American Surgeon最新文献_第5页

Hansei (): The Surgeon's Quiet Reckoning. 韩生（）：外科医生的平静清算。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-10-09 DOI: 10.1177/00031348251385108

Javier Arredondo Montero

引用次数: 0

Impact of a Pediatric Appendicitis Clinical Pathway on Offering Non-operative Management. 小儿阑尾炎临床路径对提供非手术治疗的影响。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-10-09 DOI: 10.1177/00031348251385112

Margaret U Nguyen, Audrey D Kamzan, Alexandra Mv Klomhaus, Howard Ch Jen, Steven L Lee, Monette Gc Veral, Deepa D Kulkarni

{"title":"Impact of a Pediatric Appendicitis Clinical Pathway on Offering Non-operative Management.","authors":"Margaret U Nguyen, Audrey D Kamzan, Alexandra Mv Klomhaus, Howard Ch Jen, Steven L Lee, Monette Gc Veral, Deepa D Kulkarni","doi":"10.1177/00031348251385112","DOIUrl":"https://doi.org/10.1177/00031348251385112","url":null,"abstract":"BackgroundAppendicitis in children can be treated with operative management (OM) or non-operative management (NOM) depending on patient risk factors. Our goal was to evaluate for differences in being offered NOM before and after the implementation of a standardized clinical pathway among patients of different demographic backgrounds.MethodsThis was a single center retrospective study of patients under the age of 18 years with appendicitis. Univariate regression was used to assess for associations between demographic factors and patients who were offered NOM.ResultsThere were 730 unique patient encounters for appendicitis during the study period. Qualified patients had significantly increased odds of being offered NOM in the post-pathway period than in the pre-pathway period (OR = 2.21, 95th CI 1.28-3.82). In the post-pathway period, Hispanic/Latino patients (OR = 0.47, 95th CI 0.28-0.78) and patients in the 4th social vulnerability index quartile (OR = 0.46, 95th CI 0.23-0.94) had decreased odds of being offered NOM. Patients with private insurance (OR = 2.25, 95th CI 1.33-3.79) had increased odds of being offered NOM. When restricted to patients who qualified for NOM, female patients (OR = 2.66, 95th CI 1.02-6.93) and patients with private insurance (OR = 3.26 95th CI 1.31-8.15) were more likely to be offered NOM.ConclusionA clinical pathway for appendicitis increased the odds that qualified patients were offered NOM. However, differences in who was offered NOM based on demographic features were seen. More research on the effect of clinical pathways and factors impacting differential care is needed.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251385112"},"PeriodicalIF":0.9,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257182","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

Effect of Primary Surgery on Health-Related Quality of Life in Metastatic Breast Cancer: A Systematic Review of RCT's. 原发性手术对转移性乳腺癌患者健康相关生活质量的影响：一项RCT的系统回顾

IF 0.9 4区医学

American Surgeon Pub Date : 2025-10-09 DOI: 10.1177/00031348251387153

Zoha Asghar, Zubaid Moazzam Sheikh, Kanza Sharaf, Muhammad Amaan Nadeem, Sheraz Ali, Luciano Mignini, Khalid S Khan

{"title":"Effect of Primary Surgery on Health-Related Quality of Life in Metastatic Breast Cancer: A Systematic Review of RCT's.","authors":"Zoha Asghar, Zubaid Moazzam Sheikh, Kanza Sharaf, Muhammad Amaan Nadeem, Sheraz Ali, Luciano Mignini, Khalid S Khan","doi":"10.1177/00031348251387153","DOIUrl":"https://doi.org/10.1177/00031348251387153","url":null,"abstract":"Background: Primary surgery in metastatic breast cancer (MBC) has been a subject of debate in part due to the heterogeneity of the results of individual studies. We synthesized evidence from the existing randomized clinical trials (RCTs) to evaluate the effect of primary surgery on health-related quality of life (HRQoL) in MBC. Methods: We searched PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar, and ClinicalTrials.gov and gray literature till January 2025. Included were RCTs among patients with MBC for whom outcome data on HRQOL was reported. Results: Of the 1019 records screened, four RCTs (961 patients) were included. The risk of bias was high in one RCT and moderate in three. Four HRQoL tools were deployed. Three moderate-quality RCTs measured HRQoL specifically at 18 months: One was in favor of surgery (BR23 18.7 vs. 10.0, P = 0.009), one showed no difference (BR23 10.4 vs. 12.0, P = 0.45), and one was in favor of avoiding surgery (FACT-B 74.2 vs. 68.0, P = 0.005). Two moderate-quality RCTs measured HRQoL generically at 18 months: None showed any difference (C30 64.7 vs. 60.0, P = 0.3 and C30 63.5 vs 68.7, P = 0.2). One low-quality RCT measured HRQoL generically at 36 months: It showed no difference (SF-12 40.8 vs. 43.4, P = 0.34). Primary surgery improved specific HRQoL at 18 months in one study and deteriorated in another, compared to non-surgical treatment, among moderate-quality trials. Conclusion: The pros and cons of surgery as a palliative option should be considered in shared decision-making for improving life quality among individual patients.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251387153"},"PeriodicalIF":0.9,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257155","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

