American journal of surgery最新文献

{"title":"Gender and racial diversity in leadership roles within academic surgery internationally: a retrospective cross-sectional study pre-COVID-19.","authors":"Téa C Sue, Isabella F Churchill, Caroline Mallity, Rebecca Lau, Daniel A Peters, Jacinthe Lampron, Philippe Phan, Alexandra Stratton, Eugene K Wai, Eve C Tsai","doi":"10.1016/j.amjsurg.2025.116394","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116394","url":null,"abstract":"<p><strong>Objective: </strong>Journal editorial and society executive boards have widespread impacts, however, the associated leadership diversity remains underexplored. Our study evaluated such diversity across four surgical specialties before the influences of COVID-19.</p><p><strong>Methods: </strong>This retrospective, cross-sectional study obtained perceived gender and race of identified leaders from publicly available websites. Leadership of the top three journals and journal-affiliated societies based on the 2021 Journal Citation Reports journal impact factor was evaluated for subspecialties within neurosurgery, orthopaedic, general, and plastic surgery.</p><p><strong>Results: </strong>Leadership diversity within 58 journals and 55 societies were reviewed. Orthopedics had a significantly lower proportion of females (p ​< ​0.05) and intersectional minorities (p ​< ​0.05). Higher journal impact factor and a greater proportion of intersectional minorities were significantly related (p ​= ​0.0009).</p><p><strong>Conclusion: </strong>We assessed leadership diversity amongst both journal editorial and society executive boards and identified differences with respect to proportions of females, minorities and intersectional minorities across specialties.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116394"},"PeriodicalIF":2.7,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075472","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":"FDG-avid thyroid nodules are at a significantly increased risk of malignancy.","authors":"Brodie D Laurie, Elizabeth Thomas, Hieu Nguyen, Simon Ryan, David Leong","doi":"10.1016/j.amjsurg.2025.116400","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116400","url":null,"abstract":"<p><strong>Background: </strong>FDG-avid thyroid incidentalomas pose a diagnostic challenge due to their potential for malignancy. This study evaluated the malignancy rates in FDG-avid thyroid nodules, stratified by fine needle aspiration (FNA) cytology results.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on patients with FDG-avid thyroid incidentalomas who underwent surgical resection between 2012 and 2023. The primary outcome was malignancy rates stratified by pre-operative cytology results. Logistic regression was used to assess the utility of patient age, gender and nodule size for predicting malignancy in FDG-avid thyroid incidentaloma.</p><p><strong>Results: </strong>Of 258 patients included, malignancy rates stratified by cytology were: Bethesda I (15.4 ​%), Bethesda II(11.1 ​%), Bethesda III(29.1 ​%), Bethesda IV(34 ​%), Bethesda V (83.3 ​%), and Bethesda VI (98.3 ​%). The overall malignancy rate was 48.1 ​%, predominantly papillary thyroid carcinoma. No significant differences in malignancy were observed concerning age, gender, or nodule size.</p><p><strong>Conclusion: </strong>FDG-avid thyroid nodules exhibit a significantly higher risk of malignancy, particularly in Bethesda categories III to VI.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116400"},"PeriodicalIF":2.7,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144155562","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":"Sustainability within Surgery: Historical and Contemporary Perspectives The 2024 North Pacific Surgical Association Historian's Lecture.","authors":"Laura Collier, John Mayberry","doi":"10.1016/j.amjsurg.2025.116403","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116403","url":null,"abstract":"<p><p>Hospitals in Europe and North America, responding to surgeons' pleas for an antiseptic space to perform surgery, began to build thoughtfully designed operating rooms in the late nineteenth century. The energy consumption and waste production of early and middle twentieth century operating rooms was sustainable compared to those of the late twentieth century and early twenty-first century. The adoption of technological advances that use more energy, e.g. laparoscopy and robotic surgery, and the diminishment of the applicability of local or regional anesthesia to many common procedures diminished the sustainability of surgery. In addition, waste production dramatically increased with the growth of the global supply chain and its provision of inexpensive disposable instruments and accouterments. Surgeons can help reverse this unsustainable trend by requesting reusable instruments and accouterments and by using local or regional anesthesia whenever safely possible.