American Surgeon最新文献

Remnant Gallbladder Cholecystitis After Subtotal Cholecystectomy: Management and Outcome.

IF 1 4区医学

American Surgeon Pub Date : 2025-03-29 DOI: 10.1177/00031348251328493

Aviv Ben Zvi, Amir Dagan, Michael R Freund, Shlomo Yellinek, Menahem Ben-Haim, Elad Boaz

{"title":"Remnant Gallbladder Cholecystitis After Subtotal Cholecystectomy: Management and Outcome.","authors":"Aviv Ben Zvi, Amir Dagan, Michael R Freund, Shlomo Yellinek, Menahem Ben-Haim, Elad Boaz","doi":"10.1177/00031348251328493","DOIUrl":"https://doi.org/10.1177/00031348251328493","url":null,"abstract":"BackgroundSubtotal cholecystectomy (STC) is a viable alternative for challenging cases of severely acute or chronic inflammation of the gallbladder. However, despite its advantages, patients undergoing STC still face the risk of developing symptomatic gallstones in the remnant gallbladder. In such cases, redo resection of the gallbladder remnant is required, posing some technical challenges. In this report, we share our experience in diagnosing and surgical management of remnant gallbladder cholecystitis.MethodsA retrospective study of all patients admitted to a tertiary care hospital with symptoms directly linked to gallbladder remnant stones from 2018 to 2023 was performed.ResultsSix patients were admitted with symptoms directly linked to gallbladder remnant stones. The median age at presentation was 50 years (IQR 25-75), with median interval between the index surgery and the current presentation of 9.5 months (IQR 3-90). The presentation varied and included stump cholecystitis, cholangitis, Mirizzi syndrome, and liver abscess. All 6 patients underwent laparoscopic redo cholecystectomy, with 1 conversion to open surgery and without major complications. Symptoms resolved in all patients.ConclusionsSymptomatic gallstone disease in remnant gallbladder is rare and requires redo cholecystectomy. According to our limited series, laparoscopic redo cholecystectomy may be feasible and safe.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251328493"},"PeriodicalIF":1.0,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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

Lacunar Ligament Release for Emergent Repair of Strangulated Femoral Hernia.

IF 1 4区医学

American Surgeon Pub Date : 2025-03-28 DOI: 10.1177/00031348251329483

Wei Wei, John Ferrara

引用次数: 0

Comparison of Local and General Anesthesia on 30-Day Outcomes of Emergency Infrainguinal Endovascular Revascularization for Patients with Chronic Limb-Threatening Ischemia.

IF 1 4区医学

American Surgeon Pub Date : 2025-03-28 DOI: 10.1177/00031348251331295

Renxi Li, Anton Sidawy, Bao-Ngoc Nguyen

{"title":"Comparison of Local and General Anesthesia on 30-Day Outcomes of Emergency Infrainguinal Endovascular Revascularization for Patients with Chronic Limb-Threatening Ischemia.","authors":"Renxi Li, Anton Sidawy, Bao-Ngoc Nguyen","doi":"10.1177/00031348251331295","DOIUrl":"https://doi.org/10.1177/00031348251331295","url":null,"abstract":"BackgroundInfrainguinal endovascular interventions can be the first-choice treatment for suitable patients with peripheral artery disease (PAD). However, the choice of anesthesia for infrainguinal endovascular procedures, particularly in emergency situations, remains underexplored. This study aimed to conduct a retrospective analysis based on a multi-institutional nationwide registry to compare the 30-day outcomes of patients with chronic limb-threatening ischemia (CLTI) who received either local anesthesia (LA) or general anesthesia (GA) during emergency infrainguinal endovascular interventions.MethodsPatients who underwent emergency infrainguinal endovascular revascularization for CLTI (tissue loss or rest pain) were selected from the ACS-NSQIP database from 2012-2022. Multivariable logistic regression was used to compare 30-day outcomes between patients under GA and LA, where demographics, baseline characteristics, and symptomatology were adjusted.ResultsAmong 703 patients, 292 (41.54%) were under LA, and 411 (58.46%) were under GA. Patients under LA had lower bleeding requiring transfusion (aOR = 0.428, 95 CI = 0.281-0.653, P < 0.01), lower postoperative wound complications (aOR = 0.289, 95 CI = 0.137-0.612, P < 0.01), and shorter operative time (102.00 ± 72.38 vs 150.70 ± 105.40 minutes, P < 0.01). All other 30-day outcomes, including mortality, organ system complications, and limb-specific outcomes, were comparable between patients under LA and GA.ConclusionLA and GA can be considered equivalent options for eligible CLTI patients undergoing emergency infrainguinal endovascular revascularization, with close monitoring of wound and bleeding complications recommended for GA patients. Further studies are necessary to evaluate long-term outcomes in these patients.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251331295"},"PeriodicalIF":1.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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

Access to Care in the LGBTQIA+ Population.

