American journal of surgery最新文献

{"title":"Postoperative outcomes in super- and super-super obese patients undergoing emergency abdominal surgery","authors":"Helene M. Sterbling ,&nbsp;Brynley R. Dean ,&nbsp;Laura Madarász ,&nbsp;Courtney L. Culbreath ,&nbsp;Lolita Ramsey ,&nbsp;Jonathan M. Dort ,&nbsp;Hani M. Seoudi ,&nbsp;Erik J. Teicher","doi":"10.1016/j.amjsurg.2025.116412","DOIUrl":"10.1016/j.amjsurg.2025.116412","url":null,"abstract":"<div><div>With a rising prevalence of Class III obesity (BMI ≥40), it is crucial to identify the perioperative risks associated with super-obesity (BMI 50–59.9) and super-super-obesity (BMI ≥60) in patients undergoing emergency general surgery procedures. The American College of Surgeons National Surgery Quality Improvement Program (NSQIP) database was queried for emergency abdominal surgeries between January 1, 2015 and December 31, 2019. 19,205 patients aged ≥18 years with a BMI ≥40 were included and stratified into morbidly obese, super-obese, and super-super-obese categories.</div><div>The 30-day mortality rate in the super-super-obese group (7.2%) was significantly higher than the morbidly obese (4.1%) and super-obese (5.4%) groups. Compared to morbidly obese patients, super-obese and super-super-obese patients had significantly higher odds for septic shock and reoperation. Super-super-obese patients additionally had significantly higher odds for readmission.</div><div>These findings suggest that super- and super-super-obese patients warrant tailored perioperative management and separate risk considerations.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"246 ","pages":"Article 116412"},"PeriodicalIF":2.7,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144084121","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":"Demystifying the surgery clerkship: Tips for excelling inside and outside the operating room.","authors":"Jennifer E Geller, Ariana Naaseh, Nicole M Mott","doi":"10.1016/j.amjsurg.2025.116414","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116414","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116414"},"PeriodicalIF":2.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109112","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":"We have earned our place.","authors":"Paula Ferrada","doi":"10.1016/j.amjsurg.2025.116390","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116390","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116390"},"PeriodicalIF":2.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126627","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 fast-track anesthesia protocol in patients undergoing thoracoscopic radiofrequency ablation of atrial fibrillation","authors":"Han Xu ,&nbsp;Minghan Wang ,&nbsp;Peiling Wan ,&nbsp;Shengwen Song ,&nbsp;Dihao Pan ,&nbsp;Liangwei Chen ,&nbsp;Lei Yu ,&nbsp;Weidong Li ,&nbsp;Baoli Cheng","doi":"10.1016/j.amjsurg.2025.116405","DOIUrl":"10.1016/j.amjsurg.2025.116405","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the safety and effectiveness of fast-track anesthesia (FTA) compared with non-FTA in patients undergoing thoracoscopic atrial fibrillation (AF) radiofrequency ablation surgery and to preliminarily evaluate the risk factors for FTA failure.</div></div><div><h3>Methods</h3><div>Forty-two patients undergoing elective thoracoscopic AF radiofrequency ablation surgery were included in this retrospective observational study, and they were divided into FTA and non-FTA group based on the anesthetic protocol. The perioperative information of the two groups was compared, with postoperative hospital stay as the primary endpoint. Univariate logistic regression analysis was used to analyze the factors associated with the failure of the FTA protocol.