American Surgeon最新文献

Quality Verification in Surgical Subspecialty Programs. 外科专科项目的质量验证。

IF 1 4区医学

American Surgeon Pub Date : 2025-07-01 Epub 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":"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":"1065-1072"},"PeriodicalIF":1.0,"publicationDate":"2025-07-01","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

Reconstruction of a Sternal Cleft and Ventral Hernia in an Adolescent with Pentalogy of Cantrell Utilizing Titanium Plates. 钛板重建术治疗青少年Cantrell五联症胸骨裂腹疝1例。

IF 1 4区医学

American Surgeon Pub Date : 2025-07-01 Epub Date: 2025-04-01 DOI: 10.1177/00031348251332686

Allison B Frederick, Terence J Camilon, Evert A Eriksson, Minoo N Kavarana, Christian J Streck

引用次数: 0

Management of Synchronous Metastatic Colorectal Cancer With Recurrent Liver Metastasis. 同步转移性结直肠癌伴复发性肝转移的治疗。

IF 1 4区医学

American Surgeon Pub Date : 2025-07-01 Epub Date: 2025-04-29 DOI: 10.1177/00031348251339527

Aram Rojas, Pierce Paterakos, Sarah Hays, Melissa E Hogg

引用次数: 0

Comparison of Outcomes Following Surgery for Diverticulitis Among Immunocompetent and Immunosuppressed Patients. 免疫正常和免疫抑制患者憩室炎手术后预后的比较。

IF 1 4区医学

American Surgeon Pub Date : 2025-07-01 Epub Date: 2025-05-23 DOI: 10.1177/00031348251346532

Usama Waqar, Christina Gozza, Courtney L Devin, Terrah J Paul Olson, Seth A Rosen

{"title":"Comparison of Outcomes Following Surgery for Diverticulitis Among Immunocompetent and Immunosuppressed Patients.","authors":"Usama Waqar, Christina Gozza, Courtney L Devin, Terrah J Paul Olson, Seth A Rosen","doi":"10.1177/00031348251346532","DOIUrl":"10.1177/00031348251346532","url":null,"abstract":"BackgroundThe prevalence of immunosuppressed (IS) patients is on the rise, posing unique challenges during colectomy for diverticulitis. This study compares outcomes between immunocompetent (IC) and IS patients.MethodsWe identified all patients undergoing surgery for diverticulitis between 2021 and 2022 in the National Surgical Quality Improvement Program. We measured the textbook outcome (TO), defined as absence of prolonged length of stay (LOS), mortality, major morbidity, readmission, or reoperation within 30 days. Regression analyses were used to compare outcomes between IS and IC groups, stratified by case acuity.ResultsWe identified 16,679 patients, including 1102 (6.6%) IS patients. Immunosuppressed patients were more likely to present with complicated diverticulitis and preoperative sepsis and more often required urgent or emergent surgery, open surgery, or diversion. Textbook outcome was achieved less often in IS patients (37.2% vs 61.5%), and they had higher rates of major morbidity (37.7% vs 19.5%) (P < 0.001). On regression, IS patients undergoing elective surgery were less likely to achieve TO (OR 0.668 [95% CI 0.538-0.830]) and more likely to experience major morbidity (1.356 [1.065-1.726]), prolonged LOS, sepsis, or readmission. In the urgent setting, IS was associated with higher odds of major morbidity (1.595 [1.072-2.372]), readmission (1.877 [1.160-3.037]), and mortality (3.149 [1.549-6.402]). In the emergency setting, IS patients had increased odds of reoperation (1.566 [1.035-2.370]) and mortality (1.545 [1.033-2.310]).ConclusionEmergent or urgent surgery is associated with higher mortality in IS patients compared to IC patients. In the elective setting, IS patients have similar mortality but lower TO achievement and higher morbidity.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1093-1100"},"PeriodicalIF":1.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126630","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

Breast Cancer Risk, Screening, and Risk Reduction in Young Females. 年轻女性的乳腺癌风险、筛查和风险降低。

IF 1 4区医学

American Surgeon Pub Date : 2025-07-01 Epub Date: 2025-04-14 DOI: 10.1177/00031348251331294

April Gheller, Rebecca Tuttle, Jacqueline Oxenberg

引用次数: 0

Hepatic Portal Venous Gas in Acute Pancreatitis-A Critical Finding: A Systematic Review. 急性胰腺炎肝门静脉气体-一个重要的发现：系统综述。

