BJS Open最新文献

{"title":"Risk of malignancy in radiologically and cytologically discordant thyroid nodules, based on Thyroid Imaging, Reporting and Data System (TI-RADS) and Bethesda classifications.","authors":"Laura E Nicholls, Alexander Papachristos, Cici Guo, Adam Aniss, Anthony R Glover, Mark S Sywak, Stan B Sidhu","doi":"10.1093/bjsopen/zrad117","DOIUrl":"10.1093/bjsopen/zrad117","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10798822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139502158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Author response to: Comment on Prophylactic mesh augmentation after laparotomy for elective and emergency surgery: meta-analysis.","authors":"Simone Frassini, Paola Fugazzola, Lorenzo Cobianchi, Luca Ansaloni","doi":"10.1093/bjsopen/zrad130","DOIUrl":"10.1093/bjsopen/zrad130","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10805376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139541822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Textbook outcomes in the liver-first approach for colorectal liver metastases: prospective multicentre analysis.","authors":"José M Ramia, Celia Villodre-Tudela, Laia Falgueras-Verdaguer, Natalia Zambudio-Carroll, José T Castell-Gómez, Silvia Carbonell-Morote, Juan L Blas-Laina, Vicente Borrego-Estella, Belinda Sánchez-Pérez, Mario Serradilla-Martín","doi":"10.1093/bjsopen/zrad123","DOIUrl":"10.1093/bjsopen/zrad123","url":null,"abstract":"<p><strong>Background: </strong>Textbook outcome is a valuable tool for assessing surgical outcomes. The aim of this study was to analyse textbook-outcome rates in the prospective Spanish National Registry of the Liver-First Approach (RENACI Project) and the factors influencing textbook-outcome achievement. Additionally, a model for assessing a procedure-specific textbook outcome for the liver-first approach was proposed.</p><p><strong>Methods: </strong>A retrospective analysis of a prospective and multicentre database that included consecutive patients with colorectal cancers and synchronous liver metastases who underwent a liver-first approach between June 2019 and August 2020 was performed. Two types of textbook outcome were measured: classic textbook outcome and liver-first-approach-specific textbook outcome (which included negative margins, no perioperative transfusion, no postoperative major surgical complications, no prolonged length of hospital stay, no readmissions, no mortality, and full treatment completion). The primary endpoint was textbook-outcome rate for a liver-first approach at 90 days.</p><p><strong>Results: </strong>A total of 149 patients were included in the analysis. Classic and liver-first-approach-specific textbook-outcome rates were 71.8 per cent (107 patients) and 46 per cent (69 patients) respectively. Factors significantly associated with liver-first-approach-specific textbook-outcome achievement in the multivariable analysis were the number of metastases (OR 0.82 (95 per cent c.i. 0.73 to 0.92); P = 0.001) and intraoperative blood loss (OR 0.99 (95 per cent c.i. 0.99 to 1.00); P = 0.007). Prolonged length of hospital stay (33 patients, 41 per cent), positive margins (31 patients, 39 per cent), perioperative transfusion (27 patients, 34 per cent), and no full treatment completion (18 patients, 23 per cent) were the items that most frequently prevented liver-first-approach-specific textbook-outcome achievement.</p><p><strong>Conclusion: </strong>Liver-first-approach-specific textbook outcome is a promising tool for measuring the quality of care when using the liver-first approach for synchronous colorectal liver metastases.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10807998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139545535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal antiseptic skin preparation agents for minimizing surgical site infection following surgery: cost and cost-effectiveness analysis.","authors":"Simon Deeming, Xenia Dolja-Gore, Jon Gani, Rosemary Carroll, Natalie Lott, John Attia, Penny Reeves, Stephen R Smith","doi":"10.1093/bjsopen/zrad160","DOIUrl":"10.1093/bjsopen/zrad160","url":null,"abstract":"<p><strong>Background: </strong>The application of antiseptic skin agents prior to incision minimizes the rate of surgical site infection. Despite their ubiquity, the optimal skin preparation agent remains uncertain. A retrospective economic analysis was conducted to complement the results from the NEWSkin Prep trial which prospectively compared three preparation agents.