American Surgeon最新文献

{"title":"Barriers to Surgical Health Care Access in Rural Communities.","authors":"Kimberly Miller-Hammond, David Anderson","doi":"10.1177/00031348251323712","DOIUrl":"https://doi.org/10.1177/00031348251323712","url":null,"abstract":"<p><p>Rural surgical care is a dying specialty that needs aid. The current rural surgeon workforce is retiring at an alarming rate, and rural hospital closures diminish the accessibility of surgical care for its population. Action is needed to increase the number of surgeons entering the rural surgical field. Identifying individuals with rural backgrounds and interests needs to be paramount. Those individuals must be mentored and guided to build the surgical workforce in these communities. In addition, recruiting and retaining surgeons in these areas requires innovative solutions and strategies.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251323712"},"PeriodicalIF":1.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514343","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}

{"title":"Language Barriers in Appendicitis: What is the Cost?","authors":"Brittany E Levy, Jennifer T Castle, Lekha P Devara, Elena C Manauis, Hannah G McDonald, Wesley A Stephens, Daniel L Davenport, Eric J Rellinger, David J Worhunsky","doi":"10.1177/00031348251323710","DOIUrl":"https://doi.org/10.1177/00031348251323710","url":null,"abstract":"<p><strong>Background: </strong>In clinical scenarios, pediatricians prefer patient history over imaging to diagnose pediatric appendicitis because they wish to limit their patients' exposure to radiation. Language barriers between providers and patients with limited English proficiency may increase adverse outcomes, require more imaging studies, and lead to higher costs in cases of pediatric appendicitis.</p><p><strong>Methods: </strong>We queried the pediatric-National Surgical Quality Improvement Project database for patients under age 16 who received appendectomies from 2011-2021 at a single institution. Patients were propensity matched based on age, gender, Hispanic ethnicity, and insurance status. Medical records and hospital billing were merged to obtain primary language, initial hospitalization cost, diagnostic work up modalities, and operative findings. Patients identifying English as their primary language were termed English proficient (EP). Those selecting an alternate primary language made up the limited English proficiency (LEP) cohort. Health care utilization outcomes including cost, length of stay (LOS), and imaging usage were compared across cohorts.</p><p><strong>Results: </strong>400 patients were matched for analysis: 92 were EP and 109 LEP. When compared with the EP cohort, patients with LEP had higher rates of diagnostic imaging, longer median LOS, and higher median hospital costs. Imaging costs were also higher in patients with LEP. We also observed higher rates of negative appendectomy in the EP patients, compared to the LEP cohort.</p><p><strong>Discussion: </strong>In patients with LEP, language diversity creates communication barriers resulting in higher health care utilization. Significant variations in the cost of care, efficiency of care, and clinical outcomes related to language diversity should be reduced to ensure equitable health care delivery to all pediatric surgical patients.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251323710"},"PeriodicalIF":1.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514344","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}

{"title":"Cancer and Trauma Collide: Injury Patterns and Outcomes in the Pediatric Trauma Patient With Cancer.","authors":"Brittany Sullivan, John Schomberg, Josephine Haduong, Sourav K Bose, Yigit S Guner, Andreina Giron, Maryam Gholizadeh, Peter T Yu","doi":"10.1177/00031348251323703","DOIUrl":"https://doi.org/10.1177/00031348251323703","url":null,"abstract":"<p><strong>Purpose: </strong>There is a lack of data regarding pediatric trauma patients with a cancer diagnosis. The purpose of our study is to analyze demographics, ED admissions, procedures, and characteristics pertaining to this population.</p><p><strong>Methods: </strong>The NTDB database was queried from 2007 to 2022. This study collected 1,726,681 trauma admissions ≤18. Of these patients, 397 were identified with a cancer diagnosis and had received chemotherapy within 30 days of their trauma admission.</p><p><strong>Results: </strong>The median age of trauma patients with cancer was 9 years old vs 12 years old for non-cancer patients (<i>P</i> = 0.14), but cancer patients had a longer length of stay compared to patients without a cancer diagnosis (4.3 +/- 10 vs 3 +/- 5.7, <i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>We conclude that pediatric trauma patients with a cancer diagnosis had a longer length of stay despite a similar injury severity score, were less likely to sustain spinal cord injuries, but more likely to receive transfusions when compared to non-cancer trauma patients. There is need for further research regarding traumatic injuries in this patient population.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251323703"},"PeriodicalIF":1.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497886","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}

