American Surgeon最新文献_第10页

Predictors and Impact of Ileus on Outcomes After Laparoscopic Right Colectomy: A Case-Control Study. 腹腔镜右结肠切除术后回肠梗阻的预测因素及其对术后效果的影响：病例对照研究

IF 1 4区医学

American Surgeon Pub Date : 2024-11-01 Epub Date: 2024-06-20 DOI: 10.1177/00031348241260275

Sameh Hany Emile, Nir Horesh, Zoe Garoufalia, Rachel Gefen, Peige Zhou, Giovanna Dasilva, Steven D Wexner

{"title":"Predictors and Impact of Ileus on Outcomes After Laparoscopic Right Colectomy: A Case-Control Study.","authors":"Sameh Hany Emile, Nir Horesh, Zoe Garoufalia, Rachel Gefen, Peige Zhou, Giovanna Dasilva, Steven D Wexner","doi":"10.1177/00031348241260275","DOIUrl":"10.1177/00031348241260275","url":null,"abstract":"Background: Ileus is a common complication of major abdominal surgery, including colorectal resection. The present study aimed to assess the predictors of ileus after laparoscopic right colectomy for colon cancer.Methods: This study was a retrospective case-control analysis of a prospective IRB-approved database of patients who underwent laparoscopic right colectomy at the Department of Colorectal Surgery, Cleveland Clinic Florida. Patients who developed ileus after right colectomy were compared to patients without ileus to determine the risk factors of ileus.Results: The present study included 270 patients with a mean age of 68.7 years. Thirty-six patients (13.3%) experienced ileus after laparoscopic right colectomy. The median duration of ileus was 6 days. Factors associated with ileus were age (71.6 vs 68.2 years, P = .158), emergency colectomy (11.1% vs 3.9%, P = .082), extended hemicolectomy (19.4% vs 6.8%, P = .021), green gastrointestinal anastomosis (GIA) 4.8mm staple height cartridge (19% vs 8.1%, P = .114), and longer operative time (177.9 vs 160.4 minutes, P = .157). The only independent predictor of ileus was extended colectomy (OR: 16.7, P = .003).Conclusions: Increased age, emergency surgery, green GIA cartridge, and longer operative times were associated with ileus, yet the only independent predictor of ileus was extended right hemicolectomy.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"3054-3060"},"PeriodicalIF":1.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141431203","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

An Analysis on the Effect of Income Changes in the Resection of Early-Stage Pancreatic Adenocarcinoma. 收入变化对早期胰腺腺癌切除术的影响分析。

IF 1 4区医学

American Surgeon Pub Date : 2024-11-01 Epub Date: 2024-05-31 DOI: 10.1177/00031348241256058

Ahmer Irfan, J Bart Rose, Vikas Dudeja, Daniel I Chu, Sushanth Reddy

{"title":"An Analysis on the Effect of Income Changes in the Resection of Early-Stage Pancreatic Adenocarcinoma.","authors":"Ahmer Irfan, J Bart Rose, Vikas Dudeja, Daniel I Chu, Sushanth Reddy","doi":"10.1177/00031348241256058","DOIUrl":"10.1177/00031348241256058","url":null,"abstract":"Introduction: The impact of socioeconomic inequalities on cancer care and outcomes has been well recognized and the underlying causes are likely multifactorial. Income is regarded as a cornerstone of socioeconomic status and has been assumed to correlate with access to care. We therefore sought to investigate whether income and changes in income would affect the rate of patients undergoing surgical resection for early-stage pancreatic cancer.Methods: Inflation-adjusted income data were obtained from the United States Census Bureau from 2010 to 2019. The cancer data were obtained from the SEER database. Counties present in both data sets were included in the analysis. Patients with stage I or II pancreatic cancer who underwent formal resection were deemed to have undergone appropriate surgical management. Patients were grouped into an early (2010-2014) and late (2015-2019) time period.Results: The final analysis included 23968 patients from 173 counties across 11 states. The resection rate was 45.1% for the entire study and rose from 42.8% to 47.4% from the early to late time periods (P < .001). The median change in income between the two time periods was an increase by $2387. The rate of resection was not dependent on income class or income change in our study population.Conclusion: Our surgical care of pancreatic cancer is improving with more patients undergoing resection. In addition, there are now fewer disparities between patients of lower-income and higher-income groups with respect to receiving surgical intervention. This implies that our access to care has improved over the past decade. This is an encouraging finding with regards to reducing health care disparities.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"2885-2891"},"PeriodicalIF":1.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141178909","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

