BJS Open最新文献

{"title":"Quality of life in patients with permanent hypoparathyroidism after thyroidectomy for benign thyroid disease: population-based study with long-term follow-up.","authors":"Matilda Annebäck, Sofia Wachtmeister, Jakob Hedberg, Peter Stålberg, Olov Norlén","doi":"10.1093/bjsopen/zraf032","DOIUrl":"https://doi.org/10.1093/bjsopen/zraf032","url":null,"abstract":"<p><strong>Background: </strong>In recent years, several studies have shown that permanent hypoparathyroidism has a negative impact on health-related quality of life. However, these results could have been affected by short-term follow-up, selection bias and confounding factors. The aim of this study was to investigate health-related quality of life in patients with and without permanent hypoparathyroidism after total thyroidectomy for benign thyroid disease, using a strict definition of permanent hypoparathyroidism and long-term follow-up data.</p><p><strong>Methods: </strong>All patients who underwent total thyroidectomy for benign thyroid disease in a region of Sweden between 1 January 2005 and 31 December 2015 were assessed for eligibility. Eligible patients were invited to participate in the study through a letter on 26 August 2021. The 36-item Short Form Health Survey version 2 was used to compare health-related quality of life in patients with and without permanent hypoparathyroidism.</p><p><strong>Results: </strong>Of 1636 patients, 1483 patients were invited to participate in the study. In total, 716 (48.3%) patients answered the Short Form Health Survey questionnaire and were included in the study cohort. Mean(s.d.) follow-up was 10.9(3.2) years. Patients with and without permanent hypoparathyroidism did not differ in baseline characteristics, with the exception that patients with permanent hypoparathyroidism were younger. There were no evident differences in health-related quality of life between the two groups, encompassing all health domains and summary component scores (P > 0.05).</p><p><strong>Conclusion: </strong>No difference in health-related quality of life was found between patients with and without permanent hypoparathyroidism after total thyroidectomy on long-term follow-up. These results challenge previous findings and highlight the need for comprehensive, long-term studies to better understand the impact of this condition on health-related quality of life.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12056941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962450","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":"Water-soluble contrast agents in adhesional small bowel obstruction: meta-analysis and PRECIS-2 assessment of trials.","authors":"Matthew Gowell, Daniel M Baker, Greta McLachlan, David N Naumann, Adam Peckham-Cooper, Neil J Smart, Matthew J Lee","doi":"10.1093/bjsopen/zraf049","DOIUrl":"10.1093/bjsopen/zraf049","url":null,"abstract":"<p><strong>Background: </strong>Adhesional small bowel obstruction is a common presentation to acute general surgical services. Initial management is typically conservative and includes the use of water-soluble contrast agents. Current trials assessing water-soluble contrast agents are limited by sample size and demonstrate contrasting results. The aim of this review was to systematically appraise the use of water-soluble contrast agents in adhesional small bowel obstruction.</p><p><strong>Methods: </strong>This systematic review and meta-analysis was registered with PROSPERO (CRD42024573136) and conducted in line with PRISMA guidelines. Searches of Medline, Embase and Central databases were undertaken to include randomized clinical trials reporting the use of water-soluble contrast agents in adhesional small bowel obstruction. Searches were last updated on 26 July 2024. The primary outcome was the need for operative intervention. Secondary outcomes included the rate of intestinal ischaemia, the need for bowel resection, and mortality. A random-effects meta-analysis was conducted for outcomes reported in three or more studies. Risk of bias was assessed using the Cochrane Risk-of-Bias tool, and trial methods were appraised using the PRagmatic Explanatory Continuum Indicator Summary (PRECIS-2) tool.</p><p><strong>Results: </strong>In all, 11 randomized controlled trials were included with a median sample size of 88 (range 26-242), nine of which were single-centre studies; only one study used computed tomography imaging to diagnoses adhesional small bowel obstruction. Meta-analysis revealed no significant difference in operative intervention (odds ratio 0.63, 95% confidence interval 0.39 to 1.01; P = 0.053), small bowel ischaemia, small bowel resection, or mortality. Risk of bias raised concerns in several domains. PRECIS-2 assessment showed trials were pragmatic rather than explanatory designs.</p><p><strong>Conclusion: </strong>This review does not support the use of therapeutic water-soluble contrast agents in adhesional small bowel obstruction. Further adequately powered trials are needed. Standardization of diagnostic modality and consideration of explanatory designs should be considered.