American journal of surgery最新文献

{"title":"Family planning impact on medical students’ surgery interest and current policies in the United States: A scoping review","authors":"Sophia Dittrich ,&nbsp;Madeline Ebert ,&nbsp;Grace Elizabeth Lawson ,&nbsp;Kimberly M. Ramonell ,&nbsp;Sophie Dream","doi":"10.1016/j.amjsurg.2024.116086","DOIUrl":"10.1016/j.amjsurg.2024.116086","url":null,"abstract":"<div><h3>Introduction</h3><div>Previous reviews have examined female residents' experiences while ante- and postpartum. However, to our knowledge, no review exists that synthesizes medical students’ perception of family planning during surgical residencies. We wanted to synthesize current literature on the perceptions of family planning of medical students interested in surgical fields and current medical school policies or resources related to family planning.</div></div><div><h3>Methods</h3><div>A scoping review was performed of databases including MEDLINE (OVID), Scopus, and PubMed in April and September of 2023. Studies were excluded if they were conducted outside the US, occurred before 2003, were opinions, reviews, or editorials, included only non-surgical specialties, focused on only attending years or training years after medical school, and only mentioned “work/life balance” or “lifestyle.”</div></div><div><h3>Results</h3><div>2295 studies were identified, and a final 19 studies were included. Four major themes were identified among the studies, including family planning as a barrier to a career in surgery, fertility, onsite childcare, and parental leave. Most studies examined general barriers medical students perceive about surgery and included at least one survey question related to family planning. Only two studies focused solely on medical students’ knowledge of oocyte preservation, one on on-site childcare at medical schools and one on parental leave during medical school.</div></div><div><h3>Conclusion</h3><div>There is a lack of research examining medical students’ knowledge of family planning during a surgical residency and current childbearing policies and resources offered during residency.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"241 ","pages":"Article 116086"},"PeriodicalIF":2.7,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142646766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors and outcomes of cardiac arrest in pediatric traumatic brain injury patients","authors":"Irim Salik ,&nbsp;Sima Vazquez ,&nbsp;Nisha Palla ,&nbsp;Norbert Smietalo ,&nbsp;Richard Wang ,&nbsp;Monica Vavilala ,&nbsp;Jose F. Dominguez ,&nbsp;Iwan Sofjan ,&nbsp;Jared M. Pisapia","doi":"10.1016/j.amjsurg.2024.116087","DOIUrl":"10.1016/j.amjsurg.2024.116087","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac arrest (CA) in pediatric traumatic brain injury (pTBI) is associated with morbidity. Our objective is to investigate the incidence, risk factors, and outcomes for CA following pTBI.</div></div><div><h3>Methods</h3><div>The Kid Inpatient Database (KID) was queried for patients with pTBI. Patients who experienced CA were identified. Demographics, comorbidities, hospital course, and complications were compared between patients who developed CA and who did not. Risk factors for CA were explored using multivariate analysis.</div></div><div><h3>Results</h3><div>CA patients were more likely to have hypertension, hypertrophic cardiomyopathy, and heart defects (p ​&lt; ​0.01). CA was more likely in patients with subdural bleeding, cerebral edema, herniation, coma, or mechanical ventilation (p ​&lt; ​0.001). CA patients had higher odds of vasopressor and transfusions, tracheostomy, percutaneous endoscopic gastrotomy (p ​&lt; ​0.001), and mortality (p ​&lt; ​0.01). Mechanical ventilation, cerebral edema, heart, vasopressor use, and transfusions were associated with CA on multivariate analysis.</div></div><div><h3>Conclusion</h3><div>Risk factors for CA in pTBI patients include severity of injury and underlying cardiovascular abnormalities. CA was associated with morbidity and resource utilization in pTBI patients.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"241 ","pages":"Article 116087"},"PeriodicalIF":2.7,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The criticality of reasonable accommodations: A scoping review revealing gaps in care for patients with blindness and low vision","authors":"Grace Keegan ,&nbsp;John-Ross Rizzo ,&nbsp;Megan A. Morris ,&nbsp;Kathie-Ann Joseph","doi":"10.1016/j.amjsurg.2024.116085","DOIUrl":"10.1016/j.amjsurg.2024.116085","url":null,"abstract":"<div><h3>Background</h3><div>Health and healthcare disparities for surgical patients with blindness and low vision (pBLV) stem from inaccessible healthcare systems that lack universal design principles or, at a minimum, reasonable accommodations (RA).</div></div><div><h3>Objectives</h3><div>We aimed to identify barriers to developing and implementing RAs in the surgical setting and provide a review of best practices for providing RAs.