American Surgeon最新文献

{"title":"The Association Between Body Mass Index and 28-day Mortality in Patients With Sepsis: A Retrospective Cohort Study.","authors":"Xu Zhang, Weiwei Yuan, Tingting Li, Haiwang Sha, Zhiyan Hui","doi":"10.1177/00031348241304040","DOIUrl":"10.1177/00031348241304040","url":null,"abstract":"<p><p>BackgroundSepsis is a severe clinical syndrome with high morbidity and mortality in intensive care units (ICUs). Body Mass Index (BMI) shows a rising trend of obese patients being admitted to ICUs. The relationship between BMI and the clinical outcome of sepsis remains highly debated.MethodsThe data used in this study were sourced from the Intensive Care Information Center IV (MIMIC-IV) database. Baseline information extracted within 24 hours of ICU admission was categorized according to World Health Organization (WHO)'s BMI classifications. A multivariate Cox regression model and curve fitting assessed the independent correlation between BMI and the primary outcome.ResultsA total of 7836 patients were included in the study and categorized into five groups based on BMI. The overall 28-day mortality rate was 21.94% (1719/7836). Class I obesity (17.14%) and class II/III obesity (13.49%) individuals tended to be younger and male. Compared to patients with normal BMI (32.55%), those with low BMI (5.79%) had a 47% increased risk of 28-day mortality (HR 1.47, 95% CI 1.16-1.85, <i>P</i> = 0.0013), while class II/III obesity patients had a 17% lower 28-day mortality rate (HR 0.83, 95% CI 0.71-0.97, <i>P</i> = 0.0218). Curve fitting revealed a nonlinear relationship between BMI and 28-day mortality. The Kaplan-Meier survival analysis highlighted variations in survival rates across the five groups (<i>P</i> = 0.0123), with underweight patients exhibiting poorer survival outcomes.ConclusionIn sepsis patients, a low BMI is related to higher 28-day mortality compared to those with a normal BMI. Conversely, patients with a BMI≥35 kg/m² have significantly reduced mortality risks.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"494-504"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738130","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":"Socioeconomic and Racial Disparities in the Use of Robotic-Assisted Proctectomy in Rectal Cancer.","authors":"Sameh Hany Emile, Zoe Garoufalia, Rachel Gefen, Giovanna Dasilva, Steven D Wexner","doi":"10.1177/00031348241304013","DOIUrl":"10.1177/00031348241304013","url":null,"abstract":"<p><p>BackgroundRectal cancer surgery is technically demanding, especially in males. Robotic assistance may help overcome these challenges. This study aimed to identify factors associated with robotic-assisted proctectomy in rectal cancer.MethodsRetrospective case-control analysis of patients with clinical stage I-III rectal adenocarcinoma who underwent proctectomy from the National Cancer Database (2010-2019) was conducted. Univariable and multivariable binary logistic regression analyses were conducted to determine predictive factors of robotic-assisted proctectomy in rectal cancer.Results67 145 patients (60.9% male; mean age: 61.15 ± 12.49 years) were included. 44.7% had stage III disease and 66.2% received neoadjuvant radiation. The surgical approach was laparotomy (n = 29 725), laparoscopy (n = 21 657), and robotic-assisted proctectomy (n = 15 763). Independent predictors for the use of robotic-assisted proctectomy were age <50 years (OR: 1.06; <i>P</i> = .032), male sex (OR: 1.07, <i>P</i> < .001), Asian race (OR: 1.25; <i>P</i> < .001), private insurance (OR: 1.25; <i>P</i> < .001), rectal cancer treatment between 2015 and 2019 (OR: 3.52; <i>P</i> < .001), stage III disease (OR: 1.06; <i>P</i> = .048), neoadjuvant radiation (OR: 1.26; <i>P</i> < .001), and pull-through coloanal anastomosis (OR: 1.15; <i>P</i> < .001). Robotic-assisted surgery was less often used in Black (OR: .857, <i>P</i> < .001) and American Indian patients (OR: .62, <i>P</i> = .002) and those with a Charlson score = 3 (OR: .818, <i>P</i> = .002), living in rural areas (OR: .865, <i>P</i> = .033), who were uninsured (OR: .611, <i>P</i> < .001), and undergoing pelvic exenteration (OR: .461, <i>P</i> < .001).ConclusionsDemographic and insurance disparities of robotic-assisted proctectomy are Black and American Indian patients and those with higher Charlson comorbidity index scores and uninsured patients were less likely to undergo robotic-assisted proctectomy. While patients with advanced disease and/or received neoadjuvant radiation were more likely to undergo robotic-assisted proctectomy, robotic-assisted surgery was less often performed in pelvic exenteration.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"528-538"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765398","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":"Influence of Trauma Patients Aged ≥55 With PEC in Long Stay in the Hospital and Intensive Care Unit.","authors":"Zulmari Resto, Ilko Luque, Nicole López, Hector Mendez, Mariel Javier, Marcela Ramirez, Orlando Morejón, Mark McKenney","doi":"10.1177/00031348241304041","DOIUrl":"10.1177/00031348241304041","url":null,"abstract":"<p><p>BackgroundTrauma and pre-existing conditions (PECs) can independently impact patient hospital length of stay (H-LOS) or intensive care unit (ICU) ICU-LOS. Pre-existing conditions impact on LOS has rarely been studied in older trauma patients aged ≥55. Our purpose is to examine the relationship between PEC status and ICU-LOS and H-LOS in this population.MethodsThis is a 3-year