American journal of surgery最新文献

{"title":"The impact of externalized pancreatic stents in our practice: A comparison of outcomes after pancreaticoduodenectomy in two time periods","authors":"L. Arias-Espinosa ,&nbsp;A. Nordmann-Gomes ,&nbsp;A. Zorrilla-Villalobos ,&nbsp;A. Vargas-España ,&nbsp;F. Malcher ,&nbsp;A. Ramírez-Del Val ,&nbsp;C. Chan ,&nbsp;I. Domínguez-Rosado","doi":"10.1016/j.amjsurg.2024.116004","DOIUrl":"10.1016/j.amjsurg.2024.116004","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative pancreatic fistula is a severe complication of pancreaticoduodenectomy. Using an externalized pancreatic stent is a potential mitigation strategy not previously studied in Latin America.</div></div><div><h3>Methods</h3><div>Pancreaticoduodenectomies performed in a single center between 2006 and 2019 were retrospectively analyzed. Clinical variables were collected with a 90-day follow-up according to stent intervention: externalized stent (ES), internal stent (IS), or no stent. Before and after ES implementation (2016) periods were also compared.</div></div><div><h3>Results</h3><div>Out of 237 patients, 77 (32.5 ​%) had an ES, 24 (10.1 ​%) an IS, and 136 (57.4 ​%) none. No difference was found in the overall incidence of POPF. The use of an ES was associated with less type C POPF, despite having an increased risk for fistula development. PD performed after 2016 were also associated with a reduced incidence of type C POPF, surgical reintervention requirement, POPF-associated mortality, and intrahospital stay.</div></div><div><h3>Conclusions</h3><div>The use of an ES is a low-cost intervention that can mitigate POPF severity in high-risk patients.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"239 ","pages":"Article 116004"},"PeriodicalIF":2.7,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441535","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 association of genetic testing timing and mutation type on breast cancer management in patients with breast cancer-related mutations.","authors":"Ebunoluwa J Olunuga, Samantha M Thomas, Koumani W Ntowe, Juliet C Dalton, Ton Wang, Akiko Chiba, Jennifer K Plichta","doi":"10.1016/j.amjsurg.2024.116005","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2024.116005","url":null,"abstract":"<p><strong>Background: </strong>We aim to characterize breast management for patients with genetic mutations and concurrent breast cancer (BC) or prior BC treatment.</p><p><strong>Methods: </strong>Adults with a BC-related mutation and prior/concurrent BC diagnosis were identified. Groups were stratified by mutation type [BRCA1/2, high penetrance mutation (HPM), moderate penetrance mutation (MPM)] and timing of genetic testing (concurrent with BC versus after BC treatment). Outcomes were compared.</p><p><strong>Results: </strong>Among 338 patients included, 63 ​% had BRCA1/2 mutations, 9 ​% HPM, and 28 ​% MPM. Approximately 38 ​% had testing concurrent with a BC diagnosis and 62 ​% after BC treatment. Patients with concurrent testing favored bilateral mastectomy (57 ​%) versus 26 ​% lumpectomy, and 16 ​% unilateral mastectomy, which varied by mutation type. Patients previously treated preferred surveillance (92 ​% vs. 8 ​% additional surgery), regardless of mutation type.</p><p><strong>Conclusion: </strong>The timing of a significant BC-related genetic test result and mutation type may be associated with management decisions among patients with breast cancer.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116005"},"PeriodicalIF":2.7,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142405916","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":"Exploring the intersectionality of race and gender on the incidence of and response to microaggression experienced by Asian American women medical students","authors":"Joanna Chen ,&nbsp;Joyce Pang ,&nbsp;Crystal An ,&nbsp;B.U.K. Li ,&nbsp;Sunny Nakae ,&nbsp;Lindy Zhang","doi":"10.1016/j.amjsurg.2024.116007","DOIUrl":"10.1016/j.amjsurg.2024.116007","url":null,"abstract":"<div><h3>Background</h3><div>Discrimination faced by Asian American trainees in medical school include those reported by female trainees. This study aims to characterize the microaggressions faced by Asian American woman medical students.</div></div><div><h3>Methods</h3><div>We use a mixed methods approach to characterize the experiences of Asian Americans in United States (US) medical schools through an anonymous online survey and participation in focus groups.