American journal of surgery最新文献

The bidirectional interplay between gut dysbiosis and surgical complications: A systematic review 肠道生态失调与手术并发症之间的双向相互作用：一项系统综述

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-05-02 DOI: 10.1016/j.amjsurg.2025.116369

Lindsey Nichols , Omar El-Kholy , Ahmed Adham R. Elsayed , Marc D. Basson

{"title":"The bidirectional interplay between gut dysbiosis and surgical complications: A systematic review","authors":"Lindsey Nichols , Omar El-Kholy , Ahmed Adham R. Elsayed , Marc D. Basson","doi":"10.1016/j.amjsurg.2025.116369","DOIUrl":"10.1016/j.amjsurg.2025.116369","url":null,"abstract":"<div><h3>Background</h3><div>The gut microbiome critically influences diverse aspects of physiology and surgical recovery. Conversely, surgery alters the microbiome, potentially predisposing to complications. We aimed to clarify the bidirectional interaction between surgery and gut dysbiosis.</div></div><div><h3>Methods</h3><div>On December 22nd, 2024, a systematic search of the Cochrane Library, PubMed, VHL, and WOS was completed. Relevant studies were assessed for risk of bias using STROBE and CONSORT guidelines.</div></div><div><h3>Results</h3><div>Thirty studies, with 2500+ participants experiencing diverse procedures and complications, were incorporated. Although specifics varied, dysbiosis correlated with surgery and its complications. Patients with complications had more harmful bacteria and fewer beneficial bacteria. In some studies, probiotics reduced complications.</div></div><div><h3>Conclusion</h3><div>Gut dysbiosis is tied to postoperative complications in a complex, bidirectional relationship. Patients with surgical complications may have fewer beneficial and more pathogenic bacteria both before and after surgery. Early identification of dysbiosis and probiotic administration could predict or even reduce postoperative complications.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"245 ","pages":"Article 116369"},"PeriodicalIF":2.7,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143918385","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

Falls among older adults: An exploration of trends, clinical outcomes, predisposing risk factors, and intervention strategies 老年人跌倒：趋势、临床结果、易感危险因素和干预策略的探索

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-04-30 DOI: 10.1016/j.amjsurg.2025.116385

Sanjan Kumar , Francis Cruz , Zackary Yates , Quratulain Amin , Muhammad Usman Awan , Philip Lee , Sarthak Kumar , Adel Elkbuli

{"title":"Falls among older adults: An exploration of trends, clinical outcomes, predisposing risk factors, and intervention strategies","authors":"Sanjan Kumar , Francis Cruz , Zackary Yates , Quratulain Amin , Muhammad Usman Awan , Philip Lee , Sarthak Kumar , Adel Elkbuli","doi":"10.1016/j.amjsurg.2025.116385","DOIUrl":"10.1016/j.amjsurg.2025.116385","url":null,"abstract":"<div><h3>Background</h3><div>The aim of this study is to evaluate fall trends, risk factors, and interventions aimed at reducing falls in older adult trauma patients in the healthcare & community settings in the United States.</div></div><div><h3>Methods</h3><div>A review was conducted utilizing PubMed, ProQuest, Cochrane, and Google Scholar search databases to identify relevant articles published prior to July 7, 2024. Studies were included if they assessed falls among the older adult population aged 55 years and older.</div></div><div><h3>Results</h3><div>A total of 29 studies assessed met the inclusion criteria. Despite decreasing fall incidence in the community and hospital setting, fall-associated injuries, hospitalizations, and mortality in older adults have increased. Common predisposing factors for falls among older adults in the community and healthcare settings include advanced age, history of falls, recent hospitalization, and comorbid conditions affecting cognition, gait, and visual acuity. Interventions including strengthening exercise programs and individualized multifactorial plans reduced falls and fall-associated injuries in most studies.</div></div><div><h3>Conclusion</h3><div>Recent years demonstrated an increase in fall-associated injuries, hospitalizations, and mortality which underscores the urgent need for targeted multifactorial interventions.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"245 ","pages":"Article 116385"},"PeriodicalIF":2.7,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143918384","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

Addressing racism as a driver of racial disparities in surgical literature: A scoping review 将种族主义作为外科文献中种族差异的驱动因素：范围审查

