American journal of surgery最新文献_第3页

Gender disparities in perceived parenthood support among vascular surgery trainees. 血管外科受训者感知父母支持的性别差异。

IF 2.3 3区医学

American journal of surgery Pub Date : 2026-07-10 DOI: 10.1016/j.amjsurg.2026.117138

Margaret A Reilly, Lindsey A Olivere, Christina L Cui, Tara Zielke, Eric B Pillado, Ruojia Debbie Li, Joshua S Eng, Leanne E Grafmuller, Kathryn L DiLosa, Palma M Shaw, Yue-Yung Hu, Karl Y Bilimoria, Malachi G Sheahan, Dawn M Coleman

{"title":"Gender disparities in perceived parenthood support among vascular surgery trainees.","authors":"Margaret A Reilly, Lindsey A Olivere, Christina L Cui, Tara Zielke, Eric B Pillado, Ruojia Debbie Li, Joshua S Eng, Leanne E Grafmuller, Kathryn L DiLosa, Palma M Shaw, Yue-Yung Hu, Karl Y Bilimoria, Malachi G Sheahan, Dawn M Coleman","doi":"10.1016/j.amjsurg.2026.117138","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2026.117138","url":null,"abstract":"<p><p>Many interventions can support the unique challenges surgical trainee parents encounter. We investigated parenthood support intervention availability among vascular surgery training programs and their associations with perceived parenthood support using responses from a voluntary, national cross-sectional survey of vascular surgery trainees. Trainees characterized perceived program support and parenthood support intervention availability. Multivariable logistic regression evaluated associations of feelings of support with demographics and interventions. Among 447 respondents (65.7% response rate), 30.2% were current or expectant parents (N = 135), and 87.5% felt supported to pursue parenthood. However, perceived support varied by gender (78.7% of females vs 92.8% of males, p < 0.001), including among trainee parents (70.6% vs 91.1%, p = 0.003). After adjusting for gender, back-up call schedule availability was associated with greater odds of feeling supported (aOR 2.2, 95% CI:1.0-4.8). Policies supporting trainee parenthood can significantly influence program culture and parenthood decisions. Further interventions are needed to ensure equitable support for trainee family planning.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"117138"},"PeriodicalIF":2.3,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148597770","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

Mentoring while still learning. 一边指导一边学习。

IF 2.3 3区医学

American journal of surgery Pub Date : 2026-06-19 DOI: 10.1016/j.amjsurg.2026.117117

Diego Schaps

引用次数: 0

Non-interruptive decision support to increase appropriate screening for primary hyperparathyroidism. 增加原发性甲状旁腺功能亢进适当筛查的不间断决策支持。

IF 2.3 3区医学

American journal of surgery Pub Date : 2026-06-18 DOI: 10.1016/j.amjsurg.2026.117104

Jesse E Passman, Jasmine Hwang, Mika Epps, Justin Tang, Charles Chambers, MaryAnne Peifer, Jeremy J Flood, Heather Wachtel, Tessa Cook, Rachel R Kelz, Jeffrey P Ebert, E Madeline Fagen, M Kit Delgado, Daniel S Herman

