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

{"title":"A quality improvement project of patient perception of AI-generated discharge summaries: a comparison with doctor-written summaries.","authors":"J Bass, C Bodimeade, N Choudhury","doi":"10.1308/rcsann.2025.0014","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0014","url":null,"abstract":"<p><strong>Introduction: </strong>Every patient admitted to hospital should receive a discharge letter when they leave. Artificial intelligence (AI) has the capability to fulfil this task. Here, we investigate the use of AI to generate discharge letters compared with letters written by a doctor.</p><p><strong>Methods: </strong>Using an AI tool, ChatGPT, we generated two discharge letters for hypothetical elective tonsillectomy patients. We asked the parents of paediatric tonsillectomy patients to blindly compare the AI letters with two anonymised real discharge letters for tonsillectomy patients, written by two ear, nose and throat (ENT) doctors. Participants were asked to rate the quality of medical information, the ease of reading and the length of each of the four discharge letters. They were also asked to deduce who they thought wrote each discharge letter (AI or a doctor).</p><p><strong>Results: </strong>Forty-seven parents responded to the survey. Our results demonstrate that the AI letters were reported to contain significantly better medical information (<i>p</i> = 0.0059) and were significantly easier to read than the doctor-written letters (<i>p</i> < 0.0001). Respondents had a 50% sensitivity in correctly identifying the letters written by AI.</p><p><strong>Conclusions: </strong>AI tools have the potential to write tonsillectomy discharge letters of comparable quality (as perceived by our participant population) to those written by ENT doctors. This study provides preliminary evidence to show that AI-generated discharge letters may be an interesting avenue of further investigation as an application for this tool.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771123","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":"Clinical significance and diagnostic approach for paediatric unilateral tonsillar enlargement: insights from a retrospective analysis.","authors":"A Nelson, I Bujoreanu, J Gaskin","doi":"10.1308/rcsann.2024.0113","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0113","url":null,"abstract":"<p><strong>Background: </strong>One of the debated indications for paediatric tonsillectomy is unilateral tonsillar enlargement (UTE). The majority of UTE is innocuous in nature; however, concerns exist around a diagnosis of lymphoma, typically found in the presence of other symptoms.</p><p><strong>Methods: </strong>A retrospective case series analysis of all paediatric tonsillectomy specimens at Bristol Children's Hospital between January 2006 and January 2023 was undertaken.</p><p><strong>Results: </strong>Four (1.3%) lymphoma diagnoses were identified from the 319 patients who underwent tonsillectomy for UTE. Three patients had localised disease and one patient had systemic infiltration of disease. All patients presented with other signs of malignancy including cervical lymphadenopathy (100%), alteration of appearance of tonsil including colour or visible lesion (75%), snoring (75%), dysphagia (50%), recurrent fever (25%) and weight loss (25%).</p><p><strong>Conclusions: </strong>We recommend active monitoring of asymptomatic isolated UTE. Diagnostic tonsillectomy should be performed in patients with UTE and cervical lymphadenopathy and/or constitutional symptoms and/or altered tonsillar appearance.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771126","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":"External validation of HAS model in predicting mortality after emergency laparotomy: a retrospective cohort study.","authors":"H Soliman, C Smith, J Mena, G T Yusuf, A H Helmy","doi":"10.1308/rcsann.2025.0021","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0021","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to externally validate the performance of the HAS model (Hajibandeh Index, American Society of Anaesthesiologists status, and sarcopenia) in predicting mortality after emergency laparotomy. We also aimed to compare the HAS model with the Parsimonious NELA (National Emergency Laparotomy Audit) risk score.</p><p><strong>Methods: </strong>In this retrospective cohort study, we included adult patients who underwent emergency laparotomy between January 2022 and June 2023. The performance of the HAS score and the NELA score in predicting 30-day mortality was compared using receiver operating characteristic (ROC) curve analysis. We performed subgroup analysis for the following age groups: age ≥50, age ≥60, age ≥70, and age ≥80 years.</p><p><strong>Findings: </strong>We included 117 patients in this study. ROC curve analysis showed that area under the curve (AUC) of the HAS score for 30-day mortality was 0.90 (95% CI 0.83-0.95). Although the AUC of HAS score was higher than the AUC of NELA score for all patients, this was not statistically significant (0.90 vs 0.80, <i>p</i>=0.097). AUC of the HAS score was superior to NELA score in patients aged ≥50 (0.89 vs 0.75, <i>p</i>=0.040), patients aged ≥60 (0.87 vs 0.69, <i>p</i>=0.020), patients aged ≥70 (0.85 vs 0.67, <i>p</i>=0.030), and patients aged ≥80 (0.90 vs 0.66, <i>p</i><0.001).</p><p><strong>Conclusions: </strong>The results of the current study support the external validity of the HAS model in predicting 30-day mortality after emergency laparotomy. Prospective studies with larger sample size are required.