retrospective study, for calendar years 2020 through 2022. Multiple linear regression was used for analysis. Confounding factors were controlled for. Statistical significance was defined as <i>P</i> < 0.05.ResultsThere were 5168 patients (54.9% female) reviewed. The age breakdown was 51.6% were 70-80 years old. The injury breakdown showed 49.1% mild injury. The mean H-LOS was 6.00 and mean ICU-LOS was 2.55. Having certain PECs increases H-LOS, including congestive heart failure (CHF) by 2.29 days (<i>P</i> < 0.001), chronic obstructive pulmonary disease (COPD) by 1.10 days (<i>P</i> < 0.001), and chronic renal failure (CRF) by 0.96 days (<i>P</i> = 0.02). Increases in ICU-LOS were associated with having certain PECs, specially CRF by 1.03 days (<i>P</i> < 0.001) and CHF by 1.47 days (<i>P</i> < 0.001).ConclusionOlder trauma patients aged ≥55 with certain PECs had an associated increase in ICU and hospital length of stay. Identifying PEC is essential for the care and management of any patient. Identification of PECs on injured patients is essential since this can prolong the LOS. Early involvement of specialists in patient care directed to each PEC may improve these outcomes.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"512-517"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754579","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":"Contemporary Nationwide Assessment of Resource Utilization and Perioperative Outcomes in Open and Minimally Invasive Pancreaticoduodenectomy.","authors":"Bibek Aryal, Yue Yin, Edward A Joseph, David L Bartlett, Sricharan Chalikonda, Casey J Allen","doi":"10.1177/00031348241307401","DOIUrl":"10.1177/00031348241307401","url":null,"abstract":"<p><p><b>Background:</b> While minimally invasive pancreaticoduodenectomy (MIPD) has historically demonstrated benefits over open pancreaticoduodenectomy (OPD), recent advances in perioperative care and surgical techniques may have impacted the relative advantages of these two approaches. This contemporary analysis examines national trends to assess potential differences in resource utilization metrics along with perioperative outcomes between the two approaches. <b>Methods:</b> We analyzed the Nationwide Inpatient Sample database for cancer patients who underwent pancreaticoduodenectomies from 2016 through 2020. We compared socio-demographics, length of stay (LOS), total charges, and perioperative complications between MIPD and OPD. <b>Results:</b> In this observational study, MIPD was associated with lower total charges ($97,470 vs $126,586), shorter LOS (5.05 vs 7.37 days), and lower odds of perioperative complications (OR 1.40, 95% CI 1.18-1.65) compared to OPD. While total charges increased similarly in both groups over time, a declining trend in LOS was observed for OPD (11.49 to 10.36 days). Non-white race and private/other insurance correlated with longer stays, higher charges, and more complications regardless of surgical approach. <b>Conclusions:</b> Despite the gradual improvements in LOS observed with OPD, MIPD demonstrated advantages in resource utilization metrics, indicating potential for reduced healthcare utilization and costs compared to the open surgical approach during the study period. Continued prospective investigation is warranted to comprehensively evaluate MIPD's value proposition.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"539-547"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799035","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":"Take CARE: An Approach to the Initial Processing of Catastrophic Operative Events.","authors":"Michael J Asken, Maria Ahmad, Russell S Owens","doi":"10.1177/00031348241307395","DOIUrl":"10.1177/00031348241307395","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"668-669"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142833564","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":"Cost-Benefit Analysis of Various Management Algorithms for Suspected Choledocholithiasis.","authors":"Jesse K Kelley, Jeremy Mormol, Mary Reiber, Avery Sena, Camille Joy Abutin, Jake Sypniewski, Charles Reed, Giuseppe M Zambito, Amy L Banks-Venegoni","doi":"10.1177/00031348241312120","DOIUrl":"10.1177/00031348241312120","url":null,"abstract":"<p><p>The goal of our study is to evaluate the safest, efficient, and most cost-effective way to manage suspected choledocholithiasis. This retrospective study evaluated adult patients with suspected choledocholithiasis based on labs and imaging at a single institution between 2017 and 2022 and characterized them into 1 of 3 groups based on their management pathway: (1) ERCP-first, (2) MRCP-first, or (3) surgery-first with possible intraoperative cholangiogram pending laboratory trend. Our primary outcome was hospital length of stay. 34 patients (25%) had MRCP-first, 60 patients (45%) had ERCP-first, and 39 patients (30%) received surgery first. There was no statistically significant difference in the length of stay with respect to the management pathway utilized (<i>P</i> > .05); however, those admitted to a surgical service were discharged on average one day before those admitted to the medicine service (<i>P</i> = .01).