The American Surgeon™最新文献

{"title":"Bone Anchor Fixation in the Repair of Blunt Traumatic Abdominal Wall Hernias: A Western Trauma Association Multicenter Study","authors":"Kevin N. Harrell, Arthur D Grimes, H. Gill, Jessica K. Reynolds, Walker R. Ueland, Jason D Sciarretta, S. Todd, Marc D Trust, Marielle Ngoue, Bradley W Thomas, S. Ayuso, Aimee K. LaRiccia, Chance Spalding, Michael J Collins, Bryan R Collier, B. Karam, Marc A. De Moya, Mark J Lieser, John M. Chipko, James M Haan, Kelly L. Lightwine, D. Cullinane, C. Falank, Ryan C Phillips, M. Kemp, Hasan B Alam, Pascal O Udekwu, Gloria D. Sanin, Amy N Hildreth, W. Biffl, K. Schaffer, Gary Marshall, Omaer Muttalib, Jeffry T. Nahmias, N. Shahi, Steven L Moulton, Robert A Maxwell","doi":"10.1177/00031348241227195","DOIUrl":"https://doi.org/10.1177/00031348241227195","url":null,"abstract":"Blunt traumatic abdominal wall hernias (TAWHs) are rare but require a variety of operative techniques to repair including bone anchor fixation (BAF) when tissue tears off bony structures. This study aimed to provide a descriptive analysis of BAF technique for blunt TAWH repair. Bone anchor fixation and no BAF repairs were compared, hypothesizing increased hernia recurrence with BAF repair. A secondary analysis of the WTA blunt TAWH multicenter study was performed including all patients who underwent repair of their TAWH. Patients with BAF were compared to those with no BAF with bivariate analyses. 176 patients underwent repair of their TAWH with 41 (23.3%) undergoing BAF. 26 (63.4%) patients had tissue fixed to bone, with 7 of those reinforced with mesh. The remaining 15 (36.6%) patients had bridging mesh anchored to bone. The BAF group had a similar age, sex, body mass index, and injury severity score compared to the no BAF group. The time to repair (1 vs 1 days, P = .158), rate of hernia recurrence (9.8% vs 12.7%, P = .786), and surgical site infection (SSI) (12.5% vs 15.6%, P = .823) were all similar between cohorts. This largest series to date found nearly one-quarter of TAWH repairs required BAF. Bone anchor fixation repairs had a similar rate of hernia recurrence and SSI compared to no BAF repairs, suggesting this is a reasonable option for repair of TAWH. However, future prospective studies are needed to compare specific BAF techniques and evaluate long-term outcomes including patient-centered outcomes such as pain and quality of life.","PeriodicalId":218262,"journal":{"name":"The American Surgeon™","volume":"63 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139441220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified Frailty Index Helps Predict Mortality and Ambulation Differences Between Genders and Racial Differences Following Major Lower Extremity Amputation","authors":"Maria N. Som, Natalie T. Chao, Allison Karwoski, Luke T. Pitsenbarger, Eleanor Dunlap, Khanjan H. Nagarsheth","doi":"10.1177/00031348231220570","DOIUrl":"https://doi.org/10.1177/00031348231220570","url":null,"abstract":"Major lower extremity amputation (LEA) is associated with significant morbidity and mortality. The modified frailty index (mFI-5) has been used to predict outcomes including ambulation and mortality after LEA. It remains unknown for which patient demographics the mFI-5 is a reliable predictor. This was a retrospective review of all patients who underwent a first-time major LEA at our institution from 2015 to 2022. Patients were stratified into 2 risk groups based on their mFI-5 score: non-frail (mFI<3) and frail (mFI≥3) and assessed on outcomes. Our sample consisted of 687 patients of whom 134 (19.6%) were considered frail and 551 (80.4%) were considered non-frail. A higher mFI-5 is associated with decreased ambulation rates (OR: 0.565, P = .004), increased hospital readmission (OR: 1.657, P = .021), and increased mortality (OR: 2.101, P = .001) following major LEA. In African American patients, frail and non-frail patients differed on readmission at 90 days ( P = .008), mortality at 1 year ( P = .001), ambulatory status ( P < .001), and prosthesis use ( P = .023). In male patients, frail and non-frail patients differed on readmission at 90 days ( P = .019), death at 1 year ( P = .001), and ambulatory status ( P = .002). In Caucasian patients and female patients, frail and non-frail patients did not differ significantly on outcomes. The mFI-5 is a valuable predictor of outcomes following major LEA, specifically in males and African American patients. Moreover, surgeons should consider using frailty status to risk stratify patients and inform treatment plans.","PeriodicalId":218262,"journal":{"name":"The American Surgeon™","volume":"31 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138588988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Upstate New York Surgical Quality Improvement Opioid Reduction Project","authors":"Elizabeth A. Jacob, Alexa D. Melucci, Ethan Talbot, Fergal Fleming, Matthew Schiralli, C. Foster, Laurie Foster, Kellie Donovan, K. Simran, Vincy J. John, N. Hellenthal","doi":"10.1177/00031348231220583","DOIUrl":"https://doi.org/10.1177/00031348231220583","url":null,"abstract":"Over 5 million Americans currently abuse prescription opioids. Patients’ first exposure to opioids is often after surgery. Few opioid guidelines account for the challenges to health care institutions that serve wide catchment areas. We standardized postoperative opioid prescribing recommendations amongst surgical providers at our institutions and analyzed postoperative prescribing habits. The Upstate New York Surgical Quality Improvement (UNYSQI) collaborative met with surgical champions from 16 hospitals to standardize opioid prescribing for 21 surgical procedures. The guidelines were distributed to all surgical care providers at participating institutions. 