The American Surgeon最新文献_第3页

Disparities in Access to Bariatric Surgery in North Carolina. 北卡罗来纳州接受减肥手术的差异。

The American Surgeon Pub Date : 2024-04-23 DOI: 10.1177/00031348241248807

Jan H. Wong, Ashley E. Burch, Eric J. DeMaria, Walter J Pories, W. Irish

{"title":"Disparities in Access to Bariatric Surgery in North Carolina.","authors":"Jan H. Wong, Ashley E. Burch, Eric J. DeMaria, Walter J Pories, W. Irish","doi":"10.1177/00031348241248807","DOIUrl":"https://doi.org/10.1177/00031348241248807","url":null,"abstract":"BACKGROUND\u0000This study sought to identify factors that contribute to disparities in access to bariatric surgery in North Carolina (NC).\u0000\u0000\u0000METHODS\u0000Using the rate of bariatric surgery in the county with the best health outcome as the reference, we calculated the Surgical Equity Index (SEI) in the remaining counties in NC.\u0000\u0000\u0000RESULTS\u0000Approximately 2.95 million individuals (29%) were obese in NC. There were 992 (.5%) bariatric procedures performed on a population of 194 209 individuals with obesity in the Reference County (RC). The mean SEI for bariatric surgery in NC was .47 (SD .17, range .15-.95). A statistically significant difference was observed in 89 counties. Univariable analyses identified the following variables to be significantly associated with the SEI: percent of population living in rural areas (% rural) (relative rate change in SEI [RR] = .994, 95% CI .92-.997; <.0001), median household income (RR = 1.0, 95% CI = 1.0-1.0; P = .0002), prevalence of diabetes (RR = .947, 95% CI .917-.977; .0006), the primary care physician ratio (RR = .995, 95% CI .991-.998; P = .006), and percent uninsured adults (RR = .955, 95% CI .927-.985; P = .003). By multivariable hierarchical regression analysis, only the % rural remained statistically associated with a low SEI (RR = .995 per 1% increase in % rural, 95% CI = .992, .998; P = .0002).\u0000\u0000\u0000DISCUSSION\u0000The percent rural is the most significant predictor of disparities in access to bariatric surgery. For every 1% increase in % rural, the rate of surgery decreased by .5%. Understanding the characteristics of rurality that are barriers to access is crucial to mitigate disparities in bariatric surgical access in NC.","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"44 20","pages":"31348241248807"},"PeriodicalIF":0.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140667076","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}

引用次数: 0

Incorporating Robotic Cholecystectomy in an Acute Care Surgery Practice Model is Feasible. 将机器人胆囊切除术纳入急症护理外科实践模式是可行的。

The American Surgeon Pub Date : 2024-04-23 DOI: 10.1177/00031348241248816

Aricia Shen, Galinos Barmparas, Nicolas Melo, R. Chung, Miguel Burch, Umar F Bhatti, D. Margulies, Andrew S Wang

