Featured Articles in Oct 2022

The World Journal of Surgery welcomes Drs. Hirokaru Yamashita and Catherine Teh to the Editorial Board.

 

 

Author list:   

Author - Julie Ann Sosa

 

No Abstract

 

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https://rdcu.be/cZlAJ


Inspirational Leaders in Surgery: Dr. Haile Debas

 

 

Author list:  

Doruk Ozgediz

 

No Abstract

 

FREE LINK - https://rdcu.be/cVFa7

 


Inspirational Women in Surgery: Professor Tahmina Banu, Bangladesh

 

Author list:  
Tanvir K. Chowdhury & Doruk Ozgediz

 

No Abstract

 

FREE LINK - https://rdcu.be/cVFch


COVID: Impact of the COVID-19 Pandemic on Enhanced Recovery After Surgery (ERAS) Application and Outcomes: Analysis in the “Lazio Network” Database

 

 Author list:  


Michele Grieco, Giampaolo Galiffa, Rosa Marcellinaro, Emanuele Santoro, Roberto Persiani, Stefano Mancini, Massimiliano Di Paola, Roberto Santoro, Francesco Stipa, Antonio Crucitti & Massimo Carlini On behalf of the “Lazio Network” study group

 

Abstract –

Background

The aim of this study was to investigate how the COVID-19 pandemic influenced ERAS program application in colorectal surgery across hospitals in the Lazio region (central district in Italy) participating in the “Lazio Network” project.

 

Methods

A multi-institutional database was constructed. All patients included in this study underwent elective colorectal surgery for both malignant and benign disease between January 2019 and December 2020. Emergency procedures were excluded. The population was divided into 2 groups: a pre-COVID-19 group (PG) of patients operated on between February and December 2019 and a COVID-19 group (CG) of patients operated on between February and December 2020, during the first 2 waves of the pandemic in Italy.

 

Results

The groups included 622 patients in the PG and 615 in the CG treated in 8 hospitals of the network. The mean number of items applied was higher in the PG (65.6% vs. 56.6%, p < 0.001) in terms of preoperative items (64.2% vs. 50.7%, p < 0.001), intraoperative items (65.0% vs. 53.3%, p < 0.001), and postoperative items (68.8% vs. 63.2%, p < 0.001). Postoperative recovery was faster in the PG, with a shorter time to first flatus, first stool, autonomous mobilization and discharge (6.82 days vs. 7.43 days, p = 0.021). Postoperative complications, mortality and reoperations were similar among the groups.

 

Conclusions

The COVID-19 pandemic had a negative impact on the application of ERAS in the centers of the “Lazio Network” study group, with a reduction in adherence to the ERAS protocol in terms of preoperative, intraoperative and postoperative items. In addition, in the CG, the patients had worse postoperative outcomes with respect to recovery and discharge.

 

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Outcomes After Major Surgical Procedures in Octogenarians: A Nationwide Cohort Study

 

Author list: 

Arthur K. E. Elfrink, Anna J. Alberga, Mark I. van Berge Henegouwen, Wilhelmina H. Scheurs, Lydia G. M. van der Geest, Hence J. M. Verhagen, Jan-Willem T. Dekker, Dirk J. Grünhagen, Michel W. J. M. Wouters, Joost M. Klaase & DICA Study Group

 

 

Abstract

Introduction

Aging of the worldwide population has been observed, and postoperative outcomes could be worse in elderly patients. This nationwide study assessed trends in number of surgical resections in octogenarians regarding various major surgical procedures and associated postoperative outcomes.

 

Methods

All patients who underwent surgery between 2014 and 2018 were included from Dutch nationwide quality registries regarding esophageal, stomach, pancreas, colorectal liver metastases, colorectal cancer, lung cancer and abdominal aortic aneurysms (AAA). For each quality registry, the number of patients who were 80 years or older (octogenarians) was calculated per year. Postoperative outcomes were length of stay (LOS), 30 day major morbidity and 30 day mortality between octogenarians and younger patients.

 

Results

No increase in absolute number and proportion of octogenarians that underwent surgery was observed. Median LOS was higher in octogenarians who underwent surgery for colorectal cancer, colorectal liver metastases, lung cancer, pancreatic disease and esophageal cancer. 30 day major morbidity was higher in octogenarians who underwent surgery for colon cancer, esophageal cancer and elective AAA-repair. 30 day mortality was higher in octogenarians who underwent surgery for colorectal cancer, lung cancer, stomach cancer, pancreatic disease, esophageal cancer and elective AAA-repair. Median LOS decreased between 2014 and 2018 in octogenarians who underwent surgery for stomach cancer and colorectal cancer. 30 day major morbidity decreased between 2014 and 2018 in octogenarians who underwent surgery for colon cancer. No trends were observed in octogenarians regarding 30 day mortality between 2014 and 2018.

