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

{"title":"Coin-cidence? Have cashless payments reduced the incidence of upper aerodigestive foreign body insertion? A study of UK Hospital Episode Statistics.","authors":"A Jangan, E Watts, M Pankhania","doi":"10.1308/rcsann.2024.0050","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0050","url":null,"abstract":"<p><strong>Objectives: </strong>Insertions of nasal and oral foreign bodies (FB) are common presentations in the emergency department, with coins frequently implicated among paediatric populations. Contactless payments were first introduced in the UK in 2007, and cash payments significantly declined from 2012. This study aims to explore the potential implications of increasing contactless payments on FB ingestion.</p><p><strong>Methods: </strong>UK Hospital Episode Statistics (HES) were reviewed between 2000 and 2022. All FB retrieval procedures involving the alimentary tract, respiratory tract and nasal cavity were included. Regression analysis was performed to assess trends in the incidence of FB ingestion before and following the transition to cashless payments in 2012.</p><p><strong>Results: </strong>Following the decline in cash payments in 2012, the frequency of alimentary tract FB removal procedures decreased significantly by 27.78 procedures per year (<i>p</i> < 0.001). Similarly, respiratory FB removal procedure decreased by 4.83 per year (<i>p</i> = 0.009) and nasal cavity FB removal procedures decreased by 52.82 per year (<i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>This study suggests a statistically significant decline in the number of procedures for removal of FB performed in the UK from 2012. Although this relationship is multifactorial, our data suggest an association between the introduction of contactless payments and a reduction in the number of FB retrieval procedures from the of upper aerodigestive tract.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141247573","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":"Rare case of combined vascular malformation of the face: a successful surgical management.","authors":"S Bhatt, R M Karmacharya, S Vaidya, D Prajapati, R Napit, K Chapagain, N Bhandari, A Tamang","doi":"10.1308/rcsann.2022.0073","DOIUrl":"https://doi.org/10.1308/rcsann.2022.0073","url":null,"abstract":"<p><p>Combined vascular malformation affecting the facial region is an extremely rare clinical entity that is debilitating both functionally and emotionally. Treatment warrants a multidisciplinary approach with the aim of removing the vascular anomalies and ameliorating any functional facial disfigurement. Here, we present a case of a 40-year-old female with combined vascular malformation of the face who was treated successfully with surgical intervention accompanying significant resolution of facial disfigurement.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141174615","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":"Surgical arrest of post-tonsillectomy haemorrhage: hospital episode statistics 2016-2022.","authors":"C Heining, M Clark","doi":"10.1308/rcsann.2024.0036","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0036","url":null,"abstract":"<p><strong>Introduction: </strong>Return to theatre for arrest of post-tonsillectomy haemorrhage represents a significant complication of a commonly performed Ear, Nose and Throat procedure. We used Hospital Episode Statistics data to quantify this risk. This method has been used previously for data from 2002-2004 and again for 2010-2016. In this article, coblation tonsillectomy was considered separately as it had not been analysed in previous studies.</p><p><strong>Methods: </strong>We used Hospital Episode Statistics data provided by the Department of Health to determine the risk of return to theatre for patients undergoing tonsillectomy between 2016 and 2022. Adults and children were analysed separately.</p><p><strong>Results: </strong>Between 1 April 2016 and 30 April 2022, 179,172 tonsillectomies were performed (not including coblation tonsillectomy), 4,311 (2.41%) of which returned to theatre for control of postoperative bleeding. In children, 1.16% returned to theatre, whereas in adults, 3.80% returned (<i>p</i><0.05). When including coblation tonsillectomy, the return to theatre rate was 0.82% in children, 3.46% in adults and 1.92% overall.</p><p><strong>Conclusions: </strong>This study shows that adults remain more than three times more likely than children to require a return to theatre for arrest of haemorrhage following tonsillectomy. The rates of post-tonsillectomy haemorrhage decrease when coblation tonsillectomies are added to the analysis. The rate of return to theatre for post-tonsillectomy haemorrhage seems to have stabilised compared with previous work carried out. The authors recommend further work to assess the complication rate of tonsillectomy in the UK and to compare coblation tonsillectomy with other techniques.