BJS Open最新文献

{"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":"8 5","pages":""},"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}

{"title":"Role of the serosa in intestinal anastomotic healing: insights from in-depth histological analysis of human and murine anastomoses.","authors":"Marie-Christin Weber, Zoé Clees, Annalisa Buck, Adrian Fischer, Marcella Steffani, Dirk Wilhelm, Marc Martignoni, Helmut Friess, Yuval Rinkevich, Philipp-Alexander Neumann","doi":"10.1093/bjsopen/zrae108","DOIUrl":"10.1093/bjsopen/zrae108","url":null,"abstract":"<p><strong>Background: </strong>Anastomotic leakage following colorectal surgery remains a significant complication despite advances in surgical techniques. Recent findings on serosal injury repair in coelomic cavities, such as the peritoneum, challenge the current understanding of the cellular origins and mechanisms underlying intestinal anastomotic healing. Understanding the contribution of each layer of the intestinal wall during anastomotic healing is needed to find new therapeutic strategies to prevent anastomotic leakage. The aim of this experimental study was to investigate the role of the serosal layer of the intestinal wall in anastomotic healing.</p><p><strong>Materials and methods: </strong>Comprehensive histologic analysis of human and murine anastomoses was performed to elucidate histologic changes in the different intestinal layers during anastomotic healing. In vivo staining of the extracellular matrix (ECM) in the serosal layer was performed using a fluorophore-conjugated N-hydroxysuccinimide-ester before anastomosis surgery in a murine model.</p><p><strong>Results: </strong>Histological examination of both human and murine anastomoses revealed that closure of the serosal layer occurred first during the healing process. In vivo serosal ECM staining demonstrated that a significant portion of the newly formed ECM within the anastomosis was indeed deposited onto the serosal layer. Furthermore, mesenchymal cells within the anastomotic scar were positive for mesothelial cell markers, podoplanin and Wilms tumour protein.</p><p><strong>Conclusions: </strong>In this experimental study, the results suggest that serosal scar formation is an important mechanism for anastomotic integrity in intestinal anastomoses. Mesothelial cells may significantly contribute to scar formation during anastomotic healing through epithelial-to-mesenchymal transition, potentially suggesting a novel therapeutic target to prevent anastomotic leakage by enhancing physiological healing processes.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"8 5","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11373408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124779","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 a national guideline for the management of peripheral arterial disease on revascularization rates in England: interrupted time series analysis.","authors":"Ravi Maheswaran, Thaison Tong, Jonathan Michaels, Paul Brindley, Stephen Walters, Shah Nawaz","doi":"10.1093/bjsopen/zrae115","DOIUrl":"10.1093/bjsopen/zrae115","url":null,"abstract":"<p><strong>Background: </strong>A national guideline on peripheral arterial disease management in England was issued in August 2012. The impact on revascularization rates was examined and variation with socioeconomic deprivation assessed.</p><p><strong>Methods: </strong>Annual hospital admissions for England over 10 years (2008-2009 to 2017-2018) were examined using interrupted time series analysis. A pragmatic approach was used to classify admissions for revascularization into moderate and severe categories.</p><p><strong>Results: </strong>There were 309 839 admissions (56% for moderate peripheral arterial disease), with an overall annual admission rate for revascularization of 86 per 100 000 population aged 25+ years. The rate for moderate peripheral arterial disease marginally increased by 0.29 per 100 000 per year (95% c.i. -0.22 to 0.80) from 2008-2009 to 2012-2013. Following guideline introduction, this rate decreased. The equivalent for severe peripheral arterial disease increased by 1.33 per 100 000 (0.78 to 1.88). Following guideline introduction, this rate plateaued. The change in rate (slope) for moderate peripheral arterial disease of -2.81 per 100 000 per year (-3.52 to -2.10) after guideline introduction was greater than the change in rate for severe peripheral arterial disease of -1.95 per 100 000 per year (-2.73 to -1.17). For moderate peripheral arterial disease, the annual rate in the most socioeconomically deprived category was 15.6 per 100 000 lower in 2017-2018 compared with 2012-2013 (24.3% decrease). The impact progressively diminished with decreasing deprivation. In the least deprived category, the reduction was 5.2 per 100 000 (12.9% decrease). For severe peripheral arterial disease, the decrease was 1.2 per 100 000 (3.1% reduction) with no consistent variation in relation to deprivation.