Annali italiani di chirurgia最新文献

{"title":"Evaluation of the Performance of an Innovative Model for the Organisation of Specialised Hospital Activities throughout Italy: The \"Diffuse Hospital\".","authors":"Mattia Morri, Cristiana Forni, Anselmo Campagna, Annella Mingazzini, Viola Damen, Manuela De Clerico, Elisa Carretta, Guglielmo Celli, Matteo Buccioli, Marika Tomasello, Gerardina Protupapa, Erik Boetto","doi":"10.62713/aic.3565","DOIUrl":"10.62713/aic.3565","url":null,"abstract":"<p><strong>Aim: </strong>The objective of the study is to evaluate the performance of an innovative model of hospital activity known \"Diffuse Hospital\" (DH) that involved 3 hospital wards/departments (A, B and C) located throughout Italy and the Reference Hospital (RH) that organised the construction of this model.</p><p><strong>Methods: </strong>An organisational retrospective observational study was conducted on the orthopaedic ward of each hospital from March 2022 to March 2023. Hospitals A, B and C had organisational differences in relation to the working relationship of healthcare professionals, the care pathways implemented, the presence or absence of an emergency department and the management of operating theatres. The primary indicator was the number of Diagnosis-Related Groups (DRGs) provided by the individual facilities. Additionally, a series of indicators were collected, and to enable comparison, these indicators were calculated in relation to the available resources.</p><p><strong>Results: </strong>The total number of DRGs provided by the DH was 3904, broken down into 1187 at Hospital A, 1851 at Hospital B and 866 at Hospital C. The RH comparison standard recorded 1603 DRGs. Hospital B showed higher DRG indicators of 39.7, 2.5 and 30.9 percentage points, respectively, than the RH. In relation to theatre activities and healthcare staff, Hospitals A and C revealed lower scores than the standard.</p><p><strong>Conclusions: </strong>The DH model may become a useful tool in healthcare policy strategies to enable national RHs to deliver treatments with high standards of care at a territorial level. The facilities involved in the DH organisational model produced different outcomes in terms of both efficiency and clinical outcomes. Where there is no direct management by the RH of healthcare staff, care pathways and operating theatres, replication of the standard is more difficult and outcomes are poorer. In the hospital where there is no need for emergency surgical activity and scheduling is concentrated within the week, better efficiency levels can be achieved.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 2","pages":"221-227"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432359","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 Efficacy of Ureteroscopic Pneumatic Lithotripsy and Holmium Laser Lithotripsy in Managing Ureteral Calculi: A Propensity Score Matching Analysis.","authors":"Li-Juan Yao, Hao Yang, Xiao Lv, Sheng-Jing Zhang","doi":"10.62713/aic.3986","DOIUrl":"https://doi.org/10.62713/aic.3986","url":null,"abstract":"<p><strong>Aim: </strong>This study aims to compare the clinical efficacy of ureteroscopic pneumatic lithotripsy (URPL) and ureteroscopic holmium laser lithotripsy (URHLL) in managing ureteral calculi (UC) using the propensity score matching (PSM) method.</p><p><strong>Methods: </strong>This retrospective study recruited 288 UC patients admitted to the Huzhou Traditional Chinese Medicine Hospital between October 2019 and October 2024. Based on the surgical procedure received, patients were divided into the URPL group (137 cases) and the URHLL group (151 cases). Clinical data such as gender, age, body mass index (BMI), stone location, affected side, maximum and minimum stone diameter, and the degree of hydronephrosis were collected for analysis. After 1:1 PSM matching, the surgical efficacy, perioperative parameters, oxidative stress indicators, renal function markers, and the occurrence of complications were comparatively analyzed between the two groups.</p><p><strong>Results: </strong>After PSM, 75 matching pairs were identified, and both the patient groups were found comparable for baseline characteristics. The URHLL group demonstrated significantly higher one-time gravel success and stone excretion rates (p < 0.05) and had significantly reduced operation time, less intraoperative blood loss, and shorter hospital stay (p < 0.05). After treatment, the URHLL group showed a minimal increase in oxidative stress indicators, a more pronounced decrease in renal function markers (p < 0.05), and a significantly lower overall complication rate (p < 0.05). However, no significant differences were found between the two groups regarding the re-operation rate and hospitalization costs (p > 0.05).</p><p><strong>Conclusions: </strong>URHLL is superior to URPL in managing UC, providing improved gravel-removal and stone-expulsion, more favorable perioperative outcomes, a reduced oxidative stress response, better renal function protection, and minimal complication rate.