American Surgeon最新文献

{"title":"Pre-Operative Ankle Brachial Index in Assessing Major Amputation Level and Outcomes in Patients With Peripheral Artery Disease.","authors":"Nicole Wetoska, Anahita Shiva, Josiah Hardy, Aprill Park, Georges Jreij, Khanjan Nagarsheth","doi":"10.1177/00031348261499576","DOIUrl":"https://doi.org/10.1177/00031348261499576","url":null,"abstract":"<p><p>BackgroundThe ankle brachial index (ABI) is a non-invasive tool used to assess vessel stenosis hindering limb perfusion. It is commonly used in diagnosis of peripheral artery disease (PAD). We propose that this diagnostic tool may have predictive applications in amputation level of patients with PAD and may contribute to the diagnostic evaluation of CLTI.Materials and MethodsThis study is a retrospective chart review of 97 patients with PAD admitted from 2014 to 2022 who underwent major lower extremity amputation (MLEA) at a major tertiary referral center. Patients were stratified into two groups by ABI severity (ABI ≤0.4: severe PAD, 0.4<ABI <0.9: less severe PAD). Statistical tests included Chi-square, T-test, multivariable logistic regression with collinearity statistics, and a receiver operator curve (ROC) to determine Youden's J.ResultsNinety-seven patients were included in this study, 53.6% (n = 52) of whom had less severe PAD and 46.4% (n = 45) of whom had severe PAD. Per multivariable logistic regression, more severe PAD based on ABI ≤0.4 was predictive of receiving an AKA (<i>P</i> = 0.013; OR = 2.833) as a primary MLEA surgery. Receiver operator curve (ROC) shows that at an ABI threshold of 0.42, the model achieves a sensitivity of 0.58 and a specificity of 0.65, yielding a Youden's J of 0.23. There was no difference in readmission, ipsilateral revision, or 5-year mortality between cohorts.DiscussionBased on our cohort of 97 patients, pre-operative ABI measurements contributed modestly to amputation level assessment within the broader clinical framework; however, ABI was not independently predictive of post-operative outcomes.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261499576"},"PeriodicalIF":1.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206333","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":"Elderly Patients Incur Additional Injuries in Care Facilities Following Trauma Admissions.","authors":"Charles K Hu, Michael A Abala, Melissa S Kovacs, Daniel J Cucher, Adil M Lokhandwala, Savannah Korte, Michael Mazarei, Kaitlin Ciera G Macadangdang","doi":"10.1177/00031348261499189","DOIUrl":"https://doi.org/10.1177/00031348261499189","url":null,"abstract":"<p><p>BackgroundLittle is known about where elderly trauma injuries occur and the impact of elderly care environment on injuries. We describe differences in elderly trauma patients' injury prevalence, patterns, and trauma recidivism according to their care environment.MethodsA retrospective, observational study of trauma patients (n = 649). We performed multivariable logistic regression modeling to calculate the odds of returning to the hospital within 30 days for a new injury after controls. We repeated our analyses with age subgroups (65-84 vs 85 and older). We graphically analyzed the path of our patient population from their initial encounter through recidivism with a Sankey diagram.ResultsPatients who come from an institutional setting are more likely to return to the hospital within 30 days after controls, but this is statistically insignificant (aOR: 1.82, <i>P</i> = .064). Elderly trauma patients coming from home (aOR: .94, <i>P</i> = .828) or who are injured in a public place (aOR: .52, <i>P</i> = .117) are less likely to recidivate after controls, but these proportions are not statistically significant. Patients who come from an institutional setting and are aged 65-84 are over three times more likely to return to the hospital within 30 days than same age patients injured at home or in public, after controls (aOR: 3.06, <i>P</i> = .008), however, this subgroup finding warrants caution and future prospective study.DiscussionMost elderly trauma patients initially present from home, but elderly trauma recidivists are most likely to return from institutional settings. Trauma care decisions can benefit from an awareness of the elderly patient's injury environment in preventing further injury.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261499189"},"PeriodicalIF":1.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190580","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":"Building a Specialty: Immigrant Jewish Surgeons and the Institutions of American Plastic Surgery.","authors":"Or Friedman, Miri Mizrahi Reuveni, David Maiershon, Arnon Afek, Sheila Nazarian","doi":"10.1177/00031348261497815","DOIUrl":"https://doi.org/10.1177/00031348261497815","url":null,"abstract":"<p><p>American plastic surgery acquired its professional society in 1931, organized principally by Jacques Maliniac of Warsaw, with Gustave Aufricht of Budapest among its founders, and its journal in 1946, established largely through the efforts of Aufricht. Both were Jewish immigrants who arrived in New York in 1923 after training under Jacques Joseph in Berlin. Drawing on the accounts of Aufricht, Robert Ivy, Frank McDowell, and Robert Goldwyn, the official Society history, the published histories of the neighboring institutions, and the historical literature on Jewish quotas in American medical education, this essay asks how professional marginality and an institutionally immature specialty together created an opportunity for immigrant surgeons to become institution builders. It does not claim that discrimination caused the founding of either institution. John Staige Davis, Ivy, and McDowell are given their place, and Goldwyn, a first-generation Jewish editor, forms the epilogue.