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141086459","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":"Selective nonoperative versus operative management of liver gunshot injuries: a retrospective cohort study.","authors":"R R Dalcin, Ytm Petrillo, Lac Alves, M K Fonseca, A S Almeida, C O Corso","doi":"10.1308/rcsann.2022.0061","DOIUrl":"https://doi.org/10.1308/rcsann.2022.0061","url":null,"abstract":"<p><strong>Introduction: </strong>Experience accumulated over the last decades suggests nonoperative management (NOM) of civilian gunshot liver injuries can be safely applied in selected cases. This study aims to compare the outcomes of selective NOM versus operative management (OM) of patients sustaining gunshot wounds (GSW) to the liver.</p><p><strong>Methods: </strong>A registry-based retrospective cohort analysis was performed for the period of 2008 to 2016 in a Brazilian trauma referral. Patients aged 16-80 years sustaining civilian GSW to right-sided abdominal quadrants and liver injury were included. Baseline data, vital signs, grade of liver injury, associated injuries, injury severity scores, blood transfusion requirements, liver- and non-liver-related complications, length-of-stay (LOS), and mortality were retrieved from individual registries.</p><p><strong>Results: </strong>A total of 54 patients were eligible for analysis, of which 37 underwent NOM and 17 underwent OM. The median age was 25 years and all were male. No statistically significant differences were observed between groups regarding patients' demographics, injury scores, grade of liver injury and associated lesions. NOM patients tended to sustain higher-grade injuries (86.5% vs 64.7%; <i>p</i> = 0.08), and failure of conservative management was recorded in two (5.4%) cases. The rate of complications was 48% with no between-group statistically significant difference. Blood transfusion requirements were significantly higher in the OM group (58.8% vs 21.6%; <i>p</i> = 0.012). The median LOS was seven days. No deaths were recorded.</p><p><strong>Conclusion: </strong>Patients with liver GSW who are haemodynamically stable and without peritonitis are candidates for NOM. In this study, NOM was safe and effective even in high-grade injuries.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141086456","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":"Impact of untreated preoperative asymptomatic bacteriuria in patients undergoing holmium laser enucleation of prostate.","authors":"D Bheenick, M Conroy, J Bondad, D Dawam, T Young, P Acher","doi":"10.1308/rcsann.2024.0027","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0027","url":null,"abstract":"<p><strong>Introduction: </strong>Treatment of preoperative asymptomatic bacteriuria (ASB) before endoscopic surgery is recommended by European Association of Urology (EAU) guidelines. United Kingdom (UK) practice varies, however, owing to the historical nature of the evidence behind the guidelines, risk of increased antimicrobial resistance, the paradoxical view that treatment of ASB leads to increased infection and inefficiencies in rescheduling. We do not routinely treat ASB in our practice before holmium enucleation of the prostate (HoLEP). To determine the safety of this, we examined our experience focusing on the infective complications.</p><p><strong>Methods: </strong>Retrospective data collection was performed on consecutive patients undergoing HoLEP between 2015 and 2020. Indication, preoperative urine cultures and infective complications were recorded. No patients were pretreated with oral antibiotics. All patients received intravenous antibiotics on induction and routine postoperative oral antibiotics at the surgeon's discretion.</p><p><strong>Results: </strong>Some 443 patients were studied. No urosepsis occurred in the 125 patients with ASB compared with 2 of 318 patients (0.6%) with no growth on preoperative urine culture. Twenty-nine (7%) patients were treated with oral antibiotics for symptomatic postoperative complications (urinary tract infection without fever, epididymitis and haematuria). ASB did not predict for infective complications (urosepsis odds ratio [OR]: 0.50 <i>p</i>=0.66; oral antibiotics OR: 0.97 <i>p</i>=0.93).</p><p><strong>Conclusion: </strong>Not treating ASB before a HoLEP procedure is safe. This supports the judicious use of antimicrobials preoperatively. Other modalities of endoscopic surgery should be similarly assessed.