American journal of surgery最新文献

{"title":"Representation of online LGBTQ+ support in general surgery residency programs","authors":"Chandler A. Annesi,&nbsp;Andrada Diaconescu,&nbsp;Adam Lucy,&nbsp;Kristen Wong,&nbsp;Herbert Chen","doi":"10.1016/j.amjsurg.2024.115891","DOIUrl":"10.1016/j.amjsurg.2024.115891","url":null,"abstract":"<div><h3>Background</h3><div>Lesbian, Gay, Bisexual, Transgender, Queer, and more(LGBTQ+) trainees are underrepresented in medicine, and their experiences in surgery have not been well studied. We sought to examine the practices of general surgery residency programs by region regarding representation of LGBTQ+ ​support online.</div></div><div><h3>Methods</h3><div>Retrospective, two-person review of 100 general surgery residency programs stratified by Electronic Residency Application Service(ERAS) region comparing data on Diversity, Equity, and Inclusion(DEI) and LGBTQ+ ​-specific webpages.</div></div><div><h3>Results</h3><div>The Middle Atlantic and South Atlantic regions had 20% of programs each, with fewer programs found in other regions. Of the 100 institutions, 92% had DEI webpages, and 43% had LGBTQ+ ​-specific webpages. There was a significant difference in the likelihood of a program being an Human Rights Campaign(HRC) LGBTQ+ ​leader when compared by region(p ​&lt; ​0.01).</div></div><div><h3>Conclusions</h3><div>Few general surgery residency programs share LGBTQ+-specific DEI content online with no regional difference observed. Recommendations such as updating websites to highlight LGBTQ+ ​inclusion should aid recruitment of a diverse, surgical residency as well as create a welcoming environment for prospective residents.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"240 ","pages":"Article 115891"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141981530","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":"Obesity portends an increased risk of thromboembolic events in severely injured geriatric trauma, a retrospective study","authors":"Bardiya Zangbar,&nbsp;Nicole Lin,&nbsp;Aryan Rafieezadeh,&nbsp;Jordan Kirsch,&nbsp;Ilya Shnaydman,&nbsp;Lars Eckenberg,&nbsp;Gabriel Froula,&nbsp;Joshua Klein,&nbsp;Matthew Bronstein,&nbsp;Kartik Prabhakaran","doi":"10.1016/j.amjsurg.2024.116139","DOIUrl":"10.1016/j.amjsurg.2024.116139","url":null,"abstract":"<div><h3>Background</h3><div>Obesity is a known risk factor for thromboembolic complications in trauma patients. The aim of our study is to evaluate the prevalence of thrombotic complications in obese geriatric patients.</div></div><div><h3>Methods</h3><div>We performed a retrospective analysis of TQIP (2017–2019). A total of 119,906 patients≥65 years who sustained severe trauma were included. Primary outcomes were thrombotic complications including stroke/cerebrovascular accidents (CVA), myocardial infarction (MI), deep vein thrombosis (DVT) and pulmonary embolism (PE). Outcomes were compared between patients with obesity (BMI≥30 ​kg∖m²) and overweight (25 ​kg∖m²≤BMI&lt;30 ​kg∖m²) and normal weight (19 ​kg∖m²≤BMI&lt;25 ​kg∖m²) patients.</div></div><div><h3>Results</h3><div>A total number of 30,356 (26.8 ​%) patients were obese. All clotting complications (stroke/CVA, MI, DVT and PE) were significantly more frequent among obese patients (p ​&lt; ​0.001for all). Multivariate logistic regression showed that obese patients had significantly increased odds of stroke/CVA (OR ​= ​1.207), MI (OR ​= ​1.301), DVT (OR ​= ​1.311) and PE (OR ​= ​1.241) (p ​&lt; ​0.001 for all).</div></div><div><h3>Conclusion</h3><div>Obese geriatric patients who sustain severe traumatic injuries are at increased risk of thromboembolic complications compared to non-obese patients.</div></div><div><h3>Level of evidence</h3><div>Level III retrospective study.