American journal of surgery最新文献_第2页

A comparative meta-analysis of povidone–iodine–alcohol vs. chlorhexidine–alcohol for preoperative skin antisepsis in abdominal surgery

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-03-26 DOI: 10.1016/j.amjsurg.2025.116318

Hua-Hsin Hsieh , Yueh Yu , Che-Jui Chang, Tzu-Yen Chang

{"title":"A comparative meta-analysis of povidone–iodine–alcohol vs. chlorhexidine–alcohol for preoperative skin antisepsis in abdominal surgery","authors":"Hua-Hsin Hsieh , Yueh Yu , Che-Jui Chang, Tzu-Yen Chang","doi":"10.1016/j.amjsurg.2025.116318","DOIUrl":"10.1016/j.amjsurg.2025.116318","url":null,"abstract":"<div><h3>Introduction</h3><div>Abdominal surgeries are among the most frequently performed procedures globally and exhibit higher surgical site infection (SSI) rates, with associated complications significantly impacting morbidity and mortality. While alcohol-based antiseptics effectively reduce SSIs, debate persists over the relative efficacy of chlorhexidine–alcohol versus iodine–alcohol solutions. This meta-analysis systematically compares SSI rates in abdominal surgeries using these antiseptics, aiming to inform optimal preoperative practices.</div></div><div><h3>Methods</h3><div>A comprehensive search was conducted across the Cochrane Library, Embase, and MEDLINE databases to identify relevant studies. Meta-analysis was performed using the <em>metafor</em> package in R software, wherein risk ratios (RRs) for surgical site infections (SSIs) were compared between chlorhexidine–alcohol and iodine–alcohol groups in patients undergoing abdominal surgeries. Subgroup analyses were conducted based on wound classification and procedural categories, including general surgery and obstetrics/gynecology. A random-effects model was utilized, with effect sizes presented alongside their 95 % confidence intervals (CIs).</div></div><div><h3>Results</h3><div>Our meta-analysis included 10 randomized controlled trials and found no significant difference in SSI risk between chlorhexidine–alcohol and iodine–alcohol in abdominal surgeries (RR, 1.20; 95 % CI, 0.94–1.54). Subgroup analyses for general surgery, obstetrics/gynecology, and clean-contaminated wounds also showed no significant differences between antiseptics.</div></div><div><h3>Conclusion</h3><div>This meta-analysis indicates no significant difference in SSI incidence between chlorhexidine–alcohol and iodine–alcohol as preoperative antiseptics for abdominal surgeries.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"244 ","pages":"Article 116318"},"PeriodicalIF":2.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143783682","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

The role of AI in optimizing interventional ablative techniques for thyroid nodules: Paving the way for precision-driven endocrine surgery.

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-03-26 DOI: 10.1016/j.amjsurg.2025.116317

Niranjna Swaminathan, Isha Chaudhary, Herbert Chen

引用次数: 0

Increased incidence of complicated appendicitis in patients with neurodevelopmental disabilities

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-03-26 DOI: 10.1016/j.amjsurg.2025.116320

Daniela Feingold , Nupur Shridhar , Jianyou Liu , Srinivas H. Reddy , Dalia Alqunaibit , Edward Chao , Anna Liveris

引用次数: 0

Futility.

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

"The First Time I Caused Harm".

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

引用次数: 0

Impact of fragmented care on retroperitoneal sarcomas.

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.

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, Hector Caceres, Sanjana Balachandra, Rongzhi Wang, Jessica Fazendin, Brenessa Lindeman, Andrea Gillis, Herbert Chen

引用次数: 0

Bedside versus operating room tracheostomy: A cost-effectiveness and economic evaluation

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

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

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