</div></div><div><h3>Methods</h3><div>We conducted a search of PubMed for evidence of reasonable accommodations, or lack thereof, in the surgical setting. Articles related to gaps and barriers to providing RAs for pBLV or best practices for supporting RAs were reviewed for the study.</div></div><div><h3>Results</h3><div>Barriers to the implementation of reasonable accommodations, and, accordingly, best practices for achieving equity for pBLV, relate to policies and systems, staff knowledge and attitudes, and materials and technology.</div></div><div><h3>Conclusions</h3><div>These inequities for pBLV require comprehensive frameworks that offer, maintain, and support education about disability disparities and RAs in the surgical field. Providing RAs for surgical pBLV, and all patients with disabilities is an important and impactful step towards creating a more equitable and anti-ableist health system.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"241 ","pages":"Article 116085"},"PeriodicalIF":2.7,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142646767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re-operation following urgent and emergent colectomies: An investigation of indications and utility as a quality indicator","authors":"Raisa Gao,&nbsp;Kayla Flewelling,&nbsp;Nicholas Stevens,&nbsp;Clayton Wyland,&nbsp;Theresa McGoff,&nbsp;Austin Brubaker,&nbsp;Laurence E. McCahill","doi":"10.1016/j.amjsurg.2024.116081","DOIUrl":"10.1016/j.amjsurg.2024.116081","url":null,"abstract":"<div><h3>Background</h3><div>For urgent and emergent colectomies, return to the operating room is interpreted as a negative quality indicator. We sought to describe indications, procedures performed, and outcomes of patients undergoing reoperation after colectomy.</div></div><div><h3>Methods</h3><div>Retrospective study of patients undergoing urgent and emergent colectomy with re-operation at a single institution from 2013 to 2023. Details of the patients and surgeries indexed.</div></div><div><h3>Results</h3><div>117 patients met the study criteria. Sepsis prior to surgery was noted in 29 ​% of patients, intraoperative vasopressors were used in 80 ​% and 52 ​% were left in gastrointestinal discontinuity. Among re-operations, 60 ​% of patients underwent a “planned second look”, 17 ​% had a supportive procedure, and 23 ​% had an unplanned re-operation, the latter group most reflective of surgical complications.</div></div><div><h3>Conclusion</h3><div>Patients undergoing urgent and emergent colectomies are very ill at presentation. Planned second look and supportive procedures account for most re-operations, suggesting the current utilization of re-operation as a quality indicator is flawed.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"241 ","pages":"Article 116081"},"PeriodicalIF":2.7,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to perioperative palliative care across Veterans Health Administration hospitals: A qualitative evaluation","authors":"Emily E. Evans ,&nbsp;Sarah E. Bradley ,&nbsp;C. Ann Vitous ,&nbsp;Cara Ferguson ,&nbsp;R. Evey Aslanian ,&nbsp;Shukri H.A. Dualeh ,&nbsp;Christina L. Shabet ,&nbsp;M. Andrew Millis ,&nbsp;Pasithorn A. Suwanabol","doi":"10.1016/j.amjsurg.2024.116063","DOIUrl":"10.1016/j.amjsurg.2024.116063","url":null,"abstract":"<div><h3>Background</h3><div>Palliative care remains widely underused for surgical patients, despite a clear benefit for patients with life-limiting illness or nearing the end-of-life.</div></div><div><h3>Methods</h3><div>Interviews exploring end-of-life care among critically-ill surgical patients were conducted with providers from 14 pre-specified Veterans Affairs (VA) hospitals. Data were analyzed iteratively through steps informed by inductive and deductive descriptive content analysis.</div></div><div><h3>Results</h3><div>Six major domains were identified. At the patient and family level, barriers included managing expectations and goal-discordant care. At the provider-level, knowledge of and attitudes towards palliative care and provider role and identity were frequently cited barriers. At the system-level, participants identified institutional resources and culture as significant barriers.</div></div><div><h3>Conclusions</h3><div>While providers recognize the importance of palliative care and end-of-life care, obstacles to its use exist at various levels. Identification of these barriers highlights areas to focus future efforts to improve the quality of palliative and end-of-life care for Veterans.