American journal of surgery最新文献_第9页

Surgical training simulation modalities in minimally invasive surgery: How to achieve evidence-based curricula by translational research

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-01-17 DOI: 10.1016/j.amjsurg.2025.116197

Philipp Seeger , Nikolaos Kaldis , Felix Nickel , Thilo Hackert , Panagis M. Lykoudis , Anastasios D. Giannou

{"title":"Surgical training simulation modalities in minimally invasive surgery: How to achieve evidence-based curricula by translational research","authors":"Philipp Seeger , Nikolaos Kaldis , Felix Nickel , Thilo Hackert , Panagis M. Lykoudis , Anastasios D. Giannou","doi":"10.1016/j.amjsurg.2025.116197","DOIUrl":"10.1016/j.amjsurg.2025.116197","url":null,"abstract":"<div><h3>Background</h3><div>Surgery has evolved from a hands-on discipline where skills were acquired via the “learning by doing” principle to a surgical science with attention to patient safety, health care effectiveness and evidence-based research. A variety of simulation modalities have been developed to meet the need for effective resident training. So far, research regarding surgical training for minimally invasive surgery has been extensive but also heterogenous in grade of evidence.</div></div><div><h3>Methods</h3><div>A literature search was conducted to summarize current knowledge about simulation training and to guide research towards evidence-based curricula with translational effects. This was conducted using a variety of terms in PubMed for English articles up to October 2024. Results are presented in a structured narrative review.</div></div><div><h3>Results</h3><div>For virtual reality simulators, there is sound evidence for effective training outcomes. The required instruments for the development of minimally invasive surgery curricula combining different simulation modalities to create a clinical benefit are known and published.</div></div><div><h3>Conclusion</h3><div>Surgeons are the main creators for minimally invasive surgery training curricula and often follow a hands-on oriented approach that leaves out equally important aspects of assessment, evaluation, and feedback. Further high-quality research that includes available evidence in this field promises to improve patient safety in surgical disciplines.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"242 ","pages":"Article 116197"},"PeriodicalIF":2.7,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073574","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}

引用次数: 0

Necrotizing enterocolitis vs bowel ischemia of congenital heart disease: Apples and oranges 坏死性小肠结肠炎与先天性心脏病肠缺血：苹果和橘子

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-01-15 DOI: 10.1016/j.amjsurg.2025.116201

Catherine G. Williamson , Jordan M. Rook , Joanna Curry , Gerald Gollin , Peyman Benharash , Justin P. Wagner

{"title":"Necrotizing enterocolitis vs bowel ischemia of congenital heart disease: Apples and oranges","authors":"Catherine G. Williamson , Jordan M. Rook , Joanna Curry , Gerald Gollin , Peyman Benharash , Justin P. Wagner","doi":"10.1016/j.amjsurg.2025.116201","DOIUrl":"10.1016/j.amjsurg.2025.116201","url":null,"abstract":"<div><div>Necrotizing enterocolitis (NEC) is a devastating illness with mortality rates approaching 26 %, with 4 % of patients with congenital heart disease (CHD) receiving this diagnosis. In this retrospective cohort study, the Pediatric Health Information System database was used to compare outcomes among patients with NEC diagnoses between 2019 and 2021 by CHD. The association of clinical factors with the outcomes of interest were compared using multivariable logistic regression. Of 2415 pediatric patients diagnosed with NEC, 955 (39.5 %) had a diagnosis of CHD. Those with CHD were more frequently White and born at a later gestational age. Antibiotic courses were similar; however, CHD patients had lower rates of post-antibiotic operations (18.0 % vs 32.1 %, p < 0.001) and in-hospital mortality (11.1 % vs 15.5 %, p = 0.001). On adjusted analysis, patients without CHD were twice as likely to undergo an abdominal operation. Compared with patients without CHD, those with CHD had decreased rates of antibiotic failure for NEC diagnosis despite similar treatment courses. Distinct outcomes of bowel ischemia among infants with CHD warrant further study of treatment strategies that may differ from those of classical NEC.</div></div><div><h3>Type of study</h3><div>Retrospective Cohort Study.</div></div><div><h3>Level of evidence</h3><div>III.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"242 ","pages":"Article 116201"},"PeriodicalIF":2.7,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143035901","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

Use of natural language processing to retrospectively identify and improve follow-up of adrenal incidentalomas based on patient and nodule characteristics

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-01-15 DOI: 10.1016/j.amjsurg.2025.116199

Lillie Grace Veazey , Christopher Wu , Zhixing Song , Haleigh Negrete , Srini Tridandapani , Herbert Chen , Andrea Gillis , Jessica Fazendin , John D. Osborne , Brenessa Lindeman

引用次数: 0

Long term outcomes of gastric per oral endoscopic myotomy (GPOEM) in patients with gastroparesis.

