{"title":"Management of perioperative anaemia - Five top tips.","authors":"Sandy Abeysiri,Sashini Iddawela,Toby Richards","doi":"10.1093/bjs/znag034","DOIUrl":"https://doi.org/10.1093/bjs/znag034","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"16 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147635697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
INTRODUCTIONLarge, randomized studies have shown equivalent survival after breast-conserving surgery (BCS) plus adjuvant radiotherapy (RT) when compared to mastectomy. In contrast, more recent observational studies suggest BCS+RT to be superior, but it is questionable if patients in these treatment arms are comparable. Here, overall survival (OS) and breast cancer-specific survival (BCSS) after BCS+RT and mastectomy are compared within a randomized trial comparing intravenous- and inhalation anaesthesia during breast cancer (BC) surgery.METHODThe patient cohort was recruited from the randomized CAN-study. Patients with tumours larger than 30 mm, smaller than 10 mm, and those undergoing BCS without RT were excluded. OS and BCSS were estimated using multivariable Cox regression analyses and three different propensity score models.RESULTSThe final study cohort included 830 women, of whom 601 were treated by BCS+RT (median age 64 years) and 229 by mastectomy (median age 68 years). Women undergoing mastectomy had more comorbidities and unfavourable tumour characteristics. Mastectomy was associated with a significantly less favourable OS in unadjusted, adjusted, and propensity score matched analyses. BCSS was inferior in the mastectomy group in the unadjusted analysis with a HR 2.27 (95% CI 1.20-4.30). In the adjusted and three propensity score matched models, BCSS was equal in the treatment groups with an adjusted HR 1.02 (95% CI 0.43-2.42).CONCLUSIONIn this study, which was designed to approximate a randomized trial as closely as possible, no significant difference in BCSS was observed between BCS+RT and mastectomy. Differences in OS likely reflect occult selection bias selection of patients with higher comorbidity burden to mastectomy.
大型随机研究显示，与乳房切除术相比，保乳手术（BCS）加辅助放疗（RT）后的生存率相当。相比之下，最近的观察性研究表明BCS+RT更优越，但这些治疗组的患者是否具有可比性值得怀疑。在这里，在一项随机试验中比较了乳腺癌手术期间静脉和吸入麻醉后，BCS+RT和乳房切除术后的总生存期（OS）和乳腺癌特异性生存期（BCSS）。方法患者队列从随机can -研究中招募。排除肿瘤大于30mm，小于10mm和接受BCS而不进行RT的患者。使用多变量Cox回归分析和三种不同的倾向评分模型估计OS和BCSS。最终的研究队列包括830名妇女，其中601名接受BCS+RT治疗（中位年龄64岁），229名接受乳房切除术（中位年龄68岁）。接受乳房切除术的妇女有更多的合并症和不利的肿瘤特征。在未调整、调整和倾向评分匹配分析中，乳房切除术与显著较差的OS相关。未经校正分析，乳腺切除术组的BCSS较低，风险比为2.27 （95% CI 1.20-4.30）。在调整后的倾向评分匹配模型和三个倾向评分匹配模型中，治疗组的BCSS相等，调整后的HR为1.02 （95% CI 0.43-2.42）。结论在这项尽可能接近随机试验的研究中，BCS+RT和乳房切除术在BCS+RT和乳腺切除术之间没有显著差异。OS的差异可能反映了隐性选择偏倚，选择了合并症负担较高的患者进行乳房切除术。
{"title":"Survival after breast-conserving surgery and radiotherapy versus mastectomy: a propensity score-matched analysis within a randomized anaesthesiology trial.","authors":"Charlotta Wadsten,Anders Berglund,Emma Söderberg,Greger Nilsson,Leif Bergkvist,Mats Enlund,Fredrik Wärnberg","doi":"10.1093/bjs/znag036","DOIUrl":"https://doi.org/10.1093/bjs/znag036","url":null,"abstract":"INTRODUCTIONLarge, randomized studies have shown equivalent survival after breast-conserving surgery (BCS) plus adjuvant radiotherapy (RT) when compared to mastectomy. In contrast, more recent observational studies suggest BCS+RT to be superior, but it is questionable if patients in these treatment arms are comparable. Here, overall survival (OS) and breast cancer-specific survival (BCSS) after BCS+RT and mastectomy are compared within