Preferred Methodology Research Articles

A systematic literature review of slow tourism

This systematic literature review focuses on slow tourism, which grew in popularity during COVID-19. It highlights the gaps in the literature for future researchers by compiling the papers published on slow tourism between 2010 and 2021. In addition, the managerial suggestions we make serve as lessons for practitioners. Developed as a systematic literature review, we used different selection criteria including papers published in English in Q1 or Q2 journals between 2010 and 2021 in the sample. This study identified the following parameters: the number of publications, the most preferred research methodology and data collection methods, and the geographical coverage of slow tourism papers. The relationship between slow tourism and sustainability is strengthened by our analysis. We identified qualitative studies, particularly in-depth interviews, as the most popular data collection method for slow tourism studies. Australia, the United Kingdom, and Poland were the most popular destinations in terms of the geographical context of these studies, followed by Italy. As the literature is missing a unified definition of slow tourism, we propose one based on the four-pillar model.

Exercise intensity prescription in cardiovascular rehabilitation: bridging the gap between best evidence and clinical practice.

Optimizing endurance exercise intensity prescription is crucial to maximize the clinical benefits and minimize complications for individuals at risk for or with cardiovascular disease (CVD). However, standardization remains incomplete due to variations in clinical guidelines. This review provides a practical and updated guide for health professionals on how to prescribe endurance exercise intensity for cardiovascular rehabilitation (CR) populations, addressing international guidelines, practical applicability across diverse clinical settings and resource availabilities. In the context of CR, cardiopulmonary exercise test (CPET) is considered the gold standard assessment, and prescription based on ventilatory thresholds (VTs) is the preferable methodology. In settings where this approach isn't accessible, which is frequently the case in low-resource environments, approximating VTs involves combining objective assessments-ideally, exercise tests without gas exchange analyses, but at least alternative functional tests like the 6-minute walk test-with subjective methods for adjusting prescriptions, such as Borg's ratings of perceived exertion and the Talk Test. Therefore, enhancing exercise intensity prescription and offering personalized physical activity guidance to patients at risk for or with CVD rely on aligning workouts with individual physiological changes. A tailored prescription promotes a consistent and impactful exercise routine for enhancing health outcomes, considering patient preferences and motivations. Consequently, the selection and implementation of the best possible approach should consider available resources, with an ongoing emphasis on strategies to improve the delivery quality of exercise training in the context of FITT-VP prescription model (frequency, intensity, time, type, volume, and progression).

Assessment of material consumption planning methods in part of waste and losses at pipe industry enterprises

This article focuses on the subsystem of economic planning, specifically the standardization of material consumption in industrial production within the pipe industry, particularly in terms of calculating planned waste and loss indicators. Waste and losses are key components of the material consumption norm that currently require thorough analysis. The objective of the study is to evaluate the methodologies used in economic planning within pipe industry enterprises for standardizing waste and losses through comparison with the results of a control calculation. The main hypothesis posits that methodologies not fully adhering to the principles of the computational-analytical method of economic planning may not accurately calculate the amount of waste and losses as part of the material consumption norms. The study employs a method of comparative analysis, ensuring its reliability by developing a two-stage approach to comparing methodologies based on objective waste quantity indicators. Real data from pipe manufacturing companies is utilized to validate the author's approach, with calculations conducted using two methodologies and a control model, leading to an assessment and justification of the preferred methodology for standardization practice, highlighting its advantages. The research provides a scientific rationale for selecting the most objective standardization methodology based on two key criteria – the accuracy of economic calculations and their alignment with the production process. The conclusions and recommendations of the authors can be foundational in developing industry-specific guidelines for standardizing material consumption in the pipe industry. The adoption of a more effective methodology will result in the establishment of objective material consumption norms and enhance the quality of economic planning in pipe industry enterprises.

TOMOMAN: a software package for large scale cryo-electron tomography data preprocessing, community data sharing, and collaborative computing.

