American Surgeon最新文献

{"title":"24-hour Telemetry Monitoring May Not be Necessary for Patients With an Isolated Sternal Fracture and Minor ECG Abnormalities or Troponin Elevation: A Southern California Multicenter Study.","authors":"Fares Al-Khouja, Areg Grigorian, Brent Emigh, Morgan Schellenberg, Graal Diaz, Thomas K Duncan, Rahul Tuli, Raul Coimbra, Kacy Gilbert-Gard, Arianne Johnson, Makenna Marty, Mallory Jebbia, Amal K Obaid-Schmid, Nicole Fierro, Eric Ley, Dunya Bayat, Walter Biffl, Shayan Ebrahimian, Areti Tillou M, Erica Tay-Lasso, Claudia Alvarez, Jeffry Nahmias","doi":"10.1177/00031348241278904","DOIUrl":"10.1177/00031348241278904","url":null,"abstract":"<p><strong>Background: </strong>Current guidelines recommend 24-hour telemetry monitoring for isolated sternal fractures (ISFs) with electrocardiogram (ECG) abnormalities or troponin elevation. However, a single-center study suggested ISF patients with minor ECG abnormalities (sinus tachycardia/bradycardia, nonspecific arrhythmia/ST-changes, and bundle branch block) may not require 24-hour telemetry monitoring. This study sought to corroborate this, hypothesizing ISF patients would not develop blunt cardiac injury (BCI).</p><p><strong>Materials & methods: </strong>A retrospective study was performed at 8 trauma centers (1/2018-8/2020). Patients with ISF (abbreviated injury scale <2 for the head/neck/face/abdomen/extremities) and minor ECG abnormalities or troponin elevations were included. Patients with multiple rib fractures or hemothorax/pneumothorax were excluded. The primary outcome was an echocardiogram confirmed BCI. The secondary outcome was significant BCI defined as cardiogenic shock, dysrhythmia requiring treatment, post-traumatic cardiac structural defects, unexplained hypotension, or cardiac-related procedures. Descriptive statistics were performed.</p><p><strong>Results: </strong>Of 124 ISF patients with minor ECG abnormalities or troponin elevation, 90% were admitted with a mean stay of 35 hours. Echocardiogram was performed for 31.5% of patients, 10 (25.6%) of which had abnormalities. However, no patient had BCI diagnosed on echocardiography. In total, 2 patients (1.6%) had a significant BCI (atrial fibrillation and supraventricular tachycardia at 10 and 82 hours after injury). No patient died.</p><p><strong>Conclusions: </strong>Following ISF with minor ECG changes or troponin elevation, <2% suffered significant BCI, and none had an echocardiogram diagnosed BCI, despite >30% receiving echocardiogram. These findings challenge the dogma of mandatory observation periods following ISF with associated ECG abnormalities and support the lack of utility for routine echocardiography in these patients.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"126-132"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142078905","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":"SMARCA4-Deficient Colonic Tumor in a Patient with mutY DNA Glycosylase (MUTYH) Associated Polyposis.","authors":"Jessica Wassef, Peter Kaye","doi":"10.1177/00031348241269413","DOIUrl":"10.1177/00031348241269413","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"141-143"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141873976","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":"Promoting Standardization of Clinical Evidence With Severity-Guided Treatments for Idiopathic Granulomatous Mastitis: A Narrative Review.","authors":"Nora Gillen, Jada Leahy","doi":"10.1177/00031348241275717","DOIUrl":"10.1177/00031348241275717","url":null,"abstract":"<p><p>Idiopathic granulomatous mastitis (IGM) is a benign disease of the breast which causes a great deal of discomfort for patients. More comparable data and greater consensus in treatment are needed to better understand the disease and help with evidence-based clinical decision making. This narrative review aims to discuss the literature available on IGM and illustrate the need for consensus on treatment. We highlight the existing severity scores for this disease in the literature and discuss the value of severity-guided treatment. In our review, 81 studies out of 319 reviewed publications met established criteria. With the selected results from our search results, the available research on IGM etiology, risk factors, diagnosis, and treatment is summarized with an emphasis on the existing severity scores. A total of four proposed severity scores were found in our review. Consensus on the treatment of IGM must be established. There are varying severity scores on IGM severity. We suggest using an established standardized severity score to guide treatment and recommend one such score.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"133-140"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142016124","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":"Plain Chest Film Versus Computed Tomography of the Chest as the Initial Imaging Modality for Blunt Thoracic Injury.","authors":"Joseph C L'Huillier, Hannah L Carroll, Jane Y Zhao, Kabir Jalal, Jihnhee Yu, Weidun A Guo","doi":"10.1177/00031348241260267","DOIUrl":"10.1177/00031348241260267","url":null,"abstract":"<p><strong>Background: </strong>While chest X-ray (CXR) is an efficient tool for expeditious detection of life-threatening injury, chest computed tomography (CCT) is more sensitive albeit with added time, cost, and radiation. Thus far, there is limited evidence and lack of consensus on the best imaging practices. We sought to determine the association between imaging modality and outcomes in isolated blunt thoracic trauma.