American Surgeon最新文献

Propensity Score Matching: A Step-by-Step Guide to Coding in R and Application in Observational Research Studies. 倾向得分匹配：一步一步的指南在R编码和应用观察研究。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-11-01 Epub Date: 2025-06-02 DOI: 10.1177/00031348251331293

Melissa A Kendall, Tyler Zander, Rachel L Wolansky, Lucas Teixeira, Paul C Kuo

{"title":"Propensity Score Matching: A Step-by-Step Guide to Coding in R and Application in Observational Research Studies.","authors":"Melissa A Kendall, Tyler Zander, Rachel L Wolansky, Lucas Teixeira, Paul C Kuo","doi":"10.1177/00031348251331293","DOIUrl":"10.1177/00031348251331293","url":null,"abstract":"Although randomized controlled trials are the gold standard approach to identify relationships between an intervention and outcomes, observational studies remain invaluable. They allow for increased study power and efficiency, decreased cost, and demonstrate unique relationships that would be otherwise unfeasible or unethical. However, they are inherently biased by their non-randomized nature. Propensity score matching (PSM) combats this. We outline a step-by-step guide, from PICO question development, database and data processing/analytics software selection, and PSM coding techniques. We demonstrate this through an example evaluating cholecystectomy timing and outcomes in pregnant patients with cholecystitis. We discuss matching methods selected based on data set characteristics. Average Treatment Effect on the Treated (ATT) is applied to evaluate the intervention effect on patients who received the intervention. Balance between the intervention and comparison groups pre- and post-PSM is demonstrated mathematically by calculating standard mean differences and visually with Love Plots. Finally, treatment effect post-PSM is evaluated.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1949-1955"},"PeriodicalIF":0.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12354325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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

Can American Board of Surgery in Training Examinations be passed by Large Language Models? Comparative assessment of Gemini, Copilot, and ChatGPT. 大型语言模型能否通过美国外科培训委员会考试？双子星、副驾驶和ChatGPT的比较评估。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-11-01 Epub Date: 2025-05-12 DOI: 10.1177/00031348251341956

Ahmet Necati Sanli, Deniz Esin Tekcan Sanli, Ali Karabulut

{"title":"Can American Board of Surgery in Training Examinations be passed by Large Language Models? Comparative assessment of Gemini, Copilot, and ChatGPT.","authors":"Ahmet Necati Sanli, Deniz Esin Tekcan Sanli, Ali Karabulut","doi":"10.1177/00031348251341956","DOIUrl":"10.1177/00031348251341956","url":null,"abstract":"ObjectiveThis study aimed to evaluate the performance of large language models (LLMs) in answering questions from the American Board of Surgery In-Training Examination (ABSITE).MethodsMultiple choice ABSITE Quiz was entered into the most popular LLMs as prompts. ChatGPT-4 (OpenAI), Copilot (Microsoft), and Gemini (Google) were used in the study. The research comprised 170 questions from 2017 to 2022, which were divided into four subgroups: Definitions, Biochemistry/Pharmaceutical, Case Scenario, and Treatment & Surgical Procedures. All questions were queried in LLMs, between October 1, 2024, and October 5, 2024. Correct answer rates of LLMs were evaluated.ResultsThe correct response rates for all questions were 79.4% for ChatGPT, 77.6% for Copilot, and 52.9% for Gemini, with Gemini significantly lower than both LLMs (P < 0.001). In the definition category, the correct response rates were 93.5% for ChatGPT, 90.3% for Copilot, and 64.5% for Gemini, with Gemini significantly lower (P = 0.005 and P = 0.015, respectively). In the Biochemistry/Pharmaceutical question category, the correct response rates were equal in all three groups (83.3%). In the Case Scenario category, the correct response rates were 76.3% in ChatGPT, 72.8% for Copilot, and 46.5% for Gemini, with Gemini significantly lower (P < 0.001). In the Treatment & Surgical Procedures category, the correct response rates were 69.2% for ChatGPT, 84.6% for Copilot, and 53.8% for Gemini. Although Gemini had the lowest accuracy, there was no statistically significant difference (P = 0.236).ConclusionIn the ABSITE Quiz, ChatGPT and Copilot had similar success, whereas Gemini was significantly behind.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1923-1929"},"PeriodicalIF":0.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958974","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

