{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T20:14:42Z","timestamp":1785442482129,"version":"3.56.0"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2023,5,17]],"date-time":"2023-05-17T00:00:00Z","timestamp":1684281600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,5,17]],"date-time":"2023-05-17T00:00:00Z","timestamp":1684281600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100006447","name":"University of Zurich","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100006447","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["International Orthopaedics (SICOT)"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>It is known that the magnitude of surgery and timing of surgical procedures represents a crucial step of care in polytraumatized patients. In contrast, it is not clear which specific factors are most critical when evaluating the surgical load (physiologic burden to the patient incurred by surgical procedures). Additionally, there is a dearth of evidence for which body region and surgical procedures are associated with high surgical burden. The aim of this study was to identify key factors and quantify the surgical load for different types of fracture fixation in multiple anatomic regions.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A standardized questionnaire was developed by experts from Soci\u00e9t\u00e9 Internationale de Chirurgie Orthop\u00e9dique et de Traumatologie (SICOT)-Trauma committee. Questions included relevance and composition of the surgical load, operational staging criteria, and stratification of operation procedures in different anatomic regions. Quantitative values according to a five-point Likert scale were chosen by the correspondents to determine the surgical load value based on their expertise. The surgical load for different surgical procedures in different body regions could be chosen in a range between \u201c1,\u201d defined as the surgical load equivalent to external (monolateral) fixator application, and \u201c5,\u201d defined as the maximal surgical load possible in that specific anatomic region.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>This questionnaire was completed online by 196 trauma surgeons from 61 countries in between Jun 26, 2022, and July 16, 2022 that are members of SICOT. The surgical load (SL) overall was considered very important by 77.0% of correspondents and important by 20.9% correspondents. Intraoperative blood loss (43.2%) and soft tissue damage (29.6%) were chosen as the most significant factors by participating surgeons. The decision for staged procedures was dictated by involved body region (56.1%), followed by bleeding risk (18.9%) and fracture complexity (9.2%). Percutaneous or intramedullary procedures as well as fractures in distal anatomic regions, such as hands, ankles, and feet, were consistently ranked lower in their surgical load.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>This study demonstrates a consensus in the trauma community about the crucial relevance of the surgical load in polytrauma care. The surgical load is ranked higher with increased intraoperative bleeding and greater soft tissue damage\/extent of surgical approach and depends relevantly on the anatomic region and kind of operative procedure. The experts especially consider anatomic regions and the risk of intraoperative bleeding as well as fracture complexity to guide staging protocols. Specialized guidance and teaching is required to assess both the patient\u2019s physiological status and the estimated surgical load reliably in the preoperative decision-making and operative staging.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00264-023-05828-4","type":"journal-article","created":{"date-parts":[[2023,5,17]],"date-time":"2023-05-17T09:03:38Z","timestamp":1684314218000},"page":"1677-1687","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Surgical load in major fractures \u2014 results of a survey on the optimal quantification and timing of surgery in polytraumatized patients"],"prefix":"10.1007","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6438-5208","authenticated-orcid":false,"given":"Felix