581,465 pills were dispensed for 12,672 surgeries (average of 45.9 pills per procedure) before implementation. Post-implementation, 1,097,849 pills were dispensed for 28,772 surgeries (average of 38.2 pills per surgery) with over 222,000 fewer pills being prescribed. Our project suggests opioid prescribing guidelines for institutions that serve diverse communities.","PeriodicalId":218262,"journal":{"name":"The American Surgeon™","volume":"29 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138589390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Postoperative Neck Dissection Cervical Lymphocele With Percutaneous Bleomycin Sclerotherapy","authors":"Marshall L. Robaczewski, Reese W. Randall, Thomas P. Sullivan","doi":"10.1177/00031348231220577","DOIUrl":"https://doi.org/10.1177/00031348231220577","url":null,"abstract":"Lymphatic leak after lymph node dissection is a rare but well-known surgical complication that is often treated with conservative management and ultimately reoperation. The purpose of this report is to offer an alternative treatment for chyle leak that avoids hospitalization and subsequent surgery. Sclerotherapy has been used to treat lymphatic leaks in the past and has been shown to be safe and effective. This report presents a patient with a known cervical lymphocele who was followed through multiple sclerotherapy appointments until resolution of the lymphocele.","PeriodicalId":218262,"journal":{"name":"The American Surgeon™","volume":"9 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138590150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Preoperative Chlorhexidine Baths on Surgical Site Infections and Readmissions in Pediatric Patients Undergoing Laparoscopic Cholecystectomy","authors":"Monique Motta, Azalia Avila, Shenae Samuels, Michael Weiss, Tamar L. Levene","doi":"10.1177/00031348231220587","DOIUrl":"https://doi.org/10.1177/00031348231220587","url":null,"abstract":"","PeriodicalId":218262,"journal":{"name":"The American Surgeon™","volume":"116 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138590474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rural Melanoma Patients Have Less Surgery and Higher Melanoma-Specific Mortality","authors":"Alexandra E. Hernandez, Kelley N. Benck, Carlos T. Huerta, I. Ogobuiro, Gabriel De la Cruz Ku, Mecker G. Möller","doi":"10.1177/00031348231216485","DOIUrl":"https://doi.org/10.1177/00031348231216485","url":null,"abstract":"Melanoma causes most skin cancer–related deaths, and disparities in mortality persist. Rural communities, compared to urban, face higher levels of poverty and more barriers to care, leading to higher stage at presentation and shorter survival in melanoma. To further evaluate these disparities, we sought to assess the association between rurality and melanoma cause-specific mortality and receipt of recommended surgery in a national cohort. Patients with primary non-ocular, cutaneous melanoma from the SEER database, 2000-2017, were included. Outcomes included melanoma-specific survival and receipt of recommended surgery. Rurality was based on Rural-Urban Continuum Codes. Variables included age, sex, race, ethnicity, income, and stage. Multivariate regression models assessed the effect of rurality on survival and receipt of recommended surgery. 103,606 patients diagnosed with non-ocular cutaneous primary melanoma met criteria during this period. 93.3% ( n = 96620) were in urban areas and 6.7% ( n = 6986) were in rural areas. On multivariate regression controlling for age, sex, race, ethnicity, and stage patients living in a rural area were less likely to receive recommended surgery (aOR .52, 95% CI: .29-.90, P = .02) and had increased hazard of melanoma-specific mortality (aHR 1.19, 95% CI: 1.02-1.40, P = .03) even after additionally controlling for surgery receipt. Using a large national cohort, our study found that rural patients were less likely to receive recommended surgery and had shorter melanoma cause-specific survival. Our findings highlight the importance of access to cancer care in rural areas and how this ultimately effects survival for these patients.","PeriodicalId":218262,"journal":{"name":"The American Surgeon™","volume":"45 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138592163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fragmentation of Care After Geriatric Trauma: A Nationwide Analysis of outcomes and Predictors","authors":"S. Gogna, B. Zangbar, Aryan Rafieezadeh, Kamil Hanna, Ilya Shnaydman, Jorge Con, M. Bronstein, J. Klein, K. Prabhakaran","doi":"10.1177/00031348231220569","DOIUrl":"https://doi.org/10.1177/00031348231220569","url":null,"abstract":"The health care system for the elderly is fragmented, that is worsened when readmission occurs to different hospitals. There is limited investigation into the impact of fragmentation on geriatric trauma patient outcomes. The aim of this study was