{"title":"Non-interruptive decision support to increase appropriate screening for primary hyperparathyroidism.","authors":"Jesse E Passman, Jasmine Hwang, Mika Epps, Justin Tang, Charles Chambers, MaryAnne Peifer, Jeremy J Flood, Heather Wachtel, Tessa Cook, Rachel R Kelz, Jeffrey P Ebert, E Madeline Fagen, M Kit Delgado, Daniel S Herman","doi":"10.1016/j.amjsurg.2026.117104","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2026.117104","url":null,"abstract":"<p><strong>Objective: </strong>Primary hyperparathyroidism (PHPT) affects 1% of adults, but fewer than one-third of screen-eligible patients are tested. We developed and evaluated two new non-interruptive, clinician-facing alerts to increase appropriate PHPT screening.</p><p><strong>Materials and methods: </strong>We designed process changes to facilitate guideline-informed patient identification via electronic phenotyping, laboratory test ordering, result interpretation, and follow-up. The computable phenotype was retrospectively validated. Clinician-facing alerts were built atop existing workflows for health maintenance (HM) and pended orders (PO) and evaluated in separate primary care clinics.</p><p><strong>Results: </strong>Screening laboratory orders were more frequent in PO (81%; n = 30/37; p < 0.001) and HM (57%; n = 51/90; p < 0.001) than in control (19%; n = 373/1945) clinics. Increased screening appeared to yield higher detection of likely PHPT in PO (43%; 16/37; p < 0.001) and HM (8%; 7/90; p = 0.01) than in control (2%; 48/1945) clinics.</p><p><strong>Conclusion: </strong>Non-interruptive alerts demonstrate potential to substantially increase PHPT screening among appropriate patients.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"117104"},"PeriodicalIF":2.3,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315192","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

Predictive value of QoR-15 scores at hospital discharge for unplanned healthcare utilization after elective surgery: A prospective observational study. QoR-15评分在出院时对择期手术后非计划医疗保健利用的预测价值：一项前瞻性观察研究

IF 2.3 3区医学

American journal of surgery Pub Date : 2026-06-17 DOI: 10.1016/j.amjsurg.2026.117103

Fernando Dana, Raquel Sebio-García, Rubèn González-Colom, Beatriz Tena, David Capitan, Dulce Momblan, Betina Campero, Elena García, Eva Rivas, Adelaida Zabalegui, Graciela Martínez-Pallí

{"title":"Predictive value of QoR-15 scores at hospital discharge for unplanned healthcare utilization after elective surgery: A prospective observational study.","authors":"Fernando Dana, Raquel Sebio-García, Rubèn González-Colom, Beatriz Tena, David Capitan, Dulce Momblan, Betina Campero, Elena García, Eva Rivas, Adelaida Zabalegui, Graciela Martínez-Pallí","doi":"10.1016/j.amjsurg.2026.117103","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2026.117103","url":null,"abstract":"<p><strong>Background: </strong>Unplanned healthcare utilization after elective surgery remains a relevant quality indicator; discharge decision support remains limited. This study evaluated whether the Quality of Recovery-15 (QoR-15) score at hospital discharge is associated with unplanned healthcare utilization within 30 days.</p><p><strong>Methods: </strong>A prospective observational study (2024-2025) included patients undergoing elective general surgery. Unplanned healthcare utilization within 30 days was analyzed using multivariable logistic regression models including QoR-15 and the Comprehensive Complication Index (CCI), and clinical covariates.</p><p><strong>Results: </strong>Among 372 patients, 20% required post-discharge emergency care and 10% were readmitted within 30 days. Lower QoR-15 scores at discharge were associated with emergency department visits. Multivariable models including QoR-15 and CCI demonstrated discriminative performance for emergency visits (AUC 0.69) and readmissions (AUC 0.78), surgical reinterventions were infrequent (3%).</p><p><strong>Conclusions: </strong>QoR-15 assessed at hospital discharge provides information that complements complication-based metrics and may support postoperative risk stratification for discharge planning after elective general surgery.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"117103"},"PeriodicalIF":2.3,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148337404","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

Machine learning-based prediction of adverse events following colorectal resection to guide optimal surgeon-hospital selection. 基于机器学习的结肠直肠切除术后不良事件预测，以指导最佳手术医院选择。

IF 2.3 3区医学

American journal of surgery Pub Date : 2026-06-17 DOI: 10.1016/j.amjsurg.2026.117106

Drew W Goldberg, Charles C Horn, Isaac J Perron, J Walker Rosenthal, Gary E Weissman, Rachel R Kelz