{"title":"Incorporating Robotic Cholecystectomy in an Acute Care Surgery Practice Model is Feasible.","authors":"Aricia Shen, Galinos Barmparas, Nicolas Melo, R. Chung, Miguel Burch, Umar F Bhatti, D. Margulies, Andrew S Wang","doi":"10.1177/00031348241248816","DOIUrl":"https://doi.org/10.1177/00031348241248816","url":null,"abstract":"INTRODUCTION\u0000The role of robotic surgery in the nonelective setting remains poorly defined. Accessibility, patient acuity, and high turn-over may limit its applicability and utilization. The goal is to characterize the role of robotic cholecystectomy (CCY) in a busy acute care surgery (ACS) practice at a quaternary medical center, and compare surgical outcomes and resource utilization between robotic and laparoscopic CCY.\u0000\u0000\u0000METHODS\u0000Adult patients who underwent robotic (Da Vinci Xi) or laparoscopic CCY between 01/2021-12/2022 by an ACS attending within 1 week of admission were included. Primary outcomes included time from admission to surgery, off hour (weekend and 6p-6a) cases, operation time, and hospital costs, to reflect \"feasibility\" of robotic compared to laparoscopic CCY. Secondary outcomes encompassed surgery-related outcomes and complications.\u0000\u0000\u0000RESULTS\u0000The proportion of robotic CCY increased from 5% to 32% within 2 years. In total 361 laparoscopic and 89 robotic CCY were performed. Demographics and gallbladder disease severity were similar. Feasibility measures-operation time, case start time, time from admission to surgery, proportion of off-hour cases, and cost-were comparable between robotic and laparoscopic CCY. There were no differences in surgical complications, common bile duct injury, readmission, or mortality. Conversion to open surgery occurred more often in laparoscopic cases (5% vs 0%, P = .02, OR = 1.05).\u0000\u0000\u0000DISCUSSION\u0000Robotic CCY is associated with fewer open conversions and otherwise similar outcomes compared to laparoscopic CCY in the non-elective setting. Incorporation of robotic CCY in a busy ACS practice model is feasible with available resources.","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"126 44","pages":"31348241248816"},"PeriodicalIF":0.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140669161","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}

引用次数: 0

Non-Binary Trauma Patients: Delineating a Vulnerable, At-Risk Population. 非二元创伤患者：划定弱势高危人群。

The American Surgeon Pub Date : 2024-04-23 DOI: 10.1177/00031348241248786

Amanda Hambrecht, M. Schellenberg, Natthida Owattanapanich, Kelly A Boyle, Chaiss Ugarte, Corey Ambrose, K. Matsushima, Matthew J Martin, Kenji Inaba

{"title":"Non-Binary Trauma Patients: Delineating a Vulnerable, At-Risk Population.","authors":"Amanda Hambrecht, M. Schellenberg, Natthida Owattanapanich, Kelly A Boyle, Chaiss Ugarte, Corey Ambrose, K. Matsushima, Matthew J Martin, Kenji Inaba","doi":"10.1177/00031348241248786","DOIUrl":"https://doi.org/10.1177/00031348241248786","url":null,"abstract":"INTRODUCTION\u0000An increasing proportion of the population identifies as non-binary. This marginalized group may be at differential risk for trauma compared to those who identify as male or female, but physical trauma among non-binary patients has not yet been examined at a national level.\u0000\u0000\u0000METHODS\u0000All patients aged ≥ 16 years in the National Trauma Data Bank were included (2021-2022). Demographics, injury characteristics, and outcomes after trauma among non-binary patients were compared to males and females. The goal was to delineate differences between groups to inform the care and future study of non-binary trauma patients.\u0000\u0000\u0000RESULTS\u0000In total, 1,012,348 patients were included: 283 (<1%) non-binary, 610,904 (60%) male, and 403,161 (40%) female patients. Non-binary patients were younger than males or females (median age 44 vs 49 vs 67 years, P < .001) and less likely to be White race/ethnicity (58% vs 60% vs 74%, P < .001). Despite non-binary patients having a lower median Injury Severity Score (5 vs 9 vs 9, P < .001), mortality was highest among non-binary and male patients than females (5% vs 5% vs 3%, P < .001).\u0000\u0000\u0000DISCUSSION\u0000In this study, non-binary trauma patients were younger and more likely minority races/ethnicities than males or females. Despite having a lower injury severity, non-binary patient mortality rates were comparable to those of males and greater than for females. These disparities identify non-binary trauma patients as doubly marginalized, by gender and race/ethnicity, who experience worse outcomes after trauma than expected based on injury severity. This vulnerable patient population deserves further study to identify areas for improved trauma delivery care.","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"52 6","pages":"31348241248786"},"PeriodicalIF":0.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140667040","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}

引用次数: 0

Race, Insurance, and Socioeconomic Influences on Outcomes Following Roux-En-Y Gastric Bypass. 种族、保险和社会经济对 Roux-En-Y 胃旁路术后效果的影响。

