Jennifer Hernandez, Luis A. Quintero, Zaineb Shatawi, Lisa Ngo, Dino Romero, Rainya Heath, Anna Redden, Tamar Levene, Oliver B Lao, Joshua P Parreco
{"title":"Venous Thromboembolism in Children and Teenagers Admitted for Trauma: A 5-Year Nationwide Perspective.","authors":"Jennifer Hernandez, Luis A. Quintero, Zaineb Shatawi, Lisa Ngo, Dino Romero, Rainya Heath, Anna Redden, Tamar Levene, Oliver B Lao, Joshua P Parreco","doi":"10.1177/00031348241241687","DOIUrl":"https://doi.org/10.1177/00031348241241687","url":null,"abstract":"Venous thromboembolism (VTE) in pediatric trauma patients is under-investigated. The purpose of this study was to perform an evaluation of the risk factors for VTE after pediatric trauma, including readmissions across the United States. The Nationwide Readmissions Database for 2016-2020 was queried for all patients under the age of 18 years admitted for trauma. 276 670 patients were identified; 2063 (.8%) were diagnosed with VTE. Among those with VTE, 300 (15%) were identified during a readmission. Higher rates of VTE were seen in ages 15-17 years (n = 1,294, 1.3%, P < .001), penetrating injuries (n = 478, .9%, P < .001), and assault (n = 271, 2.7%, P < .001). The strongest risk factor for VTE was prolonged mechanical ventilation (OR 5.5 [4.9-6.3] P < .001). Our study found that a significant portion of post-traumatic VTE in children and teenagers occur during readmissions. A deeper understanding of the risk factors outlined here can guide enhanced clinical protocols, ensuring early detection and prevention of this complication.","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"28 4","pages":"31348241241687"},"PeriodicalIF":0.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140753193","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}
Azalia Avila, Monique Motta, D. Schechter, S. Samuels, Ingry Jaramillo, J. Whitehouse, H. Neville, Tamar Levene
{"title":"Ovarian Salvage With Prompt Surgical Intervention for Adnexal Torsion: Does Timing Matter?","authors":"Azalia Avila, Monique Motta, D. Schechter, S. Samuels, Ingry Jaramillo, J. Whitehouse, H. Neville, Tamar Levene","doi":"10.1177/00031348241241678","DOIUrl":"https://doi.org/10.1177/00031348241241678","url":null,"abstract":"BACKGROUND\u0000Adnexal torsion requires treatment to limit ischemic injury and tissue loss. Optimal time to surgical intervention has not been established. We compared outcomes of ovarian loss amongst pediatric patients.\u0000\u0000\u0000METHODS\u0000We conducted a retrospective review of 88 patients with adnexal torsion from March 2014 through April 2021. Rates of ovarian loss were compared for patients who underwent surgery within and beyond 60 minutes from diagnosis.\u0000\u0000\u0000RESULTS\u0000Most patients underwent surgery more than 60 minutes from the time of diagnosis (83%; median time 116 minutes). Comparing patients with and without ovarian loss, there was no statistically significant difference in time to surgery from time of diagnosis (P = .618). Patients with ovarian loss had a longer duration of symptoms (24 vs 96 hours; P = .017).\u0000\u0000\u0000CONCLUSIONS\u0000While surgical repair of adnexal torsion may be urgent, this study suggests that duration of symptoms should be considered when assessing a patient's likelihood of ovarian loss.","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"149 ","pages":"31348241241678"},"PeriodicalIF":0.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140755245","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}
Sunjay S. Kumar, Erin Briggs, Sami Tannouri, Talar Tatarian, M. Pucci, Renée M. Tholey, K. Chojnacki, Courtney Foley, F. Palazzo
{"title":"What Happens After Discharge? A 2+ Year Follow-Up After Laparoscopic Subtotal Fenestrating and Reconstituting Cholecystectomy.","authors":"Sunjay S. Kumar, Erin Briggs, Sami Tannouri, Talar Tatarian, M. Pucci, Renée M. Tholey, K. Chojnacki, Courtney Foley, F. Palazzo","doi":"10.1177/00031348241241617","DOIUrl":"https://doi.org/10.1177/00031348241241617","url":null,"abstract":"Laparoscopic subtotal cholecystectomy (LSC) is utilized to prevent complications in the difficult cholecystectomy. Medium-term outcomes are poorly studied for fenestrating and reconstituting operative techniques. A single-institution retrospective review was undertaken of all LSCs. A telephone survey was used to identify complications addressed at other institutions. We performed subgroup analyses by operative approach and of patients requiring postoperative endoscopic intervention (ERC). 28 patients met inclusion criteria. The median follow-up was 32.7 months. There were no bile duct injuries or reoperations. 21% of patients required a postoperative ERC and 50% were discharged home with a drain. Bile leaks were found to be more prevalent in the fenestrating LSC group (38% vs 0%, P = .003). The case series suggested more severe recurrent biliary disease in patients undergoing reconstituting LSC. Laparoscopic subtotal cholecystectomy appears to have satisfactory medium-term outcomes. The reconstituting LSC group trends toward more severe recurrent disease which warrants further investigation.","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"24 2","pages":"31348241241617"},"PeriodicalIF":0.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140752494","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}
