American journal of surgery最新文献_第10页

Conceptual frameworks for study design and team building. 研究设计和团队建设的概念框架。

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-02-07 DOI: 10.1016/j.amjsurg.2025.116241

Marie-Claire R Roberts, Sherene E Sharath, Ernest J Barthélemy, Danylo Orlov, Panos Kougias

引用次数: 0

Is more better? Evaluating the impact of early surgical debridement on Morel-Lavallee lesions 越多越好吗？评估早期手术清创对Morel-Lavallee病变的影响

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-02-06 DOI: 10.1016/j.amjsurg.2025.116238

Jose E. Barrera , Shuyan Wei , Chioma G. Obinero , Catherine Tang , Emily Cao , Charles Osamor III , Jessica R. Nye , Gabrielle E. Hatton , Mohin Bhadkamkar , Yuewei Wu-Fienberg , Lillian S. Kao , Matthew R. Greives

{"title":"Is more better? Evaluating the impact of early surgical debridement on Morel-Lavallee lesions","authors":"Jose E. Barrera , Shuyan Wei , Chioma G. Obinero , Catherine Tang , Emily Cao , Charles Osamor III , Jessica R. Nye , Gabrielle E. Hatton , Mohin Bhadkamkar , Yuewei Wu-Fienberg , Lillian S. Kao , Matthew R. Greives","doi":"10.1016/j.amjsurg.2025.116238","DOIUrl":"10.1016/j.amjsurg.2025.116238","url":null,"abstract":"<div><h3>Introduction</h3><div>Morel-Lavallee lesions (MLL) are closed degloving injuries, often requiring complex management when infected. We evaluated if early debridement reduces infection risk compared to observation.</div></div><div><h3>Methods</h3><div>We conducted a single-center retrospective study of MLL in adults from 2012 to 2022, analyzing diagnoses, infection, demographics, and hospital outcomes. Patients undergoing debridement within 48 h were compared to those initially observed.</div></div><div><h3>Results</h3><div>Of 219 patients, 79 (36 %) underwent initial surgical debridement, and 140 (64 %) were initially observed. The overall infection rate was 9 %. The surgery group had longer hospital stays (14vs7 days, p < 0.001) and more debridements (2vs0, p < 0.001). While infection rate was higher in the surgery group (13.9%vs6.4 %, <em>p</em> = 0.064), this difference was not statistically significant. Multivariate analysis identified higher BMI, hip location, and RBC transfusions as significant infection predictors.</div></div><div><h3>Conclusion</h3><div>No significant differences in infection rates were found, but several risk factors were identified. Greater awareness and better study designs are needed for improved MLL management guidelines.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"244 ","pages":"Article 116238"},"PeriodicalIF":2.7,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143350842","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

Pan scan for geriatric trauma patients: Overkill or necessary? Pan扫描对老年创伤患者：矫枉过正还是必要？

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-02-06 DOI: 10.1016/j.amjsurg.2025.116209

Evan Thomas , Salsabeal Al Saedy , Steven Green , Mahedi Hasan , Clair Chavez , Jacob Glaser

{"title":"Pan scan for geriatric trauma patients: Overkill or necessary?","authors":"Evan Thomas , Salsabeal Al Saedy , Steven Green , Mahedi Hasan , Clair Chavez , Jacob Glaser","doi":"10.1016/j.amjsurg.2025.116209","DOIUrl":"10.1016/j.amjsurg.2025.116209","url":null,"abstract":"<div><h3>Background</h3><div>Geriatric patients manifest pain and physical findings differently and are associated with higher mortality and complications. We hypothesized that physical exam (PE) is unreliable versus computed tomography (CT) for comprehensive injury identification in geriatric patients. Additionally, we quantified significant incidental radiologic findings.</div></div><div><h3>Study design</h3><div>Our institution adopted a policy of Pan Scan (PS) CT for trauma activations of patients ≥65 years. PS included CT of head/neck and chest/abdomen/pelvis. PE and imaging findings were extracted from physician reports.</div></div><div><h3>Results</h3><div>50 % of patients had clinically significant CT traumatic findings. Of these, 75 % had PE correlating to significant CT findings, while 25 % had significant PS findings not identifiable on PE (p < 0.001). The NPV was 0.80 for the PE. 57.7 % had clinically significant incidental findings.</div></div><div><h3>Conclusion</h3><div>Physical exam alone is not sensitive enough to detect all traumatic injuries in elderly patients. As an added benefit to PS, important incidental findings are identified. These data support use of PS in geriatric trauma to optimize care.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"243 ","pages":"Article 116209"},"PeriodicalIF":2.7,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143387677","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