The American Surgeon Pub Date : 2024-04-22 DOI: 10.1177/00031348241248803

Oluwasegun A. Akinyemi, Terhas A. Weldeslase, Tsion F Andine, M. Fasokun, Yasmin Griffiths, Eunice Odusanya, Mallory Williams, Kakra Hughes, Edward E Cornwell, T. Fullum

{"title":"Race, Insurance, and Socioeconomic Influences on Outcomes Following Roux-En-Y Gastric Bypass.","authors":"Oluwasegun A. Akinyemi, Terhas A. Weldeslase, Tsion F Andine, M. Fasokun, Yasmin Griffiths, Eunice Odusanya, Mallory Williams, Kakra Hughes, Edward E Cornwell, T. Fullum","doi":"10.1177/00031348241248803","DOIUrl":"https://doi.org/10.1177/00031348241248803","url":null,"abstract":"The effectiveness of Roux-en-Y gastric bypass (RYGB) might be shadowed by disparities in outcomes related to patient race and insurance type. We determine the influence of patient race/ethnicity and insurance types on complications following RYGB. We performed a retrospective analysis using data sourced from the National Inpatient Sample Database (2010 to 2019). A multivariate analysis was employed to determine the relationship between patient race/ethnicity and insurance type on RYGB complications. The analysis determined the interaction between race/ethnicity and insurance type on RYGB outcomes. We analyzed 277714 patients who underwent RYGB. Most of these patients were White (64.5%) and female (77.3%), with a median age of 46 years (IQR 36-55). Medicaid beneficiaries displayed less favorable outcomes than those under private insurance: Extended hospital stay (OR = 1.68; 95% CI 1.58-1.78), GIT Leak (OR = 1.83; 95% CI 1.35-2.47), postoperative wound infection (OR = 1.88; 95% CI 1.38-2.55), and in-hospital mortality (OR = 2.74; 95% CI 1.90-3.95).","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"78 21","pages":"31348241248803"},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140677196","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}

引用次数: 0

Effects of Time of Arrival on Trauma Patient Outcomes. 到达时间对创伤患者预后的影响。

The American Surgeon Pub Date : 2024-04-22 DOI: 10.1177/00031348241248694

Samantha Larosa, Xander A. Stone, Ashley A. Fenninger, Nathaniel Harshaw, Kathryn M. Hoffman, Katherine Moore, Lindsey L Perea

{"title":"Effects of Time of Arrival on Trauma Patient Outcomes.","authors":"Samantha Larosa, Xander A. Stone, Ashley A. Fenninger, Nathaniel Harshaw, Kathryn M. Hoffman, Katherine Moore, Lindsey L Perea","doi":"10.1177/00031348241248694","DOIUrl":"https://doi.org/10.1177/00031348241248694","url":null,"abstract":"BACKGROUND\u0000Arriving during \"off hours\" to the hospital can put patients at greater risk of complications or mortality given lesser staff. Our goal was to investigate this in trauma patients with an Injury Severity Score (ISS) of >15. We hypothesized that the patients admitted late at night and/or during the weekend, would have worse outcomes, delays to the operating room (OR), and longer lengths of stay (LOS) compared to those who arrive on a weekday during the day.\u0000\u0000\u0000METHODS\u0000We performed a retrospective study from 8/1/2019 to 8/1/2022 of all trauma patients with an ISS >15 at our Level 1 Trauma Center. Patients <18 years, dead on arrival, or transferred out were excluded. Univariate and multivariable analysis were performed comparing weekday vs weekend arrivals, day vs night shift arrivals, and with patients grouped as weekday day, weekday night, weekend day, and weekend night. The primary outcome was mortality.\u0000\u0000\u0000RESULTS\u0000953 patients met inclusion criteria. The patients that arrived on the weekend and at night were significantly younger than their counterparts. A significantly greater percentage of Black patients arrived during night shift. Mortality, hospital LOS, and ICU LOS did not differ based on day or time of arrival.\u0000\u0000\u0000CONCLUSION\u0000Contrary to our hypothesis, our study did not find a significant difference in outcomes when evaluating based on a patient's time of arrival. This gives credence that our mature trauma center can provide the same level of care despite the time of a severely injured patient's time of arrival.","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"39 13","pages":"31348241248694"},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140674334","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}

