Annals of the Royal College of Surgeons of England最新文献_第10页

A multicentre audit of costs, plastic waste and CO₂-equivalent emissions of single-use items in flexible nasal endoscopy in UK ENT practice. 多中心审计成本，塑料废物和二氧化碳当量排放的一次性使用项目在英国耳鼻喉科灵活鼻内窥镜的做法。

IF 1.7 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2026-06-01 DOI: 10.1308/rcsann.2025.0114

S Sheik-Ali, R Moorthy

{"title":"A multicentre audit of costs, plastic waste and CO2-equivalent emissions of single-use items in flexible nasal endoscopy in UK ENT practice.","authors":"S Sheik-Ali, R Moorthy","doi":"10.1308/rcsann.2025.0114","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0114","url":null,"abstract":"Background: In 2024, ENT UK published national guidance on sustainable practice during flexible nasal endoscopy (FNE), recommending minimisation of nonessential disposable items based on evidence-based literature. Despite these recommendations, anecdotal evidence suggests continued widespread use.Methods: A cross-sectional audit across six NHS hospitals surveyed ENT clinicians on their use of gloves, aprons, surgical masks, lubricants and anti-fog agents during FNE, as well as reasons for usage. Data were extrapolated to estimate annual cost, plastic waste and greenhouse gas emissions expressed as CO2-equivalent (CO2 eq.). Results were benchmarked against ENT UK's 2024 sustainability guidance. A supplementary qualitative questionnaire was analysed using reflexive thematic analysis to explore clinician reasoning.Results: Extrapolated annual expenditure on single-use items ranged from £7,942 to £12,634 across the region. At a single institution (Wexham Park Hospital), estimated annual waste was 135kg of plastic and 404kg CO2 eq., scaling to 7,389kg of plastic and 22,301kg CO2 eq. across all six hospitals. Significant variability and frequent noncompliance with national guidance were observed. Key drivers included entrenched departmental habits, cautious interpretations of infection control policies and limited dissemination of sustainability guidance.Conclusions: Single-use items in FNE practice across multiple hospitals diverge markedly from national recommendations, resulting in measurable financial costs, plastic waste and CO2 eq. emissions. These findings underscore the need for targeted, system-level interventions - including education, policy integration and behaviour-change strategies - to align ENT practice with sustainable healthcare objectives.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136594","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}

引用次数: 0

A novel Beath Pin-assisted technique for transosseous extensor mechanism repair. 一种新的Beath针辅助技术用于经骨伸肌机制修复。

IF 1.7 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2026-05-22 DOI: 10.1308/rcsann.2026.0047

A J Garner

引用次数: 0

Using Ametop gel as urethral anaesthetic for short urological procedures in women. 阿米托普凝胶用于女性短时间泌尿外科手术的尿道麻醉。

IF 1.7 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2026-05-21 DOI: 10.1308/rcsann.2026.0046

R Karanjia, Z Irfan, S Tadtayev

引用次数: 0

When is it best to remove a catheter: risk factors for catheter-related emergency room visits and failure of ex-catheterisation. 何时拔除导管是最好的：导管相关急诊就诊的危险因素和拔管失败。

IF 1.7 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2026-05-21 DOI: 10.1308/rcsann.2026.0035

