Audrey R. Yang , Megan Lundy , Banan Otaibi , Katharine G. Johnson , Hiyori S. Roberts , Pranamya Mahankali , Christina Colosimo , Louis J. Magnotti , Bellal Joseph , Tanya Anand
{"title":"Triage of the injured older adult: A narrative review of nationwide hospital practices","authors":"Audrey R. Yang , Megan Lundy , Banan Otaibi , Katharine G. Johnson , Hiyori S. Roberts , Pranamya Mahankali , Christina Colosimo , Louis J. Magnotti , Bellal Joseph , Tanya Anand","doi":"10.1016/j.amjsurg.2025.116615","DOIUrl":"10.1016/j.amjsurg.2025.116615","url":null,"abstract":"<div><div>Despite published Best Practice Guidelines, a standardized triaging system for older adult trauma patients is not nationally implemented. We conducted a narrative review and consolidated the literature on nationwide triage practices for injured older adults to identify effective components. Search terms included “geriatric hospital triage,” “geriatric trauma triage,” “elderly trauma triage,” and “older adult trauma triage.” We included studies conducted in the United States published from 2014 to 2024, which yielded 31 articles. Identified triaging criteria such as anticoagulation, certain comorbidities, fall mechanism, head trauma, and mental status led to improved patient outcomes, such as significantly reduced hospital length of stay and decreased odds of mortality. The parameters for defining and triaging injured older adults are not uniform; however, they could serve as adequate risk stratification or prognostic tools. Effective components of institutional practices comprise a comprehensive triaging system for these patients. Future guidelines should incorporate a consensus of age and physiological criteria of older adults.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"249 ","pages":"Article 116615"},"PeriodicalIF":2.7,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104892","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}
Vennila Padmanaban, Oindrila Bhattacharyya, Julie Stephens, James L Fisher, Akia Clark, Sachin Jhawar, Bridget A Oppong
{"title":"Refusal of recommended breast cancer surgery: Trends after the Affordable Care Act and medicaid insurance expansion.","authors":"Vennila Padmanaban, Oindrila Bhattacharyya, Julie Stephens, James L Fisher, Akia Clark, Sachin Jhawar, Bridget A Oppong","doi":"10.1016/j.amjsurg.2025.116609","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116609","url":null,"abstract":"<p><strong>Background: </strong>Poverty, unemployment, and lack of insurance contribute to surgery refusal in breast cancer treatment. This study evaluates surgery refusal before and after the Affordable Care Act (ACA) and Medicaid expansion.</p><p><strong>Methods: </strong>A retrospective analysis of breast cancer patients from the National Cancer Database (2006-2021) divided patients into pre-expansion (2006-2009), ACA (2010-2013), and ACA + Medicaid expansion (2014-2021) cohorts. Clinical and therapy data were analyzed.</p><p><strong>Results: </strong>Of 2,555,859 patients, 16,756 (0.65 %) refused surgery. The refusal rate increased from 0.28 % in 2006 to 0.77 % in 2021. Surgery refusers were older and from lower-income quartiles. After adjusting for socioeconomic and pathological factors, the odds of refusal in the ACA + Medicaid cohort were 2.8 times higher than in the pre-ACA cohort (p < 0.001).</p><p><strong>Conclusions: </strong>Black race, older age, and lower income were linked to surgery refusal. Surprisingly, refusal rates increased after ACA and Medicaid expansion, suggesting factors beyond insurance influence decisions.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116609"},"PeriodicalIF":2.7,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129811","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}
Yasmin Arda , May Abiad , Emanuele Lagazzi, Wardah Rafaqat, Tiemen E.T. Holtrop, John O. Hwabejire, Casey M. Luckhurst, George C. Velmahos, Haytham M.A. Kaafarani, Michael P. DeWane
{"title":"Disparities in the investigation of reported physical abuse among adult trauma patients in the United States","authors":"Yasmin Arda , May Abiad , Emanuele Lagazzi, Wardah Rafaqat, Tiemen E.T. Holtrop, John O. Hwabejire, Casey M. Luckhurst, George C. Velmahos, Haytham M.A. Kaafarani, Michael P. DeWane","doi":"10.1016/j.amjsurg.2025.116616","DOIUrl":"10.1016/j.amjsurg.2025.116616","url":null,"abstract":"<div><h3>Background</h3><div>Among trauma patients with suspected physical abuse, investigation often depends on clinician recognition and institutional practices. We aimed to identify patient and hospital-level factors associated with investigation of reported physical abuse.</div></div><div><h3>Methods</h3><div>We used the 2017–2019 ACS-TQIP database to identify trauma patients ≥18 years with documented physical abuse and stratified them by whether an abuse investigation was initiated. Investigation was defined as a formal evaluation by a qualified team member or external service. Multivariable logistic regression identified predictors of investigation.</div></div><div><h3>Results</h3><div>Of 27,985 patients, 82.7 % underwent investigation. Hispanic ethnicity, non-private insurance, penetrating injury, severe abdominal injury, and treatment at mid-sized hospitals were associated with increased odds of investigation. In contrast, Black race and admission to teaching hospitals and level II/III trauma centers were associated with decreased odds.