{"title":"Safety and Efficacy of the Falciformopexy Technique for Peptic Ulcer Perforation: A Systematic Review and Meta-Analysis.","authors":"Leonardo Januário Campos Cardoso, Kleuber Arias Meireles Martins, Paulo Vitor Marques Xavier, Filipe Gabriel Oliveira Nascimento, Pedro Henrique Gibram Gontijo, Juan Lima Minkauskas, Isabela Coutinho Faria, Ronaldo Duarte Araújo Abreu, Alexandre Lages Savassi Rocha, Jorge Walker Vásquez Del Aguila","doi":"10.1177/00031348251323722","DOIUrl":"https://doi.org/10.1177/00031348251323722","url":null,"abstract":"<p><strong>Objectives: </strong>Peptic ulcer perforation (PUP) is a severe complication of peptic ulcer disease, associated with significant morbidity and mortality. The Graham patch repair (GPR) is the standard surgical treatment; however, when the greater omentum is insufficient, falciformopexy has emerged as a viable alternative. This study aims to assess the efficacy and safety of falciformopexy for PUP through a systematic review and meta-analysis.</p><p><strong>Methods: </strong>A systematic search was conducted in PubMed, Scopus, Cochrane, Web of Science, and Ovid to identify studies reporting on PUP patients treated with falciformopexy. Outcomes evaluated included length of hospital stay, perioperative mortality, wound infections, and reoperation rates. A comparative analysis with patients treated with GPR was also performed. Safety and efficacy outcomes were analyzed using single proportions, while risk ratios (RR) with 95% confidence intervals were pooled for comparative assessments.</p><p><strong>Results: </strong>Six studies involving 868 patients were included, of whom 148 underwent falciformopexy for PUP. The mean hospital stay was 8.76 days (95% CI: 6.5-11.02; I² = 92%). The perioperative mortality rate was 4.38% (95% CI: 0%-10.26%; I² = 53%), the wound infection rate was 6.66% (95% CI: 2.31%-11.02%; I² = 0%), and reoperation was required in 1.76% of cases (95% CI: 0%-4.73%; I² = 0%). Comparative analysis revealed no significant differences between the falciformopexy and GPR groups regarding mortality, wound infections, or reoperation rates.</p><p><strong>Conclusion: </strong>These results indicate that the use of the falciform ligament for PUP repair is associated with low perioperative mortality, wound infection, and reoperation rates, suggesting it is a viable alternative when the omentum is unavailable.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251323722"},"PeriodicalIF":1.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482095","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}

{"title":"Preoperative Oral Antibiotics Preparation is Associated With Improved 30-day Outcomes in Elective Colectomy for Ulcerative Colitis.","authors":"Renxi Li, Susan Kartiko","doi":"10.1177/00031348251323704","DOIUrl":"https://doi.org/10.1177/00031348251323704","url":null,"abstract":"<p><strong>Background: </strong>Ulcerative colitis (UC) is characterized by colonic involvement, where the 10-year risk of colectomy remains high at about 20%. The use of preoperative oral antibiotic preparation (OAP) in colectomy remains a subject of debate and there was limited evidence for UC patients. This study aimed to retrospectively investigate the relationship between OAP and 30-day outcomes following elective colectomy in UC patients using a multi-institutional national dataset.</p><p><strong>Methods: </strong>Patients with UC as the primary indication for colectomy were selected from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2013 to 2022. Thirty-day postoperative outcomes were compared by multivariable logistic regression, where demographics, baseline characteristics, preoperative preparation, and operative approaches were adjusted.</p><p><strong>Results: </strong>Among 6075 patients who underwent elective colectomy for UC, 3193 (52.56%) of them received preoperative OAP. Patients with OAP had lower cardiac complications (aOR = 0.358, 95 CI = 0.137-0.932, <i>P</i> = 0.04), pulmonary complications (aOR = 0.686, 95 CI = 0.494-0.952, <i>P</i> = 0.02), bleeding requiring transfusion (aOR = 0.738, 95 CI = 0.601-0.906, <i>P</i> < 0.01), wound complications (aOR = 0.626, 95 CI = 0.527-0.743, <i>P</i> < 0.01), prolonged postoperative nothing by mouth (NPO) or nasogastric tube (NGT) use (aOR = 0.781, 95 CI = 0.678-0.901, <i>P</i> < 0.01), and 30-day readmission (aOR = 0.811, 95 CI = 0.676-0.972, <i>P</i> = 0.02). Moreover, patients with OAP had shorter length of stay (<i>P</i> < 0.01).</p><p><strong>Conclusion: </strong>The use of OAP in elective UC colectomy was shown to have additional benefits beyond surgical site infections. Further large-scale randomized trials may be needed to determine the cause and effect of these observations.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251323704"},"PeriodicalIF":1.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490406","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}

{"title":"Bilateral Breast Cancer.","authors":"Keiichiro Tada","doi":"10.1177/00031348251323713","DOIUrl":"https://doi.org/10.1177/00031348251323713","url":null,"abstract":"<p><p>This article is a review of the characteristics of bilateral breast cancer (BBC). Synchronous bilateral breast cancer (SBBC) and metachronous bilateral breast cancer (MBBC) account for 2.9-3.9% and 4.1-4.6% of all new breast cancer cases, respectively. The risk factors for SBBC include older patient age and lobular histology. On the other hand, younger age, lobular histology, and positive family history (or genetic factors) are the risk factors for MBBC. Contralateral prophylactic mastectomy in patients with mutations in the <i>BRCA1/2</i> genes has been reported to increase survival rates. The prognosis of patients with SBBC is worse than the prognosis of patients with unilateral breast cancer (UBC). The prognosis of patients with MBBC compared to patients with UBC remains undetermined because the ages of patients and the intervals between the occurrence of two primary breast cancers appear to have a major impact on survival outcomes. The differences between SBBC and MBBC need clarification to increase our understanding of BBCs.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251323713"},"PeriodicalIF":1.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466801","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}

