American Surgeon最新文献_第3页

Venous Thromboembolism After Bariatric Surgery: An Analysis of Predictors and Trends in Two Large Datasets. 减肥手术后静脉血栓栓塞：两个大数据集的预测因素和趋势分析。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-11-01 Epub Date: 2025-05-08 DOI: 10.1177/00031348251339525

Zachary D Leslie, Charles M Quinn, Sayeed Ikramuddin, Eric S Wise

{"title":"Venous Thromboembolism After Bariatric Surgery: An Analysis of Predictors and Trends in Two Large Datasets.","authors":"Zachary D Leslie, Charles M Quinn, Sayeed Ikramuddin, Eric S Wise","doi":"10.1177/00031348251339525","DOIUrl":"10.1177/00031348251339525","url":null,"abstract":"BackgroundDeep vein thrombosis and pulmonary embolism (collectively, venous thromboembolism [VTE]) cause significant morbidity after bariatric surgery. The aim of this study was to compare predictors of VTE after bariatric surgery in two national databases.MethodsThe core National Inpatient Sample (NIS) database and Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Participant Use data Files from 2016-2021 were concatenated, and elective vertical sleeve gastrectomy and Roux-en-Y gastric bypass procedures were included. Trends in VTE were derived for inpatient hospital stays (NIS and MBSAQIP) and compared and 30-day rates only available in the MBSAQIP were also derived. Preoperative and perioperative factors were identified to construct a multivariable logistic regression model to identify predictors of VTE for each dataset.Results204,866 and 986,210 patients were identified in the NIS and MBSAQIP, and postoperative inpatient VTE rates were 0.11% and 0.10% (P > 0.05), respectively. History of pulmonary embolism (NIS odds ratio [OR] and 95% confidence interval: 3.21 [1.86, 5.53], P < 0.05, MBSAQIP OR: 1.83 [1.45, 2.32], P < 0.05) and increased age (NIS OR: 1.22 [1.02,1.45], P < 0.05, MBSAQIP OR: 1.06 [1.0, 1.11], P < 0.05) were the only factors associated with higher risk of VTE in both databases. There was no difference in in-hospital rates between databases aside from 2021. The MBSAQIP 30-day VTE rate was 0.30%; hence, most (67%) incidences of 30-day VTE occurred after discharge.ConclusionsOur analysis identifies critical risk factors for VTE after bariatric surgery. Most incidences of VTE occurred after the initial hospitalization, and the MBSAQIP underestimates 2021 VTE rates.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1898-1905"},"PeriodicalIF":0.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952648","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

Trauma Sternotomy Closure: Drain Size May Matter. 创伤胸骨切开术闭合：引流管大小可能有影响。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-11-01 Epub Date: 2025-04-30 DOI: 10.1177/00031348251339531

Corey Ambrose, Brandon Nakashima, Amanda Hambrecht, Kazuhide Matsushima, Matthew J Martin, Kenji Inaba, Morgan Schellenberg

{"title":"Trauma Sternotomy Closure: Drain Size May Matter.","authors":"Corey Ambrose, Brandon Nakashima, Amanda Hambrecht, Kazuhide Matsushima, Matthew J Martin, Kenji Inaba, Morgan Schellenberg","doi":"10.1177/00031348251339531","DOIUrl":"10.1177/00031348251339531","url":null,"abstract":"BackgroundSternotomy for trauma (ST) can be life-saving, but optimal chest closure techniques and their impact on outcomes remain unclear. This study examines the association between mediastinal drain size used during ST closure and patient outcomes to determine if larger bore drain placement may mitigate need for reintervention after definitive chest closure.MethodsA retrospective review (2015-2023) of all ST patients at an ACS-verified Level 1 trauma center was conducted, excluding intraoperative deaths. The primary outcome was mediastinal reintervention, defined as redo sternotomy or percutaneous mediastinal drainage after closure. Patients were categorized based on mediastinal drain size: small bore drains (≤15 French) (SBD) vs large bore drains (>15 French) (LBD).ResultsForty-four patients were included: 18 (41%) in the SBD group and 26 (59%) in the LBD group. The median age was 30 years, and most were male (98%). Penetrating trauma was the primary mechanism of injury, and pericardial closure techniques were similar between groups. Mediastinal reintervention for treatment or prevention of cardiac tamponade occurred more frequently in the SBD group (22% vs 4%; P = 0.07).ConclusionAlthough mediastinal reintervention following ST was rare, SBD placement was associated with a higher incidence of reintervention compared to LBD, potentially due to inadequate mediastinal drainage. While not statistically significant, these findings suggest that larger bore drains may reduce the risk of postoperative cardiac tamponade. Multicenter study is warranted to explore these findings further with a larger patient sample size.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1876-1881"},"PeriodicalIF":0.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956272","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

