American Surgeon最新文献

{"title":"Bail Out Procedures in Acute Cholecystitis: Risk Factors and Optimal Approach.","authors":"Chaiss Ugarte, Ramsey Ugarte, Shea Gallagher, Stephen Park, Odeya Kagan, Ryan Murphy, Kazuhide Matsushima, Kenji Inaba, Matthew J Martin, Morgan Schellenberg","doi":"10.1177/00031348241304008","DOIUrl":"10.1177/00031348241304008","url":null,"abstract":"<p><p>BackgroundFor difficult cholecystectomies, bail out procedures (BOP) are performed to mitigate risk of patient harm.ObjectiveThis study sought to identify risk factors for BOP for acute cholecystitis and to compare outcomes by type of BOP performed. <i>Methods:</i> Patients with acute cholecystitis who underwent cholecystectomy were included (2020-2022). Demographics, clinical data, and outcomes were collected. Primary outcome was <30-day complication rate. Groups were defined by surgery performed: BOP vs Laparoscopic Complete Cholecystectomy (LCC). BOPs were defined as any deviation from laparoscopic complete cholecystectomy. Univariate analyses compared outcomes between groups. Multivariable analysis identified independent factors associated with BOP. Subgroup analysis compared outcomes of laparoscopic BOP vs open BOP.ResultsOf 728 patients, 659 (91%) underwent LCC and 69 (9%) underwent BOP: 34 (49%) laparoscopic BOP and 35 (51%) open BOP. Independent predictors of BOP included admission total bilirubin >0.2 mg/dL (OR 5.80, <i>P</i> = .017), >7 days of symptoms at time of cholecystectomy (OR 1.96, <i>P</i> = .019), and arrival heart rate >100 bpm (OR 1.82, <i>P</i> = .032). On subgroup analysis, laparoscopic vs open BOP demonstrated no difference in operative time (<i>P</i> = .536) and overall (<i>P</i> = .733) or gallbladder-related complications (<i>P</i> = .364), including bile leaks (<i>P</i> = .090). Laparoscopic BOP was associated with shorter postoperative lengths of stay (<i>P</i> = .005).ConclusionThe risk factors for BOP identified in this study may help inform patient consent and operative planning. Laparoscopic BOP incurred equivalent complications to open BOP but with shorter hospital stays, challenging conventional dogma that conversion to open is the optimal approach for complicated acute cholecystitis.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"505-511"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142749478","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":"Robotic Surgery in Safety-Net Hospitals: Addressing Health Disparities and Improving Access to Care.","authors":"Chevar South, Olajumoke Megafu, Carolyn Moore, Taylor Williams, Larry Hobson, Omar Danner, Shaneeta Johnson","doi":"10.1177/00031348241312121","DOIUrl":"10.1177/00031348241312121","url":null,"abstract":"<p><p>Minimally invasive surgery (MIS) has demonstrated significant clinical and economic benefits that have been consistently validated and reproduced in practice and the literature for the past few decades. These benefits include improved patient outcomes, reduced complications, shorter hospital stays, decreased narcotic use, quicker recovery times, and lower rates of wound infections. However, safety-net hospitals, which historically serve a larger percentage of underserved and marginalized populations, often lack the resources to invest in high capital equipment. This limitation decreases access for these marginalized groups to the advantages of MIS, particularly robotic surgery and a wider range of surgical operations. This disparity in access to care highlights a critical shortfall in the delivery of health care for these patients and other vulnerable populations.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"639-643"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142920604","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":"Closing the Distance: A Qualitative Study to Identify Equitable Innovations for Rural Thyroid Cancer Treatment.","authors":"Hattie H Huston-Paterson, Yifan V Mao, Elena G Hughes, Iuliana Bobanga, James X Wu, Michael W Yeh","doi":"10.1177/00031348241307399","DOIUrl":"10.1177/00031348241307399","url":null,"abstract":"<p><p>BackgroundPatients residing in rural and frontier areas experience worse thyroid cancer outcomes than those in urban areas. This novel qualitative study sought the perspectives of rural surgeons to identify practical measures that could mitigate the disparities in thyroid cancer care between rural and urban contexts.MethodsWe contacted general and head and neck surgeons at all of California's Critical Access Hospitals (n = 35), which are remote, rural hospitals, and requested self-referral to our study through the American College of Surgeons. We performed semi-structured qualitative interviews with surgeons at rural hospitals to understand the assets and vulnerabilities of rural hospitals in providing the highest quality care to patients with thyroid cancer. Responses were coded and analyzed using mixed-methods qualitative analysis methodology.ResultsRural surgeons (n = 13) from a geographically diverse sample of states and regions (AK, AR, CA, NE, NC, NM, TX, UT, WY, and Newfoundland) participated. All initially trained in general surgery; 46% had fellowship training (15% in endocrine surgery) and performed a median of 8.5 thyroidectomies annually.Rural surgeons from all training backgrounds felt adequately trained to treat thyroid cancer and reported a strong desire to provide comprehensive thyroid cancer care. Most reported patients' strong preference