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"241 ","pages":"Article 116063"},"PeriodicalIF":2.7,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impressions of inclusivity within orthopedic surgery: Differences amongst women, minority, and LGBTQIA medical students","authors":"Katherine M. Gerull ,&nbsp;Priyanka Parameswaran ,&nbsp;Ling Chen ,&nbsp;Cara A. Cipriano","doi":"10.1016/j.amjsurg.2024.116051","DOIUrl":"10.1016/j.amjsurg.2024.116051","url":null,"abstract":"<div><h3>Objective</h3><div>To better understand reasons for the underrepresentation of certain groups in orthopedic surgery, we investigated whether there were differences in medical students’ perceptions of inclusivity in orthopedic surgery between (1) men and women, (2) White, Asian and URiM, and (3) LGBTQIA and non-LGBTQIA students.</div></div><div><h3>Design</h3><div>A one-time survey consisting of validated and/or previously used instruments measuring students' sense of belonging in orthopedics, prospective belonging uncertainty (an individual's worry that they will not fit in), stereotype threat (the effect of negative stereotypes on stereotyped group-members), and pluralistic ignorance (erroneously believing your beliefs are different than “typical” group-members).</div></div><div><h3>Setting</h3><div>The survey was distributed at Loyola University, St. Louis University, University of Michigan, and Washington University in St. Louis.</div></div><div><h3>Participants</h3><div>All medical students at these institutions were offered participation, and 441 medical students completed the survey (∼20% response-rate).</div></div><div><h3>Results</h3><div>There was a lower sense of belonging for each of the following groups when compared to their majority-group peers: women (mean difference ​= ​0.5, 95% CI 0.3–0.7, p ​&lt; ​0.001), Asian students (mean difference ​= ​0.4, 95% CI 0.1–0.7, p ​&lt; ​0.001), URiM students (mean difference ​= ​0.4, 95% CI 0.07–0.7, p ​&lt; ​0.001) and LGBTQIA students (mean difference ​= ​0.4, 95% CI 0.07–0.6, p ​= ​0.003). Medical students perceived that orthopedic faculty, residents, and the general public believe that men are better orthopedic surgeons than women, and that White surgeons are better surgeons than non-White surgeons. Women reported less confidence to succeed in orthopedics compared to “typical” peers (mean −0.5, SD 1.3), whereas men felt similar confidence compared to their peers (mean 0.1, SD 1.3; mean difference 0.6, 95% CI 0.4–0.9, p ​&lt; ​0.001).</div></div><div><h3>Conclusions</h3><div>These differences in belonging, prospective belonging uncertainty, stereotype threat, and pluralistic ignorance provide insight into how medical students perceive the inclusivity of orthopedics, which may ultimately play a role in the underrepresentation of minority groups.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"241 ","pages":"Article 116051"},"PeriodicalIF":2.7,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variation in lymph node assessment after pancreatic cancer resection: Patient, surgeon, pathologist, or hospital?","authors":"Muhammad Musaab Munir,&nbsp;Selamawit Woldesenbet,&nbsp;Mujtaba Khalil,&nbsp;Muhammad Muntazir Mehdi Khan,&nbsp;Mary Dillhoff,&nbsp;Timothy M. Pawlik","doi":"10.1016/j.amjsurg.2024.116067","DOIUrl":"10.1016/j.amjsurg.2024.116067","url":null,"abstract":"<div><h3>Background</h3><div>We sought to define individual contributions at the patient, surgeon, pathologist, and hospital levels on lymph node assessment after pancreatic cancer resection.</div></div><div><h3>Methods</h3><div>SEER-Medicare beneficiaries who underwent pancreatic cancer resection were identified. Multi-level multivariable regression was performed to assess the proportion of variance explained by patient, surgeon, pathologist, and hospitals on lymph node assessment (≥12 versus &lt;12).</div></div><div><h3>Results</h3><div>2872 patients underwent pancreaticoduodenectomy by 646 distinct surgeons and 1063 distinct pathologists across 308 hospitals. Patient-related characteristics contributed the most to the variance in adequate lymph node assessment (71.0 ​%). After accounting for all explanatory variables in the full model, 5.5 ​% of the residual provider-level variation was attributed to the pathologist, 35.2 ​% to the surgeon, and 59.3 ​% to the hospital.</div></div><div><h3>Conclusions</h3><div>Patient-to-patient variation was the greatest underlying contributor to variations in adequate lymph node assessment related to pancreatic cancer surgery. Variation among hospitals was greater than among surgeons or pathologists.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"241 ","pages":"Article 116067"},"PeriodicalIF":2.7,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sublobar or lobar resection in early-stage peripheral non-small cell lung cancer less than 2cm: A meta-analysis for randomized controlled trials","authors":"Lei Wang,&nbsp;Jianming Zhou,&nbsp;Shengjie Jing,&nbsp;Bin Liu,&nbsp;Jin Fang,&nbsp;Tao Xue","doi":"10.1016/j.amjsurg.2024.116069","DOIUrl":"10.1016/j.amjsurg.2024.116069","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of our study was to investigate whether sublobar resection is non-inferior to lobar resection in early-stage non-small cell lung cancer less than 2 ​cm.