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

{"title":"A national survey of the provision of prehabilitation for oesophagogastric cancer patients in the UK.","authors":"S Barman, R C Walker, P P Pucher, S Jack, G Whyte, Mpw Grocott, M West, N Maynard, T Underwood, J Gossage, A Davies","doi":"10.1308/rcsann.2024.0092","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0092","url":null,"abstract":"<p><strong>Introduction: </strong>Studies have demonstrated that prehabilitation in oesophagogastric cancer (OGC) improves body composition, physical fitness and quality of life, and can reduce surgical complications. However, it is not offered in all OGC centres. Furthermore, definitions, funding and access to services vary. We conducted a survey of prehabilitation in OGC centres in England and Wales.</p><p><strong>Methods: </strong>OGC centres were identified through the National Oesophago-Gastric Cancer Audit (NOGCA). Survey questions were developed, piloted in two institutions and distributed via email in October 2022. Reminder emails were sent over two months until the survey closed in December 2022.</p><p><strong>Results: </strong>Responses were received from 28 of 36 centres. There was near-universal agreement that prehabilitation should be considered standard of care for patients on curative pathways (27/28; 96%). Most centres (21/28; 75%) offered prehabilitation. The majority of respondents believed that prehabilitation should commence at diagnosis (27/28; 96%) and consist of at least aerobic training and dietitian input. Most (26/28; 93%) believed access to clinical psychologists should be included; however, only 12 (43%) had access to clinical psychologists. Respondents believed prehabilitation improves quality of life (26/28; 93%), fitness (26/28; 93%), smoking cessation (28/28; 100%), surgical complication rates (25/28; 89.3%), likelihood of proceeding to surgery (25/28; 89.3%) and overall survival (20/28; 71.4%).</p><p><strong>Conclusions: </strong>Despite barriers to funding and a lack of best practice guidelines, most units deliver prehabilitation. Units require higher quality evidence, consensus on the most important aspects of the intervention and core outcome sets to support the delivery of services and facilitate audit to assess the impact of their introduction.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680687","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":"Changes in hip and knee arthroplasty practice post-COVID-19 in the English NHS: a retrospective analysis of hospital episode statistics data.","authors":"T W Wainwright, T Immins, R G Middleton","doi":"10.1308/rcsann.2024.0100","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0100","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic significantly reduced hip and knee arthroplasty surgeries across the English NHS. With the resumption of regular operations postpandemic, efforts have been made to address the surgical backlog by maximising capacity. This study assesses the current activity rates of hip and knee arthroplasty in the NHS and their return to prepandemic levels.</p><p><strong>Methods: </strong>We analysed hospital episode statistics from all English NHS providers of hip and knee arthroplasty from 1 April 2018 to 31 March 2023. Variables such as activity, location of surgery, length of stay and readmission rates were examined.</p><p><strong>Results: </strong>Data for 706,772 hip and knee arthroplasty surgeries show that overall activity from 1 April 2022 to 31 March 2023 has decreased by 8.8% compared with the initial year of the study. During the last year, 38.4% of surgeries were performed in the independent sector, an increase from 29.6% in the first year.</p><p><strong>Discussion: </strong>The postpandemic recovery phase has seen a strategic shift of surgeries to the independent sector, which helps reduce backlogs but poses risks to the role of the NHS in surgical training and innovation. This redistribution has immediate benefits for patient care but may impede trainee development and weaken research capabilities due to the lack of infrastructure in independent sectors. To maintain its leading role in orthopaedic care, the NHS needs to explore innovative solutions and strategic partnerships, incorporating advanced technologies and new training methods to adapt to the evolving healthcare landscape.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680673","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":"A case report and systematic review of periorbital emphysema following nose blowing or sneezing.","authors":"S Salar, O Edafe","doi":"10.1308/rcsann.2024.0090","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0090","url":null,"abstract":"<p><p>Periorbital emphysema following nose blowing or sneezing is rare. Although it is often self-limiting, air trapping in the orbit can raise the intraocular pressure leading to visual complications. At present, the literature on this topic is confined to case reports. In this article, we present a rare case of periorbital emphysema following nose blowing in a 34-year-old woman and a subsequent systematic review that included 43 case reports of periorbital emphysema following similar mechanisms. Orbital wall fracture was seen in 70% and a defect in the lamina papyracea is the most common finding on computed tomography imaging. Surgical intervention was performed in 30% of patients; indications included visual compromise, paranasal osteoma and inflammatory disease. Most patients can be safely discharged on the same day with oral antibiotics unless there are clinical signs of visual compromise or sinonasal mass that may necessitate surgical intervention. The recurrence rate is low (3%) and almost all will resolve within 4 weeks.