</p><p><strong>Conclusion: </strong>Introduction of the national peripheral arterial disease management guideline in England was associated with a reduction in admission rates for revascularization, especially for moderate peripheral arterial disease, with greater reduction in rates for moderate peripheral arterial disease in more socioeconomically deprived areas. Association, however, does not necessarily imply causation and alternative explanations cannot be ruled out.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"8 5","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11494374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142457412","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":"Incidence of rectal cancer after colectomy for inflammatory bowel disease: nationwide study.","authors":"Mohammed Deputy, Guy Worley, Elaine M Burns, Alex Bottle, Paul Aylin, Ailsa Hart, Omar Faiz","doi":"10.1093/bjsopen/zrae074","DOIUrl":"https://doi.org/10.1093/bjsopen/zrae074","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory bowel disease increases the risk of colorectal neoplasia. A particular problem arises in patients who have undergone subtotal colectomy leaving a rectal remnant. The risk of future rectal cancer must be accurately estimated and weighed against the risks of further surgery or surveillance. The aim of this study was to estimate the 10-year cumulative incidence of rectal cancer in such patients.</p><p><strong>Methods: </strong>A nationwide study using England's hospital administrative data was performed. A cohort of patients undergoing subtotal colectomy between April 2002 and March 2014 was identified. A competing risks survival analysis was performed to calculate the cumulative incidence of rectal cancer. The effect of the COVID-19 pandemic on endoscopic surveillance was investigated using time-trend analysis.</p><p><strong>Results: </strong>A total of 8120 patients were included and 61 patients (0.8%) were diagnosed with cancer. The cumulative incidence of rectal cancer was 0.26% (95% c.i. 0.17% to 0.39%), 0.49% (95% c.i. 0.36% to 0.68%), and 0.77% (95% c.i. 0.57% to 1.02%) at 5, 10, and 15 years respectively. A previous diagnosis of colonic dysplasia (HR 3.34, 95% c.i. 1.01 to 10.97; P = 0.047), primary sclerosing cholangitis (HR 5.42, 95% c.i. 1.34 to 21.85; P = 0.018), and elective colectomy (HR 1.83, 95% c.i. 1.11 to 3.02; P = 0.018) was associated with an increased incidence of rectal cancer. Regarding endoscopic surveillance, there was a 43% decline in endoscopic procedures performed in 2020 (333 procedures) compared with 2019 (585 procedures).</p><p><strong>Conclusion: </strong>The incidence of rectal cancer after subtotal colectomy is low. Asymptomatic patients without evidence of rectal dysplasia should be carefully counselled on the possible benefits and risks of prophylactic proctectomy.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"8 5","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11474238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142457413","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 laparoscopic training course for surgical trainees based on an evidence-based pedagogical framework: randomized trial.","authors":"Ruijun Pan, Xueliang Zhou, Chao Wu, Luyang Zhang, Jiayu Wang, Minhua Zheng, Ting Shi, Wei Cai, Jing Sun","doi":"10.1093/bjsopen/zrae109","DOIUrl":"10.1093/bjsopen/zrae109","url":null,"abstract":"<p><strong>Background: </strong>The 'Learn, See, Practice, Prove, Do, Maintain' (LSPPDM) pedagogical framework is an evidence-based framework developed through a careful review and synthesis of the literature. The purpose of the study was to explore the effectiveness and applicability of the LSPPDM pedagogical framework in the laparoscopic training course for surgical residents.</p><p><strong>Methods: </strong>Prospective study of surgical residents who underwent standardized surgical residency training in a single institution from December 2020 to December 2022. Trainees were randomized to either the pedagogical group (6-step LSPPDM pedagogical framework) or traditional group (2-step traditional approach with twice-weekly lectures and a weekly laparoscopic operating skills session). The Global Operative Assessment of Laparoscopic Skills scale was used for technical skills, and the Non-Technical Skills for Surgeons assessment form was used for non-technical skills.