Cryo-electron tomography (cryo-ET) and subtomogram averaging (STA) are becoming the preferred methodologies for investigating subcellular and macromolecular structures in native or near-native environments. While cryo-ET is amenable to a wide range of biological problems, these problems often have data processing requirements that need to be individually optimized, precluding the notion of a one-size-fits-all processing pipeline. Cryo-ET data processing is also becoming progressively more complex due to an increasing number of packages for each processing step. Though each package has its own strengths and weaknesses, independent development and different data formats makes them difficult to interface with one another. TOMOMAN (TOMOgram MANager) is an extensible package for streamlining the interoperability of packages, enabling users to develop project-specific processing workflows. TOMOMAN does this by maintaining an internal metadata format and wrapping external packages to manage and perform preprocessing, from raw tilt-series data to reconstructed tomograms. TOMOMAN can also export this metadata between various STA packages. TOMOMAN also includes tools for archiving projects to data repositories; allowing subsequent users to download TOMOMAN projects and directly resume processing where it was previously left off. By tracking essential metadata, TOMOMAN streamlines data sharing, which improves reproducibility of published results, reduces computational costs by minimizing reprocessing, and enables distributed cryo-ET projects between multiple groups and institutions. TOMOMAN provides a way for users to test different software packages to develop processing workflows that meet the specific needs of their biological questions and to distribute their results with the broader scientific community.

Infection preventionists’ current and preferred training strategies and tools

Educating healthcare staff on infection prevention and control (IPC) is an essential role of infection preventionists (IPs), but the COVID-19 pandemic diverted resources away from IPC education. Association for Professionals in Infection Control and Epidemiology members were invited to complete an online survey from spring 2023 to assess current and preferred approaches and tools for training healthcare personnel on IPC. Vendors, retirees, APIC staff, or those not working in healthcare or public health were excluded. In all, 2,432 IPs participated. IPs were more likely to report engaging in impromptu healthcare worker training (ie, just-in-time teaching and team huddles) versus planned educational activities (ie, learning modules, formal presentations, train-the-trainer, or simulation; Kruskal-Wallis=288, P<.001). IPs' top preferred teaching methodologies included simulation or interactive activity, and their lowest preferred approach was independent learning modules. IPC training apps were frequently requested technology. IPs ranked simulation as their top preferred teaching method; however, simulation was one of the least frequently used approaches. IP education should include strategies for delivering effective impromptu training and how to develop and implement interactive simulation-based education. The expressed needs and preferences of IPs should be considered when developing IPC-related teaching and training tools.

Identifying Rule-Based Rationality

Abstract The revealed preference methodology allows an observer to infer preferences from choices. This paper extends this fundamental idea by experimentally identifying the preference for basing choices on simple decision rules. Subjects not only make case-by-case portfolio allocations but also design a simple investment rule for selecting portfolios. They then choose between these two decision modes for an additional set of problems. The majority opt for the rule interface and in most cases choose a simple investment rule that cannot be rationalized by any simple utility function or accounted for by reductions in decision time or by cognitive costs.

Constructing Research Preferences by Prospective Indonesian EFL Teachers

Several studies have discussed the features and characteristics of research on English language teaching in Indonesia by both lecturers and students. However, there is very little research that discusses topics, research methods, designs, and reasons for choosing topics, as well as the efforts to improve the quality of research conducted by prospective EFL teachers in the Indonesian context. The study aims to identify, assess, and characterize the research conducted by prospective Indonesian EFL teachers. The study used mixed research methods utilizing 477 research works as the objects of study, while the research participants were 67 prospective Indonesian EFL teachers and 5 heads of the English education program. The results showed that students' selected research topics were the process of learning English at the secondary school level and that their preferred methodologies were quantitative research, qualitative research, and classroom action research (mixed methods). The most popular topics in English language learning research were methods for learning, classroom action research, textbook analysis, media for learning English, and viewpoints on English teaching concerns. The reasons for choosing certain research topics and methods were dominated by issues of ease of research completion. The results contribute as a basis for future research to select variables, designs, issues, or study subjects to explore as well as for directing and defining the themes and research topics in the English Education study program.