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 6","pages":"833-840"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301076","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":"Comparison of Efficacy and Safety of Endoscopic Breast-Conserving Surgery Versus Conventional Breast-Conserving Surgery in Elderly Patients With Breast Cancer: Insights From a Single-Center Retrospective Analysis.","authors":"Wei Zhang, Jundan Wang, Yun Xiong, Ying Hong","doi":"10.62713/aic.3989","DOIUrl":"https://doi.org/10.62713/aic.3989","url":null,"abstract":"<p><strong>Aim: </strong>Breast-conserving surgery (BCS) has been increasingly favored by elderly breast cancer patients to preserve their quality of life. This study compares the efficacy and safety of endoscopic versus conventional BCS in elderly patients, focusing on operative and aesthetic outcomes.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 261 elderly breast cancer patients (age ≥70) treated from January 2020 to January 2022. Patients were divided into endoscopic (n = 126) and conventional (n = 135) BCS groups. Surgical observations, complications, immune cell changes, adipokine levels, and survival rates were evaluated. Statistical analyses were performed using SPSS software.</p><p><strong>Results: </strong>Compared to the conventional BCS group, the endoscopic BCS group had significantly lower intraoperative blood loss (12.82 vs. 128.29 mL; p < 0.001), reduced hospitalization costs (13,289.74 vs. 16,032.41 Yuan; 1 Chinese Yuan ≈ 0.1385 US Dollars, p < 0.001), and shorter drainage duration (p = 0.002). The endoscopic BCS group reported superior aesthetic outcomes (66.67% rated as excellent vs. 50.37%; p = 0.047) and fewer surgical complications compared to the conventional BCS group, including lower rates of axillary pain, numbness, and arm swelling (p = 0.002, p = 0.002, and p = 0.008, respectively). No significant differences were observed in perioperative immune cell markers, adipokine levels, or survival outcomes between the groups.</p><p><strong>Conclusions: </strong>Endoscopic BCS offers advantages in reducing operative morbidity and enhancing aesthetic outcomes without compromising oncological safety for elderly patients.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 6","pages":"759-770"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301077","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":"Comparison of the Short-Term Quality of Life Changes of Patients Undergoing Orthognathic Surgery With Clear Aligners and Fixed Appliances: A Retrospective Study.","authors":"Hong Gu, Guifeng Li, Hui Zhang","doi":"10.62713/aic.4083","DOIUrl":"https://doi.org/10.62713/aic.4083","url":null,"abstract":"<p><strong>Aim: </strong>To assess and compare the short-term impact of clear aligners and fixed appliances on oral, psychological and physical health of patients undergoing orthognathic surgery.</p><p><strong>Methods: </strong>A total of 60 patients who underwent orthognathic surgery between 2021 and 2024 were invited to fill out questionnaires. These patients who were diagnosed with skeletal malocclusion and required a combined surgical and orthodontic treatment approach were divided into clear aligners (CA) and fixed appliances (FA) groups. Oral, psychological and physical health were used to evaluate the quality of life (QoL) multidimensionally by 36-item Short-Form Health Survey (SF-36) and 14-item Short-Form Oral Health Impact Profile (OHIP-14) at two time points: preoperative (T0) and 2 weeks postoperative (T1). Comparative analyses of OHIP-14 and SF-36 scores were conducted between the two cohorts.</p><p><strong>Results: </strong>The OHIP-14 total scores exhibited a notable increase from T0 to T1 in both the CA and FA groups, whereas the physical health summary (PCS) and mental health summary (MCS) scores decreased from T0 to T1. Significant differences in the OHIP-14 total scores, PCS and MCS (p < 0.0001) were observed between the two groups at T1, demonstrating better postoperative QoL in the CA group. Significant negative correlations between age and PCS were observed in both groups (r < -0.5, p < 0.0001) at T1. Age demonstrated significant correlation with MCS in the FA group (r < -0.5, p < 0.0001) at T1. A longer duration of presurgical orthodontics treatment was associated with higher OHIP-14 scores in the FA group (r > 0.3, p < 0.05) and lower MCS scores in both FA and CA groups (r < -0.3, p < 0.05).</p><p><strong>Conclusions: </strong>Compared to traditional orthodontics with fixed appliances, patients managed with clear aligners after orthognathic surgery had better oral, mental, and physical QoL.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 6","pages":"731-741"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301087","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":"Influencing Factors and Prediction Model of Postoperative Delirium for Elderly Femoral Neck Fracture Patients Under Remimazolam Intrathecal Anesthesia.","authors":"Xiufeng Liu, Zhitao Wu, Juan Liu","doi":"10.62713/aic.3927","DOIUrl":"https://doi.org/10.62713/aic.3927","url":null,"abstract":"<p><strong>Aim: </strong>This study aims to explore the factors affecting postoperative delirium (POD) in elderly femoral neck fracture (FNF) patients under intrathecal anesthesia with remimazolam and to construct a prediction model.