{"title":"Machine learning-based prediction of adverse events following colorectal resection to guide optimal surgeon-hospital selection.","authors":"Drew W Goldberg, Charles C Horn, Isaac J Perron, J Walker Rosenthal, Gary E Weissman, Rachel R Kelz","doi":"10.1016/j.amjsurg.2026.117106","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2026.117106","url":null,"abstract":"<p><strong>Background: </strong>Post-colectomy adverse events occur in up to one third of patients. We used machine learning (ML) models to predict complications and inform optimal surgeon-hospital assignment.</p><p><strong>Study design: </strong>Adults ≥18 undergoing colon or rectal resection in an academic system from 2018 to 2024 were included. Multiple ML algorithms trained on patient and provider features predicted postoperative complications. Model performance was compared by the scaled Brier score. Patients were simulated to their optimal surgeon-hospital dyad to estimate risk reduction.</p><p><strong>Results: </strong>Among 4689 cases, 1562 (33.3%) experienced ≥1 adverse event. LightGBM outperformed alternate ML models (p < 0.05). LightGBM achieved a scaled Brier score of 0.11 (95% CI 0.08-0.16). Top predictors included pre-operative diagnosis, surgeon identifier, and ostomy. Simulations suggested a 4.6% (CI 4.2-4.9%) net absolute complication risk reduction and 6.9% (CI 6.5-7.3%) reduction with reassignment to an optimal surgeon-hospital dyad.</p><p><strong>Conclusions: </strong>ML models could enable a proactive referral strategy to promote optimal surgical outcomes.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"117106"},"PeriodicalIF":2.3,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403240","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

Social drivers of health and perioperative outcomes: Identifying domains and barriers with significant impact 健康和围手术期结果的社会驱动因素：确定具有重大影响的领域和障碍

IF 2.7 3区医学

American journal of surgery Pub Date : 2026-06-01 Epub Date: 2026-02-28 DOI: 10.1016/j.amjsurg.2026.116890

Michael A. Edwards , Skye Buckner Petty , Kashmira Chawla , Sreya Pattipati , Ryan May , Erin Westfall , Mohanad R. Youssef , Nathan L. Delafield , Jaxon K. Quillen , Adam J. Milam

{"title":"Social drivers of health and perioperative outcomes: Identifying domains and barriers with significant impact","authors":"Michael A. Edwards , Skye Buckner Petty , Kashmira Chawla , Sreya Pattipati , Ryan May , Erin Westfall , Mohanad R. Youssef , Nathan L. Delafield , Jaxon K. Quillen , Adam J. Milam","doi":"10.1016/j.amjsurg.2026.116890","DOIUrl":"10.1016/j.amjsurg.2026.116890","url":null,"abstract":"<div><h3>Objectives</h3><div>This retrospective cohort of patients undergoing surgery from 2019 to 2023 evaluated the association between individual-level social drivers of health (SDoH) and postoperative outcomes (length of stay, 30-day mortality, 30-day readmission).</div></div><div><h3>Methods</h3><div>Patients from a multi-site health system who completed a SDoH questionnaire were categorized as high-risk or not high-risk across five SDoH domains (e.g., financial resources) and were stratified into 3 surgical cohorts (elective outpatient, inpatient and emergency surgery). Regression models, adjusted for potential confounders, assessed the association between SDoH and postoperative outcomes.</div></div><div><h3>Results</h3><div>Among 297,723 patients, 74% completed the SDoH questionnaire. High-risk transportation need was associated with higher unplanned 30-day readmission for all cohorts; for elective surgeries, high-risk transportation was also associated with higher mortality. The other SDoH domains were inconsistently associated with postoperative outcomes.</div></div><div><h3>Conclusions</h3><div>Individual-level SDoH, particularly transportation needs and financial strain, are linked to adverse postoperative surgical outcomes. Systematic SDoH interventions are crucial to addressing healthcare disparities.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"256 ","pages":"Article 116890"},"PeriodicalIF":2.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147388413","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