</p><p><strong>Results: </strong>Sixty trainees were randomized. The pedagogical group scored higher on subjective perception (P < 0.050) and the theoretical assessment (mean(s.d.) 41.83(6.66)) than those in the traditional group (37.83(5.77)) (P = 0.016). Trainees in the pedagogical group took less time to complete the assessment of models, had fewer failures and higher scores, took less time to complete laparoscopic sutures and knots, showed better proficiency with laparoscopic instruments, and completed at higher quality (P < 0.050). Trainees performing laparoscopic cholecystectomy in animal models demonstrated higher technical and non-technical skill scores in the pedagogical group (P < 0.050). 'Tissue handling' and 'Decision making' were common areas for improvement for both groups of trainees.</p><p><strong>Conclusions: </strong>The LSPPDM pedagogical framework is feasible and demonstrated improvements in technical and non-technical skills in surgical trainees compared to a traditional training programme.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"8 5","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11426165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142341079","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":"Influence of pancreatic fistula on survival after upfront pancreatoduodenectomy for pancreatic ductal adenocarcinoma: multicentre retrospective study.","authors":"Fanny Castanet, Jeanne Dembinski, Bastien Cabarrou, Jonathan Garnier, Christophe Laurent, Nicolas Regenet, Antonio Sa Cunha, Charlotte Maulat, Laurence Chiche, Gabriella Pittau, Nicolas Carrère, Jean-Marc Regimbeau, Olivier Turrini, Alain Sauvanet, Fabrice Muscari","doi":"10.1093/bjsopen/zrae125","DOIUrl":"https://doi.org/10.1093/bjsopen/zrae125","url":null,"abstract":"<p><strong>Background: </strong>The effects of postoperative pancreatic fistula on survival rates remain controversial. The aim of the present study was to evaluate the influence of postoperative pancreatic fistula on overall survival and recurrence-free survival after upfront pancreatoduodenectomy for pancreatic ductal adenocarcinoma.</p><p><strong>Methods: </strong>Patients operated on between January 2007 and December 2017 at seven tertiary pancreatic centres for pancreatic ductal adenocarcinoma were included in the study. Postoperative pancreatic fistula was defined using the 2016 International Study Group on Pancreatic Surgery grading system. The impact of postoperative pancreatic fistula on overall survival, recurrence-free survival (excluding 90-day postoperative deaths) and corresponding risk factors were investigated by univariable and multivariable analyses. Comparisons between groups were made using the chi-squared or Fisher's exact test for categorical variables and the Mann-Whitney U test for continuous variables. Odds ratios were estimated with their 95% confidence intervals. Survival rates were calculated using the Kaplan-Meier method with their 95% confidence intervals.</p><p><strong>Results: </strong>A total of 819 patients were included between 2007 and 2017. Postoperative pancreatic fistula occurred in 14.4% (n = 118) of patients; of those, 7.8% (n = 64) and 6.6% (n = 54) accounted for grade B and grade C postoperative pancreatic fistula respectively. The 5-year overall survival was 37.0% in the non-postoperative pancreatic fistula group and 45.3% in the postoperative pancreatic fistula cohort (P = 0.127). Grade C postoperative pancreatic fistula (excluding 90-day postoperative deaths) was not a prognostic factor for overall survival. The 5-year recurrence-free survival was 26.0% for patients without postoperative pancreatic fistula and 43.7% for patients with postoperative pancreatic fistula (P = 0.003). Eight independent prognostic factors for recurrence-free survival were identified: age over 70 years, diabetes, moderate or poor tumour differentiation, T3/T4 tumour stage, lymph node positive status, resection margins R1, vascular emboli and perineural invasion.</p><p><strong>Conclusion: </strong>This high-volume cohort showed that grade C postoperative pancreatic fistula, based on the 2016 International Study Group on Pancreatic Surgery grading system, does not impact overall or recurrence-free survival (excluding 90-day postoperative deaths).