American Surgeon最新文献

{"title":"Modified Pain, Inspiratory Capacity, and Cough (PIC) Score: An Easy Alternative Triage Tool in Blunt Thoracic Trauma.","authors":"Paula A Grisales, Haley Krachman, John D Cull","doi":"10.1177/00031348251412267","DOIUrl":"10.1177/00031348251412267","url":null,"abstract":"<p><p>BackgroundThe severity of injury in patients with rib fractures has historically been underestimated at the time of presentation, making early identification of high-risk patients essential for optimal care. The Pain, Inspiratory Capacity, and Cough (PIC) scoring system was developed to assess rib fracture severity, incorporating pain, inspiratory capacity, and cough strength. However, the original PIC score is cumbersome to obtain at the bedside. We used a modified PIC score by simplifying the inspiratory capacity assessment with fixed inspiratory volume thresholds (1500 mL and 750 mL). This study aimed to determine if our modified PIC score is an appropriate substitute for the original PIC score to determine the need for intensive care unit (ICU) level of care and/or predict adverse outcomes.MethodsThis is a retrospective cohort study at a level 1 trauma center. All adults who sustained rib fractures from January 2019 to December 2020 were identified using the local trauma registry. The electronic medical record was queried for standard demographics, admission modified PIC score, ICU admission, ICU length of stay (LOS), complications, and mortality. The original PIC score was then calculated among these same patients and compared.ResultsThe results showed high concordance (≥89.6%) between the original and modified scores. Importantly, using the modified score reduced ICU admissions by 22.4%, without missing any patients requiring intensive care.DiscussionThe modified PIC score demonstrated equivalent prognostic value while being easier to use, offering a practical tool for guiding ICU triage decisions.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1637-1643"},"PeriodicalIF":0.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145846485","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":"Comparison of Wound Infusion Catheter Versus Epidural Catheter for Analgesia After Midline Incision for Major Abdominal Surgery: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.","authors":"Mohamed Albendary, Hussam Khougali Mohamed, Salma Saeed Mohammed, Dina Nada, Asaad Yassin Mohamedahmed, Mohamed Refaie, Mohamed Elaraby, Ali Yasen Mohamedahmed","doi":"10.1177/00031348251409737","DOIUrl":"10.1177/00031348251409737","url":null,"abstract":"<p><p>BackgroundTo evaluate comparative outcomes of wound infusion catheter (WC) vs epidural analgesia (EP) for analgesia following midline laparotomy for abdominal surgery.MethodsA systematic search of PubMed, Cochrane Library, and Scopus was conducted, and all randomised controlled trials (RCTs) comparing WC vs EP for analgesia after midline laparotomy were included. Overall pain scores, total morphine consumption, respiratory depression, catheter-related complications, time of first bowel movement, and length of hospital stay (LOS) were set as outcome parameters for the meta-analysis. Subgroups of catheter positions, including preperitoneal, rectus sheath and transversus abdominis plane block as deep WC and subcutaneous WC, were examined for pain scores superiority.ResultsTwelve RCTs were pooled in a meta-analysis, involving a total of 778 patients who received WC (n = 390) or EP (n = 388). There was no significant difference in pain scores at rest and movement between WC and EP groups at 24 hours [<i>P</i> = .85 and <i>P</i> = .30, respectively] and 48 hours [<i>P</i> = .33 and <i>P</i> = .06, respectively]. However, subgroup analysis, excluding subcutaneous catheters, showed favourable pain scores on movement at 48 hours of use (mean difference [MD] -0.97, <i>P</i> = .03). The LOS was notably shorter in the WC group [MD, -0.50; <i>P</i> < .001]. There were no significant differences between both groups in cumulative morphine consumption [<i>P</i> = .33], return of bowel function [<i>P</i> = .13], respiratory depression [<i>P</i> = .43], or catheter-related complications [<i>P</i> = .16].ConclusionWC generally provides a comparable postoperative analgesia to EP; however, it is associated with shorter LOS and a slight superiority of analgesia of deep catheters. Comparing different types of nerve blocks and positions of catheters in future research may optimise the use of WC.