American Surgeon最新文献_第3页

Association Between Child Life and Opioid Administration in Pediatric Trauma Patients. 儿童创伤患者儿童生命与阿片类药物使用的关系。

IF 1 4区医学

American Surgeon Pub Date : 2025-08-01 Epub Date: 2025-06-10 DOI: 10.1177/00031348251350982

Aliya G Burns, Robin K Mottern, Alexander G Sarant, Seth A Brown, Matthew A Leonard, Sarah A King, Hannah W Collins, J Bracken Burns

{"title":"Association Between Child Life and Opioid Administration in Pediatric Trauma Patients.","authors":"Aliya G Burns, Robin K Mottern, Alexander G Sarant, Seth A Brown, Matthew A Leonard, Sarah A King, Hannah W Collins, J Bracken Burns","doi":"10.1177/00031348251350982","DOIUrl":"10.1177/00031348251350982","url":null,"abstract":"Introduction: Child life specialists (CLSs) are professionals who help pediatric patients navigate illness and treatment. This study hypothesizes there is a correlation between the time it takes for a pediatric trauma patient to receive a visit from CLS and the opioids administered to the patient. Methods: This retrospective study conducted between October 2020 and October 2022 included 803 patients <18. Patients were divided into three groups: patients who did not receive CLS, patients who received CLS within 6 h (CLS <6 h), and patients who received CLS more than 6 h after admission (CLS >6 h). Descriptive statistics were used to observe differences in the medians of age, total opioids (mg), MEQ/kg, MEQ/kg/length of stay, and injury severity scores between the groups. Linear regression and multivariate linear regression were run to determine the effect of time to CLS and the presence of CLS on total opioids. Results: The median age of patients who received CLS was 7 and those who did not was 11 (P < .001). Thirty-nine percent of females received CLS vs only 31% of males (P = .031). Time to being seen by CLS showed total opioids increased by 0.015 mg per minute. There were significant associations with younger age (P < .001), lower total opioids (P < .001), and lower MEQ/kg of opioids (P < .001) in patients with CLS <6 h compared to those with CLS >6 h. Conclusion: Increased time to being seen by CLS led to an increase in total opioid administration. Patients with CLS <6 h received fewer total opioids compared to those with CLS >6 h.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1233-1237"},"PeriodicalIF":1.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265121","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

2025 Southeastern Surgical Congress Presidential Address: Leadership and Innovation in Surgery: A Vision for the Future. 2025东南外科大会主席演讲：外科的领导和创新：对未来的展望。

IF 1 4区医学

American Surgeon Pub Date : 2025-08-01 Epub Date: 2025-06-19 DOI: 10.1177/00031348251350999

John F Sweeney

{"title":"2025 Southeastern Surgical Congress Presidential Address: Leadership and Innovation in Surgery: A Vision for the Future.","authors":"John F Sweeney","doi":"10.1177/00031348251350999","DOIUrl":"10.1177/00031348251350999","url":null,"abstract":"Surgeons have always been at the forefront of transformative change in medicine-driven by a unique blend of technical expertise, decisiveness, and visionary leadership. The current article explores the evolving role of the surgeon as not only a practitioner but as an innovator and change agent. Drawing on the rich legacy of the Southeastern Surgical Congress, this address honors the enduring impact of its past presidents whose forward-thinking leadership helped shape modern surgical practice-from groundbreaking procedural advancements to innovations in education, health care delivery, and advocacy. Surgery is entering an era of rapid technological progress. The advances occurring in artificial intelligence, robotics, precision medicine, and digital health are significant and will shape the way we provide care in the future. Because of this the need for engaged, ethical, and collaborative surgeon-leaders has never been greater. This address challenges the surgical community to embrace innovation not as a trend but as a responsibility, encouraging a culture that values curiosity, accountability, and long-term impact over short-term gains. Future leaders within the Southeastern Surgical Congress must champion innovation that improves patient care, expands patient access, and elevates our profession. The future of surgery will be defined by those willing to lead with vision, humility, and purpose-and the Southeastern Surgical Congress is poised to help shape that future.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1225-1232"},"PeriodicalIF":1.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324290","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

Primary IVC Leiomyosarcoma: A Case Series and Review of the Literature. 原发性下腔静脉平滑肌肉瘤：病例系列及文献回顾。