Decreased utilization of component separation techniques over time in complex abdominal wall reconstruction following introduction of preoperative botulinum toxin A 术前引入肉毒杆菌毒素A后，随着时间的推移，成分分离技术在复杂腹壁重建中的应用减少

IF 2.7 3区医学

American journal of surgery Pub Date : 2026-06-01 Epub Date: 2026-03-06 DOI: 10.1016/j.amjsurg.2026.116919

Samantha W. Kerr , William R. Lorenz , Victoria L. Walker , Robert R. Lopez , Robert J. Raible , Lucy Hinton , Alexis M. Holland , Gregory T. Scarola , Kent W. Kercher , Vedra A. Augenstein , B. Todd Heniford , Sullivan A. Ayuso

{"title":"Decreased utilization of component separation techniques over time in complex abdominal wall reconstruction following introduction of preoperative botulinum toxin A","authors":"Samantha W. Kerr , William R. Lorenz , Victoria L. Walker , Robert R. Lopez , Robert J. Raible , Lucy Hinton , Alexis M. Holland , Gregory T. Scarola , Kent W. Kercher , Vedra A. Augenstein , B. Todd Heniford , Sullivan A. Ayuso","doi":"10.1016/j.amjsurg.2026.116919","DOIUrl":"10.1016/j.amjsurg.2026.116919","url":null,"abstract":"<div><h3>Introduction</h3><div>Component separation technique (CST) facilitates anterior fascial closure but can increase wound morbidity and alter abdominal wall anatomy. Preoperative Botulinum toxin A (BTA) relaxes the oblique musculature, potentially reducing CST. This study evaluated trends in CST utilization following the adoption of BTA.</div></div><div><h3>Methods</h3><div>A prospectively maintained database was reviewed for patients who underwent open AWR (2016-2024). Primary outcome was proportion of CST use over time; secondary analysis compared early (2016-2017) versus late (2023-2024) cohorts.</div></div><div><h3>Results</h3><div>Among 1484 patients (mean age 58.8 ± 12.3 years; BMI 31.0 ± 5.8 kg/m<sup>2</sup>; defect size 211.5 ± 165.6 cm<sup>2</sup>), fascial closure was achieved in 99.5%. CST decreased from 48.0% to 19.9% (OR: 0.88,95% CI: 0.813,0.946;<em>p</em> < 0.001). BTA increased (2.9% to 11.0%), though annual change was not significant (OR: 0.98,95% CI: 0.898,1.071;<em>p</em> = 0.670). Between early and late cohorts (n = 384 vs. 356), defect size was similar (219.1 ± 160.6 vs. 213.8 ± 181.3 cm<sup>2</sup>;<em>p</em> = 0.367). There was a reduction in wound breakdown (6.5% vs. 0.8%) and recurrence (2.9% vs. 0.6%)(<em>p</em> < 0.05).</div></div><div><h3>Conclusion</h3><div>Following the introduction of BTA, utilization of CST decreased and was accompanied by a reduction in wound morbidity.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"256 ","pages":"Article 116919"},"PeriodicalIF":2.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147388406","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

Teaching residents in the operating room: What driving lessons taught me about surgical judgment 在手术室教住院医师：驾驶课教会了我什么手术判断

IF 2.7 3区医学

American journal of surgery Pub Date : 2026-06-01 Epub Date: 2026-02-26 DOI: 10.1016/j.amjsurg.2026.116878

David B. Hom MD FACS

引用次数: 0

Randomized pilot study of hybrid telemedicine and in-person pathways to metabolic bariatric surgery 混合远程医疗和亲自代谢性减肥手术途径的随机试点研究

IF 2.7 3区医学

American journal of surgery Pub Date : 2026-06-01 Epub Date: 2026-02-26 DOI: 10.1016/j.amjsurg.2026.116897

Gretchen E. Ames , Jenna L. Pennella , Michael G. Heckman , Hanna J. Sledge , Scott A. Lynch , Enrique F. Elli