Surgical Management of a Marjolin's Ulcer of the Scalp Following Recurrent Chemical Burns. 复发性化学烧伤后头皮马卓林溃疡的外科治疗。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-11-01 Epub Date: 2025-07-02 DOI: 10.1177/00031348251358427

Andrew N Hendrix, Anna V Yumen, Ashton Norris, Mariangela Rivera

引用次数: 0

The Last Scalpel: Ghosts in the Operating Room. 《最后的手术刀：手术室里的鬼魂》

IF 0.9 4区医学

American Surgeon Pub Date : 2025-11-01 Epub Date: 2025-07-28 DOI: 10.1177/00031348251363545

Amir Farah

引用次数: 0

Readiness Costs for a Statewide Trauma System. 全州创伤系统的准备费用。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-11-01 Epub Date: 2025-05-13 DOI: 10.1177/00031348251341957

Amy A Howk, Robert Seesholtz, Jessica Story, J Bracken Burns, Bradley M Dennis, Peter E Fischer, Darrell L Hunt, Robert A Maxwell, Regan F Williams, Brian J Daley

{"title":"Readiness Costs for a Statewide Trauma System.","authors":"Amy A Howk, Robert Seesholtz, Jessica Story, J Bracken Burns, Bradley M Dennis, Peter E Fischer, Darrell L Hunt, Robert A Maxwell, Regan F Williams, Brian J Daley","doi":"10.1177/00031348251341957","DOIUrl":"10.1177/00031348251341957","url":null,"abstract":"Introduction: Tennessee allocates funding to support the statewide trauma system. To better understand the costs of trauma center readiness outlined by ACS, our legislature challenged the trauma council to accurately determine the exact value for our state. Methods: Readiness components were devised from the 2014 edition of the Optimal Resources Document and state guidelines. Cost queries were sent to financial leadership of hospitals participating in the state trauma system for 2022. Data was deidentified and values vetted by an independent accounting firm. Values are reported in dollars for both state and average costs per trauma center by level. Costs were broken into administrative, clinical staff, OR availability and education/outreach. Results: Data was submitted from 5 level I, 1 level II, 8 level III, and 4 CRPC (Comprehensive Regional Pediatric Center). Total statewide costs totaled $171,000,000. Average costs for all components per level I/II was 20.6, level III 3.6, and CRPC 4.4 million dollars. The range across level I/II was 13.4 to 25.8 million dollars. Average I/II OR cost was 2.4 million and the highest provider cost was anesthesia at 2.3 million. Average education/outreach was $107,000 at Level I/II and includes registry and manager/coordinator costs for training. Conclusions: Trauma readiness is extremely costly at roughly $20,000,000 per level I/II center, $3,760,000 per level III, and $4,350,000 per CRPC. This value has doubled from that previously reported by a neighboring state. State and national leaders must be aware of costs and the need of support for trauma care when allocating health care funding.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1930-1934"},"PeriodicalIF":0.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061394","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

Enhancing Surgical Education Through Artificial Intelligence in the Era of Digital Surgery. 数字化外科时代，利用人工智能加强外科教育。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-11-01 Epub Date: 2025-06-02 DOI: 10.1177/00031348251346539

Paolo Aurello, Marco Pace, Marta Goglia, Matteo Pavone, Niccolò Petrucciani, Francesco Maria Carrano, Arianna Cicolani, Lucio Chiarini, Gianfranco Silecchia, Vito D'Andrea