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12062880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968118","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":"Purely resectable versus biological borderline resectable pancreatic cancer: closely related or worlds apart?","authors":"Laura Maggino","doi":"10.1093/bjsopen/zraf054","DOIUrl":"10.1093/bjsopen/zraf054","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109417","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":"Live surgical broadcasts: a scoping review.","authors":"Essam Rama, Vikas Khanduja","doi":"10.1093/bjsopen/zraf051","DOIUrl":"10.1093/bjsopen/zraf051","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149148","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":"Socioeconomic and ethnic disparities in major lower limb amputation related to peripheral arterial disease in England.","authors":"Thaison Tong, Ravi Maheswaran, Jonathan Michaels, Paul Brindley, Stephen Walters, Shah Nawaz","doi":"10.1093/bjsopen/zraf046","DOIUrl":"10.1093/bjsopen/zraf046","url":null,"abstract":"<p><strong>Background: </strong>Amputation is a treatment of last resort for peripheral arterial disease. This study examined associations between socioeconomic deprivation, ethnicity, above-knee amputation (AKA) and below-knee amputation (BKA) rates, and post-amputation survival in England.</p><p><strong>Methods: </strong>Hospital Episode Statistics data identified patients aged ≥25 years who underwent an AKA or BKA related to peripheral arterial disease in 2006-2018. Data on ethnicity, comorbidity and socioeconomic deprivation was recorded. An ecological study design, based on population-level data, analysed amputation rates (Poisson regression), and a cohort study design investigated mortality subsequent to amputation (Cox regression).</p><p><strong>Results: </strong>Within a population of 35.7 million people aged ≥25 years, 47 249 patients underwent peripheral arterial disease-related major amputation over 12 years (94.1% White, 1.9% Black, and 1.6% Asian ethnicity). AKA : BKA ratios were 1.03, 0.73, and 0.80 for White, Black, and Asian ethnicities respectively. Amputation rates increased with increasing socioeconomic deprivation. The amputation rate ratio for the most relative to the least deprived category varied with age, ranging from 4.94 (95% confidence interval 4.24 to 5.75) for age 45-54 years to 1.35 (1.21 to 1.49) for age ≥85 years for AKA, and from 3.88 (3.44 to 4.37) to 1.12 (0.97 to 1.29) for BKA. Post-amputation mortality hazard ratios also increased with increasing socioeconomic deprivation, ranging from 1.26 (1.04 to 1.53) for age 25-54 years to 1.11 (1.03 to 1.19) for age ≥75 years for AKA, and from 1.25 (1.08 to 1.46) to 1.17 (1.08 to 1.27) for BKA. Over 12 years, amputation rates decreased in all socioeconomic categories in the population aged ≥65 years, but there was little change in the population aged 25-64 years. Black ethnicity was associated with lower adjusted AKA and BKA rate ratios relative to White ethnicity in those aged 25-64 years, and similar AKA but higher BKA rate ratios in those aged ≥65 years. Black ethnicity was also associated with lower post-amputation mortality, except in those aged 25-54 years within 90 days of BKA. Asian ethnicity was associated with lower AKA and BKA rate ratios relative to White ethnicity, but similar post-amputation mortality with some exceptions.</p><p><strong>Conclusion: </strong>The main policy and practice implications relate to socioeconomic inequalities. Greater efforts are needed in disadvantaged areas to prevent and manage peripheral arterial disease and reduce amputation.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12130681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207599","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 transversus abdominis plane blocks in abdominoplasties on postoperative outcomes.","authors":"Sascha Wellenbrock, Bettina Zidek, Laetitia S Chiarella, Fabian Nehls, Mirkka Hiort, Vanessa Neef, Tobias Hirsch, Matthias Maas, Maximilian Kueckelhaus","doi":"10.1093/bjsopen/zraf067","DOIUrl":"10.1093/bjsopen/zraf067","url":null,"abstract":"<p><strong>Background: </strong>Acute postoperative pain after surgery may lead to significant complications including chronification of pain, impaired cardiopulmonary function, and increased healthcare costs. As a common and complex procedure, abdominoplasty is a key focus for pain management strategies. Although transversus abdominis plane blocks, which target the abdominal wall's sensory nerves to reduce postoperative pain by blocking nociceptive input, have shown promise in reducing postoperative pain in abdominal surgeries, their use in abdominoplasty remains underexplored.</p><p><strong>Methods: </strong>Outcomes for patients undergoing abdominoplasty between 2013 and 2024 were analysed, comparing those who received a transversus abdominis plane block with those who did not. Postoperative analgesia followed a standardized protocol using oral narcotics and piritramide. Pain outcomes were assessed in both groups via chart review. The primary outcome, length of hospital stay, was analysed by multivariable linear regression adjusted for patient and surgical factors. Secondary outcomes, including complications and revision rates, were assessed by logistic regression. Exploratory analyses examined how reductions in medication use affected length of hospital stay and discharge timing.