</div></div><div><h3>Methods</h3><div>This is a meta-analysis for randomized controlled trials. Databases including PubMed, Web of Science, EMBASE and Cochrane Central Register were searched up to June 3, 2023. The primary outcome was 5-year survival, and the secondary outcomes were 5-year disease-free survival, cancer-related mortality, recurrence rate, postoperative lung function and perioperative events.</div></div><div><h3>Results</h3><div>A total of 5 studies enrolling 2035 patients were included. Sublobar resection was found to be non-inferior to lobar resection concerning the 5-year survival rate, 5-year disease-free survival rate and cancer-related mortality. However, sublobar resection was associated with higher recurrence rate and less reduction of postoperative lung function.</div></div><div><h3>Conclusions</h3><div>Sublobar resection was non-inferior to lobar resection in terms of survival outcomes and was associated with better postoperative lung function.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"241 ","pages":"Article 116069"},"PeriodicalIF":2.7,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malignancy risk associated with radioactive iodine therapy for Graves’ disease","authors":"Sruthi Ramesh ,&nbsp;Jason C. Fisher ,&nbsp;Paige Curcio ,&nbsp;Gary D. Rothberger ,&nbsp;Jason Prescott ,&nbsp;John Allendorf ,&nbsp;Insoo Suh ,&nbsp;Kepal N. Patel","doi":"10.1016/j.amjsurg.2024.116075","DOIUrl":"10.1016/j.amjsurg.2024.116075","url":null,"abstract":"<div><h3>Background</h3><div>Radioactive iodine therapy (RAI) is a frequently chosen therapy for Graves' disease. The aim of this study was to determine whether RAI for Graves’ disease increases the risk of thyroid malignancy.</div></div><div><h3>Methods</h3><div>A retrospective analysis was performed of all Graves’ disease patients who underwent thyroidectomy at a single institution between 2013 and 2022. Comparative analyses were performed with cohorts based on RAI therapy as the primary grouping variable.</div></div><div><h3>Results</h3><div>413 patients were identified, of which 38 received RAI prior to surgery. RAI treated patients were more likely to undergo surgery for known malignancy or indeterminate nodules. RAI patients were also more likely to have malignancies larger than 1 ​cm. Among RAI treated patients, those who developed malignancy were older at the time of Graves’ diagnosis and received early RAI therapy.</div></div><div><h3>Conclusions</h3><div>Use of RAI for treatment of Graves’ disease increases the progression of thyroid carcinoma, but not the prevalence. Older age and early RAI therapy may be risk factors for malignancy in RAI treated patients.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"241 ","pages":"Article 116075"},"PeriodicalIF":2.7,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variation in commercial prices for thyroidectomy and parathyroidectomy at US hospitals.","authors":"Samuel J Enumah, David C Chang, Nancy L Cho, Carrie E Cunningham, Gerard M Doherty, Matthew A Nehs, Gregory W Randolph, Jason B Liu","doi":"10.1016/j.amjsurg.2024.116072","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2024.116072","url":null,"abstract":"<p><strong>Background: </strong>The 2021 Hospital Price Transparency Rule mandated hospitals to publicly disclose their service prices to improve competition and lower healthcare costs. Our aim was to characterize commercial price variation for thyroidectomy and parathyroidectomy.</p><p><strong>Methods: </strong>We performed a national cross-sectional study of hospital price variation in 2022 and 2023 using the Turquoise Health dataset. Our main outcomes were within- and across-hospital 90th-to-10th percentile commercial price ratios and a high commercial-to-Medicare (1.5) price ratio. We performed logistic regressions to identify hospital factors associated with a high commercial-to-Medicare price ratio.</p><p><strong>Results: </strong>For 16,794 unique commercial rates across 564 facilities, within-hospital price ratios ranged from 2.0 to 2.4, and across-hospital price ratios ranged from 2.7 to 4.1. High market concentration and five-star hospital rating were associated with high commercial-to-Medicare price ratios compared to low market concentration and three-star hospital rating, respectively.</p><p><strong>Conclusions: </strong>Notable variation exists within and across hospitals signaling facilities have negotiated different payments from insurance companies for the same service. Quality may be a modifiable factor to increase hospital revenue and improve care for patients.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"241 ","pages":"116072"},"PeriodicalIF":2.7,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142674914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}