Economic valuation of Harmful Algal Blooms (HAB): Methodological challenges, policy implications, and an empirical application

This paper presents a literature review on the economic valuation of Harmful Algal Bloom (HAB) impacts, identifying methodological challenges, policy implications, and gaps. Unlike previous literature reviews, we are particularly interested in determining whether the economic valuations of HABs have included a policy analysis. Our paper provides a conceptual framework that allows us to evaluate whether applications of economic studies of HABs are consistent with a well-defined economic welfare analysis. It links methodologies and techniques with welfare measures, data types, and econometric methods. Based on this literature review, we present an example of economic valuation that closes the gap between policy analysis and valuation methodology. We use a stated preferences study to estimate a “seafood price premium” to create a fund to support monitoring systems and for damage compensation to producers in the presence of HABs. Results show that most economic studies on HAB valuation do not consider any cost-benefit analysis of a defined policy intervention. The predominant economic valuation methodology uses market information to estimate a proxy for welfare measure of the impact of HABs (loss revenue, sales, exports). Moreover, nonuse and indirect use values are ignored in the literature, while stated preference methodologies are underrepresented. Finally, results from 1293 surveys found that people are willing to pay an increase in the price of mussels to support a policy that informs on HAB. However, the lack of institutional trust affects the probability of paying negatively.

Learning Style Preferences Among Undergraduate Medical Students of Lahore, Pakistan and Factors Related to it

Objectives: The objectives of the study were to assess the learning styles of medical students using the VARK Questionnaire and to study factors related to their learning style preferences. Methods: A descriptive cross-sectional study, using the validated 16-point VARK Questionnaire Version 8.01, was conducted among medical students in Lahore, Pakistan, from May to October 2023. Through non-probability virtual snowball sampling, 360 students from various medical colleges responded to online Google forms distributed via emails and WhatsApp groups. Data were entered, cleaned, and analyzed using Statistical Package for the Social Sciences (SPSS) Version 26. The Chi-square test determined associations between variables, with a significance level set at p &lt; 0.05. Results: The respondents had a mean age of 21.56±1.608. The study revealed that 68.9% preferred a unimodal learning style, with Visual (25%) being the most favored, followed by Read/Write (15.2%), Aural (14%), and Kinesthetic (13.5%).About 65% of respondents were unaware of their learning styles. No statistically significant relationships were found between learning style and gender, clinical year, schooling background, or institute type. However, significant relationships were found with age, academic performance, and preferred teaching methodology (p=0.05, p=0.04, and p=0.007, respectively). Conclusion: The present study highlighted the independence of learning styles from demographics. The identified relationship between learning styles, preferred teaching methodologies, and academic performance emphasizes the significance of this knowledge for medical educators and students in fostering lifelong learning. It's noteworthy that majority of students demonstrated unimodal sensory preferences, reinforcing the importance of tailored teaching strategies to maximize learning potential. Keywords: Learning, style, VARK, Medical Education, Teaching Methods, Medical Students

Impact of risk perception and trust in autonomous vehicles on pedestrian crossing decision: Navigating the social-technological intersection with the ICLV model