</p><p><strong>Methods: </strong>A cost and cost-effectiveness analysis was performed from a healthcare service perspective to compare chlorhexidine with 70% ethanol, and aqueous povidone-iodine, against povidone-iodine with 70% ethanol. Resource use estimates accounted for hospital admissions, readmissions associated with surgical site infection, outpatient and general practitioner attendances, visits from community nurses and therapeutic consumables. The measure of effectiveness comprised the net difference in number of patients with surgical site infections per 1000 patients. Costs were compared using a two-sample Welch's t-test. Deterministic and probabilistic sensitivity analyses were performed to evaluate the incremental cost-effectiveness ratio.</p><p><strong>Results: </strong>The null hypothesis that the mean costs for the trial arms were significantly different was not rejected (Welch's t-test P value: 0.771 for chlorhexidine with 70% ethanol against povidone-iodine with 70% ethanol; and 0.955 for aqueous povidone-iodine against povidone-iodine with 70% ethanol). Based on bootstrap averages, the chlorhexidine with 70% ethanol intervention generated 8.0 fewer surgical site infections per 1000 patients and net cost savings of €151,698 (Euros) per 1000 patients compared with povidone-iodine with 70% ethanol, and aqueous povidone-iodine produced a net cost saving of €37,494 per 1000 patients but generated an additional 11.6 surgical site infections per 1000 patients compared with povidone-iodine with 70% ethanol. The comparison of chlorhexidine with 70% ethanol to povidone-iodine with 70% ethanol was sensitive to the inclusion of cost outliers, while the comparison of aqueous povidone-iodine to povidone-iodine with 70% ethanol was sensitive to the estimated cost per surgical site infection.</p><p><strong>Conclusion: </strong>Based on the outcomes from the NEWSkin Prep study, this economic analysis found no definitive evidence in favour of any one of the study comparators. Future model-based economic analyses of alternative skin preparations should critically address the quality of evidence and integrate the results from the NEWSkin Prep study.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10872689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139746006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The best of HPB in BJS Open 2023.","authors":"Giovanni Marchegiani","doi":"10.1093/bjsopen/zrae005","DOIUrl":"10.1093/bjsopen/zrae005","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10869211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139746007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for multimodal conservative approach failure before bariatric surgery.","authors":"Pia Jaeger, Marie Mortier, Ahmad Alhazmi, Marlon Gaeb, Metin Senkal","doi":"10.1093/bjsopen/zrad152","DOIUrl":"10.1093/bjsopen/zrad152","url":null,"abstract":"<p><strong>Background: </strong>A multimodal conservative approach (MCA) is internationally recommended prior to bariatric surgery for the majority of patients. This research aimed to identify risk factors for therapy failure within the MCA.</p><p><strong>Methods: </strong>This study was conducted in a German bariatric obesity centre. Patients who underwent a 3- to 6-month preoperative MCA from November 2019 to October 2020 were prospectively recorded and analysed. MCA included dietary and movement therapy, psychological and endocrinological referral and connection to a patient support group. The change in BMI was considered the main parameter for therapeutic success. Explanatory factors were evaluated for this outcome of interest and included physical and mental well-being (SF-36), perceived stress (DASS-21), social and economic situation and educational background (SOEP).</p><p><strong>Results: </strong>Out of 413 eligible patients, 209 were analysed. Overall, patients gained BMI (average gain 0.23 kg/m² (s.d. 1.44 kg/m²)) during the preoperative MCA. Diverse social, demographic and economic and health properties did not influence the course of the therapy. There was a significant positive correlation between successful loss of BMI and physical well-being (β = 0.03, 95% c.i. 0.01 to 0.04, P < 0.0001) and a negative correlation between mental well-being (β = -0.02, 95% c.i. -0.004 to -0.001, P = 0.001) as well as self-perceived stress (β = -0.05, 95% c.i. -0.09 to -0.01, P = 0.019), although these effects were small and did not affect the overall trend of gaining BMI during MCA.