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116403"},"PeriodicalIF":2.7,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092683","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":"Range, and why we need to save general surgery","authors":"","doi":"10.1016/j.amjsurg.2025.116368","DOIUrl":"10.1016/j.amjsurg.2025.116368","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"250 ","pages":"Article 116368"},"PeriodicalIF":2.7,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144068739","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":"Analyzing racial and ethnic disparities among geriatric patients undergoing elective versus emergent colorectal procedures: A National Surgical Quality Improvement Program (NSQIP) analysis.","authors":"Spencer T Johnson, Venu Bangla, Adriano Cuadros, Alexandra Z Agathis, Jeanne Wu, Celia M Divino","doi":"10.1016/j.amjsurg.2025.116397","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116397","url":null,"abstract":"<p><strong>Objective: </strong>Non-elective colorectal surgeries are associated with an increased risk of complications compared to elective procedures, which is accentuated amongst geriatric patients. This study examines racial/ethnic disparities in rates of elective versus non-elective colorectal procedures among geriatric patients.</p><p><strong>Methods: </strong>This retrospective cohort study included data from patients aged ≥65 registered in the National Surgical Quality Improvement Program database. Using multivariate logistic regression, we examined associations between race/ethnicity and elective versus non-elective surgical status.</p><p><strong>Results: </strong>Among 79,497 patients included, 24,544 (30.9 ​%) received non-elective colorectal surgery. 81.1 ​% of patients were White, 8.93 ​% were Black, 5.3 ​% were Hispanic, 4.1 ​% were Asian, and 0.6 ​% were NAPI. Multivariate analysis revealed higher odds ratios for receiving non-elective surgery amongst Black and Hispanic patients (Black ​= ​1.38, 95 ​% CI 1.30-1.47, p ​< ​0.01; Hispanic ​= ​1.54, 95 ​% CI 1.43-1.67, p ​< ​0.01).</p><p><strong>Conclusions: </strong>Black and Hispanic geriatric patients were more likely to receive non-elective procedures.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116397"},"PeriodicalIF":2.7,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085620","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":"Comparative value of frailty versus ECOG performance in preoperative risk assessment for elderly patients with gastric cancer","authors":"Chi-Lin Hsieh ,&nbsp;Chi-Chen Lan ,&nbsp;Keng-Hao Liu ,&nbsp;Jun-Te Hsu ,&nbsp;Chun-Yi Tsai ,&nbsp;Ta-Sen Yeh ,&nbsp;Yu-Shin Hung ,&nbsp;Wen-Chi Chou","doi":"10.1016/j.amjsurg.2025.116396","DOIUrl":"10.1016/j.amjsurg.2025.116396","url":null,"abstract":"<div><h3>Background</h3><div>Radical gastrectomy with D2 lymphadenectomy reduces the postoperative recurrence in gastric cancer, but increases risk of complications, especially among elderly patients. This study aimed to assess the predictive value of frailty in determining postoperative complication risks in patients aged ≥80 years undergoing D2 gastrectomy.</div></div><div><h3>Methods</h3><div>This prospective observational study enrolled 78 patients aged ≥80 years who underwent gastrectomy with D2 lymphadenectomy for gastric cancer between January 2020 and December 2021 ​at a medical center in Taiwan. Frailty was evaluated using the Comprehensive Geriatric Assessment (CGA) within one week before surgery. Outcomes: Length of hospital stay (LOS), intensive care unit (ICU) stays, postoperative complications, and survival were analyzed and compared with the Eastern Cooperative Oncology Group (ECOG) performance status.</div></div><div><h3>Results</h3><div>Among the 78 patients, ECOG performance scores were 0, 1, 2, and 3 in 47 ​%, 40 ​%, 12 ​%, and 1 ​% of patients, respectively; 19 patients (24 ​%) were classified as fit and 59 (76 ​%) as frail based on CGA. Frail patients had a significantly longer median LOS (20 days vs. 12 days, p ​= ​0.001), a higher ICU admission rate (46 ​% vs. 16 ​%, p ​= ​0.027), a higher incidence of any surgical complication (85 ​% vs. 47 ​%, p ​= ​0.001), and an increased rate of major surgical complications (Accordion grade 2 or higher) (24 ​% vs. 0 ​%, p ​= ​0.012) compared to fit patients. Although ECOG performance was associated with major complication rates, it did not significantly predict LOS, ICU admissions, or overall complication rates. Survival did not differ significantly between the frail and ECOG performance groups.</div></div><div><h3>Conclusions</h3><div>This study demonstrates that frailty is commonly observed in Taiwanese octogenarian patients and is a valuable predictor of postgastrectomy outcomes.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"246 ","pages":"Article 116396"},"PeriodicalIF":2.7,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143936939","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":"Tumor molecular signatures: bridging the bench and the operating room","authors":"Iakovos N. Nomikos ,&nbsp;Christos Kosmas ,&nbsp;Vasiliki Gkretsi","doi":"10.1016/j.amjsurg.2025.116393","DOIUrl":"10.1016/j.amjsurg.2025.116393","url":null,"abstract":"<div><div>Contemporary diagnostic and therapeutic strategies for many solid tumors rely on understanding the Mismatch Repair (MMR) system, a fundamental DNA repair mechanism responsible for correcting errors introduced during DNA replication. Pathology reports written for tumors excised in surgery, often indicate the expression status of MMR proteins. This is of significant clinical value, as loss of MMR protein expression is associated with the accumulation of DNA replication errors.</div><div>The MMR system recognizes and replaces mismatched nucleotides, particularly in microsatellite regions. These are short, repetitive non-coding DNA sequences prone to replication errors. When MMR proteins are inactivated by genetic or epigenetic alterations, MMR deficiency (dMMR) occurs, preventing repair and leading to microsatellite instability (MSI). MSI is a hallmark of Lynch syndrome, which is commonly associated with colorectal cancer (CRC) and endometrial cancer.