In the rapidly evolving realm of transportation technology, the dynamic relationship between pedestrians and technological innovations has attained unprecedented importance. The complex social-technological intersection surrounding pedestrian road crossings has emerged as an attention for traffic safety. What distinguishes the contemporary urban environment is the rapid assimilation of intelligent transportation systems (ITS) into the transportation infrastructure, including technological elements such as autonomous vehicles, advanced surveillance systems, and smart infrastructure. To investigate how pedestrians perceive risks, trust technology, and make decisions in this era of technological progress, we designed a video-based questionnaire utilizing the stated preference (SP) methodology. We collected SP data from 589 Chinese pedestrians and employed an integrated choice and latent variable (ICLV) model to quantify the influence of risk perception and trust in autonomous vehicle (trust in AV), treated as latent variables, on their crossing decisions. Our findings indicate that the presence of autonomous vehicles significantly affects pedestrian crossing decisions. Specifically, an increase in the approaching vehicle speed and a decrease in the approaching vehicle distance increase the pedestrians’ tendency to choose not to cross the road, and the latent variables of risk perception and trust in AV strongly predict this phenomenon. The results of the scenario analysis show that, compared with overall pedestrians, middle-aged pedestrians and high-risk perception-level pedestrians are more conservative in their crossing decisions, but high levels of trust in AV improve pedestrians’ willingness to cross the street. Additionally, the pedestrian-related findings of this study at the social-technological intersection provide better understanding of the decision process and contribute to the planning and development of urban intelligent transportation systems.

Optimization of Well Placement in Carbon Capture and Storage (CCS): Bayesian Optimization Framework under Permutation Invariance

Carbon Capture and Storage (CCS) stands as a pivotal technological stride toward a sustainable future, with the practice of injecting supercritical CO2 into subsurface formations being already an established practice for enhanced oil recovery operations. The overarching objective of CCS is to protract the operational viability and sustainability of platforms and oilfields, thereby facilitating a seamless transition towards sustainable practices. This study introduces a comprehensive framework for optimizing well placement in CCS operations, employing a derivative-free method known as Bayesian Optimization. The development plan is tailored for scenarios featuring aquifers devoid of flow boundaries, incorporating production wells tasked with controlling pressure buildup and injection wells dedicated to CO2 sequestration. Notably, the wells operate under group control, signifying predefined injection and production targets and constraints that must be adhered to throughout the project’s lifespan. As a result, the objective function remains invariant under specific permutations of the well locations. Our investigation delves into the efficacy of Bayesian Optimization under the introduced permutation invariance. The results reveal that it demonstrates critical efficiency in handling the optimization task extremely fast. In essence, this study advocates for the efficacy of Bayesian Optimization in the context of optimizing well placement for CCS operations, emphasizing its potential as a preferred methodology for enhancing sustainability in the energy sector.

From unobserved to observed preference heterogeneity: a revealed preference methodology

AbstractWe present an easy‐to‐apply non‐parametric revealed preference method to identify observed preference heterogeneity from cross‐sectional data. Building on the partitioning approach that was developed by Crawford and Pendakur (Economic Journal, 2013, 123(567), 77–95) and Cosaert (Computational Economics, 2019, 53(2), 533–54), it quantifies the contribution of observable consumer characteristics to describing the identified preference heterogeneity. We demonstrate the practical usefulness of our method through an application to newly gathered experimental data on consumer choice behaviour in two types of decision situations: the allocation of money (choosing between two products) and the allocation of time (choosing between leisure and work). We investigate whether the same consumer characteristics drive the observed variation in choice behaviour in these two settings.

Return to Sports Following Spondylolysis Surgery in Children and Adolescents: A Systematic Review.