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771127","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":"Initial experience of benign upper gastrointestinal robotic-assisted surgery: first 200 cases and early postoperative outcomes.","authors":"K Greene, E J Nevins, T Akharaekpanya, S Bawa, L Horgan","doi":"10.1308/rcsann.2024.0093","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0093","url":null,"abstract":"<p><strong>Introduction: </strong>Robotic-assisted surgery is an alternative approach to minimally invasive surgery for benign upper gastrointestinal (UGI) conditions and abdominal wall hernia - its application in the United Kingdom is still in the initial phases in many National Health Service (NHS) trusts. We detail the experience of Northumbria Healthcare NHS Foundation Trust in implementing a robotic-assisted surgery service for benign UGI procedures and abdominal wall hernia repair.</p><p><strong>Methods: </strong>The robotic service for benign UGI was established in the trust in February 2022. All theatre staff received online and simulation training before working in the dedicated robotic surgery theatre. Operative timings, surgical outcome measures and patient outcomes including day-case rates were prospectively recorded and analysed to assess the impact of the introduction of this service.</p><p><strong>Results: </strong>Between February 2022 and June 2023, some 200 robotic-assisted procedures were performed: cholecystectomy (<i>n</i> = 103), hernia repair (<i>n</i> = 74), anti-reflux surgery (<i>n</i> = 9) and Heller's myotomy (<i>n</i> = 14). Median docking times were recorded: cholecystectomy, 9min (4-94min); hernia repair, 10min (4-50min); anti-reflux surgery, 19min (9-37min); and Heller's myotomy, 15min (6-26min). There were no intraoperative complications. Two patients returned to theatre for bile leak following cholecystectomy, presenting on day 2 and day 9 postoperatively.</p><p><strong>Discussion: </strong>Robotic-assisted benign UGI surgery can be safely performed in a day-case centre and does not impact day-case rates. There were no theatre delays because of prolonged docking times, even in the initial introductory period. There are higher costs associated with robotic-assisted surgery; however, with time and industry development, these are likely to improve.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143770869","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":"Trapeziectomy and ligament reconstruction tendon interposition: an in vivo, patient-controlled, biomechanical study relating to pinch grip.","authors":"H L Morley, M Argyropoulos, P Souroullas, Jaf Read","doi":"10.1308/rcsann.2024.0109","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0109","url":null,"abstract":"<p><strong>Introduction: </strong>Trapeziectomy and ligament reconstruction tendon interposition (LRTI) is a commonly used procedure in the management of first carpometacarpal osteoarthritis. Debate persists regarding the degree of biomechanical improvement following trapeziectomy and subsequently LRTI. This preliminary, single-centre, in vivo, biomechanical study addresses the biomechanical effect of LRTI following trapeziectomy at the time of surgery, with each participant acting as their own control.</p><p><strong>Methods: </strong>Trapeziectomy and LRTI were performed under wide-awake local anaesthetic with no tourniquet (WALANT) with a flexor carpi radialis (FCR) donor graft. Key pinch grip was assessed in each participant.</p><p><strong>Results: </strong>The surgical method that resulted in biomechanically the most significant decrease in grip strength compared with preoperative grip strength was trapeziectomy alone with a mean difference of 4.27kg, which was also statistically significant (Tukey's test <i>p</i><0.001). Mean post-WALANT key pinch grip strength was 6.4kg (sd 2.61); post LRTI the mean key pinch grip strength was 6.33kg (sd 2.63). Following the surgical procedure (trapeziectomy and LRTI) the mean key pinch grip strength was -0.1kg (95% confidence interval -0.93 to 0.81) (Tukey's test <i>p</i>=1), demonstrating no statistically significant difference between the two values. This indicates that LRTI restores pinch grip strength.</p><p><strong>Conclusions: </strong>Our preliminary research presents a novel method to evaluate for biomechanical advantages following trapeziectomy and LRTI. This supports the biomechanical advantages of FCR LRTI following trapeziectomy, at the time of surgery. There is scope for this research process to be applied more widely in future.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143770861","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":"Medium-term restenosis after carotid endarterectomy by patch type: a single-centre retrospective study comparing biological with synthetic patch materials.","authors":"M Power Foley, N Doolan, T Connelly, M P McMonagle","doi":"10.1308/rcsann.2024.0097","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0097","url":null,"abstract":"<p><strong>Introduction: </strong>Carotid endarterectomy (CEA) with patch angioplasty is associated with lower restenosis rates compared with primary closure alone. However, evidence regarding patch-material superiority in the mitigation against neointimal hyperplasia and restenosis is limited. This retrospective observational study investigated medium-term restenosis rates between commercially available biological and synthetic carotid patches.</p><p><strong>Methods: </strong>All primary CEA with patch angioplasty performed between 2007 and 2019 at a single university hospital were identified from theatre records. Restenosis was defined using the European Society for Vascular Surgery duplex criteria, either moderate (50-69%, PSV >213cm/s) or critical (70-99%, PSV >274cm/s). Chi-square tests and Kaplan-Meier curves were used to compare restenosis rates between biological (bovine pericardium) and synthetic patches (Dacron, PFTE and polyester-urethane).</p><p><strong>Results: </strong>Overall, 127 CEAs were included in the restenosis analysis. Bovine pericardium was the patch material used most frequently (60%, <i>n</i>=75). Median follow-up with duplex was 40.0 months (range 0-144). Moderate restenosis was detected in 14 CEAs (11%) and critical restenosis in 10 (7.8%). Compared with synthetic material, bovine was significantly associated with >50% restenosis but not >70% (<i>p</i>=0.042 and <i>p</i>=0.197, respectively). However, Kaplan-Meier curves demonstrated similar rates of >50% and >70% restenosis between patch types at five years (<i>p</i>=0.081 and <i>p</i>=0.080, respectively). There was no significant difference in peri-operative complication rates between patch types.