BJS Open最新文献

{"title":"Nationwide prospective audit for the evaluation of appendicitis risk prediction models in adults: right iliac fossa treatment (RIFT)-Turkey.","authors":"Ali Yalcinkaya, Ahmet Yalcinkaya, Bengi Balci, Can Keskin, Ibrahim Erkan, Alp Yildiz, Erdinc Kamer, Sezai Leventoglu","doi":"10.1093/bjsopen/zrae120","DOIUrl":"10.1093/bjsopen/zrae120","url":null,"abstract":"<p><strong>Background: </strong>Appendicitis is the most prevalent surgical emergency. The negative appendicectomy rate and diagnostic uncertainty are important concerns. This study aimed to assess the effectiveness of current appendicitis risk prediction models in patients with acute right iliac fossa pain.</p><p><strong>Methods: </strong>A nationwide prospective observational study was conducted, including all consecutive adult patients who presented with right iliac fossa pain. Diagnostic, clinical and negative appendicectomy rate data were recorded. The Alvarado score, Appendicitis Inflammatory Response (AIR), Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Adult Appendicitis Score systems were calculated with collected data to classify patients into risk categories. Diagnostic value and categorization performance were evaluated, with use of risk category-based metrics including 'true positive rate' (percentage of appendicitis patients in the highest risk category), 'failure rate' (percentage of patients with appendicitis in the lowest risk category) and 'categorization resolution' (true positive rate/failure rate).</p><p><strong>Results: </strong>A total of 3358 patients from 84 centres were included. Female patients were less likely to undergo surgery than men (71.5% versus 82.5% respectively; relative risk 0.866, 95% c.i. 0.834 to 0.901, P < 0.001); with a three-fold higher negative appendicectomy rate (11.3% versus 4.1% respectively; relative risk 2.744, 95% c.i. 2.047 to 3.677, P < 0.001). Ultrasonography was utilized in 56.8% and computed tomography in 75.2% of all patients. The Adult Appendicitis Score had the best diagnostic performance for the whole population; however, only RIPASA was significant in men. All scoring systems were successful in females patients, but Adult Appendicitis Score had the highest area under the receiver operating characteristic curve value. The RIPASA and the Adult Appendicitis Score had the best categorization resolution values, complemented by their exceedingly low failure rates in both male and female patients. Alvarado and AIR had extremely high failure rates in men.</p><p><strong>Conclusion: </strong>The negative appendicectomy rate was low overall, but women had an almost three-fold higher negative appendicectomy rate despite lower likelihood to undergo surgery. The overuse of imaging tests, best exemplified by the 75.2% frequency of patients undergoing computed tomography, may lead to increased costs. Risk-scoring systems such as RIPASA and Adult Appendicitis Score appear to be superior to Alvarado and AIR.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11463697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387738","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":"Carbon footprint of non-melanoma skin cancer surgery.","authors":"Ky-Leigh Ang, Matthew Jovic, Ian Malin, Stephen R Ali, Sairan Whitaker, Iain S Whitaker","doi":"10.1093/bjsopen/zrae084","DOIUrl":"https://doi.org/10.1093/bjsopen/zrae084","url":null,"abstract":"<p><strong>Background: </strong>Climate change poses a significant global health threat and healthcare, including surgery, contributes to greenhouse gas emissions. Efforts have been made to promote sustainability in surgery, but the literature on sustainability in plastic surgery remains limited.</p><p><strong>Methods: </strong>A life-cycle analysis was used to assess and quantify the environmental emissions associated with three distinct reconstructive methods utilized in non-melanoma skin cancer surgery: direct closure, split-thickness skin graft, and full-thickness skin graft. Analyses were conducted in March 2023 in Morriston Hospital, Swansea, UK. The carbon footprints for non-melanoma skin cancer surgery in England and Wales were then estimated.