Spondylolysis is common in athletes participating in gymnastics, football, dance, and weightlifting. Few studies have reviewed return to sports (RTS) rates in young athletes after surgical intervention for spondylolysis. We sought to review the literature on RTS frequencies and timing, as well as postoperative treatment, in children and adolescents who underwent spondylolysis surgery. This was a systematic review, using the PubMed, Embase, and Cochrane databases, of primary, peer-reviewed studies published from 2014 to 2022 that investigated child and adolescent RTS after spondylolysis surgery. Each author independently reviewed each study's design, number of participants, age range, fixation, postoperative course of treatment, frequency of RTS, and reasons for failure of RTS. The initial search produced 106 articles; 25 were reviewed in full and 9 were included in the final analysis, with a combined total of 177 patients. Sample sizes ranged from 5 to 52 participants. The most common fixations were direct repair (6 studies, n = 120), indirect repair (3 studies, n = 22), and fusion (2 studies, n = 35). Five studies mentioned the use of immediate postoperative immobilization. Physical therapy programs were initiated most often at 6 weeks postoperatively. The RTS rate of the 177 athletes (median age younger than 23 years) was 76% to 100%. The most common reason for failure to RTS was lower back pain. This systematic review suggests that young athletes RTS at a high rate following spondylolysis surgery, but more rigorous study is warranted. The review also found varied preferred fixation methodologies and postoperative treatment regimens across the available studies.

The impact of a regionally based translational cancer research collaborative in Australia using the FAIT methodology

BackgroundTranslating research, achieving impact, and assessing impact are important aspirations for all research collaboratives but can prove challenging. The Hunter Cancer Research Alliance (HCRA) was funded from 2014 to 2021 to enhance capacity and productivity in cancer research in a regional centre in Australia. This study aimed to assess the impact and benefit of the HCRA to help inform future research investments of this type.MethodThe Framework to Assess the Impact from Translational health research (FAIT) was selected as the preferred methodology. FAIT incorporates three validated methodologies for assessing impact: 1) Modified Payback; 2) Economic Analysis; and 3) Narrative overview and case studies. All three FAIT methods are underpinned by a Program Logic Model. Data were collected from HCRA and the University of Newcastle administrative records, directly from HCRA members, and website searches.ResultsIn addition to advancing knowledge and providing capacity building support to members via grants, fellowships, scholarships, training, events and targeted translation support, key impacts of HCRA-member research teams included: (i) the establishment of a regional biobank that has distributed over 13,600 samples and became largely self-sustaining; (ii) conservatively leveraging $43.8 M (s.a.$20.5 M - $160.5 M) in funding and support from the initial $9.7 M investment; (iii) contributing to clinical practice guidelines and securing a patent for identification of stem cells for endometrial cell regeneration; (iv) shifting the treatment paradigm for all tumour types that rely on nerve cell innervation, (v) development and implementation of the world’s first real-time patient treatment verification system (Watchdog); (vi) inventing the effective ‘EAT’ psychological intervention to improve nutrition and outcomes in people experiencing radiotherapy for head and neck cancer; (vi) developing effective interventions to reduce smoking rates among priority groups, currently being rolled out to disadvantaged populations in NSW; and (vii) establishing a Consumer Advisory Panel and Consumer Engagement Committee to increase consumer involvement in research.ConclusionUsing FAIT methodology, we have demonstrated the significant impact and downstream benefits that can be achieved by the provision of infrastructure-type funding to regional and rural research collaboratives to help address inequities in research activity and health outcomes and demonstrates a positive return on investment.

The effect of multiple triage points on the outcomes (time and accuracy) of hospital triage during mass casualty incidents