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-01-15 DOI: 10.1016/j.amjsurg.2025.116203

Mélissa V Wills, Ayan Farah, Moustafa Moussally, Komol Chaivanijchaya, Sol Lee, Juan S Barajas-Gamboa, Jerry Dang, Andrew Strong, Salvador Navarrete, Matthew Kroh, Matthew Allemang

{"title":"Long term outcomes of gastric per oral endoscopic myotomy (GPOEM) in patients with gastroparesis.","authors":"Mélissa V Wills, Ayan Farah, Moustafa Moussally, Komol Chaivanijchaya, Sol Lee, Juan S Barajas-Gamboa, Jerry Dang, Andrew Strong, Salvador Navarrete, Matthew Kroh, Matthew Allemang","doi":"10.1016/j.amjsurg.2025.116203","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116203","url":null,"abstract":"<p><strong>Background: </strong>Gastroparesis often requires procedural intervention when dietary and medication therapies prove ineffective. Gastric per-oral endoscopic myotomy (G-POEM) is used to treat refractory gastroparesis, but long-term outcomes of this proceudre remain unclear.</p><p><strong>Methods: </strong>The 100 patients from our initial study, now >6 years post-procedure from G-POEM, were contacted by phone survey for follow-up to determine clinical outcomes, including gastroparesis cardinal symptom index (GCSI). Clinical success was defined as a decrease in GCSI of ≥1.</p><p><strong>Results: </strong>Of 30 participants, 33.3 % achieved long-term clinical success. Overall mean GCSI improved from 3.7 ± 0.8 to 2.8 ± 1.2 (p < 0.01). 76.7 % expressed satisfaction about undergoing G-POEM. 14 patients were deceased, primarily from cardiac causes.</p><p><strong>Conclusion: </strong>G-POEM is a safe procedure that shows promising long-term outcomes for gastroparesis symptom relief. Larger studies with more complete follow-up are needed.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116203"},"PeriodicalIF":2.7,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143121742","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

Surgical leadership: How far have we come in diversity? 外科领导：我们在多元化方面走了多远？

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-01-14 DOI: 10.1016/j.amjsurg.2025.116198

Raj Roy, Mitchell Disharoon, Zhixing Song, Rongzhi Wang, Polina Zmijewski, Chandler Mcleod, Andrea Gillis, Herbert Chen

引用次数: 0

Hemodialysis Outcomes Score In Trauma (HOST): A novel and easy model for predicting death in patients receiving pre-injury hemodialysis

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-01-12 DOI: 10.1016/j.amjsurg.2024.116176

Gregory R. Stettler , Hannah L. Carroll , Heidi L. Roeber , Martin D. Avery , Mohamed-Omar S. Arafeh , Gregory B. Russell , J Jason Hoth , Nathan T. Mowery , Andrew M. Nunn

{"title":"Hemodialysis Outcomes Score In Trauma (HOST): A novel and easy model for predicting death in patients receiving pre-injury hemodialysis","authors":"Gregory R. Stettler , Hannah L. Carroll , Heidi L. Roeber , Martin D. Avery , Mohamed-Omar S. Arafeh , Gregory B. Russell , J Jason Hoth , Nathan T. Mowery , Andrew M. Nunn","doi":"10.1016/j.amjsurg.2024.116176","DOIUrl":"10.1016/j.amjsurg.2024.116176","url":null,"abstract":"<div><h3>Introduction</h3><div>We sought to construct a simple clinical mortality prediction model in trauma patients that required pre-injury hemodialysis: Hemodialysis Outcomes Score in Trauma (HOST).</div></div><div><h3>Methods</h3><div>Trauma patients on pre-injury hemodialysis admitted between July 2013 to December 2021 were reviewed. Univariate and multivariable analysis was used to determine independent predictors of mortality and construct the HOST score.</div></div><div><h3>Results</h3><div>There were 663 patients identified as receiving pre-injury hemodialysis. Most patients were male (54.6 %), suffered a blunt mechanism (97.4 %), and were severely injured (median ISS 21). Mortality at 28-days for patients receiving pre-injury hemodialysis was 6.8 % compared to 4.8 % in injured patients that did not require pre-injury hemodialysis (p = 0.03). Multivariate logistic regression identified GCS, HR, and hematocrit to be associated with 28-day mortality.</div></div><div><h3>Conclusion</h3><div>HOST may serve as a tool with readily accessible input variables that is able to predict 28-day mortality.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"242 ","pages":"Article 116176"},"PeriodicalIF":2.7,"publicationDate":"2025-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021855","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

Permanent hypoparathyroidism following total thyroidectomy - Incidence and preventative strategies without imaging adjuncts. 甲状腺全切除术后永久性甲状旁腺功能减退-无影像学辅助的发病率和预防策略。

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-01-09 DOI: 10.1016/j.amjsurg.2025.116196