Risk Factor Analysis for Trauma Patients Readmitted Within 30 Days. 创伤患者30天内再入院的危险因素分析。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-11-01 Epub Date: 2025-08-24 DOI: 10.1177/00031348251371213

Hannah Tan, Seth A Battad, Caleb W Brown, Derek C Wenger, Alexis N Lacey, Jared M Lentchner, Michael A Zaskey, Sarah A King, Hannah E Collins, Lou M Smith, J Bracken Burns

{"title":"Risk Factor Analysis for Trauma Patients Readmitted Within 30 Days.","authors":"Hannah Tan, Seth A Battad, Caleb W Brown, Derek C Wenger, Alexis N Lacey, Jared M Lentchner, Michael A Zaskey, Sarah A King, Hannah E Collins, Lou M Smith, J Bracken Burns","doi":"10.1177/00031348251371213","DOIUrl":"10.1177/00031348251371213","url":null,"abstract":"BackgroundUnplanned hospital readmissions within 30 days of discharge for trauma (UR-30) are associated with adverse outcomes but remain underexplored in trauma populations.MethodsThis study retrospectively reviewed 164 trauma patients at a Level I center during 2022-2023, analyzing demographics, comorbidities, injury severity, socioeconomic factors, medications, and hospital events. Propensity matching ensured comparability between 82 UR-30 and 82 patients not readmitted (NoReadmission-30).ResultsKey findings include median hospital length of stay (LOS) of 5 days for UR-30 vs 3 days for NoReadmission-30 (P = .022) and ICU LOS of 2 vs 0 days (P < .001), respectively. Final in-hospital hemoglobin was lower in UR-30 (10.7 vs 12; P = .014). Discharge home rates were lower for UR-30 (51.2% vs 69.5%; P = .017). Transfusion requirements significantly increased readmission risk, with UR-30 patients 6.7 times more likely to be readmitted. Significant comorbidities included smoking (P = .042), hyperlipidemia (P = .012), CHF (P = .013), substance use disorder (P = .043), and ≥3 comorbid diagnoses (P = .001). Most readmissions were for infections, neurological decline, and inadequate pain control. Discharge on anticoagulants (P = .007) or with ≥7 discharge medications (P < .001) increased readmission likelihood, while chronic NSAID use reduced it (P = .046). Family as PoA was more common in UR-30 (83% vs 40%; P < .001). Non-significant factors included discharge vital signs, injury mechanism, insurance, and race.DiscussionUR-30 occurs predominantly in moderately injured patients and is influenced by ICU and hospital LOS, discharge disposition, comorbidities, and transfusion status, underscoring its value as a trauma quality metric.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1862-1867"},"PeriodicalIF":0.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939151","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

Association Between Unlocked Firearms and Pediatric Accidental Gunshot Wounds. 未上锁枪支与儿童意外枪伤之间的关系。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-11-01 Epub Date: 2025-08-15 DOI: 10.1177/00031348251367050

Bailee K Price, Alexander P McNally, Steven G Miller, Kevin A Slaughter, Ryan Deci, Yann-Leei L Lee, Ashley Y Williams, C Caleb Butts, Maryann I Mbaka, Andrew C Bright, Jon D Simmons, Thomas Capasso, Chistopher M Kinnard, Courtney Thomson, Kayla Hall, Nathan M Polite