{"title":"Factors Predicting Incidentally Found Appendiceal Tumors Following Appendectomy: Propensity Score Matching Analysis.","authors":"Sadettin Er, Abidin Göktaş Goktas, Sabri Özden Ozden, Merve Akın Akin, Tezcan Akın Akin, Hüseyin Fahri Martlı Martli, Arzu Hazal Aydın Aydin, Birkan Birben, Fatih Acehan","doi":"10.1177/00031348251323706","DOIUrl":"https://doi.org/10.1177/00031348251323706","url":null,"abstract":"<p><strong>Purpose: </strong>The factors that predict coincidental appendiceal neoplasms in patients who underwent appendectomy due to appendicitis were investigated.</p><p><strong>Methods: </strong>5829 patients diagnosed with appendicitis and underwent appendectomy in the department of surgery were examined. Among these patients, patients with appendiceal neoplasia and benign pathology were selected by propensity score matching analysis in a ratio of 1:4. As a result of analysis, 74 and 274 patients were grouped as appendiceal neoplasia and benign pathology, respectively.</p><p><strong>Results: </strong>The mean age of the 348 appendiceal neoplasia and benign pathology groups included in the study was 45.6 and 46.4, respectively. Appendiceal diameter, contrast enhancement in the appendix wall, and neutrophil count were independent parameters for appendiceal neoplasia pathology. The AUC value of the combination of appendix diameter, lack of enhancement in the appendix wall, and neutrophil count in distinguishing appendiceal neoplasia pathology was 0.787.</p><p><strong>Conclusion: </strong>Appendix diameter, lack of wall enhancement, and neutrophil count are the three predictive indicators useful in helping clinicians suspect appendiceal neoplasms.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251323706"},"PeriodicalIF":1.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476201","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}

{"title":"Effects of Exercise Training on Body Composition and Exercise Capacity After Bariatric Surgery: A Systematic Review and Meta-Analysis.","authors":"Jingru Li, Unyong Jo","doi":"10.1177/00031348251313527","DOIUrl":"https://doi.org/10.1177/00031348251313527","url":null,"abstract":"<p><strong>Purpose: </strong>Bariatric surgery is a widely used treatment for obesity; however, it may be associated with certain complications. Effective postoperative management, including lifestyle interventions and exercise training, is essential for optimal outcomes. This study explores the effectiveness of exercise training in postoperative care.</p><p><strong>Methods: </strong>We searched PubMed, Web of Science, Cochrane, and Embase up to April 3, 2024. Articles were screened and data extracted based on inclusion/exclusion criteria. Risk of bias was assessed using RoB 2.0, and data were analyzed with Stata 15.0.</p><p><strong>Results: </strong>Twenty-three articles involving 1940 patients were included; 16 were analyzed quantitatively. Exercise training did not significantly reduce body weight compared to routine care (WMD: -0.26; 95% CI, -2.11 to 1.58; I² = 54%), but it significantly reduced fat mass (WMD: -2.42; 95% CI, -3.50 to -1.34; I² = 42.9%) and maintained lean mass (WMD: 1.40; 95% CI, 0.32 to 2.48; I² = 0.0%). Additionally, it reduced waist circumference (WMD: -2.58; 95% CI, -4.43 to -0.73; I² = 13.4%) and improved exercise capacity (VO₂ max: WMD: 1.88; 95% CI, 0.64 to 3.13; I² = 0.0%).</p><p><strong>Conclusion: </strong>While exercise training did not significantly lower body weight post-surgery, it effectively reduced fat mass, maintained lean mass, and improved waist circumference and exercise capacity. Given the limited sample sizes in most studies, further large-scale controlled trials are warranted for more definitive conclusions, along with further consideration of their long-term impact on health metrics.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251313527"},"PeriodicalIF":1.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143456642","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}

{"title":"Letter re: BMI is Inadequate in Proposing an Immunological Effect of Excess Adipose Tissue.","authors":"Sol Lee, Davin Agustines","doi":"10.1177/00031348251314155","DOIUrl":"https://doi.org/10.1177/00031348251314155","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251314155"},"PeriodicalIF":1.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143447985","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}

{"title":"Letter re: Pathological Examination in Pilonidal Sinus Surgery: Evaluating Necessity and Cost-Effectiveness: A 10-Year Retrospective Analysis.","authors":"İlyas Kudaş, Fatih Başak, Yahya Kemal Çalışkan, Aylin Acar, Hüsna Tosun","doi":"10.1177/00031348251318401","DOIUrl":"https://doi.org/10.1177/00031348251318401","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251318401"},"PeriodicalIF":1.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389599","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}