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1673-1685"},"PeriodicalIF":0.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145793090","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: Osman Criteria and Timing of Repair After Bile Duct Injury: Methodologic and Reporting Clarifications.","authors":"Alexis Salgado González, Gilberto Carlos Garcia Bernal","doi":"10.1177/00031348261429459","DOIUrl":"10.1177/00031348261429459","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1862"},"PeriodicalIF":0.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147316105","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":"The Impact of Minimally Invasive Surgery on the Incidence of Adhesive Small Bowel Obstruction and Related Complications Following Colorectal Cancer Resections: A Systematic Review and Meta-Analysis.","authors":"Valberto Sanha, Josip Plascevic, Vanio Livramento Junior Antunes, Yuki Miyazaki, Chase J Wehrle, Kumaran Shanmugarajah, Dante L S Souza, Mohamed Maklad, Mohammed Osman, Koji Hashimoto, Masato Fujiki","doi":"10.1177/00031348251407346","DOIUrl":"10.1177/00031348251407346","url":null,"abstract":"<p><p>BackgroundColorectal cancer is the third most common malignancy in the U.S., frequently managed with surgical resection. Adhesion-related complications, specifically small bowel obstruction (SBO), are frequent postoperative issues. This study examines whether minimally invasive surgery (MIS) reduces the risk of adhesive SBO compared to open surgery.MethodsThe PubMed, EMBASE/MEDLINE, and Cochrane databases were queried to identify studies comparing open vs MIS colorectal cancer resection. The primary endpoints were the incidence of adhesive SBO, SBO requiring surgery, parastomal hernia, and incisional hernia rate.ResultsTen studies met inclusion criteria, comprising six randomized controlled studies (RCTs) and four non-RCTs, with a total of 23 032 patients-36.5% in the MIS group and 63.5% in the open group. Pooled analysis revealed a significantly lower incidence of adhesive SBO (RR: 0.58; CI: 0.45-0.75; <i>P</i> < .0001), SBO requiring surgery (RR: 0.69; CI: 0.49-0.96; <i>P</i> = .03), and infection rate (RR: 0.67; CI: 0.55-0.82; <i>P</i> < .0001) in the MIS group. No difference was seen in SBO requiring admission, incisional hernia (IH), IH requiring surgery, or length of hospital stay (LOS). The open group had a lower incidence of parastomal hernias (RR: 2.06; CI: 1.31-3.25; <i>P</i> = .002). Sensitivity analysis by using leave-one-out analysis also showed a significant reduction of adhesive SBO in the MIS group.ConclusionsThis study found reduced incidence of SBO, the need for SBO surgery, and infection rate with MIS surgery in colorectal cancer patients.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1740-1751"},"PeriodicalIF":0.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145707081","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: Reply to the Letter to the Editor: \"Can American Board of Surgery in Training Examinations Be Passed by Large Language Models? Comparative Assessment of Gemini, Copilot, and ChatGPT\".","authors":"Ahmet Necati Sanli, Deniz Esin Tekcan Sanli","doi":"10.1177/00031348251403577","DOIUrl":"10.1177/00031348251403577","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1863"},"PeriodicalIF":0.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145585863","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":"Multimodal Therapy for Pancreatic Cancer: State of the Art.","authors":"Tia S Sutton, Annmarie F Butare, David B Meyer, Anastasios Mitsakos, Emmanuel E Zervos","doi":"10.1177/00031348251409254","DOIUrl":"10.1177/00031348251409254","url":null,"abstract":"<p><p>The mainstay treatment for pancreatic cancer has classically been surgical resection. However, with the adoption of multimodal therapy, the 5-year survival rates have improved from 5% to 10% over the past 2 decades. Thanks to robust clinical trials, there is strong evidence to support the use of adjuvant chemoradiation for pancreatic cancer. Neoadjuvant therapy (NAT), however, is emerging as a potential strategy to further improve survival and outcomes. The purpose of this review is to provide a historical background of the use of multimodal therapy in the treatment of pancreatic cancer, as well as to explore the latest clinical questions regarding NAT in pancreatic cancer treatment. This article reviews the latest evidence in neoadjuvant treatment, discusses ongoing clinical trials, and provides insight on future directions of multimodal therapy for pancreatic cancer.