</div></div><div><h3>Results</h3><div>Among our 305 participants, 65.9 ​% were women. More women experienced microaggressions than men (p ​&lt; ​0.001). Compared to men, women reported significantly higher rates of supervisors having higher expectations of them, implying they were submissive, and describing them as too quiet. Women felt that their experiences with microaggressions were entangled with being Asian and a woman, but could not distinguish which identity was being targeted.</div></div><div><h3>Conclusion</h3><div>The intersectionality of being Asian American and a woman in medical training has not been explored. We found that this duality intensified experiences of microaggressions.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"239 ","pages":"Article 116007"},"PeriodicalIF":2.7,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456232","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":"Survival impact of treatment utilization and margin status after resection of adrenocortical carcinoma","authors":"Kelvin Memeh ,&nbsp;Sara Abou Azar ,&nbsp;Oluwasegun Afolaranmi ,&nbsp;Tanaz M. Vaghaiwalla","doi":"10.1016/j.amjsurg.2024.115999","DOIUrl":"10.1016/j.amjsurg.2024.115999","url":null,"abstract":"<div><h3>Background</h3><div>This study examines the combined impact of margin status and adjuvant therapy utilization on overall survival (OS) for adrenocortical carcinoma (ACC) patients undergoing surgery with curative intent.</div></div><div><h3>Methods</h3><div>The 2004–2020 National Cancer Database (NCDB) was queried for ACC patients ≥18yrs undergoing curative surgery (no debulking), subdivided into R0 and R1/R2-groups, and analyzed using inverse-probability-weighted Cox Proportional Hazard-model.</div></div><div><h3>Results</h3><div>Of 5023 ACC patients, 3193 underwent curative surgery, 2213 (69 ​%) had R0 margins. Compared to the R0, the R1/R2 group had a decreased OS by 15.6 months (HR ​= ​1.89, p ​= ​0.002). While there has been no significant improvement in margin status over the years studied (2008–2017), there has been an overall increase in the proportion of patients receiving adjuvant therapy regardless of margin status, and the adverse impact of a positive margin on survival has decreased [HR 2.20 vs 1.76]</div></div><div><h3>Conclusions</h3><div>R1/R2 margins are associated with decreased OS. The adverse impact of R1/R2 margins on OS decreased over time while adjuvant therapy utilization increased for all patients.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"239 ","pages":"Article 115999"},"PeriodicalIF":2.7,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456234","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":"Navigating the changing landscape of transplant research: Trends, topics, and gender disparities.","authors":"Isabella Faria, Stalin Canizares, Patricia Viana, Michael Kueht","doi":"10.1016/j.amjsurg.2024.116003","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2024.116003","url":null,"abstract":"<p><strong>Background: </strong>Transplantation is a rapidly evolving field, reflecting advances in medical science and changing healthcare needs. This study aims to elucidate shifts in research focus over a decade, providing insights into emerging trends in transplant research.</p><p><strong>Methods: </strong>We conducted a comprehensive analysis of 9,250 articles published in five high-impact transplant journals from 2012 to 2021. Article titles were processed to extract keywords using R Studio (v. 4.3.0). STATA 18 was used for t-tests and logistic regressions, with significance set at p ​< ​0.05.</p><p><strong>Results: </strong>Emerging topics over the decade included outcomes and survival, surgical innovations, and lung transplantation. There was a downward trend in research on immunosuppression, genetics, and immunology. Over the decade, the odds of women's first authorship were higher for subjects such as public health, pediatric transplantation, infectious diseases, renal transplantation, and psychological aspects. Similarly, there were lower odds for women as first authors on surgical innovations, organ preservation, living donor transplantation, liver and lung transplantation, and multiorgan transplantation. Senior women authors had higher odds of publishing on the same topics as first author, plus immunology, kidney and heart transplantation. There were lower odds that a woman would be last author of regenerative medicine and xenotransplantation. Over the decade, there were higher odds of funding for research published on xenotransplantation, regenerative medicine, and immunology. Living donor, infectious diseases, and liver transplantation had lower odds of being funded over time.