Guideline-Concordant Provision of Extended Prophylaxis for Venous Thromboembolism After Major Cancer Surgery Differs by Social and Structural Determinants of Health. 根据健康的社会和结构决定因素，对重大癌症手术后静脉血栓栓塞的延伸预防提供指南一致。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-10-08 DOI: 10.1177/00031348251385110

Alexander Booth, Jingwen Zhang, Justin E Marsden, Colleen Donahue, Thomas Curran

{"title":"Guideline-Concordant Provision of Extended Prophylaxis for Venous Thromboembolism After Major Cancer Surgery Differs by Social and Structural Determinants of Health.","authors":"Alexander Booth, Jingwen Zhang, Justin E Marsden, Colleen Donahue, Thomas Curran","doi":"10.1177/00031348251385110","DOIUrl":"https://doi.org/10.1177/00031348251385110","url":null,"abstract":"IntroductionPatients undergoing major cancer surgery face an increased risk of venous thromboembolism. Despite guidelines recommending extended pharmacologic prophylaxis for 30 days after surgery, adoption remains low. Differences in adherence to guidelines for extended prophylaxis based on social and structural determinants of health have not been examined, but if present, may contribute to observed disparities in cancer surgery outcomes.MethodsA single-center retrospective cohort study was performed to identify patients undergoing major gastrointestinal, gynecologic, or urologic cancer resections between 2014 and 2021. Extended prophylaxis was assessed via outpatient low molecular weight heparin prescriptions on hospital discharge and analyzed by demographic factors (age, sex, race, poverty status, and insurance), and procedural factors (organ category, surgical approach, and year) using chi-squared tests and multivariable logistic regression.ResultsOf 5246 patients, 17.1% received extended prophylaxis, varying by specialty. Extended prophylaxis was higher with increasing age, female sex, and Medicare or Medicaid insurance, but lower among below poverty level (14.3% vs 18.1%), Black (14.5% vs 18.2%), and minimally invasive surgery patients (7.9% vs 23.9%). Multivariable regression showed lower odds of receiving extended prophylaxis for below poverty level (adjusted odds ratio 0.73, 95% CI: 0.60-0.88) and Black patients (0.72, 95% CI: 0.58-0.89).DiscussionOverall utilization of extended prophylaxis is low (17.1%) while differences in use based on income and race suggest potentially modifiable factors related to social and structural determinants of health. A planned randomized trial (NCT6451003) will test patient and provider education interventions and a decision-support tool to improve guideline adherence and potentially address cancer disparities.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251385110"},"PeriodicalIF":0.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249367","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

Optimal Timing of Surgical Intervention in Small Bowel Obstruction: A Systematic Review and Meta-Analysis of Clinical Outcomes and Risk Predictors. 小肠梗阻手术干预的最佳时机：临床结果和风险预测因素的系统回顾和荟萃分析。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-10-08 DOI: 10.1177/00031348251385103