Anita Niu, Lydia Zhou, Alexander Papachristos, Hazel Serrao-Brown, Adam Aniss, Mark Sywak, Stan Sidhu

{"title":"Permanent hypoparathyroidism following total thyroidectomy - Incidence and preventative strategies without imaging adjuncts.","authors":"Anita Niu, Lydia Zhou, Alexander Papachristos, Hazel Serrao-Brown, Adam Aniss, Mark Sywak, Stan Sidhu","doi":"10.1016/j.amjsurg.2025.116196","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116196","url":null,"abstract":"<p><strong>Introduction: </strong>Permanent hypoparathyroidism (pHypoPT) is the most common permanent complication of total thyroidectomy. We aim to describe the incidence and predictors of hypoparathyroidism in a consecutive series of patients treated in a high-volume centre and define strategies to reduce the risk of pHypoPT.</p><p><strong>Methods: </strong>1182 patients who underwent total thyroidectomy between April 2018 and June 2022 were analyzed. Temporary hypoparathyroidism (tHypoPT) was defined as PTH <0.4 pmol/L (<4 pg/mL) at day one post-operatively, or clinical or biochemical evidence of hypocalcemia. pHypoPT was defined as an ongoing need for calcitriol supplementation to maintain normocalcemia at 12 months. Symptomatic tHypoPT (OR 43.97, p < 0.001) and number of parathyroid glands in the operative specimen (OR 2.31, p = 0.022) were also significantly associated with pHypoPT.</p><p><strong>Results: </strong>Biochemical tHypoPT occurred in 205 (17.4 %) patients whilst pHypoPT occurred in 6 (0.5 %) patients. On multivariate analysis, parathyroid auto-transplantation (PA) independently reduced the risk of pHypoPT (OR 0.04, p = 0.004).</p><p><strong>Conclusions: </strong>The risk of pHypoPT after total thyroidectomy is 0.5 % when performed by high-volume surgeons. PA represents an important technique that reduces the risk of pHypoPT.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116196"},"PeriodicalIF":2.7,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998767","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

Clinical impacts of utilizing ceftriaxone and metronidazole versus piperacillin/tazobactam in patients diagnosed with complicated diverticulitis 头孢曲松、甲硝唑与哌拉西林/他唑巴坦治疗复杂性憩室炎的临床影响

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-01-09 DOI: 10.1016/j.amjsurg.2025.116195

Will Carns , Richard Arndt , Sara Ausman , Jason Beckermann , Kristin C. Cole , Erin Gruber , Megan Schleusner , F.N.U. Shweta , Benjamin Pierce

{"title":"Clinical impacts of utilizing ceftriaxone and metronidazole versus piperacillin/tazobactam in patients diagnosed with complicated diverticulitis","authors":"Will Carns , Richard Arndt , Sara Ausman , Jason Beckermann , Kristin C. Cole , Erin Gruber , Megan Schleusner , F.N.U. Shweta , Benjamin Pierce","doi":"10.1016/j.amjsurg.2025.116195","DOIUrl":"10.1016/j.amjsurg.2025.116195","url":null,"abstract":"<div><h3>Background</h3><div>The optimal antibiotic regimen to empirically treat complicated diverticulitis has not been well established in guidelines.</div></div><div><h3>Methods</h3><div>A 5-year retrospective cohort study was conducted with 322 patients admitted to Mayo Clinic hospitals for complicated diverticulitis. Outcomes for 89 patients treated with ceftriaxone and metronidazole were compared to 233 patients treated with piperacillin/tazobactam. Patients were included if they received one of the treatment options for at least 96 h during hospital admission and did not receive any other diverticulitis antibiotic treatment regimen for at least 96 h.</div></div><div><h3>Results</h3><div>Ceftriaxone and metronidazole was found to be non-inferior to piperacillin/tazobactam for the combined primary outcome of 30-day readmission or all-cause mortality (21.4 % vs 15.9 %, P = 0.12). No significant differences were found for 30-day antibiotic failure (P = 0.30) or 90-day Clostridioides difficile infection rate (P = 0.96). Patients who received oral antibiotic therapy in the 7 days prior to admission were found to have increased risk of mortality or readmission and antibiotic failure.</div></div><div><h3>Conclusions</h3><div>Ceftriaxone and metronidazole showed non-inferior outcomes to piperacillin/tazobactam for treating complicated diverticulitis.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"241 ","pages":"Article 116195"},"PeriodicalIF":2.7,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982503","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

Impact of the COVID-19 pandemic on the experiences of underrepresented-in-medicine women applicants to surgical residency. 2019冠状病毒病大流行对申请外科住院医师的医学女性人数不足的影响。

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-01-09 DOI: 10.1016/j.amjsurg.2025.116193