IntroductionDuring mass casualty incidents (MCIs), the accuracy and timing of the triage of patients by the emergency department (ED) triage officers are essential. The primary triage is performed at the event's location by paramedics and intends a quick evaluation of the victims. Secondary triage may be used when the transfer of the victim is delayed. In this study, we aimed to investigate the effectiveness of two-point triage in a simulated environment of an MCI in the hospital setting. Materials and methodsIn this case-control study, we used an online test module to assess single triage points (Group 1, n = 41) and two triage points (Group 2, n = 40). 60 vignettes for Group 1 and 55 vignettes (5 deceased cases removed) for Group 2 were used. The assessment utilized clinical MCI scenarios in a scheduled online meeting by using the Simple Triage and Rapid Treatment (START) system. Triage time and accuracy of the triage, along with the experience, and previous training of the participants, were assessed. ResultsA total of 81 triage officers participated in this study. The participants were divided into two independent groups homogenously according to their profession and experience. Groups were comparable primarily without any statistically significant difference in terms of the profession (p = 0.101), sex (p = 0.923), and MCI experience (p = 0.785). The difference between the two groups was not significant with regard to having received practical or theoretical triage training (p = 0.099). The mean time of a single vignette triage was 19.2 (SD 6.5) seconds and mean percentage of correct triage score was 65.0 (SD 12.6). The participants had a statistically significantly better performance in the single-point triage group regarding the median triage time (p < 0.001) and median percentages of under triage (p = 0.001), but a worse median percentage of over triage (p < 0.001). However, there was no significant difference between the two groups in terms of the percentage of accurate triage. Emergency residents performed better in accuracy and triage time than their non-physician colleagues (p = 0.019). ConclusionsTwo-point triage does not demonstrate better outcomes in terms of accuracy and timing. Triage officers should be trained frequently with the preferred training methodology to prevent improper triage accuracy and timing. Well-defined medical disaster planning should include frequent training of the triage officers with case scenarios.

Unveiling the Complexity of Medical Imaging through Deep Learning Approaches

Recent advancements in deep learning, particularly convolutional networks, have rapidly become the preferred methodology for analyzing medical images, facilitating tasks like disease segmentation, classification, and pattern quantification. Central to these advancements is the capacity to leverage hierarchical feature representations acquired solely from data. This comprehensive review meticulously examines a variety of deep learning techniques applied across diverse healthcare domains, delving into the intricate realm of medical imaging to unveil concealed patterns through strategic deep learning methodologies. Encompassing a range of diseases, including Alzheimer’s, breast cancer, brain tumors, glaucoma, heart murmurs, retinal microaneurysms, colorectal liver metastases, and more, the analysis emphasizes contributions succinctly summarized in a tabular form.The table provides an overview of various deep learning approaches applied to different diseases, incorporating methodologies, datasets, and outcomes for each condition.Notably, performance metrics such as accuracy, specificity, sensitivity, and other crucial measures underscore the achieved results. Specifically, an in-depth discussion is conducted on the Convolutional Neural Network (CNN) owing to its widespread adoption as a paramount tool in computer vision tasks. Moreover, an exhaustive exploration encompasses deep learning classification approaches, procedural aspects of medical image processing, as well as a thorough examination of key features and characteristics. At the end, we delve into a range of research challenges and put forth potential avenues for future improvements in the field.

Profile to Portfolio

This paper focuses on comparing reproducible methodologies to map an investor risk profile into portfolios, products, and solutions in a suitable manner. This study is premised on the assumption that financial advisors have access to valid measures of an individual’s tolerance to take investment risk or aggregate investor risk profile, and measures of the riskiness of products and portfolios of products. We compared three methodologies from the academic literature or regulators against investment alternatives we constructed. The alternatives were a range of 14 efficient portfolios using long-term indices in the United States, Canada, the United Kingdom, and Australia. Seven were based on an equal distribution of risk (i.e., the standard deviation increased equally between the seven portfolios), and seven portfolios where the percentage return of each portfolio increased by the same amount between each portfolio. The portfolios distributed by risk were discarded in favour of those distributed by return, and these were then mapped to determine the risk level of the investor they were considered suitable for based on the three methodologies. It was determined that (a) behavioural expectation and exposure to equities is a valid heuristic but insufficient to scale to the wide variety of portfolios and products, use of leverage, and other factors in the marketplace; (b) rolling standard deviation measures can lead to significantly understated assessments of risk in some periods; and (c) the VaR calculation is recognized in multiple sources as the preferred methodology to align investor concerns of drop in the value of their portfolio to the actual products, but like standard deviation, it is highly impacted by the period utilized. After altering two methodologies (i.e., MIFiD-II and RiskCAT) based on altered duration of data and scaling, respectively, we found that the four methodologies tested agreed with less than one risk band variance and an average correlation of 0.95 to 0.97.

