American journal of surgery最新文献

Emeritus Board

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-04-12 DOI: 10.1016/j.amjsurg.2025.116325

引用次数: 0

Angioembolization within 60 minutes for exsanguinating trauma patients: A meaningful metric with a definition gap

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-04-08 DOI: 10.1016/j.amjsurg.2025.116338

Zihan Gao , Nam Yong Cho , Aricia Shen , Nicholas Siena , Troy N. Coaston , Amulya Vadlakonda , Peyman Benharash , Galinos Barmparas , the Academic Trauma Research Consortium (ATRIUM)

{"title":"Angioembolization within 60 minutes for exsanguinating trauma patients: A meaningful metric with a definition gap","authors":"Zihan Gao , Nam Yong Cho , Aricia Shen , Nicholas Siena , Troy N. Coaston , Amulya Vadlakonda , Peyman Benharash , Galinos Barmparas , the Academic Trauma Research Consortium (ATRIUM)","doi":"10.1016/j.amjsurg.2025.116338","DOIUrl":"10.1016/j.amjsurg.2025.116338","url":null,"abstract":"<div><h3>Background</h3><div>Standards on the time from the decision to deploy interventional radiology (IR) to its initiation was recently changed from 30 to 60 min, though supporting evidence remains unclear. We aimed to identify the association of IR timing standard compliance with outcomes among trauma patients.</div></div><div><h3>Methods</h3><div>This study examined adult trauma patients (≥16 years) requiring angioembolization, stratified by IR initiation within 60 min of emergency department discharge (IR60) and beyond. Multivariable regressions were used to evaluate associations of IR timing with clinical and financial outcomes. Variation attributable to hospital-level factors was also determined using multi-level models.</div></div><div><h3>Results</h3><div>The study included 2793 patients, of which 38.3 % were IR60. All risk-adjusted outcomes were similar between the two cohorts. Additionally, notable variation in the proportion of IR60 was attributable to hospital-level factors.</div></div><div><h3>Conclusion</h3><div>Similar clinical outcomes between IR60 and non-IR60 question the validity of the current timing requirement for angioembolization in trauma patients.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"244 ","pages":"Article 116338"},"PeriodicalIF":2.7,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143828183","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}

引用次数: 0

Predictive factors for disseminated intravascular coagulation following colorectal perforation

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-04-04 DOI: 10.1016/j.amjsurg.2025.116335

Toshimichi Kobayashi, Eiji Hidaka, Shoma Iida, Kanami Iwama, Takumi Seichi, Yoshihiro Nagae, Hiroyuki Higuchi, Itsuki Koganezawa, Masashi Nakagawa, Kei Yokozuka, Shigeto Ochiai, Takahiro Gunji, Toru Sano, Koichi Tomita, Satoshi Tabuchi, Naokazu Chiba, Shigeyuki Kawachi

{"title":"Predictive factors for disseminated intravascular coagulation following colorectal perforation","authors":"Toshimichi Kobayashi, Eiji Hidaka, Shoma Iida, Kanami Iwama, Takumi Seichi, Yoshihiro Nagae, Hiroyuki Higuchi, Itsuki Koganezawa, Masashi Nakagawa, Kei Yokozuka, Shigeto Ochiai, Takahiro Gunji, Toru Sano, Koichi Tomita, Satoshi Tabuchi, Naokazu Chiba, Shigeyuki Kawachi","doi":"10.1016/j.amjsurg.2025.116335","DOIUrl":"10.1016/j.amjsurg.2025.116335","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine the relationship between postoperative disseminated intravascular coagulation (DIC) and patient prognosis after surgery for colorectal perforation and to identify preoperative predictive factors for DIC.</div></div><div><h3>Methods</h3><div>We included 112 patients who underwent emergency surgery for colorectal perforation between April 2014 and September 2023. We performed a Kaplan–Meier analysis to assess 30-day postoperative survival with and without postoperative DIC, log-rank test to compare survival curves, and logistic regression analysis to identify preoperative predictive factors for postoperative DIC.</div></div><div><h3>Results</h3><div>The postoperative DIC and 30-day mortality rates were 37.5 % and 8 %, respectively. The 30-day postoperative mortality rates significantly differed between patients with postoperative DIC and those without (16.7 % vs. 2.9 %). The preoperative Sequential Organ Failure Assessment (SOFA) score was an independent predictive factor for postoperative DIC.</div></div><div><h3>Conclusion</h3><div>Evaluating preoperative SOFA scores may help assess postoperative DIC risk and enable early initiation of anticoagulant therapy in patients undergoing surgery for colorectal perforation.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"244 ","pages":"Article 116335"},"PeriodicalIF":2.7,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143808066","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}