</p><p><strong>Conclusion: </strong>This cross-sectional study highlights the dynamic nature of transplant research, underscoring the importance of continuous observation of trends to anticipate future directions and needs in the field. The emergence of new focal areas, especially those related to technological advancements and social issues, reflects a broader trend in medical research responding to evolving challenges and opportunities. Notably, women's authorship was more prevalent in public health but less in surgical innovation. These insights can guide future research priorities, funding allocation, and clinical practices in transplantation.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116003"},"PeriodicalIF":2.7,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456228","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":"Scholarly impact of student authorship in urology research.","authors":"Maya T Zhou, Olivia T Zhou, Julia Pakey, Joanna Wang, Muhammad M Qureshi, Ariel E Hirsch, Shaun E L Wason","doi":"10.1016/j.amjsurg.2024.116006","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2024.116006","url":null,"abstract":"<p><strong>Background: </strong>H-index is an indicator of research productivity considered in faculty promotion. We examine trends in female authorship and effect of student authorship on H-index of principal investigators (PI).</p><p><strong>Methods: </strong>Author gender, degree, designation as student, PI, or other, were recorded from Journal of Endourology from 2011 to 2020. PI Scopus H-index was recorded. PIs were classified into having student authors (SA) or not (nSA). Analysis conducted with IBM SPSS.</p><p><strong>Results: </strong>Of 819 total articles, 26 ​% had SA. Articles with SAs increased from 22.2 ​% in 2011 to 31.1 ​% in 2020 (p for trend<0.01). There was an increasing trend in female authorship overall (R² ​= ​0.84). PIs with SA had a significantly higher mean H-index than those without, across all years (SA ​= ​30.91, nSA ​= ​27.45, p ​= ​0.025).</p><p><strong>Conclusions: </strong>Student authorship is increasing and positively benefits PI H-index. Female authorship is increasing overall within urology. Encouraging mentorship and student research can enhance and support female student interest in urology.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116006"},"PeriodicalIF":2.7,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142405915","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":"Development and dissemination of a series of surgical skills and procedures video tutorials using a novel, low-cost, and sustainable simulation kit (GlobalSurgBox).","authors":"Mayte Bryce-Alberti, Rachel E Wittenberg, Michael J Kirsch, Daniel Bollinger, Kiana Winslow, Matthew T Hey, Raisa Rauf, Barnabas Alayande, Geoffrey A Anderson, Yihan Lin","doi":"10.1016/j.amjsurg.2024.116002","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2024.116002","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical simulation and video-based learning are limited in lower-resource settings. We sought to develop and assess a series of surgical tutorials using a low-cost simulator.</p><p><strong>Methods: </strong>We created 8 surgical skills and procedures videos using low-cost equipment. We assessed video quality using the DISCERN scale and the Global Quality Scale (GQS).</p><p><strong>Results: </strong>Videos ranged from surgical techniques to complex procedures. We uploaded these to Youtube and included them in the curriculum of a medical school in Rwanda. Excluding the cost of the kit (25 USD), production costs ranged from 2 to 5 USD. All videos scored a mean DISCERN of 2.44 ​± ​1.05 and GQS of 3.06 ​± ​0.90. Generally, these lacked points on providing additional sources of information and addressing areas of uncertainty.</p><p><strong>Conclusions: </strong>This study addresses the demand for accessible surgical education resources. Using low-cost, standardized materials ensures consistency, democratization of training, and feasibility.