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680686","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 risk of revision surgery after trainee-led primary total hip replacement.","authors":"D J Howgate, P Garfjeld Roberts, A Palmer, A Price, A Taylor, J L Rees, B Kendrick","doi":"10.1308/rcsann.2024.0049","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0049","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to determine the impact of operating surgeon grade and level of supervision on the incidence of one-year patient mortality and all-cause revision following elective primary total hip replacement (THR).</p><p><strong>Methods: </strong>National Joint Registry data from 2005 to 2020 for a single University Teaching Hospital were used, with analysis performed on the 15-year dataset divided into 5-year block periods (B1, 2005-2010; B2, 2010-2015; B3, 2015-2020). Outcome measures were mortality and revision surgery at one year, in relation to lead surgeon grade, and level of supervision for trainee-led (TL) operations.</p><p><strong>Results: </strong>A total of 9,999 eligible primary THRs were performed, of which 5,526 (55.3%) were consultant-led (CL), and 4,473 (44.7%) TL. Of TL, 2,404 (53.7%) were nonconsultant-supervised (TU) and 2,069 (46.3%) consultant-supervised (TS). The incidence of one-year patient mortality was 2.05% (<i>n</i>=205), and all-cause revision was 1.11% (<i>n</i>=111). There was no difference in one-year mortality between TL and CL operations (<i>p</i>=0.20, odds ratio (OR) 0.78, confidence interval (CI) 0.55-1.10). The incidence of one-year revision was not different for TL and CL operations (<i>p</i>=0.15, OR 1.37, CI 0.89-2.09). Overall, there was no temporal change for either outcome measure between TL or CL operations. A significant increase in revision within one-year was observed in B3 between TU compared with CL operations (<i>p</i>=0.005, OR 2.81, CI 1.35-5.87).</p><p><strong>Conclusions: </strong>We found no difference in overall one-year mortality or all-cause revision rate between TL and CL primary THR. Despite a reduction in unsupervised THR in the latest five-year period (2015-2020), unsupervised TL THR resulted in an increased risk of early revision.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680675","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":"A novel adaption to suction-assisted seroma aspiration.","authors":"M A Langford, W Chow, P Kalu, J Birch","doi":"10.1308/rcsann.2024.0068","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0068","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680672","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":"Frailty and body composition predict adverse outcomes after emergency general surgery admission: a multicentre observational cohort study.","authors":"P May-Miller, Map Ligthart, A R Darbyshire, S Rahman, P H Pucher, N J Curtis, M A West","doi":"10.1308/rcsann.2024.0091","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0091","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency surgical admissions represent the most unwell patients admitted to any hospital. Frailty and body composition independently identify risk of adverse outcomes but are seldom combined to predict outcomes in emergency patients. We aim to determine the relationships between frailty, body composition analyses (BCA) and mortality in an undifferentiated emergency general surgical patient population.</p><p><strong>Method: </strong>A prospective, multicentre observational cohort study of patients admitted with emergency surgical pathology was conducted in eight hospitals. BCA were performed at L3 vertebrae using computed tomography images to quantify sarcopenia and myosteatosis. Sex-specific BCA cut-off values were determined by our previous study. Reported Edmonton Frail Scale (REFS) values ≥8 identified frailty. The primary outcomes were all-cause 30-day and 1-year mortality. Multivariable logistic regression was utilised to explore predictive relationships between frailty, BCA, mortality and independent discharge.</p><p><strong>Results: </strong>A total of 194 patients were included; 24% were frail, 25% were sarcopenic and 23% myosteatotic. Some 61% of patients underwent an emergency laparotomy. Frail patients were more likely to be sarcopenic (20.4% vs 40.4%; <i>p</i> = 0.011) and myosteatotic (27.2% vs 51.1%; <i>p</i> = 0.004). Thirty-day and 1-year mortality was 5.2% and 15.5%, respectively; 30-day mortality was two times higher in the frail group (4.1% vs 8.5%; <i>p</i> = 0.414), and three times higher at 1 year (10.2% vs 31.9%; <i>p</i> = 0.001). Age (odds ratio [OR] 1.06; <i>p</i> = 0.001), sarcopenia (OR 2.88; <i>p</i> = 0.047) and frailty (OR 4.13; <i>p</i> = 0.001) were associated with 1-year mortality. Only 55.3% of frail patients were discharged home independently compared with 88.4% non-frail patients (<i>p</i> < 0.001). One-year mortality was greater in those with frailty and/or BCA abnormalities than in those without (28.8% vs 9.6%; <i>p</i> = 0.003).</p><p><strong>Conclusion: </strong>Frailty, sarcopenia and myosteatosis contribute significantly to adverse outcomes.</p><p><strong>Study registration: </strong>NCT03534765.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680674","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":"A systematic review of ultrasonography-guided transcutaneous fine needle aspiration cytology in the diagnosis of laryngeal malignancy.","authors":"A Ahmed, D Yang, M Eastwood, T Saunders, S F Ahsan","doi":"10.1308/rcsann.2024.0095","DOIUrl":"10.1308/rcsann.2024.0095","url":null,"abstract":"<p><strong>Introduction: </strong>Direct laryngoscopy and biopsy is the gold standard for obtaining a tissue diagnosis in patients with suspected laryngeal cancer. In patients with advanced disease or other medical comorbidities, this may come with significant anaesthetic risks, including tracheostomy. Ultrasonography-guided biopsy has been widely used in the diagnosis of malignancy involving cervical lymph nodes but it is not commonly employed in the diagnosis of laryngeal tumours. A systematic review was undertaken to assess the literature looking at whether ultrasonography-guided transcutaneous fine needle aspiration cytology (FNAC) is an adequate method in diagnosing laryngeal malignancy.