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1759-1772"},"PeriodicalIF":0.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145809219","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":"National Patterns of Hernia Mortality, 1999-2023: Insights From the CDC WONDER Database.","authors":"Min Li, Yongan Feng","doi":"10.1177/00031348251412265","DOIUrl":"10.1177/00031348251412265","url":null,"abstract":"<p><p>BackgroundHernia is common and treatable, yet deaths persist nationally. Long-term trends and disparities through 2023, including the COVID-19 period-are not fully described.MethodsUsing the Centers for Disease Control and Prevention's Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER) database, we analyzed U.S. resident deaths with ICD-10 K40-K46 as underlying cause (1999-2023). Age-adjusted mortality rates (AAMRs, per 100 000) were standardized to the 2000 U.S. population. Temporal patterns were summarized with joinpoint average annual percent change (AAPC). Subgroups included sex, age, race/ethnicity, Census region, 2013 NCHS urbanization (to 2020), and hernia subtypes.ResultsThere were 47 248 hernia deaths; annual deaths rose from 1396 to 2617 (+87.46%). Overall AAMR increased from 1.02 to 1.23 (AAPC +0.91%). AAMRs rose for both females and males and remained elevated after 2019, with a 2020-2021 rise and subsequent stabilization. In 2023, AAMR was higher in non-Hispanic White (1.32) than in non-Hispanic Black (1.09) and Hispanic (0.99) populations, and varied by region (Northeast 1.27, Midwest 1.34, South 1.10, and West 1.30). Urbanization gradients persisted through 2020 (nonmetropolitan ≈1.22 vs metropolitan 0.99). Rates increased steeply with age. By subtype, deaths and/or AAMR increased for inguinal, diaphragmatic, unspecified abdominal, ventral, and umbilical hernias (eg, inguinal deaths 179 to 392, +118.99%); femoral AAMR declined, and deaths from other abdominal hernia decreased.ConclusionsU.S. hernia mortality shows a growing absolute burden and modest AAMR increase, alongside persistent disparities and heterogeneous subtype trajectories. Subtype-aware surveillance, resilient elective capacity, and equitable emergency pathways may help reduce preventable deaths.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1686-1696"},"PeriodicalIF":0.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145809207","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":"Role of Bariatric Surgery in Modulating Fetuin-A and Metabolic Outcomes: A Systematic Review and Meta-Analysis.","authors":"Chenglou Zhu, Wenhan Liu","doi":"10.1177/00031348251407347","DOIUrl":"10.1177/00031348251407347","url":null,"abstract":"<p><p>ObjectiveTo evaluate the impact of metabolic and bariatric surgery (MBS) on plasma Fetuin-A expression, body mass index (BMI), and glucose levels in patients with obesity.MethodsA systematic literature search was performed in PubMed, Cochrane Library, Web of science, and Embase following the PRISMA guidelines. A total of 5 studies (n = 298 participants) were included, reporting pre- and post-surgery plasma Fetuin-A levels, BMI, and glucose levels. Two independent reviewers extracted data, with discrepancies resolved by a third reviewer. Pooled standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated for each outcome. Heterogeneity was assessed using the I² statistic.ResultsThe pooled results revealed a significant reduction in plasma Fetuin-A levels post-surgery (SMD = -0.43, 95% CI = -0.73 to -0.14, <i>P</i> < .05, I² = 60.7%). BMI also decreased significantly following MBS (SMD = -1.74, 95% CI = -2.28 to -1.19, <i>P</i> < .05, I² = 84.2%). Additionally, glucose levels showed a marked reduction post-surgery (SMD = -0.94, 95% CI = -1.12 to -0.76, <i>P</i> < .05, I² = 16.2%).ConclusionMBS is associated with significant reductions in plasma Fetuin-A levels, BMI, and glucose levels. These findings indicate that changes in Fetuin-A may accompany the metabolic improvements observed after MBS, although causal mechanisms cannot be established from the available evidence.