</div></div><div><h3>Results</h3><div>Of the 42 patients, 33 successfully completed the FTA protocol and returned to the ward after surgery, while 9 patients underwent the non-FTA protocol and continued recovery in the intensive care unit. In the FTA group, postoperative hospital stay and total hospital stay were shorter (6.3 ​± ​0.6 vs 7 (7,8.5), <em>P</em> ​= ​0.01 and 8 (7.5,10) vs 14 (11.5, 14), <em>P</em> ​= ​0.00), and medical costs were lower (87800.9 (86303.6,93991.4) vs 98165.1 ​± ​2116.5, <em>P</em> ​= ​0.00). Furthermore, opioid consumption was lower (0.5 ​± ​0.1 vs 0.7 (0.6,1.7), <em>P</em> ​= ​0.00), nerve block implementation rate was higher (97 ​% vs 33.3 ​%, <em>P</em> ​= ​0.00), postoperative extubation was earlier (13 (5,40) vs 626.1 ​± ​130.2, <em>P</em> ​= ​0.00), gastrointestinal function and mobility were recovered earlier (1 (0.5,1) vs 1 (1,1.5), <em>P</em> ​= ​0.00) in the FTA group. The univariate logistic regression analysis revealed that Age (OR: 1.15, 95 %CI: 1.01,1.30, <em>P</em> ​&lt; ​0.05), women (Men vs women, OR: 0.14, 95 %CI: 0.03,0.81, <em>P</em> ​&lt; ​0.05), NYHA Class III(OR: 16, 95 %CI: 1.41,180.90, <em>P</em> ​&lt; ​0.05), chronic AF with slow ventricular rate (OR: 6.25, 95 %CI: 1.26,30.90, <em>P</em> ​&lt; ​0.05), and CHA2DS2VASc score (OR: 2.02, 95 %CI: 1.2,3.5, <em>P</em> ​&lt; ​0.05) were predictors of the FTA failure.</div></div><div><h3>Conclusion</h3><div>The FTA protocol is safe and beneficial in patients undergoing thoracoscopic AF radiofrequency ablation surgery. Elderliness, female sex, chronic AF with slow ventricular rate, NYHA Class III and high CHA2DS2VASc scores may be the contributing factors for FTA failure.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"246 ","pages":"Article 116405"},"PeriodicalIF":2.7,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144116396","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":"Perioperative and long-term outcomes of surgical treatment for penetrating aortic ulcer in the aortic arch: A retrospective cohort analysis","authors":"Luchen Wang,&nbsp;Yanxiang Liu,&nbsp;Bowen Zhang,&nbsp;Sangyu Zhou,&nbsp;Ruojin Zhao,&nbsp;Mingxin Xie,&nbsp;Xuyang Chen,&nbsp;Haoyu Gu,&nbsp;Cuntao Yu,&nbsp;Yaojun Dun,&nbsp;Xiaogang Sun","doi":"10.1016/j.amjsurg.2025.116406","DOIUrl":"10.1016/j.amjsurg.2025.116406","url":null,"abstract":"<div><h3>Objective</h3><div>This study was designed to evaluate the perioperative and long-term outcomes of surgical treatment, including open and hybrid repairs, for patients with penetrating aortic ulcer (PAU) in the aortic arch.</div></div><div><h3>Methods</h3><div>A single-center retrospective analysis from China was conducted on 72 patients with PAU in the aortic arch who underwent surgical treatment including open and hybrid repairs between January 2010 and December 2022. The study included 10 patients in the urgent repair group and 62 patients in the elective repair group. The primary endpoints included major adverse events and long-term survival. Major adverse events included in-hospital mortality, reoperation for bleeding, stroke, paraplegia, and acute renal failure.</div></div><div><h3>Results</h3><div>The rate of major adverse events was 13.9 ​% (10/72), with an in-hospital mortality rate of 2.8 ​% (2/72). The mean follow-up period was 69 months. The overall survival rates at 1, 5, and 7 years after surgery were 95.8 ​%, 91.8 ​%, and 86.0 ​%, respectively. Subgroup and regression analyses showed that urgent repair was not significantly associated with the occurrence of major adverse events and long-term survival. Age (OR: 1.12, 95 ​% CI: 1.00–1.26; P ​= ​0.042) and diabetes (OR: 5.98, 95 ​% CI: 1.01–35.32; P ​= ​0.048) were found to be independent risk factors for major adverse events as well as NYHA grade ​≥ ​III (HR: 14.68, 95 ​% CI: 2.11–102.10; P ​= ​0.007) and diabetes (HR: 5.39, 95 ​% CI: 1.10–26.37; P ​= ​0.038) proved to be independent risk factors for overall survival. Compared to the elective repair group, patients who underwent urgent repair had larger PAUs (P ​= ​0.052), more frequent localization in Zone 0 or Zone 1 (P ​= ​0.038), and were more likely to undergo open surgery, particularly total arch replacement with frozen elephant trunk (P ​= ​0.001). They also experienced longer cardiopulmonary bypass time (P ​= ​0.004), lower minimum temperature (P ​= ​0.001), and lower total expenditure (P ​&lt; ​0.001).</div></div><div><h3>Conclusions</h3><div>The surgical management of PAU in the aortic arch using open or hybrid repair techniques appears to be feasible, with favorable perioperative and long-term outcomes. However, heightened vigilance may be required for elderly patients, diabetic patients, and those with cardiac insufficiency.