American Surgeon最新文献

{"title":"Firearm Homicide Mortality is Linked to Food Insecurity in Major US Metropolitan Cities.","authors":"Michael Ghio, Ayman Ali, John Tyler Simpson, Alexandra Campbell, Juan Duchesne, Danielle Tatum, M Pia Chaparro, Joseph Constans, Julia Fleckman, Katherine Theall, Sharven Taghavi","doi":"10.1177/00031348241281848","DOIUrl":"10.1177/00031348241281848","url":null,"abstract":"<p><strong>Background: </strong>Gun violence disproportionately affects metropolitan areas of the United States (US). There is limited information regarding the influence of social determinants of health, such as food insecurity (FI) on firearm homicide mortality (FHM) in major metropolitan cities in the US. We sought to examine the relationship between FI and FHM.</p><p><strong>Materials and methods: </strong>This was a cross-sectional analysis examining the largest 51 US major metropolitan statistical areas (MSAs) using data from 2018. Demographic data, markers of social inequities, and firearm homicide data were obtained from the US Census Bureau, US Department of Education, and the Frey and Brookings Institute. Food insecurity prevalence was obtained from Feeding America. Spearman ρ and linear regression were performed.</p><p><strong>Results: </strong>Using Spearman rho analysis, higher FI (r = 0.55, <i>P</i> < 0.001) was associated with FHM. Other variables associated with FHM included percent Black/African American (AA) (r = 0.77, <i>P</i> < 0.001), poverty rate (r = 0.53, <i>P</i> < 0.001), and percent of children living in single parent households (r = 0.58, <i>P</i> < 0.001). In linear regression analyses, FI was associated with increased FHM, with 1.3 additional FHM events for each unit increase in FI (β = 1.33, 95% CI 0.27-2.39, <i>P</i> = 0.02). The percent of a population that is Black/AA was also associated with FHM, with more than 4 additional cases for each 1% increase in the population (β = 4.32, 95% CI 3.26-5.38, <i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>Food insecurity may influence FHM in major US metropolitan cities. Community- and hospital-based programs that target FI may help combat the gun violence epidemic and decrease gun violence.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"224-232"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279328","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":"Post-Traumatic Stress Disorder (PTSD) in Trauma Patients.","authors":"Brandon Radow, Nathaniel Anderson, Bryan K Richmond","doi":"10.1177/00031348241290610","DOIUrl":"10.1177/00031348241290610","url":null,"abstract":"<p><p>Post-traumatic stress disorder (PTSD) was first introduced as a diagnosis by the American Psychiatric Association in 1980. This diagnosis, included in the 3rd edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-III), was to be considered after someone was exposed to a traumatic event \"outside the range of usual human experience and would be markedly distressing to almost anyone.\" Since then, trauma survivors have been identified as being at risk for the development of post-traumatic stress symptom (PTSS) and post-traumatic stress disorder (PTSD). Despite the recognition of this fact, the screening, recognition, and diagnosis of PTSD in these at-risk populations are inconsistent. In the following review, which is designed for the clinician who is unfamiliar with PTSD and its recognition, diagnosis, and treatment, we introduce the problem in the trauma patient and define its scope. In addition, we discuss the diagnosis of PTSD in trauma patients, special considerations relating to these patient populations, treatment options, and explore future directions for how best to define, study, recognize, and treat this challenging and potentially devastating condition.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"292-299"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387371","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":"A Quality Improvement Initiative to Implement Focused Family Meetings in the Surgical Intensive Care Unit: Does It Matter?","authors":"Yesha Maniar, Haarika Chalasani, Kenneth Messerole, Lindsay Beck, Adam Stright, Patrizio Petrone, Shahidul Islam, D'Andrea K Joseph","doi":"10.1177/00031348241285549","DOIUrl":"10.1177/00031348241285549","url":null,"abstract":"<p><p><b>Introduction:</b> Communication with families is essential to improve satisfaction, especially in the critical care setting. We sought to identify patients who were not recovering as expected and to improve communication with their families.<b>Methods:</b> We implemented a novel algorithm, incorporating clinical and social criteria, to determine which patients could benefit from additional communication. Patients who qualified were randomized to the intervention of a structured interdisciplinary family meeting or to standard communication in the Intensive Care Unit at the discretion of the attending. Surveys were administered to both groups to determine the primary outcome of satisfaction with communication. Wilcoxon rank-sum, chi-square, or Fisher's exact test as appropriate was used to compare baseline characteristics and survey items between groups.