</p><p><strong>Results: </strong>The mean carbon emissions for non-melanoma skin cancer surgery ranged from 29.82 to 34.31 kgCO₂eq. Theatre energy consumption (4.29-8.76 kgCO₂eq) and consumables (16.87 kgCO₂eq) were significant contributors. Waste produced during non-melanoma skin cancer surgery accounted for 1.31 kgCO₂eq and sterilization of reusable surgical instruments resulted in 1.92 kgCO₂eq of carbon emissions. Meanwhile, transportation, dressings, pharmaceuticals, and laundry accounted for 0.57, 2.65, 1.85, and 0.38 kgCO₂eq respectively. The excision of non-melanoma skin cancer with direct closure (19.29-22.41 kgCO₂eq) resulted in the lowest carbon emissions compared with excision with split-thickness skin graft (43.80-49.06 kgCO₂eq) and full-thickness skin graft (31.58-37.02 kgCO₂eq). In 2021, it was estimated that non-melanoma skin cancer surgery had an annual carbon footprint of 306 775 kgCO₂eq in Wales and 4 402 650 kgCO₂eq in England. It was possible to predict that, by 2035, carbon emissions from non-melanoma skin cancer surgery will account for 388 927 kgCO₂eq in Wales and 5 419 770 kgCO₂eq in England.</p><p><strong>Conclusion: </strong>This study highlights the environmental impact of non-melanoma skin cancer in plastic surgery departments and emphasizes the need for sustainable practices. Collaboration between surgeons and policymakers is essential and further data collection is recommended for better analysis.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142457409","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":"Colorectal cancer prevalence in faecal immunochemical test non-returners: potential for health inequality in symptomatic referral pathways.","authors":"Adam D Gerrard, Jonty Coxon, Yasuko Maeda, Evropi Theodoratou, Malcolm G Dunlop, Farhat V N Din","doi":"10.1093/bjsopen/zrae119","DOIUrl":"https://doi.org/10.1093/bjsopen/zrae119","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to describe the faecal immunochemical test non-return rate of those referred with high-risk symptoms of colorectal cancer from primary care, and the clinical outcomes of the 'non-returners'.</p><p><strong>Methods: </strong>From January 2019 to July 2021, patients referred to secondary care with symptoms suspicious of colorectal cancer and a referral priority of urgent or urgent suspicion of cancer were sent a faecal immunochemical test. All patients were investigated regardless of faecal immunochemical test return or result. Demographics and clinical outcomes such as colorectal cancer prevalence were compared between those who returned a faecal immunochemical test and non-returners.</p><p><strong>Results: </strong>Of 7345 patients included in the study, 874 (11.9%) did not return a faecal immunochemical test. Non-returner characteristics included male sex (P = 0.040), younger age (median age 57 versus 65 years, P < 0.001), per rectal bleeding (P < 0.001) and lower socioeconomic status (median Scottish Index of Multiple Deprivation, 6 versus 7, P < 0.001) compared with those who returned a faecal immunochemical test. Of 6294 patients undergoing colorectal investigation, there was a greater prevalence of colorectal cancer (5.4% versus 3.6% P = 0.032) and significant bowel pathology than in the non-returners (15.3% versus 9.8%, P < 0.001). With a median follow-up of 25 months, the colorectal cancer prevalence for the entire 7345 cohort was equal between those who returned and did not return a faecal immunochemical test (3.2% versus 3.8%, P = 0.108). Of note, the non-returners diagnosed with colorectal cancer were younger (median age 64 versus 73 years, P < 0.001) and from a lower socioeconomic area (median Scottish Index of Multiple Deprivation 4 versus 7, P = 0.015) than faecal immunochemical test returners.</p><p><strong>Conclusion: </strong>Patients referred to secondary care, with symptoms suspicious of colorectal cancer, that did not return a faecal immunochemical test had a similar colorectal cancer prevalence to those that returned the test.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11474236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142457410","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":"Anastomotic leak after manual circular stapled left-sided bowel surgery: analysis of technology-, disease-, and patient-related factors.","authors":"","doi":"10.1093/bjsopen/zrae089","DOIUrl":"https://doi.org/10.1093/bjsopen/zrae089","url":null,"abstract":"<p><strong>Background: </strong>Anastomotic leak rates after colorectal surgery remain high. In most left-sided colon and rectal resection surgeries, a circular stapler is utilized to create the primary bowel anastomosis. However, it remains unclear whether a relationship between circular stapler technology and anastomotic leak in left-sided colorectal surgery exists.