Reframing Surgery Using the Concepts of Diversity, Equity, and Inclusion. 利用 "多样性、平等和包容 "的概念重塑外科手术。

IF 1 4区医学

American Surgeon Pub Date : 2024-11-01 Epub Date: 2024-05-30 DOI: 10.1177/00031348241259044

Vishal Kumar

引用次数: 0

History of Horsehair Hair Sutures: Perspectives in Green Surgery. 马鬃毛缝合线的历史：绿色外科的视角

IF 1 4区医学

American Surgeon Pub Date : 2024-11-01 Epub Date: 2024-04-30 DOI: 10.1177/00031348241248808

Shrinit Babel, Suman Baral, Shasi Poudel

引用次数: 0

Diffuse Dermal Angiomatosis of the Breast Clinically Mimicking Cellulitis and Inflammatory Breast Cancer. 乳腺弥漫性真皮血管瘤病临床上模仿蜂窝组织炎和炎症性乳腺癌。

IF 1 4区医学

American Surgeon Pub Date : 2024-11-01 Epub Date: 2024-05-20 DOI: 10.1177/00031348241256082

Lauren R Moore, Robin A Skrine

引用次数: 0

Palliative Intervention for Malignant Bowel Obstruction Comes at a Cost: A National Inpatient Study. 恶性肠梗阻的姑息干预需要成本：一项全国住院病人研究。

IF 1 4区医学

American Surgeon Pub Date : 2024-11-01 Epub Date: 2024-05-23 DOI: 10.1177/00031348241256083

Beatrice J Sun, Lakshika Tennakoon, David A Spain, Byrne Lee

{"title":"Palliative Intervention for Malignant Bowel Obstruction Comes at a Cost: A National Inpatient Study.","authors":"Beatrice J Sun, Lakshika Tennakoon, David A Spain, Byrne Lee","doi":"10.1177/00031348241256083","DOIUrl":"10.1177/00031348241256083","url":null,"abstract":"Background: Malignant bowel obstruction (MBO) due to peritoneal carcinomatosis (PC) is associated with poor outcomes. Optimal management for palliation remains unclear. This study aims to characterize nonoperative, procedural, and operative management strategies for MBO and evaluate its association with mortality and cost.Materials and Methods: ICD-10 coding identified patient admissions from the 2018 to 2019 National Inpatient Sample (NIS) for MBO with PC from gastrointestinal or ovarian primary cancers. Management was categorized as nonoperative, procedural, or surgical. Multivariate analysis was used to associate treatment with mortality and cost.Results: 356,316 patient admissions were identified, with a mean age of 63 years. Gender, race, and insurance status were similar among groups. Length of stay (LOS) was longest in the surgical group (surgical: 17 days; procedural: 14 days; nonoperative: 7 days; P = .001). In comparison to nonoperative, procedural and surgical patients had statistically higher hospital charges, post-discharge medical needs, palliative care consults, and admission to rehab centers. Mortality was 7% in nonoperative, 9% in procedural, and 8% in surgical (P = .007) groups. In adjusted analyses, older age, palliative care consult, and non-Medicare payer status were associated with higher mortality. Compared to nonoperative, procedural and surgical groups resulted in increased costs (procedural: $17K more; surgical: $30K more).Conclusions: Admissions for procedural and surgical treatment of MBO are associated with increased LOS, hospital costs, and discharge needs. Optimal management remains challenging. Clinicians must examine all options prior to recommending palliative interventions given a trend towards higher resource utilization and mortality.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"2848-2856"},"PeriodicalIF":1.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141086081","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