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116002"},"PeriodicalIF":2.7,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387352","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, Sarah B Fisher","doi":"10.1016/j.amjsurg.2024.115995","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2024.115995","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"115995"},"PeriodicalIF":2.7,"publicationDate":"2024-10-04","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":"Practice variations, trends, and outcomes of drain use in thyroidectomy: A NSQIP study.","authors":"Kelvin Memeh, Sara Abou Azar, Oluwasegun Afolaranmi, Tanaz M Vaghaiwalla","doi":"10.1016/j.amjsurg.2024.115998","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2024.115998","url":null,"abstract":"<p><strong>Background: </strong>The benefit of drains remains unclear and variable among thyroid surgeons. This study examines the utility and trend in drain use after thyroidectomy.</p><p><strong>Method: </strong>This is a retrospective cross-sectional study utilizing a pooled sample of thyroidectomy patients from the 2016-2019 NSQIP. The impact of drain use on outcomes of interest (rate of postoperative neck hematoma (PNH)-primary outcome, and length-of-stay (LOS)-secondary outcome), as well as year-over-year and practice variations were evaluated using inverse-probability-weighted-regression adjustment and multivariable logistic regression analyses.</p><p><strong>Results: </strong>Of 24,370 patients, 6673(27.4 ​%) received drains. The average LOS and PNH rates were 27.3 ​h and 1.87 %, respectively. Drain use increased year-over-year for concomitant neck dissections (OR ​= ​1.08,p ​= ​0.002). Year-over-year odds of drain use trended down across specialties (OR ​= ​0.96,p ​= ​0.005); however, ENT used drains more frequently than General Surgeons (RR ​= ​3.06, 95%CI ​= ​2.91-3.22). Drains were associated with longer LOS (mean-difference ​= ​9.6hrs, 95%CI 8.51-10.62) with no effect on PNH rates (RR ​= ​0.96,p ​< ​0.05).</p><p><strong>Conclusion: </strong>Drain use is decreasing, but practice variations across specialties persist. Post-thyroidectomy drain use was associated with longer LOS with no effect on PNHR.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"115998"},"PeriodicalIF":2.7,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387353","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":"Caudate lobe and posterosuperior segment hepatectomy using the robotic approach. Outcome analysis of liver resection in difficult locations","authors":"Trevor Jones,&nbsp;Maria Christodoulou,&nbsp;Sharona Ross,&nbsp;Tara M. Pattilachan,&nbsp;Alexander Rosemurgy,&nbsp;Iswanto Sucandy","doi":"10.1016/j.amjsurg.2024.115996","DOIUrl":"10.1016/j.amjsurg.2024.115996","url":null,"abstract":"<div><h3>Background</h3><div>Caudate and posterosuperior hepatectomy are technically challenging resections, especially in a minimally invasive approach. We aimed to analyze the outcomes of isolated caudate resection (ICR), en-bloc caudate resection with right/left hepatic lobectomy (ECR), and posterosuperior segment resection (PSR) using our institutional database.</div></div><div><h3>Methods</h3><div>Following IRB approval, we prospectively followed 500 consecutive patients between 2013 and 2023 who underwent robotic hepatectomy. Posterosuperior segments include segment 4 ​A, 7, and 8. The data are presented as median (mean ​± ​standard deviation).</div></div><div><h3>Results</h3><div>Of the 500 patients included in this study, 19 (4 ​%) underwent ICR, 65 (13 ​%) underwent ECR, and 131 (26 ​%) patients underwent PSR. ECR was associated with significantly longer operative time, increased EBL, and longer LOS when compared with those of ICR and PSR. The patients who underwent ICR had the shortest operation duration, lowest EBL, and shortest LOS compared to ECR and PSR.</div></div><div><h3>Conclusions</h3><div>Robotic resection of liver tumors located in difficult segments is safe and feasible with excellent clinical and oncological outcomes. With appropriate expertise, a minimally invasive approach to those operations should not be avoided.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"239 ","pages":"Article 115996"},"PeriodicalIF":2.7,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142405917","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}