{"title":"Enhancing Surgical Education Through Artificial Intelligence in the Era of Digital Surgery.","authors":"Paolo Aurello, Marco Pace, Marta Goglia, Matteo Pavone, Niccolò Petrucciani, Francesco Maria Carrano, Arianna Cicolani, Lucio Chiarini, Gianfranco Silecchia, Vito D'Andrea","doi":"10.1177/00031348251346539","DOIUrl":"10.1177/00031348251346539","url":null,"abstract":"Artificial Intelligence (AI) is transforming surgical education, playing a pivotal role in the era of digital surgery. This review, conducted from January 2023 to December 2024, examines the integration of AI into surgical training, focusing on its benefits and limitations. Thirteen studies were included, with emphasis on AI's impact in General Surgery training. Digital surgery leverages AI-powered tools such as virtual reality (VR) and augmented reality (AR) to create immersive, simulated environments where residents can practice surgical techniques safely and effectively. These platforms improve technical skills, hand-eye coordination, and error reduction, while personalized AI-driven feedback systems enhance learning and skill assessment. Digital surgery also bridges the gap between theoretical knowledge and clinical application, fostering innovative training methodologies. Despite challenges such as financial constraints and ethical concerns, AI within digital surgery emerges as a transformative force, redefining surgical education and equipping trainees with the expertise needed for modern health care.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1942-1948"},"PeriodicalIF":0.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198089","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

Futility of Radiographs After Chest Tube Removal (FRACTR) Trial. 胸管拔除（FRACTR）试验后x线片无效。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-11-01 Epub Date: 2025-07-21 DOI: 10.1177/00031348251358423

Ashton E Norris, Gunnar J Orcutt, Andrew Hendrix, Cameron McQuillen, Callie Clarke, Deborah M Hurley, James N Conner, Christopher M Watson, Jacob Hessey

{"title":"Futility of Radiographs After Chest Tube Removal (FRACTR) Trial.","authors":"Ashton E Norris, Gunnar J Orcutt, Andrew Hendrix, Cameron McQuillen, Callie Clarke, Deborah M Hurley, James N Conner, Christopher M Watson, Jacob Hessey","doi":"10.1177/00031348251358423","DOIUrl":"10.1177/00031348251358423","url":null,"abstract":"BackgroundRoutine post-pull chest X-rays (CXR) are still utilized after chest tube removal in trauma patients, though their necessity in asymptomatic individuals remains debated. This study aimed to identify predictors of chest tube reinsertion and evaluate a selective, symptom-based approach to post-pull imaging.MethodsA retrospective cohort study was conducted at a Level 1 trauma center, including 650 trauma patients who underwent chest tube placement between 2021 and 2024. Demographic and clinical variables were collected, including ICU and ventilator days, Injury Severity Score (ISS), waterseal use, and post-pull symptoms and CXR findings. Bivariate and multivariable logistic regression analyses were performed to identify predictors of reinsertion.ResultsAmong 539 eligible patients and 572 chest tubes, the reinsertion rate was 10%. Post-pull symptoms were the strongest predictor of reinsertion (OR 28.38, P < 0.001), followed by shorter chest tube duration and absence of waterseal, which decreased reinsertion odds by 89.9% (OR 0.101, P = 0.008). While post-pull CXR findings were associated with reinsertion, their positive predictive value (16.9%) was markedly lower than that of clinical symptoms (56.9%). ICU stay and ventilator days were associated with reinsertion in univariate analysis but not in multivariable modeling. Patients aged ≥65 had significantly lower odds of reinsertion compared to younger patients (OR 0.26, P = 0.031).DiscussionClinical symptoms were the most reliable predictor of reinsertion. A selective approach guided by symptoms, waterseal use, and drainage duration may reduce unnecessary imaging. Prospective validation of this strategy is warranted.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1813-1821"},"PeriodicalIF":0.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681897","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

Management of Traumatic Liver Failure Using Molecular Adsorbent Recirculating System (MARS) Treatment. 应用分子吸附剂再循环系统（MARS）治疗外伤性肝衰竭。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-11-01 Epub Date: 2025-07-27 DOI: 10.1177/00031348251363522

Theresa A Johnson, Rachel L Warner, Marie L Crandall, David J Skarupa, Joseph R Shiber

引用次数: 0

Reported Ventilator Associated Pneumonia Rates in the Trauma Population do not Reflect Clinically Significant Respiratory Infection. 创伤人群中呼吸机相关肺炎的报道率并不能反映临床显著的呼吸道感染。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-11-01 Epub Date: 2025-07-28 DOI: 10.1177/00031348251363531

Alison K Mortemore, Prashanth Balaraman, Emily McGee, Kenneth Chiep, Andrew Gross, Andrew Suh, Danielle Tatum, Patrick McGrew, Jeanette Zhang, Sharven Taghavi, Kevin N Harrell