a randomized trial comparing intravenous- and inhalation anaesthesia during breast cancer (BC) surgery.METHODThe patient cohort was recruited from the randomized CAN-study. Patients with tumours larger than 30 mm, smaller than 10 mm, and those undergoing BCS without RT were excluded. OS and BCSS were estimated using multivariable Cox regression analyses and three different propensity score models.RESULTSThe final study cohort included 830 women, of whom 601 were treated by BCS+RT (median age 64 years) and 229 by mastectomy (median age 68 years). Women undergoing mastectomy had more comorbidities and unfavourable tumour characteristics. Mastectomy was associated with a significantly less favourable OS in unadjusted, adjusted, and propensity score matched analyses. BCSS was inferior in the mastectomy group in the unadjusted analysis with a HR 2.27 (95% CI 1.20-4.30). In the adjusted and three propensity score matched models, BCSS was equal in the treatment groups with an adjusted HR 1.02 (95% CI 0.43-2.42).CONCLUSIONIn this study, which was designed to approximate a randomized trial as closely as possible, no significant difference in BCSS was observed between BCS+RT and mastectomy. Differences in OS likely reflect occult selection bias selection of patients with higher comorbidity burden to mastectomy.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"20 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147635696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mario Alejandro Fabiani,Jos C van den Berg,Oscar A De la Torre,Alfredo Verastegui,Anahita Dua,
INTRODUCTIONRevascularisation to prevent limb loss is not feasible or represents a very high risk in a significant proportion of patients with chronic limb-threatening ischaemia (CLTI). No standard definition currently exists to define this population of patients. The aim of this study was to develop a consensus-based, multidomain definition to improve clinical assessment and reporting of studies in people with 'no option' (NO) or 'poor option' (PO) CLTI.METHODSA modified Delphi process was conducted with 164 specialists from 30 countries. Two iterative survey rounds were used to reach consensus, defined as ≥70% agreement with a score of ≥7 on a nine-point scale.RESULTSSome 164 international vascular specialists participated in the study, averaging 19 years of experience. A multidomain framework including arterial disease anatomy, biology, risk, function, and context (ABRFC) achieved 83% consensus. A 'desert foot' was defined as the absence of distal arterial revascularisation targets on advanced non-invasive imaging, invasive digital subtraction angiography (DSA) and at least one failed endovascular revascularisation attempt (81.6% agreement). Inadequate autogenous bypass conduit was defined as the lack of usable autologous vein across all four limbs (85% agreement). Patients were classified as no option for revascularisation if they present with 'desert foot', prohibitive medical risk, a nonfunctional limb, or in those patients who refused arterial revascularisation. Poor option revascularization patients combined factors such as severe infection, lack of autologous vein, or treatment non-compliance (72.1% agreement).CONCLUSIONThis consensus study established a structured, expert-validated definition of no option or poor option for revascularisation of patients with CLTI. The multidomain ABRFC framework provides a foundation for standardised clinical assessment, trial design, and future guideline development.