{"title":"Association Between Unlocked Firearms and Pediatric Accidental Gunshot Wounds.","authors":"Bailee K Price, Alexander P McNally, Steven G Miller, Kevin A Slaughter, Ryan Deci, Yann-Leei L Lee, Ashley Y Williams, C Caleb Butts, Maryann I Mbaka, Andrew C Bright, Jon D Simmons, Thomas Capasso, Chistopher M Kinnard, Courtney Thomson, Kayla Hall, Nathan M Polite","doi":"10.1177/00031348251367050","DOIUrl":"10.1177/00031348251367050","url":null,"abstract":"ObjectivesFirearm-related injury has been the leading cause of mortality among the pediatric population since 2019. Some states have adopted gun storage legislation intending to reduce the incidence of pediatric firearm injuries; Alabama currently has no related statutes. The effectiveness of gun storage laws remains unclear. Herein, we hypothesize that firearm injuries among younger pediatric patients in our region are predominantly associated with unintentional discharge.MethodsA retrospective analysis at our Level 1 Trauma Center from 2019 to 2024 was conducted to determine the incidence of pediatric firearm injury data in Mobile, Alabama. Secondary demographic and injury data were defined, and geospatial mapping was performed comparing injury incidence and other socioeconomic factors.ResultsA total of 194 pediatric firearm injury cases were evaluated during the study period, 26% of which were unintentional. The incidence of unintentional injury during this period was 8.5/100,000 per year. By race, unintentional pediatric gunshot wounds were more common amongst Caucasian or White patients (53%), followed by Black or African American (43%). Intentional pediatric gunshot wounds were more prevalent in Black or African American patients (90%), followed by White (7%). Among children aged 0-5 and 13-17, most firearm injuries were intentional (62% and 67%, respectively), while for ages 6-12, the majority (52%) were unintentional. By sex, intentional injuries were most common among both males (59%) and females (74%).ConclusionOur report of unintentional pediatric firearm injuries in Mobile, Alabama may help guide injury prevention efforts in our region around pediatric.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1857-1861"},"PeriodicalIF":0.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858801","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

Intracranial Pressure Monitor Insertion in Isolated Traumatic Brain Injury: Does Timing Matter? 颅内压监测仪在孤立性创伤性脑损伤中的植入：时机重要吗？

IF 0.9 4区医学

American Surgeon Pub Date : 2025-11-01 Epub Date: 2025-08-01 DOI: 10.1177/00031348251363504

Michael D Gaziano, Peter Aziz, Alison Muller, Anthony Martin, H Christopher Lawson, Eugene F Reilly, Christopher A Butts, Thomas A Geng, Adrian W Ong

{"title":"Intracranial Pressure Monitor Insertion in Isolated Traumatic Brain Injury: Does Timing Matter?","authors":"Michael D Gaziano, Peter Aziz, Alison Muller, Anthony Martin, H Christopher Lawson, Eugene F Reilly, Christopher A Butts, Thomas A Geng, Adrian W Ong","doi":"10.1177/00031348251363504","DOIUrl":"10.1177/00031348251363504","url":null,"abstract":"BackgroundIntracranial pressure monitoring (ICPM) is recommended in selected patients with severe traumatic brain injury (sTBI). Optimal timing of ICPM insertion after sTBI is not well studied. We aimed to evaluate if timing of ICPM insertion would impact outcomes.Materials and MethodsWe utilized data from 2018 to 2021 from the American College of Surgeons Trauma Quality Improvement Program. Patients ≥16 years from level 1 and 2 trauma centers with isolated blunt sTBI were included. Nonsurvivable brain injury (AIS-head = 6) and those needing emergent open cranial (OC) procedures within 2 hours of admission were excluded. Timing of ICPM insertion was categorized as follows: no ICPM insertion, ≤4 h, >4 to ≤12 h, and >12 h. Binary logistic regression analysis was used to assess variables associated with mortality.Results17 715 patients were included. 2525 (14%) had ICPM placed, 2613 (15%) underwent open cranial surgery, and 8757 (49%) died. There was no ICPM insertion in 86% while 8%, 4%, and 2% underwent ICPM insertion ≤4 h, >4 to ≤12 h, and >12 h, respectively. Compared to no ICPM, insertion ≤4 h (odds ratio [OR] 0.94 [0.82-1.09]), >4 to ≤12 h (OR 1.18 [0.97-1.43]), and >12 h (OR 1.02 [0.81-1.31]), respectively, were not associated with mortality. Open cranial procedure was associated with reduced risk of death (OR 0.40 [0.36-0.45]).DiscussionFor blunt isolated sTBI, Timing of ICPM insertion was not associated with mortality reduction. Early ICPM insertion may be less important than expeditious OC.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1845-1850"},"PeriodicalIF":0.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144758895","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

Primary Osteosarcoma of the Breast: A Rare and Aggressive Entity. 乳腺原发性骨肉瘤：一种罕见的侵袭性肿瘤。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-11-01 Epub Date: 2025-06-03 DOI: 10.1177/00031348251346541