</p><p><strong>Methods: </strong>A retrospective study was conducted on 140 eligible patients who were diagnosed with FNFs in our hospital from January 2022 to October 2024 and underwent surgical treatment under intrathecal anesthesia with remimazolam. All individuals were grouped into a delirium group and a non-delirium group according to the occurrence of POD. The included patients were randomly stratified into a training set and a validation set at a ratio of 7:3. Clinical data were collected, and influencing factors were screened using various statistical methods. A nomogram model was constructed to evaluate its performance.</p><p><strong>Results: </strong>Apparent differences between the groups were identified in glucose, lactate level, oxygen partial pressure (PO₂), Glasgow Coma Scale (GCS) result, and alcohol consumption. The key factors used in constructing the prediction model included glucose (odds ratio [OR] = 1.011, 95% confidence interval [CI]: 0.980-1.024, p = 0.056), lactate (OR = 1.726, 95% CI: 1.252-2.660, p = 0.003), PO₂ (OR = 0.988, 95% CI: 0.977-0.996, p = 0.007), GCS score (OR = 0.346, 95% CI: 0.184-0.550, p < 0.001), and alcohol consumption (OR = 3.140, 95% CI: 0.904-12.310, p = 0.081). The model exhibited favorable discriminative ability, with the training set having an area under the curve (AUC) of 0.882 (95% CI: 0.784-0.952) and the validation set an AUC of 0.941 (95% CI: 0.877-1.000). The calibration curve revealed a strong concordance between the predicted and actual values, suggesting good accuracy. Based on the decision curve analysis (DCA) curve, the model exhibited a remarkable capacity in predicting POD in both the training and the validation sets.</p><p><strong>Conclusions: </strong>The model constructed on the basis of multiple key influencing factors identified in this study was proved to be helpful for the early recognition of high-risk patients for POD, laying a foundation for personalized perioperative management to lessen the incidence of delirium and ameliorate the prognosis. However, this investigation has limitations, requiring optimization and improvement in the future.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 6","pages":"811-823"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301089","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":"Effect of Del Nido Cardioplegia Versus Plegisol Solution on Myocardial Protection in Cardiopulmonary Bypass.","authors":"Bişar Amaç, Ertuğrul Ertuğrul, Mustafa Abanoz, Mesut Engin","doi":"10.62713/aic.3817","DOIUrl":"https://doi.org/10.62713/aic.3817","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to compare the efficacy of the routinely used modified del Nido cardioplegia and Plegisol® solution in myocardial protection.</p><p><strong>Methods: </strong>In this retrospective study, patients who underwent cardiopulmonary bypass (CPB) guided cardiac surgery and received del Nido cardioplegia solution (Group 1) and Plegisol® solution (Group 2) were compared in terms of early clinical data and myocardial protection.</p><p><strong>Results: </strong>This study included 68 patients with similar demographic characteristics who received 38 modified del Nido cardioplegia and 30 Plegisol® solutions. Creatine kinase-myocardial bound (CK-MB) and cardiac troponin T (CTnT) levels on postoperative day 1 and CTnT levels on postoperative day 5 were higher in Group 2 and there was a significant difference between the groups (p = 0.025, p = 0.001, p = 0.001, respectively). In addition, the postoperative inotrope requirement and postoperative vasoactive-inotropic score were higher in Group 2 and there was a significant difference between the two groups (p = 0.004, p = 0.002, respectively).</p><p><strong>Conclusions: </strong>In this study, the del Nido cardioplegia solution was found to be more advantageous regarding the need for intracardiac defibrillation and myocardial necrosis, although it showed similar results in some points when compared with the Plegisol® solution.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 4","pages":"488-495"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960749","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 Study on Endometrial Polyps Recurrence Post-Hysteroscopic Resection: Identification of Influencing Factors and Development of a Predictive Model.","authors":"Zhuomin Wang, Tao Sun, Jian Xu","doi":"10.62713/aic.3622","DOIUrl":"10.62713/aic.3622","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to explore influencing factors and develop a predictive model of endometrial polyps (EP) recurrence after hysteroscopic resection.