</p><p><strong>Results: </strong>Overall, 192 patients who had an abdominoplasty were included in analyses: 93 had a transversus abdominis plane block and 99 did not. The transversus abdominis plane group had a significantly shorter hospital stay, with a reduction of 2.21 (95% confidence interval (c.i.) -3.07 to -1.36) days after adjusting for confounders (P < 0.001; effect size, Cohen's d 0.45). Surgical complications occurred in 46.9% of patients. The overall complication risk in the transversus abdominis plane block group was significantly reduced by 52% (adjusted odds ratio 0.44, 95% c.i. 0.23 to 0.84; P = 0.012; effect size 0.52), particularly the occurrence of haematoma (adjusted odds ratio 0.34; P = 0.031; effect size 0.66). Additionally, patients who had a transversus abdominis plane block required less postoperative medication, including lower tilidine (P = 0.038) and metamizole (P = 0.032) doses.</p><p><strong>Conclusion: </strong>Use of the transversus abdominis plane block in patients who had an abdominoplasty was associated with improved postoperative outcomes, highlighting its potential as an effective pain management strategy and supporting its broader clinical application.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332425","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":"Environmental and financial cost of surgical-site infection by severity after lower limb vascular surgery.","authors":"Ross Lathan, Hannah Daysley, Bharadhwaj Ravindhran, Arthur Lim, Joseph Cutteridge, Misha Sidapra, Judith Long, Louise Hitchman, Pedro Beltran-Alvarez, Daniel Carradice, George Smith, Ian Chetter","doi":"10.1093/bjsopen/zraf015","DOIUrl":"https://doi.org/10.1093/bjsopen/zraf015","url":null,"abstract":"<p><strong>Background: </strong>There is sparse evidence of the relationship between environmental and financial costs of surgical-site infection. Identifying areas of high-cost burden would enable key targets for clinical interventions to aid in achieving the UK national net zero healthcare system strategies. The aim of this study was to evaluate the environmental and financial costs of surgical-site infection, subclassified by severity of infection.</p><p><strong>Methods: </strong>This prospective observational study evaluated patients with and without surgical-site infection after a variety of lower limb vascular surgery using National Health Service and Personal and Social Services perspectives. The severity of surgical-site infection was defined using both Centers for Disease Control and Prevention and management-based criteria where patients with mild surgical-site infection required oral antibiotics, patients with moderate surgical-site infection required intravenous antibiotics, and patients with severe surgical-site infection required further surgical interventions.</p><p><strong>Results: </strong>A total of 99 patients were included, with 22 patients (22.2%) diagnosed with surgical-site infection. The mean(s.d.) environmental cost without surgical-site infection was 10.3(24.3) kgCO2e (95% c.i. 4.8 to 15.9) per patient. Emissions increased with surgical-site infection severity, with mild producing 94.6(53.9) kgCO2e (95% c.i. 63.5 to 125.8, 918% increase), moderate producing 648(407.6) kgCO2e (95% c.i. -0.1 to 1296.6, 6291% increase) and severe producing 2651.4(2217.1) kgCO2e (95% c.i. -966.5 to 6347.2, 25 742% increase) per patient. The mean(s.d.) financial cost without surgical-site infection was €73.26(€160.27) (95% c.i. 36.91 to 109.72) that increased with severity, with mild costing €392.25(225.69) (95% c.i. 262.16 to 523.00, 536% increase), moderate costing €9754.46(5059.77) (95% c.i. 1704.65 to 17 820.68, 13 317% increase), and severe costing €37 035.60(32 910.84) (95% c.i. -15 376.07 to 89 447.52, 50 521% increase) per episode of infection (£1 = €1.20 (conversion date 25 October 2024)).</p><p><strong>Conclusion: </strong>Environmental and financial costs are strongly correlated with surgical-site infection severity and display an exponential increase as severity increases. Overall, surgical-site infection incurs a cost of €15.58 for every kgCO2e produced. Environmental discounting should be explored and incorporated into sustainability assessments for robust accounting methodology. Surgical-site infection should be evaluated for severity rather than as a binary outcome for comprehensive assessment.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12056366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967884","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":"Concordance of ChatGPT artificial intelligence decision-making in colorectal cancer multidisciplinary meetings: retrospective study.","authors":"Dimitrios Chatziisaak, Pascal Burri, Moritz Sparn, Dieter Hahnloser, Thomas Steffen, Stephan Bischofberger","doi":"10.1093/bjsopen/zraf040","DOIUrl":"https://doi.org/10.1093/bjsopen/zraf040","url":null,"abstract":"<p><strong>Background: </strong>The objective of this study was to evaluate the concordance between therapeutic recommendations proposed by a multidisciplinary team meeting and those generated by a large language model (ChatGPT) for colorectal cancer. Although multidisciplinary teams represent the 'standard' for decision-making in cancer treatment, they require significant resources and may be susceptible to human bias. Artificial intelligence, particularly large language models such as ChatGPT, has the potential to enhance or optimize the decision-making processes. The present study examines the potential for integrating artificial intelligence into clinical practice by comparing multidisciplinary team decisions with those generated by ChatGPT.