</div><div>This work highlights the clinical utility of MMR protein and MSI status as molecular signatures and discusses diagnostic, prognostic, and therapeutic implications. Understanding these molecular changes supports clinicians in making informed therapeutic decisions and may improve patient outcomes by providing personalized treatments to fit individual tumor profiles.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"246 ","pages":"Article 116393"},"PeriodicalIF":2.7,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144068059","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":"Thin air, thick blood: High altitude trauma centers have increased deep venous thrombosis rates","authors":"Franklin L. Wright ,&nbsp;Thomas J. Schroeppel ,&nbsp;Michael R. Bronsert ,&nbsp;Shane Urban ,&nbsp;Stephanie A. Vega ,&nbsp;Michael W. Cripps ,&nbsp;Warren C. Dorlac ,&nbsp;Whitney R. Jenson ,&nbsp;Jennifer E. Baker ,&nbsp;Robert C. McIntyre Jr.","doi":"10.1016/j.amjsurg.2025.116365","DOIUrl":"10.1016/j.amjsurg.2025.116365","url":null,"abstract":"<div><h3>Background</h3><div>Patients undergoing elective procedures at altitudes &gt;4000 ​ft have higher deep venous thrombosis (DVT) rates compared to those performed at ​≤ ​1000 ​ft.</div></div><div><h3>Design</h3><div>We reviewed the American College of Surgeons Trauma Quality Improvement Program (TQIP) database from 2014 to 2019. Adults are divided into LOW (&lt;1001 ​ft) or HIGH (&gt;4000 ​ft) altitude treatment with DVT rates compared by multivariable regression analysis as well as using a 2:1 propensity matched model.</div></div><div><h3>Results</h3><div>Risk-adjusted odds ratio (OR) for DVT at high altitude was 1.53 [95 ​% CI 1.42–1.64]. In patients with an Injury Severity Score (ISS) ​≥ ​16, the DVT rate was 1.10 ​% (LOW) vs 1.59 ​% (HIGH); risk-adjusted OR for DVT at high altitude with ISS ​≥ ​16 was 1.67 [1.53–1.83]. Under the propensity matched model, DVT rates at higher altitude had an OR of 1.59 [1.46–1.74].</div></div><div><h3>Conclusion</h3><div>Following traumatic injury, DVT rates are increased in higher altitude treatment facilities compared to their low elevation peers.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"246 ","pages":"Article 116365"},"PeriodicalIF":2.7,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143936937","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":"Total thyroidectomy does not improve survival for all patients with unilateral papillary thyroid cancer exceeding 4 ​cm","authors":"Ying Ding ,&nbsp;Ziyang Feng ,&nbsp;Ke Cao","doi":"10.1016/j.amjsurg.2025.116395","DOIUrl":"10.1016/j.amjsurg.2025.116395","url":null,"abstract":"<div><h3>Background</h3><div>Total thyroidectomy (TT) is recommended for papillary thyroid cancer (PTC) over 4 ​cm, but its universal benefit is uncertain. This study evaluates whether TT offers a significant advantage over lobectomy (LT) in improving overall survival (OS) and cancer-specific survival (CSS) for patients with unilateral PTC exceeding 4 ​cm.</div></div><div><h3>Methods</h3><div>The study included 8862 patients from the Surveillance, Epidemiology, and End Results (SEER) database (2004–2021) with unilateral PTC larger than 4 ​cm. The relationship between age and survival was assessed using the restricted cubic splines (RCS) model. The effects of LT and TT on OS and CSS across age groups were analyzed using Cox regression and Kaplan-Meier (KM) methods, with and without age stratification. Propensity score matching (PSM) and sensitivity analyses were conducted to assess the robustness of the results.</div></div><div><h3>Results</h3><div>TT did not improve OS (<em>P</em> ​= ​0.888) or CSS (<em>P</em> ​= ​0.907) compared to LT in the overall cohort. However, TT significantly improved OS (HR ​= ​0.54, <em>P</em> ​= ​0.004) and CSS (HR ​= ​0.55, <em>P</em> ​= ​0.018) in high-risk patients (T4, N1, or M1 stage), but not in low-risk patients. Age-stratified analysis showed TT benefited only young (18–55 years) high-risk patients, enhancing OS (HR ​= ​0.29, <em>P</em> ​= ​0.001) and CSS (HR ​= ​0.35, <em>P</em> ​= ​0.035). Older patients did not gain significant survival advantages from TT, regardless of risk status. These results were consistent in the PSM and sensitivity analyses.</div></div><div><h3>Conclusions</h3><div>TT may not be the best approach for all unilateral PTC patients over 4 ​cm in terms of OS and CSS. It improves survival outcomes in young patients with advanced TNM stages but does not confer a significant OS or CSS advantage over LT for older or low-risk patients.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"246 ","pages":"Article 116395"},"PeriodicalIF":2.7,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143936938","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":"A match like no other: Lessons from a pandemic application cycle","authors":"Autumn Beavers MD,&nbsp;Andrea Gillis MD","doi":"10.1016/j.amjsurg.2025.116384","DOIUrl":"10.1016/j.amjsurg.2025.116384","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"245 ","pages":"Article 116384"},"PeriodicalIF":2.7,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965371","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}