Karl-Ludwig","family":"Klingebiel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morgan","family":"Hasegawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Str\u00e4hle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yannik","family":"Kalbas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Teuben","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sascha","family":"Halvachizadeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yohei","family":"Kumabe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans-Christoph","family":"Pape","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roman","family":"Pfeifer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"SICOT Trauma Research Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Turki Bashir","family":"Al-Rouk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bergita","family":"Ganse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Hanschen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilir","family":"Hasani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gleb","family":"Korobushkin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeannie","family":"McCaul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua A.","family":"Parry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Rashed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan","family":"Saveski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hemant","family":"Sharma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Zarti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boris A.","family":"Zelle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,5,17]]},"reference":[{"key":"5828_CR1","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/s00264-021-05213-z","volume":"46","author":"ND Rossiter","year":"2022","unstructured":"Rossiter ND (2022) Trauma-the forgotten pandemic? Int Orthop 46:3\u201311","journal-title":"Int Orthop"},{"key":"5828_CR2","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1097\/BOT.0b013e3182820eba","volume":"27","author":"HA Vallier","year":"2013","unstructured":"Vallier HA, Super DM, Moore TA, Wilber JH (2013) Do patients with multiple system injury benefit from early fixation of unstable axial fractures? The effects of timing of surgery on initial hospital course. J Orthop Trauma 27:405\u2013412","journal-title":"J Orthop Trauma"},{"key":"5828_CR3","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1016\/j.jcot.2020.10.018","volume":"12","author":"G Volpin","year":"2021","unstructured":"Volpin G, Pfeifer R, Saveski J, Hasani I, Cohen M, Pape HC (2021) Damage control orthopaedics in polytraumatized patients- current concepts. J Clin Orthop Trauma 12:72\u201382","journal-title":"J Clin Orthop Trauma"},{"key":"5828_CR4","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1016\/j.injury.2011.02.011","volume":"42","author":"NG Lasanianos","year":"2011","unstructured":"Lasanianos NG, Kanakaris NK, Dimitriou R, Pape HC, Giannoudis PV (2011) Second hit phenomenon: existing evidence of clinical implications. Injury 42:617\u2013629","journal-title":"Injury"},{"key":"5828_CR5","unstructured":"Carstensen B, Plummer M, Laara E, Hills M (2022) Epi: a package for statistical analysis in epidemiology. R package version 2.47.1. https:\/\/cran.r-project.org\/web\/packages\/Epi\/citation.html"},{"key":"5828_CR6","unstructured":"Fisher RA (1935) The design of experiments. Oliver and Boyd. https:\/\/mimno.infosci.cornell.edu\/info3350\/readings\/fisher.pdf"},{"key":"5828_CR7","doi-asserted-by":"publisher","first-page":"3441","DOI":"10.1097\/00003246-200010000-00012","volume":"28","author":"HC Pape","year":"2000","unstructured":"Pape HC, Schmidt RE, Rice J, van Griensven M, das Gupta R, Krettek C, Tscherne H (2000) Biochemical changes after trauma and skeletal surgery of the lower extremity: quantification of the operative burden. Crit Care Med 28:3441\u20133448","journal-title":"Crit Care Med"},{"key":"5828_CR8","first-page":"646","volume":"65","author":"PV Giannoudis","year":"2008","unstructured":"Giannoudis PV, Harwood PJ, Loughenbury P, Van Griensven M, Krettek C, Pape HC (2008) Correlation between IL-6 levels and the systemic inflammatory response score: can an IL-6 cutoff predict a SIRS state? J Trauma 65:646\u2013652","journal-title":"J Trauma"},{"key":"5828_CR9","first-page":"1379","volume":"65","author":"HC Pape","year":"2008","unstructured":"Pape HC, Griensven MV, Hildebrand FF, Tzioupis CT, Sommer KL, Krettek