American Surgeon最新文献

{"title":"Optimal Self-Care for Surgeons: Sleep, Diet, and Exercise.","authors":"Justin Park, Kimberly McElveen","doi":"10.1177/00031348241269422","DOIUrl":"10.1177/00031348241269422","url":null,"abstract":"<p><strong>Background: </strong>Surgeons face intense stress, causing hormonal imbalances that harm their health, leading to burnout, chronic illness, and shorter lifespans due to their demanding careers.</p><p><strong>Purpose: </strong>This study explores self-care strategies focusing on sleep, nutrition, and exercise to help surgeons reduce stress and improve their overall well-being and quality of life.</p><p><strong>Research design: </strong>A thorough literature review of physiological, metabolic, and psychological principles informed the development of a structured self-care approach.</p><p><strong>Data collection and/or analysis: </strong>We reviewed existing research on brain-body interactions, highlighting hormonal balance, nutrition, and exercise to mitigate chronic stress.</p><p><strong>Results: </strong>The review underscores the importance of quality sleep for hormonal balance and overall health. Proper nutrition, emphasizing balanced macronutrients and meal timing, supports health. Exercise should be 80% low-intensity aerobic activities, with 20% high-intensity. Combining these elements strengthens resistance to chronic stress and enhances health.</p><p><strong>Conclusions: </strong>A structured self-care approach, prioritizing sleep, followed by nutrition and exercise, effectively reduces stress among surgeons. This sequence improves well-being and quality of life. Surgeons should focus on consistent sleep, balanced nutrition, and regular low-intensity exercise to enhance resilience and achieve a fulfilling professional life.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"161-164"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905668","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":"Mark Ravitch and How Surgical Stapling Devices Came to America.","authors":"Don K Nakayama","doi":"10.1177/00031348241272325","DOIUrl":"10.1177/00031348241272325","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"158-160"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141896556","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":"Letter re: Prophylactic Enoxaparin Dosing Using Anti-Factor Xa Levels in Hepatic Surgery Patients: A Pilot Study.","authors":"Stephanie S Hyon, Jana K Elsawwah, Maia A Harris, Zoltan H Nemeth","doi":"10.1177/00031348241275721","DOIUrl":"10.1177/00031348241275721","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"151-152"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142003425","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":"Medical and Surgical Weight Loss as a Pathway to Renal Transplant Listing.","authors":"Jason M Samuels, Wayne English, Kelly A Birdwell, Irene D Feurer, David Shaffer, Sunil K Geevarghese, Seth J Karp","doi":"10.1177/00031348241275714","DOIUrl":"10.1177/00031348241275714","url":null,"abstract":"<p><strong>Purpose: </strong>Severe obesity is a barrier to listing for kidney transplantation due to concern for poor outcomes. This study aims to compare bariatric surgery with medical weight loss as a means of achieving weight loss and subsequent listing for renal transplant. We hypothesize that bariatric surgery will induce greater frequency of listing for transplant within 18 months of study initiation.</p><p><strong>Materials and methods: </strong>We performed a randomized study of metabolic bariatric surgery (MBS) vs medical weight loss (MM) in patients on dialysis with a body mass index (BMI) of 40-55 kg/m². The primary outcome was suitability for renal transplant within 18 months of initiating treatment. Secondary outcomes included weight loss, mortality, and complications.</p><p><strong>Results: </strong>Twenty patients enrolled, only 9 (5 MBS, 4 MM) received treatment. Treated groups did not differ in age, gender, or race (<i>P</i> ≥ .44). There was no statistically significant difference in the primary endpoint: 2 MBS (40%) and 1 MM (25%) listed for transplant ≤18 months (<i>P</i> = 1.00). With additional time, 100% MBS and 25% MM patients achieved listing status (<i>P</i> = .048); 100% of MBS and 0 MM received kidney transplants to date (<i>P</i> = .008). Weight, weight loss, and BMI trajectories differed between the groups (<i>P</i> ≤ .002). One death from COVID-19 occurred in the MM group, and 1 MBS patient had a myocardial infarction 3.75 years after baseline evaluation.