</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"8 5","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11505446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142494665","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":"Relationship between CT-derived cervical muscle mass and quality, systemic inflammation, and survival in symptomatic patients undergoing carotid endarterectomy.","authors":"Nicholas A Bradley, Karamonique Dosanj, Sharon Yen Ming Chan, Alasdair Wilson, Tamim Siddiqui, Rachel Forsythe, Campbell S D Roxburgh, Donlad C McMillan, Graeme J K Guthrie","doi":"10.1093/bjsopen/zrae114","DOIUrl":"10.1093/bjsopen/zrae114","url":null,"abstract":"<p><strong>Background: </strong>Sarcopenia appears to be associated with inferior outcomes in surgical conditions. Chronic systemic inflammation confers an inferior long-term prognosis in cardiovascular disease and is associated with the development of sarcopenia. The aim of this study was to describe the prognostic role of sarcopenia assessed using computed tomography (CT)-derived body composition analysis and systemic inflammation in patients undergoing carotid endarterectomy for symptomatic carotid stenosis.</p><p><strong>Methods: </strong>In this retrospective cohort study, patients undergoing carotid endarterectomy for symptomatic carotid stenosis between 1 January 2011 and 1 October 2021 at four referral centres were included. The C3 skeletal muscle index and C3 skeletal muscle density were recorded from preoperative CT images. Systemic inflammation was assessed using the preoperative systemic inflammatory grade (SIG). The primary outcome was overall mortality during the study interval.</p><p><strong>Results: </strong>A total of 618 patients were included, with a median follow-up of 69 (interquartile range 34-85) months. On univariable analysis, age greater than or equal to 75 years (P < 0.001), American Society of Anesthesiologists (ASA) grade greater than II (P < 0.001), low C3 skeletal muscle index (P = 0.002), low C3 skeletal muscle density (P < 0.001), SIG greater than or equal to 2 (P < 0.001), and low L3 derived skeletal muscle index (P < 0.001) were associated with increased mortality, whereas body mass index greater than or equal to 25 kg/m2 was associated with decreased mortality (P = 0.023). On multivariable analysis, age 75 years or older (HR 2.17 (95% c.i. 1.58 to 2.97), P < 0.001), ASA grade greater than II (HR 2.06 (95% c.i. 1.35 to 3.12), P < 0.001), low C3 skeletal muscle density (HR 1.84 (95% c.i. 1.33 to 2.54), P < 0.001), and SIG greater than or equal to 2 (HR 1.63 (95% c.i. 1.33 to 1.99), P < 0.001) were independently associated with increased mortality.</p><p><strong>Conclusion: </strong>Cervical CT-derived muscle mass and density, and markers of systemic inflammation, such as systemic inflammatory grade, may be associated with an inferior long-term prognosis after carotid endarterectomy.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"8 5","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11498072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142494666","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":"Comment on: Surgeon age in relation to patients' long-term survival after gastrectomy for gastric adenocarcinoma: nationwide population-based cohort study.","authors":"André Roncon Dias, Syed Nabeel Zafar, Daniel José Szor","doi":"10.1093/bjsopen/zrae102","DOIUrl":"https://doi.org/10.1093/bjsopen/zrae102","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"8 5","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11387997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142280171","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":"Evaluating current acute aortic syndrome pathways: Collaborative Acute Aortic Syndrome Project (CAASP).","authors":"Jim Zhong, Aminder A Singh, Nawaz Z Safdar, Sandip Nandhra, Ganesh Vigneswaran","doi":"10.1093/bjsopen/zrae096","DOIUrl":"https://doi.org/10.1093/bjsopen/zrae096","url":null,"abstract":"<p><strong>Background: </strong>Diagnosis of acute aortic syndrome is challenging and associated with high perihospital mortality rates. The study aim was to evaluate current pathways and understand the chronology of acute aortic syndrome patient care.</p><p><strong>Method: </strong>Consecutive patients with acute aortic syndrome imaging diagnosis between 1 January 2018 and 1 June 2021 were identified using a predetermined search strategy and followed up for 6 months through retrospective case note review. The UK National Interventional Radiology Trainee Research and Vascular and Endovascular Research Network co-ordinated the study.