IF 1 4区医学

American Surgeon Pub Date : 2025-07-01 Epub Date: 2025-04-25 DOI: 10.1177/00031348251338383

Taha Mollah, Xingyi Zhang, Thiep Kuany, Olukunle Onasanya, Brett Knowles

{"title":"Hepatic Portal Venous Gas in Acute Pancreatitis-A Critical Finding: A Systematic Review.","authors":"Taha Mollah, Xingyi Zhang, Thiep Kuany, Olukunle Onasanya, Brett Knowles","doi":"10.1177/00031348251338383","DOIUrl":"10.1177/00031348251338383","url":null,"abstract":"BackgroundHepatic portal venous gas (HPVG) is an uncommon radiological finding in acute pancreatitis. This systematic review aims to consolidate existing literature on HPVG in acute pancreatitis and assess its clinical significance, particularly regarding surgical intervention. We also report a clinical case from our center.MethodsA systematic search was conducted across Medline, Scopus, Cochrane, and Google Scholar databases to identify studies reporting concurrent HPVG and pancreatitis. Data included demographics, clinical presentation, management, and outcomes. Descriptive statistics were employed for analysis, and methodological quality was assessed using established criteria.ResultsOut of 259 articles screened, 13 met inclusion criteria, yielding data on 17 patients (76.5% male; median age 62 years). Nonoperative management (NOM) was utilized in 75% of cases and was associated with a 54% mortality rate. In contrast, the surgical cohort (n = 4) experienced a similar overall mortality rate of 50%. Importantly, necrotic bowel was implicated in 44% of evaluable cases and was uniformly fatal. However, 2 patients who underwent early surgical resection of nonviable bowel survived the initial phase of their illness, suggesting that prompt operative intervention may confer an early survival advantage in selected patients. Fluid collections and pneumatosis intestinalis were significantly more prevalent in deceased patients (100% vs 17% in survivors; P < 0.0034). All deceased patients had either severe or necrotizing pancreatitis.ConclusionHPVG associated with severe acute pancreatitis appears to have a higher mortality than HPVG alone. It can be managed nonoperatively but when indicative of bowel necrosis, necessitates prompt surgical intervention.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1203-1212"},"PeriodicalIF":1.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962460","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

Bile Duct Injury: A Novel Risk Stratification System for the Timing of Repair. 胆管损伤：一种新的修复时机风险分层系统。

IF 1 4区医学

American Surgeon Pub Date : 2025-07-01 Epub Date: 2025-04-03 DOI: 10.1177/00031348251332689

Joshua Kong, Juan S Malo, Sammy Hashem, Sourodip Mukharjee, Joseph Lim, Joseph Buell, D Rohan Jeyarajah, Houssam Osman

{"title":"Bile Duct Injury: A Novel Risk Stratification System for the Timing of Repair.","authors":"Joshua Kong, Juan S Malo, Sammy Hashem, Sourodip Mukharjee, Joseph Lim, Joseph Buell, D Rohan Jeyarajah, Houssam Osman","doi":"10.1177/00031348251332689","DOIUrl":"10.1177/00031348251332689","url":null,"abstract":"BackgroundBile duct injuries (BDI) occur in 0.2%-0.6% of cholecystectomies. Early definitive repair prevents clinical deterioration, reduces hospital stays, and cuts costs, while delayed repairs may reduce postoperative stricture rates. Currently, there are no guidelines to support early vs delayed repair. Using our institution's risk stratification, we hypothesize that low-risk patients can undergo early repair without increased postoperative complications.MethodsThis retrospective study reviewed 53 patients with BDI treated surgically from January 2014 to September 2023 at a non-university tertiary care center. Patients were classified as low-risk (score ≤2) or high-risk (score ≥3) based on four factors: index surgical approach, vascular injury, biloma, and sepsis.ResultsThe mean age was 58.3 years, with 49.1% women. Most BDI were diagnosed within one week (median 3 days) following laparoscopic cholecystectomy (83.6%). Biloma was present in 46% of cases, and 3.8% were septic. The majority (88.7%) of patients were classified as low-risk. Strasberg-Bismuth E2 (27.3%) and E3 (20%) injuries were the most common. Additionally, 92.7% of patients underwent end-to-side hepaticojejunostomy. Early (9 of 29; 31.0%) and late repairs (8 of 18; 44%) showed no significant difference in complication rates for low-risk patients (P = 0.35).DiscussionThis study proposes a scoring system to identify low-risk patients who can safely undergo early repair without increased complications. These findings highlight the potential for stratified decision-making to optimize outcomes, but prospective validation is needed to establish evidence-based guidelines for BDI management.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1163-1169"},"PeriodicalIF":1.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778922","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