{"title":"Reported Ventilator Associated Pneumonia Rates in the Trauma Population do not Reflect Clinically Significant Respiratory Infection.","authors":"Alison K Mortemore, Prashanth Balaraman, Emily McGee, Kenneth Chiep, Andrew Gross, Andrew Suh, Danielle Tatum, Patrick McGrew, Jeanette Zhang, Sharven Taghavi, Kevin N Harrell","doi":"10.1177/00031348251363531","DOIUrl":"10.1177/00031348251363531","url":null,"abstract":"BackgroundVentilator-associated pneumonia (VAP) is a common intensive care unit (ICU) infection linked to increased morbidity and mortality. Trauma patients may be at a higher risk for VAP due to factors like chest wall injury, pulmonary contusions, and aspiration risk. Limited data exists on this population despite VAP being a quality metric reported to the Trauma Quality Improvement Program (TQIP). We hypothesized that reported VAP rates will be lower than clinically significant infections.MethodsThis retrospective study analyzed intubated adult trauma patients at a single Level 1 trauma center between January 2019 and December 2023. VAP was defined as at least moderate growth of a speciated organism on respiratory culture obtained 2 or more days after intubation. The primary aim of this study is to compare trauma registry reported VAP rates with clinically significant respiratory infection.ResultsOver 5 years, 980 patients had a median age of 42 years, sustaining blunt injuries (71.3%) with a median injury severity score of 20. While the trauma registry reported VAP in 8.3% of patients, clinical VAP was identified in 23.7%. When comparing the trauma registry ability to predict the presence of clinically significant respiratory infection, VAP predicted clinically significant respiratory infection with only 29.2% sensitivity, with an area under the receiver operating characteristic curve of 0.640.ConclusionsVAP is underreported in trauma registries. Improved definitions, reporting standards, and diagnostic use of respiratory cultures are essential to enhance the reliability and utility of VAP as a quality metric and study tool in trauma patients.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1822-1827"},"PeriodicalIF":0.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144726501","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

Re-Evaluating the Necessity of Empiric Anti-Fungal Coverage in Gastroduodenal Perforations. 重新评价胃十二指肠穿孔经验性抗真菌覆盖的必要性。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-11-01 Epub Date: 2025-08-13 DOI: 10.1177/00031348251367025

Jordan D Raine, Meredith G Rippy, M Victoria P Miles, Ziwei Ma, Breanna L Carter, Christopher Bell

{"title":"Re-Evaluating the Necessity of Empiric Anti-Fungal Coverage in Gastroduodenal Perforations.","authors":"Jordan D Raine, Meredith G Rippy, M Victoria P Miles, Ziwei Ma, Breanna L Carter, Christopher Bell","doi":"10.1177/00031348251367025","DOIUrl":"10.1177/00031348251367025","url":null,"abstract":"ObjectivesResearch has suggested empiric perioperative antifungal coverage in gastroduodenal perforations does not reduce the risk of mortality and results in unnecessary exposure to antifungals. Identifying patients at highest risk for fungal infection who could benefit from tailored empiric fungal coverage is important. This study aimed to identify risk factors for fungal infection after gastroduodenal perforation (GDP). Empiric antifungal coverage may prove beneficial in mortality, length of stay (LOS), and need for reoperation for patients with GDP.MethodsA retrospective cohort study was conducted of adult patients from 2018 to 2024. Adult patients with nontraumatic CPT codes 43631, 43632, 43840, and 43659, with complete electronic medical records were included.Results151 patients met inclusion criteria, with 19 (12.6%) developing a culture-proven fungal infection during admission. Patients with fungal infections were admitted in worse clinical condition, with higher rates of vasopressor use (47.4% vs 22.7%, P = 0.044) and anemia (hemoglobin 10.6 g/dL vs 13.5 g/dL, P = 0.002). These patients had a longer LOS (23 days vs 12 days, P = 0.003), and required more surgeries (2.53 ± 2.01 vs 1.52 ± 1.43, P = 0.048). There was no significant difference in in-hospital mortality. Empiric antifungal agents were administered to 78.9% of patients who developed a confirmed fungal infection and 44.7% of patients who did not develop a fungal infection (P = 0.011).ConclusionPatients with nontraumatic GDP and a fungal infection were more likely to require vasopressors and be anemic on admission, although a significant mortality difference was not detected. Given the rate of non-albicans species isolated, the most appropriate empiric agent needs to be investigated.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1851-1856"},"PeriodicalIF":0.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144833777","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