引用次数: 0

Defining Types of Leadership Within an Academic Surgery Department to Promote Change for Decreasing Rates of Burnout. 定义外科学术部门的领导类型，促进改革以降低倦怠率。

The American Surgeon Pub Date : 2024-04-22 DOI: 10.1177/00031348241244643

Amelia Grover, Sally A. Santen, Kelly Lockeman, Dana Burns, K. Akuamoah-Boateng, Cynthia Siner, Sarah Miller, Brian K Sparkman, Lisa Ellis, Carla Nye

{"title":"Defining Types of Leadership Within an Academic Surgery Department to Promote Change for Decreasing Rates of Burnout.","authors":"Amelia Grover, Sally A. Santen, Kelly Lockeman, Dana Burns, K. Akuamoah-Boateng, Cynthia Siner, Sarah Miller, Brian K Sparkman, Lisa Ellis, Carla Nye","doi":"10.1177/00031348241244643","DOIUrl":"https://doi.org/10.1177/00031348241244643","url":null,"abstract":"OBJECTIVES\u0000Successful leaders influence the group they represent. Effective surgical care is tied to its leadership climate. However, most surgical providers are not attuned to their individual strengths which if known they could leverage them within their teams. This study identifies leadership types within a department of surgery which may be used to better understand and cultivate their strengths.\u0000\u0000\u0000METHODS\u0000In 2022, 172 providers in an academic surgery department were offered the GallupTM CliftonStrengths assessment, a proprietary instrument that maps 34 strengths across 4 domains of leadership. The assessment provides a respondent with their top 5 strengths and the domain in which they naturally \"lead\".\u0000\u0000\u0000RESULTS\u0000Of 172 providers, 127 (74%) completed the assessment. While providers have strengths in multiple domains, they \"lead with\" a specific domain. Mapped from the providers' top 10 strengths, the most common \"lead with\" domain for surgical providers was Executing: the ability to implement ideas and produce results. Strategic Thinking: those who are analytical and push teams forward and Relationship Building: the ability to create strong and effective teams were followed by the least common domain. Influencing: the ability to communicate ideas and lead others. Formal leaders were significantly more likely to lead with Strategic Thinking. There were no significant differences between APPs and physicians.\u0000\u0000\u0000CONCLUSION\u0000A majority of surgical providers \"lead with\" the GallupTM Executing domain. Those who lead with executing skills work tirelessly to produce outcomes. Learning to leverage the strengths of our teams to create cohesion and efficiency may improve engagement and retention.","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"48 14","pages":"31348241244643"},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140676249","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}

引用次数: 0

Psychiatric Diagnoses Are Associated With Postoperative Disparities in Patients Undergoing Major Colorectal Operations. 精神病诊断与大肠直肠手术患者的术后差异有关。

The American Surgeon Pub Date : 2024-04-22 DOI: 10.1177/00031348241248690

Alexis Webber, Shruthi R. Perati, Emily M Su, A. Ata, Todd D Beyer, Megan K Applewhite, J. Canete, Edward C. Lee