</p><p><strong>Methods: </strong>This retrospective study included 180 patients who underwent hysteroscopic resection for EP between January 2021 to December 2023. The patients were divided into a modeling group (n = 135) and a validation group (n = 45) in a 3:1 ratio. The patients in the modeling group were further divided into a recurrence group (n = 35) and a non-recurrence group (n = 100) based on whether their polyps recurred. General information on patients was compared between the two groups. Univariate and multiple logistic regression analyses were conducted to identify factors influencing EP recurrence post-hysteroscopic resection. A predictive model was developed, and the receiver operating characteristic (ROC) curve analysis was performed to determine the clinical utility of the model.</p><p><strong>Results: </strong>Comparison of baseline characteristics between the modeling and validation groups showed no statistically significant differences (p > 0.05). However, 35 patients in the modeling group had recurrence, while 12 patients experienced recurrence in the validation group. Binary logistics regression analysis revealed matrix metalloproteinase-9 (MMP-9)/tissue inhibitor of metalloproteinase-1 (TIMP-1), hypoxia-inducible factor-1α (HIF-1α) and platelet-derived growth factor (PDGF) as independent predictors for polyp recurrence (p < 0.05). Furthermore, a model formula, p = eZ/1 + eZ, was developed. The slope of the calibration curve of this model in both groups were straight lines close to 1, indicating that the model's predicted recurrence risk strongly agreed with the actual risk. ROC analysis demonstrated that the area under the curve in the modeling group was 0.902, with standard error of 0.028 (95% confidence interval (CI): 0.885-0.954). The model yielded the Youden value of 0.79, with a sensitivity of 82.96% and a specificity of 95.66%. Moreover, the area under the curve in the validation group was 0.871, with a standard error of 0.040 (95% CI: 0.859-0.920). However, the model showed the Youden value of 0.59, with a sensitivity of 79.29% and a specificity of 79.96%. The Decision Curve Analysis (DCA) demonstrated significant clinical advantages of the model.</p><p><strong>Conclusions: </strong>This study identified the influencing factors of EP recurrence and successfully constructed a predictive model based on these factors. After validation, the model demonstrates significant clinical utility.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 1","pages":"40-46"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999044","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":"Gastrointestinal Complications and Laparotomy after Cardiac Surgery: A Retrospective Cohort Study.","authors":"Thomas French, Dimitrios Damaskos, Darja Clinch, Charilaos-Panagiotis Koutsogiannidis","doi":"10.62713/aic.3819","DOIUrl":"10.62713/aic.3819","url":null,"abstract":"<p><strong>Aim: </strong>Gastrointestinal (GI) complications following cardiac surgery are infrequent, but associated with high rates of postoperative mortality. The aim of our study was to identify risk factors predisposing patients to GI complications following cardiac surgery and describe the outcomes of patients suffering a GI complication.</p><p><strong>Methods: </strong>This was a retrospective cohort study of 6769 consecutive patients undergoing cardiac surgeries (at least one of coronary artery bypass grafting (CABG), aortic valve replacement, mitral valve replacement, or surgery on thoracic aorta) at a single Scottish centre between 1 January 2015 and 27 September 2023. Cohort demographics, intra-operative details and postoperative outcomes were compared between patients who did and who did not experience a gastrointestinal GI complication.</p><p><strong>Results: </strong>Patients who experienced a GI complication had greater rates of thirty-day mortality (14.4% vs 2.4%, p < 0.001) and in-hospital mortality (6.8% vs 1.1%, p < 0.001) compared with those who did not. We identified previous percutaneous coronary intervention (PCI) (Odds ratio (OR) 2.27 [1.24-4.17], p = 0.007) and combined cardiac surgery (OR 1.67 [1.02-2.74], p = 0.043) as two risk factors for developing a GI complication, in addition to several previously identified risk factors (postoperative atrial fibrillation, postoperative vascular complication, use of pre-operative inotropes and increased age).</p><p><strong>Conclusions: </strong>GI complications frequently occur in elderly, co-morbid patients and in conjunction with other complications. Particularly lethal are mesenteric ischemia, GI bleeding, and small bowel obstruction. Extra caution should be observed in the patient group undergoing more than one cardiac procedure or those with a prior history of coronary artery disease. Prompt emergency laparotomy is a potentially life-saving intervention in promptly diagnosed patients, but confers a high risk of intra-operative and thirty-day mortality.