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-04-29 DOI: 10.1016/j.amjsurg.2025.116370

Amani Sampson , Jasmine Pesante , Joanelle A. Bailey

{"title":"Addressing racism as a driver of racial disparities in surgical literature: A scoping review","authors":"Amani Sampson , Jasmine Pesante , Joanelle A. Bailey","doi":"10.1016/j.amjsurg.2025.116370","DOIUrl":"10.1016/j.amjsurg.2025.116370","url":null,"abstract":"<div><div>Since 2020, recognition of racism as a driver of health disparities has increased, yet the surgical literature lags in explicitly addressing its impact, limiting opportunities for advancing health equity. We conducted a scoping review of five high-impact U.S.-based general surgical journals using Google Scholar's H5-index, searching for original studies explicitly linking racism to surgical outcomes with the terms “racism,” “surgery,” and “surgical.” Of 67 publications, 15 met inclusion criteria.</div><div>Across studies, structural racism was consistently identified as a driver of advanced disease presentation and worse outcomes for Black patients. Surgical Oncology was the most studied field, with studies primarily addressing breast and colorectal cancer; Acute Care Surgery was the second most-studied. Several studies used geospatial analyses to reveal the lasting effects of historical redlining on surgical outcomes. Despite these findings, explicit investigations remain limited. Expanding research that examines racism within surgical practice and identifying ways to counteract its effects is essential to achieving meaningful health equity.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"245 ","pages":"Article 116370"},"PeriodicalIF":2.7,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143924347","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

Surgery clerkships & general surgery careers: A systematic review 外科办事员与普通外科职业：系统回顾

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-04-29 DOI: 10.1016/j.amjsurg.2025.116340

Sanidhya Singh , Maedeh Marzoughi , Danika E. Meldrum , Caleb Ernst , Fotovat-Ahmadi Navid , Kareem Sharabi , R. Evey Aslanian , Serena S. Bidwell , Mark P. MacEachern , Sarah E. Bradley , Pasithorn A. Suwanabol

{"title":"Surgery clerkships & general surgery careers: A systematic review","authors":"Sanidhya Singh , Maedeh Marzoughi , Danika E. Meldrum , Caleb Ernst , Fotovat-Ahmadi Navid , Kareem Sharabi , R. Evey Aslanian , Serena S. Bidwell , Mark P. MacEachern , Sarah E. Bradley , Pasithorn A. Suwanabol","doi":"10.1016/j.amjsurg.2025.116340","DOIUrl":"10.1016/j.amjsurg.2025.116340","url":null,"abstract":"<div><h3>Introduction</h3><div>By 2050, the U.S. is projected to face a critical shortage of surgeons, with general surgery experiencing the most significant shortfall. Medical student clerkship experiences play a crucial role in sustaining interest in surgical careers, making them a key area for intervention.</div></div><div><h3>Methods</h3><div>This study provides a comprehensive review of the current literature on the attributes of general surgery clerkships that influence students’ decisions to pursue a career in general surgery.</div></div><div><h3>Results</h3><div>Using the Social Ecological Model (SEM), we identify clerkship factors and facilitators and barriers to student interest in general surgery careers at the individual, interpersonal, environmental, community, and policy level.</div></div><div><h3>Conclusion</h3><div>Our findings suggest that targeted interventions - such as supporting students underrepresented in surgery, enhancing the quality of clerkships, and improving perceptions of the surgical lifestyle and culture - could increase interest in the field and address the impending surgeon shortage.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"245 ","pages":"Article 116340"},"PeriodicalIF":2.7,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143924348","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

Clinical utility of intraoperative wedge biopsies after preoperative core needle biopsies in biliary atresia 胆道闭锁术前核心针活检后术中楔形活检的临床应用

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-04-28 DOI: 10.1016/j.amjsurg.2025.116367

Christopher Nemeh , Nicholas Schmoke , Yeu Sanz Wu , Pengchen Wang , Stephen M. Lagana , Helen Remotti , Mercedes Martinez , Pooja Reddy Spector , Robert A. Cowles , Angela Kadenhe-Chiweshe , Paul Kurlansky , Vincent Duron , Steven Stylianos