引用次数: 0

Time to definitive treatment in rectal cancer care coordination

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-04-02 DOI: 10.1016/j.amjsurg.2025.116333

Alexis L. Woods , Axenya Kachen , Rebeka A. Dejenie , Sean M. Flynn , Robert J. Kucejko , Erik R. Noren , Ankit Sarin , Miquell Miller

{"title":"Time to definitive treatment in rectal cancer care coordination","authors":"Alexis L. Woods , Axenya Kachen , Rebeka A. Dejenie , Sean M. Flynn , Robert J. Kucejko , Erik R. Noren , Ankit Sarin , Miquell Miller","doi":"10.1016/j.amjsurg.2025.116333","DOIUrl":"10.1016/j.amjsurg.2025.116333","url":null,"abstract":"<div><h3>Introduction</h3><div>Timely initiation of rectal cancer treatment improves outcomes, and standard of care is to receive definitive treatment within 60 days of diagnosis.</div></div><div><h3>Methods</h3><div>A retrospective review of rectal cancer patients (2013–2023) at a tertiary cancer center was performed. Statistical analysis was conducted on patients stratified to time-to-treatment within 60 days and patient sociodemographics.</div></div><div><h3>Results</h3><div>182/342 (53.2 %) rectal cancer patients had time-to-treatment ≤60 days. Unified care was significantly faster than fragmented care (57.5 vs 77.4 days, p = 0.002). Factors associated with time-to-treatment >60 days: sex (p = 0.03), age (p = 0.004), insurance (p = 0.006), Healthy Places Index quintile (p = 0.02), distance from hospital (p = 0.01). Multivariable analysis associated delays with females (OR 1.74 [95 % CI 1.05–2.91],p = 0.03), and living >60 miles from the hospital (60–100 miles OR 2.49 [95 % CI 1.09–5.85],p = 0.03; >100 miles OR 2.87 [95 % CI 1.05–8.25],p = 0.04).</div></div><div><h3>Conclusion</h3><div>In this study, 46.8 % of rectal cancer patients initiated definitive treatment >60 days from diagnosis. Unified care improved time-to-treatment. Female sex and living >60 miles from the hospital were associated with delays.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"248 ","pages":"Article 116333"},"PeriodicalIF":2.7,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143785853","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}

引用次数: 0

The impact of Area Deprivation Index (ADI) in abdominal wall reconstruction (AWR)

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-04-02 DOI: 10.1016/j.amjsurg.2025.116331

Alexis M. Holland, Stephanie M. Jensen, William R. Lorenz, Ansley B. Ricker, Alynna J. Wiley, Caroline E. Holland, Gregory T. Scarola, Brittany S. Mead, Sullivan A. Ayuso, Vedra A. Augenstein, B. Todd Heniford

{"title":"The impact of Area Deprivation Index (ADI) in abdominal wall reconstruction (AWR)","authors":"Alexis M. Holland, Stephanie M. Jensen, William R. Lorenz, Ansley B. Ricker, Alynna J. Wiley, Caroline E. Holland, Gregory T. Scarola, Brittany S. Mead, Sullivan A. Ayuso, Vedra A. Augenstein, B. Todd Heniford","doi":"10.1016/j.amjsurg.2025.116331","DOIUrl":"10.1016/j.amjsurg.2025.116331","url":null,"abstract":"<div><h3>Background</h3><div>The Area Deprivation Index(ADI) is a validated measure of socioeconomic status(SES) with a higher percentile indicating lower SES. This study evaluated the impact of ADI on elective abdominal wall reconstruction(AWR).</div></div><div><h3>Methods</h3><div>A prospective database was queried for open AWR patients from 1/2017-12/2023. ADI was determined for each patient. An optimal cut-point analysis utilizing Youden's J determined the ADI threshold for wound complications as a primary outcome. Patients were stratified by ADI ≥62 or <62.</div></div><div><h3>Results</h3><div>Of 722 AWR patients, 362 had ADI≥62(average:79.0 ± 10.6) and 360 had ADI<62(average:39.3 ± 15.2). There was no difference in sex or age, but ADI≥62 had more Black patients(16.3 %vs.10.3 %;<em>p</em> = 0.046), less private insurance(40.9 %vs.45.8 %;<em>p</em> = 0.046), higher BMI(31.9 ± 6.9vs.30.0 ± 5.6 kg/m<sup>2</sup>;<em>p</em> < 0.001), COPD(8.3 %vs.4.4 % <em>p</em> = 0.035), diabetes(29.0 %vs.17.2 %;<em>p</em> < 0.001), ASA-III(61.9 %vs.55.0 %;<em>p</em> = 0.029), recurrent hernias(62.4 %vs.51.7 %;<em>p</em> = 0.003), and dirty cases(14.4 %vs.7.8 %;<em>p</em> = 0.004). Postoperative complications, readmissions, and reoperations were not statistically different. ADI was not predictive of wound complications on multivariable regression.</div></div><div><h3>Conclusion</h3><div>Despite increased disadvantage, comorbidity, and surgical complexity, patients of worse ADI had equal postoperative outcomes.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"244 ","pages":"Article 116331"},"PeriodicalIF":2.7,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143783680","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}