CC, Giannoudis PV (2008) Systemic inflammatory response after extremity or truncal fracture operations. J Trauma 65:1379\u20131384","journal-title":"J Trauma"},{"key":"5828_CR10","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1016\/j.cyto.2012.10.022","volume":"61","author":"R Pfeifer","year":"2013","unstructured":"Pfeifer R, Lichte P, Schreiber H, Sellei RM, Dienstknecht T, Sadeghi C, Pape HC, Kobbe P (2013) Models of hemorrhagic shock: differences in the physiological and inflammatory response. Cytokine 61:585\u2013590","journal-title":"Cytokine"},{"key":"5828_CR11","doi-asserted-by":"publisher","first-page":"2400","DOI":"10.1016\/j.injury.2022.04.009","volume":"53","author":"HC Pape","year":"2022","unstructured":"Pape HC, Moore EE, McKinley T, Sauaia A (2022) Pathophysiology in patients with polytrauma. Injury 53:2400\u20132412","journal-title":"Injury"},{"key":"5828_CR12","doi-asserted-by":"publisher","first-page":"1130","DOI":"10.1016\/j.burns.2018.04.012","volume":"44","author":"J Muniz Castro","year":"2018","unstructured":"Muniz Castro J, Burton K, Thurer RL, Bernal NP (2018) How does blood loss relate to the extent of surgical wound excision? Burns 44:1130\u20131134","journal-title":"Burns"},{"key":"5828_CR13","doi-asserted-by":"publisher","first-page":"2357","DOI":"10.1007\/s00264-013-2093-0","volume":"37","author":"J Parvizi","year":"2013","unstructured":"Parvizi J, Rasouli MR, Jaberi M, Chevrollier G, Vizzi S, Sharkey PF, Hozack WJ (2013) Does the surgical approach in one stage bilateral total hip arthroplasty affect blood loss? Int Orthop 37:2357\u20132362","journal-title":"Int Orthop"},{"key":"5828_CR14","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1007\/s00101-019-0596-9","volume":"68","author":"J Rossaint","year":"2019","unstructured":"Rossaint J, Margraf A, Zarbock A (2019) Perioperative inflammation. Anaesthesist 68:421\u2013427","journal-title":"Anaesthesist"},{"key":"5828_CR15","doi-asserted-by":"publisher","first-page":"812","DOI":"10.1016\/j.transproceed.2006.01.047","volume":"38","author":"M Marietta","year":"2006","unstructured":"Marietta M, Facchini L, Pedrazzi P, Busani S, Torelli G (2006) Pathophysiology of bleeding in surgery. Transplant Proc 38:812\u2013814","journal-title":"Transplant Proc"},{"key":"5828_CR16","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1016\/S0002-9610(96)00216-4","volume":"172","author":"EE Moore","year":"1996","unstructured":"Moore EE (1996) Thomas G. Orr Memorial Lecture. Staged laparotomy for the hypothermia, acidosis, and coagulopathy syndrome. Am J Surg 172:405\u2013410","journal-title":"Am J Surg"},{"key":"5828_CR17","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1186\/s13054-019-2347-3","volume":"23","author":"DR Spahn","year":"2019","unstructured":"Spahn DR, Bouillon B, Cerny V, Duranteau J, Filipescu D, Hunt BJ, Komadina R, Maegele M, Nardi G, Riddez L, Samama CM, Vincent JL, Rossaint R (2019) The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Crit Care 23:98","journal-title":"Crit Care"},{"key":"5828_CR18","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1016\/S0002-9610(02)00783-3","volume":"183","author":"PV Giannoudis","year":"2002","unstructured":"Giannoudis PV, Veysi VT, Pape HC, Krettek C, Smith MR (2002) When should we operate on major fractures in patients with severe head injuries? Am J Surg 183:261\u2013267","journal-title":"Am J Surg"},{"key":"5828_CR19","doi-asserted-by":"publisher","first-page":"E11","DOI":"10.3171\/2014.5.FOCUS1494","volume":"37","author":"T Koreckij","year":"2014","unstructured":"Koreckij T, Park DK, Fischgrund J (2014) Minimally invasive spine surgery in the treatment of thoracolumbar and lumbar spine trauma. Neurosurg Focus 37:E11","journal-title":"Neurosurg Focus"},{"key":"5828_CR20","doi-asserted-by":"publisher","first-page":"1779","DOI":"10.1007\/s00264-018-4127-0","volume":"43","author":"S Tiziani","year":"2019","unstructured":"Tiziani S, Dienstknecht T, Osterhoff G, Hand TL, Teuben M, Werner CML, Pape HC (2019) Standards for external fixation application: national survey under the auspices of the German Trauma Society. Int Orthop 43:1779\u20131785","journal-title":"Int Orthop"},{"key":"5828_CR21","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1007\/s00113-019-0648-2","volume":"122","author":"P