Surgery in practice and science最新文献

{"title":"Assessment of complications in third molar surgery performed by resident surgeons: A comprehensive analysis","authors":"João Mendes de Abreu ,&nbsp;Érica Cerqueira ,&nbsp;Anabela Quitério ,&nbsp;Tiago Nunes ,&nbsp;José Figueiredo ,&nbsp;Ana Corte-Real","doi":"10.1016/j.sipas.2024.100256","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100256","url":null,"abstract":"<div><h3>Introduction</h3><p>Third molar extractions present a wide spectrum of reported complications, spanning from 2.6 % to 30.9 %, making it challenging to predict outcomes for individual patients.</p><p>This study seeks to evaluate third molar extractions conducted exclusively by stomatology or maxillofacial surgery residents, examining associated complications. Its aim also extends to delineating the related risks concerning epidemiological and clinical factors, juxtaposed against findings in the existing literature.</p></div><div><h3>Materials and methods</h3><p>An observational prospective cohort study was conducted at the Clinical and Academic Centre of Coimbra, Portugal, from July 2021 to December 2023. Descriptive statistics were used considering the adequate statistical parameters. Inferential statistical analysis was performed using Student's <em>t</em>-test, the Chi-squared test, and Spearman rank correlation to analyze the relationship between study variables. A <em>p</em>-value of less than 0.05 was considered statistically significant.</p></div><div><h3>Results</h3><p>485 patients underwent third molar extractions performed exclusively by stomatology and maxillofacial surgery residents, comprising a total of 686 extracted teeth and resulting in 71 reported complications (14.6 % per patient and 10.3 % per extracted tooth). Results revealed that patients undergoing lower third molar extraction faced a 3.7 times higher risk of complications compared to those undergoing upper third molar extraction. Teeth categorized as “IIIC” by Pell and Gregory's classification and those undergoing osteotomy and odontosection also exhibited a higher-than-expected complication rate with statistically significant differences being observed. No other variables showed a positive or negative statistically significant correlation with complication occurrence.</p></div><div><h3>Discussion and conclusion</h3><p>Despite the expectation of a heightened complication rate, this study revealed that a successful and comprehensive training regimen results in encountering complication rates akin to those documented in established literature.</p><p>These findings also underscore the importance of recognizing that a resident's surgical accomplishment is intrinsically tied to acknowledging and respecting their learning curve.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"18 ","pages":"Article 100256"},"PeriodicalIF":0.6,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000238/pdfft?md5=4a27f1b5e5da63aa17d34d142cc27bd6&pid=1-s2.0-S2666262024000238-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141542733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of Guided imagery on perioperative anxiety in hospitalized adult patients: A systematic review of randomized controlled trials","authors":"Mahdiyeh Arjmandy Anamagh ,&nbsp;Mohammad Shafiei Kouhpayeh ,&nbsp;Shahab Khezri ,&nbsp;Rasoul Goli ,&nbsp;Navid Faraji ,&nbsp;Babak Choobi Anzali ,&nbsp;Himan Maroofi ,&nbsp;Nima Eskandari ,&nbsp;Fereshteh Ghahremanzad","doi":"10.1016/j.sipas.2024.100255","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100255","url":null,"abstract":"<div><h3>Objective</h3><p>Guided imagery is a relaxation technique that uses mental visualization to help individuals relax and focus their minds. This systematic review examines the effect of guided imagery on perioperative anxiety in hospitalized adult patients. The aim is to provide a comprehensive analysis of the existing evidence on the efficacy of guided imagery as an intervention for reducing perioperative anxiety.</p></div><div><h3>Methods</h3><p>A systematic search was conducted on databases including Web of Science, PubMed, Scopus, and PsycINFO. After screening titles and abstracts, full-text articles were assessed for eligibility. The selected studies were analyzed for their findings related to the effect of guided imagery on perioperative anxiety in adult patients.