Fahim Kanani, Nir Messer, Alaa Zahalka, Katia Dayan, Narmin Zoabi

{"title":"Optimal Timing of Surgical Intervention in Small Bowel Obstruction: A Systematic Review and Meta-Analysis of Clinical Outcomes and Risk Predictors.","authors":"Fahim Kanani, Nir Messer, Alaa Zahalka, Katia Dayan, Narmin Zoabi","doi":"10.1177/00031348251385103","DOIUrl":"https://doi.org/10.1177/00031348251385103","url":null,"abstract":"Optimal timing for surgical intervention in small bowel obstruction remains controversial, with traditional guidelines recommending 48-72 h of conservative management before considering surgery. We conducted a systematic review and meta-analysis to determine whether early surgical intervention improves clinical outcomes and to identify predictors of failed conservative management. We searched PubMed, Embase, Cochrane Library, and Web of Science from January 2010 to October 2024 for studies comparing surgical timing in adults with small bowel obstruction. Primary outcomes included mortality, bowel resection rates, and complications. Random-effects models were used to calculate pooled risk ratios and odds ratios with 95% confidence intervals. Among 47 studies comprising 12 486 patients, early surgery within 24 h significantly reduced mortality (RR 0.53, 95% CI 0.34-0.82, P = 0.004), bowel resection rates (RR 0.56, 95% CI 0.43-0.73, P < 0.001), and overall complications (RR 0.62, 95% CI 0.48-0.79, P < 0.001) compared to delayed intervention. Time-stratified analysis revealed a progressive increase in complications from 18% at less than 6 h to 52% beyond 48 h (P < 0.001). Conservative management succeeded in 73% of patients overall. Significant predictors of failure included absence of flatus (OR 3.3), fever (OR 2.8), complete obstruction (OR 4.1), and free fluid on CT (OR 3.7). A risk score combining three or more factors predicted failure with 84% sensitivity and 78% specificity. This meta-analysis provides robust evidence that early surgical intervention within 24 h significantly improves outcomes in appropriately selected patients with small bowel obstruction. Risk stratification using clinical and radiological predictors enables individualized decision-making rather than adherence to arbitrary waiting periods.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251385103"},"PeriodicalIF":0.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249380","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

Hepatojejunostomy for Treatment of Challenging Persistent Bile Leak After Blunt Liver Trauma. 肝空肠吻合术治疗钝性肝外伤后顽固性胆汁漏。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-10-08 DOI: 10.1177/00031348251385101

Yunus Sür, Arif Atay, Ceren Yavuz, Osman Nuri Dilek

引用次数: 0

Whistal Procedure: A Single Institution Case Series and Literature Review. 举报程序：单一机构个案系列及文献回顾。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-10-08 DOI: 10.1177/00031348251385111

Sibi Krishna Thiyagarajan, Shalyn Fullerton, Alfredo Verastegui, Katherine Poruk, John A Stauffer

{"title":"Whistal Procedure: A Single Institution Case Series and Literature Review.","authors":"Sibi Krishna Thiyagarajan, Shalyn Fullerton, Alfredo Verastegui, Katherine Poruk, John A Stauffer","doi":"10.1177/00031348251385111","DOIUrl":"https://doi.org/10.1177/00031348251385111","url":null,"abstract":"BackgroundWhistal (Whipple + Distal) is a rare parenchyma-preserving technique for select patients with disease in both the pancreatic head and tail, sparing a disease-free middle segment. It may also be used after prior partial pancreatectomy. Surgical resection remains the cornerstone of treatment for pancreatic diseases such as PDAC, RCC metastasis, and multifocal IPMN. Whistal may balance oncologic control with pancreatic function preservation. Though infrequent, it is practiced and reported in literature.MethodsWith IRB approval, a retrospective review of a prospective database (Aug 1999-Mar 2024) identified Whistal cases, categorized as staged Whistal (SW) or concomitant whistal (CW). Perioperative outcomes were assessed via Clavien-Dindo and ISGPS. A PubMed search identified reported middle segment pancreatectomy (Whistal) cases.ResultsOf 2008 resections (Aug 1999-Mar 2024), 5 were Whistals (3 CW, 2 SW) for PDAC (n = 3), RCC (n = 1), IPMN (n = 1), and bile duct stricture (n = 1). Rates for major morbidity, POPF, and DGE were each 40%. Literature review found 26 papers reporting 52 additional Whistal cases.ConclusionWhistal is safe for select patients, but wider adoption and long-term data are needed to confirm its efficacy.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251385111"},"PeriodicalIF":0.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145243643","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

Current Surgical Management of Sporadic Primary Hyperparathyroidism. 散发性原发性甲状旁腺功能亢进的外科治疗现状。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-10-07 DOI: 10.1177/00031348251385099

Loreski Collado, Adriana G Ramirez, Neil D Saunders, Snehal G Patel, Collin J Weber, Jyotirmay Sharma