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 3","pages":"409-420"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639426","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 Combining Ultrasound Parameter and the Caprini Score on Predicting Lower Extremity Deep Venous Thrombosis After Orthopedic Surgery.","authors":"Xi Chen, Yungwei Chi, Shengjun Ta, Li An, Fen Gu, Feng Tian, Ming Yan, Liwen Liu","doi":"10.62713/aic.3861","DOIUrl":"10.62713/aic.3861","url":null,"abstract":"<p><strong>Aims: </strong>This study combined a new ultrasound venous filling degree (VFD) parameter with the Caprini score to assess the clinical value of the Caprini score in predicting deep venous thrombosis (DVT) of the lower extremities.</p><p><strong>Methods: </strong>This retrospective study included 150 inpatients undergoing orthopedic lower extremity surgery at the First Affiliated Hospital of the Air Force Medical University between June 2023 and June 2024. They included 41 (27.3%) cases of knee arthroplasty, 32 (21.3%) hip arthroplasty, 30 (20%) knee arthroscopy, 28 (18.7%) lower limb fractures, 12 (8%) bone tumor, and 7 (4.7%) cases of other surgery types. The data collected involved preoperative vein diameter, flow velocity, blood flow, venous lumen cross-sectional perimeter (C), lumen cross-sectional area (A), C2/A ratio (VFD) of the common femoral vein (CFV), femoral vein (FV), and popliteal vein (POV). The postoperative sonographic parameters and clinical data were compared between the DVT and non-DVT groups. Receiver operating characteristic (ROC) curve of parameters was evaluated as predictive values for DVT. Additionally, the C2/A ratio was combined with the Caprini score to assess their combined impact on DVT prediction.</p><p><strong>Results: </strong>There were significant differences in ultrasound parameters of CFV inner diameter, CFV blood flow, CFV-C, CFV-A, CFV-C2/A, FV blood flow, FV-C, FV-C2/A, POV blood flow, POV-C, POV-A, and POV-C2/A between the DVT group (24.7%, 37/150) and the non-DVT group (75.3%, 113/150) (all p < 0 .05). Area under curve (AUC) for the C2/A (CFV, FV, and POV) were 0.939 (95% confidence interval (CI): 0.888-0.972, p < 0.001), 0.937 (95% CI: 0.886-0.970, p < 0.001), and 0.917 (95% CI: 0.861-0.956, p < 0.001), respectively. When the Caprini score >2, an AUC for predicting DVT was 0.844 (95% CI: 0.776-0.899, p < 0.001). The AUC of the Caprini score >2 combined with C2/A (CFV, FV, and POV) were 0.953 (95% CI: 0.905-0.981, p < 0.001), 0.965 (95% CI: 0.922-0.988, p < 0.001), and 0.948 (95% CI: 0.900-0.978, p < 0.001), respectively.</p><p><strong>Conclusions: </strong>The ultrasound parameter of VFD-C2/A shows a high predictive value for DVT in patients undergoing orthopedic surgery. Combined with the Caprini score, the predictive value of DVT may be further enhanced compared to using the Caprini score alone.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 3","pages":"380-390"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639428","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":"Appendectomy in the Training Program of General Surgery: Entrustable Professional Activity?","authors":"Anna Rossetto, Vittoria Morinelli, Davide Muschitiello, Rosanna Quattrin, Giovanni Terrosu, Vittorio Bresadola","doi":"10.62713/aic.3957","DOIUrl":"10.62713/aic.3957","url":null,"abstract":"<p><strong>Aim: </strong>The training of medical specialists is a decisive issue for the quality of medical practice. Autonomization in simple procedures and applying the peer education concept seem promising, particularly for general surgery. With this work, we wanted to assess whether there are differences between appendectomy operations performed by differently composed teams with the active involvement of resident doctors at a university centre.</p><p><strong>Methods: </strong>We retrospectively analyzed the laparotomies and laparoscopic appendicectomies carried out at the Udine Surgery Clinic over a period of 10 years. The interventions were divided into groups according to the experience of the surgical team that performed them: G1 (consultant), G2 (senior resident + consultant), G3 (junior resident + consultant), and G4 (junior resident + senior resident).</p><p><strong>Results: </strong>510 appendectomy procedures were considered for the present analysis. 214 (42.0%) were performed by G1, 139 (27.3%) by G2, 79 (15.5%) by G3 and 78 (15.3%) by G4 group. No difference between the groups was shown in terms of complications, reinterventions, readmissions, length of stay, and duration of surgery. A statistically significant difference was shown in the age of the observed population with respect to the degree of experience of the surgical teams: younger patients were mainly operated on by more experienced teams, and in particular, pediatric laparoscopic appendectomy was performed mainly by consultants.</p><p><strong>Conclusions: </strong>Appendectomy surgery can be performed by teams with varying levels of experience and is an example of an activity that can be used in Peer Education. It allows for the empowerment of younger residents and the autonomization of older residents in maintaining a medically, ethically, and legally correct standard of safe clinical practice.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 2","pages":"269-276"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432248","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}