<b>Results:</b> There was no difference between the intervention (n = 25) and non-intervention groups (n = 33) in demographic or clinical characteristics (<i>P</i>-value >.05). Surveys were able to be completed for 76% of the intervention group and 51% in the non-intervention group. There was no difference in the responses to the survey between the groups (<i>P</i>-value >.05), signifying that families were satisfied with communication regardless of whether they had a structured interdisciplinary family meeting.<b>Conclusion:</b> Our results are contrary to the traditionally held belief that structured family meetings improve communication. A possible explanation is that implementing an algorithm to identify patients in need of additional communication predisposes providers to be more cognizant of family needs in the Surgical Intensive Care Unit. Future research should focus on qualitative research to elucidate what aspects of communication are most useful to families.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"208-216"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279326","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":"Infectious Complications After Modified Purse-String Stoma Closure.","authors":"Scarlett B Hao, Lindsey Bridges, Michael D Honaker","doi":"10.1177/00031348241257473","DOIUrl":"10.1177/00031348241257473","url":null,"abstract":"<p><p><b>Purpose:</b> Current society guidelines recommend purse-string closure technique for stoma reversal, which has been shown to reduce but not eliminate the risk of deep surgical site infection (SSI) at the original stoma site, a complication associated with increased morbidity and cost. We studied an adjunctive technique to further reduce the risk of SSI. <b>Methods:</b> A retrospective chart review was conducted on adult patients who underwent stoma reversal between May 2016 - July 2022. Stoma reversal was performed with purse-string closure, and placement of a strip of povidone-iodine soaked non-adherent pad in the remaining two cm opening at the prior stoma site. This pad was taken out on post-operative day one and changed to wet-to-dry saline moistened gauze. <b>Results:</b> 82 patients were identified. The cohort had a median BMI 26.5 [IQR 23.0-31.0] and median age 57.5 [IQR 45.8-67.0]. Mean time from original surgery to reversal was nine months. 59.8% identified as female, 24.4% were currently smoking, 18.3% were had diabetes. The cohort experienced a 11.0% readmission rate and 18.3% rate of stoma site hernia with a mean follow up of 17 17 months. No patient developed an SSI. <b>Conclusion:</b> In this cohort study with known risk factors for SSI, no patients undergoing stoma reversal experienced a post-operative SSI. The adjunctive technique of a povidone-iodine soaked non-adherent pad in addition to purse-string closure should be further examined in conjunction with surgical bundles to reduce the risk of SSI and overall morbidity of stoma reversal surgery.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"203-207"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279329","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":"Non-Designated Preliminary to Categorical Resident: Is It All About the ABSITE?","authors":"Ace St John, Laura Cooper, Stephen M Kavic","doi":"10.1177/00031348241281556","DOIUrl":"10.1177/00031348241281556","url":null,"abstract":"<p><strong>Introduction: </strong>Obtaining a categorical general surgery residency position is recognized as a highly challenging process, and many aspiring surgeons find themselves matching into a preliminary position. The American Board of Surgery In-Training Examination (ABSITE) is relevant as a discriminator, as it is the only national evaluation metric that compares residents between programs. This study examines the correlation between ABSITE performance and the likelihood of obtaining a categorical position for non-designated preliminary surgery residents.</p><p><strong>Methods: </strong>Retrospective analysis of preliminary residents who completed the ABSITE between 2011 and 2021 at a single academic training program.</p><p><strong>Results: </strong>108 preliminary residents were included. Among preliminary residents who were successful in securing a categorical position, the average ABSITE percentile was 59 (SD = 26.7). In contrast, those who were not able to secure a categorical position, the average ABSITE percentile was 23.6 (SD = 25.3). There was a strong significant correlation between ABSITE percentile and securing a categorical position (<i>P</i> < 0.001). There was a significant association between citizenship and gaining a categorical position, with US citizens being significantly more likely to successfully gain a categorical position (<i>P</i> = 0.01; OR 3.32 (95% CI 1.28-8.56)). There was not a significant correlation between citizenship and ABSITE score.