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

{"title":"Outcomes following reverse total shoulder arthroplasty vs operative fixation for proximal humerus fractures: a systematic review and meta-analysis.","authors":"S M Heo, H Faulkner, Vvg An, M Symes, H Nandapalan, B Sivakumar","doi":"10.1308/rcsann.2022.0120","DOIUrl":"10.1308/rcsann.2022.0120","url":null,"abstract":"<p><strong>Introduction: </strong>Proximal humerus fractures are common in the older population. A consensus on the optimal management of complex fractures requiring surgery has yet to be reached. A systematic review and meta-analysis was performed to compare clinical outcomes between reverse total shoulder arthroplasty (RTSA) and open reduction and internal fixation (ORIF).</p><p><strong>Methods: </strong>A systematic search of the literature was undertaken using the Medline^®, PubMed, Embase™ and Cochrane Central Register of Controlled Trials databases. Prospective and retrospective studies comparing clinical and patient reported results as primary outcome measures were included in this review, with secondary outcome measures including complications and revision surgery. A meta-analysis was conducted.</p><p><strong>Results: </strong>A total of 326 patients from 5 studies were eligible for inclusion in this review. Superior Constant-Murley scores (mean difference [MD]: 13.4, 95% confidence interval [CI]: 6.2-20.6; <i>p</i><0.001), Oxford shoulder scores (MD: 4.3, 95% CI: 1.2-7.4; <i>p</i>=0.007), simple shoulder test scores (MD: 0.95, 95% CI: 0.01-1.89; <i>p</i>=0.05) and DASH (Disabilities of the Arm, Shoulder and Hand) scores (MD: 5.1 [1 study], 95% CI: 2.1-8.1; <i>p</i>=0.034) were noted in patients receiving RTSA. Range of motion and revision surgery rates were also superior in this group.</p><p><strong>Conclusions: </strong>This study suggests that RTSA affords more favourable outcomes and lower revision rates than ORIF following proximal humerus fractures. Definitive conclusions are precluded, however, owing to small sample sizes and risk of bias in retrospective studies.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"562-568"},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11365726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138457468","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}

{"title":"A surgeon-modified device for the evacuation of diathermy smoke.","authors":"O D Brown, S Aroori","doi":"10.1308/rcsann.2024.0061","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0061","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103765","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":"Critical values for body mass index related to morbidity in high-volume low-complexity general surgery: a systematic review and meta-analysis.","authors":"S Hajibandeh, S Hajibandeh, K Harries, W G Lewis, R J Egan","doi":"10.1308/rcsann.2024.0057","DOIUrl":"10.1308/rcsann.2024.0057","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to investigate the effect of body mass index (BMI, kg/m²) on outcomes of high-volume low-complexity (HVLC) general surgery procedures and to determine critical values for BMI when selecting patients into HVLC programmes.</p><p><strong>Methods: </strong>A systematic review was conducted of studies looking at patients in different BMI categories undergoing HVLC general surgery procedures (laparoscopic cholecystectomy, inguinal hernia repair and umbilical or paraumbilical hernia repair), in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. A comparison meta-analysis model was constructed to compare the outcomes using random-effects modelling. The QUIPS (Quality In Prognosis Studies) tool and GRADE (Grading of Recommendations Assessment, Development and Evaluation) system were used to assess bias.</p><p><strong>Results: </strong>A total of 26 studies including 486,392 patients were examined. In laparoscopic cholecystectomy, BMI ≥40 was associated with higher conversion to open surgery (odds ratio [OR]: 1.33, <i>p</i>=0.040) but did not affect complications (OR: 0.69, <i>p</i>=0.400) or length of hospital stay (mean difference [MD]: -0.01 days, <i>p</i>=0.900). In inguinal hernia repair, BMI ≥35 was associated with longer operative time (MD: 18.00 minutes, <i>p</i><0.00001), and higher risk of wound complications (OR: 3.01, <i>p</i><0.00001) and hospital readmission (OR: 1.46, <i>p</i>=0.0008). In umbilical or paraumbilical hernia repair, BMI ≥30 was associated with higher risk of wound complications (OR: 6.45, <i>p</i><0.0001) and hospital readmission (OR: 5.56, <i>p</i><0.00001), and longer operative time (MD: 4.01 minutes, <i>p</i>=0.030).</p><p><strong>Conclusions: </strong>Obesity was associated with longer operative time (up to 23 minutes) and higher risk of postoperative morbidity (up to 4-fold) in HVLC procedures. BMI <40 (moderate GRADE certainty - laparoscopic cholecystectomy) and BMI <35 (moderate GRADE certainty - inguinal hernia) appear to represent optimal critical values for perioperative safety metrics.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141974947","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":"Re: Cosmetic incision for paediatric muscle biopsy.","authors":"T Burge","doi":"10.1308/rcsann.2024.0039","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0039","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141854595","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 network meta-analysis of the timing of wound dressing removal.","authors":"Rjks Hwang, D L Crook, C S Allan, S Sarkar","doi":"10.1308/rcsann.2023.0083","DOIUrl":"https://doi.org/10.1308/rcsann.2023.0083","url":null,"abstract":"<p><strong>Introduction: </strong>Wounds are invariably dressed postoperatively but the evidence for the timing of dressing changes is limited. This meta-analysis evaluated whether the relative risk of wound infection varies depending on when dressings are changed.</p><p><strong>Methods: </strong>A frequentist random-effects network meta-analysis was conducted on the results of a systematic review of the MEDLINE^®, Ovid^®, Scopus^®, Web of Science™ and PubMed^® databases and the Cochrane Central Register of Controlled Trials performed in May 2023. Evidence quality was graded using the Confidence In Network Meta-Analysis tool.