What topics are relevant for a journal review under surgery, particularly those that impact patient outcomes across various demographics and surgical specialties?

Topics for Journal Review Under Surgery

For a surgical journal review, prioritize topics that directly impact patient morbidity, mortality, and quality of life, with emphasis on standardized reporting of surgical case reports, patient-reported outcomes, and evidence-based surgical techniques that improve postoperative recovery.

High-Priority Topics Based on Current Guidelines

Surgical Case Report Standardization

The SCARE (Surgical CAse REport) guidelines provide a consensus-based framework that should guide all surgical case report reviews 1. Key elements include:

• Patient demographics and clinical presentation - Age, sex, ethnicity, occupation, hand dominance (if relevant), main symptoms, and comprehensive medical/drug history 1
• Diagnostic assessment - Physical examination findings, laboratory testing, imaging, histopathology, diagnostic challenges, and differential diagnoses considered 1
• Therapeutic interventions - Pre-intervention patient optimization, types of interventions (operative, minimally invasive, endovascular, endoscopic), surgical technique and materials, operator experience and learning curve position, concurrent treatments (antibiotics, analgesia, VTE prophylaxis), and degree of novelty for new techniques 1
• Follow-up and outcomes - Clinician-assessed and patient-reported outcomes with specific time periods, complications categorized by Clavien-Dindo Classification, blood loss, operative time, wound complications, re-exploration/revision surgery, 30-day and long-term morbidity/mortality 1

Patient-Centered Outcome Measures

Traditional surgical outcomes (complications, length of stay, mortality) are insufficient 2. Reviews should emphasize:

• Quality of recovery scores - Global measures of patient recovery using validated instruments like the Postoperative Morbidity Survey 2
• Days alive and at home - Within 30 days after surgery as a composite outcome measure 2
• Disability-free survival - Using WHO Disability Assessment Schedule 2.0 scale for long-term functional recovery 2
• Patient perspective - Direct patient reporting on treatments received and their impact on quality of life 1

Standardized Outcome Assessment Timepoints

The consensus from Nature Medicine establishes five critical assessment periods 1:

• T0 (Pre-disease state) - Baseline quality of life, employment status, health behaviors 1
• T1 (Pre-intervention) - Disease state and symptoms a few days before intervention 1
• T2 (Early postoperative) - Immediate perioperative outcomes 1
• T3 (Mid-term) - Disease and procedure-dependent (3 months for liver resection, 6 months for pancreatic resections, >1 year for liver transplantation) 1
• T4 (Long-term) - Five years post-intervention with open-ended follow-up thereafter 1

Specialty-Specific High-Impact Topics

Hepato-Pancreato-Biliary Surgery

This represents the most frequently cited topic area in top surgical journals, accounting for 33% of highly cited articles 3. Reviews should focus on:

• Surgical breakthroughs - Original research describing significant advances in technique or outcomes 3
• Perioperative optimization - Nutritional status, metabolic considerations, and immunological alterations 4

Evidence-Based Surgical Techniques

Recent systematic reviews identify specific procedures with clear evidence of benefit 5:

• Skin preparation - Chlorhexidine cleansing shows clear benefit 5
• Incision techniques - Joel-Cohen-based abdominal incision with blunt dissection and cephalad-caudal expansion 5
• Wound closure - Chromic catgut suture for uterine closure, non-closure of peritoneum, closure of subcutaneous tissue, negative pressure wound therapy 5

Volume-Outcome Relationships

Surgeon volume and specialization demonstrate stronger associations with improved outcomes than hospital volume 6:

• Surgeon volume effects - High-volume surgeons show significantly better outcomes in 74% of studies 6
• Specialization benefits - Specialist surgeons demonstrate significantly better outcomes than general surgeons in 91% of studies 6
• Procedure-specific variations - Benefits vary in magnitude between surgical specialties 6

Perioperative Care Topics

Nutritional Optimization

Hospital-induced malnutrition affects 40-50% of surgical patients and directly impacts outcomes 7:

• Preoperative screening - Mandatory nutritional risk screening with serum albumin and prealbumin measurement 7
• Timing of intervention - Delay elective surgery 7-14 days in severely malnourished patients for optimization 7
• Postoperative appetite management - Poor appetite affects 20% of patients on surgery day, with typical improvement within 5-7 days for uncomplicated procedures 8

Metabolic and Immunological Considerations

Reviews should address the pathophysiology of perioperative alterations 4:

• Hemodynamic optimization - Strategies to increase tissue oxygen delivery 4
• Metabolic demand reduction - Approaches to minimize surgical stress response 4
• Inflammation and immune response - Interaction between patient factors, surgical intervention, and anesthesia 4

Methodological Quality Standards

Research Design for Surgical Studies

When reviewing randomized controlled trials 9:

• PICO framework - Clear definition of Population, Intervention, Comparison, and Outcome 9
• Primary outcome selection - Focus on patient-centered outcomes (morbidity, mortality, quality of life) rather than surrogate endpoints 9
• Reporting standards - Adherence to CONSORT guidelines for transparency and reproducibility 9
• Trial registration - Protocol registration before recruitment initiation 9

Common Pitfalls to Avoid

• Incomplete outcome reporting - Failing to include patient-reported outcomes alongside clinical endpoints 1
• Inadequate follow-up periods - Not capturing mid-term and long-term outcomes beyond 30-day mortality 1
• Missing technical details - Omitting surgical technique specifics, materials used, operator experience, and learning curve position 1
• Insufficient complication documentation - Not using standardized classification systems like Clavien-Dindo 1
• Neglecting patient perspective - Excluding direct patient reporting on treatment experience and outcomes 1
• Overlooking nutritional status - Particularly in obese patients who may have micronutrient deficiencies despite adequate caloric reserves 7