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"240 ","pages":"Article 116139"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142821674","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":"Comparison of emergency general surgery at a tertiary and community hospital: One surgeon's perspective","authors":"Jan J. Dekker,&nbsp;Arkadii P. Sipok,&nbsp;Katherine A. Shelton","doi":"10.1016/j.amjsurg.2024.115913","DOIUrl":"10.1016/j.amjsurg.2024.115913","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"240 ","pages":"Article 115913"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142054704","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 chance to cut is a chance to cure","authors":"Eleanor A. Fallon MD,&nbsp;Sarah B. Fisher MD, MS (Assistant Professor)","doi":"10.1016/j.amjsurg.2024.115995","DOIUrl":"10.1016/j.amjsurg.2024.115995","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"240 ","pages":"Article 115995"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456224","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":"When physician supply does not meet patient demand: A looming epidemic in vascular and renal care for a community with the highest incidence of end-stage renal disease in the United States","authors":"Valentine S. Alia ,&nbsp;Toluwani Akinpelu ,&nbsp;Aaron Dadzie ,&nbsp;Shuaibahmed Arab ,&nbsp;Robert Sanchez ,&nbsp;Aaron Silva ,&nbsp;Christian D. Cerecedo Lopez ,&nbsp;Daniel Albo","doi":"10.1016/j.amjsurg.2024.115906","DOIUrl":"10.1016/j.amjsurg.2024.115906","url":null,"abstract":"<div><h3>Background</h3><div>South Texas and the Rio Grande Valley (RGV) are medically underserved-communities near the Texas-Mexico border with the highest incidence of end-stage renal disease (ESRD) in the nation, and a shortage of available full-time equivalent (FTE) specialty-physicians.</div></div><div><h3>Methods</h3><div>Data on the incidence/prevalence of ESRD and workforce projections on vascular-surgeons and nephrologists were collected from the United States Renal Data System and Texas Department of State Health Services. We then merged data from both datasets to identify population-specific healthcare-trends.</div></div><div><h3>Results</h3><div>Texas had the highest rates of ESRD from 2016 to 2020, with its border regions leading the state. By 2032, vascular-surgery and nephrology are projected to have the 1st and 4th worst physician-shortages in the state respectively, with the percentage of these FTE specialty-physicians available to meet the need of the RGV ranging from 42.3 to 58.4 ​%.</div></div><div><h3>Conclusions</h3><div>The RGV is experiencing increased rates of ESRD, while having a paradoxical-decline in specialty-physicians available to provide adequate care.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"240 ","pages":"Article 115906"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142046126","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":"Trust issues in the operating room: What does sex have to do with it?","authors":"Alison A. Smith MD, PhD, FACS","doi":"10.1016/j.amjsurg.2024.116046","DOIUrl":"10.1016/j.amjsurg.2024.116046","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"240 ","pages":"Article 116046"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543177","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":"NET guidelines for white patients may not fit Asian patients","authors":"Ahmer Irfan ,&nbsp;Katherine E. McElroy ,&nbsp;Rui Zheng-Pywell ,&nbsp;Andrea Gillis ,&nbsp;Sushanth Reddy ,&nbsp;Clayton Yates ,&nbsp;Herbert Chen ,&nbsp;J. Bart Rose","doi":"10.1016/j.amjsurg.2024.116116","DOIUrl":"10.1016/j.amjsurg.2024.116116","url":null,"abstract":"<div><h3>Introduction</h3><div>Pancreatic neuroendocrine tumors (pNETs) are slow growing, malignant tumors that show different survival outcomes by race. Current size-based guidelines were largely developed in White patients. Our aim was to investigate tumor size and incidence of lymph node metastasis (LNM) between White and Asian pNET patients to evaluate generalizability of established guidelines.</div></div><div><h3>Methods</h3><div>Using the National Cancer Database (NCDB), we conducted a multi-institutional analysis of patients with low grade, resected, nonfunctional, sporadic, non-metastatic pNETs. Chi-squared tests were implemented to determine correlation between PTS and LMN incidence as well as race and LMN incidence. A logistic regression model was utilized to determine correlation between LMN, tumor size, and race. Overall survival was assessed using the Kaplan-Meier method.</div></div><div><h3>Results</h3><div>A total of 4977 pNET patients (205 Asian and 4772 White) were included in our analysis. Asian patients presented with smaller tumors (3.0 ​cm vs 3.9 ​cm, p ​= ​0.029) but when grouped by size, there was no difference in the distribution (p ​= ​0.77). White patients demonstrated a higher incidence of lymph node metastasis at presentation compared to Asian patients (27 ​% vs 19 ​%, p ​= ​0.013), a higher likelihood of an R0 resection (95.3 ​% vs. 89.3 ​%, p ​&lt; ​0.0001).