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141086470","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":"Trainee as trainer in paediatric laparoscopic appendicectomy<sup />.","authors":"L Henderson, N Patwardhan, H Dagash","doi":"10.1308/rcsann.2024.0032","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0032","url":null,"abstract":"<p><strong>Background: </strong>Intraoperative teaching is an essential surgical skill, but there is little literature regarding trainees acting as trainers; we characterised these cases in paediatric laparoscopic appendicectomy.</p><p><strong>Methods: </strong>This is a retrospective review of casenotes over two years (2015-2017) in a single tertiary paediatric surgical centre in the UK. Operating were: paediatric surgery Core Trainees (CT) (postgraduate year (PGY)3-4), Junior Registrars (JR) (PGY5-6) and Senior Registrars (SR) (PGY7+); collectively described as trainees.</p><p><strong>Results: </strong>A total of 53 (20.7%) of 256 appendicectomies were trainee as trainer (TT) cases; 22 cases (41.5%) were performed by a CT supervised by a Registrar, and 31 (58.4%) by a JR supervised by a SR. Among the cases, 17 (32.1%) were complex, 47 (88.7%) were in working hours (8am-5pm), and 50 (94.3%) took place Monday to Friday. Median (interquartile range) duration of surgery was 65 (52-77) minutes. In the first year, 60 (47%) appendicectomies were performed by JRs. JR 1 was TT in three cases (8.8%) and JR 2 in five cases (19.2%); in all cases, the learner was a CT. Overall, there were 26 (10.6%) negative appendicectomies, 8 (3%) conversions, 19 (7%) readmissions within 30 days of discharge and 3 (1.1%) required reoperation; there was no statistically significant difference in complications between TT and non-TT cases.</p><p><strong>Conclusion: </strong>Laparoscopic appendicectomy is an excellent model for trainees to act as trainer; case selection included simple cases during daylight hours. Our outcomes are comparable with published literature, suggesting that this teaching method is safe for patients.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141086461","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 role of social inequalities in the epidemiology of urological cancers: can this inform cancer screening?","authors":"M G Cumberbatch","doi":"10.1308/rcsann.2023.0096","DOIUrl":"https://doi.org/10.1308/rcsann.2023.0096","url":null,"abstract":"<p><p>Health inequalities are systematic and potentially remediable differences in health across populations. Understanding the origins of these discrepancies, the healthcare consequences and the manifestations of related diseases can help improve the outcomes of underserved communities. Here I discuss how social factors may be used to help identify particular at-risk populations with regards to urological malignancies, and how these can be potentially used as biomarkers that inform cancer screening targets.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140921247","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":"Adherence to General Medical Council guidance regarding disclosure of alternative treatments during the consent process.","authors":"G S Bethell, R A Wheeler, N J Hall","doi":"10.1308/rcsann.2024.0016","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0016","url":null,"abstract":"<p><strong>Introduction: </strong>General Medical Council (GMC) guidelines dictate that reasonable alternatives to treatment should be disclosed during the consent process. We aimed to determine whether GMC guidelines on disclosure of alternatives during consent are being followed in a real-world example which is disclosure of non-operative management as an alternative to appendicectomy in uncomplicated paediatric appendicitis.</p><p><strong>Methods: </strong>We undertook a retrospective single-centre observational study and national consultant specialist paediatric surgeon survey. Two groups of 50 consecutively treated children (<16 years) with acute uncomplicated appendicitis were included in the observational study during two periods. UK-based consultant surgeons who treat appendicitis were included in the national survey. The main outcomes were disclosure and use of non-operative management (NOM) as an alternative to appendicectomy.</p><p><strong>Results: </strong>Overall, in the observational study, NOM was disclosed in 30 (30%) children and 77% (23/30) opted for this treatment method when it was disclosed. There were 83 survey respondents representing all 25 eligible specialist paediatric surgery centres. Ten (12%) consultants reported routinely offering NOM, 39 (47%) offer it in select circumstances, and 34 (41%) never offer NOM. Only 25 (30%) respondents always disclose NOM as an alternative to appendicectomy, whereas 22 (27%) never do. Consultants who never disclose NOM are more likely to prefer appendicectomy over NOM compared with those who always disclose it (<i>p</i><0.001).</p><p><strong>Conclusion: </strong>In this illustrative clinical scenario, observed and reported practice regarding disclosure of alternative treatments during the consent process do not meet GMC guidance. This risks depriving children and caregivers of a choice that they are entitled to.