Alexander J. Fowler

The SCARE Statement: Consensus-based surgical case report guidelines

INTRODUCTION Case reports have been a long held tradition within the surgical literature. Reporting guidelines can improve transparency and reporting quality. However, recent consensus-based guidelines for case reports (CARE) are not surgically focused. Our objective was to develop surgical case report guidelines. METHODS The CARE statement was used as the basis for a Delphi consensus. The Delphi questionnaire was administered via Google Forms and conducted using standard Delphi methodology. A multidisciplinary group of surgeons and others with expertise in the reporting of case reports were invited to participate. In round one, participants stated how each item of the CARE statement should be changed and what additional items were needed. Revised and additional items from round one were put forward into a further round, where participants voted on the extent of their agreement with each item, using a nine-point Likert scale, as proposed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) working group. RESULTS In round one, there was a 64% (38/59) response rate. Following adjustment of the guideline with the incorporation of recommended changes, round two commenced and there was an 83% (49/59) response rate. All but one of the items were approved by the participants, with Likert scores 7-9 awarded by >70% of respondents. The final guideline consists of a 14-item checklist. CONCLUSION We present the SCARE Guideline, consisting of a 14-item checklist that will improve the reporting quality of surgical case reports.

Preferred reporting of case series in surgery; the PROCESS guidelines

INTRODUCTION Case series have been a long held tradition within the surgical literature and are still frequently published. Reporting guidelines can improve transparency and reporting quality. No guideline exists for reporting case series, and our recent systematic review highlights the fact that key data are being missed from such reports. Our objective was to develop reporting guidelines for surgical case series. METHODS A Delphi consensus exercise was conducted to determine items to include in the reporting guideline. Items included those identified from a previous systematic review on case series and those included in the SCARE Guidelines for case reports. The Delphi questionnaire was administered via Google Forms and conducted using standard Delphi methodology. Surgeons and others with expertise in the reporting of case series were invited to participate. In round one, participants voted to define case series and also what elements should be included in them. In round two, participants voted on what items to include in the PROCESS guideline using a nine-point Likert scale to assess agreement as proposed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) working group. RESULTS In round one, there was a 49% (29/59) response rate. Following adjustment of the guideline with incorporation of recommended changes, round two commenced and there was an 81% (48/59) response rate. All but one of the items were approved by the participants and Likert scores 7-9 were awarded by >70% of respondents. The final guideline consists of an eight item checklist. CONCLUSION We present the PROCESS Guideline, consisting of an eight item checklist that will improve the reporting quality of surgical case series. We encourage authors, reviewers, editors, journals, publishers and the wider surgical and scholarly community to adopt these.

A protocol for the development of reporting criteria for surgical case reports: The SCARE statement

INTRODUCTION Case reports have specific relevance within the surgical literature. The Case Report Guidelines (CARE) were developed in 2013 to provide a framework to support accuracy in the publication of case reports. As such, they have been adopted by multiple journals. However, they are not tailored to surgery. The objective of this research is to conduct a Delphi consensus exercise amongst experienced case report reviewers and editors to develop the Surgical CAse REport (SCARE) Guidelines. METHODS AND ANALYSIS The CARE statement will be used as the basis for this Delphi consensus exercise. The Delphi questionnaire will be administered via SurveyMonkey and conducted using standard Delphi Methodology. Surgeons and others with significant experience in reviewing case reports will be invited to participate. There is no pre-determined number of Delphi rounds, although the expectation is that at least three will be needed. Initially, interested parties will be invited to contribute further items for consideration. Then, in each subsequent round, the participants will rate the importance of reporting each outcome on a nine-point Likert scale as proposed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) working group. This process will also be used to agree standard definitions for the outcomes. DISSEMINATION This work will be disseminated through publication and will be presented at national and international meetings. The findings will be disseminated to interested parties, and journals will be encouraged to endorse the reporting guideline.

Use of autologous fat grafting for breast reconstruction: a systematic review with meta-analysis of oncological outcomes.

BACKGROUND There is growing interest in the use of autologous fat grafting (AFG) for breast reconstruction. Concerns have been raised regarding its effectiveness and safety. OBJECTIVE The primary objective was to determine the oncological, clinical, aesthetic and functional, patient reported, process and radiological outcomes of AFG. METHODS A protocol was published on PROSPERO (CRD42013005254). Types of studies: All original studies. TYPES OF PARTICIPANTS Women undergoing reconstruction after surgery for breast cancer. Types of Interventions: AFG techniques for reconstruction. Types of outcome measures: Oncological, clinical, aesthetic and functional, patient reported, process and radiological. Search terms and keywords: The search strategy was devised to find papers regarding AFG for breast reconstruction. DATA SOURCES Electronic databases were searched from 1st January 1986 to 31st March 2014 including: PubMed, MEDLINE, EMBASE, SCOPUS, The Cochrane Library, and clinical trial registries. Identification and selection of studies: Title and abstract screening and full text assessment undertaken separately by independent researchers. Data extraction, collection and management: Data extracted by two researchers and stored in a standardised database. RESULTS 35 studies were included (3624 patients) with a high degree of patient and surgeon satisfaction over a mean of 1.9 sessions at 18 month follow-up. Fat necrosis was the commonest reported complication (4.4%), biopsy of a subsequent breast lump was required in 2.7% and an interval mammogram in 11.5%. The weighted mean recurrence rate was 4.4% at 24.6 months. Meta-analysis of comparative studies showed no significant difference in oncological event rates between AFG and non-AFG groups (p=0.10). CONCLUSION AFG is a potentially useful reconstructive tool, has a relatively low complication rate, with the majority of patients and clinicians satisfied or very satisfied with the results. Long term clinical and radiological follow-up is required. Further research is necessary to confirm oncological ramifications.