IF 1 4区医学

American Surgeon Pub Date : 2025-08-01 Epub Date: 2025-04-14 DOI: 10.1177/00031348251333096

Vanessa Bartholomew, Christine M G Schammel, A Michael Devane, David P Schammel, Steven D Trocha

引用次数: 0

Early Routine Lung Cancer Screening Leads to Improved Treatment Options and Survival. 早期常规肺癌筛查可改善治疗选择和生存率。

IF 1 4区医学

American Surgeon Pub Date : 2025-08-01 Epub Date: 2025-04-01 DOI: 10.1177/00031348251331280

Jessica L Schweigert, Andrew J Borgert, Barbara A Bennie, Brenda L Rooney, Alec J Fitzsimmons, C Isaiah Fitzmaurice, Venki Paramesh

{"title":"Early Routine Lung Cancer Screening Leads to Improved Treatment Options and Survival.","authors":"Jessica L Schweigert, Andrew J Borgert, Barbara A Bennie, Brenda L Rooney, Alec J Fitzsimmons, C Isaiah Fitzmaurice, Venki Paramesh","doi":"10.1177/00031348251331280","DOIUrl":"10.1177/00031348251331280","url":null,"abstract":"BackgroundLung cancer is the second-most common cancer and leading cause of cancer-related deaths. American adults aged 55 to 80 years are at heightened risk for lung cancer; only 4.5% underwent screening history by computed tomography. The hypothesis is that lung cancers diagnosed on screening were an earlier stage which broadens treatment options and improves survival.MethodsThe electronic health record (EHR) was retrospectively queried to identify patients with lung cancer from 2017 to 2020. Kaplan-Maier curves were used to compare survival based on screening history.Results764 patients with lung cancer were included. 14.7% (112/764) had a history of lung cancer screening. Patients with a history of screening were significantly more likely to be diagnosed at early stages (66/112, 59% vs 215/652, 33%; P < .0001). They were significantly more likely to have surgery (46/112, 41% vs 97/652, 15%, respectively; P < 0.0001). Patients diagnosed in late stages were significantly more likely than those diagnosed at early stages to receive chemotherapy (318/483, 66% vs 76/281, 27%, respectively; P < .0001). Three-year survival was higher with screening (P < .0001). Survival rates at 3 years after initial diagnosis with screening history is 47.4% (95% CI, 34.8-59.0) while the rate without screening is 25.2% (95% CI, 21.2-29.4).DiscussionLung cancer diagnosed via screening was more likely to be earlier stages. Patients diagnosed at early stages were more likely to undergo surgery. Those diagnosed via screening had a higher 3-year survival. These findings indicate that early routine screening leads to improved treatment options and survival.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1285-1291"},"PeriodicalIF":1.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750689","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

Axillary Lymph Node Dissection With and Without Immediate Lymphatic Reconstruction: Association With Drain Days and Seromas. 腋窝淋巴结清扫伴或不伴立即淋巴重建：与引流天数和血清肿的关系。

IF 1 4区医学

American Surgeon Pub Date : 2025-08-01 Epub Date: 2025-04-15 DOI: 10.1177/00031348251332692

Samantha J Brown, Sarah A McLaughlin, Judy C Boughey, Antonio J Forte, Tina J Hieken, Mara A Piltin, Aparna Vijayasekaran, Zhuo Li, Monica M Price, James W Jakub

