Journal of the American College of Surgeons最新文献

{"title":"Discussion.","authors":"","doi":"10.1097/XCS.0000000000001341","DOIUrl":"10.1097/XCS.0000000000001341","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"336-338"},"PeriodicalIF":3.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discussion.","authors":"","doi":"10.1097/XCS.0000000000001326","DOIUrl":"10.1097/XCS.0000000000001326","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"560-563"},"PeriodicalIF":3.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Small Bowel Follow Through in Management of Small Bowel Obstruction.","authors":"Alexa Soult, Alexandra Van Horn, Emily Sturm, Molly Sternick, Jessica Burgess, Rebecca Britt","doi":"10.1097/XCS.0000000000001307","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001307","url":null,"abstract":"<p><strong>Background: </strong>Small bowel obstructions (SBOs) are a burden to healthcare. Despite a common disease, significant inconsistencies exist within management, specifically use of small bowel follow through (SBFT). We evaluated patients who had SBFT and the early vs late use of SBFT on outcomes.</p><p><strong>Study design: </strong>A retrospective chart review was performed for 799 patients with SBO admitted between 2012 and 2019. Patients between 18 and 89 years of age were included and those who required emergent operations on admission were excluded. The groups were evaluated by having SBFT compared with not, and further delineated on SBFT performance before (early) or after (late) 48 hours.</p><p><strong>Results: </strong>Of the 799 patients with an SBO, 757 (94.7%) had SBFT and 42 (5.2%) did not. Of those 757, 476 (62.8%) performed early and 281 (37.1%) completed late. In patients who received SBFT, the length of stay (LOS) was shorter (p < 0.003). If patients were admitted to the surgical service, they were more likely to receive an SBFT (p < 0.0042). When SBFT was early, patients were more frequently admitted to an academic institution (p < 0.0001) and to a surgical service (p < 0.0001), had decreased LOS (p < 0.001), decreased readmissions (p < 0.0001), were less likely to require surgery (p < 0.0009), had decreased time to operation (p < 0.0001), and had quicker operation to discharge (p < 0.0005).</p><p><strong>Conclusions: </strong>The use of SBFT for SBO resulted in improved outcomes, especially if performed early. This is supportive of surgical service admission with more frequent early SBFT with decreased LOS. There is a propensity for those patients with previous operations to have SBFT later in hospital stay and may correlate with increased need for surgery, and the use of early SBFT may help resolve SBO. Implementing early SBFT may improve outcomes and an area of future endeavors.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":"240 4","pages":"703-708"},"PeriodicalIF":3.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simple vs Complex Aortic Arch Repair in Acute Type A Aortic Dissection.","authors":"Jordyn Pendarvis, Omar M Sharaf, Ahmet Bilgili, Zhihua Jiang, Jaden A Jeng, Daniel S Demos, John R Spratt, Phillip Hess, Thomas M Beaver, Gilbert R Upchurch, Tomas D Martin, Eric I Jeng","doi":"10.1097/XCS.0000000000001300","DOIUrl":"10.1097/XCS.0000000000001300","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to evaluate the clinical outcomes of patients undergoing a simpler (hemiarch) vs complex (zone 2 arch) aortic repair for acute type A aortic dissection (TAAD).</p><p><strong>Study design: </strong>Adults (18 years or older) who underwent hemiarch or zone 2 arch repair for acute, hyperacute, or acute on chronic TAAD at a single institution between January 2018 and April 2024 were reviewed. Disabling stroke was defined as a modified Rankin scale of 4 or greater. Statistical analysis included univariate comparisons, Kaplan-Meier analysis, and multivariable modeling.