American Surgeon最新文献_第10页

"Policy and Funding Impact on Access to Care". “对获得医疗服务的政策和资金影响”。

IF 1 4区医学

American Surgeon Pub Date : 2025-05-01 Epub Date: 2025-03-24 DOI: 10.1177/00031348251329467

Ross F Goldberg

引用次数: 0

Care Fragmentation Following Bariatric Operations: A National Analysis. 减肥手术后护理碎片化：一项全国分析。

IF 1 4区医学

American Surgeon Pub Date : 2025-05-01 Epub Date: 2025-01-06 DOI: 10.1177/00031348251313525

Konmal Ali, Troy Coaston, Ayesha P Ng, Lavender Micalo, Sara Sakowitz, Amulya Vadlakonda, Barzin Badiee, Syed Shaheer Ali, Peyman Benharash

{"title":"Care Fragmentation Following Bariatric Operations: A National Analysis.","authors":"Konmal Ali, Troy Coaston, Ayesha P Ng, Lavender Micalo, Sara Sakowitz, Amulya Vadlakonda, Barzin Badiee, Syed Shaheer Ali, Peyman Benharash","doi":"10.1177/00031348251313525","DOIUrl":"10.1177/00031348251313525","url":null,"abstract":"BackgroundAlthough existing work has evaluated outcomes associated with care fragmentation (CF), these adverse consequences may be accentuated in patients undergoing bariatric operations. This retrospective study examined the association of CF with clinical and financial outcomes among patients receiving bariatric surgery.MethodsAll adult (≥18 years) records for bariatric operations were tabulated from the 2016-2021 Nationwide Readmissions Database. Patients with nonelective rehospitalization at a non-index facility within 30 days of index discharge comprised the CF cohort (others: No-CF). Multivariable linear and logistic models were developed to assess the association of care fragmentation with outcomes of interest.ResultsOf an estimated 38,842 patients, 5591 (17.0%) comprised the CF cohort. Compared to No-CF, CF was older, less likely to be female, and more frequently insured by Medicare. Following comprehensive risk adjustment, CF demonstrated increased odds of respiratory (adjusted odds ratio [AOR] 1.61, 95% CI 1.37-1.90), renal (AOR 1.56, 95% CI 1.38-1.76), and thromboembolic (AOR 2.03, 95% CI 1.71-2.41) complications. Additionally, those who experienced CF demonstrated increased odds of non-home discharge (AOR 2.03, 95% CI 1.70-2.42).ConclusionsCare fragmentation is associated with increased mortality, complications, non-home discharge, and hospitalization costs. Initiatives such as patient education, harmonizing postoperative care, and facilitating returns to the index hospitals may minimize the adverse effects of CF to improve the continuation of care following bariatric operations.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"756-763"},"PeriodicalIF":1.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930658","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. 优化儿科复苏：循证方法和新趋势。

IF 1 4区医学

American Surgeon Pub Date : 2025-05-01 Epub Date: 2025-03-26 DOI: 10.1177/00031348251329503

Micaela K Gomez, Lucas P Neff

引用次数: 0

Language Barriers in Appendicitis: What is the Cost? 阑尾炎的语言障碍：代价是什么？

IF 1 4区医学

American Surgeon Pub Date : 2025-05-01 Epub Date: 2025-02-26 DOI: 10.1177/00031348251323710

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

{"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":"10.1177/00031348251323710","url":null,"abstract":"BackgroundIn 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.MethodsWe 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.Results400 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.DiscussionIn 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.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"871-876"},"PeriodicalIF":1.0,"publicationDate":"2025-05-01","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}

引用次数: 0

Quality Improvement in Rural and Low-Resource Settings. 提高农村和资源匮乏地区的质量。

IF 1 4区医学

American Surgeon Pub Date : 2025-05-01 Epub Date: 2025-03-31 DOI: 10.1177/00031348251331296

