Annals of the Royal College of Surgeons of England最新文献_第5页

Have changes in colorectal surgery training impacted on mortality in cancer patients? A retrospective cohort study of 51,562 procedures. 结直肠手术培训的变化对癌症患者的死亡率有影响吗？对 51,562 例手术的回顾性队列研究。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2024-09-03 DOI: 10.1308/rcsann.2024.0059

A G Taib, Z Patel, A Kler, C A Maxwell-Armstrong

{"title":"Have changes in colorectal surgery training impacted on mortality in cancer patients? A retrospective cohort study of 51,562 procedures.","authors":"A G Taib, Z Patel, A Kler, C A Maxwell-Armstrong","doi":"10.1308/rcsann.2024.0059","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0059","url":null,"abstract":"Introduction: The aim of this study was to explore whether there were any differences in consultant colorectal surgeon training and adjusted 90-day postoperative colorectal cancer mortality rates (AMR).Methods: We undertook a retrospective analysis of outcomes data published on the Association of Coloproctology of Great Britain and Ireland (ACPGBI) website. A total of 51,562 procedures for patients in England diagnosed with large bowel cancer between 2010 and 2015, registered under 551 consultants were included. Consultants were split into two cohorts. The first group were the pre-Calman Trained Consultants (pre-CTr), who completed their training before 1998. The second group-the post-Calman Trained Consultants (post-CTr)-included those who received their Certificate of Completion of Training (CCT) under the Calman Training Principles (CTC, 1998-2007) and the Modernising Medical Careers Curriculum (MMC, 2008 and onwards). The outcome measure was an AMR.Results: The pre-CTr cohort (n=84) consisted of 3.6% female colorectal consultants (n=3/84), whereas the post-CTr cohort (n=467) consisted of 14.3% female colorectal consultants (n=67/467) (p=0.006). In this cross-sectional analysis over 5 years, the average pre-CTr undertook a greater number of colorectal resections than their post-CTr peers: median procedures (interquartile range, IQR): 104 (59) vs 89 (57) respectively, p=0.008. The median AMR was significantly greater among pre-CTrs compared with post-CTrs, median AMR (IQR): 2.7% (2.0) vs 2.1% (2.9), p=0.022.Conclusions: These data indicate that the implementation of the MMC and Calman training principles for colorectal training is associated with a statistically lower AMR compared with other historical training periods. This merits further exploration.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142118847","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

Patient-reported outcomes following surgery for adolescent idiopathic scoliosis performed in adolescence versus adulthood. 青少年特发性脊柱侧凸手术在青少年时期与成年期进行比较后的患者报告结果。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2024-09-03 DOI: 10.1308/rcsann.2024.0067

A Lloyd, I Harding, A Cole, A Gardner

{"title":"Patient-reported outcomes following surgery for adolescent idiopathic scoliosis performed in adolescence versus adulthood.","authors":"A Lloyd, I Harding, A Cole, A Gardner","doi":"10.1308/rcsann.2024.0067","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0067","url":null,"abstract":"Introduction: The Scoliosis Research Society 22r (SRS-22r) questionnaire is a proven tool in assessing healthcare-related quality of life (HRQoL) in idiopathic scoliosis and is the adopted patient-reported outcome measure for the deformity pathway recorded into the British Spinal Registry (BSR). Surgery for adolescent idiopathic scoliosis (AIS) is performed frequently in teenagers; however, patients also present with curves in the surgical range into adulthood. This work aimed to assess HRQoL differences between patients following surgery for AIS performed in adolescence and adulthood using SRS-22r data collected from the BSR.Methods: An anonymised BSR search of pre- and postoperative SRS-22r scores for patients with diagnoses of AIS and adult idiopathic scoliosis was conducted. Data from all subdomains were compared preoperatively and at the two-year postoperative timepoint.Results: Preoperative SRS-22r scores were analysed for 1,912 patients with AIS and 65 with adult idiopathic scoliosis. Patients with adult idiopathic scoliosis had significantly lower preoperative SRS-22r scores in all subdomains (p<0.05). By two years postoperatively, both groups of patients had improved SRS-22r scores significantly compared with baseline in all subdomains (p<0.001). A cross-group analysis revealed patients with AIS had significantly better function scores years postoperatively than their adult counterparts (p=0.005).Conclusions: This work confirms there are benefits following surgery for AIS in improving HRQoL, but has also provided HRQoL data in adult patients, who again show similar improvements following surgery from baseline. This is of value when counselling patients regarding anticipated benefits of surgery performed in childhood and adulthood.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142118849","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