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140921243","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":"Evaluation of long-term outcome following therapeutic mammaplasty: the effect of wound complication on initiation of adjuvant therapy and subsequent oncological outcome.","authors":"R Rampal, S Jones, W Hogg, B Rengabashyam, B Hogan, R Achuthan, B Kim","doi":"10.1308/rcsann.2023.0095","DOIUrl":"https://doi.org/10.1308/rcsann.2023.0095","url":null,"abstract":"<p><strong>Introduction: </strong>Therapeutic mammaplasty (TM) facilitates large tumour resection while maintaining optimal aesthetic outcome. It carries higher wound complication risks, which may delay adjuvant therapy initiation. Whether this delay affects oncological outcome requires evaluation.</p><p><strong>Methods: </strong>Data were collected for consecutive patients receiving TM at the Leeds breast unit (2009-2017). A prospectively maintained database was used to determine tumour characteristics, wound complication rates, receipt of adjuvant therapy and breast cancer recurrence or death.</p><p><strong>Results: </strong>In total 112 patients (median age of 54 years) underwent 114 TM procedures. The most common histological subtypes were invasive ductal carcinoma (61.4%), invasive lobular carcinoma (13.2%) and ductal carcinoma in situ (13.2%). Of the patients, 88.2% had oestrogen receptor-positive cancer and 14% had human epidermal growth factor receptor-positive cancer; 26.3% had multifocal cancer. The median tumour size was 30mm. The median Nottingham Prognostic Index was 4.2. The local recurrence rate was 3.5% (median follow-up of 8.6 years). The 5- and 10-year disease-free survival (DFS) was 88.5% and 83.5%, and the equivalent overall survival (OS) rates were 94% and 83.5%. Wound complication rate was 23.6% (<i>n</i>=27), the commonest being wound infection (11.4%; <i>n</i>=13) and T-junction wound breakdown (10.5%; <i>n</i>=12). The median time to adjuvant therapy was 72 days (interquartile range [IQR] 56-90) for patients with wound complications, and 51 days (IQR 42-58) for those without. However, this delay did not affect DFS or OS (log-rank test; <i>p</i>=0.58 and <i>p</i>=0.94, respectively). This was confirmed on Cox regression analysis.</p><p><strong>Conclusion: </strong>Our study finding demonstrates that although wound complications after TM leads to a modest delay to adjuvant therapy, the long-term oncological outcomes were comparable with those in patients without wound complications.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140921246","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":"Comparing the effectiveness of full-vacuum and half-vacuum drainage in reducing seroma after modified radical mastectomy: a meta-analysis.","authors":"S Oyewale, A Ariwoola","doi":"10.1308/rcsann.2024.0034","DOIUrl":"10.1308/rcsann.2024.0034","url":null,"abstract":"<p><strong>Introduction: </strong>Owing to limited outpatient support for drain management, delayed discharge after mastectomy is more prevalent in developing countries. Utilising half-vacuum (HV) suction drains for routine drainage after mastectomy could lead to a reduced incidence of seroma and a shorter hospital stay. This systematic review and meta-analysis compared the outcomes of HV against full-vacuum (FV) suction drains in patients who underwent modified radical mastectomy for breast cancer.</p><p><strong>Methods: </strong>Differences between the two groups in length of hospital stay, total volume of drain effluent and incidence of seroma were assessed. RevMan 5.4 was used to calculate the odds ratio (OR) and relative risk (RR) for dichotomous data, and the mean difference (MD) for continuous data.</p><p><strong>Results: </strong>Nine randomised controlled trials were included in this review. Using HV drains reduced both the mean length of hospital stay (MD: -2.30 days, 95% confidence interval [CI]: -4.10 to -0.49 days, I²=97%) and the mean total volume of effluent (MD: -132.61ml, 95% CI: -207.32ml to -57.91ml, I²=88%) compared with FV drains. However, there was no statistically significant difference in incidence of seroma between the two groups (RR: 0.67, 95% CI: 0.30 to 1.46, I²=65%). Likewise, there was no difference in rate of seroma occurrence on sensitivity analysis (OR: 1.29, 95% CI: 0.72 to 2.33, I²=74%).</p><p><strong>Conclusions: </strong>There was no difference in the incidence of seroma between HV and FV suction drainage. Conversely, a reduction in the length of hospital stay and the total volume of drain effluent was observed for mastectomy patients with a HV drain.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140896050","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}