M Elsweefy, A Patel, N Sharma, P Bassett, D Batura

{"title":"When is it best to remove a catheter: risk factors for catheter-related emergency room visits and failure of ex-catheterisation.","authors":"M Elsweefy, A Patel, N Sharma, P Bassett, D Batura","doi":"10.1308/rcsann.2026.0035","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0035","url":null,"abstract":"Objectives: We aimed to evaluate the nature and timing of catheter-related complications, identify factors influencing trial without catheter (TWOC) outcomes and determine a preferred interval to TWOC.Methods: Data from 672 patients referred for TWOC over 16 months included patient demographics, indication for catheterisation, urological history, interval to TWOC and TWOC outcome. Complication-free survival was assessed using Kaplan-Meier methods, predictors of complications by Cox regression, and factors associated with TWOC outcome by univariable and multivariable logistic regression.Results: The indication for catheterisation significantly influenced complication risks; patients catheterised for urinary retention were most likely to present with complications (p=0.02). No association was observed between TWOC timing and attendance at Accident and Emergency. Descriptive analysis demonstrated a substantial increase in complications from 6.9% at 7 days to 57% at 28 days postcatheterisation. TWOC success was unaffected by timing. Independent predictors of TWOC failure included age, sex and indication for catheterisation. Each ten-year increase in age was associated with a 24% higher risk of failure. Women were more likely to fail TWOC than men, and failure rates were highest in patients catheterised for urinary retention. In contrast, younger patients catheterised for monitoring or following surgery demonstrated more favourable outcomes.Conclusions: Catheter-related complications occur most frequently within four weeks, suggesting TWOC within this timeframe. Older age, female sex and urinary retention as the cause for catheterisation are associated with greater risks of failure. Catheterisation in these groups should therefore be reserved for strict indications. Younger and postoperative patients may undergo TWOC once clinically safe.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147980083","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}

引用次数: 0

Severe splenic injury following elective colonoscopy: case illustrations and practice-informed insights from published experience. 选择性结肠镜检查后的严重脾损伤：病例说明和来自已发表经验的实践见解。

IF 1.7 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2026-05-21 DOI: 10.1308/rcsann.2026.0036

O Oyeniyi, U Srinivasan, R Aseem, T Rockall

{"title":"Severe splenic injury following elective colonoscopy: case illustrations and practice-informed insights from published experience.","authors":"O Oyeniyi, U Srinivasan, R Aseem, T Rockall","doi":"10.1308/rcsann.2026.0036","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0036","url":null,"abstract":"Introduction: Splenic injury following colonoscopy is a rare but potentially life-threatening iatrogenic complication. Recognition is often delayed because symptoms are nonspecific, and evidence guiding management remains fragmented.Methods: We report two contrasting contemporary cases, one managed successfully with splenic artery embolisation (SAE) and one requiring splenectomy for haemorrhagic control, illustrating the spectrum of clinical presentation and management. To contextualise these cases, we conducted a denominator-aware synthesis of 129 published cases meeting inclusion criteria. The mean patient age was 65.8 years (range 33-88), and 69.8% were female. Most patients (88.7%) presented within 24h of colonoscopy, although delayed cases occurred. Splenectomy was performed in 58.9% of cases, SAE in 10.1%, and conservative management in 33.3%, with an overall mortality of 5.5% among cases with reported outcomes.Findings: Haemodynamic instability was strongly associated with operative treatment (odds ratio 9.11, 95% confidence interval 3.65-22.76), and splenectomy rates increased stepwise with higher computed tomography (CT) injury grades. Among haemodynamically stable patients, SAE was frequently definitive, avoiding splenectomy in all treated cases. These associations align with established trauma principles - management should be guided primarily by haemodynamic status. Early contrast-enhanced CT enables diagnosis and grading, while nonoperative management including SAE offers spleen-preserving control in stable patients.Conclusion: Splenic injury should be considered in any patient presenting after colonoscopy with abdominal pain, shoulder pain or haemodynamic disturbance. Early imaging, haemodynamic-based decision making, and appropriate follow-up can improve recognition, enable spleen preservation and reduce morbidity.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147980123","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}

引用次数: 0

Litigation in urology within NHS England: a contemporary analysis of costs and causes. 诉讼在泌尿外科NHS英格兰：成本和原因的当代分析。

IF 1.7 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2026-05-21 DOI: 10.1308/rcsann.2026.0032