Jazz Musicians and Their Disabilities: Django Reinhardt, Les Paul, and Michel Petrucciani. 爵士音乐家和他们的残疾：姜戈-莱恩哈特、莱斯-保罗和米歇尔-佩特鲁西亚尼。

IF 1 4区医学

American Surgeon Pub Date : 2024-11-01 Epub Date: 2024-06-13 DOI: 10.1177/00031348241259307

Don K Nakayama

引用次数: 0

Impostor Phenomenon Among Recently Graduated General Surgeons. 刚毕业的普外科医生中的冒名顶替现象。

IF 1 4区医学

American Surgeon Pub Date : 2024-11-01 Epub Date: 2024-06-12 DOI: 10.1177/00031348241259040

Barret Halgas, John Horton, Leopoldo Cancio

引用次数: 0

Lower Socioeconomic Status Predicts Greater Obstacles to Care: Using Outpatient Cholecystectomy as a Model Cohort. 较低的社会经济地位预示着更大的医疗障碍：将门诊胆囊切除术作为示范队列。

IF 1 4区医学

American Surgeon Pub Date : 2024-11-01 Epub Date: 2024-06-14 DOI: 10.1177/00031348241262423

Michelle Y McGee, Haroon M Janjua, Meagan D Read, Paul C Kuo, Emily A Grimsley

{"title":"Lower Socioeconomic Status Predicts Greater Obstacles to Care: Using Outpatient Cholecystectomy as a Model Cohort.","authors":"Michelle Y McGee, Haroon M Janjua, Meagan D Read, Paul C Kuo, Emily A Grimsley","doi":"10.1177/00031348241262423","DOIUrl":"10.1177/00031348241262423","url":null,"abstract":"Background: Patients with low socioeconomic status (SES) are disadvantaged in terms of access to health care. A novel metric for SES is the Distressed Communities Index (DCI). This study evaluates the effect of DCI on hospital choice and distance traveled for surgery.Methods: A Florida database was queried for patients with symptomatic cholelithiasis or chronic cholecystitis who underwent an outpatient cholecystectomy between 2016 and 2019. Patients' DCI was compared with hospital ratings, comorbidities, Charlson Comorbidity Index, and distance traveled for surgery. Stepwise logistic regression was used to determine which factors most influenced distance traveled for surgery.Results: There were 54,649 cases-81 open, 52,488 laparoscopic, and 2,080 robotic. There was no difference between surgical approach and patient's DCI group (p = 0.12). Rural patients traveled the farthest for surgery (avg 21.29 miles); urban patients traveled the least (avg 5.84 miles). Patients from distressed areas more often had surgery at one- or two-star hospitals than prosperous patients (61% vs 36.3%). Regression indicated distressed or at-risk areas predicted further travel for rural/small-town patients, while higher hospital ratings predicted further travel for suburban/urban patients.Discussion: Compared to prosperous areas, patients from distressed areas have surgery at lower-rated hospitals, travel further if they live in rural/small-town areas, but travel less if they live in suburban areas. We postulate that farther travel in rural areas may be explained by a lack of health care resources in poor, rural areas, while traveling less in suburban areas may be explained by personal lack of resources for patients with low SES.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"3024-3030"},"PeriodicalIF":1.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141320358","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

Incipient Intracholecystic Papillary Neoplasm of the Gallbladder Without Dysplasia. 无增生的胆囊内乳头状瘤

IF 1 4区医学

American Surgeon Pub Date : 2024-11-01 Epub Date: 2024-05-28 DOI: 10.1177/00031348241257466

Joseph S Lim, Alejandra Dominguez, Nathaniel Kidd, Kumaran Mudaliar, Joseph F Buell, Dhiresh Rohan Jeyarajah, Houssam Osman

引用次数: 0