</div><div>Within both populations, tumor size (&lt;2 ​cm, 2–3 ​cm, and ≥3 ​cm) positively correlated with incidence of LNM (11.5 ​%, 24.6 ​%, and 39.1 ​%). No difference of LNM was seen between racial cohorts at PTS &lt;3 ​cm, however, Asian patients were less likely to exhibit LNM at PTS ≥3 ​cm (28.2 ​% and 39.5 ​%, p ​= ​0.04). Overall survival was not significantly different between racial groups (p ​= ​0.92).</div></div><div><h3>Conclusion</h3><div>Size based surgical resection guidelines for pancreatic neuroendocrine tumors based on a predominantly White patient population may not be generalizable to the Asian population. Within this population, we found the risk of lymph node metastasis did not increase at similar rates with increasing primary tumor size.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"240 ","pages":"Article 116116"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142790989","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":"Long-term oncological outcomes of minimally invasive versus open gastrectomy for cancer","authors":"Francesco Abboretti ,&nbsp;Laura Didisheim ,&nbsp;Hugo Teixeira Farinha ,&nbsp;Markus Schäfer ,&nbsp;Styliani Mantziari","doi":"10.1016/j.amjsurg.2024.116134","DOIUrl":"10.1016/j.amjsurg.2024.116134","url":null,"abstract":"<div><h3>Background</h3><div>Although laparoscopy is widely used in oncologic digestive surgery, many centers are still reluctant to replace open surgery for gastric cancer treatment, especially in advanced disease. The aim of this study was to assess long-term survival and recurrence in patients after laparoscopic (LG) versus open (OG) oncological gastrectomy, in a tertiary reference center.</div></div><div><h3>Methods</h3><div>All consecutive patients with gastric adenocarcinoma undergoing curative gastrectomy between December 2007 and December 2021 were retrospectively analyzed. Clinico-pathological characteristics, survival and recurrence were compared among LG, OG or converted (CoG) patients. The ×2 test was used for categorical variables and the Mann-Whitney <em>U</em> test for continuous ones. Survival was assessed with the Kaplan-Meier method and log-rank test, as well as a multivariable Cox regression analysis.</div></div><div><h3>Results</h3><div>Among 156 included patients, 49 (31.4 ​%) were in the LG group, 93 (59.6 ​%) in the OG group, and 14 (9 ​%) in the CoG group. Baseline demographics were similar among the groups. R0 resection rates were 75.5 ​% in LG, 80.6 ​% in OG, and 64.3 ​% in CoG (p ​= ​0.489). Open surgery was associated with a higher mean lymph node yield (28.4 ​± ​11.6) compared to LG (22.8 ​± ​9.7) and CoG (26.5 ​± ​12.3, p ​= ​0.036). Severe postoperative complications were higher in the CoG group (64.3 ​% CoG versus 29 ​% OG, 32.7 ​% LG, p ​= ​0.035). The CoG group had a significantly inferior disease-free survival (p ​= ​0.012 vs OG, p ​= ​0.003 vs LG; 53.3 ​% OG, 62.7 ​% LG and 28.1 ​% CoG) although overall survival was similar (57.1 ​% OG, 62.7 ​% LG and 32.7 ​% CoG, all p ​&gt; ​0.005).</div></div><div><h3>Conclusions</h3><div>Laparoscopic gastrectomy, while associated with a lower lymph node yield, provides similar overall survival rates compared to open surgery. Conversion to open surgery was associated with higher major postoperative morbidity and inferior disease-free survival.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"240 ","pages":"Article 116134"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgery/non-surgery-based strategies for invasive locally-advanced non-small cell lung cancer in the era of precision medicine","authors":"Min Wang ,&nbsp;Bin Wang ,&nbsp;Xianyan Chen ,&nbsp;Ting Mei ,&nbsp;Xuexi Yang ,&nbsp;Qiang Luo ,&nbsp;Feifei Na ,&nbsp;Youling Gong","doi":"10.1016/j.amjsurg.2024.116132","DOIUrl":"10.1016/j.amjsurg.2024.116132","url":null,"abstract":"<div><h3>Background</h3><div>Treatments for invasive T₄ non-small cell lung cancer (NSCLC) tumors have been traditionally individualized and often require multidisciplinary team (MDT) evaluation. Advances in precision medicine may open up new opportunities for these patients.