{"title":"Development of a Standard Definition of \"No-option\" and \"Poor-Option\" for Revascularisation in Chronic Limb-Threatening Ischemia.","authors":"Mario Alejandro Fabiani,Jos C van den Berg,Oscar A De la Torre,Alfredo Verastegui,Anahita Dua, ","doi":"10.1093/bjs/znag040","DOIUrl":"https://doi.org/10.1093/bjs/znag040","url":null,"abstract":"INTRODUCTIONRevascularisation to prevent limb loss is not feasible or represents a very high risk in a significant proportion of patients with chronic limb-threatening ischaemia (CLTI). No standard definition currently exists to define this population of patients. The aim of this study was to develop a consensus-based, multidomain definition to improve clinical assessment and reporting of studies in people with 'no option' (NO) or 'poor option' (PO) CLTI.METHODSA modified Delphi process was conducted with 164 specialists from 30 countries. Two iterative survey rounds were used to reach consensus, defined as ≥70% agreement with a score of ≥7 on a nine-point scale.RESULTSSome 164 international vascular specialists participated in the study, averaging 19 years of experience. A multidomain framework including arterial disease anatomy, biology, risk, function, and context (ABRFC) achieved 83% consensus. A 'desert foot' was defined as the absence of distal arterial revascularisation targets on advanced non-invasive imaging, invasive digital subtraction angiography (DSA) and at least one failed endovascular revascularisation attempt (81.6% agreement). Inadequate autogenous bypass conduit was defined as the lack of usable autologous vein across all four limbs (85% agreement). Patients were classified as no option for revascularisation if they present with 'desert foot', prohibitive medical risk, a nonfunctional limb, or in those patients who refused arterial revascularisation. Poor option revascularization patients combined factors such as severe infection, lack of autologous vein, or treatment non-compliance (72.1% agreement).CONCLUSIONThis consensus study established a structured, expert-validated definition of no option or poor option for revascularisation of patients with CLTI. The multidomain ABRFC framework provides a foundation for standardised clinical assessment, trial design, and future guideline development.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"4 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147625820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Clement C Mwamba,Robert Zulu,Felix Michelo,Alick Bwanga
{"title":"Outcomes after restorative and non-restorative surgery for gangrenous sigmoid volvulus in patients treated in Zambia.","authors":"Clement C Mwamba,Robert Zulu,Felix Michelo,Alick Bwanga","doi":"10.1093/bjs/znag043","DOIUrl":"https://doi.org/10.1093/bjs/znag043","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"58 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147585813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anastomotic leak after colorectal surgery: current landscape and future directions.","authors":"Jack A Helliwell,Aaron Quyn,David G Jayne","doi":"10.1093/bjs/znag041","DOIUrl":"https://doi.org/10.1093/bjs/znag041","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"7 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147524775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
INTRODUCTIONFenestrated endovascular aneurysm repair (FEVAR) is increasingly used in patients who are not eligible for standard EVAR devices due to anatomical constraints, principally of the proximal aortic neck. The long-term outcomes of FEVAR are not well described and therefore the aim of this study was to perform an analysis of a national registry in the United Kingdom.METHODSThe UK GLOBALSTAR registry (2003-2022) was analysed to report the long-term outcomes for FEVAR. Patients were included if they underwent FEVAR with custom made or off the shelf devices for infradiaphragmatic aortic aneurysmal disease. Paitents with thoracoabdominal aneurysms or those who revievied standard EVAR were excluded. Time-to-event analyses were conducted for survival, aneurysm-related mortality, re-intervention, endoleak and target vessel patency. Subgroup analyses were conducted for octogenarians and patient sex.RESULTSSome 1651 patients across 15 centres were included. The median age was 75 years [Q1-Q3, 69-79] and 87.9% were male. Estimated survival at 3, 5 and 10 years was 79.5% [95%CI,77.6-81.5%], 64.1% [95%CI,61.7-66.6%] and 30.5% [27.7-33.5%]; median survival was 6.9 years [95%CI,6.6-7.2]. Aneurysm-related mortality was 6.7% at 10 years [95%CI,5.4-8.0%]. There were 36 secondary sac ruptures over follow-up. The cumulative incidence of re-intervention at 3, 5 and 7 years was 21.5% [95%CI,19.5-23.6%], 25.6% [95%CI,23.3-27.8%] and 27.6% [95%CI,25.3-30.0%]. Graft-related complications accounted for 73.9% of re-interventions. Women had significantly worse 2-year survival (81.1%, [95%CI,75.8-86.7%]) than men (86.1%, [95%CI,84.3-87.9%]) (p= 0.04), driven by an increased peri-operative mortality. Beyond 2 years, the differences in survival were not statisically significant. Octogenarians had equivalent survival (89.4% [95%CI,86.4-92.4%]) to non-octogenarians (92.1% [95%CI,90.7-93.6%]) up to 1 year (p=0.07). Octogenarians' median survival was 5.4 years [95%CI,5.0-6.1].CONCLUSIONSLong-term outcomes for FEVAR appear acceptable, with low rates of secondary sac rupture. Re-intervention following FEVAR carries significant risks of re-intervention and these are principally driven by graft-related complications suggesting effective graft surveillance is key to long-term durability.