</p><p><strong>Conclusion: </strong>This study presents compelling evidence that ABSITE percentile score is positively associated with the probability of securing a categorical position for preliminary general surgery residents. It is therefore imperative that both preliminary residents and their programs place a high value on ABSITE performance to enhance successful career progression.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"173-177"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142118768","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":"A Rare Case of Disseminated Strongyloidiasis Leading to Multisystem Organ Failure Following Deceased Donor Kidney Transplantation.","authors":"Natalie J Atkin, George Kasotakis, Erik J Teicher","doi":"10.1177/00031348241292725","DOIUrl":"10.1177/00031348241292725","url":null,"abstract":"<p><p>Strongyloidiasis is a rare systemic parasitic infection caused by the nematode, <i>Strongyloides stercoralis</i>, that is often insidious and may remain dormant for many years before progressing to fulminant hyperinfection in an immunocompromised host. In this report, we present a case of disseminated strongyloidiasis in a patient who underwent a deceased donor kidney transplantation 2 months prior to presentation. Our patient developed multisystem organ failure as well as secondary hemophagocytic lymphohistiocytosis (HLH) and ultimately died despite extensive resuscitative efforts and antiparasitic treatments. This report highlights the importance of routine screening for parasitic diseases prior to organ transplantation, especially with donors from endemic regions of the world.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"300-302"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456236","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":"Stop the Bleed-Wait for the Ambulance or Get in the Car and Drive? A Post Hoc Analysis of an EAST Multicenter Trial.","authors":"John T Simpson, Kristen D Nordham, Danielle Tatum, Elliot R Haut, Ayman Ali, Zoe Maher, Amy J Goldberg, Leah C Tatebe, Grace Chang, Sharven Taghavi, Shariq Raza, Eman Toraih, Michelle Mendiola Plá, Scott Ninokawa, Christofer Anderson, Patrick Maluso, Jane Keating, Sigrid Burruss, Matthew Reeves, Lauren E Craugh, David V Shatz, Apoorva Bhupathi, M Chance Spalding, Aimee LaRiccia, Emily Bird, Matthew R Noorbakhsh, James Babowice, Marsha C Nelson, Lewis E Jacobson, Jamie Williams, Michael Vella, Kate Dellonte, Thomas Z Hayward, Emma Holler, Mark J Lieser, John D Berne, Dalier R Mederos, Reza Askari, Barbara Okafor, Eric Etchill, Raymond Fang, Samantha L Roche, Laura Whittenburg, Andrew C Bernard, James M Haan, Kelly L Lightwine, Scott H Norwood, Jason Murry, Mark A Gamber, Matthew M Carrick, Nikolay Bugaev, Antony Tatar","doi":"10.1177/00031348241265135","DOIUrl":"10.1177/00031348241265135","url":null,"abstract":"<p><p><b>Background:</b> The Stop the Bleed campaign gives bystanders an active role in prehospital hemorrhage control. Whether extending bystanders' role to private vehicle transport (PVT) for urban penetrating trauma improves survival is unknown, but past research has found benefit to police and PVT. We hypothesized that for penetrating trauma in an urban environment, where prehospital procedures have been proven harmful, PVT improves outcomes compared to any EMS or advanced life support (ALS) transport.<b>Methods:</b> Post-hoc analysis of an EAST multicenter trial was performed on adult patients with penetrating torso/proximal extremity trauma at 25 urban trauma centers from 5/2019-5/2020. Patients were allocated to PVT and any EMS or ALS transport using nearest neighbor propensity score matching. Univariate analyses included Wilcoxon signed rank or McNemar's Test and logistic regression.<b>Results:</b> Of 1999 penetrating trauma patients in urban settings, 397 (19.9%) had PVT, 1433 (71.7%) ALS transport, and 169 (8.5%) basic life support (BLS) transport. Propensity matching yielded 778 patients, distributed equally into balanced groups. PVT patients were primarily male (90.5%), Black (71.2%), and sustained gunshot wounds (68.9%). ALS transport had significantly higher ED mortality (3.9% vs 1.9%, <i>P</i> = 0.03). There was no difference in in-hospital mortality rate, hospital LOS, or complications for all EMS or ALS only transport patients.<b>Conclusion:</b> Compared to PVT, ALS, which provides more prehospital procedures than BLS, provided no survival benefit for penetrating trauma patients in urban settings. Bystander education incorporating PVT for early arrival of penetrating trauma patients in urban settings to definitive care merits further investigation.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"233-241"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339512","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":"Fast-Track Score to Predict the Feasibility of Early Extubation Post Liver Transplant.","authors":"Mohamad El Moheb, Zeyad T Sahli, Badi Rawashdeh, Paola Vargas, Shawn Pelletier, Jose Oberholzer, Katherine T Forkin, Eryn Thiele, Julie Huffmyer, David Bogdonoff, Stephen Collins, Amanda Kleiman, Nicolas Goldaracena","doi":"10.1177/00031348241286073","DOIUrl":"https://doi.org/10.1177/00031348241286073","url":null,"abstract":"<p><strong>Background: </strong>Over the past several years, the liver transplant community has embraced the concept of fast-tracking patients to facilitate earlier postoperative recovery.