</p><p><strong>Methods: </strong>The 2017-2020 TQIP database was queried for adult patients who sustained isolated blunt chest trauma and underwent chest imaging within 24 hours of admission. Patients who underwent CCT were 2:1 propensity-score-matched to those who underwent CXR. The primary outcome was mortality, and the secondary outcomes were hospital and ICU length of stay (LOS), ICU admission, need for and days requiring mechanical ventilation, complications, and discharge location.</p><p><strong>Results: </strong>Propensity score matching yielded 17 716 patients with CCT and 8861 with CXR. While bivariate analysis showed lower 24-hr (CCT .2% vs CXR .4%, <i>P</i> = .0015) and in-hospital mortality (CCT 1.2% vs CXR 1.5%, <i>P</i> = .0454) in the CCT group, there was no difference in survival probability between groups (<i>P</i> = .1045). A higher percentage of CCT patients were admitted to the ICU (CCT 26.9% vs CXR 21.9%, <i>P</i> < .0001) and discharged to rehab (CCT .8% vs CXR .5%, <i>P</i> = .0178).</p><p><strong>Discussion: </strong>CT offers no survival benefit over CXR in isolated blunt thoracic trauma. While CCT should be considered if clinically unclear, CXR likely suffices as an initial screening tool. These findings facilitate optimal resource allocation in constrained environments.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"12-21"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141726793","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 Other Patient.","authors":"Simin Golestani","doi":"10.1177/00031348241269402","DOIUrl":"10.1177/00031348241269402","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"165"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141854463","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":"Keeping Up With AI Evolution: ChatGPT-4o in Surgery.","authors":"Brennan Bogdanovich, Pearl Shah, Parth A Patel, Carter J Boyd","doi":"10.1177/00031348241272423","DOIUrl":"10.1177/00031348241272423","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"5-6"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888276","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":"Tranexamic Acid and Pulmonary Complications: A Secondary Analysis of an EAST Multicenter Trial.","authors":"Shariq S Raza, Danielle Tatum, Kristen D Nordham, Jacob M Broome, Jane Keating, Zoe Maher, Amy J Goldberg, Grace Chang, Michelle Mendiola Pla, Elliott R Haut, Leah Tatebe, Eman Toraih, Christofer Anderson, Scott Ninokawa, Patrick Maluso, Sigrid Burruss, Matthew Reeves, Lauren E Coleman, David V Shatz, Anna Goldenberg-Sandau, Apoorva Bhupathi, 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, Juan Duchesne, Sharven Taghavi","doi":"10.1177/00031348241268109","DOIUrl":"10.1177/00031348241268109","url":null,"abstract":"<p><strong>Background: </strong>Anti-inflammatory effects of tranexamic acid (TXA) in reducing trauma endotheliopathy may protect from acute lung injury. Clinical data showing this benefit in trauma patients is lacking. We hypothesized that TXA administration mitigates pulmonary complications in penetrating trauma patients.</p><p><strong>Materials and methods: </strong>This is a post-hoc analysis of a multicenter, prospective, observational study of adults (18+ years) with penetrating torso and/or proximal extremity injury presenting at 25 urban trauma centers. Tranexamic acid administration in the prehospital setting or within three hours of admission was examined. Participants were propensity matched to compare similarly injured patients. The primary outcome was development of pulmonary complication (ARDS and/or pneumonia).</p><p><strong>Results: </strong>A total of 2382 patients were included, and 206 (8.6%) received TXA. Of the 206, 93 (45%) received TXA prehospital and 113 (55%) received it within three hours of hospital admission. Age, sex, and incidence of massive transfusion did not differ. The TXA group was more severely injured, more frequently presented in shock (SBP < 90 mmHg), developed more pulmonary complications, and had lower survival (<i>P</i> < 0.01 for all). After propensity matching, 410 patients remained (205 in each cohort) with no difference in age, sex, or rate of shock. On logistic regression, increased emergency department heart rate was associated with pulmonary complications. Tranexamic acid was not associated with different rate of pulmonary complications or survival on logistic regression. Survival was not different between the groups on logistic regression or propensity score-matched analysis.</p><p><strong>Conclusions: </strong>Tranexamic acid administration is not protective against pulmonary complications in penetrating trauma patients.