Surgery open science最新文献

{"title":"Predicting the severity of acute pancreatitis: Current approaches and future directions","authors":"Aida Metri,&nbsp;Nikhil Bush,&nbsp;Vikesh K. Singh MD, MSc","doi":"10.1016/j.sopen.2024.03.012","DOIUrl":"10.1016/j.sopen.2024.03.012","url":null,"abstract":"<div><p>Acute pancreatitis (AP) is a sudden-onset inflammatory disease of the pancreas. The severity of AP is classified into mild, moderate, and severe categories based on the presence and persistence of organ failure. Severe acute pancreatitis (SAP) can be associated with significant morbidity and mortality. It requires early recognition for appropriate timely management. Prognostic scores for predicting SAP incorporating many clinical, laboratory, and radiological parameters have been developed in the past. However, all of these prognostic scores have low positive predictive value for SAP and some of these scores require &gt;24 h for assessment. There is a need to develop biomarkers that can accurately identify patients at risk for SAP early in the course of the presentation. In this review, we aim to provide a summary of the most commonly utilized prognostic scores for AP and discuss future directions.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"19 ","pages":"Pages 109-117"},"PeriodicalIF":1.4,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000447/pdfft?md5=33aec8c1a1495765ae4003111a8d00d3&pid=1-s2.0-S2589845024000447-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140402447","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":"Is the robotic revolution stunting surgical skills?","authors":"Damien J. Lazar MD MBA,&nbsp;George S. Ferzli MD FACS","doi":"10.1016/j.sopen.2024.03.009","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.03.009","url":null,"abstract":"<div><p>This perspective piece aims to examine the impact of the growing utilization of robotic platforms in general and minimally invasive surgery on surgical trainee experience, skill level, and comfort in performing general surgical and minimally invasive procedures following completion of training. We review current literature and explore the application of robotic surgery to surgical training, where minimum case thresholds and breadth distribution are well defined, and where development of surgical technique is historically gained through delicate tissue handling with haptic feedback rather than relying on visual feedback alone. We call for careful consideration as to how best to incorporate robotics in surgical training in order to embrace technological advances without endangering the surgical proficiency of the surgeons of tomorrow.</p></div><div><h3>Key message</h3><p>The large-scale incorporation of robotics into general and minimally invasive surgical training is something that most, if not all, trainees must grapple with in today's world, and the proportion of robotics is increasing. This shift may significantly negatively affect trainees in terms of surgical skill upon completion of training and must be approached with an appropriate degree of concern and thoughtfulness so as to protect the surgeons of tomorrow.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"19 ","pages":"Pages 63-65"},"PeriodicalIF":1.4,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000423/pdfft?md5=4a8da2eff32831e1ebc34f2ff9d58266&pid=1-s2.0-S2589845024000423-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140339519","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":"Efficacy of damage control orthopedics strategy in the management of lower limb trauma","authors":"Fubin Li,&nbsp;Lecai Gao,&nbsp;Jiangang Zuo,&nbsp;Jindong Wei","doi":"10.1016/j.sopen.2024.03.008","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.03.008","url":null,"abstract":"<div><h3>Background</h3><p>Little is known about the efficacy of damage control (DC) surgery in the management of lower limb trauma. Here we compared the clinical parameters and complication rates of such patients received either DC or emergency comprehensive (EC) surgery treatment.</p></div><div><h3>Methods</h3><p>This study is a retrospective study on patients with lower limb trauma that received surgical treatment. Data of 120 patients were divided into DC and EC surgery groups. Clinical parameters obtained at hospital admission and complications during follow-up were analyzed. Injury Severity Score (ISS), Gustilo classification and Mangled Extremity Severity Score (MESS) were used to assess trauma severity, open fractures and viability of injured limb, respectively.