</p><p><strong>Methods: </strong>Two independent researchers conducted a systematic review of the literature using the MEDLINE^® and Cochrane Library databases in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines.</p><p><strong>Results: </strong>A total of 568 studies were identified from the search, of which 3 met the inclusion criteria, resulting in 162 patient episodes. The pooled accuracy of transcutaneous FNAC in acquiring a sample adequate for histological diagnosis was 74.9%. Data on complications were limited, with a few cases of mild haemoptysis being recorded.</p><p><strong>Conclusions: </strong>Transcutaneous FNAC can be considered a safe and quick method for establishing a histological diagnosis of laryngeal lesions, particularly in patients who may be severely comorbid, and it could therefore could reduce the risks of general anaesthesia and tracheostomy prior to commencing definitive treatment.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613753","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":"Enhancing vascular surgery outcomes through geriatric co-management: a study on the impact of the POPS team.","authors":"Mea Bakheet, M Hughes, N Darwish, S Chen, A Egun, M Banihani","doi":"10.1308/rcsann.2024.0084","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0084","url":null,"abstract":"<p><strong>Introduction: </strong>Peripheral arterial disease (PAD) involves atherosclerotic stenosis and occlusion of lower leg arteries, leading to significant disability, high cardiovascular and cerebrovascular morbidity and mortality. Critical limb ischemia (CLI) is the most severe form of PAD. With the UK's aging population set to increase, the prevalence of PAD and the burden on vascular teams are expected to rise. This study evaluates the impact of regular input from the Proactive Care of Older People Undergoing Surgery (POPS) team on vascular surgery outcomes.</p><p><strong>Methods: </strong>This prospective cohort study examined the impact of Care of the Elderly (CoE) input on predefined parameters, focussing primarily on the length of stay (LoS) over 12 months. Data included baseline demographics, comorbidities, frailty scores (assessed using the Rockwood frailty score), LoS and referrals to medical specialties. A retrospective pilot study of 50 consecutive patients indicated a need for CoE input, showing higher local LoS compared with the national average.</p><p><strong>Results: </strong>Patients in both pilot and project groups were matched for comorbidities, frailty scores and interventions. Despite higher mean age and a greater proportion of patients aged 75+ years in the project group, the study aimed to reduce LoS. Post-quality improvement project implementation, LoS beyond fit-for-discharge decreased from 11.7 days to 9 days in 6 months and to 6 days after 12 months. Referrals to medical specialties decreased from 77% to 40%, and new diagnoses on discharge increased from 28% to 37%.</p><p><strong>Conclusions: </strong>CoE team input in vascular surgery patient care significantly improved outcomes, reducing LoS and medical specialty referrals, demonstrating cost-effectiveness and suggesting a feasible multidisciplinary approach for other regions.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613756","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 2-week wait pathway for suspected head and neck cancers in patients with throat and voice symptoms: referral patterns, common clinical practice and diagnostic efficacy of NICE guidelines.","authors":"F A Chiumenti, A L Pendolino, F M Vaz, R C Dwivedi","doi":"10.1308/rcsann.2024.0072","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0072","url":null,"abstract":"<p><strong>Introduction: </strong>The 2-week wait (2ww) referral pathway has been introduced into UK clinical practice to increase the early detection of cancer and improve survivals. The efficiency of this system for head and neck (H&N) cancers has been questioned over the years because of evidence of low pick-up rates. H&N cancers present with a wide variety of non-specific symptoms, particularly throat and voice symptoms. These symptoms need to be accurately interpreted together with risk factors if they are to be addressed adequately and overload of cancer facilities avoided. One of the most common outcomes of H&N 2ww referrals is laryngopharyngeal reflux (LPR), a common condition that could be diagnosed and managed in the primary care setting with a prescription of proton pump inhibitors (PPI) trials.</p><p><strong>Methods: </strong>We retrospectively analysed a cohort of consecutive patients referred on the 2ww pathway for throat and voice symptoms at University College London Hospital H&N cancer clinic during two months in 2019.</p><p><strong>Results: </strong>A total of 101 patients (43.6% men, mean age 53.3 years) were included. Throat and voice symptoms were described as intermittent in 52.5% and non-lateralised in 88.1%. Diagnosis of LPR was made in 59.4% of the referrals. A PPI trial was prescribed by general practitioners (GPs) in only 7.9% of cases. The cancer pick-up rate in our cohort is 2.9%.</p><p><strong>Conclusions: </strong>An improved awareness of the symptoms of LPR could guide GPs to prescribe trials of PPIs in low-risk patients before rushing into a referral on a cancer pathway. This would improve the 2ww process on many levels, reduce the burden on the National Health Service and avoid patients' psychological distress.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613763","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":"Innovation and the publishing gambit.","authors":"B Rogers","doi":"10.1308/rcsann.2024.0102","DOIUrl":"10.1308/rcsann.2024.0102","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":"106 8","pages":"657"},"PeriodicalIF":1.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11528353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}