{"title":"Clinical utility of intraoperative wedge biopsies after preoperative core needle biopsies in biliary atresia","authors":"Christopher Nemeh , Nicholas Schmoke , Yeu Sanz Wu , Pengchen Wang , Stephen M. Lagana , Helen Remotti , Mercedes Martinez , Pooja Reddy Spector , Robert A. Cowles , Angela Kadenhe-Chiweshe , Paul Kurlansky , Vincent Duron , Steven Stylianos","doi":"10.1016/j.amjsurg.2025.116367","DOIUrl":"10.1016/j.amjsurg.2025.116367","url":null,"abstract":"<div><div>Pediatric surgeons often obtain intraoperative liver wedge biopsies during Kasai portoenterostomy for biliary atresia despite an existing preoperative core needle biopsy. We conducted a single-institution retrospective review analyzing preoperative factors, Batts-Ludwig fibrosis stage (preoperative percutaneous core needle and intraoperative wedge biopsies), and survival with native liver from 2004 to 2023. Of 116 patients, 87 underwent both preoperative and intraoperative biopsies, with discordant results observed in 30/87 (34.5 %) patients. Of the discordant samples, intraoperative wedge biopsies upstaged the Batts-Ludwig scoring system in 97 % of biopsies. Neither the core needle (p = 0.80) nor wedge (p = 0.18) fibrosis stage correlated with native liver survival at one year. Age at surgery (58 vs. 63 days, p = 0.04), aspartate transferase (145 vs. 195 U/L, p = 0.05), and alanine transferase (108 vs. 143 U/L, p = 0.03) demonstrated associations with native liver survival at one year. Our data suggests that routine intraoperative wedge biopsies may not be necessary after preoperative core biopsies.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"245 ","pages":"Article 116367"},"PeriodicalIF":2.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143898561","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

Addressing disparities in telehealth access for children on the Southside of Chicago 解决芝加哥南部儿童远程医疗服务的差距问题

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-04-28 DOI: 10.1016/j.amjsurg.2025.116366

Joy Ayemoba , Karen Schaller , Rachel Nordgren , Kathleen Webster , Carmelle Romain

{"title":"Addressing disparities in telehealth access for children on the Southside of Chicago","authors":"Joy Ayemoba , Karen Schaller , Rachel Nordgren , Kathleen Webster , Carmelle Romain","doi":"10.1016/j.amjsurg.2025.116366","DOIUrl":"10.1016/j.amjsurg.2025.116366","url":null,"abstract":"<div><h3>Background</h3><div>Rapid implementation of telehealth exacerbated the digital divide, creating uneven distribution in access, use, or impact of communication technologies among distinct groups. Our aim was to identify factors impacting access to telehealth in a pediatric specialty clinic.</div></div><div><h3>Methods</h3><div>This retrospective cohort study used survey methods and electronic health record (EHR) data to examine telehealth access during the COVID-19 pandemic in the South Side of Chicago.</div></div><div><h3>Results</h3><div>Of 193 patient encounters reviewed, 127 met inclusion criteria. 42 parent surveys were completed, with 36 completed visits. No shows included a higher proportion of Hispanic and non-English speaking patients from areas with lower median income.</div><div>Our parent questionnaire showed association of no-show rates with lower caregiver education (p = 0.005), non-English speaking (p = 0.015), difficulty accessing internet (p = 0.011), and only smartphone internet access (p = 0.002).</div></div><div><h3>Discussion/conclusion</h3><div>Completion of telehealth visits was impacted by ethnicity, education, and digital access. Future work is needed to address these areas.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"245 ","pages":"Article 116366"},"PeriodicalIF":2.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143924346","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

Preoperative prediction of postoperative pancreatic fistula after Pancreaticoduodenectomy: Determination and validation of a cut-off value for the Roberts Score 胰十二指肠切除术后胰瘘的术前预测：罗伯茨评分临界值的确定和验证

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-04-25 DOI: 10.1016/j.amjsurg.2025.116356

Johannes D. Kaiser, Franziska Bräuherr, Esther A. Biesel, Sophia Chikhladze, Stefan Fichtner-Feigl, Dietrich A. Ruess , Uwe A. Wittel