</p><p><strong>Conclusion: </strong>These results suggest MBS is superior to MM in achieving weight loss prior to listing for kidney transplantation. Larger studies are needed to ensure the safety profile is acceptable in patients with ESRD undergoing bariatric surgery.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"99-106"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995055","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":"Determining if Admission Thromboelastography can Predict the Development of Late Resolving Multiple Organ Failure in Trauma Patients.","authors":"Ross P Smith, Lauren K Dwyer, Jacob C O'Dell, Christopher C McCoy, Christopher A Guidry, Robert A Winfield","doi":"10.1177/00031348241275718","DOIUrl":"10.1177/00031348241275718","url":null,"abstract":"<p><strong>Background: </strong>Normal coagulation TEG values on admission negatively correlate with overall risk of multiple organ failure, but less is known about association between coagulation and late-resolving multiple organ failure (LRMOF) risk. Here, the relationship between TEG parameters and development of LRMOF was investigated.</p><p><strong>Methods: </strong>We conducted a retrospective assessment of patients at high postinjury multiple organ failure risk at our center. The primary outcome was LRMOF.</p><p><strong>Results: </strong>Analysis included 742 patients. Demographics were 76% male, mean age of 41, mean ISS of 23, 34% hypercoagulability, and 16% developed LRMOF. Patients with normal admission TEG developed LRMOF at significantly lower unadjusted rates than patients with coagulation disturbances (9 vs 16%-19%, <i>P</i> = 0.029); however, multivariable logistic regression demonstrated that neither coagulation profile nor individual admission TEG parameters showed association with LRMOF.</p><p><strong>Conclusions: </strong>In this series, we found no significant relationship between coagulation status and LRMOF development.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"38-41"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142003424","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":"Prognostic Impact of a Decrease in Serum Carbohydrate Antigen 19-9 Levels After Preoperative Therapy for 4 Months or More for Borderline Resectable Pancreatic Cancer Abutting Major Arteries.","authors":"Michinori Matsumoto, Masashi Tsunematsu, Kyohei Abe, Ryoga Hamura, Shinji Onda, Kenei Furukawa, Koichiro Haruki, Tomoyoshi Okamoto, Tadashi Uwagawa, Toru Ikegami","doi":"10.1177/00031348241278016","DOIUrl":"10.1177/00031348241278016","url":null,"abstract":"<p><p><b>Background:</b> This study aimed to identify the prognostic factors after pancreatectomy for borderline resectable pancreatic cancer abutting major arteries (BR-A).<b>Methods:</b> We retrospectively investigated relationship between preoperative and intraoperative variables and overall survival (OS) through univariate and multivariate analyses. The cut-off points of preoperative therapy duration and response rates of serum carbohydrate antigen 19-9 (CA19-9) levels after preoperative therapy were determined through a minimum <i>P</i>-value approach using the log-rank test for OS. Overall survival was compared among patients stratified according to the independent prognostic factors and the presence or absence of pancreatectomy.<b>Results:</b> After pretreatment, 17 patients underwent pancreatectomy and four patients continued chemotherapy without surgery. Multivariate analysis in 17 resected BR-A patients demonstrated decreased serum CA19-9 levels and preoperative therapy duration of ≥4 months were the independent prognostic factors [hazard ratio (HR) 0.01; <i>P</i> = 0.002, HR 0.13; <i>P</i> = 0.02]. Patients who underwent surgery with decreased serum CA19-9 levels after preoperative therapy of ≥4 months had a significantly better prognosis than those without one or both of independent prognostic factors and those who did not undergo surgery (median survival time: not estimated, 23.3 months, 10.5 months, and 10.8 months; <i>P</i> = 0.02, <i>P</i> = 0.004, and <i>P</i> = 0.001, respectively). Furthermore, the prognosis did not significantly differ between the patients who underwent surgery without meeting either one or both criteria and those without surgery.