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261497815"},"PeriodicalIF":1.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190516","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":"Intercostal Transdiaphragmatic Port Insertion During Laparoscopic Resection of Liver Tumors Below the Right Diaphragmatic Dome Based on Costal and Pulmonary Anatomy: A Systematic Review.","authors":"Kuniya Tanaka, Yuki Takahashi, Akihiro Nakamura, Hiroshi Moro","doi":"10.1177/00031348261499855","DOIUrl":"https://doi.org/10.1177/00031348261499855","url":null,"abstract":"<p><p>Several reports advocate placement of ports between ribs for performing laparoscopic liver resection involving segments 7 and 8, but adoption of this method still is debated. Further, precise positioning of these intercostal transdiaphragmatic ports (ICPs) is required to avoid complications. We undertook a literature search to compare outcomes of laparoscopic resection between use and nonuse of ICPs. We further included review of pertinent anatomic features aiming to guide safe introduction of ICPs. Among 380 articles screened, 6 compared aspects of outcomes with respect to ICPs. ICPs reduced frequency of conversion to laparotomy in 3 of these 6; less intraoperative blood loss and shorter hospital stays were observed in 1 each. More favorable long-term survival was achieved in 1. One report found increased operating time, while another noted no differences. As for anatomic details, ports should be inserted into intercostal spaces at least 12 cm ventrally to spinous processes in order not to injure costal arteries or their branches. To avoid pulmonary injury, ports should enter the 7th intercostal space or lower at a point ventral to the anterior axillary line, the 8th intercostal space or lower at a point ventral to the midaxillary line, or the 9th intercostal space or lower at any position within the zone of apposition. Further studies and systematic reviews are needed to determine whether ICPs have decisive advantages. However, with appropriate precautions and positioning, ICPs can be inserted with minimal morbidity while obtaining clear visualization of hepatic lesions underlying the diaphragmatic dome.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261499855"},"PeriodicalIF":1.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190574","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":"To Scan or Not to Scan: Evaluating CT Discrepancies in Trauma Interfacility Transfers.","authors":"Jillian E Giblin, Lina V Mata-McMurry, Eric Shaw, Timothy Kocher, Allison L Jones, Brian C Helmly, Kelsey P Zealy, James R Dunne","doi":"10.1177/00031348261489291","DOIUrl":"https://doi.org/10.1177/00031348261489291","url":null,"abstract":"<p><p>BackgroundDespite existing recommendations, trauma patients often undergo computed tomography (CT) imaging at referring hospitals (RH) prior to transferring to Level 1 trauma centers (L1TC). Inaccurate CT scan interpretations from RH can lead to diagnostic uncertainty. Therefore, this study sought to determine the frequency and type of CT scan interpretation discrepancies in patients transferred to a L1TC, evaluate the impact of discrepant reads on patient management, and identify patient risk factors associated with these discrepancies.MethodsA retrospective study was performed on 348 trauma patients transferred from RH to a L1TC between January and June 2024. 938 RH CT scans were reread by board-certified radiologists to identify discrepancies. Discrepancies included missed and over diagnosed injuries and were classified as requiring major or minor management changes. Multivariate logistic regression identified patient risk factors for discrepancies.ResultsCT interpretation discrepancies occurred in 24.4% of patients, with 69.4% having at least one missed injury and 38.8% having at least one over diagnosed injury. Inaccuracy rates were highest among chest and abdomen/pelvis CTs (31.9%). Major management changes were present in 64.3% of all discrepancies, with the most frequent being new consultations (75.9%), additional imaging (68.5%), and ICU admission (61.1%). Younger age was predictive of discrepancies (<i>P</i> < .05).ConclusionDiscrepancies in CT scan interpretations from RH to L1TC remain common and frequently have major implications for patient care. Findings support guidelines to reduce unnecessary imaging pre-transfer and highlight the burden on L1TCs to resolve diagnostic uncertainty following interfacility transfer.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261489291"},"PeriodicalIF":1.