P Nikolinakos, N I Osman, M Eldaneen, A Muneer, H M Alnajjar, K H Pang

{"title":"Litigation in urology within NHS England: a contemporary analysis of costs and causes.","authors":"P Nikolinakos, N I Osman, M Eldaneen, A Muneer, H M Alnajjar, K H Pang","doi":"10.1308/rcsann.2026.0032","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0032","url":null,"abstract":"Introduction: Urology is a moderate to high-risk specialty associated with complex procedures. Medicolegal claims provide valuable insight into recurring clinical vulnerabilities. This study aims to provide an updated national evaluation of litigation in adult urology in National Health Service England (the NHS) by examining long-term trends, financial implications and the underlying causes of successful claims over a 19-year period.Methods: Data on annual number of claims, proportion of successful outcomes, damages awarded and legal costs were obtained from NHS Resolution for the period 2006/2007 to 2024/2025. Descriptive analysis was performed to characterise changes over time and identify recurrent risk areas.Results: Between 2006/2007 and 2024/2025, 4,381 litigation claims were reported of which 2,741 (62.57%) were successful. Damages totalled £171.46 million over the period, rising from £1.66 million in 2006/2007 to £12.64 million in 2024/2025 (a 7.6-fold increase). The total number of claims increased by 2.2-fold and successful claims increased by 2.77-fold. Non-operative issues accounted for the majority of upheld claims (75.63%; 2,073 of 2,741), frequently due to failure/delay in treatment (21.05%; 577 of 2,741) or diagnosis (13.97%; 383 of 2,741). Operative causes represented 23.06% (632 of 2,741). The most common primary injuries documented were unnecessary pain (19.56%; 536 of 2,741) or additional/unnecessary operations (14.99%; 411 of 2,741).Conclusions: A progressive increase over time is apparent in both total and successful litigation claims within NHS England. Most claims stem from non-operative issues, probably influenced by extended NHS waiting lists. Continued clinician training, learning from avoidable errors, and ongoing monitoring, are essential to identify emerging risks, improve outcomes and reduce medicolegal costs.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147980152","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}

引用次数: 0

The NHS carbon footprint of paediatric tonsillectomies. 儿童扁桃体切除术的NHS碳足迹。

IF 1.7 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2026-05-19 DOI: 10.1308/rcsann.2025.0102

O Turner, S Elhag, H Ismail-Koch, A Aarvold

{"title":"The NHS carbon footprint of paediatric tonsillectomies.","authors":"O Turner, S Elhag, H Ismail-Koch, A Aarvold","doi":"10.1308/rcsann.2025.0102","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0102","url":null,"abstract":"Background: Single-use waste is prevalent in many surgical procedures; it is also a contributor to carbon emissions released during surgery. With high-frequency procedures such as coblation tonsillectomy and adenotonsillectomy it is important that we promote and implement sustainable practices going forward and explore ways of reducing single-use waste. We aimed to investigate the carbon footprint produced postoperatively by the waste and management of the waste from single-use, nonbiosafe, nonrecyclable items used in paediatric coblation tonsillectomy and adenotonsillectomy, hoping to raise awareness and provoke conversation about the vast amount of waste produced.Methods: Procedure-specific, single-use, nonrecyclable intraoperative waste was collected and weighed following paediatric intracapsular coblation tonsillectomy and adenotonsillectomy at our institution. Information regarding the production and waste management pathway was collected and carbon dioxide equivalent (CO2e) conversion factors from a variety of sources were applied.Results: On average, 1.13kg of single-use postoperative waste was collected per procedure. Extrapolated annually, matching ∼200 paediatric tonsillectomy and adenotonsillectomies that take place in our institution, waste amounted to 225.66kg. Overall, 4.36kg of CO2e, was produced from single-use nonrecyclable nonbiosafe waste from a paediatric intracapsular coblation tonsillectomy or adenotonsillectomy. Annually, in our institution, this amounts to 867kgCO2e.Conclusions: Given the threat to public health posed by climate change, efforts should be made to reduce the unsustainable practice of regularly using single-use instruments. This should be done by surgeons and manufacturers, especially in high-frequency procedures like coblation tonsillectomy and adenotonsillectomy.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147969963","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}

引用次数: 0

Gastric volvulus associated with congenital diaphragmatic hernia. 胃扭转伴先天性膈疝。

IF 1.7 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2026-05-19 DOI: 10.1308/rcsann.2026.0026

A Tahira, D Dass, A Kirby, L Middleton, A McCabe, P Cullis

引用次数: 0

The musculoskeletal health of hip surgeons: a national study. 髋关节外科医生的肌肉骨骼健康：一项全国性研究。

IF 1.7 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2026-05-19 DOI: 10.1308/rcsann.2025.0118