{"title":"Nationwide outcomes of Fenestrated Endovascular Aneurysm Repair.","authors":"Aurélien M Guéroult,M Jusczak,P Holt,S Neequaye, ","doi":"10.1093/bjs/znag037","DOIUrl":"https://doi.org/10.1093/bjs/znag037","url":null,"abstract":"INTRODUCTIONFenestrated endovascular aneurysm repair (FEVAR) is increasingly used in patients who are not eligible for standard EVAR devices due to anatomical constraints, principally of the proximal aortic neck. The long-term outcomes of FEVAR are not well described and therefore the aim of this study was to perform an analysis of a national registry in the United Kingdom.METHODSThe UK GLOBALSTAR registry (2003-2022) was analysed to report the long-term outcomes for FEVAR. Patients were included if they underwent FEVAR with custom made or off the shelf devices for infradiaphragmatic aortic aneurysmal disease. Paitents with thoracoabdominal aneurysms or those who revievied standard EVAR were excluded. Time-to-event analyses were conducted for survival, aneurysm-related mortality, re-intervention, endoleak and target vessel patency. Subgroup analyses were conducted for octogenarians and patient sex.RESULTSSome 1651 patients across 15 centres were included. The median age was 75 years [Q1-Q3, 69-79] and 87.9% were male. Estimated survival at 3, 5 and 10 years was 79.5% [95%CI,77.6-81.5%], 64.1% [95%CI,61.7-66.6%] and 30.5% [27.7-33.5%]; median survival was 6.9 years [95%CI,6.6-7.2]. Aneurysm-related mortality was 6.7% at 10 years [95%CI,5.4-8.0%]. There were 36 secondary sac ruptures over follow-up. The cumulative incidence of re-intervention at 3, 5 and 7 years was 21.5% [95%CI,19.5-23.6%], 25.6% [95%CI,23.3-27.8%] and 27.6% [95%CI,25.3-30.0%]. Graft-related complications accounted for 73.9% of re-interventions. Women had significantly worse 2-year survival (81.1%, [95%CI,75.8-86.7%]) than men (86.1%, [95%CI,84.3-87.9%]) (p= 0.04), driven by an increased peri-operative mortality. Beyond 2 years, the differences in survival were not statisically significant. Octogenarians had equivalent survival (89.4% [95%CI,86.4-92.4%]) to non-octogenarians (92.1% [95%CI,90.7-93.6%]) up to 1 year (p=0.07). Octogenarians' median survival was 5.4 years [95%CI,5.0-6.1].CONCLUSIONSLong-term outcomes for FEVAR appear acceptable, with low rates of secondary sac rupture. Re-intervention following FEVAR carries significant risks of re-intervention and these are principally driven by graft-related complications suggesting effective graft surveillance is key to long-term durability.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"88 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147524540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
James Chean Khun Ng,Alastair J Morton,Colin J Crooks,Joe West,Matthew J Grainge,Timothy R Card,David J Humes
INTRODUCTIONInflammatory bowel disease (IBD) and colorectal cancer (CRC) share overlapping symptoms. Faecal Immunochemical Test (FIT) is mandated in UK primary care to triage symptomatic patients suspected of CRC, but the extent to which IBD is identified in these patients remains unclear. We aim to assess the one-year IBD diagnosis rate in symptomatic patients following FIT for suspected CRC, and how this varies with age, FIT, and faecal calprotectin (FCP).METHODSA population-based cohort study of symptomatic patients undergoing FIT in the UK Clinical Practice Research Datalink (CPRD) (January 2019-June 2023), with one-year follow-up was conducted. Kaplan-Meier estimates were used to assess cumulative one-year IBD-risk, stratified by age, FIT, and FCP results.RESULTS2762 of 473402 (0·58%) patients were diagnosed with IBD within one-year of FIT. Patients under 50 years (N=110501) accounted for 53·6% of all IBD diagnoses, but only 6·9% of all CRC diagnoses (N=347). Overall