Danilea M Carmona Matos, Cheryl K Zogg, Mary A Siki, Hannah S Thomas, Jaina C Lane, Nensi M Ruzgar, Minerva A Romero Arenas

{"title":"Impact of the COVID-19 pandemic on the experiences of underrepresented-in-medicine women applicants to surgical residency.","authors":"Danilea M Carmona Matos, Cheryl K Zogg, Mary A Siki, Hannah S Thomas, Jaina C Lane, Nensi M Ruzgar, Minerva A Romero Arenas","doi":"10.1016/j.amjsurg.2025.116193","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116193","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic brought additional challenges to the 2020-2021 application cycle. The objective of this study was to explore how such challenges altered the perceptions/motivations/concerns of applicants to surgical fields, particularly those self-identifying as women underrepresented-in-medicine (UiM).</p><p><strong>Methods: </strong>An anonymous mixed-methods survey was electronically distributed to all medical student members of the Association of Women Surgeons between 10/1/2020-12/31/2020. The survey was also shared via social-media posts from several other identity/affinity professional organizations. Quantitative responses were analyzed using descriptive statistics. Qualitative responses were analyzed using a grounded-theory approach.</p><p><strong>Results: </strong>A total of 240 women (n = 238) applicants completed the survey; 110 (45.8 %) identified as UiM. While each expressed concerns about COVID-19, UiM applicants reported significantly greater extents of concern about delayed USMLE/COMPLEX exams (44.0-vs-29.5 %, p = 0.042), missed mentorship opportunities (38.5%-vs-19.4 %, p = 0.001), and lack of access to research experiences (27.5-vs-14.0 %, p = 0.020). In the qualitative portion of the survey, UiM applicants highlighted the importance of ensuring a holistic application review, minimizing interview monopolization, recognizing the potential detrimental effects of parallel social and political unrest, and prioritizing DEI initiatives when choosing a residency program.</p><p><strong>Conclusions: </strong>Women and gender non-conforming applicants faced important challenges in their application to surgical residency during the COVID-19 pandemic. Medical education governing bodies, program directors, and resident selection committees are encouraged to be vigilant about mitigating these challenges in the post-pandemic years.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116193"},"PeriodicalIF":2.7,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998763","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

Household income is independently associated with overall and cancer-specific survival after proctectomy for rectal cancer: A surveillance, epidemiology, and end results-based analysis 家庭收入与直肠癌直肠切除术后的总体生存率和癌症特异性生存率独立相关：一项监测、流行病学和最终结果分析。

IF 2.7 3区医学

American journal of surgery Pub Date : 2025-01-09 DOI: 10.1016/j.amjsurg.2025.116191

Sameh Hany Emile , Nir Horesh , Zoe Garoufalia , Rachel Gefen , Justin Dourado , Anjelli Wignakumar , Steven D. Wexner

{"title":"Household income is independently associated with overall and cancer-specific survival after proctectomy for rectal cancer: A surveillance, epidemiology, and end results-based analysis","authors":"Sameh Hany Emile , Nir Horesh , Zoe Garoufalia , Rachel Gefen , Justin Dourado , Anjelli Wignakumar , Steven D. Wexner","doi":"10.1016/j.amjsurg.2025.116191","DOIUrl":"10.1016/j.amjsurg.2025.116191","url":null,"abstract":"<div><h3>Background</h3><div>We assessed association among household income, overall survival (OS), and cancer-specific survival (CSS) after proctectomy for rectal cancer.</div></div><div><h3>Methods</h3><div>Population-based cohort study included stage I-III rectal adenocarcinoma patients who underwent proctectomy (2010–2020), subdivided by household income at diagnosis [low (<$50,000), average ($50,000–74,999), above-average (≥$75,000)] and compared.</div></div><div><h3>Results</h3><div>Of 39,185 patients (59 % male; mean age 60.4), 12.5 % had low, 48.1 % had average, and 39.4 % had above-average income. Low-income patients were more often Black, rural dwellers, and undergone total proctectomy (OR: 1.49, p < 0.001). Income <$50,000 patients had shorter restricted mean OS (p < 0.001) and CSS (p < 0.001) than the other groups. 5-year OS (70.5 % vs. 73.6 % vs. 82.3 %, p < 0.001) and CSS (78.3 % vs. 80.6 % vs. 87.2 %, p < 0.001) were significantly lower in the low-income group than the average and above-average income groups. Adjusted for other factors, low-income was an independent predictor of OS (HR: 1.31, 95%CI: 1.22–1.41) and CSS (HR: 1.31, 95%CI: 1.21–1.43), compared to above-average.</div></div><div><h3>Conclusions</h3><div>Black patients and rural dwellers more often had <$50,000 income. Low-income increased odds of undergoing non-restorative surgery for rectal cancer and reduced OS and CSS.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"242 ","pages":"Article 116191"},"PeriodicalIF":2.7,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998772","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}

引用次数: 0