American journal of surgery最新文献

{"title":"Optimal port site skin closure method following minimally-invasive surgery: A systematic review and network meta-analysis of randomised clinical trials","authors":"E.P. Kerin ,&nbsp;M.G. Davey ,&nbsp;L. Bouz Mkabaah ,&nbsp;N.E. Donlon","doi":"10.1016/j.amjsurg.2025.116542","DOIUrl":"10.1016/j.amjsurg.2025.116542","url":null,"abstract":"<div><h3>Background</h3><div>For minimally-invasive surgery (MIS), there are numerous acceptable port-site closure techniques with no consensus on the method used.</div></div><div><h3>Aim</h3><div>To identify optimal port site postoperative wound closure method following MIS with respect to complication rates and cosmetic outcome.</div></div><div><h3>Methods</h3><div>Network meta-analysis (NMA) was performed in accordance with PRISMA-NMA guidelines for RCTs comparing at least two methods of port-site closure.</div></div><div><h3>Results</h3><div>Nineteen RCTs were identified evaluating eight methods of wound closure in 1,932 patients; across three types of suture, three forms of tissue glue, staples and paper-tape. At NMA, there was no significant difference in wound complication, infection, dehiscence or pain rate irrespective of closure method, albeit a trend towards higher rate of dehiscence for adhesives. At NMA, wound cosmesis was superior for adhesives at both early and late postoperative follow-up.</div></div><div><h3>Conclusion</h3><div>This study validates the use of tissue adhesives with respect to primary closure of port sites following MIS while highlighting potential associated risks.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"248 ","pages":"Article 116542"},"PeriodicalIF":2.7,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144749494","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":"Moving beyond identities: The role of intersectionality within surgical society and journal leadership.","authors":"Gopika SenthilKumar, Tracy S Wang","doi":"10.1016/j.amjsurg.2025.116529","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116529","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116529"},"PeriodicalIF":2.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144758943","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":"Postoperative pancreatic fistula after pancreaticoduodenectomy: A contemporary analysis of a large national database","authors":"Felipe B. Maegawa ,&nbsp;Francisco Tustumi ,&nbsp;Ankit D. Patel ,&nbsp;Mihir Shah ,&nbsp;David Kooby ,&nbsp;Arie Szomstein ,&nbsp;Edward Lin ,&nbsp;Ioannis Konstantinidis ,&nbsp;Juan M. Sarmiento ,&nbsp;Kevin T. Nguyen","doi":"10.1016/j.amjsurg.2025.116535","DOIUrl":"10.1016/j.amjsurg.2025.116535","url":null,"abstract":"<div><h3>Background</h3><div>Despite the surgical refinement and the rise of minimally invasive surgery (MIS), postoperative pancreatic fistula (POPF) remains a common complication after pancreatoduodenectomy.</div></div><div><h3>Methods</h3><div>The ACS-NSQIP was queried, identifying patients who underwent pancreaticoduodenectomy from 2018 to 2023. A trend analysis and factors associated with POPF(Grade B/C) were examined.</div></div><div><h3>Results</h3><div>In total, 28100 patients were identified. The rate of POPF(Grade B/C) significantly increased from 2018 to 2023, from 13.3 ​% to 15.7 ​% (Cochran-Armitage trend test: p ​= ​.0007). Race was independently associated with increased POPF: Asians and other races versus whites, OR:1.42, 95 %CI:1.22–1.64 and OR:1.29, 95 %CI:1.11–1.41, respectively. Preoperative chemotherapy exerted a protective effect against POPF, OR:0.60, 95 %CI:0.54–0.67. The surgical approach was not associated with POPF. Race was independently associated with receiving preoperative chemotherapy: Asians and other races versus Whites: OR:0.57, 95 %CI:0.48–0.68 and OR:0.42, 95 %CI:0.38–0.47, respectively.</div></div><div><h3>Conclusion</h3><div>The rate of POPF(Grade B/C) after pancreatoduodenectomy is still prevalent, and racial disparities is significantly associated with its development.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"248 ","pages":"Article 116535"},"PeriodicalIF":2.