Samantha Eco, Nicole L Petcka, Kevin Li, Elizabeth M Hechenbleikner

{"title":"Quality Improvement in Rural and Low-Resource Settings.","authors":"Samantha Eco, Nicole L Petcka, Kevin Li, Elizabeth M Hechenbleikner","doi":"10.1177/00031348251331296","DOIUrl":"10.1177/00031348251331296","url":null,"abstract":"Access to surgical care is a critical determinate of health outcomes yet disparities persist across various populations, particularly in low-resource settings (LRS). Quality improvement (QI) has become an integral component of health care optimization in such areas. The challenges of health care delivery in LRS directly translate into common barriers in QI endeavors such as the need for adequate funding, personnel trained in QI processes, and appropriate systems for consistent data collection. Many initiatives have been developed to address the multifaceted barriers in accessing surgical services and to improve patient safety and the quality of surgical care in LRS. Multiple studies have highlighted successful QI projects including implementing checklists to reduce surgical site infections, augmenting patient and staff education to reduce postoperative readmission rates, and adapting telemedicine in virtual intensive care units in rural areas. As new solutions, frameworks, and literature on QI initiatives expand, opportunities to enhance surgical care in LRS are becoming more apparent. This manuscript will review multiple aspects of QI including methods used in health care, barriers frequently encountered, challenges unique to LRS as well as projects implemented in LRS, with the goal of helping underserved health care settings learn and implement quality initiatives to improve the delivery of surgical care.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"723-731"},"PeriodicalIF":1.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750693","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

Paramedic Judgment as a Basis for Trauma Triage: Is it an Effective Strategy? 护理人员判断作为创伤分诊的基础：这是一个有效的策略吗？

IF 1 4区医学

American Surgeon Pub Date : 2025-05-01 Epub Date: 2025-01-15 DOI: 10.1177/00031348241312123

Matthew P Schaefer, Chrisnel Lamy, Dalier Mederos-Rodriguez, John D Berne

{"title":"Paramedic Judgment as a Basis for Trauma Triage: Is it an Effective Strategy?","authors":"Matthew P Schaefer, Chrisnel Lamy, Dalier Mederos-Rodriguez, John D Berne","doi":"10.1177/00031348241312123","DOIUrl":"10.1177/00031348241312123","url":null,"abstract":"IntroductionAmerican College of Surgeons-Committee on Trauma (ACS-COT) defines minimum Standard Criteria (SC) for Level 1 trauma. In our hospital, discretion of prehospital personnel (\"Paramedic Judgment\" [PJ]) can initiate Full Trauma Triage Activation (FTTA) in the absence of ACS-COT criteria. The aim of this study was to evaluate overtriage and undertriage for PJ vs SC.Methods1846 patients met criteria from 1/1/19 to 1/5/23. This study utilized the Cribari Matrix to define under, over, and appropriate triage, and utilizes Chi-Squared Test to determine significance. We performed an adjusted binomial logistic regression comparing overtriage and undertriage for PJ vs SC. We analyzed the Need for Emergent Intervention-6 (NEI-6) model to see if it could be a way to accurately assess triage.ResultsOvertriage for the PJ group was 68.9%, compared to 54.8% for SC, with a P-value ≤.05, and undertriage for the PJ group was 1.23% compared to 0.13%. After adjusting for confounders, the risk of overtriage by the PJ group was 2.04 times as likely compared to the SC group (OR 2.04; P < .01). The OR for undertriage was not calculated due to lack of power. The odds of needing a blood transfusion for the PJ patients compared to the SC patients is approximately one-third (OR 0.33; P < .01). The other variables were lacking in power.ConclusionThe aim of this study is to evaluate over and undertriage for PJ and SC at our large urban center. We found that overtriage was 2 times as likely when using PJ compared with the SC.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"795-806"},"PeriodicalIF":1.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998773","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

Effects of Exercise Training on Body Composition and Exercise Capacity After Bariatric Surgery: A Systematic Review and Meta-Analysis. 运动训练对减肥手术后身体成分和运动能力的影响：系统回顾和荟萃分析。

IF 1 4区医学

American Surgeon Pub Date : 2025-05-01 Epub Date: 2025-02-20 DOI: 10.1177/00031348251313527

Jingru Li, Unyong Jo

{"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":"10.1177/00031348251313527","url":null,"abstract":"PurposeBariatric 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.MethodsWe 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.ResultsTwenty-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%).ConclusionWhile 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.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"843-853"},"PeriodicalIF":1.0,"publicationDate":"2025-05-01","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}

引用次数: 0

Impact of AI on Access to Care a Three-Pronged Approach for Enhancing Access to Surgical Care: Lessons From Electrical Safety and the Impact of AI on Health Equity. 人工智能对医疗服务可及性的影响：三管齐下提高外科护理可及性的方法：来自电气安全的经验教训以及人工智能对卫生公平的影响。

IF 1 4区医学

American Surgeon Pub Date : 2025-05-01 Epub Date: 2025-03-31 DOI: 10.1177/00031348251329495

