American journal of surgery最新文献_第10页

“The First Time I Caused Harm” “我第一次造成伤害”

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-03-26 DOI: 10.1016/j.amjsurg.2025.116322

Mohini Dasari MD MS

引用次数: 0

Futility 徒劳无益。

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-03-26 DOI: 10.1016/j.amjsurg.2025.116311

Joey Lew

引用次数: 0

Impact of fragmented care on retroperitoneal sarcomas. 碎片化护理对腹膜后肉瘤的影响。

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-03-26 DOI: 10.1016/j.amjsurg.2025.116319

Denise L Wong, Jordan Fredette, Jill Hasler, Andrea S Porpiglia, Stephanie H Greco, Sanjay S Reddy, Jeffrey M Farma, Anthony M Villano

{"title":"Impact of fragmented care on retroperitoneal sarcomas.","authors":"Denise L Wong, Jordan Fredette, Jill Hasler, Andrea S Porpiglia, Stephanie H Greco, Sanjay S Reddy, Jeffrey M Farma, Anthony M Villano","doi":"10.1016/j.amjsurg.2025.116319","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116319","url":null,"abstract":"<p><strong>Background: </strong>Fragmented care (FC) is associated with mixed outcomes. This analysis examines FC's impact on retroperitoneal sarcoma (RPS) treatment.</p><p><strong>Methods: </strong>The National Cancer Database was queried for adult patients with non-metastatic, surgically-resected RPS. FC was defined as diagnosis/treatment at >1 facility. Univariable and multivariable analyses examined factors associated with FC and its impact on overall survival.</p><p><strong>Results: </strong>4976 patients were included; 45.6 % experienced FC. Non-FC and FC cohorts were similar. Dedifferentiated liposarcoma were more common in FC cohort, as were poorly differentiated and undifferentiated tumors (p < 0.05). FC cohort had greater travel distance and time-to-treatment (both p < 0.001). Variables independently associated with FC included urban and rural setting and histology (poorly differentiated and undifferentiated) (all p < 0.05). After controlling for other variables, FC was not associated with survival.</p><p><strong>Conclusion: </strong>FC patients experienced longer distance travelled and time-to-treatment without survival impact. National emphasis must be placed on broadening access to equitable, high-quality sarcoma care.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116319"},"PeriodicalIF":2.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794447","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

My thoughts on parathyroidectomy and imaging challenges 我对甲状旁腺切除术和影像学挑战的看法。

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-03-25 DOI: 10.1016/j.amjsurg.2025.116309

Alexandra Savage BS, Hector Caceres BS, Sanjana Balachandra MD, Rongzhi Wang MD, Jessica Fazendin MD, Brenessa Lindeman MD, Andrea Gillis MD, Herbert Chen MD

引用次数: 0

Bedside versus operating room tracheostomy: A cost-effectiveness and economic evaluation 床边与手术室气管切开术：成本效益和经济评价

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-03-25 DOI: 10.1016/j.amjsurg.2025.116314

William Yu Luo , Jaclyn Portelli Tremont , Sachi Vivek Shinde , Michael Ryan Phillips , Pascal Osita Udekwu , Anthony Charles

{"title":"Bedside versus operating room tracheostomy: A cost-effectiveness and economic evaluation","authors":"William Yu Luo , Jaclyn Portelli Tremont , Sachi Vivek Shinde , Michael Ryan Phillips , Pascal Osita Udekwu , Anthony Charles","doi":"10.1016/j.amjsurg.2025.116314","DOIUrl":"10.1016/j.amjsurg.2025.116314","url":null,"abstract":"<div><h3>Background</h3><div>Prior studies have compared outcomes and costs between bedside tracheostomy (BT) and operating room tracheostomy (ORT). However, studies have not performed a formal cost-effectiveness analysis of BT versus ORT.</div></div><div><h3>Methods</h3><div>We present a cost-effectiveness study using Markov microsimulation for BT versus ORT. We abstracted model parameters from currently available literature and performed deterministic and probabilistic sensitivity analyses.</div></div><div><h3>Results</h3><div>BT was more cost-effective than ORT at a $100,000/quality-adjusted life year willingness to pay (WTP) threshold. Our model was sensitive to postoperative pneumonia rates and pneumonia treatment costs. BT was more cost-effective in most iterations within a range of WTP thresholds from $0 to $200,000.</div></div><div><h3>Conclusions</h3><div>BT is more cost-effective than ORT for critically ill patients at low-average risk for postoperative pneumonia. Our findings support considering bedside tracheostomy before performing the same procedure in the operating room, regardless of whether the approach is percutaneous or open.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"244 ","pages":"Article 116314"},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143725326","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

