{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T10:51:05Z","timestamp":1786963865964,"version":"build-2736575974"},"reference-count":19,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2008,2,2]],"date-time":"2008-02-02T00:00:00Z","timestamp":1201910400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2008,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Emergency surgical services in Edinburgh were restructured in July 2002 to deliver subspecialist management of colorectal and upper\u2010gastrointestinal emergencies on separate sites. The effect of emergency subspecialization on outcome from perforated and bleeding peptic ulceration was assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>All patients admitted with complicated peptic ulceration (January 2000\u2013February 2005) were identified from a prospectively compiled database.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Perforation: 148 patients were admitted with perforation before the service reorganization (period A \u2013 31\u00a0months) of whom 126 (85.1%) underwent surgery; 135 patients were admitted in period B (31\u00a0months) of whom 114 (84.4%) were managed operatively. The in\u2010hospital mortality was lower in period B (14\/135, 10.4%) than period A (30\/148, 20.3%; <jats:italic>P<\/jats:italic> = 0.023; relative risk (RR), 0.51; 95% confidence interval (CI), 0.28\u20130.91). There was a significantly higher rate of gastric resection in the second half of the study (period A 1\/126 vs. period B 8\/114; <jats:italic>P<\/jats:italic> = 0.015; RR, 8.84; 95% CI, 1.48\u201354.34). Length of hospital stay was similar for both groups. Bleeding: 51 patients underwent operative management of bleeding peptic ulceration in period A and 51\u00a0in period B. There were no differences in length of stay or mortality between these two groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Restructuring of surgical services with emergency subspecialization was associated with lower mortality for perforated peptic ulceration. Subspecialist experience, intraoperative decision\u2010making, and improved postoperative care have all contributed to this improvement.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-007-9444-1","type":"journal-article","created":{"date-parts":[[2008,2,1]],"date-time":"2008-02-01T12:35:31Z","timestamp":1201869331000},"page":"1456-1461","source":"Crossref","is-referenced-by-count":25,"title":["The Effect of Surgical Subspecialization on Outcomes in Peptic Ulcer Disease Complicated by Perforation and Bleeding"],"prefix":"10.1002","volume":"32","author":[{"given":"Andrew J.","family":"Robson","sequence":"first","affiliation":[{"name":"Department of Surgery, Royal Infirmary of Edinburgh, Lecturers\u2019 Office (F3339) \u2013 Ward 106, Department of Surgery Royal Infirmary of Edinburgh 51 Little France Crescent EH16 4SA Edinburgh United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer M. J.","family":"Richards","sequence":"additional","affiliation":[{"name":"Department of Surgery, Royal Infirmary of Edinburgh, Lecturers\u2019 Office (F3339) \u2013 Ward 106, Department of Surgery Royal Infirmary of Edinburgh 51 Little France Crescent EH16 4SA Edinburgh United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Ohly","sequence":"additional","affiliation":[{"name":"Department of Surgery, Royal Infirmary of Edinburgh, Lecturers\u2019 Office (F3339) \u2013 Ward 106, Department of Surgery Royal Infirmary of Edinburgh 51 Little France Crescent EH16 4SA Edinburgh United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen J.","family":"Nixon","sequence":"additional","affiliation":[{"name":"Department of Surgery, Royal Infirmary of Edinburgh, Lecturers\u2019 Office (F3339) \u2013 Ward 106, Department of Surgery Royal Infirmary of Edinburgh 51 Little France Crescent EH16 4SA Edinburgh United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Paterson\u2010Brown","sequence":"additional","affiliation":[{"name":"Department of Surgery, Royal Infirmary of Edinburgh, Lecturers\u2019 Office (F3339) \u2013 Ward 106, Department of Surgery Royal Infirmary of Edinburgh 51 Little France Crescent EH16 4SA Edinburgh United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2008,2,2]]},"reference":[{"key":"e_1_2_5_2_2","doi-asserted-by":"publisher","DOI":"10.1067\/mva.2001.113487"},{"key":"e_1_2_5_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10350\u2010004\u20106327\u20105"},{"key":"e_1_2_5_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1479\u2010666X(04)80079\u20109"},{"key":"e_1_2_5_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10350\u2010004\u20106793\u20109"},{"key":"e_1_2_5_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800790305"},{"key":"e_1_2_5_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.4458"},{"key":"e_1_2_5_8_2","doi-asserted-by":"publisher","DOI":"10.1159\/000079654"},{"key":"e_1_2_5_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102036.2006.02918.x"},{"issue":"1","key":"e_1_2_5_10_2","first-page":"CD002094","article-title":"Proton pump inhibitor treatment for acute peptic ulcer bleeding","volume":"25","author":"Leontiadis GI","year":"2006","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_5_11_2","doi-asserted-by":"publisher","DOI":"10.1080\/00365529850170838"},{"key":"e_1_2_5_12_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198904133201504"},{"key":"e_1_2_5_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010003\u20106645\u20100"},{"key":"e_1_2_5_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1590\u20108658(02)80124\u20104"},{"key":"e_1_2_5_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572\u20100241.2006.00825.x"},{"key":"e_1_2_5_16_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199903113401002"},{"key":"e_1_2_5_17_2","doi-asserted-by":"publisher","DOI":"10.3109\/00365529409092474"},{"key":"e_1_2_5_18_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.5155"},{"key":"e_1_2_5_19_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.RVI.0000126813.89981.B6"},{"key":"e_1_2_5_20_2","doi-asserted-by":"publisher","DOI":"10.1308\/147363507X161439"}],"container-title":["World Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00268-007-9444-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1007\/s00268-007-9444-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00268-007-9444-1","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,26]],"date-time":"2023-12-26T15:07:11Z","timestamp":1703603231000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1007\/s00268-007-9444-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2008,2,2]]},"references-count":19,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2008,7]]}},"alternative-id":["10.1007\/s00268-007-9444-1"],"URL":"https:\/\/doi.org\/10.1007\/s00268-007-9444-1","archive":["Portico"],"relation":{},"ISSN":["0364-2313","1432-2323"],"issn-type":[{"value":"0364-2313","type":"print"},{"value":"1432-2323","type":"electronic"}],"subject":[],"published":{"date-parts":[[2008,2,2]]}}}