Addressing the Challenge of Successful One-Stage Lumpectomy for DCIS. 解决DCIS一期肿瘤切除成功的挑战。

IF 1 4区医学

American Surgeon Pub Date : 2025-07-01 Epub Date: 2025-04-02 DOI: 10.1177/00031348251329496

Joshua A Feinberg, Pabel Miah, Charles DiMaggio, Nakisa Pourkey, Jennifer Chun Kim, Jenny Goodgal, Amber Guth, Deborah Axelrod, Freya Schnabel

{"title":"Addressing the Challenge of Successful One-Stage Lumpectomy for DCIS.","authors":"Joshua A Feinberg, Pabel Miah, Charles DiMaggio, Nakisa Pourkey, Jennifer Chun Kim, Jenny Goodgal, Amber Guth, Deborah Axelrod, Freya Schnabel","doi":"10.1177/00031348251329496","DOIUrl":"10.1177/00031348251329496","url":null,"abstract":"BackgroundBreast conserving surgery represents the preferred surgical treatment option for patients with early-stage breast cancer. Reexcision rates are generally higher for patients undergoing lumpectomies for ductal carcinoma in situ (DCIS) compared to invasive breast cancer, as the microscopic extent of disease is difficult to assess during excision. This study investigated the clinicopathological characteristics of patients undergoing BCS for pure DCIS and reexcision rates over time, including the effect of the MarginProbe™ device.MethodsWe queried our prospectively maintained Institutional Breast Cancer Database for patients diagnosed with DCIS and treated with BCS as their primary procedure from 2010-2021. The primary endpoint was the rate of reexcision. Variables of interest included age at diagnosis, race/ethnicity, mode of diagnostic imaging, mammographic breast density, method of core biopsy, nuclear grade, size of DCIS, multifocality, DCIS subtype, and MarginProbe™ use.ResultsPapillary DCIS (P < 0.004) and larger size (P < 0.001) was associated with an increased reexcision rate. There were also differences in the method of core biopsy (P < 0.001), with stereotactic core biopsy predominating among patients who did not require reexcision (71.3% vs 49.5%). In an unadjusted estimate for the odds ratio for association, patients who had MarginProbe™ used were 81% less likely to require reexcision (OR = 0.19, 95% CI = 0.12, 0.31, P < 0.0001).ConclusionYounger age, papillary DCIS, larger DCIS size, and non-stereotactic core biopsy method were found to be associated with higher reexcision rates. Additionally, patients whose primary procedures included intraoperative margin assessment with the MarginProbe™ were significantly less likely to require reexcision.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1149-1155"},"PeriodicalIF":1.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771135","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

Effectiveness of a Regionalized Care Model in Treating Fournier's Gangrene. 区域化护理模式在治疗 Fournier 坏疽中的效果。

IF 1 4区医学

American Surgeon Pub Date : 2025-07-01 Epub Date: 2025-04-01 DOI: 10.1177/00031348251331287

Sai Allu, Kamil Malshy, Borivoj Golijanin, Martus Gn, Emma Waddell, John Morgan, Benjamin Ahn, Amir Farah, Rebecca Ortiz, Raymond Che, Kennon Miller, Madeline Cancian

