practice. We review coronary anastomosis simulators, compare their educational evidence and practical trade-offs, and propose incorporation of simulation longitudinally into early UK cardiothoracic training.</p><p><strong>Methods: </strong>A search of PubMed/MEDLINE and Google Scholar was undertaken for English-language publications from January 2000 to August 2026. Reference lists of relevant reviews were hand-searched. UK policy and programme material was identified from the Intercollegiate Surgical Curriculum Programme, the Society for Cardiothoracic Surgery in Great Britain and Ireland and associated professional sources. Studies describing a simulator, educational intervention, validation, assessment or transfer outcome were prioritised.</p><p><strong>Findings: </strong>Low-fidelity models, including silicone tubes, foam-based vessels, and 3D-printed constructs, provide affordable and accessible opportunities for repetitive practice and early skills acquisition. High-fidelity simulators, such as beating-heart systems, offer enhanced realism suitable for advanced training levels. Biological models deliver superior anatomical fidelity but present logistical and cost limitations. Across modalities, simulation training consistently improves technical performance, including suture quality, procedural precision, OSATS scores and anastomosis time. Evidence demonstrating transfer of simulator-acquired skills to real operative performance remains sparse. Current UK training delivers simulation primarily through isolated short courses rather than structured longitudinal curricula.</p><p><strong>Conclusions: </strong>Simulation-based coronary anastomosis training is a valuable tool for front-loading technical skill acquisition in early cardiothoracic training. Educational impact is driven less by fidelity and more by structured curricula, deliberate practice and timely feedback. Future priorities include national standardisation, validation of clinical skill transfer and improving equitable access to simulation resources.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contrast transit time for small bowel obstruction: does it matter?","authors":"A S Sayegh, N Davis, Q Kawaji, D C Thomas, Y Wang, J Schindelheim, K Nakamoto","doi":"10.1308/rcsann.2026.0108","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0108","url":null,"abstract":"<p><strong>Background: </strong>The widespread implementation of standardised protocols, specifically nasogastric tube (NGT) decompression and gastrografin-based small bowel follow-through (SBFT), has enhanced clinical outcomes in adhesive small bowel obstruction (SBO). Nonetheless, a clinical challenge arises when a subset of patients demonstrates obstruction resolution on SBFT but fails subsequent diet advancement, resulting in prolonged hospitalisation. This study sought to identify patient characteristics or imaging markers early in the clinical course that predict the need for operative intervention in partial small bowel obstruction (pSBO).</p><p><strong>Methods: </strong>This is a retrospective, single-institution, multihospital review of outcomes in 110 patients who presented with SBO and passed a SBFT study. Patients with adhesive SBO on initial imaging who passed SBFT were categorised by surgical status and by SBFT transit time. Patient characteristics collected included demographic information, medical and surgical history, laboratory values and imaging findings.</p><p><strong>Results: </strong>When the operative and nonoperative groups were compared, significant differences were detected in sex, NGT insertion, median number of gynecologic surgeries, and length of hospitalisation. However, none of these characteristics increased the risk of surgical intervention on multivariate logistic regression analysis. Only a contrast transit time exceeding 12 hours significantly increased the risk of requiring surgery (<i>p</i><0.001).</p><p><strong>Conclusions: </strong>A contrast transit time exceeding 12 hours on SBFT was independently associated with a significantly increased risk of surgical intervention. As literature on contrast transit time and surgical outcome in SBO remains scarce, a 12-hour cutoff may help clinicians identify patients with pSBO who are more likely to require earlier operative intervention.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Handy measurements: calibrating clinicians' wound size estimation for remote referral pathways.","authors":"D A Do, N Vasudevan, T Cao, D Okata, E Shaw, L Hamilton","doi":"10.1308/rcsann.2026.0103","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0103","url":null,"abstract":"<p><strong>Introduction: </strong>Accurate documentation of wound size influences referral decisions and operative planning. As remote pathways such as the Virtual Fracture Clinic rely increasingly on documented descriptions without accompanying photographs, inaccurate estimation risks misclassification and unnecessary procedures. This study assessed baseline accuracy of clinician wound-size estimation, the effect of a hand-based measurement intervention and the relationship between confidence and accuracy.</p><p><strong>Methods: </strong>A prospective interventional study was conducted across two NHS hospitals in Sussex, England. Seventy clinical staff of all grades and specialties answered a questionnaire and estimated the length of five true-scale simulated wounds (1.6-16.1cm), first using their usual method and then using their own finger widths as a reference. Cumulative absolute error (CAE) was compared pre- and postintervention using the Wilcoxon signed-rank test, with rank-biserial correlation for effect size.