</p></div><div><h3>Results</h3><p>Nine studies met the inclusion criteria and provided sufficient data for analysis. The majority of the included studies reported a statistically significant reduction in perioperative anxiety following guided imagery interventions. The variations in intervention protocols, such as the content, duration, and frequency of guided imagery, were observed across the studies. Patient satisfaction and acceptance of guided imagery interventions were generally high.</p></div><div><h3>Conclusion</h3><p>The findings of this systematic review suggest that guided imagery is an effective intervention for reducing perioperative anxiety in hospitalized adult patients. Despite the limitations of small sample sizes and variability in measurement tools, the consistent positive results and high patient satisfaction indicate the potential benefits of incorporating guided imagery into perioperative care protocols. More comprehensive research with bigger samples and standardized tools is essential for guiding imagery integration in clinical practice.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"18 ","pages":"Article 100255"},"PeriodicalIF":0.6,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000226/pdfft?md5=307c420023f63dd7a02598159252d172&pid=1-s2.0-S2666262024000226-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141542732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of postoperative complications following thyroidectomy: A systematic review","authors":"Philip KW Hong ,&nbsp;Aman Pathak ,&nbsp;Aditya S Shirali","doi":"10.1016/j.sipas.2024.100252","DOIUrl":"10.1016/j.sipas.2024.100252","url":null,"abstract":"<div><h3>Introduction</h3><p>Thyroidectomy is considered a relatively safe procedure with a low risk of postoperative complications, making it challenging to identify predictors of complications to improve shared decision making. Recent advancements in clinical bioinformatics and surgical decision-making tools have the potential to improve patient outcomes. This systematic review aimed to assess the current understanding of factors predicting such complications following thyroidectomy.</p></div><div><h3>Methods</h3><p>We searched PubMed/MEDLINE, Web of Science, and EMBASE for studies published between 2010 and October 2023, investigating predictors of postoperative complications after thyroidectomy. Studies were included if they investigated predictors of hypocalcemia, hypoparathyroidism, vocal cord paresis (VCP), hematoma, or other postoperative complications. Studies solely reliant on univariate and ROC analyses were excluded. Independent predictors of each postoperative complication were evaluated and categorized as biochemical, surgical, and patient/disease specific.</p></div><div><h3>Results</h3><p>Forty-five studies were included. Biochemical hypocalcemia and transient hypoparathyroidism were the most investigated complications, with reported rates ranging from 15.7 % to 76.7 % and 12.9 % to 53.8 %, respectively. The majority of studies (<em>n</em> = 35, 77 %) focused on these complications. Biochemical markers (e.g., serum calcium, parathyroid hormone) were the most frequent predictors identified for these complications. Surgical factors (inadvertent parathyroidectomy) were frequently studied for all complications. Age, gender, and thyroid pathology were common patient/disease-specific predictors.</p></div><div><h3>Conclusion</h3><p>This review highlights the disparity in research on complication predictors. Most studies focused on hypocalcemia and hypoparathyroidism, with fewer examining VCP, hematoma, and mortality. Notably, a lack of high-quality evidence exists due to the scarcity of prospective and randomized controlled trials. Future research should explore incorporating a wider range of independent predictors, especially surgical factors, into comprehensive predictive models. This review can serve as a foundation for developing such models to improve risk prediction for a broader spectrum of thyroidectomy complications.