Carbon savings associated with changing surgical trends in total knee arthroplasty in England: a retrospective observational study using administrative data. 英格兰全膝关节置换术手术趋势变化带来的碳节约：一项利用行政数据进行的回顾性观察研究。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2024-09-03 DOI: 10.1308/rcsann.2024.0035

E Ojelade, J Koris, H Begum, M Van-Hove, Twr Briggs, W K Gray

{"title":"Carbon savings associated with changing surgical trends in total knee arthroplasty in England: a retrospective observational study using administrative data.","authors":"E Ojelade, J Koris, H Begum, M Van-Hove, Twr Briggs, W K Gray","doi":"10.1308/rcsann.2024.0035","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0035","url":null,"abstract":"Background: Best practice pathways for common surgical procedures, including total knee arthroplasty (TKA), have the potential to improve patient outcomes and reduce carbon emissions. We aimed to estimate the reduction in carbon emissions due to changing trends in the care of patients undergoing TKA in England.Methods: This was a retrospective analysis of Hospital Episode Statistics data from 1 April 2013 to 31 March 2022 on adults undergoing elective primary TKA in England. The carbon footprint for each patient was calculated using carbon factors for multiple steps in the pathway, including ipsilateral knee arthroscopies in the year preceding the TKA, outpatient attendances, the index TKA, revisions of the TKA performed within 180 days of the index procedure, length of hospital stay and emergency readmissions.Results: A total of 648,861 TKA operations were identified. Over the study period, the median length of stay reduced from four to three days, the proportion of patients undergoing ipsilateral knee arthroscopies performed within a year before TKA surgery fell from 5.9% to 0.5% and the number of early revisions and emergency readmissions also fell. The per-patient carbon footprint reduced from 378.8kgCO2e to 295.2kgCO2e over this time. If all the study patients had the same carbon footprint as the average patient in 2021/2022, 32.4kilotons CO2e would have been saved, enough to power 29,509 UK homes for one year.Conclusions: Practices that were introduced primarily to improve patient outcomes can contribute to a reduction in the carbon footprint.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142118846","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

Peripheral giant cell granuloma: a case series and brief review. 周围巨细胞肉芽肿：一个病例系列和简要回顾。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2024-09-01 Epub Date: 2023-06-27 DOI: 10.1308/rcsann.2023.0021

S Fligelstone, D Ashworth

引用次数: 0

The glove hand: an innovative method for effective bedside preoperative flap planning in hand injuries. 手套手：一种有效的手部损伤床边术前皮瓣规划的创新方法。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2024-09-01 Epub Date: 2023-10-16 DOI: 10.1308/rcsann.2023.0068

J Kamath, S S Baliga, L Leo

引用次数: 0

Debridement, antibiotics and implant retention (DAIR) following hip and knee arthroplasty: results and findings of a multidisciplinary approach from a non-specialist prosthetic infection centre. 髋关节和膝关节置换术后清创、抗生素和植入物保留(DAIR):来自非专业假体感染中心的多学科方法的结果和发现。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2024-09-01 Epub Date: 2023-11-20 DOI: 10.1308/rcsann.2023.0076