</div></div><div><h3>Conclusions</h3><div>Significant disparities exist in the investigation of reported abuse, emphasizing the need for standardized protocols to ensure equitable care.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"250 ","pages":"Article 116616"},"PeriodicalIF":2.7,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154262","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":"The surgeon as a high-performance athlete: Importance of sleep, hydration & exercise.","authors":"Muhammad Faran, Adam Soliman, Sam M Wiseman","doi":"10.1016/j.amjsurg.2025.116619","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116619","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116619"},"PeriodicalIF":2.7,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147453","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}
Julia Adriana Kasmirski, Raj Roy, Zhixing Song, Christopher Wu, Sanjana Balachandra, Marshall Chandler McLeod, Andrea Gillis, Jessica Fazendin, Brenessa Lindeman, Herbert Chen
{"title":"Prevalence of parathyroid multiglandular disease in Asian population.","authors":"Julia Adriana Kasmirski, Raj Roy, Zhixing Song, Christopher Wu, Sanjana Balachandra, Marshall Chandler McLeod, Andrea Gillis, Jessica Fazendin, Brenessa Lindeman, Herbert Chen","doi":"10.1016/j.amjsurg.2025.116613","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116613","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116613"},"PeriodicalIF":2.7,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147533","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":"The long-lasting effects of redlining: Editorial to the paper \"Strong laws aren't enough: Historic Redlining, state firearm laws, and urban firearm violence in the United States\".","authors":"Denzel R Woode, Andre R Campbell","doi":"10.1016/j.amjsurg.2025.116611","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116611","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116611"},"PeriodicalIF":2.7,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181810","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":"Where you live is related to death and return to the operating room after emergency surgery in a large healthcare system.","authors":"Nancy Ly, Anne M Stey","doi":"10.1016/j.amjsurg.2025.116610","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116610","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116610"},"PeriodicalIF":2.7,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145084916","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":"It's worse than it seems: Our experience with childcare costs during surgical residency.","authors":"Mackenzie Abraham, Peter Abraham","doi":"10.1016/j.amjsurg.2025.116605","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116605","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116605"},"PeriodicalIF":2.7,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079465","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}
Clara Pañella , Carmen Rodríguez-Haro , María Hernández-O’Reilly , Esther Ferrero , Daniel Sánchez-López , José María Gil , Fátima Sánchez-Cabezudo , Antonio Picardo
{"title":"Indications for combining remnant resection in a primary Roux-N-Y gastric bypass: Preliminary results","authors":"Clara Pañella , Carmen Rodríguez-Haro , María Hernández-O’Reilly , Esther Ferrero , Daniel Sánchez-López , José María Gil , Fátima Sánchez-Cabezudo , Antonio Picardo","doi":"10.1016/j.amjsurg.2025.116608","DOIUrl":"10.1016/j.amjsurg.2025.116608","url":null,"abstract":"<div><h3>Introduction</h3><div>Gastric intestinal metaplasia (GIM) is a precancerous lesion that has been independently associated with gastric cancer development. The presence of GIM in the preoperative study of Roux-n-Y gastric bypass (RYGB) raises question of whether or not remove the gastric remnant (GR) due to the impossibility of endoscopic surveillance.</div></div><div><h3>Methods</h3><div>Descriptive analysis of 6 consecutive cases of GR resection in RYGB from 2012 to 2021.</div></div><div><h3>Results</h3><div>There are six cases (100 % women) with an age of 61 (41–63) years and pre-surgical BMI of 40.5(34.8–43.3) Kg/m<sup>2</sup>. Endoscopy confirmed the presence of GIM in 83.3 % of the patients. The surgical time for the RYGB with GR resection was 141 (95–172) minutes. The hospital stay was 2 (2–4) days. No postoperative complications or mortality were observed at 30 days. Histological analysis of GR demonstrates GIM appears in 83.3 %. Weight loss results at 12 months of follow-up are equivalent to regular RYGB, BMI of 26.8 (25.9–29.6) Kg/m<sup>2</sup>.</div></div><div><h3>Conclusions</h3><div>GR resection indication in RYGB must be individualized. GIM is an independent risk factor and, given the impossibility of endoscopic surveillance, the addition of GR resection could be considered. It is a procedure that, in expert hands, is safe with the same postoperative results as a regular RYGB. However, larger samples and long-term follow-up are mandatory to confirm these results.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"249 ","pages":"Article 116608"},"PeriodicalIF":2.7,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145117920","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}