Combined influence of cardiovascular disease and chronic kidney disease on long-term mortality following major operations 心血管疾病和慢性肾脏疾病对大手术后长期死亡率的综合影响

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-02-05 DOI: 10.1016/j.amjsurg.2025.116239

Nader Zamani , Sherene E. Sharath , Panos Kougias

{"title":"Combined influence of cardiovascular disease and chronic kidney disease on long-term mortality following major operations","authors":"Nader Zamani , Sherene E. Sharath , Panos Kougias","doi":"10.1016/j.amjsurg.2025.116239","DOIUrl":"10.1016/j.amjsurg.2025.116239","url":null,"abstract":"<div><h3>Introduction</h3><div>The objective was to characterize the interactive effects of cardiovascular disease (CVD) and chronic kidney disease (CKD) on long-term mortality following major operations.</div></div><div><h3>Methods</h3><div>We performed a national, retrospective cohort study of patients undergoing high-risk operations from 1991 through 2018 using the VA Corporate Data Warehouse and Surgical Quality Improvement Program. Preoperative exposures included CVD (history of angina, CHF, MI, stroke, peripheral arterial disease, and related procedures) and CKD Stages III-V. The primary outcome was long-term mortality.</div></div><div><h3>Results</h3><div>514,057 operations were included. After adjustment, the interaction between CVD and CKD Stage III (HR 1.38, 95% CI: 1.35–1.42), Stage IV (HR 1.91, 95% CI: 1.83–2.01), and Stage V (HR 2.70, 95% CI: 2.59–2.81) progressively conferred increasing risk of mortality.</div></div><div><h3>Conclusions</h3><div>In the setting of major operations, it is more accurate to interpret CVD and CKD in context of one another while accounting for the degree of baseline renal dysfunction.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"242 ","pages":"Article 116239"},"PeriodicalIF":2.7,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143429161","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: Development of a database selection tool for large database research. 我的想法为大型数据库研究开发数据库选择工具。

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-02-05 DOI: 10.1016/j.amjsurg.2025.116240

Eric Bao, Sarah Nathaniel, Nargiz Seyidova, Olachi Oleru, Abigail Tirrell, Peter W Henderson

引用次数: 0

The impact of resection margin status according to lymph node metastasis on the survival outcome of perihilar cholangiocarcinoma 肝门周围胆管癌淋巴结转移切缘状态对生存预后的影响

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-02-05 DOI: 10.1016/j.amjsurg.2025.116236

Poowanai Sarkhampee, Weeris Ouransatien, Satsawat Chansitthichok, Nithi Lertsawatvicha, Paiwan Wattanarath