Neutrophil/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients undergoing angiography – The growing versatility of NLR

0021-9150/

Reporting Quality of Observational Studies in Plastic Surgery Needs Improvement: A Systematic Review.

e see front matter 2013 Elsevier Irela http://dx.doi.org/10.1016/j.atherosclerosis.2013.02.008 Arbel et al. are the first group to demonstrate the correlation demonstrated by Ott et al. to contribute to platelet adhesion in pabetween Neutrophil/lymphocyte ratio (NLR) and severity of coronary artery disease (CAD) [1]. NLR is a recent area of increased research interest with 166 citations in 2012, compared to 87 in 2011 indexed in the NIH library [2]. This research has been into a wide range of topics, including the use of NLR in cancer prognostication, cancer chemotherapy susceptibility, identifying high risk vascular surgical patients, non-alcoholic fatty liver disease, Alzheimer’s disease and, in one of the earliest publications in the subject, as a diagnostic marker for appendicitis [3e8]. All that is required to calculate NLR is a white blood cell count (WBC). NLR is calculated by taking the absolute neutrophil count and dividing it by the absolute lymphocyte count [1]. It demonstrates the balance of the Neutrophils e the active inflammatory component, with the Lymphocytes e the regulatory and ‘protective’ component [5]. Therefore, a higher NLR represents a higher level of inflammation [9]. The impact of such sub-acute inflammation on cardiovascular health and atheromatous disease formation is well documented. The interaction between neutrophils and endothelial tissues has been hypothesised to cause increased damage to the endothelium, and

The role of non-technical skills in surgery

Introduction Our objective was to determine the compliance of observational studies in plastic surgery with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement checklist. Methods All cohort, cross-sectional, and case-control studies published in five major plastic surgery journals in 2013 were assessed for their compliance with the STROBE statement. Results One hundred thirty-six studies were identified initially and 94 met the inclusion criteria. The average STROBE score was 12.4 (range, 2–20.1) with a standard deviation of 3.36. The most frequent reporting deficiencies were not reporting the study design in the title and abstract 30% compliance; describing the setting, locations, and relevant dates, including periods of recruitment, exposure, follow-up, and data collection (24%); describing efforts to address sources of bias (20%); reporting numbers of individuals at each stage of the study (20%); and discussing limitations (40%). Conclusions The reporting quality of observational studies in Plastic Surgery needs improvement. We suggest ways this could be improved including better education, awareness among all stakeholders, and hardwiring compliance through electronic journal submission systems.

Frequency of surgical treatment and related hospital procedures in the UK: a national ecological study using hospital episode statistics

Non-technical skills are of increasing importance in surgery and surgical training. A traditional focus on technical skills acquisition and competence is no longer enough for the delivery of a modern, safe surgical practice. This review discusses the importance of non-technical skills and the values that underpin successful modern surgical practice. This narrative review used a number of sources including written and online, there was no specific search strategy of defined databases. Modern surgical practice requires; technical and non-technical skills, evidence-based practice, an emphasis on lifelong learning, monitoring of outcomes and a supportive institutional and health service framework. Finally these requirements need to be combined with a number of personal and professional values including integrity, professionalism and compassionate, patient-centred care.

The UK Freedom of Information Act (2000) in healthcare research: a systematic review.

Background Despite evidence of high activity, the number of surgical procedures performed in UK hospitals, their cost and subsequent mortality remain unclear. Methods Time-trend ecological study using hospital episode data from England, Scotland, Wales and Northern Ireland. The primary outcome was the number of in-hospital procedures, grouped using three increasingly specific categories of surgery. Secondary outcomes were all-cause mortality, length of hospital stay and healthcare costs according to standard National Health Service tariffs. Results Between April 1, 2009 and March 31, 2014, 39 631 801 surgical patient episodes were recorded. There was an annual average of 7 926 360 procedures (inclusive category), 5 104 165 procedures (intermediate category) and 1 526 421 procedures (restrictive category). This equates to 12 537, 8073 and 2414 procedures per 100 000 population per year, respectively. On average there were 85 181 deaths (1.1%) within 30 days of a procedure each year, rising to 178 040 deaths (2.3%) after 90 days. Approximately 62.8% of all procedures were day cases. Median length of stay for in-patient procedures was 1.7 (1.3-2.0) days. The total cost of surgery over the 5 yr period was £54.6 billion (

Compliance of Systematic Reviews in Plastic Surgery With the PRISMA Statement

104.4 billion), representing an average annual cost of £10.9 billion (inclusive), £9.5 billion (intermediate) and £5.6 billion (restrictive). For each category, the number of procedures increased each year, while mortality decreased. One-third of all mortalities in national death registers occurred within 90 days of a procedure (inclusive category). Conclusions The number of surgical procedures in the UK varies widely according to definition. The number of procedures is slowly increasing whilst the number of deaths is decreasing.