 

Conclusion

No increase over time in absolute number and proportion of octogenarians that underwent major surgery was observed in the Netherlands. Postoperative outcomes were worse in octogenarians.

 

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Case Control Study of Risk Factors for Occurrence of Postoperative Hematoma After Thyroid Surgery: Ten Year Analysis of 6938 Operation

 

 

Author list: 

Katarina Tausanovic, Vladan Zivaljevic, Sandra Sipetic Grujicic, Ksenija Jovanovic, Vesna Jovanovic & Ivan Paunovic

 

Abstract

Background

Post-thyroidectomy bleeding is rare, but potentially life-threatening complication. Early recognition with immediate intervention is crucial for the management of this complication. Therefore, it is very important to identify possible risk factors of postoperative hemorrhage as well as timing of postoperative hematoma occurrence.

 

Methods

Retrospective review of 6938 patients undergoing thyroidectomy in a tertiary center in a ten year period (2009–2019) revealed 72 patients with postoperative hemorrhage requiring reoperation. Each patient who developed postoperative hematoma was matched with four control patients that did not develop postoperative hematoma after thyroidectomy. The patients and controls were matched by the date of operation and surgeon performing thyroidectomy.

 

Results

The incidence of postoperative bleeding was 1.04%. On univariate analysis older age, male sex, higher BMI, higher ASA score, preoperative use of anticoagulant therapy, thyroidectomy for retrosternal goiter, larger thyroid specimens, larger dominant nodules, longer operative time, higher postoperative blood pressure and the use of postoperative subcutaneous heparin were identified as risk factors for postoperative bleeding. Sixty-nine patients (95.8%) bled within first 24 h after surgery.

 

Conclusion

The rate of postoperative bleeding in our study is consistent with recent literature. Male sex, the use of preoperative anticoagulant therapy, thyroidectomy for retrosternal goiter and the use of postoperative subcutaneous heparin remained statistically significant on multivariate analysis (p < 0.001). When identified, these risk factors may be an obstacle to the outpatient thyroidectomy in our settings.

 

 

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Impact of Frailty on Short-Term Outcomes After Laparoscopic and Open Hepatectomy

 

Author list: 

D. Osei-Bordom, L. Hall, J. Hodson, K. Joshi, L. Austen, D. Bartlett, J. Isaac, D. F. Mirza, R. Marudanayagam, K. Roberts, B. V. Dasari, N. Chatzizacharias & R. P. Sutcliffe

 

Abstract

Background

Although laparoscopic hepatectomy (LH) is associated with improved short-term outcomes compared to open hepatectomy (OH), it is unknown whether frail patients also benefit from LH. The aim of this study was to evaluate the impact of frailty on post-operative outcomes after LH and OH.

 

Patients and methods

Consecutive patients who underwent LH and OH between January 2011 and December 2018 were identified from a prospective database. Frailty was assessed using the modified Frailty Index (mFI), with patients scoring mFI ≥ 1 deemed to be frail.

 

Results

Of 1826 patients, 34.7% (N = 634) were frail and 18.6% (N = 340) were elderly (≥ 75 years). Frail patients had significantly higher 90-day mortality (6.6% vs. 2.9%, p < 0.001) and post-operative complications (36.3% vs. 26.1%, p < 0.001) than those who were not frail, effects that were independent of patient age on multivariate analysis. For those undergoing minor resections, the benefits of LH vs. OH were similar for frail and non-frail patients. Length of hospital stay was 53% longer in OH (vs. LH) in frail patients, compared to 58% longer in the subgroup of non-frail patients.

 

Conclusions

Frailty is independently associated with inferior post-operative outcomes in patients undergoing hepatectomy. However, the benefits of laparoscopic (compared to open) hepatectomy are similar for frail and non-frail patients. Frailty should not be a contraindication to laparoscopic minor hepatectomy in carefully selected patients.

 

 

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Colonoscopy Needs for Implementation of a Colorectal Cancer Screening Program in Ukraine

 

 

Author list: 

Vanessa M. Welten, Kerollos Nashat Wanis, Solomiia Semeniv, Galyna Shabat, Kirsten F. A. A. Dabekaussen, Jennifer S. Davids, Andriy Beznosenko, Ulana Suprun, Djøra I. Soeteman & Nelya Melnitchouk

 

Abstract

Background

In Ukraine, there is no established colorectal cancer screening program. We aimed to project the number of screening colonoscopies needed for implementation of various CRC screening strategies in Ukraine.