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144722198","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":"Strong laws aren't enough: Historic redlining, state firearm laws, and urban firearm violence in the United States.","authors":"Kiana R Winslow, Taylor D Wurdeman, Alexander J Ordoobadi, Molly P Jarman, Geoffrey A Anderson","doi":"10.1016/j.amjsurg.2025.116537","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116537","url":null,"abstract":"<p><strong>Background: </strong>Urban firearm violence (UFV) has independently been associated with redlining and firearm laws. This study aims to examine how state firearm laws moderate urban firearm violence in census tracts historically exposed to redlining.</p><p><strong>Methods: </strong>We conducted a retrospective ecological study of UFV in census tracts exposed to historic redlining. We analyzed state firearm laws using the Giffords gun law scorecard. The primary outcome was the incidence of firearm violence per 100,000, calculated using the Gun Violence Archive database.</p><p><strong>Results: </strong>Among 16,236 census tracts in 38 states, the incidence of firearm violence increased with the proportion of area redlined across all levels of state firearm laws with 2.7-, 3.9-, and 3.2-times higher incidence in tracts with the greatest proportion redlined relative to the lowest in strong, moderate, and weak law states.</p><p><strong>Conclusions: </strong>Strong firearm laws aren't enough to overcome longstanding socioeconomic disparities that drive firearm violence in historically redlined communities.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116537"},"PeriodicalIF":2.7,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717327","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":"Postoperative survival evaluation of patients with Siewert II adenocarcinoma of esophagogastric junction: a population-based study","authors":"Gangzhi Zhang ,&nbsp;Yan Chen ,&nbsp;Dan Jin ,&nbsp;Ziqi Sui","doi":"10.1016/j.amjsurg.2025.116536","DOIUrl":"10.1016/j.amjsurg.2025.116536","url":null,"abstract":"<div><h3>Background</h3><div>To explore the influencing factors of postoperative survival in Siewert II adenocarcinoma of esophagogastric junction (AEG).</div></div><div><h3>Methods</h3><div>The eligible patients and 28 variables were extracted from the Surveillance, Epidemiology, and End Results database. The association of each variable with overall survival (OS) was explored by univariable COX regression analysis. Multivariable COX analysis was then conducted to determine the independent factors. Kaplan-Meier method was used to compare the OS difference between 2 groups.</div></div><div><h3>Results</h3><div>Totally 3568 patients were enrolled, of whom 2344 patients died. There were 23 variables showing the differences between alive and dead groups (all P ​&lt; ​0.05). Univariable COX and LASSO regression analyses identified 7 key features associated with OS, including age, income, M stage, chemotherapy, systemic therapy plus surgical procedures, liver metastasis, and tumor size.</div></div><div><h3>Conclusion</h3><div>The M stage and tumor size were the key factors associated with postoperative survival of patients with Siewert II AEG.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"248 ","pages":"Article 116536"},"PeriodicalIF":2.7,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144722199","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":"Sharper minds, safer surgeries: Understanding the importance of cognitive ergonomics - A perspective piece from the society of surgical ergonomics.","authors":"Nisha Narula, Frances Dixon, Jennifer Zamudio, Abigail R Wooldridge, Jenny Shao","doi":"10.1016/j.amjsurg.2025.116521","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116521","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116521"},"PeriodicalIF":2.7,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144726553","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":"Outcomes after early vs interval cholecystectomy for perforated Cholecystitis:A multicenter cohort study","authors":"Janelle Cyprich,&nbsp;Isabela Sandigo-Saballos,&nbsp;Angela Neville,&nbsp;Alexander C. Schwed,&nbsp;Lorena Garcia,&nbsp;Jessica A. Keeley","doi":"10.1016/j.amjsurg.2025.116532","DOIUrl":"10.1016/j.amjsurg.2025.116532","url":null,"abstract":"<div><h3>Introduction</h3><div>Gallbladder perforation is rare and carries significant morbidity. The optimal timing of cholecystectomy in patients with perforated cholecystitis is debated.