</p><p><strong>Conclusion: </strong>The current therapeutic approach of preoperative conservative treatment within the multimodal concept of bariatric treatment fails to achieve its intended outcome. A different conservative weight loss programme from the pre-bariatric setting, which should focus on a surgical preparation, is therefore recommended.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10848309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139696885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapeutic value of lymph node dissection for Siewert type II and III adenocarcinoma: meta-analysis.","authors":"Xiao-Dong Chen, Qing-Chuan Chen, Rui Xu, Fa-Zhi Zhao","doi":"10.1093/bjsopen/zrad138","DOIUrl":"10.1093/bjsopen/zrad138","url":null,"abstract":"<p><strong>Background: </strong>Adenocarcinoma of the oesophagogastric junction presents an increasing incidence. Surgical resection with lymphadenectomy is the only curative treatment modality at the present time, but the optimal extent of lymphadenectomy is debatable. The aim of the present meta-analysis was to estimate the therapeutic value of each nodal station.</p><p><strong>Methods: </strong>Studies reporting the therapeutic value index of each nodal station in Siewert types II/III oesophagogastric junction (EGJ) were searched in PubMed, Web of Science and Embase up to October 2022. This index was calculated by multiplication of metastatic incidence and 5-year overall survival rate at each nodal station. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies. Pooled metastatic incidence and therapeutic value index were calculated using RevMan 5.4.</p><p><strong>Results: </strong>Twelve studies involving 3513 patients were included. Nodes No. 3, 1, 7 and 2 were routinely dissected and achieved a high (≥10) or moderate (5-10) therapeutic value index in decreasing order, due to their high metastatic incidence and favourable survival rate. The index was relatively low (2-5) in suprapancreatic nodes No. 9, 11p and 8a. The index for nodes No. 4d and 10 was relatively low in Siewert type Ⅲ EGJ but very low (<2) in type Ⅱ. The index was very low for nodes No. 5, 6, 11d and 12a, due to their low metastatic incidence and poor survival if positive. Para-aortic, parahiatal and mediastinal nodes were dissected only in highly selected cases. Dissection of the lower mediastinal nodes, especially No. 110, could improve survival rates in type Ⅱ EGJ.</p><p><strong>Conclusion: </strong>These data could help assess the optimal extent of lymphadenectomy for EGJ. Nodes No. 1, 2, 3, 7, 8a, 9 and 11p need routine dissection in both Siewert types Ⅱ/Ⅲ EGJ; nodes around the lower oesophagus (especially No. 110) in Siewert type Ⅱ EGJ and nodes No. 4d and 10 in Siewert type Ⅲ EGJ might be considered for dissection.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10768987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139105733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Textbook Outcomes following emergency laparotomy: Delphi exercise.","authors":"David N Naumann, Aneel Bhangu, Adam Brooks, Matthew Martin, Bryan A Cotton, Mansoor Khan, Mark J Midwinter, Lyndsay Pearce, Douglas M Bowley, John B Holcomb, Ewen A Griffiths","doi":"10.1093/bjsopen/zrad145","DOIUrl":"https://doi.org/10.1093/bjsopen/zrad145","url":null,"abstract":"<p><strong>Background: </strong>Textbook outcomes are composite outcome measures that reflect the ideal overall experience for patients. There are many of these in the elective surgery literature but no textbook outcomes have been proposed for patients following emergency laparotomy. The aim was to achieve international consensus amongst experts and patients for the best Textbook Outcomes for non-trauma and trauma emergency laparotomy.</p><p><strong>Methods: </strong>A modified Delphi exercise was undertaken with three planned rounds to achieve consensus regarding the best Textbook Outcomes based on the category, number and importance (Likert scale of 1-5) of individual outcome measures. There were separate questions for non-trauma and trauma. A patient engagement exercise was undertaken after round 2 to inform the final round.