<b>Conclusions:</b> Preoperative therapy duration of ≥4 months and decreased serum CA19-9 levels are independent prognostic factors among BR-A patients.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"42-50"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035027","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":"Early Vasopressor Requirement Among Hypotensive Trauma Patients: Does It Cause More Harm Than Good?","authors":"Tanya Anand, Omar Hejazi, Adam Nelson, Ben Litmanovich, Audrey L Spencer, Muhammad Haris Khurshid, Arshin Ghaedi, Hamidreza Hosseinpour, Louis J Magnotti, Bellal Joseph","doi":"10.1177/00031348241269425","DOIUrl":"10.1177/00031348241269425","url":null,"abstract":"<p><strong>Background: </strong>Optimal utilization of vasopressors during early post-injury resuscitation remains unclear. Our study aims to describe the relationship between the timing of vasopressor administration and outcomes among hypotensive trauma patients.</p><p><strong>Methods: </strong>This was a retrospective analysis of the 2017-2018 ACS-TQIP database. We included adult (≥18 years) trauma patients presenting with hypotension (lowest SBP <90 mmHg) who received vasopressors within 6 hours of admission. We excluded patients who had a severe head injury (Head-AIS >3) and those with spinal cord injury (Spine-AIS >3). Patients were stratified based on the time to receive vasopressors. Multivariable regression analyses were performed to identify the independent association between timing of vasopressor initiation and outcomes.</p><p><strong>Results: </strong>1049 patients were identified. Mean age was 55 ± 20 years, and 70% of patients were male. The median ISS was 16 [9-24], 80% had a blunt injury, and the mean SBP was 61 ± 24 mmHg. The median time to first vasopressor administration was 319 [68-352] minutes. Overall, 24-hour and in-hospital mortality rates were 19% and 33%, respectively. Every one-hour delay in vasopressor administration beyond the first hour was independently associated with decreased odds of 24-hour mortality (aOR: 0.65, <i>P</i> < 0.001), in-hospital mortality (aOR: 0.65, <i>P</i> < 0.001), major complications (aOR: 0.77, <i>P</i> = 0.003), and increased odds of longer ICU LOS (β + 2.53, <i>P</i> = 0.012). There were no associations between the timing of early vasopressor administration and 24-hour PRBC transfusion requirements (<i>P</i> > 0.05).</p><p><strong>Conclusion: </strong>Earlier vasopressor requirement among hypotensive trauma patients was independently associated with increased mortality and major complications. Further research on the utility and optimal timing of vasopressors during the post-injury resuscitative period is warranted.</p><p><strong>Level of evidence: </strong>III therapeutic/care management.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"22-30"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141854462","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":"Changes in Skeletal Muscle Volume During Preoperative Chemotherapy Affect the Outcome of Pancreatic Cancer.","authors":"Michinori Matsumoto, Yoshihiro Shirai, Masashi Tsunematsu, Norimitsu Okui, Takeshi Gocho, Shinji Onda, Kenei Furukawa, Koichiro Haruki, Tadashi Uwagawa, Toru Ikegami","doi":"10.1177/00031348241278021","DOIUrl":"10.1177/00031348241278021","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to investigate the effects of changes in clinicopathological factors during preoperative chemotherapy for pancreatic cancer, including skeletal muscle volume, on recurrence and prognosis after pancreatectomy.</p><p><strong>Methods: </strong>Data from 41 patients who underwent resection for pancreatic cancer after preoperative chemotherapy from 2012 to 2021 were retrospectively reviewed. Skeletal muscle volume was substituted for the psoas muscle area (PMA) at the level of the third lumbar vertebra. We investigated the relationship of clinicopathological factors during preoperative chemotherapy with disease-free survival (DFS) and overall survival (OS). The association between clinicopathological factors and a decrease in PMA was investigated.