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"246 ","pages":"Article 116406"},"PeriodicalIF":2.7,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144068058","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":"Impact of sleep disturbances due to low anterior resection syndrome on the quality of life of patients with rectal cancer","authors":"Do Kyoon Moon,&nbsp;Seung-Bum Ryoo,&nbsp;Mi Suk Kim,&nbsp;Jae Hyun Park,&nbsp;Jesung Park,&nbsp;Jong Sung Ahn,&nbsp;Hyo Jun Kim,&nbsp;Minjung Kim,&nbsp;Ji Won Park,&nbsp;Seung-Yong Jeong,&nbsp;Kyu Joo Park","doi":"10.1016/j.amjsurg.2025.116399","DOIUrl":"10.1016/j.amjsurg.2025.116399","url":null,"abstract":"<div><h3>Purpose</h3><div>We aimed to analyze the effects of nighttime symptoms on quality of life of patients with low anterior resection syndrome (LARS) and determine the correlation between nighttime symptoms and insomnia.</div></div><div><h3>Methods</h3><div>A single-center observational study was conducted on patients with rectal adenocarcinoma who underwent sphincter-preserving surgery at Seoul National University Hospital between 2019 and 2023. Eligible patients were surveyed during routine outpatient follow-up. The primary outcomes were bowel function assessed by the Low Anterior Resection Syndrome (LARS) score including nighttime symptoms and sleep disturbance evaluated using the Insomnia Severity Index (ISI).</div></div><div><h3>Results</h3><div>Among 100 patients, 85 (85.0 ​%), nine (9.0 ​%), and six (6.0 ​%) underwent low anterior, ultra-low anterior, and intersphincteric resection, respectively; 86 (86.0 ​%) had LARS, and 58 (58.0 ​%) had nighttime symptoms. Further, 69 patients (98.6 ​%) met the criteria for insomnia. The LARS score and ISI were positively correlated (p ​= ​0.047). Differences in the frequency of bowel movements (p ​= ​0.015) and nighttime symptoms (p ​= ​0.046) were noted between the no/mild insomnia and moderate/severe insomnia groups. Physical and social functioning were lower (p ​= ​0.004 and p ​= ​0.007, respectively) and stool frequency (p ​= ​0.018), embarrassment caused by defecation pattern (p ​= ​0.025), and sore skin around the anus (p ​= ​0.006) were more severe in the moderate/severe insomnia group.</div></div><div><h3>Conclusions</h3><div>LARS and insomnia showed a significant correlation; no significant correlation was found between the occurrence of nighttime symptoms and insomnia.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"246 ","pages":"Article 116399"},"PeriodicalIF":2.7,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144070456","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":"Evaluating the efficacy and safety of low-molecular weight heparin as a chemoprophylactic agent in stable traumatic brain injury","authors":"Abdul Hafiz Al Tannir ,&nbsp;Elise A. Biesboer ,&nbsp;Morgan Tentis ,&nbsp;Simin Golestani ,&nbsp;Christopher Dodgion ,&nbsp;Jacob R. Peschman ,&nbsp;Daniel Holena ,&nbsp;Patrick B. Murphy ,&nbsp;Colleen Trevino ,&nbsp;Thomas W. Carver ,&nbsp;Stephen Miranda ,&nbsp;Marc A. de Moya ,&nbsp;Thaddeus Puzio ,&nbsp;Morgan Schellenberg ,&nbsp;Rachel S. Morris","doi":"10.1016/j.amjsurg.2025.116389","DOIUrl":"10.1016/j.amjsurg.2025.116389","url":null,"abstract":"<div><h3>Background</h3><div>There is a lack of high-quality evidence regarding the most appropriate pharmacologic venous thromboembolism chemoprophylaxis (VTEp) agent in traumatic brain injury (TBI). Low-Molecular Weight Heparin (LMWH) is presumed to reduce VTE events; however, concerns of worsening intracranial hemorrhage (ICH) persist. The aim of the present study is to compare the efficacy and safety of LWMH versus Unfractionated Heparin (UFH) in patients with non-operative TBI.</div></div><div><h3>Methods</h3><div>We performed a single-center retrospective review of all adult TBI patients (age ≥18years) admitted to a Level I trauma center (2015–2022). Exclusion criteria included neurosurgical intervention prior to VTEp, absence of VTEp, worsened ICH prior to VTEp initiation, and death or discharge within 48 ​h of admission. The study population was stratified into those who received LMWH versus UFH as VTEp. The primary outcome of interest was VTE events. Secondary outcomes included worsening ICH, transfusion requirements, and in-hospital mortality.