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"18 ","pages":"Article 100252"},"PeriodicalIF":0.0,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000196/pdfft?md5=0197fe99a28f7610c52ea5a77d650aba&pid=1-s2.0-S2666262024000196-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141413364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resident level is associated with operative time in laparoscopic cholecystectomy","authors":"Nada Lelovic ,&nbsp;Rebecca Reif ,&nbsp;Hanna Jensen ,&nbsp;Adria Abella Villafranca ,&nbsp;Mary Katherine Kimbrough ,&nbsp;Kevin Sexton","doi":"10.1016/j.sipas.2024.100251","DOIUrl":"10.1016/j.sipas.2024.100251","url":null,"abstract":"<div><h3>Background</h3><p>While previous literature has shown that resident involvement increases operative time, the influence of resident involvement on operative time is generally not considered in current methods of case time predictions or operating room planning. Furthermore, evidence of prolonged case times based on the level of the assisting resident is yet scarce. We hypothesized that operative time would increase with the post-graduate year of assisting residents as they gain more autonomy in the operating room.</p></div><div><h3>Study design</h3><p>This was an observational cohort study in which we retrospectively analyzed 802 laparoscopic cholecystectomy cases performed in a single academic institution between May 2014 and December 2020. Only cases in which a Post Graduate Year 1 to 5 (PGY) resident was assisting were included.</p></div><div><h3>Results</h3><p>PGY1–4 residents had statistically significant positive time coefficient results in all linear regression models, except PGY2s in urgent cases. PGY-2 residents had the longest overall average case time of 98 min. Emergent cases were more likely to have prolonged case times.</p></div><div><h3>Conclusions</h3><p>The increased average case time associated with PGY-2 residents is likely due to a new level of increased autonomy in the operating room (OR) during this year of training. The linear regression results indicated PGY1–4 residents were more likely to have longer laparoscopic cholecystectomy operative times than the PGY5 residents, except PGY2s in urgent cases. This may reflect the accumulation of surgical skills at the PGY5 level. Resident involvement should be considered in the prediction of operative time in an academic setting.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"17 ","pages":"Article 100251"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000184/pdfft?md5=0dd64703d3d1e4780a5478a78c6a46ec&pid=1-s2.0-S2666262024000184-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141138748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Marital status shows no protective effect on perioperative outcomes after robotic-assisted pulmonary lobectomy","authors":"Jenna C. Marek ,&nbsp;Allison O. Dumitriu Carcoana ,&nbsp;William J. West III ,&nbsp;Emily E. Weeden ,&nbsp;Ajay Varadhan ,&nbsp;Jessica Cobb ,&nbsp;Sarah Cool ,&nbsp;Gregory Fishberger ,&nbsp;Collin B. Chase ,&nbsp;Maykel Dolorit ,&nbsp;Harrison E. Strang ,&nbsp;Carla C. Moodie ,&nbsp;Joseph R. Garrett ,&nbsp;Jenna R. Tew ,&nbsp;Jobelle Joyce-Anne R. Baldonado ,&nbsp;Jacques P. Fontaine ,&nbsp;Eric M. Toloza","doi":"10.1016/j.sipas.2024.100250","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100250","url":null,"abstract":"<div><h3>Background</h3><p>Marital status has been shown to have protective effects for married patients with various cancers. We sought to determine effects of marital status on perioperative outcomes after robotic-assisted pulmonary lobectomy (RAPL).</p></div><div><h3>Methods</h3><p>We retrospectively analyzed 709 consecutive patients who underwent RAPL between 2010 and 2022 by one surgeon. Patients were stratified by marital status at time of surgery. The Married group included married, domestically partnered, and co-habitating patients (<em>N</em> = 473). The Unmarried group included never married, divorced, and widowed individuals (<em>N</em> = 236). Demographics, preoperative comorbidities, intraoperative and postoperative complications, estimated blood loss (EBL), chest tube duration, hospital length of stay (LOS), tumor characteristics, and survival data were analyzed utilizing Student's <em>t</em>-test, Wilcoxon rank-sum test, Chi-square, or Fisher's exact test as appropriate, with significance at <em>p</em><span><math><mrow><mo>≤</mo><mn>0.05</mn><mo>.</mo></mrow></math></span></p></div><div><h3>Results</h3><p>Unmarried patients were more likely to be female, while married patients were more likely to experience robotic-associated intraoperative complications and greater intraoperative estimated blood loss. Kaplan-Meier survival analysis revealed no difference in 5-year overall survival based on marital status. Other perioperative outcomes, intraoperative complications (except robotic-associated), postoperative complications, demographic history (except gender), and preoperative comorbidities did not significantly differ between the two groups.