From the Editor – In – Chief 来自总编辑。

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-03-24 DOI: 10.1016/j.amjsurg.2025.116312

Herbert Chen MD (Editor-in-Chief)

引用次数: 0

Standardized electronic order sets decreases inpatient opioid use in emergency general surgery 标准化的电子处方集减少了急诊普通外科住院患者阿片类药物的使用

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-03-24 DOI: 10.1016/j.amjsurg.2025.116299

Adam Timothy Lucy , Angela Danielle Sickels , Elise Aucoin Dasinger , Laura M. Leal , Lauren Caldwell Tanner , Virginia Strickland Pierce , Sabrina D. Goddard , Mohammad Zain Hashmi

{"title":"Standardized electronic order sets decreases inpatient opioid use in emergency general surgery","authors":"Adam Timothy Lucy , Angela Danielle Sickels , Elise Aucoin Dasinger , Laura M. Leal , Lauren Caldwell Tanner , Virginia Strickland Pierce , Sabrina D. Goddard , Mohammad Zain Hashmi","doi":"10.1016/j.amjsurg.2025.116299","DOIUrl":"10.1016/j.amjsurg.2025.116299","url":null,"abstract":"<div><h3>Background</h3><div>Effective pain management while limiting opioids optimizes surgical care. Emergency general surgery (EGS) patients are a vulnerable population and are excluded from enhanced recovery pathways. We examined the effect of standardized pain control order sets for EGS.</div></div><div><h3>Methods</h3><div>An interprofessionally designed opioid protocol was embedded into admission order sets. Oral and IV morphine milligram equivalents (MME) were monitored from Jan 2019–Jun 2023 for all EGS patients and comparted pre and post-implementation. Primary outcome was total MME and MME per opioid dose administered. Secondary outcomes were pain scores and formulation trends.</div></div><div><h3>Results</h3><div>Total MME per patient and average MME per dose per patient decreased significantly and were sustained for all administration routes. Lower MME medications were ordered and multimodal regimens increased. Pain scores were stable. MME reduction was sustained over time.</div></div><div><h3>Conclusion</h3><div>Standardized pain management protocols decreased in-hospital opioid use in EGS.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"244 ","pages":"Article 116299"},"PeriodicalIF":2.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143783681","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

From preliminary to categorical: A scoping review of trends and outcomes for non-designated preliminary general surgery residents 从初步到分类：对非指定初步普外科住院医师的趋势和结果的范围审查

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-03-24 DOI: 10.1016/j.amjsurg.2025.116313

Hazem Nasef , Sanjan Kumar , Jacob Strouse , Zackary Yates , Ruth Zagales , William S. Havron , Adel Elkbuli

{"title":"From preliminary to categorical: A scoping review of trends and outcomes for non-designated preliminary general surgery residents","authors":"Hazem Nasef , Sanjan Kumar , Jacob Strouse , Zackary Yates , Ruth Zagales , William S. Havron , Adel Elkbuli","doi":"10.1016/j.amjsurg.2025.116313","DOIUrl":"10.1016/j.amjsurg.2025.116313","url":null,"abstract":"<div><h3>Introduction</h3><div>This scoping review aims to evaluate current literature regarding non-designated preliminary surgery resident (NDPSR) demographics, transition into categorical general surgery positions (CGS), predictors for success, and institutional solutions.</div></div><div><h3>Methods</h3><div>A literature search using five databases was conducted to identify relevant articles assessing NDPSRs transitioning into CGS positions.</div></div><div><h3>Results</h3><div>Positive predictors of CGS transition included test scores (Odds Ratio (OR) 1.04, p < 0.001), US medical school graduation (OR 3.47, p = 0.02), and not requiring a work visa (OR 0.18, p = 0.03). Negative predictors were increased age (OR 0.54, p = 0.002) and identifying as Black race (OR 0.28, p < 0.001) or Hispanic ethnicity (OR:0.50, p = 0.010). The overall mean rate of NDPSRs obtaining CGS positions across included studies was 39.7 %, with success rates rising from a mean of 25.2 % after the first year to a mean of 46.0 % after the second, nearly doubling. Institutional strategies implemented include program director meetings and transition pipeline programs.</div></div><div><h3>Conclusion</h3><div>Approximately 60 % of non-designated preliminary surgery residents will not transition into categorical general surgery positions, prompting the need for strategies to aid residents in achieving their career goals.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"244 ","pages":"Article 116313"},"PeriodicalIF":2.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143776648","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