{"title":"Randomized pilot study of hybrid telemedicine and in-person pathways to metabolic bariatric surgery","authors":"Gretchen E. Ames , Jenna L. Pennella , Michael G. Heckman , Hanna J. Sledge , Scott A. Lynch , Enrique F. Elli","doi":"10.1016/j.amjsurg.2026.116897","DOIUrl":"10.1016/j.amjsurg.2026.116897","url":null,"abstract":"<div><h3>Objective</h3><div>We investigated the viability of offering a telemedicine pathway to patients seeking metabolic bariatric surgery (MBS).</div></div><div><h3>Methods</h3><div>Patients were randomized to receive hybrid telemedicine (HTM, n = 21) or face-to-face (F2F, n = 22) care. Patient characteristics, program visit completion, patient satisfaction with visits, time to surgery, and insurance payor collection ratio were compared between groups.</div></div><div><h3>Results</h3><div>The HTM group had a higher proportion of initial medical visits completed than the F2F group (100.0% vs 72.7%). Groups did not significantly differ in patient satisfaction with visits, time to surgery, or insurance payor collection ratio. In the HTM group, 42.9% of patients underwent MBS, whereas 27.3% underwent MBS in the F2F group. Overall, 30.2% of patients elected to initiate obesity management medications, and 34.8% discontinued the program.</div></div><div><h3>Conclusion</h3><div>MBS programs may improve treatment access by offering an HTM pathway. Larger investigations are needed to confirm the effect of telemedicine on MBS program access.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"256 ","pages":"Article 116897"},"PeriodicalIF":2.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147388412","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

Substance use screening and naloxone prescribing at discharge among injured adolescents 受伤青少年出院时的物质使用筛查和纳洛酮处方

IF 2.7 3区医学

American journal of surgery Pub Date : 2026-06-01 Epub Date: 2026-03-04 DOI: 10.1016/j.amjsurg.2026.116910

Jenna S. Lee , Ryan G. Spurrier , Shadassa Ourshalimian , Jordan M. Rook , Emma Kirkpatrick , Pradip P. Chaudhari , Lorraine I. Kelley-Quon

{"title":"Substance use screening and naloxone prescribing at discharge among injured adolescents","authors":"Jenna S. Lee , Ryan G. Spurrier , Shadassa Ourshalimian , Jordan M. Rook , Emma Kirkpatrick , Pradip P. Chaudhari , Lorraine I. Kelley-Quon","doi":"10.1016/j.amjsurg.2026.116910","DOIUrl":"10.1016/j.amjsurg.2026.116910","url":null,"abstract":"<div><h3>Background</h3><div>Adolescent substance use is closely linked to traumatic injuries. Screening can identify at-risk youth, while naloxone prescribing can reduce fatal overdose. This study examined drug screening and naloxone prescribing among injured adolescents.</div></div><div><h3>Methods</h3><div>This single-center retrospective cohort study included injured adolescents 12-17y treated January 2021-June 2024. Sociodemographics, clinical factors, and substance use screening associated with naloxone prescribing were analyzed.</div></div><div><h3>Results</h3><div>Among 813 injured adolescents, 86 (10.6%) underwent biochemical drug screening and 530 (65.2%) underwent interview-based screening. Among those screened, 53 (61.2%) biochemical and 81 (15.3%) interview screenings were positive. Only 28 (3.4%) received naloxone, including three (5.7%) with positive biochemical and four (4.9%) with positive interview-based screens. Adolescents with interview-based screening (p = 0.006) and hospital stays >24 h (p < 0.001) were more likely to receive naloxone. Most (96.4%) naloxone prescriptions were co-prescribed with opioids and muscle relaxants, instead of substance use screening results.</div></div><div><h3>Conclusion</h3><div>Naloxone prescribing for injured adolescents remains infrequent and unrelated to substance use screening results.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"256 ","pages":"Article 116910"},"PeriodicalIF":2.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147388414","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