to compare the outcomes following readmissions after geriatric trauma. The Nationwide Readmissions Database (2016-2017) was queried for elderly trauma patients (aged ≥65 years) readmitted due to any cause. Patients were divided into 2 groups according to readmission: index vs non-index hospital. Outcomes were 30 and 180-day complications, mortality, and the number of subsequent readmissions. Multivariable logistic regression was performed to analyze the independent predictors of fragmentation of care. A total of 36,176 trauma patients were readmitted, of which 3856 elderly patients (aged ≥65 years) were readmitted: index hospital (3420; 89%) vs non-index hospital (436; 11%). Following 1:2 propensity matching, elderly with non-index hospital readmission had higher rates of death and MI within 180 days ( P = .01 and .02, respectively). They had statistically higher 30 and 180-day pneumonia ( P < .01), CHF ( P < .01), arrhythmias ( P < .01), MI ( P < .01), sepsis ( P < .01), and UTI ( P < .01). On multivariable binary logistic regression analysis, pneumonia (OR 1.70, P = .03), congestive heart failure (CHF) (OR 1.80, P = .03), female gender (OR .72, P = .04), and severe Head and Neck trauma (AIS≥3) (OR 1.50, P < .01) on index admission were independent predictors of fragmentation of care. While the increase in time to readmission (OR 1.01, P < .01) was also associated independently with non-index hospital admission. Fragmented care after geriatric trauma could be associated with higher mortality and complications.","PeriodicalId":218262,"journal":{"name":"The American Surgeon™","volume":"45 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138593797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter re: “Adverse Events Associated With Disparity Between Patients’ BMI and Operating Table Size—A Need for Improved Surgical Innovations”","authors":"Russell K. McAllister","doi":"10.1177/00031348231220579","DOIUrl":"https://doi.org/10.1177/00031348231220579","url":null,"abstract":"","PeriodicalId":218262,"journal":{"name":"The American Surgeon™","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138591772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Aortic Injury From a BB Gun Injury Requiring Emergent Thoracotomy","authors":"Michaelia S. Sunderland, E. Lafranchise, A. Durrant","doi":"10.1177/0003134820971575","DOIUrl":"https://doi.org/10.1177/0003134820971575","url":null,"abstract":"Background The leading cause of morbidity and mortality in the pediatric population is unintentional injury. Emergent thoracotomies are rarely performed in pediatric patients, especially in the very young pediatric population. We present a case of a 10-year-old male who survived emergent clamshell thoracotomy for penetrating chest trauma. Summary Our patient sustained aortic lacerations after being shot with an air-powered rifle. Thoracotomy was performed in the emergency department. The incision was extended to a clamshell thoracotomy for repair of the aortic lacerations. He survived and made a full recovery. Conclusion This case is one of the youngest reported survivors of an emergent thoracotomy. Air-powered gun injuries can be life-threatening despite their perception as safe toys for children. Surprisingly, there is very little regulation on sale of air guns to minors in the United States. Increased public awareness and regulation of sale may prevent unintentional injury in this population.","PeriodicalId":218262,"journal":{"name":"The American Surgeon™","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127831140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Value of Tumour Size in Colon Cancer – Smaller is Better?","authors":"Siyi Lu, Bingyan Wang, Zhenzhen Liu, Fei Li, Yongqu Lu, Yan Meng, Junwei Wang, Hao Wang, Limei Guo, Xin Zhou, W. Fu","doi":"10.21203/RS.3.RS-566870/V1","DOIUrl":"https://doi.org/10.21203/RS.3.RS-566870/V1","url":null,"abstract":"\u0000 Background: The prognostic value of tumour size in colon cancer remains controversial. This study aimed to reveal the correlation between tumour size and prognosis of colon cancer.Methods: A total of 498 patients with colon cancer were included in this study. The correlation of tumour size with prognosis, mismatch repair status and other clinicopathological characteristics as well as tumour microenvironment was analysed.Results: For stage IIA microsatellite stable (MSS) colon cancer, tumours sized <3.5 cm and ≥5 cm were associated with a poorer disease free survival (DFS) compared with tumours sized between 3.5 and 5 cm (p=0.002). Small tumour size (HR=5.098, p=0.001) and large tumour size (HR=2.749, p=0.029) were found to be independent prognostic factors for stage IIA MSS colon cancer. Moreover, high expression of transgelin (TAGLN), a marker of cancer-associated fibroblasts (CAFs), was found to be an independent prognostic factor for poorer DFS (HR=9.651, p=0.009), which was also associated with smaller tumour size (p=0.027).Conclusion: Small (<3.5 cm) and large (≥5 cm) tumour sizes are associated with decreased DFS in stage IIA MSS colon cancer. Enrichment of TAGLN+ CAFs is associated with decreased DFS and small tumour size.","PeriodicalId":218262,"journal":{"name":"The American Surgeon™","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116306702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}