Perfused Intestine Gastrografin Study (PIGS) for water bead ingestion small bowel obstructions 灌注肠胃grafin研究（猪）对水珠摄入小肠阻塞的影响

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-03-24 DOI: 10.1016/j.amjsurg.2025.116315

Luke Pumiglia , Brooklyn Williams , Bobby Z. Zhang , Abi Kelly , Zachary Riggenbach , Jonathan Lutgens , Andrew Francis , Beau Prey , Molly Lonneman , Oladapo O. Akinmoladun , John Van Eaton , Allison A. Edinger , Sean Ciullo , Meade Barlow , John D. Horton , Jason R. Bingham , James Williams

{"title":"Perfused Intestine Gastrografin Study (PIGS) for water bead ingestion small bowel obstructions","authors":"Luke Pumiglia , Brooklyn Williams , Bobby Z. Zhang , Abi Kelly , Zachary Riggenbach , Jonathan Lutgens , Andrew Francis , Beau Prey , Molly Lonneman , Oladapo O. Akinmoladun , John Van Eaton , Allison A. Edinger , Sean Ciullo , Meade Barlow , John D. Horton , Jason R. Bingham , James Williams","doi":"10.1016/j.amjsurg.2025.116315","DOIUrl":"10.1016/j.amjsurg.2025.116315","url":null,"abstract":"<div><h3>Background</h3><div>Water beads (WBs) are commonly ingested by children and may expand causing obstruction often requiring surgery. Gastrografin (GG) has been shown to reduce WB diameter ex-vivo and in-vitro. We studied the impact of GG on diameters of WBs in an in-vivo model of porcine bowel.</div></div><div><h3>Methods</h3><div>48 expanded WBs were placed into 45 cm of perfused porcine bowel. Experimental animals (n = 3, 24 WBs) received 50 mL of GG. Controls (n = 3, 24 WBs) received 50 mL of tap water. WBs dwelled for 3 h before extraction.</div></div><div><h3>Results</h3><div>WBs that dwelled with GG decreased in diameter significantly compared to controls (−30.3 % vs −18 %; p < 0.01). This was conserved on subgroup analyses of 2 sizes of WBs made by 2 manufacturers (−25.35 % vs −10.9 %, p < 0.01; −33.4 % vs −22.6 %, p < 0.01).</div></div><div><h3>Conclusion</h3><div>Gastrografin significantly reduced WB size in a perfused bowel model and may have a role as a non-operative adjunct in managing pediatric WB ingestions.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"244 ","pages":"Article 116315"},"PeriodicalIF":2.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768508","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

An analysis of the effect of the reversal of concealed carry permit law on traumatic injuries 隐蔽携带许可法撤销对创伤性伤害的影响分析

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-03-24 DOI: 10.1016/j.amjsurg.2025.116301

Owen Beverlin , Kylee Wollard , Jared Reyes , Mohamad Halloum , James Haan

{"title":"An analysis of the effect of the reversal of concealed carry permit law on traumatic injuries","authors":"Owen Beverlin , Kylee Wollard , Jared Reyes , Mohamad Halloum , James Haan","doi":"10.1016/j.amjsurg.2025.116301","DOIUrl":"10.1016/j.amjsurg.2025.116301","url":null,"abstract":"<div><h3>Background</h3><div>This study examines the trend in gun-related trauma in Kansas before and after the enactment of a law nullifying the need for a concealed carry license.</div></div><div><h3>Methods</h3><div>A retrospective chart review was conducted of all patients admitted to a level 1 trauma center with a traumatic injury secondary to a gunshot wound. Comparisons were between three time periods: baseline (T1), after concealed carry with limited exceptions (T2), and after the exceptions expired (T3).</div></div><div><h3>Results</h3><div>The average number of patients per year increased from T1 (54 patients/year) to T2 (83 patients/year) and T3 (87 patients/year). The proportion of injuries caused by handguns went from 24.6 % in T1 to 72.5 % in T2 and 63.4 % in T3 (p < .001). There was no difference between the time periods for injury severity, mortality, or discharge disposition.</div></div><div><h3>Conclusion</h3><div>These findings could suggest a correlation in concealed carry law and availability of handguns in Kansas.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"244 ","pages":"Article 116301"},"PeriodicalIF":2.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143760117","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