</div></div><div><h3>Results</h3><div>A total of 2176 patients met inclusion criteria (median age 62 years and 64 ​% male) of whom 68 ​% received UFH while 32 ​% received LMWH. Overall, there was no significant difference in demographics, injury characteristics, and time to VTEp initiation; however, compared to patients who received UFH, those who received LMWH were younger (51 vs 68 years p ​&lt; ​0.001) and less likely to present with a subdural hematoma (59 ​% vs 65 ​% p ​= ​0.02). The LMWH cohort had a lower rate of VTE events (1.4 ​% vs 3.0 ​%; p ​= ​0.03) and in-hospital mortality (1.4 ​% vs 3.9 ​%; p ​&lt; ​0.01). No significant differences in worsening ICH (2.8 ​% vs 3.3 ​%; p ​= ​0.2) or transfusion requirements (7.7 ​% vs 8.2 ​%; p ​= ​0.6) were detected. After controlling for age, ISS, BMI, and presence of SDH, LMWH was associated with lower odds of VTE events (AOR: 0.47, 95 %CI: 0.30–0.86) but not mortality (AOR: 0.65, 95%CI: 0.47-1.22).</div></div><div><h3>Conclusion</h3><div>Compared to UFH, LMWH is a safe and effective chemoprophylactic agent in patients with non-operative stable TBI.</div></div><div><h3>Level of evidence</h3><div>Level III, Therapeutic/Care Management.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"246 ","pages":"Article 116389"},"PeriodicalIF":2.7,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143946624","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":"Inclusive excellence in surgery: From recognition to transformation","authors":"Shaidy Moronta ,&nbsp;Jessica Liu McMullin","doi":"10.1016/j.amjsurg.2025.116363","DOIUrl":"10.1016/j.amjsurg.2025.116363","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"246 ","pages":"Article 116363"},"PeriodicalIF":2.7,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092682","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":"Pancreatic neuroendocrine tumors: Do we need more nuanced staging?","authors":"Eunise Chen ,&nbsp;J. Bart Rose","doi":"10.1016/j.amjsurg.2025.116383","DOIUrl":"10.1016/j.amjsurg.2025.116383","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"246 ","pages":"Article 116383"},"PeriodicalIF":2.7,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075474","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":"ErgoEd: a pre-post trial investigating the effect of ergonomic education on laparoscopic surgeons' ergonomic risk scores.","authors":"Frances Dixon, Parveen Vitish-Sharma, Achal Khanna, Barrie D Keeler","doi":"10.1016/j.amjsurg.2025.116398","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116398","url":null,"abstract":"<p><p>This pre-post trial investigates whether ergonomic education using the STEPS model (Screen, Table, Equipment, Posture, Stance) can improve laparoscopic surgeons' ergonomic risk. Intraoperative photographs taken at 1-min intervals were used to calculate risk through the objective Rapid Entire Body Assessment (REBA) scale. Surgeons were reobserved immediately after an educational video, then again 4-6 weeks later. Cognitive strain (modified NASA-TLX), subjective outcomes, and knowledge retention were also assessed. Ten surgeons were recruited from colorectal, general, and gynaecology. There was no difference in REBA between baseline (REBA ​= ​5.0) and early reobservation (REBA ​= ​4.5) [0 ​= ​0.058], but between baseline and late reobservation (REBA ​= ​4.5) there was a significant reduction [p ​= ​0.028]. The overall scores for each day remained in the \"medium risk\" category. Knowledge retention was good (90 ​% correct answers). All found the education worthwhile and subsequently made changes to their practice. Ergonomic education is desired and deemed very important by surgeons, and reduces both their ergonomic risk and subjective experience of pain, but laparoscopic surgery remains ergonomically \"medium risk\" overall. Further solutions must be found to reduce risk.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116398"},"PeriodicalIF":2.7,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085523","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}