 

Methods

We modified a previously developed Markov microsimulation model to reflect the natural history of adenoma and CRC progression among average-risk 50–74-year-olds. We simulated colonoscopies needed for the following screening strategies: no screening, fecal occult blood test yearly, FOBT yearly with flexible sigmoidoscopy every 5 years, FS every 5 years, fecal immunohistochemistry test (FIT) yearly, or colonoscopy every 10 years. Assuming 80% screening adherence, we estimated colonoscopies required at 1 and 5 years depending on the implementation rate. In one-way sensitivity analyses, we varied implementation rate, screening adherence, sensitivity, and specificity.

 

Results

Assuming an 80% screening adherence and complete implementation (100%), besides a no screening strategy, the fewest screening colonoscopies are needed with an FOBT program, requiring on average 6,600 and 26,800 colonoscopies per 100,000 persons at 1 and 5 years post-implementation, respectively. The most screening colonoscopies are required with a colonoscopy program, requiring on average 76,600 and 101,000 colonoscopies per 100,000 persons at 1 and 5 years post-implementation, respectively. In sensitivity analyses, the biggest driver of number of colonoscopies needed was screening adherence.

 

Conclusions

The number of colonoscopies needed and therefore the potential strain on the healthcare system vary substantially by screening test. These findings can provide valuable information for stakeholders on equipment needs when implementing a national screening program in Ukraine.

 

 

FREE LINK - https://rdcu.be/cVFjk

 

 


Clinical Characteristics and Surgical Outcomes of Carotid Body Tumors: Data from the Carotid Paraganglioma Cooperative International Registry (CAPACITY) Group

Author list: 

Mauricio Gonzalez-Urquijo, Victor Hugo Viteri-Pérez, Andrea Becerril-Gaitan, David Hinojosa-Gonzalez, María Elizabeth Enríquez-Vega, Ivan Walter Soto Vaca Guzmán, Gregorio Eloy Valda-Ameller, José de Jesús García-Pérez, Carlos Vaquero-Puerta, Victor Hugo Jaramillo-Vergara, Miguel Angel Cisneros-Tinoco, Joaquin Miguel Santoscoy-Ibarra, Mario Alejandro Fabiani & CAPACITY

 

Abstract

Background

This study’s objective was to conduct a multinational registry of patients with carotid body tumors (CBTs) and to analyze patients’ clinical characteristics, treatments, and outcomes.

 

Methods

Retrospective study from the Carotid Paraganglioma Cooperative International Registry involving eleven medical centers in Bolivia, Ecuador, Mexico, and Spain, of all patients with a CBT who underwent resection between 2009 and 2019.

 

Results

A total of 1432 patients with a CBT surgically treated were included. Median patient age was 54 years (range: 45–63 years), and 82.9% (1184) of the study cohort were female. While at low altitude, the proportion of female-to-male cases was 2:1, at high altitude, this proportion increased to 8:1, with statistically significant differences (p = .022). Median operative time was 139 min (range: 110–180 min), while median operative blood loss was 250 ml (range: 100–500 ml), with statistically significant difference in increased blood loss (p = .001) and operative time (p = .001) with a higher Shamblin classification. Eight (0.6%) patients suffered stroke. Univariate analysis analyzing for possible factors associated with increased odds of stroke revealed intraoperative vascular lesion to present an OR of 2.37 [CI 95%; 1.19–4.75] (p = 0.001). In 245 (17.1%), a cranial nerve injury was reported. Seven (0.5%) deaths were recorded.

 

Conclusion

The most common CBT type on this cohort was hyperplasic, which might be partially explained by the high altitudes where these patients lived. Increased blood loss and operative time were associated with a higher Shamblin classification, and the risk of stroke was associated with patients presenting transoperative vascular lesions.

 

 

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Impact of PhD Degree Versus Non-PhD Research Fellowship on Future Research Productivity Among Academic Cardiothoracic Surgeons

Author list: 

Simar S. Bajaj, Hanjay Wang, Kiah M. Williams, Joseph C. Heiler, Joshua M. Pickering, Keerthi Manjunatha, Christian T. O’Donnell, Mark Sanchez & Jack H. Boyd

 

Abstract

Background

A PhD degree can offer significant research experience, but previous studies yielded conflicting conclusions on the relationship between a PhD degree and future research output. We compared the impact of a PhD degree versus research fellowship (RF) training on research productivity in cardiothoracic surgeons, hypothesizing that training pathways may influence potential associations.