{"title":"Psychiatric Diagnoses Are Associated With Postoperative Disparities in Patients Undergoing Major Colorectal Operations.","authors":"Alexis Webber, Shruthi R. Perati, Emily M Su, A. Ata, Todd D Beyer, Megan K Applewhite, J. Canete, Edward C. Lee","doi":"10.1177/00031348241248690","DOIUrl":"https://doi.org/10.1177/00031348241248690","url":null,"abstract":"BACKGROUND\u0000Over 50% of hospitalized patients have comorbid psychiatric diagnoses, resulting in increased risk of morbidity such as longer lengths of stay, worse health-related quality of life, and increased mortality. However, data regarding colorectal surgery postoperative outcomes in patients with psychiatric diagnoses (PD) are limited.\u0000\u0000\u0000METHODS\u0000We queried a single institution's National Surgical Quality Improvement Program from 2013-2019 for major colorectal procedures. Postsurgical outcomes for patients with and without PD were compared. Primary outcomes were prolonged length of stay (pLOS) and 30-day readmission.\u0000\u0000\u0000RESULTS\u0000From a total of 1447 patients, 402 (27.8%) had PD. PD had more smokers (20.9% vs 15%) and higher mean body mass index (29.1 kg/m2 vs 28.2 kg/m2). Bivariate outcomes showed more surgical site infections (SSI) (10.2% vs 6.12%), reoperation (9.45% vs 6.35%), and pLOS (34.8% vs 29.0%) (all P values <.05) in the PD group. On multivariate analysis, PD had higher likelihood of reoperation (OR 1.53, 95% CI: [1.02-2.80]) and SSI (OR 1.82, 95% CI: [1.25-2.66]).\u0000\u0000\u0000DISCUSSION\u0000Psychiatric diagnoses are a risk factor for adverse outcomes after colorectal procedures. Further studies are needed to evaluate the benefit of perioperative mental health support services for these patients.","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"60 10","pages":"31348241248690"},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140675592","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}

引用次数: 0

Letter re: "Opioid Use, Disposition, and Parent Satisfaction Following Common Pediatric Surgical Procedures". 关于 "常见儿科外科手术后阿片类药物的使用、处置和家长满意度 "的信函。

The American Surgeon Pub Date : 2024-04-22 DOI: 10.1177/00031348241248792

Zoltán Németh, Satyam K Ghodasara, Patricia B. Stopper, Renay Durling-Grover, L. Difazio

引用次数: 0

Evaluation of Postoperative Outcomes After Enterostomy Closure in Low Body Weight Infants: A Multi-Center Retrospective Analysis. 低体重婴儿肠造口术后效果评估：多中心回顾性分析。

The American Surgeon Pub Date : 2024-04-22 DOI: 10.1177/00031348241248788

William G. Lee, MaKayla L. O’Guinn, Olivia A. Keane, Vikram Krishna, Shale J. Mack, Antoine Soliman, Dean M. Anselmo, Nam X Nguyen, Christopher P. Gayer, Eugene S. Kim, Eveline H. Shue

{"title":"Evaluation of Postoperative Outcomes After Enterostomy Closure in Low Body Weight Infants: A Multi-Center Retrospective Analysis.","authors":"William G. Lee, MaKayla L. O’Guinn, Olivia A. Keane, Vikram Krishna, Shale J. Mack, Antoine Soliman, Dean M. Anselmo, Nam X Nguyen, Christopher P. Gayer, Eugene S. Kim, Eveline H. Shue","doi":"10.1177/00031348241248788","DOIUrl":"https://doi.org/10.1177/00031348241248788","url":null,"abstract":"BACKGROUND\u0000The minimum weight for enterostomy closure (EC) in infants remains debated with the current acceptable cut-off of >2 kg. As enterostomy-related complications or high enterostomy output (>30cc/kg/d) may prohibit a premature infant from reaching 2 kg, additional data is needed to evaluate the safety of EC in infants <2 kg. The objective of this study was to evaluate postoperative outcomes in low body weight (<2 kg) infants undergoing EC compared to larger infants.\u0000\u0000\u0000METHODS\u0000We performed a multi-center retrospective analysis from 1/1/2012-12/31/2022 of all infants (age <1 year) who were <4 kg at time of EC. Primary outcomes included postoperative complications and 30-day mortality. Non-parametric analysis was performed using the Kruskal-Wallis one-way analysis of variance and chi-square tests. Univariable logistic regression was performed to identify factors associated with postoperative complications.\u0000\u0000\u0000RESULTS\u0000Of 92 infants, 15 infants (16.3%) underwent EC at <2 kg, 16 (17.4%) at 2-2.49 kg, 31 (33.7%) at 2.5-2.99 kg, and 30 (32.6%) at ≥3 kg. Infants <2 kg at time of EC exhibited higher rates of hyperbilirubinemia (P = .030), neurologic comorbidities (P = .030), and high enterostomy output (P = .041). There was no difference in postoperative complications (P = .460) or 30-day mortality (P = .460) between the <2 kg group and larger weight groups. Low body weight was not associated with an increased risk for developing a postoperative complication (OR: 1.001, 95% CI: 1.001-1.001; P = .032).\u0000\u0000\u0000CONCLUSION\u0000Our findings suggest that EC in infants <2 kg may be safe with comparable postoperative outcomes to larger weight infants. Thus, the timing of EC should be based on the infant's physiologic status, in contrast to a predetermined minimum weight cut-off.","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"21 26","pages":"31348241248788"},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140674861","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}