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178827","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":"Expanding Resectability in Bilobar Colorectal Liver Metastases: Hepatic Venous Deprivation as Part of Contemporary Staged Hepatectomy.","authors":"Mohamad Younos, Maria Christodoulou, Iswanto Sucandy","doi":"10.1177/00031348261495989","DOIUrl":"https://doi.org/10.1177/00031348261495989","url":null,"abstract":"<p><p>Bilobar colorectal liver metastases (CRLM) remain one of the most challenging scenarios in hepatobiliary surgery because complete oncologic resection often requires removal of extensive hepatic parenchyma while preserving an adequate future liver remnant (FLR). Over the past two decades, advances in systemic chemotherapy, minimally invasive liver surgery, liver-directed interventions, and multidisciplinary treatment planning have substantially expanded resectability, allowing an increasing number of patients previously considered unresectable to undergo curative-intent surgery. Contemporary management now focuses on selecting among complementary strategies that safely maximize resectability while preserving functional liver reserve. Within this evolving treatment algorithm, hepatic venous deprivation (HVD) hasemerged as an important strategy for FLR augmentation in appropriately selected patients requiring major hepatectomy.As functional assessment of the FLR continues to evolve beyond volumetric measurements alone, appropriate patient selection and individualized operative planning have become increasingly important. This case-based review describes the successful management of a 66-year-old woman with bilobar CRLM treated with neoadjuvant chemotherapy, robotic first-stage parenchymal-sparing liver resection combined with synchronous sigmoid colectomy, HVD, and completion open extended right hepatectomy after adequate FLR hypertrophy. Using this case as a framework, we review the contemporary management of bilobar CRLM, current approaches to FLR augmentation, the rationale for selecting HVD over alternative strategies, evolving methods of functional liver assessment, and the role of minimally invasive staged hepatectomy within multidisciplinary oncological care. <b>This case illustrates the feasibility of integrating HVD with systemic therapy, parenchymal-sparing surgery, and staged hepatectomy in a carefully selected patient with extensive bilobar CRLM. However, further comparative evidence and longer oncologic follow-up are required to define the optimal role of HVD relative to established FLR augmentation strategies.</b></p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261495989"},"PeriodicalIF":1.0,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178899","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":"What is the Role of Anorectal Physiology Testing and Imaging in the Era of Sacral Neuromodulation? A Single-Center Experience and Literature Review.","authors":"Emanuela S Alvarenga, Sameh Hany Emile, Melissa Ulbrick, Zoe Garoufalia, Victor Strassmann, Felice De Stefano, Eric G Weiss","doi":"10.1177/00031348261496601","DOIUrl":"https://doi.org/10.1177/00031348261496601","url":null,"abstract":"<p><p>BackgroundWe aimed to investigate the association between preoperative anorectal physiology testing (APT) and outcomes of sacral neuromodulation (SNM) for fecal incontinence (FI).MethodsThis is a retrospective review of a prospective database of patients with FI who underwent SNM (2011-2020). Patients who underwent at least one preoperative APT were in the preoperative test group, those not tested served as controls. The Wexner/Cleveland Clinic Florida-Fecal Incontinence Score (Wexner/CCF-FIS) was calculated before implantation and at last follow-up. Preoperative workup included anal manometry (AM), electromyography (EMG), pudendal nerve terminal motor latency (PNTML), anal ultrasound (AUS), and defecography (DG). Primary outcome was treatment success, defined as at least 50% reduction from baseline on the Wexner/CCF-FIS at last follow-up.Results102 patients (mean age: 62.7 ± 13.9 years; 94 (92.2%) female) were included. Median preoperative Wexner/CCF-FIS was 18 (IQR: 15-20), which decreased to 10 (IQR: 4-15) at last follow-up. Anal manometry was performed in 55 (53.9%), AUS in 74 (72.5%), PNTML in 71 (69.6%), EMG in 76 (74.5%), and DG in 28 (27.5%). The overall success rate was 49%; median follow-up was 56 months (IQR: 23.25-79). Overall rates of 30-day complications, device explantation, and redo SNM were 19.6, 3.9, and 5.9%, respectively. 30-day complication rates were 25% in patients without any preoperative testing and 18.3% in those who received at least one preoperative test.ConclusionsRoutine preoperative APT was not associated with clearly better outcomes after SNM; however, the non-randomized nature of the study, selective test ordering, and limited sample size preclude definitive conclusions of absence of clinically relevant associations.