</p></div><div><h3>Results</h3><p>Age, sex, ISS, fracture type, injury site, MESS, operation time, blood loss, pulmonary and cranial injuries were compared. We found that patients in the DC group had more severe injury as reflected by the higher injury severity score (ISS) (28.1 ± 10.9 vs 21.3 ± 7.4, P &lt; 0.001). ISS was also identified as a significant influencer for the treatment selection (P &lt; 0.001). In addition, patients treated with DC surgery demonstrated less complications (7 cases vs 27 cases), which was supported by the propensity score logistic regression analysis (Odd ratio 4.667).</p></div><div><h3>Conclusions</h3><p>DC surgery is more often selected to treat patients with more severe lower limb injuries, which leads to lower complication rates.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"19 ","pages":"Pages 101-104"},"PeriodicalIF":1.4,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000393/pdfft?md5=9052e73d218f37f17effd55b7f840e43&pid=1-s2.0-S2589845024000393-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140347203","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":"Factors affecting minimally invasive surgery utilization during elective colectomies for diverticular disease in the United States","authors":"Arshad M. Bachelani ,&nbsp;Laura A. Holton","doi":"10.1016/j.sopen.2024.03.007","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.03.007","url":null,"abstract":"<div><h3>Background</h3><p>Compared with open surgery, minimally invasive surgery (MIS) has been shown to have improved outcomes when treating diverticular disease. This study aimed to analyze recent trends in MIS utilization for elective colectomy for diverticular disease and to identify individual variables and hospital characteristics associated with MIS utilization.</p></div><div><h3>Methods</h3><p>This population-based study examined individuals from the National Inpatient Sample who underwent elective colectomy for diverticular disease from 2016 to 2019.</p></div><div><h3>Results</h3><p>Hospitals in the Midwest used MIS less than those in other geographic regions. Rural hospitals used MIS less than urban hospitals. Hospital bed size and teaching status were not associated with differences in MIS utilization. Patients with private insurance were more likely to have an MIS operation. There was also a racial disparity in MIS utilization, even after adjusting for insurance status.</p></div><div><h3>Conclusions</h3><p>While there is no longer any variance in MIS utilization based on hospital bed size or teaching status, disparities concerning patient race remain, even after adjusting for insurance status. Further investigation is needed to determine the roots of these disparities.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"19 ","pages":"Pages 14-19"},"PeriodicalIF":1.4,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S258984502400040X/pdfft?md5=9a345a8e55b2211c64ae6a4f334b293e&pid=1-s2.0-S258984502400040X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140321498","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":"Tracheostomy in high-risk patients on ECMO: A bedside hybrid dilational technique utilizing a rummel tourniquet","authors":"Mark Falimirski","doi":"10.1016/j.sopen.2024.03.004","DOIUrl":"10.1016/j.sopen.2024.03.004","url":null,"abstract":"","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"19 ","pages":"Page 108"},"PeriodicalIF":1.4,"publicationDate":"2024-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S258984502400037X/pdfft?md5=03999eec4df291ff5a9ac99eed57a30b&pid=1-s2.0-S258984502400037X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140404907","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":"Association of substance-use disorder with outcomes of major elective abdominal operations: A contemporary national analysis","authors":"Baran Khoraminejad ,&nbsp;Sara Sakowitz MS MPH ,&nbsp;Zihan Gao MHSc ,&nbsp;Nikhil Chervu MD ,&nbsp;Joanna Curry BA ,&nbsp;Konmal Ali ,&nbsp;Syed Shahyan Bakhtiyar MD MBE ,&nbsp;Peyman Benharash MD MS","doi":"10.1016/j.sopen.2024.03.006","DOIUrl":"10.1016/j.sopen.2024.03.006","url":null,"abstract":"<div><h3>Background</h3><p>Affecting &gt;20million people in the U.S., including 4 % of all hospitalized patients, substance use disorder (SUD) represents a growing public health crisis. Evaluating a national cohort, we aimed to characterize the association of concurrent SUD with perioperative outcomes and resource utilization following elective abdominal operations.