引用次数: 0

Don't Let the Sun Rise on Small Bowel Obstruction Without Surgical Consultation-Redefining Nonoperative Management Pathways. 未经手术会诊，不要让小肠梗阻的太阳升起--重新定义非手术治疗途径。

The American Surgeon Pub Date : 2024-04-21 DOI: 10.1177/00031348241248797

Umar F Bhatti, Aricia Shen, Nicolas Melo, Galinos Barmparas, Andrew S Wang, D. Margulies, R. Alban

{"title":"Don't Let the Sun Rise on Small Bowel Obstruction Without Surgical Consultation-Redefining Nonoperative Management Pathways.","authors":"Umar F Bhatti, Aricia Shen, Nicolas Melo, Galinos Barmparas, Andrew S Wang, D. Margulies, R. Alban","doi":"10.1177/00031348241248797","DOIUrl":"https://doi.org/10.1177/00031348241248797","url":null,"abstract":"Introduction: Small bowel obstruction (SBO) is a common cause of hospital admission leading to resource utilization. The majority of these patients require non-operative management (NOM) which can lead to increased length of stay (LOS), readmissions, resource utilization, and throughput delays. Early surgical consultation (SC) for SBO may improve efficiency and outcomes. Methods: We implemented an institution-wide intervention (INT) to encourage early SC (<1 day of diagnosis) for SBO patients in July 2022. A retrospective analysis was performed on all patients with SBO requiring NOM from January 2021 to June 2023, categorized into pre- and post-INT groups. The primary outcome was the number of SC's and secondary outcomes were early SC (<1 day of diagnosis), utilization of SBFT, LOS, 30-day readmission, and costs of admission. Results: A total of 670 patients were included, 438 in the pre-INT and 232 in the post-INT group. Overall, SBFT utilization was significantly higher in cases with SC (17.2% vs 41.4%, P < .001). Post-INT patients were more likely to receive SC (94.0% vs 83.3%, P < .001) and increased SBFT utilization (47.0% vs 33.6%, P = .001). Additionally, early SC improved significantly in the post-INT group (74.3% vs 65.7%, P = .03). There was no difference in LOS between groups (4.0 vs 3.8 days, P = .48). There was a trend toward decreased readmission rates in the INT group at 30 days (7.3% vs 11.0%, P = .13) and reduced direct costs in the INT group (US$/admission = 8467 vs 8708, P = .1). Conclusion: Hospital-wide interventions to increase early surgical involvement proved effective by improving early SC, increased SBFT utilization, and showed a trend towards decreased readmission rates and direct costs.","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"110 12","pages":"31348241248797"},"PeriodicalIF":0.0,"publicationDate":"2024-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140678541","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}

引用次数: 0