Hassan A Tetteh, Temisan Blagogee, Dennis Robbins

{"title":"Impact of AI on Access to Care a Three-Pronged Approach for Enhancing Access to Surgical Care: Lessons From Electrical Safety and the Impact of AI on Health Equity.","authors":"Hassan A Tetteh, Temisan Blagogee, Dennis Robbins","doi":"10.1177/00031348251329495","DOIUrl":"10.1177/00031348251329495","url":null,"abstract":"As we enter the 21st century, a new wave of transformation is occurring in health care, mainly through artificial intelligence (AI). Like electricity, AI is a powerful tool that can either harm or heal, depending on how it is managed. In 2015, the United Nations created the 2030 Agenda for Sustainable Development to achieve peace and prosperity for people and the planet. Goal Three of the agenda aims to \"Ensure healthy lives and promote well-being for all at all ages\" by improving access to health care, reducing disparities, and reducing mortality and morbidity for the world's population. Nowhere is this more critical than surgical care access, where AI can reduce disparities and improve outcomes for underserved populations-rural communities, special populations, and oncology patients-while posing risks if not adequately grounded in ethical and equitable practices. We introduce the three-pronged approach as a metaphorical framework to mitigate the risks and enhance AI's benefits in addressing access to surgical care. By focusing on data quality, continuous system evaluation, and ethical governance, we can ensure AI delivers equitable, effective, and safe health care outcomes for all, especially for the most vulnerable.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"740-745"},"PeriodicalIF":1.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750691","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 Maternal Health Crisis in Rural Georgia: Challenges, Disparities, and Pathways to Improvement. 解决格鲁吉亚农村产妇保健危机：挑战、差距和改善途径。

IF 1 4区医学

American Surgeon Pub Date : 2025-05-01 Epub Date: 2025-03-20 DOI: 10.1177/00031348251329477

Myah M Griffin, Natalie D Hernandez, Anahit Mehranian, Deidre V R Wright, Kiwita Phillips, Raimot Olanrewaju, Cheryl G Franklin

引用次数: 0

Association of Preoperative Hematocrit and Intraoperative/Postoperative Transfusion Volume With Outcomes of Major Abdominal Surgery. 术前红细胞压积、术中/术后输血量与腹部大手术预后的关系

IF 1 4区医学

American Surgeon Pub Date : 2025-04-30 DOI: 10.1177/00031348251339533

Dariush Yalzadeh, Oh Jin Kwon, Nam Yong Cho, Kevin Tabibian, Daniel Tabibian, Barzin Badiee, Arjun Chaturvedi, Peyman Benharash

{"title":"Association of Preoperative Hematocrit and Intraoperative/Postoperative Transfusion Volume With Outcomes of Major Abdominal Surgery.","authors":"Dariush Yalzadeh, Oh Jin Kwon, Nam Yong Cho, Kevin Tabibian, Daniel Tabibian, Barzin Badiee, Arjun Chaturvedi, Peyman Benharash","doi":"10.1177/00031348251339533","DOIUrl":"https://doi.org/10.1177/00031348251339533","url":null,"abstract":"BackgroundDespite the independent effect of lower preoperative hematocrit levels and higher transfusion volumes with increased postoperative morbidity and mortality, the impact of the interplay between these variables on outcomes remains poorly understood. We hypothesized that after adjusting for preoperative hematocrit, red cell transfusions exhibit a stepwise association with increased mortality and complications after major abdominal surgery (MAS).MethodsAll adults (≥18 years) undergoing elective MAS (colectomy, enterectomy, proctectomy, laparotomy, splenectomy, gastrectomy, enterorrhaphy/colorrhaphy, and peritoneal drainage) were identified in the 2020-2022 American College of Surgeons National Surgical Quality Improvement Program database. The primary outcome of interest was in-hospital mortality within 30 days of discharge. Secondary outcomes included postoperative complications, as well as length of stay (LOS) and unplanned readmission.ResultsAmong 15,646 patients undergoing MAS, 88.0% were not transfused, while 5.3% received 1 unit and 6.7% received ≥2 units of blood. After multivariable adjustment, lower preoperative hematocrit levels (AOR 0.9, 95% Cl 0.9-1.0) and higher transfusion volumes (1 Unit: AOR 1.6, 95% Cl 1.1-2.4; ≥2 Unit: AOR 2.4, 95% Cl 1.6-3.4) were independently associated with an increased risk of mortality (all P < 0.05). Notably, higher transfusion volumes demonstrated a stronger association with increased rates of individual complications, prolonged LOS, and unplanned readmission compared to preoperative hematocrit levels (all P < 0.05).DiscussionGiven the independent impact of transfusion volume on acute outcomes, efforts should focus on early, multimodal anemia management to reduce transfusion requirements in the preoperative phase, rather than relying on intraoperative transfusions, when feasible.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251339533"},"PeriodicalIF":1.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966035","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