</p><p><strong>Results: </strong>Median CAE fell from 6.60cm to 2.95cm, a 55.3% reduction (<i>p</i><0.001, <i>r</i>=0.86), with significant improvement for every wound and in 85.7% of participants. The benefit was consistent across all specialties and seniority levels. Preintervention, estimates skewed toward overestimation. Neither seniority (Spearman ρ=0.02, <i>p</i>=0.87) nor self-reported confidence (ρ=-0.12, <i>p</i>=0.31) correlated with accuracy.</p><p><strong>Conclusions: </strong>Clinicians estimate wound size poorly regardless of experience, and confidence does not reflect competence. Estimates made using one's hand as a ruler were significantly more accurate across all three specialty groups, offering a low-cost, readily available means of improving referral quality. Future work should assess durability and performance on real wounds.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"25-year review of REACH model for equitable craniomaxillofacial care in LMICs.","authors":"P Raghavan, S Gosla Reddy, R Reddy, P S Reddy, T Markus","doi":"10.1308/rcsann.2026.0093","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0093","url":null,"abstract":"<p><strong>Introduction: </strong>Access to safe, timely and affordable surgical care remains a major global health challenge, particularly in low- and middle-income countries. The Lancet Commission on Global Surgery highlighted the substantial burden of surgically treatable disease and called for scalable, sustainable health system solutions. This study evaluates the REACH (Rural Effective, Affordable, Comprehensive Healthcare) model, a long-standing healthcare delivery programme implemented in rural India, in relation to the Lancet Commission's core recommendations.</p><p><strong>Methods: </strong>A retrospective programme analysis of the REACH model implemented through SHARE India and the GSR Institute between 2000 and 2025 was undertaken. Programme structure, workforce development, service delivery mechanisms, community engagement strategies, financing models and surgical care provision were reviewed. Alignment with key principles of equitable surgical access and health system strengthening was assessed.</p><p><strong>Results: </strong>The REACH model expanded to cover approximately 25 districts and 1,010 villages, serving an estimated population of 3.9 million people. The programme trained 4,800 community health volunteers supported by 48 health supervisors and 12 local doctors. Approximately 34,000 surgical procedures were performed during the study period, predominantly for cleft and craniomaxillofacial conditions, with around 60% delivered free of charge. Decentralised referral pathways, community-based patient mobilisation and a hybrid financing model contributed to sustained service delivery and improved access to care.</p><p><strong>Conclusions: </strong>The REACH model demonstrates that long-term, community-integrated healthcare systems can provide equitable and sustainable surgical care in resource-constrained settings. The framework offers a potentially replicable model for strengthening surgical systems through local capacity building and sustainable financing.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified parasacral flap for pilonidal sinus disease: an easier reproducible option.","authors":"R H Javaid, W M Chaudry, A Majid, R S Ahmad, F Naz, S Noor","doi":"10.1308/rcsann.2026.0094","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0094","url":null,"abstract":"<p><strong>Introduction: </strong>Pilonidal sinus disease (PSD) is an acquired chronic infection that commonly involves the natal cleft, is difficult to treat and has high recurrence after surgery. The parasacral perforator flap is a useful and effective flap for coverage after excision of disease. However, it requires technical expertise and specialised equipment. We have modified the technique by leaving the base of the flap, the perforator and surrounding tissue and fat intact, making the procedure easier for general or plastic surgeons to perform.</p><p><strong>Methods: </strong>We included 20 consecutive patients with PSD who underwent surgical reconstruction with this technique between November 2014 and January 2022.</p><p><strong>Results: </strong>All patients were male, with a mean age of 28.35 years. Average flap size was 5 × 11.75cm. In all cases, perforators were found at the 12 o'clock and 1 o'clock positions. All the flaps survived entirely. There were minor complications in two patients, which were managed conservatively. Mean follow-up was 8.65 months. None of the patients had recurrence at final follow-up.</p><p><strong>Conclusions: </strong>In patients with PSD, our modification of the parasacral perforator flap is useful for reconstruction. The procedure is easy to perform and does not require specialised equipment or microvascular and perforator dissection expertise.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The gamer's elbow: cubital tunnel syndrome as an under-recognised consequence of PC gaming.","authors":"A I Simpson","doi":"10.1308/rcsann.2026.0100","DOIUrl":"10.1308/rcsann.2026.0100","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}