{"title":"Axillary Lymph Node Dissection With and Without Immediate Lymphatic Reconstruction: Association With Drain Days and Seromas.","authors":"Samantha J Brown, Sarah A McLaughlin, Judy C Boughey, Antonio J Forte, Tina J Hieken, Mara A Piltin, Aparna Vijayasekaran, Zhuo Li, Monica M Price, James W Jakub","doi":"10.1177/00031348251332692","DOIUrl":"10.1177/00031348251332692","url":null,"abstract":"Background: Immediate lymphatic reconstruction (ILR) via lymphovenous anastomosis is performed in patients undergoing axillary lymph node dissection (ALND) to minimize the risk of lymphedema. Following ALND, drains are placed to prevent seromas, while prolonged drain days are associated with increased risk of infection. The study aim was to determine the impact of ILR on the number of drain days following ALND in patients with breast cancer.Methods: We report a post-hoc analysis of a prospective trial (April 2018-January 2023) comparing patients with breast cancer who underwent ALND with ILR (intervention arm) vs ALND without ILR (control arm). Wilcoxon rank sum test and chi-squared or Fisher's exact tests compared continuous and categorical variables, respectively. Multivariable quantile regression models evaluated the difference in drain days and days until drain removal criteria were met with covariates adjusted.Results: Data from 214 patients were analyzed (n = 115 interventional arm, n = 99 control arm). The intervention arm had a median of 15 axillary drain days compared to 11 days in the control arm (P = .001). There was no significant difference between groups when measuring drain days based on the date the drain met removal criteria, rather than actual drain removal date. Seroma incidence was lower in the intervention arm (3.5%) vs the control arm (12.1%) (P = .017) without a statistical difference in incidence of infection.Conclusion: ALND with ILR does not decrease the number of drain days compared to ALND without ILR in patients with breast cancer, although we found the incidence of seromas to be lower without increase in incidence of infection.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1323-1330"},"PeriodicalIF":1.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958971","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

One- and Two-Stage Approaches to Common Duct Stones. 普通管道结石的一阶段和两阶段方法。

IF 1 4区医学

American Surgeon Pub Date : 2025-08-01 Epub Date: 2025-05-09 DOI: 10.1177/00031348251341960

Shannon M Smith, Jesse K Kelley, Giuseppe M Zambito, Amy L Banks-Venegoni

{"title":"One- and Two-Stage Approaches to Common Duct Stones.","authors":"Shannon M Smith, Jesse K Kelley, Giuseppe M Zambito, Amy L Banks-Venegoni","doi":"10.1177/00031348251341960","DOIUrl":"10.1177/00031348251341960","url":null,"abstract":"The prevalence of cholelithiasis is estimated to be upwards of 30% within the United States population. Of these patients, 10-20% will progress to develop choledocholithiasis. Prior to 2000, choledocholithiasis was managed via open cholecystectomy and common bile duct exploration. However, as minimally invasive surgical techniques and endoscopy have advanced, the current management of choledocholithiasis has progressed to a two-staged, laproendoscopic approach consisting of endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy. Review of the literature from 2005 to 2025 reveals that the preferred approach to choledocholithiasis continues to evolve. Management of choledocholithiasis via a single-stage such as performing intraoperative ERCP at the time of laparoscopic cholecystectomy is associated with a statistically significant decrease in overall 30-day morbidity as well as shorter hospital length of stay compared with a twostaged laproendoscopic approach. Alternatively, performing intraoperative rendezvous endoscopy significantly improves patient morbidity profiles due the absence of post-endoscopic pancreatitis compared with ERCP. A third management option includes laparoscopic common bile duct exploration via a transcystic or transductal approach. These approaches are associated with superior stone clearance rates compared with ERCP as well as decreased cost and hospital length of stay. Barriers to implementation of these techniques include surgeon training, equipment availability, and appropriate staffing. Future studies should investigate the role of robotic surgery in the management of choledocholithiasis as well as compare patient centered outcomes between the three, single-staged approaches.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1362-1367"},"PeriodicalIF":1.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958469","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

Video-Assisted Thoracoscopy in Pediatric Thoracic Trauma. 电视胸腔镜在小儿胸外伤中的应用。

IF 1 4区医学

American Surgeon Pub Date : 2025-08-01 Epub Date: 2025-05-08 DOI: 10.1177/00031348251341964

Carlin Lee, Jeffry Nahmias, Michael Lekawa, Kelly Fairbairn, Areg Grigorian

引用次数: 0

Cut to the Point: Revisiting the Role of Gastrectomy in Peptic Ulcer Disease. 切中要害：重新审视胃切除术在消化性溃疡疾病中的作用。

IF 1 4区医学

American Surgeon Pub Date : 2025-08-01 Epub Date: 2025-05-21 DOI: 10.1177/00031348251341965