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"107-114"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141900733","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":"Preoperative Hypoalbuminemia is Associated With Higher 30-day Mortality and Complications After Esophagectomy.","authors":"Renxi Li, Yueyao Zhu","doi":"10.1177/00031348241278019","DOIUrl":"10.1177/00031348241278019","url":null,"abstract":"<p><strong>Background: </strong>Serum albumin level is routinely screened during preoperative assessments as a biomarker for poor nutritional status and/or concurrent inflammation. In esophagectomy, while early postoperative hypoalbuminemia is associated with a higher risk of adverse surgical outcomes, the effects of preoperative hypoalbuminemia on esophagectomy outcomes were conflicting. This study aimed to examine the effect of preoperative hypoalbuminemia on 30-day outcomes following esophagectomy.</p><p><strong>Methods: </strong>National Surgical Quality Improvement Program (NSQIP) esophagectomy targeted database from 2016 to 2022 was used. Patients with preoperative serum albumin <3.4 g/L were defined as having hypoalbuminemia. Patients with and without hypoalbuminemia were propensity-score matched (1:3 ratio) for demographics, baseline characteristics, neoadjuvant therapy, surgical approaches, tumor diagnosis, and pathologic staging of the malignancy. Thirty-day postoperative outcomes were examined.</p><p><strong>Results: </strong>There were 803 (10.24%) and 7046 (89.76%) patients with and without preoperative hypoalbuminemia who underwent esophagectomy, respectively. After propensity-score matching, all patients with hypoalbuminemia were matched to 2170 controls. After propensity-matching, patients with hypoalbuminemia had higher risks of mortality (4.48% vs 3.00%, <i>P</i> = 0.04), sepsis (14.94% vs 10.92%, <i>P</i> < 0.01), and bleeding requiring transfusion (21.30% vs 13.50%, <i>P</i> < 0.01). Also, patients with hypoalbuminemia had a higher rate of discharge not to home (42.65% vs 34.81%, <i>P</i> < 0.01) and longer LOS (12.69 ± 9.09 vs 11.39 ± 8.16 days, <i>P</i> < 0.01).</p><p><strong>Conclusion: </strong>Patients with preoperative hypoalbuminemia had increased risks of mortality and complications after esophagectomy. Thus, preoperative hypoalbuminemia could be a useful and cost-effective tool for preoperative risk stratification for patients undergoing esophagectomy, and correcting the underlying cause of hypoalbuminemia may help decrease the risk of adverse postoperative outcomes.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"51-58"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142016123","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":"Gun Violence in the COVID-19 Era: Using Multiple Databases to Describe the Experience in Buffalo, NY.","authors":"Joseph C L'Huillier, Andrew B Nordin, Veer V Nair, Brittany L Cantor, Bryan Tadlock, Brianna Friend, Joseph D Boccardo, Jihnhee Yu, James Lukan, Denise F Lillvis, Kathryn D Bass","doi":"10.1177/00031348241300363","DOIUrl":"https://doi.org/10.1177/00031348241300363","url":null,"abstract":"<p><strong>Objectives: </strong>In 2020, the public health crises of gun violence and novel coronavirus (COVID-19) collided and interventions to decrease COVID-19 transmission displaced millions of Americans from normal activity. We analyzed the effects of COVID-19 and its resultant shutdowns on gun violence in Buffalo, NY.</p><p><strong>Methods: </strong>We queried the Gun Violence Archive (GVA) and the hospital databases from the 2 level 1 trauma centers which serve Buffalo firearm victims between March 15th and June 24th, 2020 (\"COVID\") and the same time period for years 2013 (hospital data)/2014 (GVA data) through 2019 (\"pre-COVID\") and 2021 through 2022 (\"post-COVID\"). Data points collected included number of daily victims, victim age, gender, and morbidity/mortality. Bivariate and multivariate analyses were used to compare gun violence in these 3 periods.</p><p><strong>Results: </strong>There were 518 and 913 victims in the GVA and hospital data sets, respectively. Bivariate analyses showed fewer incidents on Saturdays during the pandemic in both data sets (<i>P</i> < 0.05). Multivariate analyses demonstrated no association between number of gun violence victims and time period in either data set (<i>P</i> > 0.05).</p><p><strong>Conclusions: </strong>There was no change in number of gun violence victims during the COVID-19 shutdowns compared to pre-COVID and post-COVID periods in Buffalo, NY. However, there was a change in the weekly temporality of gun violence during the COVID pandemic. Multiple databases are needed to accurately capture gun violence from an epidemiologic perspective.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348241300363"},"PeriodicalIF":1.0,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142880820","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":"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":"https://doi.org/10.1177/00031348241308912","url":null,"abstract":"<p><strong>Background: </strong>The 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.</p><p><strong>Methods: </strong>Patients 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.</p><p><strong>Results: </strong>A 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.</p><p><strong>Conclusion: </strong>We recommend considering the SHARP risk score to predict mortality and length of hospital stay in geriatric EGS patients.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348241308912"},"PeriodicalIF":1.0,"publicationDate":"2024-12-20","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}