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1839-1848"},"PeriodicalIF":0.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145740702","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":"Malignancy Risk and Diagnostic Accuracy of Fine-Needle Aspiration in Thyroid Nodules ≥4 cm: A Retrospective Analysis of Incidental Cancer.","authors":"Niranjna Swaminathan, Angel J Laboy, Azeem Izhar, Sanjana Balachandra, Chandler McLeod, Andrea Gillis, Jessica Fazendin, Brenessa Lindeman, Herbert Chen","doi":"10.1177/00031348251407348","DOIUrl":"10.1177/00031348251407348","url":null,"abstract":"<p><p>IntroductionThe incidence of thyroid nodules measuring ≥4 centimeters (cm) has increased over the last decade and is particularly concerning for malignancy. However, the malignancy risk and diagnostic accuracy of fine-needle aspiration biopsy (FNAB) in nodules ≥4 cm remain debated. This study aims to determine the malignancy rate in nodules ≥4 cm and evaluate the diagnostic accuracy of FNAB.MethodsWe retrospectively analyzed patients who underwent partial or total thyroidectomy from January 2015 to December 2024 at a large tertiary care center. Data collected included patient demographics, thyroid nodule size, and final surgical pathology to determine the malignancy rate. Patients with nodules ≥4 cm were identified, and those who underwent FNAB were analyzed for diagnostic concordance between cytology and surgical pathology.ResultsAmong 1049 patients who underwent thyroidectomy, 167 (16%) had nodules ≥4 cm. Of these, 95 (57%) underwent preoperative FNAB and formed the analytic cohort. In this group, 14 patients (14.7%) had malignant final pathology, and 5 of these malignancies (35.7%) were incidentally discovered. Three of the incidental malignancies were papillary thyroid microcarcinomas (<1 cm) and were excluded from diagnostic performance analysis. Fine-needle aspiration biopsy demonstrated a sensitivity of 54.1%, specificity of 91.4%, false-negative rate of 20.99%, and positive predictive value of 81.3%. Concordance between FNAB and final pathology was observed in 79% of benign and 86% of malignant cases.ConclusionFine-needle aspiration biopsy demonstrates limited sensitivity in nodules ≥4 cm, with a 21% false-negative rate and potential for missed incidental malignancies. Based on this, surgical resection should be considered for thyroid nodules ≥4 cm.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1813-1818"},"PeriodicalIF":0.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145707032","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":"The Role of Ligation in Portal Vein Trauma: A Historical Case Study.","authors":"Evan J Beck, Megan Llewellyn, Theodore N Pappas","doi":"10.1177/00031348251405549","DOIUrl":"10.1177/00031348251405549","url":null,"abstract":"<p><p>Traumatic portal vein injuries are often fatal, with historical mortality rates as high as 71%. This report examines the 1894 assassination of French President Sadi Carnot as an early case of unsuccessful surgical management of a portal vein injury. After sustaining a stab wound to the upper abdomen, Carnot underwent emergent laparotomy but died within hours. Autopsy later revealed an unrecognized laceration of the right branch of the portal vein. This assassination deeply influenced Dr Alexis Carrel, who later developed pioneering vascular anastomosis techniques. We subsequently trace the historical evolution of portal vein trauma management to modern ligation, repair, and nonoperative strategies. Recent national trauma registry analyses demonstrate in instances where repair is not feasible, ligation may be a viable option in hemodynamically unstable patients. This case highlights the impact of single case on a century of innovation in trauma surgery.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1657-1662"},"PeriodicalIF":0.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145627687","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}