{"title":"Preoperative prediction of postoperative pancreatic fistula after Pancreaticoduodenectomy: Determination and validation of a cut-off value for the Roberts Score","authors":"Johannes D. Kaiser, Franziska Bräuherr, Esther A. Biesel, Sophia Chikhladze, Stefan Fichtner-Feigl, Dietrich A. Ruess , Uwe A. Wittel","doi":"10.1016/j.amjsurg.2025.116356","DOIUrl":"10.1016/j.amjsurg.2025.116356","url":null,"abstract":"<div><h3>Background</h3><div>POPF after pancreaticoduodenectomy can be life-threatening. For risk stratification, prediction could be key. The aim of this study is to determine and validate a cut-off value for the Roberts Score, which is one of the few purely preoperative multicenter validated predictive models for POPF.</div></div><div><h3>Methods</h3><div>582 patients were included. The Youden index determined a cut-off in the exploratory cohort (n = 466). The validation cohort's (n = 116) ability to predict CR-POPF was tested using univariate and multivariate regression analysis.</div></div><div><h3>Results</h3><div>AUC of Roberts Score for the exploration cohort was 0.768. The identified cut-off of 0.268 was confirmed in the validation cohort (p < 0.001). Higher scores were significantly associated with longer time to drain removal and ICU stay. Multiple logistic regression showed the cut-off as an independent predictor of CR-POPF (p = 0.038).</div></div><div><h3>Conclusion</h3><div>The scoring variables and the cut-off itself were both independent predictors, which may improve the identification of high-risk patients and help to investigate the development of POPF.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"245 ","pages":"Article 116356"},"PeriodicalIF":2.7,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143901882","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

Revisional Roux-en-Y gastric bypass after gastric banding leads to sustainable and significant additional weight loss regardless of Roux limb length 胃束带术后复查Roux-en- y胃旁路术，无论Roux肢体长度如何，均可导致持续且显著的额外体重减轻

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-04-23 DOI: 10.1016/j.amjsurg.2025.116359

Julian Süsstrunk , Liv Zingg , Thomas Köstler , Alexander Wilhelm , Ioannis I. Lazaridis , Tarik Delko , Urs Zingg

{"title":"Revisional Roux-en-Y gastric bypass after gastric banding leads to sustainable and significant additional weight loss regardless of Roux limb length","authors":"Julian Süsstrunk , Liv Zingg , Thomas Köstler , Alexander Wilhelm , Ioannis I. Lazaridis , Tarik Delko , Urs Zingg","doi":"10.1016/j.amjsurg.2025.116359","DOIUrl":"10.1016/j.amjsurg.2025.116359","url":null,"abstract":"<div><h3>Introduction</h3><div>The aim of this study is to compare the outcomes between patients undergoing very-very long limb RYGB (VVLL-RYGB) and proximal RYGB (PRYGB) after adjustable gastric banding (LAGB).</div></div><div><h3>Methods</h3><div>All patients undergoing conversion from LAGB to RYGB in a bariatric reference center between 2010 and 2016 were analyzed.</div></div><div><h3>Results</h3><div>Sixty-six patients (80 % female, mean age 44.5 ± 9 years, pre-revisional BMI 40.2 ± 7.4 kg/m2) underwent conversion from LAGB to VVLL-RYGB, and 26 patients (88 % female, mean age 46.9 ± 7.6 years, pre-revisional BMI 37.2 ± 5.3 kg/m2) to PRYGB. ΔBMI 5 years after conversion was 8.2 ± 6.1 kg/m2 in VVLL-RYGB compared to 6.7 ± 5.1 kg/m2 in PRYGB (p = 0.35). There was no significant difference in long-term morbidity. Further revisional procedures after VVLL-RYGB occurred in 10 (15.1 %) and 8 (30.8 %) after PRYGB (p = 0.136).</div></div><div><h3>Conclusion</h3><div>VVLL-RYGB and PRYGB after LAGB are safe and lead to significant and sustainable additional weight loss without difference in BMI loss between the procedures after 5 years.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"245 ","pages":"Article 116359"},"PeriodicalIF":2.7,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912909","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