Sarah D Diaz, Raymond A Jean, Staci T Aubry

{"title":"Cut to the Point: Revisiting the Role of Gastrectomy in Peptic Ulcer Disease.","authors":"Sarah D Diaz, Raymond A Jean, Staci T Aubry","doi":"10.1177/00031348251341965","DOIUrl":"10.1177/00031348251341965","url":null,"abstract":"IntroductionThe surgical management of peptic ulcer disease (PUD) has undergone profound changes over the past decades due to advances in medical management. Despite this reduced need for surgical intervention in the management of PUD, the absence of standardized, evidence-based guidelines for when gastroduodenal resection is warranted presents a significant gap in the literature. This review seeks to address this deficiency by summarizing the current literature and clarifying the indications for gastrectomy in the management of PUD, offering a framework for consistent and informed surgical decision-making.MethodsWe performed a literature review by searching PubMed, Google Scholar, and the Cochrane Library for studies of human participants, published in English between 2010 and 2024. Keywords utilized included \"gastrectomy,\" \"surgical management in PUD,\" \"omental flap,\" and \"vagotomy.\" The results were summarized with contextual recommendations.ResultsFrom the total of 6250 publications retrieved from the databases, we ultimately included 29 publications following a review of the abstracts and manuscripts. The management of peptic ulcer disease (PUD) has undergone a significant transformation, shifting from predominantly surgical interventions to advanced medical therapies, supported by innovations in pharmacotherapy, nutritional support, and endoscopic techniques.ConclusionSurgery, particularly gastrectomy, remains essential in specific cases such as large or multiple ulcers, ulcers associated with malignancy, and complicated cases that do not respond to other treatments. Emerging technologies continue to refine risk prediction and patient management, offering hope for further reducing surgical interventions. Despite these advancements, timely surgical intervention remains critical for managing life-threatening complications.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1388-1391"},"PeriodicalIF":1.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109302","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 1 4区医学

American Surgeon Pub 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":"https://doi.org/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":"31348251358423"},"PeriodicalIF":1.0,"publicationDate":"2025-07-21","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

Approach and Management of Multiple Victims of Civilian Bombing Events With Abdominopelvic Injuries: A 20-Year Institutional Experience in Pakistan. 处理和管理多名平民爆炸事件受害者的腹部和骨盆损伤：巴基斯坦20年的机构经验。

IF 1 4区医学

American Surgeon Pub Date : 2025-07-17 DOI: 10.1177/00031348251358443

Muhammad Nadeem Ahmad, Zahra Fatima Rahmatullah, Muhammad Masood Alam, Fatima Bhojani, Mallick Muhammad Zohaib Uddin, Shahzeb Ali, Naila Nadeem, Muhammad Salman Khan, Uffan Zafar

{"title":"Approach and Management of Multiple Victims of Civilian Bombing Events With Abdominopelvic Injuries: A 20-Year Institutional Experience in Pakistan.","authors":"Muhammad Nadeem Ahmad, Zahra Fatima Rahmatullah, Muhammad Masood Alam, Fatima Bhojani, Mallick Muhammad Zohaib Uddin, Shahzeb Ali, Naila Nadeem, Muhammad Salman Khan, Uffan Zafar","doi":"10.1177/00031348251358443","DOIUrl":"https://doi.org/10.1177/00031348251358443","url":null,"abstract":"PurposeBomb blast injuries in non-combat settings have seen a surge in the last two to three decades. Third-world countries like Pakistan have been at the receiving end of these attacks. However, the extent of the damage inflicted in these regions is not fully understood due to gross underreporting. We aim to assist radiologists in identifying common abdominopelvic injuries in bomb blast victims and highlighting specific injury patterns to guide more effective management.MethodsThis was a retrospective observational study designed to analyze abdominopelvic injuries among bomb blast victims treated at our institution. Data were retrieved from the hospital's electronic health records and included demographic information (age and sex), injury classification, imaging results, treatment received, and clinical outcomes.ResultsChi-square and t-tests showed no statistically significant difference in the gender or mean age distribution between patients who underwent abdominopelvic surgery and those who did not. The most common single injury category among the patients analyzed was secondary injury, while the most common combination of injuries observed was a combination of secondary and tertiary injuries. CT was the most frequently requested first-line radiological investigation, while US was most frequently requested as a second-line modality. Injuries to the liver were the most frequently observed solid-organ injury.ConclusionEfficient practices are essential in radiology departments to manage the surge in patient numbers seen after bomb blast incidents. Our study emphasizes the role of radiology scans and details the types of abdominopelvic injury patterns observed in bomb blast victims.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251358443"},"PeriodicalIF":1.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648349","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