</p><p><strong>Methods: </strong>A post-hoc analysis was conducted using a prospectively collected data set of patients from the 2017 European Society of Coloproctology snapshot audit who underwent elective left-sided resection (left hemicolectomy, sigmoid colectomy, or rectal resection) with a manual circular stapled anastomosis. Rates of anastomotic leak and unplanned intensive care unit stay in association with manual circular stapling were assessed. Patient-, disease-, geographical-, and surgeon-related factors as well as stapler brand were explored using multivariable regression models to identify predictors of adverse outcomes.</p><p><strong>Results: </strong>Across 3305 procedures, 8.0% of patients had an anastomotic leak and 2.1% had an unplanned intensive care unit stay. Independent predictors of anastomotic leak were male sex, minimal-access surgery converted to open surgery, and anastomosis height C11 (lower third rectum) (all P < 0.050). Independent predictors of unplanned intensive care unit stay were minimal-access surgery converted to open surgery and American Society of Anesthesiologists grade IV (all P < 0.050). Stapler device brand was not a predictor of anastomotic leak or unplanned intensive care unit stay in multivariable regression analysis. There were no differences in rates of anastomotic leak and unplanned intensive care unit stay according to stapler head diameter, geographical region, or surgeon experience.</p><p><strong>Conclusion: </strong>In patients undergoing left-sided bowel anastomosis, choice of manual circular stapler, in terms of manufacturer or head diameter, is not associated with rates of anastomotic leak and unplanned intensive care unit stay.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11498054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142494664","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":"Preferences of patients and surgeons regarding counselling before pancreatectomy: 4PC trial.","authors":"Antonie Willner, Olga Radulova-Mauersberger, Anuschka Barenbrock, Marius Distler, Sandra Korn, Rolidy Jimenez, Mara R Goetz, F Guentac Uzunoglu, Tina Groß, Benjamin Muessle, Thilo Hackert, Juergen Weitz, Thilo Welsch","doi":"10.1093/bjsopen/zrae128","DOIUrl":"10.1093/bjsopen/zrae128","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11494370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142457424","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":"Parathyroid gland identification and angiography classification using simple machine learning methods.","authors":"Philip D McEntee, Joseph E Greevy, Frédéric Triponez, Marco S Demarchi, Ronan A Cahill","doi":"10.1093/bjsopen/zrae122","DOIUrl":"10.1093/bjsopen/zrae122","url":null,"abstract":"<p><strong>Background: </strong>Near-infrared indocyanine green angiography allows experienced surgeons to reliably evaluate parathyroid gland vitality during thyroid and parathyroid operations in order to predict postoperative function. To facilitate equal performance between surgeons, we developed an automatic computational quantification method using computer vision that portrays expert interpretation of visualized parathyroid gland near-infrared indocyanine green angiographic fluorescence signals.</p><p><strong>Methods: </strong>Near-infrared indocyanine green-parathyroid gland angiography video recordings (Fluobeam® LX, Fluoptics, Grenoble-part of Getinge-Göteborg) from patients undergoing endocrine cervical surgery in a high-volume unit were used for model development. Computation (MATLAB, Mathworks, Ireland) included segmentation-identification of the parathyroid gland (by autofluorescence), image stabilization (by linear translation) and adjusted time-fluorescence intensity profile generation. Relative upslope and maximum intensity ratios then trained a simple logistic regression model based on expert interpretation and outcome (including hypoparathyroidism), with subsequent unseen testing for validation.</p><p><strong>Results: </strong>The model was trained on 37 patient videos (45 glands, 29 judged well perfused by parathyroid gland angiography experts), achieving feature data separation with 100% accuracy, and tested on 22 unseen videos (27 glands, 15 judged well perfused), including four in real time. Segmentation-guided parathyroid gland detection correctly identified all parathyroid glands during unseen testing along with three additional non-parathyroid gland regions (90% positive predictive value). Subsequent time-fluorescence intensity profile extraction with vitality prediction was shown feasible in all cases within 5 min, with a 96.3% model accuracy (sensitivity and specificity were 93.3 and 100% respectively) when compared with expert judgement.