IBD-risk was 2·3% with FIT≥10µgHb/g compared to 0·1% with FIT<10µgHb/g. Among 63469 patients with elevated FCP and FIT, IBD-risk in those under 50 years was 21·0% when FIT≥10µgHb/g and FCP>50µg/g. The combined risk of CRC or IBD in those with FIT≥10µgHb/g was 7·1%. This fell to 3·3% in the subset of patients who also had FCP ≤50µg/g.CONCLUSIONIBD is more common than CRC in patients under 50 years referred on symptomatic FIT pathways using a FIT≥10µgHb/g threshold. In a selected cohort of dual-tested patients, FCP provided additional risk stratification. Incorporating routine FCP into symptomatic FIT pathways may better target further investigations.
{"title":"Diagnosis of inflammatory bowel disease following symptomatic faecal immunochemical testing - A population based cohort study.","authors":"James Chean Khun Ng,Alastair J Morton,Colin J Crooks,Joe West,Matthew J Grainge,Timothy R Card,David J Humes","doi":"10.1093/bjs/znag039","DOIUrl":"https://doi.org/10.1093/bjs/znag039","url":null,"abstract":"INTRODUCTIONInflammatory bowel disease (IBD) and colorectal cancer (CRC) share overlapping symptoms. Faecal Immunochemical Test (FIT) is mandated in UK primary care to triage symptomatic patients suspected of CRC, but the extent to which IBD is identified in these patients remains unclear. We aim to assess the one-year IBD diagnosis rate in symptomatic patients following FIT for suspected CRC, and how this varies with age, FIT, and faecal calprotectin (FCP).METHODSA population-based cohort study of symptomatic patients undergoing FIT in the UK Clinical Practice Research Datalink (CPRD) (January 2019-June 2023), with one-year follow-up was conducted. Kaplan-Meier estimates were used to assess cumulative one-year IBD-risk, stratified by age, FIT, and FCP results.RESULTS2762 of 473402 (0·58%) patients were diagnosed with IBD within one-year of FIT. Patients under 50 years (N=110501) accounted for 53·6% of all IBD diagnoses, but only 6·9% of all CRC diagnoses (N=347). Overall IBD-risk was 2·3% with FIT≥10µgHb/g compared to 0·1% with FIT<10µgHb/g. Among 63469 patients with elevated FCP and FIT, IBD-risk in those under 50 years was 21·0% when FIT≥10µgHb/g and FCP>50µg/g. The combined risk of CRC or IBD in those with FIT≥10µgHb/g was 7·1%. This fell to 3·3% in the subset of patients who also had FCP ≤50µg/g.CONCLUSIONIBD is more common than CRC in patients under 50 years referred on symptomatic FIT pathways using a FIT≥10µgHb/g threshold. In a selected cohort of dual-tested patients, FCP provided additional risk stratification. Incorporating routine FCP into symptomatic FIT pathways may better target further investigations.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"19 3 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147518428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aditi Nijhawan,Ewoud Ter Avest,Callum J Twohig,Stacey J Webster,Jason Morris,Robbie Lendrum,Virginia Fitzpatrick-Swallow,David J Lockey,Zane B Perkins
INTRODUCTIONIn mature trauma systems, most trauma deaths occur soon after injury yet studies often only include patients who survive to hospital admission. These studies exclude pre-hospital deaths and introduce substantial survival bias. Understanding trauma fatalities across all phases of care is essential to identify opportunities to further improve trauma outcomes.METHODSThis retrospective cohort study analysed adult trauma fatalities attended by London's Air Ambulance from 1 January 2019 to 31 December 2020. Deaths were classified as pre-hospital if traumatic cardiac arrest occurred before hospital arrival. Timing of death was recorded as minutes from injury to arrest for pre-hospital cases and days from admission to death for in-hospital cases. A multidisciplinary panel determined the likely cause of death