{"title":"The impact of resection margin status according to lymph node metastasis on the survival outcome of perihilar cholangiocarcinoma","authors":"Poowanai Sarkhampee, Weeris Ouransatien, Satsawat Chansitthichok, Nithi Lertsawatvicha, Paiwan Wattanarath","doi":"10.1016/j.amjsurg.2025.116236","DOIUrl":"10.1016/j.amjsurg.2025.116236","url":null,"abstract":"<div><h3>Background</h3><div>The prognostic factors for overall survival (OS) in perihilar cholangiocarcinoma (pCCA) included resection margin (RM) and lymph node metastases (LNM). Nevertheless, the advantage associated with a negative RM in patients with LNM remains unresolved.</div></div><div><h3>Methods</h3><div>The study retrospectively analyzed patients with pCCA underwent curative-intent resection between October 2013 and December 2018. The evaluation of the OS was conducted based on the presence of LNM and the status of RM.</div></div><div><h3>Results</h3><div>Of the 167 resected pCCA patients, 87 (52.1 %) were LNM negative, and 80 (47.9 %) were LNM positive. Of the 87 LNM-negative patients, 68 (78.2 %) were R0 resections, and 19 (21.8 %) were R1 resections. In LNM-negative patients, the OS was longer in the R0 resection than the R1 resection group (median survival time (MST) of 32.1 vs 15.7 months, respectively; p < 0.001). Of the 80 LNM-positive patients, 35 were R0 resections and 45 were R1 resections. Among patients with LNM positivity, the OS rates were similar between the groups who underwent R1 resection and R0 resection (MST of 8.4 vs 8.0 months, respectively; p = 0.109).</div></div><div><h3>Conclusion</h3><div>In patients with pCCA, the RM status was the most important prognostic factor for LNM-negative patients. However, there was no impact in LNM-positive patients.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"242 ","pages":"Article 116236"},"PeriodicalIF":2.7,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143387347","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 : 2025-02-04 DOI: 10.1016/j.amjsurg.2025.116218

Herbert Chen MD (Editor-in-Chief)

引用次数: 0

The pandemic hit surgery - But ACGME case logs were immune. 大流行打击了外科手术-但ACGME的病例记录是免疫的。

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-02-03 DOI: 10.1016/j.amjsurg.2025.116233

Erin M White, Peter S Yoo

引用次数: 0

General surgeon workforce density is not associated with treatment-incidence ratios at the county or hospital service area level in North Carolina 在北卡罗来纳州，普通外科医生的劳动力密度与县或医院服务区域水平的治疗发病率无关

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-02-03 DOI: 10.1016/j.amjsurg.2025.116231

Mustafa Abid , Mark Holmes , Anthony Charles

{"title":"General surgeon workforce density is not associated with treatment-incidence ratios at the county or hospital service area level in North Carolina","authors":"Mustafa Abid , Mark Holmes , Anthony Charles","doi":"10.1016/j.amjsurg.2025.116231","DOIUrl":"10.1016/j.amjsurg.2025.116231","url":null,"abstract":"<div><h3>Background</h3><div>General Surgeon Workforce Density (WFD) is used to approximate surgical access. Treatment-incidence ratios (TIR) provide a novel measure of care access. TIR's association with General Surgeon WFD has not been evaluated.</div></div><div><h3>Study design</h3><div>Retrospective cohort study of North Carolina inpatient discharges (2016–2019). The association between county and Hospital Service Area (HSA) TIRs for general surgical diseases was analyzed using adjusted linear and logistic regression.</div></div><div><h3>Results</h3><div>When adjusting for pertinent covariates, county General Surgeon WFD and TIR (−0.0009, 95 % CI -0.028,0.026; p 0.95) and HSA General Surgeon WFD and TIR (0.008, 95 % CI -0.021,0.037; p 0.58) were not statistically significantly associated. The odds of a county 0.91 (95 % CI 0.42,1.97; p 0.82) or HSA (OR 0.93, 95 % CI 0.43,2.04; p 0.86) having a high TIR was not associated with WFD.</div></div><div><h3>Conclusion</h3><div>General Surgeon WFD is not associated with disease-specific procedural rates of common surgical conditions at the county or HSA level.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"242 ","pages":"Article 116231"},"PeriodicalIF":2.7,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143419134","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

Housing, health, and harm: Gentrification's impact on firearm violence and access to care. 住房、健康和伤害：中产阶级化对枪支暴力和获得医疗服务的影响。

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-02-03 DOI: 10.1016/j.amjsurg.2025.116234

Yasmin Arda, John O Hwabejire

引用次数: 0