</p><p><strong>Results: </strong>Two hundred eighty-three patients with acute TAAD underwent hemiarch (44.5%, n = 126) and/or zone 2 arch (55.5%, n = 157) repair. Hemiarch patients were older (63.3 ± 14.1 vs 56.3 ± 12.2 years, p < 0.001), but had lower rates of preoperative cerebrovascular disease (11.1% [n = 14] vs 21.7% [n = 34], p = 0.03), chronic kidney disease (16.7% [n = 21] vs 33.1% [n = 52], p = 0.003), and previous sternotomy (13.5% [n = 17] vs 35.0% [n = 55], p < 0.001). Cardiopulmonary bypass and cross-clamp times were shorter in hemiarch patients (214 ± 78.5 vs 261 ± 62.3 minutes, p < 0.001; 135 ± 54.4 vs 182 ± 60.0 minutes, p < 0.001, respectively). Postoperatively, there was no difference in the rate of disabling stroke (4.5% [n = 13], p = 0.12), tracheostomy (14.8% [n = 43], p = 0.15), pneumonia (17.2% [n = 50], p = 0.24), or renal failure requiring permanent dialysis (6.2% [n = 18], p = 0.47). In multivariable analysis, older age (hazard ratio 1.05, 95% CI 1.02 to 1.08) was a risk factor for longitudinal mortality, while complex aortic arch repair did not confer an increased risk (hazard ratio 0.68, 95% CI 0.35 to 1.31).</p><p><strong>Conclusions: </strong>Complex aortic arch reconstruction provides a framework for downstream endovascular procedures for the remaining aorta and can be performed in acute TAAD without increased risk of morbidity or mortality compared with a simpler repair.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"439-447"},"PeriodicalIF":3.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is There Still a Need to Discuss the Use of Antibiotic Decontamination? Results of a Prospective Cohort Study Involving 999 Left-Sided Colorectal Resections.","authors":"Benjamin Wiesler, Jörn Markus Gass, Raphaele Galli, Mathias Worni, Christian Nebiker, Alexandra Müller, Martina Pabst, Daniel Stimpfle, Laura Werlen, Marco von Strauss Und Torney","doi":"10.1097/XCS.0000000000001396","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001396","url":null,"abstract":"<p><strong>Background: </strong>The benefit of antibiotic decontamination and bowel preparation (ADBP) in colorectal resections remains controversial. The objective was to evaluate the effect of ADBP in left-sided colorectal resections in an entire health-care region.</p><p><strong>Study design: </strong>This prospective, multicenter observational trial was conducted from October 2020 to October 2022. The primary endpoint was the Comprehensive Complication Index (CCI).</p><p><strong>Results: </strong>A total of 999 patients were included (371 in no ADBP group and 624 in ADBP group). The median age was 66 years, and 52.1% of patients were female. The median CCI in no ADBP group was 0.0 [IQR 0.0-20.9] and 0.0 in the ADBP group [IQR 0.0-8.7] (p = 0.85). The surgical site infection (SSI) rate was 10.2% in the no ADBP group and 4.8% in the ADBP group (p = 0.002). Anastomotic leakage (AL) occurred in 5.9% of patients in the no ADBP group and 4.3% in the ADBP group (p = 0.23). In a multivariate logistic regression analysis, ADBP had no impact on the occurrence of complications (OR 0.86, 95%-CI: 0.56-1.31). However, the estimated CCI was 5.79 points lower after the application of ADBP among those with complications (95%-CI: -11.50--0.08). In multivariate logistic regression the application of ADBP had no effect on the probability of SSI (OR 0.64, 95%-CI: 0.35-1.21) or AL (OR 0.72, 95%-CI: 0.39-1.36).</p><p><strong>Conclusions: </strong>The use of ADBP in left-sided colorectal resections was associated with a reduction of the severity of overall complications. Nevertheless, there was no impact of ADBP on SSI and AL rates.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining Geographic Disparity: Variation in Cancer Outcomes Within Appalachia.","authors":"Todd Burus, Pamela C Hull, Krystle A Lang Kuhs, Tianyan Gao, Christine F Brainson, B Mark Evers","doi":"10.1097/XCS.0000000000001273","DOIUrl":"10.1097/XCS.0000000000001273","url":null,"abstract":"<p><strong>Background: </strong>The Appalachian region of the US extends from the Mississippi Delta to southern New York. Although disparities in Appalachian cancer outcomes have long been observed, recent rates and trends have not been assessed.</p><p><strong>Study design: </strong>We calculated 5-year age-adjusted US cancer incidence and mortality rates for 2017 to 2021, stratified into Appalachian and non-Appalachian populations, as well as Appalachian subregions, using the US Cancer Statistics Incidence Analytics Database and National Center for Health Statistics mortality files. Annual rates for 2004 to 2021 were also calculated.