 

Methods

CT surgeons practicing at all accredited United States CT surgery training programs in 2018 who pursued dedicated time for research (n = 597), including earning a PhD degree (n = 92) or completing a non-PhD RF (n = 505), were included. To control for training pathways, we performed subanalyses of U.S. medical school graduates (n = 466) and international medical school graduates (IMGs) (n = 131). Surgeon-specific data were obtained from publicly available sources (e.g., institutional webpages, Scopus).

 

Results

PhD surgeons published greater total papers (68.5 vs. 52.0, p = 0.0179) and total papers per year as an attending (4.6 vs. 3.0, p = 0.0150). For U.S. medical school graduates, there were 40 PhD surgeons and 426 non-PhD RF surgeons; both groups published a similar number of total papers (64.5 vs. 54.0, p = 0.3738) and total papers per year (3.2 vs. 3.0, p = 0.7909). For IMGs, there were 52 PhD surgeons and 79 non-PhD RF surgeons; the PhD surgeons published greater total papers (80.5 vs. 45.0, p = 0.0101) and total papers per year (5.7 vs. 2.7, p = 0.0037).

 

Conclusion

CT surgeons with dedicated research training are highly academically productive. Although a PhD degree may be associated with enhanced career-long research productivity for IMGs, this association was not observed for U.S. medical school graduates.

 

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Systematic Reviews and Meta-Analyses: The Challenges Experienced By Female Surgeons in Africa: A Systematic Review

 

Author list:

Damilola Alexander Jesuyajolu, Charles Arinze Okeke & Otomi Obuh

 

Abstract

Background

There are many challenges faced by female surgeons in Africa. These challenges, when brought to the forefront, can be tackled by the necessary stakeholders to increase the participation of women in surgery. This paper will review the existing literature, across the African continent, to bring to light the challenges experienced by women currently practicing as surgeons.

 

Methods

We conducted a search using keywords ‘Challenges’ ‘Female’ ‘Surgeon’ ‘Africa’ and ‘Bias’ on PubMed, Google Scholar, and AJOL from inception till the 21st of January 2022. We then searched the same keywords on the Google search engine in addition to the names of each of the 54 African countries.

 

Results

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) in conducting this systematic review. Out of the 10 published papers that were deemed eligible, four (n = 4) originated from South Africa. Other countries that were represented include Nigeria, Rwanda, Zimbabwe and Ghana. 8 of the articles were cross-sectional studies. Underrepresentation was the most common challenge (n = 4 articles). Disrespect from colleagues, poor work-life balance, harassment, and stereotypes were also challenges identified in these articles.

 

Conclusion

Despite the increasing participation, female surgeons continue to face different challenges ranging from the unfavorable work environment to the pressures put on them by society. This narrative review serves as a stimulant for major health stakeholders in Global surgery to promote gender inclusivity in the African surgical workforce.

 

FREE LINK - https://rdcu.be/cVFdM

 

 


Academic Output in Global Surgery after the Lancet Commission on Global Surgery: A Scoping Review

Author list:

Zachary Fowler, Rohini Dutta, John L. Kilgallon, Adili Wobenjo, Soham Bandyopadhyay, Priyansh Shah, Samarvir Jain, Nakul P. Raykar & Nobhojit Roy

 

Abstract

Background

The Lancet Commission on Global Surgery (LCoGS) published its seminal report in 2015, carving a niche for global surgery academia. Six years after the LCoGS, a scoping review was conducted to see how the term 'global surgery' is characterized by the literature and how it relates to LCoGS and its domains.

 

Methods

PubMed was searched for publications between January 2015 and February 2021 that used the term ‘global surgery’ in the title, abstract, or key words or cited the LCoGS. Variables extracted included LCoGS domains, authorship metrics, geographic scope, and clinical specialty.

 

Results

The search captured 938 articles that qualified for data extraction. Nearly 80% of first and last authors had high-income country affiliations. Africa was the most frequently investigated region, though many countries within the region were under-represented. The World Journal of Surgery was the most frequent journal, publishing 13.9% of all articles. General surgery, pediatric surgery, and neurosurgery were the most represented specialties. Of the LCoGS domains, healthcare delivery and management were the most studied, while economics and financing were the least studied.