</div></div><div><h3>Methods</h3><div>A multi-institutional retrospective review of patients undergoing cholecystectomy for perforated cholecystitis from 2014 to 2023 was performed. Presenting characteristics, operative details, and short-term outcomes were compared between patients undergoing early (same-admission) vs interval cholecystectomy.</div></div><div><h3>Results</h3><div>Of 230 patients included, 201 (87.4 ​%) underwent early cholecystectomy (EC), while 29 (12.6 ​%) underwent interval cholecystectomy (IC). Patients undergoing IC were more likely to require an open surgery (55.2 ​% vs 35.3 ​%, p ​= ​0.04) and more likely to develop a surgical site infection (17.2 ​% vs 4.0 ​%, p ​= ​0.01), even after adjusting for surgical approach (aOR 3.8, 95 ​% CI 1.1–13.3, p ​= ​0.04). Total hospital length of stay (including index hospitalizations in the IC group) was longer for patients undergoing IC (median 8 days vs 5 days, p ​= ​0.02). Thirty-day biliary complications, reinterventions, and readmissions were similar between groups.</div></div><div><h3>Conclusion</h3><div>Our study suggests EC for perforated cholecystitis is safe and may be preferable to IC with fewer open surgeries, surgical site infections, and shorter overall hospital stay.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"250 ","pages":"Article 116532"},"PeriodicalIF":2.7,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144694672","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":"Seal the bleed or wait to proceed? Resuscitation and early vs. delayed timing for thoracic endovascular aortic repair in blunt thoracic aortic injury","authors":"Ladd Caballero,&nbsp;Megan Gross,&nbsp;Jessica Tran,&nbsp;Saskya Byerly,&nbsp;Emily K. Lenart,&nbsp;Sara Soule,&nbsp;Andrew J. Kerwin,&nbsp;Erica L. Mitchell,&nbsp;Dina M. Filiberto","doi":"10.1016/j.amjsurg.2025.116527","DOIUrl":"10.1016/j.amjsurg.2025.116527","url":null,"abstract":"<div><h3>Background</h3><div>In patients with blunt thoracic aortic injury (BTAI) undergoing thoracic endovascular aortic repair (TEVAR), the relationship between resuscitation (defined by markers such as lactate, base excess (BE), and need for transfusion) and TEVAR timing is not well defined. Several studies suggest repair after 24 ​h is associated with decreased mortality. The impact of related injuries and their competing need for resuscitation and intervention on the timing of TEVAR is not well defined. This study aims to compare patients who underwent early versus delayed TEVAR and determine mortality-related predictors. We hypothesize that the timing of TEVAR is not associated with mortality after accounting for covariates, including markers of resuscitation.</div></div><div><h3>Methods</h3><div>A single-center, retrospective (2017–2023) review of patients with BTAI and TEVAR was performed. Resuscitation markers [lactate, base excess (BE)], transfusions, and outcomes were collected. Patients were stratified by TEVAR timing. A multivariable logistic regression (MLR) was performed for mortality.</div></div><div><h3>Results</h3><div>93 patients underwent TEVAR and met inclusion criteria. There were 23 (25 ​%) patients in the delayed and 70 (75 ​%) in the early cohorts. There was no difference in demographics, initial vital signs, or concomitant TBI or SOI between cohorts. The delayed group had more immediate operative intervention for associated injury (52 ​% vs. 21 ​%,p ​= ​0.01) and were more likely to be resuscitated to a lactate of 2 or BE -2 before intervention (95 ​% vs. 60 ​%,p ​= ​0.002). The grade of injury was significantly different (p ​= ​0.01) between delayed and early groups: I (1 ​% vs. 0 ​%), II (43 ​% vs 13 ​%), III (56 ​% vs 71 ​%), and IV (0 ​% vs. 14 ​%). Death was most commonly from the sequela of traumatic thoracic aortic coarctation (n ​= ​3, 33 ​%) and multisystem organ failure (n ​= ​3, 33 ​%). MLR found that PRBC transfusion within the first 24 ​h (AOR 1.18, 95 %CI 1.06–1.30,p ​= ​0.02) was associated with mortality after adjusting for covariates, including time to TEVAR and grade of injury.