</p></div><div><h3>Methods</h3><p>All adult hospitalizations entailing elective colectomy, gastrectomy, esophagectomy, hepatectomy, and pancreatectomy were tabulated from the 2016–2020 National Inpatient Sample. Patients with concurrent substance use disorder, comprising alcohol, opioid, marijuana, sedative, cocaine, inhalant, hallucinogen, or other psychoactive/stimulant use, were considered the <em>SUD</em> cohort (others: <em>nSUD</em>). Multivariable regression models were constructed to evaluate the independent association between <em>SUD</em> and key outcomes.</p></div><div><h3>Results</h3><p>Of ∼1,088,145 patients, 32,865 (3.0 %) comprised the <em>SUD</em> cohort. On average, <em>SUD</em> patients were younger, more commonly male, of lowest quartile income, and of Black race. <em>SUD</em> patients less frequently underwent colectomy, but more often pancreatectomy, relative to <em>nSUD</em>.</p><p>Following risk adjustment and with <em>nSUD</em> as reference, <em>SUD</em> demonstrated similar likelihood of in-hospital mortality, but remained associated with increased odds of any perioperative complication (Adjusted Odds Ratio [AOR] 1.17, CI 1.09–1.25). Further, <em>SUD</em> was linked with incremental increases in adjusted length of stay (β + 0.90 days, CI +0.68–1.12) and costs (β + $3630, CI +2650–4610), as well as greater likelihood of non-home discharge (AOR 1.54, CI 1.40–1.70).</p></div><div><h3>Conclusions</h3><p>Concurrent substance use disorder was associated with increased complications, resource utilization, and non-home discharge following major elective abdominal operations. Novel interventions are warranted to address increased risk among this vulnerable population and address significant disparities in postoperative outcomes.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"19 ","pages":"Pages 44-49"},"PeriodicalIF":1.4,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000368/pdfft?md5=fc36f14b57729bf0b39448cf5493aa8d&pid=1-s2.0-S2589845024000368-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140279858","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":"HPB ultrasound guidance techniques - Targeting","authors":"Matthew S. Strand,&nbsp;David A. Iannitti","doi":"10.1016/j.sopen.2024.02.013","DOIUrl":"10.1016/j.sopen.2024.02.013","url":null,"abstract":"<div><p>Ultrasound is an indispensable tool for intraoperative assessment and treatment of hepatopancreatobiliary pathology. As minimally invasive approaches to HPB surgery continue to expand and the benefits of parenchymal-sparing liver surgery are increasingly appreciated, skillful targeting will play an even bigger role in HPB surgical practice. Techniques for intraoperative targeting of liver lesions for the purposes of biopsy and ablation, particularly in the laparoscopic setting, are the focus of this chapter.</p><p>Current evidence supports the use of ablation for a variety of liver lesions including hepatocellular carcinoma and metastatic colorectal cancer, particularly for smaller lesions.</p><p>Successful targeting requires optimization of patient position and port placement. When targeting multiple lesions, thoughtful treatment sequencing is critical to maintaining visualization and optimizing outcomes.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"19 ","pages":"Pages 50-62"},"PeriodicalIF":1.4,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000320/pdfft?md5=7e7464b71961670b75e1e6b5631eb9da&pid=1-s2.0-S2589845024000320-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140278155","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":"Editorial Board Page","authors":"","doi":"10.1016/S2589-8450(24)00043-5","DOIUrl":"https://doi.org/10.1016/S2589-8450(24)00043-5","url":null,"abstract":"","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"18 ","pages":"Page i"},"PeriodicalIF":1.4,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000435/pdfft?md5=f7fa0ad020256690fe52d8fb4cccec35&pid=1-s2.0-S2589845024000435-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140338620","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":"Trends, outcomes, and factors associated with in-hospital opioid overdose following major surgery","authors":"Joanna Curry ,&nbsp;Troy Coaston ,&nbsp;Amulya Vadlakonda ,&nbsp;Sara Sakowitz ,&nbsp;Saad Mallick ,&nbsp;Nikhil Chervu ,&nbsp;Baran Khoraminejad ,&nbsp;Peyman Benharash","doi":"10.1016/j.sopen.2024.03.002","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.03.002","url":null,"abstract":"<div><h3>Background</h3><p>With the growing opioid epidemic across the US, in-hospital utilization of opioids has garnered increasing attention. Using a national cohort, this study sought to characterize trends, outcomes, and factors associated with in-hospital opioid overdose (OD) following major elective operations.