</p><p><strong>Results: </strong>In 2017 to 2021, all-site cancer incidence (466.6; 95% CI 465.5 to 467.6) and mortality rates (165.5; 95% CI 164.9 to 166.1) among Appalachian residents were significantly higher (5.6% and 12.8%, respectively) than among non-Appalachian residents. Within Appalachia, the Central subregion-predominantly eastern Kentucky-had the highest rates of all-site cancer incidence (495.9) and mortality (201.9). In addition, the Central subregion had the highest rates of lung and colorectal cancer incidence, and the highest rates of lung, colorectal, and cervical cancer mortality. All-site cancer incidence and mortality rates among Appalachian individuals have decreased significantly since 2004 (-0.33% per year and -1.39% per year, respectively), with site-specific incidence rate decreases for late-stage lung (-2.19% per year), late-stage colorectal (-0.75% per year), and late-stage female breast (-0.35% per year) cancers in Appalachia.</p><p><strong>Conclusions: </strong>Although cancer incidence and mortality rates are declining in Appalachia, they remain substantially higher and demonstrate slower progress than elsewhere in the US-particularly in the Central Appalachian subregion-indicating the need for targeted research to delineate and address the factors driving these cancer health disparities.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"425-436"},"PeriodicalIF":3.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11928269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Minimally Invasive Reoperation Become the Standard Approach for Postoperatively Diagnosed T2 Gallbladder Cancer? (re Yoon and colleagues).","authors":"Yuichi Takamatsu, Tomoaki Yoh, Etsuro Hatano","doi":"10.1097/XCS.0000000000001393","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001393","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transplant Referral and Long-Term Kidney Allograft Survival for Black Patients: Single-Center Study.","authors":"Alexandra C Bolognese, Madelaine Hack, Christine Kolwitz, Oren Shaked, Christopher Connelly, David Woodland, C Kristian Enestvedt, David Scott, Ali Olyaei, Erin Maynard","doi":"10.1097/XCS.0000000000001395","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001395","url":null,"abstract":"<p><strong>Background: </strong>Despite improvements in access to transplantation there remains disparities in all aspects of transplant among minority patients. We sought to examine referral practices and long-term outcomes of kidney transplantation across racial identities at our center.</p><p><strong>Study design: </strong>We conducted a retrospective review of kidney transplant (KT) recipients from 01/2010 to 05/2024. Data was obtained from UNOS and confirmed with the electronic medical record. Patients were categorized as White, Black, Asian, Hispanic, (HI/PI), and (AI/AN).</p><p><strong>Results: </strong>1369 patients met criteria. 67% White, 6.9% Black, 7.9% Asian, 14.1% Hispanic, 2.6% (HI/PI), and 1.5% (AI/AN). There were no significant between group differences in (KDPI), (EPTS), recipient or donor age or (CMV) status, cold ischemia time, time from referral to evaluation or listing. There was a significant difference in waiting time for Black compared to White patients (733.6 vs. 595.4 days, p = 0.026). Black patients had higher mean creatinine at 6 mo. and 1 year compared to all others (1.6 vs. 1.3 mg/dL at both time points, p < 0.001). After adjusting for baseline characteristics, Blacks had an increased risk of allograft loss at 15 years compared to White patients (p < 0.001) and were to receive a living donor transplant (10.5% vs. 25.3%, p < 0.01) or a preemptive KT (10.5% vs. 27.0%, p < 0.01).</p><p><strong>Conclusions: </strong>Despite disproportionate representation among patients with chronic kidney disease, compared to age-matched White patients, Black patients at our center are referred for transplant later and have a higher rate of 10-year allograft loss. It is up to us to focus on education and to close the gap and improve outcomes for all of our transplant recipients.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One Step Forward to Minimally Invasive Reoperation for Gallbladder Cancer.","authors":"Yeshong Park, Sae Byeol Choi, Boram Lee, Ho-Seong Han, Chi-Young Jeong, Chang Moo Kang, Dae Wook Hwang, Wan-Joon Kim, Yoo-Seok Yoon","doi":"10.1097/XCS.0000000000001394","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001394","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction.","authors":"","doi":"10.1097/XCS.0000000000001391","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001391","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}