</p><p><strong>Conclusion: </strong>Automatic parathyroid gland perfusion quantification using simple machine learning computational methods discriminates parathyroid gland perfusion in concordance with expert surgeon interpretation, providing a means for near-infrared indocyanine green-parathyroid gland signal evaluation.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11518927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520942","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":"Research priorities in pancreatic surgery.","authors":"Magdalena Holze, Anna Zlatopolskaia, Frank Pianka, Thomas Pausch, Markus K Diener, Pia Antony, Martin Loos, Christoph W Michalski, Rosa Klotz, Pascal Probst","doi":"10.1093/bjsopen/zrae106","DOIUrl":"https://doi.org/10.1093/bjsopen/zrae106","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11421461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336292","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":"Effect of radiotherapy on long-term quality of life in recurrence-free rectal cancer survivors (LaTE study): nationwide inverse probability of treatment-weighted registry-based cohort study and survey.","authors":"Yasir G Malik, Jūratė Šaltytė Benth, Hanne M Hamre, Arne E Færden, Johannes K Schultz","doi":"10.1093/bjsopen/zrae091","DOIUrl":"10.1093/bjsopen/zrae091","url":null,"abstract":"<p><strong>Background: </strong>Radiotherapy reduces local recurrence in locally advanced rectal cancer, but may cause harm in patients who do not experience recurrence. The aim was to investigate the impact of radiotherapy on long-term quality of life after curative treatment for rectal cancer, i.e. in patients without a recurrence during the follow-up.</p><p><strong>Methods: </strong>All patients operated on for rectal cancer in Norway under 75 years of age between 30 September 2007 and 1 October 2020 were identified using the Cancer Registry of Norway. Exclusion criteria were distant metastasis, recurrence and dementia. The primary outcome measure was the Gastrointestinal Quality of Life Index. Secondary outcome measures included the 36-item Short Form Survey. Inverse probability weights based on a multiple logistic regression model were used to balance prechosen covariates between the radiotherapy and no radiotherapy groups when assessing differences in outcomes.</p><p><strong>Results: </strong>Of 5014 invited patients, 2142 (43%) eligible patients answered the questionnaires. Of these 762 (36%) were treated with neoadjuvant radiotherapy plus surgery and 1380 (64%) with surgery alone. The mean follow-up time was 6.4 and 7.4 years respectively. After propensity score matching, the Gastrointestinal Quality of Life Index differed significantly between irradiated and non-irradiated patients ((mean(s.d.), mean score 103.8(19.4) versus 110.8(19.6) respectively, mean difference: -6.96 (95% c.i. -8.72 to -5.19); P < 0.001). Among patients without a stoma the mean difference was -8.1 points, whereas it was -5.7 for patients with a stoma. The radiotherapy group also scored significantly lower in 7 of 8 36-item Short Form Survey domains compared with the surgery alone group.</p><p><strong>Conclusion: </strong>Long-term quality of life was significantly lower in patients without a recurrence during the follow-up who received radiotherapy compared with patients who did not. These findings warrant a critical re-evaluation of the use of radiotherapy both in traditional neoadjuvant treatment and in modern organ-preserving treatment regimens.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11378401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139243","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":"Operative versus conservative management for inguinal hernia: a methodology scoping review of randomized controlled trials.","authors":"Maria Picciochi, Matthew J Lee, Samir Pathak, Jessica Banks, Jack A Helliwell, Stephen J Chapman, Neil Smart, Katy Chalmers, Sian Cousins, Natalie Blencowe","doi":"10.1093/bjsopen/zrae116","DOIUrl":"10.1093/bjsopen/zrae116","url":null,"abstract":"<p><strong>Introduction: </strong>There is a lack of consensus on the management of inguinal hernia with limited symptoms. To address this issue a systematic review of existing randomized clinical trials (RCTs) was performed to critically appraise all existing data on asymptomatic hernia management, focusing on generalizability.