</p></div><div><h3>Methods</h3><p>We identified all adult (≥18 years) hospitalizations entailing select elective procedures in the 2016–2020 National Inpatient Sample. Patients who experienced in-hospital opioid overdose were characterized as <em>OD</em> (others: <em>Non-OD</em>). The primary outcome of interest was in-hospital OD. Multivariable logistic and linear regression models were developed to evaluate the association between in-hospital OD and mortality, length of stay (LOS), hospitalization costs, and non-home discharge.</p></div><div><h3>Results</h3><p>Of an estimated 11,096,064 hospitalizations meeting study criteria, 5375 (0.05 %) experienced a perioperative OD. Compared to others, <em>OD</em> were older (66 [57–73] vs 64 [54–72] years, p &lt; 0.001), more commonly female (66.3 vs 56.7 %, p &lt; 0.001), and in the lowest income quartile (26.4 vs 23.2 %, p &lt; 0.001). After adjustment, female sex (Adjusted Odds Ratio [AOR] 1.68, 95 % Confidence Interval [CI] 1.47–1.91, p &lt; 0.001), White race (AOR 1.19, CI 1.01–1.42, p = 0.04), and history of substance use disorder (AOR 2.51, CI 1.87–3.37, p &lt; 0.001) were associated with greater likelihood of OD. Finally, OD was associated with increased LOS (β +1.91 days, CI [1.60–2.21], p &lt; 0.001), hospitalization costs (β +$7500, CI [5900–9100], p &lt; 0.001), and greater odds of non-home discharge (AOR 2.00, CI 1.61–2.48, p &lt; 0.001).</p></div><div><h3>Conclusion</h3><p>Perioperative OD remains a rare but costly complication after elective surgery. While pain control remains a priority postoperatively, protocols and recovery pathways must be re-examined to ensure patient safety.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"18 ","pages":"Pages 111-116"},"PeriodicalIF":1.4,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000344/pdfft?md5=c48f27da79302838c0f0973babc17679&pid=1-s2.0-S2589845024000344-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140138462","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":"Correlation between research productivity during and after orthopaedic surgery training","authors":"Daniel Acevedo ,&nbsp;Henson Destiné ,&nbsp;Christopher J. Murdock ,&nbsp;Dawn LaPorte ,&nbsp;Amiethab A. Aiyer","doi":"10.1016/j.sopen.2024.02.010","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.02.010","url":null,"abstract":"<div><h3>Background</h3><p>Research experience is mandatory for all Orthopaedic Surgery residency programs. Although the allocation of required protected time and resources varies from program to program, the underlying importance of research remains consistent with mutual benefit to both residents and the program and faculty. Authorship and publications have become the standard metric used to evaluate academic success. This study aimed to determine if there is a correlation between the research productivity of Orthopaedic Surgery trainees and their subsequent research productivity as attending Orthopaedic Surgeons.</p></div><div><h3>Methods</h3><p>Using the University of Mississippi Orthopaedic Residency Program Research Productivity Rank List, 30 different Orthopaedic Surgery Residency Programs were analyzed for the names of every graduating surgeon in their 2013 class. PubMed Central was used to screen all 156 physicians and collect all publications produced by them between 2008 and August 2022. Results were separated into two categories: Publications during training and Publications post-training.</p></div><div><h3>Results</h3><p>As defined above, 156 Surgeons were analyzed for publications during training and post-training. The mean number of publications was 7.02 ± 17.819 post-training vs. 2.47 ± 4.313 during training, <em>P</em> &lt; 0.001. The range of publication post-training was 0–124 vs. 0–30 during training. Pearson correlation between the two groups resulted in a value of 0.654, <em>P</em> &lt; 0.001.</p></div><div><h3>Conclusion</h3><p>Higher research productivity while training correlates to higher productivity post-training, but overall Orthopaedic surgeons produce more research after training than during. With the growing importance of research, more mentorship, time, and resources must be dedicated to research to instill and foster greater participation while in training.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"18 ","pages":"Pages 98-102"},"PeriodicalIF":1.4,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000319/pdfft?md5=b9281ff5ba6df056798fbdcf7f5a1f91&pid=1-s2.0-S2589845024000319-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139992456","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}