{"title":"Effectiveness of a Regionalized Care Model in Treating Fournier's Gangrene.","authors":"Sai Allu, Kamil Malshy, Borivoj Golijanin, Martus Gn, Emma Waddell, John Morgan, Benjamin Ahn, Amir Farah, Rebecca Ortiz, Raymond Che, Kennon Miller, Madeline Cancian","doi":"10.1177/00031348251331287","DOIUrl":"10.1177/00031348251331287","url":null,"abstract":"ObjectivesTo evaluate the impact of transferring patients with Fournier's gangrene (FG) to a tertiary referral hospital (TRH) on survival and outcomes.MethodsWe conducted a retrospective analysis of FG cases treated at our TRH from January 2015 to January 2022. Clinicodemographic, laboratory, perioperative, and mortality data were collected. Patients were categorized into two groups: those directly presented (DP) to TRH and those transferred for treatment (TT) from other hospitals. Primary outcome was 30-day mortality. Secondary outcomes included 90-day, 180-day, 1-year and 2-year mortality. We employed chi-square, T-tests, and Fisher's exact tests for significance assessment. Survival was evaluated using Kaplan-Meier.Results136 patients (77.9% males) were analyzed: 66.9% in the TT group (n = 91), 33.1% in DP group (n = 45), with median ages of 59.2 and 56.4, respectively, P = 0.06. Median transfer distance: 10.6 miles, travel time: 16 minutes. No significant differences were observed in time from presentation to initial debridement (8.45 hours for TT, 7.3 hours for DP, P = 0.57), comorbidities, or FG Severity Index. No significant differences in 30-day mortality (TT: 5.5%, DP: 4.4%, [HR = 1.53, 95% CI: 0.31, 7.57], P = 0.6), or other mortality rates (90-day: 7.7% vs 6.6%, 180-day: 14.3% vs 8.9%, 1-year: 18.7% vs 15.6%, 2-year: 20.9% vs 15.6%, P > 0.05). DP had a higher rate of fast door-to-operation room (<6 hours) than TT (46.7% vs 18.7%, P = 0.06), although 30-day mortality was not affected.ConclusionsTransfer of FG patients to a TRH was not associated with increased mortality. Due to the rarity and complexity of this disease, centralizing care might be the preferred approach in cases of regional primary presentation.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1140-1148"},"PeriodicalIF":1.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762843","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

Very Early (≤ 24 hours) Venous Thromboembolism Prophylaxis Timing Based on Size and Type of Traumatic Brain Injury: A National Retrospective Analysis of Risk Stratification and Anticoagulation History in the Trauma Population. 基于创伤性脑损伤大小和类型的早期（≤24小时）静脉血栓栓塞预防时机：创伤人群风险分层和抗凝史的全国回顾性分析

IF 1 4区医学

American Surgeon Pub Date : 2025-07-01 Epub Date: 2025-04-10 DOI: 10.1177/00031348251329469

Heather X Rhodes-Lyons, David L McClure, Kalli Hill, Tiana Schultz, Gina Brandl, Jennifer Roberts, Lucy Martinek, Antonio Pepe

{"title":"Very Early (≤ 24 hours) Venous Thromboembolism Prophylaxis Timing Based on Size and Type of Traumatic Brain Injury: A National Retrospective Analysis of Risk Stratification and Anticoagulation History in the Trauma Population.","authors":"Heather X Rhodes-Lyons, David L McClure, Kalli Hill, Tiana Schultz, Gina Brandl, Jennifer Roberts, Lucy Martinek, Antonio Pepe","doi":"10.1177/00031348251329469","DOIUrl":"10.1177/00031348251329469","url":null,"abstract":"BackgroundThe clinical decision to administer venous thromboembolism prophylaxis (VTE PPX) is determined by an assumption of low rebleeding risk. Findings from this study will inform clinical decisions designed to help traumatic brain injury (TBI) patients avoid VTE complications.MethodsThis retrospective cohort study utilized the ACS-TQIP-PUF from 2017 to 2021. The study population consisted of adult (≥15 years) patients who received LMWH, UFH, or mechanical filter VTE PPX with no missing times and had a blunt isolated TBI. The population was split into two groups, patients with and without a comorbid history of anticoagulation or bleeding disorder (BLEED). The Modified Berne-Norwood Criteria (mBNC) was applied to distinguish each group based on size and TBI type into a low, moderate, and high risk of rebleeding.ResultsA total of 99,078 patients were included in the analysis; 75,952 (76.6%) did not have a comorbid BLEED. A protective effect against mortality, DVT and PE if VTE PPX was given very early in both the low- and moderate-risk groups (all values P < .01). The high-risk group found a higher likelihood of mortality in the very early and mid VTE PPX BLEED group (all values P ≤ .03).ConclusionVery early (≤24 hr) VTE PPX in the low- and moderate-risk mBNC reports to be effective in preventing VTE and mortality. Very early VTE PPX in the high-risk group prevents VTE; however, it is associated with a higher likelihood of mortality in BLEED groups.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1170-1177"},"PeriodicalIF":1.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143954318","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