</p><p><strong>Results: </strong>In the multivariate analyses for DFS and OS, the factors associated with recurrence were as follows: decrease in PMA (<i>P</i> = 0.003) and the absence of adjuvant therapy (<i>P</i> = 0.03), and the factors associated with poor prognosis were as follows: decrease in PMA (<i>P</i> = 0.04) and the absence of adjuvant therapy (<i>P</i> = 0.008), and the resectability of borderline resectable and unresectable-locally advanced tumors (<i>P</i> = 0.033). All patients with partial response according to the Response Evaluation Criteria in Solid Tumors (version 1.1) had no decrease in PMA (<i>P</i> = 0.01). The proportion of patients with Evans classification ≥ II was significantly higher in the group without a decrease in PMA (<i>P</i> = 0.02). The proportion of patients with an average relative dose intensity of adjuvant therapy ≥0.6 was significantly higher in the group without a decrease in PMA (<i>P</i> = 0.02).</p><p><strong>Conclusion: </strong>Changes in preoperative skeletal muscle volume during preoperative chemotherapy for pancreatic cancer is a potential predictor of recurrence and prognosis after pancreatectomy.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"115-125"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142046127","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":"24-hour Telemetry Monitoring May Not be Necessary for Patients With an Isolated Sternal Fracture and Minor ECG Abnormalities or Troponin Elevation: A Southern California Multicenter Study.","authors":"Fares Al-Khouja, Areg Grigorian, Brent Emigh, Morgan Schellenberg, Graal Diaz, Thomas K Duncan, Rahul Tuli, Raul Coimbra, Kacy Gilbert-Gard, Arianne Johnson, Makenna Marty, Mallory Jebbia, Amal K Obaid-Schmid, Nicole Fierro, Eric Ley, Dunya Bayat, Walter Biffl, Shayan Ebrahimian, Areti Tillou M, Erica Tay-Lasso, Claudia Alvarez, Jeffry Nahmias","doi":"10.1177/00031348241278904","DOIUrl":"10.1177/00031348241278904","url":null,"abstract":"<p><strong>Background: </strong>Current guidelines recommend 24-hour telemetry monitoring for isolated sternal fractures (ISFs) with electrocardiogram (ECG) abnormalities or troponin elevation. However, a single-center study suggested ISF patients with minor ECG abnormalities (sinus tachycardia/bradycardia, nonspecific arrhythmia/ST-changes, and bundle branch block) may not require 24-hour telemetry monitoring. This study sought to corroborate this, hypothesizing ISF patients would not develop blunt cardiac injury (BCI).</p><p><strong>Materials & methods: </strong>A retrospective study was performed at 8 trauma centers (1/2018-8/2020). Patients with ISF (abbreviated injury scale <2 for the head/neck/face/abdomen/extremities) and minor ECG abnormalities or troponin elevations were included. Patients with multiple rib fractures or hemothorax/pneumothorax were excluded. The primary outcome was an echocardiogram confirmed BCI. The secondary outcome was significant BCI defined as cardiogenic shock, dysrhythmia requiring treatment, post-traumatic cardiac structural defects, unexplained hypotension, or cardiac-related procedures. Descriptive statistics were performed.</p><p><strong>Results: </strong>Of 124 ISF patients with minor ECG abnormalities or troponin elevation, 90% were admitted with a mean stay of 35 hours. Echocardiogram was performed for 31.5% of patients, 10 (25.6%) of which had abnormalities. However, no patient had BCI diagnosed on echocardiography. In total, 2 patients (1.6%) had a significant BCI (atrial fibrillation and supraventricular tachycardia at 10 and 82 hours after injury). No patient died.</p><p><strong>Conclusions: </strong>Following ISF with minor ECG changes or troponin elevation, <2% suffered significant BCI, and none had an echocardiogram diagnosed BCI, despite >30% receiving echocardiogram. These findings challenge the dogma of mandatory observation periods following ISF with associated ECG abnormalities and support the lack of utility for routine echocardiography in these patients.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"126-132"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142078905","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":"SMARCA4-Deficient Colonic Tumor in a Patient with mutY DNA Glycosylase (MUTYH) Associated Polyposis.","authors":"Jessica Wassef, Peter Kaye","doi":"10.1177/00031348241269413","DOIUrl":"10.1177/00031348241269413","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"141-143"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141873976","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}