</p><p><strong>Conclusions: </strong>These results indicate medium-term restenosis rates after CEA are similar between biological and synthetic patches. However, well-designed randomised control trials are required to definitively answer the question of which patch material is superior for carotid reconstruction.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143770840","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":"Amputations in adult burns patients: a 10-year retrospective study.","authors":"E Mathews, E Chipp","doi":"10.1308/rcsann.2024.0117","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0117","url":null,"abstract":"<p><strong>Introduction: </strong>Amputation is an uncommon but potentially life-changing complication of burns. No studies of amputation among UK burns patients currently exist.</p><p><strong>Methods: </strong>A 10-year review of burns patients with amputations at the Queen Elizabeth Hospital Birmingham was conducted. Descriptive analysis was undertaken to identify patient characteristics. Statistical analysis was conducted to identify relationships between patient and injury details and the number of amputations, and relationships between the number of amputations and patient outcomes.</p><p><strong>Results: </strong>Thirty-five adult burns patients (mean age 48.1 years, 65.7% male) were identified, 62.9% of whom suffered flame burns. The median total body surface area (TBSA) burned was 24%. The amputation risk among admitted burns patients was 1.2%. Major burns patients (≥25% TBSA burned) underwent more minor (<i>p</i>=0.018) and upper limb amputations (<i>p</i>=0.035) compared with minor burns patients. Median length of hospital stay was 67.5 days. Length of stay was positively correlated with the number of total (<i>p</i>=0.001), minor (<i>p</i>=0.004) and upper limb (<i>p</i>=0.002) amputations. In total, 67.6% of amputees underwent revisional procedures. The number of revisions was positively correlated with the number of major (<i>p</i>=0.010) and lower limb (<i>p</i>=0.001) amputations.</p><p><strong>Conclusions: </strong>A minority of adult burns patients underwent amputations. Patient and injury information may predict a greater number of amputations, which in turn may predict longer hospital stays and a requirement for more revisional procedures. This information could be used to better counsel patients about their likely outcomes. A multicentre case-control study is required to clarify risk factors for amputation in burns.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771124","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 modified guidewire reinsertion technique following inadvertent wire removal during dynamic hip screw fixation surgery.","authors":"M Wanderi, H Tanner, H A Al Hussainy","doi":"10.1308/rcsann.2024.0043","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0043","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771121","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":"Ten-year outcome of a dedicated hip fracture unit embedded within a level 1 major trauma centre.","authors":"B Ahmad, F Davis, G Chan, B A Rogers","doi":"10.1308/rcsann.2024.0094","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0094","url":null,"abstract":"<p><strong>Introduction: </strong>Fragility hip fracture (FHF) care has been revolutionised by the introduction of the best practice tariff and its associated quality assessment domains. However, increasing demands on trauma services, most notably in regional major trauma centres (MTC), have resulted in competing challenges for clinical resources. This study aims to identify whether a dedicated hip fracture unit (HFU) embedded within a trust hosting the regional MTC affords sustained improvements in clinical outcomes for FHFs.</p><p><strong>Methods: </strong>A 10-year retrospective cohort study was performed using a prospectively collected database that was cross-referenced against contemporary data submitted to the National Hip Fracture Database by a single multicentre National Health Service trust. The study period encompassed a 10-year period covering 5 years before and 5 years after formation of a dedicated HFU. The outcomes evaluated include time to surgery, length of hospital stay, discharge location and mortality.</p><p><strong>Results: </strong>Some 4,998 patients sustained FHFs: 2,387 patients (2,533 injuries) treated prior to formation of the HFU formation and 2,611 patients (2,813 injuries) treated after. The mean time to surgical intervention was significantly lower in the group treated at the HFU by 3.1 days (<i>p </i>< 0.001). Length of hospital stay was also significantly reduced at the HFU (<i>p </i>< 0.001). More patients were discharged back to their premorbid residence from the HFU (47% vs 40%). The 30- and 365-day mortality rates were significantly reduced at the HFU (<i>p </i>= 0.005 and <i>p </i>= 0.024, respectively).</p><p><strong>Conclusion: </strong>When embedded within an MTC, the HFU model is a sustainable operational structure in the medium term that provides clear clinical benefits and could be replicated nationally and internationally at similar institutions.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762621","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 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, On Behalf Of The Og Prehabilitation Group And Augis Association Of Upper Gi Surgeons","doi":"10.1308/rcsann.2024.0092","DOIUrl":"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":"300-306"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957842/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}