</p><p><strong>Results: </strong>A total of 337 participants from 53 countries participated in all three rounds of the exercise. The final Textbook Outcomes were divided into 'early' and 'longer-term'. For non-trauma patients the proposed early Textbook Outcome was 'Discharged from hospital without serious postoperative complications (Clavien-Dindo ≥ grade III; including intra-abdominal sepsis, organ failure, unplanned re-operation or death). For trauma patients it was 'Discharged from hospital without unexpected transfusion after haemostasis, and no serious postoperative complications (adapted Clavien-Dindo for trauma ≥ grade III; including intra-abdominal sepsis, organ failure, unplanned re-operation on or death)'. The longer-term Textbook Outcome for both non-trauma and trauma was 'Achieved the early Textbook Outcome, and restoration of baseline quality of life at 1 year'.</p><p><strong>Conclusion: </strong>Early and longer-term Textbook Outcomes have been agreed by an international consensus of experts for non-trauma and trauma emergency laparotomy. These now require clinical validation with patient data.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141466049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tailored risk assessment and forecasting in intermittent claudication.","authors":"Bharadhwaj Ravindhran, Jonathon Prosser, Arthur Lim, Bhupesh Mishra, Ross Lathan, Louise H Hitchman, George E Smith, Daniel Carradice, Ian C Chetter, Dhaval Thakker, Sean Pymer","doi":"10.1093/bjsopen/zrad166","DOIUrl":"10.1093/bjsopen/zrad166","url":null,"abstract":"<p><strong>Background: </strong>Guidelines recommend cardiovascular risk reduction and supervised exercise therapy as the first line of treatment in intermittent claudication, but implementation challenges and poor patient compliance lead to significant variation in management and therefore outcomes. The development of a precise risk stratification tool is proposed through a machine-learning algorithm that aims to provide personalized outcome predictions for different management strategies.</p><p><strong>Methods: </strong>Feature selection was performed using the least absolute shrinkage and selection operator method. The model was developed using a bootstrapped sample based on patients with intermittent claudication from a vascular centre to predict chronic limb-threatening ischaemia, two or more revascularization procedures, major adverse cardiovascular events, and major adverse limb events. Algorithm performance was evaluated using the area under the receiver operating characteristic curve. Calibration curves were generated to assess the consistency between predicted and actual outcomes. Decision curve analysis was employed to evaluate the clinical utility. Validation was performed using a similar dataset.</p><p><strong>Results: </strong>The bootstrapped sample of 10 000 patients was based on 255 patients. The model was validated using a similar sample of 254 patients. The area under the receiver operating characteristic curves for risk of progression to chronic limb-threatening ischaemia at 2 years (0.892), risk of progression to chronic limb-threatening ischaemia at 5 years (0.866), likelihood of major adverse cardiovascular events within 5 years (0.836), likelihood of major adverse limb events within 5 years (0.891), and likelihood of two or more revascularization procedures within 5 years (0.896) demonstrated excellent discrimination. Calibration curves demonstrated good consistency between predicted and actual outcomes and decision curve analysis confirmed clinical utility. Logistic regression yielded slightly lower area under the receiver operating characteristic curves for these outcomes compared with the least absolute shrinkage and selection operator algorithm (0.728, 0.717, 0.746, 0.756, and 0.733 respectively). External calibration curve and decision curve analysis confirmed the reliability and clinical utility of the model, surpassing traditional logistic regression.</p><p><strong>Conclusion: </strong>The machine-learning algorithm successfully predicts outcomes for patients with intermittent claudication across various initial treatment strategies, offering potential for improved risk stratification and patient outcomes.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10898330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139970914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reactivation leakages following stoma reversal after rectal cancer surgery: an underestimated problem.","authors":"Kiedo Wienholts, Sarah Sharabiany, Johannes H W de Wilt, Roel Hompes, Pieter J Tanis","doi":"10.1093/bjsopen/zrad150","DOIUrl":"10.1093/bjsopen/zrad150","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10763996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139085763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}