American Surgeon最新文献_第3页

Contemporary Nationwide Assessment of Resource Utilization and Perioperative Outcomes in Open and Minimally Invasive Pancreaticoduodenectomy. 当代全国开放与微创胰十二指肠切除术资源利用及围手术期疗效评估。

IF 1 4区医学

American Surgeon Pub Date : 2025-04-01 Epub Date: 2024-12-09 DOI: 10.1177/00031348241307401

Bibek Aryal, Yue Yin, Edward A Joseph, David L Bartlett, Sricharan Chalikonda, Casey J Allen

{"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":"Background: 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. Methods: 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. Results: 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. Conclusions: 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.","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}

引用次数: 0

Take CARE: An Approach to the Initial Processing of Catastrophic Operative Events. 关爱：灾难性手术事件的初步处理方法。

IF 1 4区医学

American Surgeon Pub Date : 2025-04-01 Epub Date: 2024-12-16 DOI: 10.1177/00031348241307395

Michael J Asken, Maria Ahmad, Russell S Owens

引用次数: 0

Cost-Benefit Analysis of Various Management Algorithms for Suspected Choledocholithiasis. 疑似胆总管结石各种管理算法的成本效益分析。

IF 1 4区医学

American Surgeon Pub Date : 2025-04-01 Epub Date: 2025-01-04 DOI: 10.1177/00031348241312120

Jesse K Kelley, Jeremy Mormol, Mary Reiber, Avery Sena, Camille Joy Abutin, Jake Sypniewski, Charles Reed, Giuseppe M Zambito, Amy L Banks-Venegoni

引用次数: 0

Letter re: Volvulus in Eastern Anatolia. 字母re：安纳托利亚东部的扭转。

IF 1 4区医学

American Surgeon Pub Date : 2025-04-01 Epub Date: 2025-01-10 DOI: 10.1177/00031348251314153

Sabri Selcuk Atamanalp, Rifat Peksoz, Esra Disci

引用次数: 0

Retained Surgical Sponge Expelled Through a Rectal Fistula With Spontaneous Passage Per Rectum. 通过直肠瘘管排出的手术海绵，经直肠自动通过。

IF 1 4区医学

American Surgeon Pub Date : 2025-04-01 Epub Date: 2025-01-07 DOI: 10.1177/00031348251313526

Seyit Murat Aydın, Aziz Mutlu Barlas, Tayfun Bayraktar

引用次数: 0

Socioeconomic Deprivation and Risk of Operative Mortality After Emergency Laparotomy: A Systematic Review and Meta-Analysis. 紧急剖腹手术后社会经济剥夺与手术死亡风险：系统回顾和荟萃分析。

IF 1 4区医学

American Surgeon Pub Date : 2025-04-01 Epub Date: 2025-01-09 DOI: 10.1177/00031348251314151

Olivia Ambler, Shahin Hajibandeh, Shahab Hajibandeh

{"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":"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, P = .100) and when adjusted for other predictors (adjusted OR: 1.11, 95% CI .93, 1.32, P = .230). Subgroup analysis showed consistency of the findings in the United Kingdom (unadjusted OR: 1.36, 95% CI .92, 2.01, P = .130; adjusted OR: 1.15, 95% CI .92, 1.43, P = .230) and in the United States (unadjusted OR: 1.75, 95% CI .75, 4.06, P = .190; adjusted OR: 1.01, 95% CI .79, 1.29, P = .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.","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}

引用次数: 0

Prediction of Mortality and Length of Hospital Stay in Geriatric Patients Undergoing Emergency General Surgery: Use of the SHARP Score. 预测急诊普通外科老年患者的死亡率和住院时间：使用SHARP评分

IF 1 4区医学

American Surgeon Pub Date : 2025-04-01 Epub Date: 2024-12-20 DOI: 10.1177/00031348241308912

Nermin Damla Okay, Habibe Selmin Özensoy

{"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":"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.","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}

引用次数: 0

The Stomal Stent: A Novel Bridging Therapy for Patients Requiring Delayed Ostomy Revision. 造口支架：一种用于需要延迟造口翻修的患者的新型桥接疗法。

IF 1 4区医学

American Surgeon Pub Date : 2025-04-01 Epub Date: 2024-12-09 DOI: 10.1177/00031348241307398

Mason Henrich, Bianca Fischer, Jun Tashiro

引用次数: 0

Angiotensin-Converting Enzyme Inhibitor (ACEI) and Angiotensin Receptor Blocker (ARB) Use are Associated With Increased Readmission After Ileostomy Creation. 血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体阻滞剂（ARB）的使用与回肠造口术后再入院率增加有关。

IF 1 4区医学

American Surgeon Pub Date : 2025-04-01 Epub Date: 2024-12-10 DOI: 10.1177/00031348241307396

Connie Y Gan, Shahrose Rahman, Shaun R Flerchinger, Jeffrey S Barton

{"title":"Angiotensin-Converting Enzyme Inhibitor (ACEI) and Angiotensin Receptor Blocker (ARB) Use are Associated With Increased Readmission After Ileostomy Creation.","authors":"Connie Y Gan, Shahrose Rahman, Shaun R Flerchinger, Jeffrey S Barton","doi":"10.1177/00031348241307396","DOIUrl":"10.1177/00031348241307396","url":null,"abstract":"BackgroundHigh output is a common cause for readmission after new ileostomy creation. The loss of sodium leads to compensatory activation of the renin-angiotensin-aldosterone system (RAAS). Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are first-line therapy for hypertension in the United States. We hypothesized that concurrent use of ACEI/ARB increases the risk of readmission following new ileostomy creation due to the loss of this compensatory mechanism.MethodsPatients undergoing ileostomy creation between 2009-2022 at an integrated managed health care system were included in this retrospective study. Primary outcomes were hospital readmission and ED visit within 30-days. Additional variables included ACEI/ARB use, ileostomy type, Charlson Comorbidity Index, additional antihypertensives at discharge (furosemide, hydrochlorothiazide, spironolactone, amlodipine, nifedipine, and diltiazem), and readmission diagnosis. Descriptive and advanced statistical analysis was completed with SPSS.ResultsOf 540 patients, 41.9% were readmitted or visited an ED within 30 days. There was no difference in readmission or ED visit based on age, gender, or ileostomy type. Patients discharged with ACEI/ARB (37.4% vs 25.5%, P = .005) and additional antihypertensives (37.2% vs 17.3%, P = .006) were at a higher risk for readmission.ConclusionsInhibition of RAAS is associated with increased risk for hospital readmission. In patients with hypertension undergoing ileostomy creation, individualized care plans are needed with earlier antimotility agent use or intravenous rehydration plans.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"556-560"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799108","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

Letter re: "Pathological Examination in Pilonidal Sinus Surgery: Evaluating Necessity and Cost-Effectiveness: A 10-Year Retrospective Analysis". 回复：“脊髓窦手术病理检查：评估必要性和成本-效果：10年回顾性分析”。

IF 1 4区医学

American Surgeon Pub Date : 2025-04-01 Epub Date: 2025-01-05 DOI: 10.1177/00031348241312122

Mhd Firas Safadi, Dietrich Doll

引用次数: 0