</p><p><strong>Methods: </strong>A scoping review to identify all RCTs comparing surgical and conservative management of patients with inguinal hernias was undertaken. Medline, Embase, Cochrane and ClinicalTrials.gov databases were searched. Data collected included study characteristics and definitions of population, intervention/comparator, and outcomes; and limitations of each study were also extracted. The quality and generalizability of included RCTs were evaluated using Cochrane's ROB-2 and the PRECIS-2 tool, respectively.</p><p><strong>Results: </strong>Searches returned 661 papers; 14 full-text papers were assessed and three RCTs were identified. All RCTs included only male patients with a mean age above 55 years. All RCTs included asymptomatic patients and two included those with minimal symptoms. Different definitions for 'minimally symptomatic' were used in RCTs and none provided details of what was meant by conservative treatment. Follow-up periods varied between studies (1, 2, 3 years). All RCTs had an overall high risk of bias. According to PRECIS-2, two RCTs were classified as pragmatic, and one was equally pragmatic and explanatory.</p><p><strong>Discussion: </strong>This systematic review highlights a high risk of bias but a good generalizability of the findings from the RCTs conducted on minimally symptomatic inguinal hernia patients. To improve the guidelines for the management of this group of patients, more generalizable data are needed.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11421466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142341081","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":"Surgical complications after immediate implant-based breast reconstruction for breast cancer in women over 65 years.","authors":"Yihang Liu, Anna L V Johansson, Ira Oikonomou, Axel Frisell, Hannah C Adam, Dhirar Ansarei, Martin Halle, Helena Sackey, Jana de Boniface","doi":"10.1093/bjsopen/zrae095","DOIUrl":"10.1093/bjsopen/zrae095","url":null,"abstract":"<p><strong>Background: </strong>While immediate breast reconstruction rates in breast cancer are increasing, they remain low in women over 65 years old. The aim was to investigate surgical outcomes in women older than 65 years receiving implant-based immediate breast reconstruction.</p><p><strong>Method: </strong>The population-based Stockholm Breast Reconstruction Database includes all adult women with breast cancer receiving an implant-based immediate breast reconstruction in Stockholm, Sweden, 2005-2015. Primary outcomes within 30 days from immediate breast reconstruction were: infection requiring antibiotics and reoperation on. Implant removal was a secondary outcome. Women more than 65 years were compared with younger age groups. Chi-square tests and multivariable logistic regression were applied for the primary outcomes, and Kaplan-Meier analysis for the secondary outcome.</p><p><strong>Results: </strong>Among 1749 cases of immediate breast reconstruction, 140 (8.0%) were in women more than 65 years. Median follow-up was 74 months (1-198). Postoperative infection was not more common in women older than 65 years old (22 of 140, 15.7%) than in women under 65 years old (303 of 1609, 18.8%; P = 0.221). Reoperation on was more frequent in women older than 65 years than in other age groups (more than 65: 8.6%; 50-64: 6.5%; 40-49: 3.5%; less than 40: 1.6%; P < 0.001), however, age older than 65 years was not an independent risk factor in the multivariable analysis (OR 1.00, 95% c.i. 0.44 to 2.28). Overall, 6-year probability of implant removal was 11.4%, (8.1% due to complications and 3.3% due to patient preference). There was no statistically significant difference between age groups for either reason (P = 0.085 and P = 0.794 respectively).</p><p><strong>Conclusion: </strong>Older age alone was not associated with worse surgical outcomes after implant-based immediate breast reconstruction in highly selected patients older than 65 years when compared with their younger counterparts.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387740","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}