F Awad, J Boktor, V Joseph, M H Lewis, C Silva, S Sarasin, P M Lewis

{"title":"Debridement, antibiotics and implant retention (DAIR) following hip and knee arthroplasty: results and findings of a multidisciplinary approach from a non-specialist prosthetic infection centre.","authors":"F Awad, J Boktor, V Joseph, M H Lewis, C Silva, S Sarasin, P M Lewis","doi":"10.1308/rcsann.2023.0076","DOIUrl":"10.1308/rcsann.2023.0076","url":null,"abstract":"Introduction: Prosthetic joint infection (PJI) is a catastrophic complication following arthroplasty surgery. Recently a debridement, antibiotics and implant retention (DAIR) procedure has gained popularity for PJI where a thorough debridement, irrigation and modular component exchange is undertaken.Method: We present the outcome for DAIR, data collected prospectively, in a busy orthopaedic unit but not one specialising in PJI. All patients with PJI were included without loss of data or patients from 2012 to 2018 with a minimum follow-up of 5 years.Results: Four total knee replacements, 17 total hip replacements, one revision total hip replacement and three hip hemiarthroplasties are included with an average duration from onset of symptoms to the DAIR procedure of 11 days (range 1-22 days). Staphylococcus aureus (24%) and Staphylococcus epidermidis (32%) were the most common causative organisms, and the most common antibiotic regimens included intravenous teicoplanin and flucloxacillin. Average follow-up was 67 months (range 9-104 months). Only four patients went on to require revision surgery. An analysis of midterm patient outcome measures for 6 of the total hip replacement (THR) DAIR patients were compared with a database of 792 THRs (with a minimum two-year follow-up) carried out by the same surgeon revealed no significant difference in Oxford hip scores at one-year post-surgery (OHS DAIR 36.2 vs 39 for control group).Conclusion: This study includes 25 consecutive patients treated with DAIR with only one reinfection, with a mean follow-up period of 5 years. Using a strict protocol, DAIR appears to offer a successful treatment strategy for the management of early PJI.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"633-641"},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11365729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138046060","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}

引用次数: 0

Institution within institution. 机构内的机构。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2024-09-01 DOI: 10.1308/rcsann.2024.0080

B Rogers

引用次数: 0

Evaluation of outcomes and utility of abdominal aortic aneurysm surveillance in octogenarians and nonagenarians. 评价八九十岁和九十岁老人腹主动脉瘤监测的结果和效用。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2024-09-01 Epub Date: 2023-12-01 DOI: 10.1308/rcsann.2023.0089

I T Nasir, S S Shoab, M G Bani-Hani

{"title":"Evaluation of outcomes and utility of abdominal aortic aneurysm surveillance in octogenarians and nonagenarians.","authors":"I T Nasir, S S Shoab, M G Bani-Hani","doi":"10.1308/rcsann.2023.0089","DOIUrl":"10.1308/rcsann.2023.0089","url":null,"abstract":"Introduction: The aim of this study was to evaluate the utility of our regional abdominal aortic aneurysm (AAA) screening programme in octogenarians and nonagenarians. This was to help decide whether discontinuation might be appropriate in certain instances. Primary outcomes were the number of patients who reached threshold (5.5cm) and the number where intervention was offered. Secondary outcome was cost effectiveness.Methods: A retrospective review of a regional AAA surveillance database was carried out to evaluate outcomes. Data collected included patient age, sex, date of first and last scan, initial and latest size of aneurysm, outcome, time under surveillance and total number of scans. Patients were divided into three groups (80-84 years, 85-89 years and 90+ years).Results: The number of patients in this age group was 354. Only 2.0% (n=7) of patients underwent intervention. Threshold size was achieved in 8.3% (n=18), 14.8% (n=18) and 26.7% (n=4), in the age groups 80-84 years, 85-89 years and 90+ years, respectively. Of these patients, operative intervention was possible in 2.8% (n=6), 0.8% (n=1) and 0% (n=0), respectively.Conclusion: A relatively small number of octogenarians and nonagenarians reach the threshold size during surveillance. An even smaller proportion require repair of their aneurysm. While there may be a role for AAA surveillance in octogenarians in highly selected groups, these data should inform the discussions made with individual patients. It should also inform future evaluation of such surveillance.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"642-646"},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11365734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138457465","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}