IF 1 4区医学

American Surgeon Pub Date : 2025-03-27 DOI: 10.1177/00031348251329484

Charis Ripley-Hager, Andrew T Schlussel

引用次数: 0

Impact of Limited Access to Surgical Care in Medically Underserved Communities.

IF 1 4区医学

American Surgeon Pub Date : 2025-03-27 DOI: 10.1177/00031348251324265

Shebiki Beaton, Theodora Abah, Kimberly Miller-Hammond

{"title":"Impact of Limited Access to Surgical Care in Medically Underserved Communities.","authors":"Shebiki Beaton, Theodora Abah, Kimberly Miller-Hammond","doi":"10.1177/00031348251324265","DOIUrl":"https://doi.org/10.1177/00031348251324265","url":null,"abstract":"Summary/BackgroundMedically underserved communities and ethnic minorities constitute a significant portion of the vulnerable population within the United States. Recent changes in the health care structure, rising inflation with a decline in median household income, and the SARS-CoV-2 pandemic have disproportionately impacted communities of low socioeconomic status. Healthcare providers and federal organizations must be aware of how these factors influence access to surgical care to tailor treatment, interventions, and policies better to meet the needs of these populations.MethodWe systematically reviewed 19 articles to identify key factors influencing barriers to health care for minority populations and how the dynamic changes in healthcare structures can further exacerbate this divide.DiscussionMedically underserved populations face significant barriers to health care due to socioeconomic factors like income, housing instability, and lack of insurance. These areas often have shortages of primary care providers, access to healthy foods, and high-value health care that may lead to unfavorable outcomes. Poor access and utilization of health services can also affect hospital systems, leading to decreased funding and increased hospital closures. Despite federal intervention and policy changes, the need for further support for rural healthcare institutions and underserved populations remains, requiring financial assistance, resource allocation improvements, and incentives for healthcare providers and investors.ConclusionHealthcare systems can work towards bridging the gap in access to surgical services by implementing targeted outreach programs and ensuring equitable resource distribution. Additionally, fostering partnerships with community organizations can enhance awareness and address specific barriers these populations face.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251324265"},"PeriodicalIF":1.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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

Optimizing Pediatric Resuscitation: Evidence-Based Approaches and Emerging Trends.

IF 1 4区医学

American Surgeon Pub Date : 2025-03-26 DOI: 10.1177/00031348251329503

Micaela K Gomez, Lucas P Neff

引用次数: 0

Quality Verification in Surgical Subspecialty Programs.

IF 1 4区医学

American Surgeon Pub Date : 2025-03-25 DOI: 10.1177/00031348241298073

Anton N Sidawy

{"title":"Quality Verification in Surgical Subspecialty Programs.","authors":"Anton N Sidawy","doi":"10.1177/00031348241298073","DOIUrl":"https://doi.org/10.1177/00031348241298073","url":null,"abstract":"In 2001, the Institute of Medicine defined 6 domains in quality health care: safe, effective, patient-centered, timely, efficient, and equitable. In 2010, the Affordable Care Act (ACA) or Obamacare, was passed into law. In addition to the well-known health insurance reform, it introduced delivery system redesign based on quality performance. Basically, it heralded a transition of reimbursement from payment for service and volume to payment for quality and value. Defining value is rather elusive; but if one considers that value equals quality divided by cost, payers aim to increase the value of a service either by improving quality, decreasing cost, or, preferably for them, both. The question is who defines value and quality of surgical services. Surgical specialists and their professional organizations should. Such organizations have the knowledge in their specialty but usually lack the infrastructure necessary to do so; but quality verification programs can be established in collaboration with the American College of Surgeons (ACS). ACS has had a long history of establishing quality verification programs; it has the infrastructure and the experienced personnel to do so. All ACS verification programs are based on four guiding principles: Setting standards based on evidence based guidelines, building the right infrastructure based on the standards, collecting the appropriate outcome data, and verifying compliance with the standards by site visit by outside experts. In this article, I outline the reasons for establishing verification programs, the process used to establish and maintain such programs, and their implications using the ACS/SVS (Society for Vascular Surgery) Vascular Verification Program as an example.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348241298073"},"PeriodicalIF":1.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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 the National Cancer Database in Identifying Disparities in Cancer Treatment.