</p><p><strong>Results: </strong>From 15 UK sites, 620 patients were enrolled. The median age was 67 (range 25-98) years, 62.0% were male and 92.9% Caucasian. Type-A dissection (41.8%) was most common, followed by type-B (34.5%); 41.2% had complicated acute aortic syndrome. Mode of presentation included emergency ambulance (80.2%), self-presentation (16.2%), and primary care referral (3.6%). Time (median (i.q.r.)) to hospital presentation was 3.1 (1.8-8.6) h and decreased by sudden onset chest pain but increased with migratory pain or hypertension. Time from hospital presentation to imaging diagnosis was 3.2 (1.3-6.5) h and increased by family history of aortic disease and decreased by concurrent ischaemic limb. Time from diagnosis to treatment was 2 (1.0-4.3) h with interhospital transfer causing delay. Management included conservative (60.2%), open surgery (32.2%), endovascular (4.8%), hybrid (1.4%) and palliative (1.4%). Factors associated with a higher mortality rate at 30 days and 6 months were acute aortic syndrome type, complicated disease, no critical care admission and age more than 70 years (P < 0.05).</p><p><strong>Conclusions: </strong>This study presents a longitudinal data set linking time-based delays to diagnosis and treatment with clinical outcomes. It can be used to prioritize research strategies to streamline patient care.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"8 5","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11412149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142280173","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 structured multicentre enhanced recovery after surgery (ERAS) protocol implementation on length of stay after colorectal surgery.","authors":"Zubair Bayat, Anand Govindarajan, J Charles Victor, Erin D Kennedy","doi":"10.1093/bjsopen/zrae094","DOIUrl":"10.1093/bjsopen/zrae094","url":null,"abstract":"<p><strong>Background: </strong>Increased length of stay after surgery is associated with increased healthcare utilization and adverse patient outcomes. While enhanced recovery after surgery (ERAS) protocols have been shown to reduce length of stay after colorectal surgery in trial settings, their effectiveness in real-world settings is more uncertain. The aim of this study was to assess the impact of ERAS protocol implementation on length of stay after colorectal surgery, using real-world data.</p><p><strong>Methods: </strong>In 2012, ERAS protocols were introduced at 15 Ontario hospitals as part of the iERAS study. A cohort of patients undergoing colorectal surgery treated at these hospitals between 2008 and 2019 was created using health administrative data. Mean length of stay was computed for the intervals before and after ERAS implementation. Interrupted time series analyses were performed for predefined subgroups, namely all colorectal surgery, colorectal surgery without complications, right-sided colorectal surgery, and left-sided colorectal surgery. Sensitivity analyses were then conducted using adjusted length of stay, accounting for length of stay predictors, including: patient age, sex, marginalization, co-morbidities, and diagnosis; surgeon volume of cases, years in practice, and colorectal surgery expertise; hospital volume; and other contextual factors, including procedure type and timing, surgical approach, and in-hospital complications.</p><p><strong>Results: </strong>A total of 32 612 patients underwent colorectal surgery during the study interval. ERAS implementation led to a decrease in length of stay of 1.05 days (13.7%). Larger decreases in length of stay were seen with more complex surgeries, with a level change of 1.17 days (15.6%) noted for the subgroup of patients undergoing left-sided colorectal surgery. The observed decreases in length of stay were durable for the length of the study interval in all analyses. When adjusting for predictors of length of stay, the effect of ERAS implementation on length of stay was larger (reduction of 1.46 days).</p><p><strong>Conclusion: </strong>Introducing formal ERAS protocols reduces length of stay after colorectal surgery significantly, independent of temporal trends toward decreasing length of stay. These effects are durable, demonstrating that ERAS protocol implementation is an effective hospital-level intervention to reduce length of stay after colorectal surgery.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"8 5","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11370790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124777","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}