to be treated near home. Key challenges to local, comprehensive thyroid cancer care included limited or no access to medical endocrinology, lack of continuing education on thyroid cancer management, and professional isolation in decision-making. Interviewed rural surgeons identified connections with university health systems, expert colleagues, and telemedicine consultations as valuable assets in treating thyroid cancer in geographically isolated hospitals.DiscussionThis study identified key challenges and clear avenues for interventions in treating rural thyroid cancer patients. Interviewed rural surgeons specifically suggest improving access to endocrinology specialists, developing educational initiatives on thyroid cancer management, and fostering connections and collaborations with urban colleagues to reduce professional isolation.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"548-555"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142805873","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":"And I Thought I Was Awesome at Foosball: Practice, Instruction, Coaching, and Watching a Professional to Improve a Skill.","authors":"Eric Knauer","doi":"10.1177/00031348241309562","DOIUrl":"10.1177/00031348241309562","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"670-671"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863103","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":"Impact of AI on Access to Care a Three-Pronged Approach for Enhancing Access to Surgical Care: Lessons From Electrical Safety and the Impact of AI on Health Equity.","authors":"Hassan A Tetteh, Temisan Blagogee, Dennis Robbins","doi":"10.1177/00031348251329495","DOIUrl":"https://doi.org/10.1177/00031348251329495","url":null,"abstract":"<p><p>As we enter the 21st century, a new wave of transformation is occurring in health care, mainly through artificial intelligence (AI). Like electricity, AI is a powerful tool that can either harm or heal, depending on how it is managed. In 2015, the United Nations created the 2030 Agenda for Sustainable Development to achieve peace and prosperity for people and the planet. Goal Three of the agenda aims to \"Ensure healthy lives and promote well-being for all at all ages\" by improving access to health care, reducing disparities, and reducing mortality and morbidity for the world's population. Nowhere is this more critical than surgical care access, where AI can reduce disparities and improve outcomes for underserved populations-rural communities, special populations, and oncology patients-while posing risks if not adequately grounded in ethical and equitable practices. We introduce the three-pronged approach as a metaphorical framework to mitigate the risks and enhance AI's benefits in addressing access to surgical care. By focusing on data quality, continuous system evaluation, and ethical governance, we can ensure AI delivers equitable, effective, and safe health care outcomes for all, especially for the most vulnerable.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251329495"},"PeriodicalIF":1.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750691","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":"Quality Improvement in Rural and Low-Resource Settings.","authors":"Samantha Eco, Nicole L Petcka, Kevin Li, Elizabeth M Hechenbleikner","doi":"10.1177/00031348251331296","DOIUrl":"https://doi.org/10.1177/00031348251331296","url":null,"abstract":"<p><p>Access to surgical care is a critical determinate of health outcomes yet disparities persist across various populations, particularly in low-resource settings (LRS). Quality improvement (QI) has become an integral component of health care optimization in such areas. The challenges of health care delivery in LRS directly translate into common barriers in QI endeavors such as the need for adequate funding, personnel trained in QI processes, and appropriate systems for consistent data collection. Many initiatives have been developed to address the multifaceted barriers in accessing surgical services and to improve patient safety and the quality of surgical care in LRS. Multiple studies have highlighted successful QI projects including implementing checklists to reduce surgical site infections, augmenting patient and staff education to reduce postoperative readmission rates, and adapting telemedicine in virtual intensive care units in rural areas. As new solutions, frameworks, and literature on QI initiatives expand, opportunities to enhance surgical care in LRS are becoming more apparent. This manuscript will review multiple aspects of QI including methods used in health care, barriers frequently encountered, challenges unique to LRS as well as projects implemented in LRS, with the goal of helping underserved health care settings learn and implement quality initiatives to improve the delivery of surgical care.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251331296"},"PeriodicalIF":1.