K Saravanan, M Ahmed, K E Gill, A K Gambhir, T N Board, K Malik-Tabassum

{"title":"The musculoskeletal health of hip surgeons: a national study.","authors":"K Saravanan, M Ahmed, K E Gill, A K Gambhir, T N Board, K Malik-Tabassum","doi":"10.1308/rcsann.2025.0118","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0118","url":null,"abstract":"Background: The forceful, repetitive nature of hip surgery places surgeons at elevated risk of musculoskeletal (MSK) injury. This study investigated the prevalence of MSK conditions among hip surgeons, assessing the relationship between workplace/lifestyle factors and overall MSK health.Methods: A cross-sectional study was conducted among consultant hip surgeons in the UK using an online survey comprising 22 questions. The survey was distributed to members of the British Hip Society, with 114 completed responses. Questions focused on the most commonly reported MSK conditions experienced by orthopaedic surgeons in previously published research. MSK burden was measured by the number of conditions reported per respondent.Results: Advancing age, greater years of surgical experience and higher operative workload were all associated significantly with increased MSK burden. Higher body mass index (BMI) was also linked to a greater prevalence of MSK conditions. In contrast, regular physical activity, regardless of type, was protective against MSK injury.Conclusions: This study demonstrates a high prevalence of MSK conditions among hip surgeons, with risk amplified by increased operative workload, age and BMI. Conversely, regular physical exercise was a significant protective factor. These findings underscore the role of both occupational and personal health factors in the development of MSK injuries. Greater attention must be paid to managing repetitive overuse injuries associated with surgical volume and promoting a culture of physical wellbeing in the orthopaedic community. Addressing these risk factors may reduce sickness absence, mitigate MSK burden, support healthier and longer careers, and ultimately improve surgical performance.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147969984","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}

引用次数: 0

Omitting the sentinel lymph node biopsy: a region's perspective following recommendations from the SOUND trial. 省略前哨淋巴结活检：根据SOUND试验建议的区域视角。

IF 1.7 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2026-05-19 DOI: 10.1308/rcsann.2026.0014

R Lowe, S Das Gupta, A Leiss, A Frank, D Banfield, R Llewellyn-Bennett, D Egbeare, A Hunter-Smith, L Crocker, H Mills

{"title":"Omitting the sentinel lymph node biopsy: a region's perspective following recommendations from the SOUND trial.","authors":"R Lowe, S Das Gupta, A Leiss, A Frank, D Banfield, R Llewellyn-Bennett, D Egbeare, A Hunter-Smith, L Crocker, H Mills","doi":"10.1308/rcsann.2026.0014","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0014","url":null,"abstract":"Introduction: Sentinel lymph node biopsy (SLNB) remains the standard of care for axillary staging in early breast cancer (BC). However, its associated morbidity has prompted interest in de-escalating axillary surgery. The SOUND and INSEMA trials demonstrated that patients with small tumours and negative preoperative axillary imaging could safely omit SLNB without compromising outcomes.Methods: This multicentre retrospective study evaluated whether SLNB influenced treatment decisions in our region in patients aged 70 years and above with small, invasive BC (<2cm) and negative preoperative axillary imaging. This study included 426 patients at six hospital trusts across the Southwest UK between 2019 and 2023. Information on histology, imaging and treatment decisions was obtained from electronic records.Results: The median age was 77 years; 362 patients (85.0%) had ER-positive, HER2-negative disease. Of the 426 patients, only 25 had their treatment altered as a result of their SLNB (four patients had an axillary node clearance, 19 had radiotherapy to their axilla and the other two patients underwent further investigations, eg, staging computed tomography scans). Twelve patients with positive lymph nodes were offered chemotherapy, of which six declined. The aggregate positive predictive value was 94.1% (95% CI 91.9%-96.4%), which was generally consistent across receptor subgroups.Conclusions: Our data are concordant with the SOUND trial, which suggests that SLNB could have been omitted safely in patients with early BC and negative preoperative imaging of the axilla; however, our data cannot confer safety. By implementing SLNB omission across our region we hope to reduce surgical morbidity while providing safe, evidence-based treatment.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147969992","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}

引用次数: 0