</div></div><div><h3>Conclusion</h3><div>The timing of TEVAR was not related to outcomes. Early PRBC transfusion predicts mortality. Timing of TEVAR should depend on the patient's condition rather than a fixed time point.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"250 ","pages":"Article 116527"},"PeriodicalIF":2.7,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144749360","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":"Timing of excisional debridement and its effects on outcomes in geriatric burn patients: A retrospective analysis","authors":"Riddhi Mehta,&nbsp;Kartik Prabhakaran,&nbsp;Anna Jose,&nbsp;Michelle Bravo,&nbsp;Aryan Rafieezadeh,&nbsp;Rishwanth Vetri,&nbsp;Jordan Kirsch,&nbsp;Bardiya Zangbar","doi":"10.1016/j.amjsurg.2025.116528","DOIUrl":"10.1016/j.amjsurg.2025.116528","url":null,"abstract":"<div><h3>Introduction</h3><div>Optimal timing for excisional debridement in geriatric burns remains unclear. We hypothesized that early debridement (ED: ≤72 ​h) is associated with improved outcomes.</div></div><div><h3>Methods</h3><div>A 6-year (2017–2022) analysis of the TQIP database was done to isolate geriatric (≥65 years) burn patients (2nd or 3rd degree with TBSA ≥10 ​%) undergoing excisional debridement. Propensity score matching (1:1) adjusted for demographics, injury severity, and frailty. Outcomes were mortality, complications, length of stay (LOS), and discharge disposition.</div></div><div><h3>Results</h3><div>After matching 882 patients, ED (n ​= ​294) was associated with lower rates of sepsis (2.4 ​% vs. 7.1 ​%) and deep vein thrombosis (2.0 ​% vs. 6.1 ​%) (p ​&lt; ​0.05). There was no difference in mortality. ED had shorter hospital (12 vs. 23 days, p ​&lt; ​0.001) and ICU LOS (9 vs. 16 days, p ​&lt; ​0.001). ED had higher routine discharge (25.9 ​% vs. 16.3 ​%, p ​= ​0.039).</div></div><div><h3>Conclusion</h3><div>Early excisional debridement within 72 ​h is associated with reduced complications and shorter hospitalization in geriatric burn patients.</div></div><div><h3>Level of evidence</h3><div>Level III retrospective study.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"248 ","pages":"Article 116528"},"PeriodicalIF":2.7,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687163","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":"Examining disparities in management and outcomes among unhoused patients with traumatic brain injury","authors":"Sean Kim,&nbsp;Stephen Park,&nbsp;Steven Forman,&nbsp;Shea Gallagher,&nbsp;Chaiss Ugarte,&nbsp;Damon Clark,&nbsp;Matthew Martin,&nbsp;Kenji Inaba,&nbsp;Kazuhide Matsushima","doi":"10.1016/j.amjsurg.2025.116526","DOIUrl":"10.1016/j.amjsurg.2025.116526","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to investigate any differences in management and hospital outcomes between unhoused and housed patients with traumatic brain injury (TBI).</div></div><div><h3>Methods</h3><div>We conducted a 3-year retrospective study (2019–2021). Patients with a head Abbreviated Injury Scale≥3 were included and divided into two cohorts: unhoused (UH) and housed underinsured (HUI). Logistic regression assessed the association between the unhoused status and our study outcomes.</div></div><div><h3>Results</h3><div>A total of 1172 patients were identified. There was no significant difference in the rate of acute interventions for TBI, including intracranial pressure monitoring and neurosurgical procedures. Unhoused status was associated with a lower rate of withdrawal of care (3.7 ​% vs. 11.1 ​%, p ​= ​0.012). After adjusting for confounding factors, UH patients had increased odds of brain death (adjusted odds ratio [AOR]:8.54, p ​&lt; ​0.001) and prolonged ventilator days (AOR:3.62, p ​= ​0.048).</div></div><div><h3>Conclusion</h3><div>Our results suggest that unhoused status may have an influence on end-of-life medical decisions following TBI.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"248 ","pages":"Article 116526"},"PeriodicalIF":2.7,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687164","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}