</p></div><div><h3>Conclusion</h3><p>This study challenges the existing reports in the literature that marriage confers cancer treatment outcomes advantage and prolonged survival among cancer patients. Social support, in terms of a spouse or domestic partner, may be less protective in early-stage lung cancer and after minimally invasive pulmonary lobectomy compared to other cancer populations.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"18 ","pages":"Article 100250"},"PeriodicalIF":0.0,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000172/pdfft?md5=265d3cb74253b6c9ac59a9cbb58661ec&pid=1-s2.0-S2666262024000172-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141308068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of racial/ethnic disparities in surgical outcomes after rectal cancer resection: An ACS-NSQIP analysis","authors":"Carolina Vigna,&nbsp;Ana Sofia Ore,&nbsp;Anne Fabrizio,&nbsp;Evangelos Messaris","doi":"10.1016/j.sipas.2024.100248","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100248","url":null,"abstract":"<div><h3>Background</h3><p>Disparities exist the management of rectal cancer. We sought to evaluate short-term surgical outcomes among different racial/ethnic groups following rectal cancer resection.</p></div><div><h3>Materials and Methods</h3><p>National Surgical Quality Improvement Program (NSQIP) database (2016–2019) was queried. Patients undergoing rectal cancer resection were categorized by race/ethnicity. Circumferential resection margin positivity rate and postoperative outcomes were evaluated. 1:1 Propensity score matching (PSM) was used.</p></div><div><h3>Results</h3><p>Of 1,753 patients, 80.2 % were White, 7.6 % Black, 8.5 % Asian and 3.7 % Hispanic. On unadjusted analysis, Hispanic patients presented longer operative time(<em>p</em> = 0.029), and Black patients higher postoperative ileus(<em>p</em> = 0.003) and readmission(<em>p</em> = 0.023) rates. After PSM, Hispanics had a significantly higher circumferential resection margin positivity rate(<em>p</em> = 0.032), Black patients higher postoperative ileus rate(<em>p</em> = 0.014) and longer LOS(<em>p</em> = 0.0118) when compared to White counterparts.</p></div><div><h3>Conclusion</h3><p>Racial disparities were found in short-term postoperative outcomes. Hispanic patients presented higher margin positivity rate and Black patients worst 30-day postoperative outcomes. Comparative studies evaluating trends and a higher number of minority patients included in databases are warranted.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"17 ","pages":"Article 100248"},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000159/pdfft?md5=b8c6b9dcb291130b1c29412c364bcf2f&pid=1-s2.0-S2666262024000159-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140620922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The pulmonary contusion score: Development of a simple scoring system for blunt lung injury","authors":"Lisa J. Toelle ,&nbsp;Allison G. McNickle ,&nbsp;Declan Feery ,&nbsp;Salman Mohammed ,&nbsp;Paul J. Chestovich ,&nbsp;Kavita Batra ,&nbsp;Douglas R. Fraser","doi":"10.1016/j.sipas.2024.100247","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100247","url":null,"abstract":"<div><h3>Background</h3><p>Pulmonary contusions (PC) are common after blunt chest trauma and can be identified with computed tomography (CT). Complex scoring systems for grading PC exist, however recent scoring systems rely on computer-generated algorithms that are not readily available at all hospitals. We developed a scoring system for grading PC to predict the need for prolonged mechanical ventilation and initial hospital admission location.</p></div><div><h3>Methods</h3><p>A retrospective review was performed of adult blunt trauma patients with PC identified on initial chest CT during 2020. Data elements related to demographics, injury characteristics, disposition and healthcare utilization were extracted. The primary outcome was the need for mechanical ventilation for greater than 48 h. A novel scoring system, the Pulmonary Contusion Score (PCS) was developed. The maximum score was 10, with each lobe contributing up to 2 points. A score of 0 was given for no contusion present in the lobe, 1 for less than 50 % contusion, and 2 for greater than 50 % contusion. A PCS of 4 was hypothesized to correlate with need for mechanical ventilation for over 48 h. A confusion matrix of the scoring algorithm was created, and inter-rater concordance was calculated from a randomly selected 125 patients.