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750693","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":"Remnant Gallbladder Cholecystitis After Subtotal Cholecystectomy: Management and Outcome.","authors":"Aviv Ben Zvi, Amir Dagan, Michael R Freund, Shlomo Yellinek, Menahem Ben-Haim, Elad Boaz","doi":"10.1177/00031348251328493","DOIUrl":"https://doi.org/10.1177/00031348251328493","url":null,"abstract":"<p><p>BackgroundSubtotal cholecystectomy (STC) is a viable alternative for challenging cases of severely acute or chronic inflammation of the gallbladder. However, despite its advantages, patients undergoing STC still face the risk of developing symptomatic gallstones in the remnant gallbladder. In such cases, redo resection of the gallbladder remnant is required, posing some technical challenges. In this report, we share our experience in diagnosing and surgical management of remnant gallbladder cholecystitis.MethodsA retrospective study of all patients admitted to a tertiary care hospital with symptoms directly linked to gallbladder remnant stones from 2018 to 2023 was performed.ResultsSix patients were admitted with symptoms directly linked to gallbladder remnant stones. The median age at presentation was 50 years (IQR 25-75), with median interval between the index surgery and the current presentation of 9.5 months (IQR 3-90). The presentation varied and included stump cholecystitis, cholangitis, Mirizzi syndrome, and liver abscess. All 6 patients underwent laparoscopic redo cholecystectomy, with 1 conversion to open surgery and without major complications. Symptoms resolved in all patients.ConclusionsSymptomatic gallstone disease in remnant gallbladder is rare and requires redo cholecystectomy. According to our limited series, laparoscopic redo cholecystectomy may be feasible and safe.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251328493"},"PeriodicalIF":1.0,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741993","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":"Lacunar Ligament Release for Emergent Repair of Strangulated Femoral Hernia.","authors":"Wei Wei, John Ferrara","doi":"10.1177/00031348251329483","DOIUrl":"https://doi.org/10.1177/00031348251329483","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251329483"},"PeriodicalIF":1.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727558","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 Local and General Anesthesia on 30-Day Outcomes of Emergency Infrainguinal Endovascular Revascularization for Patients with Chronic Limb-Threatening Ischemia.","authors":"Renxi Li, Anton Sidawy, Bao-Ngoc Nguyen","doi":"10.1177/00031348251331295","DOIUrl":"https://doi.org/10.1177/00031348251331295","url":null,"abstract":"<p><p>BackgroundInfrainguinal endovascular interventions can be the first-choice treatment for suitable patients with peripheral artery disease (PAD). However, the choice of anesthesia for infrainguinal endovascular procedures, particularly in emergency situations, remains underexplored. This study aimed to conduct a retrospective analysis based on a multi-institutional nationwide registry to compare the 30-day outcomes of patients with chronic limb-threatening ischemia (CLTI) who received either local anesthesia (LA) or general anesthesia (GA) during emergency infrainguinal endovascular interventions.MethodsPatients who underwent emergency infrainguinal endovascular revascularization for CLTI (tissue loss or rest pain) were selected from the ACS-NSQIP database from 2012-2022. Multivariable logistic regression was used to compare 30-day outcomes between patients under GA and LA, where demographics, baseline characteristics, and symptomatology were adjusted.ResultsAmong 703 patients, 292 (41.54%) were under LA, and 411 (58.46%) were under GA. Patients under LA had lower bleeding requiring transfusion (aOR = 0.428, 95 CI = 0.281-0.653, <i>P</i> < 0.01), lower postoperative wound complications (aOR = 0.289, 95 CI = 0.137-0.612, <i>P</i> < 0.01), and shorter operative time (102.00 ± 72.38 vs 150.70 ± 105.40 minutes, <i>P</i> < 0.01). All other 30-day outcomes, including mortality, organ system complications, and limb-specific outcomes, were comparable between patients under LA and GA.ConclusionLA and GA can be considered equivalent options for eligible CLTI patients undergoing emergency infrainguinal endovascular revascularization, with close monitoring of wound and bleeding complications recommended for GA patients. Further studies are necessary to evaluate long-term outcomes in these patients.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251331295"},"PeriodicalIF":1.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727556","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":"Access to Care in the LGBTQIA+ Population.","authors":"Charis Ripley-Hager, Andrew T Schlussel","doi":"10.1177/00031348251329484","DOIUrl":"https://doi.org/10.1177/00031348251329484","url":null,"abstract":"<p><p>Access to surgical health care for the LGBTQIA+ community is often limited by education gaps, systemic biases, and stigmatization. Sexual and gender minority (SGM) individuals, who face higher risks of certain health issues like cancer, mental health disorders, and STIs, often encounter barriers such as provider knowledge gaps and fear of prejudice. Addressing these challenges requires comprehensive education for both providers and patients, workforce development, and policy changes. Effective solutions include tailored health approaches, such as proper STI screenings, HPV vaccination, and affirming care practices. Expanding access to knowledgeable, inclusive providers and implementing supportive health care policies can improve health outcomes for SGM patients, ensuring equitable and patient-centered care.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251329484"},"PeriodicalIF":1.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727553","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}