 

Conclusion

A lack of consensus on the definition of global surgery remains. Additional research is needed in economics and financing, while obstetrics and trauma are under-represented in literature using the term ‘global surgery’. Efforts in academic global surgery must give a voice to those carrying the global surgery agenda forward on the frontlines. Focusing on research capacity-building and encouraging contribution by local partners will lead to a stronger, more cohesive global surgery community.

 

FREE LINK - https://rdcu.be/cVFcQ

 


Can Checklists Solve Our Ward Round Woes? A Systematic Review

 

Author list:

Ellie C. Treloar, Ying Yang Ting, Joshua G. Kovoor, Jesse D. Ey, Jessica L. Reid & Guy J. Maddern

 

Abstract

Background

Accurate and thorough surgical ward round documentation is crucial for maintaining quality clinical care. Accordingly, checklists have been proposed to improve ward round documentation. This systematic review aimed to evaluate the literature investigating the use of checklists to improve surgical ward round documentation.

 

Methods

MEDLINE, EMBASE, and PsycINFO were searched on August 16, 2021. Study selection, data extraction, and risk of bias assessment were performed in duplicate. We included English studies that investigated the use of checklists during ward rounds in various surgical subspecialties compared to routine care, where the rates of documentation were reported as outcomes. We excluded studies that used checklists in outpatient, non-surgical, or pediatric settings. Due to heterogeneity of outcome measures, meta-analysis was precluded. This study was registered with PROSPERO (ID: CRD42021273735) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA 2020) reporting guidelines.

 

Results

A total of 206 studies were identified, only 9 were suitable for inclusion. All included studies were single-center observational studies, spanning across seven surgical specialties. Rates of documentation on 4–23 parameters were reported. Documentation for all measured outcomes improved in 8/9 studies; however, statistical analyses were not included. There was a high risk of bias due to the nature of observational studies.

 

Conclusion

Ward round checklists can serve as a useful tool to improve inpatient care and safety. Currently, there is no high-level evidence showing the effectiveness of checklists on ward round documentation. The synthesis of results indicates that further high-quality research is imperative.

 

FREE LINK - https://rdcu.be/cVFd6


Prevalence and Risk Factors of Mortality in Emphysematous Pyelonephritis Patients: A Meta-Analysis

 

Author list:

Xuan Thai Ngo, Tuan Thanh Nguyen, Ryan W. Dobbs, Minh Sam Thai, Duc Huy Vu, Le Quy Van Dinh, Khoa Quy, Hieu Trong Le, Tien-Dat Hoang, Hanh Thi Tuyet Ngo, Trinh Ngoc Khanh Van, Ho Yee Tiong & Huy Gia Vuong

 

Abstract

Background

Emphysematous pyelonephritis (EP) is a severe necrotizing infection of the renal parenchyma which is associated with significant case mortality. We sought to identify the incidence and predictive risk factors associated with EP mortality.

 

Methods

Two electronic databases, PubMed and Web of Science, were searched from their inception until June 06, 2021 for relevant articles. Two independent teams reviewed abstracts and extracted data from the selected manuscripts. A meta-analysis has been reported in line with PRISMA 2020 and AMSTAR Guidelines.

 

Results

Of the 1080 retrieved abstracts, 79 underwent full-text review and 45 studies were included in the final analysis, comprising a total cohort of 1303 patients and 177 mortalities. The pooled prevalence of mortality among the patients with EP disease was 13%. Our analysis found a significantly decreasing trend in mortality rates, an increasing trend in minimally invasive intervention and decreasing trends in emergency nephrectomy in the EP studies from 1985 to 2020. Significant risk factors that were associated with a negative impact on survival of EP patients included sepsis (OR = 15.99), shock (OR = 15.57), disturbance of consciousness (OR = 12.11), thrombocytopenia (OR 7.85), acute renal failure (OR = 5.41), Wan classification I (OR = 4.57), emergency nephrectomy (OR = 3.73), Huang–Tseng classification III–IV (OR = 2.4) and medical management alone (OR = 2.04). Female sex (OR = 0.52) and minimally invasive intervention (OR = 0.47) (percutaneous nephrostomy or ureteral stent placement) were associated with decreased mortality rates.

 

Conclusions

Our study results demonstrated several significant risk factors that could help guide treatment to reduce the mortality risk of EP patients. Clinically, early treatment with a combination of minimally invasive intervention and appropriate medical management may be protective for reducing mortality risk in EP patients.

 

FREE LINK - https://rdcu.be/cVFec


 

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