How legislators define research evidence

Background:Understanding how policymakers define research and differentiate it from other sources of data is critical for scientists to improve how they conduct and communicate research to policy audiences. Yet, few studies have explicitly asked policymakers – particularly state legislators in the USA – how they define research evidence. Methods:We sought to fill this gap via in-depth interviews with 168 policymakers from two Midwestern states; 32 of whom were nominated by their colleagues as exemplar research users. Findings were triangulated via interviews with experienced key informants from both states. In-depth interviews were the preferred methodology for our research question, as they offered legislators the chance to describe research in their own words and elaborate on examples when needed. Findings:For many legislators, definitions of research largely aligned with how the scientific community might define research; both Republicans and Democrats defined research as peer-reviewed studies with specific qualities that distinguish research evidence from other types of information. However, some legislators defined research with a broader lens, including different types of information (for example, anecdotes) and qualities of information (for example, accessibility, relevance, credibility, and unbiased) as part of their definition. Discussion and conclusions:Researchers may better engage policy audiences by referring to the types and qualities legislators mentioned because policymakers prefer evidence from rigorous studies to those that are poorly executed or politically motivated. Legislators called this ‘bogus’ research, ‘party’ research or ‘pseudoscience’. Researchers can signal their credibility by being transparent regarding funding sources and reasons or motivation for conducting studies.

Resilience after a nuclear accident: readiness in using mobile phone applications to measure radiation and health indicators in various groups (SHAMISEN SINGS project)

An anonymous web-based survey was developed to check different aspects (SHAMISEN SINGS project): stakeholder awareness and perceptions of available mobile applications (apps) for measuring ionising radiation doses and health/well-being indicators; whether they would be ready to use them in the post-accidental recovery; and what are their preferred methodologies to acquire information etc. The results show that participation of the citizens would be most beneficial during post-accident recovery, providing individual measurements of external ionizing dose and health/well-being parameters, with possible follow-up. Also, participants indicated different preferences for sources to gain knowledge on ionising radiation and for the functions that an ideal app should have. The level of awareness and readiness to use apps to measure ionising radiation dose depended on two main aspects: individual differences (age & gender) and whether people were from countries affected by the previous major accidents. We concluded that stakeholders could have benefits from the data management plan: (1) it potentiates resilience at individual and community level; (2) citizens’ measurements contribute to environmental monitoring and public health screening; (3) linkages between different types of data (environmental exposure, individual behavioural diaries, and measurements of health indicators) allow to perform more rigorous epidemiological studies.

Intraoperative Complications of the Anterior Retroperitoneal Approach to the Lumbosacral Spine in the Supine Position: A Proposal for an Algorithm to Predict the Degree of Difficulty of the Surgical Procedure

The main concern in anterior exposure of the lumbosacral spine is the risk of vascular injury during mobilization and retraction of the blood vessels. Preoperative planning is considered essential to reducing the incidence of vascular injury, although no consensus has been reached on the preferred methodology for such planning. This is a retrospective study, including all patients operated on by a single surgeon, who received anterior lumbar-spine surgery in the supine position as a primary procedure before undergoing an anterior lumbar interbody fusion (ALIF) or an artificial disc replacement (ADR). The aim of this study was to list the intraoperative complications observed. We included 156 patients (87 women; mean age, 48 years) who met the inclusion criteria. The overall complication rate was 6.4% (10/156). The most frequent complications were an incidental peritoneal opening (seven patients, 4.4%); two left–iliac-vein injuries (1.28%) that were sutured; and one dural tear during a decompression maneuver of the canal. No neurological, arterial, or ureteral injury or retrograde ejaculation was reported. The use of a sound protocol that includes planning, assessment of approach difficulty, and step-by-step surgical technique can reduce the rate of vascular injury in anterior lumbosacral-spine surgery.