Allie Eickholtz, Jeremy Mormol, Jesse K. Kelley, Madi Mangione, Steffen Pounders, Ryan Groseclose, M. Lypka, Charles Gibson, Alistair Chapman, Cathryn Chadwick, Laura Krech
{"title":"The Effect of COVID-19 on Rib Fracture Patients in Michigan.","authors":"Allie Eickholtz, Jeremy Mormol, Jesse K. Kelley, Madi Mangione, Steffen Pounders, Ryan Groseclose, M. Lypka, Charles Gibson, Alistair Chapman, Cathryn Chadwick, Laura Krech","doi":"10.1177/00031348241241634","DOIUrl":"https://doi.org/10.1177/00031348241241634","url":null,"abstract":"This study aims to compare outcomes of rib fracture patients with and without COVID-19 in Michigan. Data from the Michigan Trauma Quality Improvement Program (MTQIP) identified adults hospitalized from January 1, 2020, to October 31, 2022, with at least one rib fracture and a completed COVID-19 test on admission. Patients were propensity score matched 1:1 using 20 variables. The primary outcome was hospital length of stay (LOS). Secondary outcomes were mortality, ventilator days, intensive care unit (ICU) LOS, pneumonia, and ventilator-assisted pneumonia (VAP). 13,305 total patients were identified. 232 patients matched into both the COVID+ and COVID- groups. COVID was associated with increased LOS (7 days vs. 5 days, P < 0.001). There were no significant differences between the two groups when evaluating secondary outcomes. Our study indicates that although COVID-19 infection is associated with increased LOS, COVID may not contribute to additional morbidity or mortality in traumatic rib fracture patients.","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"27 7","pages":"31348241241634"},"PeriodicalIF":0.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140753416","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}
Yan Meng, Bingyan Wang, Hsinyi Lin, Fei Li, Siyi Lu, Junwei Wang, Hao Wang, Limei Guo, Xin Zhou, Wei Fu
{"title":"Prognostic Value of Tumor Size in Colon Cancer—Smaller is Better?","authors":"Yan Meng, Bingyan Wang, Hsinyi Lin, Fei Li, Siyi Lu, Junwei Wang, Hao Wang, Limei Guo, Xin Zhou, Wei Fu","doi":"10.1177/00031348231180944","DOIUrl":"https://doi.org/10.1177/00031348231180944","url":null,"abstract":"Background The prognostic value of tumor size in colon cancer remains controversial. This study aimed to reveal the correlation between tumor size and prognosis of colon cancer. Methods A total of 491 patients with colon cancer were included in this study. The correlation of tumor size with prognosis, mismatch repair status, and other clinicopathological characteristics as well as tumor microenvironment was analyzed. Results For stage IIA microsatellite stable (MSS) colon cancer, tumors sized <3.5 cm and ≥5 cm were associated with a poorer disease free survival (DFS) compared with tumors sized between 3.5 and 5 cm ( P = .002). Small tumor size (HR = 5.098, P = .001) and large tumor size (HR = 2.749, P = .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 = .009), which was also associated with smaller tumor size ( P = .027). Conclusion Small (<3.5 cm) and large (≥5 cm) tumor sizes are associated with decreased DFS in stage IIA MSS colon cancer. Enrichment of TAGLN + CAFs is associated with decreased DFS and small tumor size.","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134933055","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":"An Unusual Cause of Small Bowel Obstruction Secondary to a Perforated Giant Jejunal Diverticulum","authors":"Wendy G. Morales, R. Lutfi","doi":"10.1177/000313481408000501","DOIUrl":"https://doi.org/10.1177/000313481408000501","url":null,"abstract":"","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"84 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134024349","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}
S. Sathyanarayana, E. Agaba, V. Kamath, N. Mishra, Vikraman Gunabushanam, B. Friedman, R. Alhindawi
{"title":"Duodenal Diverticulum: An Unusual Cause of High-Grade Duodenal Obstruction","authors":"S. Sathyanarayana, E. Agaba, V. Kamath, N. Mishra, Vikraman Gunabushanam, B. Friedman, R. Alhindawi","doi":"10.1177/000313481107700704","DOIUrl":"https://doi.org/10.1177/000313481107700704","url":null,"abstract":"","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"2005 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123716783","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":"Spontaneous Iliac Vein Rupture","authors":"Matthew J. Borkon, M. Dassinger, J. Dattilo","doi":"10.1177/000313480907501130","DOIUrl":"https://doi.org/10.1177/000313480907501130","url":null,"abstract":"","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"122 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133526660","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}