</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"655-657"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926243","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: Volvulus in Eastern Anatolia.","authors":"Sabri Selcuk Atamanalp, Rifat Peksoz, Esra Disci","doi":"10.1177/00031348251314153","DOIUrl":"10.1177/00031348251314153","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"666-667"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142963547","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":"Retained Surgical Sponge Expelled Through a Rectal Fistula With Spontaneous Passage Per Rectum.","authors":"Seyit Murat Aydın, Aziz Mutlu Barlas, Tayfun Bayraktar","doi":"10.1177/00031348251313526","DOIUrl":"10.1177/00031348251313526","url":null,"abstract":"<p><p>Gossypiboma is a condition that occurs as a result of leaving sterile gauze, surgical sponges, or similar materials inadvertently retained in the body following surgery. The most common localization of gossypibomas is the intraabdominal cavity. Patients with gossypiboma can remain asymptomatic for years. Clinical manifestations and complications vary widely. Gossypibomas can result in significant complications based on the affected organ and its anatomical location. It is difficult to determine the exact incidence due to medicolegal issues. While prevention remains the most effective strategy for protecting against gossypiboma, the preferred treatment for abdominal gossypiboma is typically surgical intervention. This case aims to present a giant 25 × 25 cm textiloma that led to significant fistulization secondary to intraluminal migration and was expelled via the rectum, a phenomenon not previously reported in the literature.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"658-661"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942694","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":"Socioeconomic Deprivation and Risk of Operative Mortality After Emergency Laparotomy: A Systematic Review and Meta-Analysis.","authors":"Olivia Ambler, Shahin Hajibandeh, Shahab Hajibandeh","doi":"10.1177/00031348251314151","DOIUrl":"10.1177/00031348251314151","url":null,"abstract":"<p><p>AimsThe aim was to determine the effect of socioeconomic deprivation on operative mortality after emergency laparotomy.MethodsA PRISMA-compliant systematic review and meta-analysis (random-effects modeling) was performed searching for studies comparing operative mortality between the least and the most socioeconomically deprived patients undergoing emergency laparotomy. Both unadjusted and adjusted odds ratio (OR) were calculated as summary measure. Risk of bias was assessed using the Quality In Prognosis Studies tool, and certainty of evidence was assessed using the GRADE system.ResultsFour studies comprising 87,690 patients were included. There was no difference in the risk of operative mortality between the most and least deprived groups (unadjusted OR: 1.57, 95% CI .92, 2.68, <i>P</i> = .100) and when adjusted for other predictors (adjusted OR: 1.11, 95% CI .93, 1.32, <i>P</i> = .230). Subgroup analysis showed consistency of the findings in the United Kingdom (unadjusted OR: 1.36, 95% CI .92, 2.01, <i>P</i> = .130; adjusted OR: 1.15, 95% CI .92, 1.43, <i>P</i> = .230) and in the United States (unadjusted OR: 1.75, 95% CI .75, 4.06, <i>P</i> = .190; adjusted OR: 1.01, 95% CI .79, 1.29, <i>P</i> = .940). Sensitivity analyses showed inconsistency in favor of higher mortality risk in the most deprived patients. The GRADE certainty was moderate.ConclusionsSocioeconomic deprivation may have minor effect on operative mortality after emergency laparotomy; however, such effect fades away once adjusted for other predictors of mortality. Although independent research is required, it may be reasonable to predict that incorporation of socioeconomic deprivation into preoperative risk assessment tools may not improve their predictive performance.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"644-652"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942738","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":"Prediction of Mortality and Length of Hospital Stay in Geriatric Patients Undergoing Emergency General Surgery: Use of the SHARP Score.","authors":"Nermin Damla Okay, Habibe Selmin Özensoy","doi":"10.1177/00031348241308912","DOIUrl":"10.1177/00031348241308912","url":null,"abstract":"<p><p>BackgroundThe need for emergency general surgery (EGS) in geriatric patients is increasing with the aging population. The aim of this study was to evaluate the ability of SHARP score to predict mortality rate and length of hospital and emergency service stay for EGS patients.MethodsPatients aged ≥65 years who applied to the emergency service, required EGS, and underwent surgery between February 1, 2022, and January 31, 2023, were retrospectively analyzed from our hospital's information system. Demographic data (age, gender, and comorbidities), surgical diagnoses, and SHARP risk scores of the patients were evaluated. Also, 30-day mortality and length of stay in the emergency service and hospital were examined.ResultsA total of 386 patients were evaluated in this study. The mean age of these patients was 75 years (65-94). The most common cause of EGS was hernia. The cause with the highest mortality was intraabdominal perforations. The presence of malignancy and an increase in the number of comorbidities were associated with mortality. SHARP scores of 3, 4, and 5 were significantly associated with length of hospital stay and mortality.ConclusionWe recommend considering the SHARP risk score to predict mortality and length of hospital stay in geriatric EGS patients.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"587-592"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869290","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}