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261496601"},"PeriodicalIF":1.0,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178897","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":"Artificial Intelligence Across the Surgical Research Workflow: A Stage-Specific Framework for Benefits, Failure Modes, and Oversight.","authors":"Isaac H Lies, Alexander Urevick, Lynch Major, Kay Buerster, Addison Stewart, Meredith Rippy, Syamal D Bhattacharya","doi":"10.1177/00031348261496616","DOIUrl":"https://doi.org/10.1177/00031348261496616","url":null,"abstract":"<p><p>Artificial intelligence (AI) tools, particularly large language models (LLMs), have rapidly integrated into surgical and biomedical research, prompting fundamental questions about their appropriate role. This review presents a stage-specific framework mapping each phase of the surgical research workflow (literature review, data analysis, manuscript preparation, and research synthesis) to the role AI plays, the benefits it provides, the failure modes it introduces, and the oversight it requires. Artificial intelligence-powered query systems are designed to speed literature synthesis across thousands of publications. In data analysis, LLMs paired with statistical environments can perform regression modeling and generate auditable code, while specialized architectures support automated image segmentation and histopathology analysis. Each stage's benefits, however, are matched by characteristic failure modes: LLMs are prone to error and hallucination, reproducibility is threatened by model versioning and run-to-run variability, fabricated citations and paper-mill submissions endanger the integrity of the literature, and over-reliance risks eroding trainee competencies in critical appraisal and biostatistical reasoning. Because these failure modes are stage-specific, governance must be stage-specific as well: the framework pairs each risk with a matched oversight mechanism, and these mechanisms translate into practical implementation recommendations for surgical departments, residency programs, research groups, and journals. The integration of AI into surgical scholarship should be viewed as augmentation rather than replacement, supported by standardized disclosure frameworks, AI literacy in graduate medical education, and institutional governance structures that preserve the integrity of surgical research.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261496616"},"PeriodicalIF":1.0,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178846","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":"Supine With Moderate Frog Leg Positioning Optimizes Femoral Vein Exposure and May Reduce Arterial Injury Risk During Femoral Venipuncture.","authors":"Pin-Tarng Chen, Ya-Chun Chu, Ling-Chih Hsu, Hung-Wei Cheng, Chih-Yang Chen, Kwok-Hon Chan, Wen-Kuei Chang","doi":"10.1177/00031348261468313","DOIUrl":"https://doi.org/10.1177/00031348261468313","url":null,"abstract":"<p><p>The overlap between the femoral vein (FV) and femoral artery (FA) complicates FV cannulation. This study used ultrasonography to evaluate the combined effects of body position and passive knee bending on FV size and exposure. In 103 healthy participants, femoral vessels were imaged and compared at three positions regarding inguinal crease in either supine or Reverse Trendelenburg positions with 4 different postures of leg bending. Although most difference were not significant, the results showed the highest FV/FA ratio, but the lowest FV overlap degree can be detected in the supine position with right heel resting against the medial aspect of the left knee. This was especially true at the level of the inguinal crease. This specific body site, position, and posture may provide the best FV cannulation accessibility and lowest risk of arterial injury. More study is needed for confirmation.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261468313"},"PeriodicalIF":1.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164665","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":"Association Between Preoperative Tea Drinking Habits and Postoperative Ileus in Colorectal Cancer Patients: A Propensity Score-Matched Study.","authors":"Sian Chen, Yiwei Jiang, Hongzheng Li, Changjia Li, Long Li, Jiante Li, Weilan Cao","doi":"10.1177/00031348261496000","DOIUrl":"https://doi.org/10.1177/00031348261496000","url":null,"abstract":"<p><p>ObjectiveThis study evaluated whether preoperative tea consumption reduces postoperative ileus risk after colorectal cancer surgery, given tea's anti-inflammatory and antioxidant properties.MethodsIn this retrospective cohort of 681 patients, tea drinkers (≥1 cup/day, n = 191) were compared to non-drinkers (n = 490). The primary outcome was Clavien-Dindo grade ≥2 POI within 30 postoperative days. Propensity score matching (1:1) balanced baseline characteristics. Multivariable logistic and Cox regression analyses assessed associations, with subgroup and sensitivity analyses verifying robustness.ResultsAfter matching (191 pairs), tea drinkers showed significantly lower POI incidence (8.9% vs 15.7%). Tea consumption remained an independent protective factor (adjusted OR: 0.52, 95% CI: 0.29-0.93; HR: 0.54, 95% CI: 0.30-0.97). Enhanced protection was observed in males, patients ≤70 years, and open surgery cases. Sensitivity analyses confirmed robustness.ConclusionRegular preoperative tea consumption is associated with significantly reduced POI risk, supporting its consideration in prehabilitation protocols.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261496000"},"PeriodicalIF":1.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164194","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}