</p><p><strong>Aim: </strong>Derive and validate a novel \"fast-track\" risk score that captures the demographic and clinical characteristics of DDLT patients to predict the likelihood of early extubation after surgery.</p><p><strong>Design: </strong>Adult patients who underwent non-fulminant DDLT between January 2014 and July 2019 were included. The cohort was divided in 2 groups: patients extubated within 4 hours of surgery vs extubated after 4 h. Logistic regression was performed to identify the independent predictors of early extubation. The area under the curve (AUC) was calculated to measure the ability of the risk score to predict early extubation. The score was validated by applying coefficients of the regression model to the validation cohort and calculating the AUC.</p><p><strong>Results: </strong>A total of 290 DDLT patients were included, of which 175 (60%) were in the \"delayed extubation\" group and 115 (40%) were in the \"fast-track\" group. Patients with a MELD <29, transfused <4 units of pRBCs, and transfused <5 units of FFP during surgery were 2.30 times, 5.74 times, and 3.09 times more likely to be extubated early, respectively. A risk score with an integer point scale was derived and exhibited an AUC of .80. The proportion of patients who were extubated early increased from 2.78% at a score of 0 to 66.67% at a score of 4.</p><p><strong>Conclusions: </strong>The proposed score provides a fast and easy method to help identify DDLT patients suitable for early extubation.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":"91 2","pages":"217-223"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070816","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 Temporal and Financial Costs of Trauma Activation Wait Times.","authors":"Erik G Mattison, Daniel J Cucher, Melissa S Kovacs, Brian R Tiffany, Charles K Hu","doi":"10.1177/00031348251318377","DOIUrl":"https://doi.org/10.1177/00031348251318377","url":null,"abstract":"<p><strong>Background: </strong>Level 1 Trauma Centers alert hospital staff in advance of a trauma patient's arrival to allow time for trauma team assembly and preparedness. Excess staff wait times may result in reduced trauma center productivity and efficiency. The objective of this study was to explore the wait time expended by various hospital staff in anticipation of trauma patient arrivals and calculate cost and adequacy of preparation time.</p><p><strong>Methods: </strong>This prospective observational study recorded a sample of wait times for trauma team staff members at an urban Level 1 Trauma Center for 12 months. We observed 288 trauma activations in total. We constructed a dataset of notification alerts, patient arrival times, staff arrival, and wait times, along with a qualitative staff assessment of time to prepare for the trauma patient's arrival. We applied detailed salary data to quantify the financial cost of Trauma Center staff wait time.</p><p><strong>Results: </strong>When staff waited for a trauma patient's arrival, average wait times ranged from 4.27 to 10.67 minutes. This cost $139 791.65 during calendar year 2023 at our hospital. Staff had enough time to arrive at trauma incidents 99.1% of the time. In 4.2% of cases (n = 12), staff had no advance notification of an incoming trauma patient.</p><p><strong>Discussion: </strong>We find that a longer duration between the issuance of alerts and the actual arrival of trauma patients represents a direct financial cost attributable to lost productivity in addition to indirect and cascading effects on operational efficiency and patient care.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251318377"},"PeriodicalIF":1.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070813","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":"From Helplessness to Purpose: Beginning a Journey in Surgery.","authors":"Amir Farah","doi":"10.1177/00031348251318395","DOIUrl":"https://doi.org/10.1177/00031348251318395","url":null,"abstract":"<p><p>This piece explores a personal path to becoming a surgeon, driven by a moment of helplessness at a beloved family member's bedside. Unable to alleviate their suffering, the sense of inadequacy and helplessness fueled a determination to pursue surgery, particularly trauma surgery. Through rigorous training, purpose was found in the ability to act decisively and compassionately in moments of crisis. This journey, shaped by personal loss, reflects how vulnerability can transform into a deep commitment to healing and service of those in need.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251318395"},"PeriodicalIF":1.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073531","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}