</p><p><strong>Results: </strong>A total of 4 studies were included with 878 patients. A significant increase in the relative risk of wound infection was found when dressings were left in situ for more than 4.5 days when compared with 48 hours (3.18, 95% confidence interval: 1.22-8.33). There were no significant differences in the relative risk of infection between the other groups. Model heterogeneity and inconsistency were insignificant (Cochran's Q: 0.44, <i>p</i>=0.51). The quality of the evidence was graded as generally very low and risk of bias evaluations showed it to be of high concern for bias.</p><p><strong>Conclusions: </strong>Late dressing changes significantly increase the risks of wound infection and changes at 48 hours minimise these risks. There was no advantage demonstrated for earlier dressing changes. Ensuring that dressings are changed appropriately can minimise patient harm and health service costs.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141854588","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":"Multidisciplinary management of orthopaedic trauma - are we adhering to the guidelines?","authors":"K Hutchinson, C B Bretherton, A Gmati, B Handley","doi":"10.1308/rcsann.2024.0048","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0048","url":null,"abstract":"<p><strong>Introduction: </strong>A multidisciplinary team (MDT) approach to polytrauma patients minimises morbidity and mortality. This project assesses the extent to which British Orthopaedic Association Standards for Trauma guidelines for the management of the frail Orthopaedic patient are currently being met.</p><p><strong>Methods: </strong>A retrospective analysis was performed of all Trauma and Orthopaedic patients in multiple medical institutions over a 2-week capture period from 1 March 2022 until 14 March 2022 inclusive. Data collected included age, sex, injury, length of stay and dates of speciality input.</p><p><strong>Results: </strong>A total of 1,050 patients were included from 27 hospitals. The median age was 80 years, with 560 (53.3%) of all fractures being neck of femur fractures. Of the 1,050 patients, 870 (82.9%) were managed operatively. The median number of different speciality involvements was 3; 645 (61.4%) had an orthogeriatric (OG) review. In major trauma centres (MTC), 93.3% had OG input, compared with 66.3% in non-MTC. The speciality with the greatest input was Radiology, with Plastics having the lowest input.</p><p><strong>Conclusion: </strong>A standardised MDT approach is needed to optimise care and recovery in orthopaedic trauma patients. The difference in results regarding speciality involvement is substantial and needs to be addressed to minimise disparities in care received by this vulnerable cohort of patients.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141854592","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":"Penile tourniquet: the Wharton tourniquet.","authors":"S Nour, G H Lafford, S M Wharton","doi":"10.1308/rcsann.2024.0045","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0045","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141854593","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":"Process and outcome differences in the care of patients undergoing elective and emergency right hemicolectomy.","authors":"J Banks, A Rashid, T R Wilson, C P Challand, M J Lee","doi":"10.1308/rcsann.2024.0056","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0056","url":null,"abstract":"<p><strong>Introduction: </strong>Up to 30% of patients with colorectal cancer present as an emergency and have worse outcomes than elective patients. Compared with left-sided cancers, malignancies arising in the right colon are significantly under-researched. We sought to compare cancer care quality and clinical outcomes between emergency and elective presentations of right-sided colon cancer (RCC).</p><p><strong>Methods: </strong>This multicentre, retrospective study included all patients who underwent operative management for a RCC, from 1 April 2017 to 31 March 2022. Data were collected from electronic patient records, and host and tumour factors as well as outcomes between emergency and elective cohorts were compared.</p><p><strong>Results: </strong>Overall, 806 patients (median age 72 years) were included. Some 175 patients (22%) presented as an emergency: 140 in obstruction and 35 with tumour perforation, compared with 1 patient with tumour perforation in the elective group (<i>p</i> < 0.001). The emergency group had higher rates of postoperative complications (59.1% vs 20.0%, <i>p</i> < 0.001), increased 90-day mortality (13.7% vs 1.3%, <i>p</i> < 0.001) and a longer hospital stay (5 vs 10 days, <i>p</i> < 0.001). From the emergency cohort only 29.2% of eligible patients received adjuvant chemotherapy and in multivariate regression analysis emergency presentation was associated with a decreased likelihood of receiving adjuvant chemotherapy (odds ratio 0.26 [0.14-0.47], <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>Both short- and long-term outcomes after emergency presentation of RCC are poor, with inadequate access to subsequent chemotherapy. Strategies addressing emergency presentations of left-sided tumours have moved towards temporisation and elective surgery. Delaying major resectional surgery for optimisation may improve outcomes and access to adjuvant therapies for RCC.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141854594","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 'hashtag' K-wires configuration for the management of severe comminuted patellar fracture: the combination of tension band technique and cerclage wiring.","authors":"N E Koukoulias, A V Vasiliadis, S Savvidou, T Dimitriadis","doi":"10.1308/rcsann.2024.0044","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0044","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141854597","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 simple technique for checking nipple height in breast reduction and mastopexy.","authors":"Ye Ru Chin, David Oliver","doi":"10.1308/rcsann.2024.0042","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0042","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141854589","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}