引用次数: 0

The Operation that Saved a Future King: Henry V from Shrewsbury to Agincourt. 拯救未来国王的行动：亨利五世从什鲁斯伯里到阿金库尔。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-10-07 DOI: 10.1177/00031348251385445

Don K Nakayama

{"title":"The Operation that Saved a Future King: Henry V from Shrewsbury to Agincourt.","authors":"Don K Nakayama","doi":"10.1177/00031348251385445","DOIUrl":"https://doi.org/10.1177/00031348251385445","url":null,"abstract":"As Prince of Wales, Henry V (1386-1422, r. 1413-1422) was struck in the face by an archer's arrow during the Battle of Shrewsbury (1403), the decisive clash that secured his father Henry IV's hold on the English throne. Just sixteen and commanding the rear division, the young prince yanked the shaft from his cheek and fought on, despite a bodkin-point arrowhead lodged six inches deep below his eye. His bravery helped turn the tide of battle and reinforced the legitimacy of the new Lancastrian dynasty.The retained arrowhead, imbedded in bone in the prince's head, threatened his life from deep infection. A call went out for John Bradmore, royal surgeon, whose skill had earned Henry IV's trust in 1399 after saving a household official who had disemboweled himself in an attempted suicide. The surgeon met the wounded prince at Kenilworth Castle. A skilled metalsmith, Bradmore devised specialized forceps with serrated tips and a screw mechanism to grip and remove the embedded arrowhead.Henry survived and healed, the only remnant of his injury a facial scar. He would go on to become the hero of Agincourt (1415) and England's most celebrated warrior-king, his legacy immortalized by Shakespeare and the paragon of kingly valor.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251385445"},"PeriodicalIF":0.9,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145243583","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

Incidence, Mechanisms of Injury, and Outcomes of Golf Cart-Related Head Trauma: A Single-Center Experience. 高尔夫球车相关头部创伤的发生率、损伤机制和预后：单中心研究。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-10-06 DOI: 10.1177/00031348251387157

Victoria Morgan, Luke Bauerle, Noah Nawabi, Thomas Eckert, Rishishankar Suresh, Tyler Vasas, Habib Emil Rafka, Brian Saway, Kaitlyn Boggs, Stephen Kalhorn

{"title":"Incidence, Mechanisms of Injury, and Outcomes of Golf Cart-Related Head Trauma: A Single-Center Experience.","authors":"Victoria Morgan, Luke Bauerle, Noah Nawabi, Thomas Eckert, Rishishankar Suresh, Tyler Vasas, Habib Emil Rafka, Brian Saway, Kaitlyn Boggs, Stephen Kalhorn","doi":"10.1177/00031348251387157","DOIUrl":"https://doi.org/10.1177/00031348251387157","url":null,"abstract":"BackgroundDespite the reported rise in both golf cart (GC) usage and associated trauma in the United States, epidemiologic data describing their neurological impact is scarce. This study aims to describe the incidence, mechanisms, and outcomes of GC-associated head trauma in patients requiring neurosurgical consultation.MethodsPatients at a single institution admitted for GC-related head trauma requiring neurosurgical consultation between November 2013 and August 2023 were retrospectively analyzed and described.ResultsA total of 97 patients were identified. Most patients presented with Glasgow Coma Score (GCS) on admission of 13 to 15 (93.81%) and modified Rankin scale (mRS) score of 0 to 2 (91.75%). The most common reported mechanism of injury was fall or jump from a moving GC (73.20%) and the most common diagnosis was intracranial hemorrhage (ICH) (57.73%). Five total patients (5.15%) required neurosurgical intervention with only one patient (1.03%) expiring secondary to their trauma. 94.85% of patients (n = 92) were discharged with mRS scores ranging from 0 to 2. Univariate linear regression analyses demonstrated that patient age, presenting GCS, admission mRS score of 3-6, alcohol intoxication, presence of intracranial bleed, and LOC were predictors of hospital LOS. Necessitation of neurosurgical intervention was significantly associated only with admission mRS between 3 and 6.DiscussionGC-related neurotrauma poses a serious yet potentially preventable health concern to drivers and bystanders alike. Policies regarding seatbelt usage and safety measures for GCs continue to vary widely state-to-state and require data to inform decisions. This is the largest study to-date evaluating the incidence, mechanisms, and outcomes of GC-associated neurotrauma.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251387157"},"PeriodicalIF":0.9,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231394","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