</p></div><div><h3>Results</h3><p>A total of 217 patients were identified. 118 patients (54 %) were admitted to the ICU, but only 23 patients (19 %) were intubated, and only 17 patients (8 %) required mechanical ventilation &gt; 48 h. Sensitivity of the scoring system was 20 %, while specificity was 93 %. Negative predictive value was 93 %. Inter-rater agreement was 77 %.</p></div><div><h3>Conclusion</h3><p>The PCS is a scoring system with high specificity and negative predictive value that can be used to evaluate the need for mechanical ventilation after sustaining blunt PC and can help properly allocate hospital resources.</p></div><div><h3>Level of evidence</h3><p>IV - diagnostic criteria</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"17 ","pages":"Article 100247"},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000147/pdfft?md5=50257186706e56b5fde8be903d780796&pid=1-s2.0-S2666262024000147-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140621752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting in-hospital mortality using Elixhauser comorbidity in patients underwent single and multiple coronary artery bypass surgery","authors":"Renxi Li ,&nbsp;Stephen Huddleston","doi":"10.1016/j.sipas.2024.100246","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100246","url":null,"abstract":"<div><h3>Background</h3><p>Coronary Artery Bypass Grafting (CABG) is a high-risk surgery. Cardiovascular diseases are strongly associated with comorbidities. This study aimed to assess the prediction of in-hospital mortality by comorbidities in patients who underwent CABG.</p></div><div><h3>Methods</h3><p>The National Inpatient Sample database was used to extract patients who received 1, 2, 3, and 4+ CABG between Q4 2015 and 2020. Best-fit model by logistic regressions was used to predict in-hospital mortality by Elixhauser Comorbidity Index (ECI). Moreover, age was adjusted in ECI prediction.</p></div><div><h3>Results</h3><p>There were 190,524, 83,725, 48,147, and 13,540 patients who underwent 1, 2, 3, and 4+ CABG, respectively. In-hospital mortality was best predicted by ECI in 3 CABG (<em>c</em>-statistic = 0.63, 95 % CI = 0.62–0.65), followed by 4+ CABG (<em>c</em>-statistic = 0.63, 95 % CI = 0.60–0.66), 1 CABG (<em>c</em>-statistic = 0.62, 95 % CI = 0.61–0.63), and 2 CABG (<em>c</em>-statistic = 0.62, 95 % CI = 0.61–0.63). After adjusting for age, ECI adequately predicted in-hospital mortality in 4+ CABG (<em>c</em>-statistic = 0.72, 95 % CI = 0.69–0.75) and 3 CABG (<em>c</em>-statistic = 0.69, 95 % CI = 0.68–0.71). Predictive powers for age-adjusted ECI were comparable in 1 CABG (<em>c</em>-statistic=0.67, 95 % CI = 0.66–0.68) and 2 CABG (<em>c</em>-statistic = 0.67, 95 % CI = 0.65–0.68).</p></div><div><h3>Conclusions</h3><p>ECI was a moderate (<em>c</em>-statistic 0.6–0.7) predictor of in-hospital mortality in all CABG. Age-adjusted ECI could effectively predict in-hospital mortality, especially in patients who underwent 3 and 4+ CABG.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"17 ","pages":"Article 100246"},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000135/pdfft?md5=b5189c977c86c425a945bd1d04e9c41a&pid=1-s2.0-S2666262024000135-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140557791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indications and outcomes of liver transplantation for liver tumors in the United States","authors":"Kenji Okumura,&nbsp;Abhay Dhand,&nbsp;Kamil Hanna,&nbsp;Ryosuke Misawa,&nbsp;Hiroshi Sogawa,&nbsp;Gregory Veillette,&nbsp;Seigo Nishida","doi":"10.1016/j.sipas.2024.100245","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100245","url":null,"abstract":"<div><h3>Background</h3><p>While hepatocellular carcinoma (HCC) remains the leading cause of liver transplant (LT) for liver tumors, indications have broadened over the years. Data regarding patient characteristics and outcomes of LT for liver tumors are limited.</p></div><div><h3>Methods</h3><p>From Jan-2002 to March-2022, 14,406 LT recipients for various liver tumors were identified in United Network for Organ Sharing database. Overall post-transplant survival analysis was performed with Kaplan-Meier method and multivariable Cox proportional-hazards model.