</div></div><div><h3>Methods</h3><div>This retrospective cohort study, using the Surveillance, Epidemiology, and End Results (SEER) database, identified T₄N_0-3M₀ NSCLC patients with central structure invasion from 2010 to 2020. Precision medicine has progressed in three periods: 2010–2014 (targeted therapy), 2015–2017 (initial immunotherapy), and 2018–2020 (latest immunotherapy). We utilized Propensity Score Matching (PSM) to control confounding factors and competing risk regression models to evaluate cancer-specific survival (CSS).</div></div><div><h3>Results</h3><div>A total of 9,106 cases were matched after PSM. For all populations, the median overall survival (OS) significantly increased with the advancement of precision medicine: 23.0 months in Period I (95 ​% CI: 22.0–25.0), 28.0 months in Period II (95 ​% CI: 26.0–31.0), and not reached (NR) in Period III (95 ​% CI: 30.0 – NR). Multivariate analysis also revealed a sequential survival improvement from Period I to III (<em>p</em> ​<em>&lt;</em> ​0.001). Surgery-based treatment yielded the longest median OS at 46.0 months (95 ​% CI: 43.0–49.0, <em>p</em> ​<em>&lt;</em> ​0.001), compared with chemoradiotherapy, chemotherapy alone and radiation alone. Surgery-based treatment has also yielded the best survival in three precision medicine eras, in both N_0-1 and N_2-3 categories. After analyzing CSS, the results above remained consistent. The survival following chemoradiotherapy and chemotherapy alone has seen significant and progressive enhancements across the three eras of precision medicine. There were no significant survival differences between Periods I and II among surgery-based patients, but a slight improvement trend was noted in Period III.</div></div><div><h3>Conclusion</h3><div>This retrospective study indicated that as precision medicine for NSCLC evolved, personalized treatment strategies supported by effective <span>MDT</span> led to survival improvement. Notably, for invasive stage III patients, surgery-based strategies have consistently shown substantial benefits across all the periods, irrespective of the N stage. The integration of perioperative therapies to enhance surgical feasibility, especially the latest immunotherapy, holds particular promise for further survival benefits.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"240 ","pages":"Article 116132"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142816991","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":"Comprehensive retrospective analysis of the European hernia Society quality of life in patients undergoing abdominal wall reconstruction","authors":"Raul Castañeda-Vozmediano ,&nbsp;Bárbara Areces Carrasco ,&nbsp;Alejandra López Marsella ,&nbsp;Carmen Ahenke Francisco ,&nbsp;Joaquín Munoz-Rodriguez ,&nbsp;Luis Alberto Blazquez Hernando ,&nbsp;Alvaro Robin Valle de Lersundi ,&nbsp;Javier Lopez-Monclus ,&nbsp;Miguel Angel Garcia-Urena","doi":"10.1016/j.amjsurg.2024.115905","DOIUrl":"10.1016/j.amjsurg.2024.115905","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aimed to analyze the European Hernia Society Quality of Life (EHS-QoL) in abdominal wall reconstruction by comparing preoperative scores with those at 1 and 2 postoperative years.</div></div><div><h3>Methods</h3><div>Data from 105 patients with complex incisional hernias were collected preoperatively and at 1 and 2 years postoperatively. Statistical analyses included three ART ANOVA models to compare scores among the three time points and within each time point's items.</div></div><div><h3>Results</h3><div>The EHS score significantly decreased from preoperative (Mdn ​= ​57) to 1 year (Mdn ​= ​10.5) and 2 years postoperative (Mdn ​= ​8). The most significant changes occurred between preoperative and 1-year measurements, particularly in pain levels during activities and limitations in heavy labor and activities outside the home.</div></div><div><h3>Conclusion</h3><div>Patients' quality of life notably improved at 1 year post-surgery, with some reaching near-maximum levels, and this improvement was generally sustained or increased at 2 years post-surgery.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"240 ","pages":"Article 115905"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142046123","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}