引用次数: 0

How does drug abuse affect outcomes after trauma? A trauma quality improvement program study

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-04-01 DOI: 10.1016/j.amjsurg.2025.116332

Aryan Rafieezadeh, Kartik Prabhakaran, Jordan Kirsch, Anna Jose, Bardiya Zangbar

{"title":"How does drug abuse affect outcomes after trauma? A trauma quality improvement program study","authors":"Aryan Rafieezadeh, Kartik Prabhakaran, Jordan Kirsch, Anna Jose, Bardiya Zangbar","doi":"10.1016/j.amjsurg.2025.116332","DOIUrl":"10.1016/j.amjsurg.2025.116332","url":null,"abstract":"<div><h3>Background</h3><div>The protective effects of drug abuse on ICU admissions and ventilator weaning after trauma are debated. This study examines the impact of drug abuse on mortality, ICU admissions, and complications.</div></div><div><h3>Methods</h3><div>Trauma patients ≥16 years from the TQIP database (2020–2022) with admission toxicology testing (TOX) were analyzed. The primary outcome was mortality; secondary outcomes included in-hospital complications.</div></div><div><h3>Results</h3><div>Among 861,450 patients, decreased mortality odds were noted with cannabinoid (OR = 0.842), amphetamine (OR = 0.800), cocaine (OR = 0.851), opioid (OR = 0.625), and benzodiazepine (OR = 0.843) (P < 0.001). Reduced ICU admission odds were linked to opioid (OR = 0.882), barbiturate (OR = 0.824), oxycodone (OR = 0.829), ecstasy (OR = 0.811), and methadone (OR = 0.809). Lower intubation odds were seen with opioid (OR = 0.663), barbiturate (OR = 0.733), oxycodone (OR = 0.754), and ecstasy (OR = 0.627). Methamphetamine (OR = 0.682) was associated with reduced ARDS odds.</div></div><div><h3>Conclusions</h3><div>Recreational drugs may independently reduce ICU admissions, intubation, and mortality, warranting further investigation.</div></div><div><h3>Level of evidence</h3><div>Level III retrospective study.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"244 ","pages":"Article 116332"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143817302","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}

引用次数: 0

Initial report of “HERNIACLINIC-QoL”: The first abdominal wall hernia surgery registry from a single center in Brazil

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-04-01 DOI: 10.1016/j.amjsurg.2025.116329

Paulo H F Barros , Iron P Abreu Neto , Bruno L Hernani

{"title":"Initial report of “HERNIACLINIC-QoL”: The first abdominal wall hernia surgery registry from a single center in Brazil","authors":"Paulo H F Barros , Iron P Abreu Neto , Bruno L Hernani","doi":"10.1016/j.amjsurg.2025.116329","DOIUrl":"10.1016/j.amjsurg.2025.116329","url":null,"abstract":"<div><h3>Purpose</h3><div>Currently, Brazil does not have a registry of abdominal wall hernia surgeries. In this paper we describe the creation of HERNIACLINIC-QoL, that aims to fill this gap, and its preliminary results.</div></div><div><h3>Methods</h3><div>A RedCap form was developed to collect data on patients and surgeries for abdominal hernia repair in a private practice hospital. Data input errors were checked every 30 days, and a preliminary analysis of the database as a whole was carried out in 2024.</div></div><div><h3>Results</h3><div>We registered 554 patients (201 ventral, 227 inguinal and 103 for both hernias). The form needed corrections in the fields: preoperative data, hernia sizes and classifications, rectum diastasis and anesthesia type, ensuring completeness of data and simplifying the creation of statistical reports.</div></div><div><h3>Conclusion</h3><div>HERNIACLINIC-QoL may become a valuable tool for hernia care and research, as its use is expanded to include more surgeons and more patients.</div></div><div><h3>Clinical Trials</h3><div>Protocol Register at Brazilian Registry of Clinical Trials (ReBEC), ID: RBR-5vmhdfs <span><span>https://ensaiosclinicos.gov.br/rg/RBR-5vmhdfs</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"244 ","pages":"Article 116329"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143817301","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}

引用次数: 0

Identification of predictors for complicated acute appendicitis: A retrospective cohort study from a high-volume hospital