using clinical, radiological, and post-mortem findings.RESULTSAmong 3,089 adult trauma patients attended, 497 (16.1%) died. Most deaths (77.1%) occurred pre-hospital, with a median time from injury to traumatic cardiac arrest of 12 minutes (IQR 6-24). Haemorrhage and traumatic brain injury accounted for 81.9% of deaths overall, but their distribution differed markedly by phase of care: 96.2% of haemorrhage deaths occurred pre-hospital, whereas 84.2% of in-hospital deaths were due to traumatic brain injury. In addition, deaths from all other potentially reversible causes, and 95.1% of penetrating trauma deaths, occurred pre-hospital.CONCLUSIONIn mature trauma systems, most trauma deaths now occur before arrival in hospital, with many due to potentially reversible causes. The greatest opportunities to improve trauma outcomes now lie in the pre-hospital phase of care.
{"title":"Epidemiology of trauma deaths across a mature regional trauma system: patterns of pre-hospital and in-hospital fatalities.","authors":"Aditi Nijhawan,Ewoud Ter Avest,Callum J Twohig,Stacey J Webster,Jason Morris,Robbie Lendrum,Virginia Fitzpatrick-Swallow,David J Lockey,Zane B Perkins","doi":"10.1093/bjs/znag030","DOIUrl":"https://doi.org/10.1093/bjs/znag030","url":null,"abstract":"INTRODUCTIONIn mature trauma systems, most trauma deaths occur soon after injury yet studies often only include patients who survive to hospital admission. These studies exclude pre-hospital deaths and introduce substantial survival bias. Understanding trauma fatalities across all phases of care is essential to identify opportunities to further improve trauma outcomes.METHODSThis retrospective cohort study analysed adult trauma fatalities attended by London's Air Ambulance from 1 January 2019 to 31 December 2020. Deaths were classified as pre-hospital if traumatic cardiac arrest occurred before hospital arrival. Timing of death was recorded as minutes from injury to arrest for pre-hospital cases and days from admission to death for in-hospital cases. A multidisciplinary panel determined the likely cause of death using clinical, radiological, and post-mortem findings.RESULTSAmong 3,089 adult trauma patients attended, 497 (16.1%) died. Most deaths (77.1%) occurred pre-hospital, with a median time from injury to traumatic cardiac arrest of 12 minutes (IQR 6-24). Haemorrhage and traumatic brain injury accounted for 81.9% of deaths overall, but their distribution differed markedly by phase of care: 96.2% of haemorrhage deaths occurred pre-hospital, whereas 84.2% of in-hospital deaths were due to traumatic brain injury. In addition, deaths from all other potentially reversible causes, and 95.1% of penetrating trauma deaths, occurred pre-hospital.CONCLUSIONIn mature trauma systems, most trauma deaths now occur before arrival in hospital, with many due to potentially reversible causes. The greatest opportunities to improve trauma outcomes now lie in the pre-hospital phase of care.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"8 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147471447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
O U Rithya,Xavier Muller,Kayvan Mohkam,Jean-Yves Mabrut,Julie Perinel,Mustapha Adham,Thomas Rimmelé,Guillaume Monneret
{"title":"Early Immunoparalysis in Patients Undergoing Pancreatoduodenectomy based on mHLA-DR Profiling.","authors":"O U Rithya,Xavier Muller,Kayvan Mohkam,Jean-Yves Mabrut,Julie Perinel,Mustapha Adham,Thomas Rimmelé,Guillaume Monneret","doi":"10.1093/bjs/znag031","DOIUrl":"https://doi.org/10.1093/bjs/znag031","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"2 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147495168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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