Lichte","year":"2019","unstructured":"Lichte P, Alabdulrhaman H, Pishnamaz M, Hofman M, Hildebrand F, Kobbe P (2019) Percutaneous screw techniques for the pelvic ring and acetabulum. Unfallchirurg 122:387\u2013403","journal-title":"Unfallchirurg"},{"key":"5828_CR22","doi-asserted-by":"publisher","first-page":"S30","DOI":"10.1097\/01.bot.0000202390.40246.16","volume":"20","author":"DR Griffin","year":"2006","unstructured":"Griffin DR, Starr AJ, Reinert CM, Jones AL, Whitlock S (2006) Vertically unstable pelvic fractures fixed with percutaneous iliosacral screws: does posterior injury pattern predict fixation failure? J Orthop Trauma 20:S30-36 (discussion S36)","journal-title":"J Orthop Trauma"},{"key":"5828_CR23","doi-asserted-by":"publisher","first-page":"961","DOI":"10.1007\/s00264-015-2727-5","volume":"39","author":"DV Poenaru","year":"2015","unstructured":"Poenaru DV, Popescu M, Anglitoiu B, Popa I, Andrei D, Birsasteanu F (2015) Emergency pelvic stabilization in patients with pelvic posttraumatic instability. Int Orthop 39:961\u2013965","journal-title":"Int Orthop"},{"key":"5828_CR24","doi-asserted-by":"publisher","unstructured":"Scherer J, Coimbra R, Mariani D, Leenen L, Komadina R, Peralta R, Fattori L, Marzi I, Wendt K, Gaarder C, Pape HC, Pfeifer R (2022) Standards of fracture care in polytrauma: results of a Europe-wide survey by the ESTES polytrauma section. Eur J Trauma Emerg Surg.\u00a0https:\/\/doi.org\/10.1007\/s00068-022-02126-3","DOI":"10.1007\/s00068-022-02126-3"},{"key":"5828_CR25","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1016\/j.injury.2004.12.037","volume":"36","author":"M Keel","year":"2005","unstructured":"Keel M, Trentz O (2005) Pathophysiology of polytrauma. Injury 36:691\u2013709","journal-title":"Injury"},{"key":"5828_CR26","doi-asserted-by":"publisher","first-page":"336","DOI":"10.2106\/00004623-198971030-00004","volume":"71","author":"LB Bone","year":"1989","unstructured":"Bone LB, Johnson KD, Weigelt J, Scheinberg R (1989) Early versus delayed stabilization of femoral fractures. A prospective randomized study. J Bone Joint Surg Am 71:336\u2013340","journal-title":"J Bone Joint Surg Am"},{"key":"5828_CR27","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1097\/00005373-197702000-00005","volume":"17","author":"EB Riska","year":"1977","unstructured":"Riska EB, von Bonsdorff H, Hakkinen S, Jaroma H, Kiviluoto O, Paavilainen T (1977) Primary operative fixation of long bone fractures in patients with multiple injuries. J Trauma 17:111\u2013121","journal-title":"J Trauma"},{"key":"5828_CR28","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1097\/00005373-199304000-00010","volume":"34","author":"HC Pape","year":"1993","unstructured":"Pape HC, Auf\u2019m\u2019Kolk M, Paffrath T, Regel G, Sturm JA, Tscherne H (1993) Primary intramedullary femur fixation in multiple trauma patients with associated lung contusion\u2013a cause of posttraumatic ARDS? J Trauma 34:540\u2013547 (discussion 547-548)","journal-title":"J Trauma"},{"key":"5828_CR29","doi-asserted-by":"publisher","first-page":"622","DOI":"10.1016\/S0002-9610(02)00865-6","volume":"183","author":"HC Pape","year":"2002","unstructured":"Pape HC, Giannoudis P, Krettek C (2002) The timing of fracture treatment in polytrauma patients: relevance of damage control orthopedic surgery. Am J Surg 183:622\u2013629","journal-title":"Am J Surg"},{"key":"5828_CR30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.injury.2014.12.001","volume":"46","author":"HC Pape","year":"2015","unstructured":"Pape HC, Pfeifer R (2015) Safe definitive orthopaedic surgery (SDS): repeated assessment for tapered application of Early Definitive Care and Damage Control?: an inclusive view of recent advances in polytrauma management. Injury 46:1\u20133","journal-title":"Injury"},{"key":"5828_CR31","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1016\/j.injury.2022.11.008","volume":"54","author":"R Pfeifer","year":"2023","unstructured":"Pfeifer R, Klingebiel FK, Halvachizadeh S, Kalbas Y, Pape HC (2023) How to clear polytrauma patients for fracture fixation: results of a systematic review of the literature. Injury 54:292\u2013317","journal-title":"Injury"},{"key":"5828_CR32","doi-asserted-by":"publisher","first-page":"1656","DOI":"10.1016\/j.injury.2019.09.021","volume":"50","author":"HC Pape","year":"2019","unstructured":"Pape