Navigating the Whipple procedure patient educational materials: A readability and understandability analysis 惠普尔手术患者教育材料的导航：可读性和可理解性分析

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-04-23 DOI: 10.1016/j.amjsurg.2025.116353

Gabriela Rangel Brandao , Cristina Ponce , Manuel Castillo-Angeles , Tara Sotsky Kent

{"title":"Navigating the Whipple procedure patient educational materials: A readability and understandability analysis","authors":"Gabriela Rangel Brandao , Cristina Ponce , Manuel Castillo-Angeles , Tara Sotsky Kent","doi":"10.1016/j.amjsurg.2025.116353","DOIUrl":"10.1016/j.amjsurg.2025.116353","url":null,"abstract":"<div><h3>Objective</h3><div>Pancreatoduodenectomy (PD) is a complex surgical procedure that is challenging to understand. We aimed to assess the readability, understandability, and actionability of online patient-directed materials for PD.</div></div><div><h3>Methods</h3><div>We evaluated online patient-focused educational materials about PD. Through the Leapfrog ratings for “Pancreatic Resection for Cancer” we classified high-volume (HV) and low-volume (LV) hospitals. Readability was measured using multiple tools. Understandability and actionability were measured using the Patient Education Materials Assessment Tool for Printable materials (PEMAT-P). As an external control source of comparison, we analyzed the patient materials from three patient-focused organizations.</div></div><div><h3>Results</h3><div>Out of 550 HV hospitals, 10 % had any online patient educational material about PD. Readability was at a median grade level of 12 (IQR 4). All exceeded the recommended sixth-grade readability level. Websites solely focused on PD had significantly higher understandability and actionability scores compared to those where the procedure was only a section within a broader topic such as pancreatic cancer. There was no difference in readability, understandability, or actionability among HV, LV and control groups.</div></div><div><h3>Conclusions</h3><div>Online patient materials for PD were scarce, lengthy and difficult to comprehend. However, their understandability is crucial for providing patient education. Simplification of patient materials with clear guidance, visuals, and simple language, and strategies-focused research are needed.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"245 ","pages":"Article 116353"},"PeriodicalIF":2.7,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143918383","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

Comparative balanced salt solution and 6 % hydroxyethyl starch in goal-directed therapy for major abdominal surgery: A systematic review and meta-analysis 对比平衡盐溶液和6%羟乙基淀粉在腹部大外科目标导向治疗中的应用：一项系统综述和荟萃分析

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-04-19 DOI: 10.1016/j.amjsurg.2025.116355

Rui Lu , Srisuluk Kacha , Natsuda Phothikun , Atirut Supphapipat , Kaweesak Chittawatanarat

{"title":"Comparative balanced salt solution and 6 % hydroxyethyl starch in goal-directed therapy for major abdominal surgery: A systematic review and meta-analysis","authors":"Rui Lu , Srisuluk Kacha , Natsuda Phothikun , Atirut Supphapipat , Kaweesak Chittawatanarat","doi":"10.1016/j.amjsurg.2025.116355","DOIUrl":"10.1016/j.amjsurg.2025.116355","url":null,"abstract":"<div><div>Goal-directed fluid therapy (GDFT) improves postoperative outcomes in various surgeries, but the optimal fluid choice between balanced salt solutions (BSS) and hydroxyethyl starch (HES) remains debated. This meta-analysis compared postoperative outcomes of GDFT using BSS versus 6 % HES in elective major abdominal surgery. Comprehensive database searches identified eight RCTs (1739 patients) published between 2000 and 2024. No significant differences were found in overall postoperative complications [RR 1.04 (95 % CI 0.90–1.20); p = 0.59], including renal, cardiovascular, respiratory complications, or mortality. However, BSS required significantly higher intraoperative fluid volumes [SMD 0.61 (95 % CI 0.42–0.80); p < 0.001] and led to greater postoperative fluid balance [SMD 0.39 (95 % CI 0.20–0.59); p < 0.001]. 6 % HES should not be used routinely. GDFT using BSS achieves the same outcomes at a lower cost and without the risk of bleeding.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"245 ","pages":"Article 116355"},"PeriodicalIF":2.7,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143865137","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