引用次数: 0

Review of the national usage of antibiotics in arthroplasty surgery: a need for evidence-based prescribing. 审查关节置换手术中抗生素的全国使用情况：循证处方的必要性。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2024-09-01 Epub Date: 2023-06-29 DOI: 10.1308/rcsann.2022.0145

H Hassanzadeh, A Ferro, K Woods, T Baring

{"title":"Review of the national usage of antibiotics in arthroplasty surgery: a need for evidence-based prescribing.","authors":"H Hassanzadeh, A Ferro, K Woods, T Baring","doi":"10.1308/rcsann.2022.0145","DOIUrl":"10.1308/rcsann.2022.0145","url":null,"abstract":"Introduction: Surgical site infections (SSI) remain one of the most serious complications of arthroplasty surgery. The role of antibiotic prophylaxis in preventing SSI post-arthroplasty is well established. However, there is considerable heterogeneity in prophylactic prescribing across the United Kingdom (UK), which is contradicted by the contemporaneous evidence. This descriptive study aimed to compare the current first-line antibiotic recommendations across hospitals in the UK and The Republic of Ireland for elective arthroplasty procedures.Methods: The MicroGuide mobile phone application was used to access hospital antibiotic guidelines. First-line antibiotic recommendation and dosing regimen for primary elective arthroplasties were recorded.Findings: A total of nine distinct antibiotic regimens were identified through our search. The most frequently used first-line antibiotic was cefuroxime. This was recommended by 30 of the 83 (36.1%) hospitals in the study. This was followed by a combination of flucloxacillin and gentamicin, which was used by 38 of 124 (31%) hospitals. There was also significant heterogeneity in dosing regimens. A single prophylactic dose was most commonly recommended (52%); 4% of hospitals recommended two prophylactic doses, 19% three doses and 23% four doses.Conclusions: Single-dose prophylaxis is recognised as at least noninferior to multiple-dose prophylaxis in primary arthroplasty. There is considerable variation in the local antibiotic recommendations for surgical site prophylaxis post-primary arthroplasty surgery, with respect to both recommended first-line antibiotic and dosing regimens. With increasing emphasis on the importance of antibiotic stewardship and the emergence of antibiotic resistance, this study highlights the need for an evidence-based approach to prophylactic dosing across the UK.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"628-632"},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11365728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9695201","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}

引用次数: 0

Colon cancer survival in the elderly without curative surgery. 未接受根治性手术的老年人结肠癌存活率。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2024-09-01 Epub Date: 2024-02-26 DOI: 10.1308/rcsann.2023.0059

J Franklyn, A Poole, I Lindsey

{"title":"Colon cancer survival in the elderly without curative surgery.","authors":"J Franklyn, A Poole, I Lindsey","doi":"10.1308/rcsann.2023.0059","DOIUrl":"10.1308/rcsann.2023.0059","url":null,"abstract":"Introduction: The aim of this study was to chart the natural history of elderly patients with colon cancer who are managed nonoperatively, with the primary outcome being life expectancy from diagnosis to death.Methods: This was a retrospective analysis of patients aged 80 years and above diagnosed with colon cancer in a tertiary care referral hospital in England between 1 January 2012 and 31 December 2017.Results: Thirty-two patients were diagnosed with non-metastatic colon cancer and managed non-operatively. The median age of patients in this study was 86 years. The group had a median Charlson Comorbidity Index of 7 (range 6-12) and the median frailty score was 6 (range 3-8). Progression to metastatic disease was identified in two patients; two further patients showed locoregional progression of cancer and therefore required palliative surgical intervention. Survival of these patients ranged from 105 to 1,782 days with a median life expectancy of 586 days. Place of death was identified in 15/31 patients: 4 (27%) died in hospital, 12 (38%) died at home and 15 (47%) died in a nursing or residential home; data were missing for 1 patient (3%).Conclusions: Nonoperative management of elderly patients with colon cancer yields reasonable life expectancy and a low risk of life-threatening local complications.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"592-595"},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11365724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139970812","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}

引用次数: 0