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-03-30 DOI: 10.1016/j.amjsurg.2025.116321

Rui Li , Xu Sun , Zhiyuan Yu , Na Liu , Peiyu Li , Xudong Zhao

{"title":"Identification of predictors for complicated acute appendicitis: A retrospective cohort study from a high-volume hospital","authors":"Rui Li , Xu Sun , Zhiyuan Yu , Na Liu , Peiyu Li , Xudong Zhao","doi":"10.1016/j.amjsurg.2025.116321","DOIUrl":"10.1016/j.amjsurg.2025.116321","url":null,"abstract":"<div><h3>Background</h3><div>Acute appendicitis (AA) is the most prevalent cause of acute abdominal pain, with an incidence rate ranging from 96.5 to 100 per 100,000 adults. The rapid and accurate identification of the type and risk level of AA continues to pose a significant challenge. We aimed to develop a model for preoperative differentiation between complicated and uncomplicated AA.</div></div><div><h3>Methods</h3><div>In this retrospective study, 1196 AA patients were selected. The preoperative and postoperative clinicopathological characteristics were analyzed retrospectively. Both univariate analysis and multivariate analyses were conducted using binary logistic regression to identify the predictive factor associated with complicated AA.</div></div><div><h3>Results</h3><div>Among a total of 1196 AA patients, 465 (38.9 %) were identified as having complicated AA. Approximately 10 % of AA patients experienced postoperative complications. Multivariate logistic regression analysis indicated that several factors were associated with an increased risk of complicated AA, including male (P < 0.001, OR = 2.178), age (P < 0.001, OR = 1.028), days of abdominal pain before operation = 3 (P < 0.001, OR = 3.616), days of abdominal pain before operation = 4 (P < 0.001, OR = 7.528), temperature (P < 0.001, OR = 2.121), abdominal tension (P < 0.001, OR = 2.242), neutrophil (P < 0.001, OR = 1.053), fluid accumulates around the appendix (P = 0.002, OR = 2.010), appendiceal fecalith (P < 0.001, OR = 2.122), and the diameter of the appendix (P = 0.002, OR = 1.083).</div></div><div><h3>Conclusions</h3><div>The results of this study significantly advance the understanding of preoperative differentiation between complicated and uncomplicated AA. The predictive nomogram offers a valuable tool for clinicians, enhancing decision-making and improving patient outcomes.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"244 ","pages":"Article 116321"},"PeriodicalIF":2.7,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768507","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}

引用次数: 0

Race and sex disparities in resource use and outcomes after acute type A aortic dissection repair

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-03-27 DOI: 10.1016/j.amjsurg.2025.116323

Carlos E. Diaz-Castrillon , Derek Serna-Gallegos , Shwetabh Tarun , Nidhi Iyanna , Sarah Yousef , Julie Phillippi , Jianhui Zhu , Ibrahim Sultan

{"title":"Race and sex disparities in resource use and outcomes after acute type A aortic dissection repair","authors":"Carlos E. Diaz-Castrillon , Derek Serna-Gallegos , Shwetabh Tarun , Nidhi Iyanna , Sarah Yousef , Julie Phillippi , Jianhui Zhu , Ibrahim Sultan","doi":"10.1016/j.amjsurg.2025.116323","DOIUrl":"10.1016/j.amjsurg.2025.116323","url":null,"abstract":"<div><h3>Objective</h3><div>Evaluate race-sex-based disparities following acute type A aortic dissection (ATAAD) repair.</div></div><div><h3>Methods</h3><div>retrospective cohort study (2010–2021) conducted at a high-volume referral aortic center. Multivariable regression models were used to assess race- and sex-stratified differences in mortality and resource utilization.</div></div><div><h3>Results</h3><div>Women presented at significantly older ages than men within both racial groups (White: 68 vs. 61 years, p < 0.001; Black: 58.5 vs. 49 years, p = 0.002). Black women had the highest comorbidity burden, with 53 % having ≥3 comorbidities. They also required more intraoperative blood transfusions and had the longest postoperative hospital stays, while White women were more likely to need prolonged mechanical ventilation. In-hospital mortality did not differ significantly by sex/race, but Black patients experienced worse long-term survival, independent of sex.</div></div><div><h3>Conclusion</h3><div>Significant race- and sex-based disparities exist in perioperative care following ATAAD repair. Further research on social determinants of health is needed to understand patient interactions with surgical care.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"244 ","pages":"Article 116323"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143808065","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}

引用次数: 0

Association between surgeon age and surgical complications: A systematic review and meta-analysis

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-03-26 DOI: 10.1016/j.amjsurg.2025.116316

Baudolino Mussa , Barbara Defrancisco , Piero Petracco

引用次数: 0