IF 1 4区医学

American Surgeon Pub Date : 2025-03-24 DOI: 10.1177/00031348251329497

Fatima Mubarak, Emmanuel M Gabriel, Jade C Bowers

引用次数: 0

The Impact of Sarcopenia on Postoperative Outcomes in Colorectal Cancer Surgery: An Updated Systematic Review and Meta-Analysis.

IF 1 4区医学

American Surgeon Pub Date : 2025-03-24 DOI: 10.1177/00031348251329748

Sara Keshavjee, Tyler Mckechnie, Victoria Shi, Muhammad Abbas, Elena Huang, Nalin Amin, Dennis Hong, Cagla Eskicioglu

{"title":"The Impact of Sarcopenia on Postoperative Outcomes in Colorectal Cancer Surgery: An Updated Systematic Review and Meta-Analysis.","authors":"Sara Keshavjee, Tyler Mckechnie, Victoria Shi, Muhammad Abbas, Elena Huang, Nalin Amin, Dennis Hong, Cagla Eskicioglu","doi":"10.1177/00031348251329748","DOIUrl":"https://doi.org/10.1177/00031348251329748","url":null,"abstract":"Sarcopenia is thought to be a marker for underlying frailty and malnutrition, contributing to poor functional status and suboptimal healing postoperatively. We aimed to complete an updated systematic review and meta-analysis evaluating the impact of sarcopenia on short- and long-term outcomes following colorectal cancer surgery. We searched MEDLINE, Embase, and CENTRAL up to September 2023. Studies that compared sarcopenic and non-sarcopenic patients' short- and long-term outcomes following curative intent elective surgery for colorectal cancer were included. The main outcomes included postoperative morbidity, postoperative mortality, and length of stay (LOS), among others. Inverse variance random effects meta-analyses was performed. Risk of bias was assessed with Cochrane tools. Certainty of evidence was assessed with GRADE. After screening 215 studies, we included 40 non-randomized studies, totalling 13,422 patients, of which 5,432 (40.4%) were classified as sarcopenic. Across 27 studies, patients with sarcopenia were more likely to experience 30-day postoperative morbidity (40% vs 33%, RR 1.30, 95% CI 1.12-1.50, P < 0.01, I2 79%). The mean LOS was 1.46 days longer for sarcopenic patients (26 studies, 95% CI 0.85-2.07, P < 0.01, I2 82%). Upon pooling data from 13 studies, sarcopenic patients had increased risk of 30-day postoperative mortality (2.8% vs 1.0%, RR 2.74, 95% CI 1.63-4.62, P < 0.01, I2 0%). The findings from this systematic review suggest with low to very-low certainty evidence that in patients who are undergoing curative intent surgery for colorectal cancer, preoperative sarcopenia is associated with poor postoperative outcomes.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251329748"},"PeriodicalIF":1.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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

Outcomes After Damage Control Laparotomy Among White, American Indian, and Alaska Native Populations.

IF 1 4区医学

American Surgeon Pub Date : 2025-03-24 DOI: 10.1177/00031348251329501

Conor S Roche, Anthony J Duncan, Mark R Williamson, Mentor Ahmeti

{"title":"Outcomes After Damage Control Laparotomy Among White, American Indian, and Alaska Native Populations.","authors":"Conor S Roche, Anthony J Duncan, Mark R Williamson, Mentor Ahmeti","doi":"10.1177/00031348251329501","DOIUrl":"https://doi.org/10.1177/00031348251329501","url":null,"abstract":"BackgroundAmerican Indian and Alaska Native (AIAN) populations have been shown to have severe health disparities, with increased 30-day mortality rates and surgical complications. They continue to represent a population that has the worst outcomes, however, still underrepresented within the medical literature. Further research into AIAN is critical to start to determine why these differences exist.MethodsA retrospective review of patients undergoing damage control laparotomies (DCLs) between 2015 and 2024 was conducted. Logistic regression was used to compare variables (age, race, gender, ASA, APACHE II, ICU admission, ventilation, number of operations, and time until abdominal closure).ResultsA total of 502 patients were included in the analysis. 10% of these were AIAN. The AIANs undergoing DCL had a mean age of 47.5 years, whereas White patients had a mean age of 62.1 years (P < 0.0001). There were no statistically significant differences in mortality rates. Non-mortality complications were equally distributed between the 2 groups. Logistic regression analysis identified age, APACHE II score, and procedure count as significant predictors of mortality.ConclusionsAmerican Indians are presenting at notably younger ages compared to their White counterparts (62 vs 48 years old). Despite comparable outcomes between the groups, this highlights a distinct age-related gap within our AIAN population, underscoring the necessity for heightened care in this specific patient demographic.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251329501"},"PeriodicalIF":1.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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