Paul E Creger, Michael G Mount, Richard B Reinhardt

引用次数: 0

A Nomenclature for Surgical Knots and the Principles of Knot Security. 外科结的命名法和结安全原理。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-11-01 Epub Date: 2025-07-03 DOI: 10.1177/00031348251358436

Thomas J O'Keefe, Bard C Cosman, Louis A Perkins, Isabella Guajardo, Laura M Adams, William D Ardill, Bruce M Potenza

引用次数: 0

Evaluating Resource Utilization After Implementation of a Minimal Traumatic Brain Injury Guideline at a Rural Appalachian Level 1 Trauma Center. 评估阿巴拉契亚农村一级创伤中心实施最小创伤性脑损伤指南后的资源利用。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-11-01 Epub Date: 2025-06-30 DOI: 10.1177/00031348251356740

Verina M Sawiers, Lauren E Phemister, Samuel D Cartwright, Matthew A Leonard, Hannah W Collins, Keelin F Roche, Bracken Burns

引用次数: 0

Prospective Evaluation of Chest Tube Thoracostomy Placement by General Surgery Residents at Two Level I Trauma Centers. 两个一级创伤中心普外科住院医师胸腔插管置入的前瞻性评价。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-11-01 Epub Date: 2025-07-29 DOI: 10.1177/00031348251363542

Zachary Shelton, Baytes Gabriel Regan-Jordan, Vinila Baljepally, Tyler Locke, Chase Hayman, Ethan Ward, Sarah King, Lou Smith

{"title":"Prospective Evaluation of Chest Tube Thoracostomy Placement by General Surgery Residents at Two Level I Trauma Centers.","authors":"Zachary Shelton, Baytes Gabriel Regan-Jordan, Vinila Baljepally, Tyler Locke, Chase Hayman, Ethan Ward, Sarah King, Lou Smith","doi":"10.1177/00031348251363542","DOIUrl":"10.1177/00031348251363542","url":null,"abstract":"IntroductionOur study proposes to define accuracy of and identify areas in general surgery residents (GSR) chest tube thoracostomy (CTT) placement addressable by improved education and supervision.MethodsProspective study of resident-performed CTT from June-August 2023 and 2024 in two Level 1 trauma centers. Data collection/analysis included demographics, tube type, proceduralist PGY, placement accuracy, patient factors, and outcomes.ResultsSeventy-seven CTT were placed by GSR. Average patient age was 57 ± 16.8. 75% were male. Smokers, COPD diagnosis, and prior chest wall radiation patients experienced more resident-CTT placement errors. CTT were standard 28-32F tubes (58; 75%) and small-bore pleural catheters (19; 25%). CTT was adequate in 62 (80.5%), 19.5% were sub-optimal. Placement problems included sentinel hole outside the chest (7, 9.1%), extrapleural location (5, 6.5%), kinked tube (3, 3.9%), and ineffective fissural tube (1, 1.3%). Interns placed 41 CTT, 7 by PGY-2, 11 by PGY-3, 7 by PGY-4, and 10 PGY-5 surgery residents. PGY-1 residents had a higher incidence of CTT retraction (35%, P = 0.042). Retracted, poorly secured CTT had a longer duration compared to well-secured CTT (6 days [4-7] vs 3 [2-4], P = 0.019); but didn't affect hospital LOS (P = 0.651). No other differences based on PGY were noted.DiscussionGSR's CTT placement has an accuracy of 80%. Placement problems occur at all levels of residency training. Our findings highlight actionable training targets and recommend areas of enhanced supervision to improve GSR mastery of CTT.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1834-1839"},"PeriodicalIF":0.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144740975","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

Trauma Team Activation Criteria Effectiveness for the Management of Geriatric Patient Fall Injuries. 创伤小组激活标准对老年患者跌倒损伤管理的有效性。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-11-01 Epub Date: 2025-07-03 DOI: 10.1177/00031348251358437

Robert M Branstetter, William P Le Clercq, Monique St Romain, John P Hunt, Alan B Marr, Patrick Greiffenstein, Lance E Stuke, Jonathan E Schoen, Juan C Duchesne, Alison A Smith

引用次数: 0