</p><p><strong>Methods: </strong>A retrospective, single-centre study was conducted involving consecutive patients with newly diagnosed colorectal cancer discussed at our multidisciplinary team meeting. The pre- and post-therapeutic multidisciplinary team meeting recommendations were assessed for concordance compared with ChatGPT-4.</p><p><strong>Results: </strong>One hundred consecutive patients with newly diagnosed colorectal cancer of all stages were included. In the pretherapeutic discussions, complete concordance was observed in 72.5%, with partial concordance in 10.2% and discordance in 17.3%. For post-therapeutic discussions, the concordance increased to 82.8%; 11.8% of decisions displayed partial concordance and 5.4% demonstrated discordance. Discordance was more frequent in patients older than 77 years and with an American Society of Anesthesiologists classification ≥ III.</p><p><strong>Conclusion: </strong>There is substantial concordance between the recommendations generated by ChatGPT and those provided by traditional multidisciplinary team meetings, indicating the potential utility of artificial intelligence in supporting clinical decision-making for colorectal cancer management.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12056934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965900","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":"Three-year results of a randomized clinical trial comparing retrorectus synthetic mesh and biological mesh for incisional hernia prevention following loop ileostomy closure (Preloop trial).","authors":"Elisa J Mäkäräinen, Heikki T Wiik, Jyrki A O Kössi, Tarja M Pinta, Leena-Mari J Mäntymäki, Anne K Mattila, Pasi P Ohtonen, Tero T Rautio","doi":"10.1093/bjsopen/zraf058","DOIUrl":"10.1093/bjsopen/zraf058","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12084674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085915","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":"Impact of feeding strategy after pancreatoduodenectomy on delayed gastric emptying and hospital stay: nationwide study.","authors":"Tessa E Hendriks, Bo T M Strijbos, Michiel F G Francken, Mahsoem Ali, J Annelie Suurmeijer, Marcel G W Dijkgraaf, Jana S Hopstaken, Kees van Laarhoven, Quintus Molenaar, Vincent E de Meijer, Erwin van der Harst, Marcel den Dulk, Werner Draaisma, Vincent Nieuwenhuijs, Michael F Gerhards, Mike S L Liem, George van der Schelling, Eric Manusama, Ignace de Hingh, Hjalmar van Santvoort, Bas Groot Koerkamp, Olivier R Busch, Bert A Bonsing, Martijn W J Stommel, Marc G Besselink","doi":"10.1093/bjsopen/zraf068","DOIUrl":"10.1093/bjsopen/zraf068","url":null,"abstract":"<p><strong>Background: </strong>Delayed gastric emptying is a major contributor to prolonged hospital stay following pancreatoduodenectomy. Although enhanced recovery after surgery guidelines recommend unrestricted feeding after pancreatoduodenectomy, nationwide studies evaluating the impact of different feeding strategies after surgery on delayed gastric emptying and length of hospital stay are limited. This study aimed to identify the use and impact of different feeding strategies after pancreatoduodenectomy on delayed gastric emptying and length of hospital stay.</p><p><strong>Methods: </strong>This nationwide cohort study included consecutive patients after pancreatoduodenectomy from the Dutch Pancreatic Cancer Audit (2021-2023). Primary endpoints were delayed gastric emptying grade B/C and length of hospital stay. Feeding strategies were categorized based on structured interviews with representatives from 15 centres. Multilevel analysis was used to assess associations between feeding strategy, delayed gastric emptying, and length of hospital stay. Predictors of delayed gastric emptying were determined.</p><p><strong>Results: </strong>Overall, 2354 patients undergoing pancreatoduodenectomy were included, of whom 526 (23%) developed delayed gastric emptying grade B/C. Median length of hospital stay was 13 days longer in patients with delayed gastric emptying (23 versus 10 days; P < 0.001). Feeding strategies were: unrestricted feeding (3 centres, 637 patients; delayed gastric emptying 18%); step-up feeding (9 centres, 1462 patients; delayed gastric emptying 24%); and artificial feeding (3 centres, 255 patients; delayed gastric emptying 25%). No association was observed between feeding strategy and delayed gastric emptying: step-up versus unrestricted feeding (odds ratio 1.14, 95% confidence interval 0.53 to 2.47) and artificial versus unrestricted feeding (odds ratio 1.76, 0.65 to 4.73). Similarly, no association was found between feeding strategy and length of hospital stay. The strongest predictor of delayed gastric emptying was pancreatic fistula after surgery (odds ratio 3.16, 2.47 to 4.05).</p><p><strong>Conclusion: </strong>This study found no significant association between feeding strategy and incidence of delayed gastric emptying or length of hospital stay after pancreatoduodenectomy. Efforts to reduce delayed gastric emptying should focus on reducing pancreatic fistula after surgery.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12163990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282257","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}