</p></div><div><h3>Results</h3><p>During the study period, indications for LT for various hepatic tumors were HCC (88.5 %), benign tumors (5.1 %), cholangiocarcinoma (3.9 %), angiosarcoma (0.7 %), bile duct cancer (0.7 %), secondary tumors (0.5 %) and others (0.7 %). Compared to non-HCC, LT recipients for HCC were older (median age 61 vs 54 years, <em>P</em> &lt; 0.001), more often male (77% vs 48 %, <em>P</em> &lt; 0.001), more often Hispanic (16% vs 8.0 %), had higher BMI (28.2 vs 25.3, <em>P</em> &lt; 0.001) and higher prevalence of Hepatitis C (53% vs 3.9 %, <em>P</em> &lt; 0.001). Donor characteristics across various groups were similar. One-year survival in LT recipients of HCC was higher (HCC: 91.7% vs. non-HCC: 90.3 %) with adjusted Hazard Ratio (aHR) of 0.87; 95 % CI 0.77–0.99, <em>P</em> = 0.033 in a multivariable Cox regression analysis. Compared to HCC, survival outcomes were worse in cholangiocarcinoma (aHR 1.70; 95 %CI 1.43–2.01, <em>P</em> &lt; 0.001), bile duct cancer (aHR 3.03; 95 %CI 2.12–4.33, <em>P</em> &lt; 0.001), secondary tumors including colon cancer and neuroendocrine tumors (aHR 1.88; 95 % CI 1.24–2.85, <em>P</em> = 0.003), with best survival in patients with benign tumors (aHR 0.57; 95 %CI 0.46–0.70, <em>P</em> &lt; 0.001).</p></div><div><h3>Conclusions</h3><p>LT is performed for various liver tumors with variable outcomes among these primary indications.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"17 ","pages":"Article 100245"},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000123/pdfft?md5=6edd88d1fb293f935ce91927c2c3c344&pid=1-s2.0-S2666262024000123-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140894413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical risks and care trends: A cross sectional study of people experiencing homelessness presenting at a free clinic care in Miami-Dade County","authors":"Shivangi Parmar ,&nbsp;Emily Eachus ,&nbsp;Orly Morgan ,&nbsp;Boris Yang ,&nbsp;Violet Victoria ,&nbsp;Suhas Seshadri ,&nbsp;Armen Henderson ,&nbsp;Stefan Kenel-Pierre ,&nbsp;Joshua Laban","doi":"10.1016/j.sipas.2024.100244","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100244","url":null,"abstract":"<div><h3>Background</h3><p>The effects of housing insecurity on surgical care are under researched and largely unknown. Thus far, studies on surgery outcomes of people experiencing homelessness either focus on shelter-based patients or do not differentiate whether patients are sheltered or unsheltered, despite significant differences in care needs and health risks. Herein we provide the first report on surgical care trends of people experiencing unsheltered homelessness.</p></div><div><h3>Methods</h3><p>Clinical history, medication list, and blood pressure records of 300 people experiencing unsheltered homelessness receiving care at a free mobile clinic were deidentified, downloaded and analyzed in R studio 4.3.0. Participants were asked whether they had undergone surgery and included surgical history for those who had.</p></div><div><h3>Results</h3><p>Of 300 participants, 18 % (<em>N</em> = 55) had a history of surgery, most common being 1) orthopedics (<em>N</em> = 20), 2) vascular (<em>N</em> = 18), 3) general (<em>N</em> = 6), 4) acute trauma response (<em>N</em> = 5), 5) ophthalmology (<em>N</em> = 4), 6) surgical oncology (<em>N</em> = 2). Post-discharge, 13 % returned with wound site infections and 9 % were readmitted for treatment. Chi Square test showed Hypertension [X2 (1, <em>n</em> = 300)=10.9, <em>p</em> &lt; 0.001] and Type II Diabetes [X2 (1, <em>n</em> = 300)=10.5, <em>p</em> = 0.0012] significantly increased likelihood of needing vascular surgery, particularly lower extremity wound debridement or amputation.</p></div><div><h3>Conclusion</h3><p>Little research has been done assessing surgical care trends for people experiencing unsheltered homelessness. Results indicate possible presence of barriers accessing cancer care and increased risk for vascular disease needing surgical intervention. Future research is needed to understand, address, and overcome current surgical care barriers to help this at-risk and underserved community.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"17 ","pages":"Article 100244"},"PeriodicalIF":0.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000111/pdfft?md5=e7a3e5f9196b9324a5ff46681f19cc7f&pid=1-s2.0-S2666262024000111-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140548558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}