HC, Halvachizadeh S, Leenen L, Velmahos GD, Buckley R, Giannoudis PV (2019) Timing of major fracture care in polytrauma patients - an update on principles, parameters and strategies for 2020. Injury 50:1656\u20131670","journal-title":"Injury"},{"key":"5828_CR33","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1097\/SLA.0b013e3181485750","volume":"246","author":"HC Pape","year":"2007","unstructured":"Pape HC, Rixen D, Morley J, Husebye EE, Mueller M, Dumont C, Gruner A, Oestern HJ, Bayeff-Filoff M, Garving C, Pardini D, van Griensven M, Krettek C, Giannoudis P (2007) Impact of the method of initial stabilization for femoral shaft fractures in patients with multiple injuries at risk for complications (borderline patients). Ann Surg 246:491\u2013499 (discussion 499-501)","journal-title":"Ann Surg"},{"key":"5828_CR34","doi-asserted-by":"publisher","first-page":"2701","DOI":"10.1016\/j.injury.2022.06.045","volume":"53","author":"Y Kalbas","year":"2022","unstructured":"Kalbas Y, Pape HC (2022) What factors determine a \u201cmajor fracture\u201d? Injury 53:2701\u20132703","journal-title":"Injury"},{"key":"5828_CR35","doi-asserted-by":"publisher","first-page":"2081","DOI":"10.1007\/s00068-020-01386-1","volume":"47","author":"R Pfeifer","year":"2021","unstructured":"Pfeifer R, Kalbas Y, Coimbra R, Leenen L, Komadina R, Hildebrand F, Halvachizadeh S, Akhtar M, Peralta R, Fattori L, Mariani D, Hasler RM, Lefering R, Marzi I, Pitance F, Osterhoff G, Volpin G, Weil Y, Wendt K, Pape HC (2021) Indications and interventions of damage control orthopedic surgeries: an expert opinion survey. Eur J Trauma Emerg Surg 47:2081\u20132092","journal-title":"Eur J Trauma Emerg Surg"},{"key":"5828_CR36","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1007\/s00104-015-0139-0","volume":"87","author":"R Pfeifer","year":"2016","unstructured":"Pfeifer R, Pape HC (2016) Diagnostics and treatment strategies for multiple trauma patients. Chirurg 87:165\u2013173 (quiz 174-165)","journal-title":"Chirurg"},{"key":"5828_CR37","doi-asserted-by":"publisher","unstructured":"Kalbas Y, Klingebiel FK, Halvachizadeh S, Kumabe Y, Scherer J, Teuben M, Pfeifer R, Pape HC (2023) Developments in the understanding of staging a \"major fracture\" in polytrauma: results from an initiative by the polytrauma section of ESTES. Eur J Trauma Emerg Surg.\u00a0https:\/\/doi.org\/10.1007\/s00068-023-02245-5","DOI":"10.1007\/s00068-023-02245-5"},{"key":"5828_CR38","doi-asserted-by":"publisher","first-page":"825","DOI":"10.1007\/s00423-008-0334-2","volume":"393","author":"F Gebhard","year":"2008","unstructured":"Gebhard F, Huber-Lang M (2008) Polytrauma\u2013pathophysiology and management principles. Langenbecks Arch Surg 393:825\u2013831","journal-title":"Langenbecks Arch Surg"}],"container-title":["International Orthopaedics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00264-023-05828-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00264-023-05828-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00264-023-05828-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,6,14]],"date-time":"2023-06-14T09:10:12Z","timestamp":1686733812000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00264-023-05828-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,17]]},"references-count":38,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2023,7]]}},"alternative-id":["5828"],"URL":"https:\/\/doi.org\/10.1007\/s00264-023-05828-4","relation":{},"ISSN":["0341-2695","1432-5195"],"issn-type":[{"value":"0341-2695","type":"print"},{"value":"1432-5195","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,17]]},"assertion":[{"value":"2 March 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 April 